This book establishes a new framework for thinking critically about health policy using leading edge thinking about governance, policy and administration. It brings together a number of different aspects of health politics, policy and governance, to produce an original and coherent approach to critically analysing health politics and policy. A deliberately political analysis is used to examine the health policy process as a system which is complex, interconnected and dynamic. It also uses empirical examples from a number of countries to address important theoretical questions, synthesising theory and observation, and drawing substantially on the broader insights available from contemporary politics, policy and governance research to understand health policy.
The approach taken in this book characterises health policy as a network of interactions between people, organisations, structures and ideas. So, the formal and informal interconnections between people and organisations, the structuring of which ideas can be discussed and in what terms, and the location and use of power are all central to the book's framework.
Five interrelated elements of the framework for analysis are described. These are institutions and health systems, governance, power and influence, professions, and ideas. Both structure and action are important to varying degrees in relation to the framework's components. Structures shape the role of actors but do not fully determine them, and actors inhabit structures and also change them to support and advance their positions. Central to the framework is the realm of ideas, which is regarded as the point where structure and action meet. Ideas are crucial in shaping structures, and how actors think, yet have been generally neglected in health policy analysis.
Each element of the book's framework is described in a chapter. In the second chapter, institutions and health systems are described as formal, structural arrangements, which set certain pathways and make it difficult to break out of established policy routines. The institutions and health systems of six wealthy countries are compared to highlight similarities and differences in these histories and traditions. Governance is portrayed as a dynamic process that refers to modes of governing state and society interactions. Changing modes of governance, applied around the world as health care systems have been reformed, are examined in the third chapter.
The fourth chapter on power and influence examines clusters of actors who, when formed into interest groups, exercise considerable political power and influence in the policy process. This is complemented by a discussion of networks of influence, generating a more informal and active view of power. Professions have extraordinary importance in the health sector, and their unique position is the focus of the fifth chapter. Professions are considered as part of the institutional base of the health policy system, as powerful interests, and as a multi-faceted concept that requires a close examination of different aspects of professions.
Ideas are the final element of the book's critical framework. In the sixth chapter, they are viewed as fundamental paradigms, and as the tool for discursive policy making. In addition to the structural aspects and the role of important actors, fundamental ideas and values percolate throughout the health sector, and are central to shaping arguments about it. Analysis of health policy must consider how the foundational biomedical paradigm underpins policy proposals, rendering them more or less acceptable.
The discussion of each of the elements of the framework is followed by three contemporary health policy studies. The first of these is an investigation of state-profession relationships. The different traditions of Australia, Britain and the Netherlands, and recent changes in how governments deal with and talk to the professions in these nations are examined. The second looks at local level partnerships in health, specifically in relation to primary health care. Local level partnerships in Britain and in one state of Australia (Victoria) are explored, analysing their success in moving to new methods of governing and the impact they have on health policy. The third policy study discusses contemporary health issues, or health policy problems. It ties the structuring of the health policy agenda to the connections between influential people and their favourite issues, and foundational ideas.
The book's focus is health policy in Western liberal democracies. The empirical research included is centred on Australia, but comparative analyses with Britain, Canada, the Netherlands, New Zealand and the United States of America are included. While it will primarily be of interest to those seeking to understand health policy and politics in Australia, the insights generated are not unique to Australia.
It will be useful to anyone interested in health policy, the politics of health, and governance and administration in health, as well as those interested in public policy and social policy more broadly. Researchers of health policy, public policy, social policy, health politics, health administration and public health, will find the analytical framework useful. Health policy practitioners and administrators working in health authorities and service delivery organisations, and health professions and professionals, particularly in medicine and nursing, will also find it helpful. |
