U.S. Health Policy Groups: Institutional Profiles

U.S. Health Policy Groups: Institutional Profiles

U.S. Health Policy Groups: Institutional Profiles

U.S. Health Policy Groups: Institutional Profiles

Excerpt

The sheer size and complexity of the U.S. health care sector contributes to the wide spectrum of interests that organize to influence public policymaking. With nearly 15 percent of all economic activity flowing through this sector, the economic stakes are very high. The national health policy arena involves a complex series of interrelated issues and policy actors that have evolved over this century in response to forces in the private and public sectors. The ongoing tensions and intense episodes of policymaking activities are rooted in the fact that the personal health concerns of individual citizens are entangled with the interests of professional health care providers; the economic interests of employer and employee overlap and clash; and the private and government sectors warily acknowledge their common goals and divergent instincts.

In the nineteenth century the provision of health care services was at a very primitive stage of development (Starr, 1982). By midcentury health care providers, mainly physicians and dentists, began to address their rudimentary concerns for professional status by working for licensing laws at the state level (Shyrock, 1967). The public health movement also began to assert itself in the face of epidemics of contagious diseases and the basic sanitation needs of an increasingly urbanized society (Rosen, 1958). However, only a handful of the policy groups profiled in this book, or their predecessors, existed during this period. Virtually none of the policymaking activity occurred at the federal level.

By the first few decades of the twentieth century, hospitals organized as they became more effective treatment centers, physician specialty groups began to multiply as medical science advanced, and public crusades to eradicate certain notable diseases (e.g., tuberculosis, cancer) began to emerge (Shorter, 1987). These developments were immediately followed by a series of far-reaching changes occurring from the 1920s into the 1950s that created the foundation for . . .

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