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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.
As a distinct field of study and practice, health law is still relatively new, and its boundaries continue to be contested. As recently as 2006, Einer Elhague questioned whether health law could “become a coherent field of law.”1 The fact that Elhague’s musings appeared in a symposium dedicated to the idea that the “once vibrant … and fresh” subject of health law was haunted by a “specter of exhaustion” indicates the contested nature of the “field-ness” of this field.2 Its boundaries are even more hotly disputed. Is health law limited to the relationships among health care professionals, patients, the institutions where they meet, and the payers who finance their encounters? Or does it also encompass legal issues related to public health and the social determinants of health, which social epidemiology demonstrates3 play an even greater role than health care in shaping outcomes?4 As feminist health law scholars, we “view health law as an inherently … expansive field.”
5 For the purposes of this volume, however, and in light of the potential for other areas – such as poverty law, housing law, and employment law – to generate Feminist Judgments books of their own, we have narrowed our focus to more traditional health law topics. Nonetheless, we view the insights of social epidemiology regarding the influence of social, economic, and environmental factors on health as “an invitation to engage with the rich literature of critical legal theories that view law as an expression of social power.”6
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.
This chapter simplifies the complex multi-payer healthcare reimbursement market and explains how to position your product for successful reimbursement. The best time to bring reimbursement planning into the product development process is discussed here. The U.S. healthcare system is used as a baseline and the healthcare systems of other countries are reviewed briefly. Reimbursement for devices and administered drugs is based on many factors, and this chapter shows the steps a biomedical product company can take to maximize revenues in the US Healthcare system. The basics of reimbursement – coverage, coding, and payment – are explained in simple terms with diagrams. Case studies help show how individual companies have addressed the reimbursement process for novel breakthrough technologies.
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.
Most emergency preparedness planning seeks to identify vulnerable population subgroups; however, focusing on chronic conditions alone may ignore other important characteristics such as location and poverty. Social needs were examined as correlates of anticipated needs and desire for assistance during an emergency.
Methods:
A retrospective, secondary analysis was conducted using assessments of 8280 adult Medicaid beneficiaries in Louisiana, linked with medical (n = 7936) and pharmacy claims (n = 7473).
Results:
The sample was 73% female; 47% Black; 34% White; mean age 41 y. Many had at least 1 chronic condition (75.9%), prescription (90.3%), and social need (45.2%). Across assessments, many reported food (40%), housing (34%), and transportation (33%) needs. However, far more people anticipated social needs during an emergency than in the next month. Having social needs increased the odds of anticipating any need (odds ratio [OR] = 1.5, 1.44-1.56) and desire for assistance during an emergency, even after controlling for significant covariates including older age, race, geographic region, Medicaid plan type, and prescriptions. Chronic conditions were significantly correlated with all anticipated needs in bivariate analyses, but only modestly associated (OR = 1.03, 1.01-1.06) with anticipated medication needs in multivariable analyses.
Conclusions:
Identifying individuals with social needs, independent of their chronic disease status, will benefit emergency preparedness outreach efforts.
Consumers, public officials, and even managers of health care and insurance are unhappy about care quality, access, and costs. This book shows that is because efforts to do something about these problems often rely on hope or conjecture, not rigorous evidence of effectiveness. In this book, experts in the field separate the speculative from the proven with regard to how care is rendered, how patients can be in control, how providers should be paid, and how disparities can be reduced – and they also identify the issues for which evidence is currently missing. It provides an antidote to frustration and a clear-eyed guide for forward progress, helping health care and insurance innovators make better decisions on deciding whether to go ahead now based on current evidence, to seek and wait for additional evidence, or to move on to different ideas. It will be useful to practitioners in hospital systems, medical groups, and insurance organizations and can also be used in executive and MBA teaching.
Although health care is generally designed to help people, it has the potential to effectively impede recovery for people using substances by obvious and subtle discrimination. Stigmatizing attitudes among health professionals are common, regularly expected by people who use substances and potentially reduce quality of delivered clinical care. The power gradient that drives stigma and discriminatory behavior is particularly palpable in the healthcare setting and prevalent within different clinical situations like emergency medicine, primary care, and the psychiatric ward as within language. Comprising the current evidence of interventions, specific clinical settings and language regarding substance use stigma, we suggest recommendations for changes in clinical practice. Professionals need to avoid inflicting very real harm by increasing shame and reducing self-worth through stigmatizing settings, language, and concepts. Reducing substance use stigma is an integral and profoundly important part of caring for people who use substances and should be considered as such.
Case management skills are critical to the effective, efficient and ethical delivery of clinical psychological services. The chapter will outline how case management involves the combination of practice-based evidence with management and documentation tasks. We outline the key management and documentation tasks associated with specific phases of the treatment process, framing them in a context of generating practice-based evidence. We illustrate good record keeping, maintainance of confidentiality, treatment planning, treatment implementation (including suicide risk assessment) and treatment termination.
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.
Chapter 5 analyzes how mineral resources affect local provision of public goods. Through case studies and statistical analysis, it shows that local governments in resource-rich regions tend to spend less on human capital-developing public goods, including education and health care, due to the diminished demand for labor, the myopic decision-making of both citizens and officials, and the shedding of government responsibilities onto mining enterprises. On the other hand, wary of the tension between mining industries and local citizens and driven by the pressure to preserve social stability, the local governments in resource-rich regions spend more fiscal revenue on social security benefits for disadvantaged citizens. The redistribution of the resource wealth from resource capital to labor partially compensates for the latter’s welfare losses. Overall, while resource-rich regions have weak incentives to invest in human capital development, they do spend more on redistributive policies to redress popular grievance and ameliorate resource-triggered social conflicts.
Most people are familiar with the World Health Organization's (WHO) definition of health, which was incorporated in the WHO Constitution in 1946: ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’ Despite this decades-old definition, many governments and health services continue to take a ‘sick care’ view of health rather than focusing on wellness. In this chapter, we examine models of health and discuss the principles of primary health care in relation to the concept of health. We explore health and illness as culturally constructed experiences which reinforce the need for nurses to practice person-centred care.
A range of healthcare services are considered as the healthcare continuum is explored. We introduce the components of the Australian healthcare system and explain the fundamental aspects of Australia’s ‘universal’ healthcare coverage provided by Medicare. The concepts of primary, secondary and tertiary care are introduced and differentiated from primary, secondary and tertiary levels of health care. The chapter concludes with a discussion of the contribution of nurses and nursing to our healthcare system.
The coronavirus disease 2019 (COVID-19) pandemic and the resulting measures can impact daily life and healthcare management amongst patients with beta thalassemia major.
Methods:
The Corbin and Strauss method of grounded theory was used to explore the impact of the COVID-19 pandemic on health-related quality of life (HRQoL) amongst Iranian patients with beta thalassemia major. Semi-structured interviews with 16 patients with thalassemia major in the eastern of Iran were performed. Data collection was conducted from 19 September through 18 November 2020. Collected data were recorded, transcribed, and coded to develop themes and subthemes. Paradigm components were sought to find out what happened to these patients and explore the process and events.
Results:
Insights from these interviews led to five major themes: ‘changing physical health’, ‘emotional and psychological reactions’, ‘changing the nature of relationships and the scope of social support’, ‘metamorphosis of ongoing healthcare, and ‘functionality and adaptation to new realities.’ The emerging core concept was labelled: ‘maintaining well-being balance.’ The COVID-19 pandemic disturbed the balance of life and health of the patients. Multiple strategies to maintain balance and reduce the negative effects of the COVID-19 pandemic on HRQoL were used by the patients, the healthcare team, and support systems.
Conclusions:
Due to the fear of COVID-19, the patients with beta thalassemia were less likely to contact healthcare professionals. They considered postponing blood transfusion and abandoned evaluating disease complications. Reduced access to the healthcare system and shifting resources from existing programmes to COVID-19 by the healthcare system were incompatible policies. These policies and strategies had strong and negative effects on the physical domain of HRQoL. The patients experienced a deterioration of emotional functioning. They reported a strong reduction in social functioning and felt lonely. Online interventions supporting mental health and social interactions and telemedicine can help during the times of social distancing and lockdowns.
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’.
The statutory regime that governs employee benefit plans includes fiduciary provisions that track the obligations of loyalty and care developed in trust law. Relationships among key benefit plan actors, however, never have mapped neatly onto the trust law structure of settlors, trustees, and beneficiaries. In particular, the self-interest of the employers that sponsor benefit plans is in tension with their fiduciary obligations. Changes in the relative importance of some types of benefit plans have caused the tensions to become more acute. To address the relationships among benefit plan actors and the tensions between self-interest and fiduciary obligation, courts have developed implementing rules to adapt the fiduciary standards to the employee benefit plan ecosystem. This chapter compares two implementing rules to identify differences in the ways they function and have adapted to the current plan paradigms.
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.
This study aims at exploring the dynamics of health-care provision during recent unplanned public mass gatherings in Beirut, and how the health-care system adapts to mass movements in protests.
Methods:
A qualitative study was conducted using semi-structured interviews with 12 health-care providers who volunteered at medical tents set during protests in Beirut, Lebanon. Responses were transcribed and coded.
Results:
Three themes were noted: preparedness and logistics, encountered cases, and participants’ proposed recommendations. In terms of preparedness and logistics, participants lacked knowledge of field medicine protocols and an organizational structure. They faced difficulties in securing equipment and advertising their services. Most encountered cases were physical injuries rather than mental health problems. The participants proposed both short-term recommendations, including advice on how to boost care provided, and long-term recommendations on structuring the health-care system to be better prepared.
Conclusions:
On-site health-care provision during unplanned mass gatherings is a vital need. We recommend forming a task force of health-care workers from various fields led by the Ministry of Public Health in every respective country to plan protocols, train personnel, and secure resources beforehand.
Public service innovation, defined as the adoption of new technology and methods of service delivery, is at the heart of public management research. Scholars have long studied public and private sector innovation as distinctive phenomena, arguing that private sector innovation aims to increase firms' competitive advantage, while public sector innovation purports to improve governance and performance. The public-private dichotomy overlooks the complex way how organizations interact with each other for service delivery. Public services are increasingly delivered through the web of collaborative networks, in which organizations compete and cooperate simultaneously. This Element explores how coopetition, namely the simultaneous presence of competition and collaboration, shapes innovation in the health care sector. Analyzing panel data of 4,000+ American hospitals from 2008 to 2017, this Element finds evidence that coopetition catalyzes the technology and service process innovation and offers practical implications on managing innovation in competitive environments.