Co-payments for general practitioners in Denmark: an analysis using two policy models.

BACKGROUND: The increasing health expenditure for general practitioners (GPs) in Denmark requires that other ways of financing the health system are investigated. This study aims to analyse possibilities for implementing out-of-pocket payments to GPs in Denmark. METHODS: The study was conducted as a literature review with 11 articles included. The Health Policy Triangle and the Kingdon Model were used in analysing and discussing the implementation of a cost-sharing policy with an emphasis on the out-of-pocket payments method. RESULTS: The Danish Parliament has expressed mixed opinions about out-of-pocket payments, whereas the Danish population, the GPs and the media are against introducing payments. The public debate and the fact that Danes are used to healthcare being free of charge both work against introducing co-payments. However, experiences from Sweden, Norway and OECD countries serve to promote implementation, but at the expense of decreased accessibility for the most vulnerable population groups. CONCLUSIONS: Introducing out-of-pocket payments in Denmark may lead to decreased health expenditure, but also increased inequalities. Due to a lack of support from the relevant policy actors in the country, in addition to a lack of a policy window, it may not be possible to introduce out-of-pocket payments for GPs in Denmark in the short term.

How much do rheumatologists and orthopaedists doctors' modalities impact the cost of arthritis in Cyprus?

BACKGROUND: Osteoarthritis is one of the primary causes of long-term functional disability. With an estimated 13.5% prevalence in the general population contributes to a significant financial burden both for patients and healthcare systems. The purpose of this research is to highlight the direct annual cost of the disease to the private healthcare sector of Nicosia. METHODS: A questionnaire based on Greek and international research was completed between 10/1/2012 and 11/30/2012, with a sample of 20 doctors specialists in orthopaedics and rheumatology (50% of practising physicians in the private sector). An assessment of the annual cost of medical procedures and tests, pharmacologic therapies (modalities) and supplies per patient followed, based on current costs. Direct costs were assessed through the micro-costing "bottom-up" approach. We isolated and separately priced the original diagnosis, followed by each stage of the disease. RESULTS: The cost for the six predominant medical tests to establish a diagnosis and exclude mainly RA such as ESR, CPR, and X-ray as well as a physician's office visit was 150€ per patient. The average direct cost per patient during stages 1, 2 and 3 of the disease was 280.54€, 1,834.64€ and 5,641.72€ annually, respectively, with an annual average of 2,573€ per patient. CONCLUSIONS: Even though during the period of the study, the country had not yet established clinical guidelines, the participating physicians followed international practices. Significant rise in the cost in each stage of the disease was found, with additional increases in the following years as a result of the expected increased prevalence of the disease. It is noted here that uninsured patients, as well as those who qualified for free medical care, they seek these services in the private sector, and had to pay out of pocket money for examination and treatment. These patients, thus, contended with a serious financial burden. Therefore, it is important to inform them very extensively regarding evidence-based management of the disease to aid them in coping with this chronic illness.

Training needs among maritime professionals: a cross sectional study.

BACKGROUND: Maritime medical practice includes assessment of fitness, management of medical emergencies and healthcare on board and ashore. A better response to seagoing professionals' health requirements can be achieved when all the respective stakeholders have a common understanding. Training is a powerful tool to raise awareness and in particular continuing professional development is very significant in sustaining competencies of these professionals. The objective of the study was to identify maritime professionals' perceived training needs. MATERIALS AND METHODS: A cross-sectional study was conducted among maritime professionals participated in the 14th International Symposium on Maritime Health. Fifty responses with the response rate of 42.7% were received with medical doctors representing 78% of the sample. Descriptive statistics were used to describe the basic characteristics of the data needs using STATA 15.1. RESULTS: Among the 23 themes, the ranking of perceived training needs was highest for fitness evaluation and examination guidelines and working conditions (both with the same percentage 86%), onboard medicine 82%, rules and regulations and health and safety at work (with the same percentage 80%). The lowest was on gender issues 32%. CONCLUSIONS: The finding suggests the planning and effective implementation of further training for the maritime health professionals in a variety of topics including financing and management issues. Highest importance of training was expressed by those over 40 years and by medical doctors with more than 10 years of practice. These findings could usefully be combined with a qualitative study to gain in-depth results and may help the respective authorities to organise relevant training.

Seafarers' views on the impact of the Maritime Labour Convention 2006 on their living and working conditions: results from a pilot study.

BACKGROUND: The Maritime Labour Convention 2006 (MLC2006) entered into force in 2013 and is the first comprehensive set of standards for better living and working conditions covering aspects such as wages, contracts, food, medical care and social security. Currently, the Convention covers more than 90% of the world's shipping fleet. The aim of the study was to investigate the impact of the MLC2006 on the living and working conditions of seafarers and to test and adjust the methods for future use through a pilot study. This article presents the seafarers' perceived impact of MLC2006. MATERIALS AND METHODS: A mixed-method research approach was used (February to April 2018). The quantitative data of 55 seafarers were analysed using descriptive statistics. Qualitative data obtained through a focus group interview and thematic content analysis was applied. RESULTS: Remarkably, one third of the respondents pointed out a complete lack of improvement, while 43.6% stated that the MLC2006 had improved their working and living conditions "somewhat" and only 7.3% "to a great extend". The focus group participants agreed that the MLC2006 did not improve working conditions but mostly increased paperwork. Other issues of concern were the safety on board including safety training, long working hours connected to low manning, food and social difficulties. CONCLUSIONS: For Danish seafarers, the MLC2006 did not have a significant impact, as most standards were in place before. It must be further investigated what the MLC2006 achieved for other flag states, especially in the light of its 5-year anniversary. Both methods yielded valuable data. Focus groups are an ideal setting to study the views of seafarers.

The costs of repatriating an ill seafarer: a micro-costing approach.

Seafarers sail the high seas around the globe. In case of illness, they are protected by international regulations stating that the employers must pay all expenses in relation to repatriation, but very little is known about the cost of these repatriations. The objective of this study was to estimate the financial burden of repatriations in case of illness. We applied a local approach, a micro-costing method, with an employer perspective using four case vignettes: I) Acute myocardial infarction (AMI), II) Malignant hypertension, III) Appendicitis and IV) Malaria. Direct cost data were derived from the Danish Maritime Authority while for indirect costs estimations were applied using the friction cost approach. The average total costs of repatriation varied for the four case vignettes; AMI (98,823 EUR), Malignant hypertension (47,597 EUR), Appendicitis (58,639 EUR) and Malaria (23,792 EUR) mainly due to large variations in the average direct costs which ranged between 9560 euro in the malaria case and 77,255 in the AMI case. Repatriating an ill seafarer is a costly operation and employers have a financial interest in promoting the health of seafarers by introducing or further strengthen cost-effective prevention programs and hereby reducing the number of repatriations.