8256609 health policy analysis example[1]
TRANSCRIPT
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Health Policy Analysis
Centre for Health Services and Policy ResearchQueen’s University
Ken MacdonaldOctober 3, 2007
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1. CLASS OBJECTIVES
• to acquire an initial understanding of the policy process
• to learn the basic elements ofpolicy analysis
•To establish frameworks for doing assignments
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2. OUTLINE
a.Review: “Health policy” and “epidemiology”
b.What is policy and how is it made?
c.Techniques for doing policy analysis
d.Class Exercise: working through an example
e.Suggestions for doing assignments
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3. READING
Palfrey C. Key Concepts in Health Care Policy and Planning (London: Macmillan, 2000), Chapters 1 to 3.
Supplementary:
a. General
Les Pal, Public Policy Analysis (Toronto: Nelson, 1992)
CV Patton & DS Sawicki, Basic Methods of Policy Analysis and Planning Englewood Cliff: Prentice Hall, 1993)
DL Weimer & AR Vining, Policy Analysis Concepts and Practice (Englewoods Cliffs: Prentice Hall, 1992)
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b. Health
J. Green & N. Thorogood, Analysing Health Policy: A Sociological Approach ( London and New York: Longmans,1998)
B. Abel-Smith, An Introduction to Health Policy, Planning and Financing (London and New York: Longmans, 1994)
Canadian Institute for Health Information – 2004 “Bridging the Communication Gap Between Researchers and Policy Makers”
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4. RELATIONSHIP TO PREVIOUS CLASSES
Session #2 discussed the generic features desirable in any health system & how to evaluate their presence.
Session #3 focused on Health Economics Analysis as a policy tool
Session #1 discussed some basic definitions: “Health Policy”, “Epidemiology”, “Health Services Research”
The focus of this session is on making and analyzing policy to construct a health system.
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Epidemiology
“The study of the distribution and determinants of health-related states or events in specified populations and the application of this study to control health problems.” In this context “control” means “ to promote, protect, and restore health.” (Last, 1995)
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Health Policy
“ ...authoritative decisions made within government that are intended to direct or influence the actions, behaviors, or decisions of others pertaining to health and its determinants. These decisions can take the form of laws, rules and operational decisions...Policies can be allocative or regulatory in nature.”(Longest, 1998)
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Health Policy
1. An authoritative statement of intent adopted by governments on behalf of the public with the aim of improving the health and welfare of the population, that is, a centrally determined basis for action
-”Public Health Policy”3. What health agencies actually do rather
than what governments would like them to do. Health policy can only be determined by the observation of the outcomes of decision-making
“Health Care Policy”Palfrey
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Epidemiology< >Health Services Research< >Health Policy
Health Sciences:Basic sciences
Clinical medicinebiostatistics
Social policy
Public Policy
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EPIDEMIOLOGY
• How does epidemiology inform policy?
• Debate between “pure academics” and those researchers who wish to inform/influence policy
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“...the job of the scientist should be to formulate and evaluate scientific hypotheses, rather than to muster support for or marshal evidence against specific policies...The conduct of science should be guided by the pursuit of explanations for natural phenomena, not the attainment of political or social objectives.”(Rothman and Poole, AJPH, 1985)
Epidemiology and Policy: A Debate
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On the other side:
• “Policy makers are forced to make decisions based on their own experience and those of qualified experts. When epidemiologists avoid helping policy makers formulate public health policy, others less qualified must do so in their stead.”
• (Foxman, J Clin Epid, 1989)
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Jackson, Lee & Samet (AJPH, 1999)
reviewed a random sample of articles published in 3 major epidemiology journals from 1991-95.
They concluded:
the “majority of research articles either contained no policy recommendations or included weak statements.”
How Often to Epidemiologists Make Policy Recommendations?
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Key findings:
• 24% of papers had a “policy pronouncement”
• 55% concerned public health practices and 28% clinical practice
• 30% of papers by authors from government or public health had policy statements, 20% from universities
• papers dealing with children and African populations had policy statements in 80% of papers; studies re. adults 26%
• papers on injury and infectious diseases most frequently included policy recommendations
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Information Sources Used by Ontario Decision Makers
Source Usefulness Rank Acceptability (%)
Colleagues 1 84
Info. Gathered internally 2 82
Local experts 3 78
Scholarly journals 4 61
Consumers 5 62
Existing leg./guidelines 6 71
Feldman et al. Annals of the Royal College of Physicians & Surgeons of Canada c.1999
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Sources of Knowledge
Presentations and seminars
Clinical practice guidelines
Bulletins and newsletters
Front-line staff of my organization
Databases (e.g. CIHI, cancer registries, Child Health Survey)
Evaluation reports for a project that you were personally involved with
Documents produced by other government agencies, RHAs, or healthcare facilities
Internet Searches
Management of staff of my organization
Documents produced with my own organization
Decision-Makers
Conference Proceedings
Clinical practice guidelines
Systematic reviews (including meta-analysis)
Clinical guidelines
Presentations and seminars
Publications that focus on evidence-based medicine
Information from colleagues
Computerized literature search (e.g., MEDLINE)
Information from specialists
Original studies published in scientific journals
Physicians
Birdsell et al. The Utilization of Health Research Results in Alberta c.2005
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Manitoba Centre for Health Policy study (2000) of seasonal patterns of use at Winnipeg's 7 acute-care hospitals over the past 11 years.
Found almost every winter a period of 1 to 3 weeks during which the number of patients arriving at the hospital jumps 10% beyond normal.
Pneumonia, influenza and other respiratory conditions are the main reasons for the increase; three-quarters of patients 65 or older.
Recommended as a "pre-emptive first step, a comprehensive campaign of flu vaccination."
…government did exactly that and other provinces followed in the next few years.
A Good News Story
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1. Affinities
population level focus for both policy and epidemiology
policy is concerned with the operation of the health system; epidemiology provides health services researchers with techniques to measure and evaluate systems
Affinities and Barriers
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2. Barriers
advocacy vs evidence-based conclusions
generalizability
timelines
dissemination and uptake of findings
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b. applied
J.A.Muir Gray, Evidence-based Healthcare, How to Make Health Policy and Management Decisions, (Edinburgh, London, New York: Churchill Livingstone, 1997)
Optional Readings:
a. theoretical
R.A.Spassoff, Epidemiologic Methods for Health Policy,(New York & Oxford: Oxford University Press, 1999)
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Policy
“...a course of action or inaction chosen by public authorities to address a given problem or interrelated set of problems.”( Pal, 1992)
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Who Makes Policy?
• Public
• Interest groups
• Civil servants
• Courts
• Elected representatives
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Policy RecommendationsNine desirable qualities
• Timing – window of opportunity• Evidence-based• Acceptable Ideology/Congruence with Government
Core Values• Practical, Concrete, Prescriptive• Political Credit• Affordable• Time to Payoff/Results• Acceptable to Key Stakeholders/Public• Credibility of the Recommender
Owen Adams-CMA
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ImperativesConstraints
UncertaintiesPressure
PoliticalAdministrative
PolicyLevers for
implementationResults
INPUTS WITHINPUTS OUTPUTS OUTCOMES
Schematic of the Policy Process
Based on David Easton, A Framework for Political Analysis (1965)
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Policy Levers
• inertia • delegation• moral suasion
• economic: spending, taxation
• rule making: regulation, law• public enterprise
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Developed by the Institute on Governance- Reprinted in: “Bridging the Communication Gap Between Researchers and Policy Makers” Canadian Institute for Health Information - 2004
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THE POLICY PROCESS
Gov’t.
Agencies
Public
Branch
Ministry
Analyst
OtherBrs
Legal
OtherMins
Mgmt.Board
Policy &Priorities
Cabinet Committe
Legislat.
Leg.Counsel
Branch LegislatIMPLEMENT LAW
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Policy Analysis: Definitions
Pal (1992)
“ the disciplined application of intellect to public problems ”
Weimer & Vining (1992)
“ client-oriented advice relevant to public decisions and informed by social values ”
Patton & Sawicki (1993)
“ a process that usually begins with problem definition rather than the broader inventory phase of the planning process. It also yields alternatives, but the final document is likely to be a memorandum, issue paper, or draft legislation. It has a specific client and a single point of view, a shorter time horizon, and an openly political approach. The final product of such a process is called policy analysis.”
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The Core Of Policy Analysis
Goal Objectives Evaluation Criteria Options
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statement of a general principle or broad intent, e.g., improve the health of Canadians
Goal
assessment of how well each option achieves each criteria
Option #1 Option #2 Option #3
c.
b.
a.
c.
b.
a.
c.
b.
a. standards to judge attainment of objective, plus data and sources
Criteria
#3
#2
#1 concrete targets which together will achieve the broader goal
Objectives
A Basic Framework for Policy Analysis [“GOCO”]
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CONSTRUCTING A POLICY
ANALYSIS
Goals
Objectives
Evaluation Criteria
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GOALto enhance the health of homeless persons through the provision of optimal primary care
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Objectives
3. assuring access to primary health care through a regular primary health care provider
4. enhancing the population orientation of primary health care
5. providing comprehensive whole person care
6. enhancing an integrated approach to 24/7 access
7. strengthening the quality of primary health care
8. building patient-centered care 9. promoting continuity through
integration and co-ordination [CIHI 2006]
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Criteria for Each Objective
GOAL OBJECTIVES EVALUATION
CRITERIA
assuring access to primary health care through a regular primary health care provider
1. entitlement documents not required for care or for ancillary services 2. service available at venues likely to suit homeless persons
enhancing the population orientation of primary health care
1. collaboration with public health authorities on harm reduction strategies
providing comprehensive whole person care
1. multidisciplinary team care 2. established referral routes for specialty services 3. social work assistance available for benefit entitlement, housing
enhancing an integrated approach to 24/7 access
1. service available at times likely to suit homeless persons 2. evidence of reduced emergency room use
strengthening the quality of primary health care
1. special expertise in areas germane to the clinical conditions of homeless persons, e.g. substance abuse, sexually transmitted diseases.
building patient-centered care
1. user involvement in service planning and operation
to enhance the health of homeless persons through the provision of optimal primary care
promoting continuity through integration and co-ordination
1. appropriate access to electronic medical records by multiple providers
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Writing a policy paper
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Doing Policy Analysis (*Policy Paper format )
Issue introduction
Background
Key issues
Stakeholders
Constraints
Goal
Objectives
Evaluation Criteria
Options
Risks
Recommendations
Implementation
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Advice to the Minister
Issue: 1 -2 lines
Background: 5 to 10 key points
Options: 2 or 3, with weighted pros/cons for each
Recommended Ministerial Action: e.g. Option # x
Next Steps: e.g. press conference, legislative amendment, regulation change
Contact person: name, title, branch
[2 pages maximum, use headings & bullet points, no references]
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Policy Debates1. Issue Description - 4 minutes
2. Policy Goal and Objectives - 2 minutes
3. Evaluation Criteria - 5 minutes
4. Options - 5 minutes
5. Recommendation - 4 minutes – per speaker
Note: #1 - #4: to be presented jointly#5: clearly articulated defense of different options by each team member#6: presenters responsible for directing class discussion
6. **Facilitated Discussion ** - 5 mins.
7. Coordinator’ Summary – 5 mins.