Health Care Advocacy: A Guide for Busy Clinicians

Book Preface

With the advent of managed care in the 1980s, the failed Clinton health care reform efforts, the spiraling cost of health care, the increasing numbers of uninsured Americans, the concerns about malpractice costs and clinician fee reimbursement, and the passage in 2010 of health care reform (Affordable Care Act of 2010), it seems more clinicians than ever before are aware of the importance of outside influences affecting health care. Our goal in writing this book is to help clinicians understand the process of health policy advocacy; teach them how they can use advocacy to improve the quality, cost, and experience of health care in this country; and help them start the advocacy journey.

In clinical training, professors and clinicians teach students what they need to know to be competent to provide clinical care for individual patients. Yet clinical training often overlooks the ever-increasing outside influences that have tremendous impact on the quality, cost, and experience of giving and getting that care, and any responsibility the student should have in understanding and affecting those influences. Historically, most clinicians did not think they could impact those “outside” influences. Their role was the art and science of the care of the individual patient. Advocacy was left to the lawyers and politicians.

Many clinicians often assume the care from clinicians has a greater impact on the health of a patient than nearly anything else. However, there are many determinants of health and clinical services play only a small part. A patient’s income, working conditions, education, social support network, and culture have far more impact. In Bronfenbrenner’s Ecological Theory, the patient is at the center of a series of everenlarging concentric circles of influence on that patient’s health. The health care system is one of the smaller concentric circles (the microsystem) of influence. Institutional, community, state, and federal policies make up some of the next larger circles (macrosystems) influencing both the patient and health services for the patient. While the care of the individual patient (working within the microsystem) can and should inform our advocacy work, we can have a greater impact on the health of more patients and the health of our health care system by also working on the macrosystem.