Pub Date : 2023-11-07DOI: 10.34172/ijhpm.2023.7450
Kent Buse, Amy Bestman, Siddharth Srivastava, R. Marten, Sonam Yangchen, Devaki Nambiar
Background: While support for the idea of fostering healthy societies is longstanding, there is a gap in the literature on what they are, how to beget them, and how experience might inform future efforts. This paper explores developments since Alma Ata (1978) to understand how a range of related concepts and fields inform approaches to healthy societies and to develop a model to help conceptualize future research and policy initiatives. Methods: Drawing on 68 purposively selected documents, including political declarations, commission and agency reports, peer-reviewed papers and guidance notes, we undertook qualitative thematic analysis. Three independent researchers compiled and categorised themes describing the domains of a potential healthy societies approach. Results: The literature provides numerous frameworks. Some of these frameworks promote alternative endpoints to development, eschewing short-term economic growth in favour of health, equity, well-being and sustainability. They also identify values, such as gender equality, collaboration, human rights and empowerment that provide the pathways to, or underpin, such endpoints. We categorize the literature into four "components": people; places; products; and planet. People refers to social positions, interactions and networks creating well-being. Places are physical environments—built and natural—and the interests and policies shaping them. Products are commodities and commercial practices impacting population health. Planet places human health in the context of the ‘Anthropocene.’ These components interact in complex ways across global, regional, country and community levels as outlined in our heuristic. Conclusion: The literature offers little critical reflection on why greater progress has not been made, or on the need to organise and resist the prevailing systems which perpetuate ill-health.
{"title":"What Are Healthy Societies? A Thematic Analysis of Relevant Conceptual Frameworks","authors":"Kent Buse, Amy Bestman, Siddharth Srivastava, R. Marten, Sonam Yangchen, Devaki Nambiar","doi":"10.34172/ijhpm.2023.7450","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.7450","url":null,"abstract":"Background: While support for the idea of fostering healthy societies is longstanding, there is a gap in the literature on what they are, how to beget them, and how experience might inform future efforts. This paper explores developments since Alma Ata (1978) to understand how a range of related concepts and fields inform approaches to healthy societies and to develop a model to help conceptualize future research and policy initiatives. Methods: Drawing on 68 purposively selected documents, including political declarations, commission and agency reports, peer-reviewed papers and guidance notes, we undertook qualitative thematic analysis. Three independent researchers compiled and categorised themes describing the domains of a potential healthy societies approach. Results: The literature provides numerous frameworks. Some of these frameworks promote alternative endpoints to development, eschewing short-term economic growth in favour of health, equity, well-being and sustainability. They also identify values, such as gender equality, collaboration, human rights and empowerment that provide the pathways to, or underpin, such endpoints. We categorize the literature into four \"components\": people; places; products; and planet. People refers to social positions, interactions and networks creating well-being. Places are physical environments—built and natural—and the interests and policies shaping them. Products are commodities and commercial practices impacting population health. Planet places human health in the context of the ‘Anthropocene.’ These components interact in complex ways across global, regional, country and community levels as outlined in our heuristic. Conclusion: The literature offers little critical reflection on why greater progress has not been made, or on the need to organise and resist the prevailing systems which perpetuate ill-health.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"29 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139284966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-07DOI: 10.34172/ijhpm.2023.8334
Amy Brown, Tilley Pain, A. Edelman, Sarah Larkins, Gillian Harvey
{"title":"Measuring Research Impact in a Health Service Is a Worthy But Complex Goal; A Response to Recent Commentaries","authors":"Amy Brown, Tilley Pain, A. Edelman, Sarah Larkins, Gillian Harvey","doi":"10.34172/ijhpm.2023.8334","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.8334","url":null,"abstract":"<jats:p> </jats:p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"17 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139286182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-07DOI: 10.34172/ijhpm.2023.8005
M. Huda, N. Kitson, N. Saadi, Saira Kanwal, Urooj Gul, Maarten Jansen, S. Torres-Rueda, Rob Baltussen, A. Alwan, S. Siddiqi, Anna Vassall
Background: Countries designing a health benefit package (HBP) to support progress towards universal health coverage (UHC) require robust cost-effectiveness evidence. This paper reports on Pakistan’s approach to assessing the applicability of global cost-effectiveness evidence to country context as part of a HBP design process. Methods: A seven-step process was developed and implemented with Disease Control Priority 3 (DCP3) project partners to assess the applicability of global incremental cost-effectiveness ratios (ICER) to Pakistan. First, the scope of the interventions to be assessed was defined and an independent, interdisciplinary team was formed. Second, the team familiarized itself with intervention descriptions. Third, the team identified studies from the Tufts Medical School Global Health Cost-Effectiveness Analysis (GHCEA) registry. Fourth, the team applied specific knock-out criteria to match identified studies to local intervention descriptions. Matches were then cross-checked across reviewers and further selection was made where there were multiple ICER matches. Sixth, a quality scoring system was applied to ICER values. Finally, a database was created containing all the ICER results with a justification for each decision, which was made available to decision-makers during HBP deliberation. Results: We found that less than 50% of the interventions in DCP3 could be supported with evidence of cost-effectiveness applicable to the country context. Out of 78 ICERs identified as applicable to Pakistan from the Tufts GH-CEA registry, only 20 ICERs were exact matches of the DCP3 Pakistan intervention descriptions and 58 were partial matches. Conclusion: This paper presents the first attempt globally to use the main public GH-CEA database to estimate cost-effectiveness in the context of HBPs at a country level. This approach is a useful learning for all countries trying to develop essential packages informed by the global database on ICERs, and it will support the design of future evidence and further development of methods.
{"title":"Assessing Global Evidence on Cost-Effectiveness to Inform Development of Pakistan’s Essential Package of Health Services","authors":"M. Huda, N. Kitson, N. Saadi, Saira Kanwal, Urooj Gul, Maarten Jansen, S. Torres-Rueda, Rob Baltussen, A. Alwan, S. Siddiqi, Anna Vassall","doi":"10.34172/ijhpm.2023.8005","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.8005","url":null,"abstract":"Background: Countries designing a health benefit package (HBP) to support progress towards universal health coverage (UHC) require robust cost-effectiveness evidence. This paper reports on Pakistan’s approach to assessing the applicability of global cost-effectiveness evidence to country context as part of a HBP design process. Methods: A seven-step process was developed and implemented with Disease Control Priority 3 (DCP3) project partners to assess the applicability of global incremental cost-effectiveness ratios (ICER) to Pakistan. First, the scope of the interventions to be assessed was defined and an independent, interdisciplinary team was formed. Second, the team familiarized itself with intervention descriptions. Third, the team identified studies from the Tufts Medical School Global Health Cost-Effectiveness Analysis (GHCEA) registry. Fourth, the team applied specific knock-out criteria to match identified studies to local intervention descriptions. Matches were then cross-checked across reviewers and further selection was made where there were multiple ICER matches. Sixth, a quality scoring system was applied to ICER values. Finally, a database was created containing all the ICER results with a justification for each decision, which was made available to decision-makers during HBP deliberation. Results: We found that less than 50% of the interventions in DCP3 could be supported with evidence of cost-effectiveness applicable to the country context. Out of 78 ICERs identified as applicable to Pakistan from the Tufts GH-CEA registry, only 20 ICERs were exact matches of the DCP3 Pakistan intervention descriptions and 58 were partial matches. Conclusion: This paper presents the first attempt globally to use the main public GH-CEA database to estimate cost-effectiveness in the context of HBPs at a country level. This approach is a useful learning for all countries trying to develop essential packages informed by the global database on ICERs, and it will support the design of future evidence and further development of methods.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"26 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139287541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-06DOI: 10.34172/ijhpm.2023.7352
J. Sumankuuro, Frances Griffiths, A. Koon, Witness Mapanga, Beryl Maritim, A. Mosam, J. Goudge
Background: Efforts to move towards universal health coverage (UHC) aim to rebalance health financing in ways that increase efficiency, equity, and quality. Resource constraints require a shift from passive to strategic purchasing (SP). In this paper, we report on the experiences of SP in public sector health insurance schemes in nine middle-income countries to understand what extent SP has been established, the challenges and facilitators, and how it is helping countries achieve their UHC goals. Methods: We conducted a systematic search to identify papers on SP. Nine countries were selected for case study analysis. We extracted data from 129 articles. We used a common framework to compare the purchasing arrangements and key features in the different schemes. The evidence was synthesised qualitatively. Results: Five countries had health technology assessment (HTA) units to research what services to buy. Most schemes had reimbursement mechanisms that enabled some degree of cost control. However, we found evidenced-based changes to the reimbursement mechanisms only in Thailand and China. All countries have some form of mechanism for accreditation of health facilities, although there was considerable variation in what is done. All countries had some strategy for monitoring claims, but they vary in complexity and the extent of implementation; three countries have implemented e-claim processing enabling a greater level of monitoring. Only four countries had independent governance structures to provide oversight. We found delayed reimbursement (six countries), failure to provide services in the benefits package (four countries), and high out-of-pocket (OOP) payments in all countries except Thailand and Indonesia, suggesting the schemes were failing their members. Conclusion: We recommend investment in purchaser and research capacity and a focus on strong governance, including regular engagement between the purchaser, provider and citizens, to build trusting relationships to leverage the potential of SP more fully, and expand financial protection and progress towards UHC.
{"title":"The Experiences of Strategic Purchasing of Healthcare in Nine Middle-Income Countries: A Systematic Qualitative Review","authors":"J. Sumankuuro, Frances Griffiths, A. Koon, Witness Mapanga, Beryl Maritim, A. Mosam, J. Goudge","doi":"10.34172/ijhpm.2023.7352","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.7352","url":null,"abstract":"Background: Efforts to move towards universal health coverage (UHC) aim to rebalance health financing in ways that increase efficiency, equity, and quality. Resource constraints require a shift from passive to strategic purchasing (SP). In this paper, we report on the experiences of SP in public sector health insurance schemes in nine middle-income countries to understand what extent SP has been established, the challenges and facilitators, and how it is helping countries achieve their UHC goals. Methods: We conducted a systematic search to identify papers on SP. Nine countries were selected for case study analysis. We extracted data from 129 articles. We used a common framework to compare the purchasing arrangements and key features in the different schemes. The evidence was synthesised qualitatively. Results: Five countries had health technology assessment (HTA) units to research what services to buy. Most schemes had reimbursement mechanisms that enabled some degree of cost control. However, we found evidenced-based changes to the reimbursement mechanisms only in Thailand and China. All countries have some form of mechanism for accreditation of health facilities, although there was considerable variation in what is done. All countries had some strategy for monitoring claims, but they vary in complexity and the extent of implementation; three countries have implemented e-claim processing enabling a greater level of monitoring. Only four countries had independent governance structures to provide oversight. We found delayed reimbursement (six countries), failure to provide services in the benefits package (four countries), and high out-of-pocket (OOP) payments in all countries except Thailand and Indonesia, suggesting the schemes were failing their members. Conclusion: We recommend investment in purchaser and research capacity and a focus on strong governance, including regular engagement between the purchaser, provider and citizens, to build trusting relationships to leverage the potential of SP more fully, and expand financial protection and progress towards UHC.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"39 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139288172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.34172/ijhpm.2023.7585
Mohammadreza Zolfagharian
This commentary discusses the paper by Holmström et al that explored how system dynamics (SD) may contribute effectively to an action research (AR) process to improve five health case studies. Accordingly, we reviewed some of the methodological aspects of the proposed integration of SD into AR using ongoing debates on multi-methodology and mixed methods research. In a systemic evaluation of the proposed design, we concentrated on some of the common distinct features of SD and AR, and the challenges as well as the expected outcomes of this integration. Finally, we tried to position the suggested framework within the multi-methodology efforts and to pave the way for developing it in future research and practice.
本评论讨论了 Holmström 等人的论文，该论文探讨了系统动力学（SD）如何有效地促进行动研究（AR）过程，以改进五个健康案例研究。因此，我们利用正在进行的关于多方法论和混合方法研究的辩论，对将 SD 纳入 AR 的建议的一些方法论方面进行了回顾。在对所建议的设计进行系统评估时，我们集中讨论了 SD 和 AR 的一些共同特征，以及这种整合所面临的挑战和预期结果。最后，我们试图将建议的框架定位在多方法研究中，并为其在未来研究和实践中的发展铺平道路。
{"title":"Integrating System Dynamics Into Action Research: Drivers and Challenges in a Synergetic Complementarity Comment on \"Insights Gained From a Re-analysis of Five Improvement Cases in Healthcare Integrating System Dynamics Into Action Research\"","authors":"Mohammadreza Zolfagharian","doi":"10.34172/ijhpm.2023.7585","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.7585","url":null,"abstract":"This commentary discusses the paper by Holmström et al that explored how system dynamics (SD) may contribute effectively to an action research (AR) process to improve five health case studies. Accordingly, we reviewed some of the methodological aspects of the proposed integration of SD into AR using ongoing debates on multi-methodology and mixed methods research. In a systemic evaluation of the proposed design, we concentrated on some of the common distinct features of SD and AR, and the challenges as well as the expected outcomes of this integration. Finally, we tried to position the suggested framework within the multi-methodology efforts and to pave the way for developing it in future research and practice.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"150 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139308652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.34172/ijhpm.2022.8325
Erik Wackers, N. Stadhouders, Anthony Heil, Simone van Dulmen, P. Jeurissen
{"title":"How to Design Integrated Strategies to Improve Healthcare Quality Whilst Containing Healthcare Costs? A Response to the Recent Commentaries","authors":"Erik Wackers, N. Stadhouders, Anthony Heil, Simone van Dulmen, P. Jeurissen","doi":"10.34172/ijhpm.2022.8325","DOIUrl":"https://doi.org/10.34172/ijhpm.2022.8325","url":null,"abstract":"<jats:p> </jats:p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"59 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139307039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-29DOI: 10.34172/ijhpm.2023.7598
Essa Tawfiq, Khwaja Mir Islam SAEED, Sayed Ali Shah Alawi, Jammalluddin Jawaid, Sayed Nasir Hashimi
Background: Mothers’ care seeking behavior for childhood illness is a key factor of utilizing healthcare for children. We examined predictors of mothers’ care seeking for common childhood illnesses. Methods: This was a cross-sectional study, using data from the Afghanistan Health Survey 2015. Data were used from women who sought healthcare for their unwell children. The women were asked whether their children were sick with fever, cough, faster breathing, or diarrhea in the past 2 weeks. The outcome variable was defined as whether the mother sought healthcare for her unwell child from a public clinic, a private clinic, or from a pharmacy store. The Andersen’s healthcare seeking behavior model was used and multinomial regression analysis applied. Results: There were 4,979 women, aged 15-49 years, whose under-5 children were sick in the past 2 weeks. Thirty-nine percent of women sought healthcare for their children from a health provider. Mother’s age, child’s age, child’s sex, socioeconomic status, mothers’ perceived severity of childhood illness, and number of under-5 children were predictors of a mothers’ care seeking behavior. The likelihood of healthcare seeking was lower for older children [Adjusted odds ratio (AOR) 0.51(0.37-0.70) from public clinics; 0.33(0.23-0.47) from private clinics; 0.36(0.22-0.61) from pharmacy stores], and for girls [AOR 0.74(0.59-0.93) from private clinics]. The likelihood of healthcare seeking was greater for children whose mothers knew symptoms of childhood illness [AOR 2.97(1.44-6.16) from public clinics; 7.20 (3.04-17.04) from pharmacy stores]. The likelihood of healthcare seeking for children was greater in older mothers [AOR 1.54(1.11-2.12)]. It was less likely for the mothers who have more children to seek healthcare for their children [OR 0.53(0.43-0.65) from public clinics; 0.61(0.48-0.79) from private clinics; 0.51(0.37-0.69) from pharmacy stores]. Conclusion: Health policy makers may opt to use our findings, particularly mothers’ knowledge (perceived severity) of symptoms of childhood illness to develop interventions to enhance timely assessment and effective treatment of common preventable childhood illnesses.
{"title":"Predictors of Mothers’ Care Seeking Behaviour for Common Childhood Illnesses: Findings From the Afghanistan Health Survey 2015","authors":"Essa Tawfiq, Khwaja Mir Islam SAEED, Sayed Ali Shah Alawi, Jammalluddin Jawaid, Sayed Nasir Hashimi","doi":"10.34172/ijhpm.2023.7598","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.7598","url":null,"abstract":"Background: Mothers’ care seeking behavior for childhood illness is a key factor of utilizing healthcare for children. We examined predictors of mothers’ care seeking for common childhood illnesses. Methods: This was a cross-sectional study, using data from the Afghanistan Health Survey 2015. Data were used from women who sought healthcare for their unwell children. The women were asked whether their children were sick with fever, cough, faster breathing, or diarrhea in the past 2 weeks. The outcome variable was defined as whether the mother sought healthcare for her unwell child from a public clinic, a private clinic, or from a pharmacy store. The Andersen’s healthcare seeking behavior model was used and multinomial regression analysis applied. Results: There were 4,979 women, aged 15-49 years, whose under-5 children were sick in the past 2 weeks. Thirty-nine percent of women sought healthcare for their children from a health provider. Mother’s age, child’s age, child’s sex, socioeconomic status, mothers’ perceived severity of childhood illness, and number of under-5 children were predictors of a mothers’ care seeking behavior. The likelihood of healthcare seeking was lower for older children [Adjusted odds ratio (AOR) 0.51(0.37-0.70) from public clinics; 0.33(0.23-0.47) from private clinics; 0.36(0.22-0.61) from pharmacy stores], and for girls [AOR 0.74(0.59-0.93) from private clinics]. The likelihood of healthcare seeking was greater for children whose mothers knew symptoms of childhood illness [AOR 2.97(1.44-6.16) from public clinics; 7.20 (3.04-17.04) from pharmacy stores]. The likelihood of healthcare seeking for children was greater in older mothers [AOR 1.54(1.11-2.12)]. It was less likely for the mothers who have more children to seek healthcare for their children [OR 0.53(0.43-0.65) from public clinics; 0.61(0.48-0.79) from private clinics; 0.51(0.37-0.69) from pharmacy stores]. Conclusion: Health policy makers may opt to use our findings, particularly mothers’ knowledge (perceived severity) of symptoms of childhood illness to develop interventions to enhance timely assessment and effective treatment of common preventable childhood illnesses.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139311781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-29DOI: 10.34172/ijhpm.2023.7898
L. K. O'Connell, Nisha Botchwey
This paper responds to lessons from the Adolescent and Youth Health Policy process in South Africa by drawing comparisons with youth participation within the climate justice movement. Relationship building is essential to successful youth participation in health policy and climate change as it creates intergenerational learning and cross-cultural engagement. At the same time, both sets of youth also deal with compounding challenges due to contemporary and historical legacies of colonialism and inequality. Yet, tokenism challenges the participatory process as adults profess to value youth perspectives, yet recommendations by youth often do not get incorporated into policies or plans. For organizations and agencies trying to build youth’s capacity, organizations and agencies should look to programs that train youth in advocacy. These programs help build youth’s confidence, increase their optimism for change, and give youth a sense of ownership.
{"title":"Supporting Youth Participation in Health and Climate Justice Through Advocacy Training; Comment on \"Between Rhetoric and Reality: Learnings From Youth Participation in the Adolescent and Youth Health Policy in South Africa\"","authors":"L. K. O'Connell, Nisha Botchwey","doi":"10.34172/ijhpm.2023.7898","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.7898","url":null,"abstract":"This paper responds to lessons from the Adolescent and Youth Health Policy process in South Africa by drawing comparisons with youth participation within the climate justice movement. Relationship building is essential to successful youth participation in health policy and climate change as it creates intergenerational learning and cross-cultural engagement. At the same time, both sets of youth also deal with compounding challenges due to contemporary and historical legacies of colonialism and inequality. Yet, tokenism challenges the participatory process as adults profess to value youth perspectives, yet recommendations by youth often do not get incorporated into policies or plans. For organizations and agencies trying to build youth’s capacity, organizations and agencies should look to programs that train youth in advocacy. These programs help build youth’s confidence, increase their optimism for change, and give youth a sense of ownership.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"72 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139311770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-28DOI: 10.34172/ijhpm.2023.7700
T. Remers, F. Kruse, Simone A. van Dulmen, Dorien L. Oostra, Martijn FM Maessen, Patrick PT Jeurissen, M. Rikkert
Background: People with dementia are increasingly living at home, relying on primary care providers for most healthcare needs. Suboptimal collaboration and communication between providers could cause inefficiencies and worse patient outcomes. Innovative strategies are needed to address this growing disease burden and rising healthcare costs. The DementiaNet programme, a community care network approach targeted at patients with dementia in the Netherlands, has been shown to improve patient’s quality of care. However, very little is known about the impact of DementiaNet on admission risks and healthcare costs. This study addresses this knowledge gap. Methods: A longitudinal cohort analysis was performed, using medical and long-term care claims data from 38 525 patients between 2015-2019. The primary outcomes were risk of hospital admission and annual total healthcare costs. Mixed-model regression analyses were used to identify changes in outcomes. Results: Patients who received care from a DementiaNet community care network showed a general trend in lower risk of admission for all types of admissions studied (ie, hospital, emergency ward, intensive care, crisis, and nursing home). Also, the intervention group showed a significant reduction of 12% in nursing days (relative risk [RR] 0.88; 95% CI: 0.77– 0.96). No significant differences were found for total healthcare costs. However, we found effects in two sub-elements of total healthcare costs, being a decrease of 19.7% (95% CI: 7.7%–30.2%) in annual hospital costs and an increase of 10.2% (95% CI: 2.3%–18.6%) in annual primary care costs. Conclusion: Our study indicates that DementiaNet’s community care network approach may reduce admission risks for patients with dementia over a long-term period of five years. This is accompanied by a decrease in nursing days and savings in hospital care that exceed increased primary care costs. This improvement in integrated dementia care supports wider scale implementation and evaluation of these networks.
{"title":"Effects of DementiaNet’s Community Care Network Approach on Admission Rates and Healthcare Costs: A Longitudinal Cohort Analysis","authors":"T. Remers, F. Kruse, Simone A. van Dulmen, Dorien L. Oostra, Martijn FM Maessen, Patrick PT Jeurissen, M. Rikkert","doi":"10.34172/ijhpm.2023.7700","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.7700","url":null,"abstract":"Background: People with dementia are increasingly living at home, relying on primary care providers for most healthcare needs. Suboptimal collaboration and communication between providers could cause inefficiencies and worse patient outcomes. Innovative strategies are needed to address this growing disease burden and rising healthcare costs. The DementiaNet programme, a community care network approach targeted at patients with dementia in the Netherlands, has been shown to improve patient’s quality of care. However, very little is known about the impact of DementiaNet on admission risks and healthcare costs. This study addresses this knowledge gap. Methods: A longitudinal cohort analysis was performed, using medical and long-term care claims data from 38 525 patients between 2015-2019. The primary outcomes were risk of hospital admission and annual total healthcare costs. Mixed-model regression analyses were used to identify changes in outcomes. Results: Patients who received care from a DementiaNet community care network showed a general trend in lower risk of admission for all types of admissions studied (ie, hospital, emergency ward, intensive care, crisis, and nursing home). Also, the intervention group showed a significant reduction of 12% in nursing days (relative risk [RR] 0.88; 95% CI: 0.77– 0.96). No significant differences were found for total healthcare costs. However, we found effects in two sub-elements of total healthcare costs, being a decrease of 19.7% (95% CI: 7.7%–30.2%) in annual hospital costs and an increase of 10.2% (95% CI: 2.3%–18.6%) in annual primary care costs. Conclusion: Our study indicates that DementiaNet’s community care network approach may reduce admission risks for patients with dementia over a long-term period of five years. This is accompanied by a decrease in nursing days and savings in hospital care that exceed increased primary care costs. This improvement in integrated dementia care supports wider scale implementation and evaluation of these networks.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"43 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139311887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-24DOI: 10.34172/ijhpm.2023.8004
Rob Baltussen, Maarten Jansen, Syeda Shehirbano Akhtar, L. Bijlmakers, S. Torres-Rueda, Muhammad Khalid, Wajeeha Raza, M. Huda, Gavin Surgey, Wahaj Zulfiqar, Anna Vassall, Raza Zaidi, S. Siddiqi, A. Alwan
Background: The Disease Control Priorities 3 (DCP3) project provides long-term support to Pakistan in the development and implementation of its universal health coverage essential package of health services (UHC-EPHS). This paper reports on the priority setting process used in the design of the EPHS during the period 2019-2020, employing the framework of evidence-informed deliberative processes (EDPs), a tool for priority setting with the explicit aim of optimising the legitimacy of decision-making in the development of health benefit packages. Methods: We planned the six steps of the framework during two workshops in the Netherlands with participants from all DCP3 Pakistan partners (October 2019 and February 2020), who implemented these at the country level in Pakistan in 2019 and 2020. Following implementation, we conducted a semi-structured online survey to collect the views of participants in the UHC benefit package design about the prioritisation process. Results: The key steps in the EDP framework were the installation of advisory committees (involving more than 150 members in several Technical Working Groups [TWGs] and a National Advisory Committee [NAC]), definition of decision criteria (effectiveness, cost-effectiveness, avoidable burden of disease, equity, financial risk protection, budget impact, socio-economic impact and feasibility), selection of interventions for evaluation (a total of 170), and assessment and appraisal (across the three dimensions of the UHC cube) of these interventions. Survey respondents were generally positive across several aspects of the priority setting process. Conclusion: Despite several challenges, including a partial disruption because of the COVID-19 pandemic, implementation of the priority setting process may have improved the legitimacy of decision-making by involving stakeholders through participation with deliberation, and being evidence-informed and transparent. Important lessons were learned that can be beneficial for other countries designing their own health benefit package such as on the options and limitations of broad stakeholder involvement.
{"title":"The Use of Evidence-Informed Deliberative Processes for Designing the Essential Package of Health Services in Pakistan","authors":"Rob Baltussen, Maarten Jansen, Syeda Shehirbano Akhtar, L. Bijlmakers, S. Torres-Rueda, Muhammad Khalid, Wajeeha Raza, M. Huda, Gavin Surgey, Wahaj Zulfiqar, Anna Vassall, Raza Zaidi, S. Siddiqi, A. Alwan","doi":"10.34172/ijhpm.2023.8004","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.8004","url":null,"abstract":"Background: The Disease Control Priorities 3 (DCP3) project provides long-term support to Pakistan in the development and implementation of its universal health coverage essential package of health services (UHC-EPHS). This paper reports on the priority setting process used in the design of the EPHS during the period 2019-2020, employing the framework of evidence-informed deliberative processes (EDPs), a tool for priority setting with the explicit aim of optimising the legitimacy of decision-making in the development of health benefit packages. Methods: We planned the six steps of the framework during two workshops in the Netherlands with participants from all DCP3 Pakistan partners (October 2019 and February 2020), who implemented these at the country level in Pakistan in 2019 and 2020. Following implementation, we conducted a semi-structured online survey to collect the views of participants in the UHC benefit package design about the prioritisation process. Results: The key steps in the EDP framework were the installation of advisory committees (involving more than 150 members in several Technical Working Groups [TWGs] and a National Advisory Committee [NAC]), definition of decision criteria (effectiveness, cost-effectiveness, avoidable burden of disease, equity, financial risk protection, budget impact, socio-economic impact and feasibility), selection of interventions for evaluation (a total of 170), and assessment and appraisal (across the three dimensions of the UHC cube) of these interventions. Survey respondents were generally positive across several aspects of the priority setting process. Conclusion: Despite several challenges, including a partial disruption because of the COVID-19 pandemic, implementation of the priority setting process may have improved the legitimacy of decision-making by involving stakeholders through participation with deliberation, and being evidence-informed and transparent. Important lessons were learned that can be beneficial for other countries designing their own health benefit package such as on the options and limitations of broad stakeholder involvement.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"197 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139314560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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