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PubMed1998

Policy as an influence on public health nursing education in the Republic of Ireland.

Nurses are recognizing the need to influence health care policies; this requires an understanding of the ways in which policies are made. The key players and processes which influence public policy in the Republic of Ireland and the lack of policies referring explicitly to nurses and nursing are discussed in relation to a public health nursing curriculum. The lack of specific policies on nursing has had deleterious effects on some aspects of the curriculum but has also given the planners freedom to include primary health care and nursing values. It is argued that it may be better to have few policies than inappropriate ones. The preferred solution would be for nurses to be more involved in wider policy-making, ensuring that policies reflect nursing values and concerns. An opportunity for a nursing voice to be heard and relevant policies recommended is provided by the Irish government's Commission on Nursing.

Education, Nursing↗
PubMed1986

An approach to the assessment of learning needs for physician-managers.

In recent years physicians have become increasingly involved in the decision-making and policy-making processes in hospitals and other health service organizations. Consequently, there is a growing awareness of the need for specialized education programs for physicians who have managerial responsibilities. While education programs in management for physicians have been available in Britain and the United States for a number of years, relatively few programs have existed in Canada. Typically, physicians who have assumed administrative positions either within the medical staff organization or within the hospital's management structure have received no formal training in management. This article examines reasons for the increased demand for management education for physicians in Canada, specific needs of physicians in the area of management education, and the assessment of needs for management education programs.

Canada↗
PubMed2002

[Infection control team].

Infection control(IC) is a quality-improvement activity that focuses on improving the care of patients and protecting the health of staff. The infection control committee(ICC) should function as the central decision-making and policy-making body for IC. The infection control team(ICT) is responsible for carrying out all aspects of the IC program. ICT should have appropriate access to medical relevant staff members who can provide information on the adequacy of the institution's compliance with regard to IC programs. Healthcare facilities should use ICT to assist in maintaining compliance with IC programs. Surveillance of hospital-acquired infections should be performed and surveillance data should be analyzed appropriately and used to monitor and improve IC and healthcare outcomes.

Cross Infection↗
PubMed1983

New Haemophilus influenzae type b control strategy: premature commitment to prophylaxis?

Recent promulgation of an official policy on prevention of secondary cases of Haemophilus influenzae type b disease illustrates the challenges and frustrations inherent in the policy-making process. Despite evidence that H influenzae type b disease is "contagious" in households and probably also in day care centers and despite demonstration that rifampin eradicates nasopharyngeal H influenzae type b carriage, the single field study of rifampin use to prevent secondary cases of H influenzae type b disease remains unpublished and has yet to receive broad critical scrutiny. Promulgation of the rifampin strategy prior to publication of this critical study is unfortunate, as public and private providers are now committed to a policy that will be difficult to evaluate or alter. Now that the strategy has been issued, the central question regarding rifampin prophylaxis has changed from "Is this strategy effective?" to "Can this strategy be shown to be ineffective?" When policies are issued prior to publication of key supporting data, or when such studies are either missing or highly controversial, the policy-making committee might publish, along with its recommendations, explicit criteria for continuation, modification, or withdrawal of the new policy. This structured reassessment approach could accommodate the critical need to proceed with disease control recommendations--even though based on incomplete information--yet underscore the policy's tentative nature and provide direction for future assessment and study.

Academies and Institutes↗
PubMed2002

Political cultures, health systems and health policy.

Policies for restructuring national health systems in low- and middle-income countries tend to follow similar packages of prescriptions along the lines of those discussed in the World Development Report of 1993. An ubiquitous reform measure is that of decentralisation. Research on decentralised health care in Northeast Brazil demonstrates the critical role played by informal aspects of health system management and the political cultures of the wider context on the implementation of policy and the performance of local health systems. Discussion of incorporating these results into policy making highlights a number of points. Health systems research has failed to take seriously the role of the cultural for various reasons, particularly because of the challenge it makes to our own fundamental values and because of the difficulties of including it into approaches based on rational systems models. At the same time, health system researchers cannot easily draw upon and operationalise more complex and sophisticated explorations of the nature of the cultural domain. Nonetheless, without a concerted effort to engage with this literature, to bridge the gap to the applied policy world and tackle the challenge of incorporating considerations of political culture into policy making, health system management through decentralisation is likely to increase inequalities between local districts rather than the opposite.

Brazil↗
PubMed1987

Making healthy public policy; developing the science by learning the art: an ecological framework for policy studies.

During the 1980s increasing attention has been given to the view that a vast array of public policies have great potential for health promotion and that this potential ought to be developed. After briefly discussing the basis for this concept and its policy implications, this article turns to a major corequisite for making healthy public policy a political reality: learning how to do it. Where healthy public policy exists, how did it happen? This is a question that calls for a new generation of policy studies, one that is relevant to advocates of healthy public policy within and outside governments. An ecological framework of policy-making is proposed for such studies, delineating the social climate, key players, and strategic action. From it, operational indicators and study methods are suggested, in order to learn some general principles, within a real-world context, of how to develop public policies that are healthful.

Ecology↗
PubMed2000

Children's health insurance: the difference policy choices make.

This paper provides estimates of the cost and coverage impacts of the new State Children's Health Insurance Program (SCHIP). The estimates reflect the many choices the states are given by the legislation: whether to use traditional Medicaid or establish separate state-run programs; how far to extend eligibility up the income distribution; and how much to use premiums. We estimate the impacts of these choices on participation by the uninsured as well as by the insured--that is, the crowd-out effect--and on public expenditures. We also estimate the savings to families and firms that substitute SCHIP for private coverage. We conclude with estimates of the cost and coverage impacts of the actual initial choices that states have made.

Child↗
PubMed1997

Immigration policy in a global economy.

The author discusses trends in immigration policy making. "The state has been transformed by the growth of a transnational economic system. Because immigration policy is deeply rooted in state sovereignty, it is critical to examine the implications of global transformations as national legal innovation lags behind systemic change." Sections are included on the state and the new economic regime, constraint on states' policy making, and when different regimes intersect.

Demography↗
PubMed2003

Market competition: everybody is talking, but what do they say?. A sociological analysis of market competition in policy networks.

From providers and insurers to governments and consumers, it appears that everybody is talking about market competition in health care. However, what do they actually mean? Are they talking about the same things? These questions are relevant for health systems consisting of policy networks, such as in the Netherlands. In policy networks, different actors (besides the government) are engaged in policy-making. Based on their particular frame ('mode of interpretation'), actors proceed and, from this, give meaning to the concept of market competition. Since there are differences in frames (of reference) among the various actors, it is important to understand what market competition means from the perspective of each network participant. This study, with regard to the Dutch health care system, demonstrates 'market competition' as a broad concept, relating to 13 different frames. Only four frames (i.e. cost control, deregulation, competition and increased power) are shared by a maximum of two (out of a total of four) network participants. Clearly, there are differences in the meanings and underlying frames about market competition amongst the key players. The resulting implications and options for policy-making are discussed.

Consumer Organizations↗