Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396520170501The Rise of Post-truth Populism in Pluralist Liberal Democracies: Challenges for Health Policy249251332210.15171/ijhpm.2017.19ENEwenSpeedSchool of Health and Human Sciences, University of Essex, Colchester, UK0000-0002-3850-922XRussellMannionHealth Services Management Center, University of Birmingham, Birmingham,
UK0000-0002-0680-8049Journal Article20170125Recent years have witnessed the rise of populism and populist leaders, movements and policies in many pluralist liberal democracies, with Brexit and the election of Trump the two most recent high profile examples of this backlash against established political elites and the institutions that support them. This new populism is underpinned by a post-truth politics which is using social media as a mouthpiece for ‘fake news’ and ‘alternative facts’ with the intention of inciting fear and hatred of ‘the other’ and thereby helping to justify discriminatory health policies for marginalised groups. In this article, we explore what is meant by populism and highlight some of the challenges for health and health policy posed by the new wave of post-truth populism.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396520170501A Cost Analysis of the Jan Aushadhi Scheme in India253256330910.15171/ijhpm.2017.02ENKanchanMukherjeeCentre for Health Policy, Planning and Management, School of Health Systems Studies, Tata Institute of Social Sciences (TISS), Mumbai, India0000-0002-3291-9172Journal Article20160525Medicines constitute a substantial proportion of out-of-pocket (OOP) expenses in Indian households. In order to address this issue, the Government of India launched the Jan Aushadhi (Medicine for the Masses) Scheme (JAS) to provide cheap generic medicines to the patients (http://janaushadhi.gov.in/about_jan_aushadhi.html). These medicines are provided through the Jan Aushadhi stores established across the country. The objective of this study was to do a quick assessment for policy-makers regarding the objective of the JAS. Implications on cost savings for patients and policy implications of the scheme were analyzed. Secondary data sources were used to obtain prices of medicines under the JAS and prices of branded medicines of the same formulations. A cost analysis design was used. There are substantial differences between the JAS price and the cheapest branded medicine available in the market. However, not all JAS prices are lower than branded medicines. For example, the cheapest branded cefuroxime axetil (500 mg) (antibiotic) in the market is almost three times cheaper than its JAS price. Hence, there are cheaper brands available for some commonly prescribed medicines. From the policy perspective, it raises serious questions regarding the pricing of medicines in the JAS and its overarching goal. Since patients are dependent on physicians for medicine prescriptions and have little knowledge of the price variations among branded and generic medicines, the JAS may not provide the cheapest alternative for the patients. Hence, the government should urgently review the JAS prices to achieve its goal of providing low-cost affordable medicines.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396520170501Do Management and Leadership Practices in the Context of Decentralisation Influence Performance of Community Health Fund? Evidence From Iramba and Iringa Districts in Tanzania257265327710.15171/ijhpm.2016.130ENChakupewaJosephMkwawa University College of Education, Iringa, TanzaniaStephen OswaldMalukaInstitute of
Development Studies, University of Dar es Salaam, Dar es Salaam, TanzaniaJournal Article20151215Background <br />In early 1990s, Tanzania like other African countries, adopted health sector reform (HSR). The most strongly held centralisation system that informed the nature of services provision including health was, thus, disintegrated giving rise to decentralisation system. It was within the realm of HSR process, user fees were introduced in the health sector. Along with user fees, various types of health insurances, including the Community Health Fund (CHF), were introduced. While the country’s level of enrolment in the CHF is low, there are marked variations among districts. This paper highlights the role of decentralised health management and leadership practices in the uptake of the CHF in Tanzania. <br /> <br />Methods <br />A comparative exploratory case study of high and low performing districts was carried out. In-depth interviews were conducted with the members of the Council Health Service Board (CHSB), Council Health Management Team (CHMT), Health Facility Committees (HFCs), in-charges of health facilities, healthcare providers, and Community Development Officers (CDOs). Minutes of the meetings of the committees and district annual health plans and district annual implementation reports were also used to verify and triangulate the data. Thematic analysis was adopted to analyse the collected data. We employed both inductive and deductive (mixed coding) to arrive to the themes. <br /> <br />Results <br />There were no differences in the level of education and experience of the district health managers in the two study districts. Almost all district health managers responsible for the management of the CHF had attended some training on management and leadership. However, there were variations in the personal initiatives of the top-district health leaders, particularly the district health managers, the council health services board and local government officials. Similarly, there were differences in the supervision mechanisms, and incentives available for the health providers, HFCs and board members in the two study districts. <br /> <br />Conclusion <br />This paper adds to the stock of knowledge on CHFs functioning in Tanzania. By comparing the best practices with the worst practices, the paper contributes valuable insights on how CHF can be scaled up and maintained. The study clearly indicates that the performance of the community-based health financing largely depends on the personal initiatives of the top-district health leaders, particularly the district health managers and local government officials. This implies that the regional health management team (RHMT) and the Ministry of Health and Social Welfare (MoHSW) should strengthen supportive supervision mechanisms to the district health managers and health facilities. More important, there is need for the MoHSW to provide opportunities for the well performing districts to share good practices to other districts in order to increase uptake of the community-based health insurance.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396520170501A Comparison of Iran and UK EQ-5D-3L Value Sets Based on Visual Analogue Scale267272327810.15171/ijhpm.2016.131ENAliasghar A.KiadaliriClinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences-Lund, Lund University, Lund, SwedenHealth Services Management
Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IranJournal Article20160320Background <br />Preference weights for EQ-5D-3L based on visual analogue scale (VAS) has recently been developed in Iran. The aim of the current study was to compare performance of this value set against the UK VAS-based value set. <br /> <br />Methods <br />The mean scores for all possible 243 health states were compared using Student <em>t</em> test. Absolute agreement and consistency were investigated using concordance correlation coefficient (CCC) and Bland-Altman plot. Health gains for 29 403 possible transitions between pairs of EQ-5D-3L health states were compared. Responsiveness to change and discriminative ability across subgroups of health transitions were assessed. <br /> <br />Results <br />The mean EQ-5D-3L scores were similar for two value sets (mean = 0.31, <em>P</em> = 1.00). For 36% of health states, the absolute differences were greater than 0.10. There were three pairwise logical inconsistencies in the Iranian value set. The Iranian scores were lower (higher) for severe (mild) health states than the United Kingdom. The CCC (95% CI) was 0.85 (0.81 to 0.88) and Bland-Altman plot showed good agreement. The mean health gain for all possible transitions predicted by the Iranian value set was higher (0.22 vs. 0.20, <em>P</em> < .001) and two value sets predicted opposite transitions in 15% of transitions. The responsiveness of these two value sets were similar with lower discriminative ability for Iranian value set. <br /> <br />Conclusion <br />The Iranian value set attribute lower values to most severe health states and higher values to mild health states compared with the UK value set. Such systematic differences might translate into discrepant health gains and cost-effectiveness which should be taking into account for informed decision-making.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396520170501Stakeholders Perspectives on the Success Drivers in Ghana’s National Health Insurance Scheme – Identifying Policy Translation Issues273283328010.15171/ijhpm.2016.133ENAdamFusheiniCentre for Health Policy/MRC Health Policy Research Group, and School of
Public Health, Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, South AfricaDepartment of Health Policy, Planning and
Management, School of Public Health, University of Health and Allied Sciences,
Ho, Ghana0000-0001-7896-3841GordonMarnochSchool of Criminology, Politics and Social Policy, Faculty of Social
Sciences, University of Ulster, Jordanstown, UKAnn MarieGraySchool of Criminology, Politics and Social Policy, Faculty of Social
Sciences, University of Ulster, Jordanstown, UKJournal Article20151209Background <br />Ghana’s National Health Insurance Scheme (NHIS), established by an Act of Parliament (Act 650), in 2003 and since replaced by Act 852 of 2012 remains, in African terms, unprecedented in terms of growth and coverage. As a result, the scheme has received praise for its associated legal reforms, clinical audit mechanisms and for serving as a hub for knowledge sharing and learning within the context of South-South cooperation. The scheme continues to shape national health insurance thinking in Africa. While the success, especially in coverage and financial access has been highlighted by many authors, insufficient attention has been paid to critical and context-specific factors. This paper seeks to fill that gap. <br /> <br />Methods <br />Based on an empirical qualitative case study of stakeholders’ views on challenges and success factors in four mutual schemes (district offices) located in two regions of Ghana, the study uses the concept of policy translation to assess whether the Ghana scheme could provide useful lessons to other African and developing countries in their quest to implement social/NHISs. <br /> <br />Results <br />In the study, interviewees referred to both ‘hard and soft’ elements as driving the “success” of the Ghana scheme. The main ‘hard elements’ include bureaucratic and legal enforcement capacities; IT; financing; governance, administration and management; regulating membership of the scheme; and service provision and coverage capabilities. The ‘soft’ elements identified relate to: the background/context of the health insurance scheme; innovative ways of funding the NHIS, the hybrid nature of the Ghana scheme; political will, commitment by government, stakeholders and public cooperation; social structure of Ghana (solidarity); and ownership and participation. <br /> <br />Conclusion <br />Other developing countries can expect to translate rather than re-assemble a national health insurance programme in an incomplete and highly modified form over a period of years, amounting to a process best conceived as germination as opposed to emulation. The Ghana experience illustrates that in adopting health financing systems that function well, countries need to customise systems (policy customisation) to suit their socio-economic, political and administrative settings. Home-grown health financing systems that resonate with social values will also need to be found in the process of translation.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396520170501The Challenges of Projecting the Public Health Impacts of Marijuana Legalization in Canada; Comment on “Legalizing and Regulating Marijuana in Canada: Review of Potential Economic, Social, and Health Impacts”285287327110.15171/ijhpm.2016.124ENStephanieLakeBritish Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital,
Vancouver, BC, CanadaSchool of Population and Public Health, University of
British Columbia, Vancouver, BC, CanadaThomasKerrBritish Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital,
Vancouver, BC, CanadaDepartment of Medicine, University
of British Columbia, St. Paul’s Hospital, Vancouver, BC, CanadaJournal Article20160816A recent editorial in this journal provides a summary of key economic, social, and public health considerations of the forthcoming legislation to legalize, regulate, and restrict access to marijuana in Canada. As our government plans to implement an evidence-based public health framework for marijuana legalization, we reflect and expand on recent discussions of the public health implications of marijuana legalization, and offer additional points of consideration. We select two commonly cited public concerns of marijuana legalization – adolescent usage and impaired driving – and discuss how the underdeveloped and equivocal body of scientific literature surrounding these issues limits the ability to predict the effects of legalization. Finally, we discuss the potential for some potential public health benefits of marijuana legalization – specifically the potential for marijuana to be used as a substitute to opioids and other risky substance use – that have to date not received adequate attention.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396520170501Is It Time to Say Farewell to the ISDS System?; Comment on “The Trans-Pacific Partnership: Is It Everything We Feared for Health?”289291327310.15171/ijhpm.2016.125ENRaphaelLencuchaSchool of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada0000-0002-9273-2027Journal Article20160809Investor-state dispute settlement (ISDS) continues to plague health-oriented government regulation. This is particularly reflected in recent challenges to tobacco control measures through bilateral investment agreements. There are numerous reform proposals circulating within the public health community. However, I suggest that perhaps it is time for the community to explore a stronger position on ISDS. I draw from mounting evidence on the problematic uses of the ISDS to explore the proposition that ISDS is no longer justified. I tackle the normative question of shouldthe ISDS system persist and point out that the ISDS system is not justifiable from a development perspective and because of its nefarious use, is of no added value to a system that could rely on domestic courts.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396520170501Assessing the Health Impact of Trade: A Call for an Expanded Research Agenda; Comment on “The Trans-Pacific Partnership: Is It Everything We Feared for Health?”293294327410.15171/ijhpm.2016.126ENCourtneyMcNamaraDepartment of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, NorwayJournal Article20160814Labonté et al provide an insightful analysis of the Trans-Pacific Partnership (TPP) and its impact on a selection of important health determinants. Their work confirms concerns raised by previous analyses of leaked drafts and offers governments serious and timely reasons to carefully consider provisions of the agreement prior to moving forward with ratification. It also contributes more generally to a growing literature focused on identifying the health impacts of trade. This commentary uses the authors’ analysis as a starting point to reflect on two interrelated issues relevant both for taking seriously one of the article’s main recommendations and future work in the area of trade and health.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396520170501Advancing Public Health on the Changing Global Trade and Investment Agenda; Comment on “The Trans-Pacific Partnership: Is It Everything We Feared for Health?”295298327910.15171/ijhpm.2016.129ENAnne MarieThowMenzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia0000-0002-6460-5864DeborahGleesonSchool of Psychology and Public Health,
La Trobe University, Melbourne, VIC, Australia0000-0001-8021-9130Journal Article20160815Concerns regarding the Trans-Pacific Partnership (TPP) have raised awareness about the negative public health impacts of trade and investment agreements. In the past decade, we have learned much about the implications of trade agreements for public health: reduced equity in access to health services; increased flows of unhealthy commodities; limits on access to medicines; and constrained policy space for health. Getting health on the trade agenda continues to prove challenging, despite some progress in moving towards policy coherence. Recent changes in trade and investment agendas highlight an opportunity for public health researchers and practitioners to engage in highly politicized debates about how future economic policy can protect and support equitable public health outcomes. To fulfil this opportunity, public health attention now needs to turn to strengthening policy coherence between trade and health, and identifying how solutions can be implemented. Key strategies include research agendas that address politics and power, and capacity building for both trade and health officials.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396520170501Defining Integrated Knowledge Translation and Moving Forward: A Response to Recent Commentaries299300331910.15171/ijhpm.2017.15ENAnitaKothariSchool of Health Studies, University of Western Ontario, London, ON, Canada0000-0003-1533-6976ChrisMcCutcheonIntegrated Knowledge Translation Research Network, Ottawa Hospital
Research Institute, Ottawa, ON, CanadaIan D.GrahamSchool of Epidemiology, Public
Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada0000-0002-3669-1216Journal Article20170120