Health services and secondary provider organizations, as discussed in the previous section, are not the only entities with health policy concerns and interests. A wide variety of health-related interest groups, including some that are consumer based or that are organized around individual health practitioner memberships, exist because of the collective interests of their individual or organizational members in health policymaking and the resulting health policies.
As will be discussed more fully in Chapter 3, one of the most significant features of the policymaking process and its political environment in the United States, as much in health as in any other domain, is the presence of a large number of interest groups whose purpose is to serve the collective interests of their members. These groups seek to analyze the policymaking process to discern policy changes that might affect their members and inform them about such changes. They also seek to influence the process to provide the group's members with some advantage. The interests of their constituent members define the health policy interests of these groups.
Some of the health-related interest groups have service provider organizations and systems as their members. Hospitals can join the American Hospital Association (AHA) (www.aha.org), long-term-care organizations can join the American Health Care Association (AHCA) (www.ahca.org) or the American Association of Homes and Services for the Aging (AAHSA) (www.aahsa.org), and health insurers and health plans can join America's Health Insurance Plans (AHIP) (www.ahip.org).
Other interest groups represent individual health practitioners. Physicians can join the American Medical Association (AMA) (www.ama-assn.org). African American physicians may also choose to join the National Medical Association (NMA) (www.natmed.org), and female physicians may also choose to join the American Medical Women's Association (AMWA) (www .amwa-doc.org). In addition, physicians have the opportunity to affiliate with groups, usually termed "colleges" or "academies," where membership is based on medical specialty. Prominent examples are the American College of Surgeons (ACS) (www.facs.org) and the American Academy of Pediatrics (AAP) (www.aap.org). Other personal membership groups include the American College of Healthcare Executives (ACHE) (www.ache.org), American Nurses Association (ANA) (www.ana.org), and American Dental Association (ADA) (www.ada.org), to name only a few.
Often, in addition to national interest groups, service provider organizations as well as individual health practitioners can join state and local groups, usually affiliates or chapters of national groups, that also represent their interests. For example, states have state hospital associations and state medical societies. Many urban centers and densely populated areas even have groups at the regional, county, or city level.
The secondary provider organizations also have their own interest groups. Examples include the following:
• Association of American Medical Colleges (AAMC) (www.aamc.org)
• Association of University Programs in Health Administration (AUPHA) (www.aupha.org)
• Biotechnology Industry Organization (BIO) (www.bio.org)
• Blue Cross and Blue Shield Association (www.bluecares.com)
• Pharmaceutical Research and Manufacturers of America (PhRMA) (www.phrma.org)
Like groups whose members are service providers, these groups, whose members are secondary providers, also focus particularly on policies that affect their members directly.
In addition to interest groups of service and secondary providers, there are a number of interest groups to which individuals—as individuals or consumers rather than as executives or health practitioners—can belong. Reflecting the diversity of the population from which their members are drawn, groups with individual member constituencies are varied. In forming what Buchholz (1994) calls "solidarity groups," some of these groups are based at least in part on feelings of common identity based on a shared characteristic such as race, gender, age, or connection to a specific disease or condition. Examples include the following:
• American Association of Retired Persons (AARP) (www.aarp.org)
• American Heart Association (AHA) (www.americanheart.org)
• National Association for the Advancement of Colored People (NAACP) (www.naacp.org)
• National Organization for Women (NOW) (www.now.org)
Interest groups such as NAACP and NOW serve the health interests of their members as part of much broader agendas focused generically on racial and gender equality. Although the Fourteenth Amendment to the U.S. Constitution guarantees equal protection under the law, American history clearly shows how difficult this equality has been to achieve. Interest groups such as NAACP and NOW have made their central public policy goal equality at the polls; in the workplace; and in education, housing, health services, and other facets of life in the United States.
The specific health policy interests of groups representing African Americans encompass adequately addressing this population segment's unique health problems—widespread disparities in health status and access to health services; higher infant mortality; higher exposure to violence among adolescents; higher levels ofsubstance abuse among adults; and, compared to other segments of the population, earlier deaths from cardiovascular disease and many other causes. Similarly, groups representing the interests ofwomen seek to address their unique health problems. In particular, they focus on such health-related interests as breast cancer, childbearing, osteoporosis, family health, and funding for biomedical research on women's health problems.
A growing proportion of the American population is over the age of 65. The elderly have specific health interests related to their stage of life; as people age, they consume relatively more healthcare services and their healthcare needs differ from those of younger people. They also become more likely to consume long-term-care services and community-based services intended to help them cope with various limitations in the activities of daily living. In addition to their unique health needs, older citizens have a special health policy history and, therefore, a unique set of expectations and preferences regarding the nation's health policy. The Medicare program, in particular, includes extensive provisions for health benefits in the context of the nation's social insurance support for its older citizens and is a key feature of this history. Building on the specific interests of older people and their preferences to preserve and extend their healthcare benefits through public policies, organizations such as AARP and the National Council of Senior Citizens (www.ncscinc.org) have become important organizations for addressing the health policy interests of their members.
Other interest groups with individual constituencies reflect member interests based primarily on specific diseases or conditions, such as the American Cancer Society (ACS) (www.cancer.org) or the Consortium for Citizens with Disabilities (CCD) (www.c-c-d.org). The American Heart Association (AHA), for example, has 22.5 million volunteers and donors. Its overall goal is the reduction of disability and death from cardiovascular diseases and stroke.
AHA pursues its goal through a number of avenues, including direct funding of research, public and professional education programs, and community programs designed to prevent heart disease. It also seeks to serve its members' interests through influencing public policy related to heart disease. As AHA (2005) notes on its web page, "In working to fulfill its mission, the Association plans, coordinates and implements a federal, state and local legislative and regulatory program in conjunction with its affiliates." The Real World of Health Policy: American Heart Association's Federal Public Policy Agenda outlines AHA's federal policy agenda and is typical of the way that many interest groups seek to serve their membership by outlining and pursuing clear-cut public policy agendas on behalf of the members.
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