In this article, we compare two high‐profile strategic policy reviews undertaken for the U.K. government on environmental risks: radioactive waste management and climate change. These reviews took very different forms, both in terms of analytic approach and deliberation strategy. The Stern Review on the Economics of Climate Change was largely an exercise in expert modeling, building, within a cost‐benefit framework, an argument for immediate reductions in carbon emissions. The Committee on Radioactive Waste Management, on the other hand, followed a much more explicitly deliberative and participative process, using multicriteria decision analysis to bring together scientific evidence and stakeholder and public values. In this article, we ask why the two reviews were different, and whether the differences are justified. We conclude that the differences were mainly due to political context, rather than the underpinning science, and as a consequence that, while in our view "fit for purpose," they would both have been stronger had they been less different. Stern's grappling with ethical issues could have been strengthened by a greater degree of public and stakeholder engagement, and the Committee on Radioactive Waste Management's handling of issues of uncertainty could have been strengthened by the explicitly probabilistic framework of Stern.
AbstractThis study evaluates the mental health effects of two simultaneously implemented but conflicting policies in the UK: the National Living Wage and the benefits freeze policy. We employed the Callaway and Sant'Anna (2021) DID estimator to evaluate the heterogeneous policy effects, and we found that NLW leads to positive improvements in mental health. Also, we find the negative impact of the benefits freeze policy constricts the NLW effects. Our result is robust to the sensitivity analysis of the parallel trend assumption and the comparison group definition. Additional results support the psychosocial hypothesis that increased job satisfaction is strongly correlated with improvements in mental health. Also, we found evidence of substitution effects between work hours and leisure. Overall, our findings suggest that the effects of the NLW cannot be understood in isolation from the way the entire suite of policy instruments operates on earnings and liveable income for affected low wage workers.
Working from a description of what policy analysis entails, we review the emergence of the recent field of analytics and how it may impact public policy making. In particular, we seek to expose current applications of, and future possibilities for, new analytic methods that can be used to support public policy problem-solving and decision processes, which we term policy analytics. We then review key contributions to this special volume, which seek to support policy making or delivery in the areas of energy planning, urban transportation planning, medical emergency planning, healthcare, social services, national security, defence, government finance allocation, understanding public opinion, and fire and police services. An identified challenge, which is specific to policy analytics, is to recognize that public sector applications must balance the need for robust and convincing analysis with the need for satisfying legitimate public expectations about transparency and opportunities for participation. This opens up a range of forms of analysis relevant to public policy distinct from those most common in business, including those that can support democratization and mediation of value conflicts within policy processes. We conclude by identifying some potential research and development issues for the emerging field of policy analytics. ; The work of Katherine Daniell was supported by the HC Coombs Policy Forum. The HC Coombs Policy Forum and the Australian National Institute for Public Policy (ANIPP) received Australian Government funding under the 'Enhancing Public Policy Initiative'. The work of David Ríos is supported by the AXA-ICMAT Chair in Adversarial Risk Analysis, the AESA-RAC Agreement on Operational Safety, and the MINECO project MTM2014-56949-C3-1-R ; Peer Reviewed
Working from a description of what policy analysis entails, we review the emergence of the recent field of analytics and how it may impact public policy making. In particular, we seek to expose current applications of, and future possibilities for, new analytic methods that can be used to support public policy problem-solving and decision processes, which we term policy analytics. We then review key contributions to this special volume, which seek to support policy making or delivery in the areas of energy planning, urban transportation planning, medical emergency planning, healthcare, social services, national security, defence, government finance allocation, understanding public opinion, and fire and police services. An identified challenge, which is specific to policy analytics, is to recognize that public sector applications must balance the need for robust and convincing analysis with the need for satisfying legitimate public expectations about transparency and opportunities for participation. This opens up a range of forms of analysis relevant to public policy distinct from those most common in business, including those that can support democratization and mediation of value conflicts within policy processes. We conclude by identifying some potential research and development issues for the emerging field of policy analytics.
Working from a description of what policy analysis entails, we review the emergence of the recent field of analytics and how it may impact public policy making. In particular, we seek to expose current applications of, and future possibilities for, new analytic methods that can be used to support public policy problem-solving and decision processes, which we term policy analytics. We then review key contributions to this special volume, which seek to support policy making or delivery in the areas of energy planning, urban transportation planning, medical emergency planning, healthcare, social services, national security, defence, government finance allocation, understanding public opinion, and fire and police services. An identified challenge, which is specific to policy analytics, is to recognize that public sector applications must balance the need for robust and convincing analysis with the need for satisfying legitimate public expectations about transparency and opportunities for participation. This opens up a range of forms of analysis relevant to public policy distinct from those most common in business, including those that can support democratization and mediation of value conflicts within policy processes. We conclude by identifying some potential research and development issues for the emerging field of policy analytics.
In 2003, the UK government set up a broad‐based Committee on radioactive waste management (CoRWM) to look at the UK's policy on radioactive waste management with a view to jumpstarting a stalled policy process. The committee's brief was to come up with a set of recommendations that would protect the public and the environment, and be capable of inspiring public confidence. After consulting widely with the public and stakeholders, and drawing on advice from scientists and other experts, CoRWM arrived at a remarkably well‐received set of recommendations. On the basis of our experiences of working on CoRWM's multi‐criteria decision analysis of different management options, study of CoRWM documentation, and interviews with committee members, we describe the explicit and implicit principles that guided CoRWM. We also give an account of the process by which CoRWM arrived at its conclusions, covering four phases: framing, shortlisting, option assessment, and integration; and four cross‐cutting activities: public and stakeholder engagement (PSE), science and engineering input, ethics and social science input, and learning from overseas practice. We finish by outlining some of the key developments in the UK's radioactive waste management process, which followed on from the publication of CoRWM's report, and present our reflections for the benefit of the risk and decision analysts of future committees that, like CoRWM, are charged with recommending to government on the management of technically complex and risky technologies, drawing on extensive public and stakeholder consultation.
There is now high level international commitment to the goal of universal health coverage. But how can countries make this a reality in the face of a limited budget and an aging population? Since 2008, China has been rolling out an ambitious reform program, which aims to achieve affordable health insurance coverage for all Chinese citizens. Under this reform program, Chinese living in rural areas are eligible to enroll in a subsidized scheme called the New Cooperative Medical System (NCMS). Using a three stage game model involving a government, a private fund manager and population, we explore the impact of population aging on NCMS. Our model highlights the role of government regulation and subsidy in ensuring operation efficiency of the system. We show that at optimality the government sets the operating framework for the fund manager to constrain the potential for monopoly profits. The Government subsidizes the scheme to prevent an adverse selection death spiral. However, the effectiveness of the subsidy in achieving this goal is moderated by the age structure of the population. Our model gives insights into the strengths of the NCMS framework and also can be used to support decisions about resource allocation and understand how scheme dynamics may unfold as the Chinese population ages further.
Objectives As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. Methods A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. Results The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. Conclusions The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.
Objectives: Like many low and middle income countries, out-of-pocket payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burden of household. The objective of the study was to focus whether and to what extent socio-economic, demographic and behavioral factors of the population have impact on OOP expenditure in Bangladesh. Method: A total of 12,400 patients who spent for receiving any type of healthcare services were analyzed from Bangladesh Household Income and Expenditure Survey data, 2010. We employed a regression analysis for find out the factors influencing OOP health expenditure using ordinary least square method. Results: The mean total out-of-pocket healthcare expenditure was US$ 27.66; while cost of medicines (US$ 16.98) was the highest cost driver. In addition, the study identifies some significant factors influencing higher out-of-pocket health expenditure, namely, age, sex, marital status, place of residence, rich families. In contrary, unemployed and with no social financial safety were inversely associated. Conclusions: Findings of the study can help the decision makers by stating the determinants of OOP, discussing the mechanisms driving them and thus underscoring the need to develop policy options for the building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. Parallel to government action, the development of other prudential and sustainable risk pooling mechanism and so may be most enthusiastic subscribers to community-based health insurance schemes.
The development of COVID-19 vaccines does not imply the end of the global pandemic as now countries have to purchase enough COVID-19 vaccine doses and work towards their successful rollout. Vaccination across the world has progressed slowly in all, but a few high-income countries (HICs) as governments learn how to vaccinate their entire populations amidst a pandemic. Most low- and middle-income countries (LMICs) have been relying on the COVID-19 Vaccines Global Access (COVAX) Facility to obtain vaccines. COVAX aims to provide these countries with enough doses to vaccinate 20% of their populations. LMICs will likely encounter additional barriers and challenges rolling out vaccines compared HICs despite their significant experience from the Expanded Programme on Immunisation (EPI). This study explores potential barriers that will arise during the COVID-19 vaccine rollout in lower-middle-income countries and how to overcome them. We conducted sixteen semi-structured interviews with national-level stakeholders from Ghana and Bangladesh (eight in each country). Stakeholders included policymakers and immunisation programme experts. Data were analysed using a Framework Analysis technique. Stakeholders believed their country could use existing EPI structures for the COVID-19 vaccine rollout despite existing challenges with the EPI and despite its focus on childhood immunisation rather than vaccinating the entire population over a short period of time. Stakeholders suggested increasing confidence in the vaccine through community influencers and by utilising local government accredited institutions such as the Drug Authorities for vaccine approval. Additional strategies they discussed included training more health providers and recruiting volunteers to increase vaccination speed, expanding government budgets for COVID-19 vaccine purchase and delivery, and exploring other financing opportunities to address in-country vaccine shortages. Stakeholders also believed that LMICs may encounter challenges complying with priority ...
Antimicrobial resistance is a serious challenge to the success and sustainability of our healthcare systems. There has been increasing policy attention given to antimicrobial resistance in the last few years, and increased amounts of funding have been channeled into funding for research and development of antimicrobial agents. Nevertheless, manufacturers doubt whether there will be a market for new antimicrobial technologies sufficient to enable them to recoup their investment. Health technology assessment (HTA) has a critical role in creating confidence that if valuable technologies can be developed they will be reimbursed at a level that captures their true value. We identify 3 deficiencies of current HTA processes for appraising antimicrobial agents: a methods-centric approach rather than problem-centric approach for dealing with new challenges, a lack of tools for thinking about changing patterns of infection, and the absence of an approach to epidemiological risks. We argue that, to play their role more effectively, HTA agencies need to broaden their methodological tool kit, design and communicate their analysis to a wider set of users, and incorporate long-term policy goals, such as containing resistance, as part of their evaluation criteria alongside immediate health gains.
