Search

Objective: To analyze the trend of hospitalization rates for ambulatory care-sensitive conditions (HACSC) in Sergipe and its seven health regions between 2010 and 2019, correlating with financial investments in health and primary care, strategy coverage of family health, and the number of hospital beds. Methods: This is an ecological time-series study trend with secondary data from the Ministry of Health. The trend verification was done by segmented linear analysis and the correlation between the variables by Spearman's correlation. Results: HACSC in the state of Sergipe showed a trend towards stability. In the Nossa Senhora do Socorro region, an increasing rate trend was identified from 2010 to 2017 and a non-significant decreasing trend from 2017 to 2019, with a negative correlation with per capita investment in PHC. The Itabaiana region showed a trend of reduction in rates from 2010 to 2012, followed by a trend of growth in rates from 2012 to 2020, with no significant correlation with any of the variables. Conclusions: Monitoring HACSC rates and understanding their multifactorial influence are essential since this indicator is helpful in local situational diagnosis and contributes to planning actions., Objetivo: Analisar a tendência das taxas das internações por condições sensíveis a atenção primária (ICSAP) em Sergipe e em suas sete regiões de saúde entre os anos de 2010 e 2019, correlacionando com os investimentos financeiros em saúde e na atenção primária, cobertura da estratégia de saúde da família e número de leitos. Métodos: Trata-se de um estudo ecológico de tendências de séries temporais com dados secundários do Ministério da Saúde. A verificação da tendência foi realizada por análise linear segmentada e a correlação entre as variáveis foi feita pela correlação de Spearman. Resultados: As ICSAP no estado de Sergipe apresentaram tendência de estabilidade. Na região de Nossa Senhora do Socorro foi identificado tendência crescente das taxas de 2010 a 2017 e tendência decrescente não significativa de 2017 a 2019, com correlação negativa com o investimento per capita em APS. A região de Itabaiana apresentou tendência de redução das taxas de 2010 a 2012, seguido de tendência de crescimento das taxas de 2012 a 2020, sem correlação significativa com nenhuma das variáveis. Conclusões: Realizar o monitoramento das taxas de ICSAP e entender sua influência multifatorial são importantes, uma vez que esse indicador é útil no diagnóstico situacional local e contribuir para planejar ações.

Objective: To analyze the trend of hospitalization rates for ambulatory care-sensitive conditions (HACSC) in Sergipe and its seven health regions between 2010 and 2019, correlating with financial investments in health and primary care, strategy coverage of family health, and the number of hospital beds. Methods: This is an ecological time-series study trend with secondary data from the Ministry of Health. The trend verification was done by segmented linear analysis and the correlation between the variables by Spearman's correlation. Results: HACSC in the state of Sergipe showed a trend towards stability. In the Nossa Senhora do Socorro region, an increasing rate trend was identified from 2010 to 2017 and a non-significant decreasing trend from 2017 to 2019, with a negative correlation with per capita investment in PHC. The Itabaiana region showed a trend of reduction in rates from 2010 to 2012, followed by a trend of growth in rates from 2012 to 2020, with no significant correlation with any of the variables. Conclusions: Monitoring HACSC rates and understanding their multifactorial influence are essential since this indicator is helpful in local situational diagnosis and contributes to planning actions., Objetivo: Analisar a tendência das taxas das internações por condições sensíveis a atenção primária (ICSAP) em Sergipe e em suas sete regiões de saúde entre os anos de 2010 e 2019, correlacionando com os investimentos financeiros em saúde e na atenção primária, cobertura da estratégia de saúde da família e número de leitos. Métodos: Trata-se de um estudo ecológico de tendências de séries temporais com dados secundários do Ministério da Saúde. A verificação da tendência foi realizada por análise linear segmentada e a correlação entre as variáveis foi feita pela correlação de Spearman. Resultados: As ICSAP no estado de Sergipe apresentaram tendência de estabilidade. Na região de Nossa Senhora do Socorro foi identificado tendência crescente das taxas de 2010 a 2017 e tendência decrescente não significativa de 2017 a 2019, com correlação negativa com o investimento per capita em APS. A região de Itabaiana apresentou tendência de redução das taxas de 2010 a 2012, seguido de tendência de crescimento das taxas de 2012 a 2020, sem correlação significativa com nenhuma das variáveis. Conclusões: Realizar o monitoramento das taxas de ICSAP e entender sua influência multifatorial são importantes, uma vez que esse indicador é útil no diagnóstico situacional local e contribuir para planejar ações.

Objective: To analyze the trend of hospitalization rates for ambulatory care-sensitive conditions (HACSC) in Sergipe and its seven health regions between 2010 and 2019, correlating with financial investments in health and primary care, strategy coverage of family health, and the number of hospital beds. Methods: This is an ecological time-series study trend with secondary data from the Ministry of Health. The trend verification was done by segmented linear analysis and the correlation between the variables by Spearman's correlation. Results: HACSC in the state of Sergipe showed a trend towards stability. In the Nossa Senhora do Socorro region, an increasing rate trend was identified from 2010 to 2017 and a non-significant decreasing trend from 2017 to 2019, with a negative correlation with per capita investment in PHC. The Itabaiana region showed a trend of reduction in rates from 2010 to 2012, followed by a trend of growth in rates from 2012 to 2020, with no significant correlation with any of the variables. Conclusions: Monitoring HACSC rates and understanding their multifactorial influence are essential since this indicator is helpful in local situational diagnosis and contributes to planning actions., Objetivo: Analisar a tendência das taxas das internações por condições sensíveis a atenção primária (ICSAP) em Sergipe e em suas sete regiões de saúde entre os anos de 2010 e 2019, correlacionando com os investimentos financeiros em saúde e na atenção primária, cobertura da estratégia de saúde da família e número de leitos. Métodos: Trata-se de um estudo ecológico de tendências de séries temporais com dados secundários do Ministério da Saúde. A verificação da tendência foi realizada por análise linear segmentada e a correlação entre as variáveis foi feita pela correlação de Spearman. Resultados: As ICSAP no estado de Sergipe apresentaram tendência de estabilidade. Na região de Nossa Senhora do Socorro foi identificado tendência crescente das taxas de 2010 a 2017 e tendência decrescente não significativa de 2017 a 2019, com correlação negativa com o investimento per capita em APS. A região de Itabaiana apresentou tendência de redução das taxas de 2010 a 2012, seguido de tendência de crescimento das taxas de 2012 a 2020, sem correlação significativa com nenhuma das variáveis. Conclusões: Realizar o monitoramento das taxas de ICSAP e entender sua influência multifatorial são importantes, uma vez que esse indicador é útil no diagnóstico situacional local e contribuir para planejar ações.

BACKGROUND:The United States is the only high-income nation without universal, government-funded or -mandated health insurance employing a unified payment system. The US multi-payer system leaves residents uninsured or underinsured, despite overall healthcare costs far above other nations. Single-payer (often referred to as Medicare for All), a proposed policy solution since 1990, is receiving renewed press attention and popular support. Our review seeks to assess the projected cost impact of a single-payer approach. METHODS AND FINDINGS:We conducted our literature search between June 1 and December 31, 2018, without start date restriction for included studies. We surveyed an expert panel and searched PubMed, Google, Google Scholar, and preexisting lists for formal economic studies of the projected costs of single-payer plans for the US or for individual states. Reviewer pairs extracted data on methods and findings using a template. We quantified changes in total costs standardized to percentage of contemporaneous healthcare spending. Additionally, we quantified cost changes by subtype, such as costs due to increased healthcare utilization and savings due to simplified payment administration, lower drug costs, and other factors. We further examined how modeling assumptions affected results. Our search yielded economic analyses of the cost of 22 single-payer plans over the past 30 years. Exclusions were due to inadequate technical data or assuming a substantial ongoing role for private insurers. We found that 19 (86%) of the analyses predicted net savings (median net result was a savings of 3.46% of total costs) in the first year of program operation and 20 (91%) predicted savings over several years; anticipated growth rates would result in long-term net savings for all plans. The largest source of savings was simplified payment administration (median 8.8%), and the best predictors of net savings were the magnitude of utilization increase, and savings on administrati

Background We aimed to estimate the effect of the community-based health insurance (CBHI) scheme on the magnitude of out-of-pocket (OOP) payments for the healthcare of the informal workers and their dependents. The CBHI scheme was piloted through a cooperative of informal workers, which covered seven unions in Chandpur Sadar Upazila, Bangladesh. Methods A quasi-experimental study was conducted using a case-comparison design. In total 1292 (646 insured and 646 uninsured) households were surveyed. Propensity score matching was done to minimize the observed baseline differences in the characteristics between the insured and uninsured groups. A two-part regression model was applied using both the probability of OOP spending and magnitude of such spending for healthcare in assessing the association with enrolment status in the CBHI scheme while controlling for other covariates. Results The OOP payment was 6.4% (p < 0.001) lower for medically trained provider (MTP) utilization among the insured compared with the uninsured. However, no significant difference was found in the OOP payments for healthcare utilization from all kind of providers, including the non-trained ones. Conclusions The CBHI scheme could reduce OOP payments while providing better quality healthcare through the increased use of MTPs, which consequently could push the country towards universal health coverage.

BACKGROUND: From January 2015 to December 2016, the health authorities in Burundi piloted the inclusion of child nutrition services into the pre-existing performance-based financing free health care policy (PBF-FHC). An impact evaluation, focused on health centres, found positive effects both in terms of volume of services and quality of care. To some extent, this result is puzzling given the harshness of the contextual constraints related to the fragile setting. METHODS: With a multi-methods approach, we explored how contextual and implementation constraints interacted with the pre-identified tracks of effect transmission embodied in the intervention. For our analysis, we used a hypothetical Theory of Change (ToC) that mapped a set of seven tracks through which the intervention might develop positive effects for children suffering from malnutrition. We built our analysis on (1) findings from the facility surveys and (2) extra qualitative data (logbooks, interviews and operational document reviews). FINDINGS: Our results suggest that six constraints have weighted upon the intervention: (1) initial low skills of health workers; (2) unavailability of resources (including nutritional dietary inputs and equipment); (3) payment delays; (4) suboptimal information; (5) restrictions on autonomy; and (6) low intensity of supervision. Together, they have affected the intensity of the intervention, especially during its first year. From our analysis of the ToC, we noted that the positive effects largely occurred as a result of the incentive and information tracks. Qualitative data suggests that health centres have circumvented the many constraints by relying on a community-based recruitment strategy and a better management of inputs at the level of the facility and the patient himself. CONCLUSION: Frontline actors have agency: when incentives are right, they take the initiative and find solutions. However, they cannot perform miracles: Burundi needs a holistic societal strateg

BACKGROUND:The United States is the only high-income nation without universal, government-funded or -mandated health insurance employing a unified payment system. The US multi-payer system leaves residents uninsured or underinsured, despite overall healthcare costs far above other nations. Single-payer (often referred to as Medicare for All), a proposed policy solution since 1990, is receiving renewed press attention and popular support. Our review seeks to assess the projected cost impact of a single-payer approach. METHODS AND FINDINGS:We conducted our literature search between June 1 and December 31, 2018, without start date restriction for included studies. We surveyed an expert panel and searched PubMed, Google, Google Scholar, and preexisting lists for formal economic studies of the projected costs of single-payer plans for the US or for individual states. Reviewer pairs extracted data on methods and findings using a template. We quantified changes in total costs standardized to percentage of contemporaneous healthcare spending. Additionally, we quantified cost changes by subtype, such as costs due to increased healthcare utilization and savings due to simplified payment administration, lower drug costs, and other factors. We further examined how modeling assumptions affected results. Our search yielded economic analyses of the cost of 22 single-payer plans over the past 30 years. Exclusions were due to inadequate technical data or assuming a substantial ongoing role for private insurers. We found that 19 (86%) of the analyses predicted net savings (median net result was a savings of 3.46% of total costs) in the first year of program operation and 20 (91%) predicted savings over several years; anticipated growth rates would result in long-term net savings for all plans. The largest source of savings was simplified payment administration (median 8.8%), and the best predictors of net savings were the magnitude of utilization increase, and savings on administrati

Objetivo: Identificar brechas de investigación pediátrica relacionadas con el origen del financiamiento, los estudios realizados sin aprobación ética del ente regulador nacional, los temas de investigación con respecto a las necesidades de salud y el tipo de estudio desarrollado. Materiales y métodos: Se realizó un estudio descriptivo, observacional y basado en datos de fuentes de información secundarias para identificar los proyectos de investigación pediátrica implementados en la República Dominicana desde 2005 al 2018 que incluyeron la población de 0 a 17 años de edad, sin importar patrocinador, institución responsable de la investigación y región del país.Resultados: Los proyectos de salud representaron el 17 % de las investigaciones realizadas con fondos nacionales y de ellos, el 7,5 % se relacionaba a la pediatría. Los trabajos en el campo de la salud desarrollados con fondos internacionales fueron 40,9 %, sin embargo, el número total de investigaciones fue menor. La investigación pediátrica representó un 38,9 % del registro de los ensayos clínicos de Clinical Trials con predominio de las instituciones privadas para la implementación de los estudios en un 64,6 % de los casos.Conclusiones: Se evidenció una discrepancia entre las líneas de investigación de necesidad nacional con las que fueron patrocinadas por la industria farmacéutica o por fondos nacionales e internacionales. Además, se realizaron ensayos clínicos sin la debida aprobación ética por el ente regulador nacional., Objective: To identify the gaps in pediatric research regarding the origin of financing, the studies conducted without the ethical approval of the national regulatory body, the research topics concerning healthcare needs, and the study type.Materials and methods: A descriptive and observational study based on secondary sources of information was conducted to identify pediatric research projects developed in the Dominican Republic from 2005 to 2018. Such projects included a population between 0 and 17 years of age, regardless of the sponsor, institution in charge of the research and country region.Results: From all research conducted with national funds, health research accounted for 17 %, out of which 7.5 % was related to children. Health research carried out with international funds accounted for 40.9 %. However, the total number of research projects was lower than the number of research conducted with national funds. Thirty eight point nine percent (38.9 %) of the clinical trials included in the Clinical Trials registry were related to pediatric research, out of which 64.6 % were sponsored by private institutions.Conclusions: We found discrepancies between the research topics urged by our country and those sponsored by the pharmaceutical industry or national/international funds. Moreover, clinical trials were conducted without the pertinent ethical approval of the national regulatory body.

The aim of this study is to contribute to previous research on the use of Prospective Payment Systems (PPS) based on Diagnosis Related Groups (DRG) in Sweden with an extended evaluation of variation in the utilisation of the system on recent data. This study looks specifically at within county financing and the role the system has played on the performance and behaviour of Swedish hospitals in regards to the number of DRG-weights registered in inpatient and outpatient healthcare. The method used for the analysis is based on a higher dimension fixed effects model, taking into account time-, county-, and diagnosis fixed effects. The data covers the 21 Swedish counties for the time period 2005 - 2017. The dependent variable of interest is DRG-weights, which is analysed for inpatient care, outpatient care and the total effect of the two combined. Several robustness tests are also run. The empirical analysis lacks most statistical significance, but a trend suggests that there is a positive impact on outpatient care regarding the amount of DRG-weights registered. The results also indicate a negative impact on inpatient care and a weak negative combined effect on the full sample. This implies that the use of the NordDRG-system may have ambiguous impacts on hospital behaviour. This study suggests an indication of how the financing system influences hospital behaviours and potential changes in quality seen through unplanned readmission rates.

This cross-sectional study identified characteristics of patients using an online crowdfunding platform for unmet financial obligations associated with cancer care.

The aim of this study is to contribute to previous research on the use of Prospective Payment Systems (PPS) based on Diagnosis Related Groups (DRG) in Sweden with an extended evaluation of variation in the utilisation of the system on recent data. This study looks specifically at within county financing and the role the system has played on the performance and behaviour of Swedish hospitals in regards to the number of DRG-weights registered in inpatient and outpatient healthcare. The method used for the analysis is based on a higher dimension fixed effects model, taking into account time-, county-, and diagnosis fixed effects. The data covers the 21 Swedish counties for the time period 2005 - 2017. The dependent variable of interest is DRG-weights, which is analysed for inpatient care, outpatient care and the total effect of the two combined. Several robustness tests are also run. The empirical analysis lacks most statistical significance, but a trend suggests that there is a positive impact on outpatient care regarding the amount of DRG-weights registered. The results also indicate a negative impact on inpatient care and a weak negative combined effect on the full sample. This implies that the use of the NordDRG-system may have ambiguous impacts on hospital behaviour. This study suggests an indication of how the financing system influences hospital behaviours and potential changes in quality seen through unplanned readmission rates.

In the context of the flat-rate reimbursements in healthcare, we reviewed physicians' behavior towards laboratory test ordering. We demonstrated how it could be improved when a specific stage of the patient management is considered. We took a multi-step approach to analyze the laboratory test orders in the context of planned laparoscopic cholecystectomy in a general teaching hospital. A reference order set was defined through a collaborative analysis between clinicians and laboratory physicians. The clinical and financial impacts were then evaluated over a period of 24 months. After the introduction of the reference order set, the number of laboratory tests per order decreased significantly for patients with cholecystitis of low severity. Above the monitoring of repeated orderings during a single stay, the major impacts were achieved by a drastic reduction of inappropriate orders, particularly in the field of bacteriology. The main effects of the order set were maintained throughout a follow-up period of 24 months. Our study demonstrated that, when considering laboratory test ordering optimization, reference order sets could achieve high levels of efficiency. To ensure high compliance to reference order sets, extensive collaboration between clinicians and laboratory physician is mandatory even if very sophisticated information systems are available.

26 p., ill., SCIENTIFIC REPORT .3 -- 1 INTRODUCTION 3 -- 2 RESULTS 4 -- 2.1 GENERAL ORGANISATION OF HEALTH CARE IN PRISONS 4 -- 2.2 PRIMARY CARE .14 -- 2.3 SECONDARY CARE .18 -- 2.4 MENTAL HEALTH CARE 21 -- 2.5 DENTAL CARE 24 -- 2.6 ADDITIONAL REMARKS MADE BY RESPONDENTS 24 -- 3 CONCLUSION .25 -- 3.1 PRIMARY CARE .26 -- 3.2 SECONDARY CARE .26 -- 3.3 MENTAL HEALTH CARE 26 -- 3.4 DENTAL CARE 26 -- 3.5 PAYMENT MODALITIES 26

Introduction: The improvement of national health systems is a global concern and is part of the discussions in the current international political agenda. In the past years, most south american countries have made efforts to improve their systems introducing reforms and public policies to reach universal access to health care for all citizens. It is necessary to study them, as recommended by the World Health Organization. According to it, this present work studies the evolution of the health system in Peru over a period of 10 years aiming to extract lessons for improvement as well as to provide inputs for other countries. Objectives: To analyze the evolution, good practices and variables influencing the functioning of the health system in Peru. Participants: Former ministers and deputy ministers of health, PAHO representatives, academics, technical experts and representatives of civil society. Methods: Quality approach research, interviews that were recorded, transcribed and coded to identify and analyze the main social representations interviewers had regarding the health system. Results: Increasing funding did not result in increasing access of population to health care, the rectory of Health Ministry was slightly strengthened, and lack of access to comprehensive care and quality, interviewers are in favor of creating a single national financing fund and one health plan for all Peruvians. Conclusions: The rectory has not been strengthening enough. Financial coverage has been improved although the access to health care services has not, and there are consistent gaps in human resources, infrastructure, equipment and access to medicines, in addition to organizational inefficiency., Los últimos años, la mayoría de países sudamericanos han hecho esfuerzos por mejorarlos introduciendo reformas y políticas públicas con el objetivo que la población tenga acceso universal a atención de salud. La Organización Mundial de la Salud recomienda estudiarlos; en ese sentido, se decidió analizar la evolución del sistema de salud del Perú en un período de 10 años con el propósito de extraer aprendizajes para fortalecerlo y también como insumo para otros países. Objetivos: Analizar la evolución, las buenas prácticas y los factores que influyen en el funcionamiento del sistema de salud de Perú. Participantes: Ex ministros y viceministros de salud, representantes de la OPS, académicos, técnicos y representantes de la sociedad civil. Métodos: Se realizó un estudio cualitativo mediante entrevistas a profundidad que fueron grabadas, transcritas y codificadas para identificar y analizar las principales representaciones sociales que tienen los entrevistados respecto al sistema de salud. Resultados: El incremento del financiamiento no significo incremento del acceso a atención de salud, la rectoría del Ministerio de Salud se fortaleció poco, falta acceso a atención integral y de calidad, se propone crear un solo fondo nacional de financiamiento y un solo plan de salud para todos los peruanos. Conclusiones: La rectoría no se ha consolidado, se reconoce el mejoramiento de la cobertura financiera pero no del acceso a servicios de salud y hay serias brechas de recursos humanos, infraestructura, equipamiento y acceso a medicamentos, a lo que se suma ineficiencia organizacional.

26 p., ill., SCIENTIFIC REPORT .3 -- 1 INTRODUCTION 3 -- 2 RESULTS 4 -- 2.1 GENERAL ORGANISATION OF HEALTH CARE IN PRISONS 4 -- 2.2 PRIMARY CARE .14 -- 2.3 SECONDARY CARE .18 -- 2.4 MENTAL HEALTH CARE 21 -- 2.5 DENTAL CARE 24 -- 2.6 ADDITIONAL REMARKS MADE BY RESPONDENTS 24 -- 3 CONCLUSION .25 -- 3.1 PRIMARY CARE .26 -- 3.2 SECONDARY CARE .26 -- 3.3 MENTAL HEALTH CARE 26 -- 3.4 DENTAL CARE 26 -- 3.5 PAYMENT MODALITIES 26

69 p., ill., TABLE OF CONTENTS 1 -- LIST OF FIGURES 2 -- LIST OF TABLES 3 -- INTRODUCTION 6 -- BACKGROUND 6 -- 1.2. AIM OF THE STUDY; OUTLINE & METHODS 7 -- 2. CHARACTERISTICS OF THE BELGIAN PRISON POPULATION 10 -- 3. HEALTH PROBLEMS IN THE PRISON POPULATION 12 -- 4. HEALTH CARE USE IN BELGIAN PRISONS 17 -- 5. HEALTH CARE ORGANIZATION IN BELGIAN PRISONS 21 -- 5.1. CURRENT ORGANIZATION OF HEALTH CARE 21 -- 5.2. PROBLEMS IN ACTUAL HEALTH CARE PROVISION 24 -- 5.3. BELGIAN HEALTH CARE ORGANIZATION COMPARED TO FOUR OTHER COUNTRIES 26 -- 6. LEGISLATION RELATED TO HEALTH CARE IN PRISON 30 -- 6.1. THE RIGHT TO QUALITY HEALTH CARE 30 -- 6.2. COMPETENCIES OF THE AUTHORITIES RELATED TO HEALTH CARE IN BELGIAN PRISONS 32 -- 6.3. INSURABILITY FOR HEALTH CARE IN BELGIAN PRISONS 32 -- 7. HEALTH CARE COSTS IN BELGIAN PRISONS 34 -- 7.1. FACTS AND FIGURES 34 -- 8. SCENARIOS FOR FUTURE HEALTH CARE ORGANIZATION IN BELGIAN PRISONS 36 -- 8.1. GENERAL 36 -- 8.2. PRIMARY CARE 38 -- 8.3. SECONDARY CARE 38 -- 8.4. MENTAL CARE 39 -- 8.5. DENTAL CARE 40 -- 8.6. INSURABILITY 40 -- 8.7. PAYMENT MODALITIES FOR PRISON HEALTH CARE 41 -- 8.8. CENTRAL SERVICES 42 -- 9. CONCLUSIONS AND DISCUSSION 42 -- APPENDICES 53 -- APPENDICES 1 TO 10 53 -- APPENDIX 11 – EXAMPLES OF GUIDELINES FOR PENITENTIARY HEALTH CARE 54 -- REFERENCES 61

10 p., ill.

Diplomová práce se zabývá možnostmi a financováním zdravotní péče o terminálně nemocné v České republice. Její charakter je teoreticko-empirický. Teoretická část představuje literární kompilaci primárních zdrojů ve sledované problematice a nabízí teoretická východiska pro empirickou část. Výzkum byl zaměřen zejména na finanční oblast respondentů, na fakt, zda mají respondenti dostatek finančních prostředků na péči a z jakých zdrojů finance čerpají a jaké možnosti péče by využili. Výzkum byl orientován na respondenty pečující o těžce nemocné v domácím prostředí. Pro sběr dat byla využita technika dotazníku vlastní tvorby. Závěry výzkumu upozorňují na dobré finanční podmínky respondentů a důležitost jednotlivých profesí v péči o těžce nemocné a umírající., The thesis deals with options and financing health care for the terminally ill in the Czech Republic. Her character is a theoretic- empirical. The theoretical part presents literary compilation of primary sources in the monitored issues and provides a theoretical basis for the empirical part. Research was focused on the financial area of respondents to the fact if the respondents have sufficient funds to care and from which sources funds are and what care options would use. The research was focused on the respondents taking care of seriously ill at home. For data collection was used the questionnaire technique own creation. Conclusions of this research highlight the good financial condition of the respondents and the importance of various professions in the care of seriously ill and dying., Fakulta zdravotnických studií, Hodnocení vedoucího: velmi dobře minus Hodnocení oponenta: dobře Doplňující otázky k obhajobě: 1. Proč nebylo v rámci šetření pracováno i se závažností diagnózy, soběstačností nemocného, jeho věkem, případně jeho prognózou nebo jinými proměnnými? Myslíte si, že tyto proměnné mají vliv na náročnost péče a finanční zátěž? 2. Z jakého důvodu porovnáváte výsledky své práce pouze s jednou závěrečnou prací? 3. Jak bude nakládáno s výsledky Vašeho výzkumného šetření? Obhajoba diplomové práce s prezentací dobrá

20 p., ill., SCIENTIFIC REPORT 4 -- 1 INTRODUCTION 4 -- 2 METHODS 5 -- 3 RESULTS 5 -- 3.1 OVERALL COSTS OF HEALTHCARE PROVISION IN BELGIAN PRISONS 5 -- 3.2 COSTS OF HEALTHCARE PROVISION IN BELGIAN PRISONS BY TYPE OF COST 6 -- 3.2.1 Human resources costs 9 -- 3.2.2 Health care delivery costs 15 -- 3.2.3 Pharmaceutical Costs 15 -- 3.3 COSTS OF HEALTHCARE PROVISION IN BELGIAN PRISONS BY LINE OF CARE 18 -- 3.3.1 First line versus second line healthcare costs 18 -- 3.3.2 Mental healthcare costs 18 -- 4 DISCUSSION 19 -- REFERENCES 20

73 p., ill., SCIENTIFIC REPORT 7 -- 1 INTRODUCTION 7 -- 2 METHODOLOGY .8 -- 3 CURRENT SITUATION .9 -- 3.1 PRISON POPULATION .9 -- 3.2 HEALTH CARE ORGANIZATION/PROVISION .10 -- 3.3 HEALTH CARE USE 10 -- 3.4 HEALTH CARE COSTS .12 -- 3.5 GENERAL PROBLEMS .12 -- 4 SCENARIOS 13 -- 4.1 TRANSVERSAL KEY PRINCIPLES 13 -- 4.2 PRIMARY CARE 14 -- International recommendations 14 -- Current primary health care organization and delivery 15 -- Primary health care use 15 -- Primary health care costs 17 -- Primary care problems .17 -- Building blocks and scenarios 18 -- 4.3 SECONDARY CARE 28 -- International recommendations 28 -- Secondary care organization/provision 28 -- Secondary health care use 29 -- Secondary heath care costs .30 -- Secondary health care problems 31 -- Building blocks and scenarios 33 -- 4.4 SPECIALIZED MENTAL HEALTH CARE .41 -- International recommendations 41 -- Specialised mental health care organisation/provision 42 -- Specialized mental health care use 43 -- Specialized mental health care costs 43 -- Specialized mental health care problems 45 -- Building blocks and scenarios 45 -- 4.5 DENTAL AND ORAL HEALTH 52 -- International recommendations 52 -- Dental and oral health care organisation/provision 52 -- Dental and oral health care use 52 -- Dental and oral health care costs 52 -- Dental and oral health care problems 54 -- Building blocks and scenarios 55 -- 4.6 PHARMACEUTICAL SERVICES 57 -- International recommendations 57 -- Pharmaceutical services organisation/provision .58 -- Pharmaceutical services use 59 -- Pharmaceutical costs 59 -- Pharmaceutical services problems 61 -- Building blocks and scenarios 62 -- 4.7 PAYMENT MODALITIES 68 -- Payment modalities: 68 -- Current situation and challenges for introducing new payment modalities 69 -- REFERENCES 70

118 p., ill., SCIENTIFIC REPORT .8 -- 1 INTRODUCTION 8 -- 1.1 BACKGROUND INFORMATION 8 -- 1.2 OBJECTIVE 8 -- 2 METHODS .9 -- 2.1 PROTOCOL REGISTRATION 9 -- 2.2 ELIGIBILITY CRITERIA 9 -- 2.3 INFORMATION SOURCES 10 -- 2.3.1 Electronic database search .10 -- 2.3.2 Search strategies .10 -- 2.3.3 Supplementary data sources .10 -- 3 STUDY SELECTION .11 -- 3.1 BELGIUM-SPECIFIC SEARCH 11 -- 3.2 SYSTEMATIC REVIEW SEARCH .11 -- 4 RESULTS 13 -- 4.1 BACKGROUND 13 -- 4.2 GENERAL HEALTH AND HEALTHCARE-SEEKING BEHAVIOUR 15 -- 4.2.1 Belgian studies 15 -- 4.2.2 Systematic reviews .18 -- 4.3 TUBERCULOSIS .18 -- 4.3.1 Belgian studies 18 -- 4.3.2 Systematic reviews .19 -- 4.4 HIV, VIRAL HEPATITIS, AND BACTERIAL STI .19 -- 4.4.1 Belgian studies 19 -- 4.4.2 Systematic reviews .21 -- 4.5 MENTAL HEALTH 21 -- 4.5.1 Belgian studies 21 -- 4.5.2 Systematic reviews .26 -- 4.6 DRUGS AND DRUG ADDICTION IN PRISON 30 -- 4.6.1 Belgian studies 30 -- 4.6.2 Systematic reviews .32 -- 4.7 AGEING IN PRISON .34 -- 4.7.1 Belgian studies 34 -- 4.7.2 Systematic reviews .35 -- 4.8 EUTHANASIA (BELGIAN PUBLICATIONS) .35 -- 4.9 MEDICATION USE IN PRISON (BELGIAN PUBLICATIONS) 35 -- 4.10 ISSUES SPECIFIC TO FEMALE PRISONERS 36 -- 4.10.1 Belgian studies 36 -- 4.10.2 Systematic reviews .36 -- 5 LIMITATIONS 38 -- 6 DISCUSSION 38 -- APPENDICES 41 -- APPENDIX 1. SEARCH STRATEGIES 41 -- APPENDIX 2. CHARACTERISTIC OF INCLUDED STUDIES 49 -- APPENDIX 3. EXCLUDED STUDIES 86 -- REFERENCES . 108

52 p., ill., Il est prévu de transférer la responsabilité des soins de santé en prison du ministre de la Justice à celui de la santé publique. En vue de ce transfert, le Centre fédéral d’Expertise des Soins de santé (KCE) a été invité à faire le point sur l'organisation actuelle des soins pénitentiaires et à formuler des propositions de réforme. Beaucoup de détenus sont en mauvaise santé dans notre pays. Leur consommation de médicaments est souvent importante, en particulier pour les psychotropes. Ils consultent en moyenne 18 fois par an un médecin généraliste et 3 fois un psychiatre, des chiffres toutefois très variables d’une prison à l’autre. Les professionnels des soins travaillant en prison sont souvent très dévoués, mais ils doivent affronter de nombreux problèmes : manque de ressources financières et humaines, de coordination, de continuité des soins, de communication, de formation et fragmentation des compétences entre niveaux de pouvoir. Le KCE propose un certain nombre de scénarios d'amélioration afin de pouvoir dispenser aux détenus des soins de santé équivalents à ceux en dehors de la prison, ce qui est d’ailleurs exigé par les législations internationales autant que par la loi belge., PRÉFACE 1 -- SYNTHÈSE 2 -- 1. INTRODUCTION 8 -- 1.1. CONTEXTE 8 -- 1.2. NOTRE MÉTHODE DE TRAVAIL 8 -- 2. CARACTÉRISTIQUES DE LA POPULATION CARCÉRALE BELGE 10 -- 2.1. 35 PRISONS POUR 11 040 DÉTENUS 10 -- 2.2. DIVERSITÉ ET ROTATION IMPORTANTES 12 -- 3. PROBLÈMES DE SANTÉ DES DÉTENUS EN BELGIQUE 12 -- 3.1. CONSOMMATION ÉLEVÉE DE MÉDICAMENTS 12 -- 3.2. SURTOUT POUR DES PROBLÈMES DE SANTÉ MENTALE 13 -- 3.3. LES DÉTENUS SONT GÉNÉRALEMENT EN MOINS BONNE SANTÉ QUE LE RESTE DE LA POPULATION 15 -- 4. RECOURS AUX SOINS DE SANTÉ DANS LES PRISONS BELGES 16 -- 4.1. SURTOUT LE MÉDECIN GÉNÉRALISTE ET LE PSYCHIATRE 16 -- 4.2. GRANDE VARIABILITÉ ENTRE LES DÉTENUS 17 -- 4.3. ET ENTRE LES PRISONS 17 -- 4.4. ADÉQUATION ENTRE LES BESOINS DE SANTÉ ET L’OFFRE DE SOINS 20 -- 5. ANALYSE CRITIQUE DE L’ORGANISATION DES SOINS DE SANTÉ DANS LES PRISONS BELGES 20 -- 5.1. DROIT À DES SOINS ÉQUIVALENTS, CONTINUITÉ DES SOINS ET INDÉPENDANCE DES PRESTATAIRES DE SOINS 20 -- 5.2. DANS L'ATTENTE DE LA MISE EN ŒUVRE DE LA LOI DE PRINCIPES, LES DROITS GÉNÉRAUX S'APPLIQUENT 22 -- 5.3. FRAGMENTATION DES COMPÉTENCES 22 -- 5.4. ORGANISATION DES SOINS DE 1RE ET 2E LIGNES 24 -- 5.5. PROBLÈMES IDENTIFIÉS AU NIVEAU DES SOINS DE SANTÉ PÉNITENTIAIRES 25 -- 5.6. LES DÉTENUS NE RELÈVENT PAS DE L'ASSURANCE MALADIE OBLIGATOIRE 27 -- 6. COÛT DES SOINS DE SANTÉ DANS LES PRISONS BELGES 27 -- 6.1. PLUS DE 43 MILLIONS D'EUROS CHAQUE ANNÉE, DONT LA MAJEURE PARTIE SONT DES FRAIS DE PERSONNEL 27 -- 6.2. SOUS-ESTIMATION POSSIBLE DES FRAIS 28 -- 6.3. GRANDE VARIABILITE DES FRAIS PAR DETENU, SELON LA PRISON 28 -- 7. PISTES POUR UNE RÉFORME DES SOINS PÉNITENTIAIRES 30 -- 7.1. PRINCIPES DE BASE 30 -- 7.2. RÉFORME DES SOINS DE 1RE LIGNE : 31 -- 7.2.1. Une équipe de soins interdisciplinaire 31 -- 7.2.2. Un check up approfondi dès l’entrée en prison 32 -- 7.2.3. Dès l’entrée, penser à la continuité des soins 32 -- 7.2.4. Dépister et traiter systématiquement les maladies transmissibles 32 -- 7.2.5. Une approche globale et coordonnée de

23 p., ill., SCIENTIFIC REPORT 3 -- 1 INTRODUCTION 3 -- 2 RELEVANT LEGISLATION 4 -- 2.1 INTERNATIONAL STANDARDS 4 -- 2.2 NATIONAL STANDARDS 5 -- 3 LEGAL ISSUES 7 -- 3.1 THE RIGHT TO HIGH QUALITY HEALTH CARE 7 -- 3.1.1 The principle of equivalence 7 -- 3.1.2 Continuity of care 8 -- 3.1.3 Independence of health care staff 9 -- 3.2 THE RIGHT TO CHOOSE A HEALTH CARE PRACTITIONER FREELY 10 -- 3.3 THE RIGHT TO BE INFORMED 11 -- 3.3.1 The right to be informed on one’s state of health 11 -- 3.3.2 The right to be informed on a medical intervention 12 -- 3.4 THE RIGHT TO HEALTH RECORDS, INCLUDING THE POSSIBILITY OF PERUSAL AND -- OBTAINING A COPY 13 -- 3.5 THE RIGHT TO CONSENT FREELY TO A MEDICAL INTERVENTION 13 -- 3.6 THE RIGHT TO THE PROTECTION OF ONE’S PRIVACY 15 -- 3.7 THE RIGHT TO FILE A COMPLAINT WITH AN OMBUDSMAN SERVICE 18 -- 3.8 SOCIAL SECURITY RIGHTS FOR PRISONERS 18 -- 4 CONCLUSION 19 -- 5 DISCUSSION 20 -- REFERENCES 21

51 p., ill., Er zijn plannen om de bevoegdheid voor gezondheidszorg in gevangenissen over te hevelen van de minister van Justitie naar die van Volksgezondheid. Ter voorbereiding werd aan het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) gevraagd om de huidige zorgorganisatie in de gevangenissen in kaart te brengen, en om hervormingsvoorstellen te formuleren. Vele gevangenen in ons land verkeren in een slechte gezondheid. Ze gebruiken vaak geneesmiddelen, vooral psychofarmaca. Gemiddeld raadplegen ze jaarlijks 18 maal een huisarts en 3 maal een psychiater, maar tussen de gevangenen en gevangenissen is er een grote variabiliteit. De zorgverleners in gevangenissen zijn vaak zeer toegewijd, maar de zorg kampt met vele problemen: te weinig financiële en menselijke middelen, gebrek aan coördinatie, zorgcontinuïteit, communicatie, opleiding en de bevoegdheden zijn versnipperd. Het KCE stelt een aantal scenario’s voor ter verbetering, zodat de zorg aan gevangenen gelijkwaardig wordt met deze buiten de gevangenis, zoals de internationale en Belgische wetgeving het vereisen., 1 INLEIDING 7 -- 1.1 ACHTERGROND 7 -- 1.2 HOE GINGEN WE TE WERK? 7 -- 2 KENMERKEN VAN DE BELGISCHE GEVANGENISBEVOLKING 9 -- 2.1 35 GEVANGENISSEN VOOR 11 040 GEVANGENEN 9 -- 2.2 GROTE DIVERSITEIT EN TURNOVER 11 -- 3 GEZONDHEIDSPROBLEMEN VAN DE GEVANGENEN IN BELGIË 11 -- 3.1 HOOG GENEESMIDDELENGEBRUIK… 11 -- 3.2 …VOORAL VOOR GEESTELIJKE GEZONDHEIDSPROBLEMEN 12 -- 3.3 GEVANGENEN IN HET ALGEMEEN MINDER GEZOND DAN DE REST VAN DE BEVOLKING 14 -- 4 GEBRUIK VAN GEZONDHEIDSZORG IN DE BELGISCHE GEVANGENISSEN 15 -- 4.1 VOORAL HUISARTS EN PSYCHIATER 15 -- 4.2 GROTE VARIABILITEIT TUSSEN GEVANGENEN… 16 -- 4.3 … EN GEVANGENISSEN 16 -- 4.4 AFSTEMMEN VAN ZORGGEBRUIK OP ZORGBEHOEFTE 19 -- 5 DE ORGANISATIE VAN ZORG IN DE BELGISCHE GEVANGENISSEN 19 -- 5.1 RECHT OP GELIJKWAARDIGE ZORG, ZORGCONTINUÏTEIT EN ONAFHANKELIJKE ZORGVERLENERS 19 -- 5.2 IN AFWACHTING VAN DE UITVOERING VAN DE BASISWET, ZIJN DE ALGEMENE RECHTEN VAN TOEPASSING 21 -- 5.3 VERSNIPPERING VAN BEVOEGDHEDEN 21 -- 5.4 ORGANISATIE VAN EERSTE- EN TWEEDELIJNSZORG AAN GEVANGENEN 23 -- 5.5 VASTGESTELDE PROBLEMEN IN DE PENITENTIAIRE ZORG 24 -- 5.6 GEVANGENEN VALLEN NIET ONDER DE VERPLICHTE ZIEKTEVERZEKERING 26 -- 6 KOSTEN VAN DE GEZONDHEIDSZORG IN BELGISCHE GEVANGENISSEN 26 -- 6.1 JAARLIJKS RUIM €43 MILJOEN, WAARVAN GROOTSTE DEEL PERSONEELSKOSTEN 26 -- 6.2 KOSTEN MOGELIJK ONDERSCHAT 27 -- 6.3 GROTE VARIABILITEIT IN KOSTEN PER GEVANGENE, AFHANKELIJK VAN DE GEVANGENIS 27 -- 7 SCENARIO’S VOOR DE TOEKOMSTIGE PENITENTIAIRE ZORG IN BELGIË 29 -- 7.1 BASISPRINCIPES VOOR DE HERVORMING VAN DE ZORG 29 -- 7.2 HERVORMING VAN DE EERSTELIJNSZORG: EEN INTERDISCIPLINAIR ZORGTEAM 30 -- 7.2.1 Een interdisciplinair zorgteam 30 -- 7.2.2 Een uitgebreide medische intake bij aankomst 31 -- 7.2.3 Zorgcontinuïteit van bij aankomst 31 -- 7.2.4 Screenen en systematisch behandelen van overdraagbare aandoeningen 31 -- 7.2.5 Een globale en gecoördineerde aanpak 31 -- 7.2.6 Herzien van de minimale normen voor het zorgpersoneel 32 -- 7.2.7 Gevangenen betrekken b

14 p., ill., 1 INTRODUCTION 3 -- 2 POLICY RELATED TO HEALTH PROMOTION, PREVENTION AND WELLBEING IN THE FLEMISH COMMUNITY 6 -- 2.1 STRATEGIC PLAN HELP AND ASSISTANCE TO PRISONERS 6 -- 3 INSTANCES OFFERING SERVICES RELATED TO HEALTH PROMOTION, PREVENTION AND WELLBEING IN THE FLEMISH COMMUNITY 8 -- 3.1 INSTANCES OFFERING OVERALL PSYCHO-SOCIAL ASSISTANCE 8 -- 3.2 INSTANCES OFFERING CARE IN A SPECIFIC DOMAIN 8 -- 3.3 SCREENING FOR CONTAGIOUS DISEASES IN PRISON 8 -- 3.4 DRUGS POLICY AND DRUGS PROGRAMS 9 -- 3.4.1 Substitution treatment 9 -- 3.4.2 Harm reduction Interventions 9 -- 3.4.3 Program ‘B.Leave’ in Ruiselede 9 -- 3.4.4 Drug free wings in Bruges and Hasselt 10 -- 3.4.5 Central Registration Points (CRPs) 10 -- 4 ORGANISATION AND COORDINATION IN PRISONS IN BRUSSELS 11 -- 5 POLICY AND INSTANCES OFFERING SERVICES RELATED TO HEALTH PROMOTION, PREVENTION AND WELLBEING IN THE FÉDÉRATION WALLONIE - BRUXELLES 13 -- 5.1 SERVICES RELATED TO HEALTH PROMOTION, PREVENTION AND WELLBEING 13 -- 6 CONCLUSION 14

53 p., ill., 1 INTRODUCTION 5 -- 2 METHODS .6 -- 2.1 DATA SOURCES 6 -- 2.2 DATA MANAGEMENT 7 -- 2.3 DATA ANALYSIS 8 -- 3 RESULTS 9 -- 3.1 GENERAL DESCRIPTION OF THE POPULATION 9 -- 3.2 MEDICAL CONSULTATIONS 12 -- 3.3 DETERMINANTS OF MEDICAL CONSULTATIONS 14 -- 3.3.1 Bivariate analysis .14 -- 3.3.2 Multilevel multivariate analysis 25 -- 3.4 MEDICAL PRESCRIPTIONS 31 -- 4 DISCUSSION 36

69 p., ill., SCIENTIFIC REPORT 4 -- 1 BACKGROUND 4 -- 2 SITUATION ANALYSIS 6 -- 2.1 METHODS 6 -- 2.1.1 Setting up of an expert and stakeholder group 6 -- 2.1.2 Review of available data 6 -- 2.1.3 Interviews of key informants 7 -- 2.1.4 Questionnaire survey of head MD in prisons 8 -- 2.2 TARGET POPULATION 9 -- 2.2.1 How many prisons are there? 9 -- 2.2.2 How many prisoners are there? 9 -- 2.2.3 What is the demographic and social profile of prisoners? 12 -- 2.2.4 What are the health needs? 13 -- 2.3 HEALTH CARE ORGANIZATION AND PROVISION 13 -- 2.3.1 What health care services are available? 13 -- 2.3.2 How many health care providers are involved? 15 -- 2.4 SWOT ANALYSIS BASED ON KEY INFORMANTS’ VIEW 18 -- 2.4.1 Strengths 18 -- 2.4.2 Weakness 19 -- 2.4.3 Opportunities 24 -- 2.4.4 Possibilities for improvement 26 -- 2.4.5 Conclusion 28 -- 2.5 SURVEY AMONG MEDICAL DOCTORS 29 -- 2.5.1 Availability 29 -- 2.5.2 Accessibility 31 -- 2.5.3 Comprehensiveness 32 -- 2.5.4 Continuity 33 -- 2.5.5 Quality 34 -- 2.5.6 Problems & Solutions 35 -- 2.6 DISCUSSION OF THE MAIN RESULTS 35 -- 2.6.1 Availability 35 -- 2.6.2 Comprehensiveness 36 -- 2.6.3 Accessibility 37 -- 2.6.4 Continuity 37 -- 2.6.5 Quality of care 38 -- 2.7 STRENGTHS AND LIMITATIONS OF THE USED METHODS AND DATA SOURCES 39 -- REFERENCES 40 -- APPENDICES 45

The staggering statistics in health conditions of India demand quick actions, and thus it is advised to come up with a solution which takes less time as compared to a complete design of a new system. This paper starts with background study of UK, Netherlands and Indian health care financing models, followed by an analysis ofeasibility of transplantation of financing policies from the UK to India. It is proved from literature survey that UK and Netherlands has one of the best financing models. Though Netherlands' model is also considered; but due toeconomic incompatibility of model in India, and UK's similar legislation background with India, UK's health care system is chosen to be analyzed further as a donor country in this case. A thorough study through Hofstede's cultural dimensions (Hofstede, Hofstede, and Minkov, 2010),family of nations, and actors pulling-in and goodness of fit perspectives study end with strategies of implementation to provide some recommendations for successful transplantation. The results of transplantation can be interpreted as "great example" (Rose, 1993) if the strategies of implementation are clearly kept in mind., Technology, Policy and Management

The staggering statistics in health conditions of India demand quick actions, and thus it is advised to come up with a solution which takes less time as compared to a complete design of a new system. This paper starts with background study of UK, Netherlands and Indian health care financing models, followed by an analysis ofeasibility of transplantation of financing policies from the UK to India. It is proved from literature survey that UK and Netherlands has one of the best financing models. Though Netherlands' model is also considered; but due toeconomic incompatibility of model in India, and UK's similar legislation background with India, UK's health care system is chosen to be analyzed further as a donor country in this case. A thorough study through Hofstede's cultural dimensions (Hofstede, Hofstede, and Minkov, 2010),family of nations, and actors pulling-in and goodness of fit perspectives study end with strategies of implementation to provide some recommendations for successful transplantation. The results of transplantation can be interpreted as "great example" (Rose, 1993) if the strategies of implementation are clearly kept in mind., Technology, Policy and Management

An optimal functioning health system delivers quality, timely, and efficient services to all individuals in a convenient and accessible location. The United Arab Emirates (UAE) is a rapidly developing country hosting a multinational population with emerging health issues and needs that are influencing the growth and direction of the health system. This study offers a comprehensive review and appraisal of the structure and function of the UAE health system using the Health Systems in Transition (HiT) framework. A two-stage mixed-methods research design was used; stage one, included completing each chapter of the HiT framework using published and unpublished data; stage two entailed convening three focus group discussions with participants selected from key stakeholder groups including managers, service providers, and patients of the UAE health system to further explore the health system challenges and gaps identified after completing the HiT. Focus group discussions were taped, transcribed verbatim, and thematically analyzed. Study findings revealed that the UAE health system includes the majority of the World Health Organization's components of a well-functioning health system. Specifically, governmental leaders are committed to good health and service, a wide range of accredited health care services are available, the UAE population has universal healthcare coverage, and the system is well-resourced in terms of infrastructure, financing, and human resources. However, the study highlighted a number of challenges and potential areas of health reform including: health sector fragmentation; rising costs and uncertain outcomes; proper regulation of the fast expanding private sector; shortage of national health human resources coupled with difficulty in retaining and supporting career advancement of expatriate human resources; population growth and increased levels of chronic disease risk factors. The UAE health system has developed on an impressi

98 p., ill., 1. DESCRIPTION OF THE SITUATION IN NHS ENGLAND 8 -- 1.1. MENTAL HEALTH CARE PROFESSIONS AND THEIR ROLES 8 -- 1.1.1. Overview of professions and functions 8 -- 1.1.2. Regulation 8 -- 1.1.3. Primary care graduate mental health worker (PCGMHW) 9 -- 1.1.4. Psychologists, clinical psychologists and assistant clinical psychologists 9 -- 1.1.5. Psychotherapist 10 -- 1.1.6. Counsellors 10 -- 1.1.7. High intensity IAPT therapists 10 -- 1.1.8. Psychological wellbeing practitioner 11 -- 1.2. ORGANIZATION AND REFERRAL SCHEME 11 -- 1.2.1. Improving Access to Psychological Therapies (IAPT) programme .13 -- 1.2.2. Self-referral and referral by GP 14 -- 1.2.3. Private therapy and charities 14 -- 1.3. ELIGIBLE INDICATIONS 14 -- 1.4. OFFERED TREATMENTS 14 -- 1.5. PAYMENT MECHANISMS 17 -- 1.5.1. Payment of the GP practices 17 -- 1.5.2. Payment of secondary care: mental health and community services .17 -- 1.5.3. Payment of the IAPT programme 19 -- 1.5.4. Out-of-pocket payments 19 -- 1.6. QUALITY MANAGEMENT 19 -- 2. DESCRIPTION OF THE SITUATION IN THE NETHERLANDS 20 -- 2.1. MENTAL HEALTH CARE PROFESSIONS AND THEIR ROLES .20 -- 2.1.1. GP’s mental health care practice assistant 21 -- 2.1.2. Health care psychologist, clinical psychologist and clinical neuropsychologist 21 -- 2.1.3. Psychotherapist 21 -- 2.1.4. Mental health nurse specialists .22 -- 2.1.5. Orthopedagogists 22 -- 2.2. ORGANIZATION AND REFERRAL SCHEME 22 -- 2.2.1. Primary care: GP practice 23 -- 2.2.2. Primary mental health care: “generalistische basis” .24 -- 2.2.3. Secondary and tertiary mental health care: “gespecialiseerde GGZ” .24 -- 2.2.4. Responsible treatment professional (“hoofdbehandelaar”) .25 -- 2.3. REIMBURSED INDICATIONS 25 -- 2.4. REIMBURSED TREATMENTS 25 -- 2.5. PAYMENT MECHANISMS 27 -- 2.5.1. Payment of the GPs mental health practice assistant 27 -- 2.5.2. Payment of the primary mental health care (“generalistische basis GGZ”) 27 -- 2.5.3. Payments in the secondary and tertiary mental health care .28 -- 2.5.

40 p., ill., Anxiété, stress, burnout, sentiments dépressifs, soucis relationnels ou familiaux,… nous traversons tous des moments de vie difficiles, qui pourraient souvent être surmontés si nous avions l’aide d’un professionnel formé à cet effet. Mais les soins psychologiques ne sont généralement pas pris en charge par l’assurance maladie, et ils restent donc peu accessibles. Le Centre fédéral d’Expertise des Soins de Santé (KCE) a analysé les modèles d’organisation et de remboursement des soins psychologiques mis en place dans d’autres pays, pour ensuite élaborer un modèle adaptable à la réalité belge. Il propose un système à deux ‘étages’ : un premier niveau généraliste, largement accessible, pour accueillir sans restriction les problèmes courants et modérés, et un second niveau, d’accès plus restreint, mais permettant de délivrer des soins spécialisés à ceux pour qui le premier niveau n’est pas suffisant., PRÉFACE 1 -- MESSAGES CLÉS 2 -- SYNTHÈSE 4 -- 1. POURQUOI CETTE ÉTUDE? 6 -- 1.1. LA DÉTRESSE PSYCHIQUE, UN PROBLÈME MAJEUR 6 -- 1.2. UN IMPACT SOCIÉTAL CONSIDÉRABLE 6 -- 1.3. LES SOINS PSYCHOLOGIQUES DOIVENT ÊTRE RENFORCÉS. 6 -- 1.4. VERS UN NOUVEAU MODÈLE D’ORGANISATION ET DE FINANCEMENT POUR LES SOINS -- PSYCHOLOGIQUES. 7 -- 2. QUELLE EST LA SITUATION ACTUELLE EN BELGIQUE? 9 -- 2.1. ORGANISATION ACTUELLE DE L’OFFRE DE SOINS PSYCHOLOGIQUES 9 -- 2.1.1. Un premier niveau avec accès direct : 9 -- 2.1.2. Un deuxième niveau de soins spécialisés ambulatoires : 10 -- 2.1.3. Un troisième niveau plus hospitalo-centré : 10 -- 2.2. LES PRINCIPAUX PROBLÈMES IDENTIFIÉS 11 -- 2.2.1. Le premier contact est difficile 11 -- 2.2.2. L’offre manque de clarté et de garanties de qualité 11 -- 2.2.3. Les coûts pour le patient sont élevés 12 -- 2.2.4. Les listes d’attente sont longues 12 -- 2.2.5. La continuité des soins n’est pas garantie 12 -- 3. ACCÈS AUX SOINS PSYCHOLOGIQUES À L’ÉTRANGER13 -- 3.1. SOINS PSYCHOLOGIQUES EN ACCÈS DIRECT 13 -- 3.2. CONDITIONS D’ACCÈS AUX SOINS PSYCHOLOGIQUES SPÉCIALISÉS.14 -- 3.2.1. Gatekeeping 14 -- 3.2.2. Indications 14 -- 3.2.3. Modalités thérapeutiques 14 -- 3.2.4. Nombre de séances 14 -- 4. LES PROJETS PILOTES FLAMANDS DE PSYCHOLOGIE DE 1RE LIGNE16 -- 4.1. OBJECTIFS. 16 -- 4.2. ASPECTS ORGANISATIONNELS 16 -- 4.3. PRINCIPAUX RÉSULTATS 16 -- 5. PISTES POUR L’ORGANISATION DES SOINS PSYCHOLOGIQUES17 -- 5.1. UN SYSTÈME À DEUX COMPOSANTES 17 -- 5.2. INTERVENANTS : À CHAQUE NIVEAU SA SPÉCIFICITÉ 19 -- 5.2.1. En 1re ligne : des intervenants aux compétences complémentaires.19 -- 5.2.2. Soins spécialisés : des professionnels reconnus et agréés .21 -- 5.3. OFFRE DE SOINS : STEPPED CARE ET LIBERTÉ THÉRAPEUTIQUE MAIS NOMBRE DE -- SÉANCES LIMITÉ 22 -- 5.3.1. Stepped Care 22 -- 5.3.2. Types d’interventions 22 -- 5.3.3. Pas de listes limitatives d’indications 22 -- 5.3.4. Pas de restriction liée au type de traitements 23 -- 5.3.5. Pas uniquement des consultations en

39 p., ill., Angst, stress, burnout, depressieve gevoelens, relationele of familiale problemen,…allemaal hebben we vroeg of laat te maken met moeilijke momenten in het leven, en vaak kunnen die worden overwonnen met de hulp van een hiertoe opgeleide hulpverlener. Maar omdat de ziekteverzekering psychologische zorg vandaag meestal niet terugbetaalt, blijft deze zorg moeilijk toegankelijk. Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) onderzocht organisatie-en terugbetalingsmodellen van psychologische zorg in andere landen, en ontwikkelde een model aangepast aan de Belgische realiteit. Het stelt een systeem op twee niveaus voor : een eerstealgemeen niveau, dat vlot, en zonder voorafgaande beperkingen toegankelijk is, en dat vaak voorkomende en gematigde problemen opvangt, en een tweede niveau, dat niet direct toegankelijk is en dat gespecialiseerde zorg aanbiedt, als de zorg op het eerste niveau niet volstaat., VOORWOORD 1 -- KERNBOODSCHAPPEN 2 -- SAMENVATTING 4 -- 1. WAAROM DEZE STUDIE? 6 -- 1.1. PSYCHISCH LIJDEN, EEN BELANGRIJK PROBLEEM 6 -- 1.2. EEN AANZIENLIJKE MAATSCHAPPELIJKE IMPACT 6 -- 1.3. DE PSYCHOLOGISCHE ZORG MOET WORDEN VERSTERKT 6 -- 1.4. NAAR EEN NIEUW MODEL VOOR DE ORGANISATIE EN FINANCIERING VAN DE -- PSYCHOLOGISCHE ZORG . 7 -- 2. WAT IS DE HUIDIGE SITUATIE IN BELGIË? . 9 -- 2.1. HUIDIGE ORGANISATIE VAN HET PSYCHOLOGISCHE ZORGAANBOD 9 -- 2.1.1. Een eerste niveau met directe toegang: . 9 -- 2.1.2. Een tweede niveau van gespecialiseerde ambulante zorg: 10 -- 2.1.3. Een derde, meer ziekenhuisgericht niveau: 10 -- 2.2. DE BELANGRIJKSTE GEÏDENTIFICEERDE PROBLEMEN .11 -- 2.2.1. Het eerste contact is moeilijk 11 -- 2.2.2. Het aanbod is niet transparant genoeg en biedt onvoldoende garanties .11 -- 2.2.3. Hoge kosten voor de patiënt . 12 -- 2.2.4. Lange wachtlijsten. 12 -- 2.2.5. Zorgcontinuïteit wordt niet gegarandeerd . 12 -- 3. TOEGANG TOT PSYCHOLOGISCHE ZORG IN HET BUITENLAND 13 -- 3.1. DIRECTE TOEGANG TOT PSYCHOLOGISCHE ZORG 13 -- 3.2. TOEGANGSVOORWAARDEN VOOR GESPECIALISEERDE PSYCHOLOGISCHE ZORG 14 -- 3.2.1. Gatekeeping 14 -- 3.2.2. Indicaties 14 -- 3.2.3. Therapeutische modaliteiten. 14 -- 3.2.4. Aantal sessies 14 -- 4.1. DOELSTELLINGEN 15 -- 4.2. ORGANISATORISCHE ASPECTEN 15 -- 4.3. BELANGRIJKSTE RESULTATEN 16 -- 5. PISTES VOOR DE ORGANISATIE VAN DE PSYCHOLOGISCHE ZORG 16 -- 5.1. EEN PSYCHOLOGISCH ZORGSYSTEEM MET TWEE NIVEAUS 16 -- 5.2. BETROKKEN ACTOREN: ELK NIVEAU ZIJN EIGENHEID 19 -- 5.2.1. 1ste lijn: betrokken actoren met complementaire competenties 19 -- 5.2.2. Gespecialiseerde zorg: erkende en geaccrediteerde professionals .21 -- 5.3. ZORGAANBOD: STEPPED CARE EN THERAPEUTISCHE VRIJHEID, MAAR BEPERKT AANTAL -- SESSIES . 22 -- 5.3.1. Stepped Care 22 -- 5.3.2. Interventietypes. 22 -- 5.3.3. Geen limitatieve lijsten van indicaties 22 -- 5.3.4. Geen beperking voor het type behandeling 23 -- 5.3.5. Niet uitsluitend face-to-face consultaties 23 -- 5.3.6. Bep

107 p., ill., 1 INTRODUCTION 10 -- 2 OBJECTIVES AND METHODS 11 -- 3 THE LEGISLATIVE BELGIAN CONTEXT 13 -- 3.1 LAW OF 4 APRIL 2014 GOVERNING MENTAL HEALTH PROFESSIONS AND AMENDING ROYAL DECREE NO. 78 OF 10 NOVEMBER 1967 ON THE PRACTICE OF HEALTH PROFESSIONS 13 -- Legal framework on mental health.13 -- Reason for the Law of 4 April 2014 13 -- The development of the law 15 -- Analysis of the key provisions of the Law of 4 April 2014 15 -- Mental Health Council19 -- 3.2 RECENT EVOLUTIONS (JANUARY 2016).19 -- 4 CURRENT SITUATION OF MENTAL HEALTHCARE IN BELGIUM.20 -- 4.1 SOME CONCERNS ABOUT MENTAL HEALTH CARE IN BELGIUM21 -- 4.2 THE POSITION OF CLINICAL PSYCHOLOGISTS, CLINICAL ORTHOPEDAGOGISTS AND PSYCHOTHERAPISTS IN THE BELGIAN MENTAL HEALTH CARE SYSTEM21 -- ‘Centra voor geestelijke gezondheid’ (CGG) – ‘Services de santé mentale’ (SSM) 21 -- Various new initiatives 23 -- The 6th State Reform 26 -- 4.3 MENTAL HEALTHCARE PRACTITIONERS: REGULATION, EDUCATION AND WORK SETTING.26 -- Physicians 26 -- Clinical psychologists.27 -- Psychotherapists28 -- Clinical orthopedagogists 29 -- 4.4 CURRENT FINANCING OF AMBULATORY PSYCHOLOGICAL AND PSYCHOTHERAPY INTERVENTIONS 30 -- Financing of psychological and psychotherapeutic interventions delivered by physicians in ambulatory setting 30 -- 4.4.2 Financing for psychological and psychotherapeutic interventions delivered by psychologists or psychotherapists in ambulatory settings31 -- 4.4.3 Financing for psychological and psychotherapeutic interventions delivered in centres for mental health care (CGG – SSM) 32 -- 4.5 COST OF PSYCHOLOGISTS AND PSYCHOTHERAPISTS IN BELGIUM32 -- Current tariffs for a psychotherapist consultation 32 -- Cost of a psychologist in hospital setting 33 -- Cost of a psychologist in centres for mental healthcare 33 -- 5 INTERNATIONAL COMPARISON 34 -- 5.1 INTRODUCTION 34 -- Objective 34 -- Methods .34 -- Structure of the chapter .34 -- 5.2 THE MENTAL HEALTH CARE PRACTITIONERS 35 -- Regulated professions and functions in the mental

38 p., ill., FOREWORD 1 -- KEY MESSAGES 2 -- OVERVIEW. 4 -- 1. WHY THIS STUDY? 6 -- 1.1. PSYCHOLOGICAL SUFFERING, AN IMPORTANT PROBLEM 6 -- 1.2. A SUBSTANTIAL SOCIAL IMPACT 6 -- 1.3. PSYCHOLOGICAL CARE MUST BE ENHANCED 6 -- 1.4. TOWARD A NEW MODEL FOR THE ORGANISATION AND FINANCING OF PSYCHOLOGICAL -- CARE. 7 -- 2. WHAT IS THE CURRENT SITUATION IN BELGIUM? 9 -- 2.1. CURRENT ORGANISATION OF THE PSYCHOLOGICAL CARE OFFER 9 -- 2.1.1. A first level with direct access: 9 -- 2.1.2. A second level of specialised ambulatory care: 10 -- 2.1.3. A third, more hospital-orientated level: . 10 -- 2.2. THE MOST IMPORTANT IDENTIFIED PROBLEMS . 11 -- 2.2.1. The first contact is difficult. 11 -- 2.2.2. The offer is not transparent enough and offers inadequate guarantees 11 -- 2.2.3. High costs for the patient 11 -- 2.2.4. Long waiting lists 12 -- 2.2.5. Care continuity is not guaranteed . 12 -- 3. ACCESS TO PSYCHOLOGICAL CARE IN OTHER COUNTRIES12 -- 3.1. DIRECT ACCESS TO PSYCHOLOGICAL CARE 13 -- 3.2. ACCESS CONDITIONS FOR SPECIALISED PSYCHOLOGICAL CARE 13 -- 3.2.1. Gatekeeping 13 -- 3.2.2. Indications . 13 -- 3.2.3. Therapeutic methods 13 -- 3.2.4. Number of sessions 14 -- 4. PILOT PROJECTS FOR THE FIRST-LINE PSYCHOLOGICAL FUNCTION IN -- FLANDERS15 -- 4.1. OBJECTIVES 15 -- 4.2. ORGANIZATIONAL ASPECTS 15 -- 4.3. MAJOR RESULTS 15 -- 5. APPROACHES TO THE ORGANISATION OF PSYCHOLOGICAL CARE 16 -- 5.1. A PSYCHOLOGICAL CARE SYSTEM WITH TWO LEVELS.16 -- 5.2. PARTIES INVOLVED: EACH LEVEL HAS ITS CHARACTERISTICS 18 -- 5.2.1. First line: parties with complementary competences 18 -- 5.2.2. Specialised care: authorised and accredited professionals 20 -- 5.3. CARE OFFER: STEPPED CARE AND THERAPEUTIC FREEDOM, BUT LIMITED NUMBER OF -- SESSIONS 21 -- 5.3.1. Stepped Care 21 -- 5.3.2. Types of intervention. 21 -- 5.3.3. No restrictive lists of indications 21 -- 5.3.4. No limitation on the type of treatment 22 -- 5.3.5. Not exclusively face-to-face consultations 22 -- 5.3.6. Limitation of the number of reimbursed ses

Objectifs : Cet article s’intéresse à la controverse autour du financement basé sur la performance (FBP) dans sa réforme des systèmes de santé. Il vise une analyse objective des différentes opinions autour de l’approche de manière à contribuer à une meilleure structuration du débat. Méthodes : Notre démarche délibérative structurante a consisté à organiser un dialogue indirect entre experts critiques et partisans du FBP sur base d’une grille d’analyse conçue par Norman Daniels et coll. ; grille non partisane et comportant des critères clairs et objectifs. Exécutés en deux tours (critiques ensuite partisans), les interviews ont été analysés et des segments de réponses ont été regroupés, selon les thématiques sectorielles les plus reprises et faisant ressortir les grandes tendances de la controverse. Résultats : Les interviews ont permis de dégager des pistes de convergence autour du FBP, vu comme une stratégie complémentaire à d’autres, notamment celle visant à l’amélioration de l’accessibilité financière de la population aux soins de santé. Elle a dégagé des désaccords relevant soit de malentendus sur les prétentions accordées au FBP, soit d’une absence de données probantes suffisantes, soit encore d’une asymétrie informationnelle entre experts. Conclusions : Les discussions autour du FBP se polarisent autour de plusieurs questions. Mais une meilleure structuration des arguments convergents et divergents devrait rendre une certaine synthèse possible. Pour un plus grand bénéfice des populations, il incombe aux experts d’adopter une démarche objective avec des critères acceptés par tous., [Negotiation of a heath policy controversy: application of an indirect dialogue approach to performance-based financing in sub-Saharan Africa] Objectives: This article assesses the controversy around performance-based financing (PBF) and its contribution to the reform of health systems. It aims to reduce tensions between the different camps by restructuring the debate. Methods: Our approach was to organize an indirect dialogue between critics and supporters of PBF, based on the framework developed by Norman Daniels. This analytical framework is non-partisan and uses clear and objective criteria. The interviews were carried out in two rounds (first the critics, then the supporters) and were then analyzed. Parts of answers were regrouped according to the most common sectoral themes while also highlighting major areas of disagreement. Results: The interviews revealed some areas of convergence around PBF; the strategy is considered to be a complementary strategy to other strategies; such as those which aim to improving financial access to health care. The analysis also revealed disagreements based on misunderstandings of claims often ascribed to PBF, or lack of sufficient evidence, or asymmetrical information between experts. Conclusions: Several questions polarize PBF discussions. However, better structuring of convergent and divergent areas and arguments should facilitate a synthesis, at least to some extent. Experts need to adopt an objective approach with universally accepted criteria, for the benefit of all.

Latin America is aging. The process is occurring quickly and in unhealthy conditions with low levels of income. The number of older people who can no longer perform their daily activities will dramatically increase in the coming decades. Developed countries have already been facing this phenomenon over the last three decades, but Latin America has neither the resources nor the social protection systems of these countries. Formulating and planning health policies associated with this phenomenon should be a priority of the governments of Latin America. This paper defines what these care policies are, the models of care rich countries have developed, and the cost of such models. The situation in Latin America is then analyzed and conclusions and a series of discussions to address in the near future are proposed., América Latina envejece. Lo hace muy rápido, en condiciones poco saludables y con bajos niveles de ingreso. En las próximas décadas aumentará vertiginosamente el número de personas mayores que no podrán realizar las actividades de su vida diaria por sí mismas. Este fenómeno ya lo han enfrentado los países ricos en las últimas tres décadas pero, a diferencia de ellos, la región no dispone ni de los recursos ni de los sistemas de protección social de esos países. Pensar y planificar políticas de salud asociadas a este fenómeno debería ser una prioridad de los gobiernos latinoamericanos. En el presente trabajo se define en qué consisten estos cuidados, qué modelos han desarrollado los países ricos y a qué costo. Posteriormente se analiza la situación de América Latina y se propone una serie de discusiones para abordar en el futuro cercano.

Objectives: This article assesses the controversy around performance-based financing (PBF) and its contribution to the reform of health systems. It aims to reduce tensions between the different camps by restructuring the debate. Methods: Our approach was to organize an indirect dialogue between critics and supporters of PBF, based on the framework developed by Norman Daniels. This analytical framework is non-partisan and uses clear and objective criteria. The interviews were carried out in two rounds (first the critics, then the supporters) and were then analyzed. Parts of answers were regrouped according to the most common sectoral themes while also highlighting major areas of disagreement. Results: The interviews revealed some areas of convergence around PBF; the strategy is considered to be a complementary strategy to other strategies; such as those which aim to improving financial access to health care. The analysis also revealed disagreements based on misunderstandings of claims often ascribed to PBF, or lack of sufficient evidence, or asymmetrical information between experts. Conclusions: Several questions polarize PBF discussions. However, better structuring of convergent and divergent areas and arguments should facilitate a synthesis, at least to some extent. Experts need to adopt an objective approach with universally accepted criteria, for the benefit of all., SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives: Performance-based financing (PBF) is a strategy designed to link the funding of health services to predetermined results. Payment by an independent strategic purchaser is subject to verification of effective achievement of health outcomes in terms of quantity and quality. This article investigates the complex tensions observed in relation to performance based financing (PBF) and identifies some reasons for disagreement on this approach. Methods: This study was essentially qualitative. Interviews were conducted with a panel of experts on PBF, mobilizing their ability to reflect on the various arguments and positions concerning this financing mechanism. To enhance our analyses, we proposed a framework based on the main reasons for scientific or political controversies and factors involved in their emergence. Analysis of the information collected therefore consisted of combining experts verbatim reports with corresponding factors of controversies of our framework. Graphic representations of the differences were also established. Results: Tensions concerning PBF are based on facts (experts' interpretation of PBF), principles and values (around each expert's conceptual framework), balances of power between experts but also inappropriate behavior in the discussion process. Viewpoints remain isolated, each individual experience and an overview are lacking, which can interfere with decision-making and maintain the Health system reform crisis. Potential solutions to reduce these tensions are proposed. Conclusions: Our study shows that experts have difficulties agreeing on a theoretical priority approach to PBF. A good understanding of the nature of the tensions and an improvement in the quality of dialogue will promote a real dynamic of change and the proposal of an agenda of PBF actions., SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction: The objective of this study was to determine the source of health care funding for heads of households related to the management of severe malaria in children admitted to a Kinshasa reference hospital. Methods: This cross-sectional study was conducted on 1,350 hospitalised children under the age of 15 years treated for severe malaria in Kinshasa reference hospitals from January to November 2011 and the heads of households of these children. Results: Only 46% of heads of households reported having sufficient funds directly available in the household budget. The remaining 54% had to call upon external sources of funding (sale of assets, loans, pawning goods). The use of a loan tended to increase significantly mainly for households with a low (adjusted odds ratio = 6.2), and intermediate socioeconomic status (adjusted odds ratio = 3.8) and for households working in the informal sector (adjusted odds ratio = 2.5). Similarly, the sale of assets was more frequently reported for households working in the informal sector (adjusted odds ratio = 2.4) ) and for female heads of households (adjusted odds ratio = 3.9). Conclusion: The management of severe malaria is a burden on household income. The majority of heads of households concerned needs to use external funding sources. A State subsidy for this management would help to reduce the risk of debt and sale of assets, especially for the poorest households., SCOPUS: ar.j, info:eu-repo/semantics/published

This paper will analyse the financial relationship between private and public health insurance in Australia. Private health insurance in Australia is both highly regulated and subsidised with the argument often being it provides support for the universal public system. With private health insurance providing duplicate insurance in Australia, I present a theoretical analysis of how the private and public system may interact when duplication occurs. I investigate the theoretical arguments for and against the use of private duplicate health insurance. Empirical analysis is performed on both Australia and the OECD to provide numerical evidence of the theoretical arguments. The unique relationship of the private and public health systems is evidenced in the results which provide many interesting and complex policy issues for both Australia, and possibly other similar healthcare systems around the world.

This paper will analyse the financial relationship between private and public health insurance in Australia. Private health insurance in Australia is both highly regulated and subsidised with the argument often being it provides support for the universal public system. With private health insurance providing duplicate insurance in Australia, I present a theoretical analysis of how the private and public system may interact when duplication occurs. I investigate the theoretical arguments for and against the use of private duplicate health insurance. Empirical analysis is performed on both Australia and the OECD to provide numerical evidence of the theoretical arguments. The unique relationship of the private and public health systems is evidenced in the results which provide many interesting and complex policy issues for both Australia, and possibly other similar healthcare systems around the world.

The planning of human medical resources has been in progress since 1996. The aim of this paper is to describe the process which occurred in Belgium and to point out its assets and limits., English Abstract, Journal Article, Review, SCOPUS: ar.j, info:eu-repo/semantics/published

The planning of human medical resources has been in progress since 1996. The aim of this paper is to describe the process which occurred in Belgium and to point out its assets and limits., English Abstract, Journal Article, Review, SCOPUS: ar.j, info:eu-repo/semantics/published