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At least 253 records · Page 14Linked to original sources
PubMed1993

Health policy in a new key: setting democratic priorities.

Health policy in the United States is entering an era in which explicitly value-based allocation decisions require direct attention. Policies concerning access to care, financing, and utilization management will necessarily have redistributive effects. For these policies to command social legitimacy and political support, some consensus will have to emerge around the values and ideals justifying these policies. This article addresses the problems of conceptual clarification and democratic process raised by the prospect of an explicitly value-based allocation policy. It offers a conceptual matrix distinguishing the scope of the issue of allocation in health care. Drawing on the activities of community health decisions projects in several states, it also offers suggestions about building a participatory and educational process at the grassroots level that might lead to a democratic consensus suitable for guiding policy choice.

Community Participation↗
PubMed1997

Who should decide? Qualitative analysis of panel data from public, patients, healthcare professionals, and insurers on priorities in health care.

OBJECTIVE: To explore the arguments underlying the choices of patients, the public, general practitioners, specialists, and health insurers regarding priorities in health care. DESIGN: A qualitative analysis of data gathered in a series of panels. Members were asked to economise on the publicly funded healthcare budget, exemplified by 10 services. RESULTS: From a medical point of view, both panels of healthcare professionals thought most services were necessary. The general practitioners tried to achieve the budget cuts by limiting access to services to those most in need of them or those who cannot afford to pay for them. The specialists emphasised the possibilities of reducing costs by increasing the efficiency within services and preventing inappropriate utilisation. The patients mainly economised by limiting universal access to preventive and acute services. The "public" panels excluded services that are relatively inexpensive for individual patients. Moreover, they emphasised the individual's own responsibility for health behaviour and the costs of health care, resulting in the choice for copayments. The health insurers emphasised the importance of including services that relate to a risk only, as well as feasibility aspects. CONCLUSIONS: There were substantial differences in the way the different groups approached the issue of what should be included in the basic package. Healthcare professionals seem to be most aware of the importance of maintaining equal access for everyone in need of health care.

Attitude of Health Personnel↗
PubMed1982

Mental health service priorities and the BSW.

New Priorities in mental health service delivery call for the exploration of previously overlooked sources of mental health personnel whose preparation for practice is adapted to historically underserved populations and service delivery approaches geared to their special needs. One such source are baccalaureate level social workers. This exploratory study of 29 purposively selected baccalaureate social work education programs observes and describes their extensive mental health field instruction, in which the predominant student assignments include case management and related functions stressed in current mental health policy. Implications are drawn regarding the allocation of federal training funds and labor force issues.

Community Mental Health Services↗
PubMed2005

Patients' priorities concerning health research: the case of asthma and COPD research in the Netherlands.

BACKGROUND: Although patients are increasingly involved in agenda setting within specific fields of health research, they rarely participate in decision-making on the entire breadth of health research, including biomedical research. This might be attributable to a widely held view that patients are incapable of adequate research prioritization due to a lack of relevant knowledge, a failure to look beyond their own individual problems or an inability to objectively consider long-term targets. AIMS: By conducting transparent and structured consultations with asthma and chronic obstructive pulmonary disease (COPD) patients regarding their health research priorities, we aim to assess the ability of patients to prioritize research in a well-argued way. METHODS: Patients were consulted through seven focus groups, a feedback meeting, and a questionnaire. The focus groups and the feedback meeting aimed to explore the entire breadth of patients' problems experienced in relation to their diseases, while the questionnaire aimed to investigate patients' prioritization of possible research targets focused on solving these problems. RESULTS: The focus groups produced a wide range of problems, including those related to health-care organization, social environment, therapy and costs. In terms of research prioritization, patients focused primarily on biomedical issues, particularly aetiology, co-morbidity and effective medication. CONCLUSIONS: The consultation procedure successfully elicited patients' research priorities including the underlying arguments. Our results indicate that asthma and COPD patients are capable of research prioritization in a well-argued way and that they highly value biomedical research. Furthermore, as they prioritized some research topics that are not covered by current Dutch research programmes, we argue that patient participation can broaden research agenda setting.

Adolescent↗
PubMed2004

Physician involvement in setting priorities for health regions.

Although many authors have emphasized the importance of including physicians in organizational activities, especially in integrated delivery systems, much of the literature has focused on physician involvement in governance or as managers. In this paper, program budgeting and marginal analysis (PBMA) is suggested as a mechanism to link physicians into organizational decision-making processes. This research included a wide range of examples that demonstrate the versatility of PBMA, and many ways to involve physicians.

Alberta↗
PubMedDate not supplied

Deaf community analysis for health education priorities.

Deaf persons' access to health-related information is limited by barriers to spoken or written language: they cannot overhear information; they have limited access to television, radio, and other channels for public information; and the average reading level of Deaf adults is at a 3rd to 4th grade level. However, literature searches revealed no published reports of community analysis focusing specifically on health education priorities for Deaf communities. A seven-step community analysis was conducted to learn the health education priorities in Arizona Deaf communities and to inform development of culturally relevant health education interventions in Deaf communities. The word "Deaf" is capitalized to reflect the cultural perspective of the Deaf community. A 14-member Deaf Health Committee collected data using multimethods that included review of state census data, review of national health priorities, key informant interviews, discussions with key community groups, a mail survey (n = 20), and semistructured interviews conducted in sign language with 111 Deaf adults. The community diagnosis with highest priority for health education was vulnerability to cardiovascular disease (CVD). Following completion of the community analysis, a heart-health education intervention (The Deaf Heart Health Intervention) was developed using a train-the-trainer, community health worker model. If this model proves to be effective in addressing vulnerability to CVD, then a similar protocol could be employed to address other health concerns identified in the Deaf community analysis.

Adolescent↗
PubMed2006

A case study on determining and responding to health managers' priorities for research to assist health service decision making.

The Newcastle Institute of Public Health (NIPH) is a collaboration of health service and public health research groups in the Hunter Region of New South Wales, Australia which aims to promote the use of evidence in decision making. However, use of research evidence in decision making is a complex process, with many barriers and enablers described in the literature. Informed by strategies described in the literature around developing priority-driven research, NIPH researchers undertook to determine whether asking local health decision-makers about their needs for research information might lead to greater use of the resulting research evidence to inform health service management decisions. This paper describes a process used by NIPH to determine the research needs of 11 local senior health managers, our response to specific research questions, the communication of this research information, and the outcome.

Decision Making, Organizational↗
PubMedDate not supplied

Triage: setting priorities for health care.

The concept of triage is central to the allocation of healthcare resources. As demands for health care increase, medical technologies and providers become more expensive and more scarce. Triage decisions occur at all levels in the distribution of resources. It is essential to explore the concept of triage and some of the underlying ethical principles for triage decision-making from the perspective of the discipline of nursing. Examining how definitions of triage apply to practice will enable nurses to participate in reform strategies for the healthcare system.

Decision Making↗
PubMed2006

Priority setting for health interventions in Mexico's System of Social Protection in Health.

Explicit priority setting presents Mexico with the opportunity to match the pressure and complexity of an advancing epidemiological transition with evidence-based policies driven by a fundamental concern for how to make the best use of scarce resources to improve population health. The Mexican priority-setting experience describes how standardised analytical approaches to decision making, mainly burden of disease and cost-effectiveness analyses, combine with other criteria--eg, being responsive to the legitimate non-health expectations of patients and ensuring fair financing across households--to design and implement a set of three differentiated health intervention packages. This process is a key element of a wider set of reform components aimed at extending health insurance, especially to the poor. The most relevant policy implications include lessons on the use of available and proven analytical tools to set national health priorities, the usefulness of priority-setting results to guide long-term capacity development, the importance of favouring an institutionalised approach to cost-effectiveness analysis, and the need for local technical capacity strengthening as an essential step to balance health-maximising arguments and other non-health criteria in a transparent and systematic process.

Adolescent↗
PubMed1995

Setting targets: a three-stage model for determining priorities for health promotion.

This paper describes a three-stage model for setting targets for health promotion. The model was developed in 1992 in response to the need to identify priority areas for health promotion for women in the Hunter Region of New South Wales. The approach enabled epidemiological data and views from the community to be synthesised and integrated with those of experts from health and social services (key informants), using a nominal group process. The reliability of the method was investigated by replicating the process with two groups of key informants. There was considerable commonality in the targets generated by the two groups. The process resulted in the identification of seven targets that reflected the concerns of the community and local experts as well as the health priorities suggested by local epidemiological data. The model used could be adapted for determining priorities in a wide range of health and health care settings, where available resources restrict the range of services or activities which can be offered.

Consumer Organizations↗
PubMed1999

Multi-criteria decision making--an approach to setting priorities in health care.

The objective of this paper is to present a multi-criteria decision making (MCDM) approach to support public health decision making that takes into consideration the fuzziness of the decision goals and the behavioural aspect of the decision maker. The approach is used to analyse the process of health technology procurement in a University Hospital in Rio de Janeiro, Brazil. The method, known as TODIM, relies on evaluating alternatives with a set of decision criteria assessed using an ordinal scale. Fuzziness in generating criteria scores and weights or conflicts caused by dealing with different viewpoints of a group of decision makers (DMs) are solved using fuzzy set aggregation rules. The results suggested that MCDM models, incorporating fuzzy set approaches, should form a set of tools for public health decision making analysis, particularly when there are polarized opinions and conflicting objectives from the DM group.

Brazil↗
PubMed1994

Voting and priorities in health care decision making, portrayed through a group decision support system, using analytic hierarchy process.

Within the health care industry many decision making approaches and tools are used. This paper explores a new tool, the Analytic Hierarchy Process (AHP), which permits both subjective and objective information to be considered in a decision. AHP has tremendous potential to solve both traditional and non-traditional health care problems. Its strength as a decision-making tool is its ability to combine both subjective and objective data. Application of AHP is discussed within the context of a Group Decision Support System (GDSS) model developed by Hatcher. The model is reviewed in limited detail, and readers are referred to the original article that defined and discussed the uniqueness and level of sophistication of GDSS applications in the health care industry. Health and medical delivery problems are discussed to highlight AHP requirements and the complexity of AHP applications. Health care applications are unique in that they lend themselves ideally to the use of computer data, image, voice, text, and multimedia concepts.

Decision Making, Organizational↗