Introduction to Health Policy

Introduction to Health Policy

  • Course: SPHL100
  • Instructor: Brooke Fruman, MPH Candidate
  • Institution: Department of Health Policy and Management

Public Policy

  • Definition: Authoritative decisions made by legislative, executive, or judicial branches of government intended to direct or influence actions, behaviors, or decisions of others.
  • Represents the sum of government activities, either acting directly or through agents, affecting citizens' lives.
  • Reference: Peters, 2014

Health Policy

  • Definition: Health policy encompasses decisions, plans, and actions aimed at achieving specific health care goals within society.
    • Functions of explicit health policy:
    • Defines a vision for the future; establishes targets and reference points for the short and medium term.
    • Outlines priorities and expected roles of different groups.
    • Builds consensus and informs citizens.
    • Acknowledged as one of the three core functions of public health.
    • Serves as a means to affect health at the population level.

Key Players in Health Policy

  • Entities Involved:
    • State and Local Government
    • Federal Government
    • Private Sector
    • Citizens

Types of Health Policy

  • Categories:
    • Laws
    • Rules or Regulations
    • Judicial Decisions

Role of Federal Government

  • Involves:
    • Policy making
    • Financing
    • Public health protection
    • Data and monitoring
    • Capacity building for population health

Phases of Policy Development

  1. Formulation Phase
    • Agenda Setting: Defines the relationship between a problem, possible solutions, and political will.
    • Involvement of interest groups and public health researchers leads to dynamic agendas closely related to other policy areas.
    • Development of Legislation:
      • Proposal of specific bills.
      • Legislative process involves voting in the House and Senate, followed by Presidential signing if passed.
  2. Implementation Phase
    • Utilizes resources to pursue objectives of public laws.
    • Steps include:
      • Designing: Establishing the agenda, implementation organization, and work performance.
      • Rulemaking: Guides law implementation.
      • Operating: Operationalization of rules.
      • Evaluating: Collecting, analyzing, and using information to assess a policy's effectiveness, implementation, financial impacts, and outcomes.
  3. Modification Phase
    • Involves clarification, omission, inputs from stakeholders, evaluation results, and changes in administration.

The Affordable Care Act (ACA)

  • Goal: Increase access to affordable health insurance for the uninsured and reduce costs for those covered.
    • Changes health care financing, organization, and delivery structure.
    • Expanded Medicaid to cover more low-income individuals.
    • Mandates that all Americans possess health insurance or incur tax penalties.

Health Insurance Coverage Statistics in the U.S.

  • 2023 Coverage Types:
    • Uninsured: 8.0%
    • With health insurance: 92.0%
    • Private plans: 65.4%
      • Employment-based: 53.7%
      • Direct-purchase: 10.2%
      • Marketplace: 4.0%
      • TRICARE: 2.6%
    • Public plans: 36.3%
      • Medicare: 18.9%
      • Medicaid: 18.9%
      • VA and CHAMPVA: 1.0%

Costs of Healthcare

  • Managing Risk: Health Insurance costs approximately $14,570 annually per person (2023, Source: Peterson-KFF, 2024).

Multi-Payer System Funding

  • Stakeholders:
    • State Government
    • Federal Government
    • Private Health Insurers
    • Private Employers
    • Individuals (Patients)
    • Flow of funds:
    • State & Local Taxes: Medicaid, etc.
    • Federal Taxes: Medicare
    • Out-of-pocket Costs: Individual patient contributions
    • Employer contributions and premiums for private insurance

Differences Between Medicare and Medicaid

  • Eligibility:
    • Medicare: Based on age (65+) and disability status.
    • Medicaid: Based on income (low-income).
  • Program Structure:
    • Medicare: Federal program.
    • Medicaid: Joint federal-state program.
  • Components: Medicare has four parts covering different services.

Healthcare Expenditures in the U.S.

  • Historical data shows U.S. health expenditures as a percent of GDP have exceeded 17% from 2005-2022, detailing rising costs in relation to comparable countries.

Quality of Care in the U.S.

  • Health outcomes are measured via maternal mortality rates, with U.S. rates per 100,000 live births being notably higher than the OECD average.
  • Avoidable deaths (standardized rates) per 100,000 population in 2020:
    • OECD average: 9.8
    • U.S.: 336
    • Comparisons with other countries include Australia (144), Canada (171), and others showing a trend of higher avoidable mortality in the U.S.

The Affordable Care Act Goals and Provisions

  • Goals:
    • Subsidize premiums to make health insurance affordable.
    • Expand Medicaid eligibility for adults earning below 138% of the Federal Poverty Line.
  • Quality and Coverage:
    • Mandated coverage for 10 essential health benefits (e.g., screenings, vaccinations).
    • Protections against pre-existing conditions and caps on out-of-pocket spending.

Changes to the ACA

  • Legislative updates include the individual mandate penalty adjustment to $0 in 2017.
  • Notable court cases:
    • NFIB v. Sebelius (2012) allowed states to decide on Medicaid expansion.
    • King v. Burwell (2015) confirmed legality of exchanges as tax law.
    • Braidwood Management v. Becerra (2022) addressing religious exemptions (pending).

References

  • Longest, B. (2016). Health Policy Making in the United States. Health Administration Press.
  • Institutes of Medicine. (2003). The Future of the Public’s Health in the 21st Century. National Academies Press.
  • Griffith, K., Evans, L., Bor, J. (2017). The Affordable Care Act reduced socioeconomic disparities in health care access. Health Affairs, 36(8): 1503-1510.