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At least 145 records · Page 8Linked to original sources
PubMed2006

Economic evaluation in the US: what is the missing link?

In this paper we consider the evolving American healthcare landscape and what it means for the use of economic evaluation of health interventions. We emphasise that use of economic evaluation in the US is unlikely to follow the European, Canadian or Australian models, which use cost effectiveness openly and explicitly, given the decentralised manner in which American healthcare is organised, financed and delivered, as well as different political systems and traditions, and cultural expectations and attitudes surrounding healthcare. However, this does not mean that considerations of value are absent. On the contrary, measurement of value remains near the top of the agenda among US policy makers. With a few exceptions, it just isn't playing out explicitly. In the American context, it means in part heightened debate over clinical evidence, and cost sharing. In some cases, payers are also considering economic evaluation more directly in coverage and reimbursement decisions and indirectly for clinical practice guidelines and best practice recommendations. A dramatic shift in policy towards cost effectiveness seems unlikely in the near future. Change will likely come in incremental fashion through experimentation, and perhaps in selected circumstances with public and private leaders willing to take the political risks. Conceivably, more substantial change will occur with a major shift in the political leadership in Washington, DC in the legislative or executive branches, and/or with an economic downturn and severe pressures on federal and state health budgets. However, a more likely outcome is the ongoing indirect use of cost-effectiveness information.

Delivery of Health Care↗
PubMedDate not supplied

International migration, "middle classness" and the state.

"This paper examines the issues of who is likely to migrate and why, and what happens when people migrate, by viewing the migratory process as a strategy formulated and implemented by networks of kin for culturally surviving the redefinitions of contemporary political systems within the context of the capitalist world economy. Specifically the argument presented is that people move across the juridical boundaries of contemporary nation-states as part of household strategies designed to maintain membership in a specific social stratum. For a substantial number this social stratum is a middle class. Self-identification with a social stratum, in other words, takes precedence over self-identification with, and commitments to, nation, region or ethnic group."

Behavior↗
PubMed1999

Resilience among urban African American male adolescents: a study of the protective effects of sociopolitical control on their mental health.

Resilience refers to the notion that some people succeed in the face of adversity. In a risk-protective model of resilience, a protective factor interacts with a risk factor to mitigate the occurrence of a negative outcome. This study tested longitudinally the protective effects of sociopolitical control on the link between helplessness and mental health. The study included 172 urban, male, African American adolescents, who were interviewed twice, 6 months apart. Sociopolitical control was defined as the beliefs about one's capabilities and efficacy in social and political systems. Two mental health outcomes were examined--psychological symptoms and self-esteem. Regression analysis to predict psychological symptoms and self-esteem over time were conducted. High levels of sociopolitical control were found to limit the negative consequences of helplessness on mental health. The results suggest that sociopolitical control may help to protect youths from the negative consequences of feelings of helplessness. Implications for prevention strategies are discussed.

Adolescent↗
PubMed2002

Developing a model to enhance the capacity of statutory organisations to engage with lay communities.

OBJECTIVE: To understand the processes that constrain the capacity of statutory organisations to work effectively with lay communities and to develop a model to enhance their capacity to do so. METHODS: The research consisted of three elements: a review of relevant literature; in-depth interviews with a purposive sample of people who had recently been involved in community-statutory sector partnership; and a deliberative workshop involving ten expert witnesses, selected to reflect a range of sectors and levels within organisations. RESULTS: Many factors contribute to a lack of effective strategic partnerships between lay communities and statutory organisations. These factors fall into five domains: the community's capacity to engage; the skills and competencies of organisational staff; the dominant professional service culture; the overall organisational ethos and culture; and the dynamics of the local and national political systems. A model of the relationships and/or interaction between these domains is postulated. There is potential for testing this model with statutory organisations to see whether it concurs with their reality and whether it is enhancing their organisational capacity. CONCLUSIONS: Commonly occurring constraints to effective partnerships between statutory organisations and lay communities need to be identified and addressed by applying a dynamic model of the type presented here.

Community Health Planning↗
PubMed2000

[Differences in health status--policy, life style and genes].

BACKGROUND: The five Nordic countries seem rather homogeneous when assessed from abroad. They do have a lot in common: similar political systems, same standard of living, and even a common language root for a large part of the population. The Nordic countries have collaborated quite closely after the Second World War in fields like the labour market, pension rights and passport control. However, the health status has varied considerably during the twentieth century, even though death rates from some of the most common diseases such as cardiovascular disease are starting to converge. MATERIAL AND METHODS: Vital statistics have been compared with regard to some common diseases. The differences are described according to current knowledge on preventive programmes such as breast cancer screening and screening for cardiovascular risk. The prevalence of some lifestyle variables such as alcohol, smoking, physical activity and fat consumption are reported. RESULTS AND INTERPRETATION: Lung cancer and cancer of the stomach still show substantial variation between the countries. Both discrepancies and similarities must be related to lifestyle, culture, politics and to some extent genetics. The five countries have their own viewpoints on tobacco, alcohol and nutrition policy, with the Danes the more liberal, and Swedes, Finns and Norwegians pursuing a stricter policy. These differences are to some extent reflected in the incidence of lung cancer, which are more positive in Finland, and the high death rates from liver cirrhosis in Denmark. The relatively unsatisfactory development in Denmark may be a consequence of a much longer period of structural unemployment than the other countries, as well as a more liberal attitude towards alcohol and smoking.

Adolescent↗
PubMed1996

A physician's view from the Hill.

Rarely do physicians have the opportunity to participate in our political system on a day-to-day basis. The Robert Wood Johnson Health Policy Fellowship, a one-year program for mid-career medical professionals, provides just such an experience. The Fellows begin with a two- to three-month orientation phase before selecting a congressional work assignment. As a member of a congressional staff, a Fellow has the opportunity to learn from, as well as contribute to, the legislative process. The health policy experience provides another tool to complement the clinical and management expertise of the physician executive.

Adult↗
PubMed2004

The commons in transition: agrarian and environmental change in Central and Eastern Europe.

This paper analyzes institutional dynamics surrounding common-pool resources in postsocialist Central and Eastern Europe. It is conceived in close conjunction with the case studies by Penov, Schleyer, and Wasilewski and Krukowski (this issue). The purpose of this paper is to frame the individual case inquiries, compare their findings, and relate those to broader agrarian and environmental changes in the region. The case studies report a broad shift in resource governance from the previously dominant legal and administrative state hierarchies towards markets. In addition, state power has moved from central towards local authorities. The waning and decentralization of state power has caused the emergence of significant gaps between property legislation and rights-inpractice, which have been particularly stark in fragmented political systems. The discrepancy between legal texts and rights-in-practice leads to the exclusion of wider interests in favor of individual interests in the management of common-pool resources, resulting in resource deterioration and dwindling resource stocks. Thus, the comparative assessment suggests a tentative framework for understanding the effects of postsocialist transformations on governance of the commons and environmental change in Central and Eastern Europe. Its findings indicate an additional dimension to the diversity and distributive conflicts characterizing postsocialist privatization: the distribution of various rights to a resource among different actors. The findings also suggest the need for postsocialist states to take an active role in the governance of common-pool resources, particularly in the enforcement of legal rights.

Agriculture↗
PubMedDate not supplied

Medicine at the centre of the nation's affairs.

The medical profession was shaped a century or so ago by the interaction of three forces. These were a class structure in which doctors were largely held to be gentlemen to whom deference was due, a society dominated by the activity of production (hence the label of the working class for the majority), and the doctrines of liberalism as the guiding star in politics. Prime Minister Gladstone defined his task as "opening doors and windows." The outcome was a minimum of government interference and control with the belief that professional self regulation was the way to ensure that practice matched principle. The state (the word was hardly ever used) was self effacing almost to the point of non-existence. These are ghosts of the past, but it is a comparatively recent past. Within memory, the major domestic preoccupation of politicians of all parties was how, and to what ends, the working class could be absorbed into the political system. Health had a crucial part to play in this task, as Lloyd George and others saw early on. The "panel" was very much a forerunner of the NHS. Indeed, Bevan based part of his case in 1946 on the claim that 21 million people were already on the "panel," clear evidence of the degree to which society was still dominated by production. While speaking of Nye Bevan, we might examine his claim that the NHS was "pure socialism." In fact, it was rather closer to being "impure liberalism" in the consideration with which general practitioners and consultants were treated, the considerable freedom enjoyed by local administrations, and the low profile of government itself. That is why many remember the period as something of a golden age. It suited almost everyone very well.

Government↗
PubMed1994

Socio-economic restructuring and vulnerability to environmental hazards in Bulgaria.

The restructuring of Bulgaria's social, economic and political system includes a change in the way it handles disaster preparation and response. During the Cold War, the entire country drilled regularly in civil defense, which was under the control of the army. A recent decree and pending legislation transfers civil defense from the military to the Council of Ministers, which has developed a national plan for defense against environmental hazards. This research shows that the transformation from command to market economy, plus the country's severe economic crisis, is degrading existing civil defense structures, preventing the implementation of the proposed new organization and increasing the population's vulnerability to hazards. Case studies of a small city, a petrochemical complex, coastal-zone hazards management, earthquake hazards regulation and the Kozloduy nuclear facility demonstrate Bulgaria's increasing vulnerability to environmental hazards.

Bulgaria↗
PubMed2006

Needs assessment for health care management education in Russia.

INTRODUCTION: For more than 70 years, health care management in the Soviet Union reflected a centralized directive style familiar to the Soviet political system. Market-oriented reform in post-Soviet Russia is pushing practicing physicians and physician-executives to acquire new information and skills regarding health care management. To assist with health care management in Russia, we analyzed health care providers' educational needs, as they perceive them. METHODS: A total of 4, 367 questionnaires were sent to practicing physicians and physician-executives in 3 regions of the Russian Federation. The questionnaires included 14 items designed to determine respondents' current levels of satisfaction and preferences for health care management education in Russia. RESULTS: There were 847 questionnaires returned, for a total response rate of 19.4%. Physicians were dissatisfied with the current status of health care management education, but they were interested in learning the skills of health care management. The health care legal system and computer systems and data analysis were the most popular courses requested; health care management and marketing were the least popular. Learning interests of executives differed from those of practicing physicians, and regions differed in their combined interests for courses. Medical school and continuing education departments were seen as the best choices for delivering health care management education. DISCUSSION: As health care policy shifts in new directions, physicians in leadership positions expect Russian medical schools and continuing education departments to provide courses that enable improvements in health care.

Adult↗
PubMedDate not supplied

The metamorphosis of health planning in the Netherlands and the USA.

The United States and the Netherlands are the focus for this comparative analysis of the evolutionary interaction between health planning and the political system, seen in the context of change in social and economic ideologies. While health planning in the USA started in 1946, it was the comprehensive health planning program in 1966 that created the form to be followed by Health Systems Agency effort in 1974: local, voluntary planning, coordinated by state agencies, supported by federal funding. Health planning in the Netherlands has moved through four distinct periods: a hospital construction period starting during the post-war recovery; a hospital regionalization period, from 1971 through the late 1970s; a transition period from the late 1970s to 1982, during which several planning approaches were considered; and, the current comprehensive health and social services planning period. Today, federal support for health planning in the US has been eliminated as part of the current de-regulatory, competitive health care strategy. Health planning in the US is now an institutional activity, with less focus on community needs. Advocated changes in the Dutch planning approach incorporate ideas similar to past approaches in the US; but, a failed approach in one nation may work in another, if the underlying cultural and organizational characteristics are sufficiently different.

Delivery of Health Care↗
PubMed2005

Schools uniting neighborhoods: the SUN initiative in Portland, Oregon.

The SUN Community Schools Initiative is a community-driven model that allows each school community to design the programs that fit neighborhood needs in Portland, Oregon. County and city governments, local school districts, and community agencies have jointly leveraged resources to support fifty-one community schools. The program is managed by the Multnomah County Department of School and Community Partnerships. The City Parks and Recreation Bureau oversees twelve sites staffed by city employees. Strong support across political systems aligns funding and reduces the fragmentation in existing funding patterns.

Adolescent↗
PubMed1978

Community mental health services in rural areas: some practical issues.

Several critical issues involved in successfully initiating and maintaining a community mental health center program in a rural setting are discussed. These include the necessity of accurately assessing the existing social, cultural, and political system, and of fitting the mental health center program into these systems as smoothly as possible; the special problems faced in maintaining confidentiality; and the importance of recognizing and dealing with the front-line pressures on professional staff that are peculiar to the rural setting. Advantages as well as disadvantages of working in a rural program are considered.

Attitude of Health Personnel↗