Module 11 lecture, part 1 Flashcards
Public policies- definition and intention
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
Definition of health policy
The aggregate principles, stated or unstated, that characterize the distribution of resources, services, and political influences that impact on the health of the population
Characteristics of health policies
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
Uses of policy
Regulatory tools
Allocative tools
Regulatory tools and policy
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
Allocative tools
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
Principle features of US health policy
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
Gov’t and US health policy
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
Reason for fragmented policies
Federal, state, local gov’t policies with little coordination
The subsidiary role of gov’t with both private and public approaches to HC
Results of fragmented policies
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
What are the results of incremental and piecemeal policies? Examples?
The result of compromises involving the resolution of various competing interests
Examples: broadening of Medicaid, expansion of Medicare
Interest grps and US health policy
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
What are examples of interest grps?
AMA
AARP
American Hospital Association
Pharmaceutical Research and Manufacturers of America
Businesses
Consumers
Legislative branch and US health policy
The most active in policy making
In the form of statutes or laws
Executive branches and US health policy
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
Judicial branches and US health policy
Uphold, strike down, or modify existing laws by:
-Interpreting an ambiguous statute
Establishing judicial precedents
Interpreting the Constitution
States and US health policy
Decentralized role
Incremental policy actions by states
-State-initiated programs for vulnerable pops
-Policy initiatives to expand health insurance coverage
Forms of role of individual states in US health policy
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
Disadvantages of having states involved in US health policy
Difficult to coordinate a national strategy
Impact of presidential leadership in US health policy
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
What does the development of legislative health policy reflect?
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
Parts of the policy cycle
Issue raising
Policy design
Public support building
Legislative decision making and policy support building
Legislative decision making and policy implementation
Ways and Means Committee House
Medicare part A
Social Security
Unemployment compensation
Public welfare
HC reform
Energy and Commerce Committee House
Medicaid
Medicare part B
Matters of PH
Health personnel
HMOs
Foods and drugs
Consumer products safety
Health planning
Biomedical research
Health protection
Committee on Appropriations House
Responsible for funding substantive legislature provisions
Committee on Labor and Resources Senate
Jurisdiction over most health bills
Committee on Finance Senate
Jurisdiction over:
Taxes and revenues
Matters related to Social Security
Medicare
Medicaid
Maternal and child health
