Medicine, economics and agenda-setting

The filtering of potential policy issues from a large range of possibilitie s to a relatively small list of agenda items allows the organisation of pow er and influence within a policy sector to be examined. This study investig ated power and influence in health policy agenda-setting in one State of Au stralia (Victoria) in the years 1991, 1992 and 1993. The actors seen as inf luential were predominantly medically trained and working in academia, heal th bureaucracies and public teaching hospitals. This research supports an e lite model of health policy agenda-setting, in which outcomes are dependent on the structured interests within the policy field. However, while the co rporate elite of the profession is influential, the frontline service provi ders are not, as indicated by the location of influentials in large and pre stigious organisations. Politicians and professional associations and union s are less well represented, and consumer and community groups are virtuall y absent. In 1993 there was a sharp increase in economists being nominated as influentials, with a subsequent decrease in influentials with medical tr aining. This relates to a (perceived or real) shift in influence from the m edical profession to senior health bureaucrats. Economic concerns appear to be shaping the visible health policy agenda, through an increased number o f influentials with economics training, but also through an apparent abilit y to shape the issues that other influentials are adding as agenda items. T he corporate elite of medicine remains powerful, but their range of concern s has been effectively limited to cost containment or cost reduction, bette r planning and efficiency. This limiting of concerns occurs within an inter national policy context, where the general trends of globalisation and an e mphasis on neo-liberal economics impact on the direction of health policy i n individual countries. (C) 1998 Elsevier Science Ltd. All rights reserved.