assignment week 1 Health care organization

Chapter 2: The Policy Context for Management

Objectives

• Understand the interdependence of health management and public policy

• Be able to describe the U.S. governmental policy-making process

• Understand key distinctive features of health policy in the United States

• Be able to identify key policy issues relevant to health management

Outline

• The Policy Making Process

• Distinctive Features of U.S. Health Policy

• Key Health Policies Affecting Management

Laws and Regulations

• Laws and regulations affecting health organizations are diverse and plentiful in the United States

• Managers of health organizations are responsible for assuring that their organizations and units comply with laws and regulations

• Managers should understand the legislative process so that they can participate in it and anticipate changes in public policies

Laws and Regulations (continued)

• Laws are rules developed and approved by legislative bodies and enforceable in the courts

• Regulations are rules developed by governmental agencies or by private organizations that have been assigned authority by the government, usually to enact the provisions of laws

Health Policy

• Health policy refers to the principles and activities guiding the allocation of resources that affect the health of patients and populations

• The concept of health policy is broader than laws and regulations

• Health policy is heavily influenced by the laws and regulations formulated and implemented by governmental units

Policy Making Process

• Two principles undergird the policy making process:

- Federalism

- Separation of powers

• Federalism refers to the sharing of power between states and the national government

• Separation of powers divides government into three branches: judicial, legislative, and executive

Influencing the Policy Making Process

• Managers can develop or participate in coalitions of like-minded individuals and advocate for their viewpoints before, during, and after the legislative process

• There are 5 stages at which the public policy can be influenced (Longest, 2010):

1) Agenda setting stage 2) Legislation development stage 3) Rulemaking stage 4) Policy operation stage 5) Policy modification stage

Distinctive Features of U.S. Health Policy

• In the U.S., the government is less involved in the direct provision of health services than any other industrialized country in the world (Greenwald, 2010; Jonas, 2007)

• No central agency governs the U.S. health system

• Government funds a wide array of health research, training of health workers, and a variety of direct delivery services, such as the Veterans Health Administration

Key Health Policies Affecting Management

• Health Information Technology Support and Security

• Access to Health Services

• Quality Improvement

• Emergency Preparedness

• Prevention and Health Promotion

Health Information Technology Support and Security

• Health information technology has been targeted by recent legislation designed to modify existing policies and practices

• Information systems are often selected for their financial advantage to the purchasing organization rather than considering their utility to customers, clients, or patients

• A National Coordinator for Health Information Technology was mandated by the Health Information Technology for Economic and Clinical Health Act (HITECH Act)

National Coordinator for Health Information Technology

• This legislation was included in the American Recovery and Reinvestment Act (ARRA) of 2009

• Responsible for promoting a nationwide health information technology infrastructure that improves health quality and reduces costs

• ARRA also authorized nearly $20 billion over five years to assist physicians in adopting electronic health record (EHR) technology

Access to Health Services

• The federal Medicare health insurance program and the joint federal-state Medicaid health insurance program have served elderly and disadvantaged populations for decades in the United States

• A major expansion in the federal role in access to health services occurred in 2010, with the Patient Protection and Affordable Care Act

Patient Protection and Affordable Care Act (PPACA)

• Prohibition on denial of health insurance coverage for children due to pre-existing conditions and requirements for full coverage of selected preventive services in health insurance plans

• Individual mandate for health insurance—individuals not covered by government insurance programs must maintain health insurance or pay a penalty

• Funds a major expansion of Community Health Centers, which largely serve inner city poor populations, and increases payment levels to rural health care providers

Quality Improvement

• U.S. health policy is strongly behind efforts to improve the quality of health services, with increased expectations that health organizations will report and enhance the quality and value of their services

• A movement to accredit public health departments, formally launched in 2011, is another example of the growing inclusion of quality improvement in U.S. health policy

Emergency Preparedness

• Government is heavily involved in health policy for emergency preparedness

• U.S. Department of Homeland Security develops and deploys national strategies for prevention and response to emergencies

• States and many localities have similar emergency preparedness units

Prevention and Health Promotion

• U.S. health policy has gradually increased recognition of the importance of prevention and health promotion

• PPACA created a $15 billion Prevention and Public Health Fund

• PPACA requires health insurance plans to cover selected preventive services

Health Disparities

• Health disparities are population-specific differences in health

• Area of growing health policy concern

• Patient Protection and Affordable Care Act of 2010 expands services to low-income populations, broadens initiatives to increase racial and ethnic diversity in the health care professions, and strengthens cultural competency training for health care providers