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This paper presents suggestions for a model master's level course in public policy and aging. Course content should focus on the historical context of aging policy development, the policy making process, and the legislative history and current content of specific aging policies. Suggestions for teaching resources and class assignments are included.
This work is a synthesis of an investigation into the political economics of HIV/AIDS in Mexico within the context of globalization. It is based on a distinction between what is defined as neo-liberal globalism (an ideological and overwhelmingly economic agenda) and globalization (a worldwide, multidimensional phenomenon). The core argument is that the existence of real alternatives to the neo-liberal paradigm results from a series of political, economic and social circumstances which are very real in Mexico today in the context of globalization, which have given rise to a rather more inclusive policy-making process. Special emphasis is given to the contrast between exclusive public policy systems, such as those seen in the process of structural economic reforms or the re-structuring of the financing of healthcare systems, and public policy systems which work with HIV/AIDS, which tend to be more inclusive and democratic. Both types of system operate in Mexico and in other parts of the world.
OBJECTIVE: To analyse structural factors revealed by politicians that shaped legislation on tobacco control in New South Wales, 1955-95. METHODS: Parliamentary debates and other records were collected. Open-ended interviews were conducted with 17 Members of Parliament (MPs) who were significantly involved, and then analysed for structural elements. RESULTS: Tobacco industry lobbying had a significant but limited influence on policy making, being exerted largely through social interactions with executives and based on concerns about the economic impact on third parties. MPs saw health advocates' chief functions as (1) generating community concern about the issue and support for control measures, and (2) bringing any new information to political attention, providing pro-control arguments and data through the media. Factors that delayed tobacco control policies included: the conservative stance of Premiers and major parties, commitments to unanimous federal action, and rivalry between parties. Factors that facilitated control policies included: reforms that gave the Legislative Council increased power, the use of parliamentary committees, and backbencher and grass roots support. CONCLUSIONS: Tobacco control policy and legislation has been the product of political structures that gave power to those MPs in the least powerful positions--minor parties, Members of the Legislative Council (MLCs), backbenchers, women and party rank and file--rather than to major parties and their executives. IMPLICATIONS: Advocates should make the most of their access points to the political process, providing information, arguments and support and demonstrating public opinion in favour of further control.
This paper (a) provides a methodological taxonomy of pricing, financing, reimbursement, and cost containment methodologies for pharmaceuticals; (b) analyzes complex agency relationships and the health versus industrial policy tradeoff; (c) pinpoints financing measures to balance safety and effectiveness of medicines and their affordability by publicly funded systems in transition; and (d) highlights viable options for policy-makers for the financing of pharmaceuticals in transition. Three categories of measures and their implications for pharmaceutical policy cost containing are analyzed: supply-side measures, targeting manufacturers, proxy demand-side measures, targeting physicians and pharmacists, and demand-side measures, targeting patients. In pursuing supply side measures, we explore free pricing for pharmaceuticals, direct price controls, cost-plus and cost pricing, average pricing and international price comparisons, profit control, reference pricing, the introduction of a fourth hurdle, positive and negative lists, and other price control measures. The analysis of proxy-demand measures includes budgets for physicians, generic policies, practice guidelines, monitoring the authorizing behavior of physicians, and disease management schemes. Demand-side measures explore the effectiveness of patient co-payments, the impact of allowing products over-the-counter and health promotion programs. Global policies should operate simultaneously on the supply, the proxy demand, and the demand-side. Policy-making needs to have a continuous long-term planning. The importation of policies into transition economy may require extensive and expensive adaptation, and/or lead to sub-optimal policy outcomes.
CONTEXT: Health services policies in the UK have traditionally been developed as a 'one size fits all' approach usually based on urban models. This approach can be problematic for primary care agencies involved in the delivery of services in rural and remote areas, due to difficulties with access and also the differences in the nature of urban and rural communities. The Countryside Agency in England has developed a rural proofing framework which will assess the impact that new policies may have in rural areas. This process is currently being applied across all government departments. This article sets out the context of the National Health Service (NHS) in the UK and describes the process of Rural Proofing for Health and how it can be used to improve equity of access to care for people living in rural and remote communities in Britain and across the international healthcare community. ISSUES: There has been a considerable increase in investment in the NHS in recent years with consequent improvements such as reductions in waiting times for treatment. Despite tangible improvements there are still inequalities in health and inequities in healthcare provision, which include parts of the population who live in rural areas. The Rural Proofing for Health project has been developed and carried out by the Institute of Rural Health as a methodology to help Primary Care Organisations implement policies and methods of service delivery that take into account the needs of people living in rural and remote areas. A toolkit has been developed that adopts a solutions-based approach to healthcare delivery in rural areas and which will help people living in rural areas to have equity of access to care with their counterparts living in urban Britain. Rural proofing policies before implementation ensures that the possible impacts of the policy are measured and so that adjustments can be made to ensure that the service will be appropriate for rural communities, and that it can be delivered effectively and efficiently in a rural context. LESSONS: It is important that development of new healthcare policies includes a process that ensures such policies are rurally sensitive. Involving stakeholders at a strategic level ensures that the initiative becomes embedded into policy-making within each department. Rural proofing is a systematic methodology that will help policy makers take account of health needs in rural areas and will hold public bodies accountable to their rural communities.
As the federal government, accrediting agencies, and board-certifying organizations pay closer attention to hospitals' handling of ethical issues, the need increases for trained medical ethicists. The role of such persons should be one of an inside aide, not an outside expert. Although persons from disciplines other than medicine may have differing ideas about life-and-death issues, their perspectives can be of great help to physicians. The more medicine grapples with complex ethical issues, the greater the need for interdisciplinary cooperation. The kind of strategy most appropriate for the institutional ethicist's work is not one of abstract philosophizing but rather one that focuses on concrete cases and the development of decision-making strategies. If ethicists help physicians develop the conceptual tools to think through practical cases, then physicians will be better equipped to make defensible ethical decisions. In addition to providing consultive services, staff ethicists could serve on policy-making committees. They also could help physicians and nurses explain to patients' families the reasons for certain decisions or policies.
While it is commonly accepted that the broader political and economic climate directly influences the nature of any major changes in the provision of health care (witness the 1991 National Health Service reforms in the United Kingdom), there is less consideration of the effect of paradigm changes in health care and health care management themselves on wider political and ideological strategies. This article examines the recent health policy initiatives presented by Britain's Labour Party. The author argues that while the Conservatives' market-oriented reforms reflected the perceived political and economic realities of the 1980s, the rapidly increasing credibility of strategies of prevention within the health care sector (including an emphasis on the social determinants of ill-health, the need to plan a shift from acute to community care, and the desire for greater lay participation in policy-making) allows Labour to highlight the limitations of a strongly market-oriented system in the health care sector more so than in any other policy area.
BACKGROUND: The 50th anniversary of CCA in 2006 prompted analysis of the most highly cited articles from the Journal's history. METHODS: Lists of most highly cited CCA articles were obtained from Current Contents (1974, 1991) and CCA (2006); all based on the ISI/Thomson Scientific database. PubMed search identified country of origin. RESULTS: Distribution of the most highly cited CCA articles was skewed towards those with high total citations. From the beginning, these articles originated from a diverse group of countries. This diversity increased with time to include countries from 4 continents. The most highly cited articles emerged at least 8-16 years following their publication. During the first 35 years of the Journal, there was a significant positive correlation between the total number of citations and the publication date of cited articles. Initially, virtually all most highly cited articles were methods papers, whereas during the past 25 years less than half of them reported methods; clinical research papers and reviews making up the rest. CONCLUSIONS: Results of this analysis may help in editorial policy-making and marketing of the Journal and in assessing the impact of individual countries on the field, and may guide authors' decision in submitting articles to the Journal.
In this presentation, a brief review of tobacco control policies that are effective in decreasing tobacco use prevalence and consumption is provided, and the role of policies affecting tobacco cessation is discussed. An overview of existing coverage for cessation under different health insurance policies and a discussion of the implications that these policies have for nursing practice and research are also provided. Then, the need for nurses' knowledge of and involvement in tobacco control policy making is discussed. Finally, questions on how nursing research in the area of cessation policy development and evaluation can improve access to cessation services to a larger number of tobacco users in the population are considered.
This article describes one effort to help prevent violence against women by addressing some of the larger societal factors involved. The Dangerous Promises campaign is based on the premise that sexist advertising images contribute to an environment conducive to violence against women. The goal of the campaign is to convince alcohol companies to eliminate sexist alcohol advertising and promotions. Using the tools of community organizing and media advocacy, the campaign pressures the alcohol industry to change the ways in which they portray women in much of their advertising. Media advocacy has been instrumental in the successes of the campaign. This article examines the strategies and outcomes of the Dangerous Promises efforts to date and makes a case for application of media advocacy as a tool for increasing community voice in policy-making processes.
User charges are the major source of finance for many health care systems. However, traditional approaches to health care priority setting, such as cost-effectiveness analysis, usually assume there are no user charges and therefore may ignore important implications for equity and efficiency. This paper therefore develops a rudimentary model of priority setting in which the fixed health care budget can be augmented by user charges. The paper uses methods analogous to models of optimal commodity taxation to develop a set of rules for the inclusion of a health technology in the subsidized health care package, and the calculation of its associated copayment rate. The results indicate that optimal levels of subsidy depend on the cost-effectiveness of the intervention, its price elasticity of demand, the epidemiology of the associated disease, and the policy maker's attitude towards equity. The model has important implications for policy making in three domains: health care priority setting, evaluation of health care technologies, and charging policy.
The present paper addresses the emergence and development of Nordic food and nutrition policies, with some reference to the types of nutrition policies characteristic of other North European countries. Nutrition programmes aimed at dietary change have a long history of public responsibility in several Nordic and North European countries. The extent of involvement, the orientation and (indication of) success have, however, varied considerably between countries. First, different types of policies are characterised by their choice of programmes and measures, e.g. information campaigns v. market regulation or catering and public services. Second, the distinctions are associated not only with programmes, but also with the status and validity of nutritional advice and dietary guidelines in public policy making. Third, when focusing on how and on what grounds the governments have developed nutrition policies, it is evident that while more or less the same participants and issues are involved, their roles and relationships may be different. In this case the role and involvement of nutritional expertise and scientific arguments in various countries will be discussed. Finally, nutrition policies may entail conflicts of interest, particularly when health concerns are confronted with food industry and agricultural interests. This situation is quite evident in the question of animal fat. The present paper addresses how these issues have been dealt with quite differently in various countries.
Critical issues facing the development of telemedicine today are described and analyzed as dilemmas or paradoxes. The technological dilemma involves the difficult choice between using the latest technology regardless of how well it fits specific needs on the one hand, and the reluctance to capitalize on the available technological capability to create efficient and effective organizations for expanding the reach of health care on the other hand. The evaluation paradox points to the disjuncture between policy making requirements and the scientific enterprise. This engenders the difficulty of producing scientifically valid and policy relevant results from programs that have not achieved maturity or a steady state of operation. The contextual hazards of limiting the scope of telemedicine to rural areas are discussed, as well as the potential for creating a second tier of care for the remote and isolated populations. Finally, professional maturation is addressed as it underscores the importance of self regulation and control.
Legislation and regulation of biomedical research is seldom a one-off process since biomedical science evolves rapidly, dynamically and often unpredictably. This paper discusses the challenges faced by regulators who need to produce legislation and policy in rapidly changing fields and outlines some practical suggestions for managing law reform and policy-making under these circumstances.
Given alarming fiscal imperatives, states and interests in all advanced industrial democracies have struggled over health care policy. I explore the interface between state autonomy in health care policy and the political mobilization of provider interests, especially physicians. Evidence from Germany, Japan, Canada, and Great Britain suggests that, longitudinally, policy makers everywhere have tried to increase state autonomy in health care, and this has generally triumphed over even effectively mobilized providers. The countries that have most successfully restrained the growth of health care expenditures--while still providing ready access to relatively high-quality care--are those where states have most actively restrained both demand- and supply-side system interests in policy making. In each country, states have increasingly articulated their own greater capacities in health care policy, pushed to do so by the imperatives, especially fiscal, embedded in the policy domain.
A recent report of the Senate revealed the difficulties of elaborating an effective cancer policy in France. Senators particularly pointed to the necessity of establishing cancer care priorities and to the tremendous need for medical coordination. This paper will develop the annual state debate on social security funding. The authors will show that health policy is entirely dependent on health economics. We believe that health priorities and health outcomes should be defined before any financial decision is made, this preliminary debate being an essential contribution to evidence-based policy-making in public health.
The literature has only begun to consider what research is needed to support the development and implementation of healthy public policy initiatives. To date, a consistent methodological approach is recommended: multiple methods (document analysis and key informant interviews supplemented by quantitative data) with an aim toward understanding the perspective of key policy stakeholders. Currently, these methods are not the mainstay of policy analysis which is often driven more by a preference for technique (e.g., cost-benefit analysis) than by underlying epistemology or theory. Yet the explicit values of healthy public policy (intersectoral policy-making, public participation, etc.) suggest the importance of paying greater attention to epistemological and theoretical principles when making methodological choices.
Studies of risk perception examine the judgements people make when they are asked to characterize and evaluate hazardous activities and technologies. This research aims to aid risk analysis and policy-making by providing a basis for understanding and anticipating public responses to hazards and improving the communication of risk information among lay people, technical experts, and decision-makers. This work assumes that those who promote and regulate health and safety need to understand how people think about and respond to risk. Without such understanding, well-intended policies may be ineffective.