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PubMed1993

Cost of illness studies in health care: a comparison of two cases.

Cost of illness (COI) studies describe the economic burden of disease on society. In this article a standard procedure for a COI study is developed, including the explicit definition of the disease, choice of relevant variables and appraisal of direct and indirect costs. COI studies can be incidence-based or prevalence-based. The adjustment of cost figures for time preferences and the performance of a sensitivity analysis are presented. The standard methodology is applied to diseases in two different areas. The first disease category is dyspepsia, a complaint with a rather somatic background. The second is schizophrenia, a mental syndrome. In performing COI studies in practice, however, researchers are forced to deviate, in many aspects, from the theoretical standards. In this article these choices, and the reasons behind these choices, are explained. Furthermore, we discuss certain problems regarding the reluctance to make a diagnosis regarding certain diseases, the reliability and the validity of the sources used and the absence of certain figures. The value of the information derived from COI studies for policy-making is assessed.

Cost of Illness↗
PubMed2000

Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition.

This paper summarizes eight country studies of inequality in the health sector. The analyses use household data to examine the distribution of service use and health expenditures. Each study divides the population into "income" quintiles, estimated using consumption expenditures. The studies measure inequality in the use of and spending on health services. Richer groups are found to have a higher probability of obtaining care when sick, to be more likely to be seen by a doctor, and to have a higher probability of receiving medicines when they are ill, than the poorer groups. The richer also spend more in absolute terms on care. In several instances there are unexpected findings. There is no consistent pattern in the use of private providers. Richer households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicate that intuition concerning inequalities could result in misguided decisions. It would thus be worthwhile to measure inequality to inform policy-making. Additional research could be performed using a common methodology for the collection of data and applying more sophisticated analytical techniques. These analyses could be used to measure the impact of health policy changes on inequality.

Data Collection↗
PubMed1994

Economic development and the health care system in Hong Kong.

This article describes parallel developments of the Hong Kong economy and its health care system. The purpose is to illustrate how the Hong Kong health system evolved in response to external and internal pressures generated by economic prosperity. The Hong Kong system illustrates the importance of clear policy making in the face of these pressures. In particular, issues of investment, financing and distribution of health services are examined in relation to hospital cost control and service accessibility. In the past, health care costs in Hong Kong have been controlled at the expense of limited accessibility of health services. At present, Hong Kong policy-makers are faced with the challenge of maintaining a sharp focus on cost control as they face pressure to expand and improve health care coverage for the citizens. So far they have responded by emphasizing management efficiency through reorganization. It remains to be seen whether this strategy can be successful without passing increased health care costs to the consumers.

Cost Control↗
PubMed1989

Risk management, public policy and informed consent: a case study.

The present guidelines on the use of hepatitis B vaccine in mental handicap hospitals dictate the need for an a priori identification of occupational risk, but fail to clarify how this risk should be defined. The ethical requirement of a respect for autonomy however demands that in offering vaccine as a means of protection, the choice of options must be "informed'. The determinants of institutional transmission have not been clearly defined and it is therefore difficult to inform client groups as to the degree or nature of their occupational risk. It is questionable whether the literature can support the recommendations in their present form, and supposedly "cost-effective' solutions to the problem, pay scant regard to the fact that in risk management, the relative desirability of options is conditional on the alternatives considered, how they are framed, what evidence is consulted and how consequences are weighed. In informing the policy making process, it is imperative that the values of those whose voice is seldom heard, are considered.

Financial Management↗
PubMed1987

[The question of human resources and health reform].

In this article, the author analyses briefly the main considerations that will be the bases for the establishment of a human resources policy in the health sector. It is not the purpose of the article to determine priorities or to set strategies. It will be up to the National Commission of Sanitary Reform (CNRS) to make policy decisions and to conduct the process. The text is divided in the following topics: distribution of human resources; inequalities regarding admittance to the work force; development and training; internal composition of the health teams; and evaluation of the professional. The author's approach in each topic is to identify the problem, propose solutions, and examine the implications.

Brazil↗
PubMed2005

The "Essential Levels of Care" in Italy: when being explicit serves the devolution of powers.

The definition of an explicit health benefit package in Italy has gained importance because of devolution of powers from the national level to the regions. The set of services to be guaranteed by the public sector are defined at national level, while regions are accountable for their provision. This contribution discusses the entitlements and the decision criteria adopted by Italian policy-making bodies. Entitlements to services are clearly defined for few sectors (mainly outpatient specialist care); for hospital care the benefit catalogue is vague. The definition of the health benefit package in Italy is an essential element of the relationship between the central government and the regions. It is argued that adequate monitoring systems and accountability procedures are still needed to make the essential levels of care an effective pivotal element of the Italian National Health Service.

Financing, Government↗
PubMed1999

Market model fails: linkages between health policy and performance outcomes in western industrial countries.

In recent years, political discourse has sung the merits of the market model as a panacea for escalating health expenditures. While selected market mechanisms may be useful to control spending, there are reasons to question full-scale use of this model to shape health policy. Using the experiences of seven western industrialized countries, the argument developed in this article is that the market model's own assumptions cannot be upheld because ethical, sociological, and political factors underlying health policy make its application impossible. Specifically, a competitive equilibrium does not exist; sale of health care goods and services do not conform to the rules of marketability; and non-increasing returns are not demonstrable. A discussion of health outcome performance and spending data points out the need to attend to equity distributional concerns, state commitment to the health care access, and the extent and breadth of input into health care decision-making as other factors that should be considered.

Developed Countries↗
PubMed2003

Travel epidemiology: the Saudi perspective.

The Kingdom of Saudi Arabia occupies four-fifths of the Arabian Peninsula, with a land area of 2 million square kilometres. Saudi Arabia holds a unique position in the Islamic world, as the custodian of the two holiest places of Islam, in Mecca and Medina. Annually, some 2 million Muslims from over 140 countries embark on Hajj. This extraordinary en masse migration is a unique forum for the study of travel epidemiology since the Hajj carries various health risks, both communicable and non-communicable, often on a colossal scale. Non-communicable hazards of the Hajj include stampede and motor vehicle trauma, fire-related burn injuries and accidental hand injury during animal slaughter. Communicable hazards in the form of outbreaks of multiple infectious diseases have been reported repeatedly, during and following the Hajj. Meningococcal meningitis, gastroenteritis, hepatitis A, B and C, and various zoonotic diseases comprise some of the possible infectious hazards at the Hajj. Many of these infectious and non-infectious hazards can be avoided or averted by adopting appropriate prophylactic measures. Physicians and health personnel must be aware of these risks to appropriately educate, immunize and prepare these travellers facing the unique epidemiological challenges of Hajj in an effort to minimize untoward effects. Travel epidemiology related to the Hajj is a new and exciting area, which offers valuable insights to the travel specialist. The sheer scale of numbers affords a rare view of migration medicine in action. As data is continually gathered and both national and international policy making is tailored to vital insights gained through travel epidemiology, the Hajj will be continually safeguarded. Practitioners will gain from findings of travel related epidemiological changes in evolution at the Hajj: the impact of vaccinating policies, infection control policies and public health are afforded a real-world laboratory setting at each annual Hajj, allowing us to learn from this unique phenomenon of migration medicine.

Animals↗
PubMedDate not supplied

Internet technology: resources for perinatal nurses.

The Internet and the World Wide Web (WWW) are being discussed in many forums. This huge body of information is becoming a widely used research tool. Within the last few years, the WWW has grown enormously. In 1993, there were approximately 130 WWW sites. By 1997, experts estimated there were over a million sites on the web, many of them useful for nurses and accessible from the nearest computer. For perinatal nurses in practice, research, or education the need for information is great. Nurses need current data for clinical decision making, policy writing, patient education, continuing education, and research. Understanding how to use the Internet, being aware of its advantages and disadvantages, and knowing how to critically examine what is available will assist perinatal nurses in making use of this newest form of information technology.

Humans↗
PubMed2000

Community health care nursing in Rajasthan. A registered nurse's perspective.

This study focused on the great shortage of registered nurses (RNs) in primary health care in Rajasthan, India. It dealt especially with the nurses' own opinions about working in primary health care and their reasons for not working in it. Nurses at different levels in the health care organization were interviewed. The study was based on interviews with six RNs individually, three groups of six to eight nursing students each, and three policy-making chief nurses individually. The Minister of Health in Rajasthan also participated in the study. The study showed that the reasons for the lack of RNs in community health care were as follows: a government policy decision to place less educated nurses in the communities; the great shortage of nurses in general; the system whereby a nurse is not able to choose her/his place of work; unwillingness on the part of the nurses to work in community health care because of the great security problems; lack of support from authorities and lack of equipment. In general, community health care nursing as a work area was despised by society at large in Rajasthan.

Community Health Nursing↗
PubMed1991

Mental health crisis in California.

Over the last 30 years, California dejure (legislated) mental health policy has been based on deinstitutionalization and outpatient care through community mental health systems. But by the end of the 1970s, there was a growing concern over whether deinstitutionalization had successfully occurred, whether community mental health systems had failed and whether mental health systems had ever been adequately funded. In a national study released in 1990, California was named one of four states where mental health delivery has regressed in the past two years. A review of current California mental health policies indicates dejure and defacto policies are not the same. Most mental health dollars are going to state hospitals and community acute inpatient facilities. Budgets for community mental health have been steadily eroded, and the current mental health system is in crisis. Implementation of mental health policy is dependent on intergovernmental financing, and each level of government tries to avoid costs. Definitions of which clients are to be served remain unclear while pressures for more social control mount. Mental health remains segregated from physical health policy-making and continues to operate at a political disadvantage in general fund budget battles.

California↗
PubMed1985

Cost-benefit analysis of medicinal treatment for gastric ulcers. Long-term model including healing and recurrence.

Cost-benefit analysis (CBA) and cost-effectiveness analysis (CEA) are increasingly being used in medical practice and in health policy making. The choice among alternative treatments, the aim of a more efficient use of limited resources and the wider goal of cost containment, are so many reasons for CBA and CEA. This paper addresses the rather unexplored field of long-term cost-benefit analysis. Gastric ulcer, which is a recurrent disease is taken as a case study. Mathematical modelling is used for situation analysis of alternative long-term intervention strategies. The use of recurrence in the model makes the results of earlier CBA's based on the healing of a single episode, open to question. The paper holds important lessons for both the theoretical aspects of CBA and for its utilization in health policy formulation.

Cimetidine↗
PubMed1990

Promoting healthy behaviour: the importance of economic analysis in policy formulation for AIDS prevention.

Considerable attention has been paid in the literature to modification of high-risk behaviours as a means to control the spread of the Human Immunodeficiency Virus. The success of such policies will depend crucially on the underlying causal mechanisms of these high-risk behaviours. To date the application of economics to the problem of AIDS has tended to focus on estimating the economic burden of the condition and the resource consequences of clinical strategies for care. Yet as a behavioural science economics should provide a useful input into the policy process aimed at behaviour modification. In this paper we extend the application of economic analysis to the determinants of individual behaviour to identify (i) the implications of current policies for the incidence of high-risk behaviour and (ii) the wider determinants of behaviour warranting greater attention in the policy-making process.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Multiple-informant ranking of the disabling effects of different health conditions in 14 countries. WHO/NIH Joint Project CAR Study Group.

BACKGROUND: The Global Burden of Disease study provided international statistics on the burden of diseases, combining mortality and disability, that can be used for priority setting and policy making. However, there are concerns about the universality of the disability weights used. We undertook a study to investigate the stability of such weighting in different countries and informant groups. METHODS: 241 key informants (health professionals, policy makers, people with disabilities, and their carers) from 14 countries were asked to rank 17 health conditions from most disabling to least disabling. Kruskal-Wallis ANOVA was used to test for differences in ranking between countries or informant groups and Kendall tau-B correlations to measure association between different rank orders. FINDINGS: For 13 of 17 health conditions, there were significant (p<0.05) differences in ranking between countries; in the comparison of informant groups, there were significant differences for five of the 17 health conditions. The overall rank order in the present study was, however, almost identical to the ranking of the Global Burden of Disease study, which used a different method. Most of the rank correlations between countries were between 0.50 and 0.70 (average 0.61 [95% CI 0.59-0.64]). The average correlation of rank orders between different informant groups was 0.76. INTERPRETATION: Rank order of disabling effects of health conditions is relatively stable across countries, informant groups, and methods. However, the differences are large enough to cast doubt on the assumption of universality of experts' judgments about disability weights. Further studies are needed because disability weights are central to the calculation of disability-adjusted life years.

Analysis of Variance↗
PubMed1991

The delivery of child welfare services to African American clients.

African Americans have historically suffered inequities in the delivery of child welfare services. The necessity for awareness of cultural contexts is examined, particularly in decision making about maintenance in the child's home, out-of-home placement, reunification of child and parents, other permanency planning options, and mental health referrals. The implications of such awareness for service delivery, administration, and policy making in the child welfare system are discussed.

Adoption↗
PubMed2001

Modernization, globalization and the welfare state: a comparative analysis of old and new convergence of social insurance since 1930.

Convergence of policies and institutions across countries has been a recurrent theme within social sciences. 'Old' and 'new' convergence hypotheses have been associated with changing concepts and catchwords, such as modernization, logic of industrialism, post-industrialism, post-Fordism and globalization, but share some underlying theoretical perspectives. The purpose of this paper is to analyse tendencies towards convergence of social insurance systems in 18 OECD countries between 1930 and 1990, a period which has seen our sample of countries develop from predominantly agricultural societies to industrial or post-industrial market democracies. Data from the Social Citizenship Indicator Program (SCIP) are used to examine the development of institutional variables within the various national social insurance systems. Sub-samples of larger and smaller countries are examined separately, in order to test the open-economy hypothesis that smaller countries, being more exposed to international pressures than larger ones, could be expected to show higher degrees of social protection and also more convergence. Hypotheses on differentiated institutional barriers against pressures from the processes of transnationalization of the economy, as well as possible convergence effects of the supra-national policy making within the European Union, are discussed in the last section.

Developed Countries↗
PubMed1980

The impact of migration on women and the family: research, policy and programme issues in developing countries.

"In the context of the pervasive invisibility of migrant women in the standard data collection, policy-making and planning processes, this paper seeks to review some of the major trends and patterns of female migration in developing countries; identify some important research priorities, and to delineate some of the areas in which policies and programmes might be framed so as to assist or change the impact of migration on women and the family. In the discussion of the relevance of these issues to national services and community organisation are emphasised as priority action programmes."

Demography↗