PUBH306 PUBLIC HEALTH LAW AND ETHICS
Australian Expert Writers
WEEK 3: Policy development: definitions, concepts and theoretical frameworks
At the completion of this week, students should be able to: identify definitions, concepts, and a few theoretical frameworks relating to policy development. By usingpolicy examples, studentswillbe introducedto different aspects of policy development(identifying problems, determining context, engaging and analysing stakeholders, and processes of policy making).
You can do the following exerciseseither on your own or working in small groups.
Activity 1–Policy Triangle (20-30 mins)
Read and discuss the following passage. Apply the Walt and Gilson (1994) policy analysis triangle to identify:
1) What is the problem?
2) Who are the actors?Australian Medical Association and the National Multiple Sclerosis Society, The Australian Federal Government,
3) What processes are involved?
4) What can you discern about the context?
5) What part did content play in determining policy?
Paradigm of the medicinal benefits from cannabis.Cannabis has been shown to be useful in the alleviation of neuropathic pain, weight loss in HIV/AIDS patients, nausea and vomiting associated with chemotherapy, painful muscle spasms due to multiple sclerosis and several psychological conditions. It has also been used to treat conditions such as glaucoma, asthma, epilepsy, and Parkinson’s disease. The medical use of cannabis is legal in certain countries, including Austria, Canada, Czech Republic, Finland, Germany, Israel, Italy, the Netherlands, Portugal and Spain. The Federal Government of Australia last year legalised medicinal cannabis use and states regulate its cultivation, with Victoria having already harvested its first cannabis crop for medicinal use by people with epilepsy. Government will also relax importation law around medical cannabis.
So far 25 companies have applied for licences to grow and manufacture medicinal cannabis in Australia.
There will be provisions in place to use it on medical grounds, with certain approvals but only for very ill people. However, it will still be illegal to use or grow marijuana for recreational purposes. Advocates who work for ‘drug free Australia’ opposes the legalisation of cannabis for medical purpose. They argue that its origins have not come from the medical profession, but rather special interest groups and marijuana companies, where profit is the main motive. However, peak organisations such as Australian Medical Association and the National Multiple Sclerosis Society support the approval process.
Lucy Haslam’s son Dan was using medicinal cannabis to deal with the symptoms of bowel cancer treatment before he died in New South Wales almost two years ago. She said Wednesday’s change was “long overdue” but the proof will be in how quickly patients are able to get medicinal cannabis in their hands as many still find the application process for access difficult. “The prescribers are not allowed to advertise the fact that they can prescribe the drug, so that’s very difficult when you’re a patient looking for somebody to prescribe it. There’s also a lot of work to do on educating people and doctors, some of who remain a bit uncomfortable about prescribing medical cannabis to patients.” She added.
A ‘black market’ in cannabis currently exists, with cannabis supplied illegally to individuals who seek to buy it for the purpose of trying to treat medical conditions. These sorts of illicit products may contain unknown ingredients and pose risks to patients. Therefore, the government needs to take prompt measures. One of the problems is that there is insufficient information about the medical demand of medicinal cannabis.
Activity 2 – Royal Commission into Aged Care Quality and Safety(50 – 60 minutes)
Go to the website of the recently established Royal Commission:https://agedcare.royalcommission.gov.au/Pages/default.aspx
Read the background information about the Commission:• Letters Patent• Terms of Reference• Membership• Engaging with the public• Media Releases• Transcripts (scan one)
Discuss the following points / questions:a) What were the problems that led to the establishment of the Royal Commission?b) What methods will the Commission use to engage the community and stakeholders?c) Who are the main stakeholders in aged care? Can you determine their interests, roles and influence?d) What work has been produced by the Commission to date?e) What role, if any, does the media play in the process?f) Do you see the work of the RCACQS leading to policy development in aged care? Explain your reasons for this[For Melbourne students working on their own, write up a short paragraph on each point/question]
Activity 3–Policy on My Health Record (20-30 mins)
From Personally Controlled Electronic Health Record (PCEHR) to My Health Record (MyHR)The Personally Controlled Electronic Health Record (PCEHR) was launched in July 2012 to contribute to the creation of a “platform for health information exchange across geographic and health sector boundaries.” However, the medical profession all but abandoned PCEHR, claiming it was too hard to use in daily practice. Only 40,000 health records were ever uploaded to PCEHR, accounting for only 2% of registered users.Academic Dr Cripps compared the Australian e-health experience to that of Slovenia in her 2011 research paper. She lists a number of reasons for Australia’s sluggish progress: the country’s complex health care system, with state and federal involvement and a large private health sector; uneven adoption by clinicians; security problems associated with sharing data electronically between GPs and other clinicians; proliferation of different electronic health record formats and systems; fears about data protection and patient privacy; cost of infrastructure, maintenance and training and a disconnect between government-led implementation and software vendors.
In response to the PCEHR Review, the Government announced a $A485 million “rescue” package to “re-boot” the failed PCEHR. The cash injection would be used to trial a number of changes to the system: introduce an opt-out, instead of PCEHR’s opt-in system; improve user-friendliness and clinical utility; relaunch the platform under a new name of My Health Record; and replace the responsible agency, the National E-Health Transition Authority, with the Australian Commission for e-Health.
However, the recommendation for the opt-out approach was met with serious privacy concerns. A number of Members of Parliament expressed the view that such a substantial imposition on individual rights could only be justified if it advanced a legitimate public policy objective and that merely increasing My Health Record usage did not warrant such a step.One of MyHR’s stated benefits is that a patient’s important healthcare information will be available in one place online, and easily accessible by authorised persons. It also reduces the burden of remembering their own medical history in great detail. It could mark the end of filling out lengthy forms in the waiting room. The Government estimates that a fully functioning MyHR will save it $A7 billion in direct costs and $A2.5 billion a year on an ongoing basis.
In MyHR, the patient has complete autonomy over what health data gets uploaded to their health record and who is allowed to have access to that data. Patients can remove items from view once they have been uploaded, no matter how significant the items are. A further issue for accuracy is that MyHR allows patients to register and upload information under a pseudonym in addition to using their real name. These accounts do not have to be merged. As a result, MyHR cannot be relied on as a complete source of information. Accordingly, some sections of the medical profession say that acting on MyHR information presents clinical risks. The MyHR website itself says MyHR is not comprehensive and cannot replace official medical records held by healthcare providers. Rather, it can only be treated as an “additional source of information”.
Some steps have been taken to encourage healthcare providers to transition to MyHR compatible software. The Practice Incentives Program, ePIP, makes payments (capped at $12,500 per quarter) to practices which meet certain eligibility requirements and usage targets.
As of 12 March 2017, approximately 4.6 million patients and 10,000 healthcare providers have registered for MyHR. Almost 650,000 shared health summaries have been uploaded. These numbers show an improvement in uptake from consumers. More significantly, they show increased usage by healthcare providers to levels never seen during the days of PCEHR. As the PCEHR Review found, without adoption by healthcare providers, consumer interest will wane.
Individuals and families have been given until 15 November 2018to opt-out of participating in My Health Record, with the opt-out policy approach generating extensive community debate and discussion.
o Can you identify the problems and concerns with the previous paper-based system?o What were the barriers to implementing the PCEHR?o What strategies have been introduced to overcome these barriers& modify the policy?o What public resources have been spent in developing and implementing the earlier and modified policy?o What type of a policy is this? (remember the typology from the lecture)o What advice would you offer the Minister to successfully implement MyHR? Justify your answer.
Lectures for next two weeks:
18March:Agenda setting, evidence, politics and analysis. Presented by Dr Simon Barraclough.
25 March:Policy making: A political perspective. Presented byMs Elly Howse.
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