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Berardi C, Schut F, Paolucci F. The dynamics of international health system reforms: Evidence of a new wave in response to the 2008 economic crisis and the COVID-19 pandemic? Health Policy 2024; 143:105052. [PMID: 38569331 DOI: 10.1016/j.healthpol.2024.105052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 12/23/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024]
Abstract
Global economic and health shocks, such as the 2008 global financial crisis and the COVID-19 pandemic typically impact healthcare financing and delivery. Cutler found that profound societal changes in the 20th century induced three waves of healthcare reform across seven major OECD countries. Our study investigates whether major crises in the 21st century induced similar reform waves. Through thematic analysis, we systematically compared health system changes in response to these shocks, using data from the Observatory on Health Systems and Policies and the OECD. Our analysis reveals similar overarching reform trends across countries in response to the 2008 economic crisis: a tendency toward re-centralization of health system governance to control and leverage the efficient rationalization of public health resources. This, to some extent, countered the effects of the market-based reforms of the previous wave. The reforms induced by the 2008 crisis were mediated by its repercussions on the countries' economies. In contrast, reforms in response to the pandemic aimed primarily to address the direct impact of the shock on the health system. Despite its negative economic impact, the pandemic resulted in a substantial but temporary increase in public health spending. A better understanding reform dynamics and their impact on overarching conflicting health system objectives may prevent unintended consequences and enhance health systems' resilience in response to future shocks.
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Affiliation(s)
- Chiara Berardi
- Newcastle Business School, The University of Newcastle, Newcastle, Australia.
| | - Frederik Schut
- Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Francesco Paolucci
- Newcastle Business School, The University of Newcastle, Newcastle, Australia
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Maietti E, Sanmarchi F, Toth F, de Pietro C, Fantini MP, Golinelli D. Changes in private health service utilisation and access to the Italian National Health Service between 2006 and 2019: a cross-sectional comparative study. BMJ Open 2023; 13:e070975. [PMID: 37247961 DOI: 10.1136/bmjopen-2022-070975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES Previous research highlighted that in the early 2000s a significant share of the Italian population used and paid out of pocket for private healthcare services even when they could potentially have received the same treatments from the National Health Service (NHS). The decrease in public investments in healthcare and the increase in health needs due to the population ageing may have modified the use of private health services and equity of access to the Italian NHS. This study aims to investigate the change in the prevalence of individuals who have fully paid out of pocket for accessing healthcare services in Italy between 2006 and 2019 and the main reasons behind this choice. DESIGN Cross-sectional comparative study. PARTICIPANTS AND COMPARISON Two representative samples of the Italian population were collected in 2006 and 2019. OUTCOME MEASURES Prevalence of access to fully paid out-of-pocket private health services; type of service of the last fully paid out-of-pocket access; main reasons for the last fully paid out-of-pocket access. RESULTS We found an increase in the prevalence of people who declared having fully paid out of pocket at least one access to health services during their lifetime from 79.0% in 2006 to 91.9% in 2019 (adjusted OR 2.66; 95% CI 1.98 to 3.58). 'To avoid waiting times' was the main reason and it was significantly more frequent in 2019 compared with 2006 (adjusted OR 1.75; 95% CI 1.45 to 2.11). CONCLUSIONS This comparative study, conducted the year before the outbreak of the COVID-19 pandemic, highlighted an increase in the prevalence of Italian residents who have fully paid out of pocket for access to health services to overcome long waiting times. Our findings may indicate a reduced access and possible worsening of the equity of access to the public and universalistic Italian NHS between 2006 and 2019.
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Affiliation(s)
- Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Federico Toth
- Department of Political and Social Sciences, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Carlo de Pietro
- Department of Business Economics, Health and Social Affairs, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- Health Services Research, Evaluation and Policy Unit, Local Health Authority of Romagna, Ravenna, Italy
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Cirulli V, Marini G. Are austerity measures really distressing? Evidence from Italy. Econ Hum Biol 2023; 49:101217. [PMID: 36701929 DOI: 10.1016/j.ehb.2022.101217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 05/08/2023]
Abstract
Since 2007 financial recovery plans have been adopted by some Italian regions to contain the costs of the healthcare sector. It is legitimate to ask whether spending cuts associated with the austerity policy have had any effect on the health of the citizens. We examine the indirect impact of financial recovery plans on a broad set of health indicators, accounting for several dimensions of both physical and psychological diseases. We use an instrumental variable fixed-effects model to control for time-varying heterogeneity and to deal with the potential endogeneity of the enrolment in the austerity programme. We find that the Italian austerity policy Piano di Rientro resulted in unintended negative effects on several dimensions of health, hurting and potentially jeopardising the health of citizens.
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Cavazza M, Vecchio MD, Fattore G, Fenech L. Geographical variation in the use of private health insurance in a predominantly publicly-funded system. Health Policy 2023; 130:104720. [PMID: 36801610 DOI: 10.1016/j.healthpol.2023.104720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/03/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
We provide evidence of geographical variations in the use of private health insurance (PHI) in Italy. Our study offers an original contribution, using a 2016 dataset on the use of PHI amongst a population of more than 200,000 employees of a major company. The average claim per enrolee was €925, representing approximately 50% of public health expenditure per capita, primarily for dental care (27.2%), specialist outpatient services (26.3%) and inpatient care (25.2%). Residents in northern regions and metropolitan areas respectively claimed reimbursements for €164 and €483 more than those in southern regions and in non-metropolitan areas. Both supply and demand factors can explain these large geographical differences. The study suggests the urgency for policymakers to address the considerable disparities in the Italian healthcare system, revealing the overall social, cultural and economic conditions that shape the demand for healthcare.
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Affiliation(s)
- Marianna Cavazza
- Centre for Research on Health and Social Care Management (Cergas), SDA Bocconi School of Management, Observatory on Privately Financed Health Consumption (OCPS), Via Sarfatti 10, Milan 20136, Italy.
| | - Mario Del Vecchio
- Centre for Research on Health and Social Care Management (Cergas), SDA Bocconi School of Management, Observatory on Privately Financed Health Consumption (OCPS), Via Sarfatti 10, Milan 20136, Italy; Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, Florence 50134, Italy
| | - Giovanni Fattore
- Centre for Research on Health and Social Care Management (Cergas), SDA Bocconi School of Management, Observatory on Privately Financed Health Consumption (OCPS), Via Sarfatti 10, Milan 20136, Italy; Social and Political Sciences Department, Bocconi University, Via Roentgen 1, Milan 20136, Italy
| | - Lorenzo Fenech
- Centre for Research on Health and Social Care Management (Cergas), SDA Bocconi School of Management, Observatory on Privately Financed Health Consumption (OCPS), Via Sarfatti 10, Milan 20136, Italy
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Prędkiewicz P, Bem A, Siedlecki R, Kowalska M, Robakowska M. An impact of economic slowdown on health. New evidence from 21 European countries. BMC Public Health 2022; 22:1405. [PMID: 35870922 PMCID: PMC9308123 DOI: 10.1186/s12889-022-13740-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background The economic slowdown affects the population's health. Based on a social gradient concept, we usually assume that this detrimental impact results from a lower social status, joblessness, or other related factors. Although many researchers dealt with the relationship between economy and health, the findings are still inconsistent, primarily related to unemployment. This study reinvestigates a relationship between the economy's condition and health by decomposing it into macroeconomic indicators. Methods We use data for 21 European countries to estimate the panel models, covering the years 1995–2019. Dependent variables describe population health (objective measures – life expectancy for a newborn and 65 years old, healthy life expectancy, separately for male and female). The explanatory variables primarily represent GDP and other variables describing the public finance and health sectors. Results (1) the level of economic activity affects the population’s health – GDP stimulates the life expectancies positively; this finding is strongly statistically significant; (2) the unemployment rate also positively affects health; hence, increasing the unemployment rate is linked to better health – this effect is relatively short-term. Conclusions Social benefits or budgetary imbalance may play a protective role during an economic downturn. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13740-6.
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Masento NA, Dulay KM, Harvey K, Bulgarelli D, Caputi M, Cerrato G, Molina P, Wojtkowska K, Pruszczak D, Barlińska J, Messer D, Houston-Price C. Parent, child, and environmental predictors of vegetable consumption in Italian, Polish, and British preschoolers. Front Nutr 2022; 9:958245. [PMID: 36337641 PMCID: PMC9633668 DOI: 10.3389/fnut.2022.958245] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
This study compared the vegetable intake of preschool children from three European countries [Italy, Poland, and the United Kingdom (UK)] and explored the parent, child, and environmental factors that predicted intake in each country. A total of 408 parents of preschoolers (Italy: N = 61, Poland: N = 124, and UK: N = 225; child mean age = 32.2 months, SD = 9.47) completed an online survey comprising a set of standardised questionnaires. For all three countries, the questionnaires included measures of children's vegetable intake (VegFFQ), child eating behaviour (CEBQ-FF), parents' mealtime goals (FMGs), and sociodemographic questions about family background and environment. In the UK and Italy, additional questionnaires were used to assess child temperament (EAS-T) and parents' feeding practices (CFPQ). The results showed that the number of child-sized portions of vegetables consumed per day varied significantly across countries; Polish children consumed the most (∼3 portions) and Italian children the least (∼1.5 portions). Between-country differences were seen in parents' goals for family mealtimes; compared to Italian parents, Polish and UK parents were more motivated to minimise mealtime stress, increase family involvement in meal preparation, and share the same foods with family members. British and Italian parents also adopted different feeding practices; parents in the UK reported more use of healthy modelling behaviours and more use of foods to support their child's emotion regulation. In terms of child factors, Italian children were reported to be more emotional and more sociable than British children. Analyses of the relationships between the parent, child, and environmental factors and children's vegetable intake revealed both similarities and differences between countries. Negative predictors of vegetable intake included child food fussiness in the UK and Poland, child temperament (especially, shyness) in Italy, and the use of food as a reward and child emotionality in the UK. Positive predictors included the parental mealtime goal of 'family involvement' in the UK. These results highlight differences in the extent to which European preschoolers achieve recommended levels of vegetable intake, and in the factors that influence whether they do. The results suggest a need to develop healthy eating interventions that are adopted to meet the specific needs of the countries in which they are implemented.
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Affiliation(s)
- Natalie A. Masento
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Katrina May Dulay
- Department of Psychology, City, University of London, London, United Kingdom
| | - Kate Harvey
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | | | - Marcella Caputi
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | | | - Paola Molina
- Department of Regional & Urban Studies and Planning, University of Turin, Turin, Italy
| | | | | | | | - David Messer
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, United Kingdom
| | - Carmel Houston-Price
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom
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Chisari G, Lega F. Impact of austerity programs: Evidence from the Italian national health service. Health Serv Manage Res 2022; 36:145-152. [PMID: 36227139 DOI: 10.1177/09514848221134473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Austerity measures are widely adopted to cope with financial straits. Since 2007 Italy has operated a financial recovery program (Piani di Rientro, PdR) in certain regions of the country. This provides an interesting setting for an intra-national analysis of the differences between the regions under a PdR program and those which are not. In the regions under a PdR, efforts to achieve economic sustainability and fiscal balance have impacted on healthcare indicators, resulting in a reduction in healthcare resources, an increase in taxes, and a general weakening of regional healthcare systems since the introduction of the program more than a decade ago. The detrimental effects of the austerity measures have become evident. As the regions under a PdR have demonstrated a sufficient level of economic stability, the national government should start revising its austerity strategy to prevent further widening of gaps in healthcare performance between regions.
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Affiliation(s)
- Giorgio Chisari
- 84956EU-Health Economics and Management, Management Centre Innsbruck, Innsbruck, Austria
| | - Federico Lega
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Troisi R, De Simone S, Vargas M, Franco M. The other side of the crisis: organizational flexibility in balancing Covid-19 and non-Covid-19 health-care services. BMC Health Serv Res 2022; 22:1096. [PMID: 36038878 PMCID: PMC9421103 DOI: 10.1186/s12913-022-08486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Many healthcare systems have been unable to deal with Covid-19 without influencing non-Covid-19 patients with pre-existing conditions, risking a paralysis in the medium term. This study explores the effects of organizational flexibility on hospital efficiency in terms of the capacity to deliver healthcare services for both Covid-19 and non-Covid-19 patients. Method Focusing on Italian health system, a two-step strategy is adopted. First, Data Envelope Analysis is used to assess the capacity of hospitals to address the needs of Covid-19 and non-Covid-19 patients relying on internal resource flexibility. Second, two panel regressions are performed to assess external organizational flexibility, with the involvement in demand management of external operators in the health-care service, examining the impact on efficiency in hospital capacity management. Results The overall response of the hospitals in the study was not fully effective in balancing the needs of the two categories of patients (the efficiency score is 0.87 and 0.58, respectively, for Covid-19 and non-Covid-19 patients), though responses improved over time. Furthermore, among the measures providing complementary services in the community, home hospitalization and territorial medicine were found to be positively associated with hospital efficiency (0.1290, p < 0.05 and 0.2985, p < 0.01, respectively, for non-Covid-19 and Covid-19 patients; 0.0026, p < 0.05 and 0.0069, p < 0.01, respectively, for non-Covid-19 and Covid-19). In contrast, hospital networks are negatively related to efficiency in Covid-19 patients (-0.1037, p < 0.05), while the relationship is not significant in non-Covid-19 patients. Conclusions Managing the needs of Covid-19 patients while also caring for other patients requires a response from the entire healthcare system. Our findings could have two important implications for effectively managing health-care demand during and after the Covid-19 pandemic. First, as a result of a naturally progressive learning process, the resource balance between Covid-19 and non-Covid-19 patients improves over time. Second, it appears that demand management to control the flow of patients necessitates targeted interventions that combine agile structures with decentralization. Finally, untested integration models risk slowing down the response, giving rise to significant costs without producing effective results.
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Affiliation(s)
- Roberta Troisi
- Department of Political and Communication Science, University of Salerno, Via Giovanni Paolo II, Fisciano (Salerno), Italy.
| | - Stefania De Simone
- Department of Political Sciences, University of Naples Federico II, Largo S. Marcellino, Naples, Italy
| | - Maria Vargas
- Department of Neurosurgical, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini, Naples, Italy
| | - Massimo Franco
- Department of Political Sciences, University of Naples Federico II, Largo S. Marcellino, Naples, Italy
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Šarkić B, Simpson A, Heine C. The cost of privatization to the profession: Media representation of Audiology in Australia. Health Promot J Austr 2022; 34:603-611. [PMID: 36001413 DOI: 10.1002/hpja.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/20/2022] [Accepted: 07/23/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate how the profession of audiology was represented in the media in Australia and how the increased privatisation of the profession may have shaped this representation. METHOD A systematic search of English language media records was conducted from January 1/1/00 - 17/7/20 using ANZ News Stream, TV News, Google News, and INFORMIT. Twenty-four of 1056 originally identified articles were retained. The findings were extracted and synthesised. RESULTS Context and content analyses were preformed, revealing a predominantly negative portrayal of Audiology as a profession in 21 of 24 (87.5%) articles. Predominant themes included: sales driven by incentives, predatory strategies and malpractice, non-regulation and privatisation of the hearing care industry, and conflict of interest. CONCLUSION The media was found to highlight consumer mistrust in the profession in recent years. Increased regulation of the profession of audiology is recommended to protect the population against exploitative practices and to renew faith in the profession by the public.
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Affiliation(s)
- Bojana Šarkić
- Discipline of Audiology, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Andrea Simpson
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia.,College of Health & Human Services, Charles Darwin University, Darwin, Australia
| | - Chyrisse Heine
- School of Health, Federation University Australia, Ballarat, Australia
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Abstract
Workplace health promotion (WHP) are often depicted as an opportunity for pursuing a better and broader well-being condition under the assumption that working environments affect the physical, mental, and social well-being of individuals who spend large proportion of waking hours at work. While most empirical studies provided medical evidence to the effectiveness of WHP programs, scholars question the instrumental purposes of these programs founded on the belief that "healthy workers are better workers". Little is known, for instance, about the design of WHP programs and their acceptance by workers. Our study addresses this gap, analyzing the co-production of a WHP program in an Italian research institute promoted by the healthcare authority, the local government and the national center for prevention and security in the workplaces. To this aim, we adopt the notion of boundary object investigate how different stakeholders reclaim to take part and being involved in this process, re-shaping their goals and their boundaries and why a WHP program or parts of it may be rejected or re-negotiated by its recipients. Our analysis reveals how each stakeholder contributes to re-shape the WHP program which emerges as the modular product of the composition of each matter of concern. Most notably, the strong rooting in a clinical perspective and the original focus on only workers at risk is gradually flanked by initiatives to involve all employees. Moreover, workers draw a line as for the legitimacy of employers' intervention in the personal sphere of health promotion, embracing interventions addressing diet and physical activity while rejecting measures targeting smoking and alcohol consumption.
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Affiliation(s)
- Paolo Rossi
- Department of Sociology and Social Research, University of Milano Bicocca, Via Bicocca Degli Arcimboldi 8, 20126 Milan, Italy
| | - Francesco Miele
- Department of Political and Social Sciences, University of Trieste, Piazzale Europa 1, 34127 Trieste, Italy
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Cerutti R, Biuso GS, Dentale F, Spensieri V, Gambardella A, Tambelli R. Effectiveness of psychodynamic-oriented counselling intervention in reducing psychological distress in university students seeking help. British Journal of Guidance & Counselling 2022. [DOI: 10.1080/03069885.2022.2089632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Rita Cerutti
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Stefano Biuso
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Francesco Dentale
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Valentina Spensieri
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Aldo Gambardella
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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D'Onofrio G, Ciccone F, Placentino G, Placentino M, Tulipani C, Prencipe A, De Vincentis G. Internet-Based Psychological Interventions during SARS-CoV-2 Pandemic: An Experience in South of Italy. Int J Environ Res Public Health 2022; 19. [PMID: 35564820 DOI: 10.3390/ijerph19095425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 12/24/2022]
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to an increasing demand for online psychological intervention. The aim of this study is to evaluate the efficacy of received support in internet-based psychological intervention group (I-IG) patients, compared with a wait-list control group (CG). The Impact of Event Scale—Revised, Patient Health Questionnaire 9-item and Generalized Anxiety Disorder scale 7-item were administered. After participants had used the internet-based solution, the System Usability Scale was administered. In total, 221 patients (194 patients supported by internet-based interventions and 27 patients supported onsite) were included in intervention group, and 194 patients were included in CG. In a 6-month follow-up, participants in the I-IG demonstrated significant improvements in terms of PTSD risk (p < 0.0001, d = 0.64), depression (p < 0.0001, d = 0.68), and anxiety (p < 0.0001, d = 1.33), compared to the CG. Significant improvements in onsite intervention group patients with a large to very large effect size of PTSD risk (p < 0.0001, d = 0.91), depression (p < 0.0001, d = 0.81), and anxiety (p < 0.0001, d = 1.62) were found. After internet-based solution use, I-IG patients reported a very high usability and functionality (72.87 ± 13.11) of online intervention. In conclusion, SARS-CoV-2-related mental health problems can be improved by internet-based psychological intervention. The usability and functionality evaluation of online solutions by technological tools showed very positive results for the I-IG patients.
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DiPasquale G. The Effects of International Immigration on Inequality in Host Countries: the Case of Italy. Int Migration & Integration 2021. [DOI: 10.1007/s12134-021-00902-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Morales-Contreras MF, Leporati M, Fratocchi L. The impact of COVID-19 on supply decision-makers: the case of personal protective equipment in Spanish hospitals. BMC Health Serv Res 2021; 21:1170. [PMID: 34711231 PMCID: PMC8552980 DOI: 10.1186/s12913-021-07202-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/19/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has been recognized as a trigger for redefining supply chains at the global level, and has created an intense debate within the academic community and among policy-makers and practitioners. Among other industries, health care has been dramatically hit by the scarcity of "medical products," specifically for personal protective equipment (PPE-like), due to supply chain disruptions coupled with dramatically increased demand. We aimed to analyze how the scarcity of PPE-like during the COVID-19 pandemic has modified the behavior of decision-makers in the PPE-like supply chain at the hospital level, and to explore what changes could be implemented to cope with future PPE-like shortages. METHODS We used an explorative approach based on semi-structured interviews with key informants in the Spanish health care industry. More specifically, we held interviews to industry experts at three hospitals in three Spanish regions to map the consequences of the COVID-19 pandemic onto the buying decision-making process. RESULTS Different strategies were developed by decision-makers at hospitals before, during, and after the first wave of the COVID-19 pandemic in Spain. Our paper offers two main findings: a) decision-makers changed their purchasing behavior from a cost main driver to guaranteeing the availability of supplies; b) they supported the idea of giving more "strategic autonomy" to Spain or Europe through back and nearshoring decisions. CONCLUSIONS This paper could be of interest to health care management at the national, regional, and hospital levels, as well as for policy-makers, since it could help to establish and configure policies to support the sourcing of medical products (specifically PPE-like) to anticipate potential supply disruptions. Our paper contributes to the limited existing literature on how purchasing strategies at the decision-maker level and supply vary in the health care industry when a public health crisis appears, and what potential solutions might be for policy-makers and practitioners involved in the health care industry.
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Affiliation(s)
- Manuel F. Morales-Contreras
- Faculty of Business Management and Economics, ICADE, Universidad Pontificia Comillas, Madrid, Spain
- Institute for Research in Technology (IIT), ICAI School of Engineering, Universidad Pontificia Comillas, Madrid, Spain
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VERCELLI MARINA, LILLINI ROBERTO. Application of Socio-Economic and Health Deprivation Indices to study the relationships between socio-economic status and disease onset and outcome in a metropolitan area subjected to aging, demographic fall and socio-economic crisis. J Prev Med Hyg 2021; 62:E718-E727. [PMID: 34909500 PMCID: PMC8639118 DOI: 10.15167/2421-4248/jpmh2021.62.3.1890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/27/2021] [Indexed: 12/27/2022]
Abstract
Aims Genoa is a city affected by a deep economic, demographic and social involution. The association between disease onset and outcome and socioeconomic status (SES) was assessed in the mortality by cause in two periods, using indices referred to the distribution of deprivation in the population defined in a ten-years span (2001 to 2011). Material and Methods Two Socio-Economic and Health Deprivation Indices (SEHDIs), computed at census tract level (2001 and 2011 Censuses), were applied to analyse the SMRs by cause, age (0-64 and 65+ years) and gender of the five normalised groups of deprivation individuated in the two population distribution. The associations between SES and onset of disease was described in the mortality 2008-11 using the index referred to 2001 population. The second index, referred to 2011 population, described the associations between SES and disease outcomes in the mortality 2009-13. Two ANOVAs evaluated the statistical significance (p < 0.05) of differences in death distribution among groups. Results The population at medium-high deprivation increased in Genoa between 2001 and 2011. The mortality by age and gender showed different trends. Not significant trends (NS) in both periods regarded only the younger (respiratory diseases in both sexes, prostate cancer, diabetes in women). Linearly positives (L↑) trends in both periods were observed only in men (all cancers and lung cancers, overall mortality and cardiovascular diseases in younger, diabetes in older). Not linear trends (NL) in both periods interested both sexes for flu and pneumonia, women for lung cancer, old women for overall mortality and respiratory diseases, old men for colorectal cancers. Instead, L↑ trends in the final phases of disease interest all cancers in the elderly (NS trend at the disease onset), all cancers and breast cancer in young women, diabetes and colorectal cancers in young men (NL trends at the disease onset). On the contrary, L↑ trends at the disease onset and NL trends in the final phases regarded cardiovascular diseases in elderly, overall mortality, respiratory diseases and prostate cancer in old men, diabetes and colorectal cancers in old women. Finally, NL trends at the disease onset regarded colorectal cancers in young women (NS trend in the final phases) and breast cancer in the older (linearly negative trend, L↓, in the final phases). Discussion Deprivation trends confirmed the literature about populations shifting towards poverty. Aging-linked social risks were revealed, reflecting the weakening of social-health care, which worsened in elderly if alone. Serious problems in younger singles or in the single-parent families arose. Cardiovascular diseases, all cancers and colorectal cancers trends confirmed the advantage of less deprived when diseases are preventable and curable. Prostate and breast cancers trends reflected the rising incidence and increasing problems in care. The need of corrective interventions in social and health policies was emerging, aimed to support in a targeted way a population in an alarming condition of socio-economic deterioration.
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Affiliation(s)
- MARINA VERCELLI
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - ROBERTO LILLINI
- Analytical Epidemiology & Health Impact Unit, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy
- Correspondence: Roberto Lillini. Analytical Epidemiology & Health Impact, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy - Tel: +390223903564 - E-mail:
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Santos DB, Mendes-Da-Silva W, Norvilitis JM, Protin P, Onusic L. Parents Influence Responsible Credit Use in Young Adults: Empirical Evidence from the United States, France, and Brazil. J Fam Econ Issues 2021; 43:368-383. [PMID: 34456538 PMCID: PMC8383257 DOI: 10.1007/s10834-021-09792-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
From the start of adulthood, consumers are frequently faced with complex financial decisions, and the consequences of these decisions may be reflected throughout the rest of their lives. As access to credit has expanded among college students around the world, it is critical that we understand both universal and culture-specific processes. Although some work has examined credit card use in two cultures simultaneously, there is, to our knowledge, no research examining such use in three cultures on three continents and across both genders. This study analyzes credit card use behavior among 1458 young adults living either in Brazil, the United States, or France. A structural equations model is used to incorporate relationships between the latent variables. The model, which was validated by the study, examines how financial well-being is affected by the way in which the individual uses credit cards, which in its turn is affected by social comparison and by financial self-confidence, the latter being also impacted by the financial education received from the parents. In the comparison between groups we found evidence that men are more dependent on parental education than women.
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Affiliation(s)
- Danilo Braun Santos
- Federal University of São Paulo, R. Angélica, 100—Jardim das Flores, Osasco, SP 06132-380 Brazil
| | - Wesley Mendes-Da-Silva
- Sao Paulo School of Business Administration (FGV/EAESP), Rua Itapeva, #474, 8 floor, Sao Paulo, Sao Paulo 01332-000 Brazil
| | - Jill M. Norvilitis
- Buffalo State of The State University of New York, 1300 Elmwood Avenue, Buffalo, NY 14222 USA
| | | | - Luciana Onusic
- Federal University of São Paulo, R. Angélica, 100—Jardim das Flores, Osasco, SP 06132-380 Brazil
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Loubani K, Kizony R, Milman U, Schreuer N. Hybrid Tele and In-Clinic Occupation Based Intervention to Improve Women's Daily Participation after Breast Cancer: A Pilot Randomized Controlled Trial. Int J Environ Res Public Health 2021; 18:5966. [PMID: 34199448 PMCID: PMC8199623 DOI: 10.3390/ijerph18115966] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women after breast cancer (BC) cope with decreased daily participation and quality of life (QOL) due to physical, cognitive, and emotional symptoms. This study examined a hybrid occupation-based intervention, Managing Participation with Breast Cancer (MaP-BC), to improve daily participation in their meaningful activities. METHODS Thirty-five women after BC phase were randomly allocated to the MaP-BC intervention (n = 18) or control (n = 17) group (standard care only). Assessments were administered at baseline (T1), 6-week (T2), and 12-week (T3) post-T1. MAIN OUTCOME perceived performance and performance-satisfaction with meaningful activities according to the Canadian Occupational Performance Measure. SECONDARY OUTCOMES retained activity levels (Activity Card Sort), QOL (Functional Assessment of Cancer Therapy-Breast), cognitive abilities (Montreal Cognitive Assessment and Behavior Rating Inventory of Executive Function), and upper-extremity functioning (Disability of Arm, Shoulder, Hand). Results showed significant interaction (group x time) effects for the primary outcome in performance, F(2,66) = 29.54, p = 0.001, ɳP2 = 0.472, and satisfaction, F(2,66) = 37.15, p = 0.000, ɳP2 = 0.530. The intervention group improved more in performance, t = 5.51, p = 0.0001, d = 1.298, and satisfaction, t = -5.32, p = 0.0001, d = 1.254, than the control group between T1 and T2. Secondary outcomes demonstrated within-group improvements. CONCLUSION MaP-BC, a comprehensive occupation-based hybrid intervention tailored to women's functional daily needs after BC, improved participation in meaningful activities within a short period.
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Affiliation(s)
- Khawla Loubani
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel; (R.K.); (N.S.)
- Clalit Health Services, Haifa and Western Galilee, Tel Aviv 62098, Israel;
| | - Rachel Kizony
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel; (R.K.); (N.S.)
- Sheba Medical Center, Department of Occupational Therapy, Tel Hashomer, Ramat Gan 52621, Israel
| | - Uzi Milman
- Clalit Health Services, Haifa and Western Galilee, Tel Aviv 62098, Israel;
| | - Naomi Schreuer
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel; (R.K.); (N.S.)
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Kyriopoulos I, Nikoloski Z, Mossialos E. Financial protection in health among the middle-aged and elderly: Evidence from the Greek economic recession. Health Policy 2021; 125:1256-1266. [PMID: 34226052 DOI: 10.1016/j.healthpol.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
Since the late 2000s, the Greek economy has entered a long period of recession, with reforms and retrenchment in health care being among the main public policy priorities. This study investigates the extent to which financial protection in health has changed among older households during the Greek crisis. We focus on the middle-aged and elderly, the heavy users of health services, who have faced a substantial health and financial burden during the crisis. Our analysis shows that the headcount and overshoot of catastrophic health expenditure (CHE) substantially increased from 2007 to 2015, suggesting that financial protection has eroded to a great extent. Prior to the crisis, CHE was mainly due to inpatient care, followed by outpatient care and medicines. However, the contribution of spending for outpatient medicines to CHE substantially increased during the study period. The headcount of CHE rose across all socioeconomic groups we examined, with low-income households and households with chronic patients being disproportionately affected. In 2007, we do not report signs of socioeconomic inequalities in the risk of CHE. On the contrary, our results show that households of low socioeconomic status are more likely to incur CHE in 2015, revealing substantial inequalities in the risk of CHE. This finding raises significant distributional and equity concerns. Strengthening financial protection among older households is an imperative challenge for the Greek health system, and several policy responses need to be adopted towards this direction.
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Affiliation(s)
- Ilias Kyriopoulos
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
| | - Zlatko Nikoloski
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
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Pecoraro F, Luzi D, Clemente F. The efficiency in the ordinary hospital bed management: A comparative analysis in four European countries before the COVID-19 outbreak. PLoS One 2021; 16:e0248867. [PMID: 33750956 PMCID: PMC7984624 DOI: 10.1371/journal.pone.0248867] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/05/2021] [Indexed: 12/23/2022] Open
Abstract
During COVID-19 emergency the majority of health structures in Europe saturated or nearly saturated their availabilities already in the first weeks of the epidemic period especially in some regions of Italy and Spain. The aim of this study is to analyse the efficiency in the management of hospital beds before the COVID-19 outbreak at regional level in France, Germany, Italy and Spain. This analysis can indicate a reference point for future analysis on resource management in emergency periods and help hospital managers, emergency planners as well as policy makers to put in place a rapid and effective response to an emergency situation. The results of this study clearly underline that France and Germany could rely on the robust structural components of the hospital system, compared to Italy and Spain. Presumably, this might have had an impact on the efficacy in the management of the COVID-19 diffusion. In particular, the high availability of beds in the majority of the France regions paired with the low occupancy rate and high turnover interval led these regions to have a high number of available beds. Consider also that this country generally manages complex cases. A similar structural component is present in the German regions where the number of available beds is significantly higher than in the other countries. The impact of the COVID-19 was completely different in Italy and Spain that had to deal with a relevant large number of patients relying on a reduced number of both hospital beds and professionals. A further critical factor compared to France and Germany concerns the dissimilar distribution of cases across regions. Even if in these countries the hospital beds were efficiently managed, the concentration of hospitalized patients and the scarcity of beds have put pressure on the hospital systems.
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Affiliation(s)
- Fabrizio Pecoraro
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Daniela Luzi
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Fabrizio Clemente
- Institute of Crystallography, National Research Council, Monterotondo, Rome, Italy
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20
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Abstract
The worldwide economic crisis of the last decade, and still unresolved, led to a great recession involving all major economies. Since economic factors may influence mental wellbeing, not surprisingly a rise in poor mental health was observed in different countries, while representing a great challenge to psychiatric interventions. This paper aims at reviewing the available English literature focusing on the impact of the current economic crisis on mental health, with a special focus on depression and suicide. Available studies indicate that consequences of economic crisis, such as unemployment, increased workload or work reorganization, and reduced staff and wages, may constitute important stressing factors with a negative impact on mental health. Although data are not easily comparable in different countries, depression seems to be the most common psychiatric disorders especially in middle-aged men. Even suicide rates seem to be increased in men, mainly in countries with no public welfare or poor family relationships. All these findings require a careful attention from both governments that cut resources on public health instead of investing in it, and psychiatric associations that should implement appropriate strategies to face and to manage this sort of depression epidemic driven by economic crisis. Again, as available data suggest that the impact of the crisis might have been attenuated in countries with higher spending in social protection, they clearly urge policy makers to take into account possible health externalities associated to inadequate social protection systems.
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Abstract
The great economic crisis in 2008 has affected the welfare of the population in countries such as Italy. Although there is abundant literature on the impact of the crisis on physical health, very few studies have focused on the causal implications for mental health and health care. This paper, therefore, investigates the impact of the recent economic crisis on hospital admissions for severe mental disorder at small geographic levels in Italy and assesses whether there are heterogeneous effects across areas with distinct levels of income. We exploit 9-year (2007-2015) panel data on hospital discharges, which is merged with employment and income composition at the geographic units that share similar labour market structures. Linear and dynamic panel analysis are used to identify the causal effect of rising unemployment rate on severe mental illness admissions per 100,000 residents to account for time-invariant heterogeneity. We further create discrete income levels to identify the potential socioeconomic gradients behind this effect across areas with different economic characteristics. The results show a significant impact of higher unemployment rates on admissions for severe mental disorders after controlling for relevant economic factors, and the effects are concentrated on the most economically disadvantaged areas. The results contribute to the literature of spatio-temporal variation in the broader determinants of mental health and health care utilisation and shed light on the populations that are most susceptible to the effects of the economic crisis.
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Affiliation(s)
- Yuxi Wang
- Centre for Research on Health and Social Care Management Department of Social and Political Science, Bocconi University, 3-C1-01 Via Guglielmo Röntgen, 1, 20136, Milano, MI, Italy.
| | - Giovanni Fattore
- Centre for Research on Health and Social Care Management Department of Social and Political Science, Bocconi University, 3-C1-01 Via Guglielmo Röntgen, 1, 20136, Milano, MI, Italy
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22
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Trappolini E, Marino C, Agabiti N, Giudici C, Davoli M, Cacciani L. Disparities in emergency department use between Italians and migrants residing in Rome, Italy: the Rome Dynamic Longitudinal Study from 2005 to 2015. BMC Public Health 2020; 20:1548. [PMID: 33059671 PMCID: PMC7559990 DOI: 10.1186/s12889-020-09280-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/20/2020] [Indexed: 01/01/2023] Open
Abstract
Background The Emergency Department (ED) can be considered an indicator of accessibility and quality and can be influenced in period of economic downturns. In the last fifteen years, the number of migrants in Italy has doubled (from 2.4 million in 2005 to 5.2 in 2019, 4.1 and 8.7% of the total population, respectively). However, evidence about migrants’ healthcare use is poor, and no studies focused on the ED utilisation rate during the Great Recession are available. This study aims to analyse trends in all-cause and cause-specific ED utilisation among migrants and Italians residing in Rome, Italy, before and after 2008. Methods Longitudinal study based on data from the Municipal Register of Rome linked to the Emergency Department Register from 2005 to 2015. We analysed 2,184,467 individuals, aged 25–64 in each year. We applied a Hurdle model to estimate the propensity to use the ED and to model how often individuals accessed the ED. Results Migrants were less likely to be ED users than Italians, except for Africans (RR = 1.46, 95%CI 1.40–1.52) and Latin Americans (RR = 1.04, 95%CI 1.00–1.08) who had higher all-cause utilisation rates than non-migrants. Compared to the pre-2008 period, in the post-2008 we found an increase in the likelihood of being an ED user (OR = 1.34, 95%CI 1.34–1.35), and a decrease in ED utilisation rates (RR = 0.96, 95%CI 0.96–0.97) for the whole population, with differences among migrant subgroups, regardless of cause. Conclusions This study shows differences in the ED utilisation between migrants and Italians, and within the migrant population, during the Great Recession. The findings may reflect differentials in the health status, and barriers to access primary and secondary care among migrants. In this regard, health policies and cuts in health spending measures may have played a key role, and interventions to tackle health and access disparities should include policy measures addressing the underlying factors, adopting a Health in All Policies perspective. Further researches focusing on specific groups of migrants, and on the causes and diagnoses related to the ED utilisation, may help to explain the differences observed.
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Affiliation(s)
| | - Claudia Marino
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Laura Cacciani
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
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23
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Pecoraro F, Clemente F, Luzi D. The efficiency in the ordinary hospital bed management in Italy: An in-depth analysis of intensive care unit in the areas affected by COVID-19 before the outbreak. PLoS One 2020; 15:e0239249. [PMID: 32960908 PMCID: PMC7508364 DOI: 10.1371/journal.pone.0239249] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/12/2020] [Indexed: 01/10/2023] Open
Abstract
Since the end of February 2020 a severe diffusion of COVID-19 has affected Italy and in particular its northern regions, resulting in a high demand of hospitalizations in particular in the intensive care units (ICUs). Hospitals are suffering the high degree of patients to be treated for respiratory diseases and the majority of the health structures, especially in the north of Italy, are or are at risk of saturation. Therefore, the question whether and to what extent the reduction of hospital beds occurred in the past years has biased the management of the emergency has come to the front in the public debate. In our opinion, to start a robust analysis it is necessary to consider the Italian health system capacity prior to the emergency. Therefore, the aim of this study is to analyse the availability of hospital beds across the country as well as to determine their management in terms of complexity and performance of cases treated at regional level. The results of this study underlines that, despite the reduction of beds for the majority of the hospital wards, ICUs availabilities did not change between 2010 and 2017. Moreover, this study confirms that the majority of the Italian regions have a routinely efficient management of their facilities allowing hospitals to treat patients without the risk of having an overabundance of patients and a scarcity of beds. In fact, this analysis shows that, in normal situations, the management of hospital and ICU beds has no critical levels.
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Affiliation(s)
- Fabrizio Pecoraro
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Fabrizio Clemente
- Institute of Crystallography, National Research Council, Monterotondo (Rome), Italy
| | - Daniela Luzi
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
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24
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Guitron S, Pianykh OS, Succi MD, Lang M, Brink J. COVID-19: Recovery Models for Radiology Departments. J Am Coll Radiol 2020; 17:1460-1468. [PMID: 32979322 PMCID: PMC7476574 DOI: 10.1016/j.jacr.2020.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 10/28/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has greatly affected demand for imaging services, with marked reductions in demand for elective imaging and image-guided interventional procedures. To guide radiology planning and recovery from this unprecedented impact, three recovery models were developed to predict imaging volume over the course of the COVID-19 pandemic: (1) a long-term volume model with three scenarios based on prior disease outbreaks and other historical analogues, to aid in long-term planning when the pandemic was just beginning; (2) a short-term volume model based on the supply-demand approach, leveraging increasingly available COVID-19 data points to predict examination volume on a week-to-week basis; and (3) a next-wave model to estimate the impact from future COVID-19 surges. The authors present these models as techniques that can be used at any stage in an unpredictable pandemic timeline.
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Affiliation(s)
- Steven Guitron
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Oleg S Pianykh
- Director of Medical Analytics Group, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Marc D Succi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Director, Medically Engineered Solutions in Healthcare Incubator, Massachusetts General Hospital, Boston, Massachusetts
| | - Min Lang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Brink
- Juan M. Taveras Professor of Radiology, Harvard Medical School, Boston, Massachusetts; Radiologist-in-Chief, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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25
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Vola F, Vinci B, Golinelli D, Fantini MP, Vainieri M. Harnessing pharmaceutical innovation for anti-cancer drugs: Some findings from the Italian regions. Health Policy 2020; 124:1317-1324. [PMID: 32847692 DOI: 10.1016/j.healthpol.2020.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Governing the provision of innovative drugs is unanimously recognized as a key factor in steering the future of health care systems, by jointly affecting health outcomes and financial sustainability. AIM OF THE STUDY This paper describes the recent reforms in Italy governing the provision of innovative oncological drugs, with a focus on the different strategies implemented by the regions. It provides some preliminary findings about economic performance potentially associated with different governance models. METHODS We conducted a qualitative study based on 26 face-to-face semi-structured interviews with the Regional Directors of the pharmaceutical sector of the 13 regions involved in the study. The interviews were analysed to detect the various tools regions have adopted to manage prescriptions of innovative oncological drugs and different regional models were mapped. Additionally, we collected relevant information on the regional economic outcomes from national open data sources. RESULTS The 13 Italian regions strongly differ in how they apply national instruments and in how they devise regional governance tools. Analysis of the main economic indicators highlights that there is no direct relationship between strategies applied and performance achieved, although some preliminary results suggest a potential association between certain clinical governance models and different appropriateness performances.
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Affiliation(s)
- Federico Vola
- Management and Healthcare Laboratory, Institute of Management and Department, EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Bruna Vinci
- Management and Healthcare Laboratory, Institute of Management and Department, EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy; SSFO, Department of Pharmacy, University of Pisa, Italy.
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Italy Mater Studiorum - University of Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Italy Mater Studiorum - University of Bologna, Italy
| | - Milena Vainieri
- Management and Healthcare Laboratory, Institute of Management and Department, EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
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Badinella Martini M, D'Ascenzo F, Zaninelli A, Garattini L, Mannucci PM. The dark age of Italian general practice research - An Italian matter. Eur J Intern Med 2020; 73:98-99. [PMID: 31843354 DOI: 10.1016/j.ejim.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/07/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Fabrizio D'Ascenzo
- Department of Medical Sciences, "Città Della Salute e Della Scienza" Hospital, University of Turin, Turin, Italy
| | - Augusto Zaninelli
- District of Primary Care, Local Health Authority Bergamo (ATS Bergamo), Bergamo, Italy
| | - Livio Garattini
- "Angelo e Angela Valenti" Centre for Health Economics (CESAV), IRCCS "Mario Negri" Institute for Pharmacological Research, Milan, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, IRCCS "Ca' Granda Maggiore Policlinico" Hospital Foundation, Milan, Italy
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27
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Noto G, Belardi P, Vainieri M. Unintended consequences of expenditure targets on resource allocation in health systems. Health Policy 2020; 124:462-469. [PMID: 32098694 DOI: 10.1016/j.healthpol.2020.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
Abstract
In recent decades, several countries have reformed their health care systems leading to the devolution of power to a lower governance level and, subsequently, to re-centralisation. Due to the ambiguous results of these policies and the start of the financial crisis of 2008, a wide number of national governments implemented cutback initiatives aimed at controlling health expenditure. The literature shows that the introduction of such initiatives may have produced unintended consequences on health systems' performance. In order to better understand the power relations and the resulting decision-making processes between national governments and local authorities, it is important to focus on the effects of such expenditure control mechanisms on the inputs of the health systems, i.e. the production factors. This research aims at investigating the effects of a cutback initiative intended to control personnel costs in a federal Beveridge health system through the analysis of resource allocation at the devolved level. The paper is based on a quantitative analysis of data resulting from the financial statements published by the 21 Italian regional health systems from 2012 to 2017. The results show that, although the Italian regional health systems managed to reduce personnel costs - i.e. hitting the target - the control of the total cost dynamic was not fully addressed. Overall, the initiative implemented by the national government had the effect of limiting the decision-making autonomy of regional authorities, pushing them toward shifting resource allocation from personnel to the purchase of services.
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Affiliation(s)
- Guido Noto
- Management and Health Laboratory, Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies of Pisa, Piazza Martiri della Libertà 27, 56127, Pisa, Italy; Department of Economics, University of Messina, Italy.
| | - Paolo Belardi
- Management and Health Laboratory, Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies of Pisa, Piazza Martiri della Libertà 27, 56127, Pisa, Italy.
| | - Milena Vainieri
- Management and Health Laboratory, Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies of Pisa, Piazza Martiri della Libertà 27, 56127, Pisa, Italy.
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Prante FJ, Bramucci A, Truger A. Decades of Tight Fiscal Policy Have Left the Health Care System in Italy Ill-Prepared to Fight the COVID-19 Outbreak. Inter Econ 2020; 55:147-152. [PMID: 32536710 PMCID: PMC7276098 DOI: 10.1007/s10272-020-0886-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Although austerity was particularly strong in the aftermath of the economic crisis of 2008 and its consequences in the euro area, Italian fiscal policies have been characterised by tough consolidation periods ever since the 1990s.
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Affiliation(s)
- Franz J. Prante
- Institute for International Political Economy Berlin, Berlin School of Economics and Law, Badensche Straße 50-51, 10825 Berlin, Germany
| | - Alessandro Bramucci
- Institute for International Political Economy Berlin, Berlin School of Economics and Law, Badensche Straße 50-51, 10825 Berlin, Germany
| | - Achim Truger
- Institute for Socio-Economics, University Duisburg-Essen, Forsthausweg 2, 47057 Duisburg, Germany
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Signorelli C, Odone A, Oradini-Alacreu A, Pelissero G. Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary. Health Policy 2019; 124:69-74. [PMID: 31812325 DOI: 10.1016/j.healthpol.2019.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/09/2019] [Accepted: 11/05/2019] [Indexed: 01/13/2023]
Abstract
The Italian National Health Service (I-NHS) was established in 1978 to guarantee universal access to healthcare. Prominent in international reports, the I-NHS has reached a satisfactory level of efficiency and excellent standards of care in many regions, in forty years. Along the years, I-NHS has developed a structural public-private partnership in health services delivery that in some regions contributes to the achievement of very high standards of healthcare quality. However, the I-NHS is currently facing some major challenges: (a) Italy is experiencing a remarkable aging of its population with increasing health needs; (b) the recent and constant cuts to public expenditures are reducing the budget for welfare. It is of utmost importance to ensure that on-going efforts to contain health system costs do not subsume health care quality. In addition, monitoring of the essential levels of care (Livelli Essenziali di Assistenza, LEA) highlights significant differences in healthcare delivery among Italian regions that, in turns, contribute to the burdensome migration of patients to best-performing regions. Therefore, a more consolidated and ambitious approach to quality monitoring and healthcare improvement at a system level is needed to guarantee its sustainability in the future.
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Affiliation(s)
- C Signorelli
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy; Department of Medicine and Surgery, University of Parma, Italy.
| | - A Odone
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - A Oradini-Alacreu
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - G Pelissero
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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Capoluongo E, La Verde N, Barberis M, Bella MA, Buttitta F, Carrera P, Colombo N, Cortesi L, Gion M, Guarneri V, Lorusso D, Marchetti A, Marchetti P, Normanno N, Pasini B, Pensabene M, Pignata S, Radice P, Ricevuto E, Sapino A, Tagliaferri P, Tassone P, Trevisiol C, Truini M, Varesco L, Russo A, Gori S. BRCA1/2 Molecular Assay for Ovarian Cancer Patients: A Survey through Italian Departments of Oncology and Molecular and Genomic Diagnostic Laboratories. Diagnostics (Basel) 2019; 9:E146. [PMID: 31600986 DOI: 10.3390/diagnostics9040146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 12/15/2022] Open
Abstract
In Italy, 5200 new ovarian cancers were diagnosed in 2018, highlighting an increasing need to test women for BRCA1/2. The number of labs offering this test is continuously increasing. The aim of this study was to show the results coming from the intersociety survey coordinated by four different Clinical and Laboratory Italian Scientific Societies (AIOM, SIAPEC-IAP, SIBIOC, and SIGU). A multidisciplinary team belonging to the four scientific societies drew up two different questionnaires: One was targeted toward all Italian Departments of Medical Oncology, and the second toward laboratories of clinical molecular biology. This survey was implemented from September 2017 to March 2018. Seventy-seven out of 305 (25%) Departments of Medical Oncology filled our survey form. Indeed, 59 molecular laboratories were invited. A total of 41 laboratories (70%) filled in the questionnaire. From 2014 to 2017, 16 new molecular laboratories were activated. A total of 12,559 tests were performed in the year 2016, with a mean of 339 tests and a median of 254 tests per laboratory, showing a glimpse of an extreme low number of tests performed per year by some laboratories. In terms of the type and number of professionals involved in the pre- and post-test counseling, results among the onco-genetic team were heterogeneous. Our data show that the number of laboratories providing BRCA1/2 germline assays is significantly increased with further implementation of the somatic test coming soon. The harmonization of the complete laboratory diagnostic path should be encouraged, particularly in order to reduce the gap between laboratories with high and low throughput.
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Kerr R, Hendrie DV. Is capital investment in Australian hospitals effectively funding patient access to efficient public hospital care? AUST HEALTH REV 2019; 42:501-513. [PMID: 30135003 DOI: 10.1071/ah17231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 05/07/2018] [Indexed: 11/23/2022]
Abstract
Objective
This study asks ‘Is capital investment in Australian public hospitals effectively funding patient access to efficient hospital care?’
Methods
The study drew information from semistructured interviews with senior health infrastructure officials, literature reviews and World Health Organization (WHO) reports. To identify which systems most effectively fund patient access to efficient hospitals, capital allocation systems for 17 Organisation for Economic Cooperation and Development (OECD) countries were assessed.
Results
Australian government objectives (equitable access to clinically appropriate, efficient, sustainable, innovative, patient-based) for acute health services are not directly addressed within Australian capital allocation systems for hospitals. Instead, Australia retains a prioritised hospital investment system for institutionally based asset replacement and capital planning, aligned with budgetary and political priorities. Australian systems of capital allocation for public hospitals were found not to match health system objectives for allocative, productive and dynamic efficiency. Australia scored below average in funding patient access to efficient hospitals. The OECD countries most effectively funding patient access to efficient hospital care have transitioned to diagnosis-related group (DRG) aligned capital funding. Measures of effective capital allocation for hospitals, patient access and efficiency found mixed government–private–public partnerships performed poorly with inferior access to capital than DRG-aligned systems, with the worst performing systems based on private finance.
Conclusion
Australian capital allocation systems for hospitals do not meet Australian government standards for the health system. Transition to a diagnosis-based system of capital allocation would align capital allocation with government standards and has been found to improve patient access to efficient hospital care.
What is known about the topic?
Very little is known about the effectiveness of Australian capital allocation for public hospitals. In Australia, capital is rarely discussed in the context of efficiency, although poor built capital and inappropriate technologies are acknowledged as limitations to improving efficiency. Capital allocated for public hospitals by state and territory is no longer reported by Australian Institute of Health and Welfare due to problems with data reliability. International comparative reviews of capital funding for hospitals have not included Australia. Most comparative efficiency reviews for health avoid considering capital allocation. The national review of hospitals found capital allocation information makes it difficult to determine ’if we have it right’ in terms of investment for health services. Problems with capital allocation systems for public hospitals have been identified within state-based reviews of health service delivery. The Productivity Commission was unable to identify the cost of capital used in treating patients in Australian public hospitals. Instead, building and equipment depreciation plus the user cost of capital (or the cost of using the money invested in the asset) are used to estimate the cost of capital required for patient care, despite concerns about accuracy and comparability.
What does this paper add?
This is the first study to review capital allocation systems for Australian public hospitals, to evaluate those systems against the contemporary objectives of the health systems and to assess whether prevailing Australian allocation systems deliver funds to facilitate patient access to efficient hospital care. This is the first study to evaluate Australian hospital capital allocation and efficiency. It compares the objectives of the Australian public hospitals system (for universal access to patient-centred, efficient and effective health care) against a range of capital funding mechanisms used in comparable health systems. It is also the first comparative review of international capital funding systems to include Australia.
What are the implications for practitioners?
Clinical quality and operational efficiency in hospitals require access for all patients to technologically appropriate hospitals. Funding for appropriate public hospital facilities, medical equipment and information and communications technology is not connected to activity-based funding in Australia. This study examines how capital can most effectively be allocated to provide patient access to efficient hospital care for Australian public hospitals. Capital investment for hospitals that is patient based, rather than institutionally focused, aligns with higher efficiency.
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Affiliation(s)
- Rhonda Kerr
- Centre for Population Health Research, Faculty of Health Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. Email
| | - Delia V Hendrie
- Centre for Population Health Research, Faculty of Health Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. Email
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Petrou P. The Impact of Financial Crisis, Austerity Measures, and Bailout Agreement on Cypriots’ Health: The Memorandum Is Dead, Long Live the Memorandum. Value Health Reg Issues 2019; 19:99-103. [DOI: 10.1016/j.vhri.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 12/30/2018] [Accepted: 04/04/2019] [Indexed: 01/18/2023]
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Paes-Sousa R, Schramm JMDA, Mendes LVP. Fiscal austerity and the health sector: the cost of adjustments. Cien Saude Colet 2019; 24:4375-4384. [PMID: 31778488 DOI: 10.1590/1413-812320182412.23232019] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 07/12/2019] [Indexed: 12/30/2022] Open
Abstract
Fiscal austerity policies have been used as responses to economic crises and fiscal deficits in both developed and developing countries. While they vary in regard to their content, intensity and implementation, such models recommend reducing public expenses and social investments, retracting the public service and substituting the private sector in lieu of the State to provide certain services tied to social policies. The present article discusses the main effects of the recent economic crisis on public health based on an updated review with consideration for three dimensions: health risks, epidemiological profiles of different populations, and health policies. In Brazil, the combination of economic crisis and fiscal austerity policies is capable of producing a direr situation than those experienced in developed countries. The country is characterized by historically high levels of social inequality, an under-financed health sector, highly prevalent chronic degenerative diseases and persisting preventable infectious diseases. It is imperative to develop alternatives to mitigate the effects of the economic crisis taking into consideration not only the sustainability of public finance but also public well-being.
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Affiliation(s)
- Romulo Paes-Sousa
- Centro de Pesquisas René Rachou, Fiocruz Minas. Av. Augusto de Lima 1715, Barro Preto. 30190-002 Belo Horizonte MG Brasil.
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Lorini C, Bianchi J, Sartor G, Santini MG, Mersi A, Caini S, Bonaccorsi G. Trends in the use of seat belts and mobile phones and their seasonal variations in Florence (2005-2015). PLoS One 2018; 13:e0208489. [PMID: 30533029 PMCID: PMC6289414 DOI: 10.1371/journal.pone.0208489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 11/19/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION About 1.25 million people worldwide die every year because of road accidents. Risk is higher when drivers use mobile phones, whereas seat belts help to prevent crash-related injury. We aimed to evaluate the prevalence, associated factors, and temporal trend of the use of seat belts and mobile phones among drivers and passengers in Florence, Italy (2005-2015). METHODS Use of seat belts and mobile phones use was monitored via direct observation in four areas in the province of Florence. We fitted Poisson regression models with robust variance to investigate the factors associated with the use of seat belts and mobile phones use by the drivers and to explore long-term trends and seasonal patterns in the two time-series. RESULTS We observed a total of an overall 134,775 vehicles: seat belts were worn by 71.8% of drivers and front-seat passengers and 27.6% of back-seat passengers, while mobile phones were being used by 4.8% of drivers. Drivers were more likely to wear seat belt when transporting passengers (≥2 vs none: prevalence ratio [PR] 1.21, 95% confidence intervals [CI] 1.14-1.29) and while driving in the afternoon (PR 1.04, 95% CI 1.03-1.05), and less likely when the front-seat passenger was not wearing seat belts (PR 0.33, 95% CI 0.32-0.34). After an initial increase, seat belts use by the driver decreased over time (-0.5% each year during 2010-2015), with significant peaks and troughs in July and January, respectively. Mobile phone use by the driver was inversely associated with wearing seat belts (PR 0.67, 95% CI 0.64-0.70) and carrying passengers (≥2 vs. none PR 0.20, 95% CI 0.07-0.52). The proportion of drivers using mobile phones did not vary over time nor showed any clear seasonality. CONCLUSIONS Drivers' risky behaviours (not wearing a seat belt and using a mobile phone) are associated, showing a global misperception of risk among a subset of drivers. The number of passengers and their behaviour is also associated with the driver's attitude. The effectiveness of primary enforcement laws has declined in Italy in recent years; therefore, other strategies should be devised and implemented.
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Affiliation(s)
- Chiara Lorini
- Department of Health Science, University of Florence, Florence, Italy
| | - Jacopo Bianchi
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Gino Sartor
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Maria Grazia Santini
- Department of Prevention, Central Tuscany Local Health Authority, Florence, Italy
| | - Anna Mersi
- Department of Prevention, Central Tuscany Local Health Authority, Florence, Italy
| | - Saverio Caini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Borgonovi E, Adinolfi P, Palumbo R, Piscopo G. Framing the Shades of Sustainability in Health Care: Pitfalls and Perspectives from Western EU Countries. Sustainability 2018; 10:4439. [DOI: 10.3390/su10124439] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Sustainability is momentous for the appropriate functioning of health care systems. In fact, health and sustainability are two strictly related values, which could not be separately sought. While studies discussing the contextualization of this issue with respect to the distinguishing attributes of health care systems are rapidly blooming, there is still little agreement about what is ultimately meant by sustainability in the health care arena. On the one hand, attention is primarily focused on the proper use of available financial resources; on the other hand, people engagement and empowerment are gradually arising as a crucial step to enhance the viability of the health care system. This paper tries to identify, from a conceptual point of view inspired by the European integrative movement, the different shades of sustainability in health care and proposes a recipe to strengthen the long-term viability of health care organizations. The balanced mix of financial, economic, political, and social sustainability is compelling to increase the ability of health care organizations to create meaningful value for the population served. However, the focus on a single dimension of sustainability is thought to engender several side effects, which compromise the capability of health care organizations to guarantee health gains at the individual and collective levels. From this standpoint, further conceptual and practical developments are envisioned, paving the way for a full-fledged understanding of sustainability in the health care environment.
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Lancia L, Caponnetto V, Dante A, Mattei A, La Cerra C, Cifone MG, Petrucci C. Analysis of factors potentially associated with nursing students' academic outcomes: A thirteen-year retrospective multi-cohort study. Nurse Educ Today 2018; 70:115-120. [PMID: 30179783 DOI: 10.1016/j.nedt.2018.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/24/2018] [Accepted: 08/16/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Low academic success rates lead to fewer than the required number of nurses entering the national health systems, impacting on the supply of nurses and with negative consequences for global health care since low nurse-to-patient ratios are associated with an increase of patients' adverse outcomes. OBJECTIVES This study was mainly aimed at documenting any of the academic outcomes' potential predictors among Nursing Degree Program (NDP) students' characteristics. DESIGN A retrospective multi-cohort study was conducted. PARTICIPANTS AND SETTING Ten cohorts of nursing students enrolled in a central Italy university were involved. METHODS Qualitative and quantitative data on entry characteristics and academic outcomes were retrieved, observing retrospectively 10 cohorts of Italian nursing students for 13 academic years (2004-2017). Multiple regression analyses were conducted to assess if potential predictors reporting a p-value < 0.05 in univariate analyses were independently related to academic outcomes. RESULTS A total of 2278 students were enrolled in this study. Multivariate analyses showed that 'female gender', 'having attended classical or scientific upper-secondary school', and 'having higher upper-secondary diploma grade' were associated both with the qualitative outcomes (graduation within the legal duration of NDP) and the quantitative ones (final degree exam grade). The weight of the 'admission-test score' in explaining the variance of academic performances was very low (β = 0.03, 95% CI = 0.01 to 0.05) compared to the 'upper-secondary diploma grade' (β = 0.14, 95% CI = 0.12 to 0.16). CONCLUSIONS This evidence should lead to a reflection on the entry-selection methods for NDP, especially in those countries such as Italy, where these methods are essentially based on the entry-test, which in this study was shown to have a very low predictive power for academic outcomes.
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Affiliation(s)
- L Lancia
- Department of Health, Life and Environmental Sciences, University of L'Aquila, Edificio Delta 6, Via San Salvatore, 67010, Coppito, L'Aquila, Italy.
| | - V Caponnetto
- Department of Health, Life and Environmental Sciences, University of L'Aquila, Edificio Delta 6, Via San Salvatore, 67010, Coppito, L'Aquila, Italy.
| | - A Dante
- Department of Health, Life and Environmental Sciences, University of L'Aquila, Edificio Delta 6, Via San Salvatore, 67010, Coppito, L'Aquila, Italy.
| | - A Mattei
- Department of Health, Life and Environmental Sciences, University of L'Aquila, Edificio Delta 6, Via San Salvatore, 67010, Coppito, L'Aquila, Italy.
| | - C La Cerra
- Department of Health, Life and Environmental Sciences, University of L'Aquila, Edificio Delta 6, Via San Salvatore, 67010, Coppito, L'Aquila, Italy.
| | - M G Cifone
- Department of Health, Life and Environmental Sciences, University of L'Aquila, Edificio Delta 6, Via San Salvatore, 67010, Coppito, L'Aquila, Italy.
| | - C Petrucci
- Department of Health, Life and Environmental Sciences, University of L'Aquila, Edificio Delta 6, Via San Salvatore, 67010, Coppito, L'Aquila, Italy.
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Previtali P, Cerchiello P. The Prevention of Corruption as an Unavoidable Way to Ensure Healthcare System Sustainability. Sustainability 2018; 10:3071. [DOI: 10.3390/su10093071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Corruption has found very fertile ground in the health sector. Many studies demonstrate the negative relationship between sustainability and corruption. However, relatively little is known at this time about how to prevent corruption in healthcare organizations (HCOs), and thus to recover the important sustainability of the entire healthcare system. After noticing this gap in the literature, the authors’ aim in undertaking this study was twofold: first, to analyze the current state of knowledge about how Italian HCOs adopt corruption prevention plans in compliance with the National Plan issued by the National Anti-Corruption Authority; second, to identify some clusters of HCOs which represent different adoption patterns of corruption prevention interventions and to classify these HCOs. For these purposes, the authors studied 68 HCOs along 13 dimensions that characterized the corruption prevention plans. The empirical results showed that the HCOs were not fully compliant with the anti-corruption legislation. At the same time, the authors identified three clusters of HCOs with different patterns of anti-corruption prevention interventions. The clusters that adopted some specific interventions seemed to be more sustainable than others.
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Saletti P, Sanna P, Gabutti L, Ghielmini M. Choosing wisely in oncology: necessity and obstacles. ESMO Open 2018; 3:e000382. [PMID: 30018817 PMCID: PMC6045771 DOI: 10.1136/esmoopen-2018-000382] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 12/25/2022] Open
Abstract
In the last decades, the survival of many patients with cancer improved thanks to modern diagnostic methods and progresses in therapy. Still for several tumours, especially when diagnosed at an advanced stage, the benefits of treatment in terms of increased survival or quality of life are at best modest when not marginal, and should be weighed against the potential discomfort caused by medical procedures. As in other specialties, in oncology as well the dialogue between doctor and patient should be encouraged about the potential overuse of diagnostic procedures or treatments. Several oncological societies produced recommendations similar to those proposed by other medical disciplines adhering to the Choosing Wisely (CW) campaign. In this review, we describe what was reported in the medical literature concerning adequacy of screening, diagnostic, treatment and follow-up procedures and the potential impact on them of the CW. We only marginally touch on the more complex topic of treatment appropriateness, for which several evaluation methods have been developed (including the European Society for Medical Oncology-magnitude of clinical benefit scale). Finally, we review the possible obstacles for the development of CW in the oncological setting and focus on the strategies which could allow CW to evolve in the cancer field, so as to enhance the therapeutic relationship between medical professionals and patients and promote more appropriate management.
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Affiliation(s)
- Piercarlo Saletti
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | - Piero Sanna
- Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luca Gabutti
- Internal Medicine Department, Ente Ospedaliero Cantonale (EOC), Choosing Wisely EOC, Bellinzona, Switzerland
| | - Michele Ghielmini
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Grima S, Spiteri JV, Jakovljevic M, Camilleri C, Buttigieg SC. High Out-of-Pocket Health Spending in Countries With a Mediterranean Connection. Front Public Health 2018; 6:145. [PMID: 29876340 PMCID: PMC5974227 DOI: 10.3389/fpubh.2018.00145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/30/2018] [Indexed: 11/13/2022] Open
Abstract
In this study, we analyzed healthcare provision and health expenditure across six Mediterranean countries that adopt the National Health System (Beveridge model) and that form part of the European Union (EU) with the main aim being that of analyzing and comparing out-of-pocket health spending in countries with a European Mediterranean connection. To this end, we considered various economic indicators and statistics to derive commonalities and differences across these countries and also compared trends in these indicators to those observed across the rest of the EU. We then analyzed these findings in light of other data related to the quality of healthcare delivery and the infrastructure of the health system and discussed recent developments in healthcare within each country and the main challenges faced by the respective health systems. The results show that on average, Mediterranean countries spend less on total healthcare expenditure (THE) than the EU average, both as a proportion of GDP, as well as in per capita terms. This is primarily driven by lower-than-EU-average public funding of healthcare. The 2008/2009 macro-economic and financial crisis had a significant impact on the countries under review, and explains the persistent reductions in public health spending as part of the austerity measures put in force across sectors. On the flipside, Mediterranean countries have a higher presence of private health providers in total funding, thereby explaining the higher Out-of-Pocket (OOPs) health expenditures in these countries relative to the EU-average. With regard to the overall health infrastructure in these countries, we observed that although the supply of physicians is largely in line with the rest of the EU, there is under-supply when it comes to hospital beds. This may be symptomatic of lower government funding. Nonetheless, all countries score highly in the evaluation of the quality of health services, as recorded by international rankings like the WHO's 2000 metric, whereas health system performance indicators, namely mortality rates and life expectancy reveal favorable health outcomes in the Mediterranean EU countries. The findings in this paper may be seen in light of the Mediterranean region's lifestyle in terms of diet, health behavior, health beliefs and shared culture. In particular, the higher out-of-pocket expenditure may reflect the tendency for one-to-one relationships with private clinicians and the pursuit of person-centered care (1). Additionally, the Mediterranean people may not be as disciplined as their European counterparts in accessing and using the public health sector. The lower THE also reflects the fact that the Mediterranean countries are less wealthy than the more economically-advanced European countries.
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Affiliation(s)
- Simon Grima
- Insurance Department, Faculty of Economics Management and Accountancy, University of Malta, Msida, Malta
| | - Jonathan V Spiteri
- Insurance Department, Faculty of Economics Management and Accountancy, University of Malta, Msida, Malta
| | | | - Carl Camilleri
- Economics Department, Faculty of Economics Management and Accountancy, University of Malta, Msida, Malta
| | - Sandra C Buttigieg
- Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta.,Health Services Management Centre, School of Social Policy, College of Social Sciences, University of Birmingham, Birmingham, United Kingdom
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Loughnane C, Murphy A, Mulcahy M, McInerney C, Walshe V. Have bailouts shifted the burden of paying for healthcare from the state onto individuals? Ir J Med Sci 2018; 188:5-12. [PMID: 29633161 DOI: 10.1007/s11845-018-1798-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/19/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND/AIMS The financial crisis that enveloped Europe in 2009 created financial pressure for governments and required a number of countries to obtain a financial bailout from the IMF. The purpose of this paper is to examine the effect of the financial crisis on public health expenditure in bailout countries and if bailouts shift the burden of paying for healthcare from the state onto individuals. METHODS Quantitative health expenditure data were collected from the WHO and OECD for the period 2004-2015 and evaluated using a comparison of means Welch's t test. RESULTS The majority of bailout countries recorded a decrease in public health expenditure as a percentage of total government expenditure, with Ireland recording the largest decrease with government health expenditure as a percentage of total government expenditure, falling by 22% (P < .01). In addition, the results also suggest that the burden of paying for healthcare shifted from the state onto individuals in three countries, namely Hungary, Ireland and Portugal, where public health expenditure declined and private expenditure increased significantly. CONCLUSIONS The ramifications of shifting the burden of paying for healthcare from the state onto individuals at this point remain unclear with further research required to identify the long-term consequences for healthcare.
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Affiliation(s)
- Conor Loughnane
- Cork University Business School, University College Cork, Cork, Ireland.
| | - Aileen Murphy
- Cork University Business School, University College Cork, Cork, Ireland
| | - Mark Mulcahy
- Cork University Business School, University College Cork, Cork, Ireland
| | - Celine McInerney
- Cork University Business School, University College Cork, Cork, Ireland
| | - Valerie Walshe
- Health Service Executive, Model Business Park, Model Farm Road, Cork, Ireland
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Córdoba-Doña JA, Escolar-Pujolar A, San Sebastián M, Gustafsson PE. Withstanding austerity: Equity in health services utilisation in the first stage of the economic recession in Southern Spain. PLoS One 2018; 13:e0195293. [PMID: 29601609 PMCID: PMC5877882 DOI: 10.1371/journal.pone.0195293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 03/20/2018] [Indexed: 12/30/2022] Open
Abstract
Scant research is available on the impact of the current economic crisis and austerity policies on inequality in health services utilisation in Europe. This study aimed to describe the trends in horizontal inequity in the use of health services in Andalusia, Spain, during the early years of the Great Recession, and the contribution of demographic, economic and social factors. Consultation with a general practitioner (GP) and specialist, hospitalisation and emergency care were studied through the Andalusian Health Survey 2007 (pre-crisis) and 2011–2012 (crisis), using a composite income index as socioeconomic status (SES) indicator. Horizontal inequity indices (HII) were calculated to take differential healthcare needs into account, and a decomposition analysis of change in inequality between periods was performed. Results showed that before the crisis, the HII was positive (greater access for people with higher SES) for specialist visits but negative (greater access for people with lower SES) in the other three utilisation models. During the crisis no change was observed in inequalities in GP visits, but a pro-poor development was seen for the other types of utilisation, with hospital and emergency care showing significant inequality in favour of low income groups. Overall, the main contributors to pro-poor changes in utilisation were socio-economic variables and poor mental health, due to changes in their elasticities. Our findings show that inequalities in healthcare utilisation largely remained in favour of the less well-off, despite the cuts in welfare benefits and health services provision during the early years of the recession in Andalusia. Further research is needed to monitor the potential impact of such measures in subsequent years.
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Affiliation(s)
- Juan Antonio Córdoba-Doña
- Delegación Territorial de la Consejería de Salud de la Junta de Andalucía, Cádiz, Spain
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- * E-mail:
| | | | - Miguel San Sebastián
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Per E. Gustafsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Di Novi C, Marenzi A, Rizzi D. Do healthcare tax credits help poor-health individuals on low incomes? Eur J Health Econ 2018; 19:293-307. [PMID: 28299492 DOI: 10.1007/s10198-017-0884-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 03/02/2017] [Indexed: 06/06/2023]
Abstract
In several countries, personal income tax permits tax credits for out-of-pocket healthcare expenditure. Tax credits benefit taxpayers at all income levels by reducing their net tax liability and modify the price of out-of-pocket expenditure. To the extent that consumer demand is price elastic, they may influence the amount of eligible healthcare expenditure for which taxpayers may claim a credit. These effects influence, in turn, income distributions and taxpayers' health status and therefore income-related inequality in health. Redistributive consequences of tax credits have been widely investigated. However, little is known about the ability of tax credits to alleviate health inequality. In this paper, we study the potential effects that tax credits for health expenses may have on income-related inequality in health status with reference to the Italian institutional setting. The analysis is performed using a tax-benefit microsimulation model that reproduces the personal income tax and incorporates taxpayers' behavioral responses to changes in tax credit rate. Our results suggest that the current healthcare tax credit design tends to favor the richest part of the population.
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Affiliation(s)
- Cinzia Di Novi
- Department of Economics and Management, University of Pavia, via San Felice, 5/7, 27100, Pavia, Italy.
- Health, Econometrics and Data Group, University of York, York, UK.
- LCSR, National Research University Higher School of Economics, Moscow, Russian Federation.
| | - Anna Marenzi
- Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Dino Rizzi
- Department of Economics, Ca' Foscari University of Venice, Venice, Italy
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Di Novi C, Rizzi D, Zanette M. Scale Effects and Expected Savings from Consolidation Policies of Italian Local Healthcare Authorities. Appl Health Econ Health Policy 2018; 16:107-122. [PMID: 29124677 DOI: 10.1007/s40258-017-0359-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Consolidation is often considered by policymakers as a means to reduce service delivery costs and enhance accountability. OBJECTIVE The aim of this study was to estimate the potential cost savings that may be derived from consolidation of local health authorities (LHAs) with specific reference to the Italian setting. METHODS For our empirical analysis, we use data relating to the costs of the LHAs as reported in the 2012 LHAs' Income Statements published within the New Health Information System (NSIS) by the Ministry of Health. With respect to the previous literature on the consolidation of local health departments (LHDs), which is based on ex-post-assessments on what has been the impact of the consolidation of LHDs on health spending, we use an ex-ante-evaluation design and simulate the potential cost savings that may arise from the consolidation of LHAs. RESULTS Our results show the existence of economies of scale with reference to a particular subset of the production costs of LHAs, i.e. administrative costs together with the purchasing costs of goods (such as drugs and medical devices) as well as non-healthcare-related services. CONCLUSIONS The research findings of our paper provide practical insight into the concerns and challenges of LHA consolidations and may have important implications for NHS organisation and for the containment of public healthcare expenditure.
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Affiliation(s)
- Cinzia Di Novi
- Department of Economics and Management, University of Pavia, via San Felice, 5/7, 27100, Pavia, Italy.
- Health, Econometrics and Data Group, University of York, Heslington, York, UK.
- Laboratory for Comparative Social Research, National Research University Higher School of Economics, Moscow, Russia.
| | - Dino Rizzi
- Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Michele Zanette
- Department of Economics, Ca' Foscari University of Venice, Venice, Italy
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Piumatti G. Relations between longitudinal trajectories of subjective financial wellbeing with self-rated health among elderly. Medicina (B Aires) 2017; 53:323-30. [DOI: 10.1016/j.medici.2017.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 07/17/2017] [Accepted: 09/04/2017] [Indexed: 11/17/2022] Open
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Bianchetti L, Squazzoni F, Casnici N, Bianchini D, Garrafa E, Archetti C, Romano V, Rozzini L, Melchiori M, Fiorentini C, Uberti D, Calza S, Marengoni A. Social networks and health status in the elderly: the 'ANZIANI IN-RETE' population-based study. Aging Clin Exp Res 2017; 29:1173-1179. [PMID: 28211026 DOI: 10.1007/s40520-017-0726-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Certain features of the social environment could maintain and even improve not only psychological well-being, but also health and cognition of the elderly. AIMS We tested the association between social network characteristics and the number of chronic diseases in the elderly. METHODS A randomized sample of the elderly population of Brescia, Italy, was evaluated (N = 200, age ≥65 years). We performed a comprehensive geriatric assessment, including information on socio-demographic variables (family, friendships, and acquaintance contacts). We measured each person's social network, i.e., degree, efficiency, and variety. RESULTS The sample included 118 women and 82 men, mean age 77.7 years. The mean number of chronic diseases was 3.5. A higher social network degree, i.e., more social connections, was associated with fewer diseases. We also found that having more contacts with people similar to each other or intense relationships with people who do not know each other were associated with fewer diseases. CONCLUSION More healthy people tend to share certain characteristics of social networks. Our study indicates that it is important to look at diseases and health as complex phenomena, which requires integrating different levels of analysis.
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Sakellariou D, Rotarou ES. The effects of neoliberal policies on access to healthcare for people with disabilities. Int J Equity Health 2017; 16:199. [PMID: 29141634 PMCID: PMC5688676 DOI: 10.1186/s12939-017-0699-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022] Open
Abstract
Neoliberal reforms lead to deep changes in healthcare systems around the world, on account of their emphasis on free market rather than the right to health. People with disabilities can be particularly disadvantaged by such reforms, due to their increased healthcare needs and lower socioeconomic status. In this article, we analyse the impacts of neoliberal reforms on access to healthcare for disabled people. This article is based on a critical analytical review of the literature and on two case studies, Chile and Greece. Chile was among the first countries to introduce neoliberal reforms in the health sector, which led to health inequalities and stratification of healthcare services. Greece is one of the most recent examples of countries that have carried out extensive changes in healthcare, which have resulted in a deterioration of the quality of healthcare services. Through a review of the policies performed in these two countries, we propose that the pathways that affect access to healthcare for disabled people include: a) Policies directly or indirectly targeting healthcare, affecting the entire population, including disabled people; and b) Policies affecting socioeconomic determinants, directly or indirectly targeting disabled people, and indirectly impacting access to healthcare. The power differentials produced through neoliberal policies that focus on economic rather than human rights indicators, can lead to a category of disempowered people, whose health needs are subordinated to the markets. The effects of this range from catastrophic out-of-pocket payments to compromised access to healthcare. Neoliberal reforms can be seen as a form of structural violence, disproportionately affecting the most vulnerable parts of the population - such as people with disabilities - and curtailing access to basic rights, such as healthcare.
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Affiliation(s)
- Dikaios Sakellariou
- School of Healthcare Sciences, Cardiff University, Eastgate House, Newport Road 35-43, Cardiff, CF24 0AB, UK.
| | - Elena S Rotarou
- Department of Economics, University of Chile, Diagonal Paraguay 257, Office 1506, 8330015, Santiago, Chile
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Tavares LP, Zantomio F. Inequity in healthcare use among older people after 2008: The case of southern European countries. Health Policy 2017; 121:1063-71. [DOI: 10.1016/j.healthpol.2017.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/21/2017] [Accepted: 08/28/2017] [Indexed: 11/22/2022]
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Wenzl M, Naci H, Mossialos E. 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. Health Policy 2017; 121:947-954. [DOI: 10.1016/j.healthpol.2017.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 04/20/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
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Buffel V, Beckfield J, Bracke P. The Institutional Foundations of Medicalization: A Cross-national Analysis of Mental Health and Unemployment. J Health Soc Behav 2017; 58:272-290. [PMID: 29164950 DOI: 10.1177/0022146517716232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this study, we question (1) whether the relationship between unemployment and mental healthcare use, controlling for mental health status, varies across European countries and (2) whether these differences are patterned by a combination of unemployment and healthcare generosity. We hypothesize that medicalization of unemployment is stronger in countries where a low level of unemployment generosity is combined with a high level of healthcare generosity. A subsample of 36,306 working-age respondents from rounds 64.4 (2005-2006) and 73.2 (2010) of the cross-national survey Eurobarometer was used. Country-specific logistic regression and multilevel analyses, controlling for public disability spending, changes in government spending, economic capacity, and unemployment rate, were performed. We find that unemployment is medicalized, at least to some degree, in the majority of the 24 nations surveyed. Moreover, the medicalization of unemployment varies substantially across countries, corresponding to the combination of the level of unemployment and of healthcare generosity.
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50
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Graffigna G, Barello S, Riva G, Savarese M, Menichetti J, Castelnuovo G, Corbo M, Tzannis A, Aglione A, Bettega D, Bertoni A, Bigi S, Bruttomesso D, Carzaniga C, Del Campo L, Donato S, Gilardi S, Guglielmetti C, Gulizia M, Lastretti M, Mastrilli V, Mazzone A, Muttillo G, Ostuzzi S, Perseghin G, Piana N, Pitacco G, Polvani G, Pozzi M, Provenzi L, Quaglini G, Rossi M, Varese P, Visalli N, Vegni E, Ricciardi W, Bosio AC. Fertilizing a Patient Engagement Ecosystem to Innovate Healthcare: Toward the First Italian Consensus Conference on Patient Engagement. Front Psychol 2017. [PMID: 28634455 PMCID: PMC5460315 DOI: 10.3389/fpsyg.2017.00812] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal. This contributes to a wide "system" inertia-really difficult to be overcome-and put at risk any form of innovation in this filed. As a result, patient engagement risk today to be a buzz words, rather than a real guidance for practice. To make the field clearer, we promoted an Italian Consensus Conference on Patient Engagement (ICCPE) in order to set the ground for drafting recommendations for the provision of effective patient engagement interventions. The ICCPE will conclude in June 2017. This document reports on the preliminary phases of this process. In the paper, we advise the importance of "fertilizing a patient engagement ecosystem": an oversimplifying approach to patient engagement promotion appears the result of a common illusion. Patient "disengagement" is a symptom that needs a more holistic and complex approach to solve its underlined causes. Preliminary principles to promote a patient engagement ecosystem are provided in the paper.
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Affiliation(s)
| | - Serena Barello
- Faculty of Psychology, Università Cattolica del Sacro CuoreMilan, Italy
| | - Giuseppe Riva
- Faculty of Psychology, Università Cattolica del Sacro CuoreMilan, Italy.,Istituto Auxologico Italiano (IRCCS)Milan, Italy
| | | | - Julia Menichetti
- Faculty of Psychology, Università Cattolica del Sacro CuoreMilan, Italy.,Istituto Nazionale dei Tumori (IRCCS)Milan, Italy
| | - Gianluca Castelnuovo
- Faculty of Psychology, Università Cattolica del Sacro CuoreMilan, Italy.,Istituto Auxologico Italiano (IRCCS)Milan, Italy
| | | | | | - Antonio Aglione
- Federazione Italiana delle Associazioni di Volontariato in Oncologia (FAVO)Rome, Italy
| | | | - Anna Bertoni
- Faculty of Psychology, Università Cattolica del Sacro CuoreMilan, Italy
| | - Sarah Bigi
- Department of Linguistics, Università Cattolica del Sacro CuoreMilan, Italy
| | - Daniela Bruttomesso
- Società Italiana di Diabetologia (SID)Rome, Italy.,Dipartimento di Medicina, Azienda Ospedaliero-Universitaria di PadovaPadova, Italy
| | - Claudia Carzaniga
- Gruppo Italiano Infermieri di Area Cardiovascolare (GITIC)Rome, Italy
| | - Laura Del Campo
- Federazione Italiana delle Associazioni di Volontariato in Oncologia (FAVO)Rome, Italy
| | - Silvia Donato
- Faculty of Psychology, Università Cattolica del Sacro CuoreMilan, Italy
| | - Silvia Gilardi
- Dipartimento di Scienze Sociali e Politiche, Università degli Studi di MilanoMilan, Italy
| | - Chiara Guglielmetti
- Department of Economics, Management and Quantitative Methods, Università degli Studi di MilanoMilan, Italy
| | - Michele Gulizia
- Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)Rome, Italy
| | | | | | - Antonino Mazzone
- Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI)Rome, Italy
| | | | - Silvia Ostuzzi
- Associazione Lombarda Malati Reumatici (ALOMAR)Milan, Italy
| | | | - Natalia Piana
- Interdepartmental University Research Center on Motor Activity, University of PerugiaPerugia, Italy
| | - Giuliana Pitacco
- Azienda Sanitaria Universitaria Integrata di TriesteTrieste, Italy
| | - Gianluca Polvani
- Centro Cardiologico Monzino (IRCCS)Milan, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di MilanoMilan, Italy
| | | | - Livio Provenzi
- 0-3 Center for the at-Risk Infant, IRCCS Eugenio MedeaBosisio Parini, Italy
| | | | - Mariagrazia Rossi
- Department of Linguistics, Università Cattolica del Sacro CuoreMilan, Italy
| | - Paola Varese
- Federazione Italiana delle Associazioni di Volontariato in Oncologia (FAVO)Rome, Italy
| | | | - Elena Vegni
- Department of Health Sciences, Università degli Studi di MilanoMilan, Italy
| | | | - A Claudio Bosio
- Faculty of Psychology, Università Cattolica del Sacro CuoreMilan, Italy
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