Health policy analysis: a tool to evaluate in policy documents the alignment between policy statements and intended outcomes

Abstract

Objective. Health policy analysis remains surprisingly undeveloped in Australia given the power that policy exercises over the direction of public health. This paper describes the use of a policy analysis tool to evaluate the alignment between policy statements and intended outcomes of principal chronic illness policy documents in New South Wales (NSW) from 1999 to 2008. In doing so, it demonstrates the utility of a set of predefined criteria for use in retrospective policy analysis and potential for use in reviewing policy proposals and making future health policies. Methods. We analysed the major health policy for the care of people with chronic disease in NSW, the Chronic Care Program, using a modified set of existing criteria derived from the logic of events theoretical framework, which conceptualises the connection between policy determinants and outcomes. A document map was also developed to identify linkages between the policy documents analysed. Results. Internal validity, the alignment between policy statements and intended outcomes, was highest for policy background and goal-setting criteria, and lowest for accessibility, resources, public opportunities and monitoring and evaluation criteria. The use of document mapping was vital in determining linkages between the closely related policy documents of this complex initiative. Conclusions. The use of predefined criteria to identify in policy documents where policy statements are not consistent with intended outcomes, in conjunction with policy mapping, are useful methods of analysing complex policy initiatives. In the Australian context, the use of a validated policy-analysis tool might help achieve greater consistency. Implications. The use of a tool during policy development to identify in policy documents where statements are not consistent with intended outcomes may increase the likelihood of the successful implementation of future health policy. The tool can also assist those who make and review future policies. What is known about the topic?Chronic diseases are an increasing burden on the Australian community and effective policy is required for their prevention and management. Evidence-based policy making has much potential in effecting policy impact yet there is very little Australian research into policy making. Health policy analysis has been conducted in the past but there has not been an attempt to evaluate or analyse the documents that communicate policy in NSW. What does this paper add?This is the first attempt to analyse the policy documentation of a major health initiative for internal validity, that is, the alignment between policy statements and intended outcomes. It offers a framework that may be used to assess policy documents and demonstrates the utility of document maps to identify policy linkages. What are the implications for practitioners?The use of a predefined set of criteria highlights opportunities where policies such as the NSW Chronic Care Program can potentially be strengthened. The criteria can be used by reviewers of policy proposals to find where policy documents can be improved to better reflect their intention. This may increase the chance of successful implementation. Document maps may clarify the relationships between policy documents in policy-rich programs and improve their accessibility to target audiences.