In The. United States. Second Edition. Beaufort B. Longest, Jr. Health Administration Press Chicago, Illinois

Transcription

1 Health Policymaking In The United States Second Edition Beaufort B. Longest, Jr. Health Administration Press Chicago, Illinois

2 CONTENTS List of Acronyms and Initials List of Web Sites Listed in Text Preface xiii xvii xxi 1 Health and Health Policy 1 Health Defined 1 Health Policy Defined 4 Forms of Health Policies 6 Laws 6 Rules/Regulations 7 Operational Decisions 7 Judicial Decisions 7 Macro Policies 8 Categories of Health Policies 8 Allocative Policies 9 Regulatory Policies 10 The Connection Between Health Policies and Health 12 Health Policies and the Environment 13 Health Policies and Human Behavior and Genetics 15 Health Policies and Health Services 16 Money 16 People 18 Technology 19 Healthcare System 20 The Importance of Political Competence in the Pursuit of Health 26 VII

3 Summary 27 Discussion Questions 28! The Context and Process of Public Policymaking 31 The Context of Health Policymaking: The Political Marketplace 32 The Operation of Political Markets 34 Demanders and Suppliers of Health Policies 35 The Demanders of Health Policies 35 Interest Groups in the Political Marketplace 37 The Pluralist Perspective 38 The Elitist Perspective 39 But Which Perspective Is Correct? 41 The Suppliers of Health Policies 41 Legislators as Suppliers 41 Executives and Bureaucrats as Suppliers 43 The Judiciary as Supplier 45 The Interplay Among Demanders and Suppliers in the Political Marketplace 47 Power and Influence in Political Markets 48 The Power and Influence of Interest Groups 50 Ethics in the Political Marketplace 52 The Process of Public Policymaking: A Conceptual Model 55 Summary 60 Discussion Questions 61 I Policy Formulation: Agenda Setting 65 An Overview of the Policy Formulation Phase of Health Policymaking 65 Agenda Setting 68 Problems 68 Problems that Drive Policy Formulation 69 Possible Solutions 71 A Case in Point: The Search for Policy Solutions to the High Cost of Health Services 71 The Role of Research in Health Policy Agenda Setting 73 Decision Making Regarding Alternative Possible Solutions 75 Political Circumstances 77 Interest Group Involvement in the Political Circumstances of Agenda Setting 78 Lobbying 80 Electioneering 82 Litigation 83 Shaping Public Opinion 84 The Influential Role of Chief Executives in Agenda Setting 87

4 The Nature of the Health Policy Agenda 88 Summary 90 Discussion Questions 91 Policy Formulation: Development of Legislation 95 The Choreography of Legislation Development 96 The Result of Legislation Development: Laws 98 Originating and Drafting Legislative Proposals 98 Origins of Ideas for Public Policy 98 A Case in Point: Input into the Legislation Development for Fiscal Year (FY) 1998 Appropriations for the National Institutes of Health (NIH) 100 Drafting Legislative Proposals 103 A Case in Point: The Clinton Health Reform Proposal of Introducing and Referring Proposed Legislation to Committees 105 Legislative Committees and Subcommittees 105 Committees with Health Policy Jurisdiction 107 Committee and Subcommittee Operations 108 House or Senate Floor Action on Proposed Legislation 109 Conference Committee Actions on Proposed Legislation 110 Presidential Action on Proposed Legislation 110 Legislation Development for the Federal Budget 110 Procedures in Establishing the Federal Budget 111 Health Policy in the Omnibus Budget Reconciliation Legislation 113 Legislation Development: Not Just for Legislators 119 Summary 120 Discussion Questions 121 Exhibit Policy Implementation 135 Responsibility for Policy Implementation 138 Legislative Oversight of Implementation 138 Implementation as Public Management 140 The Beginning of Implementation: Rulemaking 140 The Role of Interest Groups in Rulemaking 142 Other Interactions Between Rulemakers and Those Affected by the Rules 145 Operation 146 The Impact of a Policy on Its Own Operation 146 The Impact of Implementing Organizations on Implementation 149

5 The Fit Between Implementing Organizations and the Goals of the Policies They Seek to Implement 151 The Skills and Capabilities of Implementing Organizations' Managers 153 The Designer Role 153 The Strategist Role 154 The Leader Role 155 Interorganizational Relationships and Capabilities 157 A Case in Point: Food Safety 158 Management Capabilities for Interorganizational Relationships 161 A Hypothetical Case in Point: Implementing a National HIV Vaccination Policy 163 Summary 166 Discussion Questions 167 i Policymaking Outcomes and Consequences 171 Consequences for Whom? 171 Health Policies and Individuals 173 Health Policies and Health-Related Organizations 174 Health Policies and Health-Related Interest Groups 180 Consequences of Consequences 184 Analyzing Public Policy Environments 185 The Procedure of Analyzing Public Policy Environments 187 Scanning the Environment to Identify Strategic Public Policy Issues 188 Who/What Should Be Scanned? 189 Monitoring Strategic Public Policy Issues 190 Forecasting Changes in Strategic Public Policy Issues 191 Assessing the Strategic Importance of Public Policy Issues 193 Diffusing the Results of Environmental Analysis into Organizations and Interest Groups 194 Influencing Public Policy Environments 195 Influence: A Matter of Power and Focus 198 A Case in Point: Academic Medical Center (AMC) 200 Summary 203 Discussion Questions Policy Modification 207 Distinguishing Policy Initiation from Policy Modification 208 The Concept of Incrementalism in Policymaking 210 The Mechanics of the Modification Phase 212 Modification in the Policy Formulation Phase 212

6 Modification at Agenda Setting 213 Modification at Legislation Development 214 Modification in the Policy Implementation Phase 214 Modification at Rulemaking 214 Modification in Operation 215 Modification Through the Cyclical Relationship Between Rulemaking and Operation 217 A Case in Point: Implementing the Medicare PPS 217 A Case in Point: Modifications in Medicare Policy 220 The Role of Oversight Actors in Policy Modification 231 The Role of Evaluation in Policy Modification 233 Policy Evaluation as a Basis for Policy Modification 234 Responsibility for Policy Evaluations 237 One More Time: Modification Makes Policymaking a Cyclical Process 239 Summary 239 Discussion Questions The Future of American Health Policy 243 Critical Influences on Future Health Policy 246 The Objectives of Health Policy 246 The Political Marketplace 248 The Limitations of Public Policy in a Market Economy 251 The Growing Role of States in Health Policy 255 The Looming Economic Limits on the Pursuit of Health 258 The Challenges of Future Health Policy 261 Summary 263 Discussion Questions 264 Appendix 267 Index 299 About the Author 316