Health Policy
Health Policy
Know the policy process: agenda setting, formulation, adoption, implementation, and evaluation. Understand the major public payers and programs-Medicare (Part A hospital, Part B outpatient, Part C Medicare Advantage, Part D drugs), Medicaid (federal-state, eligibility, waivers), and the role of the ACA in coverage expansion, essential health benefits, and insurance marketplaces. Grasp the difference between coverage, access, and outcomes as policy targets.
Policy tools to recognize: regulation, payment incentives, mandates, subsidies, and public reporting. Understand concepts like adverse selection, moral hazard, cost-shifting, and the iron triangle of access, cost, and quality.
Traps: conflating Medicare and Medicaid eligibility; treating a policy's intent as its measured effect; assuming a mandate guarantees access; forgetting that waivers create state variation. Questions may ask which lever best addresses a problem-match the lever to the mechanism (payment to behavior, regulation to prohibition, subsidy to affordability).
Worked example: A state wants to expand coverage for low-income adults. Rule of thumb-Medicaid expansion or a Section 1115 waiver is the tool; Medicare is not income-tested, so it is the wrong answer. Identify the population first, then the program, then the mechanism.
Track evaluation: compare intended versus observed outcomes and watch for unintended consequences and equity effects across groups.