ACP's widely cited paper on universal access grew out of intensive policy development process

Achieving consensus on complicated policy issues to produce meaningful, evidence-based policy presents a significant challenge for large membership organizations like ACP.

Achieving consensus on complicated policy issues to produce meaningful, evidence-based policy presents a significant challenge for large membership organizations like ACP. In response to the challenge, the College has developed a robust process that involves the membership, leadership, committee members, chapters, staff, and occasionally outside experts. The process works; ACP policies reach millions of Americans and influence debate at all levels of government. Even presidential hopefuls consider ACP's input on health issues.

ACP's recent position paper, “Achieving a High Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries,” serves as an example of how the College develops public policy that is factual, evidence-based and representative of its members' views.

Policy development began in 2006 in response to ACP's strategic theme develop public policies that increase access to health care for persons who are uninsured or under-insured, as well as expand health insurance coverage.

The College's Strategic Plan articulates ACP's high-level priorities, such as eliminating disparities in access to health care. ACP's content-focused committees and its councils, which represent key member groups, develop objectives with oversight by the Strategic Planning Committee and ultimate approval by the Board of Regents. Staff then develops programs to achieve each objective and performance indicators to track progress and assess outcomes. Governance and staff annually follow developments in the health care arena to adapt the College's positions.

The Health and Public Policy Committee (HPPC) develops ACP's positions on issues affecting the health care of the American public and the practice of internal medicine. It consists of 13 members, including representatives from the Council of Student Members, the Council of Associates and the Council of Young Physicians. The committee includes a diverse mix of generalists and specialists, academics and private practitioners, ACP Regents and Governors, with special attention paid to representing different genders, races and ethnicities, and geographic regions.

HPPC members initially addressed the objective of improving access to care by focusing on controlling health care costs. ACP staff conducted literature searches and prepared background materials and numerous drafts that HPPC members discussed and reviewed. HPPC members soon concluded that a broader look at systemic reform was needed and directed staff also to examine other health care systems with universal access to health care.

On Aug. 1, 2007, HPPC members sought Regents' comments on a preliminary, embargoed draft, as well as from more than 20 outside experts in public policy. Harold Sox, MACP, editor of the Annals of Internal Medicine, also offered input in anticipation that an abridged version of the paper might be submitted to Annals. All of the comments and a revised draft showing suggested revisions were provided to the HPPC by the end of August 2007.

Revisions and suggestions were sought throughout August and September from ACP Governors and Regents, the chapters and/or their health policy committees, and the councils representing subspecialists, students, residents and young physicians (those less than 16 years into their practice.)

Further revised drafts were prepared, and by the end of September, HPPC approved submission of the paper to the Regents for final approval. Copies of the final draft were also sent by e-mail to all ACP Governors. The Board of Regents reviewed the document as well as a summary of comments received, and approved it at the end of October 2007. An abridged version of the paper was then prepared and published in Annals and available at, and the full position paper is available online.

The strength of the ACP's policy process, though, ultimately must be measured by results. Since its publication, ACP's paper has received media coverage that has reached millions of people; it has been cited positively by numerous health policy experts; and it has sparked a spirited discussion within the College's membership (as well as within the broader medical profession) on how to improve the U.S. health care system. It is precisely because of the rigor, strength and inclusiveness of ACP's policy process that our position papers have such impact.