SWK 3150 Healthcare HISTORY OF HEALTHCARE – FEDERAL HEALTH AGENCIES Three of the largest federal health agencies in the U.S. Public Health Service: only national agency concerned with broad health issues (1798)Marine Service Hospital Children’s Bureau (1912) Veterans Administration (1917/1930 name) © 2018. Cengage Learning. All rights reserved. FEDERAL FINANCING OF HEALTH CARE: MEDICAID (SLIDE 1 OF 4) Medicaid Cost Containment: due to rising costs Prospective payment system (DRG’s) Provider cuts Welfare reform Managed Care © 2018. Cengage Learning. All rights reserved. FEDERAL FINANCING OF HEALTH CARE: MEDICAID (SLIDE 2 OF 4) Great Recession: Medicaid enrollment grew from 42.3 million in 2007 to 52.6 million in 2011 Long-Term Care: Medicaid pays for 50-75% of the nation’s long-term care expenditures (nursing homes) © 2018. Cengage Learning. All rights reserved. FEDERAL FINANCING OF HEALTH CARE: MEDICARE (SLIDE 3 OF 4) Medicare differs fundamentally from Medicaid Not means tested Providers for workers at least 65 years old or disabled Also eligible for Social Security benefits Managed exclusively by the federal gov’t – not $ given to states © 2018. Cengage Learning. All rights reserved. FEDERAL FINANCING OF HEALTH CARE: MEDICARE (SLIDE 4 OF 4) Medicare Financing – Grant-in-Aid (categorical grants): Part A: Hospital, home care, hospice Part B: Regular doctor visits (open enroll) Part C: Medicare Advantage (1995) – can get if have A & B Part D: prescription coverage (Bush 2006) optional © 2018. Cengage Learning. All rights reserved. MEDICARE PRESCRIPTION COVERAGE George Bush - Medicare Prescription Drug, Improvement and Modernization Act passed despite high cost (est. $400 Billion over 10 yrs.) Act started Medicare Part D in 2006 – control medication costs (avg. $44/mo) Lobbying efforts of pharmaceutical industry ($197 Million in campaign contributions, 2001) AARP – organization support legislation © 2018. Cengage Learning. All rights reserved. PRIVATE MARKET IN FINANCING AND DELIVERY OF HEALTH CARE Medicare and Medicaid contributed to rise in “health industry”; expanded “for profit” presence – grew corporations First: pharmaceuticals Then: hospitals Followed by: nursing homes Private insurance: central element of the U.S. health-care system © 2018. Cengage Learning. All rights reserved. FACTORS INFLUENCING HEALTH OUTCOMES IN US Poverty and Health Disparities The Uninsured Race and Health Disparities People of color more likely to fall ill Infant Mortality in Harlem (1995) Gender and Health – men acute illnesses & women chronic illnesses © 2018. Cengage Learning. All rights reserved. HARLEM HEALTHLINE PROGRAM IMR in 1996 was 15.2 per 1,000 live births in Harlem IMR in 1997 was 6.6 per 1,000 live births in Harlem Healthline Program – Intervention & allocation matters Information and referral services Adolescent parent education program that trained young parents Child health plus insurance for children Health start-- focused on decreasing mortality in high risk neighborhoods © 2018. Cengage Learning. All rights reserved. INFANT MORTALITY BY MOTHER’S RACE © 2018. Cengage Learning. All rights reserved. CAUSES OF HEALTH DISPARITIES Subtle interactive effects of race and class Long term oppression can discourage vulnerable populations from seeking treatment HIV/AIDS and health disparities © 2018. Cengage Learning. All rights reserved. MODERN EPIDEMICS AND GLOBAL GOVERNANCE HIV/AIDS: A Global Epidemic (37.9 million) – 1980’s Some have poor access to prevention, treatment and care Ryan White Programs SARS - Severe Acute Respiratory Syndrome – buckled economies – pandemic in 2003 (outbreak in China) Covid-19 – pandemic in March 2020 Ends with vaccine, infection or death rate decline, or social end (people tired of living in fear and accept disease) © 2018. Cengage Learning. All rights reserved. COBRA - 1985 COBRA = Consolidated Omnibus Budget Reconciliation Act of 1985 Older Women’s League sought health coverage after divorce or the death of a spouse Health Insurance can be paid for after losing a job Lasts 18-36 months depending on precipitating event Can cost up to 150% of what coverage cost before Eliminate gaps in health care coverage © 2018. Cengage Learning. All rights reserved. COBRA ELIGIBILITY © 2018. Cengage Learning. All rights reserved. AAPACA - 1990 The Patient Protection and Affordable Care Act (PPACA) “Obamacare” provide affordable quality health care to all Americans upheld by a supreme court ruling on June 28, 2012 preventive care emphasis pre-existing condition protection mandatory coverage or pay a fine - eliminated Health Insurance exchanges Cons: expensive, high deductibles, not all doctors participate in plans © 2018. Cengage Learning. All rights reserved. FAMILY MEDICAL LEAVE ACT- 1993 Eligible employees who work for a covered employer can take up to 12 weeks of unpaid, job-protected leave in a 12-month period for the following reasons: NOTE: Employee must have worked 12 months & employers must have over 50 employees • The birth of a child or placement of a child for adoption or foster care; • To bond with a child (leave must be taken within one year of the child’s birth or placement); • To care for the employee’s spouse, child, or parent who has a qualifying serious health condition; • For the employee’s own qualifying serious health condition that makes the employee unable to perform the employee’s job; • For qualifying exigencies related to the foreign deployment of a military member who is the employee’s spouse, child, or parent. © 2018. Cengage Learning. All rights reserved. HIPAA - 1996 Passed under Bill Clinton Protected Health Information - Provides for security and privacy of health data – such as in Employee sponsored health plans Protects health coverage for workers when they change or lose their jobs coordinates with COBRA – addresses employer health insurance cannot exclude pre-existing conditions Includes right to privacy for individuals age 12-18 © 2018. Cengage Learning. All rights reserved. HEALTH CARE REFORM IN THE U.S. Market-based solutions versus public provision of care Pre-paid health insurance started when hospitals were losing money – Blue Cross as a first plan – started employer based plans Insurance regulation Single-payer proposals Universal healthcare © 2018. Cengage Learning. All rights reserved. SOCIAL WORK ROLES IN HEALTH CARE POLICY Advocates Administrators Practitioners © 2018. Cengage Learning. All rights reserved. PROGRAMS DISCUSSED IN CHAPTER 6 Program Name Description Eligible Population Medicaid Health Insurance for low-income poor Elderly, disabled, children, pregnant women. Medicare National Health Insurance Elderly Ryan White Programs Health care services and insurance funding for HIV infected patients © 2018. Cengage Learning. HIV infected patients All rights reserved. WEB LINKS FOR FURTHER REFERENCE CDC Vital Signs Census Bureau - Health Insurance The Commonwealth Fund World Health Organization © 2018. Cengage Learning. All rights reserved.
