1 Introduction to Health Policy AnalysisGuenevere Burke, MD, MBA Spring 2016 With many thanks and much credit to the GWU School of Public Health Faculty, Professors J Forstenzer Espinoza & SF Wood
2 Assignment Overview Purpose Structure 20 minute presentation10 minute Q&A Everyone gets involved! Why- its easy to critique current policies and much more challenging to propose solutions. We want students to be able to exercise 1) critical thinking about public health problems 2) become informed consumers of the health policy literature 3) synthesize and use the knowledge presented in the course 4) get to know each other, 5) share what you’ve learned
3 A few tips..
4 Your Topics
5 Your Teams! Team 1: Cybersecurity Team 2: Zika Team 3: OpioidsAngie Ng, Tuong Nguyen, Yalda Shahram, Matthew Taon, Judith Tessesma, Alexander Amon Rogers Team 2: Zika Benjamin Silverberg, Stacey Ludwig, Emmanuel Mitsinikos, Nhi Tan, Eric Tang, Melissa Romero Team 3: Opioids Melissa Ruiz, Rachel Amare, Hardeep Singh Aujla, Heather Belcher, Stephanie Kim, Alina Abby Leung Team 4: Homelessness Brigitte Watkins, Azure Adkins, Sophia Chen, Jenille Narvaez, James Yang Health P o licy Presentation Teams : REHP 2016 Homelessness 1. Brigitte Watkins 2. 3. Azure Adkins Sophia Chen 4. Jenille Narvaez James Yang 5. Opio i d Policy Melissa Ruiz Rachel Amare Hardeep Singh Aujla H e ather Belcher Stephanie Kim 6. Alina Abby Leung
6 What Is Policy Analysis?The systematic examination of a policy problem from the perspective of a particular stakeholder with the purpose of helping an individual/organization/group make a choice that is reflective of the values of the stakeholder and the practical and political realities. The use of reason (informed by judgment, intuition), And evidence (informed by data, studies, precedent) to choose the best, most practical, most feasible policy, That considers the values and goals of your decision maker- e.g. Zika & CDC- they have a specified mandate, specified powers, limited budget and political realities, ala Ebola to confront
7 What is Policy Analysis?Subjective + Objective Rational and political. Two contrasting models: Rational model: Politics and analysis should be separate; objective analysis can lead to a “correct” answer to a policy problem; politics inserted after analysis is completed. Political reason: “Reasoned analysis is necessarily political…always involves choices to include some things and exclude others and to view the world in a particular way….Policy analysis political argument, and vice versa.” (D.A. Stone. INFORMED ADVICE
8 Why Health Policy Analysis?Should action be taken to address a given problem? If so, what type of action? We’re all problem solvers. Important to remember that sometimes, the best action is inaction, which may sound crazy, but since most action is coming from the perspective of a governmental official/agency or recommending a specific course of action, makes more sense that not every problem can or should be solved by govt. If an action will be taken, what are the consequences, there are always, e.g. “death panels” we’ve decided that end of life care is an issue that cannot be regulated, or best action is inaction/private action… Why in this class? Apply concepts Go in depth (kind of) Consider alternative perspectives
9 Core Elements of a Policy AnalysisProblem statement/Issue statement Background Landscape Options Recommendation This is the methods section, there are a number of different frameworks once can use and this is one approach
10 Core Elements of a Policy AnalysisProblem statement/Issue statement Background Landscape Options Recommendation This is the methods section, there are a number of different frameworks once can use and this is one approach
11 Problem Statement Provided for you! Broad or narrow?e.g. What recommendations would you advise to this committee to more closely safeguard Protected Health Information (PHI) in light of recent security breaches? At RAND yesterday, talked about framing a question and forming a problem statement, which can be incredibly challenging in real life, identifying the REAL problem. Cybersecurity is a VERY broad question, (the only federal question)…need to clarify? E.g. committee just passed legislation that attempts to tackle the issue indirectly through mandatory information sharing.. Others have a more narrow focus.
12 Core Elements of a Policy AnalysisProblem statement/Issue statement Background Landscape Options Recommendation
13 Background Detailed description of the problem Provides fact baseSummarize evidence Determine magnitude of the problem Why is this important? e.g cybersec- ransonmware & high profile cases, also small practices, small demand amounts ($17K Hollywood pres), possible underreporting
14 Background Is the problem changing? Who is affected?Historical trends? Future projections? Who is affected? Populations Geography (national, state, city) Affected equally? Cybersecurity example. Is the problem changing, yes, example of data hostage programs. Growing. What about the increasing use of mobile technology? Drive to increasing pt engagement? Who’s affected? Everyone potentially? UCLA, MEDSTAR
15 https://youtu.be/-N35jiTIPZs
16 Core Elements of a Policy AnalysisProblem statement/Issue statement Background Landscape Options Recommendation
17 Landscape “Tries to diagnose the problem” Identify stakeholdersWho’s affected and how? e.g. groups, organizations, individuals Clarify the political landscape Politically charged? Divisive? Provide economic context Economic causes? Cost of a solution? Cost of inaction? Transition from informational tone to analytical, attempt to draw out root causes, that will naturally suggest solutions, which you will provide in the next section, options Stakeholders- who is interested in the problem and how it will be solved? How much influence do they have? Who’s interested in keeping PHI safe? Patients, physicians, hospitals/AHA, IT vendors, security companies, Have the students name stakeholders… Political- do people feel strongly? About privacy?! yes! Bipartisan, but privacy/security are very politically charged Economic- how big is the health technology industry?
18 Landscape Describe social context Legal context/considerationsEquity Ethical/moral concerns Legal context/considerations Administrative feasibility e.g. Would regulation place an undue burden on small groups that are already struggling? Potential for future litigation with a given course of action?
19 Teitelbaum & Wilensky, Ch 10, The Art of Structuring and Writing a Health Policy Analysis
20 Core Elements of a Policy AnalysisProblem statement/Issue statement Background Landscape Options Recommendation This is the methods section, there are a number of different frameworks once can use and this is one approach
21 Options Identify evaluation criteriaIdentify options (potential solutions) Evaluate Justify your final recommendation Tx should naturally follow from your diagnosis in prior section! 3-5 options depending on scope of problem statement Do not propose options before completing analysis! Evaluation criteria are designed to make more deliberate, avoid “pet” options
22 Options Potential evaluation criteria Net benefit Cost EquityAdministrative ease Legality Political feasibility Social acceptability How do you measure these? You may not be able to..high/medium/low, $$$-$ Not all criteria may be weighted equally depending on decision makers priorities and values
23 Options In identifying optionsBe creative Do some research We want you to think! Some typical options: education, mandates, taxation, subsidies.. In evaluating options, consider building a chart/grid for side-by-side comparisons Think about your vision of perfect world…how to get there? Remember, one option may be to do nothing..consider combinations of actions
24 Core Elements of a Policy AnalysisProblem statement/Issue statement Background Landscape Options Recommendation This is the methods section, there are a number of different frameworks once can use and this is one approach
25 Recommendation Choose a single optionMay be a combination of options, but needs to have been presented & evaluated as a combination Why is this the best course of action? “Analysis not advocacy”
26 A Few Resources… Health Affairs Kaiser Family FoundationJAMA, NEJM + “Grey Literature”
27 Questions?