Introducing activity-based financing: : a review of experience in Australia, Denmark, Norway and Sweden

We review and evaluate the international literature on activity-based funding of health services, focussing especially on experience in Australia (Victoria), Denmark, Norway and Sweden. In evaluating this literature we summarise the differences and pros and cons of three different funding arrangements, namely cost-based reimbursement, global budgeting and activity-based financing. The institutional structures of the four jurisdictions that are the main focus of the review are described, and an outline is provided about how activity-based funding has been introduced in each. We then turn to the mechanics of activity-based funding and discuss in detail how patients are classified, how prices are set and how other services are funded. Although concentrating on the four jurisdictions, we draw on wider international experience to inform this discussion. We review evidence of the impact of activity-based funding in the four jurisdictions on efficiency, activity rates, waiting times, quality and overall expenditure. Finally we conclude with a brief commentary of some of the challenges that would have to be faced if implementing activity-based funding

Introduction: Relationships Between Protected Areas and Sustainable Forest Management: Where are We Heading?

The relationship between protected areas and forest management has been one that has often been fraught with conflict. New practices in the forest sector and new ecological insights have led more recently to better co-operation in some regions, although it is debatable to what extent cooperative approaches are desirable. In this introduction to the special section on the relationships between protected areas and sustainable forest management, we outline the history of the forestry and protected areas sectors in Canada, and the evolution of the relationships between them. We define key terms for the debate and offer a novel framework for understanding the relationship between the two sectors as management regimes that occur along parallel continua of sustainability. This framework is contrasted against real-world findings from across Canada, and with examples from elsewhere in the world

Pharmacokinetic Drug Interactions Involving Vortioxetine (Lu AA21004), a Multimodal Antidepressant

BACKGROUND AND OBJECTIVE: The identification and quantification of potential drug–drug interactions is important for avoiding or minimizing the interaction-induced adverse events associated with specific drug combinations. Clinical studies in healthy subjects were performed to evaluate potential pharmacokinetic interactions between vortioxetine (Lu AA21004) and co-administered agents, including fluconazole (cytochrome P450 [CYP] 2C9, CYP2C19 and CYP3A inhibitor), ketoconazole (CYP3A and P-glycoprotein inhibitor), rifampicin (CYP inducer), bupropion (CYP2D6 inhibitor and CYP2B6 substrate), ethinyl estradiol/levonorgestrel (CYP3A substrates) and omeprazole (CYP2C19 substrate and inhibitor). METHODS: The ratio of central values of the test treatment to the reference treatment for relevant parameters (e.g., area under the plasma concentration–time curve [AUC] and maximum plasma concentration [C(max)]) was used to assess pharmacokinetic interactions. RESULTS: Co-administration of vortioxetine had no effect on the AUC or C(max) of ethinyl estradiol/levonorgestrel or 5′-hydroxyomeprazole, or the AUC of bupropion; the 90 % confidence intervals for these ratios of central values were within 80–125 %. Steady-state AUC and C(max) of vortioxetine increased when co-administered with bupropion (128 and 114 %, respectively), fluconazole (46 and 15 %, respectively) and ketoconazole (30 and 26 %, respectively), and decreased by 72 and 51 %, respectively, when vortioxetine was co-administered with rifampicin. Concomitant therapy was generally well tolerated; most adverse events were mild or moderate in intensity. CONCLUSION: Dosage adjustment may be required when vortioxetine is co-administered with bupropion or rifampicin. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40261-013-0117-6) contains supplementary material, which is available to authorized users

Comparison of Rx-defined morbidity groups and diagnosis- based risk adjusters for predicting healthcare costs in Taiwan

<p>Abstract</p> <p>Background</p> <p>Medication claims are commonly used to calculate the risk adjustment for measuring healthcare cost. The Rx-defined Morbidity Groups (Rx-MG) which combine the use of medication to indicate morbidity have been incorporated into the Adjusted Clinical Groups (ACG) Case Mix System, developed by the Johns Hopkins University. This study aims to verify that the Rx-MG can be used for adjusting risk and for explaining the variations in the healthcare cost in Taiwan.</p> <p>Methods</p> <p>The Longitudinal Health Insurance Database 2005 (LHID2005) was used in this study. The year 2006 was chosen as the baseline to predict healthcare cost (medication and total cost) in 2007. The final sample size amounted to 793 239 (81%) enrolees, and excluded any cases with discontinued enrolment. Two different kinds of models were built to predict cost: the concurrent model and the prospective model. The predictors used in the predictive models included age, gender, Aggregated Diagnosis Groups (ADG, diagnosis- defined morbidity groups), and Rx-defined Morbidity Groups. Multivariate OLS regression was used in the cost prediction modelling.</p> <p>Results</p> <p>The concurrent model adjusted for Rx-defined Morbidity Groups for total cost, and controlled for age and gender had a better predictive R-square = 0.618, compared to the model adjusted for ADGs (R²= 0.411). The model combined with Rx-MGs and ADGs performed the best for concurrently predicting total cost (R²= 0.650). For prospectively predicting total cost, the model combined Rx-MGs and ADGs (R²= 0.382) performed better than the models adjusted by Rx-MGs (R²= 0.360) or ADGs (R²= 0.252) only. Similarly, the concurrent model adjusted for Rx-MGs predicting pharmacy cost had a better performance (R-square = 0.615), than the model adjusted for ADGs (R²= 0.431). The model combined with Rx-MGs and ADGs performed the best in concurrently as well as prospectively predicting pharmacy cost (R²= 0.638 and 0.505, respectively). The prospective models showed a remarkable improvement when adjusted by prior cost.</p> <p>Conclusions</p> <p>The medication-based Rx-Defined Morbidity Groups was useful in predicting pharmacy cost as well as total cost in Taiwan. Combining the information on medication and diagnosis as adjusters could arguably be the best method for explaining variations in healthcare cost.</p

Innovation, technology and user experience in museums: insights from scientific literature

Museums play an important role in preserving the heritage and cultural legacy of humanity, however, one of their main weaknesses in regards the user is their static nature. At present, and in the face of the development of diverse technologies and the ease of access to information, museums have upgraded their implementation of technologies aimed at improving the user experience, trying more and more to access younger audiences with a sensitivity and natural capacity for the management of new technologies. This work identifies trends in the use of technological tools by museums worldwide and the effect of these on the user or visitor experience through a review of scientific literature. To complete the work, we performed a search of the publications in the Scopus® referencing database, and downloaded, processed, and visualized the data using the VOSviewer® tool. The main trends identified in this context of analysis are related to the role of museums with the development and improvement of the user experience; orientation to young audiences and innovation driven by the user through Interactive Systems, digital games, QR Codes, apps, augmented reality, virtual reality and gamification, among others. The objective of the implementation of new technologies in the context of museums is to satisfy the needs of contemporary communication, for all types of content and aimed at an increasingly digital audience, in order to ensure positive interaction and feedback from ideas with social and cultural changes

Protected Areas and Sustainable Forest Management: What Are We Talking About?

Recent research investigating the relationship between protected areas and sustainable forest management has revealed the need for clarity of language if cooperation is to move forward. Here, we develop a parallel framework to compare the concepts of protected areas and sustainable forest management. We address the challenge inherent in the concept of protected areas as places and sustainable forest management as a process or paradigm. Our framework outlines dominant values, management paradigms, and terms for the places managed under each paradigm

Towards Mobilizing Knowledge for Effective Decision-Making in Parks and Protected Areas

In November 2017, over 15,000 scientists issued a second letter to humanity that outlines how we are “jeopardizing our future” by failing to protect key ecological systems [...

Towards Mobilizing Knowledge for Effective Decision-Making in Parks and Protected Areas

In November 2017, over 15,000 scientists issued a second letter to humanity that outlines how we are “jeopardizing our future” by failing to protect key ecological systems [...