Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801Framing the Health Workforce Agenda Beyond Economic Growth678682350010.15171/ijhpm.2018.45ENRemcoVan De PasMaastricht Centre for Global Health, Maastricht University, Maastricht, The
NetherlandsInstitute of Tropical Medicine, Antwerp, Belgium0000-0002-6098-334XLindaMansWemos
Foundation, Amsterdam, The NetherlandsMarielleBemelmansWemos
Foundation, Amsterdam, The NetherlandsAnjaKrumeichMaastricht Centre for Global Health, Maastricht University, Maastricht, The
NetherlandsDepartment of Health Ethics and
Society, Faculty of Health Medicine and Life Sciences, Maastricht University,
Maastricht, The NetherlandsJournal Article20180217<span class="fontstyle0">The fourth Global Forum on Human Resources (HRH) for Health was held in Ireland November 2017. Its Dublin declaration mentions that strategic investments in the health workforce could contribute to sustainable and inclusive growth and are an imperative to shared prosperity. What is remarkable about the investment frame for health workforce development is that there is little debate about the type of economic development to be pursued. This article provides three cautionary considerations and argues that, in the longer term, a perspective beyond the dominant economic frame is required to further equitable development of the global health workforce. The first argument includes the notion that the growth that is triggered may not be as inclusive as proponents say it is. Secondly, there are considerable questions on the possibility of expanding fiscal space in low-income countries for public goods such as health services and the sustainability of the resulting economic growth. Thirdly, there is a growing consideration that economic growth solely expressed as increasing gross domestic product (GDP) might have intrinsic problems in advancing sustainable development outcomes. Economic development goals are a useful approach to guiding health workforce policies and health employment but this depends very much on the context. Alternative development models and policy options, such as a Job Guarantee scheme, need to be assessed, deliberated and tested. This would meet considerable political challenges but a narrow single story and frame of economic development is to be rejected.</span>https://www.ijhpm.com/article_3500_56da13f90d1eb0251f24ef941d029ed5.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis683695347010.15171/ijhpm.2018.09ENIestynWilliamsHealth Services Management Centre, University of Birmingham, Birmingham,
UK0000-0002-9462-9488HilaryBrownHealth Services Management Centre, University of Birmingham, Birmingham,
UKPaulHealyNHS Confederation, London, UKJournal Article20170504<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Decisions affecting cost and quality are taken across health and care but investigation of the mediating role of context in these is in its infancy. This paper presents a synthesis of the evidence on the contextual factors that influence ‘decisions of value’ – defined as those characterised by having a significant and demonstrable impact on both quality and resources – in health and care. The review considers the full range of resource/quality decisions and synthesises knowledge on the contextual drivers of these.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">The method involved structured evidence review and narrative synthesis. Literature was identified through searches of electronic databases (HMIC, Medline, Embase, CINAHL, NHS Evidence, Cochrane, Web of Knowledge, ABI Inform/Proquest), journal and bibliography hand-searching and snowball searching using citation analysis. Structured data extraction was performed drawing out descriptive information and content against review aims and questions. Data synthesis followed a thematic approach in accordance with the varied nature of the retrieved literature.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Twenty-one literature items reporting 14 research studies and seven literature reviews met the inclusion criteria. The review shows that in health and care contexts, research into decisions of value in health and care is in its infancy and contains wide variation in approach and remit. The evidence is drawn from a range of service and country settings and this reduces generalisability or transferability of findings. An area of relative strength in the published evidence is inquiry into factors influencing coverage and commissioning decisions in health care systems. Allocative decisions have therefore been more consistently researched than technical decisions. We use Pettigrew’s (1985) distinction between inner and outer context to structure analysis of the range of factors reported as being influential. These include: evidence/information, organisational culture and governance regimes, and; economic and political conditions.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Decisions of value in health and care are subject to range of intersecting influences that often lead to a departure from narrow notions of rational decision-making. Future research should pay greater attention to the relatively under-explored area of technical, as opposed to allocative, decision-making.</span>https://www.ijhpm.com/article_3470_230f9a22753fd44ae3e4f6fda1616bbc.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801“First, Do No Harm”: Have the Health Impacts of Government Bills on Tax Legislation Been Assessed in Finland?696698349010.15171/ijhpm.2018.39ENNatassaAaltonenFaculty of Social Sciences, University of Tampere, Tampere, FinlandMiisaChydeniusFaculty of Social Sciences, University of Tampere, Tampere, FinlandLauriKokkinenFaculty of Social Sciences, University of Tampere, Tampere, FinlandBloomberg Faculty of Nursing, University of Toronto, Toronto, ON, CanadaFinnish Institute of Occupational Health, Tampere, Finland.Journal Article20171207<span class="fontstyle0">As taxation is one of the key public policy domains influencing population health, and as there is a legal, strategic, and programmatic basis for health impact assessment (HIA) in Finland, we analyzed all 235 government bills on tax legislation over the years 2007–2014 to see whether the health impacts of the tax bills had been assessed. We found that health impacts had been assessed for 13 bills, bills dealing with tobacco, alcohol, confectionery, and energy legislation and that four of these impact assessments included impacts on health inequalities between social classes. Based on our theoretical classification, the health impacts of 40 other tax bills should have been evaluated.</span> <br /><br />https://www.ijhpm.com/article_3490_4d2341f38ef01f668bda461504188881.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801Inequities in Antenatal Care, and Individual and Environmental Determinants of Utilization at National and Sub-national Level in Pakistan: A Multilevel Analysis699710345810.15171/ijhpm.2017.148ENAmbreenSahitoDepartment of Community Medicine, Isra University, Hyderabad, PakistanDepartment of Community Health Sciences, Aga Khan University, Karachi,
PakistanZafarFatmiDepartment of Community Medicine, Isra University, Hyderabad, PakistanDepartment of Community Health Sciences, Aga Khan University, Karachi,
Pakistan0000-0001-7212-6858Journal Article20170114<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Nationally representative surveys are vital for gauging progress in health and planning health services. However, often marred with inadequate analysis to provide any guidance to health policy and planning. Most recent Pakistan Demographic and Health Survey (PDHS) 2012-2013 is an inclusive nationally representative investigation. Nonetheless, its published report offers limited evidence regarding antenatal care (ANC). Furthermore, after 18th constitutional amendment, policies are principally made at provincial level in Pakistan; therefore, it is imperative to have contextual evidence at sub-national level to feed programs and policies.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">We analysed 7142 women with a recent birth, to assess the individual and environmental determinants of ANC, adapting Andersen’s model of healthcare utilization, by multilevel analysis. Separate models of determinants were developed for the national level and five provinces using survey command in Stata version 12.1.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Besides that the recommended ANC coverage (≥4 visits) is low in Pakistan (36%), gross inequities exist predominantly across provinces (12% to 82%). Small differences exist between urban and rural localities. Education, health literacy and socio-economic status of women were strong predictors, while communities with high concentration of literate women very strongly predict ANC use (odds ratio [OR] = 12). Determinants of ANC vary at national and at sub-national level. For example, women’s education had no influence on ANC utilization in Khyber Pakhtunkhwa (KPK) and Baluchistan (BC) provinces. Notably, husband’s education was significantly associated with ANC utilization in KPK only. Significant positive interaction exists between urban areas and larger provinces (Punjab, Sindh, and KPK). Also, very strong positive interaction occurs when women have secondary or particularly higher level of education and living in urban areas or larger provinces.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">This study highlights conspicuous contextual differences which determine maternal care at national and sub-national level. It identified contextual factors which are important for planning maternal health services between and within provinces. High positive interaction for ANC utilization between women education, urban areas and larger provinces highlights the inequities which need to be addressed. It also identified factors at the community level (cluster) which relates to overall contex <span class="fontstyle0">and influence individual behavior and highlights the diminishing urban-rural gap in service utilization in Pakistan.</span> </span>https://www.ijhpm.com/article_3458_06c641d5d102f85c454e2dfc65bc312e.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801Reporting of Financial and Non-financial Conflicts of Interest in Systematic Reviews on Health Policy and Systems Research: A Cross Sectional Survey711717346310.15171/ijhpm.2017.146ENLamaBou-KarroumCenter for Systematic Reviews for Health Policy and Systems Research,
American University of Beirut, Beirut, LebanonMaram B.HakoumClinical Research Institute,
American University of Beirut Medical Center, Beirut, LebanonMira Z.HammoudDepartment
of Psychiatry, Massachusetts General Hospital, Boston, MA, USAAssem M.KhamisFaculty
of Health Sciences, American University of Beirut, Beirut, Lebanon0000-0002-5567-7065MounirAl-GibbawiFaculty
of Medicine, American University of Beirut, Beirut, LebanonSanaaBadourFaculty
of Health Sciences, American University of Beirut, Beirut, LebanonFaculty
of Medicine, American University of Beirut, Beirut, LebanonDivina JustinaHasbaniFaculty
of Medicine, American University of Beirut, Beirut, LebanonLuciane CruzLopesPharmaceutical
Science Master Course, University of Sorocaba, São Paulo, BrazilHebah M.El-RayessFaculty
of Medicine, American University of Beirut, Beirut, LebanonFadiEl-JardaliCenter for Systematic Reviews for Health Policy and Systems Research,
American University of Beirut, Beirut, LebanonFaculty
of Health Sciences, American University of Beirut, Beirut, LebanonDepartment
of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON,
Canada0000-0002-4084-6524GordonGuyattDepartment
of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON,
CanadaElie A.AklClinical Research Institute,
American University of Beirut Medical Center, Beirut, LebanonDepartment
of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON,
CanadaDepartment of Internal Medicine, American University of Beirut,
Beirut, LebanonJournal Article20170110<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Systematic reviews are increasingly used to inform health policy-making. The conflicts of interest (COI) of the authors of systematic reviews may bias their results and influence their conclusions. This may in turn lead to misguided public policies and systems level decisions. In order to mitigate the adverse impact of COI, scientific journals require authors to disclose their COIs. The objective of this study was to assess the frequency and different types of COI that authors of systematic reviews on health policy and systems research (HSPR) report.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">We conducted a cross sectional survey. We searched the Health Systems Evidence (HSE) database of McMaster Health Forum for systematic reviews published in 2015. We extracted information regarding the characteristics of the systematic reviews and the associated COI disclosures. We conducted descriptive analyses.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Eighty percent of systematic reviews included authors’ COI disclosures. Of the 160 systematic reviews that included COI disclosures, 15% had at least one author reporting at least one type of COI. The two most frequently reported types of COI were individual financial COI and individual scholarly COI (11% and 4% respectively). Institutional COIs were less commonly reported than individual COIs (3% and 15% respectively) and non-financial COIs were less commonly reported than financial COIs (6% and 14% respectively). Only one systematic review reported the COI disclosure by editors, and none reported disclosure by peer reviewers. All COI disclosures were in the form of a narrative statement in the main document and none in an online document.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">A fifth of systematic reviews in HPSR do not include a COI disclosure statement, highlighting the need for journals to strengthen and/or better implement their COI disclosure policies. While only 15% of identified disclosure statements report any COI, it is not clear whether this indicates a low frequency of COI versus an underreporting of COI, or both.</span>https://www.ijhpm.com/article_3463_82fa03338a1e3a6531517c0317468edc.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801“It’s About the Idea Hitting the Bull’s Eye”: How Aid Effectiveness Can Catalyse the Scale-up of Health Innovations718727346410.15171/ijhpm.2018.08ENDeepthiWickremasingheIDEAS Project, London School of Hygiene & Tropical Medicine, London, UKMeenakshiGauthamIDEAS Project, London School of Hygiene & Tropical Medicine, London, UKNasirUmarIDEAS Project, London School of Hygiene & Tropical Medicine, London, UKDellaBerhanuIDEAS Project, London School of Hygiene & Tropical Medicine, London, UKJoannaSchellenbergIDEAS Project, London School of Hygiene & Tropical Medicine, London, UKNeilSpicerIDEAS Project, London School of Hygiene & Tropical Medicine, London, UKJournal Article20170607<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Since the global economic crisis, a harsher economic climate and global commitments to address the problems of global health and poverty have led to increased donor interest to fund effective health innovations that offer value for money. Simultaneously, further aid effectiveness is being sought through encouraging governments in low- and middle-income countries (LMICs) to strengthen their capacity to be self-supporting, rather than donor reliant. In practice, this often means donors fund pilot innovations for three to five years to demonstrate effectiveness and then advocate to the national government to adopt them for scale-up within country-wide health systems. We aim to connect the literature on scaling-up health innovations in LMICs with six key principles of aid effectiveness: country ownership; alignment; harmonisation; transparency and accountability; predictability; and civil society engagement and participation, based on our analysis of interviewees’ accounts of scale-up in such settings.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">We analysed 150 semi-structured qualitative interviews, to explore the factors catalysing and inhibiting the scale-up of maternal and newborn health (MNH) innovations in Ethiopia, northeast Nigeria and the State of Uttar Pradesh, India and identified links with the aid effectiveness principles. Our interviewees were purposively selected for their knowledge of scale-up in these settings, and represented a range of constituencies. We conducted a systematic analysis of the expanded field notes, using a framework approach to code a priori themes and identify emerging themes in NVivo 10.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Our analysis revealed that actions by donors, implementers and recipient governments to promote the scale-up of innovations strongly reflected many of the aid effectiveness principles embraced by well-known international agreements - including the Paris Declaration of Aid Effectiveness. Our findings show variations in the extent to which these six principles have been adopted in what are three diverse geographical settings, raising important implications for scaling health innovations in low- and middle-income countries.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Our findings suggest that if donors, implementers and recipient governments were better able to put these principles into practice, the prospects for scaling externally funded health innovations as part of country health policies and programmes would be enhanced.</span>https://www.ijhpm.com/article_3464_42f85df3f5420c15a58e51080da86ee8.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801The Economic Impact of Clinical Research in an Italian Public Hospital: The Malignant Pleural Mesothelioma Case Study728737346710.15171/ijhpm.2018.13ENRobertoIppolitiScientific Promotion, General Hospital of Alessandria, Alessandria, ItalyDepartment of Management, University of Turin, Turin, Italy.GretaFalavignaResearch
Institute on Sustainable Economic Growth, National Research Council of Italy,
Moncalieri, ItalyFedericaGrossoOncology Unit, General Hospital of Alessandria, Alessandria,
ItalyAntonioMaconiScientific Promotion, General Hospital of Alessandria, Alessandria, ItalyLorenzaRandiScientific Promotion, General Hospital of Alessandria, Alessandria, ItalyGianmauroNumicoOncology Unit, General Hospital of Alessandria, Alessandria,
ItalyJournal Article20170223<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">The current economic constraints cause hospital management to use the available public resources as rationally as possible. At the same time, there is the necessity to improve current scientific knowledge. This is even more relevant in the case of patients with malignant pleural mesothelioma (MPM), given the severity of the disease, its dismal prognosis, and the cost of chemotherapy drugs. This work aims to evaluate the standard cost of patients with MPM, supporting physicians in their decision-making process in relation to budget constraints, as well as policymakers with respect research policy.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">The authors conducted a retrospective cost analysis on all the patients with MPM who were first admitted to a reference hospital specialized in MPM care between 2014 and 2015, collecting data on their diagnostic pathways and active treatments, as well as on the related official fees for each procedure. Then, using a multiple regression model, we estimated the overall expected cost of a patient with MPM treated in our hospital, to be born by the Regional Healthcare System based on the chosen clinical pathway.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">According to results, the economic impact of caring for a patient with MPM is mostly related to the selected active treatments, with drug and hospitalization costs as main drivers. Our analysis suggests that the expected reimbursed fee to care for a patient with MPM is equal to € 18 214.99, with chemotherapy and monitoring costs equal to € 12 861.43 and hospitalization cost equal to € 5353.55. This cost decreases to € 320.18 in the case of enrollment in an experimental trial of first-line treatment. In the other cases (second-line or third-line trials), the expected cost borne by the healthcare system for treating patients grows exponentially (€ 40,124.18 and € 59 839.94, respectively).<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Experimental trials might be a solution to decrease the economic burden for the public healthcare system only in the case of first-line treatments, where the cost of chemotherapy is relevant. Nevertheless, policy-makers have to accept the sharing of this economic burden between society and the pharmaceutical industry to broaden the current scientific knowledge.</span>https://www.ijhpm.com/article_3467_f89720dc372dfbb359879b88c9ff21a2.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801How and Where Do We Ask Sensitive Questions: Self-reporting of STI-associated Symptoms Among the Iranian General Population738745347110.15171/ijhpm.2018.18ENMaryamNasirianEpidemiology and Biostatistics Department, Health School; and Infectious Diseases and Tropical Medicine Research Center, Isfahan University of
Medical Sciences, Isfahan, IranHIV/STI Surveillance Research Center, and
WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies
in Health, Kerman University of Medical Sciences, Kerman, Iran0000-0002-8365-3845SamiraHosseini HooshyarHIV/STI Surveillance Research Center, and
WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies
in Health, Kerman University of Medical Sciences, Kerman, Iranhttps://orcid.org/00Ali AkbarHaghdoostModeling
in Health Research Center, Institute for Futures Studies in Health, Kerman
University of Medical Sciences, Kerman, Iran0000-0003-4628-4849MohammadKaramouzianHIV/STI Surveillance Research Center, and
WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies
in Health, Kerman University of Medical Sciences, Kerman, IranSchool of Population and Public
Health, Faculty of Medicine, University of British Columbia, Vancouver, BC,
Canada0000-0002-5631-4469Journal Article20161231<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Reliable population-based data on sexually transmitted infections (STI) are limited in Iran and selfreporting remains the main source of indirect estimation of STI-associated symptoms in the country. However, where and how the questions are asked could influence the rate of self-reporting. In the present study, we aimed to assess what questionnaire delivery method (ie, face-to-face interview [FTFI], self-administered questionnaire [SAQ], or audio self-administered questionnaire [Audio-SAQ]) and setting (ie, street, household or hair salon) leads to more reliable estimates for the prevalence of self-reported STI-associated symptoms.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">This cross-sectional study was conducted in winter 2014 on a gender-balanced (50.0% men) sample of 288 individuals aged 18–59 years old in Kerman, Iran. Respondents were recruited in (</span><span class="fontstyle0">a</span><span class="fontstyle0">) crowded public places and streets, (</span><span class="fontstyle0">b</span><span class="fontstyle0">) their households, and (</span><span class="fontstyle0">c</span><span class="fontstyle0">) hair salons. Data was collected on history of current and 6-month (ie, past 6 months) STI-associated symptoms. Three different methods including FTFI, SAQ and or Audio-SAQ were applied randomly in households and non randomly in streets and hair salons to collect data among the respondents. Generalized estimating equation (GEE) was used to compare the settings and methods separately.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">A total of 2.8% of men and 9.4% of women self-reported at least one STI-associated symptom. Respondents were significantly more likely to report STI-associated symptoms when completing questionnaires on the street compared to their household (</span><span class="fontstyle0">P </span><span class="fontstyle0">= .0001). While women were less likely to report symptoms in FTFI compared to SAQ (</span><span class="fontstyle0">P </span><span class="fontstyle0">= .036), no significant differences were found between men’s responses across different methods (</span><span class="fontstyle0">P </span><span class="fontstyle0">= .064).<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Further research is needed to evaluate the effect of different combinations of methods and settings to find the optimal way to collect data on STI-associated symptoms.</span>https://www.ijhpm.com/article_3471_d6906cbea0232429d176c06ab6ef2c4f.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage746754347210.15171/ijhpm.2018.15ENSamia A.HurstInstitute for Ethics, History, and the Humanities, Geneva University Medical
School, Geneva, Switzerland0000-0002-1980-5226MélinéeSchindlerInstitute for Ethics, History, and the Humanities, Geneva University Medical
School, Geneva, SwitzerlandSusan D.GooldDepartment of General Internal Medicine,
University of Michigan Medical Center, Ann Arbor, MI, USAMarionDanisDepartment of
Bioethics, National Institutes of Health, Bethesda, MD, USA0000-0002-4749-4568Journal Article20170826<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">As universal health coverage becomes the norm in many countries, it is important to determine public priorities regarding benefits to include in health insurance coverage. We report results of participation in a decision exercise among residents of Switzerland, a high-income country with a long history of universal health insurance and deliberative democracy.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">We adapted the Choosing Healthplans All Together (CHAT) tool, an exercise developed to transform complex healthcare allocation decisions into easily understandable choices, for use in Switzerland. We conducted CHAT exercises in twelve Swiss cities with recruitment from a range of socio-economic backgrounds, taking into account differences in language and culture.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Compared to existing coverage, a majority of 175 participants accepted greater general practice gatekeeping (94%), exclusion of invasive life-sustaining measures in dying patients (80%), longer waiting times for non-urgent episodic care (78%), greater adherence to cost-effectiveness guidelines in chronic care (66%), and lower premium subsidies (51%). Most initially chose greater coverage for dental care (59%), quality of life (57%), and long-term care (90%). During group deliberations, participants increased coverage for out-of-pocket costs (58%) and mental health to current levels (41%) and beyond current levels for rehabilitation (50%), and decreased coverage for quality of life to current levels (74%). Following group deliberation, they tended to change their views back to below current coverage for help with out-of-pocket costs, and back to current levels for rehabilitation. Most participants accepted the plan as appropriate and fair. A significant number would have added nothing.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Swiss participants who have engaged in a priority setting exercise accept complex resource allocation tradeoffs in healthcare coverage. Moreover, in the context of a well-funded healthcare system with universal coverage centered on individual choice, at least some of our participants believed a fully sufficient threshold of health insurance coverage was achieved.</span>https://www.ijhpm.com/article_3472_3b525fb580779b86a9363bc2fe658bbe.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801Ideas for Extending the Approach to Evaluating Health in All Policies in South Australia; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”755757348010.15171/ijhpm.2018.25ENKetanShankardassWilfrid Laurier University, Waterloo, ON, CanadaCentre for Urban Health
Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, Canada0000-0002-8410-2201PatriciaO’CampoCentre for Urban Health
Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, CanadaDalla Lana
School of Public Health, University of Toronto, Toronto, ON, CanadaCarlesMuntanerBloomberg
School of Nursing, University of Toronto, Toronto, ON, CanadaAhmed M.BayoumiCentre for Urban Health
Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, CanadaDepartment of
Medicine and Institute of Health Policy, Management and Evaluation, University
of Toronto, Toronto, ON, CanadaLauriKokkinenFaculty of Social Sciences, University of
Tampere, Tampere, FinlandFinnish Institute of Occupational Health, Tampere,
FinlandJournal Article20180131<span class="fontstyle0">Since 2008, the government of South Australia has been using a Health in All Policies (HiAP) approach to achieve their strategic plan (South Australia Strategic Plan of 2004). In this commentary, we summarize some of the strengths and contributions of the innovative evaluation framework that was developed by an embedded team of academic researchers. To inform how the use of HiAP is evaluated more generally, we also describe several ideas for extending their approach, including: deeper integration of interdisciplinary theory (eg, public health sciences, policy and political sciences) to make use of existing knowledge and ideas about how and why HiAP works; including a focus on implementation outcomes and using developmental evaluation (DE) partnerships to strengthen the use of HiAP over time; use of systems theory to help understand the complexity of social systems and changing contexts involved in using HiAP; integrating economic considerations into HiAP evaluations to better understand the health, social and economic benefits and trade-offs of using HiAP.</span>https://www.ijhpm.com/article_3480_b665439f8bc525105052ba055e4f0e4b.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801How Do We Evaluate Health in All Policies?; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”758760348110.15171/ijhpm.2018.31ENDitte HeeringHoltNational Institute of Public Health, University of Southern Denmark, Copenhagen, DenmarkNannaAhlmarkNational Institute of Public Health, University of Southern Denmark, Copenhagen, DenmarkJournal Article20180115<span class="fontstyle0">It is well-established that population health is influenced by a multitude of factors, many of which lie outside the scope of the health sector. In the public health literature it is often assumed that intersectoral engagement with nonhealth sectors will be instrumental in addressing these social determinants of health. Due to the expected desirable outcomes in population health, several countries have introduced Health in All Policies (HiAP). However, whether this systematic, top-down approach to whole-of-government action (which HiAP entails) is efficient in changing government policies remains unclear. A systematic evaluation of HiAP is therefore much needed. Lawless and colleagues present an evaluation framework for HiAP in their article: “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia.” This work is an important endeavor in addressing this problem (of uncertainty as to whether HiAP is effective) and represents an essential contribution to the HiAP literature. Nonetheless, in the spirit of encouraging ongoing reflection on this topic, we wish to highlight some challenges in the presented framework, which may pose difficulties in operationalization. We find that the evaluation framework faces two main limitations: its unclear causal logic and its level of complexity. We argue that in order to function as a tool for evaluation, the framework should be explicit about the mechanisms of change and enable us to trace whether the assumed causal relations resulted in changes in practice. Developing manageable evaluation frameworks, albeit simplified, may then be an important part of cumulating the theoretical insights aspired in theory-based evaluation. On this basis, we highlight how HiAP processes and healthy public policies respectively involve different mechanisms, and thus argue that different program theories are needed.</span><br /><br />https://www.ijhpm.com/article_3481_5a61731b9e201d9078eda902d1c5a7b3.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801Evaluating Health in All Policies; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”761762348210.15171/ijhpm.2018.33ENSebastiánPeñaDepartment of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland0000-0002-2555-4179Journal Article20180204<span class="fontstyle0">Health in All Policies (HiAP) has gained attention as a potential tool to address complex health and societal challenges at global, regional, national and subnational levels. In a recent article, Lawless et al propose an evaluation framework developed in the context of the South Australia HiAP initiative. Strategies, mediators, activities and impacts identified in the framework could potentially be useful for evaluating HiAP in other settings. Creating and sustaining political will, managing conflicts of interest and achieving financially, politically and conceptually sustainable HiAP initiatives are challenges that could be further strengthened in the current framework.</span>https://www.ijhpm.com/article_3482_c5bad8a769db95a79d93d18900a2a535.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801Policy, Theory, and Evaluation: Stop Mixing the Fruit Salad; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”763765348610.15171/ijhpm.2018.35ENEvelyneDe LeeuwCentre for Health Equity Training Research and Evaluation (CHETRE), University of New South Wales, Sydney, NSW, AustraliaSouth Western
Sydney Local Health District, Liverpool, NSW, AustraliaIngham Institute, Liverpool, NSW, Australia0000-0003-3434-1439Journal Article20180224<span class="fontstyle0">The study of Health in All Policies (HiAP) is gaining momentum. Authors are increasingly turning to wide swathes of political and social theory to frame (Program) Theory Based (or Informed) Evaluation (TBE) approaches. TBE for HiAP is not only prudent, it adds a level of elegance and insight to the research toolbox. However, it is still necessary to organize theoretical thinking appropriately. A commentary on a recent </span><em><span class="fontstyle0">Int J Health Policy Manag </span></em><span class="fontstyle0">paper argued that the framing of context and causality were hard to establish. This paper argues that this is not the most pressing issue. Rather, it claims we need to go back to basics to establish an appropriate HiAP evaluation paradigm. Such a basic paradigm would hinge on an understanding of power.</span> <br /><br />https://www.ijhpm.com/article_3486_428d440bb76677e54034da8c6afeeedc.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801A Plea for Harm Reduction Policing Involving People Who Use Drugs766767348310.15171/ijhpm.2018.29ENEhsanJozaghiThe British Columbia Centre for Disease Control, Vancouver, BC, CanadaThe School of Population and Public Health, Faculty of Medicine, University
of British Columbia, Vancouver, BC, Canadaorcid.org/0000-0002-3555-085XLornaBirdVancouver Area Network of
Drug Users, Vancouver, BC, CanadaSex Workers United Against Violence,
Vancouver, BC, CanadaJournal Article20171222https://www.ijhpm.com/article_3483_a8c43ea2e8731c6d5cb9c52d5b9abc08.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397820180801The Knowledge Translation Complexity Network (KTCN) Model: The Whole Is Greater Than the Sum of the Parts - A Response to Recent Commentaries768770350610.15171/ijhpm.2018.49ENAlisonKitsonCollege of Nursing and Health Sciences, Flinders University, Bedford Park,
SA, AustraliaGreen Templeton College, University of Oxford, Oxford, UK0000-0003-3053-8381RebekahO’SheaUniversity of Adelaide, Adelaide, SA, AustraliaAlanBrookAdelaide Dental School,
Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA,
AustraliaInstitute of Dentistry, Queen Mary University of London, London, UKGillHarveyAdelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, AustraliaAlliance Manchester Business School,
University of Manchester, Manchester, UK0000-0003-0937-7819ZoeJordanThe Joanna Briggs Institute,
Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA,
AustraliaRhianonMarshallIndependent Clinical PsychologistDavidWilsonAdelaide Medical School, Faculty of Health and Medical Sciences,
University of Adelaide, Adelaide, SA, AustraliaJournal Article20180516https://www.ijhpm.com/article_3506_e2d73938674485eacf726edaa921fc3f.pdf