Community hospitals and their services in the NHS: identifying transferable learning from international developments - scoping review, systematic review, country reports and case studies

Background: The notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential. Objectives This study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care. Methods A multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland. Results The evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented. Limitations The use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth. Conclusions At a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s). Funding: The National Institute for Health Research Health Services and Delivery Research programme

Regional Redistribution and Risk Sharing in Italy: The Role of Different Tiers of Government

Arachi G., Ferrario C. and Zanardi A. Regional redistribution and risk sharing in Italy: the role of different tiers of government, Regional Studies. This paper provides estimates of the redistribution and risk sharing across regional jurisdictions accomplished by the public sector in Italy. In this analysis the multi-level structure of the Italian government and the financial relations which link the different tiers of government are explicitly considered. Using panel data for the period 1996-2002, it is found that public policies in Italy significantly reduce differences in per-capita gross domestic product across regions. However, the public budget, far from providing insurance against idiosyncratic shocks, greatly emphasizes income fluctuations across regions. [image omitted] Arachi G., Ferrario C. et Zanardi A. La redistribution regionale et le partage des risques en Italie: le role des divers niveaux d'administration, Regional Studies. Cet article cherche a fournir des estimations de la redistribution et du partage des risques a travers des circonscriptions d'action regionale et realises par le secteur public italien. Cette analyse approfondit la structure a niveaux multiples de l'administration italienne et examine ouvertement les rapports financiers qui relient les divers niveaux d'administration. A partir des donnees provenant des enquetes permanentes pour la periode de 1996 a 2002, il s'avere que les politiques publiques en Italie reduisent sensiblement les ecarts du PIB regional par tete. Cependant, les depenses publiques, loin de fournir une protection contre des chocs particuliers, soulignent les fluctuations du revenu a travers les regions. Politique fiscale Redistribution Partage des risques Rapports entre les niveaux d'administration Regions Arachi G., Ferrario C. und Zanardi A. Regionale Umverteilung und Risikoteilung in Italien: die Rolle der verschiedenen Regierungsebenen, Regional Studies. In diesem Beitrag schatzen wir das Ausmass der Umverteilung und Risikoteilung zwischen verschiedenen regionalen Rechtsprechungsgebieten des offentlichen Sektors in Italien. Ausdrucklich in der Analyse berucksichtigt werden die mehrschichtige Struktur der italienischen Regierung sowie die finanziellen Beziehungen, die die verschiedenen Regierungsebenen miteinander verbinden. Anhand von Paneldaten fur den Zeitraum von 1996 bis 2002 stellen wir fest, dass die offentlichen Politiken in Italien die Unterschiede des Pro-Kopf-BIP zwischen den Regionen signifikant verringern. Im offentlichen Haushalt werden die Einkommensfluktuationen innerhalb der Regionen jedoch stark betont, statt eine Absicherung gegen idiosynkratische Storungen zu gewahrleisten. Steuerpolitik Umverteilung Risikoteilung Beziehungen zwischen Regierungen Regionen Arachi G., Ferrario C. y Zanardi A. Redistribucion regional y riesgo compartido en Italia: el rol de los diferentes niveles de gobierno, Regional Studies. En este articulo ofrecemos las estimaciones de la redistribucion y el riesgo compartido en varias jurisdicciones regionales del sector publico en Italia. En este analisis se consideran expresamente la estructura multinivel del gobierno italiano y las relaciones financieras vinculadas a los diferentes estratos de gobierno. Con ayuda de datos de panel para el periodo 1996-2002 observamos que las politicas publicas en Italia reducen considerablemente las diferencias entre los niveles del PIB per capita en las regiones. Sin embargo, en el presupuesto publico, lejos de ofrecer un seguro contra los choques idiosincrasicos, se acentuan en gran medida las fluctuaciones de ingresos en las regiones. Politica fiscal Redistribucion Riesgo compartido Relaciones intergubernamentales RegionesFiscal policy, Redistribution, Risk sharing, Inter-governmental relations, Regions,