Assuntos
COVID-19/prevenção & controle , Atenção Primária à Saúde/organização & administração , Administração em Saúde Pública/economia , Saúde Pública/economia , COVID-19/epidemiologia , COVID-19/transmissão , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/economia , Europa (Continente) , Disparidades em Assistência à Saúde/economia , Humanos , Vacinação em Massa/organização & administração , Pandemias/economia , Pandemias/prevenção & controle , Atenção Primária à Saúde/economia , SARS-CoV-2RESUMO
BACKGROUND: The decision by the UK government to leave the European Union comes at a time when parts of the UK are experiencing a marked rise in reported gun and knife crimes. The health effects of Brexit will have serious consequences as to how the UK tackles this upsurge in drug-related crime. HEALTH POLICY PROCESSES: The UK's future participation with the EU's specialised agencies will depend on the detail of any agreement reached on future collaboration with the EU and its drug agency, the EMCDDA. CONTEXT: The EMCDDA provides the EU and its Member States with a factual overview of European drug problems and a solid evidence base to support debates on drugs policies. It also supports early warning initiatives and coordinates measures at national and supranational levels with Europol and supranational enforcement agencies. EXPECTED OUTCOMES: While these arrangements might continue throughout any transition period, those working within the sector require guidance and assurances from the British government about its long-term intentions after any transition. CONCLUSIONS: The scale of collaboration between the UK and European institutions is extensive. It is not clear how this might be replicated after Brexit. Yet an alternative framework of collaboration between the UK and the EU is clearly needed to facilitate shared and agreed approaches to data sharing and drug surveillance after Brexit.
Assuntos
Crime/legislação & jurisprudência , Política de Saúde , Drogas Ilícitas/legislação & jurisprudência , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , União Europeia/organização & administração , Reino UnidoAssuntos
Crime/prevenção & controle , Política de Saúde/legislação & jurisprudência , Política , Psicotrópicos , Saúde Pública/legislação & jurisprudência , Transtornos Relacionados ao Uso de Substâncias , Crime/legislação & jurisprudência , Bases de Dados como Assunto , União Europeia , Humanos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Reino UnidoAssuntos
Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/mortalidade , Política de Saúde/legislação & jurisprudência , Direito Penal/legislação & jurisprudência , Surtos de Doenças/estatística & dados numéricos , Controle de Medicamentos e Entorpecentes/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Governo , HIV/isolamento & purificação , Infecções por HIV/epidemiologia , Humanos , Saúde Pública/legislação & jurisprudência , Reino Unido/epidemiologiaRESUMO
We investigate parameter heterogeneity in breast cancer 1-year cumulative hospital costs across five European countries as part of the EuroHOPE project. The paper aims to explore whether conditional mean effects provide a suitable representation of the national variation in hospital costs. A cohort of patients with a primary diagnosis of invasive breast cancer (ICD-9 codes 174 and ICD-10 C50 codes) is derived using routinely collected individual breast cancer data from Finland, the metropolitan area of Turin (Italy), Norway, Scotland and Sweden. Conditional mean effects are estimated by ordinary least squares for each country, and quantile regressions are used to explore heterogeneity across the conditional quantile distribution. Point estimates based on conditional mean effects provide a good approximation of treatment response for some key demographic and diagnostic specific variables (e.g. age and ICD-10 diagnosis) across the conditional quantile distribution. For many policy variables of interest, however, there is considerable evidence of parameter heterogeneity that is concealed if decisions are based solely on conditional mean results. The use of quantile regression methods reinforce the need to consider beyond an average effect given the greater recognition that breast cancer is a complex disease reflecting patient heterogeneity.
Assuntos
Neoplasias da Mama/economia , Europa (Continente) , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Modelos Econométricos , Análise de RegressãoRESUMO
BACKGROUND: Finland decentralised its universal healthcare system and introduced market reforms in the 1990s. Despite a commitment to equity, previous studies have identified persistent socio-economic inequities in healthcare, with patterns of service use that are more pro-rich than in most other European countries. To examine whether similar socio-economic patterning existed for mortality amenable to intervention in primary or specialist care, we investigated trends in amenable mortality by income group from 1992-2003. METHODS: We analysed trends in all cause, total disease and mortality amenable to health care using individual level data from the National Causes of Death Register for those aged 25 to 74 years in 1992-2003. These data were linked to sociodemographic data for 1990-2002 from population registers using unique personal identifiers. We examined trends in causes of death amenable to intervention in primary or specialist healthcare by income quintiles. RESULTS: Between 1992 and 2003, amenable mortality fell from 93 to 64 per 100,000 in men and 74 to 54 per 100,000 in women, an average annual decrease in amenable mortality of 3.6% and 3.1% respectively. Over this period, all cause mortality declined less, by 2.8% in men and 2.5% in women. By 2002-2003, amenable mortality among men in the highest income group had halved, but the socioeconomic gradient had increased as amenable mortality reduced at a significantly slower rate for men and women in the lowest income quintile. Compared to men and women in the highest income quintile, the risk ratio for mortality amenable to primary care had increased to 14.0 and 20.5 respectively, and to 8.8 and 9.36 for mortality amenable to specialist care. CONCLUSIONS: Our findings demonstrate an increasing socioeconomic gradient in mortality amenable to intervention in primary and specialist care. This is consistent with the existing evidence of inequity in healthcare use in Finland and provides supporting evidence of changes in the socioeconomic gradient in health service use and in important outcomes. The potential adverse effect of healthcare reform on timely access to effective care for people on low incomes provides a plausible explanation that deserves further attention.
Assuntos
Mortalidade/tendências , Sistema de Registros , Classe Social , Adulto , Idoso , Causas de Morte/tendências , Feminino , Finlândia/epidemiologia , Seguimentos , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Masculino , Registro Médico Coordenado , Pessoa de Meia-IdadeRESUMO
AIMS: Many countries experience persistent or increasing socioeconomic disparities in specialist care. This study examines the socioeconomic distribution of elective surgery from 1992 to 2003 in Finland. METHODS: Administrative registers were used to identify common elective procedures performed in all public and private hospitals in Finland in 1992-2003. Patients' individual sociodemographic data came from 1990-2003 census and employment statistics databases. First coronary revascularisation, hip and knee replacement, lumbar disc operation, cataract extraction, hysterectomy and prostatectomy on residents aged 25-84 years were analysed. Age-standardized procedure rates by income quintile were calculated for both genders, and concentration indices were developed and applied to age-standardized procedure rates in 5% income groups for each study year. RESULTS: Most procedure rates increased during the study period. Three trends emerged: declining inequality for coronary revascularisations, an increase and then a decline in cataract extractions and primary knee replacements among men, and positive relationships between income and treatment for hysterectomy and lumbar disc operations. CONCLUSIONS: Our results suggest that structural features - uneven availability, co-payments and plurality of provision - sustain inequity in access; decreasing inequities reflect directed service expansion. Increased attention to collective, prospective funding of primary and specialist ambulatory care is required to increase equity of access to elective surgery.
Assuntos
Procedimentos Cirúrgicos Eletivos , Acessibilidade aos Serviços de Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/tendências , Feminino , Finlândia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores SocioeconômicosRESUMO
For 35 years, Arnstein's ladder of citizen participation has been a touchstone for policy makers and practitioners promoting user involvement. This article critically assesses Arnstein's writing in relation to user involvement in health drawing on evidence from the United Kingdom, the Netherlands, Finland, Sweden and Canada. Arnstein's model, however, by solely emphasizing power, limits effective responses to the challenge of involving users in services and undermines the potential of the user involvement process. Such an emphasis on power assumes that it has a common basis for users, providers and policymakers and ignores the existence of different relevant forms of knowledge and expertise. It also fails to recognise that for some users, participation itself may be a goal. We propose a new model to replace the static image of a ladder and argue that for user involvement to improve health services it must acknowledge the value of the process and the diversity of knowledge and experience of both health professionals and lay people.
Assuntos
Participação da Comunidade , Modelos Teóricos , Canadá , Europa (Continente) , Reforma dos Serviços de Saúde , Programas Nacionais de Saúde/organização & administraçãoRESUMO
The appropriate criteria that should be used in setting priorities in a publicly funded health care system remain open to debate. From a health economics perspective, quality-adjusted life years (QALYs) are increasingly portrayed as a measure of societal value and the criterion of QALY maximisation is then advocated. This paper reports a study that investigated the extent to which some of the assumptions underlying the QALY maximisation approach, notably constant marginal societal value for increases in the size of health programmes, the level of risk, and the level of benefit are supported by members of the public. A general population interview-based survey was conducted. The survey design employed conjoint methods. In general, the public preference data from this study, in themselves, are not much at odds with the core proportionality assumptions concerning societal value in the QALY maximisation model assumptions. The data are, however, at odds with reports from various previous studies.
Assuntos
Atitude Frente a Saúde , Comportamento do Consumidor/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/métodos , Opinião Pública , Anos de Vida Ajustados por Qualidade de Vida , Valores Sociais , Adolescente , Adulto , Idoso , Feminino , Alocação de Recursos para a Atenção à Saúde/ética , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Alocação de Recursos , Medição de Risco , Análise de Sobrevida , Reino UnidoRESUMO
BACKGROUND: Public involvement in health care decision making and priority setting in the UK is being promoted by recent policy initiatives. In 1993, the British Medical Association called for public consultation where rationing of services was to be undertaken. The approach to priority setting advocated by many health economists is the maximization of quality adjusted life years (QALYs). Typically, for a particular health care programme, the QALY calculation takes account of four features: (1) the number of patients receiving the programme, (2) the survival gain, (3) the gain in quality of life and, (4) the probability of treatment success. Only one feature, that relating to quality of life, is based upon public preferences. If the QALY is to be used as a tool for health care resource allocation at a societal level then it should incorporate broader societal preferences. METHODS: This study used an interview-based survey of 91 members of the general public to explore whether the traditional QALY maximization model is a good predictor of public responses to health care priority setting choices. RESULTS AND CONCLUSIONS: Many respondents did not choose consistently in line with a QALY maximization objective and were most influenced by quality of life concerns. There was little support for health care programmes that provided a prognostic improvement but left patients in relatively poor states of health. The level of respondent engagement in the survey exercise was not sensitive to the provision of supporting clinical information.