Question

Identify changes in the political framework within the care industry.

Answer 1

Answers :

Identify changes in the political framework within the care industry :

Abstract and Introduction :

                                   Politics, for better or worse, plays a critical role in health affairs. The purpose of this article is to articulate a role for political analysis of public health issues, ranging from injury and disease prevention to health care reform. It begins by examining how health problems make it onto the policy agenda. Perceptions regarding the severity of the problem, responsibility for the problem, and affected populations all influence governmental responses.

                                   Next, it considers how bounded rationality, fragmented political institutions, resistance from concentrated interests, and fiscal constraints usually lead political leaders to adopt incremental policy changes rather than comprehensive reforms even when faced with serious public health problems. It then identifies conditions under which larger-scale transformation of health policy can occur, focusing on critical junctures in policy development and the role of policy entrepreneurs in seizing opportunities for innovation

Role does government play in healthcare :

The political system is the vehicle through which public health officials can achieve population-wide and lasting systems change. And from a political perspective, the vitality and economic viability of any community is highly dependent on the health of the population and the effectiveness of its health systems.

REGULATORY AND HEALTHCARE FINANCING REFORMS :

Any discussion of current healthcare system should include an examination of the role of government and regulatory agencies.

We have a fragmented health system and fragmented research institutions. Many federal agencies are gathering and reviewing evidence, from the Agency for Healthcare Research and Quality (AHRQ) to the Centers for Disease Control and Prevention to the Department of Defense (DOD) to the Veterans Administration (VA). In addition, the private sector is also doing this type of research, including all of the specialty boards and professional organizations, as well as insurance companies such as Aetna, WellPoint, United Healthcare, Humana, and Cigna. In fact, the private sector has more up-to-date usage information than many federal agencies. Many have suggested that the United States follow the lead of England and centralize this research and recommendations.

Before such a decision is made, the following questions should be asked: Should a system exist where the messenger is going to take all the shots? Can congressional protection be put in place for that messenger? When AHRQ’s predecessor, the Agency for Health Care Policy and Research, tried to change practices in back treatment based on research, the back surgeons took it apart and the agency was almost disbanded. There are many instances where research almost brought an agency to its knees because a variety of interests weighed in on that particular piece of research.

Many agree that the best option would be to tithe every health plan in this country for this research in order to build a base of support. That funding would not necessarily be funneled to only one agency, but a base for research is crucial, given the billions of dollars that we spend on health care. Furthermore, it is crucial to politically protect the messengers, those who do the research and present it in a way in which it can be translated and used for patients.

Finally, is there a political will to make these kinds of changes? Every Republican and Democratic candidate for president speaks of the importance of information technology (IT). Why are EMRs not yet standard practice? Why is agreement lacking on what goes in that medical record? The DOD and the VA have required 6 months time to begin to come to agreement about what should be included in a medical record and about the interoperability of the system. While it is not an easy task, there certainly exists political consensus in this country on IT, as well as among presidential candidates on creating an agency for evidence-based research and the possibility of greater investments in research.

However, many raise the issue of political conditions for fundamental healthcare reform. In 1991 and 1992, when the Clinton administration was introducing its healthcare reform package, healthcare premiums were increasing and spending on drugs was going up faster (Figure 7-1). The growth in uninsured Americans is much more significant now than it was then. The increase in Medicaid spending is significantly less now. Other factors such as the rates of unemployment, inflation, and the federal budget deficit also are lower now than in the early 1990s.

Even so, Americans have not changed their minds over these last decades about the health system’s need for reform. While there is agreement on the problem, Americans are not sure government ought to fix it.

The Clinton administration of the 1990s alarmed many with a bold universal healthcare plan. People are not convinced that the president of the United States should be in charge of health care, with issues such as international security and the economy at the forefront of his or her mind.

Yet it helps to illuminate a principle of public policy. In our previous grand steps to introduce large-scale government solutions—in the 1930s with the creation of Social Security and in 1965 with the development of Medicare and Medicaid—there was agreement about the problem. During those periods there was also agreement about the solution; there was no serious private-sector or state alternative. There was debate about the delivery system, which is why Medicare is delivered by private insurers, but there was an agreement that the population to be served—the old and the sick—could not be served equitably by the private sector or other levels of government. Similarly, a private-sector alternative to Social Security did not exist either.

To make a grand social policy change such as providing universal health care, there must be consensus on both the problem and the solution. The mistake we made was that we assumed both existed, but alas, in actuality, they did not. We had agreement only that there was a problem. This is similar to the challenge that faces the country today.

In the end, to bring research to bear on the way in which medicine is practiced in this country and the way in which we organize health care, the most self-interested people in our country must provide the leadership. Even though a number of presidential candidates intend to take on the issue, switching to an evidence-based system will require healthcare professionals’ making the case as shrewdly as they possibly can.

Conclusion :

Finally, it reviews the challenges confronting officials and agencies who are responsible for implementing and administering health policies. Public health professionals who understand the political dimensions of health policy can conduct more realistic research and evaluation, better anticipate opportunities as well as constraints on governmental action, and design more effective policies and programs.

If all actors in health care were to embrace value as the central goal, and work together to achieve good measurement, the resulting improvements in healthcare delivery would break the current logjam that threatens the nation’s human and economic health.