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DiStefano MJ, Zemplenyi A, McQueen RB. Assessing clinical benefit in the Medicare Drug Price Negotiation Program: A 2-step approach for improving transparency, consistency, and meaningful patient engagement. J Manag Care Spec Pharm 2024; 30:252-258. [PMID: 38241282 PMCID: PMC10906446 DOI: 10.18553/jmcp.2024.23255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
In early 2024, the Centers for Medicare & Medicaid Services (CMS) will send initial price offers to the manufacturers of the first 10 drugs selected for the Medicare Drug Price Negotiation Program, established under the Inflation Reduction Act. However, CMS has not specified exactly how it will adjust the starting point for an initial price offer based on assessment of a drug's clinical benefit. This article addresses unanswered questions relating to CMS' methods for assessing clinical benefit. Specifically, we address how CMS can weigh various measures of evidence, ensure transparency and consistency, meaningfully incorporate patient and other stakeholder perspectives, and support addressing evidence gaps. We propose a 2-step approach for assessing the overall clinical benefit of a selected drug compared with its therapeutic alternatives that builds on the framework outlined by CMS. In step 1, CMS would evaluate conventional clinical benefit, defined in terms of outcomes commonly used in clinical studies for the selected drug and indications. In step 2, CMS would evaluate other outcomes broadly related to patient experience that are not adequately represented in the clinical literature. Overall, our approach incorporates the advantages of both qualitative and quantitative approaches to value assessment and decision-making. We describe a set of loose decision rules to improve transparency and consistency, recommend incorporating ranks and weights to signal to researchers and manufacturers which elements of clinical benefit and sources of data are the most important, and center meaningful deliberation with clinical experts, patients, and caregivers.
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Affiliation(s)
- Michael J. DiStefano
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora
| | - Antal Zemplenyi
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora
- Syreon Research Institute, Budapest, Hungary
| | - R. Brett McQueen
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora
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Tugendhaft A, Christofides N, Stacey N, Kahn K, Erzse A, Danis M, Gold M, Hofman K. Moving towards social inclusion: Engaging rural voices in priority setting for health. Health Expect 2023; 27:e13895. [PMID: 37882224 PMCID: PMC10726206 DOI: 10.1111/hex.13895] [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] [Received: 05/24/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Achieving universal health coverage (UHC) in the context of limited resources will require prioritising the most vulnerable and ensuring health policies and services are responsive to their needs. One way of addressing this is through the engagement of marginalised voices in the priority setting process. Public engagement approaches that enable group level deliberation as well as individual level preference capturing might be valuable in this regard, but there are limited examples of their practical application, and gaps in understanding their outcomes, especially with rural populations. OBJECTIVE To address this gap, we implemented a modified priority setting tool (Choosing All Together-CHAT) that enables individuals and groups to make trade-offs to demonstrate the type of health services packages that may be acceptable to a rural population. The paper presents the findings from the individual choices as compared to the group choices, as well as the differences among the individual choices using this tool. METHODS Participants worked in groups and as individuals to allocate stickers representing the available budget to different health topics and interventions using the CHAT tool. The allocations were recorded at each stage of the study. We calculated the median and interquartile range across study participants for the topic totals. To examine differences in individual choices, we performed Wilcoxon rank sum tests. RESULTS The results show that individual interests were mostly aligned with societal ones, and there were no statistically significant differences between the individual and group choices. However, there were some statistically significant differences between individual priorities based on demographic characteristics like age. DISCUSSION The study demonstrates that giving individuals greater control and agency in designing health services packages can increase their participation in the priority setting process, align individual and community priorities, and potentially enhance the legitimacy and acceptability of priority setting. Methods that enable group level deliberation and individual level priority setting may be necessary to reconcile plurality. The paper also highlights the importance of capturing the details of public engagement processes and transparently reporting on these details to ensure valuable outcomes. PUBLIC CONTRIBUTION The facilitator of the CHAT groups was a member from the community and underwent training from the research team. The fieldworkers were also from the community and were trained and paid to capture the data. The participants were all members of the rural community- the study represents their priorities.
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Affiliation(s)
- Aviva Tugendhaft
- SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SASchool of Public Health, Faculty of Health Sciences, University of WitwatersrandJohannesburgSouth Africa
| | - Nicola Christofides
- School of Public HealthFaculty of Health Sciences, University of the WitwatersrandJohannesburgSouth Africa
| | - Nicholas Stacey
- Department of Health PolicyLondon School of EconomicsLondonUK
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit—AgincourtSchool of Public Health, Faculty of Health Sciences, University of the WitwatersrandJohannesburgSouth Africa
| | - Agnes Erzse
- SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SASchool of Public Health, Faculty of Health Sciences, University of WitwatersrandJohannesburgSouth Africa
| | - Marion Danis
- Department of BioethicsNational Institutes of HealthBethesdaMarylandUSA
| | - Marthe Gold
- New York Academy of MedicineNew York CityNew YorkUSA
| | - Karen Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SASchool of Public Health, Faculty of Health Sciences, University of WitwatersrandJohannesburgSouth Africa
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Krubiner CB, Tugendhaft A, DiStefano MJ, Barsdorf NW, Merritt MW, Goldstein SJ, Mosam A, Potgieter S, Hofman KJ, Faden RR. The Value of Explicit, Deliberative, and Context-Specified Ethics Analysis for Health Technology Assessment: Evidence From a Novel Approach Piloted in South Africa. Value Health Reg Issues 2023; 34:23-30. [PMID: 36455448 DOI: 10.1016/j.vhri.2022.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/26/2022] [Accepted: 10/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This article explores the perceived value, including associated strengths and challenges, of using a context-specified ethics framework to guide deliberative health technology appraisals. METHODS The South African Values and Ethics for Universal Health Coverage (SAVE-UHC) approach, piloted in South Africa, consisted of 2 phases: (1) convening a national multistakeholder working group to develop a provisional ethics framework and (2) testing the provisional ethics framework through simulated health technology assessment appraisal committee meetings (SACs). Three SACs each reviewed 2 case studies of sample health interventions using the framework. Participants completed postappraisal questionnaires and engaged in focus group discussions. RESULTS The SACs involved 27 participants across 3 provinces. Findings from the postappraisal questionnaires demonstrated general support for the SAVE-UHC approach and content of the framework, high levels of satisfaction with the recommendations produced, and general sentiment that participants were able to actively contribute to appraisals. Qualitative data showed participants perceived using a context-specified ethics framework in deliberative decision making: (1) supported wider consideration of and deliberation about morally relevant features of the health coverage decisions, thereby contributing to quality of appraisals; (2) could improve transparency; and (3) offered benefits to those directly involved in the priority-setting process. Participants also identified some challenges and concerns associated with the approach. CONCLUSIONS The SAVE-UHC approach presents a novel way to develop and pilot a locally contextualized, explicit ethics framework for health priority setting. This work highlights how the combination of a context-specified ethics framework and structured deliberative appraisals can contribute to the quality of health technology appraisals and transparency of health priority setting.
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Affiliation(s)
- Carleigh B Krubiner
- Center for Global Development, Washington, DC, USA; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA.
| | - Aviva Tugendhaft
- South African Medical Research Council (SAMRC)/Wits Centre for Health Economics and Decision Science - PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Michael J DiStefano
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nicola W Barsdorf
- Office of Research Integrity and Ethics, Division for Research Development, Stellenbosch University, Stellenbosch, South Africa
| | - Maria W Merritt
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Susan J Goldstein
- South African Medical Research Council (SAMRC)/Wits Centre for Health Economics and Decision Science - PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Atiya Mosam
- South African Medical Research Council (SAMRC)/Wits Centre for Health Economics and Decision Science - PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Sunita Potgieter
- Office of Research Integrity and Ethics, Division for Research Development, Stellenbosch University, Stellenbosch, South Africa
| | - Karen J Hofman
- South African Medical Research Council (SAMRC)/Wits Centre for Health Economics and Decision Science - PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ruth R Faden
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
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Fleck LM. Precision medicine and the fragmentation of solidarity (and justice). MEDICINE, HEALTH CARE, AND PHILOSOPHY 2022; 25:191-206. [PMID: 35006450 PMCID: PMC8744576 DOI: 10.1007/s11019-022-10067-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 05/15/2023]
Abstract
Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solidarity includes a sense of justice. Given that, I will argue that precision medicine represents a potential weakening of solidarity, albeit not a unique weakening. Precision medicine includes 150 targeted cancer therapies (mostly for metastatic cancer), all of which are extraordinarily expensive. Our critical question: Must a commitment to solidarity as defined mean that all these targeted cancer therapies should be guaranteed to all within each country in the European Union, no matter the cost, no matter the degree of effectiveness? Such a commitment would imply that cancer was ethically special, rightfully commandeering unlimited resources. That in itself would undermine solidarity. I offer multiple examples of how current and future dissemination of these targeted cancer drugs threaten a commitment to solidarity. An alternative is to fund more cancer prevention efforts. However, that too proves a threat to solidarity. Solidarity, with or without a sense of justice, is too abstract a notion to address these challenges. Further, we need to accept that we can only hope to achieve "rough justice" and "supple solidarity." The precise practical meaning of these notions needs to be worked out through a fair and inclusive process of rational democratic deliberation, which is the real and practical foundation of just solidarity.
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Affiliation(s)
- Leonard M Fleck
- Center for Bioethics and Social Justice, College of Human Medicine, Michigan State University, 965 Wilson Road C-208, East Lansing, MI, 48824, USA.
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Dalaba MA, Nonterah EA, Chatio ST, Adoctor JK, Dambayi E, Nonterah EW, Azalia S, Ayi-Bisah D, Erzse A, Watson D, Hardy-Johnson P, Kehoe SH, Tugendhaft A, Ward K, Debpuur C, Oduro A, Ofosu W, Danis M, Barker M. Engaging community members in setting priorities for nutrition interventions in rural northern Ghana. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000447. [PMID: 36962493 PMCID: PMC10022374 DOI: 10.1371/journal.pgph.0000447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/13/2022] [Indexed: 11/18/2022]
Abstract
This study used "Choosing All Together" (CHAT), a deliberative engagement tool to prioritise nutrition interventions and to understand reasons for intervention choices of a rural community in northern Ghana. The study took an exploratory cross-sectional design and used a mixed method approach to collect data between December 2020 and February 2021. Eleven nutrition interventions were identified through policy reviews, interaction with different stakeholders and focus group discussions with community members. These interventions were costed for a modified CHAT tool-a board-like game with interventions represented by colour coded pies and the cost of the interventions represented by sticker holes. Supported by trained facilitators, six community groups used the tool to prioritise interventions. Discussions were audio-recoded, transcribed and thematically analysed. The participants prioritised both nutrition-sensitive and nutrition-specific interventions, reflecting the extent of poverty in the study districts and the direct and immediate benefits derived from nutrition-specific interventions. The prioritised interventions involved livelihood empowerment, because they would create an enabling environment for all-year-round agricultural output, leading to improved food security and income for farmers. Another nutrition-sensitive, education-related priority intervention was male involvement in food and nutrition practices; as heads of household and main decision makers, men were believed to be in a position to optimise maternal and child nutrition. The prioritised nutrition-specific intervention was micronutrient supplementation. Despite low literacy, participants were able to use CHAT materials and work collectively to prioritize interventions. In conclusion, it is feasible to modify and use the CHAT tool in public deliberations to prioritize nutrition interventions in rural settings with low levels of literacy. These communities prioritised both nutrition-sensitive and nutrition-specific interventions. Attending to community derived nutrition priorities may improve the relevance and effectiveness of nutrition health policy, since these priorities reflect the context in which such policy is implemented.
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Affiliation(s)
- Maxwell Ayindenaba Dalaba
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Engelbert A Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Julius Global Health, Julius Centre for Health Science and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Samuel T Chatio
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - James K Adoctor
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Edith Dambayi
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Esmond W Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Stephen Azalia
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Doreen Ayi-Bisah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Agnes Erzse
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, University of Witwatersrand School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Daniella Watson
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Polly Hardy-Johnson
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- AECC University College, Bournemouth, United Kingdom
| | - Sarah H Kehoe
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Aviva Tugendhaft
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, University of Witwatersrand School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Kate Ward
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Cornelius Debpuur
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Abraham Oduro
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Winfred Ofosu
- Upper East Regional Health Directorate, Ghana Health Service, Bolgatanga, Ghana
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, MD, United States of America
| | - Mary Barker
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton Foundation Trust, Southampton General Hospital, Southampton, United Kingdom
- School of Health Sciences, University of Southampton, Highfield, Southampton, United Kingdom
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Pace J, Ghinea N, Pearson SA, Kerridge I, Lipworth W. Consumer perspectives of accelerated access to medicines: a qualitative study. J Health Organ Manag 2021; ahead-of-print. [PMID: 34128376 DOI: 10.1108/jhom-08-2020-0344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE In this study, the authors aimed to explore consumer perspectives on accelerated access to medicines. The authors were particularly interested in how they balance competing considerations of safety, efficacy, equity and access; whether and how their views change when there are different levels of uncertainty surrounding the safety and efficacy of new medicines; and the procedures that they think should be used to make decisions about accelerated access to new medicines. DESIGN/METHODOLOGY/APPROACH This was an exploratory qualitative study. Thirteen semi-structured interviews with patient advocates and two focus groups with patients were conducted and analysed thematically. Interviews and focus groups were audio recorded and transcribed verbatim. Data were analysed through inductive thematic analysis. FINDINGS Participants outlined a range of justifications for accelerated access, including addressing unmet medical needs and encouraging further research and development. However, they were also cognisant of the potential risks and viewed ongoing data collection, disinvestment and market withdrawal as ways to address these. They also emphasised the importance of transparent decisions being made by people with relevant expertise, based on a thorough consideration of scientific evidence and stakeholder perspectives. ORIGINALITY/VALUE This is the first study to comprehensively explore Australian consumers' views of accelerated access to medicines. The results suggest that consumers want timely access to new medicines, but not at the expense of safety, efficacy, equity and sustainability. While accelerated access programs are likely to be welcomed by consumers, they must be fully informed of their conditions and limitations, and robust post-market data surveillance must be implemented and enforced to protect the interests of both individual patients and the broader community.
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Affiliation(s)
- Jessica Pace
- Sydney Health Ethics, The University of Sydney, Sydney, Australia
| | - Narcyz Ghinea
- Sydney Health Ethics, University of Sydney, Sydney, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Ian Kerridge
- Sydney Health Ethics, University of Sydney, Sydney, Australia
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Tugendhaft A, Hofman K, Danis M, Kahn K, Erzse A, Twine R, Gold M, Christofides N. Deliberative engagement methods on health care priority-setting in a rural South African community. Health Policy Plan 2021; 36:1279-1291. [PMID: 34051093 PMCID: PMC8428615 DOI: 10.1093/heapol/czab005] [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] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
Public engagement in priority-setting for health is increasingly recognized as a means to ensure more ethical, inclusive and legitimate decision-making processes, especially in the context of Universal Health Coverage where demands outweigh the available resources and difficult decisions need to be made. Deliberative approaches are often viewed as especially useful in considering social values and balancing trade-offs, however, implementation of deliberative engagement tools for priority-setting is scant, especially in low- and middle-income settings. In order to address this gap, we implemented a context-specific public deliberation tool in a rural community in South Africa to determine priorities for a health services package. Qualitative data were analysed from seven group deliberations using the engagement tool. The analysis focused on understanding the deliberative process, what the participants prioritized, the reasons for these selections and how negotiations took place within the groups. The deliberations demonstrated that the groups often considered curative services to be more important than primary prevention which related to the perceived lack of efficacy of existing health education and prevention programmes in leading to behaviour change. The groups engaged deeply with trade-offs between costly treatment options for HIV/AIDS and those for non-communicable disease. Barriers to healthcare access were considered especially important by all groups and some priorities included investing in more mobile clinics. This study demonstrates that deliberative engagement methods can be successful in helping communities balance trade-offs and in eliciting social values around health priorities. The findings from such deliberations, alongside other evidence and broader ethical considerations, have the potential to inform decision-making with regard to health policy design and implementation.
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Affiliation(s)
- Aviva Tugendhaft
- SAMRC/Wits Centre for Health Economics and Decision Science- PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science- PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, MD, USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit -Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Agnes Erzse
- SAMRC/Wits Centre for Health Economics and Decision Science- PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit -Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marthe Gold
- New York Academy of Medicine, New York City, NY, USA
| | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Hendriks MJ, Harju E, Roser K, Ienca M, Michel G. The long shadow of childhood cancer: a qualitative study on insurance hardship among survivors of childhood cancer. BMC Health Serv Res 2021; 21:503. [PMID: 34034742 PMCID: PMC8152348 DOI: 10.1186/s12913-021-06543-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The long-term consequences of childhood cancer have received increasing attention due to the growing number of survivors over the past decades. However, insurance hardships of survivors are mostly unknown. This study explored qualitatively, in a sample of childhood cancer survivors (CCS), (i) the experiences and needs of CCS living in Switzerland with a special focus on hardships related to insurance; and (ii) the views of insurance and law experts with experience on childhood cancer. METHODS Semi-structured interviews were conducted with 28 childhood cancer survivors and 3 experts (one legal expert, two insurance experts). Data was analysed using qualitative content analysis. RESULTS Three key themes emerged from the interviews with the CCS: 1) experiences with insurance, 2) perception of discrimination, and 3) needs and barriers for support. The interviewed experts provided further detailed clarification of CCS' concerns. Our findings indicated that some CCS can move past their cancer history, while others continue to face hardships. CCS reported confusion about the opportunities and services within the social security system and most relied on their personal contacts for guidance. Finally, CCS expressed a strong need for socio-economic and legal support for social insurance questions, especially related to disability insurance. CONCLUSIONS With the growing population of CCS, it is essential to further assess the interplay between medical and psychosocial health and socio-economic hardship. Supportive psychosocial services should aim to ameliorate insurance hardships. Better understanding of the relationship between childhood cancer and insurance hardships during survivorship will inform efforts to improve long-term financial security and health outcomes for survivors. We call for the public, lawmakers, researchers, insurers, and patient organizations to come together and discuss future perspectives to avoid the risk of discrimination for cancer survivors.
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Affiliation(s)
- Manya Jerina Hendriks
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland.,Clinical Ethics, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Erika Harju
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Marcello Ienca
- Department of Health Science and Technology, Technical University of Zurich, Zurich, Switzerland
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland.
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9
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Analyzing the Criteria of Efficient Carbon Capture and Separation Technologies for Sustainable Clean Energy Usage. ENERGIES 2020. [DOI: 10.3390/en13102592] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study focuses on carbon capture and distribution technology, which is a new approach to the solution of this problem. In order to use this technology more effectively, six significant criteria are defined by considering the essentials of the international Loss Control Institute and the supported literature. Moreover, the analytic network process (ANP) is applied for measuring the relative importance of each factor. The findings demonstrate that organizational factor has the greatest importance, whereas market factor is the weakest element. In addition, the education of the personnel is the most important criterion for low-cost industrial carbon dioxide capture and separation technologies. In this context, it is seen that companies need competent personnel in order to reduce the costs of these products. There are two types of strategies that companies can develop to achieve this goal. Firstly, it would be appropriate for companies to provide their staff with the necessary training on carbon capture and storage technologies. The second most important strategy is for the new personnel to be employed in the company. When choosing new employees, it is necessary to measure whether they have sufficient knowledge about this technology. These strategies will contribute to lower costs when developing products for carbon capture and storage technology.
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Danis M, Goold SD, Schindler M, Hurst SA. The Value of Engaging the Public in CHATing About Healthcare Priorities: A Response to Recent Commentaries. Int J Health Policy Manag 2019; 8:250-252. [PMID: 31050971 PMCID: PMC6499903 DOI: 10.15171/ijhpm.2018.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/17/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, MD, USA
| | - Susan D Goold
- Department of General Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Melinee Schindler
- Institute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, Switzerland
| | - Samia A Hurst
- Institute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, Switzerland
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11
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Hurst SA, Schindler M, Goold SD, Danis M. Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage. Int J Health Policy Manag 2018; 7:746-754. [PMID: 30078295 PMCID: PMC6077280 DOI: 10.15171/ijhpm.2018.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 02/12/2018] [Indexed: 11/12/2022] Open
Abstract
Background: As universal health coverage becomes the norm in many countries, it is important to determine public priorities regarding benefits to include in health insurance coverage. We report results of participation in a decision exercise among residents of Switzerland, a high-income country with a long history of universal health insurance and deliberative democracy.
Methods: We adapted the Choosing Healthplans All Together (CHAT) tool, an exercise developed to transform complex healthcare allocation decisions into easily understandable choices, for use in Switzerland. We conducted CHAT exercises in twelve Swiss cities with recruitment from a range of socio-economic backgrounds, taking into account differences in language and culture.
Results: Compared to existing coverage, a majority of 175 participants accepted greater general practice gatekeeping (94%), exclusion of invasive life-sustaining measures in dying patients (80%), longer waiting times for non-urgent episodic care (78%), greater adherence to cost-effectiveness guidelines in chronic care (66%), and lower premium subsidies (51%). Most initially chose greater coverage for dental care (59%), quality of life (57%), and long-term care (90%). During group deliberations, participants increased coverage for out-of-pocket costs (58%) and mental health to current levels (41%) and beyond current levels for rehabilitation (50%), and decreased coverage for quality of life to current levels (74%). Following group deliberation, they tended to change their views back to below current coverage for help with out-of-pocket costs, and back to current levels for rehabilitation. Most participants accepted the plan as appropriate and fair. A significant number would have added nothing.
Conclusion: Swiss participants who have engaged in a priority setting exercise accept complex resource allocation trade-offs in healthcare coverage. Moreover, in the context of a well-funded healthcare system with universal coverage centered on individual choice, at least some of our participants believed a fully sufficient threshold of health insurance coverage was achieved.
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Affiliation(s)
- Samia A Hurst
- Institute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, Switzerland
| | - Mélinée Schindler
- Institute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, Switzerland
| | - Susan D Goold
- Department of General Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, MD, USA
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Schindler M, Danis M, Goold SD, Hurst SA. Solidarity and cost management: Swiss citizens' reasons for priorities regarding health insurance coverage. Health Expect 2018; 21:858-869. [PMID: 29654652 PMCID: PMC6186533 DOI: 10.1111/hex.12680] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 11/30/2022] Open
Abstract
Context Approaches to priority‐setting for scarce resources have shifted to public deliberation as trade‐offs become more difficult. We report results of a qualitative analysis of public deliberation in Switzerland, a country with high health‐care costs, an individual health insurance mandate and a strong tradition of direct democracy with frequent votes related to health care. Methods We adapted the Choosing Healthplans All Together (CHAT) tool, an exercise developed to transform complex health‐care allocation decisions into easily understandable choices, for use in Switzerland. We conducted focus groups in twelve Swiss cities, recruiting from a range of socio‐economic backgrounds in the three language regions. Findings Participants developed strategic arguments based on the importance of basic coverage for all, and of cost‐benefit evaluation. They also expressed arguments relying on a principle of solidarity, in particular the importance of protection for vulnerable groups, and on the importance of medical care. They struggled with the place of personal responsibility in coverage decisions. In commenting on the exercise, participants found the degree of consensus despite differing opinions surprising and valuable. Conclusion The Swiss population is particularly attentive to the costs of health care and means of reducing these costs. Swiss citizens are capable of making trade‐offs and setting priorities for complex health issues.
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Affiliation(s)
- Mélinée Schindler
- Institute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, Switzerland
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, MD, USA
| | - Susan D Goold
- Department of General Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Samia A Hurst
- Institute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, Switzerland
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