Thesis (Ph.D.)--Australian National University, 2001.

It is acknowledged that part of the failure to improve Indigenous health is due to the lack of participation of Indigenous people in national policy and decision making processes. In this three part study I investigated the nature of Indigenous people’s participation in national Indigenous health policy processes. I combined quantitative and qualitative methods through the perspective of policy networks. / The first part of the study was directed at the prominence of informal networks in the evolution of Indigenous affairs policy. I aimed to determine and describe the structural location of Indigenous people in an informal network of influential people. I administered a network survey questionnaire during the period 2003/04. In a snowball nomination process influential people nominated a total of 227 influential people. Of these, 173 people received surveys of which 44 people returned surveys, a return rate of 25 per cent. I analysed the data to detect the existence of network groups; measure the degree of group interconnectivity; measure the characteristics of bonds between influential people; and I used demographic information to characterise the network and its groups. I found a stable pattern of relationships in the three features of the informal network: the whole network was diverse, and the Indigenous people were integrated and embedded in the network. It would not have existed without Indigenous people due to a combination of their greater number, their distribution throughout the network groups, and the interconnections between the groups. I argued that the findings showed that Indigenous people were fundamental in this informal network of influential people. / The second part of the study was directed at the role of national health committees in engaging with advice about Indigenous health. I aimed to describe the structural location of Indigenous people in national health committees. Using internet sites I identified 121 national health committees at the end of 2003, and obtained information from 77 committees or 64 per cent of all committees. I calculated the proportion of members who were Indigenous within each committee; the proportion of committees which were Indigenous health committees; and constructed a visual representation of the formal reporting relationship between all the committees and Cabinet. I then determined the importance of each committee in terms of a committee network using eigenvector centrality scores. Finally, I identified the linking people between the informal network and the national health committees. I found that in a traditional hierarchical view that Indigenous people and Indigenous health committees were small in number and distant from Cabinet. In contrast a network view assumes that the importance of a committee depends on the combination of the number of interlocks, comembership, and betweenness with other committees. In this network view, Indigenous health committees were similarly located to other committees. A small number of elite knowledge brokers linked the informal networks and the national health committees. I argued that the findings showed a formal systemic deficiency in the strategic location of Indigenous people. / The third part of the study was directed at the significance of inter-personal bonds between influential people in influencing policy processes. I aimed to describe the interpersonal relationships between influential people through a semi-structured interview. The interview questions were designed to elicit responses in the broad context of knowledge and influence in national Indigenous health policy processes. From a list of 47 potential interviewees I obtained 34 interviews (a response rate of 72 per cent), transcribed 32 interviews and coded them thematically. I found that underlying the episodic meetings of national health committees was the constant activities of informal networking. The influential non-Indigenous people had to pass some rules of entry in order to engage in and utilise informal processes. The interviewees demonstrated a value of connectedness in interpersonal relationships through agreement with principles such as social models of health. However, advice about Indigenous health issues may need to be continually rediscovered as it remains anchored to local contexts in a macro context where advice faces pathways that are confusing and convoluted. I argued that the findings indicated a meta-level vacuum in conceptualising the relationship between the concepts of participation and advice in national Indigenous health policy processes. / The findings from the three parts indicated three characteristics of an ongoing meta-process (informal network), absence of a meta-perspective (national health committees), and a meta-concept of participation (interviews). I suggest that they form a meta-frame of participation. In this frame the energy dispersed in the many efforts at improving Indigenous peoples‟ participation are unfocussed because of multiple and uncoordinated policy origins. Therefore I concluded that the nature of participation of Indigenous people in national Indigenous health policy processes is one of unfocussed energy.

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (leaves 189-202).

Thesis (Ph.D.)--Australian National University, 2003.

Thesis (Ph. D.)--University of Nebraska -- Omaha, 2009. / Presented to the faculty of the Graduate College in the University of Nebraska in partial fulfillment of the requirements for the degree of Doctor of Philosophy. Medical Sciences Interdepartmental Area Health Services Research and Administration. Under the supervision of Professor Keith J. Mueller. Includes bibliographical references.

This thesis is about UK healthcare decision-makers’ responses to guidance that a new interventional procedure is safe and efficacious, and whether additional information would be helpful.  The aims were to conceptualise how evidence could be used to best inform decision-making; investigate the ways in which decision-makers currently respond to such guidance; identify types of additional useful information, and assess the feasibility and value of providing these. The study was based on the UK Interventional Procedures Programme (IPP).  A multidimensional framework for categorising evidence (explanatory vs. pragmatic) was developed and tested using IPP-evaluated procedures.  A qualitative study explored how local NHS decision-makers respond to IPP guidance and whether additional information might be useful to them.  A range of approaches – from simple descriptive data, through evidence syntheses, to economic models of cost-effectiveness – were explored in a case study of radiofrequency ablation (RFA) for snoring. NHS decision-makers’ responses to IPP guidance varied and they indicated additional information would be helpful.  Available evidence on the effects of procedures went beyond ‘efficacy’.  The case study showed it was possible, within limitations, to provide useful additional information but at increasing costs as complexity increased. Decision-makers vary in their responses to IPP guidance.  Additional information (such as prevalence, incidence, costs and likely cost-effectiveness), which they indicated would be useful, is potentially available but the feasibility of providing this varies depending on the nature of the evidence available and the related costs.  The thesis indicates that the quality of decision-making would be improved if guidance that a new procedure is safe and efficacious were to be contextualised through specific extra information.

Healthcare services, traditionally provided by the government in a welfare state, have become a tradable commodity in the era of globalisation. Indeed, globalisation has led to the creation of a new international healthcare market with increased participation of the private sector, assisted with enhanced mobility of health professionals, service providers and patients across borders. Soon after its inception, the 1995 General Agreement on Trade in Services (GATS) has come under fire from critics, especially for its broad scope and inclusion of basic services like healthcare, water or education that fulfil social objectives. In establishing a multilateral legal framework, GATS mandates progressive liberalisation of trade in services among the WTO members through successive rounds of negotiations. Since GATS applies to the measures by WTO Members affecting trade in services (whether taken at central, regional or local government level), inclusion of health services therein has raised concern regarding a government's ability to regulate health-related services. Availability and accessibility of healthcare services is crucial from the right to health perspective. The International Convention on Economic Social and Cultural Rights (ICESCR) obligates its Member States to respect, protect and realise progressively and to the maximum of its available resources 'the right to the highest attainable standard of health.' When a WTO Member is also a signatory to the ICESCR, the question arises whether the legislative framework regulating healthcare services under GATS conflicts with the said Member's obligation to respect, protect and fulfil the right to health. The present thesis attempts to answer this question through an analysis of GATS and the right to health norms within the framework of conflict of norms in international law. Although norm conflicts are generally assessed in terms of a legal relationship between a given State with another State, the present thesis focuses on a single State bound by both sets of rules where compliance with both obligations may/does lead to a legal, social or factual conflict.

Thesis (Ph. D.)--University of Texas at Austin, 2000. / Vita. Includes bibliographical references (leaves 231-242). Available also in a digital version from Dissertation Abstracts.

Thesis (Ph. D.)--University of New South Wales, 1999. / Also available online.

Thesis (Ph.D.)--University of Delaware, 2007. / Principal faculty advisor: Robert Warren, School of Urban Affairs & Public Policy. Includes bibliographical references.