Important Questions For Policymakers Research Articles

A systematic review of economic evaluation literature in Thailand: are the data good enough to be used by policy-makers?

In many countries, including Thailand, there is an increasing impetus to use economic evaluation to allow more explicit and transparent healthcare priority setting. However, an important question for policy makers in low- and middle-income countries is whether it is appropriate and feasible to introduce economic evaluation data into healthcare priority-setting decisions. In addition to ethical, social and political issues, information supply challenges need to be addressed. This paper systematically reviewed the literature on economic evaluation of health technology in Thailand published between 1982 and 2005. Its aim was to analyse the quantity, quality and targeting of economic evaluation studies that can provide a framework for those conducting similar reviews in other settings. The review revealed that, although the number of publications reporting economic evaluations has increased significantly in recent years, serious attention needs to be given to the quality of reporting and analysis. Furthermore, there is an absence of economic evaluation publications for 15 of the top 20 major health problems in Thailand, indicating a poor distribution of research resources towards the determination of cost-effective interventions for diminishing the disease burden of certain major health problems. If economic evaluation is only useful for policy makers when performed correctly and reported accurately, these findings depict information barriers to using economic evaluation to assist health decision-making processes in Thailand.

Inflation Persistence and Monetary Policy Design: An Overview

How monetary policy should be set optimally when the structure of the economy exhibits inflation persistence is an important question for policy makers. This paper provides an overview of the implications of inflation persistence for the design of monetary policy.

White men are under-represented in UK medical schools

White men are significantly underrepresented in medical school, says research published in the BMJ this month (2004;329:597-600). The study, done by researchers at Oxford University, found that white men now comprise 26% of all UK medical students, despite making up 44% of the UK population. It also suggested that UK medical schools were increasingly dominated by white women and students from ethnic minorities. Researchers looked at data from the Universities and Colleges Admissions Service (UCAS), the NHS national database of consultants in England, and the UK Medical Careers Research Group, which spanned the last 30 years. Nearly all medical school graduates in 1974 were white (97%), but by 2000 this had reduced to 74%, with 26% made up of ethnic minorities. Most students from an ethnic background were Asian. Asian students accounted for 19% of new medical students in 2001, although Asian people make up 7% of the UK population. The researchers wrote, “From less than 2% of newly qualified doctors in the early 1970s, it [the percentage of newly qualified doctors from ethnic minorities] will soon approach 30%, well in excess of the representation of people from ethnic minorities in the general population.” This raises important questions for policy makers: should the ethnic mix of intake to medical schools broadly reflect the ethnic mix of the community from which students are drawn? “I say chaps, we're going to be extinct” “The high representation of ethnic minorities, and specifically those of Asian origin, indicates high academic achievement by them. It probably indicates that many of the most able school pupils from these ethnic groups, and perhaps particularly women, choose medicine as a career.” The researchers called for further studies into the reasons behind the under-representation of white male medical students. The paper also said that the NHS was heavily dependent …

Care-seeking patterns for fatal malaria in Tanzania

BackgroundOnce malaria occurs, deaths can be prevented by prompt treatment with relatively affordable and efficacious drugs. Yet this goal is elusive in Africa. The paradox of a continuing but easily preventable cause of high mortality raises important questions for policy makers concerning care-seeking and access to health systems. Although patterns of care-seeking during uncomplicated malaria episodes are well known, studies in cases of fatal malaria are rare. Care-seeking behaviours may differ between these groups.MethodsThis study documents care-seeking events in 320 children less than five years of age with fatal malaria seen between 1999 and 2001 during over 240,000 person-years of follow-up in a stable perennial malaria transmission setting in southern Tanzania. Accounts of care-seeking recorded in verbal autopsy histories were analysed to determine providers attended and the sequence of choices made as the patients' condition deteriorated.ResultsAs first resort to care, 78.7% of malaria-attributable deaths used modern biomedical care in the form of antimalarial pharmaceuticals from shops or government or non-governmental heath facilities, 9.4% used initial traditional care at home or from traditional practitioners and 11.9% sought no care of any kind. There were no differences in patterns of choice by sex of the child, sex of the head of the household, socioeconomic status of the household or presence or absence of convulsions. In malaria deaths of all ages who sought care more than once, modern care was included in the first or second resort to care in 90.0% and 99.4% with and without convulsions respectively.ConclusionsIn this study of fatal malaria in southern Tanzania, biomedical care is the preferred choice of an overwhelming majority of suspected malaria cases, even those complicated by convulsions. Traditional care is no longer a significant delaying factor. To reduce mortality further will require greater emphasis on recognizing danger signs at home, prompter care-seeking, improved quality of care at health facilities and better adherence to treatment.

The Effects Of Adjudicating And Sentencing Juveniles As Adults

Across the nation, serious and chronic juvenile offenders are increasingly being tried as adults in criminal court and incarcerated in adult correctional facilities. This trend raises important questions for policy makers. To what extent do trials in criminal courts and incarceration in adult prisons promote or inhibit community protection and the accountability and rehabilitation of juvenile offenders? This article discusses the legal consequences of adjudication in criminal court and offers a comprehensive review of research findings on the deterrent effects of transfer laws, conviction and sentencing patterns and recidivism rates in juvenile versus criminal courts, and conditions and programming in juvenile versus adult correctional facilities. The implications of these research findings for juvenile justice policies on adjudicating and sentencing juveniles as adults and directions for future research are discussed.

Efficiency, performance and regulation of the international gas industry—a bootstrap DEA approach

Natural gas has become increasingly important as a source of energy in recent years. It is widely viewed as an attractive means of realizing environmental objectives post Kyoto, and individual country gas industries have been extensively restructured to encourage investment from the private sector. Barriers to international trade in gas have fallen particularly in areas such as Europe and Asia as pipeline facilities have expanded and trading systems have become established. An important question for policy makers concerns the use of scarce resources by this expanding industry. Regulatory authorities increasingly use efficiency comparators to incentivise minimum cost use of resources by price cap methods, yardstick competition and other techniques. This paper explores some of the policy developments, which affect efficiency of resource use in the gas industry, and uses data envelopment analysis to measure relative performance at the individual country level. Recent developments in bootstrapping techniques are used to correct efficiency estimates for bias and to assess the uncertainty surrounding such estimates. The implications of these results for regulatory authorities are then explored.

The effectiveness of Nurture Groups: preliminary research findings

Interest in Nurture Groups continues to grow. As Rebecca Doyle’s article in the previous issue of this journal demonstrated, practitioners are enthusiastically exploring nurture‐based practice as one approach to the inclusion of pupils with social, emotional and behavioural difficulties. In this article, Paul Cooper, Professor of Education at the University of Leicester, Ray Arnold and Eve Boyd, both researchers with the Nurture Groups project, provide a report on their research to date. This interim report raises some important questions for policy makers and practitioners as well as indicating ways forward into further enquiry.

Preface to a feminist theory of poverty

The study of justice has been what John Scharr calls a "sunrise indust ry" in academia for the last decade.~ But while production has been remarkable on the "supply side" with almost every graduate student and doctor of political philosophy contributing views on the issue, the "demand side" continues to lag. What has all this discussion of justice come to? Are we any closer to finding or establishing a basic distributive principle which applies everywhere and always, or even provisionally within a given historical and cultural sphere? This is an important question for policy makers and activists as well as for scholars from many fields. In this paper I propose to discuss an approach which has not generally been explored by political theorists interested in the question of justice--namely, a feminist approach which critiques the way gender inequality structures economic systems and informs the process of theorizing itself. The literature of social theory, in its classic as well as contemporary versions, has given us a starting point, a perspective, from which we can begin to assess the quality of justice in any society. Marx argued that one must consider the justice of any system of distribution from the point of view of the lowest and most wretched in that society. Rawls' "difference principle" similarly argues that no advantage in a society can be justified unless it is in the interest of the least advantaged g r o u p . 2 T h e fact that women are the least advantaged group in all societies is taken to be accidental. That is, from a theoretical, formal point of view, gender is not funda-