THE ROLE OF HEALTH POLICY IN THE PROVISION OF HEALTH CARE

Department of Health Policy and Administration UP College of Public Health

COURSE OBJECTIVES:
1.

2.

To define Health Policy What is it? To discuss the framework for health policy in a developing country like the Philippines

OTTAWA DECLARATION
Prerequisite to Health

peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, and equity.

FIVE ACTION AREAS

Building healthy public policy Creating supportive environments Strengthening community action Developing personal skills Re-orientating health care services toward prevention of illness and promotion of health

THREE BASIC STRATEGIES

Advocate
Enable Mediate

PRIMORDIAL PREVENTION

prevention of risk factors themselves, beginning with change in social and environmental conditions in which these factors are observed to develop, and continuing for high risk children, adolescents and young adults. Amendable to policy

WHY IS POLICY IMPORTANT

WHY IS POLICY IMPORTANT

DEFINITIONS: POLICY

Principles that govern action directed towards given ends (Titmus, 1974)

Consciously chosen course of action (or inaction) directed toward some end (Kalisch and Kalisch, 1982)

DEFINITIONPOLICY

Policy : a position taken on an issue by an organization or individual in a position of authority .

IT CAN BE

Statement, Decision Document Programme of action

Non action A deliberate attempt to block a decision

THREE ELEMENTS OF POLICY

Concern with order, systematic and consistent approach Legitimatized by authority of

Individuals Offices Organization

Expertise

HEALTH POLICY

Blanc and Burau (2004): those courses of action proposed or taken by government that impact on the financing and or provision of health services Health policy is about process and power and how that happends

WHAT IS POLICY ATTRIBUTES OF POLICY

Belongingness : it belongs to someone or somebody?

Government Department Party

Source, Colin ,Palfrey , Key Concepts in Health Care Policy and Planning,2000

ATTRIBUTE OF POLICY
Policy denotes commitment . stated intention Desire to make things happen Policy has status It has the backing of some influential entity
Source, Colin ,Palfrey , Key Concepts in Health Care Policy and Planning,2000

POLICY COMES IN DIFFERENT FORMS

HOGWOOD AND GUNN (1984)

Policy as an aspiration or general purpose We believe that the health of the nation is the first priority is terms of public spending Example : Corruption will not be tolerated by the PNOY administration. The programs of the new administration will be primarily for the poor and the marginalized

HOGWOOD AND GUNN (1984)

Policy as one proposal or set of proposal Government declaring that it shall reduce maternal mortality by 2/3 by year 2015

Health sector declaring its support to Universal Health Care

POLICY AS A PARTICULAR PROGRAM

Universal health screening (DEP ED) The TB DOTS program

POLICY AS A FORMALLY AUTHORIZED ACTION

When government states its intention in a piece of legislation ( white paper, charter ) Health care organization publishes its prospectus

Magna Carta for Health workers Cheaper medicines act Reproductive Health Bill

POLICY AS A PROCESS

Process as the progress of any policy from its original appearance on the agenda to its eventual implementation ,review and evaluation.

POLICIES COMES IN DIFFERENT FORMS

Embodied in Plans Programs Projects, Decision, Actions, Budgets, Rules and regulations

HEALTH POLICY

Public

health policy Health care policy

HEALTH POLICY
An

authoritative statement of intent adopted by government on behalf of the public with the aim of improving the health and welfare of the populations (centrally determined basis for action)

WHAT IS HEALTH POLICY

What

health agencies actually do rather than what governments would like them to do (Observing outcomes of decision making).

RATIONALIZATION OF VALUES

Heart of all political decisions is the allocation of value. Easton(1965) : allocation of values is the process by which government choose which values to grant and which to deny the process of making and altering policies

POLICY AS A RATIONALIZATION OF VALUES

Competing demands on finite resources: Demands made by individuals and groups seeking particular policies Resources help the government to respond to the demands being made ( money , building staff , time ) Support relates to the extent to which any government is authorised to pass legislation

Resources

Demands
Support Inbox

Policies are formulated, implemented and if necessary revised

What is the level of involvement of government? Government may choose to do nothing. (policy of inaction) Example : abortion, euthanasia

Policies are usually made within a framework of competing values

A SOCIAL PROBLEM IS NOT A SOCIAL PROBLEM UNLESS THOSE IN POWER DECIDES THAT THE ISSUE IS WORTHY OF ATTENTION

LEE AND MILLS (1985)

Policy making is concerned with what is politically feasible and technically desirable .

FOUR KEY CONSIDERATIONS

1. Political

pragmatism: 2. Ideological 3. Financial 4. Moral

ROLE OF THE STATE AND INDIVIDUAL ?

Individual

and state responsibility Obligations or responsibility

Wearing

of helmets, Smoking in Public

WHO DECIDES ? AND WHO ARE INVOLVED?

The consensus model -power granted to governments by people through periodic elections Pluralistic model no one group holds total power.

WHO DECIDES ? AND WHO ARE INVOLVED?

Elitist model government acts a honest brokers reconciling the competing interest of different groups towards agreed goals, not all interest groups are equally powerful or influential.

POLICY NETWORK

Several organization collaborating in order to plan a co-ordinated assessment and provision of services.

WHO ARE THE ACTORS ?

National Congress POLITICS International MDGs,WH0 DOH PHILHEALTH Academe

Local Provinces, City , Municipalities

Policies

Problems Health needs and demands

PEOPLE in the Community

DEFINITIONS: POLICY

Policy encompasses the choices that a society, segment of society, or organization makes regarding its goals and priorities and how it will allocate its resources.

POLICY PROCESS HOW ARE POLICY MADE?

RATIONAL MODEL
Step by step procedure Highly logical and carefully sequenced Does not allow for competing rationalities Considered too prescriptive

INCREMENTALISM (LINDBLOM,1959)

Muddling through a decision

Incremental change Involves mutual adjustments and negotiation Excludes options by accident Policy is not made once and for all Proceeds through a series of incremental changes

INCREMENTALISM (LINDBLOM,1959)
The test of good decision is agreement rather than meeting of objectives It involves trial and error

POLICY ANALYSIS: RATIONALIST MODE

Problem Analysis
1. Understanding the Problem
a. b. Receiving the problem: Assessing the symptoms Framing the problem : Analyzing market and government failures Modeling the problem: Identifying policy variables

Solution Analysis
1. 2. 3. 4. 5. Choosing impact categories for goals Concretely specifying Policy alternatives Predicting impacts of Alternatives Valuing impacts of Alternatives Evaluating and Recommending

Communication

c. 2.

Choosing and explaining relevant

goals and constraints 3. Selecting a solution method

Information Gathering
Identifying and organizing relevant data, theories, and facts for assessing problems and predicting consequences of current and alternative policies

POLICY PROCESS FRAMEWORK

Issues Agendas Decisions
Policy Formulation and Legitimation

Progress/Impact Monitoring
Implementation Design and Organizational Structuring

Constituency Building
Resource Mobilization

= primary linkage = secondary linkage

AGENDA SETTING

What is an agenda?

The list of subjects or problems to which government officials (or several sectors) are paying some serious attention to.

Process of agenda setting: Getting an Issue recognized Identification of a policy problem

Nature of the problem affects how it gets into the agenda and the course of action

POLICY PROBLEM

A condition or situation that produces needs or dissatisfaction on the part of the people for which relief and redress is sought

WHAT IS AN ISSUE /PROBLEM

Widespread attention to , or at least awareness of the issue Shared concern of a sizeable portion of the public that some type of action is needed to remedy the problem A shared concern that the matter is an appropriate concern of some governmental unit and falls within the bounds of its authority.

POLICY ANALYSIS: RATIONALIST MODE

Problem Analysis
1. Understanding the Problem
a. b. Receiving the problem: Assessing the symptoms Framing the problem : Analyzing market and government failures Modeling the problem: Identifying policy variables

Solution Analysis
1. 2. 3. 4. 5. Choosing impact categories for goals Concretely specifying Policy alternatives Predicting impacts of Alternatives Valuing impacts of Alternatives Evaluating and Recommending

Communication

c. 2.

Choosing and explaining relevant

goals and constraints 3. Selecting a solution method

Information Gathering
Identifying and organizing relevant data, theories, and facts for assessing problems and predicting consequences of current and alternative policies

How do issues get on to the policy agenda?

Problem Policy (Solutions) Politics (Political will)

No Change

No Change

No Change

No Change

ACTION

FRAMEWORKS OF POLICY DEVELOPMENT

Policy Making Policy Analysis Policy Research

THE POLICY CHANGE CYCLE

Initial Agreement (Plan for Planning) Issue Policy of Plan or Formulation Proposal Review and Adoption Policy or Plan Maintenance, Succession or Termination

Problem Formulation Creation Search for Solution

Implementation And Evaluation

Containment Triggering Mechanisms Mechanisms Public Agenda

Formant Agents

The Policy Environment

THE WORLD IN WHICH POLICIES ARE MADE (LOMAS)

Social Problem/ Issue
Knowledge CORE VALUES
Researchers and Universities FORMAL STRUCTURE

Evidence Data Research

VALUES
BELIEFS Causal Assumptions INTERESTS

Ideologies

Advocates Policy Brokers Media

Executive
Legislative

Bureaucracy

INFORMAL SRUCTURE Networks Coalitions

Stakeholders

Citizens

Policies

POLICY ANALYSIS: RATIONALIST MODE

Problem Analysis
1. Understanding the Problem
a. b. Receiving the problem: Assessing the symptoms Framing the problem : Analyzing market and government failures Modeling the problem: Identifying policy variables

Solution Analysis
1. 2. 3. 4. 5. Choosing impact categories for goals Concretely specifying Policy alternatives Predicting impacts of Alternatives Valuing impacts of Alternatives Evaluating and Recommending

Communication

c.

2.

Choosing and explaining relevant

goals and constraints 3. Selecting a solution method

Information Gathering
Identifying and organizing relevant data, theories, and facts for assessing problems and predicting consequences of current and alternative policies

QUICK AND DIRTY POLICY ANALYSIS PROCESS

Verify, Define, Detail the PROBLEM

MONITOR the implemented policy

Establish EVALUATION CRITERIA

DISPLAY and DISTINGUISH among alternatives

Identify ALTERNATIVE POLICIES

EVALUATE alternative policies

Source: Patton and Sawicki, 1993

COMMITMENT

To search for the COMMON GOOD Through Health Policy Development