The Health Policy Agenda for the American People: framework for the future.
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Forecasting↗
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A pharmacy benefit manager perspective.
Lipid-lowering therapy can account for 7% of per patient per month drug costs. Because this can be a significant proportion of a payer's drug expenditure, this class of drugs attracts payers' attention and thus becomes a focus of efforts designed to control drug expenditures. Pharmacy benefit managers (PBMs) use several techniques and capabilities to affect the use of these drugs to improve overall medical care and to capture financial opportunities. There is a gap between the marketplace needs for lipid therapy value information and current pharmacoeconomic evaluations of lipid therapy. The measurement units that current pharmacoeconomic analyses tend to use are not necessarily intuitive and do not easily conform to the existing conceptual framework of policy makers. The successful evaluation of PBM activities will be contingent on a recognizable and widely accepted quantitative measurement framework.
Journal Article↗
Transferable learning from international primary care developments.
Alternative approaches to the comparative analysis of international health systems developments are reviewed in relation to the advent of new primary care organizations in countries with parallel 'modernizing' policies. A framework for transferable learning between these is articulated and its design described. This is derived from priorities defined by lead policy and practice representatives in UK primary care. It points to the benefits of examining the interaction of critical new public management and planning functions as an effective vehicle for identifying both individual country role models and shared international experiences. Illustrative examples are provided in five subject areas ranging from local engagement to multiple forms of financing.
Health Care Reform↗
Ideas and inducements in mental health policy.
Between 1946 and 1963, federal officials sought to change the national practice of providing mental health care, away from state-run mental institutions and toward outpatient care based in local communities. These policy makers relied on two policy instruments, ideas and inducements. Both instruments contributed to unexpectedly significant changes in federal, state, and local policy. I conclude that a policy instrument framework helps to disentangle the strands of successful public management, and that it is useful to think of ideas as policy instruments that offer leverage on policy outcomes.
Community Mental Health Centers↗
Design of policy mechanism to promote cleaner production in China.
In order to promote cleaner production in China, a package of policy options was presented based on the identification of the barriers encountered in the CP demonstration project and the effectiveness and feasibility of policy options for the CP implementation were analyzed. Furthermore, the policy mechanism framework was given, which composes of compulsory, economic incentive, social pressure and supportive function. Finally, the implementation strategy of the policy mechanism, in which the emphasis will be changed from compulsory policy options towards economic and social pressure policy options, was proposed.
China↗
A framework to guide thinking and analysis regarding climate change policies.
The potential impacts from climate change, and climate change policies, are massive. Careful thinking about what we want climate change policies to achieve is a crucial first step for analysts to help governments make wise policy choices to address these concerns. This article presents an adaptive framework to help guide comparative analysis of climate change policies. The framework recognizes the inability to forecast long-term impacts (due in part to path dependance) as a constraint on the use of standard policy analysis, and stresses learning over time as a fundamental concern. The framework focuses on the objectives relevant for climate change policy in North America over the near term (e.g., the next 20 years). For planning and evaluating current climate policy alternatives, a combination of fundamental objectives for the near term and proxy objectives for characterizing the state of the climate problem and the ability to address it at the end of that term is suggested. Broad uses of the framework are discussed, along with some concrete examples. The framework is intended to provide a basis for policy analysis that explicitly considers the benefits of learning over time to improve climate change policies.
Journal Article↗
Accessing a new medication in Germany: a novel approach to assess a health insurance-related barrier.
PURPOSE: Knowledge of the existence, position, and magnitude of barriers to equitable healthcare is an important consideration in shaping healthcare policies. METHODS: The authors developed a novel three-dimensional person-time-related hurdle model and followed a cohort of 7358 statutorily (SHI) and 457 privately health insured (PHI) patients with migraine headaches at 377 primary-care practices (MediPlus, IMS Health) in the second to fourth year of the HealthCare Structural Reform Act in Germany. RESULTS: For SHI compared with PHI migraine patients, there was a hurdle to receiving sumatriptan at all (2.4-fold lower hazard, 95% confidence interval, 1.8-3.2). Among patients who received sumatriptan, frequency and intensity of use differed only minimally between SHI and PHI patients. CONCLUSIONS: These findings have implications for healthcare researchers and healthcare policies. The framework extends traditional hurdle models and can serve as a model for quantifying barriers to receipt of services under different funding policies.
Adolescent↗
Improving the quality of health care for chronic conditions.
Chronic conditions are increasingly the primary concern of health care systems throughout the world. In response to this challenge, the World Health Organization has joined with the MacColl Institute for Healthcare Innovation to adapt the Chronic Care Model (CCM) from a global perspective. The resultant effort is the Innovative Care for Chronic Conditions (ICCC) framework which expands community and policy aspects of improving health care for chronic conditions and includes components at the micro (patient and family), meso (health care organisation and community), and macro (policy) levels. The framework provides a flexible but comprehensive base on which to build or redesign health systems in accordance with local resources and demands.
Chronic Disease↗
[School health education in California. The policies and contents of The Health Framework].
This paper introduces school health education activities in California. We focus on The Health Framework published by the California Department of Education. It describes the policies, objectives, and contents of health education for California public schools. This framework emphasizes health literacy for students and a comprehensive school health system that supports effective health education and make health an important priority at the school. The nine content areas presented by the framework describe health concepts, skills, and behaviors important for students. We analyzed this framework and its background including the trend of school health education in the United States and other health education related activities in California. Finally we compared the framework with school health education in Japan.
Adolescent↗
Appraising clinical practice guidelines in England and Wales: the development of a methodologic framework and its application to policy.
BACKGROUND: Clinical guidelines are pervading all aspects of health care. Their potential benefits are vast--from decreasing unjustified variation in treatment, to improving outcomes for patient, to containing escalating costs. However, there is increasing concern that many of the guidelines produced may be of low quality and recommend ineffective treatment. A framework to appraise the methodologic quality of clinical guidelines, commissioned by the NHS in 1997, was developed and validated in the United Kingdom (UK) under the auspices of the National Research and Development Programme. THE INDEPENDENT APPRAISAL SERVICE: This framework is now used to assess all national guidelines funded by the National Health Service (NHS) in the UK as part of an independent appraisal service. The appraisal provides a basis for policymakers to decide which guidelines should be commended for use in the NHS. Each guideline is appraised by a minimum of six appraisers. Twenty-one guidelines had been appraised as of July 1999. The mean time for completion of the appraisals, from receipt of the guidelines to dispatch of the reports, was just over ten weeks. There has been a marked improvement in the quality of documentation for national guidelines--including the search strategy and synthesis of evidence--in the past three years, although some areas of development remain inadequately reported. POLICY IMPLICATIONS: Ensuring that the clinical guidelines are sound before recommending their use is essential to policymakers responsible for guideline programs, and a formal appraisal should be an integral part of those programs.
England↗
Integration and immigration pressures in western Europe.
"With xenophobia resurgent in Europe, this article addresses some of the complexities of immigration and integration in EC [European Community] and EFTA [European Free Trade Association] countries. The categories of legal and illegal immigrants (including estimates thereof) are first described, as are the necessary ingredients of an integration policy (a framework law, a secure environment, cultural tolerance, demarginalization in housing and the labour market). The author then considers what types of action would help to ease the present immigration pressure, discussing in turn quota policies, project-tied or training migration and, finally, the use of international aid."
Acculturation↗
Agriculture sector resource and environmental policy analysis: an economic and biophysical approach.
Agricultural pollution of the environment is jointly determined by economic decisions driving land use, production practices, and stochastic biophysical processes associated with agricultural production, land and climate characteristics. It follows that environmental and economic statistics, traditionally collected independently of each other, offer little insight into non-point pollutant loadings. We argue that effective policy development would be facilitated by integrating environmental and economic data gathering, combined with simulation modelling linking economic and biophysical components. Integrated data collection links economics, land use, production methods and environmental loadings. An integrated economic/biophysical modelling framework facilitates policy analysis because monetary incentives to reduce pollution can be evaluated in the context of market costs and returns that influence land use and production activity. This allows prediction of environmental and economic outcomes from alternative policies to solve environmental problems. We highlight steps taken to merge economic and biophysical modelling for policy analysis within the Economic Research Service of the United States Department of Agriculture. An example analysis of a policy to reduce agricultural nitrogen pollution is presented, with the economic and environmental results illustrating the value of linked economic and biophysical analysis.
Agriculture↗
The Mine Safety and Health Administration's criterion threshold value policy increases miners' risk of pneumoconiosis.
BACKGROUND: The Mine Safety and Health Administration (MSHA) proposes to issue citations for non-compliance with the exposure limit for respirable coal mine dust when measured exposure exceeds the exposure limit with a "high degree of confidence." This criterion threshold value (CTV) is derived from the sampling and analytical error of the measurement method. CONCEPTUAL FRAMEWORK: This policy is based on a combination of statistical and legal reasoning: the one-tailed 95% confidence limit of the sampling method, the apparent principle of due process and a standard of proof analogous to "beyond a reasonable doubt." CRITIQUE: This policy raises the effective exposure limit, it is contrary to the precautionary principle, it is not a fair sharing of the burden of uncertainty, and it employs an inappropriate standard of proof. Its own advisory committee and NIOSH have advised against this policy. For longwall mining sections, it results in a failure to issue citations for approximately 36% of the measured values that exceed the statutory exposure limit. DISCUSSION: Citations for non-compliance with the respirable dust standard should be issued for any measure exposure that exceeds the exposure limit.
Dust↗
Enhancing participation for children with disabilities: application of the ICF enablement framework to pediatric physical therapist practice.
PURPOSE: This paper describes how pediatric physical therapists can utilize the enablement framework, embraced by the World Health Organization in the current International Classification of Functioning, Disability, and Health (ICF). The ICF can guide clinical reasoning related to enhancing participation in desired activities for children with disabilities. In the ICF framework, participation reflects the person's engagement in important life situations. By emphasizing what the person can do in valued contexts, the enablement framework is a positive complement to a focus on functional limitations and disability of the disablement model. SUMMARY OF KEY POINTS: Current conceptual frameworks and policies advocate attention to children's participation. Legislation (Individuals with Disabilities Education Act, Amendments of 1991 and 1997 and the Americans with Disabilities Act of 1990), the Guide to Physical Therapist Practice, and motor control and action perspectives all support the inclusion of children with disabilities in natural environments. These frameworks and laws can guide therapists' clinical reasoning to focus on children's participation in desired activities during the evaluation, goal-setting, and intervention process. A case study of a child with spastic diplegia illustrates how pediatric physical therapists can apply the enablement framework to develop meaningful goals and interventions focused on enhancing the child's participation in desired activities. CONCLUSIONS: Adoption of an enablement perspective may help pediatric physical therapists to focus their evaluations and interventions on promoting children's participation as well as the specific functional activities that enhance participation.
Journal Article↗
European union water policy--tasks for implementing "Water Framework Directive" in pre-accession countries.
Water Framework Directive aiming to maintain and improve the aquatic environment in the EU was launched by the European Parliament in 2000. According to this directive, control of quantity is an ancillary element in securing good water quality and therefore measures on quantity, serving the objective of ensuring good quality should also be established. Accordingly, it is a comprehensive and coordinated package that will ensure all European waters to be protected according to a common standard. Therefore, it refers to all other Directives related to water resources management such as Urban Wastewater Treatment Directive Nitrates Directive, Drinking Water Directive, Integrated Pollution Prevention Control etc. Turkey, as a candidate state targeting full-membership, should comply the necessary preparations for the implementation of the "Water Framework Directive" as soon as possible. In this study, the necessary legislative, political, institutional, and technical attempts of the pre-accession countries have been discussed and effective recommendations have been offered for future activities in Turkey.
Environment↗
Advancing practice inquiry: research foundations of the practice doctorate in nursing.
The University of Washington Doctor of Nursing Practice program entails 3 curricular dimensions: advanced practice, leadership, and practice inquiry. In this article, the practice inquiry dimension is discussed and defined as a type of clinical investigation that closely aligns with the realities and complexities of everyday practice by advanced practice nurses (APNs). The advancement of APNs' practice inquiry competencies is timely for its interfaces with the national scientific agenda's emphasis on translating science to clinical practice, health care delivery systems and policy. A framework for conceptualizing a practice inquiry curriculum and competencies is proposed. In addition, the divergent and convergent comparisons with Doctor of Philosophy (PhD) nursing programs are discussed, with emphasis placed on potential collaborative clinical research endeavors.
Clinical Competence↗
National health policies: sub-Saharan African case studies (1980-1990).
Four countries, Botswana, Cote d'Ivoire, Ghana and Zimbabwe, were chosen as cases to study the impact of national health policies on national health status in sub-Saharan Africa. Through a conceptual framework that covers health problem identification, policy formulation and implementation procedures, the study examined national translations of Primary Health Care (PHC) and Health for All by the Year 2000 (HFA/2000) strategies. A series of government measures, taken between 1980-1986 for health policy development and implementation in these countries, were treated as policy determinants of national health outcomes for the period ending 1990. The impact of these determinants on national health status was then analyzed through a comparative description and documentation of observable patterns and trends in infant mortality rates (IMR), under-5 mortality rates (U5MR) and life expectancy. Policy guidelines from PHC and HFA/2000 were used in conjunction with the respective per capita Gross National Products to categorize the four cases. Based on these guidelines, Botswana was ranked high, both in terms of policy development and the level of economic development, while Zimbabwe ranked high in terms of policy development but relatively low in economic terms. Cote d'Ivoire ranked high on economic development but low with regard to its policy framework. Ghana was at the other end of the spectrum, ranking low both in terms of its policy development and its economic performance. The comparative analysis revealed that Botswana and Zimbabwe performed better than Cote d'Ivoire and Ghana on the three outcome indicators. Despite Cote d'Ivoire's superior level of economic development, its health status fell behind that of Zimbabwe and even Ghana. The study concluded that policies formulated and implemented in accordance with key PHC principles could account for improvements in national health status. Since the end of the study period (1990), there have been significant political changes in the sub-Saharan African region as a whole and in some of the case countries in particular. Political leadership has changed in Ghana and Cote d'Ivoire with some course corrections in Ghana's health plans. Health sector financing in the region has become more dependent on external donors. The World Bank leads the external donor community in promoting policy-based lending. The complexity of a number of health problems has changed while the problems themselves remain the same as before. Essentially, building viable public health infrastructures to address basic public health needs must still be high on the agenda of action for most governments in the region. Thus, notwithstanding some course corrections and reasonable shifts in priorities, all the PHC principles are still applicable, indeed, much needed in the sub-Saharan African region. This study's findings, underscoring the fact that significant improvements in health are possible even where financial resources are limited, still hold true.
Africa South of the Sahara↗
Environmental justice and regional inequality in southern California: implications for future research.
Environmental justice offers researchers new insights into the juncture of social inequality and public health and provides a framework for policy discussions on the impact of discrimination on the environmental health of diverse communities in the United States. Yet, causally linking the presence of potentially hazardous facilities or environmental pollution with adverse health effects is difficult, particularly in situations in which diverse populations are exposed to complex chemical mixtures. A community-academic research collaborative in southern California sought to address some of these methodological challenges by conducting environmental justice research that makes use of recent advances in air emissions inventories and air exposure modeling data. Results from several of our studies indicate that communities of color bear a disproportionate burden in the location of treatment, storage, and disposal facilities and Toxic Release Inventory facilities. Longitudinal analysis further suggests that facility siting in communities of color, not market-based "minority move-in," accounts for these disparities. The collaborative also investigated the health risk implications of outdoor air toxics exposures from mobile and stationary sources and found that race plays an explanatory role in predicting cancer risk distributions among populations in the region, even after controlling for other socioeconomic and demographic indicators. Although it is unclear whether study results from southern California can be meaningfully generalized to other regions in the United States, they do have implications for approaching future research in the realm of environmental justice. The authors propose a political economy and social inequality framework to guide future research that could better elucidate the origins of environmental inequality and reasons for its persistence.
Air Pollutants↗