Why did some Danish counties introduce breast cancer screening and others not? An exploratory study of four selected counties

2008 ◽  
Vol 24 (03) ◽  
pp. 326-332
Author(s):  
Kasper Hjulmann ◽  
Hindrik Vondeling ◽  
Mickael Bech
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Priority Setting ◽  
Central Government ◽  
Ethical Issues ◽  
County Level ◽  
Healthcare Provision ◽  
Policy Documents ◽  
Explanatory Factors ◽  
A Minor

Objectives:Of the fourteen counties and two municipalities that until recently were responsible for healthcare provision in Denmark, five introduced mammography screening (MS) programs. The objective of this research is to explain this decision-making variation and to gain insight into priority setting processes in health-care provision at the county level in Denmark.Methods:Literature on priority setting in health care was used to derive seven explanatory factors for comparing decision making on MS between four selected counties, of which two had implemented MS. The relative importance of each explanatory factor in each county was determined by analyzing policy documents, supplemented with interviews of selected stakeholders. The results were combined and compared at the county level.Results:Evidence of effectiveness of MS was considered satisfactory and ethical issues related to MS were perceived relatively unproblematic only in those counties that introduced MS. Lack of resources, that is, radiologists, was an additional important factor for counties not implementing MS. Local opinion leaders have played a stimulating role, whereas advisory policy documents at the central government level and even legislation have had a minor impact.Conclusions:The four counties have based their decision making on the introduction of MS on different combinations of a limited number of factors that have been differentially weighted. The pattern of relevant factors in both counties not introducing MS is rather similar. The study elucidates the role of complementary factors to evidence in decision making. Of interest, recent public sector reforms have resulted in the decision to have MS implemented nationwide.

Technology assessment, priority setting and appropriate care in Dutch health care

2004 ◽  
Vol 20 (4) ◽  
pp. 564-564 ◽  
Author(s):  
Marc Berg ◽  
Tom van der Grinten ◽  
Niek Klazinga
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Comparative Analysis ◽  
Priority Setting ◽  
Technology Assessment ◽  
Economic Evaluations ◽  
Technol Assess Health ◽  
Appropriate Care ◽  
Dutch Health ◽  
Dutch Health Care

References 8, 29, and 32 are incorrect as they appear in the article entitled “Technology assessment, priority setting, and appropriate care in Dutch health care,” by Marc Berg, Tom van der Grinten, and Niek Klazinga (Int J Technol Assess Health Care. 2004;20[1]:35-43). They should appear as follows: 8. Burgers JS, Bailey JV, Klazinga NS, et al. Inside guidelines: comparative analysis of recommendations and evidence in diabetes guidelines from 13 countries. Diabetes Care 2002;11:1933-1939.29. Zwart-van Rijkom JE, Leufkens HG, Busschbach JJ, et al. Differences in attitudes, knowledge and use of economic evaluations in decision-making in The Netherlands. The Dutch results from the EUROMET Project. Pharmacoeconomics 2000;2:149-160.32. Van der Grinten TED. Hervorming van de gezondheidszorg. Zal het deze keer wel lukken? Beleid & Maatschappij 2002;3:172-176.

Supporting tough decisions in Norway: A healthcare system approach

2010 ◽  
Vol 26 (4) ◽  
pp. 398-404 ◽  
Author(s):  
Berit Mørland ◽  
Ånen Ringard ◽  
John-Arne Røttingen
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Organizational Structure ◽  
Healthcare System ◽  
Priority Setting ◽  
System Approach ◽  
Health Technology ◽  
Complex Task ◽  
Key Stakeholders ◽  
Priorities In Health Care

Objectives: We describe, in general, the principles used in priority setting and, in particular, policy processes and decision making in Norway.Methods: A newly established council for setting priorities in health care is presented to illustrate how health technology assessments (HTAs) can support national advisors in complex priority-setting processes.Results and Conclusions: Setting priorities in health care is a complex task. Careful thinking is, therefore, required in determining the components of a system for priority-setting. Based on recent Norwegian experiences, we believe that the following generic parts may provide some of the solution: a common set of values; an organizational structure made up of key stakeholders; supporting mechanisms in the form of HTA organizations and documented best evidence; and loyalty to decisions by stakeholders responsible for implementing national policies.

Participation in health care priority-setting through the eyes of the participants

2002 ◽  
Vol 7 (4) ◽  
pp. 222-229 ◽  
Author(s):  
Douglas Martin ◽  
Julia Abelson ◽  
Peter Singer
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Priority Setting ◽  
Decision Makers ◽  
Medical Specialist ◽  
Committee Chair ◽  
The Public ◽  
Health Care Priority Setting ◽  
Patient Representative

Objectives: The literature on participation in priority-setting has three key gaps: it focuses on techniques for obtaining public input into priority-setting that are consultative mechanisms and do not involve the public directly in decision-making; it focuses primarily on the public's role in priority-setting, not on all potential participants; and the range of roles that various participants play in a group making priority decisions has not been described. To begin addressing these gaps, we interviewed individuals who participated on two priority-setting committees to identify key insights from participants about participation. Methods: A qualitative study consisting of interviews with decision-makers, including patients and members of the public. Results: Members of the public can contribute directly to important aspects of priority-setting. The participants described six specific priority-setting roles: committee chair, administrator, medical specialist, medical generalist, public representative and patient representative. They also described the contributions of each role to priority-setting. Conclusions: Using the insights from decision-makers, we have described lessons related to direct involvement of members of the public and patients in priority-setting, and have identified six roles and the contributions of each role.

scholarly journals Describing practices of priority setting and resource allocation in publicly funded health care systems of high-income countries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Brayan V. Seixas ◽  
Dean A. Regier ◽  
Stirling Bryan ◽  
Craig Mitton
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Resource Allocation ◽  
Priority Setting ◽  
Health Care Systems ◽  
Scientific Work ◽  
Developed Countries ◽  
High Income ◽  
Publicly Funded ◽  
Care Systems

Abstract Background Healthcare spending has grown over the last decades in all developed countries. Making hard choices for investments in a rational, evidence-informed, systematic, transparent and legitimate manner constitutes an important objective. Yet, most scientific work in this area has focused on developing/improving prescriptive approaches for decision making and presenting case studies. The present work aimed to describe existing practices of priority setting and resource allocation (PSRA) within the context of publicly funded health care systems of high-income countries and inform areas for further improvement and research. Methods An online qualitative survey, developed from a theoretical framework, was administered with decision-makers and academics from 18 countries. 450 individuals were invited and 58 participated (13% of response rate). Results We found evidence that resource allocation is still largely carried out based on historical patterns and through ad hoc decisions, despite the widely held understanding that decisions should be based on multiple explicit criteria. Health technology assessment (HTA) was the tool most commonly indicated by respondents as a formal priority setting strategy. Several approaches were reported to have been used, with special emphasis on Program Budgeting and Marginal Analysis (PBMA), but limited evidence exists on their evaluation and routine use. Disinvestment frameworks are still very rare. There is increasing convergence on the use of multiple types of evidence to judge the value of investment options. Conclusions Efforts to establish formal and explicit processes and rationales for decision-making in priority setting and resource allocation have been still rare outside the HTA realm. Our work indicates the need of development/improvement of decision-making frameworks in PSRA that: 1) have well-defined steps; 2) are based on multiple criteria; 3) are capable of assessing the opportunity costs involved; 4) focus on achieving higher value and not just on adoption; 5) engage involved stakeholders and the general public; 6) make good use and appraisal of all evidence available; and 6) emphasize transparency, legitimacy, and fairness.

Evaluation of a deliberative approach to citizen involvement in health care priority setting

2014 ◽  
Vol 27 (1) ◽  
pp. 5-19 ◽  
Author(s):  
Iestyn Williams ◽  
Daisy Phillips ◽  
Charles Nicholson ◽  
Heather Shearer
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Decision Making ◽  
Public Engagement ◽  
Priority Setting ◽  
Primary Care Trust ◽  
Content Type ◽  
The Public ◽  
Novel Approach ◽  
Health Care Priority Setting

Purpose – The purpose of this paper is to describe and evaluate a novel approach to citizen engagement in health priority setting carried out in the context of Primary Care Trust (PCT) commissioning in the English National Health Service. Design/methodology/approach – Four deliberative events were held with 139 citizens taking part in total. Events design incorporated elements of the Twenty-first Century Town Meeting and the World Café, and involved specially-designed dice games. Evaluation surveys reporting quantitative and qualitative participant responses were combined with follow-up interviews with both PCT staff and members of the public. An evaluation framework based on previous literature was employed. Findings – The evaluation demonstrates high levels of enjoyment, learning and deliberative engagement. However, concerns were expressed over the leading nature of the voting questions and, in a small minority of responses, the simplified scenarios used in dice games. The engagement exercises also appeared to have minimal impact on subsequent Primary Care Trust resource allocation, confirming a wider concern about the influence of public participation on policy decision making. The public engagement activities had considerable educative and political benefits and overall the evaluation indicates that the specific deliberative tools developed for the exercise facilitated a high level of discussion. Originality/value – This paper helps to fill the gap in empirical evaluations of deliberative approaches to citizen involvement in health care priority setting. It reports on a novel approach and considers a range of implications for future research and practice. The study raises important questions over the role of public engagement in driving priority setting decision making.

scholarly journals Allocation of scarce resources in health care: values and concepts

2006 ◽  
Vol 15 (spe) ◽  
pp. 125-134
Author(s):  
Per-Erik Liss
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Decision Making ◽  
Cost Effectiveness ◽  
Priority Setting ◽  
Ethical Principles ◽  
Health Care Need ◽  
Scarce Resources ◽  
Short Presentation

In many countries, a gap exists between the population's need for health care and available resources. These nations have attempted to eliminate or reduce the gap through such activities as improving efficiency and narrowing responsibilities. Since these measures have proven insufficient, decisions must be made regarding how to best use the scarce resources. The priority-setting and rationing processes involve key decisions in the sense that they have consequences for people's health and quality of life and they should therefore be rational and based on solid grounds. This means that the decisions involve three issues: facts, concepts and values. In this presentation the focus is on the conceptual and value issues. A basic ethical platform as a guide for decision-making will be presented. The ethical principles that constitute the platform contain central concepts like health care need, cost-effectiveness, health and goal. A short presentation of these concepts will be carried out. This will end with the concept of a goal and its importance for decision-making.

scholarly journals Reconciling mental health, public policing and police accountability

2018 ◽  
Vol 92 (1) ◽  
pp. 72-94 ◽  
Author(s):  
John LM McDaniel
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Policy Documents ◽  
Cultural Attitude ◽  
England And Wales ◽  
Parliamentary Debates ◽  
Police Accountability

The paper evaluates a range of policy documents, parliamentary debates, academic reports and statutes in an attempt to contextualise the condition of mental health policing in England and Wales. It establishes that mental health care plays an important role in public policing and argues that police organisations need to institute urgent reforms to correct a prevailing culture of complacency. An unethical cultural attitude towards mental health care has caused decision-making and the exercise of police discretion to be neither well informed nor protective in many cases, resulting in the substandard treatment of people with mental health problems. The paper argues that changes introduced by the Policing and Crime Act 2017 and the revised College of Policing mental health guidelines do not go far enough and that more extensive root-and-branch reforms are needed.

Ethical Issues

2021 ◽  
pp. 176-203
Author(s):  
Dena S. Davis ◽  
Paul T. Menzel
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Directives ◽  
Moral Distress ◽  
Ethical Issues ◽  
Severe Dementia ◽  
Relevant Change ◽  
Decision Making Capacity ◽  
Behavioral Expression ◽  
Pain And Suffering

The implementation of advance directives to withhold food and water by mouth faces significantly more challenges than VSED by persons with decision-making capacity, though with sufficient care and attention, many of these can be resolved. Reduced awareness may leave the person with little understanding of her directive or no awareness at all. In severe dementia, is behavioral expression of a simple desire for food or drink a relevant change of mind about the directive, or by then does the person no longer have the capacity to make such a change? How relevant is the moral distress that caregivers and health care agents will often experience when implementing the person’s directive, or when they are unable to get it implemented? Patients in severe dementia also may be relatively content, with little pain and suffering—is the deterioration itself, without pain and suffering, a legitimate reason for implementing a VSED directive?

scholarly journals Agency and Famine in China's Sichuan Province, 1958–1962

2011 ◽  
Vol 208 ◽  
pp. 990-1008 ◽  
Author(s):  
Chris Bramall
Keyword(s):  
Government Policy ◽  
Central Government ◽  
Sichuan Province ◽  
Minor Role ◽  
County Level ◽  
Death Toll ◽  
Level Data ◽  
A Minor

AbstractA revisionist literature on the Great Chinese Famine has emerged in recent years. These revisionists focus primarily on the question of agency. They claim that that neither poor weather nor the excesses of local cadres can explain the extent of mortality; rather, responsibility lies squarely with Mao and the CCP leadership. Using county-level data on mortality, output, rainfall and temperature for Sichuan province, I argue that this revisionist view is unconvincing. Weather admittedly played only a minor role, and the zealotry of the Party centre contributed significantly to the death toll. However, variations in mortality between Sichuan's counties appear to have been essentially random – suggesting that differences in local cadre responses to central government policy were decisive in determining the scale of famine.

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