Tobacco control advocates must demand high-quality media campaigns: the California experience.
OBJECTIVE: To document efforts on the part of public officials in California to soften the media campaign's attack on the tobacco industry and to analyse strategies to counter those efforts on the part of tobacco control advocates. METHODS: Data were gathered from interviews with programme participants, direct observation, written materials, and media stories. In addition, internal documents were released by the state's Department of Health Services in response to requests made under the California Public Records Act by Americans for Nonsmokers' Rights. Finally, a draft of the paper was circulated to 11 key players for their comments. RESULTS: In 1988 california voters enacted Proposition 99, an initiative that raised the tobacco tax by $0.25 and allocated 20% of the revenues to anti-tobacco education. A media campaign, which was part of the education programme, directly attacked the tobacco industry, exposing the media campaign to politically based efforts to shut it down or soften it. Through use of outsider strategies such as advertising, press conferences, and public meetings, programme advocates were able to counter the efforts to soften the campaign. CONCLUSION: Anti-tobacco media campaigns that expose industry manipulation are a key component of an effective tobacco control programme. The effectiveness of these campaigns, however, makes them a target for elimination by the tobacco industry. The experience from California demonstrates the need for continuing, aggressive intervention by nongovernmental organisations in order to maintain the quality of anti-tobacco media campaigns. (+info)
Regulating the private health care sector: the case of the Indian Consumer Protection Act.
Private medical provision is an important constituent of health care delivery services in India. The quality of care provided by this sector is a critical issue. Professional organizations such as the Medical Council of India and local medical associations have remained ineffective in influencing the behaviour of private providers. The recent decision to bring private medical practice under the Consumer Protection Act (COPRA) 1986 is considered an important step towards regulating the private medical sector. This study surveyed the views of private providers on this legislation. They believe the COPRA will be effective in minimizing malpractice and negligent behaviour, but it does have adverse consequences such as an increase in fees charged by doctors, an increase in the prescription of medicines and diagnostics, an adverse impact on emergency care, etc. The medical associations have also argued that the introduction of COPRA is a step towards expensive, daunting and needless litigation. A number of other concerns have been raised by consumer forums which focus on the lack of standards for private practice, the uncertainty and risks of medicines, the effectiveness of the judiciary system, and the responsibility of proving negligence. How relevant are these concerns? Is the enactment of COPRA really appropriate to the medical sector? The paper argues that while this development is a welcome step, we need to comprehensively look into the various quality concerns. The effective implementation of COPRA presumes certain conditions, the most important being the availability of standards. Besides this, greater involvement of professional organizations is needed to ensure appropriate quality in private practice, since health and medical cases are very different from other goods and services. The paper discusses the results of a mailed survey and interview responses of 130 providers from the city of Ahmedabad, India. The questionnaire study was designed to assess the opinion of providers on various implications of the COPRA. We also analyze the data on cases filed with the Consumer Disputes and Redressal Commission in Gujarat since 1991. Four selected cases filed with the National Commission on Consumers Redressal are discussed in detail to illustrate various issues affecting the implementation of this Act. (+info)
Nonprofit to for-profit conversions by hospitals, health insurers, and health plans.
Conversion of hospitals, health insurers, and health plans from nonprofit to for-profit ownership has become a focus of national debate. The author examines why nonprofit ownership has been dominant in the US health system and assesses the strength of the argument that nonprofits provide community benefits that would be threatened by for-profit conversion. The author concludes that many of the specific community benefits offered by nonprofits, such as care for the poor, could be maintained or replaced by adequate funding of public programs and that quality and fairness in treatment can be better assured through clear standards of care and adequate monitoring systems. As health care becomes increasingly commercialized, the most difficult parts of nonprofits' historic mission to preserve are the community orientation, leadership role, and innovation that nonprofit hospitals and health plans have provided out of their commitment to a community beyond those to whom they sell services. (+info)
Public advocacy and allocation of federal funds for biomedical research.
Members of Congress and officials of the National Institutes of Health face heightened pressure from public advocacy groups seeking more funding for research on specific health conditions. In response, Congress and the Institute of Medicine have urged the NIH to create more opportunities for the public to participate in decision making on allocation of biomedical research resources. The ethical and policy implications of including advocates in the deliberations are explored, leading to the conclusion that public participation could contribute to more defensible decisions under three conditions: public participants are fairly selected and meaningful opinions are solicited; public participants look beyond their narrow constituencies to consider the health needs of the broader public; and NIH officials develop materials to assist participants with their deliberations. (+info)
Reporting comparative results from hospital patient surveys.
Externally-reported assessments of hospital quality are in increasing demand, as consumers, purchasers, providers, and public policy makers express growing interest in public disclosure of performance information. This article presents an analysis of a groundbreaking program in Massachusetts to measure and disseminate comparative quality information about patients' hospital experiences. The article emphasizes the reporting structure that was developed to address the project's dual goals of improving the quality of care delivered statewide while also advancing public accountability. Numerous trade-offs were encountered in developing reports that would satisfy a range of purchaser and provider constituencies. The final result was a reporting framework that emphasized preserving detail to ensure visibility for each participating hospital's strengths as well as its priority improvement areas. By avoiding oversimplification of the results, the measurement project helped to support a broad range of successful improvement activity statewide. (+info)
Public disclosure of health care performance reports: comments and reflections from Sweden.
In all countries quality improvement is a very important issue. At the same time the demands for information from consumers are increasing. By combining these two principles we can gain a great deal. In my opinion we will go both ways. Bad results, if publicly disclosed, are probably the strongest incentive to improve if they are reliable. Confidential performance feedback for self improvement is the way Sweden is heading at the moment. In the near future, I am sure, we will publish performance reports accompanied by analytic comments regarding quality indicators that are well defined and easy for consumers to evaluate. A pre-condition is that the medical profession must have time to get accustomed. Only experience will show how to devise the most effective means to improve quality and confidence in health care. We will follow the progress in the USA with great interest. (+info)
Public disclosure of health care performance reports: a response from the UK.
In the UK, the experience with public disclosure of health care performance data related to provider organizations is limited to a small set of administrative data known as the 'Patient's Charter' which has concentrated mainly on aspects of efficiency and which is currently being reviewed, and, most recently, to a set of reference costs by case type (known as Healthcare Resource Groups). Clinically oriented performance data has been published in Scotland since 1994 and will be published in England and Wales early in 1999. Knowledge about the impact and effect of such publication is limited, even in the USA, but there is some evidence that consumers and purchasers become gradually familiar with them and confident in their use. However, even with this scant knowledge, it would appear that the publication of data across the public services will continue to be a policy of the current UK Government for the foreseeable future. It would seem likely that this policy will have the tacit approval of the general population who have been educated to be somewhat wary of professional self-regulation. The greater public accountability that public disclosure of information brings, needs to be evaluated against the overall costs of the exercise, particularly within a publicly financed system, and against the disadvantages in public confidence and impact on the patient-doctor relationship that might occur if not managed appropriately. (+info)
Lobbying and advocacy for the public's health: what are the limits for nonprofit organizations?
Nonprofit organizations play an important role in advocating for the public's health in the United States. This article describes the rules under US law for lobbying by nonprofit organizations. The 2 most common kinds of non-profits working to improve the public's health are "public charities" and "social welfare organizations." Although social welfare organizations may engage in relatively unlimited lobbying, public charities may not engage in "substantial" lobbying. Lobbying is divided into 2 main categories. Direct lobbying refers to communications with law-makers that take a position on specific legislation, and grassroots lobbying includes attempts to persuade members of the general public to take action regarding legislation. Even public charities may engage in some direct lobbying and a smaller amount of grassroots lobbying. Much public health advocacy, however, is not lobbying, since there are several important exceptions to the lobbying rules. These exceptions include "non-partisan analysis, study, or research" and discussions of broad social problems. Lobbying with federal or earmarked foundation funds is generally prohibited. (+info)