HA 545 UNIT 1 DISCUSSION

Public policies are authoritative decisions that are made in legislative, executive, or judicial branches of government. They are authoritative in the context that the actions taken at these levels have legitimacy and are binding, at least until the point that changes are made in one of those branches that affects the policy.

When those authoritative actions relate to health care decisions, they become health policies.

Forms of Health Policies:

1.      Laws – a law enacted at any level of government is a policy. At the federal level, an example is the Social Security Act that authorized the prospective payment system (PPS) for Medicare. At the State level, actions such as creating a Certificate of Need (CON) process, or expansion of Medicaid are laws. At the local level, a law may be generated by a health department such as local level options for smoking.

2.      Rules/Regulations – these are established to guide the implementation of law. Typically, these are made in the executive branches of government either at the federal or state level.

3.      Operational Decisions – these are generally those decisions that influence the implementation of decisions. These are different from rules. Rules are intended to be more permanent, operational decisions can be changed to meet the needs of implementation.

4.      Judicial Decisions – such as a legal case that changes the intent of a law. This then becomes precedent and policy.

Macro policies such as Medicare or implementation of pharmaceuticals are also types of policies.

Overview of Healthcare Market: Why Policy Development is Necessary

Even though the face of healthcare has changed over the past 20 years – with much of the change due to a movement away from non-profit or public healthcare that emphasized the altruistic aspect of care to a more business-like approach dominated by healthcare systems – the products of healthcare are not typical of other business products.

The healthcare product cannot be treated in the same way as other products sold in the marketplace. When someone sells us a defective product, we might chalk it up to caveat emptor “let the buyer beware”. Certainly, a good company backs its products or consumer protection laws allow us restitution for goods sold in bad faith. And while much of these same characteristics can apply to health care goods and services, a defective healthcare product or service has results in much more devastating consequences. We therefore institute regulatory policies to help protect us against bad products or services. Moreover, the moral judgment of society requires us to take care of those who can’t take care of themselves unlike the normal liaise faire system of the marketplace. So we develop allocative policies to help us provide care for those who don’t have the resources for care. But because we have regulatory and allocative policies, we still must recognize that the distribution of healthcare (in the U.S.) is uneven. To believe that there is equity in the healthcare delivered in this country is to not understand how much the business end of healthcare has impacted the profession