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Introduction A policy is a set of values, controlling decision making and actsas a framework for testing proposals and to determine their progress. The values are organized and guided by various, particular self-induced processes.Policy stages include identifying the issue, setting agenda, formulating proposals, adopting legitimate policies, implementation and evaluation. Apolicyencompasses problem definition, statement of objectives and approaches to achieve them. A public policy such as the Medicaid is a course pointed out by the government as a guideline of current and future decisions. A health policy not only includes healthcare but also the health factors in order to enhance or maintain public health through evaluating current and future aims,through various institutions’ service provision as well as funds. A health policy has to ensure that the public health is at the forefrontand acknowledging the effects that arises as a result of the policy,while remaining responsible for their health(Mason et al., 2007). Policy Evaluation A public policy does not only involves legislation passage and its implementation but also has to assess whether the goal was effectively achieved, the effects and if modifications are necessary. This process involves evaluation. A Policy entails authoritative guidelines, which regulate the public’s conduct to pursue certain goals. This involves public and private sector and encompasses various engagements to implement decisions. Health care organizations drafts private policies such as those guiding employees and terms of service provision. A public policy e.g. Medicare, on the other hand entails a state legislation, which is directed towards organizations or persons in line with government jurisdiction. Medicare is such one service which mostly involves an institutional policy that often is a reflection of agreement with public policy(Mason et al., 2007). The policy evaluation handles the question ‘did the policy work?’ (Mason et al., 2007p.82). The stage involves evaluating implementation, performance as well as consequences to determine the effectiveness of the policy. Evaluation entails pointing out whether it attained the original objective, the degree in which they have met and the other issues, which have cropped up as a result. If the policy has been effective, it may be terminated or replaced with another one such as the policy aimed at dis-institutionalizing the mentally sick, which was followed by closure of mental institutions in states. This policy could have achieved the original aim of having fewer institutions of mentally ill persons. All the same, the issue of enough community mental-health services particularly for those who have no homes is still an unresolved issue. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 is notably a current policy problem, which was geared at the reduction of expensive prescriptive drugs as well as absence of drug benefit. It was noted by the media that the elderly foregone eating so as to cater for prescription medicine. The state programs were not in line with federal administrations’ need to negotiate with medical producers, to decline the drug costs as well as their imports from Canada (Mason et al., 2007). Health care delivery as well as reimbursement is guided by a health policy. Government has a role of not only planning but also organizing and delivering healthcare in all regions of the U.S. Medicare is one such program that is used to finance health care for senior citizens in the U.S. this is done especially through the Department of Veterans Affairs, Defense, and Health and Human Services through the federal government’s U.S Public Health Service which engage in funding the program by offering grants to state and local government (Wallace, 2003). Following enacting of a Policy, implementation follows through drafting crucial guidelines. For Medicare, the agency that is responsible for the process is the Centers for Medicaid and Medicare Services (CMS) as well as the Department Of Health and Human Services (HHS). Analysis of a policy may depict its outcomes, which could be intended or not as in the case of state’s Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Huber, 2006) the policy intended for a reduction of drug expenses for managing chronic diseases.Unfortunately, the prescription drug costs did not decline for the old as well as those who were mentally handicapped. The policy however, saw to the rise of admissions in hospital as well as nursing homes, incomplete hospitalization, psychoactive drug supply by community health providers as well as psychological health emergences. After analysis, it was clear that vulnerable persons had a likelihood of having adverse consequences from speedily practical drug containment policies as well as the outcome of compensatory measures, which may have led to higher expenses instead of reducing them (Huber, 2006). Policy analysis is mostly geared on explanations instead of prescriptions through monitoring the policy by observing, recording, and surveying. Policy Analysis Policy analysis is defined as a “systematic study of the content and anticipated or actual effects of existing or proposed policies” (Huber, 2006p.122). It is a “systematic approach to describing and explaining the causes of government action and inaction. The consequences of inaction may be important as those of action” (Mason et al., 2007p.82).Policy analysis involves defining the differentalternative policies,which may attain specified aims depending on how they relate. It is bothdescriptiveas well as analytical as it tries to give an explanation of the policy as well as how to develop it. It also could be prescriptive when it formulatesproposals as well as policies meant to enhance social wellbeing. The analysis however, depends on the type to be involved but it is mostly involved in the public sector. According to Mason et al, “policy analysis is the systematic study of the background, purpose, content, and anticipated or actual effects of standing or proposed policies and the study of relevant social, economic, and political factors” (2007, p.76).The process is very essential to practitionersand is made for the public, followed by sanctionsin case it is bleached (Mason et al.,2007). To come up with a public policy entails implementation of the legislation, as well as the guidelineswhich are lawful, and which may prove complex. Policy analysis occurs in universities, related firms, agencies and other organizations through application of analytical tools and principles in statistically, economically and in probability theory. It ranges from being academic to being political in nature.Nurses apply their clinical skills as well as advocacy in analyzing a policy as it applies research, governance and change. To analyze a policy, it is recommendable to determine the context such as defining the problem as well as objective, having alternative way to resolve them, outline the consequences, draft criteria for their evaluation and have a recommendation of the optimal solution (Mason et al., 2007). Medicareprogram as a health insurance for senior citizens aged more than sixty five yearscan become a policy when there is a need to adjust the age in which one is eligible or the insurance plans. Policy Modification/Revision The stage that follows implementation is the policy modification, which has its effects on healthcare. This oversees if the aim has been attained, which monitors futureexpenditures on Medicareprogram. Following unclear policy objectives, which are incalculable or have failed in achieving the outlined objectives, they are returned to the legislative process to be further modified (Wallace, 2003) following this, the policy process is termed as cyclical since its formation results to implementation, to modification and then back to formation stage once again. Various health policies are modified as reflected by the Medicare and Medicaid programs, which resulted from Social Security Act amendment and extended the former programs as Old Age, Survivors and Disa
bility insurance Program as well as Kerr-Mills program, for provision of healthcare for the old and impoverished citizens. Medicare resulted from vital amendments, which affected hospital payments in 1983 as well as the 1989 physician payments due to the increased healthcare costs. Most importantly, the Balanced Budget Act of 1997 portrays another crucial Medicarepolicy modification due to extensive oversight hearings (Wallace, 2003). Policy making process is complex following vulnerability of implementation to external influence as well as cyclical aspect arising from modifications, which has resulted to incremental approach whose failure to follow could lead to the collapse of the policy such as that of the Health Care Reform Plan by president Clinton.Major modification in policy, its effects and status quo in policy process has seen failure of many policies, calling for a major policy reform (Wallace, 2003) In the modification phase of policymaking, the public and other institutions gives their responses to those who drafted and implemented the policy pertainingtheeffects. The new policy may thus be modified or may be overlooked as for the case of Medicare Catastrophic Coverage, which had its passage in 1988 and it did not persist but was rather dissolved (Huber, 2006). Elderly citizens disregarded it and contacted the congregational representativesresulting to its repeal in 1989. Therefore, policy modification is a crucial stage in policy making since peoplepursue alterations that might benefitthem more or even safeguard the already present policies. The ones that experience its negativeeffects alter it to reduce the effects while the policy makers adjust it on its failure to fulfill its objectives. This stage is very crucial since enables the policy making to be dynamic as well as evolving. Besides, policies become obsolete due to changes in social, culture, demography, ecology, economy, ethics, legal systems, psychology as well as technology(Huber, 2006). References Huber, D. (2006). Leadership and Nursing Care Management. Philadelphia, Pennsylvania: Elsevier Health Sciences. Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2007). Policy & Politics in Nursing and Health Care. St. Louis, MO: Elsevier Health Sciences. Wallace, H. M. (2003). Health and Welfare for Families in the 21st Century. Sudbury, MA: Jones & Bartlett Learning.
