Master in Health Economics and Policy Ethics and Health (April 10-June 19, 2012)

1. Master in Health Economics and PolicyEthics and Health(April 10-June 19, 2012) Marc Le Menestrel marc.lemenestrel@upf.edu Raquel Gallego raquel.gallego@uab.cat

2. Session 4: Policy making: Problem definition and power. • What is a problem? What sort of ideas become problems? • What is power? Who is powerful? Essay: What is a problem from a policy analysis perspective? Give an example. Required reading: • Dery, D. 1984. Problem Definition in Policy Analysis, University Press of Kansas, Ch.2-3, pp.14-36. [PDF] Optional reading: • Dowing, K 1996. Power. Buckingham: Open University Press • Loseke, D.R. 2003. Thinking about social problems. London: Aldine Transaction.

3. Policycycle Problem Agenda- Decision- Implementation DefinitionSettingMaking Epistèmic Conflicts Simbolic dimension Style Dimension Interaction models Fundamental choice SubstantiveDimension Management scenarios OperationalDimension Source: AdaptedfromGomàand Subirats, 1998

4. Problemdefinition (I) “Wheretobuild a highway?” Bettertoaskhowtodesign a consultation and negotiationproceduretohelp decide wheretobuildit. (Do weneed a highway?...)

5. Problemdefinition(II) Problem:Substantialdiscrepancybetweenwhatitis and whatitshould be: • (+) doesnotidentifyproblemwithinsatisfactorysituation • (+) there’s no problemwherethere’s no insatisfaction • (+) there’s no insatisfactionwherethere’s no aspirationforimprovement • (-) desiredstatemaynot be attainable • (-) ifdesiredstateistaken as constant, onlypresentconditionsmay be manipulated

6. Problemdefinition (III) • Differentsolutionsassumedifferentproblems: • It’simportanttochoosetherightobjective • Choosingthewrongobjectiveinvolvessolvingthewrongproblem • Chooingbetweendifferentobjectivesinvolveschoosingbetweendifferentproblems

7. Problemdefinition(IV) • Analyticalconstruct • Problemvs objectivesituation • Who defines a situation as a problem? • Whoseproblemdefinitionwillprevail? • Qualifiedrelativism: • Instrumental solution • Interventionistperspective • Improvement

8. Problemdefinition (V) • Problem=situation=causes • Causalitychain? • Defining a problem: • Identifying a discrepancythat can be overcome (betweenwhatitisand whatitshould be) • Identifyingthemap/trajectorytogofromwhatitistowhatitshould be • Conceivablesolution: net benefit in relationtotheprevioussituation

9. Problemdefinition(VI) • Problem= opportunityof improvement • Criteriaforchoosingbetweenalternatives • Net benefit • Pareto, Kaldor& Hicks • Technological and politicalviability

10. The role of analysis • “Expert” definitionvs “democratic” definition of problems • Limitations of “scientific/expert” analysis • Ideologicalanalysis

11. Advocacycoalitiontheory

12. Actorsand power(I) • Politics: collectiveactivitythatpursuestheregulation and management of social conflictthroughbindingdecisions(componentof compulsionorimposition => idea of power) • Power: capacitytointervene in thisactivity • Question:whogetswhat, when, how and why? • Pluralistapproach • Elitistapproach

13. Actors and power (II) • Thecapacitytosuccessfullynegotiatedependsonthe use of yourresources: • Expertknowledge • Information • Legitimateautority (legal, expertise, knowledge) • (Un)conditional incentives • Reputation • Context, preferences, resources and stances of alies and opponents.

14. Actors and power (III) • Power: “gettingwhatyouwant” vs “gettingwhatyouwantevenagainstothers’ preferences” • Luck: probability of gettingwhatyouwantwithouttrying • Success: probability of gettingwhatyouwantifyou try. • Luck+ Beingdecisive = Success • Luck= Success – Beingdecisive

15. Actors and power(IV) Luck FortunateUnfortunate Success Successful1 2 Unsuccessful3 4

16. Actors and power(V) • Some are systemicallylucky: theygetwhattheywantwithouttryingbecause of howsocietyisstructured. • Whilepowerisbasedonthe use of specific social resourcesfornegotiation, luckisbased in the social position of individualsorgroups. • Exemple: thecapital’ssystemicluck(Przeworski -’Thevalley of transition’).