Pub Date : 2020-08-19DOI: 10.1093/oso/9780198837206.003.0009
Hugh Alderwick, J. Dixon, J. Bibby
Healthcare systems across the globe face the challenge of redesigning services to respond to their population’s changing health needs. Existing models of care are often outdated, fragmented, and imbalanced towards treating illness rather than preventing it upstream. This chapter provides a broad framework for thinking about healthcare redesign for improving population health—from understanding population health needs and setting shared objectives, to designing and testing new services—focusing in particular on the role of healthcare systems in disease prevention, and working with other services and sectors to address the wider determinants of health. While greater policy attention on the role of healthcare systems in disease prevention is welcome, the chapter emphasizes that healthcare systems can only do so much: broader policy decisions will continue to shape the underlying social and economic conditions that fundamentally determine population health.
{"title":"Healthcare redesign and population health","authors":"Hugh Alderwick, J. Dixon, J. Bibby","doi":"10.1093/oso/9780198837206.003.0009","DOIUrl":"https://doi.org/10.1093/oso/9780198837206.003.0009","url":null,"abstract":"Healthcare systems across the globe face the challenge of redesigning services to respond to their population’s changing health needs. Existing models of care are often outdated, fragmented, and imbalanced towards treating illness rather than preventing it upstream. This chapter provides a broad framework for thinking about healthcare redesign for improving population health—from understanding population health needs and setting shared objectives, to designing and testing new services—focusing in particular on the role of healthcare systems in disease prevention, and working with other services and sectors to address the wider determinants of health. While greater policy attention on the role of healthcare systems in disease prevention is welcome, the chapter emphasizes that healthcare systems can only do so much: broader policy decisions will continue to shape the underlying social and economic conditions that fundamentally determine population health.","PeriodicalId":100513,"journal":{"name":"Evidence-based Healthcare and Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79987842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-19DOI: 10.1093/oso/9780198837206.003.0005
A. Viens
This chapter explores some of the philosophical and ethical presuppositions of population healthcare; it investigates the implications for how we should understand the jurisdiction, aims, and evaluation of population healthcare. The jurisdiction of population healthcare is primarily within the healthcare system but necessarily extends beyond the walls of clinics and hospitals, given the need for social coordination to bring about healthcare access at the population level. The dual aims of population healthcare in maximizing population benefits of healthcare and reducing health inequalities are clearly moral in nature, but they can give rise to conflicting goals that the ethics of population healthcare should seek to resolve. While population healthcare’s aim is to advance a value-based approach to healthcare, which seeks to promote what is called technical, allocative, and personalized value, there are a number of questions that remain unanswered: in particular, the justification and evaluation of personalized value, and why the satisfaction of individual preferences in relation to health outcomes should be a population-level concern alongside promoting health and health equity.
{"title":"Populations, values, and health","authors":"A. Viens","doi":"10.1093/oso/9780198837206.003.0005","DOIUrl":"https://doi.org/10.1093/oso/9780198837206.003.0005","url":null,"abstract":"This chapter explores some of the philosophical and ethical presuppositions of population healthcare; it investigates the implications for how we should understand the jurisdiction, aims, and evaluation of population healthcare. The jurisdiction of population healthcare is primarily within the healthcare system but necessarily extends beyond the walls of clinics and hospitals, given the need for social coordination to bring about healthcare access at the population level. The dual aims of population healthcare in maximizing population benefits of healthcare and reducing health inequalities are clearly moral in nature, but they can give rise to conflicting goals that the ethics of population healthcare should seek to resolve. While population healthcare’s aim is to advance a value-based approach to healthcare, which seeks to promote what is called technical, allocative, and personalized value, there are a number of questions that remain unanswered: in particular, the justification and evaluation of personalized value, and why the satisfaction of individual preferences in relation to health outcomes should be a population-level concern alongside promoting health and health equity.","PeriodicalId":100513,"journal":{"name":"Evidence-based Healthcare and Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86235765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-19DOI: 10.1093/oso/9780198837206.003.0006
Andrew J. O’shaughnessy, John Wright
Healthcare needs assessment is an evaluative process that aims to quantify population needs for healthcare. Need is defined as the capacity to benefit from healthcare. It is characterized by a deficit in health linked to the potential for effective healthcare intervention. The epidemiological approach to needs assessment considers the burden of illness in terms of the incidence, prevalence, and mortality of a disease or health condition. This approach also draws on estimates of clinical and cost effectiveness from systematic reviews of well-designed studies. These estimates can be mapped to existing patterns of service utilization to identify potential gaps in services. Needs assessment should evaluate inequalities in health needs and access to services in key population subgroups. The comparative approach to needs assessment contrasts locally derived estimates with data from comparator areas as well as national benchmarks and other normative data. The corporate approach engages with stakeholders, including service providers and patients, to understand their perspectives and concerns. Epidemiological, corporate, and comparative assessments of need should be summarized to make quantified recommendations for changes to existing services, informing the development of a business case, and being integrated into service commissioning.
{"title":"Healthcare needs assessment","authors":"Andrew J. O’shaughnessy, John Wright","doi":"10.1093/oso/9780198837206.003.0006","DOIUrl":"https://doi.org/10.1093/oso/9780198837206.003.0006","url":null,"abstract":"Healthcare needs assessment is an evaluative process that aims to quantify population needs for healthcare. Need is defined as the capacity to benefit from healthcare. It is characterized by a deficit in health linked to the potential for effective healthcare intervention. The epidemiological approach to needs assessment considers the burden of illness in terms of the incidence, prevalence, and mortality of a disease or health condition. This approach also draws on estimates of clinical and cost effectiveness from systematic reviews of well-designed studies. These estimates can be mapped to existing patterns of service utilization to identify potential gaps in services. Needs assessment should evaluate inequalities in health needs and access to services in key population subgroups. The comparative approach to needs assessment contrasts locally derived estimates with data from comparator areas as well as national benchmarks and other normative data. The corporate approach engages with stakeholders, including service providers and patients, to understand their perspectives and concerns. Epidemiological, corporate, and comparative assessments of need should be summarized to make quantified recommendations for changes to existing services, informing the development of a business case, and being integrated into service commissioning.","PeriodicalId":100513,"journal":{"name":"Evidence-based Healthcare and Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84649879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-19DOI: 10.1093/oso/9780198837206.003.0008
A. Molloy
Knowledge management is the process of identifying, appraising, and synthesizing evidence to inform healthcare organization and delivery. This chapter summarizes the role and use of evidence in healthcare. Evidence identification, appraisal, and synthesis are described, and the use of evidence to inform the development of healthcare guidelines is discussed. The challenges of guideline implementation are explored and potential solutions are outlined. The future direction of knowledge management is complex and may involve individualized risk scoring and new approaches to analysing large datasets. Knowledge management should be used to guide more coherent care across healthcare systems; evidence and knowledge management must also promote appropriateness in healthcare.
{"title":"Knowledge management","authors":"A. Molloy","doi":"10.1093/oso/9780198837206.003.0008","DOIUrl":"https://doi.org/10.1093/oso/9780198837206.003.0008","url":null,"abstract":"Knowledge management is the process of identifying, appraising, and synthesizing evidence to inform healthcare organization and delivery. This chapter summarizes the role and use of evidence in healthcare. Evidence identification, appraisal, and synthesis are described, and the use of evidence to inform the development of healthcare guidelines is discussed. The challenges of guideline implementation are explored and potential solutions are outlined. The future direction of knowledge management is complex and may involve individualized risk scoring and new approaches to analysing large datasets. Knowledge management should be used to guide more coherent care across healthcare systems; evidence and knowledge management must also promote appropriateness in healthcare.","PeriodicalId":100513,"journal":{"name":"Evidence-based Healthcare and Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75862362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-19DOI: 10.1093/oso/9780198837206.003.0010
E. Winrow, R. Edwards
Health economics is the study of scarcity and choice. It focuses on the evaluation of the cost effectiveness of health and social care programmes, and the efficiency and equity implications of whole system change. Programme budgeting and marginal analysis (PBMA) is one framework for incorporating evidence of cost effectiveness alongside other relevant goals of service commissioners. A business case is designed to support proposals for a new service development or a capital project. The UK Treasury has set out guidance on the construction of a business case using a five-case model. This guidance was used in the business case for redesign of the Possilpark Health Centre in a deprived area of Glasgow. This business case emphasized that redesign could potentially improve the connection between health, social care, and other community services to meet the complex needs of patients in deprived areas of Glasgow.
{"title":"Programme budgeting and marginal analysis, and developing a business case for a new service","authors":"E. Winrow, R. Edwards","doi":"10.1093/oso/9780198837206.003.0010","DOIUrl":"https://doi.org/10.1093/oso/9780198837206.003.0010","url":null,"abstract":"Health economics is the study of scarcity and choice. It focuses on the evaluation of the cost effectiveness of health and social care programmes, and the efficiency and equity implications of whole system change. Programme budgeting and marginal analysis (PBMA) is one framework for incorporating evidence of cost effectiveness alongside other relevant goals of service commissioners. A business case is designed to support proposals for a new service development or a capital project. The UK Treasury has set out guidance on the construction of a business case using a five-case model. This guidance was used in the business case for redesign of the Possilpark Health Centre in a deprived area of Glasgow. This business case emphasized that redesign could potentially improve the connection between health, social care, and other community services to meet the complex needs of patients in deprived areas of Glasgow.","PeriodicalId":100513,"journal":{"name":"Evidence-based Healthcare and Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88213941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-19DOI: 10.1093/oso/9780198837206.003.0015
M. Gulliford, E. Jessop, L. Yardley
New digital technologies are having important impacts on the practice of public health and the organization and delivery of healthcare. Developments in information technology ensure that public health information is now available in more timely and accessible formats; data linkage has enriched public health information by making it possible to analyse multiple data sources simultaneously; and the use of smart devices and smart cards is generating even larger data resources that may be utilized for public health benefit. Computationally intensive approaches, derived from machine learning and artificial intelligence research, can be employed to develop algorithms that may efficiently automate healthcare-related tasks that previously relied on human analytical capabilities. Prediction modelling and risk stratification are being developed to promote precision public health. Increasing population coverage, with smartphones and other smart devices, makes it possible to deliver health-related interventions remotely, blurring the distinction between healthcare and public health. The availability of social media makes the exchange of knowledge and opinion more open, but this may also contribute to the propagation of false information that may be detrimental to public health. Public health needs to embrace and understand these developments in order to be at the forefront in harnessing these new technologies to improve population health and reduce inequalities. This must be accompanied by awareness of some of the ethical challenges of big-data analysis, the potential limitations of new analytical techniques, the relevance of behavioural science in understanding the human–machine interface, and the importance of critical evaluation in an era of rapid change.
{"title":"Digital healthcare public health","authors":"M. Gulliford, E. Jessop, L. Yardley","doi":"10.1093/oso/9780198837206.003.0015","DOIUrl":"https://doi.org/10.1093/oso/9780198837206.003.0015","url":null,"abstract":"New digital technologies are having important impacts on the practice of public health and the organization and delivery of healthcare. Developments in information technology ensure that public health information is now available in more timely and accessible formats; data linkage has enriched public health information by making it possible to analyse multiple data sources simultaneously; and the use of smart devices and smart cards is generating even larger data resources that may be utilized for public health benefit. Computationally intensive approaches, derived from machine learning and artificial intelligence research, can be employed to develop algorithms that may efficiently automate healthcare-related tasks that previously relied on human analytical capabilities. Prediction modelling and risk stratification are being developed to promote precision public health. Increasing population coverage, with smartphones and other smart devices, makes it possible to deliver health-related interventions remotely, blurring the distinction between healthcare and public health. The availability of social media makes the exchange of knowledge and opinion more open, but this may also contribute to the propagation of false information that may be detrimental to public health. Public health needs to embrace and understand these developments in order to be at the forefront in harnessing these new technologies to improve population health and reduce inequalities. This must be accompanied by awareness of some of the ethical challenges of big-data analysis, the potential limitations of new analytical techniques, the relevance of behavioural science in understanding the human–machine interface, and the importance of critical evaluation in an era of rapid change.","PeriodicalId":100513,"journal":{"name":"Evidence-based Healthcare and Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80207114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-19DOI: 10.1093/oso/9780198837206.003.0017
E. Jessop, M. Gulliford
Demographic change and economic constraints are likely to drive change in healthcare systems over the next few decades. It seems inevitable that both the amount and the shape of healthcare systems will be stretched by increasing numbers of old people, even as the definition of ‘old age’ is itself stretched. Concepts of ‘disease’ may need to change; such changes will need to be mirrored in coding systems. As healthcare becomes more specialized, pathways become more complex. This will disadvantage people who lack the cognitive, physical, and financial resources to navigate complex systems. Specialists in healthcare public health will need to adapt their knowledge, skills, and attitudes.
{"title":"Concluding remarks","authors":"E. Jessop, M. Gulliford","doi":"10.1093/oso/9780198837206.003.0017","DOIUrl":"https://doi.org/10.1093/oso/9780198837206.003.0017","url":null,"abstract":"Demographic change and economic constraints are likely to drive change in healthcare systems over the next few decades. It seems inevitable that both the amount and the shape of healthcare systems will be stretched by increasing numbers of old people, even as the definition of ‘old age’ is itself stretched. Concepts of ‘disease’ may need to change; such changes will need to be mirrored in coding systems. As healthcare becomes more specialized, pathways become more complex. This will disadvantage people who lack the cognitive, physical, and financial resources to navigate complex systems. Specialists in healthcare public health will need to adapt their knowledge, skills, and attitudes.","PeriodicalId":100513,"journal":{"name":"Evidence-based Healthcare and Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88047624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-19DOI: 10.1093/oso/9780198837206.003.0007
M. Gulliford
Access to healthcare is concerned with the processes of gaining entry to the healthcare system. Analysis of access focuses on inequality and inequity in the availability and use of health services. In order to address global inequalities in access to healthcare, international organizations have promoted access to healthcare as a human right. This is linked to the ideal of universal health coverage, with shared funding of some or all healthcare for everyone, as a key strategy for achieving this. At a national level, rational strategies for resource allocation and priority setting are used to promote equity of access in terms of equal access for equal need, but historical inequalities based on the ‘inverse care law’ have been resistant to change. In health systems led by primary care, access to a general practitioner (GP) tends to reduce inequalities in ‘entry’ access to the health system, but the gatekeeping role of GPs may contribute to the development of inequalities of ‘in-system’ access. Wide variations in the utilization of both primary and secondary care services are indicative of access inequalities, but these variations may sometimes reflect clinical uncertainty or poor-quality care. Access inequalities may also arise from personal, social, and cultural barriers experienced by patients in accessing healthcare. These barriers typically represent more severe obstacles for marginalized groups in the population. Promoting equity means ensuring that services are responsive and acceptable to all groups, including those with stigmatized conditions.
{"title":"Access to healthcare","authors":"M. Gulliford","doi":"10.1093/oso/9780198837206.003.0007","DOIUrl":"https://doi.org/10.1093/oso/9780198837206.003.0007","url":null,"abstract":"Access to healthcare is concerned with the processes of gaining entry to the healthcare system. Analysis of access focuses on inequality and inequity in the availability and use of health services. In order to address global inequalities in access to healthcare, international organizations have promoted access to healthcare as a human right. This is linked to the ideal of universal health coverage, with shared funding of some or all healthcare for everyone, as a key strategy for achieving this. At a national level, rational strategies for resource allocation and priority setting are used to promote equity of access in terms of equal access for equal need, but historical inequalities based on the ‘inverse care law’ have been resistant to change. In health systems led by primary care, access to a general practitioner (GP) tends to reduce inequalities in ‘entry’ access to the health system, but the gatekeeping role of GPs may contribute to the development of inequalities of ‘in-system’ access. Wide variations in the utilization of both primary and secondary care services are indicative of access inequalities, but these variations may sometimes reflect clinical uncertainty or poor-quality care. Access inequalities may also arise from personal, social, and cultural barriers experienced by patients in accessing healthcare. These barriers typically represent more severe obstacles for marginalized groups in the population. Promoting equity means ensuring that services are responsive and acceptable to all groups, including those with stigmatized conditions.","PeriodicalId":100513,"journal":{"name":"Evidence-based Healthcare and Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87563638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-19DOI: 10.1093/oso/9780198837206.003.0012
S. Russ, N. Sevdalis
This chapter offers an introduction to the recently developed applied health science fields of patient safety, improvement, and implementation sciences. Healthcare is a high-risk activity because of the complexity of its systems and processes. Errors arise frequently and these can impact negatively on patients by causing adverse events. Errors and adverse events are generally attributable to defective systems for organizing care, which create conditions in which errors arise. This represents a failure of risk management. Patient safety science takes a scientific approach to understanding why errors occur and how to prevent their occurrence or minimize their impact. Learning from analysis of patient safety incidents, through root-cause analysis, enables an organization or service to learn and avoid repeating similar failures in the future. Patient safety incidents represent one aspect of the wider problem of poor-quality care. Improvement science offers standardized tools and measurements that can be used to monitor and improve healthcare delivery. The Model for Improvement employs repeated Plan–Do–Study–Act (PDSA) cycles to quantify problems and to develop and test potential solutions. Engagement with stakeholders is an essential part of this process. Implementation science can contribute by providing methods to promote the uptake of new research evidence into healthcare practice. It can address the second translational gap by facilitating the widespread adoption of strategies for improving health-related processes and outcomes, and advancing knowledge on how best to replicate intervention effects from trials into real-world settings. These new scientific fields provide well-established approaches to addressing some of the key problems arising in healthcare. Modern public health needs to reap the benefits of these newly emerged sciences to address the burden of adverse events and harm that arises in the delivery of healthcare and to promote evidence-based practice.
{"title":"Perspectives on healthcare quality and safety","authors":"S. Russ, N. Sevdalis","doi":"10.1093/oso/9780198837206.003.0012","DOIUrl":"https://doi.org/10.1093/oso/9780198837206.003.0012","url":null,"abstract":"This chapter offers an introduction to the recently developed applied health science fields of patient safety, improvement, and implementation sciences. Healthcare is a high-risk activity because of the complexity of its systems and processes. Errors arise frequently and these can impact negatively on patients by causing adverse events. Errors and adverse events are generally attributable to defective systems for organizing care, which create conditions in which errors arise. This represents a failure of risk management. Patient safety science takes a scientific approach to understanding why errors occur and how to prevent their occurrence or minimize their impact. Learning from analysis of patient safety incidents, through root-cause analysis, enables an organization or service to learn and avoid repeating similar failures in the future. Patient safety incidents represent one aspect of the wider problem of poor-quality care. Improvement science offers standardized tools and measurements that can be used to monitor and improve healthcare delivery. The Model for Improvement employs repeated Plan–Do–Study–Act (PDSA) cycles to quantify problems and to develop and test potential solutions. Engagement with stakeholders is an essential part of this process. Implementation science can contribute by providing methods to promote the uptake of new research evidence into healthcare practice. It can address the second translational gap by facilitating the widespread adoption of strategies for improving health-related processes and outcomes, and advancing knowledge on how best to replicate intervention effects from trials into real-world settings. These new scientific fields provide well-established approaches to addressing some of the key problems arising in healthcare. Modern public health needs to reap the benefits of these newly emerged sciences to address the burden of adverse events and harm that arises in the delivery of healthcare and to promote evidence-based practice.","PeriodicalId":100513,"journal":{"name":"Evidence-based Healthcare and Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79557603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-19DOI: 10.1093/oso/9780198837206.003.0003
B. Burström
The provision of healthcare should be in relation to the need of care, but this is not always the case, as examples given in this chapter illustrate. The impact on equity in the utilization of care of need-based resource allocation versus recent market-oriented choice reforms and changes in reimbursement systems in primary care in Sweden are discussed. Examples are given of alternative ways of providing services in primary care in disadvantaged areas. Further, the chapter describes an applied example of the concept of proportionate universalism in child healthcare services, where extra postnatal home visits are provided in a disadvantaged area of Stockholm. Finally, the emerging needs of integrated care in an ageing population are contrasted against current health policy reform, which emphasizes freedom of choice of providers, and discussed.
{"title":"Promoting equity through health services","authors":"B. Burström","doi":"10.1093/oso/9780198837206.003.0003","DOIUrl":"https://doi.org/10.1093/oso/9780198837206.003.0003","url":null,"abstract":"The provision of healthcare should be in relation to the need of care, but this is not always the case, as examples given in this chapter illustrate. The impact on equity in the utilization of care of need-based resource allocation versus recent market-oriented choice reforms and changes in reimbursement systems in primary care in Sweden are discussed. Examples are given of alternative ways of providing services in primary care in disadvantaged areas. Further, the chapter describes an applied example of the concept of proportionate universalism in child healthcare services, where extra postnatal home visits are provided in a disadvantaged area of Stockholm. Finally, the emerging needs of integrated care in an ageing population are contrasted against current health policy reform, which emphasizes freedom of choice of providers, and discussed.","PeriodicalId":100513,"journal":{"name":"Evidence-based Healthcare and Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85071361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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