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PubMed1994

Researcher-driven versus policy-driven economic appraisal of health technologies: the case of France.

From the failure of early voluntarist attempts of the 1970's to introduce formal economic assessment in administrative decision-making for public health policies, to the recent introduction of new regulatory mechanisms to control the diffusion and use of health care technologies, the French experience deeply questions the mechanistic idea that reinforcement of cost-containment policies necessarily means successful opportunities for economic appraisal. The article presents various examples from the French health care system showing how ambiguities between the management goals of cost-containment and the promotion of economic appraisal can create barriers for acceptance of any form of economic analysis. But, it also draws some positive lessons about the ways to surpass the traditional opposition between 'researcher-driven' vs 'policy-driven' research in the field of health economic assessment through institutional innovations and methodological advances.

Cost Control↗
PubMed2006

A flexible environmental reuse/recycle policy based on economic strength.

Environmental policies based on fixed recycling rates may lead to increased environmental impacts (e.g., landfilled wastes) during economic expansion. A rate policy is proposed, which is adjusted according to the overall strength or weakness of the economy, as reflected by overall packaging demand and consumption, production and imports-exports. During economic expansion featuring rising consumption, production or exports, the proposed flexible policy suggests a higher reuse/recycle rate. During economic slowdown a lower rate results in lower impacts. The flexible target rates are determined in terms of annual data, including consumption, imports-exports and production. Higher environmental gains can be achieved at lower cost if the flexible policy is applied to widely consumed packaging products and materials associated with low rates, or if cleaner recycling technology is adopted.

Conservation of Natural Resources↗
PubMed2002

Were NZ's structural changes to the welfare state in the early 1990s associated with a measurable increase in oral health inequalities among children?

OBJECTIVE: To test the hypothesis that the 1990-91 social and economic policy changes in New Zealand were associated with a subsequent increase in socioeconomic and ethnic inequalities in the dental caries experience of five-year-old children. METHOD: Dental caries data from the School Dental Service treating the greater Wellington area were analysed for the period 1995-2000. Multivariate models were developed for deciduous caries prevalence (logistic regression) and severity (negative binomial regression). RESULTS: In the years 1995, 1996, 1997, 1998, 1999 and 2000, complete data were available for 2,627, 3,335, 4,404, 4,155, 3,154 and 2,804 children, respectively. Ethnic and socio-economic differences in caries prevalence and severity were substantial and persistent during the observation period. Where caries severity was concerned, there was a significant interaction between time and Maori ethnicity, indicating that (on average) the oral health of Maori children deteriorated in comparison to their European counterparts. CONCLUSIONS: The early-1990s social and economic policy changes were associated with an apparent widening of ethnic inequalities in caries severity among five-year-old children. IMPLICATIONS: Economic rationalism appears to have oral health disadvantages for non-European children. Before implementation of proposed major social and economic policy changes, policymakers should consider their health implications.

Child↗
PubMed1993

International labour migration in the Asian-Pacific region: patterns, policies and economic implications.

"This paper reviews the literature on international labour migration from and within the Asian-Pacific region. It deals with patterns and characteristics of migration flows, government policies towards labour migration, and economic implications of labour migration for both labour-exporting and importing countries in the region. The indications are that, despite gradual slowing down of labour flows to the western industrial countries and the Middle East, labour migration will continue to be a major economic influence on surplus-labour countries in the region. As an integral part of the growth dynamism in the region, labour migration has now begun to take on a regional dimension, with immense implications for the process of industrial restructuring in high growth economies and the changing pattern of economic interdependence among countries."

Asia↗
PubMed1995

Environment, health, and sustainable development: the role of economic instruments and policies.

Recent years have seen considerable progress in integrating environmental concerns into the mainstream of development policy and planning. Economic instruments designed explicitly for environmental purposes may help to achieve cost-effective solutions, and generate public revenues. Macroeconomic and sectoral policies may impact heavily upon the environment, and there is much scope for policy reforms that are justified in both economic and environmental terms. Progress in this area has been much more rapid than in the case of health objectives, even though the rationale for environmental improvement is often ultimately related to human health and well-being. It is proposed that lessons from recent experience in the use of economic instruments and policies to achieve environmental objectives are highly relevant for the health sector, which should seek and encourage support for measures that requires consumer and producers of environmentally degrading products to pay for the economic and social costs of the damage resulting from their use. Policy reform at the macroeconomic or sectoral level may yield cost-effective solutions to some health problems, and may even bring about improvements in health status that involve no net cost at all. The countrywide impact of such policies indicate that health agencies, including WHO, should develop the capacity to understand how economic policies and the adjustment process impact upon human health, not only direct through the effect on incomes, but also indirectly, via changes in the natural environment. Ability to conduct rigorous health impact assessment of economic policy reform, which requires a multidisciplinary effort, is a necessary condition if health ministries are to maximize their effectiveness in influencing overall government economic policy.

Economics↗
PubMedDate not supplied

[An approach to indirect costs of disability in Colombia].

OBJECTIVES: This document studies the relationships between economic policy and disability, representing an attempt at providing a theoretical analysis for economic policy of disability in Colombia. METHODS: The absolute figures and percentages of distribution of disability in the Colombian population from 1981 to 2003, obtained from 3 official sources, were used. The following variables were selected: age, education, employment, socio-economic level, income and dependence. Several hypotheses were formulated and contrasted with frequency analysis and the Chi-square test to estimate differences between groups. RESULTS: The analysis demonstrated that vulnerability to disability is different according to: 1. Sex, with a greater impact on males; 2. Age: greater impact for older age groups and, in the last 3 years, greatest impact in the 25 to 55 year age group under potential risk of disability; 3: Region: greater vulnerability in rural areas and 4. Socio-economic level: persons with disabling conditions belong to the lower socio-economic strata. The typical profile of persons with disabling conditions is poor education, income of less than a minimum monthly wage, unemployed, belonging to the 1 or 2 socio-economic strata, forming part of homes defined as poor, being male and living in rural areas. CONCLUSIONS: Poverty seems to enhance disability increasing vulnerability, risk and restricting opportunities for welfare. These results can be used as arguments for redirecting the policies and actions for greater access of disabled persons to social and economic opportunities.

Adolescent↗
PubMed1986

Urbanization and economic development policy in Korea.

"This paper has firstly discussed the development strategy and urbanization in [the Republic of] Korea for the period 1960-1980. [This is] followed with an intensive review of the past and recent population redistribution policy of Korea. Finally the authors make some general suggestions which are characterized as an expansion of opportunities and services in the underprivileged areas." (summary in CHI)

Asia↗
PubMed1991

A strategy for reducing numbers? Response.

I am not particularly knowledgeable on the subject-matter of this article; but would like to make brief comments from the broad economic point of view. The concept of a demographic 'trap' is not sound. For one thing, this concept completely ignores the possibility of 'trade' in food by implicitly assuming that the capacity of a community to support its population depends on its own output of food through appropriate economic policies. There were many predictions of disastrous famines in India in the early 70s on the basis of considerations such as those advanced by Dr Ding. Amartya Sen has argued, quite plausibly, that famines occur because of maldistribution of food and lack of adequate 'safety nets' rather than a decline in total food output. Sen is referred to at 1 place in the article; but somewhat out of context. The conclusion that if the birth rate does not fall, the death rate should also not be allowed to fall is repugnant. Look at the countries of Latin America; population growth is high, but there is no 'entrapment'. The so called 'trap' can, of course, occur because of failure of economic and social policies and international economic policies. However, there is nothing inevitable about it (at any given rate of population growth). The author's plea for greater information and public education in respect of demographic trends and consequences is valid. There is also an urgent need for a new thrust in family planning programs on wider economic and social grounds. However, this case is quite independent of the 'entrapment' theory.

Asia↗
PubMed1993

Structural adjustment and health policy in Africa.

World Bank/International Monetary Fund Structural Adjustment Programs (SAPs) have been introduced in over 40 countries of Africa. This article outlines their economic policy measures and the experience of the countries that have introduced them, in terms of nutrition, health status, and health services. The evidence indicates that SAPs have been associated with increasing food insecurity and undernutrition, rising ill-health, and decreasing access to health care in the two-thirds or more of the population of African countries that already lives below poverty levels. SAPs have also affected health policy, with loss of a proactive health policy framework, a widening gap between the affected communities and policy makers, and the replacement of the underlying principle of equity in and social responsibility for health care by a policy in which health is marketed commodity and access to health care becomes an individual responsibility. The author argues that there is a deep contradiction between SAPs and policies aimed at building the health of the population. Those in the health sector need to contribute to the development and advocacy of economic policies in which growth is based on human resource development, and to the development of a civic environment in Africa that can ensure the implementation of such policies.

Africa↗