7 results
Search Results
2. The NIHR Public Health Research Programme: responding to local authority research needs in the United Kingdom.
- Author
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Dorling, Hannah, Cook, Andrew, Ollerhead, Liz, and Westmore, Matt
- Subjects
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PUBLIC health , *MEDICAL care costs , *ADOLESCENT health , *INDUSTRIAL hygiene research , *ECOLOGICAL economics , *PUBLIC health & economics , *INDUSTRIAL hygiene standards , *COST effectiveness , *DECISION making , *ECOLOGY , *LOCAL government , *HOUSING , *MEDICAL care research , *NATIONAL health services , *SCHOOL health services , *STUDENTS , *TRANSPORTATION , *GOVERNMENT aid , *EVIDENCE-based medicine , *ECONOMICS , *STANDARDS - Abstract
The remit of the National Institute for Health Research Public Health Research (PHR) Programme is to evaluate public health interventions, providing new knowledge on the benefits, costs, acceptability and wider impacts of interventions, set outside of the National Health Service, intended to improve the health of the public and reduce inequalities. This paper illustrates how the PHR Programme is providing new knowledge for public health decision makers, based on the nine key areas for local authority public health action, described by the King's Fund. Many funded PHR projects are evaluating interventions, applied in a range of settings, across the identified key areas for local authority influence. For example, research has been funded on children and young people, and for some of the wider determinants of health, such as housing and travel. Other factors, such as spatial planning, or open and green spaces and leisure, are less represented in the PHR Programme. Further opportunities in research include interventions to improve the health of adolescents, adults in workplaces, and communities. Building evidence for public health interventions at local authority level is important to prioritise and implement effective changes to improve population health. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
3. Varying Costs to Change? Institutional Change in the Public Sector.
- Author
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Gingrich, Jane
- Subjects
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ORGANIZATIONAL change , *PUBLIC sector , *SOCIAL services , *ADMINISTRATIVE reform , *PUBLIC welfare , *HEALTH care reform , *PUBLIC institutions , *EXTERNALITIES , *COST control , *COST structure ,PATIENT Protection & Affordable Care Act - Abstract
Many scholars have argued that social programs are marked by a logic of 'increasing returns' that makes change difficult. Yet over the past decades, reformers across industrialized countries have introduced substantial administrative reforms in these services, even as entitlement reform remains politically difficult. This paper explains these shifts by breaking apart the logic of 'increasing returns' into three distinct 'costs to change': technical, political, and expectations. Decreases in a particular type of costs produce different logics of institutional change-back end, informal, and front end-that privilege the state, professionals or private, or political actors in distinct ways. I support these claims by reexamining three cases that were considered exemplars of stability but that ultimately had major entitlement reform: health care in the United Kingdom and United States and welfare programs in the United States. I show that even before radical reforms occurred, reformers introduced distinct logics of administrative change that underpinned later changes. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
4. Capitalism, the state and health care in the age of austerity: a Marxist analysis.
- Author
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Porter, Sam
- Subjects
- *
HEALTH services administration , *HEALTH services accessibility , *ECONOMICS , *HEALTH status indicators , *HEALTH insurance , *PHILOSOPHY , *PRACTICAL politics , *LABELING theory - Abstract
The capacity to provide satisfactory nursing care is being increasingly compromised by current trajectories of healthcare funding and governance. The purpose of this paper is to examine how well Marxist theories of the state and its relationship with capital can explain these trajectories in this period of ever-increasing austerity. Following a brief history of the current crisis, it examines empirically the effects of the crisis, and of the current trajectory of capitalism in general, upon the funding and organization of the UK and US healthcare systems. The deleterious effect of growing income inequalities to the health of the population is also addressed. Marx's writings on the state and its relation to the capitalist class were fragmentary and historically and geographically specific. From them, we can extract three theoretical variants: the instrumentalist theory of the state, where the state has no autonomy from capital; the abdication theory, whereby capital abstains from direct political power and relies on the state to serve its interests; and the class-balance theory, whereby the struggle between two opposed classes allows the state to assert itself. Discussion of modern Marxist interpretations includes Poulantzas's abdication theory and Miliband's instrumentalist theory. It is concluded that, despite the pluralism of electoral democracies, the bourgeoisie do have an overweening influence upon the state. The bourgeoisie's ownership of the means of production provides the foundation for its influence because the state is obliged to rely on it to manage the supply of goods and services and the creation of wealth. That power is further reinforced by the infiltration of the bourgeoisie into the organs of state. The level of influence has accelerated rapidly over recent decades. One of the consequences of this has been that healthcare systems have become rich pickings for the evermore confident bourgeoisie. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
5. Architectures of Genetic Medicine: Comparing Genetic Testing for Breast Cancer in the USA and the UK.
- Author
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Parthasarathy, Shobita
- Subjects
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HUMAN chromosome abnormality diagnosis , *BREAST cancer , *CHROMOSOMES - Abstract
This paper compares the development of genetic testing for breast cancer (BRCA testing) in the USA and the UK. It argues that national political cultures played an important role in how these genetic testing technologies were shaped, and that the shapes of these technologies had important implications for the users of these systems. In order to demonstrate the roles of national social and political elements in the development of new genetic testing technologies, I introduce the concept of a technology's architecture, which is made up of component and the specific ways in which these components are assembled to fulfill particular functions. In the USA, four very different BRCA testing systems initially emerged. However, one biotechnology company, Myriad Genetics, eventually used its legal and economic position to become the sole provider of testing. It offered BRCA testing the way many other laboratory tests were provided in the USA, available to anyone through any physician. The shape of this testing service had important implications for its participants, defining the client as a consumer who could demand access to any of Myriad's laboratory services, but could not choose among testing systems. In the UK, the government-run National Health Service provided testing through regional genetics clinics, using family history information to assess risks and triage care. Clients in the UK were defined as citizens and patients, who had the right to equal access to the testing system but could not demand any specific services. [ABSTRACT FROM AUTHOR]
- Published
- 2005
- Full Text
- View/download PDF
6. Commentary: Recent Reforms in the British National Health Service--Lessons for the United States.
- Author
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Holland, Walter W. and Graham, Clifford
- Subjects
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HEALTH care reform , *HEALTH policy - Abstract
President Clinton recently announced his reform plan for health care in the United States. The United Kingdom, along with other countries, has already enacted reforms in an effort to overcome the basic problem of having insufficient funds to provide a health service to meet modern demands. This paper briefly describes the recent health reforms in the United Kingdom and highlights some lessons for the United States, which include the need to choose procedures that should be universally provided. Health reforms that involve some fundamental restructuring need to be evaluated everywhere and agreed to by the staff in advance. [ABSTRACT FROM AUTHOR]
- Published
- 1994
- Full Text
- View/download PDF
7. The National Health Service and the U.S. Veterans Health Administration.
- Author
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Knickrehm, Kay, Adolino, Jessica R., and Blake, Charles H.
- Subjects
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HEALTH services administration , *PUBLIC health - Abstract
Can the national health service (NHS) model work in the United States? We examine various indicators to determine if the Veterans Health Administration has performed similarly to the experience with the NHS model abroad. ..PAT.-Conference Proceeding [ABSTRACT FROM AUTHOR]
- Published
- 2006
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