Building on value-based health care: Towards a health system perspective.

A variety of methodologies have been developed to help health systems increase the 'value' created from their available resources. The urgency of creating value is heightened by population ageing, growth in people with complex morbidities, technology advancements, and increased citizen expectations. This study develops a policy framework that seeks to reconcile the various approaches towards value-based policies in health systems. The distinctive contribution is that we focus on the value created by the health system as a whole, including health promotion, thus moving from value-based health care towards a value-based health system perspective. We define health system value to be the contribution of the health system to societal wellbeing. We adopt a framework of five dimensions of value, embracing health improvement, health care responsiveness, financial protection, efficiency and equity, which we map onto a society's aggregate wellbeing. Actors within the health system make different contributions to value, and we argue that their perspectives can be aligned with a unifying concept of health system value. We provide examples of policy levers and highlight key actors and how they can promote certain aspects of health system value. We discuss advantages of value-based approach based on the notion of wellbeing and some practical obstacles to its implementation.

From Health in All Policies to Health for All Policies.

Worldwide responses to the COVID-19 pandemic have shown that it is possible for politicians to come together across departmental boundaries. To this end, in many countries, heads of government and their health ministers work closely with all other ministries, departments, and sectors, including social affairs, internal affairs, foreign affairs, research and education, transport, agriculture, business, and state aid. In this Viewpoint, we ask if and how the Sustainable Development Goals (SDGs) can support intersectoral collaboration to promote health, since governments have already committed to achieving them. We contend that SDGs can do so, ultimately advancing health while offering co-benefits across society.

Drawing light from the pandemic: Rethinking strategies for health policy and beyond.

The COVID-19 pandemic is a catastrophe. It was also preventable. The potential impacts of a novel pathogen were foreseen and for decades scientists and commentators around the world warned of the threat. Most governments and global institutions failed to heed the warnings or to pay enough attention to risks emerging at the interface of human, animal, and environmental health. We were not ready for COVID-19, and people, economies, and governments around the world have suffered as a result. We must learn from these experiences now and implement transformational changes so that we can prevent future crises, and if and when emergencies do emerge, we can respond in more timely, robust and equitable ways, and minimize immediate and longer-term impacts. In 2020-21 the Pan-European Commission on Health and Sustainable Development assessed the challenges posed by COVID-19 in the WHO European region and the lessons from the response. The Commissioners have addressed health in its entirety, analyzing the interactions between health and sustainable development and considering how other policy priorities can contribute to achieving both. The Commission's final report makes a series of policy recommendations that are evidence-informed and above all actionable. Adopting them would achieve seven key objectives and help build truly sustainable health systems and fairer societies.

Innovation, value and reimbursement in radiation and complex surgical oncology: Time to rethink.

BACKGROUND AND PURPOSE: Complex surgery and radiotherapy are the central pillars of loco-regional oncology treatment. This paper describes the reimbursement schemes used in radiation and complex surgical oncology, reports on literature and policy reviews. MATERIAL AND METHODS: A systematic review of the literature of the reimbursement models has been carried out separately for radiotherapy and complex cancer surgery based on PRISMA guidelines. Using searches of PubMed and grey literature, we identified articles from scientific journals and reports published since 2000 on provider payment or reimbursement systems currently used in radiation oncology and complex cancer surgery, also including policy models. RESULTS: Most European health systems reimburse radiotherapy using a budget-based, fee-for-service or fraction-based system; while few reimburse services according to an episode-based model. Also, the reimbursement models for cancer surgery are mostly restricted to differences embedded in the DRG system and adjustments applied to the fees, based on the complexity of each surgical procedure. There is an enormous variability in reimbursement across countries, resulting in different incentives and different amounts paid for the same therapeutic strategy. CONCLUSION: A reimbursement policy, based on the episode of care as the basic payment unit, is advocated for. Innovation should be tackled in a two-tier approach: one defining the common criteria for reimbursement of proven evidence-based interventions; another for financing emerging innovation with uncertain definitive value. Relevant clinical and economic data, also collected real-life, should support reimbursement systems that mirror the actual cost of evidence-based practice.

Innovation, value and reimbursement in radiation and complex surgical oncology: Time to rethink.

BACKGROUND AND PURPOSE: Complex surgery and radiotherapy are the central pillars of loco-regional oncology treatment. This paper describes the reimbursement schemes used in radiation and complex surgical oncology, reports on literature and policy reviews. MATERIAL AND METHODS: A systematic review of the literature of the reimbursement models has been carried out separately for radiotherapy and complex cancer surgery based on PRISMA guidelines. Using searches of PubMed and grey literature, we identified articles from scientific journals and reports published since 2000 on provider payment or reimbursement systems currently used in radiation oncology and complex cancer surgery, also including policy models. RESULTS: Most European health systems reimburse radiotherapy using a budget-based, fee-for-service or fraction-based system; while few reimburse services according to an episode-based model. Also, the reimbursement models for cancer surgery are mostly restricted to differences embedded in the DRG system and adjustments applied to the fees, based on the complexity of each surgical procedure. There is an enormous variability in reimbursement across countries, resulting in different incentives and different amounts paid for the same therapeutic strategy. CONCLUSION: A reimbursement policy, based on the episode of care as the basic payment unit, is advocated for. Innovation should be tackled in a two-tier approach: one defining the common criteria for reimbursement of proven evidence-based interventions; another for financing emerging innovation with uncertain definitive value. Relevant clinical and economic data, also collected real-life, should support reimbursement systems that mirror the actual cost of evidence-based practice.

Health system performance assessment: a primer for policy-makers

This policy brief is one of a new series to meet the needs of policy-makers and health system managers. The aim is to develop key messages to support evidence-informed policy-making and the editors will continue to strengthen the series by working with authors to improve the consideration given to policy options and implementation.

Health systems resilience during COVID-19: lessons for building back better

COVID-19 has created huge challenges. The lessons it has generated on preparing for future pandemics are clear but they are by no means the only learning. All health systems are vulnerable and there are practical steps that all countries can take, not simply to increase the resources available, but to ensure the capacity to mobilize, adapt and use those resources in different shock scenarios. The Health systems resilience during COVID-19: Lessons for building back better study gathers the evidence of how countries have managed (or not managed) to re-engineer what they do, who does what and how, and draws out the implications for future resilience. The study understands resilience as the ability of the health system to prepare for, manage and learn from a sudden and extreme disturbance. It is about maintaining the performance of core heath system functions. While the focus here is on responding to shock, it is increasingly evident that the ability to transform and evolve will also be critical in meeting long-term structural challenges to health systems.

Станет ли старение населения концом социального государства? Обзор фактических данных и варианты политики

Данный краткий обзор представляет общую информацию и является введением в серию обзоров «Экономика здорового и активного старения». В нем рассматриваются основные фактические данные о расходах на здравоохранение и долгосрочный уход, связанных со старением, с тем чтобы лучше понять ожидаемое увеличение затрат в связи с изменением возрастного состава населения. В то же время в данном кратком обзоре обсуждается, каким образом пожилые люди могут вносить и вносят значимый вклад как в экономическом, так и в социальном плане, особенно если они способны оставаться здоровыми и активными в пожилом возрасте, формируя так называемую «серебряную экономику». В заключение данного обзора рассматриваются отдельные меры политики, которые продемонстрировали своюдейственность в поддержании здоровья и активного долголетия пожилых людей, либо могут иным образом укреплять устойчивые системы ухода в более широком контексте старения населения.

Editorial: governance strategies for building health system resilience

Governance is about making and implementing collective decisions. It is therefore vitally important to health policy and implementation and is a pivotal, yet often underestimated, enabler for leading a health system in times of emergencies, preventing them from becoming a crisis.

Predicción de mortalidad en recién nacidos prematuros. Revisión sistemática actualizada / Prediction of mortality in premature neonates. An updated systematic review

INTRODUCCIÓN: La prematuridad extrema se asocia a altas tasas de mortalidad. Para profesionales y familias, es prioritario establecer de forma individualizada las probabilidades de muerte en diferentes momentos. El objetivo de este estudio es efectuar una revisión sistemática de modelos predictivos de mortalidad en prematuros publicados recientemente. MÉTODOS: Doble búsqueda de artículos publicados en PubMed sobre modelos predictivos de muerte en prematuros. Población estudiada: prematuros con edad gestacional ≤ 30 semanas o peso al nacer ≤ 1.500 g. Inclusión: trabajos publicados con nuevos modelos desde junio del 2010 hasta julio del 2019, tras revisión sistemática de Medlock (2011). Se valoran: población, características de modelos, variables utilizadas, medidas de funcionamiento y validación. RESULTADOS: De 7.744 referencias (primera búsqueda) y 1.435 (segunda búsqueda), se seleccionaron 31 trabajos, incluyéndose al final 8 nuevos modelos. Cinco modelos (62,5%) se desarrollaron en América del Norte y 2 (25%) en Europa. Un modelo secuencial (Ambalavanan) permite realizar predicciones de muerte al nacer, 7, 28 días de vida y 36 semanas posmenstruales. Análisis de regresión logística múltiple en el 87,5% de modelos. La discriminación poblacional se midió por odds ratio (75%) y área bajo la curva (50%). La «validación» se ha realizado en 5 modelos (interna). Tres modelos disponen de acceso online. No hay modelos predictivos validados en España. CONCLUSIONES: La toma de decisiones basada en modelos predictivos permite una mayor individualización de la atención dada a un niño prematuro y una mejor utilización de recursos. Es necesario desarrollar modelos de predicción de mortalidad en prematuros de España

INTRODUCTION: Extreme prematurity is associated with high mortality rates. The probability of death at different points in time is a priority for professionals and parents, and needs to be established on an individual basis. The aim of this study is to carry out a systematic review of predictive models of mortality in premature infants that have been published recently. METHODS: A double search was performed for article published in PubMed on models predicting mortality in premature neonates. The population studied were premature neonates with a gestational age of ≤ 30 weeks and / or a weight at birth of ≤ 1500g. Works published with new models from June 2010 to July 2019 after a systematic review by Medlock (2011) were included. An assessment was made of the population, characteristics of the model, variables used, measurements of functioning, and validation. RESULTS: Of the 7744 references (1st search) and 1435 (2nd search) found, 31 works were selected, with 8 new models finally being included. Five models (62.5%) were developed in North America and 2 (25%) in Europe. A sequential model (Ambalavanan) enables predictions of mortality to be made at birth, 7, 28 days of life, and 36 weeks post-menstrual. A multiple logistic regression analysis was performed on 87.5% of the models. The population discrimination was measured using Odds Ratio (75%) and the area under the curve (50%). "Internal Validation" had been carried out on 5 models. Three models can be accessed on-line. There are no predictive models validated in Spain. CONCLUSIONS: The making of decisions based on predictive models can lead to the care given to the premature infant being more individualised and with a better use of resources. Predictive models of mortality in premature neonates in Spain need to be developed