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The healthcare policy development process continued

The goal of any healthcare policy is to promote and protect the health of individuals and the community.

The complexity of healthcare policy development

Policymakers should aim to accomplish this goal in a way that is inclusive. Because of this, the process of developing policies in healthcare is complex as it involves legal, political, financial, ethical and social considerations, as well as multiple stakeholders. Similarly, healthcare policy development often reflects choices between competing priorities, as well as the assessment of data. Interest groups, including stakeholders with various priorities in healthcare, select their values and evaluate the data through their own lenses.

Multiple considerations, stakeholders and priorities mean that healthcare policy development encompasses a vast range of issues. This gives rise to questions on whether healthcare policies are developed through rigorous and objective assessment of data or if they’re based on interest groups lobbying policymakers.

Policy development cycle

Easton (1965) and Koh (2006), have pointed out that the policy development process is a cyclical process consisting of issue identification, policy formulation, policy selection, policy advocacy, policy adoption, policy implementation, policy evaluation and policy reformulation, as shown below.

The Policymaking cycle - Starts with pressure for change (new problem/s) - Review evidence and consult experts - policy options - health impact for each option - identify barrier to local implementation - stakeholder consultation - revise policy - implement policy - evaluate policy - pressure for change... Click to expand

In addition to the cycle illustrated above, Pencheon (2006) has pointed out that the policymaking process encompasses three main parts that are outlined below:

Setting the environment for health policy

This involves the assessment of the institutional structures including governance systems, key stakeholders, decision-makers, the broader society and the political context within which the policy is formulated (R). It’s also important to note that the policymaking process is a continuous and iterative process characterised by diversity, with actors competing with each other.

Methodological considerations

The use of a sound methodology is important to develop a flawless or technically sound explicit health policy in terms of its evidence base, political context, and socio-economic acceptance and resource requirements. Accordingly, the methodological requirement encompasses the following:

  • A need assessment
  • An assessment of resources as a situation/ gap analysis
  • Prioritisation and quantitative techniques like modelling
  • Case study and scenario comparisons
  • A micro simulation for impact evaluation

Health policy analysis

This is a multidisciplinary approach to public policy that aims to explain the interaction between institutions, interests and ideas in the policy process. Key components of health policy analysis are illustrated below:

Triangular diagram showing the key components of healthcare analysis - context, actors, content, process

(Adapted from Walt and Gilson 1994)

Click to expand

Your task

Now that we’ve considered the policymaking cycle and stages in healthcare policy development, let’s pause to consider your opinion on this process.

Do you think those involved in developing healthcare policies may have competing interests?

In the context of national and global healthcare policy, do stakeholders have any incentives for supporting or not supporting the policy?

Share your thoughts with your fellow learners in the comments area.

Further reading

Baicker, K. and Chandra, A. (2017). Evidence-based Health Policy. New England Journal of Medicine, 377(25). https://locate.coventry.ac.uk/permalink/f/1ea4mrv/TN_medline29262287

Coles, L., & Porter, E. (2011). Policy and Strategy for Improving Health and Wellbeing. Learning Matters. https://locate.coventry.ac.uk/permalink/f/gr8698/COV_ALMA2137112920002011

Hangulu, L., and Akintola, O. (2017). Perspectives of Policy-makers and Stakeholders about Health Care Waste Management in Community-based Care in South Africa: A Qualitative Study. BMC Health Services Research, 17(1), 290. https://locate.coventry.ac.uk/permalink/f/1ea4mrv/TN_gale_ofa490266797

Toth, F. (2010). Healthcare Policies Over the Last 20 Years: Reforms and Counter-Reforms. Health Policy, 95(1). https://locate.coventry.ac.uk/permalink/f/1ea4mrv/TN_elsevier_sdoi_10_1016_j_healthpol_2009_11_006

World Health Organization. (2020). National Health Policies, Strategies, and Plans. https://www.who.int/nationalpolicies/processes/en/


Easton, D. (1965). A Framework for Political Analysis. Prentice-Hall

Koh, Y.M. (2006). 4.4 Shaping Your Organization’s Policy. In D. Pencheon, Oxford Handbook of Public Health Practice (2nd ed.). Oxford University Press. https://locate.coventry.ac.uk/permalink/f/1r06c36/COV_ALMA5199861310002011

Pencheon, D. (2006). Oxford Handbook of Public Health Practice (2nd ed.). Oxford University Press. https://locate.coventry.ac.uk/permalink/f/1r06c36/COV_ALMA5199861310002011

Walt, G. and Gilson, L. (1994). Reforming the health sector in developing countries: the central role of policy and analysis. Health and Policy Planning, 9(4). https://locate.coventry.ac.uk/permalink/f/1ea4mrv/TN_medline10139469

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This article is from the free online course:

Policy Formulation and Analysis in Healthcare

Coventry University