HST211 Lec 3

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University of Notre Dame *

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2018

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Political Science

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Oct 30, 2023

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Health Policy in Canada HST211 H1S Adalsteinn Brown Donna Plett Tim Zhang
First assignment – I Choose a topic that interests you • The first evaluation is the reflection paper due on February 7 th . This short paper (maximum of 750 words) is meant to give students the chance to reflect critically on a major challenge faced by the Canadian health system because of how it is structured. • Identify a question about a major challenge such as: • How could we be ready for the next pandemic? • Should we include drugs in Medicare? • How can we respond to massive inequities in health (Indigenous Health or Black Health)? • How can we afford to build more hospital beds?
First assignment – II We will use the same rubric throughout the course
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Key Messages • Policy can be articulated through many different vehicles including but not limited to legislation (laws), generally applied rules (policies), programs (services), or strategies and exhortations (plans and speeches). • The policy developed is not always the policy implemented • Policies always involve challenging trade-offs • Politics - or the interplay of actors who can affect the policy process – can shape policy in a way that is separate from evidence
What is policy? One view: Policy – for lack of a sharper definition – is simply a standing position on a repeated decision. Policy, although it sounds dry, is critical. Because it describes how organizations make decisions, policy reflects – whether implicitly or explicitly – a world view, an understanding of evidence, and a set of values. Another view: A course or principle of action adopted or proposed by an organization or individual (Oxford Dictionary) A third view: A set of interrelated decisions taken by a political actor or group of actors concerning the selection of goals and the means of achieving them within a specified situation where these decisions should, in principle, be within power of these actors to achieve (William Jenkins in Policy Analysis: A political and organizational perspective)
Policy can be articulated through many different vehicles • Bill – A proposed statute that is before the Legislative Assembly for consideration. • Act (or statute) – A bill is enacted or becomes an act (i.e., law) when it is passed by the Legislative Assembly after its third reading and receives Royal Assent. • Legislation – This term includes statues enacted by the Legislature and regulations made by a person or body whose authority to make them is set out in a statute. • Regulation – A law that is made by a person or body whose authority to make the law is set out in a statute. Source: https://www.ontario.ca/laws/e-laws-definitions
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Policy can be articulated through many different vehicles
An o.k. theory of the policy process 8 Problem Policy Development Implementation Agenda setting Problem identification ? Evaluation
Policy Design and Program Development (Policy Advisor Perspective) 9 Policy Development Implementation Agenda setting Problem identification Evaluation 1 Mandate 1a Scoping and framing 2 Consultation with the public, stakeholders and experts 2a Stakeholder analysis, prepare consultation materials (e.g., discussion paper) 3 Prepares report back for the public (‘what we heard’), shares outcomes with ministries 3a Approves government’s response 4 Develops policy options 5 Cabinet decision + Sub Committees 6 Program design 6a News release, launch event 7 Program begins 8 Monitor results and outcomes 9 Review and assess Constant check-ins Adapted from the “What is Policy ? Policy and Delivery Roadmap , Ontario Public Service
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Quick breakout question • Why would government not bring all of its COVID strategies together into one over-arching strategy?
The policy developed is not always the policy implemented • Policy Drift • Policy Layering • Poor Communication • Policy Take-over • Implementation Failure
The policy developed is not always the policy implemented PURCHASERS PROVIDERS EVALUATORS Federal Government Federal Government Provincial Government Municipal Government Local Health Int. Networks* Cancer/Quality Agencies* All Hospitals Long-term Care Homes Community Health Centres Community Mental Health Independent Clinics Community Care Access Centres* Individuals / Employers Primary Care Providers Home Care Providers Ambulance Services Outpatient Drugs/Devices Health Quality Ontario ICES/CIHI Research Provincial Government Cancer/Organ Agencies Accreditation Canada Provincial Government Public Health Units FUNDERS Media Ontario Health
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The policy developed is not always the policy implemented
Quick breakout question • What would you do to make sure that governments actually implemented the policies that were approved?
Policies always involve challenging trade-offs • Deborah Stone’s 4 Key Policy Objectives • Security – satisfying minimum human needs • Liberty – allowing people to do what they want as long as they do not harm others • Equity – treating likes alike • Efficiency – getting the most for the money spent • Arthur Okun’s key trade -off • Efficiency vs. Equality • Stein Ringen’s trade-off • Equity, legitimacy, stability
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Politics - or the interplay of actors who can affect the policy process – can shape policy in a way that is separate from evidence • Politics – authoritative allocation of resources, or who gets what, when, and how • Ideas – deal with values and with what we want to do. They help structure how we see the world and what we think is important. • Institutions – the structures within which decisions will be made, including who will not be at the table, and the rules of the game. • Interests – refer to the stakeholders – those who can affect or be affected by what that organization does or what policy is adopted. Source: Case Studies in Canadian Health Policy and Management, 2nd Edition, edited by Raisa B. Deber
Politics can shape policy in a way that is separate from evidence
Politics can shape policy in a way that is separate from evidence Political Staff Academia Government Agencies Policy Analysts “ Stakeholder ” Lobby The Economy (etc.) Public Sentiment Other Governments *Craft & Howlett 2012 emphasize the interaction of content & access among actors in influencing policy. Appointed Commissions/Advisors
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Politics can shape policy in a way that is separate from evidence New Policy Idea Public Service Analysi s Cabine t CTTEE Financ e CTTEE Cabine t Policy Implement New Policy Idea C1 New Policy Idea C2 New Policy Idea C3 Final Policy Many doors to go through
Politics can shape policy in a way that is separate from particular types of evidence
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