1
|
Garattini L, Badinella Martini M. Modeling European health systems: a theoretical exercise. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1249-1252. [PMID: 37665522 DOI: 10.1007/s10198-023-01628-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/05/2023]
Affiliation(s)
- L Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy.
| | - Marco Badinella Martini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
2
|
Garattini L, Freemantle N, Nobili A, Mannucci PM. Conceptualizing a model for European health systems: the institutional framework. Intern Emerg Med 2023; 18:1213-1215. [PMID: 37014494 DOI: 10.1007/s11739-023-03261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Affiliation(s)
- L Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - N Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - P M Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| |
Collapse
|
3
|
Garattini L, Nobili A, Badinella Martini M, Mannucci PM. The role of general practitioners in the EU: time to draw lessons from a too wide range? Intern Emerg Med 2023; 18:343-346. [PMID: 36680736 DOI: 10.1007/s11739-023-03205-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
Although the role played by general practitioners (GPs) is historically consolidated, continuous changes have been recently introduced in Europe because of the increasing multimorbidity and complexity of patients. Here we try to compare the roles played by GPs in the four major countries of Europe. In France GPs are self-employed medical doctors, and their remuneration consists of a payment scheme for the services provided. The weekly opening hours of French GPs are on average approximately 48. In Germany primary care is mainly provided by GPs and outpatient internists, and patients are free to choose the facility and the professional. German GPs are self-employed professionals mainly remunerated for each consultation, who work for an average of 50 opening hours per week. In Italy GPs are self-employed professionals mainly paid on per capita basis, who have their own list of patients and must guarantee a minimum number of clinical opening hours per week, which has often become the average number in practice. Accordingly, the patients' weekly access to Italian GPs' clinics is very limited. In Spain GPs are civil servants who work in multifunctional facilities with multi-professional teams. The weekly hours worked by Spanish GPs are 38 hours, as for any other civil servant. Trying to draw positive lessons from the comparison, the Spanish facilities seem to be the most advanced examples of horizontal-integrated organizations able to fulfil the expectations of a growing population of ageing people. The range of generalist professionals could be enlarged beyond GPs, as the German example shows.
Collapse
Affiliation(s)
- Livio Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Alessandro Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Marco Badinella Martini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| |
Collapse
|
4
|
Garattini L, Badinella Martini M, Nobili A. General practice in the EU: countries you see, customs you find. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:153-156. [PMID: 36399195 DOI: 10.1007/s10198-022-01549-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy.
| | | | - Alessandro Nobili
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
5
|
Including mental health care in a model of European health system. Epidemiol Psychiatr Sci 2023; 32:e12. [PMID: 36803918 PMCID: PMC9971856 DOI: 10.1017/s2045796023000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
The management of a health system is a matter of economics and business administration because of the costs induced by goods and services delivered. Economics teaches us that the positive effects induced by competition in free markets cannot be expected in health care, which is a classic example of market failure from both demand and supply sides. The most sensible key concepts to refer for managing a health system are funding and provision. While the logical solution for the first variable is universal coverage through general taxation, the second one requires a deeper understanding. Integrated care is the modern approach that better supports the choice in favour of the public sector also for service provision. A major threat against this approach is dual practice legally allowed for health professionals, which inevitably raises financial conflicts of interest. An exclusive contract of employment for civil servants should be the sine qua non for providing public services effectively and efficiently. Integrated care is particularly important for long-term chronic illnesses associated with high levels of disability, such as neurodegenerative diseases and mental disorders, where the mix of health and social services needed can be very complex. Nowadays the growing number of community-dwelling patients with multiple physical and mental health needs is the major challenge for the European health systems. This happens also in public health systems, which should provide universal health coverage in principle, and the case of mental disorders is striking. In the light of this theoretical exercise, we strongly believe that a public National Health and Social Service should be the most indicated model for both funding and providing health and social care in modern societies. The big challenge of the common model of European health system here envisaged would be to limit the negative influences of politics and bureaucracy.
Collapse
|
6
|
Garattini L, Badinella Martini M, Freemantle N, Nobili A. Integrated care in a National Health Service: better horizontal than vertical for general practice? Fam Pract 2022; 39:1194-1195. [PMID: 35595259 DOI: 10.1093/fampra/cmac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Livio Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Marco Badinella Martini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Alessandro Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
7
|
Garattini L, Bozzetto M, Remuzzi G, Freemantle N, Nobili A. Primary care in a National Health Service: time for radical reform. Fam Pract 2022; 39:994-995. [PMID: 35325100 DOI: 10.1093/fampra/cmac019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Livio Garattini
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Michela Bozzetto
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giuseppe Remuzzi
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Nick Freemantle
- Institute for Clinical Trials and Methodology, University College of London, London, United Kingdom
| | - Alessandro Nobili
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
8
|
Garattini L, Badinella Martini M, Nobili A. Community care reform in Italy: Get a move on! Eur J Intern Med 2022; 101:130-131. [PMID: 35314120 DOI: 10.1016/j.ejim.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/14/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research "Mario Negri" IRCCS, Via Gian Battista Camozzi 3, Ranica 24020, Italy
| | - Marco Badinella Martini
- Institute for Pharmacological Research "Mario Negri" IRCCS, Via Gian Battista Camozzi 3, Ranica 24020, Italy.
| | - Alessandro Nobili
- Institute for Pharmacological Research "Mario Negri" IRCCS, Via Gian Battista Camozzi 3, Ranica 24020, Italy
| |
Collapse
|
9
|
Garattini L, Badinella Martini M, Nobili A. Integrated care in Western Europe: a wise solution for the future? Expert Rev Pharmacoecon Outcomes Res 2022; 22:717-721. [PMID: 35196951 DOI: 10.1080/14737167.2022.2046465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION IC is a term commonly adopted across the world underpinning a positive attitude against fragmentation of healthcare service provision. While the principles supporting IC are simple, their implementation is more controversial. AREAS COVERED The growing number of IC definitions is related to the increasing domains of applications, which reflect the increasing demand induced by aging multi-morbid patients. A comprehensive definition of IC should now include the coordination of health and social services useful to deliver continuous care across organizational boundaries. The recent debate on IC is largely influenced by the mismatch between the increasing burden of health and social needs for chronic conditions from the demand side, and the design of health-care systems still focused on acute care from the supply side. EXPERT OPINION The major reasons of persisting IC weakness in European countries stem from arguable choices of health policy taken in the recent past. The political creed in 'market competition' is probably the most emblematic. All initiatives encouraging health-care providers to compete with each other are likely to discourage IC. Since most European GPs are still self-employed professionals working in their own cabinets, the anachronistic professional status of GPs is another historically rooted reason of IC weakness.
Collapse
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | | | - Alessandro Nobili
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
10
|
Garattini L, Badinella Martini M, Nobili A. Integrated Care in Europe: Time to Get it Together? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:145-147. [PMID: 34458969 DOI: 10.1007/s40258-021-00680-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
| | | | - Alessandro Nobili
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy
| |
Collapse
|
11
|
Garattini L, Badinella Martini M, Zanetti M. The Italian NHS at regional level: same in theory, different in practice. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1-5. [PMID: 34009494 PMCID: PMC8131486 DOI: 10.1007/s10198-021-01322-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 05/09/2023]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy.
| | | | - Michele Zanetti
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
12
|
Garattini L, Badinella Martini M, Mannucci PM. Integrated care: easy in theory, harder in practice? Intern Emerg Med 2022; 17:3-6. [PMID: 34491514 DOI: 10.1007/s11739-021-02830-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
Integrated care (IC) is a term now commonly adopted across the world, which implies a positive attitude towards addressing fragmentation of service provision inside health systems. While the principles of IC are simple, their implementation is more controversial. The ever growing number of IC definitions is related to the increasing domains of applications, which reflect the increasing demand induced by ageing multi-morbid patients. An exhaustive definition of IC should now enclose the coordination of health and social services useful to deliver seamless care across organizational boundaries. The current debate on IC is largely fueled by the modern mismatch between the growing burden of health needs for chronic conditions from the demand side and the design of health systems still largely centered on acute care from the supply side. The major reasons of persisting IC weakness in Western European nations stem from arguable choices of health policy taken in a quite recent past. The political creed in 'market competition' is likely to be the most emblematic. All initiatives encouraging healthcare providers to compete with each other are likely to discourage IC. Another historically rooted reason of IC weakness is the occupational status of European general practitioners (GPs). While single large-scale organizations have become a pressing priority for a modern primary care, most GPs are still selfemployed professionals working in their own cabinets. It is time to reconsider the anachronistic status of GPs so as to enhance IC in the future.
Collapse
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
| | | | | |
Collapse
|
13
|
Garattini L, Padula A, Freemantle N. Pricing vaccines and drugs in Europe: worth differentiating? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1345-1348. [PMID: 32577858 PMCID: PMC7308223 DOI: 10.1007/s10198-020-01211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Livio Garattini
- Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy.
| | - Anna Padula
- Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy
| | - Nicholas Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| |
Collapse
|
14
|
Garattini L, Badinella Martini M, Nobili A. The Italian NHS in Lombardy and Veneto: near but far. Intern Emerg Med 2021; 16:2335-2337. [PMID: 33934297 PMCID: PMC8088402 DOI: 10.1007/s11739-021-02754-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/24/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy.
| | | | - Alessandro Nobili
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
15
|
Pennestrì F, Gaudioso A, Jani A, Bottinelli E, Banfi G. Is administered competition suitable for dealing with a public health emergency? Lessons from the local healthcare system at the centre of early COVID-19 outbreak in Italy. Cent Eur J Public Health 2021; 29:109-116. [PMID: 34245550 DOI: 10.21101/cejph.a6533] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/23/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The Lombardy Region, Italy, was the most severely affected by the COVID-19 outbreak. In absence of effective treatments and with basic hygiene measures made mandatory, Lombardy response to COVID-19 relied on its healthcare system characteristics, the administered competition or "quasi-market" model. The aim of the study was to review the strengths and weaknesses of Lombardy's response during the first wave of the COVID-19 epidemic, to explore whether the healthcare model influenced crisis management and describe which policies could help to contain future outbreaks. The results are expected to provide similar healthcare systems with lessons to avoid mistakes and learn from best practice. METHODS Data for quantitative analyses on the performance of the Lombardy and Veneto Regions healthcare systems were derived from existing government sources including the Italian Civil Protection Agency and the Ministry of Health. RESULTS Lombardian quasi-market model, traditionally characterized by a strong hospital network, was held responsible for many suboptimal outcomes. According to critics, years of disinvestments in community care resulted in a hospital overload. However, the same model was responsible for other positive outcomes which have been substantially neglected, such as the opportunity to test for effective containment treatments in a safe environment and rapidly extend the number of beds. CONCLUSIONS The performance of a quasi-market model against public health emergencies largely depends on integration between policy-makers and balance between healthcare providers, which require clear regulation. Reducing institutional fragmentation between levels of governance, improving the coordination of healthcare facilities and adopting telemedicine technologies are means by which healthcare networks could strengthen their resilience against future outbreaks.
Collapse
Affiliation(s)
| | | | - Anant Jani
- Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | | | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
16
|
Garattini L, Badinella Martini M, Mannucci PM. Improving primary care in Europe beyond COVID-19: from telemedicine to organizational reforms. Intern Emerg Med 2021; 16:255-258. [PMID: 33196973 PMCID: PMC7668282 DOI: 10.1007/s11739-020-02559-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 12/04/2022]
Abstract
The COVID-19 pandemic has put under pressure all the health national systems in Europe and telemedicine (TM) has been an almost unavoidable answer for primary care (PC) services to constrain the contagion. PC includes all the healthcare services that are the first level of contact for individuals. General practitioners (GPs) are the pivotal providers of PC throughout Europe. Although GP costs are mainly covered by public services or social insurances in Europe, they are still self-employed physicians everywhere, differently from their colleagues in hospitals who are traditionally employees. TM is a very general term open to various interpretations and definitions. TM can now be practiced by means of modern audio-visual devices and is an alternative to the traditional face-to-face consultation in general practice. Although the adoption of TM seems to be compelling in our era, its practical dissemination in PC has been quite slow so far, and many different concerns have been raised on it. On the whole, TM widespread adoption in PC seems to be more a matter of labor organization and health care funding than of technology and ethics. Larger-scale organizations comprising a wide range of health professionals have become a pressing priority for a modern PC, because working together is crucial to provide high-quality care to patients, and co-location should boost teamwork and facilitate the management of information technology. A national network of large organizations in PC could be rationally managed through local budgets and should increase efficiency by adopting tools such as TM.
Collapse
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
| | | | | |
Collapse
|
17
|
Garattini L, Badinella Martini M, Zanetti M. More room for telemedicine after COVID-19: lessons for primary care? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:183-186. [PMID: 33231825 PMCID: PMC7683583 DOI: 10.1007/s10198-020-01248-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 05/05/2023]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy.
| | | | - Michele Zanetti
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy
| |
Collapse
|
18
|
O'Selmo E, Collin V, Whitehead P. Commissioning in the community dental services: what do dentists think? Br Dent J 2020:10.1038/s41415-020-2401-1. [PMID: 33303922 DOI: 10.1038/s41415-020-2401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/01/2020] [Indexed: 11/09/2022]
Abstract
Aims This study aims to elucidate the thoughts and experiences of community dental service (CDS) dentists on procurement. Interviews were conducted and accompanied by secondary analysis of census data.Methods Demographics and working conditions were examined and interview participants discussed the tendering process.Results CDS dentists were motivated by their patients and overall enjoyed their work. Interviews identified three key themes relating to commissioning: 1) process - dentists' experience of the tendering process; 2) effects - what dentists believe their service looks like after tendering; and 3) results - how dentists believe tendering has affected patients. The point of commissioning was questioned. It was perceived to negatively affect the working environment and the care provided to patients, and was seen to cause a shift in service priorities. It was suggested that providers entered into a state of stasis during commissioning, leaving services to decay.Discussion This paper, the second in a series examining the community and public dental services, highlights the effects that commissioning has on staff and patient care, and builds on the understanding developed in the first paper of this series.Conclusions Further work is needed to examine the place of competitive commissioning in dentistry and, given its ubiquitous use, it is of importance to all dentistry stakeholders.
Collapse
Affiliation(s)
- Ellena O'Selmo
- British Dental Association, Policy and Research, 64 Wimpole Street, London, W1G 8YS, UK. ellena.o'
| | - Victoria Collin
- British Dental Association, Policy and Research, 64 Wimpole Street, London, W1G 8YS, UK
| | - Penny Whitehead
- British Dental Association, Policy and Research, 64 Wimpole Street, London, W1G 8YS, UK
| |
Collapse
|
19
|
de Vries H, Vahl J, Muris J, Evers S, van der Horst H, Cheung KL. Effects of the reform of the Dutch healthcare into managed competition: Results of a Delphi study among experts. Health Policy 2020; 125:27-33. [PMID: 33189409 DOI: 10.1016/j.healthpol.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/17/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In 2006 a major healthcare reform was introduced in the Netherlands, implying managed competition. This study explored the level of consensus on the outcomes and desired changes of this new system, and differences between stakeholder groups. METHODS A three-round Delphi-study was conducted among Dutch healthcare insurers, health economists, and professionals in general practice (GP) care and mental health (MH) care. In the first round, 20 experts indicated the most important advantages and disadvantages of the Dutch managed competition, and desired changes. Experts in the second (n = 106) and third round (N = 88) rated the importance of the 88 factors identified in the first round. RESULTS Only healthcare insurers reached consensus on important advantages (i.e. improved efficiency; room for choice). Health economists reached almost no consensus on any factors. GP and MH-care professionals reached most consensus on disadvantages (i.e. focus on price over quality, increased bureaucracy) and desired changes (i.e. reduce bargaining power of healthcare insurers; increase attention for care of complex patients); half of them suggested abolishment of managed competition. CONCLUSION GP and MH-care professionals were most dissatisfied and suggested several changes or even abolishment of the 2006 reform; healthcare insurers mentioned some benefits. This level of dissatisfaction among health care professionals indicates that there is room for improvement, preferably developed in conjunction with stakeholders.
Collapse
Affiliation(s)
- Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands.
| | - Jos Vahl
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands
| | - Jean Muris
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands
| | - Silvia Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Henriëtte van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Free University Amsterdam, the Netherlands
| | - Kei Long Cheung
- Health Behaviour Change Research Group, Department of Health Sciences, College of Health and Life Sciences, Brunel University London, United Kingdom
| |
Collapse
|
20
|
Garattini L, Zanetti M, Freemantle N. The Italian NHS: What Lessons to Draw from COVID-19? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:463-466. [PMID: 32451979 PMCID: PMC7247917 DOI: 10.1007/s40258-020-00594-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- Livio Garattini
- Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Via GB Camozzi 3, 24020, Ranica, BG, Italy.
| | - Michele Zanetti
- Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Via GB Camozzi 3, 24020, Ranica, BG, Italy
| | - Nicholas Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| |
Collapse
|
21
|
Garattini L, Padula A. Defensive medicine in Europe: a 'full circle'? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:477-482. [PMID: 31919702 DOI: 10.1007/s10198-019-01151-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy.
| | - Anna Padula
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy
| |
Collapse
|
22
|
Garattini L, Padula A, Mannucci PM. Defensive medicine: Everything and its opposite. Eur J Intern Med 2020; 74:117-118. [PMID: 32001095 DOI: 10.1016/j.ejim.2020.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 11/15/2022]
|
23
|
Garattini L, Padula A, Mannucci PM. Conflicts of interest in medicine: a never-ending story. Intern Emerg Med 2020; 15:357-359. [PMID: 32124207 DOI: 10.1007/s11739-020-02293-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/11/2020] [Indexed: 10/24/2022]
Abstract
Individuals may have conflicts of interest (CoI) when they choose between the duties of their jobs and their own private interests. In medicine, CoI are potentially ubiquitous and their disclosure has now become the most frequent strategy to address them in professional lives. In the medical literature, CoI are classified into two different types-financial and non-financial. Financial CoI are easy to identify and can bias any kind of results in research; so, their disclosure is very important. The unsolvable dilemma is where to set the lowest limit for sums received from industry. Non-financial CoI are a very large category intrinsically related to the individuals concerned, ranging from family relationships to religious beliefs, and the mere disclosure of many of them can raise privacy and ethical issues. Two opposite narratives characterize the debate on financial CoI caused by pharmaceutical industry. The critical side argues that, because the primary goal of pharmaceutical industry is inevitably to promote its products, the best strategy is to stay away from financial CoI. On the other hand, the defensive side claims that financial CoI are boosted by ideology but meaningless in real practice, since any kind of interest can raise a potential conflict. A missing point in the debate on financial CoI is that health care is a classical example of 'market failure' in the economic theory. Since health cannot be considered a 'consumer good', the economic paradigm of 'free market' does not fit for healthcare products. To conclude, even though transparency on financial CoI cannot itself deter the risk of bias, rejecting it would be an even bigger mistake. At variance, mandatory disclosure of non-financial CoI risks to be confusing and questionable in many cases, paradoxically distracting attention from the potential bias created by financial CoI.
Collapse
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
| | - Anna Padula
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy
| | | |
Collapse
|
24
|
Garattini L, Padula A. Defensive medicine in Europe: a 'full circle'? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:165-170. [PMID: 31879861 DOI: 10.1007/s10198-019-01144-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 12/03/2019] [Indexed: 05/24/2023]
Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy.
| | - Anna Padula
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy
| |
Collapse
|
25
|
Garattini L, Padula A. Pharmaceutical expenditure control in Europe: time to move from pricing to budgeting? J R Soc Med 2020; 113:93-97. [PMID: 31858868 PMCID: PMC7068764 DOI: 10.1177/0141076819894681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, Institute for
Pharmacological Research Mario Negri IRCCS, Ranica 24020, Italy
| | - Anna Padula
- CESAV, Centre for Health Economics, Institute for
Pharmacological Research Mario Negri IRCCS, Ranica 24020, Italy
| |
Collapse
|
26
|
Garattini L, Padula A. Conflict of interest disclosure: striking a balance? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:633-636. [PMID: 30607655 DOI: 10.1007/s10198-018-1028-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Livio Garattini
- Centre for Health Economics, CESAV, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy.
| | - Anna Padula
- Centre for Health Economics, CESAV, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy
| |
Collapse
|
27
|
Garattini L, Padula A. Urgent reforms for general practice in Italy. Eur J Intern Med 2019; 64:e17. [PMID: 31014909 DOI: 10.1016/j.ejim.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Italy.
| | - Anna Padula
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Italy
| |
Collapse
|
28
|
Abbasi K. An era of caution and careful planning. Med Chir Trans 2019; 112:3. [DOI: 10.1177/0141076818823154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|