POLICY ANALYSIS
Leadership and Policy Course
Agustin Indracahyani
Magister of Nursing Leadership and Management
Faculty of Nursing Universitas Indonesia
2018
WHAT IS POLICY ANALYSIS
• investigations that produce accurate and useful information for
decision makers (Chochran & Malone, 1995)
• an applied social science discipline which uses multiple methods of
inquiry and argument to produce and transform policy -relevant
information that may be utilized in political setting to resolve
policy problems (Dunn , 1981)
• a set of techniques and criteria with which to evaluate public policy
options and select among them .... to rationalize the development
and implementation of public policy .... and as the means to greater
efficiency and equity in allocation of public resources (JenkinsSmith, 1990)
Islamy, M.I. (2008). Public policy analysis.
WHAT IS POLICY ANALYSIS
• A social and political activity, focusing its
attention on the lives and well being of a
society
• The process and results may involve other
professionals and interested parties
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving (4th ed.).
California: SAGE Publications
BARDACH EIGHT FOLD PATH
[Not all aspects are appropriate for all contexts, and other
issues outside this framework should be considered as well]
1.
2.
3.
4.
5.
6.
7.
8.
Define the Problem
Assemble Evidence
Construct the Alternatives
Select the Criteria
Project the Outcomes
Confront the Trade-offs
Decide
Tell Your Story
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving (4th ed.).
California: SAGE Publications
1 – DEFINE THE PROBLEM
•
Identify and understand the problem
Problem definition: Think of deficit and excess  “too”, Imbalance of demand and supply (market failure)
Who is affected
Nature of the problem
Eg:
–
–
–
•
•
there are too many disasters in Indonesia,
the demand for nursing career ladder is growing faster than hospital’s ability to accommodate it
The number of nursing schools is growing significantly but the number of students who pass the national licensure exams is not growing
nearly as fast; the number of MDR TB/ diphtery/ lung cancer in Indonesia remains high ....
Quantify—Be specific about problem’s scope and magnitude
Past history
Now, have a piece of paper and identify one specific health/ nursing related problem
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving (4th ed.). California: SAGE
Publications.
Weiner, Jonathan. (2005). Health policy analysis checklist: For the development, selection, and assessment of programs within healthcare organizations.
1 – DEFINE THE PROBLEM
•
Causes
Diagnose key factors – and define them
Focuses on primary causes out of other possible ones
Factors associated with action/ inaction
Risky conditions:”the odds”; one event may minimize or maximize the likelihood of other events in the
future
latent/ missed opportunities, errors of commission/ omission)
•
Avoid common pitfalls in problem definition
Don’t say: “There is too little control of antibiotics use.” Inadvertently implying that “more antibiotics use
control” is the best solution may inhibit you from thinking about ways to prevent antibiotics resistance in
the first place. Try instead: “Too many antibiotis resistance occurs nowadays.”
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving (4th ed.). California: SAGE
Publications.
Weiner, Jonathan. (2005). Health policy analysis checklist: For the development, selection, and assessment of programs within healthcare organizations.
2 – ASSEMBLE EVIDENCE
•
Assess the nature and extent of the problems : Background literature on scope of problem
•
Assess the particular features of the concrete policy situation: Existing data on this population:
i) Internal to organization : characteristics, including agency workloads, budget figures, demographic
changes in service area, political ideology of the agency chief, competency of middle level managers]
ii) Other sources
•
New data collection/analysis
i) Re-analysis of existing data
ii) New surveys/special studies
iii) Commission problem assessment research (for major initiative)
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving (4th ed.). California: SAGE Publications.
Weiner, Jonathan. (2005). Health policy analysis checklist: For the development, selection, and assessment of programs within healthcare organizations.
3 – CONSTRUCT THE ALTERNATIVES
“policy options,” or “alternative courses of action,” or “alternative strategies of intervention to solve or
mitigate the problem.”
Make a list of all the alternatives you might wish to consider in the course of your analysis. Later
on, you will discard some obvious losers, combine others, and reorganize still others into a single
“basic” alternative with one or more subsidiary “variants.”
•
Best practices/benchmarks (literature and consultants)
•
Input from stakeholders/decision makers (also start of consensus process)
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving (4th ed.). California: SAGE Publications.
Weiner, Jonathan. (2005). Health policy analysis checklist: For the development, selection, and assessment of programs within healthcare organizations.
3 – CONSTRUCT THE ALTERNATIVES
“policy options,” or “alternative courses of action,” or “alternative strategies of intervention to solve or
mitigate the problem.”
•
•
•
Approaches to consider within complex HEALTH CARE SYSTEM
i) Financial incentives (provider, consumer, others)
ii) Education/information (provider, consumer, others)
iii) Organizational infrastructure
o New program
o Modification to existing program
iv) Collaborate with others (community, other organizations)
v) Policy considerations
o Internal policies
o Payers’ (e.g., employer or insurance) policies
o District (or central) law or regulation
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving (4th ed.). California: SAGE Publications.
Weiner, Jonathan. (2005). Health policy analysis checklist: For the development, selection, and assessment of programs within healthcare organizations.
4 – SELECT THE CRITERIA
•
This step is more evaluative than analytical, is all about the value judgments (focusing on the outcomes for
each alternatives, and not the alternative itself). Eg: “Alternative A will very probably lead to Outcome Oa,
which we judge to be the best of the possible outcomes; therefore, we judge Alternative A to be the best.”
•
It is the most important step for introducing values and philosophy into the policy analysis, because some
possible “criteria” are evaluative standards used to judge the goodness of the projected policy outcomes that
are associated with each of the alternatives.
•
The most important evaluative criterion is whether or not the projected outcome will solve the policy
problem to an acceptable degree.
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving (4th ed.). California: SAGE Publications.
Weiner, Jonathan. (2005). Health policy analysis checklist: For the development, selection, and assessment of programs within healthcare organizations.
4 – SELECT THE CRITERIA
[potential criteria used to assess alternative policies]
•
Population benefit
i)
ii)
iii)
iv)
•
Quality of life/outcomes of care
Concordance with evidence-based process standards
Improve access for those not getting ideal treatment
Reduce disparities in access, quality of care, outcomes
Cost/economics
i) Cost/benefit (maximize positive effects given input costs) (potential measure: CBA/ CEA)
ii) Efficiency per unit of service (potential measure: QALYs, DALYs)
iii) Contain costs (to stay within available resource budget and to insure “margin” between input and output costs)
•
Ethics/equity/ equality/ fairness/ justice
i)
ii)
iii)
iv)
Maximize total good (utilitarianism)
Consider fairness of resource allocation decisions, with attention to need, equity, etc. (potential measure: Gini index)
Fulfill individuals’ rights to certain goods or outcomes (liberalism)
Consider trade-offs between individual autonomy and the common good
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving (4th ed.). California: SAGE Publications.
Weiner, Jonathan. (2005). Health policy analysis checklist: For the development, selection, and assessment of programs within healthcare organizations.
4 – SELECT THE CRITERIA
•
Administrative feasibility
i)
ii)
iii)
iv)
v)
•
Degree of organization’s control
Timeframe of implementation/success
Resources required for developing and implementing policy (distinct from cost benefit of program itself)
Simplicity/robustness of policy/intervention (the fewer “moving parts,” the better)
Legal/regulatory issues
The perspectives of various constituencies (beyond patient/consumer above)
i) Providers
ii) Sponsors (employers, Medicaid agency)
iii) Community groups and politicians
iv) Employees of your organization
v) Board of directors (shareholders, if investor owned)
Consider costs and benefits to various constituencies, and the “politics” involved
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving (4th ed.). California: SAGE Publications.
Weiner, Jonathan. (2005). Health policy analysis checklist: For the development, selection, and assessment of programs within healthcare organizations.
4 – SELECT THE CRITERIA
Islamy, M.I. (2008). Public policy analysis
4 – SELECT THE CRITERIA
•
From the problem you identified, identify the alternatives and criteria
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving (4th ed.). California: SAGE Publications.
Weiner, Jonathan. (2005). Health policy analysis checklist: For the development, selection, and assessment of programs within healthcare organizations.
5 – PROJECT THE OUTCOMES
steps 5 and 6 are to some extent done iteratively/concurrently.
All potential alternatives should be assessed (“scored”) on preliminary basis. Move on to in-depth assessment for top alternatives.
Various approaches (often termed “evidence-based policy” tools):
•
Review the existing evidence
i) The published literature
ii) The experience to date of other providers/programs (possible site visits)
•
Estimate impact on health outcomes using quantitative techniques. These may include operations
research/forecasting/statistical analysis.
•
Estimate economic impact using cost-effectiveness and cost-benefit analysis. (Note that these
techniques can be applied during both this policy development phase and the program evaluation
phase.)
•
As needed, perform “policy formulation” evaluation research
i) Collect information from your delivery system to help “populate” the decision matrix (see #6 below)
ii) Initiate a small-scale pilot program and evaluate to aid in selecting one policy alternative. (Obviously, only for major
initiatives or extremely innovative ones for which there is no track record)
•
Consider the undesirable outcomes, eg: moral hazards.
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving (4th ed.). California: SAGE Publications.
Weiner, Jonathan. (2005). Health policy analysis checklist: For the development, selection, and assessment of programs within healthcare organizations.
6 – CONFRONT THE TRADE- OFFS
•
Form decision-making group. (Need to decide which constituencies will have advise and/or consent
roles.) Develop final “decision matrix” with group’s input
•
Develop decision matrix by operationalizing a subset of the criteria you identified above. Determine
relative importance (“relative weights”) of each criterion. As needed, do sensitivity analyses of
alternative weights
•
For each alternative, develop a quantitative score for its characteristics along each decision criteria to
help array “trade-offs.” As needed, undertake sensitivity analysis assessing implications of different
scores if outcome is unclear. Focus on outcomes, eg: extending Puskesmas service hours, weighing costs of
service against social benefits (improved health of the affected population)
•
After completing the matrix, consider making changes
i) Think about the possibility of combining some of the strengths of multiple policy alternatives into a
new “combined” policy approach.
ii) Modify aspects of the matrix as indicated by decision making body.
iii) As appropriate, involve other key executives and board members, in selecting final policy alternative.
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving (4th ed.). California: SAGE Publications.
Weiner, Jonathan. (2005). Health policy analysis checklist: For the development, selection, and assessment of programs within healthcare organizations.
7 & 8 – DECIDE AND TELL YOUR
STORY
•
Decide what to do, based on your own analysis.
•
Develop series of public documents: you will need one-page, 3–5-pages, and detailed document (if a
major initiative)
i)
ii)
iii)
Include rationale for policy decision (based on decision memo)
Explain why other alternatives were rejected
Offer some details of implementation
•
Develop strategy/PR campaign (tell some real “stories”)
•
Meet with key constituencies one-on-one and in groups to get feedback
•
Advisory group should address, as appropriate, final program design, implementation, and
evaluation.
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving (4th ed.). California: SAGE Publications.
Weiner, Jonathan. (2005). Health policy analysis checklist: For the development, selection, and assessment of programs within healthcare organizations.
ANOTHER APPROACH
• A seven- step framework, includes:
1. Policy background
2. Statement of the policy issue
3. Normative values and stakeholder analysis
4. Criteria for success
5. Systematic review of policy options
6. Recommendation
7. Policy strategies
Seavey, J.W., Aytur, S.A., McGrath, R.J. Health policy analysis: Framework and tools for success.
COMPARISON TO BARDACH
MODEL
Features
Bardach Framework
7 Step Framework
Policy issue
Define the problem
Policy background
Statement of the policy issue
Policy associated evidence
Assemble evidence (literature
and policy evaluation)
Normative values and
stakeholder analysis
Alternatives*
Construct the Alternatives
Systematic review of policy
options
Criteria*
Select the criteria
Criteria for success
Analysis of outcomes on each
alternative
Project the Outcomes
Confront the Trade-offs
Systematic review of policy
options
Recommendations
Decide
Recommendation
Strategies and actions
Policy strategies
Implementation (and
evaluation)
Tell your story
COMPARISON TO BARDACH MODEL
Islamy, M.I. (2008). Public policy analysis.
HOW SELECTING THE ISSUE?
• You may need to consider the situations of the
health system in Indonesia (to better vision a
broader issue) or healthcare services/
organization (to vision a specific issue)
HOW SELECTING THE ISSUE?
• WHO (2007): A health system consists of all
organizations, people and actions who
primary intent to promote, restore and
maintain health
WORLD BANK/ HARVARD CONTROL KNOBS
FRAMEWORK OF HEALTH SYSTEM
THE WHO’S HEALTH SYSTEM FRAMEWORK
WHO. 2007. Strengthening health systems to improve health outcomes: WHO’s framework for action.
REFERENCES
•
Bardach, Eugene. (2012). A practical guide for policy analysis: The eightfold
path to more effective problem solving (4th ed.). California: SAGE Publications.
•
Islamy, M.I. (2008). Public policy analysis
•
Robert, et al. 2004. Getting health reform right.
•
Seavey, J.W., Aytur, S.A., McGrath, R.J. Health policy analysis: Framework and
tools for success.
•
Weiner, Jonathan. (2005). Health policy analysis checklist: For the
development, selection, and assessment of programs within healthcare
organizations.
•
WHO. 2007. Strengthening health systems to improve health outcomes:
WHO’s framework for action.
Example articles of research policy
analysis
• A Cost-Effectiveness Analysis of India’s 2008
Prohibition of Smoking in Public Places in
Gujarat
(https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3108108/)
POLICY BRIEF
• The Policy Brief is a “short, neutral summary of what is
known about a particular issue or problem. Policy
briefs are a form of report designed to facilitate policymaking” (Eisele, 2006).
• The main purpose is to “succinctly evaluate policy
options regarding a specific issue, for a specific policymaker audience” (Eisele, n.d.). Policy-makers need to
make practical decisions under time-constraints, so the
brief should provide evidence and actionable
recommendations (Eisele, n.d.).
POLICY BRIEF
• Executive summary
• Context and importance of the problem
• Critique of (the available/ unavailable) policy
options
• Policy recommendations (including alternatives
and the analysis of their possible favorable/
unfavorable outcomes, prioritized alternative(s)
and policy actions)
• Appendices
• Sources consulted
• Relevant References\Tsai_Guidelines for
Writing a Policy Brief.pdf
• Policy Brief.docx