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HEALTH AND SAFETY (544 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: 12)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access   (Followers: 1)
Adultspan Journal     Hybrid Journal   (Followers: 1)
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)
Ageing & Society     Hybrid Journal   (Followers: 38)
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: 26)
American Journal of Health Sciences     Open Access   (Followers: 7)
American Journal of Health Studies     Full-text available via subscription   (Followers: 11)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 27)
American Journal of Public Health     Full-text available via subscription   (Followers: 207)
American Journal of Public Health Research     Open Access   (Followers: 27)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 4)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 12)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access   (Followers: 3)
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: 9)
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)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 3)
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: 7)
Behavioral Healthcare     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: 8)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 6)
BMC Pregnancy and Childbirth     Open Access   (Followers: 21)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 10)
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: 16)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Cambridge Quarterly of Healthcare Ethics     Hybrid Journal   (Followers: 11)
Canadian Family Physician     Partially Free   (Followers: 11)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 9)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 2)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 19)
Case Reports in Women's Health     Open Access   (Followers: 3)
Case Studies in Fire Safety     Open Access   (Followers: 15)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
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 e Innovación en Salud     Open Access  
Ciencia y Cuidado     Open Access   (Followers: 1)
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: 3)
Conflict and Health     Open Access   (Followers: 7)
Contraception and Reproductive Medicine     Open Access  
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 4)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access   (Followers: 3)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 11)
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: 17)
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: 19)
EcoHealth     Hybrid Journal   (Followers: 4)
Education for Health     Open Access   (Followers: 6)
electronic Journal of Health Informatics     Open Access   (Followers: 6)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 4)
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: 1)
Epidemics     Open Access   (Followers: 4)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 5)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 18)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 4)
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: 2)
Food and Public Health     Open Access   (Followers: 12)
Food Quality and Safety     Open Access  
Frontiers in Public Health     Open Access   (Followers: 6)
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: 6)
Global Health Promotion     Hybrid Journal   (Followers: 15)
Global Journal of Health Science     Open Access   (Followers: 10)
Global Journal of Public Health     Open Access   (Followers: 13)
Global Medical & Health Communication     Open Access   (Followers: 2)
Global Mental Health     Open Access   (Followers: 6)
Global Security : Health, Science and Policy     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: 9)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 7)
Health and Social Work     Hybrid Journal   (Followers: 55)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 3)
Health Care Analysis     Hybrid Journal   (Followers: 15)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 17)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Notions     Open Access  
Health Policy     Hybrid Journal   (Followers: 42)
Health Policy and Technology     Hybrid Journal   (Followers: 4)
Health Professional Student Journal     Open Access   (Followers: 2)
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: 8)
Health Promotion Practice     Hybrid Journal   (Followers: 16)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 50)
Health Psychology Research     Open Access   (Followers: 19)
Health Psychology Review     Hybrid Journal   (Followers: 40)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 13)
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: 4)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 12)
Health, Risk & Society     Hybrid Journal   (Followers: 12)
Healthcare     Open Access   (Followers: 3)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
Healthcare Technology Letters     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: 12)
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: 3)
Indonesian Journal for Health Sciences     Open Access   (Followers: 1)
Indonesian Journal of Public Health     Open Access  
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: 2)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 5)
International Journal for Equity in Health     Open Access   (Followers: 6)
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: 19)

        1 2 3 | Last

Journal Cover Health Policy
  [SJR: 1.182]   [H-I: 36]   [42 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0168-8510
   Published by Elsevier Homepage  [3175 journals]
  • Funding breakthrough therapies: A systematic review and recommendation
    • Authors: E. Hanna; M. Toumi; C. Dussart; B. Borissov; O. Dabbous; K. Badora; P. Auquier
      Pages: 217 - 229
      Abstract: Publication date: March 2018
      Source:Health Policy, Volume 122, Issue 3
      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: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2017.11.012
  • 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
      Pages: 256 - 262
      Abstract: Publication date: March 2018
      Source:Health Policy, Volume 122, Issue 3
      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: 2018-04-15T09:38:36Z
      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
      Pages: 263 - 268
      Abstract: Publication date: March 2018
      Source:Health Policy, Volume 122, Issue 3
      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: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2017.10.004
  • The meaning of severity – do citizenś views correspond to a severity
           framework based on ethical principles for priority setting'
    • Authors: Mari Broqvist; Lars Sandman; Peter Garpenby; Barbro Krevers
      Abstract: Publication date: Available online 22 April 2018
      Source:Health Policy
      Author(s): Mari Broqvist, Lars Sandman, Peter Garpenby, Barbro Krevers
      The importance for governments of establishing ethical principles and criteria for priority setting in line with social values, has been emphasised. The risk of such criteria not being operationalised and instead replaced by de-contextualised priority-setting tools, has been noted. The aim of this article was to compare whether citizenś views are in line with how a criterion derived from parliamentary-decided ethical principles have been interpreted into a framework for evaluating severity levels, in resource allocation situations in Sweden. Interviews were conducted with 15 citizens and analysed by directed content analysis. The results showed that the multi-factorial aspects that participants considered as relevant for evaluating severity, were similar to those used by professionals in the Severity Framework, but added some refinements on what to consider when taking these aspects into account. Findings of similarities, such as in our study, could have the potential to strengthen the internal legitimacy among professionals, to use such a priority-setting tool, and enable politicians to communicate the justifiability of how severity is decided. The study also disclosed new aspects regarding severity, of which some are ethically disputed, implying that our results also reveal the need for ongoing ethical discussions in publicly-funded healthcare systems.

      PubDate: 2018-04-23T14:05:45Z
      DOI: 10.1016/j.healthpol.2018.04.005
  • Infectious disease health services for refugees and asylum seekers during
           a time of crisis: a scoping study of six European Union countries
    • Authors: Kayvan Bozorgmehr; Mariya Samuilova; Roumyana Petrova-Benedict; Enrico Girardi; Pierluca Piselli; Alexander Kentikelenis
      Abstract: Publication date: Available online 11 April 2018
      Source:Health Policy
      Author(s): Kayvan Bozorgmehr, Mariya Samuilova, Roumyana Petrova-Benedict, Enrico Girardi, Pierluca Piselli, Alexander Kentikelenis
      Background Systematic information on infectious disease services provided to refugees and asylum seekers in the European Union (EU) is sparse. We conducted a scoping study of experts in six EU countries in order to map health system responses related to infectious disease prevention and control among refugees and asylum seekers. Methods We conducted 27 semi-structured in-depth interviews with first-line staff and health officials to collect information about existing guidelines and practices at each stage of reception in first-entry (Greece/Italy), transit (Croatia/Slovenia), and destination countries (Austria/Sweden). Thematic coding was used to perform a content analysis of interview material. Results Guidance on infectious disease screening and health assessments lack standardisation across and—partly—within countries. Data collection on notifiable infectious diseases is mainly reported to be performed by national public health institutions, but is not stratified by migrant status. Health-related information is not transferred in a standardized way between facilities within a single country. International exchange of medical information between countries along the migration route is irregular. Services were reported to be fragmented, and respondents mentioned no specific coordination bodies beyond health authorities at different levels. Conclusion Infectious disease health services provided to refugees and asylum seekers lack standardisation in health assessments, data collection, transfer of health-related information and (partly) coordination. This may negatively affect health system performance including public health emergency preparedness.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.04.003
  • Harnessing the private health sector by using prices as a policy
           instrument: Lessons learned from South Africa
    • Authors: Sarah L. Barber; Ankit Kumar; Tomas Roubal; Francesca Colombo; Luca Lorenzoni
      Abstract: Publication date: Available online 29 March 2018
      Source:Health Policy
      Author(s): Sarah L. Barber, Ankit Kumar, Tomas Roubal, Francesca Colombo, Luca Lorenzoni
      Governments frequently draw upon the private health care sector to promote sustainability, optimal use of resources, and increased choice. In doing so, policy-makers face the challenge of harnessing resources while grappling with the market failures and equity concerns associated with private financing of health care. The growth of the private health sector in South Africa has fundamentally changed the structure of health care delivery. A mutually reinforcing ecosystem of private health insurers, private hospitals and specialists has grown to account for almost half of the country’s spending on health care, despite only serving 16% of the population with the capacity to pay. Following years of consolidation among private hospital groups and insurance schemes, and after successive failures at establishing credible price benchmarks, South Africa’s private hospitals charge prices comparable with countries that are considerably richer. This compromises the affordability of a broad-based expansion in health care for the population. The South African example demonstrates that prices can be part of a structure that perpetuates inequalities in access to health care resources. The lesson for other countries is the importance of norms and institutions that uphold price schedules in high-income countries. Efforts to compromise or liberalize price setting should be undertaken with a healthy degree of caution.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.03.018
  • Paying hospital specialists: Experiences and lessons from eight
           high-income countries
    • Authors: Wilm Quentin; Alexander Geissler; Friedrich Wittenbecher; Geoff Ballinger; Robert Berenson; Karen Bloor; Dana A. Forgione; Peer Köpf; Madelon Kroneman; Lisbeth Serden; Raúl Suarez; Johan W. van Manen; Reinhard Busse
      Abstract: Publication date: Available online 23 March 2018
      Source:Health Policy
      Author(s): Wilm Quentin, Alexander Geissler, Friedrich Wittenbecher, Geoff Ballinger, Robert Berenson, Karen Bloor, Dana A. Forgione, Peer Köpf, Madelon Kroneman, Lisbeth Serden, Raúl Suarez, Johan W. van Manen, Reinhard Busse
      Payment systems for specialists in hospitals can have far reaching consequences for the efficiency and quality of care. This article presents a comparative analysis of payment systems for specialists in hospitals of eight high-income countries (Canada,England,France,Germany,Sweden,Switzerland,the Netherlands,and the USA/Medicare system). A theoretical framework highlighting the incentives of different payment systems is used to identify potentially interesting reform approaches. In five countries,most specialists work as employees − but in Canada,the Netherlands and the USA,a majority of specialists are self-employed. The main findings of our review include: (1) many countries are increasingly shifting towards blended payment systems; (2) bundled payments introduced in the Netherlands and Switzerland as well as systematic bonus schemes for salaried employees (most countries) contribute to broadening the scope of payment; (3) payment adequacy is being improved through regular revisions of fee levels on the basis of more objective data sources (e.g. in the USA) and through individual payment negotiations (e.g. in Sweden and the USA); and (4) specialist payment has so far been adjusted for quality of care only in hospital specific bonus programs. Policy-makers across countries struggle with similar challenges,when aiming to reform payment systems for specialists in hospitals. Examples from our reviewed countries,may provide lessons and inspiration for the improvement of payment systems internationally.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.03.005
  • Cost-effectiveness of HIV screening in high-income countries: A systematic
    • Authors: Fabrizio Bert; Maria Rosaria Gualano; Paolo Biancone; Valerio Brescia; Elisa Camussi; Maria Martorana; Silvana Secinaro; Roberta Siliquini
      Abstract: Publication date: Available online 23 March 2018
      Source:Health Policy
      Author(s): Fabrizio Bert, Maria Rosaria Gualano, Paolo Biancone, Valerio Brescia, Elisa Camussi, Maria Martorana, Silvana Secinaro, Roberta Siliquini
      Introduction Over 2 million people in high-income countries live with HIV. Early diagnosis and treatment present benefits for infected subjects and reduce secondary transmissions. Cost-effectiveness analyses are important to effectively inform policy makers and consequently implement the most cost-effective programmes. Therefore, we conducted a systematic review regarding the cost-effectiveness of HIV screening in high-income countries. Methods We followed PRISMA statements and included all papers evaluating the cost-effectiveness of HIV screening in the general population or in specific subgroups. Results Thirteen studies considered routine HIV testing in the general population. The most cost-effective option appeared to be associating one-time testing of the general population with annual screening of high-risk groups, such as injecting-drug users. Thirteen studies assessed the cost-effectiveness of HIV screening in specific settings, outlining the attractiveness of similar programmes in emergency departments, primary care, sexually transmitted disease clinics and substance abuse treatment programmes. Discussion Evidence regarding the health benefits and cost-effectiveness of HIV screening is growing, even in low-prevalence countries. One-time screenings offered to the adult population appear to be a valuable choice, associated with repeated testing in high-risk populations. The evidence regarding the benefits of using a rapid test, even in terms of cost-effectiveness, is growing. Finally, HIV screening seems useful in specific settings, such as emergency departments and STD clinics.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.03.007
  • The impact of pay-for-performance on the quality of care in ophthalmology:
           Empirical evidence from Germany
    • Authors: T. Herbst; J. Foerster; M. Emmert
      Abstract: Publication date: Available online 22 March 2018
      Source:Health Policy
      Author(s): T. Herbst, J. Foerster, M. Emmert
      Background Pay-for-performance (P4P) has become a popular approach to increase effectiveness and efficiency in healthcare. So far, there is little evidence regarding the potential of P4P in the German healthcare setting. The aim of this study was to determine the impact of P4P on the quality of care in cataract surgery. Methods In 2012, a P4P program was implemented in a German surgical centre for ophthalmology. Five quality measures regarding process quality, outcomes, and patient satisfaction were measured over a period of 4.5 years. The P4P scheme consisted of bonus and penalty payments accounting for five per cent of total compensation. Overall, 1657 P4P cases were examined and compared with 4307 control cases. Interrupted time series and group comparisons were conducted to identify quality and spill-over effects. Results We found a positive impact on process quality and patient satisfaction before the implementation of the P4P scheme, but declining trends during and after the implementation. Our findings did not show an impact of P4P on outcome measures. Furthermore, P4P did not result in better quality of care, compared with the German hospital-based reimbursement scheme. Conclusion This study did not show any positive long-term effects of the implementation of P4P on quality of care. Therefore, our results do not support the hypothesis that P4P leads to significant improvements in quality of care.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.03.013
  • Strengthening the public health workforce: An estimation of the long-term
           requirements for public health specialists in Serbia
    • Authors: Milena Santric Milicevic; Milena Vasic; Matt Edwards; Cristina Sanchez; John Fellows
      Abstract: Publication date: Available online 21 March 2018
      Source:Health Policy
      Author(s): Milena Santric Milicevic, Milena Vasic, Matt Edwards, Cristina Sanchez, John Fellows
      At the beginning of the 21st century, planning the public health workforce requirements came into the focus of policy makers. The need for improved provision of essential public health services, driven by a challenging non-communicable disease and causes of death and disability within Serbia, calls for a much needed estimation of the requirements of the public health professionals. Mid and long-term public health specialists’ supply and demand estimations out to 2025were developed based on national staffing standards and regional distribution of the workforce in public health institutes of Serbia. By 2025, the supply of specialists, taking into account attrition rate of −1% reaches the staffing standard. However, a slight increase in attrition rates has the impact of revealing supply shortage risks. Demand side projections show that public health institutes require an annual input of 10 specialists or 2.1% annual growth rate in order for the four public health fields to achieve a headcount of 487 by 2025 as well as counteract workforce attrition rates. Shortage and poor distribution of public health specialists underline the urgent need for workforce recruitment and retention in public health institutes in order to ensure the coordination, management, surveillance and provision of essential public health services over the next decade.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.03.012
  • Decoding disclosure: Comparing conflict of interest policy among the
           United States, France, and Australia
    • Authors: Quinn Grundy; Roojin Habibi; Adrienne Shnier; Christopher Mayes; Wendy Lipworth
      Abstract: Publication date: Available online 21 March 2018
      Source:Health Policy
      Author(s): Quinn Grundy, Roojin Habibi, Adrienne Shnier, Christopher Mayes, Wendy Lipworth
      “Sunshine” policy, aimed at making financial ties between health professionals and industry publicly transparent, has recently gone global. Given that transparency is not the sole means of managing conflict of interest, and is unlikely to be effective on its own, it is important to understand why disclosure has emerged as a predominant public policy solution, and what the effects of this focus on transparency might be. We used Carol Bacchi’s problem-questioning approach to policy analysis to compare the Sunshine policies in three different jurisdictions, the United States, France and Australia. We found that transparency had emerged as a solution to several different problems including misuse of tax dollars, patient safety and public trust. Despite these differences in the origins of disclosure policies, all were underpinned by the questionable assumption that informed consumers could address conflicts of interest. We conclude that, while transparency reports have provided an unprecedented opportunity to understand the reach of industry within healthcare, policymakers should build upon these insights and begin to develop policy solutions that address systemic commercial influence.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.03.015
  • Improving quality of psychiatric care in Latvia by measuring patient
    • Authors: Maris Taube; Natalija Berzina-Novikova
      Abstract: Publication date: Available online 20 March 2018
      Source:Health Policy
      Author(s): Maris Taube, Natalija Berzina-Novikova
      In Latvia, as in many former Soviet Union countries, there used to be little priority given to systematic assessments of the quality of psychiatric care. Furthermore, using the experiences of patients as a measure of quality was unthinkable because psychiatric patients were seen as incapable of assessing quality of psychiatric services. Over the past few years, and facilitated by Latvia's progress along the route of Western democracy and participation in international organizations (EU, OECD), as well as funding support from the EU, several policy documents have been developed with the aim of improving healthcare quality. Simultaneously, several small-scale initiatives have emerged aiming at the promotion of quality of care, such as the quality award, and the quality comparison of psychiatric hospitals. Furthermore, the Psychiatric Inpatient Patient Experience Questionnaire for on-site measurement (PIPEQ-OS) has recently been adapted for use in Latvia. The first application of PIPEQ-OS in a psychiatric hospital in Riga reveals high patient responsiveness, interest and surprise about being asked to participate in the decision-making process regarding treatment and pharmaceutical choices. More widespread use of the PIPEQ-OS has considerable potential for (1) improving information about treatment shortcomings from the patients' perspective and (2) improving the treatment process by opening doors of cooperation with patients and changing deep-rooted paradigms.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.03.011
  • Out-of-pocket costs, primary care frequent attendance and sample
           selection: Estimates from a longitudinal cohort design
    • Authors: Carly Pymont; Paul McNamee; Peter Butterworth
      Abstract: Publication date: Available online 20 March 2018
      Source:Health Policy
      Author(s): Carly Pymont, Paul McNamee, Peter Butterworth
      This paper examines the effect of out-of-pocket costs on subsequent frequent attendance in primary care using data from the Personality and Total Health (PATH) Through Life Project, a representative community cohort study from Canberra, Australia. The analysis sample comprised 1197 respondents with two or more GP consultations, and uses survey data linked to administrative health service use (Medicare) data which provides data on the number of consultations and out-of-pocket costs. Respondents identified in the highest decile of GP use in a year were defined as Frequent Attenders (FAs). Logistic regression models that did not account for potential selection effects showed that out-of-pocket costs incurred during respondents’ prior two consultations were significantly associated with subsequent FA status. Respondents who incurred higher costs ($15–$35; or >$35) were less likely to become FAs than those who incurred no or low (<AUS$15 per consultation) costs, with no difference evident between the no and low-cost groups. However, a counterfactual model that adjusted for factors associated with the selection into payment levels did not find an influence of payment, with only a non-significant gradient in the expected direction. Hence these findings raise doubts that price drives FA behaviour, suggesting that co-payments are unlikely to affect the number of GP consultations amongst frequent attenders.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.03.014
  • Integrated care in Switzerland: Results from the first nationwide survey
    • Authors: Séverine Schusselé Filliettaz; Peter Berchtold; Dimitri Kohler; Isabelle Peytremann-Bridevaux
      Abstract: Publication date: Available online 17 March 2018
      Source:Health Policy
      Author(s): Séverine Schusselé Filliettaz, Peter Berchtold, Dimitri Kohler, Isabelle Peytremann-Bridevaux

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.03.006
  • Mapping existing hip and knee replacement registries in Europe
    • Authors: A. Lübbeke; A.J. Silman; C. Barea; D. Prieto-Alhambra; A.J. Carr
      Abstract: Publication date: Available online 17 March 2018
      Source:Health Policy
      Author(s): A. Lübbeke, A.J. Silman, C. Barea, D. Prieto-Alhambra, A.J. Carr
      The general shortage of evidence regarding benefits and harms of medical devices has been highlighted following the serious safety concerns with metal-on-metal hip replacements and silicone breast implants and was again pointed out in a recent survey of European Health Technology Assessment institutions. In this context the new European medical device regulation will enforce post-marketing surveillance of existing and new implants. The usefulness of registry data as a source of information for medical device real-world clinical performance and safety has been demonstrated. However, these data might be under-used by researchers and policy makers. One reason for this is the insufficient awareness of their existence. The aim of this review is to provide information to relevant stakeholders on the extent and breadth of the data currently collected in European joint replacement registries. We identified 24 registries, most of them of national coverage. Total numbers of primary total hip and knee replacements included were over 3.1 and 2.5 million records, respectively. The current focus of these registries is on whole-lifespan implant surveillance via revision rate monitoring, quality assessment of surgical and perioperative care, and hospital performance assessment. More recently, national and international comparison and benchmarking have increasingly become part of their endeavors.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.03.010
  • A cost-effectiveness analysis of lowering residential radon levels in
           Sweden—Results from a modelling study
    • Authors: Mikael Svensson; Lars Barregård; Gösta Axelsson; Eva Andersson
      Abstract: Publication date: Available online 17 March 2018
      Source:Health Policy
      Author(s): Mikael Svensson, Lars Barregård, Gösta Axelsson, Eva Andersson
      Purpose Residential exposure to radon is considered as the second leading cause of lung cancer after smoking. The purpose of this study was to conduct a cost-effectiveness analysis of reducing the indoor radon levels in Sweden from the current reference level of 200 Bq/m3 to the WHO suggested reference level of maximum 100 Bq/m3. Methods We constructed a decision-analytic cost-effectiveness model using input data from published literature and administrative records. The model compared the increase in economic costs to the health benefits of lower indoor radon-levels in a Swedish policy context. We estimated the cost per life-year and quality adjusted life year (QALY) gained and assessed the robustness of the results using both deterministic and probabilistic sensitivity analysis. Results Including (excluding) costs of added life years the cost per QALY for existing homes was €130,000 (€99,000). For new homes the cost per QALY including (excluding) costs of added life years was €39,000 (€25,000). Conclusions The results indicate that it is not cost-effective to reduce indoor radon levels from 200 Bq/m3 to a maximum of 100 Bq/m3 in existing homes, whereas it is cost-effective for new homes.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.03.009
  • Development of voluntary private health insurance in Nordic countries –
           An exploratory study on country-specific contextual factors
    • Authors: Liina-Kaisa Tynkkynen; Nina Alexandersen; Oddvar Kaarbøe; Anders Anell; Juhani Lehto; Karsten Vrangbӕk
      Abstract: Publication date: Available online 16 March 2018
      Source:Health Policy
      Author(s): Liina-Kaisa Tynkkynen, Nina Alexandersen, Oddvar Kaarbøe, Anders Anell, Juhani Lehto, Karsten Vrangbӕk
      The Nordic countries are healthcare systems with tax-based financing and ambitions for universal access to comprehensive services. This implies that distribution of healthcare resources should be based on individual needs, not on the ability to pay. Despite this ideological orientation, significant expansion in voluntary private health insurance (VPHI) contracts has occurred in recent decades. The development and role of VPHIs are different across the Nordic countries. Complementary VPHI plays a significant role in Denmark and in Finland. Supplementary VPHI is prominent in Norway and Sweden. The aim of this paper is to explore drivers behind the developments of the VPHI markets in the Nordic countries. We analyze the developments in terms of the following aspects: the performance of the statutory system (real or perceived), lack of coverage in certain areas of healthcare, governmental interventions or inability to reform the system, policy trends and the general socio-cultural environment, and policy responses to voting behavior or lobbying by certain interest groups. It seems that the early developments in VPHI markets have been an answer to the gaps in the national health systems created by institutional contexts, political decisions, and cultural interpretations on the functioning of the system. However, once the market is created it introduces new dynamics that have less to do with gaps and inflexibilities and more with cultural factors.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.03.008
  • The view of experts on initiatives to be undertaken to promote equity in
           the access to orphan drugs and specialised care for rare diseases in
           Spain: A Delphi consensus
    • Authors: J. Torrent-Farnell; M. Comellas; J.L. Poveda; I. Abaitua; L.G. Gutiérrez-Solana; J. Pérez-López; J. Cruz; J. Urcelay; L. Lizán
      Abstract: Publication date: Available online 15 March 2018
      Source:Health Policy
      Author(s): J. Torrent-Farnell, M. Comellas, J.L. Poveda, I. Abaitua, L.G. Gutiérrez-Solana, J. Pérez-López, J. Cruz, J. Urcelay, L. Lizán
      Objectives To reach a consensus amongst experts on the most feasible actions to be undertaken to facilitate patient access to specialised care and orphan drugs (OD) in the public health sector in Spain. Methods Two Delphi rounds were completed. The questionnaire was based on a literature review and 2 focus groups. Agreement was sought on the desire (D) and prognosis (P) for the implementation within the next 5 years, on a 5-point Likert scale. Consensus was reached when ≥75% participants chose agreement (1–2) or disagreement options (4–5). Results 82 experts on rare disease (RD) participated. Agreement on the D and P was reached in 66.07% statements: OD pricing review [absence of clinical effectiveness (D:85.37%; P:85.90%), target population increase (D:79.27%; P:91.03%)]; reference team definition of referral protocols and clinical practice guidelines (D: 97.56%; P: 89.74%); and a unified, usable, etiology-based registry (D:97.56%; P:84.62%). D and P assessment diverged in 32.14% items: creation of a specific funding system for OD (D: 97.56%; P: 60.25%); and a network of medical teams to coordinate the care of RD patients (D: 99%; P: 62%). Conclusions The results have shown the need to promote dialogue between stakeholders, introduce European recommendation to national and regional Spanish policies and set up priorities and undertake actions to drive relevant changes in current medical practice in managing RD patients.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.03.002
  • Experts’ perspectives on SwissDRG: Second class care for vulnerable
           patient groups'
    • Authors: A. Leu; H. Wepf; B. Elger; T. Wangmo
      Abstract: Publication date: Available online 14 March 2018
      Source:Health Policy
      Author(s): A. Leu, H. Wepf, B. Elger, T. Wangmo
      On the 1st of January 2012, Switzerland introduced the diagnosis-related group hospital tariff structure (SwissDRG). It was recognised that healthcare provided to the most vulnerable patient groups would be a challenge for the new SwissDRG. Coincident with the implementation of SwissDRG, we explored hospital experts' perceptions of which patient groups are vulnerable under the SwissDRG system, what has changed for this group, as well as solutions to ensure adequate access to health care for them. We interviewed 43 experts from 40 Swiss hospitals. Participating experts named several vulnerable patient groups who share some common characteristics. These hospital experts were concerned about the patient groups that are not financially profitable and questioned the practicability of the current regulation. At the same time, they highlighted the complexity associated with caring for this group under the new SwissDRG and reported measures at the macro, meso, and micro levels to protect vulnerable patient groups from negative effects. To curb negative outcomes for vulnerable patient groups after the introduction of the SwissDRG, the Swiss legislation has introduced various instruments including the acute and transitional care (ATC) measures. We conclude that ATC measures do not produce the expected effect the legislators had hoped for. More health data is needed to identify situations where vulnerable patient groups are more susceptible to inadequate health care access in Switzerland.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.03.001
  • Innovative pharmaceutical pricing agreements in five European markets: A
           survey of stakeholder attitudes and experience
    • Authors: William C.N. Dunlop; Alexandra Staufer; Pierre Levy; Guy J. Edwards
      Abstract: Publication date: Available online 8 March 2018
      Source:Health Policy
      Author(s): William C.N. Dunlop, Alexandra Staufer, Pierre Levy, Guy J. Edwards
      Background Innovative pricing agreements for medicines have been used in European markets for more than 20 years, and offer an opportunity for payers and pharmaceutical companies to align on value, optimise speed to patients, and share risk. Developing successful agreements requires alignment between key stakeholders, yet there is a lack of summative data on how current innovative agreements are used in the real-world (e.g. the level of realised access to medicines, and rebates and discounts, which are often non-transparent). Methods This research used a web-based survey of payer stakeholders to determine what kinds of innovative agreements are currently used, anticipated future usage, attitudes, and drivers of adoption. Participants included national and regional payers (or former payers) and hospital-level decision makers. Results Sixty-six payers completed the survey. Respondents expected that the use of innovative pricing agreements will remain the same or increase in the future. Overall, they felt there is a positive attitude towards new schemes, and that innovative agreements are likely to be used when they reduce total costs or reduce uncertainty. Conclusions Given payer expectations, pharmaceutical companies should continue to take a role in ensuring that they have sufficient capacity to support payers in the design and implementation of innovative pricing agreements.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.02.008
  • Taking stock of Roma health policies in Spain: Lessons for health
    • Authors: M. Escobar-Ballesta; M. García-Ramírez; C. De Freitas
      Abstract: Publication date: Available online 8 March 2018
      Source:Health Policy
      Author(s): M. Escobar-Ballesta, M. García-Ramírez, C. De Freitas
      Roma health inequities are a wicked problem. Despite concerted efforts to reduce them under the Decade of Roma Inclusion initiative, the health gap between Roma and non-Roma populations in Europe persists. To address this problem, the European Commission devised the National Roma Integration Strategies (NRIS). This paper provides a critical assessment of the implementation of the NRIS’ health strand (NRIS-H) in Spain and proposes an evaluation tool to monitor Roma health policies – the Roma Health Integration Policy Index (RHIPEX). It also makes recommendations to promote Roma health governance. To achieve these goals, four community forums, 33 stakeholder interviews and a scoping review were conducted. Results show that the NRIS-H implementation is hindered by lack of political commitment and poor resource allocation. This has a negative impact on Roma’s entitlement to healthcare and on their participation in decision-making processes, jeopardising the elimination of the barriers that undermine their access to healthcare and potentially contributing to reproduce inequalities. These unintended effects point out the need to rethink Roma health governance by strengthening intersectional and intersectoral policies, enabling transformative Roma participation in policymaking and guaranteeing shared socio-political responsibility and accountability.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.02.009
  • Patient and public involvement in hospital policy-making: Identifying key
           elements for effective participation
    • Authors: S. Malfait; A. Van Hecke; G. De Bodt; N. Palsterman; K. Eeckloo
      Abstract: Publication date: Available online 2 March 2018
      Source:Health Policy
      Author(s): S. Malfait, A. Van Hecke, G. De Bodt, N. Palsterman, K. Eeckloo
      The involvement of patients and the public in healthcare decisions becomes increasingly important. Although patient involvement on the level of the individual patient-healthcare worker relationship is well studied, insight in the process of patient and public involvement on a more strategic level is limited. This study examines the involvement of patient and public (PPI) in decision-making concerning policy in six Flemish hospitals. The hospitals organized a stakeholder committee which advised the hospital on strategic policy planning. A three-phased mixed- methods study design with individual questionnaires (n = 69), observations (n = 10) and focus groups (n = 4) was used to analyze, summarize and integrate the findings. The results of this study indicate that: (1) PPI on hospital level should include the possibility to choose topics, like operational issues; (2) PPI-stakeholders should be able to have proper preparation; (3) PPI-stakeholders should be externally supported by a patient organization; (4) more autonomy should be provided for the stakeholder committee. Additionally, the study indicates that the influence of national legislation on stakeholder initiatives in different countries is limited. In combination with the growing importance of PPI and the fact that the recommendations presented are not claimed to be exhaustive, more transnational and conceptual research is needed in the future.

      PubDate: 2018-04-15T09:38:36Z
      DOI: 10.1016/j.healthpol.2018.02.007
  • Stakeholder views on the role of spiritual care in Australian hospitals:
           An exploratory study
    • Authors: Cheryl Holmes
      Abstract: Publication date: Available online 20 February 2018
      Source:Health Policy
      Author(s): Cheryl Holmes
      Research increasingly demonstrates the contribution of spiritual care to patient experience, wellbeing and health outcomes. Responsiveness to spiritual needs is recognised as a legitimate component of quality health care. Yet there is no consistent approach to the models and governance of spiritual care across hospitals in Australia. This is consistent with the situation in other developed countries where there is increased attention to identifying best practice models for spiritual care in health. This study explores the views of stakeholders in Australian hospitals to the role of spiritual care in hospitals. A self-completion questionnaire comprising open and closed questions was distributed using a snowball sampling process. Analysis of 477 complete questionnaires indicated high levels of agreement with ten policy statements and six policy objectives. Perceived barriers to spiritual care related to: terminology and roles, education and training, resources, and models of care. Responses identified the issues to inform a national policy agenda including attention to governance and policy structures and clear delineation of roles and scope of practice with aligned education and training models. The inclusion of spiritual care as a significant pathway for the provision of patient-centred care is noted. Further exploration of the contribution of spiritual care to wellbeing, health outcomes and patient experience is invited.

      PubDate: 2018-02-26T04:36:48Z
      DOI: 10.1016/j.healthpol.2018.02.003
  • Financial protection in Europe: a systematic review of the literature and
           mapping of data availability
    • Authors: Pooja Yerramilli; Óscar Fernández; Sarah Thomson
      Abstract: Publication date: Available online 19 February 2018
      Source:Health Policy
      Author(s): Pooja Yerramilli, Óscar Fernández, Sarah Thomson

      PubDate: 2018-02-26T04:36:48Z
      DOI: 10.1016/j.healthpol.2018.02.006
  • Health systems reforms in Singapore: A qualitative study of key
    • Authors: Suan Ee Ong; Shilpa Tyagi; Jane Mingjie Lim; Kee Seng Chia; Helena Legido-Quigley
      Abstract: Publication date: Available online 19 February 2018
      Source:Health Policy
      Author(s): Suan Ee Ong, Shilpa Tyagi, Jane Mingjie Lim, Kee Seng Chia, Helena Legido-Quigley
      In response to a growing chronic disease burden and ageing population, Singapore implemented Regional Health Systems (RHS) in 2008. In January 2017, the MOH announced that the six RHS clusters would be reorganised into three in 2018. This qualitative study sought to identify the health system challenges, opportunities, and ways forward for the implementation of the RHS. We conducted semi-structured interviews with 35 key informants from RHS clusters, government, academia, and private and voluntary sectors. Integration, innovation, and people-centeredness were identified as the key principles of the RHS. The RHS was described as an opportunity to holistically care for a person across the care continuum, address social determinants of health, develop new models of care, and work with social and community partners. Challenges to RHS implementation included difficulties aligning the goals, values, and priorities of multiple actors, the need for better integration across clusters, differing care capabilities and capacities across partners, healthcare financing structures that may not reflect RHS goals, scalability and evaluation of pilot programmes, and disease-centricity, provider-centricity, and medicalisation in health and healthcare. Suggested ways forward included building relationships between actors to facilitate integration; exploring innovative new models of care; clear long-term/scale-up plans for successful pilots; healthcare financing reforms to meet changing patient and population needs; and developing evaluation systems reflective of RHS principles and priorities.

      PubDate: 2018-02-26T04:36:48Z
      DOI: 10.1016/j.healthpol.2018.02.005
  • No-shows in appointment scheduling – a systematic literature review
    • Authors: Leila F. Dantas; Julia L. Fleck; Fernando L. Cyrino Oliveira; Silvio Hamacher
      Abstract: Publication date: Available online 15 February 2018
      Source:Health Policy
      Author(s): Leila F. Dantas, Julia L. Fleck, Fernando L. Cyrino Oliveira, Silvio Hamacher
      No-show appointments significantly impact the functioning of healthcare institutions, and much research has been performed to uncover and analyze the factors that influence no-show behavior. In spite of the growing body of literature on this issue, no synthesis of the state-of-the-art is presently available and no systematic literature review (SLR) exists that encompasses all medical specialties. This paper provides a SLR of no-shows in appointment scheduling in which the characteristics of existing studies are analyzed, results regarding which factors have a higher impact on missed appointment rates are synthetized, and comparisons with previous findings are performed. A total of 727 articles and review papers were retrieved from the Scopus database (which includes MEDLINE), 105 of which were selected for identification and analysis. The results indicate that the average no-show rate is of the order of 23%, being highest in the African continent (43.0%) and lowest in Oceania (13.2%). Our analysis also identified patient characteristics that were more frequently associated with no-show behavior: adults of younger age; lower socioeconomic status; place of residence is distant from the clinic; no private insurance. Furthermore, the most commonly reported significant determinants of no-show were high lead time and prior no-show history.

      PubDate: 2018-02-26T04:36:48Z
      DOI: 10.1016/j.healthpol.2018.02.002
  • Participants, Physicians or Programmes: Participants’ educational level
           and initiative in cancer screening
    • Authors: Barbara Willems; Piet Bracke
      Abstract: Publication date: Available online 12 February 2018
      Source:Health Policy
      Author(s): Barbara Willems, Piet Bracke
      This study is an in-depth examination of at whose initiative (participant, physician or screening programme) individuals participate in cervical, breast and colorectal cancer screening across the EU-28. Special attention is paid to (1) the association with educational attainment and (2) the country’s cancer screening strategy (organised, pilot/regional or opportunistic) for each type of cancer screened. Data were obtained from Eurobarometer 66.2 ‘Health in the European Union’ (2006). Final samples consisted of 10,186; 5443 and 9851 individuals for cervical, breast, and colorectal cancer, respectively. Multinomial logistic regressions were performed. Surprisingly, even in countries with organised screening programmes, participation in screenings for cervical, breast and colorectal cancer was most likely to be initiated by the general practitioner (GP) or the participant. In general, GPs were found to play a crucial role in making referrals to screenings, regardless of the country’s screening strategy. The results also revealed differences between educational groups with regard to their incentive to participate in cervical and breast cancer screening and, to a lesser extent, in colorectal cancer screening. People with high education are more likely to participate in cancer screening at their own initiative, while people with less education are more likely to participate at the initiative of a physician or a screening programme. Albeit, the results varied according to type of cancer screening and national screening strategy.

      PubDate: 2018-02-26T04:36:48Z
      DOI: 10.1016/j.healthpol.2018.02.001
  • Hospital centralization and performance in Denmark—Ten years on
    • Authors: Terkel Christiansen; Karsten Vrangbæk
      Abstract: Publication date: Available online 9 February 2018
      Source:Health Policy
      Author(s): Terkel Christiansen, Karsten Vrangbæk
      Denmark implemented a major reform of the administrative and political structure in 2007 when the previous 13 counties were merged into five new regions and the number of municipalities was reduced from 271 to 98. A main objective was to create administrative units that were large enough to support a hospital structure with few acute hospitals in each region and to centralize specialized care in fewer hospitals. This paper analyses the reorganization of the somatic hospital sector in Denmark since 2007, discusses the mechanisms behind the changes and analyses hospital performance after the reform. The reform focused on improving acute services and quality of care. The number of acute hospitals was reduced from about 40–21 hospitals with new joint acute facilities, which include emergency care wards. The restructuring and geographical placement of acute hospitals took place in a democratic process subject to central guidelines and requirements. Since the reform, hospital productivity has increased by more than 2 per cent per year and costs have been stable. Overall, indicators point to a successful reform. However, it has also been criticized that some people in remote areas feel “left behind” in the economic development and that hospital staff are under increased workload pressure. Concurrent with the centralization of hospitals municipalities strengthened their health service with an emphasis on prevention and health promotion.

      PubDate: 2018-02-26T04:36:48Z
      DOI: 10.1016/j.healthpol.2017.12.009
  • Reconciling a “pleasant exchange” with evidence of information bias: A
           three-country study on pharmaceutical sales visits in primary care
    • Authors: Ellen Reynolds; Line Guénette; Joel Lexchin; Alan Cassels; Michael S. Wilkes; Geneviève Durrieu; Marie-Dominique Beaulieu; Barbara Mintzes
      Abstract: Publication date: Available online 1 February 2018
      Source:Health Policy
      Author(s): Ellen Reynolds, Line Guénette, Joel Lexchin, Alan Cassels, Michael S. Wilkes, Geneviève Durrieu, Marie-Dominique Beaulieu, Barbara Mintzes
      Objectives To examine and compare the experiences and attitudes of primary care physicians in three different regulatory environments (United States, Canada, and France) towards interactions with pharmaceutical sales representatives, particularly their perspectives on safety information provision and self-reported influences on prescribing. Methods We recruited primary care physicians for 12 focus groups in Montreal, Sacramento, Toulouse and Vancouver. A thematic analysis of the interview data followed a five-stage framework analysis approach. Results Fifty-seven family physicians (19 women, 38 men) participated. Physicians expected a commercial bias and generally considered themselves to be immune from influence. They also appreciated the exchange and the information on new drugs. Across all sites, physicians expressed concern about missing harm information; however, attitudes to increased regulation of sales visits in France and the US were generally negative. A common solution to inadequate harm information was to seek further commercially sourced information. Physicians at all sites also expressed sensitivity to critiques from medical students and residents about promotional interactions. Conclusions Physicians have contradictory views on the inadequate harm information received from sales representatives, linked to their lack of awareness of the drugs’ safety profiles. Commonly used strategies to mitigate information bias are unlikely to be effective. Alternate information sources to inform prescribing decisions, and changes in the way that physicians and sales representatives interact are needed.

      PubDate: 2018-02-05T15:56:08Z
      DOI: 10.1016/j.healthpol.2018.01.010
  • The Canadian Cannabis Act legalizes and regulates recreational cannabis
           use in 2018
    • Authors: Chelsea Cox
      Abstract: Publication date: Available online 31 January 2018
      Source:Health Policy
      Author(s): Chelsea Cox
      Canada is on the cusp of an unprecedented change in its governmental approach to recreational cannabis consumption. By July of 2018 the country will legalize and regulate recreational cannabis use across the country via the implementation of the Cannabis Act, representing the second country in the world and the first in North America to do so. With almost half of Canadians having admitted to using the drug illegally, this change in policy has been long advocated. While medical cannabis has been legal since 2001 this represents the first time in recent history that recreational cannabis will be legal on a federal level. As the country moves away from criminal prohibition into a framework centered on harm minimization and public health and safety, the policy specifics are being worked out by a variety of stakeholders. With limited peer-reviewed research and similar regulatory schemes to shape the Cannabis Act off of, Canada is entering unchartered territory. As other countries around the world struggle with illegal cannabis consumption, the Canadian example and novel regulatory scheme could prove a useful guiding tool for future policy in other jurisdictions. The following paper discusses key areas to watch and a brief intro of how Canada got to where it is and the foundational need for a shift in policy.

      PubDate: 2018-02-05T15:56:08Z
      DOI: 10.1016/j.healthpol.2018.01.009
  • Extending’ euthanasia to those ‘tired of living’ in the Netherlands
           could jeopardize a well-functioning practice of physicians’ assessment
           of a patient's request for death
    • Authors: Barend W. Florijn
      Abstract: Publication date: Available online 31 January 2018
      Source:Health Policy
      Author(s): Barend W. Florijn
      The Dutch Euthanasia Act (EA) took effect in 2002 and regulates the ending of one’s life by a physician at the request of a patient who is suffering unbearably. According to the Dutch Supreme Court, unbearable suffering is a state for which the presence of a medical condition is a strict prerequisite. As a consequence, the Dutch EA has attributed the assessment of unbearable suffering to physicians who evaluate the presence of a medical classifiable disorder. Currently, a debate within the Netherlands questions whether older people, without a medical condition, who value their life as completed, should be granted euthanasia. To concede the autonomy of such a person, the Dutch government intends to create a separate legal framework that regulates this tired of living euthanasia request. This debate is crucial for policy-makers and an international audience because it discusses if a self-directed death of older people, should be implemented in (the current Dutch) euthanasia practice. However, this article argues that the current legal proposal that regulates the tired of living euthanasia request ignores crucial jurisprudence on physicians’ application of the unbearable suffering criterion in practice. Furthermore it points out that this proposal neglects physicians role in guaranteeing a euthanasia practice of due care and that its use of an ethic of absolute autonomy could jeopardize this well-established practice.

      PubDate: 2018-02-05T15:56:08Z
      DOI: 10.1016/j.healthpol.2018.01.007
  • Improving health care service provision by adapting to regional diversity:
           An efficiency analysis for the case of Germany
    • Authors: Helmut Herwartz; Katharina Schley
      Abstract: Publication date: Available online 12 January 2018
      Source:Health Policy
      Author(s): Helmut Herwartz, Katharina Schley
      The provision of health care in Germany exhibits sizeable geographic variation with a heterogeneous allocation of medical services in rural and urban areas. Furthermore, distinct utilisation patterns and access barriers due to the socio-economic environment might cause inefficiencies in the provision of health care services. Accordingly, an improved understanding of factors governing inefficiencies in health care provision is likely to benefit an efficient spatial allocation of health care infrastructure. We analyse how socio-economic factors influence the regional distribution of (in)efficiencies in the provision of health care services by means of a stochastic frontier analysis. Our results highlight that regional deprivation relates to inefficient provision of health care services. As a consequence, policies should also consider socio-economic conditions to improve the allocation of medical services and overall health.

      PubDate: 2018-02-05T15:56:08Z
      DOI: 10.1016/j.healthpol.2018.01.004
  • Ten Years after the Creation of the Portuguese National Network for
           Long-Term Care in 2006: Achievements and Challenges
    • Authors: Hugo Lopes; Céu Mateus; Cristina Hernández-Quevedo
      Abstract: Publication date: Available online 11 January 2018
      Source:Health Policy
      Author(s): Hugo Lopes, Céu Mateus, Cristina Hernández-Quevedo
      The Portuguese National Network for Long-term Integrated Care (Rede Nacional de Cuidados Continuados, RNCCI) was created in 2006 as a partnership between the Ministry of Health and the Ministry of Labour and Social Solidarity. The formal provision of care within the RNCCI is made up of non-profit and non-public institutions called Private Institutions of Social Solidarity, public institutions belonging to the National Health Service and for-profit-institutions. These institutions are organized by type of care in two main settings: (i) Home and Community-Based Services and (ii) four types of Nursing Homes to account for different care needs. This is the first study that assess the RNCCI reform in Portugal since 2006 and takes into account several core dimensions: coordination, ownership, organizational structure, financing system and main features, as well as the challenges ahead. Evidence suggests that despite providing universal access, Portuguese policy-makers face the following challenges: multiple sources of financing, the existence of several care settings and the sustained increase of admissions at the RNCCI, the dominance of institutionalization, the existence of waiting lists, regional asymmetries, the absence of a financing model based on dependence levels, or the difficulty to use the instrument of needs assessment for international comparison.

      PubDate: 2018-02-05T15:56:08Z
      DOI: 10.1016/j.healthpol.2018.01.001
  • Rationalizing the introduction and use of pharmaceutical products: The
           role of managed entry agreements in Central and Eastern European countries
    • Authors: Alexandru M. Rotar; Alin Preda; Olga Löblová; Vanesa Benkovic; Szymon Zawodnik; Laszlo Gulacsi; Maciej Niewada; Imre Boncz; Guenka Petrova; Maria Dimitrova; Niek Klazinga
      Abstract: Publication date: Available online 11 January 2018
      Source:Health Policy
      Author(s): Alexandru M. Rotar, Alin Preda, Olga Löblová, Vanesa Benkovic, Szymon Zawodnik, Laszlo Gulacsi, Maciej Niewada, Imre Boncz, Guenka Petrova, Maria Dimitrova, Niek Klazinga
      This paper aims to provide an overview of the rationalization strategies for the introduction and use of pharmaceuticals, focusing on the role of managed entry agreements (MEA) in Central and Eastern European (CEE) countries, namely Bulgaria, the Czech Republic, Croatia, Hungary, Poland and Romania. We developed a conceptual framework on MEAs that was used as the basis for a standardized assessment questionnaire sent to country experts to capture their perceptions on their countries’ rationalization strategies and MEAs. Our study shows that the main role of MEAs and other related policies embedded in the health care system is to limit the budget impact of drugs in all examined 6 countries. Uncertainty about outcomes and appropriate utilization seem to be of lower priority. Finance-based MEAs are used by all countries. Performance-based MEAs are scarce and used to a limited extent by Hungary and Poland. The overall transparency of the existence and details of MEAs is limited. Expansion of the use and increased transparency of MEAs is recommended. Still, the informational infrastructure and competencies in implementing MEA’s need to be developed further.

      PubDate: 2018-02-05T15:56:08Z
      DOI: 10.1016/j.healthpol.2018.01.006
  • Cognitive determinants of healthcare evaluations – A comparison of
           Eastern and Western European countries
    • Authors: Simone M. Schneider; Tamara Popic
      Abstract: Publication date: Available online 5 January 2018
      Source:Health Policy
      Author(s): Simone M. Schneider, Tamara Popic
      Knowing the public opinion of healthcare is essential when assessing healthcare system performance; but little research has focussed on the links between the public’s general attitude to the healthcare system and its perceptions and expectations of specific healthcare-related aspects. Using data from the fourth round of the European Social Survey 2008/09, we explore the cognitive determinants of global evaluations of the healthcare system in 12 Eastern and 16 Western European countries. We find that healthcare evaluations follow a coherent cognitive reasoning. They are associated with (i) perceptions of the performance of healthcare systems (i.e. efficiency, equality of treatment, health outcomes), (ii) expectations of the government’s role in providing healthcare, and (iii) reflections on demographic pressures (i.e. aging populations). Contrary to the general assumption that normative expectations are responsible for differences in healthcare evaluations between Eastern and Western Europe, our results suggest that regional differences are largely due to a more negative perception of the performance of healthcare systems within Eastern Europe. To enhance the public opinion of healthcare, policy makers should improve the efficiency of healthcare systems and take measures to assure equality in health treatment.

      PubDate: 2018-02-05T15:56:08Z
      DOI: 10.1016/j.healthpol.2017.12.012
  • The role of the 2011 patients' rights in cross-border health care
           directive in shaping seven national health systems: Looking beyond patient
    • Authors: Natasha Azzopardi-Muscat; Rita Baeten; Timo Clemens; Triin Habicht; Ilmo Keskimäki; Iwona Kowalska-Bobko; Anna Sagan; Ewout van Ginneken
      Abstract: Publication date: Available online 4 January 2018
      Source:Health Policy
      Author(s): Natasha Azzopardi-Muscat, Rita Baeten, Timo Clemens, Triin Habicht, Ilmo Keskimäki, Iwona Kowalska-Bobko, Anna Sagan, Ewout van Ginneken
      Reports on the implementation of the Directive on the application of Patients' Rights in Cross-border Healthcare indicate that it had little impact on the numbers of patients seeking care abroad. We set out to explore the effects of this directive on health systems in seven EU Member States. Key informants in Belgium, Estonia, Finland, Germany, Malta, Poland and The Netherlands filled out a structured questionnaire. Findings indicate that the impact of the directive varied between countries and was smaller in countries where a large degree of adaptation had already taken place in response to the European Court of Justice Rulings. The main reforms reported include a heightened emphasis on patient rights and the adoption of explicit benefits packages and tariffs. Countries may be facing increased pressure to treat patients within a medically justifiable time limit. The implementation of professional liability insurance, in countries where this did not previously exist, may also bring benefits for patients. Lowering of reimbursement tariffs to dissuade patients from seeking treatment abroad has been reported in Poland. The issue of discrimination against non-contracted domestic private providers in Estonia, Finland, Malta and The Netherlands remains largely unresolved. We conclude that evidence showing that patients using domestic health systems have actually benefitted from the directive remains scarce and further monitoring over a longer period of time is recommended.

      PubDate: 2018-02-05T15:56:08Z
      DOI: 10.1016/j.healthpol.2017.12.010
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