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Introduction to State Health Policy

Traditional & Emerging Roles

Of State Government in Determination of Health Policy


John McDonough, Dr.P.H., Senior Associate, Institute for Health Policy, Brandeis University, Waltham, MA.

Given the significant role that States legislators play in establishing policies that affect the American health care system, the purpose of this introductory session was to:

  • Provide an overview of the evolutionary changes in the health care system that provide the content for health care policymaking.
  • Highlight and discuss traditional and emerging State roles and responsibilities in the health field.

John McDonough, Senior Associate for the Institute for Health Policy at Brandeis University and former Massachusetts State Representative, described the evolutionary changes in the health care system by presenting a historical overview of the four periods of health policy:

  • Pre/Emerging System Period (distinguished by infectious disease as the leading cause of death, no licensure or regulation).
  • Professionalization and Growth (professional standards, development of insurance, chronic disease emergence).
  • Government Regulation (Medicaid and Medicare, HMO Act, Hospital Rate Setting).
  • Market Dominance (surge in managed care, different government role).

Dr. McDonough then highlighted the key roles that State governments play in the health care arena, including:

  • Protector of the public health (i.e., sanitation, environmental protection, disease control).
  • Monitor of quality.
  • Regulator of facilities, professionals, and insurance.
  • Provider and supporter of medical education opportunities (i.e., State medical/nursing schools).

Throughout the discussion, Dr. McDonough referred to the importance of access, cost, and quality considerations in health care policymaking. He also emphasized the need for policymakers to understand that policy debates are often driven by values and beliefs that may be presented as if they are facts. This is a critical distinction that policymakers must recognize in this environment, as objective evidence-based information is a valuable and useful commodity for legislators seeking to develop sound policy.


Stone DA. The Struggle for the Soul of Health Insurance. J Health Polit Policy Law 1993;18(2):287-317.

Lipson D. Health Politics and Policy, 3rd Ed. New York: Delmar Publishers; 1997. State Roles in Health Care Policy: Past as Prologue.

Gawande A. When Doctors Make Mistakes. New Yorker 1999 Feb;1:40-55.

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