health policy analysis assignment

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Conducting health policy analysis in primary care research: turning clinical ideas into action

Alina engelman.

1 Health Sciences, California State University, East Bay, Hayward, California, USA

2 Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA

Michael D Fetters

3 Family Medicine, University of Michigan, Ann Arbor, Michigan, USA

Healthcare guidelines play a prominent role in the day-to-day practice of primary care providers, and health policy research leads to the formation of these guidelines. Health policy research is the multidisciplinary approach to public policy explaining the interaction between health institutions, special interests and theoretical constructs. In this article, we demonstrate how primary care providers can conduct high-impact health policy research using Eugene Bardach’s eightfold policy analysis framework in a primary care context. In a medical case, a woman with a history of total hysterectomy had scheduled a visit for a Papanicolaou (Pap) smear screening test as part of a well-woman health check-up with a family medicine resident. Conflicting recommendations on Pap smear screening after total hysterectomy sparked an investigation using the US Preventive Services Task Force criteria for conducting a health policy analysis. We illustrate broadly how clinical care dilemmas can be examined by using Bardach’s broadly applicable health policy framework in order to inform meaningful policy change. Bardach’s framework includes (1) defining the problem, (2) assembling evidence, (3) constructing alternatives, (4) selecting criteria, (5) projecting outcomes, (6) confronting trade-offs, (7) decision-making and (8) sharing the results of the process. The policy analysis demonstrated insufficient evidence to recommend Pap test screening after hysterectomy and the findings contributed to national recommendations. By following Bardach’s steps, primary care researchers have a feasible and powerful tool for conducting meaningful health policy research and analysis that can influence clinical practice.

Statement of significance

Primary care providers often serve at the front lines where patient care and policy intersect and are uniquely situated to conduct health policy research, illustrated by the example of a clinical encounter that prompted clinical policy analysis of the utility of Papanicolaou (Pap) smear screening after total hysterectomy. Bardach’s 1 policy framework can empower primary care providers to engage in health policy research while meeting competing demands of patient care and advocacy, even with limited resources and in the absence of extensive training and research experience.

Introduction

Health policy often dictates clinical care protocols and helps physicians and other providers make evidence-based decisions about patient care. However, if recommended actions are conflicting, clinically ineffective, cost-prohibitive or result in questionable health improvements, they warrant review. 2 Primary care providers are at the intersection of policy and practice and are naturally positioned to address gaps in healthcare policy and to conduct health policy research. Health policy guides many decisions that clinicians make about patient care in preventive, acute, chronic and end-of-life care. Well-crafted health policy has implications for ensuring timely and accurate guidance for healthcare providers to deliver effective medical care. Primary care providers seeking guidance on screening or intervention for patients may find recommendations that do not comport with their daily clinical experiences. This can prompt them to reassess prevailing policy in specific contexts or with unique populations. As health policies profoundly impact patient care and the overall health of populations, health policy analysis is a critical research tool for primary care providers.

Primary care providers operate as the point of first contact where policy intersects with clinical care, and are positioned optimally for recognising gaps, inconsistencies, or questionable guidelines or health policies ( table 1 ). For this reason, primary care physicians should feel empowered to conduct basic policy analysis, regardless of available resources. Our aim for this article is twofold: (1) to introduce the basics of health policy research explicated in Eugene Bardach’s eightfold policy analysis framework 1 and (2) to illustrate the feasibility of conducting health policy analysis by deconstructing the process step by step. Specifically, we use the example of a clinical encounter that prompted clinical policy analysis of the utility of Papanicolaou (Pap) smear screening after total hysterectomy that ultimately contributed to policy change. While hospital processes or population-based research studies can inform clinical decision-making, doctors facing individual patients often face additional considerations.

Health policy analysis studies that have been led by primary care and public health researchers

Health policy context

Health policy is a course of action and inaction that affects the institutions, organisations, services, clinical practices and funding arrangements of the health system, and generally falls into two categories: (1) policies that define the functions and powers of agencies, or (2) policies aimed at the protection and promotion of health. 3 4 While government plays a key role in forming policies, private entities, such as insurance companies, as well as primary care physicians and other influential actors, also contribute to new and revised health policies. 4

Health policy analysis

A crucial aspect of health policy formation and change is health policy analysis, a multidisciplinary approach to public policy that aims to explain the interaction among institutions, interests and ideas in the policy process. 5 Often situated as a review of documents and guidelines, health policy analysis is a critical mechanism for ensuring best practices in light of new evidence and the promotion of good health. 6 For example, the growing evidence of disability-related health disparities, including lung cancer screening among the deaf, and case studies on the inclusion of medical residents with disabilities, can drive policy change. 7 8 The Alliance for Disability in Health Care Education, based on existing policy and research literature, crafted a policy document on core competencies on disabilities for healthcare education. 9 Primary care providers may be called on to create clinical policies within their own practices or within their institution, 10 to provide national guidance or highlight the lack of policies or need for guidance. 9–13 Although there is a robust research literature making the case for the importance of policy analysis, there is less guidance on how a practitioner may do so. This overview of health policy analysis procedures is aimed at empowering primary care providers and researchers to identify, improve and prioritise policies that can enhance health policies.

Example of health policy analysis methodology: a study triggered by a clinical encounter

We introduce the example of a clinical encounter that prompted a clinical policy analysis of the utility of Pap smear screening after total hysterectomy and ultimately contributed to policy change. Primary care providers are often the primary professional contact for women seeking cancer screening for breast, cervical or colon cancer, placing primary care providers in a unique position to address policies related to women’s health. A doctor encountered a woman in her 50s who had scheduled a well-woman health examination including a Pap smear in a family medicine clinic. Chart review indicated she had undergone a total hysterectomy for fibroids, a benign disease. After consulting with the preceptor and reading available guidelines, recommendations about cytological testing after hysterectomy were ambiguous. This prompted a health policy analysis on the utility of Pap smears after total hysterectomy for benign disease ( figure 1 ). 14

Figure defining a healthcare policy problem prompted by the question of whether women who have undergone hysterectomy should undergo Papanicolaou screening for cancer.

The authors began their health policy analysis by examining (1) the recommendations and quality of guidance provided by multiple organisations vested in women’s healthcare and women’s cancers; (2) the existing literature on posthysterectomy Pap smear; and (3) recommendations in associated medical textbooks. They examined the risk of malignancy after total hysterectomy for benign disease and the extent Pap test screening after total hysterectomy for benign disease met the three US Preventive Services Task Force (USPSTF) criteria for an effective test. 15 These criteria include (1) the burden of suffering (does the test accurately identify the disease through screening and do those identified early have better health outcomes?), (2) the accuracy of the screening tool and (3) the effectiveness of early detection. 15 Having illustrated how the authors used health policy analysis according to the USPSTF criteria, in the following we introduce a broad, widely applicable health policy framework by Bardach. 1 Bardach’s framework affords primary care researchers a comprehensive, step-by-step approach for conducting policy analysis. 1

Steps for conducting health policy analysis: Bardach’s eightfold policy analysis framework

Eugene Bardach 1 established an eightfold policy analysis framework that is commonly applied in policy and administration research as well as in public health. Bardach’s eightfold policy analysis framework includes (1) defining the problem, (2) assembling evidence, (3) constructing alternatives, (4) selecting criteria, (5) projecting outcomes, (6) confronting trade-offs, (7) decision-making and (8) sharing the results of the process. In table 2 , we break down Bardach’s eightfold policy analysis framework using the same example to illustrate how Bardach’s more comprehensive approach can similarly illustrate the utility of Pap smears after total hysterectomy for benign disease. 14

Example of health policy analysis to inform improvements in guidelines for Pap smears after total hysterectomy for benign disease through Bardach’s steps 1–8

Pap smear, Papanicolaou smear; USPSTF, US Preventive Services Task Force.

Step 1. Define the problem

First, in health policy analysis, primary care researchers must define the problem . Defining the problem is critical in policy analysis because it guides the research method and helps establish the structure used in communicating the results. In the exemplar article regarding the utility of Pap smears after total hysterectomy, the authors identify the problem as both a concern that applies to individual patients and as a public problem—one that affects multiple patients, increases healthcare costs, and includes the potential misappropriation of resources without evidence of need or efficacy. 14 The policy scope was narrowed by excluding a history of abnormal Pap testing and of subtotal hysterectomy where the cervix remains intact. Once the background is synthesised, a problem statement can be developed that will allow for improved public health policies. Given the critical importance of developing the problem statement, this message can consider primary care practice and the need for governmental interventions, as well as relevant public and private collaborations.

Step 2. Assemble the evidence

Step 2 involves assembling the evidence by investigating the background, trends, and systematic, institutional, interpersonal or financial barriers and facilitators to successful resolution. The research design and scope of the study will dictate the approach to analysis. In the exemplar study, the authors collected and reviewed existing guidance on Pap smear screening after a total hysterectomy, as well as data from from multiple organisations, the medical literature and textbooks. 14 In reviewing evidence, researchers should explicitly examine their own assumptions and propositions to facilitate a logical process as they compile evidence. Examining assumptions and evidence bases of existing guidelines can often be very informative as well. Once the background is synthesised, the problem statement can be revisited and sharpened to allow for well-defined focus of the policy analysis. As part of defining the problem or assembling evidence, primary care researchers can map a framework through a schematic figure ( figure 1 ). This process permits a comprehensive understanding of the problem to investigate and allows for a more focused literature review on policies, best practices and key barriers as the policy focus evolves.

Step 3. Construct policy alternatives

Step 3 of Bardach’s framework, constructing policy alternatives , guides primary care researchers to consider the advantages and disadvantages of each policy alternative and consider using alternative approaches to policy alone or in combination with other alternatives. Step 3, an explicit description of the assumptions and positions being made for each policy alternative, is critical for successful implementation of the policy. For example, if physicians address a decision choice that requires outside funding, they would be explicit in including funding agencies as part of the consideration of its implementation. Additionally, this discussion will aid the understanding of the evolution of policy and evaluation of the success of policy implementation. In the exemplar case, alternatives would include following existing cervical cancer screening guidelines (despite patients no longer having a cervix), an alternative interval or cessation of the practice.

The challenge to primary care researchers in this step is to adequately consider all the plausible alternative solutions and then pare down alternatives that best meet the needs of the population. This means the physician researcher needs to construct alternatives that are responsive to the highly complex environments in which they are made. To strengthen a policy analysis, physicians should also discuss their own assumptions about where they place the efficacy of the alternatives being constructed and consider the policy implementation.

Step 4. Select the criteria

Selecting the criteria , step 4 in Bardach’s framework, explores how alternatives can be measured and evaluated. This is an essential step to determine the effectiveness of current policy. Criteria can be established based on prior research and can include the feasibility of each alternative given local, epidemiological, political and socioeconomic conditions. Considerations can also include primary health outcomes, cost-effectiveness, feasibility of implementation, acceptability, political feasibility, sustainability and practicality.

Selecting the criteria includes establishing how the physician evaluates each alternative and prioritising each option. In determining how the alternatives are evaluated, physicians can draw from their unique perspectives and backgrounds. This includes considering prior research as well as clinical experiences with patients. These experiences, in turn, can inform considerations of the feasibility of each alternative, in addition to local, epidemiological, political and socioeconomic conditions. In the exemplar, the authors used the widely accepted USPSTF criteria to frame the evaluation. 14

In evaluating the alternatives, physicians can include any clinical or research knowledge on the cost-effectiveness of the alternative. They may establish a scoring system, with low to high, or less favourable to more favourable rankings. This may include categories about the impact on health, the feasibility, and the economic and budgetary impact of the alternative. 14 It is also important to think about the political implications, particularly if the alternative includes legislative or governmental action. In healthcare, this may involve recommendations or policies of disease specialists. Specialty organisation guidelines can be swayed by potential conflicts of interest based on the outcomes of the policy analysis. For example, policy favouring prostate-specific antigen screening for prostate cancer impacts the revenue of urologists. Policy guiding the frequency of mammograms for breast cancer screening impacts the revenue of radiologists. In the exemplar, multiple professional organisation perspectives were considered. When conducting the analysis, two organisations supported screening, two opposed screening and six lacked specific guidelines. 14 Physicians should incorporate considerations of the sustainability and practicality of the alternatives, drawing upon their experience-based expertise.

Step 5. Projecting the outcomes

Often considered the most challenging step, projecting the outcomes is an opportunity to consider how realistic or viable each alternative policy outcome is given resource constraints. In order to project the outcomes, primary care researchers must consider both the direction and the magnitude of the outcome. In the case of Pap smears after a total hysterectomy, it is important to state the positive or negative impact, and to quantify the magnitude of the impact using a point estimate or range. The physician should consider, estimate, project or provide a range for how many cases of cervical cancer are expected to be diagnosed in time for effective treatment as a result of each alternative policy. In the exemplar, the authors weigh the very low incidence of the disease, as well as the costs of false positives inherent in an extremely low prevalence condition. In a situation in which there are resource constraints, it is important to ensure proper balance between unrealistic expectations and cost considerations in light of projected effectiveness. The physician should consider whether simpler or less costly changes in policies and procedures can produce the same or better outcomes. In all projections, the costs of implementing a failed policy and which population would bear those costs need to be measured.

Step 6. Confronting trade-offs

In step 6, confronting trade-offs , the primary care researcher needs to consider the trade-offs between and within each policy alternative. The trade-offs need to be considered in terms of the criteria by which they can be evaluated, and the criteria themselves need to be weighted. In the exemplar, the researchers considered the trade-offs that could occur should women not receive a yearly Pap smear and the evidence or lack thereof for each, including the potential missed opportunity to check the ovaries for ovarian cancer or the potential for decreased breast cancer screening. A policy alternative that challenges an important criterion, such as survival rate, may need to be discarded even if it stacks up very well in regard to a criterion that may be perceived as less important, such as temporary patient discomfort. In essence, primary care researchers must, within and across each alternative, weigh the relative benefit and importance of each criterion, such as the cost savings of eliminating screenings against the relative risks of missed diagnoses.

Step 7. Decision-making

Decision-making is an opportunity for primary care researchers to go through the process of clarifying the costs and benefits in order to present a final decision to stakeholders. This will ensure that, when they explain the costs and benefits, their explanations are clear and the logic behind their choice is sound and easy to follow. In the exemplar study, using the criteria of the USPSTF, the authors concluded that there was insufficient evidence to support Pap smear testing after total hysterectomy for benign disease.

Step 8. Sharing the results of the process

Sharing the results of the process may take the form of a narrative, and primary care researchers need to clearly understand the reasons behind their decision. Most importantly, primary care researchers need to define the audience and ‘pitch’ the story to a target population, keeping in mind both the larger political environment and the story-telling medium. In the exemplar, the results of the analysis were shared with a member of the USPSTF, and the full paper was sent for consideration as part of the USPSTF cervical cancer screening guidelines. Shortly afterwards, another paper demonstrated very low yield of any abnormalities in vaginal cytological smears obtained after total hysterectomy. 16 In contrast to the first edition of the USPSTF guidelines, 15 the second edition of the USPSTF 17 provided a recommendation against Pap smear screening after total hysterectomy for benign disease. An additional analysis published by the authors demonstrated poor cost-effectiveness of testing, and the USPSTF continues to recommend against Pap test after total hysterectomy for benign disease. 18 19 When presenting findings and recommendations, the family physician should consider the audience and tailor the ‘pitch’ accordingly. If hospital administrators are the decision-makers, consider whether an oral presentation or a written policy document is warranted, or whether a combination of the two is best for communicating key points.

Using new media interventions, primary care researchers conducting health policy analysis can share their findings in an impactful way to inform, persuade and motivate their audience. 20 Media interventions are often used to communicate health research to other health professionals, patients and policy makers through social media, including Twitter. Abstracts shared via Twitter infograph can elicit interest in a full report or manuscript and has the potential to effectively share health-related research to policy makers and the public. 21 Depending on the specific topic, writing an op-ed or commentary for local or national professional journals, organisations or newspapers can help to stimulate public interest in the topic and catch the attention of policy makers. Rather than using one media strategy, primary care researchers doing health policy analysis should consider multiple strategies and messages tailored to specific target audiences. Strategies may shift depending on the audience, which can include the public, healthcare providers, grant funding agencies and policy makers.

Conducting a health policy analysis has the potential to change clinical practice at the national and international levels. While the initial step of defining the problem is critical, the lack of guidelines or conflicting guidelines among various organisations remains both a challenge and an invitation to conduct all steps of Bardach’s policy analysis. Yet the process requires a primary care researcher to spend considerable time engaging in all steps, including a review of the academic literature. Reviewing current health policies requires access to the literature and the analytical skills needed to interpret the evidence. After identifying a valid health policy problem, a physician should consider seeking assistance from an established health policy analyst or health economist with previous experience in the topic at hand.

An information sciences specialist could greatly enhance a policy analysis by grounding data in a rich evidence base, if available through academic affiliates. Policy analysis requires a critical eye for identifying guidelines that are not well supported by empirical evidence. For some clinical issues, there may be insufficient information to support changes in practice, even though a provider has identified an important policy question. Fortunately, the Bardach framework provides an approach to this limitation. Primary care researchers with limited infrastructure may need to think creatively about how to disseminate findings and analysis beyond publication in the academic literature, including the use of new media.

Additional resources

In addition to Bardach’s framework, readers may find helpful sources and approaches for policy analysis. 1 The Centers for Disease Control and Prevention policy analytical framework may be helpful prior to policy implementation. 22 Bodenheimer and Grumbach 23 are family physicians and policy analysts who provide a clinical perspective on policy analysis. Teitelbaum and Wilensky 4 offer a perspective on the intersection of health policy and law, including an overview of case law and the ethics of health policy. Dunn 24 provides a resource with a public policy analysis focus.

Conclusions

Primary care providers are often at the front lines where patient care and policy intersect and are uniquely situated to conduct health policy research. The scale of health policy analysis by primary care providers can range from setting clinical policies within their own practices, institutions and organisations, or on a nationwide scale. As illustrated by the featured policy analysis of Pap testing after total hysterectomy for benign disease, meaningful policy research can arise from a single clinical experience for a research-minded family physician. As some health policies and guidelines do not pose a financial conflict of interest, policy framing by primary care providers may provide invaluable balance with regard to recommendations for or against services. Primary care researchers need to recognise that they have a unique power to drive policy change. Due to primary care providers’ front-line expertise, their concerns are widely viewed as practical, can motivate policy research and help attract funding. Bardach’s policy framework can empower primary care providers to engage in health policy research while meeting competing demands of patient care and advocacy, even in the absence of extensive training and research experience.

Contributors: AE developed the conceptual framework, wrote and revised the manuscript. BC contributed to revisions, including references and formatting. LM contributed to manuscript writing and analysis. MDF contributed to manuscript edits.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: None declared.

Patient consent for publication: Not required.

Provenance and peer review: Not commissioned; internally peer reviewed.

How to Write a Policy Analysis Paper : A Nursing/Med Student Guide

Healthcare practice has shifted to evidence-based decision-making, which nurses and other healthcare practitioners can achieve through policy analysis. Therefore, students pursuing health sciences such as nursing, pharmacy, and health sciences and medicine courses must understand the importance of evidence-based policymaking. In doing so, they are often assigned tasks where they critically appraise the policy processes and responses. Unfortunately, most students find completing a health policy document analysis paper, essay or report difficult.

The overarching purpose of a policy analysis paper is to investigate and integrate the knowledge of advanced nursing practice, scholarly research, and healthcare leadership through a critical examination of a policy at the level of clinical practice, social or public health, and healthcare systems policy.

Most policy analysis papers are above 2000 words, meaning their lower limit is 8 or 10 pages, giving you sufficient space to investigate a policy.

Writing a paper of such a scope is arduous and time-consuming. Therefore, we have compiled this ultimate guide to take you through the process and help you discover some tips for success when writing a policy analysis paper for your nursing class. But first, let's get solid on a policy analysis paper.

What is a Policy Analysis Paper?

Research shows that engaging nursing students in health policy prepare them for a holistic practice. So, if you are a medical or nursing student, expect to engage more in writing healthcare policy analysis papers or policy briefs.

Analyzing a policy helps identify the potential policy options that can sustainably, pragmatically, and feasibly address a health issue. It is a process that has evolved from a technical approach to a process that enables sharing of social meaning.

A Policy Analysis paper, sometimes referred to as a strategy paper or policy brief, is a document that entails a critical analysis of a healthcare policy at the level of clinical practice, healthcare systems, and public or social issues.

It entails in-depth research of a healthcare issue from a political perspective (analyzing a bill that touches on a healthcare issue). To better analyze a policy, it is imperative to reflect on the policy process (formulation, adoption, implementation, monitoring and evaluation). You should then consider the policy analysis framework that can be applied to nursing and health policies because they shape your policy critique paper. You can choose the analysis framework from the legal, historical, social, ethical, economic, and cultural contexts.

When analyzing a policy, you need to define the problem or issue of interest, provide background and significance, and include a well-balanced assessment of the options that policymakers can pursue to resolve the issue.

The analysis should also include recommendations for the best course of action for the policymakers.

Now that we know what a policy analysis paper or essay entails, let's focus on how it is done. What steps does one follow when writing a policy analysis paper or doing a policy analysis? We answer these questions comprehensively in the next section.

Steps for Health Policy Analysis - How to Get it Right

P olicy analysis is a systematic and disciplined application where an individual defines a problem, gathers evidence, considers alternatives, selects a criterion, predicts the outcomes, confronts tradeoffs and makes or recommends a decision .

Writing a policy analysis paper is time-consuming, stressful, and demands attention and keenness. In most cases, given the possibility of problems arising when deciding which aspect of a policy to analyze, you must be meticulous.

You must distinguish between analyzing a policy process and a document or content. If it is process analysis, focus on the policy formulation process, and if it is content analysis, base your entire analysis on the composition or substance of the policy.

Our focus in this guide is on the analysis of the policy document or the contents of a policy. Policy analysis generally entails five processes: definition, prediction, prescription, description, and evaluation. It can further be condensed into policy making, cause and consequences, and policy prescription.

Step 1: Identify the Policy Issue

The first thing you need to do when assigned to write a policy paper is to determine the policy issue of interest. For instance, choose a topic that you find interesting to handle.

You can choose to focus on health promotion, mental health problems, stigmatization, drug and substance abuse, the opioid epidemic, adult obesity, road traffic accidents, chronic diseases, use of technology in healthcare, etc. look at the health policy issue from the political, social, cultural, spiritual, national, and economic lenses. To identify a problem, focus on a literature review, environmental scan, and survey the best practices.

The main aim of this step is to contextualize the issue. Look at the issue's broad and impactful and have a rationale for choosing it.

Consider the discrepancy between the status quo and the ideal or planned situation. You can also consider the reasons for the difference and the available solutions.

Defining the health issue or problem is like a typical problem statement and must to accompanied by a citation from credible scholarly sources. The statement should describe the problem and present a diagnosis of the causes of the problem using critical statistics such as mortality rates, live births, morbidity, and other statistics.

You should understand the problem conceptually and empirically for successful policy analysis. Then, with the problem stated, you should select a policy to evaluate the many alternatives and provide a rationale. Let's see how to do that in the next step.

Step 2: Select the Policy document for analysis

After identifying the problem, go ahead and search for the relevant evidence. First, collect data about the policies meant to address the health issue. You can access the relevant healthcare policies through research on government websites and publications. Next, look at the various policy options available to address the problem. Considering different policy options can entail adding a policy action that solves the issue or forgoing a policy alternative. Policy options can be described and determined through their health impact, cost of implementation, and feasibility. You should then rank the options and select the top choice.

When considering alternative policies, your focus should be on the outcomes of the alternative. Consider a feasible, practical, and relevant policy to your healthcare issue.

Step 3: Read the policy document and take notes

After choosing a policy of interest for the analysis, you must extract data further and compile excepts from the policy document. Here is where you apply your preferred evaluation criteria.

The evaluation criteria focus on assessing the suitability of an intervention. You need to have standards to measure the projected outcomes. The criteria will hugely depend on the issue of interest. When evaluating a policy, focus on its relevance, progress, efficiency, effectiveness, and impact on the health problem.

Consider the policy background, including its historical context, available evidence, its implementation, monitoring and evaluation, and strategies for stakeholder engagement. You need to take notes that will come in handy as you write the outline and later when compiling the entire policy analysis paper.

Related reading:

• How to write a great nursing diagnosis.
• Best nursing research, essay, and term paper topics.
• Nursing theories to consider when writing nursing papers.

Step 4: Outline the Policy Analysis Paper

Given that you have defined the problem and are now conversant with the central policy of interest, the alternatives, and your evaluation criteria, it is time to outline your policy analysis report. The outline will depend on the selected framework or model for health policy analysis ( we have discussed choosing a framework/model elsewhere in this comprehensive guide ).

The outline should be based on the appropriate structure of a policy analysis paper. For example, plan what to include in the executive summary or abstract, introduction, problem statement, background information, policy alternatives, recommendations, and conclusion.

The outline is a roadmap that comes in handy as you begin to write the paper at the advanced stages of policy analysis. Remember, the focus is not on the policy but its outcomes. For instance, consider the improved health status of people with obesity after health promotion interventions versus improved knowledge of healthy lifestyle practices. Depending on its feasibility (resources, finance, human capital, etc.), you can then decide on the best policy to pursue.

Step 5: Write the Policy Analysis Paper

Assuming everything is in place, you need to take a break before resuming to write the policy paper.

When writing the paper, begin with the introduction. You can break this into separate sections as long as the underlying motivation of the report comes out clearly. For example, include the historical context and the current status quo of the healthcare problem or issue. Next, explain to your readers why you selected the problem or issue and why you settled on a specific policy option.

The next step is to write the methodology, which entails the evaluation criteria. You should also include a literature review where you contextualize the policy based o existing academic work. Next, explore the policy context or options by describing the current policy and the intervention efforts. Finally, look at case studies and best practice guidelines to get a good rationale for selecting a given policy.

Write down the policy options and recommendations before concluding the paper. Finally, include the reference pages and the appendices. When writing the first draft, focus on researching and writing. You should leave editing and proofreading for the final step.

Step 6: Review, Revise, and Polish the paper

Writing a policy analysis paper is the same task as critiquing a policy. It needs to be done in a professional and academic tone. After writing the sections of the policy paper, your next move is to edit it.

When editing, focus on the flow of information, paragraph structure, sentence structure, formatting, in-text citations, tenses, content, and the choice of words.

You should also proofread your policy analysis paper for grammar, spelling, and punctuation. You can use software such as Grammarly, Ginger, or Hemmingway Editor.

 This step aims to convert the first draft into a final one you will submit to your instructor for grading. First, therefore, you must ensure that it Then, you can use the reverse outline method to uncover the inadequacies in your paper.

Check whether all the citations are represented in the reference list. Equally, ensure that the references are consistent with the selected formatting style.

 You can read your paper loud so that you can spot the errors. Then, if you need further help, you can hire a proofreader and editor to check whether you omitted something or reduced the number of words but retained the message.

Structure of a Policy Analysis Paper in Nursing

When assigned to write a policy analysis paper, below is a standard structure to adopt. Note that some instructors will have a breakdown of how to do the policy analysis, but we share the standard structure here. Of course, the wording could differ depending on institutions, but these are the major sections or parts of a policy analysis paper or essay.

Contains information about yourself. Include:

• Course name and code
• Coordinator or instructor's name
• Name of your institution (i.e., nursing school or university)
• Date of submission

Abstract/Executive Summary

The abstract is a brief 200-word paragraph that condenses the entire policy analysis paper. It should elaborate on the chosen policy, its strengths and weaknesses, relevance to nursing or healthcare, implications, policy evidence, monitoring and evaluation, stakeholder engagement, the target population, how the policy addresses healthcare's social and ecological determinants, and the areas of improvement. The abstract is never indented and is presented as a whole paragraph. Some instructors will ask for an executive summary instead, a summary of your entire policy document analysis paper.

Introduction

The introduction should begin with an attention grabber or hook statement that not only attracts the readers' attention but also announces the focus or direction of the policy paper. It should also generally define and describe the policy issue of interest. It further entails a few sentences that identify the purpose of the analysis, the targeted policy level (clinical, public/social health, or healthcare systems), the policy's scope, and the topic's significance. Finally, it also identifies the questions the policy intended to address.

Background and Significance

In the background section of a policy paper, you will include the details of the issue or problem. Identify the scope of the problem and present its context, then explore relevant literature that details its history. You should also describe the existing policy that addresses the issue. Expound on the policy you are about to analyze regarding the health issue. You should also examine the enforcement implications. Explore the strengths and weaknesses of the existing policy. It should also identify and describe the major stakeholders (groups or individuals) that are or will be affected by the policies, including the reasons. The background should be supported by evidence from credible scholarly sources. Consider the fiscal impact of the policy or issue, its impact on social justice, and the recommended policy's potential barriers and unintended consequences.

Methods and Analysis

This section of the paper is where you describe the policy analysis plan. First, establish the evaluation criteria to guide your analysis and the policy selection. You can also identify the various policy alternatives to help achieve objectives and evaluate each alternative. Next, demonstrate the potential impact of the policies based on the evaluation criteria. Finally, assess the tradeoffs between the options.

Recommendations

In the recommendations section, you must identify the best policy among the alternatives to address the current problem or issue (the policy scenario). You should follow it by explaining the rationale for selecting it among the alternatives. Next, you should describe the potential strategies that can be used to implement the policy successfully. Also, explore the barriers to the implementation of the selected alternative. Finally, explain the methods to monitor and control (evaluate) the effectiveness of policy implementation.

In this section of the policy analysis paper, you must discuss the analysis and recommendations relative to the policy level and the original questions in your introduction. Further, include the limitations of the analysis and discuss the implications for practice, research, policy formulation, implementation, and education.

The conclusion summarizes the findings and recommendations of the entire analysis. It should also feature the questions addressed in future policy analyses or studies.

This is where you list all the references cited in your policy analysis paper.

The appendices can be a table displaying the results of your analysis. You can include the list of policy alternatives you considered, the criteria you use, and the degree to which each alternative meets the criteria. You can also include illustrations such as graphs, tables, images, charts, etc. be sure to cite them appropriately in either ASA, AMA, APA, or Harvard referencing formats if they are sourced from other sources.

Format of a Policy Analysis Paper in Nursing

You must follow academic and professional writing conventions in nursing and most healthcare sciences. Below are some formatting requirements you need to achieve for this assignment:

• Writing Style: Ensure that you use person-centered terminology in your analysis document. Write complete sentences and support your writing with appropriate references. Use the correct in-text citation format and limit the use of quotes. You should never include direct quotes unless asked to, so stick to the parenthetical citation.
• Paper Size: You should write or type the paper on standard A4 (210 x 297mm) paper.
• Margins. Set the margins to 1 inch or 2.0 cm around the document.
• Font. Use at least 12 points and Times New Roman or Arial.
• Line Spacing. 0 or double spacing, 1.5-line spacing, or single-spacing (1.0)
• Do not include any graphics in the body, such as pictures, graphs, and diagrams. Those should go to the appendix and should only be relevant if specified by your instructor.
• Tabulated information can be included if contained within the world limits provided by your instructor. Format, cite, and reference the tables appropriately.
• Title Page. Include your credentials, such as student name and number, instructor's name, course name and code, and institution.
• Header. Should include the relevant information as per the citation and formatting style chosen. Most instructors will prefer that it consists of the page number.
• Footer. You should include your name, student number, and page number. But this depends on your instructor or course coordinator's preferences.

Use APA, Harvard, AMA, or ASA writing format for your policy analysis paper. In most cases, health sciences and nursing use APA, Harvard, and AMA. If unsure, ask your instructor for clarification.

How to Select a Policy Analysis Framework

A policy analysis framework informs the entire policy analysis paper. Therefore, you must select a plausible policy analysis framework after determining and defining the policy. A good policy analysis paper provides in-depth, reasoned, relevant, and evaluative information about a policy in the context of a health issue or problem.

The role of the framework is to guide the evaluation process. It provides the structure of the paper, allowing you to explore a policy issue logically. When selecting a framework, consider the assignment instructions and the policy focus you will analyze. It will depend on whether the policy is prescriptive or predictive.

Nursing practice and the consumers of healthcare have a social contract. Nurses should evaluate what is best for the consumers and promote/advocate for their best interests. Engaging in the policy process helps nurses influence healthcare, solve health issues, and promote social justice. One way to develop policy acumen is through using policy analysis frameworks to analyze policies.

In broad form, the policy analysis framework includes the stages of analyzing a policy. It could be done in many stages or a few steps. One of the most popular policy analysis models or frameworks advocates for an analysis process focusing on:

• Defining the problem
• Assembling evidence
• Considering the policy alternatives
• Selecting the evaluation criteria
• Monitoring and evaluation of outcomes
• Confronting tradeoffs
• Decision making
• Dissemination

Considering that health policy analysis is a social and political activity, the best healthcare policy framework to adopt (one that considers the contexts relevant to healthcare) entails:

• Defining the context
• Statement of the problem
• Searching for evidence
• Considering the alternative policy options
• Projecting the outcomes
• Applying the evaluative criteria
• Weighing the outcomes
• Making a decision.

The above framework is similar to CDC's Policy analytical framework ( PDF) . Therefore, you can use the model to analyze and prioritize policy.

You can also consider the data-driven policy-analysis model presented in 2003 by the  Agency for Healthcare Research and Quality (AHRQ) to assist in evaluating the impact of health policies. Consult your class resources to select the best policy analysis models or frameworks. Asking for instructor clarification is also highly encouraged to get everything right.

Related Reading: How to write a personal nursing philosophy.

Questions to ask yourself before and when analyzing a health policy

• What is the context of the policy? Is it regulatory, administrative, legislative, ethical, etc.?
• How does the policy work? What's its scope?
• What are the aims and objectives of the policy?
• What is the value of the policy?
• What are the short, medium, and long-term outcomes of the policy?
• What are the unforeseeable negative and positive impacts of the policy?
• Who are the stakeholders? What are their interest and values?
• What are the available resources, capacity, and technical requirements for implementing the policy?
• What time frame is needed to formulate and implement the policy?
• How does the policy address the problem or issue?
• What are the populations of interest? How are they affected? What outcomes will affect them, and how?
• How grave is the health issue of interest?
• How does the policy relate to nursing practice and profession?
• What are the cost and benefits of the policy?
• How do the costs compare to the benefits (consider ROI, cost-to-benefit ratio, costs averted, cost savings, etc.)?
• What is the distribution of the cost?
• What are the timelines for the costs and benefits?
• Can you tell if there are any gaps in the data?
• Is there available local and national empirical data to support the policy?
• A conceptual model of Nursing and health policy
• CDC's Policy Analysis Framework (Website)
• Health Policy Analysis by Wendy L. Thomson (DNP, MPH, PHN) (Demonstrative Video)
• Healthcare Policy, Analysis, and Advocacy: Policy Initiative (Website)
• Is there life after policy streams, advocacy coalitions, and punctuations: Using evolutionary theory to explain policy change? 
• Policy Analysis by CDC
• Policy Analysis Examples (Issue Briefs) (Download Samples here)
• Policy Analysis Format
• Policy analysis paper Structure
• Policy analysis: A framework for nurse managers
• Putting policy theory to work: tobacco control in California
• Sample Expert Policy analysis papers (download)
• Theory and Methods in Comparative Policy Analysis Studies: Volume One
• How to write a policy paper (extended version)

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CDC’s Policy Analytical Framework

This website provides a guide for identifying, analyzing, and prioritizing policies that can improve health. The policy analytical framework ( Figure 1 ) expands on domains I, II and III of the CDC’s Policy Process (Problem Identification, Policy Analysis, and Strategy and Policy Development). The goals of this website are to:

• Improve the analytic basis for identifying and prioritizing policies that can improve health
• Improve the strategic approach to identify and further the adoption of policy solutions.

The key steps include:

• Identify the problem or issue
• Identify and describe policy options
• Assess policy options
• Prioritize policy options
• Develop a strategy for furthering adoption of a policy solution

CDC plays an important role in identifying and describing policy options to address public health problems, analyzing policies to understand their potential health, economic and budgetary impacts, and identifying evidence-based policy solutions and gaps in the evidence base. Note that federal law prohibits lobbying related activities by CDC at the federal, state, and local level.

FIGURE 1: THE POLICY ANALYTICAL FRAMEWORK (DOMAINS I, II, III OF CDC’S POLICY PROCESS)

CDC’s Policy Analytical Framework text

Domain 1: problem identification.

Step 1: Identify the Problem or Issue

The first step is to clearly identify the problem or issue you are trying to address. Synthesize data on the characteristics of the problem or issue, including the burden (how many people it affects), frequency (how often it occurs), severity (how serious of a problem is it), and scope (the range of outcomes it affects).

It helps to define the problem or issue as specifically as possible—for example “lack of access to fresh fruits and vegetables” (instead of “obesity”) or “barriers to sustaining HIV treatment” (instead of “HIV/AIDS”). A way to look for these is as contributing factors or risk factors in the literature on the public health problem. This level of specificity can help you understand how best to address the problem. In addition, it is also useful to frame the problem in a way that helps illuminate possible policy solutions. For example, “providing safe places for people to be physically active in their communities” (which has clear policy solutions) instead of “increasing physical activity” (where the policy options are not as clear).

Domain 2: Policy Analysis

Step 2a: Identify and Describe Policy Options

Identify Research possible policy options relevant to the problem or issue you have identified and described. Potential strategies for gathering evidence include:

• reviewing literature on the topic,
• surveying best practices (including best practices in other problem/issue areas),
• conducting an environmental scan to understand what other jurisdictions are doing.

Be sure to collect evidence that addresses alternative and opposing points of view on the problem or issue and include the option of maintaining the status quo.

Describe The first step is to describe each of the policy options you have identified. Answer the overarching questions to describe the process and structure as well as the questions for each of the three interrelated criteria: health impact, feasibility, and economic and budgetary impacts Table 1. To focus attention on the key components of each criterion, we developed a list of sample questions for each. Not all questions are appropriate for all problems or issues; furthermore, questions beyond those noted here should sometimes be considered. Addressing these questions will enable you to assess policy options in Step 2b.

In answering the questions, it is possible to pull from different sources and types of evidence. Keep in mind that some sources and study design are of higher quality (see link—table showing varying strength of different types of evidence). If you find that data are lacking on the specific policy, consider data from similar policies used to address a different problem or issue.

Step 2b: Assess Policy Options

Use the answers to the questions from Table 1 to rate the policy options. Also, for each criterion, note whether or not there are concerns about the amount or quality of data.

At this step, assess each option independently against the criteria included in the Table 2 . If appropriate, include “no policy change” as an option. Although the ratings you provide should be grounded in data and evidence, they are inherently subjective. Table 2 is intended to be a guide. In order to justify your ratings, it may be helpful to systematically document the evidence, data, and reasoning you used to assign the rating in a separate matrix.

Note about scoring : If possible and appropriate, consider ways to quantify the rankings. For simplicity sake, we have presented a basic option in Table 2 —rating as “low,” “medium” or “high.”. For clarity, the economic and budgetary descriptors are “less favorable,” “favorable,” or “more favorable.” However, you may be able to use more robust, empirical data (return on investment, lives saved, etc.) as available.

Step 2c: Prioritize Policy Options

On the basis of the ratings you assigned in Step 2b, evaluate policy alternatives against each other and prioritize the policy option(s). Criteria are not intended to be examined in isolation. Which policy(s) you prioritize will depend on the weight you place on the three criteria and the overall analysis.

Domain 3: Strategy and Policy Development

Step 3: Develop a Strategy for Furthering Adoption of the Policy Solution

Once a policy solution has been prioritized, the next step is to define a strategy for getting the policy enacted and implemented. For CDC, this will include clarifying operational issues, identifying and educating stakeholders and sharing relevant information, and conducting additional analyses as appropriate to support adoption, implementation and evaluation.

Clarifying Operational Issues Identify how the policy will operate and what steps are needed for policy implementation. Identify considerations and assistance for those who will adopt the policy (e.g., state/local government, organizations), taking into account jurisdictional context and information needs.

Sharing Information To help describe and disseminate the results of the analysis, you will want to share relevant information with key stakeholder groups, including state, tribal, local and territorial governments, other federal agencies, community-based organizations or groups, and decision-makers.

In developing products, keep in mind the stakeholders’ information needs and preferred ways of receiving information. Potential products might include:

• A background white paper that summarizes data related to health impact, feasibility, and budget and economic impact of prioritized policy
• A bibliography and data compendium
• A presentation of policy priorities or recommendations
• A policy brief or multiple policy briefs that summarize policy options or recommend actions

Conducting Additional Background Work If policy is not prioritized or ready for “prime time” (e.g., because it has low feasibility, insufficient data on health impact, insufficient stakeholder support), there may be other steps you can take. If data are insufficient, consider developing a policy research agenda that identifies key questions that need to be addressed. Also, consider a more incremental policy to address the problem or issue.

CDC’s Policy Analytical Framework

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

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Master of Public Health

Health policy analysis.

As health systems in the United States and abroad cope with issues of access, quality, and cost, there is increasing demand for health policy analysts, consultants, and advocates to help develop and implement new and innovative ideas. The 2010 enactment of the Patient Protection and Affordable Care Act, for example, requires dramatic changes in U.S. insurance systems, a reorganized health and public health delivery system, and politically difficult cost-containment strategies. These and other reform initiatives require individuals with the analytic skills to formulate, implement, and evaluate health policy and programs at organizational and system-wide levels. 

The Health Policy Analysis Certificate provides the education to address the urgent policy problems facing health organizations and healthcare systems. Students will learn from faculty working at the forefront of policy issues, who focus on topics including access to care, insurance markets, health economics, mental health policy, health manpower, and health systems more generally, in both domestically and globally.  

Graduates will be prepared to work with other health professionals and policymakers in government, think tanks and foundations, health departments, consulting firms, international health organizations, and hospitals to improve quality, expand access, and lower disparities in a cost effective manner.

Admissions Eligibility

Health Policy Analysis is only open to Columbia MPH students enrolled in the Department of Health Policy and Management . Prospective students are encouraged to specify the Health Policy Analysis certificate in their application. 

The Competencies for this Certificate are as follows:

• Analyze the history and structure of the United States healthcare system and specify how social, political, legal, technological, and economic forces have shaped it. 
• Analyze key policies and components of the US healthcare system, including public and private insurance coverage and regulation, quality monitoring, payment methods, and financing of healthcare. 
• Apply economic, political and organizational theories to the analysis of healthcare policy and management issues in order to inform decision making and policy development.
• Design policy solutions based on sound analysis of stakeholder views, political institutional features, technical feasibility and value acceptability. 
• Apply statistical methods in order to explain causal relationships between policy interventions and population health outcomes.

Visit the  Certificates Database  to learn more about core and credit requirements.

Sample Courses

Program evaluation design for health policy and management.

Program evaluation is an applied field that is intended to provide the evaluator and the organizations for which they work with performance data on programs of interest. This class is designed to provide students with an introduction to the techniques and methods associated with designing and performing effective and user focused evaluations. Learning objectives include designing a program evaluation appropriate to the intended purpose, identifying strengths and weaknesses of existing evaluations, understanding the uses of different approaches and techniques, and communicating evaluation results effectively in both oral and written form. The course will focus on lecture and in-class exercises with a key service learning component.

Public Health Law

This course is intended to introduce students to (i) certain basic principles of the legal system in the United States and (ii) major elements of the legal framework of health care administration. Students will be exposed to legal terms and approaches, and analyze federal and state statutes and regulations, as well as case law relevant to health care administrators, providers and consumers. We will review the development of certain laws shaping health care delivery and concurrently how public policy shapes the law. Students will have the opportunity to examine the legal issues that will affect health care providers, consumers and regulators. In addition, if time permits and a "health reform law" is passed, we will likely allocate at least one session to reviewing certain legal elements of health reform.

At the end of the course, the student should understand the legal principles governing health care administration and have the basic ability to recognize common legal problems and approaches to their management. In addition, the student should have a basic substantive understanding of the major elements of the most commonly encountered laws focused on health care administration. Finally, students should have a better understanding of the interrelationships among the major players in health care delivery, and how these interrelationships are implicated in ethics, law and public policy.

In this course we explore constitutional law through the lens of public health policy. We examine the relationships and tensions between individual and collective concerns. We evaluate public health issues from an American legal perspective to determine the constitutional soundness of the health promotion objective. In this course we consider multi-disciplinary factors and how they interact with issues of federalism, morality, economics and the politics of science. Readings include case law and related legal materials, in addition to writings by public health practitioners, historians, sociologists, economists and philosophers. Core topics include, among others, constitutional law and major constitutional cases relating to public health, economic analysis in law, tort litigation in public health, historical public health law perspectives, health promotion campaigns, property regulation, privacy protection, various case studies including immunization, civil commitment, infectious disease, tobacco policy and abortion law. Guest speakers provide additional current perspectives from practitioners.

Health Policy and the Political System

Why does the government play such a central role in the health of its citizens? What factors unique to American politics have given us the healthcare system we currently have, and how much change can be accomplished within our philosophical and ethical confines? How do political changes yield policy shifts—or not?

This course analyzes the role of major institutions—the central government, the federal system, the private sector, interest groups, and so on—in formulating and implementing health policy in the United States. We will discuss underlying normative issues and crossnational perspectives on healthcare to situate American healthcare policy along a broader global political spectrum, and attempt to forecast what changes are likely—or unlikely—to occur. Topics will include political history, policy formation and recommendations, market forces and economic influences, and more.

Related Links

• Columbia Center for Children's Environmental Health
• The National Center for Disaster Preparedness

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4 Public Health Policy Analysis and Evaluation

• Published: January 2016
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Policy analysis is an important component of the policy process. When a problem has been identified and deemed worthy of government attention, policy analysis uses the best facts, data, and evidence to identify and compare the range of possible policy solutions to be considered. Policy analysis plays a role in the decision to revise, amend, terminate, or retain the existing policy. Policy analysis is also critical to the empirical evaluation of the impact of policies. This chapter outlines policy analysis as a profession and examines the methods and tools for conducting it. The information presented helps create a foundation of basic policy analysis knowledge for a public health student, researcher, or practitioner.

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NR506NP Week 4 Health Policy Analysis

Nr506np week 4 health policy analysis ppt.

NR506NP Week 4 Health Policy Analysis PPT: Kaltura Health Policy Analysis

This assignment will focus on developing a health policy analysis presentation that includes a problem statement, background, landscape, options and recommendations from the week’s readings. The health policy analysis presentation is based upon an identified healthcare issue in one’s local community.

Total Points Possible: 200

Requirements:

• Problem Statement
• Recommendations
• Speaker notes
• Next, record your Kaltura presentation and upload it into the week 4 assignment . How to use Kaltura resources are in Home/Resources/Technology Resources

Posting your recording:

NR506NP_WK 4 Health Policy Analysis_SEPT19

This criterion is linked to a Learning OutcomeKaltura Recording

This criterion is linked to a Learning OutcomeLate penalty deductions

Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment.

Total Points: 200.0

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Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. NR506NP Week 4 Health Policy Analysis PPT

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

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Health policy analysis: a simple tool for policy makers

Affiliation.

• 1 Department of Global Health, School of Public Health and Health Services, The George Washington University, Washington, DC, USA. [email protected]
• PMID: 15661129
• DOI: 10.1016/j.puhe.2004.03.006

Policy analysis is not an easy task. Its scope is broad and can include both the analysis of policy process and the analysis of policy content. This paper is concerned with the analysis of policy content and offers some practical guidance regarding how to analyse health policy and link it to health outcomes. An eight-step framework for policy analysis is proposed that public health policy makers and public health practitioners may find especially useful due to its simplicity.

• Decision Making, Organizational
• Health Policy*
• Outcome Assessment, Health Care / methods*
• Policy Making*
• Public Health / methods*

Medicare Health Policy Analysis

Health care is an essential element of the social sphere and has as its goal the preservation and strengthening of the health of the population through preventive, curative, and other types of activities of medical institutions. Medicare is a highly effective method to ensure that older adults can access sufficient medical aid, but the demographic shift to older age requires more program expansion.

In the United States of America, there is no unified and clear system of a healthcare organization, but its model is a schematic form that can be represented by structural elements. The guarantor of providing medical care is the health insurance system, which is public and private (Strawbridge, Lloyd, Meadow, Riley, & Howell, 2015). Many Americans who do not have private insurance are covered by government programs such as Medicare and Medicaid, as well as other regional programs for the poor.

Existing Policy

The current state of the Medicare program provides health insurance for all Americans over 65 with work experience of 5-10 years as well as those who are approaching this age and have serious health problems. It was established in 1965, and since 1972 it has also served the disabled and consists of four main parts. First, hospital insurance includes payment for hospital services, some forms of home care. Second, health insurance involves a fee for doctors and all kinds of outpatient services not included in the previous component (Colligan, Pines, Colantuoni, & Wolff, 2017). Third, preferred insurance is a plan combining the first two elements with an additional provision of different types of specialized medical care and prescription drugs on special conditions. Lastly, drug insurance is related to prescription drug costs (Colligan et al., 2017).

The effectiveness of Medicare is obvious, because, in 1991, this program reached 39.2 million people, in 2010 – 47.5 million, of which 39.6 million people over 65 and 7.9 million people with disabilities (Duncan, Ahmed, Dove, & Maxwell, 2019). By 2020, it is projected to include 61.3 million Americans. The program is partially funded by a special tax, which is paid equally by entrepreneurs and employees in the amount of 7.65% of the payroll, of which 1.45% is withdrawn by Medicare (Lloyd, Blackwell, Wei, Howell, & Shrank, 2015). Non-self-employed citizens, as well as small business representatives, pay a social tax of 15.3% of their income, of which 2.9% is deducted for this program. In total, the US government, at the expense of taxpayers, pays 52% of the cost of medical care for pensioners (Colligan et al., 2017).

Shortcomings

In recent years, social and health insurance programs have faced serious difficulties associated with demographic changes. An aging population and an increase in the proportion of Americans are over 65. Social Security and Medicare provide benefits that are far greater than previous investments. If in 1950 16 workers provided one recipient of social insurance benefits, in 1996 – three employees, then by 2030, if current trends continue, only two employees will fall for each pensioner (Strawbridge et al., 2015). At the end of the 1990s, Medicare expenditures were 2.6% of GDP; in 2030, they are projected to be 7.5% of GDP. From 1991 to 2010, they have grown 2.1 times – from $ 244.8 to $ 522.8 billion (Colligan et al., 2017).

Stakeholders

Individuals.

Medicare is a national social security program that provides insurance to US citizens who are over 65 who have worked and made contributions. It also provides health insurance for young people with certain medical conditions. The program has existed since 1966 and is covered by the expenses of the US federal government. In 2011, nearly half of the costs of inpatient care (47.2%) were covered by Medicare (Duncan et al., 2019).

Healthcare Professionals

Healthcare professionals can be classified as hospital units and their personnel. Unlike most ratings, hospital data is collected by them independently, and it looks as if no one is monitoring the collection and analysis of this data. However, this is not so, since data collection methods are carefully monitored, and each hospital undergoes regular validation and verification (Strawbridge et al., 2015). Thus, only data whose highest quality provides important and useful information for the consumer is used.

Hospital ratings, according to patient estimates, are based on several key parameters. For instance, patient treatment results include prevention of infections, repeated hospitalizations, complications, and adverse events in surgical patients. The opinion of the patients themselves, including how clear and understandable the information was to the patients when they were discharged from the hospital (Parashuram, Kim, & Dowd, 2018). The doctor’s appointments and recommendations are critical, as well as whether the explanations about the drugs being taken were clear. Hospital practices, such as proper use of scanning and an electronic health card. Subsequently, these rating techniques can be combined to create a common security rating.

Effectiveness

The effectiveness of the program is difficult to evaluate due to the instability of expenditure values. However, this does not mean that all expenses of the patient are covered from the funds of the program. They pay part of the services, and their participation in payments depends on the volume of these services. In 2014, 15.6% of Americans were covered by Medicare. It is expected that by 2050, their number will increase to 95.8 million people (Strawbridge et al., 2015).

Problem Solving

The development of a quality assurance strategy for Medicare required its organizers to choose a clear conceptual framework and set program goals. First of all, the traditional model “structure – process – result”, known as the Donabedian model, and the model of continuous quality improvement were identified as a conceptual basis (Parashuram et al., 2018).

Implications

This program was not chosen by chance, because the American government pays considerable attention to the ratings of medical organizations, considering them as a fairly effective information and marketing tool for managing the quality of medical care. Therefore, it seems appropriate to review the ratings of indicators used to assess the quality of work in hospitals included in this program. Hospital Ratings 2011-2013 based on parameters that allow you to visually evaluate the quality of patient care from a state perspective (Colligan et al., 2017).

Recommendations

With the introduction of new quality assessment parameters, it is necessary to enlist the support of external experts to receive feedback on the new measurement methodology so that they can be included in the Ratings. The given system should be one of the most important elements of the rating system. Ratings should use a scale from 1 to 5, and a more accurate range is used to assess safety, which is from 0.5 to 5.5 (Strawbridge et al., 2015).

In addition to inpatient care, the program pays 100 days for the treatment of chronic disease in a nursing home. The patient receives a conclusion on the need for such care, as well as an unlimited number of doctor visits to the patient at home. Over 90% of Medicare is spent on hospital services, and only 9% on nursing and home care (Parashuram et al., 2018). Clients with terminal conditions can use hospitalization for up to 90 days twice a year, and one reserve hospitalization for up to 60 days (Lloyd et al., 2015).

On average, more than 20% of all medical and more than 30% of all hospital services are paid from government programs, mainly Medicare and Medicaid. For 5700 medical facilities, participation in these programs is the only source of income (Duncan et al., 2019). Thus, Medicare can be considered as a highly effective policy for medical assistance among older people.

Evaluation of the Implication of the Policy

The Medicare Hospital Part is funded by insurance tax from employers and employees and is designed to treat acute illnesses. It pays for 90 days of inpatient treatment, ending with discharge from the hospital, or stay in a nursing home for 60 days (Lloyd et al., 2015). The number of such periods per year is not limited. The subprogram also provides for a one-time stand-by hospitalization in case the client has exceeded the hospital stay.

The increase in the cost of medical care in recent years has forced the government to take voluntary responses in the form of tightening the rules for adherence to clinical protocols. Thus, it should increase the cost of the franchise paid by Medicare participants before starting the distribution of medical benefits to them.

In conclusion, the fundamental role of healthcare as an inalienable condition of society is recognized in the legislative acts of all civilized countries and is considered an important factor in the national security of the country. It is a system of public and state socio-economic measures ensuring a high level of protection and improvement of public health. Effective public policy contributes to the implementation of the main tasks of healthcare.

Colligan, E. M., Pines, J. M., Colantuoni, E., & Wolff, J. L. (2017). Factors associated with frequent emergency department use in the Medicare population. Medical Care Research and Review, 74 (3), 311–327.

Duncan, I., Ahmed, T., Dove, H., & Maxwell, T. L. (2019). Medicare cost at end of life. American Journal of Hospice and Palliative Medicine, 36 (8), 705–710.

Lloyd, J. T., Blackwell, S. A., Wei, I. I., Howell, B. L., & Shrank, W. H. (2015). Validity of a claims-based diagnosis of obesity among Medicare beneficiaries. Evaluation & the Health Professions, 38 (4), 508–517.

Parashuram, S., Kim, S., & Dowd, B. (2018). Inappropriate utilization in fee-for-service Medicare and Medicare advantage plans. American Journal of Medical Quality, 33 (1), 58–64.

Strawbridge, L. M., Lloyd, J. T., Meadow, A., Riley, G. F., & Howell, B. L. (2015). Use of Medicare’s diabetes self-management training benefit. Health Education & Behavior, 42 (4), 530–538.

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Health Policy Analysis - Assignment Example

• Subject: Health Sciences & Medicine
• Type: Assignment
• Level: High School
• Pages: 4 (1000 words)
• Downloads: 4
• Author: lynchschuyler

Extract of sample "Health Policy Analysis"

The options I would propose, which would be suitable for your campaign, are as such: This move leads toward covering a large number of people, as a universal coverage is far from practical given the level of private medical care. The current system of care adheres to giving care to anyone with emergency conditions. However, in reality only those with health care plans are taken care of, while those without any are taken care of at later stages (Teisberg). This could be backed up using government funding, although other options could be used such as a national insurance, which is used in the United Kingdom.

Wider coverage for all would lead to more people being taken care off. Employers would not have to worry about covering their employees, since the government would now be able to cover their employee’s health plans. Would be expensive to maintain at this point, considering that unemployment is a major issue within the current economy. Even considering a national insurance scheme would mean that employees would have to pay national insurance, and this would not be welcomed by those who are earning.

This would include opening clinics and having them subsidized to encourage them to survive in the long run. The process would need a bit of funding at the start to cover initial costs, after which these clinics would pay back after a certain period of time. If after a certain period, say two years, a clinic is still unable to pay its debts, then the amount would be waivered. The affluent families could assist in furthering this option. This option would also lead small clinics to, in some way, compete against the larger medical organizations, leading to a more capitalized economy.

This would, in effect, eventually force prices for health care to drive downwards, and therefore also have a favorable impact upon the insurance coverage mentioned in the earlier option. This could prove extremely useful for women in labor. The initial

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