People often choose the option that is better on the most subjectively prominent attribute — the prominence effect. We studied the effect of prominence in health care priority setting and hypothesized that values related to health would trump values related to costs in treatment choices, even when individuals themselves evaluated different treatment options as equally good. We conducted pre-registered experiments with a diverse Swedish sample and a sample of international experts on priority setting in health care (n = 1348). Participants, acting in the role of policy makers, revealed their valuation for different medical treatments in hypothetical scenarios. Participants were systematically inconsistent between preferences expressed through evaluation in a matching task and preferences expressed through choice. In line with our hypothesis, a large proportion of participants (General population: 92%, Experts 84% of all choices) chose treatment options that were better on the health dimension (lower health risk) despite having previously expressed indifference between those options and others that were better on the cost dimension. Thus, we find strong evidence of a prominence effect in health-care priority setting. Our findings provide a psychological explanation for why opportunity costs (i.e., the value of choices not exercised) are neglected in health care priority setting.

Authors explore the influence of Russian aggression on Ukrainian healthcare and humanitarian crises. On 24 February 2022, Ukraine faced an unprovoked brutal Russian invasion resulting in multiple negative consequences. During the three months of full-scale war, Russians damaged more than 600 hospitals and killed at least 12 medics. Access to health care is severely impacted due to security concerns, restricted mobility, broken supply chains, and mass population displacement. Health care continues to come under attack (including attacks against health facilities, transport, personnel, patients, supplies, and warehouses), with a total of 295 attacks on health care, resulting in 59 injuries and 76 deaths, reported between 24 February and 15 June. Ministry of Health reported that 1658 medical workers had been forced to change their residence and employed in other regions of the country. Russian aggression negatively influenced not only the medical system and economics, but it led humanitarian crisis in the whole of Ukraine.

Increasingly, transgender minors are seeking medical care such as puberty-suppressing or gender-affirming hormone therapies. Yet, whether these interventions should be performed at all is highly controversial. Some healthcare practitioners oppose irreversible interventions, considering it their duty to protect children from harm. Others view minors, like adults, as transgender individuals who must be protected from discrimination. The underlying ethical question is presented as a problem of priority. Is it primarily relevant that minors are involved? Or should decision makers focus on the fact that they treat transgender individuals? The paper explores the relevance for medical practice. We provide results of an interview study with German healthcare professionals. We discuss the general question whether prioritization among different group memberships of the same person is ethically defensible. We conclude that priority conflicts between group memberships of the same person can be deceptive and should be addressed by an intersectional approach. Eventually, we discuss practical implications.

Evidence of the impact of public reporting of health care performance on quality improvement is not yet sufficient for definitive conclusions to be drawn, despite the important policy implications. This study explored the association of public reporting of performance indicators of long-term care facilities in Canada with performance trends. We considered 16 performance indicators in long-term care in Canada, 8 of which are publicly reported at a facility level, whereas the other 8 are not publicly reported, between the fiscal years 2011–2012 and 2018–2019. Data from 1,087 long-term care facilities were included. Improving trends were observed among publicly reported indicators more often than among indicators that were not publicly reported. Our analysis also suggests that the association between publication of data and improvement is stronger among indicators for which there was no improvement prior to publication and among the worst performing facilities.

This article contributes to ongoing discussions about frailty and vulnerability in critical gerontology by asserting that possibilities to engage and enact influence in everyday life situations is a crucial dimension of democracy in later life. We discuss how democracy in this sense can be threatened for older persons for whom health and social care services are needed, following from the labelling practices of frailty and the non-recognition of the social processes that set capabilities in motion. We utilise three examples grounded in research with older persons in their home environment in a Swedish context. The examples show how older people use creative, emotional, practical and social resources to integrate activities in a manner that address their needs and capabilities, and influence the situations in direction towards how and when to be engaged in everyday activities. Based on a discussion of the examples, we argue that health and social care services that provide and build social infrastructures need to recognise the potential concurrency of interdependency, vulnerability and agency within older persons’ local everyday practices. This to address capabilities and enable concrete expression of democracy in everyday situations. Overall, we suggest that conceptual and methodological shifts in research, as well as policy and practice, are needed to bring democratic processes forward through the relational and situated aspects of resources, agency and influence.

There is growing recognition of the importance of dignity and support with eating as markers of high-quality and older-person-centred hospital services. We use data on these markers from the national Adult Inpatient Survey for England to build up statistical evidence on older people's experiences. We find that poor and inconsistent experiences of being treated with dignity and respect, and of receiving support with eating, affect a substantial proportion of inpatients across the vast majority of acute hospital trusts. There has been remarkably little change over time, although small improvements provide some grounds for optimism relating to policy developments in the period following the Francis Inquiry. Amongst people over 65, the prevalence of inconsistent and poor experiences of dignity and support with eating was higher amongst the ‘oldest of the old’ (inpatients aged over 80), individuals who experience a long-standing limiting illness or disability, and women. The highest rates of prevalence were observed amongst disabled women over 80. Perceptions of inadequate nursing quantity and quality, and lack of choice of food, stand out from logistic regression analysis as having consistent, large associations with lack of support with eating. These factors provide potential policy levers since they are within the control of hospitals to a certain extent. In drawing lessons from our analysis for inspection, regulation and monitoring, we highlight the importance of inequalities analysis – including systematic disaggregation and separate identification of at risk sub-groups (e.g. older disabled women) – rather than relying on a ‘population average approach’.

Sweden's coronavirus disease 2019 (COVID-19) response, initially based largely on voluntary measures, has evoked strong reactions nationally and internationally. In this study, we describe Sweden's national policy response with regard to the general public, the community and the health care system, with a focus on how the response changed from March 2020 to June 2021. A number of factors contributed to Sweden's choice of policy response, including its existing legal framework, independent expert agencies and its decentralized, multi-level health care governance system. Challenges to the health- and elder care system during the pandemic, such as the need to increase intensive care- and testing capacity, and to ensure the safety of the elderly were addressed largely at the regional and local levels, with national authorities assuming a primarily coordinative role. Although the overall response based on voluntary compliance has persisted, the national government started to take a more prominent role in public messaging, and in enacting legally binding restrictions during subsequent waves of the pandemic. This study illustrates that not only policy responses, but also the fundamental structure of the health- and elder care system and its governance should be considered when evaluating the impact of the COVID-19 pandemic.