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Health Policy

1. What is Public Policy?

Laws, Policies and Regulations: Key Terms & Concepts

1.1 What is public?

"of, relating to, or affecting all the people or the whole area of a nation or state." - Merriam-Webster Dictionary

  • Everyone (all American)
  • The voters or likely voters
  • The politcally active (their voices/preferences are heard/represented)
  • Federal/State/Local

1.2 What is policy?

"a definite course or method of action selected from among alternatives and in light of given conditions to guide and determine present and future decisions." - Merriam-Webster Dictionary

“a system of laws, regulatory measures, courses of action, and funding priorities concerning a given topic promulgated by a governmental entity or its representatives.” Dean G. Kilpatrick, Ph.D. https://mainweb-v.musc.edu/vawprevention/policy/definition.shtml

"Policy is a law, regulation, procedure, administrative action, incentive, or voluntary practice of governments and other institutions. " - CDC

1.3 Why policy is needed?

"To err is human; to forgive, divine." - English poet Alexander Pope

Humans form societies and governments to survive, sustain, and prosper. Human societies are full of conflicts, issues, and problems. Government's role is to govern in the intereests of everyone in the society (the public).

In a free market economy, people less strong and/or less lucky will be left behind. To have a just, fair, and compassionate society, governments need to implement laws, regulations, and programs to help the less privileged and disadvantaged at the same time also protect the private properties and liberty of everyone.

Public policy is a critical part of a modern society, regardless of the form or system of the government - democratic or authoritarian, capitalist or socialist.

1.4 Examples of public policy

  • Economic policy
  • Monetory policy
  • Environmental policy (in response to climate change and global warming)
  • Health policy

1.5 System Approach in Policy Design and Implementation

Policies must address the society as a whole instead of silos. It requires the Whole-of-Government (WoG) and the Whole-of-Society (WoS) approach based on the principles of system thinking.

In addition to system thinkjing, also considering Systems of Systems (SoS) thinking especially in a democratic and federalist system like US. Think about the five characteristics of a SoS:

  • A - Autonomy (from authority, command-and-control to autonomy and self-governace and independence)
  • B - Belonging (from tight-coupling to loose-coupling and common goal sharing)
  • C - Connectivity (from unilateral to multi-lateral communications, collaborations via feedbacks)
  • D - Diversity (from homogeneity to hetrogeneity)
  • E - Emergence (from rigid planning to innovative solutions)

2.Health Policy

2.1 Definition

"The public policy for public health." - Dr. Wang's lazy definition

"Decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society." - WHO

"Health policy must be made in the contexts of politics, economy, and culture." - Jay

Discuss health ploicy in response to COVID-19 pandemic:

  • Political climate
    • Partisan fights
    • Election year
  • Economic impacts
    • The concern of negative impact of lockdown on economy
    • Worsen economic situation reduce resources needed to respond to the pandemic
    • Worsen economic situation has long-term impact on physical and mental health due to the untreated illness and prolonged stress
  • Cultural values and norms
    • Individualism vs Collectivism (self-care vs care for others)
    • Short-term orientation vs long-term orientation (you may have the right to do something, but it is a right thing to do it now?)
    • Indulgence vs Refrain
    • Power distance (civil obedience vs civil disobedience)
    • Uncertainty Avoidance
    • Masculinity vs femininity

2.2 Different Flavors of Health Policy

  • Legislative vs regulatory
  • Distributive vs re-distributive
  • Long-term vs short-term (Health policy to contain coronasvirus pandemic is considered shor-term measures)
  • Mandatory vs voluntary (masking, social distancing, hand-washing, reduced restaurant seating, shutting down of businesses, etc)
  • Medical practices focused vs cross-cutting: mail-in voting is both social policy (election) and health policy (to prevent further spread of coronasvirus)

2.3 Health Policy Making and Implementation

2.4 Health Policy Example - ESRD QIP

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/05_LawsandRegs