The Process of Health Policy Reform in the EnglishSpeaking Caribbean.docx
- 文档编号:28053896
- 上传时间:2023-07-07
- 格式:DOCX
- 页数:42
- 大小:44.41KB
The Process of Health Policy Reform in the EnglishSpeaking Caribbean.docx
《The Process of Health Policy Reform in the EnglishSpeaking Caribbean.docx》由会员分享,可在线阅读,更多相关《The Process of Health Policy Reform in the EnglishSpeaking Caribbean.docx(42页珍藏版)》请在冰豆网上搜索。
TheProcessofHealthPolicyReformintheEnglishSpeakingCaribbean
TheProcessofHealthPolicyReformintheEnglish-SpeakingCaribbean:
CaseStudiesinNationalHealthInsurance
RickyVanKalliecharan
December2002
UniversityofLeeds,NuffieldInstituteforHealth
71-75ClarendonRd.
Leeds,U.K.
LS29PL
MinistryofHealth–TrinidadandTobago
10-12IndependenceSq.
Port-of-Spain
TrinidadW.I.
SubmittedtothePanAmericaHealthOrganisation
ResearchGrantsProgramme,Post-GraduateThesisinPublicHealth
(AwardedOctober1998–HDP/HDR/RG-T/TRT/1485)
DivisionofHealthandHumanDevelopment(HDP)
PanAmericanHealthOrganisation(PAHO)
52523rdStreet,N.W.
Washington,D.C.20037-2895-USA
ABSTRACT
ThispaperdocumentsandanalysestheprocessofHealthPolicyReformintheEnglish-speakingCaribbean.ItfocusesonthedevelopmentofpoliciesforNationalHealthInsuranceinthreecountriesintheRegion:
TrinidadandTobago,StLuciaandStVincent&theGrenadines.Thestudyisunique,asitprovidesthefirstdocumentationofthepolicyprocessforNationalHealthInsuranceProgrammesintheEnglish-speakingCaribbean,therebyaddingtotheliteratureonHealthPolicyProcess.Theresearchwasconducted(1996-2002part-time)inaccordancewiththedegreerequirementsforDoctorofPhilosophy(PhD)attheUniversityofLeeds,NuffieldInstituteforHealth,UK.
Thestudyadoptsaqualitativemethodologicalapproachusingthethreecountriesascasestudies.Semi-structuredinterviewswereconductedwith60keystakeholders,fromthethreecasestudies,whowereinvolvedinthedevelopmentoftheNationalHealthInsuranceProgrammes.Insupportofthisprimarydata,variousdocumentsrelatingtothedevelopmentofthepolicywerecollectedandanalysedforeachcasestudy.
AnanalyticalframeworkdevelopedbyWalt&Gilson(1994)wasusedasaguidefordatacollectionandanalysisoftheresearchfindings.Thisframeworkforhealthpolicyanalysisincludesaninvestigationofthe“context”,“process”,and“actors”and“content”oftheNationalHealthInsurancepolicy.Astheinvestigationdeveloped,apictureoftheNationalHealthInsurancepolicyprocessemergedfromtheprimaryandsecondarysourcesofdata.
Thedocumentationofthispolicyprocessforeachcountryispresentedintwoparts.ThefirstpartdescribesthedevelopmentoftheNationalHealthInsurancepolicy,givingachronologicalaccountofactivitiesduringthestagesofagendasetting,policyformulationandpolicyimplementation.Thesecondpartprovidesananalysisofthefactors,whichfacilitatedand/orconstrainedthepolicyprocess.Theresearcherfoundfivecategoriesoffactors,whichfacilitateand/orconstrainthepolicyprocessforaNationalHealthInsuranceamongthecasestudies.Thesecategoriesareidentifiedaspolitical,interpersonal,organisational,technicalandexternal.
Inacomparisonofthethreecasestudies,patternsinthedevelopmentofhealthpolicyareidentifiedfortheEnglish-speakingCaribbean.Inafinaldiscussiontheresearcheridentifieslessonstobelearntfromeachcountry’sexperienceofNationalHealthInsurancedevelopmentanddiscussesissueswhichpolicy-makers,intheRegion,shouldtakeintoaccountwhenformulatingsuchpolicies.
KeyWords:
HealthPolicyProcess,HealthPolicyReform,NationalHealthInsurance,English-speakingCaribbean.
TABLEOFCONTENT
ListofAbbreviationsiv
ListofIllustrationsiv
1.0Introduction1
1.1AimandObjectives2
1.1.1Aim2
1.1.2Objectives2
1.1.3BroadResearchQuestions3
1.2HealthPolicyReformintheEnglish-speakingCaribbean3
1.3AFrameworkforHealthPolicyAnalysis5
1.3.1HealthPolicyProcess6
1.3.2HealthPolicyAnalysis7
1.3.3InternationalInterestforNationalHealthInsurance9
2.0Methodology10
2.1DataCollection12
2.2DataAnalysis14
3.0Results15
3.1TheoryBuilding20
4.0Discussion23
4.1LessonsonHealthPolicyProcess23
4.2LessonsontheResearchProcess27
4.3FuturePractice28
4.4FutureResearch30
Conclusion31
References32
ListofAbbreviations
CARICOMCaribbeanCommunityandCommonMarket
CCHCaribbeanCo-operationinHealth
ECDEasternCaribbeanDollars
GOTTGovernmentofTrinidadandTobago
GOSVGGovernmentofStVincentandtheGrenadines
IADBInterAmericanDevelopmentBank
OECSOrganisationofEasternCaribbeanStates
NHINationalHealthInsurance
NHIPNationalHealthInsuranceProgramme
PAHOPanAmericaHealthOrganisation
SVGStVincentandtheGrenadines
USDUnitedStatesDollars
WHOWorldHealthOrganisation
ListofIllustrations
Table1:
StagesofPolicyDevelopment6
Figure1:
FrameworkforHealthPolicyAnalysis8
Box1:
KeyMilestonesintheDevelopmentofNHIPinTrinidadandTobago15
Box2:
KeyMilestonesintheDevelopmentofNHIinStLucia17
Box3:
KeyMilestonesinNHIPDevelopmentinStVincentandtheGrenadines18
1.0INTRODUCTION
ThispaperdocumentsandanalysesthehealthpolicyprocessintheEnglish-speakingCaribbean.Usingacasestudyapproach,thestudyanalysesthepolicyprocessforNationalHealthInsuranceinTrinidadandTobago,StLuciaandStVincent&theGrenadines.
Inthelasttwodecades,governmentsintheEnglish-speakingCaribbeanhavebeendiscussingoptionsforincreasingfundstotheHealthSector.MinistriesofHealthhadits’budgetsreducedinrealterms,ascompetingnationalprioritiesandincreasingcostofdeliveringhealthcarecontinuetostripthefinancialresourcesavailabletopublichealthservicesintheRegion.Asaresult,somecountriesenteredintoinvestigationstowardstheuseofalternativemethodsforfundingtheirhealthservicesincluding,NationalHealthInsuranceandUser-Fees.ThisstudyfocusesonNationalHealthInsurance,asitwasidentifiedasthemostsoughtafteroptionamongcountriesintheRegion.
AlthoughafewcountriesdecidedtoimplementNationalHealthInsuranceandformulatedpoliciestowardsitsimplementation,nonewereabletooperationalisetheirprogrammes.Itisprudentthataninvestigationofthepolicyprocessisconductedatthistime,inordertodocumenttheprocessesinvolvedduringtheearlystagesofpolicydevelopment.Byunderstandingtheprocessesinvolvedinagendasetting,decisionsmakingandpolicyformulation,countriesintheRegioncanusethisinformationtoassistindeterminingthesuitabilityofaNationalHealthInsuranceand/orforbetterformulationandimplementationoftheirownNationalHealthInsuranceProgrammes.
1.1AIMANDOBJECTIVES
TheaimsandobjectiveofthisstudyweredevelopedfromaninitialinvestigationofHealthSectorReformintheEnglish-speakingCaribbean.ThisRegionischosenforthestudybecauseofacommoncolonialhistory,theexistenceofsimilarpublicservicestructuresandasharedidentitythroughorganisationsliketheCaribbeanCommunityCommonMarket(CARICOM)andtheOrganisationforEasternCaribbeanStates(OECS).Amongthereformsidentified,itwasfoundthatrestructuringofHealthSectorFinancingwasthemostcommonreformonthepolicyagenda.Inaddition,governmentsweremostinterestedindevelopingNationalHealthInsurance(NHI)asameansofincreasingfundstotheHealthSector.
1.1.1Aim
Theaimofthisstudyis:
Toconductananalysisofthepolicyprocess(agendasetting,policyformulationandimplementation)forNationalHealthInsurance,throughacomparativecasestudyofthreecountriesintheEnglish-speakingCaribbean,inthecontextofHealthPolicyReform.
1.1.2Objectives
Theobjectivesofthestudyindicatehowtheaimwillbeachieved.Theseobjectivesareasfollows:
❑Todocumenttheevolutionofpolicies(stepsinagendasetting,policyformulationandimplementation)forNationalHealthInsuranceinTrinidadandTobago,StLuciaandStVincent&theGrenadines.
❑ToanalysethepoliciesforNationalHealthInsuranceineachcountrybyinvestigatingthe;
a.context
b.process
c.actors
d.content
involvedineachcountry’spolicyprocess.
❑Toidentifythefactorsthatfacilitatedand/orconstrainedtheformulationandimplementationofpoliciesforNationalHealthInsurance.
❑Tocompareeachcountry’sexperienceoftheformulationandimplementationofpoliciesforNationalHealthInsurance.
1.1.3BroadResearchQuestions
Asadevelopmentfromtheresearchobjectivesthreebroadresearchquestionswereidentifiedtoguidetheresearchprocess.Thesebroadresearchquestionsareasfollows:
❑WhatprocessesareinvolvedindevelopingpoliciesforNationalHealthInsuranceintheEnglish-speakingCaribbean?
❑Whatfactorsfacilitatedand/orconstrainedtheformulationandimplementationforNationalHealthInsurancepolicies,amongthosecountriesintheEnglish-speakingCaribbeanthatinitiatedNationalHealthInsuranceschemes?
❑WhatlessonscanbelearntfromtheexperiencesofthesecountriesinNationalHealthInsurance,todeterminetheappropriatenessand/ordevelopmentofNationalHealthInsuranceforothercountriesintheRegion?
1.2HEALTHPOLICYREFORMINTHEENGLISH-SPEAKINGCARIBBEAN
TheEnglish-speakingCaribbeanconsistsof19countrieswithacombinedpopulationofapproximately6.3millionpeople.Thecountriesareclassifiedasmiddleorlow-incomedevelopingcountriesandhaveagriculture,tourism,bauxiteandpetroleumasthemajorcontributorstotheRegion’seconomy.In1998,estimatesofunemploymentvariedbetweenthecountries,rangingfrom15to25percentofthelabourforce.
Likemostformercolonialcountries,healthservicesbeganasaserviceforcolonialregimentsandadministrators(Zwi&Mills1995,Gulliford1994).AstheIslands’politicalstructuresdeveloped,healthserviceswerealsoexpandedtoprovidea
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- The Process of Health Policy Reform in EnglishSpeaking Caribbean
链接地址:https://www.bdocx.com/doc/28053896.html