As Seen on TV: Health Policy Issues in TV's Medical Dramas

"What ideas do U.S. mass media present to Americans about health policy issues? Television's hospital shows are an important place to look for answers to this question.....These tales of the medical world are viewed by millions....In ways that news reports cannot, they play out various assumptions about how health care ought to be delivered, about what conflicts arise that affect health care, and about how those conflicts should be resolved and why. Doing that, hospital dramas represent an important part of viewers' curriculum on the problems and possibilities of health care in America. Just how much attention does this dramatic curriculum pay to health policy issues?"

In an effort to respond to this question, the Henry J. Kaiser Family Foundation (KFF) supported a research project that involved use of quantitative content analysis to explore the extent to which, and the way in which, arguments over health policy issues appeared on United States' prime-time television over several months. Researchers examined a total of 74 first-run episode of every prime-time hospital drama on network TV from September 2000 through May 2001. The series were ER, Gideon's Crossing, City of Angels, and Strong Medicine.

For the purposes of this study, a health policy issue is a disagreement or expressed dissatisfaction with government or institutional rules about non-clinical issues in patient care. The basic unit of analysis was a health policy interaction (HPI), or a scene in which a health policy issue appears. This category was further divided into resource HPIs (e.g., disagreements about, or expressed dissatisfaction with, the basic allocation of resources for patient care by governments, businesses, or medical organisations - with explicit mention of the problem's impact on patient care) and ethical HPIs (characters disagreeing had to make explicit mention of ethical, legal or organisational policies they were challenging or with which they were agreeing).

Highlights of the research findings point to various trends in the use of entertainment-education strategies to stimulate debate about US health care policy. These findings include:

• 76 health policy incidents were identified during the 74 hourly episodes, suggesting that "health policy issues do regularly enter the plots of prime time hospital series".
• 127 health policy interactions appeared in those episodes - "the hospital programs reflected public policy debates fairly frequently but did so without explicit reference to legislation or legal activities. The debates, instead, were acted out through plot lines that stressed the aspects of human drama inherent in the policy debates". Based on this finding, the authors suggest that the issues were not explored in depth.
• 98 (78%) of the 127 HPIs centred on ethical issues related to health care; 17 scenes (13%) revolved around health resource issues; and 12 scenes (9%) involved an overlap of both resource and ethical concerns
• At least 80% of all 127 HPIs included one or more physicians; nurses appeared in only 10% of HPIs. Patients showed up in about 1 of 3 scenes in which health care issues came up (they actually had input into only one-fifth of them), while their friends or relatives came into only 1 in 7 scenes.
• About 50% of the scenes that involved health care policy disputes presented the viewpoints in an evenhanded manner. Among the rest of the scenes, the ones that favoured current policy were balanced in number by the ones that bolstered anti-policy positions.

The authors conclude that "the programs may help to stimulate thought and discussion by showing people how health policy issues might play out in 'real' people's lives. While these features of the programs may have stimulated discussion, our data suggest that other aspects of the health care policy scenes may have worked against public knowledge and action....[C]haracters hardly ever pointed out that their arguments were speaking to issues that resonate beyond their hospital to the larger, 'real world.' Moreover, the shows portrayed doctors as dominating discussions around health policy issues....Series in which doctors are depicted as dominating the arena do not suggest that the health care system invites, or even provides opportunities for, public involvement in key debates about health policy issues."