Policy Implementation:

1
Chapter 7

• Policy Implementation
• Rulemaking

2
Enactment of a Law

• Enactment denotes transition from formulation to
  implementation.
• The transition boundary is not solid b/o of
  interaction between formulators and implementers.
• Health policies must be effectively implemented
  if they are to realize intended impact.

3
Implementation

• When laws are implemented, sociocultural,
  physical and economic aspects of the
• environment can change
• human lifestyles behaviors change
• availability accessibility of health care
  services can change

4
Implementation

• Policy implementation involves
• Rulemaking
• -establishing formal rules
  regulations

5
Rulemaking

• This phase is a system within a system b/o
  feedback loop

6
Rulemaking

• Because the language is vague, the exec.
  administrators use their discretion to implement
  policies.
• Before implementation begins, the developed rules
  and regs. are published and circulated for
  feedback.
• By definition, rules and regulations are policies
  in and of themselves.

7
Rulemaking

• NPRM draft of rules used as an implementation
  guide while the final rules are evaluated and
  approved
• Continuous process (rules can be added, deleted,
  or modified)
• Publication of an NPRMan open invitation for
  int. groups to become involved in the process.

8
Implementation

• The executive branch of govt is responsible for
  implementing policy formulated by the legislative
  branch.
• HCFA (now call Center for M/care M/caid
  Services-CMS) was created to implement M/care and
  M/caid.

9
Implementation

• Control mechanismOversight
• Oversight check balance to
• -improve govt efficiency effectiveness
• -make sure intent accomp.
• -assess capabilities of implem. org.
• -ensure implem. reflects pub. int. intent

10
Oversight

• Common techniques
• Funding appropriations
• Direct contact betw. Congress, staff, execs.
• Judicial hearings

11
Management

• Definition a set of interrelated activities
  through which org. obj. are specified and pursued
  by utilizing human and physical resources and
  technology.
• Mgmt. is implementation and implementation is
  public management.