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authoritative decisions made in all three branches of govt to direct behaviors of others |
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Aggregate principals that characterize the distribution of resources, services, political influences that impact population health |
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ed/state policies/laws shape all aspects of health care systems |
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it is the main too to organize ourselves a society as sprawling as ours needs something to provide a measure of control |
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a power or privilege that haws been guaranteed to an individual under the law |
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a SYSTEM by which rules are created, disseminated, enforced, violated, disputed, interpreted, applied, reversed... |
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wHhat are the three branches of legal structure |
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LEGISLATIVE/congressional - makes it EXECUTIVE - enforces it JUDICIAL - interprets it |
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What are the three important powers that congress to be influential in the health policy process? |
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The power to make all laws.. the power to tax the power to spend |
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What are the sources of law? |
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federal/state - constitutions, statues federal - regulations ordinances: municipal (city/county) judicial |
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what is the three tier court system |
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1)supreme court - big cases go here 2) court of appeals - only hears judges legal arguments 3) trial court - hears all cases first |
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What are the two categories of health policies? |
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allocative and rergulatory |
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What are allocative policies? |
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provide net benefits to some distinct group at the expense of others to make sure public objectives are met they direct the goods to a group or to individuals |
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what is a distributive allocative policy? |
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-they distribute (through policy) - a policy that spreads benefits -a redistrubutive allocative policy, redistributes goods (takes money from here and puts it over there) |
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What is a regulatory policy? |
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one that influences the actions, behaviors, and decision of others in a target group directly they monitor the group, offer incentives and impose sanctions if they fail to comply |
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What are some major dilemmas in the future of health care management? |
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- Universal coverage—not achievable. Other models haven’t achieved this. Achieving this would require single-payer system
- Preexisting conditions—risk increases premiums for everyone; how will these remain affordable?
- Cost—reform not feasible w/out cost controls; universal care for any ailment not feasible. Mindset change is needed (individual responsibility, self-management, prevention service, health education)
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individual mandate, with penalties tax penalties for larger employers expansion of medicaid tax credit for small businesses Outlaw denial of health ins for preexisting conditions premium subsidies for those 400% of the FPL |
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- expansin of medicaid, enrollment in MC, rationing,
- state funding to offer health ins to those with pre-existing conditions
- employer mandate (pay or play was not authorizd under ERISA)
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What is the policy making model? |
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FIM -Formulation of phase -implementation of phase -modification phase |
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What are the five components of a policy making CYCLE? |
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1. issue raising 2. policy design 3. public support 4. legislative decision making,policy support 5. legislative implementation |
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What are some fetures of health policymaking? |
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fragmented pleuralistic interest group politics decentralized role for states govt as subsidary for frivate sector politics |
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How can govt infringe on public health? |
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govt can infringe on the rights of individuals and business to promote communical good |
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What are the four principals of medical ethics? |
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Autonomu beneficence nonmaleficence justice - fair treatment for everyone MAUF |
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What are the public health ethics? |
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beneficence - GOAL IN PH (promote welfare of others) Autonomy - not as much a big deal in PH, rights to privacy and freedom as long as they dont result in harm social justice - CENTRAL IN PH (equality of opportunity, access, equity of benefits) |
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What mechanisms are there for resolving ethical issues in health care? |
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ombudsmen- someone who investigates individuals complaints institutional review boards ethics committees standards set by professional associations practice guidences Financing mechanisms Courts of law NIH- has Bioethics department CDC - forme an ethics subcommitte for their advisory group |
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the limiting of resources going to medical care not all care expected to be beneficial is provided to all the distribution of limited resources in a fair manner |
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What is explicit rationing? |
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Withholding care based on social policy choices
(we all ready ration care by ability to pay) |
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No hope - no treatment
the belief that in cases where there is no hope for improvement, no course of treatment is called for. |
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What is the dilemma of universal coverage? |
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even the ACA would leave 23 million uninsured Oregon and HI have not been able to achieve universal healthcare Achieving universal coverage would require a single-payer plan |
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What is the dilemma of pre-existing conditions? |
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underwriting without risk rating increases the premiums for everyone. |
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What is the dilemma of cost? |
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any health reform is UNSUSTAINABLE without cost control in MA, both health care costs and premium increases have surpassed the national averages Universal care for ANY ailment ON DEMAND is UNFEASIBLE |
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