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At least 217 records · Page 12Linked to original sources
PubMed1990

Public health policy-making in the presence of incomplete evidence.

In conclusion, when it can be demonstrated that the need is great, an action produces the desired benefits, the risks are not too high, the intervention is economically feasible, and there are no viable, more scientifically certain alternatives, then policy-makers should proceed even in the face of less than complete evidence. It should be remembered that scientific uncertainty may be exploited by special interest groups as a shield for opposition to the measure. Public policy decisions may be said to be made or not made on the basis of scientific uncertainty, but they may in actuality be driven by political or economic considerations. With respect to balancing individual rights and the public interest, it is clear that, in many instances, these two interests will be congruent. If they conflict, however, then weight should be given to the public interest in line with the principle that public health is social justice.

Humans↗
PubMed1995

[Decision making policies on the utilization of antimalarials in response to a modification of chloroquine efficacity. Applications to Africa].

The strategy for malaria control in Africa is based on the association of malaria case management, selective and lasting vector control and prevention and control of outbreaks. Emergence and wide-spread of Plasmodium falciparum chloroquine resistance enjoins a change of the malaria case management. This change is difficult. It is function of the quality of health services, the epidemiological surveillance of malaria, the monitoring of drug efficacy and acceptability, the drug utilization policy, the time for reaction and adaptation to changes in new drug policy, the different epidemiological patterns. In Africa, alternatives to the loss of chloroquine efficacy are the implementation of public health performances, the control of the circulation of antimalarials, the training of health operators, the education of the beneficiary target populations and to draw up and implement strategies that are relevant, i.e. useful and usable.

Africa↗
PubMed1988

Anorectic drugs: drug policy making at the state level.

This study outlines the attempts of four states (Louisiana, Kansas, Wisconsin, and Michigan) to restrict anorectic prescriptions. The actions in these four states exemplify the various mechanisms used in regulating anorectics, ranging from educational efforts to legislative enactments. We examine the evidence used in promulgating these policies and review some of the current literature on the safety and efficacy of anorectics. Despite the existence of evidence demonstrating the safety and efficacy of anorectics, the states seem to be moving toward more severe restrictions, in contrast to the federal regulatory agencies.

Appetite Depressants↗
PubMed1990

Community care of the severely mentally ill: is social control a "necessary evil" in policy-making considerations?

Analysis of the crisis in community care for the severely mentally ill (SMI) reveals that it stems not only from organizational and financial problems, but also from the social structure and ideological perspectives embedded in American society. The desire of society for social control and the maintenance of orderly social life is illuminated as a central factor in public policies regarding the SMI. Policy planning, aimed at improving services for the SMI, must take social structural consideration into account and accept the social control component, perhaps as a necessary evil, nevertheless a necessity, in policies regarding the severely mentally ill.

Community Mental Health Services↗
PubMed1998

Clinical trials comparing two treatment policies: which aspects of the treatment policies make a difference?

We discuss pragmatic clinical trials with survival endpoints in which subjects commonly change treatment during follow-up. Suppose that an intention-to-treat (ITT) analysis shows a significant difference between the randomized groups. We may want to ask questions about the reason for such a difference in outcome between randomized groups: for example, was the difference due to different policies for change to a third more beneficial regime? We address such questions using the semi-parametric accelerated life models of Robins, which exploit the randomization assumption fully and avoid direct comparisons of possibly differently selected subgroups. No assumption is made about the relationship of treatment actually prescribed to prognosis. A sensitivity analysis, using a range of plausible values for the causal effect of a covariate, estimates the contrasts between randomized groups that would have been observed if the covariate had universally been 0. The main technical problem is in dealing with censoring, for the method requires different degrees of recensoring for different values of the causal effect, and this can lead to estimates of low precision. The methods are applied to a randomized comparison of two anti-hypertensive treatments in which approximately half the subjects changed treatment during follow-up. Various time-dependent covariates, representing patterns of side-effects and treatments, are used in the model. We find that the observed difference in cardiovascular deaths between the randomized groups cannot be explained in this way by their different covariate patterns.

Adrenergic beta-Antagonists↗
PubMed2006

Utilization and costs of chiropractic care for work-related low back injuries: do payment policies make a difference?

BACKGROUND: Chiropractic care is frequently used in the treatment of work-related low back pain. Chiropractors have been shown to be more sensitive to cost-sharing than other providers. PURPOSE: This study examined the differences in utilization and costs of chiropractic care for work-related low back injuries in seven jurisdictions and whether these differences can be associated with workers' compensation (WC) payment policies. STUDY DESIGN: A retrospective analysis of WC data from a single insurer. METHODS: Analyzed data included individuals with chiropractic care performed between 1999 and 2002. Utilization (visits and services per person, services per visit) and costs (cost per person and cost per visit) were examined. Actual reimbursement index was developed to proxy payment policies based on actual payments made to chiropractors. RESULTS: Utilization and costs varied significantly across the analyzed states. Restrictive payment policies were associated with lower costs of chiropractic care and lower number of services per visit, but had no impact on visits or services per person. CONCLUSIONS: Findings indicate necessary components of effective cost containment, even in the presence of utilization adjustment.

Adult↗
PubMed1986

Survey research guiding public policy making in Maryland: the case of Alzheimer's disease and related disorders.

The Maryland Governor's Task Force on Alzheimer's Disease and Related Disorders conducted a comprehensive 18-month assessment of the extent of dementing illness in Maryland, the needs of Maryland dementia victims and their families, and the availability of resources to meet these needs. A major tool in this assessment was a series of 16 specially designed surveys which were sent to physicians, family caregivers, nursing homes, geriatric aide training programs, and other populations. The survey findings, along with hearing testimony, provided the basis for the Task Force's 18 principal and 35 further recommendations, published in the Maryland Report on Alzheimer's Disease and Related Disorders (Governor's Task Force, 1985). These recommendations have become the basis of public policy discussion for services to dementia victims and their families in Maryland.

Aging↗
PubMed1996

Medical workforce policy making in Canada: are we creating more problems for the future?

The current approach to the management of physician resources in Canada needs to be re-examined by all concerned. Canada is about to enter a phase of accelerating depletion of physicians as the result of two separate and evolving circumstances. Because of the unusually large number of physicians who graduated from Canadian medical schools in the late 1960s and early 1970s, a significantly larger than usual number of practising physicians will reach their normal retirement age in the decade ahead. In addition, if the recent surge in the emigration of Canadian physicians continues, the loss of so many physicians will exaggerate the impact of the expected increase in retirements. Therefore, the decision to cut medical school class sizes in the 1990s would have been more suitable in the early 1980s. Existing physician work force policies may be leading to unexpected or undeclared consequences for health care across Canada. On the basis of current trends, the author concludes that policy makers now should reconsider current physician workforce policies in anticipation of a possible shortfall of physicians beginning in the early decades of the next century.

Canada↗
PubMed2005

Smoking practices in New York City: the use of a population-based survey to guide policy-making and programming.

To inform New York City's (NYC's) tobacco control program, we identified the neighborhoods with the highest smoking rates, estimated the burden of second-hand smoke exposure, assessed the early response to state taxation, and examined cessation practices. We used a stratified random design to conduct a digit-dialed telephone survey in 2002 among 9,674 New York City adults. Our main outcome measures included prevalence of cigarette smoking, exposure to second-hand smoke, the response of smokers to state tax increases, and cessation practices. Even after controlling for sociodemographic factors (age, race/ethnicity, income, education, marital status, employment status, and foreign-born status) smoking rates were highest in Central Harlem and in the South Bronx. Sixteen percent of nonsmokers reported frequent exposure to second-hand smoke at home or in a workplace. Among smokers with a child with asthma, only 33% reported having a no-smoking policy in their homes. More than one fifth of smokers reported reducing the number of cigarettes they smoked in response to the state tax increase. Of current smokers who tried to quit, 65% used no cessation aid. These data were used to inform New York City's smoke-free legislation, taxation, public education, and a free nicotine patch give-away program. In conclusion, large, local surveys can provide essential data to effectively advocate for, plan, implement, and evaluate a comprehensive tobacco control program.

Adolescent↗
PubMed2006

Effects of design flow and treatment level on construction and operation costs of municipal wastewater treatment plants and their implications on policy making.

Construction costs of 55 municipal wastewater treatment plants in Israel (secondary, advanced secondary, and advanced treatment) were analysed in order to derive cost functions expressing the effects of design flow and treatment level on construction costs. Three equations were derived (statistically significant, p<0.01), one for each treatment level. These indicate that economy of scale may become weaker as treatment level rises. Analysis of the distribution of construction costs revealed negative correlation (p<0.05) between the proportional cost of civil engineering and design flow, positive correlation (p<0.05) between the proportional cost of elecromechanical equipment and design flow, and no correlation between the proportional cost of electricity and control and design flow. Operation costs were found to be 20-70% more sensitive than construction costs to treatment level. The share of operation costs as part of the total annual costs was found to increase both with design flow and treatment level, whereas the share of construction costs concurrently decreased. The implication of the findings on policy, and consequently on treatment plants performance is discussed in the last part of the paper.

Costs and Cost Analysis↗
PubMedDate not supplied

The art of the deal: health policy making on the fly.

In September 1991 the Health Care Financing Administration touched off a two-month scramble by issuing regulations sharply curtailing states' use of voluntary donations and provider taxes to raise money for Medicaid. Days and nights of intrigue and dealmaking followed. Finally, on the day before Thanksgiving, Congress, the Administration, and the nation's governors agreed to a deal that may resolve the matter. During the course of those talks, all sides honed their negotiating skills and, in the process, uncovered basic flaws in the U.S. health care system.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2004

Economic implications of hormesis in policy making.

Economists face no fundamental problem in calculating the optimal exposure of a hormetic substance and this could potentially be set as a regulatory level. This level would be where the marginal cost of control is equal to the slope of the exposure-response function. There are a number of reasons, however, to expect public resistance to assuming hormesis. These reasons include the fact that hormesis implies a lower level or risk for any given exposure; it might be viewed as weakening regulatory standards; and it could justify low emissions if marginal costs are low. If all we care about are the negative effects measured by a single health endpoint, then the RfD (the level of exposure below which there is no appreciable risk) may be appropriate. Hormesis maintains the single endpoint, but accepts beneficial as well as deleterious effects. If we are going to accept beneficial effects then we should consider all health endpoints and all costs and benefits. This is simply benefit-cost analysis with a hormetic exposure-response curve. Because of legal constraints, this type of analysis may be of little use in setting tolerance levels, but may be important if the EPA chooses to adopt more voluntary policy measures.

Cost-Benefit Analysis↗
PubMed2007

Health care provision for illegal migrants: may health policy make a difference?

Illegal migrants in Europe are, generally, only entitled to emergency care and services for children and pregnant women. In 2002 legal changes in Spain made accessible medical cards and free medical care for illegal migrants in similar terms than the legal migrants or the Spanish population. We interviewed 380 migrants to assess whether there were differences on health services utilization by legal status. We did not find differences in the utilization of health services when ill between legal and illegal migrants. However, a significantly lower utilization of health services was associated with less education (RP = 0.4; 95% CI: 0.2-0.9).

Adolescent↗
PubMed1981

Lead: a case study in interagency policy-making.

Exposures to low levels of lead in the environment are believed to have potentially significant health effects, especially in children; such exposures to the general population come from many sources. Responsibility for regulating lead exposures has been derived from a multitude of laws passed by the Congress, and thus ultimate protection of people depends on actions taken by several agencies of the federal government. For this reason, the history of efforts to reduce exposures to lead is an excellent case study in the way that federal agencies do or do not work well together. The issue of reduction of lead in gasoline is discussed in relation to the evidence generated by HUD concerning the relationship of blood lead in urban children in New York City to seasonal variations in consumption of leaded gasoline in that area. Some recommendations for developing interagency cooperation in such controversies are presented.

Air Pollutants↗