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Silva, Valtania Ferreira da. "Problema de alocação de viaturas policiais: estudo de caso na cidade de João Pessoa-PB." Universidade Federal da Paraíba, 2014. http://tede.biblioteca.ufpb.br:8080/handle/tede/5264.
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Find emergency public services falls into one of the classic optimization problems where points are available for candidates who are chosen, among them, those that optimize the efficiency criteria established, to find a limited number of facilities. The set of candidate sites have great influence on the final solution generated by a model location . In the research, three strategies were used to elect local candidates to position the cars of police : decision of the Security Manager , p-median model and method of clustering k-means. With the support of Geographical Information Systems (GIS ) it was possible to georeference the occurrences of crimes , to visualize the distribution of selected local candidates and identify the presence of hotspots of crime. Aiming to solve the problem of allocating vehicles adopted two approaches : exact and heuristic . Therefore, two hybrid meta - heuristics were implemented - GRASP combined with VND and GRASP with exact model. They obtained same or very approximate solutions of the optimal solution . It was developed a system of spatial decision support based on the solution of the formulation of the problem of locating facilities with restricted coverage and backup coverage. It is a Web tool built with by WebGIS technology
Localizar serviços públicos emergenciais se enquadra em um dos problemas clássicos de otimização onde pontos candidatos são disponibilizados para que sejam escolhidos, dentre eles, aqueles que otimizem o critério de eficiência estabelecido, visando localizar um número limitado de facilidades. O conjunto de locais candidatos tem grande influência sobre a solução final gerada por um modelo de localização. Na pesquisa, foram definidas três estratégias para eleger os locais candidatos ao posicionamento de viaturas policiais: decisão do gestor de segurança, modelo de Pmedianas e método de clusterização k-means. Com apoio de Sistemas de Informação Geográfica (SIG) foi possível georreferenciar as ocorrências de crimes, visualizar a distribuição dos locais candidatos selecionados e identificar a presença de hotspots de crimes. Visando resolver o problema de alocação de viaturas adotou-se duas abordagens: exata e heurística. Para tanto, duas meta-heurísticas híbridas foram implementadas - GRASP combinado com VND e GRASP com modelo exato, as quais obtiveram soluções iguais ou muito aproximadas da solução ótima. Foi desenvolvido um sistema de apoio a decisão espacial baseado na solução da formulação do problema de localização de facilidades com restrições de cobertura e cobertura backup. Trata-se de uma ferramenta WEB construída com base os padrões usados pela tecnologia WebGIS
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Bailey, Andrew Brian. "Factors influencing police investigation of sexual crimes committed against people who have a learning disability and the implications for public policy." Thesis, University of Ulster, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.365942.
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Vichare, Anushree M. "Affordability, Utilization and Satisfaction with Care: A Policy Context for Improving Health Care Experiences." VCU Scholars Compass, 2017. http://scholarscompass.vcu.edu/etd/4978.
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Disparate healthcare experiences continue to pose a challenge; vulnerable populations such as low-income and racial and ethnic minorities may not be able to afford or utilize care when needed or receive quality care. The sources of disparities are complex and multi-factorial, which include health care system-level factors such as insurance and health care workforce. It is relatively less known to what extent these contribute to disparities related to a patient’s overall health care experience across three important domains – affordability, utilization and satisfaction with care.
This dissertation has three objectives. First, to assess how insurance benefit design affects health care utilization among poorest adults. Second, examine the role of insurance in addressing racial and ethnic disparities in access to preventive care. Finally, examine the role of health care providers in differences related to satisfaction with care among low-income patients.
To answer questions posed in this dissertation, two different types of datasets are used: a unique hospital administrative data from a coverage program for low-income adults and 2008-2014 Medical Expenditure Panel Survey (MEPS). To examine the role of insurance and health care providers in disparities related to different outcomes of patient experience, several models are estimated; including mixed effects linear probability and negative binomial regressions, decomposition and multivariate linear probability models.
Several efforts are being made to address inequalities through coverage expansions, removal of financial barriers for preventive services and incentivizing health care providers to improve patient satisfaction. The findings suggest that differences in utilization and satisfaction with care continue to persist among low-income and racial and ethnic minorities. However, policy levers and system-level reforms including value-based insurance designs that may curb healthcare costs without shifting the cost burden to poorer adults, continued reforms to expand coverage and improve access to a usual of care, and policy interventions that extend beyond improving workforce diversity and enhance provider skills to elicit patient communication preferences may foster positive patient experiences and ameliorate existing disparities. Improving patient experiences of care will thus require policy efforts with a comprehensive multi-level strategy that targets broad sectors – including payers, health care providers and society at large.
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O'Driscoll, Rosalind. "Uncertainty in exhaust emissions from passenger cars : a policy perspective." Thesis, Imperial College London, 2017. http://hdl.handle.net/10044/1/58016.
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In Europe the regulations that limit vehicle emissions, the Euro Standards, have failed to effectively tackle pollutant emissions in the real world. This thesis contains an appraisal of the real world emissions of modern European vehicles, which were identified as a major cause of uncertainty in UK policy with respect to compliance with air pollution legislation. The thesis includes key background information on air pollution and its control in the UK and a comprehensive review of the existing literature relating to real world emissions of petrol and diesel passenger cars. The real world emissions performance of modern vehicles was assessed using Portable Emissions Measurement System (PEMS) data, provided by Emissions Analytics, which included 147 Euro 5 and 6 diesel and petrol vehicles. Comparisons were made to the emissions factors of the recommended air quality transport model of the European Union, COPERT, as well as the Euro standard type approval limits. The potential impact of these real world emissions was also assessed using the UK Integrated Assessment Model to perform scenario analysis up to 2030. Scenarios were used to explore the potential effect of different passenger car emissions factors on total UK NOx (nitrogen oxides) and CO2 (carbon dioxide) emissions, damage costs and annual mean concentrations of nitrogen dioxide (NO2). Considering the results of these investigations, wider conclusions were drawn as to how policy makers might effectively reduce passenger car related pollution in European towns and cities. A key conclusion of this thesis is that due to the large variability in the real world emissions of vehicles within a single Euro class, policies could be more effect if real world variability was taken into account, as opposed to relying solely on the Euro standard.
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VELASCO, AMANDA DINUCCI ALMEIDA B. "NOBODY CARES FOR POLICE OFFICERS: THE DISCOURSE OF THE POLICE OFFICERS OF A PACIFYING POLICE UNIT AND ITS RHETORICAL RESOURCES." PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2014. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=24435@1.
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PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIROCONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO
A presente dissertação investiga o modo como policiais de uma Unidade de Polícia Pacificadora (UPP) do Rio de Janeiro percebem sua prática profissional e os riscos e relações que modelam e são modelados por essa prática na comunidade. Com base na análise de recursos retóricos utilizados na fala dos policiais em cinco entrevistas de pesquisa, buscou-se contribuir para o entendimento desse novo modelo de policiamento em um contexto que apresenta demandas específicas recentemente organizadas. Buscou-se também trazer contribuições para uma reflexão crítica sobre os cursos de formação desses policiais. Os resultados apontam que os policiais da nova geração se posicionam em contraste com os policiais de rua e os policiais mais antigos, em função do maior grau de risco de suas atividades e do maior grau de efetividade no serviço ao cidadão. Por outro lado, apontam também para fatores que dificultam o sucesso do modelo, como a falta de apoio da comunidade, de reconhecimento de seus superiores, do Estado, da Polícia Civil e da sociedade como um todo.
This dissertation investigates how police officers from a Unidade de Polícia Paificadora, Pacifying Police Unit, perceive their professional practice and the risks and relationships that shape and are shaped by this community practice. Based on the analysis of rhetorical discourse seen in five research interviews, the goal was to contribute to the understanding of this new law enforcement model in a context that presents specific demands that were just recently organized. An effort was made to bring contributions to critical thinking about the training courses that these professionals attend. Results show that the new generation of police officers contrast to street policing and more experienced police work force. It is this way because there is a higher risk of activities and a greater level of effectiveness in serving citizens. On the other hand it also shows the factors that will make the success of the model more difficult, such as: lack of community support, acknowledgement from their superiors, the State, Civil Police and society as a whole.
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Leary, Mary A. "Policy intersections or policy chasms state elder mobility policy, practice and long-term care reform /." Fairfax, VA : George Mason University, 2008. http://hdl.handle.net/1920/3139.
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Thesis (Ph.D.)--George Mason University, 2008.Vita: p. 169. Thesis director: Laurie A. Schintler. Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Public Policy. Title from PDF t.p. (viewed July 7, 2008). Includes bibliographical references (p. 142-168). Also issued in print.
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Al-Ali, Ibrahim Jassim. "Child care policy and fostering in Kuwait." Thesis, Cardiff University, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.238135.
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Cavazza, Elena <1989>. "The Energy Card in Russian Foreign Policy." Master's Degree Thesis, Università Ca' Foscari Venezia, 2015. http://hdl.handle.net/10579/6030.
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Abstract
The energy card in Russian Foreign Policy
Since the beginning of the twentieth century, energy resources have shaped many aspects of modern life, economies and relations among states. Given the geo-strategic salience of oil and gas reserves and the growing reliance upon them, “petro-states” ( producer and exporter countries) have started to use resources as a foreign policy tool, the so called “energy weapon”, in order to obtain their strategic objectives and influence the international affairs.
Since it is the today world's largest oil producer, Russia stands out as an “energy superpower” . Already during the Soviet period, Russian political leadership has pursued a policy of energy lever to reward friends and punish enemies.
This “carrots and sticks” policy is fulfilled by subsidized oil and gas sales, cut-offs, disruptions, transit pipelines fees and sanctions to neighbor countries.
In particular, under President Putin Russia's energy influence reached unprecedented heights, as a result of: high oil and gas prices, high export revenues, maximization of power and centralization of energy sector in the state's hands.
The dissertation analyses the “energy card” in foreign policy of Russia. First of all why it is recurring in Russian history and how is linked with Russian strategic culture. Secondly, through a comparative analysis, two perceptions of Russian energy policies will be considered : the first as a purely political coercion against post- Soviet space in attempt to prevent the breakaway from Russian sphere of influence. The second one includes instead economic underpinnings in Russian foreign policy, which therefore hides commercial interests.
After a brief historical background about gas disputes in Ukraine and Belarus, the feasibility and effectiveness of “stick and carrot” policy are examined, in view of two major obstacles respectively :the absolute reliance on revenue from gas and oil exports of Russian economy and the drift towards the Western umbrella.
Finally, the paper will investigate the strategic goals of Russian foreign energy policy and its future projections.
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Holden, Christopher John. "Globalization and the U. K. market in long term care for older people." Thesis, Brunel University, 2000. http://bura.brunel.ac.uk/handle/2438/5290.
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The thesis aims to build on what is known about large and internationalized welfare firms, and to make a contribution to the debate about social policy and globalization, through an empirical and exploratory study of large and internationalized firms within the UK market in long term care for older people. The thesis utilizes two levels of analysis: a micro level analysis based on case studies of the three largest private providers of long term care in the UK; and a meso level analysis of the relationships between these firms and three other actors: the state and its agencies, staff and unions, and older people themselves. The findings of the thesis contradict deterministic claims concerning the loss of power by the state. The state is found to be the most powerful actor in the sector in ten-ns of its ability to regulate the sector and influence its overall structure. In contrast, the relative weakness of unions and older people's organizations leads them to attempt to exert influence on private providers through the medium of the state. State policies, however, are likely to facilitate greater concentration and internationalization within the sector, an outcome which is in the long term interests of those firms which are already large and internationalized. The parallel processes of concentration and internationalization in the sector have significant implications for the delivery of care.
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Sandhu, Sima. "Care worker motivations : implications for social policy and the future care workforce." Thesis, University of East London, 2013. http://roar.uel.ac.uk/3088/.
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The United Kingdom is facing an ageing population, which has repercussions for those receiving care, as well as for those funding and providing these essential services. Providing suitable and committed care staff is crucial to meet demand, but the care sector faces poor recruitment and retention of staff. The central aim of this thesis was to understand the factors that motivate individuals to engage and remain in paid care giving, from an evolutionary perspective, and the impact this may have for the recruitment and retention of care workers. Applying an evolutionary perspective, this thesis reconceptualised care work as mutualistic cooperation where both parties gain benefits from the formation of close and distinctive social alliances. Based on a review of the literature and a thematic analysis of semi-structured interviews with care workers, care work emerged as a mutualist strategy, dependent on a set of key demographic, dispositional and situational factors, functioning within certain resource and environmental constraints. These insights informed the development of a psychometric measure appropriate for the assessment of individual differences associated with participation in care work. Principal component analytic techniques applied to pooled items reduced these to coherent subsets that were relativity unidimensional and potentially associated with care work as mutualistic cooperation. The resulting questionnaire was surveyed amongst care workers and workers of a similar socioeconomic status to identify individual differences and preferences associated with participation in care work. Logistic regression models indicated significant predictors associated with participation in care work, including preferences for prosocial outcomes, amenable behaviours, and a demographic composition predictable of care work. This thesis concludes that care workers are mutualistic cooperators and that care environments should be structured to promote mutualist benefits in order to recruit and retain committed staff.
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Li, Xinzhu. "Policy Recommendations to Improve Health Care in China." Scholarship @ Claremont, 2015. http://scholarship.claremont.edu/cmc_theses/1181.
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Since the economic reform in 1978, China’s health system moved from a commune-based system to a market-driven system. This drastic change resulted in various market failures, including cost inflation, perverse incentives for providers and supplier-induced demand for unnecessary care, increasing inequality in access across regions based on economic status, and other problems. Though China attempted to correct its policy mistakes and reform its inadequate and unjust health care system in order to provide basic universal health coverage for all over the past decade, not everyone has equal access to the same quality of affordable health care, especially the non-resident workers, the poor urban residents, and the rural population. This research uses the framework of the five intellectual tasks to assess the history of China’s health policies, the political economy factors that have driven and shaped the reform of China’s health system, the likely projections of policy options, and potential alternatives for policymakers.
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Böhl, Gregor [Verfasser], Herbert [Akademischer Betreuer] Dawid, and Cars [Akademischer Betreuer] Hommes. "Macrofinance dynamics, heterogeneity, and policy design / Gregor Böhl ; Herbert Dawid, Cars Hommes." Bielefeld : Universitätsbibliothek Bielefeld, 2017. http://d-nb.info/1150181931/34.
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Böhl, Gregor [Verfasser], Herbert [Akademischer Betreuer] Dawid, and Cars H. [Akademischer Betreuer] Hommes. "Macrofinance dynamics, heterogeneity, and policy design / Gregor Böhl ; Herbert Dawid, Cars Hommes." Bielefeld : Universitätsbibliothek Bielefeld, 2017. http://nbn-resolving.de/urn:nbn:de:0070-pub-29150211.
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Le, Fevre Anne M. "Health care policy and reform a comparative study of policy making and the health care systems in five OECD countries." Thesis, Curtin University, 1997. http://hdl.handle.net/20.500.11937/1765.
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Many of the assumptions underlying health care issues appear to be taken for granted by policy makers, when if fact they ought to be examined for their relevance to today's problems. This research attempts to do so, by analysing the non-economic issues and factors involved in the financing and provision of health care. It will be argued that policy makers commonly have a unidirectional economic perspective in both policy making and in health care system reform directives, a situation which leaves issues such as the health status of the population and of equity in resource allocation to political rhetoric, while in practice, policies deal with the issue of cost reduction. Of major importance is the moral dimension in policies dealing with health and welfare, which is clearly either forgotten or is afforded too little consideration in policy making. This is particularly relevant to the issue of rationing of health care in publicly provided health care systems. While always quietly practised by clinicians in the past, rationing is now required to be overt because demand for health care has outstripped available resources.The substance of the argument comes from the analysis of a very large literature on the broader issues affecting health care policy, such as concepts of social justice, ethics of resource allocation and the physician-patient relationship, all of winch ought to underpin policies for the mechanisms of funding and provision of health care systems.A conceptual diagram of a health care system is offered to provide a framework for the discussion of how the issues are interrelated at micro, meso and macro levels in policymaking. Examples of reforms to health care systems are taken from five OECD countries which share a common social, political and economic heritage: Australia, United Kingdom, New Zealand, Canada and the United States of America.The conclusions from this research show that theoretical incoherence pervades this most complex of policy areas, allowing the economic imperative to take precedence over the substantive health care issues.
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Le, Fevre Anne M. "Health care policy and reform a comparative study of policy making and the health care systems in five OECD countries." Curtin University of Technology, School of Marketing, 1997. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=11246.
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Many of the assumptions underlying health care issues appear to be taken for granted by policy makers, when if fact they ought to be examined for their relevance to today's problems. This research attempts to do so, by analysing the non-economic issues and factors involved in the financing and provision of health care. It will be argued that policy makers commonly have a unidirectional economic perspective in both policy making and in health care system reform directives, a situation which leaves issues such as the health status of the population and of equity in resource allocation to political rhetoric, while in practice, policies deal with the issue of cost reduction. Of major importance is the moral dimension in policies dealing with health and welfare, which is clearly either forgotten or is afforded too little consideration in policy making. This is particularly relevant to the issue of rationing of health care in publicly provided health care systems. While always quietly practised by clinicians in the past, rationing is now required to be overt because demand for health care has outstripped available resources.The substance of the argument comes from the analysis of a very large literature on the broader issues affecting health care policy, such as concepts of social justice, ethics of resource allocation and the physician-patient relationship, all of winch ought to underpin policies for the mechanisms of funding and provision of health care systems.A conceptual diagram of a health care system is offered to provide a framework for the discussion of how the issues are interrelated at micro, meso and macro levels in policymaking. Examples of reforms to health care systems are taken from five OECD countries which share a common social, political and economic heritage: Australia, United Kingdom, New Zealand, Canada and the United States of America.The conclusions ++from this research show that theoretical incoherence pervades this most complex of policy areas, allowing the economic imperative to take precedence over the substantive health care issues.
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Sowa, Jessica Elizabeth O'Leary Rosemary. "Changing a policy field? : policy design and collaboration in early care and education." Related Electronic Resource: Current Research at SU : database of SU dissertations, recent titles available full text, 2003. http://wwwlib.umi.com/cr/syr/main.
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Parisian, Esther Elizabeth. "Health Care Reform and Rural Hospitals: Opportunities and Challenges under the Affordable Care Act." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1313596532.
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Donato, Francis A. "Reforming health care through managed care." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1995. http://www.kutztown.edu/library/services/remote_access.asp.
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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1995.Source: Masters Abstracts International, Volume: 45-06, page: 2939. Abstract precedes thesis as [1] preliminary leaf. Typescript. Includes bibliographical references (leaves 91-92).
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Botta, Michael David. "Technological Innovation and Policy Responses in Health Care." Thesis, Harvard University, 2013. http://dissertations.umi.com/gsas.harvard:10798.
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This dissertation consists of three papers, two quantitative and one mixed-methods. Paper 1 uses cross-sectional and logistic regression analyses of survey data to assess Americans' opinion on the use of cost effectiveness research (CER) in government health coverage decisions, and to examine the factors predicting approval or disapproval of specific decisions. I use vignettes drawn from real international decisions to assess opinions. I find that opposition to a CER agency is widespread, with partisan affiliations playing a significant role. In general, Republicans are more likely to oppose a government agency playing a role in cost effectiveness determinations. With regards to specific examples, Americans hold even greater opposition, with no significant differences by political affiliations.
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Pothisiri, Wiraporn. "Postpartum care in Thailand : experience, practice and policy." Thesis, London School of Economics and Political Science (University of London), 2010. http://etheses.lse.ac.uk/2205/.
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In developing countries, hundreds of thousands of women still die shortly after giving birth and thousands who make it to survive suffer with short-term or longterm health problems related to pregnancy and childbirth that impact their quality of life. However, empirical evidence shows that the majority of these women did not receive any care after delivery. Unlike antenatal and obstetric care, relatively little is known about the factors that explain levels of postpartum care use. This thesis examines the utilisation of postpartum care services in the context of Thailand, which is best known among the developing countries for its success on maternal and child healthcare improvement. Thailand's maternal mortality rate is low (12 deaths per 100,000 live births) and 92 per cent of women have at least four antenatal visits and 97 per cent of women deliver in hospitals. However, rates of postpartum service use remain low at 61.2 per cent. The thesis considers the explanations for low levels of postpartum service use observed in Thailand from a range of perspectives: women, health providers, policy actors and interrelationships among them. Using sequential mixed methods, the study first examines quantitatively the contemporary context of postpartum services and the individual-level factors influencing the use of postpartum services. This is followed by a qualitative analysis which explores the attitudes and perceptions of women, health providers and policy actors towards postpartum care services. Analyses reveal interacting influences that facilitate and impede women's use of postpartum care service. Whilst the quantitative study reveals several demographic, socio-economic and motivating factors, the qualitative study shows that women's perception of the content of postpartum care services and healthcare systems, as well as their experience of encounters with health providers, have significant impact on decisions whether to use postpartum services. The health service delivery system has some significant negative impacts on women's use of postpartum services. Although Thailand has had postpartum care policies in place since the 1960s, the significance of postpartum care for the mother's health has been neglected. The study finds that there is a complex array of individual, health system-related and political factors that influence the utilisation of postpartum care services. Unless adequate attention is given to these factors and their interrelation, it is unlikely that women's use of postpartum care services will be improved.
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Kocman, David. "Quality matters : re-formatting the boundaries of care in Czech social care policy." Thesis, University of Kent, 2013. https://kar.kent.ac.uk/47654/.
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This thesis deals with knowledge about the mechanics and effects of quality reforms in public service as advanced by critical policy studies. Critical policy studies have identified managerialism and marketization of public services as key conditions in introducing quality reforms. The argument has been built in opposition to proponents of quality who argue that marketization, when introduced to services, enhances their quality. In contrast, critical studies have shown that quality reforms have restructured organizational contexts of public services where quality acted mainly as a rhetorical figure, and where improvements remain dubious. The real effects of quality reforms, they argue, are increased control over practitioners’ labour process and de-professionalization. This thesis is a case study of a recent Czech social care reform. The Czech case is a case of a quality reform without marketization and managerialism, yet with a similar outcome in the form of managerialised care. As such, the Czech case offers an opportunity to further our knowledge about the mechanics of quality reforms provided we make a methodological step outside the analytics of managerialism. The thesis undertakes this methodological shift by drawing on Actor Network Theory. The question this thesis asks is how could managerialised care be achieved without either marketization or managerialism? Methodologically, the thesis argues that mapping social alliances among policy actors is necessary but in itself not sufficient to explain the outcome. The thesis traces the Czech quality reform from its inception as a policy project at the Ministry of Labour and Social Affairs to its circulation in social care sector. The Czech case shows how articulating quality service in quality standards re-organised care by extending (both conceptually and practically) its boundaries. Care traditionally understood as interactional bodywork was extended horizontally to include practices and forms outside the practitioner-client interaction (such as support planning), and it was extended vertically shifting the agency in care from an equipped practitioner to an equipped service. The contribution of the thesis is twofold. It shows that quality has gained a life in its own outside the managerialist causation model and may not necessarily follow in the footsteps of marketization and managerialism. Mainly, the thesis shows that quality is a complex shibboleth able to re-format the content of practitioner work rather than merely re-structure organizational contexts of public service provision.
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Jackson, Kevin Lee. "Health Care Reform and the Transition from Volume to Quality Payment Models: A Primary Care Focus." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/445.
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The 2010 Patient Protection and Affordable Care Act (PPACA) resulted in providers and health care organizations conforming to new payment models that connect reimbursement to patient outcomes. Primary care providers (PCPs) are tasked to provide new quality provisions as chronic disease management is a key focus to improve outcomes. The purpose of this study was to understand the transition to new payment models and determine whether care is improved. The conceptual framework is grounded in health care access models geared towards the improvement of quality outcomes including the chronic care model (CCM). The research questions were designed to understand providers' perspectives on new metrics to improve quality and the implications on practice workflows and patient outcomes. This phenomenological study consisted of interviews with 9 PCPs directly impacted by health care reform and the implementation of new quality metrics designed to improve patient outcomes. The study analyzed PCPs' perspectives on health care reform and the transition to new quality focused payment models and determined if quality is improved. Collection of data was designed to understand PCPs' challenges in alignment of their medical practices to newly defined provisions of quality expectations. Respondents reported concern with new payment models focused on quality outcomes and reported overall patient care had not improved as a result of alignment of quality initiatives to payment. The implications of positive social change will be an improved understanding of new models of payment intended to maximize reimbursement and address potential challenges with the implementation of quality metrics in order to effectively improve patient outcomes.
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McCabe, Louise Frances Mary. "Policy transfer and policy translation : day care for people with dementia in Kerala, India." Thesis, University of Stirling, 2003. http://hdl.handle.net/1893/21547.
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This thesis explores and explains the development of day care for people with dementia in Kerala, India. The development process is framed within the context of social globalisation. The central aim of the thesis is to further build theory on how and why social policy from one context is transferred and utilised in the development of social policy in another. The theoretical constructs of policy transfer and policy translation are used to explore the development process. Policy transfer is an existing concept within policy and politics literature. Theory on the concept of policy translation is built up within the thesis using theories of literary translation. Exploration of these processes provides an explanation of the development of day care. Policy transfer and policy translation are found to take place between the UK and Kerala. Policy ideas and information from the UK are transferred and then used within the implementation of day care in Kerala. A two-part research design explores firstly policy transfer and then policy translation. Policy transfer is examined within an analytical framework developed from existing models of policy transfer. Policy translation is investigated through a comparative analysis of day care for people with dementia between the UK and Kerala. The differences between day care in the two contexts represent the changes caused by the processes of policy transfer and policy translation. The main findings of the thesis are that policy transfer and policy translation have taken place within the development of day care in Kerala. The two concepts are found to complement each other. The theoretical construct of policy translation provides additional detail and clarity on the process of policy development to that provided by policy transfer. Policy transfer and policy translation can be described as mechanisms by which social globalisation is taking place and in turn globalisation promotes these processes. The thesis concludes that the theoretical constructs of policy transfer and policy translation as developed here could be used within other research to explore the processes of globalisation.
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Johnston, Jean Gabrielle. "Relationships in the community care policy arena 1987-1993 : changing dynamics in policy networks." Thesis, Nottingham Trent University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299138.
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Ng, Suk-han Christina. "The health policy network and policy community in Hong Kong : from concertation to pressure pluralism /." View the Table of Contents & Abstract, 1998. http://sunzi.lib.hku.hk/hkuto/record/B36628979.
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Thompson, Diane. "The social and political construction of care : community care policy and the 'private' carer." Thesis, University of Bedfordshire, 2000. http://hdl.handle.net/10547/233629.
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This thesis presents a retrospective critique of the social and political construction of 'informal care' within community care policy from the period of the late 1970s to the mid 1990s. The thesis considers the question of the degree of 'choice' available to informal carers to say 'no' to caring, or aspects of caring, within the reforms' positioning of informal care as the first line of support for adult dependants. The critique focuses on subjectivity, difference, agency and choice. A theoretical and methodological synthesis is developed between feminist post-structuralism, feminist critiques of mainstream social policy, and feminist theory and research, within which a qualitative in-depth interview study with informal carers is situated. The critique is then expanded through the development of a 'Q' Methodology study with a larger cohort of informal carers. The research identified gendered generational differences between the carers, and a 'burden' of care imposed as an outcome of consecutive governments' attempts to residualise welfare. The older carers' levels of agency and choice were severely curtailed. However, the younger female carers were more able to resist the drive of the community care reforms, their counter discourses being based on a new emergent notion of 'rights'. The direction of community care policy was found to be out of step with how the carers within this study perceived their responsibilities and 'obligations'. The thesis argues that whilst post-modernism may have constrained the capacity of governments and reconstituted our understanding of 'care', it has not done so to the extent that we are no longer prepared to make demands for 'care' from and by the state.
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Spratt, Trevor Martin. "Organisational and professional responses to child care policy developments." Thesis, Queen's University Belfast, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.411825.
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Varvasovsky, Zsuzsa. "Alcohol policy in Hungary." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1998. http://researchonline.lshtm.ac.uk/682262/.
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The thesis aims: - to analyse the extent of alcohol-related problems in Hungary, - to assess available policy options to reduce the incidence of alcohol-related problems - to understand Hungarian policy making in the alcohol field - to prepare recommendations for alcohol policy that are relevant to the Hungarian situation It consists of eight chapters. Chapters follow the aims by first introducing the target and the place of the study (Chapter 1), second providing evidence about the extent of alcohol related problems in Hungary and in comparison to other countries (Chapter 2), third summarising policy means to influence the incidence of alcohol related problems based on experiences of other countries and locate alcohol policy in the broader policy context (Chapter 3), then presenting the framework and the methods used for the analysis (Chapter 4), analysing the policy environment by looking at the legislative background (Chapter 5), the organisational structure and major alcohol policy movements of the past decades (Chapter 6), characteristics of public policy making in general and public health and alcohol policy making in particular (Chapter 7), and the current situation of alcohol policy through actors - their understanding, interests, influence, relation to each other and to specific alcohol policy instruments - (Chapter 8), finally summarising the findings and preparing feasible policy recommendations for Hungary (Chapter 9).
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Anderton, Karen L. "Sub-national government responses to reducing the climate impact of cars." Thesis, University of Oxford, 2012. http://ora.ox.ac.uk/objects/uuid:806e646b-ff12-4e78-b412-55422e6f8da3.
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This D.Phil. thesis is an international comparative study looking at the development and implementation stages of policies tasked to reduce emissions from transport. The substance of policy is all too often the primary focus of research, leaving the settings in which these policies are developed and implemented relatively underexplored. Examining the relationships and interplay that exists between departments responsible for climate change and transport at the sub-national (state) level and those with their local and national counterparts, this research tries to unpick the organisational intricacies that may act as barriers to delivery. State governments have become a promising source of action to reduce emissions from other sectors for which they have legislative responsibility; however, the private road transport sector remains a challenge. This research examines the barriers preventing such progress and whether the lack of collaboration between departments and across levels of government are responsible in part for these challenges. Taking a specific policy intervention designed to reduce transport-related emissions from four case study governments (Bavaria, California, Scotland and South Australia) this research is about organisational structures of government and policy processes. The main hypothesis of the research is that conventional environmental/climate change- and transport-policymaking practices are incompatible – and that this incompatibility is hampered by organisational structures of government. Together these factors render implementation of policies to reduce the climate impact of transport difficult. The hypothesis is guided by four research themes – scale, scope, leadership and process. Each of these themes has a distinct yet important part to play in understanding and comparing the case study contexts, in terms of the cross-departmental and cross-level interactions occurring within each of the sub-national governments. Each of the subject case study governments have been chosen since they are self-determined ‘leaders’ on climate change. This research serves to highlight some of the governance issues that need to be overcome or removed for such positive political intent to be realised. It posits that without successfully linking frameworks and interested stakeholders in the process, tangible emissions reductions will be difficult to achieve. The main objective of the research is to investigate the frameworks, interplay and dynamics at the sub-national level of government across departments and between levels of government. The relationship and collaboration with industry is also examined as a supplementary consideration. The second objective is to look at how and whether climate change policy can be more closely integrated with transport policy and the barriers to this integration. This investigation is underpinned by cross-disciplinary governance theory, as well as notions from socio-political governance and applies the concept of institutional interplay in this context between levels of government. It develops the concept of sub-national governance which argues that relationships between levels are distinct and non-hierarchical in terms of policy development and implementation.
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Green, Susan Elizabeth. "Mental health policy implementation : a case study." Thesis, University of Birmingham, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368414.
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Reynolds, Jack. "Policing print : the novel before the police ; Three Card Trick : a novel." Thesis, University of East Anglia, 2016. https://ueaeprints.uea.ac.uk/67076/.
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This thesis is presented in two sections; the first, ‘Policing Print: The novel and the practice of law enforcement 1720-1750,’ is a critical essay examining the interrelated development of the novel and the culture of policing in eighteenth-century London. ‘Policing Print’ investigates what D.A. Miller refers to as ‘the possibility of a radical entanglement between the nature of the novel and the practice of the police.’ While Miller’s book, The Novel and the Police, engages with post-1860 novels and policing practices, this thesis takes his subject back further and argues that the eighteenth-century novel was already engaged with the culture and practice of policing. The second, though primary, section is the historical novel, Three Card Trick, which is a fictionalised telling of the confrontation between the notorious housebreaker, Jack Sheppard, and the thief-taker, Jonathan Wild. Three Card Trick is an attempt to write a crime novel differently; to bend and stretch the genre in order to make it speak to the specificities of my historical characters and the milieu in which they are embedded. Three Card Trick therefore derives its narrative structures and strategies from the acts and institutions of crime and law enforcement which it describes; Wild is at once criminal and policeman, antagonist and ally, Sheppard both self-interested criminal and ascendant folk hero. These two parts of the thesis are significantly in dialogue with each other. ‘Policing Print’ argues that the novel and the culture of policing informed and were informed by one another. Attention to this movement between novelistic and policing practice produces new readings of Daniel Defoe’s Moll Flanders and Henry Fielding’s The Life of Jonathan Wild the Great. In turn, these readings directly shape the creative methodology of my novel, Three Card Trick, by enabling it to engage creatively with the arguments made in my critical work.
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Dawson, Walter. "The CLASS act and long-term care policy : the politics of long-term care financing reform in the United States." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:fa5269a1-8ce2-4105-b643-f9c2fffb23d8.
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This thesis seeks to contribute to the knowledge base about social policy in the United States, using long-term care (LTC) financing policy reform as an illustrative example. Specifically, this thesis explores LTC financing reform efforts during three U.S. Presidential administrations: Bill Clinton (1993-2001), George W. Bush (2001-2009), and Barack Obama (2009-2010). Within this historical framework, the LTC provisions of the Health Security Act of 1993, the development of the Community Living Assistant Services and Supports or 'CLASS' Act during the Bush Administration, and the legislative success of the CLASS Act as a part of the Patient Protection and Affordable Care Act of 2010 provide comparable cases to compare the drivers of social policy. Drawing on the explanatory frameworks of the welfare state such as ideology, historical institutionalism, and an actor-centered approach to policy analysis, this thesis argues that successful path-departing legislation is difficult to achieve due, in part, to the presumed high costs of social programs and the complex institutional framework of the American political system. Policy outcomes result from the interaction between the complex processes and dynamics of the political system through which policy change (or the failure to change) actually occurs. The fact that the CLASS Act was politically successful, yet administratively inoperable as designed, reinforces the argument that social policy outcomes in the United States are reflective of a complex, enduring struggle of competing ideologies. This continual struggle, coupled with a heightened concern over cost control and fiscal austerity, helps to ensure that policies which are legislatively successful within the institutional architecture of the American political system are unlikely to produce major expansions of the welfare state. Social change is therefore highly difficult to achieve, even in the face of significant unmet social needs. Comprehensive reform of U.S. LTC financing arrangements will remain an elusive goal for the foreseeable future. Instead, incremental, highly pro-market solutions are likely to be the types of policies promoted in the years of ahead.
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Mykhalovskiy, Eric. "Knowing health care / governing health care exploring health services research as social practice /." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0018/NQ56249.pdf.
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Hwang, Yuan-Shie. "Funding health care in Britain and Taiwan." Thesis, University of Newcastle Upon Tyne, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.283167.
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Ross, Gabrielle Catherine. "Sustaining menstrual regulation policy : a case study of the policy process in Bangladesh." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2002. http://researchonline.lshtm.ac.uk/1742272/.
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Bangladesh introduced menstrual regulation (early abortion) into its national family planning program in 1979, and for more than 20 years women with unwanted pregnancies have been able to avail themselves of a relatively safe and accessible service. Over the years, however, concern has been expressed about deficiencies in the implementation of the policy, and by the mid-1990s, the menstrual regulation (MR) policy was approaching a critical juncture. The introduction of health sector reforms and the waning of international and domestic support raised questions regarding the sustainability of the policy. This study was conducted to determine the factors that influenced the development of and support for the MR policy in Bangladesh, in order to explore how far those factors might influence future sustainability. The study used an analytic framework based on literature from the policy field to test what factors were important in the policy process in Bangladesh. Qualitative data was gathered from interviews and documents in an inductive approach to determine the development of the MR policy, which was then subjected to a retrospective analysis of the entire life cycle of the MR policy-how it came to be placed on the policy agenda, how and why it was formulated the way it was, and why it was not implemented as well as it could have been. Data gathered from interviews and document reviews were then used in a political mapping exercise undertaken in a prospective analysis for the policy, providing insights in relation to the future sustainability of the MR policy. The research suggested that the analytic framework used was helpful in providing a systematic analysis of contextual conditions, agenda-setting circumstances, and policy characteristics that could explain much of the variability in the policy process. The role of international donors and attitudes toward religion were found to be particularly relevant to explaining the policy process. The study concluded that the MR policy would likely not be sustained in the future unless purposeful action were taken to mobilise additional bureaucratic and political resources in support of the policy.
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Gallagher, Naomh. "Diabetes in Northern Ireland : using routine health care data to inform public health care policy." Thesis, Queen's University Belfast, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.601482.
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Diabetes is a leading cause of morbidity and mortality around the world, and the prevalence is increasing dramatically. Rather surprisingly, there is no consensus regarding the burden of diabetes in Northern Ireland. This thesis outlines the creation and utilisation of a novel centrally collated population wide dataset of dispensed prescriptions known as the Enhanced Prescribing Data base (EPO). This was successfully used, together with linkage of other demographic and health-related data, to provide estimates of the prevalence, incidence and changing prevalence of diabetes in Northern Ireland over a three year period, and of the associated relative mortality risk for patients with diabetes. Through further linkage to unique and individual-level indicators of socioeconomic status, a comprehensive picture of the differential burden of diabetes across society was produced. Variation related to geography, demographics, socioeconomic variables, and over time was investigated. In addition, the thesis demonstrates how routine administrative data can be used to investigate the relationship between health policy and diabetes ca re. This was outlined in two studies; the first, using a time series analysis, showed how the introduction of financial incentives for GPs in the UK, , , through the Quality and Outcomes Framework (QOF) initiative changed the care of t he approximately 30% of patients with type 2 diabetes who are usually managed non• pharmacologically. The second study demonstrated how use of routine data can be used to undertake comparative analysis of patients with diabetes in Northern Ireland and the Republic of Ireland (two similar populations with distinct health systems) to the potentially mutual benefit of both jurisdictions. This thesis provides both a novel methodology to estimate diabetes in Northern Ireland, and a number of unique examples of how administrative datasets and record linkage can be successfully utilised to answer important and policy Relevant questions in diabetes and heather services research.
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Abu-El-Noor, Mysoon K. "Spiritual Care of the Hospitalized Patients Following Admission to the Cardiac Care Units: Policy Implications." University of Akron / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=akron1334636792.
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Leon-Espinoza, Diana. "Explaining The Adoption Of Care Policies In Latin America: A Care Streams Approach." Thesis, Griffith University, 2021. http://hdl.handle.net/10072/417014.
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Care policies can provide women economic independence, increase their participation in the public sphere of society, and reduce class, gender, race, and ethnic inequalities. In recent decades, socioeconomic transformations in women’s status in society, demography, and the structure of families have placed these policies at the centre of academic and political debates around the world. Most of the literature examining these dynamics concentrates on advanced economies, with developed welfare states, and large state and fiscal capacities to respond to changes in labour markets and families. In the developing world, Latin America has been a region that stands out for having experienced rapid socioeconomic and political transformations similar to those in the developed world. Women have been increasingly participating in the labour force, countries are experiencing demographic shifts, and the traditional male breadwinner model has eroded. In the first decades of the twenty-first century, political transformations placed an emphasis on expanding social benefits and entitlements to wider segments of the population. Amongst this expansion, care policies have featured prominently on the agendas of governments. This thesis aims to answer the following question: how do Latin American countries adopt care policies? The literature focuses on four main approaches to explain the adoption of these policies. The economic approach assumes that socioeconomic transformations place pressure on states to adopt care policies. The civil society approach explains that women’s movements or interest groups pressure the state or influence policymakers to adopt these policies. The power resource approach assumes that parties from left/centre-left ideologies and/or high electoral competition contexts are conducive to the adoption of care policies. Finally, the state-centric approach examines the role of women in legislatures, women’s agencies, and bureaucrats/technocrats/femocrats in influencing the adoption processes within the state apparatus. All of these approaches are important to demonstrate the centrality of agents and contexts influencing the adoption of care policies. However, policymaking is a complex and dynamic process in which several agents and contexts interact with each other. Concentrating on one or a combination of approaches assumes that policy processes are static and it leads to limited answers. This thesis adapts the classic ‘Multiple Streams Approach’ from public policy into a ‘Care Streams Approach’. This new approach integrates existing theoretical drivers into a single approach comprised of multiple elements or streams. Drawing on the adoption of two unique care policies in Costa Rica and Uruguay, the thesis applies the Care Streams Approach to key features of the policy processes in order to build theory about the adoption of care policies in Latin America. The thesis uses a qualitative strategy and a multiple-case study research design to analyse the two policy processes. The research relies on two main sources of data. First, the collection of texts/documents from civil society, political parties, and governments.
Second, the implementation of semi-structured interviews conducted with thirteen key participants of the policy processes in each country. Thematic analysis was used to analyse the qualitative data and interpret the policy process according to the multiple care streams. Through the Care Streams Approach, the thesis finds that different configurations of drivers interact with each other in the adoption of care policies in Latin America. By different configurations, I refer to different economic contexts, civil society agents, politics, and state agents. The key to understanding the adoption of policies lies within each care stream and their alignment. Problems can be constructed as a top-down process by a women’s agency with a high-ranking position in government or as a bottom-up process from a feminist Non-Governmental Organisation. Care solutions can be designed in different contexts, for instance, in close-knit policy networks of technocrats/bureaucrats or in open policy networks of bureaucrats/femocrats and civil society organisations. Care policies become prominent items on government agendas in the presence of programmatic political parties and high electoral competition that place these policies at the centre of electoral campaigns to attract or consolidate support from voters. The alignment of problems, solutions, and politics triggers favourable opportunities for the adoption of these policies. The findings from this thesis make a contribution at both theoretical and practical levels. First, by integrating all of the approaches that explain the adoption of care policies, the Care Streams Approach creates powerful explanations. This approach demonstrates that the interplay between agents and contexts is the main feature that explains the adoption of care policies, rather than individual theoretical drivers. Second, the results enhance our understanding of the adoption of these policies in developing countries beyond the geographic limits of the global North. Third, the findings provide information for policymakers, feminist organisations, and agents in political parties about how different settings, contexts, and agents can lead to the adoption of progressive care policies.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
Griffith Business School
Griffith Business School
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Lart, Rachel Anne. "HIV and English drugs policy." Thesis, Online version, 1996. http://ethos.bl.uk/OrderDetails.do?did=1&uin=uk.bl.ethos.243811.
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Tatar, Fahreddin. "Privatisation and Turkish health policy." Thesis, University of Nottingham, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.356998.
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Deiters, Maximilian. "Policy receptiveness as a determinant of policy effectiveness:German child care and women’s transition to first birth." Thesis, Stockholms universitet, Sociologiska institutionen, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-152788.
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Current micro-level studies on the effect of formal child care on fertility behavior cannot establish an indisputable positive link. Especially in Germany’s policy context however, such a link is crucial to en-hance the legitimacy of the more recent but long overdue policy turnaround towards the dual-earner model. The results of this paper illustrate the reliance of policy success on an alignment of preferences presupposed by the implemented policy and preferences prevalent within the exposed population. Preferences central to driving policy success are distinguished by women’s receptiveness to such policy in terms of policy applicability and acceptability. The approach is empirically tested by means of Event-History analysis of German women’s first-birth transition based on the German Pairfam panel data set. The results indicate that if formal child care options are provided to 1) women who desire to reconcile family and career, or are provided to 2) women who are open to give their child into formal care, the provision of child care is a significant factor in stimulating women’s transition to first birth. On the contrary, women with career- or family-foci and women averse to formal care are not stimulated by the provision of formal care options. From the results I conclude that a continued expansion of formal child care will aid in overcoming lowest-low fertility by providing child care to those who are receptive to it and promoting a timelier motherhood image to women who are still averse to it.
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Havers, Sally. "From policy to patient care: Exploring the implementation of government directed policy in the hospital setting." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/134261/1/Sally%20Havers%20Thesis.pdf.
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Effective policy implementation remains a significant challenge for health care administrators and policy makers. Using interpretive description methods, this thesis identified important factors and associated principles that influence the implementation of government directed policy in the hospital setting. These principles were that government directed policy needs to be understood, accepted, validated, integrated, and supported; and that implementation of government directed policy needs to be planned. Consideration of these principles is of value in guiding both policy development and implementation planning to maximize the impact of these policies on clinical practice and patient outcomes.
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Song, Jaemin. "Emission trading with absolute and intensity caps." Thesis, Massachusetts Institute of Technology, 2005. http://hdl.handle.net/1721.1/85796.
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Thesis: S.M., Massachusetts Institute of Technology, Technology and Policy Program, 2005.Cataloged from PDF version of thesis.
Includes bibliographical references (page 66).
The Kyoto Protocol introduced emission trading to help reduce the cost of compliances for the Annex B countries that have absolute caps. However, we need to expand the emission trading to cover developing countries in order to achieve the maximum benefits from both higher environment quality and lower abatement cost. In this sense, the emission trading scheme at a global level in the future needs to consider the inclusion of countries with intensity caps as well as with absolute caps, since many countries, including developing countries and the United States, are interested in intensity caps. In this thesis, we aim to address the issue of two different emission cap-setting methods, absolute and intensity caps, under international emission trading; How would the changes in BAU emission levels and GDP affect the market-clearing price, total cost, and costs for the affected countries? What would be the differences in the price and costs when a country with an intensity cap is the trading partner instead of one with an absolute cap? A two-country mathematical model is developed to answer these questions. The model analysis shows that there are complex interactions among the elasticities of price and costs in response to the changes in emissions and GDP of the affected countries. For the same emission size countries, the BAU condition changes of a country have greater impacts on the own cost changes than the changes of the trading partner do. For the different size emission countries, the relative size of emissions of the countries is the key factor to determine the total cost and its distribution to each country. The changes of the bigger emission country tend to dominate the trading system in terms of price and costs. Generally, we can conclude that selection of proper caps should be made considering the relative size of emissions and commitment levels of the affected countries, their marginal coefficients and own characteristics of correlation between GDP and emissions.
by Jaemin Song.
S.M.
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Virk, Amrit Kaur. "Expanding health care services for poor populations in developing countries : exploring India's RSBY national health insurance programme for low-income groups." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:3e65305c-ba60-408a-8c0a-8957767f6596.
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Health is deemed central to a nation’s development. Accordingly, health care reform and expansion are key policy priorities in developing countries. Many such nations are now testing various methods of funding and delivering health care to local disadvantaged populations. Similarly, India launched the Rashtriya Swasthya Bima Yojana (RSBY) national health insurance programme for low-income groups in 2008. The RSBY intends preventing catastrophic health-related expenditure by improving recipients’ access to hospital-based care. This thesis is an in-depth qualitative evaluation of the RSBY in Delhi state. It examines the RSBY’s effectiveness in fulfilling its goals and meeting local health care needs. Walt and Gilson’s (1994) actors-content-process-context model informs the research design and an actor-centred “responsive” (Stake 1975) or “constructivist” approach guides data analysis. Three research questions are examined: (i). Why was a health insurance programme launched and why now? Why was this model favoured over alternate methods of service expansion? (ii). Is the RSBY delivered as intended? If not, why? (iii) How does the RSBY affect patients’ access to services? The findings are based on documentary sources, observation of implementation sites and activities and 164 semi-structured interviews with RSBY policymakers, insurers, NGOs, doctors, and patients. The results show improved access to curative and surgical care for RSBY patients. However, RSBY’s focus on hospitalisation and omission of primary and outpatient services had undesired negative effects. The lack of ambulatory facilities led RSBY patients to self-medicate or use dubious quality informal providers. By only allowing inpatient care, the RSBY also seemingly encouraged the substitution of outpatient care with costlier hospitalisations. In effect, the RSBY’s design contributed to cost increases and poor patient outcomes. While more funds and human resources were needed to improve RSBY implementation, the performance of frontline agencies could potentially improve through more stable, longer-term contracts. Similarly, modifying RSBY’s monetary incentives for doctors may lead to better service delivery by them. By evaluating the RSBY’s strong points and shortcomings, this thesis provides key lessons on strengthening policy design and health service delivery in developing countries. Thereby, it makes a broader contribution to understanding the determinants of successful policymaking.
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Ellis, Beverley Suzanne. "Managing governance programmes in primary care : lessons from case studies of the implementation of clinical governance in two primary care trusts." Thesis, University of Central Lancashire, 2008. http://clok.uclan.ac.uk/19290/.
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This thesis applies a conceptual framework to determine the key insights that complex adaptive system theories provide to the novel challenges facing the introduction of clinical governance in two English Primary Care Trusts (PCTs). It presents empirical research on governance through qualitative case studies of the implementation of clinical governance arrangements within two North West PCTs, during a time of flux and change. The study is located within the English National Health Service (NHS) between 1999 and 2005. The Department of Health (DH) describes clinical governance as an evolving organisational structure and process that: "Provides NHS service organisations and individual health professionals with a framework within which to build a single, coherent local programme for quality improvement." (Department of Health, 1998a p.33). The thesis reviews the literature on governance models, quality improvement frameworks and complexity-based approaches to establish an appropriate theoretical base to the study. The literature relates to the nature of PCTs as a networked structure with autonomous parts. This approach contextualises the origins of clinical governance and related quality concepts. The study encompasses the introduction of the most recent contractual arrangements for primary care in 2004 (NHS, 2004). The research question posed is: "How can governance of quality improvement programmes be managed in a way that is appropriate to the characteristics of English PCTs?" Detailed evidence demonstrates the nature of local clinical governance programmes and the implementation within two North West PCTs, from the perspective of those involved. The results of the analysis show that multiple perspectives were taken into account in the decisions made about the content and delivery of clinical governance programmes. It is suggested that the application of a complex adaptive system conceptual framework helped to provide insight and interpretation of the accounts of those involved in the two case studies. The variation in clinical governance approaches across the two PCTs is explained in part by the strategic and policy orientation of each PCT. The results are consistent with the argument that the characteristics of quality improvement programmes in two PCTs go beyond linear based concepts, and can be thought of as real-world exemplars of the emergent properties of complex adaptive systems. In practice, the lessons learned provide opportunities to inform future management approaches to quality improvement programmes in PCTs.
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Connor, Albert Stuart. "Quality policy in specialist health promotion services : a constructivist analysis of concepts, policy and practice." Thesis, Manchester Metropolitan University, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337184.
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Clark, Joseph David. "A global social policy analysis of international palliative care development." Thesis, University of Sheffield, 2016. http://etheses.whiterose.ac.uk/13627/.
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A global lack of pain and palliative care services means that millions of people each year spend their last weeks and days suffering serious, but avoidable physical and psychological pain. More usually understood as a national issue, this multiple methods study considers why palliative care should be considered an issue for the international development community. Use of Global Social Policy as a theoretical lens to view development reveals opportunities for palliative care to make gains within the incoming global health priority of achieving Universal Health Coverage. It is argued that there is a need to move beyond consideration of palliative care as a moral concern towards new ways of ‘framing’ the issue. Presentation of palliative care as being economically beneficial is therefore encouraged. By doing so may allow the presentation of palliative care as an important element of international development and attract new funding streams. A systematic review reveals a lack of ‘international evidence’ for palliative care, particularly in low and middle income countries. More encouragingly, opportunities are revealed for existing policies and practices to be ‘transferred’ to other similar settings. Yet, an analysis of the national contexts from which palliative care has (and has not) developed shows that countries which have not developed palliative care are likely to face significant challenges in the delivery of basic healthcare. This raises serious questions regarding how such countries can also integrate palliative care into their health systems. International palliative care experts were consulted to find out how they thought the field can move forwards through global advocacy. The far-reaching benefits of palliative care encourage the need for palliative care to be constructed in new ways. However ongoing disunity regarding whether palliative care is a long term approach or an end of life intervention threatens to undermine how activists can construct tractable arguments for palliative care to policymakers.
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Granlund, David. "Economic policy in health care : Sickness absence and pharmaceutical costs." Doctoral thesis, Umeå : Department of Economics, Umeå University, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1137.
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Baldwin, Mark. "Constructing care management : policy implementation as a participative learning process." Thesis, University of Bath, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285339.
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This thesis is a record of research exploring the limitations to successful policy implementation. Using Community Care as the illustrative example, it asks what these limitations might be, casting a particular light on the part played by care managers, the front-line policy implementers responsible for "needs assessments" which is a key activity in the implementation of Community Care. There is a tension in care management between the influence of procedures and the degree of discretion necessary for needs assessment to be completed effectively. In what ways, then, are policy intentions affected by the activities of care managers? Community Care is an illustration of a public policy imposed by central government through a top-down process of implementation in what is argued as a rationalist endeavour to simplify the complexities of community care and reduce it to questions of technique and structure. This attempt to present a unified conceptualisation of community care is backed by managerial procedures referred to in the public management and policy literature as "managerialism". Social work practice theory provides a third example of the rationalist attempt to simplify processes involving complex social interactions. The limitations to rationalist explanations of community care implementation and the necessity for a different kind of analysis are explored. There is a parallel with the research methodologies employed for this research. The initial interviews were helpful in revealing the degree to which policy implementation was being thwarted by care managers, but this resistance was mirrored in their rejection of my interpretation of their practice. The common thread running through the normative approach to policy implementation, management, social work practice and research methodology is an adherence to positivist forms of knowledge. The implementation of Community Care raises questions of epistemology and ontology that undermine these powerful forms of knowledge. The claim is that a different epistemology suggests practices more likely to lead to effective outcomes. An organisational orientation to effectiveness is revealed in the degree to which outcome has become wedded to techniques of scientific rationalism. A service orientation would define outcome by the degree to which the needs of vulnerable adults were met through reflection upon key relationships. The first of these is an exercise in objectivity which is not well equipped to take account of the subjective experiences of practitioners exploring needs in relationship with vulnerable adults. The service orientation suggests an experiential and participative epistemology in which people engage in the process of learning and understanding most successfully when it is collaborative rather than imposed. The second phase of fieldwork was an experiment using a method built upon a participatory epistemology and gives the reader a glimpse of what might be possible in direct contrast to rationalist approaches. Work with two co-operative inquiry groups has led me to new understandings about the nature of learning for individuals and organisations. The thesis concludes that an effective learning environment facilitating positive and reflective use of discretion can be created through co-operative inquiry, although any approach would need to include other important participants, notably managers and service users, if it is to maximise its effectiveness in the long term.
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Spink, Jane Elizabeth. "Public involvement in primary care : an analysis of policy implementation." Thesis, University of Hertfordshire, 2006. http://hdl.handle.net/2299/14352.
Full textAbstract:
Public involvement in primary care has gained increasing acceptance through a sustained position in government policy since New Labour began in 1997. When Primary Care Groups (PCGs) were introduced (Department of Health 1997), they were seen as vehicles for public involvement, reflecting devolution of power and local decision-making. During the process of this study (1999 - 2006) policy directives have highlighted a number of paradoxes, with the potential to impact on public involvement. Detailed development was left to local discretion, set against a national agenda that emphasised citizenship and consumerism. The purpose of this study was to explore, interpret and understand how public involvement policy was interpreted and implemented within the new organisational structures. The study was designed to address the research question `How is public involvement defined and operationalised within PCGs'. Due to the pace of organisational change, the research expanded to track lay experiences within Primary Care Trusts (PCTs). The research methods included case study, national survey, telephone interviews and the development of a conceptual framework for public involvement in primary care. From the analysis of the national survey and two in-depth case studies, the study provided a detailed profile of lay members across England. Issues regarding representativeness and the identification of a potentially discriminatory appointment system were raised. Despite inadequate training lay members were strongly represented in public involvement and health-related issues but less so in financial and operational areas. There were widespread difficulties with individual capacity and a minority of members identified themes relating to isolation, exploitation and lack of skills recognition. There was little evidence of strategic and organisational development in implementing and responding to involvement initiatives. The majority of approaches to public involvement within this study focused on information exchange and therefore, were tokenistic in relation to power sharing. The impact of the national agenda was evident and the lack of specific central directives relating to involvement led it to remain a low priority. As the move to PCT status became central, public involvement was reclaimed as a management prerogative. The analysis showed that the concept of citizenship, so central to Third Way politics was poignantly missing. The study reflected a focus on service users and the different roles of citizen and user were not clearly demarcated. The use of Foucault's concepts of governmentality and discipline provided an explanatory framework for elucidating the study's findings. The effects of governmentality embedded in policy directives and disciplinary mechanisms within NHS organisations were identified as crucial factors for the lack of significant progress of public involvement over the period of the research study.