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PubMed1980

Lead modelling--a decision-making tool.

The difficulties of decision-making in a state of ignorance regarding the problem area, true for many questions of environmental pollution, are discussed with reference to lead. Before irrevocably committing a considerable amount of both capital and material resources, the policy-making wound like to make a prediction as to the potential effectiveness of any control measure. To this end a mathematical model is suggested which represents the transport of lead within a standard man. It may be used at two discrete levels, either to analyse a number of control strategies in terms of their relative effectiveness in reducing blood lead concentrations, or, dependent upon the model's accuracy and the availability of data concerning the exposure to, and metabolism of, lead by a specific population, to select between two, or more, directly competing strategies for the control of that population's lead exposure, the selection of the optimum strategy being based on the model's output. Modelling may be seen, therefore, to satisfy, at least in part, the need for decision-making information in an area where time may not permit the acquisition of appropriate, unequivocable scientific evidence.

Cost-Benefit Analysis↗

PubMed2000

County commissioners as a key constituency for public health.

Local government elected officials are an important constituency for public health as they represent all citizens in their cities and counties, make policy decisions that affect the public's health, and allocate funding to support public health activities. This article describes efforts to determine the current knowledge and perspective of county commissioners regarding factors that affect local governmental decision making, particularly involving public health. Interview findings indicate that county commissioners are influenced by what their constituents consider important. The article suggests actions that public health managers can take to increase local elected officials' understanding of public health.

Community-Institutional Relations↗

PubMed2002

Attacks on science: the risks to evidence-based policy.

As government agencies, academic centers, and researchers affiliated with them provide an increasing share of the science base for policy decisions, they are also subject to efforts to politicize or silence objective scientific research. Such actions increasingly use sophisticated and complex strategies that put evidence-based policy making at risk. To assure the appropriate use of scientific evidence and the protection of the scientists who provide it, institutions and individuals must grow more vigilant against these tactics. Maintaining the capacity for evidence-based policy requires differentiating between honest scientific challenge and evident vested interest and responding accordingly, building and diversifying partnerships, assuring the transparency of funding sources, agreeing on rules for publication, and distinguishing the point where science ends and policy begins.

Evidence-Based Medicine↗

PubMed1989

Professional nursing in Iraq.

This paper examines professional nursing in Iraq, with emphasis on selected sociopolitical policies and the role of women. A baccalaureate program in nursing was established at the University of Baghdad in 1963, followed by a masters' program in 1986. Although modernization policies encouraged the development of nursing, the profession was influenced negatively by the restricted role and low status of women in Arab society. Shortly after the ceasefire in the Iran-Iraq war, the professional nursing program was closed by the government. The analysis suggests that nursing leaders have not had access to sources of power through a role in policy making and thus have not been able to ensure the development of the profession.

Education, Nursing, Baccalaureate↗

PubMed1999

Synthesis of qualitative research on drug use in the European Union: report on an EMCDDA project. European Monitoring Centre for Drugs and Drug Addiction.

This paper is a synthesis of the information in the report Inventory, Bibliography and Synthesis of Qualitative Research in the European Union which was co-ordinated for the European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal, by the National Addiction Centre, London, UK. It is based on the work of a network of qualitative researchers from the European Union. The report includes detailed information from each member state on current qualitative projects, relevant publications from the last 10 years and a directory of those researchers active in this area. The paper introduces the project, outlines its future direction and discusses what can be defined as 'qualitative research'. Historical developments and the role of qualitative methodology in relation to research into drug use are examined. A summary of the project's findings is presented, and the relevance of qualitative research for policy-making is discussed. Finally, the methodology used to collect data for the project is described.

Crime↗

PubMed1991

Ethical issues in health care institutions. Lesson 2: Ethical considerations in group decision making and groupthink.

In this second lesson of a five-part WMU/AHRA magazine course on ethics, Dr. Alie tackles an interesting concept--group-think. According to the author, this tendency occurs when cohesive groups lose their ability to critically evaluate alternatives in problem solving. Since groups such as committees or task forces frequently resolve issues and make policy in health care organizations, warning signs of this phenomenon are detailed as well as suggestions to help avoid the problem.

Decision Making, Organizational↗

PubMed1996

Renewal of the health-for-all strategy.

It will soon be 20 years since the much-publicized Alma-Ata Declaration calling for health for all through primary health care. This article aims to stimulate debate on the successes and failures of past efforts, on the values that should guide policy-making in national and international health work, and on approaches to promoting equity and solidarity in future health strategies.

Forecasting↗

PubMed1999

Medical care and public policy: the benefits and burdens of asking fundamental questions.

This article questions two assumptions that regularly appear in discussions of what a fundamental discussion of medical care policy choices should include. First, we review skeptically the presumption that explicit specification of the scope of publicly financed medical services is a crucial step in improving policy-making in the health and medical care arenas. Second, we question the appropriateness, in many if not most contexts, of explicit rationing, the belief that being clear about who gets what (and who does not) constitutes proper public policy. The article proceeds by looking back on the grounds for universal access to medical care, discusses the disputes about how to set limits on care, and illustrates its argument with references to Dutch debates about explicit choice, the Oregon experiment with priority setting, and the appeals to 'healthy public policy' as a standard for sensible policy reform. The article closes with a brief discussion of the spread of assumptions about health reform as they move across national borders.

Choice Behavior↗

PubMed2006

The contribution of general practice based research to the development of national policy: case studies from Ireland and Australia.

BACKGROUND: This paper aims to describe the influence of general practice based research on the development of two specific policy initiatives, namely the Heartwatch Programme in Ireland and the Better Outcomes in Mental Health Care (BOiMHC) program in Australia. A case study approach was used to explore the extent to which relevant general practice based research shaped these initiatives. RESULTS: In both case studies, a range of factors beyond general practice based research shaped the initiative in question, including political will, the involvement of stakeholders (including key opinion leaders), and the historical context. Nonetheless, the research played an important role, and was not merely put to 'symbolic use' to support a position that had already been reached independently. Rather, both case studies provide examples of 'instrumental use': in the case of Heartwatch, the research was considered early in the piece; in the case of the BOiMHC program, it had a specific impact on the detail of the components of the initiative. CONCLUSION: General practice based research can influence policy-making and planning processes by strengthening the foundation of evidence upon which they draw. This influence will not occur in a vacuum, however, and general practice researchers can maximise the likelihood of their work being 'picked up' in policy if they consider the principles underpinning knowledge transfer.

Journal Article↗

PubMed2006

California American Indian and Alaska natives tribal groups' care access and utilization of care: policy implications.

Background. We used the 2001 California Health Interview Survey (CHIS) to examine differences in cancer care access and utilization by subgroups of American Indian and Alaskan Natives (AIAN). Methods. The CHIS 2001 includes over 55,000 Californian households, with an oversampling of California American Indian, non-California AIAN, and unknown AIAN tribal groups. Results. We found significant differences among the 3 tribal subgroups for various measures of health care coverage and utilization. Conclusions. AIAN must be disaggregated to provide appropriate data for public health and policy making.

Adolescent↗

PubMed1997

Current issues in German healthcare.

Germany has developed a model of social health insurance for financing healthcare. The basic characteristics of this model are compulsory membership, income-dependent contributions paid by employers and employees, a comprehensive package of healthcare entitlements, stringent government regulation and implementation by not-for-profit health insurers--the sickness funds--which operate under public law. Since the mid-1970s, when health care cost containment gradually evolved as a new issue in German healthcare policy-making, a long series of reform programmes have been initiated. Two recent development can be noted: the introduction of market competition in health insurance and the introduction of fixed budgets. Market competition in health insurance is now an explicit policy tool in Germany. This article analyses the German healthcare system, the history of healthcare reforms and the current healthcare acts. Special emphasis is given to the German drug market and its regulation. The paper describes the present cost-containment policy for pharmaceutical products, especially the global budget concept which was introduced for medicines and patients' copayments.

Delivery of Health Care↗

PubMedDate not supplied

[Equity and health: research needs for the development of a social policy].

This article presents a general view of the evolution of the conceptual approach to equity in health and its current meaning. The analysis of equity from the standpoint of distribution-accesibility, use and outcome of health services is proposed. Every point of view is addressed to an operational and policy-making position. This paper concludes with a proposal of perspectives for research development in this field.

Health Policy↗

PubMed1988

Hospital-physician integration and hospital costs.

The integration of physicians into the management and policy-making structure of the hospital has been widely touted as necessary to achieve organizational efficiencies in a changing health care environment. This paper examines the implications of five such integrative strategies for hospital costs. Our findings indicate that greater administrative participation by physicians is consistently related to higher costs. We also found that other integrative strategies are associated with higher hospital costs in specific types of hospitals. We discuss the implications of our findings for hospital managers and policy makers.

Costs and Cost Analysis↗

PubMedDate not supplied

Medical education, women's status, and medical issues' effect on women's health in the Caribbean.

At an international conference in 1992 on women and health, an attempt was made to redefine health concerns for women of the English-speaking Caribbean in the 1990s. Medical practices in developing countries change as advances are made in public health; clinical issues on the islands now resemble those in the United States (e.g. hypertension, cancer, sexually transmitted diseases, domestic violence, and abortion). In the Caribbean, however, these problems exist in a unique socioeconomic context, and women's health there suffers indirectly because of cultural mores. Gender bias in medical education and practice influences treatment of women and obstructs their advancement to policy-making levels in the design and delivery of programs that bear on maternal and child health, among others. The effect of local cultural beliefs and practices on women's health must be considered when setting goals and direction for health policy if aid or educational programs are to be effective.

Abortion, Induced↗

PubMed1988

Dealing with uncertainty: statistics for an aging population.

"Uncertainty in statistics and demographic projections for aging and other policy purposes comes from four sources: differences in definitions, sampling error, nonsampling error, and scientific uncertainty. Some of these uncertainties can be reduced by proper planning and coordination, but most often decisions have to be made in the face of some remaining uncertainty. Although decision makers have a tendency to ignore uncertainty, doing so does not lead to good policy-making. Techniques for estimating and reporting on uncertainty include sampling theory, assessment of experts' subjective distributions, sensitivity analysis, and multiple independent estimates." The primary geographical focus is on the United States.

Americas↗

PubMed1999

The future of genetic counselling: an international perspective.

The focus of clinical genetics, and thus genetic counselling, is forecast to expand from the diagnosis and prediction of rare, often untreatable conditions, to the prediction of common, often treatable or preventable conditions. Whether this evolution is likely to proceed rapidly or at a pace that permits sensible integration of molecular genetic tools is unknown and a source of debate. It is clear, however, that genetic discoveries will modify the way in which disease and risk are conceptualized. Here, we predict how genetic counselling, specifically for more common diseases, might be provided in the decades to come. We envisage an expansion of professional roles and expertise for many health care providers and highlight the need for counselling practices to become more evidence based. Although we support an evidentiary-based approach to the integration of genetic testing into practice, genetic advance is unlikely to occur in an orderly and standardized manner within countries, much less among different countries and health care systems. Geneticists will become increasingly involved in professional education and policy-making regarding genetic testing and screening programs.

Delivery of Health Care↗

PubMed1990

A clinician's guide to cost-effectiveness analysis.

Cost-effectiveness analysis can be used to help set priorities for funding health care programs. For each intervention, the costs and clinical outcomes associated with that strategy must be compared with an alternate strategy for treating the same patients. If an intervention results in improved outcomes but also costs more, the incremental cost per incremental unit of clinical outcome should be calculated. The incremental cost-effectiveness ratios for various programs can be ranked to set funding priorities. By using this list, the person responsible for allocating resources can maximize the net health benefit for a target population derived from a fixed budget. Clinicians may not share this objective because, individually, they are appropriately concerned solely with the effectiveness of a specific intervention for their patients and are not concerned with the benefit derived from spending those resources on other patients in the target population. In addition, allocation may be driven by distributional and political objectives. Nevertheless, cost-effectiveness analysis demonstrates the consequences of allocation decisions. Because clinicians should participate in policy making, they must understand d the role of this technique in setting funding priorities.

Cost-Benefit Analysis↗

PubMed2005

Factors associated with interorganizational relationships among outpatient drug treatment organizations 1990-2000.

OBJECTIVE: To identify the factors associated with drug abuse treatment center participation in interorganizational relationships (IORs). DATA SOURCES: Three nationally representative samples of outpatient drug abuse treatment units surveyed in 1990, 1995, and 1999/2000 as part of the National Drug Abuse Treatment System Survey (NDATSS), stratified by public/private status, treatment modality (methadone or nonmethadone), and organizational affiliation. STUDY DESIGN: Probit analyses on 647 lagged treatment center-year observations from the years 1990 to 1995 with outcomes in 1995 and 2000, respectively. Standard errors were adjusted for clustering of center-year observations within centers. PRINCIPAL FINDINGS: Centers with greater motivation to form IORs (e.g., as a result of client diversity or government revenue) were more likely to do so, as were centers with greater opportunities to form IORs (e.g., centers whose directors participated in policy making). CONCLUSIONS: Both motivating and enabling factors promoted the formation of IORs by drug abuse treatment centers. Managed care also played a distinct role, in this case appearing to undermine interorganizational cooperation. Because IORs can improve access to care and quality, policy makers should consider using both incentives and support such as management training to promote IOR formation.

Cooperative Behavior↗