Health Policy最新文献

Background

Portugal introduced freedom of choice for initial specialist consultations in 2016 to boost quality via competition. However, for tangible benefits, specialized care demand must be quality-elastic. This research probes the relation between choosing hospital out the residence area and their quality traits.

Methods

We used data for all primary consultation requests from primary care centres to hospitals from 1/1/2017 to 31/12/2018 (n = 3,346,335). We modelled the choice of a hospital as a function of its quality characteristics, adjusting for area-based socioeconomic variables using logistic regressions.

Results

Results indicate that patients and their general practitioners consider quality indicators when choosing a hospital. Higher mortality, longer waiting times and higher readmission rates at the hospital of origin were positively associated with the patient's choice. Freedom of choice is less used when the distance to the hospital of origin increases. Similar patterns were observed for larger hospitals and those with academic status.

Discussion

This study underscores the relevance of quality considerations in hospital selection by both patients and their general practitioners (GPs). The implications are two-fold. Firstly, improving quality appears as a factor to increase attractiveness, so that hospital competition may lead to improved health outcomes. Secondly, it highlights that hospital financing should include an activity dimension in which “money follows the patient”, otherwise no financial incentive exists to improve quality. Hence, the current hospital financing model and the limited possibility to choose in certain areas limit the potential of quality improvement based on enhanced attractivity. Decision makers should be aware that quality is a driver of patient choice, as our study demonstrates, and adapt the system to take advantage of this reality.

Palliative care is a crucial discipline that alleviates suffering and enhances the quality of life for patients with life-limiting illnesses and their families. However, there is gap globally between the need for and availability of these services. Integrated health service networks offer a promising solution to address this gap in rural areas, by coordinating care across different levels and sectors. This scoping review aimed at identifying the key characteristics of palliative care networks in rural communities. A broad search without time limits was conducted in four databases. Analysis and synthesis were conducted using Latent Dirichlet Allocation topic modeling. Sixteen studies were included, revealing four key themes regarding the development of palliative care networks in rural areas: community engagement is essential to secure the reach of rural networks, tailored approaches acknowledging diversity enrich these networks, team-centric efforts involving stakeholder coordination ensure successful implementation, and a multifaceted approach—empowering non-traditional stakeholders and incorporating technology resources into primary health services—dynamizes palliative care delivery in rural areas. These findings underscore the potential of collaborative and innovative approaches to enhance the accessibility and effectiveness of palliative care in underserved rural communities. Further cost-effectiveness studies are warranted to better understand the impact these strategies can have on health systems.

Pharmaceutical companies spend hundreds of millions of pounds on marketing/R&D-related payments annually to healthcare organisations and healthcare professionals. UK pharmaceutical industry self-regulatory bodies require member companies who sign up to their code of conduct to publish details of their payments. They are also required to publish the methodologies underlying these payments, namely methodological notes. This study aimed to analyse UK pharmaceutical companies’ methodological notes and their adherence to the Association of the British Pharmaceutical Industry code of conduct and other relevant guidance. We conducted a content analysis of methodological notes for the years 2015, 2017 and 2019 and assessed companies’ adherence to self-regulatory bodies’ requirements and recommendations for methodology disclosure. Overall, 90 companies made payment disclosures in all three years, publishing 269 methodological notes. We found gaps in adherence to self-regulatory requirements. Only 3 (3.3 %) companies provided clear information for all self-regulatory body recommendations and regulations in all of their notes. Companies also varied in their approaches to important areas. For example, of the 244 notes with clear information on VAT management, 36.1 % (N = 88) included VAT, 30.3 % (N = 74) excluded VAT, and 33.6 % (N = 82) had multiple rules for VAT. There was evidence of widespread non-adherence to self-regulatory requirements. This suggests flaws with self-regulation and a need for greater enforcement of rules or consideration of a publicly mandated disclosure system.

Newborn screening is a public health measure to diagnose rare diseases at birth, thereby minimising negative effects of late treatment. Genomic technologies promise an unprecedented expansion of screened diseases at low cost and with transformative potential for newborn screening programmes. However, barriers to the public funding of genomic newborn screening are poorly understood, particularly in light of the heterogenous European newborn screening landscape. This study therefore aims to understand whether international newborn screening experts share a common understanding of the barriers to fund genomic newborn screening. For this purpose, we convened 21 European newborn screening experts across a range of professions and national backgrounds in a Delphi study. Stable consensus, determined via the Wilcoxon matched-pairs signed-ranks test, was found via three consecutive survey rounds for all presented barriers. Experts generally judged the scenario of genomic newborn screening being available to every newborn in seven years to be unlikely, identifying treatability and the absence of counselling and a skilled workforce as the most significant barriers to public funding. We identify value re-definition for rare disease treatments, centralisation of genomic expertise, and international research consortia as avenues for pan-European actions which build on the consensus achieved by our Delphi panel.