Essentials of Health Policy and Law

1 Essentials of Health Policy and Law Third Edition Joel B. Teitelbaum, JD, LLM. The George Washington University Milken Institute School of Public Health Department of Health Policy and Management Washington, DC. Sara E. Wilensky, JD, PhD. The George Washington University Milken Institute School of Public Health Department of Health Policy and Management Washington, DC. 1 1/30/16 5:59 PM. World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803. 978-443-5000. Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones &. Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to Copyright 2017 by Jones & Bartlett Learning, LLC, an Ascend Learning Company All rights reserved.

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3 There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the activi- ties represented in the images. Any screenshots in this product are for educational and instructive purposes only. Any individuals and scenarios featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only. This publication is designed to provide accurate and authoritative information in regard to the Subject Matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional service. If legal advice or other expert assistance is required, the service of a competent professional person should be sought. 09422-0. Production Credits Composition: Integra Software Services Pvt. Ltd. VP, Executive Publisher: David D. Cella Cover Design: Kristin E. Parker Publisher: Michael Brown Rights & Media Research Specialist: Merideth Tumasz Associate Editor: Lindsey Mawhiney Sousa Media Development Editor: Shannon Sheehan Associate Production Editor: Rebekah Linga Cover and Title Page Image: holbox/Shutterstock Senior Marketing Manager: Sophie Fleck Teague Printing and Binding: Edwards Brothers Malloy Manufacturing and Inventory Control Supervisor: Amy Bacus Cover Printing: Edwards Brothers Malloy Library of Congress Cataloging-in-Publication Data Names: Teitelbaum, Joel Bern, author.

4 | Wilensky, Sara E., author. Title: Essentials of Health Policy and law/Joel B. Teitelbaum and Sara E. Wilensky. Other titles: essential public Health . Description: Third edition. | Burlington, Massachusetts: Jones & Bartlett Learning, [2015] | Series: essential public Health | Includes bibliographical references and index. Identifiers: LCCN 2015040134 | ISBN 9781284087543 (pbk.). Subjects: | MESH: Health Policy legislation & jurisprudence United States. | Health Care Reform United States. | Insurance, Health legislation & jurisprudence United States. | Social Determinants of Health United States. Classification: LCC | NLM WA 33 AA1 | DDC dc23 LC record available at 6048. Printed in the United States of America 20 19 18 17 16 10 9 8 7 6 5 4 3 2 1. 2 1/30/16 5:59 PM. holbox/Shutterstock Contents Prologue vii The essential Public Health Series ix Preface xi Acknowledgments xv About the Authors xvii Contributors xix Part I Setting the Stage: An Overview of Health Policy and Law 1.

5 Chapter 1 Understanding the Role of and Conceptualizing Health Policy and Law 3. Learning Objectives 3. Introduction 3. Role of Policy and Law in Health Care and Public Health 3. Conceptualizing Health Policy and Law 5. Conclusion 7. Chapter 2 Policy and the Policymaking Process 11. Learning Objectives 11. Introduction 11. Defining Policy 11. Public Policymaking Structure and Process 13. The Health Bureaucracy 24. Conclusion 28. 3 1/30/16 5:59 PM. iv Contents Chapter 3 Law and the Legal System 31. Learning Objectives 31. Introduction 31. The Role of Law 32. The Definition and Sources of Law 33. Key Features of the Legal System 36. Conclusion 43. Chapter 4 Overview of the United States Healthcare System 45. Learning Objectives 45. Introduction 45. Healthcare Finance 46. Healthcare Access 49. Healthcare Quality 60. Comparative Health Systems 64. Conclusion 70. Chapter 5 Public Health Institutions and Systems 73. Learning Objectives 73.

6 What Are the Goals and Roles of Governmental Public Health Agencies? 74. What Are the 10 essential Public Health Services? 75. What Are the Roles of Local and State Public Health Agencies? 77. What Are the Roles of Federal Public Health Agencies? 79. What Are the Roles of Global Health Organizations and Agencies? 82. How can Public Health Agencies Work Together? 83. What Other Government Agencies Are Involved in Health Issues? 83. What Roles Do Nongovernmental Organizations Play in Public Health ? 84. How Can Public Health Agencies Partner with Health Care to Improve the Response to Health Problems? 84. How Can Public Health Take the Lead in Mobilizing Community Partnerships to Identify and Solve Health Problems? 85. Part I Addendum. Timeline 90. Part II essential Issues in Health Policy and Law 99. Chapter 6 Individual Rights in Health Care and Public Health 101. Learning Objectives 101. Introduction 101. Background 102. Individual Rights and Health Care: A Global Perspective 104.

7 4 1/30/16 5:59 PM. Contents v Individual Rights and the Healthcare System 105. Individual Rights in a Public Health Context 115. Conclusion 119. Chapter 7 Social Determinants of Health and the Role of Law in Optimizing Health 123. Learning Objectives 123. Introduction 123. Social Determinants of Health 124. Law as a Social Determinant of Health 127. Combating Health -Harming Social Conditions Through Medical-Legal Partnership 131. Conclusion 134. Chapter 8 Understanding Health Insurance 137. Learning Objectives 137. Introduction 137. A Brief History of the Rise of Health Insurance in the United States 138. How Health Insurance Operates 140. Managed Care 146. Conclusion 153. Chapter 9 Health Economics in a Health Policy Context 155. Learning Objectives 155. Introduction 155. Health Economics Defined 156. Economic Basics: Demand 158. Economic Basics: Supply 161. Economic Basics: Markets 163. Conclusion 168. Chapter 10 Health Reform in the United States 169.

8 Learning Objectives 169. Introduction 170. Difficulty Achieving Health Reform in the United States 170. Unsuccessful Attempts to Pass National Health Insurance Reform 173. The Stars Align (Barely): How the Affordable Care Act Became Law 176. Overview of the Patient Protection and Affordable Care Act 180. The Supreme Court's Decision in the Case of National Federation of Independent Business v. Sebelius 192. Key Implementation Issues Going Forward 194. Conclusion 195. 5 1/30/16 5:59 PM. vi Contents Chapter 11 Government Health Insurance Programs: Medicaid, CHIP, and Medicare 199. Learning Objectives 199. Introduction 199. Medicaid 201. State Children's Health Insurance Program 215. Medicare 219. Conclusion 229. Chapter 12 Healthcare Quality Policy and Law 233. Learning Objectives 233. Introduction 233. Quality Control Through Licensure and Accreditation 234. Medical Errors as a Public Health Concern 235. Promoting Healthcare Quality Through the Standard of Care 236.

9 Tort Liability of Hospitals, Insurers, and Managed Care Organizations 239. Federal Preemption of State Liability Laws Under the Employee Retirement Income Security Act 242. Measuring and Incentivizing Healthcare Quality 246. Conclusion 251. Chapter 13 Public Health Preparedness Policy 253. Learning Objectives 253. Introduction 253. Defining Public Health Preparedness 254. Threats to Public Health 255. Public Health Preparedness Policy 263. Public Health Preparedness Federalism 269. Conclusion 270. Part III Basic Skills in Health Policy Analysis 275. Chapter 14 The Art of Structuring and Writing a Health Policy Analysis 277. Learning Objectives 277. Introduction 277. Policy Analysis Overview 277. Structuring a Policy Analysis 279. Conclusion 288. Glossary 291. Index 297. 6 1/30/16 5:59 PM. holbox/Shutterstock Prologue The third edition of Essentials of Health Policy and Law is a textbook that describes and analyzes the transformations taking place across the healthcare delivery and public Health systems in the United States.

10 Building on the core con- tent and engaging style of earlier editions, this edition is heavily influenced by the implementation and interpretation of the Patient Protection and Affordable Care Act (ACA), the most far-reaching effort at national Health reform in generations. Professors Joel Teitelbaum and Sara Wilensky are both experienced in analyzing and communicating about the ACA and many other aspects of Health Policy and law, and this edition benefits from their expertise. Beyond the issue of Health reform, Essentials of Health Policy and Law, Third Edition takes a broad approach to the study of Health Policy and law and provides a coherent framework for grappling with important healthcare, public Health , and bioethical issues in the United States. Health policies and laws have become an inescapable and critical component of our everyday lives. The accessibility, cost, and quality of Health care; the country's preparedness for disasters; the safety of the food, water, and medications we consume; the right to make individual decisions about one's own Health and well-being; and scores of other important issues are at the heart of Health Policy and law.