Assessing and Regulating Health Services

Role of Government Plays a major role in planning, directing, and financing health services Health policies and programs have evolved piecemeal in response to needs not being met by private sector or by states and local governments

Government Role Continued The burden of financing publicly supported health programs now falls more heavily on state and local governments A Paradox: Government spends more money to support wide range of health programs, services and agencies, yet the role of government in the reform of our health care system remains limited and halting

Dimensions of Policy Making Public & Private Sector: primary concern is the absence of any blueprint for governmental reform Federal System: A shift in responsibilities do not pose a problem for health policy if regulatory responsibilities and financial accountability are consonant and the levels of government possess the capacity to assume responsibilities assigned to them.

State and Local Governments What matters most in the structure of relationships within federalism is not so much distribution of activities but the relationships among levels of government.

State Government May have less political will to make decisions in public interest than the federal government Wide variations among states in program outputs suggest significant inequities Failure of states to provide their citizens equal rights and equal protections has been in the area of civil rights

State Government Evidence that the capacity and will to govern is becoming more widely diffused with the federal system Considerable increase at the state level in conduct of policy analysis and its use in policy deliberations is one indication that state capacity to plan and manage is improving. States spend a large portion of their general fund budgets on health care for the poor, mental health services, support of a range of public health programs and education of health professionals

State and Local Government Local governments remain an important provider of health care Both state and local governments are mandated by higher levels of government to provide services or implement various environmental health or occupational health and safety regulations

Pluralistic Politics Describe a set of values about the effective functioning of democratic governments Physicians, large insurance organizations, hospitals, and highly diversified groups of profit makers in health care are the power centers that influence nature of health care and role of government in policy making.

Incremental Reform Policy is made in small steps (increments) and that policy is rarely modified in dramatic ways. Policy makers prefer reform in small steps to a more radical change due to the risks involved in the political market.

Quality of Health Care Assessment of quality can be performed through implicit and explicit measurement Explicit measurement involves comparing the quality of care against some predetermined standard Implicit measurement is usually subjective

Quality of Care The dimensions of quality of care include structure of care, process of care, and outcomes of care. Another important measure of quality of care is access to necessary health care services.

Quality and Cost Containment Some efforts may maintain and possibly enhance quality of care, while others may compromise quality of care, especially when necessary and appropriate care is eliminated

Managed Care and Quality Some studies have been completed to compare quality of care in managed care and fee-for-service health systems. No clear differences are seen when comparing most quality of care and outcome measures