Where do women birth during a pandemic? Changing perspectives on Safe Motherhood during the COVID-19 pandemic

During the coronavirus disease 2019 (COVID-19) pandemic, health systems all over the world are either stressed to their maximum capacity or anticipating becoming overwhelmed. The population is advised not to attend hospital unless strictly necessary, yet this advice seems to apply to all but healthy women during childbirth. Specialized hospital care during childbirth can be lifesaving in case of obstetric complications or for COVID-19 symptomatic women, while strong evidence suggests the appropriateness of midwifery units that are integrated into the healthcare system for eligible women. We must ask ourselves whether obstetric units are the appropriate birthing facilities for healthy women during the pandemic. We have learned from previous crises that the needs of women and children are often badly served during disasters. The COVID-19 pandemic raises concerns over escalation of mistreatment and abuse media are already reporting on restrictions to the rights of birthing women in Europe and the US. In addition, concerns have emerged over increased risk of infection to COVID-19 among birthing women and familied by concentrating all women in obstetric units and lack of optimal care due to pressure on staff and resources. Women's rights in childbirth are being threatened by lack of care during labor, restrictions on accompaniment, unnecessary interventions including inductions, separation of mother and baby and prohibition on breastfeeding. An effective response to the crisis depends on strong and coordinated health care systems where mothers can birth safely, and the needs of the newborn babies are met. The interpretation of what constitute safe care is a stimulus for a strong debate between those who argue for strengthening community and primary care services and those who recommend for centralization of all births in hospitals. This debate is particularly salient during this pandemic and in preparation of future pandemics. We propose a strategic response in the face of the pandemic by expanding the use of midwifery units both alongside the obstetric unit and freestanding (in the community). Where midwifery units are absent pop-up units can be created quickly following the example of the Netherlands. This strategy in high income countries is evidence-based and also serves as a response to the surge in requests of safe childbirths pathways away from the obstetric unit by concerned women at unprecedented rates. We urge policy makers to consider replicating this model in low- and middle-income countries where hospital conditions are more precarious. A strong collaboration between midwives, nurses, obstetricians and neonatologists and the integration of primary care and acute services could ensure safety while maximizing the rational use of resources. Immediate strategic action would ensure that women are able to access appropriate care at the appropriate time, while hospitals continue to respond to the COVID-19 crisis and obstetric units are kept for women needing specialist care

Instability and Trade in Currency Areas

In a currency area, when a country faces a positive shock inflation goes up, real interest rate decreases and competitiveness deteriorates. We show that the stability of equilibrium depends on the rationality of expectations and budget balance of the public sector.Publicad

Parallel imports, innovations and national welfare: The role of the sizes of the income classes and national markets for health care.

This paper shows that regardless of any intra-country income differences, parallel imports result in a lower level of health-care innovation but, contrary to popular as well as conventional theoretical wisdom, a lower price in the Third World compared to market-based discrimination. Despite such a lower price, however, parallel imports unambiguously make all buyers in the Third World worse off when intra-country income disparity exists. On the other hand, even discarding the MNC's profit, there will be cases in which the richer country prefers price discrimination as well. That is, in those cases, no countries will have any incentive under the welfare criterion to undo price discrimination, contrary to Richardso

Instability and trade in currency areas

We present a model of a currency area in which labor markets of country members are isolated but there is trade among these countries. When a country experiences a negative (resp. positive) shock, inflation goes down (up). This causes two effects. On the one hand the real interest rate of this country increases (decreases). On the other hand the goods produced in this country become more (less) competitive. We show that the stability of the system depends on several factors, including a large competitive effect, how inflation expectations are formed and fiscal policy. In general, stability requires a trade-off between the rationality of expectations and budget balance

Service Users’ Conceptualisations of Compassionate Care in an Improving Access to Psychological Therapies Service: A Grounded Theory Study

Background The clinical relevance of compassionate care is now widely accepted and is currently one of the most cited requirements for best practice in guidelines and policies. The latest Improving Access to Psychological (IAPT) Services manual states that effective and efficient approaches should be balanced with compassionate care (NHS England, 2019). However, despite its current centrality, the concept lacks a consensual definition and a framework for practice in this context. Aim Knowledge of relational aspects, such as compassion, is best elicited by exploring individual experiences and perceptions (Robert et al., 2011). Therefore, an empirical understanding of compassionate care in IAPT based on the perspective of service users, the recipients of compassionate care, is essential. To the day, there is limited research investigating service users’ conceptualisations of compassionate care, and studies have generally been based in physical healthcare settings, arising questions regarding the generalisability of the findings to an IAPT service. To address the identified gap in the literature, this study will investigate service users’ understandings and experiences of compassionate care in an IAPT service. Method This grounded theory (GT) study used semi-structured interviews to investigate how service users understand and experience compassionate care in an IAPT service. Thirteen people who used or had used an IAPT service were interviewed. Drawing from the constructivist GT guidelines of Charmaz (2014), the analysis process was iterative in nature, occurring simultaneously with data collection, using methods of transcription, systematic coding, memo writing and diagramming. Findings The analysis yielded five categories, each containing specific themes. Together, they constitute the grounded theory model ‘Humanising Responses to Distress’. This is the first empirically based model of compassionate care in a psychological therapies service in the UK. The model defines compassion as a humanising response to distress. This response involves striving to understand the individual experience, acting to meet the person’s needs, empowering the person and creating a secure relationship with them. Conclusions The components of the compassion model provide insight into how service users understand and experience compassionate care in IAPT. The model highlights the importance of prioritising individualised, relational and empowering approaches over rigid and prescriptive interventions that are not tailored to service users’ needs and preferences. Therefore, the current emphasis on standardised approaches and outcome measures may have a negative impact on compassionate care in IAPT as defined by service users

The relationship of drug reimbursement with the price and the quality of pharmaceutical innovations

This paper studies the strategic interaction between pharmaceutical firms' pricing decisions and government agencies' reimbursement decisions which discriminate between patients by giving reimbursement rights to patients for whom the drug is most effective. We show that if the reimbursement decision preceeds the pricing decision, the agency only reimburses some patients if the private and public health benefits from the new drug diverge. That is, when (i) there are large externalities of consuming the drug and (ii) the difference in costs between the new drug and the alternative treatment is large. Alternatively, if the firm can commit to a price in advance of the reimbursement decision, we identify a strategic effect which implies that by committing to a high price ex ante, the firm can force a listing outcome and make the agency more willing to reimburse than in the absence of commitment