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Health Economics and Policy

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Christi Emerson

on 2 February 2018

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Transcript of Health Economics and Policy

- "...authoritative governmental decisions that are intended to direct or influence the actions, behaviors, or decisions of others" (Savage, Kub, & Groves, 2016, p. 533).
Policy Types
Economics and Healthcare Policy
U.S. supports an open market for the exchange of goods and services, including healthcare services.

In the purest sense, an open market minimizes government regulation. This is not always evident in U.S. markets, thus decreasing some flexibility in the market.

Market Economy
- An economy in which the prices of goods and services are set by supply and demand. There are many buyers and sellers, and complete information about goods and services is communicated.
Health Insurance
Even though employer based and private insurance plans are common, federal health insurance policies were developed in the 1960's to the health of vulnerable populations.


- provides care for adults over the age of 65 and individuals with end stage renal disease and/or disabilities under the age of 65


- provides care for low-income families with dependent children, low-income older adults, and disabled individuals.

These populations are NOT typically covered by employers and may require a federal insurance plan to receive adequate healthcare.
Health Outcomes in the U.S.
**Not so fun fact - The U.S. has the highest healthcare costs yet ranks 51st in the world for life expectancy!!

Spend 17.9% of the GDP is spent on healthcare in the U.S. - $8,680 per person annually.
Health Economics and Policy
Christi Emerson EdD, MSN, RN
1. Identify factors that influence the development of
health policy in the U.S.

2. Apply public health principles to public health policy

3. Identify ethical issues related to public health policy.

4. Examine the role of nurses in public health policy.

5. Describe U.S. government policies related to financing
health care.

Public Health Policy
- "...policies specifically intended to direct or influence actions, behaviors, or decisions that influence the health of populations" (Savage, Kub, & Groves, 2016, p. 533).
- "...actively engaging in strategies to effect policies that improve the health of populations, especially those who are experiencing disparity" (Savage, Kub, & Groves, p. 534).
**Policies directly or indirectly protect or promote health.**

Education - teaching the public and stakeholders

Practice - Texas Nurse Practice Act designed to protect the public through scope of

Occupational Safety and Health Administration (OSHA)

Hospital Safety - staff and patients

Local/County - fluoride in the water
sex education in schools

Federal/State Taxes - tax breaks for businesses providing health benefits

Disparities in outcomes and access are greatest for minority groups and those living in poverty with the greatest impact for those with low SES, despite race or ethnicity.
Why do those who qualify for public insurance programs, often at little or no cost, continue to have
poor health outcomes??
FYI - Healthy People 2020 is a national agenda, not a policy.
Affordable Care Act of 2010
Most significant revision of the U.S. health care system since the advent of Medicare and Medicaid.

Key Goal: Reduce the number of uninsured
) Expand Medicaid eligibility to people at 133% of the
federal poverty level
2) Create state-based insurance exchanges
Federal Legislation and Policy
State Legislation and Policy
Medicaid is jointly financed by federal and state governments.
States set eligibility guidelines but must follow federal mandates for basic services.
States define predetermined criteria for
healthcare providers and facilities.
Each state has an official public health agency
: monitor health status, enforce public health laws,
distribute state and federal funds to local agencies.
Texas Department of State Health Services (TDSHS)

Local Legislation and Policy
Local public health agencies are governed by state
and local laws and regulations.
Local agencies have a CEO who collaborates boards of health and other stakeholders.
Personnel develops, monitors, and enforces local laws and regulations.
Develop policies related to payment for services.
Develop policies for disaster planning
Policy Development
"Effective public health policy is grounded in the
health assessment and planning process, a problem-focused process"
(Savage, Kub, & Groves, 2016, p. 540).
Key Evaluation Criteria:
Likelihood of achieving goals and objectives of the policy
Achievement of policy goals relative to cost
Fairness or justice in the distribution of a
policy's costs, benefits, and risks
Policy Development
Theory links proposed policy with actions, behaviors, and/or decisions of others.
Research provides evidence for policy development
based on trends and health outcomes for populations.
a person or organization with an interest or concern in policy development.
Stakeholders may identify a need or a problem and can offer reccomendations, funding, and other forms of support.
Potential concerns: safety, transportation, crime, drugs
Policy Development
Determinants of Health - guide policy development
Figure 7-1, p. 166
Designed with
upstream thinking
to prevent problems

from occurring.
Table 22-2, p. 542
Research and Policy Development
Research in human subjects is strictly regulated to ensure safety and ethical treatment.
Vulnerable populations - children, elderly, pregnant
Agency for Health Research and Quality (AHRQ)
Sources for reviews for EBP influencing policy:

Guide to Clinical Preventative Services
Centers for Disease Control and Prevention (CDC)
Guide to Community Preventative Services
Cochrane Collaboration
Table 22-4, p. 545
Ethics and Culture in Policy Development
Policies must consider balance between individual rights and autonomy and collective interests in promoting population health.
Culturally aceptable health policies are those that make sense to the people they affect.
Education and commication are key to assisting popultions to understand and embrace policies.
Legislative Process -
Complex and time consuming!!
Figure 22-2, p. 547
Power in numbers via professional organizations.
Boxes 22-2 and 22-2, p. 549
Public Health Finance
There are limited resources for multiple needs across
the state and the nation.
EBP and cost-benefit analysis are key to grants, budgetary allocations, private funding.
**Greatest amount of good for greatest number of people**
Health Economics - process for understanding the supply and demand of health-care services
Public Health Economics - examines financing of public health from a governmental perspective - delivery of goods and financing of programs
Public Health Finance
Federal Funding -
federal and state provided resources for the United States Public Health Services, which is charged with protecting the health of the nation
The CDC provides funds for grants/contracts with shifting of funds based on trends and evidence.
State Funding -
Each state is primarily responsible for the health of it's citizens with the state public health agency reporting to the governor.
Funding varies from state to state and is provided by federal grants, program fees, and tax revenues.
Public Health Finance
Local Funding -
The most direct public health service delivery for preventative services occurs at the local health department.
More than 30 billion dollars is spent annually in the US for people accessing public health services.
Federal dollars are allocated to the states and dispersed to public health departments.

Medicaid and Medicare contribute the majority of local health department funding.
Public Health Finance
Each state is unique regarding populations, geography, and priority healthcare needs.
**Table 22-5 - Comparison of Medicaid and Medicare

H1N1 - CDC mobilized public health departments
Special circumstances required immediate action
Federal government provided the necessary
funds and guidelines for use
Multiple government insuance programs to help vulnerable populations - p. 555


Cost of healthcare
and patient outcomes
drive policy development.
Increased ER visits for those
without access affects both.
Role of the Public Health Nurse in Policy Development
* Assess the public health need to determine priorities (assess and diagnose)

* Meet with members of the population and/or community leaders to explore concerns and possible solutions. (planning)

* Establish relationship with community stakeholders to
for policy development to address population concerns. (interventions)

* Discuss potential outcomes and benchmarks. (evaluation)
5% of the population - requires 49% of healthcare $
1% of the population - requires 22% of healthcare $
ER visits for non-emergent needs drives up the cost of health.
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