Most research on health care equity focuses on accessing services, with less attention given to how revenue is collected to pay for a country's health care bill. This article examines the progressivity of revenue collection among publicly funded sources: income taxes, social insurance (often in the form of payroll) taxes, and consumption taxes (e.g., value-added taxes). We develop methodology to derive a qualitative index that rates each of 29 high-income countries as to its progressivity or regressivity for each of the three sources of revenue. A variety of data sources are employed, some from secondary data sources and other from country representatives of the Health Systems and Policy Monitor of the European Observatory on Health Systems and Policies. We found that countries with more progressive income tax systems used more income-based tax brackets and had larger differences in marginal tax rates between the brackets. The more progressive social insurance revenue collection systems did not have an upper income cap and exempted poorer persons or reduced their contributions. The only pattern regarding consumption taxes was that countries that exhibited the fewest overall income inequalities tended to have least regressive consumption tax policies. The article also provides several examples from the sample of countries on ways to make public revenue financing of health care more progressive.
- MeSH
- daň z příjmu ekonomika MeSH
- daně * ekonomika MeSH
- financování vládou * MeSH
- lidé MeSH
- poskytování zdravotní péče ekonomika MeSH
- sociální zabezpečení ekonomika MeSH
- vyspělé země MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Using the Slovak pharmacy retail market case, this study examines the evolving interdependency between general practitioners (GPs) and pharmacies. Traditionally, they have operated symbiotically, with pharmacy revenues heavily reliant on prescriptions. However, the development of the market structures of these providers after the liberalization of the pharmacy retail market in 2005 raises a question about the stability of this relationship. By analyzing entry thresholds as a measure of the market size required for pharmacies to cover their entry costs, the study reveals that the dependency of pharmacies on the presence of GPs has diminished over time. In the initial year following the liberalization, the presence of a GP decreased the market size sufficient to cover entry costs for the first pharmacy by about 83% compared to a market without a GP. However, in 2019, this effect decreased to approximately 65%. This could imply worsened coverage of pharmaceutical services in small and rural areas with GPs as the entry decision of pharmacies is less elastic towards their presence.
- MeSH
- farmaceutické služby * MeSH
- lékárny * MeSH
- lidé MeSH
- praktičtí lékaři * MeSH
- symbióza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Slovenská republika MeSH
A cross countries in Europe, health policy is seeking to adapt to the post-pandemic 'permacrisis', where high demands on the healthcare workforce and shortages continue and combine with climate change, and war. The success of these efforts depends on the capacities of the healthcare workforce. This study aims to compare health policy responses to strengthen the capacities of the healthcare workforce and to explore the underpinning dynamics between health systems, policy actors and health policies. The study draws on a qualitative, comparative analysis of Austria, the Czech Republic, Denmark, Germany, Italy and the Netherlands. The findings suggest that policy responses at the national level focused on hospitals and absorptive capacities, while policy responses at local/regional levels also included general practice and adaptive capacities. There were only few examples of policies directed at transformative capacities. The underling dynamics were shaped by health systems, where individual parts are closely connected, by embeddedness in specific service delivery and areas, and by power dynamics. In conclusion, sub-national health policy responses emerge as key to effective responses to the post-pandemic permacrisis, where health professions are central policy actors. Sub-national health policy responses build on existing power relations, but also have the potential to transcend these power relations.
- MeSH
- COVID-19 * MeSH
- lidé MeSH
- poskytování zdravotní péče MeSH
- pracovní síly MeSH
- psychická odolnost * MeSH
- zdravotní politika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND: Since 2010, the Czech Republic has been experiencing a spontaneous phenomenon in which General Practitioner (GPs) practices have been transferred to a legal limited liability company as defined by the Commercial Code. OBJECTIVES: Our research attempted to ascertain the reasons that induced GPs to change their legal form, thereby opting for an entrepreneurial orientation (EO). A second objective was to measure the impact of this change on the healthcare performance of GP practices. METHODOLOGY/APPROACH: We used exploratory research to examine this phenomenon in healthcare service provision. Data from 131 questionnaires was evaluated using an exploratory survey with descriptive statistics. To assess the healthcare performance of GP practices, we used secondary data from the Institute of Health Information and Statistics of the Czech Republic. FINDINGS: The GPs interviewed considered their practices to be businesses. Their decision to change to a limited company form was influenced by the possibility of selling or transferring the business, employment sustainability and job security, and advantages related to cost structure and taxation. Our study shows that, in a generational exchange, the change in legal form enhances the sustainability and operation of the practice within the context of the current demands for high-quality healthcare.
- MeSH
- kvalita zdravotní péče MeSH
- lidé MeSH
- postoj zdravotnického personálu MeSH
- praktické lékařství * MeSH
- praktičtí lékaři * MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Medical residents work long, continuous hours. Working in conditions of extreme fatigue has adverse effects on the quality and safety of care, and on residents' quality of life. Many countries have attempted to regulate residents' work hours. OBJECTIVES: We aimed to review residents' work hours regulations in different countries with an emphasis on night shifts. METHODS: Standardized qualitative data on residents' working hours were collected with the assistance of experts from 14 high-income countries through a questionnaire. An international comparative analysis was performed. RESULTS: All countries reviewed limit the weekly working hours; North-American countries limit to 60-80 h, European countries limit to 48 h. In most countries, residents work 24 or 26 consecutive hours, but the number of long overnight shifts varies, ranging from two to ten. Many European countries face difficulties in complying with the weekly hour limit and allow opt-out contracts to exceed it. CONCLUSIONS: In the countries analyzed, residents still work long hours. Attempts to limit the shift length or the weekly working hours resulted in modest improvements in residents' quality of life with mixed effects on quality of care and residents' education.
- MeSH
- kurzy a stáže v nemocnici * MeSH
- kvalita života MeSH
- lidé MeSH
- personální obsazení a rozvrh * MeSH
- pracovní zátěž MeSH
- vyspělé země MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
This paper analyses the health policy response to the COVID-19 pandemic in the four Visegrad countries - Czechia, Hungary, Poland, and Slovakia - in spring and summer 2020. The four countries implemented harsh transmission prevention measures at the beginning of the pandemic and managed to effectively avoid the first wave of infections during spring. Likewise, all four relaxed most of these measures during the summer and experienced uncontrolled growth of cases since September 2020. Along the way, there has been an erosion of public support for the government measures. This was mainly due to economic considerations taking precedent but also likely due to diminished trust in the government. All four countries have been overly reliant on their relatively high bed capacity, which they managed to further increase at the cost of elective treatments, but this could not always be supported with sufficient health workforce capacity. Finally, none of the four countries developed effective find, test, trace, isolate and support systems over the summer despite having relaxed most of the transmission protection measures since late spring. This left the countries ill-prepared for the rise in the number of COVID-19 infections they have been experiencing since autumn 2020.
- MeSH
- COVID-19 * MeSH
- lidé MeSH
- pandemie * prevence a kontrola MeSH
- vláda MeSH
- zdravotní politika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Provider payment mechanisms were adjusted in many countries in response to the COVID-19 pandemic in 2020. Our objective was to review adjustments for hospitals and healthcare professionals across 20 countries. We developed an analytical framework distinguishing between payment adjustments compensating income loss and those covering extra costs related to COVID-19. Information was extracted from the Covid-19 Health System Response Monitor (HSRM) and classified according to the framework. We found that income loss was not a problem in countries where professionals were paid by salary or capitation and hospitals received global budgets. In countries where payment was based on activity, income loss was compensated through budgets and higher fees. New FFS payments were introduced to incentivize remote services. Payments for COVID-19 related costs included new fees for out- and inpatient services but also new PD and DRG tariffs for hospitals. Budgets covered the costs of adjusting wards, creating new (ICU) beds, and hiring staff. We conclude that public payers assumed most of the COVID-19-related financial risk. In view of future pandemics policymakers should work to increase resilience of payment systems by: (1) having systems in place to rapidly adjust payment systems; (2) being aware of the economic incentives created by these adjustments such as cost-containment or increasing the number of patients or services, that can result in unintended consequences such as risk selection or overprovision of care; and (3) periodically evaluating the effects of payment adjustments on access and quality of care.
We use survey data to study how trust in government and consensus for the pandemic policy response vary with the propensity for altruistic punishment in Italy, the early epicenter of the pandemic. Approval for the management of the crisis decreases with the size of the penalties that individuals would like to see enforced for lockdown violations. People supporting stronger punishment are more likely to consider the government's reaction to the pandemic as insufficient. However, after the establishment of tougher sanctions for risky behaviors, we observe a sudden flip in support for the government. Higher amounts of the desired fines become associated with a higher probability of considering the COVID policy response as too extreme, lower trust in government, and lower confidence in the truthfulness of the officially provided information. These results suggest that lockdowns entail a political cost that helps explain why democracies may adopt epidemiologically suboptimal policies.
- MeSH
- COVID-19 * MeSH
- kontrola infekčních nemocí MeSH
- lidé MeSH
- pandemie MeSH
- SARS-CoV-2 MeSH
- vláda MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
We provide an explorative and international comparison of the governance models of academic medical centres (AMCs). These centres face significant challenges, including disruptive external pressures and enduring financial conflicts pertaining to patient treatment, research and education. Therefore, we covered 10 European countries (Cyprus, Czechia, Denmark, Germany, Italy, Latvia, the Netherlands, Norway, Poland and Spain) and one associated state (Israel) in our analysis. In addition, we developed an expert questionnaire to collect data on the governance of AMCs in these 11 countries. Our results revealed no standardised definition of AMCs, with countries combining patient care, education/teaching and research differently. However, the ownership of such institutions is significantly homogeneous and is limited to public or private, nonprofit ownership. Furthermore, significant differences are associated with the (functional) integration level between the hospital and medical school. Therefore, most experts believe that the governance of AMCs will evolve into a more functionally integrated model of patient care, research and education.
Traditional health systems typologies were based on health system financing type, such as the well-known OECD typology. However, the number of dimensions captured in classifications increased to reflect health systems complexity. This study aims to develop a taxonomy of primary care (PC) systems based on the actors involved (state, societal and private) and mechanisms used in governance, financing and regulation, which conceptually represents the degree of decentralisation of functions. We use nonlinear canonical correlations analysis and agglomerative hierarchical clustering on data obtained from the European Observatory on Health Systems and Policy and informants from 24 WHO European Region countries. We obtain four clusters: 1) Bosnia Herzegovina, Czech Republic, Germany, Slovakia and Switzerland: corporatist and/or fragmented PC system, with state involvement in PC supply regulation, without gatekeeping; 2) Greece, Ireland, Israel, Malta, Sweden, and Ukraine: public and (re)centralised PC financing and regulation with private involvement, without gatekeeping; 3) Finland, Norway, Spain and United Kingdom: public financing and devolved regulation and organisation of PC, with gatekeeping; and 4) Bulgaria, Croatia, France, North Macedonia, Poland, Romania, Serbia, Slovenia and Turkey: public and deconcentrated with professional involvement in supply regulation, and gatekeeping. This taxonomy can serve as a framework for performance comparisons and a means to analyse the effect that different actors and levels of devolution or fragmentation of PC delivery may have in health outcomes.
- MeSH
- lidé MeSH
- primární zdravotní péče * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Bosna a Hercegovina MeSH
- Bulharsko MeSH
- Česká republika MeSH
- Chorvatsko MeSH
- Evropa MeSH
- Finsko MeSH
- Francie MeSH
- Irsko MeSH
- Izrael MeSH
- Malta MeSH
- Německo MeSH
- Norsko MeSH
- Polsko MeSH
- Řecko MeSH
- Republika Severní Makedonie MeSH
- Rumunsko MeSH
- Slovenská republika MeSH
- Slovinsko MeSH
- Španělsko MeSH
- Spojené království MeSH
- Srbsko MeSH
- Švédsko MeSH
- Švýcarsko MeSH
- Turecko MeSH
- Ukrajina MeSH
