217 research outputs found
Funding intensive care - approaches in systems using diagnosis-related groups.
This report reviews approaches to funding intensive care in health systems that use activitybased
payment mechanisms based on diagnosis-related groups (DRGs) to reimburse
hospital care. The report aims to inform the current debate about options for funding
intensive care services for adults, children and newborns in England.
Funding mechanisms reviewed here include those in Australia (Victoria), Denmark,
France, Germany, Italy, Spain, Sweden and the United States (Medicare). Approaches to
organising, providing and funding hospital care vary widely among these countries/states,
largely reflecting structural differences in the organisation of healthcare systems.
Mechanisms of funding intensive care services tend to fall into three broad categories:
⢠those that fund intensive care through DRGs as part of one episode of hospital
care only (US Medicare, Germany, selected regions in Sweden and Italy)
⢠those that use DRGs in combination with co-payments (Victoria, France)
⢠those that exclude intensive care from DRG funding and use an alternative form
of payment, for example global budgets (Spain) or per diems (South Australia).
Approaches to funding paediatric and neonatal intensive care largely reflect the overall
funding mechanism for intensive care. Evidence reviewed here indicates a general concern
of potential underfunding of intensive care. These problems may be particularly pertinent
for those settings that provide neonatal and paediatric care because of the very high costs
and the relatively smaller number of cases in these settings compared with adult intensive
care. Similar issues apply to highly specialised services in adult intensive care, such as
treatment of severe burns.
Given the variety of approaches to funding intensive care services, this review suggests that
there is no obvious example of âbest practiceâ or dominant approach used by a majority of
systems. Each approach has advantages and disadvantages, particularly in relation to the
financial risk involved in providing intensive care. While the risk of underfunding
intensive care may be highest in systems that apply DRGs to the entire episode of hospital
care, including intensive care, concerns about potential underfunding were voiced in all
systems reviewed here. Arrangements for additional funding in the form of co-payments or
surcharges may reduce the risk of underfunding. However, these approaches also face the
difficulty of determining the appropriate level of (additional) payment and balancing the
incentive effect arising from higher payment
What we have learned about policy-research linkage from providing a rapid response facility for international healthcare comparisons to the Department of Health in England
In this paper we reflect on our experience of providing a rapid response facility for international healthcare policy comparisons to the English Department of Health. We examine the challenges of developing sustained relationships with policy officials while providing an 'on-demand' service in an environment with high turnover of policies and staff. It may be easier for policy makers to draw on researchers in such a setting than for researchers to foster 'linkage and exchange' relationships with policy makers. Under the facility, knowledge transfer has mostly been from researchers to policy officials, affording us little insight into the policy process or the impact of our work
Evidence Advisory System Briefing Notes: Germany
There has been a growing global concern for improving the use of evidence to inform health policy in
recent years. Increasingly there is recognition that individual projects or programmes building evidence
synthesis skills, may be limited in their effect without a broader consideration of the systems in place
which âembedâ or âinstitutionaliseâ evidence informed policy making practices (Alliance for Health Policy
and Systems Research and WHO 2007).
The GRIP-Health programme is a five-year project supported by the European Research Council which
studies the political nature of health policy to understand how to best improve the use of evidence. This
explicitly political lens enables us to focus on the contested nature of health issues as well as the
institutions that shape the use of evidence in health policy making. We understand institutions as
including both formal structures and rules, as well as informal norms and practices (Lowndes and
Roberts 2013). The GRIP-Health programme follows the World Health Organizationâs view that Ministries
of Health remain the ultimate stewards of a nationâs health, and further play a key role in providing
information to guide health decisions (World Health Organization 2000, Alvarez-Rosette, Hawkins, and
Parkhurst 2013). As such, GRIP-Health is particularly concerned with the structures and rules created by
government to gather, synthesise, or otherwise provide evidence to inform policy making.
This working paper is one of a series of six briefs covering a set of countries in which the GRIP-Health
programme is undertaking research. This brief presents an overview of what is termed the âEvidence
Advisory Systemâ (EAS) for health policy making within the country of interest, which is taken to
encompass the key entry points through which research evidence can make its way into relevant health
policy decisions. This can include both formal (government mandated) and informal structures, rules,
and norms in place.
Individual reports in this series can be useful for those considering how to improve evidence use in
specific country settings, while taken together the reports identify the differences that can be seen
across contexts, permitting reflection or comparison across countries about how evidence advisory
systems are structured â including which responsibilities are given to different types of bodies, and how
well evidence advice aligns with decision making authority structures
Advice on commissioning external academic evaluations of policy pilots in health and social care: a discussion paper
This discussion document aims to provide guidance to those thinking of initiating policy pilots and commissioning or requesting others to commission their evaluations. It addresses a number of issues that are specific to policy piloting and that need to be considered before selecting pilot sites and commissioning evaluation.
Much advice on evaluation today is focused on advocating the adoption of specific study designs â especially randomised controlled trial (RCTs). While RCTs will be relevant to consider for specific purposes, as we discuss below, they may well not be the best option for the evaluation of policy pilots. We therefore aim to encourage
consideration of a range of evaluation designs so as to capitalise fully on the opportunities for learning from policy piloting but, more importantly, to encourage more thinking about other aspects of commissioning evaluations of policy pilots. The advice is primarily designed for national level staff involved in policy making, programme management, monitoring and analysis, and responsible for initiating policy-relevant pilots and commissioning their evaluations
The Multiple Purposes of Policy Piloting and Their Consequences: Three Examples from National Health and Social Care Policy in England
AbstractIn England, policy piloting has become firmly established in almost all areas of public policy and is seen as good practice in establishing âwhat worksâ. However, equating piloting with evaluation can risk oversimplifying the relationship between piloting and policy-making.Using three case studies from health and social care â the Partnerships for Older People Projects (POPP) pilots, the Individual Budgets pilots and the Whole System Demonstrators (WSD) â the paper identifies multiple purposes of piloting, of which piloting for generating evidence of effectiveness was only one. Importantly, piloting was also aimed at promoting policy change and driving implementation, both in pilot sites and nationally. Indeed, policy makers appeared to be using pilots mainly to promote government policy, using evaluation as a strategy to strengthen the legitimacy of their decisions and to convince critical audiences. These findings highlight the ambiguous nature of piloting and thus question the extent to which piloting contributes to the agenda of evidence-based policy-making.</jats:p
Policy experiments: Investigating effectiveness or confirming direction?
In England, âpolicy experimentsâ are largely synonymous with the use of randomized controlled trials (RCTs) to test whether one policy âworksâ better than another. While advocacy of the use of RCTs in public policy presents this as relatively straightforward, even common sense, the reality is different, as shown through analysis of three high profile policy pilots and their evaluations undertaken in health and social care in England in the mid/late 2000s. The RCTs were expected to confirm the direction of policy by resolving any remaining uncertainty about the effectiveness of the chosen path and their existence was used largely as instruments of persuasion. The findings from the analysis of the three pilots confirm the continuing relevance of Campbellâs 1969 insight that governments struggle to experiment in the scientific sense and explain the limited effect of these policy experiments on policy decisions
Evidence Advisory System Briefing Notes: England
There has been a growing global concern for improving the use of evidence to inform health policy in
recent years. Increasingly there is recognition that individual projects or programmes building evidence
synthesis skills, may be limited in their effect without a broader consideration of the systems in place
which âembedâ or âinstitutionaliseâ evidence informed policy making practices (Alliance for Health Policy
and Systems Research and WHO 2007).
The GRIP-Health programme is a five year project supported by the European Research Council which
studies the political nature of health policy to understand how to best improve the use of evidence. This
explicitly political lens enables us to focus on the contested nature of health issues as well as the
institutions that shape the use of evidence in health policy making. We understand institutions as
including both formal structures and rules, as well as informal norms and practices (Lowndes and
Roberts 2013). The GRIP-Health programme follows the World Health Organizationâs view that Ministries
of Health remain the ultimate stewards of a nationâs health, and further play a key role in providing
information to guide health decisions (World Health Organization 2000, Alvarez-Rosette, Hawkins, and
Parkhurst 2013). As such, GRIP-Health is particularly concerned with the structures and rules created by
government to gather, synthesise, or otherwise provide evidence to inform policy making.
This working paper is one of a series of six briefs covering a set of countries in which the GRIP-Health
programme is undertaking research. This brief presents an overview of what is termed the âEvidence
Advisory Systemâ (EAS) for health policy making within the country of interest, which is taken to
encompass the key entry points through which research evidence can make its way into relevant health
policy decisions. This can include both formal (government mandated) and informal structures, rules,
and norms in place.
Individual reports in this series can be useful for those considering how to improve evidence use in
specific country settings, while taken together the reports identify the differences that can be seen
across contexts, permitting reflection or comparison across countries about how evidence advisory
systems are structured â including which responsibilities are given to different types of bodies, and how
well evidence advice aligns with decision making authority structures
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