Question

Within our health care system there are a number of stakeholders that influence the health care policy development process and ultimately help shape our health care policies.

• Government (primarily federal and state governments) and interest groups like the American Medical Association, AARP, and the Henry J. Kaiser Family Foundation can have a direct impact on the outcome on the type of health care we receive.
• Patients (the largest consumers of health care) are stakeholders in the health care system, and the needs and wants of the public also drive the decisions made by health care decision-makers.

This assignment will help you better understand the role and influences of the main stakeholders in the health care policy development process.

Research the main stakeholders in the health care policy development process.

Select one of the main stakeholders at the government level (federal or state), a professional organization, or an interest group.

• Identify the stakeholder and their level in the policy development process.
• Describe their role in the policy development process.
• Describe why the stakeholder identified is important in the policy development process.
• Describe the impact the selected stakeholder has on the policy development process.

Answer 1

The term stakeholder has been defined as ''a person who has something to gain or lose through the outcomes of a planning process, program, or project''. The different stakeholders participated in a policy development process includes diverse groups of patients, research participants, the public, providers, researchers, advocacy groups, payers, policymakers etc.

Policymakers establish the framework within which health care is provided to the country’s citizens. The policymakers aggregate data from patients, providers, and payors to develop population-level metrics that inform their health and health economic policies.

Payers. Payers operationalize the financial elements of the policy framework. Payers enrol patients as beneficiaries. They procure care services from the providers on behalf of their patient beneficiaries. They also must take on the actuarial task of ensuring the financial sustainability of the care program. They report to policymakers.

Policymakers set the context within which the health care system operates. Providers and payers are regulated by these policies and operate within them. Ideally, the policies are designed to maximize the health of the population within the country’s financial and resource constraints.

The payers’ view is dominated by their role as procurers of services on behalf of their beneficiaries. In financial terms, payors and providers have a customer/supplier relationship. Of course, in turn, patients may have a choice of payors, and so payors may have a supplier/customer relationship with their patient beneficiaries. To be sustainable, payors endeavour to minimize the costs of funding their portfolios of care services. This incentivizes payors to encourage and even invest in the uptake of healthy-living initiatives within their beneficiary population.