eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-03-01
6
3
127
128
10.15171/ijhpm.2017.10
3316
Global Developments in Priority Setting in Health
Rob Baltussen
rob.baltussen@radboudumc.nl
1
Craig Mitton
craig.mitton@ubc.ca
2
Marion Danis
mdanis@nih.gov
3
Iestyn Williams
i.p.williams@bham.ac.uk
4
Marthe Gold
mgold@nyam.org
5
Radboud University Medical Center, Nijmegen, The Netherlands
University of British Columbia, Vancouver, BC, Canada
National Institutes of Health, Bethesda, MD, USA
University of Birmingham, Birmingham, UK
New York Academy of Medicine, New York City, NY, USA
Countries around the world are experiencing an ever-increasing need to make choices in investments in health and healthcare. This makes it incumbent upon them to have formal processes in place to optimize the legitimacy of eventual decisions. There is now growing experience among countries of the implementation of stakeholder participation, and a developing convergence of methods to support decision-makers within health authorities in making tough decisions when faced with the stark reality of limited resources. We call for further interaction among health authorities, and the research community to develop best practices in order to confront the difficult choices that need to be made.
https://www.ijhpm.com/article_3316_8ed196cdfc322be73c81139cb7d529e3.pdf
Priority Setting
Legitimacy
Stakeholder Participation
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-03-01
6
3
129
133
10.15171/ijhpm.2017.01
3307
A Case for Open Network Health Systems: Systems as Networks in Public Mental Health
Michael Grant Rhodes
orreryconsulting@gmail.com
1
Marten W. de Vries
m.devries@maastrichtuniversity.nl
2
Mind Venture International, Maastricht, The Netherlands
Mind Venture International, Maastricht, The Netherlands
Increases in incidents involving so-called confused persons have brought attention to the potential costs of recent changes to public mental health (PMH) services in the Netherlands. Decentralized under the (Community) Participation Act (2014), local governments must find resources to compensate for reduced central funding to such services or “innovate.” But innovation, even when pressure for change is intense, is difficult. This perspective paper describes experience during and after an investigation into a particularly violent incident and murder. The aim was to provide recommendations to improve the functioning of local PMH services. The investigation concluded that no specific failure by an individual professional or service provider facility led to the murder. Instead, also as a result of the Participation Act that severed communication lines between individuals and organizations, information sharing failures were likely to have reduced system level capacity to identify risks. The methods and analytical frameworks employed to reach this conclusion, also lead to discussion as to the plausibility of an unconventional solution. If improving communication is the primary problem, non-hierarchical information, and organizational networks arise as possible and innovative system solutions. The proposal for debate is that traditional “health system” definitions, literature and narratives, and operating assumptions in public (mental) health are ‘locked in’ constraining technical and organization innovations. If we view a “health system” as an adaptive system of economic and social “networks,” it becomes clear that the current orthodox solution, the so-called integrated health system, typically results in a “centralized hierarchical” or “tree” network. An overlooked alternative that breaks out of the established policy narratives is the view of a ‘health systems’ as a non-hierarchical organizational structure or ‘Open Network.’ In turn, this opens new technological and organizational possibilities in seeking policy solutions, and suggests an alternative governance model of huge potential value in public health both locally and globally.
https://www.ijhpm.com/article_3307_ce06eadc81b00469db14d048fcec6b1b.pdf
Social and Economic Networks
Public Mental Health (PMH)
Non-hierarchical Organization Governance
Adaptive Systems
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-03-01
6
3
135
145
10.15171/ijhpm.2016.104
3255
The Importance of Community Consultations for Generating Evidence for Health Reform in Ukraine
Olena Hankivsky
oah@sfu.ca
1
Anna Vorobyova
avorobyo@sfu.ca
2
Anastasiya Salnykova
salnykova@alumni.ubc.ca
3
Setareh Rouhani
srouh057@uottawa.ca
4
London School of Hygiene and Tropical Medicine, London, UK
Institute for Intersectionality Research and Policy, Simon Fraser University, Vancouver, BC, Canada
Institute for Intersectionality Research and Policy, Simon Fraser University, Vancouver, BC, Canada
Institute of Population Health, University of Ottawa, Ottawa, ON, Canada
Background The paper presents the results of community consultations about the health needs and healthcare experiences of the population of Ukraine. The objective of community consultations is to engage a community in which a research project is studying, and to gauge feedback, criticism and suggestions. It is designed to seek advice or information from participants directly affected by the study subject of interest. The purpose of this study was to collect first-hand perceptions about daily life, health concerns and experiences with the healthcare system. This study provides policy-makers with additional evidence to ensure that health reforms would include a focus not only on health system changes but also social determinants of health (SDH). Methods The data collection consisted of the 21 community consultations conducted in 2012 in eleven regions of Ukraine in a mix of urban and rural settings. The qualitative data was coded in MAXQDA 11 software and thematic analysis was used as a method of summarizing and interpreting the results. Results The key findings of this study point out the importance of the SDH in the lives of Ukrainians and how the residents of Ukraine perceive that health inequities and premature mortality are shaped by the circumstances of their daily lives, such as: political and economic instability, environmental pollution, low wages, poor diet, insufficient physical activity, and unsatisfactory state of public services. Study participants repeatedly discussed these conditions as the reasons for the perceived health crisis in Ukraine. The dilapidated state of the healthcare system was discussed as well; high out-of-pocket (OOP) payments and lack of trust in doctors appeared as significant barriers in accessing healthcare services. Additionally, the consultations highlighted the economic and health gaps between residents of rural and urban areas, naming rural populations among the most vulnerable social groups in Ukraine. Conclusion The study concludes that any meaningful reforms of the health sector in Ukraine must include a broad range of factors, including the healthcare system but importantly, must extend to SDH approach and include the prioritization of health promotion, limiting alcohol and tobacco availability and enforcing environmental protection.
https://www.ijhpm.com/article_3255_3ae725d21786bfdba95428e300310165.pdf
Ukraine
Health Crisis
Community Consultations
Public Perceptions
Citizen Engagement
Civil
Participatory Approach
Social Determinants of Health (SDH)
Health Reform
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-03-01
6
3
147
153
10.15171/ijhpm.2016.107
3260
Being Single as a Social Barrier to Access Reproductive Healthcare Services by Iranian Girls
Shahnaz Kohan
kohan@nm.mui.ac.ir
1
Fatemeh Mohammadi
mohamady_kh@yahoo.com
2
Firoozeh Mostafavi
mostafavi@hlt.mui.ac.ir
3
Ali Gholami
a_gho_d@yahoo.com
4
Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Islamic Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
Background Iranian single women are deprived of reproductive healthcare services, though the provision of such services to the public has increased. This study aimed to explore the experiences of Iranian single women on their access to reproductive health services. Methods A qualitative design using a conventional content analysis method was used. Semi-structured interviews were held with 17 single women and nine health providers chosen using the purposive sampling method. Results Data analysis resulted in the development of three categories: ‘family’s attitudes and performance about single women’s reproductive healthcare,’ ‘socio-cultural factors influencing reproductive healthcare,’ and ‘cultural factors influencing being a single woman.’ Conclusion Cultural and contextual factors affect being a single woman in every society. Therefore, healthcare providers need to identify such factors during the designing of strategies for improving the facilitation of access to reproductive healthcare services.
https://www.ijhpm.com/article_3260_32de251f304e2a789f4d95906c2fbd38.pdf
Reproductive Healthcare
Women
Culture
Qualitative Study
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-03-01
6
3
155
164
10.15171/ijhpm.2016.108
3256
The Contribution of Ageing to Hospitalisation Days in Hong Kong: A Decomposition Analysis
Chi Leung Kwok
raykcl@hku.hk
1
Carmen KM Lee
lcarmen@connect.hku.hk
2
William TL Lo
lotl@ha.org.hk
3
Paul SF Yip
sfpyip@hku.hk
4
HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong
Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
Kwai Chung Hospital, Hospital Authority, Kwai Chung, Hong Kong
HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong
Background Ageing has become a serious challenge in Hong Kong and globally. It has serious implications for health expenditure, which accounts for nearly 20% of overall government expenditure. Here we assess the contribution of ageing and related factors to hospitalisation days in Hong Kong. We used hospital discharge data from all publicly funded hospitals in Hong Kong between 2001 and 2012. Methods A decomposition method was used to examine the factors that account for the change of total hospitalisation days during the two periods, 2001-2004 and 2004-2012. The five factors include two demographic factors – population size and age-gender composition – and three service components – hospital discharge rate, number of discharge episodes per patient, and average length of stay (LOS) – which are all measured at age-gender group level. In order to assess the health cost burden in the future, we also project the total hospitalisation days up to 2041, for a range of scenarios. Results During the decreasing period of hospitalisation days (2001-2004), the reduction of LOS contributed to about 60% of the reduction. For the period of increase (2004-2012), ageing is associated with an increase in total hospitalisation days of 1.03 million, followed by an increase in hospital discharge rates (0.67 million), an increase in the number of discharge episodes per patient (0.62 million), and population growth (0.43 million). The reduction of LOS has greatly offset these increases (-2.19 million days), and has become one of the most significant factors in containing the increasing number of hospitalisation days. Projected increases in total hospitalisation days under different scenarios have highlighted that the contribution of ageing will become even more prominent after 2022. Conclusion Hong Kong is facing increasing healthcare burden caused by the rapid increase in demand for inpatient services due to ageing. Better management of inpatient services with the aim of increasing efficiency and reducing LOS, avoidable hospitalisation and readmission, without compromising patient satisfaction and quality of service, are crucial for containing the rapid and enormous increases in total hospitalisation days for Hong Kong. The results would be relevant to many rapidly ageing societies in this region.
https://www.ijhpm.com/article_3256_0ac063c6fbf2621f6364ff42ee43325a.pdf
Decomposition
Hospitalisation Days
Ageing
Length of Stay (LOS)
Patient Discharge
Hong Kong
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-03-01
6
3
165
168
10.15171/ijhpm.2016.113
3258
Business as Usual: A Lack of Institutional Innovation in Global Health Governance; Comment on “Global Health Governance Challenges 2016 – Are We Ready?”
Kelley Lee
kelley_lee@sfu.ca
1
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
There were once again high expectations that a major global health event - the Ebola virus outbreak of 2014-2015 - would trigger meaningfully World Health Organization (WHO) reform and strengthen global health governance (GHG). Rather than a “turning point,” however, the global community has gone back to business as usual. This has occurred against a backdrop of worldwide political turmoil, characterised by a growing rejection of existing political leaders and state-centric institutions. Debates about GHG so far have given insufficient attention to the need for institutional innovation. This entails rethinking the traditional bureaucratic model of postwar intergovernmental organizations which is disconnected from the transboundary, fast-paced nature of today’s globalizing world.
https://www.ijhpm.com/article_3258_9adc9a35de478ccd95a5b23b5c08839a.pdf
Global Health Governance (GHG)
World Health Organization (WHO) Reform
Globalization
Institutional Innovation
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-03-01
6
3
169
171
10.15171/ijhpm.2016.115
3259
A New Gilded Age, and What It Means for Global Health; Comment on “Global Health Governance Challenges 2016 – Are We Ready?”
Ted Schrecker
theodore.schrecker@newcastle.ac.uk
1
School of Medicine, Pharmacy and Health, Durham University, Durham, UK
New contours of global inequality present new challenges for global health, and require that we consider new kinds of health issues as global. I provide a number of illustrations, arguing the need for a political science of health that goes beyond conventional preoccupations with formal institutional and interstate interactions and takes into account how globalization has affected the health policy landscape and restructured the distribution of economic and political power not only among countries, but also within them.
https://www.ijhpm.com/article_3259_6aa8796653b365425fbd377dec5e57ee.pdf
Global Health Politics
Political Economy
Neoliberalism
Inequality
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-03-01
6
3
173
176
10.15171/ijhpm.2016.114
3263
The Devil Is in the Details! On Regulating Cannabis Use in Canada Based on Public Health Criteria; Comment on “Legalizing and Regulating Marijuana in Canada: Review of Potential Economic, Social, and Health Impacts”
Jürgen Rehm
jtrehm@gmail.com
1
Jean-François Crépault
jeanfrancois.crepault@camh.ca
2
Benedikt Fischer
bfischer@sfu.ca
3
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
Communications and Partnerships, CAMH, Toronto, ON, Canada
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
This commentary to the editorial of Hajizadeh argues that the economic, social and health consequences of legalizing cannabis in Canada will depend in large part on the exact stipulations (mainly from the federal government) and on the implementation, regulation and practice of the legalization act (on provincial and municipal levels). A strict regulatory framework is necessary to minimize the health burden attributable to cannabis use. This includes prominently control of production and sale of the legal cannabis including control of price and content with ban of marketing and advertisement. Regulation of medical marijuana should be part of such a framework as well
https://www.ijhpm.com/article_3263_1ecd227478a6d6b154afa4ed8f6fb740.pdf
Cannabis
Marijuana
Health Burden
Legalization
Regulation
Production
Sale
Medical Marijuana
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-03-01
6
3
177
179
10.15171/ijhpm.2016.116
3262
Current Models of Investor State Dispute Settlement Are Bad for Health: The European Union Could Offer an Alternative; Comment on “The Trans-Pacific Partnership: Is It Everything We Feared for Health?”
Martin McKee
martin.mckee@lshtm.ac.uk
1
David Stuckler
david.stuckler@unibocconi.it
2
ECOHOST, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
Department of Sociology, University of Oxford, Oxford, UK
In this commentary, we endorse concerns about the health impact of the trans-pacific partnership (TPP), paying particular attention to its mechanisms for investor state dispute settlement. We then describe the different, judgeled approach being advocated by the European Commission team negotiating the Trans-Atlantic Trade and Investment Partnership, arguing that, while not perfect, it offers significant advantages.
https://www.ijhpm.com/article_3262_61846d623b6739c3b4ce7fc3765541d3.pdf
Social Determinants of Health (SDH)
Trade and Investment Policy
Population Health
Global
Governance for Health
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-03-01
6
3
181
182
10.15171/ijhpm.2016.152
3299
Legalizing Marijuana in Canada — A Double-Edged Sword: A Response to Recent Commentaries
Mohammad Hajizadeh
m.hajizadeh@dal.ca
1
School of Health Administration, Dalhousie University, Halifax, NS, Canada
https://www.ijhpm.com/article_3299_305566377835f627c095a06a704f8d82.pdf
Legalization of Recreational Marijuana
Canada
Potential Impacts