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1.
BMC Public Health ; 21(1): 1631, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488695

RESUMO

BACKGROUND: Hot weather leads to increased illness and deaths. The Heatwave Plan for England (HWP) aims to protect the population by raising awareness of the dangers of hot weather, especially for those most vulnerable. Individuals at increased risk to the effects of heat include older adults, particularly 75+, and those with specific chronic conditions, such as diabetes, respiratory and heart conditions. The HWP recommends specific protective actions which relate to five heat-health alert levels (levels 0-4). This study examines the attitudes to hot weather of adults in England, and the protective measures taken during a heatwave. METHODS: As part of a wider evaluation of the implementation and effects of the HWP, a survey (n = 3153) and focus groups, a form of group interview facilitated by a researcher, were carried out after the June 2017 level 3 heat-health alert. Survey respondents were categorised into three groups based on their age and health status: 'vulnerable' (aged 75+), 'potentially vulnerable' (aged 18-74 in poor health) and 'not vulnerable' (rest of the adult population) to hot weather. Multivariable logistic regression models identified factors associated with these groups taking protective measures. In-person group discussion, focused on heat-health, were carried out with 25 people, mostly aged 75 + . RESULTS: Most vulnerable and potentially vulnerable adults do not consider themselves at risk of hot weather and are unaware of the effectiveness of important protective behaviours. Only one-quarter of (potentially) vulnerable adults reported changing their behaviour as a result of hearing hot weather-related health advice during the level 3 alert period. Focus group findings showed many vulnerable adults were more concerned about the effects of the sun's ultra-violet radiation on the skin than on the effects of hot temperatures on health. CONCLUSIONS: Current public health messages appear to be insufficient, given the low level of (potentially) vulnerable adults changing their behaviour during hot weather. In the context of increasingly warmer summers in England due to climate change, public health messaging needs to convince (potentially) vulnerable adults of all the risks of hot weather (not just effects of sunlight on the skin) and of the importance of heat protective measures.


Assuntos
Mudança Climática , Temperatura Alta , Idoso , Atitude , Inglaterra/epidemiologia , Humanos , Estações do Ano , Tempo (Meteorologia)
2.
BMJ Glob Health ; 6(5)2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34016578

RESUMO

The recent growth of medicine sales online represents a major disruption to pharmacy markets, with COVID-19 encouraging this trend further. While e-pharmacy businesses were initially the preserve of high-income countries, in the past decade they have been growing rapidly in low-income and middle-income countries (LMICs). Public health concerns associated with e-pharmacy include the sale of prescription-only medicines without a prescription and the sale of substandard and falsified medicines. There are also non-health-related risks such as consumer fraud and lack of data privacy. However, e-pharmacy may also have the potential to improve access to medicines. Drawing on existing literature and a set of key informant interviews in Kenya, Nigeria and India, we examine the e-pharmacy regulatory systems in LMICs. None of the study countries had yet enacted a regulatory framework specific to e-pharmacy. Key regulatory challenges included the lack of consensus on regulatory models, lack of regulatory capacity, regulating sales across borders and risks of over-regulation. However, e-pharmacy also presents opportunities to enhance medicine regulation-through consolidation in the sector, and the traceability and transparency that online records offer. The regulatory process needs to be adapted to keep pace with this dynamic landscape and exploit these possibilities. This will require exploration of a range of innovative regulatory options, collaboration with larger, more compliant businesses, and engagement with global regulatory bodies. A key first step must be ensuring that national regulators are equipped with the necessary awareness and technical expertise to actively oversee this e-pharmacy activity.


Assuntos
Saúde Global , Assistência Farmacêutica , Farmácia , Tecnologia , COVID-19 , Humanos , Índia , Quênia , Legislação de Medicamentos , Nigéria , Assistência Farmacêutica/tendências , Farmácias , SARS-CoV-2
3.
Health Econ Policy Law ; 15(1): 30-42, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30051795

RESUMO

Health technology assessment is frequently credited with making difficult resource allocation decisions in health care fairer, more rational and more transparent. In Germany, a constitutional 'right to health' allows patients to challenge decisions by sickness funds to withhold reimbursement of treatment excluded from public funding because of insufficient evidence of effectiveness. The ability to litigate was qualified by the Constitutional Court in its 2005 'Nikolaus decision' that sets out criteria to be applied to these cases. Treatment must be made available if (1) the condition is life-threatening, (2) no alternative treatment is available and (3) there is an indication that the treatment could benefit the patient. This paper examines how courts struggled to apply these criteria based on an analysis of cases of patients who sought treatment for cancer between 2005 and 2015, and explores the implications of applying a constitutional 'right to health' to treatment decisions.


Assuntos
Acesso aos Serviços de Saúde , Alocação de Recursos , Direito à Saúde/legislação & jurisprudência , Avaliação da Tecnologia Biomédica , Medicina Baseada em Evidências , Alemanha , Humanos
4.
Int J Equity Health ; 17(1): 112, 2018 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-30075777

RESUMO

BACKGROUND: In Germany and Chile, substitutive private health insurance has been shaped by its co-existence with statutory social health insurance. Despite differences in the way choice is available to users in the health insurance regimes of Chile and Germany, the way in which each country has managed choice between private health insurance and statutory social health insurance provides a unique opportunity to comparatively assess the consequences of such an arrangement that has been previously underexamined. METHODS: We conducted a Most Similar Systems Design comparative policy analysis of the co-occurring private health insurance and statutory social health insurance systems in Germany and Chile. We describe and review the origins and development of the German and Chilean health care insurance systems with an emphasis on the substitutive co-existence between private health insurance and statutory social health insurance. We provide a critique of the market performance of the private health insurance regime in each country followed by a comparative assessment of the impact of private health insurance on financial protection, equity, and risk segmentation. RESULTS: Segmentation of insurance markets in both Germany and Chile has had significant consequences for equity, fairness, and financial protection. Due to market failures in health insurance and differences in the regulatory frameworks governing public and private insurers, the choice of public or private coverage has produced strong incentives for private insurers to select for risks, compromising equity in health care funding, heightening the financial risk borne by public insurers and lowering incentives for private insurers to operate efficiently. CONCLUSIONS: The degree of conflict arising from the substitutive parallel private health insurance system and the statutory social health insurance system varies between Germany and Chile, though policy goals remain similar. Recent reforms in both countries have attempted to improve the financial protection of the privately insured through regulation; nevertheless, concerns about risk segmentation remain largely unresolved.


Assuntos
Seguro Saúde/economia , Medicina Estatal/economia , Chile , Alemanha , Humanos
5.
J Health Polit Policy Law ; 42(3): 513-538, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28213395

RESUMO

This article examines the role of scientific evidence in informing health policy decisions in Germany, using minimum volumes policy as a case study. It argues that scientific evidence was used strategically at various stages of the policy process both by individual corporatist actors and by the Federal Joint Committee as the regulator. Minimum volumes regulation was inspired by scientific evidence suggesting a positive relationship between service volume and patient outcomes for complex surgical interventions. Federal legislation was introduced in 2002 to delegate the selection of services and the setting of volumes to corporatist decision makers. Yet, despite being represented in the Federal Joint Committee, hospitals affected by its decisions took the Committee to court to seek legal redress and prevent policy implementation. Evidence has been key to support, and challenge, decisions about minimum volumes, including in court. The analysis of the role of scientific evidence in minimum volumes regulation in Germany highlights the dynamic relationship between evidence use and the political and institutional context of health policy making, which in this case is characterized by the legislative nature of policy making, corporatism, and the role of the judiciary in reviewing policy decisions.


Assuntos
Tomada de Decisões/ética , Política de Saúde , Hospitais com Alto Volume de Atendimentos , Política , Saúde Pública/legislação & jurisprudência , Alemanha , Humanos , Formulação de Políticas
6.
Health Policy ; 112(1-2): 156-62, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23628482

RESUMO

There is a growing body of cross-country comparisons in health systems and policy research. However, there is little consensus as to how to assess its quality. This is partly due to the fact that cross-country comparison constitutes a diverse inter-disciplinary field of study, with much variation in the motives for research, foci and levels of analyses, and methodological approaches. Inspired by the views of subject area experts and using the distinction between variable-based and case-based research, we briefly review the main different types of cross-country comparisons in health systems and policy research to identify pertinent quality issues. From this, we identify the following generic quality criteria for cross-country comparisons: (1) appropriate use of theory, (2) explicit selection of comparator countries, (3) rigour of the comparative design, (4) attention to the complexity of cross-national comparison, (5) rigour of the research methods, and (6) contribution to knowledge. This list may not be exclusive though publication and discussion of the list of criteria should help raise awareness in this field of what constitutes high quality research. In turn, this should be helpful for those planning, undertaking, or commissioning cross-country comparative research.


Assuntos
Atenção à Saúde/normas , Política de Saúde , Garantia da Qualidade dos Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde/normas , Internacionalidade , Projetos de Pesquisa
7.
Rand Health Q ; 1(4): 7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-28083214

RESUMO

This article summarizes a review of approaches to funding intensive care in health systems that use activity-based payment mechanisms based on diagnosis-related groups (DRGs) to reimburse hospital care in Australia (Victoria), Denmark, France, Germany, Italy, Spain, Sweden and the United States (Medicare). The study aims to inform the current debate about options for funding intensive care services for adults, children and newborns in England. Mechanisms of funding intensive care services tend to fall into three broad categories: (1) those that fund intensive care through DRGs as part of one episode of hospital care only (US Medicare, Germany, selected regions in Sweden and Italy; (2) those that use DRGs in combination with co-payments (Victoria, France); and (3) those that exclude intensive care from DRG funding and use an alternative form of payment, for example global budgets (Spain) or per diems (South Australia). The review suggests that there is no obvious example of "best practice" or dominant approach used by a majority of systems. Each approach has advantages and disadvantages, particularly in relation to the financial risk involved in providing intensive care. While the risk of underfunding intensive care may be highest in systems that apply DRGs to the entire episode of hospital care, including intensive care, concerns about potential underfunding were voiced in all systems reviewed here. Arrangements for additional funding in the form of co-payments or surcharges may reduce the risk of underfunding. However, these approaches also face the difficulty of determining the appropriate level of (additional) payment and balancing the incentive effect arising from higher payment.

8.
Health Policy ; 106(1): 50-9, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22153724

RESUMO

OBJECTIVES: With markets and competition dominating much of the debate on health care reform, health care planning has received little scholarly attention in recent years. Yet in many high-income countries, governments have continued to plan some elements of their health care systems. We use a new framework for analysing health care planning organised around the dimensions of 'vision', 'governance' and 'intelligence' to assess the approach in two deliberately contrasting countries, Germany and New Zealand. METHODS: A review of the literature on health care planning in general and specifically in Germany and New Zealand, supported by key participant interviews. RESULTS: Planning in both countries largely reflects the different institutional arrangements of their wider health systems. Planning in Germany is fragmented, in part due to federalism and corporatism, with separate approaches in different health care sectors and regions. In contrast, New Zealand's NHS-style health system favours a more hierarchical, integrated approach, with clear lines of accountability, and central government capacity to define objectives and monitor developments. Both countries find it difficult to use planning to align demand for and supply of health care though New Zealand makes some use of population needs assessments to support this process while these are currently absent in Germany. CONCLUSIONS: While it remains challenging to compare health care systems that are institutionally very different, this new framework for analysing their approaches to planning draws attention to their advantages and disadvantages. It also generates an agenda for future research to improve our understanding of the role and effectiveness of different forms of planning versus, and in combination with, other policy tools to relating health care supply and demand.


Assuntos
Planejamento de Instituições de Saúde/organização & administração , Planejamento em Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Alemanha , Nova Zelândia
9.
J Health Serv Res Policy ; 16 Suppl 2: 48-60, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21737529

RESUMO

OBJECTIVE: As an applied field of research, health services research (HSR) is undertaken primarily to inform health care policy. However, the relationship between policy and HSR is not straightforward. Many policies are developed without taking account of available evidence. Our objective was to provide an overview of the infrastructure and capacity of HSR in Europe, and to explore the links between HSR and policy in European countries. METHODS: A survey of health policy experts in 34 European countries undertaken between September 2009 and June 2010, covering: funding and prioritizing HSR; production and producers of HSR; health policy users of HSR; activities to promote the use of HSR; and barriers and facilitators to using HSR in policy-making. Experts were selected based on their professional expertise and reputation in HSR and/or health policy. RESULTS: Information was returned from 30 of the 34 countries. Infrastructure and capacity for HSR varied widely across countries as did the mechanisms likely to promote the use of research for national policy-making. In many cases, HSR was not separately identified from other health-related research. Government funding for HSR varied between zero and over €170 million per year (in 2004). Few countries had mechanisms to match HSR priorities with those of policy-makers. Although most countries provided some relevant training, multidisciplinary training was available in few countries. Few mechanisms supporting the use of research in policy were reported. One exception was coverage decisions for new drugs and technologies where formal accountability for the use of health technology assessments appeared to be most developed. Overall, respondents struggled to locate information on many aspects of HSR, particularly its use in decision-making. CONCLUSION: HSR is unevenly developed across Europe. There is considerable scope to build the infrastructure and to take steps to improve the use of HSR in policy-making. There is also a need for research, as opposed to expert opinion, on how HSR is undertaken and used.


Assuntos
Política de Saúde , Pesquisa sobre Serviços de Saúde/organização & administração , Europa (Continente) , Financiamento Governamental/estatística & dados numéricos , Prioridades em Saúde/organização & administração , Pesquisa sobre Serviços de Saúde/economia , Humanos , Disseminação de Informação , Sociedades/organização & administração
11.
Rand Health Q ; 1(1): 11, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-28083167

RESUMO

This article provides details on a report that reviews and discusses information systems reporting on the quality or performance of providers of healthcare ("quality information systems") in seven countries: Denmark, England, Germany, Italy, the Netherlands, Sweden and the United States. Data collection involves a review of the published and grey literature and is complemented by information provided by key informants in the selected countries using a detailed questionnaire. Quality information systems typically address a number of audiences, including patients (or respectively the general public before receiving services and becoming patients), commissioners, purchasers and regulators. We observe that as the policy context for quality reporting in countries varies, so also does the nature and scope of quality information systems within and between countries. Systems often pursue multiple aims and objectives, which typically are (a) to support patient choice (b) to influence provider behaviour to enhance the quality of care (c) to strengthen transparency of the provider-commissioner relationship and the healthcare system as a whole and (d) to hold healthcare providers and commissioners to account for the quality of care they provide and the purchasing decisions they make. We emphasise that the main users of information systems are the providers themselves as the publication of information provides an incentive for improving the quality of care. Finally, based on the evidence reviewed, we identify a number of considerations for the design of successful quality information systems, such as the clear definition of objectives, ensuring users' accessibility and stakeholder involvement, as well as the need to provide valid, reliable and consistent data.

12.
J Health Serv Res Policy ; 13 Suppl 2: 58-64, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18416931

RESUMO

Recognizing that robust information on health systems in other countries can provide valuable lessons for the English National Health Service, the Department of Health commissioned an academic team to provide an 'On-call Facility for International Healthcare Comparisons' in 2005. This paper describes the work of this novel approach to informing policy and reviews the experience of the first two years. It illustrates the well-documented challenges of comparative analysis of health systems. One important issue is understanding the health system context so as to interpret phenomena and draw appropriate policy conclusions. Other challenges include the potential tension between academic interest and rigour, and the need for timely analysis to inform the Department of Health's rapidly changing policy agenda. The diversity and nature of topics covered, as well as the rapid turn-around time have meant that the Facility has had to balance rigour and timeliness carefully to ensure the value and relevance of reports. A strong research base linked with an international network of country experts promotes the provision of high quality analyses at relatively low costs. However, such an arrangement can only be sustained if it provides scope for additional primary research. A formal evaluation of the influence on health care policy-making in England is not yet available. Such knowledge will be of crucial importance for the development of similar resources elsewhere.


Assuntos
Atenção à Saúde/organização & administração , Política de Saúde , Cooperação Internacional , Aprendizagem , Humanos , Medicina Estatal , Reino Unido
13.
J Public Health (Oxf) ; 28(4): 299-303, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17071816

RESUMO

BACKGROUND: Evidence-based policies have become increasingly accepted in clinical practice. However, policies on many of the non-clinical activities that take place in health care facilities may be less frequently evidence based. METHODS: We carried out a review of literature on safety of mobile phones in hospitals and survey of practice in selected European countries. RESULTS: When first evidence on the dangers of electronic interference associated with mobile phones appeared in the 1990s, hospitals in many countries introduced complete bans on mobile phones. Yet a review of recent evidence suggests that there is no significant risk from using mobile phones in hospitals as long as they are more than a metre away from sensitive equipment, whereas the risk to the most modern equipment is even less. With the technological evolution of mobile phones, the residual risk of interference appears to be minimal and controllable. Although some countries are reluctant to relax regulation, others now limit bans to areas in which sensitive equipment is used and some discourage the use of mobile phones on the grounds of noise exposure. CONCLUSION: With new technology on the doorstep, the potential benefits and risks associated with mobile phones should be examined explicitly in the light of the evidence.


Assuntos
Telefone Celular/normas , Campos Eletromagnéticos/efeitos adversos , Medicina Baseada em Evidências , Administração Hospitalar , Política Organizacional , Segurança , Coleta de Dados , Europa (Continente) , Humanos , Noruega , Risco
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