De griepprik in Nederland: motivatie voor deelname en distributiekanalen.

Eenderde van de mensen die vanwege leeftijd of gezondheidstoestand in aanmerking komt voor een gratis influenza-vaccinatie, haalt de griepprik niet. Men denkt er ten onrechte niet voor in aanmerking te komen (23%) of men denkt voldoende weerstand te hebben tegen griep (32%). Vijf procent van de 'weigeraars' is principieel tegen inenten (5%). Over het algemeen is de vaccinatiecampagne in Nederland succesvol, vergeleken met de ons omringende landen. Nederland scoort de hoogste vaccinatiegraad voor ouderen. Toch zou de huisarts nog meer mensen over de streep kunnen trekken, door ze een persoonlijke uitnodiging te sturen en ze betere, meer op hun persoon en specifieke aandoening toegesneden, voorlichting te geven over de risico's van griep. Eén op de tien van de niet-gevaccineerden die deel uitmaken van een risicogroep, meent dat de gevolgen van griep niet ernstig zijn. Ongeveer 30 procent van de mensen in de risicogroepen krijgt geen persoonlijke uitnodiging van hun dokter. Eerder onderzoek toonde aan dat vaccineren van ouderen en risicopatiënten een aanzienlijke positieve invloed op de economie heeft. Er is minder ziekteverzuim en door minder ziekenhuisopnames blijven veel kosten voor zorg bespaard. De gezondheidsraad adviseert artsen, mede om deze redenen, leden uit de risicogroep te vaccineren. Dat zijn patiënten met een hartziekte, longziekte, nierziekte of met diabetes. Sinds 1996 heeft bovendien iedere 65-plusser ongeacht zijn gezondheidsstatus recht op gratis vaccinatie. Ongeveer 23 procent van alle Nederlanders laat zich inenten tegen griep. De meeste van hen behoren tot één van de risicogroepen. 'Gezonde' volwassenen noemen als reden voor vaccinatie vooral het niet willen krijgen van griep of het lopen van een hoger risico vanwege een beroep met veel contacten met andere mensen. Het NIVEL onderzocht de motivatie voor deelname en distributiekanalen van de griepvaccinatie in Nederland in opdracht van het College voor Zorgverzekeringen (www.cvz.nl). Het onderzoek is verricht onder leden van het Patiëntenpanel Chronisch Zieken en door middel van een steekproef van de Nederlandse bevolking

Stagnating influenza vaccine coverage rates among high-risk groups in Poland and Sweden in 2003/4 and 2004/5.

This paper examines influenza vaccine coverage rates (VCR) in Poland and Sweden during the 2003/4 and 2004/5 influenza seasons. An average sample of 2,500 persons was interviewed in each country and each season. Questions regarded age and possible chronic diseases, as well as information on whether they had had an influenza vaccination in the given season. Those who had not received the vaccine were also asked to give reasons for non-vaccination. About one in four (Sweden) to one in three (Poland) of the persons surveyed belonged to high-risk groups (>=65 years of age or suffering from chronic diseases). In the 2004/5 season, 17% (CI 12-19%) of the Polish elderly and 45% (CI 39-50%) of the Swedish elderly were vaccinated. In Poland, 9% (CI 7-12%) of respondents younger than 65 years of age with a chronic condition were vaccinated, whereas in Sweden the corresponding rate was 12% (CI 9-16%). In both countries, the VCR did not change significantly from the previous season. Personal invitations resulted in a higher VCR. In Sweden, the most frequently mentioned reasons for not being vaccinated were the assumption of not qualifying for a vaccination and perceived resistance. In Poland in both years, perceived resistance to flu and the cost of the vaccination were the most often mentioned reasons. The influenza vaccination rates in Poland and Sweden remain far below World Health Organization (WHO) recommendations for the high-risk population. No increase in VCR as demonstrated in this study may indicate that these two countries will not be able to meet the 2010 WHO target, if no further action is taken concerning vaccine uptake. (aut. ref.

Health policy as a fuzzy concept: methodological problems encountered when evaluating health policy reforms in an international perspective.

Investigating health policy reforms at a national level is a troublesome task, since it is difficult to establish exactly when a certain policy change took place and it is also difficult to determine the content of the reform. In this paper three main causes are distinguished that contribute to the 'fuzziness' surrounding reforms. Firstly, ordinary mistakes occur, even experts err. Secondly, in some countries responsibility for (part of the) health care system is delegated to the regional level, causing regional variations which lead to uninterpretable effects at country-level health care descriptions. Thirdly policy reforms are often not a straightforward process. Implementations can be characterized as a gradual process which can be disturbed at any point in time. For example, the use of framework legislation, effects of public discussions and law enforcement problems contribute to the fuzziness. To strengthen the validity of information from secondary sources (often the best available and linguistically accessible sources) the use of primary sources and expert consultation highly recommended, respectively giving insight in formal rules and initial intentions of policy measures and in the impact of reforms at performance level. The fuzziness can be captured into an index (reform implementation index), containing the gathered information and thus facilitating statisticial analyses controlling for process-information. (aut.ref.

Income development of general practitioners in eight European countries from 1975 to 2005.

Background: This study aims to gain insight into the international development of GP incomes over time through a comparative approach. The study is an extension of an earlier work (1975-1990, conducted in five yearly intervals). The research questions to be addressed in this paper are: 1) How can the remuneration system of GPs in a country be characterized? 2) How has the annual GP income developed over time in selected European countries? 3) What are the differences in GP incomes when differences in workload are taken into account? And 4) to what extent do remuneration systems, supply of GPs and gate-keeping contribute to the income position of GPs? Methods: Data were collected for Belgium, Denmark, Germany, Finland, France, the Netherlands, Sweden and the United Kingdom. Written sources, websites and country experts were consulted. The data for the years 1995 and 2000 were collected in 2004-2005. The data for 2005 were collected in 2006-2007. Results: During the period 1975-1990, the income of GPs, corrected for inflation, declined in all the countries under review. During the period 1995-2005, the situation changed significantly: The income of UK GPs rose to the very top position. Besides this, the gap between the top end (UK) and bottom end (Belgium) widened considerably. Practice costs form about 50% of total revenues, regardless of the absolute level of revenues. Analysis based on income per patient leads to a different ranking of countries compared to the ranking based on annual income. In countries with a relatively large supply of GPs, income per hour is lower. The type of remuneration appeared to have no effect on the financial position of the GPs in the countries in this study. In countries with a gate-keeping system the average GP income was systematically higher compared to countries with a direct-access system. Conclusions: There are substantial differences in the income of GPs among the countries included in this study. The discrepancy between countries has increased over time. The income of British GPs showed a marked increase from 2000 to 2005, due to the introduction of a new contract between the NHS and GPs. (aut. ref.

Direct access in primary care and patient satisfaction: a European study.

Objective: This study addressed the question to what extent gate-keeping or direct access to health care services influences the satisfaction with GP-services by the population in 18 European countries ("old" EU-countries plus Norway, Iceland and Switzerland). METHODS: Two datasets were collected. Firstly, country experts were asked to indicate for 17 different health care providers whether they were directly accessible. A direct accessibility scale was computed from the percentage of services that were directly accessible. Secondly, for patient satisfaction the EUROPEP study was used. This dataset contained information about patient satisfaction with general practitioners services in 14 European countries. RESULTS: If more health care providers were directly accessible in a country, patients showed a higher satisfaction with general practice than in countries where more referrals were required (Pearson's r = 0.54, p = 0.05). Satisfaction with organisational aspects of general practice (concerning amongst others waiting time and possibilities to make appointments) correlates significantly with a high score on our direct accessibility measure (Pearson's r = 0.67, p = 0.01). Satisfaction with patient physician communication (Pearson's r = 0.46, p = 0.10) and medical technical content of the care (Pearson's r = 0.41, p = 0.14) are not influenced by direct accessibility. CONCLUSIONS: Direct accessibility appeared to be important for patients. Apparently, if patients have freedom of choice for the type of health care provider, they evaluate the GP-services more positively. However, this mainly concerns satisfaction with organisational aspects of GP-services; the accessibility does not influence patient's judgement about the actual care provided by their GP. (aut.ref.