Ensuring affordable access to healthcare for everyone in the European Union: what gaps remain and how can the EU support Member States to overcome them?

European Union (EU) Member States have made multiple commitments to progress towards universal health coverage (UHC), so that everyone can access quality healthcare without experiencing financial hardship. Yet, significant gaps in all three dimensions of health coverage (population coverage, user charges, and benefits packages) remain. This article highlights some of these gaps, looks at how access to healthcare has been addressed through the EU’s socioeconomic governance and funding instruments, and suggests ways in which the EU can further support national progress towards UHC

Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts

Background: Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods: This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days. Results: The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion: The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies

Couverture vaccinale du personnel des hôpitaux et maisons de repos et de soins contre le covid-19 : - une analyse cross-sectionnelle

18 p.ill.,Ce rapport donne un aperçu de la couverture vaccinale dans tous les établissements de soins de santé belges (hôpitaux et MR/MRS), ainsi que des informations plus détaillées par type d'établissement, province et groupe d'âge. Cette analyse a été réalisée en collaboration avec l’ONSS, la Banque Carrefour de la Sécurité Sociale et la plateforme eHealth.MESSAGES CLÉS 1 -- 1 INTRODUCTION 3 -- 1.1 Contexte 3 -- 1.2 Questions de recherche et portée de l’étude 3 -- 2 MÉTHODE 4 -- 2.1 Sources de données 4 -- 2.2 Couplage 5 -- 2.3 Analyse 5 -- 3 RÉSULTATS 7 -- 3.1 Couverture vaccinale dans les établissements de soins 7 -- 3.2 Variation de la couverture vaccinale en fonction de la taille des établissements de soins 9 -- 3.3 Variation de la couverture vaccinale en fonction de l’âge 11 -- 3.4 Qui est vacciné et qui ne l’est pas ? 1

Trends in the utilisation rates and acute hospital capacity needs for total hip replacements: results of an analysis of administrative data

Total hip replacement surgery is the mainstay of treatment for end-stage hip arthritis. In 2014, there were 28227 procedures (incidence rate 252/100000 population). Using administrative data, we projected the future volume of total hip replacement procedures and incidence rates using two models.The constant rate model fixes utilisation rates at 2014 levels and adjusts for demographic changes. Projections indicate 32248 admissions by 2025 or an annual growth of 1.22% (incidence rate 273).The time trend model additionally projects the evolution in age-specific utilisation rates. 34895 admissions are projected by 2025 or an annual growth of 1.95% (incidence rate 296). The projections show a shift in performing procedures at younger age.Forecasts of length of stay indicate a substantial shortening. By 2025, the required number of hospital beds will be halved. Despite more procedures, capacity can be reduced, leading to organisational change (e.g. elective orthopaedic clinics) and more labour intensive stays

Neighborhood peer effects in the use of preventive health care

Individual participation in preventive care may depend on preventive health behavior in an individual’s peer group. This paper analyzes the importance of social interactions in the context of new social policies (PROGRESA) in Mexico that aim to increase the participation in different types of preventive care. We follow the promising approach of analyzing social interactions in real world peer groups. Identification of social interactions is based on a partial-population design. Results indicate that PROGRESA succeeded in increasing preventive care usage among program eligible households. In addition, endogenous social interactions increase preventive care usage both among eligibles and non-eligibles for various types of prevention. The overall treatment effect of PROGRESA on prevention can be decomposed in a direct effect related to financial incentives and an indirect effect related to social interactions. The indirect effect accounts for 10% up to 58% of the total treatment effect.status: publishe

Vaccinatiegraad tegen COVID-19 van het personeel in Ziekenhuizen en Woonzorgcentra : - Een Cross-sectionele analyse

18 p.ill.,Deze KCE-analyse geeft informatie over de vaccinatiegraad in alle Belgische zorginstellingen (ziekenhuizen en woonzorgcentrum) met verdere detailinformatie per type instelling, provincie en leeftijdsgroep. Deze analyses werden uitgevoerd in samenwerking met de RSZ, de Kruispuntbank Sociale Zekerheid en het eHealth platform.KERN BOODSCHAPPEN 1 -- 1 INTRODUCTIE 3 -- 1.1 Context 3 -- 1.2 Onderzoeksvraag en scope 3 -- 2 METHODE 4 -- 2.1 Gegevensbronnen 4 -- 2.2 Koppeling 5 -- 2.3 Analyse 5 -- 3 RESULTATEN 7 -- 3.1 Vaccinatiegraad in zorginstellingen 7 -- 3.2 Variatie in vaccinatiegraad naar grootte van de zorginstelling 9 -- 3.3 Variatie in vaccinatiegraad naar leeftijd 11 -- 3.4 Wie is gevaccineerd en wie niet? 1

An EQ-5D-5L value set for Belgium : How to value health-related quality of life?

106 p.ill.,KEY POINTS 1 -- LIST OF FIGURES 5 -- LIST OF TABLES 6 -- LIST OF ABBREVIATIONS 7 -- SCIENTIFIC REPORT 9 -- 1 INTRODUCTION 9 -- 1 1 HEALTH-RELATED QUALITY OF LIFE 9 -- 1 2 APPLICATION OF HEALTH STATE UTILITY DATA IN CLINICAL AND ECONOMIC -- EVALUATIONS 12 -- 1 3 THE EQ-5D INSTRUMENT 13 -- 1 4 STUDY OBJECTIVE 15 -- 2 METHODS 16 -- 2 1 STUDY PROTOCOL 16 -- 2 1 1 Valuation techniques 16 -- 2 1 2 EQ-VT Software 19 -- 2 1 3 Structure of the interview 19 -- 2 1 4 Target sample 20 -- 2 1 5 Number of interviewers 20 -- 2 1 6 Training and pilot tests 21 -- 2 1 7 Quality control 21 -- 2 2 SAMPLING PROCESS 21 -- 2 2 1 Inclusion and exclusion criteria 21 -- 2 2 2 Sampling procedure 22 -- 2 3 STUDY APPROVAL AND PRIVACY PROTECTION ASPECTS 31 -- 2 4 DATA COLLECTION 32 -- 2 4 1 Initial recruitment of interviewers 32 -- 2 4 2 Recruitment of respondents 32 -- 2 4 3 Data collection time frame and recruitment of new interviewers 32 -- 3 DATA ANALYSIS 37 -- 3 1 DATA PREPARATION AND REPRESENTATIVENESS 37 -- 3 1 1 Creation modelling dataset 37 -- 3 1 2 Representativeness 38 -- 3 2 MODEL CONSTRUCTION 39 -- 3 2 1 Modelling cTTO valuation 39 -- 3 2 2 Modelling DCE valuation 41 -- 3 2 3 Hybrid model 42 -- 3 2 4 Fitting of the models 43 -- 3 3 MODEL SELECTION 43 -- 3 3 1 Logical consistency 43 -- 3 3 2 Goodness of fit 43 -- 3 3 3 Predictive accuracy 44 -- 3 3 4 Theoretical considerations 45 -- 3 4 PREFERRED MODEL AND VALUE SET 46 -- 4 RESULTS: THE BELGIAN EQ-5D-5L VALUE SET 47 -- 4 1 SAMPLE CHARACTERISTICS 47 -- 4 2 DATA CHARACTERISTICS 52 -- 4 2 1 cTTO data 52 -- 4 2 2 DCE data 59 -- 4 3 MODELLING RESULTS AND SELECTION 60 -- 4 3 1 Logical consistency 60 -- 4 3 2 Goodness of fit 60 -- 4 3 3 Predictive accuracy 62 -- 4 3 4 Theoretical considerations 63 -- 4 4 VALUE SET 68 -- 4 4 1 Summary of model selection 68 -- 4 4 2 Preferred model and value set 68 -- 4 4 3 Comparison with 3L value set and value sets of other countries 72 -- 5 DISCUSSION AND CONCLUSION 75 -- 5 1 STRENGTHS AND LIMITATIONS IN THE DEVELOPMENT OF THE NEW VALUE SET 75 -- 5 2 IMPLICATIONS OF THE NEW VALUE SET 76 -- 5 3 APPLICABILITY OF THE BELGIAN EQ-5D-5L VALUE SET 77 -- 5 4 FUTURE RESEARCH AND REFLECTIONS 78 --  APPENDICES 79 -- APPENDIX 1 LIKELIHOOD FUNCTIONS IN REGRESSION ANALYSIS 79 -- APPENDIX 2 REPRESENTATIVENESS OF THE POPULATION AT REGIONAL LEVEL 82 -- APPENDIX 3 FINAL VALUE SET 85 -- REFERENCES 10