Mental Health Policy Making in South Korea Structural and Cultural Influences

신창식 University of Nottingham 2004 해외박사

This study focuses on the way in which rapid structural changes (such as economic development, urbanisation and other demographic factors, and the economic crisis of 1997) have raised issues that are seen to require a social policy response in the mental health care arena under Confucian governance in South Korea. These structural changes happened over a couple of hundred years in Western Europe but have taken place over only the past 40 years in Korea. The main thrust of the study is on the extent to which the decisions about policy responses to perceived social problems, especially the increasing number of people with mental health problems, are structurally driven or the extent to which they are informed and shaped by Korean politics and culture. The industrial and economic base of Korea grew dramatically until the late 1990s. This facilitated the development of social policies - particularly in areas such as education, health and housing, which support economic growth. However, although the structure of the family changed to be closer to its structure in the West, it could be argued that evidence pointing to a broader 'Westernisation' of Korean society was premature. Confucianism may have been a factor in Korea's development, but it may yet prove a hindrance to any further moves to modernity and equalisation of life chances amongst its citizens. Since the economic crisis of 1997, Korea has experienced a rapid expansion of social welfare provision following a series of reforms. These reforms have gone beyond the functional minima necessary to deal with social problems caused by the economic crisis. However, the government has tended to stress the greater role played by family members, particularly women, in providing care to their elderly relatives, and the desirability of multigenerational households over nuclear families. A similar emphasis on the caring roles of the family and community is also seen in the Korean state's renewed public emphasis on the country's Confucian cultural tradition. As a result of this, there has been a tension between the increased emphasis given to the role of the informal carer within mental health policy as the Korean government has introduced a community-based scheme which assumes that families want to care and those with mental health problems want to be cared for by their families. Accordingly, the main burden of care falls upon women. This still tends to be ignored by policy makers. Despite the country's rapid demographic, economic and social changes, there has been a widening gap between the population's expectations and needs and health and social service provision in the mental health arena. Neither long-term care services nor personal social services are well developed for those with long-term mental health problems. In addition there is a marked disparity between the acute services, which are predominantly provided by private sector organisations in a highly competitive market and broadly achieve high standards, and public primary care and rudimentary residential services in the mental health arena. In this context, it could be argued that Korean mental health policy is concerned with maintaining social order rather than care and treatment of those with mental health problems.

State Healthcare Policy Environment and the Well-Being of Transgender and Gender Diverse Youth

Houghtaling, Laura M University of Minnesota ProQuest Dissertations & T 2023 해외박사(DDOD)

소속기관이 구독 중이 아닌 경우 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

Poor mental health among children and adolescents is a significant public health concern in the U.S. There are significant disparities in mental health outcomes between LGBTQ+ adolescents and their heterosexual and cisgender peers. Transgender youth, in particular, have 2-3 times greater risk of anxiety, depression, suicidal ideation, suicide attempts and self-harming behaviors in comparison to cisgender youth. The developmental period of adolescence is a crucial time for not only the emergence of secondary sex characteristics but also the exploration of gender identity. One important but understudied predictor of adolescent mental health is policy that supports access to gender affirming healthcare (GAC). GAC is a model of care that seeks to affirm the experienced gender identity of youth and reduce psychological distress. Forms of GAC such as counseling, hormone therapy and surgery, can be lifesaving for some transgender youth.Policy is a key macrosocial determinant of health, and policies related to GAC likely affect mental health and drive disparities through the mechanisms of structural stigma and social safety. A small body of research has identified modifying effects of state-level laws regarding LGBTQ+ rights on health disparities in LGBTQ+ youth. Yet there are only a handful of studies evaluating the effect of policy on health outcomes in transgender and gender diverse (TGD) populations, and to the best of our knowledge none yet have evaluated the association between gender-affirming healthcare policy and health in TGD youth. There is existing evidence that delaying transition related care may contribute to higher psychological distress among adolescents and gender-affirming surgery improves quality of life and mental health among transgender individuals. Thus, policies affecting access to gender-affirming care may create excess stress that manifests as an increase in self-reported stress levels and physiologic stress responses.In the first manuscript, we created and validated novel state-level index measures that capture the supportiveness or restrictiveness of the policy environment across 50 states and Washington, D.C. regarding access to gender-affirming healthcare for transgender and gender diverse youth (Aim 1). The two indices we introduced, the Healthcare and Health Insurance Access index (Healthcare Index) and the Progression of Bans on Gender-Affirming Care Index (Ban Progression Index), conceptually quantify the degree of structural level stigma regarding medical affirmation of gender identity at the state level. The Healthcare Index includes private insurance nondiscrimination laws based on gender identity, Medicaid regulations for coverage of GAC, guidance regarding exclusion of coverage of GAC, and religious exemptions or denial of services laws. The Ban Progression Index quantifies the introduction and progression of bills that prohibit or restrict GAC for minors through state legislatures in 2020 and 2021 through categorization into treatment groups representing 1) strong and 2) weak progression of bills and a comparison group representing no progress of bills (no ban states). Empirically, both indices performed as hypothesized, in that they correlated strongly with other state level measures of non-healthcare policy that restrict the rights of gender diverse youth, as well as other measures of the social and political environment that capture the attitudes and social norms around diverse gender identities.In lieu of biologic data, in the following two manuscripts, we measured the impact of our novel state-level policy indices on individual level health with three self-reported outcomes that may be sensitive to acute and chronic stressors: depressive symptoms, stress management and health status, in a large convenience sample of LGBTQ+ youth in all 50 states and Washington, D.C. with diverse sexual and gender identities.In the second manuscript, we tested the main effects of the state-level Healthcare Index on individual-level health (poor stress management, Kutcher Adolescent Depression scale, poor or fair self-rated health status), in a cross-sectional, national survey with large numbers of LGBTQ+ youth; and whether these associations varied by gender identity (Aim 2). We found that a more supportive state policy environment for coverage of GAC was associated with fewer depressive symptoms in our sample of LGBTQ+ youth overall and in gender diverse youth, as hypothesized. Counterintuitively, we found that a higher score on the Healthcare Index was associated with higher odds of poor or fair health status among transgender youth compared to cisgender LGBQ+ youth. This counterintuitive finding and lack of other findings for transgender youth may be potentially due to pre-existing health differences, the intersection of other minoritized identities, or other factors such as family and friend support or school climate being more salient for health. Finally, we did not find evidence for an association between the Healthcare Index and our third health outcome: poor stress management. Additional research is needed to unpack explanations for these findings and corroborate them in other samples of LGBTQ+ youth.In the third manuscript, we estimated the average effect of the Ban Progression Index on differences in cross-sectional mean depressive symptoms over a 5-year period in repeated, nationwide surveys of LGBTQ+ youth overall and by gender identity, using a quasi-experimental approach (classic and triple difference-in-differences models). We did not find evidence for an independent effect of the Ban Progression Index on differences in depressive symptoms between 2017 and 2022 (the pre- and post-periods) among LGBTQ+ youth in states that introduced one or more bills banning GAC, adjusted for time-varying individual level demographic characteristics. Counterintuitively, we found a small decrease in depressive symptoms on average among gender diverse youth in states with strong progression of bills banning GAC. We speculate that this finding could be due to a violation of the common trends assumptions, the change in demographic composition of our repeat cross-sectional sample, different confounding structures by gender identity, unmodeled interactions by sexual orientation and/or racial/ethnic identity, or a higher prevalence of resilience and protective factors in the gender diverse sample.Overall, the findings of our research suggest distinct differences in the relationship between our policy indices and health by gender identity. More lag time between the introduction or passage of bills banning or restricting access to GAC for minors may be needed to detect a further differential effect by gender identity. Additional quasi-experimental approaches in other samples of LGBTQ+ youth and with a longer time horizon are needed to build the evidence base for a causal effect of discriminatory or alternatively protective policies on mental health outcomes for TGD youth. In addition, we need concurrent studies evaluating the mediating roles of school and community level factors, and social support from family, friends and other sources.Since we conducted this study in late 2021, there has been a marked increase in the introduction of bills and passage of laws prohibiting or limiting access to gender-affirming care. The discriminatory rhetoric and legislation targeting transgender and gender diverse youth is growing at a rapid pace, and state-level policies that protect legal access to gender-affirming care and its coverage by insurance are vital to combating widespread misinformation, ignorance and neglect of what we believe are basic human rights for transgender and gender diverse people.

Disasters Divided: Federalism, Authority, and the Role of States in US COVID-19 Pandemic Response

Klasa, Katarzyna A University of Michigan ProQuest Dissertations & Th 2025 해외박사(DDOD)

소속기관이 구독 중이 아닌 경우 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

The COVID-19 pandemic was an unprecedented, catastrophic disaster. But why did the United States-despite its wealth of resources and strong institutions-have a slow, fragmented, and highly politicized pandemic response? Moreover, why did US states vary in their responses to COVID-19? Using a qualitative approach, I conducted elite interviews of state-level bureaucrats across public health agencies, emergency management agencies, and the governor's office and a historical analysis of the development of disaster and pandemic policy in the United States to answer these questions. I frame my analysis through a theory of policy alignment: the ability of two or more actors to agree on a goal, adopt policies that do not conflict towards the agreed upon goal, and implement said policies. Alignment occurs when the methods, processes, and structures employed are congruent with the identified and agreed upon goals. Misalignment happens when there is a lack of congruence on goals, on policies adopted, or on the implementation of policies, resulting in a failure to meet the original goal(s). While important, neither partisanship, federalism, nor COVID-19 policy choices independently or completely explain the US pandemic response. I argue that US COVID-19 pandemic response stemmed from path dependent policy decisions which impacted how disaster and public health emergency response frameworks developed. These path dependent policy decisions predisposed the US towards policy misalignment. The US developed a two-tier disaster response framework: a federal centralized, command-and-control system and a subnational varied, fragmented system. US pandemic policy developed separately and independently from disaster policy, placing public health emergencies outside of the traditional disaster response framework. While pandemic policy originated in the public health domain, pandemic response was split between the public health system and the private medical healthcare system. The US pandemic response framework became further bifurcated between public health and biosecurity policy priorities, impacting federal pandemic response capacity. I further find that 3 variables act as "levers" of alignment (or misalignment): authority, bureaucratic structures, and capacity. Authority is having the power (or ability) to make decisions, implement them, and enforce them. Bureaucratic structures are the formal or informal set of expectations within federal or state agencies that determine who is expected to do what, how, and when. Capacity is the state's ability to achieve its policy goals. Capacity is critical in achieving alignment because goals (once agreed upon and passed as policy) cannot be implemented without it. Process tracing across 3 distinct time periods ("arcs of crisis") during the COVID-19 pandemic, I highlight how the 3 "levers" interacted with federalism, fragmentation, and partisanship to predispose the US towards misalignment. I identify broad patterns of alignment and misalignment: the use of the Stafford Act for COVID-19; the important role of executive authority (president, governors) and disaster emergency powers; fragmentation of bureaucratic authorities in public health emergency response; variation in state emergency management and public health bureaucratic institutions and their baseline capacities; breakdown of disaster response coordination structures; entrenchment of disaster federalism; strong federal biosecurity capacity; and state legislative partisanship. Political partisanship from state legislatures grew over time, leading to state legislative backlash against gubernatorial pandemic emergency powers. As a result, state legislatures began to reshape state statutory frameworks to limit gubernatorial and public health emergency powers. These findings have broad implications for future US disaster response and public health emergency response capacities and capabilities.

제20대 대통령 선거 보건의료정책 빅데이터 분석 : 텍스트마이닝을 통한 정책공약집·언론기사 탐색

송수현 연세대학교 보건대학원 2022 국내석사

Background The 20th presidential election held on March 9, 2022 showed a different characteristic from the previous one in that both the ruling and opposition party candidates concentrated on the microtargeting strategy. Micro-targeting pledges need to be wary of pushing domestic health policy concerns out of priority due to concerns about populist competition. This is because the presidential election is an important opportunity for the policy window to be opened and the policy agenda that has been publicized through the media to lead to actual policies. Therefore, in this study, we will explore the characteristics and problems of health policy-related communication revealed in the presidential election through big data analysis of the presidential candidate's health policy pledge and media coverage of health policy. Subject and Methods The subject of this study is the media reported in relation to the policy pledges of Yun Seokyul and Lee Jae-myung during the 20th presidential election and the health care policy for the relevant period. It's an article. The media that collected the articles were the Chosun Ilbo, the DongA Ilbo, the JoongAng Ilbo, the Hankyoreh newspaper, the Kyunghyang newspaper, and the Yonhap News, and the collection period was from October 10, 2021 to March 8, 2022. As for the research method, first, the policy pledges are used to grasp the main contents of the health care policy officially announced by the political parties to which both candidates belong, and frequency analysis, semantic network analysis(using pie coefficient), and comparative analysis(using log odds ratio). In order to understand what kind of content of the health and medical policy pledges of both candidates was taken up by the media and how it was recognized, the transition of media coverage by time and the semantic network analysis by time(using pie coefficient) We proceeded with comparative analysis(using TF-IDF) according to the political tendency of the media, and derived the core theme that attracted attention in the media through topic modeling. Finally, a comparative analysis(using TF-IDF) was performed to confirm the mutual differences between the three types of text data. Results It was confirmed that the two candidates confirmed through the policy pledges proposed different health care policies, and although some subjects were treated in common, the details and policy directions were almost different. The policies that both candidates took up in the same way were ‘Support medical expenses to war veterans’, ‘Support for infant development’, ‘Support for infertility and HPV vaccine’. Policies related to ‘Convalescence and nursing’ and ‘Family doctor system’ were proposed both, however, details were different between candidates. The policies that Yun treated relatively more importantly than Lee were ‘Support catastrophic medical expenses’ and ‘Support medical system and side effect of COVID19 vaccine’. On the other hand, the policies that Lee treated relatively more importantly than Yun were ‘Non-face-to-face medical care’, ‘Nursing law enactment’, ‘Support contraception and pregnancy discontinuation’ and ‘Working safety and health’. As a result of analyzing the media articles reported related to the health policy pledges of both candidates, Lee's pledge ‘Reimbursement of hair losses’ was reported most intensively during the overall presidential period. Thus, there were some policies alienated among major policies in the previous analysis. The result of classifying media articles into 10 topics through topic modeling were here. ‘Nursing law enactment’, ‘COVID19 epidemic prevention measures’, ‘Support for persons with disabilities’ of both candidates, ‘Reorganize health insurance system’ of Yun and ‘Reimbursement of hair losses’, ‘Support bio-health industry’ and ‘Expansion of public health care’. Through comparisons between three texts; Yoon's policy pledges, Lee's policy pledges and media articles, the policies in each candidate's policy proposal which were not proposed by the other candidate as well as referred to public opinion by media were analyzed. Yun's policies that unique but out of the spotlight were ‘Support for intractable fertility treatment costs’, ‘Support for medical community related to COVID19’, ‘Be responsible for side effects of COVID19’, ‘Improve health checkups for infants / children and support for infants with developmental disabilities’, ‘New drug rapid registration system’ and ‘Health doctors for the disabled’. Lee’s policies were ‘Non-face-toface treatment’, ‘Support for war veterans’, ‘Working safety and health’, ‘Reimbursement for atopy dermatitis’, ‘Crackdown illegal hospitals’ and ‘Sexual / reproduction rights’. Conclusion This study is significant that it was the first case using big data analysis that showed how the health care policies proposed by the candidates were selected, disseminated, or exposed by the media at the period of the presidential election that the important time when the policies are actively promoted. The presidential election is an important momentum to determine the direction of domestic health policy in the next five years so that the policies more fundamental and important should be taken attention of media and public and discussed actively among them. Therefore, if follow-up studies are conducted, such as analyzing a wider range of media articles or using more recent big data analysis techniques, it could be helpful in terms of strategies to improve health and medical policies. 연구 배경 및 목적: 제20대 대통령 선거는 여야 후보 모두 마이크로타기팅 전략에 집중했다는 점에서 이전과 다른 특징을 보였다. 대통령 선거는 보건의료 분야 문제가 정책 의제화되어 실제 새로운 정권의 주요 정책으로 이어질 수 있는 ‘정책 창문’이라는 점에서 중요한 시기이다. 그러나 이번과 같이 마이크로타기팅 공약 대결로 언론과 여론의 관심이 집중되면 결국 보다 중요한 보건의료정책 현안들이 논의의 우선순위에서 밀려날 수밖에 없다는 점에서 경계할 필요가 있다. 이에 본 연구에서는 대통령 후보들의 보건의료정책 공약과 언론의 보건의료정책 보도 내용을 빅데이터 기법으로 통해 분석하여 대선 과정에서 드러난 보건의료정책 관련 커뮤니케이션의 특징과 문제점을 탐색하고자 한다. 연구 대상 및 방법: 본 연구의 대상은 제20대 대통령 선거 기간 동안 윤석열 후보(국민의힘), 이재명 후보(더불어민주당)의 정책공약집과 해당 기간 보건의료정책과 관련해 보도된 언론기사다. 기사를 수집한 언론사는 조선일보, 동아일보, 중앙일보, 한겨레신문, 경향신문, 연합뉴스 등 6개 매체이며, 수집 기간은 2021년 10월 10일부터 2022년 3월 8일까지였다. 연구 방법은 먼저 두 후보가 속한 정당에서 공식적으로 발표한 보건의료정책의 주요 내용을 파악하기 위해 정책공약집을 활용해 빈도 분석, 의미망 분석(파이 계수 활용), 비교 분석(로그 오즈비 활용)을 이용했다. 다음으로는 두 후보의 보건의료정책 공약 중 어떠한 내용이 언론에서 다뤄지고 어떻게 인식되었는지 파악하기 위해 시기별 언론 보도 추이와 시기별 의미망 분석(파이 계수 활용)을, 언론사의 정치 성향에 따라 비교 분석(TF-IDF 활용)을 진행했으며, 토픽 모델링을 통해 언론에서 주목한 핵심 주제를 도출했다. 마지막으로 세 종류의 텍스트 데이터 간 상호 차이를 확인하기 위한 비교 분석(TF-IDF 활용)을 수행했다. 연구 결과: 정책공약집을 통해 확인한 두 후보들은 서로 다른 보건의료정책을 제안했으며, 일부 공통적으로 다룬 주제도 있었으나 세부 내용과 정책 방향은 대부분 상이한 것으로 확인되었다. 두 후보가 비슷하게 다룬 정책은 ‘보훈대상자 의료비 지원’, ‘영유아 발달 지원’, ‘난임 지원, HPV 무료 백신’이었고, ‘요양·간병’ 관련 정책, ‘주치의’ 제도는 두 후보 모두 제안했으나 정책 방향이 달랐다. 윤 후보가 이 후보 대비 상대적으로 중요하게 다룬 정책은 ‘재난적 의료비 지원’, ‘코로나19 관련 의료계, 백신 부작용 지원’ 등이었다. 반대로 이 후보가 윤 후보와 비교해 상대적으로 더 중요하게 다룬 정책은 ‘비대면 진료’, ‘간호법 제정’, ‘피임·임신중지 지원’, ‘노동안전보건’ 등이었다. 두 후보의 보건의료정책 공약과 관련해 보도된 언론기사를 분석한 결과 이 후보의 ‘탈모 건강보험 적용’ 공약이 전체 대선 기간을 통틀어서 가장 집중적으로 보도되었으며, 그로 인해 앞서 정책공약집에서 확인된 주요 정책 중 소외되는 정책들이 존재했다. 토픽 모델링을 통해 10개의 토픽으로 언론기사를 분류한 결과 공통 토픽은 ‘간호법 제정’, ‘코로나 방역 대책’, ‘장애인 지원’, 윤 후보 관련 토픽은 ‘건강보험료 부과 체계 개편’ 등, 이 후보 관련 토픽은 ‘탈모 건강보험 적용’, ‘바이오헬스산업 지원 등’, ‘공공의료 확충’이었다. 윤석열 후보의 정책공약집, 이재명 후보의 정책공약집, 언론기사 등 세 텍스트 간 비교를 통해 각 후보의 정책 제안 중 상대 후보가 제안하지 않았으면서 언론에 의제화되지 않은 정책들을 탐색했다. 윤 후보의 ‘난임 치료비 지원’, ‘코로나19 관련 의료계 지원’, ‘코로나19 백신 부작용 국가책임제’, ‘영유아·소아청소년 건강검진 개선 및 발달장애 영유아 지원’, ‘신약 신속등재제도’, ‘장애인 건강 주치의’ 등, 이 후보의 ‘비대면 진료’, ‘보훈대상자 지원’, ‘노동안전보건’, ‘아토피 건강보험 적용’, ‘불법 사무장 병원 단속’, ‘성·재생산 권리’ 등이 이에 해당되었다. 결론: 본 연구는 대통령 선거라는 정책 의제화가 활발하게 진행되는 중요한 시기에 후보에 의해 발의된 보건의료정책이 언론에 의해 어떻게 선택되어 확산되거나 혹은 외면되는지를 빅데이터 분석 기법을 통해 연구한 최초의 사례라는 점에서 의의가 있다. 대통령 선거는 향후 5년의 국내 보건의료 정책 방향을 결정하는 중요한 시기이며, 보다 근본적이며 중요한 보건의료정책 아젠다가 언론, 공중의 관심을 받고 활발하게 논의되어야 한다. 따라서 보다 더 광범위한 언론기사를 분석하거나 보다 최신의 빅데이터 분석 기법을 활용하는 등 후속 연구들이 이뤄진다면 보건의료정책 개선을 위한 전략 측면에서 도움이 될 수 있을 것이라고 생각한다.

Role of information technology in policy implementation of maternal health benefits in India

Vij, Nidhi Syracuse University 2016 해외박사(DDOD)

소속기관이 구독 중이 아닌 경우 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

Fifty thousand women died during childbirth in India in 2013, the highest total in the world; that is, one maternal death every 10 minutes. India and Nigeria account for almost one-third of total global maternal deaths. Universal access to free public healthcare for maternal health has been a national goal since 2005, but its quality of service and utilization rate of maternal healthcare remains an elusive dream for many of the rural women even after a decade of substantial efforts. In a stark contrast, mobile technology has become more pervasive than the most basic infrastructure across the world. There are over 7 billion mobile phones subscriptions worldwide, but only 4.5 billion people have access to basic sanitation facilities, implying more people have access to mobile phones than toilets in the world, including India. The ubiquity of mobile phones can no longer be ignored. According to the 2011 census of India, 47 percent of the rural households owned mobile phones, and mobile phone network coverage spanned over 99 percent of the rural landscape, but only 31 percent of these rural households had a toilet. This exponential growth in mobile phone ownerships and adaptation has captured the imagination of academic scholars, public administration and the private sector to push for mobile based solutions and services in almost every aspect of public, social and personal life. M-governance has gained prominence too, aimed at improving service delivery, transparency, policy monitoring, public engagement, combatting corruption and poverty, especially in the developing world, leap-frogging poor-resource and low-income constraints. Today there is a mobile app for everything and the solution to any problem is a mobile app, including maternal health. However, amidst this optimism, it is surprising that the potential of mobile phones to improve social policy awareness is yet to be fully exploited. There are initiatives toward health literacy and mobile based cash transfers but few initiatives are geared toward improving awareness of social welfare policies, informing people about eligibility, enrollment and entitlements. Here lies the uniqueness of this research. Motivated to find solutions to actual policy implementation problems in practice, this research lies at the intersection of information communication technology, maternal health benefit policies and public management. In India, low maternal health benefits policy awareness imposes an administrative burden on rural women and leads to uptake of cash and public health service benefits. This research explores if mobile phones can be used as an effective medium to increase maternal health benefit awareness; thereby increasing the claiming of benefits. Using mixed methods of research, insights are drawn from a longitudinal case study in Melghat, a tribal belt of Amravati District in Maharashtra, India; a region that suffers from high maternal morbidity and high infant mortality rate. Forty-two percent of total childbirths take place in the home despite four different maternal benefit policies promoting institutional delivery and safe motherhood. In this dissertation, customized audio messages about maternal healthcare benefit policies were designed and broadcasted to 82 pregnant tribal women and followed up with qualitative interviews to examine any improvements in claiming of the policy benefits in 2013. The research provided an in-depth view of how information was disseminated through mobiles phones, and what factors and trade-offs, beyond information, were actually considered by the households in claiming the policy benefits. This research offers four contributions. First, it provides a deeper understanding of maternal health policies, how incentives work and the impact of conditions attached to these incentives, providing a plausible explanation for why the policies remain only partially effective. Second, in an era of m-governance, it illuminates the potential and limitations of the mobile phones in policy implementation and civic engagement, through a gendered lens. Third, it yields a caution to the technological optimistic use of mobile phones. By evaluating the causal mechanism of whether and how information awareness led to greater claiming of benefits, the findings revealed that information awareness alone was insufficient to improve claims when there were structural and systemic deficiencies in the policy design and management. Fourth, it advances the theory of administrative burden, by using mobile phones to reduce learning costs and by expanding the concepts of compliance costs and psychological costs, and highlights the relative interaction and trade-offs between components of administrative burden in an international context. The research concludes that although mobile phones have the potential to trigger demand for policy benefits and public engagement, and reduce learning cost, they are not the "silver bullet" because they cannot bypass the fundamental challenges of other administrative burdens, policy design deficiencies and bureaucratic processes. (Abstract shortened by ProQuest.).

Newtown, Parkland, and Uvalde: Why (Some) Mass Shootings Transform Community Mental Health

Mauri, Amanda I University of Michigan ProQuest Dissertations & Th 2023 해외박사(DDOD)

소속기관이 구독 중이 아닌 경우 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

Some of the most horrific tragedies in the past 15 years transformed federal community mental health policy. On December 14, 2012, a shooter killed 26 people at Sandy Hook Elementary School in Newtown, Connecticut, and on May 22, 2022, a shooter murdered 21 people at Robb Elementary School in Uvalde, Texas. Newtown led to Congress adopting a bill that ruptured three decades of community mental health policy impasse. Uvalde resulted in a law that substantially expanded the program created after Newtown. But this policymaking process was a long time coming. Legislators introduced each bill over 10 times before enactment after Newtown and Uvalde. What happened between these mass shootings and policy adoption that led political actors to awaken the paralyzed policy area of community mental health policy?The Newtown and Uvalde shootings increased the likelihood of adopting community mental health legislation by motivating political actors to adapt existing bills to become the perceived solution to a problem prioritized by each event: mental illness allegedly causing violence. I build on existing research examining this coupling process by explaining adaptation granularly. Newtown and Uvalde incentivized political actors to make two adaptations to existing legislation. First, each mass shooting motivated politicians to adapt their rhetoric describing the bill and policy entrepreneurs to modify the legislation's design. These adaptations attached the bills to the problem garnering attention, and this link carried the bills through the legislative process toward enactment.However, political actors did not modify or adopt related community mental health bills after a similar incident on February 14, 2018 in Parkland, Florida, where a shooter killed 17 people at Marjory Stoneman Douglas High School. Understanding what happened after Newtown, Parkland, and Uvalde will be crucial to explaining why some mass shootings lead political actors to adapt and adopt community mental health policy reforms.I employ a most similar systems design that compares akin cases except for the studied phenomenon. Newtown, Parkland, and Uvalde share many features. A male pupil murdered students and staff at his former school. Each shooting heightened attention to the problem of mental illness allegedly causing violence, creating an incentive to adapt existing policies to become the solution to this issue. Lawmakers had introduced related community mental health bills only months before each shooting. And a bipartisan coalition led by the same four lawmakers sponsored the bills. Why did Newtown and Uvalde catalyze the adaptation of these bills, contributing to their enactment, while Parkland did not? Lawmakers who possess control over the legislative agenda, which I call agenda setters, are crucial to answering this question. Agenda setters have immense influence over which bills progress through the legislative process and which stagnate in committee. Political actors only engaged in the adaptation process if they judged that agenda setters would not use these controls to prevent the modified bill from progressing through the legislative process. Following Newtown and Uvalde, relevant agenda setters - some Democratic and some Republican - supported the community mental health bills, signaling that their agenda controls would not act as an impediment. Lawmakers occupying these agenda setting positions at the time of Parkland did not offer this support. Together, this research shows that agenda setter support was a necessary condition for political actors to adapt and adopt community mental health policy after a mass shooting.

국내 보건대학원 보건정책 전공자 석·박사 학위논문의 연구 경향 분석

하신 고려대학교 보건대학원 2011 국내석사

목적 : 보건정책 전공자 및 전문가들이 연구의 중복을 피하고 필요로 하는 정확한 연구 자료를 얻기 위해 지금까지 수행되지 않은 학위논문의 경향성을 파악, 연구 지표를 제시할 필요성이 있다. 보건정책분야 연구 경향의 기초자료를 제공함과 동시에 보건정책분야 연구자 및 학위 수여를 위해 수학하고 있는 전공자들에게 바람직한 연구 방향을 제시하는데 있다. 방법 : 2003년에서 2010년 사이에 국회도서관에 납본된 보건정책 전공 석·박사 학위논문 원문 575건을 대상으로 선행연구자에 의해 개발된 보건관리연구(HSR) 분류체계를 적용, 연구 경향을 분석하였으며 학위논문의 타이틀(논제)에 사용된 키워드(단어)를 추출, 보건복지백서, 대통령업무보고와의 연관성을 분석하였다. 결과 : 보건정책 전공자의 575건 학위논문은 전체 보건대학원 학위논문 대비 25%를 차지하였고 연도별 비율은 2005년을 기점으로 일시적을 증가하였다. 분류항목과 적용 결과 16개 분류항목 전 영역에 걸쳐 연구가 이루어지고 있었고 6개 대분류 항목에서 논문의 73%가 집중되었다. 연도별 논문수는 6개 항목에서는 지속적 발행 증가 경향을 확인하였으나 10개 분류항목에서는 발견할 수 없었다. 4개 대학에서는 16개 분류항목 전반에 걸쳐 연구가 이루어 졌고 상위 6개 분류항목에 연구가 집중되었다. 575건의 타이틀(논제)을 통해 추출된 키워드(단어) 2,823개의 분석 결과 31개 키워드(단어)가 23%의 점유율을 가졌고 ‘영향요인’, ‘노인’, ‘환자’, ‘영향’, ‘만족도’, ‘관련요인’과 ‘의료이용’이 최다 빈도를 보였다. 이 중 5개 키워드(단어)에서만 연도별 사용 빈도 증가가 관찰되었다. 보건복지부 백서에서 추출한 4개 키워드(단어), ‘고령화’, ‘국민건강보장’, ‘국민안전보장’, ‘저출산’과 대통령연두업무보고에서 추출한 10개의 키워드(단어), ‘고령화’, ‘보건의료산업’, ‘건강보험’, ‘의약분업’, ‘저출산’, ‘장애인’, ‘보험재정’, ‘노인요양보험’, ‘오송생명과학단지’,와 ‘간병서비스’를 2,823개 키워드(단어)와의 일치 및 사용 빈도를 조사한 결과 ‘노인’과 ‘보험재정’에서만 일치 및 다빈도 사용이 관찰되었다. 결론 : 연구대상 학위논문 575건은 보건관리연구(HSR) 분류항목 전 영역에 연구가 이루어지고 있으나 특정 분류항목에 편중되고 있었고 연구자들의 학위논문이 정부의 보건정책 흐름을 반영하고 있음을 확인하지 못하였다. 학위논문 연구자들의 현실 참여적이고 책임 있는 논제 선택 및 연구가 필요하며 정부의 보건정책에 대해 보다 많은 연구가 요구된다. Objectives : In order to avoid study overlap and to find accurate data, we need to study research trends of masters and doctoral theses which no one has studied in Korea and to suggest graduate students studying health policy and researchers for research indicators. The aim of this paper is to offer the preliminary data on research trends of health policy and to suggest graduate students studying health policy and researchers for the advisable direction of research. Methods : 575 masters and doctoral theses on health policy from 2003 to 2010 that selected from a legal deposit National Library in Korea were analyzed with the classification system of health services research (HSR) which were developed by a former researcher. The keywords that were extracted from 575 masters and doctoral theses on health policy from 2003 to 2010 were compared with the White Paper and the beginning-of-the-year task report of the Ministry of Health & Welfare. Results : 575 masters and doctoral theses on health policy hold 25% of masters and doctoral theses articles have increased with time and three main research areas are health from graduate school of public health in Korea. The average annual rate of increase was observed since 2005. The study on 16 items of the classification system of health services research (HSR) was conducted without exception and some studies focused too much on 6 items (73%) of the classification system of HSR. It finds that the annual number of theses showed a rising tendency in 6 categories except 10 categories. At 4 graduate schools in Korea Studies on 16 items of the classification system of HSR have conducted without exception and some studies focused on 6 top rank items. Results of analysis of 2,823 keywords were extracted from the titles of 575 papers showed that 31 keywords hold 23% (641) and 6 words (‘influencing’, ‘old’, ‘patient’, ‘satisfaction’, ‘related factors’ and ‘using medical services’) were top ranked the most frequently used words. It finds that the annual increasing use of words was observed in 5 words of the most frequently used 6 words. Analyzing 4 keywords (‘aging’, ‘national health assure’, ‘national security assure’ and ‘low birth rate’) extracted from the White Paper and 10 keywords (‘aging’, ‘health care industries’, ‘health insurance’, ‘separation of dispensing and prescribing function’, ‘low birth rate’, ‘the disabled’, ‘fund insurance’, ‘Long-Term Care Insurance’, ‘Osong Bio-Health Science Technopolis’ and ‘nursing service’) extracted from the beginning-of-the-year task report with 2,823 keywords were extracted from the titles of 575 papers indicated that ‘old’ and ‘fund insurance’ were used frequently. Conclusion : The conclusions drawn from this study indicated that the study on each item of the classification system of health services research (HSR) was conducted without exception but some studies focused too much on specific items of the classification system of HSR. And the paper found that theses have not reflected the Korean government’s health policy. These findings suggest graduate students studying health policy and researchers should find and study subjects reflecting fields of the government’s health policy and needs of Korean society.

保健政策의 選擇과 保健醫療體系의 成果에 관한 國家간 比較硏究 : OECD國家를 中心으로

김진현 慶尙大學校 2005 국내박사

The purpose of this paper is to evaluate the performance of health care systems and identify its determinants with a comparative analysis of panel data for the last 30 years in OECD countries, suggesting policy implications for Korea. The main findings could be summarized as follows: A universal coverage for the entire population improved accessibility to health services and equity in financing and utilization. A universal coverage can be accomplished through either social insurance or private insurance. However, a universal coverage has not been completed in a health care system without mandatory policy. Accessibility was not insured by universal coverage only, indicating need of public investments in order to remove social barriers to accessibility. An increase in cost-sharing was effective in reducing public expenditure on health services, but could not decrease national health expenditure in most OECD countries. It showed crowding out effect or shifting medical costs to private sector, and hardly reduced expenditures on health services with inelastic demand, specially hospital services, while it influenced negatively on equity and accessibility to health services. Horizontal index measuring equity in health service utilization showed little inequity in ambulatory care services but there were serious inequites in hospital services and dental care. Quality of care, safety, and consumer satisfaction were enhanced through improvements in management information system, health care delivery system, evidence-based medicine. Payment system has given effective incentives to improve performance of health care system. Empirical results showed good performance in global budget and capitation, while bad in fee-for-service. A public-integrated model(public financing-single payer system), service volume control, and global budget are considered as effective policy instruments for cost containment and improving efficiency. Competition policy was not successful due to a fundamental characteristic of monopoly in medical service market. Selective contracts with providers, economic evaluation for medical technology, price control for pharmaceuticals were also effective in cost containment. Significant determinants of good performance in health care systems were identified as public financing, payment system of capitation or salary, public-integrated model, prospective payment, increase in physicians per population. All these results imply government regulation policy(Policy X) is more effective than competition policy in improving performance of health care system, which means health care system belongs to System X. Responsiveness to comsumer's demand, measured by waiting time for elective surgery, has positive association with number of beds, number of specialists, medical expenditure, and fee-for-service. This suggests that responsiveness and efficiency may be in trade-off in health care system. Consumer satisfaction and medical technology progress have been enhanced in a system with fee-for-service and public financing. However, private health insurance has been negative in quality of care, equity, and efficiency, although it has contributed to responsiveness for small number of subscribers.

(A) study of the quality of health care services in dhaka city

Yesmin, Choudury Shamiya 서울대학교 행정대학원 2015 국내석사

In Bangladesh, there are a lot of government and private community hospitals to serve quality health care service to the people. But due to rapid increasing population, it is difficult to ensure quality health care service to the entire community people. It is important to understand how the quality of services provided by private and public hospitals is perceived by the clients. Very little is known about how the customers access health-care service quality or satisfaction and select hospitals to receive health care services in Bangladesh, especially in Dhaka city. Therefore, the present research was conducted to assess the existing health care services of private and public hospitals, to identify why government policies could not improve the quality of health care service of public hospitals and how to improve the quality of health care service. The findings of the research revealed that more than 50% clients were not satisfied with the health policy. Respondents were more satisfied with the private hospital in terms of behavior of employees (72%), sincerity and willingness of employees (50%), and appearance of the employee (49%) as compared to public hospitals. It also exposed that two-third of respondents were unsatisfied with the physical facilities of the public hospitals. Similarly, one-half of clients (52%) were agreed to pay tips in public hospitals. In this study, it revealed that three-fourth of clients (75%) agreed with the planning, management and monitoring of hospitals, more than two-third (71%) agreed that doctors needed training, almost two-third of clients (62%) were agreed to coordinate between hospital administration and doctors. The research also identified that the present health care service can be improved by involving investment from rich people and NGOs (68%), modernization of existing hospitals (90%) and involvement of mass media (90%). The present study revealed that there is still a gap between the services of public and private hospitals in case of health care service and existing health care policy undertaken. The findings of the present research will help the government of Bangladesh to amend the existing health policy and it will also help to reduce the gap between the service of public and private hospitals. Finally, this finings helps the government to improve the health care services in Bangladesh, especially in Dhaka City and ultimately people of Bangladesh will get quality health services.

The Overview of Implication for Health & Welfare Policy : An Empirical Analysis of Korea

문도원 위덕대학교 대학원 2016 국내박사

The Korean government achieved universal health insurance coverage for the entire population in 1989. It was the most remarkable change to not only the health care security system but also the social security system in Korea. It is clear from various health indices that the Korean health care system has contributed to the improvement in the health of the nation. One of the greatest advantages of Korea's health care system is its effectiveness in terms of both costs and outcomes. People have access to high-quality care at a low cost. Despite the positive results so far, there are several problems that have arisen due to the Ministry of Health and Welfare’s laissez faire policy towards public health and social welfare. One problem is the regional inequalities of accessibility to medical care services. Another problem is growing insurance coverage. The National Health Insurance began to run a financial deficit starting in 1996. The price of medical care services and the demand for medical care relative to supply continue to rise, especially because of an increase in the elderly population. Korean society is ageing faster than any other country. The other problem is medical service liberalization. The Neo-liberal government has the economy-first agenda, which has accelerated an open-market policy, the medical liberalization. Essentially, health outcome is affected by multiple factors such as lifestyle, income distribution, and socio-economic and environmental elements. However, we still do not know how much of a change in health outcome is attributable to utilization of medical services or reliance on the health care system. Specifically, three main questions follow: What is the contribution of medical care to population health status? Which factors are most influential in determining demand for medical care? How do welfare policies contribute to public health and the reduction of health inequalities? The purpose of this study is to provide new insights into the healthcare sector analysis applied to Gary Becker’s household production theory based on the social determinant of health. The starting point is to explore the relationship between health status and medical care demand. Unlike most studies, which dealt with health production and the demand for medical care separately, this study will integrate them into a system of equations and consider their simultaneous nature. This research investigates the production of health for the population and the demand for medical care by concentrating on the contribution of medical care to health status, the influence of health status on medical care demand, and the impact of welfare policies on public health status in Korea. This study specifies and estimates the model of health production function and demand equation for medical care to analyze the interaction between health status and demand for medical care. This empirical work used a fully integrated theoretical framework to build the model and estimate health production and demand for medical care. This paper is based on a cross-sectional analysis using 2010 aggregate data for the community (si, gun,gu). Therefore, given the data set, this study can directly analyze government policy about the health care sector and it may give a few social welfare policy implications. The empirical results of the health production analysis which account for more than 60 present of the inter-community (si, gun, gu) difference in health status, revealed that socioeconomic factors have greater effect on health status than medical care services. The specific findings for the more important factors affecting inter-community difference in health status are as follows. Primarily, the marginal contribution of medical care to health status is approximately -0.152. It suggests that a 10 percent increase in the amount of medical care would reduce the age adjusted death rate by 1.5 percent. Second, labor force participation rate is the most important determinant of health status, more than twice as large as for medical care, at -0.381. It means that a 10 percent increase in labor force participation rate will lead to a 3.8 percent decrease in age adjusted death rate. Third, formal four-year college education has a positive effect on health status. The elasticity of age adjusted death rate with respect to education has an elasticity of -0.171, meaning that a 10 percent increase in formal four-year college education will lead to a 1.7 percent decrease in age adjusted death rate. Fourth, smoking has a negative effect on health status. The elasticity estimate is 0.101, meaning that a 10 percent increase in smoking rate will lead to a 1.0 percent increase in age adjusted death rate. Other factors affecting health status are: decreasing divorce rate, reducing lower income group, and increasing local government financial independence. In the demand analysis, the study finds that decision makers face the inelastic demand curve and medical care as an inferior good under the universal health insurance system based on the income elastic. Our estimates of the price elasticity of -0.160 in the demand analysis shows price elasticities similar to other estimates reported in the literature, ranging from -0.27 to -0.11. The price elasticity of demand is undoubtedly inelastic. It implies that the quantity demand is less responsive to the price of medical care. One possible explanation is that most medical care bills are paid by third party payers (NHIC) and the price of 60% of medical expenditure is regulated under National Health Insurance scheme. Usually, medical care is considered to be a normal good, meaning as incomes rise, people prefer to spend part of their increased income on additional medical services. But our result shows that the income elasticity for medical care is -0.016. The negative relationship between income and demand is characteristic of an “inferior” good. An “inferior” good is one where an increase