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INTRODUCTION TOPUBLIC POLICY -101David M. Mirvis, MD
WHAT IS PUBLIC POLICY?“Public policies are authoritativedecisions that are made in thelegislative, executive or judicialbranches of government. Thesedecisions are intended to direct orinfluence the actions, behaviors ordecisions of others.”-B B Longest Jr, Health Policymakingin the United States, 1998
NOT ALL POLICIES ARE PUBLICPOLICIES Public policies Organizational policies – policies impactingbehavior within an organization. Ex: policieson prior approvals before ordering tests. Professional policies – policies guidingprofessional behavior. Ex: best practices fortreating a disease Macro policies – overarching policies affectingmany areas of public policy. Ex: a balancedbudget amendment forcing zero growth in allpolicy areas, one of which is health.We will limit our discussion to public policies.
WHAT MAKES AN ISSUE A“PUBLIC” POLICY ISSUE? Private problems – perceived to be theresponsibility of the parties involved. Public problems –entail some kind ofsubstantial social or individual difficultythat cannot easily be addressed by theparties or that should not be ignored bysociety.Is health insurance coverage a public or aprivate policy issue?
HOW DO HEALTH CAREPOLICIES IMPACT HEALTH?HEALTH POLICIESIMPACTHEALTH
HOW DO HEALTH CAREPOLICIES IMPACT HEALTH?HEALTH POLICIESIMPACTDETERMINANTS OF HEALTHTHATIMPACTHEALTHX
PUBLIC POLICY INTERVENTIONSWHAT GOVERNMENTS CAN DO –THE POLICY TOOLS INCLUDE PrivatizeRegulateSubsidize Charge fees EducateRationTax and spend Create publictrustsContract out Conduct researchUse marketincentives WITH DIFFERING POLITICAL BASES,COERCIVENESS & EFFECTIVENESS.
HOW IS PUBLIC POLICY MADE?STEPS IN PUBLIC POLICY MAKING PROBLEM IDENTIFICATIONAGENDA SETTINGPOLICY FORMULATIONPOLICY ADOPTIONPOLICY IMPLEMENTATIONPOLICY EVALUATIONPOLICY TERMINATION OR CHANGE IN AN IDEALIZED WORLD
PROBLEM IDENTIFICATION: THEPROBLEM MUST BE“ACTIONABLE”DEVELOPING A DIAGNOSTIC TREE HIGH MATERNAL MORTALITY UNHEALTHY BEHAVIORS INADEQUATE HEALTH CARE POOR SOCIOECONOMICCONDITIONS
DEVELOPING A DIAGNOSTICTREE UNHEALTHY BEHAVIORS INADEQUATE HEALTH CARE9POOR SOCIOECONOMICCONDITIONS LOW EDUCATIONAL ACHIEVEMENT LOW AVERAGE WAGE IN REGION
DEVELOPING A DIAGNOSTICTREE 9LOW EDUCATIONAL ACHIEVEMENT LOW AVERAGE WAGE IN REGIONACTIONABLELACK OF TECHNICALEDUCATION OPPORTUNITIES
AGENDA SETTING: HOW DOES ANISSUE GET ON THE POLITICALAGENDA? THE RECOGNITION THAT AN ISSUE IS ASIGNIFICANT PUBLIC PROBLEM DEVELOPMENT OF PROPOSALS FORPOSSIBLE SOLUTIONS TO THE PROBLEM APPROPRIATE POLITICAL CIRCUMSTANCES––––PUBLIC ATTITUDESINTEREST GROUP ATTITUDESLEADERSHIP ATTITUDES (“Policy Entrepreneurs”)RELATED/COMPETING AGENDA ITEMS“POLICY WITHOUT POLITICS IS LIKEARCHITECTURE WITHOUT ENGINEERING”
AGENDA SETTING THE WINDOW OF OPPORTUNITYMODELTHREE ncesDEVELOPMENTOFLEGISLATIONWINDOW OF OPPORTUNITY
AGENDA SETTING THE WINDOW OF OPPORTUNITYMODELAGENDA ncesDEVELOPMENTOFLEGISLATIONCOUPLING OF STREAMS -- WHEN ALL THREECRITERIA ARE MET, A PROBLEM CAN PASS THOUGHA WINDOW OF OPPORTUNITY
STEPS IN IMPACTING anceto lowincomeuninsuredand EMLOGIC MODEL OF THE IMPACT OF SCHIPON CHILD HEALTHINTERIM STEPSFamiliesaware ofprogram;statesprovideaide inenrollmentEligiblechildrenenrollProposed pathSCHIP State Children’s Health Insurance ProgramEnrolleesreceiveneededcareHealthstatus ofenrolledchildrenimproves
STEPS IN IMPACTING anceto lowincomeuninsuredand EMLOGIC MODEL OF THE IMPACT OF SCHIPON CHILD HEALTHINTERIM STEPSFamiliesaware ofprogram;statesprovideaide inenrollmentEligiblechildrenenrollRealProposed pathSCHIP State Children’s Health Insurance ProgramEnrolleesreceiveneededcareHealthstatus ofenrolledchildrenimproves
YOUR CHALLENGE Select a childhood health condition Identify the social determinants of thatcondition Identify a problem that is an actionable,public policy issue Propose a public policy “solution” to theissue that can get to the political agenda
ON CHILD HEALTH. Uninsured low-income children SCHIP provides insurance to low-income uninsured and low-income children Families aware of program; states provide aide in enrollment Eligible children enroll Enrollees receive needed care Health status of enrolle
