What is Healthcare Policy?

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

In most capitalist, developed nations, except the United States, healthcare policy is based on universal access to healthcare. There are two general models. One is the single payer system, used in countries such as the United Kingdom and Canada and one is a social insurance system, used in countries such as Japan and Germany.

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

Countries like Taiwan have a hybrid of the single payer and social insurance systems. They require residents to buy healthcare insurance, but the government is the insurance company. Most of the countries requiring insurance have a mechanism to help people afford the premiums if they are unable.

The United States has a combination of both systems. Healthcare is financed primarily through private insurance companies which individuals usually access through their employers. It is not mandatory that individuals carry insurance and in fact, millions of people are uninsured in the United States. There are three main government sponsored programs as well.

Medicare is a government health program that provides health insurance to those 65 years and older, as well as some disabled people. Medicaid is a government health program that provides health insurance to the poor. It is restricted to certain categories of individuals, such as those receiving welfare payments and those who are disabled. The State Children’s Health Insurance program, also known as SCHIP, provides health insurance to uninsured, low income children.

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

Aside from the financing of health care, healthcare policy includes the prioritization of certain health care problems and special funds made available for research and increasing access. Thus, when President Richard Nixon declared a “War on Cancer” in 1971, he was setting healthcare policy by funneling millions of federal dollars into cancer research.

Similarly, throughout history other health issues have been targeted for special attention such as smallpox, AIDS, cigarette smoking, suicide prevention and substance abuse. Typically, issues gain prominence when those directly affected by them become organized and lobby their elected officials for resources or when reports come out which show a desperate need for action. In addition to funding for research, these public health initiatives usually include programs aimed at changing the behaviors that lead to the 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 can include public advertising to promote the use of condoms to help prevent the spread of AIDS, or information about the health risks of smoking. Programs to change behavior often focus on the doctor/patient relationship and the types of advice dispensed during routine office visits. In addition, programs often include support systems to those who are at risk of the health problem, such as suicide prevention hotlines.