Understanding Health Care Policy Chapter 13 Understanding Health Care Policy

What is Health Care Policy? Health policy is the collection of specific laws, programs, entitlements, regulations, administrative directions, and conditions of participation in various aspects of the health care system.

Development Process Follows a formal legal or judicial action that enables or requires the development of a new program. Once the law is passed, the next phase involves the creation of regulations and administrative guidelines and procedures.

Development Process The conditions of participation provide an additional lever in the implementation of health policy. In this set of actions, a governmental program will specify how an organization must be structured and what role it must adopt in order to participate.

The Role of Health Care Professionals Health care professionals can actively take part in the general development of values, beliefs, goals, ethics, and social directions to build the initial groundswell of support for a particular course of action.

The Role of Health Care Professionals They can provide data, research, and experience that can be used to develop ideas for legislative action. They can also help shape the activities of organizations by taking part in public commentary opportunities.

Health System Design and Policy Issues Universal health insurance coverage. Rationale: The size of the uninsured population increases annually both in number and as a percentage of the U.S. population.

Health System Design and Policy Issues Universal health insurance coverage as a state or national activity. Rationale: Attempts to deal with universal coverage and lack of insurance have not made any significant progress at the national level.

Health System Design and Policy Issues Considerable dependence on employers to provide health insurance coverage. Rationale: This approach may not be viable in the future due to the retrenchment of insurance coverage offered by employers.

Health System Design and Policy Issues Focus on acute illness versus chronic illness. Rationale: Current system fails to adequately address the issue of chronic illnesses. Given the unprecedented size of the “Baby Boomer” cohort, a chronic care model may be more appropriate.

Health System Design and Policy Issues Adoption of new electronic information systems. Rationale: The need for rapid/accurate dissemination of health data.

Financing and Cost Issues The amount of economic resources allocated to health care. Rationale: Health care currently accounts for 16 percent of GNP.

Financing and Cost Issues Which cost-containment efforts are logical and can be imposed effectively? Rationale: Cost containment efforts may have unintended consequences on various components of the health care system and its consumers.

Financing and Cost Issues How should society reward and reimburse physicians so as to encourage their involvement in the improvement of the health system and the overall health status of Americans?

Financing and Cost Issues Rationale: Hospitals are currently operating under relatively tight financial constraints and are struggling to meet the demands of their medical staff and the public.

Financing and Cost Issues How to handle the unprecedented rises in the cost of new pharmaceuticals. Rationale: To find an appropriate balance between the economic needs of competitive business entities and the medical needs of society.

Quality and Access Issues Transparency of the health care system, particularly with regard to clinical results and outcomes.

Quality and Access Issues Rationale: Increasingly, insurance organizations, employers, and the general public want to know how well a particular physician, medical group, or hospital performs specific processes of care.

Quality and Access Issues Patient safety and accident avoidance, particularly in hospitals. Rationale: Concerns expressed by the general public and leading health care critics.

Personnel and Workforce Issues Nursing shortage. Rationale: Increased demand for well-trained nurses for the aging population.

Personnel and Workforce Issues Availability of reasonably priced malpractice insurance for physicians. Rationale: Cost of malpractice insurance and the fear of legal actions have a significant impact on morale and the physician’s sense of value to our society.

People and Consumer Issues Direct-to-consumer advertising for drugs and medical procedures. How can consumers obtain comparative costs for medical procedures, etc. in order to make decisions about their health care?

People and Consumer Issues What types of health-related information should be available to the public? How should the accuracy and completeness of information be monitored and regulated? Uncertainty of health insurance coverage and the interest of insurance carriers.

Global and International Health Issues Bioterrorism Rationale: Terrorist activities have not yet involved viable health threats Potential is real and will require continuous attention.

Global and International Health Issues Rapid transmission of infectious disease from various parts of the world. Rationale: Formal surveillance and protection processes may be inadequate at this time.