Making policy decisions for insurance coverage: one nurse's role.
Explore the source record for details and available documents.
Child↗
SEARCH · Search PubMed
Results for “Policy Making”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
State health policy making determinants, theory, and methods: a synthesis.
The American states exhibit considerable differences in health policy and market characteristics. Not only do they display substantial variation in spending, but they also display substantial variation in the strategies chosen to control costs, improve access, and ensure quality care. This article synthesizes studies that use 50-state statistical techniques to model policy adoption in the health sector. The purpose is to assess the strengths and weaknesses of this literature, to place it in the context of comparative state policy research generally, and to identify factors that best predict 17 health policy outcomes at the state level. A database was assembled containing 245 equations abstracted from 63 studies published between 1975 and 2002. Some predictors (such as income, aged population, public opinion, and nursing home beds) were studied much more frequently than others (e.g., education, divided government, federal Medicaid mandates, other states' adoptions). Results show that 43 of the 87 policy making determinants examined consistently predict two or more state-level outcomes, including four that predict five outcomes (non-white, urban, income, unemployment), two that predict six (tax capacity/effort, hospital beds), and two that predict seven (nursing home beds, liberal public opinion). Gaps are shown to exist in our understanding of the policy making effects of political system and intergovernmental characteristics.
Financing, Government↗
Weighing the evidence: prospects for evidence-based policy-making.
Evidence-based policy (EBP) is currently one of the "big ideas" in policy circles. From its origins in the medical community, EBP is now being applied to other policy domains including environment. But will it really ensure that the public policy grease gets to the environmental squeak? And what are the implications for scientists themselves?
Conservation of Natural Resources↗
Time, complex systems, and public policy: a theoretical foundation for adaptive policy making.
Can public policy development and implementation be improved by closely tracking and coordinating its timing with that of the regulated sector? Built-in asynchronies between political process and regulated sectors or activities can produce unintended disruptions in rates of economic change and development undermining the original intent of the policy or regulatory action. Such events sometimes lead to unexpected future disruptions as well. A policy approach is needed that adaptively ties the right mix of resources and regulatory activity to the timing of particular stages of economic development or growth associated with a particular industry. These public policy timing problems are explored using a new theory based on the concepts of "time-ecology," "heterochrony," and "temporal signature." The full range of linear and nonlinear time-space web linkages (electronic, selling and buying, technology transfer are examples) in an government-industry cluster between political, economic, and other elements creates an interconnected ecology-a time-ecology-of unique, more or less intense, and often complex rhythmic pulses occuring in parallel or in a punctuated way, and entrained with or influencing each other across multiple time scales flowing into the future. Each organizational structure is situated in its own past, present, and future in a unique way (time signature). Outside linkages mutually influence structuration by varying rates of development and growth (heterochrony). Nonlinear dynamics may be involved in these interactions. This whole process occurs on linked government/industry adaptive landscapes. The approach detailed in this paper may be applicable to organizational and time related issues in other disciplines. The paper ends with suggestions for testing the theory.
Adaptation, Psychological↗
[Research utilization in health policy-making: obstacles and strategies].
Management of a health system requires knowledge of the health situation and administration, among other factors. The use of scientific knowledge by health policy-makers is thus recommendable. However, policy-making processes and scientific practices themselves often appear to pose obstacles to the actual utilization of research results. Many such obstacles result from reifying views of the decision-making process and objectivist conceptions of science. We propose a re-conceptualization of health policy-making and scientific practices based on the language game notion. The use of research results would thus become an exchange of significant metaphors between policy-makers and scientists. Adoption of pluralistic research systems and intensification of interfaces between researchers and policy-makers in a context of knowledge-sharing would be the main strategies to improve this exchange. Such strategies would be efficient to the extent that they succeeded in drawing science and common sense closer together, thereby transforming both.
Decision Making, Organizational↗
Evidence-based policy-making in the NHS: exploring the interface between research and the commissioning process.
BACKGROUND: The UK National Health Service (NHS) R&D strategy acknowledges the importance of developing an NHS where practice and policy is more evidence-based. This paper is based on a qualitative study which aimed to identify factors which facilitate or impede evidence-based policy-making at a local level in the NHS. METHODS: The study involved a literature review and case studies of social research projects which were initiated by NHS health authority managers or general practitioner (GP) fundholders in one region of the NHS. Data were collected through in-depth interviews with lead policy-makers, GPs and researchers working on each of the case studies and analysis of project documentation. RESULTS: An over-arching theme from the analysis was that of the complexity of R&D in purchasing. The two worlds of research and health services management often sit uncomfortably together. For this reason it was not possible to describe a 'blueprint' for successful R&D, although several important issues emerged. These include sharing an appropriate model for research utilization, the importance of relationships in shaping R&D, the importance of influence and commitment in facilitating evidence-based change, and the resourcing of R&D in purchasing. CONCLUSIONS: These issues have important implications for the strategic development of R&D as well as for individual project application. Moving beyond the rhetoric of evidence-based policy-making is more likely if both policy-makers and researchers openly acknowledge this complexity and give due concern to the issues outlined.
Evidence-Based Medicine↗
Evidence-based policy making in health care: what it is and what it isn't.
In this paper, I aim to re-establish the meaning and importance of the concept of 'evidence-based policy making' (EBP) in health care. The term EBP is often misunderstood as being either vacuous (who thinks that public policy should not be based on evidence?), unrealistic (the naive product of ivory tower thinking) or conservative (an excuse permanently to delay reform). It need be none of these things. EBP should be thought of as a set of rules and institutional arrangements designed to encourage transparent and balanced use of evidence in public policy making. As well as controlled trials and observational studies, a broad range of theoretical and empirical evidence about human behaviour may be relevant to predicting policy outcomes - including stakeholder opinions and other sources of intelligence that might not qualify as scientific research. Gradual progress towards EBP, properly understood, has the potential to facilitate open democracy and to improve policy outcomes. The argument is illustrated using examples based on large-scale policies of health care reform in England, where progress towards EBP over the last decade has been real but modest.
Evidence-Based Medicine↗
Public participation in medical policy-making and the status of consumer autonomy: the example of newborn-screening programs in the United States.
OBJECTIVES: State newborn-screening programs collectively administer the largest genetic-testing initiative in the United States. We sought to assess public involvement in formulating and implementing medical policy in this important area of genetic medicine. METHODS: We surveyed all state newborn-screening programs to ascertain the screening tests performed, the mechanisms and extent of public participation, parental access to information, and policies addressing parental consent or refusal of newborn screening. We also reviewed the laws and regulations of each state pertaining to newborn screening. RESULTS: Only 26 of the 51 state newborn-screening programs reported having advisory committees that include consumer representation. Fifteen states reported having used institutional review boards, another venue for public input. The rights and roles of parents vary markedly among newborn-screening programs in terms of the type and availability of screening information as well as consent-refusal and follow-up policies. CONCLUSIONS: There is clear potential for greater public participation in newborn-screening policy-making. Greater public participation would result in more representative policy-making and could enhance the quality of services provided by newborn-screening programs.
Advisory Committees↗
Evidence-based health policy-making, hospital funding and health insurance.
An important goal of health services research is to improve the efficiency and effectiveness of health services through a quantitative and evidence-based approach. There are many limitations to the use of evidence in health policy-making, such as differences in what counts as evidence between the various disciplines involved, and a heavy reliance on theory in social science disciplines. Community and interest group values, ideological positions and political assessments inevitably intrude into government health policy-making. The importance of these factors is accentuated by the current absence of evidence on the impact of policy options for improving the health status of the community, and ensuring that efficiency and equity objectives for health services are also met. Analysis of recent hospital funding and private health insurance initiatives shows the limited role of evidence in the making of these decisions. Decision-making about health policy might be improved in the future by initiatives such as greater exposure of health professionals to educational inputs with a policy focus; increased contribution of doctors to health services research via special postgraduate programs; and establishing a national, multidisciplinary centre for health policy research and evaluation.
Academies and Institutes↗
The evolution of health-policy making in Italy.
An analysis of the dynamics of health care policy in Italy suggests that in recent years the pace of change in the health care system has accelerated. Although the basic features of universalism, comprehensiveness, and funding from general taxation have remained remarkably constant, the capacity to innovate policy tools and their settings and to take account of domestic and international experience seems to have increased. The political will and capacity to combat entrenched interests may also have increased, although implementation is still weak. The imperative to contain public expenditure has heavily conditioned health policy and will continue to do so. This has occurred mainly at the national level, but as the principal locus of health-policy making progressively shifts to the regions, so too will the constraining effect of this imperative move downward. If the decentralization process continues, problems could arise due to interregional differences in capacities to formulate and implement appropriate policies and to tackle special interest groups.
Decision Making, Organizational↗
Making evidence synthesis more useful for management and policy-making.
Explore the source record for details and available documents.
Evidence-Based Medicine↗
Strategies for successful evaluation and policy-making toward health care technology on the move: the case of medical lasers.
Evaluating new health care technology that is rapidly diffusing is one of the greatest challenges to researchers and policy-makers. If no evaluation is done until the technology is mature, evaluation will not influence processes of diffusion. If evaluation is done early, it may be irrelevant when it is completed, because of developments in the technology and changing indications for its use. Nonetheless, early evaluation seems to be the only strategy possible to improve the integration of evaluation and diffusion. These difficulties are illustrated by the case of lasers. Lasers are diffusing relatively rapidly into health care, and yet few laser applications have been well-evaluated. Looking back over the past 20 years or so, only one public body, the National Eye Institute of the U.S. National Institutes of Health (NIH) seems to have tried to address the problem of laser evaluation. In the case of the Eye Institute, it has consistently identified new technologies for treatment of eye conditions and has mounted well-designed prospective evaluations aimed at influencing clinical practice. However, these evaluations have not been integrated with public policy-making, and therefore their influence has been relatively slow to develop. In recent years, concerns about technology have brought more active attempts to develop public policies to affect diffusion. Excimer laser treatment of coronary artery disease, especially as dealt with in the Netherlands, illustrates how a strategy can be developed. Regulation has allowed diffusion to be constrained while evaluation is carried out. Results of the evaluation will guide subsequent diffusion. In the future, such results will probably be used in determining if the laser treatment should be included in the benefit package of health insurance. A strategy for improving diffusion processes requires continuous monitoring of technological developments in health care to identify candidates for such early assessment. Since assessment resources are limited, setting priorities between candidates for assessment is necessary. Once priorities have been determined, an evaluative strategy can be formulated. As in the case of laser treatment of coronary disease, a mechanism for constraining diffusion until evaluations are completed is necessary. Once the studies are completed, policy-making must be done promptly. The problem of successful implementation of this strategy lies with the public bodies, which are often not prepared to develop an integrated strategy of diffusion based on technology assessment and economic appraisal. Developing such a strategy, which would involve slowing diffusion in some cases and speeding it up in others, seems to have clear benefits.(ABSTRACT TRUNCATED AT 400 WORDS)
Coronary Disease↗
Conflicting agendas, interests, and actors in disease prevention policy-making: business, labor, and the High Risk Act.
During 1985-1988, the U.S. Congress considered and nearly passed the controversial "High Risk Act." This article analyzes the case in terms of a class-dialectic perspective that views contradictory class interests, the political economy context, intraclass divisions, and institutional biases favoring dominant class interests as important, underlying factors in shaping the character, course, and outcome of the policy-making process. These concepts are used as the basis for explicating the political conflicts surrounding the legislation, the course of its consideration by the Congress, and its ultimate defeat. The sharp labor-business conflicts over the bills are shown to be closely tied to the legislation's potential effects upon their class-based economic and ideological/political interests. The course of Congressional consideration of the legislation is demonstrated as strongly influenced by contextual factors and intraclass divisions, especially those within the business community. Finally, indirect and direct institutional biases favoring business interests are shown to be particularly relevant to the legislation's defeat. In conclusion, the author develops a series of lessons regarding the disease prevention policy-making process which illustrate how the political dynamics and outcomes associated with episodes of occupational health policy reform may be interpreted through a class-dialectic perspective focusing upon class interests, divisions, and struggle.
Humans↗
Differences between systematic reviews and health technology assessments: a trade-off between the ideals of scientific rigor and the realities of policy making.
OBJECTIVES: To elucidate important differences between a health technology assessment (HTA) and a systematic review, using an HTA of positron emission tomography (PET) as an example. METHODS: Interviews with seventeen individuals who were authors or users of the PET HTA. RESULTS: Those interviewed identified seven areas in which HTAs often differ from traditional systematic reviews: (i) methodological standards (HTAs may include literature of relatively poor methodological quality if a topic is of importance to decision-makers), (ii) replication of previous studies (relatively common for HTAs but not systematic reviews), (iii) choice of topics (more policy oriented for HTAs, while systematic reviews tend to be driven by researcher interest), (iv) inclusion of content experts and policy-makers as authors (policy-makers more likely to be included in HTAs, although there are potential conflicts of interest), (v) inclusion of economic evaluations (more often with HTAs, although economic evaluations based upon poor clinical data may not be useful), (vi) making policy recommendations (more likely with HTAs, although this must be done with caution), and (vii) dissemination of the report (more often actively done for HTAs). CONCLUSIONS: This case study of an HTA of PET scanning confirms that HTAs are a bridge between science and policy and require a balance between the ideals of scientific rigor and the realities of policy making.
Cost-Benefit Analysis↗
Child psychiatric epidemiology and Canadian public policy-making: the state of the science and the art of the possible.
Epidemiological studies have characterized the high burden of suffering that child psychiatric disorders cause--14% of children (1.1 million in Canada) have clinically important disorders at any given time. In this review, we summarize the recent research and discuss several unresolved scientific issues that must be addressed to make epidemiology more useful to policy-makers. We then discuss implications for policy-making to improve children's mental health outcomes. Overall, given the high prevalence rates, increasing clinical services alone will not suffice; rather, a multifaceted mix of strategies is required.
Adolescent↗
Professional policy-making: the case of Indian population policy.
Explore the source record for details and available documents.
Asia↗
Using subjective health assessments in practice and policy-making.
This paper discusses the use of subjective health assessment in medical practice and social policy-making. The importance of recognising patients' perceptions of their health when attempting to improve patient-practitioner relationships and formulate effective health care policies is stressed. The paper describes some of the tensions that exist between objective and subjective assessments of health. It is argued that there is a need for unifying theory to underpin the use of subjective health perceptions. Suggestions are made for the effective employment of these indicators.
Health Policy↗
Clinical policies: making conflicts of interest explicit. Task Force on Clinical Policies for Patient Care. American Academy of Family Physicians.
Explore the source record for details and available documents.
Conflict of Interest↗