The Demanders of Health Policies

Broadly, the demanders of health policies can include anyone who considers such policies to be relevant to the pursuit of health for themselves or others about whom they care or who considers such policies to be a means to some other desired end, such as economic advantage. It is these desired ends of enhanced health or other advantages that motivate the participation of demanders in political markets, just as desired ends motivate participation in economic markets.

For individuals, however, effective participation in the political marketplace presents certain problems and limitations. For example, to participate effectively, individuals must acquire substantial amounts of policy-relevant information, which can require considerable amounts of time and money. Beyond this, individual participants or demanders often must be prepared to expend additional resources—again, money and time—in support of achieving desired policies. This expense problem is exacerbated by the fact that any particular health policy might have significant, or even noticeable, benefits for only a relatively small number of individuals. Consequently, demanders participate as individuals to a very limited degree in the political markets for policies.

Organizations, with their pooled resources, have a significant advantage over individuals in the political marketplace. They may have the necessary resources both to garner needed policy-relevant information and to support their efforts to achieve desired policies. Their pooled resources are not their only advantage over individuals in the political marketplace. The health policy interests of organizations may be very concentrated. A change in Medicare policy that results in an increased deductible of $100 per year for certain individuals is one thing; a policy change that results in several million dollars of revenue for a health services organization is quite another. Organizations tend to be more effective demanders of health policy than individuals, in part because the stakes for them tend to be higher.

The most effective demanders of policies, however, are the well-organized interest groups. (More is said about interest groups and their role in influencing the public policymaking process in subsequent chapters.) Interest groups are groups of people or organizations with similar policy goals that enter the political process to try to achieve those goals. By combining and concentrating the resources oftheir members, interest groups can have a much greater impact in political markets than either individuals or organizations.

In effect, interest groups provide their members, whether they are individuals or organizations, with greater opportunities to participate effectively in the political marketplace. This is what the American Medical Association (AMA) (www.ama-assn.org) does for individual physicians, what the American Association for Retired Persons (AARP) (www.aarp.org) does for older individuals; and what the Pharmaceutical Research and Manufacturers ofAmerica (PhRMA) (www.phrma.org) does for its member companies. Because of their powerful roles in political markets, interest groups, as demanders of health policy, are described more fully in the next section.

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