| 1. |
- Bremer, Patrick, et al.
(author)
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Informal dementia care: Consequences for caregivers' health and health care use in 8 European countries.
- 2015
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In: Health Policy. - : Elsevier BV. - 1872-6054 .- 0168-8510. ; 119:11, s. 1459-1471
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Journal article (peer-reviewed)abstract
- Informal (dementia) care has economic consequences throughout the health care system. Whilst the health and wellbeing of the care recipient might improve, the health of the caregiver might also change, typically for the worse. Therefore, this analysis aims to examine the association between caregiving intensity and caregivers' health and health care utilization.
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| 2. |
- Broqvist, Mari, 1958-, et al.
(author)
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The meaning of severity - do citizenś views correspond to a severity framework based on ethical principles for priority setting?
- 2018
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In: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 122:6, s. 630-637
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Journal article (peer-reviewed)abstract
- The importance for governments of establishing ethical principles and criteria for priority setting in line with social values, has been emphasised. The risk of such criteria not being operationalised and instead replaced by de-contextualised priority-setting tools, has been noted. The aim of this article was to compare whether citizenś views are in line with how a criterion derived from parliamentary-decided ethical principles have been interpreted into a framework for evaluating severity levels, in resource allocation situations in Sweden. Interviews were conducted with 15 citizens and analysed by directed content analysis. The results showed that the multi-factorial aspects that participants considered as relevant for evaluating severity, were similar to those used by professionals in the Severity Framework, but added some refinements on what to consider when taking these aspects into account. Findings of similarities, such as in our study, could have the potential to strengthen the internal legitimacy among professionals, to use such a priority-setting tool, and enable politicians to communicate the justifiability of how severity is decided. The study also disclosed new aspects regarding severity, of which some are ethically disputed, implying that our results also reveal the need for ongoing ethical discussions in publicly-funded healthcare systems.
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| 3. |
- Carson, Dean B., et al.
(author)
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The 'rural pipeline' and retention of rural health professionals in Europe's northern peripheries
- 2015
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In: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 119:12, s. 1550-1556
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Journal article (peer-reviewed)abstract
- The major advance in informing rural workforce policy internationally over the past 25 years has been the recognition of the importance of the 'rural pipeline'. The rural pipeline suggests that people with 'rural origin' (who spent some childhood years in rural areas) and/or 'rural exposure' (who do part of their professional training in rural areas) are more likely to select rural work locations. What is not known is whether the rural pipeline also increases the length of time professionals spend in rural practice throughout their careers. This paper analyses data from a survey of rural health professionals in six countries in the northern periphery of Europe in 2013 to examine the relationship between rural origin and rural exposure and the intention to remain in the current rural job or to preference rural jobs in future. Results are compared between countries, between different types of rural areas (based on accessibility to urban centres), different occupations and workers at different stages of their careers. The research concludes that overall the pipeline does impact on retention, and that both rural origin and rural exposure make a contribution. However, the relationship is not strong in all contexts, and health workforce policy should recognise that retention may in some cases be improved by recruiting beyond the pipeline.
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| 4. |
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| 5. |
- Harder, Thomas, et al.
(author)
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Towards a framework for evaluating and grading evidence in public health
- 2015
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In: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 119:6, s. 732-736
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Journal article (peer-reviewed)abstract
- The Project on a Framework for Rating Evidence in Public Health (PRECEPT) is an international collaboration of public health institutes and universities which has been funded by the European Centre for Disease Prevention and Control (ECDC) since 2012. Main objective is to define a framework for evaluating and grading evidence in the field of public health, with particular focus on infectious disease prevention and control. As part of the peer review process, an international expert meeting was held on 13-1 4 June 2013 in Berlin. Participants were members of the PRECEPT team and selected experts from national public health institutes, World Health Organization (WHO), and academic institutions. The aim of the meeting was to discuss the draft framework and its application to two examples from infectious disease prevention and control. This article introduces the draft PRECEPT framework and reports on the meeting, its structure, most relevant discussions and major conclusions.
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| 6. |
- Hedenrud, Tove, 1967, et al.
(author)
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Purchase habits, use of paracetamol, and information sources on a reregulated Swedish pharmacy market: A population-based study
- 2017
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In: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 121:1, s. 35-41
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Journal article (peer-reviewed)abstract
- © 2016 Elsevier Ireland LtdConsidering the general lack of knowledge on how over-the-counter paracetamol is used combined with the reported increase in paracetamol poisonings after the reregulation of the Swedish pharmacy market in 2009, we aimed to analyze purchase habits and use of paracetamol in Sweden. A further aim was to investigate sources of information about paracetamol. Data were collected in October 2015 through the Citizen Panel, a Web-based panel encompassing over 50,000 Swedes. A stratified sample of 6000 (aged 18 years and older) was emailed a survey invitation. Questions concerned paracetamol use, purchase habits and information sources. The participation rate was 58%. A majority (70.5%) reported use of paracetamol during the last three months. Purchasing paracetamol solely over-the-counter was most common (81.1%). Close to two-thirds usually purchased paracetamol at a pharmacy. However, it was more common to purchase OTC paracetamol at non-pharmacy outlets among younger compared to older respondents. The results of this study did not reveal any harmful paracetamol use. The most common information source overall was patient information leaflets, and it was significantly more common among the youngest compared to older subjects. Based on our results combined with previous research, we suggest more studies, both qualitative and quantitative, among young adults, both on the use of paracetamol and on the understanding of information in patient information leaflets and on the Internet.
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| 7. |
- Jakobsson, Niklas, Docent, 1981-, et al.
(author)
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Copayments and physicians visits: A panel data study of Swedish regions 2003-2012
- 2016
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In: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 120:9, s. 1095-1099
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Journal article (peer-reviewed)abstract
- Objective: This paper analyzes how primary care physician visits are affected by the level of copayment in Sweden. Data source: We use data between the years 2003-2012 from 21 Swedish health care regions that have the mandate to set their own level of copayment. The copayment per visit varies between 10 and 20 for these years and regions. Study design: Our strategy to identify the causal effect and deal with unobserved endogeneity of price changes on physician visits is based on a panel data model using fixed effects to control for region and time and regional-variation in time trends. Principal finding: We cannot reject that the copayment has no statistical or economic effect of significance, and we estimate the "zero effect" with very high precision. Conclusion: In a setting with sub-national regions with autonomy to set copayments the results points to that the copayment is not an important predictor for the number of health care visits. The result is in line with some previous studies on European data where the range of copayments used tends to be relatively low. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
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| 8. |
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| 9. |
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| 10. |
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| 11. |
- Kullberg, Linn, et al.
(author)
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Health insurance for the healthy? : Voluntary health insurance in Sweden
- 2019
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In: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 123:8, s. 737-746
-
Journal article (peer-reviewed)abstract
- Background: In Sweden, voluntary health insurance is held only by a very small part of the population, but uptake has grown rapidly since 2000. So far, little is known about who purchases this insurance and what the insurance plans contain.Aim: To provide a comprehensive description of the coverage and content of voluntary health insurance in Sweden.Methods: Data from a national survey (Riks-SOM 2016) were used to estimate insurance coverage in different population groups. Additionally, a qualitative content analysis of the voluntary health insurance plans from seven of the largest insurance companies in Sweden was conducted.Results: Voluntary health insurance was found to be more common among high income-earners, individuals employed in the private sector, business owners, and white-collar workers. Insurance benefits varied from visiting a general practitioner to more specialised treatments like knee or hip surgery. Pre-existing medical conditions, emergency medicine, highly specialised care and ongoing chronic care was excluded from the insurance plans.Conclusion: Work-related factors such as employment sector, occupation and income appeared to be key determinants for VHI uptake in Sweden. Since the insurance plans included several restrictions, individuals with high care needs are excluded. Taken together, the results indicate that voluntary health insurance in Sweden provide benefits foremost for the healthy and wealthy.
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| 12. |
- Larsson, Lena Gunvor, et al.
(author)
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Primary care managers’ perceptions of their capability in providing care planning to patients with complex needs
- 2017
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In: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 121:1, s. 58-65
-
Journal article (peer-reviewed)abstract
- The aim of this study was to investigate primary care managers’ perceptions of their capability in providing care planning to patients with complex needs. Care planning is defined as a process where the patient, family and health professionals engage in dialogue about the patient's care needs and plan care interventions together. Methods Semi-structured interviews with 18 primary care managers in western Sweden were conducted using Westrin's theoretical cooperation model. Data were analysed using a qualitative deductive method. Main findings Results reveal that the managers’ approach to care planning was dominated by non-cooperation and separation. The managers were permeated by uncertainty about the meaning of the task of care planning as such. They did not seem to be familiar with the national legislation stipulating that every healthcare provider must meet patients’ need for care interventions and participate in the care planning. Implications for practice To accomplish care planning, the process needs to cross – and overcome – both professional and organisational boundaries. There is also a need for incentives to develop working methods that promote local cooperation in order to facilitate optimal care for patients with complex needs.
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| 13. |
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| 14. |
- Lind, Susanne, et al.
(author)
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Implementation of national palliative care guidelines in Swedish acute care hospitals: A qualitative content analysis of stakeholders’ perceptions
- 2017
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In: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 121:11, s. 1194-1201
-
Journal article (peer-reviewed)abstract
- In high-income countries a large proportion of all deaths occur in hospitals. A common way to translate knowledge into clinical practice is developing guidelines for different levels of health care organisations. During 2012, national clinical guidelines for palliative care were published in Sweden. Later, guidance for palliative care was issued by the National Board of Health and Welfare. The aim of this study was two-fold: to investigate perceptions regarding these guidelines and identify obstacles and opportunities for implementation of them in acute care hospitals. Interviews were conducted with local politicians, chief medical officers and health professionals at acute care hospitals. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. The results showed little knowledge of the two documents at all levels of the health care organisation. Palliative care was primarily described as end of life care and only few of the participants talked about the opportunity to integrate palliative care early in a disease trajectory. The environment and culture at hospitals, characterised by quick decisions and actions, were perceived as obstacles to implementation. Health professionals' expressed need for palliative care training is an opportunity for implementation of clinical guidelines. There is a need for further implementation of palliative care in hospitals. One option for further research is to evaluate implementation strategies tailored to acute care. © 2017 Elsevier B.V.
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| 15. |
- Lindstrom Egholm, Cecilie, et al.
(author)
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Implementation of a politically initiated national clinical guideline for cardiac rehabilitation in hospitals and municipalities in Denmark
- 2018
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In: Health Policy. - : ELSEVIER IRELAND LTD. - 0168-8510 .- 1872-6054. ; 122:9, s. 1043-1051
-
Journal article (peer-reviewed)abstract
- A politically initiated national clinical guideline was launched in Denmark in 2013 to improve quality and equality of cardiac rehabilitation (CR) services. The guideline is to be implemented in both hospital and community (municipality) settings due to shared responsibility for provision of CR services. Little is known about implementation outcomes of a guideline in these two settings. We aimed to study this by determining the extent to which Danish CR services in hospitals and municipalities adhered to national recommendations following the launch of the guideline. The study employed an observational, longitudinal design. Data were gathered by a questionnaire survey to compare CR services at baseline, measured in 2013 immediately before the guideline was launched, with CR services at a two-year follow up in 2015. All Danish hospital departments offering CR services (N = 36) and all municipalities (N = 98) were included. Data were analysed using inferential statistics. Hospitals reported improvement of both content and quality of CR services. Municipalities reported no change in content of services, and lower level of fulfilment of one quality aspect. The results suggest that the guideline had different impact in hospitals and municipalities and that the differences in content and quality of services between the two settings increased in the study period, thus contradicting the guidelines aim of uniform, evidence-based content of CR services across settings. (C) 2018 Elsevier B.V. All rights reserved.
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| 16. |
- Melchiorre, Maria Gabriella, et al.
(author)
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eHealth in integrated care programs for people with multimorbidity in Europe : Insights from the ICARE4EU project
- 2018
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In: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 122:1, s. 53-63
-
Journal article (peer-reviewed)abstract
- Introduction: Care for people with multimorbidity requires an integrated approach in order to adequately meet their complex needs. In this respect eHealth could be of help. This paper aims to describe the implementation, as well as benefits and barriers of eHealth applications in integrated care programs targeting people with multimorbidity in European countries, including insights on older people 65+. Methods: Within the framework of the ICARE4EU project, in 2014, expert organizations in 24 European countries identified 101 integrated care programs based on selected inclusion criteria. Managers of these programs completed a related on-line questionnaire addressing various aspects including the use of eHealth. In this paper we analyze data from this questionnaire, in addition to qualitative information from six programs which were selected as 'high potential' for their innovative approach and studied in depth through site visits. Results: Out of 101 programs, 85 adopted eHealth applications, of which 42 focused explicitly on older people. In most cases Electronic Health Records (EHRs), registration databases with patients' data and tools for communication between care providers were implemented. Percentages were slightly higher for programs addressing older people. eHealth improves care integration and management processes. Inadequate funding mechanisms, interoperability and technical support represent major barriers. Conclusion: Findings seems to suggest that eHealth could support integrated care for (older) people with multimorbidity.
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| 17. |
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| 18. |
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| 19. |
- Pirhonen, Laura, et al.
(author)
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Effects of person-centred care on health outcomes—A randomized controlled trial in patients with acute coronary syndrome
- 2017
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In: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 121:2, s. 169-179
-
Journal article (peer-reviewed)abstract
- © 2016 Elsevier Ireland LtdObjectives To study the effects of person-centred care provided to patients with acute coronary syndrome, using four different health-related outcome measures. Also, to examine the performance of these outcomes when measuring person-centred care. Data and method The data used in this study consists of primary data from a multicentre randomized parallel group, controlled intervention study for patients with acute coronary syndrome at Sahlgrenska University Hospital in Gothenburg, Sweden. The intervention and control group consisted of 94 and 105 patients, respectively. The effect of the intervention on health-related outcomes was estimated, controlling for socio-economic and disease-related variables. Results Patients in the intervention group reported significantly higher general self-efficacy than those in the control group six months after intervention start-up. Moreover, the intervention group returned to work in a greater extent than controls; their physical activity level had increased more and they had a higher EQ-5D score, meaning higher health-related quality of life. These latter effects are not significant but are all pointing towards the beneficial effects of person-centred care. All the effects were estimated while controlling for important socio-economic and disease-related variables. Conclusion The effectiveness of person-centred care varies between different outcomes considered. A statistically significant beneficial effect was found for one of the four outcome measures (self-efficacy). The other measures all captured beneficial, but not significant, effects.
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| 20. |
- Rechel, Bernd, et al.
(author)
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Public reporting on quality, waiting times and patient experience in 11 high-income countries.
- 2016
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In: Health Policy. - : Elsevier BV. - 1872-6054 .- 0168-8510. ; 120:4, s. 377-383
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Journal article (peer-reviewed)abstract
- This article maps current approaches to public reporting on waiting times, patient experience and aggregate measures of quality and safety in 11 high-income countries (Australia, Canada, England, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States). Using a questionnaire-based survey of key national informants, we found that the data most commonly made available to the public are on waiting times for hospital treatment, being reported for major hospitals in seven countries. Information on patient experience at hospital level is also made available in many countries, but it is not generally available in respect of primary care services. Only one of the 11 countries (England) publishes composite measures of overall quality and safety of care that allow the ranking of providers of hospital care. Similarly, the publication of information on outcomes of individual physicians remains rare. We conclude that public reporting of aggregate measures of quality and safety, as well as of outcomes of individual physicians, remain relatively uncommon. This is likely to be due to both unresolved methodological and ethical problems and concerns that public reporting may lead to unintended consequences.
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| 21. |
- Schmidt, Ingrid, et al.
(author)
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The national program on standardized cancer care pathways in Sweden : Observations and findings half way through
- 2018
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In: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 122:9, s. 945-948
-
Journal article (peer-reviewed)abstract
- In 2015, the Swedish government initiated a national cancer reform program to standardize cancer care pathways. Primary aims included shortened waiting times among patients with suspected cancer, increased patient satisfaction and reduced regional variation. The implementation phase of the program is now more than half way through and both achievements and challenges have been identified. The ongoing evaluation demonstrates that professional engagement and adjustments on the meso- and micro-level of the system are essential to achieving sustainable improvements. Waiting times have shortened for the pathways launched first, and patients are satisfied with a more transparent process. Physicians in primary care are satisfied to inform patients about the pathways but point out problems with comorbidity and complicated diagnostic procedures related to unspecific symptoms. Mechanisms and ethical considerations behind possible crowding-out effects need to be thoroughly highlighted and discussed with staff and management. The results so far appear promising but meso- and micro-levels of the system need to be more involved in the design processes.
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| 22. |
- Severin, Franziska, et al.
(author)
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Value judgments for priority setting criteria in genetic testing: A discrete choice experiment
- 2015
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In: Health Policy. - : Elsevier BV. - 1872-6054 .- 0168-8510. ; 119:2, s. 164-173
-
Journal article (peer-reviewed)abstract
- As our understanding of genetics has increased, so has the number of genetic tests that have entered clinical practice. Given the need of many European health care systems to contain costs, the question of how to prioritise genetic tests fairly has become an emerging concern. This study uses a discrete-choice experiment to assess the value judgements of clinical geneticists, patient representatives and other stakeholders regarding the prioritisation of genetic tests. The respondents chose between two hypothetical scenarios that differed in severity of the disease, risk of the disease, aim of the test, medical benefit of the test, and costs of the test. Standard logit models and mixed effects models were used to estimate the weights different stakeholders attached to attribute levels. Responses from 594 participants were analysed. The most highly valued attribute levels were a proven medical benefit of the test, high risk of having the disease and low costs of the test. Results also showed that rankings differ between clinical geneticists and other stakeholders. The priority weights determined within this study can inform the policy debate and improve the consistency of prioritisation in genetics. Further stakeholder deliberation is needed to explore their most appropriate use in decision practice.
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| 23. |
- Skinnars Josefsson, Malin, 1966-, et al.
(author)
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Adherence to a regulation that aims to prevent and treat malnutrition : the case of Swedish elderly care
- 2019
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In: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 123:7, s. 688-694
-
Journal article (peer-reviewed)abstract
- Malnutrition constitutes a serious and challenging problem in elderly care. In 2015, a Swedish regulation that aims to prevent and treat malnutrition came into effect. This study set out to explore associations between level of adoption of the regulation reported as: no, started, yes, in a previous survey, and registrations in a national quality registry. Registry data on screening and actions extracted from the first trimester in 2014 (n=18967), 2016 (n=20318) and 2017 (n= 25669) represented 209, 197 and 199 of 290 Swedish municipalities respectively. A repeated measures ANOVA showed that there was no effect on screened nutritional status, Pearson's chi-square that there were minor differences in types of actions, and regression analysis that the number of actions increased on average by 0.3 due to a higher level of adoption of the regulation. Over the years studied, five actions were prominent regardless of level of adoption or screened nutritional status. Hence, to date, no firm conclusions regarding effects of the regulation can be drawn. Despite the regulatory nature, it appear as if the regulation and the level of adoption reported so far is routine in theory, although not yet leveraged to an implemented practice visible in the quality registry but instead decoupled from practice.
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| 24. |
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| 25. |
- Svensson, Mikael, 1980, et al.
(author)
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A cost-effectiveness analysis of lowering residential radon levels in Sweden-Results from a modelling study.
- 2018
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In: Health policy (Amsterdam, Netherlands). - : Elsevier BV. - 1872-6054 .- 0168-8510. ; 122:6, s. 687-92
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Journal article (peer-reviewed)abstract
- Residential exposure to radon is considered as the second leading cause of lung cancer after smoking. The purpose of this study was to conduct a cost-effectiveness analysis of reducing the indoor radon levels in Sweden from the current reference level of 200Bq/m3 to the WHO suggested reference level of maximum 100Bq/m3.We constructed a decision-analytic cost-effectiveness model using input data from published literature and administrative records. The model compared the increase in economic costs to the health benefits of lower indoor radon-levels in a Swedish policy context. We estimated the cost per life-year and quality adjusted life year (QALY) gained and assessed the robustness of the results using both deterministic and probabilistic sensitivity analysis.Including (excluding) costs of added life years the cost per QALY for existing homes was €130,000 (€99,000). For new homes the cost per QALY including (excluding) costs of added life years was €39,000 (€25,000).The results indicate that it is not cost-effective to reduce indoor radon levels from 200Bq/m3 to a maximum of 100Bq/m3 in existing homes, whereas it is cost-effective for new homes.
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| 26. |
- Svereus, S., et al.
(author)
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Socioeconomic distribution of GP visits following patient choice reform and differences in reimbursement models: Evidence from Sweden
- 2018
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In: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 122:9, s. 949-956
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Journal article (peer-reviewed)abstract
- Objective: This study aims to analyse changes in the socioeconomic distribution of GP visits following primary care patient choice reform, and to compare their magnitude and direction in pure capitation, versus capitation/activity-based mixed, provider reimbursement settings. Methods: We compute absolute and relative concentration indices using total population registry data from three Swedish counties (N similar to 3.6 million) two years pre, to two years post, reform. We decompose the indices by the contribution of first, non-recurrent and recurrent visits, and compare their changes in the different provider reimbursement settings. Results: In all three counties, the number of visits increased for all population groups. Increases were larger, and distributional changes more pro-poor, in the county with mixed reimbursement. Visit increases were mostly driven by recurrent and, especially, non-recurrent, visits, which were increasingly pro-poor in all counties in absolute, but not in relative, terms. First visits either became decreasingly pro-poor, or did not change significantly. Exclusion of high users removed the pro-poor patterns in the two counties with pure capitation. Conclusions: The reform led to increased access to GP visits, but implied small changes in their socioeconomic distribution. In combination with provider reimbursement models with incentives for higher visit volumes, changes were more pro-poor over time, but it is not clear whether this was at the expense of reduced visit length or content.
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| 27. |
- Tsiantou, Vasiliki, et al.
(author)
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General Practitioners intention to prescribe and prescribing patterns in selected European settings: The OTCSOCIOMED project
- 2015
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In: Health Policy. - : ELSEVIER IRELAND LTD. - 0168-8510 .- 1872-6054. ; 119:9, s. 1265-1274
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Journal article (peer-reviewed)abstract
- The aim of this paper is to explore general practitioners (GPs) prescribing intentions and patterns across different European regions using the Theory of Planned Behavior (TPB). A cross-sectional study was undertaken in selected geographically defined Primary Health Care areas in Cyprus, Czech Republic (CZ), France, Greece, Malta, Sweden and Turkey. Face-to-face interviews were conducted using a TPB-based questionnaire. The number of GP participants ranged from 39 to 145 per country. Possible associations between TPB direct measures (attitudes, subjective norms (SN) and perceived behavioral control (PBC)) and intention to prescribe were assessed by country. On average, GPs thought positively of, and claimed to be in control of, prescribing. Correlations between TPB explanatory measures and prescribing intention were weak, with TPB direct measures explaining about 25% of the variance in intention to prescribe in Malta and CZ but only between 3% and 5% in Greece, Sweden and Turkey. SN appeared influential in GPs from Malta; attitude and PBC were statistically significant in GPs from CZ. GPs prescribing intentions and patterns differed across participating countries, indicating that country-specific interventions are likely to be appropriate. Irrational prescribing behaviors were more apparent in the countries where an integrated primary care system has still not been fully developed and policies promoting the rational use of medicines are lacking. Demand-side measures aimed at modifying GPs prescribing behavior are deemed necessary. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
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| 28. |
- Waldau, Susanne
(author)
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Bottom-up priority setting revised : a second evaluation of an institutional intervention in a Swedish health care organisation
- 2015
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In: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 119:9, s. 1226-1236
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Journal article (peer-reviewed)abstract
- Background: Transparent priority setting in health care based on specific ethical principles is requested by the Swedish Parliament since 1997. Implementation has been limited. In this case, transparent priority setting was performed for a second time round and engaged an entire health care organisation. Aims: Objectives were to refine a bottom-up priority setting process, reach a political decision on service limits to make reallocation towards higher prioritised services possible, and raise systems knowledge. Methods: An action research approach was chosen. The national model for priority setting was used with addition of dimensions costs, volumes, gender distribution and feasibility. The intervention included a three step process and specific procedures for each step which were created, revised and evaluated regarding factual and functional aspects. Evaluations methods included analyses of documents, recordings and surveys. Results: Vertical and horizontal priority setting occurred and resources were reallocated. Participants' attitudes remained positive, however less so than in the first priority setting round. Identifying low-priority services was perceived difficult, causing resentment and strategic behaviour. The horizontal stage served to raise quality of the knowledge base, level out differences in ranking of services and raise systems knowledge. Conclusions: Existing health care management systems do not meet institutional requirements for transparent priority setting. Introducing transparent priority setting constitutes a complex institutional reform, which needs to be driven by management/administration. Strong managerial commitment is required.
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| 29. |
- Wilkens, Jens, et al.
(author)
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The 2015 National Cancer Program in Sweden : Introducing standardized care pathways in a decentralized system.
- 2016
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In: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 120:12, s. 1378-1382
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Journal article (peer-reviewed)abstract
- Starting in 2015, the Swedish government has initiated a national reform to standardize cancer patient pathways and thereby eventually speed up treatment of cancer. Cancer care in Sweden is characterized by high survival rates and a generally high quality albeit long waiting times. The objective with the new national program to standardize cancer care pathways is to reduce these waiting times, increase patient satisfaction with cancer care and reduce regional inequalities. A new time-point for measuring the start of a care process is introduced called well-founded suspicion, which is individually designed for each cancer diagnosis. While medical guidelines are well established earlier, the standardisation is achieved by defining time boundaries for each step in the process. The cancer reform program is a collaborative effort initiated and incentivized by the central government while multi-professional groups develop the time-bound standardized care pathways, which the regional authorities are responsible for implementing. The broad stakeholder engagement and time-bound guidelines are interesting approaches to study for other countries that need to streamline care processes.
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| 30. |
- Wisell, Kristin, 1980-, et al.
(author)
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Diversity as salvation? : A comparison of the diversity rationale in the Swedish pharmacy ownership liberalization reform and the primary care choice reform
- 2019
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In: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 123:5, s. 457-461
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Journal article (peer-reviewed)abstract
- Widespread liberalizing reform of the Swedish community pharmacy and primary care sectors took place in 2009–2010, including opening the market to private providers. One important rationale for the reforms was to increase diversity in the health-care system by providing more choices for individuals. The aim of this study was to increase the understanding how policy makers understood and defined diversity as a concept, and as a rationale for the reforms. The method used was document analysis of preparatory work and plenary parliament debate protocols. The results show that policy makers held vague and unclear definitions of diversity, which complicated its implementation. Diversity was sometimes seen as an effect of competition–a goal–while in other cases it was seen as a condition to be met in order to achieve competition–a means. Thus, policy makers viewed diversity both as a goal and as a means, making the underlying mechanisms unclear. The findings also revealed that policy makers failed to consistently demonstrate how the introduction of competition would lead to diversity.
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| 31. |
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| 32. |
- Wisell, Kristin, et al.
(author)
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Reregulation of the Swedish pharmacy sector : A qualitative content analysis of the political rationale
- 2015
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In: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 119:5, s. 648-653
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Journal article (peer-reviewed)abstract
- In 2009, a reregulation of the Swedish pharmacy sector took place, and a fundamental change in ownership and structure followed. The reregulation provides an opportunity to reveal the politicians' views on pharmacies. The aim of thiS study was to explore and analyze the political arguments for the reregulation of the Swedish pharmacy sector in 2009. The method used was a qualitative content analysis of written political documents regarding the reregulation. The primary rationales for the reregulation were better availability, efficiency, price pressure, and safe usage of medicines. During the preparatory work, the rationales of diversity on the market and entrepreneurship were added, while the original rationales of efficiency, price pressure, and better usage of medicines were abandoned. The reform can be seen as a typical New Public Management reform influenced by the notion that private actors are better equipped to perform public activities. The results point to that the reform was done almost solely in order to introduce private ownership in the pharmacy sector, and was not initiated in order to solve any general problems, or to enhance patient outcomes of medicine use.
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| 33. |
- Bremer, Patrick, et al.
(author)
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Informal and formal care : Substitutes or complements in care for people with dementia? Empirical evidence for 8 European countries
- 2017
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In: Health Policy. - : Elsevier BV. - 0168-8510. ; 121:6, s. 613-622
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Journal article (peer-reviewed)abstract
- Background: In order to contain public health care spending, European countries attempt to promote informal caregiving. However, such a cost reducing strategy will only be successful if informal caregiving is a substitute for formal health care services. We therefore analyze the effect of informal caregiving for people with dementia on the use of several formal health care services. Study design: The empirical analysis is based on primary data generated by the EU-project ´RightTimePlaceCare` which is conducted in 8 European countries. 1223 people with dementia receiving informal care at home were included in the study.
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| 34. |
- Håkonsen, Helle, 1980, et al.
(author)
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Consumer preferences for over-the-counter drug retailers in the reregulated Swedish pharmacy market
- 2016
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In: Health Policy. - : Elsevier BV. - 0168-8510. ; 120:3, s. 327-333
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Journal article (peer-reviewed)abstract
- Following a large regulatory reform in 2009, which ended the state's pharmacy monopoly, non-pharmacy retailers in Sweden today sell certain over-the-counter (OTC) drugs. The aim of this study was to investigate consumer preferences regarding OTC drug retailers and the reasons for choosing a pharmacy versus non-pharmacy retailer. We conducted a web survey aimed at Swedish adults. Out of a stratified sample of 4058 persons, 2594 agreed to take part (48% women; mean age: 50.3 years). Questions related to OTC drug use, retailer choice and factors affecting the participants' preferences for OTC drug retailers. Logistic regression was conducted to analyse OTC drug use and reasons for retailer choice in relation to sex, age and education. Nine in ten participants reported OTC drug use in the 6 months prior to the study. For their last OTC purchase, 76% had gone to a pharmacy, 20% to a grocery shop and 4% to a convenience store, gas station or online. Geographic proximity, opening hours and product range were reported as the most important factors in retailer choice. Counselling by trained staff was important to 57% of participants. The end of the state's pharmacy monopoly and the increase in number of pharmacies seem to have impacted more on Swedish consumers' purchase behaviours compared with the deregulation of OTC drug sales.
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| 35. |
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| 36. |
- Mueller, Tanja, et al.
(author)
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The correlation between regulatory conditions and antibiotic consumption within the WHO European Region
- 2016
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In: Health Policy. - : Elsevier BV. - 0168-8510. ; 120:8, s. 9-882
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Journal article (peer-reviewed)abstract
- Background: In a global perspective, bacterial infections are still a major cause of morbidity and mortality; therefore, effective antibiotics are needed. However, the emergence of antibiotic resistance due to irrational use has now become a serious public health problem. Hence, the objective of this study was to analyse the association of regulatory aspects with antibiotic consumption. Methods: A data set representing 20 countries throughout the WHO European Region was chosen based on data availability so as to analyse the correlation between specific regulatory conditions and antibiotic consumption, using total consumption data for 2011 and information about national provisions regarding rational use of medicines. Linear regression models were designed in order to evaluate individual aspects as well as the overall level of regulation. Results: A high level of regulation, assessed by an overall index, was significantly correlated with lower antibiotic consumption; however, of all individual items analysed, only the presence of Standard Treatment Guidelines for hospital care as well as paediatric conditions, the non-availability of antibiotics without a prescription, and the existence of training modules for pharmacists covering rational use of medicines gave significant results, i.e. lower use of antibiotics, when regarded in isolation. Conclusion: Although national regulatory conditions intended to foster rational use of antibiotics seem to be correlated with antibiotic consumption, this association is potentially influenced by a wide range of contextual aspects.
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| 37. |
- Richard, Emily, et al.
(author)
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Evaluating the transparency of pharmaceutical company disclosure of payments to patient organisations in the UK
- 2019
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In: Health Policy. - : Elsevier BV. - 0168-8510. ; 123:12, s. 1244-1250
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Journal article (peer-reviewed)abstract
- Patient organisations contribute to many areas of pharmaceutical policy. In developing their organisational capacity, many turn to financial support from pharmaceutical companies, which may create conflicts of interests. However, the transparency of the industry’s self-regulatory approach to the disclosure of payments to patient organisations has evaded scrutiny. Using company reports disclosing payments to UK patient organisations in 2012-2016, we evaluate the transparency of reporting using indicators derived from industry’s European patient organisation Code. We found a large proportion of companies did not have any disclosure reports available despite many having made payments, confirmed by comparing with annual financial accounts of patient organisations registered as charities. Where disclosure reports were available, many payments were not adequately described, resulting in large portions of money being disclosed without clarity as to the payment type and purpose. We found companies were clearer regarding whether payments were financial or benefits-in-kind, but transparency was particularly inadequate as to whether it could be determined if payments were indirect or direct and restricted or unrestricted, and almost no companies mentioned the VAT status of payments. Our findings suggest that the industry’s self-regulatory approach to transparency has not been working efficiently. We suggest ways for standardising and increasing the precision of information by pharmaceutical companies and advocate for the introduction of a centralised, and easily accessible national-level payment database.
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| 38. |
- Rönnerstrand, Björn, et al.
(author)
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Corruption and use of antibiotics in regions of Europe
- 2017
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In: Health Policy. - : Elsevier BV. - 0168-8510. ; 121:3, s. 250-256
-
Journal article (peer-reviewed)abstract
- The aim of this article is to investigate the association between corruption and antibiotic use at sub-national level. We explore the correlation between, on the one hand, two measures of corruption (prevalence of corruption in the health sector and prevalence of bribes in the society) at regional level from the European Quality of Government Index; and, on the other, the consumption of antibiotics in those European regions from a 2009 Special Euro Barometer. In a multivariate regression model, we control for potential confounders: purchasing power of standardized regional gross domestic product, inhabitants per medical doctor and age-standardized all-cause mortality rates. We find that there is a strong positive association between both measures of corruption (i.e. in the health sector, and in the society at large) and antibiotics use; and that this association is robust to the introduction of the control variables. These results support previous findings in the literature linking corruption to higher antibiotic use at cross-national level. We show that corruption does seem to account for some of the remarkable between-region variation in antibiotic consumption in Europe. (C) 2017 The Authors. Published by Elsevier Ireland Ltd.
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| 39. |
- Tynkkynen, Liina Kaisa, et al.
(author)
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Development of voluntary private health insurance in Nordic countries – An exploratory study on country-specific contextual factors
- 2018
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In: Health Policy. - : Elsevier BV. - 0168-8510. ; 122:5, s. 485-492
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Journal article (peer-reviewed)abstract
- The Nordic countries are healthcare systems with tax-based financing and ambitions for universal access to comprehensive services. This implies that distribution of healthcare resources should be based on individual needs, not on the ability to pay. Despite this ideological orientation, significant expansion in voluntary private health insurance (VPHI) contracts has occurred in recent decades. The development and role of VPHIs are different across the Nordic countries. Complementary VPHI plays a significant role in Denmark and in Finland. Supplementary VPHI is prominent in Norway and Sweden. The aim of this paper is to explore drivers behind the developments of the VPHI markets in the Nordic countries. We analyze the developments in terms of the following aspects: the performance of the statutory system (real or perceived), lack of coverage in certain areas of healthcare, governmental interventions or inability to reform the system, policy trends and the general socio-cultural environment, and policy responses to voting behavior or lobbying by certain interest groups. It seems that the early developments in VPHI markets have been an answer to the gaps in the national health systems created by institutional contexts, political decisions, and cultural interpretations on the functioning of the system. However, once the market is created it introduces new dynamics that have less to do with gaps and inflexibilities and more with cultural factors.
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