Running head: HEALTH POLICY AND LAW: EXECUTIVE ORDER 13985
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HEALTH POLICY AND LAW: EXECUTIVE ORDER 13985
Health Policy And Law: Executive Order 13985
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Health inequity has been a persistent issue in the USA, affecting underserved communities. In particular, people of color (Afro-Americans and Hispanics) bear the biggest brunt of inequality, contributing to disparities in health outcomes. For example, the COVID-19 crisis exposed healthcare disparities disfavoring people of color against European Americans, evidenced by greater mortality and infection rates among people of color. Health inequality takes many shapes and forms, including higher chronic mortality rates, premature deaths, and other adversities among underserved communities over privileged communities, especially Caucasians. A few hours after taking power in 2021, Joe Biden, the incumbent US president, signed Executive Order 13985, mainly focusing on health equity. Undoubtedly, this executive order showed the current administration’s commitment to creating a favorable environment with equal opportunities for all. The new executive order also marked the trajectory that Biden’s administration sought to take in promoting health equity. Addressing healthcare inequality in underserved communities must remain a top priority to improve health equity by providing equitable benefits and opportunities to everyone regardless of their social identity.
Health Policy Influence
The USA is beset with unprecedented and deep-rooted health inequities, adversely disadvantaging people of color and other underserved populations such as LGTBQ and persons with disability communities (Taylor, 2019). Health inequalities disproportionately contribute to disparities in health outcomes, evidenced by higher mortality, morbidity, life expectancy, and other adversity rates in the disenfranchised groups. In 2021 after assuming office, President Biden signed an Executive Order (EO) 13985 to address persistent health inequalities plaguing the USA. The marginalized populations, especially people of color (Hispanics, Afro-Americans, and indigenous Americans), are the primary stakeholders benefiting from this policy. However, there are other disenfranchised populations, including persons with disabilities, the LGTBQ community, and senior citizens benefiting from EO 13985 (Baciu et al., 2017). Therefore, EO 13985 is a promising policy advanced by the government.
Executive Order 13985 established an equity framework to ensure the current government works for all people without discrimination (Human & Health Services, 2022). Under this executive order, equity must remain a central principle in the decision-making framework, including capacity building, acquisitions, and grants across all agency functions. At HHS (Human & Health Services), equity is at the heart of all decisions and actions, including addressing maternal health disparities, eliminating cultural barriers to healthcare, and protecting the rights of disenfranchised populations (Human & Health Services, 2022). By integrating equity in all its decisions, policies, and initiatives, HHS and other public (state and federal) agencies revolutionize how to offer equal benefits and opportunities to all people regardless of their identity. Therefore, this exposes the government’s commitment to fostering equality.
According to HHS’ assistant secretary, HHS’ action plan on equity demonstrates its commitment to overcoming existing inequalities through programs, policies, and research. In addition, HHS is committed to understanding barriers and advancing equal opportunities across different population groups (Human & Health Services, 2022). The equity program advanced by the HHS is vital to empowering everybody without discrimination. Therefore, HHS is on the right path toward promoting health equity.
Stakeholder Needs
The underserved communities are the primary stakeholders and beneficiaries of Executive Order 13985. Underserved communities are marginalized (disenfranchised) populations sharing common characteristics, including age, sex, civic life, and social and economic factors. In addition, underserved communities encompass minority groups. Minorities are the non-dominant groups with distinct ethnocultural, racial, sexual orientation, and linguistic characteristics differentiating them from people within mainstream society. In the USA, major underserved communities are people of color (Afro-Americans, Hispanics, and indigenous Americans). Besides the racial minorities, LGTBQ, rural dwellers, persons with disabilities, homeless, and religious minorities.
Health equity is a significant need the underserved communities above seek to achieve. Under Executive Order 13985, HHS seeks to ensure that the marginalized communities and the primary beneficiaries achieve the optimum health outcomes by eliminating the barriers to quality and accessible health. From the empirical findings, health disparities facing underserved communities emanate from social-economic factors, including poverty, discrimination, food insecurity, and homelessness (White House, 2021). The social-economic factors above cause untold suffering to minority groups.
However, systemic racism is the most prominent and historical contributor to health inequity. For example, Afro-Americans have endured systemic racism across America for four to five centuries (Taylor, 2019). Studies have consistently proven that racism leads to social stratification and affects the Afro-American capacity for physical and mental health (White House, 2021). As a result, this has disproportionately affected Afro-Americans, leading to premature deaths, chronic illnesses, and other health adversities.
The HHS and other government agencies will meet the underserved populations’ needs in various ways. One way is to advance health equity by countering disparities plaguing the contemporary healthcare system (White House, 2021). For example, the HHS will work with other government agencies to address systemic racism and discrimination affecting underserved communities. Curbing discriminatory practices at all social-economic and political levels effectively reduces health inequalities facing marginalized groups. When developing and implementing the policy, it is vital to understand stakeholders’ different interests and roles (White House, 2021). Therefore, this ensures that the program implementors accommodate the needs of the diverse stakeholders.
Another way is to build on the ACA (Affordable Care Act) to expand the communities eligible for Medicaid and Medicare programs. Health affordability is necessary to address health inequality (White House, 2021). Engaging partners and communities served through policymaking and implementation are also effective ways to resolve health inequalities. The next action to address the needs of the underserved communities is to promote innovation by investing in m-Health and person-centered care. The next action to achieve health equity needs is to develop an inclusive and diverse workforce (White House, 2021). A diverse workforce effectively addresses diverse population needs in a multicultural environment.
Key Stakeholders and Interest Groups
Besides the underserved communities, other stakeholders influence Executive Order 13985. The presidency is the most influential stakeholder and the architect of this policy. The presidency led by Joe Biden is interested in cementing its legacy of serving all people equally (White House, 2021). Within the presidency, there are various stakeholders apart from the president and the vice president (White House, 2021). For example, there is DPC (Domestic Policy Council), an agency at the White House mandated to formulate and execute the administration’s domestic affairs and policy objectives. The DPC is interested in securing President Biden’s legacy by removing systemic barriers that deny underserved communities equal access to benefits and opportunities.
The CMS (Centers for Medicaid & Medicare Services) and HHS are significant stakeholders interested in achieving health equity for all demographic groups. The CMS is an agency with the HHS (department). Since Biden signed EO 13985, CMS has built a robust infrastructure to promote health equity (CMS, 2021). The mission is to help all communities achieve the highest health outcomes. Hence, the main interest of these stakeholders is consistent with Biden’s interest to leave a legacy of equity and underserved population interest in access to equal health services.
There are also other subtle stakeholders with some influence on the policy. For example, the NSC (National Security Council) and the NEC (National Economic Council) are a stakeholder with subtle responsibilities to ensure the health equity program succeeds (White House, 2021). The DPC and HHS will coordinate efforts with the NSC and NEC directors in coordinating and implementing efforts such as offering equitable access to opportunities and benefits to deal with health inequalities. OMB’s (Office of Management & Budget) director is another subtle stakeholder that will work with the department heads and study methods for evaluating whether equity action exacerbates barriers or promote equal and full participation by eligible members. The study’s primary aim is to establish the ideal approaches consistent with applicable laws to help agencies assess equity concerning various issues such as ethnicity and gender orientation (Center for Medicaid & Medicare Services, 2021). Nevertheless, the impact of NEC and NSC is relegated to the periphery.
The agencies and stakeholders above engage and work with the underserved community members. Consulting with historically underrepresented communities or being subjected to deep-rooted discrimination is essential to develop a person-centered program for improving health equity. As a result, marginalized communities will benefit from reduced discrimination and improved health outcomes, including higher quality of life, lower mortality rate, and decline in other health adversities.
A few stakeholders, including payers and providers, may feel disadvantaged. For example, the concrete dedication and efforts by the government to promote health equity and foster health affordability may contradict the payers’ and providers’ expectations. Providers will be expected to be more accountable and transparent (Center for Medicaid & Medicare Services, 2021). Hence, this will increase compliance efforts. Greater compliance efforts by payers and providers may be unpleasant outcomes for the providers.
It is essential to understand the influences of different stakeholders to earn their support. The policy champions must solicit support from various stakeholders. The stakeholder buy-out will minimize change resistance. In addition, this will improve the program’s legitimacy by accommodating the shared interests among the stakeholders. Another reason to understand the interests and influences of different stakeholders is to develop a collaborative relationship for the policy’s success above. Undoubtedly, EO 13985 cannot succeed without shared efforts across different stakeholders. Stakeholders will need to share efforts and collaborate to ensure this program thrives. Therefore, this demonstrates the role of this program in fostering success.
A few stakeholders may lose because of the equity program. For example, the initiative for health providers to prioritize emergency patients may irk non-emergency clients. In addition, attending to emergency patients may irk non-emergency patients by making them feel that the providers are non-responsive to their needs. Nevertheless, it is right for the providers to prioritize emergency cases to save lives, although this may conflict with non-emergency patient interests.
Value Conflict Analysis
Conflict of interest is inevitable among different stakeholders. Stakeholder conflict is when different stakeholder groups have incompatible goals, creating a dilemma for the decision-makers. The incompatibility of goals requires organizations to trade off interests among different stakeholders effectively. During the trade-off, decision-makers and policymakers must recognize the goals to prioritize.
Underserved clients may conflict with privileged patients because of social health determinants, including racism and discrimination. For example, the marginalized client’s interest in safe, quality, and equal services may overlap with the privileged groups’ expectations of being favored during service delivery (Center for Medicaid & Medicare Services, 2021). In addition, patients from privileged communities may demand special favors such as better treatment than the marginalized communities. In such a situation, the providers should treat patients across different social divides.
Another conflicting value is that healthcare providers could tailor their services to specific population demographics. For example, physicians may prioritize emergency patients over other patients, eliciting dissatisfaction. It is common for many providers to attend to emergencies before responding to non-emergency incidents (Garattini & Padula, 2019). As a result, non-emergency patients may lose their patience or become dissatisfied with their delays. Although this may dissatisfy some patients, providers must prioritize emergency cases because such incidents require urgent attention to salvage and protect their lives. Cultural biases and racial stereotypes may also encourage providers to discriminate against some groups over others (Garattini & Padula, 2019). Therefore, this may compound the health inequity currently addressed by EO 13985.
Transparency is another interest of the payers. The payers seek full disclosure of the healthcare services delivered to the patients. Full disclosure of the patient’s records may overlap with the client’s privacy rights (Center for Medicaid & Medicare Services, 2021). The clients have privacy and confidentiality rights. Hence, patients may be skeptical if the providers share their clinical history with the payers. Unfortunately, providers must share certain patients’ data with the payers to facilitate payment.
Another non-financial COI (conflict of interest) is that different stakeholders may seek to own the credit for the equity program developed during Biden’s presidency. For example, HHS, CMS, and other federal agencies may claim ownership or develop a sense of entitlement to this policy (Center for Medicaid & Medicare Services, 2021). The different senses of entitlement may elicit conflicts across diverse stakeholders. Therefore, diverse ownership across different stakeholder groups is an area that policy implementers must consider.
Moreover, different health professionals have conflicts in responding to patient needs. For example, nurses may conflict with physicians when responding to client needs. A nurse may the physician is responsible for certain clinical practices, including dressing wounds and vice versa. Providers may feel that their political commitments and religious beliefs contradict each other (Garattini & Padula, 2019). Hence, this may create anxieties and anxieties among the providers.
It is vital to consider these value conflicts when making decisions concerning health policy because they influence professional judgment. Understanding non-financial competing interests allows decision-makers to develop a trade-off between various vital interests (Garattini & Padula, 2019). For example, the overlapping interests between emergency and non-emergency patients may require clinicians to exercise professional judgment. Although non-emergency patients may have arrived at the health facility earlier, the right professional judgment would be to respond to the emergencies before anything else (Garattini & Padula, 2019). Non-emergency patients may feel dissatisfied, but the benefits of attending to emergency patients far outweigh the detriments of responding to client needs based on earliness on arriving at the facility.
The example of prioritizing emergency cases reflects the benefits of the right professional judgment. A significant advantage is that the providers would save fatalities or reduce worse outcomes such as irreversible incapacitation. Another advantage is that the providers can protect their faces by responding to an emergency before a non-emergency case (Garattini & Padula, 2019). The provider would also demonstrate humane and kind gestures for responding to patients needing urgent medical attention.
General Decision-Making
When developing and implementing a health equity program, stakeholder involvement throughout policy development is vital to understand the needs of different interest groups, including civil societies, donors, government agencies, and patients. Stakeholder engagement allows equity program initiatives to have desirable legitimacy. The engagement provides adequate legitimacy to the policy. In addition, this allows the program to secure the stakeholders’ desired support by recognizing their interests and needs (Baciu et al., 2017). Without the stakeholders’ support, the policy cannot succeed.
Decision-making is also significant in involving different stakeholders in policy development and implementation. The public authorities, including DPC, HHS, the president, vice president, CMS, CDC, and other government agencies at federal and local levels, are the top decision-making stakeholders involved in the health equity programs (Center for Medicaid & Medicare Services, 2021). Authorities have strong decision-making power on health policies, including equity programs. Because equity is a multifaceted phenomenon, it will involve decision-makers across different agencies. In addition, the authorities have policy advisors to ensure the smooth running of the equity program that recently came into effect.
Non-government institutions/organizations (NGOs) are critical stakeholders in implementing the EO 13985 to foster health equity. The NGOs work in solidarity with public interests, such as equity and human rights protection (Masefield et al., 2021). In addition, most NGOs are activist groups seeking equal rights and social justice. Another significant role of these NGOs is to work with international bodies and organizations to address various healthcare challenges, including inequalities facing underserved populations. NGOs are also influential in creating healthcare networks to drive equality strategies and promote projects or campaigns that serve the public welfare (Pereno & Eriksson, 2020). Therefore, EO 13985 earns enormous support from these NGOs in promoting health equity.
Additionally, the support from civil societies will help the EO 13985 to thrive. Like NGOs, civil societies work with public and private players to address community needs (Pereno & Eriksson, 2020). In addition, civil societies are the lobbyist groups that campaigns for pro-poor health programs and policies. Most civil societies are apolitical and would seek to promote the public welfare, especially of marginalized groups (Masefield et al., 2021). Besides advocacy, civil societies help in resource mobilization. For example, these groups mobilize health professionals and social workers on equity initiatives, such as serving underserved populations.
Another primary reason for involving and considering the interests of various stakeholders with non-financial interests is to develop strategic partnerships. For example, public authorities can establish alliances with community groups, civil societies, research institutions, and NGOs to support equity-based initiatives, including raising awareness against discrimination and racism (Baciu et al., 2017). Collaboration is also crucial in sharing diverse ideologies toward addressing the barriers to equity (Baciu et al., 2017). Therefore, this will promote the success of the EO 13985 in fostering health equity across various demographic groups.
Stakeholder Needs
Different stakeholders also have financial interests in the policy (EO 13985). In this policy, the patients are the primary stakeholders with financial interests. The patients seek affordable care services, especially from underserved communities or socially-economically marginalized (Pereno & Eriksson, 2020). Affordability is a significant need desired by patients to improve their health quality and reduce health costs. Underserved communities, especially poverty-stricken clients, cannot achieve equity without affordability (Pereno & Eriksson, 2020). EO 13985 is a policy complementing existing health policies such as ACA, seeking to reduce health disparities by improving affordability. Because patients are the primary stakeholders affected by healthcare policies, engaging the clients, especially from underserved communities, on the barriers to affordability is necessary. Hence, this can help decision-makers across providers and authorities implement decisions promoting health equity.
The payors are also primary stakeholders impacted by the health policy and with significant financial interests. Most payors are for-profit medical insurers and private companies. In for-profit companies, the payors’ central interest is to maximize profit (Lübbeke et al., 2019). The success of EO 13985 in addressing health inequity will succeed through involving the payors in the decision-making. Notably, the government can consult with the payors on effective ways to lower the healthcare burden for underprivileged populations without impacting the payors’ profits (Pereno & Eriksson, 2020). The government can also enact policies to promote fair practices and prevent payors from exploiting the patients.
Providers (clinical experts and facilities) are also critical stakeholders with a significant financial interest in this policy. Most providers are profit-motivated and seek to engage in practices that maximize their income (Pereno & Eriksson, 2020). For example, some providers can prioritize upscale clients or perform lucrative clinical practices because of their greed for money. The government can curb providers’ exploitative behavior by setting the price ceiling for different care services (Masefield et al., 2021). The price ceiling for different services and regulating the providers’ practice are necessary for EO 13985 to achieve desired clinical outcomes.
However, few stakeholders have subtle but essential impacts on the policy. For example, research centers such as universities and other higher learning institutions are also instrumental in the success of this program. Research centers undoubtedly have a financial interest in financing their innovation programs (Lübbeke et al., 2019). For example, research centers require enormous financial resources to investigate and develop COVID-19 vaccines. Most research institutions lacked adequate financial resources to finance their R&D programs. As a result, the government responded by offering financial resources for the success of COVID-19 vaccine development programs.
Professional consortia are also subtle stakeholders with a financial interest in the program. Consortiums provide advisory services on specific initiatives, including policy governance and capacity-building initiatives. The long-term involvement of consortia is instrumental in the success of the program. However, the consortia are profit-oriented, implying that the central decision-makers of this EO 13985 must consider their financial interests.
The stakeholders above may benefit from the program. For example, these stakeholders may improve their reputation for supporting the initiative to improve health equity. In addition, EO 13985 is a policy that promotes ethical obligations, including fairness and social justice (Center for Medicaid & Medicare Services, 2021). A greater reputation will also attract the market for profit-oriented stakeholders such as research institutions and providers. Underserved communities are also stakeholders that will benefit from improved health equity (Center for Medicaid & Medicare Services, 2021). In contrast, historically privileged groups may lose the unfair favors they receive from providers and social institutions.
It is vital to determine various stakeholders with certain financial interests. Determining the financial interests of various stakeholders will help policymakers know how to respond to such interests. In addition, this will enable policymakers to develop strategic partnerships and alliances with different stakeholders to address community needs (Center for Medicaid & Medicare Services, 2021). Therefore, this will help the policy be a success.
Stakeholders such as authorities, payors, patients, and providers will financially influence the policy. For example, authorities will influence the policy by mobilizing and allocating financial resources to support pro-poor programs such as Medicaid and Medicare. Resource mobilization and allocating sufficient resources to the Medicare and Medicaid programs will support the financial resources. In addition, the payors will partner with the Medicaid and Medicare organizations on the reimbursement. The payors will receive financial resources to collect resources and improve financial success. Therefore, this demonstrates the importance of this resource mobilization.
EO 13985 may have disadvantaged the privileged patients, such as the racial majority and white supremacists. For example, the patients may feel they are not receiving unwarranted favors from the providers. If these privileged patients fail to receive favors, they may feel they are not getting value for money. However, this should not worry other stakeholders because fairness is key in health service delivery.
Competing Value Conflicts
There are multiple competing value conflicts from the financial perspective. One conflicting value is that the patients want affordable (cost-effective services), which contradicts health providers’ profit-oriented motive (Center for Medicaid & Medicare Services, 2021). EO 13985 seeks to promote health equity by promoting affordability consistent with Obama-era ACA (Affordable Care Act). However, this may erode the financial interests of the providers. Most providers, especially profit-motivated healthcare facilities or physicians, are less concerned about healthcare affordability (Alhazmi, 2019). Instead, providers mainly care about maximizing profits. Hence, most providers would prioritize offering medical services to clients that can afford to pay, exhibiting the contracting interest between the providers and clients.
Moreover, insurance providers (payers) are profit-oriented businesses seeking to maximize income and wealth for their shareholders. However, this contradicts the cost-cutting interests of the providers. Health providers seek to cut costs and maximize returns by increasing insurance claims from the payers (Center for Medicaid & Medicare Services, 2021). In contrast, the payers seek to reduce claims to maximize claims. Therefore, this shows that payers generate more income whether the providers demand less payment and vice versa. In other others, payers and providers benefit to the detriment of each other. Providers may also seek to inflate claims to maximize income (Alhazmi, 2019). On the other hand, payers seek payment integrity to avoid paying non-existing costs.
The conflicting interest between payers and providers contradicts the patient’s financial interest, including care affordability. Undeniably, patients expect health providers to charge affordable prices and payers to pay for their healthcare costs. However, the greater expectations from the clients contradict payers’ interests because payers will be better off if they pay fewer health charges. Because public agencies are interested in improving health affordability to promote equity, they have established hand-off strategies, including managed care programs requiring providers to justify high prices (Alhazmi, 2019). Hence, this promotes accountability between providers and payers. Public agencies, including HHS, also expect providers to minimize medical costs without sacrificing patient satisfaction across the healthcare systems.
The public agencies’ interests may also conflict with the providers’ and clients’ financial interests. For example, the HHS may seek to lower its financial burden or the budget, which may contradict. Unfortunately, cutting the budget to lower the financial burden may be a blow to the providers because they would receive less funding. In addition, a lower budget may force providers to sacrifice quality to maintain quality (Alhazmi, 2019). Budget cuts will also increase healthcare costs for patients because it would apply allocations toward affordable care programs such as Medicaid and Medicare will diminish. Therefore, the patients, especially underprivileged and underserved groups, would be the primary losers.
The policy implementers must understand the prevailing financial conflicts between various providers. A significant reason for understanding these financial conflicts is to enhance providers’ collaboration toward each other’s interests (Morris, 2019). For example, government agencies can require payers and providers to develop a collaborative framework. In this framework, payers and providers can agree on the common risks, shared vision, and rewards. In addition, providers and payers can agree on acceptable risk tolerance. Payers and providers can also share workflow systems and technologies to cut costs and improve economies of scope and scale (Morris, 2019). Hence, the stakeholders, including the patients, would benefit from the quality and affordable services.
Additionally, understanding these conflicting financial interests would foster accountability by eliminating denials. As the healthcare industry grows, most infrastructure fight authorizations, and the primary losers are the patients because this delays care and adds costs. Stakeholders can collaborate by sharing automated data and rules. In addition, open communication and strategic relationships to determine financial responsibility before authorization are necessary (Morris, 2019). The greater transparency level also improves client satisfaction and reduces conflict between physicians and payers.
Financial Decision-Making
It is important to consider financial stakeholders and interest groups in financial decision-making. The stakeholders are providing financial resources for this policy to thrive. For example, the federal government is partnering with the state governments to mobilize and provide resources for Medicaid and Medicare programs. Adequate resources for Medicaid and Medicare will reduce health disparity among the financial resources. In addition, payors will support the program by reimbursing the providers after delivering health services. Reimbursement to the payers is necessary for the payors to thrive in the market. Importantly, the payors and providers should collaborate with each other on payment reimbursement and full disclosure of the services offered. The seamless information sharing and transparency in the relationship between payors and providers are necessary to promote integrity in reimbursement. For instance, this can prevent either party (payor or provider) from faking the non-existence services offered to the clients.
Recommendation
Position Statement:
Organizations, including providers and payers within healthcare, should consider changing their policies to align with EO 13985. These organizations must recognize that humans are equal and everyone deserves to live quality and healthily. However, social-economic determinants influence inequalities, including race, age, ethnicity, disability, and gender expression. Therefore, providers should consider easing these social barriers to the quality of health for the underserved population.
One significant effort is to enact anti-discrimination and equity initiatives. For example, providers must treat everybody with dignity and without discrimination. Anti-discrimination programs should also allow for equal benefits and opportunities. Awareness programs against racial and cultural stereotypes are also necessary to ease discrimination experienced by marginalized groups. In addition, providers should have inclusive programs in which they hire people across different ethnocultural, racial, religious, and political divides. An inclusive healthcare workforce is ideal for attending to the diversity-oriented needs of various healthcare providers.
Moreover, providers must support equity policy by investing in cost-effective measures. For example, providers must implement m-Health ecosystems to improve health access to underserved patients in remote areas. Providers in remote places can interact with the providers at any time of the day and in their most convenient locations. In addition, telehealth infrastructure can lower patient and care delivery costs because patients are no longer required to travel lengthy distances. Self-care behavior is also another advantage of the m-Health systems. Therefore, this demonstrates the significance of investing in the m-Health ecosystem.
References
Alhazmi, F. (2019). The Ethical Challenge of Conflicts of Interest in Healthcare. https://dsc.duq.edu/cgi/viewcontent.cgi?article=2768&context=etd
Baciu, A., Negussie, Y., Geller, A., Weinstein, J. N., & National Academies of Sciences, Engineering, and Medicine. (2017). The state of health disparities in the United States. In Communities in action: Pathways to health equity. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK425844/
Center for Medicaid & Medicare Services. (2021). Reducing Racial Disparities in Health Outcomes and Promoting Equity. https://marketplace.cms.gov/assister-webinars/health-equity.pdf
Garattini, L., & Padula, A. (2019). Conflict of interest disclosure: striking a balance?. The European Journal of Health Economics, 20(5), 633-636. https://doi.org/10.1007/s10198-018-1028-5
Human & Health Services. (2022). HHS Statements on New Plan to Advance Equity in the Delivery of Health and Human Services. https://www.hhs.gov/about/news/2022/04/14/hhs-statements-on-new-plan-advance-equity-delivery-health-human-services.html
Lübbeke, A., Carr, A. J., & Hoffmeyer, P. (2019). Registry stakeholders. EFORT open reviews, 4(6), 330-336. https://doi.org/10.1302/2058-5241.4.180077
Masefield, S. C., Msosa, A., Chinguwo, F. K., & Grugel, J. (2021). Stakeholder engagement in the health policy process in a low-income country: a qualitative study of stakeholder perceptions of the challenges to effective inclusion in Malawi. BMC Health Services Research, 21(1), 1-14. https://doi.org/10.1186/s12913-021-07016-9
Morris, M. (2019). Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together. https://www.modernhealthcare.com/opinion-editorial/reduce-total-cost-care-6-reasons-why-providers-and-payers-should-tackle-challenge
Pereno, A., & Eriksson, D. (2020). A multi-stakeholder perspective on sustainable healthcare: From 2030 onwards. Futures, 122, 102605. https://doi.org/10.1016/j.futures.2020.102605
Taylor, J. (2019). Racism, Inequality, and Health Care for African Americans. https://tcf.org/content/report/racism-inequality-health-care-african-americans/
White House. (2021). Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government. https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/