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Health Policy Journal
One of these prompts will be the basis for your final project. In your journal assignment, discuss which prompt interests you and why. How will you identify key stakeholders and their needs?
· Issue Prompt Two: Immunizations
· Issue Prompt Three: Access and Enrollment Assistance
As you review the prompts, consider that competing interests, needs, and values can make it difficult to implement a policy or recommendation that meets stakeholder needs. Which prompt strikes you as the most challenging in this regard?
Guidelines for Submission: When writing this journal, please include evidence-based sources as well as your own reflections on the topic. Use APA formatting for all references and in-text citations. Your journal should be 3–4 paragraphs in length. Submit assignment as a Word document with double spacing, 12-point Times New Roman font, and one-inch margins.
IHP 610 Final Project Issue Prompt Option #1: Language
The Health Law and Policy Issue: The General Assembly in the State of Albacore is considering a bill that would mandate that at least 30 percent of a hospital’s caregiver workforce speak Spanish. The legislation would impose the 30 percent requirement 18 months after the bill is passed. Hospitals that fail to meet the 30 percent threshold would receive only 50 percent of the Medicaid reimbursement the hospitals would otherwise be eligible to receive. The General Assembly believes this mandate will help improve the quality of care in Albacore and, specifically, provide culturally competent care for patients. The Health Committee of the General Assembly is soliciting input on the proposed bill. You are the head of contracting for Hospital Bass. Your CEO, Ms. Executive, has asked you to review the proposed legislation and take a position on what the hospital should do. Specifically, she would like you to produce a policy memorandum for her review. Before you begin drafting the memorandum, you meet with Mr. Carp, director of human resources for Hospital Bass. Mr. Carp informs you that approximately 15% of your caregiver workforce speaks Spanish. There is a shortage of caregivers who speak Spanish and a shortage of certified medical interpreters in State ABC. In order to recruit more caregivers who speak Spanish, Mr. Carp believes that Hospital Bass would have to pay the caregivers substantially more than current caregivers are being paid. He also thinks you might want to know that some caregivers at Hospital Bass are unionized and some are not. Next, you ask to meet with Mr. Flounder, the director of revenue cycle for Hospital Bass. He declines to meet with you, but leaves you some notes about reimbursement. Hospital Bass’s reimbursement mix is typically one third Medicaid, one third Medicare, and one third commercial. In addition, Hospital Bass’s major competitor is Hospital Grouper. Two percent of Hospital Grouper’s workforce speaks Spanish. After reading Mr. Flounder’s notes, you believe that Hospital Grouper cannot afford to recruit more caregivers who speak Spanish. Lastly, you review Hospital Bass’s annual report. The report gave you more information about Hospital Bass’s service area. The State of Albacore is bordered by two other states: the State of Mackerel and the State of Tilapia. Patients in Hospital Bass’s service area also travel to hospitals in Mackerel and Tilapia. The report noted that hospitals in Mackerel and Tilapia also recruit from the same pool of caregivers as Hospital Bass. You managed to dig up these additional facts, which may help you determine what recommendations to make to Ms. Executive:
Hospital Bass does not survey its patients to determine whether they are satisfied with the care they are receiving and whether the patients believe culturally competent care is being delivered.
Payers in the State of Albacore have resisted paying more for certified medical interpreter services in the past. No payers have commented on the proposed legislation at this time.
The boards of nursing, medicine, and pharmacy in the State of Albacore are presently considering whether to add continuing education requirements for cultural competency to state licensure requirements.
Approximately 40% of the patients who use Hospital Bass’s emergency department on an
annual basis self-report that Spanish is their primary language.
Approximately 15% of the patients who use Hospital Bass’s urgent care department on an annual basis self-report that Spanish is their primary language.
Approximately 5% of the patients who use primary care in Hospital Bass’s service area on an annual basis self-report that Spanish is their primary language.
The Albacore Hospital Association opposes the bill.
IHP 610 Final Project Issue Prompt Option #2: Immunizations
The Health Law and Policy Issue: The State of Evergreen adopted comprehensive immunization legislation 60 years ago. The legislation addresses compulsory immunization requirements for children attending public school and for healthcare workers. The language mandating compulsory immunizations for children makes available two exemptions: one for firmly held religious beliefs and the other for medical safety reasons. The only exemption available for healthcare workers is the exemption for medical safety reasons. The legislation has remained largely intact and without modification since it was passed. Three major counties in the State of Evergreen—Cedar, Fir, and Pine—experienced large whooping cough outbreaks during the past year. Two children and one adult died in the outbreaks. It is unclear whether any of the three had been vaccinated against whooping cough. In the past 10 years, Pine County experienced a measles outbreak and several particularly bad flu seasons. Cedar County and Fir County experienced occasional measles outbreaks. In response to the outbreaks, the Evergreen Legislature is considering legislation to remove the exemption for firmly held religious beliefs. If the legislation passes, public schools will continue to be responsible for enforcing the immunization requirements. The Tourism Bureau in Evergreen looked at statistics for the last 10 years and concluded that tourism to the state was negatively impacted by the outbreaks. As a result, the business community largely supports the proposed legislation. Elected representatives from Cedar County and Fir County oppose the bill. Several large congregations in those counties oppose vaccinations on religious grounds. Representatives from Cedar and Fir Counties have sponsored a bill to add a third exemption to the existing immunization legislation. That provision would allow parents to exempt their children from vaccination if they have a “personal objection” to the vaccine or vaccines. School nurses in all three counties are concerned about public backlash if the religious exemption is removed from the law. School administrators are worried that they will not have the funds and staff power to enforce the more restrictive immunization requirements. Funding is lean as it is. The state association of school administrators has argued in the past that it is difficult to enforce the immunization requirements. It is hard to ban a child from school if he or she is not sick. The primary care association in Evergreen was asked to provide comment on the proposed legislation. While the association refused to comment on the legislation, the association offered the following statements for consideration:
It is expensive to purchase and maintain a supply of vaccines in a primary care office.
Many primary care offices (including pediatric practices) are choosing not to administer vaccinations.
The practices send their patients to public health departments for vaccinations.
Public health departments do not know when a patient has been referred for vaccinations. There is no regional health information exchange or shared electronic medical record system.
Public health departments in Evergreen cannot bill commercial insurance plans for administration of vaccines.
You are a policy aide employed by the State of Evergreen. Your supervisor—the governor’s special advisor on health—has asked you to review the proposed legislation, consider all relevant perspectives and facts, and draft a policy memorandum. Specifically, your memorandum must make a recommendation regarding whether the governor should support the legislation, oppose the legislation (and veto it if passed), or take some other action. Be sure your policy memorandum addresses both pieces of legislation discussed above.
