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HEALTH AND SAFETY (526 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: 23)
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: 6)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 4)
AJOB Primary Research     Partially Free   (Followers: 3)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Health Economics     Full-text available via subscription   (Followers: 13)
American Journal of Health Education     Hybrid Journal   (Followers: 30)
American Journal of Health Promotion     Hybrid Journal   (Followers: 24)
American Journal of Health Sciences     Open Access   (Followers: 6)
American Journal of Health Studies     Full-text available via subscription   (Followers: 10)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 25)
American Journal of Public Health     Full-text available via subscription   (Followers: 202)
American Journal of Public Health Research     Open Access   (Followers: 29)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4)
Annals of Global Health     Open Access   (Followers: 9)
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   (Followers: 2)
Archive of Community Health     Open Access  
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 3)
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: 6)
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: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 5)
Behavioral Healthcare     Full-text available via subscription   (Followers: 6)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 8)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 20)
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: 17)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 12)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 12)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 20)
Case Reports in Women's Health     Open Access   (Followers: 3)
Case Studies in Fire Safety     Open Access   (Followers: 12)
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: 2)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 2)
Conflict and Health     Open Access   (Followers: 8)
Contraception and Reproductive Medicine     Open Access  
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 3)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access   (Followers: 1)
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: 15)
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: 4)
Education for Health     Open Access   (Followers: 5)
electronic Journal of Health Informatics     Open Access   (Followers: 6)
ElectronicHealthcare     Full-text available via subscription   (Followers: 4)
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   (Followers: 2)
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 4)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 5)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 20)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 2)
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: 2)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-based Medicine & Public Health     Open Access   (Followers: 6)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     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: 6)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 11)
Frontiers in Public Health     Open Access   (Followers: 7)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 9)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 5)
Global Health Promotion     Hybrid Journal   (Followers: 16)
Global Journal of Health Science     Open Access   (Followers: 9)
Global Journal of Public Health     Open Access   (Followers: 12)
Global Medical & Health Communication     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 3)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 15)
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: 7)
Health and Social Work     Hybrid Journal   (Followers: 51)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 14)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 15)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Notions     Open Access  
Health Policy     Hybrid Journal   (Followers: 36)
Health Policy and Technology     Hybrid Journal   (Followers: 1)
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 21)
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: 48)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 40)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 12)
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: 2)
Health Systems     Hybrid Journal   (Followers: 3)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 13)
Health, Risk & Society     Hybrid Journal   (Followers: 12)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
Healthy-Mu Journal     Open Access  
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: 11)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 6)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 4)
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: 2)
Indonesian Journal for 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: 5)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 5)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 34)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 2)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 8)
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: 20)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 16)
International Journal of Health & Allied Sciences     Open Access   (Followers: 3)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 10)

        1 2 3 | Last

Journal Cover Health Policy
  [SJR: 1.182]   [H-I: 36]   [36 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0168-8510
   Published by Elsevier Homepage  [3089 journals]
  • Optimising the introduction of multiple childhood vaccines in Japan: A
           model proposing the introduction sequence achieving the highest health
    • Authors: Baudouin Standaert; Nadia Schecroun; Olivier Ethgen; Oleksandr Topachevskyi; Yoriko Morioka; Ilse Van Vlaenderen
      Pages: 1303 - 1312
      Abstract: Publication date: December 2017
      Source:Health Policy, Volume 121, Issue 12
      Author(s): Baudouin Standaert, Nadia Schecroun, Olivier Ethgen, Oleksandr Topachevskyi, Yoriko Morioka, Ilse Van Vlaenderen
      Background Many countries struggle with the prioritisation of introducing new vaccines because of budget limitations and lack of focus on public health goals. A model has been developed that defines how specific health goals can be optimised through immunisation within vaccination budget constraints. Methods Japan, as a country example, could introduce 4 new pediatric vaccines targeting influenza, rotavirus, pneumococcal disease and mumps with known burden of disease, vaccine efficacies and maximum achievable coverages. Operating under budget constraints, the Portfolio-model for the Management of Vaccines (PMV) identifies the optimal vaccine ranking and combination for achieving the maximum QALY gain over a period of 10 calendar years in children <5 years old. This vaccine strategy, of interest and helpful for a healthcare decision maker, is compared with an unranked vaccine selection process. Results Results indicate that the maximum QALY gain with a fixed annual vaccination budget of 500 billion Japanese Yen over a 10-year period is 72,288 QALYs using the optimal sequence of vaccine introduction (mumps [1st], followed by influenza [2nd], rotavirus [3rd], and pneumococcal [4th]). With exactly the same budget but without vaccine ranking, the total QALY gain can be 20% lower. Conclusion The PMV model could be a helpful tool for decision makers in those environments with limited budget where vaccines have to be selected for trying to optimise specific health goals.

      PubDate: 2017-12-13T11:57:54Z
      DOI: 10.1016/j.healthpol.2017.08.010
  • Shelter from the Storm: Roles, responsibilities, and challenges in United
           States housing policy governance
    • Authors: Charley Willison
      Pages: 1113 - 1123
      Abstract: Publication date: November 2017
      Source:Health Policy, Volume 121, Issue 11
      Author(s): Charley Willison
      Housing is a critical social determinant of health. Housing policy not only affects health by improving housing quality, affordability, and insecurity; housing policy affects health upstream through the politics that shape housing policy design, implementation, and management. These politics, or governance strategies, determine the successes or failures of housing policy programs. This paper is an overview of challenges in housing policy governance in the United States. I examine the important relationship between housing and health, and emphasize why studying housing policy governance matters. I then present three cases of housing governance challenges in the United States, from each pathway by which housing affects health - housing quality, affordability, and insecurity. Each case corresponds to an arm of the TAPIC framework for evaluating governance (Krieger and Higgins) [1], to assess mechanisms of housing governance in each case. While housing governance has come a long way over the past century, political decentralization and the expansion of the submerged state have increased the number of political actors and policy conflict in many areas. This creates inherent challenges for improving accountability, transparency, and policy capacity. In many instances, too, reduced government accountability and transparency increases the risk of harm to the public and lessens governmental integrity.

      PubDate: 2017-11-09T00:07:09Z
      DOI: 10.1016/j.healthpol.2017.08.002
  • The governance of integrated health and social care in England since 2010:
           great expectations not met once again'
    • Authors: Mark Exworthy; Martin Powell; Jon Glasby
      Pages: 1124 - 1130
      Abstract: Publication date: November 2017
      Source:Health Policy, Volume 121, Issue 11
      Author(s): Mark Exworthy, Martin Powell, Jon Glasby
      Integrating health and social care has long been a goal of policy-makers and practitioners. Yet, this aim has remained elusive, partly due to conflicting definitions and a weak evidence base. As part of a special edition exploring the use of the TAPIC (transparency, accountability, participation, integrity and capability) framework in different national contexts and inter-agency settings, this article examines the governance of integrated care in England since 2010, focusing on the extent to which thesefive governance attributes are applicable to integrated care in England. The plethora of English policy initiatives on integrated care (such as the ‘Better Care Fund’, personal health budgets, and ‘Sustainability and Transformation Plans’) mostly shows signs of continuity over time although the barriers to integrated care often persist. The article concludes that the contribution of integrated care to improved outcomes remains unclear and yet it remains a popular policy goal. Whilst some elements of the TAPIC framework fit less well than others to the case of integrated care, the case of integrated care can be better understood and explained through this lens.

      PubDate: 2017-11-09T00:07:09Z
      DOI: 10.1016/j.healthpol.2017.07.009
  • Synthetic biology regulation and governance: Lessons from TAPIC for the
           United States, European Union, and Singapore
    • Authors: Benjamin D. Trump
      Pages: 1139 - 1146
      Abstract: Publication date: November 2017
      Source:Health Policy, Volume 121, Issue 11
      Author(s): Benjamin D. Trump
      Synthetic biology is an emerging technology with potential benefits to various fields, yet also contains potential risks to human and environmental health. The field remains in an emerging state with limited quantitative guidance and a small but growing population of international researchers that conduct work within this field. Given the uncertain nature of this technology, an adaptive and anticipatory governance framework may be necessary to balance the potential benefits that may accrue from the technology's continued research alongside a desire to reduce or eliminate potential risks that may arise. However, such developments must account for the unique political and institutional factors that form a government's risk culture - something that can facilitate or impede the development of adaptive synthetic biology governance moving forward. The TAPIC framework helps illustrate those factors that are essential to develop good governance for emerging technologies like synthetic biology. Specifically, an application of TAPIC to synthetic biology governance indicates that the factors of accountability, participation, and integrity must be bolstered to improve technology governance in governments like with the United States, European Union, and Singapore.

      PubDate: 2017-11-09T00:07:09Z
      DOI: 10.1016/j.healthpol.2017.07.010
  • Does Access to End-of-Life Homecare Nursing Differ by Province and
           Community Size': A population-based cohort study of cancer decedents
           across Canada
    • Authors: Hsien Seow; Anish Arora; Lisa Barbera; Kim McGrail; Beverley Lawson; Fred Burge; Rinku Sutradhar
      Abstract: Publication date: Available online 13 December 2017
      Source:Health Policy
      Author(s): Hsien Seow, Anish Arora, Lisa Barbera, Kim McGrail, Beverley Lawson, Fred Burge, Rinku Sutradhar
      Background Studies have demonstrated the strong association between increased end-of-life homecare nursing use and reduced acute care utilization. However, little research has described the utilization patterns of end-of-life homecare nursing and how this differs by region and community size. Methods A retrospective population-based cohort study of cancer decedents from Ontario, British Columbia, and Nova Scotia was conducted between 2004-2009. Provinces linked administrative databases which provide data about homecare nursing use for the last 6 months of life for each cancer decedent. Among weekly users of homecare nursing in their last six months of life, we describe the proportion of patients receiving end-of-life homecare nursing by province and community size. Results Our cohort included 83,746 cancer decedents across 3 provinces. Patients receiving end-of-life nursing among homecare nursing users increased from weeks −26 to −1 before death by: 78% to 93% in British Columbia, 40% to 81% in Ontario, and 52% to 91% in Nova Scotia. In all 3 provinces, the smallest community size had the lowest proportion of patients using end-of-life nursing compared to the second largest community size, which had the highest proportion. Conclusions Differences in end-of-life homecare nursing use are much larger between provinces than between community sizes.

      PubDate: 2017-12-13T11:57:54Z
      DOI: 10.1016/j.healthpol.2017.11.014
  • Does patients’ experience of general practice affect the use of
           emergency departments' Evidence from Australia
    • Authors: Chun Yee Wong; Jane Hall
      Abstract: Publication date: Available online 6 December 2017
      Source:Health Policy
      Author(s): Chun Yee Wong, Jane Hall
      AS Emergency Department (ED) attendances have been growing rapidly, various strategies have been employed in Australia to improve access to General Practitioner (GP) care, particularly after normal working hours, in order to reduce the demand for ED. However, there has been little attention paid to the quality of GP care and whether that influences ED attendances. This paper investigates whether ED use is affected by patients’ experience of GP care, using the logit model to analyse data from a survey of Australian consumers (1758 individuals). Not surprisingly, we find that people with poor health status and a greater number of chronic conditions are more likely to visit the ED. We also find that, after correcting for health status and sociodemographic factors, patients with a better GP experience are less likely to visit the ED. This suggests that policies aimed at improving the quality of primary care are also important in reducing unplanned hospital use.

      PubDate: 2017-12-13T11:57:54Z
      DOI: 10.1016/j.healthpol.2017.11.008
  • Funding breakthrough therapies: A systematic review and recommendation
    • Authors: E. Hanna; M. Toumi; C. Dussart; B. Borissov; O. Dabbous; K. Badora; P. Auquier
      Abstract: Publication date: Available online 2 December 2017
      Source:Health Policy
      Author(s): E. Hanna, M. Toumi, C. Dussart, B. Borissov, O. Dabbous, K. Badora, P. Auquier
      Background Advanced therapy medicinal products (ATMPs) are innovative therapies likely associated with high prices. Payers need guidance to create a balance between ensuring patient access to breakthrough therapies and maintaining the financial sustainability of the healthcare system. Objective The aims of this study were to identify, define, classify and compare the approaches to funding high-cost medicines proposed in the literature, to analyze their appropriateness for ATMP funding and to suggest an optimal funding model for ATMPs. Results Forty-eight articles suggesting new funding models for innovative high-cost therapies were identified. The models were classified into 3 groups: financial agreement, health outcomes-based agreement and healthcoin. Financial agreement encompassed: discounts, rebates, price and volume caps, price-volume agreements, loans, cost-plus price, intellectual-based payment and fund-based payment. Health outcomes-based agreements were defined as agreements between manufacturers and payers based on drug performance, and were divided into performance-based payment and coverage with evidence development. Healthcoin described a new suggested tradeable currency used to assign monetary value to incremental outcomes. Conclusion With a large number of ATMPs in development, it is time for stakeholders to start thinking about new pathways and funding strategies for these innovative high-cost therapies. An “ATMP-specific fund” may constitute a reasonable solution to ensure rapid patient access to innovation without threatening the sustainability of the health care system.

      PubDate: 2017-12-13T11:57:54Z
      DOI: 10.1016/j.healthpol.2017.11.012
  • Planning of Polish physician workforce – Systemic inconsistencies,
           challenges and possible ways forward
    • Authors: Alicja Domagała; Jacek Klich
      Abstract: Publication date: Available online 1 December 2017
      Source:Health Policy
      Author(s): Alicja Domagała, Jacek Klich
      Background Poland has the lowest number of physicians per 1000 population (2.2/1000) in the EU. This is accompanied by a considerable migration rate of Polish physicians to other EU countries (estimated at above 7%). Among other consequences, this results in waiting lists and unmet health needs. Objective The aim of this article is an identification of the main challenges for physician workforce planning in Poland. Methods The authors analysed national and international documents, reports, official statements, publications and statistical databases. Main findings In Poland health workforce planning is inadequate and insufficient. There is no formal structure and no strategy regarding human resource planning or regular forecasts for the health workforce, which results in many negative effects for the healthcare system. Currently the shortage of physicians in some specialties is becoming one of the most important reasons for limited access to care and lengthening the average wait time. Conclusions To improve this situation operational and strategic actions should be undertaken without unnecessary delay. Effective and close cooperation between key stakeholders is needed. Health workforce planning needs to become one of the key building blocks of the Polish health system’s reforms, strongly connected to the other functions of the health system. It is essential for Poland to follow available good practices in health workforce planning.

      PubDate: 2017-12-13T11:57:54Z
      DOI: 10.1016/j.healthpol.2017.11.013
  • Tackling the challenge of multi-morbidity: Actions for health policy and
    • Authors: Apostolos Tsiachristas; Ewout van Ginneken; Mieke Rijken
      Abstract: Publication date: Available online 29 November 2017
      Source:Health Policy
      Author(s): Apostolos Tsiachristas, Ewout van Ginneken, Mieke Rijken

      PubDate: 2017-12-13T11:57:54Z
      DOI: 10.1016/j.healthpol.2017.11.011
  • Demographic factors and attitudes that influence the support of the
           general public for the introduction of universal healthcare in Ireland: A
           national survey
    • Authors: Catherine D. Darker; Erica Donnelly-Swift; Lucy Whiston
      Abstract: Publication date: Available online 24 November 2017
      Source:Health Policy
      Author(s): Catherine D. Darker, Erica Donnelly-Swift, Lucy Whiston
      Ireland is still struggling to end the inequitable two-tiered health system and introduce universal healthcare (UHC). Public opinion can influence health policy choice and implementation. However, the public are rarely asked for their views. This study describes the demographic and attitudinal factors that influence the support of the public for the introduction of UHC. It provides data on a nationally representative survey sample of n=972. There are high levels of support for the introduction of UHC (n=846 87.0%). Logistic regression analyses indicated that demographic factors, such as, the location of respondent, whether the respondent was in receipt of Government supported healthcare, a purchaser of private health insurance or neither; plus attitudinal factors, such as, opinions on the Government prioritising healthcare, healthcare being free at the point of access, taxes being increased to provide care free at the point of access and how well informed participants felt about UHC were associated with agreeing with the introduction of UHC in Ireland. This paper is timely for policy leaders both in Ireland and internationally as countries with UHC, such as the United Kingdom, are facing difficulties maintaining health services in the public realm.

      PubDate: 2017-12-13T11:57:54Z
      DOI: 10.1016/j.healthpol.2017.11.009
  • Out-of-pocket health expenditure differences in Chile: Insurance
           performance or selection'
    • Authors: Pablo Villalobos Dintrans
      Abstract: Publication date: Available online 20 November 2017
      Source:Health Policy
      Author(s): Pablo Villalobos Dintrans
      Chile has a mixed health system with public and private actors engaged in provision and insurance. This dual system generates important differences in health expenditure between private and public insurances. Selection is a preeminent feature of the Chilean insurance system. In order to explain the role of the insurance in out-of-pocket expenditures between households for different insurance schemes, decomposition methods are applied to disentangle the effect of household ‘composition and insurance’ degree of financial protection on health expenditures. Health expenditure patterns have not changed in the last 10 years with drugs, outpatient care, and dental health representing 60% of the health expenditure. Health expenditure/income is similar for different income groups in the public insurance, but decreases with income in households with private coverage, reflecting regressivity in health expenditure. On the other hand, health expenditure as share of expenditure increases with income for both groups. Per capita health expenditure in households with private coverage is four times the expenditure of households with public insurance; this gap is mostly explained by differences in households’ expenditure and demographics. Roughly 80% of the difference in expenditure is explained by the model, showing the role of selection in understanding the expenditure gap between insurance schemes.

      PubDate: 2017-12-13T11:57:54Z
      DOI: 10.1016/j.healthpol.2017.11.007
  • The importance of population differences: Influence of individual
           characteristics on the Australian public’s preferences for emergency
    • Authors: Paul Harris; Jennifer A. Whitty; Elizabeth Kendall; Julie Ratcliffe; Andrew Wilson; Peter Littlejohns; Paul A. Scuffham
      Abstract: Publication date: Available online 17 November 2017
      Source:Health Policy
      Author(s): Paul Harris, Jennifer A. Whitty, Elizabeth Kendall, Julie Ratcliffe, Andrew Wilson, Peter Littlejohns, Paul A. Scuffham
      A better understanding of the public’s preferences and what factors influence them is required if they are to be used to drive decision-making in health. This is particularly the case for service areas undergoing continual reform such as emergency and primary care. Accordingly, this study sought to determine if attitudes, socio-demographic characteristics and healthcare experiences influence the public’s intentions to access care and their preferences for hypothetical emergency care alternatives. A discrete choice experiment was used to elicit the preferences of Australian adults (n=1529). Mixed logit regression analyses revealed the influence of a range of individual characteristics on preferences and service uptake choices across three different presenting scenarios. Age was associated with service uptake choices in all contexts, whilst the impact of other sociodemographics, health experience and attitudinal factors varied by context. The improvements in explanatory power observed from including these factors in the models highlight the need to further clarify their influence with larger populations and other presenting contexts, and to identify other determinants of preference heterogeneity. The results suggest social marketing programs undertaken as part of demand management efforts need to be better targeted if decision-makers are seeking to increase community acceptance of emerging service models and alternatives. Other implications for health policy, service planning and research, including for workforce planning and the possible introduction of a system of co-payments are discussed.

      PubDate: 2017-12-13T11:57:54Z
      DOI: 10.1016/j.healthpol.2017.11.006
  • How much do cancer specialists earn' A comparison of physician fees
           and remuneration in oncology and radiology in high-income countries
    • Authors: Seán Boyle; Jeremy Petch; Kathy Batt; Isabelle Durand-Zaleski; Sarah Thomson
      Abstract: Publication date: Available online 16 November 2017
      Source:Health Policy
      Author(s): Seán Boyle, Jeremy Petch, Kathy Batt, Isabelle Durand-Zaleski, Sarah Thomson
      The main driver of higher spending on health care in the US is believed to be substantially higher fees paid to US physicians in comparison with other countries. We aim to compare physician incomes in radiology and oncology considering differences in relation to fees paid, physician capacity and volume of services provided in five countries: the United States, Canada, Australia, France and the United Kingdom. The fee for a consultation with a specialist in oncology varies threefold across countries, and more than fourfold for chemotherapy. There is also a three to fourfold variation in fees for ultrasound and CT scans. Physician earnings in the US are greater than in other countries in both oncology and radiology, more than three times higher than in the UK; Canadian oncologists and radiologists earn considerably more than their European counterparts. Although challenging, benchmarking earnings and fees for similar health care activities across countries, and understanding the factors that explain any differences, can provide valuable insights for policy makers trying to enhance efficiency and quality in service delivery, especially in the face of rising care costs.

      PubDate: 2017-12-13T11:57:54Z
      DOI: 10.1016/j.healthpol.2017.11.003
  • Healthcare Reforms in Cyprus 2013-2017: Does the crisis mark the end of
           the healthcare sector as we know it'
    • Authors: Panagiotis Petrou; Sotiris Vandoros
      Abstract: Publication date: Available online 11 November 2017
      Source:Health Policy
      Author(s): Panagiotis Petrou, Sotiris Vandoros
      As part of a bailout agreement with the International Monetary Fund, the European Commission and the European Central Bank (known as the Troika), Cyprus had to achieve a fiscal surplus through budget constraints and efficiency enhancement. As a result, a number of policy changes were implemented, including a reform of the healthcare sector, and major healthcare reforms are planned for the upcoming years, mainly via the introduction of a National Health System. This paper presents the healthcare sector, provides an overview of recent reforms, assesses the recently implemented policies and proposes further interventions. Recent reforms targeting the demand and supply side included the introduction of clinical guidelines, user charges, introduction of coding for Diagnosis Related Groups (DRGs) and the revision of public healthcare coverage criteria. The latter led to a reduction in the number of people with public healthcare coverage in a time of financial crises, when this is needed the most, while co-payments must be reassessed to avoid creating barriers to access. However, DRGs and clinical guidelines can help improve performance and efficiency. The changes so far are yet to mark the end of the healthcare sector as we know it. A universal public healthcare system must remain a priority and must be introduced swiftly to address important existing coverage gaps.

      PubDate: 2017-11-16T01:09:31Z
      DOI: 10.1016/j.healthpol.2017.11.004
  • Effect of incentive payments on chronic disease management and health
           services use in British Columbia, Canada: Interrupted time series analysis
    • Authors: M. Ruth Lavergne; Michael R. Law; Sandra Peterson; Scott Garrison; Jeremiah Hurley; Lucy Cheng; Kimberlyn McGrail
      Abstract: Publication date: Available online 10 November 2017
      Source:Health Policy
      Author(s): M. Ruth Lavergne, Michael R. Law, Sandra Peterson, Scott Garrison, Jeremiah Hurley, Lucy Cheng, Kimberlyn McGrail
      We studied the effects of incentive payments to primary care physicians for the care of patients with diabetes, hypertension, and Chronic Obstructive Pulmonary Disease (COPD) in British Columbia, Canada. We used linked administrative health data to examine monthly primary care visits, continuity of care, laboratory testing, pharmaceutical dispensing, hospitalizations, and total health care spending. We examined periods two years before and two years after each incentive was introduced, and used segmented regression to assess whether there were changes in level or trend of outcome measures across all eligible patients following incentive introduction, relative to pre-intervention periods. We observed no increases in primary care visits or continuity of care after incentives were introduced. Rates of ACR testing and antihypertensive prescribing increased among patients with hypertension, but none of the other modest increases in laboratory testing or prescriptions dispensed reached statistical significance. Rates of hospitalizations for stroke and heart failure among patients with hypertension fell relative to pre-intervention patterns, while hospitalizations for COPD increased. Total hospitalizations and hospitalizations via the emergency department did not change. Health care spending increased for patients with hypertension. This large-scale incentive scheme for primary care physicians showed some positive effects for patients with hypertension, but we observe no similar changes in patient management, reductions in hospitalizations, or changes in spending for patients with diabetes and COPD.

      PubDate: 2017-11-16T01:09:31Z
      DOI: 10.1016/j.healthpol.2017.11.001
  • Insights from the design and implementation of a single-entry model of
           referral for total joint replacement surgery: critical success factors and
           unanticipated consequences
    • Authors: Zaheed Damani; Gail MacKean; Eric Bohm; Tom Noseworthy; Jenney Meng Han Wang; Brie DeMone; Brock Wright; Deborah A. Marshall
      Abstract: Publication date: Available online 4 November 2017
      Source:Health Policy
      Author(s): Zaheed Damani, Gail MacKean, Eric Bohm, Tom Noseworthy, Jenney Meng Han Wang, Brie DeMone, Brock Wright, Deborah A. Marshall
      Background Single-entry models (SEMs) in healthcare allow patients to see the next-available provider and have been shown to improve waiting times, access and patient flow for preference-sensitive, scheduled services. The Winnipeg Central Intake Service (WCIS) for hip and knee replacement surgery was implemented to improve access in the Winnipeg Regional Health Authority. This paper describes the system’s design design/implementation; successes, challenges, and unanticipated consequences. Methods On two occasions, during and following implementation, we interviewed all members of the WCIS project team, including processing engineers, waiting list coordinators, administrators and policy-makers regarding their experiences. We used semi-structured telephone interviews to collect data and qualitative thematic analysis to analyze and interpret the findings. Results Respondents indicated that the overarching objectives of the WCIS were being met. Benefits included streamlined processes, greater patient access, improved measurement and monitoring of outcomes. Challenges included low awareness, change readiness, and initial participation among stakeholders. Unanticipated consequences included workload increases, confusion around stakeholder expectations and under-reporting of data by surgeons’ offices. Critical success factors for implementation included a requirement for clear communication, robust data collection, physician leadership and patience by all, especially implementation teams. Conclusions Although successfully implemented, key lessons and critical success factors were learned related to change management, which if considered and applied, can reduce unanticipated consequences, improve uptake and benefit new models of care.

      PubDate: 2017-11-09T00:07:09Z
      DOI: 10.1016/j.healthpol.2017.10.006
  • Expanding the clinical role of community pharmacy: A qualitative
           ethnographic study of medication reviews in Ontario, Canada
    • Authors: Sarah J. Patton; Fiona A. Miller; Lusine Abrahamyan; Valeria E. Rac
      Abstract: Publication date: Available online 4 November 2017
      Source:Health Policy
      Author(s): Sarah J. Patton, Fiona A. Miller, Lusine Abrahamyan, Valeria E. Rac
      Medication reviews by community pharmacists are an increasingly common strategy to improve medication management for chronic conditions, and are part of wider efforts to make more effective use of community-based health professionals. To identify opportunities to optimize the medication review program in Ontario, Canada, we explored how providers and clients interpret and operationalize medication reviews within everyday community pharmacy practice. We conducted a qualitative ethnographic study at four pharmacies in Ontario, Canada, including non-participant observation of provider and client activities and interactions with specific attention to medication reviews, as well as brief ethnographic interviews with providers and clients, and in-depth, semi-structured interviews with providers. We report on 72h of field research, observation of 178 routine pharmacist-client interactions and 29 medication reviews, 62 brief ethnographic interviews with providers and clients, and 7 in-depth, semi-structured interviews with providers. We found that medication reviews were variably conducted across the dimensions of duration, provider type, location, and interaction style, and that local contexts and system-wide developments influence their meaning and practice. Medication reviews are exemplary of policy efforts to enhance the role of community pharmacies within health systems and the scope of practice of pharmacists as healthcare professionals. Our study highlights the importance of the local structure of community pharmacy practice and the clinical aspirations of pharmacists in the delivery of medication reviews.

      PubDate: 2017-11-09T00:07:09Z
      DOI: 10.1016/j.healthpol.2017.10.007
  • Exploring sociodemographic and economic factors that promote adverse drug
           reactions reporting by patients
    • Authors: Pedro Inácio; João José Gomes; Marja Airaksinen; Afonso Cavaco
      Abstract: Publication date: Available online 1 November 2017
      Source:Health Policy
      Author(s): Pedro Inácio, João José Gomes, Marja Airaksinen, Afonso Cavaco
      Background Adverse drug reactions (ADRs) are recognized as a leading cause of morbidity and mortality, and an important cost factor to health systems. Patient reporting of ADRs has emerged as an important topic in recent years but reporting rates are still low in many countries. Objective To explore different countries’ sociodemographic and economic features as explanatory factors for population ADRs reporting, including the propensity of patients’ reporting to pharmacovigilance authorities. Methods Cross-sectional observational design. A data set of 42 global sociodemographic and economic factors for 44 countries were retrieved, as to analyse statistical associations between these factors and the patient reporting rate of ADRs. Multivariate logistic regression models were designed to identify the predictive covariables. Results Health investment indicators, such as per capita public health expenditure, hospital bed density and under five mortality rate were the relevant factors responsible to discriminate between countries that have higher patient reporting rates. Conclusions This study shows that healthcare investment-related factors help explain the propensity of patients to report suspected ADRs, while pharmacovigilance features were not directly associated with higher patient participation in drug safety mechanisms. Although general, these results point a direction in further policy making to improve resources allocation concerning the promotion of patients’ participation.

      PubDate: 2017-11-09T00:07:09Z
      DOI: 10.1016/j.healthpol.2017.10.004
  • The effect of taxation and regulation on cigarette smoking: Fresh evidence
           from Turkey
    • Authors: Tamer Cetin
      Abstract: Publication date: Available online 29 September 2017
      Source:Health Policy
      Author(s): Tamer Cetin
      Enacting Law No 5247 in May 2008, Turkey has initiated crucial anti-tobacco policies in the last decade. This paper aims to reveal on the effect of anti-tobacco policies such as excise taxes and regulations on cigarette smoking. To this aim, I empirically investigate the long-term dynamics of demand for cigarettes in Turkey through the OLS estimation strategy under various scenarios and models. Using monthly and quarterly data that cover the pre- and post- anti-smoking policy periods, I estimate demand elasticities and compare the pre- and post- taxation and regulation terms. The results presented in the paper confirm that taxation and regulation have affected the long-term dynamics of demand for cigarettes. The price and income elasticities of demand for cigarettes are significantly higher than the previous literature on Turkey. Demand elasticities have increased on average in the anti-tobacco policies period.

      PubDate: 2017-10-24T23:56:17Z
      DOI: 10.1016/j.healthpol.2017.09.015
  • Good, better, best' A comprehensive comparison of healthcare
           providers’ performance: An application to physiotherapy practices in
           primary care
    • Authors: Sander Steenhuis; Niels Groeneweg; Xander Koolman; France Portrait
      Abstract: Publication date: Available online 13 October 2017
      Source:Health Policy
      Author(s): Sander Steenhuis, Niels Groeneweg, Xander Koolman, France Portrait
      Most payment methods in healthcare stimulate volume-driven care, rather than value-driven care. Value-based payment methods such as Pay-For-Performance have the potential to reduce costs and improve quality of care. Ideally, outcome indicators are used in the assessment of providers’ performance. The aim of this paper is to describe the feasibility of assessing and comparing the performances of providers using a comprehensive set of quality and cost data. We had access to unique and extensive datasets containing individual data on PROMs, PREMs and costs of physiotherapy practices in Dutch primary care. We merged these datasets at the patient-level and compared the performances of these practices using case-mix corrected linear regression models. Several significant differences in performance were detected between practices. These results can be used by both physiotherapists, to improve treatment given, and insurers to support their purchasing decisions. The study demonstrates that it is feasible to compare the performance of providers using PROMs and PREMs. However, it would take an extra effort to increase usefulness and it remains unclear under which conditions this effort is cost-effective. Healthcare providers need to be aware of the added value of registering outcomes to improve their quality. Insurers need to facilitate this by designing value-based contracts with the right incentives. Only then can payment methods contribute to value-based healthcare and increase value for patients.

      PubDate: 2017-10-17T09:45:57Z
      DOI: 10.1016/j.healthpol.2017.09.021
  • Structural integration and performance of inter-sectoral public
           health-related policy networks: An analysis across policy phases
    • Authors: D.T.J.M. Peters; Raab K.M. Stronks Harting
      Abstract: Publication date: Available online 10 October 2017
      Source:Health Policy
      Author(s): D.T.J.M. Peters, J. Raab, K.M. Grêaux, K. Stronks, J. Harting
      Background Inter-sectoral policy networks may be effective in addressing environmental determinants of health with interventions. However, contradictory results are reported on relations between structural network characteristics (i.e., composition and integration) and network performance, such as addressing environmental determinants of health. This study examines these relations in different phases of the policy process. Methods A multiple-case study was performed on four public health-related policy networks. Using a snowball method among network actors, overall and sub-networks per policy phase were identified and the policy sector of each actor was assigned. To operationalise the outcome variable, interventions were classified by the proportion of environmental determinants they addressed. Results In the overall networks, no relation was found between structural network characteristics and network performance. In most effective cases, the policy development sub-networks were characterised by integration with less interrelations between actors (low cohesion), more equally distributed distances between the actors (low closeness centralisation), and horizontal integration in inter-sectoral cliques. The most effective case had non-public health central actors with less connections in all sub-networks. Conclusion The results suggest that, to address environmental determinants of health, sub-networks should be inter-sectorally composed in the policy development rather than in the intervention development and implementation phases, and that policy development actors should have the opportunity to connect with other actors, without strong direction from a central actor.

      PubDate: 2017-10-10T14:20:09Z
  • “We don’t have the infrastructure to support them at home”: How
           health system inadequacies impact on long-term care admissions of people
           with dementia
    • Authors: Nora-Ann Donnelly; Niamh Humphries Anne Hickey Frank Doyle
      Abstract: Publication date: Available online 6 October 2017
      Source:Health Policy
      Author(s): Nora-Ann Donnelly, Niamh Humphries, Anne Hickey, Frank Doyle
      Objectives The influence of healthcare system factors on long-term care admissions has received relatively little attention. We address this by examining how inadequacies in the healthcare system impact on long-term care admissions of people with dementia. This is done in the context of the Irish healthcare system. Methods Thirty-eight qualitative in-depth interviews with healthcare professionals and family carers were conducted. Interviews focused on participants’ perceptions of the main factors which influence admission to long-term care. Interviews were analysed thematically. Results The findings suggest that long-term care admissions of people with dementia may be affected by inadequacies in the healthcare system in three ways. Firstly, participants regarded the economic crisis in Ireland to have exacerbated the under-resourcing of community care services. These services were also reported to be inequitable. Consequently, the effectiveness of community care was seen to be limited. Secondly, such limits in community care appear to increase acute hospital admissions. Finally, admission of people with dementia to acute hospitals was believed to accelerate the journey towards long-term care. Conclusions Inadequacies in the healthcare system are reported to have a substantial impact on the threshold for long-term care admissions. The findings indicate that we cannot fully understand the factors that predict long-term care admission of people with dementia without accounting for healthcare system factors on the continuation of homecare.

      PubDate: 2017-10-10T14:20:09Z
  • Evaluation of minimum volume standards for surgery in the Netherlands
           (2003-2017): a successful policy'
    • Authors: Roos Mesman; Marjan J. Faber; Bart J.J.M. Berden; Gert P. Westert
      Abstract: Publication date: Available online 29 September 2017
      Source:Health Policy
      Author(s): Roos Mesman, Marjan J. Faber, Bart J.J.M. Berden, Gert P. Westert
      Purpose To evaluate the introduction and implications of minimum volume standards for surgery in Dutch health care from 2003 to 2017 and formulate policy lessons for other countries. Setting Dutch health care. Principal findings Three eras were identified, representing a trust-and-control cycle in keeping with changing roles of different stakeholders in Dutch context. In the first era ‘regulated trust’ (2003-2009), the Dutch Inspectorate introduced national volume criteria and relied on yearly hospital reported data for information on compliance. In the second era ’contract and control’ (2009-2017), the effects of market-oriented reform became more evident. The Dutch government intervened in the market and health insurers introduced selective contracting. Medical professionals were prompted to reclaim the initiative. In the current era (2017-), a return of trust in self-regulation seems visible. The number of low- volume hospitals performing complex surgeries in the Netherlands has decreased and research has shown improved outcomes as a result. Conclusions Based on the Dutch experience, the following lessons can be useful for other health care systems: 1. professionals should be in the lead in the development of national quality standards 2. external pressure can be helpful for professionals to take the initiative and 3. volume remains a controversial quality measure. Future research and policies should focus on the underlying mechanism of volume-outcome relationships and overall effects of volume-based policies.

      PubDate: 2017-10-01T12:33:39Z
      DOI: 10.1016/j.healthpol.2017.09.017
  • A review of international coverage and pricing strategies for personalized
           medicine and orphan drugs
    • Authors: Irina Degtiar
      Abstract: Publication date: Available online 29 September 2017
      Source:Health Policy
      Author(s): Irina Degtiar
      Background Personalized medicine and orphan drugs share many characteristics—both target small patient populations, have uncertainties regarding efficacy and safety at payer submission, and frequently have high prices. Given personalized medicine's rising importance, this review summarizes international coverage and pricing strategies for personalized medicine and orphan drugs as well as their impact on therapy development incentives, payer budgets, and therapy access and utilization. Methods PubMed, Health Policy Reference Center, EconLit, Google Scholar, and references were searched through February 2017 for articles presenting primary data. Results Sixty-nine articles summarizing 42 countries’ strategies were included. Therapy evaluation criteria varied between countries, as did patient cost-share. Payers primarily valued clinical effectiveness; cost was only considered by some. These differences result in inequities in orphan drug access, particularly in smaller and lower-income countries. The uncertain reimbursement process hinders diagnostic testing. Payer surveys identified lack of comparative effectiveness evidence as a chief complaint, while manufacturers sought more clarity on payer evidence requirements. Despite lack of strong evidence, orphan drugs largely receive positive coverage decisions, while personalized medicine diagnostics do not. Conclusions As more personalized medicine and orphan drugs enter the market, registries can provide better quality evidence on their efficacy and safety. Payers need systematic assessment strategies that are communicated with more transparency. Further studies are necessary to compare the implications of different payer approaches.

      PubDate: 2017-10-01T12:33:39Z
      DOI: 10.1016/j.healthpol.2017.09.005
    • Authors: Pedro Ramos; Hélio Alves
      Abstract: Publication date: Available online 28 September 2017
      Source:Health Policy
      Author(s): Pedro Ramos, Hélio Alves
      Migration of health personnel during periods of economic crisis represents a challenge for policymakers in origin and destination countries. Portugal is going through a period of economic hardship and much has been speculated about an increase in junior doctors’ migration during this period. Using a questionnaire administered to a sample of Portuguese junior doctors who were still in the general residency (1st-year after medical school), we aim at determining the prevalence of migration intentions among Portuguese junior doctors and to identify the most important drivers of career choice for those who are considering emigrating in the near future. In our sample, 55% of Portuguese junior doctors are considering working abroad in the coming 10 years. Several variables were associated with an intention to work abroad: female sex (odds ratio [OR] 0.559; 95% confidence interval [CI] 0.488–0.640), the National Medical Exam score (OR 0.978; 95% CI 0.961–0.996;), having studied abroad (OR 1.756; 95% CI 1.086–2.867) and considering income and research opportunities as key factors for future specialty choice (OR 1.356; 95% CI 1.132–1.626; OR 2.626; 95% CI 1.228–4.172). Our study warns of the shortages the country may face due to doctors’ migration and the main factors behind migration intentions in Portugal. Developing physician retention strategies is a priority to appropriately address these factors.

      PubDate: 2017-10-01T12:33:39Z
      DOI: 10.1016/j.healthpol.2017.09.016
  • What do women want' Valuing women’s preferences and estimating
           demand for alternative models of maternity care using a discrete choice
    • Authors: Christopher G. Fawsitt; Jane Bourke; Richard A. Greene; Brendan McElroy; Nicolas Krucien; Rosemary Murphy; Jennifer E. Lutomski
      Abstract: Publication date: Available online 23 September 2017
      Source:Health Policy
      Author(s): Christopher G. Fawsitt, Jane Bourke, Richard A. Greene, Brendan McElroy, Nicolas Krucien, Rosemary Murphy, Jennifer E. Lutomski
      In many countries, there has been a considerable shift towards providing a more woman-centred maternity service, which affords greater consumer choice. Maternity service provision in Ireland is set to follow this trend with policymakers committed to improving maternal choice at hospital level. However, women’s preferences for maternity care are unknown, as is the expected demand for new services. In this paper, we used a discrete choice experiment (DCE) to (1) investigate women’s strengths of preference for different features of maternity care; (2) predict market uptake for consultant- and midwifery-led care, and a hybrid model of care called the Domiciliary In and Out of Hospital Care scheme; and (3) calculate the welfare change arising from the provision of these services. Women attending antenatal care across two teaching hospitals in Ireland were invited to participate in the study. Women’s preferred model of care resembled the hybrid model of care, with considerably more women expected to utilise this service than either consultant- or midwifery-led care. The benefit of providing all three services proved considerably greater than the benefit of providing two or fewer services. From a priority setting perspective, pursuing all three models of care would generate a considerable welfare gain, although the cost-effectiveness of such an approach needs to be considered.

      PubDate: 2017-09-25T11:53:13Z
      DOI: 10.1016/j.healthpol.2017.09.013
  • Maternity services for rural and remote Australia: barriers to
           operationalising national policy
    • Authors: Jo Longman; Jude Kornelsen; Jen Pilcher; Sue Kildea; Sue Kruske; Stefan Grzybowski; Sarah Robin; Margaret Rolfe; Deborah Donoghue; Geoffrey G. Morgan; Lesley Barclay
      Abstract: Publication date: Available online 22 September 2017
      Source:Health Policy
      Author(s): Jo Longman, Jude Kornelsen, Jen Pilcher, Sue Kildea, Sue Kruske, Stefan Grzybowski, Sarah Robin, Margaret Rolfe, Deborah Donoghue, Geoffrey G. Morgan, Lesley Barclay
      Introduction In Australia, many small birthing units have closed in recent years, correlating with adverse outcomes including a rise in the number of babies born before arrival to hospital. Concurrently, a raft of national policy and planning documents promote continued provision of rural and remote maternity services, articulating a strategic intent for services to provide responsive, woman-centred care as close as possible to a woman’s home. The aims of this paper are to contribute to an explanation of why this strategic intent is not realised, and to investigate the utility of an evidence based planning tool (the Toolkit) to assist with planning services to realise this intent. Methods Interviews, focus groups and a group information session were conducted involving 141 participants in four Australian jurisdictions. Field notes and reports were thematically analysed. Results We identified barriers that helped explain the gap between strategic intent and services on the ground. These were absence of informed leadership; lack of knowledge of contemporary models of care and inadequate clinical governance; poor workforce planning and use of resources; fallacious perceptions of risk; and a dearth of community consultation. In this context, the implementation of policy is problematic without tools or guidance. Conclusions Barriers to operationalising strategic intent in planning maternity services may be alleviated by using evidence based planning tools such as the Toolkit.

      PubDate: 2017-09-25T11:53:13Z
      DOI: 10.1016/j.healthpol.2017.09.012
  • Implementation of national palliative care guidelines in Swedish acute
           care hospitals: A qualitative content analysis of stakeholders’
    • Authors: S. Lind; L. Wallin; T. Brytting; C.J. Fürst; J. Sandberg
      Abstract: Publication date: Available online 21 September 2017
      Source:Health Policy
      Author(s): S. Lind, L. Wallin, T. Brytting, C.J. Fürst, J. Sandberg
      In high-income countries a large proportion of all deaths occur in hospitals. A common way to translate knowledge into clinical practice is developing guidelines for different levels of health care organisations. During 2012, national clinical guidelines for palliative care were published in Sweden. Later, guidance for palliative care was issued by the National Board of Health and Welfare. The aim of this study was two-fold: to investigate perceptions regarding these guidelines and identify obstacles and opportunities for implementation of them in acute care hospitals. Interviews were conducted with local politicians, chief medical officers and health professionals at acute care hospitals. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. The results showed little knowledge of the two documents at all levels of the health care organisation. Palliative care was primarily described as end of life care and only few of the participants talked about the opportunity to integrate palliative care early in a disease trajectory. The environment and culture at hospitals, characterised by quick decisions and actions, were perceived as obstacles to implementation. Health professionals' expressed need for palliative care training is an opportunity for implementation of clinical guidelines. There is a need for further implementation of palliative care in hospitals. One option for further research is to evaluate implementation strategies tailored to acute care.

      PubDate: 2017-09-25T11:53:13Z
      DOI: 10.1016/j.healthpol.2017.09.011
  • Fences and ambulances: Intersectoral governance for health
    • Authors: Scott L. Greer; Nikolai Vasev; Matthias Wismar
      Abstract: Publication date: Available online 21 September 2017
      Source:Health Policy
      Author(s): Scott L. Greer, Nikolai Vasev, Matthias Wismar

      PubDate: 2017-09-25T11:53:13Z
      DOI: 10.1016/j.healthpol.2017.09.014
  • The impact of introducing a new hospital financing system (DRGs) in Poland
           on hospitalisations for atherosclerosis: An interrupted time series
           analysis (2004–2012)
    • Authors: Elżbieta Buczak-Stec; Paweł Goryński; Aneta Nitsch-Osuch; Krzysztof Kanecki; Piotr Tyszko
      Abstract: Publication date: Available online 20 September 2017
      Source:Health Policy
      Author(s): Elżbieta Buczak-Stec, Paweł Goryński, Aneta Nitsch-Osuch, Krzysztof Kanecki, Piotr Tyszko
      Objectives Hospital payment based on diagnosis-related groups (DRGs) was introduced in Poland in July 2008. We evaluate the impact of this policy on the frequency of hospitalisation for atherosclerosis in internal medicine units of district hospitals and non-public hospitals in Poland. Methods Data were collected between 2004 and 2012 from each district and non-public hospital participating in the General Hospital Morbidity Study (165 hospitals in total). Atherosclerosis was defined using the ICD-10 code I70. Hospitalisation patterns were examined using interrupted time series with segmented regression analysis. Results were compared between public and non-public hospitals and across patient age groups. Results The rate of hospitalisation for atherosclerosis rose by 27.05 per 10,000 total hospitalisations immediately following the implementation of DRGs in 2008. It then rose by 2.5 per 10,000 hospitalisations monthly between 2008 to 2012. The largest changes were observed for patients aged 85+ and 75–84. Rates rose by 117.5 and 54.2 per 10,000 hospitalisations in these two groups respectively following implementation of DRGs. The response to introduction of DRGs was less striking in non-public hospitals than in public hospitals. Conclusions Implementation of a DRG-based system in Poland was associated with substantial increases in atherosclerosis hospitalisation rates. Failing to take into account this change in financing and not accounting for long-term trends in hospitalisation rates may result in inaccurate epidemiological data.

      PubDate: 2017-09-25T11:53:13Z
      DOI: 10.1016/j.healthpol.2017.09.009
  • Child survival in England: strengthening governance for health
    • Authors: Ingrid Wolfe; Kate Mandeville; Katherine Harrison; Raghu Lingam
      Abstract: Publication date: Available online 17 September 2017
      Source:Health Policy
      Author(s): Ingrid Wolfe, Kate Mandeville, Katherine Harrison, Raghu Lingam
      The United Kingdom, like all European countries, is struggling to strengthen health systems and improve conditions for child health and survival. Child mortality in the UK has failed to improve in line with other countries. Securing optimal conditions for child health requires a healthy society, strong health system, and effective health care. We examine inter-sectoral and intra-sectoral policy and governance for child health and survival in England. Literature reviews and universally applicable clinical scenarios were used to examine child health problems and English policy and governance responses for improving child health through integrating care and strengthening health systems, over the past 15 years. We applied the TAPIC framework for analyzing policy governance: transparency, accountability, participation, integrity, and capacity. We identified strengths and weaknesses in child health governance in all the five domains. However there remain policy failures that are not fully explained by the TAPIC framework. Other problems with successfully translating policy to improved health that we identified include policy flux; policies insufficiently supported by delivery mechanisms measurable targets, and sufficient budgets; and policies with unintended or contradictory aspects. We make recommendations for inter-sectoral and intra-sectoral child health governance, policy, and action to improve child health in England with relevant lessons for other countries.

      PubDate: 2017-09-25T11:53:13Z
      DOI: 10.1016/j.healthpol.2017.09.004
  • Trade Policy Governance: What Health Policymakers and Advocates Need to
    • Authors: Holly Jarman; John G. Searle
      Abstract: Publication date: Available online 17 September 2017
      Source:Health Policy
      Author(s): Holly Jarman, John G. Searle
      Trade policies affect determinants of health as well as the options and resources available to health policymakers. There is therefore a need for health policymakers and related stakeholders in all contexts to understand and connect with the trade policymaking process. This paper uses the TAPIC (transparency, accountability, participation, integrity, capacity) governance framework to analyze how trade policy is commonly governed. I conclude that the health sector is likely to benefit when transparency in trade policymaking is increased, since trade negotiations to date have often left out health advocates and policymakers. Trade policymakers and negotiators also tend to be accountable to economic and trade ministries, which are in turn accountable to economic and business interests. Neither tend to appreciate the health consequences of trade and trade policies. Greater accountability to health ministries and interests, and greater participation by them, could improve the health effects of trade negotiations. Trade policies are complex, requiring considerable policy capacity to understand and influence. Nevertheless, investing in understanding trade can pay off in terms of managing future legal risks.

      PubDate: 2017-09-25T11:53:13Z
      DOI: 10.1016/j.healthpol.2017.09.002
  • Reforming voluntary drug insurance in Russian healthcare: does social
           solidarity matter'
    • Authors: Christopher J Gerry; Maria Kaneva; Liudmila Zasimova
      Abstract: Publication date: Available online 8 September 2017
      Source:Health Policy
      Author(s): Christopher J Gerry, Maria Kaneva, Liudmila Zasimova
      With low take-up of both private health insurance and the existing public drug reimbursement scheme, it is thought that less than 5% of the Russian population have access to free outpatient drug treatment. This represents a major policy challenge for a country grappling with reforms of its healthcare system and experiencing low or no economic growth and significant associated reductions in spending on social services. In this paper, we draw on data from a 2011 Levada-Center survey to examine the attitudes and social solidarity of the Russian population towards drug policies in general and towards the introduction of a proposed voluntary drug insurance system in particular. In addition to being among the first to explore these important questions in the post-Communist setting, we make three important contributions to the emerging policy debates. First, we find that, if introduced immediately and without careful planning and preparation, Russia’s voluntary drug insurance scheme is likely to collapse financially due to the over-representation of high-risk unhealthy individuals opting in to the scheme. Second, the negative attitude of higher income groups towards the redistribution of wealth to the poor may further impede government efforts to introduce voluntary drug insurance. Finally, we argue that Russia currently lacks the breadth and depth of social solidarity necessary for implementing this form of health financing.

      PubDate: 2017-09-12T11:32:12Z
      DOI: 10.1016/j.healthpol.2017.09.001
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