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Volume 9 – Issue 5 by Julia Abelson

Background: Chile and Colombia are examples of Latin American countries with health sy... more Background: Chile and Colombia are examples of Latin American countries with health systems shaped by similar values. Recently, both countries have crafted policies to regulate the participation of private for-profit insurance companies in their health systems, but through very different mechanisms. This study asks: what values are important in the decision-making processes that crafted these policies? And how and why are they used?Methods: An embedded multiple-case study design was carried out for 2 specific decisions in each country: (1) in Chile, the development of the Universal Plan of Explicit Entitlements - AUGE/GES - and mandating universal coverage of treatments for high-cost diseases; and (2) in Colombia, the declaration of health as a fundamental right and a mechanism to explicitly exclude technologies that cannot be publicly funded. We interviewed key informants involved in one or more of the decisions and/or in the policy analysis and development process that contributed to the eventual decision. The data analysis involved a constant comparative approach and thematic analysis for each case study. Results: From the 40 individuals who were invited, 28 key informants participated. A tension between 2 important values was identified for each decision (eg, solidarity vs. individualism for the AUGE/GES plan in Chile; human dignity vs. sustainability for the declaration of the right to health in Colombia). Policy-makers used values in the decision-making process to frame problems in meaningful ways, to guide policy development, as a pragmatic instrument to make decisions, and as a way to legitimize decisions. In Chile, values such as individualism and free choice were incorporated in decision-making because attaining private health insurance was seen as an indicator of improved personal economic status. In Colombia, human dignity was incorporated as the core value because the Constitutional Court asserted its importance in its use of judicial activism as a check on the power of the executive and legislative branches.Conclusion: There is an opportunity to open further exploration of the role of values in different health decisions, political sectors besides health, and even other jurisdictions.

Papers by Julia Abelson

Healthcare Quarterly

As efforts to actively involve patients, family members and the broader public in health service ... more As efforts to actively involve patients, family members and the broader public in health service improvement and system redesign have grown, increasing attention has also been paid to evaluation of their engagement in the health system. We discuss key concepts and approaches related to evaluation, drawing particular attention to different and potentially competing goals, stakeholders and epistemological entry points. Evaluation itself can be supported by an increasing number of frameworks and tools, matched to the relevant purpose and approach. The patient engagement evaluation field faces several challenges, including the need for greater specification of both the form and the context of engagement, the need to balance the measurement imperative with the relational aspects of care and the need for supportive organizations with the capacity and commitment to undertake high-quality engagement and its evaluation. Résumé Tandis que les efforts visant à activement faire participer le patient, les membres de sa famille et le grand public à l'amélioration et au réaménagement des systèmes de santé se sont intensifiés, une attention croissante a également été accordée à l'évaluation de leur engagement au système de santé. Nous abordons d'importants concepts et approches liés à l'évaluation, en attirant une attention particulière aux divers objectifs, parties prenantes et points d'entrée épistémologiques éventuellement en concurrence. L'évaluation elle-même peut s'appuyer sur un nombre croissant de cadres et d'outils adaptés à l'objectif et à l'approche en question. Le domaine de l'évaluation de l'engagement du patient doit relever de nombreux défis, à savoir le besoin de préciser les modalités et le contexte de l'engagement, le besoin d'équilibrer l'impératif de la mesure avec les aspects relationnels des soins et l'aspiration des organismes disposant de la capacité et de la volonté nécessaires à concrétiser et à évaluer ce projet en engagement de grande qualité.

Journal of Health Organization and Management

PurposeIn this paper, we contribute to the theorizing of patient involvement in organizational im... more PurposeIn this paper, we contribute to the theorizing of patient involvement in organizational improvement by exploring concepts of “learning from patients” as mechanisms of organizational change. Using the concept of metaphor as a theoretical bridge, we analyse interview data (n = 20) from participants in patient engagement activities from two case study organizations in Ontario, Canada. Inspired by classic organizational scholars, we ask “what is the organization that it might learn from patients?”Design/methodology/approachPatient involvement activities are used as part of quality improvement efforts in healthcare organizations worldwide. One fundamental assumption underpinning this activity is the notion that organizations must “learn from patients” in order to enact positive organizational change. Despite this emphasis on learning, there is a paucity of research that theorizes learning or connects concepts of learning to organizational change within the domain of patient involv...

Health Policy and Planning

Priority setting represents an even bigger challenge during public health emergencies than routin... more Priority setting represents an even bigger challenge during public health emergencies than routine times. This is because such emergencies compete with routine programs for the available health resources, strain health systems, and shift health care attention and resources towards containing the spread of the epidemic and treating those that fall seriously ill. This paper is part of a larger global study the aim of which is to evaluate the degree to which National COVID-19 preparedness and response plans incorporated priority setting concepts. IT and provides important insights into what and how priority decisions were made in a context of a pandemic. Specifically, with a focus on a sample of 18 African countries’ pandemic plans, the paper aims to: (i) Explore the degree to which the documented priority setting processes adhere to established quality indicators of effective priority setting and (ii) To examine if there is a relationship between the number of quality indicators prese...

Journal of the American Medical Directors Association

Journal of Deliberative Democracy

Background: Allusions to the uniqueness and value of childhood abound in academic, lay, and polic... more Background: Allusions to the uniqueness and value of childhood abound in academic, lay, and policy discourse. However, little clarity exists on the values that should guide child health and social policymaking. We review extant academic literature on the normative dimensions of child health and social policy to provide foundations for the development of child-focused public policies. Methods: We conducted a critical interpretive synthesis of academic literature on the normative dimensions of child health and social policy-making. We employed a social constructivist lens to interpret emergent themes. Political theory on the social construction of target populations served as a bridge between sociologies of childhood and public policy analysis. Results: Our database searches returned 14,658 unique articles; full text review yielded 72 relevant articles. Purposive sampling of relevant literature complemented our electronic searches, adding 51 original articles, for a total of 123 artic...

Evidence & Policy: A Journal of Research, Debate and Practice

Journal of Health Services Research & Policy

Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent, 2018

Children's mental health in Canada is characterized by high needs coupled with stark service ... more Children's mental health in Canada is characterized by high needs coupled with stark service shortfalls. In Ontario and in many provinces, addressing these shortfalls is hampered by the absence of a measurement system, something that researchers have long called for. This commentary aims to review the issues and suggest prospects for improving the measurement of children's mental health in Ontario and elsewhere. As background, we first describe the children's mental health needs; outline the rationale for a measurement system; describe previous attempts to introduce such systems, including in Ontario; and discuss the current Ontario situation. We then explore some of the issues that constrain policy and that need to be overcome, and suggest prospects for change - for advancing the measurement of children's mental health in Ontario and Canada.

Patient Preference and Adherence

Prehospital and Disaster Medicine, 2017

Healthcare policy = Politiques de sante, Nov 1, 2016

Primary care services form the foundation of modern healthcare systems, yet the breadth and compl... more Primary care services form the foundation of modern healthcare systems, yet the breadth and complexity of services and diversity of patient populations may present challenges for creating comprehensive primary care information systems. Our objective is to develop regional-level information on the performance of primary care in Canada. A scoping review was conducted to identify existing initiatives in primary care performance measurement and reporting across 11 countries. The results of this review were used by our international team of primary care researchers and clinicians to propose an approach for regional-level primary care reporting. We found a gap between conceptual primary care performance measurement frameworks in the peer-reviewed literature and real-world primary care performance measurement and reporting activities. We did not find a conceptual framework or analytic approach that could readily form the foundation of a regional-level primary care information system. There...

International Journal of Technology Assessment in Health Care, 2016

Objective: As health technology assessment (HTA) organizations in Canada and around the world see... more Objective: As health technology assessment (HTA) organizations in Canada and around the world seek to involve the public and patients in their activities, frameworks to guide decisions about whom to involve, through which mechanisms, and at what stages of the HTA process have been lacking. The aim of this study was to describe the development and outputs of a comprehensive framework for involving the public and patients in a government agency's HTA process. Methods: The framework was informed by a synthesis of international practice and published literature, a dialogue with local, national and international stakeholders, and the deliberations of a government agency's public engagement subcommittee in Ontario, Canada. Results: The practice and literature synthesis failed to identify a single, optimal approach to involving the public and patients in HTA. Choice of methods should be considered in the context of each HTA stage, goals for incorporating societal and/or patient per...