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HPM > HPM Midterm > Flashcards

HPM Midterm Flashcards

1
Q

Private Policy

A
  • Hospital employee flu shot = private “policy”

- Private accrediting bodies (Joint Commission, NCQA)

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2
Q

Public Policy

A
  • Public policies are authoritative decisions made in the legislative, executive or judicial branches of government
  • Public policies that pertain to health are health policies
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3
Q

Role of the legislative branch

A
  • FORMULATES POLICY
  • enacts laws
  • creates and funds health programs
  • balances health policy with other domains
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4
Q

Role of executive branch

A
  • IMPLEMENTS POLICY
  • proposes legislation
  • approves or vetos legislation
  • promulgates rules and regulations
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5
Q

Role of judicial branch

A
  • INTERPRETS POLICY
  • interprets constitutional and statutory law
  • develops body of case law
  • preserves rights
  • resolves disputes
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6
Q

Operations Decisions

A
  • Once laws and regulations establish programs (like Medicare, Medicaid), health agencies (CDC, FDA, state Health Departments) have discretion to manage the programs
  • Agency operational decisions by government officials are “health policy”
  • example of decisions in Medicare: eligibility and coverage determinations, payment, fraud and abuse
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7
Q

Categories of health policies

A

Allocative & Regulatory

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8
Q

Allocative health policy

A
  • Policies that distribute or re-distribute finite resources
  • Often provide net benefits to one group at the expense of others to meet policy objective
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9
Q

Regulatory health policy

A
  • Directives that influence the actions, behaviors or decisions of others
  • Examples: licensing of practitioners, certificate of need, FDA safety/efficacy regs, antitrust, workplace safety
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10
Q

Why the government is involved in health policy

A
  • In a market economy, the private market should determine the production and consumption of health services
  • Government intervenes when the private market fails to achieve desired public objectives
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11
Q

How & Why the US health sector has failed

A

Failed to: guarantee access & control healthcare costs

Because: buyers and sellers do not have sufficient information to make informed decisions & small number of sellers control market, barriers to entry

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12
Q

National healthcare spending trends

A
  • private has decreased, public has increased, now about equal
  • government share now accounts for more than half of U.S. health care expenditures
  • growing entitlement spending
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13
Q

Why should be care about health policy

A
  • Cost – largest component of the economy – and growing
  • Quality – substantial evidence that the quality is not as good as it could be
  • Access – literally millions of people have inadequate access to health care services
  • Variability – all of these characteristics vary by location, ethnicity, income, etc.
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14
Q

Trends of healthcare cost over time

A
  • dramatic increase in US health expenditures, now approaching 3 trillion, nearly 18% of the GNP
  • US spends the most compared to all countries
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15
Q

Why does US healthcare cost so much?

A
  • higher prices than other countries for same services
  • higher administrative overhead costs
  • high-cost, high-tech equipment and procedures
  • American tort laws can lead to “defensive medicine”
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16
Q

Four main drivers of cost

A
  • technology and prescription drugs
  • chronic disease (more people who are “sick” in population: diabetes, hypertension, HIV)
  • aging of the population
  • administrative costs
  • (higher inflation rate in healthcare)
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17
Q

Combination effect

A

combination of increasing life expectancy and the increase in chronic disease with age produces a progressively on “on average” older, sicker population

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18
Q

Measurements of healthcare quality

A
  • life expectancy at birth
  • childhood mortality
  • US sucks and is worse quality than many countries, even though it also costs more
  • medical error rates
  • loooots of geographic variability - cost, quality, etc
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19
Q

Conditions necessary for free markets

A
  • infinite buyers and sellers
  • zero entry and exit barriers
  • perfect factor mobility
  • perfect information
  • zero transaction costs
  • profit maximization
  • homogeneous products
  • non-increasing returns to scale
20
Q

Forms of health policy

A
  • laws, regulations, operational decisions, judicial decisions
21
Q

Interest groups

A
  • Interests of those employed in health sector more concentrated than individual consumers
  • Both proactive and reactive (block legislation)
  • Seek to influence policymaking to some advantage of the group’s members
22
Q

How interest groups influence policy making

A
  • lobbying
  • electioneering
  • litigation
  • shaping public opinion
23
Q

Problems that get on the policy agenda

A
  • important and urgent
  • issues/trends that reach an unacceptable level
  • widespread applicability or impact small but powerful group
  • closely linked to other problems (like cost)
24
Q

Agenda setting

A

agenda setting as a consequence of the health-related problems, possible policy solutions that address those problems and the current political circumstances

25
Q

Political circumstances that either open or close the window of opportunity

A
  • political “will” necessary
  • competing issues on the agenda
  • which party controls the chamber and the executive branch
  • fillibuster
26
Q

Committees with health jurisdiction

A
  • Senate: Aging & Youth, Consumer Protection & Professional Licensure, Law & Justice, Public Health & Welfare, Veterans Affairs & Emergency Preparedness
  • House: Aging & Older Adult Services, Children & Youth, Health, Human Services, Professional Licensure
  • jurisdictions overlap & multiple committees oversee health
27
Q

Legislative hearings

A

Hearings provide a forum where facts and opinions can be presented from witnesses with varied backgrounds (experts & other interested parties)

28
Q

Types of legislative hearings

A
  • legislative
  • oversight
  • investigative
  • confirmation
29
Q

Policy Formation - Exemplary Policies

A
  • Healthcare Associated Infections (HAIs)
  • Prescription drug monitoring
  • SEE WEEK 3 POWERPOINT FOR FULL EXAMPLES
30
Q

Policy implementation

A
  • Health policies must be implemented effectively if they are to carry out the intent of the authoritative decision
  • Health policies must be implemented effectively if they are to affect the determinants of health
  • Implementation is a management exercise by the executive branch (with legislative oversight)
31
Q

Types of implementation activities

A
  • rulemaking - establishment of formal rules necessary to effect the intent of laws
  • operation - activities of implementing organizations to carry out the law
32
Q

Implementation responsibilities of the three branches of government

A
  • executive agencies - primary role is implementation of laws formulated by legislative branch
  • legislative oversight - appropriation committees (funding) & standing committees (direct oversight)
  • judicial role - Administrative Procedures Act (ALJs)
33
Q

Key features of the rule making process

A
  • Congress (or state legislature) grants rulemaking authority to an agency
  • Agency develops draft proposed rule and publish in Fed. - - Register
  • Public comment
  • Agency responds to comments and makes revisions
  • Governmental Review (OIRA/OMB or IRRC at state level)
  • Publication of Final Rule, Rule takes effect
34
Q

Key features of operation

A
  • resources (budget)
  • management: leadership and personnel
  • competencies: policy, conceptual, technical, interpersonal
35
Q

Policy Implementation - Exemplary Policies

A

ACA Health Benefit Exchanges
Clean Indoor Air Act
SEE WEEK 4 POWERPOINT FOR FULL EXAMPLES

36
Q

What gives authority to states to regulate Public Health?

A
  • Tenth amendment of the constitution (powers not delegated to the feds are reserved for the states)
  • police power
  • McCarran-Ferguson Act of 1945 (gives states authority to regulate the “business of insurance” without interference from federal regulation)
37
Q

State and Local Roles in Health Policy

A
  • Protector of the Public Health and Welfare (environmental regulations, restaurant inspection)
  • Purchaser of Healthcare Services (Medicaid)
  • Regulator (health professions, hospitals, nursing homes, health insurers)
  • Safety Net Provider (health clinics, state mental institutions, manage federal programs like WIC)
  • Health Education (subsidize GME, loan repayment, carry out public health education)
  • Policy Laboratory (medical home, health information exchange, HAI reduction)
38
Q

Air Toxic Guidelines

A

ATGs are not a regulation; they are used as guidance during Installation Permit (IP) reviews to evaluate the impact of air toxic emissions on Public Health

39
Q

Features of the Proposed ATG’s

A
  • Derived by true consensus of ATG committee members
  • Science-based, sensible risk levels
  • Cumulative risk (rather than chemical by chemical)
  • Toxicity information from authoritative published sources
  • Easy-to-follow steps to guide modeling requirements
  • Environmental Justice through protection of high risk “hot spots”
  • Creative and flexible off-setting process (including mobile sources)
  • Written in simple “non-legalistic” style
40
Q

Policy modification

A
  • Consequences of existing policies constantly feed back into policy formulation & implementation (dynamic and cyclical)
  • Majority of health policymaking is modification of existing policy
  • Modification can result from both negative and positive consequences of policies
  • Continual modification of U.S. health policymaking process is best described as incrementalism
41
Q

Policy modification process

A
  • same process as initial/original policy
  • agenda setting
  • development of legislation
  • rule making
  • operations (internal & external)
42
Q

Policy Modification - Exemplary Policies

A
  • Medicare Part D

- SEE WEEK 6 POWERPOINT FOR FULL EXAMPLE

43
Q

Medicare benefit structure

A
  • Part A: inpatient, skilled nursing, home health, hospice
  • Part B: physician visits, outpatient, preventive services, home health
  • Part C: medicare advantage
  • Part D: drug benefit
44
Q

Four key features of Medicare Part D

A
  • Market-based insurance
  • government can’t negotiate drug prices
  • donut hole
  • formulary rules
45
Q

Leadership

A 
complex and ambiguous concept, emphasizing the qualities and behaviors seen as necessary for, and characteristic of effective leadership, especially at the top
nature of relationship between leaders and followers 
- Political/socio-cultural skills
- Promoting change 
- Long term horizon
- Strategic focus
- Making waves and innovating
- Proactive, risk-taking
- Radical change
46
Q

Management

A

the process (or art) of getting things done through and with people

  • Technical/functional skills
  • Maintaining stability
  • Short-term horizon
  • Operational focus
  • Conforming to standards
  • Reactive response
  • Incremental change

HPM (2 decks)

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