CPH Policy in Public Health
policymaking process - ANSbegins with recognizing a problem in which discontent with the
status quo exists
1. agenda setting- getting the problem on the agenda whereby Congress, state legislators, or
local public officials seek to address the problem
2. policy formulation- when policies are proposed to address the problem and then debated by
policymakers
3. policy adoption- occurs through established governmental processes in which laws or
ordinances are passed by lawmakers
4. policy implementation- when governmental units make the policy operational, which required
both human and financial resources
5. policy evaluation- determines whether the policy is meeting its goals in addressing the
problem
6. policy modification- when results of evaluation are used to determine if a policy should be
continued, modified, or repealed
policy window - ANSoccurs when 3 streams of activity are present that can lead to policy
change
1. strong support among the voting public and policymakers that a problem should be resolved
3. support for the proposed policy design
3. political relationships that are receptive to change
moral hazard - ANSMedicare has a cost-sharing component (deductibles, copays, co-insurance)
to avoid a moral hazard in which demand for unnecessary services increases if they are
provided at no cost to patients
the tendency for an insured person to overuse health services because he has insurance
branches of gov't - ANSLegislative- Congress, passes laws, controls spending and tax policy,
holds power to declare war
-for a bill to become law, both chambers of Congress must each pass a version of the bill. once
both chambers have passed a version, the 2 bills are referred to a conference committee, which
includes key relevant members of the House and Senate, to resolve the differences between the
bills. if consensus is achieved, a conference report is sent back to the House and Senate for a
vote. if it is passed in both chambers, the president can sign the bill into law or veto. overriding a
president's veto requires 2/3 vote in both the House and Senate
Executive- led by president, signs bills into law, responsible for enforcing laws through various
federal agencies and depts
, Judicial- courts, laws that are passed can be challenged
iron triangle of healthcare - ANSaccess, quality, cost
IOM/NAM's 6 aims to improve healthcare quality - ANSSTEEEP-
safe
effective
timely
patient-centered
efficient
equitable
EMTALA of 1986 - ANSEmergency Medical Treatment and Active Labor Act
-ensures emergency care is accessible to all persons and not based on a patient's ability to pay
-requires that a medical screening is performed and a patient's condition is stabilized
-unfunded mandate (hospitals are at risk of not being paid for the EMTALA services they
provide)
-can result in cost-shifting in which patients with private HI may experience higher costs in order
to fund care provided to those who cannot afford to pay
value-based purchasing - ANSin Medicare
established by the ACA
rewards or penalizes hospitals according to the quality of care provided to Medicare patients
MACRA of 2015 - ANSMedicare Access and CHIP Reauthorization Act
a law that significantly changed how the federal government pays physicians. Passage of the
law permanently repealed the flawed sustainable growth rate (SGR) and set up the two-track
Quality Payment Program (QPP) that emphasizes value-based payment models.
provides a quality payment program that includes 2 programs-
Advanced Alternative Payment models
Merit-Based Incentive Payment System
examples of how public health policy is used to improve health care quality for Medicare
patients
advocacy - ANSPolicy advocacy is the process of negotiating and mediating a dialogue through
which influential networks, opinion leaders, and ultimately, decisionmakers take ownership of
your ideas, evidence, and proposals, and subsequently act upon them
policymaking process - ANSbegins with recognizing a problem in which discontent with the
status quo exists
1. agenda setting- getting the problem on the agenda whereby Congress, state legislators, or
local public officials seek to address the problem
2. policy formulation- when policies are proposed to address the problem and then debated by
policymakers
3. policy adoption- occurs through established governmental processes in which laws or
ordinances are passed by lawmakers
4. policy implementation- when governmental units make the policy operational, which required
both human and financial resources
5. policy evaluation- determines whether the policy is meeting its goals in addressing the
problem
6. policy modification- when results of evaluation are used to determine if a policy should be
continued, modified, or repealed
policy window - ANSoccurs when 3 streams of activity are present that can lead to policy
change
1. strong support among the voting public and policymakers that a problem should be resolved
3. support for the proposed policy design
3. political relationships that are receptive to change
moral hazard - ANSMedicare has a cost-sharing component (deductibles, copays, co-insurance)
to avoid a moral hazard in which demand for unnecessary services increases if they are
provided at no cost to patients
the tendency for an insured person to overuse health services because he has insurance
branches of gov't - ANSLegislative- Congress, passes laws, controls spending and tax policy,
holds power to declare war
-for a bill to become law, both chambers of Congress must each pass a version of the bill. once
both chambers have passed a version, the 2 bills are referred to a conference committee, which
includes key relevant members of the House and Senate, to resolve the differences between the
bills. if consensus is achieved, a conference report is sent back to the House and Senate for a
vote. if it is passed in both chambers, the president can sign the bill into law or veto. overriding a
president's veto requires 2/3 vote in both the House and Senate
Executive- led by president, signs bills into law, responsible for enforcing laws through various
federal agencies and depts
, Judicial- courts, laws that are passed can be challenged
iron triangle of healthcare - ANSaccess, quality, cost
IOM/NAM's 6 aims to improve healthcare quality - ANSSTEEEP-
safe
effective
timely
patient-centered
efficient
equitable
EMTALA of 1986 - ANSEmergency Medical Treatment and Active Labor Act
-ensures emergency care is accessible to all persons and not based on a patient's ability to pay
-requires that a medical screening is performed and a patient's condition is stabilized
-unfunded mandate (hospitals are at risk of not being paid for the EMTALA services they
provide)
-can result in cost-shifting in which patients with private HI may experience higher costs in order
to fund care provided to those who cannot afford to pay
value-based purchasing - ANSin Medicare
established by the ACA
rewards or penalizes hospitals according to the quality of care provided to Medicare patients
MACRA of 2015 - ANSMedicare Access and CHIP Reauthorization Act
a law that significantly changed how the federal government pays physicians. Passage of the
law permanently repealed the flawed sustainable growth rate (SGR) and set up the two-track
Quality Payment Program (QPP) that emphasizes value-based payment models.
provides a quality payment program that includes 2 programs-
Advanced Alternative Payment models
Merit-Based Incentive Payment System
examples of how public health policy is used to improve health care quality for Medicare
patients
advocacy - ANSPolicy advocacy is the process of negotiating and mediating a dialogue through
which influential networks, opinion leaders, and ultimately, decisionmakers take ownership of
your ideas, evidence, and proposals, and subsequently act upon them
