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1	Why child health policies in post-apartheid South Africa have not performed as intended : the case of the School Health Policy Shung King, Maylene January 2012 (has links) The unprecedented scale of health sector reform in the course of radical political transformation in post-apartheid South Africa is well-documented. This thesis examines child health policy reform as a crucial part of this process. The goals of broader health sector reform were to improve the overall health status of citizens, in particular those most vulnerable, and eliminate inequities in health service provision and health status outcomes. Although children were accorded explicit prioritisation during this time, child health indicators remain poor and some have worsened. Amidst the documented explanations for the poor progress with child health indicators, the specific role and contribution of child health policies had not been interrogated. The thesis examines the development, design and implementation of national child health policies, with particular focus on equity. The National School Health Policy serves as a case-study for the analysis. Three complementary policy analysis frameworks guide the enquiry. Findings are based on a documentary analysis of key policies and 81 qualitative interviews with national policy makers and managers, provincial and district managers, and service providers in three socioeconomically different provinces of South Africa. The common assertion by South African health system analysts, that "policies are good, but implementation is poor", is refuted by this research. The findings show that child health policies have many deficiencies in their design and development. These "poor policies" contribute to inadequate child health service provision, which in turn have a bearing on poor child health outcomes. In particular the failure in clearly defining and conceptualising equity in policy development and design contributed to the absence of equity considerations in the implementation phase. The explanations for these policy failures include: lack of strategic direction for child health services; poor policy making capacity; a lack of clear policy translation; and the diverse politics, power and passion of policy actors. Broader health system factors, such as an immature and poorly functioning district health system, compound these policy failures. The thesis deepens the understanding of child health policy reform through a retrospective policy analysis and so contributes to the body of knowledge on policy reform in South Africa and in low- and middle-income countries more generally. 362.70968
2	Developing a policy analysis framework to establish level of access and equity embedded in South African health policies for people with disabilities Law, Francoise Bernadette 12 1900 (has links) Thesis (MSc (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy. Centre for Rehabilitation Studies))--Stellenbosch University, 2008. / Purpose To date no health policy analysis tool has been developed to analyse access and equity for people with disabilities. Further, there is very little information available on health and disability policy implementation. The intention of this research is to develop a health policy framework to analyse access and equity, focussing on people with disabilities, that can be used by policy makers. This research analyses four health policies and focuses on the facilitators and the implementation barriers. The findings of this research will impact on new policies developed in the future. Method The study included both a desk - top review and a descriptive study. The desk - top review entailed the formulation of a disability - focussed framework for health policy. This was then used to analyse health policies in terms of their disability inclusiveness. Qualitative data was gathered from interviews and questionnaires and focussed on policy processes and implementation. This was incorporated into the analysis. An ideal seven - step policy process model was developed. This was used to compare the reported policy process with the four policies followed. The four health policies used in the research are: the Primary Health Care Policy, the National Rehabilitation Policy, the Provision of Assistive Devices Guidelines and the Free Health Care Policy. Four key informants with extensive experience and knowledge were interviewed on policy processes and implementation. Questionnaires were also sent to Provincial Rehabilitation Managers to obtain their viewpoints on barriers and facilitators to policy implementation. Results Analysis of the four health policies showed varying levels of access and equity features. In terms of policy processes: all four policies had different stakeholders who initiated the policy development process. Two of the policies viz. the National Rehabilitation Policy and the Provision of Assistive Devices Guidelines, had people with disabilities as part of the stakeholder group involved in the policy formulation. The National Rehabilitation Policy had a comprehensive monitoring and evaluation section whereas this was absent in the other three policies. From the information gained from interviews and questionnaires, it appeared that the barriers to policy implementation included: attitudes, environmental access, human and financial resources. Facilitators to policy implementation include: policy process and design, availability of human and financial resources, support systems, management support, organisational structures and finally positive attitudes that all impacted favourably on policy implementation. Conclusions The developed health policy analysis framework served its purpose. Most policies did not have monitoring and evaluation guidelines that make implementation difficult to assess. Recommendations are made to improve policy design and content, specifically related to access and equity. Intersectoral collaboration and disability coordination needs to be improved. People with disabilities also need to engage with government departments, to monitor implemented policies and to advocate for change from outside the health system. Health policy analysis South Africa Equity in health policy Disability rights Medical policy -- South Africa Equity -- South Africa Dissertations -- Rehabilitation Theses -- Rehabilitation
3	ANALISI DEL CONTENUTO E PEOPLE CENTRED APPROACH NELLE POLITICHE SANITARIE: UNA PROPOSTA METODOLOGICA / Content Analysis and People Centred Health policies: proposal for a methodology SAONARA, IRENE 16 April 2018 (has links) La ricerca svolta si propone di esplorare la possibilità di utilizzare le metodologie quantitative di analisi del contenuto per determinare, tramite l’analisi dei testi già disponibili (dati testuali secondari, non raccolti ad hoc) le affinità tra una politica sanitaria regionale ed il Framework on integrated, people-centred health services (IPCHS, WHO, 2016).. La scelta di utilizzare come fonti di dati i testi è dovuta principalmente alle tempistiche di elaborazione del lavoro. Il Framework IPCHS è stato diffuso nella sua versione ufficiale nell’aprile 2016 e al momento della consegna di questo lavoro (settembre 2017) non è stata ancora adottata nessuna strategia ufficiale per il monitoraggio dell’implementazione delle politiche people centred. Anche il caso di studio scelto, ovvero la Riforma sociosanitaria lombarda, cominciata nel 2015, è ancora in fase di implementazione.La natura metodologico-sperimentale della tesi e la metodologia scelta hanno determinato l’adozione di un approccio basato sul paradigma dei Mixed methods. Il lavoro è strutturato nel seguente modo. Nel primo capitolo sono ripresi gli elementi metodologici essenziali della Analisi del contenuto applicata alla analisi delle politiche pubbliche. Vengono inoltre illustrati i risultati di un approfondimento condotto sul concetto di parola chiave. Nel secondo capitolo viene descritto il Framework IPCHS e viene illustrato il processo di composizione delle liste di parole chiave (dizionario PCA) nella loro duplice versione in inglese e in italiano attraverso una analisi tematica. Nel capitolo III è descritta una prima applicazione del dizionario PCA ad un corpus composto da 13 note relative ad interviste svolte durante il progetto Stop TB partnership. Il fine della analisi svolta nel terzo capitolo è testare la capacità di ricognizione delle liste rispetto ai contenuti attinenti al People Centred Approach. Per questa ragione i risultati ottenuti sono stati sottoposti a validazione qualitativa. Nel capitolo IV invece, il dizionario PCA (versione italiana) è stato utilizzato per analizzare un corpus relativo alla Riforma Sociosanitaria lombarda (l.r. 23/2015 ed alcune delibere attuative). Anche in questo caso i risultati ottenuti sono stati sottoposti a validazione, secondo un approccio mixed methods, anche per individuare l’impatto della traduzione in italiano sulla efficacia delle liste di parole chiave. / The aim of this research is to investigate the possibility to develop a secondary textual-data based protocol in order to use textual material such as interviews, national strategic plans and other official documents to classify a health policy as “integrated and people centred”. According to WHO resolution A69/39 “An integrated people-centred approach is crucial to the development of health systems that can respond to emerging and varied health challenges, including urbanization, the global tendency towards unhealthy lifestyles, ageing populations, the dual disease burden of communicable and non communicable diseases, multi-morbidities, rising health care costs, disease outbreaks and other health-care crises.” But how can we determine if a health policy is integrated and people centred? In this study, I try to develop a mixed methods based protocol to analyse textual material and evaluate his relevance with WHO Framework on integrated, people-centred health services. In the first chapter, there is a literature review about content analysis methodologies applied to policy analysis. Then I examine two different health policies, one implemented at international level by WHO (Stop TB Partnership Program) and one implemented at the regional level by Regione Lombardia (Health System Reform). While the first analysis aim is to text the dictionary created by a thematic analysis of the Framework on integrated people-centred health services (described in chapter 2), the second analysis is to apply the dictionary to an Italian case, characterized by textual materials written in Italian. SECS-P/02: POLITICA ECONOMICA SPS/07: SOCIOLOGIA GENERALE SPS/04: SCIENZA POLITICA
4	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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