Ethics and Efficiency in the Provision of Health Care

1988 ◽  
Vol 23 ◽  
pp. 111-126
Author(s):  
Alan Williams
Keyword(s):  
Health Care ◽  
Driving Force ◽  
Mortality Rates ◽  
Equal Access ◽  
Demographic Structure ◽  
Major Purpose ◽  
Relative Mortality ◽  
Distribution Rule ◽  
The Uk ◽  
The Impact

1.1. A major purpose in nationalizing the provision of health care in the UK was to affect its distribution between people, and, in particular, to minimize the impact of willingness and ability to pay upon that distribution. It has never been clear, however, what alternative distribution rule is to apply. There is no shortage of rhetoric about ‘equality’ and ‘need’, but most of it is vacuous, by which I mean it does not lead to any clear operational guidelines about who should get priority and at whose expense. The closest we have got so far to such explicit guidelines has been the formulae which determine the geographical distribution of NHS funds, the driving force behind which is a notion of need based on relative mortality rates and on the demographic structure. The avowed objective is to bring about equal access for equal need irrespective of where in the UK you happen to be.

Ethics and Efficiency in the Provision of Health Care

1988 ◽  
Vol 23 ◽  
pp. 111-126 ◽  
Author(s):  
Alan Williams
Keyword(s):  
Health Care ◽  
Driving Force ◽  
Mortality Rates ◽  
Equal Access ◽  
Demographic Structure ◽  
Major Purpose ◽  
Relative Mortality ◽  
Distribution Rule ◽  
The Uk ◽  
The Impact

1.1. A major purpose in nationalizing the provision of health care in the UK was to affect its distribution between people, and, in particular, to minimize the impact of willingness and ability to pay upon that distribution. It has never been clear, however, what alternative distribution rule is to apply. There is no shortage of rhetoric about ‘equality’ and ‘need’, but most of it is vacuous, by which I mean it does not lead to any clear operational guidelines about who should get priority and at whose expense. The closest we have got so far to such explicit guidelines has been the formulae which determine the geographical distribution of NHS funds, the driving force behind which is a notion of need based on relative mortality rates and on the demographic structure. The avowed objective is to bring about equal access for equal need irrespective of where in the UK you happen to be.

scholarly journals The determinants of Covid-19 mortality rates across Europe

REGION ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 199-219
Author(s):  
Yannis Psycharis ◽  
Cleon Tsimbos ◽  
Georgia Verropoulou ◽  
Leonidas Doukissas
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Mortality Rates ◽  
Policy Implications ◽  
Economic Conditions ◽  
Demographic Structure ◽  
Death Rates ◽  
Level Of Economic Development ◽  
Care Systems ◽  
The Impact

The aim of this paper is to examine empirically the impact of the demographic structure and socio-economic environment on the Covid-19 mortality rate across 29 European countries. The analysis is based on empirical data recorded cumulatively from the start of the Covid-19 disease until 26th May 2020 covering ‘the first wave of the pandemic’. Results indicate that, although countries with a higher degree of ageing structure are anticipated to be more vulnerable to Covid-19, this study provides evidence that population ageing contributes only marginally to Covid-19 death rates across Europe. Urbanization, the level of economic development and health care systems, seem to better explain patterns of interstate mortality rates. The analysis provides important policy implications since it underlines the importance of urbanization and socio-economic conditions in the accelerating incidence of casualties and signifies the importance of health care systems for the protection of people and places from the pandemic.    

The Impact of Age on Colorectal Cancer Incidence, Treatment, and Outcomes in an Equal-Access Health Care System

2014 ◽  
Vol 57 (3) ◽  
pp. 303-310 ◽  
Author(s):  
Scott R. Steele ◽  
Grace E. Park ◽  
Eric K. Johnson ◽  
Matthew J. Martin ◽  
Alexander Stojadinovic ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Health Care System ◽  
Cancer Incidence ◽  
Equal Access ◽  
Colorectal Cancer Incidence ◽  
The Impact ◽  
Care System

NEONATAL MORTALITY IN THE EMPOWERED ACTION GROUP STATES OF INDIA: TRENDS AND DETERMINANTS

2008 ◽  
Vol 40 (2) ◽  
pp. 183-201 ◽  
Author(s):  
PERIANAYAGAM AROKIASAMY ◽  
ABHISHEK GAUTAM
Keyword(s):  
Health Care ◽  
Infant Mortality ◽  
Neonatal Mortality ◽  
Universal Coverage ◽  
Mortality Rates ◽  
Mortality Data ◽  
Registration System ◽  
Action Group ◽  
Eag States ◽  
The Impact

SummaryIn India, the eight socioeconomically backward states of Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttaranchal and Uttar Pradesh, referred to as the Empowered Action Group (EAG) states, lag behind in the demographic transition and have the highest infant mortality rates in the country. Neonatal mortality constitutes about 60% of the total infant mortality in India and is highest in the EAG states. This study assesses the levels and trends in neonatal mortality in the EAG states and examines the impact of bio-demographic compared with health care determinants on neonatal mortality. Data from India’s Sample Registration System (SRS) and National Family and Health Survey (NFHS-2, 1998–99) are used. Cox proportional hazard models are applied to estimate adjusted neonatal mortality rates by health care, bio-demographic and socioeconomic determinants. Variations in neonatal mortality by these determinants suggest that universal coverage of all pregnant women with full antenatal care, providing assistance at delivery and postnatal care including emergency care are critical inputs for achieving a reduction in neonatal mortality. Health interventions are also required that focus on curtailing the high risk of neonatal deaths arising from the mothers’ younger age at childbirth, low birth weight of children and higher order births with short birth intervals.

scholarly journals REDUCING HEALTH DISPARITIES IN THE ERA OF VALUE-BASED CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S562-S563
Author(s):  
Amit Kumar ◽  
Elham Mahmoudi ◽  
Maricruz Rivera-Hernandez
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Puerto Rico ◽  
Mortality Rates ◽  
Minority Populations ◽  
Social Risk ◽  
Social Risk Factors ◽  
Physician Visits ◽  
The Us ◽  
The Impact

Abstract The US health care system is at a critical moment of transformation. The implementation of value-based models has made significant progress towards improving care quality and coordination, continuity of care and reducing cost. However, concerns have been raised regarding “cherry-picking” healthier people that may negatively impact patients with more complex needs and minority populations. Given that the US is becoming more diverse, there is a need for understanding the impact of social risk factors including ethnicity, immigration status, income and geography on health outcomes and issues of health care disparities. This panel brings together four studies that examine these phenomena in minority populations. These studies will provide novel insight regarding 1) healthcare utilization in Mexican-American Medicare beneficiaries and showing that social determinants of health are associated with a higher risk of hospitalization, emergency room admissions, and outpatient visits. 2) Mortality rates and predialysis care among Hispanics in the US, Hispanics in Puerto Rico, and Whites in the US demonstrating substantial disparities in access to recommended nephrology care for Hispanics in Puerto Rico; 3) Trends in age-adjusted mortality rates and supply of physicians in states with different nurse-practitioners regulation. 4) The impact of social risk factors on disenrollment from Fee-For-Service and enrollment in a Medicare Advantage plan in older Mexican-Americans. 5) Racial disparities in access to physician visits, prescription drugs, and healthcare spending among older adults with cognitive limitation. Studies in this panel will also discuss the effects of changes in care delivery and payment innovations in improving health equity.

scholarly journals Examining the impact of introducing ICD-MM on observed trends in maternal mortality rates in the UK 2003–13

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Marian Knight ◽  
◽  
Manisha Nair ◽  
Peter Brocklehurst ◽  
Sara Kenyon ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Mortality Rates ◽  
The Uk ◽  
The Impact

scholarly journals The impact of Cochrane Reviews: a mixed-methods evaluation of outputs from Cochrane Review Groups supported by the National Institute for Health Research

2015 ◽  
Vol 19 (28) ◽  
pp. 1-100 ◽  
Author(s):  
Frances Bunn ◽  
Daksha Trivedi ◽  
Phil Alderson ◽  
Laura Hamilton ◽  
Alice Martin ◽  
...  
Keyword(s):  
Health Care ◽  
Systematic Reviews ◽  
Health Research ◽  
Cochrane Review ◽  
Economic Benefits ◽  
Value For Money ◽  
Health Technologies ◽  
Cochrane Reviews ◽  
The Uk ◽  
The Impact

BackgroundThe last few decades have seen a growing emphasis on evidence-informed decision-making in health care. Systematic reviews, such as those produced by Cochrane, have been a key component of this movement. The National Institute for Health Research (NIHR) Systematic Review Programme currently supports 20 Cochrane Review Groups (CRGs) in the UK and it is important that this funding represents value for money.Aims and objectivesThe overall aim was to identify the impacts and likely impacts on health care, patient outcomes and value for money of Cochrane Reviews published by 20 NIHR-funded CRGs during the years 2007–11.DesignWe sent questionnaires to CRGs and review authors, undertook interviews with guideline developers (GDs) and used bibliometrics and documentary review to get an overview of CRG impact and to evaluate the impact of a sample of 60 Cochrane Reviews. The evaluation was guided by a framework with four categories (knowledge production, research targeting, informing policy development and impact on practice/services).ResultsA total of 3187 new and updated reviews were published on the Cochrane Database of Systematic Reviews between 2007 and 2011, 1502 (47%) of which were produced by the 20 CRGs funded by the NIHR. We found 40 examples where reviews appeared to have influenced primary research and reviews had contributed to the creation of new knowledge and stimulated debate. Twenty-seven of the 60 reviews had 100 or more citations in Google Scholar™ (Google, CA, USA). Overall, 483 systematic reviews had been cited in 247 sets of guidance. This included 62 sets of international guidance, 175 sets of national guidance (87 from the UK) and 10 examples of local guidance. Evidence from the interviews suggested that Cochrane Reviews often play an instrumental role in informing guidance, although reviews being a poor fit with guideline scope or methods, reviews being out of date and a lack of communication between CRGs and GDs were barriers to their use. Cochrane Reviews appeared to have led to a number of benefits to the health service including safer or more appropriate use of medication or other health technologies or the identification of new effective drugs or treatments. However, whether or not these changes were directly as a result of the Cochrane Review and not the result of subsequent clinical guidance was difficult to judge. Potential benefits of Cochrane Reviews included economic benefits through budget savings or the release of funds, improvements in clinical quality, the reduction in the use of unproven or unnecessary procedures and improvements in patient and carer experiences.ConclusionsThis study identified a number of impacts and likely impacts of Cochrane Reviews. The clearest impacts of Cochrane Reviews are on research targeting and health-care policy, with less evidence of a direct impact on clinical practice and the organisation and delivery of NHS services. Although it is important for researchers to consider how they might increase the influence of their work, such impacts are difficult to measure. More work is required to develop suitable methods for defining and quantifying the impact of research.FundingThe NIHR Health Technology Assessment programme.

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