What does policy do? 

What does management do?

Policy guides the direction of health improvement efforts and the allocation of resources of pulic heatlh and health care services.

Management guides the organizational context within which these services are delivered.

1. Battling epidemics (prior to 1850)

2. Building state and local infrastucture (1850 - 1949)

3. Filling gaps in medical care delivery (1950 - 2000)

4. Preparing for and responding to community health threats (2001 - today)

Created by the federal government; it later because the US Public Health Services; it was the compulsary insurance system for merchant seamen.

At the federal level, in 1870, the MHS because the Bureau of Marine Hospital Services, which led to the Public Health Service Commissioned Corps.

In 1887, the MHS started a lab to research microbes causing infectious diseases. This evolved into the National Institutes of Health.

Part A: Hospital insurance (financed through payroll taxes)

Part B: Outpatient services, such as physician care (supplemental, financed through premiums and general tax revenue)

Part C: Medicare Advantage (plans are financed by payments from Medicare, and may require an additional premium); formerly known as Medicare + Choice; the goals are to maxiize plan choices - especially in rural areas, offer better benefits for lower costs, and introduce competition into Medicare managed care plans.

Part D: Prescription Drug (premiums are subsidized for low-income beneficiaries)

Gives the federal government authority to use tax revenue to provide public helath services. 

The federal government's role in public health expanded rapidly with passage of the 16th amendment, allowing the federal government to levy an income tax.

1/2 is from state government;

1/3 is from federal government; 

the remainder is from sources such as licensing fees

1. Agenda setting

2. Policy formation

3. Policy adoption

4. Implementation

5. Administartion

6. Consequences

7. Evaluation

1. Environmental Scan

2. Strategy Formulation

3. Strategy Implementation

4. Evaluation

1. Physiological needs (food, water, etc)

2. Safety needs (shelter, employement, healthcare, etc)

3. Belonging needs (social contact, frineds, etc)

4. Esteem needs (status, recognition, etc)

5. Self-actualization needs (desire for achievement, personal growth, and autonomy)

Referred to as satisfcation progression.

Two separate factors lead to job satisfcation:

1. Motivators, such as level of challenge, job responsibility, job growth, etc, lead to satisfaction 

2. Hygiene factors, such as salary, job security, company policies, etc, lead to dissatisfaction 

Modifying hygiene factors can reduce dissastisfaction, but it will not motivate the employee or lead to higher job satisfaction.

Needs are learned and developed as a result of one's life experiences. This theory has 3 types of needs:

1. Need for achievement

2. Need for affiliation

3. Need for power

Rewards are used to reinforce the behavior you want and punishments are used to prevent the behavior you do not want. Extinction is a means to stop someone from performing a learned behavior.

The technical term for these processes is called operant conditioning. Also called "Behaviorism."

It does not take into consideration that people are critical thinkers.

Theory X assumes that employees naturally dislike work and must be compelled to perform.

Theory Y assumes that employees are naturally motivated and committed, and that managers can help them achieve their full potential by giving them challenging and interesting work.

When an explanation is given to someone's behavior.

For example: A manager says that someone is unmotivated, when really it is that there is an inefficient work flow process, and that is what is slowing this employee down.

When you start each item in your budget at zero and justify/analyze the need for each cost.

This is apprpriate for new organizations or when circumstances have changed dramatically. They are projections.

Prospective Reimbursement: Payment is predetermined, fixed amount. The payment amount for a particular service is based on a classification system of that service (ie, diagnosis-related groups for inpatient hospital services)

At a national level, emergency preparedness is coordinated through DHS (Department of Homeland Security). 

But, the public health response to emergencies is the responsibility of DHHS. DHS and DHHS work together to coordinate things. The DHHS agencies involved in emergency preparedness include the CDC, HRSA (Health Resources and Services Administration), FDA, and the NIH. 

Budgeting begins with prior period infomration, which is then adjusted, based on assumptions for the future. This works well when the financial environment has not changed significantly.

The major deficiency of traditional incremental budgeting is that it does not necessarily reflect program-based allocation of resources or organizational priorities among programs.

Total Discharge Days divided by Total Discharges = Average length of stay in days

OR

Total Inpatient Days of Care divided by Total Admissions = Average length of stay in days

An award established by the U.S. Congress in 1987 to raise awareness of quality management and recognize U.S. companies that have implemented successful quality management systems.

Awards can be given annually in six categories: manufacturing, service, small business, education, healthcare and nonprofit. 

They are judged on the 7 Baldridge Criteria for Performance Excellence, including leadership, strategy, customers, measurement/analysis, workforce, operations, and results.

The Belmont Report summarizes ethical principles and guidelines for research involving human subjects. Three core principles are identified: respect for persons, beneficence, and justice.

Beneficence is an ethical principle stating that you should do no harm and you should protect people from harm by maximizing possible benefits and minimizing possible risks of harm.

An ethical principle discussed in the Belmont Report.

It states that you should do no harm and you should protect people from harm by maximizing possible benefits and minimizing possible risks of harm.

Capitation is the cost per person.

Capitation Rate is a method of payment to someone who provides medical services, and is based on how many people that provider contracts to treat.

Conssits of 81 measures across 5 domains of care. It was developed by the NCQA (National Committee for Quality Assurance). 

It allows you to compare health plans as "apples to apples."

Employers use HEDIS data to help them select the best health plan. 

The QIO Program, one of the largest federal programs dedicated to improving health quality for Medicare beneficiaries, is an integral part of the U.S. Department of Health and Human (HHS) Services' National Quality Strategy for providing better care and better health at lower cost. There is one for each US state and territory.  

By law, the mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. 

The goal is for patients to get the right care at the right time -- and especially patients who are traditionally underserved.

Uses conventional reward and punishment to gaine compliance from employees or consitutents.

Two types of transactional leadership are contingent reward and management by exception.

Medicaid Waiver programs provide states flexibility in operating Medicaid programs. 

Does Medicare cover long-term care? Does Medicare cover nursing homes?

Medicare does not cover long-term care.

Medicare has very stringent requirements around nursing home care and does not cover most of it. It does cover "skilled nursing" after an illness.

Medicaid is the major public payer for long-term care.

From a systems perspective, boundary management refers to the processes that the organization uses to attempt to control its interactions with relevant actors and forces within its environment. Among other activities, boundary management includes buffering, monitoring, communicating, and adapting to environmental stimuli. 

An example is scheduling the Director of the county health department to be interviewed by a journalist about a recent outbreak of food-borne illness