Health Policy Midterm 1

actor

indviiduals/ orgs/states that impact policy

content

what is the policy actually doing?

context

systemic factors (eg. political, social, economic)

relationship between health and health policy

• lots of things don’t seem directly health related but they are

• eg. selling sodas at schools

health policy

policies that impact

policies include

things that are done and not done

purpose of health policy triangle

show the role of politics in health policy

3 points of policy triangle

• context

• content

• process

downfall of the health policy triangle

oversimplifies and implies that actors processes and context are all separate. not true in reality

civil society organizations

interest groups (eg. ACS) falling between state and household level

do not seek power themselves

understanding actors requires

studying power and dynamics

power is characterized by

• individual wealth

• organizational access

• authority

• dependent on existing networks and institutions

power is the result of

the interplay of agency and structure

types of contextual factors

• situational factors

• structural factors

• contextual factors

• international/exogenous factors

situational factors

• impermanent situations that can impact policy (eg. flood impx economics of food policy OR can be gradual eg. HIV/AIDS increased TB screening)

structural factors

• political system and how citizens can participate

• type of economy/economic base

• demographics (eg. old population)

• country’s national wealth

cultural factors

• misogyny

• religious restrictions

• cultural stigmas

why are these factors important?

• factors can influence policy outcomes

• policy delivery

process of policy making

how are policies formulated, negotiated, implemented?

Problem identification and issue recognition:

how do issues make it into the policy agenda

policy formulation

• actors involved in policy

• how are policies created

• how are policies communicated

policy implementation

• neglected often

• how is the policy actually put into effect

• how do changes of policies occur at the implementation level

policy evaluation

• what happens once a policy is put into effect

• what are the policy outcomes

analysis of policy

retrospective, did the policy help??

analysis for policy

• prospective

• what will happen if this occurs

authority vs. power

• power = ability to influence others

• authority = the RIGHT to influence others

bounded rationality

• actors don’t make optimum decisions they only make satisfactory ones

• bc/ of imperfect knowledge

• in short: they do what’s easier and seemingly convenient

govt. vs state

• govt = institutions that are involved in MAKING and ENFORCING RULES

• narrower than state: all the governmental orgs

Incrementalism

• decisions are not made all at once but gradually

rationalism

says that cost benefit analysis is applied to all options

power is

the ability to acheive a desired outcome

power has many dimensions:

• decision making

examples of political resources needed to influence decision making

• cash

• credit

• legal padding of being in office

• control over information

range of resources available for political purposes

limited by the policy content and context

power as non-decision making

the act of limitng the scope of policy is a policy too

soft power

• ‘getting others to want what you want’

• cultural

• values and ideas

3 sources of authority

1. traditional authority (eg. stay home ot take care of kids)

2. charismatic authority (eg. Nelson Mandela)

3. rational-legal authority (eg. surgeon general over doctors)

4. technical authority (eg. doctors over patients due to knowledge)

authority is legitimate if

it’s being used based on trust and acceptance

power as thought control

• related to soft power

• shaping perceptions

• eg. Ronald McDonald being perceived as kind = McDonald’s is seen as good

pluralism

power is distributed across many institutions

• electoral distribution across many parties

• pressure and political groups can exist

• lobbying is allowed

• no elite group dominates

challenges to public choice

• agree that society has many competing groups

• argue that state is not neutral

• the state itself is an interest group

elitism theorists

• disagree with pluralism in that policy is not dominated by a priv minority

• elites are well and alive coming from higher socioeconomic strata

• interest groups don’t have equal access

• elites are conservative and therefore probably going to be incremental

other elitist theories

• marxism

• professionalism - some professions are more influential

• feminism

what is the black box of inputs and outputs

governmental policy making processes

are outputs of policy = the outcomes

no, output is the actual policy that results while impacts are the way they are received by individuals

liberal democratic regimes/Western polyarchies

• stable govt

• lots of civic participation

• lots of groups involved like media and interest groups

egalitarian-authoritiarian

• ruled by elites

• state mandated participation

• lots of social security, everything state financed

traditional egalitarian

• king shi

• health policy is the priv sector’s job

populist

• single political party

• mass movements = participation

• health systems only accessible to ruling elites

authoritarian-inegalitarian.

• military repression

3 different ways decisions are made in the black box

1. rationalism

2. incremental (builds)

3. bounded rationalism

4. mixed scanning

rational model of decision mkaing

• identify problem

• goals/objectives of decision makers (eg. goal acheivement)

• alternative strategies for goal achievement

• analyze consequences

criticisms of rational decisions

• problem definition difficult

• who sets the goals?

• data collection difficult

• some options aren’t even on the table (bc/ of financial, interest reasons)

bounded rationalism

• cognitive limitations on rationalism

• same problems of rational theory

incrementalism

• inhibits major policy reform

• descriptive no prescriptive

• conservative bias

mixed scanning

• wide sweep

• detailed analysis of part of the problem

• fundamental vs. routine decisions

  • more detail for fundamental decisions

new public management

apply private sector techniques to govt

trans vs multinational

• transnational = multiple branches in many countries

• multinational = operations in many countries even if not owning a separate corp

why is the state involved in health

market failures, health is not sorted out by simply doing work

3 reasons why market failures result in state involvement

1. externalities (eg. costs and benefits) are not always considered

2. no incentive to provide public interest goods like health

3. monopolies will overcharge

arguments in favor of state

• consumers are at a disadvantage bc/ not enough info

• healthcare is uncertain and expensive

• equity/ethical reasons

critcisms of the state

• inefficient, IMF austerity reforms as part of the conservative agenda

• patronage and employment but no actual goods/services

• state saw increased expenditure but not enough coverage

how was the state supposed to become more efficient

• decentralizationa

• introducing competition

2 theories regarding role of state

1. public choice

2. property rights

public choice

• politicians do wtv THEY want

• maximize budgets/get reelected

property rights

• politicians no incentive to do better bc they have no stake

• no property = no reason to try

decentralization

• improve state healthcare

• spread out the authority and responsibility

2 main functions govts. needed

• steward: leading policy to protect people, regulations (negative control)

• enable: fund and enable the private sector (positive control)

how is the private sector involved in health policy

• self-regulation

  • market regulations: reducing business costs

  • social standards: doing things so they’re not bad for business (increases market share, adaptable)

problems with voluntary codes

• not accountable or transparent

• not involved in major areas of concern

• only promising things to shareholders