A retrospective health policy analysis of the development and implementation of the voluntary health insurance system in Lebanon: Learning from failure
A retrospective health policy analysis of the development and implementation of the voluntary health insurance system in Lebanon: Learning from failure
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DOI：
10.1016/j.socscimed.2014.10.044
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发表时间：
2014-12-01
影响因子：
5.4
通讯作者：
Hammoud, Rawan
中科院分区：
文献类型：
--
作者：
El-Jardali, Fadi;Bou-Karroum, Lama;Hammoud, Rawan
公共政策制定非常复杂，而且研究证据的利用有限，特别是在东地中海地区 (EMR)。缺乏深入的案例研究来检验电子病历中的卫生政策制定。这项回顾性政策分析旨在通过使用黎巴嫩自愿健康保险政策作为案例研究，深入了解政策的制定方式，确定影响政策制定的因素，并评估在此过程中使用证据的程度。该研究通过覆盖 12 年的政策追踪技术考察了政策制定过程。该研究采用案例研究方法的定性研究设计，并在两年内分两个阶段进行。数据是通过多种来源收集的，包括：1）全面且按时间顺序排列的媒体评论； 2) 对政策制定者、利益相关者和记者进行 22 次关键信息采访； 3) 对立法、会议记录、精算研究和正式文件的文件审查。使用主题分析对数据进行分析和验证。调查结果表明，自愿医疗保险政策是政府为解决紧迫的政治问题而做出的政治决定。没有使用证据来指导政策制定和实施，政策实施者和其他利益相关者也没有参与政策制定。影响决策的因素包括政策制定者的政治利益、宗派主义、紧迫性和价值观。使用证据的障碍是缺乏与政策相关的研究证据、政治背景、个人利益和资源限制。研究结果表明，政策制定者应更多地认识到证据在为公共政策制定提供信息方面的重要作用，以及建设制定、实施和评估政策的能力的必要性。鉴于一些阿拉伯国家正在发生的变化以及迫在眉睫的政策改革机会，研究结果可能很重要。 (C) 2014 年作者。由爱思唯尔有限公司出版
Public policymaking is complex and suffers from limited uptake of research evidence, particularly in the Eastern Mediterranean Region (EMR). In-depth case studies examining health policymaking in the EMR are lacking. This retrospective policy analysis aims at generating insights about how policies are being made, identifying factors influencing policymaking and assessing to what extent evidence is used in this process by using the Lebanese Voluntary Health Insurance policy as a case study. The study examined the policymaking process through a policy tracing technique that covered a period of 12 years. The study employed a qualitative research design using a case study approach and was conducted in two phases over the course of two years. Data was collected using multiple sources including: 1) a comprehensive and chronological media review; 2) twenty-two key informant interviews with policymakers, stakeholders, and journalists; and 3) a document review of legislations, minutes of meetings, actuarial studies, and official documents. Data was analyzed and validated using thematic analysis. Findings showed that the voluntary health insurance policy was a political decision taken by the government to tackle an urgent political problem. Evidence was not used to guide policy development and implementation and policy implementers and other stakeholders were not involved in policy development. Factors influencing policymaking were political interests, sectarianism, urgency, and values of policymakers. Barriers to the use of evidence were lack of policy-relevant research evidence, political context, personal interests, and resource constraints. Findings suggest that policymakers should be made more aware of the important role of evidence in informing public policymaking and the need for building capacity to develop, implement and evaluate policies. Study findings are likely to matter in light of the changes that are unfolding in some Arab countries and the looming opportunities for policy reforms. (C) 2014 The Authors. Published by Elsevier Ltd.