Lecture 11/Chapter 13

Question 1

Learning Objectives

Answer 1

• Definition, scope, and role of the US health policy
• principal features of US health policy
• describe the legislative health policy process
• identify critical health policy issues in the US
• passage, implementation, and repeal of the ACA from a political perspective

Question 2

health policy introduction

Answer 2

• government involvement in social welfare -> traced to almshouse and pesthouses
• social programs created under the social security legislation in the 1940s
• government has had success bringing about social change through health policy

Question 3

public policies

Answer 3

• decision made in the legislative, executive, or judicial branches of government
• direct actions, behaviors, or decisions of others

Question 4

health policy

Answer 4

• aggregate of principles, stated or unstated
• characterize distribution of resources, services, and political influences impacting the population
• plan to promote better health
• made by legislative, executive, and judicial branches
• laws
• affect how businesses function

Question 5

uses of policy

Answer 5

• regulatory tools- laws and regulations, procedures, people need to conform to these laws
• allocative tools- how do we distribute resources and money
• affect stakeholders

Question 6

different forms of health policies

Answer 6

• affect groups or classes of individuals

- physicians, the poor, the elderly, and children

Question 7

principal features of US health policy

Answer 7

• government as subsidiary to the private sector
• fragmented policies
• incremental and piecemeal policies
• interest groups as demanders of policy
• pluralistic suppliers of policy
• decentralized role of the states- a lot of health care is managed at a state level
• impact of presidential leadership

Question 8

politics of the ACA

Answer 8

• obama stated everyone would have health insurance
• ACA become reality following a unique set of political circumstances
• speed with which the reform was pushed through the legislative process
• general public was confused and not supportive about the legislation

Question 9

aspects of the US government and populace

Answer 9

• relationship of the government to the private sector
• distribution of authority and responsibility within a federal system of government
• relationship between policy formulation and implementation
• a pluralistic ideology as the basis of politics
• incrementalism as the strategy for reform

Question 10

comprising five components of policy cycle

Answer 10

• 1. issue raising
• 2. policy design
• 3. public support building
• 4. legislative decision making and policy support building
• 5. legislative decision making and policy implementation

Question 11

congress has 3 important powers

Answer 11

• power to enact laws
• power to tax
• power to spend (allocate resources)

Question 12

most influential house committees

Answer 12

• ways and means committee
• commerce committee
• committee on appropriations

Question 13

most influential senate committees

Answer 13

• committee on labor and human resources

- committee on finance

Question 14

legislative process

Answer 14

• a bill is introduced in the house of representatives
• if approved it is forwarded to the senate
• sent to president after passing the house and senate
• if signed it becomes a law

Question 15

policy implementation

Answer 15

• new law is forwarded to the appropriate agency of the executive branch -> multiple level interpret and implement legislation
• proposed regulation published in the federal register -> hearing on how law is to be implemented
• parties may adjourn to the courts

Question 16

implementation of the ACA

Answer 16

• 12 states had decided to create state based health insurance exchanges
• 5 states opted for a state based marketplace through the federal platform
• 6 selected state partnership marketplaces
• 28 states health insurance exchanges were created by the federal government

Question 17

critical policy issues

Answer 17

• most health initiative focused on access, cost, and quality of care
• access to care:
• providers
• integrated access
• access and minorities
• access in rural areas
• access and low income
• access and persons with HIV/AIDS

Question 18

critical policy issues: cost of care

Answer 18

• increasing drug prices have drawn public attention
• no government action taken to prevent price hiking
• prices of prescription drugs may continue to rise

Question 19

critical policy issues: quality of care

Answer 19

• research on quality
• malpractice reform
• 6 areas of quality improvement:
• 1. safety
• 2. effectiveness
• 3. patient centeredness
• 4. timeliness
• 5. efficiency
• 6. equity

Question 20

critical policy issues: role of research in policy development

Answer 20

• documentation
• analysis
• prescription

Question 21

critical policy issues: future considerations in health policy

Answer 21

• domestic health policy- initiative to expand and evaluate primary care delivery models
• international health policy- government spending on global health initiative is stable

Question 22

summary

Answer 22

• health policies are developed to serve the publics interests
• interest group politics have an influence on policy
• presidential leadership and party politics played a major role in the ACA passage
• critical policy issues pertaining to access, cost, and quality remain unresolved

Question 23

social security act

Answer 23

provided pensions (money from federal government) for people to live on

• 1965- amendment to social security act -> medicare and medicaid
• people didnt have insurance because people werent working -> medicare and medicaid changes that

Question 24

khbj

Question 25

regulatory tools

Answer 25

• health policies may be used as regulatory tools
• they call on government to prescribe and control the behavior of a particular target group by monitoring the group and imposing sanction if it fails to comply

Question 26

allocative tools

Answer 26

• health policies may be used as allocative tools
• they involve the direct provision of income, services, or good to certain groups of individuals or institutions
• distributive policies include:
• funding of medical research through the national institute of health
• the development of medical personnel
• the construction of facilities
• initiation of new institutions
• redistributive policies:
• creates visible beneficiaries and payers
• take money or power form one group and gives it to another

Question 27

private sector dominant role

Answer 27

• private sector dominant role
• government spending on health care fills the private sector gaps
• intervention includes:
• environmental protection
• preventative services
• communicable disease control
• care of special groups
• institutional care of mentally and chronically ill
• medical care to the indigent
• support for research and training

Question 28

pluralistic and interest group politics

Answer 28

• US health policy outcomes result from compromises to satisfy demands
• the first two communities supply policies demanded by the third
• legislative and executive respond to demands of the private interest groups
• the policy community has included:
• legislative committees
• executive branch
• private interest group

Question 29

interest groups demand power

Answer 29

• well organized interest groups are the most effective demanders of policies
• ex. american medical association, american association of retired persons, american hospital association, pharmaceutical research and manufacturers of america
• to overcome pluralistic interests and maximize policy outcomes, diverse interest groups form alliances with legislators

Question 30

impact of presidential leadership

Answer 30

• Lyndon B Johnson passed Medicare and Medicaid
• harry Truman passed the hill-burton hospital construction act
• Richard Nixon passes the federal support of health maintenance organizations in 1973 (HMO) and the enactment of the national health planning and resources development act of 1974 (CON)
• Barack Obama- ACA of 2010

Question 31

incrementalism

Answer 31

• there are multiple phases to the policy

- first phase might collect taxes for the next phase