DNP 825 Topic 5 Discussion Question Two
DNP 825 Topic 5 Discussion Question Two
Provide an evaluation of the current political climate related to health care and define how the DNP can positively impact through policy or advocacy.
Politics, for better or worse, plays a critical role in health affairs. The purpose of this article is to articulate a role for political analysis of public health issues, ranging from injury and disease prevention to health care reform. It begins by examining how health problems make it onto the policy agenda. Perceptions regarding the severity of the problem, responsibility for the problem, and affected
populations all influence governmental responses. Next, it considers how bounded rationality, fragmented political institutions, resistance from concentrated interests, and fiscal constraints usually lead political leaders to adopt incremental policy changes rather than comprehensive reforms even when faced with serious public health problems.
It then identifies conditions under which larger-scale transformation of health policy can occur, focusing on critical junctures in policy development and the role of policy entrepreneurs in seizing opportunities for innovation. Finally, it reviews the challenges confronting officials and agencies who are responsible for implementing and administering health policies. Public health professionals who understand the political dimensions of health policy can conduct more realistic research and evaluation, better anticipate opportunities as well as constraints on governmental action, and design more effective policies and programs.
The multiyear shifting of federal controls over select healthcare-related decision-making has emboldened state legislatures to act when Congress has been unable to do so. As a result, laws requiring pharmacy benefit management registrations have been on the rise, while faster approvals that allow the broader use of prescription drugs (eg, naloxone) are addressing fast-changing public health issues, such as the opioid crisis, in most states. In addition, regulatory changes resulting from the Affordable Care Act (ACA) have also contributed to state-level engagement in healthcare change. Coupled with the current “healthcare for all” movement and select cases decided by the federal courts that support further ACA changes or elimination of the ACA, less federal control over state matters seems likely.
Rather than focus on illness, the healthcare industry is moving toward wellness as part of a value-based system of care.5 Virtual care and the use of technology will allow a continued focus on population health, which is an increasing challenge for states in balancing their urban versus rural areas. Similarly, challenges remain with balancing the economics of healthcare delivery with state financial obligations (eg, pensions, Medicaid, infrastructure services) and the politics of running a state government.5
Other aspects of market change, such as pharmacogenomic testing, have increasingly been incorporated into medical plan coverage through state insurance commission–approved plan offerings. Allowing more testing for targeting appropriate drug use has gained acceptance, along with paying for related services that will create delivery system efficiencies and cost-savings.
Harnessing technology to aid the management of healthcare costs remains a standard strategy for states as purchasers and payers of care. At the same time, subtle changes in government oversight or regulatory control contribute to the ripple effects of change in the healthcare ecosystem (eg, allowing for the increased use of technology or removing regulatory requirements that cost administrative time and/or money while still achieving desired clinical outcomes).