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PubMed2003

Lumping and splitting: the health policy agenda in India.

India's health system was designed in a different era, when expectations of the public and private sectors were quite different. India's population is also undergoing transitions in the demographic, epidemiologic and social aspects of health. Disparities in life expectancy, disease, access to health care and protection from financial risks have increased. These factors are challenging the health system to respond in new ways. The old approach to national health policies and programmes is increasingly inappropriate. By analyzing inter- and intra-state differences in contexts and processes, we argue that the content of national health policy needs to be more diverse and accommodating to specific states and districts. More 'splitting' of India's health policy at the state level would better address their health problems, and would open the way to innovation and local accountability. States further along the health transition would be able to develop policies to deal with the emerging epidemic of non-communicable diseases and more appropriate health financing systems. States early in the transition would need to focus on improving the quality and access of essential public health services, and empowering communities to take more ownership. Better 'lumping' of policy issues at the central level is also needed, but not in ways that have been done in the past. The central government needs to focus on overcoming the large inequalities in health outcomes across India, tackle growing challenges to health such as the HIV epidemic, and provide the much needed leadership on systemic issues such as the development of systems for quality assurance and regulation of the private sector. It also needs to support and facilitate states and districts to develop critical capacities rather than directly manage programmes. As India develops a more diverse set of state health policies, there will be more opportunities to learn what works in different policy environments.

Delivery of Health Care↗
PubMed1998

Human resources for health--challenges for the 21st century.

A quality health workforce is critical for the development of health systems and the delivery of health services. Although significant resources have been devoted to this area, imbalances persist in most countries. There is a growing recognition that to address current demographic, epidemiological, technological and socioeconomic changes, approaches to human resources for health development must be more comprehensive. While education and training of health personnel is a crucial element, the areas of policy development, planning and management of human resources must receive appropriate attention. Health sector reform initiatives have not included human resources development as an integral part in their processes, which has led to failures of reforms in some cases. Human resources for health must have a more prominent place on the political agenda of countries. It is apparent that to meet current and future challenges, partnerships between the many actors must be established.

Forecasting↗
PubMed2002

Biocomplexity: the post-genome challenge in ecotoxicology.

There are four crucial challenges for the environmental toxicologists in the next decade: (1) understanding the mechanisms of molecular and subcellular interactions with pollutant chemicals, including genomic and proteomic aspects; (2) the development of predictive simulation models of toxic effects on complex cellular and physiological processes; (3) linking molecular, cellular and patho-physiological 'endpoints' with higher level ecological consequences; and (4) precautionary anticipation of possible harmful impacts of novel developments in industrial processes, including biotechnology and nanotechnology. One of the major difficulties in ecotoxicology is to link harmful effects of chemical pollutants in individual animals and plants with the ecological consequences. Consequently, this obstacle has resulted in a 'knowledge-gap' for those seeking to develop policies for sustainable use of resources and environmental protection. The overall problem is: how to develop effective procedures for environmental/ecological impact and risk assessment? However, the use of diagnostic 'clinical-type' tests or 'biomarkers' has started to provide information on the health-status of populations based on relatively small samples of individuals. Also, biomarkers can now be used to begin to link processes of molecular and cellular damage through to the higher levels (i.e. prognostic capability), where they can result in reduced performance and reproductive success. Research effort to meet this challenge must be inter-disciplinary in character, since the key questions mainly involve complex interfacial problems. These include effects of physico-chemical speciation on uptake and toxicity, the toxicity of complex mixtures; and linking the impact of pollutants through the various hierarchical levels of biological organisation to ecosystem and human health. Finally, the development and use of process-based computational simulation models (i.e. 'virtual' cells, organs and animals), illustrated using an endosomal/lysosomal uptake and cell injury model, will facilitate the development of a predictive capacity for estimating risk associated with the possibility of future environmental events.

Animals↗
PubMed1989

Public and private responsibility for mental health services.

Relative to public services, private sector corporate mental health care has significantly increased since the late 1960s. The many tensions encountered in assigning public and private responsibility for mental health service give rise to significant value-laden questions for psychologists. These questions go to the heart of community mental health, deinstitutionalization, mental health policy development and evaluation, and many other areas in which psychologists are playing major roles. The public-private issue should be understood historically, from the twin vantage points of developments in general medicine and in mental health. Among the many public interest and public policy matters psychologists and others concerned with mental health should address are the emergence of corporate chains; the nature, cost, and quality of private sector services; the compatibility of profit motivation and the motivation to provide care; and patient selection issues (e.g., cream-skimming). Public and private cooperation and planning are certainly in order if the public interest is to be served in addressing the nation's mental health problems.

Community Mental Health Services↗
PubMed2000

Nursing participation in health care reform efforts of 1993 to 1994: advocating for the national community.

This report of a postmodern feminist oral history tells a contemporary story of the success of nursing in overcoming the impediments of tradition, organizing and acting as an identifiable group, and speaking out with clarity as advocates for the health of American society. This was an important historical, transitional, and celebratory time for nursing. Continuing advocacy for health care for all Americans requires developing expertise in both traditional and feminist leadership, understanding how political theories and history affect policy development, and active participation in American democracy. Future actions require incorporation of lessons from the recent past.

American Nurses' Association↗
PubMed1995

Policy research: lessons from the field.

Nursing's involvement in policy development has become a standard and expected part of nursing practice. One avenue of involvement, policy research, is clarified through description and case example. Policy research is described as context-driven, multimethodological, and time-sensitive. Considering these essential characteristics when planning and implementing policy research enhances nursing's ability to positively influence the policy process. A case example of policy research from the criminal justice system evaluated the effectiveness of a diversion program with alcohol and marijuana misdemeanants (N = 1,239). The purposes of the study were to describe the percentage of diversion participants with alcohol or marijuana-possession charges who were successful in completing the diversion program and to examine the incidence of subsequent arrests on alcohol or marijuana-possession charges among those who successfully completed the program. The case example demonstrates the intricate and unique relationship between research and the policy arena. Policy research can equip nursing to enter policy debates with data and to participate as a persuasive agent of social change.

Alcoholism↗
PubMed2003

Protecting rural communities from terrorism: a statewide, community-based model.

Given the number of Americans who live in rural areas and the unique challenges they face in the provision of health care services, special attention to planning for and responding to terrorist acts is warranted. After September 11, 2001, Florida developed a statewide, community-based model that applies the public health principles of assessment, policy development, and assurance. This model can serve as a possible framework for other states and communities.

Civil Defense↗
PubMed2002

[Comparative study on objective-setting public health policy--historical background and path dependence].

The historical background and the path dependence of objective-setting public health policy are described in this review. The New Public Health movement appeared in the 1980s and was inspired by the Ottawa Charter on Health Promotion. This movement is based on the idea that public health is mostly promoted by creating a supportive environment for health as well as by individual efforts toward a healthy life style. The first objective-setting public health policy called Healthy People was proposed in USA, 1979, under the influence of The Lalonde Report published in Canada, 1974. Goals and targets were set in order to reduce the mortality of American people. This project led to Healthy People 2000 and Healthy People 2010. In the 1990s, objective-setting public health policies prevailed in Western countries, such as United Kingdom, Australia, New Zealand, and also in Japan. The objective-setting public health policy is the application of the management by objectives in the health policy domain. This policy is especially accepted in Anglo-Saxon countries where public sector reform was conducted on the basis of the New Public Management theory in the 1980s, which is when the WHO Regional Office for Europe started the Healthy Cities project that emphasized a network of project cities. The Health 21 in 1999 is another model of object-setting public health policy. A comparative study of four different objective-setting public health policies (USA, United Kingdom, WHO Regional Office for Europe, and Japan) was conducted regarding the goals and domains of the targets, methods of targeting, and evaluation of the project. The goals were almost identical in the four public health policies, while the domains of the targets were different. These differences were explained by the past experience of public health policy development in each country.

Europe↗
PubMed1984

Shaping public policy: a challenge in faith.

Religious health care's involvement in public policy is an essential part of Christian life. The most important way in which Catholic hospitals and health care systems can contribute to public policy is through faith-reflection upon their identity and calling. To guide the shaping of public policy, several theological models have been set forth. The theology of democratic capitalism is based on individual human creativity. As a system of political economy organized to prevent the centralization of government power, it thrives on free competition. Well- intentioned social programs that seek to equalize results, according to democratic capitalists , inevitably lead to greater government control and should be avoided. Inequality, in fact, according to this theory, can create incentive for individuals and industry to be more productive. The stewardship approach to theological reflection calls for a distribution of goods and services based on need. The right to health care, for example, is founded in God's gift of creation to all inhabitants. The resources of creation are allotted to individuals as property in a sense of cooperation and sharing. Thus, according to this notion, government programs that help society steward its resources wisely should be promoted. The U.S. bishops ' 1981 pastoral letter on health and health care presents a third model, which reflects on the dignity of human beings as images of God to guide public policy. Models, however, must not replace personal theological reflection. Catholic health care providers share a responsibility to evaluate social issues from their perspective as members of the healing ministry and to participate in public policy development.

Catholicism↗
PubMed2003

Complying with the Privacy Act. A survey of medical records management.

BACKGROUND: A survey of 142 South Australian general practices was conducted on the eve of the new Privacy Act amendments coming into force. OBJECTIVE: The survey had two aims: to establish the extent to which medical records systems were already compliant, and to identify those areas in which change would be required in order to achieve compliance with the requirements of the new legislation. DISCUSSION: The sample was biased in favour of larger group practices. Among the practices surveyed, the areas of best compliance were in providing security, allowing patients access to records and obtaining consent for disclosure of information. There was poor compliance with the requirement to provide patients with information about medical records, or to have a practice policy on privacy. Anonymous care was rarely offered to patients. General practices will need to develop policies and procedures to address these requirements of the new law. Some general practices met the standard required by the amended Privacy Act before it came into force. For those who were not compliant, relatively simple measures will overcome the most common deficiencies.

Australia↗
PubMed2003

Tackling socioeconomic inequalities in health: analysis of European experiences.

Effective strategies must be developed to reduce socioeconomic inequalities in health. Most efforts take place in isolation, and only the UK experience has been discussed widely in international published work. We therefore analysed policy developments on health inequalities in different European countries between 1990 and 2001. We noted that countries are in widely different phases of awareness of, and willingness to take action on, inequalities in health. We identified innovative approaches in five main areas: policy steering mechanisms; labour market and working conditions; consumption and health-related behaviour; health care; and territorial approaches. National advisory committees in the UK, the Netherlands, and Sweden have proposed comprehensive strategies to reduce health inequalities. Variations between these packages suggest that policymaking in this area still is largely intuitive and would benefit from incorporation of more rigorous evidence-based approaches. Further international exchanges of experiences with development, implementation, and evaluation of policies and interventions to reduce health inequalities can help to enhance learning speed.

Cross-Cultural Comparison↗
PubMed1997

Professional ideologies and the development of syringe exchange: Wales as a case study.

This paper is derived from an evaluative study of HIV prevention programs for drug injectors across Wales. It considers how different professional territories and ideologies, concepts of drug misuse and models of HIV prevention may influence policy development. The research involved monitoring the introduction and development of agency and community based syringe exchange schemes and initiatives taken by community pharmacists. Interviews with staff, managers and administrators, and descriptions of service history, development and delivery inform the discussion. HIV prevention varied in different areas of Wales depending on the particular professional group involved, local ideologies regarding drug use treatment, and the extent to which HIV prevention was seen either as a specialist area of expertise and specific remit of drug workers or a generic health care task. Drug agencies with an abstinence policy rejected syringe exchange; instead, prevention in those areas developed in ad hoc ways as health care workers and pharmacists attempted to develop a community based service. Drug agencies with a pre-existing harm minimisation model easily integrated syringe exchange into their work and played the major part in establishing the service, but there was difficulty in extending it beyond their professional caseloads. As there were disincentives to use treatment agencies, and their catchment areas were limited, these factors influenced effective service provision.

Attitude of Health Personnel↗
PubMed1986

International environmental problems and international organisations.

A cross comparison of environmental programmes of major International Organisations reveals a convergent tendency. A relatively small number of priority areas for action have been identified, in the domain of pollution prevention and control, natural resource management, and quality of life in human settlements. Policy development in each of the priority areas requires specific scientific research efforts. The dialogue between policy-makers and scientists raises some problem, relative, inter alia, to the independence of science and to the practical need to act before various environmental threats become irretrievable. A rational sharing of tasks between International Organisations could work towards greater effectiveness.

Conservation of Natural Resources↗
PubMed1991

A model hospital policy on prosecuting patients for presumptively criminal acts.

Evidence suggests that violence by psychiatric inpatients, especially in public-sector hospitals, may be on the rise. The authors present a model policy developed at a state hospital for deciding whether to prosecute presumptively criminal assaults by patients. The policy addresses the circumstances under which it is ethically permissible to file a criminal complaint while emphasizing the need to use clinical interventions first and to consider the clinical sequelae of prosecution. The authors also review criticisms made of the policy, which reflect opposing views that prosecution is unjustified and that the policy unduly restricts the use of prosecution. In the first six months after the policy became effective, state hospital staff considered filing charges against five patients, but no case progressed beyond the first steps in the implementation procedure.

Confidentiality↗
PubMed1994

Immigration policies: a comparative overview.

"This is a short comparative overview of the present immigration policies of certain Western countries which, as regards questions of migration, are comparable. It is based on data provided by the International Centre for Migration Policy Development (ICMPD) in Vienna.... It covers the following European countries: Austria, Denmark, Finland, France, Germany, the Netherlands, Norway, Switzerland, Sweden and the United Kingdom. For comparative purposes it also covers three countries overseas which are regarded as typical countries of immigration: Australia, Canada, and the U.S.A."

Americas↗
PubMed2002

Learning to plan? A critical fiction about the facilitation of professional and practice development plans in primary care.

A shift from continuing medical education towards professional and organisational development policies, coupled with the introduction of accountability frameworks (clinical governance), has generated interest in professional and practice development plans (PPDPs) in general practice. The problems of implementing this change in an independent contractor-based service remain unexplored and the aims of this study were to focus on the facilitator's experience of the issues that hampered or fostered development in general practice. Facilitators of PPDPs were asked to document their experience of supporting 12 practices in an all Wales feasibility study. In order to maintain organisational anonymity while reporting accurate accounts of the obstacles encountered, a method known as critical fiction was employed. This method allowed the authors to write detailed reflective accounts that were then fictionalised. The culture of general practice reflects the development of an independent contractor service that has developed into partnerships that employ some professionals (practice nurses, managers and administrative staff) and collaborate with others in variable arrangements (community nurses, health visitors, midwives and others). Developing organisation-wide systems in so-called 'primary health care teams' is a difficult exercise, given the ethos of autonomous decision-making processes and the lack of experience of 'whole systems' approaches in primary care. The potential for multiprofessional synergy and the evidence that systematic changes lead to sustained health care improvements are well established. But the implementation issues of these concepts have not been addressed. Existing educational policies are based in uniprofessional paradigms and the protected time requirements and funding streams required for PPDPs have not been clarified.

Attitude of Health Personnel↗
PubMed2000

Health plan responses to Medicaid managed care policy in New York City.

Nearly all states in the United States have instituted managed care programs to serve Medicaid recipients and are developing policies to increase program participation. State practices regarding managed care contracting, premiums, and enrollment have implications for whether managed care plans will respond in a manner consistent with overall state policy objectives for the Medicaid managed care program. The experience of expanding the Medicaid managed care program in New York City, where the number of Medicaid beneficiaries exceeds the number in all but three states, has provided an interesting opportunity to look at the relationship between Medicaid managed care policy and plan enrollment. This paper analyzes trends in Medicaid managed care enrollment in New York City from January 1991 to September 1998, a period of critical changes in Medicaid managed care policy in New York.

Attitude of Health Personnel↗