Wykorzystanie programu policy maker w polityce zdrowotnej. Niektóre aspekty wdrażania reformy opieki zdrowotnej w Polsce
Instytut Zdrowia Publicznego Collegium Medicum Uniwersytetu Jagiellońskiego
Data publikacji: 08-06-2020
Problemy Polityki Społecznej 2000;2:63–87
Political mapping is a technique of political analysis at the service of study effectiveness, formulation and implementation of social politics targets. A computer program, Policy Maker was developed at Harvard’s University as a tool enabling practical application of mapping. It is based upon extensive theoretical grounds including a model of rational behaviour, model of public administration, model of bureaucracy, concepts of business groups, model of public option, principles of Marxist analysis and stakeholders analysis. In the past each approach was used in analyses of health sector. Policy Maker enables us or at least makes us easier to make use of the analytical and constructive potential of the technique. Researchers describing and explaining the processes in health politics, as well as political decision-makers that want to be more effective may equally collect benefits. The main aim of the authors was not only to demonstrate the tool but also to prove its usefulness in direct co-operation with leaders of the health care reforms. The starting point was to define the goals, prepared for this purpose in co-operation between the researchers and the members of the health care reforms leader group. However, it should be emphasised that the goals presented below should be regarded as ‘obligatory only in the present phase of the reform’. The following four goals were considered as most important in the implementation of the health care reform: Organisation of the negotiation process within the system Restructuring of the employment with the assumption that the increase in the number of professional workers is not the aim of the reform process Achievement of a high level of professionalism among the participants of the health care system Utilisation of external (informal) resources for the public benefit. A very important element in PM analysis is stakeholders analysis. It is a systematised way of analysing groups and individuals depending on their involvement and role in the implementation of the defined goals. One should identify all critical groups and individuals, both with respect to their true or hidden interests and general approach, which is indispensable for building up an effective coalition and strategy. The most difficult stage in analysis is working out a strategy. Policy Maker comprises two methods of strategy planning: a general set of suggested strategies to be used or adjusted, and a tool for reviewing and evaluating the information, which has already been entered to provide original solutions. Two dangers that may be encountered in the implementation of the reform emerged upon scrutiny: opposition or less than expected support due to a lack of knowledge about the reform in a large number of the participants of the health care system, and marked opposition by the key medical staff. Thus, the fundamental goal of the suggested strategy was to overcome these difficulties. In the course of work with the reform leaders the following recommendations have been proposed: 1. Provide clear interpretation of legal regulations. 2. Ensure security for the laid off persons 3. Neutralise environments of opposition 4. Provide concrete and solid information 5. Consult independent experts 6. Apply temporary solutions in POZ (Primary Care) 7. Motivate doctors to individual practice 8. Eliminate unprofitable organisations in the health care. 9. Guarantee financial benefits 10. Establish clear principles of contracting 11. Increase nurses’ scopes of authorization It should be emphasised that the strategies although worked out in co-operation with the reform leaders have never been applied and in this way the effects of the procedure have only a cognitive nature.
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