PHLT 412 EXAM 1 (Modules 1.1-1.8) Elia

Policy

-Outlines of what government is going to do and what it can achieve for society as a whole.

-Principles that are needed for achieving the goal

-Policies are only documents and not laws, but these policies can lead to new laws

Law

-Set of standards, principles, and procedures that must be followed in society

-Made for implementing justice in society

-Different types of laws: Health laws, education laws, criminal laws, international laws, etc.

T or F: Policies and laws are NOT the same and cannot be used interchangeably

True

The Patient Protection and Affordable Care Act (PPACA)

-A series of policy and legal decisions aimed at transforming health insurance coverage

-The law also includes other important reforms and new programs (provisions) unrelated to insurance

• Higher quality healthcare

• Population health

• Access to healthcare

• Long-term carer and others

The Patient Protection and Affordable Care Act (PPACA) Goals:

-Coverage expansions to reduce number of uninsured

-Health insurance reform to improve affordability of coverage

-Delivery system changes to contain costs and improve quality

-And others

“Advocacy” include a wide range of activities that influence decision makers

-For example: litigation, lobbying, public education, relationship building, forming networks, and leadership development

-”lobbying” refers to activities that are intended to influence a specific piece of legislation

Role of Policy and Law in Health Care & Public Health (Part 1)

-Choices made by policymakers and decisions handed down through the legal system have important impacts

• How we approach, experience, analyze, and research all of these and other specific aspects of the healthcare system

-Policy and law shape all aspects of the health care system

• Such as cost, access, quality

-Policy and law have long played an important role in everyday public health activities as well as in many historic public health accomplishments

-Huge impact, but less visible and articulate

-Require both vigorous policymaking and adequate legal powers to successfully combat public health threats

• Ex: Food inspections, Occupational safety standards

Role of Policy and Law in Health Care & Public Health (Part 2)

-One main focus of policy and law:

• Locating the appropriate balance between public regulation of private individuals (balancing approach) and corporations, and the ability of those same parties to exercise rights that allow them to function free of overly intrusive government intervention

-Two types of policy and laws:

1. Define the functions and powers of public agencies

2. Aims to directly protect and promote health

Conceptual Frameworks for Studying Health Policy & Law

1) Study Based on the broad topical domains (aka topics)

2) Based on historically dominant social, political, and economic perspectives (ex: studying policy before covid and then after covid to make a comparison)

3) Based on the perspectives of key skateholders

Conceptual Frameworks for Studying Health Policy & Law 1) Study based on the broad topical domains of health policy and law

• Health care

• Public health

• Bioethics

Conceptual Frameworks for Studying Health Policy & Law 2) Study based on prevailing historically dominant social, political, and economic factors

• Professional autonomy (1880 -1960)

• Social contract (1960 – 1980)

• Free market (1990 to now)

We usually compare before and after, then break them into time frames to better understand policies

Conceptual Frameworks for Studying Health Policy & Law 3) Study based on the perspectives of key stakeholders

• Who are the stakeholders?

Definition of stakeholder: any person, group, or organization that has an interest in a business, project, or decision and can affect or be affected by its outcome.

Conclusion of understanding Health Policy & law

• Study of policy and law is essential to the study of both health care and public health

• Policy and law have long been used to promote positive social change

(policies are never set in stone, they can be erased, modified, protested against, etc.)

Defining Policy

Who makes policy?

-Government (federal, state, local)

-Private actors (not owned by governments ex: starbucks, etc.)

-Authoritative decision maker (ex: professor’s class policy)

Public policy problems

-Beyond individual concerns

Structuring policy options

-Mandatory vs. Voluntary (ex: certain vaccines, having a drivers license if you want to drive)

-Take action (ex: you have to wear a seatbelt) vs. refrain from acting (ex: no smoking)

3 Branches of Government (Federal Level)

Legislative Branch (also called legislators/lawmakers)

-Congress

• House of Representatives

• Senate

Executive Branch (makes executive orders which is a policy)

-White House

-Administrative agencies

Judicial Branch

3 Branches of Government (State Level)

Legislative Branch

-Legislature

Executive Branch

-Governor

Judicial Branch

-Trial and appellate court

Congress

Lawmaking body of the federal government (referred to as lawmakers/policy makers)

Federal Legislative Branch (STATE): Congress consists of two chambers

Senate: Statewide. Two senators from each state. 6-year term

• Our senators are Cruz and Cornyn

House of Representatives: Elected by district, proportional to populations. At least one representative per state. 2-year term

• Based on population size not land size

Federal Legislative Branch (FEDERAL):

Leadership position: Determined by political party affiliation, with the party in the majority gaining many advantages (usually part with the most representation is majority)

Senate: Vice president of the US is the president of the Senate (shows up when there’s a tie, makes it 51)

House: The speaker of the House

-Leadership positions are determined by the members of the party who have been elected to Congress

Key Congressional Leadership Positions

• Senate majority leader: person that’s leading the party that has the most people

• House majority leader

• House and senate minority leaders: people leading the party that has the least people

• House and senate majority and minority whips

Whip

An official in a legislature whose job is to make sure party members show up for votes and vote the way the party wants. (counts votes)

Legislative Branch: Committees

-Small group of people that are experts in a certain area that do initial work (they do NOT appoint anyone)

-”Workhorses” of Congress

-Roles:

• Drafting and amending legislation

• Educating members not in committee on key issues so they know what is going on

• Shepherding the committee’s legislation on the floor (helps decide what to vote)

• Holding hearings (Purpose: invite experts to testify, share research, to tell how things work in a community)

• Working with the president, his administration, and lobbyist to gain support for bill

• Conducting oversight of executive branch departments, agencies, commissions, and programs, within their purview (make sure they’re doing what they’re supposed to do)

Legislative Branch Standing committees:

Permanent committees with specified duties and powers

-20 in the House

-17 in the Senate

Some have authorization jurisdiction (some committees have power to approve creation of new agencies), some have appropriation authority (power to approve budgets), some have oversight authority (overseeing that everything is staying on track and not overstepping)

-normally a committee only has one power at a time

Congressional Commissions & Staff Agencies

Provide Congress members with information they need for research and policy analysis

-Important behind the scenes role

• Congressional Budget Office

• Government Accountability Office

• Congressional Research Service

• Medicare Payment Advisory Commission

• …and many more

General Process of How a Bill becomes a law

A bill can be introduced in either the House or Senate.

It is then read and assigned to a committee, where it is reviewed and may be amended.

If it moves forward, it goes to the floor for debate and a vote.

If the House passes it, it goes to the Senate, and vice versa. Both the House and Senate must pass the exact same version; if they do not, a conference committee works out the differences.

Once both chambers agree, the bill is sent to the President, who can sign it into law, allow it to become law without signing it after 10 days while Congress is in session, or veto it.

If the President vetoes it, Congress can override the veto with a two-thirds vote in both the House and Senate.

Legislative Branch: Constituents

A Voter or resident represented by a politician or any individual part that makes up a larger whole

-Voters in state or district

-Voters in nation if have leadership role or national aspirations

-Political party

-President

Federal Executive Branch: White House

-President

-Executive Offices

• Council of Economic Advisers

• Council of Environmental Quality

• Office of Management and Budget

• Office of Security and more

Federal Executive Branch: 15 Cabinet Departments

• Department of Defense

• Department of Agriculture

• Department of Commerce

• and more

Federal Executive Branch: Presidential duties and powers

-Agenda Setting: president’s goals/priorities (president set agenda)

-Budget Proposal: estimate how much money they wanna spend on issues (congress approves the budget)

-Persuasion: encourage people to approve their bills, ideas, and proposals

-Sign/veto bills

-Executive Orders: we usually see more executive orders near the beginning of a person’s presidency. it is more like a policy but they are pretty powerful

Federal Executive Branch: Presidential Constituents

• Nation (all voters)

• Public who voted for president

• Political party

• Other nations (our allies)

• International organizations (ex: WHO, World Banks)

Federal Executive Branch: Administrative Agencies

Implement the laws passed by Congress and the executive orders signed by the president

-They make things happen but don’t write the law (implement)

-Under cabinet departments

-Two Categories

• Executive department agencies

• Independent agencies

-Can be created by statue, internal department reorganization, or presidential directive

Federal Executive Branch: Administrative Agencies Duties/ Powers

Issuing policy statement, developing rules, and promulgating regulations (they tell us what we need to do)

-Constituents

• President: head of departments are appointed by President

• Congress: approves those appointed by president

• Individuals and entities regulated by agency

• No one?

Executive Agency Policy Making

When administrative agencies are making their policies they have to talk to a lot of people

Federal Health Bureaucracy - Key agencies (not the only ones)

-Department of Health and Human Services (HHS): deal with any/all human health related stuff ex: CDC

-Department of Veterans Affairs (VA)

-Department of Defense (DOD)

Federal Health Bureaucracy - VA & DoD

VA (Department of Veterans Affairs): Provides comprehensive care to veterans who were not dishonorably discharged

DoD (U.S. Department of Defense): TriCare Provides health insurance to current and retired military personnel and their families

State and Local Policymaking and Health Bureaucracy

State-level policymaking is important (states have most power over our health related issues)

-Key decisions made on state level

-Variation among states in how policymaking process is structured (ex: drivers license)

State/local health bureaucracy

-State level agencies (ex: Medicaid, public health)

-Local public health agencies

Advocacy

The process of stakeholders making their voices heard on issues that affect their lives and the lives of others at the local, state, and national level

• Speak in favor of

• Supports or defends a cause

• Pleads on another’s behalf

Why is Advocacy Important?

• Inform and impact public policy

• Keeps the focus on those in need who may not be able to speak for themselves

• Promotes change at the “systems” level

• Works to overcome system barriers

• Highlights the work of your organizations and your profession

Why don’t people engage in Advocacy?

• Lack of comfort with/knowledge of advocacy process

• Think they can’t

• Think they shouldn’t

What is Policy Advocacy?

• Involves a wide range of activities

• Finds solutions for systemic or community problems

• Can happen at all levels of government

• Seeks to influence decision makers

• Who are the decision makers?

Planning a Policy Advocacy Campaign

1) Identify a problem

-Individual members of Congress or staff, constituents, news, executive branch agencies, state and localities, stakeholder organization, policy research

2) Select a policy solution

-Is it effective? How can it be accomplished? Is it politically feasible right now? How can we attract support? What evidence is available to support the solution? What is the best way to communicate this problem and solution?

3) Identify the decision makers and who influences them

-People with power and/or authority to approve or implement the changes, people/organization who influence decision makers

Four Key Tools of a Policy Advocacy Campaign

-Policy Research

-Direct lobbying and coalition building (forming groups)

-Grassroots and grasstops campaigns

-Communication and media

…Don’t forget to plan the budget and timeline

Policy Advocacy Campaign: Develop a Foundation of Knowledge

-Do your research!

• Really get to know the issue(s)

• What is the challenge

• What is or isn’t happening that makes it an issue

-Identify all “players” that are involved in the issue

• Identify who might be against your issue

• Understand their position and see if there is any common ground

-Identify the possible solutions

Policy Advocacy Campaign: Identify the Process

• What is the local/state legislative process?

• Where is your issue in this process?

• What agencies have any influence authority or control over the issue?

• Who needs to know about your advocacy?

• What key contacts do we need to make?

Policy Advocacy Campaign: Build Credibility

• NETWORK!

• Keep up with key contacts/advocates

• Send information without asking anything in return

• Identify, work with, and encourage others to get engaged

Advocacy Groups & Coalitions (ex of coalition: The Big Event) Adds Value

• Increase links to decision makers

• Provide background information on legislative issues

• Identify others interested in same issue(s)

• Enhance credibility with governmental agencies and other advocacy groups

• Increase resources, share workload

Policy Advocacy Campaign: After the Campaign

• The work is not finished once a bill is passed or regulation published.

• Continued need to advocate for funding

• Continued engagement in the regulatory and political process regarding implementation

• Consider if more steps are needed

• Don’t forget to say thank you to advocates and allies!

Advocacy vs. Lobbying

The goals of advocacy and lobbying are similar, but the processes are different

Lobbying

Activities that are in direct support of or opposition to a specific piece of introduced legislation.

Interest Groups

Organizations that focus on a particular issue or issues and have the goal of influencing and educating policymakers and the general public

Interest groups do not make policy. They use different ways to influence policy

-Research

-Connect with the decision maker

-Develop persuasive argument

The Role of Law

To function as the main tool with which we organize ourselves as an advanced, democratic society

-A society as sprawling and complex as ours needs formal, enforceable rules of law to provide a measure of control

The Study of Law

Study of human beings, particularly their evolving customs, beliefs, and value system

Legal Right

Power or privilege that has been guaranteed to an individual under the law

Legal rights presuppose that their enforcement can be achieved through public institutions.

• Federal Medicare program

Defining Law

-Think of “law” not just as words on a page, but as the many interacting parts that are involved in drafting those words in the first place, and in bringing them to life once they have been enacted as laws.

-Thus, consider “law” as a system by which rules are created, disseminated, enforced, violated, disputed, interpreted, applied, revised, etc.

-Laws are constantly changing, evolving, updating, eliminating

Source of Law

The laws meant to maintain order, define the outer limits of our interactions with others and with the government, and delineate legal rights and responsibilities

Primary Sources of Law:

• Constitutions

• Statues (written and passed by legislative branch ex: social security act)

• Regulations

• Common law/ case law (written by the court)

Primary sources of law - Constitutions

Establishes a government and delineates fundamental rights and obligations of that government and of individuals who fall within the territory covered by the constitution

-Federal constitution (apply to the entire U.S., not very long or detailed)

-State constitutions (more specific, much longer)

Constitutional Interpretation

-Judges and lawyers job is to interpret the constitution

There’s multiple ways to interpret constitution, For example:

• Living constitution: we interpret constitution differently based on personal lived experiences

• Moral constitution: based on own morals

• Originalism: how constitution was at the time it was written vs. now (ex: even the word “firearms” back then, doesn’t mean what it could mean now

• Strict constructionism: literal words, strictly what’s written

Primary sources of law - State Constitutions

-Provide organizational structure of the particular state’s government

-Cannot limit or take away rights conferred (given to the people) by the US Constitutions, some state constitutions go further than federal law in conferring rights or extending protections

-Easier to amend (update) and are done more frequently

Primary sources of law - Statutes

-Laws written by legislative bodies (senators & House of Representatives) at all levels of government (ex: social security act, Americans with disabilities)

-Written as broad policy statements, and often need for courts to interpret and apply general statues to specific legal cases or controversies

-State legislatures have greater ability than does Congress to use statutes to regulate issues

Primary sources of law - Regulations

-Specific regulations written to assist with the implementation of statutory directives and to promote their underlying policy goals

-Create by administrative agencies of the executive branch of government

Regulations are used to implement policies

-Administrative agencies in the executive branch implements policies

Primary sources of law - Common Laws

-Court opinions interpreting and applying law to specific cases

-Based on the traditions and customs of society, yet heavily influence by legal precedent and the doctrine of stare decisis (using historical/past cases to make current decisions)

Key Features of the Legal System

-Laws are only one component of the complex, interacting legal system

-Others include the separation of powers doctrine, federalism, the role and structure of federal and state courts, judicial review, due process, and constitutional standards of review

Separation of Powers

-US government include three independent and equally powerful branches

• Legislative, Executive and Judicial

-The legal doctrine supports the arrangement of shared governance

-Includes concept of “checks and balances”

Federalism (Part 1)

Powers not given in US constitution is given to states (ex: health and education powers are given to the states)

-Allocation of Federal and State legal authority

-Under the Constitution, the federal government is one that has limited powers, while the states more or less retain all powers not expressly given to the federal government

-States have most power on public health issues

• Marriages, divorces, and adoptions

• Schooling

• Driving

• Medical

• Licenses

• and others

Federalism (Part 2)

-Federal government also have role in regulating health care and public health

• Taxation (ex: social security tax, medicare tax

• Spending (ex: how much they want to spend on research and expanding)

• Interstate commerce

-Federal and state court each has unique authority and jurisdiction

The Role of Courts

Judicial: 3rd branches of government

-Two separate court systems: federal and state

• Federal Court system: Lowest level court (a trial court) and two separate, higher-level courts (appellate courts and Supreme court)

• State has similar structure as federal, but not always

-Courts have responsibility to determine what the Constitution means permits, and prohibits

-Courts protect and enforce individual legal rights, determine whether the political branches of government have violated the Constitution, and maintain stability in the law through the application of legal precedent

Goals and services of government public health agencies

• To prevent epidemics and the spread of disease

• To protect against environmental hazards

• To prevent injuries

• To promote and encourage healthy behaviors

• To respond to disasters and assist communities in recovery

• To ensure the quality and accessibility of health services

Governmental Public Health Agencies - The Institute of Medicine (IOM) defined three core public health functions:

• Assessment

• Policy Development

• Assurance

-Theses jobs cannot be delegated to other agencies or nongovernmental organizations

-Governmental public health agencies need to work together to accomplish these function

Ten Essential Public Health Services

Not a linear process, there’s continued evaluation and it’s a cycle

Equity: trying to give people what they need to reach equal

-Assess and monitor population health

-Investigate, diagnose, and address health hazards and causes

-Communicate effectively to inform and educate

-Strengthen, support, and mobilize communities and partnerships

-Create, champion, and implement policies, plans, and laws

-Utilize legal and regulatory actions

-Enable equitable access

-Build a diverse and skilled workforce

-Improve and innovate through evaluation, research, and quality improvement

-Build and maintain a strong organizational infrastructure for public health

Assessment

1) Assess and monitor population health status, factors that influence health, and community needs and assets

2) Investigate, diagnose, and address health problems and hazards affecting the population

Policy Development

3) Communicate effectively to inform and educate people about health, factors that influence it, and hows improve it

4) Strengthen, support, and mobilize communities and partnerships to improve health

5) Create, champion, and implement policies, plans, and laws that impact health

6) Utilize legal and regulatory actions designed to improve and protect the public’s health

Who implements policies?

Who enforces laws?

-The 15 administrative agencies in the executive branch ex: CDC

-Executive branch ex: police

Assurance: making sure plan/intervention works because you don’t want to continue to pay for something if it doesn’t work

7) Assure an effective system that enables equitable access to the individual services and care needed to be healthy

8) Build and support a diverse and skilled public health workforce (continued education is needed)

9) Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement

10) Build and maintain a strong organizational infrastructure for public health

Inform, Educate, and Empower Activities - Activities by state and/or local public health agencies:

• Community health education and health promotion

• Public health education through the media, presentations, the Internet, displays, etc.

• HIV/AIDS risk reduction curriculum

• Child-abuse education

• Domestic violence education

• WIC educational programs

• Informing, educating parties involved in nuisance investigations

• Public education about well construction

Mobilize Community Partnerships Activities - Activities by state and/or local public health agencies:

•  Tobacco-free coalitions

• Bio-emergency regional collaboration

• Collaborative efforts with private industry to combat domestic violence

• Community partnerships with law enforcement, county attorneys, community betterment groups, housing authorities

• Referrals and collaboration with health-care providers

• Collaboration with WIC, public health nursing, special- population advocates to meet the needs of special populations

Develop Policies Activities - Activities by state and/or local public health agencies:

• State board of health oversight and regulatory functions

• Local board of health oversight and regulatory functions

• Public hearings

• Administration of state and local public health departments

• Monitoring of contractors/providers

• Community health planning

• Strategic and performance planning

• Development of a plan to address housing needs

• Updating of health and nuisance ordinances

• Development of policies on investigations, police assistance and trespass and safety issues

• Board of health adoption of rules that require better management of water systems in small, rural subdivisions

• Determination of need for community water supplies

• Development of variance procedures

• Establishment of procedures for water well permits

• Establishment of financial assistance for well sampling, plugging or rehabilitation

All three IOM core functions: Research

Research for new insights and innovative solutions to health problems

Local and State Public Health Agencies (Part 1)

Public health is a state responsibility

States may:

-Retain the authority (keep all the power)

-Voluntarily request/accept help from the federal government (ex : When there's a hurricane)

-Delegate responsibility/authority to local agencies

Role of local agencies:

-Home rule or local autonomy model

-Branch office model (follows whatever state tells them to do)

Local and State Public Health Agencies (Part 2)

-Many local PH departments have similar responsibilities

-Serve as healthcare safety net (ex: vaccinations [most used local service], food safety [inspecting food])

-State Health Department’s responsibilities includes:

• Collecting vital statistics

• Running public health labs

• Licensing health professionals (states decide what are requirements to get license)

• Drinking water regulation

• Administration of state Medicaid program

Role of Federal Public Health Agencies

-Federal public health authority provide funding to states

-Healthy People Initiative (Healthy People 2030)

-The Department of Health & Human Services (DHHS) is central public health agency of the federal government

-Only about 5% of health-related funding goes to public health

-Less than half goes to population-based prevention

-The role of governmental public health is limited by social attitudes toward government

• Americans favor individual or private efforts over governmental interventions (main reason we can’t achieve universal healthcare: individualism)

Key Federal Health Agencies of the DHHS

• Centers for Disease Control and Prevention (CDC)

• Agency for Toxic Substances and Disease Registry (ATSDR)

• National Institutes of Health (NIH)

• Food and Drug Administration (FDA)

• Health Resources and Services Administration (HRSA)

• Agency for Healthcare Research and Quality (AHRQ)

• Substance Abuse and Mental Health Services Administration (SAMHSA)

• Indian Health Service (IHS)

Global Public Health Organizations

• World Health Organization (WHO)

• UNICEF

• UNAIDS

• The World Bank

• United States Agency for International Development (USAID)

PH Agencies Working Together

• Collaborations between different level of public health agencies

• Collaboration between governmental public health and other governmental agencies, nongovernmental organizations, and the healthcare delivery system

• e.g., Tobacco control, food safety, COVID-19

-Communication is one of the most important skills a public health professional needs

Other Government Agencies Involved in Health Issues

-Many government agencies serve public health functions even though they are not defined as health agencies.

• Environmental Protection Agency (EPA)

• Occupational Safety & Health Administration (OSHA)

• Department of Homeland Security

• Dept. of Agriculture

• US Food and Drug Administration

• Dept. of Energy

• Dept. of Housing and Urban Development

Nongovernmental Organizations (NGOs) in Public Health

-Play increasingly important roles in public health in the US and around the world

• American Red Cross

• American Heart Association

• Mothers Against Drunk Driving (MADD)

• HIV/AIDS advocacy groups

International Global Nongovernmental Organizations in Public Health

-Care

-The Global Fund

-Medecins Sans Frontieres

-Oxfam

-Bill & Melinda Gates Foundation

-Robert Wood Johnson Foundation

PH Agencies Partnering with Health Care: Community-oriented primary care (COPC)

-Expand the delivery of health services from a focus on the individual to include additional focus on the needs of communities

-Bring healthcare and public health together to serve the needs of communities

COPC (Community-Oriented Primary Care) Process

1. Community Definition

2. Community Characterization

3. Prioritization

4. Detailed assessment of the selected health problem

5. Intervention

6. Evaluation

What is a policy analysis

An analysis that provides informed advice to a client that relates to a public policy decision, includes a recommended course of action/inaction and is framed by the client’s powers and values.

(helping other people make a decision)

Purpose of Policy Analysis

-Client-Oriented advice

-Informed advice (give them a reason to change and do better)

-Public policy decision

-Providing Options and Suggestions (normally public health issues have more than one solution)

-Your Client’s Power & Values

Policy Analysis Structure and Tone: 5 Step Structure

1) Problem Statement

2) Background

3) Landscape

4) Options Analysis

5) Recommendation

-Tone should be neutral and non-judgmental throughout the analysis

Policy Analysis Structure: 1) Problem Statement

-defines the problem being addressed in the analysis

-How a problem is framed is one of the most important steps in a policy analysis (you’ll spend most time here)

-1-2 sentences, usually in the form of a question

-May be broad or narrow (the more specific and clear the better)

-May be neutral or value-laden

-Must lead to the possibility of several options (more than one solution)

-Do not include recommendation in problem statement

Policy Analysis Structure: 2) Background

-Informs the reader why a problem has been chosen for analysis.

-Provides much of the facts and information necessary to understand the problem being

addressed.

-May have to tailor some background information based on the knowledge base of the client.

• But much of the information provided in the background is necessary regardless of client.

(How long has the situation been going on? How bad is the situation? Who’s being impacted? Put facts! Explain technical terms)

Policy Analysis Structure: 3) Landscape

-Provides the overall context of the analysis by identifying key stakeholders interested in the problem and the key factors that must be considered when analyzing the problem

-Which stakeholders must be included depends on the issue at hand and the phrasing of the problem statement

-Some examples of the aspects of a problem that a policy analyst may consider include:

• Political factors, social factors, economical factors, legal factors, practical factors, other factors

Policy Analysis Structure: 4) Option Analysis

-The policy analysis should provide 3–5 options for a client to consider

-All options must

• Be within the power of the client to do

• Be consistent with the client’s values

• Address the issue identified in the problem statement

-Identify criteria that will be used to evaluate the option (which option from 2-3 options you created is best? How do we determine this?)

-Identify pros and cons for each option

• There is no perfect option

-May use a side-by-side table to assist in analyzing the options

• Descriptive or analytical tables may be appropriate

Policy Analysis Structure: 5) Recommendation

-Choose one of the options as the recommended course of action for the client

• Status quo/inaction may be an option

-Discuss why this option is better than the others despite the cons associated with the option

-Identify any action that may be taken to ameliorate the cons associated with the option

-Do not choose a hybrid option that mixes two or more of your options

Healthcare’s Iron Triangle

-Cost

-Quality

-Access

Unlike other developed countries, the US does not have a unified healthcare system

You’re responsible for your own health in the US, we don’t have universal healthcare

-The US spends much more on health care per person

-US Ranks at or near the bottom on important health outcomes

-Lacks coordination within the healthcare system

National health expenditures, by service type: Where do we spend the most of our money?

Hospitals and Physicians & Clinics

Healthcare Finance: Insurance

-Uncertain

-Most people in US obtain insurance through their employer (Why? because if employees are sick, they can’t work)

-Health insurance acts as an intermediary between patients and providers

-In 2022 an estimated 93% had insurance coverage

• 8.4 % or 27.6 million Americans of all ages did not have health insurance in 2022, compared to 10.3 % or 33.2 million in 2019