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PubMed2001

A policy analysis of the introduction and dissemination of external peer review (visitatie) as a means of professional self-regulation amongst medical specialists in The Netherlands in the period 1985-2000.

By examining the introduction and dissemination of external peer review through site-visits (visitatie) amongst Dutch medical specialists, this paper sets out to deepen our insight into the dynamics of professional self-regulation and health care policy making. We explore how visitatie has been used in the political process between medical specialists and the state, serving as a strategy in protecting the autonomy of physicians. In the late eighties and early nineties, factors both internal as well as external to the medical profession all together determined the start and spread of visitatie. The conflict between state and doctors over the specialists' income, the introduction of the market oriented policies, new visions on quality assurance, the debate on the future of medical specialistic care and a new legal framework on quality assurance, challenged the medical community to find ways to reconfirm the public's trust in the self-regulating mechanism of the profession. One answer is found in carrying out 300-400 visitaties annually. During the past years, many stakeholders have perceived visitatie as a credible instrument in assuring quality patient care. The dynamics of professionalization and measurable impact of visitatie will determine whether or not it is here to stay.

Health Services Research↗
PubMed1995

Developing indicators for environment and health.

This article demonstrates the need for indicators in the policy-making process and presents some of the current work on developing environmental indicators at the international, national and local levels. The paucity of indicators to demonstrate relationships between environment and health is outlined and a causal chain for physical pollutants--from source activity to emission, concentration and exposure--is presented. While indicators can be developed at each of these stages, indicators from earlier in the chain reflect processes which can more readily be controlled by policy; data is also more readily available for these indicators, yet only the later indicators are likely to provide a reliable guide to human exposure. A survey of 26 indicator projects from around the world yielded 8 sets which are in use and for which data exists. These were found to be only partially health-related and heavily weighted towards the source activity indicator category. Their utility as reliable indicators of human exposure is therefore seriously open to doubt and there is consequently a need to develop indicators specifically to assess environmental and health relationships.

Bias↗
PubMed2004

The science of politics/the politics of science: examining the snowmobile controversy in Yellowstone National Park.

The snowmobile controversy in Yellowstone National Park not only pits snowmobilers against environmentalists, but it also pits the Bush Administration against the Clinton Administration. Caught in the middle are the National Park Service, scores of natural and social scientists, and Yellowstone's permanent residents-the flora and fauna. The controversy's political aspects are the focus of this paper; specifically, the tenuous relationship among research scientists, whose job it is to inform management and policy decisions; politicians, whose job it is to formulate those same decisions in the public arena; and public land management agencies, whose job it is to implement the decisions. The crux of the paper concerns the politicization of natural resource policy and ways in which research scientists tend to get caught up in it. Lessons learned from this Yellowstone episode regarding the role of science in policy-making processes are also considered. Two recent federal court rulings shed additional light on the politics surrounding Yellowstone's snowmobile controversy, as does the importance of governmental checks and balances in resolving natural resource management disputes.

Conservation of Natural Resources↗
PubMed2004

Unhealthy landscapes: Policy recommendations on land use change and infectious disease emergence.

Anthropogenic land use changes drive a range of infectious disease outbreaks and emergence events and modify the transmission of endemic infections. These drivers include agricultural encroachment, deforestation, road construction, dam building, irrigation, wetland modification, mining, the concentration or expansion of urban environments, coastal zone degradation, and other activities. These changes in turn cause a cascade of factors that exacerbate infectious disease emergence, such as forest fragmentation, disease introduction, pollution, poverty, and human migration. The Working Group on Land Use Change and Disease Emergence grew out of a special colloquium that convened international experts in infectious diseases, ecology, and environmental health to assess the current state of knowledge and to develop recommendations for addressing these environmental health challenges. The group established a systems model approach and priority lists of infectious diseases affected by ecologic degradation. Policy-relevant levels of the model include specific health risk factors, landscape or habitat change, and institutional (economic and behavioral) levels. The group recommended creating Centers of Excellence in Ecology and Health Research and Training, based at regional universities and/or research institutes with close links to the surrounding communities. The centers' objectives would be 3-fold: a) to provide information to local communities about the links between environmental change and public health; b) to facilitate fully interdisciplinary research from a variety of natural, social, and health sciences and train professionals who can conduct interdisciplinary research; and c) to engage in science-based communication and assessment for policy making toward sustainable health and ecosystems.

Agriculture↗
PubMed1999

Identifying insanity acquittals: is it any easier?

Following the highly publicized insanity acquittal of John Hinckley in 1982, legislators throughout the country attempted to reform the insanity defense. At the time, policy makers had virtually no empirical evidence with which to guide their reforms. The focus of this research is to determine if more informed policy-making would be possible today? Results show that more states are able to identify cases involving an insanity acquittal than during the 1980's and provide annual data on the number of rate of insanity acquittals. The data collected by many of the states have significant limitation.

Data Collection↗
PubMed1986

Health policy opinions of graduate students in nursing.

Post-graduate students in a School of Nursing whose curriculum represents a broad view of the problems and improvement strategies of contemporary health were surveyed on issues in health policy at the beginning of their study and two years later. They formed one group in a survey of the training programs of 12 health professions; this was part of a project surveying leadership of the major organizations active in health policy-making in the United States. Nursing students moved significantly toward more progressive positions on all categories of issues. At the end of two years of graduate study, student opinions were consistent with the leadership of the nursing profession.

Attitude of Health Personnel↗
PubMed2000

Epidemiology of participation: an Australian community study.

STUDY OBJECTIVE: To determine the levels of participation in social and civic community life in a metropolitan region, and to assess differential levels of participation according to demographic, socioeconomic and health status. To contribute to policy debates on community participation, social capital and health using these empirical data. DESIGN: Cross sectional, postal, self completed survey on health and participation. SETTING: Random sample of the population from the western suburbs of Adelaide, the capital city of South Australia, a population of approximately 210 000. PARTICIPANTS: 2542 respondents from a sample of 4000 people aged 18 years and over who were registered on the electoral roll. MAIN RESULTS: The response rate to the survey was 63.6% (n=2542). Six indices of participation, on range of social and civic activities, with a number of items in each, were created. Levels of participation were highest in the informal social activities index (46.7-83.7% for individual items), and lowest in the index of civic activities of a collective nature (2.4-5.9% for individual items). Low levels of involvement in social and civic activities were reported more frequently by people of low income and low education levels. CONCLUSIONS: Levels of participation in social and civic community life in an urban setting are significantly influenced by individual socioeconomic status, health and other demographic characteristics. An understanding of the pattern of participation is important to inform social and health policy making. Increasing levels of participation will reduce social exclusion and is likely to improve the overall quality of community life.

Adolescent↗
PubMed1988

Alternative health care delivery systems--nursing opportunity or threat?

Alternative health care systems, organizationally and financially, pose a potential threat to the growth of autonomous nursing practice. Support of a system of health care delivery that retains the physician as sole "primary provider" restricts direct access to professional nursing services. Nurses must take the responsibility for becoming knowledgeable about health policy-making in order to assure that their services remain available to all consumers who seek them. This article presents an overview of the current alternative health care systems, and suggests strategies to assure that nursing does not remain in a dependent position in the hierarchy of health care.

Delivery of Health Care↗
PubMed1997

Overdose among youth in Bahrain: psycho-social characteristics, contact with helping agencies and problems.

A one year cohort of 67 overdose attempts among youth (15-24 years) was examined as part of a case control study. The prevalence rate of 105 per 100,000 population is lower than reported rates in the West but higher than those for the region. The majority of attempters were females and nationals who used paracetamol, and their suicide intent was low. Thirteen percent visited a helping agency in the previous week and 18% in the previous month. The most common difficulties preceding the overdoses were problems with parents, school or work, social isolation and problems with boyfriends, or girlfriends respectively. Adjustment disorder was the most common diagnosis followed by depression. A seasonal variation was noted with 46% of the cases occurring in the summer months. The implications of these findings with respect to future policy making and prevention were discussed.

Acetaminophen↗
PubMed1999

Racial bias in federal nutrition policy, Part I: The public health implications of variations in lactase persistence.

The Dietary Guidelines for Americans from the basis for all federal nutrition programs and incorporate the Food Guide Pyramid, a tool to educate consumers on putting the Guidelines into practice. The Pyramid recommends two to three daily servings of dairy products. However, research has shown that lactase nonpersistence, the loss of enzymes that digest the milk sugar lactose, occurs in a majority of African-, Asian-, Hispanic-, and Native-American individuals. Whites are less likely to develop lactase nonpersistence and less likely to have symptoms when it does occur. Calcium is available in other foods that do not contain lactose. Osteoporosis is less common among African Americans and Mexican Americans than among whites, and there is little evidence that dairy products have an effect on osteoporosis among racial minorities. Evidence suggests that a modification of federal nutrition policies, making dairy-product use optional in light of other calcium sources, may be a helpful public health measure.

Adolescent↗
PubMed1999

The impact of teaching status on average costs in Spanish hospitals.

In this paper, the observed systematic differences in costs for teaching hospitals (TH) in Spain are examined. Concern has been voiced regarding the existence of a bias in the financing of TH once prospective budgets are introduced for hospital finance. Claims for adjustment to take into account the 'legitimate' extra costs of teaching on hospital expenditure may be well grounded. Focus is on the estimation of the impact of teaching status on average cost, using a version of a multi-product hospital cost function, taking into account some relevant factors from which to derive the observed differences. It is assumed that the relationship between the explanatory and the dependent variables follows a flexible form for each of the explanatory variables. Also, the underlying covariance structure of the data is modelled. Two qualitatively different sources of variation are assumed: random effects and serial correlation. Random variation refers to both general level variation (through the random intercept) and the variation specifically related to teaching status. It is postulated that the impact of the random effects is dominant over the impact of the serial correlation effects. The model is estimated by restricted maximum likelihood. The results show that costs are 9% higher (15% in the case of median costs) in teaching than in non-teaching hospitals. That is, teaching status legitimately explains no more than half of the observed difference in actual costs. The impact on costs of the teaching factor depends on the number of residents, with an increase of 51.11% per resident for hospitals with fewer than 204 residents (third quartile of the number of residents) and 41.84% for hospitals with more than 204 residents. In addition, the estimated dispersion is higher among teaching hospitals. As a result, due to the considerable observed heterogeneity, results should be interpreted with caution. From a policy making point of view, it is concluded that since a higher relative burden for medical training falls on public hospitals, an explicit adjustment for the extra costs that the teaching factor imposes on hospital finance is needed, before hospital competition for inpatient services takes place.

Education, Medical, Graduate↗
PubMed1991

P & T Committee rises to challenges of the changing healthcare environment.

The ever-increasing importance of the P & T Committee is well illustrated in this exclusive interview with members of a committee from a leading academic, private-practice, health-science center--Rush-Presbyterian-St. Luke's Medical Center. The participants detail the progress achieved in P & T Committee policy making, particularly in recent years. Unprecedented change in the healthcare environment has demanded a more aggressive P & T Committee, and theirs has responded appropriately. Because the medical staff at Rush constitute a unique blend of academicians and private practitioners, the mechanics of their decision making tends to be consensus-related, while the implementation of those decisions is education-oriented. Other P & T Committees can learn from their political and professional strategies in the management of drug therapy.

Chicago↗
PubMed2000

Representation: a call to action for allied health professionals.

The Coalition of Allied Health Leadership (CAHL) Representation Project committee examined the representation of allied health professionals in political and other policy-making groups and found it both fragmented and lacking. The benefits to individuals participating in such groups, as well as to the allied health profession as a whole and to the groups themselves, are described. Individuals are urged to participate, and the means to do so are presented.

Allied Health Personnel↗
PubMedDate not supplied

Cost-effectiveness in surgery. The insurers' point of view.

Cost-effectiveness in surgery is only one example of a global health care policy by the Belgian social insurers aiming at optimal price-quality ratios for the offered care provision and within budgetary constraints. As a main partner in health care management the insurers' decision is guided by socio-economical evaluation of medical technology and care. This evaluation distinguishes respectively cost-benefit (CBA), cost-effectiveness (CEA) and cost-utility (CUA) analyses. In surgery the principles of cost-effective management are illustrated with examples for minor surgery in general practice, one day clinic, tympanostomy tube placement for recurrent otitis media, and laparoscopic vs. laparotomic cholecystectomy. Even if we need economic evaluation for policy making it can only be one instrument for making choices in the increasingly complex and expensive health care sector. To maintain the access, the quality and the actually fair cost-level in Belgium's compulsory health insurance system there is need for standardized indications, clinical guidelines, outcome evaluation and quality assurance by credentialing of providers and service centers.

Belgium↗
PubMed1998

A survey of mental health consumers' and family members' involvement in advocacy.

As the service delivery system is redesigned, the involvement of consumers and family members in mental health policy-making is essential. Advocacy is a way for them to have an impact on policy or decision-making. To determine the extent of their participation in advocacy efforts, consumers and family members were surveyed by other consumers and family members about their involvement in advocacy and mental healthcare reform. Although more family than consumers reported receiving mental healthcare reform information, both groups had difficulty understanding this information. Consumers were more likely to have received information from a mental health professional while family were more likely to have received information from an advocacy group. Lack of economic resources and communication problems were the most often cited barriers to advocacy for consumers. Strategies are suggested for how to increase involvement of consumers and family in advocacy efforts. The limitations of conducting a state-wide study with consumers and family as data collectors is discussed.

Adult↗
PubMed2002

The politics of discretionary Medicaid spending, 1980-1993.

Why do some states choose to spend more than four times as much as others to provide health care to the disadvantaged? Political scientists who have traditionally explored this question by analyzing trends in overall Medicaid expenditures lumped states' discretionary spending in with other money that states are mandated to spend. Analyses of total expenditures found that socioeconomic factors drove spending but that party control of state legislatures made no difference in health policy making. By isolating discretionary state Medicaid expenditures from total spending figures, I reexamine the influences of political as well as economic and demographic factors. The often-doubted importance of party control becomes clear. This study investigates spending patterns in the discretionary portions of state Medicaid programs in forty-six states from 1980 to 1993 and analyzes both incremental program changes and absolute differences in state spending. To discover how greatly the researcher's choice of dependent variables can affect results, optional spending is separated from total spending levels and the variation is modeled in both. Focusing not on the spending that the federal government requires of state officials but on the policies that state officials actually choose allows a balanced exploration of both political and economic effects on welfare expenditures. This research also provides new insights about which forces will shape policy decisions if more and more control of the public health care system is devolved to the states.

Aid to Families with Dependent Children↗
PubMed1996

The balance of prevention, investigation, and treatment in the management of child protection services.

The planning, development, and review of child protection services and policies (management) is vitally important and yet to date has received very little consideration. This paper explores the balance between three components of child protection policy: prevention, investigation, and treatment. As part of a review of the management of child protection services in Wales, the authors examined the effectiveness of Area Child Protection Committees (ACPCs), which are multidisciplinary forums responsible for the local provision of child protection services. Thirty-eight (of 171) representatives were interviewed. The balance of the three components (prevention, investigation, and treatment) in policy making was explored. Overall, there was a substantial emphasis on investigation procedures, with very little consideration of prevention strategies, and treatment services virtually ignored. Treatment was described as a "gap" in the service consideration of ACPCs. The authors consider ways to shift the balance so that treatment and prevention services can be given more priority within a comprehensive child protection service.

Child↗
PubMed1998

Sailing without radar: an excursion in resource allocation.

This paper deals with the knowledge base employed in resource allocation. It deliberately distinguishes between 'thick-textured' and 'thin-textured' knowledge. A thick-textured view of change in the health sector accounts for the history, civic goods and variety of human needs and passions which rationalist economics defines out as a thin-textured matter of individual choices in a free market. The narrative material begins with a discussion of health service policy-making in South Australia and elsewhere in the 1980s and 1990s, then proceeds to a discussion of priority-setting literature, which we regard as thin-textured. We offer two accounts of approaches to setting priorities in health care which we think have overcome some of the deficiencies of the thin-textured approach.

Community Participation↗