New Provider Models for Sweden and Spain: Public, Private or Non-profit? Comment on “Governance, Government, and the Search for New Provider Models”

Sweden and Spain experiment with different provider models to reform healthcare provision. Both models have in common that they extend the role of the for-profit sector in healthcare. As the analysis of Saltman and Duran demonstrates, privatisation is an ambiguous and contested strategy that is used for quite different purposes. In our comment, we emphasize that their analysis leaves questions open on the consequences of privatisation for the performance of healthcare and the role of the public sector in healthcare provision. Furthermore, we briefly address the absence of the option of healthcare provision by not-for-profit providers in the privatisation strategy of Sweden and Spai

Information and choice of residential care provider for older people: a comparative study in England, the Netherlands and Spain

This study compared how older people use quality information to choose residential care providers in England, the Netherlands and Spain (Catalonia). The availability of information varies between each country, from detailed inspection and survey information in the Netherlands, through to a lack of publicly available information in Catalonia. We used semi-structured interviews and group workshops with older people, families and professionals to compare experiences of the decision-making process and quality information, and also to explore what quality information might be used in the future. We found that most aspects of the decision-making experience and preferences for future indicators were similar across the three countries. The use of quality information was minimal across all three, even in England and the Netherlands where information was widely available. Differences arose mainly from factors with the supply of care. Older people were most interested in the subjective experiences of other residents and relatives, rather than 'hard' objective indicators of aspects such as clinical care. We find that the amount of publicly available quality information does not in itself influence the decisions or the decision-making processes of older people and their carers. To improve the quality of decisions, more effort needs to be taken to increase awareness and to communicate quality in more accessible ways, including significant support from professionals and better design of quality information

How do patient characteristics influence informal payments for inpatient and outpatient health care in Albania: Results of logit and OLS models using Albanian LSMS 2005

Abstract Background Informal payments for health care are common in most former communist countries. This paper explores the demand side of these payments in Albania. By using data from the Living Standard Measurement Survey 2005 we control for individual determinants of informal payments in inpatient and outpatient health care. We use these results to explain the main factors contributing to the occurrence and extent of informal payments in Albania. Methods Using multivariate methods (logit and OLS) we test three models to explain informal payments: the cultural, economic and governance model. The results of logit models are presented here as odds ratios (OR) and results from OLS models as regression coefficients (RC). Results Our findings suggest differences in determinants of informal payments in inpatient and outpatient care. Generally our results show that informal payments are dependent on certain characteristics of patients, including age, area of residence, education, health status and health insurance. However, they are less dependent on income, suggesting homogeneity of payments across income categories. Conclusions We have found more evidence for the validity of governance and economic models than for the cultural model.</p

Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study

Background Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex. Methods CKD patients (&gt;= 65 years; estimated glomerular filtration rate &lt;= 20 mL/min/1.73 m(2)) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off &lt;= 70; 0-100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders. Results Overall kidney function decline in 1326 patients was -0.12 mL/min/1.73 m(2)/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03-1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality). Conclusions There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men

Eigen betalingen in de zorg

7. Eigen betalingen in de zorg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 7.1 Inleiding............................................................. 123 7.2 Eigen betalingen in 2018. . . . . . . . . . . . . . . . . . . . . . . . .................... 125 7.3 Eigen betalingen in internationaal perspectief. .................... 128 7.4 Eigen bijdragen als financieringsbron . . . . . . . . . .................... 129 7.5 Motieven voor eigen betalingen . . . . . . . . . . . . . . . . .................... 130 7.6 Effecten van eigen betalingen op de zorgvraag .................... 132 7.7 Effecten van eigen betalingen op de gezondheid van verzekerden.......................................................... 134 7.8 Effecten van eigen betalingen op de betaalbaarheid. . . . . . . . . . . . . . . 135 7.9 Eigen betalingen en solidariteit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 7.10 Uitvoeringskosten van eigen betalingen. . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 7.11 Toekomstperspectief................................................ 139 7.12 Conclusie ............................................................ 13

The market reform in Dutch health care:Results, lessons and prospects

In 2006, the Netherlands embarked upon an ambitious reform of the Dutch health care system based upon the principles of regulated competition. Some 15 years later, it is an appropriate time to find out how this ‘market reform’ has worked out, and what the experience has been like for those involved in putting it into practice. The authors of this important new study review the reforms and their impact to date and ask whether the reforms merit being counted as a success. Did they alter the relationship between state, insurers, providers and patients? Has there been evidence of problems that market-based systems are often associated with, such as high administrative costs, restricted access to health care, rent-seeking, skimming and adverse selection? Whilst addressing these questions and suggesting possible answers, the authors also examine what can be learned from the Dutch experience with competition in health care and what changes might be expected in the near future in the Netherlands and more broadly, especially considering the context of the COVID-19 pandemic