Essentials of Health Policy and Law

Description

Cover......Page 1 Essentials of Health Policy and Law......Page 2 Copyright......Page 3 Contents......Page 4 Prologue......Page 8 About the Editor......Page 10 Preface......Page 12 Acknowledgments......Page 16 About the Authors......Page 18 Contributors......Page 20 PART I Setting the Stage: An Overview of Health Policy and Law......Page 22 Role of Policy and Law in Health Care and Public Health......Page 24 The Three Broad Topical Domains of Health Policy and Law......Page 26 Social, Political, and Economic Historical Context......Page 27 Key Stakeholders......Page 28 Conclusion......Page 29 Endnotes......Page 30 Identifying Public Problems......Page 32 Structuring Policy Options......Page 33 State-Level Policymaking......Page 34 The Federal Legislative Branch......Page 35 The Federal Executive Branch......Page 42 The Federal Government......Page 46 State and Local Governments......Page 49 Interest Groups......Page 50 References......Page 51 Endnotes......Page 52 Introduction......Page 54 The Role of Law......Page 55 Sources of Law......Page 56 Separation of Powers......Page 60 Federalism: Allocation of Federal and State Legal Authority......Page 61 The Role of Courts......Page 62 References......Page 67 Endnotes......Page 68 Introduction......Page 70 Healthcare Finance......Page 71 Health Insurance......Page 72 Direct Services Programs......Page 74 The Uninsured......Page 75 The Underinsured......Page 81 Insurance Coverage Limitations......Page 82 Safety Net Providers......Page 84 Workforce Issues......Page 86 Key Areas of Quality Improvement......Page 89 A National Health Insurance System: Canada......Page 92 A National Health System: Great Britain......Page 94 A Socialized Insurance System: Germany......Page 95 The Importance of Health Insurance Design......Page 96 Conclusion......Page 97 References......Page 98 What Are the Goals and Roles of Governmental Public Health Agencies?......Page 102 What Are the 10 Essential Public Health Services?......Page 104 What Are the Roles of Local and State Public Health Agencies?......Page 106 What Are the Roles of Federal Public Health Agencies?......Page 108 What Are the Roles of Global Health Organizations and Agencies?......Page 111 What Other Government Agencies Are Involved in Health Issues?......Page 112 Nongovernmental Organizations......Page 113 How Can Public Health Agencies Partner With Health Care to Improve the Response to Health Problems?......Page 114 How Can Public Health Take the Lead in Mobilizing Community Partnerships to Identify and Solve Health Problems?......Page 116 Endnotes......Page 117 Source for Political Affiliation of the House of Representatives......Page 130 PART II Essential Issues in Health Policy and Law......Page 132 Introduction......Page 134 Background......Page 135 Individual Rights and Health Care: A Global Perspective......Page 137 Individual Rights and the Healthcare System......Page 138 Rights Under Healthcare and Health Financing Laws......Page 139 Rights Related to Freedom of Choice and Freedom From Government Interference......Page 140 The Right to Be Free From Wrongful Discrimination......Page 146 Overview of Police Powers......Page 149 The Jacobson v Massachusetts Decision......Page 150 The “Negative Constitution”......Page 151 Conclusion......Page 153 References......Page 154 Endnotes......Page 155 Chapter 7 Social Determinants of Health and the Role of Law in Optimizing Health......Page 158 Introduction......Page 159 Types of SDH......Page 160 The Link Between Social Determinants and Health Outcomes......Page 162 Law as a Social Determinant of Health......Page 163 Right to Criminal Legal Representation vs Civil Legal Assistance......Page 165 Combating Health-Harming Social Conditions Through Medical-Legal Partnership......Page 167 The Evolution of an “Upstream” Innovation......Page 168 The Benefits of MLPs......Page 169 Conclusion......Page 170 References......Page 171 Endnotes......Page 172 Introduction......Page 174 A Brief History of the Rise of Health Insurance in the United States......Page 175 Basic Terminology......Page 177 Uncertainty......Page 178 Risk......Page 179 Setting Premiums......Page 181 Medical Underwriting......Page 182 Managed Care......Page 183 Cost Containment and Utilization Tools......Page 184 Utilization Control Tools......Page 185 Common Managed Care Structures......Page 187 The Future of Managed Care......Page 190 References......Page 191 Endnotes......Page 192 Introduction......Page 194 How Economists View Decision Making......Page 195 Demand Changers......Page 197 Elasticity......Page 199 Health Insurance and Demand......Page 200 Profit Maximization......Page 201 Health Insurance and Supply......Page 202 Market Structure......Page 203 Market Failure......Page 204 Endnotes......Page 208 Introduction......Page 210 Difficulty Achieving Health Reform in the United States......Page 211 U.S Political System......Page 212 Path Dependency......Page 214 Unsuccessful Attempts to Pass National Health Insurance Reform......Page 215 Commitment and Leadership......Page 218 Lessons From Failed Health Reform Efforts......Page 220 Overview of the ACA......Page 222 Individual Mandate......Page 224 State Health Insurance Exchanges/Marketplaces......Page 227 Employer Mandate......Page 234 Changes to the Private Insurance Market......Page 235 Financing Health Reform......Page 236 Public Health, Workforce, Prevention, and Quality......Page 237 The U.S Supreme Court’s Decision in the Case of National Federation of Independent Business v Sebelius......Page 238 States and Health Reform......Page 239 Key Issues Going Forward......Page 240 Congressional Activity......Page 241 Insurance Plan Premium Rates......Page 243 ACA Litigation......Page 245 References......Page 246 Chapter 11 Government Health Insurance Programs: Medicaid, CHIP, and Medicare......Page 252 Introduction......Page 253 Program Administration......Page 254 Eligibility......Page 255 Benefits......Page 259 Amount, Duration, and Scope, and Reasonableness Requirements......Page 262 Medicaid Spending......Page 263 Medicaid Financing......Page 264 Medicaid Provider Reimbursement......Page 265 Medicaid Waivers......Page 268 Children’s Health Insurance Program......Page 269 CHIP Structure and Financing......Page 270 CHIP Eligibility......Page 271 CHIP Benefits and Beneficiary Safeguards......Page 272 The Future of CHIP......Page 273 Medicare Eligibility......Page 274 Medicare Benefits......Page 276 Medicare Financing......Page 279 Medicare Provider Reimbursement......Page 283 References......Page 286 Endnotes......Page 289 Introduction......Page 292 Quality Control Through Licensure and Accreditation......Page 293 Medical Errors as a Public Health Concern......Page 294 The Origins of the Standard of Care......Page 296 The Evolution of the Standard of Care......Page 297 Hospital Liability......Page 299 Insurer Liability......Page 300 Managed Care Liability......Page 301 Overview of ERISA......Page 302 ERISA Preemption......Page 303 The Intersection of ERISA Preemption and Managed Care Professional Medical Liability......Page 304 Measuring and Incentivizing Healthcare Quality......Page 305 Public Reporting......Page 307 Value-Based Purchasing......Page 308 National Quality Strategy......Page 309 Role of Health Information Technology......Page 310 References......Page 311 Endnotes......Page 312 Introduction......Page 314 Defining Public Health Preparedness......Page 315 CBRN Threats......Page 316 Naturally Occurring Disease Threats......Page 320 Natural Disasters......Page 321 Federal Response Agencies and Offices......Page 324 Preparedness Statutes, Regulations, and Policy Guidance......Page 326 Presidential Directives......Page 328 International Agreements......Page 329 Conclusion......Page 331 References......Page 332 PART III Basic Skills in Health Policy Analysis......Page 336 Client-Oriented Advice......Page 338 Your Client’s Power and Values......Page 339 Structuring a Policy Analysis......Page 340 Problem Identification......Page 341 The Background Section......Page 343 The Landscape Section......Page 344 The Options Section......Page 347 References......Page 351 Glossary......Page 352 Index......Page 358