Policies and programs in nutrition and physical fitness: framework for a national physical activity policy.
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Adolescent↗
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Results for “policy frameworks”
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Smaller hospitals: purchasing. Written policies are the vital framework for orderly purchasing.
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Hospital Administration↗
Transfer of Health for All policy - What, how and in which direction? A two-case study.
BACKGROUND: This article explores the transfer of World Health Organization's (WHO) policy initiative Health for All by the Year 2000 (HFA2000) into national contexts by using the changes in the public health policies of Finland and Portugal from the 1970's onward and the relationship of these changes to WHO policy development as test cases. Finland and Portugal were chosen to be compared as they represent different welfare state types and as the paradigmatic transition from the old to new public health is assumed to be related to the wider welfare state development. METHODS: The policy transfer approach is used as a conceptual tool to analyze the possible policy changes related to the adaptation of HFA into the national context. To be able to analyze not only the content but also the contextual conditions of policy transfer Kingdon's analytical framework of policy analysis is applied. CONCLUSIONS: Our analysis suggests that no significant change of health promotion policy resulted from the launch of HFA program neither in Finland nor in Portugal. Instead the changes that occurred in both countries were of incremental nature, in accordance with the earlier policy choices, and the adaptation of HFA program was mainly applied to the areas where there were national traditions.
Journal Article↗
The conceptual framework of the International Tobacco Control (ITC) Policy Evaluation Project.
This paper describes the conceptual model that underlies the International Tobacco Control Policy Evaluation Project (ITC Project), whose mission is to measure the psychosocial and behavioural impact of key policies of the Framework Convention on Tobacco Control (FCTC) among adult smokers, and in some countries, among adult non-smokers and among youth. The evaluation framework utilises multiple country controls, a longitudinal design, and a pre-specified, theory-driven conceptual model to test hypotheses about the anticipated effects of specific policies. The ITC Project consists of parallel prospective cohort surveys of representative samples of adult smokers currently in nine countries (inhabited by over 45% of the world's smokers), with other countries being added in the future. Collectively, the ITC Surveys constitute the first-ever international cohort study of tobacco use. The conceptual model of the ITC Project draws on the psychosocial and health communication literature and assumes that tobacco control policies influence tobacco related behaviours through a causal chain of psychological events, with some variables more closely related to the policy itself (policy-specific variables) and other variables that are more downstream from the policy, which have been identified by health behaviour and social psychological theories as being important causal precursors of behaviour (psychosocial mediators). We discuss the objectives of the ITC Project and its potential for building the evidence base for the FCTC.
Evaluation Studies as Topic↗
Reflections on national rural health policy: the 'big picture' framework.
A major concern of many rural and remote communities, as they struggle to cope with the impacts of social, economic and demographic changes, is the effect of government policies on health services. The National Rural Health Strategy has evolved as the key framework guiding action for improving health services for people in rural and remote Australia. The importance of maintaining an awareness of the 'big picture' of rural health remains paramount if interventions designed to bring about improved health status are to tackle the underlying causes of the problems, minimise problems associated with lack of co-ordination between health authorities, and avoid duplication of activity. Given the communality of rural health problems across Australia, close co-operation and collaboration among rural health groups is vital in developing appropriate national rural health policy. At the same time rural communities must continue to participate actively in the policy formulation and implementation process.
Australia↗
When do developing countries adopt managed care policies and technologies? Part I: Policies, experience, and a framework of preconditions.
OBJECTIVE: For developing countries with constrained economic resources, managed care holds out the promise of being able to control healthcare costs and reduce unnecessary utilization. However, little empirical evidence has been gathered about when managed care techniques can be applied to these countries and no framework considers the macroeconomic context. We propose a straightforward method to evaluate the economic and policy environment of a developing country to assess when managed care might be introduced. STUDY DESIGN AND METHODS: Analysis of available developing country health system and healthcare spending data, review of the available literature, and authors' experience evaluating healthcare reforms in developing countries. RESULTS: Many countries have implemented managed care techniques, which are driven by policy efforts to increase quality or to control costs. Successful implementation of managed care, however, appears to depend on five major preconditions. One precondition is an adequately developed formal wage sector in which patients have a sufficient ability to pay for healthcare services. Another is an adequate labor supply of trained professionals to support managed care administration, foster competition, and use available information technology. CONCLUSIONS: Although managed care encompasses a range of incentives and arrangements, implementation in developing countries appears to depend on attaining macroeconomic preconditions.
Developing Countries↗
Generational equity and public health policy: a critique of "age/race war" thinking.
A potent new tool in the politics of fiscal retrenchment lies in the creation of a framework for policy analysis which implicitly or explicitly "blames" the old for poverty and economic hardships in the young. This paper examines the recent efforts to promulgate this generational equity or "age/race wars" perspective and demonstrates that opinion poll data fail to support the rhetoric of growing age/race group antagonisms over entitlement programs for the old. The assumptions underlying the generational equity framework are critiqued, and the race and ethnic issues embedded within this framework are examined. In particular, we explore spurious assumptions concerning the relative financial wellbeing of the elderly, escalating Social Security and Medicare costs as a primary cause of poverty in the young, and growing resentment of programs for the old among minorities and youth. Attempts to deligitimate the claims of the elderly through the advancement of the ideology of age/race wars are seen to have significant implications for public health policy, with the country's recent experience with the Medicare Catastrophic Coverage Act serving as an important case in point. The need for an alternative policy framework stressing the interdependence of generations is suggested, and some guiding principles put forward toward the development of such an alternative framework.
Age Factors↗
Exchanging health information: local distribution, national coordination.
The fragmentation of our health care system, our need to accommodate the diversity of existing health information exchanges, the lack of consistent implementation of clinical information standards, and the need to protect patients' privacy and maintain trust are all challenges to overcome in achieving broad-scale interoperable health information exchange. We propose several steps to coordinate information sharing among regional and other networks through universal adherence to a basic framework of policies and standards. The critical policy action is the identification of a "common framework" of standards and policies, maintained by a new Standards and Policy Entity that reflects both public- and private-sector participation.
Community Health Planning↗
Healthcare technology assessment: methods, framework, and role in policy making.
UNLABELLED: This activity is designed for healthcare organization managers and clinicians, particularly those involved in technology-related decisions, including coverage decisions, technology acquisition, practice guideline development, and evidence-based medicine. GOAL: To provide a basic understanding of the principles, methods, and systematic framework of healthcare technology assessment. OBJECTIVES: 1. Understand the role of healthcare technology assessment in policy making and the technical properties and impact assessed. 2. Become familiar with the categories and basic attributes of methods used in healthcare technology assessment. 3. Comprehend the ten-step framework for conducting a healthcare technology assessment.
Data Collection↗
Pathways to "evidence-informed" policy and practice: a framework for action.
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Diffusion of Innovation↗
A development framework for promoting evidence-based policy action: drawing on experiences in Sri Lanka.
Most developing countries have embarked on one form or another of 'health sector reform' as a result of the global trend for health and health care reform that has emerged during the past decade. One consequence is that the issue of health sector performance is moving higher on the agenda of many developing countries, and particularly that of the corporate performance of health sector staff. Along with this movement has come increased attention to strengthening evidence-based management decision-making. To date, studies on measuring health sector performance, have had little impact on developing country health systems and have been limited to explorations primarily at an operational level. However, there is a growing recognition that there is a need to strengthen the policy function of ministries and their ability to monitor policy impact. Sri Lanka is one country that has identified the need to strengthen policy at national level. Many developing countries, like Sri Lanka, are familiar with input, process and output dimensions of operational performance. However, most are not ready to engage in routine performance assessment that can strengthen policy processes at national level. This paper explores (1) the implication and the use of indicators to support evidence based policy decision-making, and (2) the complexity of doing so in Ministries of Health that are undergoing some form of health sector reform. The paper emphasizes that new forms of organizational support are required for performance management at policy level. A conceptual framework for managing the collection and use of performance evidence is developed, including proposals for the introduction of outcome indicators into that process. The paper concludes with recommendations on initiatives required to develop appropriate organizational and technical capacity to engage with performance management at policy level and for further research towards creating ministries of health as 'learning organizations' that can change and adapt with informed decisions.
Decision Support Systems, Management↗
Doing the right thing and doing it right: toward a framework for assessing the policy relevance of health services research.
OBJECTIVES: Health services research is atypical instance of applied research, meaning that its research findings should contribute to a more evidence-based health policy. A basic assumption for the usefulness of policy research is that it is of good scientific quality, but evaluation of health services research would be incomplete without an assessment of its societal relevance. However, there is no generally accepted framework in which criteria to assess societal relevance are defined. METHODS: In this study, we made an effort to specify criteria and indicators for policy relevance. RESULTS AND CONCLUSIONS: In general, we concluded that it is important to define from the start of a research project, what kind of answers are being sought to the questions at hand, who the intended users of these answers will be, and how they can be reached. Furthermore, a productive dialogue between researchers and policy makers is indispensable for remaining in tune with policy thinking. In addition, we specified domains and a list of potential criteria for assessing policy relevance. For the purpose of quality assurance, these criteria have to be integrated into a quality improvement cycle. This means that the societal output of health services research should be related to the aims and missions at the level of projects, programs, and institutes. Furthermore, it is important that consensus is reached about (the weighting of) relevant indicators and that routines are developed for collecting information on these indicators.
Evidence-Based Medicine↗
Physician responses to global physician expenditure budgets in Canada: a common property perspective.
Global expenditure budgets in the fee-for-service physician sector create management problems for both funders and physicians. Global expenditure cap policies must be designed, and appropriate institutional structures created, to mitigate perverse utilization incentives, manage collective utilization, and diffuse the internal professional and the funder-profession tensions created by a capped budget. Two Canadian provinces that adopted different approaches to the design of their physician expenditure cap policies experienced different outcomes in utilization growth. The outcomes, however, are the opposite to what one would predict based on an analysis of the incentive structures embodied in the two provinces' policies. An analytic framework developed for the study of common-property resources is applied to the differing physician responses to global budgets across the two provinces. The insights offered by this framework can guide policy design for global physician budgets, and they indicate the critical importance of physician acceptance of such a policy.
Alberta↗
A proposed ethical framework for prescription drug benefit allocation policy.
OBJECTIVES: To present an ethical framework that could aid prescription drug benefit design and to propose that such a framework could be organized around a benefit allocation hierarchy. SUMMARY: Four hierarchical levels of allocation are proposed, as follows: (1) drug categories and subcategories, (2) individual drugs within covered drug categories, (3) specific indications of covered drugs, and (4) special features of drug use, such as quantities covered for specific indications. Rationales for decision making should address the distinct ethical issues apparent at each level. CONCLUSION: Ethical issues associated with designing and managing a pharmacy benefit can be identified by using a hierarchical prescription drug allocation scheme. Articulating these issues is an important first step toward arriving at a fully developed framework that will serve to produce rationales acceptable to typical stakeholders in prescription drug benefits.
Health Policy↗
Building bridges between academic research and policy formulation: the PRUFE framework - an integral part of Ontario's evidence-based HTPA process.
Healthcare expenditure in Ontario has been escalating at increasing rates and a growing proportion of this has come from medical devices and other technologies. A comprehensive evidence-based process for the assessment of new health technologies in Ontario was recently established (the Health Technology Policy Analysis [HTPA] process). Requests for funding for new technologies are directed through a department of the Ministry called the Medical Advisory Secretariat (MAS) who, using a systematic and evidence-based approach, provides information on the safety, effectiveness, and cost effectiveness of the technology to the Ontario Health Technology Advisory Committee (OHTAC). If the OHTAC determines that the evidentiary base for making recommendations is too uncertain, a request is made to reduce this uncertainty through the conduct of a 'real world' Ontario-based study. The Program for Assessment of Technology in Health (PATH) reduction of Uncertainty through Field Evaluation (PRUFE) framework is an iterative process for collecting new information, updating prior knowledge and providing new 'real world' evidence back to the Ministry regarding the cost effectiveness of new health technologies. MAS/OHTAC has undertaken evidence-based analyses for >50 new technologies. The PRUFE framework has been successful for reducing uncertainty and controlling healthcare expenditures while providing access and improving patient outcomes.
Biomedical Research↗
Strategy development in dealing with violence against employees in the workplace.
The creation of health promoting workplaces is a key development in contemporary workplace health. This paper focuses on the issue of workplace violence and the efforts which must be made to address its prevention and to deal with its consequences as a contribution towards developing a health promoting workplace. A critical overview of the issue as it is currently addressed in the international literature is a precursor to the formulation of an inclusive definition of workplace violence. This forms the basis for a framework for the development and implementation of workplace violence policies. The framework takes account of needs assessment, policy formulation in terms of prevention, incident management and reporting, and post-incident support strategies. The needs for effective education and training and good internal and external communications are also explored. The paper concludes by highlighting the necessity for workplaces to take seriously the need for a coherent and well-planned workplace violence strategy.
Health Promotion↗
Impacts of the Doha Round framework agreements on dairy policies.
Dairy is highly regulated in many countries for several reasons. Perishability, seasonal imbalances, and inelastic supply and demand for milk can cause inherent market instability. Milk buyers typically have had more market power than dairy farmers. Comparative production advantages in some countries have led to regulations and policies to protect local dairy farmers by maintaining domestic prices higher than world prices. A worldwide consensus on reduction of border measures for protecting dairy products is unlikely, and dairy will probably be an exception in ongoing World Trade Organization (WTO) negotiations. Under the Doha Round framework agreements, countries may name some products such as dairy as "sensitive," thereby excluding them from further reforms. However, new Doha Round framework agreements depart from the current WTO rule and call for product-specific spending caps. Such caps will greatly affect the dairy sector because dairy accounts for much of the aggregate measure of support (AMS) in several countries, including the United States and Canada. Also, the amounts of dairy AMS in several countries may be recalculated relative to an international reference price. In addition, all export subsidies are targeted for elimination in the Doha Round, including export credit programs and state trading enterprises, which will limit options for disposing of surplus dairy products in foreign markets. Currently, with higher domestic prices, measures for cutting or disposing of surpluses have been used in many countries. Supply control, which is not regulated by WTO rules, remains as an option. Although explicit export subsidies are restricted by WTO rules, many countries use esoteric measures to promote dairy exports. If countries agree to eliminate "consumer financed" export subsidies using a theoretical definition and measurements proposed herein as Export Subsidy Equivalents (ESE), dairy exports in many countries may be affected. Although domestic supports and export subsidies will be reduced in the Doha Round, possible exclusion of "sensitive" products from tariff reduction will help some countries' dairy sectors survive after those final agreements. A key concern for those countries will be the simultaneous restriction of surplus-disposing measures. With fewer marketing options for surpluses, countries that continue border protection and high internal prices will likely be forced to use domestic supply control programs in the future.
Animals↗
Sustainability indicator system and policy processes in Malaysia: a framework for utilisation and learning.
Formulation of effective sustainability indicators for national assessment demands a comprehensive understanding of the utilisation, diffusion and dissemination of information in policy processes. To illustrate the dynamic of sustainability assessment within the context of policy processes, this paper uses a case study of national sustainability indicators development in Malaysia. Subsequently, this paper ascribes the limited achievement of national sustainability assessment in Malaysia to four types of constraints: meta-policy issues; technical capacities; communication concerns; and the inherent knowledge gaps within the indicator developer community vis-a-vis their theoretical limitations. It is proposed that such constraints will be encountered in many countries. Drawing from the literature on public policy, this paper outlines a framework for investigating indicator behaviour within policy processes based on well-established concepts such as knowledge utilisation and policy learning. I conclude this paper by elaborating on the corresponding future challenges that must be addressed before effective integration of sustainability indicators within policy systems can occur.
Conservation of Natural Resources↗