Health economics Investment in health could be good for Europe's economies

A sick population is an expensive population. But a new European report shows the benefits of improved public health are likely to extend beyond reduced healthcare cost

The contribution of health to the economy in the European Union

Despite increasing recognition of the link between health and economic development in low-income countries, the relationship has to date received scant attention in rich countries. We argue that this lack of attention is not justifiable. While the economic argument for investing in health in rich countries may differ in detail from that in low-income countries, there is considerable and convincing evidence that significant economic benefits can be achieved by improving health not only in poor, but also in rich countries. Better health increases labour supply and productivity and historically, health has been a major contributor to economic growth. In spite of remaining evidence gaps economic policy-makers also in developed countries should consider investing in health as one (of few) ways by which to achieve their economic objectives

Efficiency assessment of primary care providers: A conditional nonparametric approach

This paper uses a fully nonparametric approach to estimate efficiency measures for primary care units incorporating the effect of environmental factors. This methodology allows us to account for different types of variables (continuous and discrete) regarding the main characteristics of patients served by those providers. In addition, we use an extension of this nonparametric approach to deal with the presence of undesirable outputs in data, represented by the number of readmissions and hospitalization rates of ambulatory care sensitive condition (ASCS). The empirical results of our application show that all the exogenous variables considered have a significant and negative effect on efficiency estimates

Does interprofessional collaboration between care levels improve following the creation of an integrated delivery organisation? The Bidasoa case in the Basque Country

<strong>Introduction: </strong>This article explores the impact of the creation of a new integrated delivery organisation on the evolution of interprofessional collaboration between primary and secondary care levels. In particular, the case of the Bidasoa Integrated Healthcare Organisation is analysed. <strong>Theory and methods: </strong>The evolution of interprofessional collaboration is measured through a validated Spanish questionnaire, with 10 items and a 5-point Likert scale, based on the D’Amour’s model of collaboration [20]. The final sample included 146 observations (doctors and nurses).    <strong>Results: </strong>The questionnaire identified a significant improvement on the mean scores for interprofessional collaboration of 0.57 points before and after the intervention. A significant improvement was also found in the two dimensions of the measure of interprofessional collaboration used, with the size of the change being higher for the dimension related to the organisational setting (0.63) than for interpersonal relationships (0.47). <strong>Conclusions: </strong>Before and after the creation of the Bidasoa Integrated Healthcare Organisation, an improvement in the perceived degree of interprofessional collaboration between primary and secondary care levels was observed. This finding supports the benefit of a multilevel and multidimensional approach to integration, as in the described Bidasoa case. <strong>Discussion: </strong>Results on the two dimensions of the measure of interprofessional collaboration used, seem to point to the longer time required for interpersonal relationships to change, compared to the organisational setting

Does interprofessional collaboration between care levels improve following the creation of an integrated delivery organisation? The Bidasoa case in the Basque Country

Introduction: This article explores the impact of the creation of a new integrated delivery organisation on the evolution of interprofessional collaboration between primary and secondary care levels. In particular, the case of the Bidasoa Integrated Healthcare Organisation is analysed.Theory and methods: The evolution of interprofessional collaboration is measured through a validated Spanish questionnaire, with 10 items and a 5-point Likert scale, based on the D’Amour’s model of collaboration [20]. The final sample included 146 observations (doctors and nurses).   Results: The questionnaire identified a significant improvement on the mean scores for interprofessional collaboration of 0.57 points before and after the intervention. A significant improvement was also found in the two dimensions of the measure of interprofessional collaboration used, with the size of the change being higher for the dimension related to the organisational setting (0.63) than for interpersonal relationships (0.47).Conclusions: Before and after the creation of the Bidasoa Integrated Healthcare Organisation, an improvement in the perceived degree of interprofessional collaboration between primary and secondary care levels was observed. This finding supports the benefit of a multilevel and multidimensional approach to integration, as in the described Bidasoa case.Discussion: Results on the two dimensions of the measure of interprofessional collaboration used, seem to point to the longer time required for interpersonal relationships to change, compared to the organisational setting

Development of a questionnaire to assess the collaboration between clinicians from different levels of care

PURPOSE: The purpose was to develop a questionnaire, gathering the professionals’ opinion, to measure the degree of collaboration between clinicians from different levels of care (primary care and specialised care) in a given healthcare organisation. This questionnaire was originally developed to assess processes of care integration in the Basque Health System (Spain), but can also be used in other contexts. METHODOLOGY: The questionnaire was based on the four-dimension model and 10 indicators of interprofessional collaboration in healthcare organisations proposed by D’Amour et al. [1]. The resulting questionnaire was pre-tested and its construct validity and homogeneity evaluated in three healthcare organisations of the Basque Health Service. RESULTS AND CONCLUSIONS: A 10 items questionnaire has been developed. Each of its items corresponds to one of the indicators proposed by D’Amour et al. [1]. The title of each of these items is: 1) Shared goals, 2) Patient-centred approach, 3) Mutual knowledge, 4) Trust, 5) Strategic guidelines, 6) Shared leadership, 7) Support for Innovation, 8) Forums for meeting, 9) Protocolisation and 10) Information Systems. Clinicians are asked to value each of these aspects in their healthcare organisation on a Likert scale of 5 degrees

Development of a questionnaire to assess interprofessional collaboration between two different care levels

Introduction. This paper reports the development and validation of a questionnaire to assess collaboration between clinical professionals from two different care levels (primary and specialised care), according to the clinicians' own perceptions. This questionnaire has been elaborated to be used as part of the monitoring and evaluation process of the integrated care pilots in the public Basque Health Service.Methods. The process was carried out in four phases: development of the first version of the questionnaire, validation of the content, pre-testing, and evaluation of its construct validity and homogeneity in a sample of doctors and nurses. This last phase involved confirmatory factor analysis, as well as the calculation of Cronbach's α and various correlation coefficients.Results. The process demonstrated that the theoretical content of the questionnaire was appropriate, and also that its items were clear, relevant and intelligible. The fit indices for the confirmatory factor analysis were: c2 of 45.51 (p = 0.089), RMSEA of 0.043, RMR of 0.046, GFI of 0.92 and CFI of 0.99.Discussion. The statistics indicate a good fit between the data and a conceptual two-factor structure, in which both personal relationships between professionals and characteristics of the organisational environment are understood to underlie interprofessional collaboration.Conclusion. The end-product is a new instrument with good validity to assess the degree of interprofessional collaboration between clinicians working at two different levels of care