Pub Date : 2024-06-06DOI: 10.1016/j.healthpol.2024.105097
Madelon Kroneman , Gemma A. Williams , Juliane Winkelmann , Peter Spreeuwenberg , Krisztina Davidovics , Peter P. Groenewegen
This study aimed to assess the preparedness of European countries regarding personal protective equipment (PPE) for health and care workers (HCWs), the COVID-19 infection rates of HCWs compared to the general working age population, and the association between these. We developed a PPE-preparedness scale based on responses to a questionnaire from experts in the Health Systems and Policy Monitor network, with a response rate of 19 out of 31 countries. COVID-19 infection data were retrieved form the European center for Disease Prevention and Control. Shortages of PPE were found in most countries, in particular in home care and long-term care. HCW infection rates, compared to the general population, varied strongly between countries, influenced by different testing regimes. We found no relationships between HCW infection rates, PPE preparedness and shortages of PPE. Improved surveillance in the population as well as for HCWS are needed to be able to better assess these relationships.
{"title":"Personal protective equipment for healthcare workers during COVID-19: Developing and applying a questionnaire and assessing associations between infection rates and shortages across 19 countries","authors":"Madelon Kroneman , Gemma A. Williams , Juliane Winkelmann , Peter Spreeuwenberg , Krisztina Davidovics , Peter P. Groenewegen","doi":"10.1016/j.healthpol.2024.105097","DOIUrl":"https://doi.org/10.1016/j.healthpol.2024.105097","url":null,"abstract":"<div><p>This study aimed to assess the preparedness of European countries regarding personal protective equipment (PPE) for health and care workers (HCWs), the COVID-19 infection rates of HCWs compared to the general working age population, and the association between these. We developed a PPE-preparedness scale based on responses to a questionnaire from experts in the Health Systems and Policy Monitor network, with a response rate of 19 out of 31 countries. COVID-19 infection data were retrieved form the European center for Disease Prevention and Control. Shortages of PPE were found in most countries, in particular in home care and long-term care. HCW infection rates, compared to the general population, varied strongly between countries, influenced by different testing regimes. We found no relationships between HCW infection rates, PPE preparedness and shortages of PPE. Improved surveillance in the population as well as for HCWS are needed to be able to better assess these relationships.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024001076/pdfft?md5=c632870a8d0dbb4150709d5531f55a70&pid=1-s2.0-S0168851024001076-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312984","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 : 2024-06-05DOI: 10.1016/j.healthpol.2024.105099
Wynand P.M.M. van de Ven , Konstantin Beck , Florian Buchner , Erik Schokkaert , Frederik T. Schut , Amir Shmueli , Juergen Wasem
From the mid-1990s several countries have introduced elements of the model of regulated competition in healthcare. In 2012 we assessed the extent to which in five countries ten important preconditions for achieving efficiency and affordability in competitive healthcare markets were fulfilled. In this paper we assess to what extent the fulfilment of these preconditions has changed ten years later.
In 2022, as in 2012, in none of the five countries all preconditions are completely fulfilled. In the period 2012–2022 on balance there have been some improvements in the fulfillment of the preconditions, although to a different extent in the five countries. The only preconditions that were improved in most countries were ‘consumer information and transparency’ and ‘cross-subsidies without incentives for risk selection’. On balance the Netherlands and Switzerland made most progress in the number of better fulfilled preconditions. For Belgium these preconditions no longer seem relevant because the idea of regulated competition has been completely abandoned. In Germany, Israel and Switzerland, the preconditions ‘effective competition policy’ and ‘contestability of the markets’ are not sufficiently fulfilled in 2022, just as in 2012. In Germany and Switzerland this also holds for the precondition ‘freedom to contract and integrate’. Overall, the progress towards realizing the preconditions has been limited.
{"title":"Preconditions for efficiency and affordability in competitive healthcare markets: Are they fulfilled in Belgium, Germany, Israel, the Netherlands and Switzerland? Ten years later","authors":"Wynand P.M.M. van de Ven , Konstantin Beck , Florian Buchner , Erik Schokkaert , Frederik T. Schut , Amir Shmueli , Juergen Wasem","doi":"10.1016/j.healthpol.2024.105099","DOIUrl":"https://doi.org/10.1016/j.healthpol.2024.105099","url":null,"abstract":"<div><p>From the mid-1990s several countries have introduced elements of the model of regulated competition in healthcare. In 2012 we assessed the extent to which in five countries ten important preconditions for achieving efficiency and affordability in competitive healthcare markets were fulfilled. In this paper we assess to what extent the fulfilment of these preconditions has changed ten years later.</p><p>In 2022, as in 2012, in none of the five countries all preconditions are completely fulfilled. In the period 2012–2022 on balance there have been some improvements in the fulfillment of the preconditions, although to a different extent in the five countries. The only preconditions that were improved in most countries were ‘consumer information and transparency’ and ‘cross-subsidies without incentives for risk selection’. On balance the Netherlands and Switzerland made most progress in the number of better fulfilled preconditions. For Belgium these preconditions no longer seem relevant because the idea of regulated competition has been completely abandoned. In Germany, Israel and Switzerland, the preconditions ‘effective competition policy’ and ‘contestability of the markets’ are not sufficiently fulfilled in 2022, just as in 2012. In Germany and Switzerland this also holds for the precondition ‘freedom to contract and integrate’. Overall, the progress towards realizing the preconditions has been limited.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S016885102400109X/pdfft?md5=eb0ae95b5a48a2d3179a5742ed5e4195&pid=1-s2.0-S016885102400109X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141303212","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 : 2024-05-30DOI: 10.1016/j.healthpol.2024.105098
Zombor Berezvai , József Vitrai , Gergely Tóth , Zoltán Brys , Márta Bakacs , Tamás Joó
Several countries have introduced public health product taxes with the objective of reducing the absolute amount of consumption of unhealthy food and tackling obesity. This study aims to estimate the long-term impact of the Hungarian public health product tax introduced in 2011.
To achieve this, a unique consumer purchase dataset was analysed to examine daily fast-moving consumer goods purchases from a representative sample of 2,000 households from 2010 to 2018. The results indicate that the tax has been fully reflected in consumer prices. A decline in consumption was observed initially, consistent with previous experiences in Hungary and other countries. However, over time, the data suggests a recovery and even an increase in line with the growth of disposable income. The proportion of taxed products in total fast-moving consumer goods purchases increased from 5.9 % (95 % CI: 5.7 % to 6.0 %) in 2010 to 7.4 % (95 % CI: 7.3 % to 7.6 %) in 2018. Furthermore, the tax has contributed to increased inequality as low-income households spend a higher proportion of their total expenditure on it.
Although taxes on unhealthy foods have proven effective in the short-term, they may not be adequate for reducing overall consumption in the long-term, particularly as disposable income increases. In conclusion, implementing complex interventions is necessary to achieve sustainable positive changes in dietary habits.
{"title":"Long-term impact of unhealthy food tax on consumption and the drivers behind: A longitudinal study in Hungary","authors":"Zombor Berezvai , József Vitrai , Gergely Tóth , Zoltán Brys , Márta Bakacs , Tamás Joó","doi":"10.1016/j.healthpol.2024.105098","DOIUrl":"10.1016/j.healthpol.2024.105098","url":null,"abstract":"<div><p>Several countries have introduced public health product taxes with the objective of reducing the absolute amount of consumption of unhealthy food and tackling obesity. This study aims to estimate the long-term impact of the Hungarian public health product tax introduced in 2011.</p><p>To achieve this, a unique consumer purchase dataset was analysed to examine daily fast-moving consumer goods purchases from a representative sample of 2,000 households from 2010 to 2018. The results indicate that the tax has been fully reflected in consumer prices. A decline in consumption was observed initially, consistent with previous experiences in Hungary and other countries. However, over time, the data suggests a recovery and even an increase in line with the growth of disposable income. The proportion of taxed products in total fast-moving consumer goods purchases increased from 5.9 % (95 % CI: 5.7 % to 6.0 %) in 2010 to 7.4 % (95 % CI: 7.3 % to 7.6 %) in 2018. Furthermore, the tax has contributed to increased inequality as low-income households spend a higher proportion of their total expenditure on it.</p><p>Although taxes on unhealthy foods have proven effective in the short-term, they may not be adequate for reducing overall consumption in the long-term, particularly as disposable income increases. In conclusion, implementing complex interventions is necessary to achieve sustainable positive changes in dietary habits.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024001088/pdfft?md5=33a1328951d3e5308e96810362019f99&pid=1-s2.0-S0168851024001088-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293983","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 : 2024-05-24DOI: 10.1016/j.healthpol.2024.105085
Vanessa J. Watkins , Anna Wong Shee , Michael Field , Laura Alston , Danny Hills , Simon L. Albrecht , Cherene Ockerby , Alison M. Hutchinson
Background
Low population density, geographic spread, limited infrastructure and higher costs are unique challenges in the delivery of healthcare in rural areas. During the COVID-19 pandemic, emergency powers adopted globally to slow the spread of transmission of the virus included population-wide lockdowns and restrictions upon movement, testing, contact tracing and vaccination programs. The aim of this research was to document the experiences of rural health service leaders as they prepared for the emergency pandemic response, and to derive from this the lessons learned for workforce preparedness to inform recommendations for future policy and emergency planning.
Methodology and methods
Interviews were conducted with leaders from two rural public health services in Australia, one small (500 staff) and one large (3000 staff). Data were inductively coded and analysed thematically.
Participants
Thirty-three participants included health service leaders in executive, clinical, and administrative roles.
Findings
Six major themes were identified: Working towards a common goal, Delivery of care, Education and training, Organizational governance and leadership, Personal and psychological impacts, and Working with the Local Community. Findings informed the development of a applied framework.
Conclusion
The study findings emphasise the critical importance of leadership, teamwork and community engagement in preparing the emergency pandemic response in rural areas. Informed by this research, recommendations were made to guide future rural pandemic emergency responses or health crises around the world.
{"title":"Rural healthcare workforce preparation, response, and work during the COVID-19 pandemic in Australia: Lessons learned from in-depth interviews with rural health service leaders","authors":"Vanessa J. Watkins , Anna Wong Shee , Michael Field , Laura Alston , Danny Hills , Simon L. Albrecht , Cherene Ockerby , Alison M. Hutchinson","doi":"10.1016/j.healthpol.2024.105085","DOIUrl":"10.1016/j.healthpol.2024.105085","url":null,"abstract":"<div><h3>Background</h3><p>Low population density, geographic spread, limited infrastructure and higher costs are unique challenges in the delivery of healthcare in rural areas. During the COVID-19 pandemic, emergency powers adopted globally to slow the spread of transmission of the virus included population-wide lockdowns and restrictions upon movement, testing, contact tracing and vaccination programs. The aim of this research was to document the experiences of rural health service leaders as they prepared for the emergency pandemic response, and to derive from this the lessons learned for workforce preparedness to inform recommendations for future policy and emergency planning.</p></div><div><h3>Methodology and methods</h3><p>Interviews were conducted with leaders from two rural public health services in Australia, one small (500 staff) and one large (3000 staff). Data were inductively coded and analysed thematically.</p></div><div><h3>Participants</h3><p>Thirty-three participants included health service leaders in executive, clinical, and administrative roles.</p></div><div><h3>Findings</h3><p>Six major themes were identified: <em>Working towards a common goal, Delivery of care, Education and training, Organizational governance and leadership, Personal and psychological impacts,</em> and <em>Working with the Local Community</em>. Findings informed the development of a applied framework.</p></div><div><h3>Conclusion</h3><p>The study findings emphasise the critical importance of leadership, teamwork and community engagement in preparing the emergency pandemic response in rural areas. Informed by this research, recommendations were made to guide future rural pandemic emergency responses or health crises around the world.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024000952/pdfft?md5=cd6973c05293cca3fdb29ed0a690ab84&pid=1-s2.0-S0168851024000952-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141130657","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 : 2024-05-24DOI: 10.1016/j.healthpol.2024.105084
Nicolai Savaskan , Benedikt M.J. Lampl , Mesut Yavuz , Peter Tinnemann
In the aftermath of the COVID-19 pandemic, the German federal government recently orchestrated a fundamental change to its public health infrastructure. This reconstruction centers around the founding of a National Institute for Prevention and Education in Medicine (Bundesinstitut für Prävention und Aufklärung in der Medizin, BIPAM) at the cost of two federal institutions, the Robert Koch-Institute (RKI) and the Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BzGA). Thus, the Federal Ministry of Health (Bundesministerium für Gesundheit, BMG) plans to dissolve the BzGA and integrate its personnel into the future BIPAM. Further, all RKI research and surveillance activities related to non-communicable diseases, including AI methods development will be transferred into the BIPAM. The RKI responsibilities will solely focus on infectious diseases. According to announced plans of the BMG the primary objective for establishing the BIPAM is to address non-communicable diseases and enhance overall population health. However, the medical specialist training for public health remains non-academic at a state institution. Simultaneously the BMG already replaced two thirds of experts of the permanent commission on vaccination (Ständige Impfkommission, STIKO) and determined new procedures for appointing future expert commissioners. With these changes, Germany embarks on an extraordinary reshuffling of its national public health organizations and responsibilities, by fundamentally separating all issues around non-communicable diseases from those of infectious diseases. Germany's unraveled research tasks of public health authorities however remains unmet. Thus, 2024 marks a pivotal caesura for public health in the modern history of Germany.
COVID-19 大流行之后,德国联邦政府最近对其公共卫生基础设施进行了根本性改革。这次重建的核心是成立国家医学预防和教育研究所(Bundesinstitut für Prävention und Aufklärung in der Medizin, BIPAM),由罗伯特-科赫研究所(Robert Koch-Institute, RKI)和联邦健康教育中心(Bundeszentrale für gesundheitliche Aufklärung,BzGA)这两个联邦机构出资。因此,联邦卫生部(BMG)计划解散 BzGA,并将其人员纳入未来的 BIPAM。此外,所有与非传染性疾病相关的 RKI 研究和监测活动,包括人工智能方法的开发,都将移交给 BIPAM。RKI 的职责将完全集中在传染病方面。根据 BMG 公布的计划,建立 BIPAM 的主要目标是应对非传染性疾病和提高整体人口健康水平。然而,公共卫生方面的医学专家培训仍然是在国立机构进行的非学术性培训。与此同时,BMG 已经更换了疫苗接种常设委员会(Ständige Impfkommission, STIKO)三分之二的专家,并确定了任命未来专家委员的新程序。随着这些变化,德国开始对其国家公共卫生组织和职责进行非同寻常的调整,从根本上将所有与非传染性疾病有关的问题与传染性疾病问题分开。然而,德国公共卫生机构尚未完成的研究任务仍未完成。因此,2024 年标志着德国现代史上公共卫生领域的一个关键转折点。
{"title":"Germany's national public health gets reorganized: A new institute shall take center stage","authors":"Nicolai Savaskan , Benedikt M.J. Lampl , Mesut Yavuz , Peter Tinnemann","doi":"10.1016/j.healthpol.2024.105084","DOIUrl":"10.1016/j.healthpol.2024.105084","url":null,"abstract":"<div><p>In the aftermath of the COVID-19 pandemic, the German federal government recently orchestrated a fundamental change to its public health infrastructure. This reconstruction centers around the founding of a National Institute for Prevention and Education in Medicine (Bundesinstitut für Prävention und Aufklärung in der Medizin, BIPAM) at the cost of two federal institutions, the Robert Koch-Institute (RKI) and the Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BzGA). Thus, the Federal Ministry of Health (Bundesministerium für Gesundheit, BMG) plans to dissolve the BzGA and integrate its personnel into the future BIPAM. Further, all RKI research and surveillance activities related to non-communicable diseases, including AI methods development will be transferred into the BIPAM. The RKI responsibilities will solely focus on infectious diseases. According to announced plans of the BMG the primary objective for establishing the BIPAM is to address non-communicable diseases and enhance overall population health. However, the medical specialist training for public health remains non-academic at a state institution. Simultaneously the BMG already replaced two thirds of experts of the permanent commission on vaccination (Ständige Impfkommission, STIKO) and determined new procedures for appointing future expert commissioners. With these changes, Germany embarks on an extraordinary reshuffling of its national public health organizations and responsibilities, by fundamentally separating all issues around non-communicable diseases from those of infectious diseases. Germany's unraveled research tasks of public health authorities however remains unmet. Thus, 2024 marks a pivotal caesura for public health in the modern history of Germany.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141142366","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 : 2024-05-23DOI: 10.1016/j.healthpol.2024.105096
Evandro Antonio Sbalcheiro Mariot , Stela Barbas , Rui Nunes
Background
Private sector acting in healthcare does not remove the public nature of a health system, nor mitigate the right to health as a human right.
Methods
This scoping review aims to answer the question: what factors influence the pattern of lawsuits seeking to enforce the right to health in private healthcare systems? The search was carried out in Pubmed, SciELO, DOAJ and Scopus.
Results
Out of 464 articles found, after inclusion and exclusion criteria, 30 articles were included. The survey covered 36 different countries and four main factors were identified. The socioeconomic context, the health system model, the incorporation of the right to health in legislation, and the model of regulation of private health.
Conclusions
Understanding these patterns help understanding the difficulties of implementing and guaranteeing universal health. Health systems must be based on responsibility, solidarity, equity, and distributive justice, since the sum of these values generates mutualism. Judicial decision-making regarding to health access must be reasoned on equity and distributive justice, scientific evidence and ethical factors. Even private health systems must be funded in a well-defined ethical platform and social moral valuation.
{"title":"Enforcing the right to health in private health systems through Judicialization what can we learn from the scoping review of the cross-national perspective?","authors":"Evandro Antonio Sbalcheiro Mariot , Stela Barbas , Rui Nunes","doi":"10.1016/j.healthpol.2024.105096","DOIUrl":"10.1016/j.healthpol.2024.105096","url":null,"abstract":"<div><h3>Background</h3><p>Private sector acting in healthcare does not remove the public nature of a health system, nor mitigate the right to health as a human right.</p></div><div><h3>Methods</h3><p>This scoping review aims to answer the question: what factors influence the pattern of lawsuits seeking to enforce the right to health in private healthcare systems? The search was carried out in Pubmed, SciELO, DOAJ and Scopus.</p></div><div><h3>Results</h3><p>Out of 464 articles found, after inclusion and exclusion criteria, 30 articles were included. The survey covered 36 different countries and four main factors were identified. The socioeconomic context, the health system model, the incorporation of the right to health in legislation, and the model of regulation of private health.</p></div><div><h3>Conclusions</h3><p>Understanding these patterns help understanding the difficulties of implementing and guaranteeing universal health. Health systems must be based on responsibility, solidarity, equity, and distributive justice, since the sum of these values generates mutualism. Judicial decision-making regarding to health access must be reasoned on equity and distributive justice, scientific evidence and ethical factors. Even private health systems must be funded in a well-defined ethical platform and social moral valuation.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141132318","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 : 2024-05-18DOI: 10.1016/j.healthpol.2024.105083
Robert Kupis , Alicja Domagała
The Polish healthcare system faces many problems, among which the shortage of healthcare professionals is one of the most urgent. In less than ten years, more than twenty Higher Education Institutions (HEIs) have been allowed to add medical programmes to their offer, aiming to increase the number of doctors in Poland. Recently, the healthcare system was faced with a proposal to abolish the mandatory postgraduate internship which has been a mandatory component of medical training for years.
Two main reforms were considered. The first one focused on the programme of the internship and aimed to update it. The second one recommended an abolition of the internship. The authors of this article analysed the opinions and positions of key players within the system regarding the postgraduate internship.
Opinions in this regard are diverse, leading to the conclusion that additional actions would be required prior to the internship abolition. Undergraduate training has changed and currently students are taught in modern facilities, using new teaching methods. On the other hand, internship allows trainees to improve or even acquire skills they may not have obtained during their studies. The postgraduate internship is an essential part of doctors’ training. However, in Poland, there is still a lack of a well-thought, long-term policy or strategy for physicians' workforce development. Our study presents a Polish perspective on common challenges in medical training and workforce policy, highlighting the clash over the growing demand for physicians and the limitations of the existing system.
{"title":"Are Polish doctors ready to start working right after graduation? The 2023 modification to physicians’ postgraduate internship and possible paths forward","authors":"Robert Kupis , Alicja Domagała","doi":"10.1016/j.healthpol.2024.105083","DOIUrl":"https://doi.org/10.1016/j.healthpol.2024.105083","url":null,"abstract":"<div><p>The Polish healthcare system faces many problems, among which the shortage of healthcare professionals is one of the most urgent. In less than ten years, more than twenty Higher Education Institutions (HEIs) have been allowed to add medical programmes to their offer, aiming to increase the number of doctors in Poland. Recently, the healthcare system was faced with a proposal to abolish the mandatory postgraduate internship which has been a mandatory component of medical training for years.</p><p>Two main reforms were considered. The first one focused on the programme of the internship and aimed to update it. The second one recommended an abolition of the internship. The authors of this article analysed the opinions and positions of key players within the system regarding the postgraduate internship.</p><p>Opinions in this regard are diverse, leading to the conclusion that additional actions would be required prior to the internship abolition. Undergraduate training has changed and currently students are taught in modern facilities, using new teaching methods. On the other hand, internship allows trainees to improve or even acquire skills they may not have obtained during their studies. The postgraduate internship is an essential part of doctors’ training. However, in Poland, there is still a lack of a well-thought, long-term policy or strategy for physicians' workforce development. Our study presents a Polish perspective on common challenges in medical training and workforce policy, highlighting the clash over the growing demand for physicians and the limitations of the existing system.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141078604","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 : 2024-05-16DOI: 10.1016/j.healthpol.2024.105082
Pablo Arija Prieto , Marcello Antonini , Mehdi Ammi , Mesfin Genie , Francesco Paolucci
The COVID-19 pandemic is one of the most significant public health crises in modern history, with considerable impacts on the policy frameworks of national governments. In response to the pandemic, non-pharmaceutical interventions (NPIs) and mass vaccination campaigns have been employed to protect vulnerable groups. Through the lens of Political Budget Cycle (PBC) theory, this study explores the interplay between incumbent electoral concerns and political dynamics in influencing the implementation of NPIs and vaccination rollout within the administrative regions of Italy and Spain during the period spanning June 2020 to July 2021. The results reveal that incumbents up for the next scheduled election are 5.8 % more likely to increase the stringency of containment measures than those that face a term limit. The findings also demonstrate that the seats of the incumbent and coalition parties in parliament and the number of parties in the coalition have a negative effect on both the efficiency of the vaccination rollout and the stringency of NPIs. Additionally, the competitiveness of the election emerges as an important predictor of the strictness of NPIs. Therefore, our results suggest that incumbents may strategically manipulate COVID-19 policy measures to optimize electoral outcomes. The study underscores the substantive influence of political incentives, competitive electoral environments, and government coalitions on policy formulation during health emergencies.
{"title":"Political determinants of COVID-19 restrictions and vaccine rollouts: The case of regional elections in Italy and Spain","authors":"Pablo Arija Prieto , Marcello Antonini , Mehdi Ammi , Mesfin Genie , Francesco Paolucci","doi":"10.1016/j.healthpol.2024.105082","DOIUrl":"10.1016/j.healthpol.2024.105082","url":null,"abstract":"<div><p>The COVID-19 pandemic is one of the most significant public health crises in modern history, with considerable impacts on the policy frameworks of national governments. In response to the pandemic, non-pharmaceutical interventions (NPIs) and mass vaccination campaigns have been employed to protect vulnerable groups. Through the lens of Political Budget Cycle (PBC) theory, this study explores the interplay between incumbent electoral concerns and political dynamics in influencing the implementation of NPIs and vaccination rollout within the administrative regions of Italy and Spain during the period spanning June 2020 to July 2021. The results reveal that incumbents up for the next scheduled election are 5.8 % more likely to increase the stringency of containment measures than those that face a term limit. The findings also demonstrate that the seats of the incumbent and coalition parties in parliament and the number of parties in the coalition have a negative effect on both the efficiency of the vaccination rollout and the stringency of NPIs. Additionally, the competitiveness of the election emerges as an important predictor of the strictness of NPIs. Therefore, our results suggest that incumbents may strategically manipulate COVID-19 policy measures to optimize electoral outcomes. The study underscores the substantive influence of political incentives, competitive electoral environments, and government coalitions on policy formulation during health emergencies.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024000927/pdfft?md5=df19be176e3510ccf8e0aa36d5a0546e&pid=1-s2.0-S0168851024000927-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141043656","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 : 2024-05-14DOI: 10.1016/j.healthpol.2024.105079
Mauro Laudicella , Paolo Li Donni , Vincenzo Prete
Improving the management of diabetic patients is receiving increasing attention in the health policy agenda due to increasing prevalence in the population and raising pressure on healthcare resources. This paper examines the determinants of healthcare services utilisation in patients with type-2 diabetes, investigating the potential substitution effect of general practice visits on the utilisation of emergency department visits. By using rich longitudinal data from Denmark and a bivariate econometric model, our analysis highlights primary care services that are more effective in preventing emergency department visits and socioeconomic groups of patients with a weak substitution response. Our results suggest that empowering primary care services, such as preventive assessment visits, may contribute to reducing emergency department visits significantly. Moreover, special attention should be devoted to vulnerable groups, such as patients from low socioeconomic background and older patients, who may find more difficult achieving a large substitution response.
{"title":"Healthcare utilisation by diabetic patients in Denmark: the role of primary care in reducing emergency visits","authors":"Mauro Laudicella , Paolo Li Donni , Vincenzo Prete","doi":"10.1016/j.healthpol.2024.105079","DOIUrl":"10.1016/j.healthpol.2024.105079","url":null,"abstract":"<div><p>Improving the management of diabetic patients is receiving increasing attention in the health policy agenda due to increasing prevalence in the population and raising pressure on healthcare resources. This paper examines the determinants of healthcare services utilisation in patients with type-2 diabetes, investigating the potential substitution effect of general practice visits on the utilisation of emergency department visits. By using rich longitudinal data from Denmark and a bivariate econometric model, our analysis highlights primary care services that are more effective in preventing emergency department visits and socioeconomic groups of patients with a weak substitution response. Our results suggest that empowering primary care services, such as preventive assessment visits, may contribute to reducing emergency department visits significantly. Moreover, special attention should be devoted to vulnerable groups, such as patients from low socioeconomic background and older patients, who may find more difficult achieving a large substitution response.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168851024000897/pdfft?md5=751cf5c7dd69c048196164a03cd3350c&pid=1-s2.0-S0168851024000897-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141035340","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 : 2024-05-11DOI: 10.1016/j.healthpol.2024.105081
Maria Vandoni, Barbara D'Avanzo, Angelo Barbato
The shift of mental health care from mental institutions to community-based services has been implemented differentially throughout the EU. However, because a comprehensive overview of the current mental health provision in member states is lacking, it is challenging to compare services across nations. This study investigates the extent of implementation of community-based mental health services within the EU using data collected from the WHO Mental Health Atlas. Results show that, although great cross-country variation exists in the implementation of community-based services, mental hospitals remain the prominent model of care in most countries. A few countries endorsed a balanced care model, with the co-occurrence of community services and mental hospitals. However, missing data, low quality of data and different service definitions hamper the possibility of a thorough analysis of the status on deinstitutionalization. Although policies on the closing and downsizing of mental institutions have been endorsed by the EU, the strong presence of mental hospitals slows down the shift towards community-based mental health care. This study highlights the need for an international consensus on definitions and a harmonization of indicators on mental health services. Together with the commitment of member states to improve the quality of data reporting, leadership must emerge to ensure quality monitoring of mental health-related data, which will help advance research, policies and practices.
{"title":"The transition towards community-based mental health care in the European Union: Current realities and prospects","authors":"Maria Vandoni, Barbara D'Avanzo, Angelo Barbato","doi":"10.1016/j.healthpol.2024.105081","DOIUrl":"10.1016/j.healthpol.2024.105081","url":null,"abstract":"<div><p>The shift of mental health care from mental institutions to community-based services has been implemented differentially throughout the EU. However, because a comprehensive overview of the current mental health provision in member states is lacking, it is challenging to compare services across nations. This study investigates the extent of implementation of community-based mental health services within the EU using data collected from the WHO Mental Health Atlas. Results show that, although great cross-country variation exists in the implementation of community-based services, mental hospitals remain the prominent model of care in most countries. A few countries endorsed a balanced care model, with the co-occurrence of community services and mental hospitals. However, missing data, low quality of data and different service definitions hamper the possibility of a thorough analysis of the status on deinstitutionalization. Although policies on the closing and downsizing of mental institutions have been endorsed by the EU, the strong presence of mental hospitals slows down the shift towards community-based mental health care. This study highlights the need for an international consensus on definitions and a harmonization of indicators on mental health services. Together with the commitment of member states to improve the quality of data reporting, leadership must emerge to ensure quality monitoring of mental health-related data, which will help advance research, policies and practices.</p></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946495","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}