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  Subjects -> HEALTH AND SAFETY (Total: 1270 journals)
    - CIVIL DEFENSE (18 journals)
    - DRUG ABUSE AND ALCOHOLISM (86 journals)
    - HEALTH AND SAFETY (506 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (375 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (106 journals)
    - PHYSICAL FITNESS AND HYGIENE (99 journals)
    - WOMEN'S HEALTH (80 journals)

HEALTH AND SAFETY (506 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
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: 19)
African Health Sciences     Open Access   (Followers: 2)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 6)
African Journal of Health Professions Education     Open Access   (Followers: 4)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 2)
AJOB Primary Research     Partially Free   (Followers: 2)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Health Economics     Full-text available via subscription   (Followers: 12)
American Journal of Health Education     Hybrid Journal   (Followers: 24)
American Journal of Health Promotion     Hybrid Journal   (Followers: 24)
American Journal of Health Studies     Full-text available via subscription   (Followers: 8)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 21)
American Journal of Public Health     Full-text available via subscription   (Followers: 172)
American Journal of Public Health Research     Open Access   (Followers: 27)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 7)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access  
Archives of Medicine and Health Sciences     Open Access   (Followers: 2)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 1)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Association of Schools of Allied Health Professions     Full-text available via subscription   (Followers: 5)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 2)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 2)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access  
Behavioral Healthcare     Full-text available via subscription   (Followers: 4)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 6)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 9)
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 19)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 7)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 15)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 11)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 10)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 18)
Case Reports in Women's Health     Open Access   (Followers: 2)
Case Studies in Fire Safety     Open Access   (Followers: 11)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
Central European Journal of Public Health     Full-text available via subscription   (Followers: 4)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 9)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access  
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 1)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 1)
Conflict and Health     Open Access   (Followers: 8)
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 1)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription  
Duazary     Open Access   (Followers: 1)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 13)
East African Journal of Public Health     Full-text available via subscription   (Followers: 2)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 16)
EcoHealth     Hybrid Journal   (Followers: 3)
Education for Health     Open Access   (Followers: 4)
electronic Journal of Health Informatics     Open Access   (Followers: 4)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 4)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 3)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 18)
Ethics, Medicine and Public Health     Full-text available via subscription  
Ethiopian Journal of Health Development     Open Access   (Followers: 9)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 8)
Ethnicity & Health     Hybrid Journal   (Followers: 14)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 1)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 8)
Evidence-based Medicine & Public Health     Open Access   (Followers: 4)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 3)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 10)
Frontiers in Public Health     Open Access   (Followers: 8)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 11)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 4)
Global Health Promotion     Hybrid Journal   (Followers: 14)
Global Journal of Health Science     Open Access   (Followers: 3)
Global Journal of Public Health     Open Access   (Followers: 9)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 7)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 14)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 9)
Health and Human Rights     Free   (Followers: 8)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 9)
Health and Social Work     Hybrid Journal   (Followers: 46)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 11)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 10)
Health Issues     Full-text available via subscription   (Followers: 1)
Health Policy     Hybrid Journal   (Followers: 34)
Health Policy and Technology     Hybrid Journal  
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 19)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 9)
Health Promotion Practice     Hybrid Journal   (Followers: 14)
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: 9)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Sciences and Disease     Open Access   (Followers: 1)
Health Services Insights     Open Access   (Followers: 1)
Health Systems     Hybrid Journal   (Followers: 2)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 10)
Health, Risk & Society     Hybrid Journal   (Followers: 9)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
Heart Insight     Full-text available via subscription  
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: 9)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 5)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 2)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 2)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 1)
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 6)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 4)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 32)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 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: 4)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 19)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 13)
International Journal of Health & Allied Sciences     Open Access   (Followers: 1)
International Journal of Health and Rehabilitation Sciences     Open Access   (Followers: 13)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 6)
International Journal of Health Geographics     Open Access   (Followers: 6)
International Journal of Health Policy and Management     Open Access   (Followers: 2)
International Journal of Health Professions     Open Access   (Followers: 2)
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 12)
International Journal of Health Sciences Education     Open Access   (Followers: 2)
International Journal of Health Services     Full-text available via subscription   (Followers: 9)
International Journal of Health Studies     Open Access   (Followers: 3)
International Journal of Health System and Disaster Management     Open Access   (Followers: 2)
International Journal of Healthcare Delivery Reform Initiatives     Full-text available via subscription   (Followers: 1)
International Journal of Healthcare Information Systems and Informatics     Hybrid Journal   (Followers: 10)
International Journal of Healthcare Management     Hybrid Journal   (Followers: 16)

        1 2 3 | Last

Journal Cover Health Policy
  [SJR: 1.182]   [H-I: 36]   [34 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0168-8510
   Published by Elsevier Homepage  [3043 journals]
  • HTA of medical devices: Challenges and ideas for the future from a
           European perspective
    • Authors: Sabine Fuchs; Britta Olberg; Dimitra Panteli; Matthias Perleth; Reinhard Busse
      Pages: 215 - 229
      Abstract: Publication date: March 2017
      Source:Health Policy, Volume 121, Issue 3
      Author(s): Sabine Fuchs, Britta Olberg, Dimitra Panteli, Matthias Perleth, Reinhard Busse
      Objectives Health Technology Assessment (HTA) of Medical devices (MDs) and MD-based procedures can be challenging due to the unique features and particularities of this group of technologies, such as device-operator interaction. The aim of this study was to (1) clarify, and supplement earlier findings on European HTA institutions’ structural, procedural and methodological characteristics with regard to the assessment of MDs and to (2) capture the institutions’ perceptions regarding challenges and future trends. Methods Semi-structured telephone interviews with 16 representatives from leading European HTA institutions were performed between April and July 2015. Summative and directed content analysis was used for the analysis, which is reported according to the COREQ checklist. Results Findings from the analysis of the interviews were manifold and partially confirmed what has been noted in the literature (e.g. scarce evidence; identifying relevant studies challenging due to more incremental innovations). Additional themes emerged that can be important for future considerations by HTA institutions and policy-makers alike (e.g. areas for future research; need for specific tools). Conclusions The collective opinion of 16 European HTA institutions on MD evaluation could provide ideas to ameliorate the current regulatory situation beyond the modified EU regulation and start broader, more in-depth methodological discussions around the issue. Interviewed experts seem to agree that new approaches such as coverage with evidence development as some countries already introduced could help to overcome the problem with scarce evidence.

      PubDate: 2017-03-05T06:32:08Z
      DOI: 10.1016/j.healthpol.2016.08.010
       
  • Drug information by public health and regulatory institutions: Results of
           an 8-country survey in Europe
    • Authors: Giulio Formoso; Maria Font-Pous; Wolf-Dieter Ludwig; David Phizackerley; Dick Bijl; Juan Erviti; Blanka Pospíšilová; Jean Louis Montastruc
      Pages: 257 - 264
      Abstract: Publication date: March 2017
      Source:Health Policy, Volume 121, Issue 3
      Author(s): Giulio Formoso, Maria Font-Pous, Wolf-Dieter Ludwig, David Phizackerley, Dick Bijl, Juan Erviti, Blanka Pospíšilová, Jean Louis Montastruc
      Purpose To evaluate the framework of drug information produced by public health and regulatory institutions in Europe. Materials and methods We carried out a short survey asking editors of ISDB bulletins of the European region to indicate the main sources of drug information provided by public health and regulatory authorities in their countries, the specific kind of information produced and their opinions about strengths and weaknesses of such information. The availability of evaluations about the added therapeutic value of drugs and of tools facilitating the implementation of such information were particularly addressed and checked on the websites of those institutions. Results Answers pertaining to eight countries were available. Regulatory information and safety alerts are generally available, but just UK and Germany stand out by showing quite an advanced framework of evidence-based, comparative drug information for health professionals, decision-makers and for the general public. National plans to implement evidence-based drug information seem lacking. Conclusion More efforts are warranted to develop sharp formats to make evidence-based drug information easier to access, understand and put in context, showing the place in therapy of medicines and their added therapeutic value. Harmonization of different sources, also at European level, would be important to favor their access and limit dispersion. Appropriate tools and specific plans are then necessary to favor implementation of information materials.

      PubDate: 2017-03-05T06:32:08Z
      DOI: 10.1016/j.healthpol.2016.12.007
       
  • Features of public healthcare services provided to migrant patients in the
           Eastern Macedonia and Thrace Region (Greece)
    • Authors: Christos A. Tsitsakis; Anastasios Karasavvoglou; Efstathios Tsaridis; Georgia Ramantani; Giannoula Florou; Persefoni Polychronidou; Stamatios Stamatakis
      Pages: 329 - 337
      Abstract: Publication date: March 2017
      Source:Health Policy, Volume 121, Issue 3
      Author(s): Christos A. Tsitsakis, Anastasios Karasavvoglou, Efstathios Tsaridis, Georgia Ramantani, Giannoula Florou, Persefoni Polychronidou, Stamatios Stamatakis
      Background The influx of migrants, refugees and asylum-seekers into European Union (EU) countries, especially into Greece, in the last 20 years is an issue of growing concern and requires a rational approach. The aim of this study is to chart the use of public health services by the migrants of the Eastern Macedonia and Thrace Region, which forms the northeastern border of Greece. Methods We collected data from five of the six public hospitals in the specified region, and we carried out a per clinic cross tabulation analysis of admission diagnosis and citizenship variables in order to establish the frequency at which the various diagnoses emerge per distinct group of migrant and non-migrant patients in each clinic. The main limitation of the study was the lack of age-standardised data. An additional analysis of frequencies per clinic focusing on migrant patients yielded hospitalisation frequencies per country of origin. We also performed a t-test to compare the average length of stay per clinic between the two groups. Finally, we utilised our available data to map the insurance status of migrant patients. Results The results have indicated that the hospitalisation rate of migrant patients due to chronic medical conditions is statistically significantly lower compared to non-migrant patients, while the opposite is true when looking at accident-related diagnoses, certain infectious diseases and medical conditions pertaining to depression and alcohol abuse. The comparisons of the average length of stay showed no overall differences between migrants and non-migrants. Only 2.04% of the migrant patients were uninsured. Conclusions One of the key issues raised by the influx of migrants settling in host countries is concerned with health policy. The knowledge afforded by the medical parameters that characterise the provision of healthcare to them and the findings of relevant studies can lead to a more efficient identification of health risk factors and more effective prevention and treatment. This knowledge also constitutes a particularly crucial and useful tool to help authorities shape their healthcare policies and modify national health systems, which are currently based on the size and characteristics of indigenous populations, to take into account the different conditions with regard to both the number of patients treated and the epidemiological characteristics of the migrants. A greater appreciation of the particular current and potential roles of non-governmental organisations (NGOs) can help to provide appropriate healthcare services to migrants, refugees and asylum-seekers, especially when these groups are excluded from the public health system.

      PubDate: 2017-03-05T06:32:08Z
      DOI: 10.1016/j.healthpol.2016.12.006
       
  • Policies towards hospital and GP competition in five European countries
    • Authors: Luigi Siciliani; Martin Chalkley; Hugh Gravelle
      Pages: 103 - 110
      Abstract: Publication date: February 2017
      Source:Health Policy, Volume 121, Issue 2
      Author(s): Luigi Siciliani, Martin Chalkley, Hugh Gravelle
      This study provides an overview of policies affecting competition amongst hospitals and GPs in five European countries: France, Germany, Netherlands, Norway and Portugal. Drawing on the policies and empirical evidence described in five case studies, we find both similarities and differences in the approaches adopted. Constraints on patients’ choices of provider have been relaxed but countries differ in the amount and type of information that is provided in the public domain. Hospitals are increasingly paid via fixed prices per patient to encourage them to compete on quality but prices are set in different ways across countries. They can be collectively negotiated, determined by the political process, negotiated between insurers and providers or centrally determined by provider costs. Competition amongst GPs varies across countries and is limited in some cases by shortages of providers or restrictions on entry. There are varied and innovative examples of selective contracting for patients with chronic conditions aimed at reducing fragmentation of care. Competition authorities do generally have jurisdiction over mergers of private hospitals but assessing the potential impact of mergers on quality remains a key challenge. Overall, this study highlights a rich diversity of approaches towards competition policy in healthcare.

      PubDate: 2017-02-05T18:30:41Z
      DOI: 10.1016/j.healthpol.2016.11.011
       
  • Competition policy for health care provision in Germany
    • Authors: Mathias Kifmann
      Pages: 119 - 125
      Abstract: Publication date: February 2017
      Source:Health Policy, Volume 121, Issue 2
      Author(s): Mathias Kifmann
      Since the 1990s, Germany has introduced a number of competitive elements into its public health care system. Sickness funds were given some freedom to sign selective contracts with providers. Competition between ambulatory care providers and hospitals was introduced for certain diseases and services. As competition has become more intense, the importance of competition law has increased. This paper reviews these areas of competition policy. The problems of introducing competition into a corporatist system are discussed. Based on the scientific evidence on the effects of competition, key lessons and implications for future policy are formulated.

      PubDate: 2017-02-05T18:30:41Z
      DOI: 10.1016/j.healthpol.2016.11.014
       
  • Selective contracting and channelling patients to preferred providers: A
           scoping review
    • Authors: Romy E. Bes; Emile C. Curfs; Peter P. Groenewegen; Judith D. de Jong
      Abstract: Publication date: Available online 24 March 2017
      Source:Health Policy
      Author(s): Romy E. Bes, Emile C. Curfs, Peter P. Groenewegen, Judith D. de Jong
      Selective contracting by health insurers and channelling patients to contracted providers is crucial in a health care system based on managed competition, as this should lead to better value for money delivery of healthcare. However, an important consequence for enrolees is that health insurers interfere with their choice of care provider. This scoping review aims to find out what is known about selective contracting from the enrolee’s perspective. Is it being done and how do enrolees feel about the role of their health insurer in their care provider choice? A literature search was conducted, and, in addition, experts were consulted for extra information and documents. Results show that selective contracting and channelling is practised in several countries. This is mostly through negative financial incentives, which are also found to be the most effective strategy. However, enrolees are very negative about restrictions on provider choice introduced by their insurer. This results in enrolees feeling less satisfaction with, and trust in, care providers and health insurers. Choice is crucial in this respect since enrolees are more satisfied with their health plans and care providers when they have chosen them themselves. Future research should focus on the role of trust and how people weigh different attributes of health plans if selective contracting and channelling is to be implemented in a manner acceptable to enrolees.

      PubDate: 2017-03-25T07:38:08Z
      DOI: 10.1016/j.healthpol.2017.03.008
       
  • The Emerging Market for Supplemental Long Term Care Insurance in Germany
           in the Context of the 2013 Pflege-Bahr Reform
    • Authors: Pamela Nadash; Alison Evans Cuellar
      Abstract: Publication date: Available online 21 March 2017
      Source:Health Policy
      Author(s): Pamela Nadash, Alison Evans Cuellar
      The growing cost of long term care is burdening many countries'health and social care systems, causing them to encourage individuals andfamilies to protect themselves against the financial risk posed by longterm care needs. Germany's public long-term care insurance program, whichmandates coverage for most Germans, is well-known, but fewer are aware ofGermany's growing voluntary, supplemental private long-term careinsurance market. This paper discusses German policymakers' 2013 effortto expand it by subsidizing the purchase of qualified policies. Weprovide data on market expansions and the extent to which policy goalsare being achieved, finding that public subsidies for purchasingsupplemental policies boosted the market, although the effect of thisstimulus diminished over time. Meanwhile, sales growth in theunsubsidized market appears to have slowed, despite design features thatcreate incentives for lower-risk individuals to seek better deals there.Thus, although subsidies for cheap, low-benefit policies seem to haveachieved the goal of market expansion, the overall impact and long-termsustainability of these products is unclear; conclusions about its impactare further muddied by significant expansions to Germany's core program.The German example reinforces the examples of the US and France privatelong term care insurance markets, to show how such products flourish bestwhen supplementing a public program.

      PubDate: 2017-03-25T07:38:08Z
      DOI: 10.1016/j.healthpol.2017.03.006
       
  • The new regulatory tools of the 2016 Health Law to fight drug shortages in
           France
    • Authors: François Bocquet; Albane Degrassat-Théas; Jérôme Peigné; Pascal Paubel
      Abstract: Publication date: Available online 18 March 2017
      Source:Health Policy
      Author(s): François Bocquet, Albane Degrassat-Théas, Jérôme Peigné, Pascal Paubel
      Drug shortages are becoming worrying for public health in the European Union. The French public authorities first took action against the causes of drug shortages in 2011 with a law, followed by a decree in 2012 to overcome the dysfunctions of the pharmaceutical distribution channel. These texts would establish emergency call centres implemented by pharmaceutical companies for pharmacists and for wholesalers to inform of shortages, and would oblige pharmaceutical companies to inform health authorities of any risk of potential shortage situation; they would also reinforce the declaration regime of the territory served by wholesalers. Through the Health Law of January 2016, France acquired new regulatory tools in order to fight against these shortages and wanted to target the drugs for which they are the most detrimental: the major therapeutic interest (MTI) drugs. Furthermore, this new text reinforces the legal obligations of pharmaceutical companies and of wholesalers for drug shortages and sets out the enforcement of sanctions in case of breach of these obligations. France’s goal is ambitious: to implement coercive measures aiming at making the actors of the drug distribution channel aware of their responsibilities in order to take up the public health challenge triggered by drug shortages.

      PubDate: 2017-03-25T07:38:08Z
      DOI: 10.1016/j.healthpol.2017.03.007
       
  • Including values in evidence-based policy making for breast screening: an
           empirically grounded tool to assist expert decision makers
    • Authors: Lisa Parker
      Abstract: Publication date: Available online 18 March 2017
      Source:Health Policy
      Author(s): Lisa Parker
      Values are an important part of evidence-based decision making for health policy: they guide the type of evidence that is collected, how it is interpreted, and how important the conclusions are considered to be. Experts in breast screening (including clinicians, researchers, consumer advocates and senior administrators) hold differing values in relation to what is important in breast screening policy and practice, and committees may find it difficult to incorporate the complexity and variety of values into policy decisions. The decision making tool provided here is intended to assist with this process. The tool is modified from more general frameworks that are intended to assist with ethical decision making in public health, and informed by data drawn from previous empirical studies on values amongst Australian breast screening experts. It provides a structured format for breast screening committees to consider and discuss the values of themselves and others, suggests relevant topics for further inquiry and highlights areas of need for future research into the values of the public. It enables committees to publicly explain and justify their decisions with reference to values, improving transparency and accountability. It is intended to act alongside practices that seek to accommodate the values of individual women in the informed decision making process for personal decision making about participation in breast screening.

      PubDate: 2017-03-25T07:38:08Z
      DOI: 10.1016/j.healthpol.2017.03.002
       
  • Understanding what matters: an exploratory study to investigate the views
           of the general public for priority setting criteria in health care
    • Authors: Julie Ratcliffe; Emily Lancsar; Ruth Walker; Yuanyuan Gu
      Abstract: Publication date: Available online 16 March 2017
      Source:Health Policy
      Author(s): Julie Ratcliffe, Emily Lancsar, Ruth Walker, Yuanyuan Gu
      Health care policy makers internationally are increasingly expressing commitment to consultation with, and incorporation of, the views of the general public into the formulation of health policy and the process of setting health care priorities. In practice, however, there are relatively few opportunities for the general public to be involved in health care decision-making. In making resource allocation decisions, funders, tasked with managing scarce health care resources, are often faced with difficult decisions in balancing efficiency with equity considerations. A mixed methods (qualitative and quantitative) approach incorporating focus group discussions and a ranking exercise was utilised to develop a comprehensive list of potential criteria for setting priorities in health care formulated from the perspective of members of the general public in Australia. A strong level of congruence was found in terms of the rankings of the key criteria with the size of the health gain, clinical effectiveness, and the ability to provide quality of life improvements identified consistently as the three most important criteria for prioritising the funding of an intervention. Findings from this study will be incorporated into a novel DCE framework to explore how decision makers and members of the general public prioritize and trade off different types of health gain and to quantify the weights attached to specific efficiency and equity criteria in the priority setting process.

      PubDate: 2017-03-18T07:13:05Z
      DOI: 10.1016/j.healthpol.2017.03.003
       
  • INTRODUCING A GP COPAYMENT IN AUSTRALIA: WHO WOULD CARRY THE COST
           BURDEN?
    • Authors: Rosemary k. Elkins; Stefanie Schurer
      Abstract: Publication date: Available online 16 March 2017
      Source:Health Policy
      Author(s): Rosemary k. Elkins, Stefanie Schurer
      Recent policy changes designed to contain unsustainable health expenditure growth imply that many more Australians may soon be charged a copayment to consult a GP. We explore the distributional consequences associated with a range of hypothetical GP copayment scenarios using nationally-representative Australian survey data. For each scenario, we estimate the cost burden that individuals and households across the income distribution would need to absorb to maintain their current GP service utilisation. Even when concessional patients are charged a third or a quarter of the non-concessional copayment rate, the average estimated cost burden in the lowest income quartile is typically between three and six times that of the highest, and the average cost burden for women is significantly higher than for men within every income quartile. These disparities are intensified for those with a chronic illness. We conclude that the widespread implementation of GP copayments would disproportionately burden lower-income families, who experience higher rates of chronic illness, higher demand for GP services, and lower capacity to absorb price increases. The regressive nature of GP copayments is reduced when concessional and child patients are exempted entirely, highlighting the importance of supporting GPs—particularly in disadvantaged areas—to maintain bulk-billing arrangements for vulnerable patient groups.

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

      PubDate: 2017-03-18T07:13:05Z
      DOI: 10.1016/j.healthpol.2017.03.005
       
  • Assessing impacts of the WHO FCTC on national legislations: A case study
           of the Republic of Korea
    • Authors: Sun Goo Lee
      Abstract: Publication date: Available online 12 March 2017
      Source:Health Policy
      Author(s): Sun Goo Lee
      The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is an international treaty that was adopted in 2003 with the aim of addressing public health problems related to tobacco. The treaty is expected to bring substantial changes to global tobacco control because it has legally binding power over its signatory countries. However, its actual impact on national legislative processes, to date, has not been thoroughly examined. This article assesses the effect of the WHO FCTC on national tobacco legislation, with the Republic of Korea serving as a case study. This article also reviews whether and how lawmakers and government officials actually refer to the WHO FCTC as a justification for amending tobacco law after Korea ratified the WHO FCTC in 2005. This review shows that the WHO FCTC served as an important ground upon which to amend laws to strengthen tobacco control in Korea. The legally binding power of the WHO FCTC compelled lawmakers to comply with international standards. Furthermore, various tobacco control measures listed in the treaty have provided practical tips for Korean policymakers to refer to in designing tobacco control laws.

      PubDate: 2017-03-18T07:13:05Z
      DOI: 10.1016/j.healthpol.2017.02.017
       
  • Brexit and the NHS: challenges, uncertainties and opportunities
    • Authors: Victoria L. Simpkin; Elias Mossialos
      Abstract: Publication date: Available online 12 March 2017
      Source:Health Policy
      Author(s): Victoria L. Simpkin, Elias Mossialos


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

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

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

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

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

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

      PubDate: 2017-03-05T06:32:08Z
      DOI: 10.1016/j.healthpol.2017.02.013
       
  • Association between copayment, medication adherence and outcomes in the
           management of patients with Diabetes and Heart Failure
    • Authors: G. Gourzoulidis; G. Kourlaba; P. Stafylas; G. Giamouzis; J. Parissis; N. Maniadakis
      Abstract: Publication date: Available online 28 February 2017
      Source:Health Policy
      Author(s): G. Gourzoulidis, G. Kourlaba, P. Stafylas, G. Giamouzis, J. Parissis, N. Maniadakis
      Objective To determine the association between copayment, medication adherence and outcomes in patients with Heart failure (HF) and Diabetes Mellitus (DM). Methods PubMed, Scopus and Cochrane databases were searched using combinations of four sets of key words for:drug cost sharing; resource use, health and economic outcomes; medication adherence; and chronic disease. Results Thirty eight studies were included in the review. Concerning the direct effect of copayment changes on outcomes, the scarcity and diversity of data, does not allow us to reach a clear conclusion, although there is some evidence indicating that higher copayments may result in poorer health and economic outcomes. Seven and one studies evaluating the relationship between copayment and medication adherence in DM and HF population, respectively, demonstrated an inverse statistically significant association. All studies (29) examining the relationship between medication adherence and outcomes, revealed that increased adherence is associated with health benefits in both DM and HF patients. Finally, the majority of studies in both populations, showed that medication adherence was related to lower resource utilization which in turn may lead to lower total healthcare cost. Conclusion The results of our systematic review imply that lower copayments may result in higher medication adherence, which in turn may lead to better health outcomes and lower total healthcare expenses. Future studies are recommended to reinforce these findings.

      PubDate: 2017-03-05T06:32:08Z
      DOI: 10.1016/j.healthpol.2017.02.008
       
  • On the role of environmental corruption in healthcare infrastructures: An
           empirical assessment for Italy using DEA with truncated regression
           approach
    • Authors: Marina Cavalieri; Calogero Guccio; Ilde Rizzo
      Abstract: Publication date: Available online 27 February 2017
      Source:Health Policy
      Author(s): Marina Cavalieri, Calogero Guccio, Ilde Rizzo
      Objectives This paper investigates empirically whether the institutional features of the contracting authority as well as the level of ‘environmental’ corruption in the area where the work is localised affect the efficient execution of public contracts for healthcare infrastructures. Methods A two-stage Data Envelopment Analysis (DEA) is carried out based on a sample of Italian public contracts for healthcare infrastructures during the period 2000–2005. First, a smoothed bootstrapped DEA estimator is used to assess the relative efficiency in the implementation of each single infrastructure contract. Second, the determinants of the efficiency scores variability are considered, paying special attention to the effect exerted by ‘environmental’ corruption on different types of contracting authorities. Results Our results show that the performance of the contracts for healthcare infrastructures is significantly affected by ‘environmental’ corruption. Furthermore, healthcare contracting authorities are, on average, less efficient and the negative effect of corruption on efficiency is greater for this type of public procurers. Conclusions The policy recommendation coming out of the study is to rely on ‘qualified’ contracting authorities since not all the public bodies have the necessary expertise to carry on public contracts for healthcare infrastructures efficiently.

      PubDate: 2017-03-05T06:32:08Z
      DOI: 10.1016/j.healthpol.2017.02.011
       
  • Using administrative data to look at changes in the level and distribution
           of out-of-pocket medical expenditure: An example using Medicare data from
           Australia
    • Authors: Xinyang Hua; Guido Erreygers; John Chalmers; Tracey-Lea Laba; Philip Clarke
      Abstract: Publication date: Available online 23 February 2017
      Source:Health Policy
      Author(s): Xinyang Hua, Guido Erreygers, John Chalmers, Tracey-Lea Laba, Philip Clarke
      Objectives Australia’s universal health insurance system Medicare generates very large amounts of data on out-of-pocket expenditure (OOPE), but only highly aggregated statistics are routinely published. Our primary purpose is to develop indices from the Medicare administrative data to quantify changes in the level and distribution of OOPE on out-of-hospital medical services over time. Methods Data were obtained from the Australian Hypertension and Absolute Risk Study, which involved patients aged 55 years and over (n=2653). Socio-economic and clinical information was collected and linked to Medicare records over a five-year period from March 2008. The Fisher price and quantity indices were used to evaluate year-to-year changes in OOPE. The relative concentration index was used to evaluate the distribution of OOPE across socio-economic strata. Results Our price index indicates that overall OOPE were not rising faster than inflation, but there was considerable variation across different types of services (e.g. OOPE on professional attendances rose by 20% over a five-year period, while all other items fell by around 14%). Concentration indices, adjusted for demographic factors and clinical need, indicate that OOPE tends to be higher among those on higher incomes. Conclusions A major challenge in utilizing large administrative data sets is to develop reliable and easily interpretable statistics for policy makers. Price, quantity and concentration indices represent statistics that move us beyond the average.

      PubDate: 2017-02-26T10:19:02Z
      DOI: 10.1016/j.healthpol.2017.02.003
       
  • The Role, Costs and Value for Money of External Consultancies in the
           Health Sector: A study of New Zealand’s District Health Boards
    • Authors: Erin Penno; Robin Gauld
      Abstract: Publication date: Available online 21 February 2017
      Source:Health Policy
      Author(s): Erin Penno, Robin Gauld
      Public spending on external consultancies, particularly within the health sector, is highly controversial in many countries. Yet, despite the apparently large sums of money involved, there is little international analysis surrounding the scope of activities of consultants, meaning there is little understanding of how much is spent, for what purpose and with what result. This paper examines spending on external consultancies in each of New Zealand’s (NZ) 20 District Health Boards (DHB). Using evidence obtained from DHBs, it provides an insight into the cost and activities of consultants within the NZ health sector, the policies behind their engagement and the processes in place to ensure value for money. It finds that DHB spending on external consultants is substantial, at $NZ10–60 million annually. However, few DHBs had policies governing when consultants should be engaged and many were unable to easily identify the extent or purpose of consultancies within their organisation, making it difficult to derive an accurate picture of consultant activity throughout the DHB sector. Policies surrounding value for money were uncommon and, where present, were rarely applied. Given the large sums being spent by NZ’s DHBs, and assuming expenditure is similar in other health systems, our findings point to the need for greater accountability for expenditure and better evidence of value for money of consultancies within publicly funded health systems.

      PubDate: 2017-02-26T10:19:02Z
      DOI: 10.1016/j.healthpol.2017.02.005
       
  • Leveraging consumer’s behaviour to promote generic drugs in Italy
    • Authors: Cristina Zerbini; Beatrice Luceri; Donata Tania Vergura
      Abstract: Publication date: Available online 21 February 2017
      Source:Health Policy
      Author(s): Cristina Zerbini, Beatrice Luceri, Donata Tania Vergura
      Objective The aim of this study was to fill the lack of knowledge regarding a more grounded exploration of the consumer’s decision-making process in the context of generic drugs. In this perspective, a model, within the theoretical framework of the Theory of Planned Behaviour (TPB), for studying the consumers’ purchase intention of generic drugs was developed. Methods An online survey on 2,222 Italian people who bought drugs in the past was conducted. The proposed model was tested through structural equation modelling (SEM). Results Almost all the constructs considered in the model, except the perceived behavioural control, contribute to explain the consumer’s purchase intention of generic drugs, after controlling for demographic variables (age, income, education). Specifically, attitude, subjective norm, past behaviour, self-identity and trust in the pharmacist have a positive influence on the intention to buy generic drugs. On the contrary, perceived risk towards products and brand sensitivity act negatively. Conclusions The results of the present study could be useful to public policy makers in developing effective policies and educational campaigns aimed at promoting generic drugs. Specifically, marketing efforts should be directed to inform consumers about the generic drugs’ characteristics to mitigate the perceived risk towards these products and to raise awareness during their decision-making process.

      PubDate: 2017-02-26T10:19:02Z
      DOI: 10.1016/j.healthpol.2017.01.008
       
  • Private health insurance in Sweden: Fast-track lanes and the alleged
           attempts to stop them
    • Authors: John Lapidus
      Abstract: Publication date: Available online 20 February 2017
      Source:Health Policy
      Author(s): John Lapidus
      According to the Health and Medical Services Act (1982:763), those who have the greatest need for healthcare shall be given priority. This is being challenged by the rapid emergence of private health insurance which increases the share of private funding and creates fast-track lanes where some people get faster access to healthcare than others. The Stop Law, implemented by a Social Democratic government in 2006, was generally regarded as a way to put an end to the fast-track lanes in Swedish healthcare. Based on a thorough examination of the law and its legislative history – official reports, propositions, comments on official reports – this article argues that the Stop Law was so full of exceptions and loopholes that it did not threaten the existence of fast-track lanes. The same goes for a similar Social Democratic proposal from 2016, which is also examined in the article. Further, the article analyses centre-right wing positions on fast-track lanes in Swedish healthcare. In summary, it is argued that politicians of all stripes have allowed the development to proceed in spite of unanimous support for the idea that Swedish healthcare shall be provided to all on equal terms.

      PubDate: 2017-02-26T10:19:02Z
      DOI: 10.1016/j.healthpol.2017.02.004
       
  • The 2016 proposal for the reorganisation of urgent care provision in
           Belgium: A political struggle to co-locate primary care providers and
           emergency departments
    • Authors: Koen Van den Heede; Wilm Quentin; Cécile Dubois; Stephan Devriese; Carine Van de Voorde
      Abstract: Publication date: Available online 20 February 2017
      Source:Health Policy
      Author(s): Koen Van den Heede, Wilm Quentin, Cécile Dubois, Stephan Devriese, Carine Van de Voorde
      Internationally the number of emergency department (ED) visits is on the rise while evidence suggests that a substantial proportion of these patients do not require emergency care but primary care. This paper presents the Belgian 2016 proposal for the reorganisation of urgent care provision and places it into its political context. The proposal focused on re-designing patient flow aiming to reduce inappropriate ED visits by improving guidance of patients through the system. Initially policymakers envisaged, as cornerstone of the reform, to roll-out as standard model the co-location of primary care centres and EDs. Yet, this was substantially toned down in the final policy decisions mainly because GPs strongly opposed this model (because of increased workload and loss of autonomy, hospital-centrism, etc.). In fact, the final compromise assures a great degree of autonomy for GPs in organising out-of-hours care. Therefore, improvements will depend on future developments in the field and continuous monitoring of (un-)intended effects is certainly indicated. This policy process makes clear how important it is to involve all relevant stakeholders as early as possible in the development of a reform proposal to take into account their concerns, to illustrate the benefits of the reform and ultimately to gain buy-in for the reform.

      PubDate: 2017-02-26T10:19:02Z
      DOI: 10.1016/j.healthpol.2017.02.006
       
  • Implementation of the 2013 amended Patients’ Rights Act in Norway:
           Clinical priority guidelines and access to specialised health care
    • Authors: Kjell Arne Johansson; Elizabeth Nygaard; Berit Herlofsen; Frode Lindemark
      Abstract: Publication date: Available online 20 February 2017
      Source:Health Policy
      Author(s): Kjell Arne Johansson, Elizabeth Nygaard, Berit Herlofsen, Frode Lindemark
      In 2013, the Norwegian Patient Rights’ Act was amended in order to simplify the priority setting process for specialized elective health care and to improve access to care. As a result of the amendment, priority for treatment is now determined by only two criteria: 1) clinical effectiveness; and 2) cost-effectiveness of the intervention. There are 33 clinical priority-setting guidelines organised by medical specialty, which help hospitals evaluate whether individual patients have a right to access care. Following the amendment of the Patient Rights’ Act, these guidelines had to be revised in order to assure coherence with the new legislation. The revised guidelines define and score a total of 556 condition-intervention pairs, and will give all patients who are evaluated as having a need for specialist elective healthcare the right to access these services. This is different from the old guidelines, where patients could be evaluated as having a need but no right for treatment. According to the new guidelines, a much larger share of patients will be granted a right to necessary specialist healthcare service (93% of condition-intervention pairs versus 77% of condition-intervention pairs in the old guidelines). One reason for this is that the severity of the condition is no longer considered as part of the evaluation process, which means that patients with low levels of severity now have a right to receive treatment. In addition, a new “don’t do” list of 40 conditions was created, which may prevent unnecessary treatment.

      PubDate: 2017-02-26T10:19:02Z
      DOI: 10.1016/j.healthpol.2017.02.007
       
  • Public reaction to the UK government strategy on childhood obesity in
           England: A qualitative and quantitative summary of online reaction to
           media reports
    • Authors: Rebecca Gregg; Ajay Patel; Sumaiya Patel; Laura O’Connor
      Abstract: Publication date: Available online 20 February 2017
      Source:Health Policy
      Author(s): Rebecca Gregg, Ajay Patel, Sumaiya Patel, Laura O’Connor
      This work aimed to summarise public real-time reaction to the publication of the UK government childhood obesity strategy by applying a novel research design method. We used a netnographic technique to carry out thematic analysis of user-generated comments to online newspaper articles related to the strategy. We examined likes/dislikes associated with comments as a proxy of agreement of the wider community with identified themes. To examine media influence on the comments we carried out thematic analysis of online media headlines published about the strategy, and compared these themes with themes identified from comments. Three newspaper articles and 1704 associated comments were included. Three parent themes were identified: paternalism/libertarianism, lobbyist influence and, anecdotal solutions. The comments were largely negative (94%). Commenters were split as to individual responsibilities and the role of the government, some felt that lobbyist influence had won out over the nation’s health and others offered non-evidence based solutions. The ten most liked and disliked comments reflected themes identified in our main analysis. There was parity between themes that emerged from comments and from headlines. This summary of public reaction to the obesity strategy publication may aid translation of public views and receptiveness into practice and inform subsequent government action and policy. Furthermore, the process applied herein may provide a means of informal public engagement.

      PubDate: 2017-02-26T10:19:02Z
      DOI: 10.1016/j.healthpol.2017.02.010
       
  • Unmet healthcare needs in Ireland: analysis using the EU-SILC survey
    • Authors: Sheelah Connolly; Maev-Ann Wren
      Abstract: Publication date: Available online 16 February 2017
      Source:Health Policy
      Author(s): Sheelah Connolly, Maev-Ann Wren
      The analysis used the 2013 Survey of Income and Living Conditions to examine the extent and causes of unmet need for healthcare services in Ireland. The analysis found that almost four per cent of participants reported an unmet need for medical care. Overall, lower income groups, those with poorer health status and those without free primary care and/or private insurance were more likely to report an unmet healthcare need. The impact of income on the likelihood of reporting an unmet need was particularly strong for those without free primary care and/or private insurance, suggesting a role for the health system in eradicating income based inequalities in unmet need. Factors associated with the healthcare system – cost and waiting lists – accounted for the majority of unmet needs. Those with largely free public healthcare entitlement were more likely than all other eligibility categories to report that their unmet need was due to waiting lists (rather than cost). While not possible to explicitly examine in this analysis, it is probable that unmet need due to cost is picking up on the relatively high out-of-pocket payments for primary care for those who must pay for GP visits; while unmet need due to waiting is identifying the relatively long waiting times within the acute hospital sector for those within the public system.

      PubDate: 2017-02-19T17:11:40Z
      DOI: 10.1016/j.healthpol.2017.02.009
       
  • Payers’ experiences with confidential pharmaceutical price discounts: a
           survey of public and statutory health systems in North America, Europe,
           and Australasia
    • Authors: Steven G. Morgan; Sabine Vogler; Anita Wagner
      Abstract: Publication date: Available online 16 February 2017
      Source:Health Policy
      Author(s): Steven G. Morgan, Sabine Vogler, Anita Wagner
      Institutional payers for pharmaceuticals worldwide appear to be increasingly negotiating confidential discounts off of the official list price of pharmaceuticals purchased in the community setting. We conducted an anonymous survey about experiences with and attitudes toward confidential discounts on patented pharmaceuticals in a sample of high-income countries. Confidential price discounts are now common among the ten health systems that participated in our study, though some had only recently begun to use these pricing arrangements on a routine basis. Several health systems had used a wide variety of discounting schemes in the past two years. The most frequent discount received by participating health systems was between 20% and 29% of official list prices; however, six participants reported their health system received one or more discount over the past two years that was valued at 60% or more of the list prices. On average, participants reported that confidential discounts were more common, complex, and significant for specialty pharmaceuticals than for primary care pharmaceuticals. Participants had a more favourable view of the impact of confidential discount schemes on their health systems than on the global marketplace. Overall, the frequency, complexity, and scale of confidential discounts being routinely negotiated suggests that the list prices for medicines bears limited resemblance to what many institutional payers actually pay.

      PubDate: 2017-02-19T17:11:40Z
      DOI: 10.1016/j.healthpol.2017.02.002
       
  • Does enrollment in multidisciplinary team-based primary care practice
           improve adherence to guideline-recommended processes of care? Quebec’s
           Family Medicine Groups, 2002-2010
    • Authors: Mamadou Diop; Julie Fiset-Laniel; Sylvie Provost; Pierre Tousignant; Roxane Borgès Da Silva; Marie-Jo Ouimet; Eric Latimer; Erin Strumpf
      Abstract: Publication date: Available online 13 February 2017
      Source:Health Policy
      Author(s): Mamadou Diop, Julie Fiset-Laniel, Sylvie Provost, Pierre Tousignant, Roxane Borgès Da Silva, Marie-Jo Ouimet, Eric Latimer, Erin Strumpf
      Background We investigated whether multidisciplinary team-based primary care practice improves adherence to process of care guidelines, in the absence of financial incentives related to pay-for-performance. Methods We conducted a natural experiment including 135,119 patients, enrolled with a general practitioner (GP) in a multidisciplinary team Family Medicine Group (FMG) or non-FMG practice, using longitudinal data from Quebec's universal insurer over the relevant time period (2000-2010). All study subjects had diabetes, chronic obstructive pulmonary disease, or heart failure and were followed over a 7-year period, 2 years prior to enrollment and 5 years after. We constructed indicators on adherence to disease-specific guidelines and composite indicators across conditions. We evaluated the effect of FMGs using propensity score methods and Difference-in-Differences (DD) models. Results Rates of adherence to chronic disease guidelines increased for both FMG and non-FMG patients after enrollment, but not differentially so. Adherence to prescription-related guidelines improved less for FMG patients (DD [95% CI]=− 2.83% [-4.08%, − 1.58%]). We found no evidence of an FMG effect on adherence to consultation-related guidelines, (DD [95% CI]=− 0.24% [- 2.24%; 1.75%]). Conclusions We found no evidence that FMGs increased adherence to the guidelines we evaluated. Future research is needed to assess why this reform did not improve performance on these quality-of-care indicators.

      PubDate: 2017-02-19T17:11:40Z
      DOI: 10.1016/j.healthpol.2017.02.001
       
  • Assessing decentralisation is a challenging but necessary task if it
           should continue as a reform strategy: Reflections from the systematic
           review by Sumah, Baatiema, and Abimbola
    • Authors: Harvy Joy Liwanag; Kaspar Wyss
      Abstract: Publication date: Available online 7 February 2017
      Source:Health Policy
      Author(s): Harvy Joy Liwanag, Kaspar Wyss


      PubDate: 2017-02-12T18:46:07Z
      DOI: 10.1016/j.healthpol.2017.01.009
       
  • The Financial Burden of Prescription Drugs for Neurological Conditions in
           Canada: Results from the National Population Health Study of Neurological
           Conditions
    • Authors: Sara J.T. Guilcher; Sarah E.P. Munce; James Conklin; Tanya Packer; Molly Verrier; Connie Marras; Tarik Bereket; Joan Versnel; Richard Riopelle; Susan B. Jaglal
      Abstract: Publication date: Available online 4 February 2017
      Source:Health Policy
      Author(s): Sara J.T. Guilcher, Sarah E.P. Munce, James Conklin, Tanya Packer, Molly Verrier, Connie Marras, Tarik Bereket, Joan Versnel, Richard Riopelle, Susan B. Jaglal
      This paper describes the current situation in Canada concerning the availability and use of prescription drugs for neurological conditions. We conducted semi-structured qualitative interviews with health care providers, administrators, community organization representatives, opinion leaders and policy makers. The analysis revealed three primary themes related to the availability of and access to prescription drugs to treat neurological conditions. First, we learned that across Canada there is significant vulnerability and a need for advocacy on behalf of people living with these conditions. Second, we learned that the heightened level of vulnerability and need for advocacy stems in part from the significant differences in the drug coverage available in the different provinces and territories. As a result, there are significant inequities across Canada. Third, we determined that the existing situation is also due to the current approach to health governance (i.e., accountability, transparency). Our study provides evidence for the urgent need for a formal discourse on national pharmacare in Canada, with representatives of neurological conditions having a voice at the table

      PubDate: 2017-02-05T18:30:41Z
      DOI: 10.1016/j.healthpol.2017.01.010
       
  • Competition policy for health care provision in France
    • Authors: Philippe
      Abstract: Publication date: February 2017
      Source:Health Policy, Volume 121, Issue 2
      Author(s): Philippe Choné
      There are more than two thousand hospitals in France, about equally divided between government-owned and privately-owned hospitals. Activity-based payment, which has been generalized in 2008 for acute care hospitals, has raised competition issues as DRG tariffs differ according to ownership status. Furthermore, the payment rule has been criticized for preventing the realization of potential hospital synergies, and as a result a recent reform has mandated close cooperation between public hospitals. The physician market is dual, with most GPs being subject to fee regulation and many self-employed, private-practice, specialist doctors being allowed to set their prices freely. Government regulation and centralized negotiations have traditionally been preferred to market mechanisms in this industry.

      PubDate: 2017-02-05T18:30:41Z
       
  • EU Accession: A policy window opportunity for Nursing?
    • Authors: Paul De Raeve; Anne-Marie Rafferty; Louise Bariball; Ruth Young; Olga Boiko
      Abstract: Publication date: Available online 25 January 2017
      Source:Health Policy
      Author(s): Paul De Raeve, Anne-Marie Rafferty, Louise Bariball, Ruth Young, Olga Boiko
      European enlargement has been studied in a wide range of policy areas within and beyond health. Yet the impact of EU enlargement upon one of the largest health professions, nursing, has been largely neglected. This paper aims to explore nurse leadership using a comparative case study method in two former Communist countries, Romania and Croatia. Specifically, it considers the extent to which engagement in the EU accession policy-making process provided a policy window for the leaders to formulate and implement a professional agenda while negotiating EU accession. Findings of qualitative interviews and documentary analysis indicate that the mechanisms used to facilitate the accession process were not successful in achieving compliance with the education standards in the Community Acquis, as highlighted in the criteria on the mutual recognition of professional qualifications set out in Directive 2005/36/EC. EU accession capacity building and accession funds were not deployed efficiently to upgrade Romanian and Croatian nursing education towards meeting EU standards. Conflicting views on accession held by the various nursing stakeholders (nursing regulator, nursing union, governmental chief nurse and the professional association) inhibited the setting of a common policy agenda to achieve compliance with EU standards. The study findings suggest a need to critically review EU accession mechanisms and better align leadership at all governance levels.

      PubDate: 2017-01-29T18:18:57Z
      DOI: 10.1016/j.healthpol.2017.01.004
       
  • The Determinants of Medical Technology Adoption in Different Decisional
           Systems: A Systematic Literature Review
    • Authors: Yauheniya Varabyova; Carl Rudolf Blankart; Ann Lennarson Greer; Jonas Schreyögg
      Abstract: Publication date: Available online 24 January 2017
      Source:Health Policy
      Author(s): Yauheniya Varabyova, Carl Rudolf Blankart, Ann Lennarson Greer, Jonas Schreyögg
      Studies of determinants of adoption of new medical technology have failed to coalesce into coherent knowledge. A flaw obscuring strong patterns may be a common habit of treating a wide range of health care innovations as a generic technology. We postulate three decisional systems that apply to different medical technologies with distinctive expertise, interest, and authority: medical-individualistic, fiscal-managerial, and strategic-institutional decisional systems. This review aims to examine the determinants of the adoption of medical technologies based on the corresponding decision-making system. We included quantitative and qualitative studies that analyzed factors facilitating or inhibiting the adoption of medical technologies. In total, 65 studies published between 1974 and 2014 met our inclusion criteria. These studies contained 688 occurrences of variables that were used to examine the adoption decisions, and we subsequently condensed these variables to 62 determinants in four main categories: organizational, individual, environmental, and innovation-related. The determinants and their empirical association with adoption were grouped and analyzed by the three decision-making systems. Although we did not identify substantial differences across the decision-making systems in terms of the direction of the determinants’ influence on adoption, a clear pattern emerged in terms of the categories of determinants that were targeted in different decision-making systems.

      PubDate: 2017-01-29T18:18:57Z
      DOI: 10.1016/j.healthpol.2017.01.005
       
  • Determinants of Evidence Use in Public Health Policy Making. Results from
           a study across six EU countries
    • Authors: L.A.M. van de Goor; R.M. Hämäläinen; A.M. Syed; C. Juel Lau; P. Sandu; H.P.E.M. Spitters; L. Eklund Karlsson; D. Dulf; A. Valente; T. Castellani; A.R. Aro
      Abstract: Publication date: Available online 20 January 2017
      Source:Health Policy
      Author(s): L.A.M. van de Goor, R.M. Hämäläinen, A.M. Syed, C. Juel Lau, P. Sandu, H.P.E.M. Spitters, L. Eklund Karlsson, D. Dulf, A. Valente, T. Castellani, A.R. Aro
      The knowledge-practice gap in public health is widely known. The importance of using different types of evidence for the development of effective health promotion has also been emphasized. Nevertheless, in practice, intervention decisions are often based on perceived short-term opportunities, lacking the most effective approaches, thus limiting the impact of health promotion strategies. This article focuses on facilitators and barriers in the use of evidence in developing health enhancing physical activity policies. Data was collected in 2012 by interviewing 86 key stakeholders from six EU countries (FI, DK, UK, NL, IT, RO) using a common topic guide. Content analysis and concept mapping was used to construct a map of facilitators and barriers. Barriers and facilitators experienced by most stakeholders and policy context in each country are analysed. A lack of locally useful and concrete evidence, evidence on costs, and a lack of joint understanding were specific hindrances. Also users’ characteristics and the role media play were identified as factors of influence. Attention for individual and social factors within the policy context might provide the key to enhance more sustainable evidence use. Developing and evaluating tailored approaches impacting on networking, personal relationships, collaboration and evidence coproduction is recommended.

      PubDate: 2017-01-22T18:05:29Z
      DOI: 10.1016/j.healthpol.2017.01.003
       
  • Eliciting Preferences for Medical Devices in South Korea: A Discrete
           Choice Experiment
    • Authors: Hye-Jae Lee; Eun-Young Bae
      Abstract: Publication date: Available online 10 January 2017
      Source:Health Policy
      Author(s): Hye-Jae Lee, Eun-Young Bae
      This study aims to identify the attributes that contribute to the value of medical devices and quantify the relative importance of them using a discrete choice experiment. Based on a literature review and expert consultation, seven attributes and their levels were identified—severity of disease (2), availability of substitutes (2), improvement in procedure (3), improvement in clinical outcomes (2), increase in survival (2), improvement in quality of life (3), and cost (4). Among 576 hypothetical profiles, optimal choice sets with 20 choices were developed and experts experienced in health technology assessment and reimbursement decision making in South Korea were surveyed. A total of 102 respondents participated in the survey. The results of the random-effect probit model showed that among the seven attributes, six, except for improvement in procedure, had a significant impact on respondents’ choices on medical devices. Respondents were willing to pay the highest amount for devices that provided substantial improvements in quality of life, followed by increased survival, improved clinical outcome, treatment without substitutes, and technology for treating severe diseases. The findings of this experiment will inform decision-makers of the relative importance of the criteria and help them in reimbursement decision making of medical devices.

      PubDate: 2017-01-15T15:45:07Z
      DOI: 10.1016/j.healthpol.2017.01.002
       
  • “Why Do Generic Drugs Fail to Achieve an Adequate Market Share in
           Greece? Empirical Findings and Policy Suggestions”
    • Authors: T. Balasopoulos; A. Charonis; K. Athanasakis; J. Kyriopoulos; E. Pavi
      Abstract: Publication date: Available online 9 January 2017
      Source:Health Policy
      Author(s): T. Balasopoulos, A. Charonis, K. Athanasakis, J. Kyriopoulos, E. Pavi
      Objectives Since 2010, the Memoranda of Understanding were implemented in Greece as a measure of fiscal adjustment. Public pharmaceutical expenditure was one of the main focuses of this implementation. Numerous policies, targeted on pharma spending, reduced the pharmaceutical budget by 60.5%. Yet, generics' penetration in Greece remained among the lowest among OECD countries. This study aims to highlight the factors that affect the perceptions of the population on generic drugs and to suggest effective policy measures. Methodology The empirical analysis is based on a national cross-sectional survey that was conducted through a sample of 2003 individuals, representative of the general population. Two ordinal logistic regression models were constructed in order to identify the determinants that affect the respondents' beliefs on the safety and the effectiveness of generic drugs. Findings The empirical findings presented a positive and statistically significant correlation with income, bill payment difficulties, safety and effectiveness of drugs, prescription and dispensing preferences and the views towards pharmaceutical companies. Also, age and trust towards medical community have a positive and statistically significant correlation with the perception on the safety of generic drugs. Policy interventions are suggested on the bases of the empirical results on 3 major categories; (a) information campaigns, (b) incentives to doctors and pharmacists and (c) to strengthen the bioequivalence control framework and the dissemination of results.

      PubDate: 2017-01-15T15:45:07Z
      DOI: 10.1016/j.healthpol.2016.12.011
       
  • Financial hardship on the path to Universal Health Coverage in the Gulf
           States
    • Authors: Riyadh Alshamsan; Hannah Leslie; Azeem Majeed; Margaret Kruk
      Abstract: Publication date: Available online 7 January 2017
      Source:Health Policy
      Author(s): Riyadh Alshamsan, Hannah Leslie, Azeem Majeed, Margaret Kruk
      Background Countries globally are pursuing universal health coverage to ensure better healthcare for their populations and prevent households from catastrophic expenditure. The countries of the Gulf Cooperation Council (GCC) have and continue to implement reforms to strengthen their health systems. A common theme between the countries is their pursuit of universal health coverage to provide access to necessary health care without exposing people to financial hardship. Methods Using nationally representative data from the Global Findex study, we sought to analyze the hardship faced by individuals from four high-income countries in the GCC. We estimated the weighted proportion of individuals borrowing for medical reasons and those who are not able to obtain emergency funds. We further examined variations in these outcomes by key socioeconomic factors. Results We found up to 11% of respondents borrowed money for medical purposes, double of that reported in other high-income countries. In contrast to affluent respondents, we found that respondents from deprived background were more likely to borrow money for medical purposes (adjusted odds ratio: 1.81, P<0.001) and expected to fail in obtaining emergency funds (adjusted odds ratio: 4.03, P<0.001). Conclusion In moving forward with their reforms, GCC countries should adopt a financing strategy that addresses the health needs of poorer groups in their pursuit of universal health coverage.

      PubDate: 2017-01-15T15:45:07Z
      DOI: 10.1016/j.healthpol.2016.12.012
       
  • Addressing health inequalities by using Structural Funds. A question of
           opportunities.
    • Authors: Oana Maria Neagu; Kai Michelsen; Jonathan Watson; Barrie Dowdeswell; Helmut Brand
      Abstract: Publication date: Available online 7 January 2017
      Source:Health Policy
      Author(s): Oana Maria Neagu, Kai Michelsen, Jonathan Watson, Barrie Dowdeswell, Helmut Brand
      Making up a third of the EU budget, Structural and Investment Funds can provide important opportunities for investing in policies that tackle inequalities in health. This article looks back and forward at the 2007-2013 and 2014-2020 financial periods in an attempt to inform the development of health equity as a strand of policy intervention under regional development. It combines evidence from health projects funded through Structural Funds and a document analyses that locates interventions for health equity under the new regulations. The map of opportunities has changed considerably since the last programing period, creating more visibility for vulnerable groups, social determinants of health and health systems sustainability. As the current programming period is progressing, this paper contributes to maximizing this potential but also identifying challenges and implementation gaps for prospective health system engagement in pursuing health equity as part of structural funds projects. The austerity measures and their impact on public spending, building political support for investments as well as the difficulties around pursuing health gains as an objective of other policy areas are some of the challenges to overcome. European Structural and Investment Funds could be a window of opportunity that triggers engagement for health equity if sectors adopt a transformative approach and overcome barriers, cooperate for common goals and make better use of the availability of these resources.

      PubDate: 2017-01-15T15:45:07Z
      DOI: 10.1016/j.healthpol.2017.01.001
       
  • Corruption and use of antibiotics in regions of Europe
    • Authors: Björn Rönnerstrand; Victor Lapuente
      Abstract: Publication date: Available online 7 January 2017
      Source:Health Policy
      Author(s): Björn Rönnerstrand, Victor Lapuente
      The aim of this article is to investigate the association between corruption and antibiotic use at sub-national level. We explore the correlation between, on the one hand, two measures of corruption (prevalence of corruption in the health sector and prevalence of bribes in the society) at regional level from the European Quality of Government Index; and, on the other, the consumption of antibiotics in those European regions from a 2009 Special Euro Barometer. In a multivariate regression model, we control for potential confounders: purchasing power of standardized regional gross domestic product, inhabitants per medical doctor and age-standardized all-cause mortality rates. We find that there is a strong positive association between both measures of corruption (i.e. in the health sector, and in the society at large) and antibiotics use; and that this association is robust to the introduction of the control variables. These results support previous findings in the literature linking corruption to higher antibiotic use at cross-national level. We show that corruption does seem to account for some of the remarkable between-region variation in antibiotic consumption in Europe.

      PubDate: 2017-01-15T15:45:07Z
      DOI: 10.1016/j.healthpol.2016.12.010
       
  • A Knowledge Translation Framework on Ageing and Health
    • Authors: Moriah E. Ellen; Ulysses Panisset; Islene Araujo de Carvalho; James Goodwin; John Beard
      Abstract: Publication date: Available online 6 January 2017
      Source:Health Policy
      Author(s): Moriah E. Ellen, Ulysses Panisset, Islene Araujo de Carvalho, James Goodwin, John Beard
      Background The world's population aged 60 and over will more than triple from 600 million to 2 billion between the years 2000 to 2050. This demographic change has significant impact on health, social, and economic sectors. The need to ensure that research into older peoples' health is effectively translated to policy is immediate. Objective The purpose of this paper is to present a proposed framework to support evidence informed policymaking in ageing and health. Methods We undertook a two stage process to develop the framework. We a) conducted a review of the literature, and b) convened an expert panel to provide feedback. Results Numerous frameworks have been proposed yet the majority do not address all the barriers. The Lavis et al., framework addresses a majority of the obstacles associated with evidence-informed policymaking and this framework was modified to include sub-elements important to ageing and health and to reflect the order of importance of the elements. The main elements are: a climate and/or context for research use, linkage and exchange efforts, creation of new knowledge, push efforts, facilitating pull efforts, pull efforts, and evaluation. A four-step implementation process is proposed. Discussion This paper offers an approach to Knowledge Translation within the field of aging and health. The framework and proposed implementation could be used to conceptualize and implement evidence-informed policymaking.

      PubDate: 2017-01-06T18:59:23Z
      DOI: 10.1016/j.healthpol.2016.12.009
       
  • Poverty and private health expenditures in Italian households during the
           recent crisis
    • Authors: Simone Sarti; Marco Terraneo; Mara Tognetti Bordogna
      Abstract: Publication date: Available online 6 January 2017
      Source:Health Policy
      Author(s): Simone Sarti, Marco Terraneo, Mara Tognetti Bordogna
      The global financial crisis that began in 2008 had an overall effect on the health behaviours of Italian households. Aggregate private health expenditures have decreased while the citizens have increasingly been asked to share health costs. The reduction of households’ health expenditure could have serious consequences for health, especially if it concerns the most vulnerable people. The aim of this paper is to analyse the relation between poverty and household health expenditure, considering regional and social group variations. The data used stem from the “Family Expenditure Survey” collected by the Italian Statistical Institute (ISTAT) from 1997 to 2013. Results of multivariate analysis controlling for potential socio-demographic confounders show that poor households have significantly cut down on health spending compared to not poor households. In particular, the propensity to spend for poor families is decreased in the last years whereas the expenditure in euro seems to have been more stable over time. This is an alarming signal for the health of the most vulnerable households. These conditions could result in a gradual deterioration of health in poor families, which is likely to increase the burden on health systems in future. Hence, at this moment public intervention does not seem able to alleviate this situation.

      PubDate: 2017-01-06T18:59:23Z
      DOI: 10.1016/j.healthpol.2016.12.008
       
  • The Likely Effects of Employer-Mandated Complementary Health Insurance on
           Health Coverage in France
    • Authors: Aurélie Pierre; Florence Jusot
      Abstract: Publication date: Available online 5 January 2017
      Source:Health Policy
      Author(s): Aurélie Pierre, Florence Jusot
      In France, access to health care greatly depends on having a Complementary Health Insurance coverage (CHI). Thus, the generalisation of CHI became a core factor in the national health strategy created by the government in 2013. The first measure has been to compulsorily extend employer-sponsored CHI to all private sector employees on January 1st, 2016 and improve its portability coverage for unemployed former employees for up to 12 months. Based on data from the 2012 Health, Health Care and Insurance survey, this article provides a simulation of the likely effects of this mandate on CHI coverage and related inequalities in the general population by age, health status, socio-economic characteristics and time and risk preferences. We show that the non-coverage rate that was estimated to be 5% in 2012 will drop to 4% following the generalisation of employer-sponsored CHI and to 3.7% after accounting for portability coverage. The most vulnerable populations are expected to remain more often without CHI whereas non coverage will significantly decrease among the less risk averse and the more present oriented. With its focus on private sector employees, the policy is thus likely to do little for populations that would benefit most from additional insurance coverage while expanding coverage for other populations that appear to place little value on CHI.

      PubDate: 2017-01-06T18:59:23Z
      DOI: 10.1016/j.healthpol.2016.12.004
       
 
 
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