Elisa Catania

HAN300-06

Chapter 13 Assignment

18 November 2025

1.​ Definitions

Allocative Tools Direct provision of income, services, or goods to certain groups of

individuals or institutions; may be either distributive or redistributive.

Distributive Policies Policies which spread benefit throughout society.

Health Policy Aggregate of principles, stated or unstated, that characterize the

distribution of resources, services, and political influences that impact

on the health of the population

Public Policy Authoritative decisions made in the legislative, executive, or judicial

branch of government intended to direct or influence the actions,

behaviors, or decisions of others.

Redistributive Policies designed to benefit only certain groups of people by taking

Policies money from one group and using it for the benefit of another, often

creating visible beneficiaries and payers.

Regulatory Tools Policies which call on the government to prescribe and control the

behavior of a particular target group by monitoring the group and

imposing sanctions if it fails to comply.

2.​ Health policies can be formally defined as “the aggregate of principles, stated or

unstated, that characterize the distribution of resources, services, and political

influences that impact on the health of the population” (Shi, 2019). Health

policies can be used as both a regulatory as well as an allocative tool. When

health policies are used as a regulatory tool, they call on the government to

prescribe and control the behavior of a particular target group by monitoring the

group and imposing sanctions if it fails to comply. One example of this showing

up in the U.S. healthcare system is within federally funded quality improvement

organizations (QIOs; formerly called peer review organizations), which develop

and enforce standards concerning appropriate care under the Medicare program. It

can additionally be used as an allocative tool when it comes to direct provision of

income, services, or goods to certain groups of individuals or institutions, which

may be either distributive or redistributive. An example of a distributive allocative

policy would be a policy that spreads benefits throughout society, such as funding

of medical research through the National Institutes of Health (NIH).

Redistributive policies are designed to benefit only certain groups of people by

taking money from one group and using it for the benefit of another. This system

often creates visible beneficiaries and payers, and is believed to be essential for

addressing the fundamental causes of health disparities.

 3.​ Principal features of U.S. health policy include the government’s subsidiary

position relative to the private sector; fragmented, incremental, and piecemeal

reform; pluralistic politics associated with demanders and suppliers of policy; a

decentralized role for the states; and the impact of presidential leadership. These

features often act or interact to influence the development and evolution of health

policies. Unlike many other developed countries in the U.S., health care isn’t

characterized as a right of citizenship or a primary responsibility of the

government. Often, this system creates barriers to healthcare access for many

individuals.

Healthcare Interest Groups Concerns Examples

Federal / state government • Cost containment Medicare’s Prescription Drug Improvement and
• Access to care Modernization Act (2003)
• Quality of care

Employers • Cost containment Employers must comply with federal and state
• Workplace health/safety regulations focusing on employee health and
• Minimum regulation well-being and on the prevention of job-related
illnesses and injuries. Employers are often
inspected by regulatory agencies to ensure that they
adhere to workplace health and safety policies.

Consumers • Access to care Tea Party movement / conservative vs liberal

• Quality of care Americans in ACA debates
• Lower out-of-pocket costs

Insurers • Administrative Public (Medicare / medicaid) Private (Aetna,

simplification Cigna, etc).
• Elimination of cost shifting

Practitioners • Income maintenance Physicians in the American Medical Association

• Professional autonomy (AMA)
• Malpractice reform practicing defensive medicine to avoid malpractice
lawsuits

Provider organizations • Profitability Hospitals belonging to the American Hospital

 • Administrative Association (AHA)
simplification
• Bad debt reduction

Technology producers • Tax treatment Utilization of medical technology provides

• Regulatory environment economic benefits by creating jobs in health care
• Research funding and other sectors of the economy.
Desire to develop cost-saving technology and
expand access to it.

5. While the Clinton plan had been presented in full to the public in 1993, details of the

ACA legislation were largely kept secret from the public. The Clinton plan ultimately

failed, but the Obama health reform, the ACA, succeeded due to several factors. Instead

of employing different reform strategies, members of the House of Representatives

introduced a single health reform bill that combined three bills from three House

committees, demonstrating greater agreement among Democrats. The final legislation

also allowed certain exemptions from individual and employer mandates. Another factor

was Obama’s ability and willingness to compromise with opposing groups, instead of

waging a war against industries disagreeing with his policies. An example of this is when

Obama promised growth in the congressional Democrat’s markets— millions of newly

insured people who would use health care— received pledges from important industry

stakeholders, including PhRMA and the AHA, to support healthcare reform. Another key

factor behind the ACA’s success was the speed with which the reform was pushed

through the legislative process.

6. The formation and implementation of health policy occurs in a five component policy

cycle: (1) raise the issue, (2) design a policy, (3) build public support, (4) legislative

decision-making and policy support building, and (5) legislative decision-making and
policy implementation. This process relates to the principle features of U.S. health policy,

such as: including the government’s subsidiary position relative to the private sector;

fragmented, incremental, and piecemeal reform; pluralistic politics associated with

demanders and suppliers of policy; a decentralized role for the states; and the impact of

presidential leadership. This is because these features often act or interact to influence the

development and evolution of health policies.

7. Access to care, cost of care, and quality of care have been the three key focus points of

past health policy initiatives. Some Americans believe that they have the right (access) to

the best care (quality) at the least expensive (cost) regardless of level of income or social

class. The underlying support for government policies to enhance access to care is the

social justice principle that access to health care is a right that should be guaranteed to all

American citizens. It can be argued that cost of care is the most significant of the three

policy issues because no other aspect of healthcare policy has received more attention

during the past 40 years than efforts to contain healthcare costs. Cost regulation of

prescription drugs is a key example. prescription drug spending has been rising rapidly

over the past few years, significantly driving up overall healthcare costs. Along with

access and cost, quality of care is the third main concern of healthcare policy. A report

published in March 2001 by the IOM identified six areas for quality improvement in

healthcare, including safety, effectiveness, patient-centeredness, timeliness, efficiency,

and equity.
8. During the COVID-19 pandemic, Trump’s role was largely to delegate responsibility

for dealing with the pandemic to the states. He “did” this by withdrawing the United

States from the World Health Organization (WHO), and his stances on certain hygiene

and distancing guidelines were in conflict with official guidance laid out by the Centers

for Disease Control and Prevention (CDC). There are several things the U.S. healthcare

policymakers could have done to handle the pandemic more effectively. Better

government direction and support would help increase the clarity and coordination

among the sectors involved. A reevaluation of the healthcare structure could also induce

the system-level changes needed to tackle problems more effectively. Currently, a good

systems approach to dealing with population health is sorely lacking. From the national

level to the individual level, and from homes to workplaces to neighborhoods,

recognizing how these units are interconnected and influence one another allows for the

creation of strategies that can better target the structures and policies that impact specific

issues (Diez Roux, 2020). It’s also worth noting that in the wake of the global COVID-19

pandemic, nations around the world have been reevaluating their health priorities and

healthcare infrastructures. Many of these countries offer important takeaways that the

United States can apply to improve its own health system.

9. If I had the power to change any U.S. healthcare system policy, I would significantly

lower costs for healthcare, including lower monthly costs, expanding medication

coverage, lower copays, and low or even free emergency care costs. This would largely

benefit middle / working class Americans. However, lowering costs too much may

compromise or harm hospitals and health institutions, healthcare workers, and medical
research and technology. My ultimate goal would be to find a better balance between

granting better access to healthcare for American people while still adequately paying

employees and funding research and technology. Since implementing policy requires

compromise, I would urge this balancing goal strongly to convince the public and

lawmakers to both see a benefit to this.