Health policy
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Review
Relevant models and elements of integrated care for multi-morbidity: Results of a scoping review.
In order to provide adequate care for the growing group of persons with multi-morbidity, innovative integrated care programmes are appearing. The aims of the current scoping review were to i) identify relevant models and elements of integrated care for multi-morbidity and ii) to subsequently identify which of these models and elements are applied in integrated care programmes for multi-morbidity. ⋯ Most models and elements found in the literature focus on integrated care in general and do not explicitly focus on multi-morbidity. In line with this, most programmes identified in the literature build on the CCM. A comprehensive framework that better accounts for the complexities resulting from multi-morbidity is needed.
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Risk-equalization (RE) models in competitive health insurance markets have become increasingly sophisticated. However, these models still have important imperfections. A specific problem in the Netherlands is that insurers are insufficiently compensated for individuals who can persistently be found in the right-end tail of the cost distribution. ⋯ Although this study provides useful insights in the possibilities for improving RE-models for persistently high-cost individuals, improving compensation remains challenging and dependent on the ongoing debate regarding coverage and reimbursement of expensive drugs.
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Medical regulation is rapidly changing with claims that systems such as revalidation/relicensing will reassure the public. Yet the impact of such initiatives is unknown. ⋯ There are potential advantages to McDonaldization including appraisals available to all, not just for doctors working in the NHS, and a potentially more appetizing recipe for their completion. As yet a state of McAppraisal has not been reached; with a complete transfer of trust in the doctor to trust in the appraisal process within revalidation. However policymakers will need to continue to ensure that regulatory initiatives, such as revalidation, are not just a process for their own sake.
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Medical devices play a central role in the diagnosis and treatment of diseases but also bring the potential for adverse events, hazards or malfunction with serious consequences for patients and users. Medical device manufacturers are therefore required by law to monitor the performance of medical devices that have been approved by the competent authorities (post market surveillance). Conducting a nationwide online-survey in the German medical device sector in Q2/2014 in order to explore the current status of the use of post market instruments we obtained a total of 118 complete data sets, for a return rate of 36%. ⋯ We found significant differences between the different risk classes of medical devices produced and the intensity of use of post market instruments. Differences between company size and the intensity of instruments used were hardly detected. Results may well contribute to the development of device monitoring which is a crucial element of the policy and regulatory system to identify device-related safety issues.
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Historical Article
The Directorate-General for Health and Consumers 1999-2014: An assessment of its functional capacities.
Capacity assessment has become a popular measure in the health sector to assess the ability of various stakeholders to pursue agreed activities. The European Commission (EC) is increasingly dealing with a variety of health issues to coordinate and complement national health policies. This study analyses the functional capacity of the Directorate-General for Health and Consumers (DG SANCO) between 1999 and 2004. ⋯ In contrast, capacities tend to be less established for defining a clear strategy for the overall sector, for setting priorities and for budgeting, managing and implementing policies. We conclude that improvements to the effectiveness of DG SANTE's (the successor of DG SANCO) policies can be made within the existing mandate. A priority setting exercise may be conducted to limit the number of pursued actions to those with the greatest European added value within DG SANTE's responsibilities.