Introduction to Health Policy

What is policy?

- Collective decision and has some authority to shape collective life

- Made by government, organizations, etc.

What is public policy?

What government choose to do and not to do based on a framework of values and beliefs

What is policy implementation?

Implemented through laws, regulations, programs, etc.

What are the 2 types of policy development?

- Public

- Organizational

What elements are involved in the process of policy development?

- Agenda setting

- Policy development

- Policy adoption

- Policy implementation

- Evaluation

What is a health policy?

Policies developed, adopted, and implemented by governments in the health sector

In general, who are some big players who influence healthcare policies?

- American Medical Association

- Specialty-specific groups

- Patient advocacy groups

- Third parties (insurance companies , association of hospitals, etc.)

Who are big players specifically in OT involved with health policy?

- AOTA

- State associations

- NBCOT

- ACOTE

- Patient advocacy groups

- Disability advocacy groups

In what ways can policy impact OT practice?

- Establishes scope of practice

- Service accessibility

- Policy shapes clients' environment

- How OT services are reimbursed

- New opportunities

In what ways does policy help establish the scope of OT practice?

- What an OT can and cannot do

- Who can practice OT

In what ways does policy impact service accessibility?

- Telehealth

- Mandatory rural service

- Workforce shortage

In what ways does policy shape a client's environment?

- Living situation

- Ex. occupational opportunities for homeless population

- Ex. Leisure opportunities for children with disability

In what ways does policy effect how OT services are reimbursed?

- Type of health insurance

- Coverage of OT services

In what ways does policy create new opportunities for OTs?

- Mental health

- Workplace injuries

- Health promotion and wellness

- Primary care

What are some influential policies for OT?

- Americans with Disabilities Act, 1990 (ADA)

- Individuals with Disabilities Education Act, 2004 (IDEA)

- Rehabilitation Act of 1973 - Section 504 (RA)

What is socialized medicine?

Government operates all hospitals and pays all healthcare workers

What is modified socialized medicine?

- Hospitals and practices are private

- Government pays for healthcare services

What is hybrid medicine?

- Government insurance for poor

- Affordable to receive services through private insurance

- Cost sharing models

What are examples of health insurance?

- Medicare

- Medicaid

- Private

- Medicare Advantage

Who is Medicare applicable for?

- Administered at federal level

- All people > 65 years of age

- People with disability, etc.

How is Medicaid administered?

- Administered through states

- Vary by state

What is private insurance?

- Administered through companies

- Plans vary

- Ex. Aetna, Cigna, Blue Cross, etc.

What is Medicare Advantage?

- Combination of Medicare and private insurance

- Plans vary

What is a premium?

Amount you pay each month to have your insurance policy

What is a deductible?

Minimum amount you have to pay before your insurance kicks in

What is a co-pay?

Amount you have to pay at each healthcare encounter