The trend toward greater citizen participation in health care policy reform has its roots in the consumerism of the 1960s. This era witnessed the beginning of a dispersion of power in health care and an increase in the number and variety of stakeholders involved in the policy development process. Using the reform Ontario's long-term care policy as a case example, this paper offers observations about the benefits and challenges of participative policy-making. Despite the challenges and the paucity of hard evidence pointing to benefits, the author concludes that broad citizen participation in health care policy reform is a desirable goal. However, the capacity for genuine collaboration remains underdeveloped and requires more systematic refinement. PMID:10159410
Witte, Ann Dryden; Queralt, Magaly; Witt, Robert; Griesinger, Harriet
We provide descriptive evidence from Miami-Dade County (MDC) in FL and from five representative areas in Massachusetts (MA) that government policies governing welfare reform, the child-care subsidy system, and minimum-standards regulations have had considerable influence on the availability, price, and quality of infant and toddler care as welfare reform progressed from 1996 to 2000. We suspect that the markedly different proportion of the population that is native born and differences in inc...
Maarse, J A M Hans; Jeurissen, P P Patrick
As of 2015 a major reform in LTC is taking place in the Netherlands. An important objective of the reform is to reign in expenditure growth to safeguard the fiscal sustainability of LTC. Other objectives are to improve the quality of LTC by making it more client-tailored. The reform consists of four interrelated pillars: a normative reorientation, a shift from residential to non-residential care, decentralization of non-residential care and expenditure cuts. The article gives a brief overview of these pillars and their underlying assumptions. Furthermore, attention is paid to the political decision-making process and the politics of implementation and evaluation. Perceptions of the effects of the reform so far widely differ: positive views alternate with critical views. Though the reform is radical in various aspects, LTC care will remain a largely publicly funded provision. A statutory health insurance scheme will remain in place to cover residential care. The role of municipalities in publicly funded non-residential care is significantly upgraded. The final section contains a few policy lessons. PMID:26872702
During the twentieth-century, dramatic changes in the manner and location of care for the dying resulted in the conception and birth of the modern American hospice movement. Idealistic nurses, clergy, and others concerned about the plight of terminally ill cancer patients launched hospice as a necessary health care reform. As new hospice programs opened across the country, the idealism of the early leaders gave way to more pragmatic issues such as program viability. As hospice was studied and integrated into the health care system, it came to be redefined by the politics of health policy and the health care industry. As a result, there is a disarticulation between the needs of seriously ill persons and their families and the health care that is available to them. Important lessons can be learned from the history of the Medicare hospice benefit to help guide current palliative care policy initiatives. While formalized reimbursement for hospice enhanced organizational sustainability, many critical issues remain. PMID:22184500
Bara, AC; Van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.
Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of the health care system. Results. The reforms of the health care system in Romania have been realized in a rather difficult context of scarcity of financial and human resources. The Gross Domestic Pro...
Bara, AC; van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.
Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of th
Zlotnik, Sarah; Wilson, Leigh; Scribano, Philip; Wood, Joanne N; Noonan, Kathleen
Improving the health of children in foster care requires close collaboration between pediatrics and the child welfare system. Propelled by recent health care and child welfare policy reforms, there is a strong foundation for more accountable, collaborative models of care. Over the last 2 decades health care reforms have driven greater accountability in outcomes, access to care, and integrated services for children in foster care. Concurrently, changes in child welfare legislation have expanded the responsibility of child welfare agencies in ensuring child health. Bolstered by federal legislation, numerous jurisdictions are developing innovative cross-system workforce and payment strategies to improve health care delivery and health care outcomes for children in foster care, including: (1) hiring child welfare medical directors, (2) embedding nurses in child welfare agencies, (3) establishing specialized health care clinics, and (4) developing tailored child welfare managed care organizations. As pediatricians engage in cross-system efforts, they should keep in mind the following common elements to enhance their impact: embed staff with health expertise within child welfare settings, identify long-term sustainable funding mechanisms, and implement models for effective information sharing. Now is an opportune time for pediatricians to help strengthen health care provision for children involved with child welfare. PMID:26403650
Eliasoph, H; Ronson, J
Clearly, the building blocks are in place for true reform of the healthcare system. Leadership and political fortitude will be needed to direct the reform process and remove existing obstacles. It is the intention of the Policy Group on Health Reform to continue to develop and articulate new thinking and act as a catalyst for implementing solutions, respecting health reform. PMID:10345292
Ellen Marie Nedde
High and rapidly rising health care costs in the United States and growing ranks of uninsured persons have brought health care reform to the top of the U.S. Administration’s policy agenda. This paper describes the health care financing system in the United States, highlights what are viewed as its most serious shortcomings, and explores possible reasons for high and rising medical care costs. After brief descriptions of alternative reform proposals, the paper discusses universal coverage unde...
Full Text Available In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.
One of the main public health concerns in medium and high-income countries is how to deal with problems of functional dependency of a growing number of elderly individuals. This study aimed to identify converging issues in 30 countries with formal long-term care systems. A systematic review included articles, studies, and comparative international reports published from 2010 to 2015. The results show three trends in the design and development of these policies: (a) focus on the oldest or most dependent elderly, (b) expansion of financing based on individual contribution, and (c) promotion of home care and financial benefits for care in specialized centers (nursing homes and similar establishments). All three have positive effects on cost containment, despite limited evidence of impacts on people's health. PMID:26872224
Success in reforming energy sector depends on the implementation of the programme of economic reform agreed in February 1993. The difficulty of the negotiations between the International Monetary Fund and the Romanian government reflects the wider difficulties faced by the economy as a whole. They can be blamed in part on the legacy of uneconomic and inflexible industrial development and in part on opposition from interest groups which stand to lose from reform. Nonetheless, in spite of hesitant approach, the government does appear committed to the economic reform necessary to establish a market-oriented economy. But as the danger of a financial crisis engendered by the inadequately supported short-term borrowing of foreign exchange becomes urgent, the question is whether economic reform can be now implemented fast enough to protect economic enterprises and saving from a debt crisis. The scope for further delay in implementing the 1993 economic reform programme is fast disappearing. Procrastination should not be allowed to threaten the success of the reforms achieved in the energy and other sectors of the economy. 8 refs., 2 figs
Despite relatively generous coverage of the over-65 population, Danish home help services receive regular criticism in the media and public opinion polls. Perhaps as a consequence, reforms of Danish home care policy for senior citizens have placed strong emphasis on quality since the 1990s. This...... reform strategy represents a shift from the welfare state modernisation program of the 1980s, which built mainly on economic strategies of cost-efficiency and New Public Management (NPM) princi-ples, including contract management and performance management. Recent reforms have instead attempted to...... increase the overall quality of care by increasing the transparency at the political, administrative and user levels. However, reforms have revolved around conflicting principles of standardisation and the individualisation of care provision and primarily succeeded in increasing the political and ad-ministrative...
Kornstad, Tom; Thoresen, Thor Olav
Mothers of preschool children represent one part of the population that might be able to increase its labor supply. We discuss effects of family policy changes that encourage the labor supply of these mothers, as child care fee reductions and increased availability of center-based care. Effects of policy changes are described by employing a joint labor supply and child care choice decision model. Detailed empirical results are provided with respect to mothers’ labor supply, famili...
Janssen, David; Jongen, Wesley; Schröder-Bäck, Peter
In this case study, European quality benchmarks were used to explore the contemporary quality of the long-term care provision for older people in the Belgian region of Flanders and the Netherlands following recent policy reforms. Semi-structured qualitative interviews were conducted with various experts on the long-term care provision. The results show that in the wake of the economic crisis and the reforms that followed, certain vulnerable groups of older people in Belgium and the Netherlands are at risk of being deprived of long-term care that is available, affordable and person-centred. Various suggestions were provided on how to improve the quality of the long-term care provision. The main conclusion drawn in this study is that while national and regional governments set the stage through regulatory frameworks and financing mechanisms, it is subsequently up to long-term care organisations, local social networks and informal caregivers to give substance to a high quality long-term care provision. An increased reliance on social networks and informal caregivers is seen as vital to ensure the sustainability of the long-term care systems in Belgium and in the Netherlands, although this simultaneously introduces new predicaments and difficulties. Structural governmental measures have to be introduced to support and protect informal caregivers and informal care networks. PMID:27531456
我国医药卫生领域现行税收政策与新一轮医药卫生体制改革目标存在一定冲突。现行税收政策不利于医疗行业公益性目标的实现,不利于吸引民营资本进入,不利于营利性民营医疗机构的发展,不利于鼓励商业健康保险的发展。我国应建立和完善能够与医药卫生体制改革目标相适应的税收政策体系,包括医疗服务营业税及税收优惠制度、医疗机构所得税税收优惠制度、药品增值税及税收优惠制度、商业健康保险税收优惠制度等。%There exist some conflicts between the present tax policies and the objectives of the health care system reform, The current tax policies hamper the realization of public welfare goals of the medical industry, fail to attract the private capital, hinder the development of the profit-making private medical institutions and that of commercial health insurance. A new tax system should be established and improved to comply with the goals of the health care reform, including sales tax policies for medical services, value-added tax policies for medicines, income tax policies for medical institutions, and tax incentives for private health insurance.
It is remarkable how health care systems, created over decades and influenced by very different cultures exhibit similar problems. Most health care systems are compartmentalised with managers at margins responding to perverse incentives and seeking to shift patients and costs onto rival organisations. Decision makers behave selfishly, considering the welfare of their own organisations rather than those of the health care system as a whole, and in the absence if evidence about the cost-effecti...
Full Text Available Among the many reasons that may limit the adoption of promising reform ideas, policy capacity is the least recognized. The concept itself is not widely understood. Although policy capacity is concerned with the gathering of information and the formulation of options for public action in the initial phases of policy consultation and development, it also touches on all stages of the policy process, from the strategic identification of a problem to the actual development of the policy, its formal adoption, its implementation, and even further, its evaluation and continuation or modification. Expertise in the form of policy advice is already widely available in and to public administrations, to well-established professional organizations like medical societies and, of course, to large private-sector organizations with commercial or financial interests in the health sector. We need more health actors to join the fray and move from their traditional position of advocacy to a fuller commitment to the development of policy capacity, with all that it entails in terms of leadership and social responsibility
Forest, Pierre-Gerlier; Denis, Jean-Louis; Brown, Lawrence D; Helms, David
Among the many reasons that may limit the adoption of promising reform ideas, policy capacity is the least recognized. The concept itself is not widely understood. Although policy capacity is concerned with the gathering of information and the formulation of options for public action in the initial phases of policy consultation and development, it also touches on all stages of the policy process, from the strategic identification of a problem to the actual development of the policy, its formal adoption, its implementation, and even further, its evaluation and continuation or modification. Expertise in the form of policy advice is already widely available in and to public administrations, to well-established professional organizations like medical societies and, of course, to large private-sector organizations with commercial or financial interests in the health sector. We need more health actors to join the fray and move from their traditional position of advocacy to a fuller commitment to the development of policy capacity, with all that it entails in terms of leadership and social responsibility. PMID:25905476
Joseph, Tiffany D
The 2010 Patient Protection and Affordable Care Act (ACA) was passed to provide more affordable health coverage to Americans beginning in 2014. Modeled after the 2006 Massachusetts health care reform, the ACA includes an individual mandate, Medicaid expansion, and health exchanges through which middle-income individuals can purchase coverage from private insurance companies. However, while the ACA provisions exclude all undocumented and some documented immigrants, Massachusetts uses state and hospital funds to extend coverage to these groups. This article examines the ACA reform using the Massachusetts reform as a comparative case study to outline how citizenship status influences individuals' coverage options under both policies. The article then briefly discusses other states that provide coverage to ACA-ineligible immigrants and the implications of uneven ACA implementation for immigrants and citizens nationwide. PMID:26567382
The paper contributes to the debate on the implementation of policy reforms developing a typology for implementation based on the initial agreement on means and goals at the time of reform design. It is argued that the volume and nature of knowledge gathering and stakeholder involvement required to gain approval of a policy and avoid the…
Points out some of the important considerations and compares how two competing health reform initiatives, the Clinton administration's "Health Security Act" and Representative Cooper's "Managed Competition Act," deal with health care reform.
Marc K Chan; Liu, Kai
We investigate the importance of various mechanisms by which child care policies can affect life-cycle patterns of employment and fertility among women, as well as long-run cognitive outcomes among children. A structural life-cycle model of employment, fertility, and child care use is estimated using Norwegian administrative data. The estimation exploits a large-scale child care reform, which provided generous cash transfers to mothers who did not use formal child care facilities. Combining w...
Forest and colleagues have persuasively made the case that policy capacity is a fundamental prerequisite to health reform. They offer a comprehensive life-cycle definition of policy capacity and stress that it involves much more than problem identification and option development. I would like to offer a Canadian perspective. If we define health reform as re-orienting the health system from acute care to prevention and chronic disease management the consensus is that Canada has been unsuccessful in achieving a major transformation of our 14 health systems (one for each province and territory plus the federal government). I argue that 3 additional things are essential to build health policy capacity in a healthcare federation such as Canada: (a) A means of "policy governance" that would promote an approach to cooperative federalism in the health arena; (b) The ability to overcome the "policy inertia" resulting from how Canadian Medicare was implemented and subsequently interpreted; and (c) The ability to entertain a long-range thinking and planning horizon. My assessment indicates that Canada falls short on each of these items, and the prospects for achieving them are not bright. However, hope springs eternal and it will be interesting to see if the July, 2015 report of the Advisory Panel on Healthcare Innovation manages to galvanize national attention and stimulate concerted action. PMID:26673650
Cutler, David M.
There are four rationales for health care reform: increasing the efficiency of health delivery; reforming the market for health insurance; providing universal coverage; and reducing the federal deficit. These goals are reflected in most reform proposals. Achieving these goals involves several problems, however. Paying for universal coverage may lead to labor supply or demand reductions. In addition, reform involves large federal risks that must be dealt with through deficit financing, reduced...
Glennerster, H; Matsaganis, M
England and Sweden have two of the most advanced systems of universal access to health care in the world. Both have begun major reforms based on similar principles. Universal access and finance from taxation are retained, but a measure of competition between providers of health care is introduced. The reforms therefore show a movement toward the kind of approach advocated by some in the United States. This article traces the origins and early results of the two countries' reform efforts. PMID:8034391
Courageous steps are required to reform the European Union Emissions Trading Scheme. To this end, an independent carbon authority has been proposed -- this is a move in the right direction, but should be part of a much broader discussion about reforming emissions trading.
In this paper, I start out with a standard political economy of trade policy model to guide the subsequent estimation of the determinants of trade policy in a developing country. I carefully test the model with Colombian data from 1983 to 1998 accounting for endogeneity and omitted variable bias concerns and then expand it empirically in several directions. I show that it is important to control for the impact of a drastic trade reform shock that affects all sectors and disentangle its effect...
Soffel, D; Luft, H S
The current proliferation of proposals for health care reform makes it difficult to sort out the differences among plans and the likely outcome of different approaches to reform. The current health care system has two basic features. The first, enrollment and eligibility functions, includes how people get into the system and gain coverage for health care services. We describe 4 models, ranging from an individual, voluntary approach to a universal, tax-based model. The second, the provision of...
One of the measures that can help developing countries in meeting Target 10 of the Millennium Development Goals – halving the number of people without access to water and adequate sanitation by 2015 – is through a water sector reform. In this research the Malaysian water sector reform is assessed by answering the following questions: • How can we understand and explain the policy process of the reform? • To what extent have the outputs of th...
Jennings, D L; White-Means, S I
As Medicaid moves toward a system of managed care, Aid for Families with Dependent Children (AFDC) recipients often are assigned to an organization that assumes responsibility for managing their annual receipt of health care. This study reports the results of an investigation into the patterns of medical care utilization by AFDC recipients and their children under reformed Medicaid. The issues explored include whether or not medical care utilization patterns vary by race, and if there are identifiable factors that determine the utilization patterns of AFDC recipients and their children. We conclude that racial differences in medical care utilization do exist for AFDC recipients, but not for their children. Policy makers involved in reforming Medicaid should recognize that certain cohorts continue to exhibit undesirable medical care utilization patterns, and implement measures to rectify this situation. PMID:11190655
Arrow, Kenneth; Auerbach, Alan; Bertko, John; Casalino, Lawrence Peter; Crosson, Francis; Enthoven, Alain; Falcone, E.; Feldman, R.C.; Fuchs, Victor; Garber, Alan; Gold, Marthe Rachel; Goldman, D A; Hadfield, Gillian; Hall, Mark Ann; Horwitz, Ralph
textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspective...
Du Wei; Liu Xinping
China＇s natural gas price policy reform lags behind refined oil price reform comparatively, and current natural gas price policy could not adapt to the new situation of large scale import of foreign natural gas. Natural gas price reform could refer to the reform mode of refined oil price.
Gunter, Helen M.
Current workforce reform, known as Remodelling the School Workforce, is part of an enduring policy process where there have been tensions between public and private sector structures and cultures. I show that the New Right and New Labour governments who have built and configured site based performance management over the past quarter of a century…
Full Text Available Pierre-Gerlier Forest and his colleagues make a strong argument for the need to expand policy capacity among healthcare actors. In this commentary, I develop an additional argument in support of Forest et al view. Forest et al rightly point to the need to have embedded policy experts to successfully translate healthcare reform policy into healthcare change. Translation of externally generated innovation policy into local solutions is only one source of healthcare system change. We also need to build learning healthcare systems that can discover new health solutions at the frontline of care. Enhanced policy capacity staffing in those organizations will be key to building continuously learning health systems.
Frandsen, Soren E.; Jensen, Hans Grinsted
This article presents and analyses the impacts of the EU sugar policy. Particular attention is given to the modelling of the quite complex policy and the calibration of the global general equilibrium model at the member state level. Two scenarios are analysed, namely a reduction in the intervention price of sugar and the sugar quota. It is found that the economic impacts of the two scenarios are quite different in terms of the effects on European production and trade in sugar as well in terms...
Moreno-Fuentes, Francisco Javier
Full Text Available The NorSpaR project aims to analyse the main public policy initiatives by which Norway and Spain cope with the new social and economic challenges derived from the so-called New Social Risks (NSR. Although both countries present significant differences in their institutional settings (such as Spanish EU membership, or its belonging to diverse welfare regimes types (Norway is generally included in the Nordic regime, while Spain is part of the Mediterranean one, both countries share a common interest in addressing the aforementioned challenges while maintaining social cohesion. In the last decade, governments in both countries have tried to respond to those challenges by reforming their labour markets, adapting their unemployment schemes, as well as their gender, family and long-term care policies. The analysis covered in this project includes three areas of public policy addressing NSR. First, dependency is one of the most daunting challenges for post-industrial societies experiencing population ageing and with an increasing number of frail people in need of care. This situation is forcing governments to rethink their long-term care policies. Second, family and gender public programs need to respond to the growing difficulties of families in reconciling professional and family life. Third, in the transition to a post-industrial order, and in a context of mass unemployment, social protection systems have a renewed prominence. Along with the so-called passive policies offering financial support to the unemployed, active labour market policies are geared to put people back into work. In our analysis we try to find answers to the following questions: What are the challenges that each of these policies have been trying to address in recent years? How have these policies evolved? What kinds of reforms have been implemented, and which ones have been neglected? Have the policy goals and targets of welfare programs been modified in any significant way
Wang, Chen; Rao, Keqin; Wu, Sinan; Liu, Qian
Over the past 2 decades, significant progress has been made in improving the health-care system and people's health conditions in China. Following rapid economic growth and social development, China's health-care system is facing new challenges, such as increased health-care demands and expenditure, inefficient use of health-care resources, unsatisfying implementation of disease management guidelines, and inadequate health-care insurance. Facing these challenges, the Chinese government carried out a national health-care reform in 2009. A series of policies were developed and implemented to improve the health-care insurance system, the medical care system, the public health service system, the pharmaceutical supply system, and the health-care institution management system in China. Although these measures have shown promising results, further efforts are needed to achieve the ultimate goal of providing affordable and high-quality care for both urban and rural residents in China. This article not only covers the improvement, challenges, and reform of health care in general in China, but also highlights the status of respiratory medicine-related issues. PMID:23381317
Health care consumerism is an important frame in U.S. health care policy, especially in recent media and policy discourse about federal health care reform. This article reports on qualitative fieldwork with health care users to find out how people interpret and make sense of the identity of "health care consumer." It proposes that while the term consumer is normally understood as a descriptive label for users who purchase health care and insurance services, it should actually be understood as a metaphor, carrying with it a host of associations that shape U.S. health care policy debates in particular ways. Based on interviews with 36 people, patient was the dominant term people used to describe themselves, but consumer was the second most popular. Informants interpreted the health care consumer as being informed, proactive, and having choices, but there were also "semiotic traps," or difficult-to-resolve tensions for this identity. The discourse of consumerism functions in part as code for individual responsibility, and therefore as a classed moral discourse, with implications for U.S. health care policy. PMID:23631595
Change theory concepts--drivers, vision, current and future states, and social buy-in--provide some analytical leverage in understanding current reform challenges. Various contentious issues in the health care reform battle have long served to polarize stakeholders and differentiate conservative and liberal positions. Successful change efforts are led by the development of a compelling vision, which has certain attributes. Change theory postulates that if there is not strong dissatisfaction with the current state, the future state is less feasible. Social systems change theory is another way to conceptualize and broaden our understanding of health policy as a form of social change, how environmental or external forces influence policy design, and how the ongoing media presentation of a policy influences direction of the outcome. PMID:20050495
Mónica Duarte Oliveira; Carlos Gouveia Pinto
Since 1979, the Portuguese health care system has been based on a National Health Service structure that is expected to promote equity, efficiency, quality, accountability and the devolution of power. In this article, we analyse the content and impact of policies designed to reform the system between 1979 and 2002. This article differs from previous studies in that it uses a stage-based framework to evaluate the policy-making process and the impact of health care reform throughout different p...
Xianyang City is located in the center of northwest China's Shaanxi Province. In 2001, it was designated as one of the pilot cities for comprehensive reform of family planning work initiated by the National Population and Family Planning Commission. This has provided a good opportunity for the city to better implement the quality of care approach.
Budin, Wendy C.
In this column, the editor of The Journal of Perinatal Education discusses the current health-care crisis and the need for health-care reform to promote, support, and protect natural, safe, and healthy childbirth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote normal birth.
Ferran Brunet Cid
Full Text Available This paper considers the social and structural policies in contemporary Europe. The presentation is organized in four sections. First, we discuss the emerging Europe, the new unity based on democracy and the market economy, the special European Union formula, and comparisons with America. Second, we analyze the dynamics of the European economy, the convergence process, the gaps between United States in productivity and standard of living, competitiveness issues, and the emergence of a new European economy and new European policy mix.Third, we consider European social conditions, the stationary and aging population, Europe’s low employment rate and permanently high unemployment. European economic growth could draw on two major sources: the labor reserves and reforms in factor, product and service markets. In a monetary union, advanced industrial relations should promote labor mobility and salary flexibility. The social security systems permit the redistribution and cohesion which defines the European model.Fourth, for the new Europe, the structural reform strategy is the way forward for the challenge of European economic policy and social policy: more and better jobs thanks to sustainable growth in a dynamic and competitive knowledge-based economy, favoring greater social cohesion.
Elbehri, Aziz; Umstaetter, Johannes; Kelch, David R.
The European Union’s sugar policy, in place since 1968, underwent its first major reform in 2005 in response to mounting and unsustainable imbalances in supply and demand. The reform, however, targeted only a few policy instruments (intervention price cut, voluntary production quota buyout, and restrictions on nonquota sugar exports), while leaving other key policies unchanged (interstate quota trading, sugar-substitute competition, and import barriers). Consequently, the extent of the reform...
Arndt, Thomas Channing; Tarp, Finn
into a computable general equilibrium model of an African economy (Mozambique) to study the implications of trade policy reform. Model simulations indicate that lowering tariff rates and reducing duty-free importation in a manner that maintains official revenue benefit nearly everyone. The main exception is those......In many African countries, large discrepancies exist between revenues implied by published tariff rates multiplied by estimated import volumes and actual receipts. We develop a stylised trade model where average and marginal tariff rates diverge and incorporate insights from this model...
Full Text Available Forest and colleagues have persuasively made the case that policy capacity is a fundamental prerequisite to health reform. They offer a comprehensive life-cycle definition of policy capacity and stress that it involves much more than problem identification and option development. I would like to offer a Canadian perspective. If we define health reform as re-orienting the health system from acute care to prevention and chronic disease management the consensus is that Canada has been unsuccessful in achieving a major transformation of our 14 health systems (one for each province and territory plus the federal government. I argue that 3 additional things are essential to build health policy capacity in a healthcare federation such as Canada: (a A means of “policy governance” that would promote an approach to cooperative federalism in the health arena; (b The ability to overcome the ”policy inertia” resulting from how Canadian Medicare was implemented and subsequently interpreted; and (c The ability to entertain a long-range thinking and planning horizon. My assessment indicates that Canada falls short on each of these items, and the prospects for achieving them are not bright. However, hope springs eternal and it will be interesting to see if the July, 2015 report of the Advisory Panel on Healthcare Innovation manages to galvanize national attention and stimulate concerted action.
Full Text Available With the implementation of universal health care, participants are basically saturated and the increase space of the health insurance fund is limited, so the government proceeded the total amount control of medicare reform, medicare management into a new stage,which emphasized the importance of medicare quality. So the hospital has to face the challenge of policy management, cost control, and the best medical treatment should be linked with the business development. The hospital should change concepts and keep aware of the health care quality, implement the rules of the three reasonable requirements, relying on and striving for the health insurance policies. The limited medical resources could be fully applied by the innovation of health care management, such as cancer chemotherapy and single disease daytime ward, selective operation and oncology booking service. More effective services should be provided while developing key disciplines, developing new technology to improve the quality of the hospital,be initiative to meet the payment reform to achieve the same purpose of hospital,patients and the government.
David T. Coe; Snower, Dennis J.
This paper argues that an important group of labor market policies are complementary in the sense that the effect of each policy is greater when implemented in conjunction with the other policies than in isolation. This may explain why the diverse, piecemeal labor market reforms in many European countries in recent years have had so little success in reducing unemployment. What is required instead is deeper labor market reforms across a broader range of complementary policies and institutions...
César Mattos; Paulo Coutinho
One of the important characteristics of the Brazilian Model of Telecommunications Reform (BMTR) was the adoption of a duopoly policy, constraining the entry of new players in the wire segment in the transitional phase until free competition in 2002. This policy was also used in the reform experience of the United Kingdom in telecommunications in the 80's. The theoretical explanations behind this kind of policy are not strong enough to justify the duopoly policy in telecommunications. The most...
Navin, J C; Pettit, M A
One of the major issues in the health care reform debate is the requirement that employers pay a portion of their employees' health insurance premiums. This paper examines the method for calculating the employer share of the health care premiums, as specified in the President's health care reform proposal. The calculation of the firm's cost of providing employee health care benefits is a function of marital status as well as the incidence of two-income earner households. This paper demonstrates that this method provides for lower than average premiums for married employees with no dependents in communities in which there is at least one married couple where both individuals participate in the labor market. This raises the non-wage labor costs of employing single individuals relative to individuals which are identical in every respect except their marital status. This paper explores the economic implications for hiring, as well as profits, for firms located in a perfectly-competitive industry. The results of the theoretical model presented here are clear. Under this proposed version of health care reform, ceteris paribus, firms have a clear preference for two-earner households. This paper also demonstrates that the incentive to discriminate is related to the size of the firm and to the size of the average wage of full-time employees for firms which employ fewer than fifty individuals. While this paper examines the specifics of President Clinton's original proposal, the conclusions reached here would apply to any form of employer-mandated coverage in which the premiums are a function of family status and the incidence of two-earner households. PMID:7613598
Milner, H. Richard, IV.
This brief discusses how three recent popular educational reform policies move teaching towards or away from professionalization. These reforms are (1) policies that evaluate teachers based on students' annual standardized test score gains, and specifically, those based on value-added assessment; (2) fast-track teacher preparation and licensure;…
Bruce, John W.; Giovarelli, Renée; Rolfes, Jr., Leonard; Bledsoe, David; Mitchell, Robert
This book examines issues at the forefront of the debate on land law reform, pays particular attention to how reform options affect the poor and disadvantaged, and recommends strategies for alleviating poverty more effectively through land law reform. It reviews the role of the World Bank in land law reform, examining issues of process as well as substance. It also identifies key challenge...
William M. Gentry; R. Glenn Hubbard
How tax reform affects corporate financial decisions helps determine whether reform will increase capital formation and simplify the tax system. This paper describes the effects of fundamental tax reform on corporate tax planning and summarizes economists' knowledge of the magnitude of these effects. We analyze income tax reform, consisting of integrating corporate and personal income taxes, and moving to a broad-based consumption tax. As prototypes of reform, we use the U.S. Treasury's Compr...
Sanchez, Gabriel R.; Medeiros, Jillian; Sanchez-Youngman, Shannon
At the start of their term, the Obama administration pledged to reform two failing policy systems in the United States: immigration and health care. The Latino populations' attitudes toward these two critical policy areas are particularly relevant due to the large foreign born population in the Latino community and the large number of Latinos who…
The chapters discuss the following aspects: 1. Energy policy as a strategic element of economic policy in dynamic open economies. 2. Phasing out nuclear energy and core elements of sustainable energy strategy. 3. Ecological tax reform: Theory, modified double dividend and international aspects. 4. The policy framework in Europe and Germany. 5. Optimal ecological tax reform: Options and recommendations for an EU-action plan. 6. Conclusions. (orig./CB)
This thesis is concerned with US health care. It is focused especially on the health insurance market. It introduces basic characteristics of the US insurance system and discusses its main problems. The goal of this thesis is to determine whether voluntary private insurance is the main source of problems that the US health care system currently experiences. In order to do that, greatest deficiencies of US insurance policies, especially private ones, are identified based on the efficiency crit...
Orrenius, Pia M.; Zavodny, Madeline
The authors agree with Vernon M. Briggs, Jr., that U.S. immigration policy has had unexpected consequences. The 1965 immigration reforms led to unanticipated chain migration from developing countries whereas the 1986 Immigration Reform and Control Act failed to slow unauthorized immigration. The result is a large foreign-born population with…
The changed economic scenario in India has made the issues of labour a central point. The private as well as foreign investors are demanding more reforms in labour sector. Labour reforms should be under taken carefully without undermining the self esteem, dignity of the labour, but bring in work discipline and remove the redundant labour. Hence Labour Reforms essentially refers to steps taken to increase production, productivity and employment opportunities in the economy with...
The Obama administration has confronted a formidable array of obstacles in implementing the Affordable Care Act (ACA). The ACA has overcome those obstacles to substantially expand access to health insurance, though significant problems with its approach have emerged. What does the ACA's performance to date tell us about the possibilities and limits of health care reform in the United States? I identify key challenges in ACA implementation-the inherently disruptive nature of reform, partisan polarization, the limits of "near universal" coverage, complexity, and divided public opinion-and analyze how these issues have shaped its evolution. The article concludes by exploring the political and policy challenges that lie ahead for the ACA. PMID:27127261
An earlier version of this paper was presented in Workshop 9: ‘Changing Party Political Constellations and Public Policy Reform in Southern Europe’ at the Tenth Mediterranean Research Meeting, Florence & Montecatini Terme, 25-28 March 2009, organised by the Mediterranean Programme of the Robert Schuman Centre for Advanced Studies at the European University Institute. The purpose of this paper is to explore the question of small and incremental reform in Turkish minority policie...
Eigenraam, M.; Stoneham, G.; Branson, Jane; Sappideen, B.; Jones, R
In February 1994, the Council of Australian Governments (COAG) endorsed a strategic framework for water sector reform in Australia to be implemented by the year 2001. In response to the COAG strategy, a project was initiated in association with the NSW Agriculture and the Victorian Water Bureau to assess the economic welfare effects of different water policy reforms. A spatial equilibrium model was developed to facilitate evaluation of policy measures. The purpose of this paper is to report o...
Pating, David R; Miller, Michael M; Goplerud, Eric; Martin, Judith; Ziedonis, Douglas M
This article outlined ways in which persons with addiction are currently underserved by our current health care system. However, with the coming broad scale reforms to our health care system, the access to and availability of high-quality care for substance use disorders will increase. Addiction treatments will continue to be offered through traditional substance abuse care systems, but these will be more integrated with primary care, and less separated as treatment facilities leverage opportunities to blend services, financing mechanisms, and health information systems under federally driven incentive programs. To further these reforms, vigilance will be needed by consumers, clinicians, and policy makers to assure that the unmet treatment needs of individuals with addiction are addressed. Embedded in this article are essential recommendations to facilitate the improvement of care for substance use disorders under health care reform. Ultimately, as addiction care acquires more of the “look and feel” of mainstream medicine, it is important to be mindful of preexisting trends in health care delivery overall that are reflected in recent health reform legislation. Within the world of addiction care, clinicians must move beyond their self-imposed “stigmatization” and sequestration of specialty addiction treatment. The problem for addiction care, as it becomes more “mainstream,” is to not comfortably feel that general slogans like “Treatment Works,” as promoted by Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment during its annual Recovery Month celebrations, will meet the expectations of stakeholders outside the specialty addiction treatment community. Rather, the problem is to show exactly how addiction treatment works, and to what extent it works-there have to be metrics showing changes in symptom level or functional outcome, changes in health care utilization, improvements in workplace attendance and
Jennings, Bruce; Morrissey, Mary Beth
Health reform in the United States must address both access to medical services and universal insurance coverage, as well as health care cost containment. Uncontrolled health care costs will undermine improvements in access and coverage in the long-run, and will also be detrimental to other important social programs and goals. Accordingly, the authors offer an ethical perspective on health care cost control in the context of end-of-life and palliative care, an area considered by many to be a principal candidate for cost containment. However, the policy and ethical challenges may be more difficult in end-of-life care than in other areas of medicine. Here we discuss barriers to developing high quality, cost effective, and beneficial end-of-life care, and barriers to maintaining a system of decision making that respects the wishes and values of dying patients, their families, and caregivers. The authors also consider improvements in present policy and practice-such as increased timely access and referral to hospice and palliative care; improved organizational incentives and cultural attitudes to reduce the use of ineffective treatments; and improved communication among health professionals, patients, and families in the end-of-life care planning and decision-making process. PMID:22150176
Daugbjerg, Carsten; Swinbank, Alan
dynamics that can result in lasting reform trajectories. The European Union's Common Agricultural Policy (CAP) has changed substantially over the last three decades in response to emerging policy concerns by adding new layers. This succession of reforms proved durable and resilient to reversal in the lead...
Bogetic, Zeljko; Heffley, Dennis
All countries - whether industrial, developing, or in transition to a market economy - are interested in health care reform. A central focus of reform everywhere is to make patients more responsive to health care costs without diluting the protection offered by public or private insurance. Conventional insurance offers customers little incentive to monitor their own use of health care services or to adopt and maintain better health habits. The authors describe an alternative health insurance ...
This paper examines the determinants of child nutritional status in seven provinces of China during the 1990s, focusing specifically on the role of two areas of public policy, namely health system reforms and the one child policy. The empirical relationship between income and nutritional status, and the extent to which that relationship is mediated by access to quality healthcare and being...
Johansson, Matilda; Nordin, Annelie
This paper studies the police reform in Egypt in the light of the revolution 2011. The ousting of the authoritarian president Hosni Mubarak was the beginning of the transition towards democracy. Within 15 months both parliamentary and presidential election had taken place. The political leaders were new and the transitional process had begun however the institutions where still the same and one feature of the revolution was to reform the police since the police was hated as the oppressive pow...
Craig, Debbie I.
OBJECTIVE: To apply a policy-analysis framework to the athletic training educational reform policy that will be fully implemented by January 2004. DATA SOURCES: Policy analysis is not a specific science. No one framework exists for conducting all policy analyses. I used literature from the education, policy analysis, and athletic training fields as data sources to provide background and to create a framework from which to conduct the policy analysis. DATA SYNTHESIS: Once the policy-analysis framework was selected, I began data synthesis, using several athletic training sources in support of the findings. The tension among the myriad stakeholders in this policy is clear. Although many see the benefits of accreditation, some experience hardships from the imposed policy. CONCLUSIONS/RECOMMENDATIONS: Of the 4 possible alternatives suggested, following the route currently under implementation (Committee on Accreditation of Health Education Programs accreditation) was the most agreeable solution. The goals as stated by the policy makers are attained by the policy. However, issues within the accreditation process itself need to be addressed. Of the many stakeholders in the reform effort, some will see little gain and have many hardships imposed on them. As the policy is implemented, unintended implications will likely arise, as with any new policy. Thus, I recommend that the National Athletic Trainers' Association develop a system dedicated solely to reducing the hardships faced by many of its members as the policy is implemented. PMID:14737218
This dissertation shows the relevance of political agency under conditions of globalisation through a sub-national comparative study of labour market reforms. The study builds upon existing literature by highlighting ‘relative autonomy’ of political actors and dynamics in determining policy and outcome. Such an assertion contradicts the purely structuralist interpretations of reform and asserts that forces of globalisation can be negotiated by domestic political actors. Base...
Jorge Martinez-Vazquez; Duanje Chen
The North American Free Trade Agreement (NAFTA) has had a significant effect on Mexico’s economy and institutions. The ongoing consideration of tax reform in Mexico requires an evaluation of the role of NAFTA in Mexico’s economy, including its tax structure; it also requires an assessment of the impact of the Mexico’s tax system on the trade and capital flows between Mexico and its NAFTA partners, the United States and Canada. Clearly, no good tax reform in Mexico can ignore the role of NAFTA...
One of the measures that can help developing countries in meeting Target 10 of the Millennium Development Goals – halving the number of people without access to water and adequate sanitation by 2015 – is through a water sector reform. In this research the Malaysian water sect
This report presents the main characteristics of reforms in the Swedish health services, as exemplified by the "Stockholm Model" introduced in 1992 in Stockholm county. The author discusses the motives behind these reforms, the already-evident increases in costs that are occurring, and the effect...
Atun, Rifat Ali; Menabde, Nata; Saluvere, Katrin; Jesse, Maris; Habicht, Jarno
All post-Soviet countries are trying to reform their primary health care (PHC) systems. The success to date has been uneven. We evaluated PHC reforms in Estonia, using multimethods evaluation: comprising retrospective analysis of routine health service data from Estonian Health Insurance Fund and health-related surveys; documentary analysis of policy reports, laws and regulations; key informant interviews. We analysed changes in organisational structure, regulations, financing and service provision in Estonian PHC system as well as key informant perceptions on factors influencing introduction of reforms. Estonia has successfully implemented and scaled-up multifaceted PHC reforms, including new organisational structures, user choice of family physicians (FPs), new payment methods, specialist training for family medicine, service contracts for FPs, broadened scope of services and evidence-based guidelines. These changes have been institutionalised. PHC effectiveness has been enhanced, as evidenced by improved management of key chronic conditions by FPs in PHC setting and reduced hospital admissions for these conditions. Introduction of PHC reforms - a complex innovation - was enhanced by strong leadership, good co-ordination between policy and operational level, practical approach to implementation emphasizing simplicity of interventions to be easily understood by potential adopters, an encircling strategy to roll-out which avoided direct confrontations with narrow specialists and opposing stakeholders in capital Tallinn, careful change-management strategy to avoid health reforms being politicized too early in the process, and early investment in training to establish a critical mass of health professionals to enable rapid operationalisation of policies. Most importantly, a multifaceted and coordinated approach to reform - with changes in laws; organisational restructuring; modifications to financing and provider payment systems; creation of incentives to enhance
Full Text Available Abstract Unsafe abortion is a significant contributor to worldwide maternal mortality; however, abortion law and policy liberalization could lead to drops in unsafe abortion and related deaths. This review provides an analysis of changes in abortion mortality in three countries where significant policy reform and related service delivery occurred. Drawing on peer-reviewed literature, population data and grey literature on programs and policies, this paper demonstrates the policy and program changes that led to declines in abortion-related mortality in Romania, South Africa and Bangladesh. In all three countries, abortion policy liberalization was followed by implementation of safe abortion services and other reproductive health interventions. South Africa and Bangladesh trained mid-level providers to offer safe abortion and menstrual regulation services, respectively, Romania improved contraceptive policies and services, and Bangladesh made advances in emergency obstetric care and family planning. The findings point to the importance of multi-faceted and complementary reproductive health reforms in successful implementation of abortion policy reform.
de Castro, Alexandre Samy; Goldin, Ian; Luiz A. Pereira da Silva
The authors aim at contributing to understand the dispersion of returns from policy reforms using cross-country regressions. The authors compare the "before reform" with "after reform" GDP growth outcome of countries that undertook import-liberalization and fiscal policy reforms. They survey a large sample (about 54) of developing countries over the period 1980-99. The benefits of openness...
Howard, Steven W; Bernell, Stephanie L; Yoon, Jangho; Luck, Jeff; Ranit, Claire M
To control Medicaid costs, improve quality, and drive community engagement, the Oregon Health Authority introduced a new system of coordinated care organizations (CCOs). While CCOs resemble traditional Medicaid managed care, they have differences that have been deliberately designed to improve care coordination, increase accountability, and incorporate greater community governance. Reforms include global budgets integrating medical, behavioral, and oral health care and public health functions; risk-adjusted payments rewarding outcomes and evidence-based practice; increased transparency; and greater community engagement. The CCO model faces several implementation challenges. If successful, it will provide improved health care delivery, better health outcomes, and overall savings. PMID:25480844
This thesis deals with the factors shaping forest policy output during the stages implementation and bases its main message on empirical findings from the forestry sector in Ghana. Policy and institutional factors are important underlying causes for deforestation, especially in the tropics. Forest...
The author explains how recent developments in political economics improve our understanding of macroeconomic policy - especially the timing, design, and likelihood of stabilization's success through monetary and fiscal reform. The author reviews the literature on political business cycles and emphasizes several issues involving the relationship between the timing of elections and the timing of macroeconomic policies and outcomes. He also addresses how models can be useful in studying non-dem...
Tsutsui, Takako; Muramatsu, Naoko
Japan implemented a mandatory social long-term care insurance (LTCI) system in 2000, making long-term care services a universal entitlement for every senior. Although this system has grown rapidly, reflecting its popularity among seniors and their families, it faces several challenges, including skyrocketing costs. This article describes the recent reform initiated by the Japanese government to simultaneously contain costs and realize a long-term vision of creating a community-based, prevention-oriented long-term care system. The reform involves introduction of two major elements: "hotel" and meal charges for nursing home residents and new preventive benefits. They were intended to reduce economic incentives for institutionalization, dampen provider-induced demand, and prevent seniors from being dependent by intervening while their need levels are still low. The ongoing LTCI reform should be critically evaluated against the government's policy intentions as well as its effect on seniors, their families, and society. The story of this reform is instructive for other countries striving to develop coherent, politically acceptable long-term care policies. PMID:17767690
Federal government policies are a major cause of high costs throughout the aviation supply chain, often leading Canadians to waste time and money by seeking lower fares at nearby US airports, or not travel at all. High fuel taxes and onerous foreign ownership and airline-specific policies are harming the competitiveness of airlines. Meanwhile, airports have been transformed from the rundown state they were in when operated by the federal government to become world leaders in customer service ...
Muntaner, Carles; Salazar, René M Guerra; Rueda, Sergio; Armada, Francisco
Throughout the 1990s, all Latin American countries but Cuba implemented to varying degrees health care sector reforms underpinned by a neoliberal paradigm that redefined health care as less of a social right and more of a market commodity. These health care sector reforms were couched in the broader structural adjustment of Latin American welfare states prescribed consistently by international financial institutions since the mid-1980s. However, since 2003, Venezuela has been developing an alternative to this neoliberal trend through its health care reform program called Misión Barrio Adentro (Inside the Neighbourhood). In this article, we introduce Misión Barrio Adentro in its historical, political, and economic contexts. We begin by analyzing Latin American neoliberal health sector reforms in their political economic context, with a focus on Venezuela. The analysis reveals that the major beneficiaries of both broader structural adjustment of Latin American welfare states and neoliberal health reforms have been transnational capital interests and domestic Latin American elites. We then provide a detailed description of Misión Barrio Adentro as a challenge to neoliberalism in health care in its political economic context, noting the role played in its development by popular resistance to neoliberalism and the unique international cooperation model upon which it is based. Finally, we suggest that the Venezuelan experience may offer valuable lessons not only to other low- to middle-income countries, but also to countries such as Canada. PMID:17203729
OBJECTIVE: To determine the effect on a cohort of family physicians of health care system reforms in Ontario and the relationship of reforms to their career satisfaction. DESIGN: Follow-up survey in 1999 of a cohort initially studied in 1993, posing many of the original questions along with some new ones. Four focus groups of other Ontario family physicians. SETTING: Family practices in Ontario. PARTICIPANTS: All family physicians who had received certification after completing a family medic...
The article examines the potential effectiveness of the renewable energy policy in China and its regulatory Law framework. It frames the option of renewable energy technology within the background of the long-lasting electricity problems that China has faced including serious supply shortages, reliance on coal, and severe environmental contamination. Its dual administrative and ownership system based on state and privately owned industry is discussed together with the market reform measures adopted in the sector. Current renewable energy policy is analysed, and the scope of the 2005 Renewable Energy Promotion Law is investigated. This is conducted within the context of the electricity sector reform that China adopted, and its effects upon the prospects of encouraging as well as expanding the development of renewable energy. This study draws upon primary information collected from interviews with stakeholders on the policy adequacy, and identifies three main types of shortcomings that have interfered with a more successful expansion of renewable energy in China. (author)
Korkeamaki, Timo; Liljeblom, Eva; Pasternack, Daniel
Changes in taxation of corporate dividends offer excellent opportunities to study dividend clientele effects. We explore payout policies and ownership structures around a major tax reform that took place in Finland in 2004. Consistent with dividend clienteles affecting firmsâ dividend policy decisions, we find that Finnish firms altered their dividend policies based on the changed tax incentives of their largest shareholders. While firms adjust their payout policies, our results also indica...
Frenk, Julio; Gómez-Dantés, Octavio
This paper discusses the use of an explicit ethical and human rights framework to guide a reform intended to provide universal and comprehensive social protection in health for all Mexicans, independently of their socio-economic status or labor market condition. This reform was designed, implemented, and evaluated by making use of what Michael Reich has identified as the three pillars of public policy: technical, political, and ethical. The use of evidence and political strategies in the design and negotiation of the Mexican health reform is briefly discussed in the first part of this paper. The second part examines the ethical component of the reform, including the guiding concept and values, as well as the specific entitlements that gave operational meaning to the right to health care that was enshrined in Mexico's 1983 Constitution. The impact of this rights-based health reform, measured through an external evaluation, is discussed in the final section. The main message of this paper is that a clear ethical framework, combined with technical excellence and political skill, can deliver major policy results. PMID:26766859
Buchanan, Larry M.
It is widely recognized throughout the health care industry that the United States leads the world in health care spending per capita. However, the chilling dose of reality for American health care consumers is that for all of their spending, the World Health Organization ranks the country's health care system 37th in overall performance--right…
Jensen, Maria Skovager; Lind, Kim Martin Hjorth; Zobbe, Henrik
A connection exists between enlargement of the European Union and reforms of the Common Agricultural Policy (CAP). Based upon rational choice theory, we examine whether the member states’ CAP positions are related to structures in their agricultural sectors. The overall hypothesis is that...... intensiveness of agricultural production corresponds to the willingness to reform the CAP. Political CAP positions, together with the development of member states’ structural fundamentals, are analysed using cluster analysis. The results show that EU enlargements have extensified agricultural production at the...... EU level, and that extensive agricultural production in a member state is often an indicator of reduced willingness to reform. However, the intensiveness of agricultural production is only part of the explanation. Moreover, negotiation tactics play an important role for the positions on the CAP....
K. Arrow (Kenneth); A. Auerbach (Alan); J. Bertko (John); L.P. Casalino (Lawrence Peter); F.J. Crosson (Francis); A. Enthoven (Alain); E. Falcone; R.C. Feldman; V.R. Fuchs (Victor); A.M. Garber (Alan); M.R. Gold (Marthe Rachel); D.A. Goldman; G.K. Hadfield (Gillian); M.A. Hall (Mark Ann); R.I. Horwitz (Ralph); M. Hooven; P.D. Jacobson (Peter); T.S. Jost (Timothy Stoltzfus); L.J. Kotlikoff; J. Levin (Jonathan); S. Levine (Sharon); R. Levy; K. Linscott; H.S. Luft; R. Mashal; D. McFadden (Daniel); D. Mechanic (David); D. Meltzer (David); J.P. Newhouse (Joseph); R.G. Noll (Roger); J.B. Pietzsch (Jan Benjamin); P. Pizzo (Philip); R.D. Reischauer (Robert); S. Rosenbaum (Sara); W. Sage (William); L.D. Schaeffer (Leonard Daniel); E. Sheen; B.N. Silber (Bernie Michael); J. Skinner (Jonathan Robert); S.M. Shortell (Stephen); S.O. Thier (Samuel); S. Tunis (Sean); L. Wulsin Jr.; P. Yock (Paul); G.B. Nun; S. Bryan (Stirling); O. Luxenburg (Osnat); W.P.M.M. van de Ven (Wynand); J. Cooper (Jim)
textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a
Gen, Sheldon; Wright, Amy Conley
Policy capacity focuses on the managerial and organizational abilities to inform policy decisions with sound research and analysis, and facilitate policy implementation with operational efficiency. It stems from a view of the policy process that is rational and positivistic, in which optimal policy choices can be identified, selected, and implemented with objectivity. By itself, however, policy capacity neglects the political aspects of policy-making that can dominate the process, even in health policies. These technical capabilities are certainly needed to advance reforms in health policies, but they are not sufficient. Instead, they must be complemented with public engagement and policy advocacy to ensure support from the public that policies are meant to serve. PMID:26673469
Full Text Available Policy capacity focuses on the managerial and organizational abilities to inform policy decisions with sound research and analysis, and facilitate policy implementation with operational efficiency. It stems from a view of the policy process that is rational and positivistic, in which optimal policy choices can be identified, selected, and implemented with objectivity. By itself, however, policy capacity neglects the political aspects of policy-making that can dominate the process, even in health policies. These technical capabilities are certainly needed to advance reforms in health policies, but they are not sufficient. Instead, they must be complemented with public engagement and policy advocacy to ensure support from the public that policies are meant to serve.
Degeling, Pieter; Carr, Adrian
The case literature strongly suggests that both in England and in Australia health care reforms have had very little impact in terms of "improved performance". It is in the context of a perceived failure in the implementation of the reforms that an interest has arisen in leadership at the level of individual clinical units (e.g an orthopaedics unit or birth unit), as the possible "fix" for bridging the promise-performance gap. Drawing upon extensive case studies that highlight the problem and context for appropriate forms of leadership, this paper argues that the appropriate discourse, in terms of leadership in health reform, needs to focus upon the issue of authorization. In making this argument, addresses the current conceptions of leadership that have been advanced in the discourse before offering some case study material that is suggestive of why attention should be focused on the issue of authorization. Illustrates how and why the processes of leading, central to implementing reform, cannot be construed as socially disembodied processes. Rather, leading and following are partial and partisan processes whose potential is circumscribed by participants' position-takings and what is authorized in the institutional settings in which they are located Argues that the "following" that clinical unit managers could command was shaped by the sub-cultures and "regulatory ideals" with which staff of each profession are involved In the interests of reform, policy players in health should not be focusing attention solely upon the performative qualities and potential leadership abilities of middle level management, but also on their own performance. They should consider how their actions affect what is authorized institutionally and which sets the scope and limits of the leadership-followership dialectic in clinical settings. PMID:15588011
In this paper, I start out with a standard political economy of trade policy model to guide the subsequent estimation of the determinants of trade policy in a developing country. I carefully test the model with Colombian data from 1983 to 1998 accounting for endogeneity and omitted variable bias concerns and then expand it empirically in several directions. I show that it is important to control for the impact of a drastic trade reform shock that affects all sectors and disentangle its e¤ect ...
textabstractIn times of crisis, such as in the case of the volcanic ash cloud, the role of science in policy-making processes becomes more apparent than in ‘normal’, less controversial times. There is, however, hardly a policy area imaginable where science is not involved – even though that role, in general, stays hidden from the public at large. In the Netherlands, policy programmes such as the financial reform in the health care sector or those that support health promotion rely upon scient...
China has embarked on an ambitious and unprecedented programme of energy reform and climate change mitigation. Yet the motivations for this important shift remain unclear. This paper surveys key central government documents and articles by China's leading energy academics to investigate the ideas influencing China's new energy and climate policies. Three key ideas in particular are supportive of greater climate mitigation than in the past. First, domestic energy security concerns have risen o...
Witzke, Heinz Peter; Heckelei, Thomas
The research presented is part of a larger study aiming at the analysis of reform options for the EU sugar policy regime. This paper focuses on the effects of quota reduction and support price cuts. A thorough theoretical analysis investigates the implications of farm heterogeneity for aggregate supply modeling purposes under the current sugar regime. It can be shown that the treatment of sugar quantities produced under the different quotas and without quota can be treated as different produc...
This is a collection of essays written for the Financial Express, an Indian financial daily. The common theme of these essays, which cover a period of almost four years, from June 2010 to March 2014, is the India’s struggles with economic policy reform. The essays are organized into several broad topical groupings, and chronologically within each section. The first section considers overall development goals, followed by a group of essays on foreign investment in retailing, financial inclusio...
This paper examines the policy alternatives faced by developing countries in their endeavor to preserve and develop their electricity and gas systems, two service-oriented industries which--along with oil--provide the bulk of energy supply both in developed and in developing countries. Even in very poor countries, industrially generated energy is indispensable for carrying out most economic activities. Therefore, governments traditionally recognize that the supply of gas and electricity entails a fundamental public service dimension. The Introduction presents the case for reforming of energy utilities, discusses in general terms the pros and cons of privatization, and attempts to locate the reforms in a broader historical framework in which developing countries' governments faced characterized by increasing financial hardship. Section 2 constitutes the core of the paper. It reviews the main features of gas and power sector reforms in the developing world and analyzes specifically the cases of five semi-industrialized countries in Latin America and Asia. Section 3 (Concluding remarks) briefly evaluates the country experiences reviewed above and indicates a few policy lessons which can be learnt from them. The main conclusion is that, in a long-run development perspective, full-scale privatization of gas and power sectors in developing countries entails significant risks, and therefore a flexible policy approach is preferable to a rigid commitment to extensive liberalization
The Korean government is setting up an ambitious policy for an engineering innovation program called “engineering education innovation program.” Its primary goal is to resolve quantitative and qualitative imbalance problems in industrial manpower of the country. It is also a policy that aims at progressively reforming engineering education in Korea in cooperation with the Ministries of Education (MOE) and Commerce, Industry and Energy (MOCIE) . The development of specialized centers for engineering education programs by engineering schools, in particular, can help the government provide suitable supports for enhancing industrial competitiveness.
This article reviews current policy trends concerning the practice of ability grouping in K-12 science education. Relevant statements of key policy-making, policy-influencing organizations such as the NSTA, AAAS, NSF, the National Research Council, the U.S. Office of Education Department of Civil Rights, NAACP, the National Governors' Association, programs related to the Jacob Javits Grants for the Gifted and Talented, and others are summarized. The author's interpretation of the various positions are presented herein. The article also explores the research base supporting the various policies on grouping by examining selected general research literature on grouping, followed by research that is science education specific. Methodological issues color the research findings. The ethical and pragmatic implications of developing research and policy are discussed. The conclusions are that there is a dearth of recent empirical research specifically related to ability grouping in science, and that the time is ripe for the concerted development of a research agenda by key players in science education reform. Moreover, as controversial and value-laden as the topic is, it should be noted that grouping practices alone are unlikely to influence science education reform unless considered in the context of comprehensive restructuring efforts at the local school level.Received: 10 April 1993; Revised: 26 August 1993;
Kolassa, E. M.
It is argued that the discipline of pharmacoeconomics has much to offer the pharmacy field during a period of health care reform but that these specialists must let their colleagues in related fields know how they can assist in facilitating change. (MSE)
Kumar, Neha; Agnes R. Quisumbing
There is growing interest in the role of policy reforms to promote gender equality and empower women, two key objectives of development policy. From a policy perspective, it would be ideal for reforms undertaken in different policy areas to be consistent, so that they reinforce each other in improving gender equity. We use data from the Ethiopian Rural Household Survey (ERHS) to show how two seemingly unrelated reformsâ€”community-based land registration, undertaken since 2003, and changes in...
Pines, Jesse M; McStay, Frank; George, Meaghan; Wiler, Jennifer L; McClellan, Mark
Current alternative payment models (APMs) that move away from traditional fee-for-service payment often have explicit goals to reduce utilization in episodic settings, such as emergency departments (ED). We apply the new HHS payment reform taxonomy to illustrate a pathway to success for EDs in APMs. Despite the unique challenges faced by EDs, a variety of category 2 and 3 APMs may be applicable to EDs in the short- and long term to improve efficiency and value. Full and partially capitated models create incentives for longitudinal and episodic ED providers and payers to unite to create interventions to reduce costs. However, prospective attribution remains a challenge for EDs because of exogenous demand, which makes it important for EDs to be one of the components of capitated payment along with longitudinal providers who can exert greater control on overall care demands. The goal of payment and delivery reforms in ED care is to improve population health across the continuum of acute and longitudinal care. In order to deliver cost-conscious care, ED providers will need additional resources, expanded information, and new processes and metrics to facilitate cost-conscious decisions. Improved availability of electronic information across settings, evidence generated from developing and testing acute care-specific payment models, and engaging acute care providers directly in reform efforts will help meet these goals. PMID:27541697
Giovanella, Lígia; Stegmüller, Klaus
The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date), and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms' impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems. PMID:25493982
Paul-Shaheen, P A
During the past decade, an area of major policy activity among the states has been that of health care reform. As of May 1993, seven states--Florida, Hawaii, Massachusetts, Minnesota, Oregon, Vermont, and Washington--had progressed the furthest in enacting comprehensive statutes designed to expand health insurance coverage and slow the growth of health care costs. This article reviews the activities of these states to achieve health care reform and the lessons learned from those activities. The analysis focuses specifically on identifying the common problems addressed and determining the common factors that maximized states' opportunities for success. In all, some nine lessons are identified that have relevance for other states wishing to follow a similar road to reform. Most important among these are a "window of opportunity" for policy action, having entrepreneurial leadership to push the reform agenda forward, and support from key stakeholder interests. If these conditions of opportunity, policy entrepreneurship, and stakeholder commitment are met, a state can move forward in addressing key aspects of its health care reform agenda. PMID:9565896
The new millennium brings change and new ways of thinking to the energy sector. Today the sector faces new challenges which it must deal with at a time where increasing market liberalisation and increasing internalisation is creating completely new frameworks for the sector. The Danish tradition of progressive energy policy action plans is the best possible basis on which to build. The target remains set. Energy policy must create the framework for structuring future energy systems so as to ensure that they are sustainable. Over many years there have been numerous initiatives to transfer consumption to cleaner energy sources, which has now led to a steady reduction in CO2 emissions. The government places great importance on a continuation of this current development, both short term and long term. The adoption of the Electricity Reform in spring 1999 was an important step in the right direction. The government can, with great satisfaction, conclude that an agreement has now been made with most of the Parliament regarding a Gas reform, modernisation of the heat Supply Act and a new Energy Saving Act. In addition to this, the agreement also includes a follow up to the Electricity Reform concerning utilisation of biomass, offshore wind turbines, harmonisation of costs for priority electricity production, private generator's payment to priority electricity and the establishment of a market for electricity based on renewable. (author)
Full Text Available Drug policies affect a large set of outcomes and may reflect the concerns of several policy stakeholder groups. Researchers analysing policies typically employ a public health approach, extended to reflect concerns beyond population health and longevity. I argue that the resulting approach, as currently practised, fails to capture several concerns seen as important by recent drug policy reform movements, that is, the full harms of illegal markets, the subjectively valued consumption of intoxicants, the dysfunctionality of current policy processes in the drug field and the value of the knowledge gained from policy experiments. I illustrate this by referring to the book Drug policy and the public good, a public health-based review of research evidence and its relevance for drug policy written by leading international researchers in the field.
Palliative care for patients with advanced illness is a subject of growing importance in health services, policy and research. In 2001 Ireland became one of the first nations to publish a dedicated national palliative care policy. This paper uses the \\'policy analysis triangle\\' as a framework to examine what the policy entailed, where the key ideas originated, why the policy process was activated, who were the key actors, and what were the main consequences. Although palliative care provision expanded following publication, priorities that were unaddressed or not fully embraced on the national policy agenda are identified. The factors underlying areas of non-fulfilment of policy are then discussed. In particular, the analysis highlights that policy initiatives in a relatively new field of healthcare face a trade-off between ambition and feasibility. Key policy goals could not be realised given the large resource commitments required; the competition for resources from other, better-established healthcare sectors; and challenges in expanding workforce and capacity. Additionally, the inherently cross-sectoral nature of palliative care complicated the co-ordination of support for the policy. Policy initiatives in emerging fields such as palliative care should address carefully feasibility and support in their conception and implementation.
Galland, Daniel; Enemark, Stig
spatial development processes. The reasoning behind this argument stems from the case of Denmark, where a structural reform that changed the country’s geographies of inter-governmental arrangements significantly transformed the configuration and functioning of the national spatial planning system. Once...... designed to pursue ‘equal development’ as a result of a structural reform of a different nature implemented during the 1970s, Danish planning as a whole and national and regional planning policies, in particular, currently seem to have become less ‘spatial’ in the sense that the latter only tend to exhibit...... limited strategic reasoning and geographical thinking in addressing the potential physical structure of and functional relationships within the national territory. At the same time, the planning system seems to display narrower measures of spatial coherence in terms of horizontal and vertical coordination...
McGorry, Patrick D; Hamilton, Matthew P
Mortality from mental illnesses is increasing and, because they frequently occur early in the life cycle, they are the largest source of disability and reduced economic productivity of all non-communicable diseases. Successful mental health reform can reduce the mortality, morbidity, growing welfare costs and losses in economic productivity caused by mental illness. The government has largely adopted the recommendations of the National Mental Health Commission focusing on early intervention and stepwise care and will implement a reform plan that involves devolving commissioning of federally funded mental health services to primary health networks, along with a greater emphasis on e-mental health. Stepwise expanded investment in and structural support (data collection, evaluation, model fidelity, workforce training) for evidence-based care that rectifies high levels of undertreatment are essential for these reforms to succeed. However, the reforms are currently constrained by a cost-containment policy framework that envisages no additional funding. The early intervention reform aim requires financing for the next stage of development of Australia's youth mental health system, rather than redirecting funds from existing evidence-based programs. People with complex, enduring mental disorders need more comprehensive care. In the context of the National Disability Insurance Scheme, there is a risk that these already seriously underserved patients may paradoxically receive a reduction in coverage. E-health has a key role to play at all stages of illness but must be integrated in a complementary way, rather than as a barrier to access. Research and evaluation are the keys to cost-effective, sustainable reform. PMID:27169969
Kaminski, Jonathan; Serra, Renata
This paper explores the case for believing endogenous reforms to be more developmental than externally-imposed reforms, by drawing on the recent unorthodox experience of cotton sector reform in Burkina Faso. We address questions about reform emergence, feasibility, developmental impact, and sustainability. Our analysis, which carefully incorporates local social and political realities, suggests that the urban elites dominating the Burkinabè state favoured a particular cotton reform process, b...
An extensive programme of health service reform has begun in England. Improvement in the quality of care is a key objective of the reforms, and several initiatives are being introduced in response. These include systems to provide national guidance about appropriate treatment and services, a local system to support quality improvement and arrangements to monitor performance, including a new performance framework, an inspection agency and an annual survey of patients. The local quality improvement system has features of particular interest. These include arrangements for setting objectives for quality improvement, the use of various quality improvement methods tailored to local needs and a new system to provide accountability to both the health service and the public. The introduction of clinical governance and all the other reforms presents primary care practitioners with a major challenge. However, if sufficient time is allowed and adequate resources are made available, the reforms do have the potential to improve health care in England. PMID:10944059
Full Text Available BACKGROUND: The Australian Private Health Insurance Incentive (PHII policy reforms implemented in 1997-2000 increased PHI membership in Australia by 50%. Given the higher rate of obstetric interventions in privately insured patients, the reforms may have led to an increase in surgical deliveries and deliveries with longer hospital stays. We aimed to investigate the effect of the PHII policy introduction on birth characteristics in Western Australia (WA. METHODS AND FINDINGS: All 230,276 birth admissions from January 1995 to March 2004 were identified from administrative birth and hospital data-systems held by the WA Department of Health. Average quarterly birth rates after the PHII introduction were estimated and compared with expected rates had the reforms not occurred. Rate and percentage differences (including 95% confidence intervals were estimated separately for public and private patients, by mode of delivery, and by length of stay in hospital following birth. The PHII policy introduction was associated with a 20% (-21.4 to -19.3 decrease in public birth rates, a 51% (45.1 to 56.4 increase in private birth rates, a 5% (-5.3 to -5.1 and 8% (-8.9 to -7.9 decrease in unassisted and assisted vaginal deliveries respectively, a 5% (-5.3 to -5.1 increase in caesarean sections with labour and 10% (8.0 to 11.7 increase in caesarean sections without labour. Similarly, birth rates where the infant stayed 0-3 days in hospital following birth decreased by 20% (-21.5 to -18.5, but rates of births with >3 days in hospital increased by 15% (12.2 to 17.1. CONCLUSIONS: Following the PHII policy implementation in Australia, births in privately insured patients, caesarean deliveries and births with longer infant hospital stays increased. The reforms may not have been beneficial for quality obstetric care in Australia or the burden of Australian hospitals.
U.S. Department of Health & Human Services — The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly...
Schwartz, Mark D
To establish and sustain the high-performing health care system envisioned in the Affordable Care Act (ACA), current provisions in the law to strengthen the primary care workforce must be funded, implemented, and tested. However, the United States is heading towards a severe primary care workforce bottleneck due to ballooning demand and vanishing supply. Demand will be fueled by the “silver tsunami” of 80 million Americans retiring over the next 20 years and the expanded insurance coverage fo...
Balabanova, Dina; McKee, Martin
Health financing reform in Bulgaria has been characterised by lack of political consensus on reform direction, economic shocks, and, since 1998, steps towards social insurance. As in other eastern European countries, the reform has been driven by an imperative to embrace new ideas modelled on systems elsewhere, but with little attention to whether these reflect popular values. This study explores underlying values, such as views on the role of the state and solidarity, attitudes to, and understanding of compulsory and voluntary insurance, and co-payments. The study identifies general principles (equity, transparency) considered important by the population and practical aspects of implementation of reform. Data were obtained from a representative survey (n=1547) and from 58 in-depth interviews and 6 focus groups with users and health professionals, conducted in 1997 before the actual reform of the health financing system in Bulgaria. A majority supports significant state involvement in health care financing, ranging from providing safety net for the poor, through co-subsidising or regulating the social insurance system, to providing state-financed universal free care (half of all respondents). Collectivist values in Bulgaria remain strong, with support for free access to services regardless of income, age, or health status and progressive funding. There is strong support (especially among the well off) for a social insurance system based on the principle of solidarity and accountability rather than the former tax-based model. The preferred health insurance fund was autonomous, state regulated, financing only health care, and offering optional membership. Voluntary insurance and, less so, co-payments were acceptable if limited to selected services and better off groups. In conclusion, a health financing system under public control that fits well with values and population preferences is likely to improve compliance and be more sustainable. Universal health insurance
Moy, Beverly; Polite, Blase N; Halpern, Michael T; Stranne, Steven K; Winer, Eric P; Wollins, Dana S; Newman, Lisa A
Patients in specific vulnerable population groups suffer disproportionately from cancer. The elimination of cancer disparities is critically important for lessening the burden of cancer. The Patient Protection and Affordable Care Act provides both opportunities and challenges for addressing cancer care disparities and access to care. The American Society of Clinical Oncology (ASCO) advocates for policies that ensure access to cancer care for the underserved. Such policies include insurance reform and the reduction of economic barriers to quality health care. Building on ASCO's prior statement on disparities in cancer care (2009), this article summarizes elements of the health care law that are relevant to cancer disparities and provides recommendations for addressing major provisions in the law. It outlines specific strategies to address insurance reform, access to care, quality of care, prevention and wellness, research on health care disparities, and diversity in the health care workforce. ASCO is committed to leading efforts toward the improvement of cancer care among the most vulnerable patients. PMID:21810680
Public finance principles, though usually treated as a minor consideration, lie at the heart of effective national health care reform. Four principles are discussed: charge for a service where its cost is created; distinguish rents, resources, and transfers; know what services cost and pay accordingly; balance distributional and equity concerns. The principles' implications include: since employment does not much affect health costs, financing (particularly of incremental insureds) need not b...
While most healthcare reforms have thus far been focused outside of the ED, they nonetheless have big implications for emergency providers, according to a panel of experts who discussed the future of emergency care at a conference sponsored by the Brookings Institution in Washington, DC. Going forward, the experts noted that emergency providers need to engage on how to most-effectively deliver higher value while also achieving better alignment with primary care providers. And they highlighted reforms that are already delivering results in pioneering EDs. Through the use of high-risk care plans, a specialized protocol for chest pain, and other reforms, the ED at the University of Maryland Upper Chesapeake Health System, based in Bel Air, MD, has been able to prevent more than 500 hospital admissions in the past year. Working with partners, emergency physicians in Washington state have managed to save the state more than $32 million while also slashing narcotic prescribing to Medicaid recipients by 24%. Their interventions include a prescription drug monitoring program, a mechanism for information sharing on key data points, and the development of care plans for frequent ED utilizers. A program called Bridges to Care in Denver, CO, has thus far been able to reduce ED and hospital utilization among frequent utilizers by 40%, generating $2 million in cost-savings to the health care system. The program focuses on identifying the key drivers of utilization, and then addressing these drivers with interventions. Program developers say connecting with patients while they are still in the ED, as opposed to making follow-up phone calls, is key to the program's success. PMID:26131537
Vietnam was one of the five poorest countries in the world in the 1980's. Since then, Vietnam has adopted a market economic policy, and she has made substantial economic progress. In the last 10 years Meanwhile Vietnam's per capita income has increased by 3 times, the volume of export doubled very two years, and the inflation rate was reduced to 4.5 % in 1997 from 775 % in 1986. The GDP also has increased, the exchange rate with the US$ was stabilized and foreign direct investment (FDI) and trade has increased. There was about US$35 billion were invested by the foreign investors between 1987 to the middle of June 1998. However, the current crisis in the economies of Southeast Asian countries has put pressure on Vietnam to rethink seriously her future reform program with respect to stabilization and sustainable current economic policies. Since FDI is an imperative for the development of a country like Vietnam, it is necessary to use this capital very careful for her economy. Thus, the main objective of this dissertation is to study the role of FDI in the development of Vietnam. To examine this objective, various investigations were made, especially focusing on development dimensions such as reforming state enterprises, foreign trade policy, foreign investment and so on. Therefore, in the future, FDI and privatization policies should be strengthened to maintain and create an international market. Moreover, there are some major reforms required to transform the state sector into a private sector with appropriate policy measures, such as improving management of financial companies, developing the agricultural sector and minimizing bureaucracy and red tapism of the government. This dissertation provides a set of recommendations how to strengthen Vietnams economic and market situation in the 21st century. (author)
Donelan, Karen; Buerhaus, Peter I; DesRoches, Catherine; Burke, Sheila P
Although registered nurses rank similarly with physicians in the public's esteem, physicians are more visible than nurses in media coverage, public policy, and political spheres. Thus, nursing workforce issues are overshadowed by those of other health priorities, including Medicare and health reform. The purpose of this research was to understand the visibility and salience of the health workforce in general, gain an understanding about the effectiveness of messages concerning the nursing workforce in particular, and to understand why nursing workforce issues do not appear to have gained more traction in national health care policymaking. The National Survey of Thoughtleaders about the Health Workforce was administered via mail, telephone and online to health workforce and policy thoughtleaders from August 2009-October 2009. Of 301 thoughtleaders contacted, 123 completed questionnaires for a response rate of 41%. Thoughtleaders agree that nurses are critical to the quality and safety of our healthcare system, that there are current nursing shortages, and that nursing shortages will be intensified by health reform. Thoughtleaders reported that while they do hear about nursing issues frequently, they do not view most sources of information as proposing effective policy solutions. This study highlights a critical gap in effective policy advocacy and leadership to advance nurse workforce issues higher on the national health agenda. PMID:20637930
Steaban, Robin Lea
This article is meant to spur debate on the role of the professional nurse in care coordination as well as the role of nursing leaders for defining and leading to a future state. This work highlights the opportunity and benefits associated with transformation of professional nursing practice in response to the mandates of the Affordable Care Act of 2010. An understanding of core concepts and the work of care coordination are used to propose a model of care coordination based on the population health pyramid. This maximizes the roles of nurses across the continuum as transformational leaders in the patient/family and nursing relationship. The author explores the role of the nurse in a transactional versus transformational relationship with patients, leading to actualization of the nurse in care coordination. Focusing on the role of the nurse leader, the challenges and necessary actions for optimization of the professional nurse role are explored, using principles of transformational leadership. PMID:26938188
Jacobi, Lena; Kluve, Jochen
"Having faced high unemployment rates for more than a decade, the German government implemented a comprehensive set of labour market reforms during the period 2003-2005. This paper describes the economic and institutional context of the German labour market before and after these so-called Hartz reforms. Focussing on active policy measures, we delineate the rationale for reform and its main principles. As preliminary results of programme evaluation studies post-reform have become available ju...
Basu, Sanjay; Rehkopf, David H; Siddiqi, Arjumand; Glymour, M Maria; Kawachi, Ichiro
We studied the health of low-income US women affected by the largest social policy change in recent US history: the 1996 welfare reforms. Using the Behavioral Risk Factor Surveillance System (1993-2012), we performed 2 types of analysis. First, we used difference-in-difference-in-differences analyses to estimate associations between welfare reforms and health outcomes among the most affected women (single mothers aged 18-64 years in 1997; n = 219,469) compared with less affected women (married mothers, single nonmothers, and married nonmothers of the same age range in 1997; n = 2,422,265). We also used a synthetic control approach in which we constructed a more ideal control group for single mothers by weighting outcomes among the less affected groups to match pre-reform outcomes among single mothers. In both specifications, the group most affected by welfare reforms (single mothers) experienced worse health outcomes than comparison groups less affected by the reforms. For example, the reforms were associated with at least a 4.0-percentage-point increase in binge drinking (95% confidence interval: 0.9, 7.0) and a 2.4-percentage-point decrease in the probability of being able to afford medical care (95% confidence interval: 0.1, 4.8) after controlling for age, educational level, and health care insurance status. Although the reforms were applauded for reducing welfare dependency, they may have adversely affected health. PMID:26946395
Full Text Available Abstract Background In Finland, dental services are provided by a public (PDS and a private sector. In the past, children, young adults and special needs groups were entitled to care and treatment from the public dental services (PDS. A major reform in 2001 – 2002 opened the PDS and extended subsidies for private dental services to all adults. It aimed to increase equity by improving adults' access to oral health care and reducing cost barriers. The aim of this study was to assess the impacts of the reform on the utilization of publicly funded and private dental services, numbers and distribution of personnel and costs in 2000 and in 2004, before and after the oral health care reform. An evaluation was made of how the health political goals of the reform: integrating oral health care into general health care, improving adults' access to care and lowering cost barriers had been fulfilled during the study period. Methods National registers were used as data sources for the study. Use of dental services, personnel resources and costs in 2000 (before the reform and in 2004 (after the reform were compared. Results In 2000, when access to publicly subsidised dental services was restricted to those born in 1956 or later, every third adult used the PDS or subsidised private services. By 2004, when subsidies had been extended to the whole adult population, this increased to almost every second adult. The PDS reported having seen 118 076 more adult patients in 2004 than in 2000. The private sector had the same number of patients but 542 656 of them had not previously been entitled to partial reimbursement of fees. The use of both public and subsidised private services increased most in big cities and urban municipalities where access to the PDS had been poor and the number of private practitioners was high. The PDS employed more dentists (6.5% and the number of private practitioners fell by 6.9%. The total dental care expenditure (PDS plus private
Juana, James S.
This study was designed to quantitatively investigate the economy-wide impact of land reform policies in Zimbabwe. Land reforms came with the realm of independence in Zimbabwe. Four models were used to implement the reform policies. The paper uses the updated 1991 Social Accounting Matrix for Zimbabwe and the Central Statistics Office's household data on resettled families in Zimbabwe. The paper computes the sectoral SAM multipliers and then uses household data on resettled families to simula...
G. Hammerschmid (Gerhard); S.G.J. Van de Walle (Steven); A. Oprisor (Anca); V. Štimac (Vid)
markdownabstract__Abstract__ This policy brief summarizes the findings from a large-scale executive survey on public administration reforms in Europe, and presents initial policy recommendations for current and future reforms.
Full Text Available The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date, and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms’ impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems.
Md. Mahmudul Alam
Full Text Available The paper tries to find evidence supporting the impact of continuous policy reforms on the market efficiency on the Dhaka Stock Exchange (DSE. Different policies formed/reformed from 1994 to 2005 were categorized in eleven groups depending on their time of issue and subject matter. To get the result, both nonparametric test (Kolmogrov-Smirnov normality test and run test and parametric test (autocorrelation test, autoregression have been performed. Analyses were done for each policy group, and it is found that formed/reformed policies for DSE during the study period failed to improve the market efficiency even in the weak form level.
This video clip comprises one of the 5 presentations of the PANEL SESSION: “The Front Line – Home Care Providers” held at the 21st Annual John K. Friesen Conference, "Innovations in Home Care: A Public Policy Perspective," MAY 16-17, 2012, Vancouver, BC. Presented by Lou Black, Researcher and Policy Analyst, BC Hospital Employees’ Union. It is well known that jurisdictions with more comprehensive and integrated home care delivery systems are able to extend independent living for older...
Manchikanti, Laxmaiah; Caraway, David L; Parr, Allan T; Fellows, Bert; Hirsch, Joshua A
accounted for, we will be facing a significant increase in deficits rather than a reduction. When posed as a global question, polls suggest that public opinion continues to be against the health insurance reform. The newly elected Republican congress is poised to pass a bill aimed at repealing health care reform. However, advocates of the repeal of health care reform have been criticized for not providing a meaningful alternative approach. Those criticisms make clear that it is not sufficient to provide vague arguments against the ACA without addressing core issues embedded in health care reform. It is the opinion of the authors that while some parts of the ACA may be reformed, it is unlikely to be repealed. Indeed, the ACA already is growing roots. Consequently, it will be extremely difficult to repeal. In this manuscript, we look at reducing the regulatory burden on the public and providers and elimination of IPAB and PCORI. The major solution lies in controlling the drug and durable medical supply costs with appropriate negotiating capacity for Medicare, and consequently for other insurers. PMID:21267047
The world's largest gas producer and exporter, Russia has an enormous energy saving potential. At least 30 billion cubic meters, a fifth of Russian exports to European OECD countries, could be saved every year by enhanced technology or energy efficiency. As the era of cheap gas in Russia comes to an end, this potential saving is increasingly important for Russians and importing countries. And, as domestic gas prices increase, efficiency investments will become increasingly economic - not to mention the incentive for Gazprom to enhance its efficiency against a backdrop of high European gas prices. The book analyzes and estimates the potential savings and the associated reductions in greenhouse gas emissions in the oil extraction (flaring), gas transmission, and distribution sectors. Achieving these savings will require linking long-standing energy efficiency goals with energy sector reforms, as well as climate policy objectives. The book also describes Russia's emerging climate policy and institutional framework, including work still ahead before the country is eligible for the Kyoto Protocol's flexibility mechanisms and can attract financing for greenhouse gas reductions. Stressed is the need for Russia to tap the full potential of energy savings and greenhouse gas emission reductions through a more competitive environment in the gas sector to attract timely investments.
Rostgaard, Tine; Szebehely, Marta
continued the generous provision of home care. This article focuses on the implication of such diverse policies for the provision and combination of formal and informal care resources for older people. Using data from Level of Living surveys (based on interviews with a total of 1,158 individuals aged 67......Despite pursuing the policy of ageing in place, the two Nordic countries of Denmark and Sweden have taken diverse roads in regard to the provision of formal, public tax-financed home care for older people. Whilst Sweden has cut down home care and targeted services for the most needy, Denmark has...... countries tax-funded home care is used across social groups but targeting of resources at the most needy in Sweden creates other inequalities: Older people with shorter education are left with no one to resort to but the family, whilst those with higher education purchase help from market providers...
Ekman, Björn; Wilkens, Jens
The introduction in 2010 of the Freedom of Choice Act represents one of the most far-reaching reforms of the Swedish health system. While it is mandatory for the regional counties to introduce choice plans for primary care it is voluntary for ambulatory specialist services. The voluntary nature of the regulations for the latter types of care generates a potential gap between the central government's reform attempts and the regional implementation of the plans. We review the regional implementation of this reform with respect to specialist services from a political economy perspective. Data on the scope of implementation show that counties of the same political ideology as the central government have introduced the most choice plans for specialist care. In particular, counties ruled by right-wing majorities have introduced the Choice Act to a considerably larger extent than left-wing counties. This creates a highly uneven situation across the various parts of the country, possibly at odds with the basic premises of the country's health law of equal access to care. The introduction of choice plans forms part of a decidedly contentious set of issues that are high on the political agenda of Sweden. The nature and impacts of these reforms are also a concern to the general public and the broader industry. Considerably more rigorous analyses will be needed to assess the impact on key policy parameters such as overall system efficiency and equitable access to services as a result of these changes to the health care markets. PMID:26650814
Collins, Lauren G; Wender, Richard; Altshuler, Marc
The US health care system has become increasingly unsustainable, threatened by poor quality and spiraling costs. Many Americans are not receiving recommended preventive care, including cancer screening tests. Passage of the Affordable Care Act in March 2010 has the potential to reverse this course by increasing access to primary care providers, extending coverage and affordability of health insurance, and instituting proven quality measures. In order for health care reform to succeed, it will require a stronger primary care workforce, a new emphasis on patient-centered care, and payment incentives that reward quality over quantity. Innovations such as patient-centered medical homes, accountable care organizations, and improved quality reporting methods are central features of a redesigned health care delivery system and will ultimately change the face of cancer care in the United States. PMID:21131791
David Chu; Kolleen Rask
This paper is a case study of China’s recent reforms in hospital accounting. We analyze the Chinese health care system in transition to highlight the changing role and nature of accounting services before and after the recent reforms. Prior to reforms, the accounting system provided data solely for government central planning purposes. Reforms were supposed to decentralize hospital decision making, thus signaling a need for a new accounting system that would provide information to managers an...
Are values and social priorities universal, or do they vary across geography, culture, and time? This question is very relevant to Asia's emerging economies that are increasingly looking at Western models for answers to their own outmoded health care systems that are in dire need of reform. But is it safe for them to do so without sufficient regard to their own social, political, and philosophical moorings? This article argues that historical and cultural legacies influence prevailing social values with regard to health care financing and resource allocation, and that the Confucian dimension provides a helpful entry point for a deeper understanding of ongoing health care reforms in East Asia--as exemplified by the unique case of Singapore. PMID:23175795
Blaauw, Duane; Ditlopo, Prudence; Rispel, Laetitia C.
Background: Nursing education reform is identified as an important strategy for enhancing health workforce performance, and thereby improving the functioning of health systems. Globally, a predominant trend in such reform is towards greater professionalisation and university-based education. Related nursing education reform in South Africa culminated in a new Framework for Nursing Qualifications in 2013.Objective: We undertook a policy analysis study of the development of the new Nursing Qual...
Karakhanyan, Susanna; van Veen, Klaas; Bergen, T.C.M.
The paper seeks to understand how higher education policy from the European Community is defused and transferred to Armenia, a developing country. Particularly, this study aims to delve deeper in the actual implementation process of higher education reforms in Armenia through teachers' perceptions. The findings mainly reveal that teachers do long…
Xinhua Gu; Lan Zhang
This paper examines the effectiveness of China's monetary policy in curbing the overheating and speculation problems under the current foreign exchange system. The paper stresses the necessity of capital controls in China's gradual foreign exchange reform and the importance of credible government policy in guiding market expectations. Also, the paper discusses the persistence of China's external imbalance, and provides policy recommendations for its reduction.
Yamat, Hamidah; Umar, Nur Farita Mustapa; Mahmood, Muhammad Ilyas
Today's global economy and dependency on technology has led to educational reforms in Malaysia, which includes language policies; namely the Upholding the Malay Language, and Strengthening the English Language ("MBMMBI") policy. This policy underpins the project presented and discussed in this paper; on the development of a bilingual…
The higher education (HE) subsystem in Ethiopia has passed through a series of policy reforms in the last 10 years. Key reform areas ranged from improving quality and relevance of programmes to promoting equality in access to and success in HE. Despite the effort underway, gender inequality has remained a critical challenge in the subsystem. This…
Chua Reyes, Vicente
The purpose of this research inquiry focuses on how school leaders "make sense" of educational reform in their local contexts. In order to do this, an exploratory qualitative case study of two schools that took part in policy reform initiatives directed at ubiquitous use of information communication and technology (ICT) in the Singapore…
Gandin, Luis Armando
This article focuses on the contribution of Stuart Hall to the study of educational policy and reform, using the experience of the Citizen School initiative in Porto Alegre, Brazil as a concrete example. This experience was a participatory educational reform implemented during the 16 years of the Workers' Party tenure in Porto Alegre's municipal…
Hyde, Justeen K; Mackie, Thomas I; Palinkas, Lawrence A; Niemi, Emily; Leslie, Laurel K
Considerable attention is being given to the use of research evidence to inform public policy making. Building upon Weiss's model of research utilization, we examined the types and uses of evidence that child welfare administrators used in response to federal policy reforms requiring psychotropic medications oversight for children in foster care. Participants relied on a range of "global" and "local" evidence types throughout the policy development phase. Global research evidence was used to raise awareness about problems associated with psychotropic medication use. Local evidence helped to contextualize concerns and had problem-solving and political uses. In most states, policy actions were informed by a combination of evidence types. PMID:25711392
Balicer, Ran D; Shadmi, Efrat
In March 2010 the United States enacted the most significant health care reform in several decades. The Patient Protection and Affordable Care Act, amongst other provisions, addresses two of the main current shortcomings of the U.S. health system: the large portion of the population that are uninsured and the high percentage of hsealth expenditures (mostly private] which amounts to about 16% of the GDP. Changes to the current structure and financing of the U.S. health system will have implications for other health systems, for science (e.g., through enhanced federal funding for comparative effectiveness research), and for technological advance (e.g., through accelerated development and use of electronic health records). There are several lessons from the reform, and the factors leading to its implementation, for the Israeli health system. Firstly, the basic principles of the Israeli health system are a source of pride, and undermining its main values can have deleterious effects. Overreliance on private, out-of-pocket, spending and lack of support for public practice of medicine (in community and hospital settings) will weaken the public sector, strengthen the private sector, and could result in a tiered lower quality and less accessible public system with greater widening of gaps in health and health care utilization. This paper reviews the main provisions of the U.S. health care reform and the potential implications for the IsraeLi health system. PMID:21939111
Hsu, T.; Tien, K. C.
This research investigates selected South Dakota science educational outcomes as a function of selected educational reform policies. In the state of South Dakota, echoing divergent reform initiatives from "A Nation at Risk" to "No Child Left Behind," new guidelines and requirements have been instituted. Yet, very little effort has been made to assess the progress of these educational changes. In this study, selected educational outcomes-SAT8/9/10 scores-as a function of selected South Dakota educational reform policies were examined. School districts, ranked in the top and bottom five percent of socioeconomic status (SES) in the state, were selected for analysis. Comparison on student's science educational outcomes was also be made between the two major ethnic populations-Caucasians and Native Americans. All research questions were stated in the null form for hypothesis for statistical testing. Critical t was the statistic technique used to test the hypotheses. The findings revealed that the selected reform policies in South Dakota appeared to assist students from the higher socioeconomic backgrounds to perform better than pupils from the lower socioeconomic backgrounds. The academic performance for the ethnic and social class minorities remained unchanged within the study timeline for reform. Examined from the prism of Michael Apple's critical theory, the selected South Dakota reform policies have paid little attention to the issues of social equality. Continuing and collective efforts to promote equitable reform policies for enhancing the learning experience of all children in South Dakota seem necessary.
Superfine, Benjamin Michael
Courts hearing school finance reform cases have recently begun to consider several issues related to standards-based accountability policies. This convergence of school finance reform litigation and standards-based accountability policies represents a chance for the courts to reallocate decision-making authority for each type of reform across the…
... direct care workforce. Division of Behavioral Health and Intellectual Disabilities Policy The Division of Behavioral Health and Intellectual Disabilities Policy focuses on financing, delivery, and quality of ...
Real reforms attempt to change how health care is financed and how it is rationed. Three main explanations have been offered to explain why such reforms are so difficult: institutional gridlock, path dependency, and societal preferences. The latter posits that choices made regarding the health care system in a given country reflect the broader societal set of values in that country and that as a result public resistance to real reform may more accurately reflect citizens' personal convictions, self-interest, or even active social choices. "Conscientious objectors" may do more to derail reform than previously recognized. PMID:22466049
Atun, Rifat A; Kyratsis, Ioannis; Jelic, Gordan; Rados-Malicbegovic, Drazenka; Gurol-Urganci, Ipek
Most transition countries in Central and Eastern Europe and Central Asia are engaged in health reform initiatives aimed at introducing primary health care (PHC) centred on family medicine to enhance performance of their health systems. But, in these countries the introduction of PHC reforms has been particularly challenging; while some have managed to introduce pilots, many have failed to these scale up. Using an innovation lens, we examine the introduction and diffusion of family-medicine-centred PHC reforms in Bosnia and Herzegovina (BiH), which experienced bitter ethnic conflicts that destroyed much of the health systems infrastructure. The study was conducted in 2004-05 over a 18-month period and involved both qualitative and quantitative methods of inquiry. In this study we report the findings of the qualitative research, which involved in-depth interviews in three stages with key informants that were purposively sampled. In our research, we applied a proprietary analytical framework which enables simultaneous and holistic analysis of the context, the innovation, the adopters and the interactions between them over time. While many transition countries have struggled with the introduction of family-medicine-centred PHC reforms, in spite of considerable resource constraints and a challenging post-war context, within a few years, BiH has managed to scale up multifaceted reforms to cover over 25% of the country. Our analysis reveals a complex setting and bidirectional interaction between the innovation, adopters and the context, which have collectively influenced the diffusion process. Family-medicine-centred PHC reform is a complex innovation-involving organizational, financial, clinical and relational changes-within a complex adaptive system. An important factor influencing the adoption of this complex innovation in BiH was the perceived benefits of the innovation: benefits which accrue to the users, family physicians, nurses and policy makers. In the case of Bi
Borren, P; Maynard, A
Everywhere there is a recognition that the delivery of health care is ineffective and inefficient and that these unpleasant outcomes are a product of the perverse incentives inherent in all health care systems. In New Zealand the Government documented the defects of the health care system and has introduced radical competitive market reforms, with a purchaser-provider split, in the belief that these will improve the system's performance. The nature of these reforms, centred on the purchaser-provider divide, is similar to changes introduced in the Netherlands, the UK, Sweden, Israel and Russia. The reforms which have been introduced in New Zealand are evaluated in terms of the eight major problems its Government sought to eradicate. It is shown that instead of mitigating these problems the reforms may worsen them, with the system becoming fragmented and less equitable. The move away from a single (tax) source of funds (i.e. the single pipe) may make cost control more difficult. The Government is seeking to address the issue of information generation to facilitate market trading but it is not clear how effectiveness and efficiency data will be produced in adequate volume and quality, let alone how it will be used to change producers behaviour. Many of the problems identified by the New Zealand Government are significant and in need of resolution. However whilst the political imperative may require immediate action, the economic case for these reforms is quite poor. Incremental change, with careful evaluation, would 'inform' policy change with knowledge of the attributes of competing management mechanisms and reward systems. Instead there is the too familiar combination of political assertions and an unwillingness to measure the impact of change, behaviours which may create the causes for the advocacy of the next 'redisorganisation' of the health care system. PMID:10134581
Purvis, Taylor E
This article considers how religious and economic factors shape assisted reproductive technology (ART) policy in Indonesia, the world's most populous Muslim country. Infertility clinic policies are grounded on both the views of the country's powerful Islamic coalition and those of the worldwide Islamic community. Indonesian government officials, physicians, and Islamic scholars have expressed concern over who can use ART and which procedures can be performed. Indonesia has also faced economic challenges related to ART, including inadequate health insurance coverage, inequitable access to ART, and maintenance of expensive ART infrastructure. The prohibitive price of infertility treatment and regional differences in the provision of health care prohibit most Indonesians from obtaining ART. In the absence of a shift in religious mores and a rapid reduction in poverty and inequality, Indonesia will need to adopt creative means to make ART both more available and less necessary as a solution to infertility. This paper suggests policy reforms to promote more affordable treatment methods and support preventative health programmes to reduce infertility rates. This country-specific analysis of the laws and customs surrounding ART in Indonesia reveals that strategies to reduce infertility must be tailored to a country's unique religious and economic climate. PMID:26371707
receivers. Question To explore experiences of post bureaucratic hospital reforms and their impact on care provision. Method Data builds on nine mini group interviews with midwives (n = three), nurses (n = three) and physiotherapists (n = three), in all thirty participants. Data was analysed using existing....... Although midwives, nurses and physiotherapists share similar experiences of post bureaucratic hospital reforms, changes in care provision can impact these professions in different ways. As a discipline, midwifery is founded on relationships between women and midwives. Standardised clinical care...
Shue, Carolyn K.; McGeary, Kerry Anne; Reid, Ian; Fan, Maoyong
Since passage of the Affordable Care Act (ACA) was signed into law by President Barrack Obama, little is known about state-level perceptions of residents on the ACA. Perceptions about the act could potentially affect implementation of the law to the fullest extent. This 3-year survey study explored attitudes about the ACA, the types of information sources that individuals rely on when creating those attitudes, and the predictors of these attitudes among state of Indiana residents. The respondents were split between favorable and unfavorable views of the ACA, yet the majority of respondents strongly supported individual components of the act. National TV news, websites, family members, and individuals' own reading of the ACA legislation were identified as the most influential information sources. After controlling for potential confounders, the respondent's political affiliation, age, sex, and obtaining ACA information from watching national television news were the most important predictors of attitudes about the ACA and its components. These results mirror national-level findings. Implications for implementing health care reform at the state-level are discussed. PMID:25045705
André van der Walt
The programme of land reform laws introduced in South Africa since 1991 is often seen and discussed as nothing more than a highly technical, black-letter aspect of South African law. In this article, the author directs attention to the policies that underly the land reform laws, and discusses the transformative potential and effect of land reform laws in view of these policies. The main question is whether the land reform programme has succeeded in breaking away from or undermining the hierar...
Educational R & D in Sweden is to a large extent policy-oriented. It has been an integrated part of the Swedish educational reform system and has brought about a dialogue between politicians, administrators and researchers. Several circumstances have contributed to the `Swedish model'. One is the system with government-appointed committees in which researchers often play an active part. Another is that the Swedish educational system is highly centralized, with the National Board of Education (NBE) as the central authority, responsible for primary, secondary and adult education. A third — and a crucial one — is that, since 1962, the NBE has had increasing funds for educational R & D at its disposal. These funds account for the main part of the economic resources for R & D, along with resources allocated to research appointments at research departments of universities. Educational R & D, conducted primarily within the NBE funds, has recently been evaluated by a government-appointed committee. In its evaluations of the impact of educational R & D, the committee distinguished between the effects of R & D and the effect correlates. It concluded that the impact of R & D is more indirect than direct, more long-term than immediate. The effects are also more easily recognized at levels above the actual school situation. This finding could be interpreted as a consequence of the policy-orientation of educational R & D, which at the same time shows the difficulties in reaching the `school level' with research and development results. There are two general trends in Sweden, which will influence both research planning and research use. First, there is a trend towards the decentralization of decision-making and responsibility for the educational system. Secondly, there is a trend towards the `sectionalization' of the R & D system as a whole. This sectionalization will mean that research will to a great extent be planned to meet needs from different parts of society — labour
Yang, Wei; Jingwei He, Alex; Fang, Lijie; Mossialos, Elias
A rapid ageing population coupled with changes in family structure has brought about profound implications to social policy in China. Although the past decade has seen a steady increase in public funding to long-term care (LTC), the narrow financing base and vast population have created significant unmet demand, calling for reforms in financing. This paper focuses on the financing of institutional LTC care by examining new models that have emerged from local policy experiments against two pol...
The beginning of the most important elements of the Patient Protection and Affordable Care Act of 2010 (ACA) is an opportune time to review the history of health care reform in the United States, the issues involved in the development of the ACA and its prospects. Efforts for reform trace back to President Teddy Roosevelt and have moved forward since then. The ACA is the culmination of years of debate and discussion at the federal level, but the Massachusetts Health Care Reform Plan adopted i...
Brink, Anna; Nordblom, Katarina; Wahlberg, Roger
The effects of a recent Swedish child-care fee reform are compared with those of an alternative reform, increased child benefits. The fee reform implied considerably decreased fees and was intended to increase both labor supply among parents and their economic well-being. We estimate labor supply effects using a discrete choice labor supply model, and simulate behavioral responses to the changes. We find positive, but small, effects on labor supply from reduced fees, while increased child ben...
Wilson, Anne; Whitaker, Nancy; Whitford, Deirdre
Health reform worldwide is required due to the largely aging population, increase in chronic diseases, and rising costs. To meet these needs, nurses are being encouraged to practice to the full extent of their skills and take significant leadership roles in health policy, planning, and provision. This can involve entrepreneurial or intrapreneurial roles. Although nurses form the largest group of health professionals, they are frequently restricted in their scope of practice. Nurses can help to improve health services in a cost effective way, but to do so, they must be seen as equal partners in health service provision. This article provides a global perspective on evolving nursing roles for innovation in health care. A historical overview of entrepreneurship and intrapreneurship is offered. Included also is discussion of a social entrepreneurship approach for nursing, settings for nurse entre/intrapreneurship, and implications for research and practice. PMID:22686113
Johnson, Carla C.
Enactment of federal educational policy has direct implications for states and local school districts across the nation, particularly in the areas of accountability and funding. This study utilized constructivist grounded theory to examine the impact of policy on science education reform in a large, urban school district over a 5-year period. The…
Khoon, Chan Chee
In Malaysia, the shifting balance between market and state has many nuances. Never a significant welfare state in the usual mold, the Malaysian state nonetheless has been a dominant social and economic presence dictated by its affirmative action-type policies, which eventually metamorphosed into state-led indigenous capitalism. Privatisation is also intimately linked with emergence of an indigenous bourgeoisie with favored access to the vast accumulation of state assets and prerogatives. Internationally, it is conditioned by the fluid relationships of converging alliances and contested compromise with international capital, including transnational health services industries. As part of its vision of a maturing, diversified economy, the Malaysian government is fostering a private-sector advanced health care industry to cater to local demand and also aimed at regional and international patrons. The assumption is that, as disposable incomes increase, a market for such services is emerging and citizens can increasingly shoulder their own health care costs. The government would remain the provider for the indigent. But the key assumption remains: the growth trajectory will see the emergence of markets for an increasingly affluent middle class. Importantly, the health care and social services market would be dramatically expanded as the downsizing of public-sector health care proceeds amid a general retreat of government from its provider and financing roles. PMID:17208722
Ung, Brian L; Mullins, C Daniel
The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability. PMID:25217142
The past two decades have witnessed three important international trends: an increase in the number of democratic states; economic globalization; and educational reforms in light of the challenges of the new millennium. A great deal of research has addressed educational change in relation to either globalization or democratization, but little has been said about the complex interactions among all three processes. In view of recent educational reforms in Hong Kong and Taiwan, the present contribution examines the local nature of education policy in a globalized age. It challenges those globalization theories which minimize the role of the state and exaggerate the power of globalization over local factors. In particular, it explores how the governments of these two Chinese societies have employed democratization to generate and legitimate reform proposals and have used economic globalization to justify educational reforms. The study concludes by discussing the complex interrelations of these processes, including tensions between global and local concerns in educational reform.
Oborn, Eivor; Barrett, Michael; Exworthy, Mark
The development of health policy is recognized as complex; however, there has been little development of the role of agency in this process. Kingdon developed the concept of policy entrepreneur (PE) within his ‘windows’ model. He argued inter-related ‘policy streams' must coincide for important issues to become addressed. The conjoining of these streams may be aided by a policy entrepreneur. We contribute by clarifying the role of the policy entrepreneur and highlighting the translational processes of key actors in creating and aligning policy windows. We analyse the work in London of Professor Sir Ara Darzi as a policy entrepreneur. An important aspect of Darzi's approach was to align a number of important institutional networks to conjoin related problems. Our findings highlight how a policy entrepreneur not only opens policy windows but also yokes together a network to make policy agendas happen. Our contribution reveals the role of clinical leadership in health reform. PMID:22069793
Mulvihill, James E.
Economic and social trends that will affect the health care system are examined, including federal health care reform efforts, federal budget trimming through managed care and cost-cutting, declines in state spending, adoption of single-payer systems, growing competition in the private sector (mergers, alliances, acquisitions), dominance of health…
Since the 1980s a major change took place in public policies for water resources management. The role of governments shifted under this reform process from an emphasis on investment in the development, operation and maintenance of water infrastructure to a focus on managing water resources systems by stipulating general frameworks and defining key principles for water allocation. This interdisciplinary research examines how this water reform process unfolds within four African waterscapes tha...
Full Text Available Abstract Background Following a situation appraisal in 2001, a six year mental health reform programme (Egymen 2002-7 was initiated by an Egyptian-Finnish bilateral aid project at the request of a former Egyptian minister of health, and the work was incorporated directly into the Ministry of Health and Population from 2007 onwards. This paper describes the aims, methodology and implementation of the mental health reforms and mental health policy in Egypt 2002-2009. Methods A multi-faceted and comprehensive programme which combined situation appraisal to inform planning; establishment of a health sector system for coordination, supervision and training of each level (national, governorate, district and primary care; development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at each level; integration of mental health into health management systems; and dedicated efforts to improve forensic services, rehabilitation services, and child psychiatry services. Results The project has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, mental health masterplan (policy guidelines to accompany the general health policy, updated Egyptian mental health legislation, Code of Practice, adaptation of the WHO primary care guidelines, primary care training, construction of a quality system of roles and responsibilities, availability of medicines at primary care level, public education about mental health, and a research programme to inform future developments. Intersectoral liaison with education, social welfare, police and prisons at national level is underway, but has not yet been established for governorate and district levels, nor mental health training for police, prison staff and teachers. Conclusions The bilateral collaboration programme
Reforming health care systems which are predominantly publicly provided and financed has usually been motivated as a way of increasing efficiency even if it seldom is explicit whether it is in the official sense related to individual utility or in the unofficial sense related to health outcomes. In the case of Sweden the welfare state has been made politically sustainable through a construction where cash benefits and service provision are tailored to satisfy not only the basic needs but even the more discriminating needs of the middle classes. Their loyalty with the taxes is politically crucial and therefore their evaluation of the services in the welfarist sense equally important. That loyalty was however threatened in a situation where cost-containment policies were applied while equity principles were still a strong priority. Health care utilization was increasing among the very old and chronically ill while it was decreasing for other groups. The reforms introduced in some counties during the 1990s have been focussing on a purchaser-provider split and fee-for-service payment of providers. They have increased productivity sharply, increased utilization even among the groups that previously were 'pressed out' and reduced waiting lists. Increased efficiency however, threatens equity in some specific aspects. Fee-for-service payment means increased production and so far even increased costs. If they are to be met with increased private financing, rather than with present tax financing, it will bring the risk of inequities. Payment of hospitals through DRG systems means payment to providers for medical interventions with no incentives to deal with social consequences of illness. Inequities in health care can be related to the way health care deals with inequalities in health due to inequalities in living conditions or inequalities in living conditions due to ill health. In the short perspective the reforms may threaten equity in the second aspect, in the longer
Rutten, F; Lapré, R; Antonius, R; Dokoui, S; Haqq, E; Roberts, R; Mills, A
This paper considers health care finance in four Caribbean territories and plans for reform in comparison with developments in European countries, to which these territories are historically linked. European health care reforms are aimed at making resource allocation in health care more efficient and more responsive to consumers' demands and preferences. These reforms in Europe have been continuing without appearing to have influenced the developments in the Caribbean very much, except in Martinique. In Trinidad and Tobago current reform entails delegation of responsibility for providing services to four regional health authorities and no purchaser/provider split at the regional or facility level as in the UK has been implemented. In the Bahamas, managed care arrangements are likely to emerge given the proximity of the United States. Recent universal coverage reform in Martinique was aimed at harmonisation of finance by bringing social security and social aid functions together under one management structure and may provide more opportunities for contracting and other initiatives towards greater efficiency. The first priority in Suriname is to restore proper functioning of the current system. Reforms in the four Caribbean territories have a largely administrative character and affect the organisation of the third party role in health care rather than fundamentally changing the relationship between this third party and the various other parties in health care. PMID:12151137
This response to the two papers (by Rodriguez and Carlone et al.) on science education reform acknowledges first the coherence of the arguments presented around four reform narratives; that of the process of becoming science-enthusiastic, the nature of beliefs of science reform teachers, the barriers to reform, and the institutional expressions of these barriers. In the commentary I first discuss the reform `problem' in terms of two interacting issues—the purposes of school science and the value placed on it in an elementary school curriculum. The insights produced in these papers are then used to reflect on a range of experiences and current policy debates in Australia. Finally, in this commentary, I point out: (a) the relationship of the papers to the reform issue of opposition to Standards Based Science (SBS) from proponents' traditional conceptions of science education, discussing how this more specific reform question relates to the two papers; and (b) the singular nature of the I-meanings characterised in the Carlone et al. paper, describing (using Australian examples) how the notions of tempered radicals and I-meanings might also be used to characterise complexities in the processes of school science reform.
Despite having succeeded in passing important and even epochal reforms(health care, financial sector) and avoided the US economy falling in a depressive spiral, the Obama Administration and the Democrats were heavily punished at the mid-term elections of November 2010. What went wrong? This article argues that by choosing a strategy aimed at fighting the global financial crisis while pushing forward major economic and social reforms may have overstretched President Obama's political resources...
Indonesia's recovery was already slowing several months before the events of September 11. Political instability had raised social tensions and slowed reforms--fueling capital flight, alarming investors, and delaying official external finance for development. Progress on bank restructuring had slowed and the debt of financially strapped corporations remained largely unresolved. Corruption ...
Mendoza, Roger Lee
Purpose - Moral hazard is a concept that is central to risk and insurance management. It refers to change in economic behavior when individuals are protected or insured against certain risks and losses whose costs are borne by another party. It asserts that the presence of an insurance contract increases the probability of a claim and the size of a claim. Through the US Affordable Care Act (ACA) of 2010, this study seeks to examine the validity and relevance of moral hazard in health care reform and determine how welfare losses or inefficiencies could be mitigated. Design/methodology/approach - This study is divided into three sections. The first contrasts conventional moral hazard from an emerging or alternative theory. The second analyzes moral hazard in terms of the evolution, organization, management, and marketing of health insurance in the USA. The third explains why and how salient reform measures under the ACA might induce health care consumption and production in ways that could either promote or restrict personal health and safety as well as social welfare maximization. Findings - Insurance generally induces health care (over) consumption. However, not every additional consumption, with or without adverse selection, can be considered wasteful or risky, even if it might cost insurers more in the short run. Moral hazard can generate welfare and equity gains. These gains might vary depending on which ACA provisions, insured population, covered illnesses, treatments, and services, as well as health outcomes are taken into account, and because of the relative ambiguities surrounding definitions of "health." Actuarial risk models can nonetheless benefit from incorporating welfare and equity gains into their basic assumptions and estimations. Originality/value - This is the first study which examines the ACA in the context of the new or alternative theory of moral hazard. It suggests that containing inefficient moral hazard, and encouraging its desirable
M. J. Saka
Full Text Available The study was carried out to demonstrate the impact of National weight on the process of health sector reform from 2001 to 2010 and to specifically determine Health policies and plans initiated at Federal level and adopted or adapted at State level including capacity for implementation. Multiple data collection was used to collate data. A tool was developed and sent to trained interviewers each for each state including Federal Capital Territory (FCT to administer on the States within their span of work. Reportedly, at least 21 States in Nigeria had either started or are implementing various types of reforms. However, it is not very clear how much of these efforts may be attributed to an interest groups, professional groups, Talkawa group, Eminent personality group (EPG, and other elite groups. National, State and LGAs levels elite had dominated policy through their control of resources, but more importantly through their ‘control of the terms of debate through expert knowledge, support of research, and occupation of key nodes’ in the network. The findings were not that a small group of leaders shaped the policy debates, but rather that the leadership was not representative of the interest at stake: ‘the national policy network on health sector reform had been narrowly based in a small number of institutions. We concluded that without continuous and sustained institutional or structural reform in health, it is unlikely that existing organizational structures and management systems in health sector will be able to deal adequately with the weak and fragile National Health Care Delivery System and improving its performance. It is recommended that health sector reform should therefore be concerned with defining priorities, refining policies and reforming the institutions through which those policies are implemented.
Polelo, Mompati Mino
A number of global discourses have gained currency in national education policies. The need to reform education systems is coated in economic terms, the rationale of which is efficiency, productivity and competitiveness. Education is assigned the task of producing a competitive workforce in the global market. In these reforms, education is…
This report examines current issues relating to day care and challenges many of the policy assumptions that underlie a major public program of subsidized day care for children. A historical perspective of day care is presented and various types of day care are described. The costs and benefits of day care are examined and the relation of day care…
El-Kholei, Ahmed Mohammed Salah
In 1986, Egypt implemented a succession of comprehensive economic reforms both in the agriculture sector and more generally such as the Economic Reform and Structural Adjustment Program (ERSAP) of 1991. Since then, the agricultural sector has been gradually transformed from one characterised by central planning and governmental controls to one that is more free market oriented. This study employs the Policy Analysis Matrix technique to evaluate the impacts of reform policies on eleven maj...
De Leon, I. L.
Until recently, institutional reforms implemented under the so-called 'apertura' economic strategy has emphasized the correction of macroeconomic imbalances through specific policy measures (i.e. privatization, open trade, fiscal balance, stable exchange rates). As overall imbalances have been corrected, policy makers are considering the introduction of a second generation of 'institutional reforms'. Consequently, the focus of reform would shift into the promotion of productivity, competition...
This article analyses the cause–effect relation of the structural reform in the Mexican electricity sector, called the Public Electricity Service Act, from 1992 to 2009. One of the main arguments of the reform is to attract private investment in order to reduce the financial load of the government in infrastructure for the development of the National Electric Power System by means of six modalities (Power Self-Supply, Cogeneration, Small Power Production, Independent Power Production, Power Export and Power Import). The article presents the global context of reforms adopted in 1990. The major policies and events are presented in chronological order (before and after reform). In addition, it analyses the new institutional framework, the evolution of modalities, technologies of electricity generation and tariffs. The main conclusion is that the result of reform could be considered a partial progress. The Independent Power Production modality shows greater participation, while Power Self-Supply and Cogeneration are lower. The subsidy policy is maintained. Progress is needed in policies and strengthening, and also in updating regulatory and normative frameworks
This book, which is based on the work carried out by the International Energy Agency and UNEP, explores the potential impacts of energy subsidies and provides guidelines for policy makers on how to implement reform of energy subsides. The background on energy subsidies is traced and an analytical framework is presented covering defining and measuring energy subsidies, the size of the subsidies, and analysis of the impact of subsidies and their reform. Energy subsidies in OECD countries, Czech and Slovak Republics, Russia, India, Indonesia, Korea, Iran and Senegal are examined along with the impact of removing energy subsidies in Chile, the findings of country case studies, and the design and implementation of energy subsidies reforms. Methodological approaches to analysing the economic, environmental and social effects of energy subsidy reform are considered in the Annex
Chin, Chee Wei Winston; Phua, Kai-Hong
Singapore, like many developed countries, is facing the challenge of a rapidly aging population and the increasing need to provide long-term care (LTC) services for elderly in the community. The Singapore government's philosophy on care for the elderly is that the family should be the first line of support, and it has relied on voluntary welfare organizations (VWOs) or charities for the bulk of LTC service provision. For LTC financing, it has emphasized the principles of co-payment and targeting of state support to the low-income population through means-tested government subsidies. It has also instituted ElderShield, a national severe disability insurance scheme. This paper discusses some of the challenges facing LTC policy in Singapore, particularly the presence of perverse financial incentives for hospitalization, the pitfalls of over-reliance on VWOs, and the challenges facing informal family caregivers. It discusses the role of private LTC insurance in LTC financing, bearing in mind demand- and supply-side failures that have plagued the private LTC insurance market. It suggests the need for more standardized needs assessment and portable LTC benefits, with reference to the Japanese Long-Term Care Insurance program, and also discusses the need to provide more support to informal family caregivers. PMID:26808468
Kabir, Ariful Haq
Bangladesh has introduced neoliberal policies since the 1970s. Military regimes, since the dramatic political changes in 1975, accelerated the process. A succession of military rulers made rigorous changes in policy-making in various sectors. This article uses a critical approach to document analysis and examines the perceptions of key…
In the 1990s, Latin American countries introduced similar national gender equality policy reforms. The key policy areas in which this convergence took place were the criminalization of domestic violence, the introduction of state agencies for women, and the incorporation into law of candidate gender quotas for national parliamentary elections. This thesis evaluates the explanations offered in the existing literature, including both national and international level analyses that could explain ...
To understand the long shadow of education policy and reform in the United States, especially in the urban core, requires a full and elaborate understanding of the neighborhoods and communities that have transformed in the last 20 or 30 years. Studying classrooms and educational spaces without concomitant understanding of the dynamics and facets…
Since the 1980s a major change took place in public policies for water resources management. The role of governments shifted under this reform process from an emphasis on investment in the development, operation and maintenance of water infrastructure to a focus on managing water resources systems b
Parker, Dan; McGray. Robert
This research draws into question the effects that neoliberal policy reforms--with an emphasis on individual and measurable "competencies"--has on new teachers teaching sexuality education in Quebec. While we examine professional competencies that teachers can use to define their mandate for teaching sexuality education as a beginning…
This article concentrates on the policy reforms of schools in England, Germany, France and Italy, from 1988 to 2009, with a focus on the introduction of market accountability. Pressing demands for organisational change in schools, shaped by the objectives of "efficiency" and competition, which were introduced in England in the 1980s, have been…
Bryer, Fiona; Main, Katherine
Three well-established issues for educational reform to insert middle schooling into the traditional primary-secondary tiers are (a) lack of preservice training of specialist middle school teachers, (b) the absence of clear positive educational outcomes linked to the promotion of middle schooling policy as a philosophy of teaching, and (c) the ad…
Risley-Curtiss, Christina; Kronenfeld, Jennie Jacobs
Examined health care policies and services for children under 46 state welfare agencies. Found that most states had written policies regarding health care for foster children, but half had no management system to record health care data. Most states did not meet standards set by the Child Welfare League of America for health care of these…
Formal child care services can expand women's economic opportunities and promote equity through early childhood development. However, academics and policy makers often overlook the role of relatives as child care providers. This note discusses how grandparent-provided child care can be factored into child care policies in the context of Organization for Economic Co-operation and Developmen...
Since more than a decade and half, a number of African countries have embarked on implementing power sector reform programmes in a bid to address the deficiencies in the management and operations of their power utilities. The rationale for power sector reforms was to: (i) improve the technical, commercial and financial performance of utilities; (ii) boost sector cash flow and enhance utilities' creditworthiness; (iii) facilitate mobilization of resources for capital investment on a commercial basis, thereby releasing public funds for other investments; and (iv) extend access to electricity to poor and rural communities. However, one of the most critical drivers for power sector reform, which is linked to lack of capital to expand and rehabilitate existing systems, is probably pressure from the development finance institutions including the World Bank. Most African countries have thus decided to embark on reforming their power sectors following the announcement of the 1993 World Bank's Electric Power Lending Policy calling developing countries to demonstrate a clear indication to implement comprehensive power sector reform programmes as a precondition of the Bank's continued assistance in the sector. Under this Bank's new policy, developing countries were invited to: - Establish transparent regulatory processes; - Commercialize and corporatize the power enterprises; - Allow for importation of power services in some cases; and - Encourage private investment in the power sector. As a follow-up to its new electric power lending policy, the World Bank Energy Sector Management Assistance Programme (ESMAP) organized a symposium on 'Power Sector Reform and Efficiency Improvement in sub-Saharan Africa' in Johannesburg, South Africa, in December 1995 with a view to addressing the problem of inefficiencies in operations and management of the power utilities. The purpose of the symposium was to provide an open forum in which high-level decision-makers in the Ministries of
Petra Došenović; Maks Tajnikar
In the paper the authors analyse some unresolved issues regarding the health care reform that is under way in the Republic of Slovenia. They believe the reform is necessary due to the problems that have accumulated. So far the transition processes have not been undertaken in a systematic way by the public sector. With this in mind, the authors discuss the problems of compulsory and voluntary insurance, and the goals that can be achieved by enforcing the role of voluntary health insurance. The...
Zechner, Minna; Valokivi, Heli
Negotiation is an integral part of all elder care, which by definition involves a relation between at least two people. In this article we analyse negotiations concerning elder care in the context of Finnish and Italian elder care policies. At the macro level negotiations on elder care are shaped by elder care policies and at the micro level by individual skills and resources. Our focus is on the negotiations on eligibility that take place when elders attempt to access care. The data consist ...
Bureau, Jean-Christophe; Gohin, Alexandre; Guindé, Loïc; Millet, Guy; Brandão, Antônio Salazar P.; Haley, Stephen; Wagner, Owen; Orden, David; Sandrey, Ron; Vink, Nick
"Sugar is one of the most highly protected agricultural commodities worldwide. This protection depresses trade opportunities and the prices received by exporters without preferential market access. For this reason, dialogues about sugar policy are often polarized and short sound bites caustic. Yet today's sugar markets are being driven by a complex array of dynamic and emerging supply, demand, and policy forces that need to be understood. A number of these forces have the potential to reshape...
Nugent, Michael E
Health reform promises to fundamentally change what and how CMS and commercial payers reimburse providers. Providers need to transition from their traditionally adversarial, transactions-based payer relationships to ones that optimize purchaser and patient value for the dollar. To avoid negotiation table showdowns and to prepare for reform, commercial payers and providers should take three actions: Recognize the dead ends with their historical relationships. Formulate their road map to value-based contracting. Avoid operational pot-holes along the way. PMID:20608414
Vujicic, Marko; Sparkes, Susan; Mollahaliloglu, Salih
The health status of the Turkish population has improved significantly over the past few decades, accompanying improvements in the scale and functioning of the health-care system. Impressive progress has been made in expanding financial protection to the population through expansions in the breadth and depth of health insurance coverage combined with service delivery reforms to improve equ...
Full Text Available The paper discusses the role that government policies and macroeconomic reforms have played in influencing economic growth in Malawi during the period 1960-2013. The study identifies a Stateregulated economic system that dominated the Malawian economy, in which economic growth patterns were influenced mainly by activities financed by the State. Two fundamental challenges are identified that have led to a subdued performance of the economy – the crowding-out effect of State-interventionism affecting private sector-led growth; and regulatory arbitrage that has created an environment for rent-seeking behaviour. The study concludes that policy inconsistencies in implementing economic policies and reforms in Malawi have been instrumental in influencing the suboptimal growth patterns of the Malawian economy.
Legal reforms in the Americas are influencing the public debate on cannabis policy. Uruguay and the two US states of Colorado and Washington have taken steps to regulate and legitimize the production, distribution, and use of cannabis and its derivatives. Earlier experiences with medical cannabis in the United States and limited access and production models in Europe have been insightful. However, these reforms are going further still, venturing into a new area of cannabis policy. A lack of empirical evidence regarding the effects of such reforms poses a challenge for policymakers. These examples will inform the design and implementation of any future cannabis policies. Therefore, a clear understanding of the details of each jurisdiction is necessary in developing future legal changes. Literature comparing the models of Uruguay, Colorado, and Washington is thin. This paper is based on an exhaustive examination of the laws, regulations, and discussions with regulators and functionaries of each jurisdiction. The research and analysis herein will provide policymakers with a greater understanding of the laws and regulations relevant to legal cannabis in these three jurisdictions, as well as draw to their attention some potential impacts and challenges of cannabis reform that require additional consideration to ensure public safety and health. PMID:24970383
Full Text Available Background: Nursing education reform is identified as an important strategy for enhancing health workforce performance, and thereby improving the functioning of health systems. Globally, a predominant trend in such reform is towards greater professionalisation and university-based education. Related nursing education reform in South Africa culminated in a new Framework for Nursing Qualifications in 2013. Objective: We undertook a policy analysis study of the development of the new Nursing Qualifications Framework in South Africa. Design: We used a policy analysis framework derived from Walt and Gilson that interrogated the context, content, actors, and processes of policy development and implementation. Following informed consent, in-depth interviews were conducted with 28 key informants from national and provincial government; the South African Nursing Council; the national nursing association; nursing academics, managers, and educators; and other nursing organisations. The interviews were complemented with a review of relevant legislation and policy documents. Documents and interview transcripts were coded thematically using Atlas-ti software. Results: The revision of nursing qualifications was part of the post-apartheid transformation of nursing, but was also influenced by changes in the education sector. The policy process took more than 10 years to complete and the final Regulations were promulgated in 2013. The two most important changes are the requirement for a baccalaureate degree to qualify as a professional nurse and abolishing the enrolled nurse with 2 years training in favour of a staff nurse with a 3-year college diploma. Respondents criticised slow progress, weak governance by the Nursing Council and the Department of Health, limited planning for implementation, and the inappropriateness of the proposals for South Africa. Conclusions: The study found significant weaknesses in the policy capacity of the main institutions
Full Text Available We explore the impact of forest policy reforms implemented in the early 1990s in Niger in the wake of the severe droughts that affected the Sahel in the 1970s and 1980s. We focus on Sahelian multiple-use forest ecosystems and set out to analyze policy-induced changes in the patterns of interactions between various uses, users, and dry-forest ecosystems, interactions that influence the effective management of rural forests. We put forward the hypothesis that the new forest policy reforms were designed according to a vulnerability diagnosis, highlighting two stressors: droughts and increased demand for firewood. This led to a single-issue policy focused on firewood provision and was implemented through the Household Energy Strategy (HES. The HES established new local management schemes for “rural forests” through “rural firewood markets” (RMs to regulate firewood harvesting and trade. We studied one of the first rural forests to become an RM in Niger in 1993. We used the concept of social-ecological functions as processes emerging from the interactions between social and ecological systems (SES. We identified sixteen SES functions and specifically analyzed the changes in three of them, whether they were targeted by the policy reform (firewood provision or not (gum provision and livestock production. The changes generated by the creation of the RM have had different impacts on SES functions, as well as on the social and ecological components that contribute to these functions, because of their interaction with firewood provision. Mutual benefits and competitions between SES functions have been identified. The analysis of mutual benefits and competitions reflects the ambiguous role of the policy reform on rural forest ecosystems in Niger. Our results show that the patterns of interactions between key SES functions have played a more important role in the SES trajectory than any single resource such as timber or firewood. This provides
Full Text Available Abstract Background The aim of this research paper is to study job satisfaction of physicians and general practitioners at primary health care institutions during the health care reform in Lithuania. Methods Self-administrated anonymous questionnaires were distributed to all physicians and general practitioners (N = 243, response rate – 78.6%, working at Kaunas primary health care level establishments, in October – December 2003. Results 15 men (7.9% and 176 women (92.1% participated in the research, among which 133 (69.6% were GPs and 58 (30.4% physicians. Respondents claimed to have chosen to become doctors, as other professions were of no interest to them. Total job satisfaction of the respondents was 4.74 point (on a 7 point scale. Besides 75.5% of the respondents said they would not recommend their children to choose a PHC level doctor's profession. The survey also showed that the respondents were most satisfied with the level of autonomy they get at work – 5.28, relationship with colleagues – 5.06, and management quality – 5.04, while compensation (2.09, social status (3.36, and workload (3.93 turned to be causing the highest dissatisfaction among the respondents. The strongest correlation (Spearmen's ratio was observed between total job satisfaction and such factors as the level of autonomy – 0.566, workload – 0.452, and GP's social status – 0.458. Conclusion Total job satisfaction of doctors working at primary health care establishments in Lithuania is relatively low, and compensation, social status, and workload are among the key factors that condition PHC doctors' dissatisfaction with their job.
Niculescu Oana Marilena
Full Text Available The paper proposed for being presented belongs to the field research International Affairs and European Integration. The paper entitled Common Agricultural Policy from Health Check decisions to the post-2013 reform aims to analyze the Common Agricultural Policy (CAP from the Health Check adoption in November 2008 to a new reform post-2013. The objectives of the paper are the presentation of the Health Check with its advantages and disadvantages as well as the analysis of the opportunity of a new European policy and its reforming having in view that the analysis of Health Check condition was considered a compromise. The paper is related to the internal and international research consisting in several books, studies, documents that analyze the particularities of the most debated, controversial and reformed EU policy. A personal study is represented by the first report within the PhD paper called The reform of CAP and its implications for Romanias agriculture(coordinator prof. Gheorghe Hurduzeu PhD, Academy of Economic Studies Bucharest, Faculty of International Business, research studies in the period 2009-2012. The research methodology used consists in collecting and analysis data from national and international publications, their validation, followed by a dissemination of the results in order to express a personal opinion regarding CAP and its reform. The results of the research consist in proving the opportunity of a new reform due to the fact that Health Check belongs already to the past. The paper belongs to the field research mentioned, in the attempt to prove the opportunity of building a new EU agricultural policy. The challenges CAP is facing are: food safety, environmental and climate changes, territorial balance as well as new challenges-improving sustainable management of natural resources, maintaining competitiveness in the context of globalization growth, strengthening EU cohesion in rural areas, increasing the support of CAP for
This brief considers the scope for policy action in seven areas: (1) regulation of microfinance institutions, (2) provision of saving services, (3) product innovation, (4) organizational issues in microfinance, (5) poverty impact of microfinance, (6) agricultural finance, and (7) subsidy and sustainability issues.
@@ During the financial crisis of the past three years,central banks and governments around the world have adopted of prompt,decisive and innovative measures to settle down the world economy.With these policies,the market conditions tend to improve,though some countries troubled by deficits and structural problems.
Kendall, D B
Health reform isn't a popular subject in Washington these days, but problems of cost and access persist. The author, a senior health policy analyst for the Progressive Policy Institute, argues that in next year's debate of tax reform, a few modest changes could lead to a more effective and universal market for health care. PMID:10158552
Andersson Bäck, Monica
Recognizing the advantages of primary care as a means of improving the entire health system, this text comments on reforms of publicly funded primary health centers, and the rapid development of private for-profit providers in Sweden. Many goals and expectations are connected to such reforms, which equally require critical analyses of scarce resources, professional trust/motivation and business logic in the wake of freedom and control of ownership and management. In line with Saltman and Duran, this article calls for research and a methodologically developed approach to capture everyday practice in-depth and how regulation, market incentives and patient demands are met by professionals and primary care leaders.
The objective of this report is to present information on the different health financing reform options available to Kosovo, which can help the government to make informed policy decisions about financing reforms. The report focuses on the key insurance functions of revenue collection and management, risk pooling, and purchasing of health care, as well as the supportive regulatory and gove...
Marchildon, Gregory P; Hutchison, Brian
Primary care has proven to be extremely difficult to reform in Canada because of the original social compact between the state and physicians that led to the introduction of universal medical care insurance in the 1960s. However, in the past decade, the provincial government of Ontario has led the way in Canada in funding a suite of primary care practice models, some of which differ substantially from traditional solo and group physician practices based on fee-for-service payment. Independent evaluations show some positive improvements in patient care. Nonetheless, the Ontario government's large investment in the reform combined with high expectations concerning improved performance and the deteriorating fiscal position of the province's finances have led to major conflict with organized medicine over physician budgets and the government's consideration of an even more radical restructuring of the system of primary care in the province. PMID:27160481
Two of the three leading health care reform proposals being considered by Congress—the House “Tri-Committee” health care reform legislation and the Senate Health, Education, Labor, and Pensions (HELP) Committee’s reform legislation—include sensibly designed “play-or-pay” provisions that require employers to pay an assessment if they do not offer insurance to some or all of their employees. The third leading health care reform proposal—the bill proposed by Sen. Max Baucus and currently under c...
Chong, Chyi Ming
The indications of Malaysia government to remove its subsidize policy in its health care system and privatizing certain hospitals and health care services has inflicted numerous heated debates and discussions among individuals and Non-Governmental Organizations (NGO). The author wishes to contribute some insightful information to the public through her research about Malaysia citizen’s access to medical health care inline with its current health care system and policy. Health care systems of ...
Dragoi Mihaela Cristina
Full Text Available The issue of health has always been, both in social reality and in academia and research, a sensitive topic considering the relationship each individual has with his own health and the health care system as a public policy. At public opinion levels and not only, health care is the most important sector demanding the outmost attention, considering that individual health is the fundamental prerequisite for well-being, happiness and a satisfying life. The ever present research and practical question is on the optimal financing of the health care system. Any answer to this question is also a political decision, reflecting the social-economic value of health for a particular country. The size of the resource pool and the criteria and methods for resource allocation are the central economic problems for any health system. This paper takes into consideration the limited resources of the national health care system (the rationalization of health services, the common methods of health financing, the specificity of health services market (the health market being highly asymmetric, with health professionals knowing most if not all of the relevant information, such as diagnosis, treatment options and costs and consumers fully dependent on the information provided in each case and the performance of all hospitals in Romania, in order to assess the latest strategic decisions (introduction of co-payment and merging and reconversion of hospitals taken within the Romanian health care system and their social and economic implications. The main finding show that, even though the intention of reforming and transforming the Romanian health care system into a more efficient one is obvious, the lack of economic and demographic analysis may results into greater discrepancies nationwide. This paper is aimed to renew the necessity of joint collaboration between the economic and medical field, since the relationship between health and economic development runs both ways
Pradeep Kumar Misra
Full Text Available India, a country of 1.27 billion, nowadays needs reforms, improvements, and new approaches in teacher education to cater to the demands of changing economy and society. This call to improve teacher education becomes more significant considering the fact that 50% of India’s current population is below the age of 25 and over 65% below 35. There are two ways to proceed in this direction. First, making an internal review and assessment of present scenario of teacher education and suggesting need-based measures. The second one is to learn from those countries that have recently reviewed their teacher education systems and are continuously working for the betterment of teacher education. Following second approach, present paper analyzes teacher education policies, practices, and reform in Scotland, argues that concerns and commitments to reform teacher education in India and Scotland are similar, and suggests implications of Scottish experiences in the Indian context.
Nentjes, Andries; Meijer, G; Heijman, WJM; VanOphem, JAC; Verstegen, BHJ
Welfare states citizens have entitlements to a variety of social services provided for free or a price far below cost, such as education, health care, social security and housing. Every citizen benefits, but in their present organisation the social services also have major deficiencies: lack of choi
Tierney, William G.
Postsecondary institutions always have been in a state of change. The author discusses four key areas of higher education--systems of tertiary education, privatization, academic work, and technology--that demand careful analysis that have always been of concern but now are entering a new phase of change. The author offers an interpretation of the…
Rodwin, Marc A
Improper dependencies slant policy over a drug's life span, biasing the development of new drugs, the testing and marketing approval for new drugs, and the monitoring of patient safety after drugs are marketed. This article examines five ways in which the public improperly depends on pharmaceutical firms that compromise the integrity of pharmaceutical policy. Today the public relies on pharmaceutical firms: (1) to set priorities on drug research and development; (2) to conduct clinical trials to test whether drugs are safe and effective; (3) to decide what clinical trial data to disclose to the public; (4) to monitor post marketing drug safety; (5) to supply product information to physicians and to finance continuing medical education and other professional activities. The article suggests options to overcome each of these dependencies. PMID:24088148
The paper tracks the concept of rehabilitation within official thinking in Ireland since the foundation of the State. It explores when and how the term was first used and how it has fared since. It then examines barriers to and the role of research in the making of prison policy and comments on data deficits in the system at present. Finally it looks at the role of interest groups within the criminal justice system in Ireland, and specifically their effect, or potential effect,...
Silva, Orlando Monteiro da; Grennes,Thomas
In recent years, the wheat sector in Brazil has moved from governmental protection and public intervention to a free market and privatization. In this study, those changes are analyzed through measures of governmental intervention on nominal rates of protection and on welfare of producers and consumers. Elasticities of demand and supply of wheat are estimated, and the effects of changes in policies are analyzed under official and shadow exchange rates. Welfare measures indicate that almost US...
Amani Elobeid; John C. Beghin
We analyze the removal of current market interventions in world sugar markets using a partial-equilibrium international sugar model calibrated on 2002 market data and current policies. We analyze the impact of trade liberalization and the removal of production subsidies and consumption distortions. The removal of trade distortions alone induces a 27 percent price increase by the end of the decade relative to the baseline level for sugar. The removal of all trade and production distortions ind...
Lara, Carlos Icaza; Pezzini, Mario; Villarreal, Roberto; Garcilazo, Enrique; Davies, Andrew
The characteristics, assets and economic performance of Chile’s regions are particularly diverse, and their potential for growth will largely depend on how public policies are adapted to their diversity and integrate their different synergies, attributes and assets. Enhancing the productivity and competitiveness of specific regions and sectors requires agile, responsive institutional arrangements that can make targeted efforts to improve the quality of specific public investments and servi...
Full Text Available Though to-date the European Union (EU has played the most significant leadership role in international negotiations to reduce greenhouse gas (GHG emissions, the emission-reducing performance of individual EU Member states has for many been less than stellar. Several EU15 Member states continue to raise rather than lower emissions. Analysing the most successful policy instruments, this paper argues EU policy efforts could benefit from three important innovations. The following strategies – the adoption of an EU-wide FIT (feed-in tariff, an EU-wide carbon tax and more flexibility in the trading of carbon credits – could significantly improve emission reductions, their relative cost-efficiency and spread burden-sharing more evenly across technologies and Member states. This raises important questions, both about the effectiveness of EU and Kyoto-style commitments, as well as the EU Emission Trading Scheme (ETS. The commitment strategy, and in particular the EU ETS mechanism, have had the smallest impact on emission reductions. The proposed set of strategies could make a far greater contribution to future EU efforts and potentially lock in the impressive progress already made. Such a policy shift, if successful, would also greatly enhance the EU’s already significant credibility and bargaining power in international climate negotiations.
Rodwin, Marc A
The conventional wisdom is that managed care's brief life is over and we are now in a post-managed care era. In fact, managed care has a long history and continues to thrive. Writers also often assume that managed care is a fixed thing. They overlook that managed care has evolved and neglect to examine the role that it plays in the health system. Furthermore, private actors and the state have used managed care tools to promote diverse goals. These include the following: increasing access to medical care; restricting physician entrepreneurialism; challenging professional control over the medical economy; curbing medical spending; managing medical practice and markets; furthering the growth of medical markets and private insurance; promoting for-profit medical facilities and insurers; earning bounties for reducing medical expenditures: and reducing governmental responsibility for, and oversight of, medical care. Struggles over these competing goals spurred the metamorphosis of managed care. This article explores how managed care transformed physicians' conflicts of interests and responses to them. It also examines how managed care altered the opportunities for patients/medical consumers to use exit and voice to spur change. PMID:20579232
Jaime A Usma Wilches
This paper examines the National Bilingual Program in connection with other education and language reforms in Colombia and some of the processes of inclusion, exclusion, and stratification that accompany current school reforms. The author outlines some patterns that have accompanied language innovations in the country and highlights some interconnected processes that seem to be favored in international reform and are reflected in current national policy agendas; namely, the externalization...
Patrick, Walter K; Cadman, Edwin C
Globalisation of economies, diseases and disasters with poverty, emerging infectious diseases, ageing and chronic conditions, violence and terrorism has begun to change the face of public health and medical education. Escalating costs of care and increasing poverty have brought urgency to professional training to improve efficiency, cut costs and maintain gains in life expectancy and morbidity reduction. Technology, genetics research and designer drugs have dramatically changed medical practice. Creatively, educational institutions have adopted the use of: (1) New educational and communication technologies: internet and health informatics; (2) Problem based learning approaches; Integrated Practice and Theory Curricula; Research and Problem Solving methodologies and (3) Partnership and networking of institutions to synergise new trends (e.g. core competencies). Less desirably, changes are inadequate in key areas, e.g., Health Economics, Poverty and Health Development, Disaster Management & Bioterrorism and Ethics. Institutions have begun to adjust and develop new programs of study to meet challenges of emerging diseases, design methodologies to better understand complex social and economic determinants of disease, assess the effects of violence and address cost containment strategies in health. Besides redesigning instruction, professional schools need to conduct research to assess the impact of health reform. Such studies will serve as sentinels for the public's health, and provide key indicators for improvements in training, service provision and policy. PMID:12597516
Lee, Jaekyung; Park, Daekwon
This study examines key school reform policies and outcomes of the USA and Korea over the past three decades from comparative perspectives. Since the two nations' unique educational problems brought divergent educational reform paths--standardization versus differentiation, high-stakes testing versus individualized assessment, and…
Thomas, Harold G.
In 2007, Kwara State in Nigeria embarked on a process of college of education reform. This article explores the strategic and managerial issues associated with that process. It sets out the policy imperative for reform within the context of an urgent need to improve the quality of education in Nigeria and traces progress over a four year period,…
Mariner, W K
Like most reform proposals, President Clinton's proposed Health Security Act offers universal access to care but does not significantly alter the nature of patients' legal rights to services. The act would create a system of delegated federal regulation in which the states would act like federal administrative agencies to carry out reform. To achieve uniform, universal coverage, the act would establish a form of mandatory health insurance, with federal law controlling the minimum services to which everyone would be entitled. Because there is no constitutionally protected right to health care and no independent constitutional standard for judging what insurance benefits are appropriate, the federal government would retain considerable freedom to decide what services would and would not be covered. If specific benefits are necessary for patients, they will have to be stated in the legislation that produces reform. PMID:8059899
The present paper provides an empirical assessment of the effects associated with the reorganization of minute reserve markets in Germany. As the aim of the regulator is to assure a competitive market with transparent pricing, we analyze whether the recent policy reform has had an impact on the dynamics of minute reserve prices. Our results show that the level and volatility of positive and negative minute reserve prices decreased substantially. Furthermore, we provide evidence that the degree of integration between reserve and spot markets has increased. Overall, prices reacted to the policy change in a manner that is in line with the regulator's objective. The reform can thus be viewed as a step towards an efficient reserve market.
Governor's Advisory Committee on Child Development Programs, Sacramento, CA.
This document provides a revision of a report on employer supported child care prepared by the California Governor's Advisory Committee on Child Development. The focus of the document is a series of policy discussions and recommendations on employer sponsored child care; a description and a history of employer sponsorship of day care are given.…
A market-driven, community-based, competitive health care model has effectively assisted Memphis employers to achieve their cost containment and health care reform objectives. Members of the Memphis Business Group on Health joined forces and successfully implemented a variety of programs and services that resulted in dramatic cost savings and reform of health care delivery systems. Programs included development of a purchasing alliance for negotiating contracts for hospital, medical, workers' compensation, psychiatric, and substance abuse care and other service and product options. Utilization management programs focused on appropriate consumption of resources and intensive management of critical cases. While increases in per employee costs averaged 14.7 percent per year for five years nationally, members of the Memphis Business Group on Health held their increases to an average of 6 percent per year. PMID:10132786
experience, as well as expertise in the new technologies, industries, economics, policy development, and law to present and critique the principles, policies and regulatory practices associated with telecom reform. Twenty six international experts address thirty two topics that are essential to successful......Telecom Reform: Principles, Policies and Regulatory Practices, provides a comprehensive and definitive review and assessment of the unfolding telecom reform process, and its implications for information society development. It is an invaluable resource and authoritative reference on telecom reform...
Frelick, R W
Many managed care plans propose short-term economics, without stressing quality, assuring universal access, supporting research, or caring for the poor. None provide much in the way of preventive services. In the absence of any major national changes to assure universal access to health services, local health care providers and state regulatory agencies need to be freed from many restrictive federal laws and regulations. Relief is needed from well-intended federal controls which have usually made the health care system more expensive 1) by applying federal anti-trust regulations to prevent physicians from self-regulation and working to improve the health care system, 2) by making it difficult for physicians to do office laboratory work for their patients' convenience, 3) by making "safe" drugs expensive because of FDA regulations, 4) by sequentially spawning PRO, PSRO, and now the Health Care Quality Improvement Program (HCQIP) to "assure quality control" (they probably have not paid for themselves), 5) by not using the RBRVS system (accepted by HCFA as a way to relate a physician's fees to the resources required to perform a service) to stimulate physicians to enter primary care practice, 6) by giving tax breaks for insurance costs to big corporations but not to small businesses, and 7) by protecting self-insured businesses from state regulations. States should be allowed to obtain waivers from ERISA (which incidentally would improve competition) so states could regulate health insurers, try such proposals as a single payer system, or at least restore community rating and equity. This should improve access to technological advances in prevention and health care for all. More commissions and studies and federal laws are not the answer. Health care providers should be able to work together freely to deliver efficient, cost-effective health care. States should be able to assure preventive services, clinical research, public health support, professional education and
Harris, Mark F; Advocat, Jenny; Crabtree, Benjamin F; Levesque, Jean-Frederic; Miller, William L; Gunn, Jane M; Hogg, William; Scott, Cathie M; Chase, Sabrina M; Halma, Lisa; Russell, Grant M
Context A key aim of reforms to primary health care (PHC) in many countries has been to enhance interprofessional teamwork. However, the impact of these changes on practitioners has not been well understood. Objective To assess the impact of reform policies and interventions that have aimed to create or enhance teamwork on professional communication relationships, roles, and work satisfaction in PHC practices. Design Collaborative synthesis of 12 mixed methods studies. Setting Primary care practices undergoing transformational change in three countries: Australia, Canada, and the USA, including three Canadian provinces (Alberta, Ontario, and Quebec). Methods We conducted a synthesis and secondary analysis of 12 qualitative and quantitative studies conducted by the authors in order to understand the impacts and how they were influenced by local context. Results There was a diverse range of complex reforms seeking to foster interprofessional teamwork in the care of patients with chronic disease. The impact on communication and relationships between different professional groups, the roles of nursing and allied health services, and the expressed satisfaction of PHC providers with their work varied more within than between jurisdictions. These variations were associated with local contextual factors such as the size, power dynamics, leadership, and physical environment of the practice. Unintended consequences included deterioration of the work satisfaction of some team members and conflict between medical and nonmedical professional groups. Conclusion The variation in impacts can be understood to have arisen from the complexity of interprofessional dynamics at the practice level. The same characteristic could have both positive and negative influence on different aspects (eg, larger practice may have less capacity for adoption but more capacity to support interprofessional practice). Thus, the impacts are not entirely predictable and need to be monitored, and so that
This paper investigates the macroeconomic effects of services sector reform policies using two computable general equilibrium models of Sri Lankan economy. First model assumes perfect competitive market and second one assumes monopoly supplier economy. Both models have been calibrated using Sri Lanka’s social accounting matrix currently available. Impacts of both services sector production tax reduction and import tariff increase have been simulated. Simulation results imply that reduction of...
Manlagñit, Ma. Chelo V.; Lamberte, Mario B.
This paper has attempted to examine the impacts of competition policy reforms on the efficiency of the Philippine commercial banking system. It uses the stochastic frontier approach to come up with estimates of profit efficiency and cost inefficiency measures. The results are quite interesting. First, the average measured profit efficiency is 0.85, implying that on the average the commercial banks are using only 85 percent of their resources efficiently compared to the best practice commercia...
This study has basically two major concerns; - describe and assess the role of the Teachers Unions, in particular the Government Teachers Union (GTU), regarding their conditions of service and their impact on educational policies and reforms. The report gives an outline of the educational system in Mauritius and its socio-cultural background, before it sets out to discuss the role of the most important trade union (GTU) within the primary education sector. Although Mauritius ha...
Don Fullerton; James B. Mackie
The Economic Recovery Tax Act of 1981 reduced personal marginal tax rates and provided significant business tax breaks. Subsequent changes through 1985 cut back on business allowances. The Tax Reform Act of 1986 reduced marginal rates again, but added significantly to business taxes. Was there any unifying theme to these tax changes, or do they represent frequent changes in course for tax policy? This paper uses a general equilibrium model capable of second- best analysis to investigate the n...
McDonald, Scott; Kirsten, Johann F.; van Zyl, Johan
In this paper the format of a Social Accounting Matrix (SAM) for use as a database for the Computable General Equilibrium (CGE) modelling of agricultural policy reform in South Africa is detailed. It is shown that the published South African SAMs impose limitations upon their suitability as databases for CGE models, but that they can be readily modified. An additional benefit of a SAM is its use as a framework for the specification of the behavioural relationships necessary to the development...
Catherine Bell discusses the Tsilhqot'in ruling (2014), and explores how Canadian Aboriginal rights law and consultation is applied to First Nations heritage sites, the challenges to realizing First Nation ownership and control through Canadian Constitutional Law, the unique issues that arise when heritage sites are located on private land, and the need for legal and policy reform. Catherine Bell is Professor of Law at the University of Alberta, specializing in Aboriginal leg...
Hill, Berkeley; Blandford, David
This document was prepared by David Blandford, Penn State University and Berkeley Hill, London University. It is based on results from a research project funded by the Economic Research Service of the U.S. Department of Agriculture entitled "Policy Reform and Agricultural Adjustment" under a Cooperative Agreement with the Pennsylvania State University (No. 43-3AEK-3-80047). Additional funding was provided by the International Agricultural Trade Research Consortium (IATRC). Under the project, ...
Henk J Kloppers; Gerrit J. Pienaar
The need for the current land reform programme arose from the racially discriminatory laws and practices which were in place for the largest part of the twentieth century, especially those related to land ownership. The application of these discriminatory laws and practices resulted in extreme inequalities in relation to land ownership and land use. This article provides an overview of the most prominent legislation which provides the framework for the policy of racially-based territorial seg...
This is a collection of essays written for the Financial Express, an Indian financial daily. The common theme of these essays, which cover a period of almost four years, from June 2010 to March 2014, is the Indiaâ€™s struggles with economic policy reform. The essays are organized into several broad topical groupings, and chronologically within each section. The first section considers overall development goals, followed by a group of essays on foreign investment in retailing, financial inclus...
YAMAUCHI Isamu; NAGAOKA, SADAO
We investigate how a deferred patent examination system promotes ex-ante screening of patent applications, which reduces both the number of granted patents and the use of economic resources for examinations, without reducing the return from R&D. Based on a real option theory, we develop a model of examination request behaviors. Exploiting the responses of Japanese firms to recent policy reform, we find that the shortening of the allowable period for an examination request significantly increa...
Ntim, Collins G; Opong, Kwaku K.; Danbolt, jo
Manuscript Type: EmpiricalResearch Question/Issue: South Africa (SA) has pursued distinctive corporate governance (CG) disclosure policy reforms in the form of the King Reports, which require firms to disclose a set of recommended good CG practices on both shareholders and stakeholders. This paper investigates the effect of the new shareholder and stakeholder CG disclosure rules on firm value, as well as the relative value relevance of disclosing good CG practices on shareholders versus stake...
Fortes, Paulo Antônio de Carvalho; Carvalho, Regina Ribeiro Parizi; Louvison, Marília Cristina Prado
The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities. PMID:26083942
Paulo Antônio de Carvalho Fortes
Full Text Available The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities.
Fortes, Paulo Antônio de Carvalho; Carvalho, Regina Ribeiro Parizi; Louvison, Marília Cristina Prado
The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities. PMID:26083942
鲁菁; 方红娟; 王小万
基于WHO欧洲委员会"增加财富与增进健康的卫生系统-塔林宪章"的卫生改革框架,卫生服务的供给模式已经成为欧洲卫生改革的重点.本文从卫生服务供给的角度介绍了欧洲国家近年来所实施的改革政策与措施.通过强调转变卫生服务模式,提高卫生系统的反应性,改善卫生服务的质量,加强公共卫生、疾病预防和健康促进,以及加强卫生人力资源建设等关键措施来完善卫生服务供给模式,为我国深化卫生改革提供了可以借鉴和学习的经验.%Based on the health reform framework of WHO European Commission"increasing wealth and the promotion of a healthy health system-Tallinn charter", Health care delivery has been the key point in the European health care reforms. This paper introduced the policies and measures of health care delivery reforms in recent years. European countries have changed their health care models, made health systems more responsive to patients needs; enhanced the quality of care; strengthened public health, disease prevention and health promotion; and invested in human and capital resources to improve health care delivery model. These policies and methods have provided valuable references to our deepening health reformation.
Full Text Available Review of the monograph: Miller, Michelle Ann, Rebellion and Reform in Indonesia – Jakarta’s Security and Autonomy Policies in Aceh, London/ New York: Routledge, 2009, ISBN 13: 978-0-415-45467-4, 240 pages.