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Affiliation(s)
- Vittoradolfo Tambone
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome 00128, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco De Micco
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome 00128, Italy.
| | - Giampaolo Ghilardi
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome 00128, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
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Affiliation(s)
- Kiran Patel
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Rachel Chapman
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Raj Gill
- South Asian Health Foundation, Coventry, UK
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Murray R. NHS reforms: politicians will be back in the driving seat. BMJ 2021; 372:n481. [PMID: 33608257 DOI: 10.1136/bmj.n481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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The Lancet Oncology. Pandemics and the health of a nation. Lancet Oncol 2021; 22:1. [PMID: 33387487 DOI: 10.1016/S1470-2045(20)30748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Erniaty E, Harun H. Understanding the impacts of NPM and proposed solutions to the healthcare system reforms in Indonesia: the case of BPJS. Health Policy Plan 2020; 35:346-353. [PMID: 31965166 DOI: 10.1093/heapol/czz165] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2019] [Indexed: 11/14/2022] Open
Abstract
This study critically evaluates the adoption of a universal healthcare system recently introduced by the Indonesian government in 2014. Our study is driven by the lack of critical analysis of social and political factors and unintended consequences of New Public Management, which is evident in the healthcare sector reforms in emerging economies. This study not only examines the impact of economic and political forces surrounding the introduction of a universal health insurance programme in the country but also offers insights into the critical challenges and undesirable outcomes of a fundamental reform of the healthcare sector in Indonesia. Through a systematic and detailed review of prior studies, legal sources and reports from government and media organizations about the implementation and progress of an UHC health insurance programme in Indonesia, the authors find that a more democratic political system that emerged in 1998 created the opportunity for politicians and international financial aid agencies to introduce a universal social security administration agency called Badan Penyelenggara Jaminan Sosial (BPJS). Despite the introduction of BPJS to expand the health services' coverage, this effort faces critical challenges and unintended outcomes including: (1) increased financial deficits, (2) resistance from medical professionals and (3) politicians' tendency to blame BPJS's management for failing to pay healthcare services costs. We argue that the adoption of the insurance system was primarily motivated by politicians' own interests and those of international agencies at the expense of a sustainable national healthcare system. This study contributes to the healthcare industry policy literature by showing that a poorly designed UHC system could and will undermine the core values of healthcare services. It will also threaten the sustainability of the medical profession in Indonesia. The authors offer several suggestions for devising better policies in this sector in the developing nations.
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Affiliation(s)
- Erniaty Erniaty
- Faculty of Health Science, University of Canberra, Kirinari Street, Bruce, ACT 2617, Australia
| | - Harun Harun
- Faculty of Business, Government & Law, University of Canberra, Kirinari Street, Bruce, ACT 2617, Australia
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Ben Abdelaziz A, Berkane S, Ben Salem K, Dahdi SA, Mlouki I, Benzarti S, Nouira S, Azzaza M, Azouaou M, Bouamra A, Achouri MY, Soulimane A. Lessons learned from the fight against COVID-19 in the Great Maghreb. Five lessons for a better response. Tunis Med 2020; 98:879-885. [PMID: 33479988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Identify the lessons learned in the Greater Maghreb, during the first semester of the fight against the COVID-19 pandemic, in the field of response. METHODS During the first week of May 2020, a consultation of experts was conducted, using the "Delphi" technique, through an email asking each of them, the drafting of a good practice recommendation for "Public health". The Group coordinator finalized the text of the lessons, later validated by the signatories of the manuscript. RESULTS Five lessons of good «response» against epidemics have been deduced and approved by Maghreb experts, linked to the following aspects: 1. Total reservation of hospital beds for patients; 2. Clinical management of the response; 3. Discreet conflict of interest; 4. Community participation in the response; 5. Contextualization of the global fight strategy. CONCLUSION Based on the finding of low relevance of the Maghreb response against COVID-19, this list of lessons would help support the performance of Maghreb health systems in the management of epidemics.
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Marchildon GP, Allin S, Merkur S. Canada: Health System Review. Health Syst Transit 2020; 22:1-194. [PMID: 33527903] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This analysis of the Canadian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Life expectancy is high, but it plateaued between 2016 and 2017 due to the opioid crisis. Socioeconomic inequalities in health are significant, and the large and persistent gaps in health outcomes between Indigenous peoples and the rest of Canadians represent a major challenge facing the health system, and society more generally. Canada is a federation: the provinces and territories administer health coverage systems for their residents (referred to as "medicare"), while the federal government sets national standards, such as through the Canada Health Act, and is responsible for health coverage for specific subpopulations. Health care is predominantly publicly financed, with approximately 70% of health expenditures financed through the general tax revenues. Yet there are major gaps in medicare, such as prescription drugs outside hospital, long-term care, mental health care, dental and vision care, which explains the significant role of employer-based private health insurance and out-of-pocket payments. The supply of physicians and nurses is uneven across the country with chronic shortages in rural and remote areas. Recent reforms include a move towards consolidating health regions into more centralized governance structures at the provincial/ territorial level, and gradually moving towards Indigenous self-governance in health care. There has also been some momentum towards introducing a national programme of prescription drug coverage (Pharmacare), though the COVID-19 pandemic of 2020 may shift priorities towards addressing other major health system challenges such as the poor quality and regulatory oversight of the long-term care sector. Health system performance has improved in recent years as measured by in-hospital mortality rates, cancer survival and avoidable hospitalizations. Yet major challenges such as access to non-medicare services, wait times for specialist and elective surgical care, and fragmented and poorly coordinated care will continue to preoccupy governments in pursuit of improved health system performance.
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Ben Abdelaziz A, Berkane S, Ben Salem K, Dahdi SA, Mlouki I, Benzarti S, Nouira S, Azzaza M, Azouaou M, Bouamra A, Achouri MY, Soulimane A. Lessons learned from the fight against COVID-19 in the Great Maghreb.Five lessons for better resilience. Tunis Med 2020; 98:657-663. [PMID: 33479936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To compile the lessons learned in the Greater Maghreb, during the first six months of the fight against the COVID-19 pandemic, in the field of "capacity building" of community resilience. METHODS An expert consultation was conducted during the first week of May 2020, using the "Delphi" technique. An email was sent requesting the formulation of a lesson, in the form of a "Public Health" good practice recommendation. The final text of the lessons was finalized by the group coordinator and validated by the signatories of the manuscript. RESULTS A list of five lessons of resilience has been deduced and approved : 1. Elaboration of "white plans" for epidemic management; 2. Training in epidemic management; 3. Uniqueness of the health system command; 4. Mobilization of retirees and volunteers; 5. Revision of the map sanitary. CONCLUSION Based on the evaluation of the performance of the Maghreb fight against COVID-19, characterized by low resilience, this list of lessons could constitute a roadmap for the reform of Maghreb health systems, towards more performance to manage possible waves of COVID-19 or new emerging diseases with epidemic tendency.
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Singh V. Finding hope amidst a pandemic. J Nucl Cardiol 2020; 27:1637-1639. [PMID: 32405987 PMCID: PMC7220609 DOI: 10.1007/s12350-020-02183-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Vasvi Singh
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
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Braithwaite J, Ludlow K, Churruca K, James W, Herkes J, McPherson E, Ellis LA, Long JC. Systems transformation: learning from change in 60 countries. J Health Organ Manag 2020; 34:237-253. [PMID: 32364345 DOI: 10.1108/jhom-01-2019-0018] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Much work about health reform and systems improvement in healthcare looks at shortcomings and universal problems facing health systems, but rarely are accomplishments dissected and analyzed internationally. The purpose of this paper is to address this knowledge gap by examining the lessons learned from health system reform and improvement efforts in 60 countries. DESIGN/METHODOLOGY/APPROACH In total, 60 low-, middle- and high-income countries provided a case study of successful health reform, which was gathered into a compendium as a recently published book. Here, the extensive source material was re-examined through inductive content analysis to derive broad themes of systems change internationally. FINDINGS Nine themes were identified: improving policy, coverage and governance; enhancing the quality of care; keeping patients safe; regulating standards and accreditation; organizing care at the macro-level; organizing care at the meso- and micro-level; developing workforces and resources; harnessing technology and IT; and making collaboratives and partnerships work. PRACTICAL IMPLICATIONS These themes provide a model of what constitutes successful systems change across a wide sample of health systems, offering a store of knowledge about how reformers and improvement initiators achieve their goals. ORIGINALITY/VALUE Few comparative international studies of health systems include a sufficiently wide selection of low-, middle- and high-income countries in their analysis. This paper provides a more balanced approach to consider where achievements are being made across healthcare, and what we can do to replicate and spread successful examples of systems change internationally.
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Affiliation(s)
- Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Wendy James
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jessica Herkes
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Elise McPherson
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Abstract
This article explores how health governance has evolved into an enormously complicated-and inequitable and exclusionary-system of privatized, fragmented bureaucracy, and argues for addressing these deficiencies and promoting health justice by radically deepening democratic participation to rebalance decision-making power. It presents a framework for promoting four primary outcomes from health governance: universality, equity, democratic control, and accountability, which together define health justice through deep democracy. It highlights five mechanisms that hold potential to bring this empowered participatory mode of governance into health policy: participatory needs assessments, participatory human rights budgeting, participatory monitoring, public health care advocates, and citizen juries.
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Affiliation(s)
- Ben Palmquist
- Ben Palmquist is the Program Director for Health Care and Economic Democracy at Partners for Dignity & Rights. He has a Masters of Urban & Regional Planning from the University of California - Los Angeles in Los Angeles, CA and a B.A. from Stanford University in Palo Alto, CA
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Abstract
Health reform debate understandably focuses on large system design. We should not omit attention to the "last mile" problem of physician payment theory. Achieving fundamental goals of integrative, patient-centered primary care depends on thoughtful financial support. This commentary describes the nature and importance of innovative primary care payment programs.
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Affiliation(s)
- John V Jacobi
- John V. Jacobi, J.D., is the Dorothea Dix Professor of Health Law & Policy, Seton Hall Law School
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Abstract
The ACA shifted U.S. health policy from centering on principles of actuarial fairness toward social solidarity. Yet four legal fixtures of the health care system have prevented the achievement of social solidarity: federalism, fiscal pluralism, privatization, and individualism. Future reforms must confront these fixtures to realize social solidarity in health care, American-style.
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Affiliation(s)
- Erin C Fuse Brown
- Erin C. Fuse Brown, J.D., M.P.H., is an Associate Professor of Law and Director of the Center for Law, Health & Society at Georgia State University College of Law. Elizabeth Y. McCuskey, J.D., is a Professor of Law, University of Massachusetts School of Law. Matthew B. Lawrence, J.D., is an Associate Professor of Law, Emory University School of Law. Lindsay F. Wiley, J.D., M.P.H., Professor of Law and Director of the Health Law and Policy Program at American University Washington College of Law
| | - Matthew B Lawrence
- Erin C. Fuse Brown, J.D., M.P.H., is an Associate Professor of Law and Director of the Center for Law, Health & Society at Georgia State University College of Law. Elizabeth Y. McCuskey, J.D., is a Professor of Law, University of Massachusetts School of Law. Matthew B. Lawrence, J.D., is an Associate Professor of Law, Emory University School of Law. Lindsay F. Wiley, J.D., M.P.H., Professor of Law and Director of the Health Law and Policy Program at American University Washington College of Law
| | - Elizabeth Y McCuskey
- Erin C. Fuse Brown, J.D., M.P.H., is an Associate Professor of Law and Director of the Center for Law, Health & Society at Georgia State University College of Law. Elizabeth Y. McCuskey, J.D., is a Professor of Law, University of Massachusetts School of Law. Matthew B. Lawrence, J.D., is an Associate Professor of Law, Emory University School of Law. Lindsay F. Wiley, J.D., M.P.H., Professor of Law and Director of the Health Law and Policy Program at American University Washington College of Law
| | - Lindsay F Wiley
- Erin C. Fuse Brown, J.D., M.P.H., is an Associate Professor of Law and Director of the Center for Law, Health & Society at Georgia State University College of Law. Elizabeth Y. McCuskey, J.D., is a Professor of Law, University of Massachusetts School of Law. Matthew B. Lawrence, J.D., is an Associate Professor of Law, Emory University School of Law. Lindsay F. Wiley, J.D., M.P.H., Professor of Law and Director of the Health Law and Policy Program at American University Washington College of Law
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Nambiar D, Sankar D. H, Negi J, Nair A, Sadanandan R. Monitoring Universal Health Coverage reforms in primary health care facilities: Creating a framework, selecting and field-testing indicators in Kerala, India. PLoS One 2020; 15:e0236169. [PMID: 32745081 PMCID: PMC7398520 DOI: 10.1371/journal.pone.0236169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 02/18/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022] Open
Abstract
In line with the Sustainable Development Goals (SDGs) and the target for achieving Universal Health Coverage (UHC), state level initiatives to promote health with "no-one left behind" are underway in India. In Kerala, reforms under the flagship Aardram mission include upgradation of Primary Health Centres (PHCs) to Family Health Centres (FHCs, similar to the national model of health and wellness centres (HWCs)), with the proactive provision of a package of primary care services for the population in an administrative area. We report on a component of Aardram's monitoring and evaluation framework for primary health care, where tracer input, output, and outcome indicators were selected using a modified Delphi process and field tested. A conceptual framework and indicator inventory were developed drawing upon literature review and stakeholder consultations, followed by mapping of manual registers currently used in PHCs to identify sources of data and processes of monitoring. The indicator inventory was reduced to a list using a modified Delphi method, followed by facility-level field testing across three districts. The modified Delphi comprised 25 participants in two rounds, who brought the list down to 23 approved and 12 recommended indicators. Three types of challenges in monitoring indicators were identified: appropriateness of indicators relative to local use, lack of clarity or procedural differences among those doing the reporting, and validity of data. Further field-testing of indicators, as well as the revision or removal of some may be required to support ongoing health systems reform, learning, monitoring and evaluation.
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Affiliation(s)
- Devaki Nambiar
- The George Institute for Global Health India, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Karnataka, India
| | - Hari Sankar D.
- The George Institute for Global Health India, New Delhi, India
| | - Jyotsna Negi
- Independent Consultant, Baltimore, MD, United States of America
| | - Arun Nair
- ACCESS Health International Inc, New Delhi, India
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Bertolaccini L, Spaggiari L. Reorganization of thoracic surgery activity in a national high-volume comprehensive cancer centre in the Italian epicentre of coronavirus disease 2019. Eur J Cardiothorac Surg 2020; 58:210-212. [PMID: 32642777 PMCID: PMC7454541 DOI: 10.1093/ejcts/ezaa234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Moss HA, Wu J, Kaplan SJ, Zafar SY. The Affordable Care Act's Medicaid Expansion and Impact Along the Cancer-Care Continuum: A Systematic Review. J Natl Cancer Inst 2020; 112:779-791. [PMID: 32277814 PMCID: PMC7825479 DOI: 10.1093/jnci/djaa043] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Health reform and the merits of Medicaid expansion remain at the top of the legislative agenda, with growing evidence suggesting an impact on cancer care and outcomes. A systematic review was undertaken to assess the association between Medicaid expansion and the goals of the Patient Protection and Affordable Care Act in the context of cancer care. The purpose of this article is to summarize the currently published literature and to determine the effects of Medicaid expansion on outcomes during points along the cancer care continuum. METHODS A systematic search for relevant studies was performed in the PubMed/MEDLINE, EMBASE, Scopus, and Cochrane databases. Three independent observers used an abstraction form to code outcomes and perform a quality and risk of bias assessment using predefined criteria. RESULTS A total of 48 studies were identified. The most common outcomes assessed were the impact of Medicaid expansion on insurance coverage (23.4% of studies), followed by evaluation of racial and/or socioeconomic disparities (17.4%) and access to screening (14.5%). Medicaid expansion was associated with increases in coverage for cancer patients and survivors as well as reduced racial- and income-related disparities. CONCLUSIONS Medicaid expansion has led to improved access to insurance coverage among cancer patients and survivors, particularly among low-income and minority populations. This review highlights important gaps in the existing oncology literature, including a lack of studies evaluating changes in treatment and access to end-of-life care following implementation of expansion.
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Affiliation(s)
| | - Jenny Wu
- Duke University School of Medicine, Durham NC, USA
| | | | - S Yousuf Zafar
- Duke Cancer Institute, Duke-Margolis Center for Health Policy, Durham, NC, USA
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Hou J, Tian L, Zhang Y, Liu Y, Li J, Wang Y. Study of influential factors of provincial health expenditure -analysis of panel data after the 2009 healthcare reform in China. BMC Health Serv Res 2020; 20:606. [PMID: 32611335 PMCID: PMC7327486 DOI: 10.1186/s12913-020-05474-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/26/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Total Healthcare Expenditure (THE) has increased substantially in all countries. Since the health system reform and health policy environment differ from each country, it is necessary to analyze the motivations of THE in a specific country. METHODS The objective of this study was to analyze the influential factors of Provincial THE (PTHE) per capita in China by using spatiotemporal panel data across 31 provinces (including provinces, autonomous regions, and municipalities, all called provinces in here) from 2009 to 2016 at the provincial and annual level. Generalized Estimating Equation (GEE) was used to identify the influential factors of PTHE per capita. RESULTS The number of beds per 10,000 population explained most of the variation of PTHE per capita. The results also showed that health expenditure in China reacts more to mortality compared with the Gross Domestic Product (GDP) per capita. But mortality and Out-Of-Pocket Payments (OOP) as a percentage of THE were associated with PTHE per capita negatively. The rate of infectious diseases and THE as a percentage of GDP had no statistical significance. And the Proportion of the Population Aged 65 and Over (POP65) impact PTHE per capita positively. But the coefficient was small. CONCLUSIONS In response to these findings, we conclude that the impact of the increasing percentage of OOP in THE diminishes the PTHE. Furthermore, we find that both the "baseline" health level and health provision are positively correlated with PTHE, which outweighs the effect of GDP.
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Affiliation(s)
- Jifei Hou
- The Affiliated Hospital of Qingdao University, Qingdao, 266003 Shandong China
- Department of Medicine, Qingdao University, Qingdao, 266071 Shandong China
| | - Liqi Tian
- The Affiliated Hospital of Qingdao University, Qingdao, 266003 Shandong China
| | - Yun Zhang
- The Affiliated Hospital of Qingdao University, Qingdao, 266003 Shandong China
| | - Yanzheng Liu
- Department of Research, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China
| | - Jing Li
- The Affiliated Hospital of Qingdao University, Qingdao, 266003 Shandong China
| | - Yue Wang
- Department of Medicine, Qingdao University, Qingdao, 266071 Shandong China
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Abstract
Sustainability has become a major goal of domestic and international development. This essay analyzes the transitions of normative ideas embedded in the notion of sustainability by reviewing the discourses in the representative reports and literature from different periods. Three sets of ideas are proposed: inter- and intra-generational equity, stability of public systems, and a sense of solidarity, which confirms the scope of community and functions as a precondition for the previous two ideas. This essay uses the case of a health system in a hypothetical country to illustrate that, besides securing financial sustainability, a genuinely sustainable public system must also meet the three normative ideas of sustainability. This essay also finds that these three ideas may create intrinsic tensions within the prevalent policy-making model-democracy. The pursuit of sustainability is not only the responsibility of a democratic government, but also a shared moral obligation of the body politic.
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Affiliation(s)
- Ming-Jui Yeh
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
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Valaitis RK, Wong ST, MacDonald M, Martin-Misener R, O’Mara L, Meagher-Stewart D, Isaacs S, Murray N, Baumann A, Burge F, Green M, Kaczorowski J, Savage R. Addressing quadruple aims through primary care and public health collaboration: ten Canadian case studies. BMC Public Health 2020; 20:507. [PMID: 32299399 PMCID: PMC7164182 DOI: 10.1186/s12889-020-08610-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/29/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Health systems in Canada and elsewhere are at a crossroads of reform in response to rising economic and societal pressures. The Quadruple Aim advocates for: improving patient experience, reducing cost, advancing population health and improving the provider experience. It is at the forefront of Canadian reform debates aimed to improve a complex and often-fragmented health care system. Concurrently, collaboration between primary care and public health has been the focus of current research, looking for integrated community-based primary health care models that best suit the health needs of communities and address health equity. This study aimed to explore the nature of Canadian primary care - public health collaborations, their aims, motivations, activities, collaboration barriers and enablers, and perceived outcomes. METHODS Ten case studies were conducted in three provinces (Nova Scotia, Ontario, and British Columbia) to elucidate experiences of primary care and public health collaboration in different settings, contexts, populations and forms. Data sources included a survey using the Partnership Self-Assessment Tool, focus groups, and document analysis. This provided an opportunity to explore how primary care and public health collaboration could serve in transforming community-based primary health care with the potential to address the Quadruple Aims. RESULTS Aims of collaborations included: provider capacity building, regional vaccine/immunization management, community-based health promotion programming, and, outreach to increase access to care. Common precipitators were having a shared vision and/or community concern. Barriers and enablers differed among cases. Perceived barriers included ineffective communication processes, inadequate time for collaboration, geographic challenges, lack of resources, and varying organizational goals and mandates. Enablers included clear goals, trusting and inclusive relationships, role clarity, strong leadership, strong coordination and communication, and optimal use of resources. Cases achieved outcomes addressing the Q-Aims such as improving access to services, addressing population health through outreach to at-risk populations, reducing costs through efficiencies, and improving provider experience through capacity building. CONCLUSIONS Primary care and public health collaborations can strengthen community-based primary health care while addressing the Quadruple Aims with an emphasis on reducing health inequities but requires attention to collaboration barriers and enablers.
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Affiliation(s)
- Ruta K. Valaitis
- School of Nursing, McMaster University, 1280 Main Street W., HSC 3N25E, Hamilton, ON L8S4K1 Canada
| | - Sabrina T. Wong
- School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Marjorie MacDonald
- School of Nursing, University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Ruth Martin-Misener
- Dalhousie University, School of Nursing, Room G26, Forrest Bldg, 5869 University Avenue, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Linda O’Mara
- McMaster University, School of Nursing, 1280 Main Street W, Hamilton, ON L8S4K1 Canada
| | - Donna Meagher-Stewart
- Dalhousie University, School of Nursing, Room G26, Forrest Bldg, 5869 University Avenue, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Sandy Isaacs
- McMaster University, School of Nursing, 1280 Main Street W, Hamilton, ON L8S4K1 Canada
| | - Nancy Murray
- McMaster University, School of Nursing, 1280 Main Street W, Hamilton, ON L8S4K1 Canada
| | - Andrea Baumann
- McMaster University, School of Nursing, 1280 Main Street W, Hamilton, ON L8S4K1 Canada
| | - Fred Burge
- Dalhousie University Department of Family Medicine, 8th floor, 8525 Abbie J Lane Building, 5909 Veterans’ Memorial Lane, Halifax, NS B3H 2E2 Canada
| | - Michael Green
- Queen’s University Centre for Studies in Primary Care, 220 Bagot Street, P.O. Bag 8888, Kingston, ON K7L 5E9 Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montreal, Tour Saint-Antoine, 850, rue St-Denis Montreal, Quebec, H2X 0A9 Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Tour Saint-Antoine, 850, rue St-Denis Montreal, Quebec, H2X 0A9 Canada
| | - Rachel Savage
- Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th Floor, Toronto, ON M5T 3M7 Canada
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21
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Sakellarides C. [National Health Service: Responding to Current Challenges Through Necessary Transformations]. ACTA MEDICA PORT 2020; 33:133-142. [PMID: 32035499 DOI: 10.20344/amp.12626] [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: 07/26/2019] [Accepted: 07/31/2019] [Indexed: 11/20/2022]
Abstract
After a decade experiencing clear difficulties, the Portuguese National Health Service needs a significant public investment for its development. This means more resources for the National Health Service, but also an increased capacity to manage its necessary transformation. Current health challenges differ significantly from those prevailing when the National Health Service was institutionalized, 40 years ago: (i) A significant increase in the prevalence of patients with multimorbidity has been observed; (ii)There is a need to delay and attenuate the expression of multimorbidity; (iii) In this context, a strong investment in integrating health care is of a paramount importance. The transformations that the National Health Service needs to respond to these challenges are very complex and demanding: (i) Effective local adaptive change management requires a very elaborate strategic, governance and government framework, which is yet to be developed; (ii) Collaborative architectures, processes and tools need to be promoted in order to induce and facilitate change in the Portuguese health system; (iii) Common understanding of current challenges and increased capabilities to deal with complex change processes may facilitate the implementation of effective strategic management in the National Health Service, focused on its more critical domains - financing, infrastructures and resource management, organizational development, policies for attracting and retaining health professional and cooperation with the social and private sectors. Such a transformation agenda is urgently needed.
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Affiliation(s)
- Constantino Sakellarides
- Professor Catedrático jubilado. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal
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22
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Tangcharoensathien V, Mills A, Patcharanarumol W, Witthayapipopsakul W. Universal health coverage: time to deliver on political promises. Bull World Health Organ 2020; 98:78-78A. [PMID: 32015572 PMCID: PMC6986228 DOI: 10.2471/blt.20.250597] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Anne Mills
- London School of Hygiene and Tropical Medicine, University of London, London, England
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23
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Woods P. Integrated Care in Ontario: Unicorn or Black Swan? Healthc Pap 2020; 19:26-39. [PMID: 32310751 DOI: 10.12927/hcpap.2020.26157] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The movement away from traditional models to organize, finance and deliver healthcare toward integrated models focusing on delivering value has been under way in many health systems and jurisdictions in the world with varying degrees of intensity and success for much of the past 20 years. I have had the opportunity to lead aspects of a multi-state health system committed to the concepts of accountable care during the first 10 years of the Patient Protection and Affordable Care Act (PPACA) in the US. For the past two years, I have assumed the role as CEO of a large academic health sciences centre in Ontario as the province embarks on a shift in policies to support integrated models of care delivery similar to those associated with the PPACA. I will describe my observations comparing two countries' move toward integrated delivery models and potential lessons for Canada.
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Affiliation(s)
- Paul Woods
- President and CEO, London Health Sciences Centre, London, ON
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24
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Affiliation(s)
- George Wharton
- Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, UK
| | - Omar E Ali
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Siddiq Khalil
- University of Medical Sciences and Technology, Khartoum, Sudan
| | - Hatim Yagoub
- Ahmed Gasim Cardiac and Renal Transplant Center, Khartoum, Sudan
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, UK.
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25
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Saunes IS, Karanikolos M, Sagan A. Norway: Health System Review. Health Syst Transit 2020; 22:1-163. [PMID: 32863241] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This analysis of the Norwegian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Norway is among the wealthiest nations in the world, with low levels of income inequality. Norwegians enjoy long and healthy lives, with substantial improvement made due to effective and high-quality medical care and the impact of broader public health policies. However, this comes at a high cost, as the Norwegian health system is among the most expensive in Europe, with most financing coming from public funds. Yet there are several areas requiring substantial co-payments, such as adult dental care, outpatient pharmaceuticals, and institutional care for older or disabled people. Recent and ongoing reforms have focused on aligning provision of care to changing population health needs, including adapting medical education, strengthening primary care and improving coordination between primary and specialist care sectors. There has been an increasing use of e-health solutions, and information and communication technologies. Improvements in measuring performance and a more effective use of indicators is expected to play a larger role in informing policy and planning of health services.
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Affiliation(s)
| | | | - Anna Sagan
- European Observatory on Health systems and policies
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Behmane D, Dudele A, Villerusa A, Misins J, Klavina K, Mozgis D, Scarpetti G. Latvia: Health System Review. Health Syst Transit 2019; 21:1-165. [PMID: 32863240] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This analysis of the Latvian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. After regaining independence in 1991, Latvia experimented with a social health insurance type system. However, to overcome decentralization and fragmentation of the system, the National Health Service (NHS) was established in 2011 with universal population coverage. More recently, reforms in 2017 proposed the introduction of a Compulsory Health Insurance System, with the objective of increasing revenues for health, which links access to different health care services to the payment of social health insurance contributions. In June 2019 the implementation of this proposal was postponed to 2021. Latvia has recovered from the severe economic recession of 2008, which resulted in the adoption of austerity measures that significantly affected the health care system. The recovery has created fiscal space to focus on policy challenges neglected in the past, especially regarding health. Despite recent increases in spending, the health system remains underfunded and resources have to be allocated wisely. Latvia's health outcomes should be considered within this context of limited health system resources. While life expectancy at birth in Latvia has increased since 2000, reaching 74.9 years in 2017, it remains among the lowest in the EU. Recent reforms have focused on improving access to services in rural/remote areas, increasing funding for health care services, and tougher regulation of tobacco and alcohol. However, a number of longstanding unresolved problems still need to be addressed, including financial sustainability and low public funding, high levels of unmet need, high rates of preventable and treatable mortality, and challenges in both communicable and noncommunicable diseases.
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Affiliation(s)
| | | | | | | | | | | | - Giada Scarpetti
- Berlin University of Technology and European Observatory on Health Systems and Policies
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Abstract
When health systems aim to improve, two key considerations tend to be front and centre: cost and quality. On the cost side, health spending in Canada continues to rise. On the quality side, improvement is needed across the country. As the primary funder of healthcare, governments' historical role has focused on managing costs through their powers to set budgets, decide who gets paid, and how. Increasingly, governments are recognizing that the ways in which they choose to pay providers and organizations can also have an impact on the quality of care provided. Using Ontario as an example, we present a Canadian vision for modernizing how healthcare is organized and reimbursed and for using evidence and evaluation as the backbone for iterating new models. Realizing this vision will move Canada closer to international leadership in delivering high-quality, affordable care.
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Affiliation(s)
| | - Irfan Dhalla
- Health Quality Ontario, Toronto, Ontario, Canada
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Bjegovic-Mikanovic V, Vasic M, Vukovic D, Jankovic J, Jovic-Vranes A, Santric-Milicevic M, Terzic-Supic Z, Hernandez-Quevedo C. Serbia: Health System Review. Health Syst Transit 2019; 21:1-211. [PMID: 32851979] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This analysis of the Serbian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the Serbian population has improved over the last decade. Life expectancy at birth increased slightly in recent years, but it remains, for example, around 5 years below the average across European Union countries. Some favourable trends have been observed in health status and morbidity rates, including a decrease in the incidence of tuberculosis, but population ageing means that chronic conditions and long-standing disability are increasing. The state exercises a strong governance role in Serbia's social health insurance system. Recent efforts have increased centralization by transferring ownership of buildings and equipment to the national level. The health insurance system provides coverage for almost the entire population (98%). Even though the system is comprehensive and universal, with free access to publicly provided health services, there are inequities in access to primary care and certain population groups (such as the most socially and economically disadvantaged, the uninsured, and the Roma) often experience problems in accessing care. The uneven distribution of health professionals across the country and shortages in some specialities also exacerbate accessibility problems. High out-of-pocket payments, amounting to over 40% of total expenditure on health, contribute to relatively high levels of self-reported unmet need for medical care. Health care provision is characterized by the role of the "chosen doctor" in primary health care centres, who acts as a gatekeeper in the system. Recent public health efforts have focused on improving access to preventive health services, in particular, for vulnerable groups. Health system reforms since 2012 have focused on improving infrastructure and technology, and on implementing an integrated health information system. However, the country lacks a transparent and comprehensive system for assessing the benefits of health care investments and determining how to pay for them.
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Affiliation(s)
| | - Milena Vasic
- Institute of Public Health of Serbia "Dr Milan Jovanovic Batut"
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Blake S. Healthcare transformations: implications for patients. Br J Gen Pract 2019; 69:503. [PMID: 31558527 PMCID: PMC6774699 DOI: 10.3399/bjgp19x705797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Sarah Blake
- University of Bristol, Bristol. @sarahblake200
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Doshmangir L, Bazyar M, Majdzadeh R, Takian A. So Near, So Far: Four Decades of Health Policy Reforms in Iran, Achievements and Challenges. Arch Iran Med 2019; 22:592-605. [PMID: 31679362] [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] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/16/2019] [Indexed: 06/10/2023]
Abstract
The Islamic revolution of 1979 in Iran emphasized social justice as a pillar for development. The fundamental steps towards universal equitable access to high-quality healthcare services began with the creation of the Ministry of Health and Medical Education (MoHME) and the nationwide establishment of primary healthcare (PHC) network in 1985. Now, in the 40th anniversary of the Islamic revolution, the history of health system development in Iran is characterized by constant policy changes; i.e. structural and procedural transformations. Ever since and despite the imposed 8-year war with Iraq and continuous unfair sanctions against the country, noticeable progress has been achieved in the health system that has led to better population health including among others: self-sufficiency in training health workforce; advances in public health and medical sciences; establishment and expansion of health facilities within the hard-to-reach areas aiming to enhance equity in access to needed healthcare services; domestic production of most medicines and medical equipment; and meaningful expansion of health insurance coverage. These have led to admirable improvement in public health indicators; i.e. maternal mortality, child mortality, life expectancy, and vaccination coverage. Despite achievements, there still remain challenges in health financing, protecting the public against high expenditure of medical care, establishment of referral system and rationalization of service utilization, provision of high quality healthcare services to all in need, and conflict of interest in health policy making, all of which may hinder the goal to reach "universal health coverage", identified as the main goal of the health system in Iran by 2025. Recently, the MoHME began structural and functional reforms to boost societal efforts and enhance intersectoral collaboration to address social determinants of health, improve actions for prevention and control of non-communicable diseases and other social health problems. Drawing upon the World Health Organization (WHO)'s "six building blocks" model, this article presents an analytical description of the main health policy reforms during the last four decades after the Islamic revolution in Iran, divided by each decade. Learning from the historical reforms will create, we envisage, a better understanding of health system developments, its advances and challenges, which might in turn contribute to better evidence-informed policy making and sustainable health development in the country, and perhaps beyond.
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Affiliation(s)
- Leila Doshmangir
- Tabriz Health Services Management Research Canter, Department of Health Services Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Bazyar
- Department of Public Health, School of Public Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Reza Majdzadeh
- Knowledge Utilization Research Center, Community Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
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Aggarwal M, Williams AP. Tinkering at the margins: evaluating the pace and direction of primary care reform in Ontario, Canada. BMC Fam Pract 2019; 20:128. [PMID: 31510942 PMCID: PMC6739997 DOI: 10.1186/s12875-019-1014-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/19/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary care reform has been on the political agenda in Canada and many industrialized countries for several decades; it is widely seen as the foundation for broader health system transformation. Federal investments in primary care, including major cash transfers to provinces and territories as part of a 10-year health care funding agreement in 2004, triggered waves of primary care reform across Canada. Nevertheless, Commonwealth Fund surveys show, Canada continues to lag behind other industrialized nations with respect to timely access to care, electronic medical record use and audit and feedback for quality improvement in primary care. This paper evaluates the pace and direction of primary care reform as well as the extent of resulting change in the organization and delivery of primary care in Ontario, Canada's most populous province. METHODS Qualitative and quantitative methods were used for this study. A literature review was conducted to analyze the core dimensions of primary care reform, the history of reform in Ontario, and the extent to which different dimensions are integrated into Ontario's models. Quantitative data on the number of family physicians/general practitioners and patients enrolled in these models was examined over a 10-year period to determine the degree of change that has taken place in the organization and delivery of primary care in Ontario. RESULTS There are 11 core reform dimensions that individually and collectively shift from conventional primary care toward the more expansive vision of primary health care. Assessment of Ontario's models against these core dimensions demonstrate that there has been little substantive change in the organization and delivery of primary care over 10 years in Ontario. CONCLUSIONS Primary care reform is a multi-dimensional construct with different reform models bundling core dimensions in different ways. This understanding is important to move beyond the rhetoric of "reform" and to critically assess the pace and direction of change in primary care in Ontario and in other jurisdictions. The conceptual framework developed in this paper can assist decision-makers, academics and health care providers in all jurisdictions in evaluating the pace of change in the primary care sector, as well as other sectors.
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Affiliation(s)
- Monica Aggarwal
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
| | - A Paul Williams
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
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Abstract
Recent debates on the rise of right-wing or neoliberal populism globally have prompted public health and health systems researchers to explore its implications in the healthcare systems. This case study of Turkey's recent health reform initiative, the Health Transformation Program, aims to contribute to this debate by examining the nexus among populism, professionalism and the contemporary market and managerial reforms, often described as New Public Management (NPM). Building on document analysis and secondary sources, this article introduces a framework to explore whether and how populist agendas grow up in the shadow of NPM policies. We aim to deepen our understanding of the governance settings that might be used in different ways by right-wing populist leaders to advance their agendas. Our research reveals that the NPM reforms in Turkey have opened a 'backdoor' through which right-wing populist agendas were supported and the position of the medical profession as an important stakeholder in the institutional settings was weakened. However, what mattered most in the reform process was not the policies themselves but the ways new managerialist policies were implemented. Our analysis makes blind spots of the NPM reforms and healthcare governance research visible and calls for greater attention to implementation processes.
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Affiliation(s)
- Tuba I Agartan
- Health Policy and Management Department, Providence College, Providence, RI, USA
- Takemi Fellow in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ellen Kuhlmann
- Institute of Epidemiology, Social Medicine and Health Systems Research, Medical School Hannover, Hannover, Germany
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
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Wolfe JD, Joynt Maddox KE. Heart Failure and the Affordable Care Act: Past, Present, and Future. JACC Heart Fail 2019; 7:737-745. [PMID: 31401094 DOI: 10.1016/j.jchf.2019.04.021] [Citation(s) in RCA: 4] [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: 03/08/2019] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 01/14/2023]
Abstract
The Affordable Care Act (ACA) and other major health care legislative acts have had an important impact on the care of heart failure patients in the United States. The main effects of the ACA include regulation of the health insurance industry, expansion of access to health care, and health care delivery system reform, which included the creation of several alternative payment models. Particular components of the ACA, such as the elimination of annual and lifetime caps on spending, Medicaid expansion, and the individual and employer mandate, could have positive effects for heart failure patients. However, the benefits of value-based and alternative payment models such as the Hospital Readmissions Reduction Program and bundled payment programs for heart failure outcomes are less clear, and controversy exists regarding whether some of these programs may even worsen outcomes. As the population ages and the prevalence of heart failure continues to rise, this syndrome will likely remain a key clinical focus for policymakers. Therefore, heart failure clinicians should be aware of how legislation affects clinical practice and be prepared to adapt to continued changes in health policy.
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Affiliation(s)
- Jonathan D Wolfe
- Cardiology Division, Washington University School of Medicine, St. Louis, Missouri
| | - Karen E Joynt Maddox
- Cardiology Division, Washington University School of Medicine, St. Louis, Missouri.
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Watt RG, Daly B, Allison P, Macpherson LMD, Venturelli R, Listl S, Weyant RJ, Mathur MR, Guarnizo-Herreño CC, Celeste RK, Peres MA, Kearns C, Benzian H. Ending the neglect of global oral health: time for radical action. Lancet 2019; 394:261-272. [PMID: 31327370 DOI: 10.1016/s0140-6736(19)31133-x] [Citation(s) in RCA: 370] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/15/2019] [Accepted: 04/26/2019] [Indexed: 12/13/2022]
Abstract
Oral diseases are a major global public health problem affecting over 3·5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now needed. In this second of two papers in a Series on oral health, we present a critique of dentistry, highlighting its key limitations and the urgent need for system reform. In high-income countries, the current treatment-dominated, increasingly high-technology, interventionist, and specialised approach is not tackling the underlying causes of disease and is not addressing inequalities in oral health. In low-income and middle-income countries (LMICs), the limitations of so-called westernised dentistry are at their most acute; dentistry is often unavailable, unaffordable, and inappropriate for the majority of these populations, but particularly the rural poor. Rather than being isolated and separated from the mainstream health-care system, dentistry needs to be more integrated, in particular with primary care services. The global drive for universal health coverage provides an ideal opportunity for this integration. Dental care systems should focus more on promoting and maintaining oral health and achieving greater oral health equity. Sugar, alcohol, and tobacco consumption, and their underlying social and commercial determinants, are common risk factors shared with a range of other non-communicable diseases (NCDs). Coherent and comprehensive regulation and legislation are needed to tackle these shared risk factors. In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority.
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Affiliation(s)
- Richard G Watt
- WHO Collaborating Centre in Oral Health Inequalities and Public Health, Department of Epidemiology and Public Health, University College London, London, UK.
| | - Blánaid Daly
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Paul Allison
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Lorna M D Macpherson
- Department of Dental Public Health, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Renato Venturelli
- WHO Collaborating Centre in Oral Health Inequalities and Public Health, Department of Epidemiology and Public Health, University College London, London, UK
| | - Stefan Listl
- Quality and Safety of Oral Healthcare, Department of Dentistry, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands; Section for Translational Health Economics, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Robert J Weyant
- Department of Dental Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Carol C Guarnizo-Herreño
- Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Roger Keller Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marco A Peres
- Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Gold Coast, QLD, Australia
| | - Cristin Kearns
- Department of Preventive and Restorative Dental Sciences and Philip R Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Habib Benzian
- WHO Collaborating Centre for Quality-Improvement, Evidence-Based Dentistry, Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA; New York University College of Global Public Health, New York, NY, USA
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Abstract
Qingyue Meng and colleagues assess what China’s health system reform has achieved and what needs to be done over the next decade
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Affiliation(s)
- Qingyue Meng
- Peking University China Center for Health Development Studies, Beijing, China
| | - Anne Mills
- London School of Hygiene and Tropical Medicine, London, UK
| | - Longde Wang
- China Association of Preventive Medicine, Beijing, China
| | - Qide Han
- Peking University Health Science Centre, Beijing, China
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37
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Sowada C, Sagan A, Kowalska-Bobko I, Badora-Musial K, Bochenek T, Domagala A, Dubas-Jakobczyk K, Kocot E, Mrozek-Gasiorowska M, Sitko S, Szetela AM, Szetela P, Tambor M, Wieckowska B, Zabdyr-Jamroz M, van Ginneken E. Poland: Health System Review. Health Syst Transit 2019; 21:1-234. [PMID: 31333192] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This analysis of the Polish health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In late 2017, the Polish government committed to increase the share of public expenditures on health to 6% of GDP by 2024. If the GDP continues to grow in the years to come, this will present an opportunity to tackle mounting health challenges such as socioeconomic inequalities in health, high rates of obesity, rising burden of mental disorders and population ageing that put strain on health care resources. It is also an opportunity to tackle certain longstanding imbalances in the health sector, including overreliance on acute hospital care compared with other types of care, including ambulatory care and long-term care; shortages of human resources; the negligible role of health promotion and disease prevention vis-a-vis curative care; and poor financial situation in the hospital sector. Finally, the additional resources are much needed to implement important ongoing reforms, including the reform of primary care. The resources have to be spent wisely and waste should be minimized. The introduction, in 2016, of a special system (IOWISZ) of assessing investments in the health sector that require public financing (including from the EU funds) as well as the work undertaken by the Polish health technology assessment (HTA) agency (AOTMiT), which evaluates health technologies and publicly-financed health policy programmes as well as sets prices of goods and services, should help ensure that these goals are achieved. Recent reforms, such as the ongoing reform of primary care that seeks to improve coordination of care and the introduction of the hospital network, go in the right direction; however, a number of longstanding unresolved problems, such as hospital indebtedness, need to be tackled.
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Affiliation(s)
| | - Anna Sagan
- European Observatory on Health Systems and Policies
| | | | | | | | | | | | - Ewa Kocot
- Jagiellonian University Medical College
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Maharani C, Djasri H, Meliala A, Dramé ML, Marx M, Loukanova S. A scoping analysis of the aspects of primary healthcare physician job satisfaction: facets relevant to the Indonesian system. Hum Resour Health 2019; 17:38. [PMID: 31146752 PMCID: PMC6543658 DOI: 10.1186/s12960-019-0375-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although there is extensive literature on the different aspects of physician job satisfaction worldwide, existing questionnaires used to measure job satisfaction in developed countries (e.g., the Job Satisfaction Scale) do not capture the aspects specific to Indonesian primary healthcare physicians. This is especially true considering the 2014 healthcare system reform, which led to the implementation of a national social health insurance scheme in Indonesia that has significantly changed the working conditions of physicians. Therefore, the current study aimed to identify aspects of primary care physician job satisfaction featured in published literature and determine those most suitable for measuring physician job satisfaction in light of Indonesia's recent reforms. METHODS A scoping literature review of full-text articles published in English between 2006 and 2015 was conducted using the PubMed, Psycinfo, and Web of Science databases. All aspects of primary care physician job satisfaction included in these studies were identified and classified. We then selected aspects mentioned in more than 5% of the reviewed papers and identified those most relevant to the post-reform Indonesian context. RESULTS A total of 440 articles were reviewed, from which 23 aspects of physicians' job satisfaction were extracted. Sixteen aspects were deemed relevant to the current Indonesian system: physical working conditions, overall job satisfaction, patient care/treatment, referral systems, relationships with colleagues, financial aspects, workload, time of work, recognition for good work, autonomy, opportunity to use abilities, relationships with patients, their families, and community, primary healthcare facilities' organization and management style, medical education, healthcare systems, and communication with health insurers. CONCLUSION Considering the recent reforms of the Indonesian healthcare system, existing tools for measuring job satisfaction among physicians must be revised. Future research should focus on the development and validation of new measures of physician job satisfaction based on the aspects identified in this study.
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Affiliation(s)
- Chatila Maharani
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
- Department of Public Health, Universitas Negeri Semarang, Semarang, Indonesia
| | - Hanevi Djasri
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Andreasta Meliala
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mohamed Lamine Dramé
- Success in Africa, Conakry University Medical Faculty based think tank, Conakry, Guinea
| | - Michael Marx
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Svetla Loukanova
- Department of General Practice and Implementation Research, Medical Faculty, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
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Sirili N, Frumence G, Kiwara A, Mwangu M, Goicolea I, Hurtig AK. Public private partnership in the training of doctors after the 1990s' health sector reforms: the case of Tanzania. Hum Resour Health 2019; 17:33. [PMID: 31118038 PMCID: PMC6532226 DOI: 10.1186/s12960-019-0372-6] [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] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 05/09/2019] [Indexed: 06/09/2023]
Abstract
Similar to many other low- and middle-income countries, public private partnership (PPP) in the training of the health workforce has been emphasized since the launch of the 1990s' health sector reforms in Tanzania. PPP in training aims to contribute to addressing the critical shortage of health workforce in these countries. This study aimed to analyse the policy process and experienced outcomes of PPP for the training of doctors in Tanzania two decades after the 1990s' health sector reforms. We reviewed documents and interviewed key informants to collect data from training institutions and umbrella organizations that train and employ doctors in both the public and private sectors. We adopted a hybrid thematic approach to analyse the data while guided by the policy analysis framework by Gagnon and Labonté. PPP in training has contributed significantly to the increasing number of graduating doctors in Tanzania. In tandem, undermining of universities' autonomy and the massive enrolment of medical students unfavourably affect the quality of graduating doctors. Although PPP has proven successful in increasing the number of doctors graduating, unemployment of the graduates and lack of database to inform the training needs and capacity to absorb the graduates have left the country with a health workforce shortage and maldistribution at service delivery points, just as before the introduction of the PPP. This study recommends that Tanzania revisit its PPP approach to ensure the health workforce crisis is addressed in its totality. A comprehensive plan is needed to address issues of training within the framework of PPP by engaging all stakeholders in training and deployment starting from the planning of the number of medical students, and when and how they will be trained while taking into account the quality of the training.
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Affiliation(s)
- Nathanael Sirili
- Department of Epidemiology and Global Health, Umeå University, 90185, Umeå, SE, Sweden.
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65454, Dar es Salaam, Tanzania.
| | - Gasto Frumence
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65454, Dar es Salaam, Tanzania
| | - Angwara Kiwara
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65454, Dar es Salaam, Tanzania
| | - Mughwira Mwangu
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65454, Dar es Salaam, Tanzania
| | - Isabel Goicolea
- Department of Epidemiology and Global Health, Umeå University, 90185, Umeå, SE, Sweden
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, 90185, Umeå, SE, Sweden
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Schwendimann R, Fierz K, Spichiger E, Marcus B, De Geest S. A master of nursing science curriculum revision for the 21st century - a progress report. BMC Med Educ 2019; 19:135. [PMID: 31068167 PMCID: PMC6506956 DOI: 10.1186/s12909-019-1588-9] [Citation(s) in RCA: 4] [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: 03/02/2018] [Accepted: 05/02/2019] [Indexed: 05/20/2023]
Abstract
BACKGROUND Preparing a 21st century nursing workforce demands future-oriented curricula that address the population's evolving health care needs. With their advanced clinical skill sets and broad scope of practice, Advanced Practice Nurses strengthen healthcare systems by providing expert care, especially to people who are older and/or have chronic diseases. Bearing this in mind, we revised our established Master of Nursing Science curriculum at the University of Basel, Switzerland. METHODS Guided by the Advanced Nursing Practice framework, interprofessional guidelines, fundamental reports on the future of health care and the Bologna declaration, the reform process included three interrelated phases: preparation (work packages (WPs): curriculum analysis, alumni survey), revision (WPs: program accreditation, learning outcomes), and regulations (WPs: legal requirements, program launch). RESULTS The redesigned MScN curriculum offers two specializations: ANP and research. It was implemented in the 2014 fall semester. CONCLUSIONS This curriculum reform's strategic approach and step-by-step processes demonstrate how, beginning with a solid conceptual basis, congruent logical steps allowed development of a program that prepares nurses for new professional roles within innovative models of care.
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Affiliation(s)
- René Schwendimann
- Departement Public Health DPH, Nursing Science, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
- Patient Safety Office, University Hospital Basel, Spitalstrasse 22, 4031 Basel, Switzerland
| | - Katharina Fierz
- Departement Public Health DPH, Nursing Science, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Elisabeth Spichiger
- Departement Public Health DPH, Nursing Science, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
- Head Office of Nursing and Allied Health Professionals, Inselspital Bern University Hospital, Freiburgstrasse 44a, 3010 Bern, Switzerland
| | - Brenda Marcus
- Departement Public Health DPH, Nursing Science, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Sabina De Geest
- Departement Public Health DPH, Nursing Science, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
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Sajadi HS, Majdzadeh R. From Primary Health Care to Universal Health Coverage in the Islamic Republic of Iran: A Journey of Four Decades. Arch Iran Med 2019; 22:262-268. [PMID: 31256600] [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] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/07/2019] [Indexed: 06/09/2023]
Abstract
Despite all the problems caused by the imposed war, sanctions and accidents after the Islamic Revolution, materializing primary health care (PHC) in Iran through establishing the National Health Network (NHN) has had substantial gains. Many health indicators in Iran have undergone significant changes. As an example, the change in death of children under the age of 5 years has been studied by adjusting the economic status, and it is estimated that about 2 million deaths in this age group were avoided within 30 years after the Islamic Revolution. Nevertheless, the global experience implies that the PHC has its limitations. By changing the social, economic, and epidemiological patterns of diseases, demands and expectations of community has changed. With the emergence of chronic conditions and new technologies, health expenditures have become a major concern. Meanwhile, in the 2000s, the revision at PHC was aimed at strengthening through the universal health coverage (UHC). Therefore, UHC is along the PHC and not against it.
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Affiliation(s)
- Haniye Sadat Sajadi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Knowledge Utilization Research Center, Community-Based Participatory-Research Center, and School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Hammond J, Mason T, Sutton M, Hall A, Mays N, Coleman A, Allen P, Warwick-Giles L, Checkland K. Exploring the impacts of the 2012 Health and Social Care Act reforms to commissioning on clinical activity in the English NHS: a mixed methods study of cervical screening. BMJ Open 2019; 9:e024156. [PMID: 30987985 PMCID: PMC6500278 DOI: 10.1136/bmjopen-2018-024156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Explore the impact of changes to commissioning introduced in England by the Health and Social Care Act 2012 (HSCA) on cervical screening activity in areas identified empirically as particularly affected organisationally by the reforms. METHODS Qualitative followed by quantitative methods. Qualitative: semi-structured interviews (with NHS commissioners, managers, clinicians, senior administrative staff from Clinical Commissioning Groups (CCGs), local authorities, service providers), observations of commissioning meetings in two metropolitan areas of England. Quantitative: triple-difference analysis of national administrative data. Variability in the expected effects of HSCA on commissioning was measured by comparing CCGs working with one local authority with CCGs working with multiple local authorities. To control for unmeasured confounders, differential changes over time in cervical screening rates (among women, 25-64 years) between CCGs more and less likely to have been affected by HSCA commissioning organisational change were compared with another outcome-unassisted birth rates-largely unaffected by HSCA changes. RESULTS Interviewees identified that cervical screening commissioning and provision was more complex and 'fragmented', with responsibilities less certain, following the HSCA. Interviewees predicted this would reduce cervical screening rates in some areas more than others. Quantitative findings supported these predictions. Areas where CCGs dealt with multiple local authorities experienced a larger decline in cervical screening rates (1.4%) than those dealing with one local authority (1.0%). Over the same period, unassisted deliveries decreased by 1.6% and 2.0%, respectively, in the two groups. CONCLUSIONS Arrangements for commissioning and delivering cervical screening were disrupted and made more complex by the HSCA. Areas most affected saw a greater decline in screening rates than others. The fact that this was identified qualitatively and then confirmed quantitatively strengthens this finding. The study suggests large-scale health system reforms may have unintended consequences, and that complex commissioning arrangements may be problematic.
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Affiliation(s)
- Jonathan Hammond
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, UK
- School of Health Sciences, University of Manchester, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Thomas Mason
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, UK
- School of Health Sciences, University of Manchester, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Matt Sutton
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, UK
- School of Health Sciences, University of Manchester, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alex Hall
- School of Health Sciences, University of Manchester, Manchester, UK
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Nicholas Mays
- Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Coleman
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, UK
- School of Health Sciences, University of Manchester, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Lynsey Warwick-Giles
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, UK
- School of Health Sciences, University of Manchester, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Kath Checkland
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, UK
- School of Health Sciences, University of Manchester, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Eckermann S, Phillipson L, Fleming R. Re-design of Aged Care Environments is Key to Improved Care Quality and Cost Effective Reform of Aged and Health System Care. Appl Health Econ Health Policy 2019; 17:127-130. [PMID: 30328015 DOI: 10.1007/s40258-018-0435-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Simon Eckermann
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia.
| | - Lyn Phillipson
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
| | - Richard Fleming
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
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Thapa R, Bam K, Tiwari P, Sinha TK, Dahal S. Implementing Federalism in the Health System of Nepal: Opportunities and Challenges. Int J Health Policy Manag 2019; 8:195-198. [PMID: 31050964 PMCID: PMC6499910 DOI: 10.15171/ijhpm.2018.121] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 03/06/2018] [Accepted: 12/01/2018] [Indexed: 11/09/2022] Open
Abstract
Nepal moved from unitary system with a three-level federal system of government. As federalism accelerates, the national health system can also speed up its own decentralization process, reduce disparities in access, and improve health outcomes. The turn towards federalism creates several potential opportunities for the national healthcare system. This is because decision making has been devolved to the federal, provincial and local governments, and so they can make decisions that are more representative of their localised health needs. The major challenge during the transition phase is to ensure that there are uninterrupted supplies of medical commodities and services. This requires scaling up the ability of local bodies to manage drug procurement and general logistics and adequate human resource in local healthcare centres. This article documents the efforts made so far in context of health sector federalization and synthesizes the progress and challenges to date and potential ways forward. This paper is written at a time while it is critical to review the federalism initiatives and develop way forward. As Nepal progress towards the federalized health system, we propose that the challenges inherent with the transition are critically analysed and mitigated while unfolding the potential of federal health system.
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Affiliation(s)
- Rajshree Thapa
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Kathmandu, Nepal
| | - Kiran Bam
- FHI 360 Nepal, LINKAGES Nepal Project, Kathmandu, Nepal
| | - Pravin Tiwari
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Kathmandu, Nepal
| | - Tirtha Kumar Sinha
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Kathmandu, Nepal
| | - Sagar Dahal
- Province Health Directorate, Ministry of Social Development, Dhankuta, Nepal
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Jansen T, Verheij RA, Schellevis FG, Kunst AE. Use of out-of-hours primary care in affluent and deprived neighbourhoods during reforms in long-term care: an observational study from 2013 to 2016. BMJ Open 2019; 9:e026426. [PMID: 30872553 PMCID: PMC6429913 DOI: 10.1136/bmjopen-2018-026426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/11/2018] [Accepted: 01/21/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Major long-term care (LTC) reforms in the Netherlands in 2015 may specifically have disadvantaged socioeconomically deprived groups to acquire LTC, possibly impacting the use of acute care. We aimed to demonstrate whether LTC reforms coincided with changes in the use of out-of-hours (OOH) primary care services (PCSs), and to compare changes between deprived versus affluent neighbourhoods. DESIGN Ecological observational retrospective study using routinely recorded electronic health records data from 2013 to 2016 and population registry data. SETTING Data from 15 OOH PCSs participating in the Nivel Primary Care Database (covering approximately 6.5 million inhabitants) in the Netherlands. PCS utilisation data on neighbourhood level were matched with sociodemographic characteristics, including neighbourhood socioeconomic status (SES). PARTICIPANTS Electronic health records from 6 120 384 OOH PCS contacts in 2013-2016, aggregated to neighbourhood level. OUTCOME MEASURES AND ANALYSES Number of contacts per 1000 inhabitants/year (total, high/low-urgency, night/evening-weekend-holidays, telephone consultations/consultations/home visits).Multilevel linear regression models included neighbourhood (first level), nested within PCS catchment area (second level), to account for between-PCS variation, adjusted for neighbourhood characteristics (for instance: % men/women). Difference-in-difference in time-trends according to neighbourhood SES was assessed with addition of an interaction term to the analysis (year×neighbourhood SES). RESULTS Between 2013 and 2016, overall OOH PCS use increased by 6%. Significant increases were observed for high-urgency contacts and contacts during the night. The largest change was observed for the most deprived neighbourhoods (10% compared with 4%-6% in the other neighbourhoods; difference not statistically significant). The increasing trend in OOH PCS use developed practically similar for deprived and affluent neighbourhoods. A a stable gradient reflected more OOH PCS use for each lower stratum of SES. CONCLUSIONS LTC reforms coincided with an overall increase in OOH PCS use, with nearly similar trends for deprived and affluent neighbourhoods. The results suggest a generalised spill over to OOH PCS following LTC reforms.
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Affiliation(s)
- Tessa Jansen
- Department of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Robert A Verheij
- Department of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Francois G Schellevis
- Department of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute Amsterdam University Medical Centers | Location VUmc, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
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Abstract
Australia and the United Kingdom have significantly expanded access to psychotherapy over the past decade. With this international experience to draw upon and a new $5 billion federal mental health transfer, Canada is well positioned to address long-standing gaps and inequities in access to psychotherapy. In Canada's more decentralized context, a concerted effort from health leaders at all levels of government and across multiple sectors and professions is needed to make the most of this opportunity for reform. Key priorities for health leaders include using the full range of provincial and territorial policy levers for either a grants-based or insurance-based approach; implementing a strong approach to performance monitoring, with equity targets built in from the outset; addressing gaps in workforce planning; and forming a pan-Canadian coalition for expanding access to psychotherapy.
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Affiliation(s)
- Mary Bartram
- 1 Faculty of Law, Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
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Abstract
Federal health care reform has expanded medical insurance to millions of people, altering the role that hospitals play in improving community health. However, current federal and state community benefit policy is an ineffective tool for ensuring that hospitals address the social determinants of health afflicting their communities. Policy shifts and other incentives that promote improved population health outcomes can encourage health care organizations to do the same.
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Affiliation(s)
- Hannah R Sullivan
- A legal scholar for the American Medical Association Council on Ethical and Judicial Affairs in Chicago, Illinois
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Abstract
The relatively poor health outcomes in Iraq have been attributed to the inability to address the shortfalls in the public health model. Calls for health system reform in Iraqi Kurdistan Region started in 2004; however, few, if any, significant changes have been achieved since then. This research examines the factors impeding public health system reform in the Iraqi Kurdistan Region, as perceived by the health policy makers, through 11 in-depth, unstructured interviews. Participants attributed the delay in reform to 16 impeding factors that can be categorized into 5 major themes: historical, ethical, cultural, political and institutional. The intricate network of these inter-dependent factors provides a possible explanation for the failure or unsustainability of reform efforts. Reform initiatives might have a better chance of success if they take into consideration the well-established and unique background and social construct in Iraq, as well as the impact of decades of conflict and insecurity, both of which influence the individual and institutional reasoning and behaviour across the entire health system.
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Affiliation(s)
- Ashraf S Al-Hamadani
- a Faculty of Health and Life Sciences, School of Medicine , University of Liverpool , Liverpool , UK
| | - Dilshad Jaff
- b Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Mark Edwards
- c Faculty of Health and Life Sciences, School of Medicine , University of Liverpool , Liverpool , UK
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Williams MD, Asiedu GB, Finnie D, Neely C, Egginton J, Finney Rutten LJ, Jacobson RM. Sustainable care coordination: a qualitative study of primary care provider, administrator, and insurer perspectives. BMC Health Serv Res 2019; 19:92. [PMID: 30709349 PMCID: PMC6359857 DOI: 10.1186/s12913-019-3916-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/18/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Care coordination has been a common tool for practices seeking to manage complex patients, yet there remains confusion about the most effective and sustainable model. Research exists on opinions of providers of care coordination but there is limited information on perspectives of those in the insurance industry about key elements. We sought to gather opinions from primary care providers and administrators in Minnesota who were involved in a CMS (Center for Medicare and Medicaid Services) transformational grant implementing COMPASS (Care Of Mental, Physical And Substance-use Syndromes), an evidence-based model of care coordination for depressed patients comorbid with diabetes and/or cardiovascular disease. We then sought to compare these views with those of private insurance representatives in Minnesota. METHODS We used qualitative methods to conducted forty-two key informant interviews with primary care providers (n = 15); administrators (n = 15); and insurers (n = 12). We analyzed the recorded and transcribed data, once de-identified, using a frameworks analysis approach. RESULTS We identified six primary themes: 1) a defined scope, rationale, and key partnerships for building comprehensive care coordination programs, 2) effective information exchange, 3) a trained and available workforce, 4) the need for a business model and a financially justifiable program, 5) a need for evaluation and ongoing improvement of care coordination, and 6) the importance of patient and family engagement. Overall consensus across stakeholder groups was high including a call for payment reform to support a valued service. Despite their role in paying for care, insurance representatives did not stress reduced utilization as more important than other outcomes. CONCLUSIONS Primary care providers and administrators from different organizations and backgrounds, all with experience in COMPASS, in large part agreed with insurance representatives on the main elements of a sustainable model and the need for health reform to sustain this service.
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Affiliation(s)
| | | | - Dawn Finnie
- Mayo Clinic, 200 1st St SW, Rochester, MN 55905 USA
| | - Claire Neely
- Institute for Clinical Systems Improvement, Minneapolis, MN USA
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Robert E, Ridde V, Rajan D, Sam O, Dravé M, Porignon D. Realist evaluation of the role of the Universal Health Coverage Partnership in strengthening policy dialogue for health planning and financing: a protocol. BMJ Open 2019; 9:e022345. [PMID: 30782678 PMCID: PMC6340476 DOI: 10.1136/bmjopen-2018-022345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 10/08/2018] [Accepted: 10/19/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION In 2011, WHO, the European Union and Luxembourg entered into a collaborative agreement to support policy dialogue for health planning and financing; these were acknowledged as core areas in need of targeted support in countries' quest towards universal health coverage (UHC). Entitled 'Universal Health Coverage Partnership', this intervention is intended to strengthen countries' capacity to develop, negotiate, implement, monitor and evaluate robust and integrated national health policies oriented towards UHC. It is a complex intervention involving a multitude of actors working on a significant number of remarkably diverse activities in different countries. METHODS AND ANALYSIS The researchers will conduct a realist evaluation to answer the following question: How, in what contexts, and triggering what mechanisms, does the Partnership support policy dialogue for health planning and financing towards UHC? A qualitative multiple case study will be undertaken in Togo, Liberia, Democratic Republic of Congo, Cape Verde, Burkina Faso and Niger. Three steps will be implemented: (1) formulating context-mechanism-outcome explanatory propositions to guide data collection, based on expert knowledge and theoretical literature; (2) collecting empirical data through semistructured interviews with key informants and observations of key events, and analysing data; (3) specifying the intervention theory. ETHICS AND DISSEMINATION The primary target audiences are WHO and its partner countries; international and national stakeholders involved in or supporting policy dialogues in the health sector, especially in low-income countries; and researchers with interest in UHC, policy dialogue, evaluation research and/or realist evaluation.
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Affiliation(s)
- Emilie Robert
- Training and Research Transcultural Team, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Valery Ridde
- Centre Population et Développement, Paris, Île-de-France, France
- Institut de recherche en santé publique, Université de Montréal, Montreal, Quebec, Canada
| | - Dheepa Rajan
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Omar Sam
- Inter-Country Support Team, World Health Organization, Ouagadougou, Burkina Faso
| | - Mamadou Dravé
- Country Office, World Health Organization, Lomé, Togo
| | - Denis Porignon
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
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