eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2016-11-01
5
11
615
618
10.15171/ijhpm.2016.83
3231
Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness
Rob Baltussen
rob.baltussen@radboudumc.nl
1
Maarten P. Jansen
jansenm@who.int
2
Evelinn Mikkelsen
evelinn.mikkelsen@radboudumc.nl
3
Noor Tromp
noor.tromp@radboudumc.nl
4
Jan Hontelez
jan.hontelez@gmail.com
5
Leon Bijlmakers
leon.bijlmakers@radboudumc.nl
6
Gert Jan Van der Wilt
gertjan.vanderwilt@radboudumc.nl
7
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
Priority setting of health interventions is generally considered as a valuable approach to support low- and middle-income countries (LMICs) in their strive for universal health coverage (UHC). However, present initiatives on priority setting are mainly geared towards the development of more cost-effectiveness information, and this evidence does not sufficiently support countries to make optimal choices. The reason is that priority setting is in reality a value-laden political process in which multiple criteria beyond cost-effectiveness are important, and stakeholders often justifiably disagree about the relative importance of these criteria. Here, we propose the use of ‘evidence-informed deliberative processes’ as an approach that does explicitly recognise priority setting as a political process and an intrinsically complex task. In these processes, deliberation between stakeholders is crucial to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. Such processes then result in the use of a broader range of explicit criteria that can be seen as the product of both international learning (‘core’ criteria, which include eg, cost-effectiveness, priority to the worse off, and financial protection) and learning among local stakeholders (‘contextual’ criteria). We believe that, with these evidence-informed deliberative processes in place, priority setting can provide a more meaningful contribution to achieving UHC.
https://www.ijhpm.com/article_3231_0b8154abfa743a669765193093e58f9c.pdf
Universal Health Coverage (UHC)
Priority Setting
Cost-Effectiveness Analysis
Evidence-Informed Deliberative Processes
Decision-Making
Legitimacy
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2016-11-01
5
11
619
622
10.15171/ijhpm.2016.121
3269
Medicalisation and Overdiagnosis: What Society Does to Medicine
Wieteke van Dijk
wieteke.vandijk@radboudumc.nl
1
Marjan J. Faber
marjan.faber@radboudumc.nl
2
Marit A.C. Tanke
marit.tanke@radboudumc.nl
3
Patrick P.T. Jeurissen
patrick.jeurissen@radboudumc.nl
4
Gert P. Westert
gert.westert@radboudumc.nl
5
Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
The concept of overdiagnosis is a dominant topic in medical literature and discussions. In research that targets overdiagnosis, medicalisation is often presented as the societal and individual burden of unnecessary medical expansion. In this way, the focus lies on the influence of medicine on society, neglecting the possible influence of society on medicine. In this perspective, we aim to provide a novel insight into the influence of society and the societal context on medicine, in particularly with regard to medicalisation and overdiagnosis.
https://www.ijhpm.com/article_3269_e100f2351e57ebd7069f76847dda3de5.pdf
Medicalisation
Overdiagnosis
Society
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2016-11-01
5
11
623
630
10.15171/ijhpm.2016.102
3261
Values in Health Policy – A Concept Analysis
Lida Shams
shams_lida@yahoo.com
1
Ali Akbari Sari
akbarisari@tums.ac.ir
2
Shahram Yazdani
shahram.yazdani@yahoo.com
3
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Department of Medical Education, School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Background Despite the significant role “values” play in decision-making no definition or attributes regarding the concept have been provided in health policy-making. This study aimed to clarify the defining attributes of a concept of value and its irrelevant structures in health policy-making. We anticipate our findings will help reduce the semantic ambiguities associated with the use of “values” and other concepts such as principles, criteria, attitudes, and beliefs. Methods An extensive search of literature was carried out using electronic data base and library. The overall search strategy yielded about 1540 articles and 450 additional records. Based on traditional qualitative research, studies were purposefully selected and the coding of articles continued until data saturation was reached. Accordingly, 31 articles, 2 books, and 5 other documents were selected for the review. We applied Walker and Avant’s method of concept analysis in studying the phenomenon. Definitions, applications, attributes, antecedents, and consequences of the concept of “value in health policy-making” were extracted. We also identified similarities and differences that exist between and within them. Results We identified eight major attributes of “value in health policy-making”: ideological origin, affect one’s choices, more resistant to change over time, source of motivation, ability to sacrifice one’s interest, goal-oriented nature for community, trans-situational and subjectivity. Other features pinpointed include alternatives, antecedents, and consequences. Alternative, antecedents and consequences case may have more or fewer attributes or may lack one of these attributes and at the same time have other distinctive ones. Conclusion Despite the use of the value framework, ambiguities still persist in providing definition of the concept value in health policy-making. Understanding the concept of value in health policy-making may provide extra theoretical support to decision-makers in their policy-making process, to help avoid poor policy formulation and wastage of limited resources.
https://www.ijhpm.com/article_3261_f0d5821c502e473c02447e53d7aac01b.pdf
Values
Health
Policy-Making
Ideology
Principle
Belie
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2016-11-01
5
11
631
642
10.15171/ijhpm.2016.52
3197
Private Practitioners’ Perspectives on Their Involvement With the Tuberculosis Control Programme in a Southern Indian State
Solomon Salve
solomon.salve@gmail.com
1
Kabir Sheikh
kabir.sheikh@gmail.com
2
John DH Porter
john.porter@lshtm.ac.uk
3
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
Public Health Foundation of India, New Delhi, India
Departments of Clinical Research and Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
Background Public and private health sectors both play a crucial role in the health systems of low- and middleincome countries (LMICs). The tuberculosis (TB) control strategy in India encourages the public sector to actively partner with private practitioners (PPs) to improve the quality of front line service delivery. However, ensuring effective and sustainable involvement of PPs constitutes a major challenge. This paper reports the findings from an empirical study focusing on the perspectives and experiences of PPs towards their involvement in TB control programme in India. Methods The study was carried out between November 2010 and December 2011 in a district of a Southern Indian State and utilised qualitative methodologies, combining observations and in-depth interviews with 21 PPs from different medical systems. The collected data was coded and analysed using thematic analysis. Results PPs perceived themselves to be crucial healthcare providers, with different roles within the public-private mix (PPM) TB policy. Despite this, PPs felt neglected and undervalued in the actual process of implementation of the PPM-TB policy. The entire process was considered to be government driven and their professional skills and knowledge of different medical systems remained unrecognised at the policy level, and weakened their relationship and bond with the policy and with the programme. PPs had contrasting perceptions about the different components of the TB programme that demonstrated the public sector’s dominance in the overall implementation of the DOTS strategy. Although PPs felt responsible for their TB patients, they found it difficult to perceive themselves as ‘partners with the TB programme.’ Conclusion Public-private partnerships (PPPs) are increasingly utilized as a public health strategy to strengthen health systems. These policies will fail if the concerns of the PPs are neglected. To ensure their long-term involvement in the programme the abilities of PPs and the important perspectives from other Indian medical systems need to be recognised and supported.
https://www.ijhpm.com/article_3197_befe3b0663f3a52d0b2d1e09dc891d8c.pdf
Public Sector
Private Sector
Private Practitioners (PPs)
Public-Private Mix (PPM)
Tuberculosis
(TB)
India
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2016-11-01
5
11
643
652
10.15171/ijhpm.2016.53
3199
Bed Utilisation in an Irish Regional Paediatric Unit – A Cross-Sectional Study Using the Paediatric Appropriateness Evaluation Protocol (PAEP)
Coilín ÓhAiseadha
coilin.ohaiseadha@hse.ie
1
Mai Mannix
mai.mannix@hse.ie
2
Jean Saunders
jean.saunders@ul.ie
3
Roy K. Philip
roy.philip@hse.ie
4
Department of Public Health, Health Service Executive, Dublin, Ireland
Department of Public Health, Health Service Executive, Dublin, Ireland
Statistical Consulting Unit, University of Limerick, Limerick, Ireland
Regional Paediatric Unit (Children’s Ark), University Hospital Limerick (UHL), Limerick, Ireland
Background Increasing demand for limited healthcare resources raises questions about appropriate use of inpatient beds. In the first paediatric bed utilisation study at a regional university centre in Ireland, we conducted a cross-sectional study to audit the utilisation of inpatient beds at the Regional Paediatric Unit (RPU) in University Hospital Limerick (UHL), Limerick, Ireland and also examined hospital activity data, to make recommendations for optimal use of inpatient resources. Methods We used a questionnaire based on the paediatric appropriateness evaluation protocol (PAEP), modified and validated for use in the United Kingdom, to prospectively gather data regarding reasons for admission and for ongoing care after 2 days, from case records for all inpatients during 11 days in February (winter) and 7 days in May–June (summer). We conducted bivariate and multivariate analysis to explore associations between failure to meet PAEP criteria and patient attributes including age, gender, admission outside of office hours, arrival by ambulance, and private health insurance. Inpatient bed occupancy and day ward activity were also scrutinised. Results Mean bed occupancy was 84.1%. In all, 12/355 (3.4%, 95% CI: 1.5%–5.3%) of children failed to meet PAEP admission criteria, and 27/189 (14.3%, 95% CI: 9.3%–19.3%) who were still inpatients after 2 days failed to meet criteria for ongoing care. 35/355 (9.9%, 95% CI: 6.8%–13.0%) of admissions fulfilled only the PAEP criterion for intravenous medications or fluid replacement. A logistic regression model constructed by forward selection identified a significant association between failure to meet PAEP criteria for ongoing care 2 days after admission and admission during office hours (08.00–17.59) (P = .020), and a marginally significant association between this outcome and arrival by ambulance (P = .054). Conclusion At a mean bed occupancy of 84.1%, an Irish RPU can achieve 96.6% appropriate admissions. Although almost all inpatients met PAEP criteria, improvements could be made regarding emergency access to social services, management of parental anxiety, and optimisation of access to community-based services. Potential ways to provide nasogastric or intravenous fluid therapy on an ambulatory basis, and outpatient antimicrobial therapy (OPAT) should be explored. Elective surgical admissions should adhere to day-of-surgery admissions (DOSA) policy.
https://www.ijhpm.com/article_3199_c2a6896cef8df1838624785bcfe9ed21.pdf
Bed Utilisation
Bed Occupancy
Hospitalisation
Paediatrics
Quality Of Healthcare
Social Work
Clinical
Audit
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2016-11-01
5
11
653
662
10.15171/ijhpm.2016.55
3206
Key Ethical Issues Discussed at CDC-Sponsored International, Regional Meetings to Explore Cultural Perspectives and Contexts on Pandemic Influenza Preparedness and Response
Aun Lor
aal8@cdc.gov
1
James C. Thomas
jim.thomas@unc.edu
2
Drue H. Barrett
dhb1@cdc.gov
3
Leonard W. Ortmann
hsq3@cdc.gov
4
Dionisio J. Herrera Guibert
dherrera@tephinet.org
5
Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
Gilllings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
Office of Science Integrity, Office of the Associate Director for Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
Office of Science Integrity, Office of the Associate Director for Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
Training Programs in Epidemiology and Public Health Interventions Network, Task Force for Global Health Inc., Atlanta, GA, USA
Background Recognizing the importance of having a broad exploration of how cultural perspectives may shape thinking about ethical considerations, the Centers for Disease Control and Prevention (CDC) funded four regional meetings in Africa, Asia, Latin America, and the Eastern Mediterranean to explore these perspectives relevant to pandemic influenza preparedness and response. The meetings were attended by 168 health professionals, scientists, academics, ethicists, religious leaders, and other community members representing 40 countries in these regions. Methods We reviewed the meeting reports, notes and stories and mapped outcomes to the key ethical challenges for pandemic influenza response described in the World Health Organization’s (WHO’s) guidance, Ethical Considerations in Developing a Public Health Response to Pandemic Influenza: transparency and public engagement, allocation of resources, social distancing, obligations to and of healthcare workers, and international collaboration. Results The important role of transparency and public engagement were widely accepted among participants. However, there was general agreement that no “one size fits all” approach to allocating resources can address the variety of economic, cultural and other contextual factors that must be taken into account. The importance of social distancing as a tool to limit disease transmission was also recognized, but the difficulties associated with this measure were acknowledged. There was agreement that healthcare workers often have competing obligations and that government has a responsibility to assist healthcare workers in doing their job by providing appropriate training and equipment. Finally, there was agreement about the importance of international collaboration for combating global health threats. Conclusion Although some cultural differences in the values that frame pandemic preparedness and response efforts were observed, participants generally agreed on the key ethical principles discussed in the WHO’s guidance. Most significantly the input gathered from these regional meetings pointed to the important role that procedural ethics can play in bringing people and countries together to respond to the shared health threat posed by a pandemic influenza despite the existence of cultural differences.
https://www.ijhpm.com/article_3206_193a5ab3c5d46c96a8914bd9fcb6c6e5.pdf
Public Health Ethics
Culture
Influenza
Pandemic Preparedness
Global Health
Emergency Response
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2016-11-01
5
11
663
665
10.15171/ijhpm.2016.82
3229
Low Decision Space Means No Decentralization in Fiji; Comment on “Decentralisation of Health Services in Fiji: A Decision Space Analysis”
Jean-Paul Faguet
j.p.faguet@lse.ac.uk
1
Department of International Development & STICERD, London School of Economics, London, UK
Mohammed, North, and Ashton find that decentralization in Fiji shifted health-sector workloads from tertiary hospitals to peripheral health centres, but with little transfer of administrative authority from the centre. Decisionmaking in five functional areas analysed remains highly centralized. They surmise that the benefits of decentralization in terms of services and outcomes will be limited. This paper invokes Faguet’s (2012) model of local government responsiveness and accountability to explain why this is so – not only for Fiji, but in any country that decentralizes workloads but not the decision space of local governments. A competitive dynamic between economic and civic actors that interact to generate an open, competitive politics, which in turn produces accountable, responsive government can only occur where real power and resources have been devolved to local governments. Where local decision space is lacking, by contrast, decentralization is bound to fail because it has not really happened in the first place.
https://www.ijhpm.com/article_3229_2327af22894c19b20cb69636e79e79dc.pdf
Decentralization
Democracy
Local Government
Good Governance
Civil Society
Fiji
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2016-11-01
5
11
667
669
10.15171/ijhpm.2016.84
3230
Consumers or Citizens? Whose Voice Will Healthwatch Represent and Will It Matter?; Comment on “Challenges Facing Healthwatch, a New Consumer Champion in England”
Brad Wright
brad_wright@med.unc.edu
1
Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
Efforts to achieve effective and meaningful patient and public involvement (PPI) in healthcare have existed for nearly a century, albeit with limited success. This brief commentary discusses a recent paper by Carter and Martin exploring the “Challenges Facing Healthwatch, a New Consumer Champion in England,” and places these challenges in the context of the broader struggle to give a voice to healthcare consumers and citizens. With an overview of what can go right and—perhaps more importantly—what can go wrong, the question remains: will Healthwatch—and other PPI efforts in healthcare—represent the voice of consumers or citizens and will it matter?
https://www.ijhpm.com/article_3230_00e838396ee9e8504b7feccfca5380c7.pdf
Patient and Public Involvement (PPI)
Consumer Involvement
Governance
Representation
Healthwatch
England
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2016-11-01
5
11
671
672
10.15171/ijhpm.2016.86
3232
Have Non-physician Clinicians Come to Stay?; Comment on “Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians”
Gottlieb Lobe Monekosso
globalhealth2202@yahoo.fr
1
Regional Office for Africa, World Health Organization (WHO), Republic of Congo, Africa
A decade ago, sub-Saharan Africa accounted for 24% of the global disease burden but was served by only 4% of the global health workforce. The chronic shortage of medical doctors has led other health professionals especially nurses to perform the role of healthcare providers. These health workers have been variously named clinical officers, health officers, physician assistants, nurse practitioners, physician associates and non-physician clinicians (NPCs) defined as “health workers who have fewer clinical skills than physicians but more than nurses.” Although born out of exigencies, NPCs, like previous initiatives, seem to have come to stay and many more medical doctors are being trained to care for the sick and to supervise other health team members. Physicians also have to assume new roles in the healthcare system with consequent changes in medical education.
https://www.ijhpm.com/article_3232_ea67174387c06ea256634b4f7fce090c.pdf
Non-physician Clinician (NPC)
Physician
Tradi-Practitioner
Health Worker
Healthcare
Workforce
Medical Education
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2016-11-01
5
11
673
674
10.15171/ijhpm.2016.94
3242
From Almost Empty to Half Full? A Response to Recent Commentaries
Lisa Forman
lisa.forman@utoronto.ca
1
Gorik Ooms
gorik.ooms@lshtm.ac.uk
2
Claire E. Brolan
c.brolan@sph.uq.edu.au
3
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
Institute of Public Health, Heidelberg University Hospital, Heidelberg, Germany
School of Public Health, University of Queensland, Brisbane, QLD, Australia
https://www.ijhpm.com/article_3242_33c65861df7dd4a413be37ab7360b0d9.pdf
Right to Health
Global Health Policy
Sustainable Development Goals (SDGs)