Lecture 9: Introduction to the policy process

Question 1

what is policy?

Answer 1

• Policy is often thought of as decisions taken by those with responsibility for a given policy area - may be health, environment, education
• policy as a ‘stance’ which, once articulated, contributes to the context within which a succession of future decisions will be made
• policy is also about ‘inaction’
• policy as a web, or series, of changing decisions

Question 2

what is public policy?

Answer 2

• it is about government and decision to act or not to act, is about the commitment of public resources and is informed by values
• public policy is what public officials within government, and by extension the citizens they represent, choose to do or not to do about public problems

Question 3

what are the types of public policy?

Answer 3

• regulatory
• distributory
• redistributive

Question 4

what are distributive policies?

Answer 4

• services/benefits to particular groups (Under 14’s access to GPs)

Question 5

what are regulatory policies?

Answer 5

policies of practices and standards (alcohol reform, tobacco control)

Question 6

what are self-regulatory policies?

Answer 6

councils, professional associations etc (medical associations, midwifery regulation)

Question 7

what are redistributive policies?

Answer 7

from and to groups (welfare reform)

Question 8

what is health policy?

Answer 8

• courses of action proposed or taken by a government (or on behalf of government) that influence the health of citizens and/or the population - courses of action (and inaction) that affect the set of institutions, organisations, services and funding arrangements of the health and health care system

Question 9

what is the difference between health and health care policy?

Answer 9

Health policy: - encompasses a broad range of decisions and actions taken (or not taken) affecting health - it overlaps with economic, social welfare, employment, housing policies - it is about process and power and concerned with who influences whom in the making of policy, and how that happens Healthcare policy: - slightly narrower focus on decisions and actions affecting financing, configuration, provision and governance of health services

Question 10

what is this?

Answer 10

A model for health policy analysis.

When analysing a policy, we need to think of it as a triange.

• first, we need to consider the context of the policy. How did this policy come about? It is important to think about the Situational, structural, cultural and international factors that influenced the adoption of the policy.
• Once you analyze the context, you need to consider the content (substance of a policy (its objectives). Need to find out: what does this policy aim to achieve?
• Then you need to consider the process. How did this policy get to the attention of the policy makers? Question the agenda setting, the formulation of the policy, how the decision was made, how the policy was implemented and evaluated. In terms of health systems, the aims are often to make health care accessible to entire NZ population, also to have efficient and flexible services
• finally, at the core of every policy are actors. Actors could be individuals, groups, state or government. These people push for the policy changes. The state is often the major actor and the ones that usually initiate health policy.

Question 11

who are some health policy actors?

Answer 11

• government (e.g. ministries of health, education, local government etc)
• International non-government organizations
• national non-governmental organizations (faith-based organisations)
• pressure/interest groups
• international organisations
• bilateral agencies
• funding organisations
• private sector companies
• researchers
• media
• the public

Question 12

what are the intentions of the policy process?

Answer 12

it represents a ‘perfect world’ model

• policy process into a series of stages (theoretical) which doesn’t necessarily represent what happens in the real world.

Question 13

what does the policy process help us do?

Answer 13

• despite the limitations of being very complex, the stage model allows us to think about the policy process
• each stage is associated with theories and models

Question 14

what are the stages of the policy process? what does it look like?

Answer 14

• agenda setting
• policy formulation
• decision making
• implementation
• evaluation

Question 15

what is involved in agenda-setting?

Answer 15

• agenda-setting is the process by which problems and alternative solutions gain or lose public and elite attention;

OR

• the activities of various actors and groups that cause issues to gain greater attention or prevent them from gaining attention

Question 16

how do issues get to the agenda?

Answer 16

there are two ways!

1: crisis/events
2: a ‘politics as usual’ situation - [the Hall et al model: legitimacy, feasibility and support; Kingdon Model: politics, policy and problem streams]

Question 17

what are sources of policy agenda?

Answer 17

internal drivers and external drivers

Question 18

what are internal drivers?

Answer 18

election promises, government departments’ advice, select committees

Question 19

what are external drivers?

Answer 19

lobby/interest groups, public pressure

Question 20

what is agenda-setting for the hall et al model?

Answer 20

there are 3 elements which need to exist:

Legitimacy: governments feel concerned about certain issues and in which they have the right to intervene

Feasibility: The potential for implementing the policy

Support: Is about ‘trust’ in or backing for the government

Question 21

what is agenda-setting for kingdons model for policy making?

Answer 21

These streams must exist:

Problem stream: are there perceived problems that require attention?

Solution stream: ideas and policy exist, to be picked up and placed on the agenda

politics stream: Political will- driven by changes in government, national mood, interest group campaigns etc

Question 22

what is involved in the policy formation and decision making?

Answer 22

It is about considering options

• all may agree there is a problem
• opinions of the solution may differ
• need to find an agreed solution
• different groups and sources of information come into play
• this could be consultation with stakeholders, interest groups or citizens
• co-production of policy (collaborative governance)

Question 23

what is involved in implementation?

Answer 23

• it represents the conversion of new laws and programmes into practice
• great hopes are pinned on policy but hopes routinely dashed through the implementation process

factors affecting the implentation include:

• complexity of the problem addressed
• administrative structures
• human and financial resources
• devoted to implementation

Question 24

what is involved in a top-down approach to implementation?

Answer 24

It envisages clear division between policy formulation and policy execution

• policy formulation is a political process
• implementation is a technical managerial process
• chains of command need to be in place
• goals need to be clearly understood
• right resources must be available

Question 25

what is involved in a bottom-up approach to implementation?

Answer 25

• it depends on ‘street level’ actors such as doctors, nurses etc
• motivations and policy references must be understood
• dislike of the policy could mean resistance, or distortion

Question 26

what is involved in the monitoring and evaluation stage?

Answer 26

• considering if the policy is working, if it’s effective and efficient
• question what it means and if the policy goals and objectives are being met
• formative and summative evaluation
• evaluation rarely happens in the real world!

Question 27

what can we expect of the policy process in the real world?

Answer 27

• the policy process model provides an analytical framework of policy analysis

but we don’t expect the policy process to be followed perfectly in reality. in the real world, the policy process is complex and messy!