Chapter 13 Health Policy

CRITICAL POLICY ISSUES

Government health policies have been enacted to resolve or prevent perceived deficiencies in health care delivery. Over the last four decades, most health policy initiatives and legislative efforts have focused on access to care

Regulatory Tools

Policy used by government to prescribe and control the behavior of a particular target group by monitoring the group and imposing sanctions if it fails to comply. -example:State insurance departments across the country regulate health insurance companies in an effort to protect customers from excessive premiums, mendacious practices, and defaults on coverage in case of financial failure of an insurance company.

Fragmented, Incremental, and Piecemeal Reform

Public power in U.S. is enormously fragmented based on design of founding fathers (system of "checks and balances") Health policies have resulted from compromises involving the resolution of a variety of competing interests Broadening of Medicaid program since its inception in 1965 Broadening and changes made to Medicare Health Reform Law 31 congressional committees and subcommittees claim some jurisdiction over health legislation Difficulty of the public policymaking process

Distributive policies

spread benefits throughout society. Typical distributive policies include funding of medical research through the NIH, the construction of facilities

Different Forms of Health Policies

-Health policies often come as a by-product of public social policies enacted by the government. A relevant example is the expansion of health insurance coverage.

Government as Subsidiary to the Private Sector

-In the United States, health care is not seen as a right of citizenship or a primary responsibility of government. Instead, the private sector plays a dominant role -Americans generally prefer market solutions over government intervention in health care financing and delivery, and for this reason, they have a strong preference for minimizing the government's role in the delivery of health care. -One result is that Americans have been far more reluctant than their counterparts in most industrialized democracies to develop social insurance programs -In addition, public opinion in the United States often presumes such programs to be overly generous.

Interest Groups

-Powerful interest groups involved in health care politics are adamant about resisting any major change (Alford, 1975). Each group fights hard to protect its own interests. -The policy agenda of interest groups is typically reflective of their own interests. For example, AARP advocates programs to expand financing for long-term care for the elderly.

Providers

-Several groups of providers are involved in delivering health care. Policy issues include ensuring that there is a sufficient number of providers and that their geographic distribution is desirable -The debate over the supply of physicians is an important public policy issue because policy decisions influence the number of persons entering the medical profession; that number, in turn, has implications for other policies.

Access and Persons with AIDS

-The CDC estimates that 1.2 million persons are HIV positive in the United States, one-fourth of whom are unaware of their own infection. Each year, 50,000 are newly infected with HIV, with a disproportionate burden occurring among the black and Hispanic populations. -The Department of Health and Human Services supports research, prevention initiatives, and efforts to expand access to quality health care and services for those in need of them.

Consumer Groups

-The interests of consumers are not uniform, nor are the policy preferences of their interest groups -Often, consumers do not have sufficient financial means to organize and advocate for their own best interests. -African Americans and, more recently, the rapidly growing numbers of Hispanic Americans face special health problems

What are Public policies?

-are authoritative decisions made in the legislative (congressional), executive (presidential), or judicial (courts, including the Supreme Court) branches of government that are intended to direct or influence the actions, behaviors, or decisions of others -When public policies pertain to or influence the pursuit of health, they become health policies

Redistributive policies

-take resources from one group and give it to another—a system that often creates visible beneficiaries and payers. -Redistributive policies include the Medicaid program, which takes tax revenue from the public and spends it on the poor in the form of free health insurance.

Policy Cycle

1) issue raising, (2) policy design, (3) building of public support, (4) legislative decision making and building of policy support, and (5) legislative decision making and policy implementation. These activities are likely to be shared with Congress and interest groups in varying degrees.

Impact of Presidential Leadership

Americans often look to strong presidential leadership to catalyze major change in health policies, and presidents have important opportunities to influence congressional outcomes through their efforts to achieve political compromises that allow bills with at least some of their preferred agendas to be passed.

Legislative Process

Bill passed to a house of congress; bill gets majority of votes in both houses; president can then pass bill into law or veto it. If vetoed, bill must attain 2/3 majority in both houses to become law.

Access in Rural Areas

Delivery of health care services in rural communities has always posed the problems of how to make advanced medical care available to residents of sparsely settled areas. Purchasing high-tech equipment to serve a few people is not cost-efficient, and finding physicians who want to reside in rural areas is difficult.

Pluralistic and Interest Group Politics

Established groups resist innovative, non-incremental policies Well-organized interest groups are the most effective "demanders" of policies To overcome pluralistic interests and maximize policy outcomes, diverse interest groups form alliances among themselves and with legislators

Allocative Tools

Health policies can also be used as allocative tools (Longest, 2002); that is, they may involve the direct provision of income, services, or goods to certain groups of individuals or institutions. Allocative

Decentralized Role of the States

In the United States, individual states play a significant role in the development and implementation of health policies. 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, authorization of local government health services

Smoking and Tobacco Use

In the United States, lung cancer is the leading cancer cause of death, killing 157,000 people annually. The American Cancer Society has estimated that 87% of these deaths are a result of smoking and exposure to secondhand smoke. Overall, tobacco use causes almost 1 in 5 deaths in the United States.

Access and Minorities

Minorities are more likely than whites to face access problems. Hispanics, blacks, Asian Americans, and Native Americans, to name the most prevalent minorities, all experience difficulties accessing the health care delivery system. In some instances, the combination of low income and minority status creates difficulties; in others, the interaction of special cultural habits and minority status causes problems in accessing health care.

Public Financing

Over the years, policies have been enacted to provide access to health care for specific groups otherwise unable to pay for and receive care. These groups include the elderly (Medicare), poor children (Medicaid), poor adults

Access to Care

Policies on access are aimed primarily at providers and financing mechanisms, with the purpose of expanding care to the most needy and underserved populations, including the elderly, minorities, rural residents, individuals with low incomes, and persons with AIDS.

Research and Policy Development

The research community can influence the making of health policy through documentation, analysis, and prescription (Longest, 2002). The first role of research in policy making is documentation—that is, the gathering, cataloging, and correlating of facts that depict the state of the world that policy makers face. This process may help define a given public policy

Alliances

To overcome pluralistic interests and maximize policy outcomes, diverse interest groups may form alliances among themselves and with members of the legislative body to protect and enhance the interests of those receiving benefits from government programs

Access and the Elderly

Two main concerns about the Medicare policy: -Spending must be restrained to keep the program viable. -The program must be made comprehensive by adding service not currently covered or covered inadequately

Universal Health Coverage

Universal health coverage has been a long-standing policy issue in the United States. Despite the recent enactment of the ACA of 2010, two issues remain: (1) The law faces constitutional challenges, and if it is repealed, alternative measures to cover the uninsured would become necessary; and (2) even though the ACA is expected to cover an additional 30 million uninsured, it still falls short of universal coverage (Buettgens & Hall, 2011).

PRINCIPAL FEATURES OF U.S. HEALTH POLICY

government acting as a subsidiary to the private sector; fragmented, incremental, and piecemeal reform; pluralistic (interest group) politics; a decentralized role for the states; and the impact of presidential leadership. These features often act or interact to influence the development and evolution of health policies.

WHAT IS HEALTH POLICY?

health policy can be defined as "the aggregate of principles, stated or unstated, that... characterize the distribution of resources, services, and political influences that impact on the health of the population"

Employers

health policy concerns of American employers are mostly shaped by the degree to which employers are involved in the provision of health insurance benefits for their employees, their dependents, and their retirees. Many small business owners adamantly oppose health policies that would mandate them to provide coverage for employees because they believe they cannot afford to do so.

Manufacturers of Technology

health policy concerns of pharmaceutical and medical technology organizations include discerning changes in health policy areas and exerting influence over the formulation of policies. Health policy concerns regarding medical technology (including pharmaceuticals) are driven by three main factors three main factors: (1) Medical technology plays an important role in rising health costs, (2) medical technology often provides health benefits to people (albeit not always), and (3) the use of medical technology provides economic benefits aside from its potential to provide health benefits.

Cost Containment

procedures used to control costs or expenses Development Act of 1974 became law in 1975. This act marked the transition from improvement of access to cost containment as the principal theme in federal health policy. Health planning, through certificate-of-need review, was used as a policy tool to contain hospital costs.