Health Policy Defined

There are many definitions of public policy, and no universal agreement has been reached on which is best. For example, Peters (2003) defines public policy as the "sum of government activities, whether acting directly or through agents, as it has an influence on the life of citizens." Birkland (2001, 132) defines public policy as "a statement by government of what it intends to do or not to do, such as a law, regulation, ruling, decision, or order, or a combination of these." Cochran and Malone (1999) define public policy as "political decisions for implementing programs to achieve societal goals." Drawing on these and many other definitions, in this book I define public policy as authoritative decisions made in the legislative, executive, or judicial branches of government that are intended to direct or influence the actions, behaviors, or decisions of others.

The phrase authoritative decisions is crucial in the definition of public policy. It specifically refers to decisions that are made anywhere within the three branches of government—at any level of government—that are within the legitimate purview (i.e., within the official roles, responsibilities, and authorities) of those making the decisions. The decision makers can be legislators, executives of government (presidents, governors, mayors), or judges. Part of playing these decision-making roles is the legitimate right—indeed, the responsibility—to make certain decisions. For example, legislators are entitled to decide on laws, executives to decide on rules to implement laws, and judges to review and interpret decisions made by others. These relationships are illustrated in Figure 1.1. A useful web site for information about all three branches

Three Branches Government

Figure 1.1

Roles of the Three Branches of Government in Policymaking

Interprets constitutional and statutory law Develops body of case law Preserves rights Resolves disputes

Figure 1.1

Roles of the Three Branches of Government in Policymaking

Interprets constitutional and statutory law Develops body of case law Preserves rights Resolves disputes

Judicial Branch Interprets Policy of the federal government, as well as information about state and local governments, is www.firstgov.gov. FirstGov is an official U.S. government web site.

In the United States, public policies, whether they pertain to health or to other policy domains such as defense, education, transportation, or commerce, are made through a dynamic public policymaking process. This process, which is modeled in Chapter 3, involves many interactive participants in three interconnected phases of activities.

When public policies pertain to health or influence the pursuit of health, they are health policies. Health policies are established at federal, state, and local levels of government, although usually for different purposes. Generally, health policies affect or influence groups or classes of individuals (e.g., physicians, the poor, the elderly, children) or types or categories of organizations (e.g., medical schools, health plans, integrated healthcare systems, pharmaceutical manufacturers, employers).

At any given time, the entire set of health-related policies, or authoritative decisions that pertain to health, made at any level of government can be said to constitute that level's health policy. Thus, health policy is a very large set of decisions reached through the public policymaking process. Some countries, Canada and Great Britain most notably, have developed expansive, well-integrated policies to help shape their society's pursuit of health in fundamental ways. The United States, in contrast, has a few large health-related policies, such as its Medicare program or its regulation of pharmaceuticals, but the U.S. government takes a more incremental or piecemeal approach to health policy. The net result is a very large number of policies, but few of them deal with the pursuit of health in any broad, comprehensive, or integrated way.

Policies made through the public policymaking process are distinguished from policies established in the private sector. Although discussing private-sector health policies in any depth is beyond the scope of this book, authoritative decisions made in the private sector by executives of healthcare organizations about such issues as their product lines, pricing, and marketing strategies, for example, are policies. Similarly, authoritative decisions made within such organizations as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (www.jcaho.org), a private accrediting body for health-related organizations, or by the National Committee for Quality Assurance (NCQA) (www.ncqa.org), a private organization involved in assessing and reporting on the quality of managed care plans, are also private-sector health policies.

This book focuses on the public policymaking process and on the public-sector health policies that result from this process. Private-sector health policies also play a vitally important role in the ways society pursues health. The rich and complex blend of public policies and private-sector policies and actions that shape the American pursuit of health is a reflection of the fact that Americans have been extraordinarily reluctant to yield control of the healthcare system to government. In part, this reflects a unique feature of the American psyche that Morone (1990, 1) captures eloquently when he says,

At the heart of American politics lies a dread and a yearning. The dread is notorious. Americans fear public power as a threat to liberty. Their government is weak and fragmented, designed to prevent action more easily than to produce it. The yearning is an alternative faith in direct, communal democracy. Even after the loose collection of agrarian colonies had evolved into a dense industrial society, the urge remained: the people would, somehow, put aside their government and rule themselves directly.

In no aspect of American life is this "dread and yearning" more visible or relevant than in regard to health and health policy. Despite government's substantive role in health policy, which is more fully explored in subsequent chapters, and its role as a provider of health services in government facilities, most of the resources used in the pursuit of health in the United States are under the control of the private sector. Even when government is involved in health affairs, it often seeks ways to ensure broader access to health services that are provided predominantly through the private sector. The operation of the Medicare and Medicaid programs provide clear examples ofthis approach. Public dollars purchase services in the private sector for the beneficiaries of these programs. Overviews of the Medicare and Medicaid programs are provided as Appendixes A and B, respectively, at the end of the book. These programs and the policies that guide them are so important to an understanding of health policy and its impact on health that it is useful to read the overviews now; the information provided will be helpful throughout the book.

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Responses

  • onni
    What are the three interconnected phases of health policy making how do they affect each other?
    7 years ago
  • welde
    Can anyone define what health policy is?
    7 years ago
  • SINIT
    What are three interconnected phases of health care policy making?
    6 years ago
  • amanuel
    Why is the three interconnected phases of health care policy important?
    6 years ago
  • SAVANNAH
    How is health policy made?
    6 years ago

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