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  Subjects -> HEALTH AND SAFETY (Total: 1313 journals)
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    - HEALTH AND SAFETY (538 journals)
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HEALTH AND SAFETY (538 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: 10)
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: 11)
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: 36)
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: 32)
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: 11)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 26)
American Journal of Public Health     Full-text available via subscription   (Followers: 233)
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: 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: 6)
Behavioral Healthcare     Full-text available via subscription   (Followers: 6)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 9)
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: 8)
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)
Cambridge Quarterly of Healthcare Ethics     Hybrid Journal   (Followers: 11)
Canadian Family Physician     Partially Free   (Followers: 13)
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: 14)
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   (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: 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: 3)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 12)
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: 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: 19)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 3)
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: 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)
Global Mental Health     Open Access   (Followers: 5)
Global Security : Health, Science and Policy     Open Access  
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: 16)
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: 2)
Health Care Analysis     Hybrid Journal   (Followers: 14)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 16)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Notions     Open Access  
Health Policy     Hybrid Journal   (Followers: 41)
Health Policy and Technology     Hybrid Journal   (Followers: 3)
Health Professional Student Journal     Open Access   (Followers: 2)
Health Promotion International     Hybrid Journal   (Followers: 22)
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: 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: 42)
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: 11)
Healthcare     Open Access   (Followers: 2)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 9)
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: 35)
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)

        1 2 3 | Last

Journal Cover Health Policy
  [SJR: 1.182]   [H-I: 36]   [41 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0168-8510
   Published by Elsevier Homepage  [3177 journals]
  • Explaining regional variation in home care use by demand and supply
    • Authors: Olivier van Noort; Fredo Schotanus; Joris van de Klundert; Jan Telgen
      Pages: 140 - 146
      Abstract: Publication date: February 2018
      Source:Health Policy, Volume 122, Issue 2
      Author(s): Olivier van Noort, Fredo Schotanus, Joris van de Klundert, Jan Telgen
      In the Netherlands, home care services like district nursing and personal assistance are provided by private service provider organizations and covered by private health insurance companies which bear legal responsibility for purchasing these services. To improve value for money, their procurement increasingly replaces fee-for-service payments with population based budgets. Setting appropriate population budgets requires adaptation to the legitimate needs of the population, whereas historical costs are likely to be influenced by supply factors as well, not all of which are necessarily legitimate. Our purpose is to explain home care costs in terms of demand and supply factors. This allows for adjusting historical cost patterns when setting population based budgets. Using expenses claims of 60 Dutch municipalities, we analyze eight demand variables and five supply variables with a multiple regression model to explain variance in the number of clients per inhabitant, costs per client and costs per inhabitant. Our models explain 69% of variation in the number of clients per inhabitant, 28% of costs per client and 56% of costs per inhabitant using demand factors. Moreover, we find that supply factors explain an additional 17–23% of variation. Predictors of higher utilization are home care organizations that are integrated with intramural nursing homes, higher competition levels among home care organizations and the availability of complementary services.

      PubDate: 2018-02-05T15:56:08Z
      DOI: 10.1016/j.healthpol.2017.05.003
  • 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
  • Strategic Purchasing in Practice: Comparing Ten European Countries
    • Authors: Katarzyna Klasa; Scott Greer; Ewout van Ginneken
      Abstract: Publication date: Available online 5 February 2018
      Source:Health Policy
      Author(s): Katarzyna Klasa, Scott Greer, Ewout van Ginneken
      Strategic purchasing of health care services is widely recommended as a policy instrument. We conducted a review of literature of material drawn from the European Observatory on Health Systems and Policies Health Systems in Transition series, other European Observatory databases, and selected country-specific literature to augment the comparative analysis by providing the most recent healthcare trends in ten selected countries. There is little evidence of purchasing being strategic according to any of the established definitions. There is little or no literature suggesting that existing purchasing mechanisms in Europe deliver improved population health, citizen empowerment, stronger governance and stewardship, or develop purchaser organization and capacity. Strategic purchasing has not generally been implemented. Policymakers considering adopting strategic purchasing policies should be aware of this systemic implementation problem. Policymakers in systems with strategic purchasing built into policy should not assume that a purchasing system is strategic or that it is delivering any expected objectives. However, there are individual components of strategic purchasing that are worth pursuing and can provide benefits to health systems.

      PubDate: 2018-02-26T04:36:48Z
      DOI: 10.1016/j.healthpol.2018.01.014
  • Promoting health-enhancing physical activity in Europe: Current state of
           surveillance, policy development and implementation
    • Authors: João Breda; Jelena Jakovljevic; Giulia Rathmes; Romeu Mendes; Olivier Fontaine; Susanne Hollmann; Alfred Rütten; Peter Gelius; Sonja Kahlmeier; Gauden Galea
      Abstract: Publication date: Available online 3 February 2018
      Source:Health Policy
      Author(s): João Breda, Jelena Jakovljevic, Giulia Rathmes, Romeu Mendes, Olivier Fontaine, Susanne Hollmann, Alfred Rütten, Peter Gelius, Sonja Kahlmeier, Gauden Galea
      This study aims to present information on the surveillance, policy developments, and implementation of physical activity policies in the 28 European Union (EU) countries. Data was collected on the implementation of the EU Recommendation on health-enhancing physical activity (HEPA) across sectors. In line with the monitoring framework proposed in the Recommendation, a questionnaire was designed to capture information on 23 physical activity indicators. Of the 27 EU countries that responded to the survey, 22 have implemented actions on more than 10 indicators, four countries have implemented more than 20 indicators, and one country has fully addressed and implemented all of the 23 indicators of the monitoring framework. The data collected under this HEPA monitoring framework provided, for the first time, an overview of the implementation of HEPA-related policies and actions at the national level throughout the EU. Areas that need more investment are the “Senior Citizens” sector followed by the “Work Environment”, and the “Environment, Urban Planning, and Public Safety” sectors. This information also enabled comparison of the state of play of HEPA policy implementation between EU Member States and facilitated the exchange of good practices.

      PubDate: 2018-02-05T15:56:08Z
      DOI: 10.1016/j.healthpol.2018.01.015
  • 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
  • Variations in non-prescription drug consumption and expenditure:
           Determinants and policy implications
    • Authors: Monica Otto; Patrizio Armeni; Claudio Jommi
      Abstract: Publication date: Available online 31 January 2018
      Source:Health Policy
      Author(s): Monica Otto, Patrizio Armeni, Claudio Jommi
      This paper analyses the determinants of cross-regional variations in expenditure and consumption for non-prescription drugs using the Italian Health Care System as a case study. This research question has never been posed in other literature contributions. Per capita income, the incidence of elderly people, the presence of distribution points alternative to community pharmacies (para-pharmacies and drug corners in supermarkets), and the disease prevalence were included as possible explanatory variables. A trade-off between consumption of non-prescription and prescription-only drugs was also investigated. Correlation was tested through linear regression models with regional fixed-effects. Demand-driven variables, including the prevalence of the target diseases and income, were found to be more influential than supply-side variables, such as the presence of alternative distribution points. Hence, the consumption of non-prescription drugs appears to respond to needs and is not induced by the supply. The expected trade-off between consumption for prescription-only and non-prescription drugs was not empirically found: increasing the use of non-prescription drugs did not automatically imply savings on prescription-only drugs covered by third payers. Despite some caveats (the short period of time covered by the longitudinal data and some missing monthly data), the regression model revealed a high explanatory power of the variability and a strong predictive ability of future values.

      PubDate: 2018-02-05T15:56:08Z
      DOI: 10.1016/j.healthpol.2018.01.012
  • 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
  • Implementing the Medicines Reconciliation Tool in Practice: Challenges and
           Opportunities for Pharmacists in Kuwait
    • Authors: Maram G. Katoue; Jean Ker
      Abstract: Publication date: Available online 5 January 2018
      Source:Health Policy
      Author(s): Maram G. Katoue, Jean Ker
      Background Using the medicines reconciliation tool which involves preparing an updated list of the patient’s medications at each transition of care can significantly enhance patient safety. The pharmacist has been leading this process in western healthcare systems. Little is known about pharmacists’ role in medicines reconciliation in Middle Eastern Countries. Objectives To explore the implementation of medicines reconciliation in Kuwait hospitals, pharmacists’ role in this process and perceptions of the challenges in implementing it in their practice. Methods This was an exploratory descriptive study of medicines reconciliation practices at eleven secondary/tertiary hospitals in Kuwait. A mixed-method research design was used whereby 110 hospital pharmacists participated in 11 focus groups and completed self-administered surveys. Results Participants reported that medicines reconciliation is poorly applied in hospitals and that they had limited role in the process. The current medicines reconciliation policy does not assign any responsibilities for pharmacists in this process. The most significant barriers to applying medicines reconciliation by pharmacists were inadequate staff numbers, lack of time, difficult access to patient information, lack of policy to support pharmacist role and patients’ lack of knowledge about their medications. Conclusions Hospital pharmacists in Kuwait advocate implementing medicines reconciliation but report significant strategic/operational barriers to its application. Efforts are needed in policy reform and team training to enable pharmacists provide effective services including medicines reconciliation.

      PubDate: 2018-02-05T15:56:08Z
      DOI: 10.1016/j.healthpol.2017.12.011
  • 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
  • Multimorbidity care model: Recommendations from the consensus meeting of
           the Joint Action on Chronic Diseases and Promoting Healthy Ageing across
           the Life Cycle (JA-CHRODIS)
    • Authors: Katie Palmer; Alessandra Marengoni; Maria João Forjaz; Elena Jureviciene; Tiina Laatikainen; Federica Mammarella; Christiane Muth; Rokas Navickas; Alexandra Prados-Torres; Mieke Rijken; Ulrike Rothe; Laurène Souchet; Jose Valderas; Theodore Vontetsianos; Jelka Zaletel; Graziano Onder
      Pages: 4 - 11
      Abstract: Publication date: January 2018
      Source:Health Policy, Volume 122, Issue 1
      Author(s): Katie Palmer, Alessandra Marengoni, Maria João Forjaz, Elena Jureviciene, Tiina Laatikainen, Federica Mammarella, Christiane Muth, Rokas Navickas, Alexandra Prados-Torres, Mieke Rijken, Ulrike Rothe, Laurène Souchet, Jose Valderas, Theodore Vontetsianos, Jelka Zaletel, Graziano Onder
      Patients with multimorbidity have complex health needs but, due to the current traditional disease-oriented approach, they face a highly fragmented form of care that leads to inefficient, ineffective, and possibly harmful clinical interventions. There is limited evidence on available integrated and multidimensional care pathways for multimorbid patients. An expert consensus meeting was held to develop a framework for care of multimorbid patients that can be applied across Europe, within a project funded by the European Union; the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). The experts included a diverse group representing care providers and patients, and included general practitioners, family medicine physicians, neurologists, geriatricians, internists, cardiologists, endocrinologists, diabetologists, epidemiologists, psychologists, and representatives from patient organizations. Sixteen components across five domains were identified (Delivery of Care; Decision Support; Self Management Support; Information Systems and Technology; and Social and Community Resources). The description and aim of each component are described in these guidelines, along with a summary of key characteristics and relevance to multimorbid patients. Due to the lack of evidence-based recommendations specific to multimorbid patients, this care model needs to be assessed and validated in different European settings to examine specifically how multimorbid patients will benefit from this care model, and whether certain components have more importance than others.

      PubDate: 2017-12-27T12:44:40Z
      DOI: 10.1016/j.healthpol.2017.09.006
  • The SELFIE framework for integrated care for multi-morbidity: Development
           and description
    • Authors: Fenna R.M. Leijten; Verena Struckmann; Ewout van Ginneken; Thomas Czypionka; Markus Kraus; Miriam Reiss; Apostolos Tsiachristas; Melinde Boland; Antoinette de Bont; Roland Bal; Reinhard Busse; Maureen Rutten-van Mölken
      Pages: 12 - 22
      Abstract: Publication date: January 2018
      Source:Health Policy, Volume 122, Issue 1
      Author(s): Fenna R.M. Leijten, Verena Struckmann, Ewout van Ginneken, Thomas Czypionka, Markus Kraus, Miriam Reiss, Apostolos Tsiachristas, Melinde Boland, Antoinette de Bont, Roland Bal, Reinhard Busse, Maureen Rutten-van Mölken
      Background The rise of multi-morbidity constitutes a serious challenge in health and social care organisation that requires a shift from disease- towards person-centred integrated care. The aim of the current study was to develop a conceptual framework that can aid the development, implementation, description, and evaluation of integrated care programmes for multi-morbidity. Methods A scoping review and expert discussions were used to identify and structure concepts for integrated care for multi-morbidity. A search of scientific and grey literature was conducted. Discussion meetings were organised within the SELFIE research project with representatives of five stakeholder groups (5Ps): patients, partners, professionals, payers, and policy makers. Results In the scientific literature 11,641 publications were identified, 92 were included for data extraction. A draft framework was constructed that was adapted after discussion with SELFIE partners from 8 EU countries and 5P representatives. The core of the framework is the holistic understanding of the person with multi-morbidity in his or her environment. Around the core, concepts were grouped into adapted WHO components of health systems: service delivery, leadership & governance, workforce, financing, technologies & medical products, and information & research. Within each component micro, meso, and macro levels are distinguished. Conclusion The framework structures relevant concepts in integrated care for multi-morbidity and can be applied by different stakeholders to guide development, implementation, description, and evaluation.

      PubDate: 2017-12-27T12:44:40Z
      DOI: 10.1016/j.healthpol.2017.06.002
  • Relevant models and elements of integrated care for multi-morbidity:
           Results of a scoping review
    • Authors: Verena Struckmann; Fenna R.M. Leijten; Ewout van Ginneken; Markus Kraus; Miriam Reiss; Anne Spranger; Melinde R.S. Boland; Thomas Czypionka; Reinhard Busse; Maureen Rutten-van Mölken
      Pages: 23 - 35
      Abstract: Publication date: January 2018
      Source:Health Policy, Volume 122, Issue 1
      Author(s): Verena Struckmann, Fenna R.M. Leijten, Ewout van Ginneken, Markus Kraus, Miriam Reiss, Anne Spranger, Melinde R.S. Boland, Thomas Czypionka, Reinhard Busse, Maureen Rutten-van Mölken
      Background In order to provide adequate care for the growing group of persons with multi-morbidity, innovative integrated care programmes are appearing. The aims of the current scoping review were to i) identify relevant models and elements of integrated care for multi-morbidity and ii) to subsequently identify which of these models and elements are applied in integrated care programmes for multi-morbidity. Methods A scoping review was conducted in the following scientific databases: Cochrane, Embase, PubMed, PsycInfo, Scopus, Sociological s, Social Services s, and Web of Science. A search strategy encompassing a) models, elements and programmes, b) integrated care, and c) multi-morbidity was used to identify both models and elements (aim 1) and implemented programmes of integrated care for multi-morbidity (aim 2). Data extraction was done by two independent reviewers. Besides general information on publications (e.g. publication year, geographical region, study design, and target group), data was extracted on models and elements that publications refer to, as well as which models and elements are applied in recently implemented programmes in the EU and US. Results In the review 11,641 articles were identified. After title and abstract screening, 272 articles remained. Full text screening resulted in the inclusion of 92 articles on models and elements, and 50 articles on programmes, of which 16 were unique programmes in the EU (n =11) and US (n =5). Wagner’s Chronic Care Model (CCM) and the Guided Care Model (GCM) were most often referred to (CCM n =31; GCM n =6); the majority of the other models found were only referred to once (aim 1). Both the CCM and GCM focus on integrated care in general and do not explicitly focus on multi-morbidity. Identified elements of integrated care were clustered according to the WHO health system building blocks. Most elements pertained to ‘service delivery’. Across all components, the five elements referred to most often are person-centred care, holistic or needs assessment, integration and coordination of care services and/or professionals, collaboration, and self-management (aim 1). Most (n =10) of the 16 identified implemented programmes for multi-morbidity referred to the CCM (aim 2). Of all identified programmes, the elements most often included were self-management, comprehensive assessment, interdisciplinary care or collaboration, person-centred care and electronic information system (aim 2). Conclusion Most models and elements found in the literature focus on integrated care in general and do not explicitly focus on multi-morbidity. In line with this, most programmes identified in the literature build on the CCM. A comprehensive framework that better accounts for the complexities resulting from multi-morbidity is needed.

      PubDate: 2017-12-27T12:44:40Z
      DOI: 10.1016/j.healthpol.2017.08.008
  • Engaging nurses in smoking cessation: Challenges and opportunities in
    • Authors: Mimi Nichter; Aslı Çarkoğlu; Mark Nichter; Şeyda Özcan; M. Atilla Uysal
      Abstract: Publication date: Available online 20 December 2017
      Source:Health Policy
      Author(s): Mimi Nichter, Aslı Çarkoğlu, Mark Nichter, Şeyda Özcan, M. Atilla Uysal
      This paper discusses the training of nurses in smoking cessation as part of routine patient care in Turkey. Formative research was carried out prior to training to identify challenges faced by smokers when trying to quit. Site visits to government hospitals and cessation clinics were conducted to observe health care provider-patient interactions involving behavior change. Four culturally sensitive cessation training workshops for nurses (n = 54) were conducted in Istanbul. Following training, nurses were debriefed on their experiences delivering cessation advice. Challenges to cessation counseling included lack of time and incentives for nurse involvement; lack of skills to deliver information about the harm of smoking and benefits of quitting; the medicalization of cessation through the use of pharmaceuticals; and hospital policy which devalues time spent on cessation activities. The pay-for-performance model currently adopted in hospitals has de-incentivized doctor participation in cessation clinics. Nurses play an important role in smoking cessation in many countries. In Turkey, hospital policy will require change so that cessation counseling can become a routine part of nursing practice, incentives for providing cessation are put in place, and task sharing between nurses and doctors is clarified. Nurses and doctors need to receive training in both the systemic harms of smoking and cessation counseling skills. Opportunities, challenges and lessons learned are highlighted.

      PubDate: 2017-12-27T12:44:40Z
      DOI: 10.1016/j.healthpol.2017.12.007
  • 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
  • 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
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