Understanding Policy Analysis Process in Health Administration

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Class 4 – Policy Analysis (edited/adapted from original 4/30/21
KGN)
Professor: K. Noonan | TA: B. Nabet
PUBH 505: Spring 2017
 
HEALTH ADMINISTRATION & POLICY
 
1
 
Informed advice to a client that relates to a
public policy decision, includes a
recommended course of action/inaction, and
is framed by the client’s powers and values
 
WHAT IS A POLICY ANALYSIS
 
2
 
Essential elements of the analysis
Issue Statement/Problem Statement
 
(Bardach elements)
Background
Landscape
Options
Recommendation
 
ELEMENTS OF POLICY ANALYSIS
 
3
 
 Defining the problem
Identify the conditions
What are you examining?  Describe the set of conditions that
are under examination.
Broad or narrow?
Issue statement
Short statement (2-3 sentences) summarizing the issue to be
considered. Ideally, 
phrase the problem in the form of a
question to guide your selection of information to include.
Provide some context by identifying the conditions creating
the problem in an introductory sentence or clause.
 
PROBLEM ANALYSIS: ISSUE
STATEMENT
 
4
 
Think in terms of excess or deficit, i.e., too
much or too little
Include a quantitative feature, if possible
Don
t include the solution in the problem
statement
Iterate!
 
ISSUE/PROBLEM STATEMENT:
BARDACH
 
5
 
“The problem with urban schools is that
teachers unions block reforms.”
 
“The problem is the schools need more
money."
 
“The problem is, until you fix the breakdown of
the American family, schools can't succeed.”
 
ISSUE/PROBLEM STATEMENT: RATE
THESE EXAMPLES
 
6
 
The 1993 Family Medical Leave Act (FMLA)
provides up to twelve weeks of unpaid, job-
protected leave per twelve-month period for
specified family and medicals reasons to nearly
60% of employees in the United States.
5
However, many Americans are not covered
under FMLA, or do not use it because of the
financial implications of unpaid leave.  What
Could NYS Senator do to address this issue in
her state?
 
ISSUE STATEMENT: EXAMPLE
 
7
 
About five percent of children in
Pennsylvania do not have health
insurance because of their immigration
or refugee status.  What options are
available to the Governor to support
coverage for these chlldren?
 
ANOTHER EXAMPLE
 
8
 
Motor vehicle crashes are the leading
cause of death for U.S. teens. According
to the CDC, every day, six teens ages 16–
19 die from motor vehicle injuries.  What
can PA do to prevent teen motor vehicle
fatalities and injuries?
 
ONE LAST EXAMPLE
 
9
 
The Options Analysis: 2 basic objectives
Proposing, evaluating policy alternatives that
address the problem
Comparing and measuring different alternatives
Determining which option is best course of
action
Justifying your recommendation
 
STRUCTURE OF OPTIONS ANALYSIS
 
10
 
Identify Options = potential solutions to
the problem
Brainstorm many possible solutions
Do research, Be creative
Search and adapt options from analogous
situations
Develop new, customized ideas
Think Incrementally
Think Ideally
 
OPTIONS/SOLUTIONS ANALYSIS
 
11
 
Consider typical policy actions
Gov’t providing or purchasing a good for public
Taxing or subsidizing to achieve outcome
Passing laws and regulations to require action
Education and information to persuade action
Always consider the status quo
Identify 3 to 5 best suited alternatives
GO BACK TO PROBLEM to make sure options
squarely address problem
 
IDENTIFYING OPTIONS
 
12
 
Describe Options
Once selected, provide information that will help in
analysis
Describe what option is
Define the populations that will be affected
Analyze options
Make an assessment of that option
Using data
Using qualitative words – high, medium, low
Create a matrix, side-by-side as tool
Or express in terms of consideration of pros/cons with
criteria embedded in that analysis
 
KEY ELEMENTS OF OPTIONS
ANALYSIS
 
13
 
Elements to include in the Background
Identify who is impacted by the problem
Who is most affected by the problem? How and why?
Are subgroups affected differently?
Quantify impact on groups and the difference between
groups
Place boundaries on the problem
Where does it exist?
National vs. state; urban vs. regional
Are there differences in scope, magnitude by region, locale?
 
PROBLEM ANALYSIS: BACKGROUND
 
14
 
Elements to include in the Background
Identify how long the problem has existed
What are historical trends?
Has it improved or worsened?
Identify how the problem might change over
time
Look at forecasts, projections (e.g. Medicare will be
bankrupt by 2019)
 
PROBLEM ANALYSIS: BACKGROUND
 
15
 
Landscape – most important section of
the problem analysis
Provides more context of the problem
Tries to diagnose the problem
What is the cause of the problem?
How amenable is the problem to a policy
intervention?
Options should make sense in light of
landscape analysis
 
PROBLEM ANALYSIS: LANDSCAPE
 
16
 
Potential elements to include in the
Landscape (not all are always relevant)
Stakeholders
Political landscape
Economic factors
Legal context
Social context
Administrative practicality, feasibility
Others…
 
PROBLEM ANALYSIS: LANDSCAPE
 
17
 
Elements to include in the Landscape
Identify the stakeholders
Groups, organizations, individuals that are invested
in the problem and how it will be solved
e.g. Advocacy, lobbying groups, industry, membership
organizations, health services orgs, consumers/citizens
What is their stake in the issue?
How much influence do they have to impact the
solution?
 
PROBLEM ANALYSIS: LANDSCAPE
 
18
 
Elements to include in the Landscape
Describe the political landscape
Is this a hot topic politically? Highly contested?
Are there differences in how politicians define the
problem and the causes of the problem?
Are there strong positions according to party lines?
Do key constituents, opponents, interest groups
have an opinion? Who supports or opposes
change?
Is there a reason to act now (e.g., election year?)
Is there a reason to delay?
 
PROBLEM ANALYSIS: LANDSCAPE
 
19
 
 Elements to include in the Landscape
Describe the economic context
What are the economic causes of the problem?
What is the problem costing individuals, groups, society as a whole?
Are certain subgroups disproportionately bearing the burden of the
cost?
What is the economic impact of addressing, or not addressing the
problem?
Will the economics of the problem play into the solution?
YES, THERE IS SOME OVERLAP HERE WITH
BACKGROUND, THIS IS ART, NOT SCIENCE.  YOU
ARE MAKING A CASE, AND LANDSCAPE PROVIDES
CONTEXT FOR FACTS IN BACKGROUND.
 
PROBLEM ANALYSIS: LANDSCAPE
 
20
 
 Elements to include in the Landscape
Describe the social context
Is the problem an individual problem or societal
problem?
Are there equity issues?
Are there ethical and moral issues?
Be careful not to elevate all issues to moral/ethical
Are vulnerable subgroups disproportionately,
negatively affected?
Are influential, valued groups affected?
 
PROBLEM ANALYSIS: LANDSCAPE
 
21
 
 Elements to include in the Landscape
Consider the legal factors
Are there legal restrictions affecting this problem?
Are there legal requirements that impact the
analysis?
Is the potential for future litigation a concern if
action is taken?
 
PROBLEM ANALYSIS: LANDSCAPE
 
22
 
Problem statement:
Teen smoking is a significant public health issue.
What policies should Governor Y support to bring
about the greatest reduction in teen smoking?
What landscape information might we
include?
Political support?
Corporate positions?
Budget context
Timing right/not right? Why?
 
LANDSCAPE: EXAMPLE
 
23
 
Essential elements of the analysis
Issue Statement/Problem Statement
 
(Bardach elements)
Background
Landscape
Options
Recommendation
 
REVIEW:  ELEMENTS OF POLICY
ANALYSIS
 
24
 
Generally you will chose one recommendation
for your stakeholder
In some situations may have conditional
recommendations
e.g.: if tax cut passes choose option 1, if tax cut does not
pass choose option 2
In some situations may chose combination of options
If recommend more than one option need to justify
Don’t take easy route of avoiding picking one option unless
there is a good reason to do so
 
RECOMMENDATION
 
25
 
Recommendation must be one of the
options evaluated
Need to be clear why this option chosen
from among all the options evaluated
Don’t just repeat analysis of option section
Identify why this option best for your
stakeholder given that all options have pluses
and minuses
Will relate to values and power of your decision-
maker
Must recognize downsides/acknowledge opposition
AND address how downsides might be mitigated or overcome
 
RECOMMENDATION
 
26
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Policy analysis involves providing informed advice to clients on public policy decisions, including recommended courses of action based on identified issues and problem statements. This process entails defining the problem, exploring options, and making recommendations to address public policy challenges effectively. Key elements include issue statements, problem analysis, and formulating recommendations to guide decision-making in the healthcare sector.


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  1. HEALTH ADMINISTRATION & POLICY Class 4 Policy Analysis (edited/adapted from original 4/30/21 KGN) Professor: K. Noonan | TA: B. Nabet PUBH 505: Spring 2017 1

  2. WHAT IS A POLICY ANALYSIS Informed advice to a client that relates to a public policy decision, includes a recommended course of action/inaction, and is framed by the client s powers and values 2

  3. ELEMENTS OF POLICY ANALYSIS Essential elements of the analysis Issue Statement/Problem Statement (Bardach elements) Background Landscape Options Recommendation 3

  4. PROBLEM ANALYSIS: ISSUE STATEMENT Defining the problem Identify the conditions What are you examining? Describe the set of conditions that are under examination. Broad or narrow? Issue statement Short statement (2-3 sentences) summarizing the issue to be considered. Ideally, phrase the problem in the form of a question to guide your selection of information to include. Provide some context by identifying the conditions creating the problem in an introductory sentence or clause. 4

  5. ISSUE/PROBLEM STATEMENT: BARDACH Think in terms of excess or deficit, i.e., too much or too little Include a quantitative feature, if possible Don Don t include the solution in the problem t include the solution in the problem statement statement Iterate! 5

  6. ISSUE/PROBLEM STATEMENT: RATE THESE EXAMPLES The problem with urban schools is that teachers unions block reforms. The problem is the schools need more money." The problem is, until you fix the breakdown of the American family, schools can't succeed. 6

  7. ISSUE STATEMENT: EXAMPLE The 1993 Family Medical Leave Act (FMLA) provides up to twelve weeks of unpaid, job- protected leave per twelve-month period for specified family and medicals reasons to nearly 60% of employees in the United States.5 However, many Americans are not covered under FMLA, or do not use it because of the financial implications of unpaid leave. What Could NYS Senator do to address this issue in her state? 7

  8. ANOTHER EXAMPLE About five percent of children in Pennsylvania do not have health insurance because of their immigration or refugee status. What options are available to the Governor to support coverage for these chlldren? 8

  9. ONE LAST EXAMPLE Motor vehicle crashes are the leading cause of death for U.S. teens. According to the CDC, every day, six teens ages 16 19 die from motor vehicle injuries. What can PA do to prevent teen motor vehicle fatalities and injuries? 9

  10. STRUCTURE OF OPTIONS ANALYSIS The Options Analysis: 2 basic objectives Proposing, evaluating policy alternatives that address the problem Comparing and measuring different alternatives Determining which option is best course of action Justifying your recommendation 10

  11. OPTIONS/SOLUTIONS ANALYSIS Identify Options = potential solutions to the problem Brainstorm many possible solutions Do research, Be creative Search and adapt options from analogous situations Develop new, customized ideas Think Incrementally Think Ideally 11

  12. IDENTIFYING OPTIONS Consider typical policy actions Gov t providing or purchasing a good for public Taxing or subsidizing to achieve outcome Passing laws and regulations to require action Education and information to persuade action Always consider the status quo Identify 3 to 5 best suited alternatives GO BACK TO PROBLEM to make sure options squarely address problem 12

  13. KEY ELEMENTS OF OPTIONS ANALYSIS Describe Options Once selected, provide information that will help in analysis Describe what option is Define the populations that will be affected Analyze options Make an assessment of that option Using data Using qualitative words high, medium, low Create a matrix, side-by-side as tool Or express in terms of consideration of pros/cons with criteria embedded in that analysis 13

  14. PROBLEM ANALYSIS: BACKGROUND Elements to include in the Background Identify who is impacted by the problem Who is most affected by the problem? How and why? Are subgroups affected differently? Quantify impact on groups and the difference between groups Place boundaries on the problem Where does it exist? National vs. state; urban vs. regional Are there differences in scope, magnitude by region, locale? 14

  15. PROBLEM ANALYSIS: BACKGROUND Elements to include in the Background Identify how long the problem has existed What are historical trends? Has it improved or worsened? Identify how the problem might change over time Look at forecasts, projections (e.g. Medicare will be bankrupt by 2019) 15

  16. PROBLEM ANALYSIS: LANDSCAPE Landscape most important section of the problem analysis Provides more context of the problem Tries to diagnose the problem What is the cause of the problem? How amenable is the problem to a policy intervention? Options should make sense in light of landscape analysis 16

  17. PROBLEM ANALYSIS: LANDSCAPE Potential elements to include in the Landscape (not all are always relevant) Stakeholders Political landscape Economic factors Legal context Social context Administrative practicality, feasibility Others 17

  18. PROBLEM ANALYSIS: LANDSCAPE Elements to include in the Landscape Identify the stakeholders Groups, organizations, individuals that are invested in the problem and how it will be solved e.g. Advocacy, lobbying groups, industry, membership organizations, health services orgs, consumers/citizens What is their stake in the issue? How much influence do they have to impact the solution? 18

  19. PROBLEM ANALYSIS: LANDSCAPE Elements to include in the Landscape Describe the political landscape Is this a hot topic politically? Highly contested? Are there differences in how politicians define the problem and the causes of the problem? Are there strong positions according to party lines? Do key constituents, opponents, interest groups have an opinion? Who supports or opposes change? Is there a reason to act now (e.g., election year?) Is there a reason to delay? 19

  20. PROBLEM ANALYSIS: LANDSCAPE Elements to include in the Landscape Describe the economic context What are the economic causes of the problem? What is the problem costing individuals, groups, society as a whole? Are certain subgroups disproportionately bearing the burden of the cost? What is the economic impact of addressing, or not addressing the problem? Will the economics of the problem play into the solution? YES, THERE IS SOME OVERLAP HERE WITH YES, THERE IS SOME OVERLAP HERE WITH BACKGROUND, THIS IS ART, NOT SCIENCE. YOU BACKGROUND, THIS IS ART, NOT SCIENCE. YOU ARE MAKING A CASE, AND LANDSCAPE PROVIDES ARE MAKING A CASE, AND LANDSCAPE PROVIDES CONTEXT FOR FACTS IN BACKGROUND. CONTEXT FOR FACTS IN BACKGROUND. 20

  21. PROBLEM ANALYSIS: LANDSCAPE Elements to include in the Landscape Describe the social context Is the problem an individual problem or societal problem? Are there equity issues? Are there ethical and moral issues? Be careful not to elevate all issues to moral/ethical Are vulnerable subgroups disproportionately, negatively affected? Are influential, valued groups affected? 21

  22. PROBLEM ANALYSIS: LANDSCAPE Elements to include in the Landscape Consider the legal factors Are there legal restrictions affecting this problem? Are there legal requirements that impact the analysis? Is the potential for future litigation a concern if action is taken? 22

  23. LANDSCAPE: EXAMPLE Problem statement: Teen smoking is a significant public health issue. What policies should Governor Y support to bring about the greatest reduction in teen smoking? What landscape information might we include? Political support? Corporate positions? Budget context Timing right/not right? Why? 23

  24. REVIEW: ELEMENTS OF POLICY ANALYSIS Essential elements of the analysis Issue Statement/Problem Statement (Bardach elements) Background Landscape Options Recommendation 24

  25. RECOMMENDATION Generally you will chose one recommendation for your stakeholder In some situations may have conditional recommendations e.g.: if tax cut passes choose option 1, if tax cut does not pass choose option 2 In some situations may chose combination of options If recommend more than one option need to justify Don t take easy route of avoiding picking one option unless there is a good reason to do so 25

  26. RECOMMENDATION Recommendation must be one of the options evaluated Need to be clear why this option chosen from among all the options evaluated Don t just repeat analysis of option section Identify why this option best for your stakeholder given that all options have pluses and minuses Will relate to values and power of your decision- maker Must recognize downsides/acknowledge opposition AND address how downsides might be mitigated or overcome 26

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