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Table of Contents Public Policy in the United States Federal System 2 Health Care Policy in Relation with the Constitutional Provisions 4 Government of the Healthcare Policy 6 Exploring the Health Care Policy in Georgia 6 Interest Groups in the Healthcare Policymaking Process 7 Political Influence of Healthcare Policymaking 8 Role of the Executive Branch of Georgia in Regards to Health Policies 10 Position of Healthcare Policy in the Governor’s Priority List 10 Administrative Agencies that Deal with the Healthcare Policy 11 Resource Allocation towards Healthcare Policy Implementation 11 Role of the Local Government in Formulating and Implementing Health Policies 12 Funding the Healthcare Policy 14

Comprehensive knowledge on public policy is important for effective citizens and public administrators. Public policies govern all economic sectors that drive a country forward including education, trade, and healthcare. Hence, adequate information on public policy allows administrators and citizens to identify policy-gaps that can affect their livelihoods in terms of their physical and emotional well-being, finances, academics, and employment opportunities. According to Portz (2011), public policy in the United States relates to federalism, which is the allocation of powers and responsibilities to different arms of the federal government. They include the local, state, and national governments. Hence, the interactions between these arms and the distinct economic sectors in a country make the public policy processes complex. This paper discusses the U.S. healthcare policy where the national arm has the primary responsibility while the states perform secondary but also significant roles. In the U.S. federal system, policymaking has both merits and demerits.

According to Crawford et al. (2012), healthcare policy makers and stakeholders have failed to involve patients during policy discussions. An effective healthcare policy ought to put patient needs first before looking at other stakeholders such as nurses and physicians. As a result, the National Health Centre continues to fight for effective changes in the policy area, such as faster development of new medicine, more comprehensive health research, and equal access to quality and affordable medical care for all citizens. Evidently, these changes represent the gaps in the current healthcare public policies.

The main work of federal governments is to formulate public policies (Portz, 2011). In this case, a policy refers to a series of activities by public officials with the intention of achieving desired outcomes and dealing with matters of concern. Healthcare remains a priority area of American public life where government officials have engaged in several discussions and activities to create laws and to design programs that address perceived needs. Hence, it is normal for policymaking to be contentious and complex since government bureaucrats and policymakers from the local, state, and national levels often have distinct perspectives and interests regarding the formulation and implementation of particular policies. For instance, in the U.S healthcare sector, state governments rejected the latest national health reform act by claiming that it conditioned citizens to contribute more to medical care costs.

Apparently, the Constitution fails to give specific responsibilities or power to state governments. However, the 10th Amendment reserves the powers that have not been delegated to the national government to the states and the local people. Nevertheless, since healthcare and education are not mentioned in the Constitution, it is unclear which arm of government should be responsible for the two policy areas fully. Similarly, local governments, such as school districts and municipalities, are not mentioned anywhere in the American Constitution.

As a result, there is an ineffective distribution of constitutional power in the U.S healthcare sector. As a policy area, the sector is shared among all three intergovernmental arms, although the state and national levels share the major responsibilities: the quality of medical care, healthcare costs, and healthcare access to all Americans. Correspondingly, this creates a high level of interdependence among the governmental arms concerning the formulation and implementation of healthcare policies. Thus, even though national policymakers have the biggest role, under the federal authority, of creating a specific policy, they have to rely on state and local governments for the final service delivery. However, this interdependence can fail to be beneficial when competition and conflicts play a part. Therefore, the American Constitution should clarify directives about public healthcare policies and people’s rights in the sector to provide distinctive roles to the three arms of government.

The state of Georgia has not performed well in the health care sector within the past decade as depicted by health rankings over the period. The biggest contributors to this state are poor dental facilities and poor implementation of health insurance policies. Georgia also depicts the highest mortality rate for HIV victims not to mention the above average number of deaths for victims of heart disease and diabetes. Nonetheless, following to the implementation of Obamacare, better services have been provided as the state government adheres to the constitutional provisions more keenly. Adherence to the healthcare policy in accordance with the state constitution has facilitated an improvement of healthcare service provision especially from 2012.

To begin, Article 37 of the constitution of Georgia states that, ‘Everyone shall have the right to enjoy health insurance as a means of accessible medical aid. In the cases determined in accordance with a procedure prescribed by law, free medical aid shall be provided (Hill & Georgia, 1994).’ However, the state has not paid appropriate attention to this provision owing to the statistical evidence that approximately 39% of citizens in Georgia lacked health insurance covers as at 2009 (Plunkett & Plunkett, 2011). As such, the substantiation shows that even with this provision, more Americans continued to suffer from health-related disparities owing to the poor implementation of the health policy as mentioned in the constitution.

Another provision as mentioned in the constitution in regards to the healthcare policy states that, “The state shall control all institutions of health protection and the production and trade of medicines” (Article 37, 2). This provision has been particularly helpful to the citizens because the state has managed to ensure that only medicine that reaches the standards is sold to the state’s public. According to health records, about 16 percent of Americans die each year due to the ingestion of medicine that is poorly manufactured or that has reached the expiry dates due to extreme shelving (Brooks & Huggett, 2012). In the sixteen percent, only 1.8% accounts for the deaths in Georgia as compared to other states with 4 percent. The legislative body remains responsible for upholding this provision of the constitution through quality assurance departments.

The health care policy is appropriately governed through the legislative arm because of the development and implementation of policies now and in the future. Policy development remains necessary in the state of Georgia because the legislative arm can develop policies purposed at solving particular concerns for the public. For instance, the state could develop a policy that requires all diabetic patients to have a medical cover with the intent of reducing their hospital expenses and lowering the mortality rates pertaining to that particular disease. The healthcare policy shows importance to the general public as it seeks to ensure that healthcare facilities are readily available for all citizens to ensure delivery of quality services. The Georgia Health Policy Centre (GHPL) works in conjunction with the state government to facilitate the implementation of these policies within the state. Over the recent past, the organization has sought to involve the public more in matters pertaining to healthcare purposed at increasing publicity on the need for insurance covers. Through such initiatives, the citizens have become more engaged in caring for their health hence the noteworthy decline in mortality rates. In this regard, sustaining such publicity will enhance public awareness and contribute to quality delivery of healthcare services within the state of Georgia.

Policies, plans, and strategies within the healthcare system are not culminations by themselves. Altogether, they form part of the larger approach that purposes to align a country’s set priorities with the actual health needs of the public. Through health and developmental partners, inclusion of the private sector, consideration of the civil societies, and the participation of the government not to mention the political parties, health policies effectively influence the available resources in favour of the public. Healthcare surfaces amongst the essential aspects in today’s life amongst education and transportation further indicating its necessity to the global population. These strategies and healthcare policies thus ensure that all citizens under state and federal governments have unlimited access to valuable healthcare services thus living longer and healthier lives (Chard, 2004). In relation to finances, better healthcare lowers government expenditure thus allowing the allocation of the saved resources to other departments such as education or agriculture. In that, a surplus of quality healthcare services is inversely proportional to demand of the same.

From another angle, the significance of healthcare policy and procedures remains undisputed as depicted by the active participation of healthcare personnel. Policies in healthcare demonstrate importance as they establish a general plan of action, which is utilized by the various healthcare facilities as a guide towards the achievement of mutual goals. In a state such as Georgia, it communicates to healthcare personnel the desired results of their participation thus aligning their diverse roles towards a mutual objective such as the provision of quality services (Abood, 2007). As such, all hospitals within a particular locality, such as Georgia in this case, end up providing standardized services thus ensuring that everyone receives quality services regardless of the hospital they visit. Therefore, healthcare policies set a platform for the delivery of safe, quality, and cost effective services hence illustrating their prominence to the population.

Interest groups within the healthcare sector are those stakeholders who have the potential to influence the outcome of a proposed policy. These actors can either limit the progression of a proposed policy to maturity, or, on the contrary, propel a policy to maturity and oversee its implementation in the healthcare sector. Therefore, the final voting decision relies on more factors and not only the presented merits and demerits of the policy (Abood, 2007). The most renowned stakeholder includes political parties, district voters, legislators, committees, and selected representatives from select healthcare agencies, which either represent the needs of the public or those of the healthcare personnel. In a quest to shape the final content and result of the proposed policy, whether it is a new policy or an amendment of an existing policy, there arises a need to identify the supporters as well as the non-supporters of that particular policy. As such, the parties seeking to push a certain policy through need to be in constant communication with the members of the germane committees, the chairperson, and most importantly the supporting legislators. Representatives of the public also play a significant role in policy formation because they present the public’s opinion and in most cases, their opinion is taken more seriously owing to the large number of people being represented.

The non-supporters in most cases comprise of the interest groups who find the proposed policy either impractical to implement, expensive to implement, or subjective to a particular party more than another. For instance, if a policy to reduce employee working hours would be favouring the doctors and nurses amongst other personnel, but disregarding the needs of the public who require health services around the clock. As such, no representatives of the public would be in support of the policy thus limiting its progression. Legislators ask themselves a series of questions before they choose to support or oppose a particular policy. Some of these considerations would include; how does this policy affect my district? What is the public opinion about this policy? Is the represented political party in support of this policy? As such, the needs of the public need to be in harmony with those of the political party and other interest groups to ensure that a policy under review benefits all interested parties equally and facilitates value addition in the healthcare sector (Abood, 2007).

The preferences of the elected party officials play a vital part in steering any healthcare policy moving through the policy process towards development, implementation, and consistent evaluation for performance. Based on the number of political parties represented, there could be any number of diverse opinions, which at times portray competition amongst themselves not to mention the interests of the democrats and republicans. In such instances, the political party that holds the majority seats is more inclined towards winning the support of other interest groups subject to the policy under review. In the state of Georgia, for instance, party preferences are to ensure that all policies established under the state constitution add value to Article 37 of the constitution (Hill & Georgia, 1994). Therefore, policies under the state constitution are bound to facilitate accessibility of medical aid through means such as increasing the number of facilities, boosting the standards of service provision, and supporting the insurance system to cover more people and consequently sinking the prices for such services. Decision makers thus rely hugely on the political influences as they attempt to find an acceptable and feasible directive amidst the conflicting proposals, values, and demands. Deeper political involvement is prompted in policy changes that involve noteworthy costs to the state government, or those that trigger substantial controversies between the public and the healthcare personnel.

All stakeholders in the state of Georgia need to strategize prior to entering the legislative arena to ensure that they utilize their political influence and power of mass numbers effectively towards the development of effectual policies (Barker, 2006). It is vital to understand the steps within the legislative process and knowing the powerful players to effectively strategize and carry out these strategies. Operative communication with legislators and the committee members also plays a vital role in the legislative activity as it fosters polished communication skills between the interested parties. Georgian legislature depicts active involvement in issues concerning policies as it ensures that all interested parties are represented. In addition, it provides a systematic process that all policy proposals must follow before they have matured to the implementation stage. The state of Georgia has also been ranked sixth in all American states in its health policy development and implementation in the last three years further showing the efficacy of their legislative arm (Institute of Medicine (U.S.) & National Academies Press (U.S.), 2011).

The executive branch of the state of Georgia plays a vital role in the administration of the health policies in pursuit of protecting the health of all citizens. It does this by ensuring that research is continuously conducted to avail new medication for existing illnesses and at the same time prevent outbreaks. Furthermore, it implements policies of food and drug safety while ensuring that the residents receive health insurance in an attempt to improve accessibility to healthcare. The office of the governor listed healthcare amongst the six most prioritized items for this term alongside provision of jobs, improvement of education, reformation of the justice system, natural resources and development of transportation and infrastructure (State of Georgia, 2015).

In regards to healthcare, the governor made it his priority to meet the demands of the growing population by devising and implementing sustainable and long-term solutions starting with fostering a culture of wellness (Nash, 2015). The state would promote Georgia’s public image by advocating for healthy lifestyle choices from a personal level. In addition, the governor would strengthen Georgia’s healthcare workforce by identifying innovative ways to attract and retain highly qualified personnel in healthcare. As such, the state would work hand-in-hand with medical colleges as well as the Department of Community and Public Health (DCPH) to promote Georgia’s ideal practice of world-class medicine. The DCPH was also tasked with advancing biotechnology research and innovation in the state of Georgia. Moreover, the state government allocated $2.59 billion to improving healthcare, which indicates a 6.5 percent increase when compared to the previous budget allocation (Raminashvili, Bakhturidze, Zarnadze, Peikrishvili, & Bull, 2014). The state has been a victim of rising mortality rates owing to conditions such as hypertension, obesity, and diabetes; hence, the additional resources are to be used to facilitate improved service provision while facilitating campaigns for healthy living among the citizens. With such resources, the governor hopes to improve research and development hence offering better services and drugs to the people of Georgia. Besides improving healthcare, these spurs will avail more jobs for the public, encourage education, and lower crime thus serving more than one purpose.

Healthcare Faculty Regulation (HFR) and Healthcare Georgia Foundation (HGF) are some of the agencies that deal with the healthcare policy implementation in Georgia. The HFR is a branch of the Department of Community Health (DCH) that is responsible for the planning of healthcare, certification, licensing, and the oversight of healthcare facilities within the state (Vanessa, 2014). Similarly, the HGF, which is a private and independent organization, seeks to advance healthcare services for all Georgians through expansion of access to affordable and quality healthcare with a particular interest in the underserved populations. Amongst other agencies, these two ensure that health facilities offer unwavering quality services as well as expanding accessibility.

The allocation of additional resources by the state government demonstrates the governor’s efforts to improve and sustain quality and accessibility in the healthcare sector in Georgia. Evidently, sufficient resources are aligned towards this goal. The HFR, under the counsel of the DCH further ensures that all Georgian health facilities adhere to the set policies strictly to ensure that the quality of health services is balanced in all facilities. As such, all Georgians receive equally worthy healthcare services thus eliminating preference and accusations of favouritism towards the state government.

Policy-making remains highly undervalued and miscomprehended in the public eye, yet it forms the central role of the federal, state, and local governments. The policies formulated by these bodies have an effect on every individual whether directly or indirectly. More precisely, health policies determine the health services to be provided to the Georgian population, the quality of these services, and the development strategies to be implemented to facilitate advancement in this field. Policies also guide the decision-making process as they put the public’s needs first. In other words, policy development and implementation remain a complex process in which the local government plays a vital role.

Georgia’s local government plays a part in healthcare policy initiation, formulation, adoption, and implementation by providing the best of local official to serve as representatives of the public (Falleth & Hovik, 2009). An operative healthcare system ought to be guided by firm policies aligned towards assuring the delivery of quality services. The local officials also outline the political and financial prerequisites for policy formulation to ensure that all the necessities are readily available before the process takes off. Furthermore, the local government utilizes five core-guiding pillars, which ensure that their role in healthcare policy formation and implementation remains focused on the well-being of Georgia’s residents. First, they make sure that the process remains transparent with all decisions made with the public interest as the priority. The local government also oversees sustainable development and micromanagement of allocated resources in line with delivering effective services (Costigliola, 2012). Its democratic representation and social inclusion guarantee that the community is engaged in issues pertaining to their welfare and allowed to give their opinion. Good governance through the ethical, legal, and moral conduct of its personnel and councilors also surfaces amongst the pillars on which their governance in regards to healthcare policy formulation is built.

Georgia’s local government, through its personnel, follows the following steps in the process of healthcare policymaking. To start with, it assesses the public health interest of the particular policy by narrowing down its purposes to see if it accomplishes a compelling health objective. Evidently, this step eliminates possible bias through a critical evaluation of the policy rationale. Secondly, the local government examines the inclusive efficacy of the policy by comparing the possible outcomes to the stated goals. In this phase, the officials gather scientific data and blend it with logic to weigh its feasibility. Next, it evaluates whether the policy is well targeted by identifying whether it is under-inclusive or over-inclusive. The bigger the target population the more difficult it is to implement because it requires more resources, which could be a challenge at times. Under inclusive policies, on the other hand, do not carry as much weight as they should because only a small number of people benefit from its implementation. Additionally, the passing ofunder-inclusive policies calls for numerous policies in pursuit of catering for the public’s entirety.

The local government then proceeds to identify the human rights burdens, which requires an in-depth inquiry into the nature, scope, invasiveness, and duration of human rights desecrations (Lubitz & Wickramasinghe, 2006). In other words, it assesses whether the policy interferes with the various individual rights or if it exerts weight the economic and social rights of the people. Finally, it scrutinizes whether the proposed policy is factually the least restrictive alternative for that particular problem. The officials verify whether the health objective could be achieved with fewer or no restrictions on the existing human rights when compared with those highlighted for its implementation. Successfully, this phase of the policymaking processes warrants that societal and individual rights are accommodated in that policy.

Starting from the 1990s, Georgia’s healthcare was under a tax-funded system until late 1995 when reforms introduced a social insurance model controlled by the State Medical Insurance Company (Foundation Centre, 2000). Under this model, the state insurance company paid for basic healthcare; as supplementary funds from Municipal Health Funds facilitated slow but gradual advancements. As a sustenance strategy, a State Health Fund was placed mandatorily on all employers and employees through the payroll system to finance the health insurance model. The municipal budget also contributed to funding the new model as it paid a flat rate amount for each person within the municipality. Being operational for more than a decade, public sources and grants started supporting Georgia’s healthcare policies with an interest in the rural population and children aged six years and below (Saltman, Bankauskaite & Vrangbæk, 2007).

The ministry of Health, Labour, and Social Affairs also plays a part in funding policy formation and implementation in Georgia for citizens living below the poverty line thus assisting them to purchase health insurance and receive healthcare services. These means of funding should not be changed because they account for the whole population whereby those above the poverty line contribute to ensuring that those below the poverty line receive quality healthcare services as well. In light of policy development and implementation, the implemented strategies ensure that even the minority groups in the state are attended to as depicted by the utilization of grants to facilitate policy formation for people living in the rural areas.

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