MHA6050 REGULATION AND POLICY IN HEALTHCARE WEEK 2 DISCUSSION AND PROJECT INSTRUCTIONS

MHA6050 WEEK 2 LECTURE NOTES 1

MHA6050 WEEK 2 LECTURE NOTES 2

Process of Health Policy Making: Framework and Implementation

There can be several approaches to the policy making process, and they could be subjective. It is best to set up a framework for policy making in order to give it structure. Stages Heuristic is a rather oversimplified framework that divides policy process into stages: agenda setting, formulation, implementation, and evaluation. However, it is useful for understanding the policy making process. Other frameworks include policy triangle framework and the networks framework that explain the role of actors and their interactions in producing a policy.

Formulation of health policy involves the crucial initial step of agenda setting, which is the process of identifying problems and possible solutions and the impacts on various constituents. The next step is the development of legislation, which occurs at a point where problems, potential solutions, and political circumstances converge to form a window of opportunity. The implementation of policy succeeds the enactment of legislation. Implementation is carried out by departments and agencies within the executive branches of the federal and state governments. It is their responsibility to be effectual in order to make a measurable impact on the determinants of health. The agencies should be equipped to manage human, financial, and other resources well enough to facilitate objectives embodied in the legislation.

This can be a tremendous management undertaking, which involves designing a working agenda for enforcing agencies and drafting a plan of action in order to perform the work. Specific and detailed directives or rules need to be developed to facilitate implementation. Of course, all these will be futile without agencies undertaking the operation of enacted legislation. For example, in the case of Affordable Care Act (ACA), expanding Medicaid enrollment involves the operational stage of successfully enrolling new people into the program. Lastly, evaluation of the merit of the policy is a core activity while implementing policy.

Frameworks for Policy Making

· Public policy is determined authoritatively by the government.

· The government applies the policy to all society members.

· Government's involvement promotes policy legitimacy.

· Policy is a continuation of previously introduced policy (base policy).

· Change is minimal and measured.

· Accepts legitimacy of "old" policies, but not necessarily "new" policies.

· Policymakers generate and choose from a wide range of logical options.

· They focus on maximizing social benefit.

· They also focus on simultaneously minimizing costs, not just monetary costs.

Additional Materials

From your course textbook, Health Policymaking in the United States, read the following chapter:

· The Process of Health Policymaking

From the Internet, review the following:

· World Health Organization. (n.d.). Understanding health policy processes. Retrieved from http://www.who.int/hac/techguidance/tools/disrupted_sectors/adhsm_mod5_en.pdf

· Centers for Disease Control and Prevention. (n.d.). CDC policy process. Retrieved from https://www.cdc.gov/policy/analysis/process/index.html

Process of Health Policy Making: Key Features

· The public policy making process is impacted by external factors to a great extent. For its part, the process impacts the larger environment. Situations and preferences of individuals, organizations, and groups influence policy making. Biological, biomedical, cultural, demographic, ecological, economic, ethical, legal, psychological, science, social, and technological variables, as well as legal variables need to be taken into consideration during the process.

Impact of External Factors on Public Policy Making

Tobacco-related illnesses are significant and severe yet entirely preventable with appropriate education, screening, diagnosis, and treatment. Current tobacco policies include smoke-free air laws, age regulations, and excise taxes. But these beneficial public policies were not always in place.

In the 1940s, smoking prevalence hit an all-time high in the United States, stemming largely from the involvement of the United States in World War II. During this time, scientific inquiry began to establish the link between smoking and lung cancer and several journal articles were published establishing the direct relationship between smoking and increased risk of death.

The emergence of scientific evidence linking smoking to ill health is further supported by governments actions to curtail tobacco advertising and community health organizations joining the cause to eliminate smoking. In 1965, Congress passed the Federal Cigarette Labeling and Advertising Act requiring a warning from the Surgeon General about the hazards of smoking.

Despite high rates of smoking through the 1970s, many Americans now believe that the science is sound and that there is an increased risk of illness associated with smoking. There is greater public outcry for smoke-free public places, and many restaurants and workplaces prohibit smoking indoors. Medical advancement allows for the development of nicotine replacement, and that coupled with a stronger set of public policies promote a decline in tobacco consumption.

This example shows us that there are a number of external factors in play during the policy-making process, including medical and scientific information, legal restrictions, and cultural factors. These factors may not always promote the policy-making process; however, it is essential to be aware of the multitude of variables that impact policy making.

The public policy making process can be modeled to involve three interactive and interdependent phases: policy formulation, policy implementation, and policy modification. The process is also cyclical, in that all decisions are subject to modifications, largely based on evaluation and feedback. It is also an inherently political process because decisions are made by humans. Therefore, the push and pull of human altruism, egoism, self-interest, bias, greed, etc. may influence the process, making it a less than rational pursuit. However, good policies take all these constraints into account in order to achieve optimal outcomes.

Interest Groups in Policy Making

· Represent the interests of “big business”

· Profit directly from the policy changes sought

· Examples: The American Federation of Labor and Congress of Industrial Organization (AFL-CIO) and the International Brotherhood of Teamsters

· Represent the interests of a “common cause”

· Receive attention and news coverage that increase donations

· Examples: The Environmental Defense Fund, the American Cancer Society, and the League of Women Voters

· Represent the interests of local and state governments

· Secure federal grants to support local activities

· Examples: The National League of Cities and the National Governors Association

· Represent the interests of organized religion

· Promote their own religious ideology and sense morality

· Example: Christian Coalition

· Represent the interest of underrepresented groups

· Ensure fair and equal treatment for all people

· Examples: The National Association for the Advancement of Colored People (NAACP), the National Organization for Women (NOW), and the National Gay and Lesbian Task Force

Additional Materials

From your course textbook, Health Policymaking in the United States, read the following chapter:

· The Process of Health Policymaking

From the Internet, review the following:

· World Health Organization. (n.d.). Understanding health policy processes. Retrieved from http://www.who.int/hac/techguidance/tools/disrupted_sectors/adhsm_mod5_en.pdf

· Centers for Disease Control and Prevention. (n.d.). CDC policy process. Retrieved from https://www.cdc.gov/policy/analysis/process/index.html

The Role of Courts in Health Policy Making

The judiciary is one of the three coequal branches of the government, each with its own responsibilities and authority. The US constitutional structure intends the judicial branch to play a less direct part in policy making. However, an examination of decisions rendered by the courts indicates that judicial decisions can affect health policy to a great extent. The federal courts have legal authority over certain types of cases that may involve the federal Constitution or statute. They also may be involved in cases that have parties residing in different states. Courts in the U.S. have traditionally acted as constitutional referees, making decisions about the scope of each branch’s reach.

When the Congress’ authority to enforce individual mandate via the ACA was challenged by the National Federation of Independent Businesses (NFIB v. Sibelius as cited in Longest, 2016), the Supreme Court acted as the referee. Courts also act as meaning givers when they interpret laws that may be particularly unclear in specific circumstances. For example, in 2003, in Kentucky Association of Health Plans, Inc. v. Miller, the Supreme Court interpreted the savings clause and ruled to permit health plans to permit any willing provider to join their networks.

Furthermore, the courts act as rights enforcers when parties allege violation of their constitutional rights in the context of evolving social conditions. For example, in 2012, a federal circuit court of appeals upheld Congress’ authority to require graphic warnings (Discount Tobacco City & Lottery, Inc. v. United States as cited in Longest, 2016). However, another circuit court of appeals in the same year (R.J. Reynolds Tobacco Co. v. FDA as cited in Longest, 2016) found that compelling tobacco companies to include the images actually chosen by the FDA on their cigarette packages would violate the companies’ First Amendment rights. It must be noted that these three roles of the courts are not mutually exclusive. In the context of health policy, the judiciary impacts both public and private sectors. For example, until the implementation of the ACA, employers had complete discretion on insurance provision to their employees and the types of benefits provided.

The Supreme Court of the United States

Courts in the U.S. have traditionally acted as constitutional referees, making decisions about the scope of each branch's reach. Courts also act as meaning givers when they interpret laws that may be particularly unclear in specific circumstances. Following are some important cases in which the judiciary branch of the U.S. government played a key role.

Review each issue to learn about important cases related to it.

Reproductive Rights

Griswold v. Connecticut  (1965): The Supreme Court of the United States (SCOTUS) overturned state law preventing use of contraception. Roe v. Wade  (1973): SCOTUS upheld a woman's right to have an abortion.

Healthcare for Prisoners

Estelle v. Gamble  (1976): SCOTUS upheld the right to healthcare for prisoners.

End of Life

Vacco, Attorney General of New York v. Quill   (1997): SCOTUS supported New York State's prohibition of assisted suicide.

Tobacco

R. J. Reynolds Tobacco Co. v. FDA  (2012): SCOTUS ruled that the FDA could not compel tobacco companies to use specific graphic images in their warnings.

Health Insurance and the Affordable Care Act

Kentucky Association of Health Plans, Inc. v. Miller   (2003): SCOTUS upheld Kentucky's efforts to institute any willing provider statutes to break exclusive provider networks of health maintenance organizations. National Federation of Independent Businesses v. Sebelius   (2012): SCOTUS upheld the individual mandate associated with the Affordable Care Act.

Additional Materials

From your course textbook, Health Policymaking in the United States, read the following chapter:

· Policy Formulation: Agenda Setting

From the Internet, review the following:

· Gostin, L. (n.d.). The Formulation of Health Policy by the Three Branches of Government. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK231979/

· The Kaiser Family Foundation. (2014, August 04). A Closer Look at the Courts' Impact on Health Policy. Retrieved from https://www.kff.org/health-reform/perspective/a-closer-look-at-the-courts-impact-on-health-policy/