There is a great variation across states in nurse practitioner (NP) scope of practice moderated by state regulations. The purpose of this study was to synthesize the evidence from studies of the ...impact of state NP practice regulations on U.S. health care delivery outcomes (e.g., health care workforce, access to care, utilization, care quality, or cost of care), guided by Donabedian’s structure, process, and outcomes framework. This systematic review was performed using Medline, CINAHL, PsycINFO, and PubMed according to Preferred Reporting Items for Systematic and Meta-Analysis on the literature from January 2000 to August 2019. The results indicate that expanded state NP practice regulations were associated with greater NP supply and improved access to care among rural and underserved populations without decreasing care quality. This evidence could provide guidance for policy makers in states with more restrictive NP practice regulations when they consider granting greater practice independence to NPs.
Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these ...new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context.
The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence.
One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users.
Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand.
Prospero registration number: 42016037725 .
Since 1978 when it embarked on sweeping agricultural and industrial reforms, Chinas economic growth has been remarkable. Its success in transforming itself within just three decades from a very poor ...low-income country to a successful middle-income country is unparalleled. During this period, however, and in contrast to the first 30 years of the Peoples Republic, progress in the health sector has been disappointing. For example, during the period 1980-2007, China increased its income per head as a percentage of the OECD average from 3 percent to 15 per cent, but infant mortality fell no faster in China than in the OECD area. Government spending on health grew in real terms, but in contrast to the pattern seen in other countries, the share of GDP allocated to government health spending stayed unchanged in China despite 30 years of economic growth of over 8 per cent per year. Household out-of-pocket spending increased to fill the gap, rising as a share of total health spending from 20 per cent in 1978 to over 60 per cent in 2000. This left many households doing without care when they needed it, and others incurring expenses so large they were driven into poverty. In 2003, as part of its program of balanced development and harmonious society, the government began launching a series of policy reforms in the rural health sector where spending and policy reform had lagged. This book examines the performance and workings of the rural health system leading up to these reforms, outlines the reforms, and presents some early evidence on their impacts. It goes on to outline ideas for building on these reforms to further strengthen Chinas rural health system, covering health financing and health insurance, service delivery, and public health. Health systems often get locked into certain reform paths. The final part of the book therefore uses the
experiences of the OECD countries to gaze into Chinas future; it asks not only what Chinas health system might look like, but also how China might get there from where it is today.
Context: There is a widespread belief that the US health care system needs to move "from volume to value." This transformation to value (eg, quality divided by cost) is conceptualized as a two-fold ...movement: (1) from fee-for-service to alternative payment models; and (2) from solo practice and freestanding hospitals to medical homes, accountable care organizations, large hospital systems, and organized clinics like Kaiser Permanente. Methods: We evaluate whether this transformation is happening quickly, shifting risk to providers, lowering costs, and improving quality. We draw on recent evidence on provider payment and organization and their effects on cost and quality. Findings: Data suggest a low prevalence of provider risk payment models and slow movement toward new payment and organizational models. Evidence suggests the impact of both on cost and quality is weak. Conclusions: We need to be patient in expecting system improvements from ongoing changes in provider payment and organization. We also may need to look for improvements in other areas of the economy or to accept and accommodate prospects of modest improvements over time.
Primary care in Ontario, Canada, has undergone a series of reforms designed to improve access to care, patient and provider satisfaction, care quality, and health system efficiency and ...sustainability. We highlight key features of the reforms, which included patient enrollment with a primary care provider; funding for interprofessional primary care organizations; and physician reimbursement based on varying blends of fee-for-service, capitation, and pay-for-performance. With nearly 75 percent of Ontario's population now enrolled in these new models, total payments to primary care physicians increased by 32 percent between 2006 and 2010, and the proportion of Ontario primary care physicians who reported overall satisfaction with the practice of medicine rose from 76 percent in 2009 to 84 percent in 2012. However, primary care in Ontario also faces challenges. There is no meaningful performance measurement system that tracks the impact of these innovations, for example. A better system of risk adjustment is also needed in capitated plans so that groups have the incentive to take on high-need patients. Ongoing investment in these models is required despite fiscal constraints. We recommend a clearly articulated policy road map to continue the transformation.
Your all-in-one companion for health personnel World Health Systems details different health systems, including their related health insurance and drug supply systems, in various parts of the world ...with both macro- and micro- perspectives. The book is arranged in five parts: the first part presents, from multidisciplinary perspectives, outlines of various health systems throughout the world, as well as current trends in the development and reform of world health systems. The second and third parts expound on the health systems in developed countries, discussing the government's role in the health service market and basic policies on medication administration and expenses, before analyzing the health systems of Britain, Canada, Australia, Sweden, Germany, France, Japan, Poland, USA, Singapore, Hongkong (China), and Taiwan (China). The fourth and fifth parts discuss health systems in less developed countries and areas, typically the BRICS and other countries in Asia (Thailand, Vietnam, the Philippines, Armenia, and Kyrghyzstan), Africa (Egypt, Morocco), Europe (Hungary, Czech Republic, and Bulgaria) and South America (Cuba, Chile, and Mexico), summarizing their past experiences, while making assessments of their current efforts to shed light on future developments. * Details a variety of health systems throughout the world * Compares their fundamental features and characteristics * Discusses their respective strengths and shortcomings * Provides insight from an author who holds multiple impressive titles in the health sector Public health professionals and academics alike will want to add World Health Systems to their library.
Tackling inequalities in health and healthcare is more important than ever. The COVID-19 pandemic starkly illustrated the disproportional impact of the virus on those who already faced disadvantage ...and discrimination. Moreover, there is evidence that the public health measures taken to contain the virus are likely to have longstanding differential impacts across populations. Numerous studies have documented avoidable differences in health, within and between populations. Similarly, studies have consistently shown inequalities in access, use, experience and outcomes from healthcare and public health programmes. The focus has often been on individual determinants, such as gender, age and ethnicity. Less attention has been paid to structural or contextual determinants, except for area-level socioeconomic conditions. In addition, to tackle inequalities, there is a need to move beyond measuring; to understand why inequalities arise and how they can be addressed. This Special Issue sought to extend the parameters of inequalities research in health and healthcare beyond measuring and documenting inequalities. Reviews, observational studies, and quasi-experimental and other evaluation designs (using quantitative, qualitative or mixed methods), focusing on the following were welcomed: • understanding inequalities across health and care systems; • methodological developments to understand drivers of inequalities; • efforts to reduce inequalities, particularly in evidence-based healthcare or public health policy and practice; • understanding and mitigating the adverse impact of the COVID-19 pandemic on inequalities.
The goals of Universal Health Coverage (UHC) are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from ...impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick. Countries as diverse as Brazil, France, Japan, Thailand, and Turkey that have achieved UHC are showing how these programs can serve as vital mechanisms for improving the health and welfare of their citizens, and lay the foundation for economic growth and competitiveness grounded in the principles of equity and sustainability. Ensuring universal access to affordable, quality health services will be an important contribution to ending extreme poverty by 2030 and boosting shared prosperity in low income and middle-income countries (LMICs), where most of the worlds poor live.
Introduction Outcome-based payment models (OBPMs) might solve the shortcomings of fee-for-service or diagnostic-related group (DRG) models using financial incentives based on outcome indicators of ...the provided care. This review provides an analysis of the characteristics and effectiveness of OBPMs, to determine which models lead to favourable effects. Methods We first developed a definition for OBPMs. Next, we searched four data sources to identify the models: (1) scientific literature databases; (2) websites of relevant governmental and scientific agencies; (3) the reference lists of included articles; (4) experts in the field. We only selected studies that examined the impact of the payment model on quality and/or costs. A narrative evidence synthesis was used to link specific design features to effects on quality of care or healthcare costs. Results We included 88 articles, describing 12 OBPMs. We identified two groups of models based on differences in design features: narrow OBPMs (financial incentives based on quality indicators) and broad OBPMs (combination of global budgets, risk sharing, and financial incentives based on quality indicators). Most (5 out of 9) of the narrow OBPMs showed positive effects on quality; the others had mixed (2) or negative (2) effects. The effects of narrow OBPMs on healthcare utilization or costs, however, were unfavourable (3) or unknown (6). All broad OBPMs (3) showed positive effects on quality of care, while reducing healthcare cost growth. Discussion Although strong empirical evidence on the effects of OBPMs on healthcare quality, utilization, and costs is limited, our findings suggest that broad OBPMs may be preferred over narrow OBPMs.
Context: In 2008, researchers at the Institute for Healthcare Improvement (IHI) described the Triple Aim as simultaneously "improving the individual experience of care; improving the health of ...populations; and reducing the per capita costs of care for populations." IHI and its close colleagues had determined that both individual and societal changes were needed. Methods: In 2007, IHI began recruiting organizations from around the world to participate in a collaborative to implement what became known as the Triple Aim. The 141 participating organizations included health care systems, hospitals, health care insurance companies, and others closely tied to health care. In addition, key groups outside the health care system were represented, such as public health agencies, social services groups, and community coalitions. This collaborative provided a structure for observational research. By noting the contrasts between the contexts and structures of those sites in the collaborative that progressed and those that did not, we were able to develop an ex post theory of what is needed for an organization or community to successfully pursue the Triple Aim. Findings: Drawing on our 7 years of experience, we describe the 3 major principles that guided the organizations and communities working on the Triple Aim: creating the right foundation for population management, managing services at scale for the population, and establishing a learning system to drive and sustain the work over time. Conclusions: The concept of the Triple Aim is now widely used, because of IHI's work with many organizations and also because of the adoption of the Triple Aim as part of the national strategy for US health care, developed during the implementation of the Patient Protection and Affordable Care Act of 2010. Even those organizations working on the Triple Aim before IHI coined the term found our concept to be useful because it helped them think about all 3 dimensions at once and organize their work around them.
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