Health policy
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The implementation of palliative care (PC) is an important challenge for health policy makers. The primary aim of this study was to analyze the effects of inpatient PC for cancer patients in the last six months of life. ⋯ Cancer patients treated on a PC inpatient unit where more likely to receive opioids (a surrogate for quality of end-of-life care) but where less likely to die at home and the cost of care for these patients was higher. The results can be interpreted both from (i) a methodological standpoint that assumes confounding due to the fact that the PC patients might have been suffering from more complex symptoms and (ii) a health policy view. For the latter it is important to recognize that the whole potential of PC can only be achieved if PC (a) is provided as a cross-sectoral network, (b) is integrated early in the disease (c) assures specialized PC expertise.
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Governments around the world are struggling to address persistent disparities in health care access. However, this priority competes with many others for support in moving onto and up the political agenda. In this paper, a novel method of agenda-setting analysis is developed by merging and modifying the Hall and Kingdon models. ⋯ Certain factors are identified that could have determined the agenda-setting process: a change in government, increase in the cost of private medical schemes, and increase in support for reform from various stakeholders. Further analysis, using a conceptual framework of interacting trends and shocks, identifies the growing middle class, the private sector, and workers unions as powerful actors and outlines further factors that may have contributed to the process: a broad political shift in the second half of the decade and the changing prioritisation of HIV/AIDS. Study findings have relevance to academics and policy makers in South Africa and beyond.