By reviewing reports required by the Lobbying Disclosure Act, the investigators found that health care lobbying expenditures totaled $237 million in the year 2000. This was more than the lobbying expenditures of every other industry, including agriculture, communications, and defense. This high level of lobbying expenditures highlights the importance of health care issues to a broad range of interest groups.
Among health care organizations, drug companies spent the most on lobbying, $96 million, followed by physicians and other health professionals, $46 million. Hospitals and nursing homes spent $40 million while health insurance and managed care organizations spent $31 million. Disease advocacy and public health organizations spent only $12 million.
From 1997 to 2000, lobbying by physicians and other health professionals grew more slowly than lobbying by other organizations (10 percent vs. 32 percent). According to the study's author, Steven Landers, M.D., M.P.H., of the Case Western Reserve University School of Medicine, this finding may indicate a decline in the political influence of physicians compared to other health care organizations such as drug companies.
"The input of physicians is essential at a time of growing concern and debate about the cost of prescription drugs, the influence of pharmaceutical marketing on patients and physicians, and access to health care for the uninsured," said Landers.
"In a previous study, legislators said they want more input from physicians about public health issues. Physicians should use the credibility they have with the public and with legislators to offset the deep pockets of drug companies," said co-author Ashwini Sehgal, M.D.
The Lobbying Disclosure Act of 1995 requires lobbyists at the federal level, including Congress, the White House, and federal agencies, to submit biannual reports describing the organization they lobbied for and the amount spent on lobbying activities. However, the lobbying reports do not specify the legislation discussed or the positions advocated by lobbyists. Thus, it is not possible to determine the extent to which health policy decisions were affected by lobbying. The Lobbying Disclosure Act could be strengthened by requiring more detailed reporting, such as specifying the legislation discussed and the positions advocated by lobbyists, say the authors of this new study.
Health care organizations lobby lawmakers in order to influence health policy decisions. Such decisions affect virtually all aspects of health care, including compensation for goods and services, licensing and oversight, and research priorities. The investigators found that a total of 1192 organizations were involved in health care lobbying. Individual organizations with the highest lobbying expenditures included the American Medical Association ($17 million), the American Hospital Association ($10 million), Pharmaceutical Research & Manufacturers of America ($7 million), Schering Corporation ($7 million), Health Insurance Association of America ($7 million), Blue Cross/Blue Shield ($6 million), and Eli Lilly & Company ($5 million).
Landers is a family practice resident at Case and at University Hospitals of Cleveland. Sehgal is director of the Center for Reducing Health Disparities at Case and a nephrologist at MetroHealth Medical Center in Cleveland.