HPM Midterm Flashcards
(46 cards)
1
Q
Private Policy
A
- Hospital employee flu shot = private “policy”
- Private accrediting bodies (Joint Commission, NCQA)
2
Q
Public Policy
A
- Public policies are authoritative decisions made in the legislative, executive or judicial branches of government
- Public policies that pertain to health are health policies
3
Q
Role of the legislative branch
A
- FORMULATES POLICY
- enacts laws
- creates and funds health programs
- balances health policy with other domains
4
Q
Role of executive branch
A
- IMPLEMENTS POLICY
- proposes legislation
- approves or vetos legislation
- promulgates rules and regulations
5
Q
Role of judicial branch
A
- INTERPRETS POLICY
- interprets constitutional and statutory law
- develops body of case law
- preserves rights
- resolves disputes
6
Q
Operations Decisions
A
- Once laws and regulations establish programs (like Medicare, Medicaid), health agencies (CDC, FDA, state Health Departments) have discretion to manage the programs
- Agency operational decisions by government officials are “health policy”
- example of decisions in Medicare: eligibility and coverage determinations, payment, fraud and abuse
7
Q
Categories of health policies
A
Allocative & Regulatory
8
Q
Allocative health policy
A
- Policies that distribute or re-distribute finite resources
- Often provide net benefits to one group at the expense of others to meet policy objective
9
Q
Regulatory health policy
A
- Directives that influence the actions, behaviors or decisions of others
- Examples: licensing of practitioners, certificate of need, FDA safety/efficacy regs, antitrust, workplace safety
10
Q
Why the government is involved in health policy
A
- In a market economy, the private market should determine the production and consumption of health services
- Government intervenes when the private market fails to achieve desired public objectives
11
Q
How & Why the US health sector has failed
A
Failed to: guarantee access & control healthcare costs
Because: buyers and sellers do not have sufficient information to make informed decisions & small number of sellers control market, barriers to entry
12
Q
National healthcare spending trends
A
- private has decreased, public has increased, now about equal
- government share now accounts for more than half of U.S. health care expenditures
- growing entitlement spending
13
Q
Why should be care about health policy
A
- Cost – largest component of the economy – and growing
- Quality – substantial evidence that the quality is not as good as it could be
- Access – literally millions of people have inadequate access to health care services
- Variability – all of these characteristics vary by location, ethnicity, income, etc.
14
Q
Trends of healthcare cost over time
A
- dramatic increase in US health expenditures, now approaching 3 trillion, nearly 18% of the GNP
- US spends the most compared to all countries
15
Q
Why does US healthcare cost so much?
A
- higher prices than other countries for same services
- higher administrative overhead costs
- high-cost, high-tech equipment and procedures
- American tort laws can lead to “defensive medicine”
16
Q
Four main drivers of cost
A
- technology and prescription drugs
- chronic disease (more people who are “sick” in population: diabetes, hypertension, HIV)
- aging of the population
- administrative costs
- (higher inflation rate in healthcare)
17
Q
Combination effect
A
combination of increasing life expectancy and the increase in chronic disease with age produces a progressively on “on average” older, sicker population
18
Q
Measurements of healthcare quality
A
- life expectancy at birth
- childhood mortality
- US sucks and is worse quality than many countries, even though it also costs more
- medical error rates
- loooots of geographic variability - cost, quality, etc
19
Q
Conditions necessary for free markets
A
- infinite buyers and sellers
- zero entry and exit barriers
- perfect factor mobility
- perfect information
- zero transaction costs
- profit maximization
- homogeneous products
- non-increasing returns to scale
20
Q
Forms of health policy
A
- laws, regulations, operational decisions, judicial decisions
21
Q
Interest groups
A
- Interests of those employed in health sector more concentrated than individual consumers
- Both proactive and reactive (block legislation)
- Seek to influence policymaking to some advantage of the group’s members
22
Q
How interest groups influence policy making
A
- lobbying
- electioneering
- litigation
- shaping public opinion
23
Q
Problems that get on the policy agenda
A
- important and urgent
- issues/trends that reach an unacceptable level
- widespread applicability or impact small but powerful group
- closely linked to other problems (like cost)
24
Q
Agenda setting
A
agenda setting as a consequence of the health-related problems, possible policy solutions that address those problems and the current political circumstances
25
Political circumstances that either open or close the window of opportunity
- political "will" necessary
- competing issues on the agenda
- which party controls the chamber and the executive branch
- fillibuster
26
Committees with health jurisdiction
- Senate: Aging & Youth, Consumer Protection & Professional Licensure, Law & Justice, Public Health & Welfare, Veterans Affairs & Emergency Preparedness
- House: Aging & Older Adult Services, Children & Youth, Health, Human Services, Professional Licensure
- jurisdictions overlap & multiple committees oversee health
27
Legislative hearings
Hearings provide a forum where facts and opinions can be presented from witnesses with varied backgrounds (experts & other interested parties)
28
Types of legislative hearings
- legislative
- oversight
- investigative
- confirmation
29
Policy Formation - Exemplary Policies
- Healthcare Associated Infections (HAIs)
- Prescription drug monitoring
- SEE WEEK 3 POWERPOINT FOR FULL EXAMPLES
30
Policy implementation
- Health policies must be implemented effectively if they are to carry out the intent of the authoritative decision
- Health policies must be implemented effectively if they are to affect the determinants of health
- Implementation is a management exercise by the executive branch (with legislative oversight)
31
Types of implementation activities
- rulemaking - establishment of formal rules necessary to effect the intent of laws
- operation - activities of implementing organizations to carry out the law
32
Implementation responsibilities of the three branches of government
- executive agencies - primary role is implementation of laws formulated by legislative branch
- legislative oversight - appropriation committees (funding) & standing committees (direct oversight)
- judicial role - Administrative Procedures Act (ALJs)
33
Key features of the rule making process
- Congress (or state legislature) grants rulemaking authority to an agency
- Agency develops draft proposed rule and publish in Fed. - - Register
- Public comment
- Agency responds to comments and makes revisions
- Governmental Review (OIRA/OMB or IRRC at state level)
- Publication of Final Rule, Rule takes effect
34
Key features of operation
- resources (budget)
- management: leadership and personnel
- competencies: policy, conceptual, technical, interpersonal
35
Policy Implementation - Exemplary Policies
ACA Health Benefit Exchanges
Clean Indoor Air Act
SEE WEEK 4 POWERPOINT FOR FULL EXAMPLES
36
What gives authority to states to regulate Public Health?
- Tenth amendment of the constitution (powers not delegated to the feds are reserved for the states)
- police power
- McCarran-Ferguson Act of 1945 (gives states authority to regulate the "business of insurance" without interference from federal regulation)
37
State and Local Roles in Health Policy
- Protector of the Public Health and Welfare (environmental regulations, restaurant inspection)
- Purchaser of Healthcare Services (Medicaid)
- Regulator (health professions, hospitals, nursing homes, health insurers)
- Safety Net Provider (health clinics, state mental institutions, manage federal programs like WIC)
- Health Education (subsidize GME, loan repayment, carry out public health education)
- Policy Laboratory (medical home, health information exchange, HAI reduction)
38
Air Toxic Guidelines
ATGs are not a regulation; they are used as guidance during Installation Permit (IP) reviews to evaluate the impact of air toxic emissions on Public Health
39
Features of the Proposed ATG’s
- Derived by true consensus of ATG committee members
- Science-based, sensible risk levels
- Cumulative risk (rather than chemical by chemical)
- Toxicity information from authoritative published sources
- Easy-to-follow steps to guide modeling requirements
- Environmental Justice through protection of high risk “hot spots”
- Creative and flexible off-setting process (including mobile sources)
- Written in simple “non-legalistic” style
40
Policy modification
- Consequences of existing policies constantly feed back into policy formulation & implementation (dynamic and cyclical)
- Majority of health policymaking is modification of existing policy
- Modification can result from both negative and positive consequences of policies
- Continual modification of U.S. health policymaking process is best described as incrementalism
41
Policy modification process
- same process as initial/original policy
- agenda setting
- development of legislation
- rule making
- operations (internal & external)
42
Policy Modification - Exemplary Policies
- Medicare Part D
| - SEE WEEK 6 POWERPOINT FOR FULL EXAMPLE
43
Medicare benefit structure
- Part A: inpatient, skilled nursing, home health, hospice
- Part B: physician visits, outpatient, preventive services, home health
- Part C: medicare advantage
- Part D: drug benefit
44
Four key features of Medicare Part D
- Market-based insurance
- government can't negotiate drug prices
- donut hole
- formulary rules
45
Leadership
```
complex and ambiguous concept, emphasizing the qualities and behaviors seen as necessary for, and characteristic of effective leadership, especially at the top
nature of relationship between leaders and followers
- Political/socio-cultural skills
- Promoting change
- Long term horizon
- Strategic focus
- Making waves and innovating
- Proactive, risk-taking
- Radical change
```
46
Management
the process (or art) of getting things done through and with people
- Technical/functional skills
- Maintaining stability
- Short-term horizon
- Operational focus
- Conforming to standards
- Reactive response
- Incremental change
