Skip header and navigation

Refine By

37 records – page 1 of 4.

Addressing the non-medical determinants of health: a survey of Canada's health regions.

https://arctichealth.org/en/permalink/ahliterature165318
Source
Can J Public Health. 2007 Jan-Feb;98(1):41-7
Publication Type
Article
Author
C James Frankish
Glen E Moulton
Darryl Quantz
Arlene J Carson
Ann L Casebeer
John D Eyles
Ronald Labonte
Brian E Evoy
Author Affiliation
Institute of Health Promotion Research, University of British Columbia, Vancouver. Frankish@interchange.ubc.ca
Source
Can J Public Health. 2007 Jan-Feb;98(1):41-7
Language
English
Publication Type
Article
Keywords
Canada
Cooperative Behavior
Health Care Reform - organization & administration
Health Priorities - organization & administration
Health Status Indicators
Humans
Interinstitutional Relations
Public Health Administration
Regional Health Planning - organization & administration
Rural Health
Socioeconomic Factors
Sociology, Medical
Urban health
Abstract
The Canadian health system is undergoing reform. Over the past decade a prominent trend has been creation of health regions. This structural shift is concurrent with a greater emphasis on population health and the broad determinants of health. In parallel, there is a movement toward more intersectoral collaboration (i.e., collaboration between diverse segments of the health system, and between the health system and other sectors of society). The purpose of this exploratory study is to determine the self-reported level of internal action (within regional health authorities) and intersectoral collaboration around 10 determinants of health by regional health authorities across Canada.
From September 2003 to February 2004, we undertook a survey of regional health authorities in Canadian provinces (N = 69). Using SPSS 12.0, we generated frequencies for the self-reported level of internal and intersectoral action for each determinant. Other analyses were done to compare rural/suburban and urban regions, and to compare Western, Central and Eastern Canada.
Of the 10 determinants of health surveyed, child development and personal health practices were self-reported by the majority of health regions to receive greatest attention, both internally and through intersectoral activities. Culture, gender and employment/working conditions received least attention in most regions.
The exploratory survey results give us the first Canadian snapshot of health regions' activities in relation to the broad range of non-medical determinants of health. They provide a starting data set for baselining future progress, and for beginning deeper analyses of specific areas of action and intersectoral collaboration.
PubMed ID
17278677 View in PubMed
Less detail

An evaluation of strategies to reduce waiting times for total joint replacement in Ontario.

https://arctichealth.org/en/permalink/ahliterature154539
Source
Med Care. 2008 Nov;46(11):1177-83
Publication Type
Article
Date
Nov-2008
Author
Lauren E Cipriano
Bert M Chesworth
Chris K Anderson
Gregory S Zaric
Author Affiliation
Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA.
Source
Med Care. 2008 Nov;46(11):1177-83
Date
Nov-2008
Language
English
Publication Type
Article
Keywords
Arthroplasty, Replacement - statistics & numerical data
Computer simulation
Health Care Rationing - organization & administration - statistics & numerical data
Health Planning - organization & administration - statistics & numerical data
Health Priorities - organization & administration - statistics & numerical data
Humans
National Health Programs - organization & administration - statistics & numerical data
Needs Assessment
Ontario
Patient Selection
Waiting Lists
Abstract
In 2005, the median waiting time for total hip and knee joint replacements in Ontario was greater than 6 months, which is considered longer than clinically appropriate. Demand is expected to increase and exacerbate already long waiting times. Solutions are needed to reduce waiting times and improve waiting list management.
We developed a discrete event simulation model of the Ontario total joint replacement system to evaluate the effects of 4 management strategies on waiting times: (1) reductions in surgical demand; (2) formal clinical prioritization; (3) waiting time guarantees; and (4) common waiting list management.
If the number of surgeries performed increases by less than 10% each year, then demand must be reduced by at least 15% to ensure that, within 10 years, 90% of patients receive surgery within their maximum recommended waiting time. Clinically prioritizing patients reduced waiting times for high-priority patients and increased the number of patients at all priority levels who received surgery each year within recommended maximum waiting times by 9.3%. A waiting time guarantee for all patients provided fewer surgeries within recommended waiting times. Common waiting list management improved efficiency and increased equity in waiting across regions.
Dramatically increasing the supply of joint replacement surgeries or diverting demand for surgeries to other jurisdictions will reduce waiting times for total joint replacement surgery. Introducing a strictly adhered to patient prioritization scheme will ensure that more patients receive surgery within severity-specific waiting time targets. Implementing a waiting time guarantee for all patients will not reduce waiting times--it will only shuffle waiting times from some patients to others. To reduce waiting times to clinically acceptable levels within 10 years, increases in the number of surgeries provided greater than those observed historically or reductions in demand are needed.
PubMed ID
18953229 View in PubMed
Less detail

Bottom-up priority setting revised. A second evaluation of an institutional intervention in a Swedish health care organisation.

https://arctichealth.org/en/permalink/ahliterature279505
Source
Health Policy. 2015 Sep;119(9):1226-36
Publication Type
Article
Date
Sep-2015
Author
Susanne Waldau
Source
Health Policy. 2015 Sep;119(9):1226-36
Date
Sep-2015
Language
English
Publication Type
Article
Keywords
Delivery of Health Care - organization & administration
Health Care Costs
Health Priorities - organization & administration
Humans
Program Evaluation
Resource Allocation - organization & administration
Sweden
Abstract
Transparent priority setting in health care based on specific ethical principles is requested by the Swedish Parliament since 1997. Implementation has been limited. In this case, transparent priority setting was performed for a second time round and engaged an entire health care organisation.
Objectives were to refine a bottom-up priority setting process, reach a political decision on service limits to make reallocation towards higher prioritised services possible, and raise systems knowledge.
An action research approach was chosen. The national model for priority setting was used with addition of dimensions costs, volumes, gender distribution and feasibility. The intervention included a three step process and specific procedures for each step which were created, revised and evaluated regarding factual and functional aspects. Evaluations methods included analyses of documents, recordings and surveys.
Vertical and horizontal priority setting occurred and resources were reallocated. Participants' attitudes remained positive, however less so than in the first priority setting round. Identifying low-priority services was perceived difficult, causing resentment and strategic behaviour. The horizontal stage served to raise quality of the knowledge base, level out differences in ranking of services and raise systems knowledge.
Existing health care management systems do not meet institutional requirements for transparent priority setting. Introducing transparent priority setting constitutes a complex institutional reform, which needs to be driven by management/administration. Strong managerial commitment is required.
PubMed ID
25724824 View in PubMed
Less detail

Case study on priority setting in rural Southern Alberta: keeping the house from blowing in.

https://arctichealth.org/en/permalink/ahliterature176949
Source
Can J Rural Med. 2004;9(1):26-36
Publication Type
Article
Date
2004
Author
Lisa Halma
Craig Mitton
Cam Donaldson
Bruce West
Author Affiliation
Lethbridge Regional Hospital, 960 19th St. S, Lethbridge AB T1J 1W5.
Source
Can J Rural Med. 2004;9(1):26-36
Date
2004
Language
English
Publication Type
Article
Keywords
Alberta
Chronic Disease - therapy
Disease Management
Health Care Rationing - organization & administration
Health Priorities - organization & administration
Humans
Regional Health Planning - organization & administration
Rural Population
Abstract
This case study describes the priority-setting process undertaken by health care providers in the Municipal District of Taber, Alta., to improve and integrate chronic disease services within a fixed budget.
Providers first reviewed the current chronic disease management system, then considered alternatives based on program priorities and costs and benefits of potential changes.
Despite reaching consensus that a chronic disease clinic was the top priority for funding, providers were unable to redesign services accordingly. Redesign efforts were hampered by the groups' difficulty in identifying services that should receive fewer resources in order to fund priority areas, inexperience with priority-setting frameworks, group composition, the belief that many programs were already at "bare bone" funding levels, and perceptions of limited budget control. In the end, recommendations were made to use attrition to release resources, establish multi-disciplinary teams and group visits, where appropriate, and relocate providers to a centralized location. Upon review of study outcomes, Taber providers were granted more decision-making authority.
Overall, the use of a systematic priority-setting process, culminating in recommendations for action, has moved Taber providers closer to an integrated model of service delivery. It is recommended that formal priority-setting frameworks continue to be used in Taber for primary care renewal or at any level where consideration of existing evidence and projected costs is required.
PubMed ID
15603672 View in PubMed
Less detail

[Competitiveness in the health care sector: analysis of the Swedish reform (1992-1995)]

https://arctichealth.org/en/permalink/ahliterature93383
Source
Rev Saude Publica. 2008 Apr;42(2):356-64
Publication Type
Article
Date
Apr-2008
Author
Mould Quevedo Joaquín F
Salinas Escudero Guillermo
Contreras Hernández Iris
Garrido Solano Carlos
Author Affiliation
Unidad de Investigación en Economía de la Salud, Instituto Mexicano del Seguro Social, México, DF, Mexico.
Source
Rev Saude Publica. 2008 Apr;42(2):356-64
Date
Apr-2008
Language
Spanish
Publication Type
Article
Keywords
Delivery of Health Care - economics - organization & administration
Economic Competition
Female
Financing, Government - organization & administration
Health Care Reform - organization & administration
Health Priorities - organization & administration
Humans
Male
Models, organizational
Sweden
Abstract
The paper reviews the outcomes and failures of the Swedish health care reform, as well as the lessons learned for accomplishing better financial results and quality standards.
PubMed ID
18372983 View in PubMed
Less detail

Do canadian researchers and the lay public prioritize biomedical research outcomes equally? A choice experiment.

https://arctichealth.org/en/permalink/ahliterature116177
Source
Acad Med. 2013 Apr;88(4):519-26
Publication Type
Article
Date
Apr-2013
Author
Fiona A Miller
Emmanouil Mentzakis
Renata Axler
Pascale Lehoux
Martin French
Jean-Eric Tarride
Walter P Wodchis
Brenda J Wilson
Christopher Longo
Jessica P Bytautas
Barbara Slater
Author Affiliation
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. fiona.miller@utoronto.ca
Source
Acad Med. 2013 Apr;88(4):519-26
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Adult
Biomedical Research - organization & administration
Canada
Choice Behavior
Cross-Sectional Studies
Female
Health Priorities - organization & administration
Humans
Male
Patient Participation - psychology
Public Opinion
Questionnaires
Research Personnel - psychology
Socioeconomic Factors
Abstract
To quantify and compare the preferences of researchers and laypeople in Canada regarding the outcomes of basic biomedical research.
In autumn 2010, the authors conducted a cross-sectional, national survey of basic biomedical researchers funded by Canada's national health research agency and a representative sample of Canadian citizens to assess preferences for research outcomes across five attributes using a discrete choice experiment. Attributes included advancing scientific knowledge (assessed by published papers); building research capacity (assessed by trainees); informing decisions in the health products industry (assessed by patents); targeting economic, health, or scientific priorities; and cost. The authors reduced a fractional factorial design (18 pairwise choices plus an opt-out option) to three blocks of six. They also computed part worth utilities, differences in predicted probabilities, and willingness-to-pay values using nested logit models.
Of 3,260 potential researchers, 1,749 (53.65% response rate) completed the questionnaire, along with 1,002 citizens. Researchers and citizens prioritized high-quality scientific outcomes (papers, trainees) over other attributes. Both groups disvalued research targeted at economic priorities relative to health priorities. Researchers granted a premium to proposals targeting scientific priorities.
Citizens and researchers fundamentally prioritized the same outcomes for basic biomedical research. Notably, they prioritized traditional scientific outcomes and disvalued the pursuit of economic returns. These findings have implications for how academic medicine assigns incentives and value to basic health research and how biomedical researchers and the public may jointly contribute to setting the future research agenda.
PubMed ID
23425982 View in PubMed
Less detail

Do longer delays for coronary artery bypass surgery contribute to preoperative mortality in less urgent patients?

https://arctichealth.org/en/permalink/ahliterature168658
Source
Med Care. 2006 Jul;44(7):680-6
Publication Type
Article
Date
Jul-2006
Author
Boris G Sobolev
Adrian R Levy
Lisa Kuramoto
Robert Hayden
J Mark FitzGerald
Author Affiliation
Department of Health Care and Epidemiology, The University of British Columbia, 828 West 10th Avenue, Vancouver, BC, Canada. sobolev@interchange.ubc.ca
Source
Med Care. 2006 Jul;44(7):680-6
Date
Jul-2006
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
British Columbia - epidemiology
Coronary Artery Bypass - mortality
Coronary Artery Disease - mortality - surgery
Health Care Rationing - statistics & numerical data
Health Priorities - organization & administration - statistics & numerical data
Health Services Accessibility - organization & administration - statistics & numerical data
Humans
Middle Aged
Outcome Assessment (Health Care) - methods
Prospective Studies
Time Factors
Waiting Lists
Abstract
Priority wait lists are common for managing access to cardiac surgery in publicly funded health systems. We evaluated whether longer delays contribute to the probability of death before surgery among patients prioritized into the less urgent category.
We studied records of 9233 patients registered for isolated coronary artery bypass graft (CABG) in British Columbia, Canada. The primary outcome was death before surgery. We estimated the probability that a patient, who could be removed from the list as a result of surgery, death, or other competing events, dies on or before a certain wait-list week.
Despite similar death rates in semiurgent and nonurgent groups, 0.63 (95% confidence interval, 0.46-0.80) versus 0.58 (0.36-0.80) per 1000 patient-weeks, nonurgent patients were remaining on the list longer, which contributed to higher cumulative incidence of all-cause death than in semiurgent group (adjusted odds ratio = 1.66; 1.03-2.68). By 52 weeks on the wait list, 0.9% (0.6-1.1) and 1.3% (0.8-1.8) of patients died in semiurgent and nonurgent groups, respectively (P
PubMed ID
16799363 View in PubMed
Less detail

Experiences from the Swedish determinants-based public health policy.

https://arctichealth.org/en/permalink/ahliterature95087
Source
Int J Health Serv. 2009;39(3):491-507
Publication Type
Article
Date
2009
Author
Lundgren Bernt
Author Affiliation
Swedish National Institute of Public Health, Ostersund, Sweden. bernt.lundgren@fhi.se
Source
Int J Health Serv. 2009;39(3):491-507
Date
2009
Language
English
Publication Type
Article
Keywords
Environment
Health Behavior
Health Policy
Health Priorities - organization & administration
Health Promotion - organization & administration
Humans
Public Health Administration - methods
Sentinel Surveillance
Sweden
Abstract
A comprehensive Swedish public health policy was adopted by the Swedish Parliament, the Riksdag, in April 2003. It pushes health up on the political agenda and affords equity in health high priority. The first phase of implementation of the policy, 2003-5, is described in the 2005 Public Health Policy Report published by the Swedish National Institute of Public Health (SNIPH). For the purpose of investigating the implementation, SNIPH has monitored the development of 42 determinants and used reports from 22 central agencies and eight county administrative boards together with interviews with all Sweden's county councils (21) and a questionnaire sent out to all municipalities (290). The experiences from the implementation of the policy are that: the determinants approach-focusing on structural factors in society, people's living conditions, and health behaviors that affect health-is in general well understood and emphasizes the role of other sectors in public health; the use of indicators to follow up exposures to determinants is of key importance; the support to actors outside the health service is needed to identify their public health role; a continuous steering from the government and other political bodies is of vital importance; public health promotion on the regional level needs a higher level of coordination; municipalities need more skills development. Sweden has a new government that was elected in September 2006; the new government has retracted the former government's public health policy communication submitted to the Riksdag in the spring of 2006, but does not intend to change the public health policy.
PubMed ID
19771952 View in PubMed
Less detail

The "Health Benefit Basket" in Denmark: a description of entitlements, actors, and decision-making processes in the curative health sector.

https://arctichealth.org/en/permalink/ahliterature172130
Source
Eur J Health Econ. 2005 Dec;Suppl:11-7
Publication Type
Article
Date
Dec-2005
Author
Lone Bilde
Anni Ankjaer-Jensen
Bent Danneskiold-Samsøe
Author Affiliation
DSI - Danish Institute for Health Services Research, Copenhagen, Denmark. lob@dsi.dk
Source
Eur J Health Econ. 2005 Dec;Suppl:11-7
Date
Dec-2005
Language
English
Publication Type
Article
Keywords
Denmark
Financing, Government - economics - organization & administration
Health Policy
Health Priorities - organization & administration
Health Services - economics - legislation & jurisprudence
Health Services Administration
Humans
National Health Programs - economics - legislation & jurisprudence - organization & administration
Patient Care
Reimbursement Mechanisms - organization & administration
Abstract
Until 2007, when the new legislation on health care becomes effective, the right to receive free health care services in Denmark, or "health benefits," are described in a comprehensive set of legislation, including laws, executive orders and legal guidelines. This contribution provides an overview of the current main legislation regulating the Danish "health benefit basket" and describes the regulatory mechanisms for the provision of curative care at Danish hospitals and primary health care offices. Although the services are both financed and planned by the counties, they differ substantially in the way that benefits are regulated.
Notes
Cites: J Health Serv Res Policy. 2002 Jul;7(3):133-4212171743
PubMed ID
16270211 View in PubMed
Less detail

37 records – page 1 of 4.