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  Subjects -> HEALTH AND SAFETY (Total: 1283 journals)
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HEALTH AND SAFETY (514 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
A Life in the Day     Hybrid Journal   (Followers: 9)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access  
Adultspan Journal     Hybrid Journal  
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 20)
African Health Sciences     Open Access   (Followers: 2)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 6)
African Journal of Health Professions Education     Open Access   (Followers: 4)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 3)
AJOB Primary Research     Partially Free   (Followers: 2)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Health Economics     Full-text available via subscription   (Followers: 13)
American Journal of Health Education     Hybrid Journal   (Followers: 25)
American Journal of Health Promotion     Hybrid Journal   (Followers: 22)
American Journal of Health Studies     Full-text available via subscription   (Followers: 8)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 21)
American Journal of Public Health     Full-text available via subscription   (Followers: 179)
American Journal of Public Health Research     Open Access   (Followers: 27)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 8)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access  
Archives of Medicine and Health Sciences     Open Access   (Followers: 2)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 2)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Association of Schools of Allied Health Professions     Full-text available via subscription   (Followers: 5)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 2)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 2)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 1)
Behavioral Healthcare     Full-text available via subscription   (Followers: 4)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 6)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 9)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 18)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 7)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 15)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 11)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 10)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 18)
Case Reports in Women's Health     Open Access   (Followers: 2)
Case Studies in Fire Safety     Open Access   (Followers: 11)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
Central European Journal of Public Health     Full-text available via subscription   (Followers: 4)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 10)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access  
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 1)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 1)
Conflict and Health     Open Access   (Followers: 8)
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 1)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription  
Duazary     Open Access   (Followers: 1)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 13)
East African Journal of Public Health     Full-text available via subscription   (Followers: 3)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 16)
EcoHealth     Hybrid Journal   (Followers: 3)
Education for Health     Open Access   (Followers: 4)
electronic Journal of Health Informatics     Open Access   (Followers: 4)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 5)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access  
Environmental Sciences Europe     Open Access   (Followers: 1)
Epidemics     Open Access   (Followers: 3)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 18)
Ethics, Medicine and Public Health     Full-text available via subscription  
Ethiopian Journal of Health Development     Open Access   (Followers: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 7)
Ethnicity & Health     Hybrid Journal   (Followers: 13)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 1)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 8)
Evidence-based Medicine & Public Health     Open Access   (Followers: 4)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 3)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 10)
Frontiers in Public Health     Open Access   (Followers: 8)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 11)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 4)
Global Health Promotion     Hybrid Journal   (Followers: 15)
Global Journal of Health Science     Open Access   (Followers: 6)
Global Journal of Public Health     Open Access   (Followers: 9)
Global Medical & Health Communication     Open Access  
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 7)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 14)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 7)
Health and Human Rights     Free   (Followers: 8)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 9)
Health and Social Work     Hybrid Journal   (Followers: 45)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 11)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 10)
Health Issues     Full-text available via subscription   (Followers: 1)
Health Policy     Hybrid Journal   (Followers: 32)
Health Policy and Technology     Hybrid Journal  
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 20)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 10)
Health Promotion Practice     Hybrid Journal   (Followers: 15)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 47)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 39)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 9)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 2)
Health Services Insights     Open Access   (Followers: 1)
Health Systems     Hybrid Journal   (Followers: 2)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 10)
Health, Risk & Society     Hybrid Journal   (Followers: 9)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 10)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 5)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 2)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 3)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 1)
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 6)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 4)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 32)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 1)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 7)
International Journal of Circumpolar Health     Open Access   (Followers: 1)
International Journal of Community Medicine and Public Health     Open Access   (Followers: 5)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 19)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 13)
International Journal of Health & Allied Sciences     Open Access   (Followers: 1)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 7)
International Journal of Health Geographics     Open Access   (Followers: 6)
International Journal of Health Policy and Management     Open Access   (Followers: 2)
International Journal of Health Professions     Open Access   (Followers: 2)
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 12)
International Journal of Health Sciences Education     Open Access   (Followers: 2)
International Journal of Health Services     Full-text available via subscription   (Followers: 9)
International Journal of Health Studies     Open Access   (Followers: 3)
International Journal of Health System and Disaster Management     Open Access   (Followers: 2)

        1 2 3 | Last

Journal Cover Health Policy
  [SJR: 1.182]   [H-I: 36]   [32 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0168-8510
   Published by Elsevier Homepage  [3031 journals]
  • On the role of environmental corruption in healthcare infrastructures: An
           empirical assessment for Italy using DEA with truncated regression
    • Authors: Marina Cavalieri; Calogero Guccio; Ilde Rizzo
      Pages: 515 - 524
      Abstract: Publication date: May 2017
      Source:Health Policy, Volume 121, Issue 5
      Author(s): Marina Cavalieri, Calogero Guccio, Ilde Rizzo
      Objectives This paper investigates empirically whether the institutional features of the contracting authority as well as the level of ‘environmental’ corruption in the area where the work is localised affect the efficient execution of public contracts for healthcare infrastructures. Methods A two-stage Data Envelopment Analysis (DEA) is carried out based on a sample of Italian public contracts for healthcare infrastructures during the period 2000–2005. First, a smoothed bootstrapped DEA estimator is used to assess the relative efficiency in the implementation of each single infrastructure contract. Second, the determinants of the efficiency scores variability are considered, paying special attention to the effect exerted by ‘environmental’ corruption on different types of contracting authorities. Results Our results show that the performance of the contracts for healthcare infrastructures is significantly affected by ‘environmental’ corruption. Furthermore, healthcare contracting authorities are, on average, less efficient and the negative effect of corruption on efficiency is greater for this type of public procurers. Conclusions The policy recommendation coming out of the study is to rely on ‘qualified’ contracting authorities since not all the public bodies have the necessary expertise to carry on public contracts for healthcare infrastructures efficiently.

      PubDate: 2017-04-30T10:27:58Z
      DOI: 10.1016/j.healthpol.2017.02.011
  • The emerging market for supplemental long term care insurance in Germany
           in the context of the 2013 Pflege-Bahr reform
    • Abstract: Publication date: June 2017
      Source:Health Policy, Volume 121, Issue 6
      Author(s): Pamela Nadash, Alison Evans Cuellar
      The growing cost of long term care is burdening many countries’ health and social care systems, causing them to encourage individuals and families to protect themselves against the financial risk posed by long term care needs. Germany’s public long-term care insurance program, which mandates coverage for most Germans, is well-known, but fewer are aware of Germany’s growing voluntary, supplemental private long-term care insurance market. This paper discusses German policymakers’ 2013 effort to expand it by subsidizing the purchase of qualified policies. We provide data on market expansions and the extent to which policy goals are being achieved, finding that public subsidies for purchasing supplemental policies boosted the market, although the effect of this stimulus diminished over time. Meanwhile, sales growth in the unsubsidized market appears to have slowed, despite design features that create incentives for lower-risk individuals to seek better deals there. Thus, although subsidies for cheap, low-benefit policies seem to have achieved the goal of market expansion, the overall impact and long-term sustainability of these products is unclear; conclusions about its impact are further muddied by significant expansions to Germany’s core program. The German example reinforces the examples of the US and France private long term care insurance markets, to show how such products flourish best when supplementing a public program.

      PubDate: 2017-05-26T05:33:33Z
  • Assessing impacts of the WHO FCTC on national legislations: A case study
           of the Republic of Korea
    • Abstract: Publication date: June 2017
      Source:Health Policy, Volume 121, Issue 6
      Author(s): Sun Goo Lee
      The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is an international treaty that was adopted in 2003 with the aim of addressing public health problems related to tobacco. The treaty is expected to bring substantial changes to global tobacco control because it has legally binding power over its signatory countries. However, its actual impact on national legislative processes, to date, has not been thoroughly examined. This article assesses the effect of the WHO FCTC on national tobacco legislation, with the Republic of Korea as a case study. This article also reviews whether and how lawmakers and government officials actually refer to the WHO FCTC as a justification for amending tobacco law after Korea ratified the WHO FCTC in 2005. This review shows that the WHO FCTC served as an important ground upon which to amend laws to strengthen tobacco control in Korea. The legally binding power of the WHO FCTC compelled lawmakers to comply with international standards. Furthermore, various tobacco control measures listed in the treaty have provided practical tips for Korean policymakers to refer to in designing tobacco control laws.

      PubDate: 2017-05-26T05:33:33Z
  • Community residential facilities in mental health services: A ten-year
           comparison in Lombardy
    • Abstract: Publication date: June 2017
      Source:Health Policy, Volume 121, Issue 6
      Author(s): Angelo Barbato, Graziella Civenti, Barbara D’Avanzo
      Residential mental health services grew steadily since 2000 in Italy. A reorganisation of residential facilities was implemented in 2007 in Lombardy, introducing supported housing in addition to staffed facilities. We compare the provision and characteristics of residential facilities in the 2007 and 2016. In 2007 there were 3462 beds (35.9/100,000 population) in 276 facilities. In 2016 beds were 4783 (47.8/100,000) in 520 facilities. The increase were unevenly distributed in the public and private sector, and the overall increase was due to a higher increase in the private sector. 72% of beds were in highly supervised facilities in 2007 and 66% in 2016. The public sector managed more facilities with a rehabilitation goal, while the private sector more for long-term accommodation. Mean numbers of beds were higher in facilities managed by the private sector in both years. The 2007 reorganisation and the stop to opening new facilities in the last years were not enough to correct the imbalance between highly supervised and flexible solutions. A wider and more diverse offer might have triggered off an increased demand, rather than a more rational use. Given the costs of highly staffed facilities, and the risk of reproducing custodial models, close evaluation of the use of residential facilities should inform policies.

      PubDate: 2017-05-26T05:33:33Z
  • What do we mean when we talk about the Triple Aim? A systematic review of
           evolving definitions and adaptations of the framework at the health system
    • Abstract: Publication date: June 2017
      Source:Health Policy, Volume 121, Issue 6
      Author(s): Gustavo Mery, Shilpi Majumder, Adalsteinn Brown, Mark J. Dobrow
      Notwithstanding important contributions of the Triple Aim, uncritical enthusiasm regarding the implications of the framework may be leading to inconsistent use, particularly when applied at the health system level, which goes beyond the original positioning of the framework as a strategic organizing principle to guide improvement initiatives at the organizational or local community level. We systematically identified uses of the Triple Aim that extended beyond its original intention to focus on uses at the whole health system level, to assess convergence and divergence with the original definition. We also attempted to identify consistencies in the way the Triple Aim was adapted for different contexts and settings. Data sources were indexed databases, web search engines, and international experts. Forty-seven articles were included in the analysis. We found that the definition of the Triple Aim has been subject to important modifications when the framework is used to define goals for whole health care systems or globally. Despite widespread recognition of the name, what constitutes the Triple Aim framework varies. We identified the need to consider the inclusion of at least two additional aims of health care systems – the provider experience of care, and the desire to achieve health equity for populations.

      PubDate: 2017-05-26T05:33:33Z
  • Deaths amenable to health care: Converging trends in the EU?
    • Abstract: Publication date: June 2017
      Source:Health Policy, Volume 121, Issue 6
      Author(s): Anke Weber, Marie Clerc
      Amenable mortality has been recently included in the joint monitoring tool by the European Commission and Member States to assess a country's health system performance. Amenable deaths are premature deaths, which should not have occurred at this stage in the light of timely and effective health care. This paper recalculated annual amenable mortality rates for 28EU countries and the EU for the period 1994–2013 based on the recently published list of deaths amenable to health care by Eurostat. Thereby, it offers a consistent calculation of amenable mortality across European Member States and provides time series data on amenable mortality. In addition, a sensitivity analysis of the amenable mortality indicator for varying age limits and attributional weights of circulatory system diseases is carried out. While large improvements were made in reducing amenable deaths in all European countries, great variations persist among Member States. Most of the decreases in amenable mortality are explained by a substantial reduction of deaths due to circulatory system diseases. In addition, even in countries with good national performance on amenable mortality, sub-national analysis shows that great regional disparities exist. The sensitivity analysis revealed that for the large majority of countries results are stable across different attributional weights used for ischaemic heart diseases and cerebrovascular diseases.

      PubDate: 2017-05-26T05:33:33Z
  • Understanding what matters: An exploratory study to investigate the views
           of the general public for priority setting criteria in health care
    • Abstract: Publication date: June 2017
      Source:Health Policy, Volume 121, Issue 6
      Author(s): Julie Ratcliffe, Emily Lancsar, Ruth Walker, Yuanyuan Gu
      Health care policy makers internationally are increasingly expressing commitment to consultation with, and incorporation of, the views of the general public into the formulation of health policy and the process of setting health care priorities. In practice, however, there are relatively few opportunities for the general public to be involved in health care decision-making. In making resource allocation decisions, funders, tasked with managing scarce health care resources, are often faced with difficult decisions in balancing efficiency with equity considerations. A mixed methods (qualitative and quantitative) approach incorporating focus group discussions and a ranking exercise was utilised to develop a comprehensive list of potential criteria for setting priorities in health care formulated from the perspective of members of the general public in Australia. A strong level of congruence was found in terms of the rankings of the key criteria with the size of the health gain, clinical effectiveness, and the ability to provide quality of life improvements identified consistently as the three most important criteria for prioritising the funding of an intervention. Findings from this study will be incorporated into a novel DCE framework to explore how decision makers and members of the general public prioritize and trade off different types of health gain and to quantify the weights attached to specific efficiency and equity criteria in the priority setting process.

      PubDate: 2017-05-26T05:33:33Z
  • The effects of population ageing on health care expenditure: A Bayesian
           VAR analysis using data from Italy
    • Abstract: Publication date: June 2017
      Source:Health Policy, Volume 121, Issue 6
      Author(s): Milena Lopreite, Marianna Mauro
      Currently, the dynamics of the population have raised concerns about the future sustainability of Italy’s national health system. The increasing proportion of people over the age of 65 could lead to a higher incidence of chronic-degenerative diseases and a greater demand for health and social care with a consequent impact on health spending. Although in recent years the quantity and quality of works on the relationship between ageing and health expenditure has increased substantially these works do not always obtain similar results. Starting from this point, we use a B-VAR model and Eurostat data to investigate over the period 1990–2013 the impact of demographic changes on health expenditure in Italy. We estimate these models using impulse-response analysis and variance decomposition. The results show that health expenditure in Italy reacts more to the ageing population compared with life expectancy and per capita GDP. In response to these findings, we conclude that the impact of the increase in the elderly population with disabilities will fall on the long-term care sector. Effective health interventions, such as health-promotion and disease-prevention programs that target the main causes of morbidity, could help to minimize the cost pressures associated with ageing by ensuring that the population stays healthy in old age. We consider the implications of this work for health care policy suggestions and for future research.

      PubDate: 2017-05-26T05:33:33Z
  • The role of private non-profit healthcare organizations in NHS systems:
           Implications for the Portuguese hospital devolution program
    • Abstract: Publication date: June 2017
      Source:Health Policy, Volume 121, Issue 6
      Author(s): Álvaro S. Almeida
      The national health services (NHS) of England, Portugal, Finland and other single-payer universalist systems financed by general taxation, are based on the theoretical principle of an integrated public sector payer-provider. However, in practice one can find different forms of participation of non-public healthcare providers in those NHS, including private for profit providers, but also third sector non-profit organizations (NPO). This paper reviews the role of non-public non-profit healthcare organizations in NHS systems. By crossing a literature review on privatization of national health services with a literature review on the comparative performance of non-profit and for-profit healthcare organizations, this paper assesses the impact of contracting private non-profit healthcare organizations on the efficiency, quality and responsiveness of services, in public universal health care systems. The results of the review were then compared to the existing evidence on the Portuguese hospital devolution to NPO program. The evidence in this paper suggests that NHS health system reforms that transfer some public-sector hospitals to NPO should deliver improvements to the health system with minimal downside risks. The very limited existing evidence on the Portuguese hospital devolution program suggests it improved efficiency and access, without sacrificing quality.

      PubDate: 2017-05-26T05:33:33Z
  • Classification trees for identifying non-use of community-based long-term
           care services among older adults
    • Abstract: Publication date: Available online 23 May 2017
      Source:Health Policy
      Author(s): Michael J. Penkunas, Kirsten Eom, Angelique W.M. Chan
      Home- and center-based long-term care (LTC) services allow older adults to remain in the community while simultaneously helping caregivers cope with the stresses associated with providing care. Despite these benefits, the uptake of community-based LTC services among older adults remains low. We analyzed data from a longitudinal study in Singapore to identify the characteristics of individuals with referrals to home-based LTC services or day rehabilitation services at the time of hospital discharge. Classification and regression tree analysis was employed to identify combinations of clinical and sociodemographic characteristics of patients and their caregivers for individuals who did not take up their referred services. Patients’ level of limitation in activities of daily living (ADL) and caregivers’ ethnicity and educational level were the most distinguishing characteristics for identifying older adults who failed to take up their referred home-based services. For day rehabilitation services, patients’ level of ADL limitation, home size, age, and possession of a national medical savings account, as well as caregivers’ education level, and gender were significant factors influencing service uptake. Identifying subgroups of patients with high rates of non-use can help clinicians target individuals who are need of community-based LTC services but unlikely to engage in formal treatment.

      PubDate: 2017-05-26T05:33:33Z
    • Authors: Deborah Debono; David Greenfield; Luke Testa; Virginia Mumford; Anne Hogden; Marjorie Pawsey; Johanna Westbrook; Jeffrey Braithwaite
      Abstract: Publication date: Available online 19 May 2017
      Source:Health Policy
      Author(s): Deborah Debono, David Greenfield, Luke Testa, Virginia Mumford, Anne Hogden, Marjorie Pawsey, Johanna Westbrook, Jeffrey Braithwaite
      Objective To examine general practice accreditation stakeholders’ perspectives and experiences to identify program strengths and areas for improvements. Design, setting and participants Individual (n=2) and group (n=9) interviews were conducted between September 2011–March 2012 with 52 stakeholders involved in accreditation in Australian general practices. Interviews were recorded, transcribed and thematically analysed. Member checking activities in April 2016 assessed the credibility and currency of the findings in light of current reforms. Results Overall, participants endorsed the accreditation program but identified several areas of concern. Noted strengths of the program included: program ownership, peer review and collaborative learning; access to Practice Incentives Program payments; and, improvements in safety and quality. Noted limitations in these and other aspects of the program offer potential for improvement: evidence for the impact of accreditation; resource demands; clearer outcome measures; and, specific experiences of accreditation. Conclusions The effectiveness of accreditation as a strategy to improve safety and quality was shaped by the attitudes and experience of stakeholders. Strengths and weaknesses in the accreditation program influence, and are influenced by, stakeholder engagement and disengagement. After several accreditation cycles, the sector has the opportunity to reflect on, review and improve the process. This will be important if the continued or extended engagement of practices is to be realised to assure the continuation and effectiveness of the accreditation program.

      PubDate: 2017-05-21T05:01:10Z
      DOI: 10.1016/j.healthpol.2017.05.006
  • Are public-private partnerships the solution to tackle neglected tropical
           diseases? A systematic review of the literature
    • Authors: Céline Aerts; Temmy Sunyoto; Fabrizio Tediosi; Elisa Sicuri
      Abstract: Publication date: Available online 19 May 2017
      Source:Health Policy
      Author(s): Céline Aerts, Temmy Sunyoto, Fabrizio Tediosi, Elisa Sicuri
      Pharmaceutical companies are reluctant to invest in research and development (R&D) of products for neglected tropical diseases (NTDs) mainly due to the low ability-to-pay of health insurance systems and of potential consumers. The available preventive and curative interventions for NTDs mostly rely on old technologies and products that are often not adequate. Moreover, NTDs mostly affect populations living in remote rural areas and conflict zones, thereby hampering access to healthcare. The challenges posed by NTDs have led to the proliferation of a variety of public-private partnerships (PPPs) in the last decades. We conducted a systematic review to assess the functioning and impact of these partnerships on the development of and access to better technologies for NTDs. Our systematic review revealed a clear lack of empirical assessment of PPPs: no impact evaluation analyses could be found, which are crucial to realize the full potential of PPPs and to progress further towards NTDs elimination.

      PubDate: 2017-05-21T05:01:10Z
      DOI: 10.1016/j.healthpol.2017.05.005
  • Processes and experiences of Portugal’s international recruitment scheme
           of Colombian physicians: did it work?
    • Authors: Erika Masanet
      Abstract: Publication date: Available online 17 May 2017
      Source:Health Policy
      Author(s): Erika Masanet
      The Portuguese Ministry of Health performed five international recruitment rounds of Latin American physicians due to the need for physicians in certain geographic areas of the country and in some specialties, as a temporary solution to shortages. Among these recruitments is that of Colombian physicians in 2011 that was the largest of the five groups. This paper presents an evaluation of the international recruitment procedure of Colombian physicians based on the criteria of procedural outcomes and health system outcomes. The methodology used is qualitative, based on semi-structured interviews with key informants and Colombian physicians recruited in Portugal and also on documentary analysis of secondary sources. International recruitment of Colombian physicians coincided with a period of political change and severe economic crisis in Portugal that caused some problems in the course of this recruitment, mainly family reunification in the later group of Colombian physicians and non-compliance of the salary originally agreed upon. Furthermore, due to the continuous resignations of Colombian physicians throughout the 3-year contract, procedural outcomes and health system outcomes of this international recruitment were not fulfilled and therefore the expected results to meet the temporary needs for medical personnel in some areas of the country were not accomplished.

      PubDate: 2017-05-21T05:01:10Z
      DOI: 10.1016/j.healthpol.2017.05.004
  • Implementing shared-decision-making for diabetes care across country
           settings: what really matters to people?
    • Authors: Michela Tinelli; Panagiotis Petrou; George Samoutis; Vivie Traynor; George Olympios; Alistair McGuire
      Abstract: Publication date: Available online 10 May 2017
      Source:Health Policy
      Author(s): Michela Tinelli, Panagiotis Petrou, George Samoutis, Vivie Traynor, George Olympios, Alistair McGuire
      Context Growing evidence of improved clinical outcomes and patient/professional satisfaction supports shared-decision-making (SDM) services as an effective primary care interventions for diabetes. However, only a few countries have actually adopted them (e.g. England). In other European countries (e.g. Cyprus) there is awareness that patients play a crucial role in decision-making, and SDM services could be considered as innovative strategies to promote the actual implementation of patient rights legislation and strengthen primary care. Objective to understand preferences of people with diabetes when choosing their care, and how they value alternative SDM services compared to their ‘current’ option. Preferences were collected from patients based in England, where SDM is already in place at national level, and Cyprus, where people are new to it, using a discrete-choice-experiment (DCE) survey. Results Cypriots valued choosing alternative SDM services compared to their ‘current’ option, whereas the English preferred their status quo to other services. Having the primary-care-physician as healthcare provider, receiving compassionate care, receiving detailed and accurate information about their care, continuity of care, choosing their care management and treatment, and reduced waiting time were the SDM characteristics that Cypriots valued; the English preferred similar factors, apart from information/continuity of care. Conclusion People with diabetes do value SDM and different SDM models may fit different groups according to their personal experience and country specific settings.

      PubDate: 2017-05-11T13:13:18Z
      DOI: 10.1016/j.healthpol.2017.05.001
  • The role of the European Structural and Investment Funds in Financing
           Health System in Lithuania: Experience from 2007 to 2013 funding period
           and implications for the future
    • Authors: Liubove Murauskiene; Marina Karanikolos
      Abstract: Publication date: Available online 10 May 2017
      Source:Health Policy
      Author(s): Liubove Murauskiene, Marina Karanikolos
      European Structural and Investment Funds (ESIF) are a major source of investments in the newer EU member states. In Lithuania’s health sector, the amount for the 2007–2013 funding period reached more than €400 million. In this paper we aim to (i) identify the key areas in the health sector which were supported by ESIF, (ii) determine the extent to which ESIF assisted the implementation of the ongoing health system reform; and (iii) assess whether the use of funds has led to expected improvements in healthcare. We review the national strategic documents and legislation, and perform calculations to determine funding allocations by specific area, based on the available data. We analyse changes according to a set of selected indicators. We find that implementation of programmes funded by the ESIF lacks formal evaluation. Existing evidence suggests that some improvement has been achieved by 2013. However, there are persisting challenges, including failure to reach a broad agreement on selection of health and healthcare indicators, lack of transparency in allocations, and absence of coherent assessment measures of healthcare quality and accessibility.

      PubDate: 2017-05-11T13:13:18Z
      DOI: 10.1016/j.healthpol.2017.04.012
  • Time-driven activity-based costing in health care: A systematic review of
           the literature
    • Authors: George Keel; Carl Savage; Muhammad Rafiq; Pamela Mazzocato
      Abstract: Publication date: Available online 10 May 2017
      Source:Health Policy
      Author(s): George Keel, Carl Savage, Muhammad Rafiq, Pamela Mazzocato
      Health care organizations around the world are investing heavily in value-based health care (VBHC), and time-driven activity-based costing (TDABC) has been suggested as the cost-component of VBHC capable of addressing costing challenges. The aim of this study is to explore why TDABC has been applied in health care, how its application reflects a seven-step method developed specifically for VBHC, and implications for the future use of TDABC. This is a systematic review following the PRISMA statement. Qualitative methods were employed to analyze data through content analyses. TDABC is applicable in health care and can help to efficiently cost processes, and thereby overcome a key challenge associated with current cost-accounting methods The method’s ability to inform bundled payment reimbursement systems and to coordinate delivery across the care continuum remains to be demonstrated in the published literature, and the role of TDABC in this cost-accounting landscape is still developing. TDABC should be gradually incorporated into functional systems, while following and building upon the recommendations outlined in this review. In this way, TDABC will be better positioned to accurately capture the cost of care delivery for conditions and to control cost in the effort to create value in health care.

      PubDate: 2017-05-11T13:13:18Z
      DOI: 10.1016/j.healthpol.2017.04.013
  • The impact of economic conditions on the disablement process: A Markov
           transition approach using SHARE data
    • Authors: Y. Arrighi; T. Rapp; N. Sirven
      Abstract: Publication date: Available online 10 May 2017
      Source:Health Policy
      Author(s): Y. Arrighi, T. Rapp, N. Sirven
      A growing number of studies underline the relationship between socioeconomic status and health at older ages. Following that literature, we explore the impact of economic conditions on changes in functional health overtime. Frailty, a state of physiological instability allowing for reversible pathways, has been identified in the public health literature as a candidate for disability prevention but received little attention from health economists. Using SHARE panel data, respondents aged 50 and over from ten European countries were categorised as robust, frail and dependent. The determinants of health states’ changes between two interviews were analysed using multinomial Probit models accounting for potential sample attrition. A particular focus was made on initial socioeconomic status, proxied by three alternative measures. Concentration indices were computed for key transition probabilities. Across Europe, poorer and less educated elders were substantially more likely to experience health degradations and also less likely to experience health improvements. The economic gradient for the recovery from frailty was steeper than that of frailty onset, but remained lower than that of dependency onset. The existing social programs in favour of deprived and dependent elders could be widened to those diagnosed as frail to reduce the onset of dependency and economic inequalities in health at older ages.

      PubDate: 2017-05-11T13:13:18Z
      DOI: 10.1016/j.healthpol.2017.05.002
  • The bare necessities? A realist review of necessity argumentations used in
           health care coverage decisions
    • Authors: Tineke Kleinhout-Vliek; Antoinette de Bont; Bert Boer
      Abstract: Publication date: Available online 5 May 2017
      Source:Health Policy
      Author(s): Tineke Kleinhout-Vliek, Antoinette de Bont, Bert Boer
      Context Policy makers and insurance companies decide on coverage of care by both calculating (cost-) effectiveness and assessing the necessity of coverage. Aim To investigate argumentations pertaining to necessity used in coverage decisions made by policy makers and insurance companies, as well as those argumentations used by patients, authors, the public and the media. Methods This study is designed as a realist review, adhering to the RAMESES quality standards. Embase, Medline and Web of Science were searched and 98 articles were included that detailed necessity-based argumentations. Results We identified twenty necessity-based argumentation types. Seven are only used to argue in favour of coverage, five solely for arguing against coverage, and eight are used to argue both ways. A positive decision appears to be facilitated when patients or the public set the decision on the agenda. Moreover, half the argumentation types are only used by patients, authors, the public and the media, whereas the other half is also used by policy makers and insurance companies. The latter group is more accepted and used in more different countries. Conclusion The majority of necessity-based argumentation types is used for either favouring or opposing coverage, and not for both. Patients, authors, the public and the media use a broader repertoire of argumentation types than policy makers and insurance companies.

      PubDate: 2017-05-06T10:51:51Z
      DOI: 10.1016/j.healthpol.2017.04.011
  • New insights into health financing: First results of the international
           data collection under the System of Health Accounts 2011 framework
    • Authors: Michael Mueller; David Morgan
      Abstract: Publication date: Available online 2 May 2017
      Source:Health Policy
      Author(s): Michael Mueller, David Morgan
      International comparisons of health spending and financing are most frequently carried out using datasets of international organisations based on the System of Health Accounts (SHA). This accounting framework has recently been updated and 2016 saw the first international data collection under the new SHA 2011 guidelines. In addition to reaching better comparability of health spending figures and greater country coverage, the updated framework has seen changes in the dimension of health financing leading to important consequences when analysing health financing data. This article presents the first results of health spending and financing data collected under this new framework and highlights the areas where SHA 2011 has become a more useful tool for policy analysis, by complementing data on expenditure of health financing schemes with information about their revenue streams. It describes the major conceptual changes in the scope of health financing and highlights why comprehensive analyses based on SHA 2011 can provide for a more complete description and comparison of health financing across countries, facilitate a more meaningful discussion of fiscal sustainability of health spending by also analysing the revenues of compulsory public schemes and help to clarify the role of governments in financing health care – which is generally much bigger than previously documented.

      PubDate: 2017-05-06T10:51:51Z
      DOI: 10.1016/j.healthpol.2017.04.008
  • Approaches to appropriate care delivery from a policy prospective: A case
           study of Australia, England and Switzerland
    • Authors: Joelle Robertson-Preidler; Matthew Anstey; Nikola Biller-Andorno; Alexandra Norrish
      Abstract: Publication date: Available online 29 April 2017
      Source:Health Policy
      Author(s): Joelle Robertson-Preidler, Matthew Anstey, Nikola Biller-Andorno, Alexandra Norrish
      Background Appropriateness is a conceptual way for health systems to balance Triple Aim priorities for improving population health, containing per capita cost, and improving the patient experience of care. Comparing system approaches to appropriate care delivery can help health systems establish priorities and facilitate appropriate care practices. Methods We conceptualized system appropriateness by identifying policies that aim to achieve the Triple Aim and their consequent trade-offs for financing, clinical practice, and the individual patient. We used secondary data sources to compare the appropriate care approaches of Australia, England, and Switzerland according to financial, clinical, and individual appropriateness policies. Findings Health system approaches to appropriate care delivery varied. England prioritizes public health, equity and efficiency at the expense of individual choice, while Switzerland focuses on individual patient preferences, but has higher per capita and out of pocket costs. Australia provides equity in public care access and private health care options that allows for more patient choice, with health care costs falling between the two. Conclusions Integrating the Triple Aim into health system design and policy can facilitate appropriate care delivery at the system, clinical, and individual levels. Approaches will vary and require countries to negotiate and justify priorities and trade-offs within the context of thehealth system.

      PubDate: 2017-04-30T10:27:58Z
      DOI: 10.1016/j.healthpol.2017.04.009
  • Gatekeeping and the Utilization of Physician Services in France: Evidence
           on the Médecin Traitant Reform
    • Authors: Magali Dumontet; Thomas Buchmueller; Paul Dourgnon; Florence Jusot; Jérôme Wittwer
      Abstract: Publication date: Available online 28 April 2017
      Source:Health Policy
      Author(s): Magali Dumontet, Thomas Buchmueller, Paul Dourgnon, Florence Jusot, Jérôme Wittwer
      In 2005, France implemented a gatekeeping reform designed to improve care coordination and to reduce utilization of specialists’ services. Under this policy, patients designate a médecin traitant, typically a general practitioner, who will be their first point of contact during an episode of care and who will provide referrals to specialists. A key element of the policy is that patients who self-refer to a specialist face higher cost sharing than if they received a referral from their médecin traitant. We consider the effect of this policy on the utilization of physician services. Our analysis of administrative claims data spanning the years 2000 to 2008 indicates that visits to specialists, which were increasing in the years prior to the implementation of the reform, fell after the policy was in place. Additional evidence from the administrative claims as well as survey data suggest that this decline arose from a reduction in self-referrals, which is consistent with the objectives of the policy. Visits fell significantly both for specialties targeted by the policy and specialties for which self-referrals are still allowed for certain treatments. This apparent spillover effect may suggest that, at least initially, patients did not understand the subtleties of the policy.

      PubDate: 2017-04-30T10:27:58Z
      DOI: 10.1016/j.healthpol.2017.04.006
  • Job Stickiness of young nurses in Ontario: Does the employer organization
           participation in the Nursing Graduate Guarantee initiative make a
    • Authors: Mohamad Alameddine; Andrea Baumann; Kanecy Onate; Mary Crea; Nour El Arnaout; Raisa Deber
      Abstract: Publication date: Available online 28 April 2017
      Source:Health Policy
      Author(s): Mohamad Alameddine, Andrea Baumann, Kanecy Onate, Mary Crea, Nour El Arnaout, Raisa Deber
      This study assesses the long-term impact of the Nursing Graduate Guarantee (NGG) initiative using the concept of “stickiness” to examine the employment trends of young nurses in Ontario and evaluate the effect of employers’ participation in the NGG on the full-time (FT) employment patterns of young nurses and whether this effect varies by category of nurse and sector of employment. A quantitative analysis of a de-identified linked subset of the College of Nurses of Ontario nursing registration database for years 2000-2014 and data collected from the NGG employment portal for years 2007-2014 was performed. One-year and two-year transition matrixes were generated to examine the stickiness trends of young nurses across the sectors of employment and the effect of the employing organization’s participation level on those trends. The NGG initiative contributed to an improved FT employment and stickiness of the young nurses in hospitals and the young RPNs in LTC institutions. A higher participation level in the NGG initiative contributed to an enhanced full time employment of the young nursing graduates only in the hospitals sector. The effect of employer participation on the stickiness of young RNs and RPNs in FT jobs in the Community sector requires further investigation.

      PubDate: 2017-04-30T10:27:58Z
      DOI: 10.1016/j.healthpol.2017.04.007
  • Increase in computed tomography in Australia driven mainly by practice
           change: a decomposition analysis
    • Authors: Cameron M. Wright; Max K. Bulsara; Richard Norman; Rachael E. Moorin
      Abstract: Publication date: Available online 28 April 2017
      Source:Health Policy
      Author(s): Cameron M. Wright, Max K. Bulsara, Richard Norman, Rachael E. Moorin
      Background Funded computed tomography (CT) procedure descriptions in Australia often specify the body site, rather than indication for use. This study aimed to evaluate the relative contribution of demographic versus non-demographic factors in driving the increase in CT services in Australia. Methods A decomposition analysis was conducted to assess the proportion of additional CT attributable to changing population structure, CT use on a per capita basis (CPC, a proxy for change in practice) and/or cost of CT. Aggregated Medicare usage and billing data were obtained for selected years between 1993/4 and 2012/3. Results The number of billed CT scans rose from 33 per annum per 1,000 of population in 1993/94 (total 572,925) to 112 per 1,000 by 2012/13 (total 2,540,546). The respective cost to Medicare rose from $145.7 million to $790.7 million. Change in CPC was the most important factor accounting for changes in CT services (88%) and cost (65%) over the study period. Conclusions While this study cannot conclude if the increase is appropriate, it does represent a shift in how CT is used, relative to when many CT services were listed for public funding. This ‘scope shift’ poses questions as to need for and frequency of retrospective/ongoing review of publicly funded services, as medical advances and other demand- or supply-side factors change the way health services are used.

      PubDate: 2017-04-30T10:27:58Z
      DOI: 10.1016/j.healthpol.2017.04.010
  • Popular initiatives in 2014–2016 call for the introduction of mandatory
           dental care insurance in Switzerland: The contrasting positions at stake
    • Authors: Enrico di Bella; Lucia Leporatti; Marcello Montefiori; Ivo Krejci; Stefano Ardu
      Abstract: Publication date: Available online 12 April 2017
      Source:Health Policy
      Author(s): Enrico di Bella, Lucia Leporatti, Marcello Montefiori, Ivo Krejci, Stefano Ardu
      “Switzerland’s mandatory health insurance system provides coverage for a standard benefits package for all residents. However, adult dental care is covered only in case of accidents and inevitable dental illnesses, while routine dental care is almost completely financed out-of-pocket. In general, unmet health needs in Switzerland are low, but unmet dental needs are significant, when compared with other countries in Europe. Recent popular initiatives in Switzerland have?”. In three cantons, the proposals have collected the required number of signatures and a public referendum is expected to be held in 2017/2018. If implemented, the insurance system is expected to have a significant impact on the dental profession, dental care demand, and the provision of dental services. The contrasting positions of stakeholders for and against the reform reflect a rare situation in which dental care policy issues are being widely discussed at all levels. However, such a discussion is of crucial relevance not only for Switzerland, but also for the whole of Europe, which has significant levels of unmet needs for dental care, especially among vulnerable and deprived individuals, and new solutions to expand dental care coverage are required.

      PubDate: 2017-04-16T08:57:24Z
      DOI: 10.1016/j.healthpol.2017.04.004
  • Health decentralization at a dead-end: towards new recovery plans for
           Italian hospitals
    • Authors: Marianna Mauro; Anna Maresso; Annamaria Guglielmo
      Abstract: Publication date: Available online 12 April 2017
      Source:Health Policy
      Author(s): Marianna Mauro, Anna Maresso, Annamaria Guglielmo
      The recent introduction by the central government of recovery plans (RPs) for Italian hospitals provides useful insights into the recentralization tendencies that are being experienced within the country’s decentralized, regional health system. The measure also contributes evidence to the debate on whether there is a long-term structural shift in national health strategy towards more centralized stewardship. The hospital RPs aim to improve the clinical, financial and managerial performance of public-hospitals, teaching-hospitals and research-hospitals through monitoring trends in individual hospitals' expenditure and tackling improvements in clinical care. As such they represent the central governments recognition of the weaknesses of the decentralization process in the health sector. The opponents of the reform argue that financial stability will be restored mainly through across-the-board reductions in hospital expenditure, personnel layoffs and closing of wards, with considerable negative effects on the most vulnerable groups of patients. While hospital RPs are comprehensive and complex, unresolved issues remain as to whether hospitals have the necessary managerial skills for the development of effective and achievable plans. Without also devising an overall plan to tackle the long-standing managerial weaknesses of public hospitals, the objectives of the hospital RPs will be undermined and the decentralization process in the health system will gradually reach a dead-end.

      PubDate: 2017-04-16T08:57:24Z
      DOI: 10.1016/j.healthpol.2017.04.003
  • Stakeholder views on criteria and processes for priority setting in
           Norway: A qualitative study
    • Authors: Jeremy Aidem
      Abstract: Publication date: Available online 12 April 2017
      Source:Health Policy
      Author(s): Jeremy Aidem
      Since 2013, Norway has engaged in political processes to revise criteria for priority setting. These processes have yielded key efficiency and equity criteria, but excluded potentially relevant social values. This study describes the views of 27 stakeholders in Norway’s health system regarding a wider set of priority-setting criteria and procedural characteristics. Between January and February 2016, semi-structured interviews and focus groups were conducted with a purposive sample of policymakers, hospital administrators, practitioners, university students and seniors. Improving health among low-socioeconomic-status groups was considered an important policy objective: some favored giving more priority to diseases affecting socioeconomically disadvantaged groups, and some believed inequalities in health could be more effectively addressed outside the health sector. Age was not widely accepted as an independent criterion, but deemed relevant as an indicator of capacity to benefit, cost-effectiveness and health loss. Cost-effectiveness, severity and health-loss measures were judged relevant to policymaking, but cost-effectiveness and health loss were considered less influential to clinical decision-making. Public engagement was seen as essential yet complicated by media and stakeholder pressures. This study highlights how views on the relevance and implementation of criteria can vary significantly according to the health system level being evaluated. Further, the findings suggest that giving priority to socioeconomically disadvantaged groups and reducing inequalities in health may be relevant preferences not captured in recent policy proposals.

      PubDate: 2017-04-16T08:57:24Z
      DOI: 10.1016/j.healthpol.2017.04.005
  • A Rapidly Changing Global Medicines Environment: How Adaptable are Funding
           Decision-Making Systems?
    • Authors: Christine Leopold; Steve Morgan; Anita Wagner
      Abstract: Publication date: Available online 10 April 2017
      Source:Health Policy
      Author(s): Christine Leopold, Steve Morgan, Anita Wagner
      Background With the launch of very highly priced therapies and sudden price increases of generics, pressures on health systems have drastically increased. Objectives We aimed to elicit opinions of key decision makers responsible for national assessment and funding decisions on their experiences to adapt to these new realities. Methods/setting Through interviews with decision makers of pharmaceutical assessment and/or funding agencies, we describe the challenges systems are currently facing, systems’ responses and systems’ characteristics facilitating or hindering responses to changes and overarching topics for the future. Results Among the most common challenges are increased funding pressures, increased uncertainty and lack of transparency in decision-making. Systems’ responses include utilization management, changing of assessment processes, stakeholder engagement and a focus on outcomes and on coordinated negotiations. Integrated delivery systems, fixed health care budgets and geographic and historical characteristics facilitate or sometimes hinder responses to change. Future policy emphasis lays on expanding data structures, managing the exit of drugs funded early, and implementing processes for communications with patients and the public. Conclusions Going forward emphasis has to be given to structured communications with all stakeholders with a specific emphasis on the broader public and patients about financial limits and priority setting in health care.

      PubDate: 2017-04-16T08:57:24Z
      DOI: 10.1016/j.healthpol.2017.04.002
  • Informal and formal care: substitutes or complements in care for people
           with dementia? Empirical evidence for 8 European countries
    • Authors: Patrick Bremer; David Challis; Ingalill Rahm Hallberg; Helena Leino-Kilpi; Kai Saks; Bruno Vellas; Sandra M.G. Zwakhalen; Dirk Sauerland
      Abstract: Publication date: Available online 8 April 2017
      Source:Health Policy
      Author(s): Patrick Bremer, David Challis, Ingalill Rahm Hallberg, Helena Leino-Kilpi, Kai Saks, Bruno Vellas, Sandra M.G. Zwakhalen, Dirk Sauerland
      Background In order to contain public health care spending, European countries attempt to promote informal caregiving. However, such a cost reducing strategy will only be successful if informal caregiving is a substitute for formal health care services. We therefore analyze the effect of informal caregiving for people with dementia on the use of several formal health care services. Study Design The empirical analysis is based on primary data generated by the EU-project ‘RightTimePlaceCare’ which is conducted in 8 European countries. 1223 people with dementia receiving informal care at home were included in the study.

      PubDate: 2017-04-09T08:45:49Z
      DOI: 10.1016/j.healthpol.2017.03.013
  • Supplementary Health Insurance from the consumer point of view
    • Authors: Giora Kaplan; Yael Shahar; Orna Tal
      Abstract: Publication date: Available online 8 April 2017
      Source:Health Policy
      Author(s): Giora Kaplan, Yael Shahar, Orna Tal
      Background The National Health Insurance Law in Israel ensures basic health basket eligibility for all its citizens. A supplemental health insurance plan (SHIP) is offered for an additional fee. Over the years, the percentage of supplemental insurance's holders has risen considerably, ranking among the highest in OECD countries. The assumption that consumers implement an informed rational choice based on relevant information is doubtful. Are consumers sufficiently well informed to make market processes work well? Objectives To examine perspectives, preferences and knowledge of Israelis in relation to SHIP. Methodology A telephone survey was conducted with a representative sample of the Israeli adult population. 703 interviews were completed. The response rate was 50.3%. Findings 85% of the sample reported possessing SHIP. This survey found that most of the Israeli public parched additional insurance coverage however did not show a significant knowledge about the benefits provided by the supplementary insurance, at least in the three measurements used in this study. Conclusions, policy implications and recommendations The scope of SHIP acquisition is very broad and cannot be explained in economic terms alone. Acquiring SHIP became a default option rather than an active decision. It is time to review the goals, achievements and side effects of SHIP and to create new policy for the future.

      PubDate: 2017-04-09T08:45:49Z
      DOI: 10.1016/j.healthpol.2017.03.019
  • The impact on productivity of a hypothetical tax on sugar-sweetened
    • Authors: Takeshi Nomaguchi; Michelle Cunich; Belen Zapata-Diomedi; J. Lennert Veerman
      Abstract: Publication date: Available online 7 April 2017
      Source:Health Policy
      Author(s): Takeshi Nomaguchi, Michelle Cunich, Belen Zapata-Diomedi, J. Lennert Veerman
      Objectives To quantify the potential impact of an additional 20% tax on sugar-sweetened beverages (SSBs) on productivity in Australia. Methods We used a multi-state lifetable Markov model to examine the potential impact of an additional 20% tax on SSBs on total lifetime productivity in the paid and unpaid sectors of the economy. The study population consisted of Australians aged 20 years or older in 2010, whose health and other relevant outcomes were modelled over their remaining lifetime. Results The SSBs tax was estimated to reduce the number of people with obesity by 1.96% of the entire population (437,000 fewer persons with obesity), and reduce the number of employees with obesity by 317,000 persons. These effects translated into productivity gains in the paid sector of AU$751 million for the working-age population (95% confidence interval: AU$565 million to AU$954 million), using the human capital approach. In the unpaid sector, the potential productivity gains amounted to AU$1,172 million (AU$929 million to AU$1,435 million) using the replacement cost method. These productivity benefits are in addition to the health benefits of 35,000 life years gained and a reduction in healthcare costs of AU$425 million. Conclusions An additional 20% tax on SSBs not only improves health outcomes and reduces healthcare costs, but provides productivity gains in both the paid and unpaid sectors of the economy.

      PubDate: 2017-04-09T08:45:49Z
      DOI: 10.1016/j.healthpol.2017.04.001
  • Economic losses and burden of disease by medical conditions in Norway
    • Authors: Jonas Minet Kinge; Kjartan Sælensminde; Joseph Dieleman; Stein Emil Vollset; Ole Frithjof Norheim
      Abstract: Publication date: Available online 7 April 2017
      Source:Health Policy
      Author(s): Jonas Minet Kinge, Kjartan Sælensminde, Joseph Dieleman, Stein Emil Vollset, Ole Frithjof Norheim
      We explore the correlation between disease specific estimates of economic losses and the burden of disease. This is based on data for Norway in 2013 from the Global Burden of Disease (GBD) project and the Norwegian Directorate of Health. The diagnostic categories were equivalent to the ICD-10 chapters. Mental disorders topped the list of the costliest conditions in Norway in 2013, and musculoskeletal disorders caused the highest production loss, while neoplasms caused the greatest burden in terms of DALYs. There was a positive and significant association between economic losses and burden of disease. Neoplasms, circulatory diseases, mental and musculoskeletal disorders all contributed to large health care expenditures. Non-fatal conditions with a high prevalence in working populations, like musculoskeletal and mental disorders, caused the largest production loss, while fatal conditions such as neoplasms and circulatory disease did not, since they occur mostly at old age. The magnitude of the production loss varied with the estimation method. The estimations presented in this study did not include reductions in future consumption, by net-recipients, due to premature deaths. Non-fatal diseases are thus even more burdensome, relative to fatal diseases, than the production loss in this study suggests. Hence, ignoring production losses may underestimate the economic losses from chronic diseases in countries with an epidemiological profile similar to Norway.

      PubDate: 2017-04-09T08:45:49Z
      DOI: 10.1016/j.healthpol.2017.03.020
  • The Directorate-General for Health and Consumers 1999–2014: An
           assessment of its functional capacities
    • Authors: Timo Clemens; Kristine Sørensen; Nicole Rosenkötter; Kai Michelsen; Helmut Brand
      Abstract: Publication date: Available online 6 April 2017
      Source:Health Policy
      Author(s): Timo Clemens, Kristine Sørensen, Nicole Rosenkötter, Kai Michelsen, Helmut Brand
      Capacity assessment has become a popular measure in the health sector to assess the ability of various stakeholders to pursue agreed activities. The European Commission (EC) is increasingly dealing with a variety of health issues to coordinate and complement national health policies. This study analyses the functional capacity of the Directorate-General for Health and Consumers (DG SANCO) between 1999 and 2004. It applies the UNDP Capacity Assessment Framework and uses a literature review, a document review of EU policy documents and expert interviews to assess the capacity of DG SANCO to fulfill its mandate for public health and health systems. Our results suggest that DG SANCO has established capacities to engage with stakeholders; to assess various health issues, to define issue-specific health policies and to collect information for evaluative purposes. In contrast, capacities tend to be less established for defining a clear strategy for the overall sector, for setting priorities and for budgeting, managing and implementing policies. We conclude that improvements to the effectiveness of DG SANTE’s (the successor of DG SANCO) policies can be made within the existing mandate. A priority setting exercise may be conducted to limit the number of pursued actions to those with the greatest European added value within DG SANTE’s responsibilities.

      PubDate: 2017-04-09T08:45:49Z
      DOI: 10.1016/j.healthpol.2017.03.018
  • Selective contracting and channelling patients to preferred providers: A
           scoping review
    • Authors: Romy E. Bes; Emile C. Curfs; Peter P. Groenewegen; Judith D. de Jong
      Abstract: Publication date: Available online 24 March 2017
      Source:Health Policy
      Author(s): Romy E. Bes, Emile C. Curfs, Peter P. Groenewegen, Judith D. de Jong
      Selective contracting by health insurers and channelling patients to contracted providers is crucial in a health care system based on managed competition, as this should lead to better value for money delivery of healthcare. However, an important consequence for enrolees is that health insurers interfere with their choice of care provider. This scoping review aims to find out what is known about selective contracting from the enrolee’s perspective. Is it being done and how do enrolees feel about the role of their health insurer in their care provider choice? A literature search was conducted, and, in addition, experts were consulted for extra information and documents. Results show that selective contracting and channelling is practised in several countries. This is mostly through negative financial incentives, which are also found to be the most effective strategy. However, enrolees are very negative about restrictions on provider choice introduced by their insurer. This results in enrolees feeling less satisfaction with, and trust in, care providers and health insurers. Choice is crucial in this respect since enrolees are more satisfied with their health plans and care providers when they have chosen them themselves. Future research should focus on the role of trust and how people weigh different attributes of health plans if selective contracting and channelling is to be implemented in a manner acceptable to enrolees.

      PubDate: 2017-03-25T07:38:08Z
      DOI: 10.1016/j.healthpol.2017.03.008
  • The new regulatory tools of the 2016 Health Law to fight drug shortages in
    • Authors: François Bocquet; Albane Degrassat-Théas; Jérôme Peigné; Pascal Paubel
      Abstract: Publication date: Available online 18 March 2017
      Source:Health Policy
      Author(s): François Bocquet, Albane Degrassat-Théas, Jérôme Peigné, Pascal Paubel
      Drug shortages are becoming worrying for public health in the European Union. The French public authorities first took action against the causes of drug shortages in 2011 with a law, followed by a decree in 2012 to overcome the dysfunctions of the pharmaceutical distribution channel. These texts would establish emergency call centres implemented by pharmaceutical companies for pharmacists and for wholesalers to inform of shortages, and would oblige pharmaceutical companies to inform health authorities of any risk of potential shortage situation; they would also reinforce the declaration regime of the territory served by wholesalers. Through the Health Law of January 2016, France acquired new regulatory tools in order to fight against these shortages and wanted to target the drugs for which they are the most detrimental: the major therapeutic interest (MTI) drugs. Furthermore, this new text reinforces the legal obligations of pharmaceutical companies and of wholesalers for drug shortages and sets out the enforcement of sanctions in case of breach of these obligations. France’s goal is ambitious: to implement coercive measures aiming at making the actors of the drug distribution channel aware of their responsibilities in order to take up the public health challenge triggered by drug shortages.

      PubDate: 2017-03-25T07:38:08Z
      DOI: 10.1016/j.healthpol.2017.03.007
    • Authors: Rosemary k. Elkins; Stefanie Schurer
      Abstract: Publication date: Available online 16 March 2017
      Source:Health Policy
      Author(s): Rosemary k. Elkins, Stefanie Schurer
      Recent policy changes designed to contain unsustainable health expenditure growth imply that many more Australians may soon be charged a copayment to consult a GP. We explore the distributional consequences associated with a range of hypothetical GP copayment scenarios using nationally-representative Australian survey data. For each scenario, we estimate the cost burden that individuals and households across the income distribution would need to absorb to maintain their current GP service utilisation. Even when concessional patients are charged a third or a quarter of the non-concessional copayment rate, the average estimated cost burden in the lowest income quartile is typically between three and six times that of the highest, and the average cost burden for women is significantly higher than for men within every income quartile. These disparities are intensified for those with a chronic illness. We conclude that the widespread implementation of GP copayments would disproportionately burden lower-income families, who experience higher rates of chronic illness, higher demand for GP services, and lower capacity to absorb price increases. The regressive nature of GP copayments is reduced when concessional and child patients are exempted entirely, highlighting the importance of supporting GPs—particularly in disadvantaged areas—to maintain bulk-billing arrangements for vulnerable patient groups.

      PubDate: 2017-03-18T07:13:05Z
      DOI: 10.1016/j.healthpol.2017.03.004
  • Neoliberal reforms in health systems and the construction of long-lasting
           inequalities in health care: A case study from Chile
    • Authors: Elena S. Rotarou; Dikaios Sakellariou
      Abstract: Publication date: Available online 16 March 2017
      Source:Health Policy
      Author(s): Elena S. Rotarou, Dikaios Sakellariou
      The aim of this article is to discuss how neoliberal policies implemented in the Chilean health system during the Pinochet regime have a lingering effect on equal access to health care today. The two-tier health system – public and private – that was introduced in the early 1980s as a means to improve efficiency and lower health-related costs, has led instead to inequality of access and dehumanisation of health care. Health has changed from being a right to being a marketable need, thus creating a structural disadvantage for several parts of the population – particularly the poor, the elderly, and women – who cannot afford the better-quality services and timely attention of private health providers, and thus, are not adequately protected against health risks. Despite the recent health reforms that aim at improving equity in health care access and financing, we argue that the Chilean health system is still biased against the poorer segments of the population, while it favours the more affluent groups that can afford private health care.

      PubDate: 2017-03-18T07:13:05Z
      DOI: 10.1016/j.healthpol.2017.03.005
  • Brexit and the NHS: challenges, uncertainties and opportunities
    • Authors: Victoria L. Simpkin; Elias Mossialos
      Abstract: Publication date: Available online 12 March 2017
      Source:Health Policy
      Author(s): Victoria L. Simpkin, Elias Mossialos

      PubDate: 2017-03-18T07:13:05Z
      DOI: 10.1016/j.healthpol.2017.02.018
  • Do benefits in kind or refunds affect health service utilization and
           health outcomes? A natural experiment from Japan
    • Authors: Reo Takaku; Shun-ichiro Bessho
      Abstract: Publication date: Available online 12 March 2017
      Source:Health Policy
      Author(s): Reo Takaku, Shun-ichiro Bessho
      Although the payment systems of public health insurance vary greatly across countries, we still have limited knowledge of their effects. To quantify the changes from a benefits in kind system to a refund system, we exploit the largest physician strike in Japan since the Second World War. During the strike in 1971 led by the Japan Medical Association (JMA), JMA physicians resigned as health insurance doctors, but continued to provide medical care and even health insurance treatment in some areas. This study uses the regional differences in resignation rates as a natural experiment to examine the effect of the payment method of health insurance on medical service utilization and health outcomes. In the main analysis, aggregated monthly prefectural data are used (N=46). Our estimation results indicate that if the participation rate of the strike had increased by 1 percentage point and proxy claims were refused completely, the number of cases of insurance benefits and the total amount of insurance benefits would have decreased by 0.78% and 0.58%, respectively compared with the same month in the previous year. Moreover, the average amount of insurance benefits per claim increased since patients with relatively less serious diseases might have sought health care less often. Finally, our results suggest that the mass of resignations did not affect death rates.

      PubDate: 2017-03-18T07:13:05Z
      DOI: 10.1016/j.healthpol.2017.02.016
  • Community perspectives on the use of regulation and law for obesity
           prevention in children: a citizens’ jury
    • Authors: Jackie M. Street; Jana Sisnowski; Rebecca Tooher; Lucy C. Farrell; Annette J. Braunack-Mayer
      Abstract: Publication date: Available online 12 March 2017
      Source:Health Policy
      Author(s): Jackie M. Street, Jana Sisnowski, Rebecca Tooher, Lucy C. Farrell, Annette J. Braunack-Mayer
      Introduction Childhood obesity is a significant challenge for public health internationally. Regulatory and fiscal measures propagated by governments offer a potentially effective response to this issue. Fearing public criticism, governments are often reluctant to use such measures. In this study we asked a descriptively representative and informed group of Australians their views on the use of legislation and fiscal measures by governments to address childhood obesity. Methods A citizens' jury, held in South Australia in April 2015, was asked to consider the question: What laws, if any, should we have in Australia to address childhood obesity? Results The jury agreed that prevention of obesity was complex requiring multifaceted government intervention. Recommendations fell into the areas of health promotion and education (n=4), regulation of food marketing (n=3), taxation/subsidies (n=2) and a parliamentary inquiry. School-based nutrition education and health promotion and mandatory front-of-pack interpretive labelling of food and drink were ranked 1 and 2 with taxation of high fat, high sugar food and drink third. Conclusion The recommendations were similar to findings from other citizens' juries held in Australia suggesting that the reticence of decision makers in Australia, and potentially elsewhere, to use legislative and fiscal measures to address childhood obesity is misguided. Supporting relevant informed public discussion could facilitate a politically acceptable legislative approach.

      PubDate: 2017-03-18T07:13:05Z
      DOI: 10.1016/j.healthpol.2017.03.001
  • Physician Payment Schemes and Physician Productivity: Analysis of Turkish
           Healthcare Reforms
    • Authors: Burcay Erus; Ozan Hatipoglu
      Abstract: Publication date: Available online 8 March 2017
      Source:Health Policy
      Author(s): Burcay Erus, Ozan Hatipoglu
      Following healthcare reforms in Turkey, inpatient and outpatient care provided in public hospitals more than doubled from 2003 to 2006. An important component of the reforms has been a shift from a salary based physician compensation scheme to one where fee-for-service component is dominant. The change did not only incentivize physicians to provide a higher volume of services but also encouraged them to practice full-time, rather than dual-time, in public hospitals. Lacking figures on full-time equivalent figures at hospital level, earlier research used head-counts for physician workforce and found technological change and scale economies to be important determinants. We employ data envelopment analysis and find that, under plausible scenarios regarding the number of dual vs full-time physician numbers, most of the change in hospital services may be explained only by the shift to full-time practice. Our estimations find the change in technology and scale economies to play a relatively minor role.

      PubDate: 2017-03-10T07:03:43Z
      DOI: 10.1016/j.healthpol.2017.02.012
  • Policy objective of generic medicines from the investment perspective: the
           case of clopidogrel
    • Authors: Péter Elek; András Harsányi; Tamás Zelei; Kata Csetneki; Zoltán Kaló
      Abstract: Publication date: Available online 7 March 2017
      Source:Health Policy
      Author(s): Péter Elek, András Harsányi, Tamás Zelei, Kata Csetneki, Zoltán Kaló
      The objective of generic drug policies in most countries is defined from a disinvestment perspective: reduction in expenditures without compromising health outcomes. However, in countries with restricted access of patients to original patented drugs, the objective of generic drug policies can also be defined from an investment perspective: health gain by improved patient access without need for additional health budget. This study examines the investment aspect of generic medicines by analyzing clopidogrel utilization in European countries between 2004 and 2014 using multilevel panel data models. We find that clopidogrel consumption was strongly affected by affordability constraints before the generic entry around 2009, but this effect decayed by 2014. After controlling for other variables, utilization had a substantially larger trend increase in lower-income European countries than in the higher-income ones. Generic entry increased clopidogrel consumption only in lower- and average-income countries but not in the highest-income ones. An earlier generic entry was associated with a larger effect. The case of clopidogrel indicates that the entrance of generics may increase patient access to effective medicines, most notably in lower-income countries, thereby reducing inequalities between European patients. Policymakers should also consider this investment aspect of generic medicines when designing pharmaceutical policies.

      PubDate: 2017-03-10T07:03:43Z
      DOI: 10.1016/j.healthpol.2017.02.015
  • A strategic document as a tool for implementing change. Lessons from the
           merger creating the South-East Health region in Norway
    • Authors: Tarald Rohde; Hans Torvatn
      Abstract: Publication date: Available online 6 March 2017
      Source:Health Policy
      Author(s): Tarald Rohde, Hans Torvatn
      In 2007, the Norwegian Parliament decided to merge the two largest health regions in the country: The South and East Health Regions became the South-East Health Region (SEHR). In its resolution, the Parliament formulated strong expectations for the merger: these included more effective hospital services in the Oslo metropolitan area, freeing personnel to work in other parts of the country, and making treatment of patients more coherent. The Parliamentary resolution provided no specific instructions regarding how this should be achieved. In order to fulfill these expectations, the new health region decided to develop a strategy as its tool for change; a change “agent”. SINTEF was engaged to evaluate the process and its results. We studied the strategy design, the tools that emerged from the process, and which changes were induced by the strategy. The evaluation adopted a multimethod approach that combined interviews, document analysis and (re)analysis of existing data. The latter included economic data, performance data, and work environment data collected by the South-East Health Region itself. SINTEF found almost no effects, whether positive or negative. This article describes how the strategy was developed and discusses why it failed to meet the expectations formulated in the Parliamentary resolution.

      PubDate: 2017-03-10T07:03:43Z
      DOI: 10.1016/j.healthpol.2017.02.014
  • Out-of-pocket expenditure and financial protection in the Chilean health
           care system – a systematic review
    • Authors: Kira Johanna Koch; Camilo Cid Pedraza; Andreas Schmid
      Abstract: Publication date: Available online 2 March 2017
      Source:Health Policy
      Author(s): Kira Johanna Koch, Camilo Cid Pedraza, Andreas Schmid
      Background Protection against financial risk due to medical spending is an explicit health guarantee within Chile’s AUGE health reform. This paper seeks to analyse the degree to which out-of-pocket expenditure still expose Chilean households to financial catastrophe and impoverishment, and to explore inequalities in financial protection. Methods A systematic literature review was conducted to identify empirical studies analysing financial protection in Chile. The search included databases as well as grey literature, i.e. governmental and institutional webpages. The indicators are based on the conceptual framework of financial protection, as portrayed in the World Health Report 2013. Results We identify n=16 studies that fulfil the inclusion criteria. Empirical studies indicate that 4% of Chilean households faced catastrophic health expenditure defined as out-of-pocket expenditure exceeding 30% of household’s capacity to pay, while less than 1% were pushed into poverty in 2012. In contrast to prior studies, recent data report that even publicly insured who should be fully protected from co-payments were affected by catastrophic health expenditure. Also in the private insurance system financial catastrophe is a common risk. Conclusion Despite health reform efforts, financial protection is insufficient and varies to the disadvantage of the poor and vulnerable groups. More research is required to understand why current mechanisms are not as effective as expected and to enable according reforms of the insurance system.

      PubDate: 2017-03-05T06:32:08Z
      DOI: 10.1016/j.healthpol.2017.02.013
  • The 2016 proposal for the reorganisation of urgent care provision in
           Belgium: A political struggle to co-locate primary care providers and
           emergency departments
    • Authors: Koen Van den Heede; Wilm Quentin; Cécile Dubois; Stephan Devriese; Carine Van de Voorde
      Abstract: Publication date: Available online 20 February 2017
      Source:Health Policy
      Author(s): Koen Van den Heede, Wilm Quentin, Cécile Dubois, Stephan Devriese, Carine Van de Voorde
      Internationally the number of emergency department (ED) visits is on the rise while evidence suggests that a substantial proportion of these patients do not require emergency care but primary care. This paper presents the Belgian 2016 proposal for the reorganisation of urgent care provision and places it into its political context. The proposal focused on re-designing patient flow aiming to reduce inappropriate ED visits by improving guidance of patients through the system. Initially policymakers envisaged, as cornerstone of the reform, to roll-out as standard model the co-location of primary care centres and EDs. Yet, this was substantially toned down in the final policy decisions mainly because GPs strongly opposed this model (because of increased workload and loss of autonomy, hospital-centrism, etc.). In fact, the final compromise assures a great degree of autonomy for GPs in organising out-of-hours care. Therefore, improvements will depend on future developments in the field and continuous monitoring of (un-)intended effects is certainly indicated. This policy process makes clear how important it is to involve all relevant stakeholders as early as possible in the development of a reform proposal to take into account their concerns, to illustrate the benefits of the reform and ultimately to gain buy-in for the reform.

      PubDate: 2017-02-26T10:19:02Z
      DOI: 10.1016/j.healthpol.2017.02.006
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