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PubMed2006

Health technology assessment.

Health technology assessment (HTA) involves the systematic evaluation of healthcare technologies and the dissemination of assessment findings. Its main purpose is to provide objective information to support healthcare decisions and policy-making. This article provides a brief overview of HTA, covering availability of assessment reports, approaches used, relevance and reliability of assessments and the influence of HTA. HTA reports vary greatly in their scope and complexity, because of the range of questions considered and the needs of those who request advice on health technologies. A key to the reliability of an HTA report is its transparency. Explicit information should be provided on the question that is addressed, data used, approach to analysis, and any assumptions that are made. Effectiveness of HTA--the extent to which it influences decisions--will be highly dependent on how well assessment findings are disseminated.

Biomedical Technology↗
PubMed1996

Community participation in health care: the Turkish case.

World Health Organization's global goal of Health for All by the Year 2000 (HFA) and achievement of this laudable goal through the Primary Health Care (PHC) approach has been accepted unanimously by participant countries of the Alma-Ata Conference in 1978. Turkey is also among the countries that showed their approval to the concept. However, that approval of the policy did not generate particular attention among the policy-makers until the 1990s. The year 1990 can be regarded as a watershed in the Turkish health policy-making environment as attempts at producing a National Health Policy document that centred around the global goal of HFA and PHC commenced. This paper aims at discussing the commitment of Turkey to one of the prerequisites of the approach, or heart of the PHC as regarded by some: community participation. After a brief presentation of community participation the Turkish commitment to the concept is analyzed based on a research carried out among Turkish health policy-makers. It is concluded that the prospect for community participation in Turkey does not look good mainly because of the medical approach adopted by the policy-makers. The need for more discussion of the topic among the academic circles has been emphasized.

Community Health Planning↗
PubMed2006

Describing the impact of health research: a Research Impact Framework.

BACKGROUND: Researchers are increasingly required to describe the impact of their work, e.g. in grant proposals, project reports, press releases and research assessment exercises. Specialised impact assessment studies can be difficult to replicate and may require resources and skills not available to individual researchers. Researchers are often hard-pressed to identify and describe research impacts and ad hoc accounts do not facilitate comparison across time or projects. METHODS: The Research Impact Framework was developed by identifying potential areas of health research impact from the research impact assessment literature and based on research assessment criteria, for example, as set out by the UK Research Assessment Exercise panels. A prototype of the framework was used to guide an analysis of the impact of selected research projects at the London School of Hygiene and Tropical Medicine. Additional areas of impact were identified in the process and researchers also provided feedback on which descriptive categories they thought were useful and valid vis-à-vis the nature and impact of their work. RESULTS: We identified four broad areas of impact: I. Research-related impacts; II. Policy impacts; III. Service impacts: health and intersectoral and IV. Societal impacts. Within each of these areas, further descriptive categories were identified. For example, the nature of research impact on policy can be described using the following categorisation, put forward by Weiss: Instrumental use where research findings drive policy-making; Mobilisation of support where research provides support for policy proposals; Conceptual use where research influences the concepts and language of policy deliberations and Redefining/wider influence where research leads to rethinking and changing established practices and beliefs. CONCLUSION: Researchers, while initially sceptical, found that the Research Impact Framework provided prompts and descriptive categories that helped them systematically identify a range of specific and verifiable impacts related to their work (compared to ad hoc approaches they had previously used). The framework could also help researchers think through implementation strategies and identify unintended or harmful effects. The standardised structure of the framework facilitates comparison of research impacts across projects and time, which is useful from analytical, management and assessment perspectives.

Evaluation Studies as Topic↗
PubMed1996

[When a sense of justice hinders social efficiency: Pareto axiom revisited].

This study addressed people's judgments about desirability of various reward allocation under different task-rules aggregating individual inputs to a group outcome. The rules used in the study were additive, conjunctive, and disjunctive (Steiner, 1972), and subjects evaluated twelve cases of reward allocation reflecting different distributive principles, such as equality and equity. It was found that no one principle was favored under all three aggregation rules. Generally, a distributive principle was favored that was most beneficial for the member whose input 'determined' group success. Specifically, equality was endorsed most often under the conjunctive rule, and equity under the disjunctive rule. It was also found that the Pareto axiom was frequently violated. In pairwise comparison, more than 60% of the subjects endorsed an allocation scheme, that was, subjectively fairer but objectively inferior in terms of Pareto optimality, revealing their commitment to a specific distributive principle. The results suggest that the universal economic assumption of Pareto optimality for social policy-making be seriously questioned.

Adult↗
PubMed2005

A rational approach to formulating public policy on substance abuse.

Unlike alcohol, which is legal and regulated, current public policy makes drugs such as heroin, cocaine, methamphetamines, and marijuana illegal. This article summarizes the history of drug and alcohol use in the United States, compares our public policies on alcohol to those on drugs, and shows the direct link between alcohol or drug use and crime, corruption, violence, and health problems in other countries and in our own. A rational approach to formulating a workable public policy is presented.

Alcohol-Related Disorders↗
PubMed2003

Psychological models of professional decision making.

People are often expected to make decisions based on all of the relevant information, weighted and combined appropriately. Under many conditions, however, people use heuristic strategies that depart from this ideal. I tested the ability of two models to predict bail decisions made by judges in two courts. In both courts, a simple heuristic proved to be a better predictor of judicial decisions than a more complex model that instantiated the principles of due process. Specifically, judges were "passing the buck" because they relied on decisions made by the police, prosecution, and previous bench. Problematically, these earlier decisions were not significantly related to case characteristics. These findings have implications for the types of models researchers use to capture professional decision-making policies.

Criminal Law↗
PubMed2003

Comparative risk and policy analysis in environmental health.

There is increasing interest in the integration of quantitative risk analysis with benefit-cost and cost-effectiveness methods to evaluate environmental health policy making and perform comparative analyses. However, the combined use of these methods has revealed deficiencies in the available methods, and the lack of useful analytical frameworks currently constrains the utility of comparative risk and policy analyses. A principal issue in integrating risk and economic analysis is the lack of common performance metrics, particularly when conducting comparative analyses of regulations with disparate health endpoints (e.g., cancer and noncancer effects or risk-benefit analysis) and quantitative estimation of cumulative risk, whether from exposure to single agents with multiple health impacts or from exposure to mixtures. We propose a general quantitative framework and examine assumptions required for performing analyses of health risks and policies. We review existing and proposed risk and health-impact metrics for evaluating policies designed to protect public health from environmental exposures, and identify their strengths and weaknesses with respect to their use in a general comparative risk and policy analysis framework. Case studies are presented to demonstrate applications of this framework with risk-benefit and air pollution risk analyses. Through this analysis, we hope to generate discussions regarding the data requirements, analytical approaches, and assumptions required for general models to be used in comparative risk and policy analysis.

Air Pollution↗
PubMedDate not supplied

Analysis of interest group influence on federal school meals regulations 1992 to 1996.

Regulatory changes proposed by the US Department of Agriculture in 1994 promised to bring progressive changes to school meals. However, lobbying by interest groups resulted in substantial changes to the final rule. This analysis retrospectively examines the federal school meals policy-making process during 1992 to 1996. Key questions address why the policy changed and what the role of interest groups was in affecting the shape, pace, and direction of the policy. The study provides suggestions for using the experiences of 1992 to 1996 to guide future advocacy efforts and for adapting the approach for application to other food and nutrition policies.

Adolescent↗
PubMed1996

Managing policy research in nursing.

This paper draws on the author's experience as a liaison officer in the Department of Health, England, to explore the topic of using research in policy making. The relationship between the worlds of the researcher and the policy maker is discussed, and an example, the research initiative on human resources and effectiveness, is chosen to illustrate how research topics are formulated.

Consumer Behavior↗
PubMed1999

Reimbursement to advanced practice nurses (APNs) through Medicare.

PURPOSE: To analyze why U.S. legislation for direct Medicare reimbursement to advanced practice nurses (APNs) was approved during the 105th congressional session. Help in understanding the complexities of policy making and in strategizing future policy activities is needed. Given their vast numbers, nurses are a formidable group with potential to influence policy. ORGANIZING CONSTRUCT: Kingdon's (1995) framework indicates that policy formation involves constant interaction among participants and the problem, its politics, and policy. When a policy is enacted into legislation, the three come together and an opportunity for policy formation exists, if even for a short period. Methods for data extraction included telephone interviews, information provided by the American Nurses Association (ANA), and information from the internet to access information. FINDINGS: Lack of access to health care by Medicare beneficiaries, tagging a policy proposal onto the Balanced Budget Act of 1997, the national mood to provide cost-effective quality care, and lobbying by interest groups helped to make direct Medicare reimbursement for advanced practice nurses a reality. CONCLUSIONS: When lobbying for the enactment of legislation, nurses should decrease their tendency to fragment. Nurses should be more effectively organized and concentrate on specific agendas. Working together can influence policy and change clinical situations to improve patient care.

Health Policy↗
PubMed2000

Trends in risk assessment and risk management.

Environmental risk assessment has matured into a powerful analytical tool, which is finding ever-wider applications in the arena of policy making and regulation. However, the principal focus of its development to date has been on the technical challenges of characterising and modelling the environmental behaviour and biological action of chemicals, whereas issues concerning its broader socio-political context have been generally neglected. Problem definition, risk analysis and decision making have, therefore, tended to be dominated by experts and by expert opinion. Fresh insights from the social sciences advocate a pluralistic, inclusive approach, with experts participating alongside other stakeholders in a consensual decision making process. Adoption of this paradigm has far reaching consequences for the form and conduct of risk assessment and risk management.

Environment↗