Prof Quiz 4 hints, part 2 Flashcards
Uses of policy
Regulatory tools
Allocative tools
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
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
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
Role of research in policy development
Documentation: gathering, cataloging, correlating of facts
Analysis: feasibility, efficacy, practicality of an intervention
Prescription: research that shows a course of action
Demographic changes and effects and future change
Demographic changes: becoming bigger, older, and ethnically diverse
Effects on:
-The need for health care
-How the needs will be met
-The nation’s ability to afford HC: expanding gov’t programs on an unsustainable financial path
-Implications for supply of health professionals
Cultural factors will create ongoing challenges
Uninsured immigrants without documents tap into resources
Personal lifestyle choices cannot be fully incentivized
Political forces and future change
Policy intertwined with almost all aspects of HC delivery
-Education and immigration policies affect the number and qualifications of the HC workforce
-Effects on total economic spending and taxes
-Americans remain divided on major policy issues, including HC
Ecological forces and future change
Major implications for PH
-New dzs
-Natural disasters
-Bioterrorism
World pop growth
-Intensify human-animal-ecosystems interface
-Probability of engendering new dzs
Dealing with new ecological threats
-Will divert resources from routine HC
Concerns and challenges from MA plan
Concerns on cost and waiting time
In the Connector (exchange), premium increases surpass inflation; the state had to set limits on the rise in premiums
Some mixed results on ability to meet HC needs
ED use has continued to rise
Income tax hikes are proposed
Implementing community-oriented primary care
Primary care must take a central place in the delivery of health svcs
Biomedical model must be broadened to include a stronger element of social and behavioral sciences
Primary care should include primary, secondary, and tertiary prevention
PH functions must be strengthened as an adjunct to clinical interventions
Pt activation and SES
Considerable difference in activation levels across socioeconomic and health status characteristics
-Lowest among Medicaid enrollees
Training in geriatrics
Critical shortage and worse shortage expected in the future
Better outcomes by geriatric professionals without cost increases
Recommendations (IOM, 2008): residency training, better recruitment and retention, and financial incentives for specialists, better pay and benefits for direct care workers in geriatric settings
Six areas of concern in LTC
Financing: reform needed in both public and private financing
Resources
Infrastructure
Workforce: a deficit of direct care workers is projected
Regulation
Information tech: interoperable IT systems are needed
