Canvas Study Guide Students - Economic Influences

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California State University, Fresno *

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Health Science

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May 8, 2024

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Uploaded by bnvasquez on coursehero.com

Study Guide Economic Influences in Healthcare (see ATI book for now, PP, and textbook) Key Concepts 1. The Role of Public Health and Policy  Public health aims to provide top-quality healthcare while actively engaging with communities.  Public health policies are designed to influence and improve health outcomes.  As nurses, you are advocates for individuals, families, and communities, and understanding health policies is crucial to your role. 2. Health Policy and Economic Factors  Healthcare policy is influenced by economic factors and often involves political debates.  These policies affect various stakeholders, including patients, healthcare providers, and the healthcare industry as a whole. 3. Types of Health Policies  Health policies can be categorized as quality, access, or cost-related.  Another classification is between allocative policies (benefiting specific groups) and regulatory policies (influencing actions and behaviors).  Policies can also be substantive (leading to significant changes) or procedural (offering step-by-step guidance). 4. Healthcare Policy Context  Health policy is established at the federal, state, and local levels, with government involvement in providing services, setting regulations, and ensuring public safety.  Key government-funded health insurance programs include Medicare and Medicaid.  The private sector in healthcare must also adhere to public policies like HIPAA. 5. Nursing's Role in Policy  Nurses play a pivotal role in advocating for public health regulations and policies.  Your scope of practice is defined by legislation and regulatory boards.  Your expertise can influence policies in various healthcare settings. 6. Public vs. Private Sector  Public sector healthcare includes government-run programs like Medicaid, Medicare, and more.  Private sector healthcare encompasses agencies, institutions, or companies owned by individuals or groups.  Each sector has strengths (innovation, private insurance) and weaknesses (limited funding, bureaucratic challenges).

7. Economic Influences  Economic factors significantly impact healthcare delivery and accessibility.  Microeconomic theory looks at individual preferences and finances in healthcare.  Macroeconomic theory focuses on overall economic behaviors, growth, and employment.  High healthcare costs can act as a barrier for many individuals seeking care. Healthy People 2030 Goals  Attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death.  Eliminate health disparities.  Achieve health equity.  Attain health literacy to improve the health and well-being of all. Third-Party Payers and Public-Private Partnerships  Third-party payers are private companies partnered with publicly funded programs.  Example: Medicare (part C) and Medicaid contract with private companies to manage care.  Purpose: Enhance healthcare services, cut costs, decrease utilization, and produce better client outcomes. Healthcare Costs  Healthcare is expensive in the U.S., with rising costs in both public and private sectors.  Impact of Rising Costs: o Public Sector: Directly impacts profit and may limit innovation. o Private Sector: Consumer premiums often increase.  Factors Contributing to Rising Costs: o Public Sector: Regulation and legislation, lack of competition. o Private Sector: Hospital consolidation, health of the economy, price transparency. Factors Contributing to Rising Costs  Other Factors: Medical provider shortages, rising cost of education in healthcare professions, consumers' inability to pay.  Impact of Provider Shortages on Chronic Diseases.  Impact of Education Costs on Aspiring Providers.  Access to Care and Funding Impact on Costs.

Healthcare Quality  Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS): Measures healthcare quality.  Requirement for Institutions Receiving Federal Funding.  Based on Patient Experience.  Influence of Nurses on HCAHPS Results.  Use of HCAHPS in Private Sector and Impact on Profit. Health Care Financing  Medicare: Insurance for those over 65 or with specific disabilities.  Federally Funded through Payroll Deductions.  Medicaid: Insurance for low-income individuals.  Funded by Federal and State Taxes.  Children's Health Insurance Program (CHIP): Insurance for low-income children not eligible for Medicaid.  Affordable Care Act (ACA): Aim to increase health insurance coverage. o Strengths: Taxpayer-funded subsidies, preventive care access, removal of pre- existing conditions, dependent eligibility until age 26, removal of lifetime benefit limits. Government Programs  Tricare: Insurance program for military and veterans.  Indian Health Service (IHS): Health program for Indigenous Peoples.  Federal Employee Health Benefits (FEHB) Program: Health coverage for federal employees.  Refugee Health Promotion Program (RHP): Provides healthcare for refugees and asylum seekers. Payment and Resources  Payment Calculation: ICD, DRGs, out-of-pocket, HCAHPS, private insurance contracts.  International Classification of Diseases (ICD): Global classification system.  Out-of-Pocket: Personal expenses for healthcare.  Health Savings Accounts: Used to pay out-of-pocket expenses.  Impact of Budgets and Legal Parameters on Funding Allocation.  Role of Grants in Healthcare Research.

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