scholarly journals Involving citizens in disinvestment decisions: what do health professionals think? Findings from a multi-method study in the English NHS

2017 ◽  
Vol 13 (2) ◽  
pp. 162-188 ◽  
Author(s):  
Tom Daniels ◽  
Iestyn Williams ◽  
Stirling Bryan ◽  
Craig Mitton ◽  
Suzanne Robinson
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Public Involvement ◽  
Health Care Systems ◽  
Future Research ◽  
Local Health ◽  
The Public ◽  
Health Care Leaders ◽  
Local Health Care ◽  
Care Systems

AbstractPublic involvement in disinvestment decision making in health care is widely advocated, and in some cases legally mandated. However, attempts to involve the public in other areas of health policy have been accused of tokenism and manipulation. This paper presents research into the views of local health care leaders in the English National Health Service (NHS) with regards to the involvement of citizens and local communities in disinvestment decision making. The research includes a Q study and follow-up interviews with a sample of health care clinicians and managers in senior roles in the English NHS. It finds that whilst initial responses suggest high levels of support for public involvement, further probing of attitudes and experiences shows higher levels of ambivalence and risk aversion and a far more cautious overall stance. This study has implications for the future of disinvestment activities and public involvement in health care systems faced with increased resource constraint. Recommendations are made for future research and practice.

Social science perspectives on schistosomiasis control in Africa: past trends and future directions

Parasitology ◽  
2009 ◽  
Vol 136 (13) ◽  
pp. 1747-1758 ◽  
Author(s):  
J. AAGAARD-HANSEN ◽  
J. R. MWANGA ◽  
B. BRUUN
Keyword(s):  
Health Care ◽  
Social Science ◽  
Community Involvement ◽  
Neglected Tropical Diseases ◽  
Health Care Systems ◽  
Local Health ◽  
Access To Health Services ◽  
Schistosomiasis Control ◽  
Local Health Care ◽  
Care Systems

SUMMARYNew ways of integrating and scaling up control of neglected tropical diseases (including schistosomiasis) are presently underway. In this context consideration of social science perspectives is essential. In this article, we review social science publications of relevance to sustained control of schistosomiasis in Africa including diagnosis and screening, treatment, supply of clean water and improved sanitation, as well as health communication. Studies of community involvement and links between schistosomiasis control programmes and broader health care systems are also explored. Directions for future social science of relevance to sustainable schistosomiasis control are outlined, including ways of ensuring equitable access to health services as well as involvement of endemic communities and local health care systems based on equal partnership.

Impact Of Purchasing Strategies On Local Health Care Systems

1996 ◽  
Vol 15 (2) ◽  
pp. 62-76 ◽  
Author(s):  
Debra J. Lipson ◽  
Jeanne M. De Sa
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Local Health ◽  
Local Health Care ◽  
Care Systems

scholarly journals Thirty-day hospital re-admission for Medicaid enrollees with schizophrenia: the role of patient comorbidity and local health-care systems

2015 ◽  
Vol 10 (S1) ◽  
Author(s):  
Alisa B Busch ◽  
Arnold M Epstein ◽  
Thomas G McGuire ◽  
Sharon-Lise T Normand ◽  
Richard G Frank
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Local Health ◽  
Day Hospital ◽  
Local Health Care ◽  
Care Systems

A Brief History of Quality Improvement

2014 ◽  
Vol 10 (3) ◽  
pp. 196-199 ◽  
Author(s):  
Gareth J. Parry
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Intrinsic Motivation ◽  
Health Care Systems ◽  
Local Health ◽  
Local Health Care ◽  
Care Systems ◽  
History Of

Intrinsic motivation can fuel people to activate improvement initiatives in their local health care systems.

scholarly journals Reducing inequality in avoidable emergency admissions: Case studies of local health care systems in England using a realist approach

2021 ◽  
pp. 135581962110216
Author(s):  
John Ford ◽  
Julia Knight ◽  
John Brittain ◽  
Chris Bentley ◽  
Sarah Sowden ◽  
...  
Keyword(s):  
Health Care ◽  
Case Studies ◽  
Health Care Systems ◽  
Decision Makers ◽  
Local Health ◽  
Emergency Admissions ◽  
Local Health Care ◽  
Local Decision ◽  
Care Systems ◽  
Local Decision Makers

Objective People in disadvantaged areas are more likely to have an avoidable emergency hospital admission. Socio-economic inequality in avoidable emergency hospital admissions is monitored in England. Our aim was to inform local health care purchasing and planning by identifying recent health care system changes (or other factors), as reported by local health system leaders, that might explain narrowing or widening trends. Methods Case studies were undertaken in one pilot and at five geographically distinct local health care systems (Clinical Commissioning Groups, CCGs), identified as having consistently increasing or decreasing inequality. Local settings were explored through discussions with CCG officials and stakeholders to identify potential local determinants. Data were analysed using a realist evaluation approach to generate context-mechanism-outcome (CMO) configurations. Results Of the five geographically distinct CCGs, two had narrowing inequality, two widening, and one narrowing inequality, which widened during the project. None of the CCGs had designed a large-scale package of service changes with the explicit aim of reducing socio-economic inequality in avoidable emergency admissions, and local decision makers were unfamiliar with their own trends. Potential primary and community care determinants included: workforce, case finding and exclusion, proactive care co-ordination for patients with complex needs, and access and quality. Potential commissioning determinants included: data use and incentives, and targeting of services. Other potential determinants included changes in care home services, national A&E targets, and wider issues - such as public services financial constraints, residential gentrification, and health care expectations. Conclusions We did not find any bespoke initiatives that explained the inequality trends. The trends were more likely due to an interplay of multiple health care and wider system factors. Local decision makers need greater awareness, understanding and support to interpret, use and act upon inequality indicators. They are unlikely to find simple, cheap interventions to reduce inequalities in avoidable emergency admissions. Rather, long-term multifaceted interventions are required that embed inequality considerations into mainstream decision making.

scholarly journals Creating sustainable health care systems

2019 ◽  
Vol 33 (1) ◽  
pp. 18-34 ◽  
Author(s):  
Peter Littlejohns ◽  
Katharina Kieslich ◽  
Albert Weale ◽  
Emma Tumilty ◽  
Georgina Richardson ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Systems ◽  
Public Involvement ◽  
Health Care Systems ◽  
Ethical Challenge ◽  
Content Type ◽  
The Public ◽  
Care Systems ◽  
Sustainable Health

Purpose In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While this approach requires technical judgements of clinical effectiveness and cost effectiveness, these are embedded in a wider set of social (societal) value judgements, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritisation and the resulting decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritisation process. Design/methodology/approach Through a multidisciplinary collaboration involving a series of international workshops, ethical and political theory (including accountability for reasonableness) have been applied to develop a practical way forward through the creation of a values framework. The authors have tested this framework in England and in New Zealand using a mixed-methods approach. Findings A social values framework that consists of content and process values has been developed and converted into an online decision-making audit tool. Research limitations/implications The authors have developed an easy to use method to help stakeholders (including the public) to understand the need for prioritisation of health services and to encourage their involvement. It provides a pragmatic way of harmonising different perspectives aimed at maximising health experience. Practical implications All health care systems are facing increasing demands within finite resources. Although many countries are introducing ways to prioritise health services, the decisions often face legal, political, commercial and ethical challenge. The research will help health systems to respond to these challenges. Social implications This study helps in increasing public involvement in complex health challenges. Originality/value No other groups have used this combination of approaches to address this issue.

scholarly journals Incidence and Death Rates from COVID-19 Are Not Always Coupled: An Analysis of Temporal Data on Local, Federal, and National Levels

Healthcare ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 338
Author(s):  
Stefan Borgmann ◽  
David Meintrup ◽  
Kerstin Reimer ◽  
Helmut Schels ◽  
Martina Nowak-Machen
Keyword(s):  
Health Care ◽  
Local Community ◽  
Health Care Systems ◽  
Case Fatality ◽  
Local Health ◽  
Infection Rates ◽  
Death Rates ◽  
Local Health Care ◽  
Care Systems ◽  
The Individual

SARS-CoV-2 has caused a deadly pandemic worldwide, placing a burden on local health care systems and economies. Infection rates with SARS-CoV-2 and the related mortality of COVID-19 are not equal among countries or even neighboring regions. Based on data from official German health authorities since the beginning of the pandemic, we developed a case-fatality prediction model that correctly predicts COVID-19-related death rates based on local geographical developments of infection rates in Germany, Bavaria, and a local community district city within Upper Bavaria. Our data point towards the proposal that local individual infection thresholds, when reached, could lead to increasing mortality. Restrictive measures to minimize the spread of the virus could be applied locally based on the risk of reaching the individual threshold. Being able to predict the necessity for increasing hospitalization of COVID-19 patients could help local health care authorities to prepare for increasing patient numbers.

Modernization, Globalization, Trends, and Convergence in Health Expenditure in Latin America and the Caribbean

2015 ◽  
Vol 1 (2) ◽  
pp. 321-346 ◽  
Author(s):  
Shiri Noy ◽  
Patricia A. McManus
Keyword(s):  
Health Care ◽  
Latin America ◽  
Health Care Systems ◽  
Health Care Financing ◽  
Health Spending ◽  
Modernization Theory ◽  
The Public ◽  
National Differences ◽  
Care Systems ◽  
Public Private Mix

Are health care systems converging in developing nations? We use the case of health care financing in Latin America between 1995 and 2009 to assess the predictions of modernization theory, competing strands of globalization theory, and accounts of persistent cross-national differences. As predicted by modernization theory, we find convergence in overall health spending. The public share of health spending increased over this time period, with no convergence in the public-private mix. The findings indicate robust heterogeneity of national health care systems and suggest that globalization fosters human investment health policies rather than neoliberal, “race to the bottom” cutbacks in public health expenditures.

Health Care

2018 ◽  
Author(s):  
Pierre Pestieau ◽  
Mathieu Lefebvre
Keyword(s):  
Health Care ◽  
Technological Progress ◽  
Health Care Systems ◽  
Third Party ◽  
Medical Expenditure ◽  
Public Health Care ◽  
The Public ◽  
Common Features ◽  
Care Systems

This chapter reviews the public health care systems as well as their challenges. It first shows how expenditure on health care has evolved in previous decades and deals with the reasons for the growth observed in almost every European country. It emphasizes the role of technological progress as a main explanatory factor of the increase in medical expenditure but also points to the challenges facing cost-containment policies. Especially, the main common features of health care systems in Europe, such as third-party payment, single provider approach and cost-based reimbursement are discussed. Finally the chapter shows that although inequalities in health exist in the population, health care systems are redistributive. Reforms are thus needed but the trade-off between budgetary efficiency and equity is difficult.

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