Integrated health and care systems in England : can they help prevent disease?

Objectives: Over the past 12 months, there has been increasing policy rhetoric regarding the role of the NHS in preventing disease and improving population health. In particular, the NHS Long Term Plan sees integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) as routes to improving disease prevention. Here, we place current NHS England integrated care plans in their historical context and review evidence on the relationship between integrated care and prevention. We ask how the NHS Long Term Plan may help prevent disease and explore the role of the 2019 ICS and STP plans in delivering this change. Methods: We reviewed the evidence underlying the relationship between integrated care and disease prevention, and analysed 2016 STP plans for content relating to disease prevention and population health. Results: The evidence of more integrated care leading to better disease prevention is weak. Although nearly all 2016 STP plans included a prevention or population health strategy, fewer than half specified how they will work with local government public health teams, and there was incomplete coverage across plans about how they would meet NHS England prevention priorities. Plans broadly focused on individual-level approaches to disease prevention, with few describing interventions addressing social determinants of health. Conclusions: For ICSs and STPs to meaningfully prevent disease and improve population health, they need to look beyond their 2016 plans and fill the gaps in the Long Term Plan on social determinants

Implementing Operations Support Systems in E-Health Based Systems

Information and communication technologies have been introduced in different dimensions of the health care. e-Health is the use of advanced communications technologies such as the Internet, portable, wireless and other sophisticated devices to support health care delivery and education. It has the potentials of improving the efficiency of health care delivery globally. With the increasing demand for information at the point of care, health care providers could explore the advances provided by mobile technologies and the increasing capabilities, compactness and pervasiveness of computing devices to adopt operations supports systems (OSS) in e-Health based systems in order to provide efficient services and enhance their performances. In this paper, we present, the development and implementation of operations supports in e- Health based systems. The system promises to deliver greater productivity for health care practitioner

Ethics and geographical equity in health care

Important variations in access to health care and health outcomes are associated with geography, giving rise to profound ethical concerns. This paper discusses the consequences of such concerns for the allocation of health care finance to geographical regions. Specifically, it examines the ethical drivers underlying capitation systems, which have become the principal method of allocating health care finance to regions in most countries. Although most capitation systems are based on empirical models of health care expenditure, there is much debate about which needs factors to include in (or exclude from) such models. This concern with legitimate and illegitimate drivers of health care expenditure reflects the ethical concerns underlying the geographical distribution of health care finance

Bismarck or Beveridge: a beauty contest between dinosaurs

<p>Abstract</p> <p>Background</p> <p>Health systems delivery systems can be divided into two broad categories: National Health Services (NHS) on the one hand and Social Security (based) Health care systems (SSH) on the other hand. Existing literature is inconclusive about which system performs best. In this paper we would like to improve the evidence-base for discussion about pros and cons of NHS-systems versus SSH-system for health outcomes, expenditure and population satisfaction.</p> <p>Methods</p> <p>In this study we used time series data for 17 European countries, that were characterized as either NHS or SSH country. We used the following performance indicators: For health outcome: overall mortality rate, infant mortality rate and life expectancy at birth. For health care costs: health care expenditure per capita in pppUS$ and health expenditure as percentage of GDP. Time series dated from 1970 until 2003 or 2004, depending on availability. Sources were OECD health data base 2006 and WHO health for all database 2006. For satisfaction we used the Eurobarometer studies from 1996, 1998 and 1999.</p> <p>Results</p> <p>SSH systems perform slightly better on overall mortality rates and life expectancy (after 1980). For infant mortality the rates converged between the two types of systems and since 1980 no differences ceased to exist.</p> <p>SSH systems are more expensive and NHS systems have a better cost containment. Inhabitants of countries with SSH-systems are on average substantially more satisfied than those in NHS countries.</p> <p>Conclusion</p> <p>We concluded that the question 'which type of system performs best' can be answered empirically as far as health outcomes, health care expenditures and patient satisfaction are concerned. Whether this selection of indicators covers all or even most relevant aspects of health system comparison remains to be seen. Perhaps further and more conclusive research into health system related differences in, for instance, equity should be completed before the leading question of this paper can be answered. We do think, however, that this study can form a base for a policy debate on the pros and cons of the existing health care systems in Europe.</p

International Profiles of Health Care Systems

Compares the healthcare systems of Australia, Canada, Denmark, England, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States, including spending, use of health information technology, and coverage

Cross-border purchases of health services : a case study on Austria and Hungary

This paper explores the structure of cross-border health purchasing between Austria and Hungary and determines the size of this phenomenon as well as the barriers to a further increase. Austrian patients may receive health care treatment in Hungary in three different ways. First, patients may receive benefits in the context of the European Community Regulations 1408/71 and 574/72 (Category I patients). Second, outside those regulatory structures, Austrian patients travel to Hungary to receive medical treatment, especially dental treatment, and then seek reimbursement from their Austrian insurance (Category II patients). Third, some patients receive medical treatment in Hungary outside both schemes (Category III patients). There are about 42,500 Category I patients per year; and 58,000 Category II patients world-wide per year. An unknown but supposedly greater number of patients travel to Hungary to receive mainly dental treatment and cosmetic surgery (Category III). Most health actors in both Austria and Hungary do not regard cross-border purchasing of health services as having cost-saving effects. They put forward major legal, institutional, political, and psychological barriers, which inhibit public and private Austrian providers, to facilitate trade in health care and which inhibit individual patients to realize cost savings through capitalizing on lower health care prices in Hungary. Therefore, for the time being, trade in health care and patient mobility between Austria and Hungary is a circumscribed phenomenon in terms of quantities, and it will most probably remain so in the near future.access to health care; adequate resources; aid; beds; cataract surgery; clinics; Community hospitals; Consumer Protection; cost effectiveness; costs of treatment; dental care; dental treatment; dentists; Diagnosis; discrimination; disease; doctor; doctors; domestic law; employment; entitlement; expenditures; families; financial resources; fundamental principles; general practitioner; Health Affairs; health care; health care centers; health care costs; health care coverage; health care facilities; health care institutions; health care insurance; health care law; health care provider; health care providers; health care sector; health care services; health care standards; health care system; health care systems; Health Care Systems in Transition; health expenditure; health facilities; health insurance; health insurance companies; health insurance funds; health insurance system; health insurers; Health Organization; health organizations; health policy; health providers; health sector; health service; Health Services; health system; health systems; Health Systems in Transition; Healthcare; hospital care; hospital financing; Hospital Operator; hospital sector; hospital treatment; hospitals; hygiene; income; insurance; insurance coverage; insurance systems; Integration; judicial proceedings; legal provisions; marketing; Medical Association; medical associations; medical benefits; medical care; medical facilities; medical science; medical services; medical treatment; medicine; Migration; National Health; National Health Insurance; National Health Insurance Fund; national health policy; nurses; patient; patient care; patient treatment; patients; physician; physicians; Policy ReseaRch; Primary Care; private health insurance; private health insurers; private hospitals; private households; private insurance; private insurer; private insurers; private sector; provision of health care; provision of services; public health; public health care; public health insurance; public hospitals; public sector; quality control; quality of health; quality of health care; rehabilitation; reimbursement rates; right to health care; social health insurance; social insurance; Social Policy; social security; social security schemes; social security systems; surgery; therapy; treatments; Use of Health Care Services; visits; workers

Promoting Age Equality in the Delivery of Health Care

Research across Europe suggests that most health care systems are ill-equipped to address the needs of the ageing populations they are meant to serve. Modern health care systems were founded on the principles of acute care and are dominated by a focus on growing specialization, efficiency, and expediency. Yet older patients presenting with chronic illness and comorbidities require continuity of care that bridges across traditional medical boundaries and care settings

Self-Assessed Health Status and Satisfaction with Health Care Services in the Context of the Enlarged European Union

The paper aims at analysing the relationship between self-rated health-status, satisfaction with health care services and socio-economic factors, in the context of different national health care systems in the enlarged European Union. The effects of socio-economic deprivation and the functioning of national health care systems on self-rated health status and satisfaction with health care services are investigated using the European Social Survey 2006 dataset (ESS3), and macro data provided by Eurostat (2007) and the World Health Organization (2007). Socio-economic deprivation is measured both at the micro-level (using indicators of economic strain, household income, education, employment status and belonging to discriminated groups), and the macro-level (national poverty rates, the values of poverty thresholds, quintile ratios and GDP per capita). The performance of national health care systems is quantified with the help of two indexes, designed for the purpose of the present study: an index of total health care provisions and an index of governmental commitment to health care. The following countries are included in the analysis: Belgium, Bulgaria, Denmark, Finland, France, Germany, Hungary, Poland, Portugal, Romania, Slovenia, Slovakia, Spain, Sweden, and the United Kingdom.self-assessed health ; health care systems ; health inequalities ; governmental policies

The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World

Critics of the U.S. health care system frequently point to other countries as models for reform. They point out that many countries spend far less on health care than the United States yet seem to enjoy better health outcomes. The United States should follow the lead of those countries, the critics say, and adopt a government- run, national health care system. However, a closer look shows that nearly all health care systems worldwide are wrestling with problems of rising costs and lack of access to care. There is no single international model for national health care, of course. Countries vary dramatically in the degree of central control, regulation, and cost sharing they impose, and in the role of private insurance. Still, overall trends from national health care systems around the world suggest the following: Health insurance does not mean universal access to health care. In practice, many countries promise universal coverage but ration care or have long waiting lists for treatment. Rising health care costs are not a uniquely American phenomenon. Although other countries spend considerably less than the United States on health care, both as a percentage of GDP and per capita, costs are rising almost everywhere, leading to budget deficits, tax increases, and benefit reductions. In countries weighted heavily toward government control, people are most likely to face waiting lists, rationing, restrictions on physician choice, and other obstacles to care. Countries with more effective national health care systems are successful to the degree that they incorporate market mechanisms such as competition, cost sharing, market prices, and consumer choice, and eschew centralized government control. Although no country with a national health care system is contemplating abandoning universal coverage, the broad and growing trend is to move away from centralized government control and to introduce more market-oriented features. The answer then to America's health care problems lies not in heading down the road to national health care but in learning from the experiences of other countries, which demonstrate the failure of centralized command and control and the benefits of increasing consumer incentives and choice

Options for finance in primary care in Australia

A number of policy initiatives aimed at reform of primary health care financing are currently either being debated nationally, or trialled in different jurisdictions. Commonwealth Government austerity and an interest from a wide range of stakeholders to mobilise capital from different parts of the economy have provided an incentive to explore new finance policy options for primary health care. However, recent reviews of primary health care finance have focused on contrasting the different payment systems, rather than the financing of primary health care in a more systemic sense. Finance is more than just an approach to payment, reflecting the flows of capital that structure service. Debates centred on payment systems (such as fee-for-service, salaries, capitation, pay for performance and activity–based funding) tend to eclipse the conceptual underpinnings of primary health care finance. This issues brief explores policy options that move beyond payment systems. It approaches primary health care from a deeper perspective with a focus on how to link objectives to outcomes through different financing approaches. For example, the separation of primary health care payment systems (mostly fee for service) from hospital payment systems (activity-based funding) creates numerous boundaries between parts of the sector. Although different payment systems separate health care into discrete segments, the lived reality for many people managing their health care is that they need to move across these fragmented elements of the system, with little overall sense of outcome. This issues brief will identify ways to consider primary health care finance policy options, by focusing on the objectives of different financing systems, how they connect to financial tools (such as impact investing), with a focus on health outcomes. It aims to broaden and deepen debate about primary health care finance. It is anticipated that the issues brief will also be a starting point for a structured debate through policy engagement events between policy makers, academics and practitioners about new models of finance for primary health