Distinguishing Policy Modification from Policy Initiation

Conceptually, policy modification can be differentiated from policy initiation, although in reality the two are closely intertwined. Policy initiation— the establishment of an original public law—results when the confluence of problems, possible solutions, and political circumstances leads to the initial development of legislation in the formulation phase (as described in Chapters 5 and 6) and, when enacted into public law, then to subsequent first iterations of rulemaking and operation as the law is implemented, as described in Chapters 7 and 8. In contrast, policy modification results when the consequences of existing policies feed back into the agenda-setting and legislation-development stages of the formulation phase and into the rulemaking and operational stages of the implementation phase and stimulate changes in legislation, rules, or operations. This is shown as the feedback loop in Figure 9.1. Examine the loop closely, noting that it feeds back into the overall process in several places.

The history of American health policy demonstrates clearly that policymakers can, and on occasion do, initiate entirely new policies. For example, in 1798, Congress established the U.S. Marine Hospital Service to provide medical care for sick and disabled seamen. This was the initial policy from which eventually grew the U.S. Public Health Service. In 1921, Congress enacted the initial Maternity and Infancy Act (P.L. 67-97), through which grants were made to states to encourage them to develop health services for mothers and children. This new policy became the prototype for federal grants in aid to the states. In 1935, Congress enacted the Social Security Act (P.L. 74-271), which initiated the major entrance of the federal government into the area of social insurance. This policy, through a long life during which it has been modified many times, now encompasses, among many other things, the Medicare and Medicaid programs.

As these examples illustrate, some health policies are indeed formulated and implemented de novo. But a very important feature of health policymaking in the United States is that the vast majority of contemporary health policies spring from relatively few earlier initial policies. Most health policies are the result of modifying prior policies. This is why understanding the modification phase of the policymaking process is so important.

A review of the chronology of important American health policies, such as the one contained in Appendix C, readily illustrates just how many contemporary health policies are, in fact, amendments of previously enacted public laws or how frequently they result from changes—often, a string of changes—in the rules and practices that determine how laws are currently

Figure 9.1 A Model of the Public Policymaking Process in the United States: Policy Modification Phase

Preferences of individuals, organizations, and interest groups, along with biological, cultural, demographic, ecological, economic, ethical, legal, psychological, social, and technological inputs

POLICY FORMULATION PHASE

Agenda Setting

Bridged by

Formal Enactment of

Legislation

Solutions

Circumstances

Development ► of Legislation

Window of Opportunity*

*The window of opportunity opens when there is a favorable confluence of problems, possible solutions, and political circumstances.

Bridged by

Formal Enactment of

Legislation

POLICY IMPLEMENTATION PHASE

Rulemaking

POLICY IMPLEMENTATION PHASE

Rulemaking

Implementation Feedback

Feedback J

POLICY MODIFICATION PHASE

Feedback from individuals, organizations, and interest groups experiencing the consequences of policies, combined with the assessments of the performance and impact of policies by those who formulate and implement them, influence future policy formulation and implementation.

Feedback J

being implemented. In fact, none ofthe authoritative decisions that have been defined as policies are permanent. Modification of prior policies—whether in the form of decisions representing public laws, implementation rules or regulations, rulings of a court, or operational practices—pervades the entire policymaking process. The likelihood that prior decisions will be revisited and changed is a distinguishing feature of public policymaking in the United States. It is the feature that makes policymaking a cyclical process.

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Responses

  • rasmus kulmala
    What is policy initiation?
    6 years ago
  • joel
    Why is healthcare rulemaking important in the policymaking process?
    6 years ago
  • Demsas
    Who can initiate modifications to existing health policies?
    6 years ago
  • ANGELA
    What is the difference between policy initiation and policy modification?
    6 years ago
  • suoma
    Who can initiate modifications to an existing health policy?
    6 years ago
  • cristina pisani
    What is policy modification in healthcare definition?
    5 years ago
  • elanor
    Why is policy modification important?
    4 years ago
  • pirkka
    What is the difference between a policy implementation and modification?
    4 years ago
  • Jessika
    Why is health care policy modification important?
    4 years ago
  • welde tewelde
    What is the relationship between policy initiation and policy modification?
    4 years ago
  • DECLAN
    What are the factors that influence policy modification to health policy ?
    3 years ago
  • roberta
    What is the distinction between policy initiation and policy formulation?
    3 years ago
  • viola
    Which definition matches the term “policy modification?
    3 years ago
  • DROGO
    What is the difference between policy formulation and policy modification or revision?
    1 year ago
  • tim
    Which branch is most responsible for modifying health policies?
    1 year ago
  • marissa
    What is the initiation of policy making?
    1 year ago
  • reino
    What is the modification phase of policy making?
    11 months ago
  • dillon
    Are new health policies result from modifying current policies?
    8 months ago
  • ELENA
    What is the difference between polocy initiation and policy modification?
    5 months ago
  • hal
    What does policy initiation means?
    5 months ago
  • Imelda
    What does a policy modification to residenential requirements mean?
    3 months ago
  • Maci Paterson
    Why we need cost of care policy modification?
    2 months ago
  • ferdinand
    What is system moification in policy development?
    2 months ago
  • frederick
    Which government branch plays the most sigifniciant role in policy modification?
    1 month ago
  • Adalgisio Napolitano
    When should you finalize policy modification?
    2 days ago

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