CH.13- Notes

What are public policies intended to do?

to direct or influence the actions, behaviors or decisions of others

What does the fragmentation of the governments power in the US flow the design of?

- founding fathers checks and balances to limit the governments power -federal, state, and local governments pursue their own policies with little coordination of purpose or programs occuring

In the US, what have national health care programs been built on?

- has not been seen as a right of citizenship or as a primary responsibility of government -instead the private sector has played a dominant role (GOV as subsidiary to the private sector)

What does it mean when public refers to someone who is politically active?

-Americans who communicate directly with their representatives by writing/calling them, contributing money to politicians and political groups, attending protests or forums, or make their voices and policy preferences heard.

What are public policies?

-Authoritative decisions made in the legislative, executive or judicial branch of government intended to direct or influence the actions, behaviors or decisions of others

What are Certificate of need programs?

-CON - states seek to regulate capital expansion in their health care systems -states that maintain CON programs often target expansion of outpatient and long-term care facilities, which make up a growing segment of the health care market

What does QIO stand for and what is it?

-Federally funded quality improvement organizations -example of regulatory policies in the health care systems

What can the growth of medical technology be traced to ?

-health policies that directly support biomedical research and encourage investments in research -policies encourage that firms recoup their investments in research and development -private industry is the largest financier of biomedical research and development in the US

What is the scope of health policy limited to?

-limited by the political and economic system of a country

Why has the role in US health care of the US government grown incrementally?

-mainly to address perceived problems and negative health consequences for the underprivileged

Examples of redistributive policies

-Medicaid- takes tax revenue from the more affluent and spends it on the poor in the form of free health insurance -CHIP -welfare -public housing programs -expansion of health insurance for the uninsured (ACA)

How do health policies affect groups or classes of individuals?

-Such as physicians, the poor, the elderly, and children - can affect organizations such as medical schools, HMOs, hospitals, nursing homes, manufacturers of medical technology, and employers Ex: -listening of physicians and nurses by states - federal certification of health care institutions -local ordinances banning smoking in public places

What do health policies often emerge as?

-a by-product of social policies enacted by the government ex: Social security started as retirement income security for elderly but also contained an old age assistance program

What are redistributive policies?

-are designed to benefit only certain groups of people by taking money from one group and using for the benefits of another -

What was the basis for ACA?

-arguments have been made that health care should be a right in the US -ACA has deeply divided the nation

Why are certain policies driven by a strong desire to keep campaign promises or please power groups?

-because politicians primary concern may be getting elected or reelected

What are redistributive policies believed to be essential for addressing?

-believed to be essential for addressing the fundamental causes of health disparities

What are health policies?

-can be defined as the aggregate (combination) of principles, stated or unstated that characterize the distribution of resources, services, and political influences that impact on the health of the population

What has the subsidiary role of the government and the mixture of private and public approaches to the delivery of health care resulted in?

-complex and fragmented pattern of health care financing in which: 1) the employed are predominantly covered by voluntary insurance provided through contributions that they and their employers make 2) the elderly are insured through a combination of private- public financing of Medicare 3) the poorer covered by Medicaid through a combination of federal and state tax revenues 4) special population groups (Veterans, American Indians, armed forces, etc) have coverage provided directly by federal government

In the developed world, what have national health care programs been built on?

-consensus that health care is the right of citizenship and that government should play a leading role of the delivery of healthcare

What does policy-for-politics approach not consider?

-does not consider cost-benefit trade-offs -policies driven by political considerations are often near sighted

What does it mean when health policies are "self-regulated"?

-ex: some physicians set standards of medical practice -ex: hospitals accredit one another as meeting the standards that the Joint Commission has set -ex: schools of public health decide which courses should be part of their graduate programs in public health -ex: MCOs (managed care organizations) voluntarily collect and report on quality measures

What has government spending for health care been largely confined to?

-filling the gaps in areas where the private sector has been unwilling or unable to address certain issues

What are allocative policies?

-health policies can be used as allocative tools -they involve the direct provision (the action of providing or supplying something for use) of income, services, or goods to certain groups of individuals or institutions -may be distributive or redistributive

Even though the US functions under imperfect market conditions, what are problems and issues in health care often blamed on?

-often blamed on the market -which prompts politicians to further regulate health care through policy interventions ex: cost escalations in the health care delivery system were assumed to reflect on the inability of private parties to control health care costs, which paved the way for various prospective payment methods (

Who is the most likely to be politically active?

-people who are older and more years of education -usually have a stronger party identification

What are statues or laws also considered?

-policies

What type of policies do politicians tend to lean toward supporting?

-policies that agree with with their own ideologies or advance their own political agendas -most policy makers are also politicians -policy making and politics are closely intertwined

What was the danger with with policy making and politics?

-policy making often becomes highly politicized and is held hostage to the ideologies of the political party that happens to be in power at a given time -the party in power exerts peer pressure on its own members to support policies along party lines

What are the features the characterize US health policy?

-position of the government as subsidiary to the private sector -fragmented, incremental, and piecemeal reform -pluralistic politics associated with demanders and suppliers of policy a decentralized role for the states -impact of presidential leadership

At the general level, what does "public" refer to?

-refers to all Americans -public can also refer to voters to likely voters in political elections -public can also refer to only those who're politically active

How are state insurance departments across the country an example of regulatory policies?

-regulate insurance companies and managed care organizations in an effort to protect customers from default on coverage in case of financial failure of the insurer, excessive premiums, and mendacious (untruthful) practices

What type of tool my policies be used as?

-regulatory tools -allocative tools

What are some of the most visible policy efforts?

-social programs created under the Social Security Act (later created medicare and medicaid), CHIP, and the Affordable care Act (ACA)

What are distributive policies?

-spread benefits throughout society -typical distributive policies include funding of medical research through the National Institutes of Health (NIH) -the development of medical personnel (medical education) -the construction of facilities -initiation of new institutions (ex: health maintenance organizations= HMOs)

Who are public policies supposed to serve?

-supposed to serve the interests of the public, but public can be interpreted in many different ways

What have certain policy interventions indirectly caused?

-the growth of health care expenditures

What is private sector?

-the part of the national economy that is not under direct government control.

How are health policies are regulatory tools?

-they call on government to prescribe and control the behavior of a particular target group by monitoring the group and imposing sanctions of it fails to comply

What 2 types of allocative policies are there?

-they may be distributive or redistributive

What do redistributive policies (allocative policies) often create?

-this system often creates visible beneficiaries and payers -for this reason, health policy is often most visible and politically charges when it performs redistributive functions

When do public policies become health policies?

-when public policies pertain to or influence the pursuit of health, they become health policies

What does CHIP stand for?

Children's Health Insurance Program

Examples of regulatory policies in the health care system: QIOs

Ex: Federally funded quality improvement organizations (QIOs, formally called peer review organizations) develop and enforce standards concerning appropriate care under the Medicare program

What are statues?

laws