4
Policy Development and Analysis
Unit 6
I. Policy Analysis
A. History
1. 2010 Gallup Survey by Robert Wood Johnson Foundation did study to see what people think regarding the professions or groups that they believe has the most influence in health reform.
a. Government officials number 1 with 74.7% of vote.
b. Nurses last at 13.8%
2. Institute of Medicine in collaboration with the Robert Wood Johnson Foundation in their Future of Nursing: Leading Change, Advancing Health (2010) stated that:
a. “Nurses should be full partners with physicians and other health professionals in redesigning health care in the US.”
B.Definition
1. Is an investigation that begins with limited information about past policy actions, outcomes, and performance, and ends with as much information as possible about the nature of a policy problem, policy futures, and policy actions to be taken in the future.
2. It explores the problem at a depth to give the reader a good idea of its dimensions and possible solutions.
3. Analysis of both content and process is needed to make decisions about the effectiveness of the policy as well as the possibility of the policy successfully being accepted and implemented.
4. Policy analysis can be done before development of a bill (prospective), or after a policy has been passed (retrospective).
5. WHO definition - Health policy refers to decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society. An explicit health policy can achieve several things: it defines a vision for the future which in turn helps to establish targets and points of reference for the short and medium term. It outlines priorities and the expected roles of different groups; and it builds consensus and informs people. (World Health Organization, 2011).
II. Politics
A. For policy to succeed in the legislative arena, it must be analyzed from a sociopolitical context. This is not only true of policies sent forward to the U.S. Congress, also for local or institutional policy.
B. Once a problem is identified and a solution proposed, there are political factors to assess:
1. research findings related to the proposed policy or program
2. current, interest groups and other stakeholder involvement
3. the political climate
4. the economy
5. emerging social issues that may impact the policy
6. the opinion of the public effected by the policy
C. Political climate affected by:
1. Election cycle, constituent relations, party agenda, economy, and budget.
2. A policy proposed by one political party may be restrained by an opposing party in power.
3. A legislator up for re-election in an election year may make a decision to hold off or move forward depending on the impact involvement may have on the opinion of the voting public.
4. Unexpected influences such as changes in economy, budget, major disaster, or military conflict may also have an impact on the progression of a policy change or program proposal.
D. Economics
1. Unexpected influences such as changes in economy, budget, major disaster, or military conflict may also have an impact on the progression of a policy change or program proposal.
2. A policy to provide a much needed but costly program will have more difficulty in a poor economy especially if cutbacks in other programs are taking place
3. To offset unexpected influences, the backing of all parties involved is necessary.
4. Economic issues arise in healthcare policy as a result of allocating scarce resources.
5. An analysis of the economic feasibility is necessary for the proposed policy and all possible alternatives.
6. When considering economics, questions to ask are:
- What is the cost of the proposed policy or program?
- How will it be paid for and by whom?
- Are people willing to pay for the proposed policy or program including possible increased taxes?
- Will implementation of this policy or program mean cutting another due to budget constraints?
- How will the policy be delivered or implemented?
- What are the benefits in relation to the cost?
E. Ethics/Values
1. Policy proposals and alternatives must also be analyzed through the lens of ethics and values.
2. Ethical principles of equity, fair access to healthcare, social welfare, rationing, confidentiality, and informed consent
3. A review of the American Nurses Association (ANA) Code of Ethics prior to analyzing healthcare policy is helpful to ensure values and ethics are involved in your decision to support a proposed policy or alternative.
F. Analysis from Nursing perspective
1. Nurses bring their experience and knowledge of patient care and outcomes to the review of proposed healthcare policy
2. Institute of Medicine Report (2010) - report charges nurses with full engagement in healthcare policy decision.
a. In the health policy arena, nurses should participate in, and sometimes lead, decision making and be engaged in healthcare reform-related implementation efforts. Nurses also should serve actively on advisory boards on which policy decisions are made to advance health systems and improve patient care.
III. Healthcare Policy Analysis Framework
A. Collin’s framework (2005) – eight steps
1. Define the context - Assess factors that influence health policy in the area in which the policy is proposed. These include evaluating the political system, geography, social and economic conditions, and national events including violence or change in government.
- Provide background information to put health policy into perspective and understand the social or cultural determinants of health problems that will form the basis for health policy decisions.
2. State the problem - Define the health problem, situation, or condition that has a current or potential adverse effect on health.
a. The statement of the problem may include data on vital statistics including births, age, gender, disease or cause and health statistics such as morbidity and mortality.
3. Search for evidence - Collect data and assess data related to the
problem and/ or proposed policy.
a. Review literature and research public data provided by government agencies or scholarly organizations.
4. Consider different policy options
a. Review the collected evidence and propose alternatives for alleviating the problem.
b. Policy options or alternatives must then be analyzed to determine the best course or courses of action.
5. Project the outcomes
a. Analyze the proposed policy and alternatives for outcomes.
b. Listing all outcomes for each proposal will provide the opportunity to choose the more feasible policy with positive outcomes
6. Apply Evaluative criteria
a. Evaluate interventions against standards or criteria
b. Suggested criteria for evaluation include:
1). Relevance: does the intervention contribute to the health needs of the target population? Is it consistent with policies and priorities?
2). Progress: how do actual results compare with projected or scheduled results?
3). Efficiency: what are the results in relation to resource expenditure of the intervention?
4). Impact: what is the effect of the activity on overall health and related socio-economic development?
7. Weigh the outcomes
a. Choose between the projected outcomes and not between alternatives.
b. The outcomes related to human health should be the focus of health policy.
8. Make the decision
a. Weigh the outcomes carefully to decide which policy option to pursue
b. The decision depends on the problem, priorities and values, and feasibility.
IV. Summary
A. Before supporting a policy, nurses should thoroughly review proposed policy and make an informed decision.
B. Policy analysis includes a review of politics, economic impact, and professional ethics.
C. Frameworks can provide a focus for the process
D. As nurses, it is time to get engaged and take a look at policies that are and will affect our patients and practice.