Interest Groups and Health Facility Regulation - Future Directions for Health Policy and Systems Research Comment on "What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya's Health Facility Inspection Reforms"

In their paper, Tama and colleagues observe that one key challenge in a pilot, multi-component intervention to strengthen health facility regulation was the reaction from health facility owners and providers to regulatory processes. In this commentary, we propose that future research and action on health facility regulation in low- and middle-income countries (LMICs) contexts adopt an explicit focus on addressing the role of interests and interest groups in health systems 'hardware' and 'software.' Research on policy processes in LMICs consist of fewer investigations into the political economy of national or sub-national interest groups, such as physician associations or associations of health facility owners. A growing body of literature explores supply-side and demand-side interest groups, power relations within and between these stakeholders, and their advocacy approaches within LMIC health sector policy processes. We posit that such analyses will also help identify facilitators and challenges to implementation and scale-up of similar reforms to health facility regulation.

Institutional non-participation in assisted dying: Changing the conversation

Whether institutions and not just individual doctors have a right to not participate in medical assistance in dying (MAID) is controversial, but there is a tendency to frame the issue of institutional non-participation in a particular way. Conscience is central to this framing. Non-participating health centres are assumed to be religious and full participation is expected unless a centre objects on conscience grounds. In this paper we seek to reframe the issue. Institutional non-participation is plausibly not primarily, let alone exclusively, about conscience. We seek to reframe the issue by making two main points. First, institutional non-participation is primarily a matter of institutional self-governance. We suggest that institutions have a natural right of self-governance which, in the case of health centres such as hospitals or hospices, includes the right to choose whether or not to offer MAID. Second, there are various legitimate reasons unrelated to conscience for which a health centre might not offer MAID. These range from considerations such as institutional capacity and expertise to a potential contradiction with palliative care and a concern to not conflate palliative care and MAID in public consciousness. It is a mistake to frame the conversation simply in terms of conscience-based opposition to MAID or full participation. Our goal is to open up new space in the conversation, for reasons unrelated to conscience as well as for non-religious health centres who might nonetheless have legitimate grounds for not participating in MAID.

Universal Design as a Technical Norm and Juridical Term - A Factor of Development or Recession?

Universal design was introduced as an ideological and technical concept in Norway in 1996 and was introduced in the first law in 2003. Since then universal design has replaced accessibility for people with disabilities in national policies, laws, regulations, standards, projects and everyday language. Accessibility is now used to characterize solutions made more exclusively for people with disabilities or when a high, general quality is not required. Few countries have made this extensive use of the concept of universal design and the concept has faced several challenges from lawmakers, architects, economists, user organizations, entrepreneurs and debaters. This paper reflects on some aspects of more than 20 years of extensive use of the concept of universal design and try to answer the question: Is universal design an academic invention with little extra positive impact compared to accessibility for people with disability, or does the concept defend its supposed role as a step towards a society with equal opportunities for all?

Proposals for harmonization of allergens regulation in the European Union

Allergen medicinal products in the European Union are regulated differently across the different Member States. Thus, whereas in some countries strict quality, safety and efficacy requirements are in place, in others, most allergens are on the market as Named Patient Products, without any regulatory oversight. This situation results on European allergic patients being exposed to totally different standards depending on where they live. Initiatives to correct this situation are needed.

Push is on to lift Medicaid restrictions on substance abuse centers

Allowing substance abuse centers to be reimbursed under Medicaid could open more beds to patients in need, experts say.

Inspector Perceptions of the Food and Drug Administration's Newest Recommended Food Facility Inspection Format: Training Matters

The Food and Drug Administration publishes the Food Code to guide restaurant inspections. The most recent version proposes a three-tier system categorizing violations as priority, priority foundation, and core. This study used a scenario-based questionnaire to examine inspector perceptions and preferences for inspection formats. Results suggest that inspectors would be able to maintain consistent evaluations when changing to the three-tier system, although the classifying terms under the three-tier system were confusing. Additionally, inspectors were not very positive about the new system; they were concerned that the new system would not be easy to understand and use, inspections would take a longer time, it would not accurately reflect the amount of risk associated with violations, and it would not be easy for consumers and managers to understand and use. The results suggest the need for additional training for inspectors before adoption, especially on the rationale and benefits of changing to a three-tier system.

Consumer Perception of the Food and Drug Administration's Newest Recommended Food Facility Inspection Format: Words Matter

The Food and Drug Administration recommended restaurant inspection scores change to a format that incorporated three new categories of violations: priority, priority foundation, and core. It was uncertain whether interested consumers would value the more in-depth information or become more confused. The purpose of this study was to assess consumer perception of the recommended inspection system. Data were collected from an online survey. Results showed that consumers want convenient access to the information either online or on the wall of restaurants, and some consumers do want to read inspection reports and use them in making dining decisions. Choice of restaurant inspection format did appear to change consumer understanding and perceptions about some of the violations. Results also demonstrated the importance of the words used to categorize violations.

Dual-eligibles could offer relief for hospital readmissions penalties

The CMS is exploring how to levy excess readmission penalties fairly on hospitals, based on their patient population.

Heat-Related Illnesses

Heat-related illnesses can occur in workplaces where hot environments pose a threat to at-risk workers. Operations involving high air temperatures and humidity, radiant heat sources, direct physical contact with hot objects, or strenuous physical activities have potential for inducing heat stress in employees engaged in job functions in specific industries. Exposure to high temperatures can lead to a progression of symptoms in the body, which can result in widespread tissue damage, organ damage, and even death if not treated in a timely and effective manner. Strategies to reduce the effects of heat in the workplace include engineering controls, administrative controls, and personal protective equipment. Occupational and environmental health nurses must be able to recognize and treat the broad range of symptoms that can result from exposure to high temperatures. They must work together with interdisciplinary teams to provide training and education to the work force so that workers are able to take appropriate measures to prevent the onset of a heat-related illness, recognize the early symptoms, and seek treatment. Interdisciplinary teams must ensure that appropriate controls in the work environment reduce the risk of heat exposure and related heat stress disorders. Education and early intervention are key to avoiding heat-induced illness and eliminating or minimizing the effects of high temperature environments.

An international constant: the crucial role of policy competence in the effective strategic management of health services organizations

In view of the pervasive impact of government policies on health services organizations worldwide, policy competence is an increasingly important element in the successful strategic management of these organizations. This article discusses a conceptual perspective of policy competence, including three intertwined components of this competence. Firstly, policy competence is built upon understanding the government policies that affect health services organizations, as well as understanding the process by which such policies are made and the forces that can affect the process and its outcomes. Secondly, policy competence helps strategic managers anticipate and lead responses of health services organizations to the opportunities and threats emanating from their policy environments. Finally, policy competence assists strategic managers to participate effectively in shaping the policy environments of health services organizations to the benefit of these organizations.

A health and environmental profile of the dry cleaning industry in King County, Washington

Workers in the dry cleaning industry are exposed to a variety of harmful solvents, and poor work practices can result in extensive environmental contamination. Of particular concern is perchloroethylene (PERC), which is the most commonly used cleaning solvent. This chlorinated hydrocarbon is a pervasive environmental contaminant and a probable human carcinogen. PERC is also a neurotoxin and is toxic to the liver and kidneys. The study described here was comprised of key informant interviews, site visits, and a countywide business survey. The 64% response rate to the survey suggests that the results are likely representative of King County's dry cleaning industry. Dry cleaning was determined to be dominated by small, Korean-owned, family-run businesses. Although the use of PERC as the primary dry cleaning agent has decreased in recent years, this solvent is still used by the majority of businesses. This industry would benefit from regulatory intervention in concert with an educational campaign and enhanced technical and financial assistance. For any intervention to be effective, however, it must account for the unique financial and demographic characteristics of this industry.