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[Korea's health care policy of the twentieth century].

This article analyzes the social transformation of Korea's health care policy in the twentieth century from a historical perspective. The whole period under the research is divided into four stages. In the first stage (1900 - 1945), two major health care policies, public hygiene and population control, were a part of political strategy for consolidating Japanese colonial dominion over Korea. The second stage (1945 - 1960) is characterized by the division of Korean peninsula and Korean war that resulted in the vicious cycle between massive poverty and social disease. In the third stage (1961 - 1991), military governments considered the health care system as a 'carrot' for enhancing national security and reinforcing legitimacy of the regime. In the final stage (1992 - 1999), the state and civil society have been influential agents in shaping forms and contents of health care policy, with the organized medicine relatively neglected. Globalization will have more influence on the arena of health care policy in which three grants would have to negotiate one another. In addition, the organized medicine will have to consider a variety of non-governmental organizations (NGOs) as an inevitable counterpart of policy-making process in harmonizing the conflicts between public deliberation and professional interests. In the next century, health care policy, along with social welfare, environment and labor policy agendas would constitute a health-related policy regime in which all the participants have to accomplish not medicalization of life but socialization of health care and to diminish the inequity in health among a variety of social class.

Health Policy↗

Leadership through policy research.

There are many ways of providing leadership, but one of the most important is through the guidance and direction provided for initiating new, improved healthcare policies. Nurses at the executive level--whether in primary, secondary, or tertiary agencies--are in an ideal position to have an impact on decisions about who should receive healthcare services, the nature of the services, and the design of the organizational structures to deliver them. A great deal has been written about nurses' participation in policy making, but there has been little attention to an extremely important mechanism for improving national and community healthcare: policy research. In this article, the authors provide an overview of the purposes and methods of policy research and discuss its inclusion in service and academic programs.

Education, Nursing↗

Control, participation, and the British National Health Service.

The experience of Britain's National Health Service since 1948 suggests that there is a conflict between different social values and policy aims, and that progress toward achieving more community or worker control is constrained by the pursuit of other desired objectives. The egalitarian ideology of the NHS emphasizes central control to achieve a nationally equitable distribution of resources. Emphasis on coordination between the NHS and other social services limits freedom of action. Democracy as accountable policy-making on a national scale may therefore be incompatible with democracy as direct control, whether by community or workers. To encourage participation means accepting diversity in the provision of health care and the multiplication of small, self-governing units. Similarly, worker control is professional autonomy writ large and may therefore conflict with community control.

Community Health Services↗

Science, policy, and the protection of human health: a European perspective.

Much emphasis is currently given to the question of how available scientific information should be used to inform and support the development of public policy. The interface between the scientific community and policy-makers poses several challenges. In order to overcome the difficulties due to differences of values, language, and purposes, it is important to formulate workable questions and achievable objectives. Effective and ethical use of scientific evidence is desirable, but the complex social and cultural context where decisions are made in modern society must be taken into consideration. A marked trend in European policy-making in environment and health has taken place in the last two decades: besides specific hazardous agents and exposures, the health implications of broad, upstream determinants such as sectoral policies are attracting growing attention. Consequently, essential tools to support rational decision-making, such as risk assessment, need to be supplemented by tools capable of dealing with the additional complexity and uncertainty. Indications and guidance on how to take forward the agenda for action in environment and health in Europe have been made by the series of Ministerial Conferences on Environment and Health, where the 52 Member States of the Regional Office for Europe of the World Health Organization set the priorities and identify common grounds to improve human health and pursue sustainability.

Electromagnetic Fields↗

Development of Environmental Indicator Systems: Experiences from Germany.

ABSTACT / Environmental indicator systems aim to improve both the information and communication on the state of the environment and the environmental policy making. They have to fulfill scientific, functional and pragmatic requirements, e.g., consideration of ecological context, transparency and reproducibility, comprehensibility, policy relevance, international comparability, and justifiable expenditure. This paper analyzes the experiences made with the development of the German environmental indicator system and draws general conclusions toward further improvements. For Germany, an indicator system has been developed that uses the pressure-state-response approach proposed by the OECD, together with a classification in 14 environmental themes. According to the general requirements, the main criteria used for selecting the indicators are the ecological significance of the indicator, its quantifiability and data availability, and its comprehensibility and policy relevance. Altogether, about 140 indicators are selected. This high number stresses the need for further high-level aggregation, e.g., using methods developed for the valuation process in LCA. Further improvement is also needed, especially for the development of response indicators and in the area of data systematization.

Journal Article↗

A fuzzy logic approach toward solving the analytic enigma of health system financing.

Improved health, equity, macroeconomic efficiency, efficient provision of care, and client satisfaction are the common goals of any health system. The relative significance of these goals varies, however, across nations, communities and with time. As for health care finance, the attainment of these goals under varying circumstances involves alternative policy options for each of the following elements: sources of finance, allocation of finance, payment to providers, and public-private mix. The intricate set of multiple goals, elements and policy options defies human reasoning, and, hence, hinders effective policymaking. Indeed, "health system finance" is not amenable to a clear set of structural relationships. Neither is there a universe that can be subject to statistical scrutiny: each health system is unique. "Fuzzy logic" models human reasoning by managing "expert knowledge" close to the way it is handled by human language. It is used here for guiding policy making by a systematic analysis of health system finance. Assuming equal welfare weights for alternative goals and mutually exclusive policy options under each health-financing element, the exploratory model we present here suggests that a German-type health system is best. Other solutions depend on the welfare weights for system goals and mixes of policy options.

Journal Article↗

Global health priorities - priorities of the wealthy?

Health has gained importance on the global agenda. It has become recognized in forums where it was once not addressed. In this article three issues are considered: global health policy actors, global health priorities and the means of addressing the identified health priorities. I argue that the arenas for global health policy-making have shifted from the public spheres towards arenas that include the transnational for-profit sector. Global health policy has become increasingly fragmented and verticalized. Infectious diseases have gained ground as global health priorities, while non-communicable diseases and the broader issues of health systems development have been neglected. Approaches to tackling the health problems are increasingly influenced by trade and industrial interests with the emphasis on technological solutions.

Journal Article↗

Politically connected: increasing the political competency of healthcare executives in health policy.

In this article we provide a teaching frame of reference for healthcare management students, to more effectively engage in the health policy-making process. We show how future executives can direct or transfer their management skills and abilities to the health policy arena. In doing so, healthcare executives attain a proactive stance in the political process, which is essential to the overall strategic management of healthcare organizations. Using organization theory as a pedagogical tool, we outline the similarities and differences in the management of hospitals versus state legislatures. We identify areas of common ground, and suggest components to frame political advocacy strategy for healthcare executives that strengthen their political competency. Thus, the article provides a teaching framework for health services management students about key intersections between management and policymaking.

Health Facility Administrators↗

A brief history of decision making.

Sometime around the middle of the past century, telephone executive Chester Barnard imported the term decision making from public administration into the business world. There it began to replace narrower terms, like "resource allocation" and "policy making," shifting the way managers thought about their role from continuous, Hamlet-like deliberation toward a crisp series of conclusions reached and actions taken. Yet, decision making is, of course, a broad and ancient human pursuit, flowing back to a time when people sought guidance from the stars. From those earliest days, we have strived to invent better tools for the purpose, from the Hindu-Arabic systems for numbering and algebra, to Aristotle's systematic empiricism, to friar Occam's advances in logic, to Francis Bacon's inductive reasoning, to Descartes's application of the scientific method. A growing sophistication with managing risk, along with a nuanced understanding of human behavior and advances in technology that support and mimic cognitive processes, has improved decision making in many situations. Even so, the history of decision-making strategies--captured in this time line and examined in the four accompanying essays on risk, group dynamics, technology, and instinct--has not marched steadily toward perfect rationalism. Twentieth-century theorists showed that the costs of acquiring information lead executives to make do with only good-enough decisions. Worse, people decide against their own economic interests even when they know better. And in the absence of emotion, it's impossible to make any decisions at all. Erroneous framing, bounded awareness, excessive optimism: The debunking of Descartes's rational man threatens to swamp our confidence in our choices. Is it really surprising, then, that even as technology dramatically increases our access to information, Malcolm Gladwell extols the virtues of gut decisions made, literally, in the blink of an eye?

Decision Making↗

Citizen participation in the decision-making activities of formal social service agencies: an unreasonable goal?

In the past, attempts by social service agencies to include nonprofessional area residents in program planning and policy-making activities have met with little success. Such failures may be due in part to mistrust and a feeling that the agencies and their programs have little relevance to the problems faced by most people. Perhaps an alternative way of developing resident participation in community action programs would be to move the planning and decision-making process away from the trained experts associated with formal institutions to the residents within the neighborhoods themselves. The people living within a defined community would decide which problems they wish to address, and then use resources available within the community to solve them.

Community Mental Health Services↗

Implications of policy and management decisions on access, quality, and type of services for the elderly in Australia.

There can be little argument that the need for a clearly articulated health care policy for the ageing is a legitimate concern. An optimum health system response will only evolve in a climate of clear definition of responsibilities, in concert with an effective policy-making mechanism. Within the health system there is likely to be a greater consensus concerning the elements of such a policy than would have been possible at any previous time. What is more likely to be debated is the question of what constitutes the legitimate boundaries of health as a concept to be applied to ageing populations and individuals. It is in our view essential that arguments about professional demarcation and alternative paradigms of ageing do not cloud the fundamental health and health care issues; these must be vigorously addressed if the otherwise inevitable burden of age-related illness and disability is to be effectively tackled.

Aged↗

Optimisation versus certainty: understanding the issue of heterogeneity in economic evaluation.

This paper considers how the information provided by economic evaluation for decision-makers can fail to optimise use of health resources and how assessment of the relative cost-effectiveness of health care interventions can be misleading unless heterogeneity within populations is taken into account. The cost-effectiveness of an intervention is not a point estimate but an average chosen from within a distribution of different results. The normal interpretation of the distribution around that point is often mistakenly assumed to be the 'white noise' of measurement error. In reality this variance is a combination of measurement error and true heterogeneity of results. There remains an overemphasis on pursuing certainty which stems from the fact that the methods involved were originally devised to measure dichotomous outcomes not continuous ones such as cost-effectiveness ratios. It is argued in this paper that more consideration be given to the heterogeneous nature of costs and effects across populations in analysis and policy making.

Cost-Benefit Analysis↗

Factors influencing general practitioners' referral decisions.

This paper presents some findings from a small scale qualitative study of referral decision making conducted in south-east Northumberland in 1988-89. The study was prompted by an interest in variability in referral rates and the view that existing studies had not attempted to understand referral from the perspective of those involved in making the decisions. Our findings suggest that such understandings are crucial in the analysis of referral decisions and in any policy making initiatives designed to influence the pattern of referring.

Clinical Competence↗

Latinas and sexually transmitted diseases: implications of recent research for prevention.

Latinas are among the poorest members of this society, and are not only exposed to greater health risks, but are less likely to have access to health care services. Both HIV infection and cervical cancer are associated with low socioeconomic status, and both have also been linked with sexual transmission. Because of their overrepresentation among the poor, Latinas are at greater risk of cervical cancer, and have also been identified as being at higher risk of HIV/AIDS. Since neither the economic status of Latinas nor the health services available to them are likely to improve within the near future, Latinas are a critical target for health promotion and prevention. This paper documents the urgent need for prevention of cervical cancer and AIDS in the Latina community and makes recommendations for gender-sensitive and culturally competent public health social work practice at the individual, community, and policy-making levels.

Female↗

Health risk assessment research: implications for synthetic vitreous fibers.

While synthetic vitreous fibers (SVFs) are thought responsible for respiratory illnesses, more research is needed to understand the nature of exposure. Much of the research necessary to evaluate the risk of the possible health effects to humans will be supported by the U.S. Federal Government, either specifically to elucidate the effects from exposure to SVFs, or more generally to improve the process of risk assessment. In this context, the Office of Technology Assessment (OTA) examined the Federal research activities to improve risk assessment, with a focus on current activities and the funding and management of that research. OTA defined risk assessment research as research designed to improve the process of health risk assessment or chemical-specific risk estimates. OTA found that risk assessment is not a national research priority. Environmental health research funding has neither kept up with increases in health research nor with increases in environmental mandates that depend on that research for decision making. OTA finds the need to stress the interdependency and the linkage of the various research activities, risk assessment, and policy making. Finally, the exploration of many promising areas for research requires linkages not only among various scientific disciplines but also with decision makers.

Animals↗

Impact of health technology assessment on preventive screening in Belgium: case studies of mammography in breast cancer, PSA screening in prostate cancer, and ultrasound in normal pregnancy.

OBJECTIVE: To describe how scientific evidence has influenced healthcare policy making in Belgium in the field of sickness prevention for mammography, PSA testing in prostate cancer screening, and use of ultrasound in pregnancy. METHODS: Review of published and gray literature and interviews with stakeholders and experts. RESULTS: At the end of 1999, a systematic national/regional screening program had not yet been implemented for any of the three screening strategies. A systematic breast cancer screening program is being prepared for implementation only in Flanders. This limited impact can be attributed to the fragmentation in healthcare policy, the different options among the different regions, fragmentation in healthcare practice, the strong impact of healthcare stakeholders (provider groups and sickness funds) on decision making, and limited attention to scientific evidence in health policy and technology assessment. CONCLUSIONS: Health technology assessment has had very little impact on policy and practice in use of mammography, PSA testing, and ultrasound in pregnancy in Belgium.

Adolescent↗

Achieving rational therapeutics through consensus-based protocols and follow-up.

In this exclusive Hospital Formulary interview, three key members of the therapeutics committee at Hartford Hospital, an 861-bed, private teaching hospital, discuss some of the techniques that they have used to ensure the development of a sound and effective formulary system within their institution. The committee emphasizes a policy-making approach that incorporates, up front, the expertise of key clinicians together with the best available information from the medical literature. Once committee policy has been set, implementation of drug use guidelines is largely automatic, and compliance is carefully monitored and reviewed.

Connecticut↗

State legislators' beliefs about legislation that restricts youth access to tobacco products.

Better understanding of the cognitive framework for decision making among legislators is important for advocacy of health-promoting legislation. In 1994, the authors surveyed state legislators from North Carolina, Texas, and Vermont concerning their beliefs and intentions related to voting for a hypothetical measure to enforce legislation preventing the sale of tobacco to minors, using scales based on the theory of planned behavior. Attitude (importance), subjective norm (whether most people important to you would say you should or should not vote for the law), perceived behavioral control (ability to cast one's vote for the law), and home state were independently and significantly related to intention to vote for the law's enforcement. The results, including descriptive data concerning individual beliefs, suggest specific public health strategies to increase legislative support for passing legislation to restrict youth tobacco sales and, more generally, a framework for studying policy making and advocacy.

Adolescent↗