In several European countries, including Norway, polices to increase patient choice of hospital provider have remained high on the political agenda. The main reason behind the interest in hospital choice reforms in Norway has been the belief that increasing choice can remedy the persistent problem of long waiting times for elective hospital care. Prior to the 2013 General Election, the Conservative Party campaigned in favour of a new choice reform: "the treatment choice reform". This article describes the background and process leading up to introduction of the reform in the autumn of 2015. It also provides a description of the content and discusses possible implications of the reform for patients, providers and government bodies. In sum, the reform contains elements of both continuity and change. The main novelty of the reform lies in the increased role of private for-profit healthcare providers.
Starting in 2015, the Swedish government has initiated a national reform to standardize cancer patient pathways and thereby eventually speed up treatment of cancer. Cancer care in Sweden is characterized by high survival rates and a generally high quality albeit long waiting times. The objective with the new national program to standardize cancer care pathways is to reduce these waiting times, increase patient satisfaction with cancer care and reduce regional inequalities. A new time-point for measuring the start of a care process is introduced called well-founded suspicion, which is individually designed for each cancer diagnosis. While medical guidelines are well established earlier, the standardisation is achieved by defining time boundaries for each step in the process. The cancer reform program is a collaborative effort initiated and incentivized by the central government while multi-professional groups develop the time-bound standardized care pathways, which the regional authorities are responsible for implementing. The broad stakeholder engagement and time-bound guidelines are interesting approaches to study for other countries that need to streamline care processes.
To identify characteristics of the public health policies of four Nordic countries concerning how they present the causes of ill health, the best ways to deal with these causes, and where to place responsibility; additionally, to investigate whether there is a common Nordic policy.
Analyses of recent public health programmes in Denmark, Finland, Norway, and Sweden.
Focus is on either, or both, individual behaviour and living conditions as causes of ill health; the remedies are classical liberal as well as social democratic policies. None of the programmes is consistent with either ideological strand; each has its peculiar combination of interpretations and policies. The Danish programme is the most liberal focusing on behaviours and individual's choices; the Norwegian programme is the most social democratic or social liberal focusing mostly on the social and physical environment and the politicians' responsibility to improve the population's health. The Swedish and the Finnish programmes lie between those of Denmark and Norway. The Finnish and Norwegian governments stress their responsibility for the health of the population.
No common Nordic political approach to public health exists. All programmes contain contradictory policies and ideological statements with differences regarding the emphasis on individual behaviour versus choice and living conditions and political responsibility. The policies are not entirely predictable from the political stance of the government; national differences seem to play a role.
The Turning Point Model State Public Health Act (Turning Point Act), published in September 2003, provides a comprehensive template for states seeking public health law modernization. This case study examines the political and policy efforts undertaken in Alaska following the development of the Turning Point Act. It is the first in a series of case studies to assess states' consideration of the Turning Point Act for the purpose of public health law reform. Through a comparative analysis of these case studies and ongoing legislative tracking in all fifty states, researchers can assess (1) how states codify the Turning Point Act into state law and (2) how these modernized state laws influence or change public health practice, leading to improved health outcomes.
This paper presents and discusses status, challenges and future developments of Health in All Policies (HiAP) in Norway. Within the frames of the identified challenge of creating coordinated and durable policies and practices in local government, it discusses The Norwegian HiAP policy. More specifically, the paper identifies status and challenges for instituting firmer political and administrative attention to population health and health equity across administrative sectors and levels, and discusses how national authorities may stimulate more coordinated and durable HiAP policies and practices in the future.
This article examines the political formulation and ideological solution of the Swedish drug problem in 1982-2000. How was the drug problem described in the Swedish parliament at the time? How serious was the problem and what solutions were proposed? What were the ideological implications of the problem description, and how was the general political and ideological solution formulated?
The empirical basis for the textual analysis consists of parliamentary bills, government bills and parliamentary records discussing the drug issue during the years 1982-2000.
In the prevailing spirit of consensus in the Swedish parliament at the time, both left-wing and right-wing parties portrayed drugs as a threat to the nation, people and the welfare state. Still, as the ideological dimension kept growing stronger, the drug question functioned even better as an arena for political discussions and ideological positions than in the 1970s.
Compared to previous decades, the problem description broadened during the 1980s and 1990s, and the drug problem could be used to support arguments on almost any topic. The drug problem became a highly politicized issue about whom or what to change when the individual and the society clashed, but also about what the individual and/or society should be changed into.
Healthcare in Europe is increasingly influenced by European Union (EU) regulation enacted to harmonise heterogeneous practices through common safety standards. In many instances directives on safety issues evade public debate because they are seen as merely 'technical matters'. In this paper I analyse the implications at a national level in Denmark of one such piece of legislation: the EU Tissues and Cells Directive. The analysis is based on participant observation, interviews and document analysis conducted in the period from May 2007 to June 2009. I follow translations of the Directive from the level of the EU text into national legislation and further into everyday practices. From a biopolitical perspective, I explore the implications of this so-called technical directive that appear necessary for policymakers and yet remain strangely detached from the everyday experiences of people for whom and on whom it is supposed to work. The Directive has serious implications for the allocation of funds, for patients and for healthcare professionals. These implications need to be discussed. Even more basically, the analysis points to a need for discussing what makes so-called technical directives necessary. This article is intended to facilitate this type of debate.
The concept of social welfare functions has been discussed in health economic literature, as it provides a way of examining the extent to which society is prepared to accept a trade-off between efficiency and equity. In this paper requirements for meaningful empirical estimates of the willingness to accept lower per capita health status in order to achieve greater equity are examined. Results from a pilot study aimed at testing the proposed measurement procedure are reported. They show that at least two thirds of the politicians who participated are prepared to accept a lower growth in per capita health in exchange for increased equity. Accordingly, we found a weak empirical support for the common health economic assumption that only total health benefit should guide the use of resources.
Policy debates about immunization frequently focus on classic trade-offs between individual versus collective well-being. Publicly funded immunization programs are usually justified on the basis of widespread public benefit with minimal individual risk. We discuss the example of the policy process surrounding the adoption of the human papillomavirus (HPV) vaccine in Canada to consider whether public good arguments continue to dominate immunization policymaking. Specifically, we show how a range of stakeholders framed HPV vaccination as a personal-rather than a public-matter, despite the absence of a controversy over mandatory immunization as was the case in the United States. Our findings suggest an erosion of the persuasiveness of public good arguments around collective immunization programs in the policy discourse.
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University of Alberta Pulmonary Research Group, CIHR Institute of Aboriginal Peoples' Health, University of Alberta, 173 HMRC University of Alberta, Edmonton, AB T6G 2S2, Canada. firstname.lastname@example.org
Indigenous peoples across all the continents of the globe live with major gaps in health status and health outcomes associated with well-described social determinants of health, such as poverty and poor education. Indigenous peoples face additional health determinant issues associated with urbanization, isolation from traditional territories, and loss of cultural continuity. Indigenous children are particularly vulnerable as they grow up in isolation from their cultural and social roots and yet are also separated from the mainstream environment of their society. Programs to address these difficult health issues should be viewed as complex clinical interventions with health researchers, social scientists, and clinicians working together with Indigenous peoples to identify the most pressing needs and most appropriate and workable solutions that will result in effective policies and practices.