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  Subjects -> HEALTH AND SAFETY (Total: 1290 journals)
    - CIVIL DEFENSE (18 journals)
    - DRUG ABUSE AND ALCOHOLISM (86 journals)
    - HEALTH AND SAFETY (520 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (378 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (106 journals)
    - PHYSICAL FITNESS AND HYGIENE (101 journals)
    - WOMEN'S HEALTH (81 journals)

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

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
A Life in the Day     Hybrid Journal   (Followers: 9)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access  
Adultspan Journal     Hybrid Journal  
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 20)
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: 3)
AJOB Primary Research     Partially Free   (Followers: 3)
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: 26)
American Journal of Health Promotion     Hybrid Journal   (Followers: 22)
American Journal of Health Studies     Full-text available via subscription   (Followers: 9)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 21)
American Journal of Public Health     Full-text available via subscription   (Followers: 181)
American Journal of Public Health Research     Open Access   (Followers: 25)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 9)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 2)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Association of Schools of Allied Health Professions     Full-text available via subscription   (Followers: 6)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 2)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 1)
Behavioral Healthcare     Full-text available via subscription   (Followers: 5)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 7)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 18)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 7)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 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: 11)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access  
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 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: 3)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 16)
EcoHealth     Hybrid Journal   (Followers: 3)
Education for Health     Open Access   (Followers: 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: 5)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access  
Environmental Sciences Europe     Open Access   (Followers: 1)
Epidemics     Open Access   (Followers: 3)
Epidemiologic Perspectives & Innovations     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: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 7)
Ethnicity & Health     Hybrid Journal   (Followers: 13)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 2)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 9)
Evidence-based Medicine & Public Health     Open Access   (Followers: 4)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 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: 7)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 11)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 5)
Global Health Promotion     Hybrid Journal   (Followers: 15)
Global Journal of Health Science     Open Access   (Followers: 7)
Global Journal of Public Health     Open Access   (Followers: 10)
Global Medical & Health Communication     Open Access  
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 3)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 15)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 7)
Health and Human Rights     Free   (Followers: 8)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 7)
Health and Social Work     Hybrid Journal   (Followers: 47)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 12)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 11)
Health Issues     Full-text available via subscription   (Followers: 1)
Health Policy     Hybrid Journal   (Followers: 33)
Health Policy and Technology     Hybrid Journal   (Followers: 1)
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 21)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 10)
Health Promotion Practice     Hybrid Journal   (Followers: 15)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 46)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 39)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 9)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 2)
Health Services Insights     Open Access   (Followers: 2)
Health Systems     Hybrid Journal   (Followers: 2)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 11)
Health, Risk & Society     Hybrid Journal   (Followers: 11)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 10)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 5)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 3)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 3)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 2)
Indonesian Journal for Health Sciences     Open Access   (Followers: 1)
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 6)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 5)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 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: 5)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 19)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 14)
International Journal of Health & Allied Sciences     Open Access   (Followers: 2)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 7)
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 Research     Open Access   (Followers: 4)

        1 2 3 | Last

Journal Cover Health Policy
  [SJR: 1.182]   [H-I: 36]   [33 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0168-8510
   Published by Elsevier Homepage  [3042 journals]
  • Approaches to appropriate care delivery from a policy perspective: A case
           study of Australia, England and Switzerland
    • Authors: Joelle Robertson-Preidler; Matthew Anstey; Nikola Biller-Andorno; Alexandra Norrish
      Pages: 770 - 777
      Abstract: Publication date: July 2017
      Source:Health Policy, Volume 121, Issue 7
      Author(s): Joelle Robertson-Preidler, Matthew Anstey, Nikola Biller-Andorno, Alexandra Norrish
      Background Appropriateness is a conceptual way for health systems to balance Triple Aim priorities for improving population health, containing per capita cost, and improving the patient experience of care. Comparing system approaches to appropriate care delivery can help health systems establish priorities and facilitate appropriate care practices. Methods We conceptualized system appropriateness by identifying policies that aim to achieve the Triple Aim and their consequent trade-offs for financing, clinical practice, and the individual patient. We used secondary data sources to compare the appropriate care approaches of Australia, England, and Switzerland according to financial, clinical, and individual appropriateness policies. Findings Health system approaches to appropriate care delivery varied. England prioritizes public health, equity and efficiency at the expense of individual choice, while Switzerland focuses on individual patient preferences, but has higher per capita and out of pocket costs. Australia provides equity in public care access and private health care options that allows for more patient choice, with health care costs falling between the two. Conclusions Integrating the Triple Aim into health system design and policy can facilitate appropriate care delivery at the system, clinical, and individual levels. Approaches will vary and require countries to negotiate and justify priorities and trade-offs within the context of thehealth system.

      PubDate: 2017-07-08T10:06:20Z
      DOI: 10.1016/j.healthpol.2017.04.009
       
  • Including values in evidence-based policy making for breast screening: An
           empirically grounded tool to assist expert decision makers
    • Authors: Lisa Parker
      Pages: 793 - 799
      Abstract: Publication date: July 2017
      Source:Health Policy, Volume 121, Issue 7
      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: 2017-07-08T10:06:20Z
      DOI: 10.1016/j.healthpol.2017.03.002
       
  • Increase in computed tomography in Australia driven mainly by practice
           change: A decomposition analysis
    • Authors: Cameron M. Wright; Max K. Bulsara; Richard Norman; Rachael E. Moorin
      Pages: 823 - 829
      Abstract: Publication date: July 2017
      Source:Health Policy, Volume 121, Issue 7
      Author(s): Cameron M. Wright, Max K. Bulsara, Richard Norman, Rachael E. Moorin
      Background Publicly funded computed tomography (CT) procedure descriptions in Australia often specify the body site, rather than indication for use. This study aimed to evaluate the relative contribution of demographic versus non-demographic factors in driving the increase in CT services in Australia. Methods A decomposition analysis was conducted to assess the proportion of additional CT attributable to changing population structure, CT use on a per capita basis (CPC, a proxy for change in practice) and/or cost of CT. Aggregated Medicare usage and billing data were obtained for selected years between 1993/4 and 2012/3. Results The number of billed CT scans rose from 33 per annum per 1000 of population in 1993/94 (total 572,925) to 112 per 1000 by 2012/13 (total 2,540,546). The respective cost to Medicare rose from $145.7 million to $790.7 million. Change in CPC was the most important factor accounting for changes in CT services (88%) and cost (65%) over the study period. Conclusions While this study cannot conclude if the increase is appropriate, it does represent a shift in how CT is used, relative to when many CT services were listed for public funding. This ‘scope shift’ poses questions as to need for and frequency of retrospective/ongoing review of publicly funded services, as medical advances and other demand- or supply-side factors change the way health services are used.

      PubDate: 2017-07-08T10:06:20Z
      DOI: 10.1016/j.healthpol.2017.04.010
       
  • Assessing impacts of the WHO FCTC on national legislations: A case study
           of the Republic of Korea
    • Authors: Sun Goo Lee
      Pages: 604 - 612
      Abstract: Publication date: June 2017
      Source:Health Policy, Volume 121, Issue 6
      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 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: 2017-05-26T05:33:33Z
      DOI: 10.1016/j.healthpol.2017.02.017
       
  • What do we mean when we talk about the Triple Aim? A systematic review of
           evolving definitions and adaptations of the framework at the health system
           level
    • Authors: Gustavo Mery; Shilpi Majumder; Adalsteinn Brown; Mark J. Dobrow
      Pages: 629 - 636
      Abstract: Publication date: June 2017
      Source:Health Policy, Volume 121, Issue 6
      Author(s): Gustavo Mery, Shilpi Majumder, Adalsteinn Brown, Mark J. Dobrow
      Notwithstanding important contributions of the Triple Aim, uncritical enthusiasm regarding the implications of the framework may be leading to inconsistent use, particularly when applied at the health system level, which goes beyond the original positioning of the framework as a strategic organizing principle to guide improvement initiatives at the organizational or local community level. We systematically identified uses of the Triple Aim that extended beyond its original intention to focus on uses at the whole health system level, to assess convergence and divergence with the original definition. We also attempted to identify consistencies in the way the Triple Aim was adapted for different contexts and settings. Data sources were indexed databases, web search engines, and international experts. Forty-seven articles were included in the analysis. We found that the definition of the Triple Aim has been subject to important modifications when the framework is used to define goals for whole health care systems or globally. Despite widespread recognition of the name, what constitutes the Triple Aim framework varies. We identified the need to consider the inclusion of at least two additional aims of health care systems – the provider experience of care, and the desire to achieve health equity for populations.

      PubDate: 2017-05-26T05:33:33Z
      DOI: 10.1016/j.healthpol.2017.03.014
       
  • 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
      Pages: 653 - 662
      Abstract: Publication date: June 2017
      Source:Health Policy, Volume 121, Issue 6
      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: 2017-05-26T05:33:33Z
      DOI: 10.1016/j.healthpol.2017.03.003
       
  • Health Policy in Times of Austerity—A Conceptual Framework for
           Evaluating Effects of Policy on Efficiency and Equity Illustrated with
           Examples from Europe since 2008
    • Authors: Martin Wenzl; Huseyin Naci; Elias Mossialos
      Abstract: Publication date: Available online 19 July 2017
      Source:Health Policy
      Author(s): Martin Wenzl, Huseyin Naci, Elias Mossialos
      The objective of this paper is to provide a framework for evaluation of changes in health policy against overarching health system goals. We propose a categorisation of policies into seven distinct health system domains. We then develop existing analytical concepts of insurance coverage and cost-effectiveness further to evaluate the effects of policies in each domain on equity and efficiency. The framework is illustrated with likely effects of policy changes implemented in a sample of European countries since 2008. Our illustrative analysis suggests that cost containment has been the main focus and that countries have implemented a mix of measures that are efficient or efficiency neutral. Similarly, policies are likely to have mixed effects on equity. Additional user charges were a common theme but these were frequently accompanied by additional exemptions, making their likely effects on equity difficult to evaluate. We provide a framework for future, and more detailed, evaluations of changes in health policy.

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

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

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

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

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

      PubDate: 2017-07-08T10:06:20Z
      DOI: 10.1016/j.healthpol.2017.06.010
       
  • Effects of EU harmonization policies on national public supervision of
           clinical trials: A dynamic cycle of institutional change and institutional
           work
    • Authors: Kor J. Grit; Hester M. van de Bovenkamp; Roland Bal; Jacqueline C.F. van Oijen
      Abstract: Publication date: Available online 30 June 2017
      Source:Health Policy
      Author(s): Kor J. Grit, Hester M. van de Bovenkamp, Roland Bal, Jacqueline C.F. van Oijen
      Background The EU Clinical Trials Directive (EUCTD) and the EU Clinical Trials Regulation aim to harmonize good clinical practice (GCP) of clinical trials across Member States. Using the Netherlands as a case study, this paper analyzes how endeavours to implement the EUCTD set in motion a dynamic process of institutional change and institutional work. This process lead to substantial differences between policy and actual practice; therefore, it is important to learn more about the implementation of harmonization policies. Methods Relevant documents, such as legal texts and previous research, were analyzed. Interviews were conducted with stakeholders in clinical trials and inspectors from (inter)national supervisory bodies (n=33), and Dutch Health Care Inspectorate inspections were observed (n=4). Results Dutch legislators’ efforts to implement the EUCTD created a new level of governance in an already multilevel legislative framework. Institutional layering caused a complex and fragmented organizational structure in public supervision, leading to difficulties in achieving GCP. This instigated institutional work by actors, which set in motion further incremental institutional change, principally drift and conversion. Conclusions Harmonization processes can create dynamic cycles between institutional change and institutional work, leading to significant divergence from the intended effects of legislation. If legislation intended to strengthen harmonization is not carefully implemented, it can become counterproductive to its aims.

      PubDate: 2017-07-08T10:06:20Z
      DOI: 10.1016/j.healthpol.2017.06.008
       
  • New decision-making processes for the pricing of health technologies in
           Japan: The FY 2016/2017 pilot phase for the introduction of economic
           evaluations
    • Authors: Takeru Shiroiwa; Takashi Fukuda; Shunya Ikeda; Tomoyuki Takura
      Abstract: Publication date: Available online 23 June 2017
      Source:Health Policy
      Author(s): Takeru Shiroiwa, Takashi Fukuda, Shunya Ikeda, Tomoyuki Takura
      Economic evaluation is used for decision-making processes in healthcare technologies in many developed countries. In Japan, no health economic data have been requested for drugs, medical devices, and interventions till date. However, economic evaluation is gradually gaining importance, and a trial implementation of the cost-effectiveness evaluation of drugs and medical devices has begun. Discussions on economic evaluation began in May 2012 within a newly established sub-committee of the Chuikyo, referred to as the "Special Committee on Cost Effectiveness." After four years of discussions, this committee determined that during the trial implementation, the results of the cost-effectiveness evaluation would be used for the re-pricing of drugs and medical devices at the end of fiscal year (FY) 2017. Chuikyo selected 13 products (7 drugs and 6 medical devices) as targets for this evaluation. These products will be evaluated until the end of FY 2017 based on the following process: manufacturers will submit the data of economic evaluation; the National Institute of Public Health will coordinate the review process; academic groups will perform the actual review of the submitted data, and the expert committee will appraise these data. This represents the first step to introducing cost-effectiveness analysis in the Japanese healthcare system. We believe that these efforts will contribute to the efficiency and sustainability of the Japanese healthcare system.

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

      PubDate: 2017-07-08T10:06:20Z
      DOI: 10.1016/j.healthpol.2017.06.004
       
  • The SELFIE framework for integrated care for multi-morbidity: Development
           and description
    • Authors: Fenna R.M. Leijten; Verena Struckmann; Ewout van Ginneken; Thomas Czypionka; Markus Kraus; Miriam Reiss; Apostolos Tsiachristas; Melinde Boland; Antoinette de Bont; Roland Bal; Reinhard Busse; Maureen Rutten-van Mölken
      Abstract: Publication date: Available online 20 June 2017
      Source:Health Policy
      Author(s): Fenna R.M. Leijten, Verena Struckmann, Ewout van Ginneken, Thomas Czypionka, Markus Kraus, Miriam Reiss, Apostolos Tsiachristas, Melinde Boland, Antoinette de Bont, Roland Bal, Reinhard Busse, Maureen Rutten-van Mölken
      Background The rise of multi-morbidity constitutes a serious challenge in health and social care organisation that requires a shift from disease- towards person-centred integrated care. The aim of the current study was to develop a conceptual framework that can aid the development, implementation, description, and evaluation of integrated care programmes for multi-morbidity. Methods A scoping review and expert discussions were used to identify and structure concepts for integrated care for multi-morbidity. A search of scientific and grey literature was conducted. Discussion meetings were organised within the SELFIE research project with representatives of five stakeholder groups (5Ps): patients, partners, professionals, payers, and policy makers. Results In the scientific literature 11,641 publications were identified, 92 were included for data extraction. A draft framework was constructed that was adapted after discussion with SELFIE partners from 8 EU countries and 5P representatives. The core of the framework is the holistic understanding of the person with multi-morbidity in his or her environment. Around the core, concepts were grouped into adapted WHO components of health systems: service delivery, leadership & governance, workforce, financing, technologies & medical products, and information & research. Within each component micro, meso, and macro levels are distinguished. Conclusion The framework structures relevant concepts in integrated care for multi-morbidity and can be applied by different stakeholders to guide development, implementation, description, and evaluation.

      PubDate: 2017-07-08T10:06:20Z
      DOI: 10.1016/j.healthpol.2017.06.002
       
  • Staff and patient perspectives of a smoke-free health services policy in
           South Australia: A state-wide implementation
    • Authors: Kimberley Martin; Joanne Dono; Greg Sharplin; Jacqueline Bowden; Caroline Miller
      Abstract: Publication date: Available online 20 June 2017
      Source:Health Policy
      Author(s): Kimberley Martin, Joanne Dono, Greg Sharplin, Jacqueline Bowden, Caroline Miller
      Few jurisdictions have implemented and evaluated a complete smoking ban across all health sites in their jurisdiction, with no designated smoking areas. This article examines staff and patient perceptions and experiences of a mandated smoke-free policy implemented across all government health facilities in South Australia, including mental health sites. An online survey of health staff was conducted prior to policy implementation (n=3098), 3 months post-implementation (n=2673) and 15 months post-implementation (n=2890). Consumer experiences of the policy were assessed via a telephone survey (n=1722; smokers n=254). Staff support for the policy was high across all time points. Two thirds of staff reported having witnessed some policy non-compliance, and self-reported exposure to second-hand smoke was comparable pre-implementation to 15 months post-implementation. Under the policy, 56.3% of smoking patients abstained completely whilst hospitalised and 37.6% cut down the amount that they smoked. Furthermore, 34.7% reported having been offered cessation support during hospitalisation. Whilst the smoke-free policy was viewed positively and had benefits for staff and patients, reports of witnessing some non-compliance were prevalent. While the extent of non-compliance is not known, and the measure used was sensitive, complementary strategies may be needed to reduce exposure to second-hand smoke, particularly at entrances. Health-care staff should be further encouraged to offer support to nicotine-dependent patients to foster compliance and promote abstinence during hospitalisation.

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

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


      PubDate: 2017-06-05T05:49:20Z
      DOI: 10.1016/j.healthpol.2017.05.013
       
  • Understanding perspectives on major system change: A comparative case
           study of public engagement and the implementation of urgent and emergency
           care system reconfiguration
    • Authors: C. Foley; E. Droog; O. Healy; S. McHugh; C. Buckley; J.P. Browne
      Abstract: Publication date: Available online 29 May 2017
      Source:Health Policy
      Author(s): C. Foley, E. Droog, O. Healy, S. McHugh, C. Buckley, J.P. Browne
      Objectives Major changes have been made to how emergency care services are configured in several regions in the Republic of Ireland. This study investigated the hypothesis that engagement activities undertaken prior to these changes influenced stakeholder perspectives on the proposed changes and impacted on the success of implementation. Methods A comparative case-study approach was used to explore the changes in three regions. These regions were chosen for the case study as the nature of the proposals to reconfigure care provision were broadlysimilar but implementation outcomes varied considerably. Documentary analysis of reconfiguration planning reports was used to identify planned public engagement activities. Semi-structured interviews with 74purposively-sampled stakeholders explored their perspectives on reconfiguration, engagement activities and public responses to reconfiguration. Framework analysis was used, integrating inductive anddeductive approaches. Results Approaches to public engagement and success of implementation differed considerably across the three cases. Regions that presented the public with the reconfiguration plan alone reported greater public opposition and difficulty in implementing changes. Engagement activities that included a range of stakeholders and continued throughout the reconfiguration process appeared to largely address public concerns, contributing to smoother implementation. Conclusions The presentation of reconfiguration reports alone is not enough to convince communities of the case for change. Genuine, ongoing and inclusive engagement offers the best opportunity to address communityconcerns about reconfiguration.

      PubDate: 2017-05-31T05:45:33Z
      DOI: 10.1016/j.healthpol.2017.05.009
       
  • Are public-private partnerships the solution to tackle neglected tropical
           diseases? A systematic review of the literature
    • Authors: Céline Aerts; Temmy Sunyoto; Fabrizio Tediosi; Elisa Sicuri
      Abstract: Publication date: Available online 19 May 2017
      Source:Health Policy
      Author(s): Céline Aerts, Temmy Sunyoto, Fabrizio Tediosi, Elisa Sicuri
      Pharmaceutical companies are reluctant to invest in research and development (R&D) of products for neglected tropical diseases (NTDs) mainly due to the low ability-to-pay of health insurance systems and of potential consumers. The available preventive and curative interventions for NTDs mostly rely on old technologies and products that are often not adequate. Moreover, NTDs mostly affect populations living in remote rural areas and conflict zones, thereby hampering access to healthcare. The challenges posed by NTDs have led to the proliferation of a variety of public-private partnerships (PPPs) in the last decades. We conducted a systematic review to assess the functioning and impact of these partnerships on the development of and access to better technologies for NTDs. Our systematic review revealed a clear lack of empirical assessment of PPPs: no impact evaluation analyses could be found, which are crucial to realize the full potential of PPPs and to progress further towards NTDs elimination.

      PubDate: 2017-05-21T05:01:10Z
      DOI: 10.1016/j.healthpol.2017.05.005
       
  • Implementing shared-decision-making for diabetes care across country
           settings: what really matters to people?
    • Authors: Michela Tinelli; Panagiotis Petrou; George Samoutis; Vivie Traynor; George Olympios; Alistair McGuire
      Abstract: Publication date: Available online 10 May 2017
      Source:Health Policy
      Author(s): Michela Tinelli, Panagiotis Petrou, George Samoutis, Vivie Traynor, George Olympios, Alistair McGuire
      Context Growing evidence of improved clinical outcomes and patient/professional satisfaction supports shared-decision-making (SDM) services as an effective primary care interventions for diabetes. However, only a few countries have actually adopted them (e.g. England). In other European countries (e.g. Cyprus) there is awareness that patients play a crucial role in decision-making, and SDM services could be considered as innovative strategies to promote the actual implementation of patient rights legislation and strengthen primary care. Objective to understand preferences of people with diabetes when choosing their care, and how they value alternative SDM services compared to their ‘current’ option. Preferences were collected from patients based in England, where SDM is already in place at national level, and Cyprus, where people are new to it, using a discrete-choice-experiment (DCE) survey. Results Cypriots valued choosing alternative SDM services compared to their ‘current’ option, whereas the English preferred their status quo to other services. Having the primary-care-physician as healthcare provider, receiving compassionate care, receiving detailed and accurate information about their care, continuity of care, choosing their care management and treatment, and reduced waiting time were the SDM characteristics that Cypriots valued; the English preferred similar factors, apart from information/continuity of care. Conclusion People with diabetes do value SDM and different SDM models may fit different groups according to their personal experience and country specific settings.

      PubDate: 2017-05-11T13:13:18Z
      DOI: 10.1016/j.healthpol.2017.05.001
       
  • Time-driven activity-based costing in health care: A systematic review of
           the literature
    • Authors: George Keel; Carl Savage; Muhammad Rafiq; Pamela Mazzocato
      Abstract: Publication date: Available online 10 May 2017
      Source:Health Policy
      Author(s): George Keel, Carl Savage, Muhammad Rafiq, Pamela Mazzocato
      Health care organizations around the world are investing heavily in value-based health care (VBHC), and time-driven activity-based costing (TDABC) has been suggested as the cost-component of VBHC capable of addressing costing challenges. The aim of this study is to explore why TDABC has been applied in health care, how its application reflects a seven-step method developed specifically for VBHC, and implications for the future use of TDABC. This is a systematic review following the PRISMA statement. Qualitative methods were employed to analyze data through content analyses. TDABC is applicable in health care and can help to efficiently cost processes, and thereby overcome a key challenge associated with current cost-accounting methods The method’s ability to inform bundled payment reimbursement systems and to coordinate delivery across the care continuum remains to be demonstrated in the published literature, and the role of TDABC in this cost-accounting landscape is still developing. TDABC should be gradually incorporated into functional systems, while following and building upon the recommendations outlined in this review. In this way, TDABC will be better positioned to accurately capture the cost of care delivery for conditions and to control cost in the effort to create value in health care.

      PubDate: 2017-05-11T13:13:18Z
      DOI: 10.1016/j.healthpol.2017.04.013
       
  • The impact of economic conditions on the disablement process: A Markov
           transition approach using SHARE data
    • Authors: Y. Arrighi; T. Rapp; N. Sirven
      Abstract: Publication date: Available online 10 May 2017
      Source:Health Policy
      Author(s): Y. Arrighi, T. Rapp, N. Sirven
      A growing number of studies underline the relationship between socioeconomic status and health at older ages. Following that literature, we explore the impact of economic conditions on changes in functional health overtime. Frailty, a state of physiological instability allowing for reversible pathways, has been identified in the public health literature as a candidate for disability prevention but received little attention from health economists. Using SHARE panel data, respondents aged 50 and over from ten European countries were categorised as robust, frail and dependent. The determinants of health states’ changes between two interviews were analysed using multinomial Probit models accounting for potential sample attrition. A particular focus was made on initial socioeconomic status, proxied by three alternative measures. Concentration indices were computed for key transition probabilities. Across Europe, poorer and less educated elders were substantially more likely to experience health degradations and also less likely to experience health improvements. The economic gradient for the recovery from frailty was steeper than that of frailty onset, but remained lower than that of dependency onset. The existing social programs in favour of deprived and dependent elders could be widened to those diagnosed as frail to reduce the onset of dependency and economic inequalities in health at older ages.

      PubDate: 2017-05-11T13:13:18Z
      DOI: 10.1016/j.healthpol.2017.05.002
       
  • The bare necessities? A realist review of necessity argumentations used in
           health care coverage decisions
    • Authors: Tineke Kleinhout-Vliek; Antoinette de Bont; Bert Boer
      Abstract: Publication date: Available online 5 May 2017
      Source:Health Policy
      Author(s): Tineke Kleinhout-Vliek, Antoinette de Bont, Bert Boer
      Context Policy makers and insurance companies decide on coverage of care by both calculating (cost-) effectiveness and assessing the necessity of coverage. Aim To investigate argumentations pertaining to necessity used in coverage decisions made by policy makers and insurance companies, as well as those argumentations used by patients, authors, the public and the media. Methods This study is designed as a realist review, adhering to the RAMESES quality standards. Embase, Medline and Web of Science were searched and 98 articles were included that detailed necessity-based argumentations. Results We identified twenty necessity-based argumentation types. Seven are only used to argue in favour of coverage, five solely for arguing against coverage, and eight are used to argue both ways. A positive decision appears to be facilitated when patients or the public set the decision on the agenda. Moreover, half the argumentation types are only used by patients, authors, the public and the media, whereas the other half is also used by policy makers and insurance companies. The latter group is more accepted and used in more different countries. Conclusion The majority of necessity-based argumentation types is used for either favouring or opposing coverage, and not for both. Patients, authors, the public and the media use a broader repertoire of argumentation types than policy makers and insurance companies.

      PubDate: 2017-05-06T10:51:51Z
      DOI: 10.1016/j.healthpol.2017.04.011
       
  • Gatekeeping and the Utilization of Physician Services in France: Evidence
           on the Médecin Traitant Reform
    • Authors: Magali Dumontet; Thomas Buchmueller; Paul Dourgnon; Florence Jusot; Jérôme Wittwer
      Abstract: Publication date: Available online 28 April 2017
      Source:Health Policy
      Author(s): Magali Dumontet, Thomas Buchmueller, Paul Dourgnon, Florence Jusot, Jérôme Wittwer
      In 2005, France implemented a gatekeeping reform designed to improve care coordination and to reduce utilization of specialists’ services. Under this policy, patients designate a médecin traitant, typically a general practitioner, who will be their first point of contact during an episode of care and who will provide referrals to specialists. A key element of the policy is that patients who self-refer to a specialist face higher cost sharing than if they received a referral from their médecin traitant. We consider the effect of this policy on the utilization of physician services. Our analysis of administrative claims data spanning the years 2000 to 2008 indicates that visits to specialists, which were increasing in the years prior to the implementation of the reform, fell after the policy was in place. Additional evidence from the administrative claims as well as survey data suggest that this decline arose from a reduction in self-referrals, which is consistent with the objectives of the policy. Visits fell significantly both for specialties targeted by the policy and specialties for which self-referrals are still allowed for certain treatments. This apparent spillover effect may suggest that, at least initially, patients did not understand the subtleties of the policy.

      PubDate: 2017-04-30T10:27:58Z
      DOI: 10.1016/j.healthpol.2017.04.006
       
  • Popular initiatives in 2014–2016 call for the introduction of mandatory
           dental care insurance in Switzerland: The contrasting positions at stake
    • Authors: Enrico di Bella; Lucia Leporatti; Marcello Montefiori; Ivo Krejci; Stefano Ardu
      Abstract: Publication date: Available online 12 April 2017
      Source:Health Policy
      Author(s): Enrico di Bella, Lucia Leporatti, Marcello Montefiori, Ivo Krejci, Stefano Ardu
      “Switzerland’s mandatory health insurance system provides coverage for a standard benefits package for all residents. However, adult dental care is covered only in case of accidents and inevitable dental illnesses, while routine dental care is almost completely financed out-of-pocket. In general, unmet health needs in Switzerland are low, but unmet dental needs are significant, when compared with other countries in Europe. Recent popular initiatives in Switzerland have?”. In three cantons, the proposals have collected the required number of signatures and a public referendum is expected to be held in 2017/2018. If implemented, the insurance system is expected to have a significant impact on the dental profession, dental care demand, and the provision of dental services. The contrasting positions of stakeholders for and against the reform reflect a rare situation in which dental care policy issues are being widely discussed at all levels. However, such a discussion is of crucial relevance not only for Switzerland, but also for the whole of Europe, which has significant levels of unmet needs for dental care, especially among vulnerable and deprived individuals, and new solutions to expand dental care coverage are required.

      PubDate: 2017-04-16T08:57:24Z
      DOI: 10.1016/j.healthpol.2017.04.004
       
  • Health decentralization at a dead-end: towards new recovery plans for
           Italian hospitals
    • Authors: Marianna Mauro; Anna Maresso; Annamaria Guglielmo
      Abstract: Publication date: Available online 12 April 2017
      Source:Health Policy
      Author(s): Marianna Mauro, Anna Maresso, Annamaria Guglielmo
      The recent introduction by the central government of recovery plans (RPs) for Italian hospitals provides useful insights into the recentralization tendencies that are being experienced within the country’s decentralized, regional health system. The measure also contributes evidence to the debate on whether there is a long-term structural shift in national health strategy towards more centralized stewardship. The hospital RPs aim to improve the clinical, financial and managerial performance of public-hospitals, teaching-hospitals and research-hospitals through monitoring trends in individual hospitals' expenditure and tackling improvements in clinical care. As such they represent the central governments recognition of the weaknesses of the decentralization process in the health sector. The opponents of the reform argue that financial stability will be restored mainly through across-the-board reductions in hospital expenditure, personnel layoffs and closing of wards, with considerable negative effects on the most vulnerable groups of patients. While hospital RPs are comprehensive and complex, unresolved issues remain as to whether hospitals have the necessary managerial skills for the development of effective and achievable plans. Without also devising an overall plan to tackle the long-standing managerial weaknesses of public hospitals, the objectives of the hospital RPs will be undermined and the decentralization process in the health system will gradually reach a dead-end.

      PubDate: 2017-04-16T08:57:24Z
      DOI: 10.1016/j.healthpol.2017.04.003
       
  • A Rapidly Changing Global Medicines Environment: How Adaptable are Funding
           Decision-Making Systems?
    • Authors: Christine Leopold; Steve Morgan; Anita Wagner
      Abstract: Publication date: Available online 10 April 2017
      Source:Health Policy
      Author(s): Christine Leopold, Steve Morgan, Anita Wagner
      Background With the launch of very highly priced therapies and sudden price increases of generics, pressures on health systems have drastically increased. Objectives We aimed to elicit opinions of key decision makers responsible for national assessment and funding decisions on their experiences to adapt to these new realities. Methods/setting Through interviews with decision makers of pharmaceutical assessment and/or funding agencies, we describe the challenges systems are currently facing, systems’ responses and systems’ characteristics facilitating or hindering responses to changes and overarching topics for the future. Results Among the most common challenges are increased funding pressures, increased uncertainty and lack of transparency in decision-making. Systems’ responses include utilization management, changing of assessment processes, stakeholder engagement and a focus on outcomes and on coordinated negotiations. Integrated delivery systems, fixed health care budgets and geographic and historical characteristics facilitate or sometimes hinder responses to change. Future policy emphasis lays on expanding data structures, managing the exit of drugs funded early, and implementing processes for communications with patients and the public. Conclusions Going forward emphasis has to be given to structured communications with all stakeholders with a specific emphasis on the broader public and patients about financial limits and priority setting in health care.

      PubDate: 2017-04-16T08:57:24Z
      DOI: 10.1016/j.healthpol.2017.04.002
       
  • Informal and formal care: substitutes or complements in care for people
           with dementia? Empirical evidence for 8 European countries
    • Authors: Patrick Bremer; David Challis; Ingalill Rahm Hallberg; Helena Leino-Kilpi; Kai Saks; Bruno Vellas; Sandra M.G. Zwakhalen; Dirk Sauerland
      Abstract: Publication date: Available online 8 April 2017
      Source:Health Policy
      Author(s): Patrick Bremer, David Challis, Ingalill Rahm Hallberg, Helena Leino-Kilpi, Kai Saks, Bruno Vellas, Sandra M.G. Zwakhalen, Dirk Sauerland
      Background In order to contain public health care spending, European countries attempt to promote informal caregiving. However, such a cost reducing strategy will only be successful if informal caregiving is a substitute for formal health care services. We therefore analyze the effect of informal caregiving for people with dementia on the use of several formal health care services. Study Design The empirical analysis is based on primary data generated by the EU-project ‘RightTimePlaceCare’ which is conducted in 8 European countries. 1223 people with dementia receiving informal care at home were included in the study.

      PubDate: 2017-04-09T08:45:49Z
      DOI: 10.1016/j.healthpol.2017.03.013
       
  • The Directorate-General for Health and Consumers 1999–2014: An
           assessment of its functional capacities
    • Authors: Timo Clemens; Kristine Sørensen; Nicole Rosenkötter; Kai Michelsen; Helmut Brand
      Abstract: Publication date: Available online 6 April 2017
      Source:Health Policy
      Author(s): Timo Clemens, Kristine Sørensen, Nicole Rosenkötter, Kai Michelsen, Helmut Brand
      Capacity assessment has become a popular measure in the health sector to assess the ability of various stakeholders to pursue agreed activities. The European Commission (EC) is increasingly dealing with a variety of health issues to coordinate and complement national health policies. This study analyses the functional capacity of the Directorate-General for Health and Consumers (DG SANCO) between 1999 and 2004. It applies the UNDP Capacity Assessment Framework and uses a literature review, a document review of EU policy documents and expert interviews to assess the capacity of DG SANCO to fulfill its mandate for public health and health systems. Our results suggest that DG SANCO has established capacities to engage with stakeholders; to assess various health issues, to define issue-specific health policies and to collect information for evaluative purposes. In contrast, capacities tend to be less established for defining a clear strategy for the overall sector, for setting priorities and for budgeting, managing and implementing policies. We conclude that improvements to the effectiveness of DG SANTE’s (the successor of DG SANCO) policies can be made within the existing mandate. A priority setting exercise may be conducted to limit the number of pursued actions to those with the greatest European added value within DG SANTE’s responsibilities.

      PubDate: 2017-04-09T08:45:49Z
      DOI: 10.1016/j.healthpol.2017.03.018
       
 
 
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