Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
One policy or executive order that was not specifically intended to be a health policy but most certainly has many health implications is the recent Travel Ban—commonly known as the Muslim ban. This policy essentially blocks the emigration of refugees or citizens of 7 countries: Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen. Trump is currently trying to update this policy after it has been suspended; therefore it is still very relevant. The US medical system is currently suffering a severe shortage of primary care physicians in essentially all states, and there are many healthcare systems that planned to rely on foreign-born doctors, and this travel ban became a serious impediment. Each primary care physician sees thousands of patients, thus the travel ban could be a serious concern to the US’s healthcare system.
Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
An evaluation of this policy is definitely very important and informative because of it helps assess for potential detrimental effects. There are many foreign-born doctors/medical students in the United States that come from the banned countries. Studies should assess for the potential jobs that are being lost and most importantly the number of patients that may not be able to receive care in a timely manner due to the shortage of doctors (even post-Travel ban).
Specify the outcomes and populations you think most affected or least affected by the policy.
The populations most affected include primary care physicians as they would potentially experience an overload of cases/patients, the patients (who need to see primary care physicians)—due to the shortage of physicians, the patients may not get to see a physician in a timely manner and that could simultaneously affect their health (e.g., delay in receiving necessary treatment), and obviously doctors and patients that come from the banned countries. Outcomes most affected, as mentioned, primary include patients receiving timely evaluations, referrals, and treatment.
Propose a study design to evaluate the policy.
Cross-sectional studies could be performed across primary care health homes across different states that assess for the proportion of patients that need to see a primary care physician and are actually doing so, and also the average waiting time to see a primary care physician. Essentially, the study would evaluate the association between the number of primary care physicians to effectiveness/efficiency of primary care services, thus showing the serious need for more doctors. We could also identify social determinants of health disparities (i.e., who are the patients not getting timely primary care services?/stratify by race/ethnicity /preferred language/ SES.)
Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
The biggest challenge would be to evaluate what could potentially happen once the policy is implemented. There is no guarantee that the travel ban is significantly associated with the quality of primary care services. We do not know whether foreign-born doctors are actually planning or willing to practice in the United States, which would not solve the problem of primary care physician shortage in the US.