What’s health policy?

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Healthcare policy refers to the myriad rules, regulations, and guidelines that exist to operate, finance, and shape healthcare. More of a hodgepodge than an actual policy, health policy covers a range of health-related issues, including: health care financing, public health, preventive health care, chronic disease and disability, long-term care, and mental health.

In most developed and capitalist nations, with the exception of the United States, health policy is based on universal access to health care. There are two general patterns. One is the single payment system, used in countries like the UK and Canada and one is a social insurance system, used in countries like Japan and Germany.

In the single payer model, taxes are paid to the government which then pays healthcare professionals such as doctors, nurses and dentists to provide healthcare services to individuals. In a social insurance system, citizens are required to purchase health insurance, usually from non-profit insurance companies. Then they use this health insurance to pay for the services provided by health care providers.

Countries like Taiwan have a hybrid of the single payment system and social insurance. They require residents to purchase health insurance, but the government is the insurance company. Most countries that require insurance have a mechanism to help people afford premiums if they are unable to.

The US has a combination of both systems. Healthcare is mainly funded by private insurance companies which people usually access through their employers. It is not mandatory for individuals to have insurance and in fact millions of people are uninsured in the United States. There are also three major government sponsored programs.

Medicare is a government health program that provides health insurance to those age 65 and over, as well as some people with disabilities. Medicaid is a government health program that provides health insurance to the poor. It is limited to certain categories of individuals, such as those receiving welfare payments and those with disabilities. The State Children’s Health Insurance program, also known as SCHIP, provides health insurance to uninsured and low-income children.

Health policy in developing countries often consists of a government-sponsored network of hospitals and clinics, with the goal of providing universal access. Many times this exists alongside a private provider system for which individuals pay out of pocket. Typically, as countries become more developed, the demand for health services grows.

In addition to health care funding, health policy includes prioritizing certain health issues and making special funds available for research and increasing access. So when President Richard Nixon declared a “war on cancer” in 1971, he was shaping health care policy by funneling millions of federal dollars into cancer research.

Similarly, throughout history other health issues have come under special scrutiny such as smallpox, AIDS, cigarette smoking, suicide prevention, and substance abuse. Typically, issues gain importance when those directly affected by them organize and lobby elected officials for resources, or when reports come out showing a desperate need for action. In addition to research funding, these public health initiatives usually include programs aimed at changing behaviors that lead to targeted health risk or, in the case of a disease such as smallpox, providing easy access to vaccinations to eradicate the disease.

Behavior-changing programs may include public advertising to promote condom use to help prevent the spread of AIDS or information about the health risks of smoking. Behavior change programs often focus on the doctor/patient relationship and the types of counseling provided during routine office visits. Additionally, programs often include support systems for those at risk of health problems, such as suicide prevention hotlines.

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