Health Policy Analysis: Chapters 10, 11 and 14

Nutchanart BunthumpornBeth Faiman

Policy Analysis Process and Health Professional Leadership Evaluation-Economic viability Analysis of values-Last but not

least Health professional leadership

Evaluation-Economic Viability How much will it cost? What value will we be getting for the

money? How does that value compare with

other alternatives under consideration?

If it is something we want to do, how will we pay for it?

Evaluation-Economic Viability Define the health care issue

Population, diagnosis, incidence, impact

Study the relevant intervention technologies

Agreeing on the intervention and its effectiveness

Agreeing in detail on the delivery system

Evaluation-Economic Viability Selecting the analytical approach

Cost-effectiveness analysis (CEA) Money is used to measure benefits Fixed budget and little variation in the

preferences for outcomes Cost-benefit analysis (CBA)

Variable budget and varying utilities of outcomes

Hierarchy of Analytical Approach for Comparison and Decision Making

Establish the cost of the illness Conduct a cost-minimization study Conduct a cost-effective study Do a cost-benefit study Consider a cost utility study

Selecting the analytical approach

Two other approaches The human capital approach, which

emphasizes the economic cost to society

The friction cost approach, which measures the loss in productivity

Selecting the analytical approach

Supply and demand analysis Refer to changes in perceived prices Investigate:

The rate of change in demand with a given change in price

The rate of change in supply with a given change in price

Benefit and cost analysis

Evaluation-Economic Viability

Agreeing on the resources required Determining relevant costs

Changes in costs of medicines, consumable supplies, and tests

Changed labor costs Changes in length of stay or location of

treatment Changes in costs incurred by patients and their

family Changes in overhead costs

Evaluation-Economic Viability

Agreeing on the outcomes produced Show the outcome at the both extreme of

the range and report those multiple values

Valuing the outcomes produced Determining the present value of costs

and outcomes Inflation adjusting Discounting

Evaluation-Economic Viability

Dealing with important uncertainties Adding a risk premium to the discount rates Developing a subjective probability

distribution Investing in further research to reduce the

uncertainty Identifying financing methods Considering distributional effects

Comparing with competing alternatives

Financial feasibility Capital allocation processes

Evaluation-Economic Viability

The Policy Process: Analysis of Values Chapter 11

Concerned with the values of healthcare and healthcare professionals

May or may not be considered in the political process

The Policy Process: Analysis of Values Fair access

Priester (1992) suggested the US should give greatest emphasis to equity; defined as “adequate care” but “does not require access to all beneficial care”

He felt that economic considerations have outweighed ethical ones

The Policy Process: Analysis of Values

Efficiency If lack of resources leads to “overlooked”

individuals- this is key “Waste not, Want not” …. not always

One person’s waste is another’s enhanced income

Porter and Teisberg argued against “Zero- sum”

All will get more collectively if waste is minimized

The Policy Process: Analysis of Values

Patient Privacy and Confidentiality Technology and patient record safety

Informed Consent Do the CFR place a constraint on provider

autonomy? Personal Responsibility

Patient lifestyle leads to higher costs Patients should take responsibility for their

behavior

The Policy Process: Analysis of Values

Malpractice Reform Should state and federal states “cap”

the size of awards when they are excessive?

Professional Ethics Consumer Sovereignty

Cannon and Tanner (2005)- HC to all Richmond and Fein (2005)- equity

The Policy Process: Analysis of Values

Social Welfare Do interest groups represent the public? Values over economics; difficult in policy making

Rationing Limiting care that is likely beneficial due to

scarce resources Fair distributing of available resources Society determines decision-making, not

corporations

The Policy Process: Analysis of Values Process equity

Outcome and process should be fair Influence on Society

What are the long term effects of this emphasis of health?

Direct-to-consumer advertising: $3-5B/ann Holy Fire (1996)

Ethical Review conclusion

Health Professional Leadership Health professionals must take an

active role in leadership Perception of disinterestedness? Information Credibility Start locally Take Risks Governance

Health Professional Leadership

Planning alternatives HC is a field that will have high variability and

should not be treated as science Communities: Manage not just individuals Enhance the professional’s role

Train others, networking, practice leadership Conclusion

Thank you!