Interagency implementation of government policy: Strategic management of maternal and child health care in texas

Focusing on a joint effort of the Texas Department of Health and the Texas Department of Human Services, this study examined the interagency implementation of maternal and infant health policy in the state. Thompson's typology of implementation⁽¹⁾ was integrated with the Montjoy and O’Toole⁽²⁾ model of overhead influence on intraorganizational factors in public policy implementation for analysis. The findings provide some support to the Montjoy and O’Toole model.⁽³⁾ The data suggested Type A Mandate Effects and Expected Activity for both departmental programs. Reciprocal Operating Interdependence existed between the two state departments.     

Reform: health care

The Italian National Health Service was established in 1978 as three-tier system, involving State, Regions, USLs (Unità sanitarie locali, Local Health Care Units). The division between the responsibility of determining the general features of health care policy and financing it, on one side (the State), and that of managing services, on the order side (Regions and USLs), was bound to lead to increasing levels of expenditure and large financial deficits. An important reform has been carried out over the last five years, aiming toward a more decentralized system, which, although still public, were based on competition among suppliers and free choice for consumers. We argue that although the reform seems to have been successful in containing public expenditure, it has left some important issues still unresolved: the relationship between patients' freedom of choice and competition among providers, and the definition of a model of rationing the bundle of health services financed by the public sector.     

New federalism and health policy

The making of health policy in the United States is a complex process that involves the private and public sectors, including multiple levels of government. Five characteristics of the policy process are identified, which establish the means by which policies are formulated and which affect the nature of the policies that emerge. These characteristics include (1) the relationship of the government to the private sector; (2) the distribution of authority and responsibility within a federal system of government; (3) the relationship between policy formation and implementation; (4) a pluralistic ideology as the basis of politics; and (5) incrementalism as the strategy for reform. The article focuses on the impact on health policy of the distribution of authority and responsibility within the federal system, particularly the impact of new federalism policies as they emerged during the past decade. The effects of dual federalism, cooperative federalism, creative federalism, and new federalism are examined in relation to health policies. The article concludes with an examination of the challenge to long-established values and health policies posed by new federalism.     

Health care technology assessment: A policy planning tool

Health care technology has developed more rapidly than have the tools to aid decisions regarding that technology's assessment, acquisition and allocation. This article proposes theoretical and technological bases for formulating and analyzing policies for technology assessment. A computerized procedure for measurement and reporting of judgmental sources of technology assessment is presented, accompanied by a pilot study illustrating how the procedure can be used for both research and practical applications.     

Health care policy: lessons from the past and issues of the future

Liberal distributional values, the increasingly powerful capacity of medicine to provide more and better care, and concern about the health hazards of an industrial society fueled the vast expansion of the health care sector during the last 20 years. That growth was facilitated by a growing economy. The current health policy debate at one level reexamines the distributional bases of entitlement programs, and at another seeks alternative resource allocation mechanisms to reduce the cost of health care. This article has two themes. First, distributional and allocational policies are shown to be intrinsically related, so that the health policy debate is fundamentally a clash between liberal and libertarian values. Second, the inexorable social forces driving the health care system are shown to be the aging of the population and the rapid expansion of technology. The resulting dynamics imply the further growth of the health sector, now in the environment of a sluggish economy. Future policies will have to struggle with how to ration scarce health resources and how to reorient the health care sector to the problems of the aged.     

The joint demand for health care,leisure, and commodities: Implications for health care finance and access in Vietnam

This paper explores linkages between the demand for health care providers and the consumption of food, non-food goods, and leisure in Vietnam, using a mixed continuous/discrete dependent variable model. Cross-price elasticities calculated from the model suggest there are strong substitution effects between health care, leisure, and certain commodities. The model allows us to explore the implications of replacing user fees with alternative forms of health care finance, such as commodity taxes. In particular, the results suggest financing public health care services with a non-food sales tax rather than user fees would be more progressive and would improve access to care.     

Coevolution of policy sectors: A comparative analysis of healthcare and public health

This article analyses the institutional coevolution of policy sectors – in other words, the mutual influence and adaptation of the institutional connection between related policy areas. The article proposes a two‐dimensional analytical space ranging from separation to unity on one axis and from superiority/subaltern to equality on the other. The article argues that the overall governance framework behind the coevolving sectors affects the institutional relationship between the sectors. In its empirical part, the article focuses on the healthcare and public health sectors. Based on a comparative historical examination of three countries with different healthcare systems – Australia, Germany, and the United States – the article shows that healthcare and public health coevolve differently depending on the type of national healthcare system. Further research can transfer the concepts introduced in this article to the analysis of other policy challenges, such as immigration or environmental protection.     

Action research in mental health: acute care teams

Action research applies knowledge and research findings to practical problems in order to strengthen the capability of the work unit, to contribute to the personal growth and satisfaction of organization members, and to improve theory. An action research project studying acute care teams at a state residential psychiatric facility found that foreign-born physicians chair high-performing teams. This unexpected result strengthens theories of diversity, status inconsistency, and project team effectiveness.     

Back to the future: Polish health care reform

In January 1999, the Polish government implemented a new law reorganizing the health care in the country. This paper includes an outline of the changes, the main impact of which consisted of introduction of universal health insurance administered by Health Insurance Funds (“Kasy Chorych”). In June 2001 and 2002, a survey of insurance administrators and health care workers provided data concerning the reception of the new system, the perceived inadequacies, and the postulated changes. The intended objective of privatization of health provisions appears as remote as it was before the changes. The major obstacles are identified as political hurdles, physician resistance, and continued dependence on state allocations.     

Developments in health care finance

Costs, quality, and access are the central themes in health care policy in the United States. In the 1980s the predominate issue is becoming access, and the likelihood for universal health coverage, or a national health insurance program, is growing. This paper explores how the America health care system got to this point and examines the present conditions, the trends, and the consequences of those trends.     

Incomplete vertical integration in the health care industry: pseudomarkets and pseudopolicies

Most economic relationships are either arm's-length exchange transactions, each party seeking his or her own interest, or command structures, such as a firm or public agency, integrating joint efforts toward a common goal. The health care industry, however, displays a pattern of incomplete vertical integration--relationships which are neither truly arm's-length nor completely hierarchical. The doctor-patient relationship is archetypical. Physicians appear to sell services in private markets; yet they reach through the exchange process to direct the consumer-patient's utilization decisions, implicity undertaking to act in the patient's interest, and thus integrate forward. But they also integrate backward to control the public regulatory process--self-government--and some forms of insurance. The health care systems of different countries--Canada, the United Kingdom, and the United States--can be interpreted as different patterns of incomplete integration among five basic classes of transactors: consumer-patients, first-line providers, second-line providers, insurers, and governments. Each system of linkage has characteristic strengths and weaknesses. Nowhere, however, do we find a predominance of arm's-length market relationships. Where they exist, markets in health care are usually pseudomarkets dominated by one side of the transaction. The rhetoric of market relationships serves principally to obscure political struggles over shifting patterns of integration.