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There is a great deal of variability in estimates of the lifetime medical care cost externality of obesity, partly due to a lack of transparency in the methodology behind these cost models. Several important factors must be considered in producing the best possible estimate, including age-related weight gain, differential life expectancy, identifiability, and cost model selection. In particular, age-related weight gain represents an important new component to recent cost estimates. Without accounting for age-related weight gain, a study relies on the untenable assumption that people remain the same weight throughout their lives, leading to a fundamental misunderstanding of the evolution and development of the obesity crisis. This study seeks to inform future researchers on the best methods and data available both to estimate age-related weight gain and to accurately and consistently estimate obesity’s lifetime external medical care costs. This should help both to create a more standardized approach to cost estimation as well as encourage more transparency between all parties interested in the question of obesity’s lifetime cost and, ultimately, evaluating the benefits and costs of interventions targeting obesity at various points in the life course.
We investigate the political and social consequences of the 2010 election and the gerrymandering that followed. We show that many of the governing parties that drew extremely biased maps also enacted greater restrictions on voter eligibility and ballot access prior to the 2016 presidential election. Furthermore, we find evidence that the level of partisan bias present in state legislatures influenced policy outcomes, distinct from partisan control of the legislatures. Many state legislatures, including those in crucial swing states, have effectively insulated themselves from public accountability at the same time that their constituents face growing public health challenges, such as the COVID-19 pandemic.
In Ireland, the coronavirus disease 2019 (COVID-19) pandemic has led to a total of 230,599 cases of infection as on 20 March 2021, and 4323 deaths. Although the Irish hospital network has not been overwhelmed, it has faced pressures, with a total of 13,313 persons hospitalised, including 1402 admitted to the intensive care unit. Out of caution, in spring 2020, in anticipation of possible surges in hospitals in light of international experience, the Irish government reached an agreement with private hospitals to access their capacity for three months to alleviate pressure on the public system, as part of its comprehensive response to the pandemic. This piece analyses the agreement with private hospitals, based on the legally binding Heads of Terms of the agreement, which were signed by the parties, along with publicly reported details from media reports and Oireachtas (parliamentary) committee hearings. We argue that although the new relationship could, in theory, have paved the way to the nationalisation of the whole hospital system, in fact, the experiment is best interpreted as a lost opportunity to integrate and simplify Ireland's hospital system.
U.S. immigration policies and enforcement can make immigrants fearful of accessing healthcare. Although current immigration policies restrict enforcement in “sensitive locations” including healthcare facilities, there are reports of enforcement actions in such settings.
There has been growing consensus to develop relevant guidance to improve the ethical review of global health policy and systems research (HPSR) and address the current absence of formal ethics guidance.
The onset of the economic crisis more than a decade ago posed extreme challenges to health care systems that may now be repeated with the COVID-19 pandemic. The resulting policies produced a wide range of (in some cases, even opposite) outcomes: increased or decreased public expenditures for health care. Curiously, however, countries that were considered particularly hard hit by the economic crisis showed different extremes of policy outcomes. Investigating these developments requires a dynamic view and identifying explanations for government action in one direction or the other. Using the lenses of several theoretical perspectives in public policy research, this article analyses the conditions under which public health expenditures changed in European Union member states after the financial crisis. Why did certain countries, at first sight similarly affected, show opposite outcomes? A Qualitative Comparative Analysis (QCA) confirms that left-wing governments and coordinated market economies, in combination and alone, tended to increase public health expenditures in the short term, whereas countries where neither of these conditions was present decreased public health expenditures.
To explore the #SugarTax debate on Twitter to assess actors involved, their connections and the topics being discussed during the implementation and first anniversary of the UK Soft Drink Industry Levy.
The structure of the #SugarTax debate on Twitter was assessed using social network analysis. The actors involved, their connections and the topics of discussion taking place were also explored using content, sentiment and thematic analyses.
Twitter between 2017 and 2019.
Twitter users engaging in discussions relating to the hashtag ‘SugarTax’.
Tweets (n 5366) posted between 5 August 2017 and 7 May 2019 containing #SugarTax were downloaded from Twitter using Network Overview for Discovery and Exploration in Excel. The network included 1883 users, with 686 unique edges and 4679 edges with duplicates. The majority of tweets were negative in sentiment, when assessed by both automatic (64 %, n 141) and manual sentiment analysis (52 %, n 115) methods. Nine key themes were identified and grouped into two groups according to ‘support for a sugar or SSB tax’ or ‘opposition for a sugar or SSB tax’.
Twitter was used as a platform for debating the benefits and limitations of sugar-sweetened beverage taxes. The findings indicate that numerous actors are involved in the debates on Twitter, with advocates and lobbyists using the platform to raise support for their campaigns and reshape public perceptions. The findings and the methods used may be of interest to policymakers as well as to academics and members of the public looking to explore and engage in policy debates.
On 31st January 2020, the Italian cabinet declared a 6-month national emergency after the detection of the first two COVID-19 positive cases in Rome, two Chinese tourists travelling from Wuhan. Between then and the total lockdown introduced on 22nd March 2020 Italy was hit by an unprecedented crisis. In addition to being the first European country to be heavily swept by the COVID-19 pandemic, Italy was the first to introduce stringent lockdown measures. The SARS-CoV-2 outbreak and related COVID-19 pandemic have been the worst public health challenge endured in recent history by Italy. Two months since the beginning of the first wave, the estimated excess deaths in Lombardy, the hardest hit region in the country, reached a peak of more than 23,000 deaths. The extraordinary pressures exerted on the Italian Servizio Sanitario Nazionale (SSN) inevitably leads to questions about its preparedness and the appropriateness and effectiveness of responses implemented at both national and regional levels. The aim of the paper is to critically review the Italian response to the COVID-19 crisis spanning from the first early acute phases of the emergency (March–May 2020) to the relative stability of the epidemiological situation just before the second outbreak in October 2020.
The chapter examines the main economic developments in the Israeli healthcare system and focuses on the contribution of the National Health Insurance Law (1995) to changing the configuration of incentives between the health funds and their members, between the health funds and the government, and between the health funds and the hospitals. An analysis is presented of the main trends in national health expenditure in Israel and its financing and the main reasons for its relative stability, in contrast to the upward trend that characterizes most of the OECD countries. The chapter also looks at the changes that have occurred in the private health insurance market (supplementary health insurance and commercial health insurance) and the effect of these changes on the system’s equality and efficiency. It will also discuss the trends in the main inputs into the healthcare system (manpower and hospital beds) relative to the system’s outputs (life expectancy and infant mortality).
This study reports on the changes in stress, anxiety, and depressive symptoms of subscribers after 3 months using Text4Hope, a supportive text messaging program designed to provide support during the pandemic.
Standardized self-report measures were used to evaluate perceived stress (measured with the Perceived Stress Scale-10 [PSS-10]), anxiety (measured with the General Anxiety Disorder Scale 7 [GAD-7]), and depressive symptoms (measured with the Patient Health Questionnaire [PHQ-9]), at baseline and 3rd month (n = 373).
After 3 months of using Text4Hope, subscribers’ self-reports revealed significant (p< 0.001) mean score reductions compared with baseline on: the GAD-7 by 22.7%, PHQ-9 by 10.3%, and PSS-10 scores by 5.7%. Reductions in inferred prevalence rates for moderate to high symptoms were also observed, with anxiety demonstrating the largest reduction (15.7%).
Observed Text4Hope-related reductions in psychological distress during COVID-19 indicate that Text4Hope is an effective, convenient, and accessible means of implementing a population-level psychological intervention.
This article aims to identify how the economies that do not necessarily prioritise social rights in their social policy arrangements fare in achieving various healthcare objectives. The big five of East Asian countries – China, Japan, South Korea, Taiwan, Singapore plus Hong Kong – are considered as such cases. It first highlights a wide range of variations in their healthcare offerings. It then shows that, contrary to the common belief, they constitute a surprisingly high level of redistributive elements in them. Deviating from their overall welfare regime characteristics, each healthcare system presents a unique combination of policy objectives in social, medical, economic and political terms, raising a question of the utility of social rights as a central conceptual lens to understand the world of welfare capitalism.
The relevance of the European Union (EU) for health has been widely recognised within the health community for some time, and is increasingly apparent to European policy-makers and publics. Despite being an area of policy that national governments would prefer to keep exclusive control of, and though in the past it has rarely been at the top of the agenda, many elements of health have been gradually ‘Europeanised’. This special issue marks the culmination of a British Academy-funded project – EU Health Law and Policy: Shaping a Future Research Agenda – which sought to build on the growing web of expertise in this field and reflect upon the future of health as an EU competence, at a time when it appeared to be under threat.
CHDs are one of the most frequent congenital malformations, affecting one in hundred live births. In total, 70% will require treatment in the first year of life, but over 90% of cases in low- and middle-income countries receive no treatment or suboptimal treatment. As a result, CHDs are responsible for 66% of preventable deaths due to congenital malformations in low- and middle-income countries. This study examines the unmet need of congenital cardiac care around the world based on the global burden of disease.
Materials and methods:
CHD morbidity and mortality data for 2006, 2011, and 2016 were collected from the Institute for Health Metrics and Evaluation Global Burden of Disease Results Tool and analysed longitudinally to assess trends in excess morbidity and mortality.
Between 2006 and 2016, a 20.7% reduction in excess disability-adjusted life years and 20.6% reduction in excess deaths due to CHDs were observed for children under 15. In 2016, excess global morbidity and mortality due to CHDs remained high with 14,788,418.7 disability-adjusted life years and 171,761.8 paediatric deaths, respectively. In total, 90.2% of disability-adjusted life years and 91.2% of deaths were considered excess.
This study illustrates the unmet need of congenital cardiac care around the world. Progress has been made to reduce morbidity and mortality due to CHDs but remains high and largely treatable around the world. Limited academic attention for global paediatric cardiac care magnifies the lack of progress in this area.
This article draws on the Programmatic Action Framework (PAF) to tackle the question of how the dominance and decline of a specific policy programme in a policy sector can be explained. It starts from the observation that visionary policy programmes, defined as a set of policy goals and instruments that find their expression in subsequently adopted and interconnected policy reforms, may shape a sector’s policies over several decades. Linking policy programmes to programmatic groups that promote these programmes in search of boosting their careers and authority, the programme’s rising and declining dominance can be explained by the career trajectories of programmatic actors. By displaying empirical evidence for the argument from German health policy, the article shows that proponents of today’s change are opponents of tomorrow’s change since individual careers depend on the dominance of policy programmes.
The 2019–20 coronavirus pandemic has significantly altered lives across the globe. In the United States, several states attempted to manage the pandemic by issuing stay-at-home orders. In this research note, I examine whether the gender of state policy makers in the executive branch might impact a state's adoption of a stay-at-home order. Using event history analysis, I find that the governor's gender has no impact on the likelihood of a state adopting a stay-at-home order. However, I find that gender plays a significant role for agency heads. Specifically, my analysis shows that states with a female-headed health agency tend to adopt stay-at-home orders earlier than states with a male administrator. These findings shed light on how female leadership in the executive branch may impact public policy regarding COVID-19.
The 2019 Health Technology Assessment International (HTAi) Asia Policy Forum (HAPF) discussed the role of horizon scanning (HS) and health technology reassessment (HTR) in supporting sustainable healthcare in Asia.
Discussions and presentations at the 2019 HAPF, informed by a literature review, results of a premeeting survey, and case studies of HTA agencies from the region form the basis of this paper.
Five of the fourteen HTA agencies surveyed have established or are developing HS systems (HSSs), and six reported some experience with HTR. Although there were many differences in the respective HSSs, all were proactive and identified technologies within a 1–3-year time horizon. Commonalities included the criteria used to prioritize the technologies including burden and rarity of the disease, and cost to the health system and patients. Experience in HTR was not as extensive with most HTR activity being conducted on an ad hoc basis. Challenges for both HS and HTR include a lack of HTA capacity and good quality data, as well as a need for transparency and collaboration with industry.
With developing universal health care and HTA capacity in many countries in Asia, HS and HTR are in their infancy. Whilst several countries in the region are experienced in all facets of HTA, other countries are developing their HTA skill base. As such, there was a clear appetite for setting up a collaborative network in the Asia region to facilitate information sharing around HTA activities, and more specifically, HS and HTR methodologies, experiences, and assessments.