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Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specifichealthcare goals 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]
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 health such asvaccination policy,tobacco control policy orbreastfeeding promotion policy. Health policy may also cover topics related to healthcare delivery, for example of financing and provision, access to care,quality of care, andhealth equity.[2]
Health policy also includes the governance and implementation of health-related policy, sometimes referred to as health governance,[3] health systems governance or healthcare governance.[4] Conceptual models can help show the flow from health-related policy development to health-related policy and program implementation and tohealth systems and 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.[5] 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.[6]
There are many aspects ofpolitics andevidence that can influence the decision of a government, private sector business or other group to adopt a specific policy.Evidence-based policy relies on the use of science and rigorous studies such asrandomized controlled trials to 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 eitherphilosophical oreconomic. 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]
The modern concept of healthcare involves access tomedical professionals from various fields as well asmedical technology, such asmedications andsurgical equipment. It also involves access to the latest information and evidence from research, includingmedical research andhealth 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 andpharmaceutical industries to develop research. Planning and production ofhealth human resources is 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 systems and therefore it often accounts for one of the largest areas of spending for bothgovernments and individuals all over the world.
Many countries and jurisdictions integrate ahuman rights philosophy in directing their healthcare policies. TheWorld Health Organization reports that every country in the world is party to at least one human rightstreaty that addresses health-related rights, including theright to health as well as other rights that relate to conditions necessary for good health.[7] TheUnited Nations'Universal Declaration of Human Rights (UDHR) asserts that medical care is a right of all people:[8]
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 organizations draw on the principles ofhumanism in defining their health policies, asserting the same perceived obligation and enshrinedright to health.[9][10] In recent years, the worldwide human rights organizationAmnesty International has focused onhealth as a human right, addressing inadequate access toHIV drugs and women'ssexual and reproductive rights including wide disparities inmaternal mortality within and across countries. Such increasing attention to health as a basic human right has been welcomed by the leading medical journalThe Lancet.[11]
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.[12] 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 privacy between 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.[13][14]
Another issue in the rights debate is governments' use of legislation to control competition among private medical insurance providers against nationalsocial insurance systems, such as the case inCanada's national health insurance program.Laissez-faire supporters argue that this erodes thecost-effectiveness of the health system, as even those who can afford to pay for private healthcare services drain resources from the public system.[15] The issue here is whether investor-owned medical insurance companies orhealth maintenance organizations are 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.[16]
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 completecapitalization of personal health care services through private companies, andmedical savings accounts, among others.[17][18] 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:
Claims that privately funded healthcare leads to greater quality and efficiencies in personal health care:
Health policy options extend beyond the financing and delivery of personal health care, to domains such asmedical research andhealth workforce planning, both domestically and internationally.
Medical research can 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.[26] 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.[24][27]
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.[28] A change of government eventually led to a change in policy, with new policies implemented for widespread access to HIV services.[29] Another issue relates tointellectual property, as illustrated by the case of Brazil, where debates have arisen over government policy authorizing the domestic manufacture ofantiretroviral drugs used in the treatment of HIV/AIDS in violation ofdrug patents.
Some countries and jurisdictions have an explicit policy or strategy to plan for adequate numbers, distribution and quality ofhealth workers to meet healthcare goals, such as to addressphysician andnursing shortages. Elsewhere, workforce planning is distributed among labour market participants as alaissez-faire approach to health policy. Evidence-based policies for workforce development are typically based on findings fromhealth services research.
Many governments and agencies include a health dimension in theirforeign policy in order to achieveglobal health goals. Promoting health in lower income countries has been seen as instrumental to achieve other goals on the global agenda, including:[30]
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."[31] 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.[32]
TheEU contributes 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 countries hold primary responsibility for organizing and deliveringhealth services and medical care. Therefore, EU health policy works to supplement national policies, assure health protection in all EU measures and to strengthen the Health Union.[33]The goals of EU public health policies and initiatives are to protect and improve the health of EUresidents, promote themodernization anddigitalization of health systems and infrastructure, increase the resilience of Europe's health systems, and improve the ability of EUmember states to prevent and respond topandemics in the future.In a senior-level working group on public health, representatives from theEuropean Commission and nationalgovernments debate 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.[34]
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.[35]
TheTreaty on the Functioning of the European Union grants 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,Pharmaceuticals and medical devices (pharmacovigilance, falsified medicines, clinical trials), Health security andinfectious diseases, Digital health and care, Tobacco, organs, blood, tissues and cells. TheCouncil of the EU can also send recommendations on public health to member states.[36]
EU citizens are entitled, bylaw, to receive healthcare in any member state of the EU and to have theirhome nation compensate them for care received elsewhere.[37] 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.[38]
The EU regulates theauthorisation of medicines at EU level by theEuropean Medicines Agency or at the national level by the appropriate authorities in the EU member states.[39]
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.[40]
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,infrastructure and other broader health-related issues, in particular[45]
