Health Policy Analysis: Chapters 10, 11 and 14 Nutchanart Bunthumporn Beth 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

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