scholarly journals A policy analysis of the chronic care policies in Belgium

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
K Danhieux ◽  
M Martens ◽  
E Colman ◽  
R Remmen ◽  
J Van Olmen ◽  
...  
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Policy Analysis ◽  
Integrated Care ◽  
Chronic Diseases ◽  
Health Systems ◽  
Policy Making ◽  
Chronic Care ◽  
Financing System ◽  
Vested Interests

Abstract Introduction Chronic diseases form the largest burden of disease in European countries. Redesign of health systems towards chronic integrated care is needed, with more collaboration between first and second line, between medical and social services and support to prevention and self-management. What are the levers for change in such health systems? This study addresses this knowledge gap, through a policy analysis of barriers and facilitators for change towards chronic integrated care. Methods 26 central level stakeholders were selected, based upon their influence in regulation and policy, financing, health care provision and community representation. Semi-structured face-to-face interviews were held covering assessment of past and current policies and implementation, barriers and opportunities for change. Results Reforms have taken place, such as the stimulation of local initiatives for chronic integrated care projects and the set-up of local care councils. Most stakeholders assessed the current Belgium's implementation of integrated care as low, despite a growing awareness for the need for change. A context factor often mentioned to constrain implementation was a state reform which led to a partial decentralization, fragmentation of decision power and a division of healthcare competences between federal and federated levels. Other barriers were the current financing system, the lack of investments in new models of care and the vested interests of providers. Discussion This analysis shows that chronic care reform in Belgium is constrained by partial decentralization of primary health care, and by the financing system and vested interests. It points to the need for coordination of health policy making and implementation. Disentangling the levels of decision-making and the financial leverage at these levels gives insights for change and change management, for the Belgium health system and other countries with a strong decentralized system. Key messages The current Belgium’s implementation of integrated care was assessed as low, due to different contexts factors such as division of health care competencies between different governmental levels. In a country as Belgium with a strong decentralized health care system coordination of health policy making and implementation is key in order to scale up integrated care for chronic diseases.

Comparing health policy: An assessment of typologies of health systems

2010 ◽  
pp. 185-201
Author(s):  
Keyword(s):  
Health Care ◽  
Public Policy ◽  
Health Policy ◽  
Comparative Study ◽  
Health Systems ◽  
Institutional Context ◽  
Health Policies ◽  
Ideal Types

Typologies have been central to the comparative turn in public policy and this paper contributes to the debate by assessing the capacity of typologies of health systems to capture the institutional context of health care and to contribute to explaining health policies across countries. Using a recent comparative study of health policy and focusing on the concept of the health care state the paper suggests three things. First, the concept of the health care state holds as a set of ideal types. Second, as such the concept of the health care state provides a useful springboard for analyzing health policy, but one which needs to be complemented by more specific institutional explanations. Third, the concept of the health care state is less applicable to increasingly important, non-medical areas of health policy. Instead, different aspects of institutional context come into play and they can be combined as part of a looser ‘‘organizing framework''.

scholarly journals Mental health system governance in Nigeria: challenges, opportunities and strategies for improvement

2016 ◽  
Vol 3 ◽  
Author(s):  
J. Abdulmalik ◽  
L. Kola ◽  
O. Gureje
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Policy ◽  
Health System ◽  
Health Systems ◽  
Mental Health System ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health System Governance ◽  
Low And Middle Income

IntroductionA health systems approach to understanding efforts for improving health care services is gaining traction globally. A component of this approach focuses on health system governance (HSG), which can make or mar the successful implementation of health care interventions. Very few studies have explored HSG in low- and middle-income countries, including Nigeria. Studies focusing on mental health system governance, are even more of a rarity. This study evaluates the mental HSG of Nigeria with a view to understanding the challenges, opportunities and strategies for strengthening it.MethodologyThis study was conducted as part of the project, Emerging Mental Health Systems in Low and Middle Income Countries (Emerald). A multi-method study design was utilized to evaluate the mental HSG status of Nigeria. A situational analysis of the health policy and legal environment in the country was performed. Subsequently, 30 key informant interviews were conducted at national, state and district levels to explore the country's mental HSG.ResultsThe existing policy, legislative and institutional framework for HSG in Nigeria reveals a complete exclusion of mental health in key health sector documents. The revised mental health policy is however promising. Using the Siddiqi framework categories, we identified pragmatic strategies for mental health system strengthening that include a consideration of existing challenges and opportunities within the system.ConclusionThe identified strategies provide a template for the subsequent activities of the Emerald Programme (and other interventions), towards strengthening the mental health system of Nigeria.

scholarly journals Public involvement policies in health: exploring their conceptual basis

2006 ◽  
Vol 1 (2) ◽  
pp. 149-162 ◽  
Author(s):  
Suzanne Wait ◽  
Ellen Nolte
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Health Systems ◽  
Policy Process ◽  
Health Care Services ◽  
Public Involvement ◽  
Conceptual Basis ◽  
The Public ◽  
Current Health ◽  
Care Services

Despite its obvious appeal, the concept of public involvement is poorly defined and its rationale and objectives are rarely specified when applied to current health policy contexts. This paper explores some of the underlying concepts, definitions, and issues underpinning public involvement policies and proposes a set of criteria and questions that need to be addressed to allow for the evaluation of public involvement strategies and their impact on the health policy process. It aims to further our understanding of the role that public involvement may play in contributing to health systems that are responsive to the needs and priorities of the public, and, ultimately, providing better health and health care services to the community at large.

scholarly journals Integrated Care Programs for People with Multimorbidity in European Countries: eHealth Adoption in Health Systems

2020 ◽  
Vol 2020 ◽  
pp. 1-23 ◽  
Author(s):  
Maria Gabriella Melchiorre ◽  
Roberta Papa ◽  
Sabrina Quattrini ◽  
Giovanni Lamura ◽  
Francesco Barbabella ◽  
...  
Keyword(s):  
Older People ◽  
Health System ◽  
Integrated Care ◽  
Health Systems ◽  
National Health ◽  
European Countries ◽  
Financing System ◽  
Major Barrier ◽  
Case Study Methodology ◽  
System Characteristics

Introduction. eHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), also supporting multidisciplinary care. The aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for (older) people with MM in European countries, including benefits and barriers concerning their adoption, according to some basic health system characteristics. Materials and Methods. In 2014, in the framework of the ICARE4EU project, expert organizations in 24 European countries identified 101 integrated care programs. Managers of the selected programs completed an online questionnaire on several dimensions, including the use of eHealth. We analyzed data from this questionnaire, in addition to qualitative information from six innovative programs which were studied in depth through case study methodology, according to characteristics of national health systems: a national health model (financing system), overall strength of primary care (PC) (structure/service delivery process), and level of (de)centralization of health system (executive powers in a country). Results. 85 programs (out of 101) adopted at least one eHealth tool, and 42 of these targeted explicitly older people. In most cases, Electronic Health Records (EHRs) were used and some benefits emerged like improved care management and integration, although inadequate funding mechanisms represented a major barrier. The analysis by health system characteristics showed a greater adoption of eHealth applications in decentralized countries, in countries with a National Health Service (NHS) model, and in countries with a strong/medium level of PC development. Conclusions. Although in the light of some limitations, findings indicate a relation between implementation of care programs using eHealth tools and basic characteristics of health systems, with decentralization of a health system, NHS model, and strong/medium PC having a key role. However adaptations of European health systems seem necessary, in order to provide a more innovative and integrated care.

scholarly journals Inter-Organizational Networks in Health Care

2016 ◽  
Author(s):  
Rod Sheaff ◽  
Jill Schofield
Keyword(s):  
Health Care ◽  
Integrated Care ◽  
Health Systems ◽  
Network Theory ◽  
Organizational Networks ◽  
Dual Function ◽  
Complex Care ◽  
Primary Research ◽  
Health Networks ◽  
Flat Structures

Inter-organizational networks have proliferated in health systems, as has network research, but coherent explanations relating the varieties of health network to their respective structures, activities and outcomes remain lacking. Focusing on their core productive processes and their governance structures, this chapter contrasts care networks with program networks. It compares these concepts with findings from some primary research on NHS health networks during 2005–10, and notes some implications for network theory and research. NHS networks’ dense, flat structures reflect these networks’ dual function as both care and as program networks. These findings are relevant to the “integrated care” networks developing in many health systems. The development of these networks appears, partly, to be a workaround for the obstacles that market and quasi-market health systems place in the way of coordinating complex care across multiple separate providers.

scholarly journals Diabetes assistance before, during and after Covid-19 in Ferrara, Italy

2020 ◽  
Vol 23 (2-3) ◽  
pp. 61-64 ◽  
Author(s):  
Dario Pelizzola
Keyword(s):  
Social Organization ◽  
Integrated Care ◽  
Chronic Diseases ◽  
Health Systems ◽  
General Practitioners ◽  
Diabetes Care ◽  
Psychosocial Aspects ◽  
Health Conditions ◽  
Social Contacts ◽  
Care Models

The COVID-19 pandemic has profoundly changed people's habits and social organization, including the care models of people with chronic diseases. Diabetes care in Ferrara is based on Integrated Care Protocols (ICP) in collaboration with General Practitioners (GPs). The sudden arrival of the Covid-19 pandemic has resulted in the suspension of most of the planned health activities. The Diabetes Services have mainly dedicated themselves to communicating by telephone with their clients to suspend appointments and monitor their health conditions, accepting only urgent situations that could not be managed by telephone. The psychosocial aspects of people with diabetes have led to the fear of contagion taking into account the greater risks related to age and comorbidity and the aspects of loneliness and reduction of social contacts. After the lockdown, the health systems are reactivating the suspended treatment paths even if with all the measures to avoid spreading the infection. Consequently, the assistance activities will be quantitatively less numerous to apply the safety criteria. E-health gives the opportunity to customize monitoring and assistance and to configure a profile of the monitored parameters aimed at revaluations of care in the clinic only when necessary, rather than at predetermined deadlines.

Sign in / Sign up

Export Citation Format

Share Document