Which part of the module did you think was the least beneficial to your learning? Explain your answer.
Which part of the module did you think was the most beneficial to your learning? Explain your answer.
Dynamic Influences on Health Care Policy
Dr. Carla Nye
Quality and Safety
1999 – when to err is human came out – errors 5th leading cause of death
2011 – errors 3rd leading cause of death
ACA and Value Based Care
Looking at each of these dimensions
Improving the patient experience of care (including quality and satisfaction);
Improving the health of populations; and
Reducing the per capita cost of health care.
For every action there is an equal and opposite reaction
Improve access to coverage
Aca has rules –
Community benefit – hospitals must do community health assessment, make a plan and partner with communities
Hospitals penalized for readmissions, but paid for developing transition to care programs.
US HEALTH CARE POLICY
CHARACTERISTICS OF US HEALTH POLICY: TIMELINE OF GOVERNMENT INVOLVEMENT IN HEALTHCARE
Self pay, barter Pre-Industrial
Insurance policies early 1900’s
Social Security 1935
Medicare and Medicaid 1965
Children’s Health Insurance program 1997
Affordable Care Act 2010
Government as a subsidiary to private sector – in most developed countries – health care is seen as a right and the government is fully involved to ensure citizens have access to HC. Not the case in the US. Private sector is dominant. Right to health care has led to ACA. Citizen distrust of govt, Government intrusion on personal liberty is foundational to Declaration of independence. Govt has traditionally filled gaps where private sector cannot or wont address.
Insurance policies for workers
Social security for those with retirement savings wiped out due to depression
Medicare and Medicaid – insurance only there for working middle class and wealthy – poor left to own devices, charity
Children's health insurance – States are given flexibility in designing their CHIP eligibility requirements and policies within broad federal guidelines.
CHARACTERISTICS OF US HEALTH POLICY
Incremental and piecemeal policies
Pluralistic Suppliers of Policy
Decentralized roles of the states
Impact of presidential leadership
Politics of the ACA
Fragmented policies – fragmented policies between federal, state, and local governments – came from checks and balances. Multiple combinations of public and private management of HC, and different in every state.
Incremental and piecemeal policies – Multiple compromises over the years between parties have led to smaller, incremental changes – nothing full bore until ACA. Within programs, changes are made incrementally – no big overhaul.
Interest groups as demanders of policies – each group fights hard to protect its interests – end result some type of compromise, where no one is truly happy. AMA, AARP, AHA, PharmA, labor unions, insurers.
Pluralistic Suppliers of Policy – executive, legislative and judicial branches can influence policy at fed, state, and local levels
Decentralized roles of the states – State is the primary controller of regulating managed care, care of disabled, oversight of professions. Very hard to coordinate a national strategy.
Impact of presidential leadership – and unintended consequences – Truman passed the Hill Burton act in 1946 that gave grants for building adequate hospital rooms for population. 1965 Johnson passed Medicare and Medicare. By 1980 – reached the level of hospital beds set out in Hill Burton and at same time Medicare and Medicaid reached gigantic expansion and expense. Ronald Reagan authorized PPS method of payment to reduce hospital utilization, which created a downward trend in inpatient stay and a glut of hospital beds.
Politics of the ACA – Democrats had control of house (Nancy Pelosi) and senate (Harry Reid). Obama had huge support from populace as well as party. Details of the ACA were largely kept secret from the public. (compared to when Clinton introduced his plan in 1993, which was very public). ACA passed with little contributions from the republicans, little input from the public. It won through the stakeholders with pledges to the stakeholders that they would get many new insured people – particularly the young healthy population.
CHARACTERISTICS OF US HEALTH POLICY: INTEREST GROUPS AS DEMANDERS OF POLICY
|Key Health Care Concerns of Selected Interest Groups|
|Federal and State Governments||Cost Containment Access to Care Quality of care|
|Employers||Cost Containment Workplace health and safety Minimum regulation|
|Consumers||Access to care Quality of care Lower out-Characteristics of US Health Policy of-pocket costs|
|Insurers||Administrative simplification Elimination of cost shifting|
|Practitioners||Income Maintenance Professional autonomy Malpractice reforms|
|Provider Organizations||Profitability Administrative simplification Bad debt reduction|
|Technology Producers||Tax Treatment Regulatory environment Research funding|
Politics is the use of relationships and power to gain ascendency among competing stakeholders to influence policy and the allocation of resources
Politics is a noun/a process/a system
Wide range of political philosophies – answer the question of the state and its moral and ethical responsibilities to the people and to those outside of the state.
The idea behind the state is people cannot rule on their own – that there needs to be an organizing structure to maintain balance, control, moral and ethical duties and obligations.
Early Liberalism – (Hobbes, Locke, Mill) – individuals participate in political decision making and express their views freely: intellectual freedom, limited government in economic activities and personal life, govt protections against abuse of power,
Current Liberalism – Support expanded government, holding onto the status quo (medicare and Medicaid), government makes the regulations that control
Early Conservatism – stability and structure, government had the power and duty to protect the weak
Current conservatism – oppose rapid change, decrease in federal responsibility for health and social issues to state governments, a reduced tax burden so citizens can have $$ to control the economy, decreased federal involvement in life – individual freedom to choose
Socialism (marx) equality of all, classless society, economy that contributes to the welfare of all, , lack of individual ownership, lack of privatization of property – property is owned by central government that controls economy.
Communism –revolution to achieve socialism (soviet block)
Social Democrats – willing to work within system to achieve fairness (Scandinavian countries) , welfare state – lawyer and barista making similar salaries, shorter work hours.
Social Libertarian (left): Jefferson (Democratic-Republican). Favoring a socialist democratic republic with limited power.
Social Liberal (left): Johnson (Democrat) and Lincoln (Republican). Favoring authoritative Democracy for the benefit of the collective.
Conservative Libertarian (right): Reagan (Republican). Favoring authoritative conservatism for individual liberty.
Liberal Conservative (right): Hamilton (Federalist). Favoring authoritative conservatism for the collective.
US (Canada, and Australia) are also liberal welfare states
Social Determinants of Health
Opioid crisis – USA death rates
The U.S. falls between #36, Qatar, and #38, Poland, in this analysis, below lower-income nations like South Korea (#12), Malta (#16), Chile (#18), and Slovenia (#29). (Washington Post)
Gallup’s November 2017 poll on health care costs found that about one-third of Americans put off medical treatment due to costs, and more women (37%) than men (22%) do. This may be due to the fact that women’s healthcare costs are typically higher than men’s. What’s most somber about this statistic is that nearly two-thirds of people who forego care due to cost say they have a serious condition. Self-rationing of care due to cost can lead to earlier, avoidable, disability and death.
Estimates of Death rates above normal
Framing the Discourse
Carla Nye, DNP, CPNP, CNE, CHSE
Virginia Commonwealth University School of Nursing
We are going to
talk about politics!!!
Politics are all around us
It is imperative for you to read, analyze, examine your frame, and to discuss and advocate
Politics – definition: the activities associated with the governance of a country or other organization, especially the debate or conflict among individuals or parties having or hoping to achieve power.
Politics are controversial!!!
We need to talk about politics, but we also need to be respectful.
Introduce the field of sociolinguistics and explain its relevance to Health Policy, Leadership and Advocacy;
Discuss the concept of political discourse;
Explore your political leanings, and reflect on the impact of how you grew up, what you have experienced, and pivotal events in your life that shaped who you are and what you believe.
Conflict exists whenever incompatible activities occur (Deutsch, 1973)
Sociolinguistics: (micro sociolinguistics) The study of the relationship between language and society, of language variation, and of attitudes about language.
Sociology of Language: (macro sociolinguistics) The study of the relationships between language and society with the goal of understanding the structure of society. Often concerned with large-scale socio-political issues.
Think Piaget – assimilating repative consisten behaviors.
14% at the extremes and the remaining 86% are in the Exhausted Minority
You are a product of your environment – nature and nurture
Every word evokes a frame;
Words defined within a frame evoke the frame;
Negating a frame evokes the frame;
Evoking a frame reinforces the frame;
According to Lackoff:
|Freedom to choose||Right to life|
|Right to life||Making the streets safer|
|Planned EOL discussions||Death Panel|
|Healthcare for all||Freedom to choose|
|Gun Control||Gun Safety|
|Open borders||Controlled immigration|
|Undocumented immigrants||Illegal aliens|
Productive Conflict Resolution
Development of conditions that allow reformulation of the problem
Availability of diverse ideas that can flexibly combined into novel patterns
Detachment from original viewpoint to see conflict from new perspective
The goal should never be to change a fellow member’s mind on an issue or candidate, but to elevate their thinking and discussions on political topics.
Assuming that someone with different political beliefs is somehow intellectually or morally deficient ends the conversation before it begins.
Etiquette for Effective Structured Controversies
Be respectful of each other.
Disagree with another person's position and ideas but don't be critical of the person.
Don't take criticism of your ideas as a personal attack.
Listen to everyone's ideas, especially if you don't agree with them.
Change your mind when the evidence supports this.
Try to understand both sides of the controversy.
Understand the position differences before trying to reach consensus.
Focus on reaching the best outcome, not on winning.
Encourage one to consider previously unexamined ideas
Stimulates interest and sparks curiosity
Improve advocacy skills
Enables higher level of decision making and problem solving
Moves us out of the win-lose solutions
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