scholarly journals Ethical management of limited medical resources in COVID-19 times

2021 ◽  
Vol 2 (4) ◽  
pp. 22-28
Author(s):  
Arianna Omaña-Covarrubias ◽  
Ana Teresa Nez-Castro ◽  
Adrián Moya-Escalera ◽  
Carlos Cuevas-Suárez ◽  
María del Refugio Acuña-Gorrola
Keyword(s):  
Public Health ◽  
Health Care Systems ◽  
Emergency Situation ◽  
Medical Personnel ◽  
The United States ◽  
Ethical Challenges ◽  
Sexual Preferences ◽  
Material Resources ◽  
Great Responsibility ◽  
Care Systems

The current COVID-19 pandemic has affected thousands of people around de world, regardless their race, religion, sexual preferences nor socioeconomic class, leaving all of us with the same vulnerability to suffer this disease. This emergency situation has shown to have the ability to collapse de health care systems in countries like: Italy, Spain, and the United States, because the medical personnel and the available material resources were exceeded. This conflict generates big ethical challenges for the practice of public health since difficult decisions have to be made about how, when and to whom the resources should be allocated.  Due to the great responsibility that resource allocation implies, important points in the existing literature are exposed on how to give the best solution to this situation.

scholarly journals Smoking, Mental Illness, and Public Health

2017 ◽  
Vol 38 (1) ◽  
pp. 165-185 ◽  
Author(s):  
Judith J. Prochaska ◽  
Smita Das ◽  
Kelly C. Young-Wolff
Keyword(s):  
Public Health ◽  
Mental Illness ◽  
Tobacco Use ◽  
Health Care Systems ◽  
The United States ◽  
User Characteristics ◽  
People With Mental Illness ◽  
Smoking Policies ◽  
High Smoking Prevalence ◽  
Care Systems

Tobacco use remains the leading preventable cause of death worldwide. In particular, people with mental illness are disproportionately affected with high smoking prevalence; they account for more than 200,000 of the 520,000 tobacco-attributable deaths in the United States annually and die on average 25 years prematurely. Our review aims to provide an update on smoking in the mentally ill. We review the determinants of tobacco use among smokers with mental illness, presented with regard to the public health HAVE framework of “the host” (e.g., tobacco user characteristics), the “agent” (e.g., nicotine product characteristics), the “vector” (e.g., tobacco industry), and the “environment” (e.g., smoking policies). Furthermore, we identify the significant health harms incurred and opportunities for prevention and intervention within a health care systems and larger health policy perspective. A comprehensive effort is warranted to achieve equity toward the 2025 Healthy People goal of reducing US adult tobacco use to 12%, with attention to all subgroups, including smokers with mental illness.

scholarly journals Preparing an Academic Medical Center to Manage Patients Infected With Ebola: Experiences of a University Hospital

2015 ◽  
Vol 9 (5) ◽  
pp. 558-567 ◽  
Author(s):  
Carl H. Schultz ◽  
Kristi L. Koenig ◽  
Wajdan Alassaf
Keyword(s):  
Public Health ◽  
Medical Center ◽  
Health Care Systems ◽  
Academic Medical Center ◽  
Medical Personnel ◽  
University Hospital ◽  
Treatment Center ◽  
Treatment Unit ◽  
Academic Medical ◽  
Care Systems

AbstractAs Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population’s health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered to become an Ebola Treatment Center as part of the US effort to manage the threat. We developed detailed policies and procedures for Ebola patient management at our university hospital. Both the EMS system and county public health made significant contributions during the development process. This article shares information about this process and the outcomes to inform other institutions facing similar challenges of preparing for an emerging threat with limited resources. The discussion includes information about management of (1) patients who arrive by ambulance with prior notification, (2) spontaneous walk-in patients, and (3) patients with confirmed Ebola who are interfacility transfers. Hospital management includes information about Ebola screening procedures, personal protective equipment selection and personnel training, erection of a tent outside the main facility, establishing an Ebola treatment unit inside the facility, and infectious waste and equipment management. Finally, several health policy considerations are presented. (Disaster Med Public Health Preparedness. 2015;9:558–567)

scholarly journals The Design and Methodology of the Ohio COVID-19 Survey

2021 ◽  
Vol 4 (1) ◽  
pp. 5-10
Author(s):  
Marcus E. Berzofsky ◽  
Naomi Freedner ◽  
Caroline Scruggs ◽  
Robert Ashmead ◽  
Timothy Sahr ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care Systems ◽  
The United States ◽  
Mitigation Strategies ◽  
Health Issues ◽  
Cross Sectional ◽  
Policy Makers ◽  
Health Measures ◽  
High Participation ◽  
Care Systems

Background: Governments worldwide are balancing contrasting needs to curtail the toll that coronavirus disease 2019 (COVID-19) takes on lives and health care systems and to preserve their economies. To support decisions, data that simultaneously measure the health status of the population and the economic impact of COVID-19 mitigation strategies are needed. In the United States, prior to the onset of COVID-19, surveys or tracking systems usually focused on public health or economic indicators, but not both. However, tracking public health and economic measures together allow policy makers and epidemiologists to understand how policy and program decisions are associated. The Ohio COVID-19 Survey (OCS) attempts to track both measures in Ohio as one of the first statewide population surveys on COVID-19. To achieve this there are several methodological challenges which need to be overcome. Methods: The OCS utilizes a representative panel offering both cross-sectional and longitudinal analyses. It targets 700 to 1000 respondents per week for a total of 12 600 to 18 000 respondents over an 18-week period. Leveraging a sample of 24 000 adult Ohioans developed from a statewide population health survey conducted in fall 2019, the OCS produces weekly economic and health measures that can be compared to baseline measures obtained before the COVID-19 pandemic began. Results: The OCS was able to quickly launch and achieve high participation (45.2%) and retention across waves. Conclusion: The OCS demonstrates how it is possible to leverage an existing health-based survey in Ohio to generate a panel which can be used to quickly track fast-breaking health issues like COVID-19.

Continental Divide? The Attitudes of US and Canadian Oncologists on the Costs, Cost-Effectiveness, and Health Policies Associated With New Cancer Drugs

2010 ◽  
Vol 28 (27) ◽  
pp. 4149-4153 ◽  
Author(s):  
Scott R. Berry ◽  
Chaim M. Bell ◽  
Peter A. Ubel ◽  
William K. Evans ◽  
Eric Nadler ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Cost Effectiveness ◽  
Health Care Systems ◽  
The United States ◽  
Drug Costs ◽  
Cancer Drug ◽  
Cancer Drugs ◽  
Care Systems ◽  
Effective Treatments

Purpose Oncologists in the United States and Canada work in different health care systems, but physicians in both countries face challenges posed by the rising costs of cancer drugs. We compared their attitudes regarding the costs and cost-effectiveness of medications and related health policy. Methods Survey responses of a random sample of 1,355 United States and 238 Canadian medical oncologists (all outside of Québec) were compared. Results Response rate was 59%. More US oncologists (67% v 52%; P < .001) favor access to effective treatments regardless of cost, while more Canadians favor access to effective treatments only if they are cost-effective (75% v 58%; P < .001). Most (84% US, 80% Canadian) oncologists state that patient out-of-pocket costs influence their treatment recommendations, but less than half the respondents always or frequently discuss the costs of treatments with their patients. The majority of oncologists favor more use of cost-effectiveness data in coverage decisions (80% US, 69% Canadian; P = .004), but fewer than half the oncologists in both countries feel well equipped to use cost-effectiveness information. Majorities of oncologists favor government price controls (57% US, 68% Canadian; P = .01), but less than half favor more cost-sharing by patients (29% US, 41% Canadian; P = .004). Oncologists in both countries prefer to have physicians and nonprofit agencies determine whether drugs provide good value. Conclusion Oncologists in the United States and Canada generally have similar attitudes regarding cancer drug costs, cost-effectiveness, and associated policies, despite practicing in different health care systems. The results support providing education to help oncologists in both countries use cost-effectiveness information and discuss drug costs with their patients.

Accounting for the Rising Caesarean Section Rate in Canada: What Are the Roles of Changing Needs, Practices, and Incentives?

2021 ◽  
Author(s):  
Michael Baker ◽  
Maripier Isabelle ◽  
Mark Stabile ◽  
Sara Allin
Keyword(s):  
Caesarean Section ◽  
Financial Incentives ◽  
Health Care Systems ◽  
Caesarean Section Rate ◽  
The United States ◽  
World Health ◽  
Strong Increase ◽  
Primary Determinant ◽  
Care Systems ◽  
Health Organization

In most high-income countries, including Canada, the share of births by Caesarean section (C‑section) has risen over the past decades to far exceed World Health Organization recommendations of the proportion justified on medical grounds (15 percent). Although unnecessary C-sections represent an important cost for health care systems, they are not associated with clear benefits for the mother and the child and can sometimes represent additional risks. Drawing on administrative records of nearly four million births in Canada, as well as macro data from the United States and Australia, we provide a comprehensive account of rising C-section rates. We explicitly consider the contributions of the main factors brought forward in the policy literature, including changing characteristics of mothers, births, and physicians as well as changing financial incentives for C-section deliveries. These factors account for at most one-half of the increase in C-section rates. The majority of the remaining increase in C-sections over the period 1994–2011 occurred in the early 2000s. We suggest that some event or shock in the early 2000s is likely the primary determinant of the recent strong increase in the C-section rate in Canada.

scholarly journals Assessing COVID-19 Risk, Vulnerability and Infection Prevalence in Communities

2020 ◽  
Author(s):  
Amin Kiaghadi ◽  
Hanadi S. Rifai ◽  
Winston Liaw
Keyword(s):  
Health Care Systems ◽  
Principal Component ◽  
The United States ◽  
Infection Prevalence ◽  
Planning Tool ◽  
Harris County ◽  
Census Tracts ◽  
Medical Interventions ◽  
County Population ◽  
Care Systems

AbstractBackgroundThe spread of coronavirus in the United States with nearly one million confirmed cases and over 53,000 deaths has strained public health and health care systems. While many have focused on clinical outcomes, less attention has been paid to vulnerability and risk of infection. In this study, we developed a planning tool that examines factors that affect vulnerability to COVID-19.MethodsAcross 46 variables, we defined five broad categories: 1) access to medical, 2) underlying health conditions, 3) environmental exposures, 4) vulnerability to natural disasters, and 5) sociodemographic, behavioral, and lifestyle factors. We also used reported rates for morbidity, hospitalization, and mortality in other regions to estimate risk at the county (Harris County) and census tract levels.AnalysisA principal component analysis was undertaken to reduce the dimensions. Then, to identify vulnerable census tracts, we conducted rank-based exceedance and K-means cluster analyses.ResultsOur study showed a total of 722,357 (~17% of the County population) people, including 171,403 between the ages of 45-65 (~4% of County’s population), and 76,719 seniors (~2% of County population), are at a higher risk based on the aforementioned categories. The exceedance and K-means cluster analysis demonstrated that census tracts in the northeastern, eastern, southeastern and northwestern regions of the county are at highest risk. The results of age-based estimations of hospitalization rates showed the western part of the County might be in greater need of hospital beds. However, cross-referencing the vulnerability model with the estimation of potential hospitalized patients showed that part of the County has the least access to medical facilities.ConclusionPolicy makers can use this planning tool to identify neighborhoods at high risk for becoming hot spots; efficiently match community resources with needs, and ensure that the most vulnerable have access to equipment, personnel, and medical interventions.

scholarly journals COVID-19: Rethinking the Lockdown Groupthink

2021 ◽  
Vol 9 ◽  
Author(s):  
Ari R. Joffe
Keyword(s):  
Public Health ◽  
High Risk ◽  
Cost Benefit Analysis ◽  
Health Care Systems ◽  
Herd Immunity ◽  
Cost Benefit ◽  
Risk Groups ◽  
School Closures ◽  
Trade Offs ◽  
Care Systems

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population's movements, work, education, gatherings, and general activities in attempt to “flatten the curve” of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. The initial modeling predictions induced fear and crowd-effects (i.e., groupthink). Over time, important information emerged relevant to the modeling, including the lower infection fatality rate (median 0.23%), clarification of high-risk groups (specifically, those 70 years of age and older), lower herd immunity thresholds (likely 20–40% population immunity), and the difficult exit strategies. In addition, information emerged on significant collateral damage due to the response to the pandemic, adversely affecting many millions of people with poverty, food insecurity, loneliness, unemployment, school closures, and interrupted healthcare. Raw numbers of COVID-19 cases and deaths were difficult to interpret, and may be tempered by information placing the number of COVID-19 deaths in proper context and perspective relative to background rates. Considering this information, a cost-benefit analysis of the response to COVID-19 finds that lockdowns are far more harmful to public health (at least 5–10 times so in terms of wellbeing years) than COVID-19 can be. Controversies and objections about the main points made are considered and addressed. Progress in the response to COVID-19 depends on considering the trade-offs discussed here that determine the wellbeing of populations. I close with some suggestions for moving forward, including focused protection of those truly at high risk, opening of schools, and building back better with a economy.

scholarly journals Learning from health care in other countries: the prospect of comparative research

2015 ◽  
Vol 14 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Edwin Van Teijlingen ◽  
Cecilia Benoit ◽  
Ivy Bourgeault ◽  
Raymond DeVries ◽  
Jane Sandall ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Comparative Research ◽  
Cultural Context ◽  
Health Care Systems ◽  
Cultural Factors ◽  
Reproductive Health Care ◽  
Care Systems ◽  
Cross National ◽  
The Way

It is widely accepted that policy-makers (in Nepal and elsewhere) can learn valuable lessons from the way other countries run their health and social services. We highlight some of the specific contributions the discipline of sociology can make to cross-national comparative research in the public health field. Sociologists call attention to often unnoticed social and cultural factors that influence the way national reproductive health care systems are created and operated. In this paper we address questions such as: ‘Why do these health services appear to be operating successfully in one country, but not another?’; ‘What is it in one country that makes a particular public health intervention successful and how is the cultural context different in a neighbouring country?’ The key examples in this paper focus on maternity care and sex education in the Netherlands and the UK, as examples to highlight the power of cross-national research. Our key messages are: a) Cross-national comparative research can help us to understand the design and running of health services in one country, say Nepal, by learning from a comparison with other countries, for example Sri Lanka or India. b) Cultural factors unique to a country affect the way that reproductive health care systems operate. c) Therefore,we need to understand why and how services work in a certain cultural context before we start trying to implement them in another cultural context.

scholarly journals Η επίδραση του θεσμικού, πολιτικού και διοικητικού περιβάλλοντος στη μεταρρύθμιση του τομέα της υγείας στην Ελλάδα, 1950-2005

2013 ◽  
Author(s):  
Ηλίας Γορανίτης
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Health Care Systems ◽  
Implementation Process ◽  
The United States ◽  
International Experience ◽  
Health Care Reforms ◽  
Care Systems ◽  
Veto Points ◽  
Theories Of Change

The Greek NHS, thirty years after its establishment, faces important performance deficiencies. With an ongoing economic crisis placing a further burden, a call for national health care reform is urgent. This doctoral thesis drawing upon (a) political theories of change, (b) institutional, political and administrative developments in Greece as well as (c) international experience, aims to provide a framework, in terms of planning and implementation process, for health care reform in Greece. The existing order of things, in every public policy system, impedes change and forces policies along specific paths, the deviation from which to a new policy paradigm is extremely difficult. The Greek NHS has never deviated from this path indicating the existence of strong interest groups, institutions with high set-up cost and limited political willingness or ability for strategic approach to overcome the ‘veto points’ of the reform in the system. In this thesis the way forward in reforming fragmented and path-dependent health care systems like the Greek NHS has been identified. By addressing big questions such as: How the Greek NHS reached this low performing level? What are the ingredients of a well performing health care system? What factors impede or promote successful reforms? How health care reforms in systems with multiple ‘veto points’ should be implemented? Political science and international experience from Spain, Portugal, Italy, the Netherlands and the United States provide important insights to our study.

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