Political Effects of Health Care Policy Implementation

Instructor: Alexandra Unfried

Alexandra earned her master's degree in nursing education and is currently a hospital supervisor/administrator.

Health care policy and politics don't seem like they are related, but they both have major influences on each other. This lesson will discuss the political effects of health care policy implementation.

The Relationship of Politics and Health Care Policy

Carrie is a risk management specialist who specializes in health care policy. She is preparing to guide her hospital in fine-tuning their observation unit with a focus on communicating with their Medicare patients. This is directed by a recent federal law that mandates that hospitals be transparent in what observation status is and how Medicare coverage is different than for an inpatient admission.

Observation status in a hospital means that a patient is not admitted, but still requires some medical monitoring or interventions. There are guidelines that help doctors place patients in observation, as opposed to admitting them as an inpatient. This status can be tricky when patients need to be covered or reimbursed for their medical care. This is why the new communication is being mandated.

Policies regulate health care practices for patients.
Policies regulate health care practices for patients

Carrie is meeting with the manager of the observation unit, Nancy, to explain the changes they need to make to clearly communicate and document patient care for all of their patients. She begins by discussing public health policies, political influence, and policy feedback.

What Are Health Care Policies?

Policies are plans of action that are developed to reach a specific goal. Health policies are policies that address how to positively influence a population of people; these are measured by the impact on health outcomes. Health care policies are focused on how to manage and care for disabilities, health conditions, and sickness by controlling health care professionals, health care systems, and access to health care. These terms are often used interchangeably, and each of these types of policies supports the other.

Health care policies and public health policies are developed to change the health status of the population and to help people have more access to healthier options. They are made through evaluation and evidence from research while also analyzing other policies.

Carrie went through a modified policy analysis of the observation patient system and why changes must be made to how patients are communicated with regarding their hospital stay. She realizes how intertwined policy and politics are, and she shares this information with Nancy so she understands why changes are being made:

  • The importance of health policy directly involves how they impact individuals, groups, and communities.
  • Policies, laws, regulations, and rules related to health policies are advocated for to improve the population's health.
  • Evidence-based research supports and helps develop policies for health advancement.
  • Advocacy techniques are able to influence prime decision-makers for health policy.

Policy Influences

The planning and implementation of health care policies are often influenced by different sources. These sources guide what is regulated, who the policy is meant for, and the reasons why the policy is being introduced. Once these elements are identified, the policy is created.

What Is Regulated What Is Affected How It's Decided
Health insurance plans, health care organizations, government insurance companies, research Patients, hospitals, pharmacies, public health policies Demographics, economics, insurance coverage, health care spending and costs, health information technology, government programs (Medicare/Medicaid)

Nancy is now ready to work with Carrie on educating her unit staff on how to handle their observation patients. This involves a new form for patients to read and sign, additional documentation about the patient's observation status, and monitoring the length of stay diligently to meet regulations. The new health policy implementation is affected by political regulations based on government health insurance program needs.

The new policy to provide additional forms for observation patients to read and sign, stating that they have been informed they are in an observation status in the hospital, is supposed to improve communication about health insurance coverage. This change comes from feedback from patients about how their Medicare coverage is different when they are in the hospital but not considered an admission.

Insurance reimbursement is affected by policies.
Insurance reimbursement is affected by policies

This new policy addresses this problem. However, it focuses on one part of a complex problem, meaning that additional policies and changes should be expected.

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