In a C-Suite Resources presentation, Chairman Emeritus Don Wegmiller provided INTEGRATED with knowledge and insight into the state of the provider sector of healthcare today. Topics covered include new structures, reforms impacting providers, and provider challenges.
Prof David Hunter - Meeting the Challenge - Does the new NHS promote or hinde...Cumbria Partnership
'Meeting the Challenge of Long Term Conditions: Does the new NHS promote or hinder cooperation and integration?' - Professor David Hunter (Professor of Health Policy and Management at Durham University) from the Cumbria Neuroscience Conference
In a C-Suite Resources presentation, Chairman Emeritus Don Wegmiller provided INTEGRATED with knowledge and insight into the state of the provider sector of healthcare today. Topics covered include new structures, reforms impacting providers, and provider challenges.
Prof David Hunter - Meeting the Challenge - Does the new NHS promote or hinde...Cumbria Partnership
'Meeting the Challenge of Long Term Conditions: Does the new NHS promote or hinder cooperation and integration?' - Professor David Hunter (Professor of Health Policy and Management at Durham University) from the Cumbria Neuroscience Conference
Slides from a presentation Adrian gave on the subject of indication-based pricing at the 2018 ISPOR Europe conference in Barcelona, Spain on November 12th.
Application of Pharma Economic Evaluation Tools for Analysis of Medical Condi...IJREST
Application of Pharma Economic Evaluation Tools for Analysis of Medical
Conditions: A Case Study of an Educational Institution in India
1 Dr. Debasis Patnaik, 2 Ms. Pranathi Mandadi
1Assistant Professor, Department of Economics, BITS-Pilani, K K Birla Goa Campus, Goa, India
2Research Scholar, Department of Economics, BITS-Pilani, K K Birla Goa Campus, Goa, India
ABSTRACT
The basic idea of a QALY is straightforward. The amount of time spent in a health state is weighted by the utility score given to
that health state. It takes one year of perfect health (utility score of 1) to generate one QALY, whereas one year in a health state
valued at 0.5 is regarded as being equivalent to half a QALY. Thus, an intervention that generates four additional years in a health
state valued at 0.75 will generate one more QALY than an intervention that generates four additional years in a health state valued
at 0.5. This paper discusses effect of self-medication on health care taking an educational institution population comprising of
students, teaching and non-teaching staff in 2011.
Keywords: Pharma economics, QALY, measuring clinical and health excellence
Slides from the presentation Adrian gave on payment mechanisms and handling uncertainty as part of a forum held at the 2018 ISPOR Europe conference on the topic of triangulating developers, regulators, and payors to reap rewards and address challenges with curative therapies.
Should Drug Prices Differ by Indication? Outlining the debate on indication-b...Office of Health Economics
The notion that the price of a medicine should be linked in some way to the value it generates for patients and the health system is generally accepted. Yet, how can this be achieved when, increasingly, medicines are being developed that derive patient across many different indications? We summarise the current state-of-play for indication-based pricing (IBP), both in theory as described in the key literature, and in practice by investigating its use in the US and five major European countries.
Author(s) and affiliations(s): Amanda Cole, OHE Bernarda Zamora, OHE Adrian Towse, OHE
Conference/meeting: ISPOR Europe
Event location: ISPOR Europe
Date: 13/11/2018
Is complementary and alternative medicine (CAM) cost-effective? a systematic ...home
Whereas the number and quality of economic evaluations of CAM have increased in
recent years and more CAM therapies have been shown to be of good value, the majority of CAM
therapies still remain to be evaluated
Health Economics and Health Finance :Jordan Health Policy Directions Musa Ajlouni
This presentation includes general introduction to health economics,the concept of market failure in health, health financing including health insurance and major challenges related to healthcare financing in Jordan and some policy directions to face these challenges.
CUA is a formal economic technique for assessing the efficien
cy of healthcare interventions. It is
considered by some to be a specific type of cost effectiveness analysis in which the measure of
effectiveness is a utility or preference adjusted outcome.
Slides from a presentation Adrian gave on the subject of indication-based pricing at the 2018 ISPOR Europe conference in Barcelona, Spain on November 12th.
Application of Pharma Economic Evaluation Tools for Analysis of Medical Condi...IJREST
Application of Pharma Economic Evaluation Tools for Analysis of Medical
Conditions: A Case Study of an Educational Institution in India
1 Dr. Debasis Patnaik, 2 Ms. Pranathi Mandadi
1Assistant Professor, Department of Economics, BITS-Pilani, K K Birla Goa Campus, Goa, India
2Research Scholar, Department of Economics, BITS-Pilani, K K Birla Goa Campus, Goa, India
ABSTRACT
The basic idea of a QALY is straightforward. The amount of time spent in a health state is weighted by the utility score given to
that health state. It takes one year of perfect health (utility score of 1) to generate one QALY, whereas one year in a health state
valued at 0.5 is regarded as being equivalent to half a QALY. Thus, an intervention that generates four additional years in a health
state valued at 0.75 will generate one more QALY than an intervention that generates four additional years in a health state valued
at 0.5. This paper discusses effect of self-medication on health care taking an educational institution population comprising of
students, teaching and non-teaching staff in 2011.
Keywords: Pharma economics, QALY, measuring clinical and health excellence
Slides from the presentation Adrian gave on payment mechanisms and handling uncertainty as part of a forum held at the 2018 ISPOR Europe conference on the topic of triangulating developers, regulators, and payors to reap rewards and address challenges with curative therapies.
Should Drug Prices Differ by Indication? Outlining the debate on indication-b...Office of Health Economics
The notion that the price of a medicine should be linked in some way to the value it generates for patients and the health system is generally accepted. Yet, how can this be achieved when, increasingly, medicines are being developed that derive patient across many different indications? We summarise the current state-of-play for indication-based pricing (IBP), both in theory as described in the key literature, and in practice by investigating its use in the US and five major European countries.
Author(s) and affiliations(s): Amanda Cole, OHE Bernarda Zamora, OHE Adrian Towse, OHE
Conference/meeting: ISPOR Europe
Event location: ISPOR Europe
Date: 13/11/2018
Is complementary and alternative medicine (CAM) cost-effective? a systematic ...home
Whereas the number and quality of economic evaluations of CAM have increased in
recent years and more CAM therapies have been shown to be of good value, the majority of CAM
therapies still remain to be evaluated
Health Economics and Health Finance :Jordan Health Policy Directions Musa Ajlouni
This presentation includes general introduction to health economics,the concept of market failure in health, health financing including health insurance and major challenges related to healthcare financing in Jordan and some policy directions to face these challenges.
CUA is a formal economic technique for assessing the efficien
cy of healthcare interventions. It is
considered by some to be a specific type of cost effectiveness analysis in which the measure of
effectiveness is a utility or preference adjusted outcome.
Clearly identifies the root cause of skyrocketing health cost and what companies and employees can do to reduce cost of health care.
You will learn proven strategies used successfully to reduce company health cost for over 20 years.
Florida State UniversityCollege of Nursing and Health Sciences.docxAKHIL969626
Florida State University
College of Nursing and Health Sciences
(CNHS)
HSA 526 - “Health Care Economics”
Individual Assignments/Projects
Assigned Readings
(20% of the final grade)
Instructions and Grading Scales
Instructor: Michael Durr, CPA, MHSA, CHFP
Individual projects and presentations are designed to develop competencies in students while exploring and exposing the challenges and importance of what health care professionals need to do to be successful.
Individual projects should reflect your own work, having done research, applied material from the course, and demonstrate critical thinking. Based on the subject matter of the assigned reading, your paper will reflect one or more of the following:
1. Identify and describe the components of the healthcare system in US;
2. Distinguish between the demand for health, healthcare, and health insurance;
3. Use basic cost - benefit analysis;
4. Identify and describe the role of the key players in the supply of healthcare;
5. Describe the role of government in our current health care system;
6. Identify the major economics related research questions and challenges being asked in the areas of health insurance provision, the pharmaceutical industry, the physician services industry and the long term care industry;
7. Compare and contrast the healthcare delivery system of various countries;
8. Use economic analysis to understand and criticize the changes in the healthcare system.
All documents should be prepared using the APA format. Submission subsequent to the due date will result in a reduction of 10 full points for each day or partial day late.
Instructions:
1. Based on the Assigned Reading for the week, you will prepare a two to three page critique of the paper.
2. All papers will include the standard Barry cover letter and follow APA format.
3. Your critique needs to include research based on at least two other acceptable sources (i.e. Wikipedia is not acceptable).
4. Be concise in your writing – do NOT use “fluff” (such as excessive retelling of original material from the reading or a large restatement of the situation).
5. Your grade will depend largely on the application of economic concepts and your critical thinking skills.
6. Your paper needs to have a conclusion one way or another. Do not vacillate or hedge. Your opinion counts and so make it heard!
M. Durr 1
NBER WORKING PAPER SERIES
IS HOSPITAL COMPETITION
SOCIALLY WASTEFUL?
Daniel P. Kessler
Mark B. McClellan
Working Paper 7266
http://www.nber.org/papers/w7266
NATIONAL BUREAU OF ECONOMIC RESEARCH
1050 Massachusetts Avenue
Cambridge, MA 02138
July 1999
We would like to thank David Becker, Kristin Madison, and Abigail Tay for exceptional research assistance.
Participants in the University of Chicago, Econometric Society, National Bureau of Economic Research,
Northwestern University, U.S. Department of Justice/Federal Trade Commission, and Harvard/MIT industrial
organization seminars provided numerous helpful ...
CHD Secondary Prevention Clinics in Primary Care; a critical assessmentJosep Vidal-Alaball
There is a need for CHD secondary prevention in primary care. This need has been addressed providing specialized clinics run by nurses or GPs. Whether with this clinics we are meeting this need is a question to be answered.
We don’t have a functional competitive market in health care in the U.S. Consequently, many of the attributes of competitive markets that are beneficial in our lives are not present in health care. One significant negative externality of a dysfunctional market is an inability to discern quality. Consumerism is critical. Includes data and analysis from the 5TH ANNUAL HEALTHGRADES PATIENT SAFETY IN AMERICAN HOSPITALS STUDY – APRIL 2008
Prof. Carol Propperin esitys VATT-päivässä 1.11.2016.
Professori Carol Propper on taloustieteen professori Imperial College London -yliopistossa Lontoossa, Iso-Britanniassa. Professori Propperin tutkimus keskittyy kannustin- ja kilpailukysymyksiin terveydenhuoltomarkkinoilla sekä yleisemmin kannustimien suunnitteluun ja vaikutuksiin julkisella sektorilla sekä julkisen ja yksityisen markkinoiden rajapinnalla. Hän on kuuluisa erityisesti tutkimuksistaan, joissa on tarkasteltu kilpailun ja valinnanvapautta lisäävien uudistusten vaikutuksia terveydenhuollon toimintaan Iso-Britanniassa.
Similar to John Appleby - Competition in the NHS: Good or bad (or something else)? (20)
Understanding NHS financial pressures: visual resourcesThe King's Fund
This slideset contains key visual elements from our report, Understanding NHS financial pressures: how are they affecting patient care? Please feel free to share and re-use these graphics with credit to The King's Fund.
Nine characteristics of good-quality care in district nursing taken from interviews with patients, carers and staff.
We hope this framework and these slides will be a useful resource for you – please feel free to use them in your work, in documents and presentations.
As part of a joint learning network on integrated housing, care and health, The King's Fund and the National Housing Federation have produced a set of slides illustrating the connections between housing, social care, health and wellbeing.
We hope they will be a useful resource for you – please feel free to use them in your office, in documents or presentations.
District councils’ contribution to public healthThe King's Fund
Our health is primarily determined by factors beyond just
health care. These slides illustrate the ways in which district
councils influence the health of local people through their key
functions and in their wider role supporting communities and
influencing other bodies.
The King’s Fund Events organise more than 20 health and social care events each year. Our highly-regarded conferences attract leading speakers from the government, the NHS, local authorities and the independent and voluntary sectors.
Jos de Blok set up Buurtzorg – which means ‘neighbourhood care’ in Dutch – with a team of four nurses. Today there are nearly 8,000 Buurtzorg nurses in 630 independent teams, caring for 60,000 patients a year. Nurses in Sweden, Norway, Japan and the United States are adopting the Buurtzorg model.
Our infographics highlight some key facts and figures around leadership vacancies in the NHS and some of the difficulties NHS organisations face in recruiting and retaining people for executive positions.
Sharing leadership with patients and users: a roundtable discussionThe King's Fund
‘What more is possible when patients, service users and those delivering services share the leadership task in health and social care?’
We held a roundtable discussion with patient leaders and organisational leads to discuss this question. Our slidepack summaries the conversations, including the opportunities and challenges for patient leaders, and where and how to start shared leadership working.
Making the case for public health interventionsThe King's Fund
In partnership with the Local Government Association, we have produced a set of infographics that describe key facts about the public health system and the return on investment for some public health interventions.
We hope they will be a useful resource for you – please feel free to use them in your office, in documents or presentations.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
John Appleby - Competition in the NHS: Good or bad (or something else)?
1. Competition in the NHS: Good
or bad (or something else)?
John Appleby
Chief Economist
The King’s Fund
September 2013
Improving health care in London: who will take the lead?Improving health care in London: who will take the lead?
2. • Ever since Adam Smith developed the concept of the invisible hand, many
people have assumed that the discipline of economics is synonymous with
the study of competition and markets, and that economists promote the
notion of competition as the principal mechanism for improving social
welfare.
• However, only a few zealots now adhere absolutely to the belief that
competition offers an unalloyed solution to society’s more intractable
problems.
Prof Pete Smith
Market mechanisms and the use
of health care resources, OECD, 2009
Markets and competition are not (always) the answer
3. Non-market allocation systems are not (always) the answer
• Alternatives to markets/competition do not always and everywhere
inexorably lead to the best use of scarce resources or services responsive
to patients. The interests of ‘the system’, its bureaucrats and professional
providers, may dominate over those of the patient.
• But if – amongst other things - we want to improve efficiency, patient
responsiveness and promote innovation, as well as ensure the effective
delivery of public goods such as R&D and medical education and ensure
an acceptable degree of equity in a complex system of imperfect
information, what allocation mechanisms should we use?
• The difficult policy question is not ‘what works?’ but as Pete Smith has
noted, ‘what works in what situation?’
4. Competition, help or hindrance? What’s the evidence?
• Thinking without data can be useful. It’s pretty clear without the need for
much evidence for instance that markets are probably poor at delivering
some of the things we want from health care – such as universal access.
• But economics is dominated by empirical analysis which tries to find out
how/why things work, to (sometimes) make forecasts and predictions, to
evaluate one policy action against another and so on.
• A big problem is getting hold of the data and conducting rigorous
experiments – not economists’ unwillingness to do so.
• Over the last near-quarter of a century
there have been many efforts to
evaluate the use of market mechanisms
in the English NHS…..
5. Study Subject/Title Main findings
Glennerster,
Matsaganis,
Owens (1994)
GP Fundholding
Implementing Fundholding:
WildCard or Winning Hand?
‘Fundholders provided more outreach services than
non-fundholders did. Also, fundholders, obtained
quicker admission for their patients and, generally,
better response from providers. (Le Grand, 1999)
Harris and
Scrivener (1996)
GP Fundholding
Fundholders’ Prescribing Costs:
The First FiveYear
Fundholders on average had lower prescribing costs.
Söderlund et al,
1997
1991 reforms and productivity
Impact of the NHS
reforms on English hospital
productivity: an analysis of the
first three years
‘..greater competition was associated with lower
costs.’ (Propper, Wilson, Burgess (2005))
Propper
et al, 1998;
GP Fundholding
The effects of regulation and
competition in the NHS internal
market: the case of general
practice fundholder prices
‘..hospitals that had greater business from
fundholders had lower posted prices.’ (Propper,
Wilson, Burgess (2005))
Le Grand, 1999 Review
Competition, Cooperation, or
Control? Tales From The British
National Health Service
‘Perhaps the most striking conclusion
to arise from the evidence is how little overall
measurable change there seems to have been.’
Croxson et al,
2001
GP Fundholding
Do doctors respond to financial
incentives? UK family doctors and
the GP fundholder scheme
‘Fundholders were able to secure shorter waiting
times for their patients.’ Propper, Wilson, Burgess
(2005)
Propper, Croxson
and Shearer, 2002
GP Fundholding
Waiting times for hospital
admissions: the impact of GP
fundholding
‘Fundholders were able to secure shorter waiting
times for their patients.’ Propper, Wilson, Burgess
(2005)
Propper, Burgess
and Abraham,
(2002)
Review
Competition and quality: evidence
from the NHS internal market
1991-1999
‘..quality – as measured by
deaths of patients admitted to hospitals with heart
attacks – fell during the internal
market.’ (Propper, Wilson, Burgess (2005))
Propper, Wilson,
Burgess (2005)
Review
Extending Choice In English Health
Care: The implications of the
Economic Evidence
‘..there is neither strong theoretical nor empirical
support for competition, but that there are cases
where competition has improved outcomes.’
Smith (2009) Review
Market mechanisms and the use
of health care resources.
‘..competition can take many different forms, and
sharpening competitive forces is likely in general to
be an important tool for most health systems. Policy
makers nevertheless need to shape market-type
mechanisms with care, to align other policy levers,
and to monitor vigilantly, in order to maximise the
benefits they secure.’
OHE (2012) Review
Competition in the NHS
‘Competition is potentially useful to stimulate the
provision of better quality and more health care for
the NHS’s budget beyond what is possible in the
absence of competition. But this does not mean that
competition is desirable or feasible for all NHS
services in all locations.’
Study Years studied Main findings
Treatment Control
Propper et al
(2004)
1995/6 -
1997/8
None Increasing competition from 25th to 75th
percentile increased mortality rates by 1%
Propper et al
(2008)
1992/3 -
1996/7
1991/2,
1997/8 -
1999/2000
Hospitals exposed to competition increased
elective admissions and decreased waiting
times but had increased mortality. Overall
effect was to save 1.32 million person months
of waiting and lose around 11,800 life years
due to earlier death. Costs exceeded benefits
on any reasonable valuation.
Cooper et al
(2011)
April 2006 -
December
2008
Jan 2002 -
March 2006
A one standard deviation increase in
competition led to a 0.31% fall in mortality
annually between April 2006 and December
2008 off a 2005 baseline of 13.96%. Overall
effect was about 300 fewer deaths from AMI
per year
Gaynor et al
(2011)
2007/8 2003/4 A 10% fall in the HHI [a measure of market
concentration] decreases AMI mortality rates
by 2.91% and all cause mortality rates by
0.99%. This implies a 0.3% decrease in the
average hospital’s mortality rate, or around
4,800 life years saved.
Bloom et al
(2011)
2005/6 None Adding a rival hospital increases management
quality by 0.4 standard deviations and
decreases mortality rates by 9.5%
Bevan and Skellern Does competition between hospitals
improve clinical quality? A review of evidence from two eras
of competition in the English NHS (2011)
Studies and reviews: 1994-2012
6. 2012
2008
2006
2000
2008
Hospitals
exposed to
competition
increased
elective
admissions
and decreased
waiting
times…
…but had
increased
mortality.
1994
Fund holders
provided more
outreach
services than
non-fund
holders and
obtained
quicker
admission for
their patients
and, generally,
better response
from providers .
1997
Greater
competition
was associated
with lower
costs.
1998
Hospitals that
had greater
business from
fund holders
had lower
posted prices.1996
Fund holders
on average
had lower
prescribing
costs.
1999
Perhaps the
most striking
conclusion is
how little
measureable
change there
seems to have
been
2001
Fund holders
were able to
secure shorter
waiting times
for their
patients.
2002a
Fund holders
were able to
secure shorter
waiting times
for their
patients
2002b
Quality – as
measured by
deaths of
patients
admitted to
hospitals with
heart attacks –
fell during the
internal
market
2005
There is neither
strong
theoretical nor
empirical
support for
competition,
but that there
are cases where
competition has
improved
outcomes
2009
Sharpening
competitive
forces is likely in
general to be an
important tool
for most health
systems. Policy
makers
nevertheless
need to shape
market-type
mechanisms
with care, to
align other
policy levers,
and to monitor
vigilantly, in
order to
maximise the
benefits they
secure
2012
Competition is
potentially
useful to
stimulate the
provision of
better quality
and more
health care for
the NHS’s
budget beyond
what is possible
in the absence
of competition.
But this does
not mean that
competition is
desirable or
feasible for all
NHS services in
all locations.2004
Increasing
competition
from 25th to
75th
percentile
increased
mortality
rates by 1%
2011
Adding a rival
hospital
increases
management
quality by 0.4
standard
deviations and
decreases
mortality rates
by 9.5%
2011
A 10% increase
in competition =
0.3% decrease
in the average
hospital’s
mortality rate,
or around 4,800
life years saved
2011
Overall effect
was about
300 fewer
deaths from
AMI per year
1994
1996
1998
2014
2002
2004
Key findings from
selected studies
and reviews of
competition and
the English NHS 2010
7. What to conclude?
• Some evidence of some benefits under some organisational, contractual,
payment/price and regulatory arrangements.
• Don’t know if competition cost effective or the exact combination and
design of contractual, informational, institutional and payment
arrangements which makes benefits of competition > its costs or that
would imply a policy response to increase competition in areas where
there is currently little competition.
• Julian LeGrand: “Perhaps the most striking conclusion is how little
measureable change there seems to have been”. Smith…perhaps due to
constrained/regulated input markets (for drugs, medical labour, capital
etc)? Or, choice in main market constrained (England has far fewer
hospitals than most other OECD countries per capita)? What are policy
responses – deregulate input markets? Build more, smaller hospitals,
break up big ones?
• Or just don’t expect too much from markets and competition?
8. Finally…
• Markets worth experimenting with - but need careful design, monitoring
and evaluation (and abandoning/modifying where they don’t give us what
we want)
• Markets just one of the levers to get what we want for health care
• More research needed….