Unintended consequences of expenditure targets on resource allocation in health systems

Noto, Guido; Belardi, Paolo; Vainieri, Milena

doi:10.1016/j.healthpol.2020.01.012

Cited by 10 publications

(9 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since the early 1990s, a strong decentralization policy has been adopted, leading to the devolution of power to a lower governance level that is currently exercised in 21 regional health systems. Starting from 2015, all regions have been affected by the cutback initiative imposing to implement a gradual, phased reduction of the regional costs of personnel to be achieved before the end of 2020, even for the regional systems that manage to achieve a non-negative economic result [4]. Such a centrally-imposed manoeuvre has crystallized gaps in service provision and health system performance between regions.…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 Outbreak on Healthcare Workers in Italy: Results from a National E-Survey

et al. 2020

View full text Add to dashboard Cite

Italy has been the first-hit European country to face the outbreak of coronavirus disease 2019 (COVID-19). Aim of this survey was to assess in depth the impact of the outbreak on healthcare workers (HCW). A 40-item online survey was disseminated via social media inviting Italian HCW, with questions exploring demographics, health status and work environment of respondents. A total of 527 were invited to take part in March 2020, of whom 74% (n = 388) responded to the survey. Of these, 235 (61%) were women. HCW were mostly physicians (74%), from high-prevalence regions (52%). 25% experienced typical symptoms during the last 14 days prior to survey completion, with only 45% of them being tested for COVID-19. Among the tested population, 18 (18%) resulted positive for COVID-19, with 33% being asymptomatic. Only 22% of HCW considered personal protective equipment adequate for quality and quantity. Females and respondents working in high-risk sectors were more likely to rate psychological support as useful (OR, 1.78 [CI 95% 1.14-2.78] P = 0.012, and 2.02 [1.12-3.65] P = 0.020, respectively) and workload as increased (mean increase, 0.38 [0.06-0.69] P = 0.018; and 0.54 [0.16-0.92] P = 0.005, respectively). The insights from this survey may help authorities in countries where COVID-19 epidemic has not yet broken out. Management strategies should be promptly undertaken in order to enhance safety and optimise resource allocation.

show abstract

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 Outbreak on Healthcare Workers in Italy: Results from a National E-Survey

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Over the last two decades the Italian SSN has experienced continuous financial cuts, which while guaranteeing financial sustainability, might have led to a number of negative and unintended effects. A cap to personnel costs in 2004, for example, led to a depletion of health care professionals' competencies (Noto et al ., 2020). The 2007 bail-out plans in some regions resulted in the downsizing of hospital capacity, block of staff turnover and new co-payments on pharmaceutical expenditure (Bordignon and Turati, 2009; Piacenza and Turati, 2014).…”

Section: Overview Of the Italian Ssnmentioning

confidence: 99%

Response to COVID-19: was Italy (un)prepared?

Bosa

Castelli

et al. 2021

HEPL

Self Cite

View full text Add to dashboard Cite

On 31st January 2020, the Italian cabinet declared a 6-month national emergency after the detection of the first two COVID-19 positive cases in Rome, two Chinese tourists travelling from Wuhan. Between then and the total lockdown introduced on 22nd March 2020 Italy was hit by an unprecedented crisis. In addition to being the first European country to be heavily swept by the COVID-19 pandemic, Italy was the first to introduce stringent lockdown measures. The SARS-CoV-2 outbreak and related COVID-19 pandemic have been the worst public health challenge endured in recent history by Italy. Two months since the beginning of the first wave, the estimated excess deaths in Lombardy, the hardest hit region in the country, reached a peak of more than 23,000 deaths. The extraordinary pressures exerted on the Italian Servizio Sanitario Nazionale (SSN) inevitably leads to questions about its preparedness and the appropriateness and effectiveness of responses implemented at both national and regional levels. The aim of the paper is to critically review the Italian response to the COVID-19 crisis spanning from the first early acute phases of the emergency (March–May 2020) to the relative stability of the epidemiological situation just before the second outbreak in October 2020.

show abstract

“…Although increased health resources might improve patient's reported outcomes, this is not always the case (4,5). This discrepancy might be explained by unjustified variations in care between patients (i.e., either through excessive or insufficient use of resources), adoption of new and expensive technologies without meaningful clinical impact, and the exclusion of patient's values and expectancies (1,(6)(7)(8). Under this scenario, a value-based paradigm might identify meaningful approaches that improve efficiency, patient satisfaction, and equity in healthcare (1,2).…”

Section: Introductionmentioning

confidence: 99%

Value in oncology from multi-criteria decision analysis: A systematic review

et al. 2021

View full text Add to dashboard Cite

Objective: This study aims for three purposes: a) review the published MCDAs in oncology to identify the criteria considered valuable by the stakeholders, b) evaluate the adherence to best practice recommendations, and c) Propose a value tree, based on the findings of the systematic review, reflecting the most important criteria for the different stakeholders. Material and Methods: This systematic review consisted of the following phases: identification, screening, eligibility assessment, assessment of adherence to best practices, and extraction of the information. The identification was conducted in PUBMED, EMBASE, EBSCO, SCIENCE DIRECT, SCOPUS, LILACS, and Web of Science including records from January 1st, 1990, to February 28th, 2021. The adherence to best practices in MCDA were evaluated. A new value tree was made. Results: Thirteen articles were included. Colon, breast, and hematological cancer were the most frequently evaluated (n=10, 69,2%). Physicians and patients were the most representative participants. The value measurement approach was the most used (n=11, 84,6%). The overall adherence rate to the recommendations was 77,3%. One hundred ninety-five criteria were identified. The relevant criteria for all stakeholders were “Improvement clinical efficacy" (24,5%), "Severity of disease" (13,5%), and "Improvement of safety & tolerability." (10,3%). The physicians valued "Improvement clinical efficacy" (28,4%), "Severity of disease" (10,5%), and "Improvement of safety & tolerability." (8,4%) The most relevant criterion for the patients was "Severity of disease" (34,4%), "Improvement of clinical efficacy." (24,1%), and "Improvement of perceived health status" (13,8%). The significant criteria for administrative and academics were "Innovativeness of intervention" (37%) and "Improvement clinical efficacy" (14,8%). Conclusion: The number of MCDAs in oncology is scarce and with moderate adherence to best practice recommendations. A value tree based on relevant criteria was proposed.

show abstract

Unintended consequences of expenditure targets on resource allocation in health systems

Cited by 10 publications

References 35 publications

Impact of COVID-19 Outbreak on Healthcare Workers in Italy: Results from a National E-Survey

Impact of COVID-19 Outbreak on Healthcare Workers in Italy: Results from a National E-Survey

Response to COVID-19: was Italy (un)prepared?

Value in oncology from multi-criteria decision analysis: A systematic review

Contact Info

Product

Resources

About