Health policy
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This paper examines the current state of evaluations of health care interventions in the European Union, from the identification and commissioning of research through to its impact on policy and practice. Material is drawn from a survey conducted for the ASTEC project as well as a review of literature. Although the use of evaluative research has increased substantially in the last decade, both the pace of change and preferred research methodologies employed differ markedly. ⋯ Capacity building measures should in particular ensure that dissemination expertise is strengthened, and that more emphasis is placed on developing receptor capacity within different stakeholder groups. Linking knowledge production to changes in practice remains a key challenge. Further research on implementation and impact assessment is required, to help demonstrate the value of evaluations on both policy and practice.
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Comparative Study
An international study of hospital readmissions and related utilization in Europe and the USA.
This study concerns a comparative analysis of hospital readmission rates and related utilization in six areas, including three European countries (Finland, Scotland and the Netherlands) and three states in the USA (New York, California, Washington State). It includes a data analysis on six major causes of hospitalization across these areas. Its main focus is on two questions. (1) Do hospital readmission rates vary among the causes of hospitalization and the study populations? (2) Are hospital inpatient lengths of stay inversely related to readmissions rates? The study demonstrated that diagnoses such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) were the major causes of hospital readmission rates. ⋯ Finally, it was found that countries or states with relatively shorter stays showed higher readmission rates and vice versa. Since patients with readmissions in all of the areas had on average longer initial stays, this finding at country level does illustrate that there seems to be a country specific trade off between length of stay and rate of readmission. An explanation should be sought in differences in health care arrangements per area, including factors that determine length of stay levels and readmission rates in individual countries (e.g. managed care penetration, after care by GP's or home care).
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The aim of the present study was to propose a methodology to formulate quantitative health targets which combined an extrapolation method and a benchmark method, and to estimate the targets for mortality rates (Mb) for selected causes of death by the year 2010 in Japan. Using the extrapolation method, based on the nationwide Mt from 1988 to 1997, the Mt in 2010 was predicted using a regression model. ⋯ As a results year 2010 targets as percentages compared with Mt in 1997 for cancer at all sites, stomach cancer, lung cancer, colo-rectal cancer, liver cancer and stroke were estimated to be 93, 52, 94, 102, 53 and 52% for males, and 84, 43, 86, 82, 60, and 45%, for females, respectively. The methodology presented in this article could be used as a standard procedure to formulate realistic quantified health targets, which can be adopted to develop health policies in nations, regions and communities.
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Primary care organisation in England has been subject to particularly extensive and far-reaching reform in recent years. In 1991, a quasi-market was introduced into the National Health Service and general practitioners were offered the opportunity to manage independent budgets from which to purchase and deliver care services. Practitioners joined the scheme in increasing numbers, although it was eventually abandoned following a change of government in 1997. ⋯ It concludes that, first, those opting for discretionary budgets were significantly more supportive of the policy than those not joining the scheme and this support continued long after the scheme had been abolished. Second, professional attitudes, with respect to other terms of service in primary care, remained homogenous to a considerable degree over time. Finally, physicians in favour of imposing user charges tend to be those with responsibility for more patients, suggesting a perceived need to manage patient demand.
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The organization and financing of the Danish health care system was evaluated within the framework of a SWOT analysis (analysis of strengths, weaknesses, opportunities and threats) by a panel of five members with a background in health economics. The evaluation was based on reading an extensive amount of selected documents and literature on the Danish health care system and a 1-week visit to health care authorities, providers and key persons. The present paper includes the main findings by one of the panel members. ⋯ Patients have a choice of primary care physician within a given geographic area and may go to a hospital of their choice. However, patient surveys and feedback are underdeveloped and very little effort has been made to make services responsive to patients' preferences. While innovations in electronic prescribing are noteworthy, further development of health information technology is needed.