Session 3 - Healthcare Policy Content - Diehl


Published on

USUHS MedXellence, Healthcare Policy Presentaion

  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • DoD’s health care benefit has largely been driven by Congressional action. With the military drawdown of the early 90’s, access to military hospitals for retirees and retiree family members became more limited, resulting in increased reliance on private sector care. The TRICARE benefit is a rich benefit when compared to most private sector health plans. Largely as the result of lobbying by beneficiary groups, Congress continues to add new benefits. These new benefits demand increasingly more funding from DoD’s budget “top line” each year. In addition, some new benefits are expected to be funded from within the existing DHP appropriation amounts (“carve out”).
  • This slide portrays current projections of total DoD Health Expenditures. This includes O&M, RDT&E, Procurement, MILPERS, and MILCON as well as the Department’s Normal Cost Contribution to the Medicare Eligible Retiree Health Care Fund (MERHCF). It does not include projected receipts out of the MERCHF. These projections are from the FY08 President’s Budget through FY13 but does include all dollars in the Escrow Account, as well as restoring projected savings from Sustain the Benefit (STB) . For FY14 and FY15, conservative growth rates of 6.5% for health expenditures were used. For FY06 and FY07, figures include supplemental dollars but there is no projection for supplemental dollars beyond FY07. Total DoD topline is also from the FY08 PB with projected growth in FY14 and FY15 of 2.1%. For FY07, DoD Health Expenditures are 6.7% of the DoD topline which is lower than normal because of supplementals to the topline. For FY08, without supplementals, DoD Health Expenditures (assuming no savings from STB) are projected at 8.4% of the DoD topline. This will grow to 11.4% by FY15 which is lower than previously expected (12%) only because of larger growth in the projected DoD topline. The red bars represent the increases in DoD Health Expenditures above the level if they were to be maintained at 8% (the green bars). STB was one method to reduce the red bars but would not have reduced them completely. (For FY15 the savings were projected at $5.4B compared to a shortfall of $19.4B).
  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery December 2009June 2009 Unlike healthcare, the political process does, to some extent, follow the market model The demanders – interested parties who seek something from The suppliers – may be any branch of government There is a negotiation process involved in the exchange Desire is to have a mutually acceptable outcome BUT Difference between economic marketplace and political marketplace Economic – buyers reap the benefits of choices, and bear costs Political – not always so straightforward – costs often imposed on future generations However, remember – policies are always developed to achieve someone’s policy objectives
  • Session 3 - Healthcare Policy Content - Diehl

    1. 1. Health Policy: Awareness and Application CDR Glen Diehl, PhD Program Director, Healthcare Administration and Policy Uniformed Services University 3-1
    2. 2. What Are We Going to DiscussToday?• Section 1: Health policy, values and cost• Section 2: Fundamentals of health policy• Section 3: Policy, history and reform• Section 4: Health policy stakeholders• Section 5: Government and the health policy making process 3-2
    3. 3. What is Health Policy?Junior Staffers say:• Directives for Executive Departments• It seems expensive• Happens in a vacuum• A lot of old people seem concerned about it• My Member is telling constituent groups he supports policy that strengthens healthcare• I think it has something to do with reform• Don’t they throw a good party• But there is more….. 3-3
    4. 4. What is Health Policy?• A pattern of government decisions and actions intended to address a perceived health problem• A statement of a decision regarding a goal in health care and a plan for achieving that goal. For example, to prevent an epidemic, a program for inoculating a population is developed and implemented• A means to set a political agenda involving healthcare delivery and health status• The placement of resources against health care issues and challengesIts all of these but I like the following:• An amalgamation of values affecting healthcare from political, economic and legal perspectives 3-4
    5. 5. Why Values?A simple phrase provides an illustration: “appropriate for governmental action”Do we all agree on what is appropriate for governmental action? - individual preferences vs. needs of the overall populationPolicy is about compromise and the exchange of value relationships. It is also about allocation and redistributionHealth policy example:- Is healthcare a right?If yes, then government should probably guarantee that right and healthcare becomes appropriate for governmental actionIf no, then differences in access to healthcare are seen more as a condition than a problem 3-5
    6. 6. What Values Are We Talking About?• Liberty Health policy is sometimes about value trade-offs:• Equity• Justice ex. Immunization• Security programs, health• Efficiency surveillance programs, organ transplants, tiered• Transparency healthcare systems,• Capacity etc… 3-6
    7. 7. Why is Health Policy important?• Healthcare Costs as a % of Gross Domestic Product is projected at 20% by 2016.• Health reform (arguably the biggest policy issue for the Obama Administration• Status of the un-insured – How many and what should we do?• Pandemic disease – The potential to destabilize nations and regions that are unprepared.• Technology and innovation – Who should have access and who controls costs?• Medical liability – The effects of tort reform• Understanding incentives in healthcare• Managing uncertainty: adverse selection and moral hazard 3-7
    8. 8. National Health Expenditures $4,500 25% $4,000 20% $3,500 $3,000 15% $2,500 $2,000 10% $1,500 $1,000 5% $500 $0 0% 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 National Health Expenditures (NHE) NHE as percent of GDP
    9. 9. Did You Know???• Total U.S. healthcare spending: $2.1 trillion• As part of all economic activity: 16.3%• Avg. increase in employee based insurance premiums since 1999: 120%• Avg. increases in wages since 1999: 29%• Proportion of personal bankruptcies related to illness of medical bills: 62.1%• Increase since 2001 in the proportion of personal bankruptcies caused by medical problems: 50% 3-9
    10. 10. Why Does Healthcare Cost So Much? “This is one of those cases in which the imagination is baffled by the facts.” - Adam Smith If we pay more in the U.S. for healthcare this must mean the following: •The aging of the population drives health spending Aging adds only about a .5% in per capita health spending for industrialized nations • We get better quality from our healthcare system than other nations Not necessarily, a WHO study ranked the U.S. 37th in healthcare amongst other nations. • We get better health outcomes from our system Again, this is not always the case. In fact the U.S. does not do as well in preventive care or treatment for many acute conditions 3-10
    11. 11. Lets Take Another Look At Healthcare Costs The most prominent drivers of healthcare costs are: • The Gross Domestic Product (GDP) per capita of an industrialized nation appears to be a strong indicator on the amount of per capita health care spending • We pay higher prices for the same health goods and services offered in many other nations • We have significantly higher administrative overhead costs • We tend to use more high cost, high-tech equipment and procedures than other countries • We cannot discount the effect of “defensive medicine” triggered by American tort laws 3-11
    12. 12. PPP = Purchasing Parity Dollars 3-12
    13. 13. Why is Health Policy Important inside theMHS?• Taking care of Wounded, • Psychological health, readiness Injured, and Ill service- and resiliency members • Cost of care in direct care system• Humanitarian assistance, vs. purchased care system disaster relief support and • Global health and force health capacity building protection surveillance• TRICARE copay modification • Viability of residency training, (sustaining the benefit Part II) other educational programs and• JTF Capital Medical Region research• Recaptialization of MHS • Partnerships and sharing with VA, facilities HHS, DOS and other Agencies• and activities Information technology sharing and integration • Investment, recruitment and retention of human capital 3-13
    14. 14. Growth in the Unified Medical Budget(Excluding GWOT) Increase over FY2000 $70,000 $46.7B 268% $60,000 $12.1B –26% $2.5B – 5% $50,000 $5.2B – 11%($M) $40,000 $9.0B – 19% $30,000 $18.0B – 39% $20,000 FY2000 Baseline $17.4B $10,000 $0 FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY2000 Unified Medical Program Price Inflation Volume/Intensity/Cost Share Creep, etc. New Users <65 Explicit Benefit Changes to <65 Explicit Benefit Changes to 65+, i.e. TFL Volume/Intensity/CostShare Creep, etc is the residual after all explicit causes have been removed New users accounts for increase in percentage of eligible beneficiaries under 65 who rely on TRICARE (See Slide 11 for trend) Explicit Benefit Changes <65 are estimates base on legislative changes to the benefit (See Slide 8 for examples) Explicit Benefit Changes to 65+ is the Normal cost to the department minus the Level of Effort for MTF Care prior to the MERCHF
    15. 15. Increased DoD Health Benefits 1940s-1950s Title 10 Legislated Benefit 2002 Space Required for Active Duty TRICARE Plus Space Available for Families and Retirees TRICARE For Life 1966 TRICARE Prime Remote for AD Family Members CHAMPUS Legislated Benefit Civilian Health Care where MTFs do not exist. 2003 Families and Retirees <65 TRICARE Online 1993 TRICARE implements HIPPA Patient Privacy Standard TRICARE Managed Care Legislation Elimination of AD Family Member Co-Pays Automatic enrollment for Active Duty Space Required for TRICARE Prime enrollees 2004 Space Available for Non-enrollees Transitional Assistance Management Program (TAMP) Expansion Guard/Reserve TRICARE (Early Eligibility, Reserve Family Demo) 1995-1998 Elimination of Non-Availability Statements (NAS) TRICARE Triple Option Benefits 2005 Prime, Extra and Standard TRICARE Reserve Select TRICARE Senior Prime Demonstration Extended Health Care Option/Home Health Care (ECHO / EHHC) TRICARE Maternity Care Options 1999-2000 Further Expansion: 2006 Prime Remote for Active Duty TRICARE provider rates >=Medicare Extended TRICARE benefits for dependents whose sponsor dies on Beneficiary Counseling & Assistance Coordinators Active Duty Limit deductibles/co-pays for nursing home residents under the Pharmacy Program Enhanced Benefit Enhancement of TRICARE Reserve Select coverage 2001 Catastrophic Cap Reduced to $3,000 Enhanced TRICARE Retiree Dental Program 2007 TRICARE Senior Pharmacy Expansion of TRICARE Reserve Select coverage to All Elimination of Prime Co-pays for AD Family Members Reservists Extension of Medical and Dental Benefits to Survivors Three year Extension of Joint DoD/VA Incentive Program School Physicals Planning/Management – Claims Processing Standardization Entitlement for Medal of Honor Recipients Expanded Disease Management Programs TRICARE Prime Travel Entitlement Coverage of Forensic Exams for Sexual Assaults Chiropractic Care Program Dental anesthesia for pediatric cases
    16. 16. Budget ImpactDoD Forecast $70.00 If DoD Health Budget grows at recent trend $60.00 rates, it will reach $64B, or 10.4% of DoD topline in 2015 $50.00Annual Total If DoD HealthDefense $40.00 Budget managed toHealth 8% of DoD topline,Expenditures budget would be($B) $30.00 $46 in 2015 $20.00 $10.00 $0.00 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 Maintain Health Budget at 8% of Total DoD Budget Projections are for 10.4% by FY2015
    17. 17. Implications • Without intervention, health care costs will consume a larger and larger portion of DoD budget • In extreme case, budget pressures could impact delivery of benefit and/or operation of Direct Care System • Increasing cost shares could blunt some but not all of the growth
    18. 18. EmotionPolicy/Politics Economics Practice/Art Science 3-18
    19. 19. Section 2: Fundamentalsof health policy 3-19
    20. 20. 3-20
    21. 21. 3-21
    22. 22. Fundamentals of Health Policy Market failure and why it occurs: • Public goods • Externalities • Asymmetry of information • Lack of competition • Redistribution of income 3-22
    23. 23. Policy Definitions• Market failure - When markets do not provide resource allocations that are fully acceptable- This situation allows for a potential role of government to “improve” allocations or provide some form of corrective intervention• Examples of market failure - National Defense - Monopolies - Healthcare??? 3-23
    24. 24. Policy Fundamentals• Public Goods - Non-rival in consumption – You and I both consume without affecting one another’s consumption of the good ex. National park - Non-excludable – the good is provided to everyone ex. national defense or a lighthouseIs healthcare a public good? It depends… 3-24
    25. 25. Policy Definitions …Externalities – Unintended / unplanned effects of market behavior. This may be positive or negative. Ex. immunizations – positive externality medical error – negative externalityLack of Competition - Monopoly – A market where there is a single provider - Monopsony – A market where there is a single buyer 3-25
    26. 26. Policy Definitions …Redistribution of income – transferring income or benefits fromone group to another. In healthcare this equates to two largeprograms: - Medicare - Medicaid - Healthcare reform may also cause a redistribution if theindividual mandate requires one group to subsidy another 3-26
    27. 27. Policy Definitions…Imperfect Information - Buyers and sellers are assumed to havecomplete information about products and services. In the absence ofinformation, markets may not allocate resources properly:Moral hazard – when one party in a transaction has more informationthan another and does not behave responsibly. ex. Presence of health insurance causes someone to take fewer health related precautionsAdverse selection – This occurs when high risk consumers, who knowabout their own health status, subscribe to an insured group composedof lower risk individuals. 3-27
    28. 28. Health Policy Decision-Making Tools• Cost- benefit analysis• Cost effectiveness analysis• Quality Adjusted Life Years (QALYs)• Disability Adjusted Life Years (DALYs)• Game Theory 3-28
    29. 29. Section 3: Policy, Historyand Reform 3-29
    30. 30. Policy and Historyq Adam Smith “Wealth of Nations” 1776 - “The first duty of the sovereign is that of protecting the society from the violence and invasion of other independent societies”. = National Defense - “The second duty of the sovereign is that of protecting, as far as possible, every member of the society from the injustice or oppression of every other member of it, or the duty of establishing an exact administration of justice”. = Administration of justice - “The third and last duty of the sovereign or commonwealth is that of erecting and maintaining those public institutions and those public works, which, though they may be in the highest degree advantageous to a great society, are, however, of such a nature, that the profit could never repay the expense to any individual or small number of individuals, and which it therefore cannot be expected that any individual or small number of individuals should erect or maintain”. = Public goods 3-30
    31. 31. More… Policy and History • John Maynard Keynes (1926), “Liberalism and Labour” - “The political problem of mankind is to combine three things: economic efficiency, social justice, and individual liberty.” • Richard Musgrave (1958), “The Theory of Public Finance” - Implementation of government policies have the following effects: allocation of resources, distribution of income and wealth, and stabilization. 3-31
    32. 32. Notable Health Policy Scholars Kenneth Arrow Victor Fuchs Uwe Reinhardt John Iglehart Mark Pauly Stuart Altman Donald Berwick Alexandra Shields Charles Lindblom 3-32
    33. 33. GDP Time 3-33
    34. 34. Modern U.S. Healthcare History inShort 1940s • National health care expenditures are 4.0% of Gross National Product • Wage and price controls are placed on American employers. Many companies begin to offer health benefits to compensate for lower wages • President Truman offers national health program but plan is denounced by AMA and a House Subcommittee calls his plan a communist plot • Hill-Burton Act helps fund the building of new hospitals 1950s • National health care expenditures are 4.5% of Gross National Product • Federal responsibility for sick and poor is established • Americans have a system of private insurance for those who can afford it and welfare services for the poor 3-34
    35. 35. Modern U.S. Healthcare Historyin Short 1960s • National health care expenditures are 6% of GNP • Medicare and Medicaid signed into law by President Johnson • 700 companies selling health insurance 1970s • National health care expenditures are 8% of GNP • HMO Act of 1973 provides grants and loans to expand HMOs and offer alternative to traditional insurance • President Nixon’s plan for National Health Insurance rejected • RAND Study – Concludes that insurance with no copays = greater usage 3-35
    36. 36. U.S. Healthcare HistoryContinued… 1980s • National health care expenditures are 10.5% of GNP • COBRA of 1985 extends health coverage to those losing a job • Medicare shifts to DRGs • Large scale shift to privatization, contracting and corporate medicine begins 1990s • National health care expenditures are 13% of GNP • Health care costs rise at double the rate of inflation. In an effort to control costs managed care expands • President Clinton’s healthcare reform plan defeated by Congress • HIPAA and SCHIP passed into law 3-36
    37. 37. U.S. Healthcare History …2001 – September 11th and anthrax attacks (bio-terrorismbecomes real)2003 – Major expansion of Medicare prescription drugbenefit2004 – HSPD 10 – First major inter-agency bioterrorismdirective2006 – Massachusetts health reform plan2008-2009 – Healthcare Reform??? 3-37
    38. 38. The Reform DebateComprehensive reform – Major overhaul of the current system VS.Incremental reform – Tinkering with the existing systemThe trend for healthcare reform in the U.S. points towardincrementalism. The most significant comprehensivereform in U.S. healthcare has been Medicare and Medicaidas part of the Social Security Act of 1965. 3-38
    39. 39. The Reform DebateSo, Why Reform???:• Costs are growing at an increasing rate• Growing number of un insured• Diminishing access to care• Concern over the health of U.S. economy andunemployment• Growing number of health coverage limitations,increasing co pays fear of uncovered catastrophic event• Gaps in the quality of healthcare being provided 3-39
    40. 40. What Will Reform Look Like?International Flavor??? 1. The Beveridge Model: William Beveridge - Healthcare is financed by government through tax payments - Government acts as sole payer, controls what doctors can do and what is charged - Examples: Great Britain, Spain, New Zealand, Cuba and most of Scandinavia 2. The Bismarck Model: Otto Von Bismarck - This model uses an insurance system with insurers called “sickness funds” (about 240 funds) - Financed jointly by employers and employees through payroll deductions; tight government cost control regulation - Examples: Germany, France, Netherlands, Japan, Switzerland 3. The National Health Insurance Model (NHI) - NHI provides care for all eligible residents - Care is offered primarily through private sector providers - Funding for NHI is thru provincial and federal personal/corporate taxes - Examples: Canada, Taiwan and South Korea 3-40
    41. 41. International Flavor con’t4. Out of Pocket Model: - Many separate healthcare systems - Loosely related components that include financing, insurance,delivery and payment - Lack of overall “system-wide” planning and coordination - Examples: United States and many other nationsOther features of the out of pocket model include:- Generally those with affluence and money receive care- In rural areas of the world millions of people may never see aphysician- In emergency situations patients may be admitted for life-savingcare to a medical facility if one is available 3-41
    42. 42. But Healthcare In The U.S. IsSomewhat Different The Beveridge Model – This looks similar to the care provided in the MHS and the VA The Bismarck Model – This resembles workers who receive healthcare benefits through their employer like General Motors or UPS NHI Model – Medicare closely parallels the NHI/Canada model Out of Pocket Model – This is how uninsured and higher income categories generally receive care in the U.S. 3-42
    43. 43. Politics and CompromiseWhat happened?2008 - Presidential election campaign healthcare reform becomes one of the key issues2009 – Obama Administration takes office Spring – Meetings with industry leaders and healthcare proposal generated July – A series of healthcare reform bills are proposed in House Committees August – Summer recess was used to hold town hall meetings on healthcare Fall – Posturing for reform between Democrats and Republicans and between the House and Senate November – The House passes the Affordable Health Care for America Act H.R. 3962 and forwards this to the Senate. The vote 220-215. December – The Senate completely revises the House bill and passes H.R. 3950 on Christmas Eve. The vote 60-39.2010 - President Obama stays the course January – Sen. Brown (R-MA) elected to fill Sen. Kennedy’s seat. This breaks the Democrat hold on filibuster proof majority in the Senate and causes many to rethink their position on healthcare reform February – President Obama’s unveils revised reform package based on the 3-43
    44. 44. Politics and Compromise 2010 – Healthcare reform passed March – H.R. 3950 Patient Protection and Affordable Care Act signed into law 3/23/10 H.R. 4572 Health Care and Education Affordability Reconciliation Act signed into law on 3/31/10 Why two healthcare reform bills? - H.R. 3950 became the base bill or essentially the placeholder to all the reconciliation process to be used for H.R. 4572 - H.R. 4572 became the amended health care reform act. It also included student financial aid reform. What is reconciliation and why was it used? - Reconciliation is a process that allows for an up or down vote on budget resolutions and avoids the Senate’s filibuster rules. - Reconciliation also requires the bill to meet both short and long term deficit reduction goals - Provision of reconciliation bills not affecting revenues or outlays of the federal government are prohibited. 3-44
    45. 45. Bill Comparison House Bill Senate Bill Reconciliation Bill Passed House 11/07/09 by a vote of Passed Senate 12/24/09 by a vote of 60 Amends the Senate bill, by a vote of 220-215 to 39 220-211 $1.2 trillion $940 billionGross cost of coverage provisions $875 billion $138 billionNet savings $138 billion $118 billion 36 million more people would have 31 million more people would have 32 million more people would have coverage than under current law. In coverage than under current law. In coverage than under current law. InInsurance coverage expansion total, 94% of the population would be total, 92% of the population would be total, 95% of the population would be insured insured insured 15 million Americans would be added to 15 million Americans would be added to 16 million Americans would be added toExpansion of Medicaid Medicaid Medicaid MedicaidNumber of American who would remain 23 million 18 million 24 millionuninsured 4 million fewer people would have 4 million fewer people would have 6 million more people will get employer employer coverage than under currentChange in employer-provided insurance employer coverage than under current coverage law lawAverage subsidy for people buying $6,800 per year $5,800 per year $6,000 per yearinsurance with government aid 3-45
    46. 46. How does it impact you?Some highlights extracted from the bill:- Dependent children will be permitted to remain on their parents’ insurance until their 26th birthday.- Insurers are prohibited from dropping policy-holders when they get sick.- Medicare is expanded to small, rural hospitals and facilities.-Insurers are prohibited from discriminating against or charging higher rates for any individuals based on pre-existing medical conditions.-Insurers are prohibited from establishing annual spending caps.- Imposes a $2000 per employee tax penalty on employers with over 50 employees who do not offer health insurance to their full-time workers.-Imposes a penalty of $95 , or up to 1% of income, whichever is greater, on individuals who do not secure insurance; this will rise to $695, or 2.5% of income by 2016.-Chain restaurants with over 20 locations are required to display caloric content of their foods on menus and vending machines.-Establish health insurance exchanges, and subsidization of premiums for individuals with income up to 400% of the poverty line, as well as single adults.- Indoor tanning services are subjected to a 10% service tax. 3-46
    47. 47. 3-47
    48. 48. Basic Tenets of Reform1) Provision of virtually universal health care to U.S. citizenry2) Limiting the costs of health care by reducing growth rate of costs3) No rationing of health care in new system 3-48
    49. 49. 3-49
    50. 50. Section 4: Stakeholders 3-50
    51. 51. Stakeholders in Health Policy• The President - Office of Management and Budget (OMB)• Congress - Oversight Committees for MHS only include: - House Armed Services Committee (HASC) - Senate Armed Services Committee (SASC) - House Appropriations Committee (HAC) - Senate Appropriations Committee (SAC)• Executive Departments: - Health and Human Services - Defense - State - VA• Advocacy groups and lobbyists: ex. Military coalition 3-51
    52. 52. Stakeholder’s in More GenericTerms• Patients and consumers - demanders• Healthcare providers or producers – suppliers• Insurers or third party payers 3-52
    53. 53. Section 5: Government andthe Health Policy MakingProcess “To do for people what needs to be done, but which they cannot, by individual effort, do at all, or do so well, for themselves” - Abraham Lincoln 3-53
    54. 54. The Primary Objectives ofGovernment?• Maintain law, order and defense• Improve efficiency• Redistribute income/wealthWhat is efficiency?• Technical efficiency – “do not waste resources”• Cost-effectiveness – “produce each output at the least cost”• Allocative efficiency – “produce the types and amounts of healthcare output which people value most”What is redistribution of income/wealth?• The transfer of income, wealth or property from some individuals to others.• Income redistribution is supposed to even the amount of income that individuals are permitted to earn 3-54
    55. 55. And Then There is EquityFairness in the provision of healthcare services and the improvement of health status - Should certain features of healthcare mean that it is distributed differently from other goods and services? - Does it matter who receives healthcare goods and services? - Is the process to distribute health care services and goods equitable? 3-55
    56. 56. Government Policy Instruments• Authorizations - Authorizing legislation sets policies and funding limits for agencies/programs.• Appropriations - Appropriations legislation is what a department or agency needs before it can cut a check or sign a contract.• Tax policy• Use of regulations 3-56
    57. 57. How Do We Pay For Health Policy?• General taxation• Social insurance• User charges 3-57
    58. 58. The Two Primary Theories of PolicyPublic interest – This model assumes there are two primary objectives of government: 1) Improve efficiency in the market when there are: - monopolization - existence of externalities 2) Redistribute income in a more equitable manner 3-58
    59. 59. The Two Primary Theories of PolicyEconomic (Self interest) - This model assumes the primary objective of government is the redistribution of wealth. It also implies that wealth in most cases is redistributed to those that offer political support. 3-59
    60. 60. Other Theories of Policy- The Iron Triangle- Power Clusters- Kings and Kingmakers 3-60
    61. 61. Now We Include the Objectives of Health PolicyAllocation – The cost effectiveness of the production and procurement of appropriate healthcare goods and servicesDistribution – Fair financing, fair access to healthcare goods and services, and fair payment to providersSustainable development – Development of appropriate incentives for performance and health, policy development and the management of change, and a sustainable resource base over the long-term. 3-61
    62. 62. Policy Making Models(Longest model) 3-62
    63. 63. The Healthcare Marketplace Economic Exchanges in Market TransactionsDemanders Suppliers (Buyers) (Sellers) NegotiationAdapted from : Longest, BB. Health Policymaking in the United States, 3rd edition 3-63
    64. 64. Policy FormulationPolicy formulation is a dynamic process: •Formulation •Implementation •Modification 3-64
    65. 65. The Policy Process on Capitol Hill 3-65
    66. 66. I’m Just a Bill …. School House Rock 3-66
    67. 67. Questions?? 3-67
    68. 68. Background Slides 3-68
    69. 69. 3-69
    70. 70. 3-70