Promoting equity through health services

2020 ◽  
pp. 23-32
Author(s):  
Bo Burström
Keyword(s):  
Primary Care ◽  
Policy Reform ◽  
Healthcare Services ◽  
Ageing Population ◽  
Freedom Of Choice ◽  
Disadvantaged Area ◽  
Health Policy Reform ◽  
Child Healthcare ◽  
The Impact ◽  
Proportionate Universalism

The provision of healthcare should be in relation to the need of care, but this is not always the case, as examples given in this chapter illustrate. The impact on equity in the utilization of care of need-based resource allocation versus recent market-oriented choice reforms and changes in reimbursement systems in primary care in Sweden are discussed. Examples are given of alternative ways of providing services in primary care in disadvantaged areas. Further, the chapter describes an applied example of the concept of proportionate universalism in child healthcare services, where extra postnatal home visits are provided in a disadvantaged area of Stockholm. Finally, the emerging needs of integrated care in an ageing population are contrasted against current health policy reform, which emphasizes freedom of choice of providers, and discussed.

scholarly journals Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ka Chun Chong ◽  
Hong Fung ◽  
Carrie Ho Kwan Yam ◽  
Patsy Yuen Kwan Chau ◽  
Tsz Yu Chow ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Public Sector ◽  
System Dynamics ◽  
The Elderly ◽  
Healthcare Services ◽  
Dynamics Simulation ◽  
Public And Private ◽  
The Public ◽  
The Impact

Abstract Background The elderly healthcare voucher (EHCV) scheme is expected to lead to an increase in the number of elderly people selecting private primary healthcare services and reduce reliance on the public sector in Hong Kong. However, studies thus far have reported that this scheme has not received satisfactory responses. In this study, we examined changes in the ratio of visits between public and private doctors in primary care (to measure reliance on the public sector) for different strategic scenarios in the EHCV scheme. Methods Based on comments from an expert panel, a system dynamics model was formulated to simulate the impact of various enhanced strategies in the scheme: increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for the model calibration were collected from various sources. Results The simulation results show that the current EHCV scheme is unable to reduce the utilization of public healthcare services, as well as the ratio of visits between public and private primary care among the local aging population. When comparing three different tested scenarios, even if the increase in the annual voucher amount could be maintained at the current pace or the age eligibility can be lowered to include those aged 60 years, the impact on shifts from public-to-private utilization were insignificant. The public-to-private ratio could only be marginally reduced from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in a significant drop of 0.50 in the public-to-private ratio during the early implementation phase. However, the effect could not be maintained for an extended period. Conclusions Our findings will assist officials in improving the design of the EHCV scheme, within the wider context of promoting primary care among the elderly. We suggest that an additional chronic disease-oriented voucher can serve as an alternative strategy. The scheme must be redesigned to address more specific objectives or provide a separate voucher that promotes under-utilized healthcare services (e.g., preventive care), instead of services designed for unspecified reasons, which may lead to concerns regarding exploitation.

scholarly journals The Impact of Primary Care: A Focused Review

Scientifica ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-22 ◽  
Author(s):  
Leiyu Shi
Keyword(s):  
Primary Care ◽  
Health Outcomes ◽  
Negative Impact ◽  
Healthcare Services ◽  
The United States ◽  
Emergency Department Visits ◽  
Care Practice ◽  
Quality Healthcare ◽  
The Usa ◽  
The Impact

Primary care serves as the cornerstone in a strong healthcare system. However, it has long been overlooked in the United States (USA), and an imbalance between specialty and primary care exists. The objective of this focused review paper is to identify research evidence on the value of primary care both in the USA and internationally, focusing on the importance of effective primary care services in delivering quality healthcare, improving health outcomes, and reducing disparities. Literature searches were performed in PubMed as well as “snowballing” based on the bibliographies of the retrieved articles. The areas reviewed included primary care definitions, primary care measurement, primary care practice, primary care and health, primary care and quality, primary care and cost, primary care and equity, primary care and health centers, and primary care and healthcare reform. In both developed and developing countries, primary care has been demonstrated to be associated with enhanced access to healthcare services, better health outcomes, and a decrease in hospitalization and use of emergency department visits. Primary care can also help counteract the negative impact of poor economic conditions on health.

Integrating Social and Health Services for People, Communities, Homes, and Places

2021 ◽  
pp. 21-66
Author(s):  
Maddalena Illario ◽  
Vincenzo De Luca ◽  
Regina Roller-Wirnsberger
Keyword(s):  
Older Adults ◽  
Technological Innovation ◽  
Circular Economy ◽  
Fear Of Falling ◽  
Healthcare Services ◽  
Ageing Population ◽  
Ageing Society ◽  
Regional Policies ◽  
Framework Approach ◽  
The Impact

The challenge of an ageing population requires a paradigmatic shift in the way we provide social and healthcare services, demanding the need to prioritize the functionality and independence of older adults. The risk and subsequent fear of falling is one of the most high-risk states for older adults, as it generates a destabilizing effect on their health that is often hard to recover. It is essential to thoroughly address their risk factors and mitigators. This discussion needs to be made in light of a person-centered perspective that goes beyond fragilities to capitalize on the strengths of the older adults. The chapter provides examples of how to connect assessment, interventions, and monitoring to a coherent framework approach that mitigates the risks and the impact of falls on an ageing society. The authors explore how technological innovation, urban planning, and regional policies that are culturally relevant can be incorporated in creating a circular economy while meeting the needs of an aging population and preventing falls and cognitive decline.

scholarly journals Impact of initial medication non-adherence on use of healthcare services and sick leave: a longitudinal study in a large primary care cohort in Spain

2017 ◽  
Vol 67 (662) ◽  
pp. e614-e622 ◽  
Author(s):  
Ignacio Aznar-Lou ◽  
Ana Fernández ◽  
Montserrat Gil-Girbau ◽  
Ramón Sabés-Figuera ◽  
Marta Fajó-Pascual ◽  
...  
Keyword(s):  
Primary Care ◽  
Sick Leave ◽  
Healthcare Services ◽  
Economic Consequences ◽  
Short Term ◽  
Productivity Losses ◽  
Lower Productivity ◽  
Clinical Consequences ◽  
The Impact ◽  
Initial Medication

BackgroundInitial medication non-adherence is highly prevalent in primary care but no previous studies have evaluated its impact on the use of healthcare services and/or days on sick leave.AimTo estimate the impact of initial medication non-adherence on the use of healthcare services, days of sick leave, and costs overall and in specific medication groups.Design and settingA 3-year longitudinal register-based study of all primary care patients (a cohort of 1.7 million) who were prescribed a new medication in Catalonia (Spain) in 2012.MethodThirteen of the most prescribed and/or costly medication subgroups were considered. All medication and medication subgroups (chronic, analgesics, and penicillin) were analysed. The number of healthcare services used and days on sick leave were considered. Multilevel multivariate linear regression was used. Three levels were included: patient, GP, and primary care centre.ResultsInitially adherent patients made more use of medicines and some healthcare services than non-adherent and partially adherent patients. They had lower productivity losses, producing a net economic return, especially when drugs for acute diseases (such as penicillins) were considered. Initial medication non-adherence resulted in a higher economic burden to the system in the short term.ConclusionInitial medication non-adherence seems to have a short-term impact on productivity losses and costs. The clinical consequences and long-term economic consequences of initial medication non-adherence need to be assessed. Interventions to promote initial medication adherence in primary care may reduce costs and improve health outcomes.

scholarly journals 128 Getting Healthcare Students to be More Empathatic for Geriatric Patients: The Impact of Simulation Suit on Pharmacy Students

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv28-iv33
Author(s):  
Shaun Lee ◽  
Pei-Lee Teh
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Professionals ◽  
Intervention Group ◽  
Healthcare Services ◽  
Mental Illnesses ◽  
Controlled Study ◽  
Future Research ◽  
Ageing Population ◽  
The Impact

Abstract Introduction The world’s population worldwide is greying, and it is important that health care professionals such as pharmacists are able to gain proficiency in working with older adults who may be suffering from both physical and mental illnesses. One of the challenges for many schools that offer healthcare related courses is the need to support continued empathy towards this ageing population so that they can offer better healthcare services. Recently, ageing suits which are an immersive simulation suit designed to simulate the effects of ageing have been introduced to enable nursing students to experience what older adults face in health care situation. Method In this randomised controlled study, all year 1 students enrolled in the Bachelor of Pharmacy course (n=120) at our institution were assigned to either a polypharmacy only workshop or use an ageing suit together with polypharmacy workshop (intervention). The intervention group was tasked to perform a series of exercises, including walking a flight of stairs, picking up a coin as well as filling up a form. All participants completed the Jefferson Empathy Scale and semi-structured questionnaire. Results At the end of exercise, intervention group participants had a marginal improvement in their self-reported empathy levels, with an improvement of 1.7 +14.5 points compared to 1.2 + 9.4 points in control (p=0.81). Participants in the intervention reported changes in physical performance consistent with the expected changes associated with ageing. They also reported a change in attitude and were able to empathize better with older adults especially on issues related to patient communication. Conclusion As such, future research should also include and involve a wider range of students to ensure that they become health advocates for the health care needs of older adults. This will enable them to deliver better healthcare services to meet the needs of the older adults.

PP090 Reducing Low-Value Practices In Catalonia: Essencial Project

2017 ◽  
Vol 33 (S1) ◽  
pp. 112-113
Author(s):  
Cari Almazan ◽  
Johanna Caro
Keyword(s):  
Primary Care ◽  
Health Care Services ◽  
Implementation Process ◽  
Healthcare Services ◽  
Care Level ◽  
Primary Care Level ◽  
Care Services ◽  
Baseline Status ◽  
The Impact

INTRODUCTION:In 2013 the Essencial Project launched in Catalonia promotes the identification of low-value practices (LVP) by healthcare professionals and elaborates recommendations to avoid them. This project aims to reduce unnecessary care of health care services which harm outweighs the benefits, resulting in physical, psychological to the patients and wasteful healthcare services. The main objectives are to describe the implementation process at the primary care level and to evaluate the impact of recommendations on general practitioners (GPs) practice.METHODS:The implementation process consists in:(i) Nomination of clinical leaders to promote the project among their primary care teams (PCT) and to lead the implementation activities by identification of barriers and enablers for change in clinical practice towards avoiding LVP.(ii) Selection of recommendations to be implemented and definition of corresponding activities to be carried out by each PCT according to the specific characteristics of their organizations.(iii) Development of related indicators and comparison between baseline statusRESULTS:One hundred and sixteen PCT (covering 30 percent of the Catalan population) participated in the pilot experience of implementation. Twenty-one recommendations were selected such as: bisphosphonates in post-menopausal women with low risk of fracture, PSA screening and statins for primary prevention of cardiovascular disease, among others. At 12 month follow-up, use of bisphosphonates were reduced by 21 percent (p = .0005), PSA was reduced by 14 percent (p = .0009). The use of other treatments such as antidepressants, benzodiazepines for some specific clinical conditions decreases with no statistically significant changes.CONCLUSIONS:This is the first experience in Catalonia and Spain of implementation of the recommendations to avoid LVP with early involvement of target professionals. Follow-up results provide information about the early impact of recommendations at primary care level. Our challenge is to implement the recommendations at hospital level.

scholarly journals Shaping the Future of Digitally Enabled Health and Care

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 17
Author(s):  
Maureen Spargo ◽  
Nicola Goodfellow ◽  
Claire Scullin ◽  
Sonja Grigoleit ◽  
Andreas Andreou ◽  
...  
Keyword(s):  
Older People ◽  
Chronic Conditions ◽  
Sense Of Self ◽  
Healthcare Services ◽  
Self Management ◽  
Ageing Population ◽  
Self Sufficiency ◽  
Medicines Use ◽  
Active Lifestyles ◽  
The Impact

People generally need more support as they grow older to maintain healthy and active lifestyles. Older people living with chronic conditions are particularly dependent on healthcare services. Yet, in an increasingly digital society, there is a danger that efforts to drive innovations in eHealth will neglect the needs of those who depend on healthcare the most—our ageing population. The SHAPES (Smart and Healthy Ageing through People Engaging in Supportive Systems) Innovation Action aims to create an open European digital platform that facilitates the provision of meaningful, holistic support to older people living independently. A pan-European pilot campaign will evaluate a catalogue of digital solutions hosted on the platform that have been specifically adapted for older people. ‘Medicines control and optimisation’ is one of seven themes being explored in the campaign and will investigate the impact of digital solutions that aim to optimise medicines use by way of fostering effective self-management, while facilitating timely intervention by clinicians based on remote monitoring and individualised risk assessments powered by artificial intelligence. If successful, the SHAPES Innovation Action will lead to a greater sense of self-sufficiency and empowerment in people living with chronic conditions as they grow older.

scholarly journals INVESTMENT CASE & EQUITY: A QUASI-EXPERIMENTAL ANALYSIS OF MATERNAL & CHILD HEALTHCARE SERVICES IN PUNJAB

2021 ◽  
Vol 9 (2) ◽  
pp. 475-486
Author(s):  
Majid Ali ◽  
Naeem Ahmed Qureshi ◽  
Ali Akbar Pirzado ◽  
Iftakhar Ahmed ◽  
Muhammad Rizwan Sabir
Keyword(s):  
Healthcare Services ◽  
Substantial Improvement ◽  
Child Health Care ◽  
Complex Sample ◽  
Quasi Experimental ◽  
Multivariable Regression ◽  
Newborn Child ◽  
Disaggregated Data ◽  
Child Healthcare ◽  
The Impact

Aim: This research aims to define equities determinants in maternal and child care in Punjab, a Pakistan province. The study focuses on the impact on Reproductive/ Maternal/ Newborn/ Child Adolescent Health (RMNCAH), introduced in 2016 through the Investment Case (IC) approach. Methodology: A complex-sample-analysis modified the weight of the sample. Weighted disaggregated data were produced by cross-tableting with Confidence Interval (CI). A DiD analysis was performed based on a linear model of regression. Finally, the effect of the involvement was calculated by multivariate linear regression. Principal Findings: The results show that changes had been measured in both the involvement and reference areas in involvement and no significant associations in the variables. Changes in involvement and contrast areas were similar. Also, there was no substantial improvement in aggregate outcomes from the multivariable regression analysis. In most developing countries, the IC approach is successful. Following the IC's introduction, some MNCH indicators such as ANC and the delivery of expert delivery of assistant birth showed improvements in involvement and contrast districts. Applications of this study: The research will provide a proper guideline for the policymaker to design a need-based policy for equitable admission to child health care and maternal facilities Novelty/Originality of this study: This study first analyzed the influence of investment- case in the RMNCAH program in Punjab.

scholarly journals Impact of the COVID-19 pandemic on mental healthcare consultations among children and adolescents in Norway: a nationwide registry study

2021 ◽  
Author(s):  
Miriam Evensen ◽  
Rannveig Kaldager Hart ◽  
Anna Aasen Godoy ◽  
Lars Johan Hauge ◽  
Ingunn Olea Lund ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Problems ◽  
Sleep Problems ◽  
Mental Healthcare ◽  
Healthcare Services ◽  
Health Problems ◽  
Mental Symptoms ◽  
The Stability ◽  
The Impact

ABSTRACT BACKGROUND: There have been widespread concerns about the impact of the COVID-19 pandemic and its associated restrictions on children's and adolescents' mental health. While some studies have found increasing rates of mental health problems during the pandemic, other evidence suggest that mental symptoms and disorders were increasing before the pandemic. This study compared trends in mental healthcare use during the first 15 months of the pandemic with similar pre-pandemic trends. METHODS: Consultations related to mental symptoms and disorders were identified through national registries from primary and specialist healthcare services, including hospitalizations, covering the entire population of children 6-18 years in Norway (N=908 272). The monthly likelihood of having a consultation or hospitalization related to overall mental health problems, and specific diagnoses for depression, anxiety, ADHD and sleep problems were plotted from January 2020 to May 2021 and compared to trends over the same period between 2017-2019 using event study and difference-in-difference designs. FINDINGS: We found reductions in consultations for mental health symptoms and disorders in primary and specialist healthcare during the first weeks of lockdown in 2020. This decline was temporary, and volumes of consultations quickly returned to pre-pandemic levels. However, during fall 2020, consultation volumes related to mental health in primary care increased. This increase persisted into the winter of 2021 but levelled off by the last month of the sample period. The increase in consultation volumes was about 50 % compared to the pre-pandemic period. We did not find increases in consultations in specialist healthcare, except for hospitalizations. CONCLUSION: We found an increase in primary care consultation volumes related to mental health among children that depart from the previously established increases over recent years. We did not see similar increases in consultations in the specialist healthcare. It is unknown whether increases in primary care consultations represent milder cases, which primarily do not need specialist treatment, or if the stability in specialist healthcare consultations reflects capacity problems or timelags in referrals.

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