Definition and Responsibility
A public policy is a law, regulation, procedure, administrative action, or voluntary practice of government that affects groups or populations and influences resource allocation.
Health professionals have a responsibility to contribute to population health through policy skills and leadership in national, state, and local health agencies, academia and other organizations.
Policy is about relationships.
Policy analysis is a social and political activity.
It is important to understand those most interested in solving the problem the policy is intended to address.
Key Steps When Developing Health Policy
- Understand and define the problem
- Who is affected?
- History and causes of the problem to be addressed and sources of information and evidence
- Who owns the policy (who is the authority/body that authored or can approve the policy?)
- Develop alternative solutions
- What are the best practices from literature, experts, and input from stakeholders?
- Where is there opportunity to apply the intervention/policy to make positive change?
- Identify criteria to be used in decision-making (population benefit, cost, ethics/equity, administration feasibility, constituency perspectives)
- Form a decision-making group
- Scientific evidence is unlikely to be conclusive in making decisions, "expert opinion" often also will play a role
- Develop a policy advocacy strategy
- Develop a plan to implement and evaluate your new policy
Key Criteria and Questions to Consider in Policy Decision Making
There are many ways to analyze a policy but some important questions to consider when developing, reviewing or evaluating a policy include some of the following. Answers to the questions are subjective and not all questions may apply to all policies.
| Criteria | Questions |
|---|---|
|
Public Health Impact Potential for the policy to impact risk factors, quality of life, disparities, morbidity and mortality |
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Feasibility Likelihood that the policy can be successfully adopted and implemented |
Political
Operational
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Economic and budgetary impacts Comparison of the costs to enact, implement and enforce the policy with the value of benefits |
Budget What are the costs and benefits associated with the policy from a budgetary perspective? (e.g. for entities to enact, implement and enforce the policy?) Economic How do costs compare to benefits (e.g. cost-savings, costs-averted, return-on-investment, cost-effectiveness, cost-benefit analysis, etc)? Where are there gaps in the data/evidence base? |
Example of a Decision Matrix to Compare and Critique Policy
Policy analysis is more art than science, but some framework can help guide decision making.
The scoring on this type of table is subjective and meant to be a guide to help with a discussion about alternative policies.
| Criteria | Public Health Impact | Feasibility | Budgetary Impact | Economic Impact |
|---|---|---|---|---|
| Scoring definitions |
Low: Small reach, small effect size and small impact on disparate populations Medium: Small reach with large effect size or large reach with small effect size High: Large reach, large effect size, and large impact on disparate populations |
Low: No/small likelihood of being enacted Medium: Moderate likelihood of being enacted High: High likelihood of being enacted |
Budget Less favorable: High costs to implement Favorable: Moderate costs to implement More favorable: Low costs to impement |
Economic Less favorable: Costs are high relative to benefits Favorable: Costs are moderate relative to benefits (benefits justify costs) More favorable: Costs are low relative to benefits |
| Policy 1 |
Low Medium High Concerns about the amount or quality of data? (Yes/No) |
Low Medium High Concerns about the amount or quality of data? (Yes/No) |
Less favorable Favorable More favorable Concerns about the amount or quality of data? (Yes/No) |
Less favorable Favorable More favorable Concerns about the amount or quality of data? (Yes/No) |
| Policy 2 |
Low Medium High Concerns about the amount or quality of data? (Yes/No) |
Low Medium High Concerns about the amount or quality of data? (Yes/No) |
Less favorable Favorable More favorable Concerns about the amount or quality of data? (Yes/No) |
Less favorable Favorable More favorable Concerns about the amount or quality of data? (Yes/No) |
To develop a “bottom line” score to support your decision process, multiply each criterion’s weighting factor by the score for each alternative policy. Then sum scores across each criterion to calculate a “bottom line” overall score for each alternative. (You may use a 1–100 final score, or some other scale.) You will likely want to repeat this summation process several times with slightly different scores or weights, to gauge the “sensitivity” of your final decision to your scores on each criterion.
How a Policy Can Help Prevent a Journey to Addiction
From Joan's patient/health care consumer perspective:
Policy Example: Patient Notification
A state policy is proposed to improve patient and public safety that would require all opioid prescribers to provide written and verbal “patient notification” of risks, secure storage and disposal of opioids.
Prescribers would need to provide patient education on the risks, safe use, secure storage and proper disposal of opioids upon the initial prescriptions and at each transition phase of treatment (e.g. at 6 weeks when transitioning from acute to subacute pain and at 12 weeks when transitioning to chronic pain opioid prescribing). Information must include:
(a) Risks associated with the use of opioids as appropriate to the medical condition, the type of patient, and the phase of treatment;
(b) The safe and secure storage of opioid prescriptions; and
(c) The proper disposal of unused opioid medications including, but not limited to, the availability of recognized drug take-back programs.
This requirement may be satisfied by using a patient counseling document provided by the department of health.
Exercise – Analyze the Patient Notification Policy
Consider potential unintended consequences and how this policy would be operationalized in a sustainable manner in the daily workflow for the healthcare team.
To develop a “bottom line” score to support your decision process, multiply each criterion’s weighting factor by the score for each alternative policy. Then sum scores across each criterion to calculate a “bottom line” overall score for each alternative. (You may use a 1–100 final score, or some other scale.) You will likely want to repeat this summation process several times with slightly different scores or weights, to gauge the “sensitivity” of your final decision to your scores on each criterion.
| Criteria |
Public Health Impact Weight factor = 3 |
Feasibility Weight factor = 2 |
Budgetary Impact Weight factor = 1 |
Economic Impact Weight factor = 1 |
|---|---|---|---|---|
| Scoring definitions |
Low: Small reach, small effect size and small impact on disparate populations Medium: Small reach with large effect size or large reach with small effect size High: Large reach, large effect size, and large impact on disparate populations |
Low: No/small likelihood of being enacted Medium: Moderate likelihood of being enacted High: High likelihood of being enacted |
Budget Less favorable: High costs to implement Favorable: Moderate costs to implement More favorable: Low costs to impement |
Economic Less favorable: Costs are high relative to benefits Favorable: Costs are moderate relative to benefits (benefits justify costs) More favorable: Costs are low relative to benefits |
| Policy 1 |
Low (1) Medium (2) High (3) Concerns about the amount or quality of data? (Yes/No) |
Low (1) Medium (2) High (3) Concerns about the amount or quality of data? (Yes/No) |
Less favorable (1) Favorable (2) More favorable (3) Concerns about the amount or quality of data? (Yes/No) |
Less favorable (1) Favorable (2) More favorable (3) Concerns about the amount or quality of data? (Yes/No) |
| Score | 3x3 = 9 | 2x2 = 4 | 3 |
3 Total Score 19 |
In consideration of the national opioid epidemic and rate of overdose deaths and listening to Joan's experience we've subjectively assigned weights to criteria.
This is an example of subjectively scoring one policy.
You could then weight and score an alternative policy for comparison to make a decision about which policy to pursue.
Why a Policy on Educating Patients on Proper Opioid Use is a Huge Opportunity
From Joan's patient/health care consumer perspective:
