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The author presents a teaching tool to make policy analysis accessible to a wide range of audiences, especially those who might normally be reluctant to engage in policy discussions or debate. The tool has been used with good results in a variety of venues, and is presented with brief examples of how it can be used.
Explains that Health for All is an international extra-governmental movement that seeks to pursue equity in access to health-related resources by broadening the scope of health policy. Notes that its major principles include social participation in state decision making, inter-sectoral collaboration in policy formulation and the improvement of conditions for the disadvantaged. Points out that its local initiatives often encompass health-service professionals and practitioners as well as the voluntary sector, social services and other local authority departments, and that the effect of this local activity on political understandings of health at a national level gives some indication of the extent to which this local time and effort have been justified. In this respect, notes two limits to the impact of the Health for All movement on the political debates about health in Britain. Suggests that these centre on a largely indifferent but powerful national government and an emphasis within the movement initiatives at the level of a politically marginalized local state.
This roundtable examines the role of health services research from the perspective of the state legislature. Four research and policy experts-each of whom is a current or former legislator-explore how research can be translated effectively into state health policy, and how researchers and legislators can communicate clearly with one another and engage in productive collaborations.
The AIDS epidemic touches upon basic humanities themes: sex, death and social worth, to name just three. AIDS policy in general builds upon society's discourse on these topics. The growing Latino population (25% of California and Texas) needs an AIDS policy that builds upon the Latino humanities tradition. The contours of the Latino intellectual tradition, as focused on issues attendant to health, are presented, with examples from Aztec, colonial and modern times.
Economic evaluations of health care programmes and treatments have now been conducted for about 30 years. A number of key methodological principles have been specified and there has been an exponential rise in the number of published studies. However, there is relatively little evidence of the use of these studies in decision making about health technologies. Therefore, this paper considers what policy issues are amenable to economic analysis, or could be greatly informed by economic appraisal results. It is concluded that a wide range of mechanisms exist to influence the diffusion and use of health technologies and that economic appraisal is potentially applicable to a number of them. The paper also considers how economic appraisal could be made more relevant to decision making. It is concluded that methodological standards need to be maintained, that evidence needs to be produced in a timely fashion, that the local validity of study results needs to be increased, that the dissemination of study results needs to be improved and that more note needs to be taken of the available policy instruments.
BACKGROUND: Many state Medicaid programs use prior authorization programs to limit spending on cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs (coxibs). However, the evidence base for the prior authorization criteria has not been examined previously. METHODS: We determined whether prior authorization was required for coxibs in state Medicaid programs and collected data on what precise criteria needed to be met for a coxib prescription to be authorized. Prior authorization criteria were compared to clinical evidence regarding which patients are most likely to benefit from coxibs. RESULTS: By mid-2004, 35 states had implemented prior authorization requirements for coxibs. Of 5 major clinical factors that identify patients likely to benefit from coxibs, 18 states (51%) included all 5 factors and 9 states (26%) included 2 or fewer. Most states (33/35; 94%) required a previous trial of nonselective nonsteroidal anti-inflammatory drugs before a coxib would be authorized. Several prior authorization programs included factors that had no connection to the clinical evidence. CONCLUSIONS: State Medicaid prior authorization policies for coxibs are heterogeneous in terms both of the criteria required to obtain a coxib and of the relationship of those criteria to clinical evidence. Development of clinically rational prescription drug policies should be a goal for all health insurers and represents an important priority for Medicare's prescription drug benefit program.
The purpose of this roundtable is to explore the imperfect art of estimating the budget costs of health insurance proposals-called scoring when done by government agencies. The panel addresses the complexities involved in generating these estimates, which usually depend on many untested and untestable assumptions. For example, the Medicare prescription drug "donut hole" was invented so that policymakers could achieve budget targets. These budget scores play a critical role in the design of health policies, as well as in the reform proposals put forth by candidates in an election. The roundtable discusses how policymakers can and do use health policy estimates and budget scores.
This article describes two workshops on health-promoting policy change, developed and delivered to more than 1,000 public and community health practitioners across one Canadian province. The workshops were designed to increase knowledge about the process of policy change and provide opportunities for skill development. Three basic instructional methods--minilectures, individual pen-and-paper exercises, and small-group activities--were used. Workshops were delivered using a host organization arrangement, meaning organizations willing to host workshops could do so if they provided the venue and invited members of other organizations in the community. Initial evaluations indicate that practitioners find the workshops useful and that many have integrated the information into their day-to-day work. To the author's knowledge, no other workshops of this nature have been delivered in this systematic way.
The racial politics of immigration have punctuated national discussions about immigration at different periods in US history, particularly when concerns about losing an American way of life or American population have coincided with concerns about infectious diseases. Nevertheless, the main theme running through American immigration policy is one of inclusion. The United States has historically been a nation reliant on immigrant labor and, accordingly, the most consequential public policies regarding immigration have responded to disease and its economic burdens by seeking to control the behavior of immigrants within our borders rather than excluding immigrants at our borders.
The Seniors Mental Health Policy Lens (SMHPL) is an analytical tool developed to identify unintended negative effects of current and planned policies, programs, and practices on seniors' mental health. It is designed (a) to promote social environments, including health services, supportive of older adults' mental health, and (b) to help ensure that the way mental health services are defined, delivered, and funded will result in increased emphasis on mental health promotion and on the prevention of mental health problems. The SMHPL incorporates Canadian seniors' perspectives on the factors influencing their mental health, and reflects the values of older adults.
Establishment of a rational antibiotic policy (RAP) is a key issue for both better care of patients and combating antimicrobial resistance [1-5]. The problem of rational antibiotic use is complex [6,7] and requires co-ordination of the activities of healthcare authorities, institutions and individual practitioners. Furthermore, on a community basis, it involves restriction of non-human usage of antibiotics [8] and awareness of society about both the useful and harmful effects of antibiotics [9] and, on a national basis, participation of governmental [10] and non-governmental [11] organizations in collaboration with European and international medical societies [12-14]. The rational use of antibiotics should be established in both hospital and ambulatory settings [10]. Institutional, regional, national and global aspects of antibiotic policies should be considered [2].
After the fall of the monarchy and the proclamation of the republic on 9 November 1918, the "Rat der Volksbeauftragten" ("Council of People's Representatives") was established as a provisional revolutionary government. It consisted of three members of the Majority Social Democratic Party (MSDP) and three members of the Independent Social Democratic Party (USPD). Because of irreconcilable political-ideological differences, the members of the USPD left government on 28 December, so that from this time until 10 February 1919 the MSPD governed alone. The "Rat der Volksbeauftragten" issued extensive decrees and legislation, including many laws on health policy. The study of these regulations allows a reconstruction of the interplay between the political ideas of the two social democratic parties, the requirements of health policy arising from the war, and the revolutionary events.
Most important for the events at the turn of 1918/19 was the coincidence of the revolution and the end of the war. This meant that in a very short time the troops had to be withdrawn from the front, the size of the army had to be reduced, and the wartime economy had to be transformed into a peace economy. Apart from the resulting economical and social problems, military demobilisation was closely linked with medical and health political difficulties. The revolutionary government saw itself as a provisional arrangement to ensure the unity of the state and the functioning of the German Reich. The maintenance of medical care and provision of a minimum of foodstuffs made health policy important during the months of revolution. Despite a positive balance of payments and a "health policy of continuity", the revolutionary government was unable to win the medical profession for its aims, because it failed to dispel suspicions that the medical profession was going to be socialised.
The Ministry of Health appointed the Breast Cancer Screening Policy Advisory Group in 1995 to provide policy advice on the establishment of a population-based screening programme in New Zealand. The group recommended that an organised mammographic screening programme be part of a strategic approach to breast cancer detection and management with the aim of reducing mortality from breast cancer. Service specifications should be based on those of the pilot programmes in Otago-Southland and Waikato, but modified according to the lessons learned, with special attention to such areas as recruitment and information systems. Women between the ages of 50-69 should be invited for screening every two years, and screening should be free of charge. Because of the uncertain value of general population screening by mammography in women under the age of 50, the programme should not be extended to younger women, including those at high risk, at the present time. Further reviews of the issue should be commissioned when new evidence becomes available. Pilot programmes in New Zealand have demonstrated that screening can be performed with acceptable standards in comparison with overseas trials but considerable planning and commitment will be required for the expected benefits to be experienced nationally. Implementation of a successful national programme will involve attention to key areas such as programme management, recruitment and quality standards to deliver a high quality service to a substantial proportion of the eligible population.
The author considers aspects of the socioeconomic status and living conditions of the estimated 7 million children living in Europe who are children of immigrants. Particular attention is given to issues of education, employment, and legal rights. Among the policy recommendations discussed are "equal opportunities in the interest of solidarity between native and immigrant children and youth; offering the children in question truly bicultural teaching; removing their employment disadvantages; [and] increasing their political rights." (summary in FRE)
American Health Decisions is a developing social movement that aims to work at the grassroots level to educate people about issues and problems in health care and to promote public involvement in decision making about health policy. The movement offers nurses opportunities to expand their traditional commitment to involving people in decisions about their health. By promoting the development of the movement, nurses can contribute to the creation of a structured process of direct public participation in policy decisions related to health care. Nurses may have a special role to play in the movement by promoting the participation of low-income people.
The accelerated urbanisation process that Brazil has gone through in the last 50 years has given rise to daunting challenges for public managers, especially in terms of local public policy management for the building of "healthy cities". In Sobral, a municipality of 173,000 inhabitants in Ceará in the North-eastern region of Brazil, a number of municipal policies were initiated beginning in 1997, many in partnership with the federal and state governments. They were inspired by the vision of a healthy and equitable city and were marked by strategic planning and the implementation of intersectoral projects. This article lays out some of the actions and their results, including an increase in the public supply of drinking water from 65% to 97% of households; an increase in sewage networks from 7% to 65%; an increase in public refuse collection from 42% to 90%; the expansion of green areas; the construction of nine kilometres of bicycle paths; the universalisation of integral health care through the Family Health Strategy through a network with specialised out-patient and hospital services; and a 148% increase in the number of children enrolled in primary school. These initiatives also resulted in the improvement of quality of life indicators, including a reduction in infant mortality from 61.4 to 19.0 per thousand live births, a drop in the mortality rate from traffic accidents from 33.40 per 100,000 inhabitants in 2001 to 15.25 in 2003; and a jump in literacy rates among children in the first cycle of primary school from 40 to 90.7%. In the present article, the authors describe some of the successful strategies and projects initiated between 1997 and 2003, and discuss how this experience could be reproduced in other communities across Brazil and around the world.
CONTEXT: In 2006 the Labour Government in England published its long awaited White Paper on 'community services', following on from the 2005 Green Paper on the future of social care. The policy envisages an unprecedented shift of activity and resources from acute care to community settings, along with a much stronger focus on preventive care. Several mechanisms are to be put in place to ensure this shift takes place, most notably practice-based commissioning, payments-by-results and enhanced partnership working. PURPOSE: This article outlines the intended changes and assesses the extent to which they add up to a coherent strategy. CONCLUSION: It is argued that although there is widespread support for the overall vision, the strategy contains some difficult policy tensions that are common to other welfare systems. These will have to be addressed if the vision is to be a reality.