CHAPTER 13
Health Policy
Health policy is a type of public policy. It consists of authoritative decisions made in the
legislative, executive, or judicial branches of government to influence the distribution of
healthcare resources and services.
FORMS OF HEALTH POLICY
2. By-product of other public policies—for example, policies supporting biomedical research.
4. Health policies affecting certain types of organizations, such as hospitals, nursing homes, or
employers.
5. Private policies are sometimes created to preempt public policies. For example, the
USES OF HEALTH POLICY
Two primary uses
2. Allocative tools—used to allocate resources.
Two main types
2. Redistributive policies take money or power from one group and give it to another. For
FEATURES OF US HEALTH POLICY
1. Government as subsidiary to the private sector
2. Fragmented, incremental, and piecemeal
Health policy is often fragmented for lack of coordination between federal, state, and local
3. Pluralistic and interest group politics
4. Decentralized role of the states
Health policy in the US is not concentrated at the federal level. States have a significant role.
5. Impact of presidential leadership
The executive office is often looked to for strong leadership in health policy matters.
THE MAKING OF HEALTH POLICY
The policy cycle
• The policy cycle has five stages:
1. Issue raising—evaluation of a problem requiring policy decision.
3. Public support building—public appeals and seeking support from interest groups.
5. Legislative decision making and policy implementation —vote, president’s signature, public
hearings, rulemaking, allocation of resources.
• Suppliers of policy
a. The legislative branch, senators and congressmen, are often the key suppliers of policy
because of the constitutional powers Congress has:
Legislative committees and subcommittees
• Most influential House committees:
• Ways and Means Committee—deals with tax issues; also holds jurisdiction over Medicare Part
A, Social Security, public welfare, and healthcare reform.
The legislative process
• House
1. A bill is introduced in the House of Representatives.
3. It is assigned to a subcommittee—forwarded to affected agency, hearings and testimonies,
amended if needed, decision to recommend, not recommend, or table the bill.
5. If approved, the bill is forwarded to the Senate.
• Senate
2. If recommended, the bill is presented to the full Senate, where it may be amended.
4. Controversial changes may trigger review by a Conference Committee (includes committee
members from the House and Senate).
5. After the bill has passed both the House and Senate in identical form, it is sent to the president
2. The bill is vetoed if the president does not sign it.
3. The veto may be overturned by a two thirds majority of the Congress, otherwise the bill is
2. Hearings are held.
3. Final regulations are drafted.
Critical Policy Issues
• Access to Care
• Cost of Care
• Quality of Care
ACA Takeaway
• With the enactment of the ACA the landscape of health policy in the US is on the verge of
undergoing significant change.
TERMINOLOGY
• Allocative tool—Designates a use of health policy in which there is a direct provision of
income, services, or goods to groups of individuals who usually reap benefits in receiving them.
• Distributive policies—Spread benefits throughout society. Examples are funding of medical
research through the NIH, the training of medical personnel through the National Health Services
Corps, the construction of health facilities under the Hill-Burton program, and the initiation of
new institutions (e.g., HMOs).
REVIEW QUESTIONS
1. What is health policy? How can health policies be used as regulatory or allocative tools?
Health policies refer to public policies that pertain to or influence the pursuit of health. Health
policies often come as a byproduct of public social policies enacted by the government. They
pertain to health care at all levels and include policies affecting the production, provision, and
financing of healthcare services. Health policies affect groups or classes of individuals, such as
2. What are the principal features of US health policy? Why do these features characterize
US health policy?
The principal features that characterize US health policy include the government as subsidiary to
3. Identify health care interest groups and their concerns.
a. Federal and state government—cost containment, access to care, quality of care
4. Why do you think the Clinton health reform failed but the Obama health reform
succeeded?
5. What is the process of legislative health policy in the United States? How is this
process related to the principal features of US health policy?
The formation and implementation of health policy occurs in a policy cycle that has five
components: (1) issue raising, (2) policy design, (3) public support building, (4) legislative
decision making and policy support building, and (5) legislative decision making and policy
6. Describe the critical policy issues related to access to care, cost of care, and quality of
care.
• Access to Care—Access-to-care policies are aimed primarily at providers and payment
mechanisms with the purpose of expanding care to the most needy and underserved populations,
including the elderly, minorities, rural residents, those of low income, and persons with AIDS.
CHAPTER 14
The Future of Health Services Delivery
INTRODUCTION
Future direction of health care will be governed by current developments, forces of future
change, and historical precedents.
FORCES OF FUTURE CHANGE
1. Social and demographic forces
The elderly, vulnerable populations, and people with certain health conditions all present
2. Economic forces
The national debt, economic growth, employment, and household incomes will determine
3. Political forces
4. Technological forces
5. Informational forces
6. Ecological forces
New virus strains, natural disasters, bioterrorism, and zoonoses will continue to challenge
7. Global forces
Health and health care in various countries will continue to be affected in diverse ways
8. Anthro-cultural forces
American beliefs and values have historically opposed radical changes in health care. A
significant proportion of Americans remain opposed to the ACA, and could well decide
its final fate in the future.
THE FUTURE OF HEALTH CARE REFORM
Whether the US will end up having a single-payer system would depend on the ACA’s
promises becoming reality, how it affects the majority of middle-class Americans, and
how the forces of change play out in the future.
Lessons From Massachusetts
Although there was a major improvement in reducing the number of uninsured, cost
Likely Experiences Under the ACA
A caveat: one state does not represent the ethos of the entire country. Unlike Massachusetts,
a significant number of Americans and physicians, in particular, have been against the
ACA. Access to health care would likely be an issue in the future. Mirroring the experience
What If?
The seeds for health care reform have already been sown, and it will no longer remain a
dead issue. Any future reforms would build on rather than scrap completely some of the
provisions in the ACA.
Universal Coverage and Access