The new direction in health policy.

Health policy in the United States is at a new juncture in its development. Policy choices can be made based on three decades of experience during which diverse policy goals were established in succession. Health policy is also at a point where occupational therapists can make substantial contributions. In recent legislation and other health policy, the patient's functional status and quality of life increasingly are considered as factors in assessments of the value of health care. This article describes thiS trend and the unique contribution that occupational therapy can make in today's health policy arena. It must be noted that U.S. health policy is expressed in many different forms, and each policy position is influenced by a multitude of competing interests and political actions. Federal legislation is the most visible and well-known form of policy. Legislation, however, does not determine the entire structure and provision of service. Because much of health care is prOVided through the private sector, national-level health policy is also developed through (a) coverage policies of insurance companies, (b) actions by national professional associations, (c) programs provided by foundations, (d) insurance benefits prOVided by employers, and (e) objectives of health care coalitions. This array of independent policy forums explains, in part, why health policy is complex and sometimes contradictory_ Nonetheless, overall policy trends can be discerned. Over the past three decades, health policy goals have shifted from building the structure of the health Donalda Ellek