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The failure of a failure regime: from insolvency to de-authorisation for NHS Foundation Trusts

Kurunmäki, Liisa; Miller, Peter
Fonte: Centre for Analysis of Risk and Regulation, London School of Economics and Political Science Publicador: Centre for Analysis of Risk and Regulation, London School of Economics and Political Science
Tipo: Monograph; NonPeerReviewed Formato: application/pdf
Publicado em /03/2011 EN; EN
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85.54%
This paper examines the failure of a ‘failure regime’ for NHS Foundation Trusts. More particularly, it considers the proposals to create a failure regime for NHS Foundation Trusts that were set out in the Health and Social Care Act 2003, and that drew explicitly on the Insolvency Act 1986. These proposals were subsequently abandoned in favour of a regime based on a notion of ‘de-authorisation’. This case is of considerable interest, as the category of failure has come to saturate public life, while the ideas and instruments for conceptualising and calculating failure have not received the attention they deserve. This paper suggests that failing and failure do not have the objectivity and inevitability often associated with them, and that both are formed out of a set of calculative practices and financial norms that allow complex processes of mediation between domains and desired outcomes. It is important, we argue, to analyse the roles played by metrics such as ratio analysis and risk indexes, for it is through these that this mediation takes place. It is important also, we suggest, to explore that happens when attempts are made to model ‘failure regimes’ for public services on ideas and instruments designed for the corporate world. Further...

Good hospital management can save lives and increase much needed productivity at a time of budget constraints

Homkes, Rebecca
Fonte: Blog post from London School of Economics & Political Science Publicador: Blog post from London School of Economics & Political Science
Tipo: Website; NonPeerReviewed Formato: application/pdf
Publicado em 08/04/2011 EN; EN
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Budget savings imposed through the government’s deficit reduction agenda have tended to focus on cutting out management costs and reducing layers of bureaucracy in public services. However, Rebecca Homkes presents evidence to show that in fact good management is key to increasing productivity and improving performance in hospitals, and that increasing the numbers of managers who can combine clinical and managerial skills should be a priority for the government.

Timely publication and sharing of trial data: opportunities and challenges for comparative effectiveness research in cardiovascular disease

Naci, Huseyin; Cooper, Jacob; Mossialos, Elias
Fonte: European Society of Cardiology Publicador: European Society of Cardiology
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em //2015 EN; EN
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There is growing enthusiasm for the timely publication and sharing of clinical trial data. The rationale for open access includes greater transparency, reproducibility, and efficiency of the research enterprise. In cardiovascular diseases, routinely sharing clinical trial data would create opportunities for undertaking comparative effectiveness research, providing much needed evidence on how different interventions compare to each other on key outcomes. Access to individual patient-level data would strengthen the validity of such research. Novel methodological approaches like network meta-analyses using individual patient-level data could reliably compare interventions that have not been compared to each other in head-to-head trials. However, there are significant practical, methodological, financial, and legal challenges to this utopian open access that need to be continually addressed. Sharing clinical trial data openly will only occur when the previously tolerated process of clinical research involving direct ownership and secrecy is abandoned for a new culture in which medical science is open to all of its stakeholders. With this new culture, data will be accessible, reanalysis and further analysis will be considered commonplace...

Sweating public support on the future of the NHS

Dixon, Jennifer
Fonte: Blog post from London School of Economics & Political Science Publicador: Blog post from London School of Economics & Political Science
Tipo: Website; NonPeerReviewed Formato: application/pdf
Publicado em 23/07/2012 EN; EN
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85.53%
Jennifer Dixon considers the choices for the NHS given the current and projected future financial climate, and argues for a broad, two-way dialogue with the public as a channel for discovering solutions.

The NHS is at a crossroads after the Francis Report

Kline, Roger; Martin, Brendan
Fonte: Blog post from London School of Economics & Political Science Publicador: Blog post from London School of Economics & Political Science
Tipo: Website; NonPeerReviewed Formato: application/pdf
Publicado em 11/02/2013 EN; EN
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Roger Kline and Brendan Martin suggest that recommendations in the Francis Report about policing inadequate behaviour by health care workers have been over emphasised, neglecting opportunities to ensure higher standards. There is a danger that the opportunities provided by the report to strengthen the best aspects of NHS culture will be overwhelmed by defensive responses that reinforce the weak ones.

Cost-effectiveness of long-lasting insecticide-treated hammocks in preventing malaria in south-central Vietnam

Morel, Chantal M.; Ngo Duc, T.; Nguyen, X.; Pham Van, K.; Le Xuan, H.; Le Khan, T.; Erhart, A.; Mills, A. J.; D'Alessandro, U.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em 11/03/2013 EN; EN
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95.51%
Background: Despite much success in reducing the burden of malaria in Vietnam, pockets of malaria persist and eliminating them remains an important development goal. In central Vietnam, insecticide-treated hammocks have recently been introduced to help counter the disease in the highly forested, mountainous areas, where other measures have so far been unsuccessful. This study assesses the cost-effectiveness of using long-lasting insecticide-treated hammocks in this area. Methods and Findings: This cost-effectiveness study was run alongside a randomized control trial testing the efficacy of the long-lasting insecticide-treated hammocks. Data were collected through an exit survey, a household survey, expenditure records and key informant interviews. The study estimates that under normal (non-trial) conditions the total net societal cost per malaria episode averted in using long-lasting insecticide-treated hammocks in this area was 126 USD. Cost per hammock, including insecticidal netting, sewing, transport, and distribution was found to be approximately 11.76 USD per hammock. Average savings per episode averted were estimated to be $14.60 USD for the health system and 14.37 USD for households (including both direct and indirect cost savings). The study estimates that the annual financial outlay required of government to implement this type of programme to be 3.40 USD per person covered per year. Conclusion: The study finds that the use of a hammock intervention could represent good value for money to help prevent malaria in more remote areas...

The role of risk assessment in reducing homicides by people with mental illness

Munro, Eileen; Rumgay, Judith
Fonte: The Royal College of Psychiatrists Publicador: The Royal College of Psychiatrists
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em /02/2000 EN; EN
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Background: Improved risk assessment has been stressed as the way to reduce homicides by people with mental illness. The feasibility of predicting rare events needs examining. Aims: To examine the findings of public inquiries into homicides by people with mental illness to see if they support the claim that better risk assessment would have averted the tragedy. Method: Analysis was made of the findings of the public inquiries between 1988 and 1997 in relation to the predictability and preventability of the homicides. Results: Of the homicides considered by the inquiry panels, 27.5% were judged to have been predictable, 65% preventable and 60% of the patients had a long-term history containing violence or substantial risk factors for violence. Conclusions: Improved risk assessment has only a limited role in reducing homicides. More deaths could be prevented by improved mental health care irrespective of the risk of violence. If services become biased towards those assessed as high risk, then ethical concerns arise about the care of both violent and non-violent patients.

The evaluation of the electronic prescription service in primary care: interim report on the findings from the evaluation in early implementer sites

Hibberd, Ralph; Barber, Nick; Cornford, Tony; Lichtner, Valentina
Fonte: University College London Publicador: University College London
Tipo: Monograph; NonPeerReviewed Formato: application/pdf
Publicado em 09/07/2012 EN; EN
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85.57%
This report provides and interim account of some aspects of research undertaken in to the adoptions and use of the electronic prescription service (EPS) in England. The role of EPS is a fundamentally simple one. It allows the transmission of prescription messages and digitally-signed prescriptions from primary care prescribers, via a central network and server infrastructure, the Spine, from where they can be downloaded by dispensing contractors including community pharmacists, dispensing appliance contractors and dispensing doctors. Prescriptions are then subsequently passed on electronically to NHS Prescription Services for reimbursement. The findings reported are concentrated here the findings from the early stages of implementation in which GP practices and community pharmacies were paired for initial pilot testing. Attitudes and experience of patients, GPs practice staff and community pharmacists are reported and the benefits of the service are assessed as well as its prospects for future development.

Medicine prices, availability and affordability in Southern Brazil: a study of public and private facilities

Dâmaso Bertoldi, Andréa; Helfer, Ana Paula; Camargo, Aline L.; Tavares, Noêmia U. L.
Fonte: LSE Health, London School of Economics and Political Science Publicador: LSE Health, London School of Economics and Political Science
Tipo: Monograph; NonPeerReviewed Formato: application/pdf
Publicado em /06/2010 EN; EN
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95.65%
This paper evaluates medicine prices, their availability and affordability in Brazil, considering the differences across three types of medicines on the market (originator brands, generics and similar medicines) and different types of facilities (private pharmacies, public sector pharmacies and “popular pharmacies”), using an established methodology. Data on prices and availability of 50 medicines (originator brand, lowestpriced generic and similar medicines) were collected from public, private and popular pharmacies (N=56) across six cities in Southern Brazil. Median prices obtained are divided by international reference prices to derive the median price ratio (MPR). In the private sector, prices were 8.6 MPR for similar medicines, 11.3 MRP for generics and 18.7 MRP for originator brands, respectively. Mean availability was 65%, 74% and 48% for originator brands, generics and similars, respectively. The number of working days needed to pay for a complete medicine treatment (affordability) varied considerably between medicines aimed at treating acute and chronic diseases and by type of medicine. In the public sector, the mean availability of similar medicines was 2- 7 times higher than that of generics. The mean overall availability in the public sector ranged from 68.8% to 81.7%. In “popular pharmacies”...

Initial consultation on SSCR research themes: analysis of responses. Report commissioned from Ann Richardson by the NIHR School for Social Care Research

NIHR School for Social Care Research, .
Fonte: NIHR School for Social Care Research, London School of Economics and Political Science Publicador: NIHR School for Social Care Research, London School of Economics and Political Science
Tipo: Monograph; NonPeerReviewed Formato: application/pdf
Publicado em /06/2010 EN; EN
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95.53%
The School for Social Care Research (SSCR) was set up by the National Institute for Health Research (NIHR)1 to develop the evidence base for adult social care practice in England by commissioning and conducting research. It was launched in May 2009, with a budget of £15 million over five years. Open to new ideas and suggestions, we actively sought to consult the practitioner communities, the wider public, users of social care services and carers about key social care practice issues SSCR should address through our research to inform our developing research agenda. This report sets out the responses from this exercise up to February 2010. The principal means of consultation was on-line. We put out a general call for ideas on the SSCR website, with an invitation to anyone with an interest in social care to complete a short form suggesting topics for consideration. In all, 41 individuals and organisations submitted 121 topics through this process. In addition, we invited suggestions through a number of meetings, including the SSCR Advisory Board, the SSCR User, Carer, Practitioner Reference Group, a joint meeting between Making Research Count and directors and senior managers of adult social care services, and through emails directly to SSCR contacts...

Ideas of public engagement in medical science remain little more than a public relations apparatus deployed to neutralise risk

Watermeyer, Richard
Fonte: Blog post from London School of Economics & Political Science Publicador: Blog post from London School of Economics & Political Science
Tipo: Website; NonPeerReviewed Formato: application/pdf
Publicado em 25/05/2012 EN; EN
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Questioning the academic hierarchy from contract researcher to tenured professor, Richard Watermeyer finds that the prospect of a harmonious interplay between the public and medical researchers is nothing but a chimera.

Assessing the impact of illness, caring and ethnicity on social activity

Platt, Lucinda
Fonte: Centre for Analysis of Social Exclusion, London School of Economics and Political Science Publicador: Centre for Analysis of Social Exclusion, London School of Economics and Political Science
Tipo: Monograph; NonPeerReviewed Formato: application/pdf
Publicado em /03/2006 EN; EN
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95.55%
It has long been accepted that lack of social participation in wider society is one aspect or one definition of poverty. Current concerns with the extent and distribution of social capital as both a measure of a good society and as means to upward mobility also emphasise the importance of social contacts and networks to the well-being of individuals and communities. While research has often focused on ‘civic participation’ and the measurement of trust, more informal social bonds are also a crucial part of individuals’ social capital. Moreover, informal social capital or social participation might be particularly important for those whose circumstances make them already more vulnerable to marginalisation, exclusion or poverty. For example, social interaction has been argued to be conducive to better outcomes for those with health problems; and there is an extensive literature which aims to chart and explain the role of ‘ethnic capital’ in the life chances of minority ethnic groups. I use the British Home Office Citizenship Survey 2001 for England and Wales to explore the impact on four aspects of lack of social engagement of long-term illness, caring for someone with such an illness, and ethnicity. Controlling for a range of characteristics and examining the relationships separately for men and women there is evidence that between them...

Book review: Paralysed with fear: the story of polio

Brown, Sally
Fonte: Blog post from London School of Economics & Political Science Publicador: Blog post from London School of Economics & Political Science
Tipo: Website; NonPeerReviewed Formato: application/pdf
Publicado em 20/09/2013 EN; EN
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"Paralysed With Fear: The Story of Polio." Gareth Williams. Palgrave Macmillan. June 2013. --- For much of the twentieth century, polio inspired terror as the ‘morning paralysis’ which could break into any home and disable or kill a previously healthy person. In this book Gareth Williams highlights one of the grand challenges of modern medicine, and explores the profoundly moving experiences of victims alongside the medical and scientific landmarks in the history of the disease. This history is a timely and vital book which will appeal to anyone interested in science, public health, and the history of medicine, writes Sally Brown.

Book review: the creative destruction of medicine: how the digital revolution will create better health care

Larkin, Edward
Fonte: Blog post from London School of Economics & Political Science Publicador: Blog post from London School of Economics & Political Science
Tipo: Website; NonPeerReviewed Formato: application/pdf
Publicado em 29/09/2012 EN; EN
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105.57%
In The Creative Destruction of Medicine, geneticist and cardiologist Eric Topol introduces a radical new approach to medicine. By bringing the era of big data and personal technology to the clinic, laboratory, and hospital, doctors can see a full, continuously updated picture of each patient and treat each individually. Edward Larkin believes that although Topol’s vision may be somewhat premature, the book is a must-read for anyone interested in the relationship between technology of medicine.

Does competition improve public hospitals’ efficiency?: evidence from a quasi-experiment in the English National Health Service

Cooper, Zack; Gibbons, Stephen; Jones, Simon; McGuire, Alistair
Fonte: Centre for Economic Performance, London School of Economics and Political Science Publicador: Centre for Economic Performance, London School of Economics and Political Science
Tipo: Monograph; NonPeerReviewed Formato: application/pdf
Publicado em /02/2012 EN; EN
Relevância na Pesquisa
85.56%
This paper uses a difference-in-difference style estimation strategy to test separately the impact of competition from public sector and private sector hospitals on the efficiency of public hospitals. Our identification strategy takes advantage of the phased introduction of a recent set of substantive reforms introduced in the English NHS from 2006 onwards. These reforms forced public sector health care providers to compete with other public hospitals and eventually to face competition from existing private sector providers for care delivered to publicly funded patients. In this study, we measure efficiency using hospitals’ average length of stay (LOS) for patients undergoing elective surgery. For a more nuanced assessment of efficiency, we break LOS down into its two key components: the time from patients’ admission to the hospital until their surgery and the time from their surgery until their discharge. Here, pre-surgery LOS serves as a proxy for hospitals’ lean efficiency. Our results suggest that competition between public providers prompted public hospitals to improve their productivity by decreasing their pre-surgery, overall and post-surgery length of stay. In contrast, competition from private hospitals did not spur public providers to improve their performance and instead left incumbent public providers with a more costly case mix of patients and led to increases in postsurgical LOS.

We can prevent the ‘crowding out’ of long term care insurance by family financing if government offers a level of provision that can then be topped up

Costa-i-Font, Joan
Fonte: Blog post from London School of Economics & Political Science Publicador: Blog post from London School of Economics & Political Science
Tipo: Website; NonPeerReviewed Formato: application/pdf
Publicado em 02/06/2011 EN; EN
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Families face several solutions to provide for the costs of long term care for elderly family members, should the need arise: public or private insurance, savings or family financing. Joan Costa Font argues that the prevalence of this family financing in the UK and the EU is likely to ‘crowd out’ other types of insurance, and that the government can increase take-up of insurance by offering a ‘benchmark’ level of public financing that families can then supplement.

The American government has expanded through the interweaving of public functions with private power

Ketti, Donald F.
Fonte: The London School of Economics and Political Science Publicador: The London School of Economics and Political Science
Tipo: Website; NonPeerReviewed Formato: application/pdf
Publicado em 16/04/2015 EN; EN
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In the past five decades federal spending has continued to grow at a significant rate, and yet at the same time government employment has remained relatively flat. Donald F. Kettl takes a close look at this relationship, writing that much of the trend is down to the interweaving of federal programs with private organizations, such as the provision of Medicare by private health insurance companies. He argues that this interweaving is important, because the complex programs it produces can lead to more waste, fraud and mismanagement, and that they can also create challenges for improving public trust in government, as it becomes less directly connected to citizens.

Modernisation and its side effects: an inquiry into the revival and renaissance of herbal medicine in Vietnam and Britain

Wahlberg, Ayo
Fonte: London School of Economics and Political Science Thesis Publicador: London School of Economics and Political Science Thesis
Tipo: Thesis; NonPeerReviewed Formato: application/pdf
Publicado em /10/2006 EN
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85.59%
Herbal medicine has experienced tangible revivals in both Vietnam and the United Kingdom since the mid-20th century, as reflected in sales of herbal medicinal products, numbers of users and the availability of training opportunities for aspiring herbalists. In both countries, this revival came on the back of more or less concerted official efforts to discourage and even ban the practice and use of herbal medicine, by colonial authorities (in Vietnam) or professional medical associations and regulatory bodies (in the UK). Utilising archaeological and genealogical methods as developed by Canguilhem, Foucault and others, this study seeks to account for these revivals by pursuing three particular lines of analysis. Firstly, by describing the formations of power-knowledge relations which have allowed Vietnamese and British herbal medicine to challenge biomedical monopolies in the latter half of the 20th century, it is argued that the ways in which ‘quackery’ is conceptualised and regulated against in both countries today, has undergone substantial transformations. Secondly, by identifying the techniques of truth making which either suggest or contest a superior efficacy (over placebo) for two particular herbal medicines in the treatment of depression (in the UK) and addiction (in Vietnam)...

Rationales for traditional medicines utilisation and its equity implications: the case of Ghana

Sato, Azusa
Fonte: London School of Economics and Political Science Thesis Publicador: London School of Economics and Political Science Thesis
Tipo: Thesis; NonPeerReviewed Formato: application/pdf
Publicado em /05/2012 EN
Relevância na Pesquisa
95.57%
Individuals all over the world continue to utilise traditional health care, but there is very little understanding of why this is the case, especially in light of increased availability and accessibility of effective pharmaceutical medicine and other modern technologies. The overarching objective of this thesis is to investigate rationales for utilisation of traditional medicines, using Ghana as a case study. This thesis argues that institutional constraints and cultural preferences inherited from the past shape pluralistic health systems and, consequently, individual health-seeking behaviour. The thesis fuses investigative approaches from different disciplines (e.g. anthropology, economics, psychology) and uses statistical methods to analyse four aspects of medicines utilisation: the role of culture, income, the possibility of a placebo effect in use and finally, the distributional consequences manifested in utilisation inequities. Findings indicate that cultural attitudes and income constraints are associated with use of traditional systems, and users report high rates of satisfaction that are attributable to procedural factors. Inequities are shown to differ according to whether traditional medicines are included in analysis. Generally...

Evidence, process or context? Examining the factors that drive coverage decisions of pharmaceuticals by health technology assessment bodies in Europe

Cerri, Karin H.
Fonte: London School of Economics and Political Science Thesis Publicador: London School of Economics and Political Science Thesis
Tipo: Thesis; NonPeerReviewed Formato: application/pdf
Publicado em /12/2011 EN
Relevância na Pesquisa
95.51%
In Europe, Health Technology Assessment (HTA) bodies produce coverage decisions that guide public funding of pharmaceuticals. This thesis examines and weights those factors that drive HTA coverage decisions, focusing on the National Institute for Health and Clinical Excellence (NICE) in England and Wales, the Scottish Medicines Consortium (SMC), the Dutch College voor Zorgverzekeringen (CVZ), and the French Haute Autorité de Sante (HAS). To address the research question, a dataset of approximately 1000 HTA coverage decisions by NICE, SMC, CVZ and HAS from the period 2004-2009 was created, containing more than 30 clinical, economic, process and socio-economic factors extracted from published HTA reports. A three-category outcome variable was used, defined as the decision to ‘recommend’, ‘restrict’ or ‘not recommend’ a technology. Multivariate analyses were conducted to assess the relative contribution of the explanatory variables on coverage decisions both within and between HTA bodies. Results demonstrate that different combinations of clinical/economic evidence, process and socio-economic factors drive HTA coverage decisions by NICE, SMC, CVZ and HAS. In addition, the same factor may behave differently according to the nature of the coverage decision. The analysis further suggests there is a significant difference between HTA bodies in the probability of reaching a ‘restrict’ or ‘not recommend’ decision outcome relative to a ‘recommend’ outcome...