scholarly journals Under Careful Construction: Combining Findings, Arguments, and Values Into Robust Health Care Coverage Decisions

2021 ◽  
Author(s):  
T.H. Kleinhout-Vliek ◽  
A.A. de Bont ◽  
A. Boer
Keyword(s):  
Health Care ◽  
National Level ◽  
Clinical Effectiveness ◽  
Appraisal Committee ◽  
Future Research ◽  
Final Decision ◽  
Health Care Coverage ◽  
Coverage Decision ◽  
Decision Outcomes ◽  
Care Technology

Abstract Background: Health care coverage decisions deal with health care technology provision or reimbursement on a national level. The coverage decision outcome, i.e., the publicly available document with reasons for the decision, may contain various elements: quantitative calculations like cost and clinical effectiveness analyses and formalised and non-formalised qualitative considerations. We know little about the process of combining these heterogeneous elements into robust decision outcomes.Methods: In this study, we describe a model for combining different elements into coverage decision outcomes. We build on two qualitative cases of coverage appraisals at the Dutch National Health Care Institute, for which we analysed observations at committee meetings (n=2, with field notes taken) and analysis of audio files (n=3), interviews with appraisal committee members (n=10 in seven interviews) and with Institute employees (n=5 in three interviews).Results: We conceptualise decision outcomes as combinations of elements, specifically (quantitative) findings and (qualitative) arguments and values. Our model contains three steps: 1) identifying elements; 2) designing the combinations of elements, which entails articulating links, broadening the scope of designed combinations, and black-boxing links; and 3) testing these combinations and choosing one as the final decision outcome. Conclusions: The proposed model highlights decision makers’ expertise in composing both elements and combinations. It also provides additional rationales for facilitating appeals and engaging patients and the public. Future research efforts could further explore the relationship between robustness and decision combination strength.

Health Care Coverage Decision Making in Low- and Middle-Income Countries: Experiences from 25 Coverage Schemes

2015 ◽  
Vol 18 (4) ◽  
pp. 265-271 ◽  
Author(s):  
Hialy Gutierrez ◽  
Ashwini Shewade ◽  
Minghan Dai ◽  
Pedro Mendoza-Arana ◽  
Octavio Gómez-Dantés ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Middle Income ◽  
Health Care Coverage ◽  
Middle Income Countries ◽  
Coverage Decision ◽  
Low And Middle Income

ESRC Review

2020 ◽  
pp. 55-78
Author(s):  
Simeon J. Yates ◽  
Leanne Townsend ◽  
Monica Whitty ◽  
Ronald E. Rice ◽  
Elinor Carmi
Keyword(s):  
Health Care ◽  
Technology Use ◽  
Rapid Change ◽  
Well Being ◽  
Future Research ◽  
Main Question ◽  
Qualitative Approaches ◽  
Cross Platform ◽  
Care Technology ◽  
Health And Well Being

This chapter describes the analyses and results for the ESRC Domain of Health and Well-Being, guided by a three-part main question: “whether technology makes us healthier, better educated, and more productive.” It first provides an initial overview of the major insights from the literature review and analysis, the Delphi surveys, and workshop discussions about the relevant range of the concepts of health and well-being in a digital age. The resulting focus is initially mostly about the technology but later on users, health, and research. Eight main topics emerged, including health care, measures and measurement, mobile and smartphone devices, social support, and weight loss. The analyses also highlighted theory, methods, and approaches in the literature, showing a relatively even distribution of deductive–inductive approaches and quantitative–qualitative approaches, using several well-known theories from psychology (e.g., theories of behavior change) and sociology (social networks). The review provides examples of literature from the project’s study period that illustrate these topics. The chapter concludes with a discussion of future research directions (e.g., cross-platform or holistic assessments examining the effects of broad, everyday digital technology use on health and well-being) and research challenges (e.g., methods, rapid change in health care technology, big data for health, and linking of personal and clinical health data with well-being outcomes).

The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect (Biennial 2014)

2015 ◽  
Author(s):  
Sara R. Collins Collins ◽  
Michelle M. Doty Doty ◽  
Petra W. Rasmussen Rasmussen ◽  
Sophie Beutel Beutel
Keyword(s):  
Health Care ◽  
Health Reform ◽  
Health Care Coverage

scholarly journals A gold mine, but still no Klondike: Nordic register data in health inequalities research

2019 ◽  
Vol 47 (6) ◽  
pp. 618-630 ◽  
Author(s):  
Kjetil A. Van Der Wel ◽  
Olof Östergren ◽  
Olle Lundberg ◽  
Kaarina Korhonen ◽  
Pekka Martikainen ◽  
...  
Keyword(s):  
National Level ◽  
Data Access ◽  
Register Data ◽  
Future Research ◽  
Gold Mine ◽  
Birth Cohorts ◽  
Policy And Practice ◽  
Research Papers ◽  
Processing Times ◽  
Acquisition Processes

Aims: Future research on health inequality relies on data that cover life-course exposure, different birth cohorts and variation in policy contexts. Nordic register data have long been celebrated as a ‘gold mine’ for research, and fulfil many of these criteria. However, access to and use of such data are hampered by a number of hurdles and bottlenecks. We present and discuss the experiences of an ongoing Nordic consortium from the process of acquiring register data on socio-economic conditions and health in Denmark, Finland, Norway and Sweden. Methods: We compare experiences of data-acquisition processes from a researcher’s perspective in the four countries and discuss the comparability of register data and the modes of collaboration available to researchers, given the prevailing ethical and legal restrictions. Results: The application processes we experienced were time-consuming, and decision structures were often fragmented. We found substantial variation between the countries in terms of processing times, costs and the administrative burden of the researcher. Concerned agencies differed in policy and practice which influenced both how and when data were delivered. These discrepancies present a challenge to comparative research. Conclusions: We conclude that there are few signs of harmonisation, as called for by previous policy documents and research papers. Ethical vetting needs to be centralised both within and between countries in order to improve data access. Institutional factors that seem to facilitate access to register data at the national level include single storage environments for health and social data, simplified ethical vetting and user guidance.

scholarly journals Learning from and Leveraging Multi-Level Changes in Responses to the COVID 19 Pandemic to Facilitate Breast Cancer Prevention Efforts

2021 ◽  
Vol 18 (13) ◽  
pp. 6999
Author(s):  
Deborah J. Bowen ◽  
Kelly E. Rentscher ◽  
Amy Wu ◽  
Gwen Darien ◽  
Helen Ghirmai Haile ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Cancer Prevention ◽  
Care Delivery ◽  
Breast Cancer Prevention ◽  
Health Care Use ◽  
Economic Life ◽  
Future Research ◽  
Multi Level ◽  
And Shifts

The coronavirus pandemic (COVID-19) has had multilevel effects on non-COVID-19 health and health care, including deferral of routine cancer prevention and screening and delays in surgical and other procedures. Health and health care use has also been affected by pandemic-related loss of employer-based health insurance, food and housing disruptions, and heightened stress, sleep disruptions and social isolation. These disruptions are projected to contribute to excess non-COVID-19 deaths over the coming decades. At the same time municipalities, health systems and individuals are making changes in response to the pandemic, including modifications in the environmental to promote health, implementation of telehealth platforms, and shifts towards greater self-care and using remote platforms to maintain social connections. We used a multi-level biopsychosocial model to examine the available literature on the relationship between COVID-19-related changes and breast cancer prevention to identify current gaps in knowledge and identify potential opportunities for future research. We found that COVID-19 has impacted several aspects of social and economic life, through a variety of mechanisms, including unemployment, changes in health care delivery, changes in eating and activity, and changes in mental health. Some of these changes should be reduced, while others should be explored and enhanced.

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