University of Macau / Faculty of Law

University of Macau / Faculty of Law

This dissertation investigates the position that interest groups occupy in the decisionmaking process of the government of Japan from case studies in the area of health policy. Three important points are demonstrated. First, the medical associations have created strong interdependent linkages to the party in power and have obtained their policy preferences from within the party's decision-making organs. Second, the policy design process in Japan's leading political party, the Liberal Democratic Party, has left little room for the prime minister's initiatives in health care policy. The party has deconcentrated the policy approval process in various councils over which the prime minister has little or no influence. This stands in sharp contrast to the situation prevailing in most parliamentary systems. Third, the thesis demonstrates how the prime minister can, through the design of supra-partisan national councils for reforms, temporarily bypass the normal policymaking channels of the party and enhance its ability to carry out policy adaptation. Two such national councils are investigated: the Nakasone Provisional Council on Administrative Reform (1981-84) and the Hashimoto Administrative Reform Council (1997-98). The temporary national councils are investigated as institutions complementary to the normal policymaking channels of the ministerial and party committees. In the field of health care, the national councils have introduced policy options which had been rejected for years by the medical body and the party in power. The Hashimoto national council, in particular, introduced marketoriented policies that significantly altered Japan's health care system. Three policy areas are investigated: the introduction of principles of information disclosure through the provision of medical files, the creation of transparent price determination mechanisms, and the attempt at reforming the medical fee schedule. These policy changes are seen as a first step toward the introduction of market principles in Japan's service economy.

Introduction Since the 1994 change in power in South Africa, there have been many necessary changes in health legislation (HL), in accordance with the principles enshrined in the Constitution, Such changes have been recognized as being both complex and fraught with stakeholder interests. There is a perception that private family practitioners (FP) generally harbour negative attitudes towards HL that has been brought into effect in recent years. It is also possible that FP, in general, lack knowledge regarding HL. The aim of the study was to assess the knowledge and attitudes of private family practitioners (FP) to health legislation (HL) within a localized geographical area of the eThekweni Metro, KwaZulu-Natal Province. The specific objectives were: To determine family practitioners’ knowledge of health legislation. To determine family practitioners’ attitudes towards health legislation. To assess the correlation between family practitioners’ knowledge and attitudes. To compare the self-reported knowledge of health legislation with the objective assessment of knowledge and attitudes. To establish practitioners’ perceptions of the future of the profession, and of family practice in particular. Methods A cross-sectional descriptive and analytical study was performed, using a pre-tested, validated, structured questionnaire. This instrument was personally hand-delivered to each of a group of private family practitioners practising within a confined geographical area. The sample comprised of 101 family practitioners. Data were analysed using SPSS version 15.0 (SPSS Inc., Chicago, Illinois). Results The study revealed that private FP possess limited knowledge about HL and have a negative attitude in general towards HL. The mean knowledge score was 55% (standard deviation 12.2%). The mean score for attitudes towards health legislation was 46,3% (standard deviation 4.2%). The correlation coefficient between knowledge and attitudes was 0.244 (p=0.022). Therefore, there was a weak positive, but statistically significant, correlation between knowledge and attitudes. Thus, in general, as knowledge increased, so did attitudes improve and become more positive. The self reported knowledge and attitudes of FPs seemed to show some unexpected though non-statistically significant anomaly, in that FPs who considered themselves “well aware” of certain parts of HL, together with those who were “not aware”, reporting a more negative attitude towards HL than those who considered themselves to be “aware”. FPs’ perceptions of the future of the profession, and of family practice in particular, were generally reported as being reasonable to poor. Financial viability and sustainability of FP, in particular, were reported as being reasonable to poor. The attractiveness of the profession to the youth of today was reported as being poorer than in the past. However, the majority of FP held the perception that medicine as a profession was distinct as it responds to a calling to serve society at large, giving this aspect of the question a ranking of “reasonable to good”. Conclusion and Recommendations The study revealed that this group of FPs attained an overall mean knowledge score of 55% with respect to HL. FPs’ knowledge of HL requires improvement, which can be achieved through effective education and training programmes. Private FPs need to embrace the change process, but also need to be more pro-active in vocalizing their opinions. The Health Ministry and relevant authorities and policymakers need to play a greater role in creating an atmosphere that embraces and facilitates change by involving iii relevant stakeholders. Lastly, it is recommended that this study serve as a template for a broader research project involving larger numbers of participants and a wider geographical area. In addition, an intervention tool should be devised. Such a tool could take the form of a structured education programme on HL, with an associated monitoring and evaluation aspect, which would enable an assessment of the intervention programme in terms of its value and the influence it has on improving knowledge and attitudes. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2011.

This study evaluated the benefits and the problems of implementing the World Trade Organization's decision on the implementation of Paragraph 6 of the Doha Declaration by developing country members.

Universiẗat, Diss., 2006--Frankfurt (Main).

Law / LL.M.

Magister Legum - LLM / This study evaluated the benefits and the problems of implementing the World Trade Organization's decision on the implementation of Paragraph 6 of the Doha Declaration by developing country members. / South Africa

This dissertation investigates the position that interest groups occupy in the decisionmaking process of the government of Japan from case studies in the area of health policy. Three important points are demonstrated. First, the medical associations have created strong interdependent linkages to the party in power and have obtained their policy preferences from within the party's decision-making organs. Second, the policy design process in Japan's leading political party, the Liberal Democratic Party, has left little room for the prime minister's initiatives in health care policy. The party has deconcentrated the policy approval process in various councils over which the prime minister has little or no influence. This stands in sharp contrast to the situation prevailing in most parliamentary systems. Third, the thesis demonstrates how the prime minister can, through the design of supra-partisan national councils for reforms, temporarily bypass the normal policymaking channels of the party and enhance its ability to carry out policy adaptation. Two such national councils are investigated: the Nakasone Provisional Council on Administrative Reform (1981-84) and the Hashimoto Administrative Reform Council (1997-98). The temporary national councils are investigated as institutions complementary to the normal policymaking channels of the ministerial and party committees. In the field of health care, the national councils have introduced policy options which had been rejected for years by the medical body and the party in power. The Hashimoto national council, in particular, introduced marketoriented policies that significantly altered Japan's health care system. Three policy areas are investigated: the introduction of principles of information disclosure through the provision of medical files, the creation of transparent price determination mechanisms, and the attempt at reforming the medical fee schedule. These policy changes are seen as a first step toward the introduction of market principles in Japan's service economy. / Arts, Faculty of / Political Science, Department of / Graduate

No previous study has attempted to clarify and articulate administrator attitudes regarding DNR orders in the school setting. Administrative school staff are responsible for development and implementation of school policy therefore understanding administrators' attitudes would assist discussion and decision making related to DNR orders in the school setting.