Health policy
-
This review study explores the "brain drain" currently evident amongst physicians in Greece, which is closely linked to the country's severe financial woes. In particular, it shows that the Greek healthcare labour market offers few opportunities and thus physicians are forsaking their homeland to seek jobs abroad. The main causes generating or greatly inflating the brain drain of Greek physicians are unemployment, job insecurity, income reduction, over-taxation, together with limited budgets for research institutes. It is argued that, to stop the evolving mass exodus of skilled medical staff, policy-makers should implement fiscal and human-centred approaches, thoroughly safeguarding both the right of skilled Greek physicians to work in their homeland with motivation and dignity, but also of Greek citizens to continue receiving high-quality healthcare by skilled physicians at times when this is mostly needed.
-
There is growing need for continuing professional development (CPD) among doctors, especially following the recent introduction of compulsory revalidation for all doctors in the United Kingdom (UK). We use unique datasets from two national surveys of non-training grade doctors working in the National Health Service in Scotland to evaluate doctors' perceptions of need and barriers to CPD. We test for differences over time and also examine differences between doctor grades and for other characteristics such as gender, age, contract type and specialty. ⋯ In terms of perceived barriers to CPD, lack of time was expressed as a barrier by the largest proportion of doctors, as was insufficient clinical cover, lack of funding, and remoteness from main education centres. The strength of perceived need for particular CPD activities and the perceived barriers to CPD varied significantly by doctors' job and personal characteristics. An understanding of the perceived needs and barriers to CPD among doctors is an important precursor to developing effective educational and training programmes that cover their professional practice and also in supporting doctors towards successful revalidation.
-
The financing of General Practice (GP) is a much-debated topic. In spite of out-of-pocket (OOP) payment for other primary health care provided by self-employed professionals, there is no OOP payment for the use of GP in Denmark. This article aims to explore the arguments, the actors and the decision-making context. ⋯ There is little connection between the attitudes and ideological backgrounds of the political parties. Despite factors such as perceived expert/scientific evidence for OOP payment, changes of government, financial crisis and a market-based reform wave, no government has introduced OOP payment for GP. This article suggests that governmental positions, public- and especially health-professional support are important factors in the decision-making context.
-
Rising drug costs in Germany led to the Act on the Reform of the Market for Medicinal Products (AMNOG) in January 2011. For new drugs, pharmaceutical companies have to submit dossiers containing all available evidence to demonstrate an added benefit versus an appropriate comparator therapy. The Federal Joint Committee (G-BA), the main decision-making body of the statutory healthcare system, is responsible for the overall procedure of "early benefit assessment". ⋯ The most common indications were oncology (6) and viral infections (4). For the 14 drugs assessed, the extent of added benefit was rated as minor, considerable, and non-quantifiable in 3, 8, and 2 cases; the remaining drug showed no added benefit. Despite some shortcomings, for the first time it has been possible in Germany to implement a systematic procedure for assessing new drugs at market entry, thus providing support for price negotiations and informed decision-making for patients, clinicians and policy makers.
-
Most mental health care delivery systems in welfare states currently face two major issues: deinstitutionalisation and fragmentation of care. Belgium is in the process of reforming its mental health care delivery system with the aim of simultaneously strengthening community care and improving integration of care. The new policy model attempts to strike a balance between hospitals and community services, and is based on networks of services. ⋯ Furthermore, most of the mechanisms contained within the new policy were not sufficiently detailed. Consequently, three major threats to the effectiveness of the reform were identified. These were: issues concerning the relationship between network structure and purpose, the continued influence of hospitals despite the goal of deinstitutionalisation, and the heterogeneity in the actual implementation of the new policy.