Aging, Pensions and Long-term Care: What, Why, Who, How?; Comment on “Financing Long-term Care: Lessons From Japan”

Japan has been aging faster than other industrialized nations, and its experience offers useful lessons to others. Japan has been willing to expand its welfare state with a long-term care (LTC) insurance to finance home care and nursing home care for frail elderly. As Ikegami shows, it created new facilities and expanded specialized staffing for home care, developed a country-wide assessment system and shifted responsibilities between the central and local authorities over that assessment and the determination of co-payments for LTC. Faced with rapid growth in demand for LTC, the government felt the need for new cost control measures. The Japanese experience illustrates that new social policies take time to develop. There is often a need to adjust. But there are also other lessons. The main one is that there is no direct relation between the degree of population aging and total health spending. While aging requires adjustments in the organization of care, and expanding LTC for frail elderly, international studies show there is no need to worry about the ‘unaffordability’ of aging. In this commentary, we have framed four “What, Why, Who, and How” questions about LTC to (re-)define the borderlines between public and private responsibilities for the range of activities for which some (but certainly not all) frail elderly as well as many non-elderly require support in daily life

World Cities Project: New York, Paris, London, Tokyo Fact Sheet

The World Cities Project (WCP) originated as a joint research project between the International Longevity Center-USA and New York University's Robert F. Wagner Graduate School of Public Service. It has since grown to include the active involvement of the ILC-France, ILC-Japan, and ILC-UK. Also the City of Paris Department of Health and Social Affairs, the London Regional Office of the British National Health Service, the Tokyo Metropolitan Government Bureau of Health and Social Welfare, and the New York City Department of Aging and Department of Health have provided important support to the project. The project compares health, social services, and quality of life for persons aged 65 and over in the four largest urban agglomerations in the countries belonging to the Organization for Economic Cooperation and Development (OECD): New York, Paris, Tokyo and London.Although these four cities have been the subject of numerous studies in the fields of architecture and urban planning, there have been few comparative studies of health and social services. Additionally, the WCP introduces a spatial perspective to more conventional economic and demographic analyses of population aging and longevity issues. Most comparative analyses of health systems focus on national averages that mask important variations within smaller jurisdictions. In contrast, the WCP relates smaller, more comparable units providing notable advantages for cross-national learning

Inequalities in avoidable hospitalisation in large urban areas: retrospective observational study in the metropolitan area of Milan

Significant inequalities in access to healthcare system exist between residents of world megacities, even if they have different healthcare systems. The aim of this study was to estimate avoidable hospitalisations in the metropolitan area of Milan (Italy) and explore inequalities in access to healthcare between patients and across their areas of residence

Cities and Health: A Response to the Recent Commentaries

We are grateful to our many colleagues who took the time to respond to our analysis of Shanghai’s declining “avoidable mortality.”1 The range of their perspectives across 5 recent commentaries reassures us that the topic is worthy of sustained study. Indeed, the presumption behind our comparative research on healthcare in world cities 2 is that the city is a strategic unit of analysis for understanding the health sector and that world cities share a host of important characteristics

Reduce Avoidable Hospitalisations: A Policy to Increase Value from Health Care Expenditures

An interdisciplinary examination of rates of avoidable hospitalizations in France and England to evaluate access to primary care and identify the extent to which these countries may be able to reduce hospital costs by investing in disease management and primary care

Needed: Global Collaboration for Comparative Research on Cities and Health

Over half of the world’s population lives in cities and United Nations (UN) demographers project an increase of 2.5 billion more urban dwellers by 2050. Yet there is too little systematic comparative research on the practice of urban health policy and management (HPAM), particularly in the megacities of middle-income and developing nations. We make a case for creating a global database on cities, population health and healthcare systems. The expenses involved in data collection would be difficult to justify without some review of previous work, some agreement on indicators worth measuring, conceptual and methodological considerations to guide the construction of the global database, and a set of research questions and hypotheses to test. We, therefore, address these issues in a manner that we hope will stimulate further discussion and collaboration

Shanghai rising: health improvements as measured by avoidable mortality since 2000

Over the past two decades, Shanghai, the largest megacity in China, has been coping with unprecedented growth of its economy and population while overcoming previous underinvestment in the health system by the central and local governments. We study the evolution of Shanghai’s healthcare system by analyzing “Avoidable Mortality” (AM) – deaths amenable to public health and healthcare interventions, as previously defined in the literature. Based on analysis of mortality data, by cause of death, from the Shanghai Municipal Center for Disease Control and Prevention, we analyze trends over the period 2000–10 and compare Shanghai’s experience to other mega-city regions – New York, London and Paris. Population health status attributable to public health and healthcare interventions improved dramatically for Shanghai’s population with permanent residency status. The age-adjusted rate of AM, per 1,000 population, dropped from 0.72 to 0.50. The rate of decrease in age-adjusted AM in Shanghai (30%) was comparable to New York City (30%) and Paris (25%), but lower than London (42%). Shanghai’s establishment of the Municipal Center for Disease Control and Prevention and its upgrading of public health and health services are likely to have contributed to the large decrease in the number and rate of avoidable deaths, which suggests that investments in public health infrastructure and increasing access to health services in megacities – both in China and worldwide – can produce significant mortality declines. Future analysis in Shanghai should investigate inequalities in avoidable deaths and the extent to which these gains have benefitted the significant population of urban migrants who do not have permanent residency status

The Role of Formal Policy To Promote Informed Consent of Psychotropic Medications For Youth in Child Welfare Custody: a National Examination

Active participation of youth and surrogate decision-makers in providing informed consent and assent for mental health treatment is critical. However, the procedural elements of an informed consent process, particularly for youth in child welfare custody, are not well defined. Given calls for psychotropic medication oversight for youth in child welfare custody, this study proposes a taxonomy for the procedural elements of informed consent policies based upon formal and informal child welfare policies and then examines whether enacted state formal policies across the United States endorsed these elements. A sequential multi-method study design included: (1) semi-structured interviews with key informants (n = 58) primarily from state child welfare agencies to identify a taxonomy of procedural elements for informed consent of psychotropic medications and then (2) a legislative review of the 50 states and D.C. to characterize whether formal policies endorsed each procedural element through February 2022. Key informants reported five procedural elements in policy, including how to: (1) gather social and medical history, (2) prescribe the medication, (3) authorize its use through consent and youth assent, (4) notify relevant stakeholders, and (5) routinely review the consenting decision. Twenty-three states endorsed relevant legislation; however, only two states specified all five procedural elements. Additionally, the content of a procedural element, when included, varied substantively across policies. Further research and expert consensus are needed to set best practices and guide policymakers in setting policies to advance transparency and accountability for informed consent of mental health treatment among youth in child welfare custody

Les associations de consommateurs de santé aux États-Unis

Although the medical profession is supposed to act as an agent for patients, this professional standard does not guarantee the latter a voice in the care delivered to them or its underlying policies (Rothman, 1978). This article describes the efforts made in the United States to increase the role of patients in the development of health policies, by emphasizing more particularly the role of patient associations. The introduction sets out the reasons and values which push patients to get involved in health policies and the benefits expected from this involvement. It then examines some of the most emblematic actions taken on behalf of patients while illustrating the guiding principles and efforts made by the state to institutionalize the role of patients in the process of developing health policies. Lastly, the article discusses some positive and negative aspects of different forms of representation (direct or through the intermediary of “professional” spokespersons for the associations). To conclude, it appears that the role of patients in health policies and the results of actions taken by associations must be assessed in a qualified way because, although the associative movement can rightly boast about important victories for patients and their families, its voice still remains little heard both in the political process and the field of clinical practice.La profession médicale est supposée agir en tant qu’agent des patients, mais cette norme professionnelle ne garantit pas que ces derniers puissent s’exprimer sur la nature des soins qui leurs sont délivrés ou sur les politiques qui les fondent. Cet article décrit les efforts réalisés aux États-Unis pour accroître le rôle des patients dans la construction des politiques de santé, en insistant plus particulièrement sur le rôle des associations de malades. Les motifs et les valeurs qui poussent les malades à s’engager dans les politiques de la santé sont présentées en introduction de même que les avantages qu’on peut en attendre. Nous analysons ensuite certaines de leurs actions les plus emblématiques menées en leur nom tout en illustrant les grandes lignes de forces et les efforts de l’État pour institutionnaliser cette place des patients dans le processus de construction des politiques de santé. Enfin, une discussion est engagée sur certains aspects positifs et négatifs que peuvent avoir des formes différentes de représentation (directe ou par l’intermédiaire de porte-parole «professionnels» appartenant aux associations). En conclusion, il apparaît que le jugement sur le rôle des patients dans les politiques de santé et sur les résultats de l’action des associations doit être nuancé, car si le mouvement associatif peut se targuer de victoires importantes pour les patients et leurs familles, sa voix demeure encore trop peu audible tant au niveau du processus politique que dans le champ des pratiques cliniques.Gusmano Michael. Les associations de consommateurs de santé aux États-Unis. In: Santé, Société et Solidarité, n°2, 2009. La place des usagers dans le système de santé. pp. 137-147