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PubMed1995

Musings of a Robert Wood Johnson health policy fellow.

BACKGROUND: Changes in national health policy affect all health care providers. To increase its understanding and involvement in health care development, in 1973, the medical profession, through the Institute of Medicine, developed a formal program--the Robert Wood Johnson (RWJ) Health Policy Fellowships Program--in the nation's capital. METHODS: Each year, since the mid-'70s, the RWJ Health Policy Fellowships Program provides "hands-on" health policy development experiences, to mid-career health professionals. Participants obtain an understanding of the health policy process at the national level, and an opportunity to contribute to the formulation of new policies and programs. RESULTS: The author describes his 1989-1990 RWJ Fellowship year. He reports that health professionals can and do contribute significantly in the development of national health policy. He also observes that there has been minimal participation by optometrists in the RWJ Health Policy Fellowship Program. During his fellowship, the author observed that the optometry profession was poorly understood and underrepresented at the national level. CONCLUSIONS: There is a need for direct optometric involvement in national health policy development. The RWJ Health Policy Fellowships Program provides exemplary policy experiences. This and alternative methods to increase optometric involvement and participation in health policy development, are discussed.

Fellowships and Scholarships↗
PubMed1981

Health policy and the politics of health: priorities and planning for health care in Puerto Rico.

Puerto Rico, with the rest of the Caribbean, inherited the historical legacy of colonialism, slavery, and ethnic diversity. With its neighbors, Puerto Rico shares a tropical climate, a strategic location, and an agricultural past. Despite such similarities, Puerto Rico's health systems have evolved at rates and in directions different from its Caribbean neighbors. The ways in which services are organized have varied as a function of each country's political relationship with its respective metropolitan power, its stage of economic development, its endowment in terms of natural and other resources, its size and population, and its cultural environment, among other factors. For this reason, the Caribbean presents a veritable kaleidoscope of patterns of delivering health care. The following comments are primarily devoted to Puerto Rico, where the author is directly involved with health policy and the politics of health.

Ambulatory Care↗
PubMedDate not supplied

An activist looks at nursing's role in health policy development.

Health care delivery systems are evolving and transforming rapidly. Nurses will need new leadership and policy skills to meet the challenge of ensuring patient care safety and quality health care delivery. Nurses bring a unique perspective to health care policy development because of their educational training, professional values and ethics, advocacy skills, and experiential background. Significant progress has occurred over the years toward advancing nursing's presence, role, and influence in the development of health care policy. However, more nurses need to learn how to identify issues strategically; work with decision makers; understand who holds the power in the workplace, communities, state and federal level organizations; and understand who controls the resources for health care services. In health care policy development, nurses are essential in ensuring quality health care that is accessible and affordable for all women and their infants. More nurses need to actively work as leaders in the health policy arena.

Health Policy↗
PubMed1995

[Health policy goals in child and adolescent health reporting--evaluation with reference to an intermediate-term evaluation].

As a result of the first report on the health of children in Hamburg (1990) 14 primary health policy objectives were identified and related to specific intervention fields. The health information system group at Hamburg has prepared an interim evaluative statement for 1994 on whether and how far each objective has been achieved compared to the targets formulated for the years 1995 and 2000 respectively. 8 out of 14 objectives are considered remaining unchanged as before (i.e. unintentional conception), either proceeding towards the target (i.e. low birth weight, dental health) or having reached the target for 1995 (i.e. infant mortality, age-appropriate vaccination). With 4 objectives the trend deteriorated (i.e. body weight of teenagers, accidents). One objective was monitored on the basis of a new data source (violence against children) and for one objective information could not be proved or updated (breast feeding). In traditional areas of local health policy (i.e. dental health, infant mortality) the health information system and the health targets may be sufficient to help improve the health of the city. In non-lobbied fields (i.e. breast feeding) or those without a consensus on responsibilities (i.e. violence, health and social discrimination) health reports on their own do not invoke achievements, but need to be supported by additional measures.

Adolescent↗
PubMed1996

Health for All and British health policy: a comment on the quest for "healthy public policy".

Explains that Health for All is an international extra-governmental movement that seeks to pursue equity in access to health-related resources by broadening the scope of health policy. Notes that its major principles include social participation in state decision making, inter-sectoral collaboration in policy formulation and the improvement of conditions for the disadvantaged. Points out that its local initiatives often encompass health-service professionals and practitioners as well as the voluntary sector, social services and other local authority departments, and that the effect of this local activity on political understandings of health at a national level gives some indication of the extent to which this local time and effort have been justified. In this respect, notes two limits to the impact of the Health for All movement on the political debates about health in Britain. Suggests that these centre on a largely indifferent but powerful national government and an emphasis within the movement initiatives at the level of a politically marginalized local state.

Health Care Rationing↗
PubMed2001

Testing relationships among determinants of health, health policy, and self-assessed health status in Quebec.

By removing financial barriers, the Canada Health Act (1984) equalized access to health care services in Canada. Yet class, educational, and geographical disparities in individual and population health status persist. Recent health reform policies in Quebec assert that health and well-being are a function of income, educational level, housing conditions, employment, and other socioeconomic factors. They suggest that health policy should encompass social policies that influence individual and community socioeconomic factors which in turn affect health. Against the backdrop of these reforms, this study tests the importance of socioeconomic factors as a determinant of health--while controlling for other known determinants through a logistic regression model--with data from the Santé Quebec health surveys 1987 and 1992-93. The results confirm the importance of economic security as a determinant of individual health. This effect appears to operate through an individual income variable and through the community-level variable of regional unemployment. The importance of the income effect declined between 1987 and 1992-93. This may indicate that an increased focus on the socioeconomic determinants of health has reduced inequalities in health. It may also mean that health inequalities appear inevitable until health care policy merges completely with broader health and social policies. But such integration may well conflict with economic (and political) imperatives of the post-Fordist capitalist system.

Adolescent↗
PubMed1990

Equity objectives in Portuguese health policy.

The health-equity debate has generally given far more attention to empirical rather than conceptual matters. However, empirical work on equity is at its most useful when it can be related to a specific normative framework, such as that provided by public pronouncements. This paper, therefore, aims to extract the precise equity objectives of one health care system, that of Portugal. Three seemingly distinct objectives in Portuguese health policy are identified: (i) access to health promoting commodities; (ii) equal access to NHS care for equal need; and (iii) equal access to both public and private health care. The final section attempts to find common threads running through these definitions and presents suggestions for future research. Though referred specifically to Portugal, the paper should be of interest to researchers in other countries, where a great deal of health-equity investigation continues to put the cart before the horse, by identifying unequal distributions without considering if they are simultaneously inequitable.

Health Policy↗
PubMed1983

New federalism and health policy.

The making of health policy in the United States is a complex process that involves the private and public sectors, including multiple levels of government. Five characteristics of the policy process are identified, which establish the means by which policies are formulated and which affect the nature of the policies that emerge. These characteristics include (1) the relationship of the government to the private sector; (2) the distribution of authority and responsibility within a federal system of government; (3) the relationship between policy formation and implementation; (4) a pluralistic ideology as the basis of politics; and (5) incrementalism as the strategy for reform. The article focuses on the impact on health policy of the distribution of authority and responsibility within the federal system, particularly the impact of new federalism policies as they emerged during the past decade. The effects of dual federalism, cooperative federalism, creative federalism, and new federalism are examined in relation to health policies. The article concludes with an examination of the challenge to long-established values and health policies posed by new federalism.

Government↗
PubMed1999

What does society expect from health policy makers in reproductive health?

Family planning, and preventive measures generally, are very important for the health of a society. Despite this, official policy in Hungary has not given them enough support and recognition in recent years. The latest "act for the protection of the fetus," issued some years ago, dealt mainly with abortion; shortly thereafter, the health insurance stopped subsidizing the cost of contraceptives. Nowadays, patients must pay full price not only for condoms, but for pills, IUDs and even sterilization. The cost of preventing unwanted pregnancies became high; for many today, the reliable, modern methods are almost unaffordable. This situation is more than strange in a country with such high numbers and rates of induced abortion. Another problem is that service providers have too few resources. In the wake of the political and fiscal changes that have taken place since the early 1990s, the state does not have enough money to meet the need for this type of preventive work. There are still few non-governmental organizations (NGOs) operating in Hungary: those that there are do not yet have the financial strength to sponsor these initiatives. In light of these circumstances, decision makers concerned to reverse the disturbing demographic trends should concentrate on changing the health policy.

Family Planning Services↗
PubMed1991

Analysis of health policy--principles and practice.

Health policy analysis covers a wide range of activities: from university-based research to practical activities carried out by bureaucrats and professionals working within the health system with independent unit or think tanks for health policy analysis as a third alternative. A key distinction is between analysis of policy and analysis for policy, which has eight key features: problem-centered; bias to facts and data; multidisciplinary; emphasis on feasibility; uses techniques and political awareness; quantitative and qualitative analysis; role of values; and timing of analysis. Decision-making is not a rational, logical process in which information and research determine policy outcomes, but a highly political process in which power and interest are the main driving forces. Health policy analyses can make a small contribution. Communication and salesmanship must go hand in hand with good academic techniques if research is to influence policy.

Bias↗
PubMed2002

Integrating health law and health policy: a European perspective.

Health law is intended to create an environment in which the promotion of health goes hand in hand with the protection of individual rights and the general principles of equality and justice. Over the years, the importance of health law has grown, both at national and international level. As health and human rights are closely interlinked, it is important to integrate health law and health policy. It is to be expected that, especially in Europe, the impact of health law on health policy-making will increase as a result of several developments, e.g. the internationalization of health care and health policy, the issue of consumer protection and the legalization of society. This requires a strategy to stimulate the fruitful relationship between health policy and health law. The most important components of this strategy are discussed.

Consumer Advocacy↗
PubMed1997

Reflections on national rural health policy: the 'big picture' framework.

A major concern of many rural and remote communities, as they struggle to cope with the impacts of social, economic and demographic changes, is the effect of government policies on health services. The National Rural Health Strategy has evolved as the key framework guiding action for improving health services for people in rural and remote Australia. The importance of maintaining an awareness of the 'big picture' of rural health remains paramount if interventions designed to bring about improved health status are to tackle the underlying causes of the problems, minimise problems associated with lack of co-ordination between health authorities, and avoid duplication of activity. Given the communality of rural health problems across Australia, close co-operation and collaboration among rural health groups is vital in developing appropriate national rural health policy. At the same time rural communities must continue to participate actively in the policy formulation and implementation process.

Australia↗
PubMed1985

Health policy and social workers in health: past, present, and future.

From its beginnings, social work has concerned itself with the broad social problems and issues affecting all society's citizens, and health care in this country has been one arena for this concern. Practice in health settings has both shaped and been shaped by health policy. What will its direction be in the years to come?

Forecasting↗
PubMed1995

In practice: the NHS market in the United Kingdom. Health Policy Network of the National Health Service Consultant's Association and the National Health Service Support Federation.

The National Health Service provides (and throughout its lifetime of nearly 47 years has provided) comprehensive health care of the highest professional quality at both primary and specialist levels and at very low cost whether expressed in terms of GDP or cash when compared with other industrialised countries. Until the NHS market was introduced, administrative overheads were also strikingly low, between 5% and 6% compared with at least 22% in the US. The legislation imposing the NHS market represents a fundamental reorganisation and fragmentation of the NHS into competing services with a new bureaucracy of business and financial managements topslicing funds for patient care. It is the latest of a number of reorganisations dating from the first plans published by the Conservative administration in May 1971. Our calculations show that the newly imposed market processes have doubled the administrative running costs of the NHS. This represents an additional administrative expenditure of at least I.7 billion pounds a year at current prices. This sum therefore represents a diversion of 1.7 billion pounds a year from clinical services and goes some way to explaining the criticism from clinicians and the delays and inconvenience experienced by the public despite government claims that more money is being spent on the NHS. We describe the clandestine origins of the NHS market and note good and bad effects of its introduction. Because of their serious implications, we describe eleven damaging side-effects. These include the conflict between strategic planning of care and the operation of market forces. We identify other side-effects that are considered to be inseparable from market operation and sufficiently serious to call for urgent redress. We suggest how good effects associated with the introduction of the NHS market (such as giving GPs more say in the development of hospital services) could be enhanced without the side-effects inherent in the NHS market. We urge that ways of addressing these issues should, whenever possible, be piloted before they are introduced nationally. (In the case of fundholding in general practice, this damaging and controversial change should be halted and ways found to replace it with consortium commissioning, for which there is relevant experience.) We discuss the need to halt any other fundamental and potentially destabilising reorganisation before it has been tried out in properly evaluated pilot schemes. This should not, however, be allowed to become a recipe for stagnation as the health policy of the next government.

Economic Competition↗
PubMed1977

Keeping up with ... health policy and women's health.

The author compares current data on women's health with men's, in the early and adult years, noting socioeconomic variations and similarly compares variations in their use of health services. Clues to changes in women's health are described and relevant areas of policy which can affect emerging health problems as women alter their position in society are sketched.

Acute Disease↗