Political Process: Healthcare Policy-Making Process


Politics may be defined as activities that involve the governing of society. Social life and public policy are directly influenced by the political process, which considerably relates to the objectives and direction of a society. A policy can be proposed through individual or pressure groups, who use extant mobilizing structures for collective action, although their influence is not limited to the structures at times. In liberal democracies such as in the United States, freedom of association and expression are encouraged in the society for a more open and dynamic display of political activity than in the closed repressive system of governments that do not tolerate groups, drumming up support for alternative policies. Therefore, the political process sets a momentous stage for any individual or factions desiring to uphold their own interests and objectives. It sets out a relentless process for groups contending to influence government formal institutions so that official policies replicate their goals and preferences. Since government policies have a bearing on society, such a political process usually starts with the people who as individuals or groups, are affected and affect the policies. Political parties along with the interest groups and the media serve an important role in making public policies and issues get referenced on the government’s policymaking schedule. These procedures are quite visible in the Healthcare reform process due to their implication on the general public.

Healthcare reform policy undergoes a vigorous political process since it is similar and linked to several other policy areas. Further, it is part of the general social policy on the nation. It relates to the pursuit of health, delivery of healthcare services, or even employment of healthcare professionals. The high cost of healthcare is just one of the most enduring problems in America, with both the private and public sectors experiencing spiraling costs in healthcare. Therefore, this means that the formulation of Healthcare policy is vastly influenced by the diversity and array of both economic and social factors that affect the development of social policy. Currently, the United States government plays a key role in the financing, directing, and planning of healthcare services. The policy stream in healthcare usually consists of experts and specialists in the field, who may both be inside the government or in the private sector, and advocate their ideas and solutions to the underlying problems. We are therefore going to look at the procedures involved in the healthcare policy-making process.

Agenda Setting

This is the first stage of this policymaking process and it involves the agenda-setting process, with an ardent identification of public problem or issue and its placement on the government’s policy agenda. The issue, problem definition and enlistment of support move the subjects at hand to the government’s policy agenda, together with the current issues being addressed by ‘public policymakers’. When seeking such a policy change in healthcare reform, which has great effect on society, the identification of the body holding the policy jurisdiction over the matter is vital in this stage (Wallace, 2003). During this process, some apprehensions may rise to the attention of policymakers, while others may simultaneously receive minimal attention or completely be neglected. Despite the high importance of the policy, if the problem is not recognized at this stage, then politically it does not really exist. The agenda-setting should have an issue on the political schema for it to be addressed by congress.

The Formulation Stage

This is the second stage of the healthcare policymaking process that involves the president, administrative agencies, interest groups, and members of congress. The interest groups usually play a major role in the development of proposed legislation. In this process, the agendas usually reflect the issue prioritized by policymakers in the overall policy. Policymakers are determined to weigh policy options in resolving the questions about the issues. The media is an essential force all through the policy process and plays a major role in this stage by soliciting group support, lengthening public interest, and alerting policymakers to the issues at hand. By identifying the issues and prioritizing them, the healthcare policy will be explored on a national and international level of standards, which will enhance its political development (Wallace, 2003).

All through the final enactment, political activity and negotiations are quite vigorous at this stage and play a major role in stirring issues onto the decision agenda. In the decision agenda, the technicality of the formulation will entail the collection, analysis, dissemination, and the use of legislative or regulatory language in drafting the information on the issues. The process in this stage allows policymakers and various interest groups to develop substitute proposals, which must all be evaluated according to its cost and benefits to the intended group, including its ‘spill over’ effect to the externalities (Mason et al., 2002). These beneficial policies are mutually formed through intense political negotiations, which involve the congressional committee members, bureaucrats in administrative agencies, and interest group leaders. At this stage, it is important to discern the groups and individuals who are supporting the position taken on the healthcare reform policy, and are also willing to work in the realization of this policy change.

The Legislative Stage

This is the third stage in the policymaking process and as in most democratic societies, the legislature is generally the body that reacts to and passes proposals, which are put forward by the government. The proposed healthcare policies are moved through the legislature for a policy decision. The funding appropriation process and development of the program budget is a vital component in this phase and is characterized by contributions from all those who have wager in the issue and they may range from policymakers, target groups, to interest groups (Mason et al., 2002). This phase requires different institutional characteristics for the various strategic objectives. In order to widen membership or organizational scope in this phase, the issue surrounding healthcare is narrowly focused upon and one concrete proposal is given out. This focusing brings in a great deal of zeal for the chosen option and for this to take place, it calls for leadership from either the public or private sector to orchestrate the campaign for legislation. The legislation process absorbs a wide and large organizational scope and membership for the mobilization of political resources towards the legislation of the proposal. Through the organizational scope, diverse political factions are brought together in this process and this reduces internal strife that is frequently witnessed at the point of legislation (Morone & Belkin, 1994).

The Implementation Process

The fourth process of implementation takes place after the enactment of the healthcare policy by congress. This phase involves the executive branch and the agencies in it. The executive branch or the regulatory body charged with implementation has a key role in establishing all indispensable program guidelines and regulations through its agencies. Special interest groups can potentially play a role in guiding policy implementation despite influencing the previous phases of the policy formulation. Since healthcare reform is a national policy, it will need all the necessary collaboration of the federal government and the diverse state and local governments (Mason et al., 2002). The implementation process also involves the courts since they are fundamental in the legislation and administrative regulations, and will interpret and apply the new policy to specific situations.


This is the final stage in the healthcare policymaking process and it involves a thorough evaluation and feedback on the success or failure of the policy is provided in addressing the public problem. The process will incorporate the decisions on the termination, continuation, redefinition, or modification of the problem at hand that will lead to a new policy cycle as most key health policies are modifications to pre-existing policies. After the healthcare policy is implemented, it is subject to evaluation by groups either inside or outside the government. These groups may be heard through a congressional hearing where they can give out feedback on how the healthcare policy has affected them. In this effect, scientists, analysts, and scholars may be called in to determine whether the healthcare policy has met its goals and objectives (Wallace, 2003). The feedback obtained in the evaluation process may indicate if the healthcare policy has failed and if so, a fresh start to the policymaking process may commence to either modify the healthcare policy or generate a more effective one.


The healthcare reform policy undertakes a five-phase sequence that takes account of agenda-setting, formulation, legislative, implementation, and the evaluation process. The process has shown us that all the phases in the system are inclusive with no alienation of any group or individual. Healthcare reform can be transpired from either the political system or interest groups, especially when there is a sufficiently strong will. The technocratic model and the political will and process have revealed that decisions by political leaders or interest groups are all-sufficient and necessary for policy change. They are all rational in the maximization of public interest despite the process being tedious at different levels. In conclusion, we can say that the political process can bring effective change in the healthcare sector, and can be achieved through its policymaking model.


Mason, D. L., Leavitt, J. K., & Chaffee, M. W. (2002). Policy and Politics in Nursing and Health care. St. Louis, MO: Elsevier Health Sciences.

Morone, J. A., & Belkin, G. S. (1994). The Politics of Health care Reform: lessons from the past, prospects for the future. Durham, NC: Duke University Press. Web.

Wallace, H. M. (2003). Health and Welfare for Families in the 21st Century. Sudbury, MA: Jones & Bartlett Learning.

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