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F. Marilyn E. Lorenzo, RN, MPH, DrPH University of the Philippines Manila College of Public Health Department of Health Policy Administration
Health Policy and Administration 1
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.
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) Plan, direction or goal for action; authoritative decision making (Stimpson and Hanley, 1991)
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Policy Types
Public Policy substantive decisions,
commitments, and actions made by those who hold or affect government positions of authority as they are interpreted by various stakeholders. (Bryson and Crosby) Called policies, plans, programs, projects, decisions, actions, budgets, rules and regulations.
Health Policy and Administration
Policy Types
Social Policy pertains to the directives that promote the welfare of the public. E.g. Magna Carta for Public Health Workers- law that could be viewed as a policy that promotes the welfare of health workers.
Policy Types
Health Policy includes the directives and goals for promoting the health of citizens. E.g. Generic Drug Act May be trade or economic policies that have impact on health
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Policy Types
Organizational Policies rules governing and positions taken by
Policy Types
Institutional Policies are those governing workplaces What the institutions goals will be and how it will operate, how the institution will treat its employees, and how employees will work. E.g. sexual harassment policy
Policy Analysis
Policy Research
Formant Agents
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Policy Process:
A. Need Assessment 1. Identify the scope and limits of the problem 2. Identify the actors and stakeholders B. Policy Making 1. Conceptualize the causes of the problem 2. Collect information, procedures alternative solutions 3. Involve actors in choosing from policy alternatives
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Policy Process
C. Policy Implementation 1. Disseminate and publicize policy 2. Establish behavior changes based on the policy 3. Monitor and revise the policy
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between variables that reflect social problems and other variables that can be manipulated by public policy. - Desired product of is a more-or-less verified hypothesis of the form: if the government does X, they Y will result.
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Policy Research
Iterative by recognizing that there are no
perfect solutions to policy problems and therefore that the impact of one solution will lead to the need for new solutions either in the same or in a different policy
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Policy Research
Different from bio-medical or
epidemiologic research in the following ways Multidisciplinary using multiple methods to analyze components, Inductive rather than deductiveproblem driven, not theory-driven.
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Policy Research
Pragmatic by taking account of the policy
environment and arriving at solutions that are feasible given existing institutional structures Focuses on malleable variables i.e. variables that are under the control of and can be changed by the policy makers. Responsive by involving stakeholders and taking account of their values.
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institutions and/ or individuals in order to solve a problem. May be explicit or implicit Includes public policy as well as decision-making 2. Process of Policy development a. Problem identification/ clarification b. Decision that it is an important problem to study-policy research/ analysis c. Proposal of policy alternatives d. Selecting from policy alternatives e. Implementation of policy f. Evaluation
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VALUES
BELIEFS Causal Assumptions
INTERESTS
Researchers and Universities FORMAL STRUCTURE Advocates Policy Brokers Media Executive Legislative Bureaucracy
INFORMAL SRUCTURE
Networks
Coalitions Stakeholders Citizens
Policies
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Financial measures Regulatory or control measures Information-related Symbolic priority setting Research and development
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3. Finalization of policy recommendations Revisions because of the political situation Revisions because of the value of stakeholders Revisions because the organizational structure is inadequate.
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Commitment
To search for the
COMMON GOOD
Through Health Policy Development
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organizational behavior in order to predict, and perhaps influence, the feasibility of adoption and successful implementation of policies. - Understand worldviews of clients and potential opponents
5. Analysts should have an ethical framework that explicitly takes account of their relationships to clients.
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Proximate Factors
Health Outcomes
Individual
Age, sex, education Occupation, health beliefs, attitudes Household Income/wealth Age-sex composition Social networks Community Ecological climate Markets and prices Transportation Population size, structure and distribution Social structure and organization
Mortality
Environmental contraindicators
Morbidity
Injury
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Health Care Sector General economic resources (A) Economic resource specific to health (B) Supply of health care services (C) Health care service utilization (E) Demand for health care services (D)
A. B.
Land, labor, capital, technology Physicians, nurses, other health workers, hospitals, RHU, BHS, clinics, pharmaceuticals, medical equipments Institutional services, physician services, hospital services (in-patient care, outpatient care), treatment for specific health conditions, e.g. diarrhea, ARI, TB, tropical diseases, chronic disease Demand for institutional services or specific treatments Actual use of various types of services in various institutional setting Outputs of other health-related sectors, e.g. water supply, housing, etc.; and of social and economic sectors, e.g. education, food supply, employment and income, transportation Health outcomes, mortality, nutritional status, disability
C.
D. E. F.
G.
Other health-related and socio-economic sectors (F) Adapted from Andreano and Helminlak (1988)
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7, g, i 5, e 6, f 2, b, h 4, d 3, c 1, a
Health status (G) Other health-related and socio-economic sectors (F) Policy Areas, Issues and Questions of the 1. Interpersonal resource allocation 2. Health care service structure 3. Health care service focus 4. Health care service utilization 5. Health care service resource mix 6. Management and operational procedures 7. Organization of the health care sector (i.e., private-public sector mix in service delivery and finance). Health Policy and Administration 32 Criteria for Assessing the Economic Performance Health Care Sector a. Intersectoral allocative efficiency b. Service structure efficiency c. Service focus efficiency d. Service utilization efficiency e. Production efficiency
Towards Health Policy Development in the Philippines Figure 1. Determinants of Health Major Factors and Intervention Points
Underlying Socioeconomic Demographic and Cultural Factors Individual Age, Sex Education, Occupation Health Beliefs, attitudes Household Income/wealth Age-sex composition Social network Community Ecological climate Markets and prices Transportation Population size, structure and distribution Social structure and organization
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Environmental contamination
Morbidity
Nutritional status
Disability