ChangeMedEd Initiative

Health policy and economics: What medical students should know

Tanya Albert Henry , Contributing News Writer

Health care policy and economics probably are not too high on the list of reasons most medical students decide to pursue lives as physicians. Yet, if you as a medical student know how these two areas work, they can play a significant role in ensuring that your future patients have better health outcomes.

How health systems work

Expand your understanding of how to successfully work within a health system to improve patient care with health systems science.

The COVID-19 pandemic reshaped American life and medicine, providing even greater incentive for medical students to master the basics of these complex topics. Understanding health care policy and reform efforts in the U.S.—efforts that include Medicare, Medicaid, the Health Insurance Portability and Accountability Act (HIPAA), the Children’s Health Insurance Program (CHIP) and the Patient Protection and Affordable Care Act (ACA)—will help you provide high-quality, affordable care.

An education module offered via the AMA Ed Hub helps medical students—and residents and physicians who may not have received such training—better understand health care policy and economics. The module defines the core principles of how health care policy in America has been formed and implemented and explains the economics of the U.S. health care system.

It also helps learners understand how health professionals, health plans and patients influence health care spending, and identifies central themes of health care reform over the past century and how they relate to the main components of the ACA.

The free online education module “Introducing Health Care Policy and Economics” is one of 13 modules released as part of the Health Systems Science Learning Series, a popular set of educational modules available at no cost, that prepare future physicians and health care professionals to successfully work within health systems. The series has five recently updated modules:

The AMA Ed Hub is an online platform that consolidates all the high-quality CME, maintenance of certification and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards.

Find out more about how all the modules offer medical students insight on health systems science.

The module outlines the steps that physicians can take to help patients navigate the health system so they receive the best care at a reduced cost.

Inform and empower your patients. Understanding the type of insurance plan your patient has, the plan’s benefits and the out-of-pocket costs for services you provide and recommend will help you provide more comprehensive care.

Discuss no-cost preventive services. Talk about preventive services your patient can access with no out-of-pocket cost for them.

Ask questions, address concerns. Be sure patients don’t have unaddressed concerns about the services and care provided. If they need a test, such as an MRI, make sure you discuss location options, because each will have cost implications.

Discuss prescription drug options and costs. Prescribing a generic drug instead of a brand name one could significantly cut your patient’s out of pocket costs.

Use quality measurement tools. Use patient surveys and other quality measurement tools to help assess your level of service and identify inefficiencies.

Adapt to new payment structures. The ACA shifts payment for medical services away from fee-for-service toward other methodologies.

Work with other care professionals. Incentives in the ACA shift clinical decision-making to a team approach in which physicians are encouraged to work with other health professionals to provide patient care. If making a referral, work with the patient to refer them to an in-network physician.

By understanding the economics and policy of health care and following the advice above, you can:

  • Make it more likely a diabetic patient will fill a prescription and take it as prescribed.
  • Safeguard critical prenatal care by reviewing upcoming prenatal tests and discussing insurance to make sure any updates or plan renewals are made in time.

The AMA also released in 2020 the second edition of the Health Systems Science textbook, published by Elsevier, which is a framework for this third pillar of medical education.

Health systems science is defined as the understanding of how health care is delivered, how health care professionals work together to deliver that care, and how the health system can improve patient care and health care delivery. A follow-up publication, Health Systems Science Review, was published as a study companion to the textbook.