Modele de organizare şi finanţare a sistemelor de sănătate europene (sistemul britanic versus sistemul olandez)

The improving of health represents the main goal of all health systems, and this target can be reached through a adequate national policy; a good image of a health policy could be reflected in the organization and the financing model of the health system, which includes all organizations, institutions and resources established for the improvement of the population health status. This article is a synthesis from those describing the main health systems in Europe; the presentation of each national health system contains aspects such as: the level population coverage by health insurance, types of health services covered, thegenerate revenue system, the delivery system, the quality of care, the costcontrol system.Keywords: health systems, health insurance covering, financing, delivery health system, quality of care, efficiency, cost-controlThe improving of health represents the main goal of all health systems, and this target can be reached through a adequate national policy; a good image of a health policy could be reflected in the organization and the financing model of the health system, which includes all organizations, institutions and resources established for the improvement of the population health status. This article is a synthesis from those describing the main health systems in Europe; the presentation of each national health system contains aspects such as: the level population coverage by health insurance, types of health services covered, thegenerate revenue system, the delivery system, the quality of care, the costcontrol system.Keywords: health systems, health insurance covering, financing, delivery health system, quality of care, efficiency, cost-contro

Main Features of Prevalence and Severity of Major Depressive Episode in Romania

The objectives of the current article are to present some nationally representative estimates of lifetime, 12-months prevalence of MDE the age of onset, years in episode, the effects of MDE on role impairment. The lifetime prevalence of MDE was 3.3% for “all ages”, with higher values for females than for males (4.1% versus 2.5%) and the prevalence estimates of CIDI/DSM-IV 12-months Major Depressive Episode (MDE) was 1.8% (2.2% for females and 1.4% for males).  Approximately half of those with lifetime prevalence MDE presented 12-months MDE too (53.8%).  Within the age groups “18-34”, “all ages” and “50-64”, the females have the mean onset of MDE earlier than males (a slight difference for the first two situations, a difference of about 8 years for the latter). Within the age groups “35-49” of “65 years and over”, the males have the onset of MDE earlier than the females with 3-4 years. Regarding the mean number of years in episode, for all subjects was found a value of 5.7 years. Symptom severity assessed with the Quick Inventory of Depressive Symptomatology Self Report (QIDS-SR), revealed that almost two thirds of cases with MDE were “severe” or “very severe” from clinical point of view.  Number of weeks depressed in the 365 days before the interview, expressed as mean was 30.8 for those with “severe” symptoms/domain. In the past 30 days, the highest WHODAS score was for out of role domain (36.2), then for mobility (14.6).  Regarding the number of days out of role in the last year due to depression, this was 82.1 for the age group “50-64” and 63.5 for those of “65 years old and over”.  Major Depression Episode is a seriously impairment condition. The severe consequences of the depression on functioning in labour and social areas call attention to the need for early diagnostic, proper treatment and intervention. Key words: major depressive episode, lifetime prevalence, 12-mo prevalence, Sheehan score, disability assessment schedul

Study of the Variations in the Use of Hospital Services, Based on the Case Mix, in 2008 in Romania

The healthcare system copes with economic challenges worldwide, so the healthcare reform is a topic more important than ever for social policies. What do we get for our money? Is a question that raises more and more. It has been shown that more healthcare services does not necessarily mean a better health. Many countries focus of medical practice variations or health disparities. The collection of case mix data starting with 2003 in Romania made possible several studies concerning practice variations in Romania. The present article shows how these data can be used to provide accurate comparisons in geographic profile concerning the volume of services, territorial disparities and to hypothesize about the possible causes of practice variations. Key words: Hospitals, medical practice variations, territorial disparities, case mi

Incidence of frailty: a systematic review of scientific literature from a public health perspective

Introduction. Because of the dynamic nature of frailty, prospective epidemiological data are essential to calibrate an adequate public health response. Methods. A systematic review of literature on frailty incidence was conducted within the European Joint Action ADVANTAGE. Results. Of the 6 studies included, only 3 were specifically aimed at estimating frailty incidence, and only 2 provided disaggregated results by at least gender. The mean followup length (1-22.2 years; median 5.1), sample size (74-6306 individuals), and age of participants (≥ 30-65) varied greatly across studies. The adoption of incidence proportions rather than rates further limited comparability of results. After removing one outlier, incidence ranged from 5% (follow-up 22.2 years; age ≥ 30) to 13% (follow-up 1 year, age ≥ 55). Conclusions. Well-designed prospective studies of frailty are necessary. To facilitate comparison across studies and over time, incidence should be estimated in person-time rate. Analyses of factors associated with the development of frailty are needed to identify high-risk groups

Integrated care models for managing and preventing frailty: A systematic review for the European Joint Action on Frailty Prevention (ADVANTAGE JA)

Frailty requires concerted integrated approaches to prevent functional decline. Although there is evidence that integrating care is effective for older people, there is insufficient data on outcomes from studies implementing integrated care to prevent and manage frailty. We systematically searched PubMed and Cochrane Library database for peerreviewed medical literature on models of care for frailty, published from 2002 to 2017. We considered the effective and transferable components of the models of care and evidence of economic impact, where available. Information on European Unionfunded projects or those registered with the European Innovation Partnership on Active and Healthy Ageing, and grey literature (including good practices) were also considered. We found 1,065 potential citations and 170 relevant abstracts. After excluding reports on specific diseases, processes or interventions and service models that did not report data, 42 full papers met the inclusion criteria. The evidence showed that few models of integrated care were specifically designed to prevent and tackle frailty in the community and at the interface between primary and secondary (hospital) care. Current evidence supports the case for a more holistic and salutogenic response to frailty, blending a chronic care approach with education, enablement and rehabilitation to optimise function, particularly at times of a sudden deterioration in health, or when transitioning between home, hospital or care home. In all care settings, these approaches should be supported by comprehensive assessment and multidimensional interventions tailored to modifiable physical, psychological, cognitive and social factors

Prevalence of frailty at population level in European ADVANTAGE Joint Action Member States: a systematic review and meta-analysis

Introduction. Although frailty is common among community-dwelling older adults, its prevalence in Europe and how this varies between countries is unclear. Methods. A systematic review and meta-analysis of literature on frailty prevalence in 22 European countries involved in the Joint Action ADVANTAGE was conducted. Results. Sixty-two papers, representing 68 unique datasets were included. Meta-analysis showed an overall estimated frailty prevalence of 18% (95% confidence interval, CI, 15- 21%). The prevalence in community (n = 53) vs non-community based studies (n = 15) was 12% (95% CI 10-15%) and 45% (95% CI 27-63%), respectively. Pooled prevalence in community studies adopting a physical phenotype was 12% (95% CI 10-14%, n = 45) vs 16% (95% CI 7-29%, n = 8) for all other definitions. Sub-analysis of a subgroup of studies assessed as high-quality (n = 47) gave a pooled estimate of 17% (95% CI 13-21%). Conclusions. The considerable and significant heterogeneity found warrants the development of common methodological approaches to provide accurate and comparable frailty prevalence estimates at population-level

The cross-national structure of mental disorders: results from the World Mental Health Surveys

Background: The patterns of comorbidity among mental disorders have led researchers to model the underlying structure of psychopathology. While studies have suggested a structure including internalizing and externalizing disorders, less is known with regard to the cross-national stability of this model. Moreover, little data are available on the placement of eating disorders, bipolar disorder and psychotic experiences (PEs) in this structure. Methods: We evaluated the structure of mental disorders with data from the World Health Organization Composite International Diagnostic Interview, including 15 lifetime mental disorders and six PEs. Respondents (n = 5478–15 499) were included from 10 high-, middle- and lower middle-income countries across the world aged 18 years or older. Confirmatory factor analyses (CFAs) were used to evaluate and compare the fit of different factor structures to the lifetime disorder data. Measurement invariance was evaluated with multigroup CFA (MG-CFA). Results: A second-order model with internalizing and externalizing factors and fear and distress subfactors best described the structure of common mental disorders. MG-CFA showed that this model was stable across countries. Of the uncommon disorders, bipolar disorder and eating disorder were best grouped with the internalizing factor, and PEs with a separate factor. Conclusions: These results indicate that cross-national patterns of lifetime common mental-disorder comorbidity can be explained with a second-order underlying structure that is stable across countries and can be extended to also cover less common mental disorders

Perceived helpfulness of treatment for posttraumatic stress disorder: Findings from the World Mental Health Surveys

Background: Perceived helpfulness of treatment is an important healthcare quality indicator in the era of patient-centered care. We examine probability and predictors of two key components of this indicator for posttraumatic stress disorder (PTSD). Methods: Data come from World Mental Health surveys in 16 countries. Respondents who ever sought PTSD treatment (n = 779) were asked if treatment was ever helpful and, if so, the number of professionals they had to see to obtain helpful treatment. Patients whose treatment was never helpful were asked how many professionals they saw. Parallel survival models were estimated for obtaining helpful treatment in a specific encounter and persisting in help-seeking after earlier unhelpful encounters. Results: Fifty seven percent of patients eventually received helpful treatment, but survival analysis suggests that it would have been 85.7% if all patients had persisted in help-seeking with up to six professionals after earlier unhelpful treatment. Survival analysis suggests that only 23.6% of patients would persist to that extent. Odds of ever receiving helpful treatment were positively associated with receiving treatment from a mental health professional, short delays in initiating help-seeking after onset, absence of prior comorbid anxiety disorders and childhood adversities, and initiating treatment before 2000. Some of these variables predicted helpfulness of specific treatment encounters and others predicted persistence after earlier unhelpful encounters. Conclusions: The great majority of patients with PTSD would receive treatment they considered helpful if they persisted in help-seeking after initial unhelpful encounters, but most patients whose initial treatment is unhelpful give up before receiving helpful treatment

Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys

Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys - 17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) - carried out as part of the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful