Introduction to Health Policy, 2nd Edition

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 I dedicate this book to my wife, Ruoxian,
and my children, Sylvia, Jennifer, and Victor Shi.

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 BR I E F CON T E N TS

Preface.......................................................................................................................xiii

PART I Introduction
Chapter 1 Overview of Health Policy.........................................................................3

PART II Health Policymaking

Chapter 2 Federal Health Policymaking...................................................................37
Chapter 3 Health Policymaking at the State and Local Levels
and in the Private Sector..................................................................70
Chapter 4 International Health Policymaking........................................................102

PART III Health Policy Issues

Chapter 5 Health Policy Related to Financing and Delivery...................................131
Chapter 6 Health Policy for Diverse Populations...................................................155
Chapter 7 International Health Policy Issues..........................................................202

PART IV Health Policy Research

Chapter 8 Overview of Health Policy Research......................................................255
Chapter 9 Health Policy Research Methods...........................................................292
Chapter 10 An Example of Health Policy Research..................................................339

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 viii Brief Contents

Glossary....................................................................................................................375
Index..........................................................................................................................383
About the Author...................................................................................................407

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 D ETAI L E D CON TE N TS

Preface.......................................................................................................................xiii

PART I Introduction
Chapter 1 Overview of Health Policy.........................................................................3
Learning Objectives...................................................................................3
Case Study 1: Healthcare Reform: Hillary Clinton
and Barack Obama............................................................................4
Case Study 2: Healthcare Reform After the ACA.......................................5
Health Defined.........................................................................................6
Public Health Defined...............................................................................9
What Are the Determinants of Health?...................................................10
Policy Defined.........................................................................................18
Health Policy Defined.............................................................................19
What Are the Determinants of Health Policy?.........................................21
Stakeholders of Health Policy..................................................................25
Why Is It Important to Study Health Policy?...........................................27
Key Points...............................................................................................28
Case Study Questions..............................................................................29
For Discussion.........................................................................................29
References...............................................................................................30

PART II Health Policymaking

Chapter 2 Federal Health Policymaking...................................................................37
Learning Objectives.................................................................................37

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 x Detailed Contents

Case Study 1: The Development of Medicare and Medicaid....................38

Case Study 2: The Health Insurance Portability and Accountability
Act of 1996.....................................................................................39
The US Political System..........................................................................40
Policymaking Process at the Federal Level................................................42
Attributes of Health Policymaking in the United States...........................54
Role of Interest Groups in US Health Policymaking................................58
Key Points...............................................................................................62
Case Study Questions..............................................................................62
For Discussion.........................................................................................63
References...............................................................................................63
Additional Resources...............................................................................68
Chapter 3 Health Policymaking at the State and Local Levels
and in the Private Sector..................................................................70
Learning Objectives.................................................................................70
Case Study 1: Massachusetts Healthcare Reform.....................................71
Case Study 2: Connecticut Opioid Response Initiative............................71
State Government Structure....................................................................73
Local Government Structure...................................................................79
Private Health Research Institutes...........................................................81
Private Health Foundations.....................................................................82
Private Industry.......................................................................................84
Attributes of Health Policy Development in Nonfederal Sectors..............89
Key Points...............................................................................................91
Case Study Questions..............................................................................92
For Discussion.........................................................................................92
References...............................................................................................93
Chapter 4 International Health Policymaking........................................................102
Learning Objectives...............................................................................102
Case Study 1: WHO Healthy Cities Initiative.......................................103
Case Study 2: Primary Care Workforce Around the World....................104
The World Health Organization............................................................105
Health Policymaking in Selected Countries...........................................109
Key Points.............................................................................................121
Case Study Questions............................................................................121
For Discussion.......................................................................................122
References.............................................................................................122
Additional Resources.............................................................................128

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 Detailed Contents xi

PART III Health Policy Issues

Chapter 5 Health Policy Related to Financing and Delivery...................................131
Learning Objectives...............................................................................131
Case Study 1: The Federally Funded Health Center Program:
Providing Access, Overcoming Disparities.....................................132
Case Study 2: Precision Medicine..........................................................133
Financing US Healthcare.......................................................................134
US Healthcare Delivery.........................................................................139
Policy Issues in Healthcare Financing and Delivery...............................145
Key Points.............................................................................................149
Case Study Questions............................................................................150
For Discussion.......................................................................................150
References.............................................................................................151
Chapter 6 Health Policy for Diverse Populations...................................................155
Learning Objectives...............................................................................155
Case Study 1: The Health Center Program............................................156
Case Study 2: My Health GPS Program for Patients
with Multiple Chronic Conditions................................................157
Defining Vulnerability...........................................................................158
Health Policy Issues for Diverse Populations..........................................159
Health Policy Issues for Vulnerable Subpopulations...............................168
Key Points.............................................................................................184
Case Study Questions............................................................................184
For Discussion.......................................................................................185
References.............................................................................................185
Chapter 7 International Health Policy Issues..........................................................202
Learning Objectives...............................................................................202
Case Study 1: Climate Change and Public Health.................................203
Case Study 2: Primary Care Around the World.....................................204
Health Policy Issues in Developed Countries.........................................207
Health Policy Issues in Developing Countries........................................217
Key Points.............................................................................................236
Case Study Questions............................................................................237
For Discussion.......................................................................................237
References.............................................................................................237
Additional Resources.............................................................................250

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 xii Detailed Contents

PART IV Health Policy Research

Chapter 8 Overview of Health Policy Research......................................................255
Learning Objectives...............................................................................255
Case Study 1: The RAND Health Insurance Experiment.......................256
Case Study 2: Idaho’s Preventive Health Assistance Program..................257
Defining Health Policy Research...........................................................258
The Process of Health Policy Research...................................................265
Communicating Health Policy Research................................................276
Implementing Health Policy Research...................................................279
Key Points.............................................................................................285
Case Study Questions............................................................................286
For Discussion.......................................................................................286
References.............................................................................................287
Chapter 9 Health Policy Research Methods...........................................................292
Learning Objectives...............................................................................292
Case Study 1: Health Centers and the Fight
Against Health Disparities in the United States.............................293
Case Study 2: Vermont’s Accountable Communities
for Health Learning Lab................................................................294
Quantitative Methods...........................................................................295
Qualitative Methods..............................................................................314
Key Points.............................................................................................326
Case Study Questions............................................................................326
Case Study Assignment.........................................................................327
For Discussion.......................................................................................327
References.............................................................................................327
Additional Resources.............................................................................338
Chapter 10 An Example of Health Policy Research..................................................339
by Sarika Rane Parasuraman
Learning Objectives...............................................................................339
Questions for Policy Analysis.................................................................340
Policy Analysis: Responses to Exam Questions......................................341
Key Points.............................................................................................366
For Discussion.......................................................................................366
References.............................................................................................367

Glossary....................................................................................................................375
Index..........................................................................................................................383
About the Author...................................................................................................407

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 P RE FA C E

U
S policymakers have been struggling for years to find solutions to our healthcare
challenges. Thus, healthcare reform is among the top priorities of almost every
administration. This introductory textbook on US health policy covers the related
areas of health policymaking, critical health policy issues, health policy research, and an
international perspective on health policy and policymaking. The book offers the following
features:

◆◆ Real-world cases to exemplify the theories and concepts presented from a

variety of perspectives, including the hospital setting, public health, managed
care, ambulatory care, and extended care
◆◆ Exhibits and extra feature boxes (Learning Points, For Your Consideration,
Key Legislation, Research from the Field, International Policymaking, Global
Health Impact, and others) that present background information on concepts,
examples, and up-to-date information
◆◆ Learning objectives and key points
◆◆ Discussion questions

O r g a ni z at i on of the B oo k
This book is organized in four parts: an introduction, an overview of health policymaking, a
health policy issues section, and a discussion of health policy research and analysis. Chapter 1,
the sole chapter in part I, introduces key terms related to, and the determinants of, health

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 xiv  Preface

and health policy. It lists the key stakeholders in health policymaking and presents important
reasons for studying health policy. The chapter lays the foundation for the rest of the book.
Part II—containing chapters 2, 3, and 4—examines the policymaking process at the
federal, state, and local levels; in the private sector; and in international settings. Chapter 2
focuses on the policymaking process at the federal level of the US government. Important
activities within the three policymaking stages—policy formulation, policy implementation,
and policy modification—are described. The key characteristics of health policymaking in
the United States are analyzed, and the role of interest groups in making policy is discussed.
Chapter 3 focuses on the US policymaking process at the state and local levels and in
the private sector, which includes the research community, foundations, and private industry.
Examples of policy-related research by private research institutes and foundations are described.
The impact of the private sector’s services and products on health and policy is illustrated
using the fast-food industry as well as tobacco and pharmaceutical companies as examples.
Chapter 4 discusses international health policymaking. The World Health Organiza-
tion (WHO) is presented as an example of an international agency involved in policymak-
ing related to health and major health initiatives. Three countries—Canada, Sweden, and
China—are highlighted to illustrate diverse policymaking processes in distinct geographic
regions. The experiences of these countries show that different political systems and policy-
making processes lead to diverse approaches to population health and healthcare delivery.
Part III—encompassing chapters 5, 6, and 7—examines the policy issues related to
social, behavioral, and medical care health determinants; to people from diverse or medi-
cally or socially vulnerable populations; and to international health. Chapter 5 describes
how US healthcare is financed and delivered. Private and public health insurance programs
are summarized, and the subsystems of healthcare delivery—managed care plans, safety net
providers, public health programs, long-term care services, and military-operated health-
care—are introduced. After summarizing the major characteristics of US healthcare delivery,
the chapter provides examples of health policy issues related to financing (cost containment)
and delivery (healthcare workforce, professional accreditation, antitrust regulations, patient
access to care, and patient rights).
Chapter 6 defines medically and socially vulnerable populations and discusses the
dominant healthcare policy issues related to those populations. People from diverse popu-
lations include members of racial or ethnic minorities, the uninsured, people with low
socioeconomic status, the elderly, people with chronic illness, people with mental illness,
women and children, people with disabilities, the homeless, and people with HIV/AIDS.
In each segment, the magnitude of the problem is summarized and a detailed discussion of
the policies and strategies meant to address the problem is presented.
In chapter 7, dominant health policy issues in the international community are
discussed, with examples given for select countries, to help students understand not only
international health policy applications but also the field of global health. The chapter begins

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  Preface xv

by examining issues shared by developed countries, such as modifying health systems to

better serve aging and diverse populations while maintaining high-quality care at a low cost.
It then discusses challenges faced by developing nations, such as controlling the spread of
disease, creating and maintaining high-functioning health systems with limited resources,
and dealing with the burdens of morbidity and mortality associated with poverty. Several
emerging issues are also illustrated that could affect global health in the future.
Part IV—comprising chapters 8, 9, and 10—presents an overview of policy analysis,
focusing on examples of commonly used quantitative and qualitative methods. Chapter 8
introduces health policy research (HPR) and highlights the discipline’s defining characteristics,
including applied, policy-relevant, ethical, multidisciplinary, scientific, and population-based
studies. The HPR process is summarized, and the chapter concludes with a discussion of
ways to communicate findings and the challenges in implementing those findings in practice.
Chapter 9 illustrates commonly used methods in HPR. Quantitative methods include
experimental research, survey research, evaluation research, cost–benefit analysis, and cost-
effectiveness analysis. Because evaluation research is closely tied to policy research, the process
involved in this type of research is described in greater detail. Qualitative methods include
participant observations, in-depth interviews (including focus groups), and case studies.
Examples of published studies using these methods are provided.
Chapter 10 provides an example that illustrates the key steps in health policy analy-
sis: assessing the determinants of a health problem, identifying a policy intervention to
address the problem, critically evaluating the policy intervention, and proposing next steps
in addressing the problem.

New to T h i s E d i t i on
This second edition has retained most of the features of the first edition. In addition, sig-
nificant updates have been made in the following key areas.

C ase S tudies

Each of the chapter-opening case studies from the first edition has been revised or replaced,
and a new, second case study has been added to chapters 1–9.

H ealthc are R ef orm

The latest developments in healthcare reform and legislation have been incorporated into the
book, especially in chapters 2 and 3 and in the many additions to the chapters in part III.

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 xvi  Preface

I nternati onal H ealth P olicy

The international health policy chapters (chapters 4 and 7) have broadened in scope with
more examples from the array of countries discussed in the book. New WHO initiatives
have also been added.

U pdated C ontent T hroughout

Content, references, and data (including in relevant exhibits) have been updated through-
out. New and revised content includes coverage of the impact of the Affordable Care Act,
new healthcare reform directions, the patient-centered medical home, accountable care
organizations, precision medicine and big data, state and local healthcare reform activities,
private-sector initiatives, and the pharmaceutical industry. More examples of applications
in research have been added.

A c k n o w l e d gm e n t s
My PhD advisee Sarika Rane Parasuraman contributed chapter 10 (an applied example) and
is hereby acknowledged. The editorial staff of Health Administration Press have provided
hands-on assistance in editing the manuscript. Of course, all errors and omissions remain
my responsibility.

Leiyu Shi

i n str u CtOr r esOu rCes

This book’s Instructor Resources include a test bank, PowerPoint slides for each
chapter, and answer guides for the book’s discussion questions.

For the most up-to-date information about this book and its Instructor Resources,
go to ache.org/HAP and search for the book’s order code (2374).

This book’s Instructor Resources are available to instructors who adopt this book for
use in their course. For access information, please e-mail [email protected].

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 PA R T I

I N T R O D UCTION

T
he introduction, which consists of chapter 1, provides an overview of health policy. It defines
key terms related to health policy, reviews the framework of health determinants, and outlines
the concept of health policy formulation. In addition, the chapter introduces topics related to
health policy, including stakeholders, major types of health policies, and the importance of studying
health policy. The introduction provides readers with a foundation for examining how health policy
is established in the United States and elsewhere.

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