Another important feature of the public policymaking process shown in Figure 3.2 is that the entire process is influenced by factors external to the process itself. This makes the policymaking process an open system, one in which the process interacts with and is affected by events and circumstances in its external environment. This important phenomenon is shown in the model by the impact ofthe preferences ofthe individuals, organizations, and interest groups that are affected by policies—along with biological, cultural, demographic, ecological, economic, ethical, legal, psychological, social, and technological inputs—on the policymaking process.
Legal inputs, which include decisions made in the courts, are themselves policies as was discussed in Chapter 1. In addition, however, decisions made within the legal system are important influences on the other decisions made within the policymaking process. Legal inputs help shape all other policy decisions, including reversing them on occasion when they are not consistent with the constitution.
The impact of technology provides another example of the effect of external factors on the policymaking process. The United States is the world's major producer and consumer of health-related technology. As the policymak-ing model shows, technological inputs flow into the policymaking process. Among other impacts, the costs of new technologies must be factored into public, as well as private, insurance programs. The Real World of Health Policy: Congressional Budget Office Director Testifies on the Role of Technology in the Continuing Growth in Health Care Spending discusses the role oftech-nology in health spending and its impact on health policymaking. Figure 3.2 also shows that technology is affected by the policies produced by the process. Congressional decisions regarding the annual funding for the National Institutes of Health are good examples of such impacts.
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