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PubMed1992

Breast cancer in Canada: to screen or not to screen?

Lomas (1988) and Sabatier (1987) have suggested models by which to examine the roles that values, scientific knowledge, institutions, and the learning process play in the formulation of both national and clinical health-care policies. Utilizing their frameworks, this article offers an explanation for the development of high-volume screening mammography policies in Canada, despite the suggested inefficacy of screening technologies for 'unavoidable' illnesses such as carcinoma in the breast. The preliminary results of Canada's National Breast Screening Study further complicate this tissue. Inappropriate framing of the 'problem' in the policy-making process, by actors highly influenced by societal values and scientific evidence, is identified as the reason for present and planned policies and practices contradicting the first principles of health-policy analysis.

Adult↗
PubMed1996

Complex decisions about an uncomplicated therapy: reimbursement for long-term oxygen therapy in Catalonia (Spain).

Therapies used in the management of chronic diseases cause specific problems regarding reimbursement policy. Oxygen therapy is an example of such treatments that receive little attention from health care policy makers, due to their low cost to the health care budget and to their little importance from a social point of view. In this paper, we analyze the problems posed by this therapy in the Catalan health care system, as an example of the several aspects implied in the reimbursement of such kind of therapies. A technology assessment of this therapy was carried out showing that a change in the reimbursement of long-term home oxygen therapy (LTOT) was needed. Slow diffusion of new oxygen delivery modalities and over-prescription of LTOT were among the problems observed. The new system proposed is presented, and some preliminary results and consequences of the role of technology assessment in health care policy-making are discussed.

Health Policy↗
PubMedDate not supplied

Reforming the health sector in Thailand: the role of policy actors on the policy stage.

This paper reports on exploratory research carried out into the processes of policy-making, and in particular health sector reform, in the health sector of Thailand. It is one of a set of studies examining health sector reform processes in a number of countries. Though in the period under study (1970-1996) there had been no single health sector reform package in Thailand, there was interest in a number of quarters in the development of such an initiative. It is clear, however, that despite recognition of the need for reform such a policy was far from being formulated, let alone implemented. The research, based on both documentary analysis and interviews, explores the reasons underpinning the failure of the policy process to respond to such a perceived need. The research findings suggest that the policy formation process in Thailand successfully occurs when there is a critical mass of support from strategic interest groups. The relative power of these interest groups is constantly changing. In particular the last two decades has seen a decline in the power of the bureaucratic élites (military and civilian) and a related rise in the power of the economic élites either directly or through their influence on political parties and government. Other critical groups include the media, NGOs and the professions. Informal policy groups are also significant. A number of implications for policy makers operating under such circumstances are drawn.

Delivery of Health Care↗
PubMed2002

Race and healthcare disparities: overcoming vulnerablity.

The paper summarizes recently published data and recommendations about healthcare disparities experienced by African Americans who have Medicare or other healthcare coverage. Against this background the paper addresses the ethics of such disparities and how disadvantages of vulnerable populations like African Americans are typically maintained in decision making about how to respond to such disparities. Considering how to respond to disparities reveals much that vulnerable populations would bring to the policy-making table, if they can also be heard when they get there. The paper argues that vulnerable populations like African Americans need fair representation in bodies deciding what to do about such disparities and that fairness requires proportional representation at all levels of decisions that affect healthcare--a radical change. In this decision setting, how to provide adequate protection of minorities needs much further attention. The most attractive decision-making model is deliberative democracy. The paper shows that in deliberation, fair representation requires not only having a voice in decisions, but a fair hearing of those voices. Achieving a fair hearing requires changes in norms of communication and training of all to give importance to greetings and other measures of civility and trust building, and to be open to diverse forms of expression. Decisions about how to respond to healthcare disparities would include what programs to initiate for whom, how to evaluate the programs, and what to do in response to such evaluations. Conclusions are that achieving such goals will take a sea change in how healthcare institutions and providers do their business, and that social activism at every level will be needed to effect these changes. The discussion highlights many ethical issues that need much greater attention.

Black or African American↗
PubMed2004

Public place restrictions on smoking in Canada: assessing the role of the state, media, science and public health advocacy.

While much is known about the impact of law and public policy, we know considerably less about their antecedents. Theories of policy adoption suggest that a variety of policy inputs help to shape legislative change. This research considers the enactment of municipal smoking bylaws in Canada between 1970 and 1995. The emergence of second-hand smoke (SHS) has been offered as a viable explanation for the increased enactment of local smoking restrictions. A number of indicators confirm the rising public health concern around SHS. Using Health Canada data on municipal smoking bylaw enactment in Canada, this paper employs an event history analysis to trace the role of four indicators of the increased recognition of SHS as a public health concern-scientific research, parliamentary debate, print media, and health advocacy. Findings indicate that the print media and health advocacy play the strongest role in explaining the increase in the adoption of municipal smoking bylaws in Canada. Results lend support to the quantitative study of the policy adoption process and to theories of policy making that consider multiple influences on policy adoption.

Canada↗
PubMed2004

Other people, other drugs: the policy response to petrol sniffing among indigenous Australians.

This paper examines the policy response of Australian governments to petrol sniffing in Indigenous communities from the 1980s until the present. During this period, despite the formation of numerous inquiries, working parties and intergovernmental committees, there has been little accumulation of knowledge about the nature and causes of sniffing, or about the effectiveness of interventions. Policies are fragmentary; programmes are rarely evaluated, and most rely on short-term funding. The paper sets out to explain why this should be so. It draws upon a conceptual framework known as 'analytics of government' to examine the ways in which petrol sniffing comes to the attention of government agencies and is perceived as an issue; the mechanisms deployed by governments to address petrol sniffing; ways in which knowledge about sniffing is generated; and the underlying assumptions about people that inform policy-making. Drawing upon case studies of policy responses, the paper argues that a number of structural factors combine to marginalize petrol sniffing as an issue, and to encourage reliance on short-term, one-off interventions in place of a sustained policy commitment. Four recommendations are advanced to help overcome these factors: (1) agreements should be reached within and between levels of government on steps to be taken to reduce risk factors before the eruption of petrol-sniffing crises; (2) the evidence base relevant to petrol sniffing (and other inhalants) should be improved by funding and directing one or more existing national drug research centres to collate data on inhalant-caused mortality and morbidity, and to conduct or commission research into prevalence patterns, effectiveness of interventions and other gaps in knowledge; (3) the current pattern of short-term, pilot and project funding should be replaced with longer-term, evidence-based interventions that address the multiple risk and protective factors present in communities; and (4) insistence by governments that communities must take 'ownership' of the problem should be replaced by a commitment to genuine partnerships involving governments, non-government and community sectors.

Australia↗
PubMed2005

Research influence on antimalarial drug policy change in Tanzania: case study of replacing chloroquine with sulfadoxine-pyrimethamine as the first-line drug.

INTRODUCTION: Research is an essential tool in facing the challenges of scaling up interventions and improving access to services. As in many other countries, the translation of research evidence into drug policy action in Tanzania is often constrained by poor communication between researchers and policy decision-makers, individual perceptions or attitudes towards the drug and hesitation by some policy decision-makers to approve change when they anticipate possible undesirable repercussions should the policy change as proposed. Internationally, literature on the role of researchers on national antimalarial drug policy change is limited. OBJECTIVES: To describe the (a) role of researchers in producing evidence that influenced the Tanzanian government replace chloroquine (CQ) with sulfadoxine-pyrimethamine (SP) as the first-line drug and the challenges faced in convincing policy-makers, general practitioners, pharmaceutical industry and the general public on the need for change (b) challenges ahead before a new drug combination treatment policy is introduced in Tanzania. METHODS: In-depth interviews were held with national-level policy-makers, malaria control programme managers, pharmaceutical officers, general medical practitioners, medical research library and publications officers, university academicians, heads of medical research institutions and district and regional medical officers. Additional data were obtained through a review of malaria drug policy documents and participant observations were also done. RESULTS: In year 2001, the Tanzanian Government officially changed its malaria treatment policy guidelines whereby CQ--the first-line drug for a long time was replaced with SP. This policy decision was supported by research evidence indicating parasite resistance to CQ and clinical CQ treatment failure rates to have reached intolerable levels as compared to SP and amodiaquine (AQ). Research also indicated that since SP was also facing rising resistance trend, the need for a more effective drug was indispensable but for an interim 5-10 year period it was justifiable to recommend SP that was relatively more cost-effective than CQ and AQ. The government launched the policy change considering that studies (ethically approved by the Ministry of Health) on therapeutic efficacy and cost-effectiveness of artemisinin drug combination therapies were underway. Nevertheless, the process of communicating research results and recommendations to policy-making authorities involved critical debates between policy makers and researchers, among the researchers themselves and between the researchers and general practitioners, the speculative media reports on SP side-effects and reservations by the general public concerning the rationale for policy change, when to change, and to which drug of choice. CONCLUSION: Changing national drug policy will remain a sensitive issue that cannot be done overnight. However, to ensure that research findings are recognised and the recommendations emanating from such findings are effectively utilized, a systematic involvement of all the key stakeholders (including policy-makers, drug manufacturers, media, practitioners and the general public) at all stages of research is crucial. It also matters how and when research information is communicated to the stakeholders. Professional organizations such as the East African Network on Malaria Treatment have potential to bring together malaria researchers, policy-makers and other stakeholders in the research-to-drug policy change interface.

Animals↗
PubMed2004

Equating student satisfaction measures.

Colleges and universities conduct student satisfaction studies for many important policy making reasons. However the differences in instrumentation and the use of students' self-reported ratings of satisfaction makes such decisions sample-, instrument-, and institution-dependent. A common metric of student satisfaction would assist decision makers by providing a richness of information not typically obtained. The present study investigated the extent to which two nationally known instruments of student satisfaction could be scaled on the same quantitative metric. Pseudo-common item equating (Fisher, 1997) based on five link items of low and high endorsability enabled comparisons of "similar, but not identical items, from different instruments, calibrated on different samples" (p. 87). Results suggest that both instruments measured similar constructs and could be reasonably used to create a single, common metric. While samples used in the experiment were less than ideal, results clearly demonstrated the usefulness and reasonability of the pseudo-common item equating process.

Adult↗
PubMedDate not supplied

An update on nursing involvement in hospital governance: 1990-1996.

The purpose of this study was to examine the nature and extent of nursing involvement in hospital governance in 1994; compare the 1994 level of involvement to 1990 levels; compare 1990 projections for 1995 to the actual state in 1994; and examine CNEs' projections of the nature and extent of involvement in 1996. The database compiled in the study and the author's earlier work (Havens, 1990, 1992) will assist in efforts to monitor nursing's status in hospital policy-making as monumental structural changes take place in health care organizations.

Decision Making, Organizational↗
PubMed1984

Altruism is not enough: barriers in the development of nursing as a profession.

This paper discusses the goals and strategies used by nurses to achieve professional status. It describes the several interest groups in nursing and identifies the plurality of their goals and the sometimes conflicting strategies used by them. The paper illustrates the constraints experienced by the Royal College of Nursing in policy making and proposes a pluralist structure as a basis for future planning.

Goals↗
PubMed1989

Hospital budgeting in Holland: aspects, trends and effects.

Global hospital budgeting was introduced in 1983 in Holland; it was expected to be a much more effective instrument to cost containment than classic retrospective output reimbursement. Several underlying assumptions of hospital budgeting are discussed: it will encourage hospitals to improve efficiency; it will have no negative impact upon the quality of health care; it restores hospital autonomy to some extent; hospital managers are capable to implement more efficiency. Attention is also paid to the design of external budgeting and its implications for the link between planning and budgeting as well as the relationship between hospitals and insurers. The second part deals with several effects of hospital budgeting. There are indications that hospital budgeting is effective from a cost containment perspective; it goes along with a decrease in hospital production; it also affects the organization and policy-making of hospitals as well as the public-private mix in health care. A general conclusion is that the effects of hospital budgeting far exceed the effects for cost containment.

Budgets↗
PubMed2006

Defining the spectrum of genome policy.

Many achievements in the genome sciences have been facilitated by policies that have prioritized genome research, secured funding and raised public and health-professional awareness. Such policies should address ethical, legal and social concerns, and are as important to the scientific and commercial development of the field as the science itself. On occasion, policy issues take precedence over science, particularly when impasses are encountered or when public health or money is at stake. Here we discuss the spectrum of current issues and debates in genome policy, and how to actively engage all affected stakeholders to promote effective policy making.

Advisory Committees↗
PubMed1992

Alcohol and fatal road accidents: estimates of risk in Australia 1983.

This paper concerns the statistical relationship between the risk of a fatality and the age and sobriety of drivers in New South Wales, Australia. The estimation of this relationship is based on fatal accident data from New South Wales and non-accident or control data from South Australia collected between the hours of 5.00 AM and 3.00 PM. The results are presented in new ways. In particular, tables of "accidents attributable to alcohol" and age specific intensity functions of "risk attributable to alcohol" may be an aid to policy making.

Accidents, Traffic↗
PubMed2006

Risks posed by climate change to the delivery of Water Framework Directive objectives in the UK.

The EU Water Framework Directive (WFD) is novel because it integrates water quality, water resources, physical habitat and, to some extent, flooding for all surface and groundwaters and takes forward river basin management. However, the WFD does not explicitly mention risks posed by climate change to the achievement of its environmental objectives. This is despite the fact that the time scale for the implementation process and achieving particular objectives extends into the 2020s, when climate models project changes in average temperature and precipitation. This paper begins by reviewing the latest UK climate change scenarios and the wider policy and science context of the WFD. We then examine the potential risks of climate change to key phases of the River Basin Management Process that underpin the WFD (such as characterisation of river basins and their water bodies, risk assessments to identify pressures and impacts, programmes of measures (POMs) options appraisal, monitoring and modelling, policy and management activities). Despite these risks the WFD could link new policy and participative mechanisms (being established for the River Basin Management Plans) to the emerging framework of national and regional climate change adaptation policy. The risks are identified with a view to informing policy opportunities, objective setting, adaptation strategies and the research agenda. Key knowledge gaps have already been identified during the implementation of the WFD, such as the links between hydromorphology and ecosystem status, but the overarching importance of linking climate change to these considerations needs to be highlighted. The next generation of (probabilistic) climate change scenarios will present new opportunities and challenges for risk analysis and policy-making.

Chemical Precipitation↗
PubMed2002

Governments, policy directions and the future of academic health sciences centres.

Governments and the policy-making bureaucracy are faced with all of the challenges currently facing academic health sciences centres (AHSC). Traditionally, AHSCs and their faculty partners were key players in the development of policies that defined the directions of the healthcare system. A better understanding of the determinants of health, demands for new community services and an inflexible workforce are forcing governments and policy-makers to re-evaluate the role and responsiveness of AHSCs as directions are set for the system of the future. AHSCs must engage policy-makers f they expect to continue as a major influence in the direction of a Canadian publicly funded health system.

Academic Medical Centers↗
PubMed2005

Back-to-the-future: a fresh policy initiative for fisheries and a restoration ecology for ocean ecosystems.

'Back-to-the-future' (BTF) is an integrative approach to a restoration ecology of the oceans that attempts to solve the fisheries crisis. To this end, it harnesses the latest understanding of ecosystem processes developments in whole ecosystem simulation modelling, and insight into the human dimension of fisheries management. BTF includes new methods for describing past ecosystems, designing fisheries that meet criteria for sustainability and responsibility, and evaluating the costs and benefits of fisheries in restored ecosystems. Evaluation of alternative policy choices, involving trade-offs between conservation and economic values, employs a range of economic, social and ecological measures. Automated searches maximize values of objective functions, and the methodology includes analyses of model parameter uncertainty. Participatory workshops attempt to maximize compliance by fostering a sense of ownership among all stakeholders. Some challenges that have still to be met include improving methods for quantitatively describing the past, reducing uncertainty in ecosystem simulation techniques and in making policy choices robust against climate change. Critical issues include whether past ecosystems make viable policy goals, and whether desirable goals may be reached from today's ecosystem. Examples from case studies in British Columbia, Newfoundland and elsewhere are presented.

Animals↗
PubMed1994

Relating health education research to health policy.

This paper argues that research in health education is being driven by a set of implicit values that emphasize formality, rigor and objectivity, and that relatively little attention is being paid to the ways in which research findings are subsequently used. A critique of a detached and formal research perspective is developed around the problems of 'pure' knowledge and the potential incompatibility between this and policy-making processes. In this light, it is suggested that the pursuit of academic research rigor at the expense of practical utility is hindering the development of a stronger research-policy link. The paper then goes on to suggest that in adopting a sharper political orientation, health education research could legitimately become less concerned with the restrictive nature of academic formalism with research. The nature of this type of research, the potential it has as well as its limitations are subsequently explored.

Health Education↗
PubMedDate not supplied

The role of health services research in developing state health policy.

As their responsibility for health policy making grows, states are pursuing a variety of strategies for getting the research and analytical assistance they need, including expanding their relationships with university-based health services research and policy analysis programs. These collaborations raise a number of questions about the fit between states' analytic needs and universities' interest and capacity, and about the appropriate role of the university research organization in the often highly politicized state environment. This paper discusses these questions in light of case studies of universities involved in state health policy in five states: Maryland, Minnesota, North Carolina, Washington, and Wisconsin.

Health Planning Technical Assistance↗