1. Health policy systems are complex with many interacting influences constantly modifying the system to reach equilibrium. Actors include individuals, groups, and organizations. 2. Within health policy systems, most activities have direct and indirect impacts on other actors through feedback loops. 3. The health policy process is cyclical with no clear beginning or end as the system continuously responds and adapts to feedback.

1. Comparative Systems

2.  There are three major aspects to health policy,
which may also be applied to other systems we
view this semester.
1. Complexity
 Any country’s healthy policy contains
multiple influences that interact to produce a
system that is always in flux while constantly
modifying itself in search of equilibrium.
Actors in this process are individuals, social
groups and organizations.

3. 2. Interrelatedness
 Most activities that occur in the system have
direct and indirect impacts among the actors
in the system, which are relayed through
feedback loops. “All policy actions create
reactions within the system, some perhaps
modifying the system itself” (Jones 43).

4. 3. Cyclical Processes
 The policy process has no definite beginning
or end but continues as long as the system is in
place, as it responds to the feedback and
reactions that occur within the system. There is
no ultimate success or failure of policy but
constant modification based on response
within the system.

5. Among the top lobbyists in the United States in
2012 and (2011) were:
 Doctors’ and Hospitals’ Associations
 The American Medical Association - $16,505,000
 The American Hospital Association - $19,160,200
 Insurance and Pharmaceutical Companies
 Blue Cross/Blue Shield (Insurance) - $21,949,532
 Pharmaceutical Research and Manufacturers of
America - $18,530,000
 Pfizer, Inc. - $10,910,000 (2011)
 Special Interest Groups for Older Americans (2011)
 American Association of Retired Persons - $12,430,000

6.  Other actors in the health policy system are
 Insured / uninsured /under-insured workers
 Unemployed adults
 Children
 Disease-specific lobbies such as the American Cancer
Society or American Heart Association
 Alternative health providers
 Schools
 Do you believe health care policy is
proportionately redistributive among these
actors?

7. The United States has the second highest obesity rate
in the world. In 2008, the medical costs associated
with obesity totaled 147 billion dollars.
 The Center for Disease Control and Michelle
Obama’s Let’s Move Campaign are calling upon
public schools to help reduce childhood obesity.
 General Motors ran (and pulled) an advertisement
for its college discount telling students to “Stop
pedaling… Start Driving”
 Among the top 10 most prescribed medications in
the U.S. in 2010 were 5 obesity-related drugs for
high blood-pressure, cholesterol and diabetes.

8. The obesity rate among Black adults is more than 10
percent, and among Latino adults is 5 percent higher
than among Whites.
 The poverty rate among whites was 9.9% in 2010,
while it was 27.4% for Blacks and 26.6% among Latinos.
 There are fewer grocery stores in lower-income areas, and
the grocery stores that are in these areas stock fewer
nutritious foods, including fruits and vegetables
 There is a higher concentration of fast-food restaurants and
convenience stores is higher in lower-income areas
 Fewer nutritious options and more junk food options are
available at lower-income schools
 There are fewer available recreation spaces and parks that
are safe and well maintained in lower-income areas

9.  How do you think all of these factors are
related in the system of healthy policy?
 How do they influence one another?

10.  President Obama signed the Patient Protection
and Affordable Care Act into law in March
2010.
 Insurance, Pharmaceutical and Hospital lobbies
spent millions of dollars trying to prevent and
later to overturn the bill.
 The first major action of the new Republican-
led House was a vote to repeal the Act.
 Last year, Republican presidential candidates
all vowed to repeal PPACA if they became
President.

11.  The motivating factor in any Health Policy is
resource distribution.
 “All nations face the problem that the cost of
providing modern health care with currently
accepted standards and technology is
outrunning their abilities to generate the
wealth to pay for it” (Jones 44).
 How are healthcare resources allocated in your
region of study?

12.  This module’s reading provides an in-depth
overview of comparative health policy.
Consider how the information you read reflects
the systemic nature of health policy.
 Use the reading to formulate questions
regarding health policy in your region of study.