The word "policy" is not a tightly defined concept but a highly flexible one, used in different ways on different occasions.
Policy can be defined as a definite course or method of action selected (by government, institution, group or individual) from among alternatives and in the light of given conditions to guide and, usually, to determine present and future decisions.
Policy is a specific decision or set of decisions designed to carry out such a course of action. Such a specific decision or set of decisions together with the related actions designed to implement them. Policy is projected program consisting of desired objectives and the means to achieve them
Policy is also defined as "the continuing work done by groups of policy actors who use available public institutions to articulate and express the things they value." (M. Considine 1994)
There are important overlaps between social policy, economic policy and health policy. Social policy is concerned largely with the maintenance and distribution of income, and the provision of welfare services such as housing and transport to specific target groups such as the poor. While, in principle, health policy has a narrower focus, for example in meeting the health needs of a specified population, health insurance policies may be designed to cater to the same target groups as those catered to by the social welfare sector. Similarly, health policies may have very significant budgetary implications for governments.
Policy, Public Policy and Health Policy
Policy is a deceptively simple term that conceals some very complex activities. Policy evolves, As new issues arise, e.g. AIDS, new fields of public policy emerge and develop through stages. Policy both evolves over time and goes through iterations of stages as changes occur in the context of the policy issue. Policy is a purposeful planned attempt to establish principles and programs designed to address perceived problems.
What Is Public Policy?
Public policies are normally used when we are dealing with those policies for which governments are primarily responsible.
Public policies are carried out in the name of the people as a whole, and they affect the public interest. The term "public" implies that a distinction can be made between these activities and those of private individuals and groups (Forward, 1974).
In the health field we are concerned primarily with government policy-making, although private policies of organizations such as the medical association impinge heavily on the overall policy-making process.
What is Health Policy?
Health policy generally embraces courses of action that affect that set of institutions, organizations, services and funding arrangements that we have called the health care system.
Health policy includes actions or intended actions by public, private and voluntary organizations that have an impact on health. The term also includes political parties' policies that may be translated into government action at a later stage.
Thus, policy may refer either to a set of actions and decisions, or to statements of intent.
Policy-making is a competitive process, with the competing interests of different groups involved in shaping the direction that policy takes. Policy results from "a synthesis of power relationships, demographic trends, institutional agendas, community ideologies (and) economic resources" (Brown 1992).
Some interested groups involving themselves in the policymaking process have a great deal more power than others because of their political position and their ability to influence the views represented in the mass media. For example, mainstream medical interest groups are usually listened to by members of parliament and shape the public agenda more strongly than other groups, and their opinions are reported more often by the mass media.
It is the politicians, bureaucrats and powerful interested groups who set the agenda and decide the framework and philosophy of a policy. Members of the public commenting on a document are often in the position of trying to change the policy after the framework has been set.
According to Lowi's (1964) very useful typology, as adapted by Salisbury and Heinz (1970), there are four distinct ways in which public policies are perceived to affect individuals and organizations:
- Distributive: The provision of services or benefits to particular segments of the population. Distributive policies are characterized by the relative ease with which they can be adopted and implemented, since each policy can be implemented more or less in isolation from other policies.
- Regulatory: The imposition of limitations or restrictions on the behavior of individuals or groups. An example in the health field is legislation regulating the behavior of registered health professionals, such as medical practitioners and nurses. Regulatory policies are reasonably specific and narrow in their impact. They determine who is restricted and who is given greater freedom.
- Self-regulatory: Sought by an organization as a means of promoting its own interests. Self-regulation may benefit an organization directly or indirectly since being seen to be self-regulatory may enhance the official credibility of the organization. This self-regulatory principle can apply to peer review policies as developed by a number of health professions.
- Redistributive: Deliberate efforts by governments to change the distribution of income, wealth, property, or rights between groups in the population. In general, redistributive policies tend to provoke strong disagreement between sections of the population. Redistributive policies are relatively difficult to implement, and even more difficult to maintain, because there are always parties who gain and parties who lose when money and power are reallocated between groups.