Disentangling the impact of alternative payment models and associated service delivery models on quality of chronic care: A scoping review.

Payment reforms are frequently implemented alongside service delivery reforms, thus rendering it difficult to disentangle their impact. This scoping review aims to link alternative payment arrangements within their context of service delivery, to assess their impact on quality of chronic care, and to disentangle, where possible, the impact of payment reforms from changes to service delivery. A search of literature published between 2013 and 2022 resulted in 34 relevant articles across five types of payment models: capitation/global budget (n = 13), pay-for-coordination (n = 10), shared savings/shared risk (n = 6), blended capitation (n = 3), and bundled payments (n = 1). The certainty of evidence was generally low due to biases associated with voluntary participation in reforms. This scoping review finds that population-based payment reforms are better suited for collaborative, person-centred approaches of service delivery spanning settings and providers, but also highlights the need for a wider evidence base of studies disentangling the impact of financing from service delivery reforms. Limited evidence disentangling the two suggests that transforming service delivery to a team-based model of care alongside a purchasing reform shifting to blended capitation was more impactful in improving quality of chronic care, than the individual components of payment and service delivery. Further comparative studies employing causal inference methods, accounting for biases and quantifying aspects of service delivery, are needed to better disentangle the mechanisms impacting quality of care.

Cohort Trajectories by Age and Gender for Informal Caregiving in Europe Adjusted for Sociodemographic Changes, 2004 and 2015.

OBJECTIVES: We present a dynamic view of gender patterns in informal caregiving across Europe in a context of sociodemographic transformations. We aim to answer the following research questions: (a) has the gender gap in informal caregiving changed; (b) if so, is this due to changes among women and/or men; and (c) has the gender care gap changed differently across care regimes? METHODS: Multilevel growth curve models are applied to gendered trajectories of informal caregiving of a panel sample of 50+ Europeans, grouped into 5-year cohorts and followed across 5 waves of the Survey of Health, Ageing and Retirement in Europe survey, stratified by sex and adjusted for several covariates. RESULTS: For men in cohorts born more recently, there is a decrease in the prevalence of informal care outside the household, whereas cohort trajectories for women are mostly stable. Prevalence of care inside the household has increased for later-born cohorts for all without discernible changes to the gender care gap. Gender care gaps overall widened among later-born cohorts in the Continental cluster, whereas they remained constant in Southern Europe, and narrowed in the Nordic cluster. DISCUSSION: We discuss the cohort effects found in the context of gender differences in employment and care around retirement age, as well as possible demographic explanations for these. The shift from care outside to inside the household, where it mostly consists of spousal care, may require different policies to support carers, whose age profile and possible care burden seem to be increasing.

A crisis like no other? Unmet needs in healthcare during the first wave of the COVID-19 crisis in Austria.

BACKGROUND: Many patients experienced restricted access to healthcare during the Coronavirus Disease 2019 (COVID-19) pandemic. This study is among the first to provide systematic evidence on the existence of subjective unmet needs (SUN) in different population groups during the pandemic. METHODS: Using data on individuals aged 20-64 and living in Austria from the AKCOVID survey (June 2020) and the 'European Social Survey' (2015), SUN were compared between 2015 and 2020, either related to the pandemic (fear of infection, provider closed or treatment postponed) or not (barriers related to knowledge, affordability, time and reachability). Multinomial logistic regression models identified determinants of SUN during the pandemic, adjusting for socio-demographics, socio-economic status and self-reported health. RESULTS: Shares of the population with SUN in 2020 substantially exceeded SUN in 2015. Excess unmet needs were mostly attributable to the pandemic. Postponed treatments and closed providers were the most important reasons for SUN in June 2020. Older age groups (50-64 years), inactive and retired people were most likely to report pandemic-related SUN. We did not find socio-economic differences in pandemic-related SUN. CONCLUSIONS: The pandemic resulted in a supply-side shock to healthcare, with vulnerabilities emerging especially among older people, people with poor health and/or people no longer active on the labour market. Further research could focus on health system resilience and the possibilities to improve management of healthcare services during pandemics without widening inequalities while maintaining population health.

From each according to means, to each according to needs? Distributional effects of abolishing asset-based payments for residential care in Austria.

BACKGROUND: Most countries in Europe require out-of-pocket payments (OPPs) for nursing homes based on users' income and often assets. This was also the case in Austria until 2018 when asset-based contributions to residential care -denoted the 'Pflegeregress' - were abolished, leaving a shortfall in revenue. We aim to determine how the Pflegeregress was distributed across different groups in Austria prior to 2018, what the distributional consequences of its abolishment were, and what the distributional impact of different financing alternatives would be. METHODS: Circumventing data availability issues, we construct a micro-simulation model using a matched administrative dataset on residential care users receiving the Austrian care allowance (Pflegegeldinformation, PFIF, HVB, and Pflegedienstleistungsstatistik, Statistik Austria) and survey data (SHARE, wave 6). Using this model, we estimate the expected duration of residential care and OPPs under the Pflegeregress of a representative sample of older people aged 65 + in Austria, as well as OPPs under budgetary neutral financing alternatives to the abolished asset-based contribution, namely an inheritance tax and a social insurance scheme. The distributional impact of abolishing the Pflegeregress and these alternative scenarios is assessed through a number of measures, such as ability to pay, Concentration Indices (CI) and a needs-standardized measure. RESULTS: We find that lower income individuals and homeowners disproportionately contributed to asset-based OPPs for residential care prior to 2018, due in large part to their higher use of residential care and the low asset-exemption thresholds. These groups were therefore the largest beneficiaries of its abolishment. The alternative financing scenarios tested would result in a more progressive distribution of payments (i.e. concentrated on more affluent individuals). CONCLUSION: Our findings indicate the limited ability of asset-based OPPs to target those with higher assets, thus questioning the fairness of these instruments for financing residential care facilities for older people in Austria. Findings also suggest that the parameterization of such OPPs (such as asset exemption thresholds) and patterns of residential care use are key variables for assessing the distribution of asset-based OPPs for residential care use. Policy alternatives that decouple payments from use would entail greater transfers from healthy to less healthier individuals.

Assessing Preparedness of Labor and Delivery Personnel in Transferring to a New Unit.

OBJECTIVES: This case study intends to examine how staff characteristics, training methods, and duration of training impact overall staff preparedness and comfortability when transitioning to a new Labor and Delivery. BACKGROUND: A new medical facility offers an opportunity for greater capacity and expanding services, but it also poses new challenges for staff. Success in this transition depends on how quickly the staff can adapt to their new environment and how prepared they are to deliver high-quality care to patients. METHODS: An optional survey was conducted to determine the staff's confidence in their training using a 5-point Likert-type scale. RESULTS: After responses were collected, a paired samples two-sided t test revealed that there was no statistically significant change in the confidence and preparedness for staff. CONCLUSIONS: With this overall outcome, medical facilities will have more discernment on ways to improve their employees' trust and confidence in performing their tasks and providing care while in a new environment. This will then be reflected in the care given toward patients in the future.

Working conditions in the long-term care sector: A comparative study of migrant and native workers in Austria and Sweden.

Increased demand for long-term care (LTC) services alongside precarious working conditions has resulted in labour shortages in the LTC sector, which has led to an increasing share of workers of migrant origin filling these jobs. Previous research on migrant care workers has also highlighted the seeming gap in working conditions relative to native workers. However, lack of disaggregated data on migrant and native care workers, alongside single-case studies, may have concealed potential disadvantages faced by certain groups and insufficiently accounted for differences in migration regimes and organisation of LTC sectors. To address these gaps, we carried out a comparative study on various working conditions of migrant and native LTC workers in Austria and Sweden. Using the international Nordcare survey on care sector working conditions, carried out in Austria in 2017 (n = 792) and in Sweden in 2015 (n = 708), we employed t-tests and multivariate logistic regressions to compare the working conditions of migrant and native carers in home and residential care in each country. We found that worse working conditions in Sweden compared to Austria may be explained by differences in training requirements of the LTC workforce and the relatively large for-profit private sector. Country of origin also plays a paramount role in the differences in working conditions experienced by migrants compared to native care workers, with non-European migrants being more likely to face a number of precarious working conditions. Our findings highlight the need to continue addressing precarious working conditions across the sector, particularly during the COVID-19 pandemic where poor working conditions have been linked to increased COVID-related deaths in nursing homes. Our findings also emphasise the importance of policies that consider the various challenges experienced by different migrant groups in the LTC sector, who may particularly be at risk of presenteeism during the COVID-19 pandemic.

Care in times of COVID-19: the impact of the pandemic on informal caregiving in Austria.

Much attention has been paid to the effects of the COVID-19 pandemic on long-term care but the impact on informal caregivers has remained speculative. In Austria, like in other European countries, informal care is carried out overwhelmingly by (non-cohabiting) relatives. Limited care services available during the pandemic, social-distancing, increased unemployment and competing care needs within households (e.g. due to school closures) may have changed the prevalence and intensity of informal caregiving. Moreover, these changes may have increased the psychological strain experienced by caregivers. Focusing on Austria, this study aims to empirically analyse the following research questions: how have the prevalence and intensity of informal care changed due to the pandemic? How has the psychological well-being of informal caregivers been affected? We use a pre- and post-onset of the pandemic research design based on a representative survey carried out in Austria in June 2020 (N = 2000) in combination with comparable 2015 data from the European Social Survey. Findings suggest that neither prevalence nor intensity of informal care changed significantly due to the pandemic. However, the psychological well-being gap between carers and non-carers increased with the start of the pandemic, especially among men. Findings are discussed in relation to the policy measures implemented and possible policy implications for the future. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10433-021-00611-z.

Developing and validating trace fear conditioning protocols in C57BL/6 mice.

BACKGROUND: Classical fear conditioning is commonly used to study the biology of fear, anxiety and memory. Previous research demonstrated that delay conditioning requires a neural circuit involving the amygdala, but not usually the hippocampus. Trace and contextual fear conditioning require the amygdala and hippocampus. While these paradigms were developed primarily using rat models, they are increasingly being used in mice. NEW METHOD: The current studies develop trace fear conditioning and control paradigms to allow for the assessment of trace and delay fear conditioning in C57BL/6N mice. Our initial protocol yielded clear delay and contextual conditioning. However, trace conditioning failed to differentiate from an unpaired group and was not hippocampus-dependent. These results suggested that the protocol needed to be modified to specifically accommodate trace conditioning the mice. In order to reduce unconditioned freezing and increase learning, the final protocol was developed by decreasing the intensity of the tone and by increasing the inter-trial interval. RESULTS: Our final protocol produced trace conditioned freezing that was significantly greater than that followed unpaired stimulus exposure and was disrupted by hippocampus lesions. COMPARISON WITH EXISTING METHODS: A review of the literature produced 90 articles using trace conditioning in mice. Few of those articles used any kind of behavioral control group, which is required to rule out non-associative factors causing fearful behavior. Fewer used unpaired groups involving tones and shocks within a session, which is the optimal control group. CONCLUSIONS: Our final trace conditioning protocol can be used in future studies examining genetically modified C57BL/6N mice.