Health policy and the policymaking system: A case study of primary care in Ireland

Abstract

In 2001, the Irish government published a reforming policy intended to modernise and expand the delivery of primary care in Ireland. Fifteen years later, the Irish health system remains beset by problems indicative of a fragmented and underdeveloped primary care system. This case study examines the formation and implementation of the 2001 primary care policy and identifies key risk categories within the policymaking process itself that inhibited the timely achievement of policy objectives. Our methodology includes a directed content analysis of the policy formation and implementation documents and the influencing academic literature, as well as semi-structured interviews with key personnel involved in the process.We identify three broad risk categories -power, resources and capability -within the policymaking process that strongly influenced policy formation and implementation. We additionally show that the disjoint between policy formation and policy implementation was a contested issue among those involved in the policy process and provided space for these risks to critically undermine Ireland's primary care policy.

Ethics in contemporary health care management and medical education

“…The concerns are relevant as there are indications that NPM has had a negative influence on the performance of hospitals . For example, a study found that the number of hospitals identified as efficient by data envelopment analysis—a standard approach to performance analysis commonly applied in health care—decreased after marketing reforms .…”

“…For example, a study found that the number of hospitals identified as efficient by data envelopment analysis—a standard approach to performance analysis commonly applied in health care—decreased after marketing reforms . Other authors report problems indicative of a fragmented, underdeveloped primary care system . NPM could put pressure on managers to decrease waiting time and reduce costs, which can take priority over training needs; managers may demand faster clinical services, thereby decreasing training and education opportunities …”

Local Alcohol Policy Implementation in Scotland: Understanding the Role of Accountability within Licensing

“…Indeed, the issue of accountability, a concept used extensively (albeit often somewhat opaquely) in public discourse, is somewhat rarely empirically examined within broader health policy implementation research. In a literature review of empirical health policy implementation studies conducted for the Scottish Parliament’s Information Centre [31], only a small number of empirical articles explicitly linked accountability and health policy implementation processes (e.g., Kelly et al [32] and O’Toole et al [33]). This is despite authors within public policy and implementation literature identifying accountability as being fundamental to policy implementation.…”

The Public–Private Mix in Primary Care Development: The Case of Ireland

“…39 The genesis of the 2001 Strategy and the factors that inhibited the achievement of some of its policy objectives with regard to functioning PCTs have also been examined. 40 This article seeks to address these shortcomings. It asks, what has been the nature and extent of private sector participation in the development of Ireland's PCC network?…”