Government capacities and stakeholders: what facilitates ehealth legislation?

Globalization and Health

Achim Lang¹ 

[1]Department of Politics and Public Administration, University of Konstanz, Postbox 5560, D81, Konstanz 78457, Germany

关键词: Capacity development;    Donors;    Public-private partnerships;    OECD;    European Union;    World Health Organization;    Regulation;    EHealth;   

Others  :  805078
DOI  :  10.1186/1744-8603-10-4

 received in 2013-04-23, accepted in 2013-11-11,  发布年份 2014

【 摘 要 】

Background

Newly established high-technology areas such as eHealth require regulations regarding the interoperability of health information infrastructures and data protection. It is argued that government capacities as well as the extent to which public and private organizations participate in policy-making determine the level of eHealth legislation. Both explanatory factors are influenced by international organizations that provide knowledge transfer and encourage private actor participation.

Methods

Data analysis is based on the Global Observatory for eHealth - ATLAS eHealth country profiles which summarizes eHealth policies in 114 countries. Data analysis was carried out using two-component hurdle models with a truncated Poisson model for positive counts and a hurdle component model with a binomial distribution for zero or greater counts.

Results

The analysis reveals that the participation of private organizations such as donors has negative effects on the level of eHealth legislation. The impact of public-private partnerships (PPPs) depends on the degree of government capacities already available and on democratic regimes. Democracies are more responsive to these new regulatory demands than autocracies. Democracies find it easier to transfer knowledge out of PPPs than autocracies. Government capacities increase the knowledge transfer effect of PPPs, thus leading to more eHealth legislation.

Conclusions

All international regimes – the WHO, the EU, and the OECD – promote PPPs in order to ensure the construction of a national eHealth infrastructure. This paper shows that the development of government capacities in the eHealth domain has to be given a higher priority than the establishment of PPPs, since the existence of some (initial) capacities is the sine qua non of further capacity building.

【 授权许可】

   
2014 Lang; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Buse K, Walt G: Global public-private partnerships: part I-a new development in health? Bull World Health Organ 2000, 78:549-561.
• [2]Buse K, Walt G: Global public-private partnerships: part II-what are the health issues for global governance? Bull World Health Organ 2000, 78:699-709.
• [3]Buse K, Waxman A: Public-private health partnerships: a strategy for WHO. Bull World Health Organ 2001, 79:748-754.
• [4]Richter J: Public-private partnerships for health: a trend with no alternatives? Development 2004, 47:43-48.
• [5]Mackintosh M, Chaudhuri S, Mujinja P: Can NGOs regulate medicines markets? social enterprise in wholesaling, and access to essential medicines. Glob Health 2011, 7:4. BioMed Central Full Text
• [6]Howlett M, Ramesh M: Patterns of policy instrument choice: policy styles, policy learning and the privatization experience. Review of Policy Research 1993, 12:3-24.
• [7]Howlett M, Ramesh M, Perl A: Studying public policy: policy cycles and policy subsystems. Oxford: Oxford University Press; 2009.
• [8]Potrafke N: Does government ideology influence deregulation of product markets? empirical Evidence from OECD countries. Public Choice 2010, 143:135-155.
• [9]Eysenbach G: What is e-health? J Med Internet Res 2001, 3:e20.
• [10]WHO Global Observatory for eHealth: Building foundations for ehealth: progress of member states. Geneva: WHO; 2006.
• [11]Howlett M: Governance modes, policy regimes and operational plans: a multi-level nested model of policy instrument choice and policy design. Policy Sci 2009, 42:73-89.
• [12]Hall PA: Policy paradigms, social learning, and the state: the case of economic policymaking in Britain. Comparative Politics 1993, 25:275-296.
• [13]Dougherty JE, Pfaltzgraff RL: Contending theories of international relations: a comprehensive survey. New York: Longman; 2001.
• [14]Levy ML, Young OR, Zürn M: The study of international regimes. Laxenburg (Austria): International Institute for Applied Systems Analysis (Working Paper); 1995.
• [15]Young OR: International regimes: problems of concept formation. World Politics 1980, 32:331-356.
• [16]Young OR: International regimes: toward a new theory of institutions. World Politics 1986, 39:104-122.
• [17]UN Millennium Project: Investing in development: a practical plan to achieve the millennium development goals. New York: Earthscan; 2005.
• [18]Geissbuhler A, Haux R, Kwankam SY: Towards health for all: who and IMIA intensify collaboration. Methods Inf Med 2007, 47:503-505.
• [19]Kay M, Santos J: Report on the world health organization global observatory for ehealth strategic planning workshop, april 2008. Methods Inf Med 2007, 46:503-505.
• [20]Commission E: Lisbon strategy evaluation document. Commission staff working document. European Commission: Brussels; 2010.
• [21]Commission E: Looking beyond tomorrow: scientific research in the European union. European Commission: Brussels; 2004.
• [22]Commission E: Lead market initiative for Europe: mid-term progress report. European Commission: Brussels; 2009.
• [23]Organisation for Economic Co-operation and Development: National braodband plans. Paris: OECD; 2011.
• [24]Hofmarcher MM, Oxley H, Rusticelli E: Improved health system performance through better care coordination. Paris: OECD; 2007.
• [25]Reich MR: Public-private partnerships for public health. In Public-private partnerships for public health. Edited by Reich MR. Cambridge, Massachusetts: Harvard University Press; 2002:1-18.
• [26]Lucas AO: Public-private partnerships: illustrative examples. In Public-private partnerships for public health. Edited by Reich MR. Cambridge, Massachusetts: Harvard University Press; 2002:19-39.
• [27]Farzin YH, Bond CA: Democracy and environmental quality. J Dev Econ 2006, 81:213-235.
• [28]Mukherjee S, Chakraborty D: Is environmental sustainability influenced by socioeconomic and sociopolitical factors? cross-country empirical evidence. Sustain Dev 2010. DOI: 10.1002/sd.502
• [29]Deacon RT: Dictatorship, democracy, and the provision of public goods: working paper. San Diego: Department of Economics, University of California; 2003.
• [30]Bertelli AM, Whitford AB: Perceiving credible commitments: how independent regulators shape elite perceptions of regulatory quality. Br J Polit Sci 2009, 39:517-537.
• [31]Grant W: Private Organizations as Agents of Public Policy: the Case of Milk Marketing in Britain. In Private interest governments. Edited by Streeck W, Schmitter PC. London/Newbury Park/New Delhi: Sage; 1985:182-196.
• [32]Streeck W, Grote JR, Schneider V, Visser J (Eds): Governing interests: business associations facing internationalization London: Routledge; 2006.
• [33]Streeck W, Schmitter PC: Community, market, state - and associations? The prospective contribution of interest governance to social order. Eur Sociol Rev 1985, 1:119-138.
• [34]Buse K, Walt G: An unruly melange? Coordinating external resources to the health sector: a review. Soc Sci Med 1997, 45:449-463.
• [35]Morss ER: Institutional destruction resulting from donor and project proliferation in Sub-Saharan African countries. World Dev 1984, 12:465-470.
• [36]Carmignani F, Lordan G, Tang KK: Does donor assistance for HIV respond to media pressure? Health economics 2012, 21:18-32.
• [37]Esser DE, Bench KK: Does global health funding respond to recipients’ needs? Comparing public and private donors’ allocations in 2005–2007. World Dev 2011, 39:1271-1280.
• [38]Shiffman J: Donor funding priorities for communicable disease control in the developing world. Health Policy Plan 2006, 21:411-420.
• [39]Shiffman J: Has donor prioritization of HIV/AIDS displaced aid for other health issues? Health Policy Plan 2008, 23:95-100.
• [40]Giri A, Khatiwada P, Shrestha B, Chettri RK: Perceptions of government knowledge and control over contributions of aid organizations and INGOs to health in Nepal: a qualitative study. Glob Health 2013, 9:1. BioMed Central Full Text
• [41]Shortell SM, Zukoski AP, Alexander JA, Bazzoli GJ, Conrad DA, Hasnain-Wynia R, Sofaer S, Chan BY, Casey E, Margolin FS: Evaluating partnerships for community health improvement: tracking the footprints. J Health Polit Policy Law 2002, 27:49-92.
• [42]Global Observatory fo eHealth: Global Observatory for eHealth - ATLAS eHealth country profiles. Geneva: WHO; 2011.
• [43]WHO Global Observatory fo eHealth: Management of patient information: trends and challenges in member states. Geneva: WHO; 2012.
• [44]Hood CC: The tools of government. London/Basingstoke: Macmillan; 1983.
• [45]Honaker J, King G, Blackwell M: Amelia II: a program for missing data. J Stat Softw 2011, 45:1-47.
• [46]Honaker J, King G, Blackwell M: The Amelia package, version 1.6.3. Harvard University; 2012. http://gking.harvard.edu/amelia webcite
• [47]R Development Core Team: R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2012. http://www.r-project.org webcite
• [48]Loeys T, Moerkerke B, De Smet O, Buysse A: The analysis of zero-inflated count data: beyond zero-inflated poisson regression. Br J Math Stat Psychol 2012, 65:163-180.
• [49]Zeileis A, Kleiber C, Jackman S: Regression models for count data in R. J Stat Softw 2008, 27:1-25.
• [50]Jackman S: The pscl package, version 1.04.4. Political Science Computational Laboratory, Stanford University; 2007. http://cran.r-project.org/web/packages/pscl/index.html webcite
• [51]Zuur AF, Ieno EN, Walker NJ, Saveliev AA, Smith GM: Mixed effects models and extensions in ecology with R. New York: Springer; 2009.
• [52]Bundesamt für Gesundheit (BAG): “Strategie eHealth” Schweiz. Bern: Bundesamt für Gesundheit; 2007.
• [53]Lang A, Mertes A: Die Einführung der elektronischen Gesundheitskarte in Deutschland: der Einfluss von Interessenpositionen und Sektorzugehörigkeit auf die Entstehung des Implementationsnetzwerks. Das Gesundheitswesen 2011, 73:e12-e20.
• [54]Lang A, Mertes A: Governance of Large Innovation Projects: The Implementation of the Electronic Health Card in Germany. In Innovation policy and governance in high-tech industries: the complexity of coordination. Edited by Bauer JM, Lang A, Schneider V. Berlin, New York: Springer; 2012:245-260.
• [55]Gričar J: Innovative cross-border eRegion development: possible directions and impact. Organizacija 2007, 40:86-96.
• [56]Mandil S: Review of and recommended improvements to Turkey eHealth Strategy. Geneva: ITU; 2004.
• [57]Dogac A, Hülür U, Caylan AK, Yuksel M, Heywood J: Country brief: Turkey. Ankara/Bonn: empirica - eHealth Strategies; 2010.