1. Define health. What are the determinants of health in humans? Health is defined as the “state of complete mental, physical, and social well-being that is necessary to live a meaniful and productive life. Health determinants are the physical, behavior along with biological, social factors that affects a person’s health. 2. Define public policies and health policies. Public policies is defined as the “authoritative decisions made in the legislative, executive, or judicial branches of government that are intended to direct or influence the actions, behaviors or decisions of others.
Health policies are when public policies pertain to health and or influence the pursuit of health. 3. What forms do health policies take? Give an example of each. Health policies take the form of laws, rules and operational decisions. * Law would be the 1965 federal public law that established the Medicare and Medicaid programs. * Rules would be a federal courts ruling, that an integrated delivery systems acquisition of yet another hospital violates federal antitrust laws. * Operational would be state governments’ procedures for licensing physicians and medical personnel. 4. Compare and Contrast the two basic categories of health policies.
The two basic categories of health policies are allocative and regulatory. Allocative policies are designed to provide net benefits to some distinct group or class of individuals or organization at the expense of others to ensure that public objectives are met. Regulatory policies are policies that are designed to influence the actions, behaviors, and decisions of others by directive. In comparison, both regulatory as well as allocative policies the government establish some type of policy to appeal ad meet the public goals. Both policies are always established within the context of a complex public policy making process.
5. Discuss the connection between health policies, health determinants and health. The connection between health policies, health determinants and health is first understanding what each role is. Health determinants are elements of the physical environment, behavior, biology, social factors, and health services that affects an individual’s health. Health policies are placed and implemented to ensure that the public is “healthy”. In order for a state to determine such policies the overall health determinants will be taken into account. For example, for a smoker a smoking cessation program would be beneficial.
All of the above equals a healthy individual. 6. Discuss the role of states in health policy. States in health policy are responsible for financing or paying for health services, ensuring the publics overall health and regulating health related professionals and organizations. Currently the states also must experiment with comprehensive health reform strategies. States are responsible for the health insurance and how it operates within that state. Ensuring that nurses, doctors, techs etc. are licensed and board certified to provide specific care to individuals. 7. What is policy competency?
Why is it important to anyone who is interested in being involved in the pursuit of health? The policy competency is defined as the dual abilities to analyze the impact if public policies on one’s domain of interest or responsibility and to exert influence in the public policymaking process. Being involved in the pursuit of health such as managers and health care professionals’ policy competency will allow them the opportunity to understand the affects of the determinant of health. Chapter 2: Health Policymaking in the United States 1. Discuss the impact of health policies on the physical environment.
The impact of health policies on the physical environment is directly affected. The environment that an individual is exposed to affects their overall health. For example, the agents such as radiation, toxic chemicals, mold along with hazardous agents affects an individuals health. Such affects causes an increase in disease such as lung cancer, chemical burns, hearing difficulties and increase hospitalizations. This means that the federal government must pay out more in healthcare expenses. However, effective health policies would eliminate certain aspects of health expenses.
2. Discuss the impact of health policies on human behavior and biology. Human behavior and biology are basically the human chemical(biology) along with choices that are made. For example, human behavior would be an individual that choose to smoke and have unprotected sex. Factors that often times lead to individuals desire to drink, smoke, and have unprotected sex are things such as depression, stress and anger. Also the fact that some individuals have a genetic predisposition that influence such desires. Health policies are established to prevent or limit such activities.
Today, we have smoke free restaurants and hospitals. Healthcare providers also give out literature to educate patients on the harmful effects of smoking, drinking and unprotected sex. 3. Discuss the impact of health policies on the social factors that help determine health. Health policies such as parenting classes, comprehensive preschools along with housing improvements and disease prevention all help lower the factors that contribute to unhealthy adults and children. Social factors such as poverty, unemployment, and lack of supportive family structure is the cause of worse health status.
Health policies were established to provide services for people whom fall into the above category. By providing care and enacted policies for underprivileged the government have hopes of stopping the affects of lack of care. 4. Discuss the impact of health policies on health services in terms of the money, human resources, and technology used to produce these services. The impact of health policies on money is the fact that we expect the cost to grow. We as the United States have failed to set restrictions on certain health services. The increase in cost of services has caused some employers to drop healthcare insurance altogether.
In terms of human resources, we have a huge shortage of registered nurses. The shortage of registered nurses is due in part to excessive workloads, mandatory overtime, and poor work conditions. Health policies are established in certain states to aid in the decrease of such shortage. For example, many states have set patient-nurse ratios, as well as a law banning mandatory overtime. Technology plays an important role in health policies also. Technology allows the Federal Government the opportunity to find out what works and what resources will be available to decrease hospitalization stays.
For example, the ICDs are used to find out information about whether ICDs are of benefit to the patient. In all money, human resources as well as technology have a huge impact on health policies. All of the above will aid in what policies are established to decrease budget, increase shortages, and increase advancement in technologies. 5. Discuss the impact of health policies on individuals on health related organizations and on interest groups. Health policies affect each individual, health related organization and interest groups differently.
For example, health policies affect health related organizations in that policies are established that can hinder how they provide care to individuals. Interest groups such as NAACP are primarily focused on the health care for black individuals. If policies are established that are not of the best basis by NAACP standards this causes issues in the community. Health policies are the determining factors of how individuals, health related organizations and interest groups obtain and maintain their objective in health care. Module 2 Health Policy-making in the United States by Longest Chapter 3
Discussion Questions 1. Compare and contrast the operation of traditional economic markets with political markets? Economic Market buyers or demanders express their preference by spending their own money. Buyers of economic markets reap the benefits of their choices and they also directly bear the costs of their choices. Political markets are the linkage between who receives benefits and who bears cost is not so direct. Political markets use different decision criteria than those used in traditional economic markets. Political Markets decision makers may use different time frames.
In economic markets costs and benefits of decisions are taken into account over the long run. However, in political they are more likely to base decisions on whether immediate benefits exceed immediate cost. Similarly economic and political markets value is exchanged between supplies and demanders. 2. Who are demanders’ ad suppliers of health policies? What motivates each in the political marketplace? The demanders of health policies are anyone who considers such policies to be relevant to the pursuit of health for themselves or others about whom they care or who considers such policies to be a means to some other desired end.
Suppliers are policy makers of any legislative judicial and executive branch. Demanders are motivated by enhanced health and economic advantages by self-interests and or public-interested. All interest includes money, power, prestige and reelections. 3. Compare and contrast the pluralist and elitist perspectives on interest groups in the political market place. Pluralist perspectives on interest groups in the political market place believe that because so many interest groups are operating everyone’s interest can be represented by one or more of them. Pluralist maintains that interest groups play a positive role in public policymaking.
Elitist point out how relatively powerless and influential most groups are. Elitist believe that real political power in the United States is concentrated in the population that controls the nations key institutions and organizations and its wealth. In comparison neither elitist nor the pluralist fully explains how the interest of individuals or of an organizations acting through interest groups relate to public policy making process. Both have something of value to contribute to efforts at understanding the roles that interest groups play in market place for public policies.
4. Define power and influence. What are the sources of power in political markets? Power is defined as the potential to exert influence of market relationships and exchanges. Influence is defined as the process by which people successfully persuade others to follow their advice, suggestion or order. The sources of power in political markets are legitimate, formal, reward, coercive, expert, referent, and charismatic powers. 5. What role does the application of ethical principles play in policymaking? Ethical principles play an important role in the operation of political markets.
Ethical principles help shape and guide the development of new policies by contributing to ways in which problems are defined and their policy solutions are structured. Examples of ethics are autonomy justice etc. 6. Draw a schematic model of the public policymaking process. Policy Formulation Phase———Policy Implementation Phase————-Policy——- Policy Modification Phase 7. Describe the general features of the model drawn in question 6. The general features of the model above are the Policy Formulation phase, Policy implementation, and Policy Modification.
Policy formulation basically incorporates features incorporated with policy agenda, such as setting policies and developing legislation. Policy implementation is basically implementing the rules and guidelines that will be followed to allow an effective procedure. Policy modification allows for prior ideas and of implementations to be revisited and perhaps revised for a better change. Module 3 Law, the Legal System and Health Insurance 02/10/2010 Chapter 4 Understanding Health Insurance Discussion Questions *4. 1Most people in this country obtain health insurance through employer-sponsered plans.
Although the historical background you just read explains why this occurred, it does not discuss whether this is a good or bad thing. Is our reliance on employer-sponsered health insurance ideal for individuals? Providers? Employers? Society? What are the benefits and drawbacks to having employers as the primary source of health insurance? How different are stakeholder perspectives? Would it be better to have more federal government involovement in providing health insurance? What primary policy goal would you use to decide how to answer these questions?
Our reliance on employer sponsored health insurance is ideal for individuals. By having employers pay a percentage of the cost for employyes, employees are able to see more take home income. Providers, employers, and society is not the ideal situation for our reliance. Benefits of having employers as the primary source of health insurance is employers have the ability to pick whether to (and what type of) health insurance to purchase. However, a drawback to having employers as the primary source of health insurance is the lack of coverage for individuals without jobs.
When considered from various stakeholders perspectives, the benefits and d 4-2As a general matter, all types of insurance under traditional economic models cover expensive and unforeseen events, not events that have small financial risk or little uncertainty. For example, auto insurance does not cover regular maintenance such as an oil change, and home insurance does not protect against normal wear and tear, such as the need to replace an old carpet. Accordingly, many economics argue that health insurance should not cover regular, foreseeable events such as physical exams or low-cost occurrences such as vaccinations.
Other eceonomist support a different school of thought. An alternative economic view is that health insurance should insure one’s health, not just offer protection against the financial consequences of major adverse health events. Because people without health insurance are less likely to obtain preventive care such as physical exams or vaccinations, these economists believe it is in everyone’s best interest, ethically and financially, to promote preventive care. Therefore it is appropriate for insurance to cover both unpredictable and expensive events as well as predictable and less expensive events.
Which theory do you support? What do you think is the best use of insurance? If insurance does not cover low-cost and predictable events, should another resource be available to assist individuals, or should people pay out of their pockets for these health care needs? I feel that it would be in everyones best interest to promote preventative care. If insurance companies cover care such as physical exams and vaccinations it would decrease major occurrences. For example, if insurance companies pay for mammograms then we would notice a decrease in complications of breast cancer.
If insurance fails to cover low cost and predictable events then the government should subsidize. However, I do feel that if insurance companies as well as the government are willing to pay for preventative measures, if the patients fail to use the measures then they should be held accountabile for their medical expenses if an illness results from that failure. 4-3In general, people with low incomes or nor health insurance (or both) tend to be less healthy than those who are financially better off or insured ( or both).
As a result, policy proposals that suggest including poor, uninsured individuals in already-existing insurance plans are met with resistance by individuals in those plans are met with resistance by individuals in those plans and by carriers or employers who operate them. Yet, if an insurance plan is created that only subscribes a less healthy poor or uninsured population, it is likely to be an unattractive business opportunity because beneficiaries are likely to need a high quantity of health care that will be costly to provide.
Given what you know about adverse selection and risk, what, in your opinion, is the best way to provide insurance coverage to the poor and uninsured? Should they be included in current plans? Should the government provide financial incentives for private carriers to insure them? Should a separate plan or program be created to serve them? In these various scenarios, what incentives are created for plans, current plan members, government, and so on? Can HDHPs work for low-income population?
The best way to provide insurance coverage to the poor and uninsured is to utilize a premium based on an individuals condition or lack there of. For example, if you have an individual wanting to get health coverage 4-4What populations or types of people pay more under experience rating? Does experience rating create any incentives for individuals to act in a certain way? What populations or types of people pay more under community rating? Does community rating create any incentives for individuals to act in a certain way?
Which rating system seems preferable to you? What trade-offs are most important to you? Should the focus be on the good of the individual or the good of the community? Are these mutually exclusive concerns? 4-5As discussed earlier, risk and uncertainty are important concepts in health insurance. Individuals purchase health insurance policies to protect themselves financially against health care costs, and insurance carriers try to set premiums that will cover the costs of services used by their beneficiaries.
Currently ( when allowed by law) insurance carriers may consider factors such as medical history, demographics, type of occupation, size of the beneficiary pool, and similar criteria when setting the terms of an insurance policy. Should health insurance carriers also have access to and be able to use genetic testing results when carriers decide whether to insure an individual, what premiums to charge, or which services to cover? If you think the answer to that question should be “no” why is genetic information different from all of the other kinds of information insurance carriers may take into account when making those decisions?
Conversely, what is the strongest argument you can make in favor of allowing insurance carriers to consider an applicants genetic information? How would allowing genetic testing alter an individuals or a providers diagnosis and treatment decisions? What is the primary policy goal that affects your view? 4-6Cost containment strategies embraced by MCOs were a direct result of the FFS experience with ever-increasing utilization and health care costs.
However, many consumers and providers chafe at the restrictions imposed by MCos and are concerned that someone other than the provider is making treatment decisions. Are these restrictions appropriate and necessary? Do you favor some of the restrictions over others? Is it appropriate for one entity to be responsible for both paying for and providing care? Should someone other than an MCO-say the federal or state governments-have primary responsibility for making determinations about service utilization?
4-7In terms of containing health care costs and improving care quality, do you think health care consumers and professionals need even more restrictions than are currently used in managed care? Are there any reasons to revert back to the FSS system, even knowing its inflationary qualities? If you think that managed care is not the answer to our still-rising health care costs and quality concerns, what other tools might help lower costs and imposed by government regulation or agreed to voluntarily by insurers and the insured?