Overview:
For this assignment, you will prepare a written document that analyzes a health policy. Please follow the instructions below and prepare your document. Be sure to save in .doc or .docx format, and to follow APA guidelines.
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*To view the grading rubric for this discussion, click the name of the discussion, then click “Grading Information”
Instructions:
In Module 6 we learned about the 5 steps process for policy analysis. Using the policy you selected in Module 3 identify an issue of concern with a health policy.
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Medicare for All Act of 2021 ;- Addressing the issue of access to healthcare in the United
States.
Health Policy issues of concern: Access to care
Health Policy: Medicare for all act of 2021
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The Medicare for All Act of 2021 is a proposed proposal that would create a single-payer,
national health insurance scheme that would give full health coverage to all Americans. The
fundamental concern of the policy is access to care, since it attempts to ensure that all individuals
have access to the healthcare services they require without financial obstacles. Individuals’ ability
to acquire timely and economical healthcare treatments when they need them is referred to as
access to care. Access to primary care, specialty care, hospital care, prescription medicines, and
other necessary medical services is included. A range of factors, including cost, geography, and
insurance coverage, might limit access to care.
Under the Medicare for All Act of 2021, all Americans, regardless of poverty, employment
position, or health condition, would be entitled for complete health coverage. The concept would
eliminate the current mix of public and private insurance programs in favor of a single,
government-run program that would cover all necessary healthcare services. This would remove
many of the financial hurdles that today prevent millions of Americans from receiving care.
The following organizations are involved in the Medicare for All Act of 2021:
i.
Patients: Patients would gain immediately from the approach by receiving complete health
coverage and removing financial barriers to care.
ii.
Healthcare Providers: The policy would have a considerable impact on healthcare
providers, who would be required to adjust to a new payment and delivery system under
the single-payer model.
iii.
Insurance firms: Under the policy, private health insurance firms would be unable to
provide coverage to individuals or compete in the healthcare market.
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iv.
Employers would be relieved of the burden of providing health insurance coverage to their
employees, thus lowering labor costs and enhancing market competitiveness.
v.
Government: While the concept would necessitate significant federal government
investment to build and sustain the single-payer system, it has the potential to generate in
long-term cost savings and improved health outcomes for Americans.
Reference
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H.R.1976-Medicare for all act of 2021 – congress.gov. (n.d.). https://www.congress.gov/bill/117thcongress/house-bill/1976
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Introduction to Health Policy Analysis
What Is Policy Analysis?
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The systematic examination of a policy problem from the perspective of a stakeholder
with the purpose of helping an individual/organization/group make a choice that is
reflective of the values of the stakeholder and the practical and political realities.
• Above all, do no harm – and maybe even do some good!
• What is Policy Analysis?
• Expanded definition
• The use of reason (informed by judgment, intuition)
• And evidence (informed by data, studies, precedent)
• to choose the best, most practical, most feasible policy*
• That considers the values and goals of your decision-maker* (client)
• What Is Policy Analysis?
• What is the role of policy analysis?
• To help determine whether to intervene; how to intervene
• What does policy analysis do?
• The use of reason and evidence to choose the best policy among several options
to solve a problem
• What concerns does this raise in terms of bias, subjectivity, privilege?
• What Is Policy Analysis?
• Is policy analysis objective? Should it be?
• Relies on evidence to identify a problem and to demonstrate that an option is
best possible solution to problem
• How is evidence gathered, framed, presented?
• Always informed by decision maker’s values and goals
• Uses judgment and intuition to choose best and most feasible solution
• Models of Policy Analysis
Rational model: Politics and analysis should be separate; objective analysis can lead to a
“correct” answer to a policy problem; politics inserted after analysis is completed.
Political reason: “Reasoned analysis is necessarily political…always involves choices to
include some things and exclude others and to view the world in a particular way…Policy
analysis political argument, and vice versa.” (D.A. Stone)
Which makes more sense? Is it a meaningful distinction?
• Conducting a Policy Analysis?
• How do we conduct a policy analysis?
• Helpful to have a process – often broken down into two parts
• The study of the problem AND
• The study of the consequences of using one option above others to
address the problem
• Tools for policy analysis
• Economic analysis
• Quantitative analysis
• Qualitative analysis
• Political analysis
• Elements of Policy Analysis
• Who is the stakeholder/audience?
• Entire analysis is framed around the reader/decision-maker
• Essential elements of the analysis
• Issue Statement/Problem Statement
• Background
• Landscape
• Options (with criteria)
• Recommendation
• Problem Analysis: Issue Statement
Defining the problem
Identify the conditions
What are you examining? Describe the set of conditions that are under
examination.
Broad or narrow?
Issue statement
Short paragraph summarizing the issue to be considered. Ideally, phrase
the problem in the form of a question to guide your selection of
information to include.
Provide some context by identifying the conditions creating the problem
in an introductory sentence or clause.
Problem Analysis: Issue Statement
Examples of issue statements
Problem statements vary depending on decision-maker
Allowing the importation of drugs from Canada into the US increases the
likelihood that unsafe or ineffective drugs are distributed to US
consumers. What can Senator Pharma do to assure American consumers
are protected from unscrupulous importers?
Allowing the importation of drugs from Canada into the US increases
competition in the market and decreases costs to consumers. What can
Senator Elderly do to increase the importation of safe and effective drugs
into the US?
Problem Analysis: Issue Statement
• Examples of issue statements
• Problem statements can be broad or narrow
• Obesity is a huge health problem affecting nearly 1/3 of our population;
what legislative action should Governor Slim consider that would most
effectively impact this problem?
• Sodas and other sugary drinks are a main contributor to the obesity
problem in the US; Should Governor Slim support legislation to tax sodas
and other sugary drinks?
• Problem Analysis: Background
• Background
• Provides a description of the problem in detail
• Generally, decision maker could change, and background would look about the
same
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Develops the fact base and body of existing evidence
• Careful in use of statistics/data
• Display using tables and graphs
• Problem Analysis: Background
Elements to include in the Background
• Define key terms; clarify ambiguity
• E.g. uninsured
• Identify concrete operational measures of the problem
• Figure out how to measure with numbers
• Determine magnitude and scope
• How big is the problem?
• What is the impact of the problem?
• Is the problem growing quickly, slowly declining?
• Problem Analysis: Background
Elements to include in the Background
• Identify who is impacted by the problem
• Who is most affected by the problem? How and why?
• Are subgroups affected differently
• Quantify impact on groups and the difference between groups
• Place boundaries on the problem
• Where does it exist?
• National vs. state; urban vs. regional
• Are there differences in scope, magnitude by region, locale?
• Problem Analysis: Background
Elements to include in the Background
• Identify how long the problem has existed
• What are historical trends
• Has it improved or worsened?
• Identify how the problem might change over time
• Look at forecasts; projections (e.g. Medicare will be bankrupt by 2019)
Problem Analysis: Background
Problem statement:
• Teen smoking is a significant public health issue. What policies should Governor
Fresh support to bring about the greatest reduction in teen smoking?
What background information might we include?
Problem Analysis: Landscape
Landscape – most important section of the problem analysis
• Provides more context of the problem
• Tries to diagnose the problem
• What is the cause of the problem?
• How amenable is the problem to a policy intervention?
• If done well, options fall out of landscape, analysis
• Problem Analysis: Landscape
Potential elements to include in the Landscape (not all are always relevant)
• Stakeholders
• Political landscape
• Economic factors
• Legal context
• Social context
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• Administrative practicality, feasibility
• Others….
• Problem Analysis: Landscape
Elements to include in the Landscape
• Identify the stakeholders
• Groups, organizations, individuals that are invested in the problem and
how it will be solved
• e.g. Advocacy, lobbying groups, industry, membership
organizations, health services orgs, consumers/citizens
• What is their stake in the issue?
• How much influence do they have to impact the solution?
Problem Analysis: Landscape
Elements to include in the Landscape
• Describe the political landscape
• Is this a hot topic politically? Highly contested?
• Are their differences in how politicians define the problem and the causes
of the problem?
• Are their strong positions according to party lines?
• Do key constituents, opponents, interest groups have an opinion; who
supports or opposes change?
• Is there a reason to act now (election year?)
• Is there a reason to delay?
Problem Analysis: Landscape
Elements to include in the Landscape
• Describe the economic context
• What are the economic causes of the problem?
• What is the problem costing individuals, groups, society as a whole?
• Are certain subgroups disproportionately bearing the burden of the cost?
• What is the economic impact of addressing; not addressing the problem?
• Will the economics of the problem play into the solution?
Problem Analysis: Landscape
Elements to include in the Landscape
• Describe the social context
• Is the problem an individual problem or societal problem?
• Are there equity issues?
• Are there ethical and moral issues?
• Be careful not to elevate all issues to moral/ethical
• Are vulnerable subgroups disproportionately, negatively affected?
• Are influential, valued groups affected?
Problem Analysis: Landscape
Elements to include in the Landscape
• Consider the legal factors
• Are there legal restrictions affecting this problem?
• Are there legal requirements that impact the analysis?
• Is the potential for future litigation a concern if action is taken?
Structure of Options Analysis
The Options Analysis: 2 basic objectives
• Proposing, evaluating policy alternatives that address the problem
• Comparing and measuring different alternatives
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Determining which option is best course of action
• Justifying your recommendation
• Options Analysis
• Options analysis
• Different formats of options analysis depend on the problem under consideration
• Narrow: Support or oppose a policy under consideration
• Broad: Select among three policy options to address the problem
• Problem analysis and options analysis are intimately connected
• Framework should be consistent throughout
• Options should fall out of the problem analysis
• Key Elements of
Options Analysis
• Basic steps of options analysis
• Choose evaluation criteria
• Identify policy options
• Evaluate policy options according to criteria
• Recommend an action
• NEVER discuss options until you have fully analyzed the problem
• Key Elements of
Options Analysis
Choosing Evaluation Criteria
Goal of evaluation criteria
To measure and assess the impact of options
Purpose of evaluation criteria
To establish rules for assessment
Helps rank options
To minimize temptation to choose “pet” options
Provide measurement to justify ranking
• Key Elements of
Options Analysis
• Example evaluation criteria
• Net benefit
• Cost and financing
• Efficiency
• Equity
• Administrative ease
• Legality
• Political feasibility
• Social acceptability
• Key Elements of
Options Analysis
• How do you measure criteria?
• Established, quantifiable metrics
• e.g. $$, utilization rates, etc.
• Qualitative assessments
• e.g. high, medium, low
• Not all criteria are equal
• Let decision-maker guide priorities
• Weight them according to decision-maker
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May be determined by available data
• Key Elements of
Options Analysis
• Where to identify evaluation criteria?
• From client – the framework of your PROBLEM analysis
• Direct measures of interest
• Indirect measures implied by values and goals
• From key stakeholders
• From experience – learn by doing
• Should match the policy issues analyzed in the problem
• Ideally chosen before policy options
• Key Elements of
Options Analysis
• Identify Options = potential solutions to the problem
• Brainstorm many possible solutions
• Do research, Be creative
• Search and adapt options from analogous situations
• Develop new, customized ideas
• Think Incrementally
• Think Ideally
• Key Elements of
Options Analysis
• Identifying options
• Consider typical policy actions
• Gov’t providing or purchasing a good for public
• Taxing or subsidizing to achieve outcome
• Passing laws and regulations to require action
• Education and information to persuade action
• Always consider the status quo
• Identify 3 to 5 best suited alternatives
• GO BACK TO PROBLEM to make sure options squarely address problem
• Key Elements of
Options Analysis
Describe Options
Once selected 3-5, provide information that will help in analysis
Describe what option is
Define the populations that will be affected
Analyze options according to evaluation criteria
Assess that option
Using data
Using qualitative words – high, medium, low
Create a matrix, side-by-side as tool
Or express in terms of consideration of pros/cons with criteria embedded
in that analysis
Recommendation
• Generally, you will choose one recommendation for your stakeholder
• In some situations, may have conditional recommendations
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e.g.: if tax cut passes choose option 1, if tax cut does not pass choose
option 2
• In some situations, may choose combination of options
• If recommend more than one option need to justify
• Don’t take the easy route of avoiding picking one option unless there is a
good reason to do so
• Recommendation
• Recommendation must be one of the options evaluated
• Need to be clear why this option chosen from among all the options evaluated
• Don’t just repeat analysis of option section
• Identify why this option best for your stakeholder given that all options have
pluses and minuses
• Will relate to values and power of your decision-maker
• Must recognize downsides/acknowledge opposition
• AND address how downsides might be mitigated or overcome
• Format
Clearly, concisely phrased
Background and Landscape can be merged as one section if there is significant overlap in
what you want to cover in each section
Use of bullets
Use of tables – especially to compare options, summarize literature
Rating options?
This is analysis, not advocacy
Respectful of fact that your reader — NOT you – are the decision-maker
LABEL all sections
Give headers for each option
• Kingdon on Policy Process
Inherently messy
Problems – Proposals – Politics
Why some problems are in focus?
Proposals waiting for problems.
Politics/events push problems/proposals to the fore?
Many “streams” flowing at once – convergence or divergence?
Why did politics on health care reform shift for Clinton?
Why did it work differently with Obama?
Why was public health a major part of this year’s health reform
but not under Clinton?
Ref. John Kingdon, The Reality of Public Policy Making
• Kingdon on Policy Making Constraints
Law, procedures, parties (weak or strong)
US political culture of limited government; of equality of opportunity vs. equality of
outcome
vs. European notion of solidarity
Framing an issue to a political perspective – or is it manipulation
Big government or cover the uninsured?
Kingdon on ethical perspective – does this prevent compromise and “muddling
through”?
• Meltsner’s Seven Deadly Sins
1. Channeled advice (vs. changing landscape)
2. Distant advice
3. Late advice (accurate vs. timely)
4. Superficial advice (keep simple but don’t avoid complexities)
5. Topical advice (manufactured crisis)
6. Change for its own sake (doing nothing can be an appropriate option)
7. Advice without politics
Ref. Arnold Meltsner, The Seven Deadly Sins of Policy Analysis
• Values and Analysis
• Values vs. ethics?
• What role do they play?
• Does this introduce bias?
• How do you control for bias?
• If values play a role, then whose values should drive your analysis?
• Do We Define Problems and Solutions Based on Values?
• Is the need for health reform a value or a problem identified?
• What do we mean by health reform?
• Is the approach to health reform reflected in “values”?
• Private vs. public
• Health care as a right; health care as a responsibility
• Are data objective?
• Biomedical research – endpoints
• How we count unemployed, uninsured
• Can we put aside values to make a case?
• Good vs. cost-effective
• Making Public Policy
• What is public policy?
• A government resolution to a public problem
• What constitutes a public problem?
• Public problems are conditions that the public feels are unacceptable and require
intervention
• Could be policy problem, could be public health problem
• Where does public policy occur?
• At all levels of government
• Within different government institutions
• Making Public Policy
• Why might government intervene with policy solutions to public problems?
• Three most common reasons
• Political reasons
• Moral ethical reasons
• Economic reasons
• Making Public Policy
• How does the public sector make policy?
• Create programs
• TANF (welfare reform); Community Health Centers; Ryan White Act
• Regulate behaviors of actors in the system
• Gas mileage standards; medical malpractice reform
• Create financial incentives
• Condition of receipt of public funds (can be part of authorization or
appropriations bill – 55 MPH speed limit)
• Tax treatment (Employer-based health insurance)
• Administrative policies: Program announcements, policy guidance, regulations
• Making Public Policy?
• Who Makes Public Policy?
• Within an agency
• Between an agency and the White House
• Office of Management and Budget is part of the Executive Office of the
President
• Between the Executive Branch and the Legislative Branch
• Special role of the courts
• Making Public Policy
• What is the Public Policy Process?
• Traditional linear approaches
• Setting agenda, definition of options, decision, implementation
(executive/legislative processes)
• “how a bill becomes law”
• Cyclical process
• Bringing an issue forward at any point in an interactive policy making
process
• Appropriations Process
Most linear – clearly defined stages
Presidential budget preparation and delivery to Congress
Congressional Budget committees process
Sets parameters for Congress’ financial deliberations for the year
Congressional Appropriations committees process
Traditional “how a bill becomes law” process in most years
But appropriations are just one stage of the policy making process.
• Policy Making Process
• Executive Agency Policy Making
• Getting on the Policy Agenda
• External (often unexpected) events
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September 11 and bioterrorism; Enron and accounting reform; Wall Street and
financial reform
Public or key decision makers are “educated” about the importance of an issue
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Systematic policy analysis; Public education; Constituency group
pressure/influence
• Nursing shortage
Confluence
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• Prior public health infrastructure work influenced response to September 11
• Health care costs and chronic diseases
• The Structure of Policy Making
• Congress and Executive together
• Cyclical
• Authorize new programs
• Before or after created; to influence funding decisions
• Funding of new or old programs
• Funding levels; policy associated with funding decisions
• Note: multiple budget processes occurring simultaneously
• The Structure of Policy Making
• Executive alone
• Discretion in creating new programs
• Influence implementation of existing programs
• Health reform leaves huge discretion to HHS
• Congress alone
• Oversight powers
• Force decisions
• Put issues on the agenda
• Legislative riders/report language
• Structure of Policy Making
Partners/Constituency Groups/Interest Groups
Influence executive branch
Relationship with career staff
Relationship with political leadership
White House, Department, Agency
Influence with Congress
Generate support for legislation, draft report language, assist in oversight
hearing
Public education role
Generate media interest
Generate constituency pressure
• From Policy Analysis to
HEALTH Policy Analysis
• Health vs. Health Care
• What do these terms mean? How do they differ?
• What do we mean by health care policy?
• What do we mean by public health policy?
• Do they overlap?
• Scope of Health Policy Making
What are the agencies involved in pandemic preparedness?
What are the agencies involved in obesity-related policy?
What are the agencies involved in encouraging use of electronic health records?
Is this too complex to achieve a coherent approach?
How can public health take the lead among so many diverse agencies?
Replicated at state and local levels
• Who Makes Health Policy?
• What level of government makes health policy?
• What level of government implements health policy?
• Health reform, Medicare, Medicaid/SCHIP
• Public health
• State variability – policies, access, data
• Level of complexity
• Who are the Players in
Federal Health Policy?
Executive Branch
Departments (HHS, VA, EPA, DOD, Agriculture)
Agencies
Subagencies
Charter of National Prevention and Public Health Council – health in all policies
Executive Office of the President
OMB
Domestic policy structure
Congress
Appropriations
Authorizing
Tax
Oversight
Congressional Budget Office
Government Accountability Office
Congress
What is Public Health?
1988 Institute of Medicine report The Future of Public Health defined public health as
“what we, as a society, do collectively to assure the conditions in which people can be
healthy.”
Public health sees “patient” as the population; medical care sees “patient” as individual
Tobacco regulatory standard: population health vs. individual health
• Public Health in a Federal System*
• Who has legal authority?
• How can the federal government influence behavior of state and local health
departments?
• Who responds to a flu outbreak?
• Is there also a global component?
• Who responds to a natural disaster?
• Core Public Health Functions (IOM, 1988)
• Assessment and monitoring of the health of communities and populations at risk to
identify health problems and priorities
• Formulating public policies, in collaboration with community and government leaders,
designed to solve identified local and national health problems and priorities
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Assuring that all populations have access to appropriate and cost-effective care,
including health promotion and disease prevention services, and evaluation of the
effectiveness of care
• 10 Essential Public Health Services (IOM 2003)
Monitor health status to identify community health problems.
Diagnose and investigate health problems and health hazards in the community.
Inform, educate, and empower people about health issues.
Mobilize community partnerships to identify and solve health problems.
Develop policies and plans that support individual and community health efforts.
Enforce laws and regulations that protect health and ensure safety.
Link people to needed personal health services and assure the provision of health care
when otherwise unavailable.
Assure a competent public health and personal health care workforce.
Evaluate effectiveness, accessibility, and quality of personal and population-based health
services.
Conduct research to attain new insights and innovative solutions to health problems.
• Core/Essential Public Health Functions
Who sets policies/standards/methods in each function?
Who finances each function?
Is all this a public sector discussion?
Different perspective between public health and health care delivery system
(financing):
Population health vs. individual health
Authority challenges between public and private sectors
• Resources
• U.S. Department of Health and Human Services: www.hhs.gov
• Centers for Medicare & Medicaid Services: www.cms.gov
• Centers for Disease Control and Prevention: www.cdc.gov
• GW Department of Health Policy:
http://www.gwu.edu/sphhs/departments/healthpolicy/
• Kaiser Family Foundation: www.kff.org
• Commonwealth Fund – www.cmwf.org.
• Urban Institute – www.urban.org.
• Center for Health Systems Change: www.hschange.org
• Center for Budget Priorities and Policy: www.cbpp.org
• Census Bureau: www.census.gov
• Bureau of Labor Statistics: www.bls.gov
• Health Information and the Law: www.healthinfolaw.org
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