Health Care Policy Development Scheme in Hong Kong Order Instructions:
Policy, Power and Politics in Health Care Provision: Health Care Policy Development – The Elderly Health Care Voucher Scheme in Hong Kong
To analyze the process of health care policy development with reference to one policy within the Hong Kong health care system. The policy could be one that has been developed for the health care system in general. ( Dear writer, please use Elderly health care voucher scheme in Hong Kong)
Health Care Policy Development Scheme in Hong Kong Sample Answer
Policy, Power and Politics in Health Care Provision: Health Care Policy Development – The Elderly Health Care Voucher Scheme in Hong Kong
Power and politics are critical determinants of policy development in multiple settings. Health care is an important aspect of livelihood, and as such, there always arise needs to better its accessibility, affordability, and availability among other aspects. Following the vitality of health in communities, the relevant political authorities and powers play importantly in developing and modifying health policies. Usually, such policies are developed and enacted through specified processes involving well-designed strategies. This paper discusses the process of health policy development. So as to facilitate the discussion and analysis, the paper looks into Hong Kong’s The Elderly Health Care Voucher Scheme (EHCVS) enacted in 2009 and uses it to illustrate the process of policy development. It is worth noting that Hong Kong has a well-developed primary health care system, and the said policy has significantly contributed to the observed achievements (Food and Health Bureau, 2010).
The Process of Health Care Policy Development
Policies are developed in a systematic manner so as to ensure that they are not only necessary, suitable and applicable, but they are also effective and sustainable. Policies begin with being formulated, adopted, and implemented. After being successfully incorporated into the system, they are continuously evaluated and their impact assessed. It is worth noting that the suitability of policies as determined at the stage of evaluation is influenced by the efficiency of previous processes from policy formulation to implementation. In other words, the phases are interconnected in that their effectiveness influences the final outcomes.
Problem Identification and Development of Solutions
The first stage of policy development involves problem identification and determination of possible solutions (Anthamatten & Hazen, 2011). In health care, the process involves evaluating the system, assessing the efficiency of service delivery, identifying specific challenges, and determining hindrances to effective care (Bosch-Capblanch et al., 2012). While most challenges are experienced by patients and the community, leaders including politicians are actively involved in problem identification. Indeed, the identified problem must be formulated into political agendas for them to drive policy modification or development. Usually, the process of considering problems as political issues attracts stakeholders from multiple settings including health care institutions and wellness groups in the community. Authorities such as local governments may also push for problems to be addressed through approaches such as requesting for the funding of schemes.
The process of policy formulation often involves comprehensive discussions as parties seek to confer on mechanisms to be employed in addressing issues of interest (Gaskin, Jenny, & Clark, 2012). It is worth noting that while problem formulation may appear to be a simple task, such as being able to realize that the mortality rate for a given population is high, the process has other important aspect underlain within it. Instead, rational and comprehensive models are involved where policymakers explore all necessary considerations so as to inform the course of action. These include the determination of the cause of the problem and ensuring that the interventional approach taken will not only solve the superficial problem but its root cause as well. Additionally, policymakers must consider the applicability of policies to the identified problem as some problems could be resolved by certain policies but not others (Chan & Hu, 2013).
In the case of Hong Kong, rising cost of health care services was identified as a challenge that necessitated the development of EHCVS (Chui, 2011). Owing to the susceptibility of the aged to diseases and age-associated inability to work, the elderly suffered more than most other groups. It was also determined that the financial inability of the group forced most elderly patients to rely solely on the relatively cheap public sector for health care services despite there being inadequacies in the sector. As such, the government resolved to address the financial limitations of the group so as to facilitate the population’s access to quality services. By subsidizing health care cost through EHCVS, the government enabled the elderly to seek services in the private sector where they were initially available but inaccessible to many.
The approach presented more health service choices for the group by overcoming the previously observed limitation to a few care providers hence enabling them to seek care that suited their specific needs (Andersen, Bech, &Lauridsen, 2012). At the same time, the approach resolved the issue of congestion in public health care institutions hence addressing health care access challenges among the old rigorously. The government had also observed that family doctors were vital for the promotion of health among the aged. Fundamentally, EHCVS created opportunities for the patients to interact with doctors from the private sector and consequently encouraging the population to consider the concept of hiring a family doctor (Health Care Voucher, 2016). By so being, the scheme did not only solve short-term health problems, but it also facilitated the long-term provision of high-quality care to the financially susceptible group.
Formulation of the Policy
The second stage in formation of policies entails proposing solutions as agenda issues. It involves the development of courses of actions that are effective and acceptable in addressing issues incorporated in the agenda. Effectiveness is mostly the analytical aspect and it involves determination of solution’s validity, efficiency, and ability to be implemented. Alternatives are usually considered if it is determined that the proposed solution would not be effective. Policy acceptability is mostly a political aspect on the other hand. Policymakers consider the available choices in resolving the problem of interest. Possible approaches are analyzed so that policymakers can identify the most effective ones. In health care, policies are evaluated on the basis of their feasibility and validity in solving the identified problem (Andrews, Evans, Dunn,& Masuda, 2012).The policies are analyzed by the relevant political authorities, and if they are determined to be politically feasible, they are authorized for subsequent processes.
The process involves rigorous discussions and bargaining where parties purpose to build a majority on their side. It is worth noting that though political leaders and officials in power are the ultimate decision-makers in policy formation, other parties such as the media and policy analysts are actively engaged and they often have significant impact on the decisions made (Knottnerus, 2010).In some cases, policy formation may also involve research and studies whereby different groups engage as sponsors (Burris, 2013). Essentially, policy formulation is two-sided involving both a technical domain and a political aspect. The former refer to the analyst while the latter refer to the policymaker. It is worth noting that while both parties have complementaryroles, policymakershave more responsibility on the course of the policy than the analysts (Hayes, 2014). Additionally, analysts approach policy formation from the perspective of rationality while their political counterparts focus on compromise and majority-building.
In Hong Kong, EHCVS was evaluated in relation to the criteria for eligibility, financial implications to the country, and the expected take-up rate (Wong, 2012). The process was marked with heated discussions among members of the Legislative Council (Simon, 2013). The cost of running and sustaining the scheme was of particular concern to members of the council who objected it. The voucher value was also comprehensively discussed during the formulation process. Other areas marked with arguments were eligibility to the plan and the impact that the plan was projected to have on the public health care sector (Simon, 2013). It is also worth noting that processes such as designing the voucher scheme were addressed with care so as to prevent developing a policy that was prone to misuse. Likewise, the definition of recipient policies, benefit policies, and the role of service providers was critical as their clarity would influence policy implementation (Karen, 2011).
Policy Adoption
After a policy has been developed, it is adopted into law by the relevant bodies. Adoption entails incorporating the policy into the current laws. Usually, it is the executive arm of the government that adopts policies by either conducting cabinet meetings or having the relevant departments put in place without discussions. Users of the law are directed to comply with the law from a specified time. The adoption process is often accompanied with a launching ceremony where the relevant department makes a formal communication to the public. Policies are also signed into law during their formal launch. The relevant stakeholders are invited for them for signing to be done in their presence.
In Hong Kong, EHCVS was adopted by the health department in October 5, 2009 at Hong Kong University Shenzhen Hospital (HKUSH) (News.gov.HK, 2015). The government held a press conference where it launched the scheme. The process involved highlighting the elements of the policy and inviting the public to enroll into it. In the press release, the government explained the scope and purpose of the policy by stating the policy was applicable to out-patient care for eligible persons starting from the following day. Through the director of health services, the government signed a consent form to mark the launching of the plan with the hospitals CEO in the presence of dignitaries from both the government and the hospital. During the launch, the government also reassured the public that there were high expectations for the policy to resolve the targeted health care problems that faced the elderly.
The government also promised to monitor the policy so that it overcame limitations that could halt its course. In the launching ceremony, the government also explained to the public the processes that were involved in benefiting from the program. As explained, elderly persons who were not less than 70 years and having the national Identity Card or a Certificate of Exception could open the policy’s account for them to access primary care services that were offered by providers who participated in the plan. The government also explained that eligible persons were to acquire and use the voucher electronically, but they would be issued with printed records of their expenditure.
Policy Implementation
Implementation involves practical application of the principles outlined in the policy (Brownson, Chriqui, &Stamatakis, 2010). The process is important as it directly influences the impact of the developed policy in addressing the issue of interest. Prior planning is necessary so as to ensure that a policy befits the setting in which it is to be applied and that it achieves satisfactory impact in solving issues at hand. During policy implementation, new issues may arise, and as such, adjustments are often unavoidable. When examining policy implementation, factors considered include the extent to which the law has worked, the time it has taken to deliver given expectations, the places it has worked, as well as the means through which it has impacted on a given setting (Levaggi&Menoncin, 2014). Successful implementation of policies is presided by a series of considerations and evaluations. Various stakeholders are involved and more so service delivery agencies. It is worth noting that some policies may take long for their full implementation and there might be need for their gradual implementation through phases. Factors that would necessitate gradual implementation include insufficiency of funds or high complexity of policies where by testing should be done for their continuous evaluation prior to overhauling the existing system(Bosch-Capblanchet al., 2012). In most cases, the implementation process is marked with instrumentation that facilitates the efficient running of policies.
In Hong Kong, a “money-follows-patient” basis was first implemented prior to the implementation of EHCVS (Food and Health Bureau, 2010). The process involved provision of partial subsidies for primary health care needs of the aged. The applicability of the policy in enabling the eligible group to access services that suited their needs was continuously evaluated and the feedback used to pilot the novel model. The involved primary care providers included doctors, alternative medicine practitioners, dentists, nurses, and therapists among others. It is worth noting that as a measure to avoid wastage of funds, only specific types of services were catered for in the plan. These included services whose use could be easily monitored and excluded those whose use could not be easily checked. Instrumentations employed during the implementation of EHCVS include setting up an electronic system to facilitate the access and provision of health care services. The system enabled primary health care service providers to enter data about their clients, submit it to the authorities, and generate the voucher balance in print form for patients to access it (Karen, 2011). The system enabled users to open an account from where enrolled practitioners would access their (clients’) information after they had secured the consent of their clients. As Karen (2011) noted, the process had been simplified so as to promote the implementation of the policy as it was feared that complexities would deter the elderly from embracing it. Other measures taken to facilitate implementation by avoiding deterrence to enrollment included not requiring patients to pre-register or carry their vouchers when seeking care. Despite the implementation process being mostly successful, there were significant challenges in the course. For instance, the enrollment was way below the expectations, a situation that challenged the effectiveness of the policy. The voucher value was also determined at the implementation process to be low as beneficiaries of the plan were still forced to cater for their services out-of-the-pocket to a great extent. Indeed, a large number of eligible persons failed to cease the opportunity and instead continued to rely on the public sector.
Policy Evaluation
The last component in policy formation entails monitoring it after it has been implemented. Monitoring enables stakeholders to evaluate the policy, analyze it, and criticize it (Reisman, 2014). Subsequently, stakeholders can assess it alongside other policies and determine whether it is a better alternative depending on the efficiency it achieves. The impacts the policy creates are determined by the use of records, reports, and responses from the users of the systems. In the appraisal of policies, shortcomings are assessed and their weaknesses weighed against the strengths. Usually, effectiveness of policies is determined by considerations of the margin between benefits and under achievements.
If policies are effective, their desirable impact would be felt more than their shortcomings such as heavy expenditure, inconveniences, and other constraints. Essentially, evaluation is done so as to determine chances of policy betterment by enhancing their strengths and correcting their weaknesses. It is carried out with relation to the expectations of the developers, and as such, information is continuously collected so as to determine whether predetermined parameters are fulfilled. The process is important for the government as it guides the course of implementation for optimal efficiency. It is advisable for governments to review their policies regularly so that they can solve presenting issues in time and hence avoid more severe difficulties of implementation. It is worth noting that like in the policy formulation process, analysts and political leaders engage actively but with the former carrying out the better part of activities (Hayes, 2014). In addition to evaluating data from system users, analysts may also conduct research through surveys.
In Hong Kong, reviews of the EHCVS began one-and-a-half years after its implementation (Yam, Liu, Huang, Yeoh, & Griffiths, 2011). At this time, the policy was half-way its set timeline, and therefore, it was possible to monitor its course and the impact it crated on the country’s health care system. In the reviews, parameters emphasized were participation to the plan, embracement of the vouchers, and the responses given by the elderly. The gathered information was then used to modify the plan so that it gained more effectiveness during its last half of implementation. Importantly, feedback was also gathered form service providers as they were centrally involved in the implementation process. From the evaluation process, it was determined that the usage rate of the scheme was below the projections of its developers. Surveys were also conducted by researchers and the awareness of the targeted group about the policy assessed. By assessing awareness, the government was able to determine effective approaches it would employ in informing the public and encouraging eligible persons to enroll in it. Such means included advertisements through media houses. To sum it up, the evaluation processes was necessary for enhanced implementation of the plan.
Health Care Policy Development Scheme in Hong Kong Conclusion
Policy development is an extensive process influenced by politics and power. In health care, policies are often reviewed, modified, or developed so as to suit the demands of communities. Policy development is carried out in stages and every process is critical in influencing the overall impact of plans. Various stakeholders are involved during the policy-making process from the first stage to the last one. In health care, these include the community, medical care providers, political leaders, policy analysts, as well as sponsors. EHCVS was an important scheme for Hong Kong though it did not fully meet the expectations of its developers. The policy contributed significantly to the country’s present day efficient health care system.
Health Care Policy Development Scheme in Hong Kong References
Andersen, L. B., Bech, M., &Lauridsen, J. (2012). Political or dental power in private and public service provision: a study of municipal expenditures for child dental care. Health Economics, Policy, and Law, 7(3), 327-42.
Andrews, G. J., Evans, J., Dunn, J. R., & Masuda, J. R. (2012). Arguments in Health Geography: On Sub-Disciplinary Progress, Observation, Translation. Geography Compass, 6(6), 351-383.
Anthamatten, P., & Hazen, H. (2011).An introduction to the geography of health. London: Routledge.
Bosch-Capblanch, X., Lavis, J. N., Lewin, S., Atun, R., Røttingen, J.-A., Dröschel, D., … Haines, A. (2012). Guidance for Evidence-Informed Policies about Health Systems: Rationale for and Challenges of Guidance Development. PLoS Medicine, 9(3), e1001185.
Brownson, R. C., Chriqui, J. F., &Stamatakis, K. A. (2010).Understanding evidence-based public health policy.American Journal of Public Health, 99(9), 1576–1583.
Burris, V. (2013).Policy formation. Retrieved from http://pages.uoregon.edu/vburris/whorules/policy.htm
Chan, R. K.,& Hu, K. K. (2013).Primary Health Services Utilization and Inequality.Home Health Care Services Quarterly, 29(4), 76-89.
Chui, E. W. (2011). Long-term care policy in Hong Kong: challenges and future directions. Home Health Care Services Quarterly, 30, 3, 119-132.
Food and Health Bureau. (2010). Primary care development in Hong Kong: Strategy document. Retrieved from http://www.fhb.gov.hk/download/press_and_publications/otherinfo/101231_primary_care/e_strategy_doc.pdf
Gaskin, D., Jenny, B., & Clark, S. (2012). Recent developments in health law.The Journal of Law, Medicine & Ethics, 40, 1, 160-175.
Hayes, W. (2014).Defining policy formulation. Retrieved from http://profwork.org/pp/formulate/define.html
Health Care Voucher.(2016). Background of Elderly Health Care Voucher Scheme. Retrieved from http://www.hcv.gov.hk/eng/pub_background.htm
Karen, Y. K. L. (2011). A comparison of the early stages of health care voucher schemes in United States and Hong Kong. Retrieved from http://hub.hku.hk/bitstream/10722/145780/3/FullText.pdf?accept=1
Knottnerus, R. (2010). Guidelines on lobby and advocacy. Retrieved from http://www.icco.nl/Portals/1/Documenten/Lobby%20and%20advocacy%20guidelines.pdf
Levaggi, R., &Menoncin, F. (2014).Health care expenditure decisions in the presence of devolution and equalisation grants.International Journal of Health Care Finance and Economics, 14(4), 355-68.
News.gov.HK. (2015).Press releases. Retrieved from http://www.info.gov.hk/gia/general/201510/05/P201510050880.htm
Reisman, D. A. (2014).Trade in health: Economics, ethics and public policy. Cheltenham, U.K: Edward Elgar.
Simon, K. (2013). Civil Society in China: The Legal Framework from Ancient Times to the “New Reform Era”. London: Oxford University Press.
Wong, E. (2012). Legislative council panel on health services enhancement to the elderly health care voucher pilot scheme. Retrieved from http://www.legco.gov.hk/yr12-13/english/panels/hs/papers/hs1119cb2-309-1-e.pdf
Yam, C. H., Liu, S., Huang, O. H., Yeoh, E., & Griffiths, S. M. (2011). Can vouchers make a difference in the use of private primary care services by older people? Experience from the healthcare reform programme in Hong Kong.BMC Health Services Research, 11(7), 255.
