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In short, the Affordable Care Act represents an effort to reframe the financial relationship between Americans and the health-care system to stem the health insurance crisis that has enveloped individuals, families, communities, the health-care system, and the national economy as a whole.9 It is also this basic reinvention of Americans' relationship to health insurance that lies at the epicenter of the legal battle over the law's constitutionality. This is because the question of whether the law falls within Congress' constitutional powers12 rests on whether the courts come to view the legislation as regulating our economic approach to the purchase of health care (because we all use care, the issue becomes how to pay for it), or instead (as the law's opponents argue) as a law that forces individuals, as passive non-economic actors, to buy a product they do not want.13
The Act also invests in the development of a multi-payer National Quality Strategy, whose purpose is to generate multi-payer quality and efficiency measures to promote value purchasing, greater safety, and far more extensive health information across public and private insurers.32 In this regard, the Act ultimately will build on the Health Information Technology for Economic and Clinical Health Act, enacted into law in 2009 as part of the American Recovery and Reinvestment Act,33 and further lays the groundwork for performance reporting on a system-wide basis so that patients can more readily get information about their own health care and how their health-care providers perform. In addition, the Act establishes the Institute for Comparative Clinical Effectiveness Research to promote the type of research essential to identifying the most appropriate and efficient means of delivering health care for diverse patient populations.34 Throughout these initiatives to improve quality and information, the Act emphasizes efforts to collect information about health and health-care disparities to allow the nation to better assess progress not only for the population as a whole, but also for patient subpopulations who are at elevated risk for poor health outcomes.
Health insurance Exchanges will be expected to implement broad federal standards related to access and quality for qualified health plans. Medicare and Medicaid demonstrations aimed at improving health and health care for individuals with complex and chronic conditions will be implemented. And throughout the system, large amounts of data on enrollment, health-care utilization, and performance will become available over time. What are the opportunities that flow from these changes How might public health be involved in (1) outreach and enrollment, (2) the creation of more integrated systems of care for people with chronic conditions who depend on health-care teams drawn from both health-care and public health professionals, and (3) working with Exchanges to assure that the health plans that do business in Exchanges are positioned to offer quality products whose performance can be measured
Finally, the law will leave nearly 25 million people without health insurance. What role can public health continue to play for these populations How can effective systems of care be created to protect these individuals (and the communities in which they live) from the consequences of inadequate health-care access
PRACTICE guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints, and are not intended to replace local institutional policies. In addition, practice guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data.
VA Long Beach is undergoing an unprecedented amount of construction and expansion to enhance health care for Veterans throughout our health care system. Each project is a tremendous opportunity to augment and improve the delivery of services to Veterans. We request your patience and cooperation as collectively we work towards transforming our facilities.
We offer advanced vision care and blind rehabilitation services to help you live independently. These may include vision-enhancing devices and technology as well as visual skills and related training.
My HealtheVet is a web-based tool you can use to manage your care and improve your health from your computer or mobile device. You can access your personal health records and use tools to manage your care through our My HealtheVet online system. You can also use My HealtheVet to refill your prescriptions, track appointments, and read informative health articles. If you need help using My HealtheVet, you can contact our coordinator by phone or in person. With My HealtheVet, you can:
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