Research and Evaluation in Health Policy PDF

Research, evaluation and policy Key terms            Audit Dissemination Evaluation Evidence Evidence-based medicine Evidence-based policy Formative evaluation Knowledge transfer Monitoring Research Summative evaluation Introduction Research, evaluation and other types of evidence af...

Research, evaluation and policy Key terms            Audit Dissemination Evaluation Evidence Evidence-based medicine Evidence-based policy Formative evaluation Knowledge transfer Monitoring Research Summative evaluation Introduction Research, evaluation and other types of evidence affect policy through introducing new ways to see the world, new techniques for improving health, or reasons for changing existing policies.  Formative versus summative evaluation  How do research and evaluation influence policy? Engineering model is either a problem is identified by policy maker and solved by researcher or ne knowledge leads to policy change  Enlightenment model  Strategic model views research as ammunition to support predetermined positions or to delay or obstruct politically uncomfortable decisions (Weiss 1979)  Elective affinity model: policy makers are more likely to react positively to research findings and insights if they have participated in the research process  Barriers to the use of research       Political and ideological factors Policy and scientific uncertainty Different conceptions of risk Perceived utility of research Timing Communication and reputation Improving the relationship between research and policy  Practical steps inspired by the ‘two communities’ perspective to reduce the gap between research and policy  ‘Linkage and exchange’ model of health research transfer  The ‘co-production’ of research knowledge  The conceptual model of the knowledge transfer process (Ward et al. 2009)  ◦ ◦ ◦ ◦ ◦ Problem identification and communication knowledge/research development & selection Analysis of context Knowledge transfer activities or interventions Knowledge/research utilization Beyond the ‘two communities’: are policy communities, issue networks and advocacy coalitions a better representation of reality? Policy networks and policy communities  The Advocacy Coalition Framework  Implications of enhancing the impact or research on policy p.188  Chapter 10: Doing Policy Analysis Why Do We Need Policy Analysis?        Before any change can happen, we need to understand Where is the problem? Why do things need to change? What do we need? Who is affected? How can we do this best? When can we make this happen? ◦ Analyze the issue to be able to answer these questions and develop solutions (new policy) What is Policy Analysis? An analysis that provides informed advice to a client that relates to a public policy decision, includes a recommended course of action/inaction, and is framed by the client’s powers and values. 1) Consider client’s values 2) Combine with information gathered 3) Place in political context 4) Understand client’s powers 5) Make an appropriate policy recommendation  Policy Analysis       Policy analysis for healthcare is complex Cost is a major consideration Politics plays a pivotal role Tools used in policy analysis If used appropriately can improve chances of successful policy change Tools help gather, use and apply knowledge SYSTEMATICALLY ◦ Stakeholder analysis ◦ Documentary analysis Types of Policy Analysis  Analysis of Policy  Analysis for Policy ◦ ◦ ◦ ◦ ◦ Retrospective Descriptive Explanatory Summative Evaluation Looks at why and how policy developed and if the goal was achieved ◦ Prospective ◦ Formative Evaluation ◦ To inform formulation of policy, anticipate what might happen if something was modified or introduced Stages of the Policy Cycle      Identify the problem Set the agenda Formulate the policy Implement the policy Evaluate the policy These stages should occur in a cyclical fashion • To succeed in bringing policy change: • Engage in framing the problem, understand agenda setting, recognize political opportunities, encourage acceptance of your platform, understand stakeholders, adapt to become feasible Stakeholder Analysis    Understand parties to the policy in question What is a stakeholder? Steps of Stakeholder Analysis: ◦ Identify policy actors ◦ Assess their political resources ◦ Understand their positions and interests in this issue          Brainstorm with knowledgeable sources Who is affected by the issue? Power and resources: political power, wealth, fame, etc… Context determines weight of the resources relative to the issue Positions and interests can be concealed or apparent Model how the stakeholders interact and how the policy will affect them Develop a strategy to manage their positions, their power and resources in favor of the proposed changes Power, Player and Perception Strategies Software “Policy Maker” Policy Analysis Data The quality of the analysis depends on the quality (accuracy, comprehensiveness, relevance)of the data collected  Documents, Literature Review, Statistics  Evidence to support proposal  Interviews, Surveys, Social Media  Factors Political Factors  What is the political salience of the issue?  Is this a front-burner issue?  Is this a controversial issue?  Do key constituents, opponents, interest groups, etc. have an opinion about the issue?  Who is likely to support or oppose change?  Is there bipartisan support for the issue?  Is there a reason to act now?  Is there a reason to delay action? Economic Factors  What is the economic impact of addressing and of not addressing this problem?  Are various people or groups impacted differently?  Are there competing demands for resources that relate to this issue?  What is the economic situation of the state or nation? How does this affect the politics relating to this issue? Practical Factors Is it realistic to try to solve this problem? Would it be more practical to solve this problem later? Are other people in a better position to solve this problem? What do we know about solutions that do or do not work? If this problem cannot be solved, is it still necessary (politically, socially) to act in some way to address the problem? Legal Factors Are there legal restrictions affecting this problem? Are there legal requirements that impact the analysis? Is new legislative authority necessary to solve the problem? Is there legal uncertainty relating to this problem? Is future litigation a concern if action is taken? Leichter’s 4 Factors: Situational, Structural, Cultural, External Options - Consider major actions  Taxes  Subsidies  Laws  Regulations  Programs  Government organizations  Information - Base your decision on your client’s values and powers - Include pros and cons of options recommended (cost, cost-benefit, political feasibility, legality, administrative ease, fairness, timeliness, targeted impact) - Develop a new option not previously considered by others - Find numerous possibilities that others have already suggested  Media  Scholarly articles  Interest group recommendations  Think tanks/experts in the field  Congressional testimony  Legislation (passed or proposed)  Agency reports Final Thought Think about the interplay between policy, politics, ethics, the law, and public health  What should be the starting point when considering change? 