Health Policy Flashcards
policy
settled course of action to be followed by gov, business, institute to obtain a desired effect
Examples of policies
laws, regulations, voluntary practice
Who makes policies?
Fam, hc company, community
public policies
all gov activities that influence the lives of citizens with settles courses of action
Health policy
set course of action to obtain a desired health outcome for an ind, fam, group, comm, society
Law
rules that govern relx of ind and org to other ind and to gov
- result from legislative, judicial, constitutional decisions, admin actions
Laws can be policies but…
not all policies are laws
Politics
art of influencing others to accept a specific course of action (the policy)
- plays role in dev of policies
- found in fam, prof, employing agents, gov
Goals for public health policy dev
- prioritize and address health needs
- plan and dev policies to address priority needs
- advocate for resources to address needs
Elements of policy dev
- communicate effectively to inform ppl about health and how to improve it
- strengthen, support, and mobilize comm and partnerships to improve health
- create and implement policies, plans, and laws that impact health
- utilize legal and regulatory actions designed to improve and protect the public’s health
Private health system
outside of government control
- influenced by business management
- economics is CENTRAL fx in decision-making
- decisions are swift and protective
- needs determine by consumerism and market trends
Cost shifting
- private health system idea where pts are charged based on ability to pay
- when some ppl pay, allows others to get “charity care” if they can’t pay
Public health
Authority vested in the states
- focus on populations
- econ is a fx in decision-making (not full decider)
- decisions are slow and deliberate, infl by political enviro at the moment
- needs determined by voting shifts, electoral realignment, term limits
Sub categories of public health
Federal, state, and local programs
Subcategories of pricate health sys
profit and nonprofit
What does the executive branch do
Sign/veto laws, pardon ppl, appoint federal judges, elect pres
- suggest, admin, and regulate policy
Subdivisions of executive branch
- federal: president
- state: governor
- local: mayor
Legislative fxn
make laws, approve pres appts
- ID probs, propose, debate, pass, modify laws to address those probs
Subdivisions of legislative branch
- federal: Congress (house of reps based on pop and senate (2/state))
- state: legislature (house of reps and senate)
- local: council members and county commissioners
Judicial branch
Decide if laws are constitutional, appointed by pres, 9 justices, can overturn rulings by other judges in lower level courts
- interpret laws and meaning
Subdivisions of judicial branch
federal, state, and local courts
Process of passing a bill
State and federal level
- bill made by legislators and brought to house or senate
- bill assigned to committee of reps in the House
- committee passes, goes back to house for full vote
- H.R. passes, goes to Senate
- Senate gives to committee to review
- committee passes, goes to Senate for full vote
- Senate votes and approve, to pres
- pres signs into law or vetoes
What happens if pres vetoes
Bill goes back to most recent legislative body (Senate or H.R.) who can override with 2/3 majority
Social security act
1935
- assist older adults and unemployed ppl
- survivor insurance for widows and kids
- child welfare, health dept grants, maternal and child projects
Public health act
1944
Consolidated all existing PH legislation, health services for migratory workers, fam planning services, health research facilities, NIH, nurse training acts, prevention and primary care services, rural health
When was the public health service created
1798
When was the NIH made
1948
when was medicare and medicaid made
1965
- made by congress, implemented by exec branch
What happened in 1997
state child health improvement act made
what happened in 2002
PH security and bioterrorism preparedness and response act
What happened in 2010
ACA made
What happened in 1906
pure food and drug act
what happened in 1912
Children’s bureau act
When was OSHA made
1970
What happened in 1988
Family support act
What happened in 1996
Welfare reform act
KNA legislative priorities for 2023
- workplace violence prevention
- workforce supps (nursing shortage)
- discrim of nurses (non purposeful like med errors)
How can nurses help health policy
- vote
- join professional orgs
- KNA legislative priorities
- join a coalition
- become member of political action
- committee (PAC)
- campaign for candidates
- become a lobbyist
- run office
Advocacy
- act or process of supporting a course or proposal
- garner attn and focus on particular topic in common
lobbying
- promote or secure passage of legislation by influencing public officials
- targeted efforts aimed at those in positions of power like legislators or public officials to influence public policy or dev legislation
All lobbying is advocacy…
not all advocacy is lobbying
factors influencing decision makers
- constituent needs
- scientific evidence
- potential health impact
- personal interest
U.S spending on hc
- spends more money, accesses care less frequently and has worse health outcomes
- ranks last r/t quality, access, efficiency, equity
- 5% spent on pop, 95% on ind care
- US has lower life expectancy, higher suicide rates, highest chronic disease burden, highest obesity, high premature death rate
- low numbers of dr visits and practicing drs
1800s hc
- health issues r/t social issues like poor water and sanitation
- 1850 - accident insurance was available for railroad and steamboat travel
Why wasn;t there hc in the 1800s
- fam/friends did most hc in the home
- hospitals were crowded and unsanitary
- health expenses were low
hc in the 1900s
- industrial revolution made worse working conditions from inc factories
- rapid medical advances and inc trust in the med establishment
What did the food, drug, and cosmetic act do
Rx drug regulation
- old timey FDA
When was the first insurance plan for employees
1929
- insurance for teachers and later extended
- early modern insurance and monthly payment plan
hc in the great depression
Hospital followed the model of hc for employees
- gave steady income to hospitals and drs and provided hc to ppl
McCarran-Ferguson act
1945
- entrusted states with the authority and responsibility of regulation of business and insurance d/t lack of oversight
Hill-Burton act
1946
- National direct support for community hospitals and give money and standards for planning of hospitals and establishing community service obligations
Goal of hospital beds to population ratio
4.5 beds for every 1000 people in pop
how did hc change in the 40s and 50s
unions form, esp in post-ww2
- employees offer insurance to get ppl to work for them
Medicare
65+ people and disabilities
- no income requirement
Medicaid
health insurance program for ppl with low income and limited resources
- state-based and there ARE income requirements
What happened in hc in the 1970s
- hc costs rose from the recession
Medicare dx related group (DRG) sys
1985
- created to control costs
- allows same payment for procedures/tx across the board
- private hospitals could not shift income to support charity causes
- causes lots of pt dumping cases
COBRA
1985 act by Regan
- consolidated omnibus budget recon acts
- allows some employees to keep hc after employment
- temporary and varies by state, some ppl may have to pay for full premium for coverage incl coverage previously paid for by employer
- expensive
EMTALA
1986
- emergency medical tx and active labor act
- EDs must screen all pt who go to hospitals
- EDs start to be primary care for some pts
- changes wait times and staffing
Health security act “Hillarycare”
1993 Clinton bill
- universal coverage and basic benefits for health coverage with restructure and competition that gave consumers options, would restructure, allow competition
- did not pass
SCHIP
1993 state children’s health insurance plan
- kids from low income got state-insured health insurance
Medicare modernization act (2003)
- most signif law in 40y for senior health
- provides seniors and ppl with disabilities w/ some rx drug benefits (Medicare Part D)
- more benefits and coverage
2006 MA health reform
- led by mitt romney
- provided health insurance to almost all MA residents
- share responsibility employers and gov
- ACA precursor
- cost containment still an issue
- dropped uninsurance rates considerably
Mental health parity act and addiction equity act
2008
- insures most compensate comparably for addiction and MD services and physical health
