Policy Proposals
Selecting and Weighing Criteria in Step 3
In order to select an optimal policy, policy advocates must first identify the criteria to use as a
basis of comparison. In simple cases, a single criterion suffices; given three policy options, for
example, with the single criterion being cost, the cheapest policy option would be selected. In
most cases, however, advocates identify several criteria. For example, they might consider costs,
administrative feasibility, and effectiveness in addressing consumers’ needs.
Policy advocates can select a variety of criteria. As was discussed in Chapter Two, value-based
criteria are reflected in terms such as equality, equity, social justice, and var- ious freedoms, such
as the right to free speech, the right to privacy, the right to receive accurate and honest
information, and the right to self-determination. (Moral philosophers and religious leaders
discuss these value-based criteria, which are also discussed in the due process clause of the Fifth
and Fourteenth Amendments to the U.S. Constitution and in the Bill of Rights.)
Consumer-outcome criteria define specific policies’ effectiveness in ameliorating social
problems. In the social services, for example, people often scrutinize how various policy options
will affect clients’ well-being.
Terms such as efficiency and cost reflect economic criteria. Having limited resources, policy
advocates must assess the relative cost of competing options. Feasibility criteria pertain to the
political and administrative practicality of specific policy options. An option may seem quite
attractive but may be rejected because it cannot be implemented or is not politically feasible. For
example, some people believe we should decriminalize certain drugs, such as cocaine, by selling
them at low prices in state-regulated stores. However, many practical details confound the
administration of this policy. If cocaine were legalized, what about countless other substances,
including some that have not even been invented? If cocaine were legalized, the state-regulated
stores might offer a wide assortment of mood-altering substances. Who would pay for growing
or manufacturing the currently illegal drugs? Should poor persons be allowed to use their food
stamps to purchase them? Could federal authorities easily override state laws that declare mood-
altering substances illegal? Would authorities have to limit the amount of a drug someone could
purchase, or could persons obtain unlimited quantities? Could drugs in such an open market be
kept from adolescents or schoolchildren, or would older friends, siblings, or even some parents
supply them? Some politicians would very likely assail this policy for threatening to cor- rode
youths’ morals by making drugs too accessible.
Externalities criteria are used to assess how a policy option would affect institutions or persons
who initially appear to be unrelated to the policy. If drugs, including hallu- cinogens, were
decriminalized, policy analysts would have to ask whether driving acci- dents would markedly
increase. This externality could not be dismissed as trivial because as many as 35,000 Americans
die each year from accidents caused by driving while under the influence of alcohol, which some
consider as similar to a decriminalized and accessible drug. However, some positive externalities
might offset these negative ones. The reduced price of drugs and their increased availability in
state-regulated stores would drive criminal elements, gangs, and foreign profiteers out of drug
dealing and would make it unnecessary for addicts to steal to support their habit. It would also
save the federal government the millions it currently spends on combating drug smugglers,
money that could well be used to fund social programs.
Terms such as cost effectiveness reflect how we can combine several criteria into single
measures.36 In cost-effectiveness studies, analysts want to know which policy will most benefit
consumers at the lowest cost. One policy option may yield considerable benefit to consumers,
but at a prohibitive cost; another option may yield few benefits, but at a low cost; and a third
option may provide considerable benefits at a relatively modest cost. A policy analyst who wants
a cost-effective policy would probably select the third option because it balances cost and
effectiveness.
When selecting more than one criterion, policy advocates need to weigh their relative
importance. This is not a scientific undertaking; it reflects the values of the pol- icy practitioner.
For example, when discussing alternative criteria for evaluating welfare reform (see Chapter
Seven), many policy advocates would be more likely than conserva- tives to emphasize welfare
reform’s effects on the economic well-being of former recipients, whereas many conservatives
would emphasize its effects in reducing the welfare rolls.
Our social work intern decided to select four criteria, assigning a numerical value to each of
them. To force herself to determine the relative importance of these four criteria, she decided to
make the four scores add up to 1.0. She gave the most weight to cost and effectiveness in helping
patients with translation needs, wanting to help patients immedi- ately but realizing that funds
were short in her hospital. (Each of these criteria was scored as 0.3.) She included the criteria of
political feasibility and ease of implementation, realiz- ing she would need high-level approval
that would stem partly from the administrators’ belief that the project could be easily
implemented. (Each of these criteria was scored as 0.2, so the total score for the four criteria was
1.0.) Of course, someone else might have weighted the criteria differently.
Creating a Decision-Making Matrix in Step 3
To help them select policies, advocates often construct a decision-making matrix that graphically
portrays the options and the criteria.37 Our social work intern placed her four options and her
four criteria on a decision-making matrix that organized her options and criteria into a table (see
Table 8.2
Decision-Making Matrix
CRITERIA
POLICY OPTIONS
Cultural course for new residents
Computerized list of Spanish-speaking employees
Hiring more interpreters
Recruiting 40 bilingual undergraduate volunteers
COST EFFECTIVENESS IN HELPING PATIENTS WITH TRANSLATIONS
EASE OF IMPLEMENTATION
POLITICAL FEASIBILITY
Recall that she had already rated the criteria by giving scores of 0.3 to cost-effectiveness and
scores of 0.2 to political feasibility and ease of implementation. (See the criteria at the top of
Table 8.3, which shows how she rated the criteria and the options.)
She then rated the policy options by the criteria (Table 8.3). She decided to rank each of the
options from 1 (poor) to 10 (outstanding), using information gleaned from physicians and
administrators, as well as her own best guesses. She rated the cultural course as 6 with respect to
cost because it would require the development of curriculum and staff to teach it. Because the
computerized list would be relatively inexpensive to produce, she gave it a ranking of 8. She
ranked the hiring of more interpreters as 1 because it would require more paid hospital staff. The
recruiting of undergraduate volunteers was ranked 7; while they would provide free labor, staff
time would be needed to recruit, train, and coordinate them. She then ranked the four policy
options by the remaining three criteria. As shown in Table 8.3, she gave the lowest score on
effectiveness in helping patients with translations to the cultural course (3) on the grounds that it
might sensitize residents to the culture of Latinos, but it would not provide new translation
services. Regarding political feasi- bility, she ranked the option of hiring new translators the
lowest, giving it only a score of 3 because she doubted that the hospital administrators would
fund this proposal. All of the options were relatively easy to implement, she decided, not giving
any of them a score lower than 6.
She discovered that each option had at least one weakness: The cultural course would not make
an immediate impact on the translation needs of patients; the computerized list would not prove
easy to implement because bilingual staff could not interrupt their regular assignments and
become translators on the spur of the moment; hiring new translators was too costly; and training
and coordinating undergraduate volunteers might prove difficult to implement.
The student intern now had to calculate scores that combined her ranking of the options for each
criterion and the relative importance of each criterion (the number in parentheses next to each
criterion in Table 8.3). She multiplied the option rating in each cell by each criterion score,
arriving at a final score for each cell (the subscript number in italics). To score the recruiting of
undergraduate volunteers by the cost criterion, for example, she multiplied 0.3 times 7, arriving
at a score of 2.1 in the lower-left-hand cell.
Then, she added the scores for each option across the table to discover the total score for each
option. She concluded that using undergraduate volunteers was the best solution, because it
received a total score of 7.8, compared with the next closest option, the computerized list, which
received a score of 7.3. (See the total scores for each option in the right-hand column of Table
8.3.) She hoped she could get a local foundation to provide funds for a part-time coordinator to
recruit and train these volunteers. She was excited about this option for educational reasons as
well: It would provide an excellent opportunity for the students to learn about the health care
system.
The term trade-off refers to assessing the comparative advantages of policy options. The policy
practitioner seeks to discover which option has the most weight, that is, the great- est net score
on the criteria that the policy analyst has identified and ranked.38 Thus, the student intern
selected the fourth policy option, even though other options had received higher scores on
specific criteria.
When reviewing this example of a decision-making matrix, it is important to dwell not on the
details of the scoring rules but on the style of analytic reasoning. Other approaches to scoring
could easily have been used to rank the criteria and the various options and to compute the final
scores. When using an analytic style of reasoning, the policy analyst breaks the selection process
into a series of sequential steps that eventually lead to an over- all score for specific options.
Using a policy matrix does not necessarily eliminate conflict; persons may disagree about the
criteria selected, their relative importance, and specific options’ scores for those criteria. When
policy analysis occurs before a policy is enacted, as in this hospital case, policy practitioners
must predict the outcomes, costs, and consequences of options. Such predictions often turn out to
be partially inaccurate; in this case, the student intern might later discover that she had
underestimated the costs of a policy option or its effectiveness in solving a social problem.
Assume, for example, that another policy analyst came to a strikingly different conclu- sion than
this student intern. The student intern did not realize that hospitals are required by federal civil
rights legislation to give translation services to consumers who have lim- ited English
proficiency (LEP). Nor was she aware that translation services can be accessed through
telephone connections that link a health provider and an LEP consumer with a translation-using
technology. This policy analyst, too, realized that bilingual undergrad- uate students lacked
sufficient familiarity with medical terms—even with considerable in-service training. How might
this knowledge have led this policy analyst to reconfigure Table 8.3 and possibly reach new
policy recommendations that would markedly change her policy brief?
Qualitative Rankings
Had the student intern not been quantitatively inclined, she could have ranked her four policy
options qualitatively. Some critics of quantitative techniques would readily sup- port this tactic
on the grounds that the existing data do not allow accurate quantitative rankings. However,
persons making qualitative rankings (such as high, medium, and low) would still have to develop
options and criteria and weigh the criteria to judge the relative merits of the policy options.
Table 8.4 shows some trade-offs that social workers in agencies often encounter. Indeed, the
student policy advocate discussed earlier in the chapter who developed leg- islation to help
victims of domestic violence would have encountered each of the trade- offs in Table 8.4 when
designing shelter programs at the local level (see Policy Advocacy Challenge 8.3).
ABLE 8.4 Trade-Offs in Policy Options
POLICY OPTIONS
Using intensive rather than extensive services, Developing community-based rather than agency
services, Using generalist rather than specialized services or staff, Providing preventive rather
than curative services, Using universal rather than selective eligibility, Using decentralized rather
than centralized services, Using multiprofessional teams rather than single-profession teams
ADVANTAGES
Provides in-depth services with greater impact, Decreases stigma of service; helps integrate
consumers into mainstream, Focuses on client as a whole person, Allows early detection and
treatment of social problems and educates consumers to forestall development of problems,
Allows staff to serve all applicants; makes imposing means tests unnecessary, Makes outreach to
consumers possible; improves access to services and use of community networks, Allows many
professions to contribute to service
DISADVANTAGES
Denies services to large numbers of consumers, Is difficult to orchestrate several community
services and involve transient populations, Staff members lack specialized expertise relevant to
consumers’ specific needs, May neglect the needs of people who already have a serious problem,
Makes it difficult to target scarce resources on those with particularly serious problems, Is more
expensive to operate than centralized facilities, May promote interprofessional conflict