Health policy
-
Observational Study
Association between elevated weekend mortality and the seven-day hospital services programme in England: A retrospective longitudinal study.
Patients admitted to hospital at weekends experience higher mortality rates than those admitted during the week. The NHS in England has taken the lead internationally with attempts to tackle this issue. Four priority clinical standards for emergency care have been introduced with the aim of reducing the 'weekend effect'. We investigate whether implementation of this policy has been associated with changes in the weekend effect. ⋯ Large improvements in performance against all four standards have not translated into reductions in the weekend effect. We find no evidence that England's policy is a beneficial way for health systems to respond to this phenomenon. Given the failure of the policy to achieve its aim, the current mandate for full compliance by 2020 requires urgent review.
-
Population health management (PHM) initiatives aim for better population health, quality of care and reduction of expenditure growth by integrating and optimizing services across domains. Reforms shifting payment of providers from traditional fee-for-service towards value-based payment models may support PHM. We aimed to gain insight into payment reform in nine Dutch PHM sites. ⋯ Interviewees stated that reluctance to shift financial accountability to providers was partly due to information asymmetry, a lack of trust and conflicting incentives between providers and insurers, and last but not least a lack of a sense of urgency. Small steps to payment reform have been taken in the Dutch PHM sites, which is in line with other international PHM initiatives. While acknowledging the autonomy of PHM sites, governmental stewardship (e.g. long-term vision, supporting knowledge development) can further stimulate value-based payment reforms.