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A framework for cost-sharing policy analysis.

To assess the effect of cost sharing, a framework for describing and evaluating cost-sharing programmes was constructed, followed by a comprehensive search of the international literature on the subject. The results indicated that cost sharing carries many potential advantages, one of which includes increased consumer attention to healthcare costs. However, proper design of cost-sharing programmes is necessary to mitigate regressivity and other common problems associated with many current programmes. These findings should help policy makers to understand and anticipate the effects of cost sharing, and to create innovative benefit design solutions that are targeted to promote health system goals.

Cost Sharing↗

From policy to praxis--a framework for the delivery of district mental health care in KwaZulu-Natal.

This article provides a schema for the provision of mental health care at district level. A framework for service delivery was derived from research conducted by the Community Mental Health Programme (CMHP) into the development of aspects of a district mental health care system in a semi-rural community area in KwaZulu-Natal. Furthermore, information was drawn from interviews with key stakeholders, national and provincial policy documents as well as international experience in the implementation of community-based systems of mental health care.

Community Mental Health Services↗

Beyond criminalization: toward a criminologically informed framework for mental health policy and services research.

The problems posed by persons with mental illness involved with the criminal justice system are vexing ones that have received attention at the local, state and national levels. The conceptual model currently guiding research and social action around these problems is shaped by the "criminalization" perspective and the associated belief that reconnecting individuals with mental health services will by itself reduce risk for arrest. This paper argues that such efforts are necessary but possibly not sufficient to achieve that reduction. Arguing for the need to develop a services research framework that identifies a broader range of risk factors for arrest, we describe three potentially useful criminological frameworks-the "life course," "local life circumstances" and "routine activities" perspectives. Their utility as platforms for research in a population of persons with mental illness is discussed and suggestions are provided with regard to how services research guided by these perspectives might inform the development of community-based services aimed at reducing risk of arrest.

Criminal Law↗

Ethics of resource allocation in developing countries: the case of Sri Lanka.

The issues of prioritization of health care services and allocation of resources have recently received increasing attention and discussion. Several reports have been published by governments in different countries and the issues are discussed in many recent books and papers. In this paper the focus is on the problems faced by a developing country when allocation of health care resources is considered. We consider these issues under three headings and exemplify the situation in a developing country by taking Sri Lanka as an example. Firstly the evidence to formulate an ethical basis for the existing health care system in Sri Lanka is discussed, in particular the problem of defining a minimum quality of health care for the population. Secondly, we consider the issues which arise when we want to formulate the ethical basis for health sector reform. In particular, we examine current World Bank proposals. We shall argue that there are a number of important conceptual and ethical issues that have not been properly addressed in the various policy documents. Finally, we introduce our own alternative ethical framework for policy reform.

Developing Countries↗

A framework for developing reproductive health policies and programmes in Nepal.

Based on experience in Nepal from 1996-2001, this paper presents a six-element framework to support governments in poor countries in developing and implementing reproductive health programmes. The six elements of the framework are: (i) collaborative planning and programming; (ii) strategic assessment; (iii) policy and strategy development; (iv) guideline and material development; (v) reproductive health programme management; and (vi) policy review. Its implementation calls for collaborative work between policymakers and programme managers at all levels of the health system, external donors and development agencies. Change in Nepal is constrained by poor human and financial resources, extremely difficult geography and strong cultural, religious and social traditions. An informal assessment at district level and below found that information tools, clinical protocols and operational guidelines were highly relevant, though problems with utilisation and motivation were noted. Utilisation of strategy and policy documents and tools was reported to be high at national level, but no causal link can be drawn between instruments in the framework and changes in reproductive health indicators. However, access to the tools described in this article can contribute to improvements in coverage and quality of reproductive health services in the hands of motivated people; improved indicators in family planning use, antenatal care and assisted delivery in Nepal in this period support this view.

Cooperative Behavior↗

Measuring the saving attributable to an antibiotic prescribing policy.

An analytical framework is suggested for the economic evaluation of policies to improve the management of hospital infection. Consideration of the costs and benefits to be expected from improved policies implies the existence of an optimal infection rate which is higher than the minimum attainable. It follows that hospitals can and probably do spend too much on infection control in, at least, some areas. This optimal approach is not operational at present but its data requirements might be thought of as an agenda for future research. In the meantime, progress in infection control economics depends on a piecemeal approach. An example is given in the estimation of the cost savings attributable to an improved antibiotic prescribing policy at the Royal Liverpool Hospital.

Anti-Bacterial Agents↗

Health policy analysis: a simple tool for policy makers.

Policy analysis is not an easy task. Its scope is broad and can include both the analysis of policy process and the analysis of policy content. This paper is concerned with the analysis of policy content and offers some practical guidance regarding how to analyse health policy and link it to health outcomes. An eight-step framework for policy analysis is proposed that public health policy makers and public health practitioners may find especially useful due to its simplicity.

Decision Making, Organizational↗

What drives British drug policies?

This paper identifies four broad types of influence which have contributed to the dynamics of British drug policy development over many decades: international influences, varieties of fear, professional entrepreneurship, and the perceived tension between treatment and control. A follow-through of these same themes to current policy concerns is traced. The need to develop a comparative and international framework for policy analysis is stressed. Policy research, it is argued, deserves to be given greater attention as the necessary means toward a more informed sense of feasibilities and policy options.

Health Policy↗

[The analysis and recommendation of the institutional respite care policy in Taiwan].

As the functionally impaired disabled elderly and the long-term care population has grown, concern about the physical, psychological and social demands facing primary caregivers has increased. An institutional respite care policy was adopted in Taiwan in 1998, but the rate of utilization of institutional care remains low. This article investigates the formative background, related circumstances and problems of respite care policy. The three dimensions of structure, process and outcome form the main framework for policy analysis. "Structure," includes demand and resources. "Process," includes health policy planning procedure, health administration and service delivery processes. "Outcome," covers service utilization, satisfaction, caregiver's well-being and care-receiver's institutionalization rate. In accordance with the results of the analysis the researchers propose recommendations about policy, practice, education and research, in the hope that these will be considered in relation to future modification and execution of respite care policy, in order to provide respite for suffering caregivers, and to carry out the ideal of aging in place.

Health Policy↗

Community health changes under welfare reform.

This comparative case study examined changes in community health under New Jersey welfare reform policy implementation (1994-2001). The boundaries of these case descriptions were directed by Milii's ecological framework for policy studies. The separate cases consist of descriptions of changes in social climate and health indicators within Camden, Essex, and Hudson counties in New Jersey. Data analysis revealed a greater public health challenge in these counties than the state as a whole. A large increase in the numbers of low income and uninsured in the population may begin in 2004, 2 years following the 5-year lifetime limit of the receipt of welfare benefits. A growing uninsured population would place additional burdens on the abilities of safety net providers to meet health care needs of vulnerable populations. If left unchanged, these wider effects of the New Jersey welfare reform policy would have negative implications for improving quality of care.

Aid to Families with Dependent Children↗

Integrating data for sustainable development: introducing the distribution of resources framework.

A complex, information-rich world requires frameworks that organize data to reveal succinct views and interrelationships. The goal of sustainable development requires a particularly large range of data covering many disciplines--economic, environmental, social and institutional. This paper introduces the Distribution of Resources (DOR) framework. DOR explicitly quantifies the changes in our natural and produced resources and traces the use of resources through production and consumption efficiency to distribution as welfare. The DOR framework accommodates many of the recognized concepts and principles of sustainable development resulting in a comprehensive policy-focused framework with a more extensive range of desirable features than other frameworks developed to date.

Data Interpretation, Statistical↗