Around the Tables: Contextual factors in health care coverage decisions across western Europe

Background: Across Western Europe, procedures and formalised criteria for taking decisions on the coverage (inclusion in the benefits basket or equivalent) of healthcare technologies vary substantially. In the decision documents, which display the justification of, the rationale for, these decisions, national healthcare institutes may employ ‘contextual factors,’ defined here as situation-specific considerations. Little is known about how the use of such contextual factors compares across countries. We describe and compare contextual factors as used in coverage decisions generally and 4 decision documents specifically in Belgium, England, Germany, and the Netherlands. Methods: Four group interviews with 3 experts from the national healthcare institute of each country, document and web site analysis, and a workshop with 1 to 2 of these experts per country were followed by the examination of the documents of 4 specific decisions taken in each of the 4 countries, sampled to vary widely in type of technology and decision outcome. Results: From the available decision documents, we conclude that in every country studied, contextual factors are established ‘around the table,’ ie, in deliberation. All documents examined feature contextual factors, with similar contextual factor patterns leading to similar decisions in different countries. The Dutch decisions employ the widest variety of factors, with the exception of the societal functioning of the patient, which is relatively common in Belgium, England, and Germany. Half of the final decisions were taken in another setting, with the consequence that no documentation was retrievable for 2 decisions. Conclusion: First, we conclude that in these countries, contextual factors are actively integrated in the decision document, and that this is achieved in deliberation. Conceptualising contextual factors as both situation-specific and actively-integrated affords insight into practices of contextualisation and provides an encouragement for exchange between decision-makers on more qualitative aspects of decisions. Second, the decisions that lacked a publicly acc

Business-to-Government Data Sharing for Public Interests in the European Union: Results of a Public Consultation

Lately governments and companies began experimenting with voluntary data sharing of business data for addressing public problems (so-called Data Collaboratives). This early practice revealed a number of challenges impeding business-to-government (B2G) data sharing and thus limiting the potential of data to provide answers and guide policies and action. One of the key challenges is the lack of a clear regulatory framework for B2G data sharing. To tackle this issue, the European Commission is taking regulatory action and preparing the Data Act which aims to spell out the rules and conditions for B2G data sharing for public interest. These developments, however, are met with resistance. While there is a strong push from the public sector for more private sector data, the private sector is less enthusiastic about the prospective mandatory B2G data sharing. In our study we zoom in on this issue in more detail and pose the following research question: How do public and private sector actors in the European Union view the prospect of mandatory B2G data sharing for public interest? To answer this question, we analyze the open dataset of responses to the public consultation of the European Commission. We find statistically significant results of business opposition to regulatory action and to mandating B2G data sharing, particularly among telecom and finance sectors. We also conclude that opposition to mandatory data sharing varies depending on the public interest purpose and is lowest among businesses with regards to emergencies and highest with regard to education, inclusion, and statistics

The precarious supply of physical therapists across Canada: exploring national trends in health human resources (1991 to 2005)

<p>Abstract</p> <p>Background</p> <p>Health Human Resource (HHR) ratios are one measure of workforce supply, and are often expressed as a ratio in the number of health professionals to a sub-set of the population. In this study, we explore national trends in HHR among physical therapists (PTs) across Canada.</p> <p>Methods</p> <p>National population data were combined with provincial databases of registered physical therapists in order to estimate the HHR ratio in 2005, and to establish trends between 1991 and 2005.</p> <p>Results</p> <p>The national HHR ratio was 4.3 PTs per 10,000 population in 1991, which increased to 5.0 by 2000. In 2005, the HHR ratios varied widely across jurisdictions; however, we estimate that the national average dropped to 4.8 PTs per 10,000. Although the trend in HHR between 1991 and 2005 suggests positive growth of 11.6%, we have found negative growth of 4.0% in the latter 5-years of this study period.</p> <p>Conclusion</p> <p>Demand for rehabilitation services is projected to escalate in the next decade. Identifying benchmarks or targets regarding the optimal number of PTs, along with other health professionals working within inter professional teams, is necessary to establish a stable supply of health providers to meet the emerging rehabilitation and mobility needs of an aging and increasingly complex Canadian population.</p

Green Public Procurement in Mission-Orientated Innovation Systems: Leveraging Voluntary Standards to Improve Sustainability Performance of Municipalities

Mission-oriented approaches such as green public procurement (GPP) are emerging as popular solutions for governments to tackle contemporary sustainability challenges. Voluntary standards are instruments that can be used in GPP to drive innovation toward sustainability goals. However, there exists a lack of understanding of how to theoretically situate and practically execute GPP and voluntary standards within missions-oriented innovation systems (MIS). To address this research gap, this paper investigates how voluntary standards can be used to help formulate and achieve missions for sustainable urban development (SUD) at the municipal level, followed by what role green public procurement can play in this process. To do so, it establishes a first theoretical synthesis of GPP and MIS. Next, focusing on the Municipality of Amsterdam, it conducts an empirical investigation of 95 SUD projects, of which 55 were public tender projects (in which the municipality is the landowner) and 40 were non-public tender projects (in which a private entity is the landowner), supplemented by stakeholder interviews. Based on this, it (1) conceptualizes six sustainability ambitions as missions and examines each for their formulation in terms of targets and associated standards (problem-solution diagnosis), and (2) it maps the various actors engaged in the process of implementing these missions through SUD projects, defining their positions and interrelations within the MIS at the municipal level (structural analysis). Conclusions and reflections are made regarding the relationship between changing standards and regulations over time, the potential for GPP to increase progress toward missions via use of voluntary standards in public tenders. Until programmatic approaches to measuring progress toward missions are fully implemented, the presence of voluntary standards is suggested as a potential metric