Information Trading How Information Influences the Health Policy Process (1997) / Chapter Skim
Currently Skimming:
1 The Market for Information in Health Policy: Using the
1 The Market for Information in Health Policy: Using the
Pages 11-26
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From page 11... ...
Participants in the public policymaking process are making the same discovery as Japanese manufacturers: just-in-time (~IT) management strategies can shorten production time and enhance market competition.
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From page 12... ...
Just as the IlT manufacturing strategy has helped Japanese manufacturers expand their market share, policymakers using the ITT strategy are seeking a competitive edge for influencing policy proposals and political agenclas. A look at how IlT manufacturing works at Toyota, the most cited example of the wiclespreac3 use of the ITT strategy in manufacturing, highlights the attractive features of these strategies: reducing excess supply, timeliness, more flexibility, shared risk, and reclucec3 cost (Schonberger, 19824.
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From page 13... ...
Toyota supplies are customized components, tailor-macle for each car clesign. Suppliers continuously refine their components by roaming the assembly plant and talking with workers about potential improvements in the assembly process or the performance of their components.
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From page 14... ...
The car assembly plant in Toyota City is the hub of consecutive rings of suppliers locatecl according to Toyota's dependence on them (Smith, 19954. The innermost ring contains the sole engine supplier, whose close proximity makes it possible to deliver a load of engines every 20 minutes at the clock adjacent to the engine assembly station.
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From page 15... ...
However, this industry is overproclucing, so that the supply of information has exceeded the need at any given moment, anc3 created even more reliance on ITT strategies to sort anc3 retrieve only the information needled at the moment. Growing Demand for Information Creates Excess Supply The restructuring of Congressional committees in the 1970s anc3 19SOs set off a dramatic transformation of the public policymaking process (Ricci, 1993; Smith, 1988~.
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From page 16... ...
As more outside groups participated in the policymaking process, the staffs of members of Congress anc3 committee staffs became flooclec3 with the explosion of materials supplied by this growing information inclustry. Congressional offices expanded their staffs to keep up with the growing agenda anc3 information, anc3 their growth expanded the agenda further, stimulating a new supply of information products (Smith, 1988~.
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From page 17... ...
With an endless new supply arriving daily, information products became something used at the moment for the current political agenda or cliscarclec3. ~ became aware of the information explosion as it related to health care policy almost instantly when ~ began work for Senate Minority Leacler Tom DaschIe as a 1995-1996 Robert Wood Johnson (RWI)
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From page 18... ...
One strategy crafted to oppose the May 1996 Republican Meclicaic3 reform provisions as part of the welfare reform movement highlighted how the proposed changes in Meclicaic3 would make Medicare benefits inaccessible for many vulnerable dually eligible senior citizens. Although the data were checkoff with DHHS legislative staff, the Kaiser Family Foundation anc3 Center for Budget anc3 Policy Priorities were called on for the information required to craft the message.
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From page 19... ...
During the 1996 health insurance reform debate, mental health advocacy groups pushed very strongly for prohibiting any distinction of insurance benefits for mental health coverage from other benefits. When the bill moved to conference committee to resolve differences between the House and Senate versions, these groups formed a coalition to publicly support members who acivocatec3 the compromise: no differentiation in annual and lifetime caps.
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From page 20... ...
The think tanks and interest groups that work closely with congressional office staff condense information from research reports, government reports, polls, anc3 the news media anc3 tailor it to fit into the congressional office' s political message. These customized information packages relieve congressional staff from trying to quickly reac3 anc3 interpret comprehensive information from objective sources anc3 reshape it to fit the message of the moment.
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From page 21... ...
The products of most university researchers provide the raw material that is mollified anc3 extracted by think tanks anc3 interest groups in closer proximity to the Congress that feed the daily information market on a ITT basis. The distance between most researchers anc3 Capitol Hill anc3 researchers' focus on objectivity anc3 thoroughness carve out for them a more peripheral contribution to the moment-by-moment policy anc3 political efforts on the Hill.
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From page 22... ...
Beyoncl the general interest in reducing fecleral spencling, policymakers' growing reliance on IlT information products places fec3eral agencies like OTA anc3 AHCPR at special risk anc3 eased the closure of OTA. In the heat of the moment, when the pace of policy action is extremely rapid anc3 the stakes are the highest, congressional offices may be more clepenclent on outside think tanks anc3 interest groups for the quick, tailorecl information needed to supply the political message of the moment.
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From page 23... ...
The next year, AHCPR moved away from promulgating clinical practice guidelines, and encouraged external think tanks and private-sector research centers to continue this work. CONSEQUENCES OF JIT STRATEGIES FOR HEALTH POLICY The current partisan policy environment of continuous campaigning fuelecl by the IlT supply of customized information proclucts is reducing the public's role from that of a stimulus for Congress to make policy to that of a consumer of policy made by Congress (Ricci, 1993~.
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From page 24... ...
Although the private sector is generating quality anc3 outcomes data, these self-reportec3 data are not uniformly available anc3 lack external validity, comparability, anc3 stanciarclization across demographic differences (Roper, 1996; Physician Payment Review Commission, 19954. Just after the Physician Payment Review Commission called for a strong research infrastructure to support anc3 improve the development anc3 use of practice guidelines (Physician Payment Review Commission, 1995)
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From page 25... ...
The shorter policymaking work week, clue to the ease of jet travel back to the member's district, anc3 expanclec3 television exposure have increased the value of each moment in the week. IlT information supply helps congressional staff to shorten preparation time to increase the number of opportunities for member' s public exposure.
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From page 26... ...
Washington, D.C.: Physician Payment Review Commission. Ricci, D.M.
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