Provider power and healthcare systems

Health systems spend a large percentage of their funding on the medical workforce and regularly face disputes over working conditions with their personnel. Yet health reforms rarely reduce labor force expenditures or shift employment conditions, particularly among physicians and nurses. Scholars often explain this persistent pattern through health professionals’ disproportionate influence on health policy. This chapter presents an integrated theoretical framework for understanding how providers shape policy, focusing on the incentives driving professional behavior, the levers professionals use to influence policy outcomes, and the constraints that muffle professional clout. It first establishes the key stakeholders involved in crafting health policy, then draws on literature from economics, management, sociology, and political science to establish providers’ role in policymaking. It ends by illustrating how to apply this framework to better understand the politics of the Affordable Care Act and the Covid-19 pandemic in the United States, aiming to center healthcare professionals within the broader political economy of health.