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  Subjects -> HEALTH AND SAFETY (Total: 1288 journals)
    - CIVIL DEFENSE (18 journals)
    - DRUG ABUSE AND ALCOHOLISM (86 journals)
    - HEALTH AND SAFETY (520 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (377 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (105 journals)
    - PHYSICAL FITNESS AND HYGIENE (101 journals)
    - WOMEN'S HEALTH (81 journals)

HEALTH AND SAFETY (520 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
A Life in the Day     Hybrid Journal   (Followers: 9)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access  
Adultspan Journal     Hybrid Journal  
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 22)
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: 5)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 3)
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: 12)
American Journal of Health Education     Hybrid Journal   (Followers: 28)
American Journal of Health Promotion     Hybrid Journal   (Followers: 23)
American Journal of Health Studies     Full-text available via subscription   (Followers: 10)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 21)
American Journal of Public Health     Full-text available via subscription   (Followers: 189)
American Journal of Public Health Research     Open Access   (Followers: 28)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 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: 1)
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: 2)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Association of Schools of Allied Health Professions     Full-text available via subscription   (Followers: 6)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 2)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 4)
Behavioral Healthcare     Full-text available via subscription   (Followers: 6)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 7)
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: 18)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 7)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 16)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 12)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 11)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
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: 12)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
Central European Journal of Public Health     Full-text available via subscription   (Followers: 4)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 11)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access  
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 2)
Conflict and Health     Open Access   (Followers: 8)
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 1)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription  
Duazary     Open Access   (Followers: 1)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 13)
East African Journal of Public Health     Full-text available via subscription   (Followers: 3)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 16)
EcoHealth     Hybrid Journal   (Followers: 3)
Education for Health     Open Access   (Followers: 5)
electronic Journal of Health Informatics     Open Access   (Followers: 4)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 5)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access  
Environmental Sciences Europe     Open Access   (Followers: 1)
Epidemics     Open Access   (Followers: 4)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 4)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 19)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 1)
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: 9)
Evidence-based Medicine & Public Health     Open Access   (Followers: 5)
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: 5)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 11)
Frontiers in Public Health     Open Access   (Followers: 7)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 11)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 5)
Global Health Promotion     Hybrid Journal   (Followers: 16)
Global Journal of Health Science     Open Access   (Followers: 9)
Global Journal of Public Health     Open Access   (Followers: 12)
Global Medical & Health Communication     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 3)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 15)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 7)
Health and Human Rights     Free   (Followers: 8)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 7)
Health and Social Work     Hybrid Journal   (Followers: 48)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 14)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 12)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Policy     Hybrid Journal   (Followers: 35)
Health Policy and Technology     Hybrid Journal   (Followers: 1)
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 21)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 10)
Health Promotion Practice     Hybrid Journal   (Followers: 15)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 46)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 39)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 10)
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: 2)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 11)
Health, Risk & Society     Hybrid Journal   (Followers: 11)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 10)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 5)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 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: 6)
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: 33)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 2)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 7)
International Journal of Circumpolar Health     Open Access   (Followers: 1)
International Journal of Community Medicine and Public Health     Open Access   (Followers: 5)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 20)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 16)
International Journal of Health & Allied Sciences     Open Access   (Followers: 3)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 9)
International Journal of Health Geographics     Open Access   (Followers: 6)
International Journal of Health Policy and Management     Open Access   (Followers: 3)
International Journal of Health Professions     Open Access   (Followers: 2)
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 13)

        1 2 3 | Last

Journal Cover Health Policy
  [SJR: 1.182]   [H-I: 36]   [35 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0168-8510
   Published by Elsevier Homepage  [3044 journals]
  • Effects of EU harmonization policies on national public supervision of
           clinical trials: A dynamic cycle of institutional change and institutional
           work
    • Authors: Jacqueline C.F. van Oijen; Kor J. Grit; Hester M. van de Bovenkamp; Roland A. Bal
      Pages: 971 - 977
      Abstract: Publication date: September 2017
      Source:Health Policy, Volume 121, Issue 9
      Author(s): Jacqueline C.F. van Oijen, Kor J. Grit, Hester M. van de Bovenkamp, Roland A. Bal
      Background The EU Clinical Trials Directive (EUCTD) and the EU Clinical Trials Regulation aim to harmonize good clinical practice (GCP) of clinical trials across Member States. Using the Netherlands as a case study, this paper analyzes how endeavours to implement the EUCTD set in motion a dynamic process of institutional change and institutional work. This process lead to substantial differences between policy and actual practice; therefore, it is important to learn more about the implementation of harmonization policies. Methods Relevant documents, such as legal texts and previous research, were analyzed. Interviews were conducted with stakeholders in clinical trials and inspectors from (inter)national supervisory bodies (n=33), and Dutch Health Care Inspectorate inspections were observed (n=4). Results Dutch legislators’ efforts to implement the EUCTD created a new level of governance in an already multilevel legislative framework. Institutional layering caused a complex and fragmented organizational structure in public supervision, leading to difficulties in achieving GCP. This instigated institutional work by actors, which set in motion further incremental institutional change, principally drift and conversion. Conclusions Harmonization processes can create dynamic cycles between institutional change and institutional work, leading to significant divergence from the intended effects of legislation. If legislation intended to strengthen harmonization is not carefully implemented, it can become counterproductive to its aims.

      PubDate: 2017-09-12T11:32:12Z
      DOI: 10.1016/j.healthpol.2017.06.008
       
  • Social preferences for prioritizing the treatment of severely ill
           patients: The relevance of severity, expected benefit, past health and
           lifetime health
    • Authors: John McKie; Jeff Richardson
      Pages: 913 - 922
      Abstract: Publication date: August 2017
      Source:Health Policy, Volume 121, Issue 8
      Author(s): John McKie, Jeff Richardson
      The study examined the preferences of a sample of the Australian public and health professionals regarding the relative importance of four different criteria for prioritizing between patients: the severity of the condition, the size of the benefit from the intervention, past health losses and expected lifetime health. A discussion-group methodology was adopted to elicit social preferences. This allowed participants time to consider all of the alternatives fully, to seek clarification of the task, and to engage in open debate about the issues raised. Participants traded-off cost-effectiveness for priority to the more severely ill. They placed less importance on past health and the lifetime allocation of health in deciding priority for treatment, and more importance on improving the condition of those who will be left more severely ill or disabled in the absence of treatment. The results pose a challenge to studies reporting support for the “fair innings argument”. They also support the Norwegian government’s decision not to pursue a life-time health loss criterion as recommended by the Norheim Commission. The study question is important given current debate both in the health economics literature and at the policy level in several jurisdictions

      PubDate: 2017-08-31T11:22:15Z
      DOI: 10.1016/j.healthpol.2017.05.010
       
  • The ageing society and emergency hospital admissions
    • Authors: Raphael Wittenberg; Luke Sharpin; Barry McCormick; Jeremy Hurst
      Pages: 923 - 928
      Abstract: Publication date: August 2017
      Source:Health Policy, Volume 121, Issue 8
      Author(s): Raphael Wittenberg, Luke Sharpin, Barry McCormick, Jeremy Hurst
      There is strong policy interest, in England as elsewhere, in slowing the growth in emergency hospital admissions, which for older people increased by 3.3% annually between 2001/2 and 2012/3. Resource constrains have increased the importance of understanding rising emergency admissions, which in policy discourse is often explained by population aging. This study examines how far the rise in emergency admissions of people over 65 was due to population ageing, how far to the changing likelihood of entering hospital at each age, and how far to other factors which might be more amenable to policy measures. It shows that: admission rates rose with age from age 40 upward but each successive birth cohort experienced lower emergency admission rates after standardising for age and other effects. This downward cohort effect largely offset the consequences of an older and larger population aged over 65. Other factors which could explain increasing admissions, such as new technologies or rising expectations, appear more important than the changing size and age structure of the population as drivers of rising emergency admissions in old age. These findings suggest that stemming the rate of increase in emergency admissions of older people may be feasible, if challenging, despite population ageing.

      PubDate: 2017-08-31T11:22:15Z
      DOI: 10.1016/j.healthpol.2017.05.007
       
  • Processes and experiences of Portugal’s international recruitment scheme
           of Colombian physicians: Did it work'
    • Authors: Erika Masanet
      Pages: 929 - 935
      Abstract: Publication date: August 2017
      Source:Health Policy, Volume 121, Issue 8
      Author(s): Erika Masanet
      The Portuguese Ministry of Health performed five international recruitment rounds of Latin American physicians due to the need for physicians in certain geographic areas of the country and in some specialties, as a temporary solution to shortages. Among these recruitments is that of Colombian physicians in 2011 that was the largest of the five groups. This paper presents an evaluation of the international recruitment procedure of Colombian physicians based on the criteria of procedural outcomes and health system outcomes. The methodology used is qualitative, based on semi-structured interviews with key informants and Colombian physicians recruited in Portugal and also on documentary analysis of secondary sources. International recruitment of Colombian physicians coincided with a period of political change and severe economic crisis in Portugal that caused some problems in the course of this recruitment, mainly family reunification in the later group of Colombian physicians and non-compliance of the salary originally agreed upon. Furthermore, due to the continuous resignations of Colombian physicians throughout the 3-year contract, procedural outcomes and health system outcomes of this international recruitment were not fulfilled and therefore the expected results to meet the temporary needs for medical personnel in some areas of the country were not accomplished.

      PubDate: 2017-08-31T11:22:15Z
      DOI: 10.1016/j.healthpol.2017.05.004
       
  • 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
      Abstract: Publication date: Available online 14 September 2017
      Source:Health Policy
      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 Commission; 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: 2017-09-18T11:37:53Z
      DOI: 10.1016/j.healthpol.2017.09.006
       
  • An exploration of person-centred concepts in human services: A thematic
           analysis of the literature
    • Authors: Rebecca A. Waters; Angus Buchanan
      Abstract: Publication date: Available online 8 September 2017
      Source:Health Policy
      Author(s): Rebecca A. Waters, Angus Buchanan
      Being ‘person-centred’ in the delivery of health and human services has become synonymous with quality care, and it is a core feature of policy reform in Australia and other Western countries. This research aimed to identify the uses, definitions and characteristics of the term ‘person-centred’ in the ageing, mental health and disability literature. A thematic analysis identified seven common core themes of person-centredness: honouring the person, being in relationship, facilitating participation and engagement, social inclusion/citizenship, experiencing compassionate love, being strengths/capacity focussed, and organisational characteristics. These suggest a set of higher-order experiences for people that are translated differently in different human services. There is no common definition of what it means to be person-centred, despite being a core feature of contemporary health and human service policy, and this suggests that its inclusion facilitates further misunderstanding and misinterpretation. A common understanding and policy conceptualisation of person-centredness is likely to support quality outcomes in service delivery especially where organisations work across human service groups. Further research into the application and service expressions of being ‘person-centred’ in context is necessary.

      PubDate: 2017-09-12T11:32:12Z
      DOI: 10.1016/j.healthpol.2017.09.003
       
  • Reforming voluntary drug insurance in Russian healthcare: does social
           solidarity matter'
    • Authors: Christopher J Gerry; Maria Kaneva; Liudmila Zasimova
      Abstract: Publication date: Available online 8 September 2017
      Source:Health Policy
      Author(s): Christopher J Gerry, Maria Kaneva, Liudmila Zasimova
      With low take-up of both private health insurance and the existing public drug reimbursement scheme, it is thought that less than 5% of the Russian population have access to free outpatient drug treatment. This represents a major policy challenge for a country grappling with reforms of its healthcare system and experiencing low or no economic growth and significant associated reductions in spending on social services. In this paper, we draw on data from a 2011 Levada-Center survey to examine the attitudes and social solidarity of the Russian population towards drug policies in general and towards the introduction of a proposed voluntary drug insurance system in particular. In addition to being among the first to explore these important questions in the post-Communist setting, we make three important contributions to the emerging policy debates. First, we find that, if introduced immediately and without careful planning and preparation, Russia’s voluntary drug insurance scheme is likely to collapse financially due to the over-representation of high-risk unhealthy individuals opting in to the scheme. Second, the negative attitude of higher income groups towards the redistribution of wealth to the poor may further impede government efforts to introduce voluntary drug insurance. Finally, we argue that Russia currently lacks the breadth and depth of social solidarity necessary for implementing this form of health financing.

      PubDate: 2017-09-12T11:32:12Z
      DOI: 10.1016/j.healthpol.2017.09.001
       
  • General practitioners' preferences with regard to colorectal cancer
           screening organisation Colon cancer screening medico-legal aspects
    • Authors: Frédérique Papin-Lefebvre; Elodie Guillaume; Grégoire Moutel; Guy Launoy; Célia Berchi
      Abstract: Publication date: Available online 6 September 2017
      Source:Health Policy
      Author(s): Frédérique Papin-Lefebvre, Elodie Guillaume, Grégoire Moutel, Guy Launoy, Célia Berchi
      Objective French health authorities put general practitioners at the heart of the colorectal cancer screening. This position raises organisational issues and poses medico-legal problems for the professionals and institutions involved in these campaigns, related to the key concepts of medical decisions and suitability of standards. The objective of our study is to reveal the preferences of general practitioners related to colorectal cancer screening organisation with regard to the medico-legal risk Methods A discrete choice questionnaire presenting hypothetical screening scenarios was mailed to 2114 physicians from 20 French different areas. The preferences of 358 general practitioners were analysed using logistic regression models. Results The factors that have significant impact on the preferences of general practitioners are the capacity of the primary care professional in the procedure, the manner in which pre-screening information is given to patients, the manner in which screening results are given to patients, the number of reminders sent to patients who test positive and who do not undergo a colonoscopy and the remuneration of the attending physician. Conclusions Our results reveals that current colorectal cancer screening organisation is not adapted to general practitioners preferences. This work offers the public authorities avenues for reflection on possible developments in order to optimize the involvement of general practitioners in the promotion of cancer screening programme in France.

      PubDate: 2017-09-06T11:27:22Z
      DOI: 10.1016/j.healthpol.2017.08.013
       
  • Self-help organisations as patient representatives in health care and
           policy decision-making
    • Authors: Daniela Rojatz; Rudolf Forster
      Abstract: Publication date: Available online 2 September 2017
      Source:Health Policy
      Author(s): Daniela Rojatz, Rudolf Forster
      A crucial question about participation is who is legitimised, willing and capable of representing particular collectives. Social insurance health care systems tend to focus on representation by patient organisations. Self-help organisations (SHOs), as one type of ‘health consumer and patient organisation' often take over this role. Research findings indicate that participation by SHOs is accompanied by high expectations, but also by concerns about the risks of instrumental abuse, overload and professionalisation. However, there is a dearth of in-depth knowledge about both potential and risks of participating for the SHO. To tackle this research gap, a qualitative study design was used to investigate fifteen SHOs in Austria. Data were generated by expert interviews with SHO representatives and documentary analysis of SHO websites. Content analysis was applied. SHOs in Austria advocate for patients' interests, participate in invited spaces and have various forms of cooperative relations with the health care system. Thereby, they draw on the experiential knowledge of their members without, however, systematising it. Experiences with professionalisation and instrumental use are ambiguous, whereas overload is prevalent. SHOs need resources for reflection in order to define their position visà- vis the health system and to realise their potential as patient representatives. Deepening co-operation with the health care system might lead to new participatory practices acknowledging differences in culture and the resources of both sides.

      PubDate: 2017-09-06T11:27:22Z
      DOI: 10.1016/j.healthpol.2017.08.012
       
  • PANDEMIC LEGISLATION IN THE EUROPEAN UNION: FIT FOR PURPOSE' THE NEED
           FOR A SYSTEMATIC COMPARISON OF NATIONAL LAWS
    • Authors: Elizabeth M. Speakman; Scott Burris; Richard Coker
      Abstract: Publication date: Available online 1 September 2017
      Source:Health Policy
      Author(s): Elizabeth M. Speakman, Scott Burris, Richard Coker
      Sound governance is central to effective pandemic management. Key international legal instruments governing pandemic management in the European Union (EU): the International Health Regulations (2005) and Decision 1082/13 require EU Member States to develop national plans and invite them to establish national legal frameworks to support compliance with this international legislation. Although Member States may design the legal framework as they choose, the strongest instrument of pandemic governance is national legislation.

      PubDate: 2017-09-06T11:27:22Z
      DOI: 10.1016/j.healthpol.2017.08.009
       
  • Shelter from the Storm: Roles, responsibilities, and challenges in United
           States housing policy governance
    • Authors: Charley Willison
      Abstract: Publication date: Available online 17 August 2017
      Source:Health Policy
      Author(s): Charley Willison
      Housing is a critical social determinant of health. Housing policy not only affects health by improving housing quality, affordability, and insecurity; housing policy affects health upstream through the politics that shape housing policy design, implementation, and management. These politics, or governance strategies, determine the successes or failures of housing policy programs. This paper is an overview of challenges in housing policy governance in the United States. I examine the important relationship between housing and health, and emphasize why studying housing policy governance matters. I then present three cases of housing governance challenges in the United States, from each pathway by which housing affects health - housing quality, affordability, and insecurity. Each case corresponds to an arm of the TAPIC framework for evaluating governance (Krieger and Higgins) [1], to assess mechanisms of housing governance in each case. While housing governance has come a long way over the past century, political decentralization and the expansion of the submerged state have increased the number of political actors and policy conflict in many areas. This creates inherent challenges for improving accountability, transparency, and policy capacity. In many instances, too, reduced government accountability and transparency increases the risk of harm to the public and lessens governmental integrity.

      PubDate: 2017-08-31T11:22:15Z
      DOI: 10.1016/j.healthpol.2017.08.002
       
  • Insurees’ preferences in hospital choice—A population-based
           study
    • Authors: Johannes Schuldt; Anna Doktor; Marcel Lichters; Bodo Vogt; Bernt-Peter Robra
      Abstract: Publication date: Available online 10 August 2017
      Source:Health Policy
      Author(s): Johannes Schuldt, Anna Doktor, Marcel Lichters, Bodo Vogt, Bernt-Peter Robra
      In Germany, the patient himself makes the choice for or against a health service provider. Hospital comparison websites offer him possibilities to inform himself before choosing. However, it remains unclear, how health care consumers use those websites, and there is little information about how preferences in hospital choice differ interpersonally. We conducted a Discrete-Choice-Experiment (DCE) on hospital choice with 1500 randomly selected participants (age 40–70) in three different German cities selecting four attributes for hospital vignettes. The analysis of the study draws on multilevel mixed effects logit regression analyses with the dependent variables: “chance to select a hospital” and “choice confidence”. Subsequently, we performed a Latent-Class-Analysis to uncover consumer segments with distinct preferences. 590 of the questionnaires were evaluable. All four attributes of the hospital vignettes have a significant impact on hospital choice. The attribute “complication rate” exerts the highest impact on consumers’ decisions and reported choice confidence. Latent-Class-Analysis results in one dominant consumer segment that considered the complication rate the most important decision criterion. Using DCE, we were able to show that the complication rate is an important trusted criterion in hospital choice to a large group of consumers. Our study supports current governmental efforts in Germany to concentrate the provision of specialized health care services. We suggest further national and cross-national research on the topic.

      PubDate: 2017-08-31T11:22:15Z
      DOI: 10.1016/j.healthpol.2017.08.004
       
  • Inequalities in cervical cancer screening utilisation and results: A
           comparison between Italian natives and immigrants from disadvantaged
           countries
    • Authors: Federica Gallo; Adele Caprioglio; Roberta Castagno; Guglielmo Ronco; Nereo Segnan; Livia Giordano
      Abstract: Publication date: Available online 10 August 2017
      Source:Health Policy
      Author(s): Federica Gallo, Adele Caprioglio, Roberta Castagno, Guglielmo Ronco, Nereo Segnan, Livia Giordano
      Cervical cancer screening underutilisation is documented among immigrants from poor countries and it is associated to an augmented risk for severe lesions. In a cohort of 1,410,364 Italian women and 200,491 immigrants from poor countries differences in screening participation and results were investigated. Participation rate was lower for immigrants than for Italians: 43.98% versus 48.59% (chi(1): p<0.001). This gap increased with age (ptrend<0.0001). Some socio-demographic factors negatively influenced immigrants' participation. Illiteracy (OR=0.75) versus secondary school, being single (OR=0.71) versus attached, first screens (OR=0.67) versus subsequent ones. Although the interaction between educational and professional levels showed that graduated immigrant women conducting an intellectual job have a higher inclination towards screening than their Italian peers (OR=1.43 vs OR=1.04). The Standardised Detection Ratio (SDR) suggested a frequency of severe lesions nearly double among immigrants in first screens (SDR=1.94; 95% CI: 1.82–2.08) and even higher (SDR=2.53; 95% CI: 2.35–2.73) for Central/Eastern Europeans. Multi-component interventions involving both patients and providers offer the greatest potential to increase cervical cancer screening uptake within foreign-born populations. So immigrant-specific interventions are needed for some immigrant groups, like Central/Eastern Europeans who are at higher risk of cervical lesions and, together with Asians and Africans, showed a poor attitude towards cancer prevention.

      PubDate: 2017-08-31T11:22:15Z
      DOI: 10.1016/j.healthpol.2017.08.005
       
  • Single-entry models (SEMs) for scheduled services: Towards a roadmap for
           the implementation of recommended practices
    • Authors: Elena Lopatina; Zaheed Damani; Eric Bohm; Tom W. Noseworthy; Barbara Conner-Spady; Gail MacKean; Chris S. Simpson; Deborah A. Marshall
      Abstract: Publication date: Available online 9 August 2017
      Source:Health Policy
      Author(s): Elena Lopatina, Zaheed Damani, Eric Bohm, Tom W. Noseworthy, Barbara Conner-Spady, Gail MacKean, Chris S. Simpson, Deborah A. Marshall
      Background Long waiting times for elective services continue to be a challenging issue. Single-entry models (SEMs) are used to increase access to and flow through the healthcare system. This paper provides a roadmap for healthcare decision-makers, managers, physicians, and researchers to guide implementation and management of successful and sustainable SEMs. Methods The roadmap was informed by an inductive qualitative synthesis of the findings from a deliberative process (a symposium on SEMs, with clinicians, researchers, senior policy-makers, healthcare managers, and patient representatives) and focus groups with the symposium participants. Results SEMs are a promising strategy to improve the management of referrals and represent one approach to reduce waiting times. The SEMs roadmap outlines current knowledge about SEMs and critical success factors for SEMs’ implementation and management. Conclusions This SEM roadmap is intended to help clinicians, decision-makers, managers, and researchers interested in developing new or strengthening existing SEMs. We consider this roadmap to be a living document that will continue to evolve as we learn more about implementing and managing sustainable SEMs.

      PubDate: 2017-08-31T11:22:15Z
      DOI: 10.1016/j.healthpol.2017.08.001
       
  • Time for a Change in How New Antibiotics are Reimbursed: Development of an
           Insurance Framework for Funding New Antibiotics based on a Policy of Risk
           Mitigation
    • Authors: Adrian Towse; Christopher K. Hoyle; Jonathan Goodall; Mark Hirsch; Jorge Mestre-Ferrandiz; John H. Rex
      Abstract: Publication date: Available online 5 August 2017
      Source:Health Policy
      Author(s): Adrian Towse, Christopher K. Hoyle, Jonathan Goodall, Mark Hirsch, Jorge Mestre-Ferrandiz, John H. Rex
      Healthcare systems depend on the availability of new antibiotics. However, there is a lack of treatments for infections caused by multidrug resistant (MDR) pathogens and a weak development pipeline of new therapies. One core challenge to the development of new antibiotics targeting MDR pathogens is that expected revenues are insufficient to drive long-term investment. In the USA and Europe, financial incentives have focussed on supporting R&D, reducing regulatory burden, and extending market exclusivity. Using resistance data to estimate global revenues, we demonstrate that the combined effects of these incentives are unlikely to rekindle investment in antibiotics. We analyse two supplemental approaches: a commercial incentive (a premium price model) and a new business model (an insurance model). A premium price model is familiar and readily implemented but the required price and local budget impact is highly uncertain and sensitive to cross-sectional and longitudinal variation in prevalence of antibiotic resistance. An insurance model delivering risk mitigation for payers, providers and manufacturers would provide an incentive to drive investment in the development of new antibiotics while also facilitating antibiotic conservation. We suggest significant efforts should be made to test the insurance model as one route to stimulate investment in novel antibiotics.

      PubDate: 2017-08-31T11:22:15Z
      DOI: 10.1016/j.healthpol.2017.07.011
       
  • Synthetic biology regulation and governance: Lessons from TAPIC for the
           United States, European Union, and Singapore
    • Authors: Benjamin D. Trump
      Abstract: Publication date: Available online 2 August 2017
      Source:Health Policy
      Author(s): Benjamin D. Trump
      Synthetic biology is an emerging technology with potential benefits to various fields, yet also contains potential risks to human and environmental health. The field remains in an emerging state with limited quantitative guidance and a small but growing population of international researchers that conduct work within this field. Given the uncertain nature of this technology, an adaptive and anticipatory governance framework may be necessary to balance the potential benefits that may accrue from the technology's continued research alongside a desire to reduce or eliminate potential risks that may arise. However, such developments must account for the unique political and institutional factors that form a government's risk culture - something that can facilitate or impede the development of adaptive synthetic biology governance moving forward. The TAPIC framework helps illustrate those factors that are essential to develop good governance for emerging technologies like synthetic biology. Specifically, an application of TAPIC to synthetic biology governance indicates that the factors of accountability, participation, and integrity must be bolstered to improve technology governance in governments like with the United States, European Union, and Singapore.

      PubDate: 2017-08-31T11:22:15Z
      DOI: 10.1016/j.healthpol.2017.07.010
       
  • The governance of integrated health and social care in England since 2010:
           great expectations not met once again'
    • Authors: Mark Exworthy; Martin Powell; Jon Glasby
      Abstract: Publication date: Available online 2 August 2017
      Source:Health Policy
      Author(s): Mark Exworthy, Martin Powell, Jon Glasby
      Integrating health and social care has long been a goal of policy-makers and practitioners. Yet, this aim has remained elusive, partly due to conflicting definitions and a weak evidence base. As part of a special edition exploring the use of the TAPIC (transparency, accountability, participation, integrity and capability) framework in different national contexts and inter-agency settings, this article examines the governance of integrated care in England since 2010, focusing on the extent to which thesefive governance attributes are applicable to integrated care in England. The plethora of English policy initiatives on integrated care (such as the ‘Better Care Fund’, personal health budgets, and ‘Sustainability and Transformation Plans’) mostly shows signs of continuity over time although the barriers to integrated care often persist. The article concludes that the contribution of integrated care to improved outcomes remains unclear and yet it remains a popular policy goal. Whilst some elements of the TAPIC framework fit less well than others to the case of integrated care, the case of integrated care can be better understood and explained through this lens.

      PubDate: 2017-08-31T11:22:15Z
      DOI: 10.1016/j.healthpol.2017.07.009
       
  • The impact of health expenditure on the number of chronic diseases
    • Authors: Leonardo Becchetti; Pierluigi Conzo; Francesco Salustri
      Abstract: Publication date: Available online 28 July 2017
      Source:Health Policy
      Author(s): Leonardo Becchetti, Pierluigi Conzo, Francesco Salustri
      We investigate the impact of health expenditure on health outcomes on a large sample of Europeans aged above 50 using individual and regional level data. We find a negative and significant effect of lagged health expenditure on subsequent changes in the number of chronic diseases. This effect varies according to age, health behavior, gender, income, and education. Our empirical findings are confirmed also when health expenditure is instrumented with parliament political composition.

      PubDate: 2017-08-31T11:22:15Z
      DOI: 10.1016/j.healthpol.2017.07.008
       
  • The impact of the mass media on obstetricians’ behavior in Norway
    • Authors: Jostein Grytten; Irene Skau; Rune Sørensen
      Abstract: Publication date: Available online 26 July 2017
      Source:Health Policy
      Author(s): Jostein Grytten, Irene Skau, Rune Sørensen
      Little is known about how physicians and hospitals respond to the risk of being negatively exposed in the mass media. We assume that newspapers will cover events more closely in the areas where they have most of their circulation. Within such areas the likelihood of negative publicity increases. The research question is whether obstetricians respond to negative newspaper coverage by choosing the least risky method of delivery, i.e. Caesarean section. This was tested on a large set of data from the Medical Birth Registry of Norway for the period 2000-2011. The Registry contains detailed medical information about all deliveries, for both the mother and the infant. This set of data was merged with a set of data that contained information about newspaper coverage for the municipalities in which all hospitals were located. Altogether, more than 620 000 deliveries in 46 municipalities were included in the study. The data were analyzed using a hospital fixed effects regression. The main result was that newspaper coverage had a significant positive effect on the probability of having a Caesarean section. Several supplementary analyses supported the main finding. Altogether, our results indicate that obstetricians are sensitive to the risk of being exposed in the mass media. This is likely to be because obstetricians care about their reputation.

      PubDate: 2017-07-27T14:22:17Z
      DOI: 10.1016/j.healthpol.2017.07.007
       
  • Health Policy in Times of Austerity—A Conceptual Framework for
           Evaluating Effects of Policy on Efficiency and Equity Illustrated with
           Examples from Europe since 2008
    • Authors: Martin Wenzl; Huseyin Naci; Elias Mossialos
      Abstract: Publication date: Available online 19 July 2017
      Source:Health Policy
      Author(s): Martin Wenzl, Huseyin Naci, Elias Mossialos
      The objective of this paper is to provide a framework for evaluation of changes in health policy against overarching health system goals. We propose a categorisation of policies into seven distinct health system domains. We then develop existing analytical concepts of insurance coverage and cost-effectiveness further to evaluate the effects of policies in each domain on equity and efficiency. The framework is illustrated with likely effects of policy changes implemented in a sample of European countries since 2008. Our illustrative analysis suggests that cost containment has been the main focus and that countries have implemented a mix of measures that are efficient or efficiency neutral. Similarly, policies are likely to have mixed effects on equity. Additional user charges were a common theme but these were frequently accompanied by additional exemptions, making their likely effects on equity difficult to evaluate. We provide a framework for future, and more detailed, evaluations of changes in health policy.

      PubDate: 2017-07-21T10:47:01Z
      DOI: 10.1016/j.healthpol.2017.07.005
       
  • The relationship between health services standardized costs and mortality
           is non-linear: results from a large HMO population
    • Authors: Jiska Cohen-Mansfield; Michal Skornick-Bouchbinder; Moshe Hoshen; Shai Brill
      Abstract: Publication date: Available online 12 July 2017
      Source:Health Policy
      Author(s): Jiska Cohen-Mansfield, Michal Skornick-Bouchbinder, Moshe Hoshen, Shai Brill
      Older age, male gender, and poor socioeconomic status have been found to predict mortality. Studies have also documented an elevation in health services standardized costs (HSSC) and expenditures in the last years of life. We examined the contribution of HSSC in the last years of life in predicting mortality beyond predictors that have been established in the literature, and whether the impact of HSSC on mortality is linear. Vulnerability, operationalized as being exempt from co-payments due to poverty, being a holocaust survivor, or other reasons, was examined as potentially mediating the relationship between HSSC and mortality. We used longitudinal data obtained from the largest Health Maintenance Organization in Israel. Subjects were insured persons who were over age 65 in 2006 (n=423,140). Predictors included demographics, co-morbidity, and HSSC. All factors significantly predicted time to death. For HSSC, high levels displayed the highest Hazard Ratios (HR), with medium levels having the lowest HRs. The higher mortality rate in the low HSSC group might indicate a risk of underutilizing health services. Vulnerable status remained a predictor of mortality even within a system of universal access to healthcare. There is a need for establishing mechanisms to identify those underutilizing health services. A universal health care system is insufficient for providing equal health care, indicating a need for additional means to increase equality.

      PubDate: 2017-07-21T10:47:01Z
      DOI: 10.1016/j.healthpol.2017.07.004
       
  • How have systematic priority setting approaches influenced policy
           making' A synthesis of the current literature
    • Authors: Lydia Kapiriri; Donya Razavi
      Abstract: Publication date: Available online 12 July 2017
      Source:Health Policy
      Author(s): Lydia Kapiriri, Donya Razavi
      Background There is a growing body of literature on systematic approaches to healthcare priority setting from various countries and different levels of decision making. This paper synthesizes the current literature in order to assess the extent to which program budgeting and marginal analysis (PBMA), burden of disease & cost-effectiveness analysis (BOD/CEA), multi-criteria decision analysis (MCDA), and accountability for reasonableness (A4R), are reported to have been institutionalized and influenced policy making and practice. Methods We searched for English language publications on health care priority setting approaches (2000–2017). Our sources of literature included PubMed and Ovid databases (including Embase, Global Health, Medline, PsycINFO, EconLit). Findings Of the four approaches PBMA and A4R were commonly applied in high income countries while BOD/CEA was exclusively applied in low income countries. PBMA and BOD/CEA were most commonly reported to have influenced policy making. The explanations for limited adoption of an approach were related to its complexity, poor policy maker understanding and resource requirements. Conclusions While systematic approaches have the potential to improve healthcare priority setting; most have not been adopted in routine policy making. The identified barriers call for sustained knowledge exchange between researchers and policy-makers and development of practical guidelines to ensure that these frameworks are more accessible, applicable and sustainable in informing policy making.

      PubDate: 2017-07-21T10:47:01Z
      DOI: 10.1016/j.healthpol.2017.07.003
       
  • Health-seeking behavior and medical facility choice in Samsun, Turkey
    • Authors: Cihad
      Abstract: Publication date: Available online 12 July 2017
      Source:Health Policy
      Author(s): Cihad Dündar
      Objective Examining the factors that play a role in determining patient preferences for different healthcare institutions. Method This descriptive study was conducted in five family health centers (FHC) and in six hospitals in Samsun Province in Turkey. The data were collected from 1700 volunteer patients by using a structured questionnaire, while they were waiting for consultation. Result The average number of out-patient visits was 9.5±6.4 per person in 2012. Individuals aged less than 18 and more than 65 years old had higher preferences for FHCs, while those aged 19–64 years preferred primarily private hospitals. The order of preferences for FHC, public and private hospitals did not vary with the educational level. An increase in educational level was associated with a decrease in the preference for FHCs and in increase in the preference for private hospitals. The first three reasons given for preferring a hospital were ‘the presence of a specialist’, ‘availability of good equipment and technology’, and ‘trust on the diagnosis and treatment’, while ‘proximity’, ‘receiving adequate information’, and ‘being treated well’ were the reasons given by participants who preferred a FHC. Conclusion Providing medical equipment and staff support for improving diagnostic capacity of FHCs can accommodate patient expectations and shift the demand from hospitals to FHCs.

      PubDate: 2017-07-21T10:47:01Z
       
  • The taxation of unhealthy energy-dense foods (EDFs) and sugar-sweetened
           beverages (SSBs): An overview of patterns observed in the policy content
           and policy context of 13 case studies
    • Authors: Luc Louis Hagenaars; Patrick Paulus Theodoor Jeurissen; Niek Sieds Klazinga
      Abstract: Publication date: Available online 8 July 2017
      Source:Health Policy
      Author(s): Luc Louis Hagenaars, Patrick Paulus Theodoor Jeurissen, Niek Sieds Klazinga
      Taxation of energy-dense foods (EDFs) and sugar-sweetened beverages (SSBs) is increasingly of interest as a novel public health and fiscal policy instrument. However academic interest in policy determinants has remained limited. We address this paucity by comparing the policy content and policy context of EDF/SSB taxes witnessed in 13 case studies, of which we assume the tax is sufficiently high to induce behavioural change. The observational and non-randomized studies published on our case studies seem to indicate that the EDF/SSB taxes under investigation generally had the desired effects on prices and consumption of targeted products. The revenue collection of EDF/SSB taxes is minimal yet significant. Administrative practicalities in tax levying are important, possibly explaining why a drift towards solely taxing SSBs can be noted, as these can be demarcated more easily, with levies seemingly increasing in more recent case studies. Despite the growing body of evidence suggesting that EDF/SSB taxes have the potential to improve health, fiscal needs more often seem to lay their policy foundation rather than public health advocacy. A remarkable amount of conservative/liberal governments have adopted these taxes, although in many cases revenues are earmarked for benefits compensating regressive income effects. Governments voice diverse policy rationales, ranging from explicitly describing the tax as a public health instrument, to solely explicating revenue raising

      PubDate: 2017-07-21T10:47:01Z
      DOI: 10.1016/j.healthpol.2017.06.011
       
  • Effects of Long-Term High Continuity of Care on Avoidable Hospitalizations
           of Chronic Obstructive Pulmonary Disease Patients
    • Authors: I-Po Lin; Shiao-Chi Wu
      Abstract: Publication date: Available online 6 July 2017
      Source:Health Policy
      Author(s): I-Po Lin, Shiao-Chi Wu
      Objective To examine the effects of high continuity of care (COC) maintained for a longer time on the risk of avoidable hospitalization of patients with chronic obstructive pulmonary disease (COPD). Methods A retrospective cohort study design was adopted. We used a claim data regarding health care utilization under a universal health insurance in Taiwan. We selected 2,199 subjects who were newly diagnosed with COPD. We considered COPD-related avoidable hospitalizations as outcome variables. The continuity of care index (COCI) was used to evaluate COC as short- and long-term COC. A logistic regression model was used to control for sex, age, low-income status, disease severity, and health status. Results Long-term COC had stronger effect on health outcomes than short-term COC did. After controlling for covariables, the logistic regression results of short-term COC showed that the medium COCI group had a higher risk of avoidable hospitalizations (odds ratio [OR]: 1.89, 95% CI: 1.07–3.33) than the high COCI group did. The results of long-term COC showed that both the medium (OR: 1.98, 95% CI: 1.0–3.94) and low (OR: 2.03, 95% CI: 1.05–3.94) COCI groups had higher risks of avoidable hospitalizations than did the high COCI group. Conclusions Maintaining long-term high COC effectively reduces the risk of avoidable hospitalizations. To encourage development of long-term patient–physician relationships could improve health outcomes.

      PubDate: 2017-07-08T10:06:20Z
      DOI: 10.1016/j.healthpol.2017.06.010
       
  • New decision-making processes for the pricing of health technologies in
           Japan: The FY 2016/2017 pilot phase for the introduction of economic
           evaluations
    • Authors: Takeru Shiroiwa; Takashi Fukuda; Shunya Ikeda; Tomoyuki Takura
      Abstract: Publication date: Available online 23 June 2017
      Source:Health Policy
      Author(s): Takeru Shiroiwa, Takashi Fukuda, Shunya Ikeda, Tomoyuki Takura
      Economic evaluation is used for decision-making processes in healthcare technologies in many developed countries. In Japan, no health economic data have been requested for drugs, medical devices, and interventions till date. However, economic evaluation is gradually gaining importance, and a trial implementation of the cost-effectiveness evaluation of drugs and medical devices has begun. Discussions on economic evaluation began in May 2012 within a newly established sub-committee of the Chuikyo, referred to as the "Special Committee on Cost Effectiveness." After four years of discussions, this committee determined that during the trial implementation, the results of the cost-effectiveness evaluation would be used for the re-pricing of drugs and medical devices at the end of fiscal year (FY) 2017. Chuikyo selected 13 products (7 drugs and 6 medical devices) as targets for this evaluation. These products will be evaluated until the end of FY 2017 based on the following process: manufacturers will submit the data of economic evaluation; the National Institute of Public Health will coordinate the review process; academic groups will perform the actual review of the submitted data, and the expert committee will appraise these data. This represents the first step to introducing cost-effectiveness analysis in the Japanese healthcare system. We believe that these efforts will contribute to the efficiency and sustainability of the Japanese healthcare system.

      PubDate: 2017-07-08T10:06:20Z
      DOI: 10.1016/j.healthpol.2017.06.001
       
  • Consistency of priorities for quality improvement for nursing homes in
           Italy and Canada: A comparison of optimization models of resident
           satisfaction
    • Authors: Sara Barsanti; Kevin Walker; Chiara Seghieri; Antonella Rosa; Walter P. Wodchis
      Abstract: Publication date: Available online 23 June 2017
      Source:Health Policy
      Author(s): Sara Barsanti, Kevin Walker, Chiara Seghieri, Antonella Rosa, Walter P. Wodchis
      The paper seeks to identify aspects of care that may be easily modified to yield a desired level of improvement in residents' overall satisfaction with nursing homes, comparing data across Canada and Italy. Using a structured questionnaire, 681 and 1116 nursing home residents were surveyed in Ontario in 2009 and in Tuscany in 2012, respectively. Fourteen items were common to the surveys, including willingness to recommend (WTR), which was used as the dependent variable and measure of global satisfaction. The other analogous items were entered as covariates in ordinal logistic regression models predicting residents' WTR in each jurisdiction separately. Regression coefficients were then incorporated into a constrained nonlinear optimization problem selecting the most efficient combination of predictors necessary to increase WTR by as much as 15%. Staff-related aspects of care were selected first in the optimization models of each jurisdiction. In Ontario, to improve WTR the primary focus should be on staff relationships with residents, while in Tuscany it was the technical skill and knowledge of staff that was selected first by the optimization model. Different optimization solutions might mean that the strategies required to improve global satisfaction in one jurisdiction could be different than those for the other jurisdictions. The optimization model employed provides a novel solution for prioritizing areas of focus for quality improvement for nursing homes.

      PubDate: 2017-07-08T10:06:20Z
      DOI: 10.1016/j.healthpol.2017.06.004
       
  • Staff and patient perspectives of a smoke-free health services policy in
           South Australia: A state-wide implementation
    • Authors: Kimberley Martin; Joanne Dono; Greg Sharplin; Jacqueline Bowden; Caroline Miller
      Abstract: Publication date: Available online 20 June 2017
      Source:Health Policy
      Author(s): Kimberley Martin, Joanne Dono, Greg Sharplin, Jacqueline Bowden, Caroline Miller
      Few jurisdictions have implemented and evaluated a complete smoking ban across all health sites in their jurisdiction, with no designated smoking areas. This article examines staff and patient perceptions and experiences of a mandated smoke-free policy implemented across all government health facilities in South Australia, including mental health sites. An online survey of health staff was conducted prior to policy implementation (n=3098), 3 months post-implementation (n=2673) and 15 months post-implementation (n=2890). Consumer experiences of the policy were assessed via a telephone survey (n=1722; smokers n=254). Staff support for the policy was high across all time points. Two thirds of staff reported having witnessed some policy non-compliance, and self-reported exposure to second-hand smoke was comparable pre-implementation to 15 months post-implementation. Under the policy, 56.3% of smoking patients abstained completely whilst hospitalised and 37.6% cut down the amount that they smoked. Furthermore, 34.7% reported having been offered cessation support during hospitalisation. Whilst the smoke-free policy was viewed positively and had benefits for staff and patients, reports of witnessing some non-compliance were prevalent. While the extent of non-compliance is not known, and the measure used was sensitive, complementary strategies may be needed to reduce exposure to second-hand smoke, particularly at entrances. Health-care staff should be further encouraged to offer support to nicotine-dependent patients to foster compliance and promote abstinence during hospitalisation.

      PubDate: 2017-07-08T10:06:20Z
      DOI: 10.1016/j.healthpol.2017.06.003
       
  • System influences on work disability due to low back pain: an
           international evidence synthesis
    • Authors: Serena Bartys; Pernille Fredriksen; Tom Bendix; Kim Burton
      Abstract: Publication date: Available online 3 June 2017
      Source:Health Policy
      Author(s): Serena Bartys, Pernille Fredriksen, Tom Bendix, Kim Burton
      Work disability due to low back pain is a significant global health concern. Current policy and practice aimed at tackling this problem is largely informed by the biopsychosocial model. Resultant interventions have demonstrated some small-scale success, but they have not created a widespread decrease in work disability. This may be explained by the under-representation of the less measurable aspects in the biopsychosocial evidence base; namely the influence of relevant systems. Thus, a ‘best-evidence’ synthesis was conducted to collate the evidence on how compensatory (worker’s compensation and disability benefits), healthcare and family systems (spouse/partner/close others) can act as obstacles to work participation for those with low back pain. Systematic searches of several scientific and grey literature sources were conducted, resulting in 1,762 records. Following a systematic exclusion process, 57 articles were selected and the evidence was assessed using a system adapted from previous large-scale policy reviews conducted in this field. Results indicated how specific features of relevant systems could act as obstacles to individual efforts/interventions aimed at tackling work disability due to LBP. These findings reinforce the need for a ‘whole-systems’ approach, with all key players onside and have implications for the revision of current biopsychosocial-informed policy and practice.

      PubDate: 2017-06-05T05:49:20Z
      DOI: 10.1016/j.healthpol.2017.05.011
       
  • Contrasting approaches to Primary Care Performance Governance in Denmark
           and New Zealand
    • Authors: Tim Tenbensel; Viola Burau
      Abstract: Publication date: Available online 2 June 2017
      Source:Health Policy
      Author(s): Tim Tenbensel, Viola Burau


      PubDate: 2017-06-05T05:49:20Z
      DOI: 10.1016/j.healthpol.2017.05.013
       
  • Are public-private partnerships the solution to tackle neglected tropical
           diseases? A systematic review of the literature
    • Authors: Céline Aerts; Temmy Sunyoto; Fabrizio Tediosi; Elisa Sicuri
      Abstract: Publication date: Available online 19 May 2017
      Source:Health Policy
      Author(s): Céline Aerts, Temmy Sunyoto, Fabrizio Tediosi, Elisa Sicuri
      Pharmaceutical companies are reluctant to invest in research and development (R&D) of products for neglected tropical diseases (NTDs) mainly due to the low ability-to-pay of health insurance systems and of potential consumers. The available preventive and curative interventions for NTDs mostly rely on old technologies and products that are often not adequate. Moreover, NTDs mostly affect populations living in remote rural areas and conflict zones, thereby hampering access to healthcare. The challenges posed by NTDs have led to the proliferation of a variety of public-private partnerships (PPPs) in the last decades. We conducted a systematic review to assess the functioning and impact of these partnerships on the development of and access to better technologies for NTDs. Our systematic review revealed a clear lack of empirical assessment of PPPs: no impact evaluation analyses could be found, which are crucial to realize the full potential of PPPs and to progress further towards NTDs elimination.

      PubDate: 2017-05-21T05:01:10Z
      DOI: 10.1016/j.healthpol.2017.05.005
       
  • Time-driven activity-based costing in health care: A systematic review of
           the literature
    • Authors: George Keel; Carl Savage; Muhammad Rafiq; Pamela Mazzocato
      Abstract: Publication date: Available online 10 May 2017
      Source:Health Policy
      Author(s): George Keel, Carl Savage, Muhammad Rafiq, Pamela Mazzocato
      Health care organizations around the world are investing heavily in value-based health care (VBHC), and time-driven activity-based costing (TDABC) has been suggested as the cost-component of VBHC capable of addressing costing challenges. The aim of this study is to explore why TDABC has been applied in health care, how its application reflects a seven-step method developed specifically for VBHC, and implications for the future use of TDABC. This is a systematic review following the PRISMA statement. Qualitative methods were employed to analyze data through content analyses. TDABC is applicable in health care and can help to efficiently cost processes, and thereby overcome a key challenge associated with current cost-accounting methods The method’s ability to inform bundled payment reimbursement systems and to coordinate delivery across the care continuum remains to be demonstrated in the published literature, and the role of TDABC in this cost-accounting landscape is still developing. TDABC should be gradually incorporated into functional systems, while following and building upon the recommendations outlined in this review. In this way, TDABC will be better positioned to accurately capture the cost of care delivery for conditions and to control cost in the effort to create value in health care.

      PubDate: 2017-05-11T13:13:18Z
      DOI: 10.1016/j.healthpol.2017.04.013
       
  • The bare necessities? A realist review of necessity argumentations used in
           health care coverage decisions
    • Authors: Tineke Kleinhout-Vliek; Antoinette de Bont; Bert Boer
      Abstract: Publication date: Available online 5 May 2017
      Source:Health Policy
      Author(s): Tineke Kleinhout-Vliek, Antoinette de Bont, Bert Boer
      Context Policy makers and insurance companies decide on coverage of care by both calculating (cost-) effectiveness and assessing the necessity of coverage. Aim To investigate argumentations pertaining to necessity used in coverage decisions made by policy makers and insurance companies, as well as those argumentations used by patients, authors, the public and the media. Methods This study is designed as a realist review, adhering to the RAMESES quality standards. Embase, Medline and Web of Science were searched and 98 articles were included that detailed necessity-based argumentations. Results We identified twenty necessity-based argumentation types. Seven are only used to argue in favour of coverage, five solely for arguing against coverage, and eight are used to argue both ways. A positive decision appears to be facilitated when patients or the public set the decision on the agenda. Moreover, half the argumentation types are only used by patients, authors, the public and the media, whereas the other half is also used by policy makers and insurance companies. The latter group is more accepted and used in more different countries. Conclusion The majority of necessity-based argumentation types is used for either favouring or opposing coverage, and not for both. Patients, authors, the public and the media use a broader repertoire of argumentation types than policy makers and insurance companies.

      PubDate: 2017-05-06T10:51:51Z
      DOI: 10.1016/j.healthpol.2017.04.011
       
 
 
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