introduction-to-health-policy

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  • There may be one pure form . In real life health care –may include more than one type as in Belgium and Spain
  • introduction-to-health-policy

    1. 1. Prerequisite to Health • peace, • shelter, • education, • food, • income, • a stable eco-system, • sustainable resources, • social justice, and equity.
    2. 2.  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
    3. 3. Advocate Enable Mediate
    4. 4.  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
    5. 5.  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 ands Hanley, 1991)
    6. 6.  Belongingness : it belongs to someone or somebody?  Government  Department  Party Source, Colin ,Palfrey , Key Concepts in Health Care Policy and Planning,2000
    7. 7. 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
    8. 8. 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”
    9. 9. 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
    10. 10.  Universal health screening (DEP ED)  The TB DOTS program
    11. 11.  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
    12. 12.  Process as the progress of any policy from its original appearance on the agenda to its eventual implementation ,review and evaluation.
    13. 13.  Embodied in plans,programs,projects,decision,actions,budg ets,rules and regulations
    14. 14.  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.
    15. 15.  Pertains to the directives that promote the welfare of a public.  e.g. Magna Carta for Public Health Workers- law that could be viewed as a policy that promotes the welfare of health workers.
    16. 16.  Includes the directives and goals for promoting the health of citizens.  e.g. Generic Drug Act, Tobacco Regulation Act
    17. 17.  Rules governing and positions taken by organizations  i.e. PNA, PMA, PHAP
    18. 18.  Policies that govern workplaces  What the institution’s goals will be ;  How it will operate;  How the institution will treat its employees, and  How employees will work.  e.g. sexual harassment policy, contractualization policy
    19. 19.  Public health policy  Health care policy
    20. 20.  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)
    21. 21.  What health agencies actually do rather than what governments would like them to do (Observing outcomes of decision making).
    22. 22.  Health  Policy  Contentious terms with many meanings
    23. 23.  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
    24. 24. 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
    25. 25. A policy is a plan or course of action  designed to define issues,  influence decision-making and  promote broad community actions beyond those made by individuals.
    26. 26. Inbox Demands Resources Support Policies are formulated, implemented and if necessary revised
    27. 27.  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
    28. 28.  A regulator of health care agencies  A stimulator of research  A protector of deprived and disadvantaged groups  A financier of health and health care programmes  A purchaser of health care services  A direct provider of services
    29. 29. Emergent Health System : healthcare iis viewed as an item of personal consumption Pluralistic: Health care is viewed as a consumer good. Private and Public ownership of facilities, States role is minimal and indirect Insurance/Social security. Health care is seen as an insured . Guaranteed consumer good /service. Government role : central , but indirect National Health Service: health care is state supported, facilities are mainly publicly owned, payment for services is central and direct Socialized: Health care as a state provided service. States role in health is total
    30. 30.  Power to decide  Power as non decision making -non decision -limiting the scope of actual decision to safe issues by manipulating these dominant community values, myths and political institutions and processes
    31. 31. a) Authority – whereas power concerns the ability to influence others, authority refers to the right to do so. b) When authority exits, personal judgement is surrendered to an authority on trust and acceptance. c)
    32. 32.  Power is a function of the ability to influence others by shaping their eference....  Elections  The control of information , the mass media and through the process of socialization  Mcdonalds? SMART
    33. 33.  Role of the state?  Is the state independent of society? Or is it a reflection of the distributive power in society?  Does the state serve a common good or the interest of the privilege few.?
    34. 34. therefore, is the process • by which society makes decisions, • selects goals and the best means for reaching them, • handles conflicting views about what should be done and • allocates resources to address needs.
    35. 35.  The consensus model -power granted to governments by people through periodic elections  Pluralistic model – no one group holds total power.
    36. 36.  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.
    37. 37.  Several organization collaborating in order to plan a co-ordinated assessment and provision of services.
    38. 38. National Congress POLITICS International MDGs,WH0 Policies DOH PHILHEALTH Academe Local Provinces, City , Municipalities Problems Health needs and demands PEOPLE in the Community
    39. 39.  Pluralism :power is widely distributed in society  Elitism: theory that power is concentrated in a minority group in society
    40. 40.  Open electoral competition  Ability of individuals to organize themselves into pressure groups and political parties  Ability of pressure groups to air their views freely  Openness of the state to lobby of neutral for all pressure groups  STATE as a neutral referee adjudicating between competing demands  Although society has an elite group, no elite group dominates at all times
    41. 41.  Policy is dominated by a minority  Political elite  Non elites may be induced in governing circles if they accept the basic consensus of the existing elite  Public values reflect the values of the elite- not necessarily in conflict with the values of the masses  The values of the elite are conservative, policy changes are likely to be incremental
    42. 42.  RH Bill????  Agarian Reform????  No balance billing
    43. 43.  International health financing reforms  Studied by Lee and Goodman (2002)  Contrary to pluralist claims that globalization is opening up decisions to a wider range of actors...
    44. 44.  Power and Political systems  Power and the Health System
    45. 45.  Rational models of decision making ( too idealistic)  Incrementalism : more realistic but too conservative  Mixed scanning approach – middle way
    46. 46.  … Policy making is concerned with what is politically feasible and technically desirable . “
    47. 47.  Individual and state responsibility  Obligations or responsibility  Wearing of helmets,  Smoking in Public
    48. 48.  Privatization of publicly owned property  Regulations government interventions enforcing rules and standards  Transnational corporations with branches in more than one country
    49. 49.  Which of the four dimensions of policy making are likely considered when wealthy countries offer AID to less wealthy countries?  Which rights and responsibilities might be influential in determining a governments commitment to providing public fund for various health services?
    50. 50. 1.Political pragmatism: 2.Ideological 3.Financial 4.Moral
    51. 51.  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.
    52. 52. POLITICAL PROGRAMMATIC  What you are going to do about an issue  How you are going to do it  Who will do it • An overarching course of action • A series of objectives and how to reach them • A statement of intent • A long-term plan
    53. 53.  Step by step procedure  Highly logical and carefully sequenced  Does not allow for competing rationalities  Considered too prescriptive
    54. 54.  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
    55. 55.  The test of good decision is agreement rather than meeting of objectives  It involves trial and error
    56. 56.  Appreciative setting ( Vickers 1965)  Policy choices are constrained by the cultural and ideological horizon of individuals and groups  There are no built in priorities to guide them in the multivalued choices so they must decide what to place most value on in the concrete situation of every decisions
    57. 57.  Mixed scanning (Etzioni 1967)  Policy makers need to have regard to both breadth and depth depending on how they would distinguish between problems and issues requiring detailed examination and those needing more general overview
    58. 58.  Planned bargaining ( Challis et al 1988)  combine and coordinate various interest groups towards an agreed strategic set of policies  Recognizes the importance of rationality and the reality ofpolitics
    59. 59.  Extra rationality (Dror,1989)  prescriptive account of how policy ought to be made: a mix of rationality and inspiration  Notion of extra rationality : use of judgement, creative intervention, brainstorming , the brilliant idea that may come unexpectedly
    60. 60. Problem Analysis 1. Understanding the Problem a. Receiving the problem: Assessing the symptoms b. Framing the problem : Analyzing market and government failures c. Modeling the problem: Identifying policy variables 2. Choosing and explaining relevant goals and constraints 3. Selecting a solution method Solution Analysis 1. Choosing impact categories for goals 2. Concretely specifying Policy alternatives 3. Predicting impacts of Alternatives 4. Valuing impacts of Alternatives 5. Evaluating and Recommending Communication Information Gathering Identifying and organizing relevant data, theories, and facts for assessing problems and predicting consequences of current and alternative policies
    61. 61. Policy Formulation and Legitimation Implementation Design and Organizational Structuring Resource Mobilization Progress/Impact Monitoring Constituency Building Agendas Decisions Issues = primary linkage = secondary linkage
    62. 62. • 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
    63. 63.  A condition or situation that produces needs or dissatisfaction on the part of the people for which relief and redress is sought
    64. 64. • 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.
    65. 65. Problem Analysis 1. Understanding the Problem a. Receiving the problem: Assessing the symptoms b. Framing the problem : Analyzing market and government failures c. Modeling the problem: Identifying policy variables 2. Choosing and explaining relevant goals and constraints 3. Selecting a solution method Solution Analysis 1. Choosing impact categories for goals 2. Concretely specifying Policy alternatives 3. Predicting impacts of Alternatives 4. Valuing impacts of Alternatives 5. Evaluating and Recommending Communication Information Gathering Identifying and organizing relevant data, theories, and facts for assessing problems and predicting consequences of current and alternative policies
    66. 66. How do issues get on to the policy agenda? Problem Policy (Solutions) No Change No Change No Change Politics (Political will) ACTION No Change
    67. 67.  Policy Making  Policy Analysis  Policy Research
    68. 68. Initial Agreement (“Plan for Planning”) Issue Problem Formulation Creation Search for Solution Policy of Plan or Formulation Proposal Review and Adoption Implementation And Evaluation Policy or Plan Maintenance, Succession or Termination Triggering Mechanisms Containment Mechanisms Public Agenda Formant Agents The Policy Environment
    69. 69.  Concerned with maintaining and developing the polity- “the condition of civil order, form and process of civil government, organized society and state” – with the adoption of courses of action by political parties, governments and other important social organizations, and with issues in the “science and art of governing”
    70. 70. Evidence Data Research Knowledge Researchers and Universities Advocates Policy Brokers Media BELIEFS Causal Assumptions CORE VALUES Ideologies INTERESTS FORMAL STRUCTURE Executive Legislative Bureaucracy INFORMAL SRUCTURE Networks Coalitions Stakeholders Citizens Social Problem/ Issue Policies VALUES
    71. 71.  Client- oriented advice relevant to public decisions and informed by social values  Emphasize professional mind set rather than skill mastery  Emphasize the importance of social values in policy analysis  By looking at consequences of policies beyond those that affect client, places a value on the welfare of others  Good policy analysis takes a comprehensive view of consequences and social values
    72. 72.  Systematic Comparison and evaluation of alternatives available to public actors for solving social problems  Client – Specific person or institution as decision maker  Involves synthesis of existing research and theory to predict consequences of alternative policies
    73. 73.  Time constraints – strong deadline pressures because completion of analysis usually tied to specific decision  Weakness - myopia resulting from client orientation and time pressure
    74. 74.  Focuses on relationships 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, then Y will result.
    75. 75.  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
    76. 76.  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.
    77. 77.  Problem identification/ clarification  Decision that it is an important problem to study-policy research/ analysis  Proposal of policy alternatives  Selecting from policy alternatives  Implementation of policy  Evaluation
    78. 78. Problem Analysis 1. Understanding the Problem a. Receiving the problem: Assessing the symptoms b. Framing the problem : Analyzing market and government failures c. Modeling the problem: Identifying policy variables 2. Choosing and explaining relevant goals and constraints 3. Selecting a solution method Solution Analysis 1. Choosing impact categories for goals 2. Concretely specifying Policy alternatives 3. Predicting impacts of Alternatives 4. Valuing impacts of Alternatives 5. Evaluating and Recommending Communication Information Gathering Identifying and organizing relevant data, theories, and facts for assessing problems and predicting consequences of current and alternative policies
    79. 79. Source: Patton and Sawicki, 1993 Verify, Define, Detail the PROBLEM Establish EVALUATION CRITERIA Identify ALTERNATIVE POLICIES EVALUATE alternative policies MONITOR the implemented policy DISPLAY and DISTINGUISH among alternatives
    80. 80.  To search for the  COMMON GOOD  Through Health Policy Development

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