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Health Policy: The Way Forward

Summary:
Use Surplus Property to Expand Health Facilities The United States has far fewer hospital beds per capita than other developed nations. Germany, for example, has 8 beds for every 1,000 people, while the United states only has 2.8. The federal government has plenty of underutilized facilities that could be employed in this crisis; the Government Accountability Office (GAO) discovered at least 7,000 surplus properties in 2015.  Many of these facilities still exist and remain underused. They could be repurposed to increase the supply of health facilities. The Office of Management and Budget (OMB), the General Services Administration (GSA) and the Department of Health and Human Services (HHS) should collaborate to quickly identify underutilized facilities and transfer them to state

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Use Surplus Property to Expand Health Facilities

The United States has far fewer hospital beds per capita than other developed nations. Germany, for example, has 8 beds for every 1,000 people, while the United states only has 2.8. The federal government has plenty of underutilized facilities that could be employed in this crisis; the Government Accountability Office (GAO) discovered at least 7,000 surplus properties in 2015. 

Many of these facilities still exist and remain underused. They could be repurposed to increase the supply of health facilities. The Office of Management and Budget (OMB), the General Services Administration (GSA) and the Department of Health and Human Services (HHS) should collaborate to quickly identify underutilized facilities and transfer them to state governments, local governments, and medical institutions so that they can be used to promote public health.

Relax Rigid Regulatory Procedures to Allow Vaccines and Drug Therapies to Come to Market Faster, without Compromising Safety

To curb the health and economic costs of the COVID 19 pandemic, we need to bring therapeutic, prophylactic, and vaccine treatments to market. The standard outlook is that a vaccine will not be readily available for at least 12 to 18 months, and new drug development, on average, requires 6 to 11 years of testing and regulatory reviews. 

To shorten these timelines, the Food and Drug Administration (FDA) could collaborate with industry and researchers to make new drugs or vaccines available to patients after the Phase I safety trial has been completed. This would allow patients to access promising therapies in early 2021, instead of years later. To accelerate the development of coronavirus vaccines, Congress could create an expedited process to allow patients, with informed consent, to use vaccine candidates that have not yet completed the full FDA approval process.      

Repeal CON Laws to Improve Access to High-Quality Health Care 

Certificate-of-need (CON) laws are in place in 36 states and the District of Columbia. CON laws require that those wishing to offer certain healthcare facilities, services, or devices first receive authorization from a state regulatory authority. Four decades of research shows that CON laws lead to restricted access, lower quality, and higher costs of care. A full repeal of CON laws can dramatically improve patient health in the states that undertake it. 

If political obstacles from incumbent providers arise, state legislators should consider repealing some (but not all) of their CON requirements, institute a time-bound phase out, provide administrative relief to applicants, simplify criteria used in the determination of need, and increase transparency surrounding the application and approval process.

Expand Pharmacist Practice Authority to Improve Healthcare Efficiency 

Given their medical training, pharmacists are able to perform medical tasks well beyond what most current regulations allow. Pharmacists have better knowledge of pharmaceutical drugs than other healthcare professionals and interact with patients much more frequently than physicians do. Yet prescribing authority for pharmacists remains limited across the United States. 

To tap into pharmacists' expertise and routine access to patients, states can allow online prescribing, remove restrictions to Clinical Laboratory Improvement Amendments (CLIA) waivers, accept out-of-state pharmacist licenses or enter into reciprocity agreements with other states (like Idaho did), relax restrictions on telepharmacy, and reduce restrictions on pharmacy technicians. In response to the current public health crisis, states should consider allowing pharmacists to conduct antibody tests for COVID-19 and administer FDA-approved vaccines.

Expand Access to Telemedicine to Diagnose and Treat Patients  

Telemedicine is the use of telecommunications technologies to remotely diagnose and treat patients. It is especially promising in healthcare delivery because it is a convenient way to minimize exposure to other patients and facilities. However, multiple state-level policy barriers stand in the way of telemedicine expansion. To enable fast adoption of telehealth services, states should allow online prescribing, reimburse Medicaid providers at parity for store-and-forward telemedicine and for remote patient monitoring, allow broad Medicaid reimbursement by provider type, and eliminate telepresenter requirements.

Ease Federal Restrictions to Allow State and Local Authorities to Facilitate Drone Delivery Services

The use of drones for medical, parcel, and grocery deliveries would be enormously beneficial as part of America’s response to COVID-19. These benefits are not just theoretical; drones have been effectively deployed in China in the wake of its COVID 19 outbreak. 

The barriers that prevent drone delivery services from scaling up in the United States is not technological, but institutional. The Federal Aviation Administration (FAA) and White House, perhaps through a statement of policy, could resolve some of the ambiguity in federal airspace law that would allow state and local authorities to demarcate and lease the airspace above public roads. States could undertake reforms that allow for the creation of drone highways for medical and parcel deliveries. The federal government could also implement changes that will help facilitate the widespread use of drones for medical deliveries.

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