Operational Feasibility

One of the goals of COMPARE is to determine how a given policy option might affect the way the system currently functions. Below, we describe how we assess the operational feasibility of options.

Past experiences with enacting both comprehensive and incremental health policy changes highlight the importance of examining the expected feasibility of implementing a proposed policy option. Proposals that are expected to have similar effects on health care cost, quality, and access when fully implemented may take substantially different amounts of time to implement and entail larger transition costs and more extensive efforts to modify existing organizational structure and processes. The potential of any particular proposal for reducing costs, improving quality, or increasing access may be difficult to realize if the proposal is likely to encounter substantial financial, social, or structural barriers to implementation.

We examine the degree to which a policy option requires new operational routines, involves new sets of people or professionals, requires new ways of doing business, or significantly threatens existing business interests or relationships among stakeholders.

Assessment of the feasibility of a policy option is largely qualitative and is based on reviews of the literature, surveys, and expert opinion. We examine the feasibility of implementing the policy in the context of the current health care system and describe the key challenges of implementing the policy.

In assessing feasibility, we consider questions about the context and attributes of the policy, the planned method of implementation, and the potential distributional effects. The questions below illustrate the approach we take to considering operational feasibility.

Context of the Policy:

• How motivated are different stakeholder groups to implement the policy (e.g., perceived urgency or dissatisfaction with the status quo)?
• What has been the experience of or precedent set by similar policies in the past?
• Are the effective/promising methods for implementing the policy similar or identical to any currently in use?
• How credible or influential are policy advocates with different stakeholder groups that will be required for implementation?

Attributes of the Policy:

• What is the scope of the proposal (e.g., number and types of consumers, and of health care organizations)?
• How complex is the policy (e.g., number and extent/degree of changes at different levels of the system that must occur together)?
• Is the implementation expected (or allowed) to vary across states or regions?
• Is implementation mandatory or voluntary?

Implementation Methods:

• What is the expected timing of implementation (allotted duration of implementation period, sequencing of stages)?
• Does the proposal require establishment of a new government agency or private entities? Does the new program require that any existing operations cease?
• To what degree has the participation, or buy-in, of different stakeholder groups been actively cultivated during the development and implementation of the policy?
• What kinds of processes will be in place for monitoring the progress of implementation?

Distribution of Costs and Benefits:

• Which stakeholder groups are expected to bear the costs of transition, and do they have the resources to cover those costs?
• Will the stakeholder groups expected to bear the costs of implementation be different from those benefiting from the policy?
• How certain or diffused are the expected benefits of the policy versus the expected costs of implementation?
• When are the costs and benefits expected to accrue from the proposal (e.g., how strong is the tension between short-term costs and long-term gains)?

We also identify key implementation issues and challenges likely to affect the operational feasibility of proposals across different areas (e.g., states, metropolitan areas, urban/rural areas) and stakeholder groups within the health care system (e.g., consumers, health care professionals, health plans, hospitals, and other care delivery organizations).