Module 11 lecture, part 1

Question 1

Public policies- definition and intention

Answer 1

Authoritative decisions made in the legislative, executive, or judicial branches of gov’t
Intended to direct or influence the actions, behaviors, or decisions of others

Question 2

Definition of health policy

Answer 2

The aggregate principles, stated or unstated, that characterize the distribution of resources, services, and political influences that impact on the health of the population

Question 3

Characteristics of health policies

Answer 3

Often a by-product of public social policies
Pertains to HC at all levels, including policies affecting the production, provision, and financing of HC svcs
Affect grps of individuals and orgs
Limited by the political and economic system
Influenced by anthro-cultural values of society

Question 4

Uses of policy

Answer 4

Regulatory tools
Allocative tools

Question 5

Regulatory tools and policy

Answer 5

Call on gov’t to prescribe and control the behavior of a particular target grp by monitoring the grp and imposing sanctions if it fails to comply

Question 6

Allocative tools

Answer 6

Distributive policies: spread benefits throughout society
-Funding of medical research through NIH
-The development of medical personnel
-The construction of facilities
-The initiation of new institutions
Redistributive policies
-Benefit certain grps (the poor) by taking money from another grp (the affluent)
-Medicaid, CHIP, welfare, public housing program, coverage of the uninsured under the ACA

Question 7

Principle features of US health policy

Answer 7

Gov’t as the subsidiary to the private sector
Fragmented
Incremental and piecemeal policies
Pluralistic politics associated with demanders and suppliers of policy
The decentralized role of states
The impact of presidential leadership

Question 8

Gov’t and US health policy

Answer 8

Gov’t as the subsidiary to the private sector
To fill the gaps left by the private sector
-Institutional care of mentally and chronically ill
-Medical care for the indigent
-Care of special grps
-Support for research and training
-PH measures
Americans’ opposition to major gov’t interventions in HC except for helping the underprivileged

Question 9

Reason for fragmented policies

Answer 9

Federal, state, local gov’t policies with little coordination
The subsidiary role of gov’t with both private and public approaches to HC

Question 10

Results of fragmented policies

Answer 10

The employed: predominantly covered by voluntary insurance that they and their employers make
The aged: insured through a combination of private-public financing of Medicare
The poor: covered through Medicare via federal and state tax revenues
Special pop grps: coverage that the federal gov’t provides directly

Question 11

What are the results of incremental and piecemeal policies? Examples?

Answer 11

The result of compromises involving the resolution of various competing interests
Examples: broadening of Medicaid, expansion of Medicare

Question 12

Interest grps and US health policy

Answer 12

Interest grps as demanders of policy
The result of compromises involving the resolution of various competing interests
Well-organized interest grps: the most effective “demanders” of policies
Interest grps’ alliances with legislators to overcome pluralistic interests and maximize policy outcomes

Question 13

What are examples of interest grps?

Answer 13

AMA
AARP
American Hospital Association
Pharmaceutical Research and Manufacturers of America
Businesses
Consumers

Question 14

Legislative branch and US health policy

Answer 14

The most active in policy making
In the form of statutes or laws

Question 15

Executive branches and US health policy

Answer 15

Presidents, governors, and other PH officials propose policies
Intermediary suppliers of policies
Executives and administrators make policies in the form of rules and regs used to implement statutes and programs

Question 16

Judicial branches and US health policy

Answer 16

Uphold, strike down, or modify existing laws by:
-Interpreting an ambiguous statute
Establishing judicial precedents
Interpreting the Constitution

Question 17

States and US health policy

Answer 17

Decentralized role
Incremental policy actions by states
-State-initiated programs for vulnerable pops
-Policy initiatives to expand health insurance coverage

Question 18

Forms of role of individual states in US health policy

Answer 18

Curtailing the influence of managed care
Financial support for the care and tx of the poor and chronically disabled
Quality assurance and oversight of HC practitioners and facilities
Regulation of HC costs and insurance carriers
Health personnel training
Authorization of local gov’t health svcs

Question 19

Disadvantages of having states involved in US health policy

Answer 19

Difficult to coordinate a national strategy

Question 20

Impact of presidential leadership in US health policy

Answer 20

Harry Truman’s Hill-Burton Hospital Construction Act of 1946
LBJ’s Medicare and Medicaid of 1965
Nixon’s HMO Act of 1973 and the National Health Planning and Resources Development Act of 1974 (CON legislation)
Raegan’s authorization of the PPS method of payment in 1983
Bill Clinton’s CHIP and HIPAA of 1996
W. Bush’s Medicare part D in 2003
Obama’s ACA in 2010

Question 21

What does the development of legislative health policy reflect?

Answer 21

The relationship of the gov’t to the private sector
The distribution of authority and responsibility within a federal system of gov’t
The relationship between policy formulation and implementation
A pluralistic ideology as the basis of politics
Incrementalism as the strategy for reform

Question 22

Parts of the policy cycle

Answer 22

Issue raising
Policy design
Public support building
Legislative decision making and policy support building
Legislative decision making and policy implementation

Question 23

Ways and Means Committee House

Answer 23

Medicare part A
Social Security
Unemployment compensation
Public welfare
HC reform

Question 24

Energy and Commerce Committee House

Answer 24

Medicaid
Medicare part B
Matters of PH
Health personnel
HMOs
Foods and drugs
Consumer products safety
Health planning
Biomedical research
Health protection

Question 25

Committee on Appropriations House

Answer 25

Responsible for funding substantive legislature provisions

Question 26

Committee on Labor and Resources Senate

Answer 26

Jurisdiction over most health bills

Question 27

Committee on Finance Senate

Answer 27

Jurisdiction over:
Taxes and revenues
Matters related to Social Security
Medicare
Medicaid
Maternal and child health