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Modification. Imperfect policymaking process results in modificationWhen the implemented policy indicates that preferences and reality do not match, efforts are made to modify the policy.. Policy Modification. Policy initiation and policy modification are conceptually different but related.Policy
Policy Modification

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1. Chapter 9 Policy Modification

2. Modification Imperfect policymaking process results in modification When the implemented policy indicates that preferences and reality do not match, efforts are made to modify the policy.

3. Policy Modification Policy initiation and policy modification are conceptually different but related. Policy initiation results from: -confluence of problems -possible solutions -alignment of political situations These lead to development of new policies.

4. Policy Modification Policy modification results from existing policies that need changes in legislation, rules, or operation. Specific to health policymaking, some policies are created in the traditional manner, but most health policies result from the modification of prior policies.

5. Policy Modification Incrementalism: -permits time for adjustment -creates minimal disruption -causes minimal alteration

6. Policy Modification Results of incrementalism: -predictable and stable decisions -mechanism for compromise -source of creativity

7. Policy Modification Leaders in health related organizations and interest groups are positioned to determine if implemented policies are obtaining desired results. New solutions or modification to existing solutions can be formulated to amend existing laws. Amendments go through the regular development process.

8. Policy Modification Feedback serves as the stimulus for modification One of the most frequently used ways in which modification takes place is through changes in rules and regulation. Changed rules = modified policies

9. Policy Modification 2nd Phase of modification = operation Operation Phase = actual running of the program or agency. Mangers have significant opportunities to have an impact on those affected by the law by modifying policies.

10. Policy Modification Internal & external stimuli for modifying operations. Internally: -control the results of their operations - establish standards or operating objectives -operations ensue & results are monitored -changes made in operations/objectives when results don?t measure up to predetermined standards.

11. Policy Modification Externally: -pressure for change is exerted by those affected by the consequences of the laws -opportunity for individuals & interest groups to influence managers to make modifications -leaders of orgs. and int. groups build long-standing working relationships?.

12. Policy Modification The cyclical relationship between rulemaking & operation involves the feedback of experiences gained in the operation of the program. The info gained from the operation experience can be used to influence the modification of rules & regulations.

13. Policy Modification The two structural features in the modification phase are oversight and evaluation. Oversight power: -the legislative branch -the chief executive (at all levels) -the courts

14. Policy Modification Purpose: to analyze and evaluate the execution and effectiveness of laws and to determine if additional laws or amendments to existing laws are needed, or if the results of one policy infringes or conflicts with the desired results of other laws/policies.

15. Policy Modification The courts have played an important oversight role in modifying health policy by interpreting how laws are enforced. These areas of health policies have been modified by the courts: Coverage decisions States? payment rates Antitrust rulings

16. Evaluation Evaluation=process of determining the worth or value of something appropriate to certain criteria. Evaluation is part of a continuum of analytical activities that occur throughout the entire policymaking process.

17. Evaluation Policy evaluation approaches: Before & after comparisons With and without comparisons Actual vs planned performance comparisons Limitations: None of these approaches determine causation.

18. Evaluation Alternative approaches to address limitations: Experimental & quasi-experimental designs Cost-oriented policy evaluation such as CBA and CEA

19. Who is responsible for policy evaluations? GAO OMB AHRQ CBO CRS

20. Summary Policy modification=result of positive or negative consequences which stimulates other phases of the policy process. Health policies= result of prior policies. Current policies may need future modifications b/o demographic, econ., ethical, legal, cultural, social, bio, psych & tech. changes.


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