Decision making and policy formulation: the case of health care coverage

This chapter focuses on activities and frameworks associated with policy formulation, using health care coverage (or ‘rationing’) as a case study. It outlines some of the key developments and perspectives in the study of policy formulation and their application to the study of health care coverage policy. Major developments include the rational (or design) approach which has been critiqued by advocates of pluralism and/or incrementalism. The chapter explores how current health care policy can be seen to embody elements of each of these major schools of thought, as well as subsequent contributions which foreground the role of power and institutions. It is argued that health care rationing is highly emotive, and that policy is therefore often subject to evasion, delegation and blame avoidance. Although in some ways typical of policy formulation more generally, this is perhaps one of health care coverage policy’s most consistent and distinguishing characteristics and one which continues to confound simple policy prescriptions.