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HPIM 4003: Governance, Ethics and Law: complete summary
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complete summary, based on the overview lecture including all cases and hans maarssens lectures
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HPIM 4003: Healthcare Governance, Ethics and Law: Overviewlecture summary (slides + audio file)
NL20ABNA0487909909
Lectures Health care policy analysis: 1
A problem is a gap between a standard and a perceived (expected) situation. Something only
becomes a problem if you provide a standard. Definition influences solution. Different types of
problems and an example:
Level problems: health care expenditure outstrip out nation’s financial capacity
Distributional problems: paying for health care according to risk is unfair
Coordination problems: lack of coordination explains the failure of this program
Moral problem: pro-choice or pro-life?
Private problems require private action
Collective problems require collective action
o Community action: community problem (no state involvement)
o Public policymaking: public problem (state involvement)
No clear dividing line between private and collective problems, and therefore, no clear
division between community action and public policy making
Public problems should be distinguished from collective and private problems. PH problems can
be defined in many ways. Strong interdependence between how you phrase a problem and the
policies that will be developed for it.
Historical trends: from private/community problems public problems. Growth of the public
domain/state involvement in health care. Presently, trend to redefine many public problems in
private/community problems.
Whether a problem is structured or not depends on the knowledge on the topic and the consensus
about whether it is a problem or not, see the graph below:
,Public policy: a plan or actor to achieve certain goals with certain means in a certain period of
time, or policy as an organized and purposeful activity to tackle public policy problems, or as a
series of decisions in a given field over a longer period of time.
In policy, there is a gap between what is said and what is done (look at implementation!)
Policy usually has short-term and long-term objectives/goals (time perspective)
Policy has primary and secondary objectives (priority setting)
Policy has intermediate and ultimate objectives (instrumental perspective)
Types of instruments:
Authority-based: command and control, regulatory framework
Treasury-based: finances, (dis)incentives, co-payments
Organization-based: privatization, outsourcing, reorganization
Information-based: communication, marketing, quality information
Values:
Policy paradigm: the theory/ideas underlying a policy. Why do you believe that a certain
instrument will work. Shift from medical model to more broad models is also a shift in paradigm
(assumptive world and theory of change)
Values play a role in policy content since it are general normative principles that give direction to
policymaking (e.g. solidarity, universal access, equity, freedom of choice, privacy etc.), values
are ambiguous. Interpretation of values may change over time, and may compete with each other.
Stakeholder and interest groups: a stakeholder is a person, group, organization, member or
system who affects or can be affected by public policymaking. An interest group is an
organization articulating and representing the interests of its constituent members. Interest group
is a stakeholder but not every stakeholder is an interest group.
Stakeholder theory: theory about the functions of stakeholders and the structure of the
stakeholders’ network. what are my stakeholders doing? Different functions:
Input function: to provide information: consultation, lobbying, direct participation in
decision-making
Output function: implementation of public tasks: medical profession in charge of
developing teaching programs, quality guidelines, disciplinary rules, disciplinary
jurisdiction
, Different stakeholder theories:
Pluralism: many important stakeholders
Elitism: one overriding stakeholder
Pluralist elitism: you have an elite but it differs from sector to sector
Capture model: regulators should regulate the regulated but in fact the regulated regulate the
regulators. Policy makers are captures by the beliefs of the regulated.
Neo-corporatism: collective bargaining by officially recognized interest associations which have
been accorded public tasks
Types of policy interests:
Material interests (e.g. financial interests, power interests) vs non-material interests (e.g. right or
wrong, moral conviction)
Concentrated and diffuse interests (raising the salary of nurses versus raising taxes)
Scale of interests: majority or minority of population involved?
Intensity of interests high or low?
Stakeholder analysis:
Policymaking process:
Problem recognition/agenda building:
Agenda building as selecting problems for public policymaking
Agenda building as influencing policymakers to address problems competition for
attention
Agenda building as framing problems
Agenda building as crucial stage in policymaking process, because:
o Problems may not reach the political agenda
o Problem framing has a strong impact on policymaking
Who is involved in or dominates problem recognition and agenda building? Outsider
initiative of mobilization?
The concept of agenda power
The concept of non-decision making
Policy formation: making policy proposals; role of civil servants, advisory bodies, political
parties and others. institutional arrangements: formal and informal rules for public policymaking.
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