NUR 101 Health Policy (Giddens)

Key Political Concepts (affect policy development and implementation in the United States)

*intergovernmental relationships (federalism)*- 50 sovereign states and a federal government (division of power) *participative governance*- (consent of the governed) U.S. citizens participating in decisions *values* negotiation of diverse values (Fairness and efficiency)

Institute of Medicine (IOM) reports (2)

*quality of health care -emphasized the morbidity and mortality caused by medical errors *federal government has issued new Medicare and Medicaid guidelines that provide incentives for quality outcomes while reducing reimbursements to providers for poor quality outcomes

Markets

- In capitalism, markets function to assure efficient distribution of resources to those goods and services that are the most desirable among many options

Health policy decision making is also affected by

cultural and social trends that arise from technological change, shifting demographics, economic pressures, and consumer demands

Chief executives

develop and implement institutional budgets, control the vast resources of the executive branch, and are usually able to use veto authority to influence policy changes

Public policy

the choices made by a society or social entities that relate to public goals and priorities as well as the choices made for allocating resources to those goals and priorities

The 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) the executive branches of federal and state governments, and (4) regulatory agencies

macro-level

(Medicare program funding)

micro-level effects

(co-payments for episodes of care

Exemplars of Health Care Policy

*Federal* • Access to Emergency Medical Services Act of 2009 • Americans with Disabilities Act of 1990 • Emergency Medical Treatment and Labor Act (EMTLA) of 1986 • Health Information Technology for Economic and Clinical Health Act of 2009 (electronic health records) • Health Insurance Portability and Accountability Act of 1996 • Patient Protection and Affordable Care Act of 2010 • Patient Safety and Quality Improvement Act of 2005 • Patient Self-Determination Act of 1998 • Promoting Health/Preventing Disease: Objectives for the Nation, Healthy People 1990, 2000, 2010, 2020 • Social Security Act of 1965 (Medicare and Medicaid) • The Mental Health Parity and Addiction Equity Act of 2008 • U.S. Preventive Services Task Force (USPSTF) *State* • Scope of practice and licensing for nurses as defined by state professional practice acts • State public health programs and policies related to infectious diseases • State public health regulations that govern health care facilities • State statutes and case law related to professional negligence and malpractice *Local* • City and county fire codes that govern safe occupancy limits in health care facilities • City and county ordinances that govern facility maintenance, signs, utilities, parking, and/or traffic around hospitals and other health facilities • City and county tax districts for publicly supported facilities

Nursing Practice

*States create laws that establish professional practice acts meant to regulate health professionals* -state regulatory agency and a politically-appointed board of nursing are tasked with the implementation and administration of nurse practice acts, including issuing licenses to individuals to legally practice nursing -Boards have the authority to revoke licenses for unsafe practice as defined by the practice act, including actions or behavior by the nurse that lies outside of the scope and standards of practice established by the license -Nurses deal with policy issues daily while assuring the confidentiality of patient information, allocating health care resources through staffing assignments, or teaching patients about their health care rights

Health policy is

-*determined* through laws, regulatory actions, judicial decisions, and the administrative actions of government agencies -*formulated* at the federal, state, and local levels of government

HEALTH POLICY

-defined as a form of public policy, differentiating it from other kinds of decision making -what governments decide to do or not to do -the result of choices and resource allocations made to support health-related goals and priorities -authoritative guidelines that direct human behavior toward specific goals -*goal-directed decision making about health that is the result of an authorized, public decision-making process. Health policy is further defined as 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 (PPACA

-goal is to help provide affordable health insurance coverage to most Americans and to improve access to primary care -?What remains to be seen is to what extent the PPACA will ensure affordable coverage or sufficient numbers of primary care physicians? -is expected to cover an estimated 32 million uninsured Americans - 95% of legal U.S. residents, as compared with 83% currently (32 million who otherwise would have been uninsured) -Law's major provisions: • The requirement that most U.S. citizens and legal residents have health insurance by 2014 • The creation of state-based exchanges through which individuals can purchase coverage, with subsidies available to lower-income individuals • A major expansion of the Medicaid program for the nation's poorest individuals • The requirement for employers to cover their employees or pay penalties, with exceptions for small employers • New regulations on health plans in the private market requiring them to cover all individuals, regardless of health status • Establishment of a national, voluntary insurance program for purchasing community living assistance services • Increases in payments for primary care services • Greater support for prevention, wellness, and public health activities

Institutional Policy

-govern the workplace -nurses are often familiar with the policy and procedure manual of their unit or clinic or home health agency

Accountable Care Organization (ACO)

-has sown the seeds for a major reorganization of the U.S. health care delivery system -agrees to be accountable for the quality, cost, and overall care of Medicare patients, for whom they provide the bulk of primary care services -almost every region of the country, hospitals and physicians are in the process of forming accountable care organizations (ACOs) and entering into other arrangements designed to integrate care, manage chronic conditions, and enhance the use of evidence-based practices

street-level bureaucracy (Lipsky)

-impact of frontline workers on public policy -demonstrated that these frontline workers, such as police officers and social workers, have great influence in implementing policy at the "street-level" or where the policy meets its intended -ensure that policy intent becomes the policy as experienced

Advocacy

-is integrating the support provided to others on an individual basis and rallying that support to a cause -Nursing interest groups might unite for the purpose of advancing national health policy reform that assures greater access to health care for all Americans

Social Policy

-relates to decisions that promote the welfare of the public ex) social policy goal that addresses obesity may result in legislation or regulation that governs the sale of high-fat/high-sugar content foods available in public schools

8 Recommendations for the Future of Nursing Report

. Remove scope-of-practice barriers. 2. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. 3. Implement nurse residency programs. 4. Increase proportion of nurses with BSN degree to 80% by 2020. 5. Double the number of nurses with a doctorate by 2020. 6. Ensure that nurses engage in lifelong learning. 7. Prepare and enable nurses to lead change to advance health. 8. Build an infrastructure to collect and analyze health care workforce data.

Stages (Anderson)

1. *agenda setting* a health-related issue is identified, usually as a problem ex) that assisted suicide is ethically justified because patients have a right to make their own health care decisions 2. *policy formulation* in which different policy interventions are proposed and considered 3. *policy adoption* a proposed intervention is selected 4. *policy implementation* carrying out the proposed intervention 5. *policy evaluation* determining if the policy achieved the desired policy goals

nursing licensure

Decisions related to nursing licensure by *state* boards of nursing are an example of administrative rule making

Other Interrelated Concepts

Evidence, Ethics, Safety, Health care quality, Health care economics, and Health care law

HIPAA

For example, the Health Information Portability and Accountability Act of 1996 (P.L.104-191 HIPAA) was developed with the policy intent to limit the ability of employers to deny health insurance coverage to their employees based on preexisting medical conditions - policy intent was to preserve the privacy of patients by limiting access to health care records

Health Policy Attributes

Major: 1.Decisions are made by authorized government institutions such as legislatures or courts or by government-authorized entities. 2.The decision-making process is subject to public review and public input. 3.Health policies address a public policy goal. Minor: 1.Health policies are subject to ongoing review by governing institutions and by the public. 2.Health policy goals change according to changes in political and social values, trends, and attitudes.

Policies to assure security

The creation of public policies that address health concerns has become an accepted responsibility for governments and a means for assuring some level of security from the public consequences of ill health and disability