Inhoudsopgave
Making health policy.........................................................................................................................3
Chapter 1 - The health policy framework...........................................................................................3
Why is health policy important?.........................................................................................................4
What is health policy?........................................................................................................................4
Analyzing health policy.......................................................................................................................5
The health policy triangle...................................................................................................................5
Contextual factors that affect policy..................................................................................................6
The process of policy making..............................................................................................................7
Chapter 2 - Power and the policy process..........................................................................................8
Dimensions of power..........................................................................................................................8
Who has power..................................................................................................................................9
Power and political systems.............................................................................................................10
participation, benefits and openness................................................................................................11
Incremental models of decision making: more realistic; but too conservative?...............................13
Punctuated equilibrium....................................................................................................................14
Mixed-scanning approach to decision making: the middle way.......................................................14
Summary..........................................................................................................................................15
Chapter 3 – The state and the private sector in health policy..........................................................15
Reinvention of government and health sector reform......................................................................17
The for-profit sector and health policy.............................................................................................18
What is the private sector?..............................................................................................................18
What makes the private sector a powerful actor in health policy?..................................................19
How is the private sector involved in health policy?.........................................................................19
Co-regulation....................................................................................................................................20
Summary..........................................................................................................................................20
Chapter 4 – Agenda setting..............................................................................................................21
Why do issues get onto the policy agenda?......................................................................................21
Agenda setting in ‘politics –as-usual’ circumstances........................................................................21
The Hall et al. Legitimacy, feasibility and support............................................................................22
The Kingdon model: ‘policy windows’ and three ‘streams’ within the policy process.......................22
Agenda setting and policy change under crisis.................................................................................23
Non-decision making........................................................................................................................24
Who sets the agenda?......................................................................................................................24
Governments as agenda setters.......................................................................................................25
The mass media as agenda setter....................................................................................................25
Priorities and the policy agenda.......................................................................................................27
summary..........................................................................................................................................27
Chapter 5 - Government and the policy process..............................................................................27
Characterizing government systems................................................................................................28
Federal versus unitary systems.........................................................................................................29
Majortarian versus proportional electoral systems..........................................................................29
Relations between the legislature, executive and judiciary..............................................................29
Political parties.................................................................................................................................30
The role of the legislature.................................................................................................................31
The influence of the executive..........................................................................................................32
The role of the chief executive..........................................................................................................32
The contribution of the bureaucracy................................................................................................32
1
, The position of the ministry of health...............................................................................................33
Relations with other ministries.........................................................................................................34
Professional versus other sources of advice.....................................................................................35
summary..........................................................................................................................................35
Chapter 6 - Interest groups and the policy process..........................................................................36
Insider and outsider groups:.............................................................................................................38
Functions of interest groups:............................................................................................................38
Chapter 7 - Policy implementation..................................................................................................41
Distinctive elements in New Public Mangament:.............................................................................45
Chapter 8 - Globalizing the policy process.......................................................................................47
5 aspects of Globalization:..............................................................................................................47
Chapter 9 - Research, evaluation and policy....................................................................................48
The engineering model (or rational/lineair model):.........................................................................48
Enlightenment model:......................................................................................................................49
The strategic model:.........................................................................................................................49
The elective affinity model:...............................................................................................................49
The two community’s model:...........................................................................................................50
Factors influencing whether and how research is used in policy making:........................................50
The knowledge transfer approach:...................................................................................................54
2
,Making health policy
Chapter 1 - The health policy framework
- This chapter introduces why health policy is important and how to define policy
Learning objectives
After working through this chapter, you will be better able to:
- Understand the framework for analyzing health policy used in this book to define the
following key concepts:
o Policy
o Context
o Actors
o Process
- Describe how health policies are made through the inter-relationships of context,
process and actors
- Understand a related way of looking at policy making that sees it as occurring
through the ongoing interaction among interests, ideas and institutions.
Key terms:
Actor: term used to denote any participant in the policy process that affects policy, including
individuals, organizations, groups and even the government
Content: substance of a particular policy in which details its constituent parts
Context: systemic factors: political, economic, social or cultural, both national and
international – which may have an effect on health policy
Epistemic community: policy community marked by shared political values, and a shared
understanding of a problem and its causes.
Ideas: The values, evidence, anecdote and argument that shape policy, including the way
policy problem or solution is presented
Interest: What an actor or group stands to gain or lose from a policy change
Institutions: The ‘rules of the game’ determining how government and the wider state
operate. Institutions can be formal structures and procedures, but also informal norms of
behavior that may not be written down.
Policy: broad statement of goals, objectives and means that create the framework for
activity. Often takes the form of explicit written documents, but may also be implicit or
unwritten.
3
, Policy elite: specific group of policy makers who hold high positions in a policy system, and
often have privileged access to other top members of the same, and other, organizations.
Policy makers: Those who make policies in organizations such as central or local
government, multinational companies or local businesses, clinics, or hospitals
Policy process: The way in which policies are initiated, formulates, developed, negotiated,
communicates, implemented and evaluated.
Why is health policy important?
Health is affected by many decisions that go beyond the treatment provided by the health
care system, for example, poverty, the physical environment and education all can have an
impact on health status.
Understanding the relationship between health policy and health, and the impact that other
policies have on health, is important because it may help to tackle some of the major health
problems of our time – such as rising obesity.
Health policy guides choices about health which health technologies to develop and use,
how to organize and finance health services, or which drugs will be freely available.
What is health policy?
Health policy may cover public and private policies about health. In this book, health policy is
assumed to embrace courses of action (and inaction) that affects the set of institutions,
organizations, services and funding arrangements of the health and health care system.
It includes policy made in the public sector (by government) as well as policies in the private
sector.
Health policy defined as in the lecture:
Refers to decisions, plans, and actions
- To achieve specific health care goals
- Within a society
An explicit health policy:
- Defines a vision for the future
- Which helps to establish targets and points of reference
- For the short and medium term
- Outlines priorities and expected roles of different groups; and it builds consensus and
informs people.
But because health is influences by many determinants outside the health system, health
policy analysts are also interests in the actions and intended actions of organizations
external to the health system which have an impact on health (for example the ministry of
transport or the food, tobacco or pharmaceutical industries)
4
Making health policy.........................................................................................................................3
Chapter 1 - The health policy framework...........................................................................................3
Why is health policy important?.........................................................................................................4
What is health policy?........................................................................................................................4
Analyzing health policy.......................................................................................................................5
The health policy triangle...................................................................................................................5
Contextual factors that affect policy..................................................................................................6
The process of policy making..............................................................................................................7
Chapter 2 - Power and the policy process..........................................................................................8
Dimensions of power..........................................................................................................................8
Who has power..................................................................................................................................9
Power and political systems.............................................................................................................10
participation, benefits and openness................................................................................................11
Incremental models of decision making: more realistic; but too conservative?...............................13
Punctuated equilibrium....................................................................................................................14
Mixed-scanning approach to decision making: the middle way.......................................................14
Summary..........................................................................................................................................15
Chapter 3 – The state and the private sector in health policy..........................................................15
Reinvention of government and health sector reform......................................................................17
The for-profit sector and health policy.............................................................................................18
What is the private sector?..............................................................................................................18
What makes the private sector a powerful actor in health policy?..................................................19
How is the private sector involved in health policy?.........................................................................19
Co-regulation....................................................................................................................................20
Summary..........................................................................................................................................20
Chapter 4 – Agenda setting..............................................................................................................21
Why do issues get onto the policy agenda?......................................................................................21
Agenda setting in ‘politics –as-usual’ circumstances........................................................................21
The Hall et al. Legitimacy, feasibility and support............................................................................22
The Kingdon model: ‘policy windows’ and three ‘streams’ within the policy process.......................22
Agenda setting and policy change under crisis.................................................................................23
Non-decision making........................................................................................................................24
Who sets the agenda?......................................................................................................................24
Governments as agenda setters.......................................................................................................25
The mass media as agenda setter....................................................................................................25
Priorities and the policy agenda.......................................................................................................27
summary..........................................................................................................................................27
Chapter 5 - Government and the policy process..............................................................................27
Characterizing government systems................................................................................................28
Federal versus unitary systems.........................................................................................................29
Majortarian versus proportional electoral systems..........................................................................29
Relations between the legislature, executive and judiciary..............................................................29
Political parties.................................................................................................................................30
The role of the legislature.................................................................................................................31
The influence of the executive..........................................................................................................32
The role of the chief executive..........................................................................................................32
The contribution of the bureaucracy................................................................................................32
1
, The position of the ministry of health...............................................................................................33
Relations with other ministries.........................................................................................................34
Professional versus other sources of advice.....................................................................................35
summary..........................................................................................................................................35
Chapter 6 - Interest groups and the policy process..........................................................................36
Insider and outsider groups:.............................................................................................................38
Functions of interest groups:............................................................................................................38
Chapter 7 - Policy implementation..................................................................................................41
Distinctive elements in New Public Mangament:.............................................................................45
Chapter 8 - Globalizing the policy process.......................................................................................47
5 aspects of Globalization:..............................................................................................................47
Chapter 9 - Research, evaluation and policy....................................................................................48
The engineering model (or rational/lineair model):.........................................................................48
Enlightenment model:......................................................................................................................49
The strategic model:.........................................................................................................................49
The elective affinity model:...............................................................................................................49
The two community’s model:...........................................................................................................50
Factors influencing whether and how research is used in policy making:........................................50
The knowledge transfer approach:...................................................................................................54
2
,Making health policy
Chapter 1 - The health policy framework
- This chapter introduces why health policy is important and how to define policy
Learning objectives
After working through this chapter, you will be better able to:
- Understand the framework for analyzing health policy used in this book to define the
following key concepts:
o Policy
o Context
o Actors
o Process
- Describe how health policies are made through the inter-relationships of context,
process and actors
- Understand a related way of looking at policy making that sees it as occurring
through the ongoing interaction among interests, ideas and institutions.
Key terms:
Actor: term used to denote any participant in the policy process that affects policy, including
individuals, organizations, groups and even the government
Content: substance of a particular policy in which details its constituent parts
Context: systemic factors: political, economic, social or cultural, both national and
international – which may have an effect on health policy
Epistemic community: policy community marked by shared political values, and a shared
understanding of a problem and its causes.
Ideas: The values, evidence, anecdote and argument that shape policy, including the way
policy problem or solution is presented
Interest: What an actor or group stands to gain or lose from a policy change
Institutions: The ‘rules of the game’ determining how government and the wider state
operate. Institutions can be formal structures and procedures, but also informal norms of
behavior that may not be written down.
Policy: broad statement of goals, objectives and means that create the framework for
activity. Often takes the form of explicit written documents, but may also be implicit or
unwritten.
3
, Policy elite: specific group of policy makers who hold high positions in a policy system, and
often have privileged access to other top members of the same, and other, organizations.
Policy makers: Those who make policies in organizations such as central or local
government, multinational companies or local businesses, clinics, or hospitals
Policy process: The way in which policies are initiated, formulates, developed, negotiated,
communicates, implemented and evaluated.
Why is health policy important?
Health is affected by many decisions that go beyond the treatment provided by the health
care system, for example, poverty, the physical environment and education all can have an
impact on health status.
Understanding the relationship between health policy and health, and the impact that other
policies have on health, is important because it may help to tackle some of the major health
problems of our time – such as rising obesity.
Health policy guides choices about health which health technologies to develop and use,
how to organize and finance health services, or which drugs will be freely available.
What is health policy?
Health policy may cover public and private policies about health. In this book, health policy is
assumed to embrace courses of action (and inaction) that affects the set of institutions,
organizations, services and funding arrangements of the health and health care system.
It includes policy made in the public sector (by government) as well as policies in the private
sector.
Health policy defined as in the lecture:
Refers to decisions, plans, and actions
- To achieve specific health care goals
- Within a society
An explicit health policy:
- Defines a vision for the future
- Which helps to establish targets and points of reference
- For the short and medium term
- Outlines priorities and expected roles of different groups; and it builds consensus and
informs people.
But because health is influences by many determinants outside the health system, health
policy analysts are also interests in the actions and intended actions of organizations
external to the health system which have an impact on health (for example the ministry of
transport or the food, tobacco or pharmaceutical industries)
4
