Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

The World Health Organization has just released the Global status report on road safety —the first broad assessment that describes the road safety situation in 178 countries, using data drawn from a standardised survey. The results provide a benchmark that countries can use to assess their road safety position relative to other countries, while at the international level these findings can be considered as a “baseline”, against which regional and global level progress can be measured.

The questionnaire used for this survey was developed in consultation with an expert committee of road safety researchers and practitioners. Data collection was carried out using a self-administered questionnaire, the content of which was based on the recommendations of the World report on road traffic injury prevention , developed by WHO, the World Bank and many other partners in 2004. The methodology used involved the identification of a National Data Coordinator in each country who identified up to seven other national road safety experts from multiple sectors who could complete the questionnaire. A consensus meeting was then held involving all …

/pdf/global-status-report-on-road-safety-z8sctieuwy.pdf

Global status report on road safety.

Part 1 The argumentative turn: policy institutions and practices: Policy discourse and the politics of Washington think tanks, Frank Fischer Discourse coalitions and the institutionalization of practice - the case of acid rain in Great Britain, Maarten Hajer Political judgement and the policy cycle - the case of ethnicity arguments in the Netherlands, Robert Hoppe Counsel and consensus - norms of argumentation in health policy, Bruce Jennings. Part 2 Analytical concepts - frames, tropes, and narratives: Survey research as rhetorical trope - electric power planning arguments in Chicago, J.A. Throgmorton Frame reflective policy discourse, Martin Rein and Donald Schon Reading policy narratives - beginning, middle, and end, Thomas J. Kaplan Learning from practice stories - the priority of practical judgement, John Forester. Part 3 Theoretical perspectives: Policy anlysis and planning - from science to argumentation, John Dryzek Planning through debate - the communicative turn in planning theory, Patsy Healey Policy reforms as arguments, William Dunn Two worlds of policy discourse - consensual versus adversarial proposal selection, Duncan MacRae.

http://www.untag-smd.ac.id/files/Perpustakaan_Digital_2/POLICY%20ANALYSIS%20The%20Argumentative%20turn%20in%20policy%20analysis%20and%20planning.pdf

The argumentative turn in policy analysis and planning

Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement

eMedicine创建于1996年，由近万名临床医师作为作者或编辑参与此临床医学知识库的建设，其中编辑均是来自美国哈佛、耶鲁、斯坦福、芝加哥、德克萨斯、加州大学等各分校医学院的教授或副教授。

eMedicine

ON MARCH 5, 2009, FROM A BULLY PULPIT IN the East Room of the White House, President Barack Obama opened a health care conference with a historical parable. “Since Teddy Roosevelt first called for reform nearly a century ago,” the president said, “we have talked and we have tinkered. We have tried and fallen short, we’ve stalled for time, and again we have failed to act because of Washington politics or industry lobbying.” A year later, on March 8, 2010, while stumping for the health care bill that he ultimately signed into law on March 22, President Obama again invoked his predecessor by noting, “Think about it. We’ve been talking about healthcare for nearly a century. I’m reading a biography of Teddy Roosevelt right now. He was talking about it. Teddy Roosevelt.” The president is correct that reformers have promoted measures to secure Americans against disease, disability, and want since the first decade of the 20th century. His implication that incremental solutions have always fallen short of universal coverage for health care is also correct. Nevertheless, reformers and presidents of past eras did more than talk about health reform. They overcame considerable resistance to enact and implement it, beginning with the old age and survivors insurance created by the Social Security Act of 1935. What is now simply called Social Security enabled retirees to purchase health care at a time when it was considerably less expensive because physicians had much less to offer their patients than they do now. Subsequent increments of reform helped Americans pay for health care as it became increasingly beneficial and expensive. The Eisenhower administration expanded Social Security in 1956 to provide income for persons with disabilities. A decade later, Lyndon Johnson signed Medicare and Medicaid into law to cover health care and long-term care for retirees and the poor. In 1972, during the Nixon administration, Congress passed legislation extending Medicare to persons of any age who were eligible for Social Security Disability Insurance. In 1997, three years after the Clinton administration’s failed health care bill, the State Children’s Health Insurance Program was enacted, extending coverage for millions of children in families with employed adults and low incomes. Since 2004, Medicare has covered prescription drugs—a program first endorsed by President Reagan. When President Obama cited Theodore Roosevelt but ignored subsequent health care reform events, he was using history as an analogy or moral tale to justify passage of a controversial bill. But history can also offer guidance about the implementation of legislation that, like health reform in 2010, had bitter antagonists as well as enthusiastic supporters and required complicated rules for eligibility and financing. In his campaign for president in 1912, Theodore Roosevelt vaguely called for the “protection of home life against the hazards of sickness . . . and old age through the adoption of a system of social insurance.” His successors learned how difficult it was to achieve even a portion of this noble goal in a diverse, fragmented society, which, despite national ideals, has always been characterized by conflicts about ideology, economic and professional interests, and regional values. Moreover, presidents in the decades since had to implement legislation that had flaws and gaps as a result of negotiations with members of Congress and lobbyists. With the exception of catastrophic coverage in 1989, they succeeded, against strong opposition, in expanding and institutionalizing Americans’ safety net, while always, as in 2010, falling short of universal coverage. Historians have too much respect for contingency to dare predict the future. Still, as the nation embarks on the long road of implementing the 2010 health reforms, historical research can be used to construct a checklist for measuring continuity and discontinuity with past attempts. Antagonism to reform in the months, even years, after it is enacted is often fierce and vitriolic; but it has a half-life. Opponents of “old age” insurance under Social Security insisted after its enactment that the program would increase unemployment and was unsound financially. They took political advantage of the almost 5 years between enactment in 1935 and the payment of the first

Is history relevant to implementing health reform

Pay for Performance in Health Care: Methods and Approaches

The priorities published by the National Center for Health Services Research/DHEW in 1975 were the result of more than a year of consultation between federal officials and members of the research community. The process of priority development emerged from an interpretation of the history of the National Center, of health services research as an activity, and of the previous experience of various research agencies. This paper is a combined memoir and intellectual history of the priority development process in the National Center by a participant who, because of his position, was somewhat detached from events.

The Development of Priorities for Health Services Research the National Center, 1974-76

Health policy and changing epidemiology in the United States: chronic disease in the twentieth century.

For more than a century, health policy in the united States has incentivized both expansion in the number and size of tax-exempt nonprofit organizations in the health sector and their commercialization. As a result of this history, many people who govern, manage, and provide professional services for tax-exempt organizations that care for patients, educate health professionals, represent their interests, and conduct health research have combined, comfortably, doing good with doing well. They have done good by helping relieve considerable pain and suffering and by developing and applying ever more effective interventions to diagnose, prevent, and often cure disease. They have done well by generating substantial revenue for provider systems, research universities, and other types of tax-exempt organizations; often surplus revenue that would be considered profits by commercial firms and the agencies that tax them. This revenue has also enabled many individuals employed by tax-exempt organizations to be compensated as highly as their counterparts in for-profit entities.

The implementation of the Affordable Care Act of 2010 (ACA) has initiated a new chapter in the history of this policy paradox (or, as an anonymous reviewer wrote, an “ironic” result of the politics of policymaking for health). In order to increase access to care, the ACA allocates new public funds to subsidize coverage for millions of patients and, as a result, is enhancing the revenue of insurance plans, clinicians, and provider organizations. In response to the ACA, for example, the number of nonprofit health plans and hospitals converting to for-profit status has increased for the first time in a decade, and competition among provider organizations for market share has intensified. The ACA, however, also encourages tax-exempt organizations to contribute to the public good. The provisions of the Act intended to slow the increase of health care costs could constrain the rate of growth in the revenue of provider organizations, whatever their profit status, and of clinicians. A new provision of the Internal Revenue Code, incorporated in the ACA, augments the accountability of tax-exempt provider organizations for unreimbursed benefits they provide to residents of the communities they serve.

This article explores the long history of policymakers for health incentivizing, both deliberately and as a result of achieving other purposes, the growth and the commercialization of nonprofit organizations. I focus on how the governance of the health sector has created and maintained this paradox. By governance I mean who does what, to, for, and with whom to achieve what goals. The first several sections summarize the considerable evidence about the origin of this paradox and its history from the late 19th to the early 21st century. Next, I describe how the paradox is affecting the implementation of the ACA. Then I propose an explanation of why the paradox has been sustained for so long by the federal government, the states, providers of health services, institutions that educate health professionals and conduct research, and the industries that construct health facilities and supply providers. The concluding section describes recent policies and proposals that could inhibit the further commercialization of nonprofit organizations in the health sector; or that could be too weak and too late to change significantly a policy paradox that has persisted for more than a century.

A variety of sources inform what follows. Primary sources for the history of the paradox are mainly published and unpublished documents and conversations that have been the basis of my publications as well as of my career as a public official, adviser to policymakers, manager of a provider system, chief executive of an endowed foundation, and member of governing boards of nonprofit organizations. I have agreed to keep confidential some of these unpublished documents and conversations, but most of them are matters of public record. In articles and books, I have explored the politics of policymaking for health by federal and state agencies responsible for taxation, regulating employee benefits, and subsidizing access to care; the political and policy history of health plans and academic health centers; and the governance of the health sector. In my career as a public official, executive, adviser, and board member, I have acquired and analyzed evidence and made judgments about each of these issues.

My frequent reliance on personal experience in the politics of policymaking is also a potential cause of bias. For example, several scholars who strongly defend both nonprofit organizations and markets have asked me why I criticize commercialization. I reply that although I applaud business success, I consider greed to be reprehensible when it reduces funds that tax-exempt organizations could use to benefit the public. Accordingly, at times in this article, my values may distort my interpretation of evidence.

I rely on and cite secondary sources in the rich, scholarly literatures that address the politics of policymaking for health and the organization and management of nonprofit organizations. Recent publications in each of these literatures have documented some of the effects of the commercialization of nonprofits. My intent is to supplement, and sometimes to challenge, the conclusions of some of these publications by demonstrating the historical roots of this commercialization and the central role of the federal government and the states in that history.

Daniel M. Fox

Papers

Is history relevant to implementing health reform

Pay for Performance in Health Care: Methods and Approaches

The Development of Priorities for Health Services Research the National Center, 1974-76

Health policy and changing epidemiology in the United States: chronic disease in the twentieth century.

Policy commercializing nonprofits in health: the history of a paradox from the 19th century to the ACA.