Health Equity: February 2010

Monday, February 22, 2010

[EQ] Conference: Connecting Ideas and Knowledge Sharing on Equity and Health - February 24th, 2010

Connecting Ideas and Knowledge Sharing on Equity and Health

PAHO/WHO Symposium – 9:00 am – 5:00 pm February 24th, 2010
10^th Anniversary of Equity and Health listserv

This symposium on health determinants and inequalities will be focused on the analysis of thematic trends and conceptual frameworks developed in the last 10 years and their policy implications. It also will address global methodological issues of measuring health inequalities and evaluating policy and program impact.

The agenda by topic is below. The entire meeting will be web cast in order to reach a wide international audience of health equity researchers and advocates.

The format will be a short presentation on the subject of each panel 10-15 min max – Three/four discussants 5 to 10 min max. - Q&A 15 min max. .from

Participants in person:

PAHO Pan American Health Organization Regional Office of the World Health Organization
525 Twenty-third Street, N.W.
Washington, D.C. 20037, United States of America
Room A

Virtual participants via web:
https://sas.elluminate.com/m.jnlp?sid=1110&password=M.A4FA308B5F1FA6CD60DB62C0137303

Language: Simultaneous translation English/Spanish

Note: Please connect a few minutes before 9:00am. Please make sure you have a headset or speaker and microphone.

This event is being organized by WHO, PAHO/WHO, and Kellogg Fellows

Equity and Health Connecting Ideas and Knowledge Sharing February 24th, 2010 PAHO/WHO Pan American Health Organization 525 23^rd St. NW Washington DC 20037 *Room A*
Time				Welcome remarks Dr Mirta Roses, Director PAHO/WHO
9:00 - 9:15 am
				Panel			Speakers	Discussants
9:15-10:15am				Following up the Commission on Social Determinants of Health: How Do We Move to Action?			Dr Rüdiger Krech Director, Department of Ethics, Equity, Trade and Human Rights, World Health Organization, WHO Geneva, Switzerland Sir Michael Marmot, Director, International Institute for Society and Health, University College, London Galvao, Dr. Luiz Augusto PAHO/WHO Sustainable Environmental Health SDE Area Manager Dr Jose Romero Teruel, Professor Georgetown University *Chair:* Dr. Kumanan Rasanathan, Department of Ethics, Equity, Trade and Human Rights, World Health Organization, WHO, Geneva, Switzerland			Sir George Alleyne Former PAHO/Director Emeritus Dr. Jeanette Vega, Undersecretary for Public Health, Ministry of Health, Chile Dr. Bernardo Kliksberg, UNDP advisor; UNDP-Spain Fund Director Dr Alex Scott-Samuel, EQUAL (Equity in Health Research and Development Unit) Division of Public Health University of Liverpool
10:15 –10:30 am				Thematic Networks and Dissemination of Information			Ana Lucia Ruggiero, EQ List Moderator KMC - PAHO/WHO Barbara Krimgold, Director, Kellogg Fellows and Scholars Programs, CFAH Kira Fortune, VHL- Social Determinants of Health SDE PAHO Sandra Raiher, CEDES Argentina
10:30- 10:45am coffee break

10:45 - 12:30pm			Understanding the determinants of health & implementing population health programs			Dr Paula Braveman, MD, MPH Professor of Family and Community Medicine; Director, Center on Social Disparities in Health - University of California, San Francisco Chair: Dr. Alexandra (Lexi) B. Nolen, PhD, MPH Director, Center to Eliminate Health Disparities; Associate Director of the PAHO/WHO Center for Training in International Health; University of Texas Medical Branch			Kenneth Olden, Dean, CUNY Institute for Health Equity, Lehman College, and Professor, Hunter College, NYC Dr.Ulises Pannisset, Coordinator Research Translation to Policy Unit and EVIPNet, RPC/IER, WHO Erin Ueffing Administrator, Campbell and Cochrane Equity Methods Group, Centre for Global Health, Institute of Population Health -University of Ottawa Dr. Olivia Carter-Pokras, Associate Professor, Department of Epidemiology and Biostatistics University of Maryland College Park School of Public Health Dr. Clem Bezold, Chairman, Institute for Alternative Futures Dr Oscar Mujica, Epidemiologist, Health Surveillance, Disease Prevention and Control PAHO/WHO
Lunch
1:30 - 2:00 pm	An Equity of Opportunity Framework for Child Development				Dr. Dolores Acevedo-Garcia Associate Professor, Northeastern University, Bouve College of Health Sciences and Director, Institute on Urban Health Research				Dr. Manuel Peña PAHO/WHO Nutrition Center Dr. Emma Sanchez – Kellogg Health Scholar, Center on Social Disparities in Health, University of California, San Francisco Dr. Karen Ertel – Kellogg Health Scholar, Harvard School of Public Health
2:00 - 3:00 pm	Global Health & Ethics				Dr. Lawrence O. Gostin Linda D. and Timothy J. O’Neill Professor of Global Health Law; Faculty Director, O’Neill Institute for National and Global Health Law; Professor of Public Health, the Johns Hopkins University Georgetown Law Dr. Gregg Bloche Professor of Law; Co-Director, Georgetown-Johns Hopkins Joint Program in Law and Public Health B.A., Columbia; J.D., M.D., Yale				Dr. Jennifer Prah Ruger, Associate Professor at Yale University Schools of Medicine, Public Health, Law, and Graduate School of Arts and Sciences Dr. Fernando Lolas, Bioethics Program Director PAHO/WHO Dr Javier Vasquez PAHO/WHO Human Rights Law Advisor

3:30 - 4:00 pm		Knowledge Networks			Ramesh Krishnamurthy US CDC Al Shorbaji, Najeeb Mohamed, KMC WHO				Theresa Bernardo, PAHO/WHO, KMC Agnes Soares BIREME PAHO/WHO Marcelo D’Agostino PAHO/WHO, KMC Stacey Aronson US National Library of Medicine NLM Rosina Salerno, PAHO/WHO
4:00 - 4:30 pm		Immigration and Health in the Americas: Linked Destinies			Dr. Dolores Acevedo –Garcia PhD, MPA-URP Associate Professor, Bouve College of Health Sciences Associate Director, Institute on Urban Health Research Northeastern University				Dr. Edna Viruell-Fuentas - Assistant Professor, Latino/Latina Studies, University of Illinois at Urbana-Champaign Dr. Emma Sanchez – Kellogg Health Scholar, Center on Social Disparities in Health, University of California, San Francisco Dr. Shedra Amy Snipes - NCI Cancer Prevention Fellow, University of Texas Health Science Center Dr. Rifat Latifi, MD,FACS Professor of Surgery The University of Arizona, Department of Surgery Vice Chairman, International Relations
4:30 - 5:30 pm		Health Financing			Ms. Amada Glassman, Principal Health Specialist, Inter-American Development Bank IADB/BID Dr. David Gwatkin, World Bank advisor Dr. Philip Musgrove, Health Affairs Dr. Abdo Yazbeck, Health Sector Manager, Europe and Central Asia Region The World Bank Chair: Dr. Ruben Suarez Senior Advisor, Public Policies, Regulation, & Health Financing, PAHO/WHO
5:30 pm		Closing remarks Dr Jon Andrus, Deputy Director PAHO/WHO Dr Socorro Gross, Assistant Director PAHO/EHO

* * *
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information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
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Information Technology - Virtual libraries; Research & Science issues. [DD/ KMC Area]

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and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
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[EQ] The Impact of Competition on Management Practices in Public Hospitals

The Impact of Competition on Management Practices in Public Hospitals

Nicholas Bloom Stanford University, NBER and Centre for Economic Performance

Carol Propper Imperial College, CMPO University of Bristol and CEPR

Stephan Seiler London School of Economics, Centre for Economic Performance

John Van Reenen London School of Economics, Centre for Economic Performance, NBER and CEPR

Stanford Department of Economics This draft: October 17th 2009

Available online PDF [35p] at : http://www.stanford.edu/~nbloom/hospitals.pdf

“……….We exploit a unique dataset and natural experiment to identify the impact of competition on public hospital management practices. We use a new double-blind management scoring tool to interview 161 physicians and managers in English National Health Service (NHS) hospitals, covering 61% of acute hospitals.

We find this management measure is strongly correlated with hospital performance as measured by clinical outcomes (e.g. survival rates from heart attacks) and general operational and financial outcomes. We then instrument the number of competing local public hospitals with the share of marginal local political constituencies.

In the UK the Government almost never closes public hospitals in political marginals because they risk losing seats in a general election. But they do regularly close hospitals in both their own and the oppositions non-marginal constituencies. Over the period we study the Labor government closed a large number of hospitals, leading to wide variations in hospital concentration levels, which are strongly correlated with whether the constituency was politically marginal. Exploiting this identification we find that product market competition, as proxied by the proximity of other hospitals, is significantly associated with better management…..”

“………..In this paper we have described a new methodology for quantifying the quality of management practices in the healthcare sector. We have implemented this survey tool on almost two thirds of acute hospitals in England. We found that our measure of management quality was robustly associated with better hospital outcomes across mortality rates and other indicators of hospital performance. This is consistent with Bloom and Van Reenen’s (2007) work in the manufacturing sector………..

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Thursday, February 18, 2010

[EQ] Getting the measure of quality

Getting the measure of quality

Opportunities and challenges

Veena S Raleigh, Senior Fellow in the policy directorate at The King’s Fund working on quality measurement and epidemiological issues.

Catherine Foot, Senior Fellow in the policy directorate at The King’s Fund. She is currently managing a programme of work on delivering the quality agenda

The King’s Fund 2010

Available online PDF [36p.] at: http://www.kingsfund.org.uk/research/publications/quality_measures.html

“……Another aspect of quality that has received relatively little focus in the context of the quality measurement initiatives following the Next Stage Review is that of inequalities.

Health care (preventive and curative) should be provided on the basis of clinical need, regardless of personal characteristics such as age, gender, ethnicity, disability, religion, sexual orientation, socio-economic status or geographical location, and it should aim to reduce differences in health status, access to services and outcomes across population sub-groups.

Equality legislation also mandates requirements for equity, and the Marmot Review has put a renewed focus on health inequalities (Strategic Review of Health Inequalities in England 2009). England has been among the international leaders in terms of setting targets and driving cross-government and public health policies to reduce health inequalities (Department of Health 2009b). Although health inequalities have continued to widen, they remain a top priority for the government. But the quality agenda has not yet encompassed the measurement of inequalities and equity and currently lacks an explicit focus on reducing inequalities….”

Content:

Introduction

1 Defining quality: what are we measuring?

Domains of quality

Efficiency, productivity and value for money

Equity and health inequalities

Measurement across pathways and between organisations

Not everything that matters can be measured

2 Who uses quality measures and for what purpose?

Audiences for measures of quality

The aims of measurement should determine what and how we measure

Interpretation matters: what measures of quality can and can’t tell you

The importance of a coherent policy framework for quality improvement

3 The potential impact of measuring quality

Use for measurement to improve the quality of health care

International comparisons and benchmarking

Potential for unintended consequences

4 Practical issues to consider when choosing and using quality measures

Selection of indicators

Data sources: current versus new

Data coverage and quality

Reporting on data quality

Some methodological and related issues

Centrally versus locally produced indicators

Evaluating and refining indicators

5 Conclusions

Useful reading

References

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[EQ] Nordic health care systems - Recent reforms and current policy challenges'EQUIDAD@LISTSERV.PAHO.ORG'

Nordic health care systems

Recent reforms and current policy challenges

Open University Press, McGraw-Hill Education
World Health Organization 2009 on behalf of the European Observatory on Health Systems and Policies

Available online PDF [362p.] at: http://www.euro.who.int/document/e93429.pdf

“….The Nordic model of health care systems is assumed to contain consistent features across all five Nordic countries, Finland, Sweden, Denmark, Norway and Iceland: tax-based funding, publicly owned and operated hospitals, universal access based on residency, and comprehensive coverage. The reality is considerably more complex, with great variation at the structural level in the way that institutions are designed and at the policy level in the way strategies are conceived and implemented.

This new comparative study, which also assesses the influence of the European Union on the Nordic health systems, highlights how the Nordic countries have retained the principles of universalism and equity while promoting the benefits of patient choice. These insights will be a welcome addition for health sector policy-makers and for students of health policy, not just in the Nordic countries but across Europe.

The editors:
Jon Magnussen Professor in the Department of Public Health and Community Medicine at the Norwegian University of Science and Technology in Trondheim, Norway.
Karsten Vrangbaek Lecturer at the University of Copenhagen, Denmark.
Richard B. Saltman Associate Head of Research Policy at the European Observatory on Health Systems and Policies, and Professor of Health Policy and Management at the Rollins School of Public Health, Emory University in Atlanta, Georgia.

The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Norway, Slovenia, Spain and Sweden, the Veneto Region, the European Investment Bank, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine

Part I Nordic health care systems: balancing stability and change

one Introduction: the Nordic model of health care

Jon Magnussen, Karsten Vrangbæk, Richard B. Saltman and Pål E. Martinussen

two Health care reform: the Nordic experience

Pål E. Martinussen and Jon Magnussen

three The political process of restructuring Nordic health systems

Karsten Vrangbæk

four Looking forward: future policy issues

Richard B. Saltman and Karsten Vrangbæk

Part II Nordic health systems: key issues

five The changing political governance structures of Nordic health care systems

Terje P. Hagen and Karsten Vrangbæk

six Meeting rising public expectations: the changing roles of patients and citizens

Ulrika Winblad and Ånen Ringard

seven The changing autonomy of the Nordic medical professions

Peter K. Jespersen and Sirpa Wrede

eight Maintaining fiscal sustainability in the Nordic countries

Clas Rehnberg, Jon Magnussen and Kalevi Luoma

nine Harnessing diversity of provision

Unto Häkkinen and Pia M. Jonsson

ten Changing perceptions of equity and fairness

Johan Calltorp and Meri Larivaara

eleven Reforming primary health care

Allan Krasnik and Bård Paulsen

twelve Addressing the dual goals of improving health and reducing health inequalities

Signild Vallgårda and Juhani Lehto

thirteen Changing demands for institutional management

Lars Erik Kjekshus

fourteen The European Union: single market pressures

Dorte S. Martinsen and Paula Blomqvist

fifteen The Icelandic health care system 3

Tinna L. Ásgeirsdóttir

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