The Health Care Policy Process
Publication Year: 1996
The Health Care Policy Process enables the reader to develop a clear understanding of the scope and objectives of health policy studies, to analyze the extent to which policies can be changed or influenced by those involved at the different stages of the policy process, and to assess both the need and the scope for change. The author considers the relationship between planning and policy, looks at key concepts in analyzing health care issues, and examines some of the debates overshadowing today's health policy agenda.
- Front Matter
- Back Matter
- Subject Index
- Chapter 1: Why Study Health Policy?
- In Summary
- Chapter 2: What Does Health Care Do for Society?
- Debates in Health Care Today
- The Value of Health Care
- In Summary
- Chapter 3: The Policy Process
- What Constitutes a Policy?
- Health Care Policies as Systems
- Policy and Planning
- In Summary
- Chapter 4: Approaches to Policy Studies
- What Kinds of Policy Study are Possible?
- Who Should Conduct Policy Studies?
- In Summary
- Chapter 5: Designing a Policy Study
- How Do We Decide What to Study?
- Defining Studies in Priority Areas
- What Kinds of Evidence are Available for Policy Studies?
- In Summary
- Chapter 6: Techniques and Methods for Policy Studies
- Choosing Methods
- Asking the Public
- Asking Experts
- Techniques to Assist the Decision-Making Process
- Choosing the Technique or Approach
- In Summary
- Chapter 7: Power
- What Fuels the Policy Making Process?
- Why Discuss Concepts of Power?
- Elite Theory
- Marxist Approaches
- Structuralist Approaches
- In Summary
- Chapter 8: Professionalism and Bureaucracy
- How Dominant is the Medical Profession?
- Health Professionals in Developing Countries
- Professionalism and Complementary Medicine
- Do Organisations Today Need Bureaucrats?
- How Close is the Bureaucratic Model to Real Life?
- In Summary
- Chapter 9: Poverty
- Ill-Health and Deprivation
- Defining Poverty
- Wealth and Poverty as Determinants of Health
- In Summary
- Chapter 10: Equity
- What is Equity?
- Equity and Social Welfare
- Equity in Health Care
- Can Equity Be Efficient?
- In Summary
- Chapter 11: Development
- Views of Development
- Are Things Getting Better or Worse? An Environmental Perspective
- Are Things Getting Better or Worse? A Socioeconomic Perspective
- What Can We Do to Make Things Better?
- Modernisation Theory
- Welfare and Redistribution Approaches to Development
- Changing Views about Development
- Privatisation: A Global Trend
- Sector Reform
- In Summary
- Chapter 12: Aid and the Health Sector
- Aid within Global Relationships
- Features of the Aid Process
- In Summary
- Chapter 13: Privatisation within the Health Sector
- Privatisation: A Global Trend
- Is There a Case against the Public Sector?
- What is the Market Environment for Health Care?
- Does a Market Environment Enhance Democracy and Community Participation?
- Does a Market Environment Increase Equity?
- Does a Market Environment Increase Efficiency?
- Does a Market Environment Improve the Services on Offer?
- In Summary
Part V: Can the Study of Health Policy Improve the Process?
© Carol Barker 1996
First published in 1996
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted or utilized in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without permission in writing from the Publishers.
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British Library Cataloguing in Publication data
A catalogue record for this book is available from the British Library.
ISBN 0 8039 7627 5
ISBN 0 8039 7628 3 (pbk)
Library of Congress catalog card number 96–068056
Typeset by Photoprint, Torquay, Devon
Printed in Great Britain by The Cromwell Press Ltd,
To Shubi, Kiza and my mother[Page vi]
List of Figures[Page x]
- Figure 2.1 Health expenditures as a percentage of GDP, 1990 11
- Figure 3.1 A systems diagram of the policy-making process 24
- Figure 3.2 Stages in the policy-making process 28
- Figure 4.1 Classification of policy studies 36
- Figure 12.1 Aid flows as a percentage of total health expenditure, 1990 142
- Figure 13.1 Proportion of public to private expenditure on health care, selected regions and countries 152
List of Boxes[Page xi]
- Box 1.1 Networks of interrelated decisions 7–8
- Box 3.1 Stages in the development of a policy 21–22
- Box 3.2 Pharmaceuticals policy development in post-colonial Mozambique 22–23
- Box 3.3 Development of HIV/AIDS policy 29–30
- Box 4.1 Deciding what kind of policy study is needed: a community health worker scheme 38–39
- Box 5.1 Development of a policy review process 45–46
- Box 5.2 Evidence for a haemoglobinopathy screening control 51
- Box 5.3 Policy for over-the-counter drug sales 53
- Box 12.1 Impact of aid on the national health service in Mozambique 144–145
- Box 12.2 Conditions for sustainability of health aid projects 148
- Box 13.1 Approaches to privatisation in health service provision 156–157
- Box 13.2 Approaches to privatisation in health care financing 158
List of Tables
I should like to thank the Nuffield Institute for Health at the University of Leeds for allowing study leave for the completion of this writing. Thanks also go to colleagues there for their support in covering for my leave, and for many fruitful discussions over the years. Particular thanks go to David Hunter and to Charles Collins for some useful exchanges. Colin Thunhurst read the whole book in draft, and made invaluable comments. Gill Walt of the London School of Hygiene and Tropical Medicine also read the whole draft, and led me to improve on it in a number of ways. Shubi Ishemo has provided me with many useful references and ideas, and great support. At early stages in this work, I shared formative discussions with Meredeth Turshen.
Of course, many insights have been gained from the health care professionals from all over the world who frequent the courses at the Nuffield Institute, along with their colleagues who provide counterparts for work undertaken overseas. All these people have shown me not only what are the important issues facing health care today, but also what are the crucial aspects of the various debates. Thanks to Julie Cliff, a supportive ex-colleague who was kind enough to allow me to summarise material from her article for Box 12.1. Last, thanks to Shubi and Kiza, who provided domestic support beyond that which anyone should hope for, and kept me going.[Page xiv]
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