Fertility control policy, social policy and population policy in an industrialized country

The recent history of political and social policies of fertility control in the United States is recounted. Surveys in 1941, 1955, and 1960 showed that contraception was widespread, but the poor tended to be less successful because they used less effective methods and initiated contraception later. Contraception was first mentioned in public press in 1955, first prescribed in municipal hospitals in 1958, first provided in Foreign Assistance in 1963. Some states repealed restrictive laws ag ainst disseminating contraceptive information in 1965. The Supreme Court ruled that married couples are free to use contraception in 1965, extended this right to unmarried in 1972, and in 1973 overturned state abortion restrictions for first trimester. Funds were allocated by Congress for family planning under the Economic Opportunity, Social Security, Foreign Assistance and Population Research Acts. Within the U.S. 3.5-4 million poor and marginally poor women have benefited by services in over 3000 clinics. The author calculated that expenditures for family planning rose from .02% in 1968 to .14% in 1972 of all U.S. social welfare expenditures. Since 1972, the administration has not expanded services, so that rural poor and adolescents remain without contraception. Thus experience shows that efforts to reduce fertility complement other social and economic welfare programs. The polar views that only compulsory population control, or only economic assistance without providing family planning, will solve the population problem are refuted by this analysis.     

A humane policy is also an efficient policy

The population issue and the policy-making process are connected to the politics of control at every level (from the international level to the couple level); to the political economy (i.e., growth path and its management); to the finance and organization of development delivery; and to ethics (i.e., respect for humans and the trust that people can make rational decisions). The Swaminathan Committee has examined all these connections. It has arrived at a general consensus that population and its management are not just issues of contraceptive distribution but are macro-economic and political issues. It visualizes a community-based program that requires the state governments to divest themselves of power, particularly schemes and funds. The committee proposes that the monitoring and evaluation process should no longer revolve around reaching targets to one where local committees, whose members are people of integrity, conduct social audits. Through social development indices (e.g., sex ratio, reducing abuse of women, and increasing enrollment of girls in school), the peoples' representatives are held accountable to their constituents. The committee recommends the establishment of a population social development fund and commission. The fund would make sure that social development, and not fertility control, is safeguarded. It would allow local governments and voluntary groups to adopt the more controversial approach (i.e., poverty reduction). All subdepartments of the health ministry should be integrated through one window for health. The main vehicle for health care delivery should be the primary health centers. They should be modernized to include operating rooms that could handle abortions and other surgeries. The people of the villages will resist these proposed changes in the institutional framework. They involve making hard choices on allocation of resources within health. The State needs to be a strong advocate for the changes.     

社会医疗保险的政策选择与政策偏好

社会医疗保险政策选择是医疗保险体系的重要组成部分,与体系中的行为主体存在紧密联系和关联,影响着整个体系的效率(效益),发挥着不可替代的作用,构成事实上的一种机制。医疗保险政策选择主体偏好显示的制度供给存在短缺。     

政策导向

卫生部与国家行政学院举行战略合作框架协议签署仪式2012年5月28日,卫生部与国家行政学院在京举行战略合作框架协议签署仪式。卫生部党组书记、副部长张茅,国家行政学院党委书记、常务副院长李建华出席’签署仪式并讲话。卫生部党组成员、副部长陈啸宏,国家行政学院党委委员、副院长何家成代表双方签署框架协议。国家行政学院党委委员、副院长洪毅,党委委员、教务长杨克勤等出席签署仪式。     

我国疫苗管理政策文本的量化研究——基于政策工具、政策主体、政策落点的文本分析

目的：剖析我国疫苗管理政策文本,探讨现行政策的侧重点及不足,以期为我国疫苗领域的良性发展提供建议。方法：检索2016年后发布的国家级疫苗管理文本,建立政策工具、政策主体、政策落点的三维框架,运用内容分析法开展研究。结果：本文共纳入17份政策文本,4类21种政策工具呈现“命令及规制性工具主导（74.90%）、能力建设性工具支持（16.73%）、激励性与信息及劝诫性工具欠缺（8.37%）”的差异化使用格局;药品监管部门（21.51%）、疫苗生产经营企业（17.13%）、卫生行政部门（9.96%）等主体作用更明显;政策落点则集中于疫苗使用（31.87%）、疫苗流通（20.32%）、疫苗生产（19.92%）。结论：建议加强激励性、信息及劝诫性工具的运用,提升政策工具内部的均衡性与互补性;深化各主体的参与程度,重点提升社会公众及行业协会的参与深度与共建能力;加强政策落点间的紧密衔接,紧抓追溯与监测环节的落实与完善,促进政策工具、政策主体、政策落点的多维耦合,进一步建设科学、高效、完善的疫苗管理体系。     

我国DRG政策的文本量化分析——基于政策目标、政策工具和政策力度的三维框架

目的：观察我国2009—2021年DRG政策在政策目标、工具和力度不同维度上的分布特征,为健全我国DRG政策体系提供参考。方法：用内容分析和定量分析方法,构建“基于政策目标、政策工具和政策力度”的三维框架,对国家层面DRG政策条目进行多维分类和交叉对比分析。结果：纳入74份政策文本共生成553条政策文本编码,我国DRG政策在数据标准化、绩效评价、医保支付、基金监管四个目标上的频次分别为226（40.87%）、60（10.85%）、159（28.75%）、108（19.53%）;供给型、环境型、需求型政策工具依次占23.15%（128/553）、58.95%（326/553）、17.90%（99/553）;我国DRG政策平均力度得分为2.959。讨论： DRG基本政策工具均衡性缺位,其内部结构有待优化;政策目标间缺乏协同性,要加强政策制度间的衔接,发挥政策目标的协同效应;政策力度整体偏弱,政策目标、工具和效力间不匹配,要着力加强部门间的协作,提高政策力度。     

中国生育政策的文本量化分析——基于政策工具、政策包容性、政策力度的三维分析框架

目的：对我国实施全面二孩政策以来的生育政策进行文本量化分析,为完善我国生育政策提供建议。方法：检索2016年以来发布的国家层面的生育政策文本,构建政策工具、政策包容性、政策力度三维分析框架,并对政策文本进行多维度及交叉对比分析。结果：本文共纳入45份政策文本,命令及规制性工具、能力建设性工具、激励性工具和信息及劝诫性工具占比依次为50.90%、39.16%、9.34%和9.94%;政策文本在尊重生育理念、促进生育公平、提升社会福祉三个政策包容性类型上分别占比12.14%、20.39%、67.48%;我国生育政策力度平均得分为2.67。结论：生育政策的政策工具内部均衡性不足,激励性与信息及劝诫性工具的使用有待加强;政策包容性类型丰富但使用不均衡,需要进一步促进性别平等和生育公平;政策力度整体偏弱,且与政策主体协调性不足,应进一步深化多部门参与协作,从财政、教育、文化等多个层面落实好生育配套措施,创建生育友好型社会。     

运用政策循环分析法论证我国综合烟草控制策略

运用政策循环分析和诊断树的方法,在文献收集、回顾和专家访谈的基础上,探询我国目前烟草控制工作的主要问题,及这些问题的根源,并在此基础上提出政策建议。     

Learning from policy failure and failing to learn from policy

Evaluation studies provide a key source of learning from policysuccess and failure. Policy interventions and their evaluationare, however, drenched in inescapable complexity. This makesit more difficult to evaluate this kind of intervention in thehighly regarded randomized experimental design. Based on theexperiences of the Health Action Zones (HAZs), Judge and Bauldoutline key elements of a more realistic evaluation framework,which might contribute to a further understanding of complexpolicy initiatives in the field of public health.¹ Their recommendationsprovide a good basis for the further development of the     

Health policy analysis: a simple tool for policy makers

Policy analysis is not an easy task. Its scope is broad and can include both the analysis of policy process and the analysis of policy content. This paper is concerned with the analysis of policy content and offers some practical guidance regarding how to analyse health policy and link it to health outcomes. An eight-step framework for policy analysis is proposed that public health policy makers and public health practitioners may find especially useful due to its simplicity.     

Motor vehicle deaths: failed policy analysis and neglected policy

The author of a recent book inferred that the slowed decline in U.S. vehicle fatality rates in the 1990 s relative to other industrialized countries resulted from too much emphasis on vehicle factors. He claimed that Canada had the same vehicle mix but a lower fatality rate. Actually, U.S. death rates by make and model applied to Canadian vehicle sales indicates that Canada's death rate would be the same as the U.S. if Canada had the same vehicle mix and annual miles driven. The U.S. had much greater growth in sales of large SUVs and pickup trucks that are heavier and stiffer than passenger cars, contributing to excess deaths of other road users in collisions. They are also more unstable, contributing to excess deaths of their occupants in rollovers. Lack of policy regarding these vehicle characteristics is the primary reason for the attenuated decline in vehicular fatality rates.