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PubMed1991

Social policy and economic change in Chile, 1974-1985: the case of children.

Taking the case of Chile in the period 1974-85, this article examines the impact of economic conditions and social policies on poor households, and especially on children. The study starts with an analysis of the nature of the economic policies implemented in Chile during 1974-85 and their effects on income distribution and on the material living conditions of poor households. It then looks into the social policies, government expenditure, and the main programs directed toward poor households and children, as well as at the changes in child welfare that followed. From this macrosocial level the study diverts to the household level and describes, based on several in-depth studies of small samples of households in the Santiago metropolitan area during the years 1982-85, the daily experiences of poor households--their deteriorating economic conditions and the behaviors adopted to stretch scarce resources to satisfy basic needs. The final part draws some lessons from the Chilean case.

Child↗
PubMedDate not supplied

Healthcare technology, economics, and policy: an evolving balance.

Economic and policy issues increasingly influence healthcare technology solutions as we wrestle with keeping healthcare quality high while keeping costs under control. The healthcare system is also undergoing rapid change brought about by managed care, shifting care to team providers in an outpatient or home environment. The development of health technologies under new market arrangements needs to be examined so that quality of care and cost are not at cross roads. As these issues continue to evolve in the public forum, it is critical for engineers and contributors to technology in healthcare to understand the dynamics that influence technology need and and adoption in the healthcare market. We hope that this special issue will provide a basis for initial understanding of these issues and stimulate further involvement by the bioengineering community at large, for the improvement of healthcare across all of society.

Biomedical Engineering↗
PubMed1986

Financing health development projects: some macro-economic considerations.

The paper briefly discusses the importance of macro-economic policy in health sector financing. The ways in which monetary and fiscal policy (macro-economic policy) affect interest rates, price levels and aggregate output are presented. The main portion of the paper considers a variety of methods for public financing of health and development projects. These approaches are analyzed in light of distributional and efficiency considerations. One way of increasing health sector resources is through reallocation from other sectors of the economy. The potential for redistribution from the defense to the health service industry is briefly considered.

Developing Countries↗
PubMedDate not supplied

Health cost containment: what it will mean for workers and local economies.

After decades of rapid growth, the rate of increase in health services spending appears to be moderating. Although a slowdown in health expenditure growth would release resources for other uses in the economy, concerns have been raised about the effects of a spending slowdown on health workers and regional economies. Based on projections carried out by the Bureau of Labor Statistics during the health reform debate and on state health sector employment data, the author concludes that health workers may experience costly dislocation as health spending growth slows, and some regions may be more affected than others. However, the appropriate response is a general economic policy supporting economic growth and full employment policy with regard to health expenditure growth cannot be held hostage to concerns about employment effects.

Cost Control↗
PubMed1999

Reducing the harms of drug policy: an economic perspective.

Economics is the study of choice among alternatives under conditions of scarcity. Drug policy is manifestly an "economic" problem in the sense that these policies are developed under conditions of scarcity: there are not enough police, treatment facilities, and social services to solve the drug problem, however it is defined. This paper argues that a harms reduction approach to drug policy can be characterized as pragmatic cost-effective drug control which attempts to achieve efficient drug policy. Economic aspects of drug enforcement are discussed which reveal that these policies do not necessarily reduce drug problems and can generate unintended consequences. Enforcement remains the dominant drug policy in the United States despite evidence that it is overused, in part because both federal and state asset forfeiture laws and budget processes offer police agencies incentives to focus on enforcement rather than other policy alternatives. An efficiency-based harms reduction approach may be one way to effectively advocate a rational approach to drug issues in the often strident and ideological drug policy debates. [Translations are provided in the International Abstracts Section of this issue.]

Cost-Benefit Analysis↗
PubMed1986

IV push policy: the economic effects of IV drug administration guidelines.

The economic effect of two hospital policy revisions concerning the administration of IV push injections was studied. Changes in IV piggyback (IVPB) volume, along with material and personnel costs for IVPB and IV push administration, were used to estimate the economic impact of the policy revision for three 5-month periods. The first policy revision restricted th use of IV push administration by registered nurses on medical and surgical wards and resulted in increased IVPB volume and increased costs to the hospital. The second revision allowed registered nurses on the wards a more extensive list of drugs for IV push, which reversed the cost increases seen with the original policy revision. Study methods and data are presented. IV administration policies may have a significant effect on costs to the pharmacy and the hospital, and P & T Committees will need to consider these issues when determining policy.

Hospital Bed Capacity, 300 to 499↗
PubMed1994

Evaluation of health technology: economic issues for health policy and policy issues for economic appraisal.

Economic evaluations of health care programmes and treatments have now been conducted for about 30 years. A number of key methodological principles have been specified and there has been an exponential rise in the number of published studies. However, there is relatively little evidence of the use of these studies in decision making about health technologies. Therefore, this paper considers what policy issues are amenable to economic analysis, or could be greatly informed by economic appraisal results. It is concluded that a wide range of mechanisms exist to influence the diffusion and use of health technologies and that economic appraisal is potentially applicable to a number of them. The paper also considers how economic appraisal could be made more relevant to decision making. It is concluded that methodological standards need to be maintained, that evidence needs to be produced in a timely fashion, that the local validity of study results needs to be increased, that the dissemination of study results needs to be improved and that more note needs to be taken of the available policy instruments.

Cost Sharing↗
PubMed2001

China's one-child policy: the economic choices and consequences faced by pregnant women.

This paper addresses the important issue of the effect of China's one-child policy on prenatal and obstetric care utilization. The paper provides the first detailed empirical approach to this question, exploiting a unique high quality household survey. China officially codified a set of rules and regulations in 1979 governing the approved size of Chinese families, commonly known as the one-child policy. The policy imposed economic and social costs on families failing to adhere to the family size limits. In particular, the policy raised the price of obstetric medical services for unapproved pregnancies in comparison to approved pregnancies and imposed fines on families with unapproved births. Using data from an eight-province longitudinal household survey (The China Health and Nutrition Survey), we investigate whether or not the one-child policy's financial penalties were associated with the avoidance of obstetric care by pregnant Chinese women with unapproved pregnancies. The one-child policy variables of particular interest were a dichotomous measure of the approval status of the pregnancy, a continuous measure of the fine imposed upon families with unapproved births, and a continuous measure of the prices of prenatal care and delivery services net of any subsidy available for approved births. The results partially confirm the hypotheses that the one-child policy's economic and social costs caused women to forego seeking modern obstetric care services. The fine was found to be a significant deterrent to the utilization of prenatal care. Additionally, the unapproved-status of a pregnancy was strongly negatively associated with "the use of obstetric care. However, higher prices were not consistently found to be a significant deterrent to the use of obstetric care.

Adolescent↗
PubMed2005

The SPHERE Study. Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses. [ISRCTN24081411].

BACKGROUND: The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease (CHD) in general practice across two different health systems on the island of Ireland. CHD is a common cause of death and a significant cause of morbidity in Ireland. Secondary prevention has been recommended as a key strategy for reducing levels of CHD mortality and general practice has been highlighted as an ideal setting for secondary prevention initiatives. Current indications suggest that there is considerable room for improvement in the provision of secondary prevention for patients with established heart disease on the island of Ireland. The review literature recommends structured programmes with continued support and follow-up of patients; the provision of training, tailored to practice needs of access to evidence of effectiveness of secondary prevention; structured recall programmes that also take account of individual practice needs; and patient-centred consultations accompanied by attention to disease management guidelines. METHODS: SPHERE is a cluster randomised controlled trial, with practice-level randomisation to intervention and control groups, recruiting 960 patients from 48 practices in three study centres (Belfast, Dublin and Galway). Primary outcomes are blood pressure, total cholesterol, physical and mental health status (SF-12) and hospital re-admissions. The intervention takes place over two years and data is collected at baseline, one-year and two-year follow-up. Data is obtained from medical charts, consultations with practitioners, and patient postal questionnaires. The SPHERE intervention involves the implementation of a structured systematic programme of care for patients with CHD attending general practice. It is a multi-faceted intervention that has been developed to respond to barriers and solutions to optimal secondary prevention identified in preliminary qualitative research with practitioners and patients. General practitioners and practice nurses attend training sessions in facilitating behaviour change and medication prescribing guidelines for secondary prevention of CHD. Patients are invited to attend regular four-monthly consultations over two years, during which targets and goals for secondary prevention are set and reviewed. The analysis will be strengthened by economic, policy and qualitative components.

Journal Article↗
PubMedDate not supplied

Manganese--a public health concern: its relevance for occupational health and safety policy and regulation in South Africa.

Concerns about the effects of low-level manganese exposures on human health arise at a time when South Africa finds itself in competition with newcomers to the market economy, China and the CIS. This case study illustrates how decisions about occupational health and safety and the environment are influenced by incompleteness of scientific knowledge, competing interests, differences over what is fair or just, and the compartmentalization of public policy. In addition, an assessment is made of the ability of the occupational health and safety system in South Africa in its current form to address the challenges posed by manganese-related issues. The importance of tracking developments abroad, strengthening participatory processes, developing national policy, linking economic policy and OHS policy, and establishing appropriate trade agreements is stressed.

Adult↗
PubMed2004

Health policy and systems research agendas in developing countries.

BACKGROUND: Health policy and systems research (HPSR) is an international public good with potential to orient investments and performance at national level. Identifying research trends and priorities at international level is therefore important. This paper offers a conceptual framework and defines the HPSR portfolio as a set of research projects under implementation. The research portfolio is influenced by factors external to the research system as well as internal to it. These last include the capacity of research institutions, the momentum of research programs, funding opportunities and the influence of stakeholder priorities and public opinion. These dimensions can vary in their degree of coordination, leading to a complementary or a fragmented research portfolio. OBJECTIVE: The main objective is to identify the themes currently being pursued in the research portfolio and agendas within developing countries and to quantify their frequency in an effort to identify current research topics and their underlying influences. METHODS: HPSR topics being pursued by developing country producer institutions and their perceived priorities were identified through a survey between 2000 and 2002. The response to a call for letters of intent issued by the Alliance in 2000 for a broad range of topics was also analyzed. The institutions that were the universe of this study consisted of the 176 institutional partners of the Alliance for Health Policy and Systems Research producing research in low and middle income countries outside Europe. HPSR topics as well as the beneficiaries or issues and the health problems addressed were content analyzed. Topics were classified into 19 categories and their frequency analyzed across groups of countries with similar per capita income. Agendas were identified by analyzing the source of funding and of project initiation for projects under implementation. RESULTS: The highest ranking topic at the aggregate level is "Sector analysis", followed by "Disease burden" and "Management and organization". Categories at the bottom of this ranking are "Equity", "Policy process", "Economic policy and health" and "Information systems". "Disease burden" is more often funded than other topics for which there is more demand or perceived priority. Analysis suggests few although important differences across priorities, demand for funding and actual project funding. The donors' agenda coincides most with the ranking of research topics overall.Ranking across country income groups shows important differences. Topics that gain prominence in low income countries are "Disease burden" and "Accessibility". In lower middle income countries "Insurance" gains prominence. In upper middle income countries "Decentralization/local health systems", "Equity" and "Policy process" are more prominent. "Program evaluation" is the most consistently ranked topic across income regions, showing a neutral influence by donors, governments or researchers. CONCLUSIONS: The framework proposed offers a basis to identify and contrast research needs, projects and products at the international level and to identify the actor agendas and their influence. Research gaps are suggested when comparing topic ranking against the challenges to health system strengthening and scaling up of disease control programs. Differences across per capita income groups suggests the need for differentiated priority setting mechanisms guiding international support. Data suggests that stakeholders have different agendas, and that donors predominate in determining the research portfolio. High-level consensus building at the national and international levels is necessary to ensure that the diverse agendas play a complementary role in support of health system objectives.The Ministerial Summit for Health Research to be held in Mexico in November 2004 should be an opportunity to analyze further data and to commit funding for priorities identified through sharing and discussion of agendas.

Journal Article↗
PubMed1998

[Reduction of automobile traffic: urgent health promotion policy].

During the last few decades, traffic injuries have become one of the leading causes of death and disability in the world. In urban areas, traffic congestion, noise, and emissions from motor vehicles produce subjective disturbances and detectable pathological effects. More than one billion people are exposed to harmful levels of environmental pollution. Because its combustion engine generates carbon dioxide (CO2), the automobile is one of the chief sources of the gases that are causing the greenhouse effect. The latter has already caused a rise in the average ambient temperature, and over the next decades it will predictable cause significant climatic changes whose consequences, though uncertain, are likely to be harmful and possibly catastrophic. Aside from the greenhouse effect, the relentless growth of parking zones, traffic, and the roadway infrastructure in urban and rural areas is currently one of the leading causes of environmental degradation. Urban development, which is nearly always "planned" around traffic instead of people, leads to a significant deterioration in the quality of life, while it also destroys the social fabric. Unlike the private automobile, public transportation, bicycles, and walking help reduce pollution, congestion, and traffic volume, as well as the morbidity and mortality resulting from injuries and ailments related to pollution. Non-automobile transportation also encourages physical activity--with its positive effect on general health--and helps reduce the greenhouse effect. The drop in traffic volume and the increased use of alternate means of transportation are thus an integrated health promotion policy which should become an inherent part of the movement for the promotion of healthy cities and of transportation policies and economic policy in general.

Accidents, Traffic↗
PubMed1997

Economic and policy implications of adopting paclitaxel as first-line therapy for advanced ovarian cancer: an Ontario perspective.

PURPOSE: To determine the potential economic and policy implications that result from incorporating paclitaxel into first-line therapy for stage 3 and 4 ovarian cancer patients in the province of Ontario, Canada. METHODS: A cost-effectiveness analysis was conducted to compare cisplatin/cyclophosphamide (CC), a standard therapy, with cisplatin/paclitaxel (CT). Based on survival curves from a clinical trial, mean costs and survival were calculated. Sensitivity analyses were conducted based on altering the duration of paclitaxel infusion, discount rates, and efficacy of paclitaxel. RESULTS: The mean survival duration is prolonged from 2.06 years with the standard therapy to 2.44 years with the paclitaxel combination. The paclitaxel therapy is more expensive, with a mean cost of $17,469 (Canadian) per patient treated with CT compared with $5,228 per patient with CC. The incremental cost-effectiveness ratio is $32,213 per year gained. Sensitivity analyses show that the conclusions remain unchanged. The use of CT as first-line treatment for advanced ovarian cancer patients in Ontario requires an additional $9 million per year over and above the present costs to treat this patient population. CONCLUSION: Although paclitaxel-based therapy prolongs survival, it comes at an increased cost. It may not be possible to fund paclitaxel treatment using resources presently allocated to first-line chemotherapy for advanced ovarian cancer. The policy implications for absorbing the cost of paclitaxel in the context of a publicly funded health care system are discussed.

Antineoplastic Agents, Phytogenic↗
PubMed2006

Social, economic and policy issues in the long-term control of HPAI.

Prevention and control of HPAI in Asia is a long term problem with important economic and policy consequences. The macro level impact of a single national outbreak is greatest for an exporting country, ranging in 2003-5 from dollars 65 million to over dollars 400 million. No estimates are available for the impact of market disruption if endemic disease changes the pattern of regional and international trade. In countries with minimal exports, the total financial impact may be much smaller, but there can be serious losses to vulnerable sectors of society at several stages of the market chain. The economies of the region are growing and some countries could finance recurrent costs of AI control, but substantial investment in veterinary services is required. National and regional financing structures need to be reviewed. AI control strategies should include a broad financial support system that addresses education, credit, compensation and social relief programmes. Some strategies may result in restructuring of the industry, or affect the wider development of rural areas and local food security.

Animal Husbandry↗