HS3400 Final Exam Review (Comprehensive &
Cumula ve) With complete solu on New 2025/2026
Policy implementa on - Correct Answers - Decisions -> ac on
- Most difficult and cri cal stage
- Can be poli cal - "winners and losers" become evident and tensions may arise among actors
Implementa on gap - Correct Answers Gap b/w planned and occurred
* Long history of failure, not well planned and under resourced
Actors - Correct Answers - Poli cians
- Bureaucrats
- Other actors
Poli cians - Correct Answers - Prime Minister
- Premier
- Ministers (Cabinet)
- In health - Minister of Health
Bureaucrats - Correct Answers - Civil servants in Ministries
- Departments within ministries responsible for policy implementa on
- Experts who work on policy
Other Actors - Correct Answers - Interest groups
- Individuals
,- Media
* Publicize new policy, educate and deliver program/service
Policy instruments or tools - Correct Answers Tools to implement policy decision to achieve
the policy goal:
1. Informa on and persuasion
2. Regula on
3. Public provision
4. Markets and market-like incen ves
Informa on and persuasion - Correct Answers - Change behaviour using informa on
E.g., Educa on, healthy living-ads
Regula on - Correct Answers - Change behaviour by forcing compliance through sanc ons
E.g., Laws
Public provision - Correct Answers - Government provides the services directly
E.g., Government programs
Markets and market-like incen ves - Correct Answers - Change behaviour using incen ves
associated with markets
E.g., Free 'money', tax credits on sports equip.
Policy implementa on approaches - Correct Answers 1. Top-down*
2. Bo;om-up
3. Principal-Agent
4. New performance management*
,5. Advocacy coali on framework
* Dominant approaches
Top-down approaches (general) - Correct Answers - Aligned with the ra onal model -
implementa on is seen as a linear process
* Belief systema c implementa on occurs, goals will be achieved
- Top down also refers to the idea that policy implementa on takes place in a hierarchy
* Decision-maker to those affected
** min. involvement from affected
Top-down approaches (condi ons)
[P.P.C.O.S.T.] - Correct Answers - A structured implementa on process
- Commi;ed, skilled people to implement
- No changes in the condi ons that support policy implementa on
E.g., poli cal support is maintained
- Clear and logically consistent objec ves
- Support from interest groups and government
- Adequate causal theory (valid theory linking ac ons and outcomes)
Top-down approaches - Correct Answers - Naïve
- Unrealis c
Bo;om-up approaches - Correct Answers - Awareness that those affected by policy should
be involved in its implementa on
* Principle of affected interests
- "Street Level Bureaucrats" - study of advocates for clients in the social welfare system
* Can interpret and reshape policy to meet client's needs
, - Bring affected early and consider impact of policy
- Ci zen engagement processes align well with bo;om-up approaches
Principal-agent theory - Correct Answers - Influenced by the rela onship b/w the principal
(Gv't) and the agent (civil servants/managers)
- Agent may have different understanding of the policy that the Principal intended
- Agent may have a great deal of discre on regarding how to implement the policy
- Policy intent may get "lost in transla on" from Principal to Agent
New public management - Correct Answers - Aligned with Neoliberalism
* Cdn moving in this direc on
- Use of market or market-like policy instruments
- Goals: effec veness and efficiency
- Give people more choice and informa on about the HC syst.
- Decisions are more decentralized (local involvement, regional delivery of HC, LHIN in ON)
- Performance-based funding or "pay for performance"
E.g., Excellence Care for All Act
Ontario's Excellence Care for All Act (goals)
[Q.P.I.E.] - Correct Answers - The health care system is focused on the quality of care and the
best use of resources
- The pa ent is at the centre of the health care system
- The main goal of the health care system is to get be;er and be;er at what it does (improve)
- Decisions about pa ent care are based on the best evidence and standards
Ontario's Excellence Care for All Act (quality care) - Correct Answers - HP will be paid based
on quality
Cumula ve) With complete solu on New 2025/2026
Policy implementa on - Correct Answers - Decisions -> ac on
- Most difficult and cri cal stage
- Can be poli cal - "winners and losers" become evident and tensions may arise among actors
Implementa on gap - Correct Answers Gap b/w planned and occurred
* Long history of failure, not well planned and under resourced
Actors - Correct Answers - Poli cians
- Bureaucrats
- Other actors
Poli cians - Correct Answers - Prime Minister
- Premier
- Ministers (Cabinet)
- In health - Minister of Health
Bureaucrats - Correct Answers - Civil servants in Ministries
- Departments within ministries responsible for policy implementa on
- Experts who work on policy
Other Actors - Correct Answers - Interest groups
- Individuals
,- Media
* Publicize new policy, educate and deliver program/service
Policy instruments or tools - Correct Answers Tools to implement policy decision to achieve
the policy goal:
1. Informa on and persuasion
2. Regula on
3. Public provision
4. Markets and market-like incen ves
Informa on and persuasion - Correct Answers - Change behaviour using informa on
E.g., Educa on, healthy living-ads
Regula on - Correct Answers - Change behaviour by forcing compliance through sanc ons
E.g., Laws
Public provision - Correct Answers - Government provides the services directly
E.g., Government programs
Markets and market-like incen ves - Correct Answers - Change behaviour using incen ves
associated with markets
E.g., Free 'money', tax credits on sports equip.
Policy implementa on approaches - Correct Answers 1. Top-down*
2. Bo;om-up
3. Principal-Agent
4. New performance management*
,5. Advocacy coali on framework
* Dominant approaches
Top-down approaches (general) - Correct Answers - Aligned with the ra onal model -
implementa on is seen as a linear process
* Belief systema c implementa on occurs, goals will be achieved
- Top down also refers to the idea that policy implementa on takes place in a hierarchy
* Decision-maker to those affected
** min. involvement from affected
Top-down approaches (condi ons)
[P.P.C.O.S.T.] - Correct Answers - A structured implementa on process
- Commi;ed, skilled people to implement
- No changes in the condi ons that support policy implementa on
E.g., poli cal support is maintained
- Clear and logically consistent objec ves
- Support from interest groups and government
- Adequate causal theory (valid theory linking ac ons and outcomes)
Top-down approaches - Correct Answers - Naïve
- Unrealis c
Bo;om-up approaches - Correct Answers - Awareness that those affected by policy should
be involved in its implementa on
* Principle of affected interests
- "Street Level Bureaucrats" - study of advocates for clients in the social welfare system
* Can interpret and reshape policy to meet client's needs
, - Bring affected early and consider impact of policy
- Ci zen engagement processes align well with bo;om-up approaches
Principal-agent theory - Correct Answers - Influenced by the rela onship b/w the principal
(Gv't) and the agent (civil servants/managers)
- Agent may have different understanding of the policy that the Principal intended
- Agent may have a great deal of discre on regarding how to implement the policy
- Policy intent may get "lost in transla on" from Principal to Agent
New public management - Correct Answers - Aligned with Neoliberalism
* Cdn moving in this direc on
- Use of market or market-like policy instruments
- Goals: effec veness and efficiency
- Give people more choice and informa on about the HC syst.
- Decisions are more decentralized (local involvement, regional delivery of HC, LHIN in ON)
- Performance-based funding or "pay for performance"
E.g., Excellence Care for All Act
Ontario's Excellence Care for All Act (goals)
[Q.P.I.E.] - Correct Answers - The health care system is focused on the quality of care and the
best use of resources
- The pa ent is at the centre of the health care system
- The main goal of the health care system is to get be;er and be;er at what it does (improve)
- Decisions about pa ent care are based on the best evidence and standards
Ontario's Excellence Care for All Act (quality care) - Correct Answers - HP will be paid based
on quality
