Expert answer:Discussion 9 – Health Policy

Solved by verified expert:Select a health policy (federal, state or local) that was passed within the last 20 years. Provide a brief synopsis of the policy and the process it went through to become policy.If you have a personal experience which applies to health policies, you may provide it in your answer but be sure to address the other parts of this discussion as well.
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Chapter 13
Health Policy
© 2010 Jones and Bartlett Publishers
Introduction

The United States does not have a centrally
controlled system of health care delivery,
– It does, however have a history of federal,
state, and local government involvement in
health care and health policy.
© 2010 Jones and Bartlett Publishers
What is Health Policy?

Public policies are
– authoritative decisions made in the
legislative (congressional),
 executive (presidential), or
 judicial (Supreme Court) branches of
government
– intended to direct or influence the actions,
behaviors, and/or decisions of others.

© 2010 Jones and Bartlett Publishers
What is Health Policy?

Health policies are
– public policies that


pertain to or influence the pursuit of health
Health policies are
– the aggregate of

principles that distribute resources, services, and
political influences that impact the health of the
population
© 2010 Jones and Bartlett Publishers
What is Health Policy?
 Different
Forms of Health Policies
– Health policies are often byproducts of

public social policies enacted by the
government.
– Health policies pertain to health care at all levels,

including policies affecting the production,
provision, and financing of health care services.
© 2010 Jones and Bartlett Publishers
What is Health Policy?

Different Forms of Health Policies
– Health policies can affect

groups or classes of individuals, such as
physicians, the poor, elderly and children.

types of organizations, such as medical schools,
HMOs, nursing homes, medical technology
producers and employers
© 2010 Jones and Bartlett Publishers
What is Health Policy?

Regulatory Tools
– Call on government to prescribe and control
the behavior of a target group by
monitoring the group and imposing
sanctions if it fails to comply.
© 2010 Jones and Bartlett Publishers
What is Health Policy?

Allocative Tools
– Involves the direct provision of income, services or
goods to a group of individuals or organizations
– Two main types:
Distributive
– policies spread benefits throughout society.
 Redistributive
– Takes money or power from one group and
gives it to another
• therefore health policy can be politicallycharged

© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Government as Subsidiary to the Private Sector
– It’s fragmented,
– incremental,
– piece-meal reform,
– pluralistic (special interest),
– decentralized role for the states,
– impact of presidential leadership
– These features interact or influence the
development and evolution of health policy.
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Government as Subsidiary to the Private Sector
– Health care is not seen as a right of citizenship or a
primary responsibility of government.

The private sector has a dominant role
– Americans prefer market solutions over government
intervention
– The complexity of health care makes it difficulty for
many consumers to make informed decisions
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Government as Subsidiary to the Private Sector
– Government has grown incrementally in response to
perceived problems and negative consequences
– Policy interventions begin with the identification of
a problem where markets fail or do not function well
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Government as Subsidiary to the Private Sector
– Health coverage is a privilege

government is left to fill the gap for the most
vulnerable of the uninsured population.
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Fragmented, Incremental, and Piecemeal Reform
–
The mix of government and private insurance results in
a complex and fragmented system of health care
financing in which:
1. The employed are insured by voluntary insurance
through contributions that they and their employer
pay
2. The elderly are financed by Social Security tax
revenues
– Medicare Part A and B, Medigaps
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Fragmented, Incremental, and Piecemeal Reform
3. The poor are covered through Medicaid via federal,
state, and local revenues
4. Special populations, such as Veterans, Native
Americans, and the armed forces, have coverage
provided directly by the federal government.
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy
 Pluralistic
and Interest Group Politics
– Health policies have been based on interest
groups and incremental policies

Innovative, nonincremental policies are resisted,
because the measures increase threats to interest
groups
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Pluralistic and Interest Group Politics
–
The membership of the policy community has
included,
1. the legislative committees
— with jurisdiction in a policy domain,
2. the executive branch agencies
— responsible for implementing policies in the
public domain
3. the interest groups in the private domain

The first two are suppliers of policies demanded by the third.
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Pluralistic and Interest Group Politics
–
Interest Groups
 Most effective demanders of policies
 Adamant about resisting any major change
 They combine and concentrate the resources of
their members
 Examples of health care interest groups:
– American Medical Association (AMA),
– American Association of Retired Persons
(AARP)
– American Hospital Association
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Pluralistic and Interest Group Politics
– Employers


Their concerns are about health insurance benefits
for their
– employees, dependents, and retirees
Most small businesses oppose mandates of
coverage because of the cost
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Pluralistic and Interest Group Politics
– Consumer Groups

The interests of consumers are not uniform

Consumers do not have sufficient financial means
to organize and advocate for their own best
interests.
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Pluralistic and Interest Group Politics
– Manufacturers of Technology

Health policy concerns regarding medical
technology include:
1. Its role in health costs
2. Its health benefits to people (although not always)
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Pluralistic and Interest Group Politics
– Alliances


To overcome pluralistic interests and maximize
policy outcome, diverse interest groups form
– alliances among themselves and with members of
the legislative body to
• protect and enhance the interests of those
receiving benefits from government programs.
Each member of the alliance receives benefits
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Decentralized Role of the States
–
States develop and implement health policies involving:
1. Financial support (care and treatment) for the poor
and disabled
– Medicaid, SCHIP
2. Quality assurance, practitioner and facility oversight
– Licensure and regulation
3. Regulation of health care costs and insurance carriers
4. Health personnel training
5. Authorization of local government health services
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Decentralized Role of the States
–
States have broad, legal authority to regulate the
health care system.
– The state can:
 license and regulate health care facilities and
professionals
 restrict the content, marketing, and price of health
insurance
 set and enforce environmental quality standards
 enact controls on health care costs
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Decentralized Role of the States
–
States finance much of the health care for the poor
–
Most incremental policy actions originate at the state
level
–
State-initiated programs address vulnerable
populations
–
Some argue there is too much state control over health
policy decisions
© 2010 Jones and Bartlett Publishers
Principle Features
of US Health Policy

Impact of Presidential Leadership
– Americans look to presidential leadership for major
change in health policies
– Presidents can influence outcomes through compromises
 Lyndon B. Johnson helped pass
– Medicare and Medicaid
 Harry Truman helped pass the
– Hill-Burton Hospital Construction Act
© 2010 Jones and Bartlett Publishers
Development of
Legislative Health Policy
 Policy
Cycle
– Making health policy is a complex
process

It involves both private and public
sectors, including multiple levels of
government
© 2010 Jones and Bartlett Publishers
Development of
Legislative Health Policy

Policy Cycle
– The formation and implementation of health policy
occurs in a policy cycle comprising five components:
1. issue raising
2. policy design
3. building of public support
4. legislative decision making and building of policy
support and,
5. policy implementation
– These activities are shared by Congress and interest
groups
© 2010 Jones and Bartlett Publishers
Development of
Legislative Health Policy

Legislative Process

A bill is introduced in the House of Representatives,
 it is assigned to a committee by the Speaker
 it is reassigned to a subcommittee
 it is sent to agencies to hold hearings (“markups”)
to get testimony and possible amendments
Committees and subcommittees may “recommend,”
“not recommend” or “table” the bill

 The
full House hears the bill, at which point they may
(further) amend it. If it is approved, they send it to the
Senate
© 2010 Jones and Bartlett Publishers
Development of
Legislative Health Policy
Legislative

Process
The Senate follows the same process as the House,
 however, if amendments are added in the Senate, it
goes back to the House for approval
 After
the bill has passed in both the House and Senate in
identical form, it is forwarded to the president for
signature.

If the president signs the legislation, it becomes law
© 2010 Jones and Bartlett Publishers
Development of
Legislative Health Policy
Legislative
Process

Once legislation is signed into law, it is forwarded to the
appropriate agency for implementation

The new regulation is posted in the Federal Register
Hearings are held to see how the law will be
implemented
The bureaucracy publishes, gathers comments and
rewrites regulations

The program goes to 50 states for enabling legislation (if
appropriate)


Local interests begin a new political process to shape the
final outcome
© 2010 Jones and Bartlett Publishers
Critical Policy Issues

Access to Care
–
–
–
–
–
–
–
Providers
Public Financing
Access and the Elderly
Access and Minorities
Access in Rural Areas
Access and Low Income
Access and Persons with AIDS

Cost Containment

Quality of Care
– Research and Policy Development
© 2010 Jones and Bartlett Publishers
Critical Policy Issues

Government health policies are enacted to
– Resolve or prevent deficiencies in health care delivery

Health care has been focusing on:
– Access to care

Expanding insurance coverage, outreach to rural
areas
– Cost of care

PPS, RBRVS
– Quality of care

AHRQ and clinical
practice guidelines
© 2010 Jones and Bartlett Publishers
Critical Policy Issues
• Access to Care
– Policies on access are aimed primarily at
– providers and financing mechanisms,
– with the purpose of expanding care to the most
needy and underserved populations (i.e., the
elderly, minorities, rural residents, those with
low incomes, and persons with AIDS)
© 2010 Jones and Bartlett Publishers
Critical Policy Issues
• Access to Care
• Providers
Policy helps to ensure that there are enough providers
and that their geographic distribution is desirable.

The supply of physicians is a policy issue that could
influence people entering the medical profession
 entrance to medical professions are influenced by
government assistance and grants

© 2010 Jones and Bartlett Publishers
Critical Policy Issues
• Access to Care
• Providers

Policy has expanded to include:
 The National Health Service Corp
 Legislation supporting rural health clinics to
expand access
 Student assistance programs to emergency medical
services
 Establishment of community health centers in
inner cities and rural towns
© 2010 Jones and Bartlett Publishers
Critical Policy Issues
• Access to Care
• Public Financing
 Many see national health care as the best way to
ensure access.
 the U.S., however focuses on certain groups

Medicare and Medicaid
 established the precedent that government should
facilitate access to health care among those unable to
secure it for themselves.
© 2010 Jones and Bartlett Publishers
Critical Policy Issues

Access to Care
– Access and the Elderly

Two main concerns about the Medicare policy
1. Spending must be restrained to keep the
program viable.
2. The program must be made comprehensive
by adding services not currently covered or
covered inadequately.
(i.e., nursing home coverage)
© 2010 Jones and Bartlett Publishers
Critical Policy Issues

Access to Care
– Access and Minorities
Minorities are more likely than whites to face
access problems.
 Low income, minority status, cultural habits cause
access problems
 Policies should encourage
– sensitivity programs to the special needs of
minorities, and
– delivery of services to areas populated by
minorities

© 2010 Jones and Bartlett Publishers
Critical Policy Issues

Access to Care
– Access in Rural Area
 In rural communities, making medical care available
to residents is difficult, because most health care
organizations are established in more urban areas

The National Health Service Corps helps address
personnel shortages in rural areas, but only for a
limited time

Programs to create incentives for permanent practices
in rural areas are needed
© 2010 Jones and Bartlett Publishers
Critical Policy Issues

Access to Care
– Access and Low Income

Low-income mothers and their children have
problems accessing the health care system because
– they lack insurance and generally live in
medically underserved areas.
– they are also less likely to receive prenatal care

SCHIP
– Federal funds with some state-flexibility–target
health care coverage for children
© 2010 Jones and Bartlett Publishers
Critical Policy Issues

Access to Care
– Access and Person with AIDS
Persons with AIDS and those who have HIV have
problems obtaining health care.
 AIDS patients have difficulty getting insurance
– Their disease process leads to catastrophic
expenses
 Financial access can be a barrier
 AIDS is a challenge to policymakers committed to
universal access

© 2010 Jones and Bartlett Publishers
Critical Policy Issues

Cost Containment
– The strengths of the U.S. health care system contribute
to its weaknesses.
– The U.S. has the latest technology and well-trained
specialists
 This leads to the most expensive means of providing
health care in the world
– Two major policy initiatives enacted by the federal
government to contain costs have targeted
 Hospitals with PPS, and
 Physicians’ services with RBRVS
© 2010 Jones and Bartlett Publishers
Critical Policy Issues

Cost Containment
– The National Health Planning and Resources
Development Act of 1974 became law in 1975.

This act marked the transition from improvement of
access to cost containment as the principle theme in
federal health policy.
– Health planning through a CON review was a
policy tool to contain costs
© 2010 Jones and Bartlett Publishers
Critical Policy Issues

Quality of Care
– Along with access and cost, quality of care is the third
main concern of health care policy.
– The Health Care Quality Act of 1986

Legislation that mandated the collection of national
data on legal actions against health care providers

This information allows people to know actions
brought against physicians in other states
© 2010 Jones and Bartlett Publishers
Critical Policy Issues

Quality of Care
– Agency for Healthcare Research and Quality
(AHRQ)

is to conduct and support research on outcomes,
effectiveness, and appropriateness of health care
services and procedures
© 2010 Jones and Bartlett Publishers
Critical Policy Issues
– Agency for Healthcare Research and Quality
(AHRQ) (cont.)
 funds patient outcomes research teams
(PORTS):
– that focuses on certain medical conditions
– that are part of the medical treatment
effectiveness program which has 4 elements:
1.Medical treatment effectiveness research
2.Development of databases for research
3.Development of clinical guidelines
4.Dissemination of research findings and
clinical guidelines
© 2010 Jones and Bartlett Publishers
Critical Policy Issues

Quality of Care
– Research and Policy Development

Research can influence health policy through
– documentation,
• gathering, cataloging, and correlating
– analysis
• program evaluation and outcomes research
– prescription
• a course of action that has a desirable
consequence
© 2010 Jones and Bartlett Publishers
Conclusion

Health policies are developed to serve the public’s
interest

National health care is supported, but the idea of
federal government running the system is not
preferred

The challenge is:
– finding a balance between government provisions and
control, and the market to improve coverage and
affordability
© 2010 Jones and Bartlett Publishers
…
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