Health Policy (Two Types)
Public Policy and Health Policy
Public Policy
- authoritative decisions made in the legislative, executive, or judicial branch of government (supplier of policy)
- supposed to serve the interest of the public
Health Policy
-characterize the distribution of resources, services, and political influences
-and the impact on the health of the population
Health policies can be made through the
private sector or the public policymaking process
Health policies
a by-product of
public social policies enacted by
tools of Policy
Regulatory Tools and Allocative Tools
Regulatory Tools
- calls on government to prescribe and control the behavior of a particular target group by monitoring the group and imposing sanctions if it fails to comply
Allocative Tools
The direct provision of income, services, or goods to certain groups of individuals or institutions
- Distributive Policies
- Redistributive Policies
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
takes money or power from one group and gives it to another
Principal Features of U.S. Health Policy
-Fragmented
-Incremental
-Piecemeal reform
-Pluralistic (interest group)
-The decentralized role of the states
-The impact of presidential leadership
-Policy intervention begins with identifying what markets fail or do not function well
Most cited problems associated with government involvement in health care
Bureaucratic inflexibility
Excessive regulation
Red tape
Irrational paperwork
Arbitrary and conflicting public directives
Inconsistent enforcement of rules and regulations
Escalating costsFraud and abuse
Inadequate reimbursement schedules
Arbitrary denial
fragmented
The employed are predominantly covered by voluntary insurance that they and their employers make
The aged are insured through a combination of coverage financed out of Medicare Part A and Medicare Part B
The poor are covered through Medicaid via federal,
The policy community has included
Legislative committees
Executive branch
Private interest groups
first two supply policies demanded by the third
To overcome pluralistic interests and maximize policy outcomes,
diverse interest groups form alliances with legislators
who are the most effective demanders of policy
Well-organized interest groups
Decentralized Role of the States
-Financial support for the care and treatment of the poor and chronically disabled
-Quality assurance and oversight of health care practitioners and facilities
-Regulation of health care costs and insurance carriers
-Health personnel training
-Authorizati
Lyndon B. Johnson
passed Medicare and Medicaid
Harry Truman
Hill-Burton Hospital Construction Act
Richard Nixon
Federal support of health maintenance organizations in 1973
The enactment of the National Health Planning and Resources Development Act
Insurance risk pool",
24 state governments
helps people acquire private insurance
incrementalism (think treaty)
Small policy changes that reflect a compromise amongst different groups' demands
Disadvantage of Decentralized Role of the States
makes it difficult to coordinate a national strategy in many areas
The Development of Legislative Health Policy (5 factors)
involves private and public sectors; it reflects:
1. The relationship of the government to the private sector
2. The distribution of authority and responsibility within a federal system of government
3. The relationship between policy formulation and impl
Policy Cycle (5 compononents)
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
Congress has three important powers that make it extremely influential in the health policy process:
policy process:
The power to "make all laws which shall be necessary and proper for carrying into execution"
The power to tax
The power to spend
Policy Design
presidents have substantial resources to develop new policy proposals
(they call on segments of the executive branch of government and policy staffs within the Department of Health and Human Services)
House Committees
- Ways and Means Committee
- Energy and Commerce
- Committee on Appropriations
Ways and Means Committee
has sole jurisdiction over Medicare Part A, Social Security, unemployment compensation, public welfare, and health care reform
Energy and Commerce
has jurisdiction over Medicaid, Medicare Part B, matters of public health, mental health, health personnel, HMO's, foods and drugs, air pollution, consumer products safety, health planning, biomedical research, and heath protection
Committee on Appropriations
responsible for funding substantive legislature provisions
Senate Committees
- Committee on Labor and Human Resources
- Committee on Finance
Committee on Labor and Human Resources
has jurisdiction over most health bills
Committee on Finance
has jurisdiction over taxes and revenues, matters related to Social Security, Medicare, Medicaid, and Maternal and Child Health
Access to Care
- All citizens have a right to the same level of care
- All citizens have a right to the same minimum level of care
areas for quality improvement
Timeliness, Safety, Patient-centeredness
Public Financing (think medicare)
Policies that have been enacted to provide access to health care for specific groups otherwise unable to pay for and receive care
(ex: Medicaid)
Kerr-Mills program (1960)
Provision of federal grants to state government programs assisting the elderly
The National Health Planning and Resources Development Act of 1974:
the transition from improvement of access to cost containment
the principal theme in federal health policy.
The AHRQ established funding for patient outcomes research teams (PORTs)
focuses on particular medical conditions
It's the medical treatment effectiveness program that consists of four elements:
medical treatment effectiveness research,
development of databases for such research,
development of clinical guidelines and
the diss
Block grants
consolidates funds from different categorical programs into one lump sum
distributed to the states on a formula basis
became a key vehicle to achieve all three goals
Mental Health Benefits
Employers offer lower treatment benefits
Possible federal law requiring equal treatment
been charged with the responsibilities for regulating most of the ACA's provisions.
DHHS IRS