- Describe the steps in legislation development from proposal to passage of a bill.
The proposition and passage of a bill into law is a long, arduous, and interrelated process involving interest groups, stakeholders, and legislation. What begins as ideas that align the framework and set an agenda in the formulation phase, policies are introduced as a draft and, if accepted, passed through several committees as action and written reports and later bills. Through the implementation phase, public policy is then undertaken, designed, establishing a working agenda of the facilitating of organizations involved, and rulemaking. Organizing policies and evaluating other elements can lead to new rounds of designing, rulemaking, and operating of said policy. After a policy is implemented and enacted, the modification process is conducted adjusting and accommodating changing circumstances of the policy. The initial version is formulated and then evolves as it is implemented, either through amendments or to the original legislation, through new revised rules completing the full cycle of the policy making process.
- Discuss rulemaking. Include the role of interest groups in rulemaking.
Rulemaking is a vital step in the implementation phase of the policymaking process. It is the method through which federal agencies develop, amend, or repeal rules. Acting as guides in the implementation phase, rulemaking is typically encountered when: new technologies or data is available on existing issues, concerns from accidents or problems affecting society, petitions or lawsuits are filed by interest groups, corporations, states, and/or members of the public, and requests, studies, and/or recommendations are submitted from agency staff, the Office of Management and Budget, or other agencies.
Interest groups play an important role in rulemaking as they represent broad spectrum of individuals, communities, and organizations which could be directly affected by such policies and/or various public laws. Interest groups tend to be well organized and aggressive in pursuit of their preferences, seeking to influence the formulation and implementation of policies that affect them. They form to influence policies that are enacted to reflect their preferences, and can be composed of employers, insurers, suppliers, professional organizations, technology producers, groups of affected individuals, and/or consumers.
- Discuss the concept of incrementalism in public policymaking.
Incrementalism is the method of changing a policy using small incremental changes that are enacted over time in order to create a larger broad-based policy. Significant policy change occurs, if at all, through a gradual accumulation of small changes, emphasizing the conception of policy making as a rational analysis culminating a value-maximizing decision affecting the public. Large drastic changes are not received well and cause much debate amongst legislation and interest groups, stagnating projected policy. Small changes over a longer time period allows for possible policy changes with decreased opposition, increasing the likelihood or reaching compromises.
- Discuss the role of policy analysis in policy modification. Include brief descriptions of three federal agencies that support policymaking process through policy analysis.
Policy analysis in the modification phase is approached in a variety of ways: before and after, with and without, actual verses planned, experimental versus quasi experimental, and cost oriented. Assessing consequences of policy for individuals and/or groups with the enacted policy verses where the policy does not exist. The same is done with comparing policy objectives and whether or not they support the assigned causation. Additionally, evaluations are conducted, and policies are assessed to see if they provide the best value for public dollars based on the relationship between benefits and costs. The analysis provides a way to examine existing policies with an agenda toward recommending modifications and/or improvements.
- The Government Accountability Office (GAO) is the investigative arm of Congress. It reviews how federal government spends tax dollars. Striving to make the government more efficient, effective, ethical, equitable, and responsive, the GAO “supports Congress in meeting its constitutional responsibilities and help improve the performance and ensure the accountability of the federal government for the benefit of the American people.”
- The Congressional Budget Office (CBO) is to provide Congress with the objective, timely, and non-partisans analysis needed for economic and budget decisions. Utilizing the information collected, the CBO estimates planning and suggestions for alternative approaches and projecting required budget processes.
- Congressional Research Service (CRS) serves Congress throughout the legislative process and provides comprehensive and reliable legislative research analysis. Focusing on specific areas of public policy such as education, labor, taxes, and health, CRS analytical statistics are timely, objective, authoritative, and confidential.
- Discuss the effect of health policies on individuals, health-related organizations, and interest groups.
Health policy decisions affect virtually all aspects of health care, including compensation for goods and services, health care access, disease prevention, licensing and oversight, and research priorities. Examining problems within a health care policy, perceptions regarding the severity and responsibility of the problem, and the affected population are all influential determinants when evaluating and modifying health policies. Politics plays a critical role in health affairs and is central in determining how citizens and policy makers recognize and define problems. The effects of health policies effect individuals on a personal basis providing or eliminating access to health care at what costs. Health-related organizations and interest groups are affected by health policies at both a personal level (for staff and/or investors) and financial level (rules, regulations, increased costs or limitations).
- What is disease prevention and what are its benefits?
Disease prevention is the method of utilizing interventions aiming to minimize disease (both primary and secondary) and associated risk factors. Chronic diseases such as heart disease, stroke, and diabetes can be prevented with lifestyle changes and health promotion. Maintaining a healthy diet and exercise regimen is a form of disease prevention. Additionally, methods such as vaccinations have been implemented as a disease prevention method. Inoculation introduces a small amount of a specific strain of virus to allow the body to produce white blood cells and increase immunity to disease caused by said virus. Through the vaccinations of Hepatitis, Polio, Measles, Mumps, Rubella, Diphtheria, and Tetanus eradication of diseases associated with these viruses have been accomplished.
- Discuss the three levels of care (primary, secondary, and tertiary).
Primary care is typically the first stop in medical treatment. Consisting of primary care providers, primary care focuses on general care for overall patient education and wellness. An example of this is regular consistent health care for chronic “controlled” conditions such as hypertension and/or diabetes is followed through the primary sector. Primary care specialists such as OBGYNS, pediatricians, or geriatricians are also primary care, specializing in caring for a particular group. Additionally, seeking treatment for acute rash, cold, flu, injury through urgent care can also be addressed through the primary sector.
Secondary care is the referral to specialist for further treatment which is out of the primary care scope. For example, cardiologists, endocrinologists, orthopaedist, and oncologists are specialized physicians practicing treating a specialized disease process or processes. Typically, certain insurances require a referral to the specialist for their visits to be authorized and covered.
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Tertiary care occurs once a patient is hospitalized and needs a higher level of specialty care within the hospital. Requiring highly specialized equipment and expertise tertiary care includes procedures such as coronary artery bypass surgery, renal or hemodialysis, severe burn treatments, neurosurgeries, or some plastic surgeries.
- What are the differences between vertically and virtually integrated models of healthcare organization?
Vertical integration refers to having all levels of care consolidated under one organizational roof. The common ownership of all levels of care: primary, secondary and tertiary, in addition to the facilities and staff necessary to provide the full spectrum of care. Virtual integration involves contractual involvement between HMOs and hospitals, physician groups, and other provider units within the HMO. The challenge with virtually integrated healthcare models is the renegotiations among various HMOs and bouncing between physicians and specialists that are within the network of the HMO. Additionally, evidence suggests a strong association exists between integrated health care delivery systems and quality of care.
- In the healthcare insurance market, what problems did government financing attempt to address?
Since the beginning of healthcare-related insurance, escalating costs continued to rise and the government’s largest focus has been on cost containment. The first managed care insurance plans followed a negotiated reimbursement methodology called “cost plus.” In this payment scheme, physicians were compensated according to charges that they themselves set, and hospitals were reimbursed on a percentage of their actual costs plus a percentage of their working and equity capital. This type of payment plan allowed doctors to charge fees they wanted and encouraged hospitals to increase costs so their cost-based income would be greater. By 1950, national health care expenditures equaled nearly 5 percent of the gross national product (GNP) and were continuing to grow. In 1965, the federal government intervened as the largest single purchaser of health care services by enacting a Medicare and Medicaid law which provided public medical coverage to the elderly and the poor. The insurance program followed a fee-for-service (FFS) model, in which the government reimbursed hospitals and physicians for the customary and “reasonable” fees they charged. Many of the insurance companies follow the same regulations and fee-schedule governed by Medicare attempting to contain healthcare costs.
- Bodenheimer, T.S. & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). Chicago, IL: McGraw Hill Medical.
- Gordon, J. S. (2018). A short history of American medical insurance. Imprimis, 47(9). https://imprimis.hillsdale.edu/wp-content/uploads/2018/10/Imprimis_Sept_8pgWeb.pdf.
- Longest, B. B. (2016). Health Policymaking in the United States (6th ed.). Chicago, IL: Health Administration Press; Washington, DC: AUPHA Pres.
- Moseley, G. (2008). The U.S. health care non-system, 1908-2008. AMA Journal of Ethics, 10(5), pp. 324-331. doi: 10.1001/virtualmentor.2008.10.5.mhst1-0805.
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