Health grantmakers and public policy.

Abstract

Loren Renz and Steven Lawrence have pointed out in the GrantWatch essay several of the key trends in health policy funding by philanthropy in the early 1990s. Although, overall, support for health policy is a relatively small part of most foundations’ portfolio of funded projects, grant making for health policy grew dramatically between 1990 and 1995, particularly for projects relating to health care cost, quality, and access. 1 Behind these numbers is another story, however, about the relationship between health philanthropy and public policy. Despite many mutual interests as well as long traditions of cooperation and exchange between some foundations and the public sector, grantmakers and policymakers have often been unclear about how they should relate to one another or what they might learn from each other. Grantmakers in Health, an educational organization that has been serving foundation boards, executives, and staff since 1982, is embarking on a major new effort to build bridges between the two communities. Grantmakers and policymakers both aim to effect change through their actions. Throughout this century both sectors have shaped the U.S. health care system. Public policy has been determined by prevailing views about the role of government and how much it should spend on health and other social programs. Foundations, in contrast, have focused primarily on improving the health of populations, especially vulnerable groups. Their commitment to population health needs has placed them in the positions of both leading the policy agenda and responding to adverse repercussions of policy change. Now, in the late 1990s, many of the rules of the game are changing for both policymakers and grantmakers. First, with the evolution of the Medicaid program, funding for many social services, and welfare reform, more and more policy decisions are being made in state capitals, county seats, and city halls rather than in Washington. Moreover, traditional distinctions between government and privatesector roles have become blurred, with public entities increasingly shifting decision making to managers of private organizations. At the same time, the health care delivery system is undergoing tremendous turmoil with the shift from inpatient to outpatient care; the fast pace of mergers and acquisitions of hospitals, health plans, and physician practices; growth in the for-profit sector; changes in the health care workforce; shifts in corporate attitudes about employer-sponsored health care coverage; and technological developments of interest to patients, providers, and purchasers. Demographic changes and the life circumstances of many Americans also are drawing attention to the social determinants of health, not just the inputs and outcomes of medical care. Foundations’ views on policy differ consid