Subjects -> HEALTH AND SAFETY (Total: 1508 journals)
    - CIVIL DEFENSE (22 journals)
    - DRUG ABUSE AND ALCOHOLISM (86 journals)
    - HEALTH AND SAFETY (704 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (385 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (106 journals)
    - PHYSICAL FITNESS AND HYGIENE (123 journals)
    - WOMEN'S HEALTH (82 journals)

HEALTH AND SAFETY (704 journals)                  1 2 3 4 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access   (Followers: 2)
Acta Informatica Medica     Open Access  
Acta Scientiarum. Health Sciences     Open Access   (Followers: 2)
Adultspan Journal     Hybrid Journal   (Followers: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11)
Advances in Public Health     Open Access   (Followers: 27)
Adversity and Resilience Science : Journal of Research and Practice     Hybrid Journal   (Followers: 2)
African Health Sciences     Open Access   (Followers: 4)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 7)
African Journal of Health Professions Education     Open Access   (Followers: 6)
Afrimedic Journal     Open Access   (Followers: 2)
Ageing & Society     Hybrid Journal   (Followers: 43)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 6)
AJOB Empirical Bioethics     Hybrid Journal   (Followers: 3)
Akademika     Open Access   (Followers: 1)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Health Economics     Full-text available via subscription   (Followers: 18)
American Journal of Health Education     Hybrid Journal   (Followers: 34)
American Journal of Health Promotion     Hybrid Journal   (Followers: 34)
American Journal of Health Sciences     Open Access   (Followers: 10)
American Journal of Health Studies     Full-text available via subscription   (Followers: 13)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 29)
American Journal of Public Health     Full-text available via subscription   (Followers: 264)
American Journal of Public Health Research     Open Access   (Followers: 27)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 6)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 6)
Annales des Sciences de la Santé     Open Access  
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 12)
Annals of Health Law     Open Access   (Followers: 6)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 14)
Applied Biosafety     Hybrid Journal   (Followers: 1)
Applied Research In Health And Social Sciences: Interface And Interaction     Open Access   (Followers: 4)
Apuntes Universitarios     Open Access   (Followers: 1)
Archive of Community Health     Open Access   (Followers: 1)
Archives of Community Medicine and Public Health     Open Access   (Followers: 2)
Archives of Medicine and Health Sciences     Open Access   (Followers: 4)
Archives of Suicide Research     Hybrid Journal   (Followers: 7)
Archivos de Prevención de Riesgos Laborales     Open Access   (Followers: 1)
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 10)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 4)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 11)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 4)
Asian Journal of Medicine and Health     Open Access   (Followers: 1)
Atención Primaria     Open Access   (Followers: 2)
Atención Primaria Práctica     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 5)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 12)
Behavioral Healthcare     Full-text available via subscription   (Followers: 8)
Bijzijn     Hybrid Journal   (Followers: 1)
Bijzijn XL     Hybrid Journal  
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
Biosalud     Open Access   (Followers: 1)
Birat Journal of Health Sciences     Open Access  
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 7)
BMC Pregnancy and Childbirth     Open Access   (Followers: 22)
BMJ Simulation & Technology Enhanced Learning     Hybrid Journal   (Followers: 12)
Boletin Médico de Postgrado     Open Access  
Brazilian Journal of Medicine and Human Health     Open Access  
British Journal of Health Psychology     Hybrid Journal   (Followers: 49)
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 21)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Cambridge Quarterly of Healthcare Ethics     Hybrid Journal   (Followers: 12)
Canadian Family Physician     Partially Free   (Followers: 13)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 11)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 2)
Canadian Journal of Public Health     Hybrid Journal   (Followers: 23)
Cannabis and Cannabinoid Research     Hybrid Journal   (Followers: 1)
Carta Comunitaria     Open Access  
Case Reports in Women's Health     Open Access   (Followers: 4)
Case Studies in Fire Safety     Open Access   (Followers: 23)
CASUS : Revista de Investigación y Casos en Salud     Open Access   (Followers: 1)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
CES Medicina     Open Access  
CES Salud Pública     Open Access   (Followers: 1)
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 11)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access   (Followers: 2)
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia & Salud     Open Access   (Followers: 1)
Ciencia & Trabajo     Open Access   (Followers: 1)
Ciencia e Innovación en Salud     Open Access  
Ciencia y Cuidado     Open Access   (Followers: 1)
Ciencia y Salud     Open Access   (Followers: 4)
Ciencia y Salud Virtual     Open Access  
Ciencia, Tecnología y Salud     Open Access   (Followers: 2)
Cities & Health     Hybrid Journal   (Followers: 2)
Clinical and Experimental Health Sciences     Open Access   (Followers: 1)
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
Clocks & Sleep     Open Access   (Followers: 2)
CME     Hybrid Journal   (Followers: 2)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 5)
Conflict and Health     Open Access   (Followers: 8)
Contraception and Reproductive Medicine     Open Access   (Followers: 2)
Cuaderno de investigaciones: semilleros andina     Open Access   (Followers: 3)
Cuadernos de la Escuela de Salud Pública     Open Access  
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 10)
Current Opinion in Environmental Science & Health     Hybrid Journal   (Followers: 1)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Design for Health     Hybrid Journal  
Digital Health     Open Access   (Followers: 5)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 15)
Diversity of Research in Health Journal     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 3)
Drogues, santé et société     Open Access   (Followers: 2)
Duazary     Open Access   (Followers: 1)
Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi / Journal of Duzce University Health Sciences Institute     Open Access  
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 23)
East African Journal of Public Health     Full-text available via subscription   (Followers: 4)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 22)
EcoHealth     Hybrid Journal   (Followers: 5)
Education for Health     Open Access   (Followers: 8)
electronic Journal of Health Informatics     Open Access   (Followers: 6)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 5)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência : Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access   (Followers: 4)
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 5)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 6)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 20)
EsSEX : Revista Científica     Open Access   (Followers: 1)
Estudios sociales : Revista de alimentación contemporánea y desarrollo regional     Open Access   (Followers: 1)
Ethics & Human Research     Hybrid Journal   (Followers: 3)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 6)
Ethiopian Journal of Health Development     Open Access   (Followers: 7)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 8)
Ethnicity & Health     Hybrid Journal   (Followers: 14)
Eurasian Journal of Health Technology Assessment     Open Access  
EUREKA : Health Sciences     Open Access   (Followers: 2)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 4)
European Medical, Health and Pharmaceutical Journal     Open Access   (Followers: 1)
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-based Medicine & Public Health     Open Access   (Followers: 9)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 9)
Family & Community Health     Hybrid Journal   (Followers: 14)
Family Medicine and Community Health     Open Access   (Followers: 10)
Family Relations     Partially Free   (Followers: 14)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 2)
Finnish Journal of eHealth and eWelfare : Finjehew     Open Access  
Food and Public Health     Open Access   (Followers: 17)
Food Quality and Safety     Open Access   (Followers: 1)
Frontiers in Digital Health     Open Access  
Frontiers in Public Health     Open Access   (Followers: 8)
Frontiers of Health Services Management     Partially Free   (Followers: 3)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access   (Followers: 1)
Ganesha Journal     Open Access  
Gazi Sağlık Bilimleri Dergisi     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 9)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Advances in Health and Medicine     Open Access  
Global Challenges     Open Access  
Global Health : Science and Practice     Open Access   (Followers: 7)
Global Health Journal     Open Access   (Followers: 1)
Global Health Promotion     Hybrid Journal   (Followers: 17)
Global Journal of Health Science     Open Access   (Followers: 10)
Global Journal of Public Health     Open Access   (Followers: 13)
Global Medical & Health Communication     Open Access   (Followers: 2)
Global Mental Health     Open Access   (Followers: 9)
Global Reproductive Health     Open Access  
Global Security : Health, Science and Policy     Open Access   (Followers: 1)
Global Transitions     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 8)
Hacia la Promoción de la Salud     Open Access  
Hastane Öncesi Dergisi     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 4)
HCU Journal     Open Access  
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 17)
Health & Justice     Open Access   (Followers: 6)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 13)
Health and Human Rights     Open Access   (Followers: 10)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 10)
Health and Social Work     Hybrid Journal   (Followers: 69)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 3)
Health Care Analysis     Hybrid Journal   (Followers: 16)
Health Equity     Open Access  
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 23)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Notions     Open Access  

        1 2 3 4 | Last

Similar Journals
Journal Cover
Health Policy
Journal Prestige (SJR): 1.252
Citation Impact (citeScore): 2
Number of Followers: 48  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0168-8510 - ISSN (Online) 1872-6054
Published by Elsevier Homepage  [3204 journals]
  • Trends in the use of mind-altering drugs among European adolescents during
           the Great Recession
    • Abstract: Publication date: Available online 19 March 2020Source: Health PolicyAuthor(s): Nicoletta Balbo, Piergiorgio Carapella, Veronica Toffolutti
       
  • Delisting Eye Examinations from Public Health Insurance: Empirical
           Evidence from Canada regarding Impacts on Patients and Providers
    • Abstract: Publication date: Available online 19 March 2020Source: Health PolicyAuthor(s): Chao Wang, Arthur Sweetman
       
  • Moving Health Professionals as an alternative to moving Patients: The
           contribution of Overseas Visiting Medical Specialists to the health system
           in Malta
    • Abstract: Publication date: Available online 17 March 2020Source: Health PolicyAuthor(s): Annalise Casha, Ramon Casha, Natasha Azzopardi Muscat
       
  • Drug shortages as a result of parallel export in Poland –
           pharmacists’ opinions
    • Abstract: Publication date: Available online 16 March 2020Source: Health PolicyAuthor(s): Tomasz Zaprutko, Dorota Kopciuch, Maria Bronisz, Michał Michalak, Krzysztof Kus, Elżbieta Nowakowska
       
  • Integration and retention of American physician assistants/associates
           working in English hospitals: a qualitative study
    • Abstract: Publication date: Available online 16 March 2020Source: Health PolicyAuthor(s): Francesca Taylor, Vari M Drennan, Mary Halter, Melania Calestani
       
  • Strengthening Vaccination Programmes and Health Systems in the European
           Union: A Framework for Action
    • Abstract: Publication date: Available online 6 March 2020Source: Health PolicyAuthor(s): Luigi Siciliani, Claudia Wild, Martin McKee, Dionne Kringos, Margaret M. Barry, Pedro Pita Barros, Jan De Maeseneer, Liubove Murauskiene, Walter Ricciardi, On behalf of the members of the Expert Panel on Effective Ways of Investing in Health
       
  • The Portuguese generic medicines market: What’s next'
    • Abstract: Publication date: Available online 29 February 2020Source: Health PolicyAuthor(s): Alexandre Morais Nunes, Diogo Cunha Ferreira, Andreia de Matos, Rui Miranda Julião
       
  • Mapping variability in allocation of Long-Term Care funds across payer
           agencies in OECD countries
    • Abstract: Publication date: Available online 29 February 2020Source: Health PolicyAuthor(s): Ruth Waitzberg, Andrea E. Schmidt, Miriam Blümel, Anne Penneau, Antonis Farmakas, Åsa Ljungvall, Francesco Barbabella, Gonçalo Figueiredo Augusto, Gregory P. Marchildon, Ingrid Sperre Saunes, Dorja Vočanec, Iva Miloš, Joan Carles Cantel, Liubove Murauskiene, Madelon Kroneman, Marzena Tambor, Pavel Hroboň, Raphael Wittenberg, Sara Allin, Zeynep Or
       
  • Steering by their own lights: Why regulators across Europe use different
           indicators to measure healthcare quality
    • Abstract: Publication date: Available online 29 February 2020Source: Health PolicyAuthor(s): Anne-Laure Beaussier, David Demeritt, Alex Griffiths, Henry Rothstein
       
  • Out of Pocket or Out of Control: A Qualitative Analysis of Healthcare
           Professional Stakeholder Involvement in Pharmaceutical Policy Change in
           Ireland
    • Abstract: Publication date: Available online 28 February 2020Source: Health PolicyAuthor(s): Gary L O’Brien, Sarah-Jo Sinnott, Bridget O’ Flynn, Valerie Walshe, Mark Mulcahy, Stephen Byrne
       
  • Quality improvement in healthcare: Six Sigma systematic review
    • Abstract: Publication date: Available online 28 February 2020Source: Health PolicyAuthor(s): Angels Niñerola, María-Victoria Sánchez-Rebull, Ana-Beatriz Hernández-Lara
       
  • Provision of complementary and alternative medicine: Compliance with the
           health professional requirements
    • Abstract: Publication date: March 2020Source: Health Policy, Volume 124, Issue 3Author(s): Jitka Pokladnikova, Ivo Telec
       
  • Characterizing patients with high use of the primary and tertiary care
           systems: A retrospective cohort study
    • Abstract: Publication date: March 2020Source: Health Policy, Volume 124, Issue 3Author(s): Alexander Singer, Leanne Kosowan, Alan Katz, Paul Ronksley, Kerry McBrien, Gayle Halas, Tyler Williamson
       
  • Containing or shifting' Health expenditure decomposition for the aging
           Dutch population after a major reform
    • Abstract: Publication date: March 2020Source: Health Policy, Volume 124, Issue 3Author(s): Yvonne Krabbe-Alkemade, Peter Makai, Victoria Shestalova, Tessa Voesenek
       
  • Accessibility of cancer drugs in Switzerland: Time from approval to
           pricing decision between 2009 and 2018
    • Abstract: Publication date: March 2020Source: Health Policy, Volume 124, Issue 3Author(s): Kerstin N. Vokinger, Urs Jakob Muehlematter
       
  • Socioeconomic differences in prescription drug supplemental coverage in
           Canada: A repeated cross-sectional study
    • Abstract: Publication date: March 2020Source: Health Policy, Volume 124, Issue 3Author(s): Elaine Xiaoyu Guo, Arthur Sweetman, G. Emmanuel Guindon
       
  • Variation in the prescription drugs covered by health systems across
           high-income countries: A review of and recommendations for the academic
           literature
    • Abstract: Publication date: March 2020Source: Health Policy, Volume 124, Issue 3Author(s): Steven G. Morgan, Jamie R. Daw, Devon Greyson, Adrienne Shnier, Anne Holbrook, Joel Lexchin
       
  • Predictors of unmet needs and family debt among children and adolescents
           with an autism spectrum disorder: Evidence from Ireland
    • Abstract: Publication date: March 2020Source: Health Policy, Volume 124, Issue 3Author(s): Áine Roddy, Ciaran O’Neill
       
  • Additional reimbursement for outpatient physicians treating nursing home
           residents reduces avoidable hospital admissions: Results of a
           reimbursement change in Germany
    • Abstract: Publication date: Available online 24 February 2020Source: Health PolicyAuthor(s): Christian Kümpel, Udo Schneider
       
  • Impact of payment model on the behaviour of specialist physicians: a
           systematic review
    • Abstract: Publication date: Available online 22 February 2020Source: Health PolicyAuthor(s): Amity E. Quinn, Aaron J. Trachtenberg, Kerry A. McBrien, Yewande Ogundeji, Sepideh Souri, Liam Manns, Elissa Rennert-May, Paul Ronksley, Flora Au, Nikita Arora, Brenda Hemmelgarn, Marcello Tonelli, Braden J. Manns
       
  • Risk sharing in managed entry agreements—A review of the Swedish
           experience
    • Abstract: Publication date: Available online 18 February 2020Source: Health PolicyAuthor(s): Emelie Andersson, Johanna Svensson, Ulf Persson, Peter Lindgren
       
  • Unintended consequences of expenditure targets on resource allocation in
           health systems
    • Abstract: Publication date: Available online 12 February 2020Source: Health PolicyAuthor(s): Guido Noto, Paolo Belardi, Milena Vainieri
       
  • Factors underlying the growth of hospital expenditure in Spain in a period
           of unexpected economic shocks: A dynamic analysis on administrative data
    • Abstract: Publication date: Available online 7 February 2020Source: Health PolicyAuthor(s): Enrique Bernal-Delgado, Micaela Comendeiro-Maaløe, Manuel Ridao-López, Andreu Sansó Rosselló
       
  • An evaluation of universal vouchers as a demand-side subsidy to change
           primary care utilization: A retrospective analysis of longitudinal
           services utilisation and voucher claims data from a survey cohort in Hong
           Kong
    • Abstract: Publication date: February 2020Source: Health Policy, Volume 124, Issue 2Author(s): Eng-Kiong Yeoh, Carrie H.K. Yam, Ka-Chun Chong, Tsz-Yu Chow, Valerie L.H. Fung, Eliza L.Y. Wong, Sian M. Griffiths
       
  • Has the clinical governance development agenda stalled' Perceptions of
           New Zealand medical professionals in 2012 and 2017
    • Abstract: Publication date: February 2020Source: Health Policy, Volume 124, Issue 2Author(s): Robin Gauld, Simon Horsburgh
       
  • Convergence, decentralization and spatial effects: An analysis of Italian
           regional health outcomes
    • Abstract: Publication date: February 2020Source: Health Policy, Volume 124, Issue 2Author(s): Marina Cavalieri, Livio Ferrante
       
  • How does participating in a deliberative citizens panel on healthcare
           priority setting influence the views of participants'
    • Abstract: Publication date: February 2020Source: Health Policy, Volume 124, Issue 2Author(s): Vivian Reckers-Droog, Maarten Jansen, Leon Bijlmakers, Rob Baltussen, Werner Brouwer, Job van Exel
       
  • Applying priority-setting frameworks: A review of public and vulnerable
           populations’ participation in health-system priority setting
    • Abstract: Publication date: February 2020Source: Health Policy, Volume 124, Issue 2Author(s): S. Donya Razavi, Lydia Kapiriri, Michael Wilson, Julia Abelson
       
  • Selected factors determining outsourcing of basic operations in healthcare
           entities in Poland
    • Abstract: Publication date: Available online 31 January 2020Source: Health PolicyAuthor(s): Mariola Borowska, Anna Augustynowicz, Krzysztof Bobiński, Michał Waszkiewicz, Aleksandra Czerw
       
  • The effects of DRGs-based payment compared with cost-based payment on
           inpatient healthcare utilization: A systematic review and meta-analysis
    • Abstract: Publication date: Available online 25 January 2020Source: Health PolicyAuthor(s): Zhaolin Meng, Wen Hui, Yuanyi Cai, Jiazhou Liu, Huazhang Wu
       
  • Hospital staff shortages: Environmental and organizational determinants
           and implications for patient satisfaction
    • Abstract: Publication date: Available online 10 January 2020Source: Health PolicyAuthor(s): Vera Winter, Jonas Schreyögg, Andrea Thiel
       
  • Community involvement in the development and implementation of chronic
           condition programmes across the continuum of care in high- and
           upper-middle income countries: A systematic review
    • Abstract: Publication date: Available online 7 December 2019Source: Health PolicyAuthor(s): Victoria Haldane, Shweta R. Singh, Aastha Srivastava, Fiona L.H. Chuah, Gerald C.H. Koh, Kee Seng Chia, Pablo Perel, Helena Legido-Quigley
       
  • Achieving the SDGs: Evaluating indicators to be used to benchmark and
           monitor progress towards creating healthy and sustainable cities
    • Abstract: Publication date: Available online 7 March 2019Source: Health PolicyAuthor(s): Billie Giles-Corti, Melanie Lowe, Jonathan Arundel
       
  • Preventing HIV under financial constraints: the 2011-12 reform of the
           Portuguese HIV/AIDS Programme
    • Abstract: Publication date: Available online 22 February 2020Source: Health PolicyAuthor(s): G.F. Augusto, I. Aldir, J. Bettencourt, T. Melo, S.F. Dias, A. Abrantes, M.O. MartinsAbstractThe national HIV/AIDS Programme has been a core health programme in Portugal, and has led the country’s response to the HIV epidemics since the 1980s. In 2011, the Portuguese Government reorganised central services and reformed all vertical programmes, including the HIV/AIDS Programme. This paper describes the main features of that reform and analyses selected outcomes, as well as how those financial constraints affected the response to HIV/AIDS. Despite some transitory cuts in spending, the National Programme for HIV/AIDS Infection was able to successfully expand testing and prevention interventions. Strategic partnerships with non-governmental and community-based organisations were crucial to continue delivering adequate HIV testing services and reaching most-at-risk groups. Scaling-up access to pre-exposure prophylaxis (PrEP), improving access and adherence to antiretroviral therapy, and continuously promoting access to HIV testing services and HIV self-testing are the main challenges that the National Programme for HIV/AIDS Infection will face in the upcoming years.
       
  • Predictors of choice of public and private maternity care among
           nulliparous women in Ireland, and implications for maternity care and
           birth experience
    • Abstract: Publication date: Available online 22 February 2020Source: Health PolicyAuthor(s): Patrick S. Moran, Deirdre Daly, Francesca Wuytack, Margaret Carroll, Michael Turner, Charles Normand, Cecily BegleyAbstractMaternity care in Ireland is provided through a mixture of free public and fee-based private or semi-private services. We examined factors associated with choice of care pathway among nulliparous women and how this influences the care they receive and their experience of childbirth using data from a prospective cohort study. Complete data were available for 1,789 women on choice of care pathway and birth outcomes, and for 1,336 women on birth experience. Maternal age (marginal effect [ME] 1.6 percentage points [ppts], p 
       
  • Effect of a National Population-based Breast Cancer Screening Policy on
           Participation in Mammography and Stage at Breast Cancer Diagnosis in
           Taiwan
    • Abstract: Publication date: Available online 21 February 2020Source: Health PolicyAuthor(s): Cheng-Ting Shen, Fang-Ming Chen, Hui-Min HsiehAbstractIn Taiwan, a Cancer Screening Quality Improvement Program (CAQIP), implemented in 2010, provides financial support to qualified hospitals to improve accessibility. This study examined whether the CAQIP program increased participation in mammography and achieved more early stage diagnosis of breast cancer. We utilised a natural experiment to compare outcomes of interest in women aged 50-69 years with their first mammography date in two different phases, 2005-2009 and 2010-2014. Propensity score matching was used to match comparable cohorts in each phase. In total, 468,259 matched participants in phases 1 and 2 were analyzed. Patient-level logistic regressions were used and adjusted for patient risk factors. Compared with phase 1, our findings indicated women in phase 2 were more likely to have repeat mammography participation (OR, 1.33; 95% CI, 1.32-1.34), and be diagnosed with early stage breast cancer (OR, 1.15 times; 95% CI, 1.05-1.26). Women living in rural areas were less likely to repeatedly participate mammography (OR, 0.86; 95% CI, 0.85-0.86) and experience early diagnosis (OR, 0.90, 95% CI, 0.81-0.99). Women at low socioeconomic status were less likely to experience early diagnosis, and those with reproductive and hormonal risk factors were less likely to repeatedly participate mammography. Our findings provide evidence of potential benefits of health policy intervention to improve accessibility on participation in mammography and early stage diagnosis of breast cancer.
       
  • Between a rock and a hard place: comparing arms’ length bodies for
           public involvement in healthcare across the UK
    • Abstract: Publication date: Available online 21 February 2020Source: Health PolicyAuthor(s): Stewart Ellen, Angelo Ercia, Scott L. Greer, Peter D. DonnellyAbstractArms' length bodies are often seen as a tool of technocratic governance, designed to insulate decision-making from the politicizing pressures of populist influence. This article examines a subset of arms' length bodies in the UK which challenge this convention: agencies which exist to 'champion' the voice of patients and the public in the four NHS systems (England, Northern Ireland, Scotland and Wales). We compare the functions of these agencies on paper and through qualitative interviews in each system which focused on public involvement in major service change (such as closing hospitals). We found that agencies in all four systems had struggled to demonstrate their legitimacy, squeezed between the demands of the elected Governments they answer to, the NHS organisations they are meant to support and challenge, and the publics whose voices they are meant to amplify. We argue that the evolving solutions found in each system demonstrate a foundational tension between locally- legitimate actors and nationally-capable political savvy.
       
  • Lost in definitions: reducing duplication and clarifying definitions of
           knowledge and decision support tools. A RAND-modified Delphi consensus
           study
    • Abstract: Publication date: Available online 21 February 2020Source: Health PolicyAuthor(s): Dunja Dreesens, Leontien Kremer, Jako Burgers, Trudy van der WeijdenAbstractBackgroundA review of tools for knowledge translation and decision support yielded an abundance of tool types and confusion over the definitions of these knowledge tools. The aim of this study was to limit the number of tool types, reach consensus on their definitions and clarify their intended use.MethodsWe used the RAND-modified Delphi approach to select a core set of knowledge tools and to reach agreement on the tools’ definitions. The knowledge tool types were scored using a Likert scale in two Delphi rounds on importance; the provided definitions were also scored and commented on by the experts.ResultsOver 20 experts from parties involved with development of knowledge and decision support tools limited the number of tool types from 34 to 13. The participants reached consensus on nine tools as being important for knowledge translation and supporting (shared) decision-making. Furthermore, they reached consensus on the definition of five of the 13 tools.Conclusions/discussionA large group of experts, representatives of Dutch knowledge developers, managed to reach consensus on a core set of 13 knowledge tool types for the Netherlands. Implementing the use of this set and limiting the expansion with other tool types remains challenging.
       
  • Hospital reforms in 11 Central and Eastern European countries between 2008
           and 2019: a comparative analysis
    • Abstract: Publication date: Available online 20 February 2020Source: Health PolicyAuthor(s): K. Dubas-Jakóbczyk, T. Albreht, D. Behmane, L. Bryndova, A. Dimova, A. Džakula, T. Habicht, L. Murauskiene, S.G. Scîntee, M. Smatana, Z. Velkey, W. QuentinAbstractThis paper aims to: (1) provide a brief overview of hospital sector characteristics in 11 Central and Eastern European countries (Bulgaria, Czech Republic, Estonia, Croatia, Latvia, Lithuania, Hungary, Poland, Romania, Slovakia, Slovenia); (2) compare recent (2008 – 2019) hospital reforms in these countries; and (3) identify common trends, success factors and challenges for reforms. Methods applied involved five stages: (1) a theoretical framework of hospital sector reforms was developed; (2) basic quantitative data characterizing hospital sectors were compared; (3) a scoping review was performed to identify an initial list of reforms per country; (4) the list was sent to national researchers who described the top three reforms based on a standardized questionnaire; (5) received questionnaires were analysed and validated with available literature. Results indicate that the scope of conducted reforms is very broad. Yet, reforms related to hospital sector governance and changes in purchasing and payment systems are much more frequent than reforms concerning relations with other providers. Most governance reforms aimed at transforming hospital infrastructure, improving financial management and/or improving quality of care, while purchasing and payment reforms focused on limiting hospital activities and/or on incentivising a shift to ambulatory/day care. Three common challenges included the lack of a comprehensive approach; unclear outcomes; and political influence. Given similar reform areas across countries, there is considerable potential for shared learning.
       
  • Health promotion policies for elderly – some comparisons across Germany,
           Italy, the Netherlands and Poland
    • Abstract: Publication date: Available online 11 February 2020Source: Health PolicyAuthor(s): Jelena Arsenijevic, Wim GrootAbstractObjectiveThe aim of this study is to compare health promotion policies (HPP) for older adults in four European countries: Germany, Italy, the Netherlands and Poland. We focus on the design, regulations and implementation of policies in these countries.MethodAs policy relevant information is mostly available in national languages we have approached experts in each country. They filled in a specially designed questionnaire on the design, regulation and implementation of health promotion policies. To analyze the data collected via questionnaires, we use framework analyses. For each subject we define several themes.ResultsRegarding regulations, Poland and Italy have a top-down regulation system for health promotion policy. Germany and Netherlands have a mixed system of regulation. Regarding the scope of the policy, in all four countries both health promotion and prevention are included. Activities include promotion of a healthy life style and social inclusion measures. In Poland and Italy the implementation plans for policy measures are not clearly defined. Clear implementation plans and budgeting are available in Germany and the NetherlandsConclusionsIn all four countries there is no document that exclusively addresses health promotion policies for older adults. We also found that HPP for older adults appears to be gradually disappearing from the national agenda in all four countries.
       
  • Alcohol control policy: The emperor’s new clothes'
    • Abstract: Publication date: Available online 25 January 2020Source: Health PolicyAuthor(s): Alain Braillon
       
  • Healthcare Spending Inequality: Evidence from Hungarian Administrative
           Data
    • Abstract: Publication date: Available online 23 January 2020Source: Health PolicyAuthor(s): Aniko Biro, Dániel PrinzAbstractUsing administrative data on a random 50% of the Hungarian population, including individual-level information on incomes, healthcare spending, and mortality for the 2003-2011 period, we develop new evidence on the distribution of healthcare spending and mortality in Hungary by income and geography. By linking detailed administrative data on employment, income, and geographic location with measures of healthcare spending and mortality we are able to provide a more complete picture than the existing literature which has relied on survey data. We compute mean spending and 5-year and 8-year mortality measures by geography and income quantiles, and also present gender and age adjusted results.We document four patterns: (i) substantial geographic heterogeneity in healthcare spending; (ii) positive association between labor income and public healthcare spending; (iii) geographic variation in the strength of the association between labor income and healthcare spending; and (iv) negative association between labor income and mortality. In further exploratory analysis, we find no statistically significant correlation between simple county-level supply measures and healthcare spending. We argue that taken together, these patterns suggest that individuals with higher labor income are in better health but consume more healthcare because they have better access to services.Our work suggests new directions for research on the relationship between health inequalities and healthcare spending inequalities and the role of subtler barriers to healthcare access.
       
  • REVIVING CLINICAL GOVERNANCE' A QUALITATIVE STUDY OF THE IMPACT OF
           PROFESSIONAL REGULATORY REFORM ON CLINICAL GOVERNANCE IN HEALTHCARE
           ORGANISATIONS IN ENGLAND
    • Abstract: Publication date: Available online 22 January 2020Source: Health PolicyAuthor(s): Tristan Price, John Tredinnick-Rowe, Kieran Walshe, Abigail Tazzyman, Jane Ferguson, Alan Boyd, Julian Archer, Marie BryceABSTRACTBackgroundUntil recently, processes of professional regulation and organisational clinical governance in the UK have been largely separate. However, the introduction of medical revalidation in 2012 means that all doctors have to demonstrate periodically to the regulator that they are up to date and fit to practise, and as part of this process doctors must engage with clinical governance activities in the organisations in which they work.ObjectiveTo explore how the recent implementation of medical revalidation has affected the arrangements for clinical governance in healthcare organisations in England.DesignThematic analysis of interviews with 62 senior clinicians and non-clinicians in management or senior administrative roles, from a range of healthcare organisations in England.ResultsRevalidation has engendered changes to clinical governance systems, resulting in: increased doctor engagement with clinical governance activities; new or improved systems for access to clinical governance data for doctors and leaders within healthcare organisations; and more leverage - through the Responsible Officer role – to enforce engagement with clinical governance. Organisational context has been an important mediator of the impact of revalidation on clinical governance.ConclusionRevalidation has increased alignment between systems for organisational and professional oversight and accountability, resulting in increased scrutiny of clinical practice. However, it is still a matter of conjecture whether this will in turn lead to improvements in medical performance.
       
  • Comparing the education gradient in health deterioration among the elderly
           in six OECD countries
    • Abstract: Publication date: Available online 17 January 2020Source: Health PolicyAuthor(s): Aurelie Côté-Sergent, Raquel Fonseca, Erin StrumpfAbstractInequalities in health by educational attainment are persistent both over time and across countries. However, their magnitudes, evolution, and main drivers are not necessarily consistent across jurisdictions. We examine the health deterioration-education gradient among older adults in the United States, Canada, France, the Netherlands, Spain and Italy, including how it changes over time between 2004 and 2010. Using longitudinal survey data, we first assess how rates of health deterioration in terms of poor health, difficulties with activities of daily living, and chronic conditions vary by educational attainment. We find systematic differences in rates of health deterioration, as well as in the health deterioration-education gradients, across countries. We then examine how potential confounders, including demographic characteristics, income, health care utilisation and health behaviours, affect the health deterioration-education gradient within countries over time. We demonstrate that while adjusting for confounders generally diminishes the health deterioration-education gradient, the impacts of these variables vary somewhat across countries. Our findings suggest that determinants of, and policy levers to affect, the health deterioration-education gradient likely vary across countries and health systems.
       
  • Exploring the impacts of organisational structure, policy and practice on
           the health inequalities of marginalised communities: Illustrative cases
           from the UK healthcare system
    • Abstract: Publication date: Available online 16 January 2020Source: Health PolicyAuthor(s): Ada Hui, Asam Latif, Kathryn Hinsliff-Smith, Timothy ChenAbstractThis paper explores how organisational structure, policies and practices in healthcare can inadvertently disadvantage marginalised populations (e.g. individuals from ethnic minority backgrounds) and reinforce health inequalities. We draw upon three diverse UK healthcare settings (long term care institutions, high security hospitals and community pharmacies) to illustrate how systemic injustices negatively impact on access to care, treatment and health outcomes. The first case study considers the care of older people within nursing homes; specifically the disempowering effects of this service structure and impacts of choice reduction upon health and their access to health provision. The second case study explores the impact of security restrictions upon patients within high security hospitals, focusing particularly on the maintenance of relationships and support networks outside of the hospital. The third and final case study, draws upon the national community pharmacy medicine management service to illustrate ways in which policies and guidelines inadvertently obstruct patients' engagement with the service within a community setting. We draw upon these settings to highlight inequalities within different contexts and to illustrate the ways in which well intended services can inadvertently disadvantage marginalised communities in multiple ways.
       
  • Tackling the problem of regulatory pressure in Dutch elderly care: the
           need for recoupling to establish functional rules
    • Abstract: Publication date: Available online 15 January 2020Source: Health PolicyAuthor(s): Hester M. van de Bovenkamp, Annemiek Stoopendaal, Marianne van Bochove, Roland BalAbstractRegulatory pressure is widely recognized as a problem in healthcare. At first sight the solution seems simple: discard rules and give caregivers more resources to provide personalized care. Based on qualitative research in four elderly care organizations in the Netherlands, this paper shows that regulatory pressure is a persistent problem that cannot be solved on an individual level, as it results from a disconnect between the work of different actors in the healthcare system. Drawing on concepts from Organization Studies, the paper shows that the work of caregivers, healthcare managers and external actors is often decoupled. Caregivers experience regulatory pressure when the origin and function of rules are unclear. The studied care organizations are experimenting with rules, reconsidering and creating functional rules. They do so by stimulating reflection among actors in the healthcare system, thereby recoupling their work. The findings suggest that recoupling can be achieved by creating comfort zones, focusing on stimulating debate between stakeholders on the functionality and origin of rules and aligning ideas about good quality care, the role different actors can play and the rules that are needed to accommodate this.
       
  • The 2019 Neuro-Rehabilitation Implementation Framework in Ireland:
           challenges for implementation and the implications for people with brain
           injuries
    • Abstract: Publication date: Available online 9 January 2020Source: Health PolicyAuthor(s): Sara Burke, Grainne McGettrick, Karen Foley, Manjula Manikandan, Sarah BarryAbstractIn 2019, eight years after the publication of Ireland’s first neuro-rehabilitation strategy, an implementation framework was published. This paper describes and assesses the Irish health policy journey to the publication of the 2019 Implementation Framework with a particular focus on tracking the rehabilitation needs of people with acquired brain injury (ABI).Internationally, rehabilitation services are a low priority for governments, with policy makers having limited knowledge and understanding of rehabilitation. This low political priority and policy understanding contributes to under-developed and poorly co-ordinated services for people who need neuro-rehabilitation services, including people with Acquired Brain Injury (ABI).Despite the publication of the 2019 Implementation Framework, key challenges remain for people with ABI in Ireland, including the absence of services across the ‘pathway’, the under-resourcing of specialist rehabilitation services, the impact on the lives of people with brain injury of poor or no access to services, and the lack of good data on this population. The paper concludes with recommendations on how increased political priority of the rehabilitation needs of people with ABI could enhance implementation of the Neuro-Rehabilitation Implementation Framework.
       
  • Health workforce monitoring in Portugal: does it support strategic
           planning and policy-making'
    • Abstract: Publication date: Available online 7 January 2020Source: Health PolicyAuthor(s): Tiago Correia, Inês Gomes, Patrícia Nunes, Gilles DussaultAbstractThe quality of the available information on Human Resources for Health (HRH) is critical to planning strategically the future workforce needs. This article aims to assess HRH monitoring in Portugal: the data availability, comparability and quality.A scoping review of academic literature was conducted, which included 76 empirical studies. The content analysis was guided by the World Health Organization ‘AAAQ framework’ that covers availability, accessibility, acceptability and quality of the health workforce.The analysis identified three types of problems affecting HRH monitoring in Portugal: insufficient data, the non-use of available data, and the general lack of analysis of the HRH situation. As a consequence, the data availability, comparability and quality is poor, and therefore HRH monitoring in Portugal makes strategic planning of the future health workforce difficult.Recommendations to improve HRH monitoring include: 1) make data collection aligned with the standardized indicators and guidelines by the Joint Eurostat-OECD-World Health Organization questionnaire on Non-Monetary Health Care Statistics; 2) cover the whole workforce, which includes professions, sectors and services; 3) create a mechanism of permanent monitoring and analysis of HRH at the country level.
       
  • A systematic review of case-mix models for home health care payment:
           Making sense of variation
    • Abstract: Publication date: Available online 2 January 2020Source: Health PolicyAuthor(s): Anne O.E. van den Bulck, Maud de Korte, Arianne M.J. Elissen, Silke F. Metzelthin, Misja C. Mikkers, Dirk RuwaardAbstractBackgroundCase-mix based payment of health care services offers potential to contain expenditure growth and simultaneously support needs-based care provision. However, limited evidence exists on its application in home health care (HHC). Therefore, this study aimed to synthesize available international literature on existing case-mix models for HHC payment.MethodsWe performed a systematic review of scientific literature, supplemented with grey literature. We searched for literature using six scientific databases, reference lists, expert consultation, and targeted websites. Data on study design, case-mix model attributes, and conclusions were extracted narratively.ResultsOf 3,303 references found, 22 scientific studies and 27 grey documents met eligibility criteria. Eight case-mix models for HHC were identified, from the US, Canada, New Zealand, Australia, and Germany. Three countries have implemented a case-mix model as part of a HHC payment system. Different combinations of in total 127 unique case-mix predictors are included across models to predict HHC use. Case-mix models also differ in targeted services, operationalization, and outcome measures and predictive power.ConclusionsCase-mix based payment is not yet widely used within HHC. Multiple varieties were found between HHC case-mix models, and no one best form of a model seems to exist. Even though varieties are partly inevitable due to country-specific contexts, developing a shared vision in case-mix model attributes would be key to achieving efficient, needs-based HHC.
       
  • The controversy on HPV vaccination in Japan: Criticism of the ethical
           validity of the arguments for the suspension of the proactive
           recommendation
    • Abstract: Publication date: Available online 26 December 2019Source: Health PolicyAuthor(s): Taketoshi Okita, Aya Enzo, Yasuhiro Kadooka, Masashi Tanaka, Atsushi AsaiAbstractThe Human Papillomavirus (HPV) vaccine was integrated into Japan’s national immunization program (NIP) in April 2013. However, numerous instances of serious adverse reactions were widely reported in the media, resulting in the Ministry of Health, Labor, and Welfare (MHLW) suspending the official recommendation of the HPV vaccine on June 14, 2013. Investigating the reported incidents, the Vaccine Adverse Reactions Review Committee (VARRC)—an MHLW advisory committee—found no high-quality evidence supporting a causal relationship between the reported events and the HPV vaccination. However, rather than lifting the suspension, they have opted to maintain a “pseudo informed consent” confirming the perceptions of Japanese citizens regarding the vaccine. Accordingly, there appears to be a fundamental difference in the approach to vaccine policymaking between Japan (MHLW/VARRC) and other countries and the World Health Organization, which base policy decisions on the effectiveness and safety of the vaccine. Consequently, the arguments for the suspension of the HPV vaccine recommendation are not ethically appropriate. Relevant bodies must make a clear decision regarding the HPV vaccine and its status in the NIP: the proactive recommendation must either be reinstated or the HPV vaccine legal framework altered to rely entirely on voluntary individual decisions.
       
  • The Relation between Selective Contracting and Healthcare Expenditures in
           Private Health Insurance Plans in the United States
    • Abstract: Publication date: Available online 23 December 2019Source: Health PolicyAuthor(s): Eline M. van den Broek-Altenburg, Adam J. AtherlyAbstractMany healthcare systems, including The Netherlands, Germany and Switzerland, have incorporated elements of managed competition, whereby insurers compete for enrollees in a marketplace organized or facilitated by a government or governing entity. In these countries, managed competition was introduced with the idea that the system would contain cost growth while maximizing value for consumers and employers. An important mechanism to control costs is selective contracting: the process of contracting providers into a network and offer insurance packages with varying levels of provider coverage. In these systems, enrollees are expected to choose lower cost plans which offer access to only contracted providers in the network. The questions is, however, if restricting provider choice leads to reduced healthcare expenditures.In the United States, enrollees often have a choice between plans with restricted networks of providers and plans that offer more provider choice, where care outside the contracted network of providers is (partly) covered. The purpose of this study is to understand whether insurance plans with restrictions on provider access in the United States have reduced healthcare expenditures and to identify the mechanism by which that reduction occurred. We used data from the Medical Expenditure Panel Survey (MEPS), a nationally representative sample of families and individuals. We estimated expenditures for enrollees in restricted network plans using two-part models and generalized linear models. We found that restricted network plans, on average, save $761 per enrollee.Our results suggest that cost savings due to restricted network plans are largely a result of price reductions rather than utilization reductions, although both play a role in cost savings. When introducing reforms shifting from a supply‐oriented to a demand‐oriented health care system, these findings might be worth considering by other countries.
       
  • The development of the Primary Care Clusters Multidimensional Assessment
           (PCCMA): A mixed-methods study
    • Abstract: Publication date: Available online 13 December 2019Source: Health PolicyAuthor(s): Marian Andrei Stanciu, Rebecca-Jane Law, Paul Myres, Rachel Parsonage, Julia Hiscock, Nefyn Williams, Clare WilkinsonAbstractA strong primary care (PC) system is essential for an efficient and high-quality healthcare service. Many countries have adopted a model of PC that encourages different healthcare providers to work together, at scale, in multidisciplinary/multiagency teams (PC clusters). The aim of the present work was to develop a quantitative instrument for the systematic and comprehensive assessment of PC clusters. This was a non-experimental, mixed-methods study grouping four work packages (WP), and involving PC cluster leads and a wide range of key stakeholders from across Wales. Interviews with 22 PC cluster leads (34 %) investigated the clusters' functioning (WP1). A systematic review identified relevant PC assessment frameworks and instruments (WP2). An expert group reviewed the evidence and drafted the new assessment tool, further evaluated and amended in two stakeholder workshops (WP3).Thirty-eight cluster leads (62 %) completed the newly developed online assessment (WP4). The final instrument consisted of 53 indicators, across 11 systemic dimensions of PC and produced a comprehensive assessment of the functioning of PC clusters in Wales. This rigorous early development of an innovative instrument to evaluate PC at a scaled-up (cluster) level (particularly in the format of a 360-degree assessment) can inform healthcare policy decisions regarding the expansion and ongoing adjustment of the model in response to local needs and challenges.
       
  • Do pharmaceutical budgets deliver financial sustainability in
           healthcare' Evidence from Europe
    • Abstract: Publication date: Available online 12 December 2019Source: Health PolicyAuthor(s): Mackenzie Mills, Panos KanavosAbstractPayers have increasingly implemented a variety cost-containment measures to promote sustainability within the pharmaceutical sector. This paper provides an assessment of a range of different applications of budgets within the pharmaceutical sector and assesses the impact of pharmaceutical budgets in the context of health financing goals. A comprehensive literature review was carried out in order to identify evidence on the presence and impact of budget capping in the pharmaceutical sector and an analytical framework was developed. Evidence generated from the literature was validated by experts in pharmaceutical policy through a round-table meeting and a series of semi-structured interviews. Five broad types of budgets were employed in the pharmaceutical sector: global, regional, disease-specific, product-specific, and prescribing. Global budgets on total pharmaceutical expenditure are relatively straightforward tools for promoting cost-containment however their use often restricts flexibility in terms of total health budget allocation. Disease specific budgets without consequences for exceeding the budget are unlikely to promote fiscal sustainability as these budgets are frequently exceeded. Product specific budgets and prescribing budgets can play an important role in promoting microeconomic efficiency however evidence on their impact is mixed. Overall, budgets are present at both macroeconomic and microeconomic levels. While they are important tools for promoting fiscal sustainability, additional policy measures are needed to further enhance value for money within the pharmaceutical sector.
       
  • Transparency about internal audit results to reduce the supervisory
           
    • Abstract: Publication date: Available online 7 December 2019Source: Health PolicyAuthor(s): Mirelle Hanskamp-Sebregts, Paul B. Robben, Hub Wollersheim, Marieke ZegersAbstractMany working hours of healthcare professionals are spent on administrative tasks. Administrative burden is caused by political choices, legislation, the requirements of health insurers and supervisors. Coordination between the parties involved, is lacking. Therefore, we studied to what extent sharing internal audit results of hospitals with external supervisors is possible and the necessary preconditions. We interviewed 42 individuals from six hospitals and the Dutch Health and Youth Care Inspectorate.The interviewees expressed that there is no coordination in timing and content between internal audits and external supervision. They were in favour of sharing internal audit results with external supervisors to reduce the supervisory burden. They stated that internal audits give insight into quality problems and improvements, how hospital directors govern quality and safety, and the culture of improvement within healthcare provider teams. With this information, the inspectorate can judge to what extent hospitals are learning organisations. The interviewees mentioned the following preconditions for sharing audit results: reliable and risk-based information about quality and safety, collected by expert, trained auditors, and careful use of this information by the inspectorate in order to maintain openness among audited healthcare professionals.In conclusion, internal audit results can be shared conditionally with external supervisors. When internal audit results show that hospitals are open, learning and self-reflecting organisations, the healthcare inspectorate can reduce their supervisory burden.
       
  • Knowledge management infrastructure to support quality improvement: A
           qualitative study of maternity services in four European hospitals
    • Abstract: Publication date: Available online 22 November 2019Source: Health PolicyAuthor(s): Anette Karltun, Johan M. Sanne, Karina Aase, Janet E. Anderson, Alexandra Fernandes, Naomi J. Fulop, Per J. Höglund, Boel Andersson-GareAbstractThe influence of multilevel healthcare system interactions on clinical quality improvement (QI) is still largely unexplored. Through the lens of knowledge management (KM) theory, this study explores how hospital managers can enhance the conditions for clinical QI given the specific multilevel and professional interactions in various healthcare systems.The research used an in-depth multilevel analysis in maternity departments in four purposively sampled European hospitals (Portugal, England, Norway and Sweden). The study combines analysis of macro-level policy documents and regulations with semi-structured interviews (96) and non-participant observations (193 hours) of hospital and clinical managers and clinical staff in maternity departments.There are four main conclusions: First, the unique multilevel configuration of national healthcare policy, hospital management and clinical professionals influence the development of clinical QI efforts. Second, these different configurations provide various and often insufficient support and guidance which affect professionals’ action strategies in QI efforts. Third, hospital managers’ opportunities and capabilities for developing a consistent KM infrastructure with reinforcing enabling conditions which merge national policies and guidelines with clinical reality is crucial for clinical QI. Fourth, understanding these interrelationships provides an opportunity for improvement of the KM infrastructure for hospital managers through tailored interventions.
       
  • New partnerships, new perspectives: The relevance of sexual and
           reproductive health and rights for sustainable development
    • Abstract: Publication date: Available online 16 March 2019Source: Health PolicyAuthor(s): Susannah H. Mayhew, Karen Newman, David Johnson, Emily Clark, Michael Hammer, Vik Mohan, Sarah SsaliAbstractIn the light of the opportunities presented by the Sustainable Development Goals (SDGs) debate is being reignited to understand the connections between human population dynamics (including rapid population growth) and sustainable development. Sustainable development is seriously affected by human population dynamics yet programme planners too often fail to consider them in development programming, casting doubt on the sustainability of such programming. Some innovative initiatives are attempting to cross sector boundaries once again, such as the Population Health and Environment (PHE) programmes, which are integrated programmes encompassing family planning service provision with broader public health services and environmental conservation activities. These initiatives take on greater prominence in the context of the SDGs since they explicitly seek to provide cross-sector programming and governance to improve both human and planetary wellbeing. Yet such initiatives remain under-researched and under promoted.
       
 
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