What type of information is needed to inform mental health policy?

The most valuable research integrates from thre levels of investigation: clinical efficacy, "real life" effectiveness (including cost-effectiveness) and policy research. Successful applications of systematic reviews have largely been limited to clinical efficacy questions. The contribution of systematic reviews/meta-analyses to effectiveness and economic questions in mental health has been very minor and their contribution to inform policy is negligible. The latter is unlikely to change due to the different type of information that policy makers need.     

What is population health?

Population health is a relatively new term that has not yet been precisely defined. Is it a concept of health or a field of study of health determinants? We propose that the definition be "the health outcomes of a group of individuals, including the distribution of such outcomes within the group," and we argue that the field of population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two. We present a rationale for this definition and note its differentiation from public health, health promotion, and social epidemiology. We invite critiques and discussion that may lead to some consensus on this emerging concept.     

What is evidence-based public health?

Evidence based Public Health is the execution and evaluation of the efficiency of interventions, plans, programs, projects and politics in public health through the application of the scientific principles of reasoning, including the systematic use of information and information systems. Evidence based public health involves the use of methodologies similar to those applied in evidence-based clinical medicine, but differs in its contents. In public health two types of evidence are described. The type I evidence in which a strong relation exists between the preventable risk and disease, and type II evidence in which there exists a relative effectivity of the public health interventions. In evidence based Public Health research designs more appropriate for the social sciences are used, as the observational and quasi-experimental studies. Likewise the decisions are more of interdisciplinary teams.     

What is consumer-directed health care?

To control health care costs, someone must choose between health care and other uses of money. The value of most health care is experienced subjectively, as is the value of other goods and services. No one is in a better position to make these subjective trade-offs than patients themselves. The current system not only systematically denies patients the opportunity to make such choices, it distorts the incentives of providers in the process. Chronic patients in particular would be much better off if they could manage more of their own health care dollars and if providers were free to compete to meet their needs.     

What is vaccine advocacy? Proposal for a definition and action

Successful immunization programmes have reduced the burden of a number of infectious diseases on a global scale. Yet, as the fear of sequelae of vaccine-preventable diseases diminishes in the public, the focus of interest has shifted towards true and alleged "side effects". Maintaining confidence in the necessity, tolerability and safety of immunizations is of paramount importance today. This requires, amongst other prerequisites, precise definitions of "adverse events following immunization". In Europe, a collaborative effort named EUSAFEVAC in concert with the globally active "Brighton Collaboration" has been initiated. Volunteers from academic institutions, vaccine licensing authorities, public health institutes, governmental organizations, safety units within the vaccine manufacturing industry as well as practising physicians are working together to achieve this goal.     

What is the health care product?

Because of the current competitive environment, health care providers (hospitals, HMOs, physicians, and others) are constantly searching for better products and better means for delivering them. The health care product is often loosely defined as a service. The authors develop a more precise definition of the health care product, product line, and product mix. A bundle-of-elements concept is presented for the health care product. These conceptualizations help to address how health care providers can segment their market and position, promote, and price their products. Though the authors focus on hospitals, the concepts and procedures developed are applicable to other health care organizations.     

What is a national health policy?

Unfortunately, most nation states have taken "health policy" to mean "medical care policy." Medical care, however, is only one variable in a nation's health equation. The article describes what the main components of a national health policy should be, including (1) the political, economic, social, and cultural determinants of health, the most important determinants of health in any country; (2) the lifestyle determinants, which have been the most visible types of public interventions; and (3) the socializing and empowering determinants, which link the first and second components of a national health policy: the individual interventions and the collective interventions. The author discusses the indicators that should be used for each component and for each intervention. The feasibility of this approach depends to a large degree on the political will of the national authorities and the broad understanding of the actual determinants of health. A good first step is the National Health Policy plan developed by the Swedish social democratic government. This article builds on and expands on that model.     

Promoting health information technology: is there a case for more-aggressive government action?

Health information technology (HIT) could save $81-$162 billion or more annually while greatly reducing morbidity and mortality. However, gaining these benefits requires broad adoption, effective implementation, and associated changes in health care processes and structures. The policy options that could speed the adoption of HIT and the realization of these benefits include incentives to promote standard-based electronic medical record (EMR) system adoption; subsidies to develop information-exchange networks; and programs to measure, report, and reward performance. Investments in these and other identified policy options should pay for themselves while also laying the foundation for needed transformation of the U.S. health care system.     

What is needed on a laboratory test request form?

In the development of a screening programme for genital tract Chlamydia trachomatis infection, a modified test request form was devised and used successfully both to request the test, to collect data and to inform patients. Our examination of the practicalities and ethical and confidentiality issues involved in making a request for a laboratory test to assist clinical diagnosis or management, resulted in the introduction of extra features that we had not previously seen used in the design of request forms. Coded response boxes can have adjacent questions attached as a perforated strip. Removal of this question strip leaves a completed form with no explicit sensitive data (figure 2). A detachable information sheet for patients can also be incorporated into the request form (figure 1). The design of a request form raises issues that do not appear to have been widely or formally debated.