The perceived level of self-determination in health care in four First Nations communities in Canada is examined through a multiple case study approach. Twenty-three participants from federal, provincial and First Nations governments as well as health care professionals in the communities of Blood Tribe, Lac La Ronge, Garden Hill and Wasagamack First Nations provided insight into the diversity of perception of self-determination in First Nations health care. The difference in definition between Aboriginal and the federal and provincial governments is a factor in the varying perceptions of the level of control First Nations communities have over their health care system. Participants from the four First Nations communities perceived their level of self-determination over their health care system to be much lower than the level perceived by provincial and federal government participants. The organization and delivery of health care is based on the location of the community, the availability of the human resources, the level of communication, the amount of community resources, and the ability to self-manage. The socio-political history including impact of contact, residential schools, and integration of Aboriginal worldview are factors in the organization and delivery of health care as well as the perceived level of self-determination that the community sees. The duration and intensity of contact influences how health care is organized as the communities become more familiarized with the biomedical model that most Canadians use. Having a holistic health care system that includes acknowledging the socio-political history, culture, language, worldview and traditional medicines is important to the four First Nations communities, but this has not been fully embraced in any of the communities. Despite their differences, all four communities are working toward self-determination that hopefully would result in an ‘ideal’ First Nations health care system which is holistic, cultural, spiritual, and interdisciplinary and ultimately lead to full management of the health care system.

The health care industry’s involvement with biosimilar policies suggests that building coalitions and reducing opposition are critical factors for interest group success. As government decision-makers wrestle with how to handle a perplexing category of prescription drugs, companies and patient groups alike receive ample opportunities to contribute to the policymaking process. When stakeholders in the biosimilar arena – including manufacturers, physicians, and patients – unite, we see that the United States government takes steps toward fixing the policy problem. This occurred most recently with policies about biosimilar drug coverage under Medicare Part D and reimbursement under Medicare Part B. In both cases, stakeholders took a united stance and consequently faced no opposition. On the contrary, internal industry disputes between brand and biosimilar manufacturers about patent exclusivity laws and interchangeability rules revealed the nuances of biosimilar policy and the challenge that regulators face when they receive mixed messages. Across all of their efforts, biosimilar stakeholders pursued numerous strategies which may have contributed to their successes. They focused on niche issues and used their lobbying expertise to actively submit comments, testify in hearings, and meet with government officials; however, the differentiating tactic between the industry’s successes and failures was whether they formed coalitions. By coming together, stakeholders lowered their chances of facing opposition. A closer analysis of the politics of biosimilars illustrates that when they present a united front to lawmakers, interest groups reduce the likelihood of opposition and successfully influence policy change.

The diploma thesis Formation of the Health Policy in Vysočina Region is interested in the development of the health policy of the Vysočina Region and the creation and utilization of policy documents aimed at the health care. The constitution of regional public administrations in 2000, the abolition of districts in 2003 and the transfer of hospitals to the region brought new competences to regions. One of them is the health care administration. Originally, in cooperation with the Ministry of Health, and later self Vysočina Region decided to prepare a conceptual document, which would describe the current situation of the regional health service, define objectives and goals for its future direction. Vysočina Region authority started with arrangements of regional health care strategy in 2003 and finished 2007 with Zdravotní plán kraje Vysočina, which was not fully completed. Program Zdraví 21 pro kraj Vysočina and Koncepce eHealth Kraje Vysočina were presented later focused on other areas of health and health care. This thesis is interested by the formation of health care policy in Vysočina Region. The most important questions are how Vysočina Region authority prepared the strategic papers, how are these strategies applied and how is used the feedback in a renewal of the plans. There will be also compared the...

Indiana University-Purdue University Indianapolis (IUPUI) / Nonprofit organizations that “speak for, act for, and look after the interests of their constituents when they interact with government are, by any definition of political science, interest groups.” Indiana’s recent implementation of the Healthy Indiana Plan 2.0 (HIP 2.0) under the Affordable Care Act (ACA) opened a window of opportunity to closely examine the role of nonprofits in shaping the implementation of health care policy. Existing literature on health and human service nonprofit organizations did not examine in depth the role and influence of nonprofits as interest groups in the implementation of public policy. This study examines a deeper research question that was not given adequate attention under existing studies with a special focus on the health care policy field: whose interest do nonprofit organizations advance when they attempt to influence the implementation of public policy? To answer this question, it is critical to understand why nonprofits engage in the public policy process (motivation and values), the policy actions that nonprofits make during the implementation of the policy (how?), and the method by which nonprofits address or mitigate conflicts and contradictions between organizational interest and constituents’ interest (whose interest do they advance?). The main contribution of this study is that it sheds light on the implementation of the largest extension of domestic social welfare policy since the “War on Poverty” using Robert Alford’s theory of interest groups to examine the role of nonprofit organizations during the implementation of HIP 2.0 in Indiana. Given the complexity of the policy process, this study utilizes a qualitative methods approach to complement existing quantitative findings. Finally, this study provides a deeper examination of the relationships between nonprofits as actors within a policy field, accounts for the complexity of the policy and political environment, analyzes whether or not dominant interest groups truly advance the interest of their constituents, and provides additional insights into how nonprofits mitigate and prioritize competing interests.

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The high cost of prescription drugs has been an issue that numerous federal agencies have examined for years. In 2003, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act, better known as Medicare Part D, in an effort to ease the burden of skyrocketing prescription prices for citizens 65 and older. While much of the discussion has focused on the impact on Medicare and Medicaid, the search for the source of high prescription drug prices has possible benefits for all patients. Unfortunately, the vast majority of research into this topic focuses only on the manufacturers of prescription drugs. This thesis examined the relationship between wholesale and retail prices of prescription drugs to discover whether this is another possible source of high prescription drug costs that policy makers need to consider. The findings suggest that more research is warranted. Many of the pharmacies surveyed reported unexpected negative mark-ups. Moreover, the Average Wholesale Rice evidently is not an accurate basis for comparison with actual retail prices. The findings suggest that more research is warranted, including studies by federal legislative and executive branch actors with investigatory authority. / Master of Arts

The health care system within the United States is in a state of transition. The industry, confronted with a variety of new technologies, new ways of organizing, spiraling costs, diminishing service quality and new actors, is changing, almost on a daily basis. Reports issued by the Institute of Medicine raise quality issues such as avoidable errors and underuse/overuse of services; other studies document regional variation in care. Improvement in the quality of care, according to health care experts is accomplished through measuring and comparing performance, but there are a number of disparate actors involved in this endeavor. Through a network of both public and private actors, collaboration on the development of a set of national performance measures is underway. Organizations such as the National Quality Forum (NQF), the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS) and other have formed networks to develop and standardize performance measurement systems that can distinguish between quality services and substandard ones. While there is some available research about the processes involved in performance measurement system design, there is little known about the factors that influence the development and work of the network, particularly the selection of hospital performance measures. This dissertation explored the development of a national performance measurement system for hospitals, using an institutional rational choice perspective and actor-network theory as frameworks for discussion. Through qualitative research methods such as direct observation, interviews, participant observations and document review, a theoretically informed case study of the NQF's Hospital Steering Committee was performed, to address the following questions: How is a national performance measurement system developed and what is the role of federal agencies (e.g., AHRQ and CMS) in the process? / Ph. D.

Networks are an increasingly common aspect of administrative life in almost any policy arena. In 1999 the health care industry created the National Quality Forum, a network administrative organization, whose founding mission was to improve American healthcare through endorsement of consensus-based national standards for measurement and public reporting of healthcare performance data that provide meaningful information about whether care is safe, timely, beneficial, patient-centered, equitable and efficient. The NQF is representative of a network administrative organization because it was created to address issues of health care quality in a new way by bringing together organizations from the public and private sectors and providing them with a forum to discuss and debate measures of quality, and ultimately, to effect change. The NQF thus represents a major administrative experiment in addressing health policy issues. In spite of the popularity of networks, little is known about a network manager's or, more appropriately for this dissertation, a network entrepreneur's critical tasks in creating a network administrative organization. The purpose of this dissertation is to present the results of an empirical study of the critical leadership tasks of the NQF's President and CEO during the NQF's formative stages. This dissertation identifies and conceptualizes three critical leadership tasks of the NQF's President and CEO: defining the NQF's mission, building and maintaining the NQF's social base, and creating the NQF's Consensus Development Process. In addition, this dissertation proposes a series of testable hypothesis based on these three critical tasks that can be used for exploring leadership in other NAOs. The findings indicate that leadership is crucial to the formation of a network administrative organization and fills a gap in our understanding of network management by developing the concept of network leadership and exploring the critical tasks a leader undertakes during the formative stages of building an NAO like the NQF. / Ph. D.

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