TU, Germany
Policy
In a restrictive way “policy” may be understood as norms issued by governmental institutions and seems to be equivalent to “laws” (independently of these need to be approved in a parliament or are directly issued by a Ministry –i.e. decree). It can be also used to refer to the rules which govern the functioning of the health system in general, including both the ones issued from governmental institutions and the ones issued by non-governmental institutions (i.e. self-governing institutions, sickness funds, professional associations, etc.). Common to both understanding of the term policy is that it refers to the regulatory framework of the health system.
Another meaning of the term “policy” which is frequently found is that it refers to any rules at any level of the health system, independently of whether they are legally binding or not. In this context, the area of application of a policy might be as small as a ward of a hospital or a single surgery. In these cases the term “policy” is understood as set of statements aiming at providing guidance on how to act in some situations. So for example one may find “The policy of this hospital for avoiding deep vein thrombosis after major surgery is to…” or “From this point of view Clinical Practice Guidelines are also considered a kind of “policy”.
Compared to the former, the latter understanding of “policy” is much broader and implies much more types of policy and much more types of individuals involved (see “Policy Makers”).
Policy Makers
The general understanding is that this term refers to the persons involved in the process of formulating policies. Which persons are actually meant under the term will depend on the understanding of the term “policy” (see “Policy”). Since the latter shows some variation, so too will the term “policy maker” vary. Related to HTA policy makers can be understood as the ones who are supposed to make use or take into account evidence from assessments (i.e. the persons for which HTA-reports are written). The term may be understood restrictively meaning persons operating only in a macro level (i.e. institutions with influence at the national level) or persons operating in governmental institutions. To some extent it might be confused with politicians (i.e. persons elected) or persons occupying political positions (Ministers, etc.).
Frequently the terms “policy maker” and “decision maker” are used as synonyms. In fact “policy makers” are also “decision makers”, since the process of policy formulation implies taking decisions (i.e. making choices among available options). However not all “decision makers” should be considered to be “policy makers” too. As said before decision makers are the ones who make choices among available options to solve a problem, thus a patient or a clinician are considered decision makers. Since their decisions affect only the individual situations and are not intended to guide the actions of a group or to establish a general rule, they cannot be considered “policy makers”.
The following persons can be considered to be policy-makers in different countries:
Politicians (MPs, Ministers, etc.), civil servants at national, regional or local authorities, managers (hospital managers, PHC managers, sickness funds managers, private health insurance managers), (clinical) staff involved in formulating CPGs (incl. local use CPGs), persons operating in provider associations (e.g. medical associations, hospital associations) or in purchaser associations, persons operating in self-governing institutions (e.g. joint committees of provider and purchasers).
Policy Question
The term “policy question” seems to be mostly understood as the problem motivating the initiation of an HTA project. Some refer to the term as the questions that policy makers have concerning a technology assuming that policy-makers have formulated concise questions –which can be found in, for example, the commissioning document.
The term can also be understood more generally as the problem policy makers face and for which information from HTA is required/ can be provided. Similarly it may mean the policy process in which the assessment is/ should be embedded. In those cases actually no questions have been worded by policy makers.
In some HTA-reports “Policy Question” refers to a section in which beside the problem / policy process which has motivated the assessment the circumstances surrounding the assessment are also described. These include the sources of funding of the report, who commissioned the assessment and to whom is it addressed.