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Introduction

to Health
Policy

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AUPHA/HAP Editorial Board for Undergraduate Studies


Wayne B. Sorensen, PhD, FACHE, Chair
Texas State University
Deborah E. Bender, PhD, MPH
University of North Carolina
Diane Duin
Montana State University
Gary L. Filerman, PhD
Georgetown University
Peter Fitzpatrick, EdD
Clayton State University
Leonard H. Friedman, PhD
George Washington University
Sheila McGinnis, PhD
Montana State University
Carol Molinari, PhD
Jefferson College of Health Sciences
Lydia M. Reed, MBA, CAE
AUPHA
Susan D. Roggenkamp, PhD
Appalachian State University
Grant T. Savage, PhD
University of Missouri
Jon M. Thompson, PhD
James Madison University

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Introduction
to Health
Policy
Leiyu Shi

Health Administration Press, Chicago, Illinois


AUPHA Press, Washington, DC

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official positions of the American College of Healthcare Executives, of the Foundation of the American College
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Copyright 2014 by the Foundation of the American College of Healthcare Executives. Printed in the United
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Library of Congress Cataloging-in-Publication Data


Shi, Leiyu.
Introduction to health policy / Leiyu Shi.
pages cm
Includes index.
ISBN 978-1-56793-580-6 (alk. paper)
1. Medical policy--History. 2. Health care reform. 3. Public health--International cooperation. I. Title.
RA393.S473 2014
362.1--dc23
2013005276
The paper used in this publication meets the minimum requirements of American National Standard for Information SciencesPermanence of Paper for Printed Library Materials, ANSI Z39.48-1984.
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Preface

ix

DETAILED CONTENTS

Brief Contents.......................................................................................................vii
Detailed Contents................................................................................................. ix
Preface...................................................................................................................xiii
Part I

Introduction........................................................................................1

Chapter 1
Overview Of Health Policy.................................................................3
Learning Objectives................................................................................................3
Case Study: Healthcare Reform: Hillary Clinton and Barack Obama......................4
Health Defined.......................................................................................................5
Public Health Defined............................................................................................9
What Are the Determinants of Health?...................................................................9
Policy Defined......................................................................................................16
Health Policy........................................................................................................16
Determinants of Health Policy..............................................................................18
Stakeholders of Health Policy................................................................................21
ix
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Detailed Contents

Why Is It Important to Study Health Policy? .......................................................23


Key Points.............................................................................................................24
Case Study Questions...........................................................................................24
For Discussion......................................................................................................24
References.............................................................................................................25
Part II

Health Policymaking.........................................................................29

Chapter 2
Federal Health Policymaking.............................................................31
Learning Objectives..............................................................................................31
Case Study: The Development of Medicare and Medicaid....................................32
The US Political System........................................................................................33
Policymaking Process at the Federal Level.............................................................35
Attributes of Health Policymaking in the United States........................................43
Role of Interest Groups in US Health Policymaking.............................................46
Key Points.............................................................................................................49
Case Study Questions...........................................................................................49
For Discussion......................................................................................................49
References.............................................................................................................50
Health Policymaking at The State and
Local Levels and in the Private Sector.............................................53
Learning Objectives..............................................................................................53
Case Study: Massachusetts Healthcare Reform......................................................54
State Governmental Structure...............................................................................55
Local Government Structure.................................................................................57
Private Health Research Institutes.........................................................................60
Private Health Foundations ..................................................................................61
Private Industry ....................................................................................................63
Attributes of Health Policy Development in Nonfederal Sectors...........................65
Key Points.............................................................................................................68
Case Study Questions...........................................................................................68
For Discussion......................................................................................................68
References.............................................................................................................69

Chapter 3

Chapter 4
International Health Policymaking....................................................74
Learning Objectives..............................................................................................74
Case Study: Chinas Healthcare Reform................................................................75

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Detailed Contents

Stage 1, July 2005October 2006:


Issue Raising and Agenda Setting......................................................................75
Stage 2, October 2006February 2008:
Designing and Selecting Policy Options...........................................................75
Stage 3, February 2008September 2008:
Deliberating the Final Healthcare Reform Program .........................................75
Case Study: Chinas Healthcare Reform................................................................75
Stage 4, October 2008November 2008:
Consulting the Public.......................................................................................76
Stage 5, December 2008March 2009:
Unveiling the Formal Healthcare Reform Policy ..............................................76
World Health Organization..................................................................................76
Health Policymaking from Selected Countries......................................................79
Key Points.............................................................................................................90
Case Study Questions...........................................................................................91
For Discussion......................................................................................................91
References.............................................................................................................92
Part III

Health Policy Issues...........................................................................97

Chapter 5
Health Policy Related to Financing and Delivery..............................99
Learning Objectives..............................................................................................99
Case Study: The Federally Funded Health Center Program:
Providing Access, Overcoming Disparities......................................................100
Financing US Healthcare....................................................................................101
US Healthcare Delivery ......................................................................................105
Policy Issues Related to Healthcare Financing and Delivery................................109
Key Points...........................................................................................................114
Case Study Questions.........................................................................................114
For Discussion....................................................................................................114
Referneces...........................................................................................................115
Chapter 6
Health Policy For Diverse Populations............................................118
Learning Objectives............................................................................................118
Case Study: The Health Center Program.............................................................119
Defining Vulnerability .......................................................................................120
Health Policy Issues for Diverse Populations.......................................................121
Health Policy Issues for Vulnerable Subpopulations............................................128
Key Points...........................................................................................................139

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xi

xii

Detailed Contents

Case Study Questions.........................................................................................139


For Discussion....................................................................................................140
For Discussion....................................................................................................140
Chapter 7
International Health Policy Issues...................................................150
Learning Objectives............................................................................................150
Case Study: Climate Change and Public Health.................................................151
Health Policy Issues in Developed Countries......................................................154
Health Policy Issues in Developing Countries.....................................................161
Key Points...........................................................................................................173
Case Study Questions.........................................................................................173
For Discussion....................................................................................................173
References...........................................................................................................174

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