eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-10-01
6
10
551
553
10.15171/ijhpm.2017.43
3343
Ethics in HTA: Examining the “Need for Expansion”
Payam Abrishami
pabrishami@zinl.nl
1
Wija Oortwijn
w.oortwijn@radboudumc.nl
2
Bjørn Hofmann
bjorn.hofmann@medisin.uio.no
3
National Health Care Institute, Diemen, The Netherlands
Ecorys Nederland, Sector Health, Rotterdam, The Netherlands
The Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
The article by Daniels and colleagues on expanding the scope of health technology assessment (HTA) to embrace ethical analysis has received endorsement and criticism from commentators in this journal. Referring to this debate, we examine in this article the extent and locus of ethical analysis in HTA processes. An expansion/no-expansion framing of HTA is, in our view, not very fruitful. We argue that meaningfulness and relevance to the needs of the population are what should determine the extent of ethics in HTA. Once ‘relevance’ is the guiding principle, engaging in ethical analysis becomes inevitable as values are all over the place in HTA, also in how assessors frame research questions. We also challenge dividing the locus of ethical analysis into assessment and appraisal as this would detach HTA from its purpose, ie, supporting legitimate decision-making. Ethical analysis should therefore be considered integral to the HTA process.
https://www.ijhpm.com/article_3343_469ba8cd3c84a05eb3847bfb472cb8af.pdf
Health Technology Assessment (HTA)
Ethical Analysis
Organizational Decision-Making
Resource
Allocation
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-10-01
6
10
555
560
10.15171/ijhpm.2017.40
3346
Professionalizing Healthcare Management: A Descriptive Case Study
Erika L. Linnander
erika.linnander@yale.edu
1
Jeannie M. Mantopoulos
jeannie.mantopoulos@yale.edu
2
Nikole Allen
nikole.allen@yale.edu
3
Ingrid M. Nembhard
ingrid.nembhard@yale.edu
4
Elizabeth H. Bradley
ebradley@vassar.edu
5
Yale School of Public Health, Yale University, New Haven, CT, USA
Yale School of Public Health, Yale University, New Haven, CT, USA
Yale School of Public Health, Yale University, New Haven, CT, USA
Yale School of Public Health, Yale University, New Haven, CT, USA
Yale School of Public Health, Yale University, New Haven, CT, USA
Despite international recognition of the importance of healthcare management in the development of high-performing systems, the path by which countries may develop and sustain a professional healthcare management workforce has not been articulated. Accordingly, we sought to identify a set of common themes in the establishment of a professional workforce of healthcare managers in low- and middle-income country (LMIC) settings using a descriptive case study approach. We draw on a historical analysis of the development of this profession in the United States and Ethiopia to identify five common themes in the professionalization of healthcare management: (1) a country context in which healthcare management is demanded; (2) a national framework that elevates a professional management role; (3) standards for healthcare management, and a monitoring function to promote adherence to standards; (4) a graduatelevel educational path to ensure a pipeline of well-prepared healthcare managers; and (5) professional associations to sustain and advance the field. These five components can to inform the creation of a long-term national strategy for the development of a professional cadre of heathcare managers in LMIC settings.
https://www.ijhpm.com/article_3346_b233cd463f33f21db46b730df792dedb.pdf
Healthcare Management
Health Policy
Quality Improvement
Low- and Middle-Income Countries (LMICs)
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-10-01
6
10
561
571
10.15171/ijhpm.2017.04
3318
A Process Evaluation to Assess Contextual Factors Associated With the Uptake of a Rapid Response Service to Support Health Systems’ Decision-Making in Uganda
Rhona Mijumbi-Deve
rmijumbi@chs.mak.ac.ug
1
Nelson K. Sewankambo
sewankam@infocom.co.ug
2
Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
Background Although proven feasible, rapid response services (RRSs) to support urgent decision and policymaking are still a fairly new and innovative strategy in several health systems, more especially in low-income countries. There are several information gaps about these RRSs that exist including the factors that make them work in different contexts and in addition what affects their uptake by potential end users. Methods We used a case study employing process evaluation methods to determine what contextual factors affect the utilization of a RRS in Uganda. We held in-depth interviews with researchers, knowledge translation (KT) specialists and policy-makers from several research and policy-making institutions in Uganda’s health sector. We analyzed the data using thematic analysis to develop categories and themes about activities and structures under given program components that affected uptake of the service. Results We identified several factors under three themes that have both overlapping relations and also reinforcing loops amplifying each other: Internal factors (those factors that were identified as over which the RRS had full [or almost full] control); external factors (factors over which the service had only partial influence, a second party holds part of this influence); and environmental factors (factors over which the service had no or only remote control if at all). Internal factors were the design of the service and resources available for it, while the external factors were the service’s visibility, integrity and relationships. Environmental factors were political will and health system policy and decision-making infrastructure. Conclusion For health systems practitioners considering RRSs, knowing what factors will affect uptake and therefore modifying them within their contexts is important to ensure efficient use and successful utilization of the mechanisms.
https://www.ijhpm.com/article_3318_62da92b9df0635ee8ac2c1fd1cbd44ce.pdf
Evidence-Informed Health Policy
Knowledge Translation (KT)
Rapid Response Services (RRSs)
Innovations
Process Evaluations
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-10-01
6
10
573
586
10.15171/ijhpm.2017.16
3321
Out-of-Pocket and Informal Payment Before and After the Health Transformation Plan in Iran: Evidence from Hospitals Located in Kurdistan, Iran
Bakhtiar Piroozi
bpiroozi@gmail.com
1
Arash Rashidian
arash.rashidian@gmail.com
2
Ghobad Moradi
moradi_gh@yahoo.com
3
Amirhossein Takian
takiana@gmail.com
4
Hooman Ghasri
hooman569@yahoo.com
5
Tayyeb Ghadimi
tayeb.ghadimi@muk.ac.ir
6
Department of Health Services Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Department of Health Services Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Deputy of Treatment, Kurdistan University of Medical Sciences, Sanandaj, Iran
Department of Surgery, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
Background One of the objectives of the health transformation plan (HTP) in Iran is to reduce out-of-pocket (OOP) payments for inpatient services and eradicate informal payments. The HTP has three phases: the first phase (launched in May 5, 2014) is focused on reducing OOP payments for inpatient services; the second phase (launched in May 22, 2014) is focused on primary healthcare (PHC) and the third phase utilizes an updated relative value units for health services (launched in September 29, 2014) and is focused on the elimination of informal payments. This aim of this study was to determine the OOP payments and the frequency of informal cash payments to physicians for inpatient services before and after the HTP in Kurdistan province, Iran. Methods This quasi-experimental study used multistage sampling method to select and evaluate 265 patients discharged from hospitals in Kurdistan province. The study covered 3 phases (before the HTP, after the first, and third phases of the HTP). Part of the data was collected using a hospital information system form and the rest were collected using a questionnaire. Data were analyzed using Fisher exact test, logistic regression, and independent samples ttest. Results The mean OOP payments before the HTP and after the first and third phases, respectively, were US$59.4, US$17.6, and US$14.3 in hospital affiliated to the Ministry of Health and Medical Education (MoHME), US$39.6, US$33.7, and US$13.7 in hospitals affiliated to Social Security Organization (SSO), and US$153.3, US$188.7, and US$66.4 in private hospitals. In hospitals affiliated to SSO and MoHME there was a significant difference between the mean OOP payments before the HTP and after the third phase (P < .05). The percentage of informal payments to physicians in hospitals affiliated to MoHME, SSO, and private sector, respectively, were 4.5%, 8.1%, and 12.5% before the HTP, and 0.0%, 7.1%, and 10.0% after the first phase. Contrary to the time before the HTP, no informal payment was reported after the third phase. Conclusion It seems that the implementation of the HTP has reduced the OOP payments for inpatient services and eradicated informal payments to physician in Kurdistan province.
https://www.ijhpm.com/article_3321_c6a088459b7b903d1c4d542c17dadc89.pdf
Informal Payment
Health System Reform
Out-of-Pocket (OOP) Payment
Health Expenditure
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-10-01
6
10
587
600
10.15171/ijhpm.2017.17
3324
Ineffective Healthcare Technology Management in Benin’s Public Health Sector: The Perceptions of Key Actors and Their Ability to Address the Main Problems
P. Thierry Houngbo
thierryhoungbo@hotmail.com
1
Tjard De Cock Buning
tjard.de.cockbuning@vu.nl
2
Joske Bunders
j.g.f.bunders-aelen@vu.nl
3
Harry L. S. Coleman
harry.coleman@live.co.uk
4
Daton Medenou
dmedenou@bj.refer.org
5
Laurent Dakpanon
dakpanonlaurent@yahoo.fr
6
Marjolein Zweekhorst
m.b.m.zweekhorst@vu.nl
7
Ministry of Health, Cotonou, Republic of Benin
Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
Polytechnic School, University of Abomey-Calavi, Cotonou, Republic of Benin
Polytechnic School, University of Abomey-Calavi, Cotonou, Republic of Benin
Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
BackgroundLow-income countries face many contextual challenges to manage healthcare technologies effectively, as the majority are imported and resources are constrained to a greater extent. Previous healthcare technology management (HTM) policies in Benin have failed to produce better quality of care for the population and costeffectiveness for the government. This study aims to identify and assess the main problems facing HTM in Benin’s public health sector, as well as the ability of key actors within the sector to address these problems. MethodsWe conducted 2 surveys in 117 selected health facilities. The first survey was based on 377 questionnaires and 259 interviews, and the second involved observation and group interviews at health facilities. The Temple-Bird Healthcare Technology Package System (TBHTPS), tailored to the context of Benin’s health system, was used as a conceptual framework. ResultsThe findings of the first survey show that 85% of key actors in Benin’s HTM sector characterized the system as failing in components of the TBHTPS framework. Biomedical, clinical, healthcare technology engineers and technicians perceived problems most severely, followed by users of equipment, managers and hospital directors, international organization officers, local and foreign suppliers, and finally policy-makers, planners and administrators at the Ministry of Health (MoH). The 5 most important challenges to be addressed are policy, strategic management and planning, and technology needs assessment and selection – categorized as major enabling inputs(MEI) in HTM by the TBHTPS framework – and installation and commissioning, training and skill development and procurement, which are import and use activities(IUA). The ability of each key actor to address these problems (the degree of political or administrative power they possess) was inversely proportional to their perception of the severity of the problems. Observational data gathered during site visits described a different set of challenges including maintenance and repair, distribution, installation and commissioning, use and training and personnel skill development. ConclusionThe lack of experiential and technical knowledge in policy development processes could underpin many of the continuing problems in Benin’s HTM system. Before solutions can be devised to these problems, it is necessary to investigate their root causes, and which problems are most amenable to policy development.
https://www.ijhpm.com/article_3324_6db8bf25d9499de81609a43a7a375418.pdf
Stakeholders
Healthcare Technology Management (HTM)
Benin
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-10-01
6
10
601
603
10.15171/ijhpm.2017.06
3311
Priority Setting for Universal Health Coverage: We Need to Focus Both on Substance and on Process; Comment on “Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, not Just More Evidence on Cost-Effectiveness”
Jeremy A. Lauer
lauerj@who.int
1
Dheepa Rajan
rajand@who.int
2
Melanie Y. Bertram
bertramm@who.int
3
Economic Analysis and Evaluation, World Health Organization, Geneva, Switzerland
Health Systems Governance, Policy and Aid Effectiveness, World Health Organization, Geneva, Switzerland
Economic Analysis and Evaluation, World Health Organization, Geneva, Switzerland
In an editorial published in this journal, Baltussen et al argue that information on cost-effectiveness is not sufficient for priority setting for universal health coverage (UHC), a claim which is correct as far as it goes. However, their focus on the procedural legitimacy of ‘micro’ priority setting processes (eg, decisions concerning the reimbursement of specific interventions), and their related assumption that values for priority setting are determined only at this level, leads them to ignore the relevance of higher level, ‘macro’ priority setting processes, for example, consultations held by World Health Organization (WHO) Member States and other global stakeholders that have resulted in widespread consensus on the principles of UHC. Priority setting is not merely about discrete choices, nor should the focus be exclusively (or even mainly) on improving the procedural elements of micro priority setting processes. Systemic activities that shape the health system environment, such as strategic planning, as well as the substantive content of global policy instruments, are critical elements for priority setting for UHC.
https://www.ijhpm.com/article_3311_f083fea0f2a75b2a2e2b729158f083cb.pdf
Priority Setting
Cost-Effectiveness Analysis
Universal Health Coverage (UHC)
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-10-01
6
10
605
607
10.15171/ijhpm.2017.20
3323
Mistaking the Map for the Territory: What Society Does With Medicine; Comment on “Medicalisation and Overdiagnosis: What Society Does to Medicine”
Alistair Wardrope
ajwardrope1@sheffield.ac.uk
1
University of Sheffield, Sheffield, UK
Van Dijk et al describe how society’s influence on medicine drives both medicalisation and overdiagnosis, and allege that a major political and ethical concern regarding our increasingly interpreting the world through a biomedical lens is that it serves to individualise and depoliticize social problems. I argue that for medicalisation to serve this purpose, it would have to exclude the possibility of also considering problems in other (social or political) terms; but to think that medical descriptions of the world seek to or are able to do this is to misunderstand the purpose and function of model construction in science in general, and medicine in particular. So, if medicalisation is nonetheless used for the depoliticization described by many critics, we must ask what society does with medicine to give it this exclusive authority. I propose that the problem arises from a tendency to mistake the map for the territory, and think a tool to understand certain aspects of the world gives us the complete picture. To resist this process, I suggest health workers should be more open about the purpose and limitations of medicalisation, and the value of alternative descriptions of different aspects of human experience.
https://www.ijhpm.com/article_3323_51727eba8752252945a7dac897ec5285.pdf
Medicalisation
Philosophy of Science
Biomedical Model
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-10-01
6
10
609
610
10.15171/ijhpm.2017.21
3327
On the Social Construction of Overdiagnosis; Comment on “Medicalisation and Overdiagnosis: What Society Does to Medicine”
Bjørn Hofmann
bjorn.hofmann@medisin.uio.no
1
Department for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
In an interesting article Wieteke van Dijk and colleagues argue that societal developments and values influence the practice of medicine, and thus can result in both medicalisation and overdiagnosis. They provide a convincing argument that overdiagnosis emerges in a social context and that it has socially constructed implications. However, they fail to show that overdiagnosis per se is socially constructed and how this construction occurs. Moreover, the authors discuss overdiagnosis on a micro level without acknowledging that overdiagnosis cannot be observed in individuals “in the doctor’s office.” We cannot tell whether a diagnosed person is overdiagnosed or not. This is the core of the problem. Despite these shortcomings, Wieteke van Dijk and her colleagues are certainly on to something important, and they should be encouraged to elaborate their perspective. We certainly need to deepen our understanding of the social construction of overdiagnosis.
https://www.ijhpm.com/article_3327_0db70f0f777fc65f8cb0e82213e838c6.pdf
Overdiagnosis
False Test Results
Social Construction
Medicalization
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-10-01
6
10
611
613
10.15171/ijhpm.2017.24
3328
Overdiagnosis: An Important Issue That Demands Rigour and Precision; Comment on “Medicalisation and Overdiagnosis: What Society Does to Medicine”
Stacy M. Carter
stacy_carter@uow.edu.au
1
Centre for Values, Ethics and the Law in Medicine, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
Van Dijk and colleagues present three cases to illustrate and discuss the relationship between medicalisation and overdiagnosis. In this commentary, I consider each of the case studies in turn, and in doing so emphasise two main points. The first is that it is not possible to assess whether overdiagnosis is occurring based solely on incidence rates: it is necessary also to have data about the benefits and harms that are produced by diagnosis. The second is that much is at stake in discussions of overdiagnosis in particular, and that it is critical that work in this area is conceptually rigorous, well-reasoned, and empirically sound. van Dijk and colleagues remind us that overdiagnosis and medicalisation are not just matters for individual patients and their clinicians: they also concern health systems, and society and citizens more broadly.
https://www.ijhpm.com/article_3328_237c4515b54ea4043d7297eb4c844e99.pdf
Overdiagnosis
Medicalisation
Overtreatment
eng
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
2017-10-01
6
10
615
616
10.15171/ijhpm.2017.41
3344
The Potential Possibility of Symptom Checker
Tomohiro Morita
t.morita526@gmail.com
1
Abidur Rahman
abidavid@yahoo.com
2
Takanori Hasegawa
tk.hasegawa@gmail.com
3
Akihiko Ozaki
ozakiakihiko@gmail.com
4
Tetsuya Tanimoto
tetanimot@yahoo.co.jp
5
Department of Internal Medicine, Soma Central Hospital, Soma, Japan
Department of Medicine, Shaheed Suhrawardy Medical College & Hospital, Dhaka, Bangladesh
Health Intelligence Center, The Institute of Medical Science, The University of Tokyo, Minato-ku, Japan
Department of Surgery, Minamisoma Municipal General Hospital, Fukushima, Japan
Department of Internal Medicine, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
https://www.ijhpm.com/article_3344_3963eb2857ce53dda20e10736aa040f0.pdf
Telemedicine
Information and Communication Technology
Artificial Intelligence
Diagnostics