What is the value of explicit priority setting for health interventions? A simulation study

Health Care Management Science - Many countries seek to secure efficiency in health spending through establishing explicit priority setting institutions (PSIs). Since such institutions divert...     

GPs working in solo practice: obstacles and motivations for working in a group? A qualitative study

OBJECTIVE: Our aim was to analyse the obstacles and eventual motivations of solo GPs for working in group practice. METHODS: A qualitative study using 12 focus groups was carried out in primary care in French-speaking Belgium. The subjects comprised four samples of GPs: 20 GP trainers, 18 GP trainees, 25 women GPs and 25 other GPs. The focus groups were taped and transcribed. Two independent researchers carried out the analysis using the QSR NUD.IST software. RESULTS: The participants (88 GPs) did not share a common definition of group practice-in particular multidisciplinary working-the need for a common pool of patients and shared premises. Their main sources of motivation for eventually setting up a group practice were better quality of life, continuity of care and sharing professional knowledge. The main obstacles were a required agreement between colleagues, the loss of a personal patient-GP relationship, budgetary constraints, and divergent views on group practice and GPs' profession (especially true for the association of GPs from different age groups). CONCLUSION: The current study shows that GPs working solo have divergent views of group practice. However, they clearly perceive advantages to this type of association (e.g. better quality of life and continuity of care). This study also confirms the high level of stress and tiredness felt by GPs and especially senior practitioners.     

What is the evidence for parenting interventions offered in a Canadian community?

BACKGROUND: The evidence supporting interventions offered in the community is often not examined. This study examines the evidence base supporting parenting interventions offered in a Canadian community and, in so doing, illustrates a community assessment mechanism that could be applied routinely for other psychosocial interventions. METHODS: An inventory of all manual-guided, group-based parenting interventions offered in a moderate-sized Canadian city was developed by reviewing existing community information guides and contacting key providers of parenting programs. Interventions offered between July 1, 2000 and June 30, 2001 were selected for evaluation. Evaluation reports for each intervention were assessed by two independent raters using a modification of the Effective Public Health Practice Project Quality Assessment Tool. RESULTS: Twelve parenting interventions were offered in the study community. Only three (25%) had been evaluated with at least one randomized controlled trial. No evaluation identified an a priori primary outcome measure to assess effectiveness. Multiple statistical testing without including a correction factor limits confidence in the robustness of the small number of positive results. Under-powered evaluations were common. Three interventions had only post-intervention client satisfaction data. The study community used none of the existing parenting interventions that are supported by extensive empirical evidence of efficacy. INTERPRETATION: There is a substantial research-practice gap in the parenting interventions offered in the study community. Similar community assessments could be used to spur debates within other communities about how best to reduce the research-practice gap.     

Health technology assessment and clinical decision making: which is the best evidence?

This paper examines the rationality of the concepts underlying evidence-based medicine and health technology assessment (HTA), which are part of a new current aimed at promoting the use of the results of scientific studies for decision making in health care. It describes the different approaches and purposes of this worldwide movement, in relation to clinical decision making, through a summarized set of specific HTA case studies from Catalonia, Spain. The examples illustrate how the systematic process of HTA can help in several types of uncertainties related to clinical decision making.     

Is decentralisation the real solution? A three country study

Decentralisation in the health care sector has been perceived in these last years as a means to revamp the performance of health care systems. Many European countries have undergone this process of delegating funding and/or management responsibilities to sub-layers of government. However, there has also been a recentralisation of health care systems in Nordic states, which typically had a highly decentralised model of service provision and funding. Three country cases will be analysed (Italy, Spain and Norway) and light will be shed on some possible difficulties that Italy and Spain might experience, given their present health decentralised structure. Moreover, there will be an analysis of the reasons that led to recentralisation of health care in Norway. The scope is to make people aware that decentralisation per se is not always successful. The three country cases highlight possible drawbacks that can arise from decentralisation.     

Support for tobacco control interventions: do country of origin and socioeconomic status make a difference?

Objective

To examine the attitudes to various tobacco control regulations among smokers from four different countries and explore differences by country and socioeconomic status.

Methods

Questions relating to tobacco regulation were asked of adult smokers from the 2007–2008 International Tobacco Control Four Country Survey (ITC4). Measures included attitudes to tobacco industry and product regulation, and measures of socioeconomic status and economic disadvantage.

Results

Overall smokers supported greater regulation of the tobacco industry with least supportive US smokers and most supportive Australian smokers. Reporting smoking-related deprivation and a lower income was independently associated with increased support for regulation of the tobacco industry (both p?≤?0.01).

Conclusions

Policy-makers interested in doing more to control tobacco should be reassured that, for the most part, they have the support of smokers, with greatest support in countries with the strongest regulations. Smokers economically disadvantaged by smoking were more supportive of government policies to regulate the tobacco industry suggesting that reactance against regulation is not likely to differentially contribute to lower cessation rates in this group.     

Do hospital mergers increase hospital efficiency? Evidence from a National Health Service country

OBJECTIVES: To analyse the effects on technical and cost efficiency of seven hospital mergers over the period 1992-2000 in Norway. The mergers involved 17 hospitals. METHODS: First, efficiency scores were generated using Data Envelopment Analysis for 53 merged and non-merged hospitals over the nine years. Second, the effect of mergers was estimated through panel data analysis. RESULTS: In general, the mergers showed no significant effect on technical efficiency and a significant negative effect of 2-2.8% on cost efficiency. However, positive effects on both cost and technical efficiency were found in one merger where more hospitals were involved, and where administration and acute services were centralized. CONCLUSION: The findings indicate that large mergers involving radical restructuring of the treatment process may improve efficiency as intended, but most mergers do not.     

Are women in female jobs for their health? A study of working conditions and health effects in the fish-processing industry in Quebec

A questionnaire concerning environmental conditions, work organization, and health-related symptoms was administered to 209 male and female workers in fish-processing plants in Quebec. Jobs in these factories were "ghettoized," with 88.9 percent of job titles held primarily (more than 75 percent) by members of one sex. In general, significantly more women than men reported that their work sites exposed them to environmental aggressors such as noise and cold. Women also reported significantly more often that their jobs were uninteresting, that they could not move around, and that their work speed was fast. Women reported fatigue, stress, insomnia, digestive problems, and aches and pains significantly more often than did men (analysis controlled for age). When the effects of work speed were examined specifically, it was found that a fast work speed was associated with fatigue, stress, insomnia, and digestive problems in both sexes, and with aches and pains in women. It is suggested that women are required to work at a faster speed than men, and that this is a factor in the greater prevalence of health-related symptoms among women. Our interpretation of these data calls into question the commonly held belief that men and women are assigned to sex-specific jobs in order to protect the health of "the weaker sex."     

Reducing maternal mortality: can we derive policy guidance from developing country experiences?

Developing countries are floundering in their efforts to meet the Millennium Development Goal of reducing maternal mortality by 75% by 2015. Two issues are being debated. Is it doable within this time frame? And is it affordable? Malaysia and Sri Lanka have in the past 50 years repeatedly halved their maternal mortality ratio (MMR) every 7-10 years to reduce MMR from over 500 to below 50. Experience from four other developing countries--Bolivia, Yunan in China, Egypt, and Jamaica-confirms that each was able to halve MMR in less than 10 years beginning from levels of 200-300. Malaysia and Sri Lanka, invested modestly (but wisely)--less than 0.4% of GDP--on maternal health throughout the period of decline, although the large majority of women depended on publicly funded maternal health care. Analysis of their experience suggests that provision of access to and removal of barriers for the use of skilled birth attendance has been the key. This included professionalization of midwifery and phasing out of traditional birth attendants; monitoring births and maternal deaths and use of such information for high profile advocacy on the importance of reducing maternal death; and addressing critical gaps in the health system; and reducing disparities between different groups through special attention to the poor and disadvantaged populations.     

What is a 'planned' pregnancy? Empirical data from a British study

The terms "planned", "unplanned", "intended", "unintended", "wanted" and "unwanted" are often used in relation to pregnancy in health policy, health services and health research. This paper describes the findings relating to women's understanding of these terms from the qualitative stage of a British study. We found that when discussing the circumstances of their pregnancies, women tended not to use the above terms spontaneously. When asked to explain the terms, women were able to do so but there was considerable variation in understanding. Most, but not all, were able to apply the terms. Women applied the term "planned" only if they had met four key criteria. Intending to become pregnant and stopping contraception were not sufficient criteria, in themselves, to apply the term; partner agreement and reaching the right time in terms of lifestyle/life stage were also necessary. In contrast, "unplanned" was a widely applied term and covered a variety of circumstances of pregnancy. The other terms were less favoured, "unwanted" being positively disliked. We recommend that survey questions eliciting information on women's circumstances of pregnancy do not rely on the above terms in isolation and, further, that a more circumspect use of the terms in policy and clinical settings is required.     

Transfer of Health for All policy - What, how and in which direction? A two-case study

BACKGROUND: This article explores the transfer of World Health Organization's (WHO) policy initiative Health for All by the Year 2000 (HFA2000) into national contexts by using the changes in the public health policies of Finland and Portugal from the 1970's onward and the relationship of these changes to WHO policy development as test cases. Finland and Portugal were chosen to be compared as they represent different welfare state types and as the paradigmatic transition from the old to new public health is assumed to be related to the wider welfare state development. METHODS: The policy transfer approach is used as a conceptual tool to analyze the possible policy changes related to the adaptation of HFA into the national context. To be able to analyze not only the content but also the contextual conditions of policy transfer Kingdon's analytical framework of policy analysis is applied. CONCLUSIONS: Our analysis suggests that no significant change of health promotion policy resulted from the launch of HFA program neither in Finland nor in Portugal. Instead the changes that occurred in both countries were of incremental nature, in accordance with the earlier policy choices, and the adaptation of HFA program was mainly applied to the areas where there were national traditions.