How Are Healthcare Policies Formed?

For those in the healthcare industry, policies that are set out by those in charge are to be followed. The general health of the public relies on these policies being fair and accurate. Of course, many medical professionals, including those on the front-line who have completed a nursing CEU, never get the chance to be involved in the creation of healthcare policies and this can lead to further issues down the line.

In this article, we are going to look at some of the ways that healthcare policies are formed in the USA. We’ll look at everything from the local practices to the government branches set up to make these decisions. 

What Is A Healthcare Policy? 

If you are unfamiliar with the phrase ‘healthcare policy’ then you should know that this refers to any plans or actions that are made in order to meet certain goals. For example, when the COVID-19 pandemic first began, professionals across the country were required to put their heads together and come up with a plan that would then become policy. 

Policies will typically cover a few things including the delivery of the healthcare, the access to the care and how it will be financed. Many people believe that it is always medical professionals calling the shots but often, the government will make the final decision when it comes to a healthcare policy.

Of course, there are many healthcare professionals that are involved in the creation of these policies as their opinions are often valuable. These professionals might come from a business background as opposed to a medical one, but that does not mean that they are unable to create policies that could be put in place on a global level. With such a strong base of knowledge backing them up, they can confidently step into other areas of healthcare, including the creation of healthcare policy.


Some healthcare policies that you might have come across in the past are formed by those on the frontline. These are known as microsystems and are often seen in hospital systems and outpatient clinics. These institutions will set their own policies that their medical personnel need to stick to in order to improve local healthcare. Usually, you’ll be informed of any policies that are in place when you visit these institutions and you’ll need to adhere to them. 

Any policies that are written by anyone in microsystems need to be written in line with any state and federal regulations. These policies are typically in place to instruct staff and reduce the risk of human error. Policies must fulfil the requirements set out by any accreditation agencies and professional practices. While they might appear to be made by the individual institution, those above them must agree. 


Another kind of healthcare policy that is usually made comes from mesosystems. This refers to policies that are made on regional and state levels and are often more official than those made by the individual practices. Due to government regulations, each state in the USA will have their own healthcare regulatory agencies who are required to follow any policies that are set out by local legislators. 

Some of the common policies that you might expect to be formed by those on this level include disease reporting policies, laws for minimum stays for new mothers and more. Each policy is carefully thought out and passed on to those who are required to stick to it. Each state will usually make the final call on the kind of policies that are set out by the agencies at this level.

Macro-Level Policies

One of the most popular kinds of healthcare policies that you might have heard of come from those in the macro-level organisations. These are the policies that are on the news and those that are readily available to the public. These policies are formed by appointed and elected officials on the federal level. Typically, you’ll find that these officials will take advice from healthcare professionals who have experience in analysing data and managing healthcare on a global scale.

Interestingly, there are three branches of government that will help to form the healthcare policies and could possibly prevent a policy from being pushed through. These three branches include the executive branch, the legislative branch and the judicial branch. The legislative branch is the branch that will typically form the policy in the first place and pass it on to those who can make the final decision. The President of the USA can actually veto the policy if they do not think that it will be effective. This causes problems for many healthcare professionals. 

What Is the Most Effective?

While healthcare policies set out by the three branches of government are often the most official, they are not always the most effective. When the President is able to veto a policy if they are not impressed by it, the advice of medical professionals who have experience can often be thrown out the window.

For this reason, the policies set out by those in the lower levels are often more effective, as long as they are approved. These professionals are more in touch with those who are suffering from any medical conditions and so can make an informed decision. Of course, these people are not always able to have the final say on what goes on in their practice. 

Final Verdict

As you can see, there are many ways in which a healthcare policy can be formed in the USA. This doesn’t always happen in the same way across the world, as often there are bodies set up to create new policies in other countries. For now, it is worth noting that whilst some medical institutions are able to make their own policies, policies set out by the government will overrule these.

For those in the healthcare industry, understanding policies and how they work is very important. If you are interested in setting some policies for yourself, you’ll need to complete the relevant training at a local or online institution.

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