Policy

(page 55)

(ppt slide 3)

• statement of decision, choice or Action/ INaction chosen by the governing agencies r/t an issue or set of issues.
• Outputs of a process of inter-related decisions
• Attempts to achieve a goal or solve a problem
• The concept r/t not just the decisions, but HOW the decisions were reached
• Course of action/decision adopted or proposed by a party/business/indiv/govt (public policy = govt)
• A course of action chosen by government to address what has come to be indentified as a public issue

the policy cycle

(PPT slide 22, p8)

• the ____ ____ = "stagist approach"
• tool used for analyzing development of a policy item

1. agenda setting (problem ID)
2. policy formulation
3. adoption
4. implementation
5. evaluation

the Three I's

These influence dvlp't & implement'n of health policy

1. Interests
2. Ideology
3. Institutions

ideas

(PPT p10)

• depicts interaction and interface b/w research and value

values

(PPT p.10)

• each theory has a set of values that inform their approaches
• enduring, moral beliefs about the way the world aught to be

lobbying

• Act to influence legislation > desired action
• Trying to influence legislation on behalf of a special interest

democracy

• the political orientation of those who favour govt by the people OR their elected representatives
• govt by the people / elected agents under a free electoral system
• that institutional arrangement for arriving at political decision in which individuals acquire power to decide by means of a competitive struggle for people vote

politics of the right

• Politics of the _____ = conservatism
• traditional
• status quo
• business
• upper class 

Politics of the left

• Politics to the _____ = Liberal
• people (poor)
• working class
• capitalist
• fascism (extreme)

legislation

• making law

regulation

• A principle / rule / law to be followed
• designed to govern or crtl 

Levels of Policy

Health Policy Analysis: 

1. Clinical
2. Administrative / managerial
3. Legislative

• service providers contributing to the development and implementation of clinical protocols or guidelines

Health Policy Analysis

The study of:

• how health policies are made, what they are, what they might become and what their effects are

• why some problems get policy attention and not others; why some policies get implemented and not others

• Interdisciplinary: political science, economics, sociology, public health, nsg, ethics)

Health Policy Analysis (HPA):

what can it do?

1. describe: what is (or has) happened?
2. explain: why did it happen?
3. evaluate: what are the policies effects (cost, use of services, satisfaction, health outcomes)
4. predict: what will happen in future?
5. prescribe: what should happen?

[1] Describing Policy

[2] Explaining Policy

• Are we getting value for the money we are spending on pharmaceuticals?
• What else could we be spending our public resources on?

[3] Evaluating Policy

[4] Predicting Policy

[5] Prescribing Policy

• whose interests are advanced by pursuing this policy direction?
• another take on prescriptive policy analysis

Health Policy Analysis (HPA)

who produces it and where?

• Scholarly activity in universities
• professional activity: govt and non-govt org (Ont Ministry of Health and LTC, CNA)
• advocacy-oriented activity (e.g., prof associations, consumers/patient org)

Conducting HPA:

Core Elements

Melds: Analytic Frameworks

with Rigorous Methods

Melds: Analytic Frameworks

Frameworks of Analysis:  

The Policy Cycle (stages model)

[Agenda setting]

1. Problem identification >
2. Policy Formation >
3. Policy Implimentation >
4. Evaluation > step 1 

Defining Problems and Setting Agendas

Genesis of policies depends on how the problem is defined, interpreted and understood through the agenda setting process

Problems and Agenda Setting:

how do problems come to our attention?

• focusing events, crisis and their media portrayal (sars, hiv/aids in Africa)
• Changes in indicators (rising health care costs) detected via routine monitoring and research reports
• feedback from the operation of current programs (auditor general reports)

3 sets of influence (the Three I's)

[1] Interests

[2] Institutions

[3] Ideas

3 types of participants

[A] government actors

[B] interest groups

[C] mass publics

The Three I's

[1] Interests

[2] Institutions

[3] Ideas

1, 2, +3 each/all impact the Policy Cycle

[1] Interests

The Three I's

• A common goal, cause or issue that brings people together
• two key dimensions:

1. Economic (to be protected or advanced
2. Political (i.e., exerting ctrol through avail resources over people, processes and decisions)

• Often portrayed as "sides" on an issue that produce winners and losers

Groups with Health Policy *Interests*

• providers
• facilities
• consumers
• industries

[2] Institutions

The Three I's

• Focus on "procedures" for making policies (i.e., rules for the game)
• Procedures / rules are selective and exclusive and can determine whose views will be represented and influential
• Institutions shape how interests organize themselves and how much power they have

• Depicts the interaction and interface b/w research and [values]

Values (r/t ideas)

• enduring, moral beliefs about the way the world ought to be

- distinct from 'causal beliefs' which could be changed with research evidence

• Values guide action, fuel rhetoric, facilitate and constrain our receptivity to research evidence

Influences on the

Policy Development Process

[ideas, three I's]

• Ideas at the margin, or marginalized ideas?

Influences on the

Policy Development Process

[interests]

• losers: those deriving incomes from the health-care system
• diffuseness and far-off benefits of policy action on determinants of health act as deterrents for advocates
• difficult to build strong constituency for action among the general public

• momentum from past policies to continue huge resource commitments to the health-care system
• "this is how we've done things"
• few formal decision-making structures for making policies across different areas (e.g., housing, environment, taxation)
• Health ministries don't have full responsibility for health!

how HPA (Health Care Analysis)

Can Be Uses

• To explain how and why policy decisions are taken (or not taken)
• To assess the impacts of these policies on individuals, pop'ns, society, costs
• To inform and enlighten future policy decision-making