US Health Policy and the Legislative Process

::written circa. Fall 2013.

Over the past century, the legislative process in the United States has been well known for its overwhelming complexity.  With many steps involved in the legislative procedure, final policy implementation can take anywhere from a few months to a few years.  And depending on one’s personal views, the lag time can be both beneficial and disadvantageous.  Inevitably, this holds most significant, especially in the area of health policy reform in hospital facilities (but not limited to).

As summarized by Shi & Singh (2012), a piece of legislative literature (or bill) is first introduced to the U.S. House of Representatives.  Various committees and subcommittees then review and make recommendations to the bill, while affected institutions are given the chance to voice and influence their opinions.  From there, once the bill is approved, it will then be introduced to the U.S. Senate to follow similar procedures.  And ultimately, the final frontier of the bill is to be approved by the U.S. President.

Furthermore, the formulation of health policy in the U.S. is described to follow a 5-step implementation cycle (Shi & Singh, 2012).  This policy cycle is made up of (1) issue raising, (2) policy design, (3) public support building, (4) legislative decision-making and policy support building, and (5) legislative decision-making and policy implementation (Shi & Singh, 2012).  Interestingly, steps 1 and 3 can be argued to be the most significant on imposing limitations on the U.S. political system.

It is commonly known that the first step in solving any issue is by identifying that there is one.  Unfortunately, in today’s society, the political spectrum can be drastically divided.  With the power of antagonistic activists, health reform can be considerably hindered.  And while a bill could be beneficial to some, it may be disadvantageous to others.  In addition, in today’s U.S. political arena, power groups/lobbying power can be significantly biased.  Vicente Navarro (2003) suggests, those with lobbying power are also members of a societal class, race, and gender that control the majority of political movements. Essentially, what Navarro implies is that a sample of political representatives might not necessarily be an accurate representation of the population. And thus, influencing only to the standards of selective kin.

Fortunately, these limitations can also work in favor for healthcare administrators, advocating for hospital facility reform.  As key players in policymaking, continued association and collaborative efforts with local administrative and political leaders are absolutely necessary.  And with societal limitations placed on reform, studies on these influences shouldn’t be taken lightly.  Perhaps it is in the best interest for health administrators, amongst the spectrum of varying facilities, to establish reforms that are most suited to the needs of their own individualistic population.




Shi, L., Singh, D. (2012). Delivering healthcare in america: a systems approach. Burlington, MA. Jones & Barlett Learning, LLC.

Navarro, V. (2003).  Policy without politics: the limits of social engineering. American Journal of Public Health. 93 (1)

Author: nursesarereal

My nursing professor once said that keeping a journal, over time, will allow me to see growth. In myself? I’m not sure yet. I’m hoping. I like to believe that nursing school saved my life. Maybe I’ll have some fun doing this. Cheers.

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