Health Policy Review.doc

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Western University
Health Sciences
Health Sciences 3400A/B
Sharon Regan

Week 2 – Agenda Setting 09/10/2012 15:55:00 ← 308 seats in the House ← ← MP (Member of Parliament): handle complaints, rep. geographical location, address issues brought to their attn., brings it up to high rankings - Rep. constituents - act as “ombudsman” handling complaints - act as “business agent” for constituency - act on behalf of party - caucus duties - Parliamentarian and/or Committee person - Undertake research on particular topics ← ← The Speaker • Elected by MPs in secret ballot • Ensures everyone respects rules & tradition in House • MUST be impartial and apply rules to all Member equally ← ← Leader of Opposition and Critics • Challenge gov’t policies • Hold gov’t accountable for its actions • Give voters an alternative in the next election • Each critic handles a certain subject (ie. Health or defense) o Present party’s policies on subject and comment on gov’t policies ← ← House Leaders • Each recognized party (min. 12 seats) appoints one member to be its House leader • Meet regularly together to discuss agenda, how long bills are debated and when special issues will be discussed ← ← Whips • Each recognized party has one • Ensures enough party members are in Chamber for debates and votes • Determine which committee a party member will sit on, assign offices and seats in House • Discipline members who break party ranks ← ← Prime Minister • Chooses cabinet and chairs it • Head of party usually w/ most seats • Decides when to call election (5 year limit) • Extensive appointment powers ← ← Cabinet • Chosen by PM from elected party members • Responsible to Commons • 3 main roles: o Develop policies for issues facing country o Translate policies into bills, get them passed o Oversee administration of laws and policies ← ← Senate • At least 30 yrs and retire at 75 • Committees range from 5-15 senators o 3 tasks:  approve/amend legislation  investigate policy matters and make recommendations  examine government’s spending proposals (AKA Estimates) • Duties: o Sharing law-making with Commons o Acting as “sober second thought” o Representing provinces in federal system ← ← Civil Service • Employees of gov’t • Organized into department & boards • Accountable to public through Ministers • Increasingly influential in postwar period ← ← Health Canada • Minister of Health: maintain and improve health of Canadians • Health Portfolio includes: o Health Canada o Public Health Agency of Canada o Canadian Institutes of Health Research o Hazardous Materials Info Review Commission o Patented Medicine Prices Review Boards o Assisted human Reproduction Canada • Consists of 12 000 full-time employees • 3.8 billion budget ← ← Territorial Governments • Yukon, NWT, Nunavut • Based on Aboriginals traditional approaches to governance • Legislative assembly – 19 members • Choose amongst themselves Speaker, Premier and 6 others to serve as Executive Council ← ← Provincial Governments • 10 provinces • similar to Federal, but no Senate (unicameral) • Legislative Assembly ← ← Minority Government • Sometimes called “laying duck” bcuz they haven’t done anything to make policies happen • Occurs when no party has a majority of seats in legislature • Non-confidence vote: "loss of confidence" in the gov't o Gov't can resign or ask Lieutenant Government to dissolve Parliament leading to election ← ← Ministry of Health and Long-term care • London MPP for London North Centre = Hon. Deb Mathews • Establishes direction and provincial priorities for health system • Develops legislation, regulations, standards, policies and directives to support those strategic directions • Monitors and reports on performance of health system and health of Ontarians • Plans and establishes funding models and levels of funding for health care system • Ensures ministry and system directions and expectations are fulfilled ← ← Municipal Government • No separate executive and legislature • Everything centered on council, elected by ward or general vote • No “Government” or “Official Opposition” • May have standing committees • Basic model is council and departments • Plan for balanced growth, environmental issues (water, sewage, garbage), safety and security in neighbourhoods, social programs • Local boards o School boards, health units, library boards, police boards o Most are independent of council, obtain some funds from user fees • London Mayor = Joe Fontana o London City Council has established a Standing Committee system to hear delegations from public  Write to chair and members of appropriate Standing Committee  After letter is received, you will be contacted by City Clerk’s Office by phone or letter to arrange time for your delegation • Middlesex London Health Unit (board) o Must provide or ensure provision of minimum level of public health programs and services o Expected to deliver additional programs and services in response to local needs o Delegates responsibility to administer programs to Medical Officer of health (Dr. Graham Pollett) as Chief Executive Officer o Programs: immunization, well baby, family health, harm reduction, tobacco control, chronic disease prevention ← ← Intergovernmental Relations • First Ministers = Premiers, PM, National Chief of the assembly of First Nations • Council of the Federation – Premiers only • Ministers of Health • Ministers with related issues ← ← Agenda setting • Nonlinear – not every issue gets addressed • Political and technical – process in place to define issues and relates to who is in power and what their agenda is • Complex network - # of actors involved, interest groups and others buying for attn. and being pressured by other to put issues on the table ← ← Actors • People who seek to influence the dev’t and implementation of policy • Multiple levels • Individuals, groups, orgs., researchers, media • Influence through values and principles • Elected individuals ← ← Inside initiation – issues put on agenda from within gov’t ← Outside initiation – issues put on agenda from outside gov’t (public) ← Formal agenda – budgets ← Informal agenda – media ← Policy communities – groups using collective power to influence gov’t • Ie. ParticipACTION Canada, parent councils, food companies for childhood obesity ← ← Framing Issue – dictates how problem is treated ← ← Policy Windows: • Routine – ie. Budget, how money is allocated • Discretionary – PM can put in agenda depending on situation • Random – crisis can get something on agenda (ie. Death in hospital and patient can approach media) • Spill-over – something happens and policy gets on agenda ← ← Agenda can be influenced by media, be overcrowded, be dominated by demands for responses to crises ← ← Strategies for Agenda Setting: • Define or frame issue • Use windows • Form alliances Week 3 – Policy Formulation 09/10/2012 15:55:00 ← Policy – course of action or inaction chosen by public authorities to address a given problem or interrelated set of problems ← ← Provincial Gov’t • 107 seats in Ontario’s legislature ← ← Ideology – set of beliefs, values, principles and ideals that influence/shape policy • Neoliberalism (dominant world view) o Role of gov’t is limited in health and social services/programs; economic policy is dominant  Thinks business policy should pervade  Strengthens private business and competitive markets in society  Conservative Party  Let markets decide if we have money to spend on health policy issues, if not, don’t spend on health issues because we need to keep economy moving forward  Related to economy crash because gov’t wanted to have less involvement in markets, but they needed to be regulated  Features:  Individualism – individual responsibility and freedom  Economy – min. gov’t interference, deregulation, privatization  Role of gov’t – decentralized • Shift to provincial gov’t means less funds and less involvement by higher gov’t • Liberalism o Provision of health and social programs/ services expected  Obeys economic policies  Liberty, equality and community  Safety net for disadvantaged (unemployment insurance, welfare, money to keep people above poverty line)  New Democratic Party & Liberal Party  Features:  Social justice – distribution of economic and social resources for benefit of all society  Economy – regulated free markets, income redistribution/progressive taxation (people with more wealth, pay more)  Role of government – important role to ensure equal opportunity • Democratic Socialist/ Social Democratic o Provision of social/health programs a “right”  Social/health and economic policies equally important ← ← Political Spectrum • Left wing: major role for gov’t (collective support) o Social/health issues: Believes role is to provide programs to meet need; ensure equity o Law and order issues: believes social conditions must be improved to reduce cause of crime • Right wing: limited role (individual freedom) o Social/health issues: Believes role of gov’t it to empower individuals to meet need  Last resort to provide programs o Law and order issues: individuals must accept responsibility (punishment) for actions ← ← Conservative Party • Stephen Harper • Right of center on spectrum • Freedom of individual Canadians to pursue their enlightened and legitimate self-interest within a competitive economy ← ← Liberal Party • Bob Rae • Left of center on spectrum • Individual freedom, responsibility and human dignity in a framework of a just society, and political freedom in the framework of meaningful participation by all persons ← ← New Democratic Party • Thomas Mulcair (Official Opposition) • Left wing • Social, economic, and political progress of Canada assured by application of democratic socialist principles to gov’t and administration of public affairs ← ← Policy Formulation – generating set of plausible policy choices or addressing problems • Actors – direct authority for policy formulation o Cabinet ministers (ie. Minister of Health) o Senior officials (ie. Directors in Ministry of Health, public “managers”) o Other actors - Indirect/direct influence on policy formulation  Societal actors (interest groups – assoc, think tanks, universities, researchers) ← ← Types of Policy Options ← 1) Incremental alternatives – marginal change from status quo; small changes ← 2) Fundamental alternatives – policy options significant departure from status quo; drastic and creative solutions ← ← Policy Instruments or Tools • Private instruments – private resources o Little or no gov’t involvement o Business, family, voluntary social organizations • Public instruments – rely on public authority o Direct gov’t involvement o Laws, taxes, penalties (fines) ← ← Policy formulation challenges • Political nature of policy – gov’t not directly involved, fund some • Lack of public support for particular options • Closed policy community – individuals get together for an issue and don’t want other people to join with their ideas • Technical challenges: o How issue is framed o Potential policy options to select (need to be cost effective) o Resources must be allocated to policy option • Institutional challenges o Constitutional issues – may have pre-existing costs  If federal solution affects municipal it won’t work o Electoral system – politicians don’t look at long-term issues o Powerful interest groups – some groups don’t want issues fixed bcuz they benefit from issue o Structures and processes in gov’t itself  Intergovernmental issues when one ministry doesn’t talk to another ministry about making a policy ← ← Strategies to improve policy formulation • Understanding source of problem •
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