Allocating municipal services to individuals with complex rehabilitation needs - a discourse analysis of individual administrative decision letters.

BACKGROUND: Rehabilitation is considered paramount for enhancing quality of life and reducing healthcare costs. As a result of healthcare reforms, Norwegian municipalities have been given greater responsibility for allocating rehabilitation services following discharge from hospital. Individual decision letters serve as the basis for implementing services and they have been described as information labels on the services provided by the municipality. They play an important role in planning and implementing the services in collaboration with the individual applicants. Research indicates that the implementation of policies may lead to unintended consequences, as individuals receiving municipal services perceive them as fragmented. This perception is characterised by limited user involvement and a high focus on body functions. The aim of this study was to examine how municipal decision letters about service allocation incorporate the recommendations made in the official national guideline and reflect a holistic approach to rehabilitation, coordination and user involvement for individuals with comprehensive needs. METHODS: The decision letters of ten individuals with moderate to severe brain injury allocating rehabilitation services in two municipalities were examined. It was assessed whether the content was in accordance with the authorities' recommendations, and a discourse analysis was conducted using four tools adapted from an established integrated approach. RESULTS: The letters primarily contained standard texts concerning legal and administrative regulations. They were predominantly in line with the official guideline to municipal service allocation. From a rehabilitation perspective, the focus was mainly on medically oriented care, scarcely referring to psychosocial needs, activity, and participation. The intended user involvement seemed to vary between active and passive status, while the coordination of services was given limited attention. CONCLUSIONS: The written decision letters did fulfil legal and administrative recommendations for service allocation. However, they did not fulfil their potential to serve as a means of conveying rehabilitation issues, such as specification of the allocated services, a holistic approach to health, coordination, or the involvement of users in decision processes. These elements must be incorporated throughout the allocation process if the policies are to be implemented as intended. Findings can have international relevance for discussions between clinicians and policy makers.

[The challenges of human resources governance in public healthcare. SESPAS Report 2024]. / Los retos de la gobernanza de los recursos humanos de la sanidad pública. Informe SESPAS 2024.

Recurrent imbalances between supply, demand and personnel needs are one of the main challenges facing the National Health System (NHS). This situation has its origin both in supply factors and in the conditioning factors of the demand for human resources in the public health sector. The demographic structure of the NHS health professionals is generating an increasing number of outflows of doctors and nurses. On the other hand, the complex institutional architecture of the public health system produces dysfunctions in the structure of demand and in the form of recruitment. This paper argues for the need to articulate a strategic response that addresses the improvement of the governance of the human resources of the NHS and the reform of the instruments of coordination and harmonization of actions at the three levels of government of public healthcare.

The relationship between mental health reforms and general population suicide rates in Australia over the past three and a half decades: 1987-2021.

Nearly 3,000 Australians tragically end their lives by suicide each year, underscoring a major national public health challenge with substantial socio-economic ramifications. Australia's National Mental Health Plans (NMHPs) aim to improve mental health and reduce suicide rates. This study investigates their effectiveness by analyzing how age-standardized suicide rates across Australian jurisdictions have fluctuated alongside the implementation of five NMHPs from 1987 to 2021. Findings reveal mixed impacts, with some plans linked to decreases and others associated with increases in suicide rates across different periods and regions. Notably, the recent decline in 2020 requires careful consideration amidst COVID-19 pandemic influences. These insights not only provide valuable evidence for shaping future mental health policies and initiatives but also for future health services research.

Improvement opportunities for the achievement of reciprocal nursing academic-practice partnerships.

American healthcare reform efforts are driving healthcare organizations to demonstrate the ability to reduce costs while improving quality and optimizing healthcare outcomes. Nurses are the largest healthcare clinicians and need proper preparatory education to enter the profession as practice-ready clinicians; however, medical errors and reduced nursing board examination success rates highlight the need for improved nurse academic preparation standards. Evidence has elucidated an expanding nursing education-practice gap problem arising from inadequate integration of academic leadership and faculty within the clinical practice arena. The nursing education-practice gap has been exacerbated by governance structures in academia that limit opportunities for nursing faculty to remain actively engaged in clinical practice settings. To improve new graduate nurse practice readiness, healthcare quality, and cost-effectiveness, academic institutions must partner with healthcare delivery organizations within mutually beneficial models. The purpose of this article is to describe the expanding nursing education-practice gap problem in relevance to American healthcare quality and reform initiatives and to propose innovative solutions assigned with evidence-based standards.

No Country for Sick Men: The Political Determinants of Health Policy in Poland.

The objective of this paper is to explain the political factors determining the relatively weak performance of the Polish health care (HC) sector. This can be treated as a critical case due to several reasons: first, the Poles as patients belong to the most unsatisfied ones in the European Union (EU), second, Poland spends on its HC-related expenditures one of the lowest shares of the GDP among the OECD countries, third, the number of doctors per 1000 inhabitants remains at the lowest European level, and the life expectancy in Poland is one of the lowest in the EU and is decreasing. The Authors argue that the policy inertia in the HC sector in Poland is determined by the group of inter-related political factors that effectively block the development of any positive trajectory in the Polish HC reforms. Of the various determinants analyzed the most significant appeared to be the post-communist legacy of the organization of the HC system, which combined with a short-term approach by politicians and weak decision-making processes in HC policy, makes any changes difficult to implement.

Towards leaving no one behind in North Macedonia: a mixed methods assessment of barriers to effective coverage with health services.

BACKGROUND: The Government of North Macedonia's Primary Health Care reform is committed to leaving no one behind on the path to Universal health Coverage (UHC). During mid-2022 to March 2023, the World Health Organization (WHO) collaborated with the Government and other national stakeholders for an assessment of barriers to effective coverage with health services experienced by adult citizens, with a specific focus on rural areas and subpopulations in situations of vulnerability. METHODS: This study constituted the piloting of a draft forthcoming WHO handbook on assessing barriers for health services, grounded in the Tanahashi framework for effective coverage with health services. In North Macedonia, the convergent parallel mixed methods study involved four sources. These were: a nationally representative Computer Assisted Telephone Interview Survey (1,139 respondents); 24 key informant interviews with representatives from government, professional associations, non-governmental and civil society organizations, and development partners; 12 focus groups in four regions with adults from vulnerable/high risk groups in rural areas and small urban settlements and an additional focus group with persons with disabilities; and a literature review. Instrument design was underpinned by the Tanahashi framework, which also orientated data triangulation and deductive analysis. The research team synergistically incorporated emerging themes in an inductive way. A key component of the assessment was participatory design of the study protocol with inputs from national stakeholders as well as participatory deliberation of the results and the ways forward. RESULTS: Despite considerable progress towards UHC in North Macedonia, the assessment elucidated remaining challenges. These included: insufficient numbers of health workers, in general and particularly in the more disadvantaged regions of the country; inadequate number of outpatient medicines covered by health insurance; distance and transportation obstacles, including indirect travel costs, particularly in rural areas; adverse gender norms and relations for both women and men inhibiting timely treatment seeking; perceived discrimination by providers on multiple grounds; bottlenecks including waiting times to get appointments for specialist referrals; and lack of patient adherence, due several factors including costs of medicines and health products. CONCLUSIONS: The outputs from this study of barriers to effective coverage with health services for adult citizens of North Macedonia are feeding into the ongoing Primary Health Care reform, and provide evidence for equity-related actions in the forthcoming National Development Strategy.

Country of Origin of Medical Products and Risk of Labour Rights Abuse: A Cross-Sectional Analysis Using Four Procurement Datasets.

Background Case studies have highlighted labour rights abuse in the manufacture of several healthcare products, but little is known about the scale of the problem or the specific products involved. We aimed to quantify and compare the overall and product-specific risks of labour rights abuse in the manufacture of healthcare products supplied to high-income settings using multiple datasets on the product country of origin (COO). Methods Public procurement data from South-Eastern Norway (n=23,972 products) were compared to datasets from three other high-income settings: procurement data from Cambridge University Hospitals, trade data from UN Comtrade, and registry data from the US Food and Drug Administration (FDA). In each dataset, the product COO was matched to the International Trade Union Confederation risk rating for labour abuse and deemed high-risk when rated 4, 5, or 5+. Results In the Norway data, 55.4% of products by value had a COO declared, 49.1% of which mapped as high-risk of labour rights abuses. COO was identified for 70/100 products in the Cambridge data, with COO matching high-risk at 59.9% by value. The level of risk for specific medical product categories varied between the Norway, US FDA, and UN Comtrade datasets, but those with higher proportional risk included medical/surgical gloves and electrosurgical products. Conclusion Evidence of high-risk of labour rights abuse in the manufacture of healthcare products present in these data indicates a likely high level of risk across the sector. There is an urgent need for global legislative and political reform, with a particular focus on supply chain transparency as a key mechanism for tackling this issue.

Impact of an oral care subsidization reform on intersectional inequities in self-rated oral health in Sweden.

BACKGROUND: Oral health in Sweden is good at the population level, but seemingly with persisting or increasing inequities over the last decades. In 2008, a major Swedish reform introduced universal partial subsidies to promote preventive care and reduce the treatment cost for patients with extensive care needs. This study aimed to apply an intersectional approach to assess the impact of the 2008 subsidization reform on inequities in self-rated oral health among adults in Sweden over the period 2004-2018. METHODS: Data from 14 national surveys conducted over 2004-2018 were divided into three study periods: pre-reform (2004-2007), early post-reform (2008-2012) and late post-reform (2013-2018). The final study population was 118,650 individuals aged 24-84 years. Inequities in self-rated oral health were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy across 48 intersectional strata defined by gender, age, educational level, income, and immigrant status. RESULTS: Overall, the prevalence of poor self-rated oral health decreased gradually after the reform. Gender-, education- and income-related inequities increased after the reform, but no discernible change was seen for age- or immigration-related inequities. The majority of intersectional strata experienced patterns of persistently or delayed increased inequities following the reform. CONCLUSIONS: Increased inequities in self-rated oral health were found in most intersectional strata following the reform, despite the seemingly positive oral health trends at the population level. Applying an intersectional approach might be particularly relevant for welfare states with overall good oral health outcomes but unsuccessful efforts to reduce inequities.

[Japanese National Plan for Promotion of Measures against Stroke and Cardiovascular Diseases and Data-Based Health Management Initiatives].

This review outlines the recent advances in stroke and cardiovascular diseases control and direction of national data health reform. Since the enactment of the Basic Act on Countermeasures against Cardiovascular Diseases, the national government and related academic societies have collaborated to promote countermeasures based on five key pillars; medical systems development, registration projects promotion, human resource development, public awareness, and research promotion. Simultaneously, the government is intensively promoting data health reform to compensate for the delay in digital medicine that became evident in the new coronary infection. Data health reform has four major pillars; promotion of using genomic medicine and artificial intelligence(AI), promotion of personal health records(PHR), promotion of information utilization in medical and nursing care settings, and promotion of effective database utilization. Five years have passed since the Basic Act on Countermeasures for Cardiovascular Diseases was enacted, and it is important that the Japanese Stroke Association, Japanese Cardiovascular Society and other related academic societies, government, prefectures, and National Cardiovascular Center collaborate to vigorously promote the cardiovascular disease countermeasures.

Effectiveness evaluation of China's water resource tax reform pilot and path optimization from the perspective of policy field.

The water resource tax reform played an important role in promoting sustainable development in China. Subsequent to the seven-year reform, the effectiveness evaluation of the policy in each pilot area and the exploration of the optimization path directly affected the promotion of water resource tax policy and the improvement of water use efficiency. Therefore, the theoretical framework of the water resource tax policy field was constructed to examine the mechanism of the three subsystems of policy scenario, policy orientation, and policy effect; fuzzy-set qualitative comparative analysis (fsQCA) was then used to evaluate and quantitatively compare the policy implementation effect and policy path in each pilot area, with emphasis put on three policy orientations, i.e., the decision and decomposition effect of policy goals, the selection and im plementation effect of policy tools, and the policy supervision and security effect. As shown by the research results: ① the water resource tax reform had effectively improved the efficiency of water resource utilization in the pilot areas; ② three pilot models of water resource tax policy had been extracted, namely the policy goal and tool-driven model centering on a single dimension of the policy field, the implementation-supervision dual drive model emphasizing the supervision and security effect of the policy, and the three-dimensional policy orientation linkage model that focused on the synergistic effect of the policy field; ③ strong heterogeneity existed in water resource tax policy implementation paths and effects in each pilot area. Accordingly, regional heterogeneity could be considered in the process of reform to construct institutionalized, precise, and differentiated reform implementation methods from the perspective of the policy field.

[Embracing the Era of Artificial Intelligence: Innovation and Preparation in Nursing Education].

Rapid recent advances in information technology have opened the door for artificial intelligence (AI)-related technologies to be applied extensively across many industries. The Ministry of Education has emphasized the importance of cultivating advanced-level professionals in diverse fields, particularly in smart machinery, the Asia-Silicon Valley sector, green energy technology, biotechnology, national defense, new agricultural, and circular economy industries, to enhance innovation and promote industrial competitiveness (Kuo, 2019). While interdisciplinary talent in AI and digital innovation is being actively developed elsewhere, nursing education remains in the exploratory phase of AI and digital technology talent cultivation. Although AI is now a well-known term, the competencies required for its application in nursing remain unclear. Moreover, most nursing professionals are unfamiliar with how to best integrate AI into nursing expertise or practice settings. With the application of AI in the healthcare industry now unstoppable, it is vital to consider how to help nursing students adapt to healthcare's new technology landscape (Huang et al., 2021). AI facilitates the digital simulation of human thought patterns, logic, and behaviors with the goal of assisting human users solve problems, especially those that are time-consuming and require repetitive processing. The development of AI requires interdisciplinary collaboration among domain experts, data scientists, software engineers, robotics experts, and computer programmers. Such collaboration is essential to developing products able to meet the demands of the times and to help students become competent future nursing professionals (Murray, 2018). Nurses spend the most time interacting with patients and are thus best able to understand the perceptions and challenges of patients and their families. Collaborating with professionals from interdisciplinary fields is the best strategy for achieving optimal healthcare outcomes. However, nursing schools have yet to provide a clear response to the impact of AI on nursing education. Nursing educational institutions must enable nursing students to comprehend the concepts and principles of AI and equip them with AI literacy to allow them to unleash their potential, continuously innovate, and stay abreast with the times (Ng et al., 2021). In this issue, experts and scholars currently engaged in AI-related research in the nursing discipline share their research findings in the realms of machine learning, deep learning, emotional recognition, and natural language application. These articles offer insights into the implications of AI, suggest how nursing education may best respond to emerging AI trends, and provide the authors' perspectives on nursing education reform. The editor hopes readers will be inspired to explore new concepts, gain a deeper understanding of the application and significance of AI, and apply AI to address clinical and educational challenges to foster competent nursing professionals for tomorrow.

Change in avoidable hospitalizations for low-income elders following quasi-market reform in primary care - Evidence from a natural experiment in Sweden.

Quasi-market reforms have been increasingly implemented in tax-funded health care, but their effects in terms of equity, quality and socioeconomic differentials in quality remain sparsely studied. We create a natural experiment setup exploiting the differential timing of a set of quasi-market reforms - including patient choice, free establishment of providers and changes in provider remuneration -, implemented in primary care in the two largest Swedish regions (Stockholm and Västra Götaland) in 2008-2009. Using a database with individual level data from 2005 to 2009, we construct a difference-in-difference-in-differences model that compares pre to post reform changes in avoidable hospitalizations (AHs) for low-income elders and a matched comparison group, in the region exposed to, versus unexposed to, reform (total N âˆ¼ 200 000). The results show that for low-income elders - a group dominated by older women - reform led to higher AH rates, i.e., worse primary health care quality, than what would have been the case in absence of reform. Specifically, low-income elders exposed to reform missed out on improvements in AHs seen simultaneously in the unexposed region. At the same time, the reform had on average no effect for comparable, non-low-income, peers. The fact that this pattern was specific for avoidable hospitalizations - judged as amenable to interventions in primary care -, but not present for total hospitalizations, supports that it was driven by reform implementation rather than other factors. The study contributes with high-quality empirical evidence to a policy relevant but sparsely researched area and highlights the necessity to consider differential effects of organizational changes across socioeconomic groups.

The effect of health-care privatisation on the quality of care.

Over the past 40 years, many health-care systems that were once publicly owned or financed have moved towards privatising their services, primarily through outsourcing to the private sector. But what has the impact been of privatisation on the quality of care? A key aim of this transition is to improve quality of care through increased market competition along with the benefits of a more flexible and patient-centred private sector. However, concerns have been raised that these reforms could result in worse care, in part because it is easier to reduce costs than increase quality of health care. Many of these reforms took place decades ago and there have been numerous studies that have examined their effects on the quality of care received by patients. We reviewed this literature, focusing on the effects of outsourcing health-care services in high-income countries. We found that hospitals converting from public to private ownership status tended to make higher profits than public hospitals that do not convert, primarily through the selective intake of patients and reductions to staff numbers. We also found that aggregate increases in privatisation frequently corresponded with worse health outcomes for patients. Very few studies evaluated this important reform and there are many gaps in the literature. However, based on the evidence available, our Review provides evidence that challenges the justifications for health-care privatisation and concludes that the scientific support for further privatisation of health-care services is weak.

South African healthcare reforms towards universal healthcare - where to next?

The National Assembly approval of the National Health Insurance (NHI) Bill represents an important milestone, but there are many uncertainties concerning its implementation and timeline. The challenges faced by the South African healthcare system are huge, and we cannot afford to wait for NHI to address them all. It is critical that the process of strengthening the health system to advance universal healthcare (UHC) begins now, and there are several viable initiatives that can be implemented without delay. This article examines potential scenarios after the Bill is passed and ways in which UHC could be advanced. It begins with an overview of the trajectory of health system reform since 1994, then examines the scenarios that may emerge once the Bill is passed by Parliament and makes a case for finding ways in which UHC could be advanced within the country, regardless of any legal or financial barriers that may delay or limit NHI implementation.

National Rural Health Mission reforms in light of decentralised planning in Kerala, India: a realist analysis of data from three witness seminars.

BACKGROUND: The People's Planning Campaign (PPC) in the southern Indian state of Kerala started in 1996, following which the state devolved functions, finances, and functionaries to Local Self-Governments (LSGs). The erstwhile National Rural Health Mission (NRHM), subsequently renamed the National Health Mission (NHM) was a large-scale, national architectural health reform launched in 2005. How decentralisation and NRHM interacted and played out at the ground level is understudied. Our study aimed to fill this gap, privileging the voices and perspectives of those directly involved with this history. METHODS: We employed the Witness Seminar (WS), an oral history technique where witnesses to history together reminisce about historical events and their significance as a matter of public record. Three virtual WS comprised of 23 participants (involved with the PPC, N(R)HM, civil society, and the health department) were held from June to Sept 2021. Inductive thematic analysis of transcripts was carried out by four researchers using ATLAS. ti 9. WS transcripts were analyzed using a realist approach, meaning we identified Contexts, Mechanisms, and Outcomes (CMO) characterising NRHM health reform in the state as they related to decentralised planning. RESULTS: Two CMO configurations were identified, In the first one, witnesses reflected that decentralisation reforms empowered LSGs, democratised health planning, brought values alignment among health system actors, and equipped communities with the tools to identify local problems and solutions. Innovation in the health sector by LSGs was nurtured and incentivised with selected programs being scaled up through N(R)HM. The synergy of the decentralised planning process and N(R)HM improved health infrastructure, human resources and quality of care delivered by the state health system. The second configuration suggested that community action for health was reanimated in the context of the emergence of climate change-induced disasters and communicable diseases. In the long run, N(R)HM's frontline health workers, ASHAs, emerged as leaders in LSGs. CONCLUSION: The synergy between decentralised health planning and N(R)HM has significantly shaped and impacted the health sector, leading to innovative and inclusive programs that respond to local health needs and improved health system infrastructure. However, centralised health planning still belies the ethos and imperative of decentralisation - these contradictions may vex progress going forward and warrant further study.

Effects of medical consortium policy on health services: an interrupted time-series analysis in Sanming, China.

Objectives: China has implemented reforms to enhance the operational efficiency of three-level medical services through medical consortiums (MCs). This study evaluated the impact of MCs reform on health services in Sanming, China. Methods: An interrupted time-series analysis (ITSA) was conducted to assess the impact of MCs on changes in health service levels and trends across the overall situation of MCs and different institutional types within MCs, including county hospitals and grassroots medical institutions. The evaluation focused on various indicators such as outpatient and emergency visits, inpatients, average length of stay, occupancy rate of hospital beds, and hospital bed turnover times. Monthly data were collected from April 2015 to June 2019 through reports on the Sanming Municipal Health Commission website and the Sanming public hospital management monitoring platform. Results: After the intervention of MCs reform, a significant increase was observed in the total number of inpatients (ß3 = 174.28, p < 0.05). However, no statistically significant change was observed in the total number of outpatient and emergency visits (ß3 = 155.82, p = 0.91). Additionally, the implementation of MCs reform led to an amplification in service volumes provided by county hospitals, with significant increases in the number of outpatient and emergency visits (ß3 = 1376.54, p < 0.05) and an upward trend in the number of inpatients (ß3 = 98.87, p < 0.01). However, no significant changes were observed under the MCs policy for grassroots medical institutions regarding the number of outpatient and emergency visits (ß3 = -1220.72, p = 0.22) and number of inpatients (ß3 = 75.42, p = 0.09). Conclusion: The Sanming MCs reform has achieved some progress in augmenting service volumes. Nevertheless, it has not led to an increase in service volumes at the grassroots medical institutions. There persists an insufficiency in the efficiency of services and a need for further improvement in primary healthcare. To address these concerns, it is imperative for county hospitals to offer targeted assistance that can enhance motivation among grassroots medical institutions. Besides the MCs should explore initiatives, including improved management of medical equipment, allocation of funding, and personnel resources.

Causes & Consequences of Health Care CEO Turnover in Australia and Retention Strategies: A Qualitative Study.

It has been highlighted the increasing CEO turnover is a major issue for Australian and international health care organizations. Some of the negative consequences of CEO turnover includes organizational instability, high financial costs, and affecting patient care. On average, CEOs leave their role within 1 to 2 years after commencement, which can be detrimental to the hospital's overall functioning. Therefore, this study aims to identify the causes and consequences of increasing CEO turnover in health care, so retention strategies could be devised. Fourteen hospital CEOs across Australia were interviewed online to answer 5 open ended questions related to qualities of a CEO, challenges of the CEO role, Causes and consequences of increasing CEO turnover and recommendation for CEOs retention. Interviews followed a semi-structured schedule to prompt discussion in relation to the above. The study has identified that CEOs possess certain qualities such as self-awareness, leadership style, resilience that enable them to perform their role well. Challenges of this role such as COVID-19, managing organizational change staff management has been found and discussed. Broadly, causes have been divided into 5 major categories such as Organization, Performance, Pressure, Personal and Health reform. It was found that increasing CEO turnover can be damaging to the hospital, not just the staff and patients suffer but the surrounding community gets adversely affected. To minimize CEO turnover, it was suggested that the board needs to support their CEO by advocating and investing in organizational culture and leadership programs. The findings of this study aid, the board with certain strategies through which CEO can be supported. CEOs made certain recommendations in this study to minimize the turnover which can make such a big impact on health care as this may lead to better functioning hospitals in Australia. Moreover, these strategies could be used internationally to help them CEOs retain in their position.