Health Impact Assessment: Privatization and Medicare

I. Screening

A Health Impact Assessment (HIA) is an effort designed at gauging the effects of a given policy on human health. By focusing on the human health impact of the privatization of the federal healthcare program known as Medicare, it is clear that an HIA is both appropriate and necessary in order to effectively determine what the impact of a management decision to privatize the industry would have on what is the single largest provider of healthcare services to the elderly and retired people of the United States. Ideally, the decision to privatize Medicare would rest largely on the HIA's conclusions, as the basic premise of the program to benefit the health of elderly and disabled Americans. The resources required to perform the HIA are available and the wealth of nonpartisan data accessible is sufficient to render a balanced conclusion. 

II. Scoping r

The HIA will be conducted by narrowing the field of the study to specific effects regarding the privatization of Medicare. The policy change will affect the population of elderly and disabled people, as the program does not apply to people under the age of 65 or fully functional adults. Data sources will include the Congressional Budget Office (CBO) and a myriad of independent research institutions that will present, as a whole, a balanced and relevant conclusion to the matter at hand. 

III. Assessment

The baseline condition of the social groups in question, specifically the elderly and disabled, is one of the health services guaranteed by federal expenditure. According to Polivka and Jung and their 2002 study of American healthcare from the 1970s the present, “Medicare achieved greater cost-containment than private plans after controlling for coverage”. Similarly, a landmark study of the British National Health Service by Collyer and White in 2011 showed “there is no evidence of cost efficiency, improved quality or greater equity, even according to the Government’s own costings agencies.” Thus, it is the opinion of this HIA that the level of impact on the affected demographic would be negative, as the lack of any tangible financial benefit to the elderly would not improve care or health services. Svihula (2008) argues that the likelihood of the detrimental effect to the health of the demographic in question is high, as any disruption to the current health system is likely to have periods of uninsured groups in society and a reduction of coverage to the elderly. As the impacts of this policy change would at least disrupt coverage and quality of care to the community, the privatization of Medicare and any new legislation regarding reimbursements would have a negative health impact. 

IV. Recommendations

To avoid adverse health effects of privatization, White (2007) argues that Medicare could offer larger subsidies to private industry in for cost-containment purposes. Moreover, by guaranteeing periods of coverage during the transition to privatization, Medicare could continue to function per its federal mandate while ensuring a positive health impact on the community during the time required to implement the policy change. In addition, employers can be offered the chance to implement either private or public health plans in their companies, enabling the privatization efforts to shift the cost of services onto third-party providers, instead of burdening the federal budget. 

V. Reporting

Presenting the findings of this HIA can be achieved by distributing the document to Congressional hearings regarding the direction of Medicare and the ways in which cost-containment procedures can be created to increase efficiency in the federal budget. Gross (2002) argues that the issue of privatization in Medicare is one of political ideology, thus communicating the practical deficiency of converting federal Medicare to a private entity is one that relies largely on ideological association. Thus, distribution and communication to bipartisan political endeavors will aid in the discussion of the HIA.

VI. Monitoring and Evaluation 

A central aspect of the Health Impact Assessment is whether the HIA itself influenced or impacted the policy change in question. The passage of the Medicare Modernization Act in 2003 allowed for patients to choose to receive their benefits from either Medicare itself or through private industry providers. Svihula (2002) reports that, while Medicare is by all metrics and measurements a cheaper and generally more effective system than private insurers with regards to complete coverage for the elderly and disabled, “market rationalists” nonetheless hold much more sway and political power in the federal government. Thus, while the actual impact of the policy change through the partial privatization of the Modernization Act of 2003 had a negative effect on cost-containment procedures, it is clear that the impact of the HIA will not be felt unless more concrete analysis is shown to lawmakers and market reformers to convince them of the findings.  

References

Collyer, F., & White, K. (2011). The privatization of Medicare and the National Health Service, and the global marketization of healthcare systems. Health Sociology Review, 20(3), 238- 244. 

Gross, A. (2013). Is There a Human Right to Private Health Care?. Journal Of Law, Medicine & Ethics, 41(1), 138-146. 

Polivka, L., & Jung, K. (2008). Medicare Privatization and the Erosion of Retirement Security. Journal Of Aging & Social Policy,20(3), 340-352. 

Svihula, J. (2008). Political Economy, Moral Economy and the Medicare Modernization Act of 2003. Journal Of Sociology & Social Welfare, 35(1), 157-173.

White, J. (2007). Protecting Medicare: The Best Defense Is a Good Offense. Journal Of Health Politics, Policy & Law, 32(2), 221-246. doi:10.1215/03616878-2006-037