Read Chapter 14 the Art of Structuring and Writing a Health Policy Analysis

The Art of Structuring and Writing a Health Policy Analysis

Teitelbaum, J. B., & Wilensky, Due south. East. (2017). Essentials of health policy and law (tertiary ed.). Burlington, MA: Jones & Bartlett Learning.

Chapter xiv

The Art of Structuring and Writing a Health Policy Analysis

INTRODUCTION
Imagine y'all work for the governor of a state that recently received a large sum of federal money for anti-bioterrorism efforts and your boss asks you how information technology should exist spent. How are you going to respond? Or, assume y'all are an assistant to the manager of a state nutrition program for low-income children and the program'southward upkeep was slashed by the legislature. The programme's director needs to reduce costs and turns to you for aid. How will you approach this problem? Finally, pretend you lot work in the White House every bit a domestic policy counselor and the president is because revising the administration's methane emissions guidelines. What guidance will y'all offer? While the substance of wellness policy and police has been discussed in detail up to this point, this affiliate teaches you lot what policy analysis is and the skill of addressing circuitous health policy questions through a written policy analysis.

POLICY Assay OVERVIEW
In this section nosotros define policy analysis and review the purposes for developing 1. In the following department, we provide a step-past-step process detailing how to create a written health policy analysis.

Customer-Oriented Advice

The customer is the item stakeholder that requests the policy analysis, and the analysis must be developed to adjust the needs of the client. (The client could be a policymaker who hires yous, a fictional policymaker in an exercise developed by your professor, an employer who asks yous to analyze a problem, etc.) In full general, a stakeholder refers to an individual or a group that has an interest in the outcome at manus. There may exist many stakeholders related to a item policy upshot. Of course, the client requesting an analysis is also a stakeholder because that person or entity has an interest in the issue. Nonetheless, to avoid confusion, we refer to the person or group that requests the analysis equally the client, and the other interested parties equally stakeholders.

Informed Communication

Providing informed advice means the assay is based on thorough and well-rounded information. The information included in the analysis must convey all sides of an issue, not merely the facts and theories supporting a particular perspective. If a decision maker is just presented with evidence supporting ane course of action or one side of a fence, it will be impossible for the client to make a well-informed decision. In add-on, to be effective in persuading others to favor the recommended policy, your client must be able to understand and, when necessary, refute culling solutions to the problem.

Public Policy Determination

Policy analyses involve public policy decisions. A public policy problem goes beyond the private sphere and affects the greater community.

Providing Options and a Recommendation

A cardinal component of whatsoever policy analysis is providing the client with several options to consider, analyzing those options, and settling on one recommendation. In other words, a policy analysis is not simply a background study that identifies a diversity of issues relating to a particular problem; instead, it gives the client ideas virtually what steps to take to address the trouble and concludes by recommending a specific course of action.

Your Customer's Power and Values

Finally, the assay should exist framed by the client's ability and values. The first requirement is fairly straightforward and uncontroversial: the options presented and the recommendation made must be within the power of the client to attain. On the other hand, the notion of framing an analysis co-ordinate to the client's values is more controversial. In near conceptualizations of policy analysis, including the one discussed afterwards in this chapter, the process is roughly the same: define the problem and provide information almost it, analyze a set of alternatives to solve the trouble, and implement the best solution based on the analysis.one(p3) Equally new information is uncovered or the problem is reformulated, analysts may motility back and forth amidst these steps in an iterative procedure.ii(p47) However, although there is full general agreement that politics and values play a role in policy analysis, in that location is disagreement over at which phase of the analysis they come into play.

To understand this controversy, it is necessary to discuss two models of policy assay: the rational model and the political model. The rational model was developed in an effort to base of operations policy decisions on reason and science rather than the vagaries of politics.2(p7) In the traditional rational model, the analyst does not consider politics and values. Instead, she should recommend the "rational, logical, and technically desirable policy."two(p51) According to the rational model, the decision maker infuses the analysis with politics and values once the analyst's work is complete.

Professor John Kingdon and others have moved away from the rational model and toward a political model. King-don suggests that policy analysis occurs through the evolution of three streams: bug, policies, and politics.iii The problem stream is where problems are defined and noticed by decision makers. The policy stream is where solutions are proposed. These proposals may be solutions to identified problems, but they are often favored projects of policymakers or advocates that be divide from specific problems that have garnered attending. Finally, the political stream refers to the ever-changing political mood. As a general matter, these streams develop separately, only coming together at critical junctures when the problem reaches the top of the agenda, the solutions to that problem are viable, and the political temper makes the time right for change.4(p87)

Kingdon'due south approach discusses occurrences the rational model does not, such equally why some problems are addressed and others are not, why some solutions are favored even if they are not technically the best arroyo, and why activity is taken at some junctures but not at others.three In improver, the rational model but refers to one cycle of problems. As Rex-don and others have noted, solutions to 1 trouble oft lead to unintended consequences that create other problems to be addressed, resulting in an ongoing policy assay wheel instead of an event with a start and a cease.4(p260)

Professor Deborah Stone also focuses on the role of politics and values in analysis.2(pp1–14) She argues that the idea of the rational policy analysis model misses the point considering "analysis itself is a creature of politics."2(p8) Co-ordinate to Stone, everything from defining a problem, to selecting analytic criteria, to choosing which options to evaluate, to making a recommendation is a political and value-laden pick. "Rational policy analysis can brainstorm only after the relevant values have been identified and … these values change over time as a consequence of the policymaking procedure."2(p32) She contends that policy analysis should do the very things that the rational model does not permit—allow for changing objectives, permit contradictory goals, and turn credible losses into political gains.2(p9) The goal of the rational model founders—to divorce analysis from the vagaries of politics—is merely not possible in Stone'south view.

Having differentiated these models, nosotros now return to our definition of policy analysis: an analysis that provides informed advice to a customer that relates to a public policy determination, includes a recommended form of action/inaction, and is framed by the customer's powers and values. Y'all can see that this definition follows Stone's political model of policy analysis, requiring the assay to be developed with a particular customer'southward values in listen. Later on reviewing the numerous examples provided in the post-obit section, it volition exist axiomatic that client values permeate all aspects of a policy analysis. Merely after you take into account your client'due south values, combine it with the information you have gathered, identify information technology in the prevailing political context, and sympathize your client'southward powers, can you make an appropriate policy recommendation.

Multiple Purposes
The ultimate production of a policy analysis is a recommendation to a specific customer about how to address a trouble. Still, a policy analysis has several other purposes as well. Information technology provides full general data necessary to empathize the problem at mitt and may be an important tool to inform stakeholders about a policy trouble. In addition, the analysis may exist a vehicle for widespread broadcasting of ideas and arguments. Although your assay is targeted to the client requesting advisement, it may also be used to inform and persuade other supporters, opponents, the media, the general public, and others. Finally, it will help y'all, the policy annotator, larn how to recall through problems and develop solutions in an organized, concise, and useful fashion.

Policy analyses can accept many forms—a memorandum, an oral conference, a report, and so on—and, correspondingly, have varying degrees of formality. This chapter explains how to construct a curt, written assay because it is a unremarkably used, highly effective, and oft applied manner to provide a policy analysis to your client. Whether you are aiding a governor, the director of a state program, the CEO of a individual business concern, or any other decision maker, yous often will non accept the opportunity to talk over issues in person or for a significant length of time. Furthermore, given time pressures, the demands on high-level policymakers, the demand for rapid determination making, and the multifariousness of bug well-nigh policymakers deal with, many clients will non read a lengthy assay. That is why it is essential for anyone who wants to influence policy to be able to craft a articulate and curtailed written assay.

STRUCTURING A POLICY ANALYSIS
We now plough to a v-step method for writing a thorough nevertheless curtailed policy assay. Regardless of the subject matter, you can use this structure to analyze the question your client is considering. As you lot review each part of the analysis, notice the various disciplines and tools that may exist part of writing an constructive policy analysis. Analysts draw from a variety of disciplines—law, economics, political science, sociology, history, and others—and employ a number of quantitative and qualitative tools when explaining bug, analyzing options, and making recommendations.

Although policy analyses come up in various formats and use different terminology, they will all contain these essential elements:

Problem statement: Defines the problem addressed in the analysis

Groundwork: Provides factual information needed to sympathize the problem

Landscape: Reviews the various stakeholders and their concerns

Options: Describes and analyzes several options to accost the trouble

Recommendation: Offers one option equally the best action to pursue

The following sections talk over each of these elements in particular.

The Trouble Statement
The first step in writing a policy analysis is to conspicuously define the problem you are analyzing. A problem statement should be succinct and written in the form of a question that identifies the trouble addressed in the assay. Information technology unremarkably consists of a single judgement, though it may be two sentences if you are analyzing a specially complex issue. Although a problem statement is simple to define, it is often ane of the most difficult parts of the analysis to do well. It is too 1 of the most important.

The problem statement is the key to your analysis because it frames the problem at paw. Indeed, some policy battles are won or lost simply by how the problem statement is crafted. For example, consider the dissimilar questions asked in these problem statements:

Problem statement i:

What type of taxation credit, if whatever, should the president include in the next budget proposal?

Problem statement two:

What type and size of health insurance tax credit should the president include in the next budget proposal?

The get-go trouble statement asks what type of tax credit, if any, should be considered. One possible respond to that question is that no tax credit of any kind should exist considered. Another answer could involve a tax credit, but not one related to wellness insurance. The 2nd problem argument suggests that the option of not proposing a health insurance tax credit is unacceptable. Instead, the second problem statement lends itself to an assay of identifying the pros and cons of various health insurance tax credit options. In other words, 1 option that may be considered based on the first trouble argument (no taxation credit) is excluded based on the 2d trouble argument.

Consider another example:

Trouble statement 1:

Should the governor's top priorities include initiating a new state program to reduce the number of obese residents?

Problem statement 2:

Should the governor's priority of reducing the number of obese residents exist accomplished by relying on currently existing programs?

Once more, the first trouble statement asks whether providing a new healthcare program relating to obesity should be at the summit of the governor'due south agenda. It is possible that the reply is "No, other priorities such as education and transportation should accept priority." The 2d problem argument starts with the governor committed to reducing the obesity charge per unit and asks how to best accomplish that goal. These may sound similar similar questions, but they atomic number 82 to very different analyses and (almost probable) different recommendations.

It is possible that your customer'south values will be evident from the fashion the problem statement is phrased. For instance, in the 2d example, the second policy statement clearly reflects the governor's want to reduce the obesity charge per unit. Consider another example. Yous have been asked to write a policy analysis almost the merits of importing depression-price prescription drugs from Canada. How might the problem statement differ if your customer is a pharmaceutical lobbying group, on the one hand, and an elder rights association on the other? Here are two possible problem statements.

Adequate problem statement for the pharmaceutical lobbying firm:

How can this firm aid improve medical intendance quality in the U.s.a. by reducing the importation of unsafe prescription drugs from Canada?

Acceptable problem statement for the elder rights association:

How tin can this association help seniors obtain low-priced prescription drugs from Canada?

The vast differences in these trouble statements reflect differing viewpoints regarding the importation of prescription drugs. A pharmaceutical lobbying firm is more likely to exist concerned about reduced profits for its drug visitor clients and therefore would want to deter or restrict importation, which could lead to more competition in the marketplace. I way to attain that goal is to phrase the event as a safety/quality-of-care concern. An elder rights clan is more likely to exist concerned with high-priced prescription drugs in the U.s. and would therefore desire to promote drug importation (assuming there is no bodily safety business organization with the drugs, of class). One way to accomplish that goal is to phrase the event equally one of cost reduction.

Information technology is also possible to write solid, still neutral, problem statements. From the immediately previous example, analysts for both groups could use the following problem statement:

What action should [the customer] take in response to recent congressional proposals relating to importing prescription drugs from Canada?

A neutral argument is not necessarily ameliorate or worse than a value-driven statement. The value-driven statement provides additional information virtually the direction of the policy analysis and clearly limits some of the options that might otherwise exist considered. A neutral statement is oft broader, leaving more options on the table at the outset. Yet, even if a neutral statement is used, the options the annotator considers and the recommendation the analyst makes will even so be constrained by the client's values and needs.

Because it is possible to create numerous trouble statements for any issue, how practise you develop the best ane? Follow these guidelines.

Make the Problem Statement Analytically Manageable
Acceptable problem statements can be broad or narrow. 1 is non improve than the other; they arrange different purposes. Policy analyses with broad problem statements may crave more various information in terms of background and may consider a wider range of problems in the paper's landscape section. Also, the recommendations may promote "big picture" changes instead of specific and tailored ideas. Narrower problem statements may require less extensive groundwork and mural data, simply they may non capture big flick, systemic concerns relating to the problem under consideration.

Reflect on the following examples. They both may be acceptable problem statements, depending on the needs of your customer.

A broad problem statement:

What action should the U.S. Department of Health and Human Services accept to avoid another influenza vaccine shortage?

A narrow trouble statement:

How can the U.South. Department of Health and Human Services create incentives for additional manufacturers to supply influenza vaccine to the United States?

The first trouble argument could effect in a diversity of recommendations, such as improving surveillance to lower the incidence of flu in the future, developing new vaccines that accept longer-lasting amnesty, finding ways to entice additional manufacturers to provide supplies to the The states, and others. It is a broad problem argument that will lead to an analysis that could recommend a wide variety of actions. The 2nd problem statement focuses on 1 item way to decrease a flu vaccine shortage—increasing the number of suppliers. Although the analysis will likewise provide a number of options, all of the options will address the specific issue of increasing suppliers. Once again, at that place is no unmarried right or wrong trouble argument. Whether it is more useful to take a broad or narrow problem statement will depend on the needs and concerns of your customer.

Withal, it is possible to brand a problem statement and then vague that it will exist impossible to write a audio policy assay. Unfortunately, there is no piece of cake way to differentiate an passably broad trouble statement from an unmanageably vague one when you begin your analysis. You volition know your problem statement is too vague, however, if y'all detect it impossible to write a complete and concise policy analysis and you tin can think of many diverse options to include. Your paper volition require too much information in the groundwork and landscape sections if you draft an overly vague problem statement. In addition, you will find that you cannot devise a coherent series of options addressing the trouble considering the trouble statement is too broadly defined. Instead of a curtailed and useful policy assay, y'all will end up with a lengthy and unfocused paper.

If you believe your problem statement may exist so vague that it is analytically unmanageable, ask yourself if you lot are addressing one specific trouble that may exist countered with a few specific options. If yous are having trouble narrowing your trouble argument, you can try including limitations based on geography (e.g., refer to a particular state or metropolis), time (due east.g., focus on the next year or over the next 5 years), or numerical boundaries (e.g., use a goal of reducing a figure by a certain percentage or a budget by a specific dollar corporeality). Consider this case:

An unmanageably vague trouble statement:

What is the best utilize of Centers for Illness Control and Prevention's resources to improve the wellness status of our citizens?

This problem statement is non analytically manageable. It is extremely broad and unfocused. Using this problem argument, your analysis could address whatsoever health event, such equally access to intendance problems, the need to meliorate vaccination rates, racial disparities in health care, or many others. The list is endless and your policy analysis will be likewise.

A manageable problem statement:

What preventive health issue should be the height priority for the Centers for Illness Control and Prevention next year?

This problem statement is analytically manageable. Information technology is focused on preventive measures specifically and is limited to determining the top priority. In improver, the problem is focused on what tin can exist washed in the upcoming yr. The second trouble argument allows for a much more than concise and directed policy assay.

Do Non Include the Recommendation in Your Problem Argument
Some other pitfall in writing problem statements is crafting a trouble in a mode that suggests a item solution to the consequence. A problem statement should define a specific problem; it should not indicate how that problem should exist solved. If the answer is preordained, why bother with the analysis? When drafting your trouble statement, enquire yourself if you can imagine four, five, or vi potentially feasible options to accost the problem. If you lot cannot, then yous have non defined the problem well.

For case, assume you've been asked to address how to reduce medical malpractice insurance premiums. Here is a trouble statement that leads the reader to one decision:

To what extent should jury awards be express in malpractice cases in order to reduce malpractice premiums?

This problem argument leads to one very specific solution (limiting jury awards) every bit a way to counter a broad problem (reducing malpractice premiums). The only question presented by this problem argument is what the honour limit should be. Information technology does not provide a range of options for reducing malpractice premiums (one of which may be limiting jury awards) for your customer to consider. (Of grade, if y'all were specifically asked to accost how to limit jury awards in malpractice cases, this would exist an appropriate problem statement.) A better problem statement would be "What activity should be taken to stem the rise in malpractice premiums nationwide?"

This trouble statement lends itself to an analysis that considers several options. Possible alternatives include limiting jury awards, enacting regulations that limit the amount insurance companies tin can increase premiums each year, and a host of other options. The trouble argument also narrows the focus of the analysis to national solutions.

Once you have written your concise and precise problem statement, you have set the framework for your analysis. Every other section of the analysis should chronicle directly to the problem statement. Remember that writing a policy assay is an iterative process; you must review, revise, and tighten the information and arguments throughout the writing process. As you review the other components of your policy analysis, it may become evident that what y'all thought was the best problem statement tin exist further improved. There is nix wrong with revising your problem statement as yous arts and crafts your analysis, as long equally you remain true to your client's values and ability.

The Background Section
The first substantive information your analysis provides is in the groundwork section. The background informs the reader why the particular problem has been chosen for analysis. This section should brand articulate why the issue is important and needs to exist addressed now. In addition to providing full general information nigh the topic, your groundwork and landscape (discussed adjacent) sections provide the information necessary to assess the options you lay out.

Much of the information in the background will be relevant regardless of who assigned the assay. Even so, considering the background provides information necessary to understand the trouble, it is essential to sympathize the knowledge level of your client when constructing the background. For example, assume you are writing an analysis relating to state preparedness planning for smallpox vaccination in the event of a bioterror attack. Regardless of your client, your background would likely include information about why a smallpox attack is a threat, including (but not express to) the following:

• Reference to the September 11, 2001, attacks on the World Trade Centre and subsequent events

• The belief that although smallpox has been eradicated every bit a natural disease, it is probable that samples of the virus still exist

• Reference to any information provided past the federal regime or other sources relating to the possibility of a bioterror attack

If your client does not accept knowledge relating to smallpox, y'all would also include details about smallpox transmission, the effects of the illness, the vaccination process, and the risks associated with vaccination.

In addition, your background should include any factual data is necessary to fully assess the options discussed. Remember, your client needs a consummate picture, non merely the information that supports the recommended activeness or your client's viewpoint. Past the time the reader reaches your paper's options department, all of the information necessary to evaluate the options should have been presented in your groundwork or landscape.

For example, presume ane of your options for the smallpox vaccination state preparedness analysis is firsthand compulsory vaccination of all outset responders and establishment of a protocol for vaccinating the remaining population if there is a smallpox outbreak. In that case, your groundwork (and perchance the landscape) should provide information regarding who offset responders are, where they are located, how many there are, legal issues relating to compulsory vaccination, and and then on.

Because the background department is an informational—not analytical—part of the assay, the fabric provided in it should be more often than not factual. The tone of the groundwork is not partisan or argumentative. Information technology should merely state the necessary information.

The Landscape Section
Together, the background and mural sections frame the context of the analysis for your client. Whereas the background provides factual data to assist the customer in understanding what the problem is and why it is being addressed, the landscape provides the overall context for the analysis by identifying key stakeholders and the factors that must be considered when analyzing the problem. In the following discussion, you will read nearly numerous types of people, groups, and issues that might be included in a landscape. These examples are meant to provide suggestions and provoke idea about what should be included in an analysis. It would be incommunicable to include everything discussed here in any unmarried landscape department. It is the job of the policy analyst to choose among these options—to exist able to identify whose views and which factors are the most salient ones in creating a complete landscape.

Identifying Key Stakeholders
Upwardly to this point, the policy analysis give-and-take has focused on simply ane stakeholder: the client who asked for the policy analysis. The mural brings in other stakeholders who take an involvement in the issue. Although information technology is oft impossible to include every possible stakeholder in a single analysis, it is necessary to identify the cardinal stakeholders whose positions and concerns must be understood before a well-informed conclusion can be made.

How practice you identify the key stakeholders particular to your issue? Unfortunately, in that location is no magic formula. The best arroyo is through research and thinking. Also, acquit in mind that the stakeholders and issues discussed in the landscape must relate to your overall policy analysis. Your options must accost the problem identified initially, and all of the information necessary to appraise the options must be presented in the background and landscape. As you learn about the trouble to be analyzed and retrieve virtually options for addressing the problem, information technology should get apparent which stakeholders have a significant interest in the issue.

For example, assume your analysis relates to proposed legislation regulating pharmacists and pharmaceuticals. Who are possible cardinal stakeholders regarding this issue? They may include several parties:

• Democratic and Republican politicians (you might need to distinguish amid those in Congress, land legislatures, and governors)

• Pharmaceutical industry

• Health insurance industry

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