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Book Details
Abstract
This title is directed primarily towards health care professionals outside of the United States. This introductory text explores Australian health policy through a novel, problem-orientated approach. It shows the problem-solving techniques that are used when developing policy and demonstrates the skills of analysis and decision making. Introductory chapters explain the problem-orientated approach to health policy development and introduce the policy making process. These are followed by case studies that explore developments in Australian health policy in priority and topical areas. Chapters illustrate how policy-makers respond to perennial and emerging policy problems and demonstrate problem-solving approaches to the conception, development and implementation of health policy. Of particular concern are areas which are in transition or are highly contested. A team of prominent and expert contributors gives an overview of key issues, analyse the policy responses that have occurred and propose directions for the future. Topics covered span governance, values and specific service areas within major established areas of health policy of national concern as well as emerging problems and developments that have occurred in response to well-known cases.
- Takes a novel, problem-oriented approach to analysing health policy in Australia, which fits well with how policy is often created in practice.
- Combines a conceptual framework with a rich selection of pertinent and topical case studies by prominent researchers and policy practitioners to put policy analysis in context and give insights from practical experience.
- Topics have been chosen to appeal to students from a wide range of health backgrounds and include issues in nursing, management, rehabilitation, health information, and technology.
- Includes questions for discussion in each chapter.
- A companion Evolve website for Instructors contains chapter-by-chapter notes on review questions, suggestions for tutorial exercises, assignment topics and examination questions.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Front cover | ||
| Front Matter | i | ||
| Copyright | iv | ||
| Dedications | v | ||
| CONTENTS | vii | ||
| PREFACE | ix | ||
| CONTRIBUTORS | xi | ||
| REVIEWERS | xv | ||
| ABBREVIATIONS | xvii | ||
| SECTION 1 : Health policy:an overview | 1 | ||
| CHAPTER 1 - A problem-oriented approach to health policy analysis\r | 3 | ||
| SEMANTICS: THE PROBLEM OF THE WORD ‘PROBLEM’ | 4 | ||
| PROBLEM SOLVING AND POLICY ANALYSIS | 4 | ||
| PROBLEM DEFINITION | 6 | ||
| CATEGORIES OF HEALTH POLICY PROBLEMS | 7 | ||
| KINGDON ON PROBLEMS AND THE POLICY AGENDA | 7 | ||
| INTERROGATING THE PROBLEM:SOME ANALYTICAL QUESTIONS | 10 | ||
| How is the problem categorised and would a different category change howwe approach it? | 10 | ||
| Who is seeking to place the problem on the policy-making agenda? | 11 | ||
| What story or discourse about the policy is being presented? | 11 | ||
| Is the problem contested and what is the nature of the contestation? | 11 | ||
| What is the evidence for the existence and nature of the problem? | 11 | ||
| Is causality for the problem suggested and what are the complexities of theproblem? | 12 | ||
| How long has the problem been recognised and what previous steps havebeen taken to deal with it? What knowledge and experience about theproblem exists? | 12 | ||
| Is there a potential benefi t from comparative analysis of a problem? | 12 | ||
| Have efforts to deal with the problem caused, or are likely to cause, further ordifferent problems? | 12 | ||
| What are some possible solutions and how are choices limited? | 13 | ||
| What values are relevant to the problem and to possible solutions? | 13 | ||
| References | 14 | ||
| CHAPTER 2 - Health policy as a process\r | 15 | ||
| WHAT IS POLICY? | 15 | ||
| WHO IS INVOLVED OR IS POLICY POLITICAL? | 16 | ||
| Federalism and health | 17 | ||
| Political parties and the policy process | 19 | ||
| POLICY AS PROCESS: ARE MODELS USEFUL? | 20 | ||
| PLURALISM AND HEALTH | 21 | ||
| STRUCTURAL INTERESTS AND HEALTH | 22 | ||
| NEW PUBLIC SECTOR MANAGEMENT | 22 | ||
| CAN POLICY BE RATIONAL? | 23 | ||
| CONCLUSION | 26 | ||
| References | 26 | ||
| CHAPTER 3 - Institutional problems and health policy\r | 28 | ||
| REFORMING THE SYSTEM | 31 | ||
| FUTURE DIRECTIONS FOR POLICY DEVELOPMENT | 33 | ||
| Private health insurance | 35 | ||
| CONCLUSION | 38 | ||
| References | 39 | ||
| CHAPTER 4 - Population health, the health system and policy\r | 41 | ||
| TOWARDS EVIDENCE-BASED HEALTH POLICY:THE IMPORTANCE OF RESEARCH | 42 | ||
| COMMUNICABLE DISEASE | 43 | ||
| DATA FOR HEALTH | 46 | ||
| ACCOUNTABILITY AND COST EFFECTIVENESS | 47 | ||
| HEALTH EXPENDITURE | 48 | ||
| ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE | 50 | ||
| HOW DOES AUSTRALIA COMPARE? | 50 | ||
| THE HEALTH WORKFORCE | 51 | ||
| THE CORPORATISATION OF HEALTHCARE | 52 | ||
| CONCLUSION | 52 | ||
| References | 52 | ||
| CHAPTER 5 - Health Impact Assessment in a policy context\r | 55 | ||
| ANALYSIS OF HEALTH IMPACT ASSESSMENT | 56 | ||
| IDENTIFICATION OF THE PROBLEM | 58 | ||
| FRAMING THE PROBLEMS AND LINKS TO HIA | 59 | ||
| HIA as a solution to achieving healthy public policy | 59 | ||
| HIA as an extension of EIA | 60 | ||
| THE POLICY RESPONSES:THE IMPLICATIONS OF REPRESENTATIONS | 61 | ||
| HIA as a solution to achieving healthy public policy | 62 | ||
| HIA as an extension of EIA | 63 | ||
| FUTURE DIRECTIONS FOR POLICY DEVELOPMENT | 65 | ||
| References | 65 | ||
| SECTION 2 : Governance of thehealth system | 67 | ||
| CHAPTER 6 Federalism and health | 69 | ||
| IDENTIFYING THE PROBLEM | 69 | ||
| THE CURRENT DISTRIBUTION OF FEDERAL AND STATEGOVERNMENT RESPONSIBILITIES | 70 | ||
| POLICY RESPONSES: THE INSTITUTIONS OF FEDERALISM | 72 | ||
| The Constitution | 72 | ||
| High Court decisions | 73 | ||
| Federal–state councils | 74 | ||
| PROGRAM BOUNDARIES AND COORDINATION | 75 | ||
| FUTURE DIRECTIONS FOR POLICY DEVELOPMENT | 78 | ||
| Functional separation | 78 | ||
| Capitated fund holding | 78 | ||
| Jurisdictional realignment | 79 | ||
| Addressing perverse incentives | 79 | ||
| Strengths and weaknesses of functional separation options | 79 | ||
| Improved cooperative action | 80 | ||
| Joint governance | 80 | ||
| Better benefi t sharing | 80 | ||
| Clearer national policy and goal setting | 81 | ||
| Strengths and weaknesses of cooperative action options | 81 | ||
| CONCLUSION | 82 | ||
| References | 82 | ||
| Endnotes | 82 | ||
| CHAPTER 7 - The public service and health\r | 83 | ||
| PUBLIC SERVANTS AND THE PUBLIC INTEREST | 84 | ||
| SIZE AND STRUCTURE OF THE AUSTRALIAN PUBLIC SERVICE | 84 | ||
| PUBLIC SERVICE REFORM | 86 | ||
| The effects of reform | 87 | ||
| Effects of reform 1: political–bureaucratic relations | 88 | ||
| Effects of reform 2: privatisation and outsourcing | 90 | ||
| Effects of reform 3: the structure of the public service | 91 | ||
| LOOKING AHEAD | 91 | ||
| References | 92 | ||
| CHAPTER 8 -\r Municipal public healthplanning policy in Victoria | 94 | ||
| THE POLICY CONTEXT | 94 | ||
| IDENTIFYING THE POLICY PROBLEM | 96 | ||
| THE POLICY RESPONSES | 97 | ||
| Environments for Health development strategy | 97 | ||
| Implementation | 98 | ||
| Impact of Environments for Health | 98 | ||
| Problems faced when developing Environments for Health | 99 | ||
| Factors affecting the success of Environments for Health | 100 | ||
| Ministerial support | 100 | ||
| Strong reference committee | 100 | ||
| Key champion – Director of Public Health | 100 | ||
| Strategic and entrepreneurial Local Government Partnerships Team | 101 | ||
| FUTURE DIRECTIONS FOR POLICY DEVELOPMENT | 102 | ||
| CONCLUSION | 102 | ||
| References | 103 | ||
| CHAPTER 9 - \rThe health workforce:innovation, substitutionand reform | 105 | ||
| IDENTIFYING THE HEALTH WORKFORCE PROBLEM | 106 | ||
| Health workforce as an arena of contest | 106 | ||
| Health workforce complexity and multi-professionalism | 107 | ||
| Indicators of health workforce problems | 107 | ||
| 1. Continuing shortages despite a protracted period of growth | 107 | ||
| 2. A projected signifi cant reduction in total workforce entrants: all industries | 109 | ||
| Sustainability of new entrant policies | 109 | ||
| Profession-centred workforce planning | 109 | ||
| New models of workforce planning | 110 | ||
| THE POLICY RESPONSE TO THE HEALTH WORKFORCE ‘CRISIS | 111 | ||
| The National Health Workforce Strategic Framework | 111 | ||
| The Productivity Commission: Australia’s health workforce | 113 | ||
| FUTURE POLICY DEVELOPMENT: WORKFORCE REFORM | 113 | ||
| References | 116 | ||
| CHAPTER 10 - Regulating complementary and alternative medicine practitioners\r | 119 | ||
| COMPLEMENTARY AND ALTERNATIVE MEDICINE DEFINED | 120 | ||
| AUSTRALIAN POLICY FRAMEWORK FORHEALTH WORKFORCE REGULATION | 121 | ||
| A LONGSTANDING PROBLEM: THE HISTORICAL BACKGROUNDTO POLICY DEVELOPMENTS FOR CAM | 122 | ||
| RECENT POLICY RESPONSES | 124 | ||
| Victorian review of Chinese medicine | 124 | ||
| Review of naturopathy and western herbal medicine | 125 | ||
| National positioning relating to complementary and alternative medicine | 125 | ||
| National approach to health workforce regulation | 128 | ||
| POLICY ANALYSIS | 129 | ||
| CONCLUSION AND FUTURE DIRECTIONS FOR POLICYDEVELOPMENT | 131 | ||
| References | 132 | ||
| SECTION 3: Values in health policy | 137 | ||
| CHAPTER 11 - Conflicting values in health information policy\r | 139 | ||
| THE PROBLEM | 139 | ||
| THE ACCESS CARD POLICY DEVELOPMENTS | 141 | ||
| Population-based health identifi cation of Australians | 144 | ||
| SHARING HEALTH INFORMATION | 144 | ||
| The electronic health information infrastructure | 144 | ||
| The states and territories and the identifi er problem | 146 | ||
| Current policy on patient identifi ers | 146 | ||
| The key problems | 147 | ||
| Duplication and confl ict with parallel smart card developments | 147 | ||
| The predominance of the technological solution | 147 | ||
| The Access Card as a national identity card | 147 | ||
| Function creep | 148 | ||
| The costs of the project | 148 | ||
| Access | 148 | ||
| Ownership | 148 | ||
| The use of taxpayers’ money to fund the project | 148 | ||
| When is a health record not a health record? | 149 | ||
| Benefi ts and disbenefi ts: Access Card health information | 149 | ||
| The threshold question | 150 | ||
| Future policy directions | 151 | ||
| The status of the legislation | 151 | ||
| CONCLUDING OBSERVATIONS | 152 | ||
| References | 152 | ||
| CHAPTER 12 - The problem of trust in health policy\r | 155 | ||
| IN WHAT WAY IS TRUST A PROBLEM IN PUBLIC POLICY? | 156 | ||
| POLICY RESPONSES TO THE PROBLEM OF TRUST | 160 | ||
| Clinical governance | 160 | ||
| Communities’ experience of health institutions | 161 | ||
| FUTURE DIRECTIONS FOR HEALTH POLICY DEVELOPMENT | 162 | ||
| References | 163 | ||
| CHAPTER 13 - Dilemmas in end-of-life care: the Maria Korp case\r | 166 | ||
| IDENTIFYING THE PROBLEM | 166 | ||
| THE POLICY RESPONSES | 169 | ||
| Advance care planning | 171 | ||
| FUTURE DIRECTIONS FOR POLICY DEVELOPMENT | 173 | ||
| References | 174 | ||
| Endnotes | 175 | ||
| CHAPTER 14 - The problem of failing to provide culturally and linguistically appropriate healthcare\r | 176 | ||
| ABORIGINAL HEALTH | 177 | ||
| IDENTIFYING THE PROBLEM | 177 | ||
| Getting the problem on the policy agenda | 178 | ||
| The policy responses | 179 | ||
| FUTURE DIRECTIONS FOR POLICY DEVELOPMENT | 180 | ||
| Towards a new agenda | 183 | ||
| References | 184 | ||
| Endnotes | 187 | ||
| CHAPTER 15 - \rGovernment, medical error,and problem defi nition | 188 | ||
| IDENTIFYING THE PROBLEM | 188 | ||
| A system problem | 189 | ||
| A fi nancial problem | 190 | ||
| A human problem | 191 | ||
| POLICY RESPONSES | 192 | ||
| Government advocates | 192 | ||
| Government reforms | 192 | ||
| Government funds | 193 | ||
| Government regulates | 193 | ||
| FUTURE DIRECTIONS FOR POLICY DEVELOPMENT | 195 | ||
| CONCLUSION | 196 | ||
| References | 196 | ||
| Endnotes | 199 | ||
| SECTION 4: Responding to perennialor emerging healthpolicy problems | 201 | ||
| CHAPTER 16 - \rThe ageing population: insearch of a policy | 203 | ||
| IDENTIFYING THE PROBLEM AND THEVARIABILITY OF STATISTICS | 203 | ||
| POLICY RESPONSES | 203 | ||
| The ‘crisis’ argument and the ‘burden’ of the ageing population | 203 | ||
| The expansion of private sector health delivery | 204 | ||
| Increasing taxation and reform | 204 | ||
| The ‘benefi ts’ argument | 204 | ||
| We don’t know anything for certain | 204 | ||
| Indications are negative | 205 | ||
| We can manage it easily: older people are an asset | 205 | ||
| FUTURE DIRECTIONS | 205 | ||
| Fiscal | 206 | ||
| Migration | 206 | ||
| Employment | 206 | ||
| Case study 1 | 207 | ||
| Sweden: decentralised public sector health with some controlledprivatisation | 207 | ||
| Health reforms | 208 | ||
| Case study 2 | 209 | ||
| Japan: multi-payer, government controlled and semi-privatised | 209 | ||
| Management strategies | 210 | ||
| LESSONS FOR AUSTRALIA | 210 | ||
| References | 211 | ||
| CHAPTER 17 - Reform of the pharmaceutical benefits scheme\r | 214 | ||
| A ‘WICKED’ PROBLEM | 215 | ||
| THE POLICY RESPONSE | 216 | ||
| Changes to the pricing of PBS-listed medicines | 216 | ||
| Price reductions | 218 | ||
| Price disclosure | 218 | ||
| Compensation arrangements for pharmacists and wholesalers | 219 | ||
| Streamlining authority approvals for some medicines | 219 | ||
| Access to medicines working group and stakeholder engagement | 219 | ||
| SOLUTIONS OR LONG-TERM PROBLEM? | 220 | ||
| Arrangements for pharmacists | 220 | ||
| Reference pricing | 221 | ||
| FUTURE DIRECTIONS FOR POLICY DEVELOPMENT | 222 | ||
| References | 223 | ||
| Endnote | 224 | ||
| CHAPTER 18 - Rethinking policy in mental health\r | 225 | ||
| IDENTIFYING THE PROBLEM | 225 | ||
| THE POLICY RESPONSES | 226 | ||
| The National Mental Health Plans | 227 | ||
| Changes under the National Mental Health (NMH) Strategy | 229 | ||
| State-funded mental health services | 229 | ||
| Private sector and primary care services | 230 | ||
| Consumer and carer participation | 231 | ||
| Service quality and accountability | 232 | ||
| Continuing problems despite the NMH Strategy | 233 | ||
| FUTURE DIRECTIONS FOR POLICY DEVELOPMENT | 234 | ||
| The Senate Committee on Mental Health | 234 | ||
| The National Action Plan on Mental Health 2006–2011 | 235 | ||
| BEYOND NATIONAL MENTAL HEALTH POLICY? | 237 | ||
| References | 238 | ||
| CHAPTER 19 - \rAccommodating newtechnology: robotics inprostate cancer surgery | 240 | ||
| A PERENNIAL AND AN EMERGING PROBLEM | 240 | ||
| THE ROBOT | 241 | ||
| PROSTATE CANCER | 242 | ||
| ANALYSIS OF THE PROBLEM | 243 | ||
| Outcomes | 243 | ||
| Cost | 244 | ||
| Access | 245 | ||
| CONCLUSION | 247 | ||
| References | 247 | ||
| CHAPTER 20 - Implementing post-injury rehabilitation policy\r | 250 | ||
| IDENTIFYING THE PROBLEM | 250 | ||
| THE POLICY CONTEXT | 251 | ||
| The salience of vocational goals within rehabilitation | 251 | ||
| The health benefi ts of employment | 251 | ||
| WORKERS COMPENSATION POLICY AND POST-INJURYRETURN-TO-WORK ACHIEVEMENTS | 252 | ||
| The 1985 Victorian WorkCare scheme | 252 | ||
| The problem of the ‘leaking bucket’ | 253 | ||
| Replication of the weaknesses of the Victorian scheme in otherjurisdictions | 255 | ||
| Motor vehicle accident insurance and rehabilitation | 255 | ||
| Vocational achievement following work-related or transportaccidents | 256 | ||
| Research design for understanding post-injury vocationalachievements | 257 | ||
| Unrealised vocational potential following work or transportaccident injury | 257 | ||
| The recent return-to-work performance of the Victorian workerscompensation scheme | 259 | ||
| CONCLUSION | 259 | ||
| References | 260 | ||
| CHAPTER 21 - Achieving uniformity in food hygiene regulation\r | 262 | ||
| THE DEVELOPMENT OF NATIONAL FOOD STANDARDS | 262 | ||
| THE PROBLEM OF NON-UNIFORM FOOD HYGIENEREGULATION | 263 | ||
| THE POLICY RESPONSE | 265 | ||
| THE PROBLEMS OF UNIFORM APPLICATION ANDIMPLEMENTATION | 267 | ||
| FUTURE DIRECTIONS FOR POLICY DEVELOPMENT | 269 | ||
| CONCLUSION | 269 | ||
| References | 270 | ||
| CHAPTER 22 - Improving hygiene and childrens health in remote Indigenous communities\r | 271 | ||
| ABORIGINAL AND TORRES STRAIT ISLANDER POLICIES | 272 | ||
| Extreme levels of disadvantage | 272 | ||
| A historical perspective | 272 | ||
| Health, housing and environmental health policy | 273 | ||
| POOR CHILD GROWTH AND DEVELOPMENT | 276 | ||
| The high burden of infection and poor childhood growth | 276 | ||
| Family and community dysfunction | 277 | ||
| LOOKING TOWARDS THE FUTURE | 278 | ||
| Essential conditions | 278 | ||
| An ecological approach | 278 | ||
| Sectoral harmonisation | 279 | ||
| Enabling environments | 279 | ||
| References | 281 | ||
| GLOSSARY | 284 | ||
| INDEX | 287 |