Policy 1 Flashcards
Define key terms related to health policy
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Appreciate the influence of health determinants
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Understand the frameowrk of health policy formulation
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Identify the stakeholders in health policy.
lots of them
Describe the major types of health policies
regulatory, allocative (distributive, redistributive)
Discuss the imporotance of studying health policy
Understanding how health policy is developed is the first step toward influencing policy. Also, policy is an integral part of framework of health determinants.
Describe Bardach’s eightfold path
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Discuss application of the model to policymaking using Oklahoma and national examples
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Understand the US policymaking process at the federal level
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Discuss the policy formulation stage
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Provide examples of the types ofhealth and health care policies developed.
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Understand the policy implementation stage
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Analyze the characteristics of health policymaking in the US
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appreciate the role of interest groups in US health policymaking
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Describe the features of the US state-level policymaking process and political system and provide examples of state health care legislation.
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Discuss features of the US local government policymaking process and local political system and provide examples of local health care legislation.
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Address the health policy-related activities of private health research institutes and foundations
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Understand the implications for the US health care system of policies created and practices followed by private industry
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Appreciate the attributes of health policy development at the US state and local levels and in the private sector.
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Provide examples of health policymaking at the international level.
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Describe the functions and policy-related activities of the World Health Organization.
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Become familiar with health related policymaking in Canada, Sweden, and China.
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Describe how health care is financed and delivered in the US.
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Provide examples of and discuss health policy issues related to financing and delivery.
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Define vulnerable populations
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Identify policy issues for racial and ethnic minorities
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Describe policy issues for those with low income.
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Highlight policy issues for the uninsured.
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Discuss policy issues for vulnerable subpopulations, such as the elderly, chronically ill, mentally ill, women and children, the disabled, the homeless, and people with HIV/AIDS.
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Why did Obama’s health care reform bill pass and Clinton’s did not?
In the 90s, insurance companies along with medical interests had more power and there was a lot of anti-tax rhetoric.
What is gross domestic product?
refers to value of all goods and services produced within a country for a given period; a key indicator of the country’s economic activity and financial well being.
How does WHO define helath?
not merely the absence of disease or infirmity but a state of complete physical, mental and social well-being.
What is the major problem that public health faces?
balancing public health with personal liberty.
List of words that you need to know: life expectancy mortality morbidity disability quality-adjusted life years
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What is the most common measure of physical health?
life expectancy.
What is the quality-adjusted life year?
a combined mortality-morbidity index that reflects years of life free of disability and symptoms of illness
What is the history of health care reform in the US?
- Old age assistance program as part of 1935 social security act
- medicare program - 1965
- SCHIP - 1997 Balanced Budget Act
- ACA of 2010
Waht is the most comon measure of social well-being?
SES
What factors do you consider when looking at SES?
education level, income, occupation. You also look at social contacts and social resources.
What are social contact?
the frequency of social activities that a person undertakes within a specified period.
What are social resources?
interpersonal relationships with social contacts and the extent to which the individual can rely on them for support.
What are some morbidity measures?
incidence and prevalence of disease
What are some mortality measures?
crude death rate, age specific death rate, condition specific death rate, infant mortality, maternal mortality
What are some disability measures?
restricted activity days, limitation in performing ADLs, limitations in performing IADLs
What is the difference between activities of daily living and instrumental activities of daily living?
adls - bathing, dressing, toileting, continence, eating
iadls - doing housework, chores, grocery shopping, cooking, travling, taking medicine
What is the definition of public health?
science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of individual in principles of personal hygiene, the organization of medical and nursing service for the early diagnosis and preventive treatment of diseae, and the development of social machinery which will ensure to every individual in the community a standard of living adquate for the maintenance of health.
What are some direct benefits of public health?
healthier children, less chronic disease, less need for acute care
What are some indirect benefits of public health?
fewer days missed from school and work, increased funding available for other initiatives
What are determinants of health?
factors that influence one’s health status. SES, environmenta, behaviors, heredity, and access to medical care.
How does the dahlgren and whitehead model look at determinants of health?
there are fixed factors - unchangeable, such as age, sex, and genetic makeup
there are also modifiable factors - such as lifestyle choices, social netowkrs and community conditions, environment, access to goods and services
What is the Ansari model of public health and determinants of health?
- social determinants
- health care system attributes
- disease-inducing behaviors
- health outcomes.
What are the three dominants theories on causes of disease?
- germ theory - every disease has a specific cuase which should be identifable leading to a cure. (epidemiologic triangle of agent, host, environment)
- lifestyle theory - isolates specific behaviors as cause of diseases
- environmental theory - health is understood by examining the larger context of community.
How does the environment influence health?
policy, community, family.
there is both a physical dimension to environment and a social dimension.
What are some individual characteistics related to health?
demographics - age, gender, race, ethnicity
behaviors - epidemiologic transition. The level of behavioral risk factors is related to SES.
What are the three categories of behavioral risk factors?
- leisure activity risks - they have the most control
- consumption risks
- employment participation and occupational risks - they have least control over this.
What are the 4 ways in which medical differs from regular commodities?
- demand for medical care is derived from the demand for health itself
- agency relationship - physicians make decisions on behalf of health care consumers
- health care prices vary according to who pays the fees
- medical care service provision is influenced by the environment in which it takes place, whereas commoddities are not.
What is a policy?
decision made by an authority about an action to promote or limit the occurrence of a particular circumstance in a population.
What is health policy?
aggregate of principles, stated or unstated, that characterizethe distribution of resources, services, and political influences that impact on the health of the population. Policy that pertains to or limits the attainment of health.
What is health care policy
part of health policy with a focus on health care. Related to financing, delivery, and governance of health services for the populations or subpopulations within a jurisdiction.
What is the goal of health policy?
improve population health
What is the goal of health care policy?
provide equitable and efficient access to and quality of needed health care services
What are teh two types of health policies?
regulatory and allocative.
What are regulatory policies?
regulations or rules that impose restrictions and are intended to control the behavior of a target group by monitoring the group and imposing sanctions if it fails to comply.
What are some examples of regulatory policies?
porhibition of smoking in public places, licensure requirements for medical professions, processes related to the approval of new drugs, accreditation by joint commission (private)
What are allocative health policies?
Involve the direct provision of income, services, or good to certain groups of individuals or instititutions.
What are the two types of allocative health policies?
distributive - spread benefits through society targetng population, usually entitlements
redistributive - takemoney or power from one group and give it to another
What are examples of distributive health policies?
funding of medical research through NIH, provision of public health and health promotion services, training of medical personnel.
What are examples of redistributive health policies?
medicaid, public housing
What is the framework for health determinants policy?
politicl system, health policy, sociocultural norms, health problems
What is the framework for health determinants?
environment, ehalth status, medical care, individual characteristics
What are some factors that we look at when considering which health problems to make policies about?
magnitude and severity (urgency)
Why do we consider sociocultural norms when we make health determinants policy?
public perception is important.
What are the narrow determinants of health policy?
- solutions - potential solutions facilitiate policy developemnt
- stakeholders - their influence is important
- leadership - they need leadership
- resources - they need financial and administrative resources.
Who are some stakeholders that we need to think about in health policy?
- interest groups - collection of individuals or entities that hold a common set of preference on particulat health issue and often seek to influence policymaking or public opinion
- consumers and patients - suffer health problems and policy affects them
- health care providers
- health care organizations
- payers and insurers - HMOs, PPOs, medicare, medicaid.
- regulators
- medical device and pharmaceutical manufacturers - with regards to payment of their products
- educational and research institutions -
- businesses and corporations
What is an HMO?
a managed care organization that focuses on wellness care and requires use of specified panel of providers
What is a PPO?
a managed care organization that offers unrestricted provider options to enrollees and discountered fee arrangements to providers
What are the responsibilities of health care administrators?
plan, coordinate, supervise, develop and implement standards, operating procedures, and organizational policies.
What level of policymaking has the most profound impact on care delivery?
federal level
What level of policymaking has the most profound impact on care delivery?
federal level
What are the powers of congress?
- power to use any reasonable means not prohibited by the constitution to carry out the will of the people
- power to tax - allows regulation indireclty
- power to spend - allocates funding.
What are the powers of congress?
- power to use any reasonable means not prohibited by the constitution to carry out the will of the people
- power to tax - allows regulation indireclty
- power to spend - allocates funding.
How does the executive branch participate in policymaking?
crafts legislation to try to make legislatures push it through. Also make up rules and regulations in agencies.
How does the executive branch participate in policymaking?
crafts legislation to try to make legislatures push it through. Also make up rules and regulations in agencies.
What are the three major stages of policymaking?
- policy formulation
- policy implementation
- policy modification
They are consecutive but also interactive and reinforcing.
What are the three major stages of policymaking?
- policy formulation
- policy implementation
- policy modification
They are consecutive but also interactive and reinforcing.
What are the two main components of the policy formulation stage?
agenda setting
legislation development
What are the two main components of the policy formulation stage?
agenda setting
legislation development
What are the two main components of the policy implementation stage?
rulemaking
operation
What are the two main components of the policy implementation stage?
rulemaking
operation
what are the two main components of policy modification stage?
feedback
policy analysis
what are the two main components of policy modification stage?
feedback
policy analysis
What is agenda setting and what part of policymaking doe sit fall under?
refers to ability to influence the priorities of issues for policy consideration. Need to figure out what issue you want to target.
Look at : impact of health problem public opinion presidential involvement and policy positions legislator interest media coverage
What is agenda setting and what part of policymaking doe sit fall under?
refers to ability to influence the priorities of issues for policy consideration. Need to figure out what issue you want to target.
Look at : impact of health problem public opinion presidential involvement and policy positions legislator interest media coverage
What are the steps of federal legislative development?
- bill introduced and assigned to a congressionalcommittee.
- committee sends it to all appropriate people
- committee determines to accept, reject, or modify it.
- bill passed in congress
- bill presented to president
- president signs bill into law.
What are the steps of federal legislative development?
- bill introduced and assigned to a congressionalcommittee.
- committee sends it to all appropriate people
- committee determines to accept, reject, or modify it.
- bill passed in congress
- bill presented to president
- president signs bill into law.
What is one problemw ith House and Senate committees?
there is fragmentation because there are so many of them.
What is one problemw ith House and Senate committees?
there is fragmentation because there are so many of them.
Which Committee oversees public programs?
Committee on Ways and Means - excpet medicaid
Which Committee oversees public programs?
Committee on Ways and Means - excpet medicaid
What are two levels of local government?
county, municipal
What happens to a health law after it is passed?
usually sent to department of health and human services to make rules and regulations.
What is rulemaking?
process by which implementation agencies set detailed rules and regulations for the application of laws. there has to have procedural due process for this too.
What is rulemaking?
process by which implementation agencies set detailed rules and regulations for the application of laws. there has to have procedural due process for this too.
How do you carry out the rules in an efficient and effective manner?
this is about operation. Must meet economic constraints. Need to know all factors which may affect what you are trying to do.
How do you carry out the rules in an efficient and effective manner?
this is about operation. Must meet economic constraints. Need to know all factors which may affect what you are trying to do.
What is policy modifications?
revisions to the rules or regulations pertaining to a piece of original legislation to enhance its benefits to the targeted population, reduce its negative consequences, refine its policy objectives, or address other issues related to the policy.
What is policy modifications?
revisions to the rules or regulations pertaining to a piece of original legislation to enhance its benefits to the targeted population, reduce its negative consequences, refine its policy objectives, or address other issues related to the policy.
Why would you modify policy?
- change in logic model
- consequences of implementations
- policy analysis and evaluation
- resource constraints
- changing goals
- interest group involvement
- oversight - activities to review, monitor, or supervise the process of formulating, implementing, and modiffying public policy.
Why would you modify policy?
- change in logic model
- consequences of implementations
- policy analysis and evaluation
- resource constraints
- changing goals
- interest group involvement
- oversight - activities to review, monitor, or supervise the process of formulating, implementing, and modiffying public policy.
What is the office of management and budget?
largest components of executive office, implements and enforces the commitments and priorities of the president and assists executive departments and agencies from across the federal government.
What is the office of management and budget?
largest components of executive office, implements and enforces the commitments and priorities of the president and assists executive departments and agencies from across the federal government.
What are some attributes of health policymaking in the US?
- gov in subordinate role to private sector
- fragmented gov and programs
- incremental approach to reform
- importance of congressional support
What are some attributes of health policymaking in the US?
- gov in subordinate role to private sector
- fragmented gov and programs
- incremental approach to reform
- importance of congressional support
What are some groups of people who are covered by the government directly (health insurance)?
veterans, Indians, members of armed forces, congress, executive branch of gov.
What are some groups of people who are covered by the government directly (health insurance)?
veterans, Indians, members of armed forces, congress, executive branch of gov.
What is a republic?
a type of democratic government in which the head of state is not a monarch. Govrnmental activities and affairs are open to all interested citizens.
What happens to a bill in the state level?
the bill is read three times before beign voted on by elected representatives.
What are some examples of states’ responsibilties through health policy?
major payer of health care services through medicaid
fund CHIP
regulate state’s health care system
establish and monitor compliance with quality standards for environmental protection
provide safety net facilities through support of local health departments and community based healthcare organizations and through programs that provide charity care to low-income populations
provide subsidies for graduate medical educations and support lar-ge scale educational campaigns
What are two levels of local government?
county, municipal
How does local policymaking differ from state policymaking/
only one chamber. proposals for new laws are written into resolutions (referalls, ordinances, bills). They are brought to the local governing body. Once voted on and then signed by mayor, they are called bylaws, local laws, or ordinances
What are some examples of local healthy policy?
regulation of tobacco products and smoking in public environments.
What is the RAND corporation?
conducts research and analys to improve and inform policymaking in health, education, national security. Do research on a lot of things including high deductible plans. Found that health care costs increased for both those with high ductible plans and those with traditional plans. It is a private health research instititue.
What is an example of a private health foundation?
pew charitable trusts
What does the pew charitable trusts do?
conduct research and public policy work to address the challenges facing the US and global community. Conducts public opinion polls to study trends in specific issues relevant to Americans. The y support resarch in four policy areas:
- consumer product safety
- emerging science
- food and health
- medical safety
What are the major characteristics of health policy development in nonfederal sectors?
- constraints imposed by borader policy landscape (preemption)
- relationship between politics and policy
- level of PH funding
- private sector shapes policy direction
- polcy entrepreneurship at grassroots level
- lack of integratio and coordination among groups
What is the relationship between politics and policy?
legislation is more likely to pass if the same political parties control each of the bodies that work on legislation. The election cycle affects this. If the timing is not right, policy will not go through.
What is a policy entrepreneur?
public innovator who from outside the formal positions of gov, introduces, translates, and implements new ideas into public practice.
Tell me about China’s health care reform system?
Did not think that a market oriented approach would work. Gov made the health reform coordination group which conducted research for more than a year. Drafted a report which had several revisions. Then they consulted the public. At the same time, local projects were underway. Adopted ten amendments based on what the public said. 2009 - introdued the formal policy.
Who makes up WHO?
World health assembly, assembly’s executive board, and WHO’s secretariat.
What are the 6 core functions of the WHO?
- act as leader and partner on health issues worldwid3
- set resarch priorities and encourage sharing of health related knowledge
- establish standards of practice andsupport and monitor their adoption
- advance policy options founded on ethical and EBM
- lend technical support to health initiatives and contribute to capacity building
- monitor health issues around the world and identify patterns and trends
How is a policy made in WHO?
- submitted by assembly member
- referred to committee
- adoption by vote in the world health assembly.
- who secretariat oversees program design and logisitcs for implementation
What are some criticisms of the WHO?
no standard way to measure the severity of outbreak, not always transparent, difficultly distributing vaccines in devloping countries.
Tell me about the Canadian health policy system.
parliamentary democracy, queen of England is Canada’s head of state. House of Commons. Senate put together by prime minister. have opposition party. 11% GDP on health care. It is administered by provicial and territorial govs and is taxpayer funded (canada health transfer) Each province and territory must meet standards to receive full amount of federal funding (Canada health act). Physicians are working private but bill the public insurance on a fee for service basis. Stakeholders are health canada, the gov, the federal health department, the provincial govs, physicians and nurses, industry and trade groups, canadian public. Conservatives in favor of more privatization. Focused on health of elderly and access to health care in rural and remote areas.
Tell me about policymaking in Sweden.
It is a constitutional monarchy and parliamentary democracy. When new law proposed, going to committee to see if it is feasible, then given to relevant agencie.s Then goes to parliament (Riksdag), then a vote. Health care funded through county council income tax paid by individuals.There is a small fee for service. County council pays the rest of the cost. There is a cap on out of pocket expenses. Gov responsible for health care regulation but not delivery. Get care from PCP who refers then to specialist. Revolves around counties and municipalities delivering care.
Tell me about the health policymaking system of China.
China is under single party socialist sytem of gov through communitst party of china and national people’s congress. Most leaders are appointed throughout china except the national legislature. Law governing health care are the fundamental health law and hygienic common law. Reform in 2009 to cover more rural. Care given through local health clinics and small hospitals. specialized care at larger hospitals. Must go through the small ones first like a gatekeeper.
What percentage of medical expenditures do private health insurance companies cover?
33%
What type of private health insurance is the most common?
managed care.
What is managed care?
a car model characterized by a designated provider network, standardized review and quaity improvemnt measures, an emphasis on preventive rather than acute care, and financial incentives for doctors and patients to reduce unnecessary medical care use.
What percentage of medical expenditures are from public health insurance?
52% this is medicare and medicaid.
How were medicaid and medicare created?
in 1965 witht he social security amendments of 1965. Administered by CMS.
Who is eligible for medicare?
- > 65 o
- disabilities who are entitled for social security benefits
- ESRD
What are the parts of Medicare?
A - health care services received in hospitals, nursing facilities, hospice care, home health care (no premium). this is from mandatory payroll taxes
b - monthly premium, physicians’ services and outpatient care. Many fo the screening tests
C - optional, private plan that contracts with medicare and provides all part A and part B services.
D - coverage for prescription drugs
TEll me about Medicaid?
low-income elderly and nonelderly individuals and also womena nd children and low income disabilities. It is a joint federal-state program. State sets own eligibility criteria and covered services.
What is CHIP?
children’s health insurance program. For children in uninsured families whose income is <200% of FPL.
What are the 5 most common PH programs?
- prepareness
- vital statistics
- tobacco prevention and control
- public health laboratories
- WIC
What is long term care?
care provided in nursing homes, skilled nursing, specialized care facilities, hospice agencies, home health care and adult foster care.
Who pays most nursing home services?
medicare. Medicare part A covers a very limited portion of these.
What are some key features of long term care?1
- individualized, coordinated services
- maximized functional independence
- holistic approach, quality of life
What are safety net providers?
providers that by mandate or mission organize and deliver a significant level of health care and other health related services to the uninsured, medicaid, and other vulnerable patients.
What is unique about financing of health care compared to other goods?
it is a good investment for primary care but the more specialized care that you get (the sicker you are) doesn’t proportionately improve health status.
How do we regulate cost containment in health care?
- control of supply
- price
- utilization.
What are two examples of how regulation has helped contain health expenditures/
- health planning - certifate of need
2. price controls - pay for performace
What are some special issues with the health care workforce?
not enough providers, especially nurses and rural health professionals.
What are the conditions of participation?
accreditation by medicare and medicaid. health and safety standards defined by cms as the minimum requirements that hospitals and medical centers must meet to be eligible to serve publicly insured patients.
Tell me about antitrust.
this is anticompetition activites that ead to higher health care costs. they want to stop them. This includes mergers, acquisitions, price fixing, boycott agreements, pay for delay drug patent settlements
What are the aims of informed consent?
- respect and promote the autonomy of patients and research participants
- protect patients and research participants from potential harm
What are the components of informed consent:
- prerequisitites - compenetence and voluntariness
- clear and truthful information
- free and voluntary enrollment
How does HIPAA help protect patients?
- prohibits insurers from discriminating against their subscribers
- allows certain individuals to enroll in group or indivisiaul health plans following the loss of their employment based coverage
- mandated development of personal health records.
What is EMTALA?
eliminate discriminatory practices by providers to increase access to health care for indigent and uninsured. Medical screening exam, stabilization and further care or transfer as needed regardless of ability to pay.
What is a federally qualified health center?
low income and minority care. facilitiate and coordinate care.
What is vulnerability?
convergence of health risks that can be physiical, mental, or social. Health risks consist of predisposing, enabling, and need characteristics at the individual and ecological levels.
What are some predisposing health risk characteristics?
demographic characteristics, social structure variables, health beliefs
What are some enabling characteristics for health risk?
resources avail to individuals and families for the use of services, attributes ofthe surrounding community or region that affect the availability of healthcare services
What are some need factors that contribute to health risk characteristics?
the specific illnesses or health needs that drive the receipt of healthcare.
What measure can help us assess an individual’s access to care?
regular source of care.
What effect does having a regular source of care have?
increases chances of receiving better coordinated care, better treatment for chronic and acute health conditions, fewer delays in care, and access to preventive care. You are less likely to have this if you are a minority even when other factors controlled. Hispanics are least likely.
what are some factors that contribute to lack of regular source of care?
- absence of health insurance coverage
- low family income
- language other than english spoken in the home
What are culturally appropriate services?
efforts by health care organizations and providers to increase understanding and produce effective interventions for patients by taking into account patients’ cultural and linguistic characteristics.
What are some things that minorities have in the disparities?
health care access
health care quality
health status
What are some programs that eliminate racial and ethnic disparities
- federal initiatives - office of minority health and individan health services - funding, collecitng data, promotoes minority health policy in congress
- state and local - state programs are models for federal initiatives
- private initiatives - ASPH
What are some problems that the uninsured encounter?
- health care access = delayed care, ED use
2. health care quality - less preventive care
What are some programs to hep eliminate disparities in health insurance?
- federal - ACA, medicare, medicaid, chip
2. state and private - medicaid, chip, insure oklahoma
What are some barriers that people with low SES encounter?
- health care access - greater impact than race or ethnicity
- health care quality - less preventive care, less utilization, worse physician perception.
- health status - high health risks, poor health status, high mortality rates, more mental health issues
What are some programs to eliminate socioeconomic disparities?
federal initiatives - health care safety net, public housing primary care program, health care for the homeless, head start
- state and loca - volunteer state programs, universities
- private - project health design
What are some of the vulnterable subpopulations?
- elderly
- chronically ill
- mentally ill
- women and children
- the disabled
- the homeless
- people with HIV/AIDS
What are the main concerns about health policy that revolve around the elderly?
- containing costs
- reforming health system to better serve a new, large generation of elderly
- increasing quality of life as far as possible into old age.
What are the most proactive ways to raise the quality of life for the elderly?
- provide effective and low cost preventive treatments designed to lower risk factors for future adverse health outcomes
- provide such treatments throughout the patient’s flie
What is the 8fold path to policy analysis?
- define the problem
- assemble some evidence
- construct the alternatives
- select the criteria
- project the outocomes
- confront the trade-offs
- decide
- tell your story
