ORCID Profile
0000-0002-1372-0440
Current Organisations
University of Queensland
,
University of Manchester
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Applied Economics | Health Economics | Applied Economics not elsewhere classified | Medical molecular engineering of nucleic acids and proteins | Pharmaceutical sciences | Economic Models and Forecasting | Pharmacology and pharmaceutical sciences | Health Policy | Nanomanufacturing |
ANZSRC Socio-Economic Objective (SEO)
Demography | Dental Health | Health Related to Ageing | Public Services Policy Advice and Analysis | Health Policy Economic Outcomes | Health Policy Evaluation
Related Links
Publications
Selective Opportunistic Screening for Hypercholesterolemia in Primary Care Practice
Publisher: Elsevier BV
Date: 10-1998
DOI: 10.1016/S0895-4356(98)00068-7
Abstract: To assess the performance of selective opportunistic screening in a primary care group practice. Cross-sectional survey of coronary heart disease risk factors and retrospective chart audit of cholesterol testing. Capitation-funded primary care group practice in Ontario, Canada. 7785 enrolled patients between the ages of 20 and 69 years. Protocol-based selective opportunistic screening program for hypercholesterolemia of 45 months duration. Targeting (proportion of screening tests that were appropriate), coverage (proportion of those meeting screening criteria who had a screening test performed), over-screening (proportion of those not meeting screening criteria who had a screening test performed), and screening ratio (likelihood that a screening test was performed on an in idual who met screening criteria rather than one who failed to meet screening criteria). 64.7% of patients tested met the practice criteria for screening. 37.7% of patients who met the practice screening criteria were tested and 24.9% of those not meeting practice screening criteria had a cholesterol test performed. The screening ratio was 1.52. Our findings bring into question the effectiveness of opportunistic approaches to preventive care.
Health Care Funding
Publisher: Wiley
Date: 12-1991
Hosting pre-registration physiotherapy students in Australian private practices does not change service and economic outcomes; an economic analysis
Publisher: Elsevier BV
Date: 04-2021
The technical efficiency of oral healthcare provision: Evaluating role substitution in National Health Service dental practices in England
Publisher: Wiley
Date: 27-02-2017
DOI: 10.1111/CDOE.12292
Abstract: In many countries increasing use is being made of dental care professionals (DCPs) to provide aspects of clinical activity previously undertaken by dentists. This study evaluates the differences in practice efficiency associated with the utilisation of DCPs in the provision of General Dental Services in the National Health Service (NHS) in England. One hundred twenty-one NHS practices completed a questionnaire and shared practice information held at the NHS Business Services Authority. Practice efficiency was estimated using data envelopment analysis with the robustness of the findings checked using Stochastic Frontier Model estimation. Dental practices operated at an estimated mean level of technical efficiency of 64%. Variations among practices in the use of DCPs were not associated with variations in practice efficiency after controlling for other staffing levels, patient population characteristics and practice variables. The current NHS dental contract limits the potential for efficiency improvements by setting annual practice activity targets that produce little incentive for role substitution. Whilst DCPs may by practising efficiently, this is not reflected in practice-level efficiency, possibly because of dentists using the time released for other non-NHS activity.
Who you know, where you live: social capital, neighbourhood and health
Publisher: Elsevier BV
Date: 06-2005
DOI: 10.1016/J.SOCSCIMED.2004.11.013
Abstract: This article examines the degree to which relationships between social capital and health are embedded in local geographical contexts and influenced by demographic factors, socio-economic status, health behaviours and coping skills. Using data from a telephone survey of a random s le of adults (N=1504 respondents, response rate=60%), the article determines if relationships between involvement in voluntary associations and various measures of in idual health are associated with neighbourhood of residence in the mid-sized city of Hamilton, Canada. Associational involvement and overweight status (assessed by body-mass score) were weakly but significantly related after controlling for the other variables involvement had relationships with self-rated health and emotional distress before but not after controlling for socio-economic status, health behaviours and coping skills. Relationships between neighbourhood of residence and two health outcomes, self-rated health and overweight status, were statistically significant before and after controlling for the other characteristics of respondents neighbourhood of residence was not a significant predictor of number of chronic conditions and emotional distress in multivariate models. The neighbourhood and associational involvement relationships with health were not dependent upon one another, suggesting that neighbourhood of residence did not help to explain the positive health effects of this particular measure of social capital.
A Literature Review of Preferences for End-of-Life Care in Developed Countries by Individuals With Different Cultural Affiliations and Ethnicity
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2008
Cost effectiveness/utility analyses
Publisher: Elsevier BV
Date: 10-1992
DOI: 10.1016/0167-6296(92)90004-K
Abstract: Despite the growing literature on economic evaluation of health care programmes, little attention has been paid to the theoretical foundations of cost-effectiveness and cost utility analyses and the validity of the decision rules adopted as methods of achieving the stated goals. We show that although applications of the techniques can be used to pursue some managerial objectives in the context of highly constrained environments, such applications are inconsistent with both welfare economic objectives and the interpretations of the findings of these applications. Alternative strategies are identified as potential and practical methods for pursuing welfare economic objectives.
Preferences for outcomes in economic evaluation: An economic approach to addressing economic problems
Publisher: Elsevier BV
Date: 03-1995
DOI: 10.1016/0277-9536(94)E0109-6
Abstract: In this paper we critically appraise the appropriateness and validity from an economic perspective of alternative preference-based approaches to measuring outcomes in economic evaluations of health care interventions. We describe the properties of an outcome measure for economic evaluation to make it compatible with the principles of economics when applied to the problem of resource allocation. We also describe the difference and similarities between the psychometric and the economic approaches for the measurement of outcome. Using these properties we critically appraise the use of QALY and HYE methods of measuring in idual and social preferences for health outcome. We argue that the most advanced measure currently available that meets these required properties is the HYE. Because the HYE, unlike the QALY, has its foundations in utility theory under uncertainty, it neither assumes particular formulations of the in idual utility function, nor is it incompatible with the principles of economics. As such it represents a further stage in the continuing development of methods for economic evaluation of health care programmes.
Planning the oral health workforce: Time for innovation
Publisher: Wiley
Date: 15-12-2020
DOI: 10.1111/CDOE.12604
Home Care Developments in the Canadian Province of Alberta with Regionalization
Publisher: Canadian Center of Science and Education
Date: 05-04-2011
DOI: 10.5539/GJHS.V3N1P3
Retrospective economic analysis of the transfer of services from hospitals to the community: an application to an enhanced eye care service
Publisher: BMJ
Date: 07-2017
Access as a policy-relevant concept in low- and middle-income countries
Publisher: Cambridge University Press (CUP)
Date: 04-2009
DOI: 10.1017/S1744133109004836
Abstract: Although access to health care is frequently identified as a goal for health care policy, the precise meaning of access to health care often remains unclear. We present a conceptual framework that defines access to health care as the empowerment of an in idual to use health care and as a multidimensional concept based on the interaction (or degree of fit) between health care systems and in iduals, households, and communities. Three dimensions of access are identified: availability, affordability, and acceptability, through which access can be evaluated directly instead of focusing on utilisation of care as a proxy for access. We present the case for the comprehensive evaluation of health care systems as well as the dimensions of access, and the factors underlying each dimension. Such systemic analyses can inform policy-makers about the ‘fit’ between needs for health care and receipt of care, and provide the basis for developing policies that promote improvements in the empowerment to use care.
Not enough doctors or not enough needs? Refocusing health workforce planning from providers and services to populations and needs
Publisher: SAGE Publications
Date: 04-2013
Abstract: The importance of allocating services in accordance with population needs is well-established. Needs-based approaches to geographical resource allocation were established in the National Health Service in the UK in the 1970s, but the role of population needs has not extended to planning for the quantity and mix of health care services or for the providers required to deliver these services. We present a framework that integrates health service and workforce planning focused on responding to population needs. Using data from the General Household Survey for England over the period 1985–2006, we illustrate trends in health needs and service use per capita. Despite needs per capita falling, service use has increased. Rates of increase in service use are greater among those with less needs illustrating that, in the absence of appropriate planning methods, increases in service use may result from supplier influence rather than policy decisions.
Barriers to treatment adherence for individuals with latent tuberculosis infection: A systematic search and narrative synthesis of the literature.
Publisher: Wiley
Date: 12-02-2018
DOI: 10.1002/HPM.2495
Abstract: We investigated the rates of initiation and completion of treatment for latent TB infection (LTBI), factors explaining nonadherence and interventions to improve treatment adherence in countries with low TB incidence. A systematic search was performed in PubMed and Embase. All included articles were assessed for risk of bias. A narrative synthesis of the results was conducted. There were 54 studies included in this review. The proportion of people initiating treatment varied from 24% to 98% and the proportion of people completing treatment varied from 19% to 90%. The main barriers to adherence included the fear or experience of adverse effects, long duration of treatment, financial barriers, lack of transport to clinics (for patients), and insufficient resources for LTBI control. While interventions like peer counseling, incentives, and culturally specific case management have been used to improve adherence, the proportion of people who initiate and complete LTBI treatment still remains low. To further improve treatment and LTBI control and to fulfill the World Health Organization goal of eliminating TB in low-incidence countries, greater priority should be given to the use of treatment regimens involving shorter durations and fewer adverse effects, like the 3-month regimen of weekly rifapentine plus isoniazid, supported by innovative patient education and incentive strategies.
Variation in healthcare services for specialist genetic testing and implications for planning genetic services: the example of inherited retinal dystrophy in the English NHS
Publisher: Springer Science and Business Media LLC
Date: 09-01-2015
The distribution problem in economic evaluation: income and the valuation of costs and consequences of health care programmes
Publisher: Wiley
Date: 2002
DOI: 10.1002/HEC.642
Abstract: To date, a common view in the health economics literature is that the applicability of cost-benefit analysis (CBA) is limited, due to the distribution problem which underlies its main method of valuation (e.g. willingness to pay). One view is that cost effectiveness analysis (CEA) overcomes these problems. We show that the same distributional concerns apply to non-monetary valuations of health consequences, to measurement of costs and to the decision rules of CEA. Hence adopting CEA over CBA cannot be justified on the basis of "avoiding" distributional considerations. The implications of our results are discussed, including alternative strategies for the use of "income-based" research findings in social decision-making.
Opportunity costs and uncertainty in the economic evaluation of health care interventions
Publisher: Wiley
Date: 2002
DOI: 10.1002/HEC.641
Abstract: Considerable methodological research has been conducted on handling uncertainty in cost-effectiveness analysis. The current literature suggests the concepts of net health benefits and cost-effectiveness acceptability curves to circumvent the technical shortcomings of cost-effectiveness ratio statistics. However, these approaches do not provide a solution for the inherent problem that the threshold cost-effectiveness ratio itself is unknown. The authors suggest analysing uncertainty in cost-effectiveness analysis by directly addressing the concept of opportunity costs using the decision rule described by Birch and Gafni (1992) and introduce a new graphical framework (the "decision making plane") for communicating with policy makers.
Geographic disparity in premature mortality in Ontorio, 1992-1996
Publisher: Springer Science and Business Media LLC
Date: 2003
Unmet Needs Reported by Adults with Chronic Conditions:An Analysis of Data from the Canadian Community Health Survey
Publisher: International Journal of Physiotherapy
Date: 12-2016
Reconfiguring health workforce: a case-based comparative study explaining the increasingly diverse professional roles in Europe
Publisher: Springer Science and Business Media LLC
Date: 08-11-2016
Human Resources Planning and the Production of Health: A Needs-Based Analytical Framework
Publisher: University of Toronto Press Inc. (UTPress)
Date: 2007
DOI: 10.3138/9R62-Q0V1-L188-1406
Abstract: Traditional approaches to health human resources planning emphasize the effects of demographic change on the needs for health human resources. Planning requirements are largely based on the size and demographic mix of the population applied to simple population-provider or population-utilization ratios. We develop an extended analytical framework based on the production of health-care services and the multiple determinants of health human resource requirements. The requirements for human resources are shown to depend on four separate elements: demography, epidemiology, standards of care, and provider productivity. The application of the framework is illustrated using hypothetical scenarios for the population of the combined provinces of Atlantic Canada.
Provision of home medicines reviews in Australia: linking population need with service provision and available pharmacist workforce
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/AH19207
Abstract: ObjectiveIdentifying and quantifying the health needs of a population are the basis of evidence-based health policy and workforce planning. The motivation for undertaking the present study was to evaluate whether the current level of medication review services corresponds to population need, as proxied by the rate of polypharmacy, and to undertake a preliminary analysis of the sufficiency of the current workforce. This paper: (1) estimates the age- and sex-standardised rates of polypharmacy as a proxy for population need for home medicines review (2) compares the rate of polypharmacy with current service provision of home medicines reviews and (3) links the estimated need for services with the current number and location of pharmacist providers. MethodsAge- and sex-adjusted polypharmacy rates, by state, were estimated from the National Health Survey of Australia (2017–18), service levels were estimated from national-level administrative claims data (2017–18) and the current workforce was estimated from the Australian Association of Consultant Pharmacists (2018). The current level of service provision was compared to the estimated population need for services, alongside the size of the pharmacy workforce required if need was met. ResultsThe adjusted rate of polypharmacy in Australia, using the strictest definition of ≥10 medications and ≥3 current chronic illnesses, was 1389 per 100000 population. The illustrative needs-based analysis suggests that there may be a disconnect between the current level of service provision and population health needs. ConclusionGiven that polypharmacy is a risk factor for medication-related problems, and that medication review is one of the few targeted strategies currently available to address medication-related problems in the population, service provision may be inadequate. Policy options to improve service provision could include interventions to increase workforce productivity and relaxing the current eligibility criteria for review, especially in rural and remote areas. What is known about the topic?Polypharmacy is a risk factor for medication-related problems, which can cause increased morbidity and mortality in the population. What does this paper add?This paper provides representative, population-based rates of polypharmacy in Australia and uses these rates in a needs-based analysis of service provision and workforce adequacy to provide home medicines review services. What are the implications for practitioners?Several policy options are available for consideration, including interventions to increase workforce productivity and relaxation of the current eligibility criteria for medicines review, especially in rural and remote areas.
A Needs-Based Approach to Resource Allocation in Health Care
Publisher: JSTOR
Date: 03-1993
DOI: 10.2307/3551791
The health service impact of an occupational therapy practice placement model: Student-resourced service delivery of groups
Publisher: University of Otago Library
Date: 30-06-2022
Abstract: Introduction: Student-resourced service delivery of groups is a practice education placement model in which students deliver therapy to groups, with graded supervision. This study examined an application of this model in occupational therapy to determine its costs to the health service and impact on hospital rehabilitation throughput and patient outcomes. Methods: Retrospectively collected data were compared between periods when groups were student-resourced and staff-resourced. Patient data were analysed separately to group data. Results: Seventeen patients received staff-resourced group therapy, and 52 patients received student-resourced group therapy, with no statistically significant differences identified in the characteristics of patients between group types. There was no evidence student-resourced therapy was associated with change in patient rehabilitation outcomes or length of rehabilitation stay. Student-resourced therapy groups had an average duration of 10.8 minutes per session shorter (95% CI: 3.7, 18.0 P: 0.002) than staff-resourced groups. Under the student-resourced groups placement model, mean clinician time per group—both direct patient time and time spent on group facilitation—was not adversely affected and was reduced for occupational therapy assistants’ direct time (mean difference -7.6 minutes, 95% CI: 0.8, -16.0 P: 0.04) and for occupational therapists’ indirect time (mean difference -30.28 minutes 95% CI: -1.0, -59.6 P:0.02). Despite an implied mean cost savings per group of $49.61 under the student-resourced model, there was no evidence of any statistically significant impact on overall costs. Conclusions: Student-resourced service delivery of rehabilitation groups provide an opportunity for student practice education placements and do not appear to negatively impact occupational therapists’ time, costs or patient outcomes.
Relationships between job satisfaction, organizational commitment, burnout and job performance of healthcare professionals in a district-level health care system of Shenzhen, China
Publisher: Frontiers Media SA
Date: 28-11-2022
DOI: 10.3389/FPSYG.2022.992258
Abstract: Existing research indicates that job satisfaction has effects on job performance, but little evidence exists about the mechanism through which the satisfaction-performance association operates. This study aims to examine the effect of job satisfaction on job performance in a district-level health care system of China and to explore the effect mechanism mediated by organizational commitment and burnout. Cluster s ling was used in this study. All healthcare professionals in the Nanshan Medical Group, who were at work in the last 3 months and able to complete online questionnaire independently were invited to participate the anonymous online survey. Job satisfaction, organizational commitment, burnout and job performance were measured by tools, which have been validated in China. Descriptive statistics were used for the socio-demographic variables and the four job psychological variables. Pearson correlation coefficients was used to determine associations among each of the psychological variables. Linear regression was used to examine association between job performance and other three psychological variables. PROCESS macro was used to examine the mediation effects of organizational commitment and burnout on the association between job satisfaction and performance. In total, 1,200 healthcare professionals completed the anonymous online survey. Job satisfaction, organizational commitment, and job performance were positively correlated with one another, with burnout negatively correlated with them. Linear regression revealed that demographic characteristics, job satisfaction, organizational commitment, and burnout explained 5, 6, 2, and 9% of the variance in job performance. Path analysis showed that the coefficient of the direct effect of job satisfaction on job performance was 0.18, the coefficients of the indirect effects of job satisfaction on job performance through organizational commitment and burnout were 0.17 and 0.37, respectively. The coefficients of the indirect effects of organizational commitment on job performance through burnout was −0.04, but it was not significant. It is promising to improve job performance of providers in Chinese healthcare systems by improving job satisfaction and reducing burnout. Tailored support policies for female healthcare professionals, appropriate incentive mechanisms and improving multidisciplinary healthcare delivery are potential to improve job performance of healthcare professionals in integrated healthcare systems.
Provider incentives and access to dental care: Evaluating NHS reforms in England
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.SOCSCIMED.2012.09.035
Abstract: Changes were made to the management and delivery of primary dental care in the NHS in England in 2006 aimed at improving access to NHS dental services among populations with low use. These included: (i) commissioning of NHS dental services by primary care trusts (ii) replacing item of service patient charges by Course of Treatment cost bands and (iii) changing the remuneration of dentists providing NHS dental care. Using longitudinal data from the 1991-2008 waves of the British Household Panel Survey, we estimate the effects of these changes on the levels and distribution of dental care in the population and on the public-private mix of primary dental care services in England using dynamic probit models. We find evidence of a decrease in NHS use, driven by reductions in use among populations with previously good access to care and a positive effect of the reforms on consumer transitions from NHS to private practice. Our results highlight the potential (unintended) consequences of reforming public health care systems. It appears that contrary to expanding NHS access, the dental reforms contracted NHS use amongst those with previously good access. This contraction relied upon the ability of the private sector to absorb this group.
UNCERTAINTY AND THE DECISION MAKER: ASSESSING AND MANAGING THE RISK OF UNDESIRABLE OUTCOMES
Publisher: Wiley
Date: 26-12-2012
DOI: 10.1002/HEC.2883
Abstract: We present an approach to rank order new programs in ways that accommodate uncertainty of different outcomes occurring, on the basis of the size and nature ('bad' or 'good') of those outcomes. This represents an improvement on the way uncertainty has been accommodated in existing approaches (e.g., threshold approach to cost-effectiveness analysis). We illustrate the approach using the decision making plane, which explicitly incorporates opportunity costs and relaxes the assumptions of perfect isibility and constant returns to scale of the cost-effectiveness plane. The nature of the bad (or good) outcome is determined by the quadrant that it falls into (i.e., a 'quadrant effect') and its magnitude by its location within the quadrant (i.e., 'within quadrant effect'). By explicitly defining the loss function, the process of accepting (or rejecting) a new program becomes transparent. We illustrate the approach using a loss function and a net gain function. We show that by recognizing that, not all bad (or good) outcomes are equal and the choice of a loss or a net gain function can result in different ranking of resource allocation options. Further implications of the proposed approach are discussed.
Charging the patient to save the system? Like bailing water with a sieve
Publisher: CMA Joule Inc.
Date: 08-06-2004
DOI: 10.1503/CMAJ.1040699
GALLSTONE LITHOTRIPSY
Publisher: Elsevier BV
Date: 08-1988
Modelling the economic impact of COVID19 under different policy choices: Mitigation versus suppression when time is a scarce resource
Publisher: Elsevier BV
Date: 12-2020
A Validation Study of the Rainbow Model of Integrated Care-Measurement Tool for Patients in China
Publisher: Ubiquity Press, Ltd.
Date: 2021
DOI: 10.5334/IJIC.5603
Health Human Resources Planning and the Production of Health
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2009
Equitable access to health care: Methodological extensions to the analysis of physician utilization in Canada
Publisher: Wiley
Date: 07-1993
Abstract: In this paper we analyse the distribution of family physician use in Canada to explore whether the stated goal of reasonable access to care has been achieved. We test hypotheses to see whether (a) variations in incidence and quantity of use are independent of need for care as proxied by self-assessed health status and (b) any observed relationship between variations in use and need is independent of other population characteristics. Previous research has conceptual, statistical and data limitations which bring into question the validity of the findings. These limitations are addressed by using more appropriate data, a conditional model for service utilization and correction for self-selectivity of users in the statistical analysis. Variations in need are identified as important and significant in explaining variations in both incidence and quantity of use with the estimated relationship between use and need being positive. Other population characteristics were found to be important and significant in explaining variations in use although household income is not among them. The relationship between use and need is associated with other variables including education, social support and region of residence. These findings suggest that analyses of utilization based on simple multivariate techniques and aggregate data can produce a picture of utilization that conceals important, policy relevant relationships while revealing other relationships that are essentially artifacts of inappropriate aggregation in ways which provide a false sense of achievement.
General population preferences for cancer care in health systems of China: A discrete choice experiment
Publisher: Wiley
Date: 08-12-2022
DOI: 10.1002/CAM4.5473
Abstract: The increasing incidence of cancer in China has posed considerable challenges for cancer care delivery systems. This study aimed to determine the general population's preferences for cancer care, to provide evidence for building a people‐centered integrated cancer care system. We conducted a discrete choice experiment that involved 1,200 participants in Shandong Province. In iduals were asked to choose between cancer care scenarios based on the type and level of hospitals, with various out‐of‐pocket costs, waiting time, and contact working in the hospitals. In idual preferences, willingness to pay, and uptake rate were estimated using a mixed‐logit model. This study included 848 respondents (70.67%). Respondents preferred county hospitals with shorter hospitalization waiting times and contact working in hospitals. Compared to the reference levels, the three highest willingness to pay values were related to waiting time for hospitalization (¥97,857.69–¥145411.70–¥212,992.10/$14512.70–$21565.16–$31587.61), followed by the county‐level hospital (¥32,545.13/$4826.58). The preferences of the different groups of respondents were erse. Based on a county‐level general hospital with contact in the hospital, 50% out‐of‐pocket costs and a waiting time of 15 days, the probability of seeking baseline care was 0.37. Reducing the waiting time from 15 to 7, 3, and 0 days, increases the probability of choosing a county‐level hospital from 0.37 to 0.58, 0.64, and 0.70, respectively. This study suggests that there is a substantial interest in attending county‐level hospitals and that reducing hospitalization waiting time is the most effective measure to increase the probability of seeking cancer care in county‐level hospitals.
Using small‐area variations to inform health care service planning: what do we ‘need’ to know?
Publisher: Wiley
Date: 22-03-2013
DOI: 10.1111/JEP.12026
Abstract: Allocating resources on the basis of population need is a health care policy goal in many countries. Thus, resources must be allocated in accordance with need if stakeholders are to achieve policy goals. Small area methods have been presented as a means for revealing important information that can assist stakeholders in meeting policy goals. The purpose of this review is to examine the extent to which small area methods provide information relevant to meeting the goals of a needs-based health care policy. We present a conceptual framework explaining the terms 'demand', 'need', 'use' and 'supply', as commonly used in the literature. We critically review the literature on small area methods through the lens of this framework. 'Use' cannot be used as a proxy or surrogate of 'need'. Thus, if the goal of health care policy is to provide equal access for equal need, then traditional small area methods are inadequate because they measure small area variations in use of services in different populations, independent of the levels of need in those populations. Small area methods can be modified by incorporating direct measures of relative population need from population health surveys or by adjusting population size for levels of health risks in populations such as the prevalence of smoking and low birth weight. This might improve what can be learned from studies employing small area methods if they are to inform needs-based health care policies.
Five-Year follow up of Patients Treated with Inpatient Psychotherapy at the Cassel Hospital for Nervous Diseases
Publisher: SAGE Publications
Date: 09-1987
DOI: 10.1177/014107688708000906
Abstract: Twenty-eight patients who were admitted consecutively to a single-adult unit of the Cassel Hospital in 1977/8 were followed up 5 years after discharge. Those who were found to have improved at the end of treatment remained well 5 years later. These could be distinguished by their combination of neurotic psychopathology, considerable depression, superior intelligence, and lack of a chronic outpatient history. Patients who had improved 5 years after discharge did not show these characteristics, but had all spent at least 9 weeks on the waiting list and had the capacity to form close and helpful relationships. Patients who were judged to have improved were less dependent on the Health Service and their economic productivity was improved, often as a consequence of returning to education or training. Those who did not improve clinically continued to be admitted to hospital and tended to become less economically productive.
Economic Evaluation of Alternative Programs of Reduced-Stay Senile Cataract Surgery
Publisher: Cambridge University Press (CUP)
Date: 1991
Inclusiveness and health economics: Reflections on the work of Gavin Mooney (1943–2012)
Publisher: Elsevier BV
Date: 05-2014
Needs-based primary medical care capitation: development and evaluation of alternative approaches.
Publisher: Springer Science and Business Media LLC
Date: 2000
Abstract: To develop and evaluate alternative methods of adjusting primary medical care capitation payments for variations in relative need for health care among enrolled practice populations. We developed alternative needs-based capitation formulae and applied them to a s le of capitation-funded primary care practices to assess each formula's performance against a reference standard of capitation payments based on age, sex and self-assessed health status of the enrolled populations. The alternative formulae were based on: (1) age and sex (2) age, sex and in idually-measured socioeconomic characteristics (3) age, sex and socioeconomic characteristics imputed from census data for enrollees' neighbourhood of residence (4) age, sex and standardized mortality ratio for enrollees' neighbourhood of residence. Age/sex-adjusted capitation payments for the six practices studied ranged from 10% higher to 18% lower than the reference standard payments. Capitation formulae based on socioeconomic and mortality data did not perform consistently better than the current age/sex-based formula. Primary medical care capitation payments adjusted only for age and sex do not reflect the relative health care needs of enrolled practice populations. Our alternative formulae based on socioeconomic and mortality data also failed to reflect relative needs. Methods that use other approaches to adjusting for differences in relative need among enrolled populations should be investigated.
Increasing Patient Charges in the National Health Service: A Method of Privatizing Primary Care
Publisher: Cambridge University Press (CUP)
Date: 04-1986
DOI: 10.1017/S0047279400001653
Abstract: Frequent increases in the real value of National Health Service (NHS) patient charges have been made since the Conservative Party's return to office in 1979. For those patients subject to these charges the increases have led to a substantial reduction in the level of subsidization of the cost of the service. The rationale for the subsidization of health care is shown to be unrelated to ‘ability to pay’ considerations. Consequently the ‘backdoor privatization’ of these services is inconsistent with the objectives of the NHS even though the Government has continually committed itself to these objectives. Alternative policies to increasing patient charges are suggested which would encourage the efficient use of NHS resources without compromising NHS objectives.
The effects of a sugar-sweetened beverage tax: moving beyond dental health outcomes and service utilisation
Publisher: Cambridge University Press (CUP)
Date: 02-08-2023
DOI: 10.1017/S1744133122000147
Abstract: Despite considerable academic and policy interest in the taxation of sugar-sweetened beverages (SSBs), its extra-health implications remain largely unexplored. We investigated the impact of an SSB tax on school absenteeism due to improved dental health, in a framework that accounted for the distribution of the benefit. We designed a quantitative, decision-analytic model that synthesised existing evidence in the areas of dental epidemiology, public health and economics, and simulated causal mechanisms that lead to changes in school attendance in Australian children and adolescents aged 6–17, in a tax vs no tax scenarios. Introducing a 20% sales tax on SSBs would result in a 0.73% (95% confidence interval: 0.38 1.10), or 4684 (2412 7071) days per year nationwide, reduction in school absences attributable to dental health reasons. While positive impacts would be seen across the board, the distribution of benefit was favourable towards boys, older teens and those from lower socio-economic status. Our study highlights the need for, and the viability of, quantifying distributions of direct and indirect consequences of public health policy. Despite modest effect size, the equity profile of SSB tax, the long-lasting benefits of educational gains, and potential synergies with other interventions, make it an attractive option for policymakers to consider.
How effective and cost-effective is water fluoridation for adults? Protocol for a 10-year retrospective cohort study
Publisher: Springer Science and Business Media LLC
Date: 21-01-2021
DOI: 10.1038/S41405-021-00062-9
Abstract: Tooth decay can cause pain, sleepless nights and loss of productive workdays. Fluoridation of drinking water was identified in the 1940s as a cost-effective method of prevention. In the mid-1970s, fluoride toothpastes became widely available. Since then, in high-income countries the prevalence of tooth decay in children has reduced whilst natural tooth retention in older age groups has increased. Most water fluoridation research was carried out before these dramatic changes in fluoride availability and oral health. Furthermore, there is a paucity of evidence in adults. The aim of this study is to assess the clinical and cost-effectiveness of water fluoridation in preventing invasive dental treatment in adults and adolescents aged over 12. Retrospective cohort study using 10 years of routinely available dental treatment data. In iduals exposed to water fluoridation will be identified by s led water fluoride concentration linked to place of residence. Outcomes will be based on the number of invasive dental treatments received per participant (fillings, extractions, root canal treatments). A generalised linear model with clustering by local authority area will be used for analysis. The model will include area level propensity scores and in idual-level covariates. The economic evaluation will focus on (1) cost-effectiveness as assessed by the water fluoridation mean cost per invasive treatment avoided and (2) a return on investment from the public sector perspective, capturing the change in cost of dental service utilisation resulting from investment in water fluoridation. There is a well-recognised need for contemporary evidence regarding the effectiveness and cost-effectiveness of water fluoridation, particularly for adults. The absence of such evidence for all age groups may lead to an underestimation of the potential benefits of a population-wide, rather than targeted, fluoride delivery programme. This study will utilise a pragmatic design to address the information needs of policy makers in a timely manner.
Reorienting Oral Health Services to Prevention: Economic Perspectives
Publisher: SAGE Publications
Date: 21-01-2021
Abstract: Despite the recognized need to change the emphasis of health services by shifting the balance from treatment to prevention, limited progress has been made in many settings. This is true in oral health, where evidence for preventive interventions that work has not been systematically exploited in oral health services. While reorienting health services is complex and context specific, economics can bring a helpful perspective in understanding and predicting the impact of changes in resource allocation, provider remuneration systems, and patient payments. There is an increasing literature on the economics of different prevention approaches. However, much of this literature focuses on the costs and potential savings of alternative approaches and fails to take into account benefits. Even where benefits are taken into account, these tend to be narrowly focused on clinical outcomes using cost-effectiveness analysis, which may be of little relevance to the policy maker, patient, and the public. Some commonly used economic approaches (such as quality-adjusted life years and incremental cost-effectiveness ratios) may also not be appropriate to oral health. Using alternative techniques, including wider measures of benefit and employing priority setting and resource allocation tools, may provide more comprehensive information on economic impact to decision makers and stakeholders. In addition, it is important to consider the effects of provider remuneration in reorienting services. While there is some evidence about traditional models of remuneration (fee for service and capitation), less is known about pay for performance and blended systems. This article outlines areas in which economics can offer an insight into reorientation of health systems toward prevention, highlighting areas for further research and consideration.
Equity in the use of antiretroviral treatment in the public health care system in urban South Africa
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1016/J.HEALTHPOL.2010.10.016
Abstract: The scaling up of antiretroviral treatment (ART) for HIV-infected adults requires a sizeable investment of resources in the South African public health care system. It is important that these resources are used productively and in ways that reach those in need, irrespective of social status or personal characteristics. In this study we evaluate whether the distribution of ART services in the public system reflects the distribution of need among adults in the urban population. Data from a 2008 national survey were used to estimate the distribution of socioeconomic status (SES) and sex in HIV-positive adults in urban areas. These findings were compared to SES and sex distributions in 635 ART users within 6 urban public ART facilities. Close to 40% of those with HIV are in the lowest SES quintile, while 67% are women. The distributions in users of ART are similar to these distributions in HIV-positive people. Patterns of ART use in study settings correspond to patterns of HIV in the urban population at the national level. This suggests that the South African ART programme is on track to ensure equitable delivery of treatment services in urban settings.
An Applied Simulation Model for Estimating the Supply of and Requirements for Registered Nurses Based on Population Health Needs
Publisher: SAGE Publications
Date: 11-2009
Abstract: Aging populations, limited budgets, changing public expectations, new technologies, and the emergence of new diseases create challenges for health care systems as ways to meet needs and protect, promote, and restore health are considered. Traditional planning methods for the professionals required to provide these services have given little consideration to changes in the needs of the populations they serve or to changes in the amount/types of services offered and the way they are delivered. In the absence of dynamic planning models that simulate alternative policies and test policy mixes for their relative effectiveness, planners have tended to rely on projecting prevailing or arbitrarily determined target provider—population ratios. A simulation model has been developed that addresses each of these shortcomings by simultaneously estimating the supply of and requirements for registered nurses based on the identification and interaction of the determinants. The model’s use is illustrated using data for Nova Scotia, Canada.
Chemoprevention: Drug pricing and mortality
Publisher: Wiley
Date: 2006
DOI: 10.1002/CNCR.22075
Abstract: Tamoxifen is a prototypic cancer chemopreventive agent, yet clinical trials have not evaluated its effect on mortality or the impact of drug pricing on its cost-effectiveness. A state-transition Markov model for a hypothetical cohort of women age 50 years was used to evaluate the effects of tamoxifen on mortality and tamoxifen price on cost-effectiveness. Incidence and mortality rates for breast and endometrial cancers were derived from Surveillance, Epidemiology and End Results statistics, and noncancer outcomes were obtained from published studies. Relative risks of outcomes were derived from the National Surgical Adjuvant Breast and Bowel Project P-1 trial. Costs were based on Medicare reimbursements. Projected overall mortality for women at 1.67% 5-year breast cancer risk showed little difference with or without tamoxifen, resulting in a cost-effectiveness ratio of $1,335,690 per life-year saved as a result of tamoxifen use. Adjusting for the differential impact of estrogen receptor-negative cancers, tamoxifen increased mortality for women with a uterus until the 5-year breast cancer risk reached > or =2.1%. Assigning the Canadian price for tamoxifen dramatically reduced the incremental cost (to $123,780 per life-year saved). At that price, the use of tamoxifen was less costly and more effective for women with 5-year breast cancer risks >4%. Tamoxifen may increase mortality in women at the lower end of the "high-risk" range for breast cancer. If prices in the U.S. approximated Canadian prices, then tamoxifen use for breast cancer risk reduction in women with a 5-year risk >3% could be a reasonable strategy to reduce the incidence of breast cancer. Because they are used by many unaffected in iduals, the price of chemopreventive agents has a major influence on their cost-effectiveness.
Does treatment collection and observation each day keep the patient away? An analysis of the determinants of adherence among patients with Tuberculosis in South Africa
Publisher: Oxford University Press (OUP)
Date: 16-09-2015
Abstract: Directly observed treatment short course (DOTS) has been the recommended strategy for Tuberculosis (TB) control since 1995. Developed as an alternative to inpatient treatment, it involves observation of patients' medication intake to promote adherence. However, the burden of daily clinic visits may affect access to care. Using a mixed methods approach, we consider whether (1) non-adherence differs systematically between patients required to make daily clinic visits and patients cared for under less frequent clinic visits and (2) the association between frequency of required clinic visits and adherence depends on affordability and acceptability of care. Data were collected in facility exit interviews with 1200 TB patients in two rural and two urban sub-districts in South Africa. Additionally, 17 in-depth interviews were completed with TB patients. After controlling for socioeconomic and demographic factors, patient type (new or retreatment) and treatment duration, regression analyses showed that daily attending patients were over twice as likely to report a missed clinic visit (P < 0.001) or a missed dose of treatment (P = 0.002) compared with patients required to attend clinics for treatment collection less frequently. Missed visits increased with treatment duration (P = 0.01). The significant interaction between clinic visit frequency and treatment duration indicated that sustaining daily visits over time may become increasingly difficult over the course of treatment. The qualitative analysis identified treatment cost and duration, patients' physical condition and varying social contexts (family, community and work) as important influences on adherence. These findings suggest that strategies involving daily clinic visits may require reconsideration if resources for TB care are to be used efficiently. The adoption of approaches that place patient interests at the centre of TB treatment delivery would appear to be of high priority, particularly in countries where TB prevalence is high and resources for TB care are highly constrained.
Performance indicators and performance assessment in the UK national health service: Implications for management and planning
Publisher: Wiley
Date: 1986
Abstract: Throughout the Western world policy makers are seeking to control the use of health care resources. Often the primary motive for these policies is to control or the total level of public expenditure on health care. One manifestation of such policies in the USA is the use of diagnostic related groups (DRGs), and this instrument is now being adopted in Europe (for ex le, in France as from January 1986). In Britain, as similar management tool is that of performance indicators, which are basically measures of input and activity. In this article it is argued that management responses to these measures may not lead to greater efficiency in resource utilization. Whilst the use of input and process measures to control resource allocation are better than no controls at all, the achievement of efficiency requires that such measures are supplemented with the assessment of outcomes and analyses of input-output relationships. Such supplementation, for ex le by using quality-adjusted life years (QALYs), is urgently required if policy makers are not to become disenchanted with the usefulness of existing performance indicators.
Researching a Best-Practice End-of-Life Care Model for Canada
Publisher: Cambridge University Press (CUP)
Date: 2008
DOI: 10.3138/CJA.27.4.319
Abstract: De nos jours, la majorité des 220 000 Canadiens qui meurent chaque année, principalement de vieillesse ou des suites de problèmes de santé dégénératifs, n'ont pas accès à des centres de soins palliatifs ou spécialisés en fin de vie. Les programmes de soins palliatifs et d'hospices sont inégalement répartis au Canada, la plupart n'ont qu'une faible capacité de services, et ces services varient considérablement d'un programme à l'autre. Les services de fin de vie sont « les services qui permettent aux familles et aux amis d'aider une personne en phase terminale à vivre ses dernières semaines, ainsi que des services de soutien aux personnes en deuil. » Bien que des services de santé et des services sociaux soient disponibles, la plupart des Canadiens en phase terminale n'ont pas facilement accès à un ensemble complet de services qui pourraient les aider à traverser cette période difficile. La plupart risquent donc d'être soumis en fin de vie à des soins non coordonnés et potentiellement inadéquats. Les personnes en phase terminale sont les plus vulnérables de toutes. Le passage de la vie à la mort est souvent difficile en raison des défis émotionnels et physiques que cela engendre. Bien que le soutien des parents et des amis soit irremplaçable, les soins de fin de vie constituent une obligation publique importante. Un projet de recherche de synthèse a été mené dans le but de déterminer un modèle des meilleures pratiques de prestation de soins de fin de vie qui favoriserait la coordination et l'intégration de ces soins au Canada. Par le truchement de visites, d'analyses documentaires, de sondages sur le web, et d'une analyse des données sur les soins à domicile, quatre éléments essentiels d'un modèle intégrant les meilleures pratiques en matière de soins en fin de vie au Canada ont été dégagés: 1) universalité, 2) coordination des soins, 3) accès assuré à un vaste éventail de soins de vie de base et spécialisés, et 4) assurance de services de fin de vie peu importe où les soins sont prodigués. Le présent modèle est proposé comme guide pour l'établissement de soins intégrés de fin de vie au Canada.
The Drive towards Sustainable Health Systems Needs an Alignment: Where are the Innovations in Health Systems Planning?
Publisher: Longwoods Publishing
Date: 18-01-2017
Willingness to Pay and the Valuation of Programmes for the Prevention and Control of Influenza
Publisher: Springer Science and Business Media LLC
Date: 1999
DOI: 10.2165/00019053-199916001-00008
Abstract: In this paper, we consider the role of willingness to pay (WTP) as a method for measuring the impact of healthcare programmes on population well-being. Alternative methods of outcome valuation, such as quality-adjusted life-years (QALYs), measure values through in iduals' willingness to trade off a particular commodity, future life. Moreover, the method of valuation fails to incorporate several dimensions of benefit relevant to measuring well-being that are particularly important in programmes aimed at the prevention and control of influenza. In contrast, WTP provides a broad method of valuation based on in iduals' willingness to trade off a much wider range of commodities. In addition, WTP incorporates externalities and uncertainty within in idual valuations. We show that the main limitations of the WTP approach are not avoided by adoption of the QALY approach.
Economists’ dream or nightmare? Maximizing health gains from available resources using the NICE guidelines
Publisher: Cambridge University Press (CUP)
Date: 04-2007
Exploring inequalities in access to and use of maternal health services in South Africa
Publisher: Springer Science and Business Media LLC
Date: 21-05-2012
Charging for health care: Evidence on the utilisation of NHS prescribed drugs
Publisher: Elsevier BV
Date: 1991
DOI: 10.1016/0277-9536(91)90022-5
Abstract: The effects of regular and frequent increases in charges for health care on patient utilisation are analysed using monthly data on National Health Service (NHS) prescribed drugs in England for the period 1979-1985. Using a partial adjustment model a utilisation equation of prescribed drugs is estimated for the adult non-elderly population that is subject to the NHS prescription charge. The maximum likelihood estimates of the coefficients of the equation imply that the charges policy followed in the U.K. has led to a significant reduction in utilisation among non-exempt patients. The short-run price elasticity of utilisation is -0.109 and the long-run elasticity is -0.09, while exempt utilisation is unaffected. Although the policy has generated a reduction in the central Government expenditure for prescribed drugs, on the basis of these estimates around 66% of these savings arise from the reduction in service use as opposed to the increased revenue per item of drugs.
Geographically-decentralized planning and management in health care: Some informational issues and their implications for efficiency
Publisher: Elsevier BV
Date: 07-1995
DOI: 10.1016/0277-9536(94)00283-Y
Abstract: Geographically decentralized planning and management is an emerging theme within the health sector in many OECD countries. Advocates of decentralization argue that providing greater authority to local decision-making bodies can improve both the technical and allocative efficiency with which health care systems operate. Using concepts drawn from organizational theory and the economics of organizations, we examine the potential of centralized and decentralized planning and management structures to be efficient in light of the informational problems that must be overcome to allocate resources efficiently. We focus in particular on the need to integrate information regarding: (1) the effectiveness and efficiency of alternative clinical interventions and of alternative ways organize the delivery of health care (2) the needs, values, and preferences in the population and (3) local circumstances that affect delivery of care across regions. Informational concerns suggest that decentralized structures have greater potential to be efficient. We then briefly discuss some principles for the design of decentralized structures to aid in realizing these potential efficiency gains.
Evidence-Based Medicine
Publisher: Routledge
Date: 22-07-2004
Yarning about pain
Publisher: SAGE Publications
Date: 30-01-2023
DOI: 10.1177/20494637221149831
Abstract: Providing cultural education to health professionals is essential in improving the quality of care and outcomes for Aboriginal and Torres Strait Islander patients. This study reports the evaluation of a novel training workshop used as an intervention to improve communication with Aboriginal and Torres Strait Islander patients of persistent pain services. In this single-arm intervention study, health professionals undertook a one-day workshop, which included cultural capability and communication skills training based on a clinical yarning framework. The workshop was delivered across three adult persistent pain clinics in Queensland. At the end of the training, participants completed a retrospective pre ost evaluation questionnaire (5 points Likert scale , 1 = very low to 5 = very high), to rate their perceived importance of communication training, their knowledge, ability and confidence to communicate effectively. Participants also rated their satisfaction with the training and suggested improvements for future trainings. Fifty-seven health professionals were trained ( N = 57/111 51% participation rate), 51 completed an evaluation questionnaire ( n = 51/57 90% response rate). Significant improvements in the perceived importance of communication training, knowledge, ability and confidence to effectively communicate with Aboriginal and Torres Strait Islander patients were identified ( p 0.001). The greatest increase was in the perceived confidence pre-training mean of 2.96 (SE = 0.11) to the post-training mean of 4.02 (SE = 0.09). This patient-centred communication training, delivered through a novel model that combines cultural capability and the clinical yarning framework applied to the pain management setting, was highly acceptable and significantly improved participants’ perceived competence. This method is transferrable to other health system sectors seeking to train their clinical workforce with culturally sensitive communication skills.
The 39 steps: the mystery of health inequalities in the UK
Publisher: Wiley
Date: 06-1999
DOI: 10.1002/(SICI)1099-1050(199906)8:4<301::AID-HEC446>3.0.CO;2-T
Comparison of the effects of secondary prevention in schoolchildren between hospitals with and without mobile dental services in Southern Thailand
Publisher: Nihon University School of Dentistry
Date: 2009
Abstract: The aim of the present study was to compare the performance of hospital clinics with and without adjunct mobile services for the delivery of secondary prevention for caries in Thai schoolchildren. A dental survey was conducted in schools served by different dental services. 711 schoolchildren were selected from primary schools in Southern Thailand by multistage cluster random s ling. WHO basic oral health survey methods were employed to evaluate three outcomes of secondary prevention: 1) Coverage of secondary prevention - all filled teeth (FT+D(F)T) among caries experienced teeth (DMFT), 2) Effectiveness of secondary prevention - successfully filled teeth (FT) among all filled teeth (FT+D(F)T) and 3) Protective effect of secondary prevention- successfully filled teeth (FT) among caries experienced teeth (DMFT). The respective percentages were 74.3, 97.5 and 72.5 in the children served by hospital-only services, and 41.3, 97.2 and 40.2 in the other group. From clustered logistic regression modeling, only the first and third outcomes were significantly different between the two access groups. This study showed that adjunct mobile service may be less effective in secondary prevention.
The ‘NICE’ Approach to Technology Assessment: An Economics Perspective
Publisher: Springer Science and Business Media LLC
Date: 02-2004
DOI: 10.1023/B:HCMS.0000005396.69890.48
Abstract: The National Institute for Clinical Excellence has published guidelines for economic evaluations for considering whether new health care technologies contribute to the efficient use of National Health Service resources. The analytical basis of the guidelines is a comparison of the costs and consequences of new and existing methods for dealing with particular conditions using the incremental cost-effectiveness ratio (ICER). However, this fails to provide an explicit and systematic basis for addressing the dual objectives of health maximisation and equitable availability of technologies in the context of a fixed NHS budget. We show that information on the costs and consequences of a particular technology is insufficient to address issues of efficiency of resource use. In addition, information is required about the total resources available and the alternative uses of those resources. Moreover, because these factors are unlikely to be identical for all settings, it is unlikely that the efficiency of using resources to support a new technology will be the same for all settings, even if the cost and consequences of the technology are the same across settings. Instead of improving the health outcomes from NHS resources, we show that using NICE guidelines to inform decisions about new technologies may lead to increased resources allocated to new technology, increased local variations in the use of new technologies and concerns about the sustainability and affordability of public funding for new technologies.
Health care charges: lessons from the U.K.
Publisher: Elsevier BV
Date: 11-1989
DOI: 10.1016/0168-8510(89)90069-9
Abstract: The introduction of increase in user charges is often suggested as a means of restraining the demands on the health care system. Patient charges have been used in the U.K. National Health Service since 1951 in the provision of prescribed drugs, dental treatment and spectacles. Recently, these charges have been extended to eyesight examinations and dental check-ups, while the levels of charges have increased far in excess of the rate of inflation. In this paper the implications of the extended use of patient charges are considered from the perspective of patients, the health care system and the Government, using available evidence on the effects of charges on consumer behaviour.
A geometric confidence ellipse approach to the estimation of the ratio of two variables. Statistics in Medicine 2008; 27:5956–5974.
Publisher: Wiley
Date: 11-08-2009
DOI: 10.1002/SIM.3642
Reconsidering value for money in periodontal treatment
Publisher: Wiley
Date: 15-03-2013
DOI: 10.1111/JCPE.12085
Technology Resource Planning in Radiation Oncology: Application of a Needs-Based Analytic Framework to Radiosurgery Planning in Ontario
Publisher: American Society of Clinical Oncology (ASCO)
Date: 11-2012
Abstract: The authors demonstrate through the ex le of single brain metastases in Ontario that it is feasible to perform explicit needs-based resource planning in radiation oncology.
Workforce Planning Models for Oral Health Care: A Scoping Review
Publisher: SAGE Publications
Date: 16-12-2022
Abstract: For health care services to address the health care needs of populations and respond to changes in needs over time, workforces must be planned. This requires quantitative models to estimate future workforce requirements that take account of population size, oral health needs, evidence-based approaches to addressing needs, and methods of service provision that maximize productivity. The aim of this scoping review was to assess whether and how these 4 elements contribute to existing models of oral health workforce planning. A scoping review was conducted. MEDLINE, Embase, HMIC, and EconLit were searched, all via OVID. Additionally, gray literature databases were searched and key bodies and policy makers contacted. Workforce planning models were included if they projected workforce numbers and were specific to oral health. No limits were placed on country. A single reviewer completed initial screening of abstracts 2 independent reviewers completed secondary screening and data extraction. A narrative synthesis was conducted. A total of 4,009 records were screened, resulting in 42 included articles detailing 47 models. The workforce planning models varied significantly in their use of data on oral health needs, evidence-based services, and provider productivity, with most models relying on observed levels of service utilization and demand. This review has identified quantitative workforce planning models that aim to estimate future workforce requirements. Approaches to planning the oral health workforce are not always based on deriving workforce requirements from population oral health needs. In many cases, requirements are not linked to population needs, while in models where needs are included, they are constrained by the existence and availability of the required data. It is critical that information systems be developed to effectively capture data necessary to plan future oral health care workforces in ways that relate directly to the needs of the populations being served. Policy makers can use the results of this study when making decisions about the planning of oral health care workforces and about the data to routinely collect within health services. Collection of suitable data will allow for the continual improvement of workforce planning, leading to a responsive health service and likely future cost savings.
Incorporating Portfolio Uncertainty in Decision Rules for Healthcare Resource Allocation
Publisher: MDPI AG
Date: 14-03-2021
DOI: 10.3390/HEALTHCARE9030325
Abstract: Cost-effectiveness analysis is widely adopted as a means to inform policy and decision makers in setting priorities for healthcare resource allocation. In resource-constrained settings, decision makers are confronted with healthcare resource reallocation decisions, e.g., moving funds from one or more existing healthcare programs to fund new healthcare programs. The decision-making plane (DMP) has been developed as a means to graphically present the results of reallocating available healthcare resources when healthcare program costs and effects are uncertain. Mapping a value function over the DMP allows the analyst to value all possible combinations of net costs and net effects that may result from reallocating available healthcare resources under conditions of uncertainty. In this paper, we extend this approach to include a change in portfolio risk, stemming from a change in the portfolios of funded healthcare programs, as an additional source of uncertainty, and demonstrate how this can be incorporated into the value function over net costs and net effects for a risk-averse decision maker. The methodology presented in this paper is of particular interest to decision makers who are risk averse, as it will help to better incorporate their preferences in the process of deciding how to best allocate scarce healthcare resources.
Protocol for a Randomised controlled trial to Evaluate the effectiveness and cost benefit of prescribing high dose FLuoride toothpaste in preventing and treating dEntal Caries in high-risk older adulT
Publisher: Springer Science and Business Media LLC
Date: 24-05-2019
Public policy and the market for dental services
Publisher: Wiley
Date: 14-07-2008
DOI: 10.1111/J.1600-0528.2008.00438.X
Abstract: Social inequality in access to oral health care is a feature of countries with predominantly privately funded markets for dental services. Private markets for health care have inherent inefficiencies whereby sick and poor people have restricted access compared to their healthy and more affluent compatriots. In the future, access to dental care may worsen as trends in demography, disease and development come to bear on national oral healthcare systems. However, increasing public subsidies for the poor may not increase their access unless availability issues are resolved. Further, increasing public funding runs counter to policies that feature less government involvement in the economy, tax policy on private insurance premiums, tax reductions and, in some instances, free-trade agreements. We discuss these issues and provide international ex les to illustrate the consequences of the differing public policies in oral health care. Subsidization of the poor by inclusion of dental care in social health insurance models appears to offer the most potential for equitable access. We further suggest that nations need to develop national systems capable of the surveillance of disease and human resources, and of the monitoring of appropriateness and efficiency of their oral healthcare delivery systems.
The public’s viewpoint on the right to hastened death in Alberta, Canada: findings from a population survey study
Publisher: Hindawi Limited
Date: 06-12-2012
DOI: 10.1111/HSC.12007
Abstract: A research study was conducted to determine public opinion in Alberta, a Canadian province, on the controversial topic of death hastening. Questions on the right to hastened death, end-of-life plans and end-of-life experiences were included in the Population Research Laboratory's annual 2010 health-care telephone survey, with 1203 adults providing results relatively representative of Albertans. Of all 1203, 72.6% said yes to the question: 'Should dying adults be able to request and get help from others to end their life early, in other words, this is a request for assisted suicide'? Among all who provided an answer, 36.8% indicated 'yes, every competent adult should have this right' and 40.6% indicated 'yes, but it should be allowed only in certain cases or situations'. Over 50% of respondents in all but one socio-demographic population sub-group (Religious-other) were supportive of the right to hastened death. However, multinomial regression analysis revealed that the experiences of deciding to euthanise a pet/animal and developing or planning to develop an advance directive predicted support, while self-reported religiosity predicted non-support. Finding majority public support for death hastening suggests that legalisation could potentially occur in the future but with this policy first requiring a careful consideration of the model of assisted suicide or euthanasia that best protects people who are highly vulnerable to despair and suffering near the end of life.
As a matter of fact: evidence-based decision-making unplugged
Publisher: Wiley
Date: 11-1997
DOI: 10.1002/(SICI)1099-1050(199711)6:6<547::AID-HEC307>3.0.CO;2-P
Abstract: The rationale of evidence-based decision-making is to inform the decision-making process with information relevant to the decisions being taken. In this paper the models of research and analytical approaches used to generate the evidence are shown to be generally not 'decision-informing'. The researcher's interest in health care interventions has led to the development and use of designs which strip the research of contextual issues and hence represent a major departure from both the underlying notions of the complex pathways to health and the empirical findings concerning the importance of population context. In this way, the evidence-based approach, dominated by a focus on health outcomes from health care interventions, overlooks the notion that society is not a 'level playing field'. Decisions based on research 'evidence' of this type risk redeploying resources inefficiently and in ways which systematically favour those groups with favourable 'prospects for health' (or non-health care determinants of health), and the conditions that those groups in society tend to suffer from, and away from those groups with less favourable prospects for health. Existing approaches to informing the decision-making process could be enhanced by broadening the scope of the research to incorporate relevant determinants of health in both the specification of the problem and the selection of methods of analysis that enable us to explore the complex pathways to health.
Efficacy and Cost Benefit of Inhaled Corticosteroids in Patients Considered to Have Mild Asthma in Primary Care Practice
Publisher: Hindawi Limited
Date: 1996
DOI: 10.1155/1996/105967
Abstract: OBJECTIVE: Inhaled corticosteroids are infrequently used as asthma therapy in patients considered to have mild asthma in primary care practice. The purpose of this study was to determine whether the use of low doses of inhaled corticosteroids (budesonide), supplemented with bronchodilators as needed, provides clinical benefit and is cost beneficial compared with therapy with bronchodilators alone, in patients considered by their physicians in a primary care setting to have mild asthma, not requiring inhaled corticosteroids. DESIGN: Double-blind, randomized controlled study comparing three parallel treatment groups receiving 400 mg or 800 mg inhaled budesonide/day or placebo. SETTING: Seven primary care practices across Canada. PATIENTS: Fifty-seven adult asthmatics considered to have mild asthma not needing inhaled corticosteroids. OUTCOME MEASURES: Patients recorded morning and evening peak expiratory flow rates (PEFR) and daily asthma symptom scores. Economic data were collected regarding drug and service use and willingness to pay. RESULTS: Budesonide significantly reduced early morning and nocturnal symptoms and sputum production, and reduced the use of a bronchodilator compared with placebo. The budesonide groups also showed significant improvements in PEFR, before and after bronchodilator. No differences were found between the two dosages of budesonide however, the study had insufficient power to detect differences between dosages, had they been present. There was a similar frequency of adverse events in all three treatment groups. The willingness-to-pay assessment found that both doses of budesonide were more cost beneficial than placebo. CONCLUSIONS: These results demonstrate that inhaled budesonide 400 mg/day provides better asthma control and is cost beneficial compared with bronchodilators alone in the management of patients with mild asthma who were not considered to need inhaled corticosteroids in primary care practice.
Willingness to Pay for Mandibular Overdentures: A Societal Perspective
Publisher: SAGE Publications
Date: 08-05-2019
Abstract: Dental services in many countries are funded out-of-pocket by patients whose acceptance of a dental treatment depends on their valuation of it. Using a willingness-to-pay (WTP) strategy, this study aimed to determine how people who do not wear dentures value the benefits of dentures retained by implants and what factors explain variations in WTP among subjects. Telephone numbers of a representative Canadian s le were obtained from a consumer database provider. Respondents completed either an internet-based or telephone survey with 3 payment scenarios: paying oneself (out-of-pocket), coverage with private health insurance, and publicly financed through additional taxes. Personal information data (e.g., age, income) were used as independent variables in regression models to assess the determinants of WTP amounts. Among 1,096 respondents, 317 participated in the survey (response rate, 28.9%). The mean WTP of participants (mean ± SD age: 41.2 ± 0.6 y 54.3% male) who were dentate artially edentate was $5,347 for implant overdentures. Considering a 1 in 5 chance of becoming edentate, they were willing to pay $26.93 as monthly payments for private insurance. They were also willing to pay an additional yearly tax of $103.63 to support a public program. WTP private payments increased substantially with increase in household income and dental needs. This preference study provides information to dentists, insurance companies, and policy makers on what dentate people are willing to pay for implant overdentures, whether directly or with insurance/government coverage. This study provides results of interest to many stakeholders. For clinicians, the results reveal what people are willing to pay for implant overdentures for themselves. It also provides information to employers and insurance companies on how people value having coverage for this kind of service. Furthermore, it provides public policy makers the value that people place on public funding of such treatments and how they would support a decision to publicly fund such a treatment.
An opportunity cost approach to sample size calculation in cost-effectiveness analysis
Publisher: Wiley
Date: 2007
DOI: 10.1002/HEC.1244
Abstract: The inclusion of economic evaluations as part of clinical trials has led to concerns about the adequacy of trial s le size to support such analysis. The analytical tool of cost-effectiveness analysis is the incremental cost-effectiveness ratio (ICER), which is compared with a threshold value (lambda) as a method to determine the efficiency of a health-care intervention. Accordingly, many of the methods suggested to calculating the s le size requirements for the economic component of clinical trials are based on the properties of the ICER. However, use of the ICER and a threshold value as a basis for determining efficiency has been shown to be inconsistent with the economic concept of opportunity cost. As a result, the validity of the ICER-based approaches to s le size calculations can be challenged. Alternative methods for determining improvements in efficiency have been presented in the literature that does not depend upon ICER values. In this paper, we develop an opportunity cost approach to calculating s le size for economic evaluations alongside clinical trials, and illustrate the approach using a numerical ex le. We compare the s le size requirement of the opportunity cost method with the ICER threshold method. In general, either method may yield the larger required s le size. However, the opportunity cost approach, although simple to use, has additional data requirements. We believe that the additional data requirements represent a small price to pay for being able to perform an analysis consistent with both concept of opportunity cost and the problem faced by decision makers.
Workshop 1: Appraising the Methods for Economic Evaluation
Publisher: Springer Science and Business Media LLC
Date: 1999
Willingness to Pay for Periodontal Therapy: Development and Testing of an Instrument
Publisher: Wiley
Date: 03-1999
DOI: 10.1111/J.1752-7325.1999.TB03234.X
Abstract: The objective of this study was to develop and test the feasibility and validity of a willingness to pay (WTP) tool in a dental setting. A questionnaire measured in iduals' preferences among alternative treatments for periodontal disease and the maximum they would be willing to pay for their treatment of choice in terms of dental insurance premiums. The questionnaire provides detailed information, in probabilistic terms, of the risks and benefits of treatment choices for moderate to advanced adult periodontitis. It was pilot tested on 23 periodontal patients and 18 dental school faculty and staff. The majority (92.6%) felt the questionnaire was an accurate representation of treatments and outcomes, establishing face and content validity. In terms of construct validity, four hypotheses were tested: (1) manipulation of the outcomes of the preferred treatment led to a predictable shift in preferences for 38 subjects (92.7%) (2) although periodontal patients were not more likely to choose periodontal surgery than nonpatients (P = .14), those with a history of surgery were more likely to choose surgery again (P = .06) (3) WTP was positively related to income level (P = .05) and (4) subjects were willing to pay more for coverage for themselves than for others. Periodontal surgery was the preferred treatment for moderate to advanced periodontal disease, and was more strongly preferred than other choices (i.e., a higher WTP) for all income groups. The intraclass correlation coefficient for treatment preferences was 0.95 (P < .001) and the kappa for WTP was 0.78 (P < .001). This pilot study supports some of the criteria concerning validity of the WTP questionnaire to measure preferences for alternative periodontal therapies. Further testing on larger s les is required to confirm these results.
Cost-Effectiveness of Caries Prevention in Practice: A Randomized Controlled Trial
Publisher: SAGE Publications
Date: 18-05-2017
Abstract: A 2-arm parallel-group randomized controlled trial measured the cost-effectiveness of caries prevention in caries-free children aged 2 to 3 y attending general practice. The setting was 22 dental practices in Northern Ireland. Participants were centrally randomized into intervention (22,600 ppm fluoride varnish, toothbrush, a 50-mL tube of 1,450 ppm fluoride toothpaste, and standardized prevention advice) and control (advice only), both provided at 6-monthly intervals during a 3-y follow-up. The primary outcome measure was conversion from caries-free to caries-active states assessed by calibrated and blinded examiners secondary outcome measures included decayed, missing, or filled teeth surfaces (dmfs) pain and extraction. Cumulative costs were related to each of the trial’s outcomes in a series of incremental cost effectiveness ratios (ICERs). Sensitivity analyses examined the impact of using dentist’s time as measured by observation rather than that reported by the dentist. The costs of applying topical fluoride were also estimated assuming the work was undertaken by dental nurses or hygienists rather than dentists. A total of 1,248 children (624 randomized to each group) were recruited, and 1,096 (549 in the intervention group and 547 in the control group) were included in the final analyses. The mean difference in direct health care costs between groups was £107.53 (£155.74 intervention, £48.21 control, P 0.05) per child. When all health care costs were compared, the intervention group’s mean cost was £212.56 more than the control group (£987.53 intervention, £774.97 control, P 0.05). Statistically significant differences in outcomes were only detected with respect to carious surfaces. The mean cost per carious surface avoided was estimated at £251 (95% confidence interval, £454.39–£79.52). Sensitivity analyses did not materially affect the study’s findings. This trial raises concerns about the cost-effectiveness of a fluoride-based intervention delivered at the practice level in the context of a state-funded dental service (EudraCT No: 2009-010725-39 ISRCTN: ISRCTN36180119).
Valuing the benefits and costs of health care programmes: where's the ‘extra’ in extra-welfarism?
Publisher: Elsevier BV
Date: 03-2003
DOI: 10.1016/S0277-9536(02)00101-6
Abstract: The application of Sen's notion of capabilities to problems of the allocation of resources to health in the form of an extra-welfarist framework underlies the justification of quality adjusted life years (QALYs) as the method for valuing the benefits of health care. In this paper we critically appraise this application from both conceptual and empirical perspectives. We show that the alleged limitations of the welfarist approach are essentially limitations in its application, not in the capacity of the approach to accommodate the concerns of extra-welfarists. Moreover, the arguments used to justify the application of the extra-welfarist framework are essentially welfarist. We demonstrate that the methods used to measure QALYs share their basic theoretical roots with welfarist valuation methods, such as willingness to pay (WTP). Although QALYs and WTP share many challenges, we argue that WTP provides a method which performs better with respect to those challenges. In the context of evaluating alternative allocations of health care resources we are left asking what is 'extra' in extra-welfarism?
Building Bridges Between Academic Research and Policy Formulation: When Costing Less Means Costing More
Publisher: Springer Science and Business Media LLC
Date: 2007
Physiotherapy student clinical placements in Australian private practice: Patient-reported outcomes with supervised student care.
Publisher: Wiley
Date: 31-10-2022
DOI: 10.1002/PRI.1929
Abstract: The sustainability of physiotherapy clinical placements is an ongoing challenge, yet there is potential to increase placement capacity within the private practice sector. Barriers to hosting students, including perceived impacts on patient care, reportedly limit the uptake of hosting students within this setting. This study aimed to evaluate the effect of physiotherapy student involvement on patient-reported Global Rating of Change (GRoC) in Australian physiotherapy private practice care. A cross-sectional, patient survey study was conducted in three private physiotherapy practices over two 5-week periods. At their completion of care, participants completed the survey seeking demographic information, GRoC and aspects of care including number of consultations involving students, proportion of physiotherapy time involving students and frequency of student involvement in treatment delivery. After accounting for clinic-level differences, ordinal logistic regression analyses were performed to explore the impact of supervised student care on GRoC. 119 participants across three practices completed the survey. There were no significant associations between patient-reported GRoC and: (1) student involvement in patient care (2) number of consultations involving students (3) proportion of physiotherapy time involving students or (4) frequency of student involvement in treatment delivery (p > 0.05). Supervised student care in private physiotherapy practice does not appear to have a detrimental impact on patient-reported outcomes. These findings may address concerns relating to student involvement in patient care within this setting. Future research should address economic and service delivery impacts of supervised student care on private practices.
Cost-effectiveness ratios: in a league of their own
Publisher: Elsevier BV
Date: 05-1994
DOI: 10.1016/0168-8510(94)90031-0
Abstract: There is an increasing tendency for papers appearing in the medical literature to propose or use league tables of cost-effectiveness ratios as a means of comparing health-care interventions. In this paper we identify what the information in cost-effectiveness league tables tells us and how this is inadequate and inappropriate for addressing questions about improving efficiency in the use of resources at either the broad system level or at the in idual care-group level. We present an alternative approach which provides decision makers with a practical way of deciding whether the adoption of a particular programme represents an unambiguous improvement in economic efficiency.
Estimation, Power and Sample Size Calculations for Stochastic Cost and Effectiveness Analysis
Publisher: Springer Science and Business Media LLC
Date: 2007
DOI: 10.2165/00019053-200725060-00002
Abstract: Various methods have been proposed to address uncertainty in economic evaluations of healthcare programmes. One approach suggested in the literature is to estimate separate confidence intervals for the incremental costs and effects of a new health programme in comparison with an existing programme. These intervals are then combined to generate a rectangular confidence region in the cost-effectiveness plane that implicitly defines a corresponding confidence interval for the incremental cost-effectiveness ratio (ICER). The same approach has been used to calculate s le sizes and study power. This application of the rectangle method is consistent with the adoption of ICERs and a threshold as a decision rule, this being the most commonly used approach in empirical applications of cost-effectiveness analysis, as well as the one recommended by agencies that assess medical technology around the world. In this paper, we first outline the rectangle method, and then propose a modification that recognises that separate inferences are being drawn on the cost and effectiveness domains, and that corrects for multiple statistical comparisons. The confidence rectangle is otherwise too small, the corresponding confidence interval for the ICER is too narrow and s le sizes are under-estimated. Our modification corrects these problems. A further difficulty is that the placement of the confidence rectangle around the null value is somewhat arbitrary, and does not correspond to a unique value of ICERs. As a result, different values of s le size and power for the estimation of ICERs can be obtained, depending on the null values of the cost and effectiveness. We conclude that it is important to clearly identify the analytic goal in terms of estimating differential costs, differential effects or a combination of the two using the ICER index. These ideas are illustrated using numerical ex les.
The consideration of clinicians' time needed to treat by guideline developers is not a solution to the scarcity of healthcare resources problem
Publisher: Wiley
Date: 23-07-2023
DOI: 10.1111/JEP.13901
Estimating Unit Costs for Dental Service Delivery in Institutional and Community-Based Settings in Southern Thailand
Publisher: SAGE Publications
Date: 17-11-2008
Abstract: In this cross-sectional study, the cost of different dental services was estimated and the unit costs of dental services for schoolchildren were compared between 2 settings: hospital-based and community-based mobile dental clinics. Heads of all departments in a selected community hospital were invited to attend 2 workshops to collect relevant data. Unit costs of different dental services varied from 41 to 2693 baht, with services falling into 4 unit cost groups: very high, high, moderate, and low. The very-high-unit-cost services included rehabilitative dental services. The high-unit-cost services covered removal of an impacted tooth, root canal treatment, and tooth-color fillings. The moderate-unit-cost group included a wide range of other dental services, with screening and oral hygiene instruction in community-based dental clinics falling into the low-unit-cost group. Generally, services provided in the community-based mobile clinic had lower unit costs than the same services provided in the hospital dental clinic.
Incremental cost-effectiveness ratios (ICERs): The silence of the lambda
Publisher: Elsevier BV
Date: 05-2006
DOI: 10.1016/J.SOCSCIMED.2005.10.023
Abstract: Despite the central role of the threshold incremental cost-effectiveness ratio (ICER), or lambda (lambda), in the methods and application of cost-effective analysis (CEA), little attention has been given to the determining the value of lambda. In this paper we consider 'what explains the silence of the lambda'? The concept of the threshold ICER is critically appraised. We show that there is 'silence of the lambda' with respect to justification of the value of ICER thresholds, their use in decision-making and their relationship to the opportunity cost of marginal resources. Moreover, the 'sound of silence' extends to both 'automatic cut-off' and more sophisticated approaches to the use of lambda in determining recommendations about health care programs. We argue that the threshold value provides no useful information for determining the efficiency of using available resources to support new health care programs. On the contrary, the threshold approach has lead to decisions that resulted in increased expenditures on health care programs and concerns about the sustainability of public funding for health care programs without any evidence of increases in total health gains. To improve efficiency in resource allocation, decision-makers need information about the opportunity costs of programs.
Optimizing a portfolio of health care programs in the presence of uncertainty and constrained resources
Publisher: Elsevier BV
Date: 12-2003
DOI: 10.1016/S0277-9536(03)00086-8
Abstract: Much research has been devoted to handling uncertainty in cost-effectiveness analysis. The current literature suggests summarizing uncertainty in cost-effectiveness analysis using acceptability curves or net health benefits. These approaches, however, focus only on uncertainty associated with costs and effects of the programs under consideration. In the real world, most decision-makers have to fund a portfolio of health care programs. Therefore, a more comprehensive approach would include in the analysis the uncertainty of costs and effects of all programs supported by the fixed budget. This paper extends the decision rule described by Birch and Gafni (J. Health Econ. 11(3) (1992) 279) within the context of a portfolio of programs when costs and effects are uncertain and resources constrained.
Eliminating the shortage of registered nurses in Canada: An exercise in applied needs-based planning
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.HEALTHPOL.2011.11.009
Abstract: To demonstrate the application of a needs-based framework for health human resources (HHR) planning to illustrate the potential effects of policies on the shortage of Registered Nurses (RNs) in Canada. A simulation model was developed to simultaneously estimate the supply of and requirements for RNs based on data on the health needs of Canadians with current service delivery patterns and levels of productivity as a baseline scenario. The potential in idual and cumulative effects of various policy scenarios on the 'gap' between these were simulated. A baseline scenario estimated a shortage of about 11,000 RN FTEs in 2007 for Canada, increasing to over 60,000 by 2022. However, multifaceted approaches have the potential to eliminate the estimated shortage. Estimating the requirements for health human resources must explicitly consider population health needs, levels of service delivery and HHR productivity while changing supply to meet requirements involves consideration of a broad range of comprehensive interventions. Investments in improved data collection and planning tools are needed to support more effective HHR planning. The estimated Canadian shortage of RNs based on current circumstances can be resolved in the short to medium tern through modest improvements in RN retention, activity and productivity.
Capitation and Primary Care in Canada: Financial Incentives and the Evolution of Health Service Organizations
Publisher: SAGE Publications
Date: 07-2001
DOI: 10.2190/2FEN-AQKK-LCEV-7KU5
Abstract: Alternative approaches to the funding, organization, and delivery of primary care have been the subject of ongoing discussion and debate in many industrialized nations for many years. One common recommendation has been to use capitation, as opposed to fee-for-service, as the payment method for physicians. In this study the authors use data from interviews with physicians and Ministry of Health officials to trace the evolution of Ontario's Health Service Organization (HSO) program, the only program of capitation-funded physician care in Canada. The program has developed in three phases: formation in the early 1970s, expansion in the late 1970s and throughout the 1980s, and restructuring in the 1990s. The analysis focuses on the perceptions and actions of policymakers and physicians who became involved with the program at different points in its evolution, and identifies how they perceived and responded to the financial incentives that were introduced to promote the program. This case study allows an examination of the shifting objectives, communications, perceptions, and responses of policymakers and stakeholders in changing contexts over a period of more than 20 years. The long history of the HSO program provides the opportunity to examine the factors that can cause financial incentives to go awry. The authors suggest how this case study offers lessons for financial incentive policymaking.
Tamoxifen for Breast Cancer Risk Reduction
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2008
Different dental care setting: does income matter?
Publisher: Wiley
Date: 2007
DOI: 10.1002/HEC.1237
Abstract: In this paper we consider the use of mobile dental clinics as a means of improving access to dental care among primary school children in Southern Thailand by reducing the opportunity cost of service use to parents. Parents' willingness to pay (WTP) is measured for three different services provided in a community hospital dental clinic and a school-based mobile clinic. Although the service setting does not affect significantly the WTP for treatment directly, the estimated positive association between WTP and income is modified by setting. The results indicate that the potential for mobile clinics to increase utilization of services among primary school children is associated with parents' income, with the difference in valuation of dental services between the two settings being less among lower income parents than higher income parents. However, even among lower income parents our results indicate that the potential for increasing service utilization among children depends on the improvements in access associated with the mobile clinic not being achieved at the opportunity cost of lower levels of effectiveness.
Caring for the Elderly: A European Perspective on Today and Tomorrow
Publisher: Duke University Press
Date: 06-1985
DOI: 10.1215/03616878-10-3-469
Abstract: There is always a temptation to suppose that one's own problems (whether personal or national) are unique. They rarely are. The “problem” of the elderly is no exception and so there is no particular point in looking to the specific characteristics of one's own health, social service, and social security systems for causes. There is, however, every reason to be looking at them for the consequences. They can also exacerbate the causes. In this paper we sketch the principal features (economic, social, and demographic) that have contributed to the “problem” of the elderly in Europe and then outline the main intellectual issues that need to be explored and resolved. That sounds a bit pompous but, if one is to avoid an intellectual morass consisting of the various assertions about needs, obligations, and so on that emanate from rival concerned parties and various professional interests on the one hand, and simplistic political slogans whose only virtue is that they cut the Gordian Knot (but provide no real enlightenment) on the other, then we need to be doing just this. We shall take a few things for granted: that cost-containment is not the be-all-and-end-all of policy that value for money depends equally on what you get as on what you spend that overall expenditure per head is mainly determined by income per head (though some countries have managed to get and stay below the regression line) and that it “ain't so” that all one needs to do is to “leave it to the market.” To have justified each of these would have taken too much space so we can only assert them and trust that, in swallowing these camels, you won't strain at the gnats to come.
An eReferral Management & Triage System for minor Oral surgery referrals from primary care dentists: a cost-effectiveness evaluation
Publisher: Springer Science and Business Media LLC
Date: 07-08-2021
DOI: 10.1186/S12913-021-06775-9
Abstract: Oral surgery referrals from NHS dental practices are rising, increasing the pressures on available hospital resources. We assess if an electronic referral system with consultant or peer (general dental practitioner) led triage of patient referrals from general dental practices can effectively ert patients requiring minor oral surgery into specialist led primary care settings at a reduced cost whilst providing care of the same or enhanced quality. One year of no triage (all referrals treated in secondary care) was followed by one-year of consultant led triage, which in turn was followed by year of peer-led triage. A health economic evaluation of all patient referrals from 27 UK dental practices for oral surgery procedures. The follow-up is over a three-year period at hospital dental services in two general hospitals, one dental hospital, and a single specialist oral surgeon based in two primary care practices. The evaluation is a comparison of mean outcomes in the hospitals and in specialist primary care dental services between the study periods (i.e. periods with and without the triage system). The main outcomes of interest are mean NHS cost saving per referral (costs to the NHS and costs to broader society), proportion of erted referrals, case-mix of referrals and patient reports of the quality of dentistry services received at their referral destination. The proportion of referrals erted to specialist primary care was similar during both periods (45% under consultant-led triage and 43% under GDP-led triage). Statistically significant savings per referral erted were found (£116.11 under consultant-led triage, £90.25 under GDP-led triage). There were no statistically significant changes in the case-mix of referrals. Cost savings varied according to the coding (and hence tariff) of referred cases by the provider hospitals. Patients reported similarly high levels of satisfaction scores for treatment in specialist primary care and secondary care settings. Implementation of electronic referral management in primary care, when combined with triage, led to appropriate ersions to specialist primary care. Although cost savings were realised by referral ersion these savings are dependent on the particular tariff allocation (coding) practices of provider hospitals.
Proxies for healthcare need among populations: validation of alternatives--a study in Quebec.
Publisher: BMJ
Date: 10-1996
Abstract: To compare the use of a non-mortality based proxy for relative needs for healthcare among regional populations with a mortality based proxy for population relative needs and to evaluate the additional value of a proxy based on a combination of non-mortality and mortality based proxies. Analysis of cross sectional data on mortality, socioeconomic status, and self assessments of health taken from registrar general records, a population census, and a population health survey. The province of Quebec, Canada. COVERAGE: The populations of the 15 health regions in Quebec. The levels of correlation of indicators based on mortality data, socioeconomic data, and combined data with a standardised indicator of self assessed health. Variations in scores of a proxy based on socioeconomic data among regions explain 37% of the observed variation in self assessed health, 4% more than the level of variation explained by the standardised mortality rate scores. A weighted combination of both mortality and socioeconomic based proxies explains 56% of variation in self assessed health. Justification of "deprivation weights" reflecting variations in socioeconomic status among populations should be based on empirical support concerning the performance of such weights as proxies for relative levels of need among populations. The socioeconomic proxy developed in this study provides a closer correlation to the self assessed health of the populations under study than the mortality based proxy. The superior performance of the combined indicator suggests that the development of social deprivation indicators should be viewed as a complement to, as opposed to a substitute for, mortality based measures in needs based resource allocation exercises.
Searching for a common currency: Critical appraisal of the scientific basis underlying European harmonization of the measurement of health related quality of life (EuroQol©)
Publisher: Elsevier BV
Date: 03-1993
DOI: 10.1016/0168-8510(93)90059-X
Abstract: The EuroQol has recently been proposed as a measure of health-related quality of life based on in iduals' valuations of health states. The derived values would be used in assessing cost-effectiveness and establishing priorities across a wide range of health-care activities. In this paper we identify some of the limitations of the EuroQol in its role as a particular method for deriving the more generic QALYs. More specifically we explore the implications of using the EuroQol as a measure of in iduals' and communities' valuation of health outcomes. We show that the EuroQol suffers from several major limitations and thus cannot be relied upon to provide a valid measure to be used in economic appraisals or studies concerned with establishing priorities as proposed by its proponents. An alternative approach is identified and discussed.
Tax-Deductible Provisions for Gluten-Free Diet in Canada Compared with Systems for Gluten-Free Diet Coverage Available in Various Countries
Publisher: Hindawi Limited
Date: 2015
DOI: 10.1155/2015/508156
Abstract: Celiac disease affects 1% of the North American population, with an estimated 350,000 Canadians diagnosed with this condition. The disease is triggered by the ingestion of gluten, and a lifelong, strict gluten-free diet (GFD) is the only currently available treatment. Compliance with a strict GFD is essential not only for intestinal mucosal recovery and alleviation of symptoms, but also for the prevention of complications such as anemia, osteoporotic fractures and small bowel lymphoma. However, a GFD is difficult to follow, socially inconvenient and expensive. Different approaches, such as tax reduction, cash transfer, food provision, prescription and subsidy, have been used to reduce the additional costs of the GFD to patients with celiac disease. The current review showed that the systems in place exhibit particular advantages and disadvantages in relation to promoting uptake and compliance with GFD. The tax offset system used in Canada for GFD coverage takes the form of a reimbursement of a cost previously incurred. Hence, the program does not help celiac patients meet the incremental cost of the GFD – it simply provides some future refund of that cost. An ideal balanced approach would involve subsidizing gluten-free products through controlled vouchers or direct food provision to those who most need it, independently of ‘ability or willingness to pay’. Moreover, if the cost of such a program is inhibitive, the value of the benefits could be made taxable to ensure that any patient contribution, in terms of additional taxation, is directly related to ability to pay. The limited coverage of GFD in Canada is concerning. There is an unmet need for GFD among celiac patients in Canada. More efforts are required by the Canadian medical community and the Canadian Celiac Association to act as agents in identifying ways of improving resource allocation in celiac disease.
The Location of Death and Dying Across Canada: A Study Illustrating the Socio-Political Context of Death and Dying
Publisher: MDPI AG
Date: 09-11-2018
DOI: 10.3390/SOC8040112
Abstract: Background: Concern has existed for many years about the extensive use of hospitals by dying persons. In recent years, however, a potential shift out of hospital has been noticed in a number of developed countries, including Canada. In Canada, where high hospital occupancy rates and corresponding long waits and waitlists for hospital care are major socio-political issues, it is important to know if this shift has continued or if hospitalized death and dying remains predominant across Canada. Methods: Recent in idual-anonymous population-level inpatient Canadian hospital data were analyzed to answer two questions: (1) what proportion of deaths in provinces and territories across Canada are occurring in hospital now? and (2) who is dying in hospital now? Results: In 2014–2015, 43.9% of all deaths in Canada (excluding Quebec) occurred in hospital. However, considerable cross-Canada differences in end-of-life hospital utilization were found. Some cross-Canada differences in hospital decedents were also noted, although most were older, male, and they died during a relatively short hospital stay after being admitted from their homes and through the emergency department after arriving by ambulance. Conclusion: Over half of all deaths in Canada are occurring outside of hospital now. Cross-Canada hospital utilization and inpatient decedent differences highlight opportunities for enhanced end-of-life care service planning and policy advancements.
Health workforce planning: which countries include nurse practitioners and physician assistants and to what effect?
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.HEALTHPOL.2018.07.016
Abstract: An increasing number of countries are introducing new health professions, such as Nurse Practitioners (NPs) and Physician Assistants (PAs). There is however limited evidence, on whether these new professions are included in countries' workforce planning. A cross-country comparison of workforce planning methods. Countries with NPs and/or PAs were identified, workforce planning projections reviewed and differences in outcomes were analysed, based on a review of workforce planning models and a scoping review. Data on multi-professional (physicians/NPs/PAs) vs. physician-only models were extracted and compared descriptively. Analysis of policy implications was based on policy documents and grey literature. Of eight countries with NPs/PAs, three (Canada, the Netherlands, United States) included these professions in their workforce planning. In Canada, NPs were partially included in Ontario's needs-based projection, yet only as one parameter to enhance efficiency. In the United States and the Netherlands, NPs/PAs were covered as one of several scenarios. Compared with physician-only models, multi-professional models resulted in lower physician manpower projections, primarily in primary care. A weakness of the multi-professional models was the accuracy of data on substitution. Impacts on policy were limited, except for the Netherlands. Few countries have integrated NPs/PAs into workforce planning. Yet, those with multi-professional models reveal considerable differences in projected workforce outcomes. Countries should develop several scenarios with and without NPs/PAs to inform policy.
Opportunities for, and implications of, skill mix changes in health care pathways: Pay, productivity and practice variations in a needs-based planning framework
Publisher: Elsevier BV
Date: 04-2020
The identification of supplier-inducement in a fixed price system of health care provision
Publisher: Elsevier BV
Date: 06-1988
DOI: 10.1016/0167-6296(88)90012-4
Abstract: The analysis in this paper extends the existing research on supplier-inducement by introducing a fixed price constraint on supplier behaviour and analysing output by treatment episode. Testable predictions are generated which distinguish between the inducement and traditional approaches to explaining supplier behaviour. Using data on dental care provision under the U.K. National Health Service support is found for the presence of supplier-inducement. The implications of the findings for the organisation of dental care in the U.K. are considered.
How Do Type 2 Diabetes Patients Value Urban Integrated Primary Care in China? Results of a Discrete Choice Experiment
Publisher: MDPI AG
Date: 23-12-2019
Abstract: Objectives: Fragmented healthcare in China cannot meet the needs of the growing number of type 2 diabetes patients. The World Health Organization proposed an integrated primary care approach to address the needs of patients with chronic conditions. This study aims to measure type 2 diabetes patients’ preferences for urban integrated primary care in China. Methods: A discrete choice experiment was designed to measure type 2 diabetes patient preferences for seven priority attributes of integrated care. A two-stage s ling survey of 307 type 2 diabetes mellitus (T2DM) patients in 16 community health stations was carried out. Interviews were conducted to explore the reasons underpinning the preferences. A logit regression model was used to estimate patients’ willingness to pay and to analyze the expected impact of potential policy changes. Results: Travel time to care providers and experience of care providers are the most valued attributes for respondents rather than out-of-pocket cost. Attention to personal situation, the attentiveness of care providers, and the friendliness and helpfulness of staff were all related to interpersonal communication between patients and health care providers. Accurate health information and multidisciplinary care were less important attributes. Conclusions: The study provides an insight into type 2 diabetes patients’ needs and preferences of integrated primary care. People-centered interventions, such as increasing coverage by family doctor and cultivating mutual continuous relationships appear to be key priorities of policy and practice in China.
Developing Management Information from an Administrative Database of Dental Services: Identifying Factors that Influence Costs
Publisher: Wiley
Date: 09-2005
DOI: 10.1111/J.1752-7325.2005.TB02805.X
Abstract: We describe service patterns and compare changes in program expenditures with the Consumer Price Index over eight years in a dental program with a controlled-fee schedule offered to Canadian First Nations and Inuit people. We obtained the computerized records of dental services for the period from 1994 to 2001. Each record identified the date and type of service, region and type of provider, age of the client and encrypted identifying information on clients, bands, and providers. We classified the in idual services into related types (diagnostic, preventive, etc.). We aggregated the records by client and developed indices for the numbers of clients, mean numbers of services per client, cost per service, and prices. Over the 8 years, 16.0 million procedures, totaling 811.8 million dollars, were provided to 538,034 different in iduals, approximately 76% of the eligible population. Restorative procedures accounted for 36% of all expenditures followed by diagnostic (12.7%), preventive (12.2%), and orthodontic (8.9%) services. For much of the period, increases in program expenditures were exceeded by increases in the Consumer Price Index. This was consistent with fewer services per client, a less expensive mix of services, and relatively flat prices. However, in 2000 and 2001 higher prices and more clients resulted in increasing expenditures. Program expenditures were influenced by different factors over the study period. In the final two years, increasing expenditures were driven by price increases and increasing numbers of clients, but not by increasing numbers of services per client, nor a 'richer' mix of services.
Demand-based models and market failure in health care: projecting shortages and surpluses in doctors and nurses
Publisher: Cambridge University Press (CUP)
Date: 02-08-2018
DOI: 10.1017/S1744133118000336
Abstract: Models for projecting the demand for and supply of health care workers are generally based on objectives of meeting demands for health care and assumptions of status quo in all but the demographic characteristics of populations. These models fail to recognise that public intervention in health care systems arises from market failure in health care and the absence of an independent demand for health care. Hence projections of demand perpetuate inefficiencies in the form of overutilisation of services on the one hand and unmet needs for care on the other. In this paper the problems with basing workforce policy on projected demand are identified and the consequences for health care system sustainability explored. Integrated needs-based models are offered as alternative approaches that relate directly to the goals of publicly funded health care systems and represent an important element of promoting sustainability in those systems.
Commentary: Social inequalities in health, social epidemiology and social value
Publisher: Oxford University Press (OUP)
Date: 04-2001
DOI: 10.1093/IJE/30.2.294
Examining End-of-Life Case Management: Systematic Review
Publisher: Hindawi Limited
Date: 2014
DOI: 10.1155/2014/651681
Abstract: Case management was initiated in the 1970s to reduce care discontinuity. A literature review focused on end-of-life (EOL) case management identified 17 research articles, with content analysis revealing two themes: (a) seeking to determine or establish the value of EOL case management and (b) identifying ways to improve EOL case management. The evidence, although limited, suggests that EOL case management is helpful to dying in iduals and their families. Research is needed to more clearly illustrate its usefulness or outcomes and the extent of need for it and actual availability. Among other benefits, EOL case management may help reduce hospital utilization, a major concern with the high cost of hospital-based care and the increased desire for home-based EOL care.
Delivering the Goods? Access to Family Physician Services in Canada: A Comparison of 1985 and 1991
Publisher: SAGE Publications
Date: 12-1995
DOI: 10.2307/2137322
Inequalities in neighbourhood socioeconomic characteristics: potential evidence-base for neighbourhood health planning
Publisher: Springer Science and Business Media LLC
Date: 10-08-2005
Abstract: Population health planning aims to improve the health of the entire population and to reduce health inequities among population groups. Socioeconomic factors are increasingly being recognized as major determinants of many aspects of health and causes of health inequities. Knowledge of socioeconomic characteristics of neighbourhoods is necessary to identify their unique health needs and enhance identification of socioeconomically disadvantaged populations. Careful integration of this knowledge into health planning activities is necessary to ensure that health planning and service provision are tailored to unique neighbourhood population health needs. In this study, we identify unique neighbourhood socioeconomic characteristics and classify the neighbourhoods based on these characteristics. Principal components analysis (PCA) of 18 socioeconomic variables was used to identify the principal components explaining most of the variation in socioeconomic characteristics across the neighbourhoods. Cluster analysis was used to classify neighbourhoods based on their socioeconomic characteristics. Results of the PCA and cluster analysis were similar but the latter were more objective and easier to interpret. Five neighbourhood types with distinguishing socioeconomic and demographic characteristics were identified. The methodology provides a more complete picture of the neighbourhood socioeconomic characteristics than when a single variable (e.g. income) is used to classify neighbourhoods. Cluster analysis is useful for generating neighbourhood population socioeconomic and demographic characteristics that can be useful in guiding neighbourhood health planning and service provision. This study is the first of a series of studies designed to investigate health inequalities at the neighbourhood level with a view to providing evidence-base for health planners, service providers and policy makers to help address health inequity issues at the neighbourhood level. Subsequent studies will investigate inequalities in health outcomes both within and across the neighbourhood types identified in the current study.
People-centred integrated care in urban China
Publisher: WHO Press
Date: 10-2018
Area-Level Variation in Children’s Unmet Need for Community-Based Mental Health Services: Findings from the 2014 Ontario Child Health Study
Publisher: Springer Science and Business Media LLC
Date: 23-01-2020
DOI: 10.1007/S10488-020-01016-3
Abstract: There is limited empirical evidence documenting the magnitude and correlates of area-level variability in unmet need for children's mental health services. Research is needed that identifies area-level characteristics that can inform strategies for reducing unmet need in the population. The study purpose is to: (1) estimate area-level variation in children's unmet need for mental health services (using Service Areas as defined by the Ontario Ministry of Children and Youth Services), and (2) identify area-level service arrangements, and geographic and population characteristics associated with unmet need. Using in idual-level general population data, area-level government administrative data and Census data from Ontario, Canada, we use multilevel regression models to analyze unmet need for mental health services among children (level 1) nested within Service Areas (level 2). The study finds that 1.64% of the reliable variance in unmet need for mental health services is attributable to between-area differences. Across areas, we find that Service Areas with more agencies had a lower likelihood of unmet need for mental health services. Compared to other Service Areas, Toronto had much lower likelihood of unmet need compared to the rest of Ontario. Rural areas, areas with unsatisfactory public transport, and areas with higher levels of socio-economic disadvantage had a higher likelihood of unmet need for mental health services. These findings identify challenges in service provision that researchers, policymakers and administrators in children's mental health services need to better understand. Policy implications and potential Service Area strategies that could address equitable access to mental health services are discussed.
Socioeconomic disparities in orthodontic treatment outcomes and expenditure on orthodontics in England’s state-funded National Health Service: a retrospective observational study
Publisher: Springer Science and Business Media LLC
Date: 19-09-2017
Utilities of dentin regeneration among insured and uninsured adults
Publisher: Wiley
Date: 22-12-2003
Children’s Mental Health Need and Expenditures in Ontario: Findings from the 2014 Ontario Child Health Study
Publisher: SAGE Publications
Date: 04-2019
Abstract: To estimate the alignment between the Ontario Ministry of Children and Youth Services (MCYS) expenditures for children’s mental health services and population need, and to quantify the value of adjusting for need in addition to population size in formula-based expenditure allocations. Two need definitions are used: “assessed need,” as the presence of a mental disorder, and “perceived need,” as the subjective perception of a mental health problem. Children’s mental health need and service contact estimates (from the 2014 Ontario Child Health Study), expenditure data (from government administrative data), and population counts (from the 2011 Canadian Census) were combined to generate formula-based expenditure allocations based on 1) population size and 2) need (population size adjusted for levels of need). Allocations were compared at the service area and region level and for the 2 need definitions (assessed and perceived). Comparisons were made for 13 of 33 MCYS service areas and all 5 regions. The percentage of MCYS expenditure reallocation needed to achieve an allocation based on assessed need was 25.5% at the service area level and 25.6% at the region level. Based on perceived need, these amounts were 19.4% and 27.2%, respectively. The value of needs-adjustment ranged from 8.0% to 22.7% of total expenditures, depending on the definition of need. Making needs adjustments to population counts using population estimates of children’s mental health need (assessed or perceived) provides additional value for informing and evaluating allocation decisions. This study provides much-needed and current information about the match between expenditures and children’s mental health need.
The Diabetes Continuity of Care Scale: the development and initial evaluation of a questionnaire that measures continuity of care from the patient perspective*
Publisher: Hindawi Limited
Date: 11-2004
DOI: 10.1111/J.1365-2524.2004.00517.X
Abstract: The purpose of the present study was to develop and pilot test a questionnaire to assess continuity of care from the perspective of patients with diabetes. Seven patient and two healthcare-provider focus groups were conducted. These focus groups generated 777 potential items. This number was reduced to 56 items after item reduction, face validity testing and readability analysis, and to 47 items after a preliminary factor analysis. Readability was assessed as requiring 7-8 years of schooling. Sixty adult patients with diabetes completed the draft Diabetes Continuity of Care Scale (DCCS) at a single point in time to assess the validity of the instrument. Patients completed the draft DCCS again 2 weeks later to assess test-retest reliability. A provisional factor analysis and grouping according to clinical sense yielded five domains: access and getting care, care by doctor, care by other healthcare professionals, communication between healthcare professionals, and self-care. The internal consistency (Cronbach's alpha) for the whole scale was 0.89. The test-retest reliability was r = 0.73. The DCCS total score was moderately correlated with some of the measures used to establish construct validity. The DCCS could differentiate between patients who did and did not achieve specific process and clinical indicators of good diabetes care (e.g. Hba1c tested within 6 months). The development of the DCCS was centred on the patient's perspective and revealed that the patient perspective regarding continuity of care extends beyond the concept of seeing one doctor. Initial testing of this instrument demonstrates that it has promise as a reliable and valid measure in this area.
On beingNICE in the UK: guidelines for technology appraisal for the NHS in England and Wales
Publisher: Wiley
Date: 2002
DOI: 10.1002/HEC.706
“No One dies of Old Age”: Implications for Research, Practice, and Policy
Publisher: SAGE Publications
Date: 06-2011
Alternative funding and delivery models
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-1993
Changing the problem to fit the solution: Johannesson and Weinstein's (mis) application of economics to real world problems
Publisher: Elsevier BV
Date: 12-1993
Screening for hypercholesterolaemia in primary care: randomised controlled trial of postal questionnaire appraising risk of coronary heart disease
Publisher: BMJ
Date: 18-04-1998
DOI: 10.1136/BMJ.316.7139.1208
Abstract: To validate a self administered postal questionnaire appraising risk of coronary heart disease. To determine whether use of this questionnaire increased the percentage of people at high risk of coronary heart disease and decreased the percentage of people at low risk who had their cholesterol concentration measured. Validation was by review of medical records and clinical assessment. The questionnaire appraising risk of coronary heart disease encouraged those meeting criteria for cholesterol measurement to have a cholesterol test and was tested in a randomised controlled trial. The intervention group was sent the risk appraisal questionnaire with a health questionnaire that determined risk of coronary heart disease without identifying the risk factors as related to coronary heart disease the control group was sent the health questionnaire alone. One capitation funded primary care practice in Canada with an enrolled patient population of about 12 000. Random s le of 100 participants in the intervention and control groups were included in the validation exercise. 5686 contactable patients aged 20 to 69 years who on the basis of practice records had not had a cholesterol test performed during the preceding 5 years were included in the randomised controlled trial. 2837 were in the intervention group and 2849 were in the control group. Sensitivity and specificity of assessment of risk of coronary heart disease with risk appraisal questionnaire. Rate of cholesterol testing during three months of follow up. Sensitivity of questionnaire appraising coronary risk was 87.5% (95% confidence interval 73.2% to 95.8%) and specificity 91.7% (81.6% to 97.2%). Of the patients without pre-existing coronary heart disease who met predefined screening criteria based on risk, 45 out of 421 in the intervention group (10.7%) and 9 out of 504 in the control group (1.8%) had a cholesterol test performed during follow up (P<0.0001). Of the patients without a history of coronary heart disease who did not meet criteria for cholesterol testing, 30 out of 1128 in the intervention group (2.7%) and 18 out of 1099 in the control group (1.6%) had a cholesterol test (P=0.175). Of the patients with pre-existing coronary heart disease, 1 out of 15 in the intervention group (6.7%) and 1 out of 23 in the control group (4.3%) were tested during follow up (P=0.851, one tailed Fisher's exact test). Although the questionnaire appraising coronary risk increased the percentage of people at high risk who obtained cholesterol testing, the effect was small. Most patients at risk who received the questionnaire did not respond by having a test.
Targeting services to reduce social inequalities in utilisation: an analysis of breast cancer screening in New South Wales
Publisher: Springer Science and Business Media LLC
Date: 05-06-2007
Abstract: Many jurisdictions have used public funding of health care to reduce or remove price at the point of delivery of services. Whilst this reduces an important barrier to accessing care, it does nothing to discriminate between groups considered to have greater or fewer needs. In this paper, we consider whether active targeted recruitment, in addition to offering a 'free' service, is associated with a reduction in social inequalities in self-reported utilization of the breast screening services in NSW, Australia. Using the 1997 and 1998 NSW Health Surveys we estimated probit models on the probability of having had a screening mammogram in the last two years for all women aged 40–79. The models examined the relative importance of socio-economic and geographic factors in predicting screening behaviour in three different needs groups – where needs were defined on the basis of a woman's age. We find that women in higher socio-economic groups are more likely to have been screened than those in lower groups for all age groups. However, the socio-economic effect is significantly less among women who were in the actively targeted age group. This indicates that recruitment and follow-up was associated with a modest reduction in social inequalities in utilisation although significant income differences remain.
Portfolio theory and the alternative decision rule of cost-effectiveness analysis: theoretical and practical considerations
Publisher: Elsevier BV
Date: 05-2004
Answers in search of questions: what does the comparison of COVID19 data among regions in Northern Italy tell us?
Publisher: Cambridge University Press (CUP)
Date: 04-09-2020
DOI: 10.1017/S1744133120000377
Abstract: Since the outbreak of the COVID-19 pandemic, discussions about the capabilities of health and social systems to control and contain infectious diseases have been reignited. In Resilient Managed Competition During Pandemics: Lessons from the Italian Experience , Costa-Font, Turatti and Levaggi ask whether or not institutional differences between the managed competition (MC) systems in three of Italy's regions may have affected their performance – and hence, population health outcomes – during the pandemic. Fuchs (2000) previously argued that institutional arrangements not only ‘ matter ’, but also sometimes ‘matter a great deal’ (p. 149, emphasis in original) and this may be particularly true in emergencies.
Cohort effects on the need for health care and implications for health care planning in Canada
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.HEALTHPOL.2015.10.007
Abstract: The sustainability of publicly funded health care systems is an issue for governments around the world. The economic climate limits governments' fiscal capacity to continue to devote an increasing share of public funds to health care. Meanwhile the demands for health care within populations continue to increase. Planning the future requirements for health care is typically based on applying current levels of health service use by age to demographic projections of the population. But changes in age-specific levels of health over time would undermine this 'constant use by age' assumption. We use representative Canadian survey data (Canadian Community Health Survey) covering the period 2001-2012, to identify the separate trends in demography (population ageing) and epidemiology (population health) on self-reported health. We propose an approach to estimating future health care requirements that incorporates cohort trends in health. Overall health care requirements for the population increase as the size and mean age of the population increase, but these effects are mitigated by cohort trends in health-we find the estimated need for health care is lower when models account for cohort effects in addition to age effects.
Investigating the affordability of key health services in South Africa
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.SOCSCIMED.2012.11.035
Abstract: This paper considers the affordability of using public sector health services for three tracer conditions (obstetric care, tuberculosis treatment and antiretroviral treatment for HIV-positive people), based on research undertaken in two urban and two rural sites in South Africa. We understand affordability as the 'degree of fit' between the costs of seeking health care and a household's ability-to-pay. Exit interviews were conducted with over 300 patients for each of the three tracer conditions in each of the four sites (i.e. a total s le of over 3600). Total direct costs for the service used at the time of the interview, as well as other health related costs incurred during the preceding month either for self-care or the use of plural providers were assessed, as were a range of indicators of ability-to-pay. The percentage of households incurring direct costs exceeding 10% of household consumption expenditure and those borrowing money or selling assets as a mechanism for coping with the burden of direct costs were calculated. Logistic regressions were also conducted to identify factors that were significantly associated with these indicators of affordability. There were significant differences in affordability between rural and urban sites costs were higher, ability-to-pay was lower and there was a greater proportion of households selling assets or borrowing money in rural areas. There were also significant differences across tracers, with a higher percentage of households receiving tuberculosis and antiretroviral treatment borrowing money or selling assets than those using obstetric services. As these conditions require expenses to be incurred on an ongoing basis, the sustainability of such coping strategies is questionable. Policy makers need to explore how to reduce direct costs for users of these key health services in the context of the particular characteristics of different treatment types. Affordability needs to be considered in relation to the dynamic aspects of the costs of treating different conditions and the timing of treatment in relation to diagnosis. The frequently high transport costs associated with treatments involving multiple consultations can be addressed by initiatives that provide close-to-client services and subsidised patient transport for referrals.
Preferences for surveillance strategies for women treated for high-grade precancerous cervical lesions
Publisher: Elsevier BV
Date: 08-2010
The impact of Cone Beam CT on financial costs and orthodontists’ treatment decisions in the management of maxillary canines with eruption disturbance
Publisher: Oxford University Press (OUP)
Date: 24-06-2017
DOI: 10.1093/EJO/CJX039
Abstract: Examination with Cone Beam CT (CBCT) is common for localizing maxillary canines with eruption disturbance. The benefits and costs of these examinations are unclear. To measure: 1. the proportion of orthodontists' treatment decisions that were different based on intraoral and panoramic radiography (M1) compared with CBCT and panoramic radiography (M2) and 2. the costs of producing different treatment plans, regarding patients with maxillary canines with eruption disturbance. Orthodontists participated in a web-based survey and were randomly assigned to denote treatment decisions and the level of confidence in this decision for four patient cases presented with M1 or M2 at two occasions for the same patient case. One hundred and twelve orthodontists made 445 assessments based on M1 and M2, respectively. Twenty-four per cent of the treatment decisions were different depending on which method the raters had access to, whereof one case differed significantly from all other cases. The mean total cost per examination was €99.84 using M1 and €134.37 using M2, resulting in an incremental cost per examination of €34.53 for M2. Benefits in terms of number of different treatment decisions must be considered as an intermediate outcome for the effectiveness of a diagnostic method and should be interpreted with caution. For the patient cases presented in this study, most treatment decisions were the same irrespective of radiological method. Accordingly, this study does not support routine use of CBCT regarding patients with maxillary canine with eruption disturbance.
Managing moral hazard in motor vehicle accident insurance claims
Publisher: Springer Science and Business Media LLC
Date: 05-2013
DOI: 10.1057/JPHP.2013.11
Abstract: Motor vehicle accident (MVA) insurance in Canada is based primarily on two different compensation systems: (i) no-fault, in which policyholders are unable to seek recovery for losses caused by other parties (unless they have specified dollar or verbal thresholds) and (ii) tort, in which policyholders may seek general damages. As insurance companies pay for MVA-related health care costs, excess use of health care services may occur as a result of consumers' (accident victims) and/or producers' (health care providers) behavior - often referred to as the moral hazard of insurance. In the United States, moral hazard is greater for low dollar threshold no-fault insurance compared with tort systems. In Canada, high dollar threshold or pure no-fault versus tort systems are associated with faster patient recovery and reduced MVA claims. These findings suggest that high threshold no-fault or pure no-fault compensation systems may be associated with improved outcomes for patients and reduced moral hazard.
Stigma and HIV/AIDS in South Africa: Exploring Respect and Treatment Adherence
Publisher: Sciencedomain International
Date: 10-01-2014
A synthesis of recent analyses of human resources for health requirements and labour market dynamics in high-income OECD countries
Publisher: Springer Science and Business Media LLC
Date: 29-09-2016
DOI: 10.1186/S12960-016-0155-2
Abstract: Recognition of the importance of effective human resources for health (HRH) planning is evident in efforts by the World Health Organization (WHO) and the Global Health Workforce Alliance (GHWA) to facilitate, with partner organizations, the development of a global HRH strategy for the period 2016-2030. As part of efforts to inform the development of this strategy, the aims of this study, the first of a pair, were (a) to conduct a rapid review of recent analyses of HRH requirements and labour market dynamics in high-income countries who are members of the Organisation for Economic Co-operation and Development (OECD) and (b) to identify a methodology to determine future HRH requirements for these countries. A systematic search of peer-reviewed literature, targeted website searches, and multi-stage reference mining were conducted. To supplement these efforts, an international Advisory Group provided additional potentially relevant documents. All documents were assessed against predefined inclusion criteria and reviewed using a standardized data extraction tool. In total, 224 documents were included in the review. The HRH supply in the included countries is generally expected to grow, but it is not clear whether that growth will be adequate to meet health care system objectives in the future. Several recurring themes regarding factors of importance in HRH planning were evident across the documents reviewed, such as aging populations and health workforces as well as changes in disease patterns, models of care delivery, scopes of practice, and technologies in health care. However, the most common HRH planning approaches found through the review do not account for most of these factors. The current evidence base on HRH labour markets in high-income OECD countries, although large and growing, does not provide a clear picture of the expected future HRH situation in these countries. Rather than HRH planning methods and analyses being guided by explicit HRH policy questions, most of the reviewed studies appeared to derive HRH policy questions based on predetermined planning methods. Informed by the findings of this review, a methodology to estimate future HRH requirements for these countries is described.
The Structure and Effectiveness of Health Systems: Exploring the Impact of System Integration in Rural China
Publisher: Ubiquity Press, Ltd.
Date: 12-08-2016
DOI: 10.5334/IJIC.2197
Who Are High Users of Hospitals in Canada? Findings From a Population-Based Study
Publisher: SAGE Publications
Date: 07-03-2019
Abstract: Dying people and older people have often been thought of as high users of hospitals, but current population-based evidence is needed to confirm or refute this claim. Quantitative population-based study designed to identify and describe hospital patients who are high users. Data for all 2014–2015 Canadian hospital patients (excluding Quebec) were analyzed to identify and describe high users through descriptive-comparative and regression analysis tests. Only a small proportion of patients are high users in relation to multiple admissions or 30+ inpatient days of care, and with considerable ersity among them and relatively few of these advanced in age or dying in hospital. Relatively few patients are high users of hospitals. These people are most often under age 65, so they have the potential to be ill and high users for many years. Flagging would enable in idualized care planning to reduce illness exacerbations or slow disease progression and address other risk factors for long or repeat hospitalizations.
Allocating resources in health care: alternative approaches to measuring needs in resource allocation formula in Ontario
Publisher: Elsevier BV
Date: 03-1998
DOI: 10.1016/S1353-8292(97)00025-7
Abstract: Maintaining or improving the welfare of the population is a complex issue involving in idual and collective actions and institutions. Despite questions regarding the relevance of health care systems to these aims, they remain vital policy and treatment arenas with respect to curative and preventative regimes. As a component of social welfare, health care resources should be distributed equitably, according to need for health care. This paper evaluates alternative indicators of health status within Ontario against self-reported health as a means of allocating health care resources. Proxies of need for health care include standardized mortality ratios (based on the population aged 0-64) and a socioeconomic based indicator. Mortality indicators are found to be more closely correlated with self-reported health status than the socioeconomic indicator, suggesting that mortality is better able to reflect variations in health status and health care needs.
DRGs U.K. style: a comparison of U.K. and U.S. policies for hospital cost containment and their implications for health status
Publisher: Elsevier BV
Date: 10-1988
DOI: 10.1016/0168-8510(88)90003-6
Abstract: Health care cost containment in the U.K. has been characterised by the imposition of cash limits on health and personal social services. More recently performance appraisal has been introduced. The U.S. approach, on the other hand, has linked both cost containment and implicit performance appraisal by funding hospital activities on a DRG basis. Under the U.K. approach there is an internal inconsistency between the funding of hospital activities, primarily determined by the characteristics of the served population, and the appraisal of hospital performance by reference to the use of resources in relation to national norms not necessarily corresponding to the characteristics of the served population. Under the U.S. approach performance is appraised implicitly, not by the use of real resources but by the cost to the hospital of the service provision for each in idual patient. Consequently the incentive is to minimise the cost of the service provision regardless of the output produced. The incentives, in both the U.K. and the U.S. approach, generate similar effects: an off-loading of responsibility for service provision at the margin onto other sectors of the health care system. They are the response to the incentive to minimise the costs incurred by the hospital in providing services to the patient. Until greater attention in paid to the monitoring of the outcomes achieved by all sectors of the health care system, and to the incentives generated to shift demands between the sectors, the respective policies will continue to be successful simply in controlling the resource cost of the hospital system.
Health Human Resources Policy in the 21 st Century: Addressing the Complexities of Who Does What in a Canadian Context
Publisher: University of Toronto Press Inc. (UTPress)
Date: 2007
CHARGES FOR PREVENTIVE SERVICES
Publisher: Elsevier BV
Date: 1988
DOI: 10.1016/S0140-6736(88)91099-9
Abstract: Comparing outcomes of arteriovenous grafts and fistulas is challenging because the pathophysiology of access dysfunction and failure rate profiles differ by access type. Studying how risks vary over time may be important. Longitudinal data from 535 incident hemodialysis patients were used to study the relationship between access type and access survival, without (semiparametric Cox modeling) and with specification of the underlying hazard function (parametric Weibull modeling). The hazard for failure of fistulas and grafts declined over time, becoming proportional only after 3 months from surgery, with a graft versus fistula hazard ratio of 3.2 (95% confidence interval 1.9 to 5.3 Cox and Weibull estimation) and time ratio of 0.11 (i.e., the estimated access survival time was approximately one tenth shorter in grafts 95% confidence interval 0.04 to 0.28 Weibull estimation only). Considering the entire observation period, grafts had slower hazard decline (P<0.001) with shorter median survival times than fistulas (8.4 versus 38.3 months Weibull regression only). Parametric models of arteriovenous access survival may provide relevant information about temporal risk profiles and predicted survival times.
A randomised controlled trial to measure the effects and costs of a dental caries prevention regime for young children attending primary care dental services: the Northern Ireland Caries Prevention In
Publisher: National Institute for Health and Care Research
Date: 09-2016
DOI: 10.3310/HTA20710
Abstract: Dental caries is the most common disease of childhood. The NHS guidelines promote preventative care in dental practices, particularly for young children. However, the cost-effectiveness of this policy has not been established. To measure the effects and costs of a composite fluoride intervention designed to prevent caries in young children attending dental services. The study was a two-arm, parallel-group, randomised controlled trial, with an allocation ratio of 1 : 1. Randomisation was by clinical trials unit, using randomised permuted blocks. Children/families were not blinded however, outcome assessment was blinded to group assessment. The study took place in 22 NHS dental practices in Northern Ireland, UK. The study participants were children aged 2–3 years, who were caries free at baseline. The intervention was composite in nature, comprising a varnish containing 22,600 parts per million (p.p.m.) fluoride, a toothbrush and a 50-ml tube of toothpaste containing 1450 p.p.m. fluoride plus standardised, evidence-based prevention advice provided at 6-monthly intervals over 3 years. The control group received the prevention advice alone. The primary outcome measure was conversion from caries-free to caries-active states. Secondary outcome measures were the number of decayed, missing or filled tooth surfaces in primary dentition (dmfs) in caries-active children, the number of episodes of pain, the number of extracted teeth and the costs of care. Adverse reactions (ARs) were recorded. A total of 1248 children (624 randomised to each group) were recruited and 1096 (549 in the intervention group and 547 in the control group) were included in the final analyses. A total of 87% of the intervention children and 85% of control children attended every 6-month visit ( p = 0.77). In total, 187 (34%) children in the intervention group converted to caries active, compared with 213 (39%) in the control group [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.64 to 1.04 p = 0.11]. The mean number of tooth surfaces affected by caries was 7.2 in the intervention group, compared with 9.6 in the control group ( p = 0.007). There was no significant difference in the number of episodes of pain between groups ( p = 0.81). However, 164 out of the total of 400 (41%) children who converted to caries active reported toothache, compared with 62 out of 696 (9%) caries-free children (OR 7.1 95% CI 5.1 to 9.9 p 0.001). There was no statistically significant difference in the number of teeth extracted in caries-active children ( p = 0.95). Ten children in the intervention group had ARs of a minor nature. The average direct dental care cost was £155.74 for the intervention group and £48.21 for the control group over 3 years ( p 0.05). The mean cost per carious surface avoided over the 3 years was estimated at £251.00. The usual limitations of a trial such as generalisability and understanding the underlying reasons for the outcomes apply. There is no mean willingness-to-pay threshold available to enable assessment of value for money. A statistically significant effect could not be demonstrated for the primary outcome. Once caries develop, pain is likely. There was a statistically significant difference in dmfs in caries-active children in favour of the intervention. Although adequately powered, the effect size of the intervention was small and of questionable clinical and economic benefit. Future work should assess the caries prevention effects of interventions to reduce sugar consumption at the population and in idual levels. Interventions designed to arrest the disease once it is established need to be developed and tested in practice. Current Controlled Trials ISRCTN36180119 and EudraCT 2009-010725-39. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment Vol. 20, No. 71. See the NIHR Journals Library website for further project information.
Cost-Effectiveness and Cost Utility Analyses: Methods for the Non-Economic Evaluation of Health Care Programmes and How We Can Do Better
Publisher: Springer US
Date: 1996
Developing a Web Site: A Strategy for Employment Integration of Internationally Educated Nurses
Publisher: SAGE Publications
Date: 12-2015
DOI: 10.1177/084456211504700403
Abstract: This review is focused on the effectiveness of nursing interventions for patient outcomes and healthcare costs. It was guided by ecological and economic evaluation frameworks. Restricting the first-tier search of over 4,000 articles to randomized controlled trials (RCTs) yielded 203 studies and 9 additional trials that used identical methods of cost evaluation. Of 212 RCTs, 37 met the eligibility criteria. Of the 37 articles, 29 came from the literature search and 8 came from the first author's research unit, which used identical methods of economic evaluation. Of the first 29 studies, 26 found that nurse interventions were more or equally effective and less or equally costly compared to usual care, as was true of 7 of the 9 RCTs with comprehensive economic evaluations. It is effective and efficient to deploy specialty-trained nurses to lead teams of professionals, including physicians, assembled to address complex patient needs. A nurse-led model of proactive and supplemental care for the chronically ill, versus the on-demand, physician-led model now in place, would be more or equally effective and less or equally costly.
Human Papillomavirus Triage of Atypical Squamous Cells of Undetermined Significance: Cost-Effective, But At What Cost?
Publisher: Oxford University Press (OUP)
Date: 18-01-2006
DOI: 10.1093/JNCI/DJJ035
Medical Necessity, Benefit and Resource Allocation in Health Care
Publisher: SAGE Publications
Date: 10-1997
DOI: 10.1177/135581969700200407
Abstract: Many health care systems espouse medical necessity, or need, as a guiding principle for the allocation of resources. Yet, logic and experience suggest that it is likely impossible to develop a concise, explicit, operational definition of medical necessity that would allow it to be used as an administrative or management tool. Even if such a definition could be developed, it would likely do little to solve the fundamental challenges facing policy-makers attempting to reform health care systems. This implies that we should refrain from further efforts to define medical necessity operationally. But does it follow that medical necessity is an empty concept? No. Even if it cannot be defined precisely, it can still serve as a guiding principle for health policy. Given that ability-to-benefit is a core concept underlying necessity, we develop a conceptual framework that encompasses alternative notions of benefit and then illustrate some selected implications of alternative benefit notions for processes required to use medical necessity as a guiding principle and for the types of services that would be deemed to produce a benefit.
Optimizing the mix of basic dental services for Southern Thai schoolchildren based on resource consumption, service needs and parental preference
Publisher: Wiley
Date: 07-07-2009
DOI: 10.1111/J.1600-0528.2009.00481.X
Abstract: To identify the optimal levels and mix of basic dental services (sealants and fillings for permanent teeth and extraction of primary teeth) under two different dental settings: hospital-based and mobile dental clinics under specified resource constraints. A linear programming model is used based on explicit identification of system objectives and resource constraints. The objective was to maximize benefits as measured by parental willingness to pay (WTP) for basic dental services provided to schoolchildren subject to constraints on total resources, service need and parental preferences among different dental care settings. Optimization was identified to require 270, 180, 552, 828, 228 and 532 cases of hospital sealant, mobile sealant, hospital filling, mobile filling, hospital extraction and mobile extraction, respectively. The corresponding current service levels were 48, 281, 191, 170, 479, and 677 respectively. The optimal service configuration produced a total WTP of 485 860 baht which exceeded the WTP for the current service configuration by more than 75.4%. Mobile clinic fillings were the highest priority among basic dental services. The current service configurations fail to reflect the setting preferences and provide greater emphasis to extractions than the optimal configuration with less emphasis given to preventive and restorative services.
IMPACT OF NATIONWIDE ANTI-SMOKING CAMPAIGN
Publisher: Elsevier BV
Date: 10-1985
DOI: 10.1016/S0140-6736(85)90154-0
Abstract: Human diseases associated with exposure to asbestos fibers include pleural fibrosis and plaques, pulmonary fibrosis (asbestosis), lung cancer, and diffuse malignant mesothelioma. The critical determinants of fiber bioactivity and toxicity include not only fiber dimensions, but also shape, surface reactivity, crystallinity, chemical composition, and presence of transition metals. Depending on their size and dimensions, inhaled fibers can penetrate the respiratory tract to the distal airways and into the alveolar spaces. Fibers can be cleared by several mechanisms, including the mucociliary escalator, engulfment, and removal by macrophages, or through splitting and chemical modification. Biopersistence of long asbestos fibers can lead to inflammation, granuloma formation, fibrosis, and cancer. Exposure to synthetic carbon nanomaterials, including carbon nanofibers and carbon nanotubes (CNTs), is considered a potential health hazard because of their physical similarities with asbestos fibers. Respiratory exposure to CNTs can produce an inflammatory response, diffuse interstitial fibrosis, and formation of fibrotic granulomas similar to that observed in asbestos-exposed animals and humans. Given the known cytotoxic and carcinogenic properties of asbestos fibers, toxicity of fibrous nanomaterials is a topic of intense study. The mechanisms of nanomaterial toxicity remain to be fully elucidated, but recent evidence suggests points of similarity with asbestos fibers, including a role for generation of reactive oxygen species, oxidative stress, and genotoxicity. Considering the rapid increase in production and use of fibrous nanomaterials, it is imperative to gain a thorough understanding of their biologic activity to avoid the human health catastrophe that has resulted from widespread use of asbestos fibers.
Does capitation affect the delivery of oral healthcare and access to services? Evidence from a pilot contact in Northern Ireland
Publisher: Springer Science and Business Media LLC
Date: 06-03-2017
The NICE Reference Case Requirement
Publisher: Springer Science and Business Media LLC
Date: 2004
Planning for what? Challenging the assumptions of health human resources planning
Publisher: Elsevier BV
Date: 10-2009
DOI: 10.1016/J.HEALTHPOL.2009.04.001
Abstract: Health human resource planning has traditionally been based on simple models of demographic changes applied to observed levels of service utilization or provider supply. No consideration has been given to the implications of changing levels of need within populations over time. Recently, needs based resource planning models have been suggested that incorporate changes in needs for care explicitly as a determinant of health care needs. In this paper, population indicators of morbidity, mortality and self-assessed health are analyzed to determine if health care needs have changed across birth cohorts in Canada from 1994 to 2005 among older age groups. Multivariate regression analysis was used to estimate the age pattern of health by birth year with interaction terms included to examine whether the association of age with health was conditional on the birth year. Results indicate that while the probability of mortality, mobility problems and pain rises with age, the rate of change is greater for those born earlier. The probability of self-assessed poor health increases with age but the rate of change with age is constant across birth years. Even in the short time period covered, our analysis shows that health care needs by age are changing over time in Canada.
QALYs and HYEs Spotting the differences
Publisher: Elsevier BV
Date: 10-1997
Surveillance After Treatment for Cervical Intraepithelial Neoplasia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2010
Option B+ Program for the Prevention of Vertical Transmission of HIV: A Case Study in Johannesburg, South Africa
Publisher: Frontiers Media SA
Date: 28-10-2020
Determining the optimal model for role-substitution in NHS dental services in the United Kingdom
Publisher: Springer Science and Business Media LLC
Date: 24-09-2013
Equity in health care: Methodological contributions to the analysis of hospital utilization within Canada
Publisher: Elsevier BV
Date: 05-1995
DOI: 10.1016/0277-9536(94)00229-M
Abstract: The main objective of this paper is to determine whether the distribution of hospital service utilization corresponds to the distribution of needs within Canada. This is accomplished by identifying the factors affecting the relationship between the incidence and quantity of hospital services and self-assessed need for such care in Canada. The data were derived from the General Social Survey (Statistics Canada, 1987) which is a weighted random s le of the Canadian population aged 15 and over. Employing methodological extensions over previous studies, the results indicate that although variation in quantity of hospital use is largely independent of income, household income has a significant positive effect on the incidence of hospital utilization. Additionally, variations in both incidence and quantity of use of hospital services are associated with variations in need and other factors within the model.
Communication and access to healthcare
Publisher: Frontiers Media SA
Date: 06-12-2022
DOI: 10.3389/FPAIN.2022.1041968
Abstract: Pain management requires a multidisciplinary approach and a collaborative relationship between patient-provider in which communication is crucial. This study examines the communication experiences of Aboriginal and Torres Strait Islander patients and Aboriginal and Torres Strait Islander Hospital Liaison Officers (ATSIHLOs), to improve understanding of how pain is managed in and through patient-health professional communication. This qualitative study involved a purposive s le of patients attending three persistent pain clinics and ATSIHLOs working in two hospitals in Queensland, Australia. Focus groups and in-depth interviews explored the communication experiences of patients managing pain and ATSIHLOs supporting patients with pain. This study adopted a descriptive phenomenological methodology, as described by Colaizzi (1978). Relevant statements (patient and ATSIHLOs quotes) about the phenomenon were extracted from the transcripts to formulate meanings. The formulated meanings were subsequently sorted into thematic clusters and then integrated into themes. The themes were then incorporated into a concise description of the phenomenon of communication within pain management. Findings were validated by participants. A total of 21 Aboriginal and Torres Strait Islander participants were involved in this study. Exploration of the communication experiences of patients and ATSIHLOs revealed overlapping themes of important barriers to and enablers of communication that affected access to care while managing pain. Acknowledging historical and cultural factors were particularly important to build trust between patients and health professionals. Some patients reported feeling stigmatized for identifying as Aboriginal and Torres Strait Islander, while others were reluctant to disclose their background for fear of not having the same opportunity for treatment. Differences in the expression of pain and the difficulty to use standard pain measurement scales were identified. Communication was described as more than the content delivered, it is visual and emotional expressed through body language, voice intonation, language and the speed of the conversation. Communication can significantly affect access to pain management services. Aboriginal and Torres Strait Islander patients highlighted the burden of emotional pain caused by historical factors, negative stereotypes and the fear of discrimination. Pain management services and their health professionals need to acknowledge how these factors impact patients trust and care.
Equity and efficiency in medical manpower planning: defining objectives and looking towards the future
Publisher: Elsevier BV
Date: 1985
DOI: 10.1016/0168-8510(85)90015-6
Abstract: If medical manpower planning is to be successful in terms of providing the correct future manpower levels to produce the desired (efficient) health care services then the planners must recognise the ultimate objectives of the provision of health care services and the production relationship between the services provided (inputs) and the effects on patient health status (outputs). Furthermore the planning of medical manpower should not be done in isolation under the implicit assumption that other important inputs will be available as required but should be part of an overall planning process for the future production of improvements in health status. Having determined the objectives for outputs the future levels of different types of manpower will depend on the identification of the efficient mix of inputs. In addition the values of other variables influencing the production relationship (e.g. trends in the consumption of certain goods) should be considered in the planning process since observed trends show that they do not remain constant over time.
The reason that I did not go – determinants of the use of antenatal care services in South Africa, two decades after the end of apartheid
Publisher: Informa UK Limited
Date: 04-2013
Oral health behaviours of parents and young children in a practice‐based caries prevention trial in Northern Ireland
Publisher: Wiley
Date: 22-12-2017
DOI: 10.1111/CDOE.12357
Abstract: The NICPIP trial evaluated the costs and effects of a caries prevention intervention delivered to 2- to 3-year-old children attending dental practices in Northern Ireland. This supplementary study explored the oral health behaviours of children and their parents to help understand the reasons for the trial's findings. A mixed methods study that included a questionnaire completed by all parents (n = 1058) at the time they brought their child for the NICPIP final clinical assessment. The questionnaire collected data on frequency of toothbrushing and sugar consumption. Questionnaire data were analysed by trial group and caries status. Parents of trial participants (n = 42) were invited to take part in telephone interviews. Parents were purposively s led according to trial group and whether or not their child developed caries. The interviews explored how and why oral health behaviours happened. Interview data were audio-recorded, transcribed verbatim and analysed thematically. The questionnaire data indicated that toothbrushing and between-meal sugar snacking were common in the majority of children. The children of parents who automatically reminded their child to brush their teeth were more likely to remain caries-free (Odds Ratio 1.24 95% CI 1.08, 1.41 P = .002). Frequency of sweet drink consumption was associated with the child developing caries (Odds Ratio 0.88 95% CI 0.79, 0.98 P = .021). The interview data showed that parents had positive attitudes towards brushing both in terms of perceived importance and expected outcomes. Attitudes towards sugar snacking were more complex, with parents reporting difficulties in controlling this behaviour. Sugar was described as being something that was "ever present" in children's lives. Toothbrushing was widely adopted from a young age, but between-meal sugar consumption was highly prevalent. The results suggest that effective family-level and population-level interventions are needed to reduce sugar consumption if substantial improvements in caries prevention are to be achieved.
Health Human Resource Planning in Home Care: How to Approach It - That Is the Question
Publisher: Longwoods Publishing
Date: 15-09-2000
Abstract: In her paper, MacAdam refers to future challenges in health human resources for the home-care sector. This paper builds on her comments and discusses conceptual and practical approaches to future planning of health human resources. Necessary national data requirements are identified for this type of planning. The authors point out the limitations of traditional supply-side modelling and describe a new framework linking population health needs to outcomes that builds upon earlier conceptual work in needs-based, utilization-based and effective demand-based models.
Preferences and Acceptance of Colorectal Cancer Screening in Thailand
Publisher: Asian Pacific Organization for Cancer Prevention
Date: 03-04-2015
DOI: 10.7314/APJCP.2015.16.6.2269
Abstract: Colorectal cancer (CRC) is now common in Thailand with an increase in incidence over time. Health authorities are planning to implement a nationwide CRC screening program using fecal immunochemical test (FIT) as a primary screening tool. This study aimed to estimate preferences and acceptance of FIT and colonoscopy, explore factors influencing the acceptance, and investigate reasons behind choosing and rejecting to screen before the program was implemented. Patients aged 50-69, visiting the primary care unit during the study period, were invited to join this study. Patients with a history of cancer or past CRC screening were excluded. Face-to-face interviews were conducted. Subjects were informed about CRC and the screening tests: FIT and colonoscopy. Then, they were asked for their opinions regarding the screening. The total number of subjects was 437 (86.7% response rate). Fifty-eight percent were females. The median age was 58 years. FIT was accepted by 74.1% of subjects compared to 55.6% for colonoscopy. The acceptance of colonoscopy was associated with perceived susceptibility to CRC and family history of cancer. No symptoms, unwilling to screen, healthy, too busy and anxious about diagnosis were reasons for refusing to screen. FIT was preferred for its simplicity and non-invasiveness compared with colonoscopy. Those rejecting FIT expressed a strong preference for colonoscopy. Subjects chose colonoscopy because of its accuracy it was refused for the process and complications. If the screening program is implemented for the entire target population in Thailand, we estimate that 106,546 will have a positive FIT, between 8,618 and 12,749 identified with advanced adenoma and between 2,645 and 3,912 identified with CRC in the first round of the program.
Gender differences in experiences of ART services in South Africa: a mixed methods study
Publisher: Wiley
Date: 18-05-2012
DOI: 10.1111/J.1365-3156.2012.03009.X
Abstract: A mixed methods study exploring gender differences in patient profiles and experiences of ART services, along the access dimensions of availability, affordability and acceptability, in two rural and two urban areas of South Africa. Structured exit interviews (n = 1266) combined with in-depth interviews (n = 20) of women and men enrolled in ART care. Men attending ART services were more likely to be employed (29%vs. 20%, P = 0.001) and were twice as likely to be married/co-habiting as women (42%vs. 22%P = 0.001). Men had known their HIV status for a shorter time (mean 32 vs. 36 months, P = 0.021) and were also less likely to disclose their status to non-family members (17%vs. 26%, P = 0.001). From both forms of data collection, a key finding was the role of female partners in providing social support and facilitating use of services by men. The converse was true for women who relied more on extended families and friends than on partners for support. Young, unmarried and unemployed men faced the greatest social isolation and difficulty. There were no major gender differences in the health system (supply side) dimensions of access. Gender differences in experiences of HIV services relate more to social than health system factors. However, the health system could be more responsive by designing services in ways that enable earlier and easier use by men.
Simulating future supply of and requirements for human resources for health in high-income OECD countries
Publisher: Springer Science and Business Media LLC
Date: 12-2016
An evaluation of a referral management and triage system for oral surgery referrals from primary care dentists: a mixed-methods study
Publisher: National Institute for Health and Care Research
Date: 02-2018
DOI: 10.3310/HSDR06080
Abstract: Oral surgery referrals from dentists are rising and putting increased pressure on finite hospital resources. It has been suggested that primary care specialist services can provide care for selected patients at reduced costs and similar levels of quality and patient satisfaction. Can an electronic referral system with consultant- or peer-led triage effectively ert patients requiring oral surgery into primary care specialist settings safely, and at a reduced cost, without destabilising existing services? A mixed-methods, interrupted time study (ITS) with adjunct diagnostic test accuracy assessment and health economic evaluation. The ITS was conducted in a geographically defined health economy with appropriate hospital services and no pre-existing referral management or primary care oral surgery service. Hospital services included a district general, a foundation trust and a dental hospital. Patients, carers, general and specialist dentists, consultants (both surgical and Dental Public Health), hospital managers, commissioners and dental educators contributed to the qualitative component of the work. Referrals from primary care dental practices for oral surgery procedures over a 3-year period were utilised for the quantitative and health economic evaluation. A consultant- then practitioner-led triage system for oral surgery referrals embedded within an electronic referral system for oral surgery with an adjunct primary care service. Diagnostic test accuracy metrics for sensitivity and specificity were calculated. Total referrals, numbers of referrals sent to primary care and the cost per referral are reported for the main intervention. Qualitative findings in relation to patient experience and whole-system impact are described. In the diagnostic test accuracy study, remote triage was found to be highly specific (mean 88.4, confidence intervals 82.6 and 92.8) but with lower values for sensitivity. The implementation of the referral system and primary care service was uneventful. During consultant triage in the active phases of the study, 45% of referrals were erted to primary care, and when general practitioner triage was used this dropped to 43%. Only 4% of referrals were sent from specialist primary care to hospital, suggesting highly efficient triage of referrals. A significant per-referral saving of £108.23 [standard error (SE) £11.59] was seen with consultant triage, and £84.13 (SE £11.56) with practitioner triage. Cost savings varied according the differing methods of applying the national tariff. Patients reported similar levels of satisfaction for both settings, and speed of treatment was their over-riding concern. Implementation of electronic referral management in primary care can lead, when combined with triage, to ersions of appropriate cases to primary care. Cost savings can be realised but are dependent on tariff application by hospitals, with a risk of overestimating where hospitals are using day case tariffs extensively. The geographical footprint of the study was relatively small and, hence, the impact on services was minimal and could not be fully assessed across all three hospitals. The findings suggest that the intervention should be tested in other localities and disciplines, especially those, such as dermatology, that present the opportunity to use imaging to triage. The National Institute for Health Research Health Services and Delivery Research programme.
Complex Problems or Simple Solutions? Enhancing Evidence‐Based Economics to Reflect Reality
Publisher: Wiley
Date: 09-04-2010
Eliciting Preferences of Providers in Primary Care Settings for Post Hospital Discharge Patient Follow-Up
Publisher: MDPI AG
Date: 05-08-2021
Abstract: Background: Post-hospital discharge follow-up has been a principal intervention in addressing gaps in care pathways. However, evidence about the willingness of primary care providers to deliver post-discharge follow-up care is lacking. This study aims to assess primary care providers’ preferences for delivering post-discharge follow-up care for patients with chronic diseases. Methods: An online questionnaire survey of 623 primary care providers who work in a hospital group of southeast China. Face-to-face interviews with 16 of the participants. A discrete choice experiment was developed to elicit preferences of primary care providers for post-hospital discharge patient follow-up based on six attributes: team composition, workload, visit pattern, adherence of patients, incentive mechanism, and payment. A conditional logit model was used to estimate preferences, willingness-to-pay was modelled, a covariate-adjusted analysis was conducted to identify characteristics related to preferences, 16 interviews were conducted to explore reasons for participants’ choices. Results: 623 participants completed the discrete choice experiment (response rate 86.4%, aged 33 years on average, 69.5% female). Composition of the follow-up team and adherence of patients were the attributes of greatest relative importance with workload and incentives being less important. Participants were indifferent to follow-up provided by home visit or as an outpatient visit. Conclusion: Primary care providers placed the most importance on the multidisciplinary composition of the follow-up team. The preference heterogeneity observed among primary care providers suggests personalized management is important in the multidisciplinary teams, especially for those providers with relatively low educational attainment and less work experience. Future research and policies should work towards innovations to improve patients’ engagement in primary care settings.
A Population-Based Study on Advance Directive Completion and Completion Intention among citizens of the Western Canadian province of Alberta
Publisher: SAGE Publications
Date: 03-2013
DOI: 10.1177/082585971302900102
Abstract: Determining what proportion of the public has completed an advance directive and which population subgroups complete or do not complete such a directive is crucially important for planning purposes. Our research objective was to examine and compare advance directive completion, intention to complete, and noncompletion rates among citizens of one Canadian province. A telephone survey was conducted with 1,203 Albertans who met gender, age, and other requirements for a representative s le. When asked, “Do you have a living will or personal directive?” 43.6 percent reported having completed a directive and 42.1 percent indicated that they planned or intended to complete one. Completion rates increased with age. Widowed, self-employed, and retired people, and those who had lost a family member or friend and had other select end-of-life experiences and viewpoints were significantly more likely to have completed one. Although older people more often had an advance directive, personal life-and-death experiences should be recognized as major influences on directive completion.
Determining the optimal model for role substitution in NHS dental services in the UK: a mixed-methods study
Publisher: National Institute for Health and Care Research
Date: 07-2016
DOI: 10.3310/HSDR04220
Abstract: Maximising health gain for a given level and mix of resources is an ethical imperative for health-service planners. Approximately half of all patients who attend a regular NHS dental check-up do not require any further treatment, whereas many in the population do not regularly attend. Thus, the most expensive resource (the dentist) is seeing healthy patients at a time when many of those with disease do not access care. Role substitution in NHS dentistry, where other members of the dental team undertake the clinical tasks previously provided by dentists, has the potential to increase efficiency and the capacity to care and lower costs. However, no studies have empirically investigated the efficiency of NHS dental provision that makes use of role substitution. This programme of research sought to address three research questions: (1) what is the efficiency of NHS dental teams that make use of role substitution? (2) what are the barriers to, and facilitators of, role substitution in NHS dental practices? and (3) how do incentives in the remuneration systems influence the organisation of these inputs and production of outputs in the NHS? Data envelopment analysis was used to develop a productive efficiency frontier for participating NHS practices, which were then compared on a relative basis, after controlling for patient and practice characteristics. External validity was tested using stochastic frontier modelling, while semistructured interviews explored the views of participating dental teams and their patients to role substitution. NHS ‘high-street’ general dental practices. 121 practices across the north of England. No active interventions were undertaken. Relative efficiency of participating NHS practices, alongside a detailed narrative of their views about role substitution dentistry. Social acceptability for patients. The utilisation of non-dentist roles in NHS practices was relatively low, the most common role type being the dental hygienist. Increasing the number of non-dentist team members reduced efficiency. However, it was not possible to determine the relative efficiency of in idual team members, as the NHS contracts only with dentists. Financial incentives in the NHS dental contract and the views of practice principals (i.e. senior staff members) were equally important. Bespoke payment and referral systems were required to make role substitution economically viable. Many non-dentist team members were not being used to their full scope of practice and constraints on their ability to prescribe reduced efficiency further. Many non-dentist team members experienced a precarious existence, commonly being employed at multiple practices. Patients had a low level of awareness of the different non-dentist roles in a dental team. Many exhibited an inherent trust in the professional ‘system’, but prior experience of role substitution was important for social acceptability. Better alignment between the financial incentives within the NHS dental contract and the use of role substitution is required, although professional acceptability remains critical. Output data collected did not reflect the quality of care provided by the dental team and the input data were self-reported. Further work is required to improve the evidence base for the use of role substitution in NHS dentistry, exploring the effects and costs of provision. The National Institute for Health Research Health Services and Delivery Research programme.
A Review of Web-Based Tools for Value-of-Information Analysis
Publisher: Springer Science and Business Media LLC
Date: 28-05-2021
DOI: 10.1007/S40258-021-00662-4
Abstract: Value-of-information analysis (VOI) is a decision-theoretic approach that is used to inform reimbursement decisions, optimise trial design and set research priorities. The application of VOI analysis for informing policy decisions in practice has been limited due, in part, to the perceived complexity associated with the calculation of VOI measures. Recent efforts have resulted in the development of efficient methods to estimate VOI measures and the development of user-friendly web-based tools to facilitate VOI calculations. We review the existing web-based tools including Sheffield Accelerated Value of Information (SAVI), the web interface to the BCEA (Bayesian Cost-Effectiveness Analysis) R package (BCEAweb), Rapid Assessment of Need for Evidence (RANE), and Value of Information for Cardiovascular Trials and Other Comparative Research (VICTOR). We describe what each tool is designed to do, the inputs they require, and the outputs they produce. Finally, we discuss how tools for VOI calculations might be improved in the future to facilitate the use of VOI analysis in practice.
Hypothesis: Charges to Patients Impair the Quality of Dental Care for Elderly People
Publisher: Oxford University Press (OUP)
Date: 1989
Abstract: Data on National Health Service (NHS) dental care utilization by the elderly are analysed to consider the distribution of dental care according to the charge status of the patient. Considerable and significant differences are observed in the type and amount of dental care provided to elderly patients exempt and not exempt from patient charges. Consideration is given to alternative explanations of the observed distribution and the implications for the performance of the NHS with regard to objectives.
Preferences of Women Evaluating Risks of Tamoxifen (POWER) study of preferences for tamoxifen for breast cancer risk reduction
Publisher: Wiley
Date: 11-04-2005
DOI: 10.1002/CNCR.20981
Abstract: The objective of this study was to understand the attitudes and preferences of risk-eligible women regarding use of tamoxifen for breast cancer risk reduction. A cross-sectional, mixed-methods interview study was conducted at a university medical center and at community sites. Participants were women who had an estimated 5-year breast cancer risk > or = 1.7% and no prior breast cancer. Interviews were conducted in English or Spanish. The interview included a 15-minute, standardized educational session on the potential benefits and harms of tamoxifen followed by close-ended and open-ended questions about participants' inclinations to take tamoxifen and factors important to their decision. A demographic questionnaire, a test on knowledge of potential benefits and harms of tamoxifen, and an interview evaluation were included. Two hundred fifty-five women completed interviews. Their estimated mean 5-year breast cancer risk was 2.8% and their mean self-perceived 5-year risk was 32.7%. After the educational intervention, 45 women (17.6%) were inclined to take tamoxifen. Very high risk women (> 3.5%) were no more inclined to take it than women with lower risk (1.7-3.5%). In a multivariable analysis, lower income, confidence in the effectiveness of tamoxifen, and concern about fractures were associated with being inclined to take it concern about pulmonary embolism, dyspareunia, cataracts, and low self-perceived breast cancer risk were associated negatively with taking tamoxifen. Participants expressed concerns about adverse effects. Less than 20% of women were interested in tamoxifen after education about potential benefits and harms, despite a very high self-perceived breast cancer risk. Candidate chemoprevention agents must have few potential adverse effects to achieve widespread acceptance.
“Interaction” and research utilisation in health policies and programs: does it work?
Publisher: Elsevier BV
Date: 2005
DOI: 10.1016/J.HEALTHPOL.2004.03.010
Abstract: The objective of this study was to assess if interaction between users and producers of research is associated with a greater level of adoption of research findings in the design and delivery of health care programs. Responses to the dissemination of a research report on breast cancer prevention were compared between two groups of public health units in Ontario, Canada. Although all public health units received the report, only a subset of units was involved in the development of the report, while others were not. Research utilisation was conceptualized in terms of stages, including reading the report, information processing, and application of findings for public health units' policies and programs. Using a multi-case study design, three units that contributed to the report's production (the interacting units) were compared with three units were not involved in producing the report (the comparison units) on the basis of research utilisation. Data collection involved group interviews and document review. Results demonstrated that interacting units had a greater understanding of the report's analysis and attached greater value to the report. However, interaction was not associated with greater levels of utilisation in terms of application. Both interacting and comparison units used the research findings to confirm that their on-going program activities were consistent with the research findings, and to compare their program performance relative to other units. In conclusion, interaction influenced the understanding of the research, and intent to use the research findings, but applied use was independent of interaction between producers and users of research.
Cost-benefit analysis: Dealing with the problems of indivisible projects and fixed budgets
Publisher: Elsevier BV
Date: 02-1987
DOI: 10.1016/0168-8510(87)90047-9
Abstract: The use of cost-benefit analysis in option appraisals in health care when the decision-maker is faced with in isible projects and a fixed budget is examined. It is argued that the methods used to overcome the problem of in isibilities, benefit-cost ratios and the net benefit method, are not suitable for choosing between alternative projects for two reasons. Firstly, the values of benefit-cost ratios are sensitive to the specification of costs and benefits, and the literature abounds with ex les of averted costs being added to the benefits of a project or reduced benefits being interpreted as an additional (psychic) cost. We show that such erroneous specification can lead to a relatively inefficient project being accepted as efficient, and vice versa. Secondly, practical applications of CBA have been performed in the absence of budget constraints on available resources. We show that once budget constraints are recognised the shadow price of resources required to implement a project may be affected by the amount of resources remaining in the budget after implementation. Once the budget constraint is recognised, a project which initially appeared to be the most efficient can be rendered relatively inefficient. It is suggested that alternative uses of remaining (or residual) resources should be identified and evaluated, thus ensuring the maximisation of benefits from the use of an overall budget.
Better data to drive more effective care for people with latent tuberculosis infection in Canada
Publisher: CMA Impact Inc.
Date: 11-06-2018
DOI: 10.1503/CMAJ.180488
The Luohu Model: A Template for Integrated Urban Healthcare Systems in China
Publisher: Ubiquity Press, Ltd.
Date: 2018
DOI: 10.5334/IJIC.3955
Being naughty about NICE? Questioning the methods used to maximize health gains from NHS resources
Publisher: Cambridge University Press (CUP)
Date: 04-2007
In place of fear: aligning health care planning with system objectives to achieve financial sustainability
Publisher: SAGE Publications
Date: 11-12-2014
Abstract: The financial sustainability of publicly funded health care systems is a challenge to policymakers in many countries as health care absorbs an ever increasing share of both national wealth and government spending. New technology, aging populations and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in need for care within populations. Attempts to promote financial sustainability of systems such as limiting the range of services is covered or the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper, an alternative view of financial sustainability is presented which identifies the failure of planning and management of health care to reflect needs for care in populations and to integrate planning and management functions for health care expenditure, health care services and the health care workforce. We present a Health Care Sustainability Framework based on disaggregating the health care expenditure into separate planning components. Unlike other approaches to planning health care expenditure, this framework explicitly incorporates population health needs as a determinant of health care requirements, and provides a diagnostic tool for understanding the sources of expenditure increase.
The iMpact on practice, oUtcomes and costs of New roles for health pROfeSsionals: a study protocol for MUNROS
Publisher: BMJ
Date: 04-2016
Promoting healthy behaviour: The importance of economic analysis in policy formulation for AIDS prevention
Publisher: Elsevier BV
Date: 12-1990
DOI: 10.1016/0168-8510(90)90420-I
Abstract: Considerable attention has been paid in the literature to modification of high-risk behaviours as a means to control the spread of the Human Immunodeficiency Virus. The success of such policies will depend crucially on the underlying causal mechanisms of these high-risk behaviours. To date the application of economics to the problem of AIDS has tended to focus on estimating the economic burden of the condition and the resource consequences of clinical strategies for care. Yet as a behavioural science economics should provide a useful input into the policy process aimed at behaviour modification. In this paper we extend the application of economic analysis to the determinants of in idual behaviour to identify (i) the implications of current policies for the incidence of high-risk behaviour and (ii) the wider determinants of behaviour warranting greater attention in the policy-making process.
NICE Methodological Guidelines and Decision Making in the National Health Service in England and Wales
Publisher: Springer Science and Business Media LLC
Date: 2003
DOI: 10.2165/00019053-200321030-00001
Abstract: The National Institute for Clinical Excellence (NICE) responds to requests by the Department of Health for guidance on the use of selected new and established technologies in the National Health Service (NHS) in England and Wales. This paper asks whether the NICE methodological guidelines help NHS decision makers meet the objectives of maximum health improvements from NHS resources and an equitable availability of technologies. The analytical basis of the guidelines is a comparison of the costs and consequences of new and existing methods of dealing with particular conditions using the incremental cost-effectiveness ratio. We explain why information on the costs and consequences of a particular technology in isolation is insufficient to address issues of efficiency of resource use. We argue that to increase efficiency, decision makers need information on opportunity costs. We show that in the absence of such information decision makers cannot identify the efficient use of resources. Finally we argue that economics provides valid methods for identifying the maximisation of health improvements for a given allocation of resources and we describe an alternative practical approach to this problem. Drawing on the experience of Ontario, Canada where an approach similar to that proposed by NICE has been in use for almost a decade, and recent reports about the consequences of NICE decisions to date, we conclude that instead of increasing the efficiency or equity of the use of NHS resources, NICE methodological guidelines may lead to: uncontrolled increases in NHS expenditures without evidence of any increase in total health improvements increased inequities in the availability of services and concerns about the sustainability of public funding for new technologies.
A geometric confidence ellipse approach to the estimation of the ratio of two variables
Publisher: Wiley
Date: 10-12-2008
DOI: 10.1002/SIM.3398
Abstract: One is often interested in the ratio of two variables, for ex le in genetics, assessing drug effectiveness, and in health economics. In this paper, we derive an explicit geometric solution to the general problem of identifying the two tangents from an arbitrary external point to an ellipse. This solution permits numerical integration of a bivariate normal distribution over a wedge-shaped region bounded by the tangents, which yields an evaluation of the tangent slopes as confidence limits on the ratio of the component variables. After suitable adjustment of the confidence coverage of the ellipse, these confidence limits are shown to be equivalent to those from Fieller's method. However, the geometric approach allows additional interpretation of the data through identification of the points of tangency, the ellipse itself, and expressions for the coverage probability of the confidence interval. Numerical evaluations using the theoretical expressions for the geometric confidence intervals (but ignoring s le variation in the underlying parameters) suggested that they perform well overall and are slightly conservative. Simulations that do take account of s le variation in the underlying parameters again suggested that the intervals perform well overall, although here they are slightly anti-conservative. Coverage probabilities for the confidence intervals were only weakly dependent on the distance and correlation of the ellipse, but there were asymmetries in the failure rates of the upper and lower confidence limits in some configurations. The probability of no real solution existing was also evaluated. These ideas are illustrated by a practical ex le.
On the margins of health economics: a response to ‘resolving NICE’S nasty dilemma’
Publisher: Cambridge University Press (CUP)
Date: 09-01-2015
DOI: 10.1017/S1744133114000462
Abstract: In a 2011 article published in this journal, Baker et al. set out to resolve a nasty dilemma for NICE by reconciling two approaches for determining whether adopting a new intervention would increase total health gains produced from available resources and hence increase system efficiency. In this response we show how the proposed reconciliation, as well as the two approaches on which it is based, fail to inform decision makers about the efficiency of a new intervention. We show how this arises from the misuse of incremental costs and effects of between-intervention comparisons as measures of changes in costs and effects associated with marginal adjustments to the scale of an intervention. Ironically, incremental data represent the choices faced by decision makers and we illustrate a method for determining unambiguously whether a new intervention represents an improvement in efficiency.
Achievements and Challenges of Medicare in Canada: Are We There Yet? Are We on Course?
Publisher: SAGE Publications
Date: 07-2005
DOI: 10.2190/RWA1-C3PB-0KY4-HBUT
Abstract: Health care policy in Canada is based on providing public funding for medically necessary physician and hospital-based services free at the point of delivery (“first-dollar public funding”). Studies consistently show that the introduction of public funding to support the provision of health care services free at the point of delivery is associated with increases in the proportionate share of services used by the poor and in population distributions of services that are independent of income. Claims about the success of Canada's health care policy tend to be based on these findings, without reference to medical necessity. This article adopts a needs-based perspective to reviewing the distribution of health care services. Despite the removal of user prices, significant barriers remain to services being distributed in accordance with need—the objective of needs-based access to services remains elusive. The increased fiscal pressures imposed on health care in the 1990s, together with the failure of health care policy to encompass the changing nature of health care delivery, seem to represent further departures from policy objectives. In addition, there is evidence of increasing public dissatisfaction with the performance of the system. A return to modest increases in public funding in the new millennium has not been sufficient to arrest these trends. Widespread support for first-dollar public funding needs to be accompanied by greater attention to the scope of the legislation and the adoption of a needs-based focus among health care policymakers.
Economic evaluation of diagnostic methods used in dentistry. A systematic review
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.JDENT.2014.07.018
Abstract: To review the literature of economic evaluations regarding diagnostic methods used in dentistry. Four databases (MEDLINE, Web of Science, The Cochrane library, the NHS Economic Evaluation Database) were searched for studies, complemented by hand search, until February 2013. Two authors independently screened all titles or abstracts and then applied inclusion and exclusion criteria to select full-text publications published in English, which reported an economic evaluation comparing at least two alternative methods. Studies of diagnostic methods were assessed by four reviewers using a protocol based on the QUADAS tool regarding diagnostic methods and a check-list for economic evaluations. The results of the data extraction were summarized in a structured table and as a narrative description. From 476 identified full-text publications, 160 were considered to be economic evaluations. Only 12 studies (7%) were on diagnostic methods, whilst 78 studies (49%) were on prevention and 70 (40%) on treatment. Among studies on diagnostic methods, there was between-study heterogeneity methodologically, regarding the diagnostic method analysed and type of economic evaluation addressed. Generally, the choice of economic evaluation method was not justified and the perspective of the study not stated. Costing of diagnostic methods varied. A small body of literature addresses economic evaluation of diagnostic methods in dentistry. Thus, there is a need for studies from various perspectives with well defined research questions and measures of the cost and effectiveness. Economic resources in healthcare are finite. For diagnostic methods, an understanding of efficacy provides only part of the information needed for evidence-based practice. This study highlighted a paucity of economic evaluations of diagnostic methods used in dentistry, indicating that much of what we practise lacks sufficient evidence.
Economics, health and health economics: HYEs versus QALYs
Publisher: Elsevier BV
Date: 10-1993
DOI: 10.1016/0167-6296(93)90015-7
Abstract: This paper responds to Culyer and Wagstaff's (CW) and Buckingham's (B) arguments. We refute their claim about the equivalence of HYEs and QALYs they fail to distinguish between choice under uncertainty and under certainty. CW assume that all in iduals have a specific form of utility function, which yields their conclusion of equivalence. B's arguments confuse the measurement technique and the utility theory from which it stems his argument about the normative superiority of the QALY construct is inconsistent with economic thinking. The HYE, by being compatible with the principles of economics, is superior to the QALY for economic evaluations of health care interventions.
Concepts of Rigour and Implications for Health Services Research
Publisher: SAGE Publications
Date: 04-1998
Casting the screening net: separating big fish from little fish
Publisher: Elsevier BV
Date: 11-1997
DOI: 10.1016/S0168-8510(97)00067-5
Abstract: Screening tests are a rapidly growing part of medical practice. If we are going to make the best use of resources, screening tests need to be considered in terms of effectiveness, efficiency and equity. We present a framework as a way to think about screening programmes. The framework expands on existing literature that recognizes two categories of screening: universal and opportunistic. By adding the dimension of 'selectivity', we identify four categories of screening: active non-selective (universal or mass screening), active selective, opportunistic non-selective and opportunistic selective. We illustrate the framework by categorizing screening recommendations for high serum cholesterol levels. We conclude there is no one ideal strategy for screening that simultaneously satisfies criteria of effectiveness, efficiency and equity. However, our framework allows a systematic consideration and balancing of these objectives in the development and assessment of screening programs. In this way, it may assist decision-makers by making this trade-off more explicit.
Comparison of spatial and contrast resolution for cone-beam computed tomography scanners
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.OOOO.2012.01.020
Abstract: The purpose was to evaluate the perceived spatial and contrast resolution for a wide range of cone-beam computed tomography (CBCT) devices. A customized polymethyl methacrylate (PMMA) phantom was developed. Inserts containing a line-pair and rod pattern were used. The phantom was scanned with 13 CBCT devices and 1 multislice CT (MSCT) device using a variety of scanning protocols. The images were presented to 4 observers for scoring. The observer scores showed excellent agreement. A wide range was seen in image quality between CBCT exposure protocols. Compared with the average CBCT scores, the MSCT protocols scored lower for the line-pair insert but higher for the rod insert. CBCT devices are generally suitable for the visualization of high-contrast structures. Certain exposure protocols can be used for depicting low-contrast structures or fine details. The user should be able to select appropriate exposure protocols according to varying diagnostic requirements.
Task shifting between physicians and nurses in acute care hospitals: cross-sectional study in nine countries
Publisher: Springer Science and Business Media LLC
Date: 25-05-2018
A Randomized Controlled Trial of Caries Prevention in Dental Practice
Publisher: SAGE Publications
Date: 04-04-2017
Abstract: We conducted a parallel group randomized controlled trial of children initially aged 2 to 3 y who were caries free, to prevent the children becoming caries active over the subsequent 36 mo. The setting was 22 dental practices in Northern Ireland, and children were randomly assigned by a clinical trials unit (CTU) (using computer-generated random numbers, with allocation concealed from the dental practice until each child was recruited) to the intervention (22,600-ppm fluoride varnish, toothbrush, 50-mL tube of 1,450 ppm fluoride toothpaste, and standardized, evidence-based prevention advice) or advice-only control at 6-monthly intervals. The primary outcome measure was conversion from caries-free to caries-active states. Secondary outcome measures were number of decayed, missing, or filled teeth (dmfs) in caries-active children, number of episodes of pain, and number of extracted teeth. Adverse reactions were recorded. Calibrated external examiners, blinded to the child's study group, assessed the status of the children at baseline and after 3 y. In total, 1,248 children (624 randomized to each group) were recruited, and 1,096 (549 intervention, 547 control) were included in the final analyses. Eighty-seven percent of intervention and 86% of control children attended every 6-mo visit ( P = 0.77). A total of 187 (34%) in the intervention group converted to caries active compared to 213 (39%) in the control group (odds ratio, 0.81 95% confidence interval, 0.64-1.04 P = 0.11). Mean dmfs of those with caries in the intervention group was 7.2 compared to 9.6 in the control group ( P = 0.007). There was no significant difference in the number of episodes of pain between groups ( P = 0.81) or in the number of teeth extracted in caries-active children ( P = 0.95). Ten children in the intervention group had adverse reactions of a minor nature. This well-conducted trial failed to demonstrate that the intervention kept children caries free, but there was evidence that once children get caries, it slowed down its progression (EudraCT No: 2009-010725-39 ISRCTN: ISRCTN36180119).
Patient Preferences and the Measurement of Utilities in the Evaluation of Dental Technologies
Publisher: SAGE Publications
Date: 07-2002
DOI: 10.1177/154405910208100702
Abstract: Advances in life sciences that are predicted in the 21st century will present many challenges for health professionals and policy-makers. The major questions will be how to allocate resources to pay for costs of new technologies and who will best benefit from advances in new diagnostic and treatment methods. We review in this paper the concept of utility and how it can be applied and expanded to provide data to help health professionals make decisions that are preferred by patients and the public at large. Utility is a measure of people's well-being or preferences for outcomes. The measurement of utilities of a new diagnostic technology, for ex le, can be carried out with the use of simple methods that do not incorporate all of the uncertainties and potential outcomes associated with providing the test, or with more complex methods that can incorporate most uncertainties. This review describes and critiques the different measurement methods of utilities.
The biggest bang for the buck or bigger bucks for the bang: the fallacy of the cost-effectiveness threshold
Publisher: SAGE Publications
Date: 2006
DOI: 10.1258/135581906775094235
Abstract: It has been suggested that scepticism among decision-makers about using cost-effectiveness analysis (CEA) is caused in part by the low level of the cost-effectiveness 'thresholds' in the economic evaluation literature. This has led Ubel and colleagues to call for higher threshold values of US& dollar ,000 or more per quality-adjusted life-year. We show that these arguments fail to identify the objective of CEA and hence do not consider whether or how the threshold relates to this objective. We show that incremental cost-effectiveness ratios (ICERs) cannot be used to identify an efficient use of resources & ndash the 'biggest bang for the bucks' & ndash allocated to health care. On the contrary, the practical consequence of using the ICER approach is shown to be an increase in health care expenditures, or 'bigger bucks for making a bang', without any evidence of the bang being bigger (i.e. that this leads to an increase in benefits to the population). We present an alternative approach that provides an unambiguous method of determining whether a new intervention leads to an increase in health gains from whatever resources are to be made available to health care decision-makers.
People engagement in health-care system transition in China
Publisher: Elsevier BV
Date: 09-2019
Clinician Perspectives of Communication with Aboriginal and Torres Strait Islanders Managing Pain
Publisher: MDPI AG
Date: 29-01-2022
Abstract: Poor communication is an important factor contributing to health disparity. This study sought to investigate clinicians’ perspectives about communicating with Aboriginal and Torres Strait Islander patients with pain. This multi-site and mixed-methods study involved clinicians from three pain management services in Queensland, Australia. Clinicians completed a survey and participated in focus groups. Clinicians rated the importance of communication training, their knowledge, ability, and confidence in communicating with Aboriginal and Torres Strait Islander patients using a 5-point Likert scale. Rating scores were combined into low (scores 1–2) moderate (score 3) and high (scores 4–5). Informed by an interpretive description methodology, thematic analysis of focus group data was used to identify the communication needs and training preferences of clinicians. Overall (N = 64), 88% of clinicians rated the importance of communication training when supporting Aboriginal and Torres Strait Islander patients as “high”. In contrast, far fewer clinicians rated as “high” their knowledge (28%), ability (25%) and confidence (28%) in effectively communicating with Aboriginal and Torres Strait Islander patients. Thematic analysis identified three areas of need: knowledge of Aboriginal and Torres Strait Islander cultures, health beliefs, and understanding cross-cultural cues. Communication skills can be learned and training, in the form of a tailored intervention to support quality engagement with Aboriginal and Torres Strait Islander patients, should combine cultural and communication aspects with biomedical knowledge.
Willingness to pay for dentin regeneration in a sample of dentate adults
Publisher: Wiley
Date: 19-05-2004
Applications of cost-benefit analysis to health care
Publisher: Elsevier BV
Date: 09-1987
DOI: 10.1016/0167-6296(87)90009-9
Abstract: In applying the principles of cost-benefit analysis to real world problems of resource allocation particular care must be taken to ensure that the welfare economic theory which underlies the cost-benefit technique is adhered to. Major problems arise where costs and benefits are used interchangeably to represent the good and bad attributes of a programme. Furthermore, in the presence of mutually exclusive projects, focussing attention upon the net benefits (or cost-benefit ratios) of in idual projects as opposed to the net benefits of the use of budgeted resources can lead to biased estimates of the shadow price of projects and, consequently, errors in analysts' conclusions. As a result, economic appraisals of in idual projects are not directly relevant for choosing between mutually exclusive projects of different sizes. Both types of problem are illustrated by reference to both simple ex les and published economic appraisals of health care techniques. Integer programming is proposed and demonstrated as a method of selecting between mutually exclusive projects.
Prevention in practice – a summary.
Publisher: Springer Science and Business Media LLC
Date: 15-09-2015
Exploring strategies used by physiotherapy private practices in hosting student clinical placements
Publisher: Bond University
Date: 15-09-2020
DOI: 10.53300/001C.17206
Abstract: Introduction: Private practice clinical education experiences are important for workforce readiness of physiotherapy graduates, however there are limited opportunities to experience this setting during training. Furthermore, private practice is considered a valuable source of placements for education providers where shortages occur. Exploring the strategies used by physiotherapy private practice providers when hosting students may provide insight into how students can be integrated into practice whilst minimising disruption to staff, clients and service delivery. Methods: A qualitative study with a general inductive thematic analytical approach was undertaken. Semi-structured interviews of ten physiotherapy private practice placement providers responsible for student placement provision were used to explore the strategies used to successfully integrate students into private practice settings. Results: Four key themes emerged following data analysis developing systems, student service provision, finding other ways to educate, and seeking support from the education provider. Conclusion: This study is the first to explore the perspective of private practice placement providers regarding how students are successfully integrated into private practice settings where learning and service delivery can be maximised. Areas for further research are outlined.
Models of evaluation under ceteris imparibus: System dynamics and the example of emergency care
Publisher: Wiley
Date: 29-08-2019
DOI: 10.1002/SRES.2615
Paying for prevention in clinical practice: Aligning provider remuneration with system objectives
Publisher: Springer Science and Business Media LLC
Date: 15-09-2015
A needs-based methodology for allocating health care resources in Ontario, Canada: Development and an application
Publisher: Elsevier BV
Date: 1991
DOI: 10.1016/0277-9536(91)90331-6
Abstract: In an attempt to limit its health care expenditures, Ontario is, as one option, exploring the possibilities of a capitated system for service delivery payments as opposed to the present mixture of global budgets and fee-for-service. After reviewing the literatures on capitation (primarily American) and on resource allocation (primarily British), the paper sets out to establish a capitation rate, based on 'need' and not prior use, for a range of health services in the northern Ontarian community of Fort Frances-Rainy River. The difficulties and limitations of the needs-based approach are explored. The results reported show the setting of the local population characteristics against provincial average health care utilization data to generate expected use rates, which are then adjusted for need and other factors, particularly relative costs and sparsity. Finally these adjusted rates are applied to current provincial expenditures to derive a target share. This target is then expressed in relation to the planning population to derive the capitation rate.
NHS patient charges and the privatisation of dental care
Publisher: Springer Science and Business Media LLC
Date: 12-1985
Economic evaluation of HIV screening in pregnant women attending antenatal clinics in India
Publisher: Elsevier BV
Date: 07-2006
DOI: 10.1016/J.HEALTHPOL.2005.07.014
Abstract: With prevalence of HIV rising in pregnant women in India, pediatric HIV/AIDS is emerging as a public health problem. We evaluated the additional costs to the health care system and the additional health outcomes of introducing a voluntary primary care HIV screening program for pregnant women in India. The analysis was conducted from the government perspective. We analyzed two scenarios: a programme of universal screening nation-wide and a programme of screening restricted to high prevalence states. Health benefits were measured by the number of perinatal HIV cases prevented and the reduction in the potential years of life lost (PYLL). Nation-wide screening would cost the government Rs. 254.78 million and would prevent 9880 cases of perinatal HIV resulting in savings of 131,700 life years (average cost per HIV case prevented Rs. 25,787 per year reduction in PYLLs Rs. 1935). Implementing the program in only the high prevalence states would achieve 45% of these reductions in cases and life years lost at only 20% of this cost, at an average of Rs. 12,091 per HIV case prevented or Rs. 907 per year reduction in PYLLs (44 Indian rupees = 1 US dollar). In sensitivity analysis, the cost of the program was influenced mainly by antenatal coverage, the cost of the HIV test, the lifetime costs of treatment of a HIV infected child and the overhead costs. We provide an estimate of the additional costs and health effects of two approaches to introducing HIV screening among pregnant women in India. Decision-makers would have to demonstrate that the resources used for its implementation would result in more health benefits than from the alternative uses of those resources.
Unemployment and health: contextual-level influences on the production of health in populations
Publisher: Elsevier BV
Date: 12-2002
DOI: 10.1016/S0277-9536(01)00344-6
Abstract: While there is a large and growing literature investigating the relationship between an in idual's employment status and health, considerably less is known about the effect on this relationship of the context in which unemployment occurs. The aim of this paper is test for the presence and nature of contextual effects in the ways unemployment and health are related, based on a simple underlying model of stress, social support and health using a large population health survey. An in idual's health can be influenced directly by own exposure to unemployment and by exposure to unemployment in the in idual's context, and indirectly by the effects these exposures have on the relationship between other health determinants and health. Based on this conceptualization an empirical model, using multi-level analysis, is formulated that identifies a five-stage process for exploring these complex pathways through which unemployment affects health. Results showed that the association of in idual unemployment with perceived health is statistically significant. Nevertheless, this study did not provide evidence to support the hypothesis that the association of unemployment with health status depends upon whether the experience of unemployment is shared with people living in the same environment. Above all, this study demonstrates both the subtlety and complexity of in idual- and contextual-level influences on the health of in iduals. Our results caution against simplistic interpretations of the unemployment-health relationship and reinforce the importance of using multi-level statistical methods for investigation of it.
Heterogeneity in the determinants of health and illness: the example of socioeconomic status and smoking
Publisher: Elsevier BV
Date: 07-2000
Student-resourced service delivery of occupational therapy rehabilitation groups: patient, clinician and student perspectives about the ingredients for success
Publisher: Informa UK Limited
Date: 17-05-2021
DOI: 10.1080/09638288.2021.1922517
Abstract: A number of innovative models of student practice placements are emerging due to pressures on universities to provide quality practice placements and on health services to deliver rehabilitation efficiently, safely and cost-effectively. The student-resourced service delivery (SRSD) group program is one such model in occupational therapy. There is a paucity of research evidence to guide services in planning, implementing and evaluating the SRSD model. The study aimed to explore and identify the factors that key stakeholders perceived as contributing to the successful development and implementation of the occupational therapy student-resourced service delivery group programs. Participants in this multi-site study were rehabilitation inpatients, clinicians, Clinical Education Liaison Managers and students completing practice placement in the student-resourced service delivery group program. Data were collected using face-to-face semi-structured interviews and focus groups. A total of 83 participants consented to the study. Four themes emerged from the data. Planning needs to be an iterative process that commences before and continues during the program. Support processes need to be established for students and clinicians during and across placements. The creation of an engaging, client-relevant and graded group dynamic is critical for success. Establishing a culture whereby groups are valued by the clients, therapy and multidisciplinary teams is important. The above-mentioned factors were perceived as contributing to successful operationalisation of a student-resourced service delivery group program, and may be helpful when developing student-resourced service delivery professional practice placements in other settings.IMPLICATIONS FOR REHABILITATIONStudent-resourced service delivery of groups are one way to achieve additional professional practice placements for students and delivery of therapy services for patients.Ongoing investment for planning and preparation, provision of continual support for students, a culture of valuing groups and students, and creating a group dynamic that engages group participants were perceived by stakeholders as key ingredients for successful implementation of the student-resourced service delivery group model.Clinicians and educators are encouraged to use the perceived success factors identified in this study as a resource for future student-resourced service delivery program development.
Environmental influences on healthcare expenditures: an exploratory analysis from Ontario, Canada
Publisher: BMJ
Date: 05-2003
Abstract: This paper explores the relation between healthcare expenditures (HCEs) and environmental variables in Ontario, Canada. The authors used a sequential two stage regression model to control for variables that may influence HCEs and for the possibility of endogenous relations. The analysis relies on cross sectional ecological data from the 49 counties of Ontario. The results show that, after control for other variables that may influence health expenditures, both total toxic pollution output and per capita municipal environmental expenditures have significant associations with health expenditures. Counties with higher pollution output tend to have higher per capita HCEs, while those that spend more on defending environmental quality have lower expenditures on health care. The implications of our findings are twofold. Firstly, sound investments in public health and environmental protection have external benefits in the form of reduced HCEs. Combined with the other benefits such as recreational values, investments in environmental protection probably yield net social benefits. Secondly, health policy that excludes consideration of environmental quality may eventually result in increased expenditures. These results suggest a need to broaden the cost containment debate to ensure environmental determinants of health receive attention as potential complements to conventional cost control policies.
From population numbers to population needs: Incorporating epidemiological change into health service planning in Australia
Publisher: Elsevier BV
Date: 07-2023
A framework for costing diagnostic methods in oral health care: An application comparing a new imaging technology with the conventional approach for maxillary canines with eruption disturbances
Publisher: Wiley
Date: 14-03-2012
DOI: 10.1111/J.1600-0528.2012.00674.X
Abstract: The aims were (i) to propose a framework for costing diagnostic methods in oral health care and (ii) to illustrate the application of the framework to the radiographic examination of maxillary canines with eruption disturbances. The framework for costing, following Drummond et al. (2005), includes three elements: (i) identification of different resources used in producing and delivering the service, (ii) measurement of the amount of each resource required and (iii) valuation of the resources in monetary terms. Four data collection instruments were designed - a protocol for apportioning the cost of capital equipment to each diagnostic procedure, separate forms for recording consumable items, for the time of different health care providers used for a diagnostic examination and a patient survey for calculation of the total cost to the patient associated with the examination. The framework was applied to the radiographic examination of maxillary canines with eruption disturbances comparing two imaging methods: (i) a new method with cone beam computed tomography and panoramic radiography and (ii) a conventional method using intraoral and panoramic radiography. The primary analysis was performed from the perspective of the health care system. A separate analysis included patient costs with health care system costs to provide a societal perspective. Comparison of the two perspectives allows consideration of whether any costs savings to the health care system are generated at the expense of greater costs for patients and their families. Data for the cost-analysis were retrieved from 47 patients (mean age 14 years) referred to a department of radiology for examination of maxillary canines. Application of the framework for costing allowed us to compare the resources used to perform examinations of the two methods. The mean total cost per examination for the new method was 128.38€ and 81.80€ for the conventional method, resulting in an incremental cost per examination of the new method of 46.58€. The application of the framework demonstrates the feasibility of measuring and comparing the total costs as well as the distribution of total costs between providers and patients for different approaches to this common examination.
Blunt Policy Instruments Deliver Blunt Policy Outcomes
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2016
Heterogeneities in the production of health: smoking, health status and place
Publisher: Elsevier BV
Date: 06-2005
DOI: 10.1016/J.HEALTHPOL.2004.09.003
Abstract: The harmful effects of smoking on health are well-established. However, little attention has been given to possible variations in the size of the association within populations. In this paper, we test for neighbourhood variation in the smoking-health relationship. We estimate equations to explain variations in self-reported health using data from a survey of adults in four distinct neighbourhood clusters in Hamilton, Ontario. After controlling for neighbourhood composition, the probability of being unhealthy remained significantly higher in the two lower socioeconomic status neighbourhoods (North East and Downtown) than in the rest of the city. The smoking-health association was not the result of more smokers living in less healthy neighbourhoods. In the Downtown neighbourhood, the relative odds of being unhealthy among smokers compared to non-smokers was less than one-half of the corresponding relative odds in the rest of the city. Although smoking represents a health risk for in iduals in all neighbourhoods, for in iduals living in the Downtown neighbourhood the size of this risk is substantially smaller than for in iduals in other neighbourhoods.
The effect of different methods of remuneration on the behaviour of primary care dentists
Publisher: Wiley
Date: 06-11-2013
Item of Service Remuneration in General Practice in the UK: What Can We Learn From Dentists?
Publisher: Oxford University Press (OUP)
Date: 1988
Abstract: In response to the UK Government's proposal to increase the proportion of general practitioner income accruing from capitation payments the General Medical Services Committee of the British Medical Association has called for an extension of fee for item of service provision in general practice. In this paper the allocation of resources in primary care dentistry, where fee for service provision is currently used, is analysed in order to shed light on the debate. Since dentists' fees are set in accordance with average dentist time inputs, differences in cost per treatment course reflect differences in course content. Multiple regression techniques are used to estimate a cost per treatment course function. Using cross-sectional data for family practitioner committees in England and Wales for 1982 a significant negative correlation is found between cost per course and population per dentist after allowing for patient demand and need characteristics. A 10% decrease in population per dentist is associated with a 2.5% increase in cost per course. The observation cannot be explained by dentists rationing treatment in the presence of excess demand owning to the nature of the dentist contract. These results imply that in areas of greater supplies of dentists additional course content is being induced by dentists in order to maintain workloads. Hence although fee for service provision offers a financial incentive to increase service provision it offers no incentive to allocate services efficiently, that is in accordance with greatest need. The extension of fee for service provision in general medical practice would appear to be inconsistent with an objective of allocating scarce primary care resources in accordance with patient need.
The Impact of New Clinical Guidelines on the North American Blood Economy
Publisher: Elsevier BV
Date: 10-1994
DOI: 10.1016/S0887-7963(94)70115-2
Abstract: Anemia is a condition in which the hemoglobin concentration falls below 11 g/dL. It impairs health and well-being in women and increases the risk of maternal and neonatal adverse outcomes. The availability of local information on the magnitude and associated factors has a major role in the management and control of anemia in women contributing to reduction in maternal morbidity and mortality. The purpose of this study was to see regional impacts and influencing factors related to the anemia among women in Ethiopia using the 2016 Ethiopia Demographic and Health Survey data. The anemia level among women aged 15-49 years ( In the study, 37.4% of women in Ethiopia had no anemia, above one-third percent (34.4%) of women had moderate anemia, and approximately 4% women's anemia level was severe. The 27.1% of variation of anemia was due to between-region variations. The odds of being normal weight in the greater category of anemia level were 0.59 times less likely as compared to underweight women. The higher levels of anemia were increased by 2.31 for pregnant women as compared to non-pregnant women. Having work being in greater anemia levels was 0.88 times less likely as compared to had no work. Older women (35-49 years) in higher anemia levels were 2.1 times more likely as compared to younger women. The women living in the rural area being in the greater category anemia levels were 1.53 times more likely as compared to women living in the urban area. The higher level of anemia in the rich quintile was 0.72 times less likely to the higher level of anemia as compared in the poor quintile women. Pregnant women in Ethiopia are more exposed for the higher anemia level and women live in rural area have the greater anemia level.
An Integrated Needs-Based Approach to Health Service and Health Workforce Planning: Applications for Pandemic Influenza
Publisher: Longwoods Publishing
Date: 31-08-2017
DOI: 10.12927/HCPOL.2017.25193
Abstract: Healthcare systems must be responsive to the healthcare needs of the populations they serve. However, typically neither health services nor health workforce planning account for populations' needs for care, resulting in substantial and unnecessary unmet needs. These are further exacerbated during unexpected surges in need, such as pandemics or natural disasters. To illustrate the potential of improved methods to help planning for these types of events, we applied an integrated, needs-based approach to health service and workforce planning in the context of a potential influenza pandemic at the provincial level in Canada. This application provides evidence on the province's capacity to respond to surges in need for healthcare and identifies specific services which may be in short supply in such scenarios. This type of approach can be implemented by planners to address a variety of health issues in different contexts.
Disposable and reusable instruments in dental health practice: A comparison of cost factors in a public provider organization in Queensland, Australia
Publisher: Wiley
Date: 05-06-2023
DOI: 10.1111/CDOE.12764
Abstract: Choosing between reusable instruments (RIs) and disposable instruments (DIs) for dental care provision requires a careful consideration of costs and their contributing factors, alongside other choice criteria. This study aimed to assess the current use of instruments in the West Moreton Oral Health Service (WMOHS) in Queensland, Australia, with a broader goal of informing future practice in this and comparable organizations. A cost model was developed reflecting costs arising from procurement, reprocessing and disposal, depending on the RI and DI composition of instrumentation. The current practice in WMOHS was compared to modular (RI‐only and DI‐only) strategies by considering four standard instrument sets (examination, simple extraction, surgical extraction, restoration) and the annual use of instruments in the organization at large. The use of resources (water, electricity) and emissions (waste) were quantified for each strategy. The robustness of findings was explored across a range of scenarios that involved varying instrument prices, lifespans, factors impacting on the cost of reprocessing (labour, water, energy), the cost of waste disposal and couriering. At the organization level, the current mix of instruments (A$1.28 m per year) was 4% more costly than the lower cost, RI‐only alternative (A$1.23 m). However, with lower DI prices or higher labour costs current practice would become the lowest cost option. Results for specific instrument sets varied by service type. DI‐only offered the lowest cost option for oral examinations (A$6.29), and the current practice of mixed instrumentation for simple extractions (A$16.56). RI‐only sets were less costly in more resource intensive procedures such as surgical extractions (A$40.19) and restorations (A$43.83). In terms of environmental impacts, the use of instruments based on current practice required 37% of water and energy use of an RI‐only alternative and generated 36% waste of the DI‐only alternative. Reusable instruments are generally less costly than DIs, but for specific instrument sets the outcome depends on the type of procedure. In some circumstances, mixed instrumentation can provide the lowest cost alternative. While the WMOHS instrument mix used in current practice does not minimize cost for the provider, it may be justified in light of operational risks, logistics and uncertainty regarding cost factors.
Health profiles of Hamilton: Spatial characterisation of neighbourhoods for health investigations
Publisher: Springer Science and Business Media LLC
Date: 2001
Variation in costs of cone beam CT examinations among healthcare systems
Publisher: British Institute of Radiology
Date: 10-2012
Quality of life and coping strategies among lung transplant candidates and their family caregivers
Publisher: Elsevier BV
Date: 05-2005
DOI: 10.1016/J.SOCSCIMED.2004.10.001
Abstract: Although numerous studies have examined coping strategies and quality of life (QOL) among patients with chronic diseases and their family caregivers, no studies have examined the reciprocal effects of patient and caregiver coping strategies on their dyad partner's QOL. Because most people who cope with stressful health experiences do so within the context of interpersonal relationships, it is important to understand the ways in which the two partners' coping strategies may reciprocally affect each other's QOL. Adult lung transplant candidates and their caregivers (N=114 pairs) participated in semi-structured interviews that included measures of QOL and coping with patients' health-related problems. Multivariate, canonical correlation analyses were performed to examine unique patterns of associations between coping and QOL in patient-caregiver dyads. Better patient QOL, across multiple domains, was associated with better caregiver QOL. Multiple elements of patients' coping, including greater use of active coping and emotionally oriented coping were related to generally poorer patient QOL in psychosocial and physical domains. Similarly, caregivers who used more emotionally oriented coping had poorer QOL. There was no statistically reliable relationship between either (a) patient and caregiver use of coping strategies, or (b) caregiver coping and patient QOL. However, patients' coping strategies were important correlates of caregivers' QOL. These findings belie common clinical beliefs that family members' coping responses to patients' health are likely to affect patient well-being. Instead, patients' coping and QOL may be critical for understanding caregiver well-being, especially in the current era in which caregivers are assuming increased responsibility for providing patient care.
Sustainability of Publicly Funded Health Care Systems
Publisher: Springer Science and Business Media LLC
Date: 08-09-2020
Equity considerations in utility-based measures of health outcomes in economic appraisals: An adjustment algorithm
Publisher: Elsevier BV
Date: 10-1991
DOI: 10.1016/0167-6296(91)90033-J
Abstract: In this paper we consider whether methods currently used to measure utility of health outcomes are consistent with the equity criteria adopted by researchers. We show that unless the chosen equity criterion is incorporated in the design of the measurement instrument, the derived health state utilities are inconsistent with the equity criterion (except under special circumstances). Adjustment algorithms are derived, based on the axioms of von Neumann-Morgenstern utility theory, which take account of difference equity criteria currently adopted in the literature. The proposed approach is based on simple lottery questions of the type already used widely in empirical studies.
Prevention versus cure: Measuring parental preferences for sealants and fillings as treatments for childhood caries in Southern Thailand
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1016/J.HEALTHPOL.2007.09.016
Abstract: To determine the parental relative preferences for prevention versus cure in the treatment of caries in children to inform service planning for publicly funded children's dental care services. We measure parents' Willingness to pay (WTP) for two basic dental treatments: prevention (sealant) and cure (filling) and consider whether the relative preferences between the two services are affected by differences in parents' incomes. Two hundred and five parents of primary school children in Southern Thailand were asked questions about their WTP for the different services as well as background information. Comparative information on caries process, treatment procedure and effectiveness was presented to subjects. Each subject's WTP was determined for sealants and fillings provided in hospital dental clinic using a bidding game approach. Mean WTP for sealants and fillings were not significantly different. After adjustment for parents' characteristics, the WTP for sealants and fillings remained similar. Adjusted WTP for both services among higher income group were greater than those in lower income group. Valuing of prevention versus cure was similar after controlling for parents' characteristics. Parent's income was a factor affected to WTP. Parental preferences might be a constraint to extending service utilization for the prevention of caries among primary school children.
Is Reasonable Access What We Want? Implications of, and Challenges to, Current Canadian Policy on Equity in Health Care
Publisher: SAGE Publications
Date: 10-1993
DOI: 10.2190/K18V-T33F-1VC4-14RM
Abstract: Considerations of equity in the context of health care systems are often related closely to the presence or level of prices incurred by users of health care services. Some politicians and commentators have suggested that the removal of user charges under the Canadian health care system has led to equal access to care. But it is not clear that the equity principle inferred from these claims corresponds to the equity goals of current Canadian health policy. In this article the authors identify the precise equity principle that lies behind current health policy in Canada and consider the extent to which that principle is reflected in the performance of the system. They then consider other approaches to equity in health care in the context of the stated objectives of Canadian health policy and identify the implications of pursuing reasonable access in future health policy. The authors suggest that the implications of the current equity goals have not been recognized by policy makers, and if they were to be recognized it is not clear that they would be acceptable to Canadian populations and/or policy makers. Moreover, some of the implications would appear to be incompatible with other stated objectives of public policy.
REFLECTIONS ON THE NICE DECISION TO REJECT PATIENT PRODUCTION LOSSES
Publisher: Cambridge University Press (CUP)
Date: 2017
DOI: 10.1017/S0266462317000952
Abstract: Objectives: Patient production losses occur when in iduals’ capacities to work, whether paid or unpaid, are impaired by illness, treatment, disability, or death. There is controversy about whether and how to include patient production losses in economic evaluations in health care. Patient production losses have not previously been considered when evaluating medications for reimbursement under the U.K. National Health Service. Proposals for value-based assessment of health technologies in the United Kingdom created renewed interest in whether and how to include costs from a wider societal perspective, such as patient production losses, within economic evaluation of healthcare interventions. Methods: A narrative review was undertaken of theoretical, ethical, and policy issues that might inform decisions that involve the normative question of whether or not to include patient production losses in economic evaluation. Results: It seems difficult to reconcile the implications of including patient production losses with the objectives of a healthcare system dedicated to providing universal healthcare coverage without regard to patients’ ability to pay. Conclusions: Tax payer funded healthcare systems may legitimately adopt maximands other than health gain, but these will be at the opportunity cost of less than maximum health gains.
The scale of hospital production in different settings: one size does not fit all
Publisher: Springer Science and Business Media LLC
Date: 17-01-2013
Weighing up the benefits and challenges of hosting physiotherapy student placements in private practice; a qualitative exploration
Publisher: Informa UK Limited
Date: 27-07-2020
Information Created to Evade Reality (ICER)
Publisher: Springer Science and Business Media LLC
Date: 2006
DOI: 10.2165/00019053-200624110-00008
Abstract: Cost-effectiveness analysis has been advocated in the health economics methods literature and adopted in a growing number of jurisdictions as an evidence base for decision makers charged with maximising health gains from available resources. This paper critically appraises the information generated by cost-effectiveness analysis, in particular the incremental cost-effectiveness ratio (ICER). It is shown that this ratio is used as comparative information on what are non-comparable options and hence evades the reality of the decision-maker's problem. The theoretical basis for the ICER approach is the simplification of theoretical assumptions that have no relevance to the decision maker's context. Although alternative, well established methods can be used for addressing the decision maker's problem, faced with the increasing evidence of the theoretical and empirical failures of the cost-effectiveness approach, some proponents of the approach now propose changing the research question to suit the approach as opposed to adopting a more appropriate method for the prevailing and continuing problem. As long as decision makers are concerned with making the best use of available healthcare resources, cost-effectiveness analysis and the ICER should not be where we look for answers.
Book: Life Without Disease: The Pursuit of Medical Utopia
Publisher: BMJ
Date: 13-03-1999
Will the Need‐Based Planning of Health Human Resources Currently Undertaken in Several Countries Lead to Excess Supply and Inefficiency? A Comment on Basu and Pak
Publisher: Wiley
Date: 13-06-2016
DOI: 10.1002/HEC.3370
Abstract: Basu and Pak (2014) argue that need-based workforce planning models would not maximize social welfare, and use of need-based models would result in inefficiency. They propose that planning be based on service utilization to incorporate preferences or other socioeconomic factors. We show that the analysis is based on inappropriate considerations of the nature of healthcare demand, a misrepresentation of need-based approaches and misunderstanding publicly funded healthcare system objectives. We explain how current levels of utilization emerge from workload and income interests of providers that underlie utilization-based models and are incompatible with public goals of maximizing health gains. Copyright © 2016 John Wiley & Sons, Ltd.
Impact of changing provider remuneration on NHS general dental practitioner services in Northern Ireland: a mixed-methods study
Publisher: National Institute for Health and Care Research
Date: 2020
DOI: 10.3310/HSDR08060
Abstract: Policy-makers wanted to reform the NHS dental contract in Northern Ireland to contain costs, secure access and incentivise prevention and quality. A pilot project was undertaken to remunerate general dental practitioners using a capitation-based payment system rather than the existing fee-for-service system. To investigate the impact of this change in remuneration. Mixed-methods design using a difference-in-difference evaluation of clinical activity levels, a questionnaire of patient-rated outcomes and qualitative assessment of general dental practitioners’ and patients’ views. NHS dental practices in Northern Ireland. General dental practitioners and patients in 11 intervention practices and 18 control practices. Change from fee for service to a capitation-based system for 1 year and then reversion back to fee for service. Access to care, activity levels, service mix and financial impact, and patient-rated outcomes of care. The difference-in-difference analyses showed significant and rapid changes in the patterns of care provided by general dental practitioners to patients (compared with the control practices) when they moved from a fee-for-service system to a capitation-based remuneration system. The number of registered patients in the intervention practices compared with the control practices showed a small but statistically significant increase during the capitation period ( p 0.01), but this difference was small. There were statistically significant reductions in the volume of activity across all treatments in the intervention practices during the capitation period, compared with the control practices. This produced a concomitant reduction in patient charge revenue of £2403 per practice per month ( p 0.05). All outcome measures rapidly returned to baseline levels following reversion from the capitation-based system back to a fee-for-service system. The analysis of the questionnaires suggests that patients did not appear to notice very much change. Qualitative interviews showed variation in general dental practitioners’ behaviour in response to the intervention and how they managed the tension between professional ethics and maximising the profits of their business. Behaviours were also heavily influenced by local context. Practice principals preferred the capitation model as it freed up time and provided opportunities for private work, whereas capitation payments were seen by some principals as a ‘retainer fee’ for continuing to provide NHS care. Non-equity-owning associates perceived the capitation model as a financial risk. The active NHS pilot period was only 1 year, which may have limited the scope for meaningful change. The number of sites was restricted by the financial budget for the NHS pilot. General dental practitioners respond rapidly and consistently to changes in remuneration, but differences were found in the extent of this change by practice and provider type. A move from a fee-for-service system to a capitation-based system had little impact on access but produced large reductions in clinical activity and patient charge income. Patients noticed little difference in the service that they received. With changing population need and increasing financial pressure on the NHS, research is required on how to most efficiently meet the expectations of patients within an affordable cost envelope. Work is also needed to identify and evaluate interventions that can complement changes in remuneration to meet policy goals. Current Controlled Trials ISRCTN29840057. This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research Vol. 8, No. 6. See the NIHR Journals Library website for further project information.
TAMOXIFEN PROPHYLAXIS
Publisher: Elsevier BV
Date: 02-1986
Equity in maternal and child health care utilization in Guangdong province of China 2009–2019: A retrospective analysis
Publisher: Frontiers Media SA
Date: 13-09-2022
DOI: 10.3389/FPUBH.2022.963344
Abstract: Equity is the principal challenge of maternal and child health care (MCH) across the world, especially in China. Existing researches focused on equity in MCH resources and outcomes. There is an evidence gap regarding equity of MCH services utilization, revealing the black box between equity in MCH resources and MCH outcomes. In the study, we evaluate the changes of equity in integrated MCH service utilization in Guangdong province of China during 2009–2019. Data used in this study are from the Guangdong Maternal and Child Health Routine Reporting System and the Guangdong Health Statistical Yearbook (2009–2019). The Gini coefficient (G) and Theil index (T) were employed to assess equity and source of inequity in four geographic regions of Guangdong province. Generally, among the integrated MCH care, coverage of pre-pregnancy care (& %) is lower than in other stages. In the past decade, inequity of MCH care in the Equalization of Essential Public Health Service (EEPHS) program has gradually reduced to G & 0.1. Screening of genetic metabolic disease and of hearing showed largest reductions of inequity ( G reducing from 0.3–0.4 to 0.03–0.04). Inequity in reproductive health tests for brides-to-be, psychological assessment and consultation, education classes for mother-to-be and health management of children under 3 were mainly contributed by intra-region disparities in 2019. Equity has gradually improved in the last decade in Guangdong. The national EEPHS program and the Integrated Prevention of Mother-to-Child Transmission of HIV, Syphilis and HBV of Guangdong have played important roles in reducing inequity in MCH service utilization. Further strategies, targeting pre-pregnancy reproductive healthcare, psychological assessments and consultations for the pregnant and education classes for mothers-to-be, should be taken to promote coverage and equity.
Unequal access to ART: exploratory results from rural and urban case studies of ART use
Publisher: BMJ
Date: 16-02-2012
DOI: 10.1136/SEXTRANS-2011-050136
Abstract: South Africa has the world's largest antiretroviral treatment (ART) programme. While services in the public sector are free at the point of use, little is known about overall access barriers. This paper explores these barriers from the perspective of ART users enrolled in services in two rural and two urban settings. Using a comprehensive framework of access, interviews were conducted with over 1200 ART users to assess barriers along three dimensions: availability, affordability and acceptability. Summary statistics were computed and comparisons of access barriers between sites were explored using multivariate linear and logistic regressions. While availability access barriers in rural settings were found to be mitigated through a more decentralised model of service provision in one site, affordability barriers were considerably higher in rural versus urban settings. 50% of respondents incurred catastrophic healthcare expenditure and 36% borrowed money to cover these expenses in one rural site. On acceptability, rural users were less likely to report feeling respected by health workers. Stigma was reported to be lowest in the two sites with the most decentralised services and the highest coverage of those in need. While results suggest inequitable access to ART for rural relative to urban users, nurse-led services offered through primary healthcare facilities mitigated these barriers in one rural site. This is an important finding given current policy emphasis on decentralised and nurse-led ART in South Africa. This study is one of the first to present comprehensive evidence on access barriers to assist in the design of policy solutions.
New Evidence on End-of-Life Hospital Utilization for Enhanced Health Policy and Services Planning
Publisher: Mary Ann Liebert Inc
Date: 07-2017
Abstract: Long-standing concern exists over hospital use by people near or at the end of life (EOL) related to the appropriateness, quality, and cost of care in hospital. It is widely believed that most people die in hospital after an escalation in hospital use over the last year of life. As most deaths in high-income countries are not sudden or unexpected, opportunities exist for planning compassionate, effective, and evidence-based EOL care. Gain current population-based evidence for EOL health policy and services planning. Retrospective study of population-based hospital utilization data. All hospital patients in every Canadian province and territory except Quebec. All decedents with hospital separations in 2014-2015. Descriptive-comparative and logical regression analysis tests. In 2014-2015, 3.5% of hospital episodes ended in death and 43.7% of all deaths in Canada (excluding Quebec) took place in hospital. 95.2% of those dying in hospital were only admitted once or twice during their last 365 days of life. 3.6% of those dying in hospital had been living in the community and receiving publicly funded home care before the hospital admission that ended in death, while 67.0% had been living at home without home care. 79.0% of hospital deaths followed an unplanned admission through the emergency room, with 70.5% arriving by ambulance. The hospital care provided in the last stay was largely noninterventionist. These findings reveal the need for a major reconceptualization of death, dying, and EOL care to ensure sufficient capacity of palliative home care and other services to support dying people and prevent the health and family caregiver crises that lead to hospital-based EOL care and death.
A cost-benefit analysis using a willingness-to-pay questionnaire of intranasal budesonide for seasonal allergic rhinitis
Publisher: Elsevier BV
Date: 2000
DOI: 10.1016/S1081-1206(10)62741-X
Abstract: The cost-benefit of intranasal steroids for the treatment of seasonal allergic rhinitis is unknown. To determine the cost-benefit of intranasal budesonide for seasonal allergic rhinitis. Subjects who were symptomatic for a baseline period of 7 to 10 days were randomized to receive intranasal budesonide by Turbuhaler (400 microg) (n = 121) or aqueous spray (256 microg) (n = 121) once daily for 4 weeks. A willingness-to-pay questionnaire that measured benefits of treatment was administered before and at study completion. Costs were collected and compared with benefits. Subjects were willing to spend on average $15.89/wk (range $1 to $75) to alleviate the problems of seasonal ragweed rhinitis. Eighty percent of subjects felt that, with treatment, rhinitis had less of an impact on their lives, compared with previous years. The mean willingness-to-pay for the drug used during another ragweed season was $12.95/wk. This was 92% (95% CI, 85% to 100%) of the pre-treatment estimate. There was no relationship between an indirect assessment of income and willingness-to-pay estimates. The benefit was greater than the cost by a mean of $5.80/wk (95% CI, $3.52 to 8.08), P < .0001. There was no difference in costs, willingness-to-pay, or cost-benefit comparing delivery modes. A sensitivity analysis revealed the conclusions were robust. Intranasal budesonide is cost-beneficial in the treatment of seasonal allergic rhinitis and a willingness-to-pay questionnaire may provide a useful method to assess a therapy's benefit.
FAIR SHARES FOR THE ZONE: ALLOCATING HEALTH-CARE RESOURCES FOR THE NATIVE POPULATIONS OF THE SIOUX LOOKOUT ZONE, NORTHERN ONTARIO
Publisher: Wiley
Date: 06-1994
Ethical economics and cost–effectiveness analysis: is it ethical to ignore opportunity costs?
Publisher: Informa UK Limited
Date: 12-2005
I dreamed a dream: England reduces health inequalities and wins the world cup
Publisher: Wiley
Date: 12-07-2010
DOI: 10.1002/HEC.1637
Global priorities for climate change and mental health research
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.ENVINT.2021.106984
Abstract: Compared with other health areas, the mental health impacts of climate change have received less research attention. The literature on climate change and mental health is growing rapidly but is characterised by several limitations and research gaps. In a field where the need for designing evidence-based adaptation strategies is urgent, and research gaps are vast, implementing a broad, all-encompassing research agenda will require some strategic focus. We followed a structured approach to prioritise future climate change and mental health research. We consulted with experts working across mental health and climate change, both within and outside of research and working in high, middle, and low-income countries, to garner consensus about the future research priorities for mental health and climate change. Experts were identified based on whether they had published work on climate change and mental health, worked in governmental and non-governmental organisations on climate change and mental health, and from the professional networks of the authors who have been active in the mental health and climate change space. Twenty-two experts participated from across low- and middle-income countries (n = 4) and high-income countries (n = 18). Our process identified ten key priorities for progressing research on mental health and climate change. While climate change is considered the biggest threat to global mental health in the coming century, tackling this threat could be the most significant opportunity to shape our mental health for centuries to come because of health co-benefits of transitioning to more sustainable ways of living. Research on the impacts of climate change on mental health and mental health-related systems will assist decision-makers to develop robust evidence-based mitigation and adaptation policies and plans with the potential for broad benefits to society and the environment.
Exploring the limitations of age-based models for health care planning
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.SOCSCIMED.2015.03.005
Abstract: Health care decision makers are required to make planning decisions over a medium to long term planning horizon. Whilst population ageing is an important consideration for planners, age-stratified demographic models may produce misleading estimates of future resource requirements if the actual relationship between age and health is not fixed. We present a methodology which tests whether the assumption of a fixed age-health relationship is valid and estimate the magnitude of planning errors using a long time-series of measures of chronic health and service utilisation (N = 2419) taken from the Great British General Household Survey (1980-2008). We find that age-only models contain significant omitted variable bias, and that the relationship between age and health varies significantly across birth cohorts. Chronic sickness has fallen across birth cohorts born between 1890 and 2008, particularly before birth year 1930. Generational health improvements have mitigated the effects of population ageing, meaning that the population rate of sickness fell between 1980 and 2008. Planning based only on age leads to overestimation of the population level of health care need if successive cohorts are becoming healthier. Many alternative approaches exist which allow planners to relax the assumption of a fixed relationship between age and health.
A scoping review of research to assess the frequency, types, and reasons for end-of-life care setting transitions
Publisher: SAGE Publications
Date: 13-08-2018
Abstract: Aims: Most people approaching the end of life develop care needs, which typically change over time. Moves between care settings may be required as health deteriorates. However, in some cases, care setting transitions may have little to do with end-of-life care needs and instead reflect the needs, demands, availability, or funding provisions of the country or funding body and organizations providing care. This paper is a scoping review of the international peer-reviewed research literature to gain evidence on the frequency and types of end-of-life care setting transitions, and the reasons for these moves. Methods: All relevant print and open access research articles published in 2000+ were sought using the Directory of Open Access Journals and EBSCO Discovery Host. Results: A total of 39 research articles were identified and reviewed. However, minimal useful evidence was revealed. Most articles focused solely on hospital admissions near death, and some focused on nursing home admissions, with other moves infrequently studied. Conclusions: This review demonstrates the need to quantify and justify end-of-life care setting transitions as it appears dying people are frequently moved, often as death nears. This research is needed to distinguish transitions related to end-of-life care needs and those arising from pressures on or from care providers and others unrelated to the person’s care needs.
Addressing the realties of health care in northern aboriginal communities through participatory action research
Publisher: Informa UK Limited
Date: 03-1970
DOI: 10.1080/13561820400011784
Abstract: To address concerns about disruptions in the continuity of health care delivered to residents in three remote aboriginal communities in northern Ontario, Canada, the local health authority initiated a study in collaboration with the department of Health Canada responsible for ensuring that aboriginal reserves receive mandatory health services, and an inter-disciplinary team of researchers from two universities. The study focussed on the delivery of oncology, diabetes and mental health care, specifically, as well as systems issues such as recruitment and retention of health human resources and financial costs. The paper discusses the procedures involved, the benefits derived and the challenges encountered in doing this as a community driven participatory action research project. It also summarizes the findings that led to community formulated policy and program recommendations.
The impact of changing provider remuneration on clinical activity and quality of care: Evaluation of a pilot NHS contract in Northern Ireland
Publisher: Wiley
Date: 14-06-2020
DOI: 10.1111/CDOE.12544
Low prioritization of latent tuberculosis infection—A systemic barrier to tuberculosis control: A qualitative study in O ntario, C anada
Publisher: Wiley
Date: 07-11-2018
DOI: 10.1002/HPM.2670
Abstract: Eliminating tuberculosis (TB) in low-incidence countries is an important global health priority, and Canada has committed to achieve this goal. The elimination of TB in low-incidence countries requires effective management and treatment of latent tuberculosis infection (LTBI). This study aimed to understand and describe the system-level barriers to LTBI treatment for immigrant populations in the Greater Toronto and Hamilton Area, Ontario, Canada. A qualitative study that used purposive s ling to recruit and interview health system advisors and planners (n = 10), providers (n = 13), and clients of LTBI health services (n = 9). Data were recorded, transcribed verbatim, and analyzed using content analysis. Low prioritization of LTBI was an overarching theme that impacted four dimensions of LTBI care: management, service delivery, health literacy, and health care access. These factors explained, in part, inequities in the system that were linked to variations in health care quality and health care access. While some planners and providers at the local level were attempting to prioritize LTBI care, there was no clear pathway for information sharing. This multiperspective study identified barriers beyond the typical socioeconomic determinants and highlighted important upstream factors that hinder treatment initiation and adherence. Addressing these factors is critical if Canada is to meet the WHO's global call to eradicate TB in all low incidence settings.
Coordination of care in the Chinese health care systems: a gap analysis of service delivery from a provider perspective
Publisher: Springer Science and Business Media LLC
Date: 12-10-2016
Conservative versus aggressive follow up of mildly abnormal Pap smears: Testing for process utility
Publisher: Wiley
Date: 08-01-2003
DOI: 10.1002/HEC.783
Abstract: Economic evaluation generally limits outcome measurement to the valuation of health outcomes produced by interventions without considering the impact of processes on utility. We test for process utility by comparing utility measurements for alternative approaches to managing abnormal Pap smears in the context of a fixed outcome. The impact of health care interventions on in idual well-being was not confined to health outcomes. Aggressive and conservative follow-up approaches were associated with statistically significant differences in utilities. We also found that relative preferences among different processes may depend on the particular circumstances or pathologies being considered.
Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa
Publisher: Springer Science and Business Media LLC
Date: 09-06-2015
Efficacy of Dose-Titrated Glucagon Infusions in the Management of Congenital Hyperinsulinism: A Case Series
Publisher: Frontiers Media SA
Date: 03-09-2020
Economics and the evaluation of health care programmes: generalisability of methods and implications for generalisability of results
Publisher: Elsevier BV
Date: 05-2003
DOI: 10.1016/S0168-8510(02)00182-3
Abstract: Increasing attention is being given to identifying standardised methods of analysis for the economic evaluation of health care programmes and generating generalisable findings from these methods. In this paper, we show how these approaches fail to reflect the social science foundations of the economics discipline and the economic theory of in idual behaviour. Using simple ex les, we show that the technical efficiency of a particular programme differs between communities, even though the underlying technology is the same for the communities. Similarly, the subjective considerations represented by the utility function are not generally transferable between settings or between in iduals within settings. As a result, the efficiency of an intervention will be influenced by the context in which the intervention is experienced, even in the presence of identical production and utility functions. The lack of generalisability includes the validity of the methods used to analyse the subjective component of the evaluation exercise. The adoption of standardised methods of measurement and analysis, together with the use of findings from the application of these methods in other settings, might ease the administrative burden presented in resource allocation exercises. However, these approaches do not accommodate the intellectual substance of the wide range of problems and circumstances that underlie these exercises.
Beyond demographic change in human resources planning: an extended framework and application to nursing
Publisher: SAGE Publications
Date: 10-2003
DOI: 10.1258/135581903322403290
Abstract: Objectives: To introduce health care production functions into human resources planning and to apply the approach to analysing the need for registered nurses in Ontario during a period of major reduction in inpatient capacity. Methods: Measurement of changes in services delivered by acute care hospitals in Ontario between 1994/95 and 1998/99, and comparison with changes in the mix of human resources, non-human resources and patient needs. Results: Inpatient episodes per nurse fell by almost 2%. At the same time the number of beds was cut by over 20%. As a result, the number of patients per bed increased by 12%. Allowing for severity, there was a 20% reduction in beds per episode and a 3.7% reduction in nurses per episode. Conclusions: The demands on nurses in acute care hospitals have increased as an increasing number of severity-adjusted episodes are served using fewer beds by a reduced number of nurses. Human resources planning traditionally only considers the effects of demographic change on the need for and supply of health care. Failure to recognize the variable and endogenous nature of other health care inputs leads to false impressions about the adequacy of existing supplies of human resources. Consideration of human resources in the context of the production function for health services provides a meaningful way of improving the effectiveness and efficiency of human resources planning.
Home and Community Occupational Therapy for Children and Youth: A before and after Study
Publisher: SAGE Publications
Date: 12-2005
DOI: 10.1177/000841740507200505
Abstract: Background. There has been an increased focus on home care service provision in recent years, yet there are few data available about the provision of home and community occupational therapy for children and youth. Purpose. To evaluate key elements of a service provision model for home care occupational therapy in terms of occupational performance outcomes, perception of care and cost. Methods. Eleven centres in Ontario and Quebec recruited 167 children and youth up to 18 years of age to a before and after study of occupational therapy services in the home and community. Occupational performance, quality of life and costs were measured at baseline and study end. Perception of care was measured at study completion. Results. A statistically and clinically significant improvement in occupational performance was demonstrated (p .001). The clients' families gave high ratings to the process of care provided by the occupational therapists. These data did not demonstrate a clear relationship between amount of service, cost and occupational performance outcome. Practice Implications. Children receiving home and community occupational therapy services change in their occupational performance abilities. These changes are not directly related to the amount or focus of the occupational therapy services.
Moving from place to place in the last year of life: A qualitative study identifying care setting transition issues and solutions in
O
ntario
Publisher: Hindawi Limited
Date: 06-11-2017
DOI: 10.1111/HSC.12513
Abstract: Moving from one care setting to another is common as death nears. Many concerns exist over these end-of-life (EOL) care setting transitions, including low-quality moves as mistakes and other mishaps can occur. Delayed or denied moves are also problematic, such as a move out of hospital for dying inpatients who want to spend their last hours or days at home. The aim of the study was to identify current issues or problems with care setting transitions during the last year of life as well as potential or actual solutions for these problems. A grounded theory analysis approach was used based on interviews with 38 key informants who represent a wide range of healthcare providers, healthcare managers, government representatives, lawyers, healthcare recipients and their family/friends across Ontario in 2016. Three interrelated themes were revealed: (a) communication complexities, (b) care planning and coordination gaps and (c) health system reform needs. Six solutions were highlighted, with these designed to prevent care setting transition issues and monitor care setting transitions for continued improvements.
Is Regular Visiting Associated with Lower Costs? Analyzing Service Utilization Patterns in the First Nations Population in Canada
Publisher: Wiley
Date: 06-2006
DOI: 10.1111/J.1752-7325.2006.TB02566.X
Abstract: Using an administrative database of dental service records from the Non-Insured Health Benefits (NIHB) program of Health Canada for 1994-2001, the authors set out to test whether regular visitors had lower program expenditures. The age-specific mean expenditures per client were compared among those with regular examinations in 8, 7 and fewer years. The study further examined the effect of regular visiting over the first 6 years on expenditures in the last 2 years. "Continuity of care" was measured by the numbers of consecutive years prior to 2000 in which clients had a regular examination. In a "gap analysis" in iduals were classified according to the number of years prior to 2000 since they last had an initial or recall examination. Mean expenditures per client were analyzed by age group and type of service. Over the 8-year period, clients with regular visits had the highest expenditures. In both the continuity of care and gap analyses, the findings were generally consistent the more that clients visited over the first 6 years, the higher the expenditures in the final 2 years. Clients with more "regular" (initial and recall) examinations received a relatively standard, age-specific, pattern of service but incurred greater expenditures compared to clients with fewer regular, or longer gaps in, examinations. The observations of the authors in this client group do not support the thesis that regular visiting is associated with lower expenditures on dental care.
Related Organisations
University Of Manchester
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
Discovery Projects - Grant ID: DP220101512
Start Date: 04-2022
End Date: 03-2025
Amount: $313,921.00
Funder: Australian Research Council
View Funded ActivityDiscovery Projects - Grant ID: DP200103049
Start Date: 02-2020
End Date: 12-2023
Amount: $249,993.00
Funder: Australian Research Council
View Funded ActivityIndustrial Transformation Research Hubs - Grant ID: IH220100017
Start Date: 09-2023
End Date: 09-2028
Amount: $4,808,669.00
Funder: Australian Research Council
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