Intro to US Health System Management of the US Health Services System Chapter 5 Dr. Tracey Lynn Koehlmoos Adjunct Professor

Management in Roemer Model Planning Administration Legislation Regulation We will discuss each of these issues within the PUBLIC sector

Planning In US NO central planning authority Projects, programs, organizations: PLANS Historical Planning Initiatives –Comprehensive Health Planning Act 1966 –National Health Planning and Resource Development Act 1974

Comprehensive Health Planning Act Designed to involve community and consumers in health service planning Part of Great Society era Federal dictate of State-wide programs CHP-A, CHP-b Failure –No assurance of resources to meet needs –Consumers & Providers: unequal knowledge unwillingness to compromise –Failed to control expansion of the system

Health Planning & Resources Development Act 1974 Grew out of concern for skyrocketing costs Established three levels of state orgs: –Statewide Health Coordinating Council –State Health Planning and Development Agency –Health Systems Agencies Certificates of Need (CON): largest long- term contribution! –All projects/changes costing >150K –No CON = No Medicare funding

Failure of Health Planning Act Repealed in 1986 CON: Providers resented the Review process Frustration led to litigation No new national health planning program

Administration “Decision making” capacity Dimensions include –Organization of programs –Staffing and budgeting –Supervision toward achieving goals –Procurement of supplies and material –Coordination of activites –Evaluation of efforts

Legislation Six types that govern healthcare system: –Authorizing legislation: enables programs –Facilitates Resource Production: either people or facilities –Social financing of health services –Quality Surveillance –Prohibition of injurious behavior –Protection of individual rights

Regulation Gov’t regulation in a free-market economy Regulation required to implement legislation: Code of Federal Regulations There is a lag-time between enactment of legislation and the establishment of regulations and implementation of programs

Specific Regulations Licensure: –National Standards in State-wide procedures –Physicians, Nurses, Hospitals –Controls Entry into market place Certification: More often programs or specialties Accreditation: usually voluntary –JCAHO, NCQA –CEPH

Summary Roemer Model: four parts to Management –Planning –Regulation –Legislation –Administration No central planning authority exists in US Regulation cause of most controversy