Chapter 3 HLTC03.docx

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12 Apr 2012
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Chapter 3 HLTC03
Introduction
Health policy is a subset of public policy
o Remember public policy is a course of action (or inaction) chosen by govt to address
what has come to be identified as public issues
A theory is a framework for understanding how a set of facts or phenomena come to be
o Consists of a set of principles or statements as ecplanation
Public policy theory therefore explains how public policies come about
o Rationale e.t.c.
o How they view society functioning informs policy suggestions
Defining the Characteristics of Different Types of Theories
Theories of public policy are either consensus or conflict models, and may be
o Macro-view theories: consider broad issues of the general shape of political systems and
how power is exercised in these political systems
Seeks to understand the economic, political, and social forces that influence and
reflect the predominant values in a society
E.g. “health care should be private/public “
o Meso-view theories: focus on the influence of advisory boards and departments within
govt, govt ministries, and other middle-level institutions upon public policy
E.g. govt organizations or even independent agencies
All still accountable to government
o Micro-view theories: concerned with the administrative routine and day-to-day govt
apparatus that shapes public policy
Minor-tinkering of public policy, but focuses on monitoring govt operations
including spending
Health policy has been argued to consist of two types of public policy (Concerns all three levels
theories) table 3.1
1. Public policy regarding the organization and delivery of health care services
a. E.g. private or publicly financed
2. Public policy concerned with the development and implementation of various health-
related public policies
Three prominent theories of public policy that help understand health policy process are:
o Pluralism
o New institutionalism
o Political economy
Each of the aforementioned has particular assumptions about the nature of society and how
public policy is made
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Pluralism
Also called pluralist interest group theory, it considers society to consist of interest groups that
vie for power and access to the state to realize their goals and objectives
o Democracy
o Policy emerges from competition in developing and advancing ideas among different
groups
Rationality emphasized
Assumes every group has equal opportunity and access to govt and public policy
implementation
Look at BOX 3.1
Pluralism and the Liberal Conception of Society
The state is considered to consist of a neutral set of institutions that mediate diverse interests
Pluralism based upon liberal democracy:
o Political rights
o Citizens access to political power
o Responsiveness of political system to all interests in society
Limitations of Pluralism
Does not consider the role that political power and ideology plays in policymaking
Presents government as neutral
o When this is not true
Thinks all interest groups are equal
Does not focus on power relations and ignores inequalities
Ignores social cleavages and political conflict
Despite limitations, pluralism is the dominant theory of public policy in Western nations
o It is a consensus approach
o Interest groups try make govt part of the solution
UK and western European nations are less pluralist and instead conflict oriented
New Institutionalism
New instituionalism is a middle-level theory about the evolution of health care systems (pg 64)
New institutionalism has some pluralist features but adds an interest in how institutions
structure the nature of politics and political debate and policymaking
Focus of new institutionalism is analysis of how societal institutions influence public policy
making
Consists of 3 theoretical approaches:
1. Historical institutionalism: traces how the past shapes the future
2. Rational choice institutionalism: highlight the economic position of political actors
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