Monday, September 27, 2010

[EQ] Priority setting in primary health care - dilemmas and opportunities

Priority setting in primary health care - dilemmas and opportunities:
a focus group study

Eva Arvidsson 1, 2*, Malin André 3,4, Lars Borgquist 4, Per Carlsson 5

1 Department of Medicine and Health Sciences, Centre for Medical Technology Assessment, Linköping University, Linköping, Sweden

2 Department of Primary Health Care, Kalmar, Sweden

3 Centre for Clinical Research, Falun, Sweden

4 Department of Medicine and Health Sciences, Division of General Practice, Linköping University, Linköping, Sweden

5 Department of Medicine and Health Sciences, Centre for Priority Setting in Health Care


BMC Family Practice 2010, 11:71doi:10.1186/1471-2296-11-71 - September 2010

Available online PDF [31p.] at: http://bit.ly/cbtZlr

Background

Swedish health care authorities use three key criteria to produce national guidelines for local priority setting:
- severity of the health condition,
- expected patient benefit, and
- cost-effectiveness of medical intervention.

Priority setting in primary health care (PHC) has significant implications for health costs and outcomes in the health care system. Nevertheless, these guidelines have been implemented to a very limited degree in PHC. The objective of the study was to qualitatively assess how general practitioners (GPs) and nurses perceive the application of the three key priority-setting criteria.

Methods

Focus groups were held with GPs and nurses at primary health care centres, where the staff had a short period of experience in using the criteria for prioritising in their daily work.

Results

The staff found the three key priority-setting criteria (severity, patient benefit, and cost-effectiveness) to be valuable for priority setting in PHC. However, when the criteria were applied in PHC, three additional dimensions were identified: 1) viewpoint (medical or patient's), 2) timeframe (now or later), and 3) evidence level (group or individual).

Conclusions

The three key priority-setting criteria were useful. Considering the three additional dimensions might enhance implementation of national guidelines in PHC and is probably a prerequisite for the criteria to be useful in priority setting for individual patients.



“…..….Priority setting can be defined as making a choice based on a ranking process, although occasionally the term is used as a synonym for rationing or resource allocation
[1,2]. Prioritising takes place in all parts of the health care system where demands and needs exceed resources. Decisions on priority setting are made at different levels [3,4]. General policy decisions are made at national and regional levels, as are comprehensive decisions on resource allocation, systems for financing providers, and national guidelines including priority setting for management of common diseases.

 

This paper addresses primary care, where priorities are set on a practical, individual level.

In Sweden nearly all health care is publicly financed through taxes, and the entire population is insured. Each primary health care centre is funded based on the number of patients linked to the centre, and in some instances the number of visits determines a small portion of the budget. Hence, each primary health care centre receives a limited, fixed budget to serve its patients…..” from background….

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
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[EQ] Obesity and the Economics of Prevention: Fit not Fat

Obesity and the Economics of Prevention: Fit not Fat

 

OECD and World Health Organization. WHO – 2010

Health Ministers will discuss this report when they meet at the OECD on 7-8 October 2010 in Paris.

Website: http://bit.ly/c25jeB

 

“…..OECD’s new report examines the scale and characteristics of the current obesity epidemic, the respective roles and influences of market forces and governments, and the impact of interventions to tackle obesity.

The report presents for the first time analyses and comparisons of the most detailed data on obesity available from 11 OECD countries. It includes a unique analysis of the health and economic impact of a range of interventions to tackle obesity in 5 countries, carried out jointly by the OECD and the World Health Organization. WHO…”

 

 

“…..Obesity has risen to the top of the public health policy agenda worldwide. Before 1980, rates were generally well below 10%. They have since doubled or tripled in many countries, and in almost half of the OECD, 50% or more of the population is overweight. A key risk factor for numerous chronic diseases, obesity is a major public health concern.

There is a popular perception that explanations for the obesity epidemic are simple and solutions within reach. But the data reveal a more complicated picture, one in which even finding objective evidence on the phenomenon is difficult. Policy makers, health professionals and academics all face challenges in understanding the epidemic and devising effective counter strategies.

This book contributes to evidence-based policy making by exploring multiple dimensions of the obesity problem. It examines the scale and characteristics of the epidemic, the respective roles and influence of market forces and governments, and the impact of interventions. It outlines an economic approach to the prevention of chronic diseases that provides novel insights relative to a more traditional public health approach….”

 

Executive Summary: http://www.oecd.org/dataoecd/21/19/46004918.pdf

 

Table of Contents
 

Chapter 1. Introduction: Obesity and the Economics of Prevention

• Obesity: The extent of the problem

• Obesity, health and longevity

• The economic costs of obesity

• The implications for social welfare and the role of prevention

• What economic analyses can contribute

• The book’s main conclusions

• Overview of the remaining chapters

• Special Focus I. Promoting Health and Fighting Chronic Diseases: What Impact on the Economy? (by Marc Suhrcke)

 

Chapter 2. Obesity: Past and Projected Future Trends

• Obesity in the OECD and beyond

• Measuring obesity

• Historical trends in height, weight and obesity

• Cohort patterns in overweight and obesity

• Projections of obesity rates up to 2020

 

Chapter 3. The Social Dimensions of Obesity

• Obesity in different social groups

• Obesity in men and women

• Obesity at different ages

• Obesity and socio-economic condition

• Obesity in different racial and ethnic groups

• Does obesity affect employment, wages and productivity?

• Special Focus II. The Size and Risks of the International Epidemic of Child Obesity (by Tim Lobstein)

 

Chapter 4. How Does Obesity Spread?

• The determinants of health and disease

• The main driving forces behind the epidemic

• Market failures in lifestyle choices

• The social multiplier effect: Clustering of obesity within households, peer groups and social networks

• Special Focus III. Are Health Behaviors Driven by Information? (by Donald Kenkel)

 

Chapter 5. Tackling Obesity: The Roles of Governments and Markets

• What can governments do to improve the quality of our choices?

• Government policies on diet and physical activity in the OECD area

• Private sector responses: Are markets adjusting to the new challenges?

• Special Focus IV. Community Interventions for the Prevention of Obesity (by Francesco Branca) 

 

Chapter 6. The Impact of Interventions

• What interventions really work?

• Cost-effectiveness analysis: A generalised approach

• Effects of the interventions on obesity, health and life expectancy

• The costs and cost-effectiveness of interventions

• Strategies involving multiple interventions

• Distributional impacts of preventive interventions

• From modelling to policy: Key drivers of success

• Special Focus V. Regulation of Food Advertising to Children: the UK Experience (by Jonathan Porter)

• Special Focus VI. The Case for Self-Regulation in Food Advertising (by Stephan Loerke)

 

Chapter 7. Information, Incentives and Choice: A Viable Approach to Preventing Obesity

• Tackling the obesity problem

• Populations or individuals?

• Changing social norms .

• A multi-stakeholder approach

• How much individual choice?

 

Authors:

Franco Sassi – Senior Health Economist and main author of the report

Michele Cecchini – Health Policy Analyst and co-author

Marion Devaux – Statistician and co-author


 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
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[EQ] Policy-Making as a Struggle for Meaning: Disentangling Knowledge Translation across International Health Contexts

Policy-Making as a Struggle for Meaning:
Disentangling Knowledge Translation across International Health Contexts

Aris Komporozos-Athanasiou, Eivor Oborn, Michael Barrett and Yolande Chan

School of Management, Royal Holloway University of London

Working Paper Series SoMWP–1005 -June 2010

Available online PDF [27p.] at: http://bit.ly/9h0jpG

 

"……While evidence-based medicine has increasingly sought to transform decision making in clinical practice, this trend has not been followed by a similar logic in health management and policy-making. This has ultimately led to significant discrepancies between policy and practice (Walshe and Rundall 2001, van der Schee et al 2007).

In this paper, we argue the need to step back and analyze the development of policy discourse in different institutional and national contexts as an important starting point in further understanding how this policy-practice „gap develops over time. We consider this discourse not only regarding its role in directing healthcare policy, but moreover vis-à-vis its ability to render visible concurrent political structures and mechanisms (Moon and Brown 2000).

Moreover, we explore the linkages between the rise of a public sector discourse and its varied manifestations with the different notions of citizen, user and, in our case, patient in co-designing best practice and transferring knowledge during service restructuring (Löffler 2009), which has emerged as an important area of debate in healthcare policy (Dawson and Morris 2009). Rather than being viewed as a passive recipient, the patient as service user may be central in re-structuring care, especially through making "informed choices" and as well as participating in the service design and thereby acquiring more control over the process of care delivery (Fotaki 2005; Le Grand 2004; Löffler 2009).

Our approach is to unearth how different underlying meanings of best practices - deemed as gold standards by medical science - are discursively enacted in health policies across different institutional and political contexts.

To this end, we analyzed stroke care related policies in the UK and Canada. In the UK, we examined both the general "umbrella" healthcare strategies that informed and influenced the re-organizing of stroke care services as well as the various reviews and policy guidelines that were generated after the launch of the National Stroke Strategy…."



 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

"Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members".
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