Sample records for care reform policies

  1. The policy and politics of the 2015 long-term care reform in the Netherlands. (United States)

    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.

  2. Managed care in Latin America: the new common sense in health policy reform. (United States)

    Iriart, C; Merhy, E E; Waitzkin, H


    This article presents the results of the comparative research project, "Managed Care in Latin America: Its Role in Health System Reform." Conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States, the study focused on the exportation of managed care, especially from the United States, and its adoption in Latin American countries. Our research methods included qualitative and quantitative techniques. The adoption of managed care reflects the process of transnationalization in the health sector. Our findings demonstrate the entrance of the main multinational corporations of finance capital into the private sector of insurance and health services, and these corporations' intention to assume administrative responsibilities for state institutions and to secure access to medical social security funds. International lending agencies, especially the World Bank, support the corporatization and privatization of health care services, as a condition of further loans to Latin American countries. We conclude that this process of change, which involves the gradual adoption of managed care as an officially favored policy, reflects ideologically based discourses that accept the inexorable nature of managed care reforms.

  3. Health care policy reform: a microanalytic model for comparing hospitals in the United States and Germany. (United States)

    Parsons, R J; Woller, G M; Neubauer, G; Rothaemel, F T; Zelle, B


    Microcomparison, or single-component analysis, of health care systems offers a potentially better basis for reform than traditional macrocomparison analysis of aggregate elements. Using macroanalysis, available evidence shows that Germany provides cheaper but more effective hospital care than the United States. To find the causes for this outcome, we developed a microanalytic model of hospital administrators' perceptions, financial ratios, medical outcomes, and pharmaceutical costs. However, only data on pharmaceutical costs were available, and these were similar in both countries. Our significant outcome was development of a microcomparative model that gives world medical care providers new criteria for analyzing and improving cost to care ratios.


    Korolenko, V V; Dykun, O P; Isayenko, R M; Remennyk, O I; Avramenko, T P; Stepanenko, V I; Petrova, K I; Volosovets, O P; Lazoryshynets, V V


    The health care system, its modernization and optimization are among the most important functions of the modern Ukrainian state. The main goal of the reforms in the field of healthcare is to improve the health of the population, equal and fair access for all to health services of adequate quality. Important place in the health sector reform belongs to optimizing the structure and function of dermatovenereological service. The aim of this work is to address the issue of human resources management of dermatovenereological services during health sector reform in Ukraine, taking into account the real possibility of disengagement dermatovenereological providing care between providers of primary medical care level (general practitioners) and providers of secondary (specialized) and tertiary (high-specialized) medical care (dermatovenerologists and pediatrician dermatovenerologists), and coordinating interaction between these levels. During research has been found, that the major problems of human resources of dermatovenereological service are insufficient staffing and provision of health-care providers;,growth in the number of health workers of retirement age; sectoral and regional disparity of staffing; the problem of improving the skills of medical personnel; regulatory support personnel policy areas and create incentives for staff motivation; problems of rational use of human resources for health care; problems of personnel training for dermatovenereological service. Currently reforming health sector should primarily serve the needs of the population in a fairly effective medical care at all levels, to ensure that there must be sufficient qualitatively trained and motivated health workers. To achieve this goal directed overall work of the Ministry of Health of Uktaine, the National Academy of Medical Sciences of Ukraine, medical universities, regional health authorities, professional medical associations. Therefore Ukrainian dermatovenereological care, in particular

  5. Reforms of health care system in Romania

    NARCIS (Netherlands)

    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

  6. Health care reforms

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    Marušič Dorjan


    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.

  7. Health care reforms. (United States)

    Marušič, Dorjan; Prevolnik Rupel, Valentina


    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.

  8. Of honey and health policy: the limits of sweet, sticky substances in reforming primary care. (United States)

    Martin, Danielle


    It is a well-known axiom that one attracts more flies with honey than vinegar. Nowhere has this approach been taken more to heart than in the past decade of primary care policy in Canada. Governments, physician and nursing organizations and regional health authorities have invested in a lot of "honey" to draw healthcare providers onto a path from single-physician offices to team-based care with flexible hours and a population-based approach. In the lead essay for this edition of Healthcare Papers, Kates and colleagues have outlined a framework that embraces this paradigm. Their articulation of a framework is a place to start, but it can only be a start. To make that framework come alive, a wider variety of policy tools will be needed than have been used thus far, and by a wider variety of actors. Within the healthcare workforce itself, leadership, vision and the courage to hold ourselves to account for changes to primary care are needed.

  9. Socialist government health policy reforms in Bolivia and Ecuador: The underrated potential of integrated care to tackle the social determinants of health

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    Herland Tejerina


    Full Text Available Background Selective vertical programs prevailed over comprehensive primary health care in Latin America. In Bolivia and Ecuador, socialist governments intend to redirect health policy. We outline both countries’ health system’s features after reform, explore their efforts to rebuild primary health care, identify and explain policy gaps, and offer considerations for improvement. Methods Qualitative document analysis. Findings Earlier reform left Bolivia’s and Ecuador’s population in bad health, with limited access to a fragmented health system. Today, both countries focus their policy on household and community-based promotion and prevention. The negative effects on access to care of decentralization, dual employment, vertical programming and targeting are largely left unattended. Neglecting care is understandable in the light of particular interpretations of social medicine and social determinants, international policy pressures, reliance on external funding and institutional inertia. Current policy choices preserve key elements of selective care and consolidate commodification. It might not improve health and worsen poverty. Interpretation Care can be considered as a social determinant on its own. Key to the accomplishment of primary care is an integrated application of family medicine, taking advantage of individual care as one of the ways to act on social determinants. It deserves a central place on the policy-makers’ priority list, in Bolivia and Ecuador as elsewhere.

  10. Reforming the health care system: implications for health care marketers. (United States)

    Petrochuk, M A; Javalgi, R G


    Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

  11. The new architects of health care reform. (United States)

    Schaeffer, Leonard D


    Rising health care costs have been an issue for decades, yet federal-level health care reform hasn't happened. Support for reform, however, has changed. Purchasers fear that health care cost growth is becoming unaffordable. Research on costs and quality is questioning value. International comparisons rank the United States low on important health system performance measures. Yet it is not these factors but the unsustainable costs of Medicare and Medicaid that will narrow the window for health care stakeholders to shape policy. Unless the health care system is effectively reformed, sometime after the 2008 election, budget hawks and national security experts will eventually combine forces to cut health spending, ultimately determining health policy for the nation.

  12. Quality Reforms in Danish Home Care

    DEFF Research Database (Denmark)

    Rostgaard, Tine


    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...... 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 control over home help at the expense of the control by users, care workers and case managers....

  13. Evolution of US Health Care Reform. (United States)

    Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A


    Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.

  14. Oncology payment reform to achieve real health care reform. (United States)

    McClellan, Mark B; Thoumi, Andrea I


    Cancer care is transforming, moving toward increasingly personalized treatment with the potential to save and improve many more lives. Many oncologists and policymakers view current fee-for-service payments as an obstacle to providing more efficient, high-quality cancer care. However, payment reforms create new uncertainties for oncologists and may be challenging to implement. In this article, we illustrate how accountable care payment reforms that directly align payments with quality and cost measures are being implemented and the opportunities and challenges they present. These payment models provide more flexibility to oncologists and other providers to give patients the personalized care they need, along with more accountability for demonstrating quality improvements and overall cost or cost growth reductions. Such payment reforms increase the importance of person-level quality and cost measures as well as data analysis to improve measured performance. We describe key features of quality and cost measures needed to support accountable care payment reforms in oncology. Finally, we propose policy recommendations to move incrementally but fundamentally to payment systems that support higher-value care in oncology.

  15. Exploring the impact of austerity-driven policy reforms on the quality of the long-term care provision for older people in Belgium and the Netherlands. (United States)

    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.

  16. Evaluation of Health Care System Reform in Hubei Province, China



    This study established a set of indicators for and evaluated the effects of health care system reform in Hubei Province (China) from 2009 to 2011 with the purpose of providing guidance to policy-makers regarding health care system reform. The resulting indicators are based on the “Result Chain” logic model and include the following four domains: Inputs and Processes, Outputs, Outcomes and Impact. Health care system reform was evaluated using the weighted TOPSIS and weighted Rank Sum Ratio met...

  17. Health care system reform in developing countries

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    Wei Han


    Full Text Available This article proposes a critical but non-systematic review of recent health care system reforms in developing countries. The literature reports mixed results as to whether reforms improve the financial protection of the poor or not. We discuss the reasons for these differences by comparing three representative countries: Mexico, Vietnam, and China. First, the design of the health care system reform, as well as the summary of its evaluation, is briefly described for each country. Then, the discussion is developed along two lines: policy design and evaluation methodology. The review suggests that i background differences, such as social development, poverty level, and population health should be considered when taking other countries as a model; ii although demand-side reforms can be improved, more attention should be paid to supply-side reforms; and iii the findings of empirical evaluation might be biased due to the evaluation design, the choice of outcome, data quality, and evaluation methodology, which should be borne in mind when designing health care system reforms.

  18. Sharing the Caring: Rethinking Current Policies. (United States)

    Edgar, Don


    This article presents an argument for reforming Australian public policy in favor of social care, rather than family, residential, or community care, for the elderly, sick, and disabled. After noting policy assumptions that families are the focus of caring and women are the natural caregivers, the paper describes changes in Australian family…

  19. Health Reform Requires Policy Capacity

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    Pierre-Gerlier Forest


    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

  20. The German health care system and health care reform. (United States)

    Kamke, K


    This article presents a structured survey of the German health care and health insurance system, and analyzes major developments of current German health policy. The German statutory health insurance system has been known as a system that provides all citizens with ready access to comprehensive high quality medical care at a cost the country considered socially acceptable. However, an increasing concern for rapidly rising health care expenditure led to a number of cost-containment measures since 1977. The aim was to bring the growth of health care expenditure in line with the growth of wages and salaries of the sickness fund members. The recent health care reforms of 1989 and 1993 yielded only short-term reductions of health care expenditure, with increases in the subsequent years. 'Stability of the contribution rate' is the uppermost political objective of current health care reform initiatives. Options under discussion include reductions in the benefit package and increases of patients' co-payments. The article concludes with the possible consequences of the 1997 health care reform of which the major part became effective 1 July 1997.

  1. Health promotion interventions and policies addressing excessive alcohol use: A systematic review of national and global evidence as a guide to health-care reform in China (United States)

    Li, Qing; Babor, Thomas F.; Zeigler, Donald; Xuan, Ziming; Morisky, Donald; Hovell, Melbourne F.; Nelson, Toben F.; Shen, Weixing; Li, Bing


    Aims Steady increases in alcohol consumption and related problems are likely to accompany China's rapid epidemiologic transition and profit-based marketing activities. We reviewed research on health promotion interventions and policies to address excessive drinking and to guide health-care reform. Methods We searched in Chinese and English language databases and included 21 studies in China published between 1980 and 2013 that covered each policy area from the WHO Global Strategy to Reduce the Harmful Use of Alcohol. We evaluated and compared preventive interventions to the global alcohol literature for cross-national applicability. Results In contrast with hundreds of studies in the global literature, 11 of 12 studies from mainland China were published in Chinese; six of ten in English were on taxation from Taiwan or Hong Kong. Most studies demonstrated effectiveness in reducing excessive drinking, and some reported the reduction of health problems. Seven were randomized controlled trials. Studies targeted schools, drink-driving, workplaces, the health sector, and taxation. Conclusions China is the world's largest alcohol market, yet there has been little growth in alcohol policy research related to health promotion interventions over the past decade. Guided by a public health approach, the WHO Global Strategy, and health reform experience in Russia, Australia, Mexico, and the USA, China could improve its public health response through better coordination and implementation of surveillance and evidence-based research, and through programmatic and legal responses such as public health law research, screening and early intervention within health systems, and the implementation of effective alcohol control strategies. PMID:25533866

  2. Policy Capacity for Health Reform: Necessary but Insufficient: Comment on "Health Reform Requires Policy Capacity". (United States)

    Adams, Owen


    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.

  3. Regulatory reform of Finnish environmental policy

    Energy Technology Data Exchange (ETDEWEB)

    Sairinen, R.


    The main question of this study concerns the regulatory reform i.e. formation and design of new policy instruments in the Finnish environmental policy. The research question is divided into two parts: (1) How have the new policy instruments evolved and been designed (2) What are the political, administrative, historical and ideological factors underlying the processes of policy instrument formation and design? Three main approaches for analysis are introduced: the model of policy instrument choice by Linder and Peters, the model of policy explanation by Jaenicke, and the concept of governmentality developed by Foucault. Within the developed theoretical framework, the general societal background of regulatory reform is composed of the various features of 'environmental governmentality'. The research questions are divided into two empirical research tasks. (1) Analysis of the historical development of Finnish environmental governing and policy style provides background information about the national institutional settings and policy cultures in order to understand the role of the new policy instruments in the Finnish environmental policy during last two decades. Here, Finnish environmental policy divides into consensual pollution policies and adversial nature conservation. Four main periods of environmental governmentality in Finland is presented: the early nature conservation initiatives (1800-1939), the neglect of environmental issues (1945-1969), the environmental institutionalisation (1970-1986), and the regulatory reform (1987-). (2) The contextual case studies concerns: the drafting of the EIA Act in 1982-1994; the formation of the carbon tax policy in 1989-1996; and the implementation of voluntary environmental agreements in 1987-99. The study shows that regulatory reform has not been an easy policy process in Finland. There has been no common environmental governmentality behind the on-going regulatory reform. The new policy instruments have been

  4. Reviewing and reforming policy in health enterprise information security (United States)

    Sostrom, Kristen; Collmann, Jeff R.


    Health information management policies usually address the use of paper records with little or no mention of electronic health records. Information Technology (IT) policies often ignore the health care business needs and operational use of the information stored in its systems. Representatives from the Telemedicine & Advanced Technology Research Center, TRICARE and Offices of the Surgeon General of each Military Service, collectively referred to as the Policies, Procedures and Practices Work Group (P3WG), examined military policies and regulations relating to computer-based information systems and medical records management. Using a system of templates and matrices created for the purpose, P3WG identified gaps and discrepancies in DoD and service compliance with the proposed Health Insurance Portability and Accountability Act (HIPAA) Security Standard. P3WG represents an unprecedented attempt to coordinate policy review and revision across all military health services and the Office of Health Affairs. This method of policy reform can identify where changes need to be made to integrate health management policy and IT policy in to an organizational policy that will enable compliance with HIPAA standards. The process models how large enterprises may coordinate policy revision and reform across broad organizational and work domains.

  5. Reform Trend of China Natural Gas Price Policy

    Institute of Scientific and Technical Information of China (English)

    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.

  6. Policy Capacity in the Learning Healthcare System; Comment on “Health Reform Requires Policy Capacity”

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    William Gardner


    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.

  7. Trade Policy Reform and the Missing Revenue

    DEFF Research Database (Denmark)

    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...

  8. Policy and Workforce Reform in England (United States)

    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…

  9. Challenges and reforms in Long-Term Care policy in Spain - See more at:

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    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

  10. Innovations In Diabetes Care Around the World: Case Studies Of Care Transformation Through Accountable Care Reforms. (United States)

    Thoumi, Andrea; Udayakumar, Krishna; Drobnick, Elizabeth; Taylor, Andrea; McClellan, Mark


    The rising prevalence, health burden, and cost of chronic diseases such as diabetes have accelerated global interest in innovative care models that use approaches such as community-based care and information technology to improve or transform disease prevention, diagnosis, and treatment. Although evidence on the effectiveness of innovative care models is emerging, scaling up or extending these models beyond their original setting has been difficult. We developed a framework to highlight policy barriers-institutional, regulatory, and financial-to the diffusion of transformative innovations in diabetes care. The framework builds on accountable care principles that support higher-value care, or better patient-level outcomes at lower cost. We applied this framework to three case studies from the United States, Mexico, and India to describe how innovators and policy leaders have addressed barriers, with a focus on important financing barriers to provider and consumer payment. The lessons have implications for policy reform to promote innovation through new funding approaches, institutional reforms, and performance measures with the goal of addressing the growing burdens of diabetes and other chronic diseases.

  11. Validity Theory: Reform Policies, Accountability Testing, and Consequences (United States)

    Chalhoub-Deville, Micheline


    Educational policies such as Race to the Top in the USA affirm a central role for testing systems in government-driven reform efforts. Such reform policies are often referred to as the global education reform movement (GERM). Changes observed with the GERM style of testing demand socially engaged validity theories that include consequential…

  12. Medical care reform: lessons from around the world. (United States)

    Rohrer, J E


    Once again the United States is in a ferment of health policy reform. Proposals abound but sage observers remark that national health insurance has been "just around the corner" more than once in the last forty years. This time may be different, however. Proposals from all across the ideological spectrum are converging on the notion of "managed care" which is perhaps best known in its guise as a health maintenance organization (HMO). Other forms of managed care exist but they have neither the history nor the incentives found in traditional HMOs. The discussion on national health insurance (NHI) proposals has focused on financing issues to the virtual exclusion of public health concerns. In this article, the author addresses rural health and public hospitals in the United States; two problems that have been with us for a long time. Then articles examining the Canadian and English medical care systems are reviewed, illustrating some of the weaknesses of these approaches to national medical care. Research studies relating to Europe and the developing nations are next. Once again, these are intended to highlight public health problems found in differing medical care systems. Finally, the author examines utopian views of the United States medical care system of the future: the reform proposal offered by the National Association for Public Health Policy, the experimental policy in Washington State, and a vision of a planned system. The review is intended to draw together the lessons offered by public health policy research in other countries and the United States and apply them to the issue at hand: reforming the United States medical care system.


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    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.

  14. After Medicare: regionalization and Canadian health care reform. (United States)

    Boychuk, Terry


    In the immediate postwar era the primary object of health reform among the advanced industrial democracies was to expand, if not universalize, access to a broad spectrum of health services through sustained, high levels of government-mandated spending. The fiscal crises of the 1970s and 1980s ushered in a new generation of policies devoted to balancing the imperatives of guaranteeing access to basic health and social services and to improving the accountability, efficiency, and effectiveness of health care industries. In Canada, the regionalization of health care administration emerged as the most prominent strategy for grappling with the contradictions and paradoxes of contemporary health reform. This essay traces the historical evolution of federal-provincial deliberations that elevated regionalization to the forefront of health policy-making in the new era of fiscal restraint, and further, assesses recent efforts to institutionalize regional health authorities.

  15. Medical liability and health care reform. (United States)

    Nelson, Leonard J; Morrisey, Michael A; Becker, David J


    We examine the impact of the Affordable Care Act (ACA) on medical liability and the controversy over whether federal medical reform including a damages cap could make a useful contribution to health care reform. By providing guaranteed access to health care insurance at community rates, the ACA could reduce the problem of under-compensation resulting from damages caps. However, it may also exacerbate the problem of under-claiming in the malpractice system, thereby reducing incentives to invest in loss prevention activities. Shifting losses from liability insurers to health insurers could further undermine the already weak deterrent effect of the medical liability system. Republicans in Congress and physician groups both pushed for the adoption of a federal damages cap as part of health care reform. Physician support for damages caps could be explained by concerns about the insurance cycle and the consequent instability of the market. Our own study presented here suggests that there is greater insurance market stability in states with caps on non-economic damages. Republicans in Congress argued that the enactment of damages caps would reduce aggregate health care costs. The Congressional Budget Office included savings from reduced health care utilization in its estimates of cost savings that would result from the enactment of a federal damages cap. But notwithstanding recent opinions offered by the CBO, it is not clear that caps will significantly reduce health care costs or that any savings will be passed on to consumers. The ACA included funding for state level demonstration projects for promising reforms such as offer and disclosure and health courts, but at this time the benefits of these reforms are also uncertain. There is a need for further studies on these issues.

  16. Policy Capacity for Health Reform: Necessary but Insufficient; Comment on “Health Reform Requires Policy Capacity”

    Directory of Open Access Journals (Sweden)

    Owen Adams


    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.

  17. Integrating Comprehensive Reform with Quality of Care

    Institute of Scientific and Technical Information of China (English)


    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.

  18. Addressing health care market reform through an insurance exchange: essential policy components, the public plan option, and other issues to consider. (United States)

    Fronstin, Paul; Ross, Murray N


    HEALTH INSURANCE EXCHANGE: This Issue Brief examines issues related to managed competition and the use of a health insurance exchange for the purpose of addressing cost, quality, and access to health care services. It discusses issues that must be addressed when designing an exchange in order to reform the health insurance market and also examines state efforts at health reform that use an exchange. RISK VS. PRICE COMPETITION: The basic component of managed competition is the creation an organized marketplace that brings together health insurers and consumers (either as individuals or through their employers). The sponsor of the exchange would set "rules of engagement" for participating insurers and offer consumers a menu of choices among different plans. Ultimately, the goal of a health insurance exchange is to shift the market from competition based on risk to competition based on price and quality. ADVERSE SELECTION AND AFFORDABILITY: Among the issues that need to be addressed if an exchange that uses managed competition has a realistic chance of reducing costs, improving quality, and expanding coverage: Everyone needs to be in the risk pool, with individuals required to purchase insurance or face significant financial consequences; effective risk adjustment is essential to eliminate risk selection as an insurance business model--forcing competition on costs and quality; the insurance benefit must be specific and clear--without standards governing cost sharing, covered services, and network coverage there is no way to assess whether a requirement to purchase or issue coverage has been met; and subsidies would be necessary for low-income individuals to purchase insurance. THE PUBLIC PLAN OPTION: The public plan option is shaping up to be one of the most contentious issues in the health reform debate. Proponents also believe of a public plan is necessary to drive private insurers toward true competition. Opponents view it as a step toward government-run health

  19. Through Common Agricultural Policy Reforms: A Short Analysis


    Andrei Jean-Vasile; Mircea Untaru


    Common Agricultural Policy (CAP) is one of the major European policies with the highest financial and social impact not only for rural communities but at the whole EU-27 level. Making this policy work has generated serious imbalances and disruptions between member states. For correcting this situation, all the reforms, starting with The MacSharry reform has aimed to improve this policy, the financial allotments and correct the functional mechanism. This paper makes a short analysis regarding ...

  20. Education and Health Care Policies in Ghana

    Directory of Open Access Journals (Sweden)

    Ziblim Abukari


    Full Text Available Education and health care policies in Ghana since independence have been universalist in approach providing free universal health care and free basic and tertiary education until the early 1980s. Precipitated primarily by a severe drought, stagnant economic growth, mismanagement, and political instability, Ghana undertook major economic reforms with prodding from the World Bank and International Monetary Fund in a bid to salvage the economy. These economic measures included cost recovery and cutback spending in education and health sectors. However, in recent years, purposive targeted interventions have been pursued to address inequalities in education and health care. These new programs include the Education Capitation Grant, school feeding program, and the National Health Insurance Scheme (NHIS, which are propelling Ghana toward the achievement of the Millennium Development Goals. The prospects of these programs in addressing disparities in access to education and health care in the country and recommendations for improved delivery are discussed.

  1. The Impact of Health Care and Immigration Reform on Latino Support for President Obama and Congress (United States)

    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…

  2. Monitoring HIV and AIDS Related Policy Reforms: A Road Map to Strengthen Policy Monitoring and Implementation in PEPFAR Partner Countries.

    Directory of Open Access Journals (Sweden)

    Jeffrey Lane

    Full Text Available Achieving an AIDS-free generation will require the adoption and implementation of critical health policy reforms. However, countries with high HIV burden often have low policy development, advocacy, and monitoring capacity. This lack of capacity may be a significant barrier to achieving the AIDS-free generation goals. This manuscript describes the increased focus on policy development and implementation by the United States President's Emergency Plan for AIDS Relief (PEPFAR. It evaluates the curriculum and learning modalities used for two regional policy capacity building workshops organized around the PEPFAR Partnership Framework agreements and the Road Map for Monitoring and Implementing Policy Reforms. A total of 64 participants representing the U.S. Government, partner country governments, and civil society organizations attended the workshops. On average, participants responded that their policy monitoring skills improved and that they felt they were better prepared to monitor policy reforms three months after the workshop. When followed-up regarding utilization of the Road Map action plan, responses were mixed. Reasons cited for not making progress included an inability to meet or a lack of time, personnel, or governmental support. This lack of progress may point to a need for building policy monitoring systems in high HIV burden countries. Because the success of policy reforms cannot be measured by the mere adoption of written policy documents, monitoring the implementation of policy reforms and evaluating their public health impact is essential. In many high HIV burden countries, policy development and monitoring capacity remains weak. This lack of capacity could hinder efforts to achieve the ambitious AIDS-free generation treatment, care and prevention goals. The Road Map appears to be a useful tool for strengthening these critical capacities.

  3. Implementing a Nation-Wide Mental Health Care Reform: An Analysis of Stakeholders' Priorities. (United States)

    Lorant, Vincent; Grard, Adeline; Nicaise, Pablo


    Belgium has recently reformed its mental health care delivery system with the goals to strengthen the community-based supply of care, care integration, and the social rehabilitation of users and to reduce the resort to hospitals. We assessed whether these different reform goals were endorsed by stakeholders. One-hundred and twenty-two stakeholders ranked, online, eighteen goals of the reform according to their priorities. Stakeholders supported the goals of social rehabilitation of users and community care but were reluctant to reduce the resort to hospitals. Stakeholders were averse to changes in treatment processes, particularly in relation to the reduction of the resort to hospitals and mechanisms for more care integration. Goals heterogeneity and discrepancies between stakeholders' perspectives and policy priorities are likely to produce an uneven implementation of the reform process and, hence, reduce its capacity to achieve the social rehabilitation of users.

  4. Comparative effectiveness research and health care reform in C hina

    Institute of Scientific and Technical Information of China (English)

    Yilong Wang; Yongjun Wang


    China has made significant progress in modernizing its healthcare system in the past 20 years. However, there are some issues that are difficult to solve on the current healthcare status, including the lack of medical care satisfaction in rural areas and urban areas, excessive consumption of medical resources, conflict and tension between the healthcare provider and patients, and the problems caused by the change of model of healthcare. Therefore, the State Council in-troduced the Opinions of the CPC Central Committee and the State Council on Deepening the Health Care System Reform in 2009 in order to provide basic, safe, effective, convenient and affordable healthcare for all residents. Despite the goals and policies set by the gov-ernment, how to implement them remains to be chal-lenging. Like evidence-based medicine, comparative effective research ( CER ) which started in the US in 2000 ’s can provide diagnosis and treatment information for patients, doctors, and health policy makers to make decisions on the effective ways of caring for both indi-vidual and population. It also may apply to the condi-tions of healthcare reform in China. And there are op-portunities and challenges of conducting CER in our country. We suggest that the government should estab-lish the national-level CER research institute, CER Leadership Committee and relevant standards, fund the CER projects, and begin CER in certain disciplines.

  5. Payment systems and incentives in primary care: implications of recent reforms in Estonia and Romania. (United States)

    Dan, Sorin; Savi, Riin


    Since the early 1990s, major reform in healthcare has been adopted in former communist countries in Central and Eastern Europe. More than 20 years after, reform in healthcare still draws much interest from policy makers and academics alike. One of the dynamic components of reform has been the reform of payment systems in primary care. This article looks at recent developments in payment systems and financial incentives in Estonia and Romania. We conclude that finding the appropriate mix in paying and incentivizing primary care providers in a transitional context is no easy solution for healthcare policy makers who need to carefully weigh in the advantages and inherent problems of various payment arrangements. In a transitional, rapidly changing healthcare system and society, and a context of financial stringency, the theoretical effects of payment mechanisms may be more difficult to predict and manage than it is expected.

  6. Reform and Relapse in Bilingual Policy in Moldova (United States)

    Ciscel, Matthew H.


    In the Republic of Moldova, language education policy has shifted since independence from an uneven Soviet policy, in which minority Russian dominated, towards somewhat more equitable European norms. Although many reforms in language education have been beneficial in producing a more balanced bilingualism, official policy has at times tended…

  7. Reforming health care in Canada: current issues

    Directory of Open Access Journals (Sweden)

    Baris Enis


    Full Text Available This paper examines the current health care reform issues in Canada. The provincial health insurance plans of the 1960s and 1970s had the untoward effects of limiting the federal government's clout for cost control and of promoting a system centered on inpatient and medical care. Recently, several provincial commissions reported that the current governance structures and management processes are outmoded in light of new knowledge, new fiscal realities and the evolution of power among stake-holders. They recommend decentralized governance and restructuring for better management and more citizen participation. Although Canada's health care system remains committed to safeguarding its guiding principles, the balance of power may be shifting from providers to citizens and "technocrats". Also, all provinces are likely to increase their pressure on physicians by means of salary caps, by exploring payment methods such as capitation, limiting access to costly technology, and by demanding practice changes based on evidence of cost-effectiveness.

  8. Credible Immigration Policy Reform: A Response to Briggs (United States)

    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…

  9. [The context of health care reforms]. (United States)

    Vergara, C


    In Latin America, health sector reforms have gone hand in hand with social and economic trends during the latter half of the twentieth century and have reflected the particular concept of "development" that has been in vogue at different times. Economic stagnation and increased social spending, both hallmarks of the 1960s, led to the decline of the "import substitution" development model, which had prevailed since the beginning of the century, and slowly gave way in the 1980s to the "globalization" model. From the earlier model, a transition took place toward a restructuring of production and a series of economic adjustment policies that led, ironically, to an increase in poverty in Latin America. Implementation of the new model has occurred in two phases. The first, known as the "social reform" or "first generation" phase, sprang from the notion that poverty is the sum of a number of material shortages that can be corrected through an equitable redistribution of a fixed volume of goods belonging to society. This conceptual framework, which was completely devoid of all historical linkages and separated from economic policy, led to social policies whose entire purpose was to mitigate poverty through subsidies targeting the poorest persons in the society. In the second phase of the globalization model, which arose in the 1990s and became known as the "second generation" or "postadjustment" phase, new economic rules came into play that were based primarily on international competition, efficiency in production, and openness and fairness in the capital markets. And if during the initial stage the conceptual strategy behind all social policy was to fight poverty, in the second stage the strategy became one of achieving equity, which was no longer interpreted as the even distribution of a fixed volume of capital goods, but as the sustained provision of greater and better opportunities for all. Having grown accustomed to the protectionism inherent in the earlier

  10. Quality reforms in Danish home care - balancing between standardisation and individualisation. (United States)

    Rostgaard, Tine


    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 a strong emphasis on quality since the 1990s. This reform strategy represents a shift from the welfare state modernisation programme of the 1980s, which built mainly on economic strategies of cost-efficiency and New Public Management principles, 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 the conflicting principles of standardisation and the individualisation of care provision. This approach has succeeded in increasing the political and administrative control over home help at the expense of the control by users, care workers and case managers.

  11. New Policy for Power Tariff Reform

    Institute of Scientific and Technical Information of China (English)

    Guan Yongsheng; Jin Wen


    @@ The "Opinions on Deepening Power Institutional Reform in the 11th Five-Year Period" (referred to as "Opinions" below for short) finally unveiled and appeared clearly in the vision of the public on April 6th, 2007. Being the core of the power institutional reform, the "route map" of power tariff reform in the 11th Five-Year Plan period has also been clearly oriented. However, on the whole, the power tariff reform is no drastic as one imagines. With this doubt, the Journalist discussed this issue with Mr. Huang Shaozhong, deputy director of the Department of Price & Financial Supervision under the State Electricity Regulatory Commission, also a member of the Working Group of Power Institutional Reform.

  12. Three decades of policy layering and politically sustainable reform in the European Union's agricultural policy

    DEFF Research Database (Denmark)

    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...

  13. European Union dairy policy reform: impact and challenges

    NARCIS (Netherlands)

    Jongeneel, R.A.


    Recent Common Agricultural Policy (CAP) reforms have affected dairy policy, including the milk quota system, and increased the market orientation of the sector. A modelling exercise, using the European Dairy Industry Model (EDIM), simulates an initial sharp decline in the EU milk price in response t

  14. Is the pro-competition policy an effective solution for China's public hospital reform? (United States)

    Pan, Jay; Qin, Xuezheng; Hsieh, Chee-Ruey


    The new round of health care reforms in China achieved significant initial results. New and emerging problems coinciding with the deepening of the reforms, however, require further institutional changes to strengthen the competition mechanism and promote public hospital efficiency. This paper provides a conceptual framework and preliminary assessment of public hospital competition in China. Specifically, we distinguish between two closely related concepts - competition and privatization, and identify several critical conditions under which hospital competition can be used as a policy instrument to improve health care delivery in China. We also investigate the current performance and identify several unintended consequences of public hospital competition - mainly, medical arms race, drug over-prescription and the erosion of a trusting relationship between patients and physicians. Finally, we discuss the policy options for enhancing the internal competition in China's hospital market, and conclude that public investment on information provision is key to reaping the positive outcomes of pro-competition policies.

  15. Impact and Countermeasure of New Health Care Reform Policy on Large-Scale Integrated Military Hospital%新医改政策对军队大型综合医院的影响及对策探讨

    Institute of Scientific and Technical Information of China (English)

    吴娅利; 周峰; 陈黎明; 蔡耘菲; 袁蕾; 刘国祥


    通过分析某地三所军队大型综合医院2008年~2011年的经济收入及收治病种数据,探讨“新医改”政策对军队大型综合医院的影响,指出军队医院要调整学科发展方向,加强与地方行政卫生部门沟通,积极争取地方政府经费支持及做好顶层经费规划等.%Through the analysis of economic income and data on categories of treated diseases in three large -scale integrated military hospitals from 2008 to 2011, the paper investigated the impact of implementation of the new health care reform policy in large -scale integrated military hospitals , and pointed out that the military hospitals need adjust the technology development direction of discipline, strengthen communication with the district health administration, actively seek the financial support of the local government and make good top -level financial planning.

  16. An overview of the intentions of health care reform. (United States)

    Tuma, Pepin Andrew


    If upheld as constitutional, the Patient Protection and Affordable Care Act that passed in 2010 promises to change health care delivery systems in the United States, partly by shifting focus from disease treatment to disease prevention. Registered dietitians (RDs) have already taken an active role in health care areas that stand to be directly affected by provisions in the health care reform bill. However, nutrition's vital role in preventing diseases and conditions potentially could translate to additional opportunities for RDs as a result of this reform. Specific dietetics-related areas targeted by health care reform include medical nutrition therapy for chronic conditions and employee wellness incentive programs. However, dietetics practitioners are not necessarily established in the language of the bill as the essential providers of specific services or as reimbursable practitioners. Thus, although it is possible health care reform could affect demand-and, in turn, supply-of RDs, the actual effect of this legislation is difficult to predict.

  17. Careful or lenient : welfare reform for lone mothers in the Netherlands

    NARCIS (Netherlands)

    Knijn, Trudie; Wel, Frits van


    The 1996 welfare reform that attempted to get lone parents out of social assistance represents a major shift in social policy in the Netherlands. Instead of having the financial right to care for their children, lone mothers are now obliged to earn their living by paid work as soon as their youngest

  18. Personal and political histories in the designing of health reform policy in Bolivia. (United States)

    Bernstein, Alissa


    While health policies are a major focus in disciplines such as public health and public policy, there is a dearth of work on the histories, social contexts, and personalities behind the development of these policies. This article takes an anthropological approach to the study of a health policy's origins, based on ethnographic research conducted in Bolivia between 2010 and 2012. Bolivia began a process of health care reform in 2006, following the election of Evo Morales Ayma, the country's first indigenous president, and leader of the Movement Toward Socialism (Movimiento al Socialism). Brought into power through the momentum of indigenous social movements, the MAS government platform addressed racism, colonialism, and human rights in a number of major reforms, with a focus on cultural identity and indigeneity. One of the MAS's projects was the design of a new national health policy in 2008 called The Family Community Intercultural Health Policy (Salud Familiar Comunitaria Intercultural). This policy aimed to address major health inequities through primary care in a country that is over 60% indigenous. Methods used were interviews with Bolivian policymakers and other stakeholders, participant observation at health policy conferences and in rural community health programs that served as models for aspects of the policy, and document analysis to identify core premises and ideological areas. I argue that health policies are historical both in their relationship to national contexts and events on a timeline, but also because of the ways they intertwine with participants' personal histories, theoretical frameworks, and reflections on national historical events. By studying the Bolivian policymaking process, and particularly those who helped design the policy, it is possible to understand how and why particular progressive ideas were able to translate into policy. More broadly, this work also suggests how a uniquely anthropological approach to the study of health policy

  19. Malaysian water sector reform : policy and performance

    NARCIS (Netherlands)

    Kim, C.T.


    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

  20. Reductions in abortion-related mortality following policy reform: evidence from Romania, South Africa and Bangladesh

    Directory of Open Access Journals (Sweden)

    Benson Janie


    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.

  1. What shapes output of policy reform?

    DEFF Research Database (Denmark)

    Carlsen, Kirsten

    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...

  2. Social Policy Reforms and Daughters' Schooling in Vietnam (United States)

    Belanger, Daniele; Liu, Jianye


    Vietnam's social policy reforms in the transition to a market economy included the introduction of fees for primary and secondary school in the late 1980s. Using data from the Viet Nam Living Standards Surveys, this paper examines how the increasing costs of education to households have impacted on school enrollment between 1993 and 1998, giving…

  3. New Directions in Education? A Critique of Contemporary Policy Reforms (United States)

    Skourdoumbis, Andrew


    This paper draws on facets of Foucault's theoretical resources to critique current education policy reform from within the Australian State of Victoria, namely the Department of Education and Early Childhood Development's (DEECD) discussion paper "New directions for school leadership and the teaching profession." Implicit in the reform…

  4. Reforming Higher Education Systems: Some Lessons to Guide Policy Implementation. (United States)

    Eisemon, Thomas Owen; Holm-Nielsen, Lauritz


    Experiences of different countries in establishing mechanisms to coordinate development of higher education systems, diversify institutional financing, and increase efficiency of public investments are examined. Attention is drawn to the need for effective policy structures to manage higher education, link reform costs to benefits, acknowledge…

  5. Impacts of the EU sugar policy reforms on developing countries

    NARCIS (Netherlands)

    Berkum, van S.; Roza, P.; Tongeren, van F.W.


    This report analyses the impacts of the Commission's July 2004 proposal for sugar policy reforms on developing countries. The study uses three approaches that complement each other: model simulations, literature review and country case studies. Model simulations indicate that the consequences of the

  6. Policy Reform: Testing Times for Teacher Education in Australia (United States)

    Fitzgerald, Tanya; Knipe, Sally


    In Australia as well as elsewhere, initial teacher education has become centre stage to a political agenda that calls for global competitiveness in the knowledge economy. The common problem cited has been declining educational standards linked with the quality of teaching and teacher education. The avalanche of review and policy reform has exposed…

  7. Stigma and Roma Education Policy Reform in Slovakia (United States)

    New, William


    This article addresses reform of Roma education in Slovakia against the backdrop of continued stigmatization of Roma students. Transnational NGOs and IGOs promote rights-based solutions leading to the fullest possible inclusion of Roma students in mainstream education. The Slovak state promotes educational policies that lead to the fullest…

  8. Setting standards at the forefront of delivery system reform: aligning care coordination quality measures for multiple chronic conditions. (United States)

    DuGoff, Eva H; Dy, Sydney; Giovannetti, Erin R; Leff, Bruce; Boyd, Cynthia M


    The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-Based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related programs addressing care coordination primarily capture continuity of care. Other key areas of care coordination, such as care transitions, patient-centeredness, and cross-cutting care across multiple conditions are infrequently addressed. The lack of a comprehensive and consistent measure set for care coordination will pose challenges for healthcare providers and policy makers who seek, respectively, to provide and reward well-coordinated care. In addition, this heterogeneity in measuring care coordination quality will generate new information, but will inhibit comparisons between these care coordination programs.

  9. Introducing a complex health innovation--primary health care reforms in Estonia (multimethods evaluation). (United States)

    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

  10. Market reforms in Swedish health care

    DEFF Research Database (Denmark)

    Diderichsen, Finn


    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...

  11. Policy Capacity Is Necessary but Not Sufficient; Comment on “Health Reform Requires Policy Capacity”

    Directory of Open Access Journals (Sweden)

    Sheldon Gen


    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.

  12. Layoff Policies Could Diminish Teacher Reform (United States)

    Sawchuk, Stephen


    This article reports that with the poor economy endangering more novice teachers' jobs, researchers and policymakers have begun to question the human-capital costs of "last hired, first fired" layoff policies. Such layoffs, those experts argue, do not consider teacher effectiveness, meaning that teachers who make vital contributions to school…

  13. Ethical and Human Rights Foundations of Health Policy: Lessons from Comprehensive Reform in Mexico. (United States)

    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.

  14. Enlargement of the European Union and agricultural policy reform

    DEFF Research Database (Denmark)

    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....

  15. Competition policy for health care provision in Norway. (United States)

    Brekke, Kurt R; Straume, Odd Rune


    Competition policy has played a very limited role for health care provision in Norway. The main reason is that Norway has a National Health Service (NHS) with extensive public provision and a wide set of sector-specific regulations that limit the scope for competition. However, the last two decades, several reforms have deregulated health care provision and opened up for provider competition along some dimensions. For specialised care, the government has introduced patient choice and (partly) activity (DRG) based funding, but also corporatised public hospitals and allowed for more private provision. For primary care, a reform changed the payment scheme to capitation and (a higher share of) fee-for-service, inducing almost all GPs on fixed salary contracts to become self-employed. While these reforms have the potential for generating competition in the Norwegian NHS, the empirical evidence is quite limited and the findings are mixed. We identify a set of possible caveats that may weaken the incentives for provider competition - such as the partial implementation of DRG pricing, the dual purchaser-provider role of regional health authorities, and the extensive consolidation of public hospitals - and argue that there is great scope for competition policy measures that could stimulate provider competition within the Norwegian NHS.

  16. Attitudes of Washington State physicians toward health care reform.


    Malter, A D; Emerson, L L; Krieger, J. W.


    Attitudes of Washington State physicians about health care reform and about specific elements of managed competition and single-payer proposals were evaluated. Opinions about President Clinton's reform plan were also assessed. Washington physicians (n = 1,000) were surveyed from October to November 1993, and responses were collected through January 1994; responses were anonymous. The response rate was 80%. Practice characteristics of respondents did not differ from other physicians in the sta...

  17. Polarization and Policy Reform : Anti-Corruption Policymaking in Sub-Saharan Africa

    NARCIS (Netherlands)

    Torenvlied, René; Klein Haarhuis, Carolien M.


    The ability of political systems to adopt policy reforms contributes to their internal stability. This article analyses 29 anti-corruption reforms in seven sub-Saharan countries. It seeks to explain the level of adopted reform in these countries from conflicts of interests between policy actors. Two

  18. Reforming the health sector in Thailand: the role of policy actors on the policy stage. (United States)

    Green, A


    This paper reports on exploratory research carried out into the processes of policy-making, and in particular health sector reform, in the health sector of Thailand. It is one of a set of studies examining health sector reform processes in a number of countries. Though in the period under study (1970-1996) there had been no single health sector reform package in Thailand, there was interest in a number of quarters in the development of such an initiative. It is clear, however, that despite recognition of the need for reform such a policy was far from being formulated, let alone implemented. The research, based on both documentary analysis and interviews, explores the reasons underpinning the failure of the policy process to respond to such a perceived need. The research findings suggest that the policy formation process in Thailand successfully occurs when there is a critical mass of support from strategic interest groups. The relative power of these interest groups is constantly changing. In particular the last two decades has seen a decline in the power of the bureaucratic élites (military and civilian) and a related rise in the power of the economic élites either directly or through their influence on political parties and government. Other critical groups include the media, NGOs and the professions. Informal policy groups are also significant. A number of implications for policy makers operating under such circumstances are drawn.

  19. Condliff v North Staffordshire Primary Care Trust: can human rights redress inequities in United Kingdom and Australian cost-containment-driven health care reforms? (United States)

    Townsend, Ruth; Faunce, Thomas


    A recent case from the English Court of Appeal (R (on the application of Condliff) v North Staffordshire Primary Care Trust [2011] EWCA Civ 910, concerning denial by a regional health care rationing committee of laparoscopic gastric bypass surgery for morbid obesity) demonstrates the problems of attempting to rely post hoc on human rights protections to ameliorate inequities in health care reforms that emphasise institutional budgets rather than universal access. This column analyses the complexities of such an approach in relation to recent policy debates and legislative reform of the health systems in the United Kingdom and Australia. Enforceable human rights, such as those available in the United Kingdom to the patient Tom Condliff, appear insufficient to adequately redress issues of inequity promoted by such "reforms". Equity may fare even worse under Australian cost-containment health care reforms, given the absence of relevant enforceable human rights in that jurisdiction.

  20. Why institutions are not the only thing that matters: twenty-five years of health care reform in New Zealand. (United States)

    Starke, Peter


    The literature on the causes of health care reform is dominated by institutionalist accounts, and political institutions are among the most prominent factors cited to explain why change takes place. However, institutionalist accounts have difficulty explaining both the timing and the content of reforms. By applying a range of explanatory approaches to a case study of health reform in New Zealand since the 1970s, this article explores some of the theories of reform beyond institutionalism, particularly those that take into account problem pressure, policy ideas, and the more agency-centered factor of partisan ideology. The aim is not to dismiss institutionalism but to try to fill some of the gaps that cannot be addressed with institutionalist theories alone. The detailed analysis shows that various factors played a role in conjunction, namely, problem pressure, policy ideas, and the ideology of parties in government. Partisan ideology, in particular, has perhaps been prematurely ignored by health care scholars.

  1. Toward a 21st-century health care system: Recommendations for health care reform

    NARCIS (Netherlands)

    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 ( held a

  2. Policy analysis: palliative care in Ireland.

    LENUS (Irish Health Repository)

    Larkin, P


    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.

  3. No theory of justice can ground health care reform. (United States)

    Trotter, Griffin


    This essay argues that no theory or single conception of justice can provide a fundamental grounding for health care reform in the United States. To provide such a grounding, (1) there would need to be widespread support among citizens for a particular conception of justice, (2) citizens would have to apprehend this common conception of justice as providing the strongest available rationale for health care reform, and (3) this rationale would have to overwhelm countervailing values. I argue that neither of the first two conditions is met.

  4. Primary Health Care Reform in Portugal: Portuguese, modern and innovative. (United States)

    Biscaia, André Rosa; Heleno, Liliana Correia Valente


    The 2005 Portuguese primary health care (CSP) reform was one of the most successful reforms of the country's public services. The most relevant event was the establishment of Family Health Units (USF): voluntary and self-organized multidisciplinary teams that provide customized medical and nursing care to a group of people. Then, the remaining realms of CSP were reorganized with the establishment of Health Center Clusters (ACeS). Clinical governance was implemented aiming at achieving health gains by improving quality and participation and accountability of all. This paper aims to characterize the 2005 reform of Portuguese CSP with an analysis of its systemic and local realms. This is a case study of a CSP reform of a health system with documentary analysis and description of one of its facilities. This reform was Portuguese, modern and innovative. Portuguese by not breaking completely with the past, modern because it has adhered to technology and networking, and innovative because it broke with the traditional hierarchized model. It fulfilled the goal of a reform: it achieved improvements with greater satisfaction of all and health gains.

  5. Economics and Health Reform: Academic Research and Public Policy. (United States)

    Glied, Sherry A; Miller, Erin A


    Two prior studies, conducted in 1966 and in 1979, examined the role of economic research in health policy development. Both concluded that health economics had not been an important contributor to policy. Passage of the Affordable Care Act offers an opportunity to reassess this question. We find that the evolution of health economics research has given it an increasingly important role in policy. Research in the field has followed three related paths over the past century-institutionalist research that described problems; theoretical research, which proposed relationships that might extend beyond existing institutions; and empirical assessments of structural parameters identified in the theoretical research. These three strands operating in concert allowed economic research to be used to predict the fiscal and coverage consequences of alternative policy paths. This ability made economic research a powerful policy force. Key conclusions of health economics research are clearly evident in the Affordable Care Act.

  6. Economic Reforms, Corporate Governance and Dividend Policy in Sectoral Economic Growth in Pakistan



    The paper attempts to establish a relationship economic reforms, dividend policy and economic growth. Broadly, the study tries to develop a link between economic reforms and economic growth. Further narrowing down, we split economic reforms into monetary, fiscal and governance reforms and find their influence on sectoral growth specifically focusing on corporate governance reforms. In Pakistan, as we have gone through phenomenon economic and structural changes during the last decade so the st...

  7. Why public health services? Experiences from profit-driven health care reforms in Sweden. (United States)

    Dahlgren, Göran


    Market-oriented health care reforms have been implemented in the tax-financed Swedish health care system from 1990 to 2013. The first phase of these reforms was the introduction of new public management systems, where public health centers and public hospitals were to act as private firms in an internal health care market. A second phase saw an increase of tax-financed private for-profit providers. A third phase can now be envisaged with increased private financing of essential health services. The main evidence-based effects of these markets and profit-driven reforms can be summarized as follows: efficiency is typically reduced but rarely increased; profit and tax evasion are a drain on resources for health care; geographical and social inequities are widened while the number of tax-financed providers increases; patients with major multi-health problems are often given lower priority than patients with minor health problems; opportunities to control the quality of care are reduced; tax-financed private for-profit providers facilitate increased private financing; and market forces and commercial interests undermine the power of democratic institutions. Policy options to promote further development of a nonprofit health care system are highlighted.

  8. Toward a 21st-century health care system: recommendations for health care reform. (United States)

    Arrow, Kenneth; Auerbach, Alan; Bertko, John; Brownlee, Shannon; Casalino, Lawrence P; Cooper, Jim; Crosson, Francis J; Enthoven, Alain; Falcone, Elizabeth; Feldman, Robert C; Fuchs, Victor R; Garber, Alan M; Gold, Marthe R; Goldman, Dana; Hadfield, Gillian K; Hall, Mark A; Horwitz, Ralph I; Hooven, Michael; Jacobson, Peter D; Jost, Timothy Stoltzfus; Kotlikoff, Lawrence J; Levin, Jonathan; Levine, Sharon; Levy, Richard; Linscott, Karen; Luft, Harold S; Mashal, Robert; McFadden, Daniel; Mechanic, David; Meltzer, David; Newhouse, Joseph P; Noll, Roger G; Pietzsch, Jan B; Pizzo, Philip; Reischauer, Robert D; Rosenbaum, Sara; Sage, William; Schaeffer, Leonard D; Sheen, Edward; Silber, B Michael; Skinner, Jonathan; Shortell, Stephen M; Thier, Samuel O; Tunis, Sean; Wulsin, Lucien; Yock, Paul; Nun, Gabi Bin; Bryan, Stirling; Luxenburg, Osnat; van de Ven, Wynand P M M


    The 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 ( held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives came together. This group agreed that the following 8 recommendations are fundamental to successful reform: 1. Replace the current fee-for-service payment system with a payment system that encourages and rewards innovation in the efficient delivery of quality care. The new payment system should invest in the development of outcome measures to guide payment. 2. Establish a securely funded, independent agency to sponsor and evaluate research on the comparative effectiveness of drugs, devices, and other medical interventions. 3. Simplify and rationalize federal and state laws and regulations to facilitate organizational innovation, support care coordination, and streamline financial and administrative functions. 4. Develop a health information technology infrastructure with national standards of interoperability to promote data exchange. 5. Create a national health database with the participation of all payers, delivery systems, and others who own health care data. Agree on methods to make de-identified information from this database on clinical interventions, patient outcomes, and costs available to researchers. 6. Identify revenue sources, including a cap on the tax exclusion of employer-based health insurance, to subsidize health care coverage with the goal of insuring all Americans. 7. Create state or regional insurance exchanges to pool risk, so that Americans without access to employer-based or other group insurance could obtain a standard benefits package through these exchanges

  9. Increase in caesarean deliveries after the Australian Private Health Insurance Incentive policy reforms.

    Directory of Open Access Journals (Sweden)

    Kristjana Einarsdóttir

    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.

  10. Postneoliberal Public Health Care Reforms: Neoliberalism, Social Medicine, and Persistent Health Inequalities in Latin America. (United States)

    Hartmann, Christopher


    Several Latin American countries are implementing a suite of so-called "postneoliberal" social and political economic policies to counter neoliberal models that emerged in the 1980s. This article considers the influence of postneoliberalism on public health discourses, policies, institutions, and practices in Bolivia, Ecuador, and Venezuela. Social medicine and neoliberal public health models are antecedents of postneoliberal public health care models. Postneoliberal public health governance models neither fully incorporate social medicine nor completely reject neoliberal models. Postneoliberal reforms may provide an alternative means of reducing health inequalities and improving population health.

  11. The readiness of addiction treatment agencies for health care reform

    Directory of Open Access Journals (Sweden)

    Molfenter Todd


    Full Text Available Abstract The Patient Protection and Affordable Care Act (PPACA aims to provide affordable health insurance and expanded health care coverage for some 32 million Americans. The PPACA makes provisions for using technology, evidence-based treatments, and integrated, patient-centered care to modernize the delivery of health care services. These changes are designed to ensure effectiveness, efficiency, and cost-savings within the health care system. To gauge the addiction treatment field’s readiness for health reform, the authors developed a Health Reform Readiness Index (HRRI survey for addiction treatment agencies. Addiction treatment administrators and providers from around the United States completed the survey located on the website. Respondents self-assessed their agencies based on 13 conditions pertinent to health reform readiness, and received a confidential score and instant feedback. On a scale of “Needs to Begin,” “Early Stages,” “On the Way,” and “Advanced,” the mean scores for respondents (n = 276 ranked in the Early Stages of health reform preparation for 11 of 13 conditions. Of greater concern was that organizations with budgets of  $5 million to have information technology (patient records, patient health technology, and administrative information technology, evidence-based treatments, quality management systems, a continuum of care, or a board of directors informed about PPACA. The findings of the HRRI indicate that the addiction field, and in particular smaller organizations, have much to do to prepare for a future environment that has greater expectations for information technology use, a credentialed workforce, accountability for patient care, and an integrated continuum of care.

  12. The readiness of addiction treatment agencies for health care reform. (United States)

    Molfenter, Todd; Capoccia, Victor A; Boyle, Michael G; Sherbeck, Carol K


    The Patient Protection and Affordable Care Act (PPACA) aims to provide affordable health insurance and expanded health care coverage for some 32 million Americans. The PPACA makes provisions for using technology, evidence-based treatments, and integrated, patient-centered care to modernize the delivery of health care services. These changes are designed to ensure effectiveness, efficiency, and cost-savings within the health care system.To gauge the addiction treatment field's readiness for health reform, the authors developed a Health Reform Readiness Index (HRRI) survey for addiction treatment agencies. Addiction treatment administrators and providers from around the United States completed the survey located on the website. Respondents self-assessed their agencies based on 13 conditions pertinent to health reform readiness, and received a confidential score and instant feedback.On a scale of "Needs to Begin," "Early Stages," "On the Way," and "Advanced," the mean scores for respondents (n = 276) ranked in the Early Stages of health reform preparation for 11 of 13 conditions. Of greater concern was that organizations with budgets of  $5 million to have information technology (patient records, patient health technology, and administrative information technology), evidence-based treatments, quality management systems, a continuum of care, or a board of directors informed about PPACA.The findings of the HRRI indicate that the addiction field, and in particular smaller organizations, have much to do to prepare for a future environment that has greater expectations for information technology use, a credentialed workforce, accountability for patient care, and an integrated continuum of care.

  13. Four proposals for market-based health care system reform. (United States)

    Sumner, W


    A perfectly free, competitive medical market would not meet many social goals, such as universal access to health care. Micromanagement of interactions between patients and providers does not guarantee quality care and frequently undermines that relationship, to the frustration of all involved. Furthermore, while some North American health care plans are less expensive than others, none have reduced the medical inflation rate to equal the general inflation rate. Markets have always fixed uneven inflation rates in other domains. The suggested reforms could make elective interactions between patients and providers work more like a free market than did any preceding system. The health and life insurance plan creates cost-sensitive consumers, informed by a corporation with significant research incentives and abilities. The FFEB proposal encourages context-sensitive pricing, established by negotiation processes that weigh labor and benefit. Publication of providers' expected outcomes further enriches the information available to consumers and may reduce defensive medicine incentives. A medical career ladder would ease entry and exit from medical professions. These and complementary reforms do not specifically cap spending yet could have a deflationary impact on elective health care prices, while providing incentives to maintain quality. They accomplish these ends by giving more responsibility, information, incentives, and choice to citizens. We could provide most health care in a marketlike environment. We can incorporate these reforms in any convenient order and allow them to compete with alternative schemes. Our next challenge is to design, implement, and evaluate marketlike health care systems.

  14. Competition policy for health care provision in the Netherlands. (United States)

    Schut, Frederik T; Varkevisser, Marco


    In the Netherlands in 2006 a major health care reform was introduced, aimed at reinforcing regulated competition in the health care sector. Health insurers were provided with strong incentives to compete and more room to negotiate and selectively contract with health care providers. Nevertheless, the bargaining position of health insurers vis-à-vis both GPs and hospitals is still relatively weak. GPs are very well organized in a powerful national interest association (LHV) and effectively exploit the long-standing trust relationship with their patients. They have been very successful in mobilizing public support against unfavorable contracting practices of health insurers and enforcement of the competition act. The rapid establishment of multidisciplinary care groups to coordinate care for patients with chronic diseases further strengthened their position. Due to ongoing horizontal consolidation, hospital markets in the Netherlands have become highly concentrated. Only recently the Dutch competition authority prohibited the first hospital merger. Despite the highly concentrated health insurance market, it is unclear whether insurers will have sufficient countervailing buyer power vis-à-vis GPs and hospitals to effectively fulfill their role as prudent buyer of care, as envisioned in the reform. To prevent further consolidation and anticompetitive coordination, strict enforcement of competition policy is crucially important for safeguarding the potential for effective insurer-provider negotiations about quality and price.

  15. Evidence-informed primary health care workforce policy: are we asking the right questions? (United States)

    Naccarella, Lucio; Buchan, Jim; Brooks, Peter


    Australia is facing a primary health care workforce shortage. To inform primary health care (PHC) workforce policy reforms, reflection is required on ways to strengthen the evidence base and its uptake into policy making. In 2008 the Australian Primary Health Care Research Institute funded the Australian Health Workforce Institute to host Professor James Buchan, Queen Margaret University, UK, an expert in health services policy research and health workforce planning. Professor Buchan's visit enabled over forty Australian PHC workforce mid-career and senior researchers and policy stakeholders to be involved in roundtable policy dialogue on issues influencing PHC workforce policy making. Six key thematic questions emerged. (1) What makes PHC workforce planning different? (2) Why does the PHC workforce need to be viewed in a global context? (3) What is the capacity of PHC workforce research? (4) What policy levers exist for PHC workforce planning? (5) What principles can guide PHC workforce planning? (6) What incentives exist to optimise the use of evidence in policy making? The emerging themes need to be discussed within the context of current PHC workforce policy reforms, which are focussed on increasing workforce supply (via education/training programs), changing the skill mix and extending the roles of health workers to meet patient needs. With the Australian government seeking to reform and strengthen the PHC workforce, key questions remain about ways to strengthen the PHC workforce evidence base and its uptake into PHC workforce policy making.

  16. [Health care reform in Chile: 2005 to 2009]. (United States)

    Valdivieso D, Vicente; Montero L, Joaquín


    Five years ago Chile implemented a Health Care Reform to reduce the great inequalities in health care provision that affects the low- income, high-risk segment of its population. A universal care plan ("AUGE") was designed to make medical coverage available to all Chilean citizens suffering from one of a specified, growing list of diseases (66 at present time). The diseases are prioritized by the Ministry of Health and its inclusion in the plan is revised periodically by an Advisory Committee according to four cardinal criteria: burden of disease, effectiveness of treatment, specific capacity of the health system and financial costs. The plan is funded by the state and enforced by law through a set of four specific guarantees: access, opportunity, quality and financial protection. This paper reviews the origin and development of the reform, the benefits and drawbacks of the application of the specific guarantees and the perception of the public regarding its strengths and weaknesses.

  17. Summary of Consultations on Child Care Reform = Sommaire des consultations sur la reforme des services de garde d'enfants. (United States)

    Ontario Ministry of Community and Social Services, Toronto.

    This document contains the English and French language versions of a report summarizing the results of a public consultation process on the subject of child care reform in Ontario, Canada. The process began with province-wide distribution of a public document called "Setting the Stage" which outlined a child care reform agenda as a focus for…

  18. Comparative effectiveness research: evidence-based medicine meets health care reform in the USA. (United States)

    Tanenbaum, Sandra J


    Rationale Comparative effectiveness research (CER) is the study of two or more approaches to a health problem to determine which one results in better health outcomes. It is viewed by some in the USA as a promising strategy for health care reform. Aims and Objectives In this paper, nascent US CER policy will be described and analysed in order to determine its similarities and differences with EBM and its chances of success. Methods Document review and process tracing Results CER shares the logic of policies promoting evidence-based medicine, but invites greater methodological flexibility to ensure external validity across a range of health care topics. Conclusions This may narrow the inferential distance from knowledge to action, but efforts to change the US health care system through CER will face familiar epistemological quandaries and 'patient-centred' politics on the left and right.

  19. Why do policies change? Institutions, interests, ideas and networks in three cases of policy reform. (United States)

    Shearer, Jessica C; Abelson, Julia; Kouyaté, Bocar; Lavis, John N; Walt, Gill


    Policy researchers have used various categories of variables to explain why policies change, including those related to institutions, interests and ideas. Recent research has paid growing attention to the role of policy networks-the actors involved in policy-making, their relationships with each other, and the structure formed by those relationships-in policy reform across settings and issues; however, this literature has largely ignored the theoretical integration of networks with other policy theories, including the '3Is' of institutions, interests and ideas. This article proposes a conceptual framework integrating these variables and tests it on three cases of policy change in Burkina Faso, addressing the need for theoretical integration with networks as well as the broader aim of theory-driven health policy analysis research in low- and middle-income countries. We use historical process tracing, a type of comparative case study, to interpret and compare documents and in-depth interview data within and between cases. We found that while network changes were indeed associated with policy reform, this relationship was mediated by one or more of institutions, interests and ideas. In a context of high donor dependency, new donor rules affected the composition and structure of actors in the networks, which enabled the entry and dissemination of new ideas and shifts in the overall balance of interest power ultimately leading to policy change. The case of strategic networking occurred in only one case, by civil society actors, suggesting that network change is rarely the spark that initiates the process towards policy change. This analysis highlights the important role of changes in institutions and ideas to drive policymaking, but hints that network change is a necessary intermediate step in these processes.

  20. Barriers and Facilitators for Primary Care Reform in Canada: Results from a Deliberative Synthesis across Five Provinces (United States)

    Haggerty, Jeannie L.; Hogg, William; Burge, Frederick; Wong, Sabrina T.; Katz, Alan; Grimard, Dominique; Weenink, Jan-Willem; Pineault, Raynald


    Introduction: Since 2000, primary care (PC) reforms have been implemented in various Canadian provinces. Emerging organizational models and policies are at various levels of implementation across jurisdictions. Few cross-provincial analyses of these reforms have been realized. The aim of this study is to identify the factors that have facilitated or hindered implementation of reforms in Canadian provinces between 2000 and 2010. Methods: A literature and policy scan identified evaluation studies across Canadian jurisdictions. Experts from British Columbia, Manitoba, Nova Scotia, Ontario and Quebec were asked to review the scope of published evaluations and draft provincial case descriptions. A one-day deliberative forum was held, bringing together researchers (n = 40) and decision-makers (n = 20) from all the participating provinces. Results: Despite a relative lack of published evaluations, our results suggest that PC reform has varied with regard to the scope and the policy levers used to implement change. Some provinces implemented specific PC models, while other provinces designed overarching policies aiming at changing professional behaviour and practice. The main perceived barriers to reform were the lack of financial investment, resistance from professional associations, too overtly prescriptive approaches lacking adaptability and an overly centralized governance model. The main perceived facilitators were a strong financial commitment using various allocation and payment approaches, the cooperation of professional associations and an incremental emergent change philosophy based on a strong decentralization of decisions allowing adaptation to local circumstances. So far the most beneficial results of the reforms seem to be an increase in patients' affiliation with a usual source of care, improved experience of care by patients and a higher workforce satisfaction. Conclusion: PC reforms currently under consideration in other jurisdictions could learn from the

  1. Lower Costs, Better Care- Reforming Our Health Care Delivery (United States)

    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...

  2. Investigating the health care delivery system in Japan and reviewing the local public hospital reform

    Directory of Open Access Journals (Sweden)

    Zhang X


    Full Text Available Xing Zhang, Tatsuo Oyama National Graduate Institute for Policy Studies, Tokyo, Japan Abstract: Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying a multivariate analysis and regression model techniques, we show the functional differences between urban populated prefectures and remote ones; the equality gap among all prefectures with respect to the distribution of the number of beds, staff, and doctors; and managerial differences between private and public hospitals. We also review and evaluate the local public hospital reform executed in 2007 from various financial aspects related to the expenditure and revenue structure by comparing public and private hospitals. We show that the 2007 reform contributed to improving the financial situation of local public hospitals. Strategic differences between public and private hospitals with respect to their management and strategy to improve their financial situation are also quantitatively analyzed in detail. Finally, the remaining problems and the future strategy to further improve the Japanese health care system are described. Keywords: health care system, health care resource, public hospital, multivariate regression model, financial performance

  3. Perceived Threat Associated with Police Officers and Black Men Predicts Support for Policing Policy Reform (United States)

    Skinner, Allison L.; Haas, Ingrid J.


    Racial disparities in policing and recent high-profile incidents resulting in the deaths of Black men have ignited a national debate on policing policies. Given evidence that both police officers and Black men may be associated with threat, we examined the impact of perceived threat on support for reformed policing policies. Across three studies we found correlational evidence that perceiving police officers as threatening predicts increased support for reformed policing practices (e.g., limiting the use of lethal force and matching police force demographics to those of the community). In contrast, perceiving Black men as threatening predicted reduced support for policing policy reform. Perceived threat also predicted willingness to sign a petition calling for police reform. Experimental evidence indicated that priming participants to associate Black men with threat could also reduce support for policing policy reform, and this effect was moderated by internal motivation to respond without prejudice. Priming participants to associate police officers with threat did not increase support for policing policy reform. Results indicate that resistance to policing policy reform is associated with perceiving Black men as threatening. Moreover, findings suggest that publicizing racially charged police encounters, which may conjure associations between Black men and threat, could reduce support for policing policy reform. PMID:27462294


    Directory of Open Access Journals (Sweden)

    Agus Darmawan


    Full Text Available The study aims to find a legal policy model the Indonesian government in the management of government investment in infrastructure financing alternatives towards improving the welfare of all the people of Indonesia. This study uses a normative approach. The results showed that the management of government investment undertaken by the Government Investment Unit as a public service unit is not optimal and governance need to be improved. Legal reform through the establishment of a legal entity sui generis and realignment of authority operators, regulators and supervision in the management of government investment is expected to realize the objectives of the management of government investment as stipulated in Article 41 of Law No. 1 of 2004 on State Treasury.

  5. Analytic Support for Washington Citizens' Work Group on Health Care: Evaluation of Health Care Reform Proposals.


    Deborah Chollet; Jeffrey Ballou; Alison Wellington; Thomas Bell; Allison Barrett; Gregory Peterson; Stephanie Peterson


    Mathematica evaluated five health care reform proposals for the state of Washington in 2008. The proposals featured, respectively: reduced regulation in the current market; Massachusetts-style insurance reforms with a health insurance connector; a health partnership program similar to the current state employee health plan; a state-operated single payer plan; and a program that would guarantee catastrophic coverage for all residents. This report provides estimates of the changes in coverage a...

  6. Changing policies, changing patterns of care

    DEFF Research Database (Denmark)

    Rostgaard, Tine; Szebehely, Marta


    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...... 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......–87 in need of practical help), the article investigates the consequences of the two policy approaches for older people of different needs and socio-economic backgrounds and evaluates how the development corresponds with ideals of universalism in the Nordic welfare model. Our findings show that in both...

  7. Mexico's "ley de narcomenudeo" drug policy reform and the international drug control regime. (United States)

    Mackey, Tim K; Werb, Daniel; Beletsky, Leo; Rangel, Gudelia; Arredondo, Jaime; Strathdee, Steffanie A


    It has been over half a century since the landmark Single Convention on Narcotic Drugs was adopted, for the first time unifying international drug policy under a single treaty aimed at limiting use, manufacture, trade, possession, and trafficking of opiates, cannabis, and other narcotics. Since then, other international drug policy measures have been adopted, largely emphasizing enforcement-based approaches to reducing drug supply and use. Recently, in response to concerns that the historic focus on criminalization and enforcement has had limited effectiveness, international drug policies have begun to undergo a paradigm shift as countries seek to enact their own reforms to partially depenalize or deregulate personal drug use and possession. This includes Mexico, which in 2009 enacted national drug policy reform partially decriminalizing possession of small quantities of narcotics for personal consumption while also requiring drug treatment for repeat offenders. As countries move forward with their own reform models, critical assessment of their legal compatibility and effectiveness is necessary. In this commentary we conduct a critical assessment of the compatibility of Mexico's reform policy to the international drug policy regime and describe its role in the current evolving drug policy environment. We argue that Mexico's reform is consistent with flexibilities allowed under international drug treaty instruments and related commentaries. We also advocate that drug policy reforms and future governance efforts should be based on empirical evidence, emphasize harm reduction practices, and integrate evidence-based evaluation and implementation of drug reform measures.

  8. Health Behaviors, Mental Health, and Health Care Utilization Among Single Mothers After Welfare Reforms in the 1990s. (United States)

    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.

  9. Evidence-based medicine in health care reform. (United States)

    Hughes, Gordon B


    The Patient Protection and Affordable Care Act of 2010 mandates a national comparative outcomes research project agenda. Comparative effectiveness research includes both clinical trials and observational studies and is facilitated by electronic health records. A national network of electronic health records will create a vast electronic data "warehouse" with exponential growth of observational data. High-quality associations will identify research topics for pragmatic clinical trials, and systematic reviews of clinical trials will provide optimal evidence-based medicine. Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Thus, health care reform will provide a robust environment for comparative effectiveness research, systematic reviews, and evidence-based medicine, and implementation of evidence-based medicine should lead to improved quality of care.

  10. The duopoly policy in the Brazilian model of telecommunications reform

    Directory of Open Access Journals (Sweden)

    César Mattos


    Full Text Available 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 plausible idea rests on the prominent role conferred to privatization revenues in the design of the reform as a means of helping the efforts to consolidate price stabilization in the country. We introduce a model with the trade-offs between competition, duplication of fixed costs and privatization revenues. Despite the importance of fixed costs in the objective function of the regulator, we show that the privatization revenue target is the aspect, which justifies the imposition of entry constraints. The British experience shows that the sacrifice of this kind of policy regarding efficiency in the long run can be substantial.Uma das características mais importantes do Modelo Brasileiro de Reforma das Telecomunicações foi a adoção de uma política de duopólio, restringindo a entrada de novas empresas no segmento de telefonia fixa durante a fase de transição até a livre concorrência a ser adotada a partir de 2002. Essa política foi também utilizada na experiência de reforma das telecomunicações ocorrida no Reino Unido na década de 80. As explicações teóricas para justificar a adoção deste tipo de política não são satisfatórias o suficiente para justificar a política de duopólio como prescrição de política nas telecomunicações. A idéia mais plausível se baseia no papel proeminente conferido às receitas de privatização no desenho da reforma como forma de auxiliar os esforços de consolidação da estabilização de preços no

  11. Policy-making for real: Politics and progress in South African health care

    Directory of Open Access Journals (Sweden)

    A. Fourie


    Full Text Available Problems have been accumulating in South African health care for well over three centuries yet when it comes to resolving the crisis by means of appropriate policy measures, one becomes aware of the powers at play and the interests at stake in maintaining the status quo, thus obstructing much initiative in the process of reform.

  12. Policy process for health sector reforms: a case study of Punjab Province (Pakistan). (United States)

    Tarin, Ehsanullah; Green, Andrew; Omar, Maye; Shaw, Jane


    The health sector in the Punjab (Pakistan) faces many problems, and, the government introduced reforms during 1993-2000. This paper explores the policy process for the reforms. A case study method was used and, to assist this, a conceptual framework was developed. Analysis of four initiatives indicated that there were deviations from the government guidelines and that the policy processes used were weak. The progress of different reforms was affected by a variety of factors: the immaturity of the political process and civil society, which together with innate conservatism and resistance to change on the part of the bureaucracy resulted in weak strategic sectoral leadership and a lack of clear purpose underpinning the reforms. It also resulted in weaknesses in preparation of the detail of reforms leading to poor implementation. The study suggests a need for broadening the stakeholders' base, building the capacity of policy-makers in policy analysis and strengthening the institutional basis of policymaking bodies.

  13. The new institutionalist approaches to health care reform: lessons from reform experiences in Central Europe. (United States)

    Sitek, Michał


    This article discusses the applicability of the new institutionalism to the politics of health care reform in postcommunist Central Europe. The transition to a market economy and democracy after the fall of communism has apparently strengthened the institutional approaches. The differences in performance of transition economies have been critical to the growing understanding of the importance of institutions that foster democracy, provide security of property rights, help enforce contracts, and stimulate entrepreneurship. From a theoretical perspective, however, applying the new institutionalist approaches has been problematic. The transitional health care reform exposes very well some inherent weaknesses of existing analytic frameworks for explaining the nature and mechanisms of institutional change. The postcommunist era in Central Europe has been marked by spectacular and unprecedented radical changes, in which the capitalist system was rebuilt in a short span of time and the institutions of democracy became consolidated. Broad changes to welfare state programs were instituted as well. However, the actual results of the reform processes represent a mix of change and continuity, which is a challenge for the theories of institutional change.

  14. Oral Health Care Reform in Finland – aiming to reduce inequity in care provision

    Directory of Open Access Journals (Sweden)

    Widström Eeva


    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

  15. Optimising Russian natural gas - reform and climate policy

    Energy Technology Data Exchange (ETDEWEB)



    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.

  16. Physician workforce planning in an era of health care reform. (United States)

    Grover, Atul; Niecko-Najjum, Lidia M


    Workforce planning in an era of health care reform is a challenge as both delivery systems and patient demographics change. Current workforce projections are based on a future health care system that is either an identified "ideal" or a modified version of the existing system. The desire to plan for such an "ideal system," however, may threaten access to necessary services if it does not come to fruition or is based on theoretical rather than empirical data.Historically, workforce planning that concentrated only on an "ideal system" has been centered on incorrect assumptions. Two examples of such failures presented in the 1980s when the Graduate Medical Education National Advisory Committee recommended a decrease in the physician workforce on the basis of predetermined "necessary and appropriate" services and in the 1990s, when planners expected managed care and health maintenance organizations to completely overhaul the existing health care system. Neither accounted for human behavior, demographic changes, and actual demand for health care services, leaving the nation ill-prepared to care for an aging population with chronic disease.In this article, the authors argue that workforce planning should begin with the current system and make adjustments based on empirical data that accurately reflect current trends. Actual health care use patterns will become evident as systemic changes are realized-or not-over time. No single approach will solve the looming physician shortage, but the danger of planning only for an ideal system is being unprepared for the actual needs of the population.

  17. The 2010 U.S. health care reform: approaching and avoiding how other countries finance health care. (United States)

    White, Joseph


    This article describes and analyzes the U.S. health care legislation of 2010 by asking how far it was designed to move the U.S. system in the direction of practices in all other rich democracies. The enacted U.S. reform could be described, extremely roughly, as Japanese pooling with Swiss and American problems at American prices. Its policies are distinctive, yet nevertheless somewhat similar to examples in other rich democracies, on two important dimensions: how risks are pooled and the amount of funds redistributed to subsidize care for people with lower incomes. Policies about compelling people to contribute to a finance system would be further from international norms, as would the degree to which coverage is set by clear and common substantive standards--that is, standardization of benefits. The reform would do least, however, to move the United States toward international practices for controlling spending. This in turn is a major reason why the results would include less standard benefits and incomplete coverage. In short, the United States would remain an outlier on coverage less because of a failure to make an effort to redistribute--a lack of solidarity--than due to a failure to control costs.

  18. Scandals in health-care: their impact on health policy and nursing. (United States)

    Hutchison, Jacqueline S


    Through an analysis of several high-profile scandals in health-care in the UK, this article discusses the nature of scandal and its impact on policy reform. The nursing profession is compared to social work and medicine, which have also undergone considerable examination and change as a result of scandals. The author draws on reports from public inquiries from 1945 to 2013 to form the basis of the discussion about policy responses following scandals in health-care. In each case, the nature of the scandal, the public and government discourses generated by events and the policy response to those failings are explored. These scandals are compared to the recent scandal at Mid Staffordshire Hospital. Conclusions are drawn about the impact of these events on the future of the profession and on health policy directions. Recent events have raised public anxieties about caring practices in nursing. Health policy reform driven by scandal may obscure the effect of under resourcing in health services and poses a very real threat to the continued support for state-run services. Understanding the socially constructed nature of scandal enables the nurse to develop a greater critical awareness of policy contexts in order that they can influence health service reform.

  19. The emerging EU quality of care policy

    DEFF Research Database (Denmark)

    Vollaard, Hans; van de Bovenkamp, Hester M.; Vrangbæk, Karsten


    involvement in healthcare policy over the last twenty years. Based on interviews and document and literature analysis we show that the scope of EU involvement has widened from public health and access to care, to quality of care. In this paper we concentrate on the latter. Focusing on the recent EU......Despite the fact that Member States and many citizens of the EU like to keep healthcare a foremost national competence and the EU treaties state that Member States remain primarily responsible for the organization and delivery of health care services, the European Union (EU) has expanded its...... and desirability of the EU's involvement is clearly needed, also considering the differences in quality of care policies between and within EU Member States. Both arguments in favour and against further EU involvement are discussed in this paper...

  20. Recognizing rhetoric in health care policy analysis. (United States)

    Russell, Jill; Greenhalgh, Trisha; Byrne, Emma; McDonnell, Janet


    Critiques of the 'naïve rationalist' model of policy-making abound in the sociological and political science literature. Yet academic debate on health care policy-making continues to be couched in the dominant discourse of evidence-based medicine, whose underlying assumptions--that policies are driven by facts rather than values and these can be clearly separated; that 'evidence' is context-free, can be objectively weighed up and placed unproblematically in a 'hierarchy'; and that policy-making is essentially an exercise in decision science--have constrained both thinking and practice. In this paper, drawing on theoretical work from political science and philosophy, and innovative empirical work in the health care sector, we argue that health care is well overdue for a re-defining of what policy-making is. Policy-making is the formal struggle over ideas and values, played out by the rhetorical use of language and the enactment of social situations. While the selection, evaluation and implementation of research evidence are important in the policy-making process, they do not equate to that process. The study of argument in the construction of policy has the potential to illuminate dimensions of the process that are systematically occluded when policy-making is studied through a naïve rationalist lens. In particular, a rhetorical perspective highlights the struggle over ideas, the 'naming and framing' of policy problems, the centrality of audience and the rhetorical use of language in discussion to increase the audience's adherence to particular framings and proposals. Rhetorical theory requires us to redefine what counts as 'rationality'--which must extend from what is provably true (by logic) and probably true (by Bayesian reasoning) to embrace, in addition, that which is plausibly true (i.e. can convince a reasonable audience). Future research into health care policy-making needs to move beyond the study of 'getting evidence into practice' and address the

  1. Effectiveness of China's Monetary Policy and Reform of Its Foreign Exchange System

    Institute of Scientific and Technical Information of China (English)

    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.

  2. Upholding the Malay Language and Strengthening the English Language Policy: An Education Reform (United States)

    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…

  3. Redesigning and reforming European regional policy : The reasons, the logic and the outcomes

    NARCIS (Netherlands)

    McCann, P.; Ortega-Argilés, R.


    This article discusses the reforms to European Union (EU) regional development policy, or more precisely EU Cohesion Policy, which have been taking place over recent years. Following a discussion of the evolution of the policy, the changes in the rationale, the logic, the architecture, and the outco

  4. Federal mandatory spending caps vital for health care reform. (United States)

    Domenici, P V


    Rising health spending creates an increasing burden on families, businesses, and government. Federal health spending--chiefly on Medicare and Medicaid--is a major contributor to a budget deficit that threatens to exceed $400 billion. In order to control that deficit, the President and the Congress must cap mandatory spending, excluding Social Security. In turn, policymakers should adopt health reforms to fit spending within the cap including enrolling more consumers in managed care plans, resolving medical liability disputes in arbitration instead of courts, and increasing assessment of research into cost-effective new technology.

  5. Failure of health care reform in the USA. (United States)

    Mechanic, D


    The failure of health reform in the USA reflects the individualism and lack of community responsibility of the American political culture, the power of interest groups, and the extraordinary process President Clinton followed in developing his highly elaborate plan. Despite considerable initial public support and a strong start, the reform effort was damaged by the cumbersome process, the complexity of the plan itself, and the unfamiliarity of key components such as alliances for pooled buying of health insurance. In addition, the alienation of important interest groups and the loss of presidential initiative in framing the public discussion as a result of international, domestic and personal issues contributed to the failure in developing public consensus. This paper considers an alternative strategy that would have built on the extension of the Medicare program as a way of exploring the possibilities and barriers to achieving health care reform. Such an approach would build on already familiar and popular pre-existing components. The massive losses in the most recent election and large budget cuts planned by the Republican majority makes it unlikely that gaps in insurance or comprehensiveness of coverage will be corrected in the foreseeable future.

  6. How Do School Leaders Navigate ICT Educational Reform? Policy Learning Narratives from a Singapore Context (United States)

    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…

  7. The Contribution of Stuart Hall to Analyzing Educational Policy and Reform (United States)

    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…

  8. Higher Education Policy Reform in Ethiopia: The Representation of the Problem of Gender Inequality (United States)

    Molla, Tebeje


    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…

  9. Reform and the politics of hybridization in mature health care states. (United States)

    Tuohy, Carolyn Hughes


    This article examines the cases of three health care states -- two of which (Britain and the Netherlands) have undergone major policy reform and one of which (Canada) has experienced only marginal adjustments. The British and Dutch reforms have variously altered the balance of power, the mix of instruments of control, and the organizing principles. As a result, mature systems representing the ideal-typical health care state categories of national health systems and social insurance (Britain and the Netherlands, respectively) were transformed into distinctive national hybrids. These processes have involved a politics of redesign that differs from the politics of earlier phases of establishment and retrenchment. In particular, the redesign phase is marked by the activity of institutional entrepreneurs who exploit specific opportunities afforded by public programs to combine public and private resources in innovative organizational arrangements. Canada stands as a counterpoint: no window of opportunity for major change occurred, and the bilateral monopoly created by its prototypical single-payer model provided few footholds for entrepreneurial activity. The increased significance of institutional entrepreneurs gives greater urgency to one of the central projects of health policy: the design of accountability frameworks to allow for an assessment of performance against objectives.

  10. Care and treatment of the mentally ill in the United States: historical developments and reforms. (United States)

    Morrissey, J P; Goldman, H H


    Three major cycles of reform in public mental health care in the United States--the moral treatment, mental hygiene, and community mental health movements--are described as a basis for assessing the shifting boundaries between the mental health, social welfare, and criminal justice systems. Historical forces that led to the transinstitutionalization of the mentally ill from almshouses to the state mental hospitals in the nineteenth and twentieth centuries have now been reversed in the aftermath of recent deinstitutionalization policies. Evidence is suggestive that the mentally ill are also being caught up in the criminal justice system, a circumstance reminiscent of pre-asylum conditions in the early nineteenth century. These trends shape the current mental health service delivery system and the agenda for policy-relevant research on issues involving the legal and mental health fields.

  11. Health care reform and Connecticut's non-profit hospitals. (United States)

    Cohen, Jeffrey R; Gerrish, William; Galvin, J Robert


    The recent federal Health Care Reform Act signed into law by President Obama is expected to lead to greater patient volumes at non-profit hospitals in Connecticut (and throughout the country). The financial implications for these hospitals depend on how the costs per patient are expected to change in response to the anticipated higher patient volumes. Using a regression analysis of costs with annual data on 30 Connecticut hospitals over the period 2006 to 2008, we find that there are considerable differences between outpatient and inpatient unit cost structures at these hospitals. Based on the results of our analysis, and assuming health care reform leads to an overall increase in the number of outpatients, we would expect Connecticut hospitals to experience lower costs per outpatient treated (economies of scale). On the other hand, an influx of additional inpatients would be expected to raise unit costs (diseconomies of scale). After controlling for other cost determinants, we find that the marginal cost of an inpatient is about $8,000 while the marginal cost of an outpatient is about $44. This disparity may provide an explanation for our finding that the effect of additional patient volumes overall (combining inpatient and outpatient) is an increase in hospitals' unit costs.

  12. Large employers that have lived through transformation say payment reform alone won't cut costs and reengineer care. (United States)

    Sepúlveda, Martín J; Darling, Helen


    As payment reform in health care gathers momentum, employers, as major payers, endorse the effort to move away from volume-driven payment to incentivizing and rewarding the delivery of better health care at lower cost. In this commentary we discuss large employers' perspectives on three particular challenges that payment reform alone, as important as it is, may not be sufficient to address: high health care prices, inefficient and complex systems, and an outdated work environment ill designed to meet the pressing goals of better health care at lower cost. We believe that policies that support health care organizations in redesigning work processes will be essential to reducing prices and simplifying interactions in care delivery. We also believe that health care organizations will need to redesign their compensation systems to align their employees' pay with improvements in performance. To that end, we describe the major transformation that IBM underwent in the 1990s to position itself to compete in a radically changed computer marketplace. We also offer several policy recommendations to support health care organizations in making the necessary changes.

  13. Assisted reproduction in Indonesia: policy reform in an Islamic culture and developing nation. (United States)

    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.

  14. Cognitive Behavior Therapy with Youth and Health Care Reform: A Congenial Union

    Directory of Open Access Journals (Sweden)

    Robert D. Friedberg


    Full Text Available This short opinion paper discusses cognitive behavioral therapy (CBT with youth in the era of health care reform. The commentary addresses the ways CBT is consistent with health care reform imperatives. Further, CBT's focus on accountability, credentialing, early intervention, and interdisciplinary collaboration is emphasized.

  15. Subsidizing "Stayers"? Effects of a Norwegian Child Care Reform on Marital Stability (United States)

    Hardoy, Ines; Schone, Pal


    Since January 1999, all parents in Norway with children aged 1 to 3 years who do not attend publicly subsidized day care are eligible for "cash-for-care" (CFC). One important purpose of the reform is to enable parents to spend more time with their children. We analyze whether the CFC reform has affected marital stability, using individual register…

  16. Antibiotic Policies in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Nese Saltoglu


    Full Text Available The antimicrobial management of patients in the Intensive Care Units are complex. Antimicrobial resistance is an increasing problem. Effective strategies for the prevention of antimicrobial resistance in ICUs have focused on limiting the unnecessary use of antibiotics and increasing compliance with infection control practices. Antibiotic policies have been implemented to modify antibiotic use, including national or regional formulary manipulations, antibiotic restriction forms, care plans, antibiotic cycling and computer assigned antimicrobial therapy. Moreover, infectious diseases consultation is a simple way to limit antibiotic use in ICU units. To improve rational antimicrobial using a multidisiplinary approach is suggested. [Archives Medical Review Journal 2003; 12(4.000: 299-309

  17. Defining the road ahead: thinking strategically in the new era of health care reform. (United States)

    Pudlowski, Edward M


    Understanding the implications of the new health care reform legislation, including those provisions that do not take effect for several years, will be critical in developing a successful strategic plan under the new environment of health care reform and avoiding unintended consequences of decisions made without the benefit of long-term thinking. Although this article is not a comprehensive assessment of the challenges and opportunities that exist under health care reform, nor a layout of all of the issues, it looks at some of the key areas in order to demonstrate why employers need to identify critical pathways and the associated risks and benefits of each decision. Key health care reform areas include insurance market reforms, grandfather rules, provisions that have the potential to influence the underlying cost of health care, the individual mandate, the employer mandate (including the free-choice voucher program) and the excise tax on high-cost plans.

  18. Educational Turbulence: The Influence of Macro and Micro-Policy on Science Education Reform (United States)

    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…

  19. Policy reforms to promote efficient and systainable water use in Swiss agriculture

    NARCIS (Netherlands)

    Finger, R.; Lehmann, N.


    The more sustainable use of scarce water resources is a policy goal in several countries. In this regard, current discussions on potential policy reforms in Switzerland revolve around the subsidization of water-saving irrigation technologies. Today, the share of drip irrigation systems is low, at 3%

  20. The study of nursing students’ learning initiative in the course reform of aged caring

    Directory of Open Access Journals (Sweden)

    Sun Wenjing


    Full Text Available Purpose: Analyzing the influence of nursing students’ learning initiative in the course reform of aged caring. Discuss the way of the aged care reform. Method: To reform the course of aged care in our school level 2013 88 nursing undergraduate. The specific content: learning aged care theory, learning Japanese care technology basic knowledge, adding Japanese and Taiwan’s nursing concepts to the traditional aged care teaching, performing sitcoms about old people’s disease and nursing way , reporting the plan of aged care by PowerPoint, organizing student volunteers to visit the nursing home and so on. The specific content lasted four months. Adopting the learning initiative (ALS scale developed by Zang Yuli and others after course reform. Measure the students’ learning initiative before and after the teaching. Result: Nursing student’s self-study ability was in the middle and lower level before the course reform(59.26±7.38; After the course reform, nursing student gain higher score than before learning on the three aspects contain “Learning motivation”,“Learning goals” and “Solid study”. The difference has statistically significant.(P<0.05.Conclusion: Through the aged care course reform, nursing students strengthen the study enthusiasm and initiative; enhance nursing student’s self-study ability. It is conducive to improve the learning interest of aged care course for nursing students.

  1. Explaining Large-Scale Policy Change in the Turkish Health Care System: Ideas, Institutions, and Political Actors. (United States)

    Agartan, Tuba I


    Explaining policy change has been one of the major concerns of the health care politics and policy development literature. This article aims to explain the specific dynamics of large-scale reforms introduced within the framework of the Health Transformation Program in Turkey. It argues that confluence of the three streams - problem, policy, and politics - with the exceptional political will of the Justice and Development Party's (JDP) leaders opened up a window of opportunity for a large-scale policy change. The article also underscores the contribution of recent ideational perspectives that help explain "why" political actors in Turkey would focus on health care reform, given that there are a number of issues waiting to be addressed in the policy agenda. Examining how political actors framed problems and policies deepens our understanding of the content of the reform initiatives as well as the construction of the need to reform. The article builds on the insights of both the ideational and institutionalist perspectives when it argues that the interests, aspirations, and fears of the JDP, alongside the peculiar characteristics of the institutional context, have shaped its priorities and determination to carry out this reform initiative.

  2. Policy entrepreneurship in the development of public sector strategy: the case of London health reform. (United States)

    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.

  3. Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program. (United States)

    Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish


    In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

  4. Psychiatric and Medical Health Care Policies in Juvenile Detention Facilities (United States)

    Pajer, Kathleen A.; Kelleher, Kelly; Gupta, Ravindra A.; Rolls, Jennifer; Gardner, William


    A study aims to examine the existing health care policies in U.S. juvenile detention centres. The results conclude that juvenile detention facilities have many shortfalls in providing care for adolescents, particularly mental health care.

  5. Getting the product right: how competition policy can improve health care markets. (United States)

    Sage, William M


    As hospital, physician, and health insurance markets consolidate and change in response to health care reform, some commentators have called for vigorous enforcement of the federal antitrust laws to prevent the acquisition and exercise of market power. In health care, however, stricter antitrust enforcement will benefit consumers only if it accounts for the competitive distortions caused by the sector's long history of government regulation. This article directs policy makers to a neglected dimension of health care competition that has been altered by regulation: the product. Competition may have failed to significantly lower costs, increase access, or improve quality in health care because we have been buying and selling the wrong things. Competition policy makers-meaning both antitrust enforcers and regulators-should force the health care industry to define and market products that can be assembled and warranted to consumers while keeping emerging sectors such as mHealth free from overregulation, wasteful subsidy, and appropriation by established insurer and provider interests.

  6. Health Care Reform: Understanding Individuals’ Attitudes and Information Sources

    Directory of Open Access Journals (Sweden)

    Carolyn K. Shue


    Full Text Available 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.

  7. Mental health policy and development in Egypt - integrating mental health into health sector reforms 2001-9

    Directory of Open Access Journals (Sweden)

    Siekkonen Inkeri


    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

  8. Early Educational Provision--Emphasised in Education Policy Reforms in Norway? An Analysis of Education Policy Documents (United States)

    Bjørnsrud, Halvor; Nilsen, Sven


    The article analyses how the intentions of early provision in Norwegian schools have been expressed in the education policy reforms in Norway from the 1970s to the present day. The first area deals with the intentions that most explicitly cover early provision; prevention, early detection and intervention. The second area of analysis relates to…

  9. Child Care Reform Consultation Infopack = Consultation sur la reforme des services de garde d'enfants. Trousse d'information. (United States)

    Ontario Ministry of Community and Social Services, Toronto.

    This information packet presented here in both the English and French language versions, summarizes the results of a public consultation on the subject of child care reform in Ontario, Canada. The packet consists of: (1) a table that describes the six modes of consultation that were used in the consultation process (public meetings, round table…

  10. Health Related Policy Reform in Nigeria;- Empirical Analysis From 2001 to 2010; The Past, Trend and Future Directions For Sustainable Health Financing and Development

    Directory of Open Access Journals (Sweden)

    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.

  11. Kuwait: Security, Reform, and U.S. Policy (United States)


    2 The Franchise ...................................................................................................................... 2...and the Trafficking in Persons Report for 2013 (June 19, 2013), pdf Kuwait: Security, Reform...Assembly, names a Prime Minister who in turn assembles a cabinet. The Franchise For at least two decades, the extent of the franchise has been a

  12. The Affordable Care Act, health care reform, prescription drug formularies and utilization management tools. (United States)

    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.

  13. Care systematization in psychiatric nursing within the psychiatric reform context. (United States)

    Hirdes, A; Kantorski, L P


    The aim of this study was to approach care systematization in psychiatric nursing in two psychiatric disorder patients who attended 'Nossa Casa', São Lourenço do Sul, RS, Brazil. Nossa Casa services psychiatric patients in the community, focussing on: (i) permanence in their environment, allowing patients to remain close to their families and social spheres; (ii) integral attendance to meet individual needs; (iii) respecting individual differences; (iv) rehabilitation practices; and (v) social reinsertion. Concepts and assumptions of the psychiatric reform and the Irving's nursing process were used as theoretical-methodological references to elaborate this systematization. A therapeutic project for the psychiatric patient was elaborated, in accordance with the interdisciplinary proposal accepted by Nossa Casa. Interdisciplinary team intervention, guided by a previously discussed common orientation and defined through an individualized therapeutic project, allowed for an effective process of psychosocial rehabilitation. The authors concluded that a therapeutic project based on the mentioned premises leads to consistent, comprehensive, dialectical and ethical assistance in mental health, thereby reinstating the citizenship of psychiatric patients.

  14. Can Historical Institutionalism Explain the Reforms of the Common Agricultural Policy?

    Directory of Open Access Journals (Sweden)

    Nicoleta Lăşan


    Full Text Available Historical institutionalism, one of the three variants of new institutionalism, has been largely employed by scholars to explain the development of one of the first policies developed at the European level, namely the Common Agricultural Policy (CAP. Due to historical institutionalism’s claim that policies tend to follow the path set at their creation, it is not surprising that it could easily account for the development of the CAP before 1990s since this was one of the most resistant policies set by the member states of the European Union. The main challenge for historical institutionalism is to explain the shifts that occurred in this policy due to the reforms agreed after 1990, reforms that are often mentioned in the literature as being crucial. The aim of this paper is to show that historical institutionalism can accommodate the 1992 and 2003 reforms of the Common Agricultural Policy, and from this we can infer that the changes needed to adapt this policy of the EU to the conditions of an ever enlarging Europe will take place slowly, if at all.

  15. Neoliberalism, Policy Reforms and Higher Education in Bangladesh (United States)

    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…

  16. Monetary Policy and Foreign Exchange Management: Reforming Central Bank Functions in Myanmar


    Nijathaworn, Bandid; Chaikhor, Suwatchai; Chotika-arpa, Suppakorn; Sakkankosone, Suchart


    Myanmar’s macroeconomic policy framework does not adequately support the new functions of the Central Bank of Myanmar. The monetary policy regime is deficient and institutions that complement the working of a market-based economy lacking. This paper identifies 10 priority areas for reform to allow the central bank to effectively perform its emerging new functions in support of economic growth and stability. This is a three-front effort: dismantle nonmarket arrangements, especially in the fina...

  17. Monetary Policy and Foreign Exchange Management: Reforming Central Bank Functions in Myanmar


    Nijathaworn, Bandid; Chaikhor, Suwatchai; Chotika-arpa, Suppakorn; Sakkankosone, Suchart


    Myanmar's macroeconomic policy framework does not adequately support the new functions of the Central Bank of Myanmar. The monetary policy regime is deficient and institutions that complement the working of a market-based economy lacking. This paper identifies 10 priority areas for reform to allow the central bank to effectively perform its emerging new functions in support of economic growth and stability. This is a three-front effort: dismantle nonmarket arrangements, especially in the fina...

  18. Packaging policies to reform the water sector: The case of the Central Valley Project Improvement Act (United States)

    Fischhendler, Itay; Zilberman, David


    Existing water policies often deviate from measures suggested by economic and environmental analysis. This is particularly true in the case of drought response policies, where effective policies are rarely adopted. This study focuses on how to enhance the political feasibility of options rather than identifying the optimal water policies. It argues that a legislative policy package may be a mechanism both to unite divergent interest groups into a coalition with common policy agendas and also to fragment or realign existing and traditional alliances. This majority building approach may have a greater chance of obtaining the required political support to advance water reforms. The negotiation over the Central Valley Project Improvement Act in California is used as an example. The case study illustrates how the policy packaging strategy split the traditional power alliance between the agricultural sector and the urban sector in California and between the agricultural sector in California and their allies in other U.S. western states. At the same time, policy packaging has created new regional and sectoral advocacy coalitions in support of water reform. As a result, the Bureau of Reclamation changed its policies in the Central Valley in California relating to the establishment of water markets, water pricing, and wildlife restoration fund and allocating water for the environment.

  19. Postcolonial Teacher Education Reform in Namibia: Travelling of Policies and Ideas (United States)

    Arreman, Inger Erixon; Erixon, Per-Olof; Rehn, Karl-Gunnar


    Long before Namibia's independence in 1990, Sweden initiated a policy dialogue with Namibia's future political leadership. This article reviews the impact of an educational reform in Namibia in the early 1990s called the Integrated Teacher Training Programme (ITTP), which was an outcome of collaboration between the South West African People's…

  20. Tensions between Teaching Sexuality Education and Neoliberal Policy Reform in Quebec's Professional Competencies for Beginning Teachers (United States)

    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…

  1. Bearing the Cost: An Examination of the Gendered Impacts of Water Policy Reform in Malawi (United States)

    Marra, Simona


    Water insecurity is one of the most pressing issues currently faced by Malawi. The consequences of these issues are borne significantly by women, who are most directly involved with water provision and use, particularly at the household level. Since the mid-1990s, Malawi has undertaken a process of water policy reform. Reflective of international…

  2. Policies lost in translation? Unravelling water reform processes in African waterscapes

    NARCIS (Netherlands)

    Kemerink-Seyoum, J.S.


    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

  3. School Reform Policy in England since 1988: Relentless Pursuit of the Unattainable (United States)

    Barker, Bernard


    There is growing concern that almost 20 years after the 1988 Education Act, top-down, large-scale reform has stalled. The policy mix of choice, competition, markets, regulation, accountability and leadership seems not to have closed the gap between advantaged and disadvantaged areas and individuals, while most variations in school performance can…

  4. Effects of agricultural policy reforms and farm characteristics on income risks in Swiss agriculture

    NARCIS (Netherlands)

    Benni, El N.; Finger, R.


    Purpose – The purpose of this study is to examine the effects of agricultural policy reform – specifically the change from market to direct payment support – on income variability of Swiss farming households. In addition, the observed heterogeneity in income risks across farms and time is explained

  5. Medication management policy, practice and research in Australian residential aged care: Current and future directions. (United States)

    Sluggett, Janet K; Ilomäki, Jenni; Seaman, Karla L; Corlis, Megan; Bell, J Simon


    Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting.

  6. [Gender equity in health sector reform policies in Latin America and the Caribbean]. (United States)

    Gómez, Elsa Gómez


    Gender equity is increasingly being acknowledged as an essential aspect of sustainable development and more specifically, of health development. The Pan American Health Organization's Program for Women, Health, and Development has been piloting for a year now a project known as Equidad de género en las políticas de reforma del sector de salud, whose objective is to promote gender equity in the health sector reform efforts in the Region. The first stage of the project is being conducted in Chile and Peru, along with some activities throughout the Region. The core of the project is the production and use of information as a tool for introducing changes geared toward achieving greater gender equity in health, particularly in connection with malefemale disparities that are unnecessary, avoidable, and unfair in health status, access to health care, and participation in decision-making within the health system. We expect that in three years the project will have brought about changes in the production of information and knowledge, advocacy, and information dissemination, as well as in the development, appropriation, and identification of intersectoral mechanisms that will make it possible for key figures in government and civil society to work together in setting and surveying policy on gender equity in health.

  7. Which moral hazard? Health care reform under the Affordable Care Act of 2010. (United States)

    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

  8. Policy and finance for preconception care opportunities for today and the future. (United States)

    Johnson, Kay; Atrash, Hani; Johnson, Alison


    This special supplement of Women's Health Issues offers 2 types of articles related to the policy and finance context for improving preconception health and health care. These articles discuss the impact of finance and policy on preconception health and health care, as well as the strategies that are being used to overcome the challenge of implementing preconception care with limited resources and inadequate health coverage for women. Invited papers from authors with expertise in health policy and finance issues describe how women's health and preconception care fit into the larger debates on health reform and how the paradigm for women's health must change. Other invited papers discuss opportunities and challenges for using programs such as Medicaid, Title X Family Planning, Title V Maternal and Child Health Services Block Grant, Healthy Start, and Community Health Centers in improving preconception health and health care. Contributed articles on health services research in this supplement characterize the types of change occurring across the country. This paper also presents a framework for understanding the role of policy and finance in the larger Centers for Disease Control and Prevention Preconception Health and Health Care Initiative.

  9. Getting what we pay for: innovations lacking in provider payment reform for chronic disease care. (United States)

    Tynan, Ann; Draper, Debra A


    Despite wide recognition that existing physician and hospital payment methods used by health plans and other payers do not foster high-quality and efficient care for people with chronic conditions, little innovation in provider payment strategies is occurring, according to a new study by the Center for Studying Health System Change (HSC) commissioned by the California HealthCare Foundation. This is particularly disconcerting because the nation faces an increasing prevalence of chronic disease, resulting in continued escalation of related health care costs and diminished quality of life for more Americans. To date, most efforts to improve care of patients with chronic conditions have focused on paying vendors, such as disease management firms, to intervene with patients or redesigning care delivery without reforming underlying physician and hospital payment methods. While there is active discussion and anticipation of physician and hospital payment reform, current efforts are limited largely to experimental or small-scale pilot programs. More fundamental payment reform efforts in practice are virtually nonexistent. Existing payment systems, primarily fee for service, encourage a piecemeal approach to care delivery rather than a coordinated approach appropriate for patients with chronic conditions. While there is broad agreement that existing provider payment methods are not well aligned with optimal chronic disease care, there are significant barriers to reforming payment for chronic disease care, including: (1) fragmented care delivery; (2) lack of payment for non-physician providers and services supportive of chronic disease care; (3) potential for revenue reductions for some providers; and (4) lack of a viable reform champion. Absent such reform, however, efforts to improve the quality and efficiency of care for chronically ill patients are likely to be of limited success.

  10. Unintended consequences of Ze Ren Zhi reforms in China: interplay of agricultural reform and population control policy. (United States)

    Yen, W; Carter, L F


    The aim of the discussion of unintended consequences of Ze Ren Zhi policy reforms in China is to show how isolating problems and developing solutions in isolation can lead to serious consequences. The Ze Ren Zhi reforms in 1978 were intended to increase agricultural productivity by changing from the collective system to an individual responsibility system, but the unintended and undesirable consequences were a growth in family size and discouragement of some environmentally sound land use practices. The prior system gave an equal share of collective income for an equal number of days worked. Under the new reform, "Baochan Daohu," each household had responsibility for a contracted quantity of grain production. Within 2-4 years, economic conditions improved considerably. A discussion is provided of the transition from rights and duties of the collectives to the new responsibility system and the experimentation with different systems. Specific attention is directed to land reforms, mutual aid teams, cooperatives, communes, variations of Ze Ren Zhi, contracting output to individual laborers, contracting jobs to households, and contracting output quotas to households. During the reforms, beginning in the 1950s and lasting until 1978, other changes were taking place. Death rates were declining and birth rates were increasing, such that in 1971 a campaign was established to promote the Late, Sparse, and Few policy for marrying and giving birth later, increasing birth intervals, and having fewer children. This voluntary program eventually took on a more universally mandatory nature. The 1950 Marriage Law stipulated 20 years as the legal age for marriage (18 years for females), and family planning (FP) workers during the 1970s were encouraging even later marriage, and by 1980 a system of rewards and penalties was established to reinforce small family size. After 1978 and a period of birth declines, the crude birth rate increased to 3.06 in 1983. The new responsibility

  11. From Policy to Practice: Implementation of Water Policies in Child Care Centers in Connecticut (United States)

    Middleton, Ann E.; Henderson, Kathryn E.; Schwartz, Marlene B.


    Objective: Child care policies may contribute to healthy beverage consumption patterns. This study documented availability and accessibility of water and correspondence with state and federal policy and accreditation standards in child care centers. Design: One-day observations were conducted in a random sample of 40 Child and Adult Care Food…

  12. On the choice of farm management practices after the reform of the Common Agricultural Policy in 2003. (United States)

    Schmid, Erwin; Sinabell, Franz


    The Common Agricultural Policy (CAP) was fundamentally reformed in 2003. From 2005, farmers will receive decoupled income support payments instead of production premiums if basic standards for environment, food safety, animal health and welfare are met. Farmers are likely to adjust production and management practices to the new policy framework. We describe how this reform fits into the EU strategy of making agricultural production more environmentally friendly by concentrating on the financial aspects of the reforms. Using an agricultural sector model for Austria, we show that the reform will further decrease agricultural outputs, reduce farm inputs, lessen nitrogen surpluses and make environmentally friendly management practices more attractive for farmers.

  13. Optimum temperature policy for sorption enhanced steam methane reforming process for hydrogen production

    Energy Technology Data Exchange (ETDEWEB)

    Retnamma, Rajasree [National Laboratory of energy and Geology (LNEG), Lisbon (PT). Energy Systems Modeling and Optimization Unit (UMOSE); Ravi Kumar, V.; Kulkarni, B.D. [National Chemical Laboratory, Pune (India). Chemical Engineering and Process Development


    Sorption enhanced steam methane reforming (SE-SMR) process offers high potential for producing H{sub 2} in fuel cell applications compared to conventional catalytic steam methane reforming (SMR) process. The reactor temperature can significantly affect the performance of the SE-SMR reaction and simultaneous adsorption behavior of CO{sub 2}. Determination of an optimal temperature policy in SE-SMR reactor is therefore an important optimization issue. Multi-stage operation is a possible way to implement optimum temperature policies. In the present work, simulation study has been carried out for multi-stage operation using a mathematical model incorporating basic mechanisms operating in a fixed bed reactor with nonlinear reaction kinetic features of an SE-SMR process. Three cases were considered for implementing the multi-stage concept and the results show that increase in temperature based on a policy leads to considerable improvement in the process performance. (orig.)

  14. Cannabis policy reforms in the Americas: a comparative analysis of Colorado, Washington, and Uruguay. (United States)

    Pardo, Bryce


    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.

  15. Primary School English Reform in Japan: Policies, Progress and Challenges (United States)

    Ng, Chin Leong Patrick


    In April 2011, the Ministry of Education in Japan formally introduced Primary School English (PSE) language teaching in Japanese elementary schools. The PSE policy made it mandatory for fourth- and fifth-graders to attend English lessons once a week. Using the theoretical framework on why educational language plans fail [Kaplan, R. B., Baldauf, R.…

  16. Brokering Knowledge Mobilization Networks: Policy Reforms, Partnerships, and Teacher Education (United States)

    Ng-A-Fook, Nicholas; Kane, Ruth G.; Butler, Jesse K.; Glithero, Lisa; Forte, Rita


    Educational researchers and policy-makers are now expected by funding agencies and their institutions to innovate the multi-directional ways in which our production of knowledge can impact the classrooms of teachers (practitioners), while also integrating their experiential knowledge into the landscape of our research. In this article, we draw on…

  17. The project organization as a policy tool in implementing welfare reforms in the public sector. (United States)

    Jensen, Christian; Johansson, Staffan; Löfström, Mikael


    Organizational design is considered in policy literature as a forceful policy tool to put policy to action. However, previous research has not analyzed the project organization as a specific form of organizational design and, hence, has not given much attention to such organizations as a strategic choice when selecting policy tools. The purpose of the article is to investigate the project as a policy tool; how do such temporary organizations function as a specific form of organization when public policy is implemented? The article is based on a framework of policy implementation and is illustrated with two welfare reforms in the Swedish public sector, which were organized and implemented as project organizations. The case studies and the analysis show that it is crucial that a project organization fits into the overall governance structure when used as a policy tool. If not, the project will remain encapsulated and will not have sufficient impact on the permanent organizational structure. The concept of encapsulation indicates a need to protect the project from a potential hostile environment. The implication of this is that organizational design as a policy tool is a matter that deserves more attention in the strategic discussion on implementing public policies and on the suitability of using certain policy tools.


    Directory of Open Access Journals (Sweden)

    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

  19. Achieving Prudent Dementia Care (Palliare: An International Policy and Practice Imperative

    Directory of Open Access Journals (Sweden)

    Debbie Tolson


    Full Text Available This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care ('Palliare', that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such as Palliare. It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities

  20. Achieving Prudent Dementia Care (Palliare): An International Policy and Practice Imperative. (United States)

    Tolson, Debbie; Fleming, Anne; Hanson, Elizabeth; de Abreu, Wilson; Crespo, Manuel Lillo; Macrae, Rhoda; Jackson, Graham; Hvalič-Touzery, Simona; Holmerová, Iva; Routasalo, Pirkko


    This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care (Palliare), that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such as Palliare. It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities undertaken by the

  1. Translating the human right to water and sanitation into public policy reform. (United States)

    Meier, Benjamin Mason; Kayser, Georgia Lyn; Kestenbaum, Jocelyn Getgen; Amjad, Urooj Quezon; Dalcanale, Fernanda; Bartram, Jamie


    The development of a human right to water and sanitation under international law has created an imperative to implement human rights in water and sanitation policy. Through forty-three interviews with informants in international institutions, national governments, and non-governmental organizations, this research examines interpretations of this new human right in global governance, national policy, and local practice. Exploring obstacles to the implementation of rights-based water and sanitation policy, the authors analyze the limitations of translating international human rights into local water and sanitation practice, concluding that system operators, utilities, and management boards remain largely unaffected by the changing public policy landscape for human rights realization. To understand the relevance of human rights standards to water and sanitation practitioners, this article frames a research agenda to ensure that human rights aspirations lead to public policy reforms and public health outcomes.

  2. End-of-Life Care in an Acute Care Hospital: Linking Policy and Practice (United States)

    Sorensen, Ros; Iedema, Rick


    The care of people who die in hospitals is often suboptimal. Involving patients in decisions about their care is seen as one way to improve care outcomes. Federal and state government policymakers in Australia are promoting shared decision making in acute care hospitals as a means to improve the quality of end-of-life care. If policy is to be…

  3. Should the EU climate policy framework be reformed?

    Directory of Open Access Journals (Sweden)

    David ELLISON


    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.

  4. Land reform policies, the sources of violent conflict, and implications for deforestation in the Brazilian Amazon

    Energy Technology Data Exchange (ETDEWEB)

    Alston, L.J.; Libecap, G.D.; Mueller, B.


    The authors examine land reform policies and their implications for violent conflict and resource use in the Brazilian Amazon. They identify the protagonists (land owners and squatters), derive their incentives to use violence, and show the role of legal inconsistencies as a basis for conflict. The authors describe the government agency involved in land reform, INCRA, and show that its intervention critically affects the actions of both squatters and land owners. Further, they point out the incentives for deforestation under land reform and associated insecure property rights to land. Forested lands are vulnerable to invasion by squatters and redistribution by INCRA. Using data from the Brazilian census and the Pastoral Land Commission, the authors examine the characteristics of regions where violent conflict predominates.

  5. Social policy and entitlements : a proposal for reform

    NARCIS (Netherlands)

    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

  6. [Health care reform in the Obama administration: difficulties of reaching a similar agreement in Argentina]. (United States)

    Belmartino, Susana


    This article presents a comparative analysis of the processes leading to health care reform in Argentina and in the USA. The core of the analysis centers on the ideological references utilized by advocates of the reform and the decision-making processes that support or undercut such proposals. The analysis begins with a historical summary of the issue in each country. The political process that led to the sanction of the Obama reform is then described. The text defends a hypothesis aiming to show that deficiencies in the institutional capacities of Argentina's decision-making bodies are a severe obstacle to attaining substantial changes in this area within the country.

  7. University Reform in the Post-Massification Era in Japan: Analysis of Government Education Policy for the 21st Century. (United States)

    Reiko, Yamada


    Examines government higher education policy and Japanese higher education reform in the globalization and post-massification eras. Explores the effects of market mechanisms on Japanese higher education policy, the kinds of phenomena that have emerged in this period, and the impact of the government policy shift on Japanese higher education. (EV)

  8. The monopolistic integrated model and health care reform: the Swedish experience. (United States)

    Anell, A


    This article reviews recent reforms geared to creating internal markets in the Swedish health-care sector. The main purpose is to describe driving forces behind reforms, and to analyse the limitations of reforms oriented towards internal markets within a monopolistic integrated health-care model. The principal part of the article is devoted to a discussion of incentives within Swedish county councils, and of how these incentives have influenced reforms in the direction of more choices for consumers and a separation between purchasers and providers. It is argued that the current incentives, in combination with criticism against county council activities in the early 1990's, account for the present inconsistencies as regards reforms. Furthermore, the article maintains that a weak form of separation between purchasers and providers will lead to distorted incentives, restricting innovative behaviour and structural change. In conclusion, the process of reforming the Swedish monopolistic integrated health-care model in the direction of some form of internal market is said to rest on shaky ground.

  9. [Reform of long-term care in the Netherlands: solidarity maintained?]. (United States)

    van der Aa, Maartje J; Evers, Silvia M A A; Klosse, Saskia; Maarse, J A M Hans


    The reform of long-term care (LTC) in the Netherlands is a much debated topic. The reform essentially comes down to a shift in healthcare claims and a cutback. As of 1 January 2015, the Long-Term Care Act (WLZ) shall replace the Exceptional Medical Expenses Act (AWBZ). In doing so, parts of the AWBZ will shift to the Health Care Insurance Act (ZVW) and the renewed Social Support Act (WMO 2015), which will be carried out by municipalities. This is a significant change: whereas the AWBZ provides a right to care, the WMO commands delivery of tailor-made support. Care that falls under the WMO is only awarded if the capacity of persons seeking care, among others their financial resources and social network, are insufficient. Higher contributions than in the AWBZ may also be requested. These developments influence the experienced level of solidarity.

  10. The Norwegian Cash-for-Care Reform. Changing behaviour and stable attitudes

    Directory of Open Access Journals (Sweden)

    Lars Gulbrandsen


    Full Text Available In 1998 Norway introduced a cash-for-care scheme. Parent with children aged one or two were offered
    a cash-for-care benefit if they did not make use of public funded day care centres. The reform was supported by
    political parties of the centre and right and strongly opposed by parties on the left. Since 1999 ever fewer parents
    have made use of the opportunity to claim the benefit and have instead sent their children to a day care centre. At-
    titudes towards the cash-for-care reform, however, have remained very stable up to now. The principle of freedom
    of choice appears to be strongly rooted among Norwegians. The political agreement on maximum prices made
    this freedom a reality even for parents who wanted to make use of child care centres.

  11. The Norwegian Cash-for-Care Reform. Changing behaviour and stable attitudes

    Directory of Open Access Journals (Sweden)

    Lars Gulbrandsen


    Full Text Available In 1998 Norway introduced a cash-for-care scheme. Parent with children aged one or two were offered a cash-for-care benefit if they did not make use of public funded day care centres. The reform was supported by political parties of the centre and right and strongly opposed by parties on the left. Since 1999 ever fewer parents have made use of the opportunity to claim the benefit and have instead sent their children to a day care centre. Attitudes towards the cash-for-care reform, however, have remained very stable up to now. The principle of freedom of choice appears to be strongly rooted among Norwegians. The political agreement on maximum prices made this freedom a reality even for parents who wanted to make use of child care centres.

  12. Do American and Korean Education Systems Converge? Tracking School Reform Policies and Outcomes in Korea and the USA (United States)

    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 centralization…

  13. An Asset Based Approach to Health Care and Wider Public Sector Reform in the Wigan Borough


    Wilson, Robert Lee; Blandamer, Will


    Introduction: The Wigan Borough’s system wide approach is based on the fastest and greatest improvement in the health of the population of the Borough. The way services are delivered to citizens are being reformed to include improved access, standardisation to best practice, technology deployment, integrated approaches to care, shifts to community and primary care orientated service delivery.Description: Wigan Borough has developed integrated care based on populations’ assets and is actively ...

  14. Review: Miller, Michelle Ann (2009, Rebellion and Reform in Indonesia – Jakarta’s Security and Autonomy Policies in Aceh

    Directory of Open Access Journals (Sweden)

    Antje Missbach


    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.

  15. Smallholder Livelihood Adaptation in the Context of Neoliberal Policy Reforms: A Case of Maize Farmers in Southern Veracruz, Mexico.

    NARCIS (Netherlands)

    Groenewald, S.F.; Berg, van den M.M.


    Governments around the world have embraced trade liberalisation as a means of enhancing efficiency to realise economic growth and alleviate poverty. Likewise, the Mexican government implemented neoliberal policy reforms, the NAFTA in particular, to stimulate sustainable development. Using the Mexica

  16. Impact of the joint-stock reform of commercial banks on the effectiveness of monetary policy in China

    Directory of Open Access Journals (Sweden)

    Fang Xianming


    Full Text Available Over the past decade, the Chinese government has conducted the joint-stock reform of state-owned commercial banks. The joint-stock reform improves the marketization level of the ownership structure of commercial banks and consequently leads to impacts on the effectiveness of monetary policy. This paper first presents the impacting mechanisms of the joint-stock reform of commercial banks on the effectiveness of monetary policy and then constructs an empirical model to test those impacts. The empirical results show that the increasing degree of joint-stock reform of commercial banks enhances the effectiveness of expansionary monetary policy but weakens the effectiveness of contractionary monetary policy in China.


    Schuftan, Claudio


    The author here distills his long-time personal experience with the deleterious effects of globalization on health and on the health sector reforms embarked on in many of the more than 50 countries where he has worked in the last 25 years. He highlights the role that the "human right to health" framework can and should play in countering globalization's negative effects on health and in shaping future health policy. This is a testimonial article.

  18. The crisis as catalyst for reframing health care policies in the European Union. (United States)

    Helderman, Jan-Kees


    Seen from the perspective of health, the global financial crisis (GFC) may be conceived of as an exogenous factor that has undermined the fiscal sustainability of European welfare states and consequently, their (expanding) health systems as well. Being one of the core programs of European welfare states, health care has always belonged to the sovereignty of European Member States. However, in past two decades, European welfare states have in fact become semi-sovereign states and the European Union (EU) no longer is an exogenous actor in European health policy making. Today, the EU not only puts limits to unsustainable growth levels in health care spending, it also acts as an health policy agenda setter. Since the outbreak of the GFC, it does so in an increasingly coercive and persuasive way, claiming authority over health system reforms alongside the responsibilities of its Member States.

  19. What is the appropriate counterfactual when estimating effects of multilateral trade policy reform?

    DEFF Research Database (Denmark)

    Anderson, Kym; Jensen, Hans Grinsted; Nelgen, Signe;


    by projecting the world economy to 2030 using the Global Trade Analysis Project (GTAP) model with those two alternative policy regimes and then simulating a move to global free trade (the maximum benefit from a multilateral trade reform) in each of those two cases. The welfare effects of removing...... the counterfactual price distortions in 2030 are shown to be much larger in the case where agricultural protection grows endogenously than in the case assuming no policy changes over the projection period. This suggests the traditional way of estimating effects of a multilateral agricultural trade agreement may...

  20. Reform,Interaction of Policies,and Economic Growth:Evidence from China's Provincial Panel Data

    Institute of Scientific and Technical Information of China (English)

    CHEN Zhao; LU Ming; YAN Ji


    Based on provincial panel data,we tested the effects of openness,denationalization,fiscal reform,and their interactions on Chinese regional economic growth.We found the following:(1) Openness,especially the growth of foreign-direct-investment/gross-domesticproduct ratio,has been important in enhancing China's growth since the mid-1980s,while this effect is not so significant in western China.(2) Fiscal reform is another significant factor for economic growth.If local governments deregulate,higher growth will be obtained.In particular,reducing extrabudget expenditure helps push economic growth,especially in western China.(3) The interaction of economic policies,such as openness,denationalization,and fiscal reform,also plays an essential role in local economic growth.Both for the whole nation and for the eastern area,denationalization does not affect growth independently but expands the effects of deregulation.(4) After controlling economic policies and their interactions,conditional convergence exists.(5) With other factors controlled,eastern China achieved higher growth,while the middle and western areas did not differ significantly in growth.(6) Western China,where policy variables have lower explanatory power for growth,has a growth pattern different from those of the eastern and middle areas.

  1. Financing institutional long-term care for the elderly in China: a policy evaluation of new models. (United States)

    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 policy goals: equity and efficiency. Three emerging models are explored: Social Health Insurance (SHI) in Shanghai, LTC Nursing Insurance (LTCNI) in Qingdao and a means-tested model in Nanjing. A focused systematic narrative review of academic and grey literature is conducted to identify and assess these models, supplemented with qualitative interviews with government officials from relevant departments, care home staff and service users. This paper argues that, although SHI appears to be a convenient solution to fund LTC, this model has led to systematic bias in affordable access among participants of different insurance schemes, and has created a powerful incentive for the over-provision of unnecessary services. The means-tested method has been remarkably constrained by narrow eligibility and insufficiency of funding resources. The LTCNI model is by far the most desirable policy option among the three studied here, but the narrow definition of eligibility has substantively excluded a large proportion of elders in need from access to care, which needs to be addressed in future reforms. This paper proposes three lines of LTC financing reforms for policy-makers: (1) the establishment of a prepaid financing mechanism pooled specifically for LTC costs; (2) the incorporation of more stringent eligibility rules and needs assessment; and (3) reforming the dominant fee-for-service methods in paying LTC service providers.

  2. What is the appropriate counterfactual when estimating effects of multilateral trade policy reform

    DEFF Research Database (Denmark)

    Anderson, Kym; Jensen, Hans Grinsted; Nelgen, Signe;


    of the DDA’s possible effects thus requires first modelling the world economy to 2030 and, in that process, projecting what trade-related policies might be by then without a DDA. Typically, modelers assume the counterfactual policy regime to be a ‘business-as-usual’ projection assuming the status quo. Yet we...... by projecting the world economy to 2030 using the Global Trade Analysis Project (GTAP) model with those two alternative policy regimes and then simulating a move to global free trade (the maximum benefit from a multilateral trade reform) in each of those two cases. The welfare effects of removing...... the counterfactual price distortions in 2030 are shown to be much larger in the case where agricultural protection grows endogenously than in the case assuming no policy changes over the projection period. This suggests the traditional way of estimating effects of a multilateral agricultural trade agreement may...

  3. US and territory telemedicine policies: identifying gaps in perinatal care (United States)

    Okoroh, Ekwutosi M.; Kroelinger, Charlan D.; Smith, Alexander M.; Goodman, David A.; Barfield, Wanda D.


    BACKGROUND Perinatal regionalization is a system of maternal and neonatal risk-appropriate health care delivery in which resources are ideally allocated for mothers and newborns during pregnancy, labor and delivery, and postpartum, in order to deliver appropriate care. Typically, perinatal risk-appropriate care is provided in-person, but with the advancement of technologies, the opportunity to provide care remotely has emerged. Telemedicine provides distance-based care to patients by consultation, diagnosis, and treatment in rural or remote US jurisdictions (states and territories). OBJECTIVE We sought to summarize the telemedicine policies of states and territories and assess if maternal and neonatal risk-appropriate care is specified. STUDY DESIGN We conducted a 2014 systematic World Wide Web–based review of publicly available rules, statutes, regulations, laws, planning documents, and program descriptions among US jurisdictions (N=59) on telemedicine care. Policies including language on the topics of consultation, diagnosis, or treatment, and those specific to maternal and neonatal risk-appropriate care were categorized for analysis. RESULTS Overall, 36 jurisdictions (32 states; 3 territories; and District of Columbia) (61%) had telemedicine policies with language referencing consultation, diagnosis, or treatment; 29 (49%) referenced consultation, 30 (51%) referenced diagnosis, and 35 (59%) referenced treatment. In all, 26 jurisdictions (22 states; 3 territories; and District of Columbia) (44%), referenced all topics. Only 3 jurisdictions (3 states; 0 territories) (5%), had policy language specifically addressing perinatal care. CONCLUSION The majority of states have published telemedicine policies, but few specify policy language for perinatal risk-appropriate care. By ensuring that language specific to the perinatal population is included in telemedicine policies, access to maternal and neonatal care can be increased in rural, remote, and resource


    Directory of Open Access Journals (Sweden)

    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

  5. EU rural policy reform (1997-1999): between politics and policy learning

    DEFF Research Database (Denmark)

    Steffensen, Jonny Trapp


    EU rural development policy is gaining in relative significance as the "second pillar" of the Common Agricultural Policy (CAP). Its substance - objectives and instruments - is still under development. This article explores the contribution of so-called "policy learning" by the European Commission...

  6. Incomplete Markets and Imperfect Institutions: Some Challenges Posed by Trust for Contemporary Health Care and Health Policy. (United States)

    Schlesinger, Mark; Gray, Bradford H


    As contemporary health policy promotes evidence-based practices using targeted incentives, policy makers may lose track of vital aspects of care that are difficult to measure. For more than a half century, scholars have recognized that these latter aspects play a crucial role in high-quality care and equitable health system performance but depend on the potentially frail reed of providers' trustworthiness: that is, their commitment to facets and outcomes of care not easily assessed by external parties. More recently, early experience with pay for performance in health settings suggests that enhancing financial rewards for the measurable undermines providers' commitment to the unmeasurable, degrading the trustworthiness of their practices. Reformers have looked to revised professional norms or reorganized practice arrangements to bolster the intrinsic motivations required for trustworthiness. We suggest here that these responses are likely to prove inadequate. We propose that they be complemented by a renewed policy-making commitment to nonprofit ownership among health care providers, insurers, and integrated delivery systems. We identify some of the concerns raised in the past with ownership-based policies and propose a set of responses. If these are pursued in combination, they hold the promise of a sustainable ownership-based policy reform for the United States.

  7. A window of opportunity for reform in post-conflict settings? The case of Human Resources for Health policies in Sierra Leone, 2002–2012 (United States)


    Background It is recognized that decisions taken in the early recovery period may affect the development of health systems. Additionally, some suggest that the immediate post-conflict period may allow for the opening of a political ‘window of opportunity’ for reform. For these reasons, it is useful to reflect on the policy space that exists in this period, by what it is shaped, how decisions are made, and what are their long-term implications. Examining the policy trajectory and its determinants can be helpful to explore the specific features of the post-conflict policy-making environment. With this aim, the study looks at the development of policies on human resources for health (HRH) in Sierra Leone over the decade after the conflict (2002–2012). Methods Multiple sources were used to collect qualitative data on the period between 2002 and 2012: a stakeholder mapping workshop, a document review and a series of key informant interviews. The analysis draws from political economy and policy analysis tools, focusing on the drivers of reform, the processes, the contextual features, and the actors and agendas. Findings Our findings identify three stages of policy-making. At first characterized by political uncertainty, incremental policies and stop-gap measures, the context substantially changed in 2009. The launch of the Free Health Care Initiative provided to be an instrumental event and catalyst for health system, and HRH, reform. However, after the launch of the initiative, the pace of HRH decision-making again slowed down. Conclusions Our study identifies the key drivers of HRH policy trajectory in Sierra Leone: (i) the political situation, at first uncertain and later on more defined; (ii) the availability of funding and the stances of agencies providing such funds; (iii) the sense of need for radical change – which is perhaps the only element related to the post-conflict setting. It also emerges that a ‘windows of opportunity’ for reform did not open

  8. Health care policy development: a critical analysis model. (United States)

    Logan, Jean E; Pauling, Carolyn D; Franzen, Debra B


    This article describes a phased approach for teaching baccalaureate nursing students critical analysis of health care policy, including refinement of existing policy or the foundation to create new policy. Central to this approach is the application of an innovative framework, the Grand View Critical Analysis Model, which was designed to provide a conceptual base for the authentic learning experience. Students come to know the interconnectedness and the importance of the model, which includes issue selection and four phases: policy focus, colleagueship analysis, evidence-based practice analysis, and policy analysis and development.

  9. Office of Disability, Aging and Long-Term Care Policy (United States)

    ... Publications Data and Tools Evaluation Database Office of Disability, Aging and Long-Term Care Policy (DALTCP) Home About Offices Disability, Aging, and Long-Te... DALTCP provides leadership on ...

  10. Child protection and out of home care: Policy, practice, and research connectionsAustralia and New Zealand

    Directory of Open Access Journals (Sweden)


    Full Text Available This article provides an outline of the early development of care and protection in Australia and New Zealand as a backdrop to an overview of child protection systems and policies and the current childprotection profile in both countries. Key issues that have become the focus of policy reform are canvassed and legislative and policy initiatives to promote child safety as well as strengthen families are elaborated. An overview of trends in relation to out of home care, including routes into care, care arrangements and permanency policies is provided. The article profiles selected research studies from Australia focusing on outcomes of care: stability of care, mental health and educational outcomes of looked after children, abuse in care, and routes out of care through reunification and aging out. Other issues treated are the overrepresentation of indigenous children in care systems in both countries and the challenges of maintaining cultural connections. The article concludes with a brief comparative analysis identifying similarities and differences in child welfare systems in both countries.

  11. The EU’s Security Sector Reform Policies in the Democratic Republic of Congo

    Directory of Open Access Journals (Sweden)

    Stephan Keukeleire


    Full Text Available In this article we approach the functioning of bureaucracy in ESDP from a governance perspective that also focuses on informal patterns of interaction between the relevant bureaucratic actors. Following the governance and related network governance approaches, the interplay between formal and informal patterns of interaction can help to overcome deadlock in policy-making and to procure effective problem-solving. This perspective is applied to security sector reform (SSR in the Democratic Republic of Congo (DRC. SSR is one of the major emerging fields of activity within the civilian crisis management dimension of ESDP, that also in the DRC became a focal point in the EU’s new security and defence policy since its inception. However, as the EU involvement in the Congolese security sector reform policies illustrates, coordination and negotiation among European actors to overcome deadlock and produce effective problem-solving is not self-evident or even desirable for all actors. In the case of the EU’s SSR policies in Congo, coordination indeed occurs between the actors that are dependent upon each other in terms of resources and have the willingness to jointly tackle the problems related to the SSR in the DRC. However, it is also often undermined by actors that prefer to engage bilaterally because they possess the resources to do so and the personal relationships with the Congolese authorities to act more efficiently and effectively.

  12. [Primary health care reform and implications for the organizational culture of Health Center Groups in Portugal]. (United States)

    Leone, Claudia; Dussault, Gilles; Lapão, Luís Velez


    The health sector's increasing complexity poses major challenges for administrators. There is considerable consensus on workforce quality as a key determinant of success for any health reform. This study aimed to explore the changes introduced by an action-training intervention in the organizational culture of the 73 executive directors of Health Center Groups (ACES) in Portugal during the primary health care reform. The study covers two periods, before and after the one-year ACES training, during which the data were collected and analyzed. The Competing Values Framework allowed observing that after the ACES action-training intervention, the perceptions of the executive directors regarding their organizational culture were more aligned with the practices and values defended by the primary health care reform. The study highlights the need to continue monitoring results over different time periods to elaborate further conclusions.

  13. 政策制定中多源流因素交互作用机制及其动态不稳定性——美国新一轮医疗卫生改革的经验%The Interaction Mechanism of the Multiple Streams of Factors in Policy-Making and Its Dynamic Instability Experiences from the New Round of Health Care Reform in the USA

    Institute of Scientific and Technical Information of China (English)



    "医改"对于一些国家而言既是对公民权利问题的回应,又是治理社会危机问题的一种政治努力。就权利而言,那些缺乏医疗卫生保险的公民是否应该得到政府的帮助而享有一定的社会保障权?从危机的视角来看,社会医疗卫生总费用的不断膨胀,无论是个人、社会保险机构,还是政府都已面临严重的支出负担压力。一旦个人无法支付医疗卫生费用,医疗保险机构与政府由此造成的入不敷出以及财务赤字严重到一定程度之后,社会性的医疗危机就爆发了。因此,医改就其性质而言,可以被视为如何通过政策制定的政治过程,以实现医疗卫生总费用的控制和公民权利保障的双重目标。%Health care reforms are not only a response to the issues of civil rights for some countries, but also a political effort to control the problem of a social crisis. With regard to civil rights, should citizens who lack health insurance get help from the government and enjoy certain social security rights? With regard to the social crisis, due to increases in total health costs, individuals, social insurance agencies and governments all face in- creased pressure to take on greater expenses. Once individuals can no longer afford health care and social insurance agencies and governments can not make ends meet and their financial deficits reach a certain level, a social health care crisis will ensue. Therefore, in terms of health care reforms, the question is how to use the political process of policy making to achieve the goals of controlling health care costs and protecting civil rights.

  14. Professional responses to post bureaucratic hospital reforms and their impact on care provision

    DEFF Research Database (Denmark)

    Johnsen, Helle


    Background Post bureaucracy is increasingly shaping how health care professionals work. Within hospital settings, post bureaucracy is frequently connected to loss of professional autonomy and protocol-based care. However, this development also affects relationships between care providers and care....... 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......, performativity demands, litigation risks and rising administrative obligations are liable to challenge the provision of woman centred care. These changes may also result in increased inequity in maternity care by affecting some groups of women more than others....

  15. The health care reform in Mexico: before and after the 1985 earthquakes. (United States)

    Soberón, G; Frenk, J; Sepúlveda, J


    The earthquakes that hit Mexico City in September 1985 caused considerable damage both to the population and to important medical facilities. The disaster took place while the country was undertaking a profound reform of its health care system. This reform had introduced a new principle for allocating and distributing the benefits of health care, namely, the principle of citizenship. Operationally, the reform includes an effort to decentralize the decision-making authority, to modernize the administration, to achieve greater coordination within the health sector and among sectors, and to extend coverage to the entire population through an ambitious primary care program. This paper examines the health context in which the reform was taking place when the September earthquakes hit. After presenting the damages caused by the quakes, the paper analyzes the characteristics of the immediate response by the health system. Since many facilities within the system were severely damaged, a series of options for reconstruction are posited. The main lesson to be learned from the Mexican case is that cuts in health care programs are not the inevitable response to economic or natural crises. On the contrary, it is precisely when the majority of the population is undergoing difficulties that a universal and equitable health system becomes most necessary. PMID:3706595

  16. Rural health care in Vietnam and China: conflict between market reforms and social need. (United States)

    Huong, Dang Boi; Phuong, Nguyen Khanh; Bales, Sarah; Jiaying, Chen; Lucas, Henry; Segall, Malcolm


    China and Vietnam have adopted market reforms in the health sector in the context of market economic reforms. Vietnam has developed a large private health sector, while in China commercialization has occurred mainly in the formal public sector, where user fees are now the main source of facility finance. As a result, the integrity of China's planned health service has been disrupted, especially in poor rural areas. In Vietnam the government has been an important financer of public health facilities and the pre-reform health service is largely intact, although user fees finance an increasing share of facility expenditure. Over-servicing of patients to generate revenue occurs in both countries, but more seriously in China. In both countries government health expenditure has declined as a share of total health expenditure and total government expenditure, while out-of-pocket health spending has become the main form of health finance. This has particularly affected the rural poor, deterring them from accessing health care. Assistance for the poor to meet public-sector user fees is more beneficial and widespread in Vietnam than China. China is now criticizing the degree of commercialization of its health system and considers its health reforms "basically unsuccessful." Market reforms that stimulate growth in the economy are not appropriate to reform of social sectors such as health.

  17. Misalignment between medicare policies and depression care in home health care: home health provider perspectives. (United States)

    Bao, Yuhua; Eggman, Ashley A; Richardson, Joshua E; Bruce, Martha L


    Semistructured interviews with nurses working for home health care agencies in five states raise serious questions about the deleterious effects of Medicare policies and procedures on depression care. The agencies have strong incentives to limit nursing time in a given payment episode and to increase volume, making it difficult to provide high-quality depression care for homebound patients. Some nurses felt forced to "abandon" many patients with depression. The authors call for incremental policy changes in several key areas.

  18. Lessons for health care reform from the less developed world: the case of the Philippines. (United States)

    Obermann, Konrad; Jowett, Matthew R; Taleon, Juanito D; Mercado, Melinda C


    International technical and financial cooperation for health-sector reform is usually a one-way street: concepts, tools and experiences are transferred from more to less developed countries. Seldom, if ever, are experiences from less developed countries used to inform discussions on reforms in the developed world. There is, however, a case to be made for considering experiences in less developed countries. We report from the Philippines, a country with high population growth, slow economic development, a still immature democracy and alleged large-scale corruption, which has embarked on a long-term path of health care and health financing reforms. Based on qualitative health-related action research between 2002 and 2005, we have identified three crucial factors for achieving progress on reforms in a challenging political environment: (1) strive for local solutions, (2) make use of available technology and (3) work on the margins towards pragmatic solutions whilst having your ethical goals in mind. Some reflection on these factors might stimulate and inform the debate on how health care reforms could be pursued in developed countries.

  19. Developing and implementing an oral care policy and assessment tool.

    LENUS (Irish Health Repository)

    Stout, Michelle


    Oral hygiene is an essential aspect of nursing care. Poor oral care results in patients experiencing pain and discomfort, puts individuals at risk of nutritional deficiency and infection, and has an adverse effect on quality of life. This article describes how an oral care policy and assessment tool were updated to ensure the implementation of evidence-based practice at one hospital in the Republic of Ireland.

  20. Policy challenges for the pediatric rheumatology workforce: Part II. Health care system delivery and workforce supply

    Directory of Open Access Journals (Sweden)

    Henrickson Michael


    Full Text Available Abstract The United States pediatric population with chronic health conditions is expanding. Currently, this demographic comprises 12-18% of the American child and youth population. Affected children often receive fragmented, uncoordinated care. Overall, the American health care delivery system produces modest outcomes for this population. Poor, uninsured and minority children may be at increased risk for inferior coordination of services. Further, the United States health care delivery system is primarily organized for the diagnosis and treatment of acute conditions. For pediatric patients with chronic health conditions, the typical acute problem-oriented visit actually serves as a barrier to care. The biomedical model of patient education prevails, characterized by unilateral transfer of medical information. However, the evidence basis for improvement in disease outcomes supports the use of the chronic care model, initially proposed by Dr. Edward Wagner. Six inter-related elements distinguish the success of the chronic care model, which include self-management support and care coordination by a prepared, proactive team. United States health care lacks a coherent policy direction for the management of high cost chronic conditions, including rheumatic diseases. A fundamental restructure of United States health care delivery must urgently occur which places the patient at the center of care. For the pediatric rheumatology workforce, reimbursement policies and the actions of health plans and insurers are consistent barriers to chronic disease improvement. United States reimbursement policy and overall fragmentation of health care services pose specific challenges for widespread implementation of the chronic care model. Team-based multidisciplinary care, care coordination and self-management are integral to improve outcomes. Pediatric rheumatology demand in the United States far exceeds available workforce supply. This article reviews the career

  1. Future European health care: cost containment, health care reform and scientific progress in drug research. (United States)

    Emilien, G


    The cost of the development of a new pharmaceutical product from its conception and synthesis through to the regulatory approval process has more than quadrupled in the last 20 years. Both clinical and total development times have increased substantially. To amortize the costs incurred, the pharmaceutical industry has taken an international dimension. The incentives for pharmaceutical firms to discover and develop new drugs depend on the length of the development and regulatory review process plus the potential market size. Recent regulatory, economic and political changes may have significant implications for the future of new drug developments in Europe. The European Union industrial policy felt that there is a need for convergence in the area of pricing. It is recommended that the policy should aim to contain growth in pharmaceutical expenses by means specific to reimbursement rather than direct price controls. By encouraging doctors to prescribe and customers to use generics, competition is enhanced to bring down drug prices. More emphasis is being laid by government in educating customers to cost-awareness and cost-benefit ratios with regard to pharmaceuticals. Concerning clinical trials, European harmonization has been achieved by significant developments: the rights and integrity of the trial subjects are protected; the credibility of the data is established; and the ethical, scientific and technical quality of the trials has improved. Future European health care forecasts a whole change in the pharmaceutical business. Important issues in cost and outcome measurement should be carefully planned and considered in drug development. Due to important mergers and acquisitions, the pharmaceutical sector will consist mainly of important multinational corporations. In this way, valuable new products may be brought to the market.

  2. Impact of Structural Reforms on Planning Systems and Policies: Loss of Spatial Consciousness?

    Directory of Open Access Journals (Sweden)

    Daniel Galland


    Full Text Available This paper argues that a planning system that allows its policies and practices to gradually lose spatial consciousness and spatial coordination capacities within and across different levels of planning administration is less likely to make national and regional plans and strategies matter or have a say in future 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 in 2007 significantly transformed the configuration and functioning of the national planning system. Originally designed to support the principle of equal development through spatial planning policies aimed at the promotion of equal access to public and private services across the national territory, the Danish planning policy framework has increasingly evolved towards expressing a lack of explicit spatial consciousness in its current plans and strategies. At the same time, the Danish planning system seems to reveal narrower measures of spatial coherence in terms of horizontal and vertical coordination and integration of sectors and policies within and across different levels of planning administration. Based on an analysis regarding the evolution of planning policies and an examination of the current governance landscape influencing planning practices at national and regional levels, the paper attempts to generate an understanding concerning how the underlying rationale and the institutional relations of Danish spatial planning have been reoriented over time.

  3. Financing long-term care for frail elderly in France: the ghost reform. (United States)

    Chevreul, Karine; Berg Brigham, Karen


    Like many welfare states, France is faced with increasing demand for long term care (LTC) services. Public LTC coverage has evolved over the past 15 years, reaching a coverage depth of 70%. Nonetheless, it does not provide adequate and equitable financial protection for the growing number of frail elderly individuals, who are expected to constitute 3% of the population by the year 2060. Since 2005, various financing reform proposals have been debated, ranging from a newly covered risk under the social security system to targeted subsidies for private LTC insurance. However, to date no reform measure has been enacted. This article provides a brief history of publicly financed LTC in France in order to provide a context for the ongoing debate, including the positions and relative political power of the various stakeholders and the doubtful short-term prospect for reform.

  4. Implementing health care reform in the United States: intergovernmental politics and the dilemmas of institutional design. (United States)

    Béland, Daniel; Rocco, Philip; Waddan, Alex


    The Affordable Care Act (ACA) was enacted, and continues to operate, under conditions of political polarization. In this article, we argue that the law's intergovernmental structure has amplified political conflict over its implementation by distributing governing authority to political actors at both levels of the American federal system. We review the ways in which the law's demands for institutional coordination between federal and state governments (and especially the role it preserves for governors and state legislatures) have created difficulties for rolling out health-insurance exchanges and expanding the Medicaid program. By way of contrast, we show how the institutional design of the ACA's regulatory reforms of the insurance market, which diminish the reform's political salience, has allowed for considerably less friction during the implementation process. This article thus highlights the implications of multi-level institutional designs for the post-enactment politics of major reforms.

  5. Nursing and Health Care Reform: Implications for Curriculum Development. (United States)

    Bowen, Mary; Lyons, Kevin J.; Young, Barbara E.


    A survey of registered nurses who graduated in 1986 (n=50) and 1991 (n-58) revealed these opinions: insurance companies increasingly control patient care; workload and paperwork have increased; and there are fewer jobs and less job security. A significant number reported decreased job satisfaction. (SK)

  6. 75 FR 24470 - Health Care Reform Insurance Web Portal Requirements (United States)


    ...(d) of the Affordable Care Act defines ``State'' to include the fifty states and the District of... Web portal context to mean the 50 States and the District of Columbia. By statute, the Web portal must... services; nurse midwife services; pediatric and family nurse practitioner services; laboratories and x-...

  7. Health Inequity and "Restoring Fairness" Through the Canadian Refugee Health Policy Reforms: A Literature Review. (United States)

    Antonipillai, Valentina; Baumann, Andrea; Hunter, Andrea; Wahoush, Olive; O'Shea, Timothy


    Refugees and refugee claimants experience increased health needs upon arrival in Canada. The Federal Government funded the Interim Federal Health Program (IFHP) since 1957, ensuring comprehensive healthcare insurance for all refugees and refugee claimants seeking protection in Canada. Over the past 4 years, the Canadian government implemented restrictions to essential healthcare services through retrenchments to the IFHP. This paper will review the IFHP, in conjunction with other immigration policies, to explore the issues associated with providing inequitable access to healthcare for refugee populations. It will examine changes made to the IFHP in 2012 and in response to the federal court decision in 2014. Findings of the review indicate that the retrenchments to the 2012 IFHP instigated health outcome disparities, social exclusion and increased costs for vulnerable refugee populations. The 2014 reforms reinstated some services; however the policy continued to produce inequitable healthcare access for some refugees and refugee claimants.

  8. The science of green chemistry and its role in chemicals policy and educational reform. (United States)

    Cannon, Amy S; Warner, John C


    Over the past 10 years, the science of green chemistry has continued to evolve and has been adopted in research labs in industry and academia. At the same time, new innovations in chemicals policy have widened opportunities for legislative action to protect human health and the environment. This article addresses the mechanisms by which the science of green chemistry and chemicals policy can work together to help attain a more sustainable future. It also speaks to the pitfalls of inappropriately merging these two, and explores how such a merger could inhibit the creation of sustainable technologies. Green chemistry's role in educational reform is discussed as a means for training students who are prepared to create truly sustainable technologies.

  9. Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers (United States)

    Mosca, Ilaria; van der Wees, Philip J.; Mot, Esther S.; Wammes, Joost J.G.; Jeurissen, Patrick P.T.


    Background: The sustainability of long-term care (LTC) is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU) Member States. Country recommendations regarding LTC are prominent under the EU’s European Semester. Methods: This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1) public- and private funding; (2) informal care and externalities; and (3) the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits. Results: The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public- and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs. Conclusion: The analysis shows why it is difficult for EU Member State governments to

  10. Health-care reforms in the People's Republic of China--strategies and social implications. (United States)

    Wong, V C; Chiu, S W


    Analyses the features, strategies and characteristics of health-care reforms in the People's Republic of China. Since the 14th Central Committee of the Chinese Communist Party held in 1992, an emphasis has been placed on reform strategies such as cost recovery, profit making, diversification of services, and development of alternative financing strategies in respect of health-care services provided in the public sector. Argues that the reform strategies employed have created new problems before solving the old ones. Inflation of medical cost has been elevated very rapidly. The de-linkage of state finance bureau and health service providers has also contributed to the transfer of tension from the state to the enterprises. There is no sign that quasi-public health-care insurance is able to resolve these problems. Finally, cooperative medicine in the rural areas has been largely dismantled, though this direction is going against the will of the state. Argues that a new balance of responsibility has to be developed as a top social priority between the state, enterprises and service users in China in order to meet the health-care needs of the people.

  11. On residents’ satisfaction with community health services after health care system reform in Shanghai, China, 2011

    Directory of Open Access Journals (Sweden)

    Li Zhijian


    Full Text Available Abstract Background Health care system reform is a major issue in many countries and therefore how to evaluate the effects of changes is incredibly important. This study measured residents’ satisfaction with community health care service in Shanghai, China, and aimed to evaluate the effect of recent health care system reform. Methods Face-to-face interviews were performed with a stratified random sample of 2212 residents of the Shanghai residents using structured questionnaires. In addition, 972 valid responses were retrieved from internet contact. Controlling for sex, age, income and education, the study used logistic regression modeling to analyze factors associated with satisfaction and to explain the factors that affect the residents’ satisfaction. Results Comparing current attitudes with those held at the initial implementation of the reform in this investigation, four dimensions of health care were analyzed: 1 the health insurance system; 2 essential drugs; 3 basic clinical services; and 4 public health services. Satisfaction across all dimensions improved since the reform was initiated, but differences of satisfaction level were found among most dimensions and groups. Residents currently expressed greater satisfaction with clinical service (average score=3.79, with 5 being most satisfied and the public health/preventive services (average score=3.62; but less satisfied with the provision of essential drugs (average score=3.20 and health insurance schemes (average score=3.23. The disadvantaged groups (the elderly, the retired, those with only an elementary education, those with lower incomes had overall poorer satisfaction levels on these four aspects of health care (P Conclusion The respondents showed more satisfaction with the clinical services (average score=3.79 and public health services/interventions (average score=3.79; and less satisfaction with the health insurance system (average score=3.23 and the essential drug system

  12. The financial crisis and recent family policy reforms in Finland, Germany and the United Kingdom : Is there a connection?

    Directory of Open Access Journals (Sweden)

    Mikael Nygård


    Full Text Available The turmoil created by the financial crisis and economic recession in Europe has served as an impetus for austerity measures in many countries. In this article, we ask whether these crises have also triggered reforms in family policy, and we focus on three European welfare states – Finland, Germany and the United Kingdom – countries that are often considered members of different family policy regimes. The article addresses two main research questions. The first one relates to the number, direction and magnitude of family policy reforms in these three countries since the beginning of the financial crisis in 2008/2009, while in the second we discuss whether the reforms observed during this period can be seen as being related to the financial crisis and its later repercussions on the Euro-zone area, or if there are other explanations.

  13. Identifying Effective Policy and Technologic Reforms for Sustainable Groundwater Management in Oman (United States)

    Madani, K.; Zekri, S.; Karimi, A.


    Oman has gone through three decades of efforts aimed at addressing groundwater over-pumping and the consequent seawater intrusion. Example of measures adopted by the government since the 1990's include a vast subsidy program of irrigation modernization, a freeze on drilling new wells, delimitation of several no-drill zones, a crop substitution program, re-use of treated wastewater and construction of recharge dams. With no major success through these measures, the government laid the ground for water quotas by creating a new regulation in 1995. Nevertheless, groundwater quotas have not been enforced to date due to the high implementation and monitoring costs of traditional flow meters. This presentation discusses how sustainable groundwater management can be secured in Oman using a suit of policy and technologic reforms at a reasonable economic, political and practical cost. Data collected from farms with smart meters and low-cost wireless smart irrigation systems have been used to propose sustainable groundwater withdrawal strategies for Oman using a detailed hydro-economic model that couples a MODFLOW-SEAWAT model of the coastal aquifers with a dynamic profit maximization model. The hydro-economic optimization model was flexible to be run both as a social planner model to maximize the social welfare in the region, and as an agent-based model to capture the behavior of farmers interested in maximizing their profits independently. This flexibility helped capturing the trade-off between the optimality of the social planner solution developed at the system's level and its practicality (stability) with respect to the concerns and behaviors of the profit-maximizing farmers. The idetified promising policy and technolgical reforms for Oman include strict enforcement of groundwater quotas, smart metering, changing crop mixes, improving irrigation technologies, and revising geographical distribution of the farming activities. The presentation will discuss how different

  14. State policies and the financing of acquired immunodeficiency syndrome care. (United States)

    Pascal, A; Cvitanic, M; Bennett, C; Gorman, M; Serrato, C A


    State policies, with respect to the operation of Medicaid programs and the regulation of private health insurance, affect who gets what care, how much is spent, and who ultimately pays. A RAND Corporation study was used to assess States and the District of Columbia in terms of the effects of their Medicaid and health insurance regulations on people with acquired immunodeficiency syndrome and other human immunodeficiency virus-related illnesses. State characteristics are used to explain the individual State policy rankings.

  15. The second pillar of the CAP: the role of Commission policy learning in the creation and reform of EU rural development policy (1968-1999)

    DEFF Research Database (Denmark)

    Steffensen, Jonny Trapp

    argument advanced in this thesis is that policy learning is a multifaceted phenomenon that can most reliably be examined employing 'method pluralism' (documentary analysis, elite interviews, and survey techniques). A second theoretical assertion is that policy learning can change the beliefs - termed....... Whilst policy learning was not found to be a primary driver of CAP reform it was significant in shaping the rural policy alternative, now the second pillar of the CAP.......This thesis examines the concept of 'policy learning' and explores its applicability to the European Commission's role in EU policymaking. Policy learning refers to 'knowledge-based' policy formulation, where content of policy proposals is shaped to a 'non-trivial' extent by administrative...

  16. Shifting subjects of health-care: placing "medical tourism" in the context of Malaysian domestic health-care reform. (United States)

    Ormond, Meghann


    "Medical tourism" has frequently been held to unsettle naturalised relationships between the state and its citizenry. Yet in casting "medical tourism" as either an outside "innovation" or "invasion," scholars have often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic health-care systems of the "developing" countries recognised as international medical travel destinations. While there is little doubt that "medical tourism" impacts destinations' health-care systems, it remains essential to contextualise them. This paper offers a reading of the emergence of "medical tourism" from within the context of ongoing health-care privatisation reform in one of today's most prominent destinations: Malaysia. It argues that "medical tourism" to Malaysia has been mobilised politically both to advance domestic health-care reform and to cast off the country's "underdeveloped" image not only among foreign patient-consumers but also among its own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective health-care consumers.

  17. cura, care, C A R E, Care: Dimensions and Qualities of Care (re)forming an Ecology of Care

    DEFF Research Database (Denmark)

    Coxon, Ian Robert; Bremner, Craig; Jensen, Jesper

    that it serves to inform is to begin a process of concretizing the otherwise lost but vitally important concept we call Care. In writing this paper we will attempt to adopt a 'position' through an extensive but not complete review of existing and past thinking in order to "find a line and then to hang...... fully acknowledge that they and the sub-elements that constitute them are never discrete or fixed at any point. Like the relationship between light particles and light waves, these 'parts' constitute an evolving system of living interaction and Being that defines Care, where any or all of Cares parts...... at any given point in time are continually co-constituting each other within a dynamic and interactive whole we call everyday life. In a highly abbreviated form our two key propositions are presented as follows; PROPOSITION 1: DIMENSIONS OF CARE Care is informed and shaped by everyday experience...

  18. Development of an Internet Security Policy for health care establishments. (United States)

    Ilioudis, C; Pangalos, G


    The Internet provides unprecedented opportunities for interaction and data sharing among health care providers, patients and researchers. However, the advantages provided by the Internet come with a significantly greater element of risk to the confidentiality and integrity of information. This paper defines the basic security requirements that must be addressed in order to use the Internet to safely transmit patient and/or other sensitive Health Care information. It describes a suitable Internet Security Policy for Health Care Establishments and provides the set of technical measures that are needed for its implementation. The proposed security policy and technical approaches have been based on an extensive study of the related recommendations from the security and standard groups both in EU amid USA and our related work and experience. The results have been utilized in the framework of the Intranet Health Clinic project, where the use of the Internet for the transmission of sensitive Health Care information is of vital importance.

  19. The development of Korea's new long-term care service infrastructure and its results: focusing on the market-friendly policy used for expansion of the numbers of service providers and personal care workers. (United States)

    Chon, Yongho


    One of the main reasons for reforming long-term care systems is a deficient existing service infrastructure for the elderly. This article provides an overview of why and how the Korean government expanded long-term care infrastructure through the introduction of a new compulsory insurance system, with a particular focus on the market-friendly policies used to expand the infrastructure. Then, the positive results of the expansion of the long-term care infrastructure and the challenges that have emerged are examined. Finally, it is argued that the Korean government should actively implement a range of practical policies and interventions within the new system.

  20. Arkansas: a leading laboratory for health care payment and delivery system reform. (United States)

    Bachrach, Deborah; du Pont, Lammot; Lipson, Mindy


    As states' Medicaid programs continue to evolve from traditional fee-for-service to value-based health care delivery, there is growing recognition that systemwide multipayer approaches provide the market power needed to address the triple aim of improved patient care, improved health of populations, and reduced costs. Federal initiatives, such as the State Innovation Model grant program, make significant funds available for states seeking to transform their health care systems. In crafting their reform strategies, states can learn from early innovators. This issue brief focuses on one such state: Arkansas. Insights and lessons from the Arkansas Health Care Payment Improvement Initiative (AHCPII) suggest that progress is best gained through an inclusive, deliberative process facilitated by committed leadership, a shared agreement on root problems and opportunities for improvement, and a strategy grounded in the state's particular health care landscape.

  1. Mental health reform at a systems level: widening the lens on recovery-oriented care. (United States)

    Kidd, Sean A; Mckenzie, Kwame J; Virdee, Gursharan


    This paper is an initial attempt to collate the literature on psychiatric inpatient recovery-based care and, more broadly, to situate the inpatient care sector within a mental health reform dialogue that, to date, has focused almost exclusively on outpatient and community practices. We make the argument that until an evidence base is developed for recovery-oriented practices on hospital wards, the effort to advance recovery-oriented systems will stagnate. Our scoping review was conducted in line with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (commonly referred to as PRISMA) guidelines. Among the 27 papers selected for review, most were descriptive or uncontrolled outcome studies. Studies addressing strategies for improving care quality provide some modest evidence for reflective dialogue with former inpatient clients, role play and mentorship, and pairing general training in recovery oriented care with training in specific interventions, such as Illness Management and Recovery. Relative to some other fields of medicine, evidence surrounding the question of recovery-oriented care on psychiatric wards and how it may be implemented is underdeveloped. Attention to mental health reform in hospitals is critical to the emergence of recovery-oriented systems of care and the realization of the mandate set forward in the Mental Health Strategy for Canada.

  2. Ensuring access to health care--Germany reforms supply structures to tackle inequalities. (United States)

    Ozegowski, Susanne; Sundmacher, Leonie


    Germany's ruling coalition has recently introduced a new bill to Parliament, the Care Structures Act (CSA), which aims to improve outpatient care supply structures, decentralize decision-making, facilitate cross-sectoral treatment, and strengthen innovation in the nation's health care sector. These objectives are to be achieved through a variety of measures, including changes in financial incentives for physicians, the transfer of decision-making to the regional level, and the creation of a new sector for highly specialized care. The opposition parties in Parliament and most health care stakeholders agree on the objectives of the reform package, but their evaluation of the bill is mixed. Physicians' representative organizations generally deem the law to be headed in the right direction, while the opposition parties, sickness funds, patients' rights groups and a majority of German federal states (Bundesländer) feel it does not adequately address the issues of supply inequity and sectoral division. This skepticism seems well founded. The reforms aimed at attracting physicians to high-need regions have significant shortcomings, and the measures to overcome sectoral barriers between the outpatient care and hospital sectors remain weak. Furthermore, the new procedure for including innovative treatment methods in the SHI benefits catalogue falls short of internationally recognized standards.

  3. Health system reform in peri-urban communities: an exploratory study of policy strategies towards healthcare worker reform in Epworth, Zimbabwe

    Directory of Open Access Journals (Sweden)

    Bernard Hope Taderera


    Full Text Available Background: Human resources for health (HRH remains a critical challenge, according to the Kampala Declaration and Agenda for Global Action of 2008 and the 2030 Sustainable Development Agenda. Available literature on health system reforms does not provide a detailed narrative on strategies that have been used to reform HRH challenges in peri-urban communities. This study explores such strategies implemented in Epworth, Zimbabwe, during 2009–2014, and the implications these strategies might have on other peri-urban areas. Design: Qualitative and quantitative methods were used in an exploratory and cross-sectional design. Purposive sampling was used to select key informants, a sample of healthcare workers that participated in in-depth interviews and community members who took part in focus group discussions. Secondary data were collected through a documentary search. Qualitative data were analysed through thematic analysis. Quantitative secondary data were examined using descriptive statistics and then compared with qualitative data to reinforce analysis. Results: The HRH reform policy strategies that were identified included ministerial intervention; policy review; and revival of the human resource for health planning, financial planning, multi-sector collaboration, and community engagement. These had some positive effects; however, desired outcomes were undermined by financial, material, human resource, and social constraints. Conclusions: Despite constraints, the strategies helped revive the health delivery system in Epworth. In turn, this had a favourable outlook on post-2008 efforts by the Global Health Alliance towards healthcare worker reform and the 2030 Sustainable Development Agenda in peri-urban communities.

  4. Exploring limits to market-based reform: managed competition and rehabilitation home care services in Ontario. (United States)

    Randall, Glen E; Williams, A Paul


    The rise of neo-liberalism, which suggests that only markets can deliver maximum economic efficiency, has been a driving force behind the trend towards using market-based solutions to correct health care problems. However, the broad application of market-based reforms has tended to assume the presence of fully functioning markets. When there are barriers to markets functioning effectively, such as the absence of adequate competition, recourse to market-based solutions can be expected to produce less than satisfactory, if not paradoxical results. One such case is rehabilitation homecare in Ontario, Canada. In 1996, a "managed competition" model was introduced as part of a province-wide reform of home care in an attempt to encourage high quality at competitive prices. However, in the case of rehabilitation home care services, significant obstacles to achieving effective competition existed. Notably, there were few private provider agencies to bid on contracts due to the low volume and specialized nature of services. There were also structural barriers such as the presence of unionized employees and obstacles to the entry of new providers. This paper evaluates the impact of Ontario's managed competition reform on community-based rehabilitation services. It draws on data obtained through 49 in-depth key informant interviews and a telephone survey of home care coordinating agencies and private rehabilitation provider agencies. Instead of reducing costs and improving quality, as the political rhetoric promised, the analysis suggests that providing rehabilitation homecare services under managed competition resulted in higher per-visit costs and reduced access to services. These findings support the contention that there are limits to market-based reforms.

  5. Public finance policy strategies to increase access to preconception care. (United States)

    Johnson, Kay A


    Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15-44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states' experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs.

  6. A comparison of job satisfaction of community health workers before and after local comprehensive medical care reform: a typical field investigation in Central China.

    Directory of Open Access Journals (Sweden)

    Hong Ding

    Full Text Available BACKGROUND: The government of China promulgated new medical care reform policies in March 2009. After that, provincial-level governments launched new medical care reform which focusing on local comprehensive medical care reform (LCMR. Anhui Province is an example of an area affected by LCMR, in which the LCMR was started in October 2009 and implemented in June 2010. The objective of this study was to compare the job satisfaction (JS of community health workers (CHWs before and after the reform in Anhui Province. METHODS: A baseline survey was carried out among 813 community health workers (CHWs of 57 community health centers (CHCs (response rate: 94.1% and an effect evaluation survey among 536 CHWs of 30 CHCs (response rate: 92.3% in 2009 and 2012 respectively. A self-completion questionnaire was used to assess the JS of the CHWs (by the job satisfaction scale, JSS. RESULTS: The average scores of total JS and satisfaction with pay, contingent rewards, operating procedures and communication in the effect evaluation survey were statistically significantly higher than those of the baseline survey (P<0.05. The average score of satisfaction with promotion (2.55 ± 1.008 in the effect evaluation survey was statistically significantly lower than that in the baseline survey (2.71 ± 0.730 (P=0.002. In both surveys, the average scores of satisfaction with pay, benefits and promotion were statistically significantly lower than the others (all P<0.05. CONCLUSIONS: After two years' implementation of the LCMR, CHWs' total JS have a small improvement. However, CHWs have lower satisfaction in the dimensions of pay, promotion and benefits dimensions before and after the LCMR. Therefore, policy-makers should take corresponding measures to raise work reward of CHWs and pay more attention to CHWs' professional development to further increase their JS.

  7. Health Care Access among Latinos: Implications for Social and Health Care Reforms (United States)

    Perez-Escamilla, Rafael


    According to the Institute of Medicine, health care access is defined as "the degree to which people are able to obtain appropriate care from the health care system in a timely manner." Two key components of health care access are medical insurance and having access to a usual source of health care. Recent national data show that 34% of Latino…

  8. The Impact of the Health Care System Reform on the Romanian Nurses Professionalization Process

    Directory of Open Access Journals (Sweden)

    Silvia POPOVICI


    Full Text Available The Romanian health sector went through a process of reform began in 2000 which entered into a final adjustment phase in 2010 when the economic crisis, the health professionals accelerated trend of labour migration, the precarious health of the population brought new challenges to the unsolved existing problems. Nurses are numerically the most important category of health professionals. Since 1994 they experienced a convergent movement of professionalization in the interior of the nurse profession. The aim of the study is to explore the nurses’ perceptions of the impact of the health care system reform on their own profession and on the internal process of professionalization. As a result a quantitative research was conducted on a sample including 411 nurses of different specialties working in Iasi county. The results of the research point out the significant impact of factors related to the reform of the health care system on the quality of the care process, on the nurses’ work conditions and professional satisfaction. The external disruptive factors produce negative effects on nurses’ group cohesion, despite the centripetal efforts of the professional organization and induce a slowdown movement of the nurses professionalization process.

  9. Reforma ou contra-reforma na proteção social à saúde Reform or contra-reform in health policy

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    Paulo Eduardo Elias


    Full Text Available Discutem-se as mudanças no sistema de saúde brasileiro em período recente da ótica das políticas sociais. A partir do enunciado da exclusão social como questão central a ser enfrentada pelas políticas sociais e da noção de contra-reforma em oposição à reforma virtuosa e necessária do Estado, analisam-se as políticas de saúde, privilegiando a denominada Reforma Sanitária e a implementação do SUS. O artigo sustenta a exigência de se promover a articulação das reformas do sistema de saúde com as políticas econômicas de modo a apontar para um novo padrão de desenvolvimento, com sólidas bases sociais e orientado ética e politicamente para a inclusão.Changes in the Brazilian health system are discussed from the point of view of social policies. Taking social exclusion as the central question to be faced by social policies and contra-reform as the opposite of the virtuous and necessary reform of the State, the article analyzes Brazilian health policies, chiefly regarding the so-called Sanitary Reform and the National Health Service (SUS. It is argued that the articulation between the reforms of the health system and economic policies should be promoted having in view a new development pattern, with strong social foundations and ethically and politically oriented towards social inclusion.

  10. Evidence on equity, governance and financing after health care reform in Mexico: lessons for Latin American countries

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    Armando Arredondo


    Full Text Available This article includes evidence on equity, governance and health financing outcomes of the Mexican health system. An evaluative research with a cross-sectional design was oriented towards the qualitative and quantitative analysis of financing, governance and equity indicators. Taking into account feasibility, as well as political and technical criteria, seven Mexican states were selected as study populations and an evaluative research was conducted during 2002-2010. The data collection techniques were based on in-depth interviews with key personnel (providers, users and community leaders, consensus technique and document analysis. The qualitative analysis was done with ATLAS TI and POLICY MAKER softwares. The Mexican health system reform has modified dependence at the central level; there is a new equity equation for resources allocation, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. Inequality on resources allocation in some regions and catastrophic expenditure for users is unequal in all states, producing more negative effects on states with high social marginalization. Special emphasis is placed on the analysis of the main strengths and weaknesses, as relevant evidences for other Latin American countries which are designing, implementing and evaluating reform strategies in order to achieve equity, good governance and a greater financial protection in health.

  11. On Rural Medical Care and Health Undertaking Development during New Medical Reform

    Institute of Scientific and Technical Information of China (English)

    ZHAO Yi-huan


    Based on in-depth survey of township hospitals in Lushan County of Henan Province, this paper studies the development situations of rural medical care and health undertaking in the course of new medical reform. Results show that both rural medical institution and public health undertaking have considerable development in this course. Working capital situation gradually turns better. However, there are still problems and challenge of shortage of high quality medical care personnel, lack of employment mechanism, poor medical environment, and imperfect bidding and purchasing system of medicines. To further develop rural medical situation, it should improve medical environment, speed up informationization construction, and give prominence to functional orientation.

  12. Waiting Time Policies in the Health Care Sector. What Works?

    DEFF Research Database (Denmark)

    Christiansen, Terkel; Bech, Mickael


    choice of hospital for somatic and psychiatric patients, short maximum waiting time guarantee for life-threatening diseases coupled with care packages for cancer and heart diseases and extra-activity targeted hospital grants. There are good reasons to believe that these policies have reduced waiting...

  13. End-of-Life Care Policies in Flemish Residential Care Facilities Accommodating Persons with Intellectual Disabilities (United States)

    D'Haene, I.; Pasman, H. R. W.; Deliens, L.; Bilsen, J.; Mortier, F.; Stichele, R. Vander


    Objective: This article aims to describe the presence, content and implementation strategies of written policies on end-of-life decisions in Flemish residential care facilities (RCFs) accommodating persons with intellectual disabilities (ID), and to describe training, education and quality assessments of end-of-life care. Methods: A…

  14. Stakeholders’ perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms (United States)


    other countries faced with the challenge of drafting reforms to tackle the issue of chronic care. PMID:24742204

  15. Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries

    Directory of Open Access Journals (Sweden)

    Harris MF


    Full Text Available Mark F Harris,1 Jenny Advocat,2 Benjamin F Crabtree,3 Jean-Frederic Levesque,1,4 William L Miller,5 Jane M Gunn,6 William Hogg,7 Cathie M Scott,8 Sabrina M Chase,9 Lisa Halma,10 Grant M Russell11 1Center for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, VIC, Australia; 3Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA; 4Bureau of Health Information, NSW Government, Sydney, NSW, Australia; 5Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA, USA; 6Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia; 7The CT Lamont Primary Care Research Center, The University of Ottawa, Ottawa, ON, 8Alberta Centre for Child, Family, and Community Research, University of Calgary, AB, Canada; 9Rutgers University, Rutgers School of Nursing, Rutgers, NJ, USA; 10Alberta Health Services, Lethbridge, AB, Canada; 11School of Primary Health Care, Monash University, Notting Hill, VIC, Australia 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

  16. Does Integrated Water Resources Management Support Institutional Change? The Case of Water Policy Reform in Israel

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    Itay Fischhendler


    Full Text Available Many international efforts have been made to encourage integrated water resources management through recommendations from both the academic and the aid and development sectors. Recently, it has been argued that integrated water resources management can help foster better adaptation of management and policy responses to emerging water crises. Nevertheless, few empirical studies have assessed how this type of management works in practice and what an integrated water management system implies for institutional adaptation and change. Our assessment of the Israeli water sector provides one view of how they can be shaped by an integrated structure in the water sector. Our analysis of recent efforts to adapt Israel's water management system to new conditions and uncertainties reveals that the interconnectedness of the system and the consensus decision-making process, led by a dominant actor who coordinates and sets the policy agenda, tends to increase the complexity of negotiations. In addition, the physical integration of water management leads to sunk costs of large-scale physical infrastructure. Both these factors create a path dependency that empowers players who receive benefits from maintaining the existing system. This impedes institutional reform of the water management system and suggests that integrated water resources management creates policy and management continuity that may only be amenable to incremental changes. In contrast, real adaptation that requires reversibility and the ability to change management strategies in response to new information or monitoring of specific management outcomes.

  17. Curriculum Testing on the Persistent Fringes: Neoliberal Policy and the New Regime of Title I High School Reform (United States)

    Sturges, Keith M.


    Neoliberal policies have opened the door to a steady stream of contract providers who assist struggling schools while producing market-ready reforms. This ethnographic example of Allport High School illustrates how constant aid, in combination with internal market expansion, destabilizes school structures, obscures curricula, and transfers local…

  18. The Early Childhood and Elementary Education Continuum: Constructing an Understanding of P-3 as State-Level Policy Reform (United States)

    Kauerz, Kristie Anne


    State-level policy attention to young children's early learning opportunities burgeons; a sense of urgency exists to identify reform agendas that are both effective and sustainable. "P-3" often is used as the term for the first level of a seamless P-20 system that stretches from early childhood through post-secondary education. While it…

  19. Past/Forward Policy-Making: Transforming Chinese Engineering Education since the Reform and Opening-Up (United States)

    Zhu, Qin; Jesiek, Brent K.; Gong, Yu


    Although engineering education has played important roles in China's growing power and influence on the world stage, engineering education policy since the Reform and Opening-up in the late 1970s has not been well documented in current English-language scholarship. Informed by historical and sociological studies of education, engineering and…

  20. Teaching Excellence through Professional Learning and Policy Reform: Lessons from around the World. International Summit on the Teaching Profession (United States)

    Schleicher, Andreas


    If the quality of an education system can never exceed the quality of its teachers, then countries need to do all they can to build a high-quality teaching force. "Teaching Excellence through Professional Learning and Policy Reform: Lessons from around the World," the background report to the sixth International Summit on the Teaching…

  1. The Logic of Policy Development: Lessons Learned from Reform and Routine within the CAP 1980-2003

    DEFF Research Database (Denmark)

    Lynggaard, Kennet; Nedergaard, Peter


    With the point of departure in the otherwise extensive knowledge on reform and routine within the Common Agricultural Policy (CAP) of the European Union (EU), this paper argues that: (1) in order to fully appreciate the insights provided we need to look into the complementary nature of ideational...


    Directory of Open Access Journals (Sweden)

    Syamsuddin Maldun


    Full Text Available This research aims to know and study the strategy of resource development policy reform of local government district of Makassar Sidenreng Rappang. The research method used is descriptive qualitative study type, while the phenomenological approach is used. This is intended to give description in a systematic, factual and actual response object is examined. Results of the research implementation of education and training is not conducted in a planned and timely to get quality apparatus of the abilities, knowledge, skills, expertise, and job skills, as well as a good mental attitude, and optimal performance. Whereas in the era of regional autonomy, it takes the resources of local government apparatus that is intelligent and responsive to the needs of an increasingly complex society services. 

  3. Reform of China’s Food Security Policies: Central Government Decentralizing Autonomous Management Right

    Institute of Scientific and Technical Information of China (English)

    Ming; LI


    Guaranteeing the food security is a fundamental state policy of China. Food security needs overall planning of central government,economic benefit allocation of local government,and increase of grain farmers’ income. Through analysis on current situations and causes of China’s food security,and comparative study on purposes and functions of foreign and domestic grain reserves,it came up with recommendations that central government should decentralize rights of grain production,reserve,sales,and management to grain producing areas and major sales provinces. It is not appropriate for central enterprises to take charge of national food security reserves. And it is required to make a new round of reform in autonomous management right of major grain producing areas and the capacity of the state purchasing social grain reserves.

  4. Achieving universal health coverage in France: policy reforms and the challenge of inequalities. (United States)

    Nay, Olivier; Béjean, Sophie; Benamouzig, Daniel; Bergeron, Henri; Castel, Patrick; Ventelou, Bruno


    Since 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers' and employers' organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancet's Series on France, we challenge conventional wisdom about health care in France. First, we focus on policy and institutional transformations that have affected deeply the governance of health care over past decades. We argue that the health system rests on a diversity of institutions, policy mechanisms, and health actors, while its governance has been marked by the reinforcement of national regulation under the aegis of the State. Second, we suggest the redistributive mechanisms of the health insurance system are impeded by social inequalities in health, which remain major hindrances to achieving objectives of justice and solidarity associated with the conception of health care in France.

  5. Explaining medical disputes in Chinese public hospitals: the doctor-patient relationship and its implications for health policy reforms. (United States)

    He, Alex Jingwei; Qian, Jiwei


    In recent years China has witnessed a surge in medical disputes, including many widely reported violent riots, attacks, and protests in hospitals. This is the result of a confluence of inappropriate incentives in the health system, the consequent distorted behaviors of physicians, mounting social distrust of the medical profession, and institutional failures of the legal framework. The detrimental effects of the damaged doctor-patient relationship have begun to emerge, calling for rigorous study and serious policy intervention. Using a sequential exploratory design, this article seeks to explain medical disputes in Chinese public hospitals with primary data collected from Shenzhen City. The analysis finds that medical disputes of various forms are disturbingly widespread and reveals that inappropriate internal incentives in hospitals and the heavy workload of physicians undermine the quality of clinical encounters, which easily triggers disputes. Empirically, a heavy workload is associated with a larger number of disputes. A greater number of disputes are associated with higher-level hospitals, which can afford larger financial settlements. The resolution of disputes via the legal channel appears to be unpopular. This article argues that restoring a healthy doctor-patient relationship is no less important than other institutional aspects of health care reform.

  6. The new medical reform policy maternal and child health work to develop new ideas%新医改政策下妇幼卫生工作发展新思路

    Institute of Scientific and Technical Information of China (English)



    目的:探讨新医改政策下妇幼卫生工作发展新思路。方法:结合我区实施新医改政策4年来的妇幼卫生工作现状,提出妇幼卫生事业适应新的医改政策下如何发展的一些方法。结果:切实贯彻落实新医改政策,才能促进妇幼卫生事业的有序发展。结论:以政府为主导,坚定不移地执行妇幼卫生工作方针,保障妇幼卫生事业在新医改政策下良好运行和发展,才能不断满足人民群众日益增长的保健需求。%Objective: to study the new medical reform policy maternal and child health work to develop new ideas. Methods: according to the implementation of the reform of our new policy in four years maternal and child health work situation, this paper proposes to cause of maternal and child health reform, how to adapt to the new policy of the development of some methods. Results: the practical implementation of the new medical reform policies, to promote the cause of maternal and child health and orderly development. Conclusion: the government as the leading, unswervingly implement the maternal and child health work policy, security maternal and child health undertakings in the new medical reform policy under a good operation and development, the ability to continuously meet the people's growing health care needs.

  7. Problem Drug Use, Marijuana, and European Projects: How Epidemiology Helped Czech Policy Reformers

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    Jan Morávek


    Full Text Available I examine the transfer of the Problem Drug Use (PDU concept into Czech scientific discourse through European institutions’ projects, and view PDU’s utilization by Czech researchers in relation to marijuana decriminalization efforts.PDU is defined as intravenous and/or long-term and regular use of opiates, cocaine, or amphetamines. Out of a vast array of illicit drug use patterns, this concept isolates a relatively small population with the riskiest use patterns to become the focus of public policies. A series of European Union and Council of Europe projects in 1990’s helped bring PDU into European research mainstream. The new common standard, promoted by the European Monitoring Centre for Drugs and Drug Addiction, was utilized by Czech authors in a 2001 policy analysis entitled “Impact Analysis Project of the New Drug Legislation in the Czech Republic” (PAD. PDU played a crucial role in PAD’s drug problem modeling, focusing on a “hard core” of opiate and methamphetamine users, while diverting attention from a large group of cannabis users.By using the new European methodological standard, PAD’s authors constructed marijuana as a non-problem. This helped drug policy reformers in the Czech Government legitimize their focus on “harder” drugs, and subsequently propose more lenient sanctions for the possession and cultivation of marijuana. I argue that continued ignorance of marijuana problems might jeopardize the tolerant expert-driven drug policy in the Czech Republic. Measurement of problem cannabis use should be introduced.

  8. Social death in end-of-life care policy


    Borgstrom, Erica


    Social death denotes a loss of personhood. The concept of social death is engaged with in English end-of-life care policy that sees social death before physical death as a problem. Policy-makers posit that dying persons are likely to be subject to a social death prior to their physical death unless they play an active and aware role in planning their death, facilitated through communication and access to services. Such a view foregrounds a vision of agency and does not address Sudnow's critiq...

  9. Mental health policy in Kenya -an integrated approach to scaling up equitable care for poor populations

    Directory of Open Access Journals (Sweden)

    Jenkins Rachel


    Full Text Available Abstract Background Although most donor and development agency attention is focussed on communicable diseases in Kenya, the importance of non-communicable diseases including mental health and mental illness is increasingly apparent, both in their own right and because of their influence on health, education and social goals. Mental illness is common but the specialist service is extremely sparse and primary care is struggling to cope with major health demands. Non health sectors e.g. education, prisons, police, community development, gender and children, regional administration and local government have significant concerns about mental health, but general health programmes have been surprisingly slow to appreciate the significance of mental health for physical health targets. Despite a people centred post colonial health delivery system, poverty and global social changes have seriously undermined equity. This project sought to meet these challenges, aiming to introduce sustainable mental health policy and implementation across the country, within the context of extremely scarce resources. Methods A multi-faceted and comprehensive programme which combined situation appraisal to inform planning, sustained intersectoral policy dialogue at national and regional level; establishment of a health sector system for coordination, supervision and training of at each level (national, regional, district and primary care; development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at national, regional, district and local levels; public education; and integration of mental health into health management systems. Results The programme 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, annual operational plans, mental health policy guidelines

  10. Policy and Practice Model of Public-Private Partnership in Public Hospitals during the New Medical Reform Period. (United States)

    Zhang, Ju-Yang; Long, Ru-Yin; Yan, Hai; Yang, Qing; Yang, Bo


    Purpose: Since the beginning of the new health care reform in 2009, the state has illustrated the top design and health care improvement strategy of "encouraging social capital to participate in the reform of public hospitals", in accordance with the program's general objective. All areas have been explored on this matter and the results obtained are very interesting, not to mention the acquisition of significant experience. At present, the existing business models in China are mainly the following: Rebuild-Operate-Transfer (ROT), franchise business model, Build-Own-Operate-Transfer (BOOT) model, mixed ownership model and business insurance model. This paper introduces a variety of alternative models, and provides a simple analysis of the advantages and disadvantages. Moreover, for the reform of public hospitals, the government shares should go into franchise mode or mixed ownership, and all property rights should be transferred to the government to ensure the conservation and proliferation of state-owned assets.

  11. [Medical care, organ and tissue transplants, and targeted policies]. (United States)

    Ribeiro, Carlos Dimas Martins; Schramm, Fermin Roland


    This article reflects on the moral legitimacy of implementing public policies for targeting advanced medical care, specifically in the case of organ and tissue transplants. The article refers to two theoretical approaches: the theory of capabilities by Nussbaum and Sen and the bioethics of protection by Schramm and Kottow, considered complementary in this context. The article begins by characterizing the issue of resource scarcity in transplantation, as well as strategies to overcome this problem. Next, the capabilities approach and bioethics of protection are briefly presented. Finally, from the perspective of the above-mentioned ethical approaches, in situations of scarce health resources such as the Brazilian case, the author contends that it would be morally justified to adopt targeted policies in advanced medical care, including organ transplantation.

  12. Changes in patient experiences of primary care during health service reforms in England between 2003 and 2007.

    NARCIS (Netherlands)

    Campbell, S.M.; Kontopantelis, E.; Reeves, D.; Valderas, J.M.; Gaehl, E.; Small, N.; Roland, M.O.


    PURPOSE: Major primary care reforms have been introduced in recent years in the United Kingdom, including financial incentives to improve clinical quality and provide more rapid access to care. Little is known about the impact of these changes on patient experience. We examine patient reports of qua

  13. Primary care reform in Central and Eastern Europe: can Belarus be taken as the control group in international comparison?

    NARCIS (Netherlands)

    Boerma, W.G.W.; Rousovich, V.S.; Schellevis, F.G.; Egorov, K.


    Background: Health care reform proceeds differently in Belarus. The country has not followed trends visible in most other countries. Financing and provision of health care is still in the hands of the state. Health insurance funds are unknown, private practices are rare and operating outside the sys

  14. Efficiency and competition in the Dutch non-life insurance industry: Effects of the 2006 health care reform

    NARCIS (Netherlands)

    Bikker, Jaap; Popescu, Adelina


    This paper investigates the cost efficiency and competitive behaviour of the non-life – or property and casualty – insurance market in the Netherlands over the period 1995-2012. We focus on the 2006 health care reform, where public health care insurance has been included in the non-life insurance se

  15. Who pays for health care in the United States? Implications for health system reform. (United States)

    Holahan, J; Zedlewski, S


    This paper examines the distribution of health care spending and financing in the United States. We analyze the distribution of employer and employee contributions to health insurance, private nongroup health insurance purchases, out-of-pocket expenses, Medicaid benefits, uncompensated care, tax benefits due to the exemption of employer-paid health benefits, and taxes paid to finance Medicare, Medicaid, and the health benefit tax exclusion. All spending and financing burdens are distributed across the U.S. population using the Urban Institute's TRIM2 microsimulation model. We then examine the distributional effects of the U.S. health care system across income levels, family types, and regions of the country. The results show that health care spending increases with income. Spending for persons in the highest income deciles is about 60% above that of persons in the lowest decile. Nonetheless, the distribution of health care financing is regressive. When direct spending, employer contributions, tax benefits, and tax spending are all considered, the persons in the lowest income deciles devote nearly 20% of cash income to finance health care, compared with about 8% for persons in the highest income decile. We discuss how alternative health system reform approaches are likely to change the distribution of health spending and financing burdens.

  16. Reform of the Individual Insurance Market in New Jersey: Lessons for the Affordable Care Act. (United States)

    Cantor, Joel C; Monheit, Alan C


    The individual health insurance market has played a small but important role in providing coverage to those without access to group insurance or public programs. With implementation of the Affordable Care Act (ACA), the individual market has attained a more prominent role. However, achieving accessible and affordable coverage in this market is a long-standing challenge, in large part due to the threat of adverse risk selection. New Jersey pursued comprehensive reforms beginning in the 1990s to achieve a stable, accessible, and affordable individual market. We review how adverse risk selection can pose a challenge to achieving such objectives in the individual health insurance market. We follow this discussion by describing the experience of New Jersey through three rounds of legislative reform and through the first year of the implementation of the ACA coverage provisions. While the New Jersey reforms did not require individuals to purchase coverage, its experiences with direct and indirect market subsidies and regulations guiding plan design, issuance, and rating have important implications for how the ACA may achieve its coverage goals in the absence of the controversial individual purchase mandate.

  17. Las políticas de salud reproductiva en el Perú: reformas sociales y derechos ciudadanos Reproductive health policies in Peru: social reforms and citizenship rights

    Directory of Open Access Journals (Sweden)

    Stéphanie Rousseau


    Full Text Available El artículo analiza el caso del proceso de elaboración de políticas de salud reproductiva en el Perú, en el contexto de las reformas de las políticas sociales implementadas durante los últimos 15 años. Las reformas en el sector de la salud sólo han reparado en forma parcial el acceso desigual de las mujeres a la planificación familiar, a los derechos reproductivos y a la atención materna. Las fuentes principales de desigualdad están relacionadas con la naturaleza segmentada del sistema de la atención de la salud que ocasiona, entre otros temas, que la mayoría de las mujeres sin seguro provenientes de las clases populares dependan de qué y cómo sean provistos los servicios públicos de la atención médica. Por otra parte, el continuo papel de sectores conservadores en los debates sobre políticas de salud reproductiva sigue teniendo un impacto sobre los servicios públicamente disponibles de planificación familiar.The article analyzes the case of reproductive health policy-making in Peru in the context of recent social policy reforms. Health-sector reforms have only partially redressed Peruvian women's unequal access to family planning, reproductive rights and maternal care. The main sources of inequalities are related to the segmented character of the health-care system, with the highest burden placed on the public sector. The majority of women from popular classes, who are not protected by an insurance plan, are dependent upon what and how public services are provided. Simultaneously, the continuing role of conservative sectors in public debates about reproductive health policy has a strong impact on public family planning services and other reproductive rights.

  18. Market reforms in health care and sustainability of the welfare state

    DEFF Research Database (Denmark)

    Diderichsen, Finn


    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...

  19. Religious Groups as Interest Groups: The United States Catholic Bishops in the Welfare Reform Debate of 1995–1996 and the Health Care Reform Debate of 2009–20101

    Directory of Open Access Journals (Sweden)

    Anne Marie Cammisa


    Full Text Available The United States has a long history of religious influence on public policy: the anti-slavery movement, progressivism, prohibition, civil rights, abortion, school vouchers, school prayer and nuclear disarmament are all issues that have involved religion and religious groups in policymaking. In recent decades, the number of religious interest groups (as well as interest groups in general has greatly expanded, but the role that the religious organizations play as interest groups in the policy arena has received relatively little attention. How are they similar to and different from other interest groups? What tactics do they use? How successful are they? Under what conditions is success or failure more likely? This article examines Roman Catholic religious groups as interest groups in the congressional policymaking process. First, it places Catholic interest groups in the context of the interest group literature, and second, it examines Catholic interest groups’ activity in the passage of welfare reform in 1996 and in the passage of health care reform in 2010. In both cases, they played a greater role in context-setting than in actually changing provisions.

  20. Challenges Faced by Health Care Reform%医保改革面临挑战

    Institute of Scientific and Technical Information of China (English)

    桑吉·古普塔; 本尼迪克特·克莱门茨; 戴维·科迪; 王宇(译)


    At present, poor medical service availability, high health care costs and inefficient of public health spending are exsiting in many countries, and health care reform still faces big challenges. To improve people's health and to make a control of the costs are dilemma of health-care reform, and thus improving the efficiency of public health expenditure is the optimal choice to improve social health. The forms of government intervention and the level of public health expenditure are different due to different countries and period. Emerging economies should expand basic health care coverage on the premise of fiscal sustainable development while developed economies should pay attention to improve the public health spending efficiency and limit the spending growth.%当前,许多国家仍存在医疗服务可得性差、医疗成本高昂、公共卫生支出效率低下等问题,医保改革面临重大挑战。医保改革目标存在两难—既要改善人们的健康状况,又要控制支出成本,因而提高公共卫生支出效率是改善社会健康状况的最优选择。各国政府的干预形式和公共卫生支出水平因国别、时间等的不同而变化。财政状况较好的新兴经济体需在保证财政可持续的前提下扩大基本医保覆盖面;发达经济体则应注重提升公共卫生支出的效率并限制支出增长速度。

  1. Science as an early driver of policy: child labor reform in the early Progressive Era, 1870-1900. (United States)

    Perera, Frederica


    Scientific evidence is an increasingly important driver of social and environmental policy concerning child health. This trend began earlier than generally recognized. The child labor reform movement of the Gilded Age and early Progressive Era reflected not only moral and economic forces but also the dramatic advances during the later decades of the 19th century in scientific knowledge concerning children's biological and psychological vulnerability to environmental and psychosocial stressors. The growing importance of scientific information in shaping policy concerning children's health between 1870 and 1900 is illustrated by the events leading up to and following the New York State Child Labor Law of 1886. Child labor reform during this period was a critical step in the development of a science-based as well as a value-driven movement to protect children's environmental health and well-being that continues today.

  2. Science as an Early Driver of Policy: Child Labor Reform in the Early Progressive Era, 1870–1900 (United States)


    Scientific evidence is an increasingly important driver of social and environmental policy concerning child health. This trend began earlier than generally recognized. The child labor reform movement of the Gilded Age and early Progressive Era reflected not only moral and economic forces but also the dramatic advances during the later decades of the 19th century in scientific knowledge concerning children’s biological and psychological vulnerability to environmental and psychosocial stressors. The growing importance of scientific information in shaping policy concerning children’s health between 1870 and 1900 is illustrated by the events leading up to and following the New York State Child Labor Law of 1886. Child labor reform during this period was a critical step in the development of a science-based as well as a value-driven movement to protect children’s environmental health and well-being that continues today. PMID:25121809

  3. Variables in health care policy-making: resolving a quandary? (United States)

    Smith, George P


    Contemporary debate on health care resource management is tied to a central moral issue: how to achieve an optimum level of reasonable or appropriate treatment based on the medical condition of each patient. Failure to tackle and resolve this issue in a confident and forthright manner ensures that the present approach to health care decision-making will continue in a state of indecisiveness if not, indeed, lethargy. Undergirding this moral issue is the foundational economic dilemma of controlling costs while limiting access to health care resources. Crafting a just solution to an equitable distribution of finite health care resources is, indeed, a quandary, if not almost an impossibility. What this article seeks to do, nonetheless, is to undertake an examination of the principles, socio-economic values and public policies needed to formulate health care compromises necessary to achieve greater stability in the normative decision-making process. In turn, this will ensure, ideally, a level of distributive justice in the total allocative process.

  4. The long shadow of the past: risk pooling and the political development of health care reform in the States. (United States)

    Chen, Anthony S; Weir, Margaret


    Why do the states seem to be pursuing different types of policy innovation in their health reform? Why so some seem to follow a "solidarity principle," while others seem guided by a commitment to "actuarial fairness"? Our analysis highlights the reciprocal influence of stakeholder mobilization and public policy over time. We find that early policy choices about how to achieve cost containment led the states down different paths of reform. In the 1970s and 1980s, states that featured oligopolistic or near-monopolistic markets for private insurance (usually dominated by Blue Cross) and strong urban-academic hospitals tended to adopt regulatory strategies for cost containment that led to broader forms of pooling and financing the costs of health risks--which subsequently positioned them to pursue major, solidaristic reform on favorable terms. On the other hand, states with competitive markets for private insurance and weak, decentralized hospitals tended to adopt market-based strategies for cost containment that led to the hypersegmentation of risk and the uneven financing of costs--thereby encouraging the proliferation of incremental policies that reinforce the principle of actuarial fairness. We illustrate our analysis with a brief comparison of Massachusetts and California, and we conclude with some thoughts on what our findings imply for the federal role in catalyzing health reform.

  5. Explaining mental health care professionals’ resistance to implement Diagnosis Related Groups: (no) benefits for society, patients and professionals

    NARCIS (Netherlands)

    L.G. Tummers (Lars); S.G.J. Van de Walle (Steven)


    textabstractEffective health system reform requires support from health care professionals. However, many studies show an increasing discontent among health care professionals toward certain government policies. When professionals resist implementing policies, this may have serious consequences for

  6. The policy of school autonomy and the reform of educational administration Hungarian changes in an East European perspective (United States)

    Halász, Gábor


    The paper presents the background, the main elements and the contradictions of the reform of educational administration in Hungary in the late '80s in a Central and East European perspective. It also tries to provide an analysis of the challenges that have emerged with the political changes of the '90s. The introductory part of the paper analyses the differences between policies of decentralization in Eastern and Western Europe. In the second part, the most important changes introduced by the 1985 Hungarian Education Act are summarized, and the policy background of these changes is presented. It is assumed that the policy behind the decentralization measures had a negative character: it intended more to abolish the existing structures of control than to establish new ones. In the final part of the paper those factors are presented which may play a role in the future for or against the policy of decentralization.

  7. Responses of Canada's health care management education programs to health care reform initiatives. (United States)

    Angus, D E; Lay, C M


    Canada's provincial health care systems have been experiencing significant changes, mostly through horizontal integration achieved by merging hospitals, and, in a few cases, through vertical integration of public health, long term care, home care and hospital services. The government motivation for forcing these changes seems to have been primarily financial. In a few cases, the integration seems to have resulted in a stable and successful outcome, but, in most others, there has been destabilization, and in some, there has been chaos. The question posed in this research was how the five accredited Canadian graduate programs in health care management were responding to these changes. Two of the programs have recently made major changes in structure and/or delivery processes, following careful examination of their perceived environments. One has rationalized by subdividing courses. Another is repatriating courses from the business school in order to achieve more health-related content. Four of the five programs have added a number of courses in the last few years, or plan to do so in the next year or two, either because of accreditation criteria or student or faculty interest. The program directors viewed the educational requirements for clinicians and non-clinicians as being identical. In spite of the major structural changes, and the resulting destabilization of the health care organizations (and even governments), none of the programs emphasized the changes as factors in their plans for program changes. They expressed some concern about the possibility of fads as opposed to significant changes. It may be that these changes are dealt with in the content of individual courses. This aspect was not examined by the survey nor by interviews with the directors. Each of the programs has emphasized its own niche, with no consensus about changes required.

  8. Let's make a deal: trading malpractice reform for health reform. (United States)

    Sage, William M; Hyman, David A


    Physician leadership is required to improve the efficiency and reliability of the US health care system, but many physicians remain lukewarm about the changes needed to attain these goals. Malpractice liability-a sore spot for decades-may exacerbate physician resistance. The politics of malpractice have become so lawyer-centric that recognizing the availability of broader gains from trade in tort reform is an important insight for health policy makers. To obtain relief from malpractice liability, physicians may be willing to accept other policy changes that more directly improve access to care and reduce costs. For example, the American Medical Association might broker an agreement between health reform proponents and physicians to enact federal legislation that limits malpractice liability and simultaneously restructures fee-for-service payment, heightens transparency regarding the quality and cost of health care services, and expands practice privileges for other health professionals. There are also reasons to believe that tort reform can make ongoing health care delivery reforms work better, in addition to buttressing health reform efforts that might otherwise fail politically.

  9. Dentistry in Taiwan, Republic of China: National health insurance reforms, illegal dentistry and peer review quality control

    DEFF Research Database (Denmark)

    Moore, R.; Shiau, Y.Y.


    licensure. Their popularity and price advantage has maintained a political base that affects policy decisions. Health care reforms of March, 1995 with a comprehensive national health insurance, as well as ambitious plans for systematic peer review quality control of dentists' work are unique health care...... developments worthy of the attention of health care policy makers in other countries who are studying health care reform processes...

  10. The impact of market-based 'reform' on cultural values in health care. (United States)

    Curtin, L L


    The many issues managed care poses for providers and health networks are crystallized in the moral problems occasioned by its shifting of the financial risks of care from insurer to provider. The issues occasioned by market-based reform include: the problems presented by clashes between public expectations and payer restrictions; the corporatization of health service delivery and the cultural shift from humanitarian endeavor to business enterprise the depersonalization of treatment as time and money constraints stretch resources, and the culture rewards efficient "business-like" behavior the underfunding of care for the poor and uninsured, even as these populations grow the restructuring of care and reengineering of healthcare roles as the emphasis shifts from quality of care to conservation of resources rapid mergers of both health plans and institutional providers with all the inherent turmoil as rules change, services are eliminated, and support services are minimized to save money the unhealthy competition inherent in market-based reform that posits profit taking and market share as the measures of successful performance the undermining of the professional ethic of advocacy the use of incentives that pander to greed and self-interest. The costs of sophisticated technologies and the ongoing care of increasingly fragile patients have pulled many other elements into what previously were considered "privileged" professional interactions. The fact that very few citizens indeed could pay out-of-pocket for the treatment and ongoing care they might need led to social involvement (few people remember that both widespread health insurance and public programs are relatively recent phenomena--only about 30 years old). However, whether in tax dollars or insurance premiums, other people's money is being spent on the patient's care. Clearly, those "other people" never intended to give either the patient or the professional open-ended access to their collective pocketbooks

  11. The public's views on health care reform in the 2008 presidential election. (United States)

    Collins, Sara R; Kriss, Jennifer L


    A Commonwealth Fund survey of adults age 19 and older,conducted from June 2007 to October 2007, finds that large majorities of the public, regardless of political affiliation or income level, say that the candidates' views on health care reform will be very important or somewhat important in their voting decision. Moreover, they believe employers--long the cornerstone of the health insurance system--should retain responsibility for providing health insurance, or at least contribute financially to covering the country's working families. A majority of adults would also favor a requirement that everyone have health insurance, with the government helping those who are unable to afford it; support for such a requirement, however, is not strong and varies by political affiliation, geographic region, and income. There is overwhelming agreement that financing for health insurance coverage for all Americans should be a responsibility shared by employers, government, and individuals.

  12. 奥巴马医改三问%Analysis of Obam's Health Care Reform

    Institute of Scientific and Technical Information of China (English)



    There are many obstacles standing on the way to formulate and implement the Patient Protection and Affordable Act. Some of the obstacles resulted from the external factors, such as partisan politics, market orientated conception and bi-federalism, etc.;some of them were caused by the imperfection of Obam's Health Care Reform itself. This article makes a comprehensive analysis of these problems from three aspects:universal coverage targeting, funds-raising mechanism and executive capacity.%奥巴马医改一波三折,既有党派政治、市场理念、二元联邦制等外在因素的影响,也有改革本身的一些问题。本文从目标定位、筹资机制和实施能力三个方面对此进行了深入分析。

  13. Application of a general health policy model in the American health care crisis. (United States)

    Kaplan, R M


    There is near consensus that the US health care system requires reform. Only a quarter of the American public has faith in the current system. Health care was one of the major issues considered in the 1992 US presidential election and the search for innovative solutions has transcended administrations.

  14. School Reforms in England, Japan, Korea and the U.S.: Policy Variation and Educational Convergence. (United States)

    Lee, Jaekyung

    Education reform during the last 2 decades has been shaped by the forces of growing public distrust of educational bureaucracies in a climate of rapid political change and growing international competition in the context of a global economy. Major school reforms in four selected industrial countries that differ significantly in terms of…

  15. Irrational Exuberance for Market-Based Reform: How Federal Turnaround Policies Thwart Democratic Schooling (United States)

    Trujillo, Tina; Renée, Michelle


    Background: In 2009, the Obama Administration announced its intention to rapidly "turn around" 5,000 of the nation's lowest-performing schools. To do so, it relied on the School Improvement Grant (SIG) program to provide temporary funding for states and schools, and to mandate drastic, school-level reforms. Most of these reforms require…

  16. Are lessons from the education sector applicable to health care reforms? The case of Uganda. (United States)

    Okuonzi, S A; Birungi, H


    The decision by donors to use external aid for poverty alleviation in very low-income countries and the redefinition of development to include human aspects of society have renewed interest in education and health services. The debate about accountability, priorities and value-for-money of social services has intensified. Uganda's universal primary education programme (UPE) has within 2 years of inception achieved 90% enrollment. The programme has been acclaimed as successful. But the health sector that has been implementing primary health care and reforms for two decades is viewed as having failed in its objectives. The paper argues that the education sector has advantages over the health sector in that its programme is simple in concept, and was internally designed involving few actors. The sector received strong political support, already has an extensive infrastructure, receives much more funding and has a straightforward objective. Nevertheless, the health sector has made some achievements in AIDS control, in the prevention and control of epidemics, and in behavioural change. But these achievements will not be noticed if only access and health-status are used to assess the health sector. However, UPE demonstrates that a universal basic health care is possible, given the same level of resources and political commitment. The lesson for the health sector is to implement a priority universal health care programme based on national values and to assess its performance using the objectives of the UPE.

  17. The emergence of managed care in Europe. Some thoughts on the politics of healthcare reform. (United States)

    Elze, C


    It is the purpose of this paper to demonstrate that healthcare reform in Europe can be successful only if it leads to more efficient resource use while maintaining a large degree of equity in the system. Globalisation is undermining the social contracts that established Europe's egalitarian societies after World War II. While socialised healthcare will continue to be an essential building block of social cohesion, public expenditures must be contained. The only approach to maintaining equity of access and financing in the face of a mounting resource constraint is to embark upon a radical re-engineering of the entire healthcare supply chain, introducing and adapting proven US managed-care techniques to the European environment. Through enabling legislation, most European countries are in a phase of testing the feasibility, cost effectiveness and quality enhancement potential of managed-care approaches, before applying them more broadly. While political opposition to change on the part of those whose current positions are threatened continues to run high, the practice of medicine can be expected to converge on the basis of standards of care and information technology over the next 10 to 15 years.

  18. Public policy update. Welfare reform and teen parents: are we missing the point? (United States)

    Wacker, B L; Gambrell, A E


    The aim of teenage pregnancy prevention initiatives should be to provide sexuality education that is age-appropriate, medically accurate, and available at each grade level with a positive view of sexuality and information and skills that contribute to sexual health and the ability to make decisions. Abstinence should be included as long as it is not fear-based and is part of the promotion of responsible sexuality. Contraceptive information must be available to those already sexually active. Subsidized day care for children of poor adolescent mothers must be at the top of the agenda of services integrated with job programs and school-to-work initiatives. Quality child care can provide a solid foundation in personal health, negotiation, self-esteem, and individual rights and responsibilities. Quick-fix and punitive measures are out of place in programs that rely on growth in individual responsibility. An innovative approach to social welfare programming would include comprehensive sexuality education, reproductive health services, child care, health insurance, and job training. The Clinton welfare reform drafts combine elements of teen pregnancy prevention with punitive action. What is needed is greater investment in programs enhancing sexuality education, acceptance and understanding of sexuality, and access to affordable reproductive health services. The Clinton plan focuses primarily on the National Mobilization for Youth Opportunity and Responsibility, which is a national media campaign to educate youth about responsibility and the benefits of staying in school and delaying childbearing. About 1000 middle and high schools in high-poverty areas would be targeted. Opportunities would be offered to go to college or have access to job training. Controls would be placed on adolescents by requiring minor parents to live with a responsible adult, minor mothers to stay in school, and to limit disbursements for additional children while on Aid to Families with Dependent

  19. The human perspective on health care reform: coping with diabetes in Kyrgyzstan. (United States)

    Hopkinson, Botagoz; Balabanova, Dina; McKee, Martin; Kutzin, Joseph


    Health systems world wide are confronted by the challenge of rising levels of chronic diseases. Yet existing approaches to health system analysis often fail to capture the complexity of the responses required to address this challenge. In this paper we describe the results of a pilot study using a rapid appraisal technique to assess the performance of the health care system in Kyrgyzstan, a former Soviet central Asian republic. The study focuses on diabetes, a condition whose effective management requires a coordinated response involving many components of the health care system. The study sets out a conceptual framework in which the system is seen from the perspectives of users, health professionals and policy-makers. It sees the effective delivery of health care as dependent on appropriate investment in human, physical, intellectual and social resources. The study reveals important weaknesses in all of these areas, although it also notes that current policies, while constrained by the legacy of the past and by limited resources, are beginning to tackle them. This pilot study indicates that rapid appraisal, using a condition such as diabetes, where those affected can be easily identified, offers a means of gaining important insights into a health care system.

  20. Exploiting Policy Obscurity for Legalising Water Grabbing in the Era of Economic Reform: The Case of Maharashtra, India

    Directory of Open Access Journals (Sweden)

    Subodh Wagle


    Full Text Available Since the last two decades, economic reform in India is exerting pressure on limited land and water resources. This article argues that sectoral reforms underway in different areas such as water, electricity, and the export sector are giving rise to a new form of water grabbing in the state of Maharashtra, India. This water grabbing is legitimised by the use, application and redefinition of reform instruments such as the sectoral policy statements and laws. Maharashtra, like many other Indian states, has been a theatre for the play of power among different interest groups over control and access to water resources developed through state funding. Dams were built at the cost of depriving the upland riparian communities of their land, water and other resources. The water provided by the dams – which strengthened the political power of the leaders representing the irrigated plains – is now at the core of a shift in regional power equations. Based on case studies of three dams the paper presents these contemporary developments around water allocation and re-appropriation. These developments pertain to the shift from the erstwhile focus on securing water for irrigation to the new focus of securing water to facilitate international and domestic private investments. The paper concludes by arguing that the state is able to legitimise this form of water grabbing due the emergence of a new and grand political coalition and nexus that has emerged at the behest of the ongoing economic reforms.

  1. Emerging patient safety issues under health care reform: follow-on biologics and immunogenicity

    Directory of Open Access Journals (Sweden)

    Liang BA


    Full Text Available Bryan A Liang1-3, Timothy Mackey1,41Institute of Health Law Studies, California Western School of Law, 2Department of Anesthesiology, University of California, San Diego School of Medicine, 3San Diego Center for Patient Safety, University of California, San Diego School of Medicine,4Joint Program in Global Health, University of California San Diego-San Diego State University, San Diego, CA, USAAbstract: US health care reform includes an abbreviated pathway for follow-on biologics, also known as biosimilars, in an effort to speed up access to these complex therapeutics. However, a key patient safety challenge emerges from such an abbreviated pathway: immunogenicity reactions. Yet immunogenicity is notoriously difficult to predict, and even cooperative approaches in licensing between companies have resulted in patient safety concerns, injury, and death. Because approval pathways for follow-on forms do not involve cooperative disclosure of methods and manufacturing processes by innovator companies and follow-on manufacturers, the potential for expanded immunogenicity must be taken into account from a risk management and patient safety perspective. The US Institute of Safe Medication Practices (ISMP has principles of medication safety that have been applied in the past to high-risk drugs. We propose adapting ISMP principles to follow-on biologic forms and creating systems approaches to warn, rapidly identify, and alert providers regarding this emerging patient safety risk. This type of system can be built upon and provide lessons learned as these new drug forms are developed and marketed more broadly.Keywords: biosimilars, follow-on biologics, immunogenicity, patient safety, law, health care reform

  2. How Health Reform is Recasting Public Psychiatry. (United States)

    Shaner, Roderick; Thompson, Kenneth S; Braslow, Joel; Ragins, Mark; Parks, Joseph John; Vaccaro, Jerome V


    This article reviews the fiscal, programmatic, clinical, and cultural forces of health care reform that are transforming the work of public psychiatrists. Areas of rapid change and issues of concern are discussed. A proposed health care reform agenda for public psychiatric leadership emphasizes (1) access to quality mental health care, (2) promotion of recovery practices in primary care, (3) promotion of public psychiatry values within general psychiatry, (4) engagement in national policy formulation and implementation, and (5) further development of psychiatric leadership focused on public and community mental health.

  3. Towards a Theory of the Reform of the Common Agricultural Policy

    Directory of Open Access Journals (Sweden)

    Adrian Kay


    Full Text Available This paper sets up two competing frameworks to assess the evidence of the CAP reforms of the 1980s and 1990s. The two frameworks differ in the degree of prominence given to interest groups in affecting CAP decisions. The paper concludes that the most important mechanism behind CAP reforms is the interaction of EU institutions and member state governments. Interest groups, at national or EU-level, have limited influence on the reform process. The paper does not claim to have developed a new theory of CAP reform but rather aims to suggest a direction for the development of a high content theory that is able to account for the differences between episodes of CAP reform as well as the similarities.

  4. Foundational ethics of the health care system: the moral and practical superiority of free market reforms. (United States)

    Sade, Robert M


    Proposed solutions to the problems of this country's health care system range along a spectrum from central planning to free market. Central planners and free market advocates provide various ethical justifications for the policies they propose. The crucial flaw in the philosophical rationale of central planning is failure to distinguish between normative and metanormative principles, which leads to mistaken understanding of the nature of rights. Natural rights, based on the principle of noninterference, provide the link between individual morality and social order. Free markets, the practical expression of natural rights, are uniquely capable of achieving the goals that central planners seek but find beyond their grasp. The history of this country's health care system and the experiences of other nations provide evidence of the superiority of free markets in reaching for the goals of universal access, control of costs, and sustaining the quality of health care.

  5. The Main Points of Obam’s Health Care Reform%奥巴马医疗保健制度改革的主要内容

    Institute of Scientific and Technical Information of China (English)



      经过多方协商和博弈,美国终于2010年3月21日通过医疗保健制度改革议案,为美国实现全民医保迈出关键的一步。医改法案着眼全民医保,在强制参保以扩大医疗保险覆盖面、增收节支以维持基金平衡、加强管理以遏制医疗费用过快增长等方面提出明确具体措施。美国医改在厘清政府责任边界、完善利益表达体系、合理定位政策目标、重视政策可操作性等方面给人启迪。%The Patient Protection and Affordable Care Act (PPACA), commonly called Obamacare, was signed into law by President Barack Obama on March 23, 2010. The PPACA is aimed at increasing the rate of health insurance coverage for Americans and reducing the overall costs of health care. It provides a number of mechanisms for employers and individuals to increase the coverage rate. Additional reforms aim to increase revenue and reduce expenses in order to mountain fund balance. Health care reform in America is enlightening in many aspects, such as clarifing the boundaries of government responsibility, improving the system of interest expression, positioning policy objectives reasonably, attaching importance to operability of policies.

  6. Chile's health sector reform: lessons from four reform periods. (United States)

    de la Jara, J J; Bossert, T


    This paper applies an interdisciplinary approach to analyze the process of health reform in four significant periods in Chilean history: (1) the consolidation of state responsibility for public health in the 1920s, (2) the creation of the state-run National Health Service in the 1950s, (3) the decentralization of primary care and privatization of health insurance in the 1980s, and (4) the strengthening of the mixed public-private market in the 1990s. Building on the authors' separate disciplines, the paper examines the epidemiological, political and economic contexts of these reforms to test simple hypotheses about how these factors shape reform adoption and implementation. The analysis underlines: (1) the importance of epidemiological data as an impetus to public policy; (2) the inhibiting role of economic recession in adoption and implementation of reforms: and (3) the importance of the congruence of reforms with underlying political ideology in civil society. The paper also tests several hypotheses about the reform processes themselves, exploring the role of antecedents, interest groups, and consensus-building in the policy process. It found that incremental processes building on antecedent trends characterize most reform efforts. However, interest group politics and consensus building were found to be complex processes that are not easily captured by the simple hypotheses that were tested. The interdisciplinary approach is found to be a promising form of analysis and suggests further theoretical and empirical issues to be explored.

  7. Reducing variation in health care: the rhetorical politics of a policy idea. (United States)

    Tanenbaum, Sandra J


    For decades, geographic variation in the use and cost of health care has captured the imagination of researchers and policy makers. As a policy problem, variation suggests its own solution--reducing variation--but the substantive weaknesses of this policy idea invite a second look at its success. This article considers the politics of policy ideas to analyze the potential rhetorical strengths of reducing variation. It finds that this idea appeals to multiple health care audiences, remains practically and politically ambiguous as to problem and solution, and resonates with long-held aspirations of policy elites, including being hopeful about solving the seemingly intractable problems of the US health care system.

  8. Improving care for people with osteoarthritis of the hip and knee: how has national policy for osteoarthritis been translated into service models in Australia? (United States)

    Brand, Caroline; Hunter, David; Hinman, Rana; March, Lyn; Osborne, Richard; Bennell, Kim


    There is strong rationale for improving care for people with chronic conditions, including osteoarthritis (OA). Successful implementation of healthcare reform requires new concepts and directions that are strongly supported by policy, new models of care (service redesign) and changes in day-to-day practice (healthcare provider and patient practice). In this paper we discuss the extent to which policy about management of OA of the hip and knee has been translated into new service models in Australia. A structured search of government and other key health websites in Australia was performed to identify policy, funding initiatives and new services models for managing OA of the hip and knee. This search was supported by a literature review. Musculoskeletal conditions were designated a National Health Priority in Australia in 2002. Under the Better Arthritis and Osteoporosis Care initiative, Australia has developed a national policy for OA care and national evidence-based clinical practice guidelines for management of OA of the hip and knee. Only two well-described examples of new chronic disease management service models, the Osteoarthritis Clinical Pathway (OACP) model and the Osteoarthritis Hip and Knee Service (OAHKS) were identified. Primarily focused within acute care public hospital settings, these have been shown to be feasible and acceptable but have limited data on clinical impact and cost-effectiveness. While policy is extant, implementation has not been systematic and comprehensive. Clinicians have evidence-based recommendations for OA management but are poorly supported by service models to deliver these effectively and efficiently.

  9. Education Reform Policy and Early Childhood Teacher Education in Hong Kong before and after the Transfer of Sovereignty to China in 1997 (United States)

    Yuen, Gail


    Built on a sociocultural framework of policy analysis and Wertsch's concept of mediation, the present study examines how early childhood teacher education has changed as a result of interactions between reform policy and the action of teacher educators. Ten teacher educators participated in the study, along with eight early childhood leaders, 15…

  10. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan. (United States)

    Alyeshmerni, Daniel; Froehlich, James B; Lewin, Jack; Eagle, Kim A


    Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

  11. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan

    Directory of Open Access Journals (Sweden)

    Daniel Alyeshmerni


    Full Text Available Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA, and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

  12. Cultures for mental health care of young people: an Australian blueprint for reform. (United States)

    McGorry, Patrick D; Goldstone, Sherilyn D; Parker, Alexandra G; Rickwood, Debra J; Hickie, Ian B


    Mental ill health is now the most important health issue facing young people worldwide. It is the leading cause of disability in people aged 10-24 years, contributing 45% of the overall burden of disease in this age group. Despite their manifest need, young people have the lowest rates of access to mental health care, largely as a result of poor awareness and help-seeking, structural and cultural flaws within the existing care systems, and the failure of society to recognise the importance of this issue and invest in youth mental health. We outline the case for a specific youth mental health stream and describe the innovative service reforms in youth mental health in Australia, using them as an example of the processes that can guide the development and implementation of such a service stream. Early intervention with focus on the developmental period of greatest need and capacity to benefit, emerging adulthood, has the potential to greatly improve the mental health, wellbeing, productivity, and fulfilment of young people, and our wider society.

  13. Effects of Policy Reforms on Price Transmission in Coffee Markets: Evidence from Zambia and Tanzania


    Mofya-Mukuka, Rhoda; Abdulai, Awudu


    In the late 1990s, several governments in Sub-Saharan Africa (SSA) embarked on various market reforms to improve commodity market performance. The success of such market reforms depends partly on the strength of the transmission of price signals between spatially separated markets and between different levels of commodity value chains. This study takes a look at these issues through an analysis of coffee producer prices for Zambia and Tanzania.

  14. The Reform of International Financial System and China’s Policy Options

    Institute of Scientific and Technical Information of China (English)


    The reform of international financial system is focused on the following aspects: international monetary system, international financial institutions (IFIs), and international financial regulatory system. The US, European Union, Japan, and the Emerging Market Countries all have different stances concerning the reforms in these fields. There is also an obvious deviation in the interests and demands of Emerging Powers and the US and EU. In addition, the G20 has become the major forum for economic coordination...

  15. National Policies that Connect ICT-Based Education Reform to Economic and Social Development


    Kozma, Robert B.


    Information and communication technology (ICT) is a principal driver of economic development and social change, worldwide. In many countries, the need for economic and social development is used to justify investments in educational reform and in educational ICT. Yet the connections between national development goals and ICT-based education reform are often more rhetorical than programmatic. This paper identifies the factors that influence economic growth and shows how they sup...

  16. Learning through Civic Participation: Policy Actors' Perspectives on Curriculum Reform Involvement in Ontario (United States)

    Pinto, Laura Elizabeth


    When citizens participate in policy production, the advantages go beyond policy outcomes--though the presumption is that participation leads to better public policy. Robust democracy characterized by agonistic exchanges among policy actors ought to encourage learning, dialogue, empow­erment, equity, and a shared spirit of inquiry. This article…

  17. Science education reform for the 21st century: Analyzing policy imperatives for effective teaching through recruitment, renewal, and retention (United States)

    Bordeaux, Amy Venning


    Concern with science education reform and how to achieve it has a long history in our education system. In recent years, national reports have targeted enhancing teaching quality as the number one priority in the list of research-based education reform efforts that will have the most impact on promoting student achievement (U.S. Department of Education, 2000). However, defining the policy imperatives and delineating the priorities must occur before reform can be achieved. Using the Delphi Technique, a total of 33 expert panelists representing universities, K--12 educators, informal science education organizations, national and federal organizations such as NSF, NASA, and the Department of Education, and parents grappled with policy imperatives needed for effective science teaching. Through a series of three iterative questionnaires, panelists had the opportunity to build consensus, pool judgments, and forecast themes that could potentially influence policymakers in science education for the "Three R's" of professional development---renewal, retention, and recruitment. The study focused on the following three objectives: (1) analyzing feedback from panelists regarding issues and strategies identified in the Glenn Commission Report for enhancing teaching quality, (2) building group consensus regarding visions, actions, and strategies for effective science teaching and professional development, and (3) moving from rhetoric to reality in addressing the policy imperatives needed in the next 10 years for policymakers to instigate at the national, state and local levels for enhancing effective science teaching practice. The results of this study validated the findings in the Glenn Commission Report and identified five major priorities. The priorities identified policy imperatives for upgrading the quality of undergraduate and graduate science education programs, changing the reward system and career ladder for teachers, designing systemic and sustained professional

  18. [Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico]. (United States)

    Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Méndez-Carniado, Oscar; Bryson-Cahn, Chloe; Barofsky, Jeremy; Maguire, Rachel; Miranda, Martha; Sesma, Sergio


    Absence of financial protection in health is a recently diagnosed "disease" of health systems. The most obvious symptom is that families face economic ruin and poverty as a consequence of financing their health care. Mexico was one of the first countries to diagnose the problem, attribute it to lack of financial protection, and propose systemic therapy through health reform. In this article we assess how Mexico turned evidence on catastrophic and impoverishing health spending into a catalyst for institutional renovation through the reform that created Seguro Popular de Salud (Popular Health Insurance). We present 15-year trends on the evolution of catastrophic and impoverishing health spending, including evidence on how the situation is improving. The results of the Mexican experience suggest an important role for the organisation and financing of the health system in reducing impoverishment and protecting households during periods of individual and collective financial crisis.

  19. Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico. (United States)

    Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Méndez-Carniado, Oscar; Bryson-Cahn, Chloe; Barofsky, Jeremy; Maguire, Rachel; Miranda, Martha; Sesma, Sergio


    Absence of financial protection in health is a recently diagnosed "disease" of health systems. The most obvious symptom is that families face economic ruin and poverty as a consequence of financing their health care. Mexico was one of the first countries to diagnose the problem, attribute it to lack of financial protection, and propose systemic therapy through health reform. In this article we assess how Mexico turned evidence on catastrophic and impoverishing health spending into a catalyst for institutional renovation through the reform that created Seguro Popular (Popular Health Insurance). We present 15-year trends on the evolution of catastrophic and impoverishing health spending, including evidence on how the situation is improving. The results of the Mexican experience suggest an important role for the organisation and financing of the health system in reducing impoverishment and protecting households during periods of individual and collective financial crisis.

  20. Rare disease policies to improve care for patients in Europe. (United States)

    Rodwell, Charlotte; Aymé, Ségolène


    Rare diseases are those with a particularly low prevalence; in Europe, diseases are considered to be rare when they affect not more than 5 in 10000 persons in the European Union. The specificities of rare diseases make the area a veritable public health challenge: the limited number of patients and scarcity of knowledge and expertise single rare diseases out as a distinctive domain of high European added-value. The Orphan Medicinal Product Regulation of 1999 was the first European legislative text concerning rare diseases, followed by many initiatives, including recommendations by the Council of Ministers of the European Union in 2009. These initiatives contributed to the development of rare diseases policies at European and national level aimed at improving care for patients with rare diseases. A review of the political framework at European level and in European countries is provided to demonstrate how legislation has created a dynamic that is progressively improving care for patients with rare diseases. This article is part of a Special Issue entitled: "Current Research on the Neuronal Ceroid Lipofuscinoses (Batten Disease)".

  1. Inpatient psychiatric care in the 21st century: the need for reform. (United States)

    Glick, Ira D; Sharfstein, Steven S; Schwartz, Harold I


    Driven by financial pressures, the sole focus of psychiatric inpatient treatment has become safety and crisis stabilization. Data are lacking on outcomes of ultrashort-stay hospitalizations; however, such stays may diminish opportunities for a sustained recovery. In the absence of an evidence base to guide clinicians and policy makers, mental health professionals have an ethical obligation to promote what they consider to be best practice. This Open Forum focuses on the need to reconsider the current model of inpatient hospitalization in order to maximize positive outcomes and emphasize appropriate transition to the community and less intensive levels of care. A model of care is presented based on rapid formulation of diagnosis, goals, and treatment modalities before treatment begins. Three phases are described--assessment, implementation, and resolution--with specific principles to guide length-of-stay decisions and requirements for staffing.

  2. Policy Levers Key for Primary Health Care Organizations to Support Primary Care Practices in Meeting Medical Home Expectations: Comparing Leading States to the Australian Experience (United States)


    Abstract Several countries with highly ranked delivery systems have implemented locally-based, publicly-funded primary health care organizations (PHCOs) as vehicles to strengthen their primary care foundations. In the United States, state governments have started down a similar pathway with models that share similarities with international PHCOs. The objective of this study was to determine if these kinds of organizations were working with primary care practices to improve their ability to provide comprehensive, coordinated, and accessible patient-centered care that met quality, safety, and efficiency outcomes—all core attributes of a medical home. This qualitative study looked at 4 different PHCO models—3 from the United States and 1 from Australia—with similar objectives and scope. Primary and secondary data included semi-structured interviews with 26 PHCOs and a review of government documents. The study found that the 4 PHCO models were engaging practices to meet a number of medical home expectations, but the US PHCOs were more uniform in efforts to work with practices and focused on arranging services to meet the needs of complex patients. There was significant variation in level of effort between the Australian PHCOs. These differences can be explained through the state governments' selection of payment models and use of data frameworks to support collaboration and incentivize performance of both PHCOs and practices. These findings offer policy lessons to inform health reform efforts under way to better capitalize on the potential of PHCOs to support a high-functioning primary health foundation as an essential component to a reformed health system. PMID:26636485

  3. Market- and Performance-Based Reforms of Teacher Compensation: A Review of Recent Practices, Policies, and Research. Program on Education Policy and Governance Working Papers Series. PEPG 10-09 (United States)

    Podgursky, Michael J.; Springer, Matthew


    This paper provides a review of recent policy initiatives to reform teacher compensation systems and evidence regarding the effect of these policies. The first section examines the current structure of teacher compensation in the U.S. K-12 public education system. The compensation "system" for teachers is fragmented and uncoordinated. Teacher…

  4. Does the EU sugar policy reform increase added sugar consumption? An empirical evidence on the soft drink market. (United States)

    Bonnet, Céline; Requillart, Vincent


    Whereas National Health authorities recommend a decrease in the consumption of 'added' sugar, a reform on the sugar market will lead to a 36% decrease of the sugar price in the EU. Using French data on soft drinks purchases, this paper investigates the anticipated impact of this reform on the consumption of sugar-sweetened beverages. The reform of the EU sugar policy leads to a decrease in regular soft drink prices by 3% and varies across brands. To assess substitution within this food category, we use a random-coefficients logit model that takes into account a large number of differentiated products and heterogeneity in consumers' behavior. Results suggest that price changes would lead to an increase in market shares of regular products by 7.5% and to substitutions between brands to the benefit of products with the highest sugar content. On the whole, it would raise consumption of regular soft drinks by more than 1 litre per person per year and consumption of added sugar by 124 g per person per year, this increase being larger in households composed of overweight and obese individuals.

  5. Decolonizing the Evidence-Based Education and Policy Movement: Revealing the Colonial Vestiges in Educational Policy, Research, and Neoliberal Reform (United States)

    Shahjahan, Riyad Ahmed


    There is a growing body of literature discussing evidence-based education, practice, policy, and decision-making from a critical perspective. In this article, drawing on the literature and policy documents related to evidence-based education in the USA, Britain, and Canada, I join this critique and offer an anticolonial perspective. I argue that…

  6. The nurse practitioner and policy in end-of-life care. (United States)

    DuBois, Janet C; Reed, Pamela G


    The focus of this column is the interface between policy and end-of-life care, particularly as provided by advanced nurse practitioners. The complexities of end-of-life along with barriers in practice can diminish quality of life for patients and their families. Changes in policy are needed to enable nurse practitioners their full scope of practice in a way that benefits patients and families at end-of-life. Three areas particularly relevant to policy for nursing practitioners and end-of-life care are addressed: scope of practice, reimbursement, and prescribing practices. Other recommendations for policy and end-of-life care are discussed.

  7. Policy and Practice in Education Reform in Mongolia and Uzbekistan during the First Two Decades of the Post-Soviet Era

    Directory of Open Access Journals (Sweden)

    John C. Weidman


    Full Text Available This article describes the social, economic, and political processes that have influenced educational reform in two countries of Central Asia since the fall of the Soviet Union in 1991. It compares and contrasts the various educational reform initiatives that have occurred in each country, including legal and policy frameworks, curriculum change, decentralization, privatization, finance, structure, and emphasis of educational systems, and the fit between what is taught in educational institutions and demands of the labor market. A sector-wide framework for education reform is presented to facilitate understanding of the very complex set of processes involved.

  8. California's "Bridge to Reform": identifying challenges and defining strategies for providers and policymakers implementing the Affordable Care Act in low-income HIV/AIDS care and treatment settings.

    Directory of Open Access Journals (Sweden)

    Patrick T Hazelton

    Full Text Available In preparation for full Affordable Care Act implementation, California has instituted two healthcare initiatives that provide comprehensive coverage for previously uninsured or underinsured individuals. For many people living with HIV, this has required transition either from the HIV-specific coverage of the Ryan White program to the more comprehensive coverage provided by the county-run Low-Income Health Programs or from Medicaid fee-for-service to Medicaid managed care. Patient advocates have expressed concern that these transitions may present implementation challenges that will need to be addressed if ambitious HIV prevention and treatment goals are to be achieved.30 semi-structured, in-depth interviews were conducted between October, 2012, and February, 2013, with policymakers and providers in 10 urban, suburban, and rural California counties. Interview topics included: continuity of patient care, capacity to handle payer source transitions, and preparations for healthcare reform implementation. Study team members reviewed interview transcripts to produce emergent themes, develop a codebook, build inter-rater reliability, and conduct analyses.Respondents supported the goals of the ACA, but reported clinic and policy-level challenges to maintaining patient continuity of care during the payer source transitions. They also identified strategies for addressing these challenges. Areas of focus included: gaps in communication to reach patients and develop partnerships between providers and policymakers, perceived inadequacy in new provider networks for delivering quality HIV care, the potential for clinics to become financially insolvent due to lower reimbursement rates, and increased administrative burdens for clinic staff and patients.California's new healthcare initiatives represent ambitious attempts to expand and improve health coverage for low-income individuals. The state's challenges in maintaining quality care and treatment for people

  9. The 2011 Estonian High School Language Reform in the Context of Critical Language Policy and Planning (United States)

    Skerrett, Delaney Michael


    This paper seeks to situate Estonian language use and policy within the emerging field of critical language policy and planning (CLPP) by investigating the discourses that frame linguistic behaviour. This done by way of an analysis of a series of interviews carried out with key actors in language policy in Estonia. The discourses framing language…

  10. Developing New Mexico Health Care Policy: An application of the Vital Issues Process

    Energy Technology Data Exchange (ETDEWEB)

    Engi, D. [Sandia National Labs., Albuquerque, NM (United States); Icerman, L. [Icerman & Associates, Santa Fe, NM (United States)


    The Vital Issues Process, developed by the Sandia National Laboratories Strategic Technologies Department, was utilized by the Health Care Task Force Advisory Group to apply structure to their policy deliberations. By convening three expert panels, an overarching goal for the New Mexico health care system, seven desired outcomes, nine policy options, and 17 action items were developed for the New Mexico health care system. Three broadly stated evaluation criteria were articulated and used to produce relative rankings of the desired outcomes and policy options for preventive care and information systems. Reports summarizing the policy deliberations were submitted for consideration by the Health Care Task Force, a Joint Interim Committee of the New Mexico Legislature, charged with facilitating the development and implementation of a comprehensive health care delivery system for New Mexico. The Task Force reported its findings and recommendations to the Second Session of the 41st New Mexico State Legislature in January 1994.

  11. Aging, care and social policy. Continuities and changes in Argentina and Mexico

    Directory of Open Access Journals (Sweden)

    María Concepción ARROYO RUEDA


    Full Text Available This paper intends to show from a comparative perspective of social policy, the provision of care in old age in Argentina and Mexico. It will also show the experience of the national policy of care in Argentina. In this country we carried out interviews with coordinators, operational personnel and users of the national program of care. The participants identify in the policy a vision of rights and social inclusion of the elderly and effective support for family caregivers. Meanwhile, in the case of Mexico, we observe scarce and ambiguous legislation on the subject, which is predominated by the practice of informal care to older people, given mainly by the women in the families. Basic care is outside the aging policy and confined within the «familist model» according to an exalted social assessment of the moral obligation of family care.

  12. 军队医疗保障制度改革的思考%Reform of Military Health Service Policy

    Institute of Scientific and Technical Information of China (English)

    刘敏; 贺桢; 潘景光; 胡安恒; 张献志


    Since 2004 Chinese military health care system reform has started to change the health service mode of military personnel with the socialized reform of logistic services, which has achieved good effect. Now combining with the fact of military medical support, we should deepen the reform, enlarge the medical socialized support range, with which to improve the support level of the military personnel and promote the development of modern logistics system.%2004年我军开始实行的新型医疗保障制度,进行军队成员社会化医疗保障的有益探索,收到良好成效,得到了普遍支持和认可.结合军队医疗保障实际,深化医疗保障制度改革,扩大医疗保障社会化范围,对提高系统内军队成员医疗保障水平、全面建设现代后勤有着重要意义.

  13. Changes in Socioeconomic Inequalities in the Use of Dental Care Following Major Healthcare Reform in Chile, 2004–2009


    Marco Cornejo-Ovalle; Guillermo Paraje; Felipe Vásquez-Lavín; Glòria Pérez; Laia Palència; Carme Borrell


    The study examines changes in the distribution and socioeconomic inequalities of dental care utilization among adults after the major healthcare reform in Chile, 2004–2009. We evaluated the proportion of people who visited the dentist at least once in the previous two years, and the mean number of visits. These outcome variables were stratified by sex, age (20–39, 40–59, 60–63; ≥64 years), educational level (primary, secondary, higher), type of health insurance (public, private, uninsured), a...

  14. Disintegrated care: the Achilles heel of international health policies in low and middle-income countries

    Directory of Open Access Journals (Sweden)

    Jean-Pierre Unger


    Full Text Available Purpose: To review the evidence basis of international aid and health policy. Context of case: Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries. Data sources: National policies, international programmes and pilot experiments are examined in both scientific and grey literature. Conclusions and discussion: We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control. Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored. We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care.

  15. Central and Eastern European Social Policy and European Union Accession: Time for Reform

    Directory of Open Access Journals (Sweden)

    Noemi Lendvai


    Full Text Available European Union enlargement and accession are reflexive of both EU and post-communist social policies. There is a unique “dialogue“ going on, indicative of fundamental aspects of post-communist, post-transitional social policy. It is also a 'mirror' that reflects shortcomings of governance, and often presents a neglected institutional landscape. Therefore, the Europeanisation of social policy is an essential transformation process for post-communist countries whereby a new language and new concepts are introduced, the outlines of new social-policy governance emerge and enter the space in which social policy is formulated and considered.

  16. Reforma, responsabilidades e redes: sobre o cuidado em saúde mental Reform, responsibilities and networks: about mental health care

    Directory of Open Access Journals (Sweden)

    Martinho Braga Batista e Silva


    Full Text Available Tendo em vista o processo paulatino de responsabilização de atores e instâncias sociais pelo cuidado no contexto da Reforma Psiquiátrica brasileira, percebe-se que familiares e vizinhos de pacientes psiquiátricos têm sido instigados a " participar" da política pública, principalmente no lugar de " suporte social" , embora oficialmente considerados " parceiros" . Essa reconfiguração da relação entre Estado e sociedade civil é consagrada pela diretriz governamental de tomada de responsabilidade dos serviços pelo território, uma mudança da lógica de demanda e oferta de atendimento no sentido de estimular serviços extra-hospitalares - como os Centros de Atenção Psicossocial, campo desse estudo - a se encarregarem pela população adscrita a uma área geográfica. O objetivo desse texto é investigar as tecnologias psicossociais produzidas nesse contexto político, institucional e histórico específico, tais como a mediação de trocas sociais e a arbitragem de conflitos. Um dos materiais analisados são os registros em prontuário, que podem constituir os atores e instâncias sociais citados como envolvidos no campo da saúde mental, enredando-os na malha administrativa construída como rede de suporte social.In the context of the Brazilian Psychiatric Reform family members and neighbors of psychiatric patients have been urged to " participate" in the public policies, mainly as " social support" although officially considered " partners" . This reconfiguration of the relationship between State and civil society is reflected in the directive that the services have to take over the responsibility for territories, a change in the logic of supply and demand aimed at stimulating extra-hospital services such as Psychosocial Care Centers, the object of this study, to provide care to the population of a certain geographical area. The purpose of this article is to investigate the psychosocial technologies produced in this specific

  17. Teacher Development against the Policy Reform Grain: An Argument for Recapturing Relationships in Teaching and Learning (United States)

    Smyth, John


    As public schools in countries like the UK, USA, Australia, Canada and New Zealand continue to suffer from the damaging effects of poorly conceptualized educational reforms, educators struggle to come up with alternatives with which to reclaim schools. While acknowledging the situational, contextual and temporal differences between these…

  18. Estimating the Effect of Student Aid on College Enrollment: Evidence from a Government Grant Policy Reform

    DEFF Research Database (Denmark)

    Nielsen, Helena Skyt; Sørensen, Torben; Taber, Christopher

    In this paper, we investigate the responsiveness of the demand for college to changes in student aid arising from a Danish reform. We separately identify the effect of aid from that of other observed and unobserved variables such as parental income. We exploit the combination of a kinked aid sche...

  19. Farm growth and exit: consequences of EU dairy policy reform for Dutch dairy farming

    NARCIS (Netherlands)

    Peerlings, J.H.M.; Ooms, D.L.


    The purpose of this paper is to analyse farm growth and exit and its interaction in Dutch dairy farming as consequences of the 2003 CAP reform and 2008 CAP Health Check. Results indicate that the decision to exit dairy farming is largely determined by household characteristics as age and the size of

  20. Policy Note on the Unfinished Fiscal Reform Agenda in Indian States


    World Bank


    Both central and state governments have carried out significant correction of financial imbalances since 2000, through the implementation of fiscal reforms including enactment of fiscal responsibility (FR) acts. However, the improvement in the finances of all states in aggregate hides wide disparities between them. Some state governments are already on a sustainable path while some others ...

  1. Regulatory and Financial Reform of Federal Research Policy: Recommendations to the NRC Committee on Research Universities (United States)

    Association of American Universities, 2011


    At the request of the National Research Council (NRC) Committee on Research Universities, the Council on Governmental Relations (COGR), the Association of American Universities (AAU), and the Association of Public and Land-grant Universities (APLU) have assembled a set of ten recommendations for regulatory reform that would improve research…

  2. A Legal Guide to State Pension Reform. Education Sector Policy Briefs (United States)

    Herriot-Hatfield, Jennie; Monahan, Amy; Rosenberg, Sarah; Tucker, Bill


    Just 18 minutes before the midnight signing deadline on May 15, 2010, Minnesota state legislators breathed a sigh of relief. Their bipartisan pension reform legislation, which passed both chambers by large margins and aimed to help shore up a potentially failing pension system, had just escaped a veto threat. Under pressure from his Republican…

  3. Teacher Education Policies, Practices, and Reform in Scotland: Implications in the Indian Context (United States)

    Misra, Pradeep Kumar


    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…

  4. Soil fertility decline and economic policy reform in Sub-Saharan Africa

    NARCIS (Netherlands)

    Heerink, N.B.M.


    Two decades of economic reforms in Africa have not resulted in the anticipated growth in per capita agricultural production. Declining output-fertiliser price ratios, particularly for food crops, contributed to soil fertility depletion and agricultural stagnation. Current prices of agricultural prod

  5. The politics of pharmaceutical reform: the case of the Philippine National Drug Policy. (United States)

    Lee, M B


    A national drug policy was formulated in the Philippines after the rise of the Aquino government in 1986. In this article, the author discusses the pharmaceutical situation before the policy was announced, and argues that the major push for a policy came from the confluence of four factors: a change in the structures of political power, especially the rise of a new government and the empowerment of health non-governmental organizations as new participants in the policy process; members of the Department of Health who pushed for a policy; a more conductive social and political climate, both locally and internationally; and a growing body of knowledge about the drug issue. The author discusses the policy's achievements as well as the limitations that have beset the policy from 1987 to 1992.

  6. Gender Policies Meet VET Practices--The Case of Health and Social Care in Norway (United States)

    Høst, Håkon; Seland, Idunn; Skålholt, Asgeir


    Could the labour market gender balance be improved by introducing new types of apprenticeship-trained workers? This article investigates what happened in the wake of the Norwegian VET programme for health and social care, a new approach introduced via the 1994 educational reform. By upgrading this traditionally female-dominated area of education,…

  7. Interactions of selected policy-stakeholder groups implementing middle school science standards-based systemic reform (United States)

    Boydston, Theodore Lewis, III


    This research is an interpretive inquiry into the views and interactions of stakeholders in a district office of a large school system responsible for implementing science systemic reform. Three major sources of data were used in this research: surveys, stakeholder interviews, and autobiographical reflection on experiences as part of the reform initiative. This is an emergent research that is evident in the shift in the focus of research questions and their supporting assumptions during the research. The literature review describes standards-based reform, arguments about reform, and the major dimensions of reform research. The results of the survey of stakeholders revealed that the views among the stakeholder groups followed the system hierarchy and could be separated into two large groups; staff responsible for implementing the reform initiative and the other stakeholder groups. Each of these groups was composed of identifiable subgroups. The interviews with stakeholders revealed how their different attitudes, values, and beliefs frame the context of stakeholder interactions. An over reliance on an authoritarian view of decision-making leaves many stakeholders feeling disempowered and critical of others. This atmosphere promotes blaming, which inhibits collegial interaction. Work experiences in the district office revealed how stakeholders' unaddressed assumptions, attitudes, and beliefs promote fragmentation and competition rather than cooperation. Hidden assumptions about management by control and mandate, competition, and teaching and learning appear to restrain the interactions of stakeholders. Support of the National Science Education Standards was identified as a unifying view among the stakeholders, yet the professional development program focused on content and pedagogical knowledge without addressing stakeholder concerns and beliefs about the intended constructivist framework of the program. Stakeholders' attitudes about the issue of equity demonstrated

  8. Competition policy for health care provision in Portugal. (United States)

    Barros, Pedro Pita


    We review the role of competition among healthcare providers in Portugal, which has a public National Health Service (NHS) at the core of the health system. There is little competition among healthcare providers within the NHS. Competition among NHS primary care providers is hindered by excess demand (many residents in Portugal do not have a designated family doctor). Competition among NHS hospitals has been traditionally limited to cases of maximum guaranteed waiting time for surgery being exceeded. The Portuguese Competition Authority enforces competition law. It has focused on mergers between private hospitals and abuse of market power (including cartel cases) by private healthcare providers. The Healthcare Regulation Authority produced several reports on particular areas of activity by private healthcare providers. The main conclusion of these reviews was lack of conditions for effective competition, with the exception of dentistry. Within the NHS, the use of tendering procedures was able to create "competition for the market" in particular areas though it was not problem free. Details in the particular design adopted matter a lot. Overall, the scope for competition policy and for competition among healthcare providers to have a main role in a health system based on a public National Health Service seems limited, with more relevance to "competition for the market" situations than to "competition in the market".

  9. Reform of the Buy-and-Bill System for Outpatient Chemotherapy Care Is Inevitable: Perspectives from an Economist, a Realpolitik, and an Oncologist. (United States)

    Polite, Blase; Conti, Rena M; Ward, Jeffery C


    Treating patients with cancer with infused or injected oncolytics is a core component of outpatient oncology practice. Currently, practices purchase drugs and then bill insurers, colloquially called "buy and bill." Reimbursement for these drugs is the largest source of gross revenue for oncology practices, and as the prices of cancer drugs have grown over time, these purchases have had significant impact on the financial health of practices and pose a risk that jeopardizes the ability of many practices to operate and provide patient care. Medicare Part B spending on drugs is under political scrutiny because of federal spending pressures, and the margin between buy and bill, lowered to 6% by the Medicare Modernization Act and further decreased to 4.3% by sequestration, is a convenient and popular target of budgetary discussions and proposals, scored to save billions of dollars over 10-year budget windows for each percentage-point reduction. Alternatives to the buy-and-bill system have been proposed to include invoice pricing, least costly alternative reimbursement, bundling of drugs into episode-of-care payments, shifting Part B drugs to the Medicare Part D benefit, and revision of the failed Competitive Acquisition Program. This article brings the perspectives of policy makers, health care economists, and providers together to discuss this major challenge in oncology payment reform.

  10. Adding home health care to the discussion on health information technology policy. (United States)

    Ruggiano, Nicole; Brown, Ellen L; Hristidis, Vagelis; Page, Timothy F


    The potential for health information technology to improve the efficiency and effectiveness of health care has resulted in several U.S. policy initiatives aimed at integrating health information technology into health care systems. However, home health care agencies have been excluded from incentive programs established through policies, raising concerns on the extent to which health information technology may be used to improve the quality of care for older adults with chronic illness and disabilities. This analysis examines the potential issues stemming from this exclusion and explores potential opportunities of integrating home health care into larger initiatives aimed at establishing health information technology systems for meaningful use.

  11. Analysis of Ukrainian legislation on state anti-corruption policy at the present stage of the reform

    Directory of Open Access Journals (Sweden)

    Liliia Bakunchyk


    Full Text Available In this article the state of implementation of anti-corruption policy in Ukraine has been analyzed. The basic legal and regulatory backgrounds of the country’s anti-corruption activities are examined. Based on analysis of the ways of improving the state anticorruption policy, improve the efficiency of its practical implementation in Ukraine. Corruption remains a major problem in Ukraine and continues to threaten its economic development, political stability, reputation (confidence level of the public authorities. Analyzing the phenomenon of corruption, it is necessary to emphasize that corruption is reformed in a reliable instrument to implement or achieve certain goals not only in individual format, but like leverage in the form of inter-state relations. This article shows the Ukraine’s achievement in the field of development the legislating basis for anticorruption policy, the practical instruments of its implementation on the institutional level. Steps made by the new elected authority involving publicity in order to improve the transparency and integrity building are reviewed as well as main tasks of the country to combat the corruption and the recommendations for its capability development. Combating corruption, our country has made considerable progress through the adoption of the anti-corruption legislation. It also covers reform of relevant government institutions that are unconditional guarantee of performance and implementing the rules. Many changes occurred and continue to occur with the support and under the close supervision of the foreign community, as well as a number of international organizations and institutions. At the same time, while preparing this materiel the influence of the international lessons learned experience had been taking in to consideration, which found its reflection and was actively implemented in the creating of anticorruption programs of governmental establishments as well as in Ministry of Defence.

  12. Foul weather friends: big business and health care reform in the 1990s in historical perspective. (United States)

    Swenson, Peter; Greer, Scott


    Existing accounts of the Clinton health reform efforts of the early 1990s neglect to examine how the change in big business reform interests during the short period between the late 1980s and 1994 might have altered the trajectory of compulsory health insurance legislation in Congress. This article explores evidence that big employers lost their early interest in reform because they believed their private remedies for bringing down health cost inflation were finally beginning to work. This had a discouraging effect on reform efforts. Historical analysis shows how hard times during the Great Depression also aligned big business interests with those of reformers seeking compulsory social insurance. Unlike the present case, however, the economic climate did not quickly improve, and the social insurance reform of the New Deal succeeded. The article speculates, therefore, that had employer health expenditures not flattened out, continuing and even growing big business support might have neutralized small business and other opposition that contributed heavily to the failure of reform. Thus in light of the Clinton administration's demonstrated willingness to compromise with business on details of its plan, some kind of major reform might have succeeded.

  13. Reform of the EU's climate policy. Small step or big hit?; Reform der EU-Klimapolitik. Kleiner Schritt oder grosser Wurf?

    Energy Technology Data Exchange (ETDEWEB)

    Janssen, Matthias; Peichert, Patrick; Perner, Jens; Riechmann, Christoph [Frontier Economics Ltd., Koeln (Germany)


    Emissions trading listed as a flexible mechanism under the Kyoto Protocol is regarded as a market economy way in climate protection. Since 2005 the European Emissions Trading System (EU ETS) is the central climate policy instrument for reducing the emissions of greenhouse gases, in particular for carbon dioxide (CO{sub 2}). For years, however, the CO{sub 2} price is too low to direct the politically and socially targeted technical innovations in the electricity sector and the industry. The article analyses the temporary and structural causes of this problem, highlights the EU's reform efforts and points to areas of activity, the basis of which the EU ETS may act in the future as a central instrument for climate protection in the European Union. [German] Der im Kyoto-Protokoll als flexibler Mechanismus aufgefuehrte Emissionshandel gilt als marktwirtschaftlicher Weg in den Klimaschutz. Das Europaeische Emissionshandelssystem (EU ETS) ist seit 2005 das zentrale klimapolitische Instrument zur Senkung des Ausstosses von Treibhausgasen, insbesondere fuer Kohlenstoffdioxid (CO{sub 2}). Seit Jahren ist der CO{sub 2}-Preis jedoch zu gering, um die politisch und gesellschaftlich angestrebten technischen Innovationen im Stromsektor und der Industrie zu lenken. Der Artikel untersucht die temporaeren und strukturellen Ursachen dieses Problems, beleuchtet die Reformbestrebungen der EU und zeigt Handlungsfelder auf, anhand derer das EU ETS auch in Zukunft als zentrales Instrument fuer Klimaschutz in der Europaeischen Union fungieren kann.

  14. Reforma del sector salud y la política farmacéutica en Perú Health sector reform and pharmaceutical policy in Peru

    Directory of Open Access Journals (Sweden)

    Carmen Phang Romero


    Full Text Available Este artículo analiza el Programa de Administración Compartida de Farmacias (PACFARM y su articulación con la Política Farmacéutica en Perú, en el contexto de la reforma del sector salud. La ejecución de los diversos Programas de Medicamentos Esenciales precedentes muestra el permanente esfuerzo por mejorar la cobertura con medicamentos esenciales a la población, no obstante, el marco jurídico en esta área presenta normas dispersas y desarticuladas, que dificultan la construcción de una Política Nacional de Medicamentos. El PACFARM es un sistema descentralizado de abastecimiento de medicamentos esenciales para el primer nivel de atención, auto-sustentado a través de fondos rotatorios. Mientras la ampliación de cobertura y la disminución de las barreras económicas de acceso a medicamentos esenciales fundamentaban lineamientos de una política farmacéutica, en tanto trazos de eficiencia gerencial en el suministro acompasaban la modernización de la gestión como parte de la reforma, otros aspectos dificultaron su implantación y limitaron sus efectos, tales como: la desregulación y los propios procesos de cambio en el sector. El abordaje metodológico incluyó técnicas cuali y cuantitativas, privilegiando el análisis de implantación del Programa.This article analyzes the Shared Pharmaceutical Management Program (PACFARM and its relationship to pharmaceutical policy in Peru within the scope of health sector reform. Implementation of various programs for essential medicines has involved an on-going effort towards improving the supply of essential drugs to the community. However, the corresponding legal framework includes random and disconnected regulations which hinder the feasibility of a consistent national drug policy. PACFARM is a decentralized system for the provision of essential medicines on a care-level basis, self-supported by revolving funds. While expanded coverage and decreased economic barriers to access to

  15. End of Life Care Policy for the Dying: Consensus Position Statement of Indian Association of Palliative Care


    Macaden, Stanley C; Naveen Salins; Maryann Muckaden; Priyadarshini Kulkarni; Anjum Joad; Vivek Nirabhawane; Srinagesh Simha


    EXECUTIVE SUMMARY Purpose: To develop an End of Life Care (EOLC) Policy for patients who are dying with an advanced life limiting illness. To improve the quality of care of the dying by limiting unnecessary therapeutic medical interventions, providing access to trained palliative care providers, ensuring availability of essential medications for pain and symptom control and improving awareness of EOLC issues through education initiatives. Evidence: A review of Country reports, observational s...

  16. State Child Care Policies for Limited English Proficient Families (United States)

    Firgens, Emily; Matthews, Hannah


    The Child Care and Development Block Grant (CCDBG), the largest source of federal funding for child care assistance available to states, provides low-income families with help paying for child care. Studies have shown that low-income LEP (limited English proficient), as well as immigrant families, are less likely to receive child care assistance.…

  17. Policy Brief: Petroleum product pricing reforms in India. Are we on the right track?

    Energy Technology Data Exchange (ETDEWEB)

    Agarwal, Pravin Kumar; Soni, Anmol


    The path to petroleum product pricing reforms in India has been full of undulations. Even though Administered Pricing Mechanism (APM) was dismantled during 1 April 1998 to 31 March 2002, the government continued to regulate the prices of petrol, diesel, Public distribution System (PDS) kerosene, and domestic LPG, except for over a year, when oil marketing companies (OMCs) revised the consumer prices of petrol and diesel in line with the international prices. In June 2010, petrol pricing was deregulated, but government control continued to an extent. This control of petroleum product prices has not only severely affected the fiscal balance of the economy, but has also adversely impacted the oil companies (both upstream and downstream), eventually affecting the overall development of the sector. In fact, the impact of petroleum product subsidies has compelled the government to announce certain reforms in the past few months.

  18. Science education reform in Confucian learning cultures: teachers' perspectives on policy and practice in Taiwan (United States)

    Huang, Ying-Syuan; Asghar, Anila


    This empirical study investigates secondary science teachers' perspectives on science education reform in Taiwan and reflects how these teachers have been negotiating constructivist and learner-centered pedagogical approaches in contemporary science education. It also explores the challenges that teachers encounter while shifting their pedagogical focus from traditional approaches to teaching science to an active engagement in students' learning. Multiple sources of qualitative data were obtained, including individual interviews with science teachers and teachers' reflective journals about Confucianism in relation to their educational philosophies. Thematic analysis and constant comparative method were used to analyze the data. The findings revealed that Confucian traditions play a significant role in shaping educational practices in Taiwan and profoundly influence teachers' epistemological beliefs and their actual classroom practice. Indeed, science teachers' perspectives on Confucian learning traditions played a key role in supporting or obstructing their pedagogical commitments to inquiry-based and learner-centered approaches. This study draws on the literature concerning teachers' professional struggles and identity construction during educational reform. Specifically, we explore the ways in which teachers respond to educational changes and negotiate their professional identities. We employed various theories of identity construction to understand teachers' struggles and challenges while wrestling with competing traditional and reform-based pedagogical approaches. Attending to these struggles and the ways in which they inform the development of a teacher's professional identity is vital for sustaining current and future educational reform in Taiwan as well as in other Eastern cultures. These findings have important implications for teachers' professional development programs in East Asian cultures.

  19. Public policy and medical tourism: ethical implications for the Egyptian health care system. (United States)

    Haley, Bob


    Egypt's medical tourism industry has been experiencing tremendous growth. However, Egypt continues to lack the necessary investment in its public health system to effectively care for its population. Current policy and the emergence of medical tourism have led to unequal health care access, resulting in high a prevalence of infectious diseases and lack of resources for its most vulnerable populations. As a new Egyptian government emerges, it is important for policymakers to understand the critical issues and ethical concerns of existing health policy. This understanding may be used to propose new policy that more effectively allocates to care for Egypt's population.

  20. A governance model for integrated primary/secondary care for the health-reforming first world – results of a systematic review (United States)


    Background Internationally, key health care reform elements rely on improved integration of care between the primary and secondary sectors. The objective of this systematic review is to synthesise the existing published literature on elements of current integrated primary/secondary health care. These elements and how they have supported integrated healthcare governance are presented. Methods A systematic review of peer-reviewed literature from PubMed, MEDLINE, CINAHL, the Cochrane Library, Informit Health Collection, the Primary Health Care Research and Information Service, the Canadian Health Services Research Foundation, European Foundation for Primary Care, European Forum for Primary Care, and Europa Sinapse was undertaken for the years 2006–2012. Relevant websites were also searched for grey literature. Papers were assessed by two assessors according to agreed inclusion criteria which were published in English, between 2006–2012, studies describing an integrated primary/secondary care model, and had reported outcomes in care quality, efficiency and/or satisfaction. Results Twenty-one studies met the inclusion criteria. All studies evaluated the process of integrated governance and service delivery structures, rather than the effectiveness of services. They included case reports and qualitative data analyses addressing policy change, business issues and issues of clinical integration. A thematic synthesis approach organising data according to themes identified ten elements needed for integrated primary/secondary health care governance across a regional setting including: joint planning; integrated information communication technology; change management; shared clinical priorities; incentives; population focus; measurement – using data as a quality improvement tool; continuing professional development supporting joint working; patient/community engagement; and, innovation. Conclusions All examples of successful primary/secondary care integration reported in

  1. Did capitation payment reform make a difference in Chinese rural primary health care?

    Directory of Open Access Journals (Sweden)

    Jing Sun


    Full Text Available This paper evaluated the effect of capitation payment reform in New Rural Cooperative Medical Scheme designating primary facilities in Qianjiang 2007-2009. Retrospective administrative claims were analyzed. Intercepts changes of cost per visit in facilities started the reform in different stages and of overall Qianjiang were compared. Referral rate, prescribing indicators, hospitalization rate, income of facility and individuals were compared pre- and post- the reform. Growth rate of cost per visit in health centers was contained in 2008, kept unchanged in 2009. Cost containment effect on village clinics was observed in each starting stage of reforms, but vanished later on. Except for the fact the proportion of essential medicines used in health centers significantly increased (X2 test, P<0.05, prescription indicators were not improved significantly in all facilities. After a slight increase in 2007, the hospitalization rate continuously dropped. The monthly income and outpatient revenue continuously increased in 2006-2009. Cost containment objective of the capitation reform was achieved immediately following the reform, but was not sustainable. Provider behaviors were partially improved with limited effects on prescriptions behaviors. The reform brought no financial loss to both the facilities and individuals.

  2. The Impact of Immigration Policy on Education Reform: Implications for the New Millennium. (United States)

    Contreras, A. Reynaldo


    Analyzes how immigration policy affects educators' efforts to teach in schools serving immigrant families, highlighting critical factors in meeting the needs of immigrant students (e.g., access to schools and differentiated curricula). Suggests that immigration policy affects education by facilitating a massive increase in immigrant enrollment,…

  3. Community Participation and Policy in Educational Reform Efforts: A Case Study of Knott County, Kentucky. (United States)

    Dixon, Marion W.

    A case study of an economically distressed rural Kentucky school district examined the theory that educational policy can enable community participation and that participation can enable policy implementation by affecting school governance and expanding the services provided. Primary data were gathered via interviews with four parent participants,…

  4. Balancing Tensions in Educational Policy Reforms: Large-Scale Implementation of Assessment for Learning in Norway (United States)

    Hopfenbeck, Therese N.; Flórez Petour, María Teresa; Tolo, Astrid


    This study investigates how different stakeholders in Norway experienced a government-initiated, large-scale policy implementation programme on "Assessment for Learning" ("AfL"). Data were collected through 58 interviews with stakeholders in charge of the policy; Ministers of Education and members of the Directorate of…

  5. Policy Intermediaries and the Reform of e-Education in South Africa (United States)

    Vandeyar, Thirusellvan


    Utilising a case study approach and backward mapping principles to policy implementation, this study set out to explore how well district and province's e-learning officials are equipped for the task of implementing the national e-Education policy. Qualitative methods were employed to capture data through interviews and document analysis. Data…

  6. Dewey and Italian School Policy: Proposals for Reform by Scuola e Città (1950–1960

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    Andrea Mariuzzo


    Full Text Available The paper analyses the role of Ernesto Codignola’s «Florence School of Pedagogy» in the renewal of Italian democratic and secular education after World War II, particularly its commitment to the diffusion of John Dewey’s educational thinking across Italy, previously dominated by the influence of traditional neo-idealism. Through a systematic analysis of the journal Scuola e Città, the group’s mouthpiece, the paper highlights the importance of Dewey’s ideas in the elaboration of educational policy proposals and potential legislative measures for school reform. It analyses the extent to which the «Deweyan laboratory» in Florence contributed to the emergence and foundation of the positions held by one of its exponents, Ernesto Codignola’s son Tristano – the Italian Socialist Party’s Education minister, in the parliamentary debate of the Sixties. The paper focuses on three main themes: (i assessment of the government’s primary school curricula, drawn up in the mid-fifties, characterized by an overhaul of the existing educational practices, which Scuola e città authors considered to be insufficient and contradictory; (ii universal access to a junior secondary education along the lines of the comprehensive school model to guide the active stimulation of students’ abilities and interests; and (iii school administration reform in response to the persistence of pre-war centralism and the authoritarian character of traditional Italian pedagogy.

  7. Music plus Music Integration: A Model for Music Education Policy Reform That Reflects the Evolution and Success of Arts Integration Practices in 21st Century American Public Schools (United States)

    Scripp, Lawrence; Gilbert, Josh


    This article explores the special case of integrative teaching and learning in music as a model for 21st century music education policy reform based on the principles that have evolved out of arts integration research and practices over the past century and informed by the recent rising tide of evidence of music's impact on brain capacity and…

  8. Influence of macro-economic growth, CAP reforms and biofuel policy on the Polish agri-food sector in 2007–2020

    NARCIS (Netherlands)

    Tabeau, A.A.


    This paper presents the possible development scenario of the Polish agricultural sector till 2020. It also assesses the impact of macroeconomic growth, CAP reforms and worldwide policies towards the agriculture on this development. The scenario is build using an extended version of the Global Trade

  9. Social limitations to livelihood adaptation : responses of maize-farming smallholder households to neoliberal policy reforms in Morelos, Southern Veracruz, Mexico

    NARCIS (Netherlands)

    Groenewald, S.F.


    This thesis describes the adaptation of smallholders to market changes shaped by neoliberal policy reforms in the Mexican maize sector. Contrary to expectations about smallholder responses to a liberalised maize market, in the study area maize still is the main source of income. Farmers did not leav

  10. Water Governance Decentralisation and River Basin Management Reforms in Hierarchical Systems: Do They Work for Water Treatment Policy in Mexico’s Tlaxcala Atoyac Sub-Basin?

    NARCIS (Netherlands)

    Casano Flores, Cesar; Vikolainen, Vera; Bressers, Hans


    In the last decades, policy reforms, new instruments development, and economic resources investment have taken place in water sanitation in Mexico; however, the intended goals have not been accomplished. The percentage of treated wastewater as intended in the last two federal water plans has not bee

  11. Actors and Ideology for Educational Policy Transfer: The Case of Education Reforms in the Two Koreas during the Soviet and US Military Occupation (United States)

    Kim, Sun


    This paper critically considers the notion of educational policy transfer by addressing the roles of significant actors, based on an analysis of educational reforms made during the Soviet and US military occupation in the two Koreas. Using evidence from the Korean cases, the paper challenges the state-centric, linear, and static views of…

  12. "Decentralised" Neoliberalism and/or "Masked" Re-Centralisation? The Policy to Practice Trajectory of Maltese School Reform through the Lens of Neoliberalism and Foucault (United States)

    Mifsud, Denise


    The politics of the later part of the twentieth century have been marked by the emergence of neoliberalism, which has consequently impregnated the global policy climate with neoliberal technologies of government. It is within this political scenario of hegemonic neoliberal discourse that I explore one aspect of school reform in Malta--contrived…

  13. Health care models guiding mental health policy in Kenya 1965 - 1997

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    Jenkins Rachel


    Full Text Available Abstract Background Mental health policy is needed to set the strategy and direction for the provision of mental health services in a country. Policy formulation does not occur in a vacuum, however, but is influenced by local and international factors in the health sector and other sectors. Methods This study was carried out in 1997 to examine the evolution of mental health policy in Kenya between 1965 and 1997 in the context of changing international concepts of health and development. Qualitative content analysis of policy documents was combined with interviews of key policy makers. Results The study showed that during the period 1965-1997 the generic health policy in Kenya changed from one based on the Medical Model in the 1960s and 1970s to one based on the Primary Health Care Model in the late 1970s and the 1980s and finally to one based on the Market Model of health care in the 1990s. The mental health policy, on the other hand, evolved from one based on the Medical Model in the 1960s to one based on the Primary Health Care Model in the 1990s, but did not embrace the Market Model of health care. This resulted in a situation in the 1990s where the mental health policy was rooted in a different conceptual model from that of the generic health policy under which it was supposed to be implemented. This "Model Muddlement" may have impeded the implementation of the mental health policy in Kenya. Conclusions Integration of the national mental health policy with the general health policy and other sector policies would be appropriate and is now underway.

  14. Operationalising unscheduled care policy: a qualitative study of healthcare professionals’ perspectives (United States)

    Drinkwater, Jessica; Salmon, Peter; Langer, Susanne; Hunter, Cheryl; Stenhoff, Alexandra; Guthrie, Elspeth; Chew-Graham, Carolyn


    Background UK health policy aims to reduce the use of unscheduled care, by increasing proactive and preventative management of patients with long-term conditions in primary care. Aim The study explored healthcare professionals’ understanding of why patients with long-term conditions use unscheduled care, and the healthcare professionals’ understanding of their role in relation to reducing the use of unscheduled care. Design and setting Qualitative study interviewing different types of healthcare professionals providing primary care or unscheduled care services in northwest England. Method Semi-structured interviews were conducted with 29 healthcare professionals (six GPs; five out-of-hours GPs; four emergency department doctors; two practice nurses; three specialist nurses; two district nurses; seven active case managers). Data were analysed using framework analysis. Results Healthcare professionals viewed the use of unscheduled care as a necessary component of care for patients with long-term conditions. Those whose roles involved working to targets to reduce the use of unscheduled care described a tension between this and delivering optimum patient care. Three approaches to reducing unscheduled care were described: optimising the system; negotiating the system; and optimising the patient. Conclusion Current policy to reduce the use of unscheduled care does not take account of the perceptions of the healthcare professionals who are expected to implement them. Lipsky’s theory of street-level bureaucrats provides a framework to understand how healthcare professionals respond to imposed policies. Healthcare professionals did not see the use of unscheduled care as a problem and there was limited commitment to the policy targets. Therefore, policy should aim for whole-system change rather than reliance on individual healthcare professionals to make changes in their practice. PMID:23561786

  15. Change of government: one more big bang health care reform in England's National Health Service. (United States)

    Hunter, David J


    Once again the National Health Service (NHS) in England is undergoing major reform, following the election of a new coalition government keen to reduce the role of the state and cut back on big government. The NHS has been undergoing continuous reform since the 1980s. Yet, despite the significant transaction costs incurred, there is no evidence that the claimed benefits have been achieved. Many of the same problems endure. The reforms follow the direction of change laid down by the last Conservative government in the early 1990s, which the recent Labour government did not overturn despite a commitment to do so. Indeed, under Labour, the NHS was subjected to further market-style changes that have paved the way for the latest round of reform. The article considers the appeal of big bang reform, questions its purpose and value, and critically appraises the nature and extent of the proposed changes in this latest round of reform. It warns that the NHS in its current form may not survive the changes, as they open the way to privatization and a weakening of its public service ethos.

  16. Unemployment protection reform in Belgium, Finland, the Netherlands, and the UK: policy learning through open coordination?

    NARCIS (Netherlands)

    M. van Gerven; M. Beckers


    This book examines how and to what extent the European Employment Strategy and the Open Method of Coordination (OMC) on Social Protection and Social Inclusion have influenced national labour market and social welfare policies.

  17. Against the odds: the OMC as a selective amplifier for reforming Belgian pension policies

    NARCIS (Netherlands)

    Vanhercke, B.


    Tackling pensions' problems means engaging with what Pierson (2001) has called 'immovable objects'. Additionally, the EU competence for drafting specific legislation in this area remains unfulfilled potential, while EU legislation in other policy areas creates indirect pressures on national pension

  18. End of life care policy for the dying: Consensus position statement of indian association of palliative care

    Directory of Open Access Journals (Sweden)

    Stanley C Macaden


    Full Text Available Purpose: To develop an End of Life Care (EOLC Policy for patients who are dying with an advanced life limiting illness. To improve the quality of care of the dying by limiting unnecessary therapeutic medical interventions, providing access to trained palliative care providers, ensuring availability of essential medications for pain and symptom control and improving awareness of EOLC issues through education initiatives. Evidence: A review of Country reports, observational studies and key surveys demonstrates that EOLC in India is delivered ineffectively, with a majority of the Indian population dying with no access to palliative care at end of life and essential medications for pain and symptom control. Limited awareness of EOLC among public and health care providers, lack of EOLC education, absent EOLC policy and ambiguous legal standpoint are some of the major barriers in effective EOLC delivery. Recommendations: Access to receive good palliative and EOLC is a human right. All patients are entitled to a dignified death. Government of India (GOI to take urgent steps towards a legislation supporting good EOLC, and all hospitals and health care institutions to have a working EOLC policy Providing a comprehensive care process that minimizes physical and non physical symptoms in the end of life phase and ensuring access to essential medications for pain and symptom control Palliative care and EOLC to be part of all hospital and community/home based programs Standards of palliative and EOLC as established by appropriate authorities and Indian Association of Palliative Care (IAPC met and standards accredited and monitored by national and international accreditation bodies All health care providers with direct patient contact are urged to undergo EOLC certification, and EOLC training should be incorporated into the curriculum of health care education.

  19. Drug policy reform and the reclassification of cannabis in England and Wales: A cautionary tale. (United States)

    Shiner, Michael


    When the legal classification of cannabis was downgraded in 2004 it represented the most significant liberalisation of British drug law in more than 30 years. Paradoxically, however, this apparently progressive reform led to an intensification of police efforts targeting minor possession offences and its failure was confirmed in January 2009 when the decision to downgrade cannabis was reversed. This article documents the impact that reclassification had on law enforcement activities and seeks to explain why it failed to deliver a more progressive approach. Drawing on official statistics, the analysis charts the process of net-widening that followed the reform, identifying a sharp increase in the number of people caught in the criminal justice net for minor possession offences. While police targeting of such offences was an unintended consequence of performance targets, broader political influences were also at play. The contradictions and reversals involved in the reclassification of cannabis, it is argued, can be readily understood in terms of the broader politics of crime and control and the 'structured ambivalence' of state responses.

  20. Women-friendly policy paradoxes?! Child Care policies and gender equality visions in Scandinavia

    DEFF Research Database (Denmark)

    Borchorst, Anette


    The chapter focuses on the political construction of the equality-difference dilemma in Scandinavian welfare policies. Different policy logics of childcare policies in Sweden, Norway and Denmark are addressed and the visions of gender equality underpinning them are analyzed....

  1. The modernization of American public law: health care reform and popular constitutionalism. (United States)

    Super, David A


    The Patient Protection and Affordable Care Act (ACA) transformed U.S. public law in crucial ways extending far beyond health care. As important as were the doctrinal shifts wrought by National Federation of Independent Business v. Sebelius, the ACA's structural changes to public law likely will prove far more important should they become entrenched. The struggle over the ACA has triggered the kind of "constitutional moment" that has largely replaced Article V's formal amendment procedure since the Prohibition fiasco. The Court participates in this process, but the definitive and enduring character of these constitutional moments' outcomes springs from broad popular engagement. Despite the Court's ruling and the outcome of the 2012 elections, the battle over whether to implement or shelve the ACA will continue unabated, both federally and in the states, until We the People render a clear decision. Whether the ACA survives or fails will determine the basic principles that guide the development of federalism, social insurance, tax policy, and privatization for decades to come. In each of these areas, the New Deal bequeathed us a delicate accommodation between traditionalist social values and modernizing norms of economic efficiency and interest group liberalism. This balance has come under increasing stress, with individual laws rejecting tradition far more emphatically than the New Deal did. But absent broad popular engagement, no definitive new principles could be established. The ACA's entrenchment would elevate technocratic norms across public law, the first change of our fundamental law since the civil rights revolution. The ACA's failure would rejuvenate individualistic, moralistic, pre-New Deal norms and allow opponents to attempt a counterrevolution against technocracy.

  2. The effects of national health care reform on local businesses--Part III: secondary research questions--discoveries and implications. (United States)

    Rotarius, Timothy; Liberman, Aaron; Perez, Bianca


    This is the third part of a 3-part examination of what may potentially be expected from the 2010 national health care reform legislation. Political researchers and pundits have speculated endlessly on the many changes mandated by the 2010 national health care reform legislation, styled the Patient Protection and Affordable Care Act. A review and assessment of this legislation at several levels (federal, state, state agency, local region, and individual business leaders) were undertaken. The results of this expanded analysis suggest strongly that nationally members of the business community and their employees will benefit from the legislation early on (years 1 through 3) and then likely will be impacted adversely as the payment mechanisms driving the legislation are tightened by new federal regulations (years 4 onward). As a result of this research, it is surmised that businesses will be immediately impacted by the legislation, with small business owners being the prime beneficiaries of the new legislation, owing to the availability of coverage to approximately 32 million individuals who previously had no access to coverage. In that regard, the soon-to-be newly insured population also will be a prime beneficiary of the legislation as the limitations on chronic illnesses and other preexisting conditions will be reduced or eliminated by the legislation.

  3. The effects of national health care reform on local businesses--part II: study methodology and primary research questions. (United States)

    Liberman, Aaron; Rotarius, Timothy; Perez, Bianca


    This is the second part of a 3-part examination of what may be potentially expected from the 2010 national health care reform legislation. Political researchers and pundits have speculated endlessly on the many changes mandated by the 2010 national health care reform legislation, styled the Patient Protection and Affordable Care Act. A review and assessment of this legislation at several levels (federal, state, state agency, local region, and individual business leaders) were undertaken. The results of this expanded analysis suggest strongly that, nationally, members of the business community and their employees will benefit from the legislation early on (years 1 through 3) and then likely will be impacted adversely as the payment mechanisms driving the legislation are tightened by new federal regulations (year 4 onward). As a result of this research, it is surmised that businesses will be immediately impacted by the legislation, with small business owners being the prime beneficiaries of the new legislation, owing to the availability of coverage to approximately 32 million individuals who previously had no access to coverage. In that regard, the soon-to-be-newly insured population also will be a prime beneficiary of the legislation as the limitations on chronic illnesses and other preexisting conditions will be reduced or eliminated by the legislation.

  4. The Influence of Trade Unions on Pension Reform in Romania and Hungary: The Role of Ideas, Interests and Institutions in Policy-Making

    Directory of Open Access Journals (Sweden)



    Full Text Available Although both Romania and Hungary have inherited pay-as-you-go defined benefit (PAYG-DB pensions systems, they have both moved towards a three-pillar pensions system, in which PAYG-DB becomes just one of three pillars together with the mandatory and the voluntary private pension funds.Trade unions have had an important influence on pension reform in both countries. The analysis of pension reform in Hungary and Romania brings evidence that trade unions’ influence on policy-making is not uniform, but it is shaped by the international policy discourse, by the institutional setting, by their relationship with other policy actors, by their organisational culture and even material inheritance.

  5. A Policy Analysis of Child Care Subsidies: Increasing Quality, Access, and Affordability (United States)

    Moodie-Dyer, Amber


    Changing family dynamics over the past four decades, including rises in the numbers of working mothers and single-parent families, have created an increased need for affordable child care. Government response to this need has involved a number of stop-and-start policy approaches, which have led to a fractured child care system that makes it…

  6. Experience from UK integrated care and the implications for health care reform in China%英国整合型保健发展经验及启示

    Institute of Scientific and Technical Information of China (English)

    谢春艳; 金春林; 王贤吉


    This paper summarized the practice and experience about integrated care carried out in UK through qualitative research methods including on-site observation and deep interview,especially the integration and coordination of health service and social service systems in recent years. And then some relevant policy recommendations were put forward on health care reform according to the problems of fragmented health care system in China,including developing primary health care and community health services,strengthening multidisciplinary team,building a gate keeping health care system in which GPs were the core,establishing mechanisms for communication and collaboration between the relevant government departments,and integrating multi-social service resources at the community level.%通过现场观察与深度访谈的定性研究方法,总结了英格兰NHS整合型保健的做法和经验,并针对我国卫生服务体系存在的碎片化问题,提出了相关的政策建议:大力发展初级卫生保健和社区卫生服务,加强以全科医生为核心的多学科服务团队建设,建立全科医生“守门人”制度,建立相关政府部门间的沟通协作机制,在社区层面横向整合多方社会服务资源等。

  7. Health literacy and the Affordable Care Act: a policy analysis for children with special health care needs in the USA

    Directory of Open Access Journals (Sweden)

    Keim-Malpass J


    Full Text Available Jessica Keim-Malpass,1 Lisa C Letzkus,1,2 Christine Kennedy1 1University of Virginia School of Nursing, 2University of Virginia Children’s Hospital, Charlottesville, VA, USA Abstract: Children with special health care needs (CSHCN represent populations with chronic health conditions that are often high utilizers of health care. Limited health literacy has emerged as a key indicator of adverse health outcomes, and CSHCN from limited health literacy families are particularly vulnerable. The purpose of this policy analysis is to outline key provisions in the Affordable Care Act (ACA that incorporate health literacy approaches for implementation and have implications for CSHCN in the USA. Several key provisions are incorporated in the ACA that involve health literacy and have implications for CSHCN. These include: expansion of public insurance coverage and simplifying the enrollment process, provisions assuring equity in health care and communication among all populations, improving access to patient-centered medical homes that can offer care coordination, ensuring enhanced medication safety by changing liquid medication labeling requirements, and provisions to train health care providers on literacy issues. More research is needed to determine how provisions pertaining to health literacy in the ACA are implemented in various states. Keywords: children, special health care needs, health literacy, Affordable Care Act, health policy  

  8. Water Governance Decentralisation and River Basin Management Reforms in Hierarchical Systems: Do They Work for Water Treatment Policy in Mexico’s Tlaxcala Atoyac Sub-Basin?

    Directory of Open Access Journals (Sweden)

    Cesar Casiano Flores


    Full Text Available In the last decades, policy reforms, new instruments development, and economic resources investment have taken place in water sanitation in Mexico; however, the intended goals have not been accomplished. The percentage of treated wastewater as intended in the last two federal water plans has not been achieved. The creation of River Basin Commissions and the decentralisation process have also faced challenges. In the case of Tlaxcala, the River Basin Commission exists only on paper and the municipalities do not have the resources to fulfil the water treatment responsibilities transferred to them. This lack of results poses the question whether the context was sufficiently considered when the reforms were enacted. In this research, we will study the Tlaxcala Atoyac sub-basin, where water treatment policy reforms have taken place recently with a more context sensitive approach. We will apply the Governance Assessment Tool in order to find out whether the last reforms are indeed apt for the context. The Governance Assessment Tool includes four qualities, namely extent, coherence, flexibility, and intensity. The assessment allows deeper understanding of the governance context. Data collection involved semi-structured in-depth interviews with stakeholders. The research concludes that the observed combination of qualities creates a governance context that partially supports the implementation of the policy. This has helped to increase the percentage of wastewater treated, but the water quality goals set by the River Classification have not been achieved. With the last reforms, in this hierarchical context, decreasing the participation of municipal government levels has been shown to be instrumental for improving water treatment plants implementation policy, although many challenges remain to be addressed.

  9. Education Policy and "Friedmanomics": Free Market Ideology and Its Impact on School Reform (United States)

    Fiala, Thomas J.; Owens, Deborah Duncan


    The purpose of this paper is to examine the impact of neoliberal ideology, and in particular, the economic and social theories of Milton Friedman on education policy. The paper takes a critical theoretical approach in that ultimately the paper is an ideological critique of conservative thought and action that impacts twenty-first century education…

  10. Universal Basic Education in Nigeria: Adult Literacy Practice and Policy Reform Needs (United States)

    Kazeem, Kolawole; Oduaran, Akpovire


    Innovative policies and practices in mainstreaming adult education on the basis of UNESCO's model of Education for All (EFA) among member states take different forms. In Nigeria, EFA has been conceptualised as the Universal Basic Education (UBE) programme. UBE has dominated some of the major political options that governments have had to make in…

  11. The Ghosts of Higher Education Reform: On the Organisational Processes Surrounding Policy Borrowing (United States)

    Brøgger, Katja


    The Bologna Process is one of the most extensive examples of policy borrowing processes. Based on qualitative data, this article argues in favour of studying part of this process as "global smallness", centring on the organisational effects of the implementation of a globalised curriculum. Through Derrida's notion on hauntology,…

  12. Education Policy as an Act of White Supremacy: Whiteness, Critical Race Theory and Education Reform (United States)

    Gillborn, David


    The paper presents an empirical analysis of education policy in England that is informed by recent developments in US critical theory. In particular, I draw on 'whiteness studies' and the application of critical race theory (CRT). These perspectives offer a new and radical way of conceptualizing the role of racism in education. Although the US…

  13. Ideational Leadership in German Welfare State Reform. How Politicians and Policy Ideas Transform Resilient Institutions

    NARCIS (Netherlands)

    Stiller, S.J.


    editors of the series Gøsta Esping-Andersen, University of Pompeu Fabra, Barcelona, Spain Anton Hemerijck, the Netherlands Scientific Council for Government Policy (Wetenschappelijke Raad voor het Regeringsbeleid - wrr) Kees van Kersbergen, Free University Amsterdam, the Netherlands Kimberly Morgan,

  14. The Medicalization of Current Educational Research and Its Effects on Education Policy and School Reforms (United States)

    Tröhler, Daniel


    This paper starts from the assumption of the emergence of an educationalized culture over the last 200 years according to which perceived social problems are translated into educational challenges. As a result, both educational institutions and educational research grew, and educational policy resulted from negotiations between professionals,…

  15. Public- Private- Partnership Policy: Proposed Nigerian Reform Programme for Electricity Development

    Directory of Open Access Journals (Sweden)

    Samuel Nnamdi Marcus


    Full Text Available The study examines the public private partnership policy in Nigeria as a panacea to the development and management of electricity in Nigeria. The study is descriptive and its objective is proposing an alternative policy that will ensure the sustainable development of electricity in Nigeria. The heavy presence of government in energy development did not seem to encourage desirable development in the sector. The SAP, Vision 2010, and NEP 1999 proposed deregulatory approach relying on private sector led development approach for the development of utilities. The NEEDS 2004 clearly and specifically proposes the PPP approach under the deregulatory devices. PPP as a contractual arrangement between the public and private sectors operators constitutes an approach to achieve well defined and shared objectives in a well-managed, cost-effective, efficient and sustainable manner, hence, is con-sidered in the paper. Findings suggest that forms of the PPP are given for consideration to bail Nigeria out of the impacts of poor quality, unreliable and limited availability of power-supply, presumed partly due to government led-development approach. The paper contains some policy issues such as the encouragement of private sector participation in the provision of energy infrastructure within the public- private- partnership policy (PPP framework.

  16. Reflection on the Education Policy Orientation in Post-May 31 Reform in Korea (United States)

    Lee, Chong Jae; Kim, Yong


    For the last 70 years, since the establishment of the Republic of Korea, Korean education has achieved universal expansion of educational opportunity from elementary to secondary to higher education. Planning, centralized policy making, top-down implementation, and administrative control had been the standards of the first few decades of Korean…

  17. The Impact of Research on Policy: A Case of Qualifications Reform (United States)

    Noyes, Andrew; Adkins, Michael


    The relationship between research and policymaking has been discussed repeatedly. However, the debate tends to be in general, abstract terms or from a macroeconomic perspective with any examples described in a fairly cursory way. Despite the inherent complexity of the research-policy interface, analyses tend to homogenise "research" and…

  18. Alternatively Certified Teachers in Urban Small Schools: Where Policy Reform Meets the Road (United States)

    Carter, Julie H.; Keiler, Leslie S.


    In this study we explore the experiences of new teachers in urban schools at the intersection of three major policy agendas--alternative certification, new teacher retention, and the small schools movement. We examine alternatively certified teachers' perceptions of the rewards and challenges of teaching in small schools, the support neophyte…

  19. Competency-based Training: Evidence of a Failed Policy in Training Reform. (United States)

    Cornford, Ian R.


    Examines whether competency-based training is working in practice in Australian vocational education and whether it is producing superior skill performance. Explores the ideological nature of the competency-based training policy framework and the nature of related research commissioned by government agencies. Reviews the empirical evidence that…

  20. The Swedish national dental insurance and dental health care policy

    DEFF Research Database (Denmark)

    Moore, Rod


    Sweden initiated a dental health care insurance in 1973. The health insurance is outlined, current problems and political issues are described. The benefits and limitations are described.......Sweden initiated a dental health care insurance in 1973. The health insurance is outlined, current problems and political issues are described. The benefits and limitations are described....

  1. The basis for improving and reforming long-term care. Part 4: identifying meaningful improvement approaches (segment 2). (United States)

    Levenson, Steven A


    While many aspects of nursing home care have improved over time, numerous issues persist. Presently, a potpourri of approaches and a push to "fix" the problem have overshadowed efforts to correctly define the problems and identify their diverse causes. This fourth and final article in the series (divided between last month's issue and this one) recommends strategies to make sense of improvement and reform efforts. This month's concluding segment covers additional proposed approaches. Despite the challenges of the current environment, all of the proposed strategies could potentially be applied with little or no delay. Despite having brought vast increases in knowledge, the research effort may be losing its traction as a formidable force for meaningful change. It is necessary to rethink the questions being asked and the scope of answers being sought. A shift to overcoming implementation challenges is needed. In addition, it is essential to address issues of jurisdiction (the apparent "ownership" of assessment and decision making over patient problems or body parts) and reductionism (the excessive management of these issues and problems without proper context) that result in fragmented and problematic care. Issues of knowledge and skill also need to be addressed, with greater emphasis on key generic and technical competencies of staff and practitioners, in addition to factual knowledge. There is a need to rethink the approach to measuring performance and trying to improve quality of care and services. There are significant limits to trying to use quality measures to improve outcomes and performance. Ultimately, vast improvement is needed in applying care principles and practices, independent of regulatory sources. Reimbursement needs to be revamped so that it helps promote care that is consistent with human biology and other key concepts. Finally, improving long-term care will require a coordinated societal effort. All social institutions and health care settings need

  2. Hospices' enrollment policies may contribute to underuse of hospice care in the United States. (United States)

    Aldridge Carlson, Melissa D; Barry, Colleen L; Cherlin, Emily J; McCorkle, Ruth; Bradley, Elizabeth H


    Hospice use in the United States is growing, but little is known about barriers that terminally ill patients may face when trying to access hospice care. This article reports the results of the first national survey of the enrollment policies of 591 US hospices. The survey revealed that 78 percent of hospices had at least one enrollment policy that may restrict access to care for patients with potentially high-cost medical care needs, such as chemotherapy or total parenteral nutrition. Smaller hospices, for-profit hospices, and hospices in certain regions of the country consistently reported more limited enrollment policies. We observe that hospice providers' own enrollment decisions may be an important contributor to previously observed underuse of hospice by patients and families. Policy changes that should be considered include increasing the Medicare hospice per diem rate for patients with complex needs, which could enable more hospices to expand enrollment.

  3. The Influence of a Policy Document in the Practice of Intersectorial Collaboration in Danish Health Care

    DEFF Research Database (Denmark)

    Andersen, Anne Bendix; Beedholm, Kirsten; Kolbæk, Raymond

    Background Policy documents are powerful actors in health care, and they play a significant role because they produce certain discursive and non-discursive conditions for intersectorial collaboration. Central documents in Denmark are the Health Agreements. These policy documents set out the premi...... of language, constructs the actors in intersectorial collaboration within the framework of a market-economy understanding, the goal being to increase productivity and efficiency in health care delivery.......Background Policy documents are powerful actors in health care, and they play a significant role because they produce certain discursive and non-discursive conditions for intersectorial collaboration. Central documents in Denmark are the Health Agreements. These policy documents set out...... the premises for collaboration between hospitals, municipalities, and general practitioners in the five regions. This area is traditionally contested, and the intention of the Health Agreements is to be a guideline for the allocation of tasks and responsibilities within the collaboration. Aim • To exemplify...

  4. Healthcare reform and the next generation: United States medical student attitudes toward the Patient Protection and Affordable Care Act.

    Directory of Open Access Journals (Sweden)

    Kristin M Huntoon

    Full Text Available CONTEXT: Over one year after passage of the Patient Protection and Affordable Care Act (PPACA, legislators, healthcare experts, physicians, and the general public continue to debate the implications of the law and its repeal. The PPACA will have a significant impact on future physicians, yet medical student perspectives on the legislation have not been well documented. OBJECTIVE: To evaluate medical students' understanding of and attitudes toward healthcare reform and the PPACA including issues of quality, access and cost. DESIGN, SETTING, AND PARTICIPANTS: An anonymous electronic survey was sent to medical students at 10 medical schools (total of 6982 students between October-December 2010, with 1232 students responding and a response rate of 18%. MAIN OUTCOME MEASURES: Medical students' views and attitudes regarding the PPACA and related topics, measured with Likert scale and open response items. RESULTS: Of medical students surveyed, 94.8% agreed that the existing United States healthcare system needs to be reformed, 31.4% believed the PPACA will improve healthcare quality, while 20.9% disagreed and almost half (47.7% were unsure if quality will be improved. Two thirds (67.6% believed that the PPACA will increase access, 6.5% disagreed and the remaining 25.9% were unsure. With regard to containing healthcare costs, 45.4% of participants indicated that they are unsure if the provisions of the PPACA will do so. Overall, 80.1% of respondents indicated that they support the PPACA, and 78.3% also indicated that they did not feel that reform efforts had gone far enough. A majority of respondents (58.8% opposed repeal of the PPACA, while 15.0% supported repeal, and 26.1% were undecided. CONCLUSION: The overwhelming majority of medical students recognized healthcare reform is needed and expressed support for the PPACA but echoed concerns about whether it will address issues of quality or cost containment.

  5. Telecom Reform

    DEFF Research Database (Denmark)

    and information infrastructure issues - for people in government, academia, industry and the consulting community. This book addresses the process of policy and regulatory reform in telecom that is now in its formative stage. It draws on detailed knowledge of industry development and regulatory experience...

  6. Impact of Alabama's immigration law on access to health care among Latina immigrants and children: implications for national reform. (United States)

    White, Kari; Yeager, Valerie A; Menachemi, Nir; Scarinci, Isabel C


    We conducted in-depth interviews in May to July 2012 to evaluate the effect of Alabama's 2011 omnibus immigration law on Latina immigrants and their US- and foreign-born children's access to and use of health services. The predominant effect of the law on access was a reduction in service availability. Affordability and acceptability of care were adversely affected because of economic insecurity and women's increased sense of discrimination. Nonpregnant women and foreign-born children experienced the greatest barriers, but pregnant women and mothers of US-born children also had concerns about accessing care. The implications of restricting access to health services and the potential impact this has on public health should be considered in local and national immigration reform discussions.

  7. Reforming Management of Behavior Symptoms and Psychiatric Conditions in Long-Term Care Facilities: A Different Perspective. (United States)

    Levenson, Steven A; Desai, Abhilash K


    Despite much attention including national initiatives, concerns remain about the approaches to managing behavior symptoms and psychiatric conditions across all settings, including in long-term care settings such as nursing homes and assisted living facilities. One key reason why problems persist is because most efforts to "reform" and "correct" the situation have failed to explore or address root causes and instead have promoted inadequate piecemeal "solutions." Further improvement requires jumping off the bandwagon and rethinking the entire issue, including recognizing and applying key concepts of clinical reasoning and the care delivery process to every situation. The huge negative impact of cognitive biases and rote approaches on related clinical problem solving and decision making and patient outcomes also must be addressed.

  8. Hospital Managers’ Perception of Recent Health Care Reform in Teaching Hospitals of Qazvin, Iran

    Directory of Open Access Journals (Sweden)

    Zakaria Kiaei


    Full Text Available Background The main purpose of any government from a healthcare reform is to improve the service quality and raised public satisfaction. Objectives As the important role of managerial human resources in any organizational changes, this paper tried to examine the point of view of this group about the recent reform in governmental hospitals of Qazvin. Patients and Methods This cross-sectional study was conducted in January 2015. The statistical population consisted of 50 executive managers of Qazvin teaching hospitals. The data gathering instrument was a research-made questionnaire with approved reliability and validity (α = 0.84. Data analyse was performed in SPSS version 20 using descriptive and analytic statistics (analysis of variance (ANOVA, Pearson correlation test and one sample t-test. Results A total of 43.2% of managers believed that this reform was a good restrictor for malpractices in healthcare and 31.8% believed that it will not be so useful to improve the society health status. The average score of resource preparation, insurance companies coordination, changing the routine workflows, and finally achieving the goals, had a meaningful difference (P ˂ 0.05 and the average score of these fields were upper than average. Conclusions The findings showed that based on the managers’ point of view, the reform plan was able to achieve its primary goals; however, it could not meet their exceptions in improving the society health status. Therefore, it is necessary to design some interventions for changing this perception.

  9. The Effect of the Common Agricultural Policy Reform by 2013 on Direct Payments in Relation to Animal Welfare in the European Union - Review

    Directory of Open Access Journals (Sweden)

    Marek Angelovič


    Full Text Available The primary role of agriculture is to provide food and the European Union should be able to contribute to rising world food demand. The Common Agriculture Policy covers the wide variety of measures used to support and protect the European Union farmers. The most important measure within the Common Agriculture Policy is direct payments paid directly to farmers to protect their income. The Common Agriculture Policy is due to be reformed by 2013. The main object of the Common Agriculture Policy, which is a provision of safe, healthy choice of food at transparent and affordable prices, will remain unchanged, but further changes of the Common Agriculture Policy are necessary to respond to the new challenges such as animal welfare, global food security, natural resources such as water, air, biodiversity and soil, climate changes, increasing globalization and rising price volatility.

  10. Developing a Child and Youth Mental Health and Addictions Framework for Yukon as a Foundation for Policy Reform: Engaging Stakeholders Through a Policy and Research Partnership

    Directory of Open Access Journals (Sweden)

    Gillian Mulvale


    Full Text Available In April 2015 the Yukon Government released a new child and youth mental health and addictions framework (CYMHAF to improve territory-wide access to basic mental health care and coordination of services for children and families. Yukon’s limited resource base and dispersed population challenges delivery of child and youth mental health and addictions services to small rural communities where needs are often high as a legacy of residential school policies. The objective of CYMHAF is to improve outcomes by identifying and capitalizing on current strengths, and reallocating existing resources to better meet the mental health needs of Yukon youth and families. Access, coordination and quality problems associated with existing services, growing public awareness of mental health issues, and a new national policy framework designed to assist provinces and territories, led Yukon policy makers to partner with researchers to capitalize on a Canadian Institutes of Health Research (CIHR strategic grant initiative. CYMHAF was based on extensive stakeholder engagement, best evidence and advice from key informants in other jurisdictions, and offers a cascading model of service delivery through which basic mental health care can be provided by existing health and human service workers in communities. These workers will be trained in child and youth mental health competencies, and will have electronic linkages and support to integrated teams of primary care providers who will be located in regional hubs once fully implemented, and to specialists in Whitehorse and out of Territory. Implementation is underway with some training of front line Health and Social Service and First Nations workers, a new mental wellness strategy for Yukon founded on CYMHAF scheduled for release in spring 2016, and may be accelerated by federal government promises of a new Health Accord and a new relationship with indigenous people.

  11. The Growth of China and India: Implications and Policy Reform Options for Malaysia


    Ianchovichina, Elena; Ivanic, Maros; Martin, Will


    This study explores the trade-related impacts of rapid growth of China and India on the Malaysian economy and evaluates policy options to better position Malaysia to take advantage of these changes. Higher growth in China and India is likely to raise Malaysia's national income and to expand Malaysia's natural resource and agricultural exports, while putting downward pressure on exports from some manufacturing and service sectors. Increases in the quality and variety of exports from China and ...

  12. The reformation of gambling policy and its social impact in Hong Kong



    The gambling policy of Hong Kong had been adopted for more than thirty years without any significant changes since the introducing of the Gambling Ordinance (Chapter 148) in accordance with the Betting Duty Ordinance (Chapter 108) in the 1970s. Under the ordinances, all gambling activities which were not played on a social occasion for non-business purpose were unlawful except some specifically permission offered by the Home Affairs Bureau (HAB). Among all these exemptions, horse race bettin...

  13. Evaluation of policy options to reform the EU Emissions Trading System. Effects on carbon price, emissions and the economy

    Energy Technology Data Exchange (ETDEWEB)

    Verdonk, M.; Brink, C.; Vollebergh, H.; Roelfsema, M.


    The EU Emissions Trading System (EU ETS) is a key instrument of EU climate policy, providing a clear reduction pathway for CO2 emissions. The current carbon price (of about 3 euros per tonne of CO2, April 2013) is much lower than previously expected (which was around 30 euros) and is likely to remain low for a long time. This fuels doubts about whether the ETS will remain a key policy instrument in the long term. Such doubts also increase investment uncertainty, which is likely to have a negative impact on further investments in low-carbon technologies needed for a low-carbon economy in 2050. In November 2012, the European Commission put forward six options for a more structural reform of the EU ETS. The proposed options vary from reducing the cap and expanding the ETS to include other sectors, to strengthening the ETS by measures directly affecting allowance prices. The Dutch Ministry of Infrastructure and the Environment (IenM) asked the PBL Netherlands Environmental Assessment Agency to assess the impact of these options. Four categories of options for reforming the ETS were evaluated: (1) reducing the supply of emission allowances; (2) expanding the ETS by including other sectors; (3) a minimum price for auctioned allowances; and (4) combining ETS with a carbon tax. Recently, the European Parliament voted against the European Commission's proposal to temporarily set aside emission allowances. In an earlier assessment of this proposal, PBL concluded that the impact of this backloading proposal on CO2 prices is likely to be limited, because the total amount of allowances up to 2020 would remain unchanged. All options analysed would reduce emissions and cause the emission price to increase. A minimum price on carbon, however, would provide the best opportunity to make the ETS more robust against unforeseen events, such as a further deterioration of the economy. Such a minimum price would result in more emission reductions if abatement proves to be cheaper

  14. Making Meaningful Improvements to Direct Care Worker Training Through Informed Policy: Understanding How Care Setting Structure and Culture Matter. (United States)

    Kemeny, M Elizabeth; Mabry, J Beth


    Well-intentioned policy governing the training of direct care workers (DCWs) who serve older persons, in practice, may become merely a compliance issue for organizations rather than a meaningful way to improve quality of care. This study investigates the relationships between best practices in DCW training and the structure and culture of long term support service (LTSS) organizations. Using a mixed-methods approach to analyzing data from 328 licensed LTSS organizations in Pennsylvania, the findings suggest that public policy should address methods of training, not just content, and consider organizational variations in size, training evaluation practices, DCW integration, and DCW input into care planning. Effective training also incorporates support for organizations and supervisors as key aspects of DCWs' learning and working environment.

  15. The establishment of a primary spine care practitioner and its benefits to health care reform in the United States

    Directory of Open Access Journals (Sweden)

    Donald Murphy R


    Full Text Available Abstract It is widely recognized that the dramatic increase in health care costs in the United States has not led to a corresponding improvement in the health care experience of patients or the clinical outcomes of medical care. In no area of medicine is this more true than in the area of spine related disorders (SRDs. Costs of medical care for SRDs have skyrocketed in recent years. Despite this, there is no evidence of improvement in the quality of this care. In fact, disability related to SRDs is on the rise. We argue that one of the key solutions to this is for the health care system to have a group of practitioners who are trained to function as primary care practitioners for the spine. We explain the reasons we think a primary spine care practitioner would be beneficial to patients, the health care system and society, some of the obstacles that will need to be overcome in establishing a primary spine care specialty and the ways in which these obstacles can be overcome.

  16. Developing public policy to advance the use of big data in health care. (United States)

    Heitmueller, Axel; Henderson, Sarah; Warburton, Will; Elmagarmid, Ahmed; Pentland, Alex Sandy; Darzi, Ara


    The vast amount of health data generated and stored around the world each day offers significant opportunities for advances such as the real-time tracking of diseases, predicting disease outbreaks, and developing health care that is truly personalized. However, capturing, analyzing, and sharing health data is difficult, expensive, and controversial. This article explores four central questions that policy makers should consider when developing public policy for the use of "big data" in health care. We discuss what aspects of big data are most relevant for health care and present a taxonomy of data types and levels of access. We suggest that successful policies require clear objectives and provide examples, discuss barriers to achieving policy objectives based on a recent policy experiment in the United Kingdom, and propose levers that policy makers should consider using to advance data sharing. We argue that the case for data sharing can be won only by providing real-life examples of the ways in which it can improve health care.

  17. [The list of drugs in the Popular Pharmacy Program and the Brazilian National Pharmaceutical Care Policy]. (United States)

    Yamauti, Sueli Miyuki; Barberato-Filho, Silvio; Lopes, Luciane Cruz


    This study aimed to analyze the list of drugs in the Popular Pharmacy Program in Brazil (PFPB) in relation to the country's pharmaceutical care policy. The list of drugs in the PFPB was compared to the Brazilian and international reference lists of essential medicines, the components of pharmaceutical care in Brazilian Unified National Health System (SUS), and drug production by the country's government pharmaceutical laboratories. The PFPB list includes 119 drugs, of which 19.3% and 47.1% were not selected on the Brazilian and international reference lists, respectively; 16.8% are not used in primary care, and 40.3% are not produced by the country's government laboratories. A revision of the PFPB list based on the essential medicines concept (World Health Organization), alignment of pharmaceutical care policies, and production by government laboratories are essential to improve quality of health care, management, training of prescribers, and information for the population.

  18. Science and Policy in Interaction: On practices of science policy interactions for policy-making in health care

    NARCIS (Netherlands)

    C. van Egmond (Stans)


    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

  19. Five Policy Levers To Meet The Value Challenge In Cancer Care. (United States)

    Callahan, Ryan; Darzi, Ara


    The burden of cancer on public finances is a serious concern for policy makers. More people are developing cancer, and as standards of care have risen, more are surviving and requiring longer-term care. Precision medicine promises better outcomes but demands commensurately higher payments for care. As both incidence and per case costs rise, we suggest that the task of expanding access to high-quality cancer care poses a "value challenge" that policies in many countries are inadequate to meet. Policy makers should respond with a new approach. We explore questions that policy makers will need to consider regarding objectives, barriers, and levers for policy development. We use transparency and accountability as cornerstones of a new approach to promote value-based decision making. Although barriers to advancing this agenda are formidable, we recommend that governments define common standards for value-based accounting; serve as information brokers for evidence development; pioneer value-based procurement of goods and services; engage in deliberative democracy in cancer care; and educate communities to facilitate knowledge sharing between communities of patients, their caretakers, and researchers.

  20. Family Models for Earning and Caring: Implications for Child Care and for Family Policy

    Directory of Open Access Journals (Sweden)

    Ravanera, Zenaida


    Full Text Available AbstractCanadian families have changed, in part due to an economy that provides more work opportunities for women, and a cultural orientation that values equal opportunity and diversity infamilies. In spite of the change, both quantitative and qualitative evidence suggest a continued preference for mothers to spend considerable time with children, especially in the infant andtoddler years. Thus, in an average couple, the presence of young children in the home brings wives to reduce their paid work and husbands to increase their paid work. Our reading of parentalpreferences suggests an interest in more services for young children in the form of early childhood education and child care, but also an interest in policies that would allow parents to spend more time with children through parental leaves, part-time work with good benefits, and subsidies that supplement market income. Many options available to two-parent families are often less feasible for lone parents, giving a higher priority to child care.RésuméLa famille canadiennes a changé, dû en partie à une économie qui offre plus de possibilités d’emploi pour les femmes, et à une tendance culturelle qui valorise l’égalité des chances et la diversité dans les familles. En dépit de ces changements, les preuves quantitatives et qualitatives suggèrent une préférence continue pour les mères de passer plus de temps avec les enfants, particulièrement quand il s’agit de nouveau-nés ou d’enfants en bas âge. Donc, pour un couple moyen, la présence de jeunes enfants au foyer pousse les femmes à réduire leurs emplois rémunérés et les maris à augmenter les leurs. Notre étude des préférences parentales suggère un intérêt pour un accroissement des services pour jeunes enfants sous la forme d’éducation préscolaire et de garde d’enfants, et aussi un intérêt pour des politiques qui permettraient aux parents de passer plus de temps avec leurs enfants tels que cong

  1. Risks and Opportunities of Reforms Putting Primary Care in the Driver’s Seat; Comment on “Governance, Government, and the Search for New Provider Models”

    Directory of Open Access Journals (Sweden)

    Monica Andersson Bäck


    Full Text Available 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 forprofit 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.

  2. Accountable care organizations and kidney disease care: health reform innovation or more same-old, same-old? (United States)

    Pauly, Mark V


    The conceptual model for an accountable care organization imagines that care will be rendered to a defined population by an entity that receives bundled payment for that care, coordinates the individual services involved in that care, provides measures of outcomes and quality, and divides the bundled payment among those who supply services. How does this concept differ from earlier efforts, and what, if anything, does it mean for the care of patients with end-stage renal disease? The concept is similar to the largely abandoned integrated delivery networks of the 1990s. The support from Medicare may make a difference, but Medicare's need to constrain spending growth will pose a challenge. Kidney disease care is already much more coordinated than health care for the rest of the population. There are some potential gains from greater coordination, especially with care for comorbid conditions associated with hospitalization. However, economic analysis suggests that the absence of large populations of patients in given geographic sites and the relatively smaller gain from incremental improvements in coordination might mean that the accountable care organization model are not ideal for the dialysis market.

  3. "A campaign won as a public issue will stay won": using cartoons and comics to fight national health care reform, 1940s and beyond. (United States)

    Knoblauch, Heidi Katherine


    On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. As it went through Congress, the legislation faced forceful resistance. Individuals and organizations opposing the ACA circulated propaganda that varied from photographs of fresh graves or coffins with the caption "Result of ObamaCare" to portrayals of President Obama as the Joker from the Batman movies, captioned with the single word "socialism." The arguments embedded in these images have striking parallels to cartoons circulated by physicians to their patients in earlier fights against national health care. Examining cartoons used in the formative health care reform debates of the 1940s provides a means for tracing the lineage of emotional arguments employed against health care reform.

  4. Unravelling the concept of consumer preference: implications for health policy and optimal planning in primary care. (United States)

    Foster, Michele M; Earl, Peter E; Haines, Terry P; Mitchell, Geoffrey K


    Accounting for consumer preference in health policy and delivery system design makes good economic sense since this is linked to outcomes, quality of care and cost control. Probability trade-off methods are commonly used in policy evaluation, marketing and economics. Increasingly applied to health matters, the trade-off preference model has indicated that consumers of health care discriminate between different attributes of care. However, the complexities of the health decision-making environment raise questions about the inherent assumptions concerning choice and decision-making behavior which frame this view of consumer preference. In this article, we use the example of primary care in Australia as a vehicle to examine the concept of 'consumer preference' from different perspectives within economics and discuss the significance of how we model preferences for health policy makers. In doing so, we question whether mainstream thinking, namely that consumers are capable of deliberating between rival strategies and are willing to make trade-offs, is a reliable way of thinking about preferences given the complexities of the health decision-making environment. Alternative perspectives on preference can assist health policy makers and health providers by generating more precise information about the important attributes of care that are likely to enhance consumer engagement and optimise acceptability of health care.

  5. [Human resources for health in Chile: the reform's pending challenge]. (United States)

    Méndez, Claudio A


    Omission of human resources from health policy development has been identified as a barrier in the health sector reform's adoption phase. Since 2002, Chile's health care system has been undergoing a transformation based on the principles of health as a human right, equity, solidarity, efficiency, and social participation. While the reform has set forth the redefinition of the medical professions, continuing education, scheduled accreditation, and the introduction of career development incentives, it has not considered management options tailored to the new setting, a human resources strategy that has the consensus of key players and sector policy, or a process for understanding the needs of health care staff and professionals. However, there is still time to undo the shortcomings, in large part because the reform's implementation phase only recently has begun. Overcoming this challenge is in the hands of the experts charged with designing public health strategies and policies.

  6. Rural Municipal Development and Reform in Canada: Policy Learning through Local - Provincial Collaboration

    Directory of Open Access Journals (Sweden)

    John Martin


    Full Text Available In a federated country like Canada, diversity challenges universal policy prescriptions for local governments. The success of its provincial governments, which have exclusive jurisdiction for systems of local government, depends on balancing the need to act comprehensively and systematically while dealing thoughtfully with the unique situation of individual local governments. Canada’s provinces are shifting their approach to strengthening rural governance – shifting away from more directive interventions and now seeking to facilitate capacity-building in a manner that is less state-centred, more bottom-up, and better adapted to variable local circumstances. A dialogue was organised to focus on this shift in provincial practice. It brought together more than 50 savvy and influential policy practitioners representing all provinces and most local government associations at the provincial level. Practice recommendations emerged for provinces, local government associations, and local governments focusing on concrete actions and tools but also on the potential for redefining the roles played by, and relations between, the associations and provincial governments.

  7. Redefining Economic Policy and Institutional Reform – Support for Economic Growth

    Directory of Open Access Journals (Sweden)

    Coralia ANGELESCU


    Full Text Available The paper addresses the effects of economic crisis fromthe perspective of theoretical developments and how they were reflectedin the economy, both nationally and among the actors of the internationalsystem. Basic economic paradigms such as the role of price as amechanism regulating the operation of free markets and the ability todetermine prices to reflect economic developments have been tested invarious markets. In the context of limited resources available, due toeconomic contraction it is necessary to redefine accepted socialbalances.The example analyzed in the paper is that of social policies. Intimes of economic expansion, modification of such arrangements, even ifsuboptimal, proves to be difficult because it involves implicit costs, lessvisible. Economic crisis brings out such costs. Changing these socialarrangements requires first the solution and coherent regulatorymechanisms and implementation. They depend on the quality ofinstitutions and social coordination system as a whole. If thesemechanisms are complex national, at supranational level we can addadditional layers of decision, which explains the difficulty of coordination. The degree of consistency in decision-making mechanismsand their quality determine the cost of adapting to new conditionsimposed by the balance.Coordination mechanisms, either national or supranationalcontext, are relevant for redefining of a new balance to streamlineexisting policies (eg social that reflects the crisis and the creation of newarrangements to accommodate new engines economic growth.

  8. [Equity and health systems reform in Latin America]. (United States)

    Vargas, Ingrid; Vazquez, Maria Luisa; Jane, Elisabet


    The aim of any health care system is to help improve the people's health, and to do so as efficiently as possible. In order to improve the efficiency and equity of health services provision, many countries around the world have implemented reforms, including several Latin American nations. However similar the objectives may appear, the various ways societies implement such reforms reflect different values and concepts. This article analyzes the egalitarian and neoliberal values underlying different concepts of equity in health care. The authors develop criteria to interpret selected health services funding and provision strategies in Latin American health system reforms. These criteria are then applied to health care financing and delivery policies under the reforms currently being implemented in Colombia and Costa Rica.


    Directory of Open Access Journals (Sweden)

    Luiz Carlos de Freitas


    Full Text Available Despite that businessmen were always trying to interfere with the educational process from the times of theory of human capital, what can be happening of new that is motivating an increased interest of the business community through education? Is it possible that changes in the socio-economic development process of countries or their own crises of capital, are mobilizing the businessmen? We think so. The current interest of businessmen has specific aspects that deserve to be examined. It is not recommended that we believe that “history is repeating itself”. This linearity of analysis disarm us for the local confrontations of contradictions placed by this new escalation of capital on education. The educational policy of the reformers is produced to articulate the need to qualify for the new forms of organization of productive work, at the same time that it preserves and amplifies the classical social functions of the school: exclusion and subordination. At stake is the political and ideological control of the school, at a time when some greater degree of access to knowledge is required by new forms of organization of productive work, new consumption demands of the capitalist system and new political pressures for social mobility through the education.

  10. Policies on Conflicts of Interest in Health Care Guideline Development: A Cross-Sectional Analysis (United States)

    Morciano, Cristina; Basevi, Vittorio; Faralli, Carla; Hilton Boon, Michele; Tonon, Sabina; Taruscio, Domenica


    Objective To assess whether organisations that develop health care guidelines have conflict of interest (COI) policies and to review the content of the available COI policies. Methods Survey and content analysis of COI policies available in English, French, Spanish, and Italian conducted between September 2014 and June 2015. A 24-item data abstraction instrument was created on the basis of guideline development standards. Results The survey identified 29 organisations from 19 countries that met the inclusion criteria. From these organisations, 19 policies were eligible for inclusion in the content analysis. Over one-third of the policies (7/19, 37%) did not report or did not clearly report whether disclosure was a prerequisite for membership of the guideline panel. Strategies for the prevention of COI such as divestment were mentioned by only two organisations. Only 21% of policies (4/19) used criteria to determine whether an interest constitutes a COI and to assess the severity of the risk imposed. Conclusions The finding that some organisations, in contradiction of widely available standards, still do not have COI policies publicly available is concerning. Also troubling were the findings that some policies did not clearly report critical steps in obtaining, managing and communicating disclosure of relationships of interest. This in addition to the variability encountered in content and accessibility of COI policies may cause confusion and distrust among guideline users. It is in the interest of guideline users and developers to design an agreed-upon, comprehensive, clear, and accessible COI policy. PMID:27846255

  11. End-of-life care in the United States: policy issues and model programs of integrated care

    Directory of Open Access Journals (Sweden)

    Joshua M. Wiener


    Full Text Available Background: End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Objective: To assess policy issues involving end-of-life care, especially involving the hospice benefit, and to analyse model programs of integrated care for people who are dying. Methods: The study conducted structured interviews with stakeholders and experts in end-of-life care and with administrators of model programs in the United States, which were nominated by the experts. Results: The two major public insurance programs—Medicare and Medicaid—finance the vast majority of end-of-life care. Both programs offer a hospice benefit, which has several shortcomings, including requiring physicians to make a prognosis of a six month life expectancy and insisting that patients give up curative treatment—two steps which are difficult for doctors and patients to make—and payment levels that may be too low. In addition, quality of care initiatives for nursing homes and hospice sometimes conflict. Four innovative health systems have overcome these barriers to provide palliative services to beneficiaries in their last year of life. Three of these health systems are managed care plans which receive capitated payments. These providers integrate health, long-term and palliative care using an interdisciplinary team approach to management of services. The fourth provider is a hospice that provides palliative services to beneficiaries of all ages, including those who have not elected hospice care. Conclusions: End-of-life care is deficient in the United States. Public payers could use their market power to improve care through a number of strategies.

  12. The Chronic Responsibility: A Critical Discourse Analysis of Danish Chronic Care Policies. (United States)

    Ravn, Iben M; Frederiksen, Kirsten; Beedholm, Kirsten


    This article reports on the results of a Fairclough-inspired critical discourse analysis aiming to clarify how chronically ill patients are presented in contemporary Danish chronic care policies. Drawing on Fairclough's three-dimensional framework for analyzing discourse, and using Dean's concepts of governmentality as an interpretative lens, we analyzed and explained six policies published by the Danish Health and Medicines Authority between 2005 and 2013. The analysis revealed that discourses within the policy vision of chronic care consider chronically ill patients' active role, lifestyle, and health behavior to be the main factors influencing susceptibility to chronic diseases. We argue that this discursive construction naturalizes a division between people who can actively manage responsible self-care and those who cannot. Such discourses may serve the interests of those patients who are already activated, while others remain subjugated to certain roles. For example, they may be labeled as "vulnerable."

  13. The Chronic Responsibility: A Critical Discourse Analysis of Danish Chronic Care Policies

    DEFF Research Database (Denmark)

    Ravn, Iben Munksgaard; Frederiksen, Kirsten; Beedholm, Kirsten


    This article reports on the results of a Fairclough-inspired critical discourse analysis aiming to clarify how chronically ill patients are presented in contemporary Danish chronic care policies. Drawing on Fairclough's three-dimensional framework for analyzing discourse, and using Dean's concepts...... of governmentality as an interpretative lens, we analyzed and explained six policies published by the Danish Health and Medicines Authority between 2005 and 2013. The analysis revealed that discourses within the policy vision of chronic care consider chronically ill patients' active role, lifestyle, and health...... behavior to be the main factors influencing susceptibility to chronic diseases. We argue that this discursive construction naturalizes a division between people who can actively manage responsible self-care and those who cannot. Such discourses may serve the interests of those patients who are already...

  14. Implementing plant clinics in the maelstrom of policy reform in Uganda

    DEFF Research Database (Denmark)

    Danielsen, Solveig; Matsiko, F.B.; Kjær, A.M.


    Pests and diseases are key production constraints for Ugandan small-scale farmers. In 2010, the Ugandan Government, as part of its agricultural development strategy, adopted plant clinics to improve plant health extension for farmers and to contribute to strengthening disease surveillance. Despite...... government commitment and a growing demand for this new type of farmer service, effective implementation of plant clinics turned out to be a challenge.We examine how agricultural policies and institutional setups, and their political context, influenced the implementation of plant clinics from 2010 to 2011...... control. This was exacerbated by the unclear roles and authority of the Ministry vs. local governments. For plant clinics to succeed the fundamental issues of governance, resources and implementation structure need to be addressed. The Ugandan experience shows the importance of understanding not only...

  15. [Health policies and politicized health? An analysis of sexual and reproductive health policies in Peru from the perspective of medical ethics, quality of care, and human rights]. (United States)

    Miranda, J Jaime; Yamin, Alicia Ely


    Health professionals view medical ethics as a discipline that provides the basis for more adequate patient care. In recent years the concepts of quality of care and human rights - with their attending discourses - have joined the concept of medical ethics among the paradigms to consider in care for humans both at the individual and health policy levels. The current study seeks to analyze such paradigms, based on a case study of sexual and reproductive health policies in Peru in the last 10 years.

  16. Moving toward a national policy on palliative and end of life care

    Directory of Open Access Journals (Sweden)

    Stanley C Macaden


    Full Text Available Indian Palliative Care has developed over the past 17 years but it has also developed disabilities due to lack of a National Policy and hence has compromised its effectiveness. It is true that we have come a long way but we still have many miles to go and we will get there only if we have a proper road map and sign posts. This article attempts to suggest some specific measures in establishing such a National Policy

  17. Care for chronic illness in Australian general practice – focus groups of chronic disease self-help groups over 10 years: implications for chronic care systems reforms

    Directory of Open Access Journals (Sweden)

    Martin Carmel M


    themes around chronic illness experience and care needs remained consistent over the 10 year period. Reforms did not appear to alleviate the burden of chronic illness across disease groups, yet some were more privileged than others. Thus in the future, chronic care reforms should build from greater understanding of the needs of people with chronic illness.

  18. Alignment between chronic disease policy and practice: case study at a primary care facility.

    Directory of Open Access Journals (Sweden)

    Claire A Draper

    Full Text Available Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009 to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy.One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10, focus groups (n = 8 and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy formed the basis of the guide questions used in focus groups and interviews.The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care.Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible

  19. Study of water resource management policy reform%水资源管理政策改革探究

    Institute of Scientific and Technical Information of China (English)



    With China's rapid economic development and rapid population growth, coupled with the rapid industrialization and city process makes the hitherto unknown pressure of water resources in China, save water and protect water resources has become an problem to be urgently solved.Although determine a series of policy objectives and priorities related to water resource management in the"eleven five"planning, but so far, the scarcity of water resources becomes a serious problem has not yet been effectively controlled.Water pollution and scarcity of water resources will bring economic higher cost, more serious is, water pollution is still threat to public health.This article from the current situation of water resources management in China, and analyze why the implementation of water resources management policies and how to reform the past unrealistic environmental policy.%  随着我国经济的高速发展和人口急剧增长,加之快速的工业化和城市化进程使得中国水资源承受前所未有的压力,节约用水/保护水资源成为亟待解决的问题。虽然“十一五”规划中确定了有关水资源管理的一系列政策目标和重点,但是到目前为止,日益严重的水资源稀缺问题尚未得到有效控制。水污染和水资源稀缺会带来更高的经济成本,更为严重的是,水污染还是威胁公众健康的侩子手。本文从目前我国水资源管理现状出发,分析为什么要落实水资源管理政策以及怎样改革以往不切实际的环境政策。

  20. Why Do Policy Leaders Adopt Global Education Reforms? A Political Analysis of SBM Reform Adoption in Post-Conflict Bosnia and Herzegovina (United States)

    Komatsu, Taro


    This paper presents a political analysis of school-based management reform in Bosnia and Herzegovina (BiH). School-based management (SBM), based on the principle of school autonomy and community participation, is a school governance system introduced in many parts of the world, including post-conflict nations. Such a phenomenon seems to follow the…

  1. Building a health care workforce for the future: more physicians, professional reforms, and technological advances. (United States)

    Grover, Atul; Niecko-Najjum, Lidia M


    Traditionally, projections of US health care demand have been based upon a combination of existing trends in usage and idealized or expected delivery system changes. For example, 1990s health care demand projections were based upon an expectation that delivery models would move toward closed, tightly managed care networks and would greatly decrease the demand for subspecialty care. Today, however, a different equation is needed on which to base such projections. Realistic workforce planning must take into account the fact that expanded access to health care, a growing and aging population, increased comorbidity, and longer life expectancy will all increase the use of health care services per capita over the next few decades--at a time when the number of physicians per capita will begin to drop. New technologies and more aggressive screening may also change the equation. Strategies to address these increasing demands on the health system must include expanded physician training.

  2. Illegal drugs, anti-drug policy failure, and the need for institutional reforms in Colombia. (United States)

    Thoumi, Francisco E


    This paper is inspired by two anomalies encountered in the study of the illegal drugs industry. First, despite the very high profits of coca/cocaine and poppy/opium/heroin production, most countries that can produce do not. Why, for example, does Colombia face much greater competition in the international coffee, banana, and other legal product markets than in cocaine? And second, though illegal drugs are clearly associated with violence, why is it that illegal drug trafficking organizations have been so much more violent in Colombia and Mexico than in the rest of the world? The answers to these questions cannot be found in factors external to Colombia (and Mexico). They require identifying the societal weaknesses of each country. To do so, the history of the illegal drugs industry is surveyed, a simple model of human behavior that stresses the conflict between formal (legal) and informal (socially accepted) norms as a source of the weaknesses that make societies vulnerable is formulated. The reasons why there is a wide gap between formal and informal norms in Colombia are explored and the effectiveness of anti-drug policies is considered to explain why they fail to achieve their posited goals. The essay ends with reflections and conclusion on the need for institutional change.

  3. Health care policies and resisting consumers in a prototypical welfare state

    DEFF Research Database (Denmark)

    Lykke Hindhede, Anette


    policies. The paper is based on qualitative methods comprising observations and interviews in two hearing clinics. The paper shows that rather than a „withdrawal‟ of the state there has been a process of reform with governing at distance. The data suggests that a distinguishing mark of the consumer role......It has been argued by researchers from the Anglo-Saxon nations that the rationality of the market has increasingly infiltrated the medical field. This paper enquires via policy analysis how these principles have affected the prototypical welfare state of Denmark in relation to Danish hearing health...... on offer in Denmark is, that along with a free hearing aid, the Danish health consumer enjoys a range of rights and reciprocal responsibilities. The paper concludes that few of the hearing impaired patients were able to embrace the consumer ethos, and those who chose not to wear their prescribed hearing...

  4. A study of human resource policies and practices for primary health care system in Delhi

    Directory of Open Access Journals (Sweden)

    Pawan Kumar


    Full Text Available Background: A comprehensive health care services requires effective human resource (HR management policy to ensure organizational success. Government is primarily concerned with the size of the workforce rather than the contemporary HR practices. This resulted into lack of attention to HR management in health sector. Objective: To critically examine HR policies and practice for primary health care system in Delhi. Materials and Methods: For critical analysis of HR policies and practices for primary urban health centers, related documents were examined from year 2005 to 2012. The policies and practices were examined with reference to HR planning, recruitment, selection, hiring, staffing, probation, induction training, performance evaluation, salary and transfer policy in the organization. Results: At present, updated HR planning is not done regularly and due to lack of such updated information actual HR requirement is not calculated leading to shortage backlog. To fill up this shortage contractual model to recruit staff has been adopted by health department. There is no induction training and training need assessment done in the organization. There is wide disparity in pay and leave provisions for different category of regular and contractual staff working under the same roof of health facilities. Conclusion: Disparity in salary, leave provision and other privileges in organization have brought discrimination and demotivation among employees. To deal with conflicting climate in organization comprehensive HR policy is suggested. Policy content should include HR planning, training and development, institute capacity building, HR information system, motivation, and retention strategies for HR.

  5. National Policy on Health Care Hearing: an evaluative study from covering services and diagnostic procedures



    PURPOSE: To evaluate the National Policy on Hearing Health Care (PNASA) based on the coverage of specialized services and diagnostic procedures in hearing health care in Brazil. METHODS: This is an evaluation study focused on the coverage of specialized services that offer moderate- and high-complexity diagnostic procedures by region and in Brazil as a whole. We analyzed the data for the period of 2004-2011 collected from the Unified Health System's Informatics Department database (DATASUS), ...

  6. Health services research in workers' compensation medical care: policy issues and research opportunities.


    Himmelstein, J; Buchanan, J L; Dembe, A E; Stevens, B


    OBJECTIVE: To describe some of the unique aspects of medical care offered under workers' compensation insurance systems and discuss the major policy considerations relevant to health services researchers undertaking investigations in this area. BACKGROUND AND FINDINGS: State-based workers' compensation (WC) insurance systems requiring employers to pay for medical care and wage replacement for workplace injuries and illnesses were first developed between 1910 and 1920 in the United States. Emp...

  7. A right to health care? Participatory politics, progressive policy, and the price of loose language. (United States)

    Reidy, David A


    This article begins by clarifying and noting various limitations on the universal reach of the human right to health care under positive international law. It then argues that irrespective of the human right to health care established by positive international law, any system of positive international law capable of generating legal duties with prima facie moral force necessarily presupposes a universal moral human right to health care. But the language used in contemporary human rights documents or human rights advocacy is not a good guide to the content of this rather more modest universal moral human right to health care. The conclusion reached is that when addressing issues of justice as they inevitably arise with respect to health policy and health care, both within and between states, there is typically little to gain and much to risk by framing deliberation in terms of the human right to health care.

  8. A geospatial analysis of the impacts of maternity care fee payment policies on the uptake of skilled birth care in Ghana



    Background Many low and middle income countries have initiated maternity fee exemption and removal policies to promote use of skilled maternity care. After two and a half decades of these policies, uptake of skilled birth care remains low and inequalities continue to exist in many low and middle income countries. This study uses 2 decades of birth histories data to examine four maternity fee paying policies enacted in Ghana over the past 3 decades and their geospatial impacts on uptake of ski...

  9. 奥巴马医疗改革管窥%On President Obama's health care reform

    Institute of Scientific and Technical Information of China (English)



    US President Obama's health care reform,approved with great difficulties,is not only Democrats' victory over Republicans,but also liberals' victory over conservatives.Behind victory,the competition against perception and group benefits is worth considering.In Democrats' opinion,health care is part of basic human rights,but Republicans don't agree.In the old health care system,insurance companies and medicine producers benefit most,but in the new system,more competition occurs in the market and at the same time federal government is under more financial pressure.%奥巴马总统力推的医疗改革方案冲破重重阻力艰难通过,这不仅是奥巴马政府中民主党在与共和党斗争中的胜利,也是美国历史上自由派对保守派的胜利。其背后的理念之争和利益集团之争值得深思:民主党认为医疗保险是一项基本人权,而共和党完全反对;保险业和医药界是旧体制的最大获益者,而新体制鼓励市场竞争,同时政府的负担也大增。

  10. Bridging the gap in ageing: Translating policies into practice in Malaysian Primary Care

    Directory of Open Access Journals (Sweden)

    Ambigga Krishnapillai S


    Full Text Available Abstract Population ageing is poised to become a major challenge to the health system as Malaysia progresses to becoming a developed nation by 2020. This article aims to review the various ageing policy frameworks available globally; compare aged care policies and health services in Malaysia with Australia; and discuss various issues and challenges in translating these policies into practice in the Malaysian primary care system. Fundamental solutions identified to bridge the gap include restructuring of the health care system, development of comprehensive benefit packages for older people under the national health financing scheme, training of the primary care workforce, effective use of electronic medical records and clinical guidelines; and empowering older people and their caregivers with knowledge, skills and positive attitudes to ageing and self care. Ultimately, family medicine specialists must become the agents for change to lead multidisciplinary teams and work with various agencies to ensure that better coordination, continuity and quality of care are eventually delivered to older patients across time and settings.

  11. Individual sustainable mobility - priorities for policy reform and an agenda for action

    Energy Technology Data Exchange (ETDEWEB)

    Gwilliam, K.M. [The World Bank, Washington, DC (United States)


    This paper argues that the problem of individual sustainable mobility is predominantly an urban problem. In that context, `individual` cannot be narrowly interpreted as private automobile, and `sustainability` cannot be narrowly interpreted as only environmental; a sound economics basis is required for the achievement of environmental and social objectives, and trade offs between economic, social and environmental objectives must be recognized and confronted. Urban form is important, as a means of influencing both total demand and modal split. But it has severe limitations, particularly in developing countries and must be supported by appropriate institutional and pricing structures. Technology can attenuate but not overcome the problems of private mobility, and the role of simple technologies needs to be given more careful attention. Public transport retains a critical role but must also be treated in a practical, economic manner. Competition, to improve efficiency, can be reconciled with social and environmental objectives through appropriate design of franchising and regulatory regimes. All of these instruments are only likely to be effectively deployed in an appropriate institutional context, involving proper coordination of land use and transport planning, of transport functions and nodes, and of local jurisdictions. (author) 16 refs.

  12. Event Attention, Environmental Sensemaking, and Change in Institutional Logics: An Inductive Analysis of the Effects of Public Attention to Clinton's Health Care Reform Initiative.


    Nigam, A; Ocasio, W.


    We explore attention to Clinton's health care reform proposal, ongoing debates, and its political demise to develop theory that explains how events create opportunities for cognitive realignment and transformation in institutional logics. Our case analysis illustrates how a bottom-up process of environmental sensemaking led to the emergence and adoption of a logic of managed care, which provided new organizing principles in the hospitals' organizational field. In addition to theorization, hig...

  13. Market principles in health care and social security policy in Japan. (United States)

    Akiyama, Hiroshi


    Although health care in Japan is under the management of an obligatory insurance system, it is within the framework of a capitalist economy, and has helped achieve longevity during the post-war period. However, average lifetime has been improving in western European and Asian countries that have developed later. It has also been said that higher longevity is not necessarily due only to health care but also to the enhancement of environmental health achieved by economic improvements. On the other hand, the so-called 'development' led by capitalism and the market economy, and the luxuries that sometimes can be construed as uncultured, have caused unnecessary environmental destruction and disparities in wealth. Is it too cynical to think that the extended lifespan of the advanced countries has been achieved at the expense of the epidemics, refugee problems and wars which have resulted in a reduced lifespan in developing countries? It is said that capitalism is an economic ideology that includes many contradictions and is following a path of destruction. In addition, under the name of globalization, capitalism has continuously and rapidly caused vicious cycles of corruption, which are features commonly seen in today's world. It is still common that financial failures and threats are indirectly solved by initiating wars--a method completely inimical to health care. Along with environmental factors and the logic of this market doctrine, we have been trying to reform our financially-collapsed health care system. However, we cannot count on the 'durability' of any reform conducted without some awareness of our economic mistakes. It is often said that it is only because of the existence of the economy that we have health care. However, it is more realistic to say that stable health care and social security lead to a stable economy. Health care did not collapse. It was the market economy upon which health care depended that collapsed. Therefore, one must not consider that

  14. Organization and functioning of primary care for women in Croatia: in relation to the health care reforms introduced between 1995 and 2012. (United States)

    Nižetić, Vlatka Topolovec; Srček, Igor; Rodin, Urelija; Tiljak, Hrvoje


    The main aim of this study was to investigate trends in the organization and functioning of the HC service. The Croatian Health Service Yearbooks, from 1995 to 2012, served as the basis for the data. The results showed that the HC reforms aimed at the organization and functioning of primary care for women somehow compromised their accessibility. A general lack of around 100 gynecologists, the huge number of women on the lists, from 4, 350 to 8,061 women, and excessively heavy daily consultations, between 23.8 and 28.4, were all observed. The location of the majority of gynecological practices in the big cities also makes the service inaccessible to women from the rural areas. A flow of service away from the public to the private providers was also observed. Since, the results of this study can be viewed only in terms of trends and more detailed research will be needed in future.

  15. Breast cancer in limited-resource countries: health care systems and public policy. (United States)

    Anderson, Benjamin O; Yip, Cheng-Har; Ramsey, Scott D; Bengoa, Rafael; Braun, Susan; Fitch, Margaret; Groot, Martijn; Sancho-Garnier, Helene; Tsu, Vivien D


    As the largest cancer killer of women around the globe, breast cancer adversely impacts countries at all levels of economic development. Despite major advances in the early detection, diagnosis, and treatment of breast cancer, health care ministries face multitiered challenges to create and support health care programs that can improve breast cancer outcomes. In addition to the financial and organizational problems inherent in any health care system, breast health programs are hindered by a lack of recognition of cancer as a public health priority, trained health care personnel shortages and migration, public and health care provider educational deficits, and social barriers that impede patient entry into early detection and cancer treatment programs. No perfect health care system exists, even in the wealthiest countries. Based on inevitable economic and practical constraints, all health care systems are compelled to make trade-offs among four factors: access to care, scope of service, quality of care, and cost containment. Given these trade-offs, guidelines can define stratified approaches by which economically realistic incremental improvements can be sequentially implemented within the context of resource constraints to improve breast health care. Disease-specific "vertical" programs warrant "horizontal" integration with existing health care systems in limited-resource countries. The Breast Health Global Initiative (BHGI) Health Care Systems and Public Policy Panel defined a stratified framework outlining recommended breast health care interventions for each of four incremental levels of resources (basic, limited, enhanced, and maximal). Reallocation of existing resources and integration of a breast health care program with existing programs and infrastructure can potentially improve outcomes in a cost-sensitive manner. This adaptable framework can be used as a tool by policymakers for program planning and research design to make best use of available resources

  16. The Political Economy of Market-Based Educational Policies: Race and Reform in Urban School Districts, 1915 to 2016 (United States)

    Scott, Janelle; Holme, Jennifer Jellison


    The authors situate the emergence and effects of contemporary market-based reforms within a framework of urban political economy that centers on racial inequality. They discuss how and why market-based reforms have evolved alongside racialized political and economic trends that have transformed cities over the past century, and they critically…

  17. Improving the care of older persons in Australian prisons using the Policy Delphi method. (United States)

    Patterson, Karen; Newman, Claire; Doona, Katherine


    There are currently no internationally recognised and approved processes relating to the care of older persons with dementia in prison. This research aimed to develop tools and procedures related to managing the care of, including the identification and assessment of, older persons with dementia who are imprisoned in New South Wales, Australia. A modified approach to the Policy Delphi method, using both surveys and facilitated discussion groups, enabled experts to come together to discuss improving the quality of care provision for older persons with dementia in prison and achieve research aims.

  18. Creating Access to Opportunities for Youth in Transition from Foster Care. An AYPF Policy Brief (United States)

    Russ, Erin; Fryar, Garet


    What happens to youth in foster care when they turn 18? Many face unprecedented challenges like homelessness, lack of financial resources, difficulty accessing educational opportunities, and unemployment. In this issue brief, The American Youth Policy Forum (AYPF) document these challenges and opportunities in three distinct yet overlapping areas…

  19. Sharing the caring : State, family and gender equality in parental leave policy

    NARCIS (Netherlands)

    Widener, Anmarie J.


    Parental leave policies give parents a temporary leave from employment in order to care for a child. Secondary aims are to increase women’s attachment to the labour force as well as supporting gender equal roles in paid and unpaid work. This study researched parent satisfaction of parental leave p

  20. Unraveling the Hidden Curriculum. Values in Youth Care Interventions and Youth Policy

    NARCIS (Netherlands)

    Hopman, M.


    Themes such as “effectiveness” and “evidence-based practice” dominate current debates about and within the professional field of youth care. The field seems to focus almost solely on the effectiveness of interventions and policy measures and there appears to be a general consensus on the objectivity

  1. Low Income and Impoverished Families Pay More Disproportionately for Child Care. Policy Brief Number 16 (United States)

    Smith, Kristin; Gozjolko, Kristi


    According to research based on the 2004 Survey of Income and Program Participation, working families with young children living in poverty pay 32 percent of their income on child care, nearly five times more than families living at more than 200 percent of the poverty level. This brief asks policy makers to consider allowing more subsidies to be…

  2. Constructions of Social Inclusion within Australian Early Childhood Education and Care Policy Documents (United States)

    Wong, Sandie; Turner, Kay


    Social inclusion discourses have been powerful in informing early childhood policy contexts, both internationally and in Australia (the context of the current study) for the past decade or so. But little research has examined the productive aspects of social inclusion discourses particularly within early childhood education and care (ECEC) policy…

  3. Capacity building for primary health care reform and its effectiveness in Feixi county, Anhui province%安徽省肥西县基层卫生服务能力提升改革及其成效

    Institute of Scientific and Technical Information of China (English)

    金音子; 何莉; 岳大海; 朱炜明; 张鲁豫; 马慧芬; 孟庆跃


    目的::分析安徽省肥西县基层卫生服务能力提升改革措施及成效,为深化基层医疗卫生服务体系改革提供参考。方法:采用关键知情人访谈、政策文件和档案资料分析以及机构问卷调查等方法收集资料,定性和定量研究结合,通过交叉分析和解释得出研究发现。结果:2010—2014年,肥西县从基层卫生人员能力、卫生服务体系网络建设、工作条件改善、机构管理制度建设四方面进行改革后,基层卫生人员能力提升、工作积极性增加、收入提高,基层卫生条件改善,纵向和横向医疗服务协作机制建立,县内就诊率和基层卫生服务利用提高。结论:肥西县“自下而上”的探索路径和“以点带面”的试点推行,不仅是基层卫生体系综合改革的核心内容,也有效撬动了其它方面的改革,触动了医疗卫生体系体制机制。%Objective:To analyze the implementation and effectiveness of primary health care reform in Feixi county, Anhui province. Methods: This paper uses data analysis of interviews with key insiders, policy documents and archives, as well as institutional questionnaire survey and other methods to collect information, and then it com-bines qualitative and quantitative research to arrive at research findings through cross-analysis and interpretation. Re-sults:From 2010 to 2014, the reform enhanced the capacity of primary health care in four main aspects, including capacity building of primary health care personnel, network construction of primary health care system, improvement of working conditions, and system construction of institutional management. Accordingly, the human capacity of pri-mary health care personnel was improved, their enthusiasm for work increased, their income was raised, the working conditions were improved, the cooperation mechanism for vertical and horizontal health care services was established, and the consultation rate

  4. Nutrition and Physical Activity Policies and Practices in Family Child Care Homes in Oregon: Baseline Findings from the Healthy Home Child Care Project (United States)

    Gunter, Katherine B.; Rice, Kelly R.; Trost, Stewart G.


    Baseline findings from the Healthy Home Child Care Project include data from Family Child Care Providers (FCCPs) in Oregon (n=53) who completed assessments of nutrition and physical activity policies and practices and BMI data for children in the care of FCCPs (n=205). Results show that a significant percentage of FCCPs failed to meet child care…

  5. Best practices in developing a national palliative care policy in resource limited settings: lessons from five African countries. (United States)

    Luyirika, Emmanuel Bk; Namisango, Eve; Garanganga, Eunice; Monjane, Lidia; Ginindza, Ntombi; Madonsela, Gugulethu; Kiyange, Fatia


    Given the high unmet need for palliative care in Africa and other resource limited settings, it is important that countries embrace the public health approach to increasing access through its integration within existing healthcare systems. To give this approach a strong foundation that would ensure sustainability, the World Health Organisation urges member states to ensure that policy environments are suitable for this intervention. The development, strengthening, and implementation of national palliative care policies is a priority. Given the lack of a critical mass of palliative care professionals in the region and deficiency in documenting and sharing best practices as part of information critical for regional development, policy development becomes a complex process. This article shares experiences with regard to best practices when advocating the national palliative care policies. It also tells about policy development process, the important considerations, and cites examples of policy content outlines in Africa.

  6. [Economic aspects of anesthesia. I. Health care reform in the German Republic]. (United States)

    Bach, A; Bauer, M


    Implications for Hospitals and Departments of Anaesthesiology. This article outlines the new German health care laws and their impact on the statutory health care system, hospitals and anaesthesia departments. The German health care system provides coverage for all citizens, although financial support from the public sector is on the downgrade. Hence, pressure to reduce public sector health care spending is likely to continue in the near future. Hospital costs account for one-third of total health care spending in Germany, and hospitals are facing increasing economic constraints: the volume and the charges for specific medical treatments are negotiated between the hospitals and the insurance agencies (or sickness funds) in advance. Only part of hospital care is still reimbursed on the basis of a per diem rate, and an increasing number of services are based on fixed payments per case or treatment. Reducing the costs for this treatment is therefore of utmost importance for hospitals and hospital departments. The prospective payment system and the pressure to contain costs demand a controlling system that allows for cost accounting per case. However, an economic evaluation must include comparative analysis of alternative therapeutic options in terms of both costs and outcome. Economic aspects challenge the traditional relationship between physicians and patients: doctors are still the advocates of their patients, but also act as agents for their institutions. Nevertheless, not only economic issues, but also ethical priorities and the value of an anaesthetic practice must be considered in the era of cost containment. Anaesthetists must be actively involved in providing high-quality care with its obvious benefits for the patient and be able to resist efforts to cut out expensive treatment modalities regardless of their benefits.

  7. Implementation of a health care policy: An analysis of barriers and facilitators to practice change

    Directory of Open Access Journals (Sweden)

    Sword Wendy


    Full Text Available Abstract Background Governments often create policies that rely on implementation by arms length organizations and require practice changes on the part of different segments of the health care system without understanding the differences in and complexities of these agencies. In 2000, in response to publicity about the shortening length of postpartum hospital stay, the Ontario government created a universal program offering up to a 60-hour postpartum stay and a public health follow-up to mothers and newborn infants. The purpose of this paper is to examine how a health policy initiative was implemented in two different parts of a health care system and to analyze the barriers and facilitators to achieving practice change. Methods The data reported came from two studies of postpartum health and service use in Ontario Canada. Data were collected from newly delivered mothers who had uncomplicated vaginal deliveries. The study samples were drawn from the same five purposefully selected hospitals for both studies. Questionnaires prior to discharge and structured telephone interviews at 4-weeks post discharge were used to collect data before and after policy implementation. Qualitative data were collected using focus groups with hospital and community-based health care practitioners and administrators at each site. Results In both studies, the respondents reflected a population of women who experienced an "average" or non-eventful hospital-based, singleton vaginal delivery. The findings of the second study demonstrated wide variance in implementation of the offer of a 60-hour stay among the sites and focus groups revealed that none of the hospitals acknowledged the 60-hour stay as an official policy. The uptake of the offer of a 60-hour stay was unrelated to the rate of offer. The percentage of women with a hospital stay of less than 25 hours and the number with the guideline that the call be within 48 hours of hospital discharge. Public health

  8. Systematic Reviews and Health Policy: The Influence of a Project on Perinatal Care since 1988 (United States)

    Fox, Daniel M


    Context: Interrelated publications between 1988 and 1992 have influenced health policy and clinical practice: The Oxford Database of Perinatal Trials (ODPT), Effective Care in Pregnancy and Childbirth (ECPC), A Guide to Effective Care in Pregnancy and Childbirth (GECPC), and Effective Care of the Newborn Infant (ECNI). These publications applied and advanced methods that had a substantial history in the medical, biological, physical, and social sciences. Their unique contribution was to demonstrate the feasibility of organizing and sustaining programs to conduct systematic reviews across an entire field of health care. The publications also influenced subsequent advances in the methodology of systematic reviews and contributed to their proliferation; in large measure, but not entirely, because their editors and many of the authors participated in organizing and developing the Cochrane Collaboration. This article describes how and why these publications attracted favorable attention and resources from policymakers in numerous countries. Methods: This article applies historical methods to the analysis of primary sources that help explain the influence of systematic reviews, mainly on health policy. These methods guide an analysis of the rhetoric of the two volumes of ECPC and of primary sources generated as systematic reviews influenced health policy. The analysis of rhetoric employs the methods of intellectual history and social studies of science. The analysis of policymaking uses the methods of political and policy history, political science, and public administration. Because the focus of this article is how science influenced policy it alludes to but does not describe in detail the literature on the methods, production, and publication of systematic reviews. Findings: The influence of the four publications on policy was mainly a result of (1) their powerful blending of the rhetoric of scientific and polemical discourse, especially but not exclusively in ECPC; (2

  9. The Affordable Care Act's pre-existing condition insurance plan: enrollment, costs, and lessons for reform. (United States)

    Hall, Jean P; Moore, Janice M


    The Pre-Existing Condition Insurance Plan (PCIP) is the temporary, federal high-risk pool created under the Affordable Care Act to provide coverage to uninsured individuals with preexisting conditions until 2014, when exchange coverage becomes avail­able to them. Nearly 78,000 people have enrolled since the program was implemented two years ago. This issue brief compares the PCIP with state-based high-risk pools that existed prior to the Affordable Care Act and considers programmatic differences that may have resulted in lower-than-anticipated enrollment and higher-than-anticipated costs for the PCIP. PCIP coverage, like state high-risk pool coverage, likely remains unaffordable to most lower-income individuals with preexisting conditions, but provides much needed access to care for those able to afford it. Operational costs of these programs are also quite high, making them less than optimal as a means of broader coverage expansion.

  10. [Policies and standards applied to municipal day care centers in Rio de Janeiro]. (United States)

    de Vasconcelos, Rafaela Moledo; Tancredi, Rinaldini Coralini Philippo; Marin, Victor Augustus


    Day care centers were first established in Brazil with the aim of reducing infant mortality rates, however the incidence of foodborne disease transmission has been on the increase. The World Health Organization (WHO) estimates that each year 1.8 million deaths worldwide occur in children under 5 years of age, which is attributed to the consumption of contaminated food. However, Brazilian legislation does not provide specific rules of operation for day care center kitchens. Thus, the scope of this study is to research the standards relating to the operation of day care centers, discussing the health regulations related to food production. By means of a review of electronic pages of various government organs, the regulations inherent to the operation and production of food in day care centers were examined. After scrutiny of the twenty-seven pieces of legislation found, there is a concern with water quality, supply of food, the control of pests and vectors, structural conditions and food policies. In spite of this, it was seen that not all the surveillance policies for the quality of food offered in day care centers are effective. Also observed was the lack of a specific regulation that establishes the quality criteria for safe handling of food in day care centers.

  11. Patient satisfaction with primary health care - a comparison between the insured and non-insured under the National Health Insurance Policy in Ghana. (United States)

    Fenny, Ama Pokuaa; Enemark, Ulrika; Asante, Felix A; Hansen, Kristian S


    Ghana has initiated various health sector reforms over the past decades aimed at strengthening institutions, improving the overall health system and increasing access to healthcare services by all groups of people. The National Health Insurance Scheme (NHIS) instituted in 2005, is an innovative system aimed at making health care more accessible to people who need it. Currently, there is a growing amount of concern about the capacity of the NHIS to make quality health care accessible to its clients. A number of studies have concentrated on the effect of health insurance status on demand for health services, but have been quiet on supply side issues. The main aim of this study is to examine the overall satisfaction with health care among the insured and uninsured under the NHIS. The second aim is to explore the relations between overall satisfaction and socio-demographic characteristics, health insurance and the various dimensions of quality of care. This study employs logistic regression using household survey data in three districts in Ghana covering the 3 ecological zones (coastal, forest and savannah). It identifies the service quality factors that are important to patients' satisfaction and examines their links to their health insurance status. The results indicate that a higher proportion of insured patients are satisfied with the overall quality of care compared to the uninsured. The key predictors of overall satisfaction are waiting time, friendliness of staff and satisfaction of the consultation process. These results highlight the importance of interpersonal care in health care facilities. Feedback from patients' perception of health services and satisfaction surveys improve the quality of care provided and therefore effort must be made to include these findings in future health policies.

  12. Obesity as a Socially Defined Disease: Philosophical Considerations and Implications for Policy and Care. (United States)

    Hofmann, Bjørn


    Obesity has generated significant worries amongst health policy makers and has obtained increased attention in health care. Obesity is unanimously defined as a disease in the health care and health policy literature. However, there are pragmatic and not principled reasons for this. This warrants an analysis of obesity according to standard conceptions of disease in the literature of philosophy of medicine. According to theories and definitions of disease referring to (abnormal functioning of) internal processes, obesity is not a disease. Obesity undoubtedly can result in disease, making it a risk factor for disease, but not a disease per se. According to several social conceptions of disease, however, obesity clearly is a disease. Obesity can conflict with aesthetic, moral, or other social norms. Making obesity a "social disease" may very well be a wise health policy, assuring and improving population health, especially if we address the social determinants of obesity, such as the food supply and marketing system. However, applying biomedical solutions to social problems may also have severe side effects. It can result in medicalization and enhance stigmatization and discrimination of persons based on appearance or behavior. Approaching social problems with biomedical means may also serve commercial and professionals' interests more than the health and welfare of individuals; it may make quick fix medical solutions halt more sustainable structural solutions. This urges health insurers, health care professionals, and health policy makers to be cautious. Especially if we want to help and respect persons that we classify and treat as obese.

  13. Three Policy Issues in Deciding the Cost of Nursing Home Care: Provincial Differences and How They Influence Elderly Couples' Experiences


    Stadnyk, Robin L.


    Nursing home care is subsidized in all Canadian provinces, but residents must personally contribute to the cost. This paper explores policy issues that have led to differences in costs of nursing home care among provinces, and how policy and cost differences influence the experiences of married couples when one spouse requires nursing home care. The paper is based on a multiple-case study of three Canadian provinces, each of which had a different system for determining personal contributions ...

  14. 深化医药卫生体制改革的监督与评估研究%Commentary on study of monitoring and evaluation of deepening health care system reform

    Institute of Scientific and Technical Information of China (English)



    This paper describes the major methods of policy monitoring and evaluation, and then introduces the main modules of health system performance evaluation.Finally, the framework of the study on monitoring and evaluation of the current deepening health care system reform in China is explained.%本文评述了政策措施监督与评估的研究进展与主要方法,并介绍了卫生系统绩效评估的主要流派,最后介绍了本次深化医药卫生体制改革监督与评估的研究思路与框架.

  15. On Relating Health Care Policy to the Provision of Health Care to Black Families. (United States)

    Darity, William A.

    This paper addresses health and social issues as well as other socioeconomic problems which affect the black family, and the development of appropriate policy and programs to deal with those problems. Data on infant mortality, life expectancy, maternal mortality, physician and dental visits, and some selected death rates from specific causes are…

  16. Integrated care: a fresh perspective for international health policies in low and middle-income countries

    Directory of Open Access Journals (Sweden)

    Jean-Pierre Unger


    Full Text Available Purpose: To propose a social-and-democrat health policy alternative to the current neoliberal one. Context of case: The general failure of neoliberal health policies in low and middle-income countries justifies the design of an alternative to bring disease control and health care back in step with ethical principles and desired outcomes. Data sources: National policies, international programmes and pilot experiments—including those led by the authors—are examined in both scientific and grey literature. Case description: We call for the promotion of a publicly-oriented health sector as a cornerstone of such alternative policy. We define ‘publicly-oriented’ as opposed to ‘private-for-profit’ in terms of objectives and commitment, not of ownership. We classify development strategies for such a sector according to an organisation-based typology of health systems defined by Mintzberg. As such, strategies are adapted to three types of health systems: machine bureaucracies, professional bureaucracies and divisionalized forms. We describe avenues for family and community health and for hospital care. We stress social control at the peripheral level to increase accountability and responsiveness. Community-based, national and international sources are required to provide viable financing. Conclusions and discussion: Our proposed social-and-democrat health policy calls for networking, lobbying and training as a joint effort in which committed health professionals can lead the way.

  17. Understanding public elderly care policy in Norway: A narrative analysis of governmental White papers. (United States)

    Jacobsen, Frode F


    How the general public in Norway conceives being an older adult and the meaning of chronological age has changed over the last few decades. As narratives of aging may be identified in the Norwegian mass media and in the population at large, dominant narratives may also be identified in policy documents, such as government health policy papers. This article explores a narrative analytical framework based on stories, subtexts, and counterstories; it argues that such narratives are characterized as much by what is unsaid as by what is said, and as much by choice of words and word combinations as by explicit messages. Culture strongly influences the conception of a likely future (what will be) and an envisioned future (what ought to be) regarding aging and geriatric care in Norway, as expressed in the public policy papers. The public policy story is discussed as both a story continuously developing, where later health policy papers relate to and comment on earlier documents, and as a story characterized by a measure of cultural incoherence. Some recent government documents dealing with professional geriatric care will serve as material for a narrative analysis.

  18. Alliance system and policy change: necessary ingredients for improvement in diabetes care and reduction of disparities. (United States)

    Clark, Noreen M; Quinn, Martha; Dodge, Julia A; Nelson, Belinda W


    Reducing diabetes inequities requires system and policy changes based on real-life experiences of vulnerable individuals living with the condition. While introducing innovative interventions for African American, Native American, and Latino low-income people, the five community-based sites of the Alliance to Reduce Disparities in Diabetes recognized that policy changes were essential to sustain their efforts. Data regarding change efforts were collected from site leaders and examined against documents provided routinely to the National Program Office at the University of Michigan. A policy expert refined the original lists to include only confirmed policy changes, scope of change (organizational to national), and stage of accomplishment (1, beginning; 2, adoption; 3, implementation; and 4, full maintenance). Changes were again verified through site visits and telephone interviews. In 3 years, Alliance teams achieved 53 system and policy change accomplishments. Efforts were implemented at the organizational (33), citywide (13), state (5), and national (2) levels, and forces helping and hindering success were identified. Three types of changes were deemed especially significant for diabetes control: data sharing across care-providing organizations, embedding community health workers into the clinical care team, and linking clinic services with community assets and resources in support of self-management.

  19. Empowering and caring professionals

    DEFF Research Database (Denmark)

    Hansen, Agnete Meldgaard

    A wave of policies to reform municipal elderly care services is sweeping across Denmark. Under headings such as ‘help for self-help’, ‘everyday rehabilitation’, and ‘re-ablement’, municipalities are working to make their elderly citizens more self-reliant, active and less dependent on municipal c...... of municipal care budgets; as normative experts; as efficient housewives performing practical tasks; and as sympathetic listeners who fulfil the elderly’s needs for contact and empathy....

  20. A critical review of Singapore's policies aimed at supporting families caring for older members. (United States)

    Mehta, Kalyani K


    This article critically examines the family-oriented social policies of the Singapore government aimed at supporting families caring for older members. The sectors focused on are financial security, health, and housing. Singaporeans have been reminded that the family should be the first line of defense for aging families, followed by the community - the state would step in as the last resort. Drawing from recent research and examination of the state policies, the author argues that more should be done to help family caregivers looking after elder relatives. Recommendations for innovative ways to recognize and reward family carers conclude the paper.

  1. Participation and coordination in Dutch health care policy-making. A network analysis of the system of intermediate organizations in Dutch health care. (United States)

    Lamping, Antonie J; Raab, Jörg; Kenis, Patrick


    This study explores the system of intermediate organizations in Dutch health care as the crucial system to understand health care policy-making in the Netherlands. We argue that the Dutch health care system can be understood as a system consisting of distinct but inter-related policy domains. In this study, we analyze four such policy domains: Finances, quality of care, manpower planning and pharmaceuticals. With the help of network analytic techniques, we describe how this highly differentiated system of >200 intermediate organizations is structured and coordinated and what (policy) consequences can be observed with regard to its particular structure and coordination mechanisms. We further analyze the extent to which this system of intermediate organizations enables participation of stakeholders in policy-making using network visualization tools. The results indicate that coordination between the different policy domains within the health care sector takes place not as one would expect through governmental agencies, but through representative organizations such as the representative organizations of the (general) hospitals, the health care consumers and the employers' association. We further conclude that the system allows as well as denies a large number of potential participants access to the policy-making process. As a consequence, the representation of interests is not necessarily balanced, which in turn affects health care policy. We find that the interests of the Dutch health care consumers are well accommodated with the national umbrella organization NPCF in the lead. However, this is no safeguard for the overall community values of good health care since, for example, the interests of the public health sector are likely to be marginalized.

  2. Polling analysis: public support for health reform was broader than reported and depended on how proposals were framed. (United States)

    Grande, David; Gollust, Sarah E; Asch, David A


    The excessive focus of news organizations on "horse race" public opinion polls during the debate about health reform in 2010 left the impression that the public was fickle, as well as sharply divided on whether the government's role in health care should expand. We examined polling data and found that public support for health reform depended very much on how individual policies were described. For example, support for the public insurance option, which was not included in the final version of the Affordable Care Act, ranged from 46.5 percent to 64.6 percent depending on how pollsters worded their questions. Our findings indicate that public support for health reform was broader and more consistent than portrayed at the time. Going forward, policy makers should strive to communicate how health care policy choices are consistent with existing public preferences or should make changes to policy that reflect those preferences.

  3. [Strengthening of the steering role of health++ authorities in health care reforms]. (United States)

    Marín, J M


    Strengthening the ability of health authorities to provide leadership and guidance, now and in the future, is an important issue within the context of health sector reform. It means, among other things, redefining the role of health in light of leading social and economic trends seen in the world at the beginning of the 21st century, increasing participation in health by nongovernmental entities, moving toward participatory democracy in many countries, and modifying concepts of what is considered "public" and "private." Within this scenario, it is necessary to redirect the role of the health sector toward coordinating the mobilization of national resources, on a multisectoral scale, in order to improve equity and social well-being and to channel the limited available resources to the most disadvantaged groups in society. The liberalization of the production and distribution of health-related goods and services, including insurance, challenges the exercise of authority in the area of health. Furthermore, the formation of regional economic blocks and the enormous weight wielded by multinational companies in the areas of pharmaceuticals and other medical supplies and technologies are forcing the health sector to seek ways of harmonizing health legislation and international negotiations. According to many experts, all of these demands surpass the ability of Latin American ministries of health to effectively respond, given most countries' current organizational, legal, and political conditions and technical infrastructure. The countries of the Americas must make it a priority to strengthen their health officials' ability to provide leadership and guidance in order to meet present and future challenges.

  4. Creating value in health care through big data: opportunities and policy implications. (United States)

    Roski, Joachim; Bo-Linn, George W; Andrews, Timothy A


    Big data has the potential to create significant value in health care by improving outcomes while lowering costs. Big data's defining features include the ability to handle massive data volume and variety at high velocity. New, flexible, and easily expandable information technology (IT) infrastructure, including so-called data lakes and cloud data storage and management solutions, make big-data analytics possible. However, most health IT systems still rely on data warehouse structures. Without the right IT infrastructure, analytic tools, visualization approaches, work flows, and interfaces, the insights provided by big data are likely to be limited. Big data's success in creating value in the health care sector may require changes in current polices to balance the potential societal benefits of big-data approaches and the protection of patients' confidentiality. Other policy implications of using big data are that many current practices and policies related to data use, access, sharing, privacy, and stewardship need to be revised.

  5. Does public reporting measure up? Federalism, accountability and child-care policy in Canada. (United States)

    Anderson, Lynell; Findlay, Tammy


    Governments in Canada have recently been exploring new accountability measures within intergovernmental relations. Public reporting has become the preferred mechanism in a range of policy areas, including early learning and child-care, and the authors assess its effectiveness as an accountability measure. The article is based on their experience with a community capacity-building project that considers the relationship between the public policy, funding and accountability mechanisms under the federal/provincial/territorial agreements related to child-care. The authors argue that in its current form, public reporting has not lived up to its promise of accountability to citizens. This evaluation is based on the standards that governments have set for themselves under the federal/provincial/territorial agreements, as well as guidelines set by the Public Sector Accounting Board, an independent body that develops accounting standards over time through consultation with governments.

  6. Preconception care policy, guidelines, recommendations and services across six European countries

    DEFF Research Database (Denmark)

    Shawe, Jill; Delbaere, Ilse; Ekstrand, Maria


    for healthy women and men were fragmented and inconsistent. Preconception guidance was often included in antenatal and pregnancy guidelines. Differences between countries were seen with regard to nutritional and lifestyle advice particularly in relation to fish, caffeine and alcohol consumption, and vitamin......Objectives Preconception care is important for the screening, prevention and management of risk factors that affect pregnancy outcomes. We aimed to investigate pre-pregnancy care policies, guidelines, recommendations and services in six European countries. Methods In 2013, an electronic search......: Governmental policy and legislation; Professional bodies and organisations; Healthcare providers; Charitable organisations; Web-based public information and internet sites. Results All countries had preconception recommendations for women with chronic diseases, such as diabetes and epilepsy. Recommendations...

  7. Perceptions of an open visitation policy by intensive care unit workers



    Background An intensive care unit (ICU) admission is a stressful event for the patient and the patient’s family. Several studies demonstrated symptoms of anxiety, depression, and posttraumatic stress disorder in family members of patients admitted to ICU. Some studies recognize that the open visitation policy (OVP) is related to a reduction in symptoms of anxiety and depression for the patient and an improvement in family satisfaction. However, some issues have been presented as barriers for ...

  8. Developing an adaptive policy for long-term care capacity planning. (United States)

    Zhang, Yue; Puterman, Martin L


    This paper describes a refined methodology for determining long-term care (LTC) capacity levels over a multi-year planning horizon based on a previous study. The problem is to find a capacity level in each year during the planning horizon to meet a wait time service level criterion. Instead of a static policy for capacity planning, we proposal an adaptive policy, where the capacity level required in this year depends on the achieved service level in the last year as the state of the LTC system. We aggregate service levels into a few groups for tractability. Our methodology integrates a discrete event simulation for describing the LTC system and an optimization algorithm to find required capacity levels. We illustrate this methodology through a case study. The results show that the refined methodology overcomes the problems observed in the previous study. It also improves resource utilization greatly. To execute this adaptive policy in practice requires availability of surge or temporary capacity.

  9. Towards an integrated approach for the analysis of gender equity in policies supporting paid work and care responsibilities

    Directory of Open Access Journals (Sweden)

    Chiara Saraceno


    Full Text Available This paper aims to develop a conceptual framework for analysing the degree to which public policies support gender equity in paid work and care. Combining the distinction between commodification and decommodification and the distinction between defamilialisation, supported familialism, and familialism by default our study identifies a number of relevant policies, ranging from services, leave entitlements, income support measures, and fiscal instruments to forms of acknowledgement of care work in pension systems. Although our main objective is conceptual, we offer a comparative overview of these policies for all of the EU countries, plus Norway. Thus, we provide a preliminary typology of policy approaches.

  10. Rules and Experiences of Fiscal Reform and Fiscal Policy in China%我国财政改革和政策实践研究

    Institute of Scientific and Technical Information of China (English)



      本文回顾了我国财政改革、财政政策演进历程,揭示了财政政策演进规律,探讨了财政政策宏观调控实践经验。研究发现:首先,与一般市场经济国家不同,我国财政政策从概念认识、实践启动、到运用技术日臻成熟,走出了一条缓解经济危机实现经济稳定、调节经济结构转变经济增长方式、化解民生难题促进社会和谐的独特之路。在这一过程中,财政政策更加注重供给管理。其次,在当前体制转轨背景下,我国财政政策突显出公共性和体制转型双重特征。最后,面对未来,我们需要在财政政策如何更好遵循市场经济规律;财政政策目标如何更聚焦于未来发展战略,如何推进财政改革以确保财政政策调控更具效力等方面总结更多的经验。%We reviewed the evolution process of the fiscal reform and the fiscal policy, observed the rules about them, discussed experiences about them in the paper. We found, firstly, that the evolution process was the significant differences in china with in general marketing economic country. The evolution of fiscal reform in china took the particular way that the fiscal policy relieved the economic crisis so as to stabilize the economy, adjusted the structure of economy so as to change the pattern of economic growth, and solved the livelihood issues so as to promote social harmony from knowing about the conception of the fiscal policy to starting up its practice, and to using proficiently it. The fiscal policy has emphasized supply management in the process. Secondly, the fiscal policy has displayed double features of public finance and system reform. Lastly, we should summarize more the experiences from three ways how fiscal policy make market Function play a bigger role in, and how fiscal policy to focus on future strategy, how the fiscal reform make macro-control efforts of the fiscal policy enhance.

  11. Collaboration with behavioral health care facilities to implement systemwide tobacco control policies--California, 2012. (United States)

    Gordon, Lauren; Modayil, Mary V; Pavlik, Jim; Morris, Chad D


    The California Tobacco Control Program (CTCP) administered 4 regional trainings in 2012 to staffers at CTCP-funded projects, tobacco control coalitions, several county departments of mental health and alcohol and drug, and administrators and providers from behavioral health care facilities. These trainings focused on the special tobacco use cessation needs and opportunities for cessation among persons with mental illness or substance abuse disorders, and they provided information about cessation and smoke-free policies. CTCP surveyed county and private behavioral health care programs to assess their readiness for adopting tobacco control strategies at treatment facilities. Between baseline and follow-up we found a decrease in the proportion of organizations at the precontemplation or contemplation stages of change and twice as many organizations at the action and maintenance stages of change. Significant obstacles remain to implementing policy: many agencies have concerns about going tobacco-free. But significant progress has been made, as evidenced by new policies and a growing number of tobacco-free coalitions consisting of public health agencies, behavioral health care agencies, and local hospitals.

  12. Immunization of Health-Care Providers: Necessity and Public Health Policies (United States)

    Maltezou, Helena C.; Poland, Gregory A.


    Health-care providers (HCPs) are at increased risk for exposure to vaccine-preventable diseases (VPDs) in the workplace. The rationale for immunization of HCPs relies on the need to protect them and, indirectly, their patients from health-care-associated VPDs. Published evidence indicates significant immunity gaps for VPDs of HCPs globally. Deficits in knowledge and false perceptions about VPDs and vaccines are the most common barriers for vaccine uptake and may also influence communication about vaccines between HCPs and their patients. Most countries have immunization recommendations for HCPs; however, there are no universal policies and significant heterogeneity exists between countries in terms of vaccines, schedules, frame of implementation (recommendation or mandatory), and target categories of HCPs. Mandatory influenza immunization policies for HCPs have been implemented with high vaccine uptake rates. Stronger recommendations for HCP immunization and commitment at the level of the health-care facility are critical in order to achieve high vaccine coverage rates. Given the importance to health, mandatory immunization policies for VPDs that can cause serious morbidity and mortality to vulnerable patients should be considered. PMID:27490580

  13. Collaboration With Behavioral Health Care Facilities to Implement Systemwide Tobacco Control Policies — California, 2012 (United States)

    Gordon, Lauren; Modayil, Mary V.; Pavlik, Jim


    The California Tobacco Control Program (CTCP) administered 4 regional trainings in 2012 to staffers at CTCP-funded projects, tobacco control coalitions, several county departments of mental health and alcohol and drug, and administrators and providers from behavioral health care facilities. These trainings focused on the special tobacco use cessation needs and opportunities for cessation among persons with mental illness or substance abuse disorders, and they provided information about cessation and smoke-free policies. CTCP surveyed county and private behavioral health care programs to assess their readiness for adopting tobacco control strategies at treatment facilities. Between baseline and follow-up we found a decrease in the proportion of organizations at the precontemplation or contemplation stages of change and twice as many organizations at the action and maintenance stages of change. Significant obstacles remain to implementing policy: many agencies have concerns about going tobacco-free. But significant progress has been made, as evidenced by new policies and a growing number of tobacco-free coalitions consisting of public health agencies, behavioral health care agencies, and local hospitals. PMID:25654218

  14. Immunization of Health-Care Providers: Necessity and Public Health Policies. (United States)

    Maltezou, Helena C; Poland, Gregory A


    Health-care providers (HCPs) are at increased risk for exposure to vaccine-preventable diseases (VPDs) in the workplace. The rationale for immunization of HCPs relies on the need to protect them and, indirectly, their patients from health-care-associated VPDs. Published evidence indicates significant immunity gaps for VPDs of HCPs globally. Deficits in knowledge and false perceptions about VPDs and vaccines are the most common barriers for vaccine uptake and may also influence communication about vaccines between HCPs and their patients. Most countries have immunization recommendations for HCPs; however, there are no universal policies and significant heterogeneity exists between countries in terms of vaccines, schedules, frame of implementation (recommendation or mandatory), and target categories of HCPs. Mandatory influenza immunization policies for HCPs have been implemented with high vaccine uptake rates. Stronger recommendations for HCP immunization and commitment at the level of the health-care facility are critical in order to achieve high vaccine coverage rates. Given the importance to health, mandatory immunization policies for VPDs that can cause serious morbidity and mortality to vulnerable patients should be considered.

  15. Going for the gold: the redistributive agenda behind market-based health care reform. (United States)

    Evans, R G


    Political conflict over the respective roles of the state and the market in health care has a long history. Current interest in market approaches represents the resurgence of ideas and arguments that have been promoted with varying intensity throughout this century. (In practice, advocates have never wanted a truly competitive market, but rather one managed by and for particular private interests). Yet international experience over the last forty years has demonstrated that greater reliance on the market is associated with inferior system performance--inequity, inefficiency, high cost, and public dissatisfaction. The United States is the leading example. So why is this issue back again? Because market mechanisms yield distributional advantages for particular influential groups. (1) A more costly health care system yields higher prices and incomes for suppliers--physicians, drug companies, and private insurers. (2) Private payment distributes overall system costs according to use (or expected use) of services, costing wealthier and healthier people less than finance from (income-related) taxation. (3) Wealthy and unhealthy people can purchase (real or perceived) better access or quality for themselves, without having to support a similar standard for others. Thus there is, and always has been, a natural alliance of economic interest between service providers and upper-income citizens to support shifting health financing from public to private sources. Analytic arguments for the potential superiority of hypothetical competitive markets are simply one of the rhetorical forms through which this permanent conflict of economic interest is expressed in political debate.

  16. 江苏推进供给侧改革的财政政策分析%Analysis on Fiscal Policy of Pushing forward the Supply-Side Reform in Jiangsu

    Institute of Scientific and Technical Information of China (English)

    孙克强; 陈涵; 范玮


    在推进供给侧改革进程中,应积极发挥政府的宏观调控职能,运用好财政政策可以起到事半功倍的效果。结合对供给侧改革的分析,论述江苏运用财政政策支持供给侧改革的有效途径与政策选择。%In the process of pushing forward the supply-side reform,the government should ac-tively play macroeconomic control functions,and make good use of fiscal policy to achieve a multiplier effect.Combining the analysis on the supply-side reform,the article will discuss the effective way and the policy option to support the supply-side reform with taking use of fiscal policy in Jiangsu.

  17. Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association. (United States)

    Braun, Lynne T; Grady, Kathleen L; Kutner, Jean S; Adler, Eric; Berlinger, Nancy; Boss, Renee; Butler, Javed; Enguidanos, Susan; Friebert, Sarah; Gardner, Timothy J; Higgins, Phil; Holloway, Robert; Konig, Madeleine; Meier, Diane; Morrissey, Mary Beth; Quest, Tammie E; Wiegand, Debra L; Coombs-Lee, Barbara; Fitchett, George; Gupta, Charu; Roach, William H


    The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidence-based care that improves patient outcomes such as health-related quality of life and is consistent with the patients' values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions. Palliative care, defined as patient- and family-centered care that optimizes health-related quality of life by anticipating, preventing, and treating suffering, should be integrated into the care of all patients with advanced cardiovascular disease and stroke early in the disease trajectory. Palliative care focuses on communication, shared decision making about treatment options, advance care planning, and attention to physical, emotional, spiritual, and psychological distress with inclusion of the patient's family and care system. Our policy recommendations address the following: reimbursement for comprehensive delivery of palliative care services for patients with advanced cardiovascular disease and stroke; strong payer-provider relationships that involve data sharing to identify patients in need of palliative care, identification of better care and payment models, and establishment of quality standards and outcome measurements; healthcare system policies for the provision of comprehensive palliative care services during hospitalization, including goals of care, treatment decisions, needs of family caregivers, and transition to other care settings; and health professional education in palliative care as part of licensure requirements.

  18. 新形势下医院财务管理办法分析%Health Care Reform in the Hospital Financial Management Analysis

    Institute of Scientific and Technical Information of China (English)



    医疗体制的改革对医院财务管理工作提出了更高的要求。文章首先剖析了在医疗体制改革下,医院财务管理工作面对的挑战,接着阐述了当前医院财务管理工作的现状和问题,最后对医疗体制改革背景下医院管理办法的改进提出几点建议。希望为医院财务管理提供理论依据。%The reform of the health care system for hospital financial management put forward higher requirements. The article first analyzes the challenges and trends in health care reform, hospital financial management to face, and then describes the cur-rent status and problems of hospital financial management, and finally to improve hospital management approach to health care re-form under the background of a few recommendations. I hope to provide a theoretical basis for hospital financial management.

  19. Neo-Democracy in Educational Policy-Making: A Critical Case Study of Neoliberal Reform in Massachusetts (United States)

    Piazza, Peter


    This paper explores changes to the educational policy-making arena through case study analysis of a Massachusetts law passed in 2012 that limits seniority-based job protections for public K-12 teachers. I use data from interviews with policy stakeholders, observations of public meetings, and policy artifacts to explore struggles over democratic…

  20. Perceived impact of the Medicare policy to adjust payment for health care-associated infections (United States)

    Lee, Grace M.; Hartmann, Christine W.; Graham, Denise; Kassler, William; Linn, Maya Dutta; Krein, Sarah; Saint, Sanjay; Goldmann, Donald A.; Fridkin, Scott; Horan, Teresa; Jernigan, John; Jha, Ashish


    Background In 2008, the Centers for Medicare and Medicaid Services (CMS) ceased additional payment for hospitalizations resulting in complications deemed preventable, including several health care-associated infections. We sought to understand the impact of the CMS payment policy on infection prevention efforts. Methods A national survey of infection preventionists from a random sample of US hospitals was conducted in December 2010. Results Eighty-one percent reported increased attention to HAIs targeted by the CMS policy, whereas one-third reported spending less time on nontargeted HAIs. Only 15% reported increased funding for infection control as a result of the CMS policy, whereas most reported stable (77%) funding. Respondents reported faster removal of urinary (71%) and central venous (50%) catheters as a result of the CMS policy, whereas routine urine and blood cultures on admission occurred infrequently (27% and 13%, respectively). Resource shifting (ie, less time spent on nontargeted HAIs) occurred more commonly in large hospitals (odds ratio, 2.3; 95% confidence interval: 1.0–5.1; P = .038) but less often in hospitals where front-line staff were receptive to changes in clinical processes (odds ratio, 0.5; 95% confidence interval: 0.3–0.8; P = .005). Conclusion Infection preventionists reported greater hospital attention to preventing targeted HAIs as a result of the CMS nonpayment policy. Whether the increased focus and greater engagement in HAI prevention practices has led to better patient outcomes is unclear. PMID:22541855