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Sandoval JL, Franzoi MA, di Meglio A, Ferreira AR, Viansone A, André F, Martin AL, Everhard S, Jouannaud C, Fournier M, Rouanet P, Vanlemmens L, Dhaini-Merimeche A, Sauterey B, Cottu P, Levy C, Stringhini S, Guessous I, Vaz-Luis I, Menvielle G. Magnitude and Temporal Variations of Socioeconomic Inequalities in the Quality of Life After Early Breast Cancer: Results From the Multicentric French CANTO Cohort. J Clin Oncol 2024:JCO2302099. [PMID: 38889372 DOI: 10.1200/jco.23.02099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/12/2024] [Accepted: 04/11/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE Socioeconomic status (SES) influences the survival outcomes of patients with early breast cancer (EBC). However, limited research investigates social inequalities in their quality of life (QoL). This study examines the socioeconomic inequalities in QoL after an EBC diagnosis and their time trends. PATIENTS AND METHODS We used data from the French prospective multicentric CANTO cohort (ClinicalTrials.gov identifier: NCT01993498), including women with EBC enrolled between 2012 and 2018. QoL was assessed using the European Organisation for Research and Treatment of Cancer QoL Core 30 questionnaire (QLQ-C30). summary score at diagnosis and 1 and 2 years postdiagnosis. We considered three indicators of SES separately: self-reported financial difficulties, household income, and educational level. We first analyzed the trajectories of the QLQ-C30 summary score by SES group. Then, social inequalities in QLQ-C30 summary score and their time trends were quantified using the regression-based slope index of inequality (SII), representing the absolute change in the outcome along socioeconomic gradient extremes. The analyses were adjusted for age at diagnosis, Charlson Comorbidity Index, disease stage, and type of local and systemic treatment. RESULTS Among the 5,915 included patients with data on QoL at diagnosis and at the 2-year follow-up, social inequalities in QLQ-C30 summary score at baseline were statistically significant for all SES indicators (SIIfinancial difficulties = -7.6 [-8.9; -6.2], SIIincome = -4.0 [-5.2; -2.8]), SIIeducation = -1.9 [-3.1; -0.7]). These inequalities significantly increased (interaction P < .05) in year 1 and year 2 postdiagnosis, irrespective of prediagnosis health, tumor characteristics, and treatment. Similar results were observed in subgroups defined by menopausal status and type of adjuvant systemic treatment. CONCLUSION The magnitude of preexisting inequalities in QoL increased over time after EBC diagnosis, emphasizing the importance of considering social determinants of health during comprehensive cancer care planning.
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Affiliation(s)
- José Luis Sandoval
- Unit of Population Epidemiology, Division of Primary Care, Department of Health and Community Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Oncology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Maria Alice Franzoi
- Unit of Molecular Predictors and New Targets in Oncology, INSERM, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Antonio di Meglio
- Unit of Molecular Predictors and New Targets in Oncology, INSERM, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
- Medical Oncology Department, Gustave Roussy Institute, Villejuif, France
| | | | | | - Fabrice André
- Unit of Molecular Predictors and New Targets in Oncology, INSERM, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
- Medical Oncology Department, Gustave Roussy Institute, Villejuif, France
| | - Anne-Laure Martin
- UNICANCER, Direction des Data et des Partenariats, Le Kremlin-Bicêtre, France
| | - Sibille Everhard
- UNICANCER, Direction des Data et des Partenariats, Le Kremlin-Bicêtre, France
| | | | | | - Philippe Rouanet
- Institut régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France
| | | | | | | | | | | | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Department of Health and Community Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Division of Primary Care, Department of Health and Community Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ines Vaz-Luis
- Unit of Molecular Predictors and New Targets in Oncology, INSERM, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
- Interdisciplinary department for the Organization of Patient Pathways (DIOPP), Gustave Roussy Institute, Villejuif, France
| | - Gwenn Menvielle
- Unit of Molecular Predictors and New Targets in Oncology, INSERM, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
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Khanpoor H, Amerzadeh M, Alizadeh A, Khosravizadeh O, Rafiei S. Developing a community-responsive research model in the healthcare system: a mixed-method study. BMC Med Res Methodol 2024; 24:119. [PMID: 38796452 PMCID: PMC11128113 DOI: 10.1186/s12874-024-02250-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 05/20/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Responsiveness to the population's non-clinical needs encompasses various dimensions, including responsive research and an educational outreach plan at the community level. This study aims to develop a community-responsive research model in the healthcare system to ensure the connection between community-identified health priorities and research funds, as well as capacity-building efforts. METHODS A mixed-methods research study was conducted in three main phases, including a comprehensive literature review, a qualitative analysis of an expert panel's points of view, and the developing of a model using the Equation Modeling (SEM) technique. R software version 3.2.4 was used to conduct statistical analysis, considering a significance level of 0.05. RESULTS Based on the literature review, 41 responsiveness components were identified from sixteen relevant studies conducted between 2000 and 2022. Ten sub-themes in four major themes, including planning, implementation, monitoring and evaluation, and action, were identified through qualitative content analysis. Standardized coefficients revealed that components such as dissemination of results to all stakeholders, research prioritization aligned with community needs, commitment to implement research findings, and collaborative learning had statistically significant effects on the community-responsive research model. CONCLUSION It is essential to identify community health priorities by following a community-focused, priority-setting process based on the principles of community engagement to develop a community-responsive research model. Afterward, dissemination of research findings to all stakeholders, commitment to apply the obtained results in the real world, and promotion of shared learning among research partners have been proven to facilitate collaborative investigation and mutual understanding between the community and academic partners.
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Affiliation(s)
- Hooman Khanpoor
- Student Research Committee, School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohammad Amerzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non- Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Ahad Alizadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non- Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Omid Khosravizadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non- Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sima Rafiei
- Social Determinants of Health Research Center, Research Institute for Prevention of Non- Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
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Azimzadeh S, Azami-Aghdash S, Tabrizi JS, Gholipour K. Reforms and innovations in primary health care in different countries: scoping review. Prim Health Care Res Dev 2024; 25:e22. [PMID: 38651337 DOI: 10.1017/s1463423623000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION The World Health Organization (WHO) recommends focusing on primary health care (PHC) as the first strategy of countries to achieve the improvement of the health level of communities and has emphasized it again in 2021. Therefore, we intend to take a different look at the PHC system with reform, innovation, and initiative by using the experiences of leading countries and identify practical and evidence-based solutions to achieve greater health. METHODS This is a scoping review study that has identified innovations and reforms related to PHC since the beginning of 2000 to the end of 2022. In this study, Scopus, Web Of Science, and PubMed databases have been searched using appropriate keywords. This study is done in six steps using Arkesy and O'Malley framework. In this study, the framework of six building blocks of WHO was used to summarize and report the findings. RESULTS By searching in different databases, we identified 39426 studies related to reforms in primary care, and after the screening process, 106 studies were analyzed. Our findings were classified and reported into 9 categories (aims, stewardship/leadership, financing & payment, service delivery, health workforce, information, outcomes, policies/considerations, and limitations). CONCLUSION The necessity and importance of strengthening PHC is obvious to everyone due to its great consequences, which requires a lot of will, effort, and coordination at the macro-level of the country, various organizations, and health teams, as well as the participation of people and society.
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Affiliation(s)
- Solmaz Azimzadeh
- Health Policy, Department of Health Policy & Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Health Policy, Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Sadegh Tabrizi
- Health Services Management, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Gholipour
- Health Services Management, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Heikkilä M, Heino O, Rautiainen P. System's Crisis Resilience as a Societal Crisis: Knowledge Structure and Gaze of the Finnish Health Care System. HEALTH CARE ANALYSIS 2024:10.1007/s10728-023-00479-3. [PMID: 38252178 DOI: 10.1007/s10728-023-00479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
The crisis resilience of vital social systems is currently the target of constant development efforts in Finland, as their drifting into crisis would weaken societies' functional abilities, safety, and security. This is also the case regarding the Finnish health care system. In an attempt to move beyond existing frameworks of crisis imagination, this article takes an unconventional stance by elucidating endogenous crisis dynamics present in the Finnish health care system. Delphi process was conducted for top experts in Finnish health care and crisis management. With a dissensus-seeking orientation, our aim was to fertilize disagreements among panelists to reveal key vulnerabilities in the health system. Despite our efforts to evoke dissensus, the panelists ended up generating a consensus that aims to protect the underlying assumptions of the health system's knowledge structure. Through inductive analysis of expert discourses, the data was analyzed through our research question "what constitutes a crisis-proof health system and a crisis-prone health system". What is framed as a strength of the system by our panelists, namely the ability to maintain legitimacy, improve efficiency, and guarantee continuity, can still have questionable implications that are left ungrasped. A system's theory approach illustrates how such effects can develop and escalate beyond the reach of social interventions, and thus be predisposed to cause objectionable yet concealed social crises. The discussion illustrates how these endogenous crisis dynamics could be seen to materialize in real-life cases.
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Affiliation(s)
- Matias Heikkilä
- Faculty of Social Sciences, Tampere University, Arvo Ylpön Katu 34 (Kauppi Campus), 33520, Tampere, Finland.
| | - Ossi Heino
- Faculty of Social Sciences, Tampere University, Arvo Ylpön Katu 34 (Kauppi Campus), 33520, Tampere, Finland
| | - Pauli Rautiainen
- Department of Social Sciences/UEF Law School, University of Eastern Finland, Kuopio, Finland
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Ebrahimoghli R, Pezeshki MZ, Farajzadeh P, Arab-Zozani M, Mehrtak M, Alizadeh M. Factors influencing social prescribing initiatives: a systematic review of qualitative evidence. Perspect Public Health 2023:17579139231184809. [PMID: 37497769 DOI: 10.1177/17579139231184809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
AIMS Social prescribing is a growing health policy agenda to improve the quality and effectiveness of health systems. However, systematically collected knowledge on factors influencing the effective implementation of SP is scarce. A systematic review was conducted to identify and categorize factors influencing social prescribing initiatives. METHODS A search of three electronic databases (PubMed, Scopus, and ISI Web of Knowledge) was carried out to retrieve studies from inception to May 2022, supplemented by grey literature searching and snowballing of the relevant references. The inclusion criteria were original empirical research, qualitative data collection, and a description of factors affecting social prescribing initiatives. Study quality was evaluated using the Critical Appraisal Skills Programme tool. We categorized the results of individual studies using a narrative approach. RESULTS A total of 23 studies were included for analysis. Along with patient-related factors (patient-centeredness, clinical complexity, perception, knowledge), three main settings of social prescribing initiatives (including healthcare providers, link workers, and voluntary and community sectors) are affected by (1) individual characteristics (knowledge, perception, skill mix); (2) interpersonal relations (collaboration, trust, feedback, supportive climate, follow-up, sustained connection, peer support within and across sectors); (3) organizational contingencies (resource adequacy, staffing, training, role description, continuity of support, caseload management, monitoring, affordability, accessibility, referral criteria, and tailored support); and (4) political context (national policy and guidance, stewardship, planning, cocreation, bureaucracy, economic condition, and the number of support organizations). CONCLUSION Many factors influencing social prescribing initiatives were identified. The results of this review can be applied by different stakeholders of social prescribing to guide development, implementation, description, and evaluation.
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Affiliation(s)
- R Ebrahimoghli
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Nursing, Institute of Health Education, Ardabil University of Medical Sciences, Ardabil, Iran
| | - M Z Pezeshki
- Department of Community and Family Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - P Farajzadeh
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - M Mehrtak
- School of Medicine and Allied Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
| | - M Alizadeh
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Golgasht St, Azadi Avenue, 5166614711, Tabriz, Iran
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Cadham CJ, Prosser LA. Eliciting Trade-Offs Between Equity and Efficiency: A Methodological Scoping Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:943-952. [PMID: 36805575 DOI: 10.1016/j.jval.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/09/2023] [Accepted: 02/12/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To identify differences in the approaches and results of studies that elicit equity-efficiency trade-offs that can inform equity-informative cost-effectiveness analysis for healthcare resource allocation. METHODS We searched Ovid (Medline), EconLit, and Scopus prior to June 25, 2021. Inclusion criteria were: (1) peer-reviewed or (2) gray literature; (3) published in English; (4) survey-based; (5) parameterized a social welfare function to quantify inequality aversion or (6) elicited a trade-off in equity and efficiency characteristics of health interventions. Exclusion criteria were: (1) studies that did not conduct a trade-off or (2) theoretical studies. We abstracted details on study methods, results, and limitations. Studies were grouped by following approach: (1) social welfare function or (2) preference ranking and distributional weighting. We described findings separately for each approach category. RESULTS Seventy-seven papers were included, 28 parameterized social welfare functions and 49 were classified as preference ranking and distributional weighting. Study methods were heterogeneous. Studies were conducted across 29 countries. Sample sizes and composition, survey methods and question framing varied. Preferences for equity were mixed. Across both approach categories: 39 studies were classified as clear evidence of inequality aversion; 33 found mixed evidence; and 4 had no evidence of aversion. Evidence of between and within-study heterogeneity was found. Preferences for equity may differ by gender, profession, political ideology, income, and education. CONCLUSIONS Substantial variability in study methods limit the direct comparability of findings and their use in equity-informed cost-effectiveness analysis. Future researches using representative samples that explore within and between country heterogeneity is needed.
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Affiliation(s)
- Christopher J Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Lisa A Prosser
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, MI, USA
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Deng J, Huang S, Wang L, Deng W, Yang T. Conceptual Framework for Smart Health: A Multi-Dimensional Model Using IPO Logic to Link Drivers and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16742. [PMID: 36554622 PMCID: PMC9779490 DOI: 10.3390/ijerph192416742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Smart health is considered to be a new phase in the application of information and communication technologies (ICT) in healthcare that can improve its efficiency and sustainability. However, based on our literature review on the concept of smart health, there is a lack of a comprehensive perspective on the concept of smart health and a framework for how to link the drivers and outcomes of smart health. This paper aims to interweave the drivers and outcomes in a multi-dimensional framework under the input-process-output (IPO) logic of the "system view" so as to promote a deeper understanding of the model of smart health. In addition to the collection of studies, we used the modified Delphi method (MDM) to invite 10 experts from different fields, and the views of the panelists were analyzed and integrated through a three-round iterative process to reach a consensus on the elements included in the conceptual framework. The study revealed that smart health contains five drivers (community, technology, policy, service, and management) and eight outcomes (efficient, smart, sustainable, planned, trustworthy, safe, equitable, health-beneficial, and economic). They all represent a unique aspect of smart health. This paper expands the research horizon of smart health, shifting from a single technology to multiple perspectives, such as community and management, to guide the development of policies and plans in order to promote smart health.
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Affiliation(s)
- Jianwei Deng
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing 100081, China
| | - Sibo Huang
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing 100081, China
| | - Liuan Wang
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
| | - Wenhao Deng
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing 100081, China
| | - Tianan Yang
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing 100081, China
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Chan MK, Volk A, Patro N, Lee W, Sonnenberg LK, Dath D, Meschino DDC. Creating space for leadership education in undergraduate medical education in Canada. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:36-48. [PMID: 36091741 PMCID: PMC9441118 DOI: 10.36834/cmej.73216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The need for effective leadership by physicians is clear, yet the design/delivery of curricula, and assessment of leadership competencies, in Undergraduate Medical Education (UGME) continues to need work. In reappraising their UGME assessment strategies, the Medical Council of Canada (MCC) invited position papers across diverse lenses, including the CanMEDS Intrinsic Roles. This article is foundational work derived from the report on leadership assessment to the MCC. Using Kern's Model of Curriculum development as a guide, we reviewed the landscape of Canadian UGME leadership education through an environmental scan of the published and grey literature, Canadian leadership frameworks and resources, and consultation with learner and faculty leadership. Leadership education across programs was highly variable and learners were often unaware of available opportunities. In response, we have suggested processes for curricular development, including strategies for key content, teaching and assessment, and program evaluation considerations. Leadership education cannot remain another checkbox on a list of UGME experiences. Such training necessitates focused attention and investment to foster ongoing identity formation toward becoming a good doctor.
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Affiliation(s)
- Ming-Ka Chan
- Office of Leadership Education, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Auriele Volk
- Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Nivedh Patro
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada
| | - Wonjae Lee
- Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada
| | - Lyn K Sonnenberg
- Office of Educational Innovation & Academic Technologies, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
- Neurodevelopmental Pediatrics, Glenrose Rehabilitation Hospital, Alberta, Canada
| | - Deepak Dath
- Department of Surgery, McMaster University, Ontario, Canada
| | - Diane de Camps Meschino
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
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Van Doren S, De Coninck D, Hermans K, Declercq A. Examining Care Assessment Scores of Community-Dwelling Adults in Flanders, Belgium: The Role of Socio-Psychological and Assessor-Related Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11845. [PMID: 34831601 PMCID: PMC8617752 DOI: 10.3390/ijerph182211845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022]
Abstract
One of the primary objectives of health systems is to provide a fair system by providing a comprehensive and holistic approach to caregiving rather than focusing on a single aspect of a person's care needs. This approach is often embodied by using standardized care assessments across health and social care settings. These assessments are completed by professional assessors and yield vital information regarding a person's health or contextual characteristics (e.g., civic engagement, psychosocial wellbeing, environmental characteristics, informal care). However, these scores may be subject to bias that endangers the fairness of the health system. In this study, we investigate to what extent socio-economic and psychological indicators and assessor-related indicators are associated with BelRAI Screener care assessment scores amongst 743 community-dwelling adults nested within 92 assessors in Flanders, Belgium. Findings indicate that there is significant variance in scores at the assessor-level. Socio-psychological characteristics of clients are associated with scores: being fluent in Dutch and providing informal care are associated with low care dependency, while living with children, feelings of depression, and the presence of an informal caregiver during assessment are associated with high care dependency. We discuss the importance of rigorous assessor training and the potential for socio-psychological factors to contribute to the allocation of welfare benefits in light of the Flemish home care system's potential (lack of) fairness.
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Affiliation(s)
- Shauni Van Doren
- LUCAS Center for Care Research and Consultancy, KU Leuven, 3000 Leuven, Belgium; (K.H.); (A.D.)
| | - David De Coninck
- Center for Sociological Research, KU Leuven, 3000 Leuven, Belgium;
| | - Kirsten Hermans
- LUCAS Center for Care Research and Consultancy, KU Leuven, 3000 Leuven, Belgium; (K.H.); (A.D.)
| | - Anja Declercq
- LUCAS Center for Care Research and Consultancy, KU Leuven, 3000 Leuven, Belgium; (K.H.); (A.D.)
- Center for Sociological Research, KU Leuven, 3000 Leuven, Belgium;
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Fene F, Serván-Mori E, Ángel Mendoza M, Chivardi C, Reyes-Morales H, Nigenda G. Measuring and analysing social efficiency in the production of maternal health services in Mexico, 2008-15. Health Policy Plan 2021; 35:889-899. [PMID: 32588053 DOI: 10.1093/heapol/czaa055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/12/2022] Open
Abstract
'Social efficiency' (SE) denotes the capacity of health systems to ensure equitable access to quality health services at no financial risk to users. Mexico and other low- and middle-income countries have rarely studied the performance of their health systems from an SE perspective. We propose a metric for assessing SE in the production of maternal health services in the public sector among populations without social security, analysing contextual correlates of the demand for these services. Analysis was based on administrative data collected from the 243 health jurisdictions (HJs) in Mexico for the period 2008-15. We defined production inputs as the availability of physical and human resources and social product as the unweighted sum of social sub-products, including an equitable distribution of maternal health resources, the provision of quality maternal health care and financial protection for users. We described the SE scores, the main contextual characteristics as well as those related to the demand for maternal health services. We then performed a variance decomposition analysis of the SE score by component and estimated the SE territorial concentration patterns. Finally, we identified the structural characteristics modelling SE by means of a spatial autoregressive panel data model with fixed effects by year. The SE score rose from 57.7% in 2008 to 71.9% in 2015 (P < 0.01), with its quality component accounting for the largest proportion of variance (30%). SE peaked in HJs with low social marginalization and rurality, and with service demand characterized by low parity and older populations. Different SE levels demonstrated territorial concentration patterns. Analysing SE as a metric for health system performance offers elements that contribute to the achievement of UHC as well as to the design and implementation of effective maternal health interventions intended particularly for the most socially vulnerable sectors of the population.
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Affiliation(s)
- Fato Fene
- School of Public Health of Mexico at the National Institute of Public Health of Mexico, Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Edson Serván-Mori
- Center for Health System Research, National Institute of Public Health of Mexico, Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Miguel Ángel Mendoza
- School of Economics, National Autonomous University of Mexico, Interior S/N, C.U., Coyoacán, 04510 Mexico City, Mexico
| | - Carlos Chivardi
- Center for Health System Research, National Institute of Public Health of Mexico, Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Hortensia Reyes-Morales
- Center for Health System Research, National Institute of Public Health of Mexico, Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Camino Viejo to Xochimilco and, Viad. Tlalpan, Huipulco, 14370 Mexico City, Mexico
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Tabrizi JS, Azami-Aghdash S, Gharaee H. Public-Private Partnership Policy in Primary Health Care: A Scoping Review. J Prim Care Community Health 2021; 11:2150132720943769. [PMID: 32842863 PMCID: PMC7453464 DOI: 10.1177/2150132720943769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Given the challenges of governments to deliver primary health care (PHC), engaging private sector in the form of public-private partnership (PPP) can be effective policy. The aim of present study is to review the experiences of implementing PPP policy in PHC. METHODS This scoping review study was conducted in 2019 using the framework proposed by Arkesy and O'Malley. Required data were collected through search the related keywords in databases, manual search of some journals, websites, and other sources of information and through references check, from January 2000 to May 2019. All studies, which focused on the results of PPP in PHC, and published in English or Persian were included in the study. RESULTS A total of 108 articles were included in the study. The studies were mostly conducted in low- and middle-income countries. The quantitative studies have demonstrated the success of this policy in improving PHC indicators. Based on the qualitative studies PPP in PHC has many benefits, including access improvement, economic benefits, and service quality enhancement. CONCLUSIONS The present study provides useful information on the experiences of different countries in the field of PPP in PHC that can be used by experts and decision makers to decide whether to engage the private sector in the form of PPP model.
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Schenkman S, Bousquat A. From income inequality to social inequity: impact on health levels in an international efficiency comparison panel. BMC Public Health 2021; 21:688. [PMID: 33832455 PMCID: PMC8033748 DOI: 10.1186/s12889-021-10395-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 02/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health equity, although addressed in several publications dealing with health efficiency analysis, is not easily translated into the operationalization of variables, mainly due to technical difficulties. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems. METHOD Fixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequity was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks. RESULTS Both methods demonstrated that countries with higher inequity levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth exhibited, in the final model, the following variables: social inequity and per capita health expenditure. The outcome infant mortality comprehended the level of education variable, in association with the following healthcare variabels: care seeking due to diarrhea in children under five, births attended by skilled health professionals and the reduction in the incidence of HIV. CONCLUSION The dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it is associated with high levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequties affect society altogether, generating mistrust and reduced social cohesion.
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Affiliation(s)
- Simone Schenkman
- Department of Policies, Management and Health, Faculdade de Saúde Pública - FSP (School of Public Health), Universidade de São Paulo - USP (Sao Paulo University), Av. Dr. Arnaldo 715, Cerqueira César, São Paulo, SP, 01246-904, Brazil.
| | - Aylene Bousquat
- Department of Policies, Management and Health, Faculdade de Saúde Pública - FSP (School of Public Health), Universidade de São Paulo - USP (Sao Paulo University), Av. Dr. Arnaldo 715, Cerqueira César, São Paulo, SP, 01246-904, Brazil
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An J, Kim S. Medical cost trends under national health insurance benefit extension in Republic of Korea. Int J Health Plann Manage 2020; 35:1351-1370. [PMID: 32754947 DOI: 10.1002/hpm.3018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 04/13/2020] [Accepted: 06/05/2020] [Indexed: 11/10/2022] Open
Abstract
This study examines whether the burden of medical expenses on households has gradually decreased since South Korea began implementing benefit expansion policies to strengthen health insurance coverage. Using Korea's Household Income & Expenditure Survey from 1995 to 2014, the annual average monthly household expenditures and the catastrophic health expenditure (CHE) indicator were analyzed. The latter is an indicator of household impoverishment resulting from out-of-pocket healthcare expenditures exceeding a defined threshold proportion of the household's income. Through descriptive and frequency data analyses and using P-values, the annual trends and differences in absolute values and share of CHE prevalence across households were measured. The study finds that the proportion of income spent on medical expenses increased from 2.47% (1995) to 4.94% (2014) on average. CHE also increased 3.6 times, 6.3 times, 9.8 times, and 11.1 times for assumed threshold sizes of 10%, 20%, 30%, and 40%, respectively. The lowest income group had the highest increase in CHE incidence. These results suggest that the benefit extension policy has lowered medical use thresholds and led to an increase in medical resource use. Therefore, the Ministries of Health and Welfare, and of Economy and Finance should collaborate to design policies for vulnerable groups.
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Affiliation(s)
- Jinha An
- Department of Public Health, Graduate School, The Catholic University of Korea, Republic of Korea
| | - Sukil Kim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Gharaee H, Tabrizi JS, Azami-Aghdash S, Farahbakhsh M, Karamouz M, Nosratnejad S. Analysis of Public-Private Partnership in Providing Primary Health Care Policy: An Experience From Iran. J Prim Care Community Health 2020; 10:2150132719881507. [PMID: 31617451 PMCID: PMC6796199 DOI: 10.1177/2150132719881507] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: This study aims to analyze the public-private
partnership (PPP) policy in primary health care (PHC), focusing on the
experience of the East Azerbaijan Province (EAP) of Iran. Methods:
This research is a qualitative study. Data were gathered using interviews with
stakeholders and document analysis and analyzed through content analysis.
Results: Participants considered political and economic support
as the most important underlying factors. Improving system efficiency was the
main goal of this policy. Most stakeholders were supporters of the plan, and
there was no major opponent. Implementing the health evolution plan (HEP) was an
opportunity to design this policy. Participants considered the lack of provision
of infrastructure as the main weakness, changing the role of the public sector
as the main strength, and promoting social justice as the main achievement of
policy. The results of the quantitative data review showed that following the
implementation of this policy, health indicators have been improved.
Conclusions: Based on the results of this study, the PPP model
in EAP is a new and successful experience in PHC in Iran. Supporting and
developing this policy may improve the quality and quantity of providing
care.
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Schenkman S, Bousquat AEM. Alteridade ou austeridade: uma revisão acerca do valor da equidade em saúde em tempos de crise econômica internacional. CIENCIA & SAUDE COLETIVA 2019; 24:4459-4473. [DOI: 10.1590/1413-812320182412.23202019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/12/2019] [Indexed: 11/22/2022] Open
Abstract
Resumo Nas últimas décadas, o sistema capitalista, transformado por meio de crises mais agressivas e globais, tem submetido a sociedade à austeridade fiscal e tensionado a garantia dos direitos à saúde, como imposição para ampliar a eficiência e efetividade dos sistemas de saúde. A equidade em saúde, por outro lado, opera como fator protetor em relação aos efeitos nocivos da austeridade sobre a saúde da população. O objetivo deste artigo é analisar o efeito da crise financeira global quanto à valorização da equidade em saúde frente à efetividade nas comparações internacionais de eficiência dos sistemas de saúde na literatura científica. Realizada revisão integrativa, com busca nas bases de dados PubMed e BVS, de 2008-18, com análise cross-case. O equilíbrio entre equidade e efetividade deve ser buscado desde o financiamento até os resultados em saúde, de modo eficiente, como forma de fortalecimento dos sistemas de saúde. A escolha entre alteridade ou austeridade deve ser feita de forma explícita e transparente, com resiliência dos valores societais e princípios de universalidade, integralidade e equidade.
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Soekhai V, de Bekker-Grob EW, Ellis AR, Vass CM. Discrete Choice Experiments in Health Economics: Past, Present and Future. PHARMACOECONOMICS 2019; 37:201-226. [PMID: 30392040 PMCID: PMC6386055 DOI: 10.1007/s40273-018-0734-2] [Citation(s) in RCA: 390] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Discrete choice experiments (DCEs) are increasingly advocated as a way to quantify preferences for health. However, increasing support does not necessarily result in increasing quality. Although specific reviews have been conducted in certain contexts, there exists no recent description of the general state of the science of health-related DCEs. The aim of this paper was to update prior reviews (1990-2012), to identify all health-related DCEs and to provide a description of trends, current practice and future challenges. METHODS A systematic literature review was conducted to identify health-related empirical DCEs published between 2013 and 2017. The search strategy and data extraction replicated prior reviews to allow the reporting of trends, although additional extraction fields were incorporated. RESULTS Of the 7877 abstracts generated, 301 studies met the inclusion criteria and underwent data extraction. In general, the total number of DCEs per year continued to increase, with broader areas of application and increased geographic scope. Studies reported using more sophisticated designs (e.g. D-efficient) with associated software (e.g. Ngene). The trend towards using more sophisticated econometric models also continued. However, many studies presented sophisticated methods with insufficient detail. Qualitative research methods continued to be a popular approach for identifying attributes and levels. CONCLUSIONS The use of empirical DCEs in health economics continues to grow. However, inadequate reporting of methodological details inhibits quality assessment. This may reduce decision-makers' confidence in results and their ability to act on the findings. How and when to integrate health-related DCE outcomes into decision-making remains an important area for future research.
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Affiliation(s)
- Vikas Soekhai
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
| | - Esther W. de Bekker-Grob
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
| | - Alan R. Ellis
- Department of Social Work, North Carolina State University, Raleigh, NC USA
| | - Caroline M. Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Identifying health system value dimensions: more than health gain? HEALTH ECONOMICS POLICY AND LAW 2017; 12:387-400. [PMID: 28294093 DOI: 10.1017/s1744133117000032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Publicly funded health system reforms increasingly require the evaluation of competing programmes. However, programmes are made of multi-dimensional attributes of value (where value refers to latent expectations of health system improvement). This paper identifies the design, implementation and validation of a methodology to elicit health system values to guide health care priority setting. The exercise suggests that the proposed methodology is suitable for eliciting and validating health system values, and its findings show that pursuing health gain alone does not fully capture the dimensions of health system value. More specifically, we identify a list of health system values (elicited by both potential and actual users) and classify them in terms of process-related values (e.g., shorter waiting lists, greater choice, etc.) and improvements in health system equity in addition to value derived from health gain.
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De Abreu Lourenco R, Haas M, Hall J, Viney R. Valuing Meta-Health Effects for Use in Economic Evaluations to Inform Reimbursement Decisions: A Review of the Evidence. PHARMACOECONOMICS 2017; 35:347-362. [PMID: 27858368 DOI: 10.1007/s40273-016-0470-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This review explores the evidence from the literature regarding how meta-health effects (effects other than health resulting from the consumption of health care) are valued for use in economic evaluations. METHODS A systematic review of the published literature (the EMBASE, MEDLINE, PsycINFO, CINAHL, EconLit and SocINDEX databases were searched for publications in March 2016, plus manual searching) investigated the associations between study methods and the resulting values for meta-health effects estimated for use in economic evaluations. The review considered which meta-health effects were being valued and how this differed by evaluation approach, intervention investigated, source of funds and year of publication. Detailed reasons for differences observed between values for comparable meta-health effects were explored, accounting for the method of valuation. RESULTS The search of the literature revealed 71 studies of interest; 35% involved drug interventions, with convenience, information and process of care the three meta-health effects most often investigated. Key associations with the meta-health effects were the evaluation method, the intervention, and the source of funds. Relative values for meta-health effects ranged from 0.9% to 68% of the overall value reported in a study. For a given meta-health effect, the magnitude of the effect evaluated and how the meta-health effect was described and framed relative to overall health explained the differences in relative values. CONCLUSIONS Evidence from the literature shows variability in how meta-health effects are being measured for use in economic evaluations. Understanding the sources of that variability is important if decision makers are to have confidence in how meta-health effects are valued.
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Affiliation(s)
- Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Level 2, Block 5D, Quay St, Haymarket, Sydney, NSW, Australia.
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Level 2, Block 5D, Quay St, Haymarket, Sydney, NSW, Australia
| | - Jane Hall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Level 2, Block 5D, Quay St, Haymarket, Sydney, NSW, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Level 2, Block 5D, Quay St, Haymarket, Sydney, NSW, Australia
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Costa-Font J, Forns JR, Sato A. Participatory health system priority setting: Evidence from a budget experiment. Soc Sci Med 2015; 146:182-90. [PMID: 26517295 DOI: 10.1016/j.socscimed.2015.10.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 10/06/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
Budget experiments can provide additional guidance to health system reform requiring the identification of a subset of programs and services that accrue the highest social value to 'communities'. Such experiments simulate a realistic budget resource allocation assessment among competitive programs, and position citizens as decision makers responsible for making 'collective sacrifices'. This paper explores the use of a participatory budget experiment (with 88 participants clustered in social groups) to model public health care reform, drawing from a set of realistic scenarios for potential health care users. We measure preferences by employing a contingent ranking alongside a budget allocation exercise (termed 'willingness to assign') before and after program cost information is revealed. Evidence suggests that the budget experiment method tested is cognitively feasible and incentive compatible. The main downside is the existence of ex-ante "cost estimation" bias. Additionally, we find that participants appeared to underestimate the net social gain of redistributive programs. Relative social value estimates can serve as a guide to aid priority setting at a health system level.
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Affiliation(s)
- Joan Costa-Font
- London School of Economics and Political Science, United Kingdom.
| | | | - Azusa Sato
- London School of Economics and Political Science, United Kingdom
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