Health Care and Cost Containment in the European Union
Abstract
First published in 1999, this volume aims to describe and analyse the experience of cost containment in Europe over the last fifteen years in order to understand that experience and to determine, as best we can, which methods were successful and which were not. Part I provides an overview of healthcare in the European Union, an overview of recent expenditure trends. Part II complements the first, examining in detail cost containment policies in each EU Member State. The country-based chapters refer to developments up to mid-1997.
... The European Parliament is calling on the Council and the Commission to ensure its full involvement in the implementation of the Kyoto Protocol. European hospitals (Mossialos and Le Grand, 2019;Johnson et al., 2020) have demonstrated that addressing this challenge requires a combination of adequate regulatory support (Prada et al., 2020) and collaboration among various entities to identify the best projects and share innovative ideas and technologies (Grillone et al., 2020). National experiences, especially in Italy, highlight several barriers to fully realizing energy efficiency potential. ...
This study investigates the integration of Artificial Intelligence (AI) to enhance energy efficiency in Italian hospitals, known for their high energy consumption due to continuous operations and stringent environmental controls. Using AI strategies from the Italian Ministry of Economic Development, the research focuses on optimizing hospital energy management. Analyzing data from 996 major hospitals (2016-2023) revealed an average annual energy consumption of 1,062 kTep. Key parameters were benchmarked against European standards, and MATLAB was utilized for hourly consumption analysis to identify inefficiencies. AI optimization, leveraging historical data, aids in predictive maintenance and reduces equipment downtime. The study underscores the complexities of managing energy in aging hospital infrastructures. Despite the critical need for energy efficiency, many opportunities have been missed due to prioritization of medical technologies and urgent structural repairs. AI offers a solution by enhancing energy management through data analysis, predictive maintenance, and real-time adjustments, leading to significant energy savings and operational improvements. Challenges include high initial investment for AI technology and training, technical integration issues, and variable energy consumption patterns. Nonetheless, the benefits of AI in improving energy efficiency and sustainability in hospitals are substantial, presenting a promising avenue for future research and investment. Strategic AI incorporation can significantly boost operational performance and sustainability, benefiting hospitals across Italy and beyond.
... Therefore, cost control and resource management should be considered in healthcare organizations under such circumstances. They need to consider budget/resource management such that the quality of healthcare services is not affected as their actions directly affect human health (14). Various budgeting methods have been addressed in many previous studies In global budgeting, a certain amount of budget is allocated to services offered to a given population for a certain time (usually one year). ...
Background
Budgeting is the process resource allocation to produce the best output according to the revenue levels involved. Among the constraints that healthcare organizations, including hospitals, both in the public and private sectors, grapple with is budgetary constraints. Therefore, cost control and resource management should be considered in healthcare organizations under such circumstances.
Methods
We aimed to identify methods of budgeting in healthcare systems and organizations as a systematic review. To extract and analyze the data, a form was designed by the researcher to define budgeting methods proposed in the literature and to identify their strengths, weaknesses, and dimensions. The search was conducted in Google Scholar, Web of science, Pub med and Scopus databases covering the period 1990–2022.
Results
Overall, 33 articles were included in the study for extraction and final analysis. The study results were reported in four main themes: healthcare system budgeting, capital budgeting, global budgeting, and performance-based budgeting.
Conclusion
Each budgeting approach has its own pros and cons and requires meeting certain requirements. These approaches are selected and implemented depending on each country’s infrastructure and conditions as well as its organizations. These infrastructures need to be thoroughly examined before implementing any budgeting method, and then a budgeting method should be selected accordingly.
... The European Parliament is calling on the Council and the Commission to ensure that the European Parliament is fully involved in the implementation of the Kyoto Protocol. The hospitals in Europe (Mossialos and Le Grand, 2019;Johnson et al., 2019) have evidenced that to withstand this challenge it is necessary to combine adequate normative support (Prada et al., 2020) the collaboration of various subjects, identifying the best projects and the sharing of ideas and cutting-edge technologies (Grillone et al., 2020;. National experiences, in particular Italian ones, confirm the presence of several barriers to the full implementation of energy efficiency potential and, in particular: a market where consumers and businesses still experience long return times, difficult access to investment capital and dispersion of measures, resulting in high transaction costs (Saint Akadiri et al., 2019;Pichler et al., 2019;Martino et al., 2019). ...
The paper aims to evaluate the possible sustainable management of energy, within the 1062 Italian hospitals. The hospital is the only public building that operates continuously throughout the year. It is a 24-hour facility. Although the theme has been treated in the literature, there is no empirical evidence concerning the same country of the European Union to the number of structures analyzed and energy consumption. Furthermore, Italy is a country heavily dependent on sources of energy supply. The methodological approach has been that of a joint evaluation both of organizational types that is energetic. In the discussion, possible solutions emerge, operational interventions, to make the energy management of hospitals, more efficient. The role of the energy manager and the presence of structures dedicated to energy management emerge as the main bottlenecks for achieving better energy efficiency
... The time elapsed between the patient presenting to the emergency department (ED) and reaching the allocated bed are system efficiency measure. 1 2 1 1 For over two centuries, policymakers have progressively tackled delay problems (such as bed availability, inside hospital transportation, nurse availability, and bed management system) before patients reach their assigned beds [4]. Supply and demand policies have been launched to address challenges caused by excessive waiting times [5]. Initiatives have been proposed based on urgency and management requirements for medium-or high-risk patients [4], or patient choice programs [6,7]. ...
Background
Shortening the patient experience time (PET) in the emergency department (ED) improves patient quality and satisfaction and reduces mortality and morbidity. Worldwide, the PET target in the ED is ≤ 6 hours; however, the PET awaiting admission to inpatient Medicine at Hamad General Hospital (HGH) in the Qatar State, through ED is currently 15.3±6.4 (mean ± SD) hours.
Aim
Identify solutions to reduce the PET duration at HGH-ED to the international target.
Method
A cohort study was done using the Discrete-event simulation (DES) model, utilizing a commercial simulation software package (Process Model Inc., Utah, version 5.2.0). One-year data, January 1, 2019 - December 30, 2019, was analyzed and found to follow seven subprocesses. The duration of each subprocess was recorded, and the average time was calculated. A computer simulation scheme was developed for all the subprocesses of the actual PET duration. The simulated PET was validated, and scenarios were proposed and assessed for each subprocess separately and in combination,
A constructed simulatory design using an iterative process involving a construction model. This model starts with the logical organization of submitted tasks based on their cycle times. A subject-matter expert interview was conducted to determine the appropriateness and frequency of actions. The duration of each activity in the considered process was defined using a triangular distribution.
Results
The actual PET duration for the Medical Department was 15.3±6.4 (mean + SD) hours. The three most prolonged PET subprocess durations were in the referral to internal medicine, the decision to admit, and finding a free bed; these represent 17.9%, 53.8%, and 16.7% of the PET, respectively. Adding two physicians to each shift, which shortens the subprocess of the decision to admit, reduced the PET duration by 27.5%. Moreover, creating a new admitting team (unit) that takes care of new patients admitted to the ED reduced PET duration by another 12.5%. Combining these two scenarios reduced the average PET duration to only 10.2±0.5 hours. In addition to these scenarios, the PET can be further decreased to six hours by increasing the number of inpatient beds.
Conclusions
The simulated scenarios indicated that restructuring the medical teams, adding two physicians to each shift, and creating an admissions team dedicated to the ED would reduce the total PET duration to 10.2 hours, Furthermore, PET's further reduction to six hours is predictable by increasing the bed number.
... Thus, we can conclude that, despite the high investments in healthcare made by the Spanish autonomous communities, their share of GDP is relatively low. As a consequence, although Spain has invested a lot of public money in healthcare, it is still insufficient to cover the needs of this sector [56,57], so more policies for increasing public spending on health are still required [58]. Thus, increasing public spending allows public hospitals to have greater flexibility when hiring additional staff [59] and to invest more in their infrastructures [60]. ...
The health systems of developed countries aim to reduce the mortality rates of their
populations. To this end, they must fight against the unhealthy habits of citizens, such as smoking,
excessive alcohol consumption, and sedentarism, since these result in a large number of deaths
each year. Our research aims to analyze whether an increase in health resources influences the
number of deaths caused by the unhealthy habits of the population. To achieve this objective, a
sample containing key indicators of the Spanish health system was analyzed using the partial least
squares structural equation modeling (PLS-SEM) method. The results show how increasing public
health spending and, thus, the resources allocated to healthcare can curb the adverse effects of the
population’s unhealthy habits. These results have important implications for theory and practice,
demonstrating the need for adequate investment in the healthcare system to reduce mortality among
the population.
... In current health policy parlance, incentives tend to be understood as narrowly economic in character, involving monetary benefits for behaviors that either improve or worsen the overall operating efficiency of health care organizations. This narrowly financial understanding is a relatively new phenomenon in health policy, reflecting the growing preoccupation in many Western European countries with expenditure restraints (Mossialos & LeGrand, 1999) and, not coincidentally, the increasing policy prominence of economists. ...
The desire of national policymakers to encourage entrepreneurial behavior in the health sector has generated not only a new structure of market-oriented incentives, but also a new regulatory role for the State. To ensure that entrepreneurial behavior will be directed toward achieving planned market objectives, the State must shift modalities from staid bureaucratic models of command-and-control to more sensitive and sophisticated systems of oversight and supervision. Available evidence suggests that this structural transformation is currently occurring in several Northern European countries. Successful implementation of that shift will require a new, intensive, and expensive strategy for human resources development, raising questions about the financial feasibility of this incentives-plus-regulation model for less-well-off CEE/CIS and developing countries.
Background and Objective: The explosion of new digital technologies is fundamentally disrupting the world as it has been perceived until now, transforming it multilevel and at an unprecedented speed. At the same time, with traditional way of providing health services, their quality and scale cannot meet user’s needs and expectations. Within this context of constant search for improved quality, the path of health services towards a digital and value-based transformation is now a one-way street, with drastic and immediate effects that are capable of disrupting the sector and making them sustainable. The most defining issue is how an organization adapts its organizational culture, strategy, leadership and mostly prepare the stuff to operate effectively in a digital world, adding value to users and sustaining prosperity. The main goal of this study was to investigate the perceptions of health professionals regarding the usability and ease of use of digital transformation applications. Material and Methods: To investigate the aim of the study, the USE Questionnaire was used. It was distributed completely paperless, exclusively through Google forms. For better common understanding, we edited an auxiliary video and embedded it in the Google form, to be watched before starting answering it. Our sample was healthcare professionals who worked in various Hospitals and health providers in Northern Greece. Results: Age appears to have a greater influence on health professional self-efficacy. Regardless of specialty, they show positive perceptions of both the usefulness and ease of use and learning of digital applications. Those with a lower level of education showed a higher perceived ease of use and learning, as well as their usefulness than expected. Conclusion: The acceptance of digital transformation in healthcare professionals is based on understanding the concerns and feelings of insecurity that overwhelm healthcare professionals. Our findings can help us in better understanding the factors that influence their adoption of new digital technologies. Likely, this will help us to reduce the time required to make all the structural changes that are necessary, but also to guide us properly for the best use of our already limited available resources. As people accept change at different rates, there is no time for delay and their preparation should begin immediately.
The chapter explores the transformations of the Italian hospital system in the period 1968–2018. Focusing on how the changing institutional framework has affected hospitals strategies and management, it aims to analyze the complexities of a system based on the coexistence/competition of public and private healthcare providers. To overcome the inefficiencies and inequalities generated by the great fragmentation inherited from the past, the reforms of the 1960s and 1970s set up a process of modernization and standardization which led to the establishment of the National Health Service (1978). However, in the 1990s a radical reform changed the system again, promoting a process of corporatization, regionalization, and liberalization, and designing a competitive framework for both public and private hospitals. In the twenty-first century, in a context marked by cuts in public health spending and major demographic and social changes, the Italian health system presents a relevant growth of private providers and a visible fragmentation at a regional level.
It must have been early 2000, around the start of the new Millennium. I was working as a junior lecturer/researcher at the then Institute for Health Care Policy and Management at Erasmus University in Rotterdam, the Netherlands. Still barely familiar with Dutch health care as a policy system, let alone with European health care policy systems I decided that it would be a good idea to attend a seminar of the recently established European Health Policy Group. I had heard good stories about this new multidisciplinary group, founded by Elias Mossialos and Adam Oliver. My PhD thesis supervisor, Tom van der Grinten, also went there, as did some of my colleagues from the Department of Health Economics and Health Insurance, people like Erik Schut and Wynand van de Ven for example. They were close colleagues of me, although our respective disciplines from which we studied health care policy were different.
Background:
Hospitals have a vital role in the future of health systems with upcoming structure, resources, and process changes. Identifying the potential aspects of change helps managers proactively approach them, use the opportunities, and avoid threats. This study presents a mind map of future changes in Iranian hospitals to develop a base for further related studies or prepare evidence for interventions and future-related decisions.
Methods:
This study is a qualitative-exploratory one, conducted in two phases. In the first phase, in-depth and semi-structured interviews were conducted to identify future hospital changes over 15 years. The interviews were analyzed using the content analysis method and MAXQDA 2018 software and holding two expert panels to develop the mind map using the 2016 Visio software.
Results:
In the first phase, 33 interviews led to 144 change patterns. In the second phase, a mind map of changes was drawn according to experts' opinions with ten categories: structure and role, knowledge management and research, service delivery, health forces, political and legal, economic, demographic and disease, technological, and values and philosophy, and environmental.
Conclusions:
Many changes affecting hospitals rooted in the past continue to the future, but the point is the increasing intensity and speed of changes. Healthcare systems need a systematic approach to monitoring the environment to be updated, agile and proactive. These monitoring systems are essential in providing evidence for Macro-level decision-makers.
This study aimed to evaluate manufacturers’ perceptions of the decision-making process for new drug reimbursement and to formulate implications in operating a health technology assessment system. In 2019, we conducted a questionnaire survey and a semistructured group interview for domestic ( n = 6) and foreign manufacturers ( n = 9) who had vast experience in introducing new medicines into the market through a health technology assessment. Representatives of manufacturers indicated that disease severity, budget impact, existence of alternative treatment, and health-related quality of life were relevant criteria when assessing reimbursement decisions. Compared with domestic manufacturers, foreign manufacturers were risk takers when making reimbursement decisions in terms of adopting a new drug and managing pharmaceutical expenditure. However, foreign manufacturers were risk-averse when evaluating new drugs with uncertainties based on real-world data such as clinical effectiveness. Based on manufacturers’ perceptions of the decision-making process for new drug reimbursement, there is room for improvement in health technology assessment systems. Explaining the underlying reasons behind their decisions, unbiased participation by various stakeholders and their embedded roles in the decision-making process need to be emphasized. However, the measures suggested in this study should be introduced with cautions. The process of health technology assessment might be a target for those who undermine the system in pursuit of their private interests.
Objectives: This study aimed to systematically review the literature on the Iranian healthcare system in the time of increasing privatization. Methods: A systematic literature review was conducted using MEDLINE, CINAHL, APA PschInfo, and Cochrane databases to identify various concepts in the literature concerning the privatization of healthcare in Iran between September and November 2020. All the included articles were assessed using the John Hopkins Nursing Evidence-Based Practice Research tool. In addition, grey literature was searched using Google targeted at academic websites and key organizations and online newspapers and magazines in the Persian language. This screening resulted in a total of 70 articles, reports, and documents. The PRISMA guidelines were followed for abstracting data and assessing the quality of the studies. Results: Six health-related items were identified at the time of increased privatization in the healthcare system. These items consisted of medical establishments, accessibility, and privatization, catastrophic health expenditure (CHE), out-of-pocket payment (OOP), health inequality, privatization, and healthcare providers, and the policy and finance of privatization. Conclusions: The review identified that the process of privatization of the healthcare system in Iran occurred with poor monitoring and evaluation mechanisms. Privatization rested on neoliberal arguments, and for-profit care has worsened healthcare performance and created an unfair, expensive healthcare system of lower quality in Iran.
Aim:
This study aimed to identify models for the participation of the city council and municipality with the health system in selected countries.
Subjects and methods:
This is a descriptive comparative study conducted in 2020 qualitatively. The countries studied were examined in terms of the following characteristics: type of political structure, type of health system, level of cooperation between local government and health system, municipal financing, type of financial participation of local government and health system, method or institution for participation Created, level of participation, local government influence on health system decisions, advantages and disadvantages of a partnership between local government and health system. Data were collected through valid databases (PubMed, Scopus, Embase, and Google Search engine) and website of the World Health Organization, local government, and the Ministry of Health of countries concerned and analyzed in a framework of analysis.
Results:
Countries were divided into two groups in terms of a partnership between the health system and local governments, which had a distinct partnership between the health system and local government and without their participation. Factors that contribute to the creating and strengthening of partnerships include beliefs of health authorities and local government, the need for participation, transparency in participatory programs, designing a specific mechanism for participation, local authority, and financing joint participation plans.
Conclusion:
In countries with planned participation, citizens have better access to services. Citizens' participation, as well as the private sector, is greater in health issues. In these countries, participation in health financing by the private sector and other related agencies has increased. Planning and service delivery increases according to neighborhood needs. The variety of services provided and the use of new methods of service are more, and in these countries, the focus of the Ministry of Health on the preparation of strategies and monitoring the quality of services is increasing.
Purpose
In the thumb carpometacarpal (CMC) joint osteoarthritis (OA) literature, there is substantial heterogeneity in outcome and outcome measure reporting. This could be rectified by a standardized core outcome set (COS). This study aimed to identify a comprehensive list of outcomes and outcome measures for thumb CMC joint OA, which represents the first step in developing a COS.
Methods
A computerized search of MEDLINE, EMBASE, Cochrane, and CINAHL was performed to identify randomized controlled trials, as well as observational studies involving at least 50 participants aged greater than 18 years undergoing surgery for thumb CMC joint OA. Reported outcomes and outcome measures were extracted from these trials and summarized.
Results
This search yielded 3,498 unique articles, 97 of which were used for analysis. A total of 33 unique outcomes and 25 unique outcome measures were identified. The most frequently used outcomes were complications (78), postoperative pain (73), radiologic outcomes (64), and grip strength (63). Within each reported outcome, there was substantial variation in how the outcome was measured. Of the 25 unique outcome measures, 10 were validated. Of the remaining 15, 12 were created ad hoc by the author. The Disabilities of the Arm, Shoulder, and Hand questionnaire was the most commonly reported outcome measure (34%).
Conclusions
There is a lack of consensus on critical outcomes after surgery for thumb CMC joint OA. A standardized COS created by stakeholder consensus would improve the consistency and therefore the quality of future research.
Clinical relevance
This systematic review of outcomes represents the first step in developing a core outcome set for thumb CMC joint OA.
Purpose:
The persistent challenges that healthcare organizations face as they strive to keep patients safe attests to a need for continued attention. To contribute to better understanding the issues currently defying patient safety initiatives, this paper reports on a study examining the aftermath of implementing a national team training program in two hospital units in France.
Design/methodology/approach:
Data were drawn from a longitudinal qualitative study analyzing the implementation of a French patient safety program aimed at improving teamwork in hospitals. Data collection took place over a four-year period (2015-2019) in two urban hospitals in France and included multiple interviews with 31 participants and 150 h of observations.
Findings:
Despite explicit efforts to improve inter-professional teamwork, three main obstacles interfered with healthcare professionals' attempts at safeguarding patients: perspectival variations in what constituted "patient safety", a paradoxical injunction to do more with less and conflicting organizational priorities.
Originality/value:
This paper exposes patient safety as misleadingly consensual and identifies a lack of alignment between stakeholders in the complex system that is a hospital. This ultimately interferes with patient safety objectives and highlights that even well-equipped, frontline actors cannot achieve long-term results without more systemic organizational changes.
In several instances, third-party payers negotiate prices of health care services with providers. We show that a third-party payer may prefer to deal with a professional association than with the sub-set constituted by the more efficient providers, and then apply the same price to all providers. The reason for this is the increase in the bargaining position of providers. The more efficient providers are also the ones with higher profits in the event of negotiation failure. This allows them to extract a higher surplus from the third-party payer.
Proposals for government decentralization rank high on the political reform agenda of health systems worldwide. Their impact on welfare state performance and change, however, is still under theoretical scrutiny. This article examines the impact of devolution on the construction of the Spanish National Health Service (NHS) in an attempt to shed some light on this debate. Against widespread claims of path dependency, we argue that the specific nature of the devolution model developed in Spain, given the more egalitarian sociopolitical structure that resulted from democratization, fostered policy innovation and institutional change. Consolidation of an NHS system was compatible with some regional diversity and apparently prevented the rise of significant territorial inequalities. The Spanish case also suggests that policy change depends more on the distribution of social power than on institutions. It underlines the key role of financial and knowledge transfers vis-à-vis institutional reforms in effecting social change as well as the potential for state intervention in supporting the development of collective action resources by social groups.
The Federal Trade Commission and Department of Justice 2004 report Improving Health Care: A Dose of Competition expresses a clear allegiance to competition as the organizing principle for health care. In Europe, by contrast, the key organizing principle of health care systems is solidarity. Solidarity means that all have access to health care based on medical needs, regardless of ability to pay. This is not to say that competition is not important in Europe, but competition must take place within the context of solidarity. This article critiques the report from a European perspective, describes the role of competition in Europe (focusing in particular on European Union law), and suggests that the United States could learn from the European perspective.
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