Priority Guidelines Research Articles

Norwegian priority guidelines: Estimating the distributional implications across age, gender and SES

Targeting hospital treatment at patients with high priority would seem to be a natural policy response to the growing gap between what can be done and what can be financed in the specialist health care sector. The paper examines the distributional consequences of this policy. 450000 elective patients are allocated to priority groups on the basis of medical guidelines developed by one of the regional health authorities in Norway. Probit models are estimated explaining priority status as a function of age, gender and socioeconomic status. Women and older people are overrepresented among patients with low priority. Conditional on age, women with low priority have lower income and less education than women with high priority. Among men below 50 years, patients with low priority have less education than patients with high priority. Targeting hospital treatment at patients with high priority, though sensible from a pure medical perspective, may have undesirable distributional consequences.

Japan’s new lifelong learning policy: exploring lessons from the European knowledge economy

The concept of ‘lifelong learning’ or shōgai gakushū has rapidly become one of the topmost priorities in Japan’s education policy agenda. This was considerably evident in December 2006 when the term ‘lifelong learning’ was added to Japan’s educational charter, the Fundamental Law of Education. This paper explores, as a means to develop Japan’s new lifelong learning policy, the lessons that can be learnt through an examination of the European countries’ efforts to build a knowledge economy, where lifelong learning is regarded as the key solution in overcoming several important social and economic concerns. In this paper, I first examine the current situation of lifelong learning in Japan, employing the ethnographic data that I have collected since 2001. Second, I provide a brief review of the European lifelong learning policy, which is one of the priority guidelines in the European Union. Under the Lisbon Strategy, for example, the argument on European lifelong learning theoretically centres on developing human capital in order to survive in the global knowledge economy. Lastly, referring to the European experience over the past decade, I propose to directly connect Japan’s latest policy development regarding lifelong learning with the trend of building human capital through lifelong learning in order to enhance its competitiveness in the era of globalisation.

Praxis der Priorisierung am Beispiel der Versorgungsleitlinie Kardiologie in Schweden

In the Swedish priority guidelines, as opposed to traditional guidelines issued by professional associations, measures (in terms of condition-treatment pairs) of prevention, diagnosis, treatment and rehabilitation of cardiovascular diseases are assigned a priority value of 1 (high priority) through 10 (low priority). In its recent 2008 version this list also comprises procedures that should not be performed and those that should only be performed in the context of research projects. The government commissions the development of this list which will then be elaborated by a multi-professional team under the supervision of the National Board of Health and Welfare. In addition to scientific evidence, the prioritylists incorporate ethical and economical aspects. Examples from the Swedish guidelines will be discussed. The impact and limits of the priority lists will be described.

Energy policies in Latin America and the Caribbean and the evolution of sustainability

PurposeThe paper seeks to offer an evaluation of the energy sector's contribution to sustainable development in Latin America and the Caribbean (LAC) in the last 30 years.Design/methodology/approachSustainable development indicators proposed by Latin American Energy Organization/Economic Commission for Latin America and the Caribbean/German Technical Cooperation are used, in conjunction with indicators proposed by IAEA, United Nations Department of Economic and Social Affairs, IEA, EUROSTAT and the EEA. They are based on objectives, priorities and available information and their values are analyzed in a period of significant changes in LAC energy policies.FindingsState and evolution of sustainability in LAC are presented at a country and sub‐regional levels. Some important remarks are drawn about energy policies' contribution to sustainable development and some key areas to improve are identified.Originality/valueThis research intends to highlight implicit deficiencies in energy policies that could suggest new priority guidelines for future policy decisions, in order to improve their contribution to sustainable development.

Model for end-stage liver disease (MELD) exception guidelines

Model for end-stage liver disease (MELD) exception guidelines

Insect Conservation under the Endangered Species Act

ABSTRACT While the rate of extinction is the same for insects and other animals, insects are underrepresented in the Fish and Wildlife Service's list of threatened or endangered species. Insect conservationists have argued that the Endangered Species Act and the Fish and Wildlife Service are biased against insects, despite the importance of insects in our lives. The reality, however, is that there is only minimal bias inherent in the provisions of the Endangered Species Act or in regulations promulgated by the Fish and Wildlife Service. The main cause of the low number of insect species listed under the Endangered Species Act is a lack of qualified biologists to file and review listing petitions. Until sufficient information about insect conservation is available, petitioners could use surrogate species to protect threatened or endangered insect species. I. INTRODUCTION II. PROTECTION OF THREATENED AND ENDANGERED SPECIES A. The Problem of Extinction B. The Endangered Species Act of 1973 1. Purposes of the ESA 2. Statutory Protections 3. What Is an Endangered or Threatened Species? III. THE LISTING PROCESS AND ITS EFFECT ON INSECT CONSERVATION A. The Petition B. The Review 1. Listing Criteria 2. Listing Priority Guidelines 3. Best Scientific and Commercial Data Available IV. IMPROVING INSECT CONSERVATION A. Increased Scientific Knowledge B. Ecological Significance as a Listing Priority Criterion C. Surrogate Species V. CONCLUSION I. INTRODUCTION Most people are oblivious to the indispensable role insects play in our lives. The disappearance of insects would mean the loss of a vital food source without which most reptiles, mammals, amphibians, and birds would die. (1) Flowering plants, which cover most of the land surface, would be unable to survive without insects facilitating their reproduction and providing favorable soil conditions. (2) The surface of the earth would be covered with dead vegetation and animals, and would sustain only wind-pollinated plants and very little animal life. (3) Humans would not last more than a couple of months in an insect-less environment? Insects also provide valuable services for free. A recent study has valued the ecological services insects provide within the United States at $57 billion. (5) The study focused on services provided by wild native insects in the areas of dung burial, pest control, pollination, and wildlife nutrition. (6) Dung burial services provided by a single species, dung beetles, are valued at $380 million. (7) Insect parasites and predators provide $4.5 billion worth of pest control services for our crops. (8) Insect pollinators, mostly bees, are responsible for approximately $3.07 billion of American crops. (9) Wildlife nutrition provided by insects resulted in $49.93 billion worth of hunting, fishing, and bird watching. (10) While these figures are significant, they vastly underestimate the economic value of insects for human society. (11) Insects are also the undisputed winners of the game of survival in the history of this planet. The first insects appeared approximately 400 million years ago and since then have managed to inhabit almost all land and aquatic habitats, and have acquired flight. (12) Today, insect species greatly outnumber all other animal species and make up over half of all organisms identified by man. (13) Another five to eight million more insect species are thought to exist, but have not been discovered or identified. (14) Careful bioprospecting (15) of this incredible insect biodiversity could yield valuable genetic and chemical raw materials that could be used to create new transgenic strains of plants and animals or the next round of cutting-edge pharmaceuticals. (16) Yet insect biodiversity faces the same ecological threats as all other biodiversity. …

Patients' views of priority setting for new medicines

Objective: To identify rheumatoid arthritis patients' perceptions about what should govern priority setting for the new class of high-cost anti-rheumatics, the TNF inhibitors. Methods: Qualitative study employing semi-structured interviews of 22 patients diagnosed with rheumatoid arthritis at three hospitals in the region of Stockholm, Sweden. The interviews were conducted from December 1999 to March 2000. Results: Patients suggest that a basis for priority setting should be need, including priority to persons with severe and/or early disease, and to those not responding to other anti-rheumatics. Some patients believe that age and productivity have to be taken into account in priority setting, while others oppose this view. Some patients want the individual physician to carry out priority setting, while others consider this too arbitrary. Respondents often suggest criteria unfavourable to themselves. Alongside suggestions for priority setting criteria, there is also a notion that, ideally, priority setting should not have to take place at all. Conclusions: Patients' views of priority setting are not necessarily influenced by the patients' individual needs and may contribute to the development of priority guidelines. Knowledge of the patients' perceptions of priority setting for a specific treatment might also support patient-provider discussions on priority setting.

An Evaluation of the Prioritisation of Referrals by Leeds Social Services Senior Occupational Therapists

Leeds occupational therapy section formally adopted a priority system for referrals in 1989. Written priority guidelines defined three levels of priority: immediate need (P1), urgent need (P2) and non-urgent (P3). Senior occupational therapists assign priority to referrals which they subsequently allocate to field workers. P1 and P2 referrals are visited by occupational therapists and P3 referrals by occupational therapy assistants. This study attempted to discover if the priority assigned by the senior occupational therapists was accurate. The senior occupational therapists were asked to allocate a number of referrals from each priority level to the occupational therapists without indicating what priority they considered the referral to be. The occupational therapists were asked to visit the client and record the priority of the case on the basis of their home assessment, using the written guidelines. The priorities assigned were compared and agreement was measured by use of the kappa statistic. The senior occupational therapists allocated 264 study referrals. Occupational therapist information was gathered on 216 of these. The occupational therapists and senior occupational therapists agreed on 64.4% of the P1s, 40.3% of the P2s and 47.4% of the P3s. The kappa statistics indicate that the level of agreement was poor to fair. Further information should be gathered on those referrals considered to be either P2 or P3 by the senior occupational therapists to allow more accurate prioritisation.