Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 8 7 2019 07 01 Monitoring Frameworks for Universal Health Coverage: What About High-Income Countries? 387 393 3612 10.15171/ijhpm.2019.21 EN Nicole Bergen Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada Arne Ruckert Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada Ronald Labonté Canada Research Chair, Globalization and Health Equity, Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada Journal Article 2018 10 23 Implementing universal health coverage (UHC) is widely perceived to be central to achieving the Sustainable Development Goals (SDGs), and is a work program priority of the World Health Organization (WHO). Much has already been written about how low- and middle-income countries (LMICs) can monitor progress towards UHC, with various UHC monitoring frameworks available in the literature. However, we suggest that these frameworks are largely irrelevant in high-income contexts and that the international community still needs to develop UHC monitoring framework meaningful for high-income countries (HICs). As a first step, this short communication presents preliminary findings from a literature review and document analysis on how various countries monitor their own progress towards achieving UHC. It furthermore offers considerations to guide meaningful UHC monitoring and reflects on pertinent challenges and tensions to inform future research on UHC implementation in HIC settings.

https://www.ijhpm.com/article_3612_988cd058cded3fc081565a02b039f73d.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 8 7 2019 07 01 Cost-Effectiveness Analysis of Psoriasis Treatment Modalities in Malaysia 394 402 3607 10.15171/ijhpm.2019.17 EN Nor Azmaniza Azizam Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Selangor, Malaysia Faculty of Business and Management, Universiti Teknologi MARA Selangor, Selangor, Malaysia Aniza Ismail Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia 0000-0002-5846-4460 Saperi Sulong Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia Norazirah Md Nor Medical Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia Journal Article 2018 10 06 Background There is limited evidence detailing the cost-effectiveness of psoriasis treatments in the Asian region. Therefore, this study is aimed to evaluate the cost-effectiveness of 3 psoriasis treatments tailored for moderate to severe psoriasis, namely topical and phototherapy (TP), topical and systemic (TS), and topical and biologic (TB) regimens, respectively. Methods This has been achieved by the participation of a prospective cohort involving a total of 90 moderate to severe psoriasis patients, which has been conducted at 5 public hospitals in Malaysia. The main outcome measures have been evaluated via cost and effectiveness psoriasis area severity index (PASI)-75 and/or body surface area (BSA)

https://www.ijhpm.com/article_3607_0ff4b5f866b1c8a515c725f7d36992cd.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 8 7 2019 07 01 Understanding Health Professional Responses to Service Disinvestment: A Qualitative Study 403 411 3610 10.15171/ijhpm.2019.20 EN Deb Mitchell Monash Health Community, Monash Health, Dandenong, VIC, Australia 0000-0002-8415-1089 Lisa O’Brien Occupational Therapy Department, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia Anne Bardoel Department of Management and Marketing, Swinburne University of Technology, Hawthorn, VIC, Australia Terry Haines School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia Journal Article 2018 08 29 Background Disinvestment from inefficient health services may be a potential solution to rising healthcare costs, but there has been poor uptake of disinvestment recommendations. This Australian study aims to understand how health professionals react when confronted with a plan to disinvest from a health service they previously provided to their patients. Methods This qualitative study took place prior to the disinvestment phase of a trial which removed weekend allied health services from acute hospital wards, to evaluate the effectiveness and cost effectiveness of the service. Observations and focus groups were used to collect data from 156 participants which was analysed thematically. Results Initial reactions to the disinvestment were almost universally negative, with staff extremely concerned about the impact on the safety and quality of patient care and planning ways to circumvent the trial. Removal of existing services was perceived as a loss and created a direct threat to some clinicians’ professional identity. With time, discussion, and understanding of the project’s context, some staff moved towards acceptance and perceived the trial as an opportunity, particularly given the service was to be reinstated after the disinvestment. Conclusion Clinicians and health service managers are protective of the services they deliver and can create barriers to disinvestment. Even when services are removed to ascertain their value, health professionals may continue to provide services to their patients. Measuring the impact of the disinvestment may assist staff to accept the removal of a service.

https://www.ijhpm.com/article_3610_26797f3fa8a81fc6feb9bb7242d7eb11.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 8 7 2019 07 01 Development of the Translating Allied Health Knowledge (TAHK) Framework 412 423 3614 10.15171/ijhpm.2019.23 EN Danielle Hitch Occupational Therapy, Health & Social Development, Deakin University, Geelong, VIC, Australia Genevieve Pepin Occupational Therapy, Health & Social Development, Deakin University, Geelong, VIC, Australia Kate Lhuede Occupational Therapy, North West Mental Health, Melbourne, VIC, Australia Sue Rowan Occupational Therapy, Barwon Health, Geelong, VIC, Australia Susan Giles Occupational Therapy, Western Health, Melbourne, VIC, Australia Journal Article 2018 06 08 Background While evidence-based practice is a familiar concept to allied health clinicians, knowledge translation (KT) is less well known and understood. The need for a framework that enables allied health clinicians to access and engage with KT was identified. The aim of this paper is to describe the development of the Translating Allied Health Knowledge (TAHK) Framework. Methods An iterative and collaborative process involving clinician and academic knowledge partners was utilised to develop the TAHK Framework. Multiple methods were utilised during this process, including a systematic literature review, steering committee consultation, mixed methods survey, benchmarking and measurement property analysis. Results The TAHK Framework has now been finalised, and is described in detail. The framework is structured around four domains – Doing Knowledge Translation, Social Capital for Knowledge Translation, Sustaining Knowledge Translation and Inclusive Knowledge Translation – under which 14 factors known to influence allied health KT are classified. The formulation of the framework to date has laid a rigorous foundation for further developments, including clinician support and outcome measurement. Conclusion The method of development adopted for the TAHK Framework has ensured it is both evidence and practice based, and further amendments and modifications are anticipated as new knowledge becomes available. The Framework will enable allied health clinicians to build on their existing capacities for KT, and approach this complex process in a rigorous and systematic manner. The TAHK Framework offers a unique focus on how knowledge is translated by allied health clinicians in multidisciplinary settings.

https://www.ijhpm.com/article_3614_4a02650394ce29825f00362ee93faef4.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 8 7 2019 07 01 Moving Towards Accountability for Reasonableness – A Systematic Exploration of the Features of Legitimate Healthcare Coverage Decision-Making Processes Using Rare Diseases and Regenerative Therapies as a Case Study 424 443 3615 10.15171/ijhpm.2019.24 EN Monika Wagner Analytica Laser, Montreal, QC, Canada Dima Samaha Analytica Laser, London, UK Roman Casciano Analytica Laser, New York City, NY, USA Matthew Brougham Analytica Laser, Montreal, QC, Canada Payam Abrishami National Health Care Institute (ZIN), Diemen, The Netherlands Charles Petrie Pfizer Inc, New York City, NY, USA (retired) Bernard Avouac Liège University, Liège, Belgium Lorenzo Mantovani Center for Public Health Research, University of Milan-Bicocca, Milan, Italy Antonio Sarría-Santamera National School of Public Health IMIENS-UNED, Madrid, Spain Department of Public Health, University of Alcalá, Alcalá de Henares, Spain Paul Kind University of Leeds, Leeds, UK Michael Schlander Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany University of Heidelberg, Heidelberg, Germany Michele Tringali ASST Niguarda and Regione Lombardia, Welfare Directorate, Milano, Italy Journal Article 2018 07 03 Background The accountability for reasonableness (A4R) framework defines 4 conditions for legitimate healthcare coverage decision processes: Relevance, Publicity, Appeals, and Enforcement. The aim of this study was to reflect on how the diverse features of decision-making processes can be aligned with A4R conditions to guide decision-making towards legitimacy. Rare disease and regenerative therapies (RDRTs) pose special decision-making challenges and offer therefore a useful case study. Methods Features operationalizing each A4R condition as well as three different approaches to address these features (cost-per-QALY-focused and multicriteria-based) were defined and organized into a matrix. Seven experts explored these features during a panel run under the Chatham House Rule and provided general and RDRT-specific recommendations. Responses were analyzed to identify converging and diverging recommendations. Results Regarding Relevance, recommendations included supporting deliberation, stakeholder participation and grounding coverage decision criteria in normative and societal objectives. Thirteen of 17 proposed decision criteria were recommended by a majority of panelists. The usefulness of universal cost-effectiveness thresholds to inform allocative efficiency was challenged, particularly in the RDRT context. RDRTs raise specific issues that need to be considered; however, rarity should be viewed in relation to other aspects, such as disease severity and budget impact. Regarding Publicity, panelists recommended transparency about the values underlying a decision and value judgements used in selecting evidence. For Appeals, recommendations included a life-cycle approach with clear provisions for re-evaluations. For Enforcement, external quality reviews of decisions were recommended. Conclusions Moving coverage decision-making processes towards enhanced legitimacy in general and in the RDRT context involves designing and refining approaches to support participation and deliberation, enhancing transparency, and allowing explicit consideration of multiple decision criteria that reflect normative and societal objectives.

https://www.ijhpm.com/article_3615_8f58488bba29cb46b19af5cffb1e2ead.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 8 7 2019 07 01 The Need for a Dynamic Approach to Health System-Centered Innovations; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review” 444 446 3622 10.15171/ijhpm.2019.25 EN Josefien Van Olmen Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium Bruno Marchal Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium Button Ricarte Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium Wim Van Damme Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium Sara Van Belle Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium Journal Article 2019 03 10 Lehoux and colleagues plea for a health systems perspective to evaluate innovations. Since many innovations and their scale-up strategies emerge from processes that are not (centrally) steered, we plea for any assessment with a dynamic, instead of a sequential, approach. We provide further guidance on how to adopt such dynamic approach, in order to better un-derstand and steer innovations for better health systems. A systems-level challenge is constituted by interactions and feedback loops between different actors and components of the health system. It is therefore essential to explore both the entry-point of innovation and the interactions with other components. If innovation is regarded as an injection of resources and opportunities into a health system, this system needs to have the capacity to transform these into desired outputs, the ‘absorption capacity.’ The highly organic diffusion of innovation in complex adapative systems cannot be easily controlled, but the system behaviours can be analysed, with occurance of phenomena such as path dependence, feedback loops, scale-free networks, emergent behaviour and phase transitions. This helps to anticipate unintended consequences, and to engage key actors in ongoing problem-solving and adaptation. By adopting a prospective approach, responsible innovation could set in motion prospective policy evaluations, which on the basis of iterative learning would allow decisionmakers to continuously adapt their policies and programmes. Priority-setting for innovation is an essentially political process that is geared towards consensus-building and grounded in values.

https://www.ijhpm.com/article_3622_e9bf04e14554097193a47fadaaa84f6c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 8 7 2019 07 01 Who is Responsible for Responsible Innovation? Lessons From an Investigation into Responsible Innovation in Health; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review” 447 449 3619 10.15171/ijhpm.2019.32 EN Bernd Carsten Stahl De Montfort University, Leicester, UK Journal Article 2019 03 29 Responsible innovation in health (RIH) takes the ideas of responsible research and innovation (RRI) and applies them to the health sector. This comment takes its point of departure from Lehoux et al which describes a structured literature review to determine the system-level challenges that health systems in countries at different levels of human development face. This approach offers interesting insights from the perspective of RRI, but it also raises the question whether and how RRI can be steered and achieved across healthcare systems. This includes the question who, if anybody, is responsible for responsible innovation and which insights can be drawn from the systemic nature RIH.

https://www.ijhpm.com/article_3619_bb1720be59662b5d36eee0e13e2e6d9c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 8 7 2019 07 01 “Big” Food, Tobacco, and Alcohol: Reducing Industry Influence on Noncommunicable Disease Prevention Laws and Policies; Comment on “Addressing NCDs: Challenges From Industry Market Promotion and Interferences” 450 454 3618 10.15171/ijhpm.2019.30 EN Belinda Reeve The University of Sydney Law School, Sydney, NSW, Australia Lawrence O. Gostin O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA Journal Article 2019 04 08 The food, tobacco and alcohol industries have penetrated markets in low- and middle-income countries (LMICs), with a significant impact on these countries’ burden of noncommunicable diseases (NCDs). Tangcharoensathien and colleagues describe the aggressive marketing of unhealthy food, alcohol and tobacco in LMICs, as well as key tactics used by these industries to resist laws and policies designed to reduce behavioural risk factors for NCDs. This commentary expands on the recommendations made by Tangcharoensathien and colleagues for preventing or managing conflicts of interest and reducing undue industry influence on NCD prevention policies and laws, focusing on the needs of LMICs. A growing body of research proposes ways to design voluntary industry initiatives to make them more effective, transparent and accountable, but governments should also consider whether collaboration with health-harming industries is ever appropriate. More fundamentally, mechanisms for identifying, managing and mitigating conflicts of interest and reducing industry influence must be woven into – and supported by – broader governance and regulatory structures at both national and international levels.

https://www.ijhpm.com/article_3618_c564dcc8827ed25e973d231d294abfa4.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 8 7 2019 07 01 It’s All About the IKT Approach: Three Perspectives on an Embedded Research Fellowship; Comment on “CIHR Health System Impact Fellows: Reflections on ‘Driving Change’ Within the Health System” 455 458 3620 10.15171/ijhpm.2019.31 EN Christine E. Cassidy IWK Health Centre, Halifax, NS, Canada School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada Stacy Burgess IWK Health Centre, Halifax, NS, Canada Ian D. Graham School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada Centre for PracticeChanging Research, The Ottawa Hospital Research Institute, Ottawa, ON, Canada Journal Article 2019 04 15 As a group of Health System Impact (HSI) postdoctoral fellows, Sim and colleagues offer their reflections on ‘driving change’ within the health system and present a framework for understanding the HSI fellow as an embedded researcher. Our commentary offers a different perspective of the fellow’s role by highlighting the integrated knowledge translation (IKT) approach we consider to be foundational to the fellowship experience. Further, we provide several recommendations to enhance Sim and colleagues’ framework to ensure we capture the full value of the fellowship program to the HSI fellow, health system organization, and academic institution.

https://www.ijhpm.com/article_3620_39a90c4ae47ff5401457fd9e7ab1a06e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 8 7 2019 07 01 The Human Resources for Health Program in Rwanda: A Response to Recent Commentaries 459 461 3613 10.15171/ijhpm.2019.19 EN Corrado Cancedda Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Agnes Binagwaho Office of the Vice-Chancellor, University of Global Health Equity, Kigali, Rwanda Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA Journal Article 2019 03 21

https://www.ijhpm.com/article_3613_130f1644213fa80d9dfdd392d4fadb9f.pdf