Innovation, Health Policy, and Community Change Concepts.

British health policy has undergone enormous change in the post-war era. The NHS established in the post-war period has been constantly reorganised, and the role of doctors and associated medical professions has radically changed. This 1999 book considers the changes in health policy and in the service provided by the NHS, and examines in detail the 'mixed economy' of health care and the role of different providers of health care, as well as their relationships both with recipients of care and the state. In doing so, Professor Berridge sheds light on the increasingly important part that lay people, especially women, have played in the provision of health care and looks at community care and the shifting balance of power within the medical profession. The book provides a guide to changes in health and health policy during and since World War II, giving an authoritative analysis of the most recent research.

British health policy has undergone enormous change in the post-war era. The NHS established in the post-war period has been constantly reorganised, and the role of doctors and associated medical professions has radically changed. This book considers the changes in health policy and in the service provided by the NHS, and examines in detail the 'mixed economy' of health care and the role of different providers of health care, as well as their relationships both with recipients of care and the state. In doing so, Professor Berridge sheds light on the increasingly important part that lay people, especially women, have played in the provision of health care and looks at community care and the shifting balance of power within the medical profession. The book provides a guide to changes in health and health policy during and since World War II, giving an authoritative analysis of the most recent research.

From the severe acute respiratory syndrome (SARS) outbreak in 2003 to the COVID-19 pandemic in 2019, a series of health measures and policies have been introduced from the central to the local level in China. However, no study has constructed an uncertainty index that can reflect the volatility, risk, and policy characteristics of the health environment. We used text mining analysis on mainstream newspapers to quantify the volume of reports about health policy and the total number of news articles and to construct a series of indexes that could reflect the uncertainty of health policy in China. Using the Wisenews database, 11 of the most influential newspapers in mainland China were selected to obtain the sample articles. The health policy uncertainty (HPU) index for each month from 2003 to 2022 was constructed by searching articles containing the specified keywords and calculating their frequency. Robustness tests were conducted through correlation analysis. The HPU index was plotted using STATA (version 16.0), and a comparative analysis of the China and US HPU indexes was then performed. We retrieved 6482 sample articles from 7.49 million news articles in 11 newspapers. The China HPU index was constructed, and the robustness test showed a correlation coefficient greater than 0.74, which indicates good robustness. Key health events can cause index fluctuations. At the beginning of COVID-19 (May 2020), the HPU index climbed to 502.0. In December 2022, China's HPU index reached its highest value of 613.8 after the release of the "New Ten Rules" pandemic prevention and control policy. There were significant differences in HPU index fluctuations between China and the United States during SARS and COVID-19, as well as during the Affordable Care Act period. National health policy is a guide for health development, and uncertainty in health policy can affect not only the implementation of policy by managers but also the health-seeking behavior of the people. Here, we conclude that changes in critical health policies, major national or international events, and infectious diseases with widespread impact can create significant uncertainty in China's health policies. The uncertainty of health policies in China and the United States is quite different due to different political systems and news environments. What is the same is that COVID-19 has brought great policy volatility to both countries. To the best of our knowledge, our work is the first systematic text mining study of HPU in China.

Background: In 2001 a number of limitations and inconsistencies were noted in the Peruvian national health system. In addition to long-standing structural issues, challenges emerged related to social determinants of health as well as health workers’ attitudes and skills. Objectives: The purpose of this paper is to describe some of the national health policy changes that the Ministry of Health of Peru considered necessary in 2002 to address the prevailing challenges and the particular implementation of such policies. Methods: The formulation of the desired national health policy changes were based on critical readings of the pertinent scientific literature, the collation of national health policy experience, and consultations with Ministry officers and recognized national experts. Results: The thrust of the national health policy changes, involving the crucial relationship between service providers and users resulting from such process was summarized by the dictum “Persons Caring for Persons” (In Spanish, “Personas que Atendemos Personas”). In order to extend the impact of this policy dictum, it was decided to inscribe it right under the Ministry’s name on the façade or frontispiece of the Ministry’s central building in Lima, the capital of Peru. Discussion: The focus of health care on persons was based on well considered Peruvian and international experience, particularly those maturing at the World Health Organization since the Alma Ata Declaration. The dictum “Persons Caring for Persons” has remained present in national health discussions as well as on the frontispiece of the Ministry’s central building across several changes in national political leadership over the past 13 years. Conclusions: The policy statement “Persons Caring for Persons”, reflects well considered national experience and wisdom, consistent with growing international aspirations. Its endurance over many years calls for renewed efforts to deepen such perspectives towards greater respect for human rights and the full humanization of health care and social life.

Even under public and universal coverage of core services with no user charges, utilization of health care services may vary among individuals with similar need depending, for example, on where the person lives, the person's income, or education status. Therefore, horizontal equity in the utilization of health care services can be influenced by health policies beyond financing, such as decisions on concentration in the hospital sector, pricing and reimbursement of non core services (drugs, home care, dental care), or physician density. We build on the well established ECuity method of income-related equity measurement to assess and interpret the changes in horizontal equity in the 10 Canadian provinces from 1990 to 2004, a period of substantial health reform in Canada. This approach uses individual-level survey data to compute a series of income-based concentration indices of need-standardized utilization of physician visits, hospital stays and dental care services. Canada provides a unique opportunity to explore the link between health policies and horizontal equity in health care utilization because provinces within Canada operate their health care system under the umbrella of the national Canada Health Act. Moreover there is a higher level of cultural and professional homogeneity than in both the US and EU, which controls for important factors of horizontal equity beyond health policies. The years 1990-2004 also provide an opportunity to study the possible impact of changes in health care policy on equity in health care utilization since they were a time of substantial changes in provincial health care systems (governance of health care, hospital sector restructuring, funding of home care services and drugs, and physicians supply). These changes differ across provinces in their qualitative nature, amplitude and year of occurrence. The project integrates a qualitative assessment of key health policy events in each province since 1990 and the quantitative measurement of equity in health care utilization over this period. First, we conduct a qualitative assessment of the co-variations in health policies in the 10 provinces on one hand and our equity measures on the other hand. We use a systematic characterization of health policy changes in Canada and take advantage of the longitudinal nature of our dataset to estimate a fixed effect model (at the province level) of the impact of changes in policy on horizontal equity. This work adds to the literature on equity measurement in the following ways: systematically links equity to health policies over time and cross-sectionally; measures equity in home care utilization, a type of services which will become more important in the future albeit still outside the set of core services in Canada; measures equity in drug expenditures using a better descriptor of drug utilization than what is available in the European Household Panel Survey; we employ a fuller and richer set of need descriptors, allowing us testing the impact of enriching the need standardization on the value of the equity measure (the more one standardizes the lower observed inequity is); in addition to income-related inequity, we assess for inequity related to degree of rurality.

Ten Years of Democracy in South Africa: Documenting Transformation in Reproductive Health Policy and Status

The author reviews the WHO-EURO report Exploring Health Policy Development in Europe, critically analyzing its content and showing the technocratic nature of the report's discourse, which lacks any grasp or understanding of the political context in which health policies are developed and reproduced in the European region. In a supposedly apolitical way, the report attributes changes in health policy primarily to economic, technological, and demographic events, without referring to the enormously important political events in Europe that mediate these health policy changes. Also, the uncritical nature of the report—which simply reproduces the “conventional wisdom” in the policy circles of most international health agencies and reflects the fact that most of its contributors are employees of their national governments—gives it a public relations tone that limits its usefulness and relevance for most health and social policy analysts.

Worldwide, healthcare policy change ranks among the top three issues in the public’s consciousness. This study introduces a case study of pediatric hospitalizations at one hospital in Northern China. It seeks to assess whether pediatric hospitalization access, costs, and costs structures favorably changed after selected health policy reforms were implemented in China. A census of all hospital pediatric discharge data from 2015 to 2018 were collected from a general public tertiary hospital in Northern China. Using generalized linear regression, changes in charges for length of stay, daily charges, total charges per discharge, and drug charges and medical service fees as a percent of total charges were analyzed as a function of two independent variables - policy changes regarding the merger of two health insurance programs, and the zero-markup drug pricing policy. These variables were included as dummy variables for the pre-and-post change periods. The covariates used included patient age, sex, and the year. After the policy implementation, significant decreases (P<.01) were found in the length of the hospital stay (-0.49 days) and drug and medical charges (-7.63%) as a percent of total charges. A significant decrease also occurred (P<.01) in the number and percent of pediatric patients served who were self-pay after the merger of the NCMS insurance plan into the URBMI. Drug costs as a proportion of total costs also decreased significantly (P<.01). Thus, the findings revealed that the zero-markup drug pricing policy was associated with a significant decrease (P<.01) in the mean percentage markup for drug charges (P<.01). Accordingly, both health policy changes were associated with positive effects on pediatric healthcare expenditures, and access. This research suggests that as these two policies are fully implemented at public tertiary hospitals throughout China, pediatric hospital care may become even more accessible and drugs less costly.

Several environmental health issues, together with access to healthcare and health policy, are inextricably connected to shaping the health of nations. Pollution, climate change, and poor housing and living standards are reasons health risks vary from one population group to another. Equally important, the use of healthcare services depends on socio-economic characteristics, regional location, and healthcare system performance. Health policy changes are fundamental to increasing access to health care and eradicating the causes of health-related issues in the environment. The present review aims to review the interaction between environmental factors and accessibility to health care and the outcome of health due to policy interventions. It explains why people have limited healthcare access and healthcare disparities among disadvantaged populations and what it says are systemic policy changes required to achieve healthy equity. The study shows that effective interventions in social determinants for health and developing policies on sustainable environmental use are necessary to improve people’s health worldwide.

Health policy in times of austerity—A conceptual framework for evaluating effects of policy on efficiency and equity illustrated with examples from Europe since 2008

Introduction to "Recontextualizing Physician Associations: Revisiting Context, Scope, Methodology".

Moving towards the greater involvement of nurses in policy development

Despite significant health care reform in the past 10 years, health disparities persist in marginalized and low-resource communities. Although there are a lot of reasons for health disparities, many of which are not related to health care, changes in health policy can lead to improved health equity. Redefining health policy as an important aspect of medical education could popularize the teaching and application of health policy competencies within academic health centers. The Kern model was applied to develop a workshop to educate medical students on basic health policy concepts and opportunities for them to apply a health policy framework to facilitate organizational change. Specifically, the workshop helped trainees to define common concepts in health policy, to understand a framework for developing policy initiatives, and to identify areas of overlap between health policy and academic medicine. Instructional methods included a PowerPoint presentation, vignette-based small-group discussion, and career reflection. The workshop was implemented at three national conferences with a total of 144 participants. Comparing pre- and postworkshop survey responses, participants felt health policy work was compatible with an academic medicine career. Over 95% of respondents agreed or strongly agreed that each objective had been met. By viewing health policy through the lens of academia, trainees were able to develop a new appreciation for how health policy activities can contribute to peer-reviewed publications, teaching, and leadership opportunities. Participants were better situated to integrate health policy skills in their academic or nonacademic careers.

Nurses and their unique disciplinary knowledge have an important role in developing meaningful policies with constituents, while being with or present for all persons involved in policy development, implementation, and maintenance. This presence is important for persons, as individuals and group communities. In this paper, the author explores presence with Parse's (2021) community change concepts to enhance understanding of policy development.

Issues Impede the Work of Many NPs