Why did some Danish counties introduce breast cancer screening and others not? An exploratory study of four selected counties

Objectives: Of the fourteen counties and two municipalities that until recently were responsible for healthcare provision in Denmark, five introduced mammography screening (MS) programs. The objective of this research is to explain this decision-making variation and to gain insight into priority setting processes in health-care provision at the county level in Denmark. - Methods: Literature on priority setting in health care was used to derive seven explanatory factors for comparing decision making on MS between four selected counties, of which two had implemented MS. The relative importance of each explanatory factor in each county was determined by analyzing policy documents, supplemented with interviews of selected stakeholders. The results were combined and compared at the county level. - Results: Evidence of effectiveness of MS was considered satisfactory and ethical issues related to MS were perceived relatively unproblematic only in those counties that introduced MS. Lack of resources, that is, radiologists, was an additional important factor for counties not implementing MS. Local opinion leaders have played a stimulating role, whereas advisory policy documents at the central government level and even legislation have had a minor impact. - Conclusions: The four counties have based their decision making on the introduction of MS on different combinations of a limited number of factors that have been differentially weighted. The pattern of relevant factors in both counties not introducing MS is rather similar. The study elucidates the role of complementary factors to evidence in decision making. Of interest, recent public sector reforms have resulted in the decision to have MS implemented nationwide

Designing a stated choice experiment: The value of a qualitative process

Designing a stated or discrete choice experiment (DCE) involves a process of developing, testing and optimizing the experiment questionnaire. This process is important for the success of the experiment and the validity of the results, but it is often not reported thoroughly. In the field of health care, one faces challenges in relation to what makes sense both for the respondent and what has clinical relevance, especially in situations with little evidence and unclear choices, where the decision making process is not clear or informed. This is the case for degenerative spine diseases, where the selection of candidates for surgical rather than non-surgical treatment has been widely discussed and where surgery rates accordingly vary across settings. In the present work, we demonstrated how the qualitative process significantly impacted and guided the design, and it was clear that a less thorough qualitative process would have resulted in a less useable and valid design. To elicit relevant attributes and levels for a DCE, fieldwork in clinical departments in Danish hospitals was performed and has been supplemented by qualitative interviews with patients and doctors. Systematic and thorough qualitative investigation of the decision context relevant attributes and levels and appropriate framing appears valuable in the process of designing a DCE for quantitative pilot testing

Spatial dynamics of public pharmaceutical expenditure

A regression model for per capita public pharmaceutical expenditure is analyzed. The necessity of simultaneously controlling for dynamic patterns and spatial spillover in such analyses is demonstrated. In contrast to previous studies of impact of small-area variation, the present study exploits important aspects related to spatial dynamics as the effects of spatial spillover are analyzed and interpreted within a framework of spatial dynamics and spatial error-correction. It is shown that such dynamics bear important implications related to spatial convergence of a pharmaceutical market. The paper is accessible to an audience experienced with linear regression; basic exposure to spatial statistics is helpful but not strictly necessary

Geographic and Temporal Heterogeneity in Public Prescription Pharmaceutical Expenditures in Spain

A panel of aggregate data for 50 provinces is used to analyze Spain’s per capita public pharmaceutical expenditures. In contrast to previous practice, our approach permits the analysis of the effects determinants on pharmaceutical expenditure to be heterogeneous across years and provinces. Considerable parametric heterogeneity over time as well as across provinces is found, even after controlling for residual temporal heterogeneity and interdependence as well as residual spatial spillovers. This underlines the need for using disaggregate spatial data when attempting to model macroeconomic behavio

A model for assessment of telemedicine applications: MAST

Objectives: Telemedicine applications could potentially solve many of the challenges faced by the healthcare sectors in Europe. However, a framework for assessment of these technologies is need by decision makers to assist them in choosing the most efficient and cost-effective technologies. Therefore in 2009 the European Commission initiated the development of a framework for assessing telemedicine applications, based on the users' need for information for decision making. This article presents the Model for ASsessment of Telemedicine applications (MAST) developed in this study. Methods: MAST was developed through workshops with users and stakeholders of telemedicine. Results: Based on the workshops and using the EUnetHTA Core HTA Model as a starting point a three-element model was developed, including: (i) preceding considerations, (ii) multidisciplinary assessment, and (iii) transferability assessment. In the multidisciplinary assessment, the outcomes of telemedicine applications comprise seven domains, based on the domains in the EUnetHTA model. Conclusions: MAST provides a structure for future assessment of telemedicine applications. MAST will be tested during 2010-13 in twenty studies of telemedicine applications in nine European countries in the EC project Renewing Health

Emergency and urgent care systems in Australia, Denmark, England, France, Germany and the Netherlands - Analyzing organization, payment and reforms.

INTRODUCTION: Increasing numbers of hospital emergency department (ED) visits pose a challenge to health systems in many countries. This paper aims to examine emergency and urgent care systems, in six countries and to identify reform trends in response to current challenges. METHODS: Based on a literature review, six countries - Australia, Denmark, England, France, Germany and the Netherlands - were selected for analysis. Information was collected using a standardized questionnaire that was completed by national experts. These experts reviewed relevant policy documents and provided information on (1) the organization and planning of emergency and urgent care, (2) payment systems for EDs and urgent primary care providers, and (3) reform initiatives. RESULTS: In the six countries four main reform approaches could be identified: (a) extending the availability of urgent primary care, (b) concentrating and centralizing the provision of urgent primary care, (c) improving coordination between urgent primary care and emergency care, and (d) concentrating emergency care provision at fewer institutions. The design of payment systems for urgent primary care and for emergency care is often aligned to support these reforms. CONCLUSION: Better guidance of patients and a reconfiguration of emergency and urgent care are the most important measures taken to address the current challenges. Nationwide planning of all emergency care providers, closely coordinated reforms and informing patients can support future reforms

Demographic Changes & Aggregate Healthcare Expenditure in Europe. ENEPRI Policy Briefs No. 4, 18 December 2007

This paper extracts the policy implications from ENEPRI Research Report No. 32, prepared under Work Package VI B of the AHEAD Project (Ageing, Health Status and Determinants of Health Expenditure) for the European Commission. The main purpose of this paper is to investigate the relationship between ageing and aggregate healthcare expenditure in EU countries on a macroeconomic level when including economic and institutional variables

Demographic Changes and Aggregate Health-Care Expenditure in Europe. ENEPRI Research Reports No. 32, 22 December 2006

The main purpose of this paper is to investigate the relationship between ageing and the development in the aggregate health care expenditure in EU countries on a macroeconomic level when economic and institutional variables are included. The results of the model will be used to extrapolate the total health care expenditure for the next 10 years