Mark Gary Embrett

McMaster University
Health Sciences
embretmg@mcmaster.ca

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I focus primarily on the role of the state in health policy decisions and how this relates to health system arrangements (governance, financing and delivery). Currently topics I am researching using this lens are: Health Equity and its relationship with various Social Determinants of Health, Disinvestment in healthcare services, Resource Allocation, and Transition between healthcare services with a focus on transition from youth to adult mental health services.

Citation:
Mulvale, G., Embrett, M., & Razavi, S. D. (2016). ‘Gearing Up’to improve interprofessional collaboration in primary care: a systematic review and conceptual framework. BMC Family Practice, 17(1), 83. Chicago
Citation:
Embrett, M. G., Randall, G. E., Longo, C. J., Nguyen, T., & Mulvale, G. (2015, March). Effectiveness of health system services and programs for youth to adult transitions in mental health care: a systematic review of academic literature. In JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS (Vol. 18, pp. S12-S13).
Citation:
Embrett, M. 2013. "Addressing the Authorization of Orphan Drugs Will Not Fix Reimbursement Problems: The Elephant is Still in the Room." Canadian Pharmacists Journal/Revue des Pharmaciens du Canada 146 (5):245-246.
DOI: 10.1177/1715163513499127
Citation:
Embrett, Mark, and Neil J. MacKinnon. 2012. "Qualitative evaluation of the Canadian Fabry Disease Initiative." Canadian Pharmacists Journal/Revue des Pharmaciens du Canada 145 (3):136-141.
Abstract: In late 2005, the federal and provincial governments responded to an increasing demand from physicians and their patients with Fabry disease for access to enzyme replacement therapy (ERT). This response took the form of a nationwide clinical research study, the Canadian Fabry Disease Initiative (CFDI). Patients who enrolled as participants in this longitudinal study received 1 of 2 ERT treatments. The present study used a qualitative evaluative approach to describe the perspectives of various key stakeholders regarding the CFDI and its potential as a model for providing access to expensive drugs for rare diseases. Methods: The CFDI was evaluated from the perspectives of 4 groups of key informants: patients, CFDI investigators, policy-makers and pharmaceutical manufacturers. The qualitative methods strategy used for the study involved semistructured interviews, a holistic-inductive design and content analysis. Results: Eighteen participants were interviewed. The study revealed that stakeholders held the following perceptions about the CFDI. The CFDI was created as a response to a drug reimbursement problem in Canada. Through specialist physicians, the CFDI has provided ERT to patients with Fabry disease across the country. The CFDI established a national database for collecting and monitoring the incidence of Fabry disease and information about ERT. The CFDI represented a collaborative effort among the various stakeholders (federal, provincial, pharmaceutical), but no stakeholder group thought that the CFDI was the correct response to the need for access to ERT. Finally, the CFDI can and should be redesigned, through modification of either its governing structure or its outcome goals. Discussion: The CFDI was a prototype for sharing the costs of expensive therapies for rare diseases. It has provided ERT to many patients with Fabry disease for several years. However, it was poorly designed to meet its outcome goals and has been unable to provide therapy to all individuals with the disease. Therefore, many stakeholders saw this initiative as an inappropriate solution. Conclusions: The CFDI has not met the expectations of key informant groups and some modifications may be necessary. A registry study might better accomplish the CFDI's original goals of providing access to treatment, gathering data and monitoring patients' progress.
URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3567523/
Citation:
Embrett, Mark. 2014. "Examining Why the Canadian Federal Government Placed an Orphan Drug Strategy on Their Decision Agenda Now." Health Reform Observer 2 (1).
Abstract: The Ministry of Health’s announcement of a National Orphan Drug Framework on 3 October 2012 was the first federal public acknowledgement of orphan drugs since the 1997 Drugs Directorate (DD) policy statement. The reform primarily announced an Orphan Drug Policy for Canada. This paper explains why the government decided to make this announcement now. Media and Parliamentary documents were analyzed for their use of symbols, numbers, and language in causal stories told by political actors. The initial story was that Canada’s population was too small and the cost too high for an orphan drug policy. Over the next fifteen years, a powerful interest group, the Canadian Organization for Rare Disorders (CORD), mobilized the rare disease community into a cooperative effort that generated collective action. They redefined the DD story from one of natural causes, to inadvertence, and finally to intentional causation. Their story invoked a federal response because it blamed the government directly for not acting on behalf of the 3 million Canadians with rare diseases, when patients in other countries were receiving better care.
URL: http://digitalcommons.mcmaster.ca/cgi/viewcontent.cgi?article=1005&context=hro-ors
Citation:
Embrett, Mark G. & Randall, G.E. 2014. "Social Determinants of Health and Health Equity Policy Research: Exploring the Use, Misuse, and Nonuse of Policy Analysis Theory." Social Science and Medicine 108:147-155.
Abstract: Despite a dramatic growth in SDH/HE (social determinants of health/health equity) public policy research and demonstrated government interest in promoting equity in health policies, health inequities are actually growing among some populations and there is little evidence that “healthy public policies” are being adopted and implemented. Moreover, these issues are typically failing to even reach governments' policy agendas, which is a critical step towards serious debate and the identification of policy options. This systematic review pursues three main objectives. First, is to identify barriers to SDH/HE issues reaching the government policy agenda. Second, to evaluate the characteristics of peer-reviewed research articles that utilize common policy analysis theories. And third, to determine the extent to which the SDH/HE literature utilizes common policy analysis theories. Our systematic review, conducted in June 2012, identified 6200 SDH/HE related articles in the peer-reviewed literature; however, only seven articles explicitly used a commonly recognized policy analysis theory to inform their analysis. Our analysis revealed that the SDH/HE policy literature appears to be focused on advocacy rather than analysis and that the use of policy analysis theory is extremely limited. Our results also suggest that when such theories are incorporated into an analysis they are often not comprehensively employed. We propose explanations for this non-use and misuse of policy analysis theory, and conclude that researchers may have greater influence in helping to get SDH/HE issues onto government policy agendas if they gain a greater understanding of the policy process and the value of incorporating policy analysis theories into their research. Using a policy analysis lens to help identify why healthy public policies are typically not being adopted is an important step towards moving beyond advocacy to understanding and addressing some of the political barriers to reforms.

Substantive Focus:
Health Policy PRIMARY
Social Policy
Comparative Public Policy SECONDARY

Theoretical Focus:
Policy Process Theory
Agenda-Setting, Adoption, and Implementation PRIMARY
Policy Analysis and Evaluation SECONDARY

Keywords

HEALTH POLICY POLICY ANALYSIS COMPARATIVE PUBLIC POLICY QUALITATIVE RESEARCH