Cultural And Diversity Awareness In Health Assessments

Pick one scenario

Case Study #1: Last names A-H:

CASE STUDY 1 JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. He has ahx of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12 injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and states “I came for my annual physical exam, but do not want to be a burden to my daughter.

Case Study #2: Last names starting with I-Q:

CASE STUDY 2 TJ, a 32-year-old pregnant lesbian, is being seen for an annual physical exam and has been having vaginal discharge. Her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank. She is currently taking prenatal vitamins and takes over the counter Tylenol for aches and pains on occasion. She has a strong family history of diabetes. Gravida 1; Para 0; Abortions 0

Case Study 3: Last names starting R-Z:

CASE STUDY 3 MR, a 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help himself too. He tells you he is afraid that he will not get into heaven if he continues in this lifestyle. He is not taking any prescriptions medications and denies drug use. He has a positive family history of diabetes, hypertension, and alcoholism.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

· Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.

· Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.

· Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

· Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Resources for reference: 

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

  • Chapter 1, “The History and      Interviewing Process”  (Previously read in Week 1)

This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients.

  • Chapter 2, “Cultural      Competency”

This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J. (2014). Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis. Journal of Asthma, 51(7), 703–713. doi:10.3109/02770903.2014.906605

Credit Line: Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis by Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J., in Journal of Asthma, Vol. 51/Issue 7. Copyright 2014 by Taylor & Francis, Inc. Reprinted by permission of Taylor & Francis, Inc. via the Copyright Clearance Center.

The authors of this study discuss the relationship between health literacy and health outcomes in African American patients with asthma.

Centers for Disease Control and Prevention. (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence

This website discusses cultural competence as defined by the Centers for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website. 

United States Department of Human & Health Services. Office of Minority Health. (n.d.). A physician’s practical guide to culturally competent care. Retrieved June 10, 2019, from https://cccm.thinkculturalhealth.hhs.gov/

From the Office of Minority Health, this website offers CME and CEU credit and equips healthcare professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.

Espey , D. K., Jim, M. A., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American Journal of Public Health, 104(Suppl 3), S303–S311. 

Three to four reference must be provided 

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Different Types Of Ethical Dilemmas That Nurses Encounter Every Day

 

After reading Chapter 14 and reviewing the lecture powerpoint (located in lectures tab),  please answer the following questions.  Each question must have at least 3 paragraphs and you must use at 3 least references (APA) included in your post.

1.  What signs might alert you to a potential professional boundary violation or crossing?

2.  Contrast the terms terminal sedation , rational suicide, and physician-assisted suicide.

3. Identify at least 3 moral dilemmas that occur during end-of life care and decision making.

Ethical Issues in Professional Nursing Practice

Chapter 14 Relationships and Professional Ethics

• Nurse–physician relationships

• Nurse–patient–family relationships

– Unavoidable trust

– Boundaries

– Dignity

– Patient advocacy

• Nurse–nurse relationships

The National Council of State Boards of Nursing’s Professional Boundaries in Nursing Video

https://www.ncsbn.org/464.htm

Moral Rights and Autonomy (1 of 2)

• Moral rights are defined as rights to perform certain activities

– Because they conform to accepted standards or  ideas of a community

– Because they will not harm, coerce, restrain, or infringe on the interests of others

– Because there are good rational arguments in support of the value of such activities

Moral Rights and Autonomy (2 of 2)

• Two types of moral rights

– Welfare rights

– Liberty rights

• Informed consent

• Patient Self-Determination Act

• Advance directives

– Living will

– Durable power of attorney Social Justice

• Sicilian priest first used term in 1840; in 1848, popularized by Antonio Rosmini-Serbati

• Center for Economic and Social Justice

definition

• John Rawls’ concept of veil of ignorance

• Robert Nozick’s concepts of entitlement

system

Allocation and Rationing of

Healthcare Resources

• Does every person have a right to health care?

• How should resources be distributed so

everyone receives a fair and equitable share of

health care?

• Should healthcare rationing ever be considered

as an option in the face of scarce healthcare

resources? If so, how?

Organ Transplant Ethical Issues

• Moral acceptability of transplanting an

organ from one person to another

• Procurement of organs

• Allocation of organs

– Justice

– Medical utility

Balanced Caring and Fairness

Approach for Nurses (1 of 2)

• Encourage patients and families to express

their feelings and attitudes about ethical issues

involving end-of-life, organ donation, and

organ transplantation

• Support, listen, and maintain confidentiality

with patients and families

• Assist in monitoring patients for organ needs

Balanced Caring and Fairness

Approach for Nurses (2 of 2)

• Be continually mindful of inequalities and

injustices in the healthcare system and how the

nurse might help balance the care

• Assist in the care of patients undergoing surgery

for organ transplant and donation patients and

their families

• Provide educational programs for particular

target populations at a broader community level

Definitions of Death

• Uniform Determination of Death Act definition of

death: “An individual who has sustained either (1)

irreversible cessation of circulatory and respiratory

functions or (2) irreversible cessation of all functions

of the entire brain, including the brain stem is dead.

A determination of death must be made in

accordance with accepted medical standards.”

• Traditional, whole-brain, higher brain, personhood.

Euthanasia

• Types of euthanasia:

– Active euthanasia

– Passive euthanasia

– Voluntary euthanasia

– Nonvoluntary euthanasia

• Blending of types may occur

• “Is there a moral difference between actively

killing and letting die?”

Rational Suicide

• Self-slaying

• Categorized as voluntary active euthanasia

• Person has made a reasoned choice of rational

suicide, which seems to make sense to others at

the time

– Realistic assessment of life circumstances

– Free from severe emotional distress

– Has motivation that would seem understandable to

most uninvolved people within the community

Palliative Care

• Approach that improves the quality of life of

patients associated with life-threatening illness,

through prevention and relief of suffering

• Do-not-resuscitate order:

– There is no medical benefit that can come from

cardiopulmonary resuscitation (CPR)

– The person has a very poor quality of life before CPR

– The person’s life after CPR is anticipated to be very

poor

Rule of Double Effect

• Use of high doses of pain medication to lessen

the chronic and intractable pain of terminally

ill patients even if doing so hastens death

• Critical aspects of the rule:

– The act must be good or at lease morally neutral

– The agent must intend the good effect not the evil

– The evil effect must not be the means to the good

effect

– There must be a proportionally grave reason to risk

the evil effect

Deciding for Others

• A surrogate, or proxy, is either chosen by

the patient, is court appointed, or has other

authority to make decisions

• Three types of surrogate decision makers:

– Standard of substituted judgment

– Pure autonomy standard

– Best interest standard

Withholding and Withdrawing

Treatment: 3 Cases

• Case 1: Karen Ann Quinlan

• Case 2: Nancy Cruzan

• Case 3: Terri Schiavo

Terminal Sedation

• “When a suffering patient is sedated to

unconsciousness…the patient then dies of

dehydration, starvation, or some other

intervening complication, as all other life-

sustaining interventions are withheld”

• Has been used in situations when patients

need relief of pain to the point of

unconsciousness

Physician-Assisted Suicide

• Act of providing a lethal dose of medication for

the patient to self-administer

• Oregon Nurses Association special guidelines

related to the Death with Dignity Act

– Maintaining support, comfort, and confidentiality

– Discussing end-of-life options with patient and family

– Being present for patient’s self-administration of

medication and death

– Nurses may not administer the medication

– Nurses may not refuse care to the patient or breach

confidentiality

End-of-Life Decisions and Moral

Conflicts with the Nurse

• Communicating truthfully with patients about death due to

fear of destroying all hope

• Managing pain symptoms because of fear of hastening

death

• Feeling forced to collaborate relative to medical treatments

that in the nurses’ opinion are futile or too burdensome

• Feeling insecure and not adequately informed about

reasons for treatment

• Trying to maintain their own moral integrity

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Genital Herpes

Please answer the following DQ’s.

Chapter 55

Isabella, a student nurse, has just started to work in a sexual health clinic part-time where there are a large number of clients who have genital herpes. The clients, both male and female range in age from 16 to 39 years, have varying levels of education and backgrounds.

a.            What features of sexually transmitted diseases would it be important for Isabella to review?

b.            Isabella states, “Why don’t these clients just stop having sex and then their conditions wouldn’t be as bad”? If you were another nurse in the clinic, how would you respond to Isabella’s comment?

 

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Organizational policy

1- What is Policy?

2- Explain each of them:     Public policy— Private policy— Health policy— Social policy— Organizational policy?

3- Who was F lorence Nightingale, and what was her contribution to the Nursing Field?

4- Who was Lillian Wald?

5- Who was Margaret Sanger, and in what way she helped to the developments of Nursing Field?6_ what is    (ICN), and what they do?

7- What is  s (NLCA) and they do?

Jeanne Blum, RN, is a nurse on a  LDRP unit. Recently, the policy and    procedures manual for Jeanne’s unit included the premature rupturing of membranes of a laboring patient    as a practice acceptable for nurses to perform. Jeanne    and some of her coworkers shared their concern over    lunch about this new responsibility.They felt uncomfortable with the possibility of cord prolapse and    other potential medical complications resulting from    this practice. Jeanne gathered data from her state and    many others states and noted that her hospital was    not in compliance with her professional organizationpractice standards. Jeanne shared this information   with her coworkers. She volunteered to contact the    state board of nursing on their behalf to request a    declaratory statement on the nurse’s role in the initiation of premature rupturing of uterine membranes.    Her state board’s clinical practice committee    reviewed her request for a declaratory statement and    gathered information from other states. A formal    declaratory statement was drafted by the board and    made it available on its Web site. A letter from the    board was sent to Jeanne’s institution, informing it of    the declaratory statement, which stated that the task    nurses were requested to perform was beyond their    scope of practice based on the Nurse Practice Act. 8-Which stage of the policy model does this scenario    represent? 

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Advanced Pharmacotherapeutics

Advanced Pharmacotherapeutics. prescribers case studies

Case Studies

Please answer all case studies questions.

Each Case study has two-three Questions each. Answer all questions. Thank you

Attached all the case study in one file of Microsoft word.

1. Answers case No 1-6. Each one has two-three questions.

Strep Throat-Sample.

Assignment-Case Studies three

Woo, Pharmacotherapeutics for APN Prescribers, 4e Student Case Study Answers-24-1

Chapter 24 Drugs Used in Treating Infectious Disease

Answers to Student Case Study

Nick is a 16 year old who presents to the clinic with a sore throat, enlarged cervical lymph nodes,

and a fever of 102°F. His rapid strep test is positive.

1. What is the plan of care for Nick’s strep throat?

Penicillin 500 mg PO bid × 10 days OR

Amoxicillin 1,000 mg PO daily × 10 days

2. What education do Nick and his parents need?

Nick is contagious for 24 hours after antibiotics are started.

He should take the full medication for 10 days to clear infection and prevent rheumatic fever.

Report any symptoms of rash or hypersensitivity.

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Diversity And Health Assessments

Diversity And Health Assessments

May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

· Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.

· By Day 1 of this week, you will be assigned a case study by your Instructor. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.

· Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.

· Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

· Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

ASSIGNMENT 

CASE STUDY: AG is a 54-year-old Caucasian male who was referred to your clinic to establish care after a recent hospitalization after having a seizure related to alcohol withdrawal. He has hypertension and a history of alcohol and cocaine abuse. He is homeless and is currently living at a local homeless shelter. He reports that he is out of his amlodipine 10 mg which he takes for hypertension. He reports he is abstaining from alcohol and cocaine but needs to smoke cigarettes to calm down since he is not drinking anymore .

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

REQUIRED READINGS

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 1, “The History and Interviewing Process” (Previously read in Week 1)

This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients.

Chapter 2, “Cultural Competency”

This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 2, “Evidenced-Based Clinical Practice Guidelines”

Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J. (2014). Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis. Journal of Asthma, 51(7), 703–713. doi:10.3109/02770903.2014.906605

Credit Line: Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis by Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J., in Journal of Asthma, Vol. 51/Issue 7. Copyright 2014 by Taylor & Francis, Inc. Reprinted by permission of Taylor & Francis, Inc. via the Copyright Clearance Center.

The authors of this study discuss the relationship between health literacy and health outcomes in African American patients with asthma.

Centers for Disease Control and Prevention. (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence

This website discusses cultural competence as defined by the Centers for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website.

United States Department of Human & Health Services. Office of Minority Health. (n.d.). A physician’s practical guide to culturally competent care. Retrieved June 10, 2019, from https://cccm.thinkculturalhealth.hhs.gov/

From the Office of Minority Health, this website offers CME and CEU credit and equips healthcare professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.

Espey , D. K., Jim, M. A., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American Journal of Public Health, 104(Suppl 3), S303–S311.

 

Assigned Patient: 

16-year-old white pregnant female living in an inner-city neighborhood.

Consider the following:

 

  • How would your communication and interview techniques for building a health history differ with each patient?
  • How might you target your questions for building a health history based on the patient’s social determinants of health?
  • What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
  • Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
  • Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
  • Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

 WRITE a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

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HEALTHCARE POLICY ANALYSIS PAPER

policy analysis paper Guidelines

Purpose: To investigate & integrate knowledge of advanced nursing practice, scholarly inquiry, & leadership by examining a policy at the level of clinical practice, health care systems, or public/social health policy. Elaborate a paper between 5-8 pages long excluding title page and reference pages. Paper must be organized according to the guidelines below and should include all the identified sections as required.  APA format and contain current scholarly sources dated from 2010 until current. The following may be selected as topics for this paper:

-Food and drug regulation

-Abortion clinic access

-Planned Parenthood funding

-Correctional health

-LGBTQ health

-Tobacco regulation

-Veterans health

-Medicaid

-Medicare

-Prescription drugs

-Managed health care

-Clean Air act

-Clean Water act

-NIH reauthorization

-Head Start

-Healthcare reform

A Sample Paper has been attached  to view an example of how this written assignment should be completed and organized. 

Running head: FOOD AND DRUG REGULATION IN USA 1

FOOD AND DRUG REGULATION IN USA 17

Food and Drug Regulation in the USA

Sample Policy Analysis Paper

University Name

Introduction

Every day across the United States, people purchase foods, groceries, eat out and prepare their families’ meals. It is expected that all food is safe, and the role of the FDA is to ensure food safety. The FDA has the authorization of ensuring the safety of the immeasurable range of foods eaten by the Americans, which is about 80% of all the foods that are sold in the Country. The food includes everything except the processed egg products, poultry, and meat that are controlled by the Department of Agriculture in the US. The FDA was given the mandate of developing an integrated and comprehensive FDA Food Protection Plan (Thomas, 2014). The plan was to make sure that the safety supply of the nation’s food from deliberate and unintended contamination. Inspired by the science and the modern technology, the Food Protection Plan aim is to identify the likely hazards and deal with them before they can harm human health. The center of such a progressive effort is the augmented focus on hazard prevention. The Food Protection Plan was developed to create safety measures that address the risks in the entire life cycle of a product, from the time a product is produced to its distribution and consumption. The plan directs the efforts of FDA on the prevention of problems and then applies interventions that are risk-based to make sure that the preventive approaches used are successful (Thomas, 2014). The plan requires a fast response as soon as there is a detection of contaminated food or products or when people or animals are harmed. The policy is a public/social health policy. The purpose analysis of the Food Protection Plan policy is to establish if the plan is effective in accomplishing preventing the problem of food poisoning. The analysis intends to answer the questions of the effectiveness of the policy in the prevention of food poisoning.

Background

Changing demographics and consumption trends

The changing consumption and demographics have raised the susceptibility of consumers to food poisoning. It was approximated that 20% of the American people were 60 years or more (Halabi, 2015). The older people are usually at a higher risk of foodborne diseases. It thus indicates that due to changing demographics the number of susceptible consumers has increased and the factors of convenience mean that small problems can result in great outbreaks. Consequently, there is a need for changes to ensure a high degree of food protection.

Convenience trends

More Americans are now consumers of convenience foods. Foods that are prepared away from home are likely to be cross contaminated from the other foods and contaminated by the food workers (Halabi, 2015). With more Americans eating ready food, it means that vulnerability to foodborne diseases has increased.

The consumption patterns have changed with a large variety of food is eaten all year round. Besides, foods that are eaten raw or with little processing tend to be linked with foodborne diseases. The consumption of fresh fruits in the US has increased by about 36% since 2000 (Halabi, 2015).

Global food supply

The United States imports from over 150 nations. Based on research, about 15% of all the food distributed in the US is from imports. In other food types like fresh vegetables and fruits, a higher proportion is imported (Halabi, 2015). The imported food increases vulnerability to food poisoning due to the transporting conditions and the production conditions that may not meet the standards required by FDA. Whereas most importing countries have well-developed regulatory mechanisms to promote food safety, others have systems that are not well-developed to make sure the imported food is safe.

New threats

Currently, CDC is aware of over 200 foodborne pathogens. These are such as parasites, viruses, bacteria, toxins and potential contaminant of metal and chemicals. The different agents linked to food borne diseases have steadily increased, and it is likely that the list will continue increasing (Thomas, 2014). The emerging of new foodborne pathogens calls for updating of technology to detect their presence in different foods. Consequently, to address the problem of emerging pathogens, there is a need for partnership between the government, industry and research institutions to establish a solution.

Existing policy

The FDA has been responding fast enough to contain problems of food safety. However, while it has maintained that kind of response, it created the plan that was to enhance its response by developing safety into the products right from the production step to encounter the current problem (Thomas, 2014). In the Food Protection Plan policy, it proposes to partner with the private institutions in building on the activities of the food sector to promote food safety.

Strengths

The policy will be useful in ensuring that the Americans continue benefiting from the safety supplies of food in the world. The food protection office will provide advice and guidelines on local and imported foods (Shames et al., 2015). The FPP will promote corporate responsibility to ensure that food problems do not happen in the first place. The FDA by reviewing the vulnerabilities in the food supply and developing and executing measures to reduce risks, it will be addressing critical weaknesses in food safety (Shames et al., 2015). In the intervention elements, the preventive measures are implemented correctly, ensuring that the existing food safety issues are addressed. The FPP will ensure speed and efficiency by responding to an emergency as soon as it is reported. Whether contamination is deliberate or unintended, fast response is important for the protection of the public.

Shortcomings

Although the plan may be viewed as a constructive development, it needs some amendments. Questions have been released since it was released. For example, the Government Accountability Office has pointed weakness on the specifics of the implementation of the Plan. The Food Protection Plan is not clear in its implementation (Shames et al., 2015). The plan lacks details on its efficient targeting of resources in its implementation, budgetary constraints as well as its implementation timeline. Without enough details on the implementation, it is likely that the plan will not be properly implemented.

Stakeholders

Individuals

All people will be affected by the policy especially those who are highly vulnerable to foodborne pathogens like the young children, older adults, and pregnant women. These groups comprise of about 25% of the U.S population. The Food Protection Plan aims at making food safe for all the people through prevention of the likely hazards (Shames et al., 2015).

Food manufacturers

The FDA regulates over 130 registered local food facilities, which includes manufacturers, food processors, food warehouses, restaurants and institutional food establishments. The FDA also oversees the activities of supermarkets and grocery stores.

Importers

All the food importers are regulated by the FDA law ensuring that food imported meets the FDA guidelines.

Other Government and Nongovernment Institutions

The FDA in the implementation of the Food Protection Plan is partnering with the other institutions like the Agriculture departments, State Health departments, Universities. Also, the FDA has to work together with governments of the importing nations to ensure the imports meet the required safety standards in the USA.

Analysis

Alternative policy

In responding to the events related to foodborne illnesses, the United States Congress passed legislation – the Food Safety Modernization Act. The law was meant to move the FDA focus for improved protection of public health by prevention instead of reacting to outbreaks. The FSMA is a large part of the law that was intended to create new practical central food safety system. FSMA changes the role of the FDA from being reactive to being preventive.

In the selection of the best policy between the Food Protection Plan policy and the FSMA, the effectiveness, goals, impacts of each will be measured.

FSMA evaluation

Effectiveness

FSMA increases the safety requirements for the food industry and vests FDA with more power to enforce the requirements. Its wide scope affects almost all the food industry members such as importers, producers, manufacturers, distributors, and transporters. The law also requires the foreign suppliers to observe with the FSMA requirements, as it raises the authority of the FDA abroad (Humphrey, 2016). It is intended that the FSMA implementation will apply scientific and risk-based principles that consider the expertise of the existing food safety of the industry.

The effectiveness of the FSMA can be witnessed by the shift towards prevention, which is in the last rules, where the policy requires that all the food consumed in the USA observe the Hazard Analysis standards and Critical Control Points (Humphrey, 2016). Effectiveness is also in the requirement to farms to take certain measures in ensuring prevention of food safety hazards. The foreign suppliers are required to confirm that they have met the specified preventive requirements before their products being accepted in the US. The FDA has conducted frequent meetings with the stakeholders to educate them on FSMA and seek feedback (Humphrey, 2016). Such efforts of the FDA through the new law have proved to increase effectiveness in enhancing food safety in the country.

Problem solving

After a decade of diseases outbreaks, market disruptions and problems with imports’ safety that cost billions of dollars on the food system, the FSMA was developed to prevent problems rather than reacting to problems (Humphrey, 2016). In that manner, it is expected that food safety goals will be achieved.

As the FSMA guidance development is continuing, the FDA is still preparing for its implementation. The preparation has been mainly in training, as well as enforcement of issues. In accommodating of the diversity and complexity of the food industry, the FDA has transformed its internal organization to fit the required specialization to effectively implement and enforce the FSMA.

Implications

The new law centers on prevention by the FDA. The FDA was accorded lawmaking authority to ask for complete, science-based preventive regulations in the supplying of food. Under the FSMA, implementation of necessary preventive regulations for food facilities, as well as the compliance with compulsory safety standards for produce will be required (Humphrey, 2016). Moreover, there is a suggested additional regulation that will be establishing least principles for safety in production and the collecting of vegetables and fruits. The rule will also tackle the issue of soil amendments, hygiene, and health of workers.

The food importers will also be required by FSMA to confirm that enough food safety is ensured while importing.

Evaluation of the Food Protection Plan policy

Effectiveness

A policy has to meet the goals that it was intended to meet. The application of scientific findings can have a strong effect on the implementation of policies diverting efforts away from the agenda of the policy (Bardach & Patashnik, 2016). In the Food Protection Plan, the FDA had a goal of improving communication with the stakeholders on the preventive measures in the protection of food supply. The goal has been met since FDA has been undertaking some of the activities to partner with the stakeholders in the implementation of the preventive measures in ensuring food protection. For example, after it was launched in 2007, the FDA held a meeting with 50 states on August 2008 at Missouri. The meeting was attended by more than 200 States, Federal, Tribal, Territorial and local partners to discuss the problems and the opportunities to promote food safety in America.

The Food Protection Plan has met the goal of building-in Food Safety Upfront by identifying and implementing the Best Practices and Standards. The FDA has been partnering with stakeholders and the industry in identifying and ensuring application of best practices to prevent threats to food safety early enough (Halabi, 2015).

The Plan has accomplished another goal of identifying food vulnerability and evaluating the risks. In this, it has increased identification and understanding of food susceptibilities. The FDA has researched in several areas associated with food protection and food safety. The FDA has in meeting this goal and been targeting risk reduction by implementing Risk-Based processes. The FDA has an established Risk-Based Steering Committee that ensures that an organized, comprehensive risk-based measure is taken concerning the protection of food.

Another goal of the plan was to increase the understanding and use of effective mitigation approaches. The goal has been accomplished through expanding the FDA research, development and the assessment of strategies for detection and mitigation.

Problem solving

Policies are designed to solve a problem that is of concern to the nations (Bardach & Patashnik, 2016). Consequently, for a policy to be considered effective, it has to provide a solution to the problem it was intended. One of the problems identified that were to be solved by the policy was the problem of increased vulnerability. The policy has addressed this problem through food protection plan. The policy aimed at focusing inspections and sampling according to the risk. In tackling the problem, FDA has expanded its field capacity for both imported and local foods using risk-based inspection. It has also reduced vulnerability by developing its screening technology at the border which prevents importation of hazardous foods. The plan has ensured increased safety for imported foods through third-party documentation programs. Since imported food increases vulnerability, taking the outlined steps tackles the problem.

Since the consumptions patterns of the people have increased the level of foodborne diseases, there is a need for updated technologies for better and faster testing of foods to understand new hazards and promote food safety. The problem of new and increased foodborne illnesses is solved through improvement of risk-based examination by increased laboratory capability.

Implications

The Food Protection Plan suggests new legislative authorities that strengthen the capacity of the FDA in ensuring food safety. The plan proposes legislations like allowing the FDA ask for control against intended defilement by criminals at high venerability points in the food chain. Legislative is also allowing the FDA to issue more preventive controls for the foods that are considered to be at high risk. The legislative authorities also require the FDA to renew registration after 2 years and authorizing the FDA to change the registration categories.

By the Plan targeting the resources required to ensure optimum reduction of risk through intervention, it centers on the risk-based surveillance (Bacchi & Goodwin, 2016). The plan includes a proposal of legislative authorities for the FDA to accredit the third parties who are highly qualified to inspect food. An accreditation program would ensure that only the safe food is allowed for human consumption. However, the accreditation program would have limitations in that it would take time before an organization is accredited despite it dealing with safe food, it may have to wait for the accreditation.

The plan suggests legislative authorities that strengthen the response ability of the FDA. The first legislative authority is to empower the FDA to require a compulsory recall of the foods when there are no voluntary recalls and when they are not effective. Consequently, the FDA will improve its effectiveness in recalling of food products. With the increase in recalls, it shows how often foods leave the producers or country of origin with a potential of causing health harm. The recalls mean a negative economic impact on the company or country involved (Mason, 2016). The other legislative authority provides the FDA with improved access to foods during emergencies. It thus assists the FDA in improving its response to emergencies. With improved response to emergencies, it means that many lives are saved.

The introduction of the efficient assessment of the greatest risk points along the food chain ensures the strengthening of the ability of the FDA to evaluate, prevent and respond positively to a likely attack along the food chain (Mason, 2016). Consequently, the system can be said to be an insurance that is sought by the company to understand the areas that are prone to risks across the production and manufacturing process and it puts in place ways of improving security and chances of safety threat to the food.

Food protection plan The FSMA
It fails to specify the actions to ensure safety It specifies the validated regulations
Its focus is on control points instead of outcome It is metric-driven with the implications being quantified.
It does not conduct training of the food industry members affected It educates the food industry members affected
It does not focus on a lot of rules to ensure safety but works in partnering with stakeholders like government institutions. It has in place many rules in ensuring safety

Recommendations

Based on the analysis, the best alternative to address the problem of food safety in the US is the FSMA. The FSMA shows a high level of effectiveness as it works with the affected members on ensuring that the regulations can be implemented and the benefits are more than the costs. For example, it offers guidance and assistance to the food industry members for them to know the regulations and they are supported in complying.

Strategies

The central role will be played by the FDA to act as an innovation and action catalyst. The FDA should leverage resources and support from others by partnering to build an integrated world food safety network comprised of federal, states, and foreign governments (United States, 2015). Due to the complexity of the food system in the world, and the demand for high assurance levels that the systems are working, it is important that the FDA include the traditional and the new tools in its implementation of FSMA.

Barriers

The greatest barrier to the implementation of FSMA is a lack of awareness on the new regulation and how they can be applied. Particularly the medium and small sized companies may not be aware of some of the laws that apply to them. The Hazard Analysis and Critical Control Points plan only are not enough to comply with the set rules. Moreover, it is not all companies that have the HACCP (United States, 2015). Another barrier is a lack of resources, as the implementation of FSMA is a major undertaking that requires technical and financial resources.

Evaluation of the implication of the policy

The policy will be evaluated based on the decline in the level of outbreaks. Proper implementation of the policy will enhance food safety which will ensure a decrease in foodborne illnesses. The statistics on foodborne illnesses will be gotten from healthcare and public health ministry. Also, the CDC would provide statistics on the decline on new illnesses as it has been previously.

Discussion

It is established that since the development of the Food Protection Plan, the level of foodborne diseases has continued to increase. That could be an indication of its low effectiveness. Consequently, an alternative FSMA law was established by the Congress addressing the shortcoming of the Food Protection Plan. The analysis of the two policies shows that the FSMA is improved in the sense that it seeks to give more authority to the FDA to play the role of leadership in the implementation of the policy.

The analysis of the Food Protection Plan was limited by the fact that there are limited details concerning the policy, thus limiting secondary data. The analysis is also limited in that there is no field research conducted but the research relies on secondary data, thus limiting the validity of data.

The research is important in determining the outcome of the policies to ensure the right allocation of resources to the most effective one.

Conclusion

The food protection plan was developed to solve the problems associated with foodborne illnesses. The analysis of the policy indicates that the policy meets the goals of the FDA of solving the problem of increased vulnerability to foodborne illnesses. However, the policy has gaps in that it is not specific on the regulations to be applied to ensure food safety. Consequently, an alternative policy that was developed later has shown to be more effective. It is thus important that the FDA would implement the FSMA policy because it has proven effective. FDA should monitor the changing trends in the food industry and make amendments to the policy based on the changes to improve its effectiveness. Awareness on food safety should also be created to improve protection and prevention of food poisoning.

References

Bacchi, C., & Goodwin, S. (2016). Poststructural Policy Analysis: A Guide to Practice. New York Palgrave Macmillan US.

Bardach, E., & Patashnik, E. M. (2016). A practical guide for policy analysis: The eightfold path to more effective problem-solving. Los Angeles: CQ Press/SAGE.

Halabi, S. F. (2015). Food and drug regulation in an era of globalized markets. Amsterdam [u.a.: Elsevier/AP.

Mason, D. J. (2016). Policy & politics in nursing and health care. St. Louis, Missouri: Elsevier, 2016.

Thomas, C. I. P. (2014). In food we trust: The politics of purity in American food regulation. Lincoln: University of Nebraska Press.

Shames, L., United States., & United States. (2015). Federal oversight of food safety: FDA has provided few details on the resources and strategies needed to implement its Food Protection Plan: testimony before the Subcommittee on Oversight and Investigations, Committee on Energy and Commerce, House of Representatives. Washington, D.C.: U.S. Govt. Accountability Office.

Humphrey, J. (2016). Food Safety, Private Standards Schemes and Trade: The Implications of the FDA Food Safety Modernization Act. Ids Working Papers, 2012, 403, 1-65.

United States. (2015). Examining the implementation of the Food Safety Modernization Act: Hearing before the Subcommittee on Health of the Committee on Energy and Commerce, House of Representatives, One Hundred Thirteenth Congress, second session, February 5, 2014.

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A literature review. Risk Management and Healthcare Policy

Berlinger, N., Guidry-Grimes, L., & Hulkower, A. (2017). Knowledge is key for safety-net providers. Health Progress: Journal of the Catholic Health Association of the United States. Retrieved from https://www.chausa.org/publications/health-progress/article/july-august-2017/knowledge-is-key-for-safety-net-providers

Hacker, K., Anies, M., Folb, B., & Zallman, L. (2015). Barriers to health care for undocumented immigrants: A literature review. Risk Management and Healthcare Policy, 8. Available in the Trident Online Library. PLEASE SEE ATTACHMENT REGARDING THIS REFERENCE

The Hastings Center. (2017). Undocumented immigrants and health care access in the United States. Retrieved from http://undocumentedpatients.org/

HHS Office of Minority Health. (2016). National CLAS Standards, health literacy, and communication [Video file]. Retrieved from https://www.youtube.com/watch?v=VkpRx1lHCu8&feature=youtu.be

National CLAS Standards: National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. Retrieved from https://www.thinkculturalhealth.hhs.gov/clas

Shi, L. (2014). Health policy for diverse populations. In Introduction to health policy, pp. 118-149. Chicago: Health Administration Press. Available in the Trident Online Library. PLEASE SEE ATTACHMENT REGARDING THIS REFERENCE

HOMEWORK ASSIGNMENT

The debate over immigration reform continues to be a hot button in American policy and unlikely to be solved in the foreseeable future. Regardless of the current policy and where one stands on dealing with illegal immigration, the reality is that there will be undocumented immigrants that come into the country and as with all human beings, they will get sick or injured and need medical care. There are a host of legal, ethical, financial, and public health considerations for policies focused on care for this vulnerable population, and arguably no easy answers.

Review the background reading for this module and conduct your own research. After you have done so, write a position paper on whether the provision of health care for undocumented immigrants should be provided without consideration of immigration status, addressing each of the issues italicized above. Keep in mind that this paper is not meant to be a debate of immigration policy, but a statement regarding healthcare services.

Be sure cite reliable sources and utilize the reference below for setting up your paper. You must use the outline in the reference below.

Reference: Xavier University Library. (2014). How to write a position paper. Retrieved from http://www.xavier.edu/library/students/documents/position_paper.pdf

SLP Assignment Expectations

  1. Limit your response to no more than 2 pages, single-spaced.
  2. Conduct additional research to gather sufficient information to justify/support your analysis.
  3. Support your paper with a minimum of 3 reliable sources; at least 2 of these should be peer-reviewed articles. Use the following link for additional information on how to recognize peer-reviewed journals: http://www.angelo.edu/services/library/handouts/peerrev.php
  4. Please use the following resource for evaluating information found on the internet: https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content
  5. You may use the following source to assist in your formatting your assignment: https://owl.english.purdue.edu/owl/resource/560/01/.

this work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further

permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php

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open access to scientific and medical research

Open Access Full Text Article

http://dx.doi.org/10.2147/RMHP.S70173

Barriers to health care for undocumented immigrants: a literature review

Karen Hacker1,2

Maria Anies2

Barbara L Folb2,3

Leah Zallman4–6

1Allegheny County Health Department, Pittsburgh, PA, USA; 2Graduate School of Public Health, 3Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA; 4institute for Community Health, Cambridge, MA, USA; 5Cambridge Health Alliance, Cambridge, MA, USA; 6Harvard School of Medicine, Boston, MA, USA

Correspondence: Karen Hacker Allegheny County Health Department, 542 4th Street, Pittsburgh, PA 15219, USA Tel +1 412 578 8008 Fax +1 412 578 8325 email khacker@achd.net

Abstract: With the unprecedented international migration seen in recent years, policies that limit health care access have become prevalent. Barriers to health care for undocumented

immigrants go beyond policy and range from financial limitations, to discrimination and fear

of deportation. This paper is aimed at reviewing the literature on barriers to health care for

undocumented immigrants and identifying strategies that have or could be used to address these

barriers. To address study questions, we conducted a literature review of published articles from

the last 10 years in PubMed using three main concepts: immigrants, undocumented, and access

to health care. The search yielded 341 articles of which 66 met study criteria. With regard to

barriers, we identified barriers in the policy arena focused on issues related to law and policy

including limitations to access and type of health care. These varied widely across countries but

ultimately impacted the type and amount of health care any undocumented immigrant could

receive. Within the health system, barriers included bureaucratic obstacles including paperwork

and registration systems. The alternative care available (safety net) was generally limited and

overwhelmed. Finally, there was evidence of widespread discriminatory practices within the

health care system itself. The individual level focused on the immigrant’s fear of deportation,

stigma, and lack of capital (both social and financial) to obtain services. Recommendations

identified in the papers reviewed included advocating for policy change to increase access

to health care for undocumented immigrants, providing novel insurance options, expanding

safety net services, training providers to better care for immigrant populations, and educating

undocumented immigrants on navigating the system. There are numerous barriers to health care

for undocumented immigrants. These vary by country and frequently change. Despite concerns

that access to health care attracts immigrants, data demonstrates that people generally do not

migrate to obtain health care. Solutions are needed that provide for noncitizens’ health care.

Keywords: undocumented immigrants, health care, access, deportation, immigration and migration

Background Over the last decade, international migration has continued to rise despite the efforts

of many countries to tighten their borders.1 Factors such as conflict, discrimination,

and the lack of employment opportunities in countries of origin contribute to migration

patterns. Today, countries have used a variety of strategies to dissuade immigrants from

crossing their borders ranging from border patrol to identity checks, detention, and

deportation.2,3 With the unprecedented rates of migration, policies that disincentivize

migration have spread to health care. Internationally, many countries, including the US,

European nations, Scandinavia, Canada, and Costa Rica, have promulgated a range of

policies that limit access to health services.4–8 In the US for example, the Affordable

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HEALTH POLICY

H EALTH POL ICY I N T R O D U C T I O N T O

Leiyu Shi

Shi

One North Franklin Street, Suite 1700 Chicago, Illinois 60606-3529 Phone: (301) 362-6905, Fax: (240) 396-5907 ache.org/HAP Order No.: 2238

ealthcare policies continue to evolve and subsequently must be integrated into healthcare system operations. This book introduces readers to health policymaking,

critical health policy issues, health policy research and evaluation methods, and international perspectives on health policy. Leiyu Shi takes a unique perspective by integrating all these topics into this one-of-a-kind book. Real-world cases and examples reinforce the theories and concepts throughout the book and address all healthcare settings, including public health, managed care, ambulatory care, extended care, and hospitals.

Introduction to Health Policy provides an overview of:

✦✦ Health determinants and health policy formulation

✦✦ Major types of health policies, including those affecting special populations, such as racial and ethnic minorities, low-income individuals, senior citizens, women and children, people with HIV/AIDS, people with mental illness, and the homeless

✦✦ Health policy issues related to financing and delivery of healthcare in the United States and abroad

✦✦ The importance of an international perspective from both developed and developing countries

✦✦ Processes and context for federal, state, and local health policymaking

✦✦ Health policy research methods for use in studying and analyzing policy issues

Leiyu Shi, DrPH, is professor of health policy and health services research at the Johns Hopkins University Bloomberg School of Public Health in the Department of Health Policy and Management. He also serves as director of the Johns Hopkins Primary Care Policy Center. He received his doctoral degree from the University of California, Berkeley, majoring in health policy and services research. He has conducted extensive studies on the association between primary care and health outcomes, in particular the role of primary care in mediating the adverse impact of income inequality on health outcomes. Dr. Shi is also well known for his extensive research on vulnerable populations in the United States. He is the author of nine textbooks and more than 150 scientific journal articles.

“Dr. Shi’s book introduces readers to the opportunities and issues of policymaking in both US and international contexts. His knack for illustrating complex theory with

challenging and relevant real-life examples makes this field really come to life.” —Gregory D. Stevens, assistant professor of family medicine and preventive medicine,

Keck School of Medicine, University of Southern California

H

IN T

R O

D U

C T

IO N

T O

H E

A LT

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O L

IC Y

Shi (2238) FM.indd 1 7/9/13 9:03 AM

AUPHA/HAP Editorial Board for Undergraduate Studies

Rosemary Caron, PhD, Chairman University of New Hampshire

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Riaz Ferdaus, PhD Our Lady of the Lake College

Brenda Freshman, PhD California State University

Mary Helen McSweeney-Feld, PhD Towson University

John J. Newhouse, PhD St. Joseph’s University

Rubini Pasupathy, PhD, FACHE Texas Tech University

Jacqueline E. Sharpe Old Dominion University

Daniel J. West Jr., PhD, FACHE University of Scranton

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Health Administration Press, Chicago, Illinois

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Your board, staff, or clients may also benefit from this book’s insight. For more information on quantity dis- counts, contact the Health Administration Press Marketing Manager at (312) 424-9470.

This publication is intended to provide accurate and authoritative information in regard to the subject matter covered. It is sold, or otherwise provided, with the understanding that the publisher is not engaged in render- ing professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

The statements and opinions contained in this book are strictly those of the author(s) and do not represent the official positions of the American College of Healthcare Executives, of the Foundation of the American College of Healthcare Executives, or of the Association of University Programs in Health Administration.

Copyright © 2014 by the Foundation of the American College of Healthcare Executives. Printed in the United States of America. All rights reserved. This book or parts thereof may not be reproduced in any form without written permission of the publisher.

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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 Infor- mation Sciences—Permanence of Paper for Printed Library Materials, ANSI Z39.48-1984. ∞ ™

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00_Shi (2238).indb 4 7/3/13 8:34 AM

I dedicate this book to my wife, Ruoxian,

and my children, Sylvia, Jennifer, and Victor Shi.

00_Shi (2238).indb 5 7/3/13 8:34 AM

00_Shi (2238).indb 6 7/3/13 8:34 AM

v i i

BRIEF CONTENTS

Preface ……………………………………………………………………………………………………xiii

PART I Introduction ……………………………………………………………………………1

Chapter 1 Overview of Health Policy ………………………………………………………..3

PART II Health Policymaking ………………………………………………………………29

Chapter 2 Federal Health Policymaking …………………………………………………..31 Chapter 3 Health Policymaking at the State and

Local Levels and in the Private Sector …………………………………….53 Chapter 4 International Health Policymaking …………………………………………..74

PART III Health Policy Issues ………………………………………………………………..97

Chapter 5 Health Policy Related to Financing and Delivery ………………………..99 Chapter 6 Health Policy for Diverse Populations ……………………………………..118 Chapter 7 International Health Policy Issues …………………………………………..150

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v i i i B r i e f C o n t e n t s

PART IV Health Policy Research ………………………………………………………….183

Chapter 8 Overview of Health Policy Research ……………………………………….185 Chapter 9 Health Policy Research Methods ……………………………………………216 Chapter 10 An Example of Health Policy Research ……………………………………255

by Sarika Rane Parasuraman

Glossary …………………………………………………………………………………………………295

Index ………………………………………………………………………………………………………303

About the Author ………………………………………………………………………………….320

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P r e f a c e i x

DETAILED CONTENTS

i x

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 ……………………………………………………………………………….8 What Are the Determinants of Health? …………………………………………………………9 Policy Defined ………………………………………………………………………………………..15 Health Policy ………………………………………………………………………………………….16 Determinants of Health Policy …………………………………………………………………..18 Stakeholders of Health Policy …………………………………………………………………….21 Why Is It Important to Study Health Policy? ………………………………………………23 Key Points ………………………………………………………………………………………………24 Case Study Questions ………………………………………………………………………………24 For Discussion ………………………………………………………………………………………..24 References ………………………………………………………………………………………………25

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x D e t a i l e d C o n t e n t s

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 ……………………………………………………34 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 Additional Resources ………………………………………………………………………………..51

Chapter 3 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 4 International Health Policymaking ……………………………………………74 Learning Objectives …………………………………………………………………………………74 Case Study: China’s Healthcare Reform ………………………………………………………75 World Health Organization ………………………………………………………………………76 Health Policymaking from Selected Countries ……………………………………………..79 Key Points ………………………………………………………………………………………………90 Case Study Questions ………………………………………………………………………………91 For Discussion ………………………………………………………………………………………..91 References ………………………………………………………………………………………………91 Additional Resources ………………………………………………………………………………..95

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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 References …………………………………………………………………………………………….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 Case Study Assignment …………………………………………………………………………..139 For Discussion ………………………………………………………………………………………140 References …………………………………………………………………………………………….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

PART IV Health Policy Research ………………………………………………………….183

Chapter 8 Overview of Health Policy Research ……………………………………….185 Learning Objectives ……………………………………………………………………………….185 Case Study: The RAND Health Insurance Experiment ………………………………..186

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Defining Health Policy Research ………………………………………………………………187 The Process of Health Policy Research ………………………………………………………193 Communicating Health Policy Research ……………………………………………………205 Implementing Health Policy Research……………………………………………………….207 Key Points …………………………………………………………………………………………….212 Case Study Questions …………………………………………………………………………….212 For Discussion ………………………………………………………………………………………212 References …………………………………………………………………………………………….212

Chapter 9 Health Policy Research Methods …………………………………………….216 Learning Objectives ……………………………………………………………………………….216 Case Study: Health Centers and the Fight Against

Health Disparities in the United States ………………………………………………….217 Quantitative Methods …………………………………………………………………………….218 Qualitative Methods ………………………………………………………………………………234 Key Points …………………………………………………………………………………………….242 Case Study Assignment …………………………………………………………………………..243 For Discussion ………………………………………………………………………………………243 References …………………………………………………………………………………………….243 Additional Resources ………………………………………………………………………………253

Chapter 10 An Example of Health Policy Research …………………………………….255 by Sarika Rane Parasuraman

Learning Objectives ……………………………………………………………………………….255 Questions for Policy Analysis …………………………………………………………………..256 Policy Analysis: Responses to Exam Questions ……………………………………………257 References …………………………………………………………………………………………….284

Glossary …………………………………………………………………………………………………295

Index ………………………………………………………………………………………………………303

About the Author ………………………………………………………………………………….320

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x i i i

PREFACE

For decades, US policymakers have been struggling to find solutions to our healthcare challenges. Thus, healthcare reform is among the top priorities of almost every admin-istration. This introductory textbook on US health policy covers the related areas of health poli-

cymaking, critical health policy issues, health policy research, and an international perspective on health policy and policymaking.

The book offers the following features:

◆ Real-world cases to exemplify the theories and concepts presented from a variety of perspectives, including the hospital setting, public health, managed care, ambula- tory care, and extended care

◆ Learning objectives and key points ◆ Discussion questions ◆ A glossary ◆ Boxes, including Learning Points, For Your Consideration, Key Legislation, and

others, as well as exhibits to present background information on concepts, exam- ples, and up-to-date information

◆ Instructor’s materials, including PowerPoint slides and answers to the discussion questions that appear in each chapter

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x i v P r e f a c e

ORGANIZATION OF THE BOOK This book is organized in four parts: an introduction, an overview of health policymak- ing, a health policy issues section, and a discussion of health policy research and analysis. Chapter 1, the sole chapter in Part I, introduces key terms related to, and the determinants of, health and health policy. It lists the key stakeholders in health policymaking and pres- ents important reasons for studying health policy. The chapter lays the foundation for the rest of the book.

Part II examines the policymaking process at the federal, state, and local levels; in the private sector; and in international settings. Chapter 2 focuses on the policymaking process at the federal level of the US government. Important activities within the three policymaking stages—policy formulation, policy implementation, and policy modifica- tion—are described. The key characteristics of health policymaking in the United States are analyzed, and the role of interest groups in making that policy is discussed.

The focus of Chapter 3 is the US policymaking process at the state and local levels and in the private sector, which includes the research community, foundations, and private industry. Examples of policy-related research by private research institutes and foundations are described. The impact of the private sector’s services and products on health and policy is illustrated using the fast-food industry and cigarette companies as examples.

Chapter 4 discusses international health policymaking. The World Health Orga- nization is presented as an example of an international agency involved in policymaking related to health and major health initiatives. Five countries—Canada, the United King- dom, Sweden, Australia, and China—are highlighted to illustrate diverse policymaking processes in various geographic regions. The experiences of these countries show that dif- ferent political systems and policymaking processes lead to different approaches to popula- tion health and healthcare delivery.

In Part III, we discuss the policy issues related to social, behavioral, and medical care health determinants; to people from diverse populations; and to international health. Chapter 5 describes how US healthcare is financed and delivered. Private and public health insurance programs are summarized, and the subsystems of healthcare delivery—managed care, the military system, care for vulnerable populations, the public health program, the long-term care system, and oral health delivery—are introduced. After summarizing the major characteristics of US healthcare delivery, the chapter provides examples of health policy issues related to financing (regulatory and market approaches) and delivery (health- care workforce, certification and accreditation of healthcare organizations, antitrust regula- tions, access-to-care issues, and patient rights concerns).

Chapter 6 defines vulnerable populations and discusses the dominant healthcare policy issues related to those populations. People from diverse populations include racial or ethnic minorities, those with low income, the elderly, women and children, people with HIV/AIDS, the mentally ill, and the homeless. In each segment, the magnitude of

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P r e f a c e x v

the problem is summarized and a detailed discussion of the policies and strategies meant to address the problem is presented.

In Chapter 7, dominant health policy issues in the international community are discussed, with examples given for select countries. The chapter begins by discussing issues shared by developed countries, such as modifying health systems to better serve aging and diverse populations while maintaining high-quality care at a low cost. It then discusses challenges faced by developing nations, such as creating and maintaining high-functioning health systems with limited resources and dealing with the burdens of morbidity and mor- tality associated with poverty. Several emerging issues are also illustrated that could affect global health in the future.

Part IV presents an overview of policy analysis, focusing on examples of commonly used quantitative and qualitative methods. Chapter 8 introduces health policy research (HPR) and highlights the discipline’s defining characteristics, including applied, policy- relevant, ethical, multidisciplinary, scientific, and population-based studies. The HPR pro- cess is summarized, and the chapter concludes with a discussion of ways to communicate findings and the challenges in implementing those findings in practice.

In Chapter 9, we illustrate commonly used methods in health policy research. Quantitative methods include experimental research, survey research, evaluation research, and cost–benefit and cost-effectiveness analysis. Because evaluation research is closely tied to policy research, the process involved in this type of research is described in greater de- tail. Qualitative methods include participant observations, in-depth interviews, and case studies.

Chapter 10 provides an example that illustrates the key steps in health policy analy- sis: assessing the determinants of a health problem, identifying policy intervention to the problem, critically evaluating the policy intervention, and proposing next steps in address- ing the problem.

ACKNOWLEDGMENTS My PhD advisee Sarika Rane Parasuraman contributed Chapter 10 (an applied example) and is hereby acknowledged. The preparation of this book was also aided by Xiaoyu Nie and Hannah Sintek, who served as my administrative assistants. The editorial staff of Health Administration Press, in particular Joyce Dunne and Janet Davis, have provided hands-on assistance in editing the manuscript to make it more compatible with the audi- ence. Of course, all errors and omissions remain the responsibility of the author.

Leiyu Shi Professor of Health Policy

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1

PA RT I

INTRODuCTION

The introduction, which consists of Chapter 1, provides an overview of health policy. It defines key terms related to health policy, reviews the frameworks of health determinants, and outlines the concept of health policy formulation. In addition, the chapter intro- duces topics related to health policy, including stakeholders, the major types of health policies, and the importance of studying health policy. The introduction should provide readers with a foundation for examining how health policy is set in the United States and elsewhere.

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3

Learning Objectives

Studying this chapter will help you to

➤➤ define➤key➤terms➤related➤to➤health➤policy,➤

➤➤ appreciate➤the➤influence➤of➤health➤determinants,

➤➤ understand➤the➤framework➤of➤health➤policy➤formulation,

➤➤ identify➤the➤stakeholders➤in➤health➤policy,➤

➤➤ describe➤the➤major➤types➤of➤health➤policies,➤and

➤➤ discuss➤the➤importance➤of➤studying➤health➤policy.➤

C H A P T E R 1

OvERvIEw OF HEALTH POLICy

I have never had a policy. I have simply tried to do what seemed best each

day, as each day came.

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Transformational Leadership

Purpose

This week’s graded topic relates to the following Course Outcome (CO).

CO2: Proposes leadership and collaboration strategies for use with consumers and other healthcare providers in managing care and/or delegating responsibilities for health promotion, illness prevention, health restoration and maintenance, and rehabilitative activities. (PO#2)

Discussion

Transformational leaders influence those around them and therefore have the potential to alter the culture of a unit or organization. Please address the following topics:

  • Summarize your general beliefs of what makes a good leader.
  • Regarding the transformational leadership skills discussed in our required article reading, how do you think your leadership style is perceived by others?
  • What aspect of the TEACH values discussed in the lesson do you think would most benefit your work environment if adopted?

References: American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.

American Nursing Association [ANA]. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: American Nurses Publishing.

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