the health policy process:
implications for healthcare
All governments in the developed world have a firm interest in shaping the healthcare industry. There are several reasons for this. Healthcare expenditures of a variety of payers, not least government, are significantly large and pressures on these expenditures are high. Since governments are major payers, they are accountable in a highly visible way for expenditure, not least at the ballot box. Every voter is a potential user of healthcare. Care and supplies are purchased from powerful corporate bodies or professional groups. There is a large difference in knowledge between providers (and their suppliers) and users (and often payers) of care, which may result in excessive care and avoidable costs. The healthcare sector employs a large number of people: for example, in the National Health Service (NHS) in England 1.3 million people out of a population of 49.1 million. The nature of healthcare is such that it is highly emotive and features frequently in the media, for there are distinct ideological and moral issues on which political parties are likely to disagree, for example, who pays for care (such as the individual, the employer, the government) and the factors which improve performance in health systems (for example, direct or indirect government intervention or market incentives). For these reasons, healthcare is rarely out of the sights of politicians.
It is no surprise then that governments and other payers regularly try to reform the healthcare sector. Managers working in provider or commissioning bodies are often at the receiving end of what might seem to be arbitrary and burdensome change. In doing their job it is important for them to understand, and therefore possibly predict, the pattern of reform that impinges on their work, partly to be able to plan better for change and where appropriate to attempt to modify the type and level of specific interventions.