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Health Policy

Peter Leslie Annear, Soonman Kwon, Luca Lorenzoni, Stephen Duckett, Dale Huntington, John C Langenbrunner, Yuki Murakami, Changwoo Shon, Ke Xu
Countries in Asia are working towards achieving universal health coverage while ensuring improved quality of care. One element is controlling hospital costs through payment reforms. In this paper we review experiences in using Diagnosis Related Groups (DRG) based hospital payments in three Asian countries and ask if there is an "Asian way to DRGs". We focus first on technical issues and follow with a discussion of implementation challenges and policy questions. We reviewed the literature and worked as an expert team to investigate existing documentation from Japan, Republic of Korea, and Thailand...
May 7, 2018: Health Policy
Rita Henderson, Stephanie Montesanti, Lindsay Crowshoe, Charles Leduc
For Indigenous people worldwide, accessing Primary Health Care (PHC) services responsive to socio-cultural realities is challenging, with institutional inequities in healthcare and jurisdictional barriers encumbering patients, providers, and decision-makers. In the Canadian province of Alberta, appropriate Indigenous health promotion, disease prevention, and primary care health services are needed, though policy reform is hindered by complex networks and competing interests between: federal/provincial funders; reserve/urban contexts; medical/allied health professional priorities; and three Treaty territories each structuring fiduciary responsibilities of the Canadian government...
May 7, 2018: Health Policy
Jason Dean-Chen Yin, Alex Jingwei He
Singapore and Hong Kong, two high-income "Tiger economies" in Asia, were ranked as the top two most efficient health systems in the world. Despite remarkable similarities in history and socioeconomic development, both economies embraced rather different paths in health care reforms in the past decades, which reflect their respective sociopolitical dynamics. Rapidly ageing populations and the anxiety about future funding of health care have prompted them to embark on major health financing reforms in the recent three years...
April 30, 2018: Health Policy
Ke Zhou, Arpana Vidyarthi, David Matchar, Yin Bun Cheung, Shao Wei Lam, Marcus Ong
Prior studies link higher workload with longer length of stay (LOS) in the US. Unlike U.S. hospitals, Singaporean hospitals, like other major hospitals in the Asia-Pacific, are partially occupied by patients with non-acute needs due to insufficient alternative facilities. We examined the association between workload and length of stay (LOS) and the impact of workload on 30-day re-hospitalization and inpatient mortality rates in retrospective cohort in this setting. We defined workload as the daily number of patients per physician team...
April 30, 2018: Health Policy
L C Edney, H Haji Ali Afzali, T C Cheng, J Karnon
There is limited empirical evidence of the nature of any relationship between health spending and health outcomes in Australia. We address this by estimating the elasticity of health outcomes with respect to public healthcare spending using an instrumental variable (IV) approach to account for endogeneity of healthcare spending to health outcomes. Results suggest that, based on the conditional mean, a 1% increase in public health spending was associated with a 2.2% (p < 0.05) reduction in the number of standardised Years of Life Lost (YLL)...
April 27, 2018: Health Policy
Glyn Elwyn, Helen Burstin, Michael J Barry, Maureen P Corry, Marie Anne Durand, Daniel Lessler, Christopher Saigal
Efforts to implement the use of patient decision aids to stimulate shared decision making are gaining prominence. Patient decision aids have been designed to help patients participate in making specific choices among health care options. Because these tools clearly influence decisions, poor quality, inaccurate or unbalanced presentations or misleading tools are a risk to patients. As payer interest in these tools increases, so does the risk that patients are harmed by the use of tools that are described as patient decision aids yet fail to meet established standards...
April 27, 2018: Health Policy
Jason Shafrin, Michelle Skornicki, Michelle Brauer, Julie Villeneuve, Michael Lees, Nadine Hertel, John R Penrod, Jeroen Jansen
INTRODUCTION: Health technology appraisal agencies often rely on cost-effectiveness analyses to inform coverage decisions for new treatments. These assessments, however, frequently measure a treatment's value from the payer's perspective, and may not capture value generated from reduced caregiving costs, increased productivity, value based on patient risk preferences, option value or the insurance value to non-patients. METHODS: To examine how using a broader societal perspective of treatment value affects cost-effectiveness estimates, this case study analyzed the net monetary benefit (NMB) of second-line nivolumab treatment of patients with squamous non-small cell lung cancer (NSCLC) in Canada...
April 26, 2018: Health Policy
Ana V Pejcic, Georgi Iskrov, Mihajlo Michael Jakovljevic, Rumen Stefanov
The aim of this study was to compare orphan drug access in a sample of Balkan countries: five EU Member States (Bulgaria, Croatia, Greece, Romania, Slovenia) and two EU Candidates (Serbia, Montenegro). The comparative analysis was based on a cross-sectional study and included medicinal products with an active orphan designation and market authorisation on January 1, 2017. Access to orphan drugs is an ongoing challenge in these countries. Three clusters of countries were identified in terms of orphan drug access: Greece and Slovenia, making the top tier, Romania, Bulgaria, and Croatia, being in the middle, and EU Candidates, Serbia and Montenegro, forming the bottom tier, where a substantial number of EU market approved orphan drugs was not even registered...
April 26, 2018: Health Policy
Viola Burau, Hanne Marlene Dahl, Lotte Groth Jensen, Stina Lou
Over past decades Activity Based Funding has been an attractive tool for hospital funding and governance, but there has been growing frustration especially with its unintended effects. There are numerous examples of alternative models, but there is little in-depth knowledge about how these models came about. The aim of our study was to analyse how the discourse of Activity Based Funding was successfully challenged. This contributes insights into how international/national debates are translated into concrete alternative models through specific discursive mechanisms...
April 24, 2018: Health Policy
Nasrin Tayyari Dehbarez, Dorte Gyrd-Hansen, Niels Uldbjerg, Rikke Søgaard
Equity of access to health care is a central objective of European health care systems. In this study, we examined whether free choice of hospital, which has been introduced in many systems to strengthen user rights and improve hospital competition, conflicts with equity of access to highly specialized hospitals. We chose to carry out a study on 134,049 women who had uncomplicated pregnancies from 2005 to 2014 in Denmark because of their homogeneity in terms of need, the availability of behavioral data, and their expected engagement in choice of hospital...
April 24, 2018: Health Policy
Mari Broqvist, Lars Sandman, Peter Garpenby, Barbro Krevers
The importance for governments of establishing ethical principles and criteria for priority setting in line with social values, has been emphasised. The risk of such criteria not being operationalised and instead replaced by de-contextualised priority-setting tools, has been noted. The aim of this article was to compare whether citizenś views are in line with how a criterion derived from parliamentary-decided ethical principles have been interpreted into a framework for evaluating severity levels, in resource allocation situations in Sweden...
April 22, 2018: Health Policy
Nils Gutacker, Karen Bloor, Chris Bojke, Kieran Walshe
Interventions to reduce variation in care quality are increasingly targeted at both individual doctors and the organisations in which they work. Concerns remain about the scope and consequences for such performance management, the relative contribution of individuals and organisations to observed variation, and whether performance can be measured reliably. This study explores these issues in the context of the English National Health Service by analysing comprehensive administrative data for all patients treated for four clinical conditions (acute myocardial infarction, hip fracture, pneumonia, ischemic stroke) and two surgical procedures (coronary artery bypass, hip replacement) during April 2010-February 2013...
April 13, 2018: Health Policy
Kayvan Bozorgmehr, Mariya Samuilova, Roumyana Petrova-Benedict, Enrico Girardi, Pierluca Piselli, Alexander Kentikelenis
BACKGROUND: Systematic information on infectious disease services provided to refugees and asylum seekers in the European Union (EU) is sparse. We conducted a scoping study of experts in six EU countries in order to map health system responses related to infectious disease prevention and control among refugees and asylum seekers. METHODS: We conducted 27 semi-structured in-depth interviews with first-line staff and health officials to collect information about existing guidelines and practices at each stage of reception in first-entry (Greece/Italy), transit (Croatia/Slovenia), and destination countries (Austria/Sweden)...
April 11, 2018: Health Policy
V T Reckers-Droog, N J A van Exel, W B F Brouwer
The increasing demand for healthcare and the resulting pressure on available budgets render priority setting inevitable. If societies aim to improve health and distribute health(care) fairly, equity-efficiency trade-offs are necessary. In the Netherlands, proportional shortfall (PS) was introduced to quantify necessity of care, allowing a direct equity-efficiency trade-off. This study describes the history and application of PS in the Netherlands and examines the theoretical and empirical support for PS as well as its current role in healthcare decision making...
April 7, 2018: Health Policy
Sarah L Barber, Ankit Kumar, Tomas Roubal, Francesca Colombo, Luca Lorenzoni
Governments frequently draw upon the private health care sector to promote sustainability, optimal use of resources, and increased choice. In doing so, policy-makers face the challenge of harnessing resources while grappling with the market failures and equity concerns associated with private financing of health care. The growth of the private health sector in South Africa has fundamentally changed the structure of health care delivery. A mutually reinforcing ecosystem of private health insurers, private hospitals and specialists has grown to account for almost half of the country's spending on health care, despite only serving 16% of the population with the capacity to pay...
March 29, 2018: Health Policy
Ines Niehaus, Charalabos-Markos Dintsios
The early benefit assessment of pharmaceuticals in Germany and their preceding market authorization pursue different objectives. This is reflected by the inclusion of varying confirmatory endpoints within the evaluation of oncology drugs in early benefit assessment versus market authorization, with both relying on the same evidence. Data from assessments up to July 2015 are used to estimate the impact of explorative in comparison to confirmatory endpoints on market authorization and early benefit assessment by contrasting the benefit-risk ratio of EMA and the benefit-harm balance of the HTA jurisdiction...
March 26, 2018: Health Policy
Wilm Quentin, Alexander Geissler, Friedrich Wittenbecher, Geoff Ballinger, Robert Berenson, Karen Bloor, Dana A Forgione, Peer Köpf, Madelon Kroneman, Lisbeth Serden, Raúl Suarez, Johan W van Manen, Reinhard Busse
Payment systems for specialists in hospitals can have far reaching consequences for the efficiency and quality of care. This article presents a comparative analysis of payment systems for specialists in hospitals of eight high-income countries (Canada, England, France, Germany, Sweden, Switzerland, the Netherlands, and the USA/Medicare system). A theoretical framework highlighting the incentives of different payment systems is used to identify potentially interesting reform approaches. In five countries,most specialists work as employees - but in Canada, the Netherlands and the USA, a majority of specialists are self-employed...
March 23, 2018: Health Policy
Fabrizio Bert, Maria Rosaria Gualano, Paolo Biancone, Valerio Brescia, Elisa Camussi, Maria Martorana, Silvana Secinaro, Roberta Siliquini
INTRODUCTION: Over 2 million people in high-income countries live with HIV. Early diagnosis and treatment present benefits for infected subjects and reduce secondary transmissions. Cost-effectiveness analyses are important to effectively inform policy makers and consequently implement the most cost-effective programmes. Therefore, we conducted a systematic review regarding the cost-effectiveness of HIV screening in high-income countries. METHODS: We followed PRISMA statements and included all papers evaluating the cost-effectiveness of HIV screening in the general population or in specific subgroups...
March 23, 2018: Health Policy
T Herbst, J Foerster, M Emmert
BACKGROUND: Pay-for-performance (P4P) has become a popular approach to increase effectiveness and efficiency in healthcare. So far, there is little evidence regarding the potential of P4P in the German healthcare setting. The aim of this study was to determine the impact of P4P on the quality of care in cataract surgery. METHODS: In 2012, a P4P program was implemented in a German surgical centre for ophthalmology. Five quality measures regarding process quality, outcomes, and patient satisfaction were measured over a period of 4...
March 22, 2018: Health Policy
Mahmut S Yardim, Sarp Uner
OBJECTIVE: To evaluate access to healthcare from an equity perspective on the way toward Universal Health Coverage in Turkey. METHODS: The country representative data from 2006 to 2013 Turkey Income and Living Conditions Surveys were analyzed. Private household residents aged fifteen and older were asked for self-reported unmet need for medical care in the past twelve months. The dependent variable had three categories: no unmet need, unmet need due to cost, and unmet need due to availability (waiting list and distance problems)...
March 22, 2018: Health Policy
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