Policy experimentation and innovation as a response to complexity in China's management of health reforms.
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ABSTRACT:
SUBMITTER: Husain L
PROVIDER: S-EPMC5541511 | biostudies-other | 2017 Aug
REPOSITORIES: biostudies-other
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Project description:Given the link between perceptions of zoonotic risk and support for regulations such as wildlife consumption bans, debates regarding the origins of COVID-19 are likely to have conservation implications. Specifically, alternative hypotheses that cast doubt on COVID-19's zoonotic origins could potentially lessen momentum for China's wildlife policy reforms and their associated conservation impacts. To better understand the impact of COVID-19 origin debates on China's wildlife policies, we conducted a 974-respondent survey across mainland China, supplemented by policy and media reviews. We examined perceptions of three facets of COVID-19 origins: geographic location, source (e.g., wildlife farm, wet market, etc.), and specific wildlife species as transmitters. Our findings reveal that 64.6 % of respondents believed COVID-19 originated in the United States or Europe, not in China. Further, compared to the baseline group of respondents who selected China as the origin country, respondents who selected the United States or Europe as the origin had a greater likelihood of selecting laboratories/research and imported frozen foods as likely sources, while these respondents had a lower likelihood of selecting wild animals in a wet market or natural causes as likely sources. Despite such varied beliefs regarding COVID-19 origins, support for wildlife policy reforms was strong: 89.5 % of respondents who previously consumed wildlife self-indicated reduced consumption after the pandemic and 70.5 % of respondents supported banning the trade of all wildlife species. Moreover, those respondents who selected wild animals in a wet market as a likely source of COVID-19 had a greater likelihood of supporting a trade ban on all wild-caught wildlife and all farmed wildlife. Our results indicate that, although investigation of COVID-19's origins is on-going and politicized, there is clear support for wildlife reforms in China that can promote conservation outcomes.
| S-EPMC10076075 | biostudies-literature
Project description:Recent work on health system strengthening suggests that a combination of leadership and policy capacity is essential to achieve transformation and improvement. Policy capacity and leadership are mutually constitutive but difficult to assemble in a coherent and consistent way. Our paper relies on the nested model of policy capacity to empirically explore how health reformers in seven Canadian provinces address the question of policy capacity. More specifically, we look at emerging representations of policy capacity within the context of health reforms between 1990 and 2020. Based on the exploration of the scientific and grey literature (legislation, annual reports of Ministries, agencies and organizations, meeting minutes, press, etc.) and interviews with key informants (n = 54), we identify how policy capacity is considered and framed within health reforms A series of core dilemmas emerge from attempts by each province to develop policy capacity for and through health reforms.
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Project description:China's comprehensive primary healthcare (PHC) reforms since 2009 aimed to deliver accessible, efficient, equitable and high-quality healthcare services. However, knowledge on the system-wide effectiveness of these reforms is limited. This systematic review synthesizes evidence on the reforms' health and health system impacts. In 13 August 2022, international databases and three Chinese databases were searched for randomized controlled trials, quasi-experimental studies and controlled before-after studies. Included studies assessed large-scale PHC policies since 2009; had a temporal comparator and a control group and assessed impacts on expenditures, utilization, care quality and health outcomes. Study quality was assessed using Risk of Bias In Non-randomized Studies of Interventions, and results were synthesized narratively. From 49 174 identified records, 42 studies were included-all with quasi-experimental designs, except for one randomized control trial. Nine studies were assessed as at low risk of bias. Only five low- to moderate-quality studies assessed the comprehensive reforms as a whole and found associated increases in health service utilization, whilst the other 37 studies examined single-component policies. The National Essential Medicine Policy (N = 15) and financing reforms (N = 11) were the most studied policies, whilst policies on primary care provision (i.e. family physician policy and the National Essential Public Health Services) were poorly evaluated. The PHC reforms were associated with increased primary care utilization (N = 17) and improved health outcomes in people with non-communicable diseases (N = 8). Evidence on healthcare costs was unclear, and impacts on patients' financial burden and care quality were understudied. Some studies showed disadvantaged regions and groups that accrued greater benefits (N = 8). China's comprehensive PHC reforms have made some progress in achieving their policy objectives including increasing primary care utilization, improving some health outcomes and reducing health inequalities. However, China's health system remains largely hospital-centric and further PHC strengthening is needed to advance universal health coverage.
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Project description:Although constructing innovative cities stimulates innovation, it may further widen regional innovation differences. Based on panel data from 275 cities in China from 2003 to 2020, the difference-in-differences method was used to examine the impact of the innovative city pilot policy on urban innovation convergence. The study finds that the pilot policy not only improves the innovation level of cities (basic effect) but also promotes innovation convergence among pilot cities (convergence effect). However, in the short-term, the policy slows the innovation convergence of the entire region. The results reveal the innovative city policy's multiple effects and dual character and capture the spatial spillover and regional heterogeneity of policy impact, highlighting the risk of further marginalizing some cities. This study supplements the evidence that government intervention affects regional innovation patterns based on the place-based innovation policy in China, providing theoretical support for expanding the follow-up pilot scope and the coordinated development of regional innovation.
| S-EPMC10138854 | biostudies-literature
Project description:BackgroundFollowing a situation appraisal in 2001, a six year mental health reform programme (Egymen) 2002-7 was initiated by an Egyptian-Finnish bilateral aid project at the request of a former Egyptian minister of health, and the work was incorporated directly into the Ministry of Health and Population from 2007 onwards. This paper describes the aims, methodology and implementation of the mental health reforms and mental health policy in Egypt 2002-2009.MethodsA multi-faceted and comprehensive programme which combined situation appraisal to inform planning; establishment of a health sector system for coordination, supervision and training of each level (national, governorate, district and primary care); development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at each level; integration of mental health into health management systems; and dedicated efforts to improve forensic services, rehabilitation services, and child psychiatry services.ResultsThe project has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, mental health masterplan (policy guidelines) to accompany the general health policy, updated Egyptian mental health legislation, Code of Practice, adaptation of the WHO primary care guidelines, primary care training, construction of a quality system of roles and responsibilities, availability of medicines at primary care level, public education about mental health, and a research programme to inform future developments. Intersectoral liaison with education, social welfare, police and prisons at national level is underway, but has not yet been established for governorate and district levels, nor mental health training for police, prison staff and teachers.ConclusionsThe bilateral collaboration programme initiated a reform programme which has been sustained beyond the end of the funding. The project has demonstrated the importance of using a multi-faceted and comprehensive programme to promote sustainable system change, key elements of which include a focus on the use of rapid appropriate treatment at primary care level, strengthening the referral system, interministerial and intersectoral liaison, rehabilitation, and media work to mobilize community engagement.
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Project description:BACKGROUND: The Australian Private Health Insurance Incentive (PHII) policy reforms implemented in 1997-2000 increased PHI membership in Australia by 50%. Given the higher rate of obstetric interventions in privately insured patients, the reforms may have led to an increase in surgical deliveries and deliveries with longer hospital stays. We aimed to investigate the effect of the PHII policy introduction on birth characteristics in Western Australia (WA). METHODS AND FINDINGS: All 230,276 birth admissions from January 1995 to March 2004 were identified from administrative birth and hospital data-systems held by the WA Department of Health. Average quarterly birth rates after the PHII introduction were estimated and compared with expected rates had the reforms not occurred. Rate and percentage differences (including 95% confidence intervals) were estimated separately for public and private patients, by mode of delivery, and by length of stay in hospital following birth. The PHII policy introduction was associated with a 20% (-21.4 to -19.3) decrease in public birth rates, a 51% (45.1 to 56.4) increase in private birth rates, a 5% (-5.3 to -5.1) and 8% (-8.9 to -7.9) decrease in unassisted and assisted vaginal deliveries respectively, a 5% (-5.3 to -5.1) increase in caesarean sections with labour and 10% (8.0 to 11.7) increase in caesarean sections without labour. Similarly, birth rates where the infant stayed 0-3 days in hospital following birth decreased by 20% (-21.5 to -18.5), but rates of births with >3 days in hospital increased by 15% (12.2 to 17.1). CONCLUSIONS: Following the PHII policy implementation in Australia, births in privately insured patients, caesarean deliveries and births with longer infant hospital stays increased. The reforms may not have been beneficial for quality obstetric care in Australia or the burden of Australian hospitals.
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Project description:Policy Points To make progress implementing payment and delivery system reforms, state governments need to make genuine stakeholder engagement routine business, develop reforms that build on past successes, and ensure health reform is a top priority for bureaucrats and political leaders. To support state-led reform initiatives, the federal government needs to provide financial support directly to state governments; build bureaucratic capability in supporting state officials with policy design and implementation; develop more flexible, outcome-focused funding programs; reform its own programs, particularly Medicare; and commit to a long-term strategy for progressing payment and delivery system reforms.ContextFor decades, Americans have debated whether the states need federal government support to reform health care. The Affordable Care Act has allowed the federal government to trial innovative ways of accelerating state-led reform initiatives through the State Innovation Model (SIM), which was run by the Centers for Medicare and Medicaid Services Innovation Center between 2013 and 2019. This study assesses states' progress implementing health reforms under SIM and examines how well the federal government supported them.MethodsDetailed case studies were conducted in six states: Arkansas, Connecticut, Oregon, New York, Tennessee, and Washington. Data was collected from SIM evaluation and annual reports and through semistructured interviews with 39 expert informants, mostly state or federal officials involved in SIM. Preliminary findings were tested and refined through an online forum with health policy experts, facilitated by the Milbank Memorial Fund.FindingsStates that made the most progress implementing reforms had a strong track record and managed to sustain stakeholder, bureaucratic, and political support for their reform agenda. There was a clear correlation between past reform success and success under SIM, which raises questions about the value of federal government support beyond providing funding. State officials said the federal government could better support states, particularly those with less reform experience, by providing tailored advice that helped state officials overcome problems designing and implementing reforms. State officials also said the federal government could better support them by reforming their own programs, particularly Medicare, and committing to a long-term strategy for health system reform.ConclusionsStates can make some progress reforming health care on their own, but real progress requires long-term cooperation between state and federal governments. Federal initiatives like SIM that foster cooperation between governments should be continued but refined so they provide better support to states.
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Project description:In the past decade, European governments have implemented activating policy reforms to maximize older workers' employment and employability, representing a paradigmatic change in approaches to work and retirement. This study isolates the factors that explain the relative success and failure of competitive frames that are either in favor of or against activating policies in European news coverage, by applying time-series analysis (ordinary least squares with panel-corrected standard errors) to monthly aggregated news coverage in the Netherlands, the United Kingdom, Denmark, and Spain over the timespan 2006-2013. The results show that pro-activating and counteractivating frames generally coincide in competitive framing environments. The pro-activating frame proliferated in times of high employment protection, whereas the counteractivating frame prevailed stronger in conservative compared with progressive newspapers, and gained momentum during the aftermath of the financial crisis and in times governments on the economic left were in power. The study advances knowledge of competitive issue framing by demonstrating how the economic, policy, and political context matters for the emergence and evolvement of competing frames. In addition, the findings contribute to the understanding of the factors that contribute to news representations that promote active aging in European news, which may foster support for policy reforms that sustain older workers' employability.
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Project description:Improving public health is the premise of sustainable human development and an essential condition of economic growth. However, increasing severe environmental pollution poses a threat to public health. Implementing environmental regulation policy has become a meaningful way to control environmental pollution and the basis and guarantee for achieving public health. This paper aims to study the impact of environmental regulation on public health. The Two Control Zones (TCZ) policy is the earliest and stricter environmental regulation in China. Based on the policy experiment of TCZ, this paper analyzes the role of TCZ policy in improving public health using the DID model and data from 112 cities. The study finds that the TCZ policy can significantly improve public health, and this improvement effect was continuous and lagging. The results of benchmark regression show that the implementation of the TCZ policy has reduced the incidence rate of respiratory diseases in TCZ areas by 5.7%. When considering city heterogeneity in terms of economic and geographical conditions, the study further found that the impact of improvement is largest for cities in more heavily non-provincial capital and central and western regions, respectively. In addition, the results of mediating test show that TCZ policy improves public health by reducing environmental pollution. Our research fills the gap in the literature on the micro effects of environmental regulation policy on public health in developing countries. The government should prioritize environmental pollution control through reasonable environmental regulation policies. The government should strengthen environmental information disclosure to remind the public to deal with air pollution. The government and enterprises also should take various environmental protection measures to reduce air pollution emissions.
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Project description:Plants have been used in cosmetic products since ancient times and are the subject of scientific investigation even nowadays. During the years, a deeper understanding of both the behavior of skin and of plants have become available drawing increasingly complex pictures. Plants are complex organisms that produce different metabolites responding to the environment they live in. Applied to the skin, phytomolecules interact with skin cells and affect the skin well-being and appearance. Ethnobotanical studies on the one hand and physico-chemical analyses on the other have pictured a rich inventory of plants with potential to enrich modern cosmetic products.
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