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1、33TheProcessofHealthPolicyReformintheEnglish-SpeakingCaribbean:CaseStudiesinNationalHealthInsuranceRickyVanKalliecharanDecember2002UniversityofLeeds,NuffieldInstituteforHealth71-75ClarendonRd.Leeds,U.K.LS29PLMinistryofHealth–TrinidadandTobago10-12IndependenceSq.Po
2、rt-of-SpainTrinidadW.I.SubmittedtothePanAmericaHealthOrganisationResearchGrantsProgramme,Post-GraduateThesisinPublicHealth(AwardedOctober1998–HDP/HDR/RG-T/TRT/1485)DivisionofHealthandHumanDevelopment(HDP)PanAmericanHealthOrganisation(PAHO)52523rdStreet,N.W.Washing
3、ton,D.C.20037-2895-USA33ABSTRACTThispaperdocumentsandanalysestheprocessofHealthPolicyReformintheEnglish-speakingCaribbean.ItfocusesonthedevelopmentofpoliciesforNationalHealthInsuranceinthreecountriesintheRegion:TrinidadandTobago,StLuciaandStVincent&theGrenadines.T
4、hestudyisunique,asitprovidesthefirstdocumentationofthepolicyprocessforNationalHealthInsuranceProgrammesintheEnglish-speakingCaribbean,therebyaddingtotheliteratureonHealthPolicyProcess.Theresearchwasconducted(1996-2002part-time)inaccordancewiththedegreerequirements
5、forDoctorofPhilosophy(PhD)attheUniversityofLeeds,NuffieldInstituteforHealth,UK.Thestudyadoptsaqualitativemethodologicalapproachusingthethreecountriesascasestudies.Semi-structuredinterviewswereconductedwith60keystakeholders,fromthethreecasestudies,whowereinvolvedin
6、thedevelopmentoftheNationalHealthInsuranceProgrammes.Insupportofthisprimarydata,variousdocumentsrelatingtothedevelopmentofthepolicywerecollectedandanalysedforeachcasestudy.AnanalyticalframeworkdevelopedbyWalt&Gilson(1994)wasusedasaguidefordatacollectionandanalysis
7、oftheresearchfindings.Thisframeworkforhealthpolicyanalysisincludesaninvestigationofthe“context”,“process”,and“actors”and“content”oftheNationalHealthInsurancepolicy.Astheinvestigationdeveloped,apictureoftheNationalHealthInsurancepolicyprocessemergedfromtheprimaryan
8、dsecondarysourcesofdata.Thedocumentationofthispolicyprocessforeachcountryispresentedintwoparts.ThefirstpartdescribesthedevelopmentoftheNationalHealthIns
