US Health Policy: Program Evaluation Essay Sample

Part 1

The Phoenix VA Health Care System operates under the U.S Department of Veterans Affairs to extend health services to veterans in central Arizona. The organization’s Cancer Program, which is delivered via its subsidiary Carl T Hayden VA Medical Center, is intended to decrease the morbidity and mortality of veteran cancer patients. Under this program, patient education is promoted to prevent the occurrence of this deadly disease, and early and accurate diagnosis is facilitated through evaluation. The Cancer Program delivers standard oncology treatment if the patient wishes so. In addition, patients are timely and appropriately referred to a comprehensive facility of supportive services such as hospice and palliative care. Life-long surveillance for recurrence is another prime feature of the Cancer Program. As described the US Department of Veterans Affairs Cancer Program (2012), it provides a full spectrum of therapeutic clinical services either directly or through referral. This program has a Cancer Committee that consists of physician representatives and clinical representatives from various departments. The Tumor Board is another core competency of the Cancer Program, and it works to review the case data and to provide recommendations in an effort to improve the patient outcomes. In addition, quality improvement studies are conducted in relation to the Cancer Program to improve the care quality and thereby to deliver better case outcomes (Cancer Program, 2012). While analyzing the effectiveness of the Cancer Program with regard to the premise of ‘your tax dollars well spent’, it seems that US taxpayers’ money is thoughtfully utilized to improve the health of veterans who sacrificed their youth to serve the nation. The 2010 cancer screening rate of Phoenix VA Health Care System was much greater than that of commercial, Medicaid, and Medicare facilities (Cancer Program, 2012). Hence, investing further in the Cancer Program is advisable.

Part 2

The mounting health care cost has been an ever challenging issue for the United States despite a series of health care reforms implemented over the last decades. Although the US Federal government has taken many initiatives towards the goal of extending the health coverage to all, a number of public health services are still unaffordable to US people. The Cancer Program is a health initiative of the Phoenix VA Health Care System designed with intent to prevent the occurrence of cancer and to deliver improved cancer treatments to US veterans. The Cancer Program offers a full range of therapeutic clinical services to the beneficiaries. In addition, this health initiative is supported by the Cancer Committee and the Tumor Board. Similarly, the US passed a controversial Medicare policy called Medicare Prescription Drug, Improvement, and Modernization Act or MMA in 2003. The major goal of this policy change was to make prescription drugs affordable to senior citizens (National Health Statistic Group, 2005). In addition to the entitlement benefit for prescription drugs, this new legislation includes provisions for private prescription coverage for retired workers; additional funding for rural hospitals, and a pretax health savings accounting for working people. The Republican Party and private health providers strongly supported this legislative change. The opponents of this new legislation argue that MMA is unfair in terms of unreasonable private health payments and would impose huge financial burden on the Federal government. The accessibility to electronically stored data might have influenced the decision-making process.

Part 3

The rising health care costs forced the U.S Congress to pass the controversial Medicare Prescription Drug, Improvement, and Modernization Act or MMA in 2003. The importance of prescription drugs in patient care had been increasing since the establishment of Medicare in 1965. With the introduction of new and expensive drugs, Medicare became unaffordable to patients, specifically senior citizens who were the ultimate beneficiaries of this facility. Hence, the US regulators thought that an extensive restructuring of the Medicare was necessary to make this service affordable to the target population.
As Oliver, Lee, and Lipton (2004) state, the federal entitlement benefit introduced for prescription drugs through concessional tax rates and subsidies is a major provision of the MMA. In order to encourage large employers to offer retired workers private prescription coverage, those employers are given a subsidy under MMA. Another major provision of this new legislation is that it discourages the US government from negotiating with drug companies for discounts. According to the new policy, the federal government is not allowed to establish a formulary. In addition, this legislative reform includes provision for providing rural hospitals with an extra $25 billion. A notable feature of the MMA is that it requires wealthier clients to pay higher fees. The working people are provided with the benefit of a pretax health savings account.
When it comes to the accomplishment of desired goals, it is clear that MMA failed to achieve all the desired objectives. However, one thing is certain that prescription drug benefits were appealing to majority of the Medicare beneficiaries who had found it harder to afford new and expensive prescription drugs. The Graham Center Report (n.d.) found that the new legislation failed to achieve some key goals such as training of more residents in primary care and rural areas because of the inadequacy of monitoring and enforcement tools.
While evaluating the history of the MMA, it is clear that health providers and political parties played a significant role in setting the agenda for this policy change. As discussed already, this Medicare reform included provisions for financing private health plans largely so as to improve patient care outcomes. Hence, private insurers and other private health providers strongly supported this policy change with intent to reap the additional financial benefits. In addition, the Republican Party, led by the then President George W Bush, perceived the MMA as its prestigious policy initiative, and therefore, Republicans took every possible effort to pass the bill. To illustrate, the House ownership unusually held the vote open for hours in order to get the bill passed.
The MMA implemented in 2003 was controversial for a number of reasons. Tanaz and Anderson (2009) point that the legislation reform included provisions for offering increased payments to private health plans that were introduced under the Medicare program; and the additional payments to the private health plans totaled $33 billion during the period 2004-2008. Scholars argue that these payments have been controversial considering the varied support that private health plans gained over the last two decades. In other words, these increased payments to private health plans could not be justified by available statistical and empirical evidences.
Supporters of the Medicare reform argued that the proposed changes would be capable of making Medicare services affordable to senior citizens. They contended that the new legislation would increase competition among private insurers and other health providers, and the situation in turn would lead to cuts in health costs and improved patient outcomes. At the same time, detractors claimed that increased payments to private plans could not be appreciated as it would impose huge financial burden on the federal government.
Undoubtedly, senior citizens would benefit from the legislation changes because they can obtain even expensive prescription drugs at affordable rates under the MMA. This Medicare reform may also benefit retired workers as they can obtain continued private prescription coverage from their employers. Since the MMA provides an additional $25 billion for rural hospitals, those local health institutions can also reap the benefits of this legislative reform. In addition, working people is another major beneficiary group of MMA because they are offered a pretax health savings account.
Evidently, electronically stored health data have played a significant role in the decision-making process. As the US regulators had access to electronically stored costs and other individual patient data, it greatly assisted them to be well informed of the cash inflow-outflow relationship in the Medicare system. In addition, this database made it easy for the regulators to perform statistical analyses and interpretations in an efficient manner and to draw up potential conclusions. Finally, the electronically stored health data might have assisted the health regulators to conduct a comprehensive cost-benefit analysis.

References

Cancer Program. Public Reporting of Outcomes. (2012). US Department of Veterans Affairs. Retrieved from http://www.phoenix.va.gov/services/Cancer_Program.asp
Graham Center Report. (n.d.). Reforming GME to Train More Primary Care Physicians Will Require Enforcement. AAFP. Retrieved from http://www.aafp.org/news/education-professional-development/20130205gmereformsreport.html
National Health Statistic Group. (2005). Display and Categorization of Source of Funds Estimates in the National Health Expenditure Accounts: Incorporating the MMA. Retrieved from http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/confpaperMMAClass.pdf
Oliver, T. R., Lee, P. R., & Lipton, H. L. (2004). A Political History of Medicare and Prescription Drug Coverage. The Milbank Quarterly, 82(2), 283–354.
Tanaz, P & Anderson, G. (2009). Payments to Medicare Advantage Plans. Health Policy Monitor. Retrieved from http://www.hpm.org/en/Surveys/Johns_Hopkins_Bloomberg_School_of__Publ._H_-_USA/13/Payments_to_Medicare_Advantage_Plans.html