What happens at the end of life? Using linked administrative health data to understand healthcare usage in the last year of life in New Zealand

May 25, 2018, 9:29 pm

≫ Next: PUBLIC SUPPORT FOR TOBACCO CONTROL POLICIES: THE ROLE OF THE PROTECTION OF CHILDREN AGAINST TOBACCO

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Publication date: Available online 25 May 2018
Source:Health Policy
Author(s): Richard Hamblin, Nikolai Minko, Carl Shuker, Jennifer Hill, Alan F. Merry
The end of life is often associated with increased use of healthcare services. This increased use can include over-medicalisation, or over-treatment with interventions designed to cure that are likely futile in people who are dying. This is an issue with medical, ethical, and financial dimensions, and has implications for health policy, funding and the structure of care delivery. We measured the annual use of nine pre-defined public healthcare services between 1 January 2008 and 31 December 2012 by elderly New Zealanders (65-99 years old) in their last year of life and compared it with that of the cohort of elderly New Zealanders who used healthcare in the period but did not die. We used linked, encrypted unique patient identifiers to reorganise and filter records in routinely collected national healthcare utilisation and mortality administrative datasets. We found that, in New Zealand, people do seem to use more of most health services in their last year of life than those of the same age who are not in their last year of life. However, as they advance in age, particularly after the age of 90, this difference diminishes for most measures, although it is still substantial for days spent in hospital as an inpatient, and for pharmaceutical dispensings.

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PUBLIC SUPPORT FOR TOBACCO CONTROL POLICIES: THE ROLE OF THE PROTECTION OF CHILDREN AGAINST TOBACCO

May 28, 2018, 2:45 am

≫ Next: Changing the neurology policy landscape in the United States: Misconceptions and facts about epilepsy

≪ Previous: What happens at the end of life? Using linked administrative health data to understand healthcare usage in the last year of life in New Zealand

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Publication date: Available online 26 May 2018
Source:Health Policy
Author(s): Thomas G. Kuijpers, Marc C. Willemsen, Anton E Kunst
Introduction In many countries, health advocates aim to increase public support for tobacco control policies by framing these policies in terms of child protection. We examined whether support for the protection of children is indeed associated with support for tobacco control policies, even among smokers, opponents of state intervention and opponents of a governmental role in tobacco control. Methods We used a survey on a representative sample of Dutch adults of 18 years and older (n = 1,631). The survey measured respondents’ support for banning tobacco displays, raising the age of sale for tobacco to 21 years and limiting tobacco sales to specialized shops. Regression analyses were done to assess the association with respondents’ support for the protection of children against tobacco. In further analyses, subgroup interactions were added. Results Respondents’ support for the protection of children against tobacco with legislation was positively related to support for all three policies. Associations were weaker for smokers (except for raising the age) but similar for opponents of state intervention and opponents of a governmental role in tobacco control. Conclusion This is the first paper to empirically support the idea that emphasizing the need to protect children against tobacco enhances support for tobacco control policies. This ‘child effect’ is effective in all segments of the population, albeit somewhat weaker among smokers.

Changing the neurology policy landscape in the United States: Misconceptions and facts about epilepsy

May 28, 2018, 2:45 am

≫ Next: Continuity of care and its effect on readmissions for COPD patients: A comparative study of Norway and Germany

≪ Previous: PUBLIC SUPPORT FOR TOBACCO CONTROL POLICIES: THE ROLE OF THE PROTECTION OF CHILDREN AGAINST TOBACCO

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Publication date: Available online 26 May 2018
Source:Health Policy
Author(s): David C. Grabowski, Jesse Fishman, Imane Wild, Bruce Lavin
Epilepsy has a relatively high prevalence, and diagnosis and treatment are often challenging. Seizure freedom without significant side effects is the ultimate goal for both physicians and patients, but not always achievable. In those cases, the treatment goals of patients and providers may differ. In the United States, many clinicians continue to prescribe older AEDs, even though newer AEDs have a more desirable safety and tolerability profile, fewer drug–drug interactions, and are associated with lower epilepsy-related hospital visits. Newer AEDs are more commonly prescribed by neurologists and epilepsy center physicians, highlighting the importance of access to specialty care. We report that antiepileptic drugs are not the dominant cost driver for patients with epilepsy and costs are considerably higher in patients with uncontrolled epilepsy. Poor drug adherence is considered a main cause of unsuccessful epilepsy treatment and is associated with increases in inpatient and emergency department admissions and related costs. Interventions and educational programs are needed to address the reasons for nonadherence. Coverage policies placing a higher cost burden on patients with epilepsy lead to lower treatment adherence, which can result in higher future health care spending. Epilepsy is lagging behind other neurological conditions in terms of funding and treatment innovation. Increased investment in epilepsy research may be particularly beneficial given current funding levels and the high prevalence of epilepsy.

Continuity of care and its effect on readmissions for COPD patients: A comparative study of Norway and Germany

May 28, 2018, 2:45 am

≫ Next: Mapping existing hip and knee replacement registries in Europe

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Publication date: Available online 26 May 2018
Source:Health Policy
Author(s): Jayson O. Swanson, Verena Vogt, Leonie Sundmacher, Terje P. Hagen, Tron Anders Moger
Background This study compares continuity of care between Germany – a social health insurance country, and Norway – a national health service country with gatekeeping and patient lists for COPD patients before and after initial hospitalization. We also investigate how subsequent readmissions are affected. Methods Continuity of Care Index (COCI), Usual Provider Index (UPC) and Sequential Continuity Index (SECON) were calculated using insurance claims and national register data (2009–14). These indices were used in negative binomial and logistic regressions to estimate incident rate ratios (IRR) and odds ratios (OR) for comparing readmissions. Results All continuity indices were significantly lower in Norway. One year readmissions were significantly higher in Germany, whereas 30-day rates were not. All indices measured one year after discharge were negatively associated with one-year readmissions for both countries. Significant associations between indices measured before hospitalization and readmissions were only observed in Norway – all indices for one-year readmissions and SECON for 30-day readmissions. Conclusion Our findings indicate higher continuity is associated with reductions in readmissions following initial COPD admission. This is observed both before and after hospitalization in a system with gatekeeping and patient lists, yet only after for a system lacking such arrangements. These results emphasize the need for policy strategies to further investigate and promote care continuity in order to reduce hospital readmission burden for COPD patients.

Mapping existing hip and knee replacement registries in Europe

May 31, 2018, 9:47 am

≫ Next: Innovative pharmaceutical pricing agreements in five European markets: A survey of stakeholder attitudes and experience

≪ Previous: Continuity of care and its effect on readmissions for COPD patients: A comparative study of Norway and Germany

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Publication date: May 2018
Source:Health Policy, Volume 122, Issue 5
Author(s): A. Lübbeke, A.J. Silman, C. Barea, D. Prieto-Alhambra, A.J. Carr
The general shortage of evidence regarding benefits and harms of medical devices has been highlighted following the serious safety concerns with metal-on-metal hip replacements and silicone breast implants and was again pointed out in a recent survey of European Health Technology Assessment institutions. In this context the new European medical device regulation will enforce post-marketing surveillance of existing and new implants. The usefulness of registry data as a source of information for medical device real-world clinical performance and safety has been demonstrated. However, these data might be under-used by researchers and policy makers. One reason for this is the insufficient awareness of their existence. The aim of this review is to provide information to relevant stakeholders on the extent and breadth of the data currently collected in European joint replacement registries. We identified 24 registries, most of them of national coverage. Total numbers of primary total hip and knee replacements included were over 3.1 and 2.5 million records, respectively. The current focus of these registries is on whole-lifespan implant surveillance via revision rate monitoring, quality assessment of surgical and perioperative care, and hospital performance assessment. More recently, national and international comparison and benchmarking have increasingly become part of their endeavors.

Innovative pharmaceutical pricing agreements in five European markets: A survey of stakeholder attitudes and experience

May 31, 2018, 9:47 am

≫ Next: Promoting health-enhancing physical activity in Europe: Current state of surveillance, policy development and implementation

≪ Previous: Mapping existing hip and knee replacement registries in Europe

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Publication date: May 2018
Source:Health Policy, Volume 122, Issue 5
Author(s): William C.N. Dunlop, Alexandra Staufer, Pierre Levy, Guy J. Edwards
Background Innovative pricing agreements for medicines have been used in European markets for more than 20 years, and offer an opportunity for payers and pharmaceutical companies to align on value, optimise speed to patients, and share risk. Developing successful agreements requires alignment between key stakeholders, yet there is a lack of summative data on how current innovative agreements are used in the real-world (e.g. the level of realised access to medicines, and rebates and discounts, which are often non-transparent). Methods This research used a web-based survey of payer stakeholders to determine what kinds of innovative agreements are currently used, anticipated future usage, attitudes, and drivers of adoption. Participants included national and regional payers (or former payers) and hospital-level decision makers. Results Sixty-six payers completed the survey. Respondents expected that the use of innovative pricing agreements will remain the same or increase in the future. Overall, they felt there is a positive attitude towards new schemes, and that innovative agreements are likely to be used when they reduce total costs or reduce uncertainty. Conclusions Given payer expectations, pharmaceutical companies should continue to take a role in ensuring that they have sufficient capacity to support payers in the design and implementation of innovative pricing agreements.

Promoting health-enhancing physical activity in Europe: Current state of surveillance, policy development and implementation

May 31, 2018, 9:47 am

≫ Next: Financial protection in Europe: a systematic review of the literature and mapping of data availability

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Publication date: May 2018
Source:Health Policy, Volume 122, Issue 5
Author(s): João Breda, Jelena Jakovljevic, Giulia Rathmes, Romeu Mendes, Olivier Fontaine, Susanne Hollmann, Alfred Rütten, Peter Gelius, Sonja Kahlmeier, Gauden Galea
This study aims to present information on the surveillance, policy developments, and implementation of physical activity policies in the 28 European Union (EU) countries. Data was collected on the implementation of the EU Recommendation on health-enhancing physical activity (HEPA) across sectors. In line with the monitoring framework proposed in the Recommendation, a questionnaire was designed to capture information on 23 physical activity indicators. Of the 27 EU countries that responded to the survey, 22 have implemented actions on more than 10 indicators, four countries have implemented more than 20 indicators, and one country has fully addressed and implemented all of the 23 indicators of the monitoring framework. The data collected under this HEPA monitoring framework provided, for the first time, an overview of the implementation of HEPA-related policies and actions at the national level throughout the EU. Areas that need more investment are the “Senior Citizens” sector followed by the “Work Environment”, and the “Environment, Urban Planning, and Public Safety” sectors. This information also enabled comparison of the state of play of HEPA policy implementation between EU Member States and facilitated the exchange of good practices.

Financial protection in Europe: a systematic review of the literature and mapping of data availability

May 31, 2018, 9:47 am

≫ Next: Development of voluntary private health insurance in Nordic countries – An exploratory study on country-specific contextual factors

≪ Previous: Promoting health-enhancing physical activity in Europe: Current state of surveillance, policy development and implementation

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Publication date: May 2018
Source:Health Policy, Volume 122, Issue 5
Author(s): Pooja Yerramilli, Óscar Fernández, Sarah Thomson
Background A comprehensive and context-specific approach to monitoring financial protection can provide valuable evidence on progress towards universal health coverage. Objectives This article systematically reviews the literature on financial protection in Europe to identify trends across countries and over time. It also maps the availability of data for regular monitoring in 53 countries. Methods Two people independently searched for studies using a standard strategy. Results were extracted from 54 publications and studies analysed in terms of geographical focus, data sources, methods and depth of analysis. Results Financial protection varies across countries in Europe; substantial changes over time have mainly taken place in the east of the region. Although the data required for regular monitoring are widely available, the literature presents major gaps in geographical scope - most studies focus on middle-income countries; it is not up to date - the latest year of data analysed is 2011; and cross-national comparison is only possible for a handful of countries due to variation in data sources and methods. The literature is also limited in depth. Very few studies go beyond analysing how many people incur catastrophic or impoverishing out-of-pocket payments. Only a small minority analyse who is most likely to experience financial hardship and what drives lack of financial protection. Conclusions The literature provides little actionable evidence on financial protection in Europe.

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Development of voluntary private health insurance in Nordic countries – An exploratory study on country-specific contextual factors

May 31, 2018, 9:47 am

≫ Next: Strategic Purchasing in Practice: Comparing Ten European Countries

≪ Previous: Financial protection in Europe: a systematic review of the literature and mapping of data availability

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Publication date: May 2018
Source:Health Policy, Volume 122, Issue 5
Author(s): Liina-Kaisa Tynkkynen, Nina Alexandersen, Oddvar Kaarbøe, Anders Anell, Juhani Lehto, Karsten Vrangbӕk
The Nordic countries are healthcare systems with tax-based financing and ambitions for universal access to comprehensive services. This implies that distribution of healthcare resources should be based on individual needs, not on the ability to pay. Despite this ideological orientation, significant expansion in voluntary private health insurance (VPHI) contracts has occurred in recent decades. The development and role of VPHIs are different across the Nordic countries. Complementary VPHI plays a significant role in Denmark and in Finland. Supplementary VPHI is prominent in Norway and Sweden. The aim of this paper is to explore drivers behind the developments of the VPHI markets in the Nordic countries. We analyze the developments in terms of the following aspects: the performance of the statutory system (real or perceived), lack of coverage in certain areas of healthcare, governmental interventions or inability to reform the system, policy trends and the general socio-cultural environment, and policy responses to voting behavior or lobbying by certain interest groups. It seems that the early developments in VPHI markets have been an answer to the gaps in the national health systems created by institutional contexts, political decisions, and cultural interpretations on the functioning of the system. However, once the market is created it introduces new dynamics that have less to do with gaps and inflexibilities and more with cultural factors.

Strategic Purchasing in Practice: Comparing Ten European Countries

May 31, 2018, 9:47 am

≫ Next: Cross-country comparative research – Lessons from advancing health system and policy research on the occasion of the European Observatory on Health Systems and Policies’ 20th anniversary

≪ Previous: Development of voluntary private health insurance in Nordic countries – An exploratory study on country-specific contextual factors

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Publication date: May 2018
Source:Health Policy, Volume 122, Issue 5
Author(s): Katarzyna Klasa, Scott L. Greer, Ewout van Ginneken
Strategic purchasing of health care services is widely recommended as a policy instrument. We conducted a review of literature of material drawn from the European Observatory on Health Systems and Policies Health Systems in Transition series, other European Observatory databases, and selected country-specific literature to augment the comparative analysis by providing the most recent healthcare trends in ten selected countries. There is little evidence of purchasing being strategic according to any of the established definitions. There is little or no literature suggesting that existing purchasing mechanisms in Europe deliver improved population health, citizen empowerment, stronger governance and stewardship, or develop purchaser organization and capacity. Strategic purchasing has not generally been implemented. Policymakers considering adopting strategic purchasing policies should be aware of this systemic implementation problem. Policymakers in systems with strategic purchasing built into policy should not assume that a purchasing system is strategic or that it is delivering any expected objectives. However, there are individual components of strategic purchasing that are worth pursuing and can provide benefits to health systems.

Cross-country comparative research – Lessons from advancing health system and policy research on the occasion of the European Observatory on Health Systems and Policies’ 20th anniversary

May 31, 2018, 9:47 am

≫ Next: Editorial Board

≪ Previous: Strategic Purchasing in Practice: Comparing Ten European Countries

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Publication date: May 2018
Source:Health Policy, Volume 122, Issue 5
Author(s): Reinhard Busse, Ewout van Ginneken

Editorial Board

May 31, 2018, 9:47 am

≫ Next: The methodological quality of nurse-sensitive indicators in Dutch hospitals: a descriptive exploratory research study

≪ Previous: Cross-country comparative research – Lessons from advancing health system and policy research on the occasion of the European Observatory on Health Systems and Policies’ 20th anniversary

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Publication date: May 2018
Source:Health Policy, Volume 122, Issue 5

The methodological quality of nurse-sensitive indicators in Dutch hospitals: a descriptive exploratory research study

June 1, 2018, 11:13 am

≫ Next: The impact of electronic health record systems on clinical documentation times: a systematic review

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Publication date: Available online 1 June 2018
Source:Health Policy
Author(s): R.A.M.M. Kieft, D. Stalpers, A.P.M. Jansen, A.L. Francke, D.M.J. Delnoij
Objective Nurse-sensitive indicators (NSIs) are increasingly being developed and used to establish quality of nursing care in Western countries. The objective was to gain insights into the methodological quality of mandatory NSIs in Dutch hospitals, including indicators for pain, wound care, malnutrition and delirium. Design A descriptive exploratory design was used, starting with desk research into publicly available documents and reports describing the development of the NSIs included in this study. We used the validated Appraisal of Indicators through Research and Evaluation (AIRE) instrument to evaluate the methodological quality. Results Although the purpose and relevance of each individual NSI have been described, no detailed information about the criteria for selecting these topics is available. It is not clear which specific stakeholders participated and how their input was used. We found no information about the process of collecting and compiling scientific evidence. It is unclear whether and to what extent the usability of NSIs has been tested. Conclusion The methodological quality of NSIs used in Dutch hospitals is less than optimal in various ways and it is therefore questionable if the indicators are accurate enough to identify changes or improve nursing practice. Our study also provides an example of how the methodological quality of NSIs can be assessed systematically, which is relevant considering the increasing use of NSIs in various countries.

The impact of electronic health record systems on clinical documentation times: a systematic review

June 8, 2018, 10:03 pm

≫ Next: Taking the measure of the profession: physician associations in the measurement age

≪ Previous: The methodological quality of nurse-sensitive indicators in Dutch hospitals: a descriptive exploratory research study

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Publication date: Available online 5 June 2018
Source:Health Policy
Author(s): Lisa Ann Baumann, Jannah Baker, Adam G. Elshaug
Background Effective management of hospital staff time is crucial to quality patient care. Recent years have seen widespread implementation of electronic health record (EHR) systems but the effect of this on documentation time is unknown. This review compares time spent on documentation tasks by hospital staff (physicians, nurses and interns) before and after EHR implementation. Methods A systematic search identified 8,153 potentially relevant citations. Studies examining proportion of total workload spent on documentation with ≥40 hours of staff observation time were included. Meta-analysis was performed for physicians, nurses and interns comparing pre- and post-EHR results. Studies were weighted by person-hours observation time. Results Twenty-eight studies met selection criteria. Seventeen were pre-EHR, nine post-EHR and two examined both periods. With implementation of EHR, physicians’ documentation time increased from 16% (95% confidence interval (CI) 11–22%) to 28% (95% CI 19–37%), nurses from 9% (95% CI 6–12%) to 23% (95% CI 15–32%) and interns from 20% (95% CI 7–32%) to 26% (95% CI 10–42%). Conclusions There is a lack of long-term follow-up on the effects of EHR implementation. Initial adjustment to EHR appears to increase documentation time but there is some evidence that as staff become more familiar with the system, it may ultimately improve work flow.

Taking the measure of the profession: physician associations in the measurement age

June 8, 2018, 10:03 pm

≫ Next: A cost-effectiveness analysis of lowering residential radon levels in Sweden—Results from a modelling study

≪ Previous: The impact of electronic health record systems on clinical documentation times: a systematic review

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Publication date: Available online 8 June 2018
Source:Health Policy
Author(s): Baruch Levi, Amos Zehavi, David Chinitz
Systematic measurement of healthcare services enables evaluation of health professionals' quality of work. Whereas policy makers find measurement a useful mechanism for quality improvement, a public choice perspective implies that physicians would resent such an initiative, which undermines their professional autonomy. In this article, we compare two healthcare systems of economically developed countries - Israel and the UK. Both systems share common features such as universal coverage, strong state intervention, and enthusiasm for New Public Management. In both countries, quality measurement was introduced in acute care hospitals at around the same time. However, while the UK succeeded in establishing a framework of surgical outcome measures during the 2000 s, a similar initiative in Israel failed completely during the 1990 s. We also refer to subsequent quality indicator efforts in Israel, in both community and hospital frameworks, that were more successful, but in a way that reinforces our central thesis. We contend that differences in reform outcomes stem from the medical profession's reaction to government's endeavors. This response, in turn, hinges on the professional organizations' relative institutional position vis-a-vis state authorities. This study constitutes a unique investigation of the medical profession's response to critical quality measurement reforms. Most importantly, it stresses the institutional position of medical associations as the primary factor in explaining cross-case variation in government's success in introducing quality measurement.

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A cost-effectiveness analysis of lowering residential radon levels in Sweden—Results from a modelling study

June 23, 2018, 9:04 pm

≫ Next: Does multimorbidity still remain a matter of the elderly: Lithuanian national data analysis

≪ Previous: Taking the measure of the profession: physician associations in the measurement age

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Publication date: June 2018
Source:Health Policy, Volume 122, Issue 6
Author(s): Mikael Svensson, Lars Barregård, Gösta Axelsson, Eva Andersson
Purpose Residential exposure to radon is considered as the second leading cause of lung cancer after smoking. The purpose of this study was to conduct a cost-effectiveness analysis of reducing the indoor radon levels in Sweden from the current reference level of 200 Bq/m³ to the WHO suggested reference level of maximum 100 Bq/m³. Methods We constructed a decision-analytic cost-effectiveness model using input data from published literature and administrative records. The model compared the increase in economic costs to the health benefits of lower indoor radon-levels in a Swedish policy context. We estimated the cost per life-year and quality adjusted life year (QALY) gained and assessed the robustness of the results using both deterministic and probabilistic sensitivity analysis. Results Including (excluding) costs of added life years the cost per QALY for existing homes was €130,000 (€99,000). For new homes the cost per QALY including (excluding) costs of added life years was €39,000 (€25,000). Conclusions The results indicate that it is not cost-effective to reduce indoor radon levels from 200 Bq/m³ to a maximum of 100 Bq/m³ in existing homes, whereas it is cost-effective for new homes.

Does multimorbidity still remain a matter of the elderly: Lithuanian national data analysis

June 23, 2018, 9:04 pm

≫ Next: Strengthening the public health workforce: An estimation of the long-term requirements for public health specialists in Serbia

≪ Previous: A cost-effectiveness analysis of lowering residential radon levels in Sweden—Results from a modelling study

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Publication date: June 2018
Source:Health Policy, Volume 122, Issue 6
Author(s): E. Jurevičienė, G. Onder, Ž. Visockienė, R. Puronaitė, D. Petrikonytė, U. Gargalskaitė, V. Kasiulevičius, R. Navickas
Introduction Multimorbidity – the coexistence of ≥2 chronic conditions in same individual is usually associated with older age. There is an increase in its prevalence at a much younger age, however with very limited research specifying that. Objective To identify age breaking points for the occurrence of multimorbidity. Methods The study included patients, who used any healthcare services between the 01/01/2012 and 30/06/2014. Patients were divided into two groups – with single chronic condition and with multimorbidity. Age-specific proportion of multimorbidity, rate of primary and outpatient visits, number of hospitalizations and prescribed reimbursed medications between these groups were analyzed. Results The study included 452578 patients, 94.63% of them had more than one chronic condition. The risk increase with every consecutive year for developing multimorbidity was between the age of 28 and 39 years. The age breaking point for the rapid increase in hospitalizations was about 29 years in multimorbidity group. The proportion of patients with multimorbidity using expensive medications starts to increase at the age of 41. Conclusions The risk of acquiring an additional chronic condition rises exponentially from the age of 29 years and platos between the age of 51 and 57. Patients with multimorbidity require increasing amounts of primary healthcare resources, where patients with single chronic condition require decreasing primary care usage, possibly attributed to successful patient empowerment.

Strengthening the public health workforce: An estimation of the long-term requirements for public health specialists in Serbia

June 23, 2018, 9:04 pm

≫ Next: The impact of pay-for-performance on the quality of care in ophthalmology: Empirical evidence from Germany

≪ Previous: Does multimorbidity still remain a matter of the elderly: Lithuanian national data analysis

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Publication date: June 2018
Source:Health Policy, Volume 122, Issue 6
Author(s): Milena Santric Milicevic, Milena Vasic, Matt Edwards, Cristina Sanchez, John Fellows
At the beginning of the 21st century, planning the public health workforce requirements came into the focus of policy makers. The need for improved provision of essential public health services, driven by a challenging non-communicable disease and causes of death and disability within Serbia, calls for a much needed estimation of the requirements of the public health professionals. Mid and long-term public health specialists’ supply and demand estimations out to 2025were developed based on national staffing standards and regional distribution of the workforce in public health institutes of Serbia. By 2025, the supply of specialists, taking into account attrition rate of −1% reaches the staffing standard. However, a slight increase in attrition rates has the impact of revealing supply shortage risks. Demand side projections show that public health institutes require an annual input of 10 specialists or 2.1% annual growth rate in order for the four public health fields to achieve a headcount of 487 by 2025 as well as counteract workforce attrition rates. Shortage and poor distribution of public health specialists underline the urgent need for workforce recruitment and retention in public health institutes in order to ensure the coordination, management, surveillance and provision of essential public health services over the next decade.

The impact of pay-for-performance on the quality of care in ophthalmology: Empirical evidence from Germany

June 23, 2018, 9:04 pm

≫ Next: Out-of-pocket costs, primary care frequent attendance and sample selection: Estimates from a longitudinal cohort design

≪ Previous: Strengthening the public health workforce: An estimation of the long-term requirements for public health specialists in Serbia

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Publication date: June 2018
Source:Health Policy, Volume 122, Issue 6
Author(s): T. Herbst, J. Foerster, M. Emmert
Background Pay-for-performance (P4P) has become a popular approach to increase effectiveness and efficiency in healthcare. So far, there is little evidence regarding the potential of P4P in the German healthcare setting. The aim of this study was to determine the impact of P4P on the quality of care in cataract surgery. Methods In 2012, a P4P program was implemented in a German surgical centre for ophthalmology. Five quality measures regarding process quality, outcomes, and patient satisfaction were measured over a period of 4.5 years. The P4P scheme consisted of bonus and penalty payments accounting for five per cent of total compensation. Overall, 1657 P4P cases were examined and compared with 4307 control cases. Interrupted time series and group comparisons were conducted to identify quality and spill-over effects. Results We found a positive impact on process quality and patient satisfaction before the implementation of the P4P scheme, but declining trends during and after the implementation. Our findings did not show an impact of P4P on outcome measures. Furthermore, P4P did not result in better quality of care, compared with the German hospital-based reimbursement scheme. Conclusion This study did not show any positive long-term effects of the implementation of P4P on quality of care. Therefore, our results do not support the hypothesis that P4P leads to significant improvements in quality of care.

Out-of-pocket costs, primary care frequent attendance and sample selection: Estimates from a longitudinal cohort design

June 23, 2018, 9:04 pm

≫ Next: Equity in access to care in the era of health system reforms in Turkey

≪ Previous: The impact of pay-for-performance on the quality of care in ophthalmology: Empirical evidence from Germany

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Publication date: June 2018
Source:Health Policy, Volume 122, Issue 6
Author(s): Carly Pymont, Paul McNamee, Peter Butterworth
This paper examines the effect of out-of-pocket costs on subsequent frequent attendance in primary care using data from the Personality and Total Health (PATH) Through Life Project, a representative community cohort study from Canberra, Australia. The analysis sample comprised 1197 respondents with two or more GP consultations, and uses survey data linked to administrative health service use (Medicare) data which provides data on the number of consultations and out-of-pocket costs. Respondents identified in the highest decile of GP use in a year were defined as Frequent Attenders (FAs). Logistic regression models that did not account for potential selection effects showed that out-of-pocket costs incurred during respondents’ prior two consultations were significantly associated with subsequent FA status. Respondents who incurred higher costs ($15–$35; or >$35) were less likely to become FAs than those who incurred no or low (<AUS$15 per consultation) costs, with no difference evident between the no and low-cost groups. However, a counterfactual model that adjusted for factors associated with the selection into payment levels did not find an influence of payment, with only a non-significant gradient in the expected direction. Hence these findings raise doubts that price drives FA behaviour, suggesting that co-payments are unlikely to affect the number of GP consultations amongst frequent attenders.