Advanced Asia's health systems in comparison

There is growing interest in comparing patterns of social and health service development in advanced Asian economies. Most publications concentrate broadly on a range of core social services such as education, housing, social security and health care. In terms of those solely focused on health, most discuss arrangements in specific countries and territories. Some take a comparative approach, but are focused on presentation and discussion of expenditure, resourcing and service utilization data. This article extends the comparative analysis of advanced Asian health systems, considering the cases of Japan, South Korea, Taiwan, Hong Kong and Singapore. The article provides basic background information, and delves into common concerns among the world's health systems today including primary care organization, rationing and cost containment, service quality, and system integration. Conclusions include that problems exist in 'classifying' the five diverse systems; that the systems face common pressures; and that there are considerable opportunities to enhance primary care, service quality and system integration. (c) 2006 Elsevier Ireland Ltd. All rights reserved.

What does the community think about lifespan extension technologies? The need for an empirical base for ethical and policy debates

Objectives: This paper examines public understandings of possibilities for increasing life expectancy, interest in taking up lifespan-extending interventions, and motivations influencing these intentions. Methods: Structured interviews were conducted with 31 adults, aged 50 and over. Results: Participants believed that technological advances would increase life expectancy but questioned the value of quantity over quality of life. Life in itself was not considered valuable without the ability to put it to good use. Participants would not use technologies to extend their own lifespan unless the result would also enhance their health. Conclusions: These findings may not be generalisable to the general public but they provide the first empirical evidence on the plausibility of common assumptions about public interest in 'anti-ageing' interventions. Surveys of the views of representative samples of the population are needed to inform the development of a research agenda on the ethical, legal and social implications of lifespan extension.

Introducing evidence-based family assessment and therapy in child and youth mental health services: Applying systemic principles to maintain, sustain and build capacity

The purpose of this article is to overview the context of the mental health service in which we work, and family therapy's status prior to and after the impact of changes wrought by the introduction of the National Mental Health Policy. We then explore some key issues that we think contribute to the persistence of the occlusion of family therapy in child psychiatric services; and the strategies that we developed and are continuing to develop to support change, finally, we describe the use of a family assessment instrument that we believe is central to our change strategy.

Inside ‘Inside View’: reflections on stimulating debate and engagement through a multimedia live theatre production on the dilemmas and issues of pre-natal screening policy and practice

Background The role of applied theatre in engaging both lay and professional publics with debate on health policy and practice is an emergent field. This paper discusses the development, production performance and discussion of ‘Inside View’.1 Objectives The objectives were to produce applied theatre from research findings of a completed study on genetic prenatal screening, exploring the dilemmas for women and health professionals of prenatal genetic screening, and to engage audiences in debate and reflection on the dilemmas of prenatal genetic screening. Methods ‘Inside View’ was developed from a multidisciplinary research study through identification of emergent themes from qualitative interviews, and development of these by the writer, theatre producer and media technologist with input from the researchers. Findings Inside View was performed in London and the Midlands to varied audiences with a panel discussion and evaluation post performance. The audiences were engaged in debate that was relevant to them professionally and personally. Knowledge translation through applied theatre is an effective tool for engaging the public but the impact subsequently is unclear. There are ethical issues of unexpected disclosure during discussion post performance and the process of transforming research findings into applied theatre requires time and trust within the multidisciplinary team as well as adequate resourcing.

Advocating alcohol abstinence to pregnant women: some observations about British policy

In 2007, the English Department of Health (DH) issued advice stating 'pregnant woman' and 'those trying to conceive' should abstain from drinking alcohol. As others have noted, this advice was issued despite their being no new evidence about the deleterious effects of low levels of alcohol consumption. In this paper, we argue this development is significant for the social construction of 'risk', since in advocating abstinence without an evidence base for this advice, policy makers formalise a connection between uncertainty and danger. We suggest this development has important implications, most obviously for pregnant women, certainly impacting on the nature of the advice they will now receive and likely more generally on their experience of the transition to motherhood. We suggest it has wider implications for individuals' experience also, as policy makers appear to be advocating the same approach to risk to non-pregnant people. Further, it suggests a noteworthy formalisation of a new definition of risk, which should be debated far more extensively, as it matters for the future development of health policy.

Assessment of national health systems performance in the WHO African region

There is growing peer and donor pressure on African countries to utilize available resources more efficiently in a bid to support the ongoing efforts to expand coverage of health interventions with a view to achieving the health-related Millennium Development Goals. The purpose of this study was to estimate the technical and scale efficiency of national health systems in African continent. Methods The study applied the Data Envelopment Analysis approach to estimate the technical efficiency and scale efficiency among the 53 countries of the African Continent. Results Out of the 38 low-income African countries, 12 countries national health systems manifested a constant returns to scale technical efficiency (CRSTE) score of 100%; 15 countries had a VRSTE score of 100%; and 12 countries had a SE score of one. The average variable returns to scale technical efficiency (VRSTE) score was 95% and the mean scale efficiency (SE) score was 59%; meaning that while on average the degree of inefficiency was only 5%, the magnitude of scale inefficiency was 41%. Of the 15 middle-income countries, 5 countries, 9 countries and 5 countries had CRSTE, VRSTE and SE scores of 100%. Ten countries, six countries and 10 countries had CRSTE, VRSTE and SE scores of less than 100%; and thus, they were deemed inefficient. The average VRSTE (i.e. pure efficiency) score was 97.6%. The average SE score was 49.9%. Conclusion There are large unmet need for health and health-related services among countries of the African Continent. Thus, it would not be advisable for health policy-makers address NHS inefficiencies through reduction in excess human resources for health. Instead, it would be more prudent for them to leverage health promotion approaches and universal access prepaid (tax-based, insurance-based or mixtures) health financing systems to create demand for under utilised health services/interventions with a view to increasing ultimate health outputs to efficient target levels.

Undermining patient and public engagement and limiting its impact:the consequences of the Health and Social Care Act 2012 on collective patient and public involvement

Patient and public involvement has been at the heart of UK health policy for more than two decades. This commitment to putting patients at the heart of the British National Health Service (NHS) has become a central principle helping to ensure equity, patient safety and effectiveness in the health system. The recent Health and Social Care Act 2012 is the most significant reform of the NHS since its foundation in 1948. More radically, this legislation undermines the principle of patient and public involvement, public accountability and returns the power for prioritisation of health services to an unaccountable medical elite. This legislation marks a sea-change in the approach to patient and public involvement in the UK and signals a shift in the commitment of the UK government to patient-centred care. © 2013 John Wiley & Sons Ltd.

Policy through procurement:introduction of digital signal process (DSP) hearing aids into the English NHS

Despite being a major user of many technologies and innovations, the healthcare sector's role and influence as a procurer of technologies has been poorly represented by the literature and consequently is not fully understood. Providing a practical example of the introduction of digital signal process (DSP) hearing aids in to the English NHS, this paper discusses the role of public sector procurement agencies in the uptake of technologies from the private sector and their adoption by the public sector. Employing a system of innovation (SI) approach, the paper highlights the need for policy-makers to adopt a dynamic as well as systemic perspective that recognises the shifting roles, responsibilities and interactions of key stakeholders throughout the innovation process.

Examining the relationship between risk assessment and risk management in mental health

Risk assessment is crucial for developing risk management plans to prevent or minimize mental health patients' risks that will impede their recovery. Risk assessments and risk management plans should be closely linked. Their content and the extent to which they are linked within one Trust is explored. There is a great deal of variability in the amount and detail of risk information collected by nurses and how this is used to develop risk management plans. Keeping risk assessment information in one place rather than scattered throughout patient records is important for ensuring it can be accessed easily and linked properly to risk management plans. Strengthening the link between risk assessment and management will help ensure interventions and care is tailored to the specific needs of individual patients, thus promoting their safety and well-being. Thorough risk assessment helps in developing risk management plans that minimize risks that can impede mental health patients' recovery. Department of Health policy states that risk assessments and risk management plans should be inextricably linked. This paper examines their content and linkage within one Trust. Four inpatient wards for working age adults (18-65 years) in a large mental health Trust in England were included in the study. Completed risk assessment forms, for all patients in each inpatient ward were examined (n= 43), followed by an examination of notes for the same patients. Semi-structured interviews took place with ward nurses (n= 17). Findings show much variability in the amount and detail of risk information collected by nurses, which may be distributed in several places. Gaps in the risk assessment and risk management process are evident, and a disassociation between risk information and risk management plans is often present. Risk information should have a single location so that it can be easily found and updated. Overall, a more integrated approach to risk assessment and management is required, to help patients receive timely and appropriate interventions that can reduce risks such as suicide or harm to others. © 2011 Blackwell Publishing.

Connecting a sociology of childhood perspective with the study of child health, illness and wellbeing:introduction

In the last decades we have seen a growing interest in research into children's own experiences and understandings of health and illness. This development, we would argue, is much stimulated by the sociology of childhood which has drawn our attention to how children as a social group are placed and perceived within the structure of society, and within inter-generational relations, as well as how children are social agents and co-constructors of their social world. Drawing on this tradition, we here address some cross-cutting themes that we think are important to further the study of child health: situating children within health policy, drawing attention to practices around children's health and well-being and a focus on children as health actors. The paper contributes to a critical analysis of child health policy and notions of child health and normality, pointing to theoretical and empirical research potential for the sociology of children's health and illness.

Preferences of Hungarian consumers for quality, access and price attributes of health care services — result of a discrete choice experiment

In 2010, a household survey was carried out in Hungary among 1037 respondents to study consumer preferences and willingness to pay for health care services. In this paper, we use the data from the discrete choice experiments included in the survey, to elicit the preferences of health care consumers about the choice of health care providers. Regression analysis is used to estimate the effect of the improvement of service attributes (quality, access, and price) on patients’ choice, as well as the differences among the socio-demographic groups. We also estimate the marginal willingness to pay for the improvement in attribute levels by calculating marginal rates of substitution. The results show that respondents from a village or the capital, with low education and bad health status are more driven by the changes in the price attribute when choosing between health care providers. Respondents value the good skills and reputation of the physician and the attitude of the personnel most, followed by modern equipment and maintenance of the office/hospital. Access attributes (travelling and waiting time) are less important. The method of discrete choice experiment is useful to reveal patients’ preferences, and might support the development of an evidence-based and sustainable health policy on patient payments.

The health and nutritional status of multiethnic perimenopausal women

An integrated, dual-phase study design assessed the health and nutritional status and practices of African-American (A-A), Caribbean (A-C), and white non-Hispanic (W-A) women during perimenopause (40–55 years). During Phase I, four focus groups (n = 37) of male and female participants discussed the health and social implications of perimenopause. A conceptual framework for the main study (Phase II) was developed from the focus groups' findings, in concert with the main study's specific aims and objectives. ^ The main study, a cross-sectional survey, quantitatively assessed the health and nutritional status of a convenience sample of 109 women (25 A-A, 31 A-C and 53 W-A), who met specific eligibility criteria. Using seven instruments, sociodemographic, dietary, medical, reproductive health, health practice and anthropometric data were collected. ^ The groups were of comparable age, education, and socioeconomic status (SES). Despite these similarities, statistically significant interethnic nutritional status differences were found. Significantly more total energy and energy from fat were consumed by A-A than W-A and A-C women. Also, significantly more A-A and A-C than W-A women were overweight or obese with android-type weight patterning. ^ Overall, iron and calcium Recommended Dietary Allowances (RDA's) were not met by 35% and 68% of participants, respectively. Iron deficiency anemia was reported by 29% of participants while 33% reported heavier menstrual bleeding. Coupled with suboptimal iron intakes, this is likely to present a serious public health problem. Similarly, increased bone demineralization characteristic of perimenopause, coupled with suboptimal calcium intakes could precipitate another public health problem, osteoporosis. ^ Participants had different expectations about the role of medical care during perimenopause. Significantly more white (57%) than black (38% [A-A and AC]) women sought medical attention for symptoms. Whereas Hormone Replacement Therapy (HRT) was prescribed for 25% of them, only 13% were compliant at enrollment. ^ The trends and statistically significant findings of this study have huge public health policy implications. It is imperative that appropriate policies are formulated to ensure that America's ethnically diverse perimenopausal women have ready access to culturally appropriate care. This would optimize their health outcomes, and enhance their quality of life and productive capacities at this critical juncture of their lives. ^

Eliciting Preferences for Social Health Insurance in Ethiopia : A Discrete Choice Experiment

Peer reviewed

The Policy Dystopia Model:an interpretive analysis of tobacco industry political activity

BACKGROUND: Tobacco industry interference has been identified as the greatest obstacle to the implementation of evidence-based measures to reduce tobacco use. Understanding and addressing industry interference in public health policy-making is therefore crucial. Existing conceptualisations of corporate political activity (CPA) are embedded in a business perspective and do not attend to CPA's social and public health costs; most have not drawn on the unique resource represented by internal tobacco industry documents. Building on this literature, including systematic reviews, we develop a critically informed conceptual model of tobacco industry political activity. METHODS AND FINDINGS: We thematically analysed published papers included in two systematic reviews examining tobacco industry influence on taxation and marketing of tobacco; we included 45 of 46 papers in the former category and 20 of 48 papers in the latter (n = 65). We used a grounded theory approach to build taxonomies of "discursive" (argument-based) and "instrumental" (action-based) industry strategies and from these devised the Policy Dystopia Model, which shows that the industry, working through different constituencies, constructs a metanarrative to argue that proposed policies will lead to a dysfunctional future of policy failure and widely dispersed adverse social and economic consequences. Simultaneously, it uses diverse, interlocking insider and outsider instrumental strategies to disseminate this narrative and enhance its persuasiveness in order to secure its preferred policy outcomes. Limitations are that many papers were historical (some dating back to the 1970s) and focused on high-income regions. CONCLUSIONS: The model provides an evidence-based, accessible way of understanding diverse corporate political strategies. It should enable public health actors and officials to preempt these strategies and develop realistic assessments of the industry's claims.