Health system priority setting: key concepts and factors.
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Biomedical subjects
Publications and source records attributed to W J Waters.
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A questionnaire survey of the 50 state CHP agencies and a case study of a single state CHP agency were conducted to contrast the concept of comprehensive health planning with the practice of health planning at the state level. Both the survey and the case study evidenced a substantial disparity between concept and practice. For example, the survey indicated that the following tasks had not been completed by the following percentages of the responding agencies: defining the system of interest (64%), ranking problems (50%), setting targets (74%), thoroughly analyzing intervention alternatives (71%), selecting criteria and procedures for intervention evaluations (57%). The state CHP agencies were found to be lacking in the following areas: (a) technical analyses, (b) explicitness, (c) priority setting, (d) attention to health status indices and preventive interventions, and (e) integration of planning activities. The implications of these findings are discussed.
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Over a 25-year period, regular surveys of physicians licensed in Rhode Island have recorded their smoking behavior. The six surveys show a decrease in the rate of cigarette smoking from 33% in 1963 to 4.6% in 1988. In the most recent survey, 65% of respondents reported never having smoked, and 87% of those who had ever smoked reported having quit. However, the statistic for the maximum number of cigarettes smoked regularly was higher for current smokers than for former smokers. Among physicians in the 1988 survey, most former smokers (85%) reported using only unassisted personal effort in quitting, whereas nearly half (48%) of current smokers tried methods involving assistance, such as self-help programs, group programs, or nicotine gum. Among former smokers who quit after 1983, the percentage trying assisted methods (34%) was closer to the percentage among current smokers. Apparently, remaining smokers include many heavy smokers who require more potent interventions in order to quit. Physicians in Rhode Island have almost become a smoke-free group. Their experience, coupled with their involvement in smoking prevention and cessation for their patients, can lead the rest of society on its path to becoming smoke-free.