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1.
Med Decis Making ; 42(1): 17-27, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34041992

ABSTRACT

BACKGROUND: Policy evaluations often focus on ex post estimation of causal effects on short-term surrogate outcomes. The value of such information is limited for decision making, as the failure to reflect policy-relevant outcomes and disregard for opportunity costs prohibits the assessment of value for money. Further, these evaluations do not always consider all relevant evidence, other courses of action, or decision uncertainty. METHODS: In this article, we explore how policy evaluation could better meet the needs of decision making. We begin by defining the evidence required to inform decision making. We then conduct a literature review of challenges in evaluating policies. Finally, we highlight potential methods available to help address these challenges. RESULTS: The evidence required to inform decision making includes the impacts on the policy-relevant outcomes, the costs and associated opportunity costs, and the consequences of uncertainty. Challenges in evaluating health policies are described using 8 categories: 1) valuation space; 2) comparators; 3) time of evaluation; 4) mechanisms of action; 5) effects; 6) resources, constraints, and opportunity costs; 7) fidelity, adaptation, and level of implementation; and 8) generalizability and external validity. Methods from a broad set of disciplines are available to improve policy evaluation, relating to causal inference, decision-analytic modeling, theory of change, realist evaluation, and structured expert elicitation. LIMITATIONS: The targeted review may not identify all possible challenges, and the methods covered are not exhaustive. CONCLUSIONS: Evaluations should provide appropriate evidence to inform decision making. There are challenges in evaluating policies, but methods from multiple disciplines are available to address these challenges. IMPLICATIONS: Evaluators need to carefully consider the decision being informed, the necessary evidence to inform it, and the appropriate methods.[Box: see text].

2.
Ann N Y Acad Sci ; 2021 Dec 02.
Article in English | MEDLINE | ID: mdl-34859451

ABSTRACT

Health systems offer unique opportunities for integrating services to promote early child development (ECD). However, there is limited knowledge about the implementation experiences of using health services to target nurturing care and ECD, especially in sub-Saharan Africa. We conducted a qualitative implementation evaluation to assess the delivery, acceptability, perceived changes, and barriers and facilitators associated with a pilot strategy that integrated developmental monitoring, nutritional screening, and early learning and nutrition counseling into the existing health facility, and community-based services for young children in rural Mozambique. We completed individual interviews with caregivers (N = 36), providers (N = 27), and district stakeholders (N = 10), and nine facility observational visits at three primary health facilities in October-November 2020. We analyzed data using thematic content analysis. Results supported fidelity to the intended pilot model and acceptability of nurturing care services. Respondents expressed various program benefits, including strengthened health system capacity and improved knowledge, attitudes, and practices regarding nurturing care and ECD. Government leadership and supportive supervision were key facilitators, whereas health system resource constraints were key barriers. We conclude that health systems are promising platforms for supporting ECD and discuss several programmatic recommendations for enhancing service delivery and maximizing potential impacts on nurturing care and ECD outcomes.

3.
Sci Total Environ ; 808: 152023, 2021 Nov 30.
Article in English | MEDLINE | ID: mdl-34861304

ABSTRACT

The takeaway food industry, involving more than 0.4 billion consumers in China, has brought mass of packaging waste and salient environmental burden. Here we mapped the distribution of takeaway food industry across China including the industry scale, diet structure and order time based on the analysis of more than 35 million takeaway food orders. The real use situation of various packaging materials in the takeaway food industry market has been clarified. The life cycle assessment of "a piece of takeaway food delivery order" has been carried out in different regions. Results show that in addition to plastic waste generation, takeaway food industry causes more types of environmental impacts. In terms of the national resource consumption, greenhouse gases emission, water pollution and health damage risk, the top 5 ranked provinces in each accounted for 44%, 48%, 43% and 49%, respectively. Under the latest Chinese plastic pollution control policy, the industry needs to reduce 1.12 million tons of non-degradable plastic packaging by the end of 2025, and 65% of the pressure is clustered in the metropolis and provincial capitals. However, without targeted and regionally differentiated plastic pollution control policies, the environmental impact control of takeaway food industry is still ineffective. It is urgent to explore the control measures applicable to different regions. Overall, packaging reduction is more effective than material substitution.

4.
PLoS One ; 16(12): e0261280, 2021.
Article in English | MEDLINE | ID: mdl-34890422

ABSTRACT

BACKGROUND: Industry self-regulation is the dominant approach to managing alcohol advertising in Australia and many other countries. There is a need to explore the barriers to government adoption of more effective regulatory approaches. This study examined relevance and quality features of evidence cited by industry and non-industry actors in their submissions to Australian alcohol advertising policy consultations. METHODS: Submissions to two public consultations with a primary focus on alcohol advertising policy were analysed. Submissions (n = 71) were classified into their actor type (industry or non-industry) and according to their expressed support for, or opposition to, increased regulation of alcohol advertising. Details of cited evidence were extracted and coded against a framework adapted from previous research (primary codes: subject matter relevance, type of publication, time since publication, and independence from industry). Evidence was also classified as featuring indicators of higher quality if it was either published in a peer-reviewed journal or academic source, published within 10 years of the consultation, and/or had no apparent industry connection. RESULTS: Almost two-thirds of submissions were from industry actors (n = 45 submissions from alcohol, advertising, or sporting industries). With few exceptions, industry actor submissions opposed increased regulation of alcohol advertising and non-industry actor submissions supported increased regulation. Industry actors cited substantially less evidence than non-industry actors, both per submission and in total. Only 27% of evidence cited by industry actors was highly relevant and featured at least two indicators of higher quality compared to 58% of evidence cited by non-industry actors. CONCLUSIONS: Evaluation of the value of the evidentiary contribution of industry actors to consultations on alcohol advertising policy appears to be limited. Modifications to consultation processes, such as exclusion of industry actors, quality requirements for submitted evidence, minimum standards for referencing evidence, and requirements to declare potential conflicts, may improve the public health outcomes of policy consultations.

5.
Trials ; 22(1): 814, 2021 Nov 17.
Article in English | MEDLINE | ID: mdl-34789314

ABSTRACT

INTRODUCTION: Healthcare systems must use treatments that are effective and safe. Regulators licensed many currently used older medications before introducing the stringent evidential requirements imposed on modern treatments. Also, there has been little encouragement to carry out within-class, head-to-head comparisons of licensed medicines. For commonly prescribed drugs, even small differences in effectiveness or safety could have significant public health implications. However, conventional clinical trials that randomise individual subjects are costly and unwieldy. Such trials are also often criticised as having low external validity. We describe an approach to rapidly generate externally valid evidence of comparative safety and effectiveness using the example of two widely used diuretics for the management of hypertension. METHODS AND ANALYSIS: The EVIDENCE (Evaluating Diuretics in Normal Care) study has a prospective, cluster-randomised, open-label, blinded end-point design. By randomising prescribing policy in primary care practices, the study compares the safety and effectiveness of commonly used diuretics in treating hypertension. Participating practices are randomised 1:1 to a policy of prescribing either indapamide or bendroflumethiazide when clinically indicated. Suitable patients who are not already taking the policy diuretic are switched accordingly. All patients taking the study medications are written to explaining the rationale for changing the prescribing policy and notifying them they can opt-out of any switch. The prescribing policies' effectiveness and safety will be compared using rates of major adverse cardiovascular events (hospitalisation with myocardial infarction, heart failure or stroke or cardiovascular death), routinely collected in national healthcare administrative datasets. The study will seek to recruit 250 practices to provide a study population of approximately 50,000 individuals with a mean follow-up time of two years. A primary intention-to-treat time-to-event analysis will be used to estimate the relative effect of the two policies. ETHICS AND DISSEMINATION: EVIDENCE has been approved by the East of Scotland Research Ethics Service (17/ES/0016, current approved protocol version 5, 26 August 2021). The results will be disseminated widely in peer reviewed journals, guideline committees, National Health Service (NHS) organisations and patient groups. TRIAL REGISTRATION: ISRCTN 46635087 . Registered on 11 August 2017 (pre-recruitment).


Subject(s)
Hypertension , Sodium Chloride Symporter Inhibitors , Diuretics/adverse effects , Humans , Hypertension/diagnosis , Hypertension/drug therapy , Policy , Prospective Studies , Randomized Controlled Trials as Topic , Sodium Chloride Symporter Inhibitors/adverse effects , State Medicine , Thiazides
6.
Article in English | MEDLINE | ID: mdl-34784432

ABSTRACT

An updated zoning policy eliminating all alcohol outlets (liquor stores) in residential districts was implemented to reduce high rates of violent crime in Baltimore City. Diverse stakeholders were engaged in group model building (GMB) activities to develop causal loop diagrams (CLDs) that elucidate the impact of the new zoning policy on crime, and more broadly, the potentially unintended social and environmental consequences of the policy. Three distinct groups, community advocates, city officials/academics, and community residents, participated in three separate GMB sessions. Three CLDs, one from each stakeholder group, were created to depict the possible outcomes of the zoning policy. Our findings offer insight into potential unintended consequences of removing liquor stores from residential areas that may undermine the policy. Community members described the need for additional supports related to mental health and substance use, opportunities for investment in the community, access to other goods and services, and community-police relations to ensure the policy achieved its intended goal of reducing violent crime. Our findings highlight the importance of timely engagement of local stakeholders to understand how complex neighborhood dynamics and contextual factors could impact the effectiveness of a zoning policy change.

7.
Int J Clin Pharm ; 2021 Nov 08.
Article in English | MEDLINE | ID: mdl-34748135

ABSTRACT

Background Polypharmacy is an important global health issue. In Japan, an amended policy has been implemented since April 2016 to offer incentives that allow claiming a payment of approximately 22.5 US$ per patient to hospitals and clinics that succeed to reduce two or more medications. However, there is no evidence on the nationwide effectiveness of polypharmacy reduction policy. Aim To evaluate the effectiveness of the polypharmacy reduction policy in Japan using nationwide outpatient prescription fee reimbursement claims data in Open Data of the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Method This nationwide retrospective observational study was conducted over 3 years (April 2015 to March 2018). The primary outcome was the polypharmacy reduction ratio calculated by the polypharmacy proportion. Factors associated with policy effectiveness were identified by performing a multiple linear regression analysis using independent variables. Results After implementing the new policy, a 7.3 % polypharmacy reduction ratio was observed, particularly in the elderly (8.2 %). Multiple linear regression analysis revealed that the proportion of elderly residents (aged ≥65 years), number of hospitals per 100,000 residents, and number of clinics per 100,000 residents were statistically significantly associated with this reduction. Conclusion The polypharmacy reduction policy indicated an association with polypharmacy reduction in Japan. The proportion of elderly residents and availability of hospitals and clinics are important factors to enhance the effectiveness of the polypharmacy reduction policy.

8.
BMJ Open Respir Res ; 8(1)2021 Nov.
Article in English | MEDLINE | ID: mdl-34799354

ABSTRACT

BACKGROUND: Continuous positive airway pressure (CPAP) mask renewal policies vary inside and between countries. There are no independent studies on the optimal mask renewal frequency. We aimed to evaluate CPAP mask function over time in a real-life clinical setting, and to compare the results against current renewal policies. METHODS: Daily performance data of 1846 CPAP masks (65% nasal, 22% nasal pillows, 12% oronasal) were recorded from 450 participants (68% male, mean age 59 years) with obstructive sleep apnoea. The unintentional leak, Apnoea-Hypopnoea Index (CPAP-AHI) and usage data were exported from the CPAP device. RESULTS: Of 656 324 nights of CPAP usage, the mean renewal time was 497 days (SD 327), mean leak 5.7 L/min (SD 8.1) and CPAP-AHI 3.8 events/h (SD 3.6). The difference in mean leak between one (5.2 L/min, SD 7.5), 12 (6.0 L/min, SD 10.2) and 24 months (5.8 L/min, SD 7.5) was minimal (p=0.59). Mean CPAP-AHI remained normal and unchanged in nasal masks and pillows up to 30 months, and was highest in oronasal masks. Different mask manufacturers performed similarly. Masks' daily or total usage did not affect the results. Shifting the mask renewal policy to 24 months could reduce the mask-related cost up to 50%-88%. CONCLUSIONS: Nasal masks and pillows could be used at least 2 years without significant changes in unintentional leak and CPAP-AHI. We suggest updating the mask renewal policies of nasal masks and pillows; results on oronasal masks and other manufacturers CPAP devices need further verification.

9.
Article in English | MEDLINE | ID: mdl-34790907

ABSTRACT

Background: The U.S. opioid crisis has been exacerbated by COVID-19 and the spread of synthetic opioids (e.g., fentanyl). Methods: We model the effectiveness of reduced prescribing, drug rescheduling, prescription monitoring programs (PMPs), tamper-resistant drug reformulation, excess opioid disposal, naloxone availability, syringe exchange, pharmacotherapy, and psychosocial treatment. We measure life years, quality-adjusted life years (QALYs), and opioid-related deaths over five and ten years. Findings: Under the status quo, our model predicts that approximately 547,000 opioid-related deaths will occur from 2020 to 2024 (range 441,000 - 613,000), rising to 1,220,000 (range 996,000 - 1,383,000) by 2029. Expanding naloxone availability by 30% had the largest effect, averting 25% of opioid deaths. Pharmacotherapy, syringe exchange, psychosocial treatment, and PMPs are uniformly beneficial, reducing opioid-related deaths while leading to gains in life years and QALYs. Reduced prescribing and increasing excess opioid disposal programs would reduce total deaths, but would lead to more heroin deaths in the short term. Drug rescheduling would increase total deaths over five years as some opioid users escalate to heroin, but decrease deaths over ten years. Combined interventions would lead to greater increases in life years, QALYs, and deaths averted, although in many cases the results are subadditive. Interpretation: Expanded health services for individuals with opioid use disorder combined with PMPs and reduced opioid prescribing would moderately lessen the severity of the opioid crisis over the next decade. Tragically, even with improved public policies, significant morbidity and mortality is inevitable.

10.
Spat Spatiotemporal Epidemiol ; 39: 100454, 2021 11.
Article in English | MEDLINE | ID: mdl-34774260

ABSTRACT

Coronavirus disease 2019 (COVID-19) has been spread globally and brought health and socioeconomic issues. Jakarta tried to accommodate health and economic interests through the Large-Scale Social Restriction (LSSR) policy that should be assessed. This study aims to (1) visualize the spatial patterns of confirmed Covid-19 cases and the locations of potential risk of transmission, and (2) determine the spatial processes underlying the spatial patterns of Covid-19 cases. The emerging hot spot analysis and space-time scan statistic were employed to analyze the dynamic of infected cases and transmission risk. A Geographical Weighted Regression (GWR) model was developed to define factors that influence the spatial transmission. The result shows that spatial transmission keeps continuing, despite a decline in the aggregate pandemic curve during LSSR implementation. This was likely affected by settlements types and population density distribution, and transportation networks. Spatial analysis supports the aggregate pandemic curve to increase the pandemic surveillance effectiveness.


Subject(s)
COVID-19 , Pandemics , Disease Outbreaks/prevention & control , Humans , Policy , SARS-CoV-2 , Spatial Analysis
11.
Article in English | MEDLINE | ID: mdl-34814676

ABSTRACT

BACKGROUND: The Government of Botswana introduced user-fees for primary healthcare consultations in 1975. The policy has remained in place since then, although the fee has remained largely unaltered despite rising inflation. Early reviews of the policy pointed to problems in its implementation, but there has been no evaluation in the past 20 years. The aim of this study was to review the policy to assess whether documented issues with its implementation have been addressed. METHODS: This qualitative study involved interviews with 32 key informants: 18 policy-makers and 14 front-line revenue collectors. Data were analysed thematically using a template approach with constructs from an established organizational capacity assessment framework used as predetermined categories to guide data collection and analysis. RESULTS: Limited administrative and management capacity has been a major hindrance to effective implementation of the policy. The lack of infrastructure for effective revenue collection led to misappropriation of funds. Lack of clear guidelines for health facilities on how to implement the policy generated interdepartmental conflicts. Study participants believed the current policy was unlikely to be cost-effective since the cost of collecting fees probably exceeded the revenue it generated. CONCLUSION: If the Botswana Government persists with the policy then it needs to improve organizational capacity to collect and manage revenues efficiently. However, policy thinking since the turn of the century has turned away from user-charges in healthcare as they impede the move towards universal access. It is timely therefore to consider alternative financing approaches that are more effective and a more equitable means of paying for healthcare.

12.
Front Public Health ; 9: 653588, 2021.
Article in English | MEDLINE | ID: mdl-34631638

ABSTRACT

Complexity approaches have gained international attention as potentially effective strategies to address population health challenges. In light of this, the Scottish government (Scot. Gov.) set the implementation of these approaches as the recommended practice for its public health sector organizations. This study evaluates the opportunity and feasibility of implementing complexity approaches in public health Scotland employees' everyday routine by employing a qualitative study that involves 20 stakeholders, representative of different organizations and roles. We made use of an assessment framework based on Soft Systems Methodology (SSm) and Normalization Process Theory (NPT) comprised of five phases: Phase One defines the boundaries, aims, and goals of the issue under study; Phase Two consists of data collection, drawing on the e-Health Implementation Toolkit (e-HIT); Phase Three involves short presentations and breakout group activities to provide information on the new policy; Phase Four employs system thinking tasks to structure debate and builds shared understanding among participants; Phase Five applies NPT to appraise the organizational position around complexity based on information from the preceding steps. We found two main obstacles to implementing complexity approaches: (1) a lack of a shared understanding of the key concepts in complexity and their practical implications; (2) stakeholders' fear of significant disruption to work routines and power relationships. We recommend addressing these issues with appropriate training and customization of goals and tools that may enable complexity approaches to succeed within the Scottish public health context. Our assessment framework allows the recognition of key mechanisms to support how Scotland's Public Health body can enhance the implementation of complexity approaches. The appraisal framework could be used to study early-stage policy implementation in other contexts.


Subject(s)
Policy Making , Public Health , Humans , Policy , Public Sector , Scotland
13.
Soc Sci Med ; 289: 114451, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34673355

ABSTRACT

Collaboration between governments and non-state actors has emerged as the dominant mode of policy making to address a wide range of public and global health issues, particularly via public-private partnerships and multi-stakeholder platforms. Despite its paradigmatic status in contemporary health governance, political claims and promises of partnership approaches as more effective than state regulation have received limited attention. This study addresses this gap by tracing negotiations over a calorie reduction 'pledge' within the Public Health Responsibility Deal: a public-private partnership between the UK Department of Health, food industry and civil society organisations focusing on obesity policy. It demonstrates how political claims-making by the Department of Health that a public-private partnership as an effective substitute for legislation, contrasted with protracted and conflictual negotiations with food industry business associations. Employing Erving Goffman's distinction between frontstage and backstage interaction and the concept of informal governance, this study traces a shift to informal back stage governance as a mechanism to cope with acute tensions between economic interests and nutrition policy goals. The study illustrates how this shift to the back stage had substantive public health implications, privileging commercial sector perspectives and marginalising civil society participation. Informalization served to reframe calorie reduction from industry-focused to personal responsibility for lifestyle behaviours, in the process reducing its effectiveness. The results suggest that, while partnership and multi-stakeholder approaches are widely promoted as a legitimate tool in health governance, visible tensions between commercial sector and public health interests challenge political claims about public-private collaboration as consensus-oriented and effective. Informal governance, when used as a coping mechanism to manage tensions public health and commercial sector interests, may be symptomatic of wider dysfunctions and conflicts of interest in partnership approaches. This suggests that there may be limited scope for effective policy innovations where commercial sector actors perceive core interests as threatened.

15.
Public Health Nutr ; : 1-10, 2021 Oct 28.
Article in English | MEDLINE | ID: mdl-34706789

ABSTRACT

OBJECTIVE: Despite broad agreement on the need for comprehensive policy action to improve the healthiness of food environments, implementation of recommended policies has been slow and fragmented. Benchmarking is increasingly being used to strengthen accountability for action. However, there have been few evaluations of benchmarking and accountability initiatives to understand their contribution to policy change. This study aimed to evaluate the impact of the Healthy Food Environment Policy Index (Food-EPI) Australia initiative (2016-2020) that assessed Australian governments on their progress in implementing recommended policies for improving food environments. DESIGN: A convergent mixed methods approach was employed incorporating data from online surveys (conducted in 2017 and 2020) and in-depth semi-structured interviews (conducted in 2020). Data were analysed against a pre-defined logic model. SETTING: Australia. PARTICIPANTS: Interviews: twenty stakeholders (sixteen government, four non-government). Online surveys: fifty-three non-government stakeholders (52 % response rate) in 2017; thirty-four non-government stakeholders (36 % response rate) in 2020. RESULTS: The Food-EPI process involved extensive engagement with government officials and the broader public health community across Australia. Food-EPI Australia was found to support policy processes, including as a tool to increase knowledge of good practice, as a process for collaboration and as an authoritative reference to support policy decisions and advocacy strategies. CONCLUSIONS: Key stakeholders involved in the Food-EPI Australia process viewed it as a valuable initiative that should be repeated to maximise its value as an accountability mechanism. The highly collaborative nature of the initiative was seen as a key strength that could inform design of other benchmarking processes.

16.
Healthcare (Basel) ; 9(10)2021 Sep 26.
Article in English | MEDLINE | ID: mdl-34682950

ABSTRACT

Many studies that assess efficiency in health systems are based on output mean values. That approach ignores the representativeness of the average statistic, which can become a serious problem in estimation. To solve this question, this research contributes in three different ways: the first aim is to evaluate the technical efficiency in the management of European health systems considering a set of DEA (Data Envelopment Analysis) and FDEA (Fuzzy Data Envelopment Analysis) models. A second goal is to assess the bias in the estimation of efficiency when applying the conventional DEA. The third objective is the evaluation of the statistical relationship between the bias in the efficiency estimation and the macroeconomic variables (income inequality and economic freedom). The main results show positive correlations between DEA and FDEA scores. Notwithstanding traditional DEA models overestimate efficiency scores. Furthermore, the size of the bias is positively related to income inequality and negative with economic freedom in the countries evaluated.

17.
Am J Public Health ; 111(S3): S215-S223, 2021 10.
Article in English | MEDLINE | ID: mdl-34709876

ABSTRACT

Public Health 3.0 approaches are critical for monitoring disparities in economic, social, and overall health impacts following the COVID-19 pandemic and its associated policy changes to slow community spread. Timely, cross-sector data as identified using this approach help decisionmakers identify changes, track racial disparities, and address unintended consequences during a pandemic. We applied a monitoring and evaluation framework that combined policy changes with timely, relevant cross-sector data and community review. Indicators covered unemployment, basic needs, family violence, education, childcare, access to health care, and mental, physical, and behavioral health. In response to increasing COVID-19 cases, nonpharmaceutical intervention strategies were implemented in March 2020 in King County, Washington. By December 2020, 554 000 unemployment claims were filed. Social service calls increased 100%, behavioral health crisis calls increased 25%, and domestic violence calls increased 25%, with disproportionate impact on communities of color. This framework can be replicated by local jurisdictions to inform and address racial inequities in ongoing COVID-19 mitigation and recovery. Cross-sector collaboration between public health and sectors addressing the social determinants of health are an essential first step to have an impact on long-standing racial inequities. (Am J Public Health. 2021;111(S3):S215-S223. https://doi.org/10.2105/AJPH.2021.306422).


Subject(s)
COVID-19 , Health Policy , Health Services Accessibility , Health Status Disparities , Public Health , COVID-19/economics , COVID-19/prevention & control , Humans , Mental Health , Population Surveillance , Unemployment/statistics & numerical data , Washington
18.
BMC Health Serv Res ; 21(1): 1168, 2021 Oct 28.
Article in English | MEDLINE | ID: mdl-34711209

ABSTRACT

BACKGROUND: The present study has been undertaken with the aim to evaluate performance and ranking of various universities of medical sciences that are responsible for providing public health services and primary health care in Iran. METHODS: Four models; Weighted Factor Analysis (WFA), Equal Weighting (EW), Stochastic Frontier Analysis (SFA), and Data Envelopment Analysis (DEA) have been applied for evaluating the performance of universities of medical sciences. This study was commenced based on the statistical reports of the Ministry of Health and Medical Education (MOHME), census data from the Statistical Center of Iran, indicators of Vital Statistics, results of Multiple Indicator of Demographic and Health Survey 2010, and results of the National Survey of Risk Factors of non-communicable diseases. RESULTS: The average performance scores in WFA, EW, SFA, and DEA methods for the universities were 0.611, 0.663, 0.736 and 0.838, respectively. In all 4 models, the performance scores of universities were different (range from 0.56-1, 0.53-1, 0.73-1 and 0.83-1 in WFA, EW, SFA and DEA models, respectively). Gilan and Rafsanjan universities with the average ranking score of 4.75 and 41 had the highest and lowest rank among universities, respectively. The universities of Gilan, Ardabil and Bojnourd in all four models had the highest performance among the top 15 universities, while the universities of Rafsanjan, Ahvaz, Kerman and Jiroft showed poor performance in all models. CONCLUSIONS: The average performance scores have varied based on different measurement methods, so judging the performance of universities based solely on the results of a model can be misleading. In all models, the performance of universities has been different, which indicates the need for planning to balance the performance improvement of universities based on learning from the experiences of well-performing universities.


Subject(s)
Education, Medical , Public Health , Humans , Iran , Primary Health Care , Universities
19.
Value Health ; 24(11): 1551-1569, 2021 11.
Article in English | MEDLINE | ID: mdl-34711355

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has had a major impact on our society, with drastic policy restrictions being implemented to contain the spread of the severe acute respiratory syndrome coronavirus 2. This study aimed to provide an overview of the available evidence on the cost-effectiveness of various coronavirus disease 2019 policy measures. METHODS: A systematic literature search was conducted in PubMed, Embase, and Web of Science. Health economic evaluations considering both costs and outcomes were included. Their quality was comprehensively assessed using the Consensus Health Economic Criteria checklist. Next, the quality of the epidemiological models was evaluated. RESULTS: A total of 3688 articles were identified (March 2021), of which 23 were included. The studies were heterogeneous with regard to methodological quality, contextual factors, strategies' content, adopted perspective, applied models, and outcomes used. Overall, testing/screening, social distancing, personal protective equipment, quarantine/isolation, and hygienic measures were found to be cost-effective. Furthermore, the most optimal choice and combination of strategies depended on the reproduction number and context. With a rising reproduction number, extending the testing strategy and early implementation of combined multiple restriction measures are most efficient. CONCLUSIONS: The quality assessment highlighted numerous flaws and limitations in the study approaches; hence, their results should be interpreted with caution because the specific context (country, target group, etc) is a key driver for cost-effectiveness. Finally, including a societal perspective in future evaluations is key because this pandemic has an indirect impact on the onset and treatment of other conditions and on our global economy.


Subject(s)
COVID-19/economics , Cost-Benefit Analysis/standards , Health Policy/economics , COVID-19/epidemiology , COVID-19/prevention & control , Cost-Benefit Analysis/trends , Health Policy/trends , Humans
20.
Article in English | MEDLINE | ID: mdl-34713521

ABSTRACT

Despite the health tourism sector's rapid growth in the past decade due to globalisation, there is little research analysing countries' health tourism policies. This study aimed to examine the relationships between stakeholders in the health tourism sector in Turkey in the context of Turkey's health tourism policies. This study connects theory and practice in multidisciplinary sectors, including health, tourism, and business, through an evaluation of major issues from a health management perspective. Social network analysis was used to assess the role of 107 stakeholders in Ankara and determine the extent of weak and strong ties among them. Issues confronting these stakeholders and the obstacles they faced in practice were also identified. The study found that, the relevant stakeholders faced comprehensive sectoral deficiencies and issues in building positive relationships. Governmental stakeholders as policymakers need to develop effective strategies to improve stakeholder collaboration and encourage greater inclusiveness through better-targeted health tourism policies. The study contributes to social network theory, resource dependency theory, and stakeholder theory, and is, to our knowledge, the first study to use social network analysis to examine the role of stakeholders in the health tourism sector.

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