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  • Physical well being of people Emotional well being of people Health as economic driver Health as social/cultural value
  • Nursing has an agenda for health policy (ANA website) Nursing has PACS to support candidates friendly to the ethical and political values of ANA members Nurses are involved at high levels of policy-making and influencing: Mary Wakefield, PhD, RN, appointed by President Obama as Director of the Health Resources and Services Administration many before her: Bev Malone assistant secretary of health and human services, head of HCFA (now CMS) Nurses on Med-Pac, Advisory Committees, Institute of Medicine, etc at state level, Susan Cooper, RN, MSN is our Commissioner of Health and Virginia Trotter Betts, RN, is Commissioner for Mental Health
  • What’s the connection with ethics for APNs or any nurses? Aristotle said ethics and politics come together to yield justice and goodness – how do these fit together for you?
  • Justice is about equitable distribution of health care asks 2 questions – how much health care should be produced (in relation to all other goods and services) and how should health care be distributed (who can receive what services and who will be restricted) Justice is an ethical principle defined as fairness – 2 contrasting theories market justice ascribes to health care as part of the free market economy, just like the production of cars or shoes health is a personal investment about which people make rationale decisions interference with the health marketplace by gov’t should be minimal theory of social justice referest to the “good society” and proposes that health care is a social respopnsibility (like Canadian and European models) health care is different from most goods and services responsibility for helath is shared between individual and society (unhealthy individual is burden to society and society is obligated to help that person) government rather than market can make rational plans about hoiw to produce best health care for all
  • What are the major issues of the Republican vs Democratic political parties’ approach to the health care debate? Do they reflect these ethical theories? Why or why not?
  • There are, of course, many types of policy that are not public – in a market-based economy, corporations have policies that affect all aspects of national life (including health) in major ways (health of employees, environmental impact, whether or not they provide health insurance for employees. Banking collapse, Enron, auto maker bailout….all are examples of results of corporate policies that deeply affect the public.
  • Defense – Robert Gates, Secretary of Defense, implemented policy changes and actions around the disposal of nuclear warheads; don’t ask-don’t tell policy recently revised and implemented so that information about homosexuality in medical records and interpersonal exchanges with health care provides cannot be used to separate someone from service Education – No Child Left Behind – closing the gap between high performing and low performing children Transportation – high speed rail, highway safety, FAA Commerce – economic policies, trademarks and patents, census, weather forecasts – recent grants to Louisiana coast from American Reinvestment and Recovery Act of 2009
  • Longest (1998) provides a classic and widely used formal definition of health policy: “ The collection of authoritative decisions made within government that pertain to health and to the pursuit of health”
  • Motivations can be altruistic or totally selfish – but they are always there, fueling the formulation of policy for better or for worse
  • Laws: PL ; Health Insurance Portability and Accountability Act of 1996 (HIPAA) – insurance portability, simplify administrative processes and promote electronic claims filing, enforce standards for health information, guarantee security and privacy of health information Regulations: CMS ruling on ; state regulations governing APN practice, CMS regulations that provide for direct payment of APNs for medicare part B services at 80% of the physician payment rate, PPACA Operational decisions: Medicaid program implementation – if you’ve seen one medicaid program you’ve seen one medicaid program Judicial decisions: Supreme Court judges’ decision on constitutionality of PPACA
  • Allocative examples: medicaid eligibility, medicare prescription drugs, who gets what and who doesn’t Regulatory examples: regulation of health professions licensing, penalties for impersonating a nurse or physician; CMS ruling on payment structure (pay for performance) for medicare
  • The legislators, judges and bureaucratic executives do not make policy in a vacuum – they interact with the world, and often the world seeks them out! As you read in Lindbloom, policy making is an untidy process. The one rule it follows is that it never follows the “rules” laid out in linear (or even cyclical) policy making models as you will see presented in your texts.
  • Who gets left out? Non voters, often lesser educated, vulnerable population groups, those who choose not to participate The characteristics, numbers, power and authority, role, and level of control of participants influence policy throughout the process
  • OHPE

    3. 3. WHY IS HEALTH A POLICY ISSUE? Physical well-being of people Emotional well-being of people Health as economic driver Health as social/cultural value
    5. 5. IMPORTANCE TO ADVANCEDNURSING PRACTICE ANDRESEARCH Available technologies / treatments raise ethical problems Evolving health care systems influence practice Healthcare policies and issues affect patients and your relationships with them Nurses have knowledge and experience invaluable to the policy making process Advanced degree is entrée into higher level of policy influence
    6. 6. POLICY LEADERS http://www.rwjfleaders.org/programs/robert- wood-johnson-foundation-doctor-philosophy- nursing-concentration-health-policy-progra http://www.hrsa.gov/about/organization/biowakef ield.html http://www.amazon.com/Jeri-A.- Milstead/e/B001IYZ82M
    7. 7. WHAT ABOUT ETHICS?What’s the fit….
    8. 8. MARKET JUSTICE VS. SOCIALJUSTICE Health care as  Health care as social economic model resource Free market position  Requires government Market-based demand involvement for services  Assumes government- Services provided on led position ability to pay  Ability to pay is not Access is reward for necessary personal effort  Access is a right
    9. 9. MARKET JUSTICE VS. SOCIALJUSTICE Individual  Collective responsibility for responsibility for health health Benefits based on  Basic benefits for individual purchasing everyone Limited obligation to  Strong obligation to collective good collective good Private solutions  Public solutions Rationing based on  Planned rationing of ability to pay health care
    10. 10. PUBLIC POLICY DEFINED “Public policy” is the authoritative decisions made in the legislative, executive or judicial branches of government that are intended to direct or influence the actions, behaviors or decisions of others (Longest, 2002) Public policy is created from the legitimate actions of persons holding the power of position
    11. 11. PUBLIC POLICY EXAMPLES Defense Education Transportation Commerce Health
    12. 12. HEALTH POLICY The collection of authoritative decisions made within government that pertain to health and the pursuit of health (Longest, 1998)  Public sector policies that pertain to or influence health  Established at federal, state and local level  Affect or influence groups or classes of individuals  Defining purpose to support people as they seek health
    13. 13. OBJECTIVE OF HEALTH POLICY Policies are always developed to achieve someone’s policy agenda  Multiple motivations  In US, often fragmented and non-integrated  Address multitude of factors that influence health
    14. 14. HOW DO POLITICS FIT IN?But in a democracy…
    15. 15. FORMS OF HEALTH POLICIES Laws Rules and Regulations Operational Decisions Judicial Decisions
    16. 16. CATEGORIES OF HEALTH POLICIES Allocative  Provide benefits to some distinct group or class of individuals or organizations Regulatory  Influence actions, behaviors and decisions of others by directive  Market-entry, price control, quality control, market preservation, social regulation
    17. 17. POLICY PROCESS Cyclical Influenced by external factors All parts of process are interactive  Formulation  Implementation  Analysis  Modification
    18. 18. HEALTH POLICY INTEREST Local State National International
    19. 19. TYPES OF PARTICIPANTS  Ordinary Citizens  Legislators  Political Party Leaders/Members  Issues Activists  Judges  Civil Servants  Professional Experts  Business Interests