Rationing in healthcare

Rationing healthcare in some form is inevitable, even in wealthy countries, because resources are scarce and demand for healthcare is always likely to exceed supply. This means that decision-makers must make choices about which health programs and initiatives should receive public funding and which ones should not. These choices are often difficult to make, particularly in Australia, because: - 1 Make explicit rationing based on a national decision-making tool (such as Multi-criteria Decision Analysis) standard process in all jurisdictions. - 2 Develop nationally consistent methods for conducting economic evaluation in health so that good quality evidence on the relative efficiency of various programs and initiatives is generated. - 3 Generate more economic evaluation evidence to inform rationing decisions. - 4 Revise national health performance indicators so that they include true health system efficiency indicators, such as cost-effectiveness. - 5 Apply the Comprehensive Management Framework used to evaluate items on the Medicare Benefits Schedule (MBS) to the Pharmaceutical Benefits Scheme (PBS) and the Prosthesis List to accelerate disinvestment from low-value drugs and prostheses. - 6 Seek agreement among Commonwealth, state and territory governments to work together to undertake work similar to the National Institute for Health and Care Excellence in the United Kingdom and the Canadian Agency for Drugs and Technologies in Health.

New directions in coach education research

There has been substantial growth in the provision of, and importance attached to, coach education in many Western countries in particular, but there is also an emerging interest in the developing world (Gilbert & Trudel, 1999; Lyle, 2002). Yet this growth in interest has not resulted in a corresponding increase in research activity. Much of the focus of the existing coach education literature has been on coach development and learning (Cushion, Armour,& Jones, 2003; Malete et al, 2000; Sage, 1989; Weiss et al, 1991), coaching behavior and coach effectiveness training in the context of youth sports (Smith & Smoll, 1990; Smith, Smoll, & Barnett, 1995; Smoll et al.,1993) and the problems associated with the privileging of technical, tactical, and bio-scientific knowledges that have been characteristic features of much coach education provision (Abraham & Collins, 1998; Campbell, 1993; Potrac et al, 2000; Schempp, 2000). While this scholarship has provided valuable insights into some aspects of coach education, it underlines the absence of research addressing a range of topics such as the development of coach education curricula, the structures for coach learning, coaches’ learning processes and coach certification (Gilbert & Trudel, 2000). In this paper we discuss a new theoretical frame for coach education research centered on the idea of communities of practice.

Diffusing research into routine midwifery practice

This research applied Greenhalgh et al's (2005) organisational change theoretical framework and a case study method approach to explore the process of implementing a smoking cessation intervention for pregnant women. The study was carried out according to the principles laid down in the National statement on ethical conduct in human research, produced by the National Health and Medical Research Council, Australia. Ethical approval for the research was sought and received from Queensland University of Technology human research ethics committee, prior to the start of the study. The sample constituted four participants who had been involved in the process of disseminating a training programme for midwives to implement a smoking cessation intervention. Eight semi-structured interviews were undertaken with these participants and the interviews and background programme data were subjected to theoretical analysis. The data were analysed through the lens of the Greenhalgh et al (2005) framework. The result was a disaggregation and (re)aggregation of data in the formation of an analytical outcome (Charmaz, 2006).

Performance based planning in Queensland : A case of unintended plan-making outcomes

Performance based planning (PBP) is purported to be a viable alternative to traditional zoning. The implementation of PBP ranges between pure approaches that rely on predetermined quantifiable performance standards to determine land use suitability, and hybrid approaches that rely on a mix of activity based zones in addition to prescriptive and subjective standards. Jurisdictions in the USA, Australia and New Zealand have attempted this type of land use regulation with varying degrees of success. Despite the adoption of PBP legislation in these jurisdictions, this paper argues that a lack of extensive evaluation means that PBP is not well understood and the purported advantages of this type of planning are rarely achieved in practice. Few empirical studies have attempted to examine how PBP has been implemented in practice. In Queensland, Australia, the Integrated Planning Act 1997 (IPA) operated as Queensland's principal planning legislation between March 1998 and December 2009. While the IPA did not explicitly use the term performance based planning, the Queensland's planning system is widely considered to be performance based in practice. Significantly, the IPA prevented Local Government from prohibiting development or use and the term zone was absent from the legislation. How plan-making would be advanced under the new planning regime was not clear, and as a consequence local governments produced a variety of different plan-making approaches to comply with the new legislative regime. In order to analyse this variation the research has developed a performance adoption spectrum to classify plans ranging between pure and hybrid perspectives of PBP. The spectrum compares how land use was regulated in seventeen IPA plans across Queensland. The research found that hybrid plans predominated, and that over time a greater reliance on risk adverse drafting approaches created a quasi-prohibition plan, the exact opposite of what was intended by the IPA. This paper concludes that the drafting of the IPA and absence of plan-making guidance contributed to lack of shared understanding about the intended direction of the new planning system and resulted in many administrative interpretations of the legislation. It was a planning direction that tried too hard to be different, and as a result created a perception of land use risk and uncertainty that caused a return to more prescriptive and inflexible plan-making methods.

Reforming technology company incentive programs for achieving knowledge-based economic development:a Brazil-Australia comparative study

This doctoral thesis aims to demonstrate the importance of incentives to technology-based firms as a strategy to promote knowledge-based economic development (KBED). To remain competitive, technology-based firms must innovate and seek new markets; therefore, this study aims to propose an incentive model to technology-based firms as a strategy to promote knowledge-based urban development, according to framework described by Yigitcanlar (2011). This is an exploratory and descriptive research with a qualitative approach. Surveys were carried out with national trade associations that represented technology-based firms both in Brazil and Australia. After analysing the surveys, structured interviews were conducted with government representatives, trade associations and businessmen who had used financial support by the federal government. When comparing both countries, the study found the importance of direct incentives through tax incentives, for it is a less bureaucratic, quicker and more direct process for firms. We suggest to include the terms incentives in the framework of knowledge-based urban development, as one of the pillars that contribute to knowledge-based economic development.

Youth programs in remote Indigenous communities: Context matters

A diversity of programs oriented to young people seek to develop their capacities and their connection to the communities in which they live. Some focus on ameliorating a particular issue or ‘deficit’ whilst others, such as sporting, recreation and youth groups are more grounded in the community. This article reports a qualitative study undertaken in three remote Indigenous communities in Central Australia. Sixty interviews were conducted with a range of stakeholders involved in a diversity of youth programs. A range of critical challenges for and characteristics of remote Indigenous youth programs are identified if such programs are to be ‘fit for context’. ‘Youth centred-context specific’ provides a positive frame for the delivery of youth programs in remote Central Australia, encouraging an explicit focus on program logic; program content and processes; and relational, temporal, and, spatial aspects of the practice context. These provide lenses with which youth program planning and delivery may be enhanced in remote communities. Culturally safe service planning and delivery suggests locally determined processes for decision-making and community ownership. In some cases, this may mean a community preference for all ages to access the service to engage in culturally relevant activities. Where activities are targeted at young people, yet open to and inclusive of all ages, they provide a medium for cross-generational interaction that requires a high degree of flexibility on the part of staff and funding programs. Although the findings are focused in Central Australia, they may be relevant to similar contexts elsewhere.