health policy and health policy making...

HEALTH POLICY

AND

HEALTH POLICY MAKING PROCESS

Leadership and Policy Course

Agustin Indracahyani

Magister of Nursing Leadership and Management

Faculty of Nursing Universitas Indonesia

2018

OVERVIEW

• Policy related terms

– Policy

– Public policy

• Hierarchy

– Private policy

– Health policy

• Types of health policy

• Determinants of health policy

• Policy cycle

POLICY

• “Policy” is a law, regulation, procedure, administrative action, incentive or voluntary practice of governments and other institutions (CDC, 2015)

• “A decision made by an authority about an action—either one to be taken or one to be prohibited—to promote or limit the occurrence of a particular circumstance in a population" (Shi, 2012, p.16)

POLICY

• Principles that govern action directed towards

given ends (Tittmus, 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 and Hanley, 1991)

PUBLIC POLICY

• In public policies, the authority charged with making policy is a legislative, executive, or judicial body operating under the purview of a federal, state, or local public administration (Shi, 2012, p.16)

• affects the general population or significant segments of the general population—is meant to improve the conditions and general welfare of the population or subpopulations under its jurisdiction.

GOVERNMENT

• Promote sustainable human development in

ways that reduce disparities in income, well

being, education and opportunity among all

people without depriving future generations, at

the very least, similar level of well being,

security and choice.

HIERARCHY OF NATIONAL POLICY

UU No 12 tahun 2011 pasal 7

(1) Jenis dan hierarki Peraturan Perundang-undangan terdiri atas:

1. Undang-Undang Dasar Negara Republik Indonesia Tahun 1945;

2. Ketetapan Majelis Permusyawaratan Rakyat;

3. Undang-Undang/Peraturan Pemerintah Pengganti Undang-Undang;

4. Peraturan Pemerintah;

5. Peraturan Presiden;

6. Peraturan Daerah Provinsi; dan

7. Peraturan Daerah Kabupaten/Kota.

(2) Kekuatan hukum Peraturan Perundang-undangan sesuai dengan hierarki sebagaimana dimaksud pada ayat (1).

PRIVATE POLICY

• The authority is conferred to the executive or

board of directors of an organization.

• affects the private organization only—is meant

to improve the conditions and general welfare

of the employees of that organization (Shi,

2012, p.16)

HEALTH POLICY

• Miller (1987, p.15) defines health policy as “the

aggregate of principles, stated or unstated, that . . .

characterize the distribution of resources,

services, and political influences that impact on

the health of the population.” (Shi, 2012, p.16)

• Decisions, plans, and actions that are undertaken

to achieve specific health care goals within a

society (WHO)

•

HEALTH POLICY

• embraces courses of action that affect the set of

institutions, organizations, services and funding

arrangements of the health care system. It goes

beyond health services, however, and includes

actions or intended actions by public, private and

voluntary organizations that have impact on

health (Walt, 1994)

• The scope of health policy is determined by the

political and economic system of a country.

TYPES OF HEALTH POLICY:

REGULATORY

to prescribe and control the behavior of a

particular target group by monitoring the group

and imposing sanctions if it fails to comply.

Eg: prohibition of smoking in public places,

licensure requirements for medical professions,

and processes related to the approval of new

drugs

TYPES OF HEALTH POLICY:

ALLOCATIVE • Distributive: provide benefits or services to targeted

populations or subpopulations, typically as entitlements. Eg: the funding of medical research, provision of public health and health promotion services, training of medical personnel, and construction of healthcare facilities.

• Redistributive: Deliberate efforts to alter the distribution of

benefits by taking money or property from one group and giving it to another. Eg: means-tested social insurance programs which takes tax revenue from the more affluent residents and spends it to provide free or low-cost health insurance to the poor, to subsidize the welfare program, and to fund public housing

DETERMINANTS OF HEALTH POLICY


• Health problem – its nature is typically the first consideration of policy, the

significance of which is determined by its magnitude and severity.

• Sociocultural norms – reflect the accepted values, beliefs, attitudes, and behaviors of a

society or group.

– play a significant role in the public’s perception of the nature of a health problem, the role of government versus individuals in addressing that problem, and the type of solution or policy implemented to manage it.

– Eg: Promotion on the improvements in mental health status, care, and treatment


Political System

• A democratically governed country is more likely to develop health policies that reflect public interest (officials are publicly elected and presumably represent the electorate’s interests), But the process of policy development is typically more difficult than in single-rule governments because the public’s interests are rarely coherent.

• In authoritarian (single-party) countries, policies can be developed quickly but may not truly reflect the public’s interests


• Solutions

– Potential solutions to a health problem facilitate policy development.

– If solutions do not emerge, polciy makers will be likely to initiating a research study

– If a health problem has more than one potential solution, policy research and analysis is conducted to identify the optimal solution given the political climate, available resources, and expectations of prominent stakeholders.


• Stakeholders

– Entities or individuals who have a direct or indirect role in the development of policy, may include:

• Consumers and patients

• Healthcare providers

• Healthcare organizations

• Payers and insurers

• Regulators

• Medical device and pharmaceutical manufacturers

• Educational and research institutions

• Businesses and corporations


• Leadership

– No matter how significant the problem or how

determined the stakeholders, health policy

addressing a particular problem will not appear on

the policy agenda without the approval of the

governing body’s leader.

• Resources

– Not even the most effective policy can be implemented without the availability of financial and administrative resources.

– Financial feasibility tests are conducted during the policy development process to ensure adequate funds are available and to verify that the benefits will outweigh the costs.

– Administrative feasibility studies examine how the policy can be translated into programs and carried out under an existing or a new infrastructure.

POLICY CYCLE

Agenda- setting

Policy Formulation and Decision- Making

Policy Implementation

Policy Evaluation and Termination

AGENDA SETTING: PROBLEM

RECOGNITION AND ISSUE SELECTION

• The agenda is nothing more than “the list of

subjects or problems to which governmental

officials, and people outside the government

closely associated with those officials, are

paying some serious attention at any given

time” (Kingdon 1995, 3).



• Problem recognition: – Raising awareness is a key to obtain political attention

– a social problem has been defined as such and that the necessity of state intervention has been expressed

• Issue selection – The crucial step in this process of agenda-setting is the move of

an issue from its recognition—frequently expressed by interested groups or affected actors—up to the formal political agenda.

– the different variables—actors, institutions, ideas, and material conditions—interact is highly contingent

– This move encompasses several substages, in which succeeding selections of issues under conditions of scarce capacities of problem-recognition and problem-solving are made.



• Issue selection

– Several studies showed that it is not the objective problem load (e.g., the degree of a particular infectious disease) which explains the intensity of problem recognition and solving activities on the side of governments (Prittwitz 1993; Jaenicke 1996). Instead, a plausible definition of a problem (see Stone 2001) and the creation of a particular policy image (Baumgartner and Jones 1993) allowing to attach a particular solution to the problem, have been identified as key variables affecting agenda-setting



• Issue selection

– the public/media play a distinctive role for agenda-

setting and policy-making, especially when novel

types of problems (like risks) emerge (see Hood,

Rothstein, and Baldwin 2001).

– Frequently, governments are confronted with forced

choice situations (Lodge and Hood, 2002) where they

simply cannot ignore public sentiment without risking

the loss of legitimacy or credibility, and must give the

issue some priority on the agenda



• Issue selection

Influences on Agenda Setting

Level of salience is HIGH Level of salience is LOW

Level of conflict is HIGH Crime, Gun control WORST CHANCE

Abortion rights

Level of conflict is LOW BEST CHANCE

Airline safety

Pork-barrel projects (e.g., research grants, water

projects)

DISAGREEMENT IS THE HIGHEST DURING

THE PROBLEM RECOGNITION STAGE

http://www.ais.unwater.org/ais/pluginfile.php/79/course/section/127/Microsoft%20PowerPoint%20-

%201%20policymaking.pdf

POLICY FORMULATION AND

DECISION- MAKING

• expressed problems, proposals, and demands

are transformed into government programs.

Policy formulation and adoption includes :

– the definition of objectives—what should be

achieved with the policy—

– the consideration of different action alternatives.

POLICY FORMULATION AND

DECISION- MAKING

Crucial aspects of policy formulation

• Resources – The scarcity of resources—not only in terms of economic

resources, but also because political support presents a critical resource in the policy-making process may cause the policy is excluded.

• The allocation of competencies between different actors (e.g., government)

• The role of (scientific) policy advice – Think tanks and international organizations are regarded as

catalysts fostering the exchange and transfer of policy ideas, solutions, and problem perceptions between governments and beyond (Stone 2004).

POLICY IMPLEMENTATION

• “what happens between the establishment of

an apparent intention on the part of the

government to do something, or to stop doing

something, and the ultimate impact in the

world of action” (O’Toole 2000, 266).


An ideal process of policy implementation would include the following core elements:

1. Specification of program details (i.e., how and by which agencies/organizations should the program be executed? How should the law/program be interpreted?);

2. Allocation of resources (i.e., how are budgets distributed? Which personnel will execute the program? Which units of an organization will be in charge for the execution?);

3. Decisions (i.e., how will decisions of single cases be carried out?).


• implementation research played a major role

in triggering the move of policy research away

from a state-centered endeavor, which was

primarily interested in enhancing the internal

administrative and governmental capacities

and in fine-tuning program design and

implementation (shifted from the top- down to

bottom up perspective)

POLICY EVALUATION AND

TERMINATION

• Policy-making is supposed to contribute to problem solving or at least to the reduction of the problem load.

• Evaluations can lead to diverse patterns of policy-learning, with different implications in terms of feed-back mechanisms and a potential restart of the policy process

• Evaluations could also lead to the termination of a policy. The primary idea of policy termination:

– a policy problem has been solved or the adopted, or

– policy measures have been recognized to be ineffective in dealing with the set policy goals—seems rather diffi cult to enforce under real-world conditions of policy-making (see Bardach 1976; Behn 1978; deLeon 1978; Kaufman 1976).

I have never had a policy. I have simply tried to

do what seemed best each day, as each day

came. — Abraham Lincoln

RECOMMENDED READING

MATERIALS

• Lancet global health policy

• Health affairs : policy brief

• http://www.dpr.go.id/uu/prolegnas

• http://www.depkes.go.id/index.php?act=regula

tion

http://www.dpr.go.id/uu/prolegnas

http://www.dpr.go.id/uu/prolegnas

http://www.depkes.go.id/index.php?act=regulation



DPR VISIT

• Work in groups

• Each group will develop structured questions according to each stage of policy cycle, and need to be familiar with some keywords

DPR VISIT

group Topic Keywords

1 Agenda- setting Badan keahlian, prolegnas (and its stages)

2 Policy formulation Naskah akademik, naskah politis, naskah hukum

3 Decision making Daftar Inventaris Masalah (DIM), pembahasan tingkat I dan II , pembahasan, pengesahan, pengundangan

4 Policy implementation Penyebarluasan

5 Policy evaluation and termination Kajian/ analisis/ evaluasi

REFERENCES

• CDC. 2015. Definition of policy. Diakses dari https://www.cdc.gov/policy/analysis/process/docs/policydefinition.pdf

• Fischer, F., Miller G.J., and Sydney, M.S. 2007. Handbook of public policy analysis: Theory, politics, and methods. Boca raton, FL: CRC Press.

• Shi, Leiyu. 2013. Introduction to health policy. 1st ed. Philadelphia: Health Administration Press.

• UU No. 12 tahun 2011. Diakses dari http://www16.plala.or.jp/bouekitousi/UU_NO_12_2011.pdf

• WHO. Diakses dari http://www.who.int/topics/health_policy/en/

https://www.cdc.gov/policy/analysis/process/docs/policydefinition.pdf

https://www.cdc.gov/policy/analysis/process/docs/policydefinition.pdf

http://www16.plala.or.jp/bouekitousi/UU_NO_12_2011.pdf

http://www16.plala.or.jp/bouekitousi/UU_NO_12_2011.pdf

http://www.who.int/topics/health_policy/en/

http://www.who.int/topics/health_policy/en/

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