The Legislative Process #415

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Policy Analysis and Design

CHAPTER 4

Stages of the Policy Process (1 of 4)

Federal Government’s Involvement in Social Issues

Rapid expansion in the 20th and 21st centuries

Creation of Medicare and Medicaid

Passage of the Patient Protection and Affordable Care Act (ACA) in 2010

Current considerations

Quadruple aim initiative

Availability of funding

How to incorporate policy design into all phases of the policy process

The Policy Process

Policies that address social problems are usually formulated by many groups.

The proliferation of participants in policy formation makes it difficult to achieve systemic program design.

Decision making is often conducted hastily.

Lack of information

Constituency impatience

Lack of expertise

Much policy that regulates nursing practice is determined at the state level.

Research Informing the Policy Process

Health services research

Examines a multitude of factors, systems, and processes in the delivery of health care

Informs policy in a number of ways

Public Opinion Informing the Policy Process

Four groups of society

Advantaged—politically influential; public views positively (scientists, veterans)

Dependent—politically weak but viewed positively (children, mothers, those with disabilities)

Contenders—politically strong but perceived negatively (the rich, big unions)

Deviants—politically weak and perceived negatively (criminals, drug addicts)

Effects of policies favoring the advantaged and punishing deviants

The Design Issue

Unclear mandates often result in a mismatch between legislative intent and bureaucratic behavior.

Unintended consequences

Policy failure

By shifting the focus of study to policy design, a more reliable answer regarding policy success can be found.

Requires understanding of policy tools or instruments chosen for policy design

Requires understanding underlying assumptions of policymakers during the design process

Policy Instruments (Government Tools)

Schneider and Ingram’s (1990) analysis uses government or instruments and underlying behavioral assumptions as variables that guide policy decisions and choices.

They argue that the tools approach moves policy beyond considering the standard analysis and improved frameworks.

To understand which tools are the most productive, emphasis should be on using them in conjunction with a particular policy design.

Authority Tools

Most frequently used by governments to guide agents and officials at lower levels

Are statements backed by legitimate power of government that grant permission and prohibit or require action under designated circumstances

Incentive Tools

Assume individuals will not be motivated to take action without encouragement or coercion

Rely on tangible payoffs as motivating factors

Positive or negative

Assume individuals have the “opportunity to make choices, recognize the opportunity, and have adequate information and decision-making skills” to choose the best option

Capacity-Building Tools

Provide information, training, education, and resources to enable individuals, groups, or agencies to make decisions or carry out activities

Assume populations will be motivated adequately without incentives

Require that populations be aware of the risk factors associated with the tools and how these tools can help

Symbolic or Hortatory Tools

Assume people are motivated from within and decide whether to take policy-related actions based on their beliefs and values

Examples of hortatory tools

Use of lower-number legislative bills reserved by congressional leadership

Federal request for proposals to research a particular topic

Examples of symbolic tools

Presidential executive orders

Learning Tools

Used when the basis upon which target populations might be moved to take problem-solving action is unknown or uncertain

Often used with policies that are open-ended in purpose and have broad goals and objectives

May require a needs assessment to be completed

Behavioral Dimensions

APRNs must understand behavioral assumptions and the political context in which tools exist.

The political climate in which social problems are addressed often prescribes the choice of tools to be implemented.

Case Study: COVID-19, Disparities, and the CARES Act

Race-related health disparities in both COVID-19 cases and deaths

Social contributors to health disparities

Income

Education

Structural racism

CARES Act beneficiaries

Authority tools at play during the pandemic

Conclusion

Active participation in the policy process is essential.

RNs and APRNs must understand:

How the process works

Points where the greatest impact can be made

The Legislative Process #415

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