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Aim: This paper highlights the difficulties and lacunae in the Mental Health Care Act 2017 that hinder its implementation and use for the care and treatment of persons with mental illness in India. Methods: An online nationwide survey, involving structured questions as well as open-ended questions, to elicit the level of implementation, experience in complying with the provisions of the Act, and level of satisfaction, of practicing psychiatrists was carried out. Responses were analyzed using appropriate statistics. Results: 600 respondents answered the online questionnaire. A majority of psychiatrists were senior practitioners with over 10 years of experience. 92.5% respondents were dissatisfied with the MHCA, wherein 73.3% wanted it amended, and 19.2% asked for repeal. Procedural issues were deterrent for 66.5% from taking medically necessary or helpful decisions for patients. Non-implementation of the Act was a major finding. Major dissatisfaction was expressed regarding judicial over reach in admission and discharge procedures, inclusion of general hospital psychiatry units in the definition of mental health establishment, non-applicability of provisions like advance directive and nominated representative in Indian setting, and that all treatment should be covered under insurance. Conclusion: The Act in its present form defies the spirit of its own objectives and is unimplementable. It needs major revisions. [ABSTRACT FROM AUTHOR]

While we have the tools to achieve this goal, the persistent barriers to healthcare services experienced by too many individuals will need to be addressed to make significant progress and improve the health and quality of life of all people with human immunodeficiency virus (HIV). The necessary structural changes require actions by federal, state, and local policymakers and range from ensuring universal access to healthcare services to optimizing care delivery to ensuring a robust and diverse infectious diseases and HIV workforce. In this article, we outlines 10 key principles for policy reforms that, if advanced, would make ending the HIV epidemic in the United States possible and could have much more far-reaching effects in improving the health of our nation. [ABSTRACT FROM AUTHOR]

Globally, the nursing profession constitutes the largest proportion of the health workforce; however, it is challenged by widespread workforce shortages relative to need. Strategies to promote recruitment of the nursing workforce are well-established, with a lesser focus on strategies to alleviate the burden on the existing workforce. This burden may be exacerbated by the impact of low-value health care, characterised as health care that provides little or no benefit for patients, or has the potential to cause harm. Low-value health care is a global problem, a major contributor to the waste of healthcare resources, and a key focus of health system reform. Evidence of variation in low-value health care has been identified across countries and system levels. Research on low-value health care has largely focused on the medical profession, with a paucity of research examining either low-value health care or the de-implementation of low-value health care from a nursing perspective. The objective of this paper is to provide a scholarly discussion of the literature around low-value health care and de-implementation, with the purpose of identifying implications for nursing research. With increasing pressures on the global nursing workforce, research identifying low-value health care and developing approaches to de-implement this care, is crucial. [ABSTRACT FROM AUTHOR]

An editorial is presented the importance of health as a central policy issue in the 2024 US election and the need for rigorous research to inform health care and public health policies. Topics include various health-related challenges, such as health disparities, immigration policies, LGBTQ rights, firearm regulations, and the impact of the economy on mental health and access to essential needs.

The process of deinstitutionalisation gained momentum in the late 20th century, driven by disability rights movements and increased awareness of the harms of institutionalisation. This paper provides an overview of deinstitutionalisation in South Korea, focusing on the transformation of large disability residential facilities since the 1970s, with efforts towards promoting independent living. Current debates highlight conflicting perspectives among stakeholders. Advocates, primarily disabled individuals, support accelerated deinstitutionalisation for its benefits in autonomy, social integration, and improved quality of life. However, oppositions from families and service providers express concerns about care gaps and the need for specialized support for people with higher support needs. The paper underscores the importance of establishing a consensus on deinstitutionalisation objectives and proposes multidimensional alternatives, including legislative reforms, expanded community services, and improved facilities. Fostering social agreement is identified as pivotal for successful deinstitutionalisation and the well-being of disabled individuals. [ABSTRACT FROM AUTHOR]

Introduction: Allied health has a valuable role in providing services to people living in residential aged care. The recent Royal Commission into Aged Care Quality and Safety included several important recommendations relating to the nursing, personal care, and allied health workforce and the care that they provide. The purpose of this paper is to review these recommendations and the Australian Government's policy responses and explore the emerging changes in allied health service provision in residential aged care. Methods: Data from the four available Quarterly Financial Reports from the 2022–2023 financial year were extracted and analysed in relation to staff costs and time per person per day across personal care, nursing, and allied health workers. Supplementary data sources including the 2020 Aged Care Workforce Census were accessed to provide contextual data relating to individual allied health professions, including occupational therapy. Results: The analysis shows a modest increase in median registered nurse minutes per person per day, and cost per person per day, from the first to second quarter, and again in the third and fourth. By contrast, median time and cost for allied health declined. From 5.6 minutes per person per day in the first quarter, reported allied health minutes fell to 4.6 minutes per person per day in the second quarter, an 18% decrease, and by the fourth quarter was 4.3 minutes per person per day. This is just over half the Australian average of 8 minutes reported to the RCACQS in 2019. Conclusion: Under recent residential aged care reforms, aged care providers have regulatory incentives to concentrate their financial resources on meeting the mandated care hours for registered nurses, enrolled nurses, personal care workers, and assistants in nursing. These same reforms do not mandate minutes of allied health services. Although providers of residential aged care in Australia continue to employ and value allied health, we argue that mandating care minutes for personal and nursing care without mandating the provision of allied health creates a perverse incentive whereby access to allied health services is unintentionally reduced. PLAIN LANGUAGE SUMMARY: Allied health has a valuable role in providing services to people living in residential aged care. The recent Royal Commission into Aged Care Quality and Safety included several important recommendations relating to the nursing, personal care, and allied health workforce and the care that they provide. In this paper, we argue that despite the positive intentions of some of the reforms following the Royal Commission, there have been unintended consequences that have reduced the spending on allied health in residential aged care and reduced the minutes residents receive of allied health. Consideration to mandating allied health care minutes in residential aged care should be considered. [ABSTRACT FROM AUTHOR]

Research on families with disabled children has highlighted how such families experience frustration in their encounters with health and welfare services. However, less attention has been given to how these encounters are linked to social class. This article explores whether levels of cultural capital and family resources influence communication with professionals among parents of disabled children. To this end, I draw upon a longitudinal qualitative dataset of fieldwork and interview data from families in Norway. The findings show that middle-class parents could utilize experts, keep communication smooth, and persist in trying to secure services for their children without any real sense of achievement to a higher degree than working-class parents. However, neither working-class nor middle-class parents thrived in navigating these bureaucracies. This study has clear implications for policy and professionals in acknowledging how levels of cultural capital and other family resources influence the ability to endure and navigate welfare institutions. Points of interest: To understand the situation of families with disabled children it is important to find out under which circumstances these families try to obtain public services for their children. The paper examines the significance of social class on how parents with disabled children manage welfare services for their children in Norway. The research uses interviews with parents and practitioners and observation of meetings. All parents fight for services for their children and find it frustrating. Working-class and middle-class parents differ in how they communicate with professionals and how they deal with frustration. [ABSTRACT FROM AUTHOR]

Whether charitable fundraising might play a part in funding Britain's ostensibly tax‐funded NHS has been a longstanding dilemma, which until recently has received only occasional scholarly attention. In 1946, Aneurin Bevan argued that one of the main goals of the reformed health care system was to liberate health care from the 'caprice of private charity'. Seven decades later, NHS Charities Together's Urgent Covid‐19 Appeal became a powerful societal rallying cry in the health emergency of the pandemic and raised £150 million in the process. This paper draws together findings from new archival research, a witness seminar with key actors in the NHS charity sector, and qualitative research based on interviews with NHS charity staff and trustees (N = 13), all conducted between 2021 and 2023. We investigate the way in which national appeals have been proposed, debated and implemented at different times in the NHS's history. We trace the recurrence of conflicting ideas about the acceptability of national fundraising for the NHS, about whether public loyalties are to their local services or the national 'brand' and about the introduction of national appeals into a complex ecology of local NHS charities. The history of charitable fundraising for the NHS is, we argue, neither a simple story of spontaneous public generosity, nor often of formal policy reform, but is an artefact of more complex dynamics between a changing cast of local and national actors over the last 75 years. [ABSTRACT FROM AUTHOR]

With the aging population, the financial burdens associated with chronic diseases continue to escalate. Among various management strategies, family physician contracting stands out as a significant initiative aimed at addressing this challenge, officially introduced in China in 2016. However, current research has given relatively little attention to the economic benefits of family physician contracting in developing countries. This paper evaluates the economic effect of family physician contracting by employing microdata of patients with chronic diseases at the Yuyuantan Community Health Service Center, Haidian District, Beijing, from January 2019 to May 2021. This research contributes to the theoretical discourse in healthcare services by introducing a modified Anderson model. The empirical findings demonstrated that family physician contracting effectively reduced healthcare costs for patients with chronic diseases. Notably, the effect of family physician contracting on healthcare costs was more pronounced among patients with chronic diseases aged less than 65 years. At the same time, it is inferred that expediting the reform of the health insurance payment system, coupled with the promotion of family physician contracting services, would enhance the wellbeing of patients with chronic diseases. This research offers valuable insights into the ongoing and future development of family physician contracting in developing countries. [ABSTRACT FROM AUTHOR]

Introduction: The Activating Lived Experience Leadership (ALEL) project was a South Australian participatory action research project that aimed to improve the ways lived experience is recognised, valued and integrated across mental health and social sector systems. ALEL was completed during 2019–2021, where it engaged 182 participants in generating community action and research knowledge. Objective: Our paper discusses the project's processes of building a collective partnership among lived experience leaders and other leaders from within the sector, so that the actions and strategies identified through research could be implemented by systems‐level impact. We describe the collaborative process and key learnings that resulted in eight key action areas for transformative systems change in South Australia. Methods: The project invited a diverse range of self‐identified lived experience and other leaders to be involved in a PAR process featuring formal qualitative research (focus groups, surveys and interviews) as well as community development activities (leaders' summit meetings, consultations, training and community of practice meetings). These processes were used to help us describe the purpose, achievements and potential of lived experience leadership. Project priorities and systems‐level analysis was also undertaken with lived experience sector leaders and project advisors across two leaders' summit meetings, integrating research outcomes with sector planning to define high‐level actions and a vision for transformational change. Results: Participatory action research as informed by systems change and collective impact strategies assisted the project to generate detailed findings about the experiences and complexities of lived experience leadership, and collective responses of how systems could better support, be accountable to and leverage lived experience perspectives, experience and peer‐work approaches. Conclusion: Systems change to define, value and embed lived experience leadership benefits from collective efforts in both formal research and sector development activities. These can be used to generate foundational understandings and guidance for working together in genuine ways for transforming mental health and social sector systems, experience and outcomes. Public Contribution: Members of lived experience communities codesigned the project, and contributed to project governance and the development of all findings and project reports. [ABSTRACT FROM AUTHOR]

The Special Issue on Digital Health commemorates the 40th Anniversary of the Takemi Program in International Health at Harvard University, examining the potential and obstacles of digital health. The articles investigate the influence of digital technologies on health systems worldwide, with a specific focus on low- and middle-income countries. Various topics are explored, such as internet-based health information access, digitally supported health workers, healthcare delivery at home, transportation and logistics management innovations, and utilizing data to enhance health system performance. The papers present detailed case studies, evaluations, and frameworks for comprehending and planning digital health interventions, including studies on chronic disease management in rural South Korea, addressing gender-based violence in rural Nigeria, analyzing the Maharashtra ambulance service in India, and discussing digital transformation in the health product supply chain. Additionally, the text examines the role of digital health within Taiwan's national health insurance system and the utilization of digital health data for Palestine refugees, shedding light on the readiness, obstacles, and possibilities for integrating digital technology into healthcare systems across diverse regions. [Extracted from the article]

Objective: To assess whether prostate biopsy rates have altered with the July 2018 change in Australian Medicare Benefits Schedule (MBS) rebates supporting multiparametric magnetic resonance imaging (mpMRI) for diagnosing prostate cancer. Methods: Biopsy data (both trans-rectal and trans-perineal) were obtained from the Victorian Agency for Health Information from July 2016 to June 2022. The data were stratified by financial year, age group and hospital type (public vs private). Comparison was made between rates pre and post the mpMRI MBS code change. Results: There was an 11.9% increase in the number of biopsies performed per year compared to the pre-MBS change period. There is a significant decreasing trend (P < 0.001–4) in number of biopsies in the 40–49, 50–59 and 60–69-year-old age groups with a significant increasing trend (P < 0.001) in the 70–79 and 80–89-year-old age groups. There was a 32.9% reduction in the mean number of biopsies performed per year in public hospitals, compared with an 18.3% increase in private. Conclusion: Contrary to expectations, and proposed funding, there has been an increase in the number of prostate biopsies since MRI became more easily available. This change will put increased pressure on the health budget and the large increase in biopsies in elderly patients was not anticipated when the changes were proposed. A review of the criteria is suggested. What is known about the topic? Multiparametric magnetic resonance imaging (mpMRI) is increasingly used in the diagnosis of prostate cancer. In 2018, it was included in the Medicare Benefits Schedule with the expectation that the number of prostate biopsies performed would decrease. What does this paper add? By 2022, biopsies increased nearly 12% with over a 50% increase in the 80–89 age group – those least likely to benefit from curative treatment. What are the implications for practitioners? The criteria for funding mpMRI and the performance of prostate biopsies should be altered to enable better use of resources. [ABSTRACT FROM AUTHOR]

The objective of this paper is to identify the main challenges and opportunities for the training of public health professionals to strengthen the public health system and implement a new health care model in Mexico. This article describes how the reform of the public health system in Mexico poses challenges and opportunities for the training of health professionals. The use of new approaches in public health education is discussed, using as an example the implementation of a competencybased constructivist approach at the School of Public Health of Mexico/National Institute of Public Health (ESPM/INSP, in Spanish). The implementation of a new public health system in Mexico requires essential and specific competencies among the health professionals. The development of innovative models in education will allow progress in the training of public health professionals. To obtain the necessary skills for the implementation of this new model, it will be necessary to increase the relationship between research and teaching, use trans and multidisciplinary approaches, seeking a greater emphasis on practice and a reduction in schooling in educational programs. It will also be important to consider the development of cross-sectional competencies, ethical and gender aspects and an evaluation of these new educational models to strengthen future activities. [ABSTRACT FROM AUTHOR]

Path-dependency theory says that complex systems, such as health systems, are shaped by prior conditions and decisions, and are resistant to change. As a result, major policy changes, such as health system reform, are often only possible in policy windows—moments of transition or contextual crisis that re-balance social power dynamics and enable the consideration of new policy ideas. However, even in policy windows there can be resistance to change. In this paper, we consider the role of ideas in constraining change. We draw on political science theory on the dynamic relationship between foreground ideas (policy programmes and frames) and background ideas (deeply held collective cognitive and normative beliefs) to better understand how ideas exert influence independently of the contextual conditions that give rise to them or the actors that espouse them. To do so, we examine two apparent policy windows in the South African National Health Insurance policy process. The analysis reveals how ideas can become institutionalised in organisations and procedures (such as policy instruments or provider networks), and in intangible cultural norms—becoming hegemonic and uncontested ideas that shape the attitudes and perspectives of policy actors. In this way, ideas operate as independent variables, constraining change across policy windows. While health policy analysts increasingly recognise the influence of ideational variables in policy processes, they tend to conceptualise ideas as tools actors wield to drive change. This analysis reveals the importance of considering ideas (values, norms, and beliefs) as persistent features of the policy-making context that constrain actors. [ABSTRACT FROM AUTHOR]

This paper studies the creation of organisations via people processing (Prottas 1979), taking as its case study a new and developing family centre that aims to offer various social and health services under the same roof. The study draws on ethnomethodology, meaning that organisations are herein understood as being created and continuously produced in and through interaction. The data consist of 11 audio-recorded meetings from the centre's steering group, which includes managers from different service fields and welfare agencies. In analysing the creation of the centre through people processing, this paper scrutinises how the meeting participants orient themselves toward and produce the centre's client categories, what characteristics they connect to these categories, and how they do boundary work regarding which categories belong or not to the centre's target groups. The meeting participants produce three different family based client categories. The first category is ordinary families, those without any special problems who just pop into the centre to see other people. These families are distinguished from the second category, best matching families, who are defined as having problems that would benefit from the integrated, multi-professional work conducted at the centre. The third category, families with too specific needs, refers to client groups whose service needs are at least partly beyond the centre's expertise and resources. The centre needs these people-processing activities to make sense of its mission, clients and co-partners; this ongoing reasoning process allows the emerging centre to exist and find its place in the local service system. [ABSTRACT FROM AUTHOR]

What is known about the topic? Little is known about the state of mental health reform in Australia. This article describes the struggle to develop the systems of accountability necessary to assess national progress. What does this paper add? We provide some historical context regarding mental health reform and consider recent efforts in particular, before then describing current key opportunities. What are the implications for practitioners? Many people working in mental health are struggling to deliver quality services to Australians. This paper considers the broad policy issues which have led to this situation. This is useful for practitioners who can then better respond and participate in processes of systemic reform. Opportunities to engage now in key policy formulation are identified in the article. [ABSTRACT FROM AUTHOR]

What is known about the topic ? Governments acknowledge that current health arrangements are unsustainable, and a better resourced, integrated, and connected primary care system is central to the future. What does this paper add ? This paper calls out the most significant barriers to implementing the required national reform and poses potential solutions in addressing them. What are the implications for practitioners ? Without action, we will see increased system cost, and decreased service access and quality for Australian communities. [ABSTRACT FROM AUTHOR]

Background: Kerala has initiated many Universal Health Coverage (UHC) reforms in the last decade. The Aardram Mission launched in 2017 stands out owing to its scope, objectives, and commitments for strengthening Primary Health Care (PHC) in the State. The current study proposes to explore access and financial protection through the lens of equity in Kerala especially in the context of major UHC reforms carried out during the last decade. This paper will also highlight the key lessons from Kerala's approach towards UHC and health systems strengthening through a political economy approach. Methods: Data from the Kerala state sample of 75th Round (2017-18) National Sample Survey is used for this study. Comparison is also drawn from the 71st Round Sample Survey, 2014, to measure the state's progress in terms of access and financial protection. Logistic regression was used for the calculation. The findings were further explored through a political economy approach. Results: The share of public facilities for outpatient care is 47.5%, which is a significant increase from 34.0% (in 2014) in the state. The share of public sector for out-patient care has increased for the lower socio-economic population in the state. The share of public sector for in-patient care has also increased to 37.3% in 2017-18 from 33.9% in 2014, but not to the extent as the increase shown in outpatient care. The average out-of-pocket-expenditure during hospitalization has increased more in private facilities as compared to public for both outpatient care and hospitalization. Conclusions: Overall increase in the share of public facilities for both outpatient care and hospitalization is indicative of the enhanced trust among the people at large of the public healthcare delivery system in Kerala, post the launch of UHC reforms in the State. The insurance linked UHC reforms would be insufficient for the State to progress further towards UHC. Kerala with a long and successful history in 'public provisioning' should focus more on strengthening PHC through Aardram Mission in its journey towards pursuit of UHC. [ABSTRACT FROM AUTHOR]

Background: Hospitalisation resulting from complications of systemic therapy and radiotherapy places a substantial burden on the patient, society, and healthcare system. To formulate preventive strategies and enhance patient care, it is crucial to understand the connection between complications and the need for subsequent hospitalisation. This review aimed to assess the existing literature on complications related to systemic and radiotherapy treatments for cancer, and their impact on hospitalisation rates. Methods: Data was obtained via electronic searches of the PubMed, Scopus, Embase and Google Scholar online databases to select relevant peer-reviewed papers for studies published between January 1, 2000, and August 30, 2023. We searched for a combination of keywords in electronic databases and used a standard form to extract data from each article. The initial specific interest was to categorise the articles based on the aspects explored, especially complications due to systemic and radiotherapy and their impact on hospitalisation. The second interest was to examine the methodological quality of studies to accommodate the inherent heterogeneity. The study protocol was registered with PROSPERO (CRD42023462532). Findings: Of 3289 potential articles 25 were selected for inclusion with ~ 34 million patients. Among the selected articles 21 were cohort studies, three were randomised control trials (RCTs) and one study was cross-sectional design. Out of the 25 studies, 6 studies reported ≥ 10 complications, while 7 studies reported complications ranging from 6 to 10. Three studies reported on a single complication, 5 studies reported at least two complications but fewer than six, and 3 studies reported higher numbers of complications (≥ 15) compared with other selected studies. Among the reported complications, neutropenia, cardiac complications, vomiting, fever, and kidney/renal injury were the top-most. The severity of post-therapy complications varied depending on the type of therapy. Studies indicated that patients treated with combination therapy had a higher number of post-therapy complications across the selected studies. Twenty studies (80%) reported the overall rate of hospitalisation among patients. Seven studies revealed a hospitalisation rate of over 50% among cancer patients who had at least one complication. Furthermore, two studies reported a high hospitalisation rate (> 90%) attributed to therapy-repeated complications. Conclusion: The burden of post-therapy complications is emerging across treatment modalities. Combination therapy is particularly associated with a higher number of post-therapy complications. Ongoing research and treatment strategies are imperative for mitigating the complications of cancer therapies and treatment procedures. Concurrently, healthcare reforms and enhancement are essential to address the elevated hospitalisation rates resulting from treatment-related complications in cancer patients. [ABSTRACT FROM AUTHOR]

Purpose: The author, who is Chair of Norfolk's Safeguarding Adults' Board (SAB) reflects on the impact of a Safeguarding Adults Review (SAR) and the actions that resulted. The purpose of the paper is to provide an insight into a significant SAR and the resulting actions desinged to change practice. Design/methodology/approach: The actions illuminate the power of hospitals and politicians over people's lives. It took the deaths of three young adults with learning disabilities, in a hospital, to move beyond the status quo and organise some very different service responses. Findings: "Progress summits" have considered local and national actions. There have been important gains and setbacks, including the delayed reform of the Mental Health Act. Despite uncertainties, SAB can be detonators to listening and taking action. Originality/value: This is a unique insight into the impact of a Safeguarding Adults Review and the actions that resulted from this. [ABSTRACT FROM AUTHOR]

Aging is a challenging process for people with gender nonconformity. Indeed, the older transgender population faces several disparities in accessing and using health care and social support services. Furthermore, the clinical management of gender transition in later life is empirical since clear research evidence is lacking. This paper aimed to present the problems encountered by older transgender adults in their access to social support and health care and to propose insightful solutions to address them both from a social and medical/nursing perspective. Trans elders face profound disparities in health and social care due to factors associated with limited accessibility to health services, social restrictions, administrative failures, and physical vulnerabilities. The medical treatment of older transgender adults also needs a careful approach to achieve satisfying gender affirmation without clinically significant risks. The potential induction of hormone-sensitive malignancies and the provocation of major adverse vascular events are the main concerns. Gender transition in older adults without a prior history of following gender-affirming therapy is challenging due to biological factors related to advanced age. Caring for elderly trans people unfolds at multiple levels. International organizations and governmental bodies should address the underprivileged status of elderly transgender people by creating and implementing inclusive policies. Safe and respectful clinical and residential environments and the formation of clearer medical guidelines could meet the unique needs of older trans adults. Care providers must advocate for their patients and be equipped to provide safe and effective services. [ABSTRACT FROM AUTHOR]

Several shifts in physiotherapy treatment of patients with rheumatoid arthritis (RA) have occurred over time. This paper aims to identify shifts in physiotherapy practice for patients with RA based on the author's work experiences from the 1980s until today at two Norwegian rheumatism hospitals, and to explore why shifts may have happened. A narrative was developed by describing events making a difference, categorizing, and ordering them with the help of narrative analysis and a sensitizing analytic lens on discourses. The storyline from the 1980s to approximately the turn of the millennium is called 'Shifts determined mainly by clinical context-driven events' which occurred in response to medical advances and physiotherapists' clinical experiences. These shifts were later justified by physiotherapists' research in the clinical context. The other storyline covers mainly the 2000s and is called 'Shifts increasingly determined by events beyond clinical physiotherapy context.' They include adjustments to further medical advances and implementation of biopsychosocial understanding of disease at the hospital, and to external research-based recommendations, health reforms, and economy. These processes have moved physiotherapy practice at the hospital from mainly providing individualized remedial and rehabilitative physiotherapy for the purpose to normalize physical function to an increasing focus on generic health measures for the purposes of health promotion and cardiovascular disease prevention. However, this shift may not fully match the complex needs presented by patients in disease remission with unrelenting fatigue and work inability and those who have multiple functional challenges and comorbidities. [ABSTRACT FROM AUTHOR]

In 2023, the UK Government published its long-awaited reform strategy for England's children's social care system. Whilst the strategy set out planned reforms for several aspects of the wider system, an area requiring particular 'priority' was the purported workforce instability seen within child protection social work. However, the strategy has subsequently faced criticism on the basis that the suggested reforms were not satisfactorily informed by the testimonies of practicing social workers. This paper draws from a mixed-method study to report on the lived experiences of a sample of 201 child protection social workers practicing across England, in the context of better understanding the factors which they believed were impacting on workforce stability within England's child protection system. Implications that emerge are the need for an increase in the monetary commitment offered by the UK Government (especially in the context of tackling high caseloads, and improving local authority pay scales to reduce the allure of agency work); a targeted emphasis on challenging local cultures preoccupied with evidencing compliance over time spent with children; and the Government taking a more assertive role in tackling the often-counterproductive commentary perpetuated by politicians and media. [ABSTRACT FROM AUTHOR]

Self-determination informed policies are key to improved outcomes for Aboriginal health. Aboriginal leadership must be reflected throughout any public health reform process that affects Aboriginal communities. This paper presents a body of oral health policy work, undertaken under Loddon Mallee Aboriginal Reference Group's (LMARG's) leadership, as an exemplar of a self-determination informed change, that led to an amendment of an Australian state (Victoria) regulation – The Drugs, Poisons and Controlled Substances Amendment (Registered Aboriginal and Torres Strait Islander Health Practitioners [AHPs]) Regulations 2022. A summary of activities undertaken by LMARG, from advocacy to leading the submission, to amend the regulation, is provided. The amendment, now in place, authorises registered AHPs to obtain, possess, and administer fluoride varnish (FV) as a part of health services they provide. FV is a concentrated form of fluoride applied to tooth surfaces to prevent tooth decay. The practical implication of this amendment is delivery of a culturally appropriate integrated oral health promotion FV model that addresses mainstream dental access barriers commonly experienced by Aboriginal people. The model aims at upskilling an Aboriginal workforce to facilitate timely FV application to Aboriginal children. Self-determination informed policies are key to improved outcomes for Aboriginal health. The paper presents work on an oral health policy, undertaken under Loddon Mallee Aboriginal Reference Group's leadership on an Australian state (Victoria) regulation – The Drugs, Poisons and Controlled Substances Amendment (Registered Aboriginal and Torres Strait Islander Health Practitioners) Regulations 2022, as an exemplar of a self-determination informed change. The amendment translates to a culturally appropriate integrated oral health promotion model that addresses dental access barriers experienced by Aboriginal people. This article belongs to the Collection Access to Primary Health Care. [ABSTRACT FROM AUTHOR]

The paper focused on the assessment of secondary healthcare administration in Lagos with respect to examined the administrative structure put in place in secondary healthcare facilities and evaluated the effects of administrative structure on secondary healthcare service in Lagos as well as analysed the challenges confronting the administration of secondary healthcare service in Lagos. The paper employed descriptive research design and quantitative research approach. The data were gathered through administration of structured questionnaire. The paper used 20% of the study population 1341, making 268 sample size for questionnaire which consisted of both medical and non-medical staff of three selected General Hospital in Lagos i.e. one from each senatorial district in Lagos State. Data collected were analysed using frequency distribution, percentages, tables, and t-test. The study revealed that sustainability of administrative structure put in place in Lagos State to manage the secondary healthcare service are impactful and has significant effects on the services rendered. Therefore, the paper recommended that hospital administration should provide up to date medical technology and infrastructure need to easy the work of health workers and promote service delivery and that government should be an increase in the financial commitment and budget allocation of the government to the health care sector to address the existing financial challenges. The paper concluded that sustainability of administrative structure has direct effect on secondary healthcare on service delivery in Lagos, Nigeria. [ABSTRACT FROM AUTHOR]

Objective: The aim was to identify healthcare payment and financing reforms to promote health equity and ways that the Agency for Healthcare Research and Quality (AHRQ) may promote those reforms. Data Sources and Study Setting: AHRQ convened a payment and financing workgroup–the authors of this paper–as part of its Health Equity Summit held in July 2022. This workgroup drew from its collective experience with healthcare payment and financing reform, as well as feedback from participants in a session at the Health Equity Summit, to identify the evidence base and promising paths for reforms to promote health equity. Study Design: The payment and financing workgroup developed an outline of reforms to promote health equity, presented the outline to participants in the payment and financing session of the July 2022 AHRQ Health Equity Summit, and integrated feedback from the participants. Data Collection/Extraction Methods: This paper did not require novel data collection; the authors collected the data from the existing evidence base. Principal Findings: The paper outlines root causes of health inequity and corresponding potential reforms in five domains: (1) the differential distribution of resources between healthcare providers serving different communities, (2) scarcity of financing for populations most in need, (3) lack of integration/accountability, (4) patient cost barriers to care, and (5) bias in provider behavior and diagnostic tools. Conclusions: Additional research is necessary to determine whether the proposed reforms are effective in promoting health equity. [ABSTRACT FROM AUTHOR]

With the deepening reform of the medical and health system, China's community health services are also continuously improving. As the "gatekeeper" of community residents' health, community medical and health services provide basic health protection for community residents. In the final analysis, community medical and health service is a kind of service. In today's era where everyone pursues experience, improving service experience has become an important goal of modern health services. The community medical and health services evaluation is a multi-attribute group decision making (MAGDM) issue. The fuzzy number intuitionistic fuzzy sets (FNIFSs) are used as a tool for characterizing uncertain information during the community medical and health services evaluation. In this paper, a novel MAGDM is built on given CoCoSo method under FNIFSs for community medical and health services evaluation. First of all, this paper extends the CoCoSo to FNIFSs environment to build the fuzzy number intuitionistic fuzzy CoCoSo (FNIF-CoCoSo) method. Secondly, a new MAGDM model for community medical and health services evaluation based on CoCoSo algorithm is built. Finally, the practical example for community medical and health services evaluation to show the practicability and some comparisons are supplied to prove the effectiveness of the decision algorithm. [ABSTRACT FROM AUTHOR]

Mental health care reform is a long-term process and a key aspect of the development and progress of society as a whole. This paper aims to present an overview and analysis of mental health care services intended for adults within the public and civil sectors in the Republic of Serbia. The main method applied in this study is content analysis. The results show that certain services and measures to improve mental health care have been created and implemented, but many goals have not yet been achieved. The biggest challenges facing the provision of mental health care services - alongside a lack of financial resources - are discrepancies in regulations, the dominance of tertiary health services in providing treatment to people with mental health, a lack of services in the community, insufficient involvement of the civil sector, and weak intersectoral cooperation between different systems. Due to the lack of data transparency and comprehensive service registries, this paper presents a large - although not comprehensive - number of public, civil, and private sector mental health care services. Mental health care in the Republic of Serbia should in the future aim to overcome the gap between mental health policy and practice, promote deinstitutionalization, establish health and social services and support systems in the community, and search for protection models that will enable better social inclusion for people with mental health problems and the fulfillment of their social, economic, and all other human rights. [ABSTRACT FROM AUTHOR]

Background: Decentralization of a health system is a complex and multidimensional phenomenon that demands thorough investigation of its process logistics, predisposing factors and implementation mechanisms, within the broader socio-political environment of each nation. Despite its wide adoption across both high-income countries (HICs) and low-and-middle-income countries (LMICs), empirical evidence of whether decentralization actually translates into improved health system performance remains inconclusive and controversial. This paper aims to provide a comprehensive description of the decentralization processes in three countries at different stages of their decentralization strategies – Pakistan, Brazil and Portugal. Main body: This study employed a systematic analysis of peer-reviewed academic journals, official government reports, policy documents and publications from international organizations related to health system decentralization. A comprehensive search was conducted using reputable databases such as PubMed, Google Scholar, the WHO repository and other relevant databases, covering the period up to the knowledge cutoff date in June 2023. Information was systematically extracted and organized into the determinants, process mechanics and challenges encountered during the planning, implementation and post-decentralization phases. Although decentralization reforms have achieved some success, challenges persist in their implementation. Comparing all three countries, it was evident that all three have prioritized health in their decentralization reforms and aimed to enhance local decision-making power. Brazil has made significant progress in implementing decentralization reforms, while Portugal and Pakistan are still in the process. Pakistan has faced significant implementation challenges, including capacity-building, resource allocation, resistance to change and inequity in access to care. Brazil and Portugal have also faced challenges, but to a lesser extent. The extent, progress and challenges in the decentralization processes vary among the three countries, each requiring ongoing evaluation and improvement to achieve the desired outcomes. Conclusion: Notable differences exist in the extent of decentralization, the challenges faced during implementation and inequality in access to care between the three countries. It is important for Portugal, Brazil and Pakistan to address these through reinforcing implementation strategies, tackling inequalities in access to care and enhancing monitoring and evaluation mechanism. Additionally, fostering knowledge sharing among these different countries will be instrumental in facilitating mutual learning. [ABSTRACT FROM AUTHOR]

The purpose of this case study is to explain the development of Queensland's strategic approach to health system reform, which promotes partnership across the health system to better deliver integrated and value-based health care across the continuum of care. The new health system vision was informed by undertaking literature searches on national and international health system approaches to reform and supported by extensive consultation across Queensland with more than 1100 stakeholders. Thematic analysis was undertaken to identify key themes that were translated into a high-level vision document that communicated Queensland's renewed focus on wellness and delivering more care in the community. This was circulated to stakeholders for iterative and collaborative refinement before final approvals. Collaboratively and iteratively developing the new health system vision for Queensland with key stakeholders has contributed to a shared understanding and ownership of a vision that is committed to system reform, focused on delivering high-value care that reflects what is important to consumers and health system stakeholders. What is known about the topic? Vision statements for organisations including health are common. However, there is little information available in the literature regarding approaches to developing a vision for a health system. What does this paper add? An overview of an approach to developing a new health system vision through comprehensive consultation that engages stakeholders broadly to develop an informed vision that has support from all levels of the health system. What are the implications for practitioners? The method used to develop this vision could be replicated across any large-scale organisation. Although time consuming, the outcome is a vision that is widely supported and sets the organisation up for success for implementation. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

People with innate variations of sex characteristics (also known as intersex traits or disorders or differences of sex development) have any of a wide range of innate physical traits that differ from medical and social norms for female and male bodies. Responses to these physical differences create experiences and risks of stigmatisation, discrimination, violence, and harmful medical practices intended to promote social and familial integration and conformity with gender stereotypes. As is evident globally, the Australian policy response to the existence and needs of people with innate variations of sex characteristics has been largely incoherent, variously framing the population as having disordered sex development in need of "fixing", and a third sex/gender identity group in need of recognition, with only recent engagement by intersex community-controlled civil society organisations. This paper presents an overview of the context and goals of the intersex human rights movement in Australia. Australian intersex community organisations have sought to apply human rights norms and develop new infrastructure to address key health and human rights issues, and necessitating new ways of resolving policy incoherence. Together with human rights, mental health, and public health institutions, they have called for significant changes to medical models of care and reform to research and classification systems. Intersex community organising and resourcing have made a tangible difference. The Australian Capital Territory is the first jurisdiction in the country to move ahead with reforms to clinical practice, including a legislative prohibition of certain practices without personal informed consent, oversight of clinical decision-making, and investment in psychosocial support. A national community-controlled psychosocial support service has also commenced. [ABSTRACT FROM AUTHOR]

Background: With the increasing number of people affected by multiple chronic conditions, it is essential for public-health professionals to promote strategies addressing patient needs for coordinated care. We aim to explore preference heterogeneity for better-coordinated care delivery models in Swiss older adults, and identify profiles of individuals more open to healthcare reforms. Methods: A DCE (discrete choice experiment) survey was developed online and on paper for the Swiss adults aged 50þ, following best practice. To elicit preferences, we estimated a latent class model allowing grouping individuals with similar preferences into distinct classes, and examined what background characteristics contributed to specific class membership. Results: The optimal model identified three classes with different openness to reforms. Class 1 (49%) members were concerned with premium increases and were in favour of integrated care structures with care managed by interprofessional teams. Individuals in class 2 (19%) were younger, open to reforms, and expressed the needs for radical changes within the Swiss healthcare system. Class 3 respondents (32%) were strongly reluctant to changes. Conclusions: Our study goes beyond average preferences and identifies three distinct population profiles, a majority open to reforms on specific aspects of care delivery, a smallest group in favour radical changes, and a third strongly against changes. Therefore, tailored approaches around healthcare reforms are needed, e.g. explaining the role of interprofessional teams in coordinating care, electronic health records and insurance premium variation. [ABSTRACT FROM AUTHOR]

Policy PointsThe implementation of large‐scale health care interventions relies on a shared vision, commitment to change, coordination across sites, and a spanning of siloed knowledge.Enablers of the system should include building an authorizing environment; providing relevant, meaningful, transparent, and timely data; designating and distributing leadership and decision making; and fostering the emergence of a learning culture.Attention to these four enablers can set up a positive feedback loop to foster positive change that can protect against the loss of key staff, the presence of lone disruptors, and the enervating effects of uncertainty. Context: Large‐scale transformative initiatives have the potential to improve the quality, efficiency, and safety of health care. However, change is expensive, complex, and difficult to implement and sustain. This paper advances system enablers, which will help to guide large‐scale transformation in health care systems. Methods: A realist study of the implementation of a value‐based health care program between 2017 and 2021 was undertaken in every public hospital (n = 221) in New South Wales (NSW), Australia. Four data sources were used to elucidate initial program theories beginning with a set of literature reviews, a program document review, and informal discussions with key stakeholders. Semistructured interviews were then conducted with 56 stakeholders to confirm, refute, or refine the theories. A retroductive analysis produced a series of context‐mechanism‐outcome (CMO) statements. Next, the CMOs were validated with three health care quality expert panels (n = 51). Synthesized data were interrogated to distill the overarching system enablers. Findings: Forty‐two CMO statements from the eight initial program theory areas were developed, refined, and validated. Four system enablers were identified: (1) build an authorizing environment; (2) provide relevant, authentic, timely, and meaningful data; (3) designate and distribute leadership and decision making; and (4) support the emergence of a learning culture. The system enablers provide a nuanced understanding of large‐system transformation that illustrates when, for whom, and in what circumstances large‐system transformation worked well or worked poorly. Conclusions: System enablers offer nuanced guidance for the implementation of large‐scale health care interventions. The four enablers may be portable to similar contexts and provide the empirical basis for an implementation model of large‐system value‐based health care initiatives. With concerted application, these findings can pave the way not just for a better understanding of greater or lesser success in intervening in health care settings but ultimately to contribute higher quality, higher value, and safer care. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Principles for Ending Human Immunodeficiency Virus (HIV) as an Epidemic in the United States: A Policy Paper of the Infectious Diseases Society of America and the HIV Medicine Association" which appeared in the August 15, 2022 issue.

Purpose: This paper aims to explore the lived experiences of key stakeholders working with homeless people during the implementation of universal credit during the austerity years. Design/methodology/approach: The literature on austerity reveals welfare reforms' impact on support services staff. Service providers' perceptions of the impact of austerity-led policies and welfare reform via nine interviews with people working in homelessness organisations in Brighton and Hove in the UK. Service providers see the situation for their service users has gotten worse and that the policies make it more difficult to extricate themselves from their current situation. Three central themes relating to the impact of austerity-led welfare reforms were, namely, Universal Credit: the imposition of a precarious livelihood on welfare claimants; a double-edged sword: "If people are sanctioned: people can't pay"; and "Hard to maintain my own mental equilibrium". Findings: More precisely, this paper captures service providers' perceptions and experiences of the impact of austerity-led policies on their services and how they believe this, in turn, impacts their clients and their own lives. Research limitations/implications: The dimension cuts across service provision to vulnerable people and is intertwined with health and well-being outcomes. Austerity is detrimental to the health of service users and their clients. It is known that when it comes to the health and well-being of the most vulnerable, who have suffered most from the impacts of austerity policies. However, in times of open austerity, it falls also on those trying to ease their suffering. Originality/value: The data suggest that policies were developed and accentuated by austerity, which led to the stripping of welfare support from vulnerable people. This process has impacted the people who rely on welfare and service providers. [ABSTRACT FROM AUTHOR]

Healthcare reforms that demand quantitative outcomes and technical innovations have emphasized the use of Disability and Functional Outcome Measurements (DFOMs) to spinal conditions and interventions. Virtual healthcare has become increasingly important following the COVID-19 pandemic and wearable medical devices have proven to be a useful adjunct. Thus, given the advancement of wearable technology, broad adoption of commercial devices (ie, smartwatches, phone applications, and wearable monitors) by the general public, and the growing demand from consumers to take control of their health, the medical industry is now primed to formally incorporate evidence-based wearable device-mediated telehealth into standards of care. To (1) identify all wearable devices in the peer-reviewed literature that were used to assess DFOMs in Spine, (2) analyze clinical studies implementing such devices in spine care, and (3) provide clinical commentary on how such devices might be integrated into standards of care. A systematic review. A comprehensive systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) across the following databases: PubMed; MEDLINE; EMBASE (Elsevier); and Scopus. Articles related to wearables systems in spine healthcare were selected. Extracted data was collected as per a predetermined checklist including wearable device type, study design, and clinical indices studied. Of the 2,646 publications that were initially screened, 55 were extensively analyzed and selected for retrieval. Ultimately 39 publications were identified as being suitable for inclusion based on the relevance of their content to the core objectives of this systematic review. The most relevant studies were included, with a focus on wearables technologies that can be used in patients' home environments. Wearable technologies mentioned in this paper have the potential to revolutionize spine healthcare through their ability to collect data continuously and in any environment. In this paper, the vast majority of wearable spine devices rely exclusively on accelerometers. Thus, these metrics provide information about general health rather than specific impairments caused by spinal conditions. As wearable technology becomes more prevalent in orthopedics, healthcare costs may be reduced and patient outcomes will improve. A combination of DFOMs gathered using a wearable device in conjunction with patient-reported outcomes and radiographic measurements will provide a comprehensive evaluation of a spine patient's health and assist the physician with patient-specific treatment decision-making. Establishing these ubiquitous diagnostic capabilities will allow improvement in patient monitoring and help us learn about postoperative recovery and the impact of our interventions. [ABSTRACT FROM AUTHOR]

BACKGROUND: At a time when welfare contracts are in crisis, it is timely to discuss different forms of disruptive innovation and responses of medical finance and economic systems, especially adjusting with new instruments for recovery and innovative solutions for health reforms. OBJECTIVE: The objective of this paper is to propose some ways to develop a framework for policy changes affecting life science sectors and healthcare. It aims to analyze the types of relationships between health or medical systems and the economic systems. METHOD: Medical systems used to be generally closed systems, but the new forms of delivery, especially with increase of telehealth and Mobile health (Mhealth) solutions (boosted by the COVID-19 pandemic, such as online consultations), have open traditional boundaries and generate more interactions with economic systems. It also led to new institutional arrangements at federal, national, or local levels, with different power games according to the history of institutions and cultural differences between countries. RESULTS: Which system dynamics prevail will also depend on the political systems in place, for instance very innovative open innovation systems dominated by private players such as the USA empower individuals and favor intuitive and entrepreneurial states. On the other hand, systems historically dominated by socialized insurance or former communist countries, have investigated "attunements" or adaptation mechanisms in system intelligence. However, systemic changes are not only implemented by traditional rulers (government agencies, federal reserve banks) but also face the emergence of systemic platforms dominated by Big Tech players. The new agendas expressed for instance in the United Nation (UN) framework and the set of Sustainable Development Goals (SDGs) for climate change and sustainable growth, also require global adjustment of supply and demand, in a context where the traditional drug/vaccine split is challenged by the new technologies (e.g., mRNA technologies). Investment for drug research led to the development of COVID-19 vaccines, but also potential cancer vaccines. Finally, welfare economics is increasingly criticized among economist circles; it requires new design for global value assessment framework, facing growing inequalities and inter-generational challenges in aging populations. CONCLUSION: This paper contributes to new models of developments and different frameworks for multiple stakeholders with major technological changes. [ABSTRACT FROM AUTHOR]

This review aims to identify healthcare providers' (HCPs) experiences with issues related to the quality use of medicines among culturally and linguistically diverse (CALD) patients, the underlying factors, and the enablers of and barriers to providing culturally safe care to promote quality use of medicines. The searched databases were Scopus, Web of Science, Academic search complete, CINHAL-Plus, Google Scholar and PubMed/Medline. The initial search returned 643 articles, of which 14 papers were included. HCPs reported that CALD patients were more likely to face challenges in accessing treatment and sufficient information about treatment. According to the theoretical domains framework, determinants such as social influences due to cultural and religious factors, lack of appropriate resources about health information and cultural needs, lack of physical and psychological capabilities such as lack of knowledge and skills, and lack of motivation could impede HCPs' abilities to provide culturally safe care. Future interventions should deploy multilevel interventions, such as education, training, and organisation structural reforms. [ABSTRACT FROM AUTHOR]

In 2016, as a trainee doctor, I wrote a paper on changing the culture of medicine. I felt the medical system was broken back then, and it seems even less functional now, with higher rates of burnout, dropout and staff shortages nationally. As a result of a lack of resources, it feels impossible to provide the care to our communities expected of us, making our work challenging and disheartening. Until all stakeholders acknowledge the systemic issues faced by our workforce, service outcomes and physician well‐being may not improve. We need to collaborate and innovate to reform the healthcare system taking a multifaceted, evidence‐based approach, implementing an appropriate balance of systemic change and interventions to support individual well‐being. As we collectively work towards these changes, tragic optimism may spur physicians to develop meaning and purpose despite the inevitable challenges. This may serve as the motivation and fuel required to survive and sustain our practice but also thrive working in careers of value. [ABSTRACT FROM AUTHOR]

India’s experience with the National Rural Health Mission (NRHM) is notable on account of nationally formalising – at scale – community action in service delivery,monitoring, and planning of health services. A study was undertaken to document and create a historical record of NRHM’s ‘communitization’ processes. The oral history method of the Witness Seminar was adopted and two virtual seminars with five and nine participants, respectively, were conducted, and supplemented with 4 in depth interviews. Analysis of transcripts was done using ATLAS.ti 22 with the broad themes of emergence, evolution, and evaluation and impact of ‘communitization’ under NRHM. This paper engages with the theme of ‘emergence’ and adopts the Multiple Streams Framework (MSF) conceptualised by John Kingdon for analysis. Key findings include the pioneering role of boundary spanning decision makers and the Jan Swasthya Abhiyan (JSA) in advocacy and design of ‘communitization’ structures, and the legacy of rights based social mobilizations and state-civil society partnerships in health during the 1990s influencing the ethos underlying ‘communitization’. Democracy, leadership from the civil society in policy design and implementation, and state-civil society partnerships are linked to the positive results witnessed as part of ‘communitization’ in NRHM. [ABSTRACT FROM AUTHOR]

In this perspective paper we use publicly-available data to show that, despite much positive rhetoric in support of reforms in Scotland to integrate health and social care, these reforms, in their current state, have failed to meet their stated objectives. Rather than regress to the previous system, we propose continued evaluation of even more radical forms of such integration. This analysis, and set of future proposals, are timely given current considerations with respect to a National Care Service in Scotland and recent similar reforms in England and in other countries. [ABSTRACT FROM AUTHOR]

Introduction: Lebanon is a middle-income country facing substantial fragility features. Its health profile shows a high burden of NCD morbidity and mortality. This paper intends to analyse the political economy of NCD prevention and control in Lebanon. Methods: This study adopted a literature-based case study research design using a problem-driven political economy analysis framework. A total of 94 peer-reviewed articles and documents from the grey literature published before June 2019 were retrieved and analysed. Results: Lebanon's political instability and fragile governance negatively affect its capacity to adapt a Health-in-All-Policies approach to NCD prevention and enable the blocking of NCD prevention policies by opposed stakeholders. Recent economic crises limit the fiscal capacity to address health financing issues and resulting health inequities. NCD care provision is twisted by powerful stakeholders towards a hospital-centred model with a powerful private sector. Stakeholders like the MOPH, UN agencies, and NGOs have been pushing towards changing the existing care model towards a primary care model. An incremental reform has been adopted to strengthen a network of primary care centres, support them with health technologies and improve the quality of primary care services. Nevertheless, outpatient services that are covered by other public funds remain specialist-led without much institutional regulation. Conclusion: Our study revealed a locked equilibrium in NCD prevention policymaking in Lebanon, but with an incremental progress in service delivery reforms towards a primary care model. Advocacy and close monitoring by policy entrepreneurs (such as civil society) could initiate and sustain the implementation of policy change and care model reforms. [ABSTRACT FROM AUTHOR]

Background: Despite the great confidence of Western governments in the principles of New Public Management (NPM) and its ability to stimulate "healthcare entrepreneurship", it is unclear how policies seeking to reform healthcare services provoke such entrepreneurship in individual institutions providing long-term healthcare. This study examines such situated responses in a Dutch nursing home for elderly people suffering from dementias such as Alzheimer's disease. Methods: A four-year inductive longitudinal single-case study has been conducted. During this time period, the Dutch government imposed various NPM-based healthcare reforms and this study examines how local responses unfolded in the nursing home. Through interviews conducted with managers, administrators and supporting staff, as well as the examination of a large volume of government instructions and internal documents, the paper documents how these reforms resulted in several types of entrepreneurship, which were not all conducive to the healthcare innovations the government aspired to have. Results: The study records three subsequent strategies deployed at the local level: elimination of healthcare services; non-healthcare related collaboration with neighboring institutions; and specialization in specific healthcare niches. These strategies were brought about by specific types of entrepreneurship – two of which were oriented towards the administrative organization rather than healthcare innovations. The study discusses the implications of having multiple variations of entrepreneurship at the local level. Conclusion: Governmental policies for healthcare reforms may be more effective, if policymakers change output-based funding systems in recognition of the limited control by providers of long-term healthcare over the progression of clients' mental disease and ultimate passing. [ABSTRACT FROM AUTHOR]

Objective: This paper outlines the evolution of mental health rehabilitation in NSW, where allocation of health resources has repeatedly contradicted the policy intention to reorient services from inpatient to community-based services, leaving community rehabilitation the poor and disconnected cousin of inpatient services. The expanding role of community-managed organisations (CMOs) in psychosocial rehabilitation, the introduction of the National Disability Insurance Scheme (NDIS), and emerging service models have helped foster a maturing housing and social care environment, but present reality and the integration of health and social care services remains at a distance from best evidence practice. Conclusion: The challenge of the next decade of mental health reform is to embrace and consolidate greater service diversity and complexity. Understanding what factors influenced present reality is important in providing guardrails for the future, enabling the current wave of renewal and reinvestment in NSW to build on the strengths of past developments and steer a course around their weaknesses. [ABSTRACT FROM AUTHOR]

The role of hospitals has significantly changed over the past decades and the 'medical city' has emerged as a new urban phenomenon in China. However, research on the significance of the medical city to China's urbanism is limited. This paper situates China's medical city in the theory of state entrepreneurialism and rethinks consumerism in healthcare. Particularly focussing on the state–market and production–consumption dyads, the paper argues that the state has engineered the institutional and market legitimacy for the rise of consumerism in healthcare and allows the medical city to capitalise on the provision and consumption of high-end healthcare services to advance the healthcare reform and capture economic opportunities. This argument is substantiated by a case study on the Shanghai New Hongqiao International Medical Center, which focusses on the public–private partnerships in the medical city. It is found that while the production of the medical city is based on private sector participation, the state's presence is diffused in the governance of the medical city through public–private partnerships, which reflect the characteristics of state entrepreneurialism. The findings add to the theory of China's urbanism with new sets of materials and render important implications for the urban future in China. [ABSTRACT FROM AUTHOR]

Objective: The personal importation scheme is a legislative mechanism that allows health consumers to import unapproved medicines under certain conditions. This article analyses the legal and policy basis for the scheme and considers how reforms to advertising laws for therapeutic goods may restrict communications about it. The article represents the first published analysis of the personal importation scheme's interaction with the communications of health professionals and buyer's clubs. It considers how these communications may be affected by legal amendments, particularly where unapproved medicines may be accessed through the scheme. Methods: An examination of Australian therapeutic goods law concerning the personal importation scheme was conducted, including both the historical law and recent regulatory reforms. Illustrative tables were prepared to identify scheme-related advertising that may contravene therapeutic goods law. Risk estimates were allocated to several new legal rules to indicate whether health professionals or buyer's clubs would contravene these laws when promoting the scheme to health consumers for unapproved medicines. Results: Representations made directly to the public by health practitioners or on buyer's clubs websites about accessing unapproved therapeutic goods through the personal importation scheme are likely to contravene one or more advertising laws. Conclusions: The Therapeutic Goods Administration has very strong powers to initiate compliance or enforcement action for advertising breaches in Australia for many promotional practices. Arguably, in the age of the internet and in the context of emerging expensive medicines, these powers should not be used to restrict health practitioners or buyer's clubs from sharing information about the lawful personal importation scheme to health consumers in need. Nevertheless, the study finds that health practitioners who promote or refer to the availability of unapproved medicines through the personal importation scheme outside of a consultation are likely to contravene the law and may be subject to disciplinary or enforcement action. What is known about the topic?. The personal importation scheme has not been studied extensively. This paper investigates whether recent updates to the advertising laws will affect the operation of the personal importation scheme and health practitioners' ability to refer to it in public. What does this paper add? This paper represents the first ever analysis of the way in which the personal importation scheme interacts with health practitioners' statements, buyer's clubs, and the internet. What are the implications for practitioners ? The study finds that health practitioners who promote the availability of unapproved medicines through the personal importation scheme outside professional consultations are likely to be liable to enforcement action from the Therapeutic Goods Administration. [ABSTRACT FROM AUTHOR]

This paper examines the implications of the second sentence in Tudor Harts statement about inverse care – that its operation was strongest when exposed to market forces. In the Australian context, we briefly review some available evidence for inverse care in three groups – Aboriginal and Torres Strait Islander people and those living in remote and socioeconomically disadvantaged areas. We then discuss the extent to which these examples can be attributed to the operation of supply-and-demand within Australia's hybrid fee-for-service system in general practice. Our analysis suggests disparities in workforce supply and the ability of disadvantaged groups to seek preventive and proactive care are critical factors. These, in turn, suggest the need to fund general practice to be responsible for proactive and preventive care of disadvantaged population groups alongside broader structural reforms in workforce, education and taxation. This paper examines the implications of the second sentence in Tudor Harts statement about inverse care – that its operation was strongest when exposed to market forces. Examples of inverse care can be found in the disparities access to primary health care in Australia, which can be attributed to both supply-and-demand factors in Australia's hybrid market model of health care. Correcting these requires changes to the funding and workforce models, as well as specific actions at the service and community level. [ABSTRACT FROM AUTHOR]

The 'modern' value-based healthcare (VBHC) movement provides an opportunity to not only reform health care towards a more equitable, community-centred system, but to also acknowledge, honour and learn from global Indigenous knowledge, systems, and ways of valuing knowing, being and doing. For Australia as a settler-colonial state, efforts to implement VBHC here are doomed to fail until the continued legacy of settler-colonial violence and systemic racism pervading Australia's healthcare system is acknowledged, addressed and ameliorated. What is known about the topic? To succeed in efforts to implement equitable, sustained value-based healthcare (VBHC), the foundations and ongoing impacts of settler-colonialism and neoliberalism on which the Australian healthcare system is built must be acknowledged and addressed. What does this paper add? The 'modern' VBHC movement provides an opportunity to not only reform health care towards a more equitable, community-centred system, but to also acknowledge, honour and learn from global Indigenous knowledge, systems, and ways of valuing knowing, being and doing. What are the implications for practitioners? This article is an invitation to sit, listen and learn. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

In 2015, Social Work Teaching Partnerships launched into a turbulent political and policy arena where a repositioning of social work education was taking place alongside the adoption of neoliberal ideologies promoting the operation of market forces within higher education nationally and globally. This paper presents findings from 11 respondents to an online survey undertaken in England to explore factors that support and hinder partnership working between universities in Social Work Teaching Partnerships. Findings suggest some merit to partnership working, with closer working relationships in practice education, student placements and research. Data suggest that some Social Work Teaching Partnerships were able to form collegiate relationships despite the competitive positioning of universities. However, respondents also commented on operational barriers, such as communication problems and size of Social Work Teaching Partnerships that created difficulties for collaboration. Tensions resulting from working in a competitive market driven environment clearly emerged from the data with some partnerships not able to engage fully in collaborative working as a result. This paper reflects on how the broader political and policy context influences the operationalisation of partnership working within Social Work Teaching Partnerships and suggests key avenues to explore further. [ABSTRACT FROM AUTHOR]

Introduction: This paper documents policy decisions and transformations in response to the COVID‐19 pandemic in Botswana and utilizes the multi‐sectoral approach (MSA) in providing this analysis. Method: A desk review of the different government gazette documents was conducted to trace health policy evolutionary developments and their impact on the general lives of the people of Botswana. Findings: Revealed the actors, roles in this policy transformation and the conditions that enhanced the smooth implementation of the policies are discussed. Conclusion: The paper concludes by making some recommendations for the country's preparedness and anticipatory guidance for any other pandemic or disaster that may arise. Clinical Relevance: This paper highlights the importance of the multisectoral approach in addressing crises such as pandemics. It also demonstrates the need for countries to have well‐defined guidelines to allow decision making in the delivery of efficient health services to the general population during pandemics. [ABSTRACT FROM AUTHOR]