Care Related Policies Research Articles

Understanding dementia care pathways for policy development and service planning in Kenya.

In Kenya, there is lack of evidence on existing dementia care pathways, with minimal or no presentation for dementia-related symptoms in health care settings. Understanding the services available for people with dementia as well as how communities access the services could offer a practical pattern for policy makers to identify strategies that encourage early detection, care and support for people with dementia and their families. To elucidate initial responses of individuals and their families to dementia and challenges encountered in help seeking through care pathways to inform dementia care-related policies and practice. The Strengthening Responses to dementia in Developing Countries (STRiDE) Kenya team adapted case vignettes (brief hypothetical stories meant to elicit responses on how the characters would behave) developed by the entire STRiDE team. A total of 29 stakeholders were then asked to provide feedback on the completed vignettes and summarize a common pathway to dementia care in Kenya while using the proposed case vignettes. We found four initial responses to dementia suspicion in Kenya where individuals:(i) Perceive symptoms as normal part of ageing, (ii) Consult a spiritual or traditional healer, (iii) Visit a private clinic or primary health care facilities, or (iv) No action taken. These were the first points within the care pathways which determined the care trajectory the person with dementia would follow. Identification of dementia care pathways could form a basis for improving the way communities perceive dementia etiology and establish standard pathways to care whilst ensuring that some pathways do not further pose an impediment to care and treatment for dementia.

The 340B Drug Discount Program Preserved After US Supreme Court Review—But Chevron Remains Vulnerable

This Viewpoint commends the ruling in favor of 340B-covered entities but contemplates if the absence of the Chevron deference will affect future health care-related policy.

Impact on the NHS and health of the UK's trade and cooperation relationship with the EU, and beyond.

The UK's relationship with the European Union (EU) is now embodied in two principal legal instruments: the EU-UK Trade and Cooperation Agreement, which formally entered into force on 1 May 2021; and the Withdrawal Agreement, with its Protocol on Ireland/Northern Ireland, which continues to apply. Using a 'building blocks' framework for analysis of national health systems derived from the World Health Organisation, this article examines the likely impacts in the UK of this legal settlement on the National Health Service (NHS), health and social care. Specifically, we determine the extent to which the trade, cooperation and regulatory aspects of those legal measures support positive impacts for the NHS and social care. We show that, as there is clear support for positive health and care outcomes in only one of the 17 NHS 'building blocks', unless mitigating action is taken, the likely outcomes will be detrimental. However, as the legal settlement gives the UK a great deal of regulatory freedom, especially in Great Britain, we argue that it is crucial to track the effects of proposed new health and social care-related policy choices in the months and years ahead.

The Care Policy Scorecard: a new tool to shift progress towards a caring economy

ABSTRACT COVID-19 has highlighted the centrality of care and women’s labour (paid and unpaid). While there is a growing body of literature on specific policy measures to address care work in different contexts, there is no global practical tool to track progress against key policy areas. This article introduces the Care Policy Scorecard, an evidence-based policy tool developed through extensive collaboration between several institutions, care policy advocates, policymakers, and researchers in the global South and North. The Scorecard helps care advocates to assess how care-related policies are adopted, budgeted for, and implemented by governments, and to what extent they can transform the social organisation of care. The paper also includes preliminary results from the application of this tool in Kenya, and shares learnings from the use of the findings for national-level care policy advocacy.

Aligning Virtual Care in Canada with the Needs of Older Adults.

Public health measures associated with coronavirus disease (COVID-19) have accelerated the adoption of virtual health care across Canada. We explore the opportunities that virtual care presents in achieving the Quadruple Aim and challenges to navigate, through the lens of care for older adults. In particular, we recommend virtual care-related policies related to older adults that address (a) limited uptake among the socio-economically disadvantaged, (b) user-centered design of virtual care technologies, and (c) integration of iterative evaluations to ensure equitable and efficient achievement of desired outcomes. As virtual care accelerates forward, we must not leave older Canadians behind.

Tracing the Expression of Resident Quality of Life Policies in Canadian Long-Term Care Settings

Policies favouring safety, security, and order are expressed in preference to those oriented towards person-centred resident quality of life in Canadian long-term care settings. Factors impacting the expression of these latent (under-utilised) rules were uncovered through an analysis of long-term care related policies in four provinces. 84 policies relating to resident quality of life in long-term care were analysed in three sequences, incorporating jurisdictions, policy types, and quality of life domains, over time. The analysis revealed three policy levers: situations–providing explicit and implicit examples of resident oriented quality of life policy suppression in each jurisdiction; structures–identifying which types of policy and quality of life expressions are more vulnerable to dominance by others; and trajectories–confirming the cultural shift towards more person-centredness in Canadian long-term care related policies over time. Although these policies exist, their potentiality remains dormant in the dominant policy discourse, thereby signaling a positive post-pandemic possibility.

Investigation of the awareness of and demand for hospice care and attitudes towards life-sustaining treatment at the end of life among community residents in Hangzhou

BackgroundTo understand the status of residents’ awareness of and demand for hospice care services in Hangzhou and to provide a reference for promoting the formulation of hospice care-related policies in China.MethodsA small cross-sectional survey of 519 adults aged over 40 years old living in the rural-urban fringe and urban area of Xihu District, Hangzhou City, was conducted using convenience sampling and a self-designed questionnaire. The measures assessed awareness of hospice care (13-item scale), attitudes towards life support therapy (3-item scale), and demand for hospice care services (9-item scale).ResultsThe rate of awareness of hospice care among community residents was 50.30%. A total of 51.0% of residents wanted only comfortable life-sustaining treatment at the end of their lives. The acceptance of hospice care was positively correlated with the degree of understanding (x2 = 18.382, P = 0.001), and residents in the urban area were more likely to prefer hospice care than residents in the urban-rural fringe (x2 = 7.186, P = 0.028). Elderly residents showed a stronger tendency to prefer comfortable life support therapy (x2 = 12.988, P < 0.001). A total of 83.04% of the residents accepted the current necessity for hospice care to be provided in medical institutions. The preferred locations were professional hospice care institutions or general hospitals. A total of 93.64% of the residents agreed that the number of beds in hospice care wards should not exceed 2. In addition, the residents could afford part of the out-of-pocket expenses for hospice care services, with the ability to pay under 200 yuan per day, and the improvement of facilities was expected.ConclusionsTo improve public awareness and acceptance of hospice care and promote healthy development in China, it is necessary to promote hospice care education for everyone.

Willingness-to-pay and willingness-to-accept of informal caregivers of dependent elderly people in Shanghai, China

BackgroundIn order to make optimal long-term care-related decisions, it is important to take a societal perspective. Shanghai is one of the pilot cities of social long-term care insurance in China. However, little knowledge exists about the economic value of the informal care provided to dependent elderly people in China. This paper aims to evaluate the economic value of informal caregiving in Shanghai using the contingent valuation method by their least-preferred care tasks, and identify the associated factors of willingness-to-pay (WTP) and willingness-to-accept (WTA) of the informal caregivers.MethodsThis study employed the contingent valuation method to elicit 371 informal caregivers’ WTP and WTA for 1 hour of reduction or increase of least-preferred caring tasks in Shanghai. Univariate and multivariate analyses were conducted to explore the associated factors with the WTP and WTA values.ResultsThe average WTP and WTA were 25.31 CNY and 38.66 CNY, respectively. The associated factors with WTP include caregiver’s income and caregiver’s relationship to the recipient. Care recipient’s age, income, least-preferred task by the caregiver, and subscales of Caregiver Reaction Assessment were found to be associated with WTA. The non-responsiveness rates were 26.1 and 33.2% for WTP and WTA questions, respectively.ConclusionsThe findings of the current study demonstrated that decision-makers and researchers should take the economic valuation results of informal care into account to make more informed and effective long-term care-related policies and analyses.

Zhu Chen: health care reform in China

Abstract As China's economy continues to prosper, adequate health care for all people has become an uppermost issue for the government. In 2007, as China began its reform of the health care system on a scale unprecedented in recent history, Zhu Chen was appointed to head the Ministry of Health and took charge of this formidable task. Since leaving his Ministry post in 2013, Chen remains actively involved in the formulation of China's health care-related policies in his capacity as a Vice Chairman of the Standing Committee of the National People's Congress of China, the Chairman of the Chinese Peasants and Workers Democratic Party, and most recently the President of the Red Cross Society of China. In addition to his achievements in administrative services, Chen also had a distinguished research career and is internationally recognized for his contribution in developing the most effective therapy for acute promyelocytic leukemia (APL). In a recent interview with NSR, Chen summarized and reflected upon his experience as the Health Minister, and expressed his view on the current status and future prospect of health care reform in China, and a variety of related issues in translational medicine, medical personnel training, precision medicine, and big data for health care in China.

Health with equality: a proposal for the incorporation of the gender perspective in health care systems.

This paper presents an analysis of the incorporation of the gender perspective in health care-related policies. Based on the recommendations of international organizations, the importance of the incorporation of the gender concept in the health field is analyzed, in order to design health policies that seeking to redress existing inequalities by virtue of sex/gender. This paper presents an analysis of the published guidelines in order to facilitate the incorporation of the gender perspective in health care systems. The article concludes with a proposal of gender-sensitive health indicators that can ensure the gender perspective in health care policies.

Reproductive Health Policy in China: A Study of Preconception Care in Rural China

Objectives: Policy plays an important role in shaping preconception health and care. The purpose of this study was to explore how preconception care was defined in Chinese government policies. The specific aims of the study were to: (a) define and critically analyze the language of preconception care in the context of Chinese government policies and (b) explore rural women’s and healthcare providers’ views on preconception care-related government policies. Materials and Methods: This was a cross-sectional study of Chinese preconception health and care-related policy at the national and provincial levels. The study included an analysis of publicly available preconception care policies issued before August 2009. In addition, individual interviews with rural women and healthcare providers were conducted from April 2009 to August 2009 in Tonglu County, Zhejiang Province, China. Results: Three major discourses in relation to defining preconception care were identified from the policy documents: (a) preconception care in relation to women’s physiology, (b) preconception in relation to marriage registration, and (c) preconception care in relation to being married. Although participants recognized the governmental policy effort in relation to preconception health promotion, they still see policy as a formality. Conclusion: This was the first study to examine language use in Chinese preconception care policies. The study found that the concept of preconception care was constructed mainly around marriage and that the public views these policies as a formality. Strategic plans are needed to increase societal awareness of the importance of preconception health policies in China.

THE RELATIONSHIP BETWEEN POSITIVE PATIENT EXPERIENCE IN ACUTE HOSPITALS AND PERSON-CENTRED CARE

Internationally, person-centred care has become a c entral tenet of many health and social care related policies and strategies. However, few studies exist that explicitly examine the linkage between patien ts’ perceptions of a person-centred care climate and pa tients’ experiences of care. This has been hampered by a dearth of instruments with acceptable psychome tric properties. The aim of this study is to examin e the relationship between patients’ perceptions of p erson-centredness and their experiences of care. A cross sectional survey design was used to purposive ly sample (n = 345, 57.5%) patients from across 10 acute hospitals settings in Ireland. The data was c ollected Feb 2013-May 2013. Standardised instruments were used to measure patients’ perceptions of perso n-centredness and their experiences of care. Questionnaire packs were distributed to a sample of patients based on predetermined inclusion criteria . Completed questionnaires were returned in a sealed envelope. The instruments were psychometrically tested prior to full analysis of the results. Ethic al approval was granted by Research Ethics Committees in all participating hospitals. The psychometric prope rties of both instruments were determined as satisfactory. There was a moderate positive and sig nificant relationship between patients’ perceptions of a person-centred climate and patient experiences. P atients who perceived care as being more personcentred also reported a more positive patient exper ience. The emergence of new instruments designed to measure patients’ perceptions of person-centredness and patient experiences have been shown to have acceptable psychometric properties. This study demo nstrates clear linkage between patients’ experience s of care and the key indicators of person-centred ca re.

Initiating Development of Genetic Counseling Services in the Health Services Unit: An Initial Assessment

Medical industry has grown rapidly take advantage of the knowledge, resources, and various applications of genetic techniques to solve various problems related to the benefit of mankind. As a result of developments in this realm of genetic, genomic medicine appears focused on the health sector. Genomic medicine is a great springboard for diagnosing, monitoring, and provide therapy in a variety of diseases. A part of genomic medicine is genetic counseling which focused in serving genetic information concerning about genetic diseases. The development of genetic counseling services are an essential part of health care-related policy. Keywords: genetic counseling, genetic disease

What should be given a priority – costly medications for relatively few people or inexpensive ones for many? The Health Parliament public consultation initiative in Israel

In the past two decades, government and civic organizations have been implementing a wide range of deliberative public consultations on health care-related policy. Drawing on these experiences, a public consultation initiative in Israel called the Health Parliament was established. To implement a public consultation initiative that will engage members of the public in the discussion of four healthcare policy questions associated with equity in health services and on priorities for determining which medications and treatments should be included in the basket of national health services. One hundred thirty-two participants from the general population recruited through a random sample were provided with background materials and met over several months in six regional sites. Dilemma activities were used and consultants were available for questions and clarifications. Participants presented their recommendations in a national assembly to the Minister of Health. Across the regional groups the recommendations were mostly compatible, in particular regarding considering the healthcare system's monetary state, even at the expense of equity, but for each policy question minority views were also expressed. A strong emphasis in the recommendations was pragmatism. Participants felt the experience was worthwhile; though the actual impact of their recommendations on policy making was indirect, they were willing to participate in future consultations. However, despite enthusiasm the initiative was not continued. Issues raised are whether consultation initiatives must have a direct impact on healthcare policy decisions or can be mainly a venue to involve citizens in the deliberation of healthcare policy issues.

Midwives and postabortion care: experiences, opinions, and attitudes among participants at the 25th triennial congress of the international confederation of midwives

Midwifery practice may not include caring for women experiencing complications from unsafe abortion, despite the importance of this care for the health and lives of millions of women around the world. This article summarizes data collected from midwives from 41 countries who attended the 25th Triennial Congress of the International Confederation of Midwives in 1999, focusing on their experiences with, and attitudes toward, the provision of postabortion care. Barriers to provision of postabortion care and factors for changes in postabortion care-related policies were explored. Midwives from developing countries, where complications from unsafe abortion present a serious public health problem, were cognizant of the need to authorize, train, and equip midwives in postabortion care, including the use of uterine evacuation of incomplete abortion with manual vacuum aspiration. Changes in policy and practice are needed throughout the world so that women will have access to quality, compassionate postabortion care services regardless of where they live. Ensuring that midwives are able to provide such services will help to reduce abortion-related morbidity and mortality.

Home care for ventilator-dependent persons: a cost-effective, humane public policy.

The study measured cost-effectiveness of home care for severely disabled persons. Findings support home care as more cost-effective than other alternatives for ventilator-dependent persons. Home care-related policy reform in Medicaid, Medicare, Supplemental Security Income, and subsidized housing, coupled with a coordinated service delivery system, could save millions of public dollars. To accomplish this, policies must accommodate and encourage independent community living for the disabled and the integrity of their families.