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1.
Gesundheitswesen ; 2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31746445

RESUMO

OBJECTIVE: Comparison is a key method in learning about what works in health and healthcare. We discuss the importance of comparability in cross-national health research using health insurance claims data, develop a framework to systematically asses these threats and apply it to the German (DaTraV) and Dutch (Vektis) national-level insurance claims datasets. METHODS: We propose a framework of threats to the comparability of health insurance claims databases, which includes three domains: (1) representation of populations compared, (2) data sources and data processing and (3) database contents and availability for research purposes. We apply the framework to analyze the comparability of DaTraV and Vektis databases using publicly available information (organization's websites, scientific publications) and our experiences from an interregional project on rare diseases (EMRaDi). RESULTS: Both databases were created for the same purpose (morbidity-based risk adjustment) and use the same underlying sources of data. Differences in population representation and uncertainty about data processing procedures represent potential sources of incomparability. Access for research purposes is feasible in both databases but may be subject to long processing time. CONCLUSIONS: We find important threats to the comparability of the Dutch and German national insurance claims databases and by extension to validity of any comparative health studies that rely on them. Standard adjustment techniques, making more information available about data collection and processing procedures and adding more diagnosis-related descriptors offer ways to overcome the identified threats to comparability.

2.
Inquiry ; 56: 46958019833869, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30845863

RESUMO

To adopt and implement innovative good practices across the European Union requires developing policies for different political and constitutional contexts. Health policies are mostly decided by national political processes at different levels. To attain effective advice for policy making and good practice exchange, one has to take different models of governance for health into account. We aimed to explore which concepts of governance research are relevant for implementing child health policies in a European Union context. We argue that taking into account the insights of good intersectoral and multilevel governance in research and practice is essential and promising for future analyses. These governance concepts help to understand what actors and institutions are potentially of relevance for developing and implementing child-centric health care approaches not only within health care but also outside health care. The framework we developed has the potential to advise on and thus support effectively the spreading and implementation of good practices of child-centric health policy approaches across the European Union. With this heuristic framework, the variety of relevant stakeholders and institutions can better be mapped and taken into account in implementation processes. Also, the normative side-particularly stressing values that make governance "good governance"-is to be taken into account.


Assuntos
Saúde da Criança , Política de Saúde , Heurística , Formulação de Políticas , Atenção Primária à Saúde , Criança , Tomada de Decisões , União Europeia , Humanos , Política
3.
Health Policy ; 122(3): 279-283, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29317109

RESUMO

Reports on the implementation of the Directive on the application of Patients' Rights in Cross-border Healthcare indicate that it had little impact on the numbers of patients seeking care abroad. We set out to explore the effects of this directive on health systems in seven EU Member States. Key informants in Belgium, Estonia, Finland, Germany, Malta, Poland and The Netherlands filled out a structured questionnaire. Findings indicate that the impact of the directive varied between countries and was smaller in countries where a large degree of adaptation had already taken place in response to the European Court of Justice Rulings. The main reforms reported include a heightened emphasis on patient rights and the adoption of explicit benefits packages and tariffs. Countries may be facing increased pressure to treat patients within a medically justifiable time limit. The implementation of professional liability insurance, in countries where this did not previously exist, may also bring benefits for patients. Lowering of reimbursement tariffs to dissuade patients from seeking treatment abroad has been reported in Poland. The issue of discrimination against non-contracted domestic private providers in Estonia, Finland, Malta and The Netherlands remains largely unresolved. We conclude that evidence showing that patients using domestic health systems have actually benefitted from the directive remains scarce and further monitoring over a longer period of time is recommended.


Assuntos
Emigração e Imigração , Acesso aos Serviços de Saúde , Turismo Médico/tendências , Direitos do Paciente , União Europeia , Programas Governamentais/economia , Humanos , Cooperação Internacional , Inquéritos e Questionários
4.
Eur J Public Health ; 28(3): 516-521, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29059294

RESUMO

Background: Western Balkan countries exhibit high levels of alcohol consumption, which constitutes a serious public health concern. We aimed to quantitatively assess the influence of the Europeanization process on levels of alcohol consumption in Western Balkans, an issue that has been under-researched. Methods: The process of Europeanization was defined as the penetration of European dimension, procedures, policy paradigms, beliefs and norms in national arenas of politics and policy development. Data about alcohol consumption in six Western Balkan countries from 1991 to 2011 were gathered from the World Bank and World Health Organization databases. Azerbaijan and Georgia were considered control countries. A difference-in-differences approach was used to assess the impact of Europeanization process on levels of alcohol consumption. Results: The Europeanization process impacts alcohol consumption in Western Balkan countries through the European Union directives and tax policies. After starting the Europeanization process, the spirits consumption in Croatia and The Former Yugoslav Republic of Macedonia decreased by 1.06 litter per capita (95% CI: from -1.63 to - 0.49) and 1.02 litter per capita in Serbia (95% CI: from -1.9 to - 0.1). Conclusion: Our analysis provides useful evidence about the possible influence of Europeanization process especially on spirits consumption levels in Western Balkans. These findings draw attention to the need to implement new policies in order to prevent alcohol health-related harm due to the possible increase of wine and beer consumption.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Bebidas Alcoólicas/estatística & dados numéricos , União Europeia , Políticas , Península Balcânica/epidemiologia , Humanos
5.
Health Policy ; 121(6): 594-603, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28446384

RESUMO

Capacity assessment has become a popular measure in the health sector to assess the ability of various stakeholders to pursue agreed activities. The European Commission (EC) is increasingly dealing with a variety of health issues to coordinate and complement national health policies. This study analyses the functional capacity of the Directorate-General for Health and Consumers (DG SANCO) between 1999 and 2004. It applies the UNDP Capacity Assessment Framework and uses a literature review, a document review of EU policy documents and expert interviews to assess the capacity of DG SANCO to fulfill its mandate for public health and health systems. Our results suggest that DG SANCO has established capacities to engage with stakeholders; to assess various health issues, to define issue-specific health policies and to collect information for evaluative purposes. In contrast, capacities tend to be less established for defining a clear strategy for the overall sector, for setting priorities and for budgeting, managing and implementing policies. We conclude that improvements to the effectiveness of DG SANTE's (the successor of DG SANCO) policies can be made within the existing mandate. A priority setting exercise may be conducted to limit the number of pursued actions to those with the greatest European added value within DG SANTE's responsibilities.


Assuntos
União Europeia/organização & administração , Política de Saúde , União Europeia/história , Gestão da Informação em Saúde , História do Século XX , História do Século XXI , Avaliação de Programas e Projetos de Saúde , Saúde Pública/história , Saúde Pública/legislação & jurisprudência , Administração em Saúde Pública
6.
Glob Public Health ; 12(9): 1156-1168, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-26610291

RESUMO

In 2013, the German government published its national Global Health Strategy, outlining principles and focal topics for German engagement in global health. We asked the question of why Germany has decided to establish a national policy framework for global health at this point in time, and how the development process has taken place. The ultimate goal of this study was to achieve better insights into the respective health and foreign policy processes at the national level. This article reports on the results of semi-structured interviews with those actors that were responsible for initiating and drafting the German Global Health Strategy (GGHS). Our study shows that a series of external developments, stakeholders, and advocacy efforts created an environment conducive to the creation of the strategic document. In addition, a number of internal considerations, struggles, and capacities played a decisive role during the development phase of the GGHS. Understanding these factors better can not only provide substantial insights into global health related policy processes in Germany, but also contribute to the general discourse on the role of the nation state in global health governance.


Assuntos
Saúde Global , Motivação , Formulação de Políticas , Desenvolvimento de Programas , Alemanha , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa
7.
Health Policy ; 119(3): 375-83, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25650138

RESUMO

In the framework of "Europe 2020", European Union Member States are subject to a new system of economic monitoring and governance known as the European Semester. This paper seeks to analyse the way in which national health systems are being influenced by EU institutions through the European Semester. A content analysis of the Country Specific Recommendations (CSRs) for the years 2011, 2012, 2013 and 2014 was carried out. This confirmed an increasing trend for health systems to feature in CSRs which tend to be framed in the discourse on sustainability of public finances rather than that of social inclusion with a predominant focus on the policy objective of sustainability. The likelihood of obtaining a health CSRs was tested against a series of financial health system performance indicators and general government finance indicators. The odds ratio of obtaining a health CSR increased slightly with the increase in level of general Government debt, with an OR 1.02 (CI: 1.01, 1.03; p=0.007) and decreased with an increased public health expenditure/total health expenditure ratio, with an OR 0.89 (CI: 0.84, 0.96; p=0.001). The European Semester process is a relatively new process that is influencing health systems in the European Union. The effect of this process on health systems merits further attention. Health stakeholders should seek to engage more closely with this process which if steered appropriately could also present opportunities for health system reform.


Assuntos
Assistência à Saúde/economia , União Europeia , Programas Governamentais , Gastos em Saúde/tendências , Europa (Continente) , Política de Saúde/economia , Humanos , Setor Público/economia , Qualidade da Assistência à Saúde , Estatística como Assunto
8.
Health Policy ; 117(1): 6-14, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24703855

RESUMO

Hospitals have become a focal point for health care reform strategies in many European countries during the current financial crisis. It has been called for both, short-term reforms to reduce costs and long-term changes to improve the performance in the long run. On the basis of a literature and document analysis this study analyses how EU member states align short-term and long-term pressures for hospital reforms in times of the financial crisis and assesses the EU's influence on the national reform agenda. The results reveal that there has been an emphasis on cost containment measures rather than embarking on structural redesign of the hospital sector and its position within the broader health care system. The EU influences hospital reform efforts through its enhanced economic framework governance which determines key aspects of the financial context for hospitals in some countries. In addition, the EU health policy agenda which increasingly addresses health system questions stimulates the process of structural hospital reforms by knowledge generation, policy advice and financial incentives. We conclude that successful reforms in such a period would arguably need to address both the organisational and financing sides to hospital care. Moreover, critical to structural reform is a widely held acknowledgement of shortfalls in the current system and belief that new models of hospital care can deliver solutions to overcome these deficits. Advancing the structural redesign of the hospital sector while pressured to contain cost in the short-term is not an easy task and only slowly emerging in Europe.


Assuntos
Economia Hospitalar , Reforma dos Serviços de Saúde/economia , Política de Saúde/economia , Controle de Custos , Assistência à Saúde/organização & administração , União Europeia , Administração Hospitalar , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/organização & administração
9.
Health Econ Policy Law ; 9(1): 49-69, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23968231

RESUMO

Since the start of the economic crisis, the European Union's (EU's) predominant discourse has been austerity and fiscal consolidation. The detrimental effects on Europe's health systems and the health status of its citizens are well described. However, little is known about the emerging EU-level initiatives to support national health systems handle the challenges of efficient care provision and system reorganisation aimed to meet their future needs. This review analyses the manner, conditions and prospects of such EU support. First, health system objectives are increasingly entering the EU health policy agenda. Second, professional and patient mobility provisions may support member states (MS) in copying with crisis related health challenges but can potentially acerbate them at the same time. Third, in recent initiatives health system goals are more closely tied to the EU's economic growth narrative. And fourth, health system issues are taken up in existing EU-level structures for debate and exchange between MS. In addition, the design of some policies may have the potential to intensify socioeconomic and health inequalities rather than ameliorate them.


Assuntos
Assistência à Saúde/economia , União Europeia/economia , Reforma dos Serviços de Saúde/economia , Política de Saúde/economia , Programas Nacionais de Saúde/economia , Assistência à Saúde/organização & administração , Recessão Econômica , Europa (Continente) , Apoio Financeiro , Humanos , Cooperação Internacional , Turismo Médico/economia , Turismo Médico/tendências , Programas Nacionais de Saúde/organização & administração
10.
BMC Public Health ; 13: 1074, 2013 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-24225055

RESUMO

BACKGROUND: The European Union (EU) health mandate was initially defined in the Maastricht Treaty in 1992. The twentieth anniversary of the Treaty offers a unique opportunity to take stock of EU health actions by giving an overview of influential public health related EU-level policy outputs and a summary of policy outputs or actions perceived as an achievement, a failure or a missed opportunity. METHODS: Semi-structured expert interviews (N = 20) were conducted focusing on EU-level actions that were relevant for health. Respondents were asked to name EU policies or actions that they perceived as an achievement, a failure or a missed opportunity. A directed content analysis approach was used to identify expert perceptions on achievements, failures and missed opportunities in the interviews. Additionally, a nominal group technique was applied to identify influential and public health relevant EU-level policy outputs. RESULTS: The ranking of influential policy outputs resulted in top positions of adjudications and legislations, agencies, European Commission (EC) programmes and strategies, official networks, cooperative structures and exchange efforts, the work on health determinants and uptake of scientific knowledge. The assessment of EU health policies as being an achievement, a failure or a missed opportunity was often characterized by diverging respondent views. Recurring topics that emerged were the Directorate General for Health and Consumers (DG SANCO), EU agencies, life style factors, internal market provisions as well as the EU Directive on patients' rights in cross-border healthcare. Among these recurring topics, expert perceptions on the establishment of DG SANCO, EU public health agencies, and successes in tobacco control were dominated by aspects of achievements. The implementation status of the Health in All Policy approach was perceived as a missed opportunity. CONCLUSIONS: When comparing the emerging themes from the interviews conducted with the responsibilities defined in the EU health mandate, one can identify that these responsibilities were only partly fulfilled or acknowledged by the respondents. In general, the EU is a recognized public health player in Europe which over the past two decades, has begun to develop competencies in supporting, coordinating and supplementing member state health actions. However, the assurance of health protection in other European policies seems to require further development.


Assuntos
União Europeia/organização & administração , Política de Saúde , Aniversários e Eventos Especiais , União Europeia/história , Política de Saúde/história , História do Século XX , História do Século XXI , Humanos , Cooperação Internacional/história , Entrevistas como Assunto , Avaliação de Programas e Projetos de Saúde , Saúde Pública/história , Saúde Pública/métodos
13.
Cent Eur J Public Health ; 20(2): 95-100, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22966730

RESUMO

BACKGROUND: In 2007 the European Commission issued the White Paper: "Together for Health". Considered the EU Health Strategy for the years 2008-2013, it offers the cornerstones for setting priorities in EU health actions. OBJECTIVES: The public health framework offered in this strategy is explicitly built on shared values--including the overarching values of universality, access to good quality care, equity and solidarity that reacted to certain health care challenges within the EU. This article analyses the Health Strategy via its ethical scope and considers implications for future health policy making. METHODS: The Health Strategy and related documents are scrutinised to explore how the mentioned values are defined and enfolded. Additionally, scientific databases are searched for critical discussions of the value base of the Health Strategy. The results are discussed and reasoned from a public health ethical perspective. RESULTS: The Health Strategy is barely documented and discussed in the scientific literature. Furthermore, no attention was given to the value base of the Health Strategy. Our analysis shows that the mentioned values are particularly focussed on health care in general rather than on public health in particular. Besides this, the given values of the Health Strategy are redundant. CONCLUSIONS: An additional consideration of consequentialist public health ethics values would normatively strengthen a population-based health approach of EU health policy making.


Assuntos
União Europeia , Política de Saúde , Prioridades em Saúde , Saúde Pública/normas , Acesso aos Serviços de Saúde , Humanos , Formulação de Políticas , Qualidade da Assistência à Saúde
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