HPM Week 1 Slides Flashcards
Health and Health Policy
What is Public Policy
Authoritative decisions made in the legislative, executive, or judicial branches of government
What are authoritative decisions?
Decisions made anywhere in the three branches of government
What are health policies?
Authoritative decisions regarding health or the pursuit of health made in the legislative, executive, or judicial branches of government that are intended to direct or influence the actions, behaviors, or decisions of others
What are the four goals of health policy?
- Improve health
- Establish equitable distribution of health care goods and services and financial burden
- Achieve efficiency and meet budget constraint
- Do something- Political feasibility is an issue sometimes we settle for less equitable or efficient policies to settle ideological dispute
What are the four forms of health policy?
- Laws
2.rules or regulations, - implementing decisions
- judicial decisions
Who can laws be enacted by?
Any level of government (ex: us congress, PA general assembly, city council)
Examples: Medicare/Medicaid and Affordable Care Act
Describe how a bill becomes a law through the house
- Representative introduces bill in the house
- Bill is read in the house and assigned to a committee by the speaker
- Bill leaves committee, is scheduled for floor consideration and debate, may be amended
- House passes bill
- Bill is sent to senate
Describe how a bill becomes a law through the senate
- Bill is read in the Senate and assigned to a committee by the Majority Leader
- Bill leaves committee, is scheduled for floor consideration and debate, may be amended
- Senate passes bill
- Bill is sent to House
After the bill is sent to the senate and house, what happens?
- A conference committee is created to resolve differences if both chambers do not pass an identical bill
- Identical bill is passed by both House and Senate OR once branch agrees to the other branch’s version OR bill is amended and both branches vote again
- Bill is presented to the President
What are the president’s four options for a bill?
- Signs the bill into law
- During congressional session, bill becomes law after 10 days without prez signature
- When not in session, bill does not become law without presidential signature
- Present vetoes bill
- 2/3s vote in house and Senate can override veto
- Rules or Regulations
Most laws direct executive branch agency l regulations
- Rule making process: posting regulations, public comment, final rule
- Designed to implement, interpret, or prescribe law
The devil is in the details -> regulations provide the details
How are legislation and regulation are tightly linked?
Legislature delegates authority to regulate to executive branch
Executive action can substitute for legislation when no action is taken
Congress is _____
“Less productive”
9/10 US policies are the results of the actions of administrative agencies
- Implementation or Operational Decisions
Once laws and regulations establish programs like Medicare and Medicaid, health agencies (CDC, FDA, and state Health Departments) have direction to manage the programs
- implementing or operational decisions by government agency officials= “health policy” ex: operational decisions in Medicare (eligibility and coverage determinations, payments, choosing plans, and preventing fraud and abuse)
What is an example of healthcare policy?
Medicare coverage of obesity medications
What is an example of a judicial decision?
2022 Supreme Court decision West Virginia vs. EPA
- Judicial Decisions
Decisions made by state and federal courts
Common law = judicial decisions based on tradition, custom and precedent
What does the legislative branch do?
- enacts laws
- creates and funds health programs
- balances health policy with other policy domains
What does the execute branch implement?
- implements laws
- proposes legislation
-approves or vetoes legislation
-promulgates rules and regulations
What does the judicial branch do?
Interprets constitutional and statutory law
Develops body of case law
Preserves rights
Resolves disputes
What are the 3 levels of government
Federal, State, and Local (city/county)
- the three branches exist at each level although the degree of power each has can very from place to place
What are recurring tensions in health policy?
Horizontal tension between 3 co-equal branches of government
Vertical tension between 3 levels of government
Disputes often resolved in the courts
What are the two categories of health policies
Allocative and Regulatory
What are allocative policies?
Policies that distribute or re-distribute finite resources
- can provide benefits to one group at the expense of others to meet policy objective
