Health Policy RSS feed: Current Issue. Health Policy is intended to be a vehicle for the exploration and discussion of health policy issues and is aimed in particular at enhancing communication between health policy researchers, legislators, decision-makers, and professionals concerned with developing, implementing, and analysing health policy. The journal encourages the submission of original, empirically based, comparative and/or global studies. To achieve the journal's objectives, authors are encouraged to write in a non-technical style, which is understandable to health policy practitioners and specialists from other disciplines. Electronic usage: An increasing number of readers access the journal online via ScienceDirect, one of the world's most advanced web delivery systems for scientific, technical and medical information. Average monthly article downloads for this journal: 21,794* * Figure is an average based on full text articles downloaded monthly via ScienceDirect between August 2008 and March 2009 http://www.journals.elsevierhealth.com/periodicals/heap/?rss=yesElsevier Inc.en © 2009 Elsevier Ireland Ltd. All rights reserved. Health Policy0168-8510932-3December 2009 © 2009 Elsevier Ireland Ltd. All rights reserved. healthpermissions@elsevier.comhttp://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009002115/abstract?rss=yesAbstract: Background: It is widely assumed that the principal objective of healthcare is to maximise health. However, people may be willing to sacrifice aggregate health gain in order to direct resources towards those who are worst off in terms of the severity of their pre-treatment health state.Objectives: This paper reviews the literature on severity in the context of economic evaluation, with the aim of establishing the extent to which popular preferences concerning severity imply a departure from the health maximisation objective.Methods: Data were obtained using a keyword search of major databases and a hand search of articles written by leading researchers in the subject area.Results: The empirical evidence suggests that people are, on the whole, willing to sacrifice aggregate health in order to give priority to the severely ill. However, there remain unresolved issues regarding the elicitation and interpretation of severity preferences (and indeed popular preferences generally).Conclusions: The use of severity as a priority setting criterion is supported by a large number of empirical studies of popular preferences. Further work is needed, however, to accurately estimate the strength of this support.Severity of illness and priority setting in healthcare: A review of the literatureKoonal K. Shah10.1016/j.healthpol.2009.08.005Health Policy 93, 2 (2009)2009-08-28Health Policy2009-08-28932-3S0168-8510(09)X0013-8Review Articles7784http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009002048/abstract?rss=yesAbstract: Rationale: Increasing attention is being given to the evaluation of public health interventions. Methods for the economic evaluation of clinical interventions are well established. In contrast, the economic evaluation of public health interventions raises additional methodological challenges. The paper identifies these challenges and provides suggestions for overcoming them.Methods: To identify the methodological challenges, five reviews that explored the economics of public health were consulted. From these, four main methodological challenges for the economic evaluation of public health interventions were identified. A review of empirical studies was conducted to explore how the methodological challenges had been approached in practice and an expert workshop convened to discuss how they could be tackled in the future.Results: The empirical review confirmed that the four methodological challenges were important. In all, 154 empirical studies were identified, covering areas as diverse as alcohol, drug use, obesity and physical activity, and smoking. However, the four methodological challenges were handled badly, or ignored in most of the studies reviewed.Discussion: The empirical review offered few insights into ways of addressing the methodological challenges. The expert workshop suggested a number of ways forward for overcoming the methodological challenges.Conclusion: Although the existing empirical literature offers few insights on how to respond to these challenges, expert opinion suggests a number of ways forward. Much of what is suggested here has not yet been applied in practice, and there is an urgent need both for pilot studies and more methodological research.Methods for assessing the cost-effectiveness of public health interventions: Key challenges and recommendationsHelen Weatherly, Michael Drummond, Karl Claxton, Richard Cookson, Brian Ferguson, Christine Godfrey, Nigel Rice, Mark Sculpher, Amanda Sowden10.1016/j.healthpol.2009.07.012Health Policy 93, 2 (2009)2009-08-26Health Policy2009-08-26932-3S0168-8510(09)X0013-8Review Articles8592http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009002073/abstract?rss=yesAbstract: In 1997 Health Visiting was deemed by New Labour to be an important player in reducing health inequalities. It was acknowledged that if Health Visiting was to fulfill this vision it would have to work out with its traditional child health role and also engage with groups, communities and populations to tackle the determinants of ill health. Twelve years on, external factors such as, NHS cut backs, recent changes to how Health Visitors are regulated throughout the UK and devolved Health Visiting policy making structures have led to the rapid demise in status and legitimacy of Health Visiting and its wider public health role. This article argues that the unintended consequences of devolved Health Visiting policy has resulted in 3 recent community nursing and health-visiting reviews in Scotland and England which have made divergent policy recommendations about the role of the Health Visitor in tackling health inequalities. The recommendations outlined in the Scottish review in particular threatened to jeopardise the very future provision of a UK wide Health Visiting service. If Health Visiting is to survive as a UK wide entity, a radical independent rethink as to its future direction and its public health role is urgently required.Health Visiting—The end of a UK wide service?Robert Alan James Hoskins10.1016/j.healthpol.2009.08.001Health Policy 93, 2 (2009)2009-09-01Health Policy2009-09-01932-3S0168-8510(09)X0013-8Review Articles93101http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009001432/abstract?rss=yesAbstract: Objectives: Our analysis assessed the impact of information on patients’ preferences in prescription versus over-the-counter (OTC) delivery systems.Methods: A contingent valuation (CV) study was implemented, randomly assigning 534 lay people into the receipt of limited or extended information concerning new influenza drugs. In each information arm, people answered two questions: the first asked about willingness to pay (WTP) for the new prescription drug; the second asked about WTP for the same drug sold OTC.Results: We show that WTP is higher for the OTC scenario and that the level of information plays a significant role in the evaluation of the OTC scenario, with more information being associated with an increase in the WTP. In contrast, the level of information provided has no impact on WTP for prescription medicine. Thus, for the kind of drug considered here (i.e. safe, not requiring medical supervision), a switch to OTC status can be expected to be all the more beneficial, as the patient is provided with more information concerning the capability of the drug.Conclusions: Our results shed light on one of the most challenging issues that health policy makers are currently faced with, namely the threat of a bird flu pandemic. Drug delivery is a critical component of pandemic influenza preparedness. Furthermore, the congruence of our results with the agency and demand theories provides an important test of the validity of using WTP based on CV methods.The impact of information on patient preferences in different delivery patterns: A contingent valuation study of prescription versus OTC drugsKarine Lamiraud, Konrade von Bremen, Cam Donaldson10.1016/j.healthpol.2009.05.014Health Policy 93, 2 (2009)2009-07-15Health Policy2009-07-15932-3S0168-8510(09)X0013-8Original Articles102110http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009001614/abstract?rss=yesAbstract: Objective: The purpose of this study was to examine inequalities of access to health care among the urban elderly in northwestern China.Methods: 4441 seniors (over 60 years of age) were drawn from a cross-sectional study conducted in three northwestern Chinese cities. The effects of these factors on the use of health care services (visits to physician and hospitalizations) were estimated using multiple binomial regressions.Results: Overall, 7.6% of the population studied had visited a physician during the past 4 weeks, 10.1% had used inpatient care during the past year, and 7.6% did not use inpatient services despite being referred by doctors for hospital admission during the previous year. Both visits to a physician and non-hospitalization were independently associated with the place of residence and household per capita income; the use of inpatient care services was significantly lower among those with less education, those with lower household per capita income and those without health insurance coverage. Women tended to make more use of outpatient services, but spent less time and money in hospital than men.Conclusion: Our findings indicate a significant inequality of access to health care services among urban seniors in northwestern China. More appropriate health care policies should be developed to achieve the goal of greater equality of access to health care services for all.Inequality of access to health care among the urban elderly in northwestern ChinaJuhua Luo, Xiulan Zhang, Chenggang Jin, Dongmin Wang10.1016/j.healthpol.2009.06.003Health Policy 93, 2 (2009)2009-07-21Health Policy2009-07-21932-3S0168-8510(09)X0013-8Original Articles111117http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009001602/abstract?rss=yesAbstract: Health governance internationally has become more complex, with both hierarchical and network modes of governance explicitly represented within single public systems.Objective: To understand the implementation of new modes and mechanisms of governance under New Zealand health reforms and to assess these in the context of international trends.Research methods sought data from key groups participating in governance policy and implementation. Methods included surveys of board members (N=144, 66% response rate), interviews with chairs (N=14) and chief executives (N=20), and interviews with national policy makers/officials (N=19) and non-government providers and local stakeholders (N=10). Data were collected over two time periods (2001/2002; 2003/2004). Analysis integrated the findings of both qualitative and quantitative methods under themes related to modes and mechanisms of governance.Results indicate that a hierarchical mode of governance was implemented quickly, with mechanisms to ensure political accountability to the government. Over the implementation period the scope of decision-making at different levels required clarification and mechanisms for accountability required adjustment. Non-government provider networks emerged only slowly whereas a network of statutory health organisations established itself quickly.Conclusion: The successful implementation of a mix of governance modes in New Zealand 2001–2004 was characterised by clear government policy, flexibility of approach and the appearance of an unintended network. In New Zealand there is less tendency than in some other some other small countries/jurisdictions towards centralisation, with local elections and community engagement policies providing an element of local participation, and accountability to the centre enhanced through political rather than bureaucratic mechanisms.Implementing new modes of governance in the New Zealand health system: An empirical studyPauline Barnett, Tim Tenbensel, Jacqueline Cumming, Clare Clayden, Toni Ashton, Megan Pledger, Mili Burnette10.1016/j.healthpol.2009.06.004Health Policy 93, 2 (2009)2009-07-21Health Policy2009-07-21932-3S0168-8510(09)X0013-8Original Articles118127http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009001754/abstract?rss=yesAbstract: Objectives: The shortage of resources for healthcare has risen the quest for more rational models and practices for technology selection at a hospital level. Uncertainty is a critical issue. This paper aims to shed first light on this issue through an investigation on the content and the process of budgeting technology adoption with respect to uncertainty.Methods: An exploratory multi-case study was carried out to gain a better understanding of the current practice of technology assessment at a hospital level. Five Italian hospitals were selected. Key informants from the budget committees have been interviewed with a structured questionnaire based on the results of an electronic literature search.Results: Five domains of uncertainty have been identified. They have been deployed in a list of 15 relevant issues that should be reviewed during the budget process. The hospitals in the sample cope with these issues in a peculiar manner. Organisational uncertainty is broadly overcome. Reporting about technology performance after the adoption is missing.Conclusion: Policy makers should facilitate hospitals: (a) to develop a multi-disciplinary and evidence based practice for technology selection, (b) to assess and manage uncertainty, and (c) to build a reporting system regarding technology performance in order to build fair practices for technology selection and support continuous learning.Uncertainty inclusion in budgeting technology adoption at a hospital level: Evidence from a multiple case studyEmanuele Lettieri10.1016/j.healthpol.2009.07.002Health Policy 93, 2 (2009)2009-08-03Health Policy2009-08-03932-3S0168-8510(09)X0013-8Original Articles128136http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS016885100900178X/abstract?rss=yesAbstract: Purpose: To investigate the emergency room (ER) utilization among disabled Taiwanese older adults with different patterns of care arrangement.Method: A national probability sample of 13,957 disabled older adults (aged 50 and above) was recruited. Individual interview data and National Health Insurance administrative data were used to examine the effects of care arrangements on ER utilization 1 year after the baseline interview.Results: One-third (33.5%) of the subjects used emergency room at least once in the follow-up year. The ER utilization rates among individuals living in institutions, in home with foreigner worker, in home with informal caregiver, and in home without caregiver, were 34.5%, 43%, 32.5% and 25% respectively. After controlling for other predisposing, enabling, need factors, and healthcare services use with multivariate logistic regression model, comparing with subjects staying home with informal caregivers, those who were institutionalized were less likely to use ER services during the study year (OR=0.64, 95%CI=0.54–0.76), those who staying home cared by foreigner worker were more likely to use ER services (OR=1.16, 95%CI=1.05–1.29), and those who staying home without caregiver were less likely to use ER services (OR=0.89, 95%CI=0.78–1.01).Conclusions: Disabled older adults staying at home were more likely to use ER compared to institutionalized individuals. More research is needed to identify the unmet healthcare needs and the quality of home care that may explain the high ER utilization rate.Social determinants of emergency utilization associated with patterns of careMei-Ju Chi, Shwu-Chong Wu, Ding-Cheng Chan, Chien-Chang Lee10.1016/j.healthpol.2009.07.005Health Policy 93, 2 (2009)2009-08-10Health Policy2009-08-10932-3S0168-8510(09)X0013-8Original Articles137142http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009001808/abstract?rss=yesAbstract: Background: It is increasingly recognized that healthcare is a complex system with limited resources and many interacting sources of both positive and negative feedback. Discrete-event simulation (DES) is a tool that readily accommodates questions of capacity planning, throughput management and interacting resources. As a result the use of DES in informing healthcare decision making is increasing. However, understanding when and how to build a DES model and use it for policy making is not yet a common knowledge.Methods: The steps in building a DES model will be demonstrated using a real-world example, i.e., pediatric ultrasound screening for hip dysplasia. The main components of a DES model such as entities, resources and queues will be introduced and we will examine questions such as referral schedule, number of ultrasound machines and type of screeners and how these entities interact. Finally a review of the statistical techniques appropriate to DES will be provided.Conclusion: Discrete-event simulation is a valuable tool in the policymakers armentarium. It can be used effectively to analyze and understand complex healthcare systems and policy problems such as population screening.A tutorial on discrete-event simulation for health policy design and decision making: Optimizing pediatric ultrasound screening for hip dysplasia as an illustrationSabrina Ramwadhdoebe, Erik Buskens, Ralph J.B. Sakkers, James E. Stahl10.1016/j.healthpol.2009.07.007Health Policy 93, 2 (2009)2009-08-12Health Policy2009-08-12932-3S0168-8510(09)X0013-8Original Articles143150http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009001791/abstract?rss=yesAbstract: Objective: Against the backdrop of a rise in cesarean section deliveries from 6.0% in 1996 to 14.8% in 2006, the objective of this study was to investigate socio-demographic, clinical and service-related factors associated with cesarean sections in the occupied Palestinian territory.Methods: Data from the Palestinian Family Health Survey 2006 were used to examine last births in the 5 years preceding the survey to women aged 15–49 years. Bivariate and multivariate associations between type of delivery (dependent variable) and selected factors were analyzed using logistic regression. Selected maternal outcomes were also investigated with type of delivery as the independent variable.Results: Cesarean section deliveries were significantly associated with maternal age (35+ years), primiparity, low birth weight and residence area in the West Bank and Gaza. There was no significant difference in the prevalence of cesarean deliveries by sector in the West Bank, but in Gaza, they were significantly more common in the governmental sector.Conclusions: There is a need for detailed audits of cesarean section deliveries, nationally and at the facility level, in order to avoid unnecessary interventions in the context of high fertility, rising poverty and fragmented health services. Variations by governorate should be studied further for focused interventions.Cesarean section deliveries in the occupied Palestinian territory (oPt): An analysis of the 2006 Palestinian Family Health SurveyHanan F. Abdul-Rahim, Niveen “Mohammad Elias” Abu-Rmeileh, Laura Wick10.1016/j.healthpol.2009.07.006Health Policy 93, 2 (2009)2009-08-12Health Policy2009-08-12932-3S0168-8510(09)X0013-8Original Articles151156http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009001468/abstract?rss=yesAbstract: Object: Although infant abandonment is a historical problem, we know remarkably little about the conditions or effects of abandonment to guide evidence driven policies. This paper briefly reviews the existing international evidence base with reference to potential mental health considerations before mapping current UK guidelines and procedures, and available incidence data. Limitations arising from these findings are discussed with reference to international practice, and interpreted in terms of future pathways for UK policy.Method: A systematic approach was utilized to gather available data on policy information and statistics on abandoned babies in the UK.Results: A review of the limited literature indicates that baby abandonment continues to occur, with potentially wide-ranging mental health ramifications for those involved. However, research into such consequences is lacking, and evidence with which to understand risk factors or motives for abandonment is scarce. International approaches to the issue remain controversial with outcomes unclear. Our systematic search identified that no specific UK policy relating to baby abandonment exists, either nationally or institutionally. This is compounded by a lack of accurate of UK abandonment statistics. Data that does exist is not comprehensive and sources are incompatible, resulting in an ambiguous picture of UK baby abandonment.Conclusions: Available literature indicates an absence of clear provision, policy and research on baby abandonment. Based on current understanding of maternal and child mental health issues likely to be involved in abandonment, existing UK strategy could be easily adapted to avoid the ‘learning from scratch’ approach. National policies on recording and handling of baby abandonments are urgently needed, and future efforts should be concentrated on establishing clear data collection frameworks to inform understanding, guide competent practice and enable successfully targeted interventions.Abandoned babies and absent policiesJoanne Mueller, Lorraine Sherr10.1016/j.healthpol.2009.06.002Health Policy 93, 2 (2009)2009-08-17Health Policy2009-08-17932-3S0168-8510(09)X0013-8Original Articles157164http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009001821/abstract?rss=yesAbstract: This paper compares the process and results of the reform which confined doctors to prescribing and pharmacists to dispensing in both Korea and Japan from comparative and politico-economic perspectives. At the present time, several years since the reforms were implemented, a ‘compulsory separation’ is being established in Korea. The claims containing antibiotics against the total claims from the doctor's clinic dropped from 55.7% in 2000 to 29.6%, and the number of drugs per claim from 5.9 in 2000 to 4.2 in 2008. Japan selected an ‘arbitrary separation’. Efforts to raise the rate of the ‘separation’ have increased the rate from 1% in 1974 to 57.2% in 2007, but nearly half of medical prescriptions are still being dispensed by doctors.Disparity in the two countries has been brought about by what follows: first, the president's political leadership caused a radical shift in the attitude of the bureaucratic group in Korea; second, in their confrontation with doctors the pharmacists’ camp in Korea proved to hold political power stronger than that in Japan; third, intervention in policy of progressive civic groups in particular played a pivotal role in accomplishing the reform in Korea.Pharmaceutical reforms: Implications through comparisons of Korea and JapanHyoung-Sun Jeong10.1016/j.healthpol.2009.07.009Health Policy 93, 2 (2009)2009-08-17Health Policy2009-08-17932-3S0168-8510(09)X0013-8Original Articles165171http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009001390/abstract?rss=yesAbstract: Aims: Associations between marital status and self-rated health were investigated, adjusting for material conditions and trust (social capital).Methods: The 2004 public-health survey in Skåne is a cross-sectional study. A total of 27,757 persons aged 18–80 years answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate associations between marital status and self-rated health, adjusting for economic problems and trust.Results: The prevalence of poor self-rated health was 28.7% among men and 33.2% among women. Older respondents, respondents born abroad, with medium/low education, low emotional support, low instrumental support, economic problems, low trust, never married and divorced had significantly higher odds ratios of poor self-rated health than their respective reference group. Low trust was significantly higher among the divorced and unmarried compared to the married/cohabitating. Adjustment for economic problems but not for trust reduced the odds ratios of poor self-rated health among the divorced, which became not significant among men.Conclusions: Never married and the divorced have significantly higher age-adjusted odds ratios of poor self-rated health than the married/cohabitating group. Economic problems but not trust seem to affect the association between marital status and poor self-rated health.Marital status, social capital, material conditions and self-rated health: A population-based studyMartin Lindström10.1016/j.healthpol.2009.05.010Health Policy 93, 2 (2009)2009-08-19Health Policy2009-08-19932-3S0168-8510(09)X0013-8Original Articles172179http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009001833/abstract?rss=yesAbstract: Objectives: The objectives of this study were (1) identifying the patterns of post-stroke care, (2) determining the care-provider and patient characteristics associated with optimal management of post-stroke care and (3) estimating the potential influence of various facilitated care policies on outcomes.Methodology: The 3946 subjects included in the study were admitted to one of Quebec's acute-care hospitals with confirmed diagnosis of stroke and subsequently discharged to their home. The records related to fee-for-service billings of this sample were obtained for the 3 months following discharge and used to define the care-provider path for each stroke survivor. These paths were analyzed and the potential impact of various facilitated care interventions was estimated via a Markov model.Results: The rate of mortality for this sample was 3.2% during the first 3 months after discharge. For the patients who were re-hospitalized, however, the mortality rates were up to 10.3% depending on the care-provider visited prior to re-hospitalization. Our analyses indicate that by avoiding such critical sub-paths via facilitated care, it is possible to achieve improvements in health outcomes as well as cost.Discussion: There is a window of opportunity for improving community-based post-stroke care. Facilitated care policies concerning planned visits upon discharge from hospital or following ER visits can improve the outcomes.Improving post-stroke health outcomes: Can facilitated care help?Beste Kucukyazici, Vedat Verter, Lyne Nadeau, Nancy E. Mayo10.1016/j.healthpol.2009.07.010Health Policy 93, 2 (2009)2009-08-20Health Policy2009-08-20932-3S0168-8510(09)X0013-8Original Articles180187http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009001766/abstract?rss=yesAbstract: Hospitals develop nurse schedules that cover a period of 4–6 weeks and are posted several weeks in advance. Once posted, changes to the schedule require voluntary participation by the nurses, making it difficult for hospitals to respond to changes in nursing needs and availability of nurses. At the same time, nursing needs’ forecasts developed several weeks in advance are often wrong. In each hospital setting, there may exist several promising strategies to enhance scheduling flexibility and reduce the mismatch between the nursing needs and the availability of nurses. However, methodologies to evaluate such strategies, before testing them in expensive pilot implementation, do not exist. We demonstrate how such evaluations can be carried out using historical data. Furthermore, we demonstrate the use of our approach by evaluating the benefits of a strategy where nurses are divided into two cohorts and schedules are phase shifted for the two cohorts. Staggering schedules allows nursing unit managers to benefit from more frequent updating of needs’ assessments without having to change work rules. Upon applying our approach to data from a large urban hospital, we discovered that in this example staggering did not improve the performance of nurse schedules. We discuss possible reasons for this result, its implications for hospital managers, and other potential uses of our approach.On evaluating the impact of flexibility enhancing strategies on the performance of nurse schedulesWen-Ya Wang, Diwakar Gupta, Sandra Potthoff10.1016/j.healthpol.2009.07.003Health Policy 93, 2 (2009)2009-08-21Health Policy2009-08-21932-3S0168-8510(09)X0013-8Original Articles188200http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009002012/abstract?rss=yesAbstract: The greatest risk factor for lung cancer is smoking, the second largest factor being raised radon levels at home. Initiatives to stop smoking and reduce domestic radon levels have met with some success, but in both cases a significant proportion of those affected have not taken action.The two risk factors combine, so that those who smoke and live in a house with high radon levels are at higher risk than if exposed to only one of the two threats. There is the potential for combined public health campaigns to better target those affected.Using postal questionnaires, we collected demographic information of those in Northamptonshire, UK, a radon Affected Area, who participated in Smoking Cessation Programmes, and compared these to a recent study by our group of those who had taken action to reduce radon. The comparison suggests that these two groups are significantly different, and in some cases differ from the general population. In addition, those who continue to quit smoking at 1 year were more likely to have children under 18 at home, and live with a parent or partner compared to those who had relapsed after the previous assessment at 4 weeks.There is merit in extending Smoking Cessation Programmes to include advice on reducing the risks from radon.Local health campaigns to reduce lung cancers induced by radon and smoking—Who responds?Antony Roger Denman, Karen Timson, George Shield, Christopher John Groves-Kirkby, Stephen Rogers, Jackie Ann Campbell, Paul Scott Phillips10.1016/j.healthpol.2009.07.011Health Policy 93, 2 (2009)2009-08-27Health Policy2009-08-27932-3S0168-8510(09)X0013-8Original Articles201206http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009002061/abstract?rss=yesAbstract: Objectives: Population modelling holds considerable promise for identifying the most efficient and cost-effective falls prevention measures, but the outcomes need to be in a readily useable form. This paper describes an iterative, collaborative process undertaken by researchers and falls prevention policy officers to develop such a format for falls prevention intervention evidence.Methods: The researchers developed a draft template that underwent several iterations and improvements, through three collaborative consultations with policy officers.Results: Although the researchers initially identified many key information needs, active engagement with policy officers ensured that policy requirements were met and that the value of the reporting formats for policy decision-making was maximised. Importantly, they highlighted the need to articulate underlying modelling assumptions clearly. The resulting formats, with complete data, were given to policy officers to inform their local jurisdictional policy decisions.Conclusions: There is strong benefit in researchers and policy officers collaborating to develop optimal formats for presenting scientific evidence to inform policy decisions. Such a process can reduce concerns of researchers that evidence is not incorporated into policy decisions. They also meet policy officers’ needs for evidence to be provided in a way that can directly inform their decision-making processes.Determining policy-relevant formats for the presentation of falls research evidenceCaroline F Finch, Lesley Day, Alex Donaldson, Leonie Segal, James E Harrison, the Australian National Injury Prevention Working Group10.1016/j.healthpol.2009.07.014Health Policy 93, 2 (2009)2009-09-01Health Policy2009-09-01932-3S0168-8510(09)X0013-8Original Articles207213http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009002103/abstract?rss=yesAbstract: Objectives: To identify the cost-effectiveness of collaborative arrangements among public and private providers to employ the Directly Observed Treatment short-course (DOTS) strategy for tuberculosis (TB) control in Indonesia.Methods: Three strategies were assessed: hospital out-patient diagnosis with referral to public health centres (PHCs) for treatment, hospital out-patient diagnosis and treatment, and private practitioner referral of suspects to PHCs. The outcome was the number of sputum smear positive TB cases successfully treated. Costs include direct costs to providers and patients. Uncertainty analysis was done for both costs and effectiveness data.Results: The average cost per case successfully treated ranged from US$169 to $567 for different strategies. The cost per additional case successfully treated incremental to existing TB programmes ranged from US$152 to $982. In three of four provinces assessed, there was a clearly preferred strategy or strategies, although the preferred strategy differed by province; in one province a preferred strategy could not be identified.Conclusions: All strategies increased TB case finding, although attribution is tentative because of the study design. Neither collaboration among private practitioners nor among hospitals is clearly preferred based on cost-effectiveness. For hospitals, this study suggests that having hospitals refer patients to health centres is preferable over hospitals administering treatment.An analysis of the costs and treatment success of collaborative arrangements among public and private providers for tuberculosis control in IndonesiaBenjamin Johns, Ari Probandari, Yodi Mahendradhata, Riris Andono Ahmad10.1016/j.healthpol.2009.08.004Health Policy 93, 2 (2009)2009-09-03Health Policy2009-09-03932-3S0168-8510(09)X0013-8Original Articles214224http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS016885100900181X/abstract?rss=yesIf prioritisation in healthcare is required, Werntof and Edberg sadly observed that politicians will be afraid of displeasing voters, while physicians will be afraid of making medically incorrect decisions . They proposed that the citizens must take part in the debate. The facts are clear, but their proposal is far from enough.Public health, politicians’ decisions, and the citizenAlain Braillon, Gérard Dubois10.1016/j.healthpol.2009.07.008Health Policy 93, 2 (2009)2009-08-10Health Policy2009-08-10932-3S0168-8510(09)X0013-8Letter to the Editors225225http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009001778/abstract?rss=yesSubsequent analyses following the publication of Smith et al. (2008), News on tobacco and public attitudes toward smokefree air policies in the United States have revealed that the description provided of the data in this paper was inaccurate. The error in Smith et al. (2008) merits a correction to the description of the data, but does not change either the results presented or the conclusions drawn from them.Erratum to “News on tobacco and public attitudes toward smokefree air policies in the United States” [Health Policy 86 (2008) 42–52]Katherine Clegg Smith, Catherine Siebel, Luu Pham, Juhee Cho, Rachel Friedman Singer, Frank Joseph Chaloupka, Michael Griswold, Melanie Wakefield10.1016/j.healthpol.2009.07.004Health Policy 93, 2 (2009)2009-08-19Health Policy2009-08-19932-3S0168-8510(09)X0013-8Erratum226227http://www.journals.elsevierhealth.com/periodicals/heap/article/PIIS0168851009002814/abstract?rss=yesContents10.1016/S0168-8510(09)00281-4Health Policy 93, 2 (2009)2009-12-01Health Policy2009-12-01932-3S0168-8510(09)X0013-8CO3CO4