Role of Health Policy in the Provision of Health Care

7/31/2019 Role of Health Policy in the Provision of Health Care

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THE ROLE OF HEALTHPOLICY IN THE PROVISION

OF HEALTH CARE

Department of Health Policy and

Administration

UP College of Public Health


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COURSE OBJECTIVES:

1. To define Health PolicyWhat is it?

2. To discuss the framework for health policy in

a developing country like the Philippines


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OTTAWA DECLARATION

Prerequisite to Health

peace,

shelter,

education, food,

income,

a stable eco-system, sustainable resources,

social justice, and equity.


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FIVE ACTION AREAS

Building healthy public policy

Creating supportive environments

Strengthening community actionDeveloping personal skills

Re-orientating health care services

toward prevention of illness andpromotion of health


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THREE BASIC STRATEGIES

Advocate

Enable

Mediate


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PRIMORDIAL PREVENTION

prevention of risk factors themselves,

beginning with change in social and

environmental conditions in which these

factors are observed to develop, andcontinuing for high risk children, adolescents

and young adults.

Amendable to policy


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WHY IS POLICY IMPORTANT


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WHY IS POLICY IMPORTANT


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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)


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DEFINITIONPOLICY

Policy : a position taken on an issue by an

organization or individual in a position of

authority .


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IT CAN BE

Statement,

Decision

Document

Programme of action

Non action

A deliberate attempt to

block a decision


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THREE ELEMENTS OF POLICY

Concern with order, systematic and

consistent approach

Legitimatized by authority of

Individuals

Offices

Organization

Expertise


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HEALTH POLICY

Blanc and Burau (2004): those courses of

action proposed or taken by government that

impacton the financing and or provision of

health services

Health policy is about process and power

and how that happends


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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


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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


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POLICY COMES IN DIFFERENT FORMS


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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


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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


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POLICY AS A PARTICULAR PROGRAM

Universal health screening (DEP ED)

The TB DOTS program


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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


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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.


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POLICIES COMES IN DIFFERENT FORMS

Embodied in

Plans

Programs

Projects,

Decision,

Actions, Budgets,

Rules and regulations


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HEALTH POLICY

Public health policy

Health care policy


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HEALTH POLICY

An authoritative statement of intent

adopted by government on behalf of

the public with the aim of improvingthe health and welfare of the

populations (centrally determined

basis for action)


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WHAT IS HEALTH POLICY

What health agencies actually

do rather than what

governments would like themto do (Observing outcomes of

decision making).


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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


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Inbox

Demands

Resources

Support

Policies are formulated, implemented

and if necessary revised


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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


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A SOCIAL PROBLEM IS NOT A SOCIALPROBLEM UNLESS THOSE IN POWER DECIDES

THAT THE ISSUE IS WORTHY OF ATTENTION


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LEE AND MILLS (1985)

Policy making is

concerned with what is

politically feasible and

technically desirable .


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FOUR KEY CONSIDERATIONS

1.Political pragmatism:

2. Ideological3.Financial

4.Moral


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ROLE OF THE STATE AND INDIVIDUAL ?

Individual and state

responsibility

Obligations or responsibility

Wearing of helmets,

Smoking in Public


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WHO DECIDES ? AND WHO ARE INVOLVED?

The consensus model -power granted to

governments by people through periodic

elections

Pluralistic model no one group holds totalpower.


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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.


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POLICY NETWORK

Several organization collaborating in order to

plan a co-ordinated assessment and

provision of services.


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National Congress POLITICS International MDGs,WH0

Policies

DOH

PHILHEALTH

Academe

Local

Provinces, City ,Municipalities

WHO ARE THE ACTORS ?

Problems

Health needs and

demands

PEOPLE

in theCommunity


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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.


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POLICY PROCESSHOW ARE POLICY MADE?


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RATIONAL MODEL

Step by step procedure

Highly logical and carefully sequenced

Does not allow for competing rationalities

Considered too prescriptive


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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


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INCREMENTALISM (LINDBLOM,1959)

The test of good decision is agreement

rather than meeting of objectives

It involves trial and error


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POLICY ANALYSIS: RATIONALIST MODE

Problem Analysis

1. Understanding the Problem

a. Receiving the problem:

Assessing the symptoms

b. Framing the problem :

Analyzing market andgovernment 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 organizingrelevant data, theories, and facts forassessing problems and predicting consequences of current and

alternative policies


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Policy Formulation

and Legitimation

Implementation Design and

Organizational Structuring

Resource

Mobilization

Progress/ImpactMonitoring

ConstituencyBuilding

Agendas

Decisions

Issues

= primary linkage

= secondary linkage


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AGENDA SETTING

What is an agenda? The list of subjects or problems to which government

officials (or several sectors) are paying some seriousattention 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


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POLICY PROBLEM

A condition or situation that produces needs

or dissatisfaction on the part of the people for

which relief and redress is sought


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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 toremedy the problem

A shared concern that the matter is an

appropriate concern of some governmentalunit and falls within the bounds of its

authority.


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POLICY ANALYSIS: RATIONALIST MODE

Problem Analysis

1. Understanding the Problem

a. Receiving the problem:

Assessing the symptoms

b. Framing the problem :

Analyzing market andgovernment 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 organizingrelevant data, theories, and facts forassessing problems and predicting consequences of current and


How do issues get on to the policy agenda?


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How do issues get on to the policy agenda?

Problem Policy (Solutions)

No Change

No Change

No Change

Politics (Political

will)

ACTION

No Change


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FRAMEWORKS OF POLICY DEVELOPMENT

Policy Making

Policy Analysis

Policy Research


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Initial

Agreement(Plan for

Planning)

Issue

Problem

Formulation

Creation

Search for

Solution

Policy of

Plan orFormulation

Proposal

Review andAdoption

Implementation

And Evaluation

Policy or Plan

Maintenance,

Succession orTermination

Triggering

Mechanisms

Containment

Mechanisms

Public Agenda Formant Agents

The Policy Environment


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Evidence DataResearch Knowledge

ResearchersandUniversities

Advocates PolicyBrokers Media

BELIEFS

CausalAssumptions

COREVALUES

Ideologies

INTERESTS

FORMALSTRUCTURE

Executive

Legislative

Bureaucracy

INFORMALSRUCTURE

Networks

Coalitions

Stakeholders

Citizens

SocialProblem/

Issue

Policies

VALUES


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QUICK AND DIRTY POLICY ANALYSIS PROCESS

Source: Patton and Sawicki, 1993

Verify, Define, Detail

the PROBLEM

Establish

EVALUATIONCRITERIA

Identify

ALTERNATIVE

POLICIES

EVALUATE


MONITOR the

implemented policy

DISPLAY and

DISTINGUISH

among alternatives


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COMMITMENT .

To search for the

COMMON GOOD

Through Health Policy Development

Documents

Role of Health Policy in the Provision of Health Care