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PubMed1997

Health policy as a fuzzy concept: methodological problems encountered when evaluating health policy reforms in an international perspective.

Investigating health policy reforms at a national level is a troublesome task, since it is difficult to establish exactly when a certain policy change took place and it is also difficult to determine the content of the reform. In this paper three main causes are distinguished that contribute to the 'fuzziness' surrounding reforms. Firstly, ordinary mistakes occur, even experts err. Secondly, in some countries responsibility for (part of the) health care system is delegated to the regional level, causing regional variations which lead to uninterpretable effects at country-level health care system descriptions. Thirdly policy reforms are often not a straightforward process. Implementations can be characterized as a gradual process which can be disturbed at any point in time. For example, the use of framework legislation, effects of public discussions and law enforcement problems contribute to the fuzziness. To strengthen the validity of information from secondary sources (often the best available and linguistically accessible sources) the use of primary sources and expert consultation highly recommended, respectively giving insight in formal rules and initial intentions of policy measures and in the impact of reforms at performance level. The fuzziness can be captured into an index (reform implementation index), containing the gathered information and thus facilitating statistical analyses controlling for process-information.

Belgium↗

PubMed2003

Time, complex systems, and public policy: a theoretical foundation for adaptive policy making.

Can public policy development and implementation be improved by closely tracking and coordinating its timing with that of the regulated sector? Built-in asynchronies between political process and regulated sectors or activities can produce unintended disruptions in rates of economic change and development undermining the original intent of the policy or regulatory action. Such events sometimes lead to unexpected future disruptions as well. A policy approach is needed that adaptively ties the right mix of resources and regulatory activity to the timing of particular stages of economic development or growth associated with a particular industry. These public policy timing problems are explored using a new theory based on the concepts of "time-ecology," "heterochrony," and "temporal signature." The full range of linear and nonlinear time-space web linkages (electronic, selling and buying, technology transfer are examples) in an government-industry cluster between political, economic, and other elements creates an interconnected ecology-a time-ecology-of unique, more or less intense, and often complex rhythmic pulses occuring in parallel or in a punctuated way, and entrained with or influencing each other across multiple time scales flowing into the future. Each organizational structure is situated in its own past, present, and future in a unique way (time signature). Outside linkages mutually influence structuration by varying rates of development and growth (heterochrony). Nonlinear dynamics may be involved in these interactions. This whole process occurs on linked government/industry adaptive landscapes. The approach detailed in this paper may be applicable to organizational and time related issues in other disciplines. The paper ends with suggestions for testing the theory.

Adaptation, Psychological↗

PubMed2002

Policy change and private health insurance: did the cheapest policy do the trick?

From the introduction of Australia's national health insurance scheme (Medicare) in 1984 until recently, the proportion of the population covered by private health insurance declined steadily. Following an Industry Commission inquiry into the private health insurance industry in 1997, a number of policy changes were effected in an attempt to reverse this trend. The main policy changes were of two types: "carrots and sticks" financial incentives that provided subsidies for purchasing, or tax penalties for not purchasing, private health insurance; and lifetime community rating, which aimed to revise the community rating regulations governing private health insurance in Australia. This paper argues that the membership uptake that has occurred recently is largely attributable to the introduction of lifetime community rating which goes some way towards addressing the adverse selection associated with the previous community rating regulations. This policy change had virtually no cost to government. However, it was introduced after subsidies for private health insurance were already in place. The chronological sequencing of these policies has resulted in substantial increases in government expenditure on private health insurance subsidies, with such increases not being a cause but rather an effect of increased demand for private health insurance. The paper also considers whether the decline in membership that has occurred since the implementation of lifetime community rating presages the re-emergence of an adverse selection problem in private health insurance. Much of the decline to date may be attributable to failure on the part of some members to honour premium payments when they first fell due. However, the changing age composition of the insured pool since September 2000, resulting in an increasing average age of those insured, suggests the possible reappearance of an adverse selection dynamic. Thus the 'trick' delivered by lifetime community ratings may not be maintained in the longer term.

Australia↗

PubMed2006

Policy for therapeutic acupuncture in an academic health center: a model for standard policy development.

Acupuncture as a therapeutic modality offers multiple applications. Its effectiveness coupled with its general acceptance by conventional health care professionals makes it one of the first complementary and alternative medicine (CAM) modalities to be incorporated in an integrative approach to care. However, few centers that offer acupuncture have written standard policies to regulate its use. This lack of standard policies may impede provision of quality care, serve as a barrier to cross-institutional data collection and clinical application of that data, and may put health care professionals and institutions at risk when credentialing or malpractice liability has not been clearly addressed. Here we present a policy for acupuncture, created by a diverse group of health care professionals at the University of Michigan Health System. It may function as a generalizable template for standard policy development by institutions incorporating acupuncture.

Academic Medical Centers↗

PubMed2002

Courts and health policy: judicial policy making and publicly funded health care in Canada.

The 1982 Canadian Charter of Rights and Freedoms provided political actors with the opportunity to make rights-based challenges to public policy decisions. Two challenges launched by providers and consumers of health care illuminate the impact of judicial review on health care policy and the institutional capacity of courts to formulate policy in this field. The significant impact of rights-based claims on cross-jurisdictional policy differences in a federal regime is noted.

Canada↗

PubMed2005

HIV/AIDS policy and policy evolution in China.

The early cases of HIV/AIDS in China were mostly foreign nationals. The Chinese government's response then was to stop and prevent HIV from entering China. However, the policy was not effective. From the middle 1990s, HIV/ AIDS spread all over China and all modes of transmission have been reported. By the end of 2003, China estimated that there were 840,000 cases of HIV/AIDS. China's HIV/AIDS policy has been changing along with its epidemic change. Based on an extensive document and literature review, I depict China's HIV/AIDS epidemic and policy and illustrate the main factors contributing to its policy evolution.

China↗

PubMed1999

Physician Leadership on National Drug Policy: advocacy for an effective drug policy.

The founders of the PLNDP envisioned an active and committed group willing to tackle the potentially controversial area of national drug policy. The group already initiated a serious national debate about drug policy, inside and outside of the medical profession. Several national professional societies moved beyond their existing policies to embrace components of the PLNDP initiative. The group meets again in the summer of 1999 to share goals and articulate the next steps in research and advocacy. This meeting invites leaders in law, the enforcement community, legislators, community coalition leaders, and experts in addiction medicine and addiction psychiatry. PLNDP leaders expect that the subsequent coalitions will affect the course of discussion about the nation's drug policy far into the future.

Chronic Disease↗

PubMed2001

Improving communication between researchers and policy makers in long-term care or "researchers are from Mars; policy makers are from Venus".

This policy brief reports the results of a study that examined how policy makers acquire information about long-term care (LTC) and why research findings in the field often don't filter through to them. It describes the "brokers" that provide LTC research information to policy makers and outlines what can be done to make certain such information reaches policy makers and is suited to their needs. It concludes by recommending that more effort be put into disseminating LTC research information, both to communicate more effectively within the resource constraints that currently exist and to encourage increased investment in research brokering activities for the future.

Communication↗

PubMed2005

Who makes alcohol policy? Science and policy networks 1950-2000.

This chapter examines the interaction between alcohol policy networks, ideological "frames" of understanding of the alcohol problem and the production and use of research evidence. The emergence and growth of policy networks and the production of research based "evidence" as the rationale for change is traced from the mid-nineteenth century over major shifts in understanding of the problem, from a "moral" model to a "disease" model to a "public health" approach and, finally, to an approach which brings together health and criminal justice perspectives. The chapter challenges policy discourse which presents a rational model of policy making supported by "scientific" research.

Alcohol Drinking↗

PubMed2005

The Conscientious Practice Policy: a futility policy for acute care hospitals.

Much attention has been paid in recent years to the conflict that may occur when patients or their families insist on a therapy that the physician feels would be futile. In 1999 the Council on Ethical and Judicial Affairs of the American Medical Association recommended that all health-care institutions adopt a policy on medical futility that follows a fair process. Development of such a policy has proved problematic for many hospitals. The Conscientious Practice Policy at Lawrence & Memorial Hospital was developed as a response to the AMA recommendation. It outlines a specific process to be followed in the event that a physician wishes to refuse to provide a requested therapy, whether that refusal is based on perceived futility or other concerns. The policy was subsequently modified slightly and adopted by two other Connecticut acute care hospitals.

American Medical Association↗

PubMed2006

Policy windows, policy change, and organizational learning: watersheds in the evolution of watershed management.

Employing in-depth, elite interviews, this empirical research contributes to understanding the dynamics among policy windows, policy change, and organizational learning. First, although much of the research on agenda setting-how issues attract enough attention that action is taken to address them-has been conducted at the national scale, this work explores the subnational, regional scale. With decentralization, regional-scale environmental decision-making has become increasingly important. Second, this research highlights the role of policy windows and instances of related organizational learning identified by natural resources managers. Having practitioners identify focusing events contrasts with the more typical approach of the researcher identifying a particular focusing event or events to investigate. A focusing event is a sudden, exceptional experience that, because of how it leads to harm or exposes the prospect for great devastation, is perceived as the impetus for policy change.

Conservation of Natural Resources↗

PubMed2003

Transport policy and health inequalities: a health impact assessment of Edinburgh's transport policy.

Health impact assessment (HIA) can be used to examine the relationships between inequalities and health. This HIA of Edinburgh's transport policy demonstrates how HIA can examine how different transport policies can affect different population groupings to varying degrees. In this case, Edinburgh's economy is based on tourism, financial services and Government bodies. These need a good transport infrastructure, which maintains a vibrant city centre. A transport policy that promotes walking, cycling and public transport supports this and is also good for health. The HIA suggested that greater spend on public transport and supporting sustainable modes of transport was beneficial to health, and offered scope to reduce inequalities. This message was understood by the City Council and influenced the development of the city's transport and land-use strategies. The paper discusses how HIA can influence public policy.

Community Participation↗

PubMed1998

Family planning policies and programmes in eight low-income countries: a comparative policy analysis.

The extent to which family planning programmes are successful at reducing fertility remains a major debate among population scholars. A comparative policy analysis of four pairs of low-income countries (Bangladesh/Pakistan, Thailand/Philippines, Tunisia/Algeria and Zimbabwe/Zambia) was carried out to understand why some countries develop appropriate and effective programmes, while other countries do not. The study found that the formation of coalitions among policy elites, spread of policy risk, and institutional and financial stability were factors which supported or inhibited the adoption of strong population policies and family planning programmes.

Developing Countries↗

PubMed2006

The costs of changing national policy: lessons from malaria treatment policy guidelines in Tanzania.

OBJECTIVE: To document the cost incurred by the Tanzanian government by changing the policy on first-line treatment of malaria, from chloroquine to sulfadoxine-pyrimethamine. METHODS: Costs were analysed from the perspective of the Ministry of Health and included all sources of funding. Costs external to the public health sector (e.g. private and community costs) were not included. The base case analysis adopted an incremental rather than a full cost approach, assuming that an organizational infrastructure was already in place. However, specific attention was paid to the burden placed on National Malaria Control Program staff. We also costed activities planned but not implemented to estimate the total expense for an 'ideal' process. RESULTS: Total costs were Tsh 795 million (USD 813,743), with the largest proportion accounted for by training. Costs of the policy change process were equivalent to about 4% of annual government and donor expenditure on malaria and to about 1% of overall public expenditure on health. A number of planned activities were not implemented; including these would bring the total cost to Ts 880 million (USD 896,130). CONCLUSION: On top of extra costs for the drugs themselves, a change in treatment policy requires time, resources and substantial management capacity at national and local level. A better understanding of these issues and the costs involved benefits countries planning and implementing policy change.

Amodiaquine↗

PubMed1995

Policy as intervention: environmental and policy approaches to the prevention of cardiovascular disease.

This paper describes the evolution of efforts to prevent cardiovascular disease, from individual health education approaches to broader community education efforts and, finally, to comprehensive and integrated programs addressing environmental, policy, and individual behavior change. Policies are divided into two areas: legislation/regulation and organizational policy. Environmental strategies are measures that alter or control the physical or social environment. Dimensions along which these strategies might be implemented are provided. Policy and environmental approaches can be justified on economic, strategic, and theoretical grounds. Experiences from other fields and other countries provide a framework for conceptualizing cardiovascular disease prevention approaches.

Cardiovascular Diseases↗

PubMed1982

The University Health Policy Consortium's Center for Health Policy Analysis and Research.

In 1978, the University Health Policy Consortium, composed of Boston University, Brandeis University and the Massachusetts Institute of Technology, established the Center for Health Policy Analysis and Research for the purpose of conducting relevant policy analyses and short-term research projects for the Health Care Financing Administration. The center has completed more than fifty analytical works since its inception and concentrates its research in three major health care areas: the financing and organization of long-term care, medical care quality, and acute care financing. The flexibility of the Center's organizational structure allows the staff of the three cooperating universities to pursue new topics while maintaining an interdisciplinary approach to emerging public policy problems.

Health Policy↗

PubMed2002

Development of vaccination policy in Japan: current issues and policy directions.

Until November 2001, eight vaccinations had been offered to Japanese children on a routine basis; namely, diphtheria-tetanus-pertussis, polio, measles, rubella, Japanese encephalitis, and BCG. The 2001 amendment of the Immunization Law introduced an influenza vaccine for the elderly population. This paper reviews the progress of the immunization program in the broader context of infectious disease control in Japan. There are two recent major policy changes in the field of infectious disease control in Japan. One is the strengthening and revitalization of the infectious disease control program, particularly surveillance, by the enactment of new 1999 legislation entitled "Law concerning the Prevention of Infectious Diseases and Patients with Infectious Diseases". The other major policy change is a review of existing immunization programs and the amendment of the Immunization Law in 2001. In this article, the present routine vaccination program, as well as the recent amendments to the law, are described. Current policy issues are then discussed, including polio vaccination after the WHO "Zero Polio" announcement in the Western Pacific Region in 2000; strategies for changes in measles, rubella, tuberculosis, and influenza control; as well as adverse reaction monitoring/surveillance and feedback for improving vaccine safety. Finally, the future prospects of intended/planned changes in the vaccination policy are considered.

Age Distribution↗

PubMed1993

National health policy: back to the future. Ad Hoc Committee on National Health Policy American Speech-Language-Hearing Association.

After an extensive review of the literature and discussion of both national and state proposed health plans, the committee arrived at the following conclusions: 1. The issues that prompted development of the 1971 American Speech-Language-Hearing Association's (ASHA) Position Statement on National Health Care have not been resolved or altered. 2. Few significant national health plans or policies are being supported by the Bush Administration other than managed-care plans. 3. A national health policy will be driven by the development of state health policies and plans. 4. Implementation of national or state health plans will affect both professions at all service provision sites, including public schools. 5. Five general models apply to all existing or proposed national and state health policies or plans: single payer (e.g., a Canadian-style plan) minimum basic benefits ("play or pay") expanded Medicare or Medicaid benefits rationed healthcare (e.g., Oregon plan) managed care (e.g., health maintenance organizations) 6. There will be continued efforts to eliminate Medicaid mandates. 7. ASHA needs to advocate for the inclusion of rehabilitative services as basic rather than optional services in all health plans. 8. ASHA must advocate for adequate access to quality care regardless of healthcare or education provider setting.

American Speech-Language-Hearing Association↗