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At least 109 records · Page 6Linked to original sources
PubMed2003

National health insurance or incremental reform: aim high, or at our feet?

Single-payer national health insurance could cover the uninsured and upgrade coverage for most Americans without increasing costs; savings on insurance overhead and other bureaucracy would fully offset the costs of improved care. In contrast, proposed incremental reforms are projected to cover a fraction of the uninsured, at great cost. Moreover, even these projections are suspect; reforms of the past quarter century have not stemmed the erosion of coverage. Despite incrementalists' claims of pragmatism, they have proven unable to shepherd meaningful reform through the political system. While national health insurance is often dismissed as ultra left by the policy community, it is dead center in public opinion. Polls have consistently shown that at least 40%, and perhaps 60%, of Americans favor such reform.

Community Participation↗
PubMed2003

Getting the big picture: the macro-politics of information system development (and failure) in a Canadian hospital.

OBJECTIVES: While recognized that global actors influence health information system design, studies of health informatics have largely focused on micro politics of technology design and implementation. Here a problematic patient care information system (PCIS) is discussed in relation to federal and provincial policies and corporate strategies to demonstrate that our understanding of health informatics can be enhanced by linking micro studies of health informatics to larger macro contexts. METHODS: Interviews and document study. RESULTS: Although the extent to which federal initiatives influenced (or failed to influence) provincial and hospital initiatives remains debateable, events initiated at one level (the hospital's decision to implement software, initiated at the organizational level) are influenced (perhaps indirectly) by developments in other contexts (federal/macro changes gave an initiative more weight; provincial initiatives such as the Labour Accord altered the industrial relations environment in which system development occurred). CONCLUSIONS: Micro-studies of work practice, invaluable in addressing interactions between technologies, users and work practices, often fail to account for the historic reach of global actors, although it is often these historic circumstances that contribute to present-day interactions between user, information system and organization, and that find expression - often indirectly - in daily work practices.

Canada↗
PubMed2003

Generating political will for safe motherhood in Indonesia.

In 1987 an international conference brought global attention to an issue that previously had been ignored: the world's alarmingly high number of maternal deaths in childbirth. The conference ended with a declaration calling for a reduction in maternal mortality by at least half by the year 2000. As the deadline approached, safe motherhood activists lamented the fact that the world was nowhere near to achieving this objective. They attributed this failure to a variety of causes, but were in agreement that the medical technology was available to prevent maternal deaths in childbirth, and the key was generating the political will to make such technology widely available to women in developing countries.What 'political will' means, however, has been left as an unopened black box. What causes governments to give priority to the issue of safe motherhood, given that national political systems are burdened with thousands of issues to sort through each year? In marked contrast to our extensive knowledge about the medical interventions necessary to prevent maternal death, we know little about the political interventions necessary to increase the likelihood that national leaders pay meaningful attention to the issue. Drawing from a scholarly literature on agenda setting, this paper identifies four factors that heighten the likelihood that an issue will rise to national-level attention: the existence of clear indicators showing that a problem exists; the presence of effective political entrepreneurs to push the cause; the organization of attention-generating focusing events that promote widespread concern for the issue; and the availability of politically palatable policy alternatives that enable national leaders to understand that the problem is surmountable. The paper presents a case study of the emergence, waning and re-generation of political priority for safe motherhood in Indonesia over the decade 1987-1997, to highlight how these four factors interacted to raise safe motherhood from near obscurity in the country to national-level prominence. While there are contextual factors that make this case unique, some elements are applicable to all developing countries. The paper draws out these dimensions in the hope that greater knowledge surrounding how political will actually has been generated can help shape strategic action to address this much neglected global problem.

Decision Making↗
PubMed2003

The struggle over employee benefits: the role of labor in influencing modern health policy.

After organized labor failed to institute national health insurance in the mid-twentieth century, its influence on health care policy diminished even further. This article proposes an alternative interpretation of the development of health care policy in the United States, by examining the association of health policy with the relationships between employers and employees. The social welfare and health insurance systems that resulted were a direct outcome of the pressures brought by organized and unorganized labor movements. The greater dependency created by industrial and demographic changes, conflicts between labor and capital over the political meaning of disease and accidents, and attempts by the political system to mitigate the impending social crisis all helped determine new health policy options.

Employment↗
PubMed1999

Health sector reform in the Republic of Macedonia.

AIM: To evaluate the results of current reforms in Macedonian health sector. METHOD: Description and situation analysis, covering the period 1991-1997, are focused on demographic and vital indicators, morbidity and mortality data, elements of health care system, legislation, health insurance, health care financing, and elements of health care reforms. RESULTS: The Republic of Macedonia experienced changes in the social and economic situation, similar to those in other countries in transition. The growing number of dependents (young and old persons) impact high health expenditures. High priority health problems were infant and premature adult mortality. As an inheritance of the former political system, the development of different parts of health care services was unbalanced and insurance and local network of health facilities were highly decentralized. The reforms addressed health financing and reimbursement, organization and management of health services, and pharmaceutical policies and supply. The legislation was revised, but new revision is needed. CONCLUSIONS: Health care reforms were needed in Republic of Macedonia in order to overcome the problems associated with early phase of transition. The disadvantages of the current reforms are: lack of proper political will for the implementation of activities according to the planned schedule, initial over-utilization of hospital care, and no significant changes in financing of the public sector facilities. The advantages are that the health system did not disintegrate, universal access to health services was maintained, free choice of physician was promoted, and public/private mix of services was established and financed by the Health Insurance Fund.

Delivery of Health Care↗
PubMed1980

Health policy and religion: conflict and accommodation in Israeli politics.

The paper focuses on the impact of religious values and organizations on two issues of health policy, abortion and autopsy, both of which have been subjects of deep controversy between religious and nonreligious groups. The comparison between the issues centers on three stages of policy making: problem formation, problem solving and decision making. Two models of influence on public policy are employed: (1) one in which political parties attempt to suppress issues, and (2) a group model which applies to a well articulated, controversial issue which is resolved by groups with direct access to decision makers. The party model is relevant to the abortion issue, which was submerged beneath the surface of the public agenda due to national-religious value orientations. The group model fits the autopsy issue, which has been a subject of controversy between the Medical Association and religious groups. Decision making on these issues was characterized by a pattern of compromise and accommodation which resulted in only slight deviations from norms of behavior previously practiced. The decisions made reflected the intricacies of the Israeli political system, and the salience of religious values in health policy making.

Abortion, Induced↗
PubMed2002

Threat to ethnic identity: the experience of White Afrikaans-speaking participants in postapartheid South Africa.

The dismantling of apartheid and the postapartheid dispensation had far-reaching implications for all the citizens of South Africa. In an urban sample of White Afrikaans-speaking South Africans (Afrikaners) in postapartheid South Africa, the authors investigated perceptions of threat to ethnic identity, as well as correlates of those perceptions. The respondents experienced threat on 2 levels: The 1st was distinctive continuity, the concern that their ethnic group would not continue as a distinctive group in society. The 2nd was the evaluative dimension of ethnic identity (i.e., well-being), the concern that group membership would no longer contribute to positive self-esteem. The respondents experienced greater threat on the 2nd level, reflecting predominantly negative experiences as White Afrikaans-speaking persons in postapartheid South Africa. A high threat perception on the 2nd level was associated with (a) a perception of other groups' negative evaluations of their ethnic group, (b) negative attitudes toward political changes, and (c) perceptions of illegitimacy and instability of the postapartheid political system. The respondents who felt that Afrikaners would not continue as a distinctive group in society had a more positive attitude toward the sociopolitical changes, did not show strong ethnic identification, and had a negative collective self-esteem. They were also politically more liberal. Those findings are discussed in relation to theoretical expectations.

Adult↗
PubMed1997

Human rights and the politics of risk and blame: lessons from the international reproductive health movement.

Recent debates about the "politicization" of public health obscure the ways in which epidemiological concepts of risk are routinely used in the legal and political systems to apportion blame and responsibility for poor health. This article uses the example of reproductive health and rights to argue that new understandings of the connection between socioeconomic conditions and poor health will only generate change when they are reframed into political claims and pressed by social movements. In this connection, human rights language, principles, and practice hold great potential for the US reproductive rights movement, which has sometimes been constrained by the narrow scope of court rulings.

Family Planning Services↗
PubMed1990

Orphans as a window on the AIDS epidemic in Sub-Saharan Africa: initial results and implications of a study in Uganda.

Provisional estimates from a Save the Children Fund enumeration study in four Ugandan districts indicate that the total number of orphans (one or both parents missing) ranges between 620,000 and 1,200,000. Needs assessments with guardians and local administrators show that although extended family networks are absorbing these children according to traditional rules, they may be vulnerable to increased mortality due to economic and health stresses on their caretakers, many of whom are elderly persons. The orphan burden will increase in Uganda and other Sub-Saharan African countries over the next few years. Allocation of additional national and international resources must be considered to avert breakdowns in community and familial support systems and consequent increases in under 5 mortality. The orphan burden is a window on the potential for massive social breakdown and dislocation in Sub-Saharan Africa resulting from high AIDS-related mortality. Methodologies for data collection and planning that use indigenous political systems must be built quickly to avert disaster.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Foundations of psychosocial dynamic personality theory of collective people.

The concept of personality emerged as a part of the development of individualism in the western world to understand the quality of the newborn (individual). In premodern society, roles were the elements that constituted the person. Presently, about 80% of the people (Africa, Asia, and South America) in the world still live in a collective, authoritarian system. Personality theories that have been developed in Europe and North America seem to be limited in understanding and predicting the behavior of these people. One major difference between individualistic and collective peoples is their degree of individuation from the family. Western social-political systems enable individuals at the end of their development course to form an independent personality (or self) that is unique and different from others. For westerners, personality structures and processes enable us to predict behavior. Psychopathology is attributed to an intrapsychic disorder within the personality. Typically, psychotherapy aims to restore that order. For people who live in collective social systems, individuation does not take place. Therefore, norms, values, roles, and familial authority directives predict behavior more than personality. Psychopathology among these people has to do with interpersonal disorder within the family. Therefore, psychotherapy should aim to restore that order. This manuscript suggests foundations of a new psychosocial dynamic theory of personality to better fit our understanding of people living in collective societies.

Arab World↗
PubMed1974

University research and the new federalism.

In this brief article we have touched on some of the solutions to problems universities are encountering in working with the expanding "new federalism." These arrangements will bring faculties into new kinds of relationships, which they can find stimulating if they are prepared ahead of time to accept the kind of public scrutiny that they have not encountered at the national level and to learn about the political system and the politician (13). Universities will find advantages for their academic programs if they involve faculty and students in programs that promote the advancement of public good provided that caution is exercised to prevent the development of arrangements that restrict academic freedom, push the university into the political arena, and drain its financial resources. Faculties need to work closely with their university administrations to make sure that valid academic principles are upheld. The exercise will be time-consuming and frustrating, but vital to the objective and the high quality support the public expects from universities.

Costs and Cost Analysis↗
PubMed1985

Gamesmanship: the art of strategizing.

How can you turn your personal power into organizational power? By recognizing that the hospital or university is motivated by politics and using the political system to your advantage. Learn how to select and use specific approaches and tactics to increase your effectiveness.

Administrative Personnel↗
PubMed1999

Litigation and public health policy making: the case of tobacco control.

Many tobacco control advocates, believing that legislators and regulators have failed to enact and implement sufficiently stringent tobacco control laws, have supported litigation as a means of achieving public health policy goals. In this article, we examine the relationship between litigation and public health policy formulation in the context of the debate over tobacco control policy. The fundamental questions are how social policy should be made regarding the use of tobacco products, and which institutions should be responsible for controlling tobacco use: the market, the political system (i.e., the legislative and regulatory branches of government), or the courts. On balance we conclude that litigation is a second-best solution. We see a distinct role for litigation as a complement to a broader, comprehensive approach to tobacco control policy making, rather than as an alternative to the traditional political apparatus of formulating and implementing public health policy. Our analysis suggests that, in general, public health goals are more directly achievable through the political process than through litigation, though situations such as those concerning tobacco control blur the bounds between litigation and the politics of public health. Litigation has stimulated a national debate over the role of smoking in society and may well move the policy agenda. But we conclude that a sustained legislative and regulatory presence ought to be the foundation of meaningful policy changes.

Humans↗
PubMedDate not supplied

Health human resource reform in Tajikistan: part of a masterplan for change.

Like many countries of the former Soviet Union, the Republic of Tajikistan inherited a poorly paid physician workforce dominated by specialists. This Central Asian republic has been forced to move slowly to change the physician workforce and to implement primary health care. Several years of civil war following independence in 1991 made reform of the struggling health system politically and economically difficult. The civil war also resulted in a loss of health personnel, with significant numbers of physicians leaving the country. The low pay of health professionals caused others to move to higher paying jobs in non-health related professions. A comprehensive masterplan for the reform of the health care system that has been developed through a participatory process is in the process of formal approval. The human resources component of the health care reform masterplan calls for a shift to emphasize the role of primary health care and the introduction of family physicians (FPs) as the cornerstone of the primary health care. With only 90 family practice physicians trained in 2000, the country faces a massive task in retraining existing physicians and training new FPs. The first 40 medical students to enter training as FPs are scheduled for 2001. Retraining at the Post Graduate Institute will be supplemented in 2002 by programs in the three oblasts. To overcome the shortage of FPs a comprehensive job analysis and workload assessment will be conducted to redefine the role of health professionals and involve others in the provision of care. Historically nurses have not been allowed to perform to their full capability and physicians have performed tasks more suitable for mid-level personnel. A strategy to solve maldistribution problems and to develop incentives to stem the loss of physicians will be also implemented. While circumstances have forced the Republic of Tajikistan to move slower than other countries to reform the inefficient health system inherited from the Soviet Union, the current masterplan for the entire system shows a commitment to change. The Masterplan, along with lessons from what has occurred in other countries, provide an opportunity for a well-ordered reform of health human resources within the overall context of health system reform.

Family Practice↗
PubMed1989

Accommodating rapid growth in physician supply: lessons from Israel, warnings for Canada.

Most developing countries find themselves grappling with the implications of rapid growth in physician supply. The purpose of this article is to search for lessons or warnings for Canada (and, ultimately, elsewhere) in the manner in which Israel has chosen to accommodate its huge supply of physicians. Under extremely conservative assumptions about immigration, and assuming rates of domestic training of physicians at levels somewhat lower than at present, Canada's physician supply will continue to grow at rates in excess of general population growth for at least the next 45 years. In this article we describe the Israeli health care system from a perspective of identifying the consequences of accommodating a physician supply about 50 percent higher than that in Canada. A number of key "accommodation attributes" (low physician incomes, restricted access to hospitals for general practitioners, intramedical-professional conflicts over income and authority, a flourishing black market) are argued to be more than simply products of a unique cultural and political system, but also symptoms of a system vastly oversupplied with physicians. Early signs in Canada of similar "products" of a growing physician supply are noted. While a two-country comparison makes drawing lessons somewhat speculative, the coincidence of events suggests that these trends in Canada warrant, if not immediate action, at least careful monitoring.

Adult↗
PubMed2000

Political change and course of schizophrenia in East Germany, 1984-1994.

BACKGROUND: We tested the hypothesis that the political change occurring in East Germany after the fall of the Berlin Wall in November 1989 affected patients with long-term schizophrenia, resulting in more and longer hospitalisations. METHODS: In two samples in East Germany (120 patients in East Berlin, 70 patients in Chemnitz) and in a control group from West Berlin (40 patients), hospitalisations for each month between November 1984 and October 1994 were assessed. Each sample included all schizophrenia patients who were in continuous treatment in the given community mental health centre throughout the full observation period. RESULTS: Hospitalisation indices were not higher after November 1989 than before in any of the groups. CONCLUSIONS: There is no evidence that political change in East Germany negatively affected the course of longterm schizophrenia as assessed by hospitalisations. If consistent medical care is provided, characteristics of the political system may have less impact on the course of schizophrenia than is sometimes assumed.

Adult↗
PubMed2003

The health crisis in Argentina.

The health crisis in Argentina is part of the larger crisis that has resulted from a collapse in the country's economic and political systems. After a brief review of the country's history over the last century, from international success story to economic failure, the author explains the health crisis in particular and the social crisis in general in terms of failed neoliberal policies imposed on Argentina by the United States and International Monetary Fund through the mediation of the country's political class.

Argentina↗