Assignment: Assessing and Regulating Health Services

Assignment: Assessing and Regulating Health Services ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Assessing and Regulating Health Services Comprehension: What is your understanding of the state of affairs in the development of health policy in the United States? What is the most important thing to “understand” about quality in healthcare? Why is it important to comprehend the complexity? Assignment: Assessing and Regulating Health Services Application: Give an example of either (but not both) a healthcare policy and its consequences or an example of a quality issue / practice in healthcare. Analysis: Analysis: In your example analyze the root causes of the issues and the pros and cons of the example. Synthesis: From your example offer a new and unique idea of yours or from the research that addresses a better solution to the issue cited. Evaluation: How is the new idea better / same / worse than the experience you described in your example? Why is it better? What improved consequences might come from your new idea? hca501__unit6.pdf Unformatted Attachment Preview P A R T F I V E R I C A R D , Assessing and Regulating Health Services A D R I E N N E 1 9 0 2 T S 295 Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. CHAPTER 13 Understanding Health Policy Paul R. Torrens CHAPTER TOPICS The Organizational Form of Health Care in the United States and Its Relation to Health Policy Types of Health Policy and How They Are Made How Individual Health Professionals Can Participate in the Development and Implementation of Health Policy The Major Policy Issues in the Future of Health Care R I C A R D , LEARNING OBJECTIVES Upon completing this chapter, the reader should be able to 1. Understand the impact of health policies on health care. A D R I E N N E 2. Gain knowledge of the development of health policy in the United States. 3. Appreciate the roles of government in health policy. 4. Appreciate the competing goals of health policy objectives. 5. Understand the key health policy issues the nation faces. 1 9 0 2 T S 296 Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. CHAPTER 13 Understanding Health Policy 297 Throughout this text, references are made to health policy issues that greatly affect health care in the United States at the present time and will continue to affect it in the future (Institute of Medicine of the National Academies, 2003). Unfortunately, for a subject that has such real and potential impacts on health care, many health professionals have little understanding of how policy is made and how it affects the system. This chapter will discuss several aspects of health policy in the United States: (1) how health care in the United States is organizedRand how the organizational form influences and,I in turn, is influenced by health policy; (2) the different types C of health policy and how they are implemented; A partici(3) how individual health professionals can pate in the development and implementation of R public policy; (4) the major health policy issues to D be addressed in the future.Assignment: Assessing and Regulating Health Services , A THE ORGANIZATIONALD FORM OF HEALTH CARE R IN THE UNITED STATES AND ITS RELATION TO I E HEALTH POLICY N The way in which a country chooses to organize its health care and the health policy of that country are N closely interrelated, but it is not clear which comes E first—which is cause and which is effect. It could be said, for example, that the health care system of a country sets the overall framework in which 1 health policy takes place and in which health policy issues are played out. At the same time, it could9 just as easily be said that the health policies of a country 0 determine what type of health care system develops and 2 are the functions; health policy decisions, therefore, drivers and shapers of the health care system T itself. In fact, both concepts are true and are actively at play in health care in the United States S and in any other country of the world; it is not an “either-or” situation but rather “both-and.” The way a health care system is organized does set the framework for health policy, and at the same time, health policy does influence the way in which a system develops and operates. The famous quote of Winston Churchill holds true: “In the beginning, we shape our institutions and thereafter, they shape us.” Therefore, it is important to understand those aspects of our health care system that have important impacts on health policy. The primary characteristic of health care in the United States has been the general theory of the least government involvement possible. From the beginning, the delivery of health care was not seen as an appropriate government function and was more likely felt to be a personal, private, and local activity. The fact that this country did not have a federal government cabinet-level department for health until l953 when the Department of Health, Education, and Welfare was created, speaks volumes about this idea. For most of our country’s history, government involvement in health was limited to protection of the public’s health in more of a policing role against dangers to health, rather than direct involvement in how health services are paid for and delivered. Directly connected to this idea of least possible government involvement, when health insurance began to be developed, it was primarily a private, employer-based system of financing, not a public system of financing as was the case in many other industrialized countries of the world. Even today, approximately two-thirds of the American population obtains health insurance through their place of employment, not through governmental programs. At the same time, it must be said that Americans value health care very highly and are quite willing to spend significant amounts of the nation’s wealth in support of a system of high excellence and standards. It has always been presumed that health care was a very highly valued social good and that our society would support it fully in economic and political ways. In line with this idea of health care being seen as high value to the society, there has always been a Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. 298 great degree of trust in science and in physicians. The American people have an almost magical belief in the power of science to eventually solve all health care problems or at least improve the health status of the people. At the same time, people in this country have had extremely strong, positive feeling toward physicians as both the deliverers of that science and as compassionate sources of personal attention. The increased respect for the benefits of scientific medicine and the already high desire to have R close relationships with skilled and compassionate physicians (and hospitals) has led to a great desire I for choice in health care options. The American C public apparently places significant value on the A ability to pick and choose among providers of care, even though they may not actually have appropriR ate evidence to make well-considered choices. Put another way, the American public does not wishD to be locked into limited systems of care and locked , out of others. This respect for science and technology as well as the desire to access the best medical care availA able have led (at least in part) to a very costly health D care system. In 2006, the United States allocated approximately 16 percent of the gross domestic R product (GDP) of the United States to health care, with estimates that this percentage will continueIto grow in the years ahead. This rapidly rising costE of care has led to greater interest in cost containment N and similar efforts to reduce the economic burden of health care. N Unfortunately, the reality is that the American E health care system is fragmented, decentralized, and unplanned, making it almost impossible to impose any type of centralized organizational reform 1 that would affect all parts of this increasingly costly 9 enterprise.Assignment: Assessing and Regulating Health Services There is simply no convenient or appropriate authority, let alone organizational structure, 0 from which rational and focused cost-containment 2 measures can be carried forward, and no real policymaking body or group that is acknowledged T by everyone in health care as having the responsibility S or authority for suggesting organizational reform, let alone to impose it (Mechanic, 2004). PART FIVE Assessing and Regulating Health Services As a result, health care policy in the United States is now driven primarily by financing and health insurance mechanisms, particularly the federal Medicare program and the federal and state Medicaid programs. Because there is no generally accepted central authority over all aspects of the American health care system, those who would try to develop health policy in this country have turned toward the only possible avenue of influence: the source of financing for health care. In particular, because Medicare and Medicaid are now responsible for providing almost half of all the financing of health care in the United States, this is a powerful lever. Also, because these two programs are governmentally organized, legislative bodies on the federal and state levels are able to develop health policy as part of their responsibility to supervise these two governmental programs (Ball, 1995; Moon, 2000). In essence, the major efforts for health care policy in the United States have been carried out through legislative and regulatory oversight of Medicare and Medicaid (Brown & Sparer, 2003). Finally, since the share of health care financing has increasingly been carried by Medicare and Medicaid, greater and greater responsibility for health care policy development has moved to federal and state governments (and their legislatures). With almost half of all health care financing now being coordinated by one federal government agency, the Centers for Medicare and Medicaid Services (CMS), it is only natural that individuals and organizations throughout the entire country increasingly focus their attention on what happens in Washington, DC. TYPES OF HEALTH POLICY AND HOW THEY ARE MADE When discussing “health policy,” it is necessary to point out that the term is often used in two different ways, each of which may lead to different conclusions, actions, and impacts. It is important to review Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. CHAPTER 13 Understanding Health Policy the two interpretations, so that health professionals can understand clearly what their objectives and efforts to influence health policy might entail. On the one hand, “health policy” is a term frequently used to describe an informal and general set of values, ethical standards, legal decisions in court cases, and the like. A statement such as “the policy of this organization will be . . .” lays out general guidelines, directions, and statement of intentions in connection perhaps with a broad statement of mission, vision, and values of a person, an organizaR strength tion, or a society. It has the advantage and of being a general summary of a broad set I of social, political, and economic truths, but also the disadC vantage of perhaps being nonspecific, lacking in deA out by tail, and without any means of being carried individual actions. It has the strength of being suffiR ciently broad and general to draw in a broader D range of opinions and participants, specifically because it doesn’t commit them to a particular set of , detailed agreements or details; the weakness is that it does not necessarily force commitment to a particular set of actions. Assignment: Assessing and Regulating Health Services More often than not, A health policy of the more formal and detailed variety does not D take place until this more informal agreement on general principles and beliefs is solidly R developed. The more frequently used interpretation of “health policy” is the collection of specificI laws, programs, entitlements, regulations, administrative diE rections, and conditions of participation in various N aspects of the health care system. In this context, health policy is specific, detailed, and focused N and is usually accompanied by descriptions of financing E and administration, as well as specific time periods to be covered, assignment of oversight and administrative authority, and other organizational 1 matters. The formal mechanisms for this interpretation of 9 action of health policy usually begin with legislative some type that creates a broad set of governmental 0 responsibilities, authorities, programs, and financ2 ing; this usually follows the more informal and broader consensus building discussedTearlier. It may result in the creation of an entirely new area S mean of governmental activities or it may simply expansion of an already existing program or orga- 299 nizational area of activity. The passage of the original Medicare legislation in the 1960s is an example of the first, while the addition of the Part D Medicare drug benefit in 2006 would be an example of the second (Inglehart, 2004). Often development of a new policy may follow a formal legal or judicial action that either enables or requires development of a new program; often, too, the development of a new policy may be followed by legal or judicial tests of the legislation and programs created by legislative action. An example of the first might be a court ruling stating that the provision of contraceptive materials and information is legal; this might, in turn, require that public insurance programs such as Medicaid include the financing or provision of contraceptive materials to appropriate individuals. An example of the latter might be a program created to provide more information to the public on the quality of care provided to Medicare beneficiaries by specific physicians in specific hospitals that is then challenged by state medical societies claiming the policy impinges on the confidentiality of patient records. No matter whether they precede the passage of specific legislation or follow it, legal and judicial actions play an important role in the development of the specifics of health policy. Once a law is passed and a particular program or set of organizational activities is put in place, the next phase of health policy development involves the creation of regulations and administrative guidelines and procedures for implementation of that program.These are typically not detailed in the original legislation or in relevant legal actions; they are usually the responsibility of those individuals managing or operating the program or activity. The regulations developed by program staff are designed to tell those involved with the program what specifically is to be done; the administrative guidelines may be less explicit or specific and are designed more to advise how the specific regulations might be carried out in practice. Formal regulations can be the subject of formal investigative actions by the inspector generals of individual government agencies or programs, while administrative guidelines would generally not be the subject of investigative activities. Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. 300 However, both administrative guidelines and formal regulations play a major role in shaping how health policy is actually carried out. The conditions of participation, that is, a specific set of health policy activities for a particular program, provide an additional lever or authority in the implementation of health policy. In this set of actions, a governmental program might specify how an organization must be structured and what role it must adopt so as to be allowed to take part in a program. Organizations are not necessarily told they must take part whether they wish to R or not, but they are told that if they want to take part, I they must meet certain qualifications to participate.Assignment: Assessing and Regulating Health Services C For example, in the case of Medicare, hospitals A are never told that they must participate per se, but they are told that if they wish to care for Medicare R beneficiaries and subsequently be reimbursed for D the care they give, they must be licensed by the appropriate state agency and be accredited by ,an appropriate accrediting agency. If a hospital decides to apply and meet the conditions of participation, it is then required to follow regulations which provide A detailed instructions on specific activities. Together, D the conditions of participation, the regulations, and any additional administrative guidelines are signifiR cant influences on the majority of what takes place I in individual participating organizations. E N N HOW INDIVIDUAL HEALTH E PROFESSIONALS CAN PARTICIPATE IN THE DEVELOPMENT AND IMPLEMENTATION OF HEALTH POLICY 1 9 0 For health care professionals who wish to play2a more active part in the development and impleT mentation of health policy, there are a variety of ways in which this can be done and a variety S of points at which professional involvement is appropriate. The idea that health policy development is a PART FIVE Assessing and Regulating Health Services specialized area of activity and should be left to policy experts, to elected politicians, or to agency administrators is a misleading and potentially dangerous one, since it may remove from the policy development process those people who have most detailed knowledge of the issues at hand. The question then is, How can health care professionals, clinical, administrative, and otherwise, participate more actively in the development of good health care policy for this country? Going back to the first definition of health policy—the general accumulation and development of values, beliefs, goals, ethics, and social directions— every health care professional can be active in this important early stage by taking part in personal and professional activities to build a consensus. In early value-setting activities, it is continuing strong participation, communication, and education that build the initial groundswell of support for a particular course of action. If a health care professional thinks that smoking is dangerous to the health of the American public, a first level of involvement would on the local level with agencies such as the American Lung Association or the local school district. Opportunities to speak at public gatherings, to influence local and state professional groups, or to contribute written materials to publications of various kinds is not just praiseworthy, but also necessary to build the broad level of support that might eventually lead to formal legislation, court action, or other specific developments. It may be tedious, time consuming, or without immediate results—or all three—but significant formal policy development does not take place unless there is a strong, broad base of public and professional support. With regard to the development of specific laws and legislative actions, there are two areas in which health care professionals can become directly active: The first involves provision of professional support and energy to the development of ideas that might eventually become legislation, and the second is the personal and professional support of proposed legislation itself. With regard to the first, there is a great deal of background work that must be done before the possibility of legislation even appears. This background Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. CHAPTER 13 Understanding Health Policy work might be the development of data, research, and experience that can be used in the creation of the idea behind legislative action, since the proposal of a course of action should always be well grounded in facts and genuine experience. Professional organizations and advocacy groups are generally the first place in which to look for opportunities to participate in building a case for particular action. Advocacy groups around specific disease conditions have great potential as motivators for legislative and policy action, and they almost always need professional support for theirR efforts. A second way for health care professionals to I help generate the demand for health policy in a parC ticular area is by education and communication with political figures and their legislativeAassistants or adviser. Very few political figures have detailed R expertise themselves about specific health matters (unless they have focused on a particularD area in the past) and they are dependent on advisers , and staff members to bring issues of importance to their attention. Contrary to the idea that political figures may not have great i … Application: Give an example of either (but not both) a healthcare policy and its consequences or an example of a quality issue / practice in healthcare. Analysis: Analysis: In your example analyze the root causes of the issues and the pros and cons of the example. Synthesis: From your example offer a new and unique idea of yours or from the research that addresses a better solution to the issue cited. Evaluation: How is the new idea better / same / worse than the experience you described in your example? Why is it better? What improved consequences might come from your new idea? hca501__unit6.pdf Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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