Reducing avoidable inequalities in health: a new criterion for setting health care capitation payments

Traditionally, most health care systems which pretend to any sort of rationality and cost control have sought to allocate their limited funds in order to secure equal opportunity of access for equal need. The UK government is implementing a fundamental change of resource allocation philosophy towards contributing to the reduction of avoidable health inequalities. The purpose of this essay is to explore some of the economic issues that arise when seeking to allocate health care resources according to the new criterion. It indicates that health inequalities might arise because of variations in the quality of health services, variations in access to those services, or variations in the way people produce health, and that the resource allocation consequences differ depending on which source is being addressed. The paper shows that an objective of reducing health inequalities is not necessarily compatible with an objective of equity of access, nor with the objective of maximising health gain. The results have profound consequences for approaches towards economic evaluation, the role of clinical guidelines and performance management, as well as for resource allocation methods

‘I wouldn't push that further because I don't want to lose her’: a multiperspective qualitative study of behaviour change for long-term conditions in primary care

Background: Health outcomes for long-term conditions (LTCs) can be improved by lifestyle, dietary and condition management-related behaviour change. Primary care is an important setting for behaviour change work. Practitioners have identified barriers to this work, but there is little evidence examining practices of behaviour change in primary care consultations and how patients and practitioners perceive these practices. Objective: To examine how behaviour change is engaged with in primary care consultations for LTCs and investigate how behaviour change is perceived by patients and practitioners. Design: Multiperspective, longitudinal qualitative research involving six primary health-care practices in England. Consultations between patients with LTCs and health-care practitioners were audio-recorded. Semi-structured interviews were completed with patients and practitioners, using stimulated recall. Patients were re-interviewed 3 months later. Framework analysis was applied to all data. Participants: Thirty-two people with at least one LTC (chronic obstructive pulmonary disease, diabetes, asthma and coronary heart disease) and 10 practitioners. Results: Behaviour change talk in consultations was rare and, when it occurred, was characterized by deflection and diffidence on the part of practitioners. Patient motivation tended to be unaddressed. While practitioners positioned behaviour change work as outside their remit, patients felt uncertain about, yet responsible for, this work. Practitioners raised concerns that this work could damage other aspects of care, particularly the patient–practitioner relationship. Conclusion: Behaviour change work is often deflected or deferred by practitioners in consultations, who nevertheless vocalize support for its importance in interviews. This discrepancy between practitioners’ accounts and behaviours needs to be addressed within primary health-care organizations

Exploring the impact of dementia friendly ward environments on the provision of care: A qualitative thematic analysis

Dementia-friendly wards are recent developments to improve care for patients with dementia in acute hospitals. This qualitative study used focus groups to understand the impact of dementia friendly ward environments on nurses experiences of caring for acutely unwell patients with dementia. Qualified nurses and health care assistants working in an acute NHS Trust in England discussed their perceptions and experiences of working in a dementia-friendly ward environment. Four themes developed from the thematic analysis: (1) ‘It doesn’t look like a hospital’: A changed environment, (2) ‘More options to provide person-centred care’: No one size fits all, (3) ‘Before you could not see the patients’: A constant nurse presence and (4) ‘The ward remains the same’: Resistance to change. Recommendations and implementations for practice are discussed

Examining cost variation across hospital departments--a two-stage multi-level approach using patient-level data

Studies of hospital efficiency seldom lead to changes in practice, partly because recommendations are unspecific or results are not seen as robust. We describe a method to compare hospital costs that utilises patient-level data. We perform a two-stage analysis in which we first consider factors that explain costs among patients and then across hospital departments. We illustrate our approach by examining the costs and characteristics of almost one million patients admitted to 136 English NHS hospital obstetrics departments in 2005/2006. We identify those departments with significantly higher costs that need to take action

Multiple factors in the assessment of firesetters' fire interest and attitudes

Purpose: The number of measures available to practitioners to assess fire interest and other fire-related attitudes is limited. To help establish the utility of such measures, this study explored whether three fire measures contained multiple factors and whether such factors related to firesetting behaviour. Method: The Fire Interest Rating Scale, the Fire Attitude Scale, and the Identification with Fire Questionnaire were administered to 234 male prisoners (117 firesetters, 117 non-firesetters) and results were factor analyzed. To determine the relationship of the resulting factors with firesetting behaviour, their ability to discriminate firesetters from controls was examined and compared to the original scales. Results: Responses were best represented by five factors, four of which discriminated firesetters from non-firesetters. One factor demonstrated significant accuracy in discriminating single offence firesetters from repeat firesetters. Taken together the factors offered more clarity than using the original scale outcomes and showed equivalent predictive accuracy. Conclusions: The five factors identified may aid practitioners in helping to formulate the specific treatment needs of identified firesetters

Real-world word learning: exploring children's developing semantic representations of a science term

Assessments of lexical acquisition are often limited to pre-school children on forced choice comprehension measures. This study assessed the understandings 30 school-age children (mean age = 6;7) acquired about the science term, eclipse following a naturalistic exposure to a solar eclipse. The knowledge children acquired about eclipses and a control term, comet was assessed at three points in time (baseline-test, two-week post-test and five-month post-test) using a range of assessment tasks (multiple-choice comprehension, picture-naming, drawing and a model of a solar system task). Children's knowledge was compared to 15 adult controls during the baseline-test and two-week post-test. Children acquired extensive knowledge about eclipses, but not comets; at the two-week post-test and five-month post-test, the majority of children named and drew eclipses and „made? an eclipse using models of the sun, moon and earth. Also, children's eclipse knowledge more closely approximated adult-level understandings at the two-week post-test than at the baseline-test. Implications for the study of lexical acquisition in later development are discussed

Written language skills in children with specific language impairment

Background. Young children are often required to carry out writing tasks in an educational context. However, little is known about the patterns of writing skills that children with Specific Language Impairment (CwSLI) have relative to their typically developing peers

Chinese Singaporean attitudes towards poverty and inequality: A comparative analysis

10.1111/j.1468-2397.2011.00785.xInternational Journal of Social Welfare212149-15

A Cross-Country Comparison of Child Welfare Systems and Workers' Responses to Children Appearing to be at Risk or in Need of Help

This paper compares how frontline staff in four national child welfare systems and policy contexts – Finland, Norway, England and the USA (specifically, California) – respond to questions about a scenario of possible harm to children. The countries have different child welfare systems that we anticipated would be reflected in the workers' responses (n = 1027). The analysis shows differences and similarities between the systems, although often not in line with system expectations. There is also variation within the country samples. The study shows the complex interactions of individual and agency characteristics in addition to the role of proceduralised decision-making systems and professional discretion