Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
I think that tax policies can always have an impact on health, either by uploading them or by lowering them. The potential increase in taxes depending on the tax structure of each country can increase family protection (Countries with a large public sector depend in large part on tax collection). On the other hand, a tax reduction can encourage a greater spending on health or employer's insurance coverage. It is important to know the tax structure and the segment in which the person is located, which can change the net result of the tax increase. Regarding the widening of disparities, there is previous evidence that suggests that income inequality is a risk factor for poor health, so that the potential increase in wealth disparities can produce worse health outcomes.
· Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
In cases such as a change in tax collection system (integrated or not) or an increase in the collection rate in some segments, a correct evaluation is especially important for the public sector in case it is the largest health provider. Another aspect is the changes in employability clearly impacting the total income of a family, therefore its health expenditure. Given the multiple ways in which this policy can affect health, it is important to study how the changes and their implications for health interact in the short and long term.
· Specify the outcomes and populations you think most affected or least affected by the policy
I believe that regardless of the direction of the change in tax policy, this impact is most likely to be the most vulnerable to those who most impact. In terms of results, the tax reform can increase the collection of the public sector by improving investment and quality in health, with the most benefited sectors with public coverage. Unfortunately, in some cases it may decrease your income and affect the possibility of co-payment by reducing your access to health.
· Propose a study design to evaluate the policy.
I think the best design in this case would be a cohort study. Generating a population after the implementation of the policy. The evaluation of a health outcome before and after the tax reform, controlling for confounding factors, would allow an examination of the reform and possible causality in certain health outcomes.
· Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
I think the biggest challenge is to be able to control all the various confounding factors that could be affecting individual patients and communities, given that many things influence health and it can be difficult to analyze at which levels a policy influences a person's health.