Iron Triangle and Medical Health Systems Questions
1) Iron Triangle Concepts
Utilizing all three concepts of the Iron Triangle, compare the need of major health reform in 2010 against the need for further health reform today.
Describe three causes of rising healthcare costs and three potential methods for cost containment.
2) Affordable Care Act
As written, the Affordable Care Act was expected to achieve “near universal” healthcare access by expanding insurance coverage to an additional 32 million people by 2019.Explain all of the major ways in which these 32 million people were supposed to achieve insurance coverage and discuss any changes to the ACA that have affected this result.
Discuss 2 reasons why health reform historically failed and 2 reasons why health reform succeeded in 2010.
3) Federal Payers
Describe Medicare Parts A, B, C, and D and the roll of Medigap.
Describe 3 ways that Medicare was affected by the ACA
4) State Payers
Compare the pre-ACA Medicaid system (eligibility, how the state/federal government paid for it, and number of covered people) to the post-ACA Medicaid system (eligibility, how the state/federal government paid for it, number of covered people) for states which elect to expand their program.
Describe the Medicaid look-back system for long-term care and then discuss why it is important to know.
Describe the 1999 IOM report “To Err is Human” and the 2001 report “Crossing the Quality Chasm” and then discuss how these two reports fundamentally changed the quality landscape in America.
Provide a brief overview of pay-for-performance programs with both Medicare Part A and Medicare Part B and describe the health system’s movement from volume to value.
6) Primary Care
Describe the expected shortage of primary care physicians and at least two reform provisions in the ACA that are aimed at addressing this shortage.
7) Long Term Care
- a) Describe the stages in the continuum of institutional long term care services. 8) Pharmaceuticals a) In what ways does the current pharmaceutical industry add positive value and which ways does the current pharmaceutical industry potentially hinder the healthcare system? b) Describe direct-to-consumer advertising, including the potential benefits and concerns. 9) The Hospital Industry a) Describe the Hill-Burton Act and Certificate of Need (CON) laws.
How are they related and what was their impact? b) Discuss how the role of the hospital has changed over time and some future trends for this industry. 10) Laws, Regulations, and Governance a) Describe EMTALA. How has the law been beneficial and why is it controversial? b) Describe the Anti-Kickback statute and the Stark law.
How do they help prevent fraud and abuse in the healthcare system? 11) The Healing of America Book a) How does Reid contest the common American misconception that universal health care is necessarily socialized medicine? b) Describe the Bismarck Model, the Beveridge Model, the National Health Insurance Model, and the Out-Of-Pocket models. If you were to design the perfect health system, which model (or models) would you choose and why?