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Health policy

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This article is about policies, plans and strategies across the healthcare sector. For health insurance policies, seeHealth insurance.For the academic journal, seeHealth Policy (journal).
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Health policycan be defined as the "decisions, plans, and actions that are undertaken to achieve specifichealthcaregoals within a society ".[1]According to theWorld Health Organization,an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people.[1]

Different approaches[edit]

Health policy often refers to the health-related content of a policy. Understood in this sense, there are many categories of health policies, including global health policy, public health policy, mental health policy, health care services policy,insurance policy,personal healthcare policy,pharmaceutical policy,and policies related topublic healthsuch asvaccination policy,tobacco control policyorbreastfeeding promotionpolicy. Health policy may also cover topics related to healthcare delivery, for example of financing and provision, access to care,quality of care,andhealth equity.[citation needed]

Health policy also includes the governance and implementation of health-related policy, sometimes referred to as health governance,[2]health systems governance or healthcare governance.[3]Conceptual models can help show the flow from health-related policy development to health-related policy and program implementation and tohealth systemsand health outcomes. Policy should be understood as more than a national law or health policy that supports a program or intervention. Operational policies are the rules, regulations, guidelines, and administrative norms that governments use to translate national laws and policies into programs and services.[4]The policy process encompasses decisions made at a national or decentralized level (including funding decisions) that affect whether and how services are delivered. Thus, attention must be paid to policies at multiple levels of the health system and over time to ensure sustainable scale-up. A supportive policy environment will facilitate the scale-up of health interventions.[5]

There are many aspects ofpoliticsandevidencethat can influence the decision of a government, private sector business or other group to adopt a specific policy.Evidence-based policyrelies on the use of science and rigorous studies such asrandomized controlled trialsto identify programs and practices capable of improving policy relevant outcomes. Most political debates surround personal health care policies, especially those that seek toreform healthcare delivery,and can typically be categorized as eitherphilosophicaloreconomic.Philosophical debates center around questions aboutindividual rights,ethics and government authority, while economic topics include how to maximize the efficiency of health care delivery and minimize costs.[citation needed]

Countries with universal health care
Countries with universal health care
Countries without universal healthcare
Countries without universal healthcare
Unknown

The modern concept of healthcare involves access tomedical professionalsfrom various fields as well asmedical technology,such asmedicationsandsurgical equipment.It also involves access to the latest information and evidence from research, includingmedical researchandhealth services research.[citation needed]

In many countries it is left to the individual to gain access to healthcare goods and services by paying for them directly asout-of-pocket expenses,and to private sector players in the medical andpharmaceuticalindustries to develop research. Planning and production ofhealth human resourcesis distributed among labour market participants.[citation needed]

Other countries have an explicit policy to ensure and support access for all of its citizens, to fund health research, and to plan for adequate numbers, distribution and quality of health workers to meet healthcare goals. Many governments around the world have establisheduniversal health care,which takes the burden of healthcare expenses off of private businesses or individuals through pooling of financial risk. There are a variety of arguments for and against universal healthcare and related health policies. Healthcare is an important part ofhealth systemsand therefore it often accounts for one of the largest areas of spending for bothgovernmentsand individuals all over the world.

Personal healthcare policy options[edit]

Philosophy: right to health[edit]

See also:Philosophy of healthcare

Many countries and jurisdictions integrate ahuman rightsphilosophy in directing their healthcare policies. TheWorld Health Organizationreports that every country in the world is party to at least one human rightstreatythat addresses health-related rights, including theright to healthas well as other rights that relate to conditions necessary for good health.[6]TheUnited Nations'Universal Declaration of Human Rights(UDHR) asserts that medical care is a right of all people:[7]

  • UDHRArticle 25:"Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, illness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."

In some jurisdictions and among differentfaith-based organizations,health policies are influenced by the perceived obligation shaped by religious beliefs to care for those in less favorable circumstances, including the sick. Other jurisdictions andnon-governmental organizationsdraw on the principles ofhumanismin defining their health policies, asserting the same perceived obligation and enshrinedright to health.[8][9]In recent years, the worldwide human rights organizationAmnesty Internationalhas focused onhealthas a human right, addressing inadequate access toHIVdrugs and women'ssexual and reproductiverights including wide disparities inmaternal mortalitywithin and across countries. Such increasing attention to health as a basic human right has been welcomed by the leading medical journalThe Lancet.[10]

There remains considerable controversy regarding policies on who would be paying the costs of medical care for all people and under what circumstances. For example, government spending on healthcare is sometimes used as a global indicator of a government's commitment to the health of its people.[11]On the other hand, one school of thought emerging from the United States rejects the notion of health care financing through taxpayer funding as incompatible with the (considered no less important) right of the physician's professional judgment, and the related concerns that government involvement in overseeing the health of its citizens could erode theright to privacybetween doctors and patients. The argument furthers that universal health insurance denies the right of individual patients to dispose of their own income as per their own will.[12][13]

Another issue in the rights debate is governments' use of legislation to control competition among private medical insurance providers against nationalsocial insurancesystems, such as the case inCanada's national health insurance program.Laissez-fairesupporters argue that this erodes thecost-effectivenessof the health system, as even those who can afford to pay for private healthcare services drain resources from the public system.[14]The issue here is whether investor-owned medical insurance companies orhealth maintenance organizationsare in a better position to act in the best interests of their customers compared to government regulation and oversight. Another claim in the United States perceives government over-regulation of the healthcare and insurance industries as the effective end of charitable home visits from doctors among the poor and elderly.[15]

Economics: healthcare financing[edit]

Public and private health expenditure by country

Many types of health policies exist focusing on the financing of healthcare services to spread the economic risks of ill health. These includepublicly funded health care(through taxation or insurance, also known as single-payer systems), mandatory or voluntary privatehealth insurance,and completecapitalizationof personal health care services through private companies, among others.[16][17]The debate is ongoing on which type of health financing policy results in better or worse quality of healthcare services provided, and how to ensure allocated funds are used effectively, efficiently andequitably.

There are many arguments on both sides of the issue of public versus private health financing policies:

Claims that publicly funded healthcare improves the quality and efficiency of personal health care delivery:

  • Government spending on health is essential for the accessibility and sustainability of healthcare services and programmes.[11]
  • For those people who would otherwise go without care due to lack of financial means, any quality care is an improvement.
  • Since people perceive universal healthcare asfree(if there is no insurance premium or co-payment), they are more likely to seekpreventive carewhich may reduce the disease burden and overall healthcare costs in the long run.[18]
  • Single-payer systems reduce wastefulness by removing the middle man, i.e. private insurance companies, thus reducing the amount of bureaucracy.[19]In particular, reducing the amount of paperwork that medical professionals have to deal with for insurance claims processing allows them to concentrate more on treatingpatients.[citation needed]

Claims that privately funded healthcare leads to greater quality and efficiencies in personal health care:

  • Perceptions that publicly funded healthcare isfreecan lead to overuse of medical services, and hence raise overall costs compared to private health financing.[20][21]
  • Privately funded medicine leads to greater quality and efficiencies through increased access to and reduced waiting times for specialized health care services and technologies.[12][22][23]
  • Limiting the allocation of public funds for personal healthcare does not curtail the ability of uninsured citizens to pay for their healthcare asout-of-pocket expenses.Public funds can be better rationalized to provideemergency careservices regardless of insured status or ability to pay, such as with theEmergency Medical Treatment and Active Labor Actin the United States.[citation needed]
  • Privately funded and operated healthcare reduces the requirement for governments to increase taxes to cover healthcare costs, which may be compounded by the inefficiencies among government agencies due to their greater bureaucracy.[22][24]

Other health policy areas[edit]

Health policy options extend beyond the financing and delivery of personal health care, to domains such asmedical researchandhealth workforceplanning, both domestically and internationally.

Medical research policy[edit]

Medical researchcan be both the basis for defining evidence-based health policy, and the subject of health policy itself, particularly in terms of its sources of funding. Those in favor of government policies for publicly funded medical research posit that removing profit as a motive will increase the rate of medicalinnovation.[25]Those opposed argue that it will do the opposite, because removing the incentive of profit removes incentives to innovate and inhibits new technologies from being developed and utilized.[23][26]

The existence of sound medical research does not necessarily lead to evidence-based policymaking. For example, in South Africa, whose population sets the record forHIV infections,previous government policy limiting funding and access for AIDS treatments met with strong controversy given its basis on a refusal to accept scientific evidence on the means of transmission.[27]A change of government eventually led to a change in policy, with new policies implemented for widespread access to HIV services.[28]Another issue relates tointellectual property,as illustrated by the case of Brazil, where debates have arisen over government policy authorizing the domestic manufacture ofantiretroviral drugsused in the treatment of HIV/AIDS in violation ofdrug patents.

Health workforce policy[edit]

Main article:Health workforce

Some countries and jurisdictions have an explicit policy or strategy to plan for adequate numbers, distribution and quality ofhealth workersto meet healthcare goals, such as to addressphysicianandnursing shortages.Elsewhere, workforce planning is distributed among labour market participants as alaissez-faireapproach to health policy. Evidence-based policies for workforce development are typically based on findings fromhealth services research.

Health in foreign policy[edit]

Many governments and agencies include a health dimension in theirforeign policyin order to achieveglobal healthgoals. Promoting health in lower income countries has been seen as instrumental to achieve other goals on the global agenda, including:[29]

  • Promotingglobal security– linked to fears of globalpandemics,the intentional spread ofpathogens,and a potential increase in humanitarian conflicts, natural disasters, and emergencies;
  • Promotingeconomic development– including addressing the economic effect of poor health on development, of pandemic outbreaks on the global market place, and also the gain from the growing global market in health goods and services;
  • Promotingsocial justice– reinforcing health as a social value and human right, including supporting the United Nations'Millennium Development Goals.

Global health policy[edit]

Global health policy encompasses the global governance structures that create the policies underlying public health throughout the world. In addressing global health, global health policy "implies consideration of the health needs of the people of the whole planet above the concerns of particular nations."[30]Distinguished from both international health policy (agreements among sovereign states) and comparative health policy (analysis of health policy across states), global health policy institutions consist of the actors and norms that frame the global health response.[31]

EU health policy[edit]

EUcontributes to the improvement of public health through financing and laws addressing medications, patient rights in cross-border healthcare, illness prevention, and the promotion of good health.EU countrieshold primary responsibility for organizing and deliveringhealth servicesand medical care. Therefore, EU health policy works to supplement national policies, assure health protection in all EU measures and to strengthen the Health Union.[32] The goals of EU public health policies and initiatives are to protect and improve the health of EUresidents,promote themodernizationanddigitalizationof health systems and infrastructure, increase the resilience of Europe's health systems, and improve the ability of EUmember statesto prevent and respond topandemicsin the future. In a senior-level working group on public health, representatives from theEuropean Commissionand nationalgovernmentsdebate strategic health concerns. The EU's health policy and yearly work programmes are implemented with the assistance of member states, institutions, and other interest groups.[33]

European Commission's role[edit]

The European Commission's Directorate for Health and Food Safety assists member states in their efforts to protect and improve the health of their people and to guarantee the accessibility, efficiency, and resilience of their healthcare structures. This is accomplished in a number of ways, such as by proposinglegislation,providingfinancial support,coordinating and facilitating the exchange of best practices between EU countries and health experts and by health promotion activities.[34]

Legislation[edit]

TheTreaty on the Functioning of the European Uniongrants the EU the authority to enact health legislation in accordance with Article 168 (protection of public health), Article 114 (single market), andArticle 153(social policy). The EU has adopted legislation in following areas: Patient's rights in cross-border healthcare,Pharmaceuticalsand medical devices (pharmacovigilance, falsified medicines, clinical trials), Health security andinfectiousdiseases, Digital health and care, Tobacco, organs, blood, tissues and cells. TheCouncil of the EUcan also send recommendations on public health to member states.[35]

Patients' rights in cross-border healthcare[edit]

EU citizens are entitled, bylaw,to receive healthcare in any member state of the EU and to have theirhome nationcompensate them for care received elsewhere.[36]The European Health Insurance Card (EHIC) guarantees that essential medical care is given under the same conditions and at the same cost as people insured in that country.[37]

Medicines and medical devices[edit]

The EU regulates theauthorisationof medicines at EU level by theEuropean Medicines Agencyor at the national level by the appropriate authorities in the EU member states.[38]

Cross-border health threats[edit]

To guarantee a high degree of health protection in the European Union, monitoring, early warning, preparedness, and reaction measures to counter major cross-border threats to health are crucial. The European Centre for Disease Prevention and Control (ECDC) offers EU member states independent scientific advice, support, and knowledge on public health risks, including infectious diseases.[39]

Promoting health and tackling diseases[edit]

  • Tobacco- With over 700 000 deaths annually, tobacco use is the single biggest preventable health risk and the leading contributor to prematuremortalityin theEuropean Union(Approximately 50% of smokers pass away too soon, on average, 14 years before non-smokers). The tobacco products directive establishes guidelines for the production, labeling, and retailing of tobacco and associated goods. Hightariffson tobacco products were implemented by another directive on the structure and rates ofexcise dutyapplied to manufactured tobacco, with the goal of reducing tobacco consumption, particularly among youth. The 2009 Council recommendation on smoke-freeenvironmentsrequires all EU member states to take precautions against tobacco smoke exposure for individuals at public places and work.[42]
  • Vaccination-Vaccination policyis a competence of member states. The EU helps its member states coordinate their policies and initiatives. In December 2018 the Council approved a recommendation to enhance EU cooperation on diseases that can be prevented by vaccination. This project sets out guidance on addressingvaccine hesitancy,increasing vaccination rates, encouraging procurement coordination for vaccines, and supporting research andinnovation.In December 2022, EU ministers of health approved Council conclusions on vaccination as one of the best methods for preventingillnessand improving public health. The conclusions focus on two areas of action: fighting vaccine reluctance and preparing for upcoming challenges through EU cooperation.[43]

Investing in health[edit]

The EU4Health program provides funds to tackle cross-border health concerns, improve the availability and cost of medical equipment, pharmaceuticals, other crisis-relevant items, and strengthen the resilience of health systems. Other EU programmes further finance healthcare systems, health research,infrastructureand other broader health-related issues, in particular[44]

  • Horizon Europe health cluster - supports innovation and research to create a resilient EU ready to face new challenges, for high-quality digital services that are available to everyone, and accessible, high-quality healthcare.[45]
  • EUcohesion funds- invest in health in EU countries and regions
  • Resilience and recovery facility[46]

See also[edit]

References[edit]

  1. ^abWorld Health Organization.Health Policy,accessed 22 March 2011.(archived 5 February 2011).
  2. ^Barbazza, Erica; Tello, Juan E. (2014-05-01)."A review of health governance: Definitions, dimensions and tools to govern".Health Policy.116(1): 1–11.doi:10.1016/j.healthpol.2014.01.007.ISSN0168-8510.PMID24485914.
  3. ^Kuhlmann, Ellen; Blank, Robert H.; Bourgeault, Ivy Lynn; Wendt, Claus (2015), Kuhlmann, Ellen; Blank, Robert H.; Bourgeault, Ivy Lynn; Wendt, Claus (eds.),"Healthcare Policy and Governance in International Perspective",The Palgrave International Handbook of Healthcare Policy and Governance,London: Palgrave Macmillan UK, pp. 3–19,doi:10.1057/9781137384935_1,ISBN978-1-137-38493-5,retrieved2022-10-03
  4. ^Cross, H, N Jewell and Karen Hardee. 2001.Reforming Operational Policies: A Pathway to Improving Reproductive Health ProgramsPOLICY Occasional Paper. No. 7. Washington DC: The Futures Group International, POLICY Project
  5. ^K. Hardee, L. Ashford, E. Rottach, R. Jolivet, and R. Kiesel. 2012.The Policy Dimensions of Scaling Up Health Initiatives.Washington, DC: Futures Group, Health Policy Project
  6. ^World Health Organization.Health and Human Rights.Geneva. Accessed 27 May 2011.
  7. ^United Nations.The Universal Declaration of Human Rights.Adopted on December 10, 1948 by the General Assembly of the United Nations.
  8. ^National Health Care for the Homeless Council."Human Rights, Homelessness and Health Care."Archived2007-06-10 at theWayback Machine
  9. ^Center for Economic and Social Rights."The Right to Health in the United States of America: What Does it Mean?"Archived2008-11-19 at theWayback MachineOctober 29, 2004.
  10. ^The Lancet (2011). "Half a century of Amnesty International".The Lancet.377(9780): 1808.doi:10.1016/S0140-6736(11)60768-X.PMID21621708.S2CID40269196.
  11. ^abLu, C.; Schneider, M. T.; Gubbins, P.; Leach-Kemon, K.; Jamison, D.; Murray, C. J. (2010). "Public financing of health in developing countries: A cross-national systematic analysis".The Lancet.375(9723): 1375–1387.doi:10.1016/S0140-6736(10)60233-4.PMID20381856.S2CID25760026.
  12. ^abSade, R. M. (1971). "Medical Care as a Right: A Refutation".New England Journal of Medicine.285(23): 1288–1292.doi:10.1056/NEJM197112022852304.PMID5113728.(Reprinted as"The Political Fallacy that Medical Care is a Right.")
  13. ^The Cato Institute.Universal Health Care Won't Work – Witness Medicare.
  14. ^Tanner MD.Revolt Against Canadian Health Care System Continues."Cato-at-liberty" – The Cato Institute, August 2006.
  15. ^David E. Kelley, "A Life of One's Own: Individual Rights and the Welfare State."Cato Institute,October 1998,ISBN1-882577-70-1
  16. ^Kereiakes, D. J.; Willerson, J. T. (2004)."US Health Care: Entitlement or Privilege?".Circulation.109(12): 1460–1462.doi:10.1161/01.CIR.0000124795.36864.78.PMID15051650.
  17. ^World Health Organization.Health financing policy.Geneva. Accessed 27 May 2011.
  18. ^Sable-Smith, Alex, Arnett, Kelly R, Nowels, Molly A, Colborn, Kathryn, Lum, Hillary D, and Nowels, David. "Interactions with the Healthcare System Influence Advance Care Planning Activities: Results from a Representative Survey in 11 Developed Countries." Family Practice 35.3 (2017): 307-11. Web.
  19. ^William F May."The Ethical Foundations of Health Care Reform."Archived2017-07-06 at theWayback MachineThe Christian Century,June 1–8, 1994, pp. 572–76.
  20. ^Heritage Foundation News Release,"British, Canadian Experience Shows Folly of Socialized Medicine, Analyst Says."Archived2009-04-17 at theWayback MachineSept. 29, 2000
  21. ^Heritage Foundation News Release,"The Cure: How Capitalism Can Save American Health Care."Archived2010-03-08 at theWayback MachineDecember 18, 2006.
  22. ^abGoodman, John."Five Myths of Socialized Medicine."Cato Institute:Cato's Letter.Winter, 2005.
  23. ^abFriedmen, David.The Machinery of Freedom.Arlington House Publishers: New York, 1978. pp. 65–9.
  24. ^The Cato Institute.Cato Handbook on Policy, 6th Edition– Chapter 7: "Health Care."Archived2006-12-29 at theWayback MachineWashington, 2005.
  25. ^For example, the recent discovery that dichloroacetate (DCA) can cause regression in several cancers, including lung, breast and brain tumors.Alberta scientists test chemotherapy alternative Last Updated: Wednesday, January 17, 2007The DCA compound is not patented or owned by any pharmaceutical company, and, therefore, would likely be an inexpensive drug to administer, Michelakis added. The bad news, is that while DCA is not patented, Michelakis is concerned that it may be difficult to find funding from private investors to test DCA in clinical trials.University of Alberta – Small molecule offers big hope against cancer. January 16, 2007ArchivedFebruary 27, 2007, at theWayback Machine
  26. ^Miller RL; DK Benjamin; DC North (2003).The Economics of Public Issues(13th ed.). Boston: Addison-Wesley.ISBN978-0321118738.
  27. ^"Controversy dogs Aids forum."BBC News,10 July 2000.
  28. ^"HIV and AIDS in South Africa."Avert.Accessed 23 June 2011.
  29. ^Kickbusch, I. (2011). "Global health diplomacy: How foreign policy can influence health".BMJ.342:d3154.doi:10.1136/bmj.d3154.PMID21665931.S2CID10914700.
  30. ^Brown, T. M.; Cueto, M.; Fee, E. (2006)."The World Health Organization and the Transition from" International "to" Global "Public Health".American Journal of Public Health.96(1): 62–72.doi:10.2105/AJPH.2004.050831.PMC1470434.PMID16322464.
  31. ^Szlezák, N. A.; Bloom, B. R.; Jamison, D. T.; Keusch, G. T.; Michaud, C. M.; Moon, S.; Clark, W. C. (2010). Walt, Gill (ed.)."The Global Health System: Actors, Norms, and Expectations in Transition".PLOS Medicine.7(1): e1000183.doi:10.1371/journal.pmed.1000183.PMC2796301.PMID20052277.
  32. ^ EU health policy. (n.d.). Consilium.[1]
  33. ^ Overview. (2024, April 29). Public Health.[2]
  34. ^ Health and food safety. (n.d.). European Commission.[3]
  35. ^ European Health Policy – progress through diversity. (n.d.).[4]
  36. ^EU health policy. (n.d.). Consilium.[5]
  37. ^ European Health Insurance Card. (n.d.). Employment, Social Affairs & Inclusion - European Commission.[6]
  38. ^ Overview. (2024a, April 17). Public Health.[7]
  39. ^ Preparedness, prevention and control tools. (2023, March 22). European Centre for Disease Prevention and Control.[8]
  40. ^Council updates its recommendation to screen for cancer. (n.d.). Consilium.[9]
  41. ^Protecting workers: health and safety at work. (n.d.). Consilium.[10]
  42. ^ EUR-LEX - 32009H1205(01) - EN - EUR-LEX. (n.d.).[11]
  43. ^Vaccination: Council calls for combatting vaccine hesitancy and closer EU cooperation (n.d.). Consilium.[12]
  44. ^EU4Health programme 2021-2027 – a vision for a healthier European Union. (2024, April 29). Public Health.[13]
  45. ^Cluster 1: Health. (2024, April 15). Research and Innovation.[14]
  46. ^Overview. (2024, April 29). Public Health.[15]

External links[edit]

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