By 2008 . 240 Pages . Published by Allen and Unwin . RRP $45.00. ISBN: 978 1 74175 395 0
Reviewed by Karen Willis
School of Sociology and Social Work, University of Tasmania
Doing Health Policy in Australia by Paul Dugdale provides an insider account of the policy environment and the issues that concern contemporary health policy makers and analysts in Australia today. I found this an interesting overview of these key issues and debates – locating these issues within their historical context demonstrates how embedded health policy is in institutional contexts and structures.
The book covers a range of health policy issues commencing with Chapter 1 providing a broad introduction to the health policy scene in contemporary Australia. Chapter 2 titled ‘What is Health’ identifies the complexity and range of definitional issues that must be taken into account in health policy making. In Chapter 3 Dugdale provides an historical perspective on how the state has intervened in health in the creation of health policy. This chapter has a section on the links between health policy and research. An historical perspective also informs Chapter 4 where the focus is on the relationship of medical practice to the State. Dugdale discusses how recent policy initiatives such as incentives programs for general practitioners have been utilised to influence medical practice. Similarly, the discussion of public hospitals (Chapter 5) and Medicare (Chapter 6) re-state the history of these institutions and consider some of the more contemporary policy initiates such as funding formulas in the case of hospitals and the rise of market-based initiatives in health insurance.
Following these foundational chapters, Chapters 7-10 focus on current health policy problematics. The chapter on quality and safety in health care, located in terms of expert knowledges, protection of consumers, and health financing, provides a useful overview of the issues. Chapter 8 (Doing Indigenous Health Policy) (written with Kerry Arabena) is a highlight of the book. It skilfully moves between the history of policy in this area, the tensions of ‘doing policy’, identity politics, contemporary policy and the need for an alternative approach. It powerfully captures an indigenous perspective on health policy. Chapter 9 on health protection brings together several examples of the need for policies that protect the public. Combining issues such as water protection, food-borne diseases, disaster response and new infections into one chapter means that quite disparate topics can only be covered descriptively. All of these issues are of interest to the public health policy analyst, and while well described, more analysis would have been welcome. Chapter 10 on health policy activism is a welcome inclusion in the book. Dugdale approaches the issue of activism from a very different perspective to my own, but still manages to identify some of the key issues in being a health activist. He raises the very important issue of who is, or can be, a policy activist, and the extent to which insiders to the policy process can be activists alongside the difficulties in obtaining active participation from those outside the bureaucratic policy arena.
While there is comprehensive coverage of key policy debates around health care provision and financing, some issues could have been fleshed out a little more. While readers of this book will think of their own particular interests in health, for me more information on two key policy problematics could have been included. The first relates to health care financing, and the changes to private health insurance. While some of these are described, there is little attention to the policy tensions of the dual public/private health financing system, particularly as they relate to the health products that are provided to consumers, and the consumer choices that flow from these.
The second area relates to health policy work in epidemic or pandemic planning and response. While the case of H1N1 (since the release of this book) has focused our attention to issues of policy and planning, there have also been precursors to this pandemic that could have been used to identify the importance of policy making in this area. Dugdale restricts discussion of ‘new infections’ to three pages at the conclusion of chapter 9. In doing so he describes recent ‘new infections’ but does not really engage with policy making beyond acknowledging the complexity of the issues generated. The issues of how to create policy in a globalised environment where the risks of pandemics are heightened would have been worthy of discussion. Preparedness of the health system, public health policy making as it affects rights and responsibilities of individuals, liaison between various policy environments and Federal-State responsibilities in pandemic planning/response could have all been analysed.
At a more general level, the use of theoretical frameworks to flesh out the power dynamics of health policy making would have enhanced the overall discussions in the book. For example, while Alford's theory of structural interests in health is now quite old, it would be interesting to reflect on the extent to which the health policy environment is constrained or challenged by the structural interests. This is alluded to in earlier discussions of the history of the policy environment, but could have more critically been applied to the role of health bureaucrats in shaping the health policy environment.
These criticisms notwithstanding, I found this a useful book and would recommend it as a source for students researching the health policy environment or for health policy makers wanting to understand the background of the field in which they are involved.