Health policies are developed and changed in order to improve access to care, control costs and expand quality. Each country will have its own challenges in accomplishing these goals dependent on the diversities of the population, including wealth, sanitation, education, location, and lifestyles.
The Centers for Medicare and Medicaid (CMS) changed the payment methodology for Medicare Advantage plans to a model that provides resources based on the chronic conditions being cared for in the senior population. CMS had the three goals in mind with the creation of the Risk Adjustment Model. This policy change took ten years to implement fully. The difficulties and trials of developing health policies have no easy answers or fixes, but are meant to improve the health of the citizens of the country creating the policies.
Challenges in Policy Development
Level of care provided
In an article by Jamison and Mosley (1991), they write the policy debate in international health has often been polarized around conflicting viewpoints on such issues as preventive versus curative services, selective versus comprehensive primary health care, or integrated versus vertical programs. As we approach the 21st century, it is becoming clear that framing the issues in these terms will not enlighten the policy process, primarily because it limits the options largely to actions that can be carried out directly by ministries of health. Profound social and economic transformations are projected to impact on health in the developing countries in the 1990s and beyond; implications for the epidemiological profiles of these countries will be dramatic. A more comprehensive analytical approach is required to formulate health policies that will not only respond to but actually guide the development process to maximize its health gains, minimize its potential adverse consequences, and deal cost-effectively with the emerging quantitative importance of non-communicable diseases.
They go on to discuss how the social and economic statuses of countries will affect the development of policies. Underdeveloped areas have to consider the prevalence of infectious and parasitic diseases, as well as under-nutrition in the population and high fertility rates. Alternatively, areas emerging into economic middle class have new health challenges to consider. Industrialization and urbanization to areas cause injuries and occupational diseases to become a focus.
Jamison and Mosley also state that any policy development will require three actions to be successful; identifying major disease problems, designing delivery systems, and defining the role of the government. One area of governmental role is in education regarding lifestyles of citizens with regard to habits, such as smoking and education in how to make water potable.
Although these are clear paths to creating health policy and a good starting point, the literature appeared to generalize populations and challenges that need to be dealt...