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Health care prioritization in ageing societies: Influence of age, education, health literacy and culture. Health Policy 2011; 100:219-33. [DOI: 10.1016/j.healthpol.2010.08.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 07/23/2010] [Accepted: 08/18/2010] [Indexed: 11/16/2022]
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Ryynänen OP, Myllykangas M, Niemelä P, Kinnunen J, Takala J. Attitudes to prioritization in selected health care activities. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1468-2397.1998.tb00252.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Myllykangas M, Ryynänen OP, Lammintakanen J, Isomäki VP, Kinnunen J, Halonen P. Clinical management and prioritization criteria. Finnish experiences. J Health Organ Manag 2004; 17:338-48. [PMID: 14628487 DOI: 10.1108/14777260310505110] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate the acceptability of 14 prioritization criteria from nurses', doctors', local politicians' and the general public's perspective. Respondents (nurses, n = 682, doctors, n = 837 politicians, n = 1,133 and the general public, n = 1,178) received a questionnaire with 16 imaginary patient cases, each containing 2-3 different prioritization criteria. The subjects were asked to indicate how important it was for them that the treatments in the presented patient cases be subsidized by the community. All respondents preferred treatments for poor people and children. With the exception of the doctors, the three other study groups also prioritized elderly patients. Treatment for institutionalised patients, those with self-induced disease, diseases with both poor and good prognosis, and mild disease were given low priorities. Priority setting in health care should be regarded as a continuous process because of changes in attitudes. However, the best method for surveying opinions and ethical principles concerning prioritization has not yet been discovered.
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Mitton CR, Donaldson C. Setting priorities and allocating resources in health regions: lessons from a project evaluating program budgeting and marginal analysis (PBMA). Health Policy 2003; 64:335-48. [PMID: 12745172 DOI: 10.1016/s0168-8510(02)00198-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Program budgeting and marginal analysis (PBMA) is a framework for setting priorities in health care, used internationally over the last 25 years in Britain, Australia and New Zealand. However, the framework has undergone limited evaluation, and insight into how such evaluation should even take place is not found in the literature. METHODS Seven PBMA case studies were conducted in three Canadian health regions to examine the feasibility of applying the PBMA framework. Structured follow-up surveys with the users of the framework were carried out following the priority setting exercises. RESULTS The PBMA framework was feasibly implemented in three regionalized contexts and was generally viewed favorably by managers and clinicians who participated in the case studies. Numerous methodological lessons were learned and it was found that successful implementation hinges on organizational context. An empirically derived model describing PBMA is outlined and put forth as an evaluation framework for future exercises. CONCLUSIONS Comparisons to the health care management literature indicate that the derived PBMA model is a novel addition to this broader literature. Overall, managers in health organizations internationally would be well-served to consider PBMA to aid regional decision-making processes, but should do so with explicit consideration of the context in which such activity is to occur.
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Affiliation(s)
- Craig R Mitton
- Centre for Health and Policy Studies, University of Calgary, 3330 Hospital Dr. N.W., Alta., Calgary, Canada T2N 4N1.
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Abstract
The organization and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weaknesses, opportunities and threats) by a panel of five members with a background in health economics. The evaluation was based on the reading of an extensive range of documents and literature on the Danish health care system, and a 1-week visit to health care authorities, providers and key persons. The present paper describes the main findings of one of the panel members. A quality assessment approach is combined with the principles of a SWOT analysis to assess the main features of the Danish health care system. In addition, a public health perspective has been used in judging the coherence of the subsystems of the health systems. It is concluded that the macro-efficiency of the health care system could be increased by improving the cooperation between the subsystems. The relatively high mortality rates suggest that greater input into health education programs could significantly improve the health status of the Danish population. Finally, it is suggested that the steering power of the public board be strengthened by transferring ownership of health care institutions to other hands (privatization).
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Affiliation(s)
- Richard Janssen
- Department of Health Economics, University of Tilburg, Tilburg, The Netherlands
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Ament L. Certified nurse-midwives' knowledge of reimbursement issues. J Midwifery Womens Health 2000; 45:157-60. [PMID: 10812860 DOI: 10.1016/s1526-9523(99)00033-1] [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: 11/29/2022]
Abstract
A recent survey examined the impact of reimbursement policies and admitting privileges on the ability of certified nurse-midwives (CNMs) to practice and maintain an income. Many CNMs reported deficits in their knowledge about reimbursement issues. The responses to the survey indicated that service directors either do not view this information as important to their leadership role, have delegated their authority to someone else, or do not have authority over this information. Education program directors may need to examine their curricular content to determine if students are being provided adequate information to better value and understand this data.
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Affiliation(s)
- L Ament
- Yale University School of Nursing, New Haven, CT, USA
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Ryynänen OP, Myllykangas M, Kinnunen J, Takala J. Attitudes to health care prioritisation methods and criteria among nurses, doctors, politicians and the general public. Soc Sci Med 1999; 49:1529-39. [PMID: 10515634 DOI: 10.1016/s0277-9536(99)00222-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this postal questionnaire study was to measure attitudes to health care prioritisation criteria among the Finnish general public (n = 1156), politicians (n = 1096), doctors (n = 803) and nurses (n = 667), altogether 3722 subjects. The questionnaire consisted of questions on background data, a list of seven alternative prioritisation methods and a list of 11 possible criteria for health care prioritisation. The most acceptable prioritisation methods were increased treatment fees and restricting expensive treatments and examinations. Only a few supported administrative prioritisation decisions. One third of the general public indicated that they did not accept any limitations in health care, whereas only 5% of doctors agreed with them. More doctors accepted prioritisation methods than respondents in other groups. Patient is a child, patient is an elderly person, severity of the disease and prognosis of the disease were the most accepted prioritisation criteria. Politicians and the general public also accepted self-induced nature of disease and patient's wealth as prioritisation crieteria. Logistic regression analysis of the general public respondents demonstrated that male gender, higher education and higher personal income were associated with acceptance of most prioritisation criteria. Similarly, older age of the respondent was associated with acceptance of self-induced nature of disease and patient's wealth as prioritisation criteria.
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Affiliation(s)
- O P Ryynänen
- Department of Community Health and General Practice, University of Kuopio, Finland.
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Abstract
Volume, costs and content of medical care depend on professional and public expectations. The UK National Health Service (NHS) removed price barriers to access, so depressed expectations became an important factor in cost control. In USA, professional control of care business inflated expectations and costs. Managed care in the NHS failed to rationalize care because managers seem even less trustworthy than clinicians as arbiters of rational expectations in contexts of underfunding. Rational expectations depend on restored trust, mutual and managerial respect for expertise of both clinicians and patients, and transcendence of the provider-consumer model for value production in medical care.
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Affiliation(s)
- Julian Tudor Hart
- Department of Primary Health Care, Royal Free Hospital Medical School, London, UK
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Stevens A, Milne R. A knowledge-based health service: how do the new initiatives work? J R Soc Med 1998; 91 Suppl 35:26-31. [PMID: 9797747 PMCID: PMC1296361 DOI: 10.1177/014107689809135s07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- A Stevens
- Department of Public Health and Epidemiology, University of Birmingham, UK
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Jones C, Wright K. Programme budgeting revisited: special reference to people with learning disabilities. Health Serv Manage Res 1997; 10:255-65. [PMID: 10174515 DOI: 10.1177/095148489701000406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The recent reorganization of community care in the UK removed many of the perverse incentives identified in the previous system. However, the organization of care for many people is still divided across several agencies in the public and independent sectors. As purchasing and providing agencies in both the National Health Service and local authority personal social services attempt to coordinate policy objectives and the means to achieve them, the total resources available and their allocation across different care groups and among people in the same care groups from a consistent focus of attention. The principles and practice of programme budgeting provide important lessons for planning and monitoring expenditure. This paper rehearses such principles in the specialized area of policies for people with learning disabilities and draws on the experience of mapping expenditure on relevant services in a survey over 10 local authorities in England.
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Affiliation(s)
- C Jones
- Department of Economics and Business Studies, Xaverian College, Manchester, UK
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Myllykangas M, Ryynänen OP, Kinnunen J, Takala J. Attitudes to cuts in expenditure and increased fees in health care. Public Health 1997; 111:71-5. [PMID: 9090279 DOI: 10.1016/s0033-3506(97)90003-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of this postal questionnaire study was to measure attitudes to cuts and increased fees in health care in various Finnish population groups. Four groups were identified; a population sample of 2000 subjects, aged 18-70 y; a random sample of 1500 medical doctors of working age; a random sample of 1000 nurses of working age; and a sample of 2200 politicians involved in health and social care administration, mostly at the municipal level (altogether 6700 subjects). The main questionnaire included, among other things, the following questions: (1) Which of 18 specified medical activities at the primary health care level could be cut without causing severe harm to the population? (2) For which of 13 specified medical activities should clients pay at least 50% of the real cost? All the groups indicated the greatest willingness to cut expenditure on health education, occupational health services, hygiene inspection, substance abuse care, rehabilitation services for war veterans, and family planning. All the groups were least willing to make cuts in home care for disabled and elderly people, maternity services and clinics for under-fives. Most respondents in all groups felt that the activities for which clients should pay at least 50% of the cost were visits to physicians, occupational health services and dental services, whereas clinics for under-five and home care for disabled and elderly persons should be kept free of charge. As a conclusion, primary health care and prevention of diseases for small children, mothers, the elderly and disabled persons, were prioritised by all the groups.
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Affiliation(s)
- M Myllykangas
- University of Kuopio, Department of Community Health and General Practice, Finland
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Myllykangas M, Ryynänen OP, Kinnunen J, Takala J. Comparison of doctors', nurses', politicians' and public attitudes to health care priorities. J Health Serv Res Policy 1996; 1:212-6. [PMID: 10180873 DOI: 10.1177/135581969600100406] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to investigate differences in attitudes concerning prioritisation in health care held by doctors, nurses, local politicians and the general public. METHODS Four groups were established: a population sample of 2000 subjects, aged 18-70 years; a random sample of 1500 doctors of working age; a random sample of 1000 nurses of working age; and a sample of 2200 politicians involved in health and social care administration, mostly at the municipal level (altogether 6700 subjects). The main questionnaire contained, among other things, a list of 12 statements concerning ethical decisions regarding prioritisation in health care. Respondents were asked to indicate their level of agreement with each statement. RESULTS Most respondents in all the groups felt able to express an opinion on the statements. Despite considerable professional and cultural differences between groups, the views were generally similar. On the whole, respondents supported liberal policies in which the community took responsibility for subsidising health care. When differences between groups occurred, it was usually the doctors who held discordant views. Doctors were less inclined to consider a patient's economic status as a determinant of priority for treatment than the other three groups. Both doctors and nurses were less punitive towards patients with self-induced diseases. And doctors and politicians were more likely to feel further cuts in health care expenditure were possible than was true for nurses and the public. CONCLUSIONS While considerable uniformity of opinion exists on ethical issues of prioritisation between the principal interested parties, the views of doctors differ substantially on some matters. If prioritisation was left entirely to doctors, health care provision would not reflect the views of other groups in some important ways.
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Affiliation(s)
- M Myllykangas
- Department of Community Health, University of Kuopio, Finland
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Ryynänen OP, Myllykangas M, Vaskilampi T, Takala J. Random paired scenarios--a method for investigating attitudes to prioritisation in medicine. JOURNAL OF MEDICAL ETHICS 1996; 22:238-42. [PMID: 8863150 PMCID: PMC1377004 DOI: 10.1136/jme.22.4.238] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE This article describes a method for investigating attitudes towards prioritisation in medicine. SETTING University of Kuopio, Finland. DESIGN The method consisted of a set of 24 paired scenarios, which were imaginary patient cases, each containing three different ethical indicators randomly selected from a list of indicators (for example, child, rich patient, severe disease etc.). The scenarios were grouped into 12 random pairs and the procedure was repeated four times, resulting in 12 scenario pairs arranged randomly in five different sets. SURVEY This method was tested with four groups of subjects (n = 8, n = 47, n = 104 and n = 36). RESULTS Children and patients with a severe disease were prioritised in all groups. The aged, patients with a mild disease and patients with a self-acquired disease were negatively prioritised in all groups. Poor or rich patients were prioritised in some groups but negatively prioritised in others. CONCLUSIONS The validity and reliability of this method are good and it is suitable for investigating attitudes towards medical prioritisation.
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Affiliation(s)
- O P Ryynänen
- Department of Community Health and General Practice, University of Kuopio, Finland
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Abstract
The final article in the series considers the ways in which the methods described previously are used in the formation of policy. When health authorities are making decisions about how to spend their money they have to draw on several sources of information about priorities: diktats from policy makers, opinions of consumers and of the professional bodies involved, and evidence gained from research. They must also consider the various methods of costing and select the right one for their circumstances. Some of these methods are still in the early stages of development, but more are being developed all the time and they have a valuable role in helping decision making throughout the NHS.
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Affiliation(s)
- R Robinson
- Institute for Health Policy Studies, Faculty of Social Sciences, The University, Southamptom
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Bowling A, Jacobson B, Southgate L. Explorations in consultation of the public and health professionals on priority setting in an inner London health district. Soc Sci Med 1993; 37:851-7. [PMID: 8211302 DOI: 10.1016/0277-9536(93)90138-t] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The methodology for eliciting the public's priorities for health services is in its infancy. This paper presents the results from a series of exploratory exercises on priorities in City and Hackney. The authors surveyed the opinions of members of community groups and tenants' associations, and compared their responses with those of a random sample of the public as well as general practitioners, consultants and public health doctors. This revealed some disagreement on priorities between these groups. The public, in consistency with the results from other studies, prioritised perceived life saving technologies as high, in contrast to community services and services for people with mental illnesses, which they prioritised as medium to low, in contrast to all the samples of doctors; the public also prioritised health education and family planning as fairly low, as did the GPs and consultants, in contrast to the public health doctors who prioritised them as high. Before DHAs embark on these studies as part of priority setting, they must answer the question: "what will they do if they disagree with the results?"
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Affiliation(s)
- A Bowling
- Department of Public Health, St Bartholomew's Hospital Medical College, London, U.K
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Walsh P. Tetraplegics and the justice of resource allocation. PARAPLEGIA 1993; 31:143-6. [PMID: 8479776 DOI: 10.1038/sc.1993.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- P Walsh
- Centre of Medical Law and Ethics, Kings College London, Strand, England
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Phelan M, Prince M. Community care for patients with schizophrenia. West J Med 1991. [DOI: 10.1136/bmj.303.6813.1334-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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