Policy, Power and Politics in Health Care Provision

To analyse 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. (Use Elderly health care voucher scheme in Hong
Kong)

Policy, Power and Politics in Health Care Provision: Health Care Policy Development – The

To analyse 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. (Use Elderly health care voucher scheme in Hong
Kong)

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

2

POLICY, POWER AND POLITICS
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

3

POLICY, POWER AND POLITICS
involved where policymakers explore all necessary considerations so as to inform the course of
action. These include 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 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 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
accessibility 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

4

POLICY, POWER AND POLITICS
Voucher, 2016). By so being, the scheme did not only solve short-term health problems, but it
also facilitated 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

5

POLICY, POWER AND POLITICS
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

6

POLICY, POWER AND POLITICS
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

7

POLICY, POWER AND POLITICS
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

8

POLICY, POWER AND POLITICS
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

9

POLICY, POWER AND POLITICS
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

10

POLICY, POWER AND POLITICS
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.

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.

11

POLICY, POWER AND POLITICS

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.

12POLICY, POWER AND POLITICS
Burris, V. (2013).Policy formation.

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.

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.

Health Care Voucher.(2016). Background of Elderly Health Care Voucher Scheme.

13

POLICY, POWER AND POLITICS
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.

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.
Yam, C. H., Liu, S., Huang, O. H., Yeoh, E., & Griffiths, S. M. (2011). Can vouchers make a
difference to 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.

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

2

POLICY, POWER AND POLITICS
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

3

POLICY, POWER AND POLITICS
involved where policymakers explore all necessary considerations so as to inform the course of
action. These include 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 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 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
accessibility 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

4

POLICY, POWER AND POLITICS
Voucher, 2016). By so being, the scheme did not only solve short-term health problems, but it
also facilitated 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

5

POLICY, POWER AND POLITICS
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

6

POLICY, POWER AND POLITICS
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

7

POLICY, POWER AND POLITICS
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

8

POLICY, POWER AND POLITICS
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

9

POLICY, POWER AND POLITICS
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

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POLICY, POWER AND POLITICS
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.

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.

11

POLICY, POWER AND POLITICS

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On Sub-Disciplinary Progress, Observation, Translation. Geography Compass, 6(6), 351-
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