Is There a Statistical Relationship between Economic Crises and Changes in Government Health Expenditure Growth? An Analysis of Twenty-Four European Countries

Objective

To identify whether, by what means, and the extent to which historically, government health care expenditure growth in Europe has changed following economic crises.

Data Sources

Organization for Economic Cooperation and Development Health Data 2011.

Study Design

Cross-country fixed effects multiple regression analysis is used to determine whether statutory health care expenditure growth in the year after economic crises differs from that which would otherwise be predicted by general economic trends. Better understanding of the mechanisms involved is achieved by distinguishing between policy responses which lead to cost-shifting and all others.

Findings

In the year after an economic downturn, public health care expenditure grows more slowly than would have been expected given the longer term economic climate. Cost-shifting and other policy responses are both associated with these slowdowns. However, while changes in tax-derived expenditure are associated with both cost-shifting and other policy responses following a crisis, changes in expenditure derived from social insurance have been associated only with changes in cost-shifting.

Conclusions

Disproportionate cuts to the health sector, as well as reliance on cost-shifting to slow growth in health care expenditure, serve as a warning in terms of potentially negative effects on equity, efficiency, and quality of health services and, potentially, health outcomes following economic crises.     

Implementation of collaborative care for depressive disorder treatment among accountable care organizations

Collaborative care – primary care models combining care management, consulting behavioral health clinicians, and registries to target mental health treatment – is a cost-effective depression treatment model, but little is known about uptake of collaborative care in a national setting. Alternative payment models such as accountable care organizations (ACOs), in which ACOs are responsible for quality and cost for defined patient populations, may encourage collaborative care use.Determine prevalence of collaborative care implementation among ACOs and whether ACO structure or contract characteristics are associated with implementation.Cross-sectional analysis of 2017–2018 National Survey of ACOs (NSACO). Overall, 55% of ACOs returned a survey (69% of Medicare, 36% of non-Medicare ACOs); 48% completed at least half of core survey questions. We used logistic regression to examine the association between implementation of core collaborative care components – care management, a consulting mental health clinician, and a patient registry to track mental health symptoms – and ACO characteristics.Four hundred five National Survey of ACOs respondents answering questions on collaborative care implementation.Only 17% of ACOs reported implementing all collaborative care components. Most reported using care managers (71%) and consulting mental health clinicians (58%), =just 26% reported using patient registries. After adjusting for multiple ACO characteristics, ACOs responsible for mental health care quality measures were 15 percentage points (95% CI 5–23) more likely to implement collaborative care.Most ACOs are not utilizing behavioral health collaborative care. Including mental health care quality measures in payment contracts may facilitate implementation of this cost-effective model. Improving provider capacity to track and target depression treatment with patient registries is warranted as payment contracts focus on treatment outcomes.     

Private Interests and the Start of Fluoride-Supplemented High-Carbohydrate Nutritional Guidelines

Fluoride has no tangible health benefits other than preventing dental caries and there is a small difference between its minimum effective dose and its minimum toxic dose. Leading global organizations currently recommend fluoride supplementation because they recommend high-carbohydrate diets which can cause dental caries. Low-carbohydrate diets prevent dental caries making such fluoride recommendations largely unnecessary. A dental organization was among the first to initiate the public health recommendations which started fluoride-supplemented high-carbohydrate nutritional guidelines. This start required expert panels at this dental organization to reverse on three key scientific points between 1942 and 1949: (1) that topical fluoride had potential harms, (2) that dental caries was a marker for micronutrient deficiencies, and (3) that low-carbohydrate diets are to be recommended for dental caries prevention. Internal documents show that private interests motivated the events which led these expert panels to engage in pivotal scientific reversals. These private interests biased scientific processes and these reversals occurred largely in an absence of supporting evidence. It is concluded that private interests played a significant role in the start of public health endorsements of fluoride-supplemented high-carbohydrate nutritional guidelines.     

地方高校基层学术组织存在问题的原因及改革对策

区域经济、文化等因素影响,学科建设水平较低,以教学为主的职能定位的拘囿,基层学术组织建设滞后及改造失当,是导致高等学校基层学术组织结构单一、体制趋同、职能偏狭、运行不畅、缺乏活力等问题的主要原因。因此,地方高校必须充分认识基层学术组织的作用,改革高校权力模式．创新高校学术组织结构。     

国内外公共卫生领域标准化工作管理体制比较与思考

目的:为了更好地促进我国的卫生健康标准化工作,为建立完善我国卫生健康领域标准化的发展战略、管理体制提供依据。方法:本文收集了公共卫生领域标准化相关国际组织标准管理机制方面的资料,并将收集到的信息进行汇总分析。结果:公共卫生领域的各种标准在各国际组织的管理体制不同,在组织性质、标准种类、应用、发布、组织结构、标准制定原则...     

国家机关工作人员健康状况、相关行为和需求调查

目的 了解国家机关工作人员健康状况、相关的行为和对健康促进的需求。方法 2002年9月对北京市西城区辖区内4所国家机关的844名工作人员进行了问卷调查。结果 国家机关工作人员患病率前10位的慢病为颈椎病、高脂血症、脂肪肝、痔疮、慢性肠炎、高血压、骨质增生、关节炎、腰椎间盘突出、慢性支气管炎；国家机关工作人员对健康促进的需求较高。结论 应该在国家机关工作员中开展健康促进工作。     

男性性病诊疗服务体系的完善及规范化服务

目的通过完善男男性行为人群（MSM）的性病诊疗服务体系,促进男性性病诊疗服务的规范化。方法完善MSM的性病转介体系和性病服务内容,形成性病、艾滋病检测阳性者的服务机构、组织之间的顺畅转介关系,开展医务人员主动提供艾滋病病毒（HIV）检测咨询（PITC）促进。对服务日志进行统计并分析。结果自2011年4月至10月15日期间,MSM社区组织向性病门诊转介疑似性病患者156例;HIV感染者组织转介的性病患者诊治17例;性病门诊求诊者中453人接受了PITC服务,完成转介初筛HIV阳性25例。性病转介诊疗服务满意度和HIV阳性转介咨询服务满意度均很高。结论社区组织和医疗机构的合作是促进规范化性病服务的重要策略,医疗机构与成熟的社区组织开展进一步实质性合作可以促进服务质量提高。     

全球健康领域政府对非政府组织的定位与合作——以世卫组织、美国和英国为例

非政府组织(NGO)在全球健康治理中发挥重要角色,已成为欧美发达国家和联合国系统全球健康战略的重要组成部分,联合国可持续发展目标也提出要强化NGO作为全球健康治理合作者的角色。本研究以全球健康战略比较成熟的世界卫生组织和美英两国为例,综述它们在全球健康战略中对NGO的定位和合作,为中国全球健康战略的制定以及与NGO的合作及定位提供参考建议。研究发现,世界卫生组织、美国和英国在其全球健康战略中均给予NGO明确定位,即加强相互合作,来扩大其在全球健康领域的影响力。因此,中国应将NGO纳入全球健康战略,建立NGO的管理和合作机制,使其成为全球健康的重要补充力量;严格筛选国际NGO进行合作,努力培育和支持本土NGO参与中国全球健康项目的实施;制定NGO合作清单和负面清单;同时加强监管和审核,规避NGO可能带来的风险。