Healthcare policy refers to the decisions, actions, and regulations that shape the healthcare system. Policies are influenced by wider forces such as socioeconomic conditions, legal frameworks, and technological change, making healthcare policy a very broad field. Choices made by health policymakers have far-reaching and potentially life-altering effects. Public health, patient safety, and the well-being of healthcare staff depend on policies made at the federal, state, and local levels.

Patients, Presidents and Pandemics: Who and What Shapes Healthcare Policy?

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Healthcare policy has two key functions: to determine the funding and regulation of healthcare provision in the US and to coordinate responses to new challenges such as the COVID-19 pandemic. Given that the Centers for Medicare & Medicaid Services declared in 2021 that the US government’s healthcare spending amounted to 18.3% of the nation’s GDP, health policy is no small issue. When analyzing healthcare policy, it is important to remember that healthcare providers have different relationships from government policies depending on their business structure. For example, privately funded hospitals are subject to healthcare regulations but are less affected by government funding policies than state-funded hospitals. Nevertheless, it is possible to identify overarching themes in the way that healthcare policy is produced and implemented, and these themes are the subject of this article.

Understanding healthcare policy sheds light on the mechanisms of the healthcare system and helps us to comprehend the challenges faced by the healthcare system and to identify potential solutions. Read on for a brief overview of healthcare policy and its origins.

How is healthcare policy made?

Ultimately, healthcare policy is defined by the laws set by Congress. However, the interpretation and implementation of these laws are carried out by federal agencies, such as the Centers for Medicare & Medicaid Services (CMS), the Federal Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration (HRSA).

These bodies regulate and monitor every aspect of care – even including the quality of food provided by the hospitals! As well as responding to imminent challenges such as the COVID-19 pandemic, policymakers work toward more general goals, such as the improvement of care coordination and the protection of patient privacy. To do so, they must take into account legal, social, and technological factors.

Legal factors

As federal agencies implement legal regulations on healthcare, health policy is largely affected by changes in the upper echelons of power. As a result, policy priorities are subject to alteration depending on the changing politics of the federal government. For example, the Affordable Care Act of 2010 extended the Medicare healthcare coverage budget so that more Americans were insured against steep medical fees, and was signed into US law by President Barack Obama. However, this legislation was partially repealed under the Trump administration in 2019, displaying the extent to which healthcare policy is buffeted by political winds. Changes in healthcare law, even at the highest level, therefore have profound effects on patient experiences and access to healthcare across the whole country.

Social factors

Social factors shape healthcare policy because an individual’s health, and their ability to access care, are highly dependent on their identity and social class, as well as their geographic location. Factors such as economic background, sexuality, gender, and ethnic background have been highlighted by the American Hospital Association (AHA) as societal factors that influence health.

According to the AHA, significant disparity around health and health provision was especially evident during the COVID-19 pandemic, resulting in health policy responses such as increased data collection from patients in order to better document and understand health inequity. Understanding trends in hospital admission is crucial to proactive healthcare policy – such as the rise in influenza among infants.

Technological factors

Technological advancements continue to transform modern life, and healthcare is no exception. Health information technology (HIT) represents a key issue for health policymakers, on account of the vast opportunities and new risks that it poses. HIT advances such as videoconferencing and electronic patient records contribute to a more efficient health service. However, they also bring new risks to patient privacy and increase the health system’s vulnerability to ransomware and other forms of cyber-attack.

As new HIT products and services become available, healthcare policy must keep up with the times in order to make sure that the technology is appropriate, safe, and beneficial to healthcare providers. An example of such a policy is the Certified Health IT Product List, produced by the Office of the National Coordinator for Health Information Technology (ONC), which certifies new HIT based on safety and interoperability.

Why is knowledge of healthcare policy so important?

We have seen that healthcare policy is an all-encompassing issue, shaped by an intricate web of multiple factors. But how, in practical terms, an understanding of health policy issues be beneficial to those working in healthcare? The simple answer is that healthcare policy acts as a link between the social, political, and financial forces that influence healthcare, and the care that is provided on a day-to-day basis.

New regulations, funding allocations, and patient demands are filtered through healthcare policy – it is the policymakers who decide how healthcare institutions should respond to these changes. Furthermore, by analyzing the way that technology interacts with health policy, health practitioners can gain a better idea of the changes made to their profession, and the mechanisms of safeguarding and safety measures that accompany new equipment.

Knowledge of healthcare policy empowers nurses and other healthcare workers to take leadership roles and to have a greater say in how their own workplaces are managed. In a field as fascinating and complicated as it is essential, health policy is a great option for nurses looking to broaden their expertise.