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In international literature policy documents are consideredas major strategic tools for health promotion in schools. InSweden, since 1991, local municipalities are obliged to producea politically approved school plan for compulsory schools, grades1–9, i.e. policy instruments which should indicate theaims and objectives, the moral and political values of the municipality.The aim of this study was to describe the content of schoolplans, focusing on health and environment in 1994 in 62 municipalitiesin four counties in Sweden, using content analysis. The studywas implemented as a total investigation of the 62 municipalitiesbased on the principles of purposeful sampling procedures inorder to provide selections of informative cases for in-depthstudies. The content analysis was conducted in four steps. Twelvethemes were identified in the school plans, representing differentissues on health and environment in the first step. Secondly,quotations illustrate and provide a broader meaning of themes.Third, similarities and differences between the counties andmunicipalities are summarized. Finally, the strategic componentsof the HELPSAM model (The HEaLth Promotion Strategy AnalysisModel) are presented in relation to the 12 themes. As policydocuments the school plans seem to be valid instruments to promotethe intentions of the municipality concerning health promotion.A supportive environment for health relates to the physicaland social aspects of our surroundings, and these aspects areprominent as themes of the school plans. The major part of themunicipalities has focused on environmental issues, well inadvance of the desired development of a local Agenda 21. Thefinding points out a rapid diffusion of environmental questionsin the Swedish society, at least in the counties of concern.  相似文献
目的 分析与探寻城市优质医疗资源下沉中的卫生政策工具选择依据与途径,为政策推进提供参考.方法 对济宁市“万名保健医生进农户”活动进行现场调查,共调查入村医生453人,乡村医生294人,居民572人;对资料进行描述性分析.结果 “万名保健医生进农户”活动公平性方面,农村居民签约率为97.8%,家庭保健医生义诊171.5万次;经济性方面,上级医生、乡村医生与农村居民认为,政策能促进城市优质资源下沉农村,能提升村医公共卫生服务水平;适应性方面,60.4%的上级医生与92.7%的乡村医生认为能胜任保健医生角色,但51.8%的上级医生不习惯当前的工作方式;可执行性方面,工作量增加、工作时间被占用、诊疗设备配备不足、机构业务收入减少,是上级医生与乡村医生主要抱怨所在;可接受性方面,90.4%的农村居民表示支持.结论 政府在推进优质医疗资源下沉中,应在充分考虑强制性、自愿性与混合型政策工具特点的基础上,对卫生政策工具进行适当选择与优化,才能保证政策推进效果.  相似文献
Universal public finance (UPF)—government financing of an intervention irrespective of who is receiving it—for a health intervention entails consequences in multiple domains. First, UPF increases intervention uptake and hence the extent of consequent health gains. Second, UPF generates financial consequences including the crowding out of private expenditures. Finally, UPF provides insurance either by covering catastrophic expenditures, which would otherwise throw households into poverty or by preventing diseases that cause them. This paper develops a method—extended cost‐effectiveness analysis (ECEA)—for evaluating the consequences of UPF in each of these domains. It then illustrates ECEA with an evaluation of UPF for tuberculosis treatment in India. Using plausible values for key parameters, our base case ECEA concludes that the health gains and insurance value of UPF would accrue primarily to the poor. Reductions in out‐of‐pocket expenditures are more uniformly distributed across income quintiles. A variant on our base case suggests that lowering costs of borrowing for the poor could potentially achieve some of the health gains of UPF, but at the cost of leaving the poor more deeply in debt. © 2014 The Authors. Health Economics published by John Wiley Ltd.  相似文献
政策工具是公共政策分析的一种重要方法。通过设计分析框架、划定分析模块、制订条目编码分类以及频数统计,对我国出台的16份"医养结合"相关政策文件的政策工具进行分析,发现我国"医养结合"政策在政策工具选择、构建中存在过溢和缺失的问题;提出了符合实际的政策优化和完善建议,以期为我国"医养结合"政策发展提供借鉴。  相似文献
This paper reports findings from an evaluation of the local implementation of a procedural public health programme whose objective is to create healthy environments (HE) for vulnerable families in the province of Quebec (Canada) through the funding of local projects. Considering the potential issue of programme–context interaction, our research question was the following: Does the procedural nature of this HE programme result in variation between local cases in terms of the types of projects and collaborations it subsidizes? Given that the creation of healthy environments requires intersectoral health action to address social determinants of health, the data were analysed with respect to intersectorality and cooperation. Results of this qualitative multiple case study (n = 8), for the period 2004–2009, show that the majority of subsidized projects were in the health and social services sector and focused on parenting, parent–child attachment, nutrition and the social networks of families. Only a few initiatives reached beyond the health and social services sector to address social health determinants such as education, housing and transportation. Membership and mandates of the local groups responsible for programme implementation also showed little intersectorality. The limited variation between these eight cases can be attributed to the configuration of the local networks, as well as to specific issues in urban and rural areas. To explain the overall similarity of results across cases, we turned to the literature on policy instruments which suggests that particular characteristics of a programme may produce effects that are independent of its intended objective. In our study, several programme mechanisms, such as those framing the definition of «healthy environment» and budget management rules, could have encouraged the local development of initiatives that focus on individual skills related to parenting and attachment rather than the development of intersectoral health action to address social determinants of health.  相似文献
目的:分析深化医改以来的社会办医相关政策的内容、特点和趋势,为社会办医政策的完善和实施提供参考。方法:将2009—2017年间国家层面出台的39份社会办医相关的政策文本作为研究对象。基于Rothwell和Zegveld对政策工具的分类,构建政策分析框架。对政策文本进行编码、归类,分析政策工具使用情况。结果:社会办医相关政策出台主要集中在2015年以前。深化医改以来,在政策工具利用方面,环境型政策工具(77. 29%)使用最多,其次为供给型政策工具(13. 56%)和需求型政策工具(9. 15%)。2009年,社会办医政策仅使用了环境型政策工具(83.33%)和需求型政策工具(16. 67%)。2010—2015年,环境型政策工具的占比呈现先上升后下降的趋势,供给型和需求型政策工具使用频率均呈先下降后上升的变化趋势。2016—2017年,环境型政策工具占比高达92%。结论:我国现有社会办医的政策工具以环境型为主,未来对环境型政策工具使用的结构有待进一步优化。政策中需求型和供给型政策工具的使用仍有待加强。  相似文献
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