Social science & medicine
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Analysis of a subset of data from a survey of 3696 relatives, friends and others who knew a sample of people dying in 1990 who lived in 20 areas of the United Kingdom (the Regional Study of Care for the Dying) is reported. Using the typology of awareness contexts developed by Glaser and Strauss [(1965) Awareness of Dying, Aldine, Chicago], the prevalence of different awareness contexts is described and compared with an earlier survey done in 1969. Open awareness of dying, where both the dying person and the respondent knew that the person was dying, is the most prevalent awareness context. ⋯ If dying from cancer, people in full open awareness are more likely to have received hospice care. It is suggested that underlying these patterns, and in contrast with some other cultures where awareness of dying is seen as less desirable, people dying in Anglophone countries are particularly concerned to maintain control over projects of self-identity. Their approach to death is a reflection of this individualism.
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Social science & medicine · Aug 1997
Economic evaluation in support of national health policy: the case of The Netherlands.
This article focuses on economic evaluation as an instrument to support national health policy in the Netherlands. National health policy concerns decision-making on which technologies may enter the health care market, which health care services are included in the package of health care benefits and under what conditions, and what the geographical distribution of medical services and facilities should be. Regarding the latter two issues in particular, the actual and potential role of economic evaluation in health policy is discussed. From the Dutch experience we can learn that a close cooperation between researchers and policy-makers helps to enlarge the impact of economic appraisal on policy-making and that incorporation of the right (financial) incentives is vital to the use of economic appraisal in health care decision-making.