Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association

Health policy analysis: a tool to evaluate in policy documents the alignment between policy statements and intended outcomes

K. Katherine Cheung A , Masoud Mirzaei B D and Stephen Leeder C

A Faculty of Medicine, The University of Sydney, Sydney, NSW 2006, Australia.

B Yazd Cardiovascular Research Centre, Shahid Sadoughi University, Yazd, 89151-73143 IR, Iran.

C Menzies Centre for Health Policy, The University of Sydney, NSW 2006, Australia.

D Corresponding author. Email:

Australian Health Review 34(4) 405-413
Submitted: 31 March 2009  Accepted: 15 February 2010   Published: 25 November 2010


Objective. Health policy analysis remains surprisingly undeveloped in Australia given the power that policy exercises over the direction of public health. This paper describes the use of a policy analysis tool to evaluate the alignment between policy statements and intended outcomes of principal chronic illness policy documents in New South Wales (NSW) from 1999 to 2008. In doing so, it demonstrates the utility of a set of predefined criteria for use in retrospective policy analysis and potential for use in reviewing policy proposals and making future health policies.

Methods. We analysed the major health policy for the care of people with chronic disease in NSW, the Chronic Care Program, using a modified set of existing criteria derived from the logic of events theoretical framework, which conceptualises the connection between policy determinants and outcomes. A document map was also developed to identify linkages between the policy documents analysed.

Results. Internal validity, the alignment between policy statements and intended outcomes, was highest for policy background and goal-setting criteria, and lowest for accessibility, resources, public opportunities and monitoring and evaluation criteria. The use of document mapping was vital in determining linkages between the closely related policy documents of this complex initiative.

Conclusions. The use of predefined criteria to identify in policy documents where policy statements are not consistent with intended outcomes, in conjunction with policy mapping, are useful methods of analysing complex policy initiatives. In the Australian context, the use of a validated policy-analysis tool might help achieve greater consistency.

Implications. The use of a tool during policy development to identify in policy documents where statements are not consistent with intended outcomes may increase the likelihood of the successful implementation of future health policy. The tool can also assist those who make and review future policies.

What is known about the topic? Chronic diseases are an increasing burden on the Australian community and effective policy is required for their prevention and management. Evidence-based policy making has much potential in effecting policy impact yet there is very little Australian research into policy making. Health policy analysis has been conducted in the past but there has not been an attempt to evaluate or analyse the documents that communicate policy in NSW.

What does this paper add? This is the first attempt to analyse the policy documentation of a major health initiative for internal validity, that is, the alignment between policy statements and intended outcomes. It offers a framework that may be used to assess policy documents and demonstrates the utility of document maps to identify policy linkages.

What are the implications for practitioners? The use of a predefined set of criteria highlights opportunities where policies such as the NSW Chronic Care Program can potentially be strengthened. The criteria can be used by reviewers of policy proposals to find where policy documents can be improved to better reflect their intention. This may increase the chance of successful implementation. Document maps may clarify the relationships between policy documents in policy-rich programs and improve their accessibility to target audiences.

Additional keywords: chronic disease, criteria, internal validity, policy formulation.


The authors acknowledge Professor Daniel M. Fox (President of the Milbank Memorial Fund, USA), Professor Alfred Rütten and Dr Karim Abu-Omar (Friedrich-Alexander-University, Germany), Associate Professor Richard H. Osborne (University of Melbourne), Dr James Gillespie (School of Public Health, University of Sydney), and Ms Laurann Yen (Australian Primary Health Care Research Institute, Australian National University) for their comments on the criteria and help in locating some of the literature and policy documents. The authors also thank Dr Andrew Kemp (Western Clinical School), Professor A. Stewart Truswell (Human Nutrition Unit, University of Sydney) and Dr Angela Beaton (Menzies Centre for Health Policy, University of Sydney) for critical reading of the manuscript. Thanks to the Serious and Continuing Illness Policy and Practice Study (SCIPPS) project team for provision of some of the policy documents. Masoud Mirzaei was supported by a National Health and Medical Research Council Program Grant (No. 402793), on which he was a postdoctoral research fellow.


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