Wednesday, May 29, 2013

health care policy

Introduction Researches have shown that health care policies sometimes fail. This means that they sometimes fail to achieve their intended objectives. Different reasons have been suggested as being behind the failure of health care policies. While some of the reasons are backed by research, others are theoretical. However, they are all possible reasons behind the failure. Practical and political obstacles have been suggested as reasons why health care policies fail from their beginning to implementation. Economists normally describe the failure as being caused by the lack of incentive structures which should be available in pursuing stable and consistent references (Friedman, 1982; Le Grand, 2006). Political analysts on their part blame the failure on the conflicting interests that are held by different players in the policy process (Buchanan and Tullock, 1962; Coleman, 1990). Organisational theorists on their part argue that the social life is the main factor behind the failure of policies to meet their intended objectives. While these factors apply to all public policies, this paper seeks to discuss the reasons why some health care policies fail to meet their intended objectives. The reasons discussed include: the foundations of the policy process are ignored; ignoring economic factors; lack of professional input; lack of adequate research and lack of public involvement. The foundations of the policy process are ignored Giving the example of patient choice in the United Kingdom, some health care policies fail because of the lack of recognition for the fantasmatic foundations of the policy-making process. Using this example in the United Kingdom, Williams-Crowe and Aultman (1994) suggest that the reason for the development of this policy in the united kingdom health care and the whole of Europe, can be well understood using the psychoanalytic conception of subjective fantasy. Powerful social fantasies are developed in the policy-making process. These are some of the intangible processes that are found in the policy-making process and should not be ignored for a policy to be successful. The social and organisational elements are very important in the policy process and should not be ignored (Williams-Crowe and Aultman, 1994; Fotaki, 1999). While most of the health care reforms are well-meaning, they are developed without proper considerations to their contributions to the public. Some of these policies are based on assumptions made on the basis of market’s power to change service provision. Fotaki (1999) suggests that with time, it is realised that such assumptions cannot be fulfilled, especially in case of any change in the market dynamics. For instance, “the perception of inequities led to the abolition of internal market reforms by the Labour government when it came to power in 1997” (Light, 2001: 683). Policies developed under such environment affect the improvement of efficiency in the health care sector in the long run. For instance, its impact on improving quality and efficiency in the united states, the united kingdom, and Canada (Tuohy, 1999); Sweden and the Netherlands (Harrison, 2004) or New Zealand and Chile (Williams and Rossiter, 2004), have been studied with mixed results. Patient choice as a health care policy, due to its failure to carefully look at the environment in which it would be implemented has negative impact on the equality of access of services for diverse groups. Regardless the argument that the development of consumer choice in public services has been argued to improve equity, quality and efficiency, this has not been the case with the introduction of consumer choice in the health care sector. The empirical evidence shows that the effect of a ‘choice’ policy in the health care sector is uncertain and unpredictable (Tuohy, 1999; Fotaki, 2006; Fotaki, 2007). While this has been contributed to by the lack of looking at the market fundamentals in the development and implementation of the policy, other factors have contributed to this failure as will be seen in the rest of the discussion (Fotaki, 2007). Ignoring economic factors The economic factor behind most health care policies is ignored. For instance as suggested by Le Grand (2006) the idea of consumer choice in public health services is based on the assumption that market forces will enhance effectiveness and efficiency while attaining quality and equity for all the consumers. This is a problematic assumption as it is important to look at the economic factors and market dynamics before developing a health care policy. According to Oliver and Evans (2005) on a theoretical level, it is thought to be a disagreement between the collective negotiations underneath the idea of the public good, aiming at delivering the most benefits for the majority as well as the notion of possibly unlimited personal wants. Fine (2002: 125) has suggested that economic assumptions reveal an apparent understanding of human incentive that is “shallow to the point of being paper thin.” Even when looked at in terms of the use of market commodities, saying noth¬ing of healthcare services which in most in most cases cannot be viewed as consumer goods. According to Stivers (1991), were the argument to follow the thought of a person being a rational utility maximizer, and individual freedom as the same with the idea of consumer autonomy, one might be caused to depend on a very limited idea of individual autonomy. As suggested by Long (2008: 157) puts it, “economic rationalism is a philosophy, like consumerism, that is instrumental’ as it ‘paradoxically destroys a more creative individual auton¬omy; one that derives from responsible group membership where personal authority can grow.” It is thus important that the economic underpinnings of a health-care policy be looked at before starting the development process. Another way of looking at the economic factor as one of the reasons why some health care policies fail is failure to consider the source of funding for its implementation. Some health care policies are developed in such away that they are funded by the public, which means through tax payers money. Barker (1996) suggests that health care policies that are developed under such environment can fail to be implemented because of the lack of adequate funding. Such cases have been seen in the United Kingdom and the United States in the past. For instance, the current policy in the United States has attracted a major public outcry because of the kind of burden it is expected to put on the tax payers. This is because its financing is meant to come from the public through an increase in taxes. It is expected to benefit some people, while others are suffering because of paying high taxes. The area of financing for any health care policy is one of the reasons some policies, not only in the health care sector, fail to be effective. Lack of professional input As health care reforms continue to take place in different nations, the role played by health care professionals in the policy process cannot be ignored. It is the health care professionals who have the knowledge of how the health care system works. They are the people who provide health care system as well as interact with the consumers of the services. They are therefore in a better place to offer professional direction in the policy process. According to Buse, Mays and Walt (2005), even if the policy process is viewed by many as a political process and because of this it has been politicised a lot, an effective health care policy is one that involves the people who have a lot of knowledge in the health care sector. As a matter of fact, Williams-Crowe and Aultman (1994) suggest that health care professionals should have an active role in the process of developing a health care policy. Use of scientific knowledge base is also important for an effective health care policy to be developed. Such knowledge is held by professionals in the health care sector. They are the people who can supply political leaders with the kind of knowledge they need in making achievable decisions in the making of a health care policy. Palfrey (2000) has provided evidence of the importance of health care professionals stepping in to provide important knowledge during the development of a health care policy. Some health care policies fail to meet their intended objectives because they are over politicised and the politicians do not give room for the input of professional knowledge. There are several factors that contribute to the historical lack of professional leadership in the making of health care policies. In the book, The Politics of Public Health: the Dilemma of a Public Profession, Camilla Stivers suggest that the conflicts between the judgment of professionals and the bargaining nature of political decision making is the root cause of issues in health care policies. Most of the times in the policy making process, the importance of professional knowledge in health care policy has been undermined by the political nature of a country. Negotiation and compromise found in the political arena have a lot of times come in the way of effective health care policy. It has also seemed hard for health care professionals to participate on the same level with political participants in the making of a health care policy. The part played by politicians always seems more important that than played by health care professionals, while in reality the reverse should apply. This is because health care professionals are equipped with what is required in making an effective health care policy. According to Williams and Rossiter (2004) such politics have discouraged health care professionals from providing their professional knowledge in the policy. The results are mostly that the policy that emerges as a result cannot meet the needs of the users of the health care services. Lack of adequate research Related to the importance of professional knowledge, is adequate research before beginning developing a health care policy. Health care policy cannot be very general or it might not cater for the needs that it is intended for. Research is thus an important factor in the policy development process. Buse, Mays and Walt (2005) assert that research onto the issues that are affecting the health care sector for which a comprehensive policy is required should be carried out. Another area of research is the area of what solutions and strategies that will work in solving the problem. Assuming things in the policy process can lead to the development of a policy that is not effective in achieving its intended objectives. As noted earlier in the discussion, some public policies are made under assumptions. This means that adequate research is not carried out to find out what contributions they are going to make and is they are viable especially under the prevailing economic conditions. Lack of public involvement It is evident that health care policies are developed to improve health care quality and this is for the sake of the public. Failure to involve them in the policy process can lead to lack of cooperation from the public who are supposed to be helped by that policy. It is important to have a health care system where the public participates. It is also important that the general public is involved in the policy regardless of health status and socio-economic status. Developing a policy that does not consider this can cause the policy not to achieve its intended objectives. According to Walt (1994) failure to involve the public who are the consumers of the health care services can only mean that a health care policy that responds to their needs cannot be achieved. It is important to note under this reason that in any event that there is involvement of the public, things are never neutral. The public is bound to take sides and thus expand the scope of the conflict. Therefore, as long as the conflict is within the individual, the process will always be limited. This means that some health care policies fail to be met their intended objectives because of the failure to consider different views and argue them using the most important in the policy (Hunter 2003). Market research is connected to looking at the reasons for failure in the previous policies before embarking on a new one. Lessons from the previous failed policies can be very important in making a more effective policy. However, as suggested by Barker (1996) present policies are normally developed without any reference to their predecessors. Given the fact that the present policies are supposed to act in the same environment as the past ones, most of the factors that led to failure of the previous policy are likely to affect the present one. For instance, the ‘choice’ policy reveals that there exists a process of selec¬tive ‘forgetting’ as well as ‘re-evocation’ of old policy models (including market rivalry and consumers of public services as rational utility maximizers), instead of than learning from experience (Brunsson and Olsen, 1993). Conclusion It is important for a health care policy to be effective and meet its intended objectives for it to be meaningful. This paper has discussed the different reasons that make some health care policies fail to be effective and in achieving their intended objectives. This problem begins in the policy making process, which is supposed to be effective for the end results to be effective too. There are various factors that need to be considered in developing any public policy, just as various stakeholders need to be involved. The major reason behind failure in health care policies is the failure to consider those important factors as well as failure to involve the main stakeholders in the policy-making process. In the past, many countries have seen lack of effectiveness in health care policies, calling for reforms immediately after the implementation of another one. This becomes a problem for the country because of the effects is had on the quality of health care as well as the cost on the tax payers. Recommendations To be effective and able to achieve its intended objectives, it is important that all the stakeholders are involved in the policy development process. Professional knowledge is particularly very important for a sound policy to be developed. Health professionals must be allowed to combine the scientific knowledge they have of public health with practical strategies of working with the users of the health care services. It is important to recognise that conflicts of opinions or points of view will always be there when different people are involved. Such conflicts should not be avoided in the health care process in order to accomplish it in proper time and with fewer disagreements. Policy developers should always remember that conflicts are essential ingredient to success and also that success in the policy process depends on how these conflicts are managed. The key is to accept and appreciate conflicts of interest and manage them well to get an effective health care policy. Though politics are important in any public policy, it is important that the policy process is not over-politicised to the point that it hinders the achievement of intended objectives of the health care policy. It is suggested that politicians or political leaders working in the policy process should rely on professional knowledge in their decision making process. Recognising the significant role that professionals in the health care sector should play in the policy making process is very important in developing an effective policy. It is also important for policy makers to realize that policy as a normative process unavoidably depends on simplistic articulations. This is due to the fact that health care reform is a process of idea explanation, influence and implementation instead of an instantaneous solution to a problem. This is because of the idealising function that is inherent in the policy process. Given the fact that a health care reform policy is not going to operate in a vacuum, it is important that all the factors that are likely to affect its effectiveness are analysed from its inception to implementation. Reference List: Barker, C. 1996. The Health Care Policy Process. 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