“Informed choice” in a time of too much medicine—no panacea for ethical difficulties

Providing information to enable informed choices about healthcare sounds immediately appealing to most of us. But Minna Johansson and colleagues argue that preventive medicine and expanding disease definitions have changed the ethical premises of informed choice and our good intentions may inadvertently advance overmedicalisation

The idea of informed patients who make reasoned decisions about their treatment based on personal preferences is appealing in a Western cultural context, with its focus on the autonomous individual. Rightly, many doctors now reject paternalism if the patient does not specifically ask for it. They prefer to elicit the patient’s preferences and embrace an ...

Understanding pressures in general practice

“General practice is in crisis”; that is how this King’s Fund report start its analysis, pointing to funding and workforce as two of the main problems in general practice situation. Increasing needs and complexity, trends of moving patients from hospital to communities and rising expectations in population act as factors that increase pressures in general practice.

This report identifies some immediate priorities and some future challenges in order to protect general practice and to make it can face future needs.

Immediate priorities would be: (I) providing practical support to practices, (II) accelerating the uptake of technologies that can help ...

Reshaping the workforce to deliver the care patients need

Workforce structure is one of the most difficult things to modulate in health systems. Current transition to new models of care could be a good opportunity to make workforce structure match actual needs of systems and populations. In this report, published by the Nuffield Trust, it is analyzed how organizations could reshape their current workforce and what the benefits would be:

There is a need to evolve from an illness-based system to a patient-centred system.
Workforce should meet future needs by incorporating professionals with a vision aligned with future models of care.
There are opportunities to develop the current workforce ...

Developing care for a changing population: Learning from GP-led organisations

The way a health system is organized may influence the care this system provides. In this Nuffield Trust report some GP-led experiences are described, analyzing what are the internal characteristics and external context that have affected GP-led progress.

The intra-organizational characteristics listed are: (I) strong links between clinical leaders and GP member practices, (II) sophisticated strategic and operational management support, (III) use of multiple forms of peer-led improvement, (IV) organizations are both entrepeneurial and pragmatic, (V) linked data between the organization’s own services and other providers.

In what concerns to external context, the three characteristics listed are: (I) a ...

Developing care for a changing population: Supporting patients with costly, complex needs

Patients with multiple chronic conditions are a challenge for health care organization. In this report, it is offered a review of the most recent evidence regarding new models of care, and they are summarized in 10 points: (I) There are no specific ‘European’ answers to the problem of high cost/complexity, but a growing body of policy-relevant evidence is emerging, (II) Multifaceted interventions seem to work best for complex problems , (III) Identifying who is at risk of complexity is a crucial first step , (IV) The needs of patients identified as ‘complex’ are likely to vary considerably , (V) Good outcomes for ...

Integrating health care and housing to promote healthy aging.

In recent decades, the influence between health status and social conditions has been broadly studied; one of the conditions that has been strongly linked to health status has been housing.

Population ageing and the increase of chronic conditions are two of the drivers that have made that housing conditions become an important factor influencing health.

Many different proposals have been made regarding home care, most of them trying to take hospital care to patient’s home; in this post, some different aspects are discussed, mainly related to what Medicare could do in order to improve housing conditions and its influence ...

Exploring payment schemes used to promote integrated chronic care in Europe

The rising burden of chronic conditions has led several European countries to reform healthcare payment schemes. This paper aimed to explore the adoption and success of payment schemes that promote integration of chronic care in European countries. A literature review was used to identify European countries that employed pay-for-coordination (PFC), pay-for-performance (PFP), and bundled payment schemes. Existing evidence from the literature was supplemented with fifteen interviews with chronic care experts in these countries to obtain detailed information regarding the payment schemes, facilitators and barriers to their implementation, and their perceived success.

Austria, France, England, the Netherlands, and Germany have implemented ...

State humanitarian verticalism versus universal health coverage: a century of French international health assistance revisited

The French contribution to global public health over the past two centuries has been marked by a fundamental tension between two approaches: State-provided universal free health care and what we propose to call State humanitarian verticalism. Both approaches have historical roots in French colonialism and have led to successes and failures that continue until the present day. In this paper, the second in The Lancet's Series on France, we look at how this tension has evolved. During the French colonial period (1890s to 1950s), the Indigenous Medical Assistance structure was supposed to bring metropolitan France's model of universal ...

Consolidating the social health insurance schemes in China: towards an equitable and efficient health system

Fragmentation in social health insurance schemes is an important factor for inequitable access to health care and financial protection for people covered by different health insurance schemes in China. To fulfil its commitment of universal health coverage by 2020, the Chinese Government needs to prioritise addressing this issue. After analysing the situation of fragmentation, this Review summarises efforts to consolidate health insurance schemes both in China and internationally. Rural migrants, elderly people, and those with non-communicable diseases in China will greatly benefit from consolidation of the existing health insurance schemes with extended funding pools, thereby narrowing the disparities among health ...

Presentation on the European Framework for Action on Integrated Health Services Delivery