US Health Policy? A 2017 Survey Christina Pagel, PhD, MSc Brigham - - PowerPoint PPT Presentation

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What Are State Legislator Priorities for the Goals of US Health Policy?

A 2017 Survey

Christina Pagel, PhD, MSc Brigham and Women’s Hospital, Boston MA Institute for Healthcare Improvement, Cambridge MA Harkness Fellow in Healthcare Policy funded by the Commonwealth Fund David Bates (BWH), Don Goldmann (IHI), Chris Koller (Milbank Memorial Fund)

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BACKGROUND

• The Affordable Care Act (ACA) → the American Health Care Act (AHCA). If

durable reforms require bipartisan support, they need to meet the goals of both parties.

• What do state legislators believe are the most important goals of health policy?
• State legislators are “the closest possible comparable sample to members of

Congress”*

• Survey designed to ask legislators to prioritize among a given set of goals.

* Butler DM, Powell EN. J Polit. 2014 Apr;76(2):492–505

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SURVEY

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RESULTS: RESPONDENT CHARACTERISTICS

Affiliation All Asked (N=2973) Responded (N=376) Response rate (Overall = 13%) Republican 55% 181 (48%) 11% Democrat 44% 192 (51%) 15% Other 1% 3 (1%) 10%

Republicans and Democrats rank significantly differently (p<0.0001*) so need to examine by party. No significant differences* in ranking between region, by chamber or by committee type.

* MANOVA test on mean ranks; Wilcoxon signed ranked or Kruskal Wallis tests for each goal, Bonferroni corrected for multiple comparisons

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RESULTS: REPUBLICANS, N=181

Point position derived from data. Goodness of fit: 95% MOST IMPORTANT LEAST IMPORTANT

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RESULTS: REPUBLICANS, N=181

MOST IMPORTANT LEAST IMPORTANT Clusters identified using cluster linkage

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RESULTS: REPUBLICANS, N=181

MOST IMPORTANT LEAST IMPORTANT Smaller government Addressing healthcare delivery Reduce costs Improving overall health Cluster and axis interpretation GOVERNMENT RESPONSIBILTY FREE MARKET The AHCA?

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RESULTS: DEMOCRATS, N=192

MOST IMPORTANT LEAST IMPORTANT Point position derived from data. Goodness of fit: 94%

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RESULTS: DEMOCRATS, N=192

MOST IMPORTANT LEAST IMPORTANT Clusters identified using cluster linkage

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RESULTS: DEMOCRATS, N=192

Cluster and axis interpretation Improving health and equity Smaller government Reduce costs Addressing healthcare delivery MACRO LARGE SCALE SYSTEMS? PATIENT FACING / LOCAL SYSTEMS? The ACA? MOST IMPORTANT LEAST IMPORTANT

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CHALLENGES AND OPPORTUNITIES

REPUBLICANS DEMOCRATS

• Difficult to reconcile difference on the role of government in health care
• Possibility for bipartisan work on costs
• Also for bipartisan work on healthcare delivery where it does not conflict with

higher priority goals

Payment reform? Payment reform?

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FINAL THOUGHTS

REPUBLICANS DEMOCRATS

• Designing policy
• Evaluating policy
• Messaging policy

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METHODS: ANALYSIS – MAPS AND CLUSTERING

It is up to the observer to interpret the clusters and their relative positions for insight

Legislator 1 Legislator 2 Legislator 3 X value Y value Z value D: Reduce overall costs 2 1 2 E: Reduce individual costs 1 2 1 F: Overall health 5 4 5 H: Reduce disparities 6 5 6 I: Increase access 4 6 4 L: Reduce government involvement 3 3 1 GIVEN RANKS GOAL

3D 2D

Number of dimensions = number of respondents (in this example 3) Mathematical technique called multi-dimensional scaling (MDS) maps goals in ND space

• nto 2D space

Clusters of goals identified using hierarchical cluster analysis