ORIGINAL_ARTICLE
Strategic Faults in Implementation of Hospital Accreditation Programs in Developing Countries: Reflections on the Iranian Experience
Establishment of hospital accreditation programs is increasingly growing across numerous developing nations. Such initiatives aim to improve quality of care. However, such establishments, mainly incentivized by successful and famous accreditation plans in developed countries, usually suffer from lack of necessary arrangements which, in turn, result in undesired consequences. Indeed, the first priority for such nations, including Iran, is not establishment of accreditation programs, yet strict licensing plans.
https://www.ijhpm.com/article_3212_1dba4e36a0640c52a3b0e790c545ceb7.pdf
2016-09-01
515
517
10.15171/ijhpm.2016.70
Hospital Accreditation
Licensure
Quality Improvement
Certification
Iran
Aidin
Aryankhesal
a.aryankhesal@gmail.com
1
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
Patterson CH. Joint Commission on accreditation of healthcare organizations. Infect Control Hosp Epidemiol. 1995;16(1):36-42. doi:10.1086/647001
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El-Jardali F, Jamal D, Dimassi H, Ammar W, Tchaghchaghian V. The impact of hospital accreditation on quality of care: perception of Lebanese nurses. Int J Qual Health Care. 2008;20(5):363-371. doi:10.1093/intqhc/mzn023
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Galukande M, Katamba A, Nakasujja N, et al. Developing hospital accreditation standards in Uganda. Int J Health Plan Manage. 2015. doi:10.1002/hpm.2317
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Wilson R, Michel P, Olsen S, et al. Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital. BMJ. 2012;344:e832. doi:10.1136/bmj.e832
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Harrison R, Cohen AW, Walton M. Patient safety and quality of care in developing countries in Southeast Asia: a systematic literature review. Int J Qual Health Care. 2015. doi:10.1093/intqhc/mzv041
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Hajizadeh M, Nghiem HS. Hospital care in Iran: an examination of national health system performance. International Journal of Healthcare Management. 2013;6(3):201-210. doi:10.1179/2047971913y.0000000042
8
Hashjin AA, Kringos DS, Manoochehri J, Aryankhesal A, Klazinga NS. Development and impact of the Iranian hospital performance measurement program. BMC Health Serv Res. 2014;14:448. doi:10.1186/1472-6963-14-448
9
Aryankhesal A, Sheldon T. Effect of the Iranian hospital grading system on patients' and general practitioners' behaviour: an examination of awareness, belief and choice. Health Serv Manage Res. 2010;23(3):139-144. doi:10.1258/hsmr.2009.009028
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Alkhenizan A, Shaw C. Impact of accreditation on the quality of healthcare services: a systematic review of the literature. Ann Saudi Med. 2011;31(4):407. doi:10.4103/0256-4947.83204
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Ministry of Health and Medical Education (MoHME). Hospital accreditation standards in Iran. Tehran: MoHME, Deputy of Curative Affairs; 2010.
12
Agrizzi D, Agyemang G, Jaafaripooyan E. Conforming to accreditation in Iranian hospitals. Accounting Forum. 2016. doi:10.1016/j.accfor.2016.02.002
13
Aryankhesal A, Sheldon TA, Mannion R, Mahdipour S. The dysfunctional consequences of a performance measurement system: the case of the Iranian national hospital grading programme. J Health Serv Res Policy. 2015;20(3):138-145. doi:10.1177/1355819615576252
14
Aryankhesal A, Sheldon TA, Mannion R. Role of pay-for-performance in a hospital performance measurement system: a multiple case study in Iran. Health Policy Plan. 2013;28(2):206-214. doi:10.1093/heapol/czs055
15
Aryankhesal A, Sheldon TA, Mannion R. Impact of the Iranian hospital grading system on hospitals’ adherence to audited standards: an examination of possible mechanisms. Health Policy. 2014;115(2):206-214. doi:10.1016/j.healthpol.2013.11.004
16
Aghaei Hashjin A, Delgoshaei B, Kringos DS, Tabibi SJ, Manouchehri J, Klazinga NS. Implementing hospital quality assurance policies in Iran: Balancing licensing, annual evaluation, inspections and quality management systems. Int J Health Care Qual Assur. 2015;28(4):343-355. doi:10.1108/ijhcqa-03-2014-0034
17
Valentine B. Licensing, accreditation and quality improvement. Australian Journal of Public Administration. 2007;66(2):238-247. doi:10.1111/j.1467-8500.2007.00531.x
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Bukonda N, Tavrow P, Abdallah H, Hoffner K, Tembo J. Implementing a national hospital accreditation program: the Zambian experience. Int J Qual Health Care. 2002;14(Suppl 1):7-16. doi:10.1093/intqhc/14.suppl_1.7
19
Sax S, Marx M. Local perceptions on factors influencing the introduction of international healthcare accreditation in Pakistan. Health Policy Plan. 2014;29(8):1021-1030. doi:10.1093/heapol/czt084
20
El‐Jardali F, Ammar W, Hemadeh R, Jamal D, Jaafar M. Improving primary healthcare through accreditation: baseline assessment of readiness and challenges in lebanese context. Int J health Plan Manage. 2013;28(4):e256-e279. doi:10.1002/hpm.2170
21
Bahadori M, Ravangard R, Alimohammadzadeh K. The accreditation of hospitals in iran. Iran J Public Health. 2015;44(2):295-296. doi:10.1136/bmj.h4407
22
Centers for Medicare & Medicaid Services. Quality inititives - General information. https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/qualityinitiativesgeninfo/index.html. Accessed May 28, 2016. Published 2016.
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Davies HT, Nutley SM, Mannion R. Organisational culture and quality of health care. Qual Health Care. 2000;9(2):111-119. doi:10.1136/qhc.9.2.111
24
Salmon JW, Heavens J, Lombard C, Tavrow P. The impact of accreditation on the quality of hospital care: KwaZulu-Natal province Republic of South Africa. Washington, DC: US Agency for International Development, Quality Assurance Project; 2003.
25
Jafary FH, Ahmed H, Kiani J. Outcomes of primary percutaneous coronary intervention at a joint commission international accredited hospital in a developing country--can good results, possibly similar to the west, be achieved? J Invasive Cardiol. 2007;19(10):417-423.
26
Smits H, Supachutikul A, Mate KS. Hospital accreditation: lessons from low-and middle-income countries. Globalization and health. 2014;10(1):1. doi:10.1186/s12992-014-0065-9
27
Saleh SS, Alameddine MS, Natafgi NM. Beyond accreditation: a multi-track quality-enhancing strategy for primary health care in low-and middle-income countries. Int J Health Serv. 2014;44(2):355-372. doi:10.2190/hs.44.2.k
28
ORIGINAL_ARTICLE
UK and Twenty Comparable Countries GDP-Expenditure-on-Health 1980-2013: The Historic and Continued Low Priority of UK Health-Related Expenditure
It is well-established that for a considerable period the United Kingdom has spent proportionally less of its gross domestic product (GDP) on health-related services than almost any other comparable country. Average European spending on health (as a % of GDP) in the period 1980 to 2013 has been 19% higher than the United Kingdom, indicating that comparable countries give far greater fiscal priority to its health services, irrespective of its actual fiscal value or configuration. While the UK National Health Service (NHS) is a comparatively lean healthcare system, it is often regarded to be at a ‘crisis’ point on account of low levels of funding. Indeed, many state that currently the NHS has a sizeable funding gap, in part due to its recently reduced GDP devoted to health but mainly the challenges around increases in longevity, expectation and new medical costs. The right level of health funding is a political value judgement. As the data in this paper outline, if the UK ‘afforded’ the same proportional level of funding as the mean averageEuropean country, total expenditure would currently increase by one-fifth.
https://www.ijhpm.com/article_3241_0c5e75fd378ee88d4982add890694d1b.pdf
2016-09-01
519
523
10.15171/ijhpm.2016.93
UK gross domestic product (GDP)
Healthcare Expenditure
International Comparison
Andrew J.E.
Harding
aharding@bournemouth.ac.uk
1
Faculty of Health & Social Sciences, Bournemouth University, Dorset, UK
LEAD_AUTHOR
Colin
Pritchard
cpritchard@bournemouth.ac.uk
2
Faculty of Health & Social Sciences, Bournemouth University, Dorset, UK
AUTHOR
Dean H. Social Policy. 2nd ed. Polity Press, 2015.
1
Demianyk G. Michael Gove Promises Just £100m For NHS, and Dismisses Unpopularity in Bid for Tory Leadership. Secondary Michael Gove Promises Just £100m for NHS, and Dismisses Unpopularity in Bid for Tory Leadership. http://www.huffingtonpost.co.uk/entry/michael-gove-nhs_uk_577641bae4b0c946080087b9. Published 2016.
2
Dominiczak P. Budget 2015: George Osborne slashes welfare but gives Britain a pay rise. The Telegraph. July 8, 2015. http://www.telegraph.co.uk/finance/budget/11727751/Budget-2015-George-Osborne-slashes-welfare-but-gives-Britain-a-pay-rise.html.
3
Dixon J, Harrison B, New B. Funding the NHS. Is the NHS underfunded? BMJ. 1997;314:58. doi:10.1136/bmj.314.7073.58
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Mladovsky P, McKee M, Ingleby D, Rechel B. Greater public investment is needed to fund the NHS at a level considered normal in other high income countries. LSE Health and Social Care, London School of Economics; 2016.
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Ingleby D, McKee M, Mladovsky P, Rechel B. How the NHS measures up to other health systems. BMJ. 2012;344:e1079. doi:10.1136/bmj.e1079
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Roberts A, Thompson S, Charlesworth A, Gershlick B, Stirling A. Filling the Gap: Tax and Fiscal Options for a Sustainable UK Health and Social Care System. London: The Health Foundation; 2015.
7
Faden RR, Chalkidou K, Appleby J, Walters HR, Leider J. Expensive cancer drugs: A comparison between the United States and the United Kingdom. Milbank Q. 2009;87:789-819. doi:10.1111/j.1468-0009.2009.00579.x
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Department of Health. Improving Outcomes: A Strategy for Cancer. London: Department of Health; 2011.
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Jonsson L, Justo NM, Krinshna A, et al. Cost of treatment in patients with metastatic soft tissue sarcoma who respond favourably to chemotherpy. The SArcoma treatment and Burden of Illness in North America and Europe (SABINE) study. Eur J Cancer Care (Engl). 2015;25(3):466-477. doi:10.1111/ecc.12322
10
Pritchard C, Hickish T, Rosenorn-Lanng E, Wallace M. Comparing UK and 20 Western countries’ efficiency in reducing adult (55–74) cancer and total mortality rates 1989–2010: Cause for cautious celebration? A population-based study. JRSM Open. 2016; Forthcoming. doi:10.1177/2054270416635036
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Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationary Office; 2013.
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Dreaper J, Triggle N. NHS finance problem being ignored, says former boss. Secondary NHS finance problem being ignored, says former boss. http://www.bbc.co.uk/news/election-2015-32325490. Published 2015.
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Triggle N. NHS to get above-inflation £3.8bn cash boost next year. Secondary NHS to get above-inflation £3.8bn cash boost next year. http://www.bbc.co.uk/news/health-34905801. Published 2015.
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Appleby J. How does NHS spending compare with health spending internationally? Published 2016.
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Gershlik B, Charlesworth A, Taylor A. Public Attitudes to the NHS: An analysis of responses to questions in the British Social Attitudes Survey. London: The Health Foundation and National Centre for Social Research; 2015.
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Harding AJE, Sanders F, Medina Lara A, et al. Patient Choice for Older People in English NHS Primary Care: Theory and Practice. ISRN Fam Med. 2014;2014: 742676. doi:10.1155/2014/742676
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US Bureau of Statistics. Statistical Abstract of the United States. Secondary Statistical Abstract of the United States 2014. http://www2.census.gov/library/publications/2011/compendia/statab/131ed/tables/12s1346.xls
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The World Bank. Health expenditure, total (% of GDP). Secondary Health expenditure, total (% of GDP). http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS. Published 2015.
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Bambra C, Fox D, Scott-Samuel A. Towards a politics of health. Health Promot Int. 2005;20(2):187-193. doi:10.1093/heapro/dah608
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Pritchard C, Hickish T. Comparing cancer mortality rates in England & Wales with other major developed countries 1979-2006. Br J Cancer. 2011;105(11):1788-1794. doi:10.1038/bjc.2011.393
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Pritchard C, Wallace MS. Comparing the USA, UK and 17 Western countries’ efficiency and effectiveness in reducing mortality. JRSM Short Rep. 2011;2(7):60. doi:10.1258/shorts.2011.011076
26
Pritchard C, Wallace MS. Comparing UK and other Westerns countries’ health expenditure, relative poverty & child mortality. Are British children doubly disadvantaged? Child Soc. 2015;29(5):462-472. doi:10:111/chso.12079
27
ORIGINAL_ARTICLE
Operationalization of the Ghanaian Patients’ Charter in a Peri-urban Public Hospital: Voices of Healthcare Workers and Patients
Background Health is a basic human right necessary for the exercise of other human rights. Every human being is, therefore, entitled to the highest possible standard of health necessary to living a life of dignity. Establishment of patients’ Charter is a step towards protecting the rights and responsibilities of patients, but violation of patients’ rights is common in healthcare institutions, especially in the developing world. This study which was conducted between May 2013 and May 2014, assessed the operationalization of Ghana’s Patients Charter in a peri-urban public hospital. Methods Qualitative data collection methods were used to collect data from 25 healthcare workers and patients who were purposively selected. The interview data were analyzed manually, using the principles of systematic text condensation. Results The findings indicate that the healthcare staff of the Polyclinic are aware of the existence of the patients’ Charter and also know some of its contents. Patients have no knowledge of the existence or the contents of the Charter. Availability of the Charter, community sensitization, monitoring and orientation of staff are factors that promote the operationalization of the Charter, while institutional implementation procedures such as lack of complaint procedures and low knowledge among patients militate against operationalization of the Charter. Conclusion Public health facilities should ensure that their patients are well-informed about their rights and responsibilities to facilitate effective implementation of the Charter. Also, patients’ rights and responsibilities can be dramatized and broadcasted on television and radio in major Ghanaian languages to enhance awareness of Ghanaians on the Charter.
https://www.ijhpm.com/article_3188_236d6605d74d1e483714fc482fb6d641.pdf
2016-09-01
525
533
10.15171/ijhpm.2016.42
Patients’ Charter
Operationalization
Peri-urban
Public Hospitals
Ghana
Lily
Yarney
babyaraba95@yahoo.com
1
Department of Public Administration and Health Services Management, Business School, University of Ghana, Accra, Ghana
LEAD_AUTHOR
Thomas
Buabeng
tbuabeng@ug.edu.gh
2
Department of Public Administration and Health Services Management, Business School, University of Ghana, Accra, Ghana
AUTHOR
Diana
Baidoo
dianabaidoo@gmail.com
3
Department of Public Administration and Health Services Management, Business School, University of Ghana, Accra, Ghana
AUTHOR
Justice Nyigmah
Bawole
jnbawole@ug.edu.gh
4
Department of Public Administration and Health Services Management, Business School, University of Ghana, Accra, Ghana
AUTHOR
World Bank. World Development Report 2002: Building Institutions for Markets. New York: Oxford University Press; 2002.
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Starfield B. Promoting equity in health through research and understanding. Developing World Bioeth, 2004;14(4):76-95. doi:10.1111/j.1471-8731.2004.00068.x
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Dowie JA. Valuing the benefits of health improvement. Australian Economic Papers. 1970;9:21-41.
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World Health Organization (WHO). Promotion of the rights of patients in Europe. http://www.who.int/genomics/public/eu_declaration1994.pdf. Published 1995.
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Silver MH. Patients’ rights in England and United States of America: The patients’ charter and the New Jersey Patient Bill of Rights: a comparison. J Med Ethics. 1997;23(4):213-220. doi:10.1136/jme.23.4.213
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Health Professions Council of South Africa.National Patients’ Rights Charter. Booklet 3, Pretoria; 2008.
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Federal Republic of Nigeria. Nigeria’s 4th Periodic Country Report: 2008-2010 on the Implementation of the African Charter on Human and People’s Rights in Nigeria. The Federal Ministry of Justice, Abuja; 2008.
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Rider ME, Makela CJ. A comparative analysis of patients’ rights: an international perspective. International Journal of Consumer Studies. 2003;27( 4):302-315. doi:10.1046/j.1470-6431.2003.00319.x
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Changole J, Bandawe C, Makanani B, et al. Patients’ satisfaction with reproductive health services at Gogo chatinkha Maternity unit Blantyre, Malawi. Malawi Med J. 2010;22(1):5-6. doi:10.4314/mmj.v22i1.55899
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Zülfikar F, Ulusoy MF. Are patients aware of their rights? A Turkish study. Nurs Ethics. 2001;8(6):487-98.
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Büken NO, Büken,E. Emerging health sector problems affecting patients’ rights in Turkey. Nurs Ethics. 2004;11(6):610-624. doi:10.1191/0969733004ne742oa
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Albishi AA. The Saudi patients’, physicians’, and nurses’ perceptions of and lived experiences with patients’ rights in Saudi Arabia: A Qualitative Phenomenological Study [Doctoral Dissertation]. George Manson University; 2004.
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Ghana Health Service. The Patients’ Charter. Accra, Ghana Health Service; 2002.
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Ghana Health Service. (2012). Report on clinical care quality assurance conference, Accra, Ghana.
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Royal Health Organisation (ROHEO). Clients and health staff lack knowledge in patients charter. http://www.newsghana.com.gh/clients-and-health-staff-lack-knowledge-in-patients-charter/. Accessed August 19, 2013.
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Vuković M, Gvozdenović BS, Stamatović-Gajić B, Ilić M, Gajić T. Development and evaluation of the nurse quality of communication with patient questionnaire. Srpski Arhiv za Celokupno Lekarstvo, 2010;138(1-2):79-84
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Topping, A. Qualitative perspectives. Nurse Researcher. 2006;13(4):4-6.
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Burns T, Catty J, White S, et al. Continuity of care in mental health: understanding and measuring a complex phenomenon. Psychol Med. 2009;39:313-323. doi:10.1017/s0033291708003747
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Lincoln YS, Guba EG. Naturalistic Inquiry. Thousand Oaks: Sage Publishers; 1985.
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Brink H. Fundamentals of Research Methodology for Health Care Professionals. Cape Town: Juta and Company Ltd; 2006.
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Wolf ZR. Exploring the Audit Trail for Qualitative Investigations. Nurse Educator. 2003;28(4):175-178. doi:10.1097/00006223-200307000-00008
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Changole JC, Bandawe B, Makanani K, Nkanaunena F, Taulo EM, Kafulafula G. Patients’ satisfaction with reproductive health services at Gogochatinkha Maternity Unit Blantyre, Malawi. Malawi Med J. 2010;22(1):5-6. doi:10.4314/mmj.v22i1.55899
27
Rider ME, Makela CJ. A comparative analysis of patients’rights: an international perspective. International Journal of Consumer Studies. 2003;27(4):302-315. doi:10.1046/j.1470-6431.2003.00319.x
28
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Steinmetz D, Tabenkin H. The difficult patient as perceived by family physicians. Oxford: Oxford University Press; 2011.
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31
Barrera CR, Negron CP, Barria M, Mendez CA. Rights and Duties Policy Implementation in Chile: Healthcare Professionals' Perceptions. Health Expectat. 2015. doi:10.1111/hex.12396
32
ORIGINAL_ARTICLE
Correcting India’s Chronic Shortage of Drug Inspectors to Ensure the Production and Distribution of Safe, High-Quality Medicines
Background Good drug regulation requires an effective system for monitoring and inspection of manufacturing and sales units. In India, despite widespread agreement on this principle, ongoing shortages of drug inspectors have been identified by national committees since 1975. The growth of India’s pharmaceutical industry and its large export market makes the problem more acute. Methods The focus of this study is a case study of Maharashtra, which has 29% of India’s manufacturing units and 38% of its medicines exports. India’s regulations were reviewed, comparing international, national and state inspection norms with the actual number of inspectors and inspections. Twenty-six key informant interviews were conducted to ascertain the causes of the shortfall. Results In 2009-2010, 55% of the sanctioned posts of drug inspectors in Maharashtra were vacant. This resulted in a shortfall of 83%, based on the Mashelkar Committee’s recommendations. Less than a quarter of the required inspections of manufacturing and sales units were undertaken. The Indian Drugs and Cosmetics Act and its Rules and Regulations make no provisions for drug inspectors and workforce planning norms, despite the growth and increasing complexity of India’s pharmaceutical industry. Conclusion The Maharashtra Food and Drug Administration (FDA) falls short of the Mashelkar Committee’s recommended workforce planning norms. Legislation and political and operational support are required to produce needed changes.
https://www.ijhpm.com/article_3190_1895d7ae0048fe698a79fac6f50d77b3.pdf
2016-09-01
535
542
10.15171/ijhpm.2016.44
Drug Inspectors
Inspections
Drug Regulation
Manufacturing and Sales Units
Drugs and Cosmetics
Act and Rules
Inspection Norms and Workforce Planning Norms
Abhay B.
Kadam
abhay_kadam7@yahoo.co.in
1
The Foundation for Research in Community Health (FRCH), Pune, India
LEAD_AUTHOR
Karen
Maigetter
karen.maigetter@swisstph.ch
2
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
AUTHOR
Roger
Jeffery
r.jeffery@ed.ac.uk
3
Centre for South Asian Studies, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
AUTHOR
Nerges F.
Mistry
frchpune@bsnl.in
4
The Foundation for Research in Community Health (FRCH), Pune, India
AUTHOR
Mitchell G.
Weiss
mitchell-g.weiss@unibas.ch
5
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
AUTHOR
Allyson M.
Pollock
allyson.pollock@newcastle.ac.uk
6
Global Public Health Unit, Queen Mary University of London, London, UK
AUTHOR
Greene W. The Emergence of India's Pharmaceutical Industry and Implications for the US Generic Drug Market; 2007.
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Parliamentary Standing C. 59th report on the functioning of the Central Drugs Standard Control Organisation (CDSCO): Department Related Parliamentary Standing Committee on Health and Family Welfare (2011-2012). New Delhi, Rajya Sabha;2012.
2
Bate R. Cheap Indian generic drugs: Not such good value after all? American Enterprise Institute. Published February 2013.
3
Bate R, Tren R, Mooney L, et al. Pilot study of essential drug quality in two major cities in India. PLoS One. 2009;4(6):e6003. Doi:10.1371/journal.pone.0006003
4
Brhlikova P, Harper I, Jeffery R, Rawal N, Subedi M, Santhosh M. Trust and the regulation of pharmaceuticals: South Asia in a globalised world. Global Health. 2011;7:10. doi:10.1186/1744-8603-7-10
5
Caudron JM. Substandard medicines in resource-poor settings: a problem that can no longer be ignored. Tropical Medicine & International Health. 2008;13(8):1062-1072. Doi:10.1111/j.1365-3156.2008.02106.x
6
Nelson D. Britain ignored warnings of Indian whistleblower at heart of drugs scandal. The Telegraph. June 13,2013. http://www.telegraph.co.uk/news/worldnews/asia/india/10119371/Britain-ignored-warnings-of-Indian-whistleblower-at-heart-of-drugs-scandal.html
7
Vidya K, Unnikrishnan CH. Ranbaxy fallout: Indian pharma under the microscope. Live mint website. http://www.livemint.com/Industry/nTIfqyG87wxdlz8txCa6HL/Indian-pharma-under-the-microscope.html. Published May 23, 2013.
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Government of M. Medical Education and Drugs Department, Annual Plan 2011-2012. Mumbai; 2011.
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FDA prohibits Ranbaxy's Toansa, India facility from producing and distributing drugs for the U.S. market. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm382736.htm. Published 2014.
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DCGI asked to check quality of drugs sold by Ranbaxy. The Hindu, Business Line website. http://www.thehindubusinessline.com/economy/dcgi-asked-to-check-quality-of-drugs-sold-by-ranbaxy-govt/article5051958.ece. Published August 23, 2013
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Drugs and Cosmetics Act 1940 and Drugs and Cosmetics Rules 1945. 2013.
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Mashelkar C. Mashelkar Committee Report, Report of the Expert Committee on a Comprehensive Examination of Drug Regulatory Issues, Including the Problem of Spurious Drugs. New Delhi: Government of India; 2003.
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World Health Organization (WHO). Multicountry Study on Effective Drug Regulation. Geneva: WHO; 2002.
18
Ramesh S. Even after one year of SC directive, Madras HC yet to hold final hearing in controversial DCGI case. Pharmabiz website. http://www.pharmabiz.com/NewsDetails.aspx?aid=77035&sid=1.Published August 08, 2013.
19
Dey S. Drug regulator to periodically inspect all clinical trial sites. Business Standard website. http://www.business-standard.com/article/companies/drug-regulator-to-periodically-inspect-all-clinical-trial-sites-113050600006_1.html. Published May 6, 2013.
20
ORIGINAL_ARTICLE
The Politico-Economic Challenges of Ghana’s National Health Insurance Scheme Implementation
Background National/social health insurance schemes have increasingly been seen in many low- and middle-income countries (LMICs) as a vehicle to universal health coverage (UHC) and a viable alternative funding mechanism for the health sector. Several countries, including Ghana, have thus introduced and implemented mandatory national health insurance schemes (NHIS) as part of reform efforts towards increasing access to health services. Ghana passed mandatory national health insurance (NHI) legislation (ACT 650) in 2003 and commenced nationwide implementation in 2004. Several peer review studies and other research reports have since assessed the performance of the scheme with positive rating while challenges also noted. This paper contributes to the literature on economic and political implementation challenges based on empirical evidence from the perspectives of the different category of actors and institutions involved in the process. Methods Qualitative in-depth interviews were held with 33 different category of participants in four selected district mutual health insurance schemes in Southern (two) and Northern (two) Ghana. This was to ascertain their views regarding the main challenges in the implementation process. The participants were selected through purposeful sampling, stakeholder mapping, and snowballing. Data was analysed using thematic grouping procedure. Results Participants identified political issues of over politicisation and political interference as main challenges. The main economic issues participants identified included low premiums or contributions; broad exemptions, poor gatekeeper enforcement system; and culture of curative and hospital-centric care. Conclusion The study establishes that political and economic factors have influenced the implementation process and the degree to which the policy has been implemented as intended. Thus, we conclude that there is a synergy between implementation and politics; and achieving UHC under the NHIS requires political stewardship. Political leadership has the responsibility to build trust and confidence in the system by providing the necessary resources and backing with minimal interference in the operations. For sustainability of the scheme, authorities need to review the exemption policy, rate of contributions, especially, from informal sector employees and recruitment criteria of scheme workers, explore additional sources of funding and re-examine training needs of employees to strengthen their competences among others.
https://www.ijhpm.com/article_3191_84c039f569f34b641c384544110cacbc.pdf
2016-09-01
543
552
10.15171/ijhpm.2016.47
Politico-Economic Challenges
Health Insurance
Implementation
Ghana
Adam
Fusheini
adam.fusheini@gmail.com
1
Centre for Health Policy/MRC Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
LEAD_AUTHOR
Sakyi EK, Atinga RA, Adzei FA. Managerial problems of hospitals under Ghana's National Health Insurance Scheme. Clinical Governance: An International Journal. 2012;17(3):178-190. doi:10.1108/14777271211251291
1
Baltussen R, Bruce E, Rhodes G, Narh-Bana SA, Agyepong I. Managing mutual health organisations in Ghana. Trop Med Int Health. 2006;II(5):654-659. doi:10.1111/j.1365-3156.2006.01621.x
2
World Health Organization (WHO). Social health insurance: sustainable health financing, universal coverage and social health insurance; 2005 16–25 May. Geneva: WHO; 2005.
3
Mishra SR, Khanal P, Karki DK, Kallestrup P, Enemark U. National Health Insurance Policy in Nepal: challenges for implementation. Glob Health Action. 2015;8:28763. doi:10.3402/gha.v8.28763
4
Ekman B. Community-based health insurance in low-income countries: a systematic review of the evidence. Health Policy plan. 2004;19(5):249-270. doi:10.1093/heapol/czh031
5
De Allegri M, Sauerborn R, Kouyaté B, Flessa S. Community health insurance in sub‐Saharan Africa: what operational difficulties hamper its successful development? Trop Med Int Health. 2009;14(5):586-596. doi:10.1111/j.1365-3156.2009.02262.x
6
Agyemang KK, Adu-Gyamfi AB, Afrakoma M. Prospects and challenges of implementing a sustainable national health insurance scheme: the case of the Cape Coast metropolis, Ghana. Developing Country Studies. 2013;3(12):140-148.
7
Preker AS, Scheffler RM, Bassett MC. Private voluntary health insurance in development: friend or foe? World Bank Publications; 2007.
8
Preker A. Health care financing for rural and low-income populations. The Role of Communities in Resource Mobilization and Risk Sharing; 2003.
9
Carrin G. Community based health insurance schemes in developing countries: facts, problems and perspectives. Geneva: WHO; 2003.
10
Carrin G, James C. Reaching universal coverage via social health insurance: key design features in the transition period. Geneva: WHO; 2004.
11
Agyepong IA, Adjei S. Public social policy development and implementation: a case study of the Ghana National Health Insurance scheme. Health Policy Plan. 2008;23(2):150-160. doi:10.1093/heapol/czn002
12
Witter S, Garshong B. Something old or something new? Social health insurance in Ghana. BMC Int Health Hum Rights. 2009;9(1):20. doi:10.1186/1472-698x-9-20
13
Seddoh A, Adjei S, Nazzar A. Ghana’s National Health Insurance Scheme: Views on Progress, Observations, and Commentary. Accra, Ghana: Centre for Health and Social Services;2011.
14
NHIA. National Health Insurance Authority, 2013 Annual Report. Accra: NHIA; 2013.
15
Durairaj V, D'Almeida S, Kirigia J. Health systems financing, the path to universal coverage. Ghana's Approach to Social Health Protection: Background Paper, 2. Geneva: World Health Organization; 2010.
16
Alhassan RK, Duku SO, Janssens W, et al. Comparison of perceived and technical healthcare quality in primary health facilities: implications for a sustainable national health insurance scheme in Ghana. PloS one. 2015;10(10):e0140109. doi:10.1371/journal.pone.0140109
17
Mohammed A, Seidu M. Assessing the quality of primary health care provided by accredited service providers in the upper east region, Ghana. International Journal of Economics, Commerce and Management. 2014;II(10):1-32.
18
Nketiah-Amponsah E. Demand for health insurance among women in Ghana: cross-sectional evidence. http://hdl.handle.net/123456789/2224. Published 2009.
19
Mensah J, Oppong JR, Schmidt CM. Ghana's National Health Insurance Scheme in the context of the health MDGs: an empirical evaluation using propensity score matching. Health Econ. 2010;19(S1):95-106. doi:10.1002/hec.1633
20
Nguyen HT, Rajkotia Y, Wang H. The financial protection effect of Ghana National Health Insurance Scheme: evidence from a study in two rural districts. Int J Equity Health. 2011;10(4):1-12. doi:10.1186/1475-9276-10-4
21
Ayimbillah Atinga R. Healthcare quality under the National Health Insurance Scheme in Ghana: Perspectives from premium holders. International Journal of Quality & Reliability Management. 2012;29(2):144-161. doi:10.1108/02656711211199883
22
Odeyemi IA, Nixon J. Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis. Int J Equity Health. 2013;12:9. doi:10.1186/1475-9276-12-9
23
Blanchet N, Fink G, Osei-Akoto I. The effect of Ghana’s National Health Insurance Scheme on health care utilisation. Ghana Med J. 2012;46(2):76-84.
24
Yevutsey S, Aikins M. Financial viability of district mutual health insurance schemes of lawra and sissala East districts, Upper West Region, Ghana. Ghana Med J. 2010;44(4):130-137.
25
Owusu-Sekyere E, Bagah DA. Towards a sustainable health care financing in ghana: is the national health insurance the solution? Public Health Res. 2014;4(5):185-194.
26
Mwinkume G, Obuadey G. Assessing the sustainability of the operations of the national health insurance scheme: a case of Oguaa Mansin Health Insurance Scheme, Cape Coast, Ghana. International Journal of Innovative Research and Development. 2014;3(5):649-657.
27
Gajate-Garrido G, Owusua R. The national health insurance scheme in Ghana: Implementation challenges and proposed solutions. Published 2013. http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2373242
28
Imurana BA, Haruna RK, Nana Kofi AB. The politics of public policy and problems of implementation in Africa: an appraisal of Ghana’s National Health Insurance Scheme in Ga East District. International Journal of Humanities and Social Science. 2014;4(4 Special Issue):196-207.
29
Abiiro GA, McIntyre D. Universal financial protection through National Health Insurance: a stakeholder analysis of the proposed one-time premium payment policy in Ghana. Health Policy Plan. 2013;28(3):263-278. doi:10.1093/heapol/czs059
30
Abiiro GA, McIntyre D. Achieving universal health care coverage: Current debates in Ghana on covering those outside the formal sector. BMC Int Health Hum Rights. 2012;12:25. doi:10.1186/1472-698X-12-25
31
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32
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Annim SK, Mariwah S, Sebu J. Spatial inequality and household poverty in Ghana. Economic Systems. 2012;36(4):487-505. doi:10.1016/j.ecosys.2012.05.002
34
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Owusu g. An assessment of Regional and Gender equity in healthcare coverage under different healthcare policies in Ghana. Ghana Journal of Geography. 2014;6:42-62.
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Adu-Gyamfi AB, Abane AM. Victims of location: Access to health care in the Lake Bosomtwe Basin of Ghana. European International Journal of Science and Technology. 2013;2(5):1-5.
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Commission NDP. Medium-term national development policy framework: Ghana shared growth and development agenda (GSGDA) II, 2014-2017. https://s3.amazonaws.com/ndpc-static/pubication/GSGDA+II+2014-2017.pdf. Published 2014.
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Asenso-Okyere WK. Financing health care in Ghana. World Health Forum. 1995;16:86-91.
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Aryeetey GC, Jehu-Appiah C, Kotoh AM, et al. Community concepts of poverty: an application to premium exemptions in Ghana’s National Health Insurance Scheme. Global Health. 2013;9:12. doi:10.1186/1744-8603-9-12
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Witter S, Garshong B, Riddle V. An exploratory study of the policy process and early implementation of the free NHIS coverage for pregnant women in Ghana. Int J Equity Health. 2013;12:16.
46
Arpoh-Baah B. Assessing financial sustainability of National Health Insurance Scheme (NHIS) in Ghana Case Study: Mpohor Wassa East Mutual Health Insurance Scheme; 2011.
47
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48
Carrin G, Doetinchem O, Kirigia J, Mathauer I, Musango L. Social health insurance: how feasible is its expansion in the African Region. Development Issues. 2008;10(2):7-9.
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50
ORIGINAL_ARTICLE
Governance: Blending Bureaucratic Rules with Day to Day Operational Realities; Comment on “Governance, Government, and the Search for New Provider Models”
Richard Saltman and Antonio Duran take up the challenging issue of governance in their article “Governance, Government and the Search for New Provider Models,” and use two case studies of health policy changes in Sweden and Spain to shed light on the subject. In this commentary, I seek to link their conceptualization of governance, especially its interrelated roles at the macro, meso, and micro levels of health systems, with the case studies on which they report. While the case studies focus on the shifts in governance between the macro and meso levels and their impacts on achievement of desired policy outcomes, they also highlight the need to better integrate the dynamics of day to day operations within micro organizations into the overall governance picture.
https://www.ijhpm.com/article_3211_603bd37b2a1a59265a84cd0e0c787358.pdf
2016-09-01
553
555
10.15171/ijhpm.2016.69
Health System Governance
Macro-Meso-Micro Levels
Bureaucratic Rules
Front Line Staff
Culture
Trust
David
Chinitz
chinitz@cc.huji.ac.il
1
School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
LEAD_AUTHOR
Saltman RB, Von Otter C. Planned Markets and Public Competition. Bristol PA: Open University Press; 1992.
1
Saltman RB, Duran A. Governance, Government, and the Search for New Provider Models. Int J Health Policy Manag. 2015;5(1):33-42. doi:10.15171/ijhpm.2015.198
2
Chinitz D, Rodwin VG. Health policy and management, mind the theory-policy-practice gap. Int J Health Policy Manag. 2014;3(7):361-363. doi:10.15171/ijhpm.2014.122
3
Einhorn ES, Logue J. Can welfare States Be Sustained in a Global Economy? Lessons from Scandinavia. Polit Sci Q. 2010;125(1):1-29. doi:10.1002/j.1538-165x.2010.tb00666.x
4
Cox R. The path-dependency of an idea: why scandinavian welfare states remain distinct. Soc Policy Adm. 2004;38(2):204-221.
5
Tucker AL. An empirical study of system improvement by frontline employees in hospital units. Manuf Serv Oper Manag. 2007;4(9):492-505.
6
ORIGINAL_ARTICLE
Universal Health Coverage – The Critical Importance of Global Solidarity and Good Governance; Comment on “Ethical Perspective: Five Unacceptable Trade-offs on the Path to Universal Health Coverage”
This article provides a commentary to Ole Norheim’ s editorial entitled “Ethical perspective: Five unacceptable trade-offs on the path to universal health coverage.” It reinforces its message that an inclusive, participatory process is essential for ethical decision-making and underlines the crucial importance of good governance in setting fair priorities in healthcare. Solidarity on both national and international levels is needed to make progress towards the goal of universal health coverage (UHC).
https://www.ijhpm.com/article_3216_f6b6689263bcd781ec3cfe1e63181bc8.pdf
2016-09-01
557
559
10.15171/ijhpm.2016.61
Ethics
Solidarity
Good Governance
Universal Health Coverage (UHC)
Andreas A.
Reis
reisa@who.int
1
Global Health Ethics Unit, Health Systems and Innovation Cluster, World Health Organization (WHO), Geneva, Switzerland
LEAD_AUTHOR
Norheim OF. Ethical perspective: five unacceptable trade-offs on the path to universal health coverage. Int J Health Policy Manag. 2015;4(11):711-714. doi:10.15171/ijhpm.2015.184
1
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4
World Health Organization (WHO). Making Fair Choices on the Path to Universal Health Coverage. Final Report of the WHO Consultative Group on Equity and Universal Health Coverage. Geneva: WHO; 2014
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European Union. Charter of Fundamental Rights of the European Union, OJ C 326, 26.10.2012, p. 391-407.
6
National Ethics Advisory Committee. Getting Through Together: Ethical Values for a Pandemic. Wellington: Ministry of Health; 2007.
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ter Meulen R, Arts W, Muffels R, eds. Solidarity in Health and Social Care in Europe. Dordrecht: Kluwer Academic Publishers; 2001.
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Kieny MP, Evans DB, Gerard Schmets G, Kadandale S. Health-system resilience: reflections on the Ebola crisis in western Africa. Bull World Health Organ. 2014;92:850. doi:10.2471/BLT.14.149278
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Siddiqi S, Masud TI, Nishtar S, et al. Framework for assessing governance in the health system in developing countries: gateway to good governance. Health Policy. 2008;90:13-25. doi:10.1016/j.healthpol.2008.08.005
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21
ORIGINAL_ARTICLE
U-Form vs. M-Form: How to Understand Decision Autonomy Under Healthcare Decentralization?; Comment on “Decentralisation of Health Services in Fiji: A Decision Space Analysis”
For more than three decades healthcare decentralization has been promoted in developing countries as a way of improving the financing and delivery of public healthcare. Decision autonomy under healthcare decentralization would determine the role and scope of responsibility of local authorities. Jalal Mohammed, Nicola North, and Toni Ashton analyze decision autonomy within decentralized services in Fiji. They conclude that the narrow decision space allowed to local entities might have limited the benefits of decentralization on users and providers. To discuss the costs and benefits of healthcare decentralization this paper uses the U-form and M-form typology to further illustrate the role of decision autonomy under healthcare decentralization. This paper argues that when evaluating healthcare decentralization, it is important to determine whether the benefits from decentralization are greater than its costs. The U-form and M-form framework is proposed as a useful typology to evaluate different types of institutional arrangements under healthcare decentralization. Under this model, the more decentralized organizational form (M-form) is superior if the benefits from flexibility exceed the costs of duplication and the more centralized organizational form (U-form) is superior if the savings from economies of scale outweigh the costly decision-making process from the center to the regions. Budgetary and financial autonomy and effective mechanisms to maintain local governments accountable for their spending behavior are key decision autonomy variables that could sway the cost-benefit analysis of healthcare decentralization.
https://www.ijhpm.com/article_3218_507099ebb7f527c8f35dd75221a28cf9.pdf
2016-09-01
561
563
10.15171/ijhpm.2016.73
Health Decentralization
Organizational Form
Health Reform
Decision Autonomy
Arturo Vargas
Bustamante
avb@ucla.edu
1
Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
LEAD_AUTHOR
Qian YY, Roland G, Xu CG. Coordination and experimentation in M-form and U-form organizations. J Polit Econ. 2006;114(2):366-402. doi:10.1086/501170
1
Smith BC. The decentralization of health care in developing countries: organizational options. Public Adm Deve. 1997;17(4):399-412. doi:10.1002/(Sici)1099-162x(199710)17:43.3.Co;2-G
2
Bossert T. Analyzing the decentralization of health systems in developing countries: Decision space, innovation and performance. Soc Sci Med. 1998;47(10):1513-1527. doi:10.1016/S0277-9536(98)00234-2
3
Mohammed J, North N, Ashton T. Decentralisation of health services in Fiji: a decision space analysis. Int J Health Policy Manag. 2015;5(3):173-181. doi:10.15171/ijhpm.2015.199
4
Prudhomme R. The dangers of decentralization. World Bank Res Obs. 1995;10(2):201-220. doi:10.1093/wbro/10.2.201
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Birn AE. Federalist flirtations: The politics and execution of health services decentralization for the uninsured population in Mexico, 1985-1995. J Public Health Policy. 1999;20(1):81-108. doi:10.2307/3343260
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Collins P. Special issue - Decentralisation and local governance in Africa. Public Adm Dev. 2003;23(1):1-3. doi:10.1002/pad.266
7
Homedes N, Ugalde A. Why neoliberal health reforms have failed in Latin America. Health Policy. 2005;71(1):83-96. doi:10.1016/j.healthpol.2004.01.011
8
Castaneda T, Beeharry G, Griffin C. Decentralization of health services in Latin American countries: Issues and some lessons. Annual World Bank Conference on Development in Latin America and the Caribbean 1999, Proceedings. 2000:249-269.
9
Vargas Bustamante A. The tradeoff between centralized and decentralized health services: evidence from rural areas in Mexico. Soc Sci Med. 2010;71(5):925-934. doi:10.1016/j.socscimed.2010.05.022
10
Bustamante AV. Comparing federal and state healthcare provider performance in villages targeted by the conditional cash transfer programme of Mexico. Trop Med Int Health. 2011;16(10):1251-1259. doi:10.1111/j.1365-3156.2011.02826.x
11
Rondinelli DA. Government decentralization and economic development: the evolution of concepts and practices. Comparative Public Administration. 2006;15:433-445. doi:10.1016/S0732-1317(06)15018-6
12
Williamson OE. Markets, Hierarchies, and the Modern Corporation - an Unfolding Perspective. J Econ Behav Organ. 1992;17(3):335-352. doi:10.1016/S0167-2681(95)90012-8
13
Chandler J. Strategy and Structure of Japanese Enterprises - Kono,T. Long Range Plann. 1986;19(6):145. doi:10.1016/0024-6301(86)90111-1
14
Roland A. Transition and Economics: Potitics, Markets and Firms. Cambridge, Ma: MIT Press; 2000.
15
ORIGINAL_ARTICLE
Expanded HTA, Legitimacy and Independence; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy”
This brief commentary seeks to develop the analysis of Daniels, Porteny and Urrutia of the implications of expansion of the scope of health technology assessment (HTA) beyond issues of safety, efficacy, and cost-effectiveness. Drawing in particular on experience in the United Kingdom, it suggests that such expansion can be understood not only as a response to the problem of insufficiency of evidence, but also to that of legitimacy. However, as expansion of HTA also renders it more visibly political in character, it is plausible that its legitimacy may be undermined, rather than enhanced by, independence from the policy process.
https://www.ijhpm.com/article_3220_51dfe6b8e818fdc8751574a6f20d3faa.pdf
2016-09-01
565
567
10.15171/ijhpm.2016.75
Health Technology Assessment (HTA)
Equity
Budget Impact
Threshold
Independence
Regulation
Legitimacy
Keith
Syrett
keith.syrett@bristol.ac.uk
1
Cardiff School of Law and Politics, Cardiff University, Wales, UK
LEAD_AUTHOR
Daniels N, Porteny T, Urrutia J [correction of Urritia J]. Expanded HTA: enhancing fairness and legitimacy [published correction appears in Int J Health Policy Manag. 2016;5(5):347]. Int J Health Policy Manag.2016;5(1):1–3. doi:10.15171/ijhpm.2015.187
1
Wild C, Jonas S. Health Policy Decisions between Rationing and Rationalisation – exemplified by Erythropoietin in Tumor Anemia. Gesundheitswesen. 2001;63(4):221-225.
2
Daniels N. Accountability for Reasonableness in Private and Public Health Insurance. In: Coulter A, Ham C. eds. The Global Challenge of Health Care Rationing. Buckingham: Open University Press; 2000:89-106.
3
Rawlins M. Pharmacopolitics and Deliberative Democracy. Clin Med. 2005;5(5):471-475. doi:10.7861/clinmedicine.5-5-471
4
Shah K, Cookson R, Culyer A, Littlejohns P. NICE's Social Value Judgements about Equity in Health and Health Care. York: Centre for Health Economics; 2011.
5
Rawlins M, Barnett D, Stevens A. Pharmacoeconomics: NICE's approach to decision-making. Br J Clin Pharmacol. 2010;70(3):346-349. doi:10.1111/j.1365-2125.2009.03589.x
6
Rawlins M, Culyer J. National Institute for Clinical Excellence and its value judgements. BMJ. 2004;329(7459):224-227. doi:10.1136/bmj.329.7459.224
7
National Institute for Health and Care Excellence (NICE). Social Value Judgements: principles for the development of NICE guidance. London: NICE; 2005.
8
McMillan J, Sheehan M, Austin D, Howell J. Ethics and opportunity costs: have NICE grasped the ethics of priority-setting? J Med Ethics. 2006;32(3):127-128. doi:10.1136/jme.2005.014860
9
Syrett K. Deconstructing Deliberation in the Appraisal of Medical Technologies: NICEly does it? Modern Law Review. 2006;69(6):869-894. doi:10.1111/j.1468-2230.2006.00615.x
10
Health and Social Care Act 2012. http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted.
11
Syrett K. NICE work? Rationing, review and the ‘legitimacy problem’ in the new NHS. Med Law Rev. 2002;10(1):1-27. doi:10.1093/medlaw/10.1.1
12
Culyer A, McCabe C, Briggs A, et al . Searching for a threshold, not setting one: the role of the National Institute for Health and Clinical Excellence. J Health Serv Res Policy. 2007;12(1):56-58. doi:10.1258/135581907779497567
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Claxton K, Martin S, Soares M, et al. Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold. Health Technol Assess. 2015;19(14):1-542. doi:10.3310/hta19140
14
Research says approval of new drugs by NICE is "doing more harm than good." University of York. Website. https://www.york.ac.uk/news-and-events/news/2015/research/nice-drugs-research/. Accessed March 6, 2016
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Council Cs. Departing from the Threshold. London: NICE; 2008.
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Klein R. Puzzling Out Priorities. BMJ. 1998;317(7164):959-960. doi:10.1136/bmj.317.7164.959
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Battista R, Hodge, M. The development of health care technology assessment: an international perspective. Int J Technol Assess Health Care. 1995;11(2):287-300. doi:10.1017/s0266462300006905
18
Rezi-Kato T. User Perspectives in Health Technology Assessment: the case of HPV vaccination in Ireland and the Netherlands. In: Horstman K, Dow, E., Penders, B., ed. Governance of Health Care Innovation: Excursions into Politics, Science and Citizenship. Raleigh: Lulu Academic; 2011:109-126.
19
Majone G. The regulatory state and its legitimacy problems. West Eur Polit. 1999;22(1):1-24. doi:10.1080/01402389908425284
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ORIGINAL_ARTICLE
Re-Conceptualising Public Health Interventions in Government: A Response to Recent Commentaries
https://www.ijhpm.com/article_3238_3f081929177fa6303ed64eecbe4b087a.pdf
2016-09-01
569
570
10.15171/ijhpm.2016.91
Social Determinants of Health (SDH)
Health Equity
Public Policy
Implementation
Gemma
Carey
gemma.carey@unsw.edu.au
1
Business School, University of New South Wales, Canberra, ACT, Australia
LEAD_AUTHOR
Carey G. Understanding the role of public administration in implementing action on the social determinants of health and health inequities. Int J Health Policy Manag. 2015;4(12):795–798. doi:10.15171/ijhpm.2015.185
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