Introduction
McLaughlin and McLaughlin (2014) describe seven policy analysis processes at length, including the identification and definition (of the problem and the process), the analysis of values, the evaluation of political feasibility and economic viability, the implementation strategy and planning, and health technology assessment and evidence-based medicine analysis. In this paper, four of these processes will be applied to Proposition 63, which will allow us to get an insight into the process of policy analysis as well as the policy itself. Given the fact that McLaughlin and McLaughlin (2014) describe policy analysis as a learning process (p. 192), such a use of their framework appears to be fitting.
The Policy
The policy that is going to be considered here is the California Proposition 63, a plan developed by the Mental Health Services Act, which involved introducing additional tax (“1 percent tax on personal income over $1 million”) in order to provide the funding to mental health services that have been created through the Mental Health Services Act (Bambauer, 2005, p. p.642). It was enacted in 2007 (Jenson & Fraser, 2015).
Bambauer (2005) analyses this policy to gain an insight into its popularity among the population of California. Here, a similar attempt is being made. We are going to consider Proposition 63 from the point of view of identification and definition, values analysis, economic viability, and political feasibility. These processes are chosen to ensure an extensive overview of the kind of reform that the Proposition intended to bring along. In the future, the implementation of the plan can be considered to try to locate similarities and difficulties with the initial intent and the final version of a policy.
The processes that remain unused in this paper include the implementation strategy and planning, which is concerned with the thorough consideration of the issues that are likely to arise in the processes of policy implementation and the preparation to resolve or avoid them. The implementation is the most important part of a policy assessment, but here, greater attention is paid to the policy’s concepts and development. Also, health technology assessment is not considered in this paper.
It is related to the consideration of the way technology advancements (that are becoming exceedingly important for modern healthcare) are being adopted and implemented, how (or if) the policy can benefit from them, and what expenses (in terms of money, time, and effort required for training, and so on) would be necessary. Finally, the evidence-based medicine process is not taken into account; it would be similarly concerned with the use of modern medicine, the related constraints and opportunities, efficient use of resources, and so on.
The Application of Processes to Policy Evaluation
The policy that emerged from Proposition 63 (that was passed on November 2, 2004) has been aimed at resolving the issue of healthcare funding as well as healthcare disparities. In the US, healthcare expenses are greater than in any other developed country (World Bank, 2016), and the sums required by the area proceed to grow (Cohen, 2015), but the efficiency of both spending and care provision is changing at a much slower rate than the prices.
The issue of disparities (that is, discrimination) is also far from being resolved (Kaiser Family Foundation, 2012). In particular, the problem of healthcare provision for people with mental issues (especially children) has been raising criticism in California and other States for decades (Jenson & Fraser, 2015). As a result, Proposition 63 was aimed at alleviating these issues and educating society about them. The target population was the people with mental health illnesses, and the realistic means of resolving their disadvantaged position in healthcare was considered the money.
The values of the policy were clearly stated: the improvement of equitability of access to healthcare and the enhancement of the welfare of a particular group of consumers as well as social welfare. Indeed, the improvement of the treatment of mental illnesses was supposed to bring benefits to the entire society. Therefore, it may be suggested that the policy demonstrated care for a vulnerable group (people with mental issues) and for the society at large.
It is noteworthy that the Proposition has apparently raised public awareness with respect to the needs of the vulnerable group, which is a valuable outcome and which is likely to have been one of the goals. I would also suggest adding the belief in the possibility of the improvement of the lives of the people with mental disorders through healthcare to the list of the policy’s values. It is noteworthy that this belief was well-founded due to then-current research (Bambauer, 2005, p., 642).
From the point of view of political feasibility, the Proposition was in a most beneficial position. Bambauer (2005) demonstrates an interesting tendency: the Proposition was being promoted by popular political and social figures and received appropriate funding (several million dollars) while the opponents generally lacked public acclaim and did not go to similar expenses to advocate for their position on the matter. Apart from that, the view of the proponents was objectively more morally and ethically acclaimed and supported by more reasonable arguments. According to Bambauer (2005), the opponents did not even come up with the problems of exceptionalism and income-based discrimination that were viable concerns for the policy.
The key counterarguments that the opponents sought to produce consisted in demonstrating the program’s inconsistency and economic inviability. However, the policy was perfectly economically viable. As pointed out by Bambauer (2005), people prefer not to pay their own money for the changes in society, regardless of how beneficial they may be. The policy-makers took this into account as the reality of the economic situation in the world and targeted the wealthiest with the tax.
The opponents attempted to insist that the wealthiest will not be willing to pay, but as it turned out, the economic situation was in favor of the Act. At the time, the number of millionaires in California grew, and the taxes that they had to pay were reduced by the cuts of 2002 (Bambauer, 2005, p. 642). As a result, they were quite willing to engage in the improvement of their society.
While the Act was primarily aimed at providing the funding, the question of whether the resources gained are being used effectively remains open. The healthcare processes that are involved in the policy (that is, the mental healthcare practices) have been evidence-based and developing back then (Bambauer, 2005), and so they are nowadays (Jenson & Fraser, 2015), which allows suggesting that the medicine and technology made the policy economically viable. Bambauer (2005) also points out that there was little consensus on the details of the process in 2005, but according to Jenson and Fraser (2015), in 2007, a valid plan was being implemented. In other words, the economic viability of the policy was fully supported by the technical details of its implementation.
Conclusions
The health policy that was considered here can be summarized with the help of the following key features. First of all, Proposition 63 and the California Mental Health Services Act were aimed at providing funding to mental health services. The funding was gained through taxing, but only less than.1 percent of the population was affected by it. The key values of the program included the benefit of the society and that of its smaller group (the mentally ill).
The policy was aimed at promoting equity and protecting the vulnerable group of people with mental issues. The policy was also politically and economically feasible, which, in effect, ensured the support of the population. The policy is not without imperfections; moreover, the analysis allows discerning a number of potential issues that can and should be taken into account while planning and carrying out the implementation.
It is also noteworthy that while the latter process was not directly considered here (primarily because of the four-process limit), it still had to be mentioned as well as the rest of the processes that were left out. As a result, it can be suggested that the seven processes are so interrelated that it appears impossible to consider them in complete isolation. It can be concluded that the analysis of a policy is a system as well as the policy itself.
References
Bambauer, K. (2005). State Mental Health Policy: Proposition 63: Should Other States Follow California’s Lead? Psychiatric Services, 56(6), 642-644. Web.
Cohen, J. P. (2015). Implementing the affordable care act: Remaining hurdles. Clinical Therapeutics, 37(4), 717-719. Web.
Jenson, J. & Fraser, M. (2015). Social Policy for Children and Families. Lond, UK: SAGE Publications.
Kaiser Family Foundation. (2012). Disparities in health and health care: Five key questions and answers. Web.
McLaughlin, C. & McLaughlin, C. (2014). Health policy analysis. Sudbury, MA: Jones and Bartlett Publishers.
World Bank. (2016). Health expenditure. Web.