[PHP 0310] - Midterm Exam Guide - Ultimate 28 pages long Study Guide!

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7 Feb 2017
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PHP 0310
MIDTERM EXAM
STUDY GUIDE
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01-25: Introduction
Wednesday, January 25, 2017
11:32 AM
Introduction
Between 2010 and 2016, uninsured non-elderly population dropped from 18% to 10%
(introduction of Obamacare)
ACA made it more possible for low-income people to get health insurance
o Benefits greater for Blacks and Hispanics who are preferentially in low-income groups
o But in terms of numbers, many more whites got insurance just due to greater population
number
Growth in national health expenditures (NHE) as a share of GDP plateaued during recession
(17.8%), didn't actually increase
o The national deficit per year shrank during Obama's presidency
House takes first step towards repealing Obamacare
o Executive orders to eliminate any "fiscal burden on any State", give states more flexibility,
encourage interstate sale of health insurance
Budget resolution
o Mechanism to pass legislation intended for budget and tax issues
o Only requires 51 votes in the senate (instead of 60) - there are 52 Republicans
Therefore, don't need a SINGLE democrat vote
o Ex. Medicaid expansion, employer mandate, premium subsidies, individual mandate, new
taxes
o On Jan 27, 4 committees to make recommendations on what to repeal using the
reconciliation process
House: Ways and Means, Energy and Commerce
Senate: Health Education Labor and Pensions, Finance
Normal Senate process (requires 60 votes)
o This is the "replace" part instead of "repeal"
o Ex. Pre-existing conditions, essential health benefits, limits on age rating, parental policies
until 26, ban on setting rates based on health status
Executive actions
o Ex. Cost-sharing subsidies, contraception coverage (can just decide that contraception is not
covered - $80-100/month)
The Dilemma
By population, China > Indian > US
By GDP, US (by far) > China > Japan
Largest industrial output, China > US > Japan, but US by far ahead in services output
Of top 20 universities in the world, US has 14-16
US has greatest number of Nobel Prizes in Peace, Economics, Medicine, Physics, Chemistry
o Second to France in Literature
"Best healthcare in the world"?
o What we do well
NIH budget >$30B/year, fuels basic science research
Amazing teaching hospitals of tertiary and quaternary care
o But what data supports the "best in the world" assertion?
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o Compound annual growth rate of US funding for medical research has dropped from 6.3% to
0.8% since 2004
Been essentially flat! Adjusted by the dollar, the investment has actually dropped
recently
o Superior amenities
Hospitals look more like luxury hotels
In the US, spending keeps going up relative to "developed" European nations
o What do we get from this spending?
o Health status of countries ranked from 1-34 (from OECD)
US is in red = bottom third for:
Life expectancy of all sorts
Obesity in adults/children and overweight children (the worst country out of all
34)
Healthcare coverage (less than 90% have healthcare coverage vs. other
countries are between 95-100%)
Asthma/COPD/diabetes hospital admissions, cervical cancer survival
US very good in smoking for adults, case-fatality for MI, stroke, breast cancer
o US does some things well, but they tend to be technology-oriented things
The dilemma: poor value
o Health to spending ratio/value is very poor
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