The Ecology of Health Policymaking and Reform in the U.S.A.

This article demonstrates how constitutional, political, legal, economic, technological, social and cultural, physical, demographic, and global factors affect health policymaking in the U.S.A. The ecological factors that influence health policy in the U.S. are uniquely different from those of other countries. Therefore, even though a number of problems may be common to health systems worldwide, these problems may require different solutions in the different countries, or in different sections of the same country. The article concludes that the above ecological factors, individually or collectively, cause U.S. health policies to be inconsistent. For example, policies were adopted in the past to promote the concentrated interests of health providers. Recently, the rise of opposing concentrated interests, a lingering economic recession, a weakened resistance to change, and policy learning from the practices of other industrialized countries and from scholarly publications give us hope that reform, although still difficult to achieve, may finally be in sight.