Feedback effects in health policy: economy, ethics, issues, and technology

A key insight from political science research holds that feedback effects of existing public policies shape future reforms. Typically, political scientists emphasize role of redistributive policies for feedback effects: once policy programs are established, they generate returns for interest groups and the mass public. After that, reforms are difficult, or they require decision-makers to find way around them. However, when it comes to health policy studies, a notable deficiency exists in our understanding of how feedback effects work. This article reviews the literature on feedback effects and discusses four mechanisms of feedback effects. Firstly, once established, universal health care programs receive important levels of support and governments struggle to implement major reforms due to the power of interest groups and beneficiaries–especially regarding cost containment. In this sense, health policy is like any other social policy fields. Secondly, in health policy, the type of policy issue matters for feedback effects. Notably, preventative health care and non-medical health policies are less popular than health policies that pay and provide the cure of disease. This mechanism is related to the prevention paradox: precautionary policies generate a benefit that many recipients do not feel because the problem was never present. Consequently, generating political support and agency for preventative measures is difficult. Thirdly, technological complexity depoliticizes health policy, in the sense that many policy issues are highly complex technologically, which reduces substantive engagement by mass public and lay people. This aspect increases the influence of firms and interest groups and potentially delays reforms, notably those related to the management of cost. Fourthly, ethical imperatives to protect human lives lead to a high level of readiness to bear very high cost, for example for new treatments and technology. These aspects also strengthen the power of non-state actors and make reforms that limit public spending commitments difficult. The paper discusses these mechanisms based on a scoping review of the literature and illustrates them with specific examples. This paper contributes to the literature by developing specific feedback mechanisms that inform political science-based research on health policy. Moreover, it develops the literature on policy change by underlining the importance of policy issues, ethics, and technology.