Technology. IT comes together

After years of decentralizing IT systems, large health networks are bringing back-office functions under one roof hoping for economies of scale.     

Actor management in the development of health financing reform: health insurance in South Africa, 1994-1999

Health reform is inherently political. Sound technical analysis is never enough to guarantee the adoption of policy. Financing reforms aimed at promoting equity are especially likely to challenge vested interests and produce opposition. This article reviews the Health Insurance policy development in South Africa between 1994 and 1999. Despite more than 10 years of debate, analysis and design, no set of social health insurance (SHI) proposals had, by 1999, secured adequate support to become the basis for an implementation plan. In contrast, proposals to re-regulate the health insurance industry were speedily developed and implemented at the end of this period. The processes of actor engagement and management, set against policy goals and design details, were central to this experience. Adopting a grounded approach to analysis of primary interview data and a range of documentary material, this paper explores the dynamics between reform drivers engaged in directing policy change and a range of other actors. It describes the processes by which actors were drawn into health insurance policy development, the details of their engagement with each other, and it identifies where deliberate strategies of actor management were attempted and the results for the reform process. The primary drivers of this process were the Minister of Health and the unit responsible for health financing and economics in the national Department of Health Directorate of Health Financing and Economics, with support from members of the South African academic community. These actors worked within and through a series of four ad hoc policy advisory committees which were the main fora for health insurance policy development and the regulation of private health insurance. The different experiences in each committee are reviewed and contrasted through the lens of actor management. Differences between these drivers and opposition from other actors ultimately derailed efforts to establish adequate support for any form of SHI, even as regulatory proposals received sufficient support to be enacted in legislation. Drawing on this South African experience together with a simple analytical framework, the authors highlight five potential strategies by which reform drivers of any policy process could create alliances of support sufficient to overcome potential opposition to proposed policy changes. As little is currently known on how to manage the process of engaging actors in reform processes, these findings provide a foundation for further analysis of this issue.     

Putting the whole grain puzzle together: health benefits associated with whole grains--summary of American Society for Nutrition 2010 Satellite Symposium

The symposium "Putting the Whole Grain Puzzle Together: Health Benefits Associated with Whole Grains" sponsored by the ASN brought together researchers to review the evidence regarding the health benefits associated with whole grains. Current scientific evidence indicates that whole grains play an important role in lowering the risk of chronic diseases, such as coronary heart disease, diabetes, and cancer, and also contribute to body weight management and gastrointestinal health. The essential macro- and micronutrients, along with the phytonutrients present in whole grains, synergistically contribute to their beneficial effects. Current evidence lends credence to the recommendations to incorporate whole grain foods into a healthy diet and lifestyle program. The symposium also highlighted the need for further research to examine the role of whole grain foods in disease prevention and management to gain a better understanding of their mechanisms of action.     

Biosafety, environmental protection and health: completing the puzzle

This work reflects on the development of the field of Biosafety. The scope of this field is presented, as well as its complex themes and its interdisciplinary perspective. The scope of this field is to propose actions capable of preventing and controlling the risk of worsening human and environmental health. This is done in order to provide alternatives to the theoretical and practical challenges posed by the rapid changes in the world, resulting from human intervention in nature and mediated by scientific and technological advances. We address questions that place Biosafety as a tool in the search for a model of sustainable development, establishing the relationship between environmental degradation, precarious health conditions, and control of the emergence and reemergence of diseases in populations.     

Pieces of the puzzle: steps toward affordable health care

This essay proposes a multiple-part solution to the health care affordability crisis. Solution elements include: changing the most commonly held health insurance product to a plan with high-deductible design, and reinstituting community-based health planning. It is proposed that the federal tax code be used to create incentives to change the most commonly held benefit. Further, it is suggested that "capital licenses" be provided to support health planning.