Health Care 101 and Systems-Based Practice

Abstract

In 2010, the delivery of health care in America was dramatically and extensively changed by the Patient Protection and Affordable Health Care Act (ACA; H.R. 3590) and the Health Care and Education Reconciliation Act (H.R. 4872). Both laws set forth insurance market reforms with the goals of achieving the triple aim: improving the individual patient care in terms of satisfaction and quality, improving the health of the population, and reducing and controlling the cost of care. This chapter will provide a broad overview of the ACA and its impact on the patient, health-care workforce, and health-care provider systems.

After a century of striving, after a year of debate, after a historic vote, health care reform is no longer an unmet promise. It is the law of the land.

Barack Obama

Appendices

Appendix A: Tables with Possible Answers to the Vignettes

Vignette 12.1: Mr. Brian Baker

Learning issue Table 12.1

Facts	Hypotheses	Information needed	Learning issues
19-year-old unemployed college student evaluated in the emergency room after a bicycle accident Medical history reveals fatigue, frequent thirst, and unintentional weight loss No serious injury; however, basic metabolic panel shows a blood glucose level above 200 mg/dL He is discharged with the recommendation to follow-up with his PCP for the elevated blood glucose level Brian wonders how he is going to pay the $3000 emergency room visit	Student health plan availability and coverage, parental coverage of college-enrolled kids	Has he investigated potential sources of coverage: individual insurance, employer-sponsored (mother’s or father’s), self-pay	How has the ACA impacted Brian’s options? What are Brian’s options to receive primary care?

1. PCP primary-care physician, ACA

Vignette 12.2: Mr. Bob Baker

Learning issue Table 12.2

Facts	Hypotheses	Information needed	Learning issues
62-year-old owner of a small auto parts company	Potential source of coverage: employer-sponsored, self-pay	What is the existing coverage plan for Bob and his employees?	How would the ACA help Bob and his employees obtain health insurance?
History of HTN and TIA	Existing employee coverage has limitations
He has not seen his internist in 2 years	Bob and employees are denied coverage for preexisting illness		How would expanding coverage to Bob and his employees control health-care cost?
	Bob considers the consequences of not seeking treatment, and whether the new ACA will help him		What are the financial benefits to small business to cover employee health care?

1. ACA, HTN hypertension, TIA transient ischemic attack

Vignette 12.3: Mrs. Betty Johnson

Learning issue Table 12.3

Facts	Hypotheses	Information needed	Learning issues
54-year-old self-employed, uninsured graphic artist experiences syncope while working and is evaluated in the Emergency Department (ED)	Denied coverage by health plan and was referred to Medicaid		What are Betty’s options to receive care?
ECG reveals Afib, and she is admitted to the hospital			How has the health-care system impacted Betty’s options?
Betty undergoes successful cardioversion and is discharged with a beta-blocker			How would the health exchange help Betty obtain insurance?
			Why was Betty referred to Medicaid?
			How will Betty decide which plan best meets her financial situation?

1. ECG electrocardiogram, Afib atrial fibrillation

Vignette 12.4-Ms. Bridgette Baker-McGladrey

Learning issue Table 12.4

Facts	Hypotheses	Information needed	Learning issues
A 22-year-old who is healthy, unemployed, and has a 5-year-old child	Potential source of coverage—Medicaid or SCHIP, self-pay	Income level, Medicaid requirements (especially concerning pregnancy)	Why did the family physician ask about depression?
			Why would the family physician ask about domestic violence?
			Why did the pediatrician ask about how the child responds to new situations?

1. SCHIP State Children's Health Insurance Program

Appendix B: Answers to Review Questions

Answers

• 1. d

• 2. c

• 3. b

• 4. a-1

• b-2

• c-3