Pub Date : 2024-11-01DOI: 10.1016/j.healthpol.2024.105197
Eyal Katvan , Orly Korin , Israel Issi Doron , Eytan Mor , Boaz Shnoor , Daniel Gelman , Tamar Ashkenazi
Introduction
Since April 2014 the age limitation on candidates listed for organ transplantation in Israel was abolished following the recommendations of a Public Committee. In this research the new policy was examined in light of scarce medical resources and the increased rate of aging in Israel.
Methods
The opinions of twelve medical staff regarding the policy change were analyzed by a qualitative methodology, using semi-structured interviews.
Results
Interviews with medical staff members revealed three main themes: 1. positive acceptance of the new policy; 2. concerns and problems regarding the change; and 3. the influence of the policy change on the organ transplant allocation system and patient-doctor relationships.
Discussion and Conclusions
The medical staff expressed positive views towards the new policy, based on age-free, individually determined admission to transplant waiting lists. However, some concerns were raised regarding the medical implications of this policy, thus potentially hindering its full application.
{"title":"Abolishing age criterion to determine organ transplant recipients in Israel: A qualitative study of medical staff perceptions","authors":"Eyal Katvan , Orly Korin , Israel Issi Doron , Eytan Mor , Boaz Shnoor , Daniel Gelman , Tamar Ashkenazi","doi":"10.1016/j.healthpol.2024.105197","DOIUrl":"10.1016/j.healthpol.2024.105197","url":null,"abstract":"<div><h3>Introduction</h3><div>Since April 2014 the age limitation on candidates listed for organ transplantation in Israel was abolished following the recommendations of a Public Committee. In this research the new policy was examined in light of scarce medical resources and the increased rate of aging in Israel.</div></div><div><h3>Methods</h3><div>The opinions of twelve medical staff regarding the policy change were analyzed by a qualitative methodology, using semi-structured interviews.</div></div><div><h3>Results</h3><div>Interviews with medical staff members revealed three main themes: 1. positive acceptance of the new policy; 2. concerns and problems regarding the change; and 3. the influence of the policy change on the organ transplant allocation system and patient-doctor relationships.</div></div><div><h3>Discussion and Conclusions</h3><div>The medical staff expressed positive views towards the new policy, based on age-free, individually determined admission to transplant waiting lists. However, some concerns were raised regarding the medical implications of this policy, thus potentially hindering its full application.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"150 ","pages":"Article 105197"},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607506","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 : 2024-10-31DOI: 10.1016/j.healthpol.2024.105195
Pushkar Silwal , Tim Tenbensel , Daniel Exeter , Arier Lee
There is growing interest in using outcome-based measures in sub-national level health system performance management, particularly in high-income countries. Increasingly, population health indicators used for making international comparisons are being applied at a sub-national level. This study aims to understand whether and under what circumstances population health outcome-based measures can be used for performance measurement and management at the sub-national level health systems. We have integrated empirical population-based data with key health system expert perspectives to evaluate the appropriateness of two population health indicators – amenable mortality and ambulatory-sensitive hospitalization of young children. Our assessment focused on two key aspects: (i) the technical validity of these indicators, ensuring they accurately measure these outcomes, and (ii) the functionality and legitimacy of performance information, determining whether it meets stakeholders' program or policy needs and supports strategic decision-making. Overall, we found that the 'intermediate' outcome measure, childhood ambulatory sensitive hospitalization, was more useful for identifying district-level health system performance variation than the 'end' outcome measure, amenable mortality. Performance information based on childhood ambulatory-sensitive hospitalization is more appropriate for improving decision-making, and it is more likely to be accepted by a wide range of stakeholders involved in health system performance improvement.
{"title":"Using outcome measures in sub-national level performance management: When and under what circumstances?","authors":"Pushkar Silwal , Tim Tenbensel , Daniel Exeter , Arier Lee","doi":"10.1016/j.healthpol.2024.105195","DOIUrl":"10.1016/j.healthpol.2024.105195","url":null,"abstract":"<div><div>There is growing interest in using outcome-based measures in sub-national level health system performance management, particularly in high-income countries. Increasingly, population health indicators used for making international comparisons are being applied at a sub-national level. This study aims to understand whether and under what circumstances population health outcome-based measures can be used for performance measurement and management at the sub-national level health systems. We have integrated empirical population-based data with key health system expert perspectives to evaluate the appropriateness of two population health indicators – amenable mortality and ambulatory-sensitive hospitalization of young children. Our assessment focused on two key aspects: (i) the technical validity of these indicators, ensuring they accurately measure these outcomes, and (ii) the functionality and legitimacy of performance information, determining whether it meets stakeholders' program or policy needs and supports strategic decision-making. Overall, we found that the 'intermediate' outcome measure, childhood ambulatory sensitive hospitalization, was more useful for identifying district-level health system performance variation than the 'end' outcome measure, amenable mortality. Performance information based on childhood ambulatory-sensitive hospitalization is more appropriate for improving decision-making, and it is more likely to be accepted by a wide range of stakeholders involved in health system performance improvement.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"151 ","pages":"Article 105195"},"PeriodicalIF":3.6,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
At least in Western Europe, competitive social health insurance systems have implemented systems of morbidity-based risk adjustment to establish a level playing field for insurers. However, insured persons with specific socio-economic characteristics are still underfunded, leaving incentives for risk selection. In Germany, there is an ongoing debate about (re)implementing socio-economic variables to reduce this undercompensation. This study analyses whether the following four socio-economic groups are systematically under- or over‐compensated under the present risk equalization system in Germany: insured persons with co‐payment exemption (1), recipients of basic income support for unemployment (2), of benefits of social long-term care-insurance (3) and insured persons with reduced earning capacity (4). On this basis, several attempts of incorporating these variables into the German risk adjustment system, allowing a better fit for the socio-economically disadvantaged groups, are examined. With a data set of about 9.2 million insured persons, the performance of the modifications is demonstrated for the German system. The disparate outcomes of the various models in different dimensions necessitate the consideration of trade-offs and their incorporation into the implementation of a model designed to mitigate the undercompensation of the affected insured groups.
{"title":"Implementation of socio-economic variables in risk adjustment systems: A quantitative analysis using the example of Germany","authors":"Gerald Lux , Theresa Hüer , Florian Buchner , Jürgen Wasem","doi":"10.1016/j.healthpol.2024.105196","DOIUrl":"10.1016/j.healthpol.2024.105196","url":null,"abstract":"<div><div>At least in Western Europe, competitive social health insurance systems have implemented systems of morbidity-based risk adjustment to establish a level playing field for insurers. However, insured persons with specific socio-economic characteristics are still underfunded, leaving incentives for risk selection. In Germany, there is an ongoing debate about (re)implementing socio-economic variables to reduce this undercompensation. This study analyses whether the following four socio-economic groups are systematically under- or over‐compensated under the present risk equalization system in Germany: insured persons with co‐payment exemption (1), recipients of basic income support for unemployment (2), of benefits of social long-term care-insurance (3) and insured persons with reduced earning capacity (4). On this basis, several attempts of incorporating these variables into the German risk adjustment system, allowing a better fit for the socio-economically disadvantaged groups, are examined. With a data set of about 9.2 million insured persons, the performance of the modifications is demonstrated for the German system. The disparate outcomes of the various models in different dimensions necessitate the consideration of trade-offs and their incorporation into the implementation of a model designed to mitigate the undercompensation of the affected insured groups.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"151 ","pages":"Article 105196"},"PeriodicalIF":3.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632092","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 : 2024-10-29DOI: 10.1016/j.healthpol.2024.105191
Stefano Gandolfi , Nicola Bellè , Sabina Nuti
Background & Objective
This systematic review evaluates the impact of guidelines on healthcare professionals’ behavior and explores the resulting outcomes.
Methods
Using PRISMA methodology, Scopus and Web of Science databases were searched, yielding 624 results. After applying inclusion criteria, 67 articles were selected for in-depth analysis.
Results
The studies focused on key clusters: Target behaviors, Effectiveness, Research designs, Behavioral frameworks, and Publication outlets. Prescription behavior was the most studied (58.2 %), followed by other health-related behaviors (31.3 %) and hygiene practices (10.4 %). Significant behavior changes were reported in 46.3 % of studies, with 17.9 % showing negative effects, and 22.4 % reporting mixed results. Quantitative methods dominated (56.8 %), while qualitative methods (19.4 %) and review designs (13.4 %) were less common. Theoretical Domain Framework (TDF) and Behavior Change Wheel (BCW) were frequently used frameworks, with the UK and the USA contributing most studies. Medical doctors (44.8 %) were the primary participants, followed by general healthcare providers (37.3 %).
Conclusions
The study highlights the varied effectiveness of guidelines, with prescription behavior being the most investigated. Guidelines influenced behavior positively in less than half of the cases, and doctors were the primary focus, rather than nurses. The complexity of interventions suggests a need for further research to develop more effective behavioral interventions and to standardize methodological approaches to reduce clinical variation in healthcare.
背景与目的：本系统性综述评估了指南对医护人员行为的影响，并探讨了由此产生的结果：采用 PRISMA 方法，对 Scopus 和 Web of Science 数据库进行了检索，共获得 624 项结果。采用纳入标准后，选择了 67 篇文章进行深入分析：结果：这些研究主要集中在以下几个方面目标行为、有效性、研究设计、行为框架和出版渠道。研究最多的是处方行为（58.2%），其次是其他健康相关行为（31.3%）和卫生习惯（10.4%）。46.3%的研究报告了显著的行为变化，17.9%的研究报告了负面影响，22.4%的研究报告了混合结果。定量方法占主导地位（56.8%），而定性方法（19.4%）和综述设计（13.4%）则不太常见。理论领域框架（TDF）和行为改变轮（BCW）是经常使用的框架，其中英国和美国的研究最多。医生（44.8%）是主要参与者，其次是普通医疗服务提供者（37.3%）：研究强调了指南的不同效果，其中处方行为是调查最多的。指导原则对行为产生积极影响的案例不到一半，主要关注点是医生而不是护士。干预措施的复杂性表明，有必要开展进一步研究，以开发更有效的行为干预措施，并统一方法论，减少医疗保健中的临床差异。
{"title":"Please mind the gap between guidelines & behavior change: A systematic review and a consideration on effectiveness in healthcare","authors":"Stefano Gandolfi , Nicola Bellè , Sabina Nuti","doi":"10.1016/j.healthpol.2024.105191","DOIUrl":"10.1016/j.healthpol.2024.105191","url":null,"abstract":"<div><h3>Background & Objective</h3><div>This systematic review evaluates the impact of guidelines on healthcare professionals’ behavior and explores the resulting outcomes.</div></div><div><h3>Methods</h3><div>Using PRISMA methodology, Scopus and Web of Science databases were searched, yielding 624 results. After applying inclusion criteria, 67 articles were selected for in-depth analysis.</div></div><div><h3>Results</h3><div>The studies focused on key clusters: Target behaviors, Effectiveness, Research designs, Behavioral frameworks, and Publication outlets. Prescription behavior was the most studied (58.2 %), followed by other health-related behaviors (31.3 %) and hygiene practices (10.4 %). Significant behavior changes were reported in 46.3 % of studies, with 17.9 % showing negative effects, and 22.4 % reporting mixed results. Quantitative methods dominated (56.8 %), while qualitative methods (19.4 %) and review designs (13.4 %) were less common. Theoretical Domain Framework (TDF) and Behavior Change Wheel (BCW) were frequently used frameworks, with the UK and the USA contributing most studies. Medical doctors (44.8 %) were the primary participants, followed by general healthcare providers (37.3 %).</div></div><div><h3>Conclusions</h3><div>The study highlights the varied effectiveness of guidelines, with prescription behavior being the most investigated. Guidelines influenced behavior positively in less than half of the cases, and doctors were the primary focus, rather than nurses. The complexity of interventions suggests a need for further research to develop more effective behavioral interventions and to standardize methodological approaches to reduce clinical variation in healthcare.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"151 ","pages":"Article 105191"},"PeriodicalIF":3.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1016/j.healthpol.2024.105190
Loup Beduchaud , Enoa Celingant , Clara Faure , Mathilda Meunier , Iñaki Blanco-Cazeaux
This review investigates the effectiveness of utilizing foreign physicians or International Medical Graduates to alleviate medical shortages in rural and underserved areas of developed countries. Conducted in February 2024, this systematic review follows PRISMA 2020 guidelines, analysing 15 English-language studies from the United States, Canada, Australia, and New Zealand. The focus is on comparing physicians with international graduation to national graduates in rural and underserved contexts. Results reveal diverse trends across countries: in the United States, national graduates are generally more represented in rural areas, while foreign physicians are more prevalent in Health Professional Shortage Areas. In Canada, foreign graduates are more common in rural areas, varying by province. Australia and New Zealand show foreign physicians practicing more in rural areas than national counterparts. This study underscores significant reliance on foreign physicians to mitigate rural healthcare disparities. While this strategy partially addresses immediate shortages, long-term effectiveness is uncertain due to retention and integration challenges. Future policies should focus on sustainable solutions for equitable healthcare access and physicians’ retention in underserved areas. This review emphasizes also the need for Europe-specific studies and further evaluation of policy effectiveness.
{"title":"Do international medical graduates’ recruitment policies help to overcome healthcare shortage areas in developed countries? A systematic review","authors":"Loup Beduchaud , Enoa Celingant , Clara Faure , Mathilda Meunier , Iñaki Blanco-Cazeaux","doi":"10.1016/j.healthpol.2024.105190","DOIUrl":"10.1016/j.healthpol.2024.105190","url":null,"abstract":"<div><div>This review investigates the effectiveness of utilizing foreign physicians or International Medical Graduates to alleviate medical shortages in rural and underserved areas of developed countries. Conducted in February 2024, this systematic review follows PRISMA 2020 guidelines, analysing 15 English-language studies from the United States, Canada, Australia, and New Zealand. The focus is on comparing physicians with international graduation to national graduates in rural and underserved contexts. Results reveal diverse trends across countries: in the United States, national graduates are generally more represented in rural areas, while foreign physicians are more prevalent in Health Professional Shortage Areas. In Canada, foreign graduates are more common in rural areas, varying by province. Australia and New Zealand show foreign physicians practicing more in rural areas than national counterparts. This study underscores significant reliance on foreign physicians to mitigate rural healthcare disparities. While this strategy partially addresses immediate shortages, long-term effectiveness is uncertain due to retention and integration challenges. Future policies should focus on sustainable solutions for equitable healthcare access and physicians’ retention in underserved areas. This review emphasizes also the need for Europe-specific studies and further evaluation of policy effectiveness.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"150 ","pages":"Article 105190"},"PeriodicalIF":3.6,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.healthpol.2024.105193
Robert Messerle , Fenja Hoogestraat , Eva-Maria Wild
Shifting care from the resource-intensive inpatient setting to the more economically efficient outpatient sector is being promoted internationally by policymakers. Financial incentives are a major focus of such efforts because low levels of hospital outpatient care are attributed to differences in payment for inpatient and outpatient services. In Germany, however, there is significant variation in the extent to which hospitals provide outpatient care despite a uniform payment system. Therefore, other factors must be influencing German hospitals’ strategic decisions whether to offer outpatient care. While most research has focused on specific procedures or lacks empirical support, our study provides a comprehensive analysis of the factors beyond financial incentives that influence the provision of hospital outpatient services in Germany. We employed a mixed-methods approach, first contacting health care experts with in-depth knowledge of the hospital outpatient landscape to identify possible influencing factors and then conducting a comprehensive quantitative analysis of all German hospitals. Our findings suggest that policymakers seeking to promote hospital outpatient care should consider a broad range of factors. We found that a hospital's service mix, size, procedure volume, and emergency care infrastructure significantly affected the proportion of outpatient services it offered. Strategic hospital planning emphasizing specialization and adherence to minimum volume standards might therefore be a valuable policy tool. Our analysis also highlights the importance of demographic and socioeconomic factors, such as the regional share of single-person households, suggesting that a comprehensive policy framework should account for broader population characteristics and not just elements directly related to hospital care.
{"title":"Which factors influence the decision of hospitals to provide procedures on an outpatient basis? –Mixed-methods evidence from Germany","authors":"Robert Messerle , Fenja Hoogestraat , Eva-Maria Wild","doi":"10.1016/j.healthpol.2024.105193","DOIUrl":"10.1016/j.healthpol.2024.105193","url":null,"abstract":"<div><div>Shifting care from the resource-intensive inpatient setting to the more economically efficient outpatient sector is being promoted internationally by policymakers. Financial incentives are a major focus of such efforts because low levels of hospital outpatient care are attributed to differences in payment for inpatient and outpatient services. In Germany, however, there is significant variation in the extent to which hospitals provide outpatient care despite a uniform payment system. Therefore, other factors must be influencing German hospitals’ strategic decisions whether to offer outpatient care. While most research has focused on specific procedures or lacks empirical support, our study provides a comprehensive analysis of the factors beyond financial incentives that influence the provision of hospital outpatient services in Germany. We employed a mixed-methods approach, first contacting health care experts with in-depth knowledge of the hospital outpatient landscape to identify possible influencing factors and then conducting a comprehensive quantitative analysis of all German hospitals. Our findings suggest that policymakers seeking to promote hospital outpatient care should consider a broad range of factors. We found that a hospital's service mix, size, procedure volume, and emergency care infrastructure significantly affected the proportion of outpatient services it offered. Strategic hospital planning emphasizing specialization and adherence to minimum volume standards might therefore be a valuable policy tool. Our analysis also highlights the importance of demographic and socioeconomic factors, such as the regional share of single-person households, suggesting that a comprehensive policy framework should account for broader population characteristics and not just elements directly related to hospital care.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"150 ","pages":"Article 105193"},"PeriodicalIF":3.6,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.1016/j.healthpol.2024.105186
Nikita Jacob , Martin Chalkley , Rita Santos , Luigi Siciliani
Background
Crowding in Accident and Emergency Departments (AEDs) and long waiting times are critical issues contributing to adverse patient outcomes and system inefficiencies. These challenges are exacerbated by varying levels of AED attendance across different local areas, which may reflect underlying disparities in primary care provision and population characteristics.
Method
We used regression analysis to determine how much variation across local areas in England of attendance at emergency departments remained after controlling for population risk factors and alternative urgent care provision.
Findings
There is substantial residual variation of the order of 3 to 1 (highest to lowest) in per person attendance rate across different areas. This is not related to in-hospital capacity as proxied by the per person number of hospital emergency doctors in an area.
Conclusion
Some areas in England have emergency departments that are under much greater pressure than others, and this cannot be explained in terms of their population characteristics or the availability of alternative treatment options. It is imperative to better understand the drivers of this variation so that effective interventions to address utilisation can be designed.
{"title":"Variation in attendance at emergency departments in England across local areas: A system under unequal pressure","authors":"Nikita Jacob , Martin Chalkley , Rita Santos , Luigi Siciliani","doi":"10.1016/j.healthpol.2024.105186","DOIUrl":"10.1016/j.healthpol.2024.105186","url":null,"abstract":"<div><h3>Background</h3><div>Crowding in Accident and Emergency Departments (AEDs) and long waiting times are critical issues contributing to adverse patient outcomes and system inefficiencies. These challenges are exacerbated by varying levels of AED attendance across different local areas, which may reflect underlying disparities in primary care provision and population characteristics.</div></div><div><h3>Method</h3><div>We used regression analysis to determine how much variation across local areas in England of attendance at emergency departments remained after controlling for population risk factors and alternative urgent care provision.</div></div><div><h3>Findings</h3><div>There is substantial residual variation of the order of 3 to 1 (highest to lowest) in per person attendance rate across different areas. This is not related to in-hospital capacity as proxied by the per person number of hospital emergency doctors in an area.</div></div><div><h3>Conclusion</h3><div>Some areas in England have emergency departments that are under much greater pressure than others, and this cannot be explained in terms of their population characteristics or the availability of alternative treatment options. It is imperative to better understand the drivers of this variation so that effective interventions to address utilisation can be designed.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"150 ","pages":"Article 105186"},"PeriodicalIF":3.6,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-20DOI: 10.1016/j.healthpol.2024.105187
Livio Garattini , Antonio Clavenna
Respiratory Syncytial Virus (RSV) is an ubiquitous respiratory virus, which spreads like seasonal influenza throughout winter time in temperate climate countries. RSV infections are usually mild in healthy children and adults, but may be severe in premature infants, young children with congenital heart disease or chronic lung disease, immunocompromised individuals and frail elderly people.
At present, the pharmaceutical options to prevent RSV negative effects can be divided into monoclonal antibodies (mABs) and vaccines (active immunization). The two mABs licensed so far are indicated only for infants, while the first vaccines approved are mainly recommended for older adults.
The pharmaceutical competitive arena of products to prevent RSV negative effects has recently become very crowded after more than two decades with only one mAB as the unique option. Here, we try to put order in the dramatically increasing mix of very different products which have been recently launched. The aim of our effort is to provide some suggestions for European policy makers in order to limit the potentially relevant financial impact of these new expensive options on public pharmaceutical expenditures. We hope the suggested strategies might help to avoid transforming RSV from an apparently underscored health issue into a clearly overestimated health risk for the whole population in European countries. This dramatic change could be driven by a bunch of powerful multinational companies.
{"title":"RSV prevention options for infants and older adults: A specific expanding competitive arena","authors":"Livio Garattini , Antonio Clavenna","doi":"10.1016/j.healthpol.2024.105187","DOIUrl":"10.1016/j.healthpol.2024.105187","url":null,"abstract":"<div><div>Respiratory Syncytial Virus (RSV) is an ubiquitous respiratory virus, which spreads like seasonal influenza throughout winter time in temperate climate countries. RSV infections are usually mild in healthy children and adults, but may be severe in premature infants, young children with congenital heart disease or chronic lung disease, immunocompromised individuals and frail elderly people.</div><div>At present, the pharmaceutical options to prevent RSV negative effects can be divided into monoclonal antibodies (mABs) and vaccines (active immunization). The two mABs licensed so far are indicated only for infants, while the first vaccines approved are mainly recommended for older adults.</div><div>The pharmaceutical competitive arena of products to prevent RSV negative effects has recently become very crowded after more than two decades with only one mAB as the unique option. Here, we try to put order in the dramatically increasing mix of very different products which have been recently launched. The aim of our effort is to provide some suggestions for European policy makers in order to limit the potentially relevant financial impact of these new expensive options on public pharmaceutical expenditures. We hope the suggested strategies might help to avoid transforming RSV from an apparently underscored health issue into a clearly overestimated health risk for the whole population in European countries. This dramatic change could be driven by a bunch of powerful multinational companies.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"150 ","pages":"Article 105187"},"PeriodicalIF":3.6,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513278","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 : 2024-10-19DOI: 10.1016/j.healthpol.2024.105188
Francesca Costanza, Giada Li Calzi
This research deals with Social Innovation (SI) and integrated and connected care in the hospital care, presenting a successful experience of telemedicine's implementation within the Italian context. Nowadays integrated care and connected care are relevant concepts for delivering people-centered healthcare; though their operationalization is challenging and requires accounting for systems' complexity. In this regard, SI may be a catalyst, since it consists in a kind of innovation motivated by social needs. Extant research on SI in healthcare is scant and fragmentary, overlooking operational features and enabling conditions. Considering these gaps, the paper investigates the potential contribution of SI management to integrated and connected care. For the purpose, it offers a revelatory case study, concerning the pediatric research hospital Gaslini (Genoa, Italy), which is, to our knowledge, the first Italian public hospital to have hired a SI manager. By referring to a telemedicine pilot project, the study analyzes main features of the SI management process and its approach to promote integrated and connected care. Research data are analyzed by combining Gioia methodology and systems thinking. The resulting grounded theory model is causal loops-shaped and highlights virtuous mechanisms of SI unveiling generative voids and existing skills.
本研究涉及医院护理中的社会创新（SI）和综合互联护理，介绍了在意大利实施远程医疗的成功经验。如今，综合护理和互联护理是提供以人为本的医疗保健服务的相关概念；尽管其操作具有挑战性，需要考虑系统的复杂性。在这方面，SI 可以起到催化剂的作用，因为它是一种以社会需求为动力的创新。关于医疗保健中的社会创新的现有研究很少且零散，忽略了操作特点和有利条件。考虑到这些差距，本文研究了 SI 管理对综合互联医疗的潜在贡献。为此，本文提供了一个具有启发性的案例研究，涉及加斯利尼儿科研究医院（意大利热那亚），据我们所知，该医院是意大利第一家聘用 SI 管理员的公立医院。通过参考远程医疗试点项目，该研究分析了 SI 管理流程的主要特点及其促进整合和连接护理的方法。研究数据结合了 Gioia 方法和系统思维进行分析。由此产生的基础理论模型是因果循环型的，并强调了揭示产生性空白和现有技能的 SI 良性机制。
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Pub Date : 2024-10-18DOI: 10.1016/j.healthpol.2024.105189
Thaksha Thavam , Michael Hong , Rose Anne Devlin , Kristin K Clemens , Sisira Sarma
Effective diabetes management can prevent avoidable diabetes-related hospitalizations. This review examines the impact of financial incentives for diabetes management in primary care settings on diabetes-related hospitalizations, hospitalization costs, and premature mortality. To assess the evidence, we conducted a literature search of studies using five databases: Medline, Embase, Scopus, CINAHL and Web of Science. We examined the results by health insurance system, study quality or diabetes population (newly diagnosed diabetes). We identified 32 articles ranging from fair- to high-quality: 19 articles assessed the relationship between financial incentives for diabetes management and hospitalizations, 8 assessed hospitalization costs, and 15 assessed mortality. Many studies found that financial incentives for diabetes management reduced hospitalizations, while a few found no effects. Similar findings were evident for hospitalization costs and mortality. The results did not differ by the type of health insurance system, but the quality of the studies did matter; most high-quality studies reported reduced hospitalizations and/or mortality. We also found that financial incentives tend to be beneficial for patients with newly diagnosed diabetes. We conclude that well-designed diabetes management incentives can reduce diabetes-related hospitalizations, especially for newly diagnosed diabetes patients.
有效的糖尿病管理可以避免可避免的糖尿病相关住院治疗。本综述探讨了基层医疗机构糖尿病管理的经济激励措施对糖尿病相关住院、住院费用和过早死亡率的影响。为了评估证据，我们使用五个数据库对研究进行了文献检索：Medline、Embase、Scopus、CINAHL 和 Web of Science。我们按照医疗保险系统、研究质量或糖尿病人群（新诊断的糖尿病）对结果进行了审查。我们共发现了 32 篇从一般到高质量的文章：19 篇评估了糖尿病管理经济激励措施与住院治疗之间的关系，8 篇评估了住院费用，15 篇评估了死亡率。许多研究发现，糖尿病管理经济激励措施降低了住院率，而少数研究发现没有影响。在住院费用和死亡率方面也有类似的发现。不同类型的医疗保险系统得出的结果并无差别，但研究的质量确实很重要；大多数高质量的研究都报告了住院率和/或死亡率的降低。我们还发现，经济激励措施往往对新诊断的糖尿病患者有益。我们的结论是，精心设计的糖尿病管理激励措施可以减少与糖尿病相关的住院治疗，尤其是新诊断的糖尿病患者。
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