paywalled: Confidence in receiving medical care when seriously ill: a seven-country comparison of the impact of cost barriers - Health Expectations

Confidence in receiving medical care when seriously ill: a seven-country comparison of the impact of cost barriers - Wendt - 2011 - Health Expectations

Abstract

Objective  This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States.

Methods  The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models.

Results  Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon.

Conclusions  The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems.

The Disparity of Motivational Drivers in International Health Care Systems

OMICS Publishing Group | Full-text | The Disparity of Motivational Drivers in International Health Care Systems

Abstract

Healthcare systems are highly convoluted and nontransparent systems that face the immense challenge of disparaging economic and ethical drivers from each player in this complicated continuum. Economic slack is a critical obstacle that is generated through the misalignment of needed outcomes for each of these silos. Understanding the economic needs of each additional and overlapping player in the continuum is the first important step toward universal health care sustainability.

Editorial

".......Undeniably, some industrialized countries, particularly in Europe, are far closer to attaining sustainable, universal (timely) healthcare access than others and yet no country can claim perfection.....

CancerWorld: Framing the argument over futile care - overdiagnose, overtreat, overpromise...media focus

Framing the argument over futile care:

We “overdiagnose, overtreat and overpromise”. This was the claim made by numerous newspaper headlines in response to the Lancet Oncology report last September on delivering affordable cancer care. While we do need open and frank discussions about how to curb the spiralling costs of cancer care, it was unfortunate that the media focused so heavily on the cost of futile treatment in the last weeks of life, blaming it all on a culture of excess. This sparked reports that patients would be denied potentially life-prolonging treatments purely on the basis of cost and generated fears that patients might be abandoned in their final months. There is no doubt that we do overtreat and overpromise in the advanced cancer setting. We know, for instance, that many patients receive cancer treatments in the last weeks of their life, and that some of these treatments have no reasonable chance of helping the patient and are associated with severe side-effects that can lead to hospitalisation and even death. We also know that receiving chemotherapy is associated with a delay in referral to palliative care. But blaming this on a culture of excess is too simplistic. Making the right decisions in later stages of advanced cancer is difficult for doctors and patients alike. It is often impossible to predict how long a patient will live, and while we have an increasing number of therapies to choose from, we don’t yet know enough about who stands to benefit and by how much. There can be a huge disconnect between the expectations of patients and families and those of clinicians, adding to the difficulty of conducting honest conversations with patients about their prognosis, treatment options and end-of-life preferences. There are no easy answers. But could we be making things harder for ourselves by posing options in terms of a choice between either fighting cancer or optimising quality of life? An emerging body of evidence shows that integrating palliative care into the mainstream care of cancer patients not only improves their quality of life, but might even help them live longer. Early involvement of palliative care specialists has also been shown to cut down on futile medical interventions and help families cope better with their loss of a loved one. ASCO is now recommending that patients should be offered concurrent palliative care and standard cancer treatments early in the course of their advanced cancer journey. This is in line with efforts to stimulate meaningful interaction between mainstream oncology and palliative care specialists that ESMO and other European professional bodies have been pursuing for some time. However, progress so far has been infuriatingly slow. Greater integration of palliative care requires changes in the way we organise care and train clinicians. We need to get on with this as a matter of urgency. If we fail to take a lead in addressing shortcomings in the way we care for patients with advanced cancer, the simplistic arguments about a wasteful culture of excess could win, and patients will be the losers.

Forbes: (U.S.) Hospital Association "Declares War" on Patient Empowerment

 Blogger's Note: click on the pdf link for letter from AHA (as below):

"A firestorm has been triggered by the American Hospital Association’s (AHA) 68 page letter (PDF) commenting on the Stage 2 Meaningful Use proposed requirements."
 "Our members are particularly concerned with the proposed objective to provide patients with the ability to view, download and transmit large volumes of protected health information via the Internet (a “patient portal”). The AHA believes that this objective is not feasible as proposed, raises significant security issues, and goes well beyond current technical capacity. We also believe that CMS should not include this objective because the Office of Civil Rights, and not CMS, regulates how health care providers and other covered entities fulfill their obligations under the Health Insurance Portability and Accountability Act (HIPAA), including the obligation to give patients access to their health records. Please see our detailed comments for more
recommendations on changes to specific objectives and measures."

                   ~~~~~~~~~~~~~~~~~~~~~~~~~~


Hospital Association "Declares War" on Patient Empowerment:

A firestorm has been triggered by the American Hospital Association’s (AHA) 68 page letter (PDF) commenting on the Stage 2 Meaningful Use proposed requirements. The reaction has been swift from various individuals and organizations focused on patient rights and empowerment.

Consumer Rights and Patient Empowerment Organizations also weighed in.

• The Center for Democracy & Technology picked apart the legal “hail mary” that the AHA was using in their response. See Hospital Association Fights Digital Data Access for Patients for more.
• The Society for Participatory Medicine stated the following. “Patient engagement is the cornerstone of a successful, cost effective, and high-quality health care system,” said Daniel Z. Sands, MD, the Society’s president and a practicing internist. “Those goals cannot be achieved unless we give patients access to their own health information and encourage them to use it.”

BMJ » Blog Archive » Chris Williams: When will we learn HOW to deliver healthcare?

 BMJ » Blog Archive » Chris Williams: When will we learn HOW to deliver healthcare?

Chris Williams is a medical student at the University of Liverpool, currently intercalating at the Liverpool School of Tropical Medicine for an MSc in Humanitarian studies.

press release: Canada, Australia and New Zealand establish a new research partnership - CIHR

Canada, Australia and New Zealand establish a new research partnership - CIHR

Ottawa (March 20, 2012) – The Canadian Institutes of Health Research (CIHR), the Australian Primary Health Care Research Institute (APHCRI) at the Australian National University and the Health Research Council of New Zealand (HRC NZ) are partnering to fund research on innovative models of Community-based Primary Healthcare (CBPHC). As part of CIHR's Signature Initiative, funded teams will examine how to better prevent and manage chronic disease, as well as improve access to care for vulnerable populations.
Recognizing that innovative research in CBPHC is essential to better health outcomes, improved equity, reduced wait times, and an improved patient experience, the partners have agreed to support cross-jurisdictional Canada-Australia and Canada-New Zealand teams of researchers, patients, decision-makers and clinicians.
"This collaborative research between Canada, Australia, and New Zealand will allow our three countries to test different models of primary healthcare", said Dr. Beaudet, President of CIHR. "The international best practices that emerge will benefit our healthcare systems and, most importantly, contribute to better health outcomes."
...........cont'd

YouTube: Interview with Dr Stukel, Author of Hospital Spending Intensity and Patient Outcomes

Also, planning a comparison study with London School of Economics and Havard

Survey Reveals Pressures to Increase Volume of Colonoscopies Adversely Impacts How Gastroenterologists Perform the Screening and Could Potentially Affect Procedure Quality

Survey Reveals Pressures to Increase Volume of Colonoscopies Adversely Impacts How Gastroenterologists Perform the Screening and Could Potentially Affect Procedure Quality

Overdiagnosis as a Flaw in Health Care - NYTimes.com "If You Feel O.K., Maybe You Are O.K."

(Canadian Medical Assoc) CMA got flood of feedback during its dialogue with Canadians

"The CMA's 2011 campaign to gather Canadians' input on their health care system was a marriage of old and new methods - town hall meetings, the Internet and social media - and it produced an unprecedented amount of feedback.
That becomes clear quickly in Voices into Action, a report that provides a synopsis of the information gathered by the CMA since the launch of its National Dialogue on Health Care Transformation last year......"

Lessons Learned in Changing Healthcare... and how we learned them :: Longwoods.com

Who Is the Customer?

........ "Who's the customer?" Well, of course, our answer was, "It's the patient." The board told us to take a closer look.
So we did. We performed a deep dive on our processes, and we found out that most of them were designed around us, not the patient. If you think about it, what are waiting rooms but places for patients to hurry up, be on time and then wait for us? What happens in most hospitals on Saturdays and Sundays? Patients wait for Monday so that things can get done.
The more we probed, the more we realized that the patient did not come first. I emphasize this point, because it is our true north and basic to everything we have done in the years since.

Nov 2010: Health Council of Canada / Conseil canadien de la santé - How Do Canadians Rate the Health Care System?

Publications     Stories of Health Care Renewal   Multimedia   Videos     Podcasts     Public Service Announcements
How Do Canadians Rate the Health Care System? November 2010 Canadians visiting emergency departments for care, instead of seeing primary health care providers Health Council of Canada releases 2010 Commonwealth Fund International Health Policy Survey results.

UK versus US health care: Atlantic rift : Editorial The Lancet

"Sadly, the political rancour about who spends what and on whom diverts attention from the real key to tackling chronic disease, and the only thing with the power to save both lives and money—disease prevention."

Pathways to the diagnosis of ovarian cancer in the UK: a cohort study in primary care BJOG

2010 Who Is Responsible? The Role of Family Physicians in the Provision of Supportive Cancer Care

Note: the issues from the family physicians' perspective