HEALTH POLICY

What is policy?

Health Policy
What is policy?

 Policy exists within different sectors

of society
 Policies exist at all levels of society
 Policies exist beyond government
legislation and regulations
 Public policy = government policy
Policy =

a set of decisions taken by those responsible for particular policy area. it may be in health or the
environment, in education or in trade.
What is policy?
 Policy as intent =
 the vision, goals, understandings, principles,
and plans that seek to e.g. guide activities,
establish accountability & responsibility

 Policy as practice =
 routine decisions, activities, understandings &
actual achievements
What is policy?
 Policies are presented in:
 documents, regulations, laws, ministerial statements
etc.
- When looking at public policy, you
should look for statements or formal
positions issued by a government, or a
government department.
- Sometimes policy is called a
programme
 What is policy

 Policies are made in the private and the public

sector. However, private sector corporations have to
ensure that their policies are made within the
confines of public law, made by governments.

 Public policy refers to government policy. For

example, Thomas Dye (2001) says that public policy
is whatever governments choose to do or not to do.

 He argues that failure to decide or act on a

particular issue also constitutes policy. For example,
some have chosen not to introduce universal health
care.
 Thomas Dye’s simple definition of public
policy being what governments do, or do
not do, contrasts with the more formal
assumptions that all policy is made to
achieve a particular goal or purpose.
Government Purposes
and Public Policies
Public policy -- a general plan
of action, designed by
government to solve a problem
or pursue an objective
Not acting is also a policy
decision
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Health Policy …

Embraces courses of action that affect

sets of institutions, organisations,
services and funding arrangements of
the health care system. It goes beyond
health services, however, and includes
actions or intended actions by public,
private (including households) or
voluntary organisations that have
impact on health
Walt 1994 p.41
Health Policy Defined
 Healthpolicies are public policies or
authoritative decisions that pertain to
health or influence the pursuit of health

 Health policies affect or influence groups

or classes of individuals or organizations
Health policy
 Health policy may cover public and private
policies about health.

 Because health is influenced by many

determinants outside the health system, health
policy analysts are also interested in the actions
and intended actions of organizations external
to the health system which have an impact on
health (for example, the food, tobacco or
pharmaceutical industries).
 Why Health Policy
 Health is also affected by many decisions that have nothing
to do with health care: poverty affects people’s health, as
do pollution, contaminated water or poor sanitation.

 Economic policies, such as taxes on cigarettes or alcohol

may also influence people’s behaviour. Current explanations
for rising obesity among many populations, for example,
include the promotion of high calorie, inexpensive fast
food,the sale of soft drinks, as well as dwindling
opportunities to take exercise.

 Understanding the relationship between health policy and

health is therefore important so that it is possible to tackle
some of the major health problems of our time – rising
obesity, the HIV/AIDS epidemic, growing drug abuse –
Categories of Public Health
Policies

Publichealth policies are

grouped into two categories
Allocative
Regulatory
Allocative Policies
 Designed to provide net benefits to some
distinct group of class of individuals or
organizations, at the expense of
others(?), in order to ensure that public
objectives are met
 In general, allocative policies come in
the form of subsidies
 Examples
 Medicare and Medicaid policies
Regulatory Policies
 Policiesdesigned to influence the actions,
behaviors, and decisions of others to ensure
that public objectives are met
 Five main categories of regulatory policies
 Social regulations
 Quality controls on the provision of health
services
 Market-entry decisions
 Rate or price-setting controls on health
service providers
 Market-preserving controls
Social Regulations
These regulations are established
in order to achieve socially
desirable outcomes and to reduce
socially undesirable outcomes
Examples
Environmental protection
Childhoodimmunization
requirements
No smoking
Quality Controls
 These regulations are intended to ensure
that health services providers adhere to
acceptable levels of quality in the
services they provide and that producers
of health-related products meet safety
and efficacy standards
 Example
 Regulation of pharmaceuticals
Market-entry Restrictions
 Theseregulations focus on licensing
of practitioners and organizations
 Example
 Certificate of Need programs
 Physiciancredentialing (Hospital
privileges)
Rate or Price-setting Controls
 Theseregulations are designed to
control the growth of prices
 Example
 Free for all primary health care
Policy process

The way in which policies are

initiated, developed or
formulated, negotiated,
communicated, implemented and
evaluated.
Definition of Policy Process

Policy process is the process

by which a government or a
society sets its activities and
allocates resources
Policy is mainly deciding

 What you are going to do about

an issue
 How you are going to do it
 Who will do it
Why care about processes used for
solving social problems?
Because policy is a process, as
well as a product
If governments are to improve
health of their citizens, they
need to develop and/or reform
existing policies, which is a
continuing activity
Policy reform
A policy reform is a change
in programmes or practices

Itis enacted by a
government agency but may
affect either public or
private institutions
• Policy process involves both
• Technical expertise to produce
analytical recommendations
• Political acumen to create the
right environment that allows for
• Policy discussion
• Policy change
 Why policies are important
In principle, some outcomes that are
desirable to society as-a-whole require
some government intervention in order
to:

Equalize, or provide stability/security to

individuals, groups, and geographic regions.
Correct for imperfections in markets
caused by fluctuations in income, station in
life, investment risks, or even climate.
A Policymaking Model
Policymaking process has four
stages:
Agenda setting
Policy formulation
Implementation
Policy evaluation

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Figure 17.3
The Policymaking Process

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Phases of Policy Process
 Problem identification and issue recognition: explores how
issues get on to the policy agenda, why some issues do not
even get discussed.

 Policy formulation: explores who is involved in formulating

policy, how policies are arrived at, agreed upon, and how
they are communicated

 Policy implementation: this is often the most neglected

phase of policy making and is sometimes seen as quite
divorced from the first two stages.

 Policy evaluation: identifies what happens once a policy is

put into effect – how it is monitored, whether it achieves its
objectives and whether it has unintended consequences.
Agenda Setting
 Issue
definition influenced by our values,
world viewpoints, and what we consider
to be a government responsibility

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Agenda setting
 Def: Process by which certain issues come onto
the policy agenda from the much larger number of
issues potentially worthy of attention by policy
makers.

 Agenda setting is the process by which problems

and alternative solutions gain or lose public and
elite attention.” Birkland P.106
Agenda Setting
 Group competition to set the agenda is fierce
because no society or political system has the
institutional capacity to address all possible
alternatives to all possible problems that arise at
any one time.

 Groups must therefore fight to earn their issues’

places among all the other issues sharing the
limited space on the agenda or to prepare for
the time when a crisis makes their issue more
likely to occupy a more prominent space on the
agenda.
Agenda Setting
 Anagenda is a collection of problems,
understandings of causes, symbols,
solutions, and other elements of public
problems that come to the attention of
members of the public and their
governmental officials.

 Agendas exist at all levels of government.

Every community and every body of
government has a collection of issues that
are available for discussion and disposition.
 Agenda Setting
 Levels of the agenda.
 Agenda universe – all ideas that could possibly be
brought up and discussed in a society or a political
system.

 Systemic agenda – all issues that are commonly

perceived by members of the political community as
meriting public attention and as involving matters within
the legitimate jurisdiction of existing governmental
authority.

 Institutionalagenda – the list of items explicitly up for

the active and serious consideration of authoritative
decision-makers.

 Decision
agenda – items about to be acted on by a
governmental body.
 Agenda setting

 One prominent model is the

 The Hall model: legitimacy, feasibility and support

 This approach proposes that only when an issue and likely
response are high in terms of their legitimacy, feasibility and
support do they get onto a government agenda.
Agenda Setting
 Because the agenda is finite, interests
must compete with each other to get
their issues and their preferred
alternative policies, on the agenda.

 They must also compete with each

other to keep their issues off the
agenda, using the power resources at
their disposal.
The Idea of Political Power
 We know instinctively that some groups are more
powerful than others.
 But, what does power mean in this context.
 Two faces of power.
 One face – the power to compel people to do things, even
against their will, a coercive power.
 Second face – the ability to keep a person from doing
what he or she wants to do, a blocking power.
 In the first face of power, “A” participates in the
making of decisions that affect “B”, even if B does
not like the decisions or their consequences.
 In the second face of power, A prevents B’s issues
and interests from getting on the agenda or
becoming policy, even when actor B really wants
these issues raised.
The Idea of Political Power

 The blocking form of power does not

arise simply because of A’s superior
resources, but usually because the
system itself (the nature and rules of
the game) is biased against B.
How other problems get
on the higher agendas

Indicators (numbers):
Magnitude and change
Deciding to count something is
itself a policy decision
Focusing events: “A disaster, crisis, personal
experience, or powerful symbol—draws attention to
some conditions more than to others. But such an
event has only transient effects unless accompanied by
a firmer indication of a problem, by a preexisting
perception, or by a combination with other similar
events.
Katrina
Past catastrophes
What problem(s) does Katrina bring into
focus?
Policy Formulation

 Policy
formulation where formal plans
are developed and officials decide about
adoption

 Not always just one stage,

 Proposals not always enacted

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 Policy environment

Policy environment or policy space

is the arena in which a particular
policy process takes place
It consists of
Institutionalactors
Individual actors
Interest groups
The citizenry, occasionally
Responsible
 The people who make policies are referred to as policy
makers.

 They are also sometimes referred to as policy elites

 For Walt (1994), health policy is synonymous with politics

and deals explicitly with who influences policy making,
how they exercise that influence, and under what
conditions.
Actors in policy environment:
They may be perceived as acting as
a result of bureaucratic or
institutional interest but they are
equally likely to act on the basis
of their:
Prior experience
Expertise
Personal values, or
Ideology
Policy environments in developing
countries
Differ from that in industrialized countries:
Few DCs consistently practice democracy
Interest groups are less visible elements
in the policy process
Decision – makers, as individuals, rather
than as representatives of their
bureaucratic institutions, assume central
roles in making and implementing public
policies
Policy environments in developing countries
Differ from that in industrialized
countries:

Littleinformation is available about

the policy space and administrative
environments

Administrative environments are

particularly fragile and vulnerable to
political storms
Implementation
Process by which policies carried out
is implementation

Process starts with notification of

affected parties

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 What Influences
implementation?

• Top-down or bottom-up approaches

Implementation in practice

Top-down approaches
 Rational,prescriptive
 Implementation is part of managing a sequential
process

 Bottom-up approaches
 Incremental,iterative
 Implementers are active participants
Other factors that influence
implementation

Clear goals

Implementation by one actor /

structure

 Rapid implementation
Types of policies influence
implementation

 Rapid implementation

 Short duration of the execution of policy is

less likely to encounter
organized resistance,
leadership changes,
distortions in policy.
Policy Evaluation
 Policy evaluation the analysis of a public
policy’s results
Measurement of program outcomes
Cost-effectiveness analysis

 Evaluation provides feedback on policies

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 CHALLENGES IN POLICY PROCESS
• Its time consuming (extensive
consultations both internally and
externally)
• Politically required.
• Donor influence/Global trends
• Inadequate resources
• Slow responses from key players
• Lack/inadequate legal framework
 End