Journal of public health policy
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J Public Health Policy · Jan 1996
ReviewGeneral practice fundholding in the UK National Health Service: evidence to date.
The published evidence on the effects of General Practitioner Fundholding, a major feature of the 1991 reorganization of the UK National Health Service, is reviewed with regard to the source and character of the evidence, as well as the findings on the outputs (including referrals, prescribing, service shifts, and the attitudes of various actors); the processes (inter- and intra-organizational); and the inputs (costs). An overall assessment based on this evidence is presented; the latest political and organisational developments in NHS primary care are outlined; and the future of GP fundholding is discussed.
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J Public Health Policy · Jan 1996
The economic costs of cardiovascular disease mortality in California, 1991: implications for public health policy.
This study estimates costs of lost productivity in California due to cardiovascular disease (CVD) mortality. Death records were used to calculate mortality losses including the number of deaths due to CVD, Years of Potential Life Lost (YPLL), and the value of productivity losses. ⋯ Racial/ethnic differences in YPLL are pronounced, which likely reflect the long-standing inverse association between CVD mortality and socioeconomic status that has been documented in a variety of populations worldwide. While it is important to effectively retain or develop low risk behaviors in populations, it is equally important to reduce barriers engendered by social, economic, and political patterns that inhibit the compression of CVD morbidity and mortality.
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The health care system of Chile evolved from rather unique historical circumstances to become one of the most progressive in Latin America, offering universal access to all citizens. Since the advent of the Pinochet regime in 1973, Chile has implemented Thatcherite/Reaganite reforms resulting in the privatization of much of the health care system. ⋯ As Chile emerges from the shadow of the Pinochet dictatorship, it faces numerous challenges as it struggles to rebuild its health care system. Other developing nations considering free-market reforms may wish to consider the high costs of the Chilean experiment.
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This study determined differences in U. S. local health department (LHD) expenditures between 1989 and 1993 and examined the factors that were associated with those changes. ⋯ The median change in LHD budgets was 0.2% growth per year. Significant associations were found between the likelihood of a department experiencing a budget increase and several measures describing the LHD's administrative and economic environment.
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J Public Health Policy · Jan 1996
Overcoming a powerful tobacco lobby in enacting local smoking ordinances: the Contra Costa County experience.
As part of a comprehensive tobacco education campaign, local health departments throughout California have been engaged in the process of enacting local clean indoor air ordinances to protect the public from the effects of secondhand smoke. This paper describes how a Northern California Bay Area health department worked with city and county governments to pass ordinances in the face of persistent tobacco industry opposition. ⋯ Tobacco industry tactics included establishing local front groups that launched a massive misinformation campaign to frighten local businesses into believing that passage of an ordinance would adversely affect their business. Finally, the authors discuss how the tobacco industry has created a climate through state and national legislative activity to undermine the ability of local health departments to pursue effective tobacco control policies, most notably through preemptive legislation.