Topic 10: Health Policy - Making
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Module: Health systems, economics and policy
Topic 10
Topic 10: Health Policy - Making
Objectives/learning outcomes
Students will be able to:
Recognise, understand and apply analytically concepts of power, authority, elitism and pluralism.
Seminar: The political economy of health policy-making: in whose interests are policies made?
The political economy of health policy-making: in whose interests are policies made?
Using the Supri and Poses papers:
a) identify examples of each of the concepts of power and authority;
b) characterize the political economy of health policy-making in the case studies;
c) and explain the theoretical framework underpinning your account of this political economy.
Set Reading
Buse K, Mays N, Walt G (2005). Making Health Policy. Understanding Public Health Series Open University Press (chapters 1 and 2).
Salinder Supri and Karen Malone. On the critical list: the US institutions of Medicine. American Journal of Medicine 2011; 124: 192-3. HERE
Roy Poses (2003). A cautionary tale: the dysfunction of American health care. European Journal of Internal Medicine 14 (2003) 123–130. HERE
Additional reading
Lukes, Steven. (New York : Palgrave Macmillan, 2005.) 2nd ed [ELECTRONIC RESOURCE] Chapter 1.
Colin Crouch. The Strange Non-Death of Neoliberalism (Polity, 2011), chapters 3 and 4.
Lecture: Power and decision-making: a conceptual framework
In this lecture we will examine standard accounts of the policy-making process and ask how power over health policy decision-making is generally conceived. Three basic distinctions are made in the examination of power and decision-making. The first concerns the difference between power and authority (Weber); the second concerns the exercise of power in the form of dominant ideas (Lukes); and the third concerns analytic frameworks for understanding who has power – elites (“elite theory”), pluralistic groups within a democratic state (“pluralism”), or pluralistic self-interested groups that include state machinery (“public choice theory”).
Power is often associated with decision-taking in the policy-making process. Policies are after all formulated, deliberated on and by some approval process adopted. So who has access to the decision-making process? Is influence and control over the process equally distributed or are some interests better represented than others? Are all important matters determined in what we call the decision-making process or are some issues dealt with outside it and elsewhere, and if so, by whom and in whose interests? Social and political theorists have developed a number of concepts and theories to address questions such as these.
