| Course | PHE 610 Health Policy and Management |
|---|---|
| Module | Module 5 |
| Paper type | graduate stakeholder analysis and policy options paper (final project milestone two) |
| Length | About 1,040 words, 6 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MPH |
| Updated | October 2026 |
Free sample paper for PHE 610 Module 5
Who Wins, Who Loses and What Else Could Work: Stakeholders and Options for Dental Therapy Licensure
[Student Name]
Southern New Hampshire University
PHE 610: Health Policy and Management
Final Project Milestone Two
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Who Wins, Who Loses and What Else Could Work: Stakeholders and Options for Dental Therapy Licensure
Introduction
Milestone One proposed evaluating a bill that would license dental therapists in a northern Plains state where 49 of 61 counties are dental shortage areas and tribal clinics wait months to fill a tooth. This milestone asks two questions that precede any recommendation: who has a stake in the decision and how much power each holds, and what realistic alternatives the state could choose. The analysis follows the stakeholder method described by Varvasovszky and Brugha (2000), which classifies actors by their position, interest and influence, and the options are described against the five criteria set in Milestone One: effectiveness, quality and safety, cost, equity, and feasibility and acceptability.
Stakeholder Analysis
Stakeholder analysis is useful only if it explains behavior, not just lists names. Brugha and Varvasovszky (2000) caution that the same organization may hold different positions on different parts of a policy, and that power can come from money, votes, expertise or legitimacy. Table 1 summarizes the nine actors identified from testimony in the two prior sessions, news coverage and interviews with the state oral health program.
Table 1. Stakeholders in Dental Therapy Licensure
| Stakeholder | Position | Core interest | Power |
|---|---|---|---|
| State dental association | Strongly opposed | Scope of practice, quality, practice income | High: campaign giving, ties to committee members, technical authority |
| Tribal governments (three nations) | Strongly supportive | Access for members, sovereignty over tribal health care | Moderate to high: legal standing, moral authority, federal partners |
| Community health centers | Supportive | Staffing rural sites at lower cost | Moderate |
| State Medicaid agency | Neutral, cautious | Budget, provider network adequacy | Moderate: controls billing rules |
| Dental hygienists' association | Supportive if hygienists can train as therapists | Career advancement | Low to moderate |
| State dental school | Divided | Accreditation, faculty views, clinic revenue | Moderate: expertise |
| Rural legislators | Mostly supportive | Constituent access, local clinics | Moderate, rising with new chair |
| Governor's office | Leaning supportive | Rural health agenda, budget | High |
| Patients and families | Supportive where aware | Affordable care close to home | Low: unorganized |
Two features of the table matter most. First, power is unevenly distributed: the strongest opponent is organized, well funded and trusted on clinical questions, while the largest group of beneficiaries, patients, is unorganized. Second, the tribes' interest is not identical to that of other supporters. For tribal governments the issue is partly sovereignty: whether the state can tell a tribal clinic which providers it may employ. That interest makes tribal-only authorization acceptable to them, but it is less attractive to community health centers in non-tribal counties.
How the Issue Is Framed
Each side has a frame. The dental association frames the bill as a patient safety question: irreversible procedures, it argues, should be performed only by dentists with four years of dental school. Supporters frame it as an access question, pointing to the man who died of a tooth infection last winter and to children waiting months for care. A third frame, sovereignty, is advanced by tribal leaders, who note that federal law already permits dental health aide therapists in Alaska's tribal system. The frame that dominates committee testimony will shape which options seem reasonable, so any recommendation will need evidence that speaks to safety directly rather than only to access.
Policy Options
Four options are considered, each of which could be enacted in the next session.
Option 1, status quo. Make no change to scope of practice or financing. Current efforts, including a small state loan repayment program and volunteer dental days, would continue.
Option 2, higher Medicaid fees with expanded loan repayment. Raise Medicaid dental fees for children and adults toward the regional private average and triple the loan repayment program, requiring recipients to practice four years in a shortage county. This option keeps the current workforce model but tries to pull more dentists into it.
Option 3, tribal-only authorization. Authorize tribal health programs to employ dental therapists certified under the federal community health aide program, without creating a state license. Washington State took a similar step for tribes before broader legislation.
Option 4, statewide licensure. Enact the bill as drafted, creating a state license for dental therapists who practice in shortage areas or in settings serving mostly public and uninsured patients, under a collaborative agreement with a dentist, with direct Medicaid billing.
Options Against the Criteria
Table 2 describes the likely effect of each option on each criterion, based on the evidence reviewed so far. Ranking and weighting are left for Milestone Three.
Table 2. Policy Options Described Against the Criteria
| Criterion | 1. Status quo | 2. Fees and loan repayment | 3. Tribal-only | 4. Statewide licensure |
|---|---|---|---|---|
| Effectiveness | No change in access | Some gain where dentists exist; limited reach in empty counties | Gains on reservations, as in Alaska | Gains in tribal and rural settings if therapists are trained |
| Quality and safety | Unchanged | Unchanged | Evidence from Alaska supports safety | Same evidence; supervision rules matter |
| Cost to state | None | High, recurring | Low; federal and Medicaid billing | Moderate start-up, training costs |
| Equity | Gaps persist | Helps urban poor more than rural | Helps tribal members only | Broadest reach to rural and tribal residents |
| Feasibility | Easy | Budget resistance | Moderate; less dental opposition | Hard; strong opposition |
The evidence behind these entries is uneven. For Option 2, Buchmueller et al. (2016) found that dentists treat more Medicaid patients when fees are higher, but the response depends on how many dentists are nearby, which is the binding constraint in our empty counties. For Options 3 and 4, Chi et al. (2018) found fewer extractions and more preventive care in Alaska communities served by therapists, though that setting differs from ours. The cost estimates are preliminary and will be refined using the state budget office's fiscal note from the last session.
Next Step
Milestone Three will weight the criteria, score the four options and recommend one, with an implementation plan that answers the strongest objections raised by stakeholders in Table 1. A combination of options, such as tribal-only authorization now with a statewide pilot later, will also be considered. Two pieces of evidence still need to be gathered before that scoring: the dental school's estimate of how many therapists it could train each year if a program were accredited, and the Medicaid agency's view of whether therapist services could be billed under existing codes or would need a state plan amendment. Both bear on feasibility, the criterion on which the options differ most.
References
Brugha, R., & Varvasovszky, Z. (2000). Stakeholder analysis: A review. Health Policy and Planning, 15(3), 239-246. https://doi.org/10.1093/heapol/15.3.239
Buchmueller, T., Miller, S., & Vujicic, M. (2016). How do providers respond to changes in public health insurance coverage? Evidence from adult Medicaid dental benefits. American Economic Journal: Economic Policy, 8(4), 70-102. https://doi.org/10.1257/pol.20150004
Chi, D. L., Lenaker, D., Mancl, L., Dunbar, M., & Babb, M. (2018). Dental therapists linked to improved dental outcomes for Alaska Native communities in the Yukon-Kuskokwim Delta. Journal of Public Health Dentistry, 78(2), 175-182. https://doi.org/10.1111/jphd.12263
Varvasovszky, Z., & Brugha, R. (2000). How to do (or not to do) . . . A stakeholder analysis. Health Policy and Planning, 15(3), 338-345. https://doi.org/10.1093/heapol/15.3.338
What the PHE 610 Module 5 instructions ask for
Milestone Two of the PHE 610 final project usually asks for two linked analyses of the policy chosen in Milestone One. The first identifies stakeholders, the groups and individuals who affect or are affected by the policy, and describes their positions, interests and influence. The second sets out policy options or alternatives, including the status quo, and describes how each would address the problem. Expect three to five pages in APA 7, and a table is often welcome. Use the criteria you stated in Milestone One to describe the options, but hold back the final recommendation for Milestone Three. Revise anything your instructor flagged in Milestone One before building on it.
How this PHE 610 Module 5 milestone two example is built
This sample opens with a stakeholder table covering nine actors: the state dental association, three tribal governments treated as one group, community health centers, the state Medicaid agency, the dental hygienists' association, the dental school, rural legislators, the governor's office and patients. Each row shows position, core interest and power. A section on framing contrasts the association's safety frame with the tribes' sovereignty and access frame. Four options follow: status quo, higher Medicaid fees with loan repayment, tribal-only authorization and statewide licensure as in the bill. A comparison table describes each against effectiveness, quality, cost, equity and feasibility without ranking them. A short closing paragraph explains what Milestone Three will decide.
Where the PHE 610 Module 5 rubric puts the points
The PHE 610 rubric for Milestone Two generally scores the identification of stakeholders, the analysis of their positions and influence, the description of alternatives and the quality of evidence. The top band goes to analyses that go beyond listing groups to explain why each holds its position and how much power it can use, and to options that are genuinely distinct and realistic rather than straw men set up to lose. Graders look for the status quo as a named option and for consistency with the criteria stated in Milestone One. Writing, organization and APA 7 make up the rest. A table for each analysis is not always required but makes the scoring rows easier for a grader to find and credit.
PHE 610 Module 5 help: the mistakes that cost points
Students lose points on this milestone by listing stakeholders without saying what each wants or how much influence it has, by leaving out groups that oppose the policy, and by offering options that are minor variations of one idea. Another frequent problem is recommending an option here when the guidelines save that for Milestone Three. If your policy is different, such as a soda tax, a nurse staffing law or a harm reduction program, send your Milestone One and the feedback on it, and the stakeholder map and options will be built from that. Make sure every option could plausibly be adopted in your state, because the next milestone has to score each one honestly.
Get PHE 610 Module 5 written to your instructions
Send the PHE 610 Milestone Two guidelines with your Milestone One feedback. The paper will map stakeholders by position, interest and power, explain how each frames the issue, and define three or four options with their likely effects on your criteria, ready in roughly two days. There is no charge for your first sample. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
More PHE 610 papers and related MPH samples
- PHE 610 Module 1 Discussion: How the System Leaves a County Without a Dentist
- PHE 610 Module 2 Financing Short Paper: Who Pays for Teeth and Who Goes Without
- PHE 610 Module 3 Milestone One: The Policy Evaluation Proposal
- PHE 610 Module 4 Discussion: How an Issue Reaches the Agenda
- PHE 610 Module 6 Reform Legislation Short Paper: What the ACA Did and Did Not Do for Teeth
- PHE 610 Module 7 Discussion: Managing a Program Through a Policy Change
- PHE 610 Module 8 Milestone Three: The Recommended Course of Action
- PHE 610 Module 9 Discussion: Communicating a Policy to People Who Decide
- PHE 610 Module 10 Final Project: The Policy Analysis and Recommendation
- PHE 500 Module 1 Discussion: What Public Health Is, Seen Through One Bat
- PHE 505 Module 7 Survey Assignment: A Rider Survey Built and Tested
- PHE 540 Module 7 Program Evaluation Journal: Judging an Air Monitoring Program
- PHE 425 Module 5 Milestone Two: The Needs Assessment and Priority Population
PHE 610 Module 5 questions, answered
Where can I find a free PHE 610 Module 5 Milestone Two sample?
This page shows a complete PHE 610 Module 5 Milestone Two paper mapping stakeholders in a dental therapy debate and defining four policy options against stated criteria.
What is a stakeholder analysis in health policy?
A structured look at the people and organizations that affect or are affected by a policy, describing their positions, interests, resources and influence so that advocates can anticipate support and opposition.
How many policy options should Milestone Two include?
Most guidelines expect three or four, including the status quo. Each should be a realistic alternative that could actually be adopted.
Should Milestone Two include a recommendation?
Usually not. Milestone Two describes stakeholders and options; Milestone Three compares them and recommends a course of action. Check your own guidelines.
What is the difference between interest and position in stakeholder analysis?
A position is what a stakeholder says it wants, such as opposing a bill. An interest is the underlying concern, such as protecting income or patient safety, which may allow compromise.