Management approaches in healthcare systems

Health Politics

"What is the role of Congress in policy making process"?

Policy is a plan to identify goal or possible course of actions with administrative or management tools to accomplish these goals. On the other hand, policy is the authoritative decision made by the U.S. executive, legislative, judicial branch of government to influence the decision of others. Government is a key player in decision-making process and congress plays important roles in decision-making . In the United States, both House of Representatives and House of Senate fulfill the congressional policy responsibilities, and congress plays important role in health policy, which includes obesity prevention measures or health insurance program. Congress is an important arm of government that makes law. Important strategy that congress uses to make policy preference is by passing a bill into law. Typically, the congress could make a decision to pass or not to the policy of the president into law by using the two-third majority vote. For example, congress may make a policy through the two-third majority vote to increase or decrease the federal government budget on health.

"Difference between Mandatory and Discretionary Spending"

Mandatory spending is the spending category that congress must approve, and which is already written into law. For example spending on Social Security is an example of mandatory spending program calculated based on the number of beneficiaries. On the other hand, discretionary spending is a spending decision based on an appropriation act where the spending decision is made on annual basis. Examples of discretionary spending include defense and non-defense, which include spending on research program for the National Institutes of Health. This type of spending could increase or decrease annually based on the government discretion.

"Primary Power/tools of the President"

The United States constitution provides some implicit and explicit power to the president. The U.S. president is the commander in chief of the armed forces. The president could call upon the armed formed based on his direction to implement national or international military assignments. Moreover, the president has the power of veto that could be used to override the decision of congress. Before congress could pass a bill into law, the president must sign the bill, and the president could use his veto power to override the decision of the congress. Moreover, the U.S. president could use his authority to reorganize executive branch of government and alter executive and administrative branch of government.

"Interests Group and their Roles in the Policy making Process"

Interest groups are group of people lobbying to influence the government decisions. The role of interest group in the policy making process is by sponsoring individual through their votes into the House of Representatives. Through their influence in the house, the interest group could pass a bill into law. Additionally, interest groups could elect or re-elect a public official. Interest group could also initiate a grassroots campaign to align public sentiments. More importantly, interest group can use money to lobby in the house to make their policy become law. (Zuckert, 2002).

2. "Concept of a Legal Right"

Legal rights are the rights written in the constitution, which are legally guaranteed for a legal entity. In the United States, legal rights are bestowed on individual through the U.S. legal system, and the sources of these rights may be through statutory, contractual, customary and personal law. Some of the legal rights include right to life, and property right. However, all the rights recognized by law are enforceable; for example, the right to vote is a legal right. The source of legal rights could come from statutes, custom, laws or action of legislature.

3. "Key Element of the various Concept of Primary Law"

Primary law is the United States legal system sourced from the federal law, state and administrative law. The key elements of primary law are statues, case and adjudications. Statues are found in the U.S. constitution and laws enacted by the U.S. legislature. Typically, statutes are published in several formats, which include statutory codes, session laws, and annotated codes. Cases are the other key elements of primary law, and cases are written decision issued by courts, which is often referred as judicial decision or judicial opinion. Typically, cases complied in prints are called reports and case law are available in individual court. For example, New York Court of Appeal provides access to court decisions. Case law is the largest body of law in the United States and is the basis of contract law, tort law, agency Law and property law. Case laws are binding on subsequent cases because they are decisions from federal and state courts. The case laws are often referred as common law because judges are not making laws.

Administrative law is other key element of primary law, and an administrative law is the law regulating to an area of conduct. For example, the Federal Food and Drug Administration are created by statute to regulate the drug safety, which pharmaceutical companies should follow with regard to drug testing and reporting. Typically, the federal government agencies may also carry out the role of enforcing the rules, laws and regulations.

4. "Separation of Power Doctrine"

Separation of power is a political doctrine originated from Montesquieu stating that there should be a separation of power among the three branches of government-legislative, executive and judiciary. Montesquieu argued that not all powers should be entrenched in only one branch of government because of the possible abuse of power. Each branch of government should serve as a watchdog on other branch of government, where each branch of government should serve as checks to other branch of government. The doctrine of separation of power influences the writing of the U.S. constitution. Under the United States constitution, the executive branch of government is separated from the legislative branch of government where both legislative and executive is separated from the judiciary. Each branch of government does not have a sole responsibility of making law, implement the law and interpret the law. The function of the legislative is to make law while the responsibility of executive is to implement the law and the judiciary interprets the law.

5. "Three Specific Roles of Judiciary branch of Government"

Specific roles of Judiciary branch of government is to:

interpret the law, act as a check on both legislative and executive branch of government, and Hearing civil cases and punishes lawbreakers.

The judiciary interprets the law challenged by executive or legislative and provides the real meaning of this law. The interpretation of law is very critical in the United States politics because it assists in settling grievance between the executive and legislative branch of government. When carrying out their functions, there could be a conflict between executive and legislative branch of government. It is the responsibility of judiciary to interpret the law. The judiciary also serves as checks on legislative and judiciary so that each branch of government does not misuse the power. The doctrine of check and balance is very important in the U.S. government because it prevents monopoly of power. Thus, the judiciary could declare the action of executive or legislative null and void.

6."Premium, Deductable and Cost Sharing in Health Insurance Plan"

Premium is the amount paid to purchase health plan. In other word, a health premium is payment that an individual pays to purchase an insurance healthcare. However, there could a discount for a premium if the payment is paid in a lump sum for the entire year. In the United States, the HIPP (Health Insurance Premium Payment) is the healthcare premium used to assist people to get Medicaid, and HIPP is used to assist people to get healthcare insurance. Government could also assist people to subsidize the monthly premium payment such as Medicare. On the other hand, deductible is the amount an individual needs to pay out of pocket before the plan starts to pay. Cost sharing is the type of healthcare insurance plan where the health plan costs are shared between employee and employers. Employer may pay part of premium contribution, where the remainders are deducted from employees' paychecks.

7. "Relations of Moral Hazard to Health Insurance"

Moral hazard is the case of information asymmetry where one party in a transaction has more information than other party. In a health insurance plan, it is generally argued that Health Insurance Companies are generally insulated from the risks because they have more information about the negative consequence and risks associated with the health insurance, which they do not disclose to other party before signing the contract transactions. To lodge a party into signing an agreement, an insurance company may provide a more elaborate medical service, which otherwise is not necessary. On the other hand, moral hazard could occur after the party has signed the agreement. For example, an insured party could behave in a risky way resulting in a more negative consequence. (Holmstrom, 1979). For example, after an insured person has purchased a health insurance, he may be less careful about driving his car thereby provoking an accident. (Dewan, 2012).

8. "Four Common Demand Shifters and how each factor Shifts Demand"

Four common demand shifters are as follows:

Change in number of consumers,

Change in consumer's preferences and tastes,

Change in consumer income, and Change in price of related good such as substitutes or complement.

An increase in the number of consumer for a particular product could lead to an increase in demand for that product. For example, few days before Christmas, there is a generally increase in the demand for the gift items because the number of consumers who purchase the items increase. If there is a change in consumer tastes and preferences, there will be a change in the demand for that product. For example, if tastes for short skirts increase, the demand for short skirts will increase in the market.

Change in consumer income is another shifter of demand. An increase in the income of consumers will make the demand for goods and services to increase. However, decrease in income level will lead to a decline in demand. Change in the price of complement or substitute goods could increase or decrease demand. If two types of goods are bought together, increase one type of good will lead to the increase in the complement goods. For example, increase in the price of hamburger will lead to a decline in the demand for hamburger buns.

Part Two

1. "Entitlement Program and Block Grant"

Entitlement program is the legal right and some benefit available to people who meet statutory eligibility criteria. For example, Medicare, federal grants, disability benefits, veteran benefits, old age assistance and farm subsidies are the examples of entitlement program. (Mashaw, 1996). On the other hand, a block grant is the federal fund received by the local governments to develop their communities. Typically, block grants allow local governments to design community programs to improve consumer access to social services. However, accountability is a major challenge to block programs. The Department of Housing & Urban Development has used block grants program to fund community development initiatives using the CDBG (Community Development Block Grant). (Waller, 2005).

2. "Medicaid, SCHIP and Medicare SCHIP or Entitlement Program"

Medicaid is an example of block grant. The U.S. government uses Medicaid to assist less privileged people who are otherwise not able to afford health insurance to have access to health insurance program. Medicaid is the third largest insurance program and cover 15% of the U.S. population. For example, Medicaid covers one out four children in Oregon. SCHIP (State Children's Health Insurance Program) is also an example of block grant, however, it is smaller program jointly sponsored by the federal and state governments aimed at increasing health coverage among children. (Oregon Department of Human Services, 2008). However, Medicare is an entitlement program that focuses on older population. Medicare is a health insurance program for people aged 65 or older.

3. "Who is covered by Medicaid?"

Medicaid covers people with low-income bracket in the United States. Medicaid also covers people of all ages whose their income and resources are not sufficient to pay for healthcare. In the United States, Medicaid is the largest government funding for health-related services for low-income people.

4. "Difference between Medicare funding and Medicaid and SCHIP funding"

Both the federal government and state government participate in funding of Medicaid and both federal and state government jointly funds Medicaid. However, only the federal government funds the Medicare. Similar to Medicaid, SCHIP is jointly funded by both the federal and state governments. While Medicare is solely funded by the federal government, both federal and state governments participate in the funding the Medicaid and SCHIP.

5. "Impact of being Uninsured on Individual Health Impact"

Uninsured people are people often unable to pay for healthcare services. Thus, uninsured people are less likely to receive adequate healthcare, and the issue may lead to a lower quality of life, and increased mortality. Moreover, uninsured people are less likely to receive adequate preventive care. (Milibank & McWilliams, 2009).

6. "Two Reason U.S. National Health Reform became a Heated Debate for Decades"

The first reason is that high-income people generally believe that the government will use a taxpayer's money to implement the health reform. People believe that the money to be used for the health reform should be used for more economic need such as generating employment for people. Moreover, Physicians, and political advocacy group claim that healthcare reform will bring out the lower quality of healthcare for people leading to increase in mortality rate.

7. "Meaning of no-duty-to-treat principle"

"No-duty-treat" principle is the U.S. law based on the Supreme Court decision that healthcare provider, either institutions or individuals, do not have obligation to deliver healthcare services to others. The U.S. common law reveals that healthcare providers do not have the obligation to deliver a healthcare to people even under emergence situation.

Conversely, the same common law principle imposes an obligation to take care of an individual with a health risk. Moreover, Good Samaritan law is another law that provides narrow scope to the "no-duty-treat" principle. While many states encourage voluntary participation of healthcare to people at the accident site, however, the same law allows physician not to deliver the healthcare at the accident site for the fear of open charge of malpractice. Similar to other states, Illinois protects physicians from charge who opt not to treat accident victims at the accident site due to lack equipment to carry out the treatment.

8. "Origin and key functions of EMTALA"

EMTALA ("Emergency Medical Treatment and Labor Act") is the U.S. Act passed by the congress in 1986 that required hospital to deliver healthcare to anyone in the need of emergency healthcare regardless of his legal status, citizenship or ability to pay. However, EMTALA is covered by the common law to provide emergence healthcare for any person who shows up in the emergency room. Participating hospitals are the hospitals that accept payments from the CMS (Centers for Medicare and Medicaid Services) or hospitals covered by Department of Health & Human Services.

9. "Determination of Federal Court of Appeal in the case of Canterbury vs. Spence"

Canterbury filed a case against Dr. Spence for failing to disclose the risk of disability inherent after the operation. In the Federal Court of Appeal, the judge ruled out the charge filed against Dr. Spence on the ground that the Appellant failed to produce medical evidence that Dr. Spence acted negligently at the time of operation, which could warrant serious paralysis of Canterbury. Thus, the Court of Appeal did not see the Canterbury's mother contention because Dr. Spence did not have the duty to disclose the risk associated with the operations.