hcd 332 final exam

Changing Practice

Medicare may move toward broader payment systems such as using episode-based payment and shifting the financial risk of controlling costs to providers. Episode based payment (bundling) is a single fee paid by the insurer that includes all the services involved in providing treatment for a certain procedure such as heart surgery for example. For now, fee for service FFS, is the predominant payment system and the financial risk of controlling Medicare costs will remain with the government and price controls will become more likely.

Who can draft a bill

Only members of Congress (House or Senate/Legislative Branch) can actually introduce proposed legislation, no matter who originates the idea or drafts the proposal. Drafting legislative proposals is an art in itself, one requiring considerable skill, knowledge, and experience. When bills are drafted in the executive branch, trained legislative counsels are typically involved. These counsels work in several executive branch departments, and their work includes drafting bills to be forwarded to Congress. No matter who drafts legislation, however, only members of Congress can officially sponsor a proposal, and the legislative sponsors are ultimately responsible for the language in their bills.

Center of Medicare and Medicaid Innovation

creates innovative technologies for healthcare.

public expenditures

for the Medicare and Medicaid programs especially— has also been linked at times to the need to control the federal budget

Regulatory policies Technology

require implementation technologies that pre- scribe and control the behaviors of whoever is being regulated. Such technologies include capacity for rule promulgation, investigatory capacity, and ability to impose sanctions.

Policy monitoring evaluation

typically undertaken to help ensure that policies are implemented as their formulators designed them and intended them to be implemented.

Government Departments

units devoted to government affairs mainly serve to enhance the policy competence of an entity's senior-level managers, especially its CEO. They must forecast what the policies may do to be successful. Leaders of entities who understand public policy environments, with all their complex interplay of actors, actions, inactions, and other variables, are better equipped to anticipate and influence policies than their less policy-competent counterparts.

Nonmaleficence

"Primum Non Nocere" First, do no harm! Policymakers who are guided by the principle of nonmaleficence make decisions that minimize harm. The principles of beneficence (do good) and nonmaleficence (do no harm) are clearly reflected in health policies that seek to ensure the quality of health services and products.

Legislative Oversight

"committee review of the activities of a federal agency or program". The CMS plays a significant legislative role in overseeing CHIP, ACA, Medicare, and Medicaid with the Office of Public Engagement. They work with the Office of Legislation to improve legislating initiatives and the Center of Program Integrity to fix any vulnerabilities including fraud or waste. It is designed to expand access to affordable health care and make the U.S. health care system more outcome-driven and cost-effective, the ACA requires that CMS coordinate with states to set up Health Insurance Marketplaces, expand Medicaid, and regulate private health insurance plans.

Center for Medicare and Medicaid Intervention

"innovative payment and service delivery models to reduce program expenditures . . . while preserving or enhancing the quality of care" The seven categories include - Accountable Care, Bundled Payments for Care Improvement, Primary Care Transformation, Initiatives Focused on the Medicaid and CHIP Population, Initiatives Focused on the Medicare-Medicaid Enrollees, Initiatives to Speed the Adoption of Best Practices, and Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models

Evaluating

"its merit, worth, value, or significance" When managers of implementing organizations evaluate a policy, or some component part of it, they are interested in determining its value among other things and bring the other units of implementation in a full circle

Congressional Research Service

"the Congress throughout the legislative process by providing comprehensive and reliable legislative research and analysis that are timely, objective, authoritative, and confidential, thereby contributing to an informed national legislature"

Competence

"the ability to do something well - the quality or state of being competent" - Miriam Webster, "having the necessary ability, knowledge, or skill to do something successfully."

Government Accountability Office

'government watchdog' "support the Congress in meeting its constitutional responsibilities and to help improve the performance and ensure the accountability of the federal government for the benefit of the American people". It is an independent organization that determines if tax payer dollars are being spent efficiently.

Clear Roles

(1) facilitating the implementation of an elder justice system in the U.S.; (2) supporting states' efforts in carrying out elder justice programs; (3) establishing federal guidelines and disseminating best practices for uniform data collection and reporting by states; (4) collecting and disseminating data relating to the abuse, neglect, and exploitation of older individuals (abuse); (5) establishing an information clearinghouse; (6) researching such abuse; (7) providing technical assistance to states and other entities; (8) conducting a study concerning the degree of abuse; and (9) promoting collaborative efforts and diminishing duplicative efforts in elder justice programs in all levels of government.

Key Variables in Operating

(1) how the policy is designed or constructed, (2) certain characteristics of the organization(s) charged with implementation, and (3) the capabilities of the implementing organizations' managers. (in order to be an operational and successful an organization need to be constructed, have good implementation character, and the manager must be capable of handling difficult tasks)

Being able to exert influence depends on two variables

(1) possession and use of social power and (2) knowing where and when to focus efforts to exert influence.

Problems also can be spotlighted by their widespread applicability

(e.g., the high cost of prescription medications to millions of Americans) or by their sharply focused impact on a small but powerful group whose members are directly affected (e.g., the high cost of medical education).

Implementation of the laws

mainly handled by the execute branch.

Steps in the Legislative Process

1. A bill (a proposed law presented to the Legislature for consideration) may be introduced in either the Senate or House of Representatives by a member; bill subjected to markups. 2. It is referred to a committee for a hearing. The committee studies the bill and may hold public hearings on it. It can then pass, reject, or take no action on the bill. 3. The committee report on the passed bill is read in open session of the House or Senate, and the bill is then referred to the Rules Committee. 4. The Rules Committee can either place the bill on the second reading of the calendar for debate before the entire body or take no action. 5. At the second reading, a bill is subject to debate and amendment before being placed on the third reading calendar for final passage. 6. After passing one house, the bill goes through the same procedure in the other house. 7. If amendments are made, the other house must approve the changes. 8. When the bill is accepted in both houses, it is signed by the respective leaders and sent to the governor/president. 9. The governor/president signs the bill into law or may veto all or part of it. If the governor/president fails to act on the bill, it may become law without a signature. 10. Congress can overturn a vetoed a bill with a 2/3 vote from both chambers of Congress.

Generally, Legislative oversight is intended to accomplish the following

1. Ensure the implementing organizations adhere to congressional intent 2. Improve the efficiency, effectiveness, and economy of government operations. 3. Assess the ability of implementing organizations and individuals to manage and accomplish implementation 4. Ensure the implementation of policies reflects the public interest.

Choices

1. How much should we spend on care? What approach should we use to make the choice? Who should decide—government or individuals? 2. Identify best way to provide services—would competition or price controls bring greater efficiency? 3. How rapidly should medical innovation be introduced? Should regulatory agencies evaluate each medical advance and determine cost/benefit or should that be left to health plans competing for enrollees? 4. How much should be spent on the indigent?

In a democratic society, voters are concerned with 2 major areas of laws

1. How will the new policies affect them? 2. How can they change the policies? Health policies can affect people in different ways, under different circumstances, to different degrees at different times. The people and organizations that have the greatest or most concentrated interest in the policymaking process are most likely to become involved with formal interest groups to formally address their concerns or interests (pg. 182) The consequences of health policies at the level of individuals, communities, or populations can be enormous!

Top Challenges in Managing Implementation policies

1. Overseeing the health insurance marketplaces 2. Transitioning to value-based payments for healthcare (Health Insurance Marketplaces complete various tasks including - insurance, tax credits, and cost-sharing subsidies; operates effectively and easily for consumers; and transmits complete, accurate, and timely information to insurers regarding enrollees. State marketplaces complete - contractor oversight, payment accuracy, security, and educating consumers/protecting identity) 3. Ensuring appropriate use of prescription drugs in Medicare and Medicaid 4. Protecting the integrity of an expanding Medicaid program 5. Fighting fraud and waste in Medicare Parts A and B 6. Preventing improper payments and fraud in Medicare Advantage 7. Ensuring quality of care in nursing facilities and home- and community-based settings 8. Effectively using data and technology to protect program integrity 9. Protecting HHS grants and contract funds from fraud, waste, and abuse 10. Ensuring the safety of food, drugs, and medical devices

Budget of the United States Government

1. President submits budget request to Congress. (First Monday in February) 2. House and Senate Budget Committees pass budget resolutions - if they fail to do so by the allotted date the prior resolution stays in effect. (April 15) 3. House and Senate Appropriations Subcommittees mark up appropriations bills; this step requires authorization and mainly occurs in two forms: mandatory and discretionary. (June 10) 4. House and Senate vote on appropriations bills and reconcile differences. (June 30) 5. President signs each appropriations bill and the budget becomes law. (October 1) 6. Congress passes continuing resolutions until budget is in place (As needed) 7. Audit and review of expenditures (ongoing). Reports include - estimates of spending, revenues, borrowing, and debt. The president needs to sign the appropriation bill every year to continue funding. If this is not done by September 31, Congress with enact CRs or government shut downs.

3 Main Types of Organizations in the Healthcare System

1. Primary health service providers 2. Secondary provider organizations 3. Health-related interest groups

Nutrition based programs

1. Reduce Hunger and food insecurity 2. Promote socialization with other seniors

Financial based programs

1. Retirement planning & counseling. The language and construction of a policy - especially in the form of a public law - are crucial to the course and success of its operation.

Rule making cyclical process

1. Rules are made 2. Operational activities are decided 3. Policy is formed & Implemented 4. Feedback is noted 5. Policies are modified if needed based on feedback 6. Rules may be changed and policies altered. (Make the DIF NM Change)

Examples of responsibilities of CMS

1. Serves as focal point for Agency interactions 2. Responsible for policies related to scope of benefits 3. Develops payment mechanisms 4. develops, evaluates and maintains policies 5. Develops, evaluates and reviews regulations, manuals, program guidelines and instructions needed for the dissemination of program policies to program contractors and the healthcare field

the five steps health professionals can use to be influential in policymaking

1. observing, including deciding what to observe; 2. assessing, including how to decide what policy information is important; 3. monitoring, including the benefits of careful monitoring; 4. forecasting, including common forecasting techniques; 5. influencing, including the role of social power and focus in general terms;

Discriminating against individuals with chronic ailments

35% of fortune 500 companies admitted to looking at medical records before hiring or promoting. Businesses want healthy individuals who will be more productive than those with previous health risks. If you have a chronic medical condition you will cost the company more money to insure you, and you would miss more time from work. If you knew their health history would you hire?

Advance directives

A legal document designed to indicate a person's wishes regarding care in case of a terminal illness or during the dying process. allow competent individuals to give instructions about their healthcare, to be implemented at some later date should they then lack the capacity to make medical decisions.

Code of Federal Regulations

A list of policies that are designed to guide the decisions, actions, and behaviors of others,

Scenario development

A narrative that describes a particular set of future conditions, Best-case, worst-case. define several alternative scenarios, or states of affairs. These can be used as the basis for developing contingent responses to the public policy information being analyzed; alter- natively, the professional can select the most likely from among the scenarios and prepare accordingly.

Committee reports

A report based on why Congress voted for a bill to be passed and the amendments made to the bill. These are useful and informative documents in the legislative history of a public law or amendments to it.

Accountable Care Organizations

A version of managed care. Consumers may be willing to trade freedom of provider choice for more coordination of care and lower co-pays. ACOs are entities consisting of a related set of providers that can be held accountable for cost and quality of care delivered to a defined population. The ACO would coordinate care and receive capitated payments. Providers would not be employed by the ACO, but would be expected to work together as a unit and accept responsibility for quality and cost.

Executive agencies

Agencies such as the Dept. of Health & Human Services, Dept. of Justice, or independent agencies like the FDA, EPA exist primarily to implement the laws formulated by the legislative branch. Centers for Medicare & Medicaid Services (CMS) is an example of an implementation agency located under the DHHS.

Formulation phase is made up of two sets of interrelated activities

Agenda Setting and Legislation Development

Modifications can take place at four parts of the policymaking process

Agenda Setting stage (before voted on), Legislation development (before voted on), Rulemaking stage (before voted on), and Operational stages (after voted on)

Legislative Branch in implementation phase

All legislative power in the government is vested in Congress, meaning that it is the only part of the government that can make new laws or change existing laws. Laws are formulated in the legislative branch and implemented primarily in the executive branch, and sometimes this role creates significant delays. Example, in 1946 Congress enacted the Hospital Survey and Construction Act. However, it wasn't until the 1970's that the DHHS issued rules to govern these hospitals and the money alloted

Legislative Oversight

Although organizations in the executive branch bear most of the responsibility for implementing policies, the legislature branch maintains oversight responsibility in the implementation phase, as mandated by the Legislative Reorganization act of 1946.

President's role in policymaking

Although the Constitution establishes a government characterized by the separation of powers, Article II, Section 3, imposes an obligation on the president to report to Congress from time to time on the state of the union and to recommend such policies in the form of laws or amendments as the president considers necessary, useful, or expedient. The president is required to submit a budget request to Congress each year to initiate the process. By doing so, the president establishes the starting point and the framework for the annual process of legislation development for the federal budget. The most important regular executive communication is the proposed federal budget the president transmits annually to Congress.

Health-related organizations

Although the missions, objectives, and internal structures and resources of these organizations and groups help shape and determine how they perform, their performance levels—whether measured in terms of contribution to health outcomes for people, financial strength, reputation, growth, competitive position, scope of services provided, or some other parameter—are also heavily influenced by the opportunities and threats posed by their external environments. for the health-related organizations and groups, policies become important variables in their external environments. Policies may determine existence and routinely determine degrees of success and failure achieved. The organization or interest group can respond to these threats and opportunities with strategies and structures created to carry them out.

Task forces

An organization that is dedicated to performing one task and providing expert advice. Another issue-raising mechanism some chief executives favor is the appointment of special commissions or task forces.

ADHS

Arizona Department of Health Services. The Arizona Department of Health Services promotes and protects the health of Arizona's children and adults. Its mission is to set the standard for personal and community health through direct care, science, public policy, and leadership. It operates programs in behavioral health, disease prevention and control, health promotion, community public health, environmental health, maternal and child health, emergency preparedness and regulation of childcare and assisted living centers, nursing homes, hospitals, other health care providers and emergency services.

Skills and resources to be an effective manager

As in any organization, the managers of implementing agencies and organizations can benefit from knowing the histories and experiences of their organization. Managers who can effectively communicate their views and preferences have a distinct advantage in guiding the behaviors of their followers. Similarly, successful managers are able to minimize conflict, mobilize widespread commitment to their preferences regarding the organization, and motivate stakeholders to help realize these preferences. The ability of managers of implementing organizations to collaborate and partner with other entities is increasingly important to successful implementation. The ability to develop shared cultures, or at least to minimize the differences that exist in the cultures of collaborating entities, is crucial to establishing and maintaining effective intergovernmental, interorganizational, or interagency collaborations.

Assessment of public policies

Assessment determines which of the many possibilities is worthy of continuing interest on the basis of increasing opportunities or decreasing threats. When possible, quantification, modeling, and simulation of the potential effects of the issues being assessed can be useful.

Slip law

At the federal level, enacted laws are first printed in pamphlet form called slip law.

Shaping Public Opinion

Because policymakers are influenced by the electorate's opinions, many interest groups seek to influence the policymaking process by shaping public opinion

Rulemaking

Creating the laws with clear and concise information.

map to guide focus of efforts to be influential;

Depending on the circumstances, the proper focus may be one or more of the formulation, implementation, or modification phases of the policymaking process, or the components of the process during the phases. As we have stated several times in this book, the vast majority of health policies result from the modification of existing policies in modest, incremental steps. Policy modification occurs when the experiences with existing policies feed back into the agenda-setting and legislation development stages of the formulation phase and into the activities of the implementation phase and stimulate changes in legislation, and in the designing, rulemaking, operat- ing, and evaluating activities of its implementation. Opportunities for health professionals, and others, to influence policies continually arise as experiences with them and preferences for alternatives trigger modification.

Implementation Roles

Designing, Operating, Evaluating, and Rulemaking (DOERs)

Where will it end

Difficult to predict how ACA will change over time. Whether the government exercises greater control over financing and delivery or whether patient and provider incentives are included in a more competitive market remains to be seen. Employers may decide it is less costly to pay a tax per employee than provide comprehensive benefits. Elimination of pre-existing conditions will increase insurer losses and government reviews of premium increases may exclude insurers from the market. Having too few private insurers may increase calls for a public plan to increase choice and competition.

Success depends on

Difficulty of problem being addressed. Legal mandates. Political and institutional actors. Degree of political and public support. External constituencies' influence. Depending on the scope of policies being implemented, the managerial tasks involved can be simple and straightforward, or they can acquire massive effort. Pres. Lyndon Johnson once observed that preparations for implementing the Medicare Program represented "the largest managerial effort the nation [had] undertaken since the Normandy invasion" (Inglehart 1992, 1468)

Center for Consumer Information and Insurance Oversight

Enforces standards and regulations on health insurance, provides the public with information about health insurances,

Policy regulations

Ensure market entry restrictions in the form of licensing of individuals and institutions. Establish rate and price control settings on providers. Provide quality controls on the provision of health services. Control the conduct of participants. Ensure desirable social outcomes such as workplace safety, environmental protection, communicable disease reporting, and childhood vaccines. Social regulation usually has an economic effect but this is not the primary purpose. Policies designed to influence the actions, behaviors, and decisions of others by directive are regulatory policies. Health care regulatory agencies are responsible for making sure those mandates are carried out. Monitor health care providers and facilities. Provide information about industry changes. Promote safety. Ensure legal compliance and quality services. Provide mandatory oversight to ensure compliance with rules and regulations. May be necessary for accreditation.

Oversight accomplishes

Ensure that implementing organizations adhere to congressional intent, Improve the efficiency, effectiveness, and economy of government's Operations, Assess the ability of implementing organizations and individuals to manage and accomplish implementation, including investigation of alleged instances of inadequate management, waste, fraud, dishonesty, or arbitrary action. Ensure that implementation of policies reflects the public interest. It's mandated by the Legislative Reorganization Act of 1946.

Center for Clinical Standards and Quality

Examines the quality of care that patients receive and the quality of the measurement tools. They help the CMS find innovative ways to manage, budget, and conduct oversights. Coordinates quality-related activities with outside organizations; monitors quality of Medicare, Medicaid, and the Clinical Laboratory and Improvement Amendments (CLIA). Prepares the scientific, clinical, and procedural basis for coverage of new and established technologies and services and provides coverage recommendations to the CMS administrator. Prepares the scientific and clinical basis for and recommends approaches to quality-related medical review activities of carriers and payment policies

The FDA tobacco regulation bill of 2009

FDA issued new rules for a variety of tobacco products, including cigarette warning labels, smokeless tobacco product warning labels and "light," "low," "mild" or similar descriptors for tobacco products. These new laws are expected to have a significant public health impact by decreasing the number of people using tobacco products, resulting in lives saved, increased life expectancy, and lower medical costs.

Utilitarian perspective

Fairness is best served when public utility is maximized. This view is sometimes expressed as the greatest good for the greatest number. (Grindelwald was a Utilitarian - greater good)

Legislation Development steps

First, Congress drafts and approves a budget resolution that provides the framework for overall federal government taxation and spending for various agencies an programs for the upcoming year. Next, the agencies and programs are authorized by way of establishment, extension, or modification. This authorization must take place before any money can be appropriated for a particular agency or program, which is the final stage of federal budget making.

Research and analysis play two especially important roles in agenda setting

First, an important documentation role is played through the gathering, cataloging, and correlating of facts related to health problems and issues.

Three Important roles of President's budget

First, the budget request tells Congress what the president recommends for overall federal fiscal policy. Second, it lays out the president's priorities for spending on health, defense, education, and so on. Finally, the budget request signals to Congress the spending and tax policy changes the president prefers. The budget is merely what the president recommends and Congress can do as they please with it.

Regulatory Policy

Government policies that limit what businesses can do; examples include minimum wages, workplace safety measures, and careful monitoring of stock sales. regulatory policies affect those to whom the regulations are targeted fairly and equitably.

Implementation

Health Policies must be implemented effectively if they are to affect the determinants of health. Otherwise, policies are only paper and words. Implementation only occurs after a policy is adopted. It is at the discretion of the administrative agency to interpret and implement the policy. Their aim is to help people when something happens and prevent the event from occuring again. People at the national, state, and local government as well as the general public are responsible for the implementation of laws. Go to regulations.gov for info about laws

Summary of Developing Competence in the Policymaking Process

Health policies affect individuals, communities, populations and health-related organizations. Health related organizations and interest groups seek to influence their public policies. Ethical principles should be involved in policymaking

Difficulties in Observing to Identify Public Policy

Health professionals cannot foretell the future through observation and analyses of public policy markets and the policymaking process; at best, they can develop informed opinions and guesses about the future. Professionals cannot possibly see every aspect of the policy market or the policymaking process, nor can they be aware of every detail of public policies that will affect them. Professionals may discern relevant public policy information but be unable to correctly interpret its effect on them or their professional goals and strategies.Professionals may discern and interpret the effect of public policy information but find that they are unable to respond appropriately.

Incrementalism in policymaking

Historically most modifications reflect only modest changes. The fact that these changes tend to be modest has led to the characterization of US public policymaking as a process of incrementalism. The affinity for modest, incremental policy change is not restricted to the health arena. In February, 2010 Phoenix faced a $175 million dollar shortfall in the economy. City council passed a 2% sales tax on previously untaxed food items - milk, meat & vegetables. January 1, 2013 - tax reduced to 1%. April, 2015 - tax will now be eliminated. "I think it was a tax that had to be at the time," Councilwoman Thelda Williams said. "I also think it's time that we kept our word and we begin to reduce it and totally eliminate it on schedule, as the public was told." In policymaking that is characterized by incrementalism, significant departures from the existing patterns of policies play out slowly and somewhat predictably.Example, the history of the National Institute on Health (NIH) reflects incremental policymaking over the past 100 years. Medicare/Medicaid has changed incrementally over the past 50 years

Some of the services and programs AoA provides

Home and Community based support services. 1. Access to transportation, case management and information 2. In home services such as personal care, chore and homemaker assistance 3. Community services such as legal, mental health and adult day care

Vague Hypothesis

If a then b. Voluntary, community-based planning on the one hand and heavy-handed regulation, at least of capital expansion in the health sector, on the other.

Designing a Theory outline

If inputs or resources a, b, and c are assembled and processed by doing m, n, and o with them, then the results will be x, y, and z.

Who Decides

If the government decides allocation of resources and controls prices the trade-off between cost and access may be different from what consumers will make. The idea of consumer sovereignty and how to improve efficiency of the current system will help determine the appropriate amount to be spent on medical services.

two important management aspects

Implementing organizations must manage the implementation of policies and the managers of these organizations must oversee their own organizations.

Beneficence

In policymaking, this means that policies should work to do good and to produce charity/kindness. Policies should bring a benefit to the system, and not just a benefit for the special interest groups involved. beneficence also includes the complex concept of balancing benefits and burdens. Using beneficence helps policymakers make decisions that maximize the net benefits to society as a whole and balance fairly the benefits and burdens of their decisions. (EX: Medicare, Medicaid, and ACA)

Influencing Policy formation

In the policy formulation phase, where the health policy agenda is shaped by the interaction of problems, possible solutions to the problems, and political circumstances, health professionals with relevant expertise could influence policymaking by helping define the problems that eventually become the focus of public policymaking or by participating in the design of possible solutions to these problems.

Modifications

Individuals, organizations or interest groups who benefit from a particular policy may seek modifications that increase or these benefits over time. Similarly, those who are negatively affected by a policy will seek to modify it to minimize the negative consequences. Is this law clearly written? Have any modifications been made in similar laws? Should any modifications be made? Almost every policy has a history. An initial version is formulated which then evolves as it is implemented, either through amendments to the original legislation or through new or revised rules and changes in operation.

Formal Organizational Structure

Intentional patterns of relationships established by managers

Litigation

Interest groups, acting on behalf of their members, seek to influence the policy agenda and the larger policymaking process through litigation in which they challenge existing policies, seek to stimulate new policies, or try to alter certain aspects of policy implementation.

Evaluation questions

Is the policy being effectively implemented? How effective is the policy, or some component of it? Were the policy's objectives achieved or were the objectives of some component of the policy achieved? What are the strengths and weaknesses of the policy or component part? To what extent do the benefits of the policy or component part justify its costs? Does the policy or a component part of it deserve continued funding? Increased funding?

U.S Code

Later, laws are published in the US Statutes at Large and eventually incorporated into the US Code.

Capabilities of Managers

Management is essential in any purposeful organization. Someone must determine, initiate, integrate, and oversee the work of others. They must establish missions and objectives; inculcate appropriate values in the individuals who make up the organization; manage the organizational culture; build intraorganizational and interorganizational coalitions; and interpret and respond to challenges and opportunities presented by the external environment.

Monitoring Public Policy

Monitoring, especially when the information is complex, poorly structured, or ambiguous, permits the professional to assemble more information so that questions and uncertainties can be answered or clarified and their importance can be more fully determined Monitoring is tracking or following important public policy information over time. The purpose of monitoring is to build a base of knowledge and insight around relevant and important public policy information that was identified through observation or verified through earlier monitoring. Monitoring affirms that public policies have histories. Many of them continually, although incrementally, evolve through modification. A

The Malpractice Crisis

Most patients injured by medical negligence do not sue and are not compensated for their injuries. Given the small percentage (2-3%) who do sue, provider negligent behavior is rarely deterred. A large percent of the malpractice premium is not used for patient compensation but for legal costs and administrative expense. Under fee for service, providers have an incentive to practice defensive medicine prescribing care of doubtful value to decrease the probability of a malpractice lawsuit.

Examples of groups that need annual funding

NIH research, Health activities of the VA, the Agency for Healthcare Research and Quality (AHRQ), FDA. The House & Senate appropriations committees review the performance of these and similar organizations in carrying out their implementation responsibilities. Money is then approved in the budgets passed by congress/

Vague roles

OSHA statute authorized the secretary of labor, in implementing the law, to issue standards dealing with toxic substances in the workplace "to the extent feasible."

Interest groups in developing laws

Once a health policy problem or issue achieves an actionable place on the policy agenda and moves to the next stage of policy formulation—development of legislation—those with concerns and preferences often continue to seek to exert influence.

Policy Operation

Once the rules are written, then the policy can begin. Operation of laws is primarily a management undertaking, requiring regulation. *The US Constitution prohibits the enactment of laws that are not specifically and directly made known to the people who are to be bound by them.*

Justice

One ethical principle of importance to policies is justice. The principle of justice provides much of the underpinning for all health policies

Effective oversight is accomplished through several means

One powerful technique involves the funding appropriations that congress must make to continue implementation of many of the laws it enacts. Although some health policies, like Medicare, are entitlements, others require annual funding.

Four Parts of ACA

Part A is hospital insurance and Part B is supplemental medical insurance. Part C, also known as Medicare Advantage, offers comprehensive Parts A and B benefits in a managed care setting through private healthcare companies. Medicare Part D provides voluntary prescription drug coverage.

Using Organizational Relationships to influence policymaking

People who are employed in these organizations, who govern them, or who independently practice their professions within them have an interest in health policies that affect the mission and purpose of these organizations, their day-to-day operations, and, ultimately, their successes and failures. One of the ways that individual health professionals can increase their competence in influencing policymaking is by joining effective organizations and groups, which typically have greater resources, in the shared pursuit of influence.

Summary of Policy Making and Modification

Policy modification is a very important process in healthcare policymaking. Modification provides continual opportunities for the performance of policies and their consequences to stimulate modification. Incremental modifications do not need to be voted on, they can be made by those in charge of the operation of the policy or law. If a bill is not found to be ethical, or reasonable - the law can be removed by the judicial branch of the government.

Center for Program Integrity

Promotes the integrity of the Medicare and Medicaid programs and CHIP through provider/contractor audits and policy reviews, identification and monitoring of program vulnerabilities, and providing of support and assistance to states and provides recommended modifications. It develops and implements a comprehensive strategic plan, objectives, and measures to carry out CMS's Medicare, Medicaid, and CHIP program integrity mission and goals and to ensure program vulnerabilities are identified and resolved

Office of Legislation

Provides other departments with ideas on how to improve their organization

How Much Insurance Should Everyone Have

Purpose is to eliminate uncertainty and the possibility of incurring a large medical expense. It spreads risk among a large number of people; when each person pays a premium, the aggregate amount of the premiums covers the large losses of relatively few people. Insurance also provides coverage for small losses such as office visits and dental care. To decrease the probability of a large loss occurring, insurers can encourage preventive measures among its insured population.

Operating

Putting Legislation into effect. At the point of operating policies, those who implement policies are required to follow the rules promulgated to guide that implementation according to the mandates inherent in the laws.

Policy Interests of Resource-Producing Organizations

Related to the organizations that provide health services directly are those that produce resources for providers to use in conducting their work or that facilitate this work in some way. Specific interests in policies that affect their markets, products, and profits (payment, insurance, education, labor and tools).

FDA's authority includes

Requiring larger, more prominent cigarette health warnings1 on all cigarette packaging and advertisements. These graphical warnings bring Americans face to face with tobacco-related disease on every cigarette package and advertisement. Requiring larger and more visible smokeless tobacco warnings3 on packages and advertisements.

Influencing Rulemaking

Rulemaking is an especially promising place for health professionals to seek to exert influence because they are literally invited to participate. With appropriate expertise, health professionals can be effective in helping shape the rules that guide policy implementation.

advisory board

Rulemaking is an especially promising place for health professionals to seek to exert influence because they are literally invited to participate. With appropriate expertise, health professionals can be effective in helping shape the rules that guide policy implementation. In the course of these meetings, commissioners consider the results of staff research, presentations by policy experts, and comments from interested parties, such as staff from congressional committees and CMS, health services researchers, health professionals and other health services providers, and beneficiary advocates. The most solid base for these working relationships is the exchange of useful information and expertise. f the information provided supports change, especially if it is buttressed by similar information from others who are experiencing the policy's effect, reasonable implementers may be influenced to make needed changes.

Changing Practice of Medicine

Shift from solo and small group practice to large medical groups. Insurer payment encourages growth of specialization. Large groups have the advantage of bargaining power over insurance plans and are able to negotiate higher payments and increased market share (receiving a greater portion of the health plan's total enrollees). Greater leverage over hospitals by determining which hospitals they will refer patients. There is a trend toward growth of single-specialty groups since greater profits accrue to those providers who can provide specialty procedures, imaging, diagnostic services, etc.

Do More Medical Expenditures Produce Better Health

Short answer - No. The cost of expanding medical treatments has become expensive. Medical programs have a much higher cost per life saved than non-medical programs. For example: Changing lifestyle behaviors offers the greatest promise for lowering mortality rates, and at a much lower cost per life saved.

When policies die

Some policies eventually die - they are repealed by the Legislative branch. In fact, no policy is permanent.

reward-based power

Some social power is based on the capacity to reward policymakers' compliance or punish their noncompliance with preferred decisions.

AHRQ

The Agency for Health care Research & Quality. A federal agency under Health & Human Services. Goal is to improve the quality, effectiveness, and safety of health care. Gathers information in surveys, funds research projects, and provides evidence-based guidelines for health. For example, its Consumer Assessment of Healthcare Providers (CAHPS) program provides a national health care standards database.

CDC

The Centers for Disease Control & Prevention. Monitors and controls infectious diseases. Assists local, national and international agencies to prevent the spread of disease. Requires health care providers to report some infectious diseases. Maintains stats on rates of infections and provides resources such as infection control and treatment guidelines and research personnel. For example: Issues guidelines for the treatment of STDs.

CMS

The Centers for Medicare & Medicaid Services. Works with providers to ensure quality, efficiency, and cost-effective care for older adults, the disabled, and the poor. Establishes reimbursement levels and standards of care. Works to modernize the health care industry by implementing electronic medical record keeping. Provides coding for diseases and treatments used throughout the industry and determines if treatment is medically necessary and appropriate. was created in 1977 specifically to administer the Medicare and Medicaid programs and is the primary federal implementing agent for the public laws that established and continue these programs. Centers for Medicare & Medicaid Services (CMS) Innovation Center's search for new and better payment and health services delivery models, illustrates, numerous ideas might serve as solutions to problems, either in single application or in various combinations.

CAHPS

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) program develops and supports the use of a comprehensive and evolving family of standardized surveys that ask consumers and patients to report on and evaluate their experiences with health care. These surveys cover topics that are important to consumers, such as the communication skills of providers and the accessibility of services. Over the past 10 years, the CAHPS Consortium has established a set of principles to guide the development of CAHPS surveys and related tools. These principles include identifying and supporting the consumer's or patient's information needs, conducting thorough scientific testing, ensuring comparability of data, maintaining an open development process, and keeping products in the public domain. Users of CAHPS survey results include patients and consumers, quality monitors and regulators, purchasers, provider organizations, and health plans. These individuals and organizations use the data to inform their purchasing or contracting decisions and to improve the quality of health care services.

FDA

The Food and Drug Administration is responsible for the oversight of food, drugs, medical devices, vaccines, blood products, and biologics. Establishes rules for testing, clinical trials, approval for new products. Monitors safety, medical errors and adverse reactions to treatment. Alerts the health care industry of risks associated with treatments. Monitors food products to ensure safety of the food supply.

OSHA

The Occupational Safety & Health Administration. Establishes and monitors safety regulations regarding workers. Provides on site inspections to evaluate workplace hazards. Investigates accidents and provides educational materials to promote workplace safety.

Budget preparation

The budget is developed and submitted to the General Assembly. Preparation begins July 1 and initiation starts a year before that. The governor will send and Executive Budget based on the Agencies heads recommendations.

Legislative review and approval

The budget is reviewed by appropriations committees of the House and the Senate. The General Assembly enacts its decisions about the budget in the form of the General Appropriation Bill and several individual appropriation bills. The legislatures will review the details of the proposals, which interest groups the chance to express their beliefs. The governor can reduce or eliminate the spending in a sector, especially if they may to exceed the expected revenue.

Pharmaceutical Dilemma

The cost of producing a drug is low, but the cost of developing a new drug is high. Valuable drugs that have no close substitutes will be priced high relative to cost of production. Lowering drug prices will decrease pharm companies incentive to invest millions of dollars in drugs that may have great value to society creating a policy dilemma. Growing concern that the government which is a large indirect purchaser of drugs via Medicare will attempt to lower expenses by controlling prices-> less research and development unless toward population groups and diseases where profitability is greater. Society would likely choose the full benefits that scientific discovery would offer.

Human Element in Influencing Public Policy

The diverse preferences, objectives, priorities, levels of understanding of issues, and other variables among the people in the policy market makes accurate analysis or successful influence difficult.

Homogeneity

The diversity among members of society and the fact that individual views on problems and potential solutions evolve over time explain in large part the greater influence of organizations and interest groups in shaping the policy agenda.

Characteristics of Implementing Organizations

The essence of the implementation phase of policymaking is that one or more organizations or agencies operate enacted legislation, ideally in a manner that realizes the intent behind the legislation. A good fit between an implementing organization and the objectives of the policies it implements is an important determinant of operational success. Fit is determined by whether (1) the organization is sympathetic to a policy's objectives and (2) the organization has the necessary resources—authority, money, personnel, status or prestige, information and expertise, technology, and physical facilities and equipment—to implement a policy effectively.

Redesign

The external environment shapes how policies are implemented. Organizations update their technologies to carry out their responsibilities and the structure of the organization is rearranged, especially in the context of larger change programs. Finally, changes in leadership will redesign the organization. Changes in implementation responsibilities trigger changes in the organization.

Healthcare Organizations

The government engages in health policymaking (HIPAA, ACA) to support citizens in their quest for health, although secondary purposes (economic impact) may also be served

Budget execution

The governor assumes responsibility for implementing the budget, although the various state agencies share this responsibility and the Office of the Budget is heavily involved.

Summary

The implementation phase of policymaking includes rule making and the operation of its policies. The operation stage involves running the programs embedded in enacted legislation. Operational activities are largely the domain of the appointees and civil servants who staff the executive branch of government. Federal and state governments make health policy. Each has legal authority to regulate almost every aspect of the health care system. States have control over licensing, health insurance, safety-net providers such as hospitals and local health departments that serve the poor. Both federal and state agencies are responsible for educating the general public on issues of public health concern. The operation phase of policy implementation involves the actual conduct or running of the programs and processes embedded in enacted laws

Policy Competence

The knowledge, skills and abilities that permit one to successfully - 1. Analyze the process and assess its affect on his/her domain of interest. 2. Influence the process The most important factor in policy competence is seeing the policymaking process as a decision-making process. If it interests enough people, it will be voted on and passed. If it works well it will remain unchanged. If it doesn't, it will be modified

Agency for Healthcare Research and Quality

The legislative and executive branches of the federal government are involved in policy evaluation and other forms of analysis because they are interested in the performance of the policies they enact and implement. Key federal policy analytical organizations are briefly described in the following sections. The first two agencies are executive branch organizations and the next three are legislative branch agencies. The analytical work done by all five agencies sup- ports policy formulation and implementation

Maricopa County Health Dept.

The older Americans Act of 1965 created the AoA as its primary implementation and operational agency. The mission of the AoA is to help elderly individuals maintain their dignity and independence in their homes and communities through comprehensive, coordinated, affordable systems of long-term care, and livable communities across the US.

Proposed Rule

The purpose of publishing proposed rules is to give those with interests in the issue an opportunity to participate in the rulemaking prior to the adoption of a final rule. Interest groups or anyone who wishes the change the law are especially active during this time.

Conferees

The ranking members of the committees that reported out the bill in each chamber if the House or Senate make amendments to a bill. If they can resolve the differences, a conference report is written and both chambers of Congress vote on it. If two sides do not come to an agreement the bill dies; if they accept the conference report then it's sent to the president/governor.

Organizations designed to support policy competence

The resources of organizations and interest groups can enhance the policy competence of their individual members beyond that of individuals acting alone.

Granting of Rulemaking Authority

The rulemaking process begins when Congress takes an action, that either requires or authorizes an executive branch agency to write and issue rules. Rulemaking is an necessary part of policymaking, because enacted laws are seldom explicit enough concerning the steps necessary to guide their implementation adequately.

Analysis of Alternate Solutions

The second way research informs, and thus influences, the health policy agenda is through analyses to determine which policy solutions may work or to compare alternative solutions.

Legislation Development

The way laws are written affects how they are subsequently implemented. The effect can be seen in operation. Example, The Older Americans Act of 1965 not only created the AoA as the agency with primary responsibility to implement the law, but the law was also written in a way that the Agency knew what was expected of it in the implementation and operational phases.

Audit

There is an ongoing audit of financial performance and monitoring. Even when the federal budget for a given fiscal year is completed and operating, however, the budgeting cycle continues in the form of ongoing oversight by legislative committees, auditing, and review of expenditures. Companies responsible for this include GAO, CBO, and OMB

Two factors in particular exert great influence in establishing the policy agenda

These are interest groups and the chief executive (president, governor, or mayor)

Secondary Health Service Providers

These are related to the organizations that provide health services (EX: Schools & Institutions, Insurance Companies, Medical Supply Companies)

Primary health service providers

These make up any job related to directly providing health services (EX: Ambulance providers, Doctors/Nurses/PA's, Hospital Administration, Alternative Care Providers, Pharmacies)

Health Related Interest Groups

These represent the interest of specific groups to help make sure favorable laws are passed and unfavorable ones are not. (EX: AMA, ADA, AARP, American Heart Association)

Positional Social Power

This power is a good reason for individuals, organizations, interest groups, and policymakers to associate themselves with organizations or groups that share their policy preferences as a means of increasing their ability to be influential in policymaking.

Hardships and Benefits of using Organizational Relationships to influence policymaking

This relative lack of influence is primarily a matter of resource availability, including the time required to engage effectively in the policy market and policymaking process. Individuals associated with organizations and groups can gain synergy from these relationships in their own efforts to exert influence in policymaking.

Policy Interests of health services

Those in charge of provider organizations tend to focus, for example, on policies that might affect access to their services, the costs of those services, or their revenues from them.

focus and influence in policymaking;

Typically, focus is guided by the identification of policies that are important or may become so and of problems, potential solutions, and political circumstances that might eventually lead to such policies. Possible foci include relevant policymakers in all three branches and all levels of government and others who have influence with these policymakers.

Rule X

Used to determine whether laws and programs addressing subjects within the jurisdiction of a committee are being implemented and carried out in accordance with the intent of Congress and whether they should be continued, curtailed, or eliminated, each standing committee

Distributive Justice

Usually based on distributive justice - not always equal, but trying to be fair. "Fairness in the distribution of health-related benefits and burdens in society."

CRS Research Divisions

Various Departments are responsible for American law; domestic social policy; foreign affairs, defense, and trade; government and finance; and resources, science, and industry. A knowledge services group serves the five divisions. Within each division, CRS analysts and specialists are organized into smaller sections that focus on specific areas of public policy such as education, labor, taxes, and health.

Omnibus bill

When some or all of the appropriations subcommittees fail to pass their spending bills, they send this bill to Congress to vote on

Executive Branch's role in policymaking

When the chairperson of the committee with jurisdiction does not introduce a bill that is based on executive communication, the committee or one of its subcommittees considers the proposed legislation to determine whether the bill should be introduced.

Management of organizations and units of organizations

a "process, composed of interrelated social and technical functions and activities, occurring in a formal organizational setting for the purpose of helping establish objectives and accomplishing the predetermined objectives through the use of human, financial, and other resources" (Managers establish objects and assembling resources such as employees to complete their mission). They also manage implementation policies. Managing is an ongoing task that involves constant redesign.

Federal Register

a daily publication that provides a uniform system for publishing presidential and federal agency documents. (It's collection of the proposed and final rules). It's mainly comprised of Presidential Documents, Rules and Regulations, Proposed Rules, and Notices.

Draft

a rule or set of rules that will guide the implementation of a law while the final rules are under development. Rules can be added, deleted, or modified; thus, rulemaking is an ongoing component in the life of any public law.

Rule

a statement that tells you what is or is not allowed in a particular game, situation, etc., a statement that tells you what is allowed or what will happen within a particular system (such as a language or science), a piece of advice about the best way to do something. "The whole or part of an agency statement of general or particular applicability and future effect designed to implement, interpret, or prescribe law or policy."

Possible Solutions

availability of possible solutions depends on the generation of ideas and, usually, a period of idea testing and refinement.

mandatory spending

also known as direct spending, is for entitlement programs such as Medicare, Medicaid, and Social Security.

problems that eventually lead to the development of legislation

are generally those that policymakers broadly identify as important and urgent. Problem receives aggressive congressional intervention in the form of policymaking depends on its public salience and the degree of group conflict surrounding it. The persistence of this problem, and many others, is also related to the difficulty of finding and pursuing potential solutions.

Amicus curiae briefs

are often filed to persuade an appellate court to either grant or deny review of a lower-court decision One particularly effective use of this tactic is seeking clarification from the courts on vague pieces of legislation.

Forms of introducing proposed legislation

bills and joint resolutions are used for making laws. The other two forms of proposed legislation, simple resolutions and concurrent resolutions, are used to handle matters of congressional administration or for expressing nonbinding policy views.

Policy evaluation

can be defined as systematically collecting, analyzing, and using information to answer basic questions about a policy, and ensuring that those answers are supported by evidence.

Health Policy Competence

competence in relation to health policy and the process through which health policy is formulated, implemented, and modified over time.

Discretionary spending

decisions occur in the context of annual appropriations acts.

Committee and subcommittee

deliberations provide the settings for intensive and thorough consideration of legislative proposals and issues. Each standing committee has jurisdiction over a certain area of legislation, and all bills that pertain to a particular area are referred to its committee. Committees are divided into subcommittees to facilitate work. By virtue of expert knowledge, the professional staff members who serve committees and subcommittees are key participants in legislation development.

Allocative policies technologies

deliver income, goods, or services. Such technologies include targeting recipients or beneficiaries, determining eligibility for benefits, and managing the supply and quality of goods or services provided through the policy.

Process evaluation

examines the extent to which a policy or component part of it is operating as intended by assessing ongoing operations and collecting data (determines if the process matches the general outline given by the government).

Political thrust

establishment of a political thrust forceful enough to move policymakers to act on a health-related problem is often the most challenging variable in the problem's emergence on the policy agenda and progression to legislation development. This variable can be seen clearly in the passage of the ACA in 2010. political circumstances attendant on any problem-potential solution combination are sufficient to actually open a window of opportunity depends on the competing entries on the policy agenda

executive communication

from members of the executive branch to members of the legislative branch. Such communications, which also play a role in agenda setting, usually take the form of a letter from a senior member of the executive branch such as a member of the president's cabinet, the head of an independent agency, or even the president. These communications typically include comprehensive drafts of proposed bills.

Effective Oversight techniques

funding appropriations (basing the budget on performance - NIH, FDA, HHS, USPHS) and direct contact between members of Congress and their staffs and executive branch personnel who are involved in implementing policies and the use of implementation oversight agencies.

Quantification and documentation of health-related problems

give the problems a better chance of finding a place on the policy agenda.

Libertarian perspective

government and other institutions should only exercise a limited role in human affairs. requires a maximum of social and economic liberty for individuals. Policies that favor unfettered markets as the means of distributing the benefits and burdens associated with the pursuit of health reflect the libertarian theory of justice

Egalitarian perspective

holds that everyone should have equal access to the benefits and burdens arising from the pursuit of health and that fairness requires recognition of different levels of need.

Public Policies

ideas come from members of the House of Representatives and the Senate but are influenced by Congress members, interest groups, and the general public

Implementation Phase

implemented law or amendment can affect one or more determinants of health by changing the physical or social environment in which people live and work, affecting their behavior and even their biology, and by influencing the availability and accessibility of health services. The implementation phase of public policymaking involves managing human, financial, and other resources in ways that facilitate achievement of the goals and objectives embodied in enacted legislation. Policy implementation is primarily a management undertaking and they use resources to pursue the objectives inherent in public laws and amendments.

Vague objectives

improving the health of people; increasing the accessibility (including overcoming geographic, architectural, and transportation barriers), acceptability, continuity, and quality of health services; and restraining increases in the cost of providing health services.

Theory or Logic Model

inherent in many policies, whether they take the form of public laws, rules or regulations, other implementation decisions, or judicial decisions. Essentially, a policy's underlying theory or logic model is an expression of how resources are meant to be used or processed to achieve the policy's objectives. The objectives are written so healthcare professionals can understand the important information in the policies. If resources a, b, and c are assembled and then processed by doing m, n, and o with the resources, the results will be x, y, and z.

Cost-benefit evaluation

involves comparing the relative costs of operating a policy or component (expenses, staff salaries, etc.) to the benefits (gains to individuals or society) the policy generates. (Is the cost saved in healthcare worth the money lost from an industry)

Cost-effectiveness evaluation

involves comparing the relative costs of operating a policy or component with the extent to which the policy or component met its objectives. (Is the current budget spent to implement the policy working)

Designing

involving establishment of the working agenda of an implementing organization and developing plans for how the work will be accomplished, organizing the agency to perform the work, directing the staff of the agency in doing the work, and controlling results—is the essence of management. (Establish agenda, address agenda, act upon decision). Design includes its clear/concise: objectives, hypothesis, causal relationships, and defining the roles of organizations that are affected by the implementation policy. It is important that all of these are well defined and concise without being too constricting, especially the roles that organizations must policy

Research

is "the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to healthcare, the quality and cost of healthcare, and ultimately our health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations. It is also defined as the "scientific inquiry into the ways in which health services are delivered to various constituents. The main goals of this type of research include identifying the most effective ways to organize, manage, finance, and deliver high-quality care and services and, more recently, how to reduce medical errors and improve patient safety.

policy marketplace

is a place where many people and groups promote their policy preferences.

Summative evaluation

is a type of outcome evaluation that assesses the results or outcomes of a policy or component. (Is the policy working?)

Formative evaluation

is a type of process evaluation of new or amended policy or component of it that focuses on collecting data on operations so that needed changes or modifications can be made to a policy or component in its early stages. (collecting data to formulate a change)

Ex-post policy evaluation, also called retrospective evaluation

is a way to determine the real value of a policy. This determination depends on an assessment of the degree to which a policy's objectives are achieved through its implementation.

Outcome evaluation

is designed to assess the extent to which a policy or a component of it results in outcomes in terms of specific variables or data elements. Compares the outcome to the hypothesis

Policymaking process

is not a perfect process. Mistakes of omission and commission are routinely made in the formulation and implementation phases. This phase is necessary because perfection eludes policymakers in the formulation and implementation phases. Even policy decisions that are correct when they are made must .adjust to accommodate changing circumstances

HIPAA

is overseen by the Office of Civil Rights. Intended to protect the identity of the patient. Why is this important? Health Insurance Portability and Accountability Act of 1996. For the first time, a set of national standards for the protection of certain health information These came into effect due to - Concerns about the collection, storage, and use of sensitive information led to the passage of HIPAA in 1996. Actually went into effect in April 2003

Executive Branch in implementation Phase Executive Branch agencies

issue regulations with the full force of law, but these are only under the authority of laws enacted by Congress.

publicly salient problem

issue with high actual or potential level of public interest.

Conflictive problems

issues are those that stimulate intense disagreements among interest groups or those that pit the interests of groups against the larger public interest. Incentives for legislators to intervene in problems or issues are greatest when salience is high and conflict is low

bill or a joint resolution

it must pass both the House of Representatives and the Senate and be signed by the president to become law. Simple resolutions (passed in either the House of Representatives or the Senate) and concurrent resolutions (passed in both the House of Representatives and the Senate) are not presented to the president because they do not become law.

Federal Administrative law judges

judges in the implementing agencies hear the appeals of people or organizations who are dissatisfied with the way the implementation of a policy affects them. Federal administrative law judges are certified by the Office of Personnel Management and ensured decisional independence.

just deserts

justice is done when a person receives that which he deserves

policy competence

knowledge, skills, and abilities that permit one to analyze the public policymaking process and assess its impact on one's domain of interest. Specifically, policy competence can help health professionals influence policymaking and the decisions reached through this process so that the decisions contribute to improved health. This idea acknowledges that a manager, physician, nurse, or other health professional can positively affect health by improving access to and the quality of appropriate health services, preventing further degradation of the physical and social environments in which people live, educating people about healthier lifestyles and choices, conducting or supporting the conduct of research, and participating in a host of other health-enhancing activities.

Influencing Policy Implementation

laws and amendments are often vague on implementation details, leaving to the implementing agencies and organizations the responsibility for designing, rulemaking, operating, and evaluating activities of policy implementation. Many implementing organizations support demonstration projects as a means of discovering ways to improve implementation

Limits of influencing policymaking

limiting—problem for those wanting to influence the policymaking process though the designing, rulemaking, operating, and evaluating activities of policy implementation is the enormity of the bureaucracy

Interest groups rely heavily on four tactics

lobbying, electioneering, litigation, and, especially recently, shaping public opinion so that it might in turn influence the policymaking process to the groups' advantage

Improving Management tips

long-standing shared values and commonly accepted principles and norms help shape the organization's mission and operating practices and resolve conflicts among competing views; a history of success in implementing policies helps legitimize the organization's claims for support from internal and external stakeholders; and a history of effective relationships with oversight actors and relevant interest groups and the availability of adequate financial resources provide a sense of organizational pride, stability, self-determination, and autonomy.

Ex-ante policy evaluation, also called anticipatory or prospective evaluation

mainly influences agenda setting, whether in the original formulation of a policy or in its subsequent modification.

Enactment of laws and amendments

marks the transition from policy formulation to the policy implementation phase of policymaking,

Decision-making model

model shares the basic pattern of the organizational decision-making process typically followed in the private and public sectors. However, differences between the two sectors in the use of this model typically arise with the introduction of the criteria used to evaluate alternative solutions. Decisions made by public-sector policymakers must reflect greater political sensitivity to the public at large and to the preferences of relevant individuals, organizations, and interest groups. The greater political sensitivity required helps explain the importance of the third variable in agenda setting in the health policymaking process, political circumstances.

Reasons for Rulemaking

new technologies or new data on existing issues; concerns arising from accidents or various problems affecting society; recommendations from congressional committees or federal advisory committees; petitions from interest groups, corporations, and members of the public; lawsuits filed by interest groups, corporations, states, and members of the public; presidential directives; requests from the Office of Management and Budget or other agencies; and studies and recommendations of agency staff

Laws and personal autonomy

no fundamental inconsistency or incompatibility exists between the autonomy of individuals and the authority of government so long as government's authority does not exceed the limits set by those who are governed. rights of individuals to independent self-determination regarding how they live their lives and to their rights regarding the integrity of their bodies and minds. Respect for persons in seeking to influence health policymaking reflects issues that pertain to privacy and individual choice, including behav- ioral or lifestyle choices.

Observing to Identify Public Policy

policy competence requires sufficient knowledge of the context and process. It is accomplished through reading the relevant literature, interacting with knowledgeable colleagues, and participating in continuing professional education programs. This first step in developing policy competence is closely akin to typical efforts to stay abreast with developments in a professional's domain of expertise. it helps them classify and organize complex information about the policy market and the public policymaking process and the forces and pressures that affect the process; • identify current public policies that do or will affect their goal accomplishment; identify the formulation of emerging public policies—including new laws, amendments, and changes in rules—that might eventually affect their goal accomplishment; speculate in a systematic way about potential future relevant public policies; and link information about public policies to their professional goals and strategies, and thus to their performance. (Identify the problem, find potential solutions, and identify political circumstance to make a change). It would help to work with others over social media or newsletters such as the Morning Briefing

three sources of social power

position in society; the ability to provide or withhold rewards; and the possession of information, knowledge, or expertise.

expert social power

possession of expertise, knowledge, or information that is valued by policymakers.

Chief executives

presidents, governors, or mayors—also influence the policy agenda, including the agenda for policy in the health domain. Chief executives can even rival powerful interest groups in their ability to shape public opinion around the public policy agenda. Chief executives can emphasize problems and preferred solutions in a number of ways, including press conferences, speeches, and addresses.

window of opportunity

problems and potential solutions move toward development of legislation

Forecasting

projecting involves extending the information and its impact beyond its current state. Information is collected through searching for signals, sometimes distant and faint, that may be the forerunners of important future circumstances.

Congressional Budget Office

provide Congress with the objective, timely, and nonpartisan analyses needed for economic and budget decisions and with the information and estimates required for the congressional budget process. They state how much a legislation is expected to cost. Their services include helping Congress formulate budget plans, helping it stay within the scope of these plans, helping it assess the impact of federal mandates, helping it consider the impact of policies on the federal budget, and suggesting more effective alternatives

Allocative policies

provide income, services, or other benefits to certain individuals or organizations at the expense of others. allocative policies distribute benefits and burdens according to the provisions of a morally defensible system rather than through arbitrary or capricious decisions.

Clear Hypothesis

provide resources necessary for public and private social service providers to meet the social service needs of the nation's elderly population.

HIPAA Privacy Rule

provides federal protections for individually identifiable health information held by covered entities and their business associates and gives patients an array of rights with respect to that information

The Statutes at Large

published annually, contains the laws enacted during each session of Congress. In effect, it is a compilation of all laws enacted in a particular year. The US Code is a complete compilation of all the nation's laws. A new edition of the code is published every six years, with cumulative supplements published annually.

Office of the Budget director

reports directly to the governor, exerts considerable influence as the office evaluates the agencies' requests and begins to help them formulate preliminary spending and revenue recommendations. They also have the authority to establish the authorized salaried complement for agencies and to request and approve agency spending plans or rebudgets with the governor and create audits to check the progress of the funded organizations.

The ethical behavior of all participants in the market where policymaking occurs should be guided by four philosophical principles

respect for the autonomy of other people, justice, beneficence, and nonmaleficence.

continuing resolution

routinely used joint resolution is one to make continuing appropriations beyond the end of a fiscal year when the regular appropriations bills for the next year have not been completed.

The rules used to implement policies can undergo revisions

sometimes extensive continual revision - and new rules can be adopted as experience dictates. This characteristic makes the process more dynamic than it would be otherwise.

Clear Objectives

serve Medicare beneficiaries' healthcare needs; • protect the financial integrity of the program and preserve the solvency of the Medicare trust funds; make sure payments to providers are adequate to ensure their participation in the program; ensure the quality of services provided to program beneficiaries; guard against fraud and abuse in the program's operation; work with numerous private contractors, ensuring their quality and keeping them satisfied with the relationship; and work with states, respond to congressional oversight, and serve the political and policy priorities of the executive branch.

Roles of organizations

should be concise but not too constricting. Preferably policies should detail the new regulations that are being enforced and give managers of the organization the freedom to accomplish these responsibilities and punish rule breakers.

Trend extrapolation

simply tracking particular information and its path or trajectory to predict future changes. Public policies do not emerge de novo. Instead, they result from chains of activities that can and typically do span many years. Understanding the history of policies and related policy information makes the results of the policymaking process easier to predict. It works best under highly stable conditions; under other conditions it has significant limitations. When used to forecast changes in public policy information, it usually predicts some general trend—such as a directional trend in the number of people served by a program or in a funding stream. Significant policy changes and changes in technology, demographics, or other variables can render the extrapolation of a trend meaningless or misleading.

Paternalism

someone else determines what is best for people. (EX: 1990 Patient Self-Determination Act (P.L. 101-508).

Competing proposals

tend to make agenda setting rather chaotic, although rigorous research and analysis can sometimes provide more clarity.

When interest groups turn to the courts, they are likely to use one of two strategies

test cases and amicus curiae ("friend of the court") briefs. interest groups may attempt to ensure that cases that pertain to their interests are brought before the courts, which is known as using the test-case strategy

Influence

the capacity to have an effect on decisions and actions of others.

social power

the degree of influence that an individual, organization, or group possesses.

Rule making

the establishment of the formal rules. 1st step in policy implementation. The relationship between rulemaking and the operational activities involved in the implementation of a law is cyclical. Rulemaking is typically a timely process, allowing implementation to proceed smoothly, but this is not always the case

Branches of government in the implementation phase

the executive branch bears much of the responsibility for implementation and plays a central role in policy implementation, the legislative branch oversees implementation, and the judicial branch also plays a role, largely refereeing implementation.

One factor clearly mitigates the usefulness of this tactic and makes difficult its use by interest groups

the heterogeneity of the American population's perceptions of problems and preferred solutions to them. The mix of physical, organizational, political, motivational, and intangible resources available to an interest group (I'm pop), and how effectively the group uses them, helps determine the group's influence on the policy agenda and other aspects of the policymaking process. A particular group's performance is also affected by its access to resources compared with groups that may be pursuing competing or conflicting policy outcomes

Specialized departments

the public affairs department, government affairs department, or government relations department—to perform the actual work.

implementation phase

the responsibility for policy making shifts from the legislative branch to the executive branch

External environment components

the situations and preferences of individuals, organizations, and groups as well as biological, biomedical, cultural, demographic, ecological, economic, ethical, legal, psychological, science, social, and technological variables affect policymaking throughout the process.

informal organization

the system that develops spontaneously as employees meet and form cliques, relationships, and lines of authority outside the formal organization. relationships and interactions that lie outside the boundaries of the formal structure—that people working together invariably establish based on the wishes of the individuals.

Lobbying

the word for these influencing activities. lobbyists, the word for people who do this work, arose in reference to the place where such activities first took place Lobbyists' whole professional purpose is to persuade others to make decisions that are in the best interests of those who employ or retain them. Lobbyists are an important source of information for policymakers. Lobbyists can assist policymakers with the development and execution of political strategy political strategy. Lobbyists can assist elected policymakers in their reelection efforts. Lobbyists can be important sources of innovative ideas for policymakers. lobbyists can be friends with policymaker Electioneering: using the resources at their disposal to aid candidates for political office, One of the most visible aspects of electioneering is the channeling of money into campaign finances. The most influential health interest groups, including those representing hospitals, physicians, and nurses, have particularly strong grassroots organizations to call into play in their lobbying and electioneering tactics.

respect for persons

treating persons as autonomous agents and protecting those with diminished autonomy. The ethical principle of respect for persons is based on the concept that individuals have the right to their own beliefs and values and to the decisions and choices that further these beliefs and values. This requires the professionals to be *respectful, honest, and keep confidentiality/fidelity*

Modification of prior policies

whether in the form of decisions representing public laws implementations of rules, rulings of a court, or operational practices - pervades the entire policymaking process. The likelihood that prior decisions will be revisited and changed distinguishes public policymaking in the US. Those who formulate and implement policies may seek modifications based on the performance and consequences of existing policies