HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy?
HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy?
Why is policy analysis an important tool in the development of health care policy? HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy? What important information can thorough health policy analysis provide? Respond to three other peers and provide additional insight and/or constructive comments. One-sentence posts or peer responses are not appropriate and will not receive full credit.
HLT 600 GC Week 3 Discussion 2 Latest
How do health care administrators use public health data to develop health care policies? Cite specific examples to support your answer.
How do cost analysis studies influence the development of health care policy? Do the most cost-effective practices always get adopted into law? Use specific examples to support your opinion. HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy? Respond to three other peers and provide additional insight and/or constructive comments. One-sentence posts or peer responses are not appropriate and will not receive full credit.
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How has immigration influenced the development of health care policy in the United States? Respond to three other peers and provide
additional insight and/or constructive comments. One-sentence posts or peer responses are not appropriate and will not receive full credit.
HLT 600 GC Week 8 Discussion 2 Latest
How do the different committees within Congress work together to influence the development of health care policy in the United States? Respond to three other peers and provide additional insight and/or constructive comments. One-sentence posts or peer responses are not appropriate and will not receive full credit. HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy?
What is the public health code of ethics, and what are the underlying values and beliefs? How does this value system drive the development of health care policy? Respond to three other peers and provide additional insight and/or constructive comments. One-sentence posts or peer responses are not appropriate and will not receive full credit.
HLT 600 GC Week 5 Discussion 2 Latest
How does Congress work with governmental agencies like the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) to develop health care policy? Cite specific examples to support your answer. Respond to three other peers and provide additional insight and/or constructive comments. One-sentence posts or peer responses are not appropriate and will not receive full credit.
Health and Health Policy
Health policy is part of the larger field of health services research, an area devoted to the discovery of new information for the improvement of individual and population health. Due to the nature of health, both health services research and health policy analysis are interdisciplinary by nature, using the knowledge of both the biological sciences and the social sciences. The evolving fields of implementation science, decision science, and sustainability science also address health policy analysis (Clark, 2007; Clark & Dickson, 2003).
Health is a complicated concept. The most famous definition of health comes from the World Health Organization (WHO): “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization Constitution Preamble, 1948, p. 100). This definition points to the comprehensive nature of health; there is both a physical and mental aspect of health as well as a sense of well-being. The definition tends to be more aspirational, with a focus on what it takes to achieve human potential rather than a description of reality. Individuals and societies transition from one state of health to another over time. Given the WHO definition, “health” may be a very temporary state.
Health is not a given. Societies create conditions that promote both disease and health. As demonstrated by Evans and Stoddart and other similar social–ecological and systems science models, societies produce health or disease through the interaction of multiple variables (e.g., policy, the natural and created environments [the built environment], building medical care systems, as well as individual behavior; Evans & Stoddart, 2003; Huang, Drewnowsksi, Kumanyika, & Glass, 2009; McLeroy, Bibeau, Steckler, & Glanz, 1988; Stokols, 1992; Stokols, Allen, & Bellingham, 1996). Manipulating any one of these variables (e.g., education or the transportation systems) creates greater disease or health for individuals and for society as a whole. Therefore, by implication, societies have the ability to influence their own health through their public policies. The creation and distribution of wealth; the educational system; natural and built environments, including but not limited to the creation of safe living and work environments; and access to the medical care system all play critical roles in determining the health status of a given population or a particular individual. All of these inputs to health are shaped by the actions of both individuals and society through the policy process; the health of a society is not predestined, and public policies play a major role in determining health.
Our understanding of these different inputs to health has changed over time. For example, efforts to increase physical activity and improve nutrition among the general population were historically aimed at changing individual-level health behaviors. Individuals were told to exercise more and eat healthier meals. The focus was on how to get the individuals motivated to change their behavior and to adopt healthy eating patterns. Thaler and Sunstein (2008) refer to this as “the nudge” or “libertarian paternalism.” However, such approaches have been found to be minimally effective, costly, and difficult to sustain (Lyn et al., 2013).
As a result, public health professionals have begun to address this problem using a more comprehensive approach referred to as “policy, systems, and environmental change.” This approach includes: (a) policy interventions that seek to change laws, ordinances, regulations, or legislation (e.g., a city council zoning ordinance prohibiting fast-food chains within a certain distance of a school); (b) system-level interventions, which promote changes that impact organizations, institutions, or communities (e.g., a school deciding to buy a certain percentage of its cafeteria food from local sources, and training the food-service staff to cook and serve vegetarian meals on certain days); and (c) environmental interventions, which involve changes to the physical environment (e.g., a school constructing bike lanes and bike storage facilities to encourage active transportation to school), often resulting from policy decisions such as zoning and transportation expenditures (Lyn et al., 2013; Michigan Cancer Consortium, 2012). As a result, our increased understanding of the interaction of various factors of health has complicated the policy process because one simple intervention is probably not going to be sufficient. These initiatives are also built on the notion that individual decisions for healthy behavior can be facilitated or frustrated by political decision making.
Health Policy Analysis
As a result of this more comprehensive and systematic understanding of the inputs to health, the breadth of “health policy” has increased dramatically. Policy regarding transportation has an impact on health. Environmental policy has an impact on health. Educational policy has an impact on health. Economic policy has implications for health. HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy? The 2010 Adelaide Statement describes this approach as “Health in All Policies” (Krech, Valentine, Reinders, & Albrecht , 2010; World Health Organization, 2010). The Adelaide Statement emphasizes the need to examine policies for these health inputs across different policy areas. It calls on the health sector to be involved in the development of policies in other sectors to maximize health status as well as to ensure health equity. HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy? This is a significant broadening of the scope of the health sector within public policy making. The Adelaide Statement describes innovative models emerging from around the world. Of critical importance to the success of this approach will be an aggregation of evidence, including studies of policy adoption and implementation in different geographic and political environments.
Health policy analysis is a type of applied research. HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy? Although one might think that our health care system is evidence based and dependent on what research demonstrates to be valuable, that is not always the case. In fact, it is not usually the case. Many health programs and proposals that have been demonstrated to have scientific validity never get broadly implemented and, even more commonly, many existing programs and practices in medicine have never been formally proven to be effective. The Institute of Medicine has estimated that about 4% of health services have strong evidence to back them and that more than half have no evidence or weak evidence to support them (Field & Lohr, 1992). Researchers have identified several aspects of policy analysis that are in need of particular attention (Brownson et al., 2006; Brownson, Chriqui, & Stamatakis, 2009; Schmid, Pratt, & Witmer, 2006). HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy? These include: (a) documenting how an impact is achieved in a particular context; (b) understanding barriers to successful implementation; (c) delineating multiple outcomes that could be important (including unintended consequences and differential impacts on different vulnerable populations); and (d) developing tools to help prioritize policy choices, including specific criteria to evaluate policy impacts.
The importance of conducting sound policy analysis is highlighted when one considers the problem of chronic diseases such as obesity. Although there is much we know about the cause and consequences of obesity, how the political and health systems should respond to that knowledge becomes the focus of health policy analysis. For example, because elderly and minority populations are at heightened risk of diabetes, how should Medicare and Medicaid policies be developed to minimize the impact of diabetes on individuals, specific groups, and society as a whole (Fradkin, 2012)? Obesity has become a modern-day American epidemic, but logical and scientifically based programs to fight obesity tend to flounder for lack of political action.
There has been a recent focus on the importance of evidence-based medicine and evidence-based public health (Anderson et al., 2005; Brownson, Chriqui, & Stamatakis, 2009; Green, 2006; Kumanyika, Parker, & Sim, 2010; Swinburn, Gill, & Kumanyika, 2005), underscoring the need for systematic evaluation of what works in medicine and public health. Although this is encouraging, evidence-based health care is something that is easier said than done. HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy? Evidence-based health systems and policy remain the goal, no matter how difficult the path may be.
Evidence-Based Health Policy
There is a great deal of literature focusing on medicine and the medical care system. Aday, Begley, Lairson, and Balkrishnan (2004) have created a useful paradigm of health policy analysis by dividing the literature into three areas of concern: effectiveness, efficiency, and equity. You will need to think about this as you develop your own policy. HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy? Is your program/policy proposal designed to increase effectiveness, efficiency, or equity? We shall briefly explore these concepts so that you have a better idea as to how to structure your policy analysis. We will discuss this in greater detail in Chapter 7, which deals with the systematic review of policy options.
Effectiveness
The effectiveness literature focuses on demonstrating what works to improve the health of the individual or the population. Certainly, public policies should encourage those treatments that work and discourage those that waste resources or do not improve the health of the population and/or potentially cause harm. HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy? The regulation of the medical care industry from the licensure of health professionals, accreditation of health care organizations, and approval of pharmaceuticals are predicated on protecting the public from harmful practices and encouraging those that are effective. Since the days of codeine-laced cure-alls, effectiveness and prevention from harm have been key components of health policies.
Effectiveness needs to be discussed from two different perspectives, population effectiveness and medical effectiveness. Medical effectiveness tends to deal with individual patients and the impact of a specific intervention. These are typically evaluated by conducting clinical trials that take a similar group of people and then randomly assign them to either the prescribed treatment or to a placebo to test the effectiveness of the treatment.
Population effectiveness rests on Geoffrey Rose’s population strategy that has become the theoretical basis for public intervention to prevent disease (Rose, 1992). Rose maintained that prevention should not just focus on high-risk individuals, but on the population as a whole. Thus, reducing salt consumption benefits not only those with hypertension, but also those who are prehypertensive. By reducing the average intake of salt for the entire the population, the population as a whole benefits. Although this reduction of the average intake in salt may not make a perceptible difference to some individuals, it is effective for the population as a whole.
In addition to the biological aspects of effectiveness, there are also the health systems and social system aspects of effectiveness. For example, although certain pharmaceuticals have been demonstrated to be effective for diseases on the individual level, the lack of clinical facilities, refrigeration, social support systems, HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy? or cultural norms may prevent those same pharmaceuticals from being effective for the population in a developing country.
The focus on evidence-based medicine is not new. However, it gained a great deal of momentum with the pioneer work done by Wennberg and Gittelsohn (1973). Their research focused on the variation in the practice of medicine from one geographic area to another and what could potentially explain such variations. The Dartmouth Atlas documents the geographic variation in the practice of medicine within the United States (http://www.dartmouthatlas.org/). In addition, there is also great variation in health status across the United States. Studies conducted by the Joint Center for Political and Economic Studies have shown that life expectancy in some parts of the United States can vary by as much as 30 years when comparing one zip code to another (Virginia Commonwealth University, 2013). What tends to explain this variation? What are the consequences of this variation? Given that variation in medical care exists, what is the right level of medical care? Geographic variation has multiple potential explanations. How much variation is warranted and how much is unwarranted is a part of the difficulty of current efforts to restructure payment systems in order to create the right incentives for increased efficiency and effectiveness of medical care (National Institute for Health Care Reform, 2011).
It is important to note several important aspects of effectiveness of medical treatments. Generally, effectiveness of medical care is tied to the biological aspects of disease and proposed therapies. Do statins reduce cholesterol and thereby reduce the risk of cardiovascular diseases? Is the use of statins related to memory loss? To test these questions, the gold standard has been a clinical trial, by which a comparison is done between those receiving treatment and those not receiving treatment. We will discuss the strengths and weaknesses of clinical trials later in this chapter.
In some areas, such as pharmaceuticals, the federal government’s Food and Drug Administration (FDA) is authorized to approve or disapprove such medical interventions. Formal approval by the FDA does not end the process of evaluation of effectiveness, because payers (Medicare, Medicaid, and private insurance companies) make their own decisions regarding whether they will categorize the treatment as “experimental” and, therefore, not list it among their covered services. HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy?
However, the FDA is restricted in terms of its authority; although it has authority to approve appliances (e.g., implants) and pharmaceuticals, it is not authorized to approve or disapprove medical procedures. There has been medical controversy over the effectiveness of vertebroplasty, a surgical procedure used for people with severe back problems (Wulff, Miller, & Pearson, 2011). As a medical procedure, the FDA was not involved in its approval. There are thousands of these procedures performed each year in the United States, at a cost of $5,000 to $6,000 per patient. This procedure also became accepted in medical practice prior to any clinical trials demonstrating its effectiveness. However, in 2009 the results of two clinical trials were published and both demonstrated that the procedure was no more effective than a sham procedure (a procedure recognized as not providing any medical benefit; Buchbinder et al., 2009; Kallmes et al., 2009). Despite these findings, the procedure continues to be performed and paid for by major insurance providers in the United States.
The analysis of comparative effectiveness has the possibility of initiating a more precise recommendation for the most effective treatment for different subpopulations and the beginning of “personalized medicine.” Frequently, the criteria for effectiveness do not take into account the experience and perspective of the patient. This is particularly important in terms of taking into account the sequelae of a particular procedure. For example, prostate surgery may remove cancerous tissue, but due to the slow-growing nature of prostate cancer in general, the patient might die of another disease before he would have died from prostate cancer. However, by undergoing the surgical procedure for prostate cancer the patient may have a diminished quality of life due to incontinence and impotence following the procedure. The effectiveness of such treatment from the patient’s perspective is far from clear. As noted by the example, the effectiveness of treatment is more complicated than the removal of cancerous tissue. The Patient-Centered Outcomes Research Institute (PCORI) has been established, not only to do comparative effectiveness research, but to also take into account the patient’s perspective, culture, and values (Garber, 2011; Patient-Centered Outcomes Research Institute, 2012). PCORI offers great possibility for dramatically changing medical care in the future and it has the potential to provide the patient with information that will allow greater control over the application of more complex medical technologies (Institute of Medicine, 2012).
One of the modern classics of effectiveness studies is that done by McGlynn et al. (2003) on the quality of care in the United States. It concluded that patients in the United States received a little more than half of what was recognized as quality care. HLT 600 GC Week 3 Discussion 1: Why is policy analysis an important tool in the development of health care policy? The study sent a shock wave through the medical community and it remains a seminal piece of evidence in the effectiveness of our medical care system.
As seen above, determining what is effective is not as clear-cut as one might initially think. This becomes compounded, given rapidly changing technology. What may appear to be effective today might be outmoded in 1 or 5 year(s). If effectiveness is a major part of your policy proposal, you should access texts in epidemiology and effectiveness