Abstract
Background/Objectives
In the Netherlands, the policy making process to realize funding for the Combined Lifestyle Intervention (CLI) by health insurance lasted twelve years. Since January 2019, the health care components of the CLI are covered by the Health Insurance Act. We aimed to identify policy design decisions, processes and implementation willingness and capacity of stakeholders.
Methods
We conducted an institutional policy analysis using backward mapping. We composed a timeline (2007-2019) based on public documents and interviewed 22 key stakeholders, representing policy-making institutions, care professions, health insurers and CLI-owners.
Results
We identified 15 policy making design decisions and three phases that marked the policy process. Three main decisions are: 1) including lifestyle coaching in the CLI.; 2) excluding the physical activity component for funding by health insurance and 3) health insurers and municipalities having own policies, resulting in a variety of contracts with health care providers and local differences in the CLI offer.
In all stages, decision-making was mainly based on scientific evidence. In phase I (2007-2011) the government imitated policy making and pilots to build evidence. However, in phase II (2011 -2014) the government stopped any further action due to politics, whereas in practice activities continues, e.g. the implementation and evaluation of CLIs. In phase III (2014-2017), many stakeholders, including governmental bodies, collaborated to realize funding by health insurance for the CLI. However, initially not all stakeholders were represented in policy making. For example, intervention owners and the new profession lifestyle coaches joined the policy making process at a later stage. In addition, vested and new stakeholders faced competing interests, which tempered their willingness and capacity to implement the CLI.
Discussion
The CLI sets a new standard - at the interface of indicated and selective prevention – by incorporating (non-medicalised) lifestyle coaching. Although the CLI is embedded in a single insurance-based scheme (instead of across domains), it institutionalizes cross-domain collaboration without providing the necessary resources. Collaborative prevention requires cross-domain trusting implementation networks, including vested stakeholders, field innovators and citizens, to avoid conflicts, and build adaptive and responsive prevention policies.
Keywords
Policy making, Combined Lifestyle Intervention, Health promotion
In the Netherlands, the policy making process to realize funding for the Combined Lifestyle Intervention (CLI) by health insurance lasted twelve years. Since January 2019, the health care components of the CLI are covered by the Health Insurance Act. We aimed to identify policy design decisions, processes and implementation willingness and capacity of stakeholders.
Methods
We conducted an institutional policy analysis using backward mapping. We composed a timeline (2007-2019) based on public documents and interviewed 22 key stakeholders, representing policy-making institutions, care professions, health insurers and CLI-owners.
Results
We identified 15 policy making design decisions and three phases that marked the policy process. Three main decisions are: 1) including lifestyle coaching in the CLI.; 2) excluding the physical activity component for funding by health insurance and 3) health insurers and municipalities having own policies, resulting in a variety of contracts with health care providers and local differences in the CLI offer.
In all stages, decision-making was mainly based on scientific evidence. In phase I (2007-2011) the government imitated policy making and pilots to build evidence. However, in phase II (2011 -2014) the government stopped any further action due to politics, whereas in practice activities continues, e.g. the implementation and evaluation of CLIs. In phase III (2014-2017), many stakeholders, including governmental bodies, collaborated to realize funding by health insurance for the CLI. However, initially not all stakeholders were represented in policy making. For example, intervention owners and the new profession lifestyle coaches joined the policy making process at a later stage. In addition, vested and new stakeholders faced competing interests, which tempered their willingness and capacity to implement the CLI.
Discussion
The CLI sets a new standard - at the interface of indicated and selective prevention – by incorporating (non-medicalised) lifestyle coaching. Although the CLI is embedded in a single insurance-based scheme (instead of across domains), it institutionalizes cross-domain collaboration without providing the necessary resources. Collaborative prevention requires cross-domain trusting implementation networks, including vested stakeholders, field innovators and citizens, to avoid conflicts, and build adaptive and responsive prevention policies.
Keywords
Policy making, Combined Lifestyle Intervention, Health promotion
| Original language | English |
|---|---|
| Publication status | Published - 16 May 2022 |
| Event | 24th World Conference on Health Promotion of the International Union for Health Promotion and Education (IUHPE): Promoting policies for health, well-being and equity - Montreal, Canada Duration: 15 May 2022 → 19 May 2022 https://iuhpe2022.com/ |
Conference
| Conference | 24th World Conference on Health Promotion of the International Union for Health Promotion and Education (IUHPE) |
|---|---|
| Country/Territory | Canada |
| City | Montreal |
| Period | 15/05/22 → 19/05/22 |
| Internet address |
Keywords
- Policy making, Combined Lifestyle Intervention, Health promotion
