Medicaid Policy Process Part 2

Evaluation stage is a systematic process of assessing the design, quality, implementation, effectiveness, costs, and goal attainment of the public policies. It involves determining how well a policy is working, and includes evaluating the policy in terms of necessity, efficiency, and also validity among others. A favorable evaluation result of the impact of a certain public policy mostly leads to the implementation and continuity. Unfavorable results may give rise to revision or termination (Nachmias, 2009).

Policies can be evaluated in a variety of formal and informal methods. However, the formal methods tend to be difficult to carry out, while the informal ones can be riddled with bias. Evaluation can take place during or after implementation to understand its overall effectiveness. Most policies fail to be evaluated due to the assessment difficulties and the tendency of the policy making process to favor the status quo (Nachmias, 2009). Policy evaluation also faces several constrains, such as budget, time, political ideologies, ethical considerations, institutional biases, values, experiences, goal clarity, measurement instruments, as well as policy restrictions. However, all these challenges should not deny the evaluation exercise to give the unbiased policy evaluation results, at least as much as possible.


Public policy evaluation assists all stakeholders in the policy making process that include law makers, implementers, and other stake holders, to measure the degree, to which a policy has achieved its target, to check the impact of it, and to determine any revision needed to the policy. Policy evaluation is one of the requirements outlined by the organizations that fund the policy implementation, mostly federal grants (Vedung, 2011). This is to ensure that there is no misappropriation of funds. Evaluation also helps in determining the effects that a policy brings about, both the intended and the unintended. It also shows whether the effects of implementing the policy are positive or negative to the target population and society as a whole. Another purpose is to discover the policy flaws and to correct them given the limitations incumbent in the overarching policy process.

Types of Evaluation

There are two main types of evaluation: formative and summative evaluations. The formative evaluation examines the operations of the policy, usually for the purpose of improving the program and assessing its implementation (Nachmias, 2009).  Summative evaluation should be conducted at the end of implementation, as it asks whether the policy has achieved its intended goals or not.


It uses social science research methods, including qualitative and quantitative techniques, to examine the effects of public policies.

Qualitative Method

This method involves getting the evaluation information through observation, interviews, and focus groups. It focuses on explaining why there is a certain behavior among the population. It answers how and why questions. Respondents involved are few, and there is use of open-ended questions. Method’s strengths include the following ones: complement and refine quantitative data, it provides more detailed information to explain complex issues, and it has multiple methods for gathering data on the sensitive subjects (Vedung, 2011). Some of its weaknesses include: findings usually cannot be used to represent the whole society, it is more difficult to analyze, as it does not fit neatly into the standard categories, and data collection is usually time consuming and costly.

Quantitative Method

This method involves pieces of information that can be counted mathematically, usually gathered surveys from a large number of randomly selected respondents and use of the secondary data. Analysis should be done using statistical methods, and it answers what, when, and who questions. Its strengths are the following: findings can be generalized to represent the whole population, relatively easy to analyze, data can be highly consistent, precise, and reliable, and data collection is cost effective. The limitations include: related secondary data may be unavailable or inaccessible, and the data may not be robust enough to explain the robust issues.

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Analysis Stage

The analysis stage should involve a multi-disciplinary approach to the health policy that aims to explain the interaction among the stakeholders in the policy making process. It is useful in understanding the past policy failures and successes and for planning for future policy implementation. Its purpose is to facilitate the reaching of sound policy decisions. It will involve examining the problem, issues, legislation, other policies, or any other subject of significance (Vedung, 2011). Analyzing of data and information collected in the evaluation phase takes place here. A conclusion should be drawn on the way forward of this policy. If the policy is achieving its set goals, has no negative repercussions, and has cost effectiveness, the implementation should continue. However, if the health policy is not solving the health issue in an effective manner, then it should be revised or terminated. This is a particularly critical stage, because of the stress exerted by the legislators, and the results may be altered by the people in power in an attempt to get their desired outcome (Vedung, 2011).

Health issues require public response, as they are highly sensitive. Professionals in the health sector and pharmaceutical industry usually significantly influence the policy process, especially analysis. This is because they have the required knowledge and access to the political processes. One of the challenges in policy analysis is that there is often a struggle between the long-term policy impact and implementation and its short-term impact. This is in funding for policy research and policy makers’ demand for answers and remedies. It is also difficult to capture and measure the quantity of resources, power of diverse stakeholders, beliefs, and values.


There is use of qualitative and quantitative methods, which include case studies, survey, analysis of statistics, and model building among others. After analyzing a policy, if it does not fit the set goals, alternatives should be identified, evaluated, and recommended.  Professional policy analysts sort the information available about the policy and come to a conclusion. They check the policy’s achievement of the  set goals, its cost effectiveness, and also if it has any negative effects that were previously not identified. According to the results of the analysis, a deduction should be made on the feasibility of the policy. This will lead to the continuity of the policy’s implementation, termination, or revision.

Revision Stage

The policies should be reviewed on the regular basis. This is because over time they may become outdated and may contradict their initial purpose. When this occurs, the policy needs modification or elimination. For the policy to be modified or terminated, it must be discussed by the policy makers, who have to vote for the same. This should be documented for the future references (Nagel, 2010). The process involves starting again with a new policy that will solve the current issue better than the previous policy. It should go through the entire policy making process. It starts from the formulation stage, where the policymakers identify the most effective policy to solve the issue. They may use the open or closed system. The policy has to be politically feasible. The policy will then go through the legislative stage (Vedung, 2011) Intense lobbying takes place, as the policy makers try to gather interest groups and public attention (Nagel, 2010). It has to be enacted to become effective by the relevant government institutions. After legislation, the policy implementation starts. This involves organization, interpretation, and application.


The main purpose of policy revision is to ensure that the policy is meeting its preset goals and does not have any unwanted effects. It also helps in ensuring that even with changes in the nature of the problem, the policy is still feasible. Policy revision also helps in ensuring termination of policies that have already achieved their target (Vedung, 2011).


The methodology used involves identifying areas of concern and generating ideas for improvement. This will include preparation of a revised policy in written format, and communicating the changes to the public. It has to go through the congress and has to be enacted for it to become a law (Nagel, 2010). The policy will undergo the whole policy making process starting from the formulation, legislative, implementation, evaluation, analysis, and revision. A health policy, being a national issue, has to have the presidential assent for it to be enacted.


The public policy making process is a tough task, and due to the involvement of many issues it may take a long time. Many challenges face it, starting from the evaluation stage to the analysis and, finally, the revision stage. Evaluating takes place to ensure that the policy is achieving its set goals and does not have some unfavorable effects. Evaluation should be an ongoing process having the policies monitored on regular bases (Vedung, 2011). Analysis involves getting into details with the results of the evaluation and concluding on the effectiveness of the policy. If a policy is ineffective or has some unwanted effects, it can be revised or terminated. Finally, the revision stage entails having the details of the policy changed, so as to solve the issue at stake. Medicare policies are essential and affect the entire nation. As a result, a thorough evaluation should always be done in order to ensure that the health care system is favorable for all, especially for the minimum wage earners and the unemployed. A public policy should be evaluated and revised regularly, as new issues come up and affect it.

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