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Article
Publication date: 28 January 2020

Anna Stephansen

The purpose of this paper is to propose an analytical approach that allows capturing a variety of outcomes of health care reforms. Specifically, by means of employing…

Abstract

Purpose

The purpose of this paper is to propose an analytical approach that allows capturing a variety of outcomes of health care reforms. Specifically, by means of employing neo-institutional perspective, it is suggested that scholars need to take a step back and analyze the interrelation between regulatory, organizational and professional norms (dimensions). This approach improves our understanding of the complex outcomes of health care reforms. To illustrate this point, the case of coordination reform in Norway is discussed. This reform has been one of the most complex health care reforms with ambitious goals of achieving perfectly integrated care between hospitals and municipalities. The analysis through the three sets of institutional norms (dimensions) provides more comprehensive understanding of the various outcomes of the reform. The conclusion is that in order to understand the vast complexity of the outcomes of different health care reforms, we need to carefully study the institutional characteristics of rules, clinical codes of conduct, organizational characteristics as well as interplay between them. Analysis based on the three dimensions, shows that the neo-institutional approach, is of highest relevance to understand the outcomes of the complex health reforms.

Design/methodology/approach

Discussion in this paper is inspired by author’s PhD dissertation that comprised a study of juridification, understood as legal regulation, in treatment practice in the field of specialized health services. Three dimensions described in this paper are derived from the analysis of two types of empirical material: legal regulations and administrative guidelines in the area of patients’ rights interviews with psychiatrists and psychologists in the region of Western Norway about how they practice the regulations. The aim of this empirical study was to explore the implications the new regulations have had for clinical practice after the patients’ rights regulations became binding for clinical reasoning in Norway. This paper presents a viewpoint that applies the three dimensions derived from the empirical analysis to the discussion about the outcomes of one of the most complex Norwegian health reforms, i.e. coordination re-form. It is argued that the observations can be relevant for the analysis of the implication of health reforms in general.

Findings

The observations presented in the discussion of the possible implications of regulations of coordination reform indicate the complexity and sometimes contradictory outcomes of health regulations. There is a complex interplay between the different kinds of regulatory tools, which might have different implications at different levels. The same regulations can both strengthen and weaken established institutional order. Implications of such processes need to be empirically explored and neo-institutional approach still is of highest relevance in helping scholars understand the complex outcomes of health regulations.

Practical implications

Outcomes of regulations will depend on the balance between regulations and other institutional dimensions. The significant aspect of it is that this balance between the dimensions is not a zero sum equation, which means that all dimensions can be strengthened or weakened simultaneously.

Originality/value

The institutional dimensions can be in different balance relation with each other. The point of departure in this paper is that the legal regulations have been strengthened, i.e. expanded with regard to the coordination in health services. This development has been called juridification. The outcomes of it will depend on the balance between regulations and other institutional dimensions at work. The significant aspect of it is that this balance is not a zero sum equation, which means that all dimensions can be strengthened or weakened simultaneously.

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Article
Publication date: 25 July 2019

Stephanie D. Short, Nikhil Hawal, Nasser Sai Albusaidi and Farah Purwaningrum

The purpose of this paper is to identify the elements of effective policies and processes to inform future health professional regulation reforms and practice in the Emirates.

Abstract

Purpose

The purpose of this paper is to identify the elements of effective policies and processes to inform future health professional regulation reforms and practice in the Emirates.

Design/methodology/approach

This study is based on qualitative exploratory methodology. Methods of data collection and analysis included document analysis of the relevant literature, newspapers (as featured on their online websites), policy documents and official statistics. In-depth semi-structured interviews were conducted with key stakeholders, including employers in the health and higher education sectors in Ras Al Khaimah, human resources managers, regulators and public health professionals and scholars.

Findings

This paper brings to light the issues of maldistribution of the medical workforce, Emiritisation and examines implications for more effective medical workforce governance in the United Arab Emirates (UAE).

Originality/value

First, the study provides policy recommendations for medical workforce governance in the context of UAE. Next, empirical studies on health workforce governance in the Middle East’s Gulf Cooperation Council are lacking and primarily focus on the international mobility of expatriates. The study addresses the lack of empirical studies on this topic in the UAE. Third, the UAE is a fertile ground for research on medical workforce governance and, more broadly, the mobility of health professionals due to its economic diversification strategy and thriving medical tourism industry.

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Article
Publication date: 16 June 2021

Parvin Ebrahimi, Mohanna Rajabi and Aidin Aryankhesal

Nongovernmental organizations (NGOs) play a critical role in modern health-care systems complementing state organizations. The purpose of this paper is to investigate the…

Abstract

Purpose

Nongovernmental organizations (NGOs) play a critical role in modern health-care systems complementing state organizations. The purpose of this paper is to investigate the challenges of NGOs' participation in Iran's health-care system.

Design/methodology/approach

This qualitative study was conducted in 2020. Data were collected through semi-structured interviews with 26 participants: 11 managers and experts at the office of NGOs in the Ministry of Health (MOH) and universities of medical sciences and 15 chief executive officers (CEOs) of health-related NGOs in Tehran, Iran. The participants were chosen using the non-probabilistic approach of purposive sampling with maximum variation. Data analysis was performed using the thematic analysis method and MAXQDA 10 software.

Findings

Challenges of NGOs' participation in Iran's health-care system are categorized into external and internal challenges. Financial issues, the process of getting permissions, lack of trust in NGOs, weak relationships with the public sector and lack of law are identified as main challenges. Building trust in NGOs, passing the NGOs' law, making people more familiar with NGOs and capacity development are the most important measures that improve the role of NGOs and resolve barriers to their participation in Iran's health-care system.

Originality/value

In this study, for the first time, the challenges of NGOs' participation in Iran's health-care system are investigated by examining the views of both the public sector and NGOs. Improving the participation of NGOs in the health-care system provides Iran's MOH with the opportunity to make use of the NGOs' capacities to eliminate public health issues.

Details

International Journal of Health Governance, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2059-4631

Keywords

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Article
Publication date: 24 February 2020

Ahmad Khanijahani

The purpose of this viewpoint is to discuss and analyze three major governance tools that have been implemented in the United States to target tobacco smoking as a major…

Abstract

Purpose

The purpose of this viewpoint is to discuss and analyze three major governance tools that have been implemented in the United States to target tobacco smoking as a major public health concern.

Design/methodology/approach

The author highlights the negative consequences of smoking as a global and U.S public health concern and discusses three categories of governance tools implemented in the U.S. Additionally, emerging challenges in the U.S. and different sides of story in developing countries are underscored.

Findings

Although some success has been reached in controlling smoking-related mortalities and morbidities in the U.S. and most of the countries, long-term and sustainable improvement require active surveillance and constant implementation of evidence-based policies and programs.

Practical implications

This viewpoint discusses the governance tools that can be implemented to decrease smoking-related preventable mortalities and morbidities. Similar tools with some tuning can be used to target smoking in other nations. Additionally, these tools can be modified to target other public health-related wicked problems such as obesity, alcohol consumption, and traffic accidents.

Originality/value

This viewpoint highlights the magnitude of smoking as a major public health concern and underscores the necessity of using governance tools in targeting this issue. Additionally, it provides application examples from the United States implementable in other countries with some contextual justifications and tuning.

Details

International Journal of Health Governance, vol. 25 no. 2
Type: Research Article
ISSN: 2059-4631

Keywords

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Article
Publication date: 4 September 2017

Norman W. Baylor

Before vaccines are marketed and used, they must be evaluated and approved by a national regulatory authority (NRA). The Food and Drug Administration (FDA) is the NRA in…

Abstract

Purpose

Before vaccines are marketed and used, they must be evaluated and approved by a national regulatory authority (NRA). The Food and Drug Administration (FDA) is the NRA in the USA responsible for overseeing and regulating the manufacturing, marketing, and distribution of vaccines. The paper aims to discuss this issue.

Design/methodology/approach

Expert review.

Findings

Developed countries have established governmental regulatory agencies to review and determine the safety and effectiveness of vaccines to ensure that the manufacture, sale, and use of vaccines are adequately regulated. However, even today, many developing countries do not have established NRAs. Furthermore, despite similarities, there are still substantial differences in how regulatory authorities in different countries perform minimum functions required for effective regulation of pharmaceutical products, including vaccines. The World Health Organization (WHO), although not a governmental NRA, uses a consultative approach involving its Expert Committee on Biological Standardization and Biologicals Unit to develop regulatory criteria and identify and consolidate current consensus opinions on key regulatory issues. It is through this approach that WHO informs NRAs on the necessary scientific background required to assess and advise on optimal regulatory approaches and methodologies. This paper will focus on the evolution of the US FDA and its role in regulation of vaccines to illustrate the function of a vaccine NRA.

Originality/value

Vaccines are an important resource for protecting people and communities from the mortality and morbidity associated with many infectious diseases. The assessment, licensure, control and surveillance of vaccines are the responsibilities of government regulatory authorities.

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Article
Publication date: 4 September 2017

Angela K. Shen, Alice Y. Tsai and Guthrie S. Birkhead

The purpose of this paper is to outline the organization and governance of the US vaccine and immunization enterprise. It describes the major components of the US system…

Abstract

Purpose

The purpose of this paper is to outline the organization and governance of the US vaccine and immunization enterprise. It describes the major components of the US system including the various relationships between major federal government entities, stakeholders, and advisory committees that inform government policymaking at various points in the system.

Design/methodology/approach

The authors describe the complex interdependent network of partners that engage in a wide range of activities such as disease surveillance, research, vaccine development, regulatory licensure, practice recommendations, financing, service delivery, communications, and post-licensure monitoring.

Findings

The US system of governance is highly participatory and focuses on a transparent and open engagement, with input from a wide range of partners to inform decision-making. This collaborative framework allows many inputs to be heard and helps support the US vaccine and immunization system as it evolves to meet the continued public health needs in the USA through the optimal use of safe and effective vaccines.

Originality/value

This is an invited article on the US vaccine and immunization enterprise. The development and availability of vaccines in the USA has had profound impact on mortality and morbidity and public health (Centers for Disease Control and Prevention, 2011). The success of this enterprise is a result of a blended public and private sector system with partnerships at the federal, state, and local levels of government to optimize the use of safe and effective vaccines. Governance structures have been established to support the interaction and decision-making among the federal and non-federal actors toward the common goal of controlling and preventing infectious diseases.

Details

International Journal of Health Governance, vol. 22 no. 3
Type: Research Article
ISSN: 2059-4631

Keywords

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Article
Publication date: 4 May 2018

David Birnbaum, Kathryn Gretsinger, Marcy G. Antonio, Elizabeth Loewen and Paulette Lacroix

Expanding networks of data portals and repositories linked to electronic patient record systems, along with advances in information technology, have created both new…

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Abstract

Purpose

Expanding networks of data portals and repositories linked to electronic patient record systems, along with advances in information technology, have created both new opportunities in improving public health and new challenges in protecting patient privacy. The purpose of this paper is to review stakeholder perspectives and provide a framework for promoting implementation of current privacy protection improvement recommendations.

Design/methodology/approach

This paper summarizes a workshop session discussion stemming from the 2017 Information Technology and Communication in Health (ITCH) biennial international conference in Victoria, British Columbia, Canada. The perspectives within health service research, journalism, informatics and privacy protection were represented.

Findings

Problems underlying gaps in privacy protection in the USA and Canada, along with then-current changes recommended by public health leaders as well as Information and Privacy Commissioners, were identified in a session of the 2015 ITCH conference. During the 2017 conference, a workshop outlined the current situation, identifying ongoing challenges and a lack of significant progress. This paper summarizes that 2017 discussion identifying political climate as the major impediment to progress on this issue. It concludes with a framework to guide the path forward.

Originality/value

This paper provides an international perspective to problems, resources and solution pathways with links useful to readers in all countries.

Details

International Journal of Health Governance, vol. 23 no. 2
Type: Research Article
ISSN: 2059-4631

Keywords

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Article
Publication date: 24 August 2021

Amirul Ashraf and Siew Chin Ong

Pharmaceutical pricing has always been a contentious issue around the world. Recently, the Government of Malaysia has proposed for drug price control. This proposal has…

Abstract

Purpose

Pharmaceutical pricing has always been a contentious issue around the world. Recently, the Government of Malaysia has proposed for drug price control. This proposal has received backlash from pharmaceutical industry. Therefore in this study, the authors would like to examine the position of various stakeholders on this issue.

Design/methodology/approach

The authors used Policy Maker software to identify and evaluate the position of the stakeholders, their interest and their power. Next, the authors contextualize the factors that might contribute to the success or failure of the policy using Kingdon's multiple stream analysis.

Findings

The authors found that the drug price control regulation received mixed reactions from the stakeholders, with the public sector mainly supporting the proposal whereas the private sectors opposing it. The findings indicate that the drug price control proposal have a high chance of success due to strong political will from both the government and the opposition and also strong support from the public and the consumer groups.

Practical implications

1. The drug price control proposal received strong political will and strong public support. Thus, it has a high chance of success. 2. The government should be careful in managing concentrated powerful groups. The government should strategically engage with the stakeholders to move them to more positive attitude. 3. The government should avoid backtracking on policies as this will portray critical weakness to other stakeholders.

Social implications

The public sector provides strong support for the regulation. However, this support must be maintained and remain as their top priority. Their opinions are important in shaping health policies. The public's feedback will provide transparency and accountability in the policy-making process.

Originality/value

The findings indicate that the drug price control proposal have a high chance of success due to strong political will from both the government and the opposition and also strong support from the public and the consumer groups.

Details

International Journal of Health Governance, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2059-4631

Keywords

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Article
Publication date: 27 June 2019

Andrew Munthopa Lipunga, Betchani M.H. Tchereni and Rhoda Cythia Bakuwa

The purpose of this paper is to present the contemporary understanding and emerging structural models of organisational governance of public hospitals in order to provide…

Abstract

Purpose

The purpose of this paper is to present the contemporary understanding and emerging structural models of organisational governance of public hospitals in order to provide evidence-based guidance to countries that are reforming their public hospital governance structures in line with best practice.

Design/methodology/approach

The paper uses the structural dimension of Cooper, Fusarelli and Randall’s policy model and institutional theory to review the legislative frameworks of four model countries supported by extant literature.

Findings

The paper conceptually distinguishes health system governance and organisational governance in the health system. It further visualises the emerging alternative legislative models of organisational governance and a hierarchy of governors applicable to public hospitals.

Originality/value

The paper provides critical knowledge for understanding organisational governance within health system governance framework and develops tools that can be used in reforming institutional mechanism of organisational governance of public hospitals.

Details

International Journal of Health Governance, vol. 24 no. 2
Type: Research Article
ISSN: 2059-4631

Keywords

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Article
Publication date: 14 December 2018

Aziz Rezapour, Seyyed Mostafa Hakimzadeh, Sirous Panahi, Ehsan Teymourzadeh, Mohammadkarim Bahadori, Peivand Bastani and Ali Tahernezhad

The purpose of this paper is to identify the most important factors for strategic purchasing of health services in the health sector by the Iran Health Insurance Company…

Abstract

Purpose

The purpose of this paper is to identify the most important factors for strategic purchasing of health services in the health sector by the Iran Health Insurance Company and to provide an applicable model for other similar organizations in developing countries.

Design/methodology/approach

The present qualitative study was conducted in 2017 to identify the factors affecting the implementation of strategic purchasing of health services in the health sector by the Iran Health Insurance Company and to provide an indigenous and practical model through two phases: semi-structured interview followed by a Delphi process.

Findings

According to the findings of this study, Ministry of Welfare, Labor and Social Security plays a central role in the strategic purchasing. In addition, this was also approved by the representatives of citizens in communities concerning professional associations, insurance agencies and representative of the Council of Ministers. Model development explored 9 themes and 54 sub-themes.

Research limitations/implications

Based on the model, most attention has been paid to consumer role and inter-sector leadership of the company with other relevant organizations and systems including other insurance organizations and the welfare ministry. More importantly, the health insurance company should be able to communicate with providers and to choose the best providers, receiving price information through competition in the most appropriate mechanism. Guided by this model, it can strategically buy the best and the most effective services for its insured population.

Social implications

It might help developing societies to promote their health systems based on targeting the health budgeting and financial constraints so that it is prioritized according to the strategic purchasing criteria and consequently, economic evaluation.

Originality/value

The linchpins of the present study are as follow: first, the pragmatic model presented in the paper could help developing health systems to overcome the impediment in the implementation progress of strategic purchasing. Second, the model satisfies the need of enough knowledge to apply strategic purchasing in the health system. Third, the indigents have long been given special protection and consideration in the model that has continued to capture the attention of every policy-maker, in particular, developing countries, the portion of which is significant. Fourth, based on this model, attention has been paid to consumer role and inter-sector leadership of organization with other relevant organizations and systems. Fifth, this model could be correspondent for every insurance company in countries with similar developing conditions.

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