A model of factors determining levels of public support for health care policy in the United States

Public preferences for policy are formed in a little-understood process that is not adequately described by traditional economic theory of choice. In this paper I suggest that U.S. aggregate support for health reform can be modeled as tradeoffs among a small number of behavioral values and the stage of policy development. The theory underlying the model is based on Samuelson, et al.'s (1986) work and Wilke's (1991) elaboration of it as the Greed/Efficiency/Fairness (GEF) hypothesis of motivation in the management of resource dilemmas, and behavioral economics informed by Kahneman and Thaler's prospect theory. ^ The model developed in this paper employs ordered probit econometric techniques applied to data derived from U.S. polls taken from 1990 to mid-2003 that measured support for health reform proposals. Outcome data are four-tiered Likert counts; independent variables are dummies representing the presence or absence of operationalizations of each behavioral variable, along with an integer representing policy process stage. Marginal effects of each independent variable predict how support levels change on triggering that variable. Model estimation results indicate a vanishingly small likelihood that all coefficients are zero and all variables have signs expected from model theory. ^ Three hypotheses were tested: support will drain from health reform policy as it becomes increasingly well-articulated and approaches enactment; reforms appealing to fairness through universal health coverage will enjoy a higher degree of support than those targeted more narrowly; health reforms calling for government operation of the health finance system will achieve lower support than those that do not. Model results support the first and last hypotheses. Contrary to expectations, universal health care proposals did not provide incremental support beyond those targeted to “deserving” populations—children, elderly, working families. In addition, loss of autonomy (e.g. restrictions on choice of care giver) is found to be the “third rail” of health reform with significantly-reduced support. When applied to a hypothetical health reform in which an employer-mandated Medical Savings Account policy is the centerpiece, the model predicts support that may be insufficient to enactment. These results indicate that the method developed in the paper may prove valuable to health policy designers. ^

Policy implications of public health workforce development for disaster preparedness in the United States

Public health efforts were initiated in the United States with legislative actions for enhancing food safety and ensuring pure drinking water. Some additional policy initiatives during the early 20th century helped organize and coordinate relief efforts for victims of natural disasters. By 1950's the federal government expanded its role for providing better health and safety to the communities, and its disaster relief activities became more structured. A rise in terrorism related incidents during the late 1990's prompted new proactive policy directions. The traditional policy and program efforts for rescue, recovery, and relief measures changed focus to include disaster preparedness and countermeasures against terrorism.^ The study took a holistic approach by analyzing all major disaster related policies and programs, in regard to their structure, process, and outcome. Study determined that United States has a strong disaster preparedness agenda and appropriate programs are in place with adequate policy support, and the country is prepared to meet all possible security challenges that may arise in the future. The man-made disaster of September 11th gave a major thrust to improve security and enhance preparedness of the country. These new efforts required large additional funding from the federal government. Most existing preparedness programs at the local and national levels are run with federal funds which is insufficient in some cases. This discrepancy arises from the fact that federal funding for disaster preparedness programs at present are not allocated by the level of risks to individual states or according to the risks that can be assigned to critical infrastructures across the country. However, the increased role of the federal government in public health affairs of the states is unusual, and opposed to the spirit of our constitution where sovereignty is equally divided between the federal government and the states. There is also shortage of manpower in public health to engage in disaster preparedness activities, despite some remarkable progress following the September 11th disaster.^ Study found that there was a significant improvement in knowledge and limited number of studies showed improvement of skills, increase in confidence and improvement in message-mapping. Among healthcare and allied healthcare professionals, short-term training on disaster preparedness increased knowledge and improved personal protective equipment use with some limited improvement in confidence and skills. However, due to the heterogeneity of these studies, the results and interpretation of this systematic review may be interpreted with caution.^

The effects of health changes on projections of health service needs for the elderly population of the United States

The 1982–1994 National Long-Term Care Surveys indicate an accelerating decline in disability among the U.S. elderly population, suggesting that a 1.5% annual decline in chronic disability for elderly persons is achievable. Furthermore, many risk factors for chronic diseases show improvements, many linked to education, from 1910 to the present. Projections indicate the proportion of persons aged 85–89 with less than 8 years of education will decline from 65% in 1980 to 15% in 2015. Health and socioeconomic status trends are not directly represented in Medicare Trust Fund and Social Security Administration beneficiary projections. Thus, they may have different economic implications from projections directly accounting for health trends. A 1.5% annual disability decline keeps the support ratio (ratio of economically active persons aged 20–64 to the number of chronically disabled persons aged 65+) above its 1994 value, 22:1, when the Hospital Insurance Trust Fund was in fiscal balance, to 2070. With no changes in disability, projections indicate a support ratio in 2070 of 8:1—63% below a cash flow balance.

Oversight on rural health care [microform] : hearings before the Subcommittee on Rural Development of the Committee on Agriculture, Nutrition, and Forestry, United States Senate, Ninety-sixth Congress, first session ....

Reuse of record except for individual research requires license from Congressional Information Service, Inc.

Occupational health hazards of older workers in New Mexico [microform] : hearing before the Special Committee on Aging, United States Senate, Ninety-sixth Congress, first session, Grants, N. Mex., August 30, 1980.

Reuse of record except for individual research requires license from Congressional Information Service, Inc.

National emission standards study : report : appendix : a report to the Congress of the United States by the Secretary of Health, Education, and Welfare, in compliance with Public Law 90-148 : Clean Air Act, as amended.

Includes bibliographies.

Full official history of the war with Spain ; written over the wires in the discharge of public duty by the highest authorities of the government, heads of departments and bureaus ... the adjutant general, the commanders of fleets and armies in active service, and the President of the United States /

Mode of access: Internet.

Life of General Lewis Cass: comprising an account of his military service in the North-west during the war with Great Britain, his diplomatic career and civil history. To which is appended, a sketch of the public and private history of Major-General W. O. Butler, of the volunteer service of the United States.

The sketch of Butler is expanded from The life and service of Gen. William O. Butler, by F. P. Blair, jr.

Survey of enterprises in the liberal, labor and radical movements in the United States, prepared for the American Fund for Public Service, Inc.,

Mode of access: Internet.

Transcript of record. Supreme court of the United States. October term, 1908. No. 396. William R. Willcox et al., constituting the Public service commission of the state of New York for the first district, appellants, vs. Consolidated gas company of New York. no. 397. The city of New York, appellant, vs. Consolidated gas company of New York. No. 398. William S. Jackson, as attorney general of the state of New York, appellant, vs. Consolidated gas company of New York. Appeals from the Circuit court of the United States for the Southern district of New York. Filed May 16, 1908. (21,176, 21,177, 21,178)

Proceedings in the Circuit court in the cause of the Consolidated Gas Company "against William S. Jackson, as attorney general, et al.," originally instituted against "Julius M. Mayer, as attorney general, et al."

Federal forest management : hearings before the Subcommittee on Forests and Public Land Management of the Committee on Energy and Natural Resources, United States Senate, One Hundred Fourth Congress, first session, on the Forest Service reinvention and national forest planning regulations.

"July 30, 1996"--Pt. 4.

Department of Energy's facilities for defense materials production : hearing before the Subcommittee on Energy Research and Development of the Committee on Energy and Natural Resources, United States Senate, One Hundredth Congress, first session, on the public health and safety and environmental aspects of operation ... July 17, 1987.

Pt. 2 has subtitle: Hearings before the Committee on Energy and Natural Resources, United States Senate, One Hundredth Congress, first session, on the status of the Department of Energy's effects to address issues concerning the defense materials production reactors ... October 27 and 29, 1987.