Choice in Diabetes Series (Article 3): How Healthcare Choice Is Shaped by Policy

By Corinna Cornejo

Diagnosed with type 2 diabetes a decade ago, Corinna Cornejo is a patient advocate and blogger who focuses is on health policy and developments in digital healthcare without losing sight of their potential impact on real people's lives. Corinna blogs at  and can be found on Twitter and Facebook as @Type2Musings.  

The opinions presented in this blog post are those of the author and may not represent the opinions of Ascensia Diabetes Care. Ascensia have paid Corinna Cornejo an honorarium for her services as a contributor to this blog.

As the coronavirus disease (COVID-19) outbreak spreads across the globe, governments are activating policies that directly affect people’s choices.

People are being stopped at international and regional borders. Those suspected of having been exposed to coronavirus are being isolated; some are housed at hospitals or military bases, others in their own homes. Still others, who have no reason to suspect they’ve been exposed, are finding their movement restricted. Affected communities are off limits. Accessible communities are shutting down public places and cancelling public gatherings.

For those who become ill, government policy dictates which medical facility they go to and what treatment protocol will be followed. The importance of stopping a potential pandemic takes precedence over individual patient choice.

In emergencies situations, such as an epidemic, it’s obvious how government policy dictates healthcare choice. What the person might choose for themself is a very small consideration when the health of the whole population is at risk.

But under normal circumstances, the impact a government’s healthcare policy has on people’s choices might not be so obvious.


Government policy dictates healthcare availability

Government policy determines the kind of healthcare available and to whom it is available within its borders.

It begins with the standards set for medical care, treatments, and technology by governmental policy. Along with these standards, governments establish approval processes for treatments and devices.

Whether a treatment or technology is legally available often depends on getting an official mark or approval from a governmental agency. This approval is given to ensure that the treatment or technology likely does what it promises or, at the very least, won’t cause any further harm. Whatever the standard set by policy, it dictates what care, treatments, and technology people have legal access to and can choose from.

Healthcare infrastructure also determines what’s available. Policy also shapes the kind of healthcare infrastructure a government puts in place. 

Healthcare infrastructure includes things like hospitals, clinics, community outreach programs, medical schools and medical education programs. If hospitals are built only in major cities, that means people living in outlying or rural areas have to travel to receive some kinds of care. If community outreach programs are available only in an official language, minority and immigrant populations are less likely to benefit from these services. If the medical training available locally is limited, that has a direct impact on which treatments are generally available. For example, if the healthcare professionals in an area are not trained on the use of continuous glucose monitors (CGM), they will not recommend them as an option for people with diabetes.

Governmental policies on the use of digital healthcare for remote consultations and ongoing management, like telehealth systems, are also important. If a government subsidizes the implementation of digital consultations with primary care physicians, it can significantly change the choices for people living in remote areas.   

Policies around healthcare infrastructure shape what level and types of care are easily available locally and which choices are widely available to individuals.

Government policy influences healthcare affordability

Government policy also has a direct effect on healthcare costs and affordability.

Policy defines which costs the government is willing to bear. Some policies, like universal healthcare, make the direct dollar cost to the individual obvious. Other policies, like decisions to build medical schools at public universities, determine the cost borne by the whole community, often through taxes.

When the government institutes universal healthcare, the out-of-pocket cost to the individual is made obvious. The same can be said of when governments put price controls on drugs and devices. While the amount paid directly by the individual may be small, less obvious is the dollar and opportunity costs to the overall community.

In those countries where government-funded healthcare is limited to certain groups, like the elderly or disabled, policy still affects affordability. One mechanism available to governments is to negotiate what they pay for drugs prescribed to the people covered by their healthcare system. In this way the government limits its own costs and may be able to influence what others can expect to pay. It is well accepted that the cost of drugs (like insulin) or devices (like insulin pumps) paid by Medicare has an impact on what private insurers expect to pay.

Even in countries where the government doesn’t pay for or subsidize healthcare costs directly, policy can have an impact on healthcare costs.

Policies regarding health insurance affects costs and affordability. Policy can dictate whether a person must buy healthcare insurance and what that insurance must include. Policy can regulate the insurance industry, including the profits allowed.

Governments can subsidize medical training by establishing medical and nursing schools at public universities and/or funding medical scholarships. These policies help establish and maintain a reliable source of qualified medical professionals to serve in their communities. This is especially true when scholarships require the recipient to practice medicine in a specific country or community after graduation. To the extent that government policy shapes the medical curriculum, through things like funding earmarks, they can also influence the types of treatments or technologies that are easily available and affordable. If the curriculum doesn’t include certain treatment approaches, time in range (TIR) for instance, then the locally trained doctors won’t be able to offer technologies or treatments that use that approach to their patients.

Healthcare policy shapes the choices available

At first glance it may not seem obvious, but everyone’s healthcare choices are shaped by government policy. Policy determines which treatments and technology are easily available and can be obtained legally. Policy influences the cost borne by the individual and the community, in both publicly- and privately-funded healthcare systems.

It’s government policy that determines how much testing supplies can be gotten easily, and how much a vial of insulin costs, and whether or not new technology like the artificial pancreas is even available legally. Because of its many impacts, policy is an invisible driver for the choices individuals ultimately can and do make when it comes to their own healthcare decisions.