Term
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Definition
| Policy modification results when the consequences of existing policies feed back into the agenda setting and legislation development stages of the formulation stage and the rulemaking and operational stages of the implementation phase and stimulate changes in legislation, rules, or operations. See feedback loop pg 14. Today, most new health policies spring from existing policy. |
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Term
| Incrementalism in Policymaking |
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Definition
| Most modifications to existing policy make only modest changes. Incrementalism is building on existing policies via modification in small, incremental steps, which allows the economic and social systems to adjust without being unduly threatened by change. |
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Term
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Definition
-increases likelihood of reaching compromises
-predictable and stable decisions
-Crises may alter incremental nature of policymaking |
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Term
| Mechanics of Modification Phase |
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Definition
Policies can be modified at 4 points in the process
1) Agenda setting
2) Legislation development
3) Rulemaking
4) Operation |
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Term
| Modification in Policy Formulation Phase |
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Definition
| Occurs in agenda setting or legislative development. Initial laws stem from interactions of 1) problems 2) possible solutions 3) dynamic political circumstances |
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Term
| Modification at Agenda setting |
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Definition
| Possible solutions to problems can be assessed and clarified especially when operational experience and the results of demonstrations and evaluations provide concrete evidence of performance of potential solutions. Leaders in health related organizations and interest groups are well positioned to observe consequences of policy and need to modify. |
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Term
| Modification at Legislation development |
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Definition
| Modifications at leg development stage follow the same procedures as original legislative proposals. Sometimes impetus to modify law comes from changes in other existing laws--e.g. budget cuts |
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Term
| Modification at Policy Implementation Phase |
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Definition
| Rulemaking or Operational stages. Feedback from consequences of formulated/implemented policies can stimulate modification at either stage in implementation |
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Term
| Modification at Rulemaking |
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Definition
| Rulemaking is necessary precursor to operation and full implementation of any public laws. Practice of modifying policies by updating or changing rules for their implementation pervades policymaking. Changed rules (by executive branch agencies) are modified policies. |
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Term
| Modification in Operation |
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Definition
Operation involves actual running of programs embedded in public laws by appointees and civil servants. Managers responsible for operating a public law have opportunities to modify the policy, especially in terms of effect on and consequences for those affected by law. Implementation by vary according to the talent and resources of managers. Stimulus for modification in operation comes from two sources
1) Internally, managers seek to control results
2) Externally, individuals and health realted organized and interest groups seek to influence managers. External opportunities arise from relationships, many of which are based in the exchange of useful information and expertise. |
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Term
| Modification Through Cyclical Relationship Between Rulemaking and Operation |
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Definition
| Although rulemaking precedes operation, the experiences gained in operation feedback into rulemaking |
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Term
| Medicare as an Example of Policy Modification in Practice |
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Definition
| Begins with Social Security Act of 1935 followed three decades later by actual Medicare in 1964. Changes in benefits have continually occurred since then. Part D added in 2003 |
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Term
| Key structural features of policy modification |
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Definition
1) Oversight of actors
2) The results of formal analysis of policy performance (assessments of evaluations) |
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Term
| The role of oversight actors in policy modification |
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Definition
Oversight actors come from every branch
-Legislative branch: oversight assigned to committees and subcommittees (hold hearings) which can stimulate modification during policy formulation and implementation
-Executives: point out when adjustments and modifications are needed. Executive agency OMB (Office of Management and Budget) plays an important role in modification because evaluates effectiveness of policies and assesses funding priorities and demands.
Courts: determine when modifications are needed. Also control how laws and interpreted and enforced. Complicated because court system is so decentralized |
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Term
| The role of analysis in policy modification |
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Definition
| Analysis occurs after a policy has been implemented. Continuum of analytical activities that can begin in agenda setting and support entire process. Ex-ante policy analysis, policy maintenance, policy monitoring, and ex-post policy analysis |
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Term
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Definition
| Anticipatory analysis mainly influences agenda setting. Helps decision makers clarify problems and assess solutions. May also address analysis of relative costs and benefits of alternatives |
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Term
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Definition
| Analysis to ensure policies are implemented as they were designed and intended to be implemented. Part of legislative oversight and managerial control in implementation |
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Term
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Definition
| Measuring and recording of ongoing operation of policy's implementation. Can help point out where modifications in rules and operations may be needed |
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Term
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Definition
| Retrospective analysis to determine real value of policy. Assess degree to which policy's objectives are achieved through its implementation |
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Term
| Policy analysis as basis for modification |
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Definition
| Approach analysis in variety of ways: before and after, with and without, actual versus planned, experimental versus quasi experimental, and cost oriented approaches |
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Term
| Analysis based on before and after |
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Definition
| Most widely used approach for policy analysis. Variation is with and without comparisons which involves assessing consequences of policy for individuals or groups with a policy versus where policy does not exist. With and without comparisons prevail in health policy domain |
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Term
| Actual versus planned performance comparisons |
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Definition
| Comparing policy objectives with actual postimplementation results. Does not support assignment of causation. |
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Term
| Experimental and quasi experimental analytical designs |
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Definition
| Permit more meaningful conclusions because individuals are assigned to control groups |
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Term
| t benefit analysis and cost effectiveness analysis |
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Definition
| Important in search for policies that provide the best value for public dollars. In CBA evaluation in based on relationship between benefits and costs of a policy all expressed in monetary terms. In CEA performance assessment is based on desire to achieve objectives in the least costly way |
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Term
| Responsibility for Policy Analysis |
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Definition
Legislative and Executive Branches.
-Government Accountability Office (GAO) investigative arm of Congress. Investigates how federal government spends tax payer dollars. Does work largely at request of congressional committees
-Congressional Budget Office (CBO)
-Congressional Research Service (CRS) |
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Term
| Government Accountability Office |
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Definition
-Audits agency operations to determine if federal funds being spent well
-Investigates allegations of illegal or improper activities
-Reports on how well government programs meeting objectives
-Performs policy analysis
-Issues legal decisions and opinions |
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Term
| Congressional Budget Office (CBO) |
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Definition
| Mission is to provide Congress with the objective, timely, and nonpartisans analysis needed for economic and budget decisions and with information and estimates required for budget process |
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Term
| Congressional Research Service (CRS) |
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Definition
| Serves congress throughout the legislative process by providing comprehensive and reliable legislative research and analysis that are timely,objective, authoritative, and confidential. |
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Term
| Competence in Policymaking Process |
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Definition
| The ability to successfully analyze and influence the public policymaking process |
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Term
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Definition
| Consequences of health policies at levels of individuals communities and populations may be enormous. Government engages in health policymaking to support citizens in their quest for health or economic interests |
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Term
| Health Policy and Health Related Organizations |
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Definition
| Accomplishments and performance of many organizations is affected by health policy. Organizations are affected by external environments including policies. Health related orgs include hospitals, state and county health departments, HMOs, hospices, nursing homes, etc. Public policies have been important in development of health related organizations but the vast majority of them have arisen in context of market economy |
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Term
| Types of Organizations in Healthcare System |
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Definition
Primary health service providers: provide health services
Secondary provider organization: provide resources for the primary providers.
-Health-related interest groups |
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Term
| Primary health services providers (policy interests) |
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Definition
| Policies that might affect access to their services, cost of services, or revenues from service. Typically concerned about policies related to structure of healthcare system |
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Term
| Secondary Provider Organizations (policy interests) |
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Definition
Education institutions, insurance companies, health plans that organize payment, pharmaceutical and medical supply companies.
-Each of these groups is affected/interested in policies in fairly predictable ways |
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Term
| Health Related Interest Groups |
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Definition
| Include interest groups of the primary service providers (AMA, AHA, ADA, ANA) secondary provider organizations (Association of American Medical College, BCBS Association, PhRMA) or individual member constituencies (AARP, NAACP, NOW) and interest groups of specific diseases |
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Term
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Definition
| "A cluster or related knowledge, skills, and ability that 1) affect a major part of ones job 2) correlate with performance on job 3) can be measured against standards 4) can be improved by training and development |
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Term
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Definition
| knowledge skills and ability that permit one to 1) successfully analyze the public policymaking process 2) influence the process |
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Term
| Organization design to support policy competence |
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Definition
| People, organizations, and interest groups can possess various levels of policy competence. Resources can enhance policy competence of group beyond individuals acting alone. Organizational design is important--all have formal aspects developed by managers and informal aspects which reflect wishes and preferences of participants |
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Term
| Best Practices in Policy Competence Design |
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Definition
| -Many organizations create public affairs or governmental affairs department. Good to have anticipatory focus. |
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Term
| Analyzing Public Policy Environments |
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Definition
| Leaders of an organization or group must be able to accurately analyze public policy environment of their entity. Policy competent leaders can assess effects in terms of opportunities and threats on their domains and make strategic adjustments. |
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Term
| Benefits and Limitations to analyzing public policy environment |
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Definition
Benefits: classify and organize complex information about public policymaking process, identify and assess current public policies that do or will affect entity, identify and assess the formulation of emerging public policies that might eventually affect, speculate about future relevant policies, link information about public policies to entities performance
Limitations: no one can foretell future, leaders may not be able to accomplish these things |
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Term
| Procedural Steps in Analyzing Public Policy Environments |
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Definition
1) Scanning environment to identify strategic pub policy issues
2) monitoring the strategic issues identified
3) forecasting future direction of strategic issues
4) assessing important of strategic issues for entity
5) diffusing the results among those in the organization who can help formulate and implement response |
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Term
| Logic Models in Analyzing Policies |
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Definition
| Depict what inputs will be used in various processes to yield results. Resources a b and c are assembled and then processed by doing m n and o with resources, results are x, y and z. Resources are used in processes to produce desired results. Results are expressed in terms of outputs, outcomes, and ultimately impact. Model includes feedback in form of loop. Logic model also shows policy exists in external environment. Resources-->Processes-->Ouputs-->Outcomes-->Impact |
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Term
| Ethics of Influencing Policymaking |
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Definition
-Respect for Autonomy: contrast to paternalism also includes principles of truth, confidentiality, fidelity
-Justice: underpins allocative policies, distributive justice. Difference perspectives of justice include egalitarians (everyone should have equal access to benefits and burdens) libertarian, and utilitarian.
-Beneficence: participants in process act with charity and kindness--seek to do good
-Nonmaleficence: do no harm |
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Term
| Influence is a matter of power and focus |
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Definition
Positional: healthcare organizations and interest groups possess power by virtue of their role in society
-Reward or coercive power: capacity to reward policymakers compliance or punishing noncompliance
-Expert power: Based on entity's possession of knowledge or expertise
FOCUS: leaders of organizations and groups consider focus of their efforts--guided by identification of policies of strategic importance |
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Term
| Influencing Policy Formulation |
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Definition
At agenda setting by:
-Defining and documenting problems
-Developing and evaluating solutions
-Shaping political circumstances through lobbying and courts
At legislation development by:
-Participating in drafting legislation
-Testifying at legislative hearings |
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Term
| Influencing Policy Implementation |
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Definition
At rulemaking by
-Providing formal comments on draft rules
-Serving on and providing input to rulemaking advisory bodies
At policy operation by:
-Interactions with policy implementers |
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Term
| Influencing Policy Modification |
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Definition
| -By documenting the case for modification through operational experience and formal evaluations |
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Term
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Definition
| Medicare Payment and Advisory Commission--independent congressional agency established to advise US Congress on issues affecting Medicare system. Analyzes fee for service program, access to care, quality of care and issues affecting Medicare |
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