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PubMed2005

Recent trends in smoking and the role of public policies: results from the SimSmoke tobacco control policy simulation model.

AIMS: After a period of steady decline in smoking prevalence, smoking rates leveled off in the United States between 1990 and 1997, but began falling between 1997 and 2003. Trends in smoking prevalence, and the role of tobacco control policies in affecting those rates, are examined. DESIGN: A computer simulation model is used in which smoking prevalence evolves through initiation and cessation, which are in turn influenced by tobacco control policies. METHODS: The results of the model are compared to smoking prevalence measures from the US National Health Interview Survey between 1993 and 2003. We also consider the role of tax/price, clean air laws, media campaigns and youth access policies in influencing these rates. FINDINGS: Both the SimSmoke model and data for recent years indicate that adult smoking prevalence changed little between 1993 and 1997, and even increased among youth. Between 1997 and 2003, smoking prevalence has been declining. Most age, gender and racial-ethnic groups show patterns similar to that of the entire population, with differences for those aged 18-24 years. The predominant trends were explained mainly by changes in price, with some residual effect of clean air laws, media campaigns and youth access laws. CONCLUSIONS: Among public tobacco control policies, price had the dominant effect on smoking prevalence between 1993 and 2003, because few states implemented other policies to the degree necessary to affect much change. Through continued tax increases, stronger clean air laws, extensive media campaigns and broader cessation treatment programs, there is the potential to have much larger reductions in smoking prevalence.

Adolescent↗

PubMed2000

How are policy makers using evidence? Models of research utilisation and local NHS policy making.

STUDY OBJECTIVE: This paper is based on a qualitative study that aimed to identify factors that facilitate or impede evidence-based policy making at a local level in the UK National Health Service (NHS). It considers how models of research utilisation drawn from the social sciences map onto empirical evidence from this study. DESIGN: A literature review and case studies of social research projects that were initiated by NHS health authority managers or GP fundholders in one region of the NHS. In depth interviews and document analysis were used. SETTING: One NHS region in England. PARTICIPANTS: Policy makers, GPs and researchers working on each of the social research projects selected as case studies. MAIN RESULTS: The direct influence of research evidence on decision making was tempered by factors such as financial constraints, shifting timescales and decision makers' own experiential knowledge. Research was more likely to impact on policy in indirect ways, including shaping policy debate and mediating dialogue between service providers and users. CONCLUSIONS: The study highlights the role of sustained dialogue between researchers and the users of research in improving the utilisation of research-based evidence in the policy process.

England↗

PubMedDate not supplied

Building a methods bridge between public policy analysis and healthy public policy.

The literature has only begun to consider what research is needed to support the development and implementation of healthy public policy initiatives. To date, a consistent methodological approach is recommended: multiple methods (document analysis and key informant interviews supplemented by quantitative data) with an aim toward understanding the perspective of key policy stakeholders. Currently, these methods are not the mainstay of policy analysis which is often driven more by a preference for technique (e.g., cost-benefit analysis) than by underlying epistemology or theory. Yet the explicit values of healthy public policy (intersectoral policy-making, public participation, etc.) suggest the importance of paying greater attention to epistemological and theoretical principles when making methodological choices.

Health Policy↗

PubMed2005

Making health policy: networks in research and policy after 1945.

Science and policy in health and medicine have interacted in new ways in Britain since 1945. The relationship between research and policy has a history. The changing role of social medicine, the rise of health services research and "customer contractor" policies in government have been important. The relationship between research and policy has been analysed by different schools of thought. This chapter categorises them as several groups: "evidence-based", "journalism", "sociology of scientific knowledge" and "science policy studies". The chapters in the book illuminate aspects of these changing relationships. The role of chronic disease epidemiology, of new networks in public health, of media-focussed activism, and of health technology and its advocates have been more important than political interest.

Biomedical Research↗

PubMed1991

Antitrust policy in the Dutch health care system and the relevance of EEC competition policy and U.S. antitrust practice.

Dutch health care policy is undergoing a radical shift from a planning-oriented towards a market-oriented approach. A fundamental restructuring of the health care financing system should bring about workable competition among providers and among health insurers. As the result of both government regulation and anticompetitive self-regulation strong cartels and dominant positions are deeply rooted in the present Dutch health care system. In order to be successful structural reforms should be supported by an effective antitrust policy. However, present Dutch antitrust policy is too lenient to fulfil this necessary condition. EEC competition policy is far more stringent, but for several reasons its relevance will be limited. For an effective enforcement of national antitrust policy in health care, the so far unique American experience in this field provides some useful lessons.

Antitrust Laws↗

PubMed2005

The role of public policies in reducing smoking and deaths caused by smoking in Vietnam: results from the Vietnam tobacco policy simulation model.

A simulation model is developed for Vietnam to project smoking prevalence and associated premature mortality. The model examines independently and as a package the effects of five types of tobacco control policies: tax increases, clean air laws, mass media campaigns, advertising bans, and youth access policies. Predictions suggest that the largest reductions in smoking rates will result from implementing a comprehensive tobacco control policy package. Significant inroads may be achieved through tax increases. A media campaign along with programs to publicize and enforce clean air laws, advertising bans and youth access laws would further reduce smoking rates. Tobacco control policies have the potential to make large dents in smoking rates, which in turn could lead to many lives saved. In the absence of these measures, deaths from smoking will increase. The model also helps to identify information gaps pertinent both to modeling and policy-making.

Adolescent↗

PubMed1999

Implications of social class and race for urban public health policy making: a case study of HIV/AIDS and TB policy in Washington, DC.

This paper explores how social class and race affect the public health policy-making process in an urban area. Ethnographic methods were used to collect and analyze information about HIV/AIDS and tuberculosis policy-making by the Washington, DC Commission of Public Health, Kingdon's conceptual model of policy making was used to analyze and understand the process. The problems of HIV/AIDS and tuberculosis in the district have important social class dimensions that were not always made explicit, but were instead defined in terms of 'race' and 'place'. Social class considerations and racial politics shaped what policies were developed or not developed and implemented successfully or failed. This study, which has national and international implications, concludes that there is a need to improve our understanding of the complex social dimensions of public health problems; there needs to be more consideration of the politics of strategy formulation and how issues of social class and race affect this process; and public health needs to strengthen its constituency in order to build support for the successful development and implementation of policy.

Acquired Immunodeficiency Syndrome↗

PubMed1983

Media and agenda setting: effects on the public, interest group leaders, policy makers, and policy.

Using an experimental design built around a single media event, the authors explored the impact of the media upon the general public, policy makers, interest group leaders, and public policy. The results suggested that the media influenced views about issue importance among the general public and government policy makers. The study suggests, however, that it was not this change in public opinion which led to subsequent policy changes. Instead, policy change resulted from collaboration between journalists and government staff members.

Chicago↗

PubMed2006

Evidence into policy and practice? Measuring the progress of U.S. and U.K. policies to tackle disparities and inequalities in U.S. and U.K. health and health care.

Health policy in both the United States and the United Kingdom has recently shifted toward a much greater concern with disparities and inequalities in health and health care. As evidence for these disparities and inequalities mounts, the different approaches in each country present specific challenges for policy and practice. These differences are most apparent in the mechanisms by which the progress of such policies is measured. This article compares the United States' and United Kingdom's strategies to gauge the challenges for policymakers in order to inform policy and practice. A cross-national comparison of selected measurement mechanisms identifies lessons for policy and practice in both countries.

Delivery of Health Care↗

PubMed2002

Policy feedback and public opinion: the role of employer responsibility in social policy.

This study extends the literature on policy feedback and explores the extent to which public attitudes reflect learning from past government initiatives. We analyze the ways in which feedback mechanisms affecting public attitudes may differ from those earlier identified in the literature. We apply this general analytic framework to help explain variation in public attitudes toward private employer involvement in health care, explore possible causal pathways, and offer some preliminary empirical tests of these hypotheses. There are different levels of public support for the notion of employer obligation involving medical care, long-term care, and the treatment of substance abuse. Our evidence suggests that lessons about the performance of institutions in each of these policy domains represent the most important effect of existing policy on public attitudes. Furthermore, these differences correspond to what one would expect based on our model of policy feedback and cannot be explained by other plausible sources of policy legitimacy.

Attitude to Health↗

PubMedDate not supplied

Quantitative policy analysis and public health policy: a macro and micro view.

This article considers three examples of the use of quantitative policy analysis in setting public health policy: (1) benefit:cost and cost-effectiveness studies of influenza immunization and their role in achieving Medicare reimbursement for influenza immunization; (2) the 1993 World Bank World Development Report, which compared the burden of various health problems in different regions of the world and the cost-effectiveness of interventions for these problems, recommending a core set of public health and primary care services as being the most cost-effective; and (3) the role of the Agency for Health Care Policy and Research and how it might change if health care reform legislation such as President Clinton's original proposal were to be enacted. Finally, I describe the use of quantitative policy analysis to guide policy in one government agency--the Centers for Disease control and Prevention (CDC).

Cost-Benefit Analysis↗

PubMed2004

The importance of engaging policy-makers at the outset to guide research on and introduction of vaccines: the use of policy-maker surveys.

Face-to-face surveys of policy-makers and other influential leaders are a useful tool to identify, at an early stage, (a) major issues regarding the introduction of a new vaccine, (b) persons and groups in a country who play a major decision-making or influential role in the introduction of vaccines, (c) potential obstacles to the introduction of vaccines, and (d) data-needs of policy-makers to overcome these obstacles. By surveying the opinions and beliefs of those who will make or influence decisions on whether to introduce a new vaccine, these studies can help ensure that research activities respond to the needs of policy-makers in countries endemic for the target diseases. These surveys can also inform vaccine-introduction strategies by identifying financially and politically feasible means of distributing, targeting, and financing the vaccines. This paper describes the methodology used in conducting such surveys and discusses methodological issues. It also presents lessons learnt from two policy-maker surveys carried out in several Asian countries in regard to new-generation vaccines against cholera, typhoid fever, and shigellosis; and future vaccines against dengue fever/dengue haemorrhagic fever.

Asia↗

PubMed2003

Is discharge policy a balanced decision between clinical considerations and hospital ownership policy? The CABG example.

OBJECTIVES: To explore to what extent patient discharge from the hospital is a balanced decision between clinical considerations and management policy; specifically: (1) to assess the role of patient risk as a determinant of discharge in comparison with administrative factors such as hospital ownership; (2) to evaluate whether variations in discharge policy were translated into differences in clinical outcomes. METHODS: A national study of coronary artery bypass surgery was used as an example. The population included 4778 patients undergoing coronary artery bypass surgery in 14 institutions. The mode of discharge day, rather than the mean, was used as the best indicator of discharge policy. Parametric survival model was used to assess factors associated with the day of discharge. RESULTS: The mode of discharge day varied widely among institutions. This variation between 4 and 7 days after surgery corresponded to hospital ownership. The mode of discharge day was almost invariant to the patients' risk, but serious postoperative complications resulted in prolonged stay for a minority of the patients. The influence of hospital ownership prevailed over patient insurance carriers. Differences in discharge policies were not associated with increased risk of late mortality or rehospitalization. CONCLUSIONS: Discharge policy beyond the rare occurrence of dramatic patient postoperative complications was mainly dependent on hospital owner's cost-effectiveness considerations. However, despite the weight given to administrative factors in the decision-making process, it did not affect the outcome of care.

Coronary Artery Bypass↗

PubMed2005

Turning science into policy: challenges and experiences from the science-policy interface.

This paper discusses key issues in the science-policy interface. It stresses the importance of linking the conservation and sustainable use of biodiversity to the Millennium Development Goals and to issues of immediate concern to policy-makers such as the economy, security and human health. It briefly discusses the process of decision-making and how the scientific and policy communities have successfully worked together on global environmental issues such as stratospheric ozone depletion and climate change, and the critical role of international assessments in providing the scientific basis for informed policy at the national and international level. The paper also discusses the drivers of global environmental change, the importance of constructing plausible futures, indicators of change, the biodiversity 2010 target and how environmental issues such as loss of biodiversity, stratospheric ozone depletion, land degradation, water pollution and climate change cannot be addressed in isolation because they are strongly interconnected and there are synergies and trade-offs among the policies, practices and technologies that are used to address these issues individually.

Biodiversity↗

PubMed2006

What drug policies cost: estimating drug policy expenditures in Sweden, 2002: work in progress.

AIM: To estimate drug policy expenditures in Sweden for 2002. DATA AND METHOD: The various governmental agencies with drug policy responsibilities were identified and then requested to provide information on their actual spending on these activities. For most agencies additional information was obtained from special studies or expert opinion. FINDINGS: Drug policy expenditures are not easily identified in Swedish official statistics. The results have a very wide range between 500 and 1,400 million Euros during 2002, with 950 million Euros as a baseline estimate. Two items each account for almost 60% of the total-police (including customs and courts) and corrections-whereas treatment expenditures and income support represent about one-fifth, respectively. Comparison with the most recent previous estimate (1991) shows a substantial higher level in 2002. CONCLUSIONS: The findings suggest that a great deal of money is invested in drug policy measures in Sweden today and that it has most probably increased since the early 1990s. This development probably reflects the increase in number of problematic drug users in Sweden as well as increasing attention paid to the drug problem, foremost in the criminal justice system. More work is needed in developing a drug budget that is more easily available and in producing more reliable estimates both across sectors and across time. The need to develop the conceptualization of drug policy measures is also discussed.

Costs and Cost Analysis↗

PubMed2006

What drug policies cost: drug policy spending in the Netherlands in 2003.

AIM: To estimate the public spending on drug policy in the Netherlands. METHODS: Calculation and extrapolation of expenditures from 2003 budgets of all Ministries of the national government, annual reports from other governments and agencies and White Papers, supported by interviews with and information obtained otherwise from policy makers. Expenditures were allocated to four drug policy functions, i.e. prevention, treatment, harm reduction and enforcement. Where exact data on expenditures were lacking, approximations were made representing expert judgement. RESULTS: The total drug policy spending estimate in 2003 was 2,185 million Euros. Allocation to functions amounted to 42 million Euros for prevention, 278 million for treatment, 220 million for harm reduction and 1,646 million for enforcement. CONCLUSIONS: Drug law enforcement is clearly the dominant expenditure. This can be said with certainty despite the noted pitfalls in estimating drug policy expenditures. Many of the available data are not precise. To achieve better figures, a much more detailed analysis would be needed (which is not planned for the foreseeable future). Even then, it would be hard to separate the drug component from more general budgets.

Costs and Cost Analysis↗

PubMed2006

Medicare program; revisions to payment policies, five-year review of work relative value units, changes to the practice expense methodology under the physician fee schedule, and other changes to payment under part B; revisions to the payment policies of ambulance services under the fee schedule for ambulance services; and ambulance inflation factor update for CY 2007. Final rule with comment period.

This final rule with comment period addresses certain provisions of the Deficit Reduction Act of 2005, as well as making other changes to Medicare Part B payment policy. These changes are intended to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule with comment period also discusses geographic practice cost indices (GPCI) changes; requests for additions to the list of telehealth services; payment for covered outpatient drugs and biologicals; payment for renal dialysis services; policies related to private contracts and opt-out; policies related to bone mass measurement (BMM) services, independent diagnostic testing facilities (IDTFs), the physician self-referral prohibition; laboratory billing for the technical component (TC) of physician pathology services; the clinical laboratory fee schedule; certification of advanced practice nurses; health information technology, the health care information transparency initiative; updates the list of certain services subject to the physician self-referral prohibitions, finalizes ASP reporting requirements, and codifies Medicare's longstanding policy that payment of bad debts associated with services paid under a fee schedule/charge-based system are not allowable. We are also finalizing the calendar year (CY) 2006 interim RVUs and are issuing interim RVUs for new and revised procedure codes for CY 2007. In addition, this rule includes revisions to payment policies under the fee schedule for ambulance services and the ambulance inflation factor update for CY 2007. As required by the statute, we are announcing that the physician fee schedule update for CY 2007 is -5.0 percent, the initial estimate for the sustainable growth rate for CY 2007 is 2.0 percent and the CF for CY 2007 is $35.9848.

Fee Schedules↗

PubMed2003

Human resources for health in Palestine: a policy analysis. Part II. The process of policy formulation and implementation.

This article is the presentation of part II of the analysis aiming at providing an insight and better understanding of human resources for health development within a conflicting and transitional context. This part focuses on the human resources for health (HRH) policy development in Palestine taking into consideration the critical elements in policy formulation and implementation, such as sound data based policy and planning, key stakeholders, role and implications of international cooperation. Moreover, it examines recent progress of HRH policy and constraints for implementation. Part I addresses the current situation and recent developments in HRH in Palestine.

Arabs↗