Health Policy

background to healthcare reform

- 20% of americans were uninsured (est. 45 million) - without insurance people don't get preventive care, don't manage chronic conditions, etc. - use the ER instead of PCP, more hospitalizations, more likely to die ------ costly in terms of dollars and human cost

political advocacy

- As a result of nursing's contract with the public to advocate for the care of individuals, families, communities, and populations - Because we understand that social and economic issues affect the health of persons and communities - Public policy, laws, can address solutions to health problems on a larger scale - As citizens we have the constitutional right to petition the government by contacting our elected officials and expressing views on policy

reform issues

- access (expanding access to helath insurance coverage) - preventive care (improved preventative care for chronic disease and care coordination; more reward for disease prevention and early intervention; more money for public health) - centralized decision making (maximizing quality through best practices, cost effectiveness, research of drugs and procedures. Focus on pay for performance based on outcomes and results, not numbers of services performed)

dynamic tension exists with:

- access to health care - health care cost - health care quality changing one of these variables can improve or lessen the effectiveness of another

Health Policy Major attributes

- authorized governmental institutions make the decisions - the decision-making process is subject to public review and input - health policies address public policy goals

20th century health care

- dominated by physicians and their hospitals - focused on acute care, not prevention - developed intractable system problems (increasing cost, quality concerns, barriers to access) ---- all attempts to address one or two of these system problems exacerbated the one or two remaining issues

participative governance

- federal, state, and local governmental power is gained through elected representation - citizens have indirect power to develop or change policy through the election process - involved citizenry leads to healthy participative governance

Policy is

- goal oriented - public - authoritative nature

health care history from 1900-1950s

- greatest advances in health care were prevention and cure of infectious diseases --- vaccines and antibiotics

health policy minor attributes

- health policies are subject to ongoing review - healthy policy goals change (mostly to political and societal values, trends, attitudes)

intergovernmental relationships

- health policy can be made at the federal level, state level, or local level - many policy initiatives require collaboration between the federal government and the state government - these relationships result in complex shared responsibilities and, at times, challenges in establishing authority

coercive power

Stems from fear of someone's real or perceived fear of another person.

information power

Stems from one's possession of selected information that is needed by others.

government inaction

as is the case when a legislative committee defers a decision on a health-related matter or when a proposed health program is not adopted by a government agency because of resource restraints

judiciary review

can be addressed to widely varying concerns including: - challenging unreasonable government action - supporting the establishment of newly created rights through legislation - ensuring protections provided by health care law

Process of policy development: policy implementation

carrying out the proposed intervention

legislature

creates laws and determines appropriate funding

framing the issue

creating a particular perspective for the issue, for example, that assisted suicide is ethically justified because patients have a right to make their own health care decisions

health policies support:

decentralized health services sector where there is no single source of decision making power --- however this can mean that policies are fragmented, complex, contradictory, and even unconstitutional.

courts and the judiciary

determines rights in health policy disputes through judicial review

Process of policy development: policy evaluation

determining if the policy achieved the desired policy goals

Process of policy development: policy adoption

during this stage a proposed intervention is selected

regulatory agencies

established by legislatures to implement and enforce laws through a rule-making process

executive branch

executes and implements laws

two competing values often at the heart of health policy decision making are:

fairness and efficiency - source of much health policy conflict because decision makers must be accountable for prudent use of public funding while also considering the needs of different constituencies

health policy

goal directed decision making about health that is the result of an authorized and public decision-making process - includes those actions, nonactions, directions, and/or guidance related to health that are decided by governments or other authorized entities

patient protection and affordable care act of 2010 has four broad headings:

1. providing new consumer protections 2. improving quality and lowering costs 3. increasing access to affordable care 4. holding insurance companies accountable

major public authorities operating at the federal, state, and local levels are

1. state and national legislatures 2. state and national as well as local courts and judiciary 3. executive branches of federal and state governments 4. regulatory agencies

Process of policy development: agenda setting

a health- related issue is identified usually as a problem

forces of insecurity in health care

- increased costs - shift to outpatient - social problems (violence and poverty) - decreased access to health care - aging population (increased lifespan) - technologic and genetic advances - shrotage of health care professionals - culturally diverse work - underrepresentation in research - economic instability - increased regulatory requirement - uncertainty about implementation of healthcare reforms

tips for being involved

- join and be active in ANA - register to vote and vote in every election - join state nursing association

health policy is determined through:

- laws - regulatory actions - judicial decisions - administrative actions of government agencies

ppaca: improve quality and decrease costs

- payment to physicians and hospitals linked to quality outcomes ---value based purchasing program for medicare --- accountable care organizations (are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients)

ppaca: providing new consumer protections

- prevent insurance companies from denying coverage or rescinding coverage for technical errors in original application - prohibits discrimination for pre existing conditions

ppaca: hold insurance companies accountable

- require insurance companies to spend 85% of premium dollars on health care services

related concepts: advocacy

- safeguard patient autonomy - act on behalf of patients - champion social justice in the provision of health care

context of health policy to nursing

- state boards of nursing - policies related to health insurance (medical assistance eligibility for example) - nurses carry out policies (HIPAA) - influence policy as advocate

health care history from 1950-2000

- technologic advances (these led to increased cost) - heart-lung machine and safer anesthesia (dvlpmnt of CABG, heart transplants) - CT scans - MRI - new pharmaceuticals

ppaca: increase access to affordable care

- young adults stay on parents plan up to age 26 - new scholarships to expand number of primary care physicians and nurses

system inefficiency and cost

-US healthcare system is the most expensive in the world, but ranks last in overall performance when compared to 11 developed countries - care in the US is fragmented, inefficient, and poorly coordinated: underuse, overuse, misuse of health services

Process of policy development

1. agenda setting 2. policy formulation 3. policy adoption 4. policy implementation 5. policy evaluation

expert power

Based on one's reputation for expertise and ones' credibility. The knowledge and skills the nurse possesses that are needed by others

connection power

Gained by association with people who are powerful or who have links to powerful people.

referent power

Granted by association with a powerful person

nursings social policy statement

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations

reward power

One is perceived as being able to provide rewards or favors.

position power (legitimate power)

Possessed by virtue of one's position within an organization or status within a group.

empowerment

The nurse is a source of shared power to build the exercise of power by others.

Process of policy development: policy formulation

in which different policy interventions are proposed and considered

related concepts: power

power is the ability to influence others in an effort to achieve goals

national and state health policy reflect:

societal values