Industry-funded religious liberty legal groups have sought to undermine healthcare policy and law while simultaneously attacking the rights of sexual and gender minorities. Whereas past scholarship has tracked religiously-affiliated healthcare providers’ growing political power and attendant transformations to legal doctrine, our account emphasizes the political donors and visionaries who have leveraged religious providers and the U.S. healthcare system’s delegated structure to transform social policy and bureaucratic agencies more generally.

COVID-19-related controversies concerning the allocation of scarce resources, travel restrictions, and physical distancing norms each raise a foundational question: How should authority, and thus responsibility, over healthcare and public health law and policy be allocated? Each controversy raises principles that support claims by traditional wielders of authority in “federal” countries, like federal and state governments, and less traditional entities, like cities and sub-state nations. No existing principle divides “healthcare and public law and policy” into units that can be allocated in intuitively compelling ways. This leads to puzzles concerning (a) the principles for justifiably allocating “powers” in these domains and (b) whether and how they change during “emergencies.” This work motivates the puzzles, explains why resolving them should be part of long-term responses to COVID-19, and outlines some initial COVID-19-related findings that shed light on justifiable authority allocation, emergencies, emergency powers, and the relationships between them.

The establishment of internal markets for healthcare provision in publicly-funded healthcare systems brings forth a number of new regulatory challenges. During the 2003 healthcare reform in Turkey, universal health coverage (UHC) was implemented concurrently with the establishment of an internal market for service provision, resulting in an increase in private sector activity. In this context, this paper explores how, in the Turkish case, the macro-level adoption of an internal market model for healthcare provision has shaped patient experiences at the micro-level in their ability to receive treatment in private hospitals offering publicly-funded services (PHOPS). It also examines the influence of the internal market on the realised publicness of healthcare services in Turkey. Data for the study were obtained from patient complaints that appeared on a private online platform and 20 patient interviews. These showed that patients sometimes face significant challenges, including pressure to make informal payments, when accessing their entitlements, which is evidence of the erosion of publicness in a hybrid healthcare system. These challenges emerge from information asymmetry between patients and providers; a large space for PHOPS to manoeuvre when deciding to register patients as insurance holders or private patients; and the ineffective public regulation of the internal market.

The COVID-19 pandemic has stunned the global community with marked social and psychological ramifications. There are key challenges for psychiatry that require urgent attention to ensure mental health well-being for all – COVID-19-positive patients, healthcare professionals, first responders, people with psychiatric disorders and the general population. This editorial outlines some of these challenges and research questions, and serves as a preliminary framework of what needs to be addressed. Mental healthcare should be an integral component of healthcare policy and practice towards COVID-19. Collaborative efforts from psychiatric organisations and their members are required to maximise appropriate clinical and educational interventions while minimising stigma.

Formularies are used by payers to optimize access and ensure the appropriate use of medications. Lack of follow-up and re-evaluation can lead to outdated formularies that are not reflective of current evidence. Formulary modernization, an approach to re-align formularies with current evidence has proven successful. The Ontario Drug Policy Research Network (ODPRN) launched a framework for conducting comprehensive drug-class reviews. This commentary describes the individual components of this framework and lessons learned through completion of 12 reviews between 2013 and 2016. We present the ODPRN drug-class review of treatments for chronic hepatitis B as a case example to illustrate the components and impact. The incorporation of foundational health technology assessment components such as economic evaluations and knowledge synthesis with contextualizing evidence such as patient and clinician perspectives (through qualitative studies), real-world evidence (through data analytics), and cross-jurisdictional comparisons (through environmental scans and data analytics), successfully developed jurisdictionally specific policy recommendations grounded in up-to-date evidence. The ODPRN framework for conducting comprehensive drug-class reviews is a robust and feasible approach to conduct formulary modernization. This framework allows for actionable and specific policies which are likely to be considered by decision makers. Adoption of similar frameworks in other jurisdictions may improve uptake of evidence-informed policy recommendations.

China's healthcare system is governed by institutions that are mutually incompatible. Although healthcare providers are supposed to offer affordable curative care services and engage in public health and administrative work, they receive insufficient financial support from the state and rely on generating informal profits and grey income. The “institutional misfit” between this public welfare mandate and medical service providers’ market orientation is particularly pronounced in the case of township health centres (THCs), a generalist type of healthcare provider with a key role in China's healthcare system. Based on fieldwork in four county-level jurisdictions, this study explores how local governments and THCs interact to cope with institutional misfit. It sheds light on a large variety of informal practices pertaining to human resources, healthcare services, drug procurement, health insurance and capital investment. Local governments deliberately neglect regulatory enforcement and collude with THCs to generate informal profits, behaviour which undermines service quality and increases healthcare costs. The study also shows that while the New Healthcare Reform altered the informal and collusive practices, it has failed to harmonize the underlying institutional misfit. To date, we see only a reconfiguration rather than an abandoning of informal practices resulting from recent healthcare reforms.

Policy entrepreneurs play a pivotal role in policy changes in both electoral democracies and authoritarian systems. By investigating the case of healthcare reform in Sanming City, this article illustrates how the fragmented bureaucracy in China enables and constrains local policy entrepreneurs, and how entrepreneurial manoeuvring succeeds in realigning the old institutional structures while attacking the vested interests. Both structural conditions and individual attributes are of critical importance to the success of policy entrepreneurship. Four factors and their dynamic interactions are central to local policy entrepreneurship: behavioural traits, political capital, network position and institutional framework. This study furthers theoretical discussion on policy entrepreneurship by elucidating the fluidity of interactional patterns between agent and structure in authoritarian China. The malleability of rigid institutions can be considerably increased by the active manoeuvring of entrepreneurial agents.

The technology appraisal program of the National Institute for Clinical Excellence (NICE) was established on April 1, 1999. Its role is to advise the NHS in England and Wales on the clinical effectiveness, cost-effectiveness, and service impact of new and emerging as well as established healthcare technologies. This paper describes the role of HTA in the NICE technology appraisal process, discusses some of the challenges of the use of HTA in national policy making, and considers some of the potential ways forward.

Decision making in health care has become increasingly reliant on information technology, evidence-based processes, and performance measurement. It is therefore a time at which it is of critical importance to make data and analyses more relevant to decision makers. Those who support Bayesian approaches contend that their analyses provide more relevant information for decision making than do classical or “frequentist” methods, and that a paradigm shift to the former is long overdue. While formal Bayesian analyses may eventually play an important role in decision making, there are several obstacles to overcome if these methods are to gain acceptance in an environment dominated by frequentist approaches. Supporters of Bayesian statistics must find more accommodating approaches to making their case, especially in finding ways to make these methods more transparent and accessible. Moreover, they must better understand the decision-making environment they hope to influence. This paper discusses these issues and provides some suggestions for overcoming some of these barriers to greater acceptance.

This paper is concerned with the emergence of consumerism as a dominant theme in the culture surrounding the organisation and provision of welfare in contemporary societies. In it we address the dilemmas produced by a consumerist discourse for older people's healthcare, dilemmas which may be seen as the conflicting representations of third age and fourth age reality. We begin by reviewing the appearance of consumerism in the recent history of the British healthcare system, relating it to the various reforms of healthcare over the last two decades and the more general development of consumerism as a cultural phenomenon of the post World War II era. The emergence of consumer culture, we argue, is both a central theme in post-modernist discourse and a key element in the political economy of the New Right. After examining criticisms of post-modernist representational politics, the limitations of consumerism and the privileged position given to choice and agency within consumerist society, we consider the relevance of such critical perspectives in judging the significance of the user/consumer movement in the lives of retired people.