Opioid abuse and austerity: Evidence on health service use and mortality in England

Opioid abuse has become a public health concern among many developed countries, with policymakers searching for strategies to mitigate adverse effects on population health and the wider economy. The United Kingdom has seen dramatic increases in opioid-related mortality following the financial crises in 2008. We examine the impact of spending cuts resulting from government prescribed austerity measures on opioid-related hospitalisations and mortality, thereby expanding on existing evidence suggesting a countercyclical relationship with macroeconomic performance. We take advantage of the variation in spending cuts passed down from central government to local authorities since 2010, with reductions in budgets of up to fifty percent in some areas resulting in the rescaling of vital public services. Longitudinal panel data methods are used to analyse a comprehensive, linked dataset that combines information from spending records, official death registry data and large administrative health care data for 152 local authorities (i.e., unitary authorities and county councils) in England between April 2010 and March 2017. A total of 280,827 people experienced a hospital admission in the English National Health Service because of an opioid overdose and 14,700 people died from opioids across the study period. Local authorities that experienced largest spending cuts also saw largest increases in opioid abuse. Interactions between changes in unemployment and spending items for welfare programmes show evidence about the importance for governments to protect populations from social-risk effects at times of deteriorating macroeconomic performance. Our study carries important lessons for countries aiming to address high rates of opioid abuse, including the United States, Canada and Sweden

Evaluation of the NHS England evidence-based interventions programme: a difference-in-difference analysis

Background The NHS England evidence-based interventions programme (EBI), launched in April 2019, is a novel nationally led initiative to encourage disinvestment in low value care. Method We sought to evaluate the effectiveness of this policy by using a difference-in-difference approach to compare changes in volume between January 2016 and February 2020 in a treatment group of low value procedures against a control group unaffected by the EBI programme during our period of analysis but subsequently identified as candidates for disinvestment. Results We found only small differences between the treatment and control group after implementation, with reductions in volumes in the treatment group 0.10% (95% CI 0.09% to 0.11%) smaller than in the control group (equivalent to 16 low value procedures per month). During the month of implementation, reductions in volumes in the treatment group were 0.05% (95% CI 0.03% to 0.06%) smaller than in the control group (equivalent to 7 low value procedures). Using triple difference estimators, we found that reductions in volumes were 0.35% (95% CI 0.26% to 0.44%) larger in NHS hospitals than independent sector providers (equivalent to 47 low value procedures per month). We found no significant differences between clinical commissioning groups that did or did not volunteer to be part of a demonstrator community to trial EBI guidance, but found reductions in volume were 0.06% (95% CI 0.04% to 0.08%) larger in clinical commissioning groups that posted a deficit in the financial year 2018/19 before implementation (equivalent to 4 low value procedures per month). Conclusions Our analysis shows that the EBI programme did not accelerate disinvestment for procedures under its remit during our period of analysis. However, we find that financial and organisational factors may have had some influence on the degree of responsiveness to the EBI programme

A comparison between the clinical frailty scale and the hospital frailty risk score to risk stratify older people with emergency care needs

Background. Older adults living with frailty who require treatment in hospitals are increasingly seen in the Emergency Departments (EDs). One quick and simple frailty assessment tool¿the Clinical Frailty Scale (CFS)¿has been embedded in many EDs in the United Kingdom (UK). However, it carries time/training and cost burden and has significant missing data. The Hospital Frailty Risk Score (HFRS) can be automated and has the potential to reduce costs and increase data availability, but has not been tested for predictive accuracy in the ED. The aim of this study is to assess the correlation between and the ability of the CFS at the ED and HFRS to predict hospital-related outcomes. Methods. This is a retrospective cohort study using data from Leicester Royal Infirmary hospital during the period from 01/10/2017 to 30/09/2019. We included individuals aged + 75 years as the HFRS has been only validated for this population. We assessed the correlation between the CFS and HFRS using Pearson's correlation coefficient for the continuous scores and weighted kappa scores for the categorised scores. We developed logistic regression models (unadjusted and adjusted) to estimate Odds Ratios (ORs) and Confidence Intervals (CIs), so we can assess the ability of the CFS and HFRS to predict 30-day mortality, Length of Stay (LOS) > 10 days, and 30-day readmission. Results. Twelve thousand two hundred thirty seven individuals met the inclusion criteria. The mean age was 84.6 years (SD 5.9) and 7,074 (57.8%) were females. Between the CFS and HFRS, the Pearson correlation coefficient was 0.36 and weighted kappa score was 0.15. When comparing the highest frailty categories to the lowest frailty category within each frailty score, the ORs for 30-day mortality, LOS > 10 days, and 30-day readmission using the CFS were 2.26, 1.36, and 1.64 and for the HFRS 2.16, 7.68, and 1.19. Conclusion. The CFS collected at the ED and the HFRS had low/slight agreement. Both frailty scores were shown to be predictors of adverse outcomes. More research is needed to assess the use of historic HFRS in the ED

Health and economic convergence in the European Union (1990-2010): an econometric approach

The main aim of this thesis is to evaluate the reduction of economic and health disparities in the European Union from 1990-2010. Through different dynamic panel models, we show that in simple economics terms there has been a catching-up process within the eurozone and that the distance between the core-periphery has been reduced. However, in terms of disparities, significant economic differences across the eurozone regions still exist. In an attempt to go beyond economic terms, we show that the EU countries also catch-up in terms of health, while in terms of disparities there are still significant inconsistencies among the EU regions. Consequently, if the reduction of dispersion is the ultimate measure of convergence, as various authors have agreed (e.g. Quah, 1993), then our overall study shows a lack of convergence across EU regions in terms of economics and healthL’objectiu principal d’aquesta tesi és avaluar la reducció de les disparitats econòmiques i en salut en la Unió Europea des de 1990-2010. A través a diferents models de panell dinàmics, mostrem que en termes merament econòmics hi ha hagut un procés d’aproximació entre els membre de l’euro zona i que la distància entre centre-perifèria s’ha reduït. No obstant, en termes de disparitats, encara existeixen diferències econòmiques significatives entre les regions de l’euro zona. Per anar més enllà de simples termes econòmics, mostrem que els països de la UE també s’han aproximat en termes de salut, mentre que en termes de disparitats, encara hi ha inconsistències significatives entre les regions de la UE. Conseqüentment, si la reducció de les disparitats és la mesura definitiva de la convergència, com diversos autors han assenyalat (ex. Quah, 1993), llavors, el nostre estudi mostra una manca de convergència econòmica i en salut entre les regions de la U

Assessing The Dangers Of A Hospital Stay For Patients With Developmental Disability In England, 2017-19

People with developmental disability have higher health care needs and lower life expectancy compared with the general population. Poor quality of care resulting from interpersonal and systemic discrimination may further entrench existing inequalities. We examined the prevalence of five avoidable in-hospital patient safety incidents (adverse drug reactions, hospital-acquired infections, pressure ulcers, postoperative pulmonary embolism or deep vein thrombosis, and postoperative sepsis) for four developmental disability groups (people with intellectual disability, chromosomal abnormalities, pervasive developmental disorders, and congenital malformation syndrome) in the English National Health Service during the period April 2017-March 2019. We found that the likelihood of experiencing harm in disability groups was up to 2.7-fold higher than in patients without developmental disability. Patient safety incidents led to an excess length-of-stay in hospital of 3.6-15.4 days and an increased mortality risk of 1.4-15.0 percent. We show persisting quality differences in patients with developmental disability, requiring an explicit national policy focus on the needs of such patients to reduce inequalities, reach parity of care, and lower the burden on health system resources

Erratum to: Economic crisis and health inequalities: evidence from the European Union

Unfortunately, after publication of this article in 'International Journal for Equity in Health 2016 15:135' it was noticed that part of the ‘Acknowledgements’ section was missing. The following sentence should have been added to the ‘Acknowledgements’ section:“This study has been developed within the PhD Programme in International Relations and European Integration of the Universitat Autònoma de Barcelona (UAB, Spain). We would also like to thank the comments of Prof. Jordi Bacaria (UAB).

Erratum to: Economic crisis and health inequalities: evidence from the European Union

Unfortunately, after publication of this article in 'International Journal for Equity in Health 2016 15:135' it was noticed that part of the ‘Acknowledgements’ section was missing. The following sentence should have been added to the ‘Acknowledgements’ section: “This study has been developed within the PhD Programme in International Relations and European Integration of the Universitat Autònoma de Barcelona (UAB, Spain). We would also like to thank the comments of Prof. Jordi Bacaria (UAB).

Comparing the dangers of a stay in English and German hospitals for high-need patients

Objective To estimate the risk of an avoidable adverse event for high-need patients in England and Germany and the causal impact that has on outcomes. Data Sources We use administrative, secondary data for all hospital inpatients in 2018. Patient records for the English National Health Service are provided by the Hospital Episode Statistics database and for the German health care system accessed through the Research Data Center of the Federal Statistical Office. Study Design We calculated rates of three hospital-acquired adverse events and their causal impact on mortality and length of stay through propensity score matching and estimation of average treatment effects

Economic crisis and health inequalities: evidence from the European Union

The Erratum to this article has been published in International Journal for Equity in Health 2016 15:178The recent economic crisis has been a major shock not only to the economic sector, but also to the rest of society. Our main objective in this paper is to show the impact of the economic crisis on convergence, i.e. the reduction or equalising of disparities, among the EU-27 countries in terms of health. The aim is to observe whether the economic crisis (from 2008 onwards) has in fact had an effect on health inequalities within the EU. Methods We estimate convergence by specifying a dynamic panel model with random-effects (time, regions and countries). We are particularly interested in σ-convergence. As dependent variables, we use life expectancy, total mortality and (cause-specific) mortality in the regions of the EU-27 countries over the period 1995–2011. Results The results of the analysis show that, in terms of health, there has been a catching-up process among the EU regions. However, we find no reduction, on average, in dispersion levels as the σ-convergence shows. The main finding of this paper has been the sharp increase in disparities in 2010 for all health outcomes (albeit less abrupt for cancer mortality). Conclusion This increase in disparities in 2010 coincides with the austerity measures implemented in the EU countries. Our main conclusion is that these austerity measures have had an impact on socioeconomic inequalitie

Comparativa de los sistemas de evaluación de medicamentos: evidencia europea. ¿Es necesaria una unificación de los criterios de evaluación?

Desde la década de los 70, la Evaluación de Tecnologías Sanitarias (ETS) ha sido un concepto cada vez más importante en el campo de la atención sanitaria, como consecuencia del incremento de nuevas tecnologías sanitarias y de los presupuestos de salud limitados (recursos). En Europa, la ETS empezó en los 70s con iniciativas formales e informales en diferentes países. Aunque los países europeos comparten objetivos comunes para la ETS, sus estructuras organizativas se han desarrollado de forma separada y operan con diferentes procedimientos.Since the 70S, Health Technology Assessment (HTA) has been an increasingly important concept in the field of health care, as a consequence of the growing numer of new medical technologies and limited health budgets (resources). In Europe, HTA started in the 70s with formal and informal initiatives in different countries. Even if the European countries have common objectives for HTA systems, their organisations have been developed separately and they work differently across countries