Health Policy Priorities Research Articles

Integrating health and social care in Brazil

Abstract Integrating health and social care is now a high priority for public health policy in high-income countries. It has received much less attention in low and middle-income country (LMIC) settings. There is particular value in assessing the potential to integrate care services for older adults, given the speed of population ageing in LMICs. The presentation provides findings of process and impact evaluations of novel local government initiatives to integrate care for older people in Brazil (drawing on a study co-funded by the UK MRC and CONFAP Brazil). Programa Maior Cuidado (PMC) was established in the Brazilian city of Belo Horizonte in 2011. It is jointly managed by the departments of health and of social assistance and involves close community-level collaboration between health posts and neighbourhood social service centres. A key element of PMC is the provision of paid trained lay carers to support family care for dependent older people in socially vulnerable families. We will present findings on the implementation process and operation of PMC, as well as its effects on the following outcomes of interest: reduced unnecessary hospitalisations, enhanced health status for older people and reduced care burden for family carers. Quasi-experimental analysis using spatial-based Propensity Score Matching shows promising results in terms of increasing planned attentions as well as access to rehabilitation services, which confirms the ability of the Program to improve interface with health services avoiding unplanned unnecessary attentions We will examine the implementation of similar interventions in other Brazilian cities, including Fortaleza and Contagem, and will study the role of national and international processes in dissemination, knowledge sharing and agenda-setting. Key messages The presentation provides findings of process and impact evaluations of novel local government initiatives to integrate care for older people in Brazil. Programme under evaluation lead to interesting outcomes of interest: reduced unnecessary hospitalisations, enhanced health status for older people and reduced care burden for family carers.

Insights from birthing experiences of fistula survivors in North-central Nigeria: Interplay of structural violence.

Obstetric Fistula is an abnormal opening between the vagina and rectum resulting from prolonged and obstructed labour. Studies indicate that delays in accessing maternal care and home birth contribute to the development of fistula. Survivors are usually women of low socioeconomic status residing in rural locations. This study explores the birthing experiences of 15 fistula survivors through a narrative inquiry approach at a repair centre in North-central Nigeria. Using structural violence as a lens, it describes the role of social, political and health systems in the inequitable access to care for women. For women opting for home births, preference for home delivery was mainly due to lack of finances, poor health systems and cultural practices. Rural location inhibited access as women seeking facility delivery faced transfer delays to referral centres when complications developed. Inequitable maternal health services in rural locations in Nigeria are inherently linked to access to health care, and these contribute to the increased incidence of fistulae. Structural intervention is a health policy priority to address poor health systems and achieve universal health coverage to address maternal health issues in Nigeria.

The COVID-19 pandemic in Norway: The dominance of social implications in framing the policy response

ObjectivesTo describe the impact and policy response to the COVID-19 Pandemic on Norway and the implications this has for future policy development and Norwegian society. MethodsDocumentary analysis of publicly available statistics, government documents and media sources. ResultsThree different agendas motivated Norwegian policy: stemming the spread of the virus domestically, mitigating the impact on the economy and addressing the social costs of the policy response. ConclusionsThe oil and gas industry and the Sovereign Wealth Fund have permitted Norway to manage the costs of the pandemic. But may also lead to a shift in government priorities in health, social and economic policy.

Coronavirus Human Infection Challenge Studies: Assessing Potential Benefits and Risks.

Human infection challenge studies (HCS) have been proposed as a means to accelerate SARS-CoV2 vaccine development and thereby help to mitigate a prolonged global public health crisis. A key criterion for the ethical acceptability of SARS-CoV2 HCS is that potential benefits outweigh risks. Although the assessment of risks and benefits is meant to be a standard part of research ethics review, systematic comparisons are particularly important in the context of SARS-CoV2 HCS in light of the significant potential benefits and harms at stake as well as the need to preserve public trust in research and vaccines. In this paper we explore several considerations that should inform systematic assessment of SARS-CoV-2 HCS. First, we detail key potential benefits of SARS-CoV-2 HCS including, but not limited to, those related to the acceleration of vaccine development. Second, we identify where modelling is needed to inform risk-benefit (and thus ethical) assessments. Modelling will be particularly useful in (i) comparing potential benefits and risks of HCS with those of vaccine field trials under different epidemiological conditions and (ii) estimating marginal risks to HCS participants in light of the background probabilities of infection in their local community. We highlight interactions between public health policy and research priorities, including situations in which research ethics assessments may need to strike a balance between competing considerations.

Temporal variations in quality of acute stroke care and outcomes in London hyperacute stroke units: a mixed-methods study

Background Seven-day working in hospitals is a current priority of international health research and policy. Previous research has shown variability in delivering evidence-based clinical interventions across different times of the day and week. We aimed to identify factors influencing such variations in London hyperacute stroke units. Objectives To investigate variations in quality of acute stroke care and outcomes by day and time of admission in London hyperacute stroke units, and to identify factors influencing such variations. Design This was a prospective cohort study using anonymised patient-level data from the Sentinel Stroke National Audit Programme. Factors influencing variations in care and outcomes were studied through interview and observation data. Setting The setting was acute stroke services in London hyperacute stroke units. Participants A total of 7094 patients with a primary diagnosis of stroke took part. We interviewed hyperacute stroke unit staff (n = 76), including doctors, nurses, therapists and administrators, and 31 patients and carers. We also conducted non-participant observations of delivery of care at different times of the day and week (n = 45, ≈102 hours). Intervention Hub-and-spoke model for care of suspected acute stroke patients in London with performance standards was designed to deliver uniform access to high-quality hyperacute stroke unit care across the week. Main outcome measures Indicators of quality of acute stroke care, mortality at 3 days after admission, disability at the end of the inpatient spell and length of stay. Data sources Sentinel Stroke National Audit Programme data for all patients in London hyperacute stroke units with a primary diagnosis of stroke between 1 January and 31 December 2014, and nurse staffing data for all eight London hyperacute stroke units for the same period. Results We found no variation in quality of care by day and time of admission across the week in terms of stroke nursing assessment, brain scanning and thrombolysis in London hyperacute stroke units, nor in 3-day mortality nor disability at hospital discharge. Other quality-of-care measures significantly varied by day and time of admission. Quality of care was better if the nurse in charge was at a higher band and/or there were more nurses on duty. Staff deliver ‘front-door’ interventions consistently by taking on additional responsibilities out of hours, creating continuities between day and night, building trusting relationships and prioritising ‘front-door’ interventions. Limitations We were unable to measure long-term outcomes as our request to the Sentinel Stroke National Audit Programme, the Healthcare Quality Improvement Partnership and NHS Digital for Sentinel Stroke National Audit Programme data linked with patient mortality status was not fulfilled. Conclusions Organisational factors influence 24 hours a day, 7 days a week (24/7), provision of stroke care, creating temporal patterns of provision reflected in patient outcomes, including mortality, length of stay and functional independence. Future work Further research would help to explore 24/7 stroke systems in other contexts. We need a clearer understanding of variations by looking at absolute time intervals, rather than achievement of targets. Research is needed with longer-term mortality and modified Rankin Scale data, and a more meaningful range of outcomes. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 34. See the NIHR Journals Library website for further project information.

May Measurement Month 2018: an analysis of blood pressure screening results in Georgia.

May Measurement Month (MMM) is aimed at raising public awareness about arterial hypertension—the main risk factor for cardiovascular diseases in the population. Screening was carried out at 200 sites on a national scale. More than 500 volunteers, including doctors (80%) and medical students (20%) participated in the screening. To familiarize them with the research tools and standard blood pressure (BP) measurement method, their training was conducted by the Georgian Society of Hypertension in Tbilisi and other large cities. Social and mass media, medical societies, and other stakeholders were actively involved in the recruitment process. A total of 10 756 people were screened. The mean age of participants was 53.1 years (SD 16.1). Males—67.9%, females—32.1%. One hundred percent were White. After multiple imputation, the number of hypertensive patients was 6.037 (56.1%) and out of them 4950 were aware and 4701 (77.9%) were on medication, 1336 (22.1%) were not taking a medication. Of those taking antihypertensive medication, 38.2% had controlled BP. In spite of non-randomized selection and certain restrictions with respect to extrapolation of the results, MMM comprehensively reflects an urgent problem and major gaps in the health system. Based on the above, its importance is extremely valuable for identifying public health policy priorities.

Assessment of Systems and Services for Management of Diabetes and Diabetic Retinopathy in Cameroon

ABSTRACT Aim To evaluate systems and services for management of diabetes and diabetic retinopathy. Methodology The National Program for Blindness Control conducted a nationwide descriptive study from 1st February to 31st October 2016. Data was collected using WHO’s:“Tool Assessment of Diabetic Retinopathy and Diabetes Management Systems” adapted to the context. Using direct interviews, all previously identified stakeholders, were involved from all levels of management and throughout the territory. The IBM version 20 software permitted analysis. Results Out of the 48 individuals selected, 46 agreed to participate in the survey. Four participants (8.7%) worked at the central level of the Ministry of Public Health, 2 (4.4%) were NGOs partners, 6 (13%) diabetic patients, and 34 (73.9%) health staff. According to the answers of participants, diabetes stands among priorities in the national health policy. Diabetic care services have been integrated into the National action plan for Chronic Non-Communicable Diseases, but a specific program for control of diabetes has not been created neither are national guidelines recommended by the Ministry available. Some health facilities provide care for diabetes and its complications. Modern technologies for evaluation and follow-up of diabetes of its complications are available only in tertiary level hospitals and in some private clinics. The cost of care obtained is the responsibility of the patients and families. Conclusion The political will to manage diabetes and diabetic retinopathy is recognized by stakeholders and beneficiaries but not translated into an effective program. A suitable implementation strategy is necessary.

Global health policy in the 21st century: Challenges and opportunities to arrest the global disability burden from musculoskeletal health conditions.

The profound burden of disease associated with musculoskeletal health conditions is well established. Despite the unequivocal disability burden and personal and societal consequences, relative to other non-communicable diseases (NCDs), system-level responses for musculoskeletal conditions that are commensurate with their burden have been lacking nationally and globally. Health policy priorities and responses in the 21st century have evolved significantly from the 20th century, with health systems now challenged by an increasing prevalence and impact of NCDs and an unprecedented rate of global population ageing. Further, health policy priorities are now strongly aligned to the 2030 Sustainable Development Goals. With this background, what are the challenges and opportunities available to influence global health policy to support high-value care for musculoskeletal health conditions and persistent pain? This paper explores these issues by considering the current global health policy landscape, the role of global health networks, and progress and opportunities since the 2000–2010 Bone and Joint Decade for health policy to support improved musculoskeletal health and high-value musculoskeletal health care.

Addressing ethical challenges of disclosure in dementia prediction: limitations of current guidelines and suggestions to proceed

BackgroundBiomarker research is gaining increasing attention focusing on the preclinical stages of the disease. Such interest requires special attention for communication and disclosure in clinical contexts. Many countries give dementia a high health policy priority by developing national strategies and by improving guidelines addressing disclosure of a diagnosis; however, risk communication is often neglected.Main textThis paper aims to identify the challenges of disclosure in the context of dementia prediction and to find out whether existing clinical guidelines sufficiently address the issues of disclosing a dementia diagnosis and of disclosing the risk of developing dementia in asymptomatic and MCI stage. We will examine clinical guidelines and recommendations of three countries (USA, Canada and Germany) regarding predictive testing and diagnostic disclosure in dementia and Mild Cognitive Impairment (MCI) to show their potentials and limits. This will provide a background to address ethical implications of predictive information and to identify ways how to proceed further. We will start by examining the guidelines and recommendations by focusing on what there is already and what is missing regarding the challenges of disclosing dementia prediction and MCI. Then, we will highlight the novel ethical issues generated by the shift to identify preclinical stages of the disease by biomarkers. We will argue for the need to develop guidelines for disclosing a risk status, which requires different considerations then disclosing a diagnosis of dementia. Finally, we will make some suggestions on how to address the gap and challenges raised by referring to German Stakeholder Conference, which presents us a good starting point to the applicability of involving stakeholders.ConclusionsThis paper underlines the need to develop empirically based guidelines that address the ethical and social strategies for risk communication of dementia prediction by genetic as well as non-genetic biomarkers. According to our analysis, the guidelines do not address the new developments sufficiently. International efforts should aim for specific guidelines on counseling, communicating risk and disclosing results. We argue that guidelines on (risk) disclosure should be developed by involving various stakeholders and should be informed by socio-empirical studies involving laypersons’ needs and wishes regarding risk communication.

The Burden of Community-Acquired Pneumonia Requiring Admission to ICU in the United States

A paucity of studies have assessed the epidemiology of community-acquired pneumonia (CAP) that require ICU admission. We conducted a study on this group of patients with the primary objective of defining the incidence, epidemiology, and mortality rate of CAP in the ICUs in Louisville, Kentucky. The secondary objective was to estimate the number of patients who were hospitalized and the number of deaths that were associated with CAP in ICU in the United States. What is epidemiology of CAP in the ICU in Louisville, Kentucky, and the projected incidence in the United States? This was a secondary analysis of a prospective population-based cohort study. The setting was all nine adult hospitals in Louisville, Kentucky. The annual incidence of CAP in the ICU per 100,000 adults was calculated for the whole adult population of Louisville. The number of patients who were hospitalized because of CAP in ICU in the United States was estimated by multiplying the Louisville incidence rate of CAP in ICU by the 2014 US adult population. From a total of 7,449 unique patients who were hospitalized with CAP, 1,707 patients (23%) were admitted to the ICU. The incidence of CAP in the ICU was 145 cases per 100,000 population of adults. Cases of CAP in the ICU were clustered in patients from areas of the city with high poverty. The mortality rate of patients with CAP in ICU was 27%at 30days and 47%at one year. In the United States, the estimated number of patients who were hospitalized with CAP requiring the ICU was 356,326 per year, and the estimated number of deaths at 30days and one year were 96,206 and 167,474, respectively. Almost one in five patients who are hospitalized with CAP requires intensive care. Poverty is associated with CAP in the ICU. Nearly one-half of patients with CAP in the ICU will die within one year. Because of its significant burden, CAP in the ICU should be a high priority in research agenda and health policy.

Cancer prevention - review paper.

Every year there is an increase in the number of cases and deaths due to the majority of cancers. Currently, these diseases constitute the second cause of death in Poland and the USA. The number of cases of malignant neoplasms in Poland has more than doubled over the last three decades. According to the National Cancer Registry, in Poland about 95.5 people per thousand die every year from malignant neoplasms. Current epidemiological data on cancer is worrying because the World Health Organization predicts a significant increase in the incidence of cancer in the general population. This problem, which is significant on the global scale, demands the search for more effective prevention methods so that more and more attention is paid to both primary and secondary prevention. Prevention and early detection of cancer have become a priority for the national health policy of many European countries. Numerous studies around the world prove that reducing the risk of cancer is most effective through adopting a healthy lifestyle, avoiding exposure to carcinogens, combined with regular screening. The aim of the study was to review knowledge on cancer prevention, including the latest research results. Due to the systematic increase in the incidence of cancer, a strong emphasis should be placed on prevention. Preventive actions bring benefits not only to the individual, but are an important aspect of health policy. The importance of primary prevention in relation to healthy people has been demonstrated, including secondary prevention aimed at controlling risk factors in relation to persons exposed to them. The combination of these activities becomes an important element in maintaining the health of the individual, as well as society.

Understanding the implications of the Sustainable Development Goals for health policy and systems research: results of a research priority setting exercise

BackgroundGiven the paradigmatic shift represented by the Sustainable Development Goals (SDGs) as compared to the Millennium Development Goals - in particular their broad and interconnected nature - a new set of health policy and systems research (HPSR) priorities are needed to inform strategies to address these interconnected goals.ObjectivesTo identify high priority HPSR questions linked to the achievement of the Sustainable Development Goals.MethodsWe focused on three themes that we considered to be central to achieving the health related SDGs: (i) Protecting and promoting access to health services through systems of social protection (ii) Strengthening multisectoral collaborations for health and (iii) Developing more participatory and accountable institutions. We conducted 54 semi-structured interviews and two focus group discussions to investigate policy-maker perspectives on evidence needs. We also conducted an overview of literature reviews in each theme. Information from these sub-studies was extracted into a matrix of possible research questions and developed into three domain-specific lists of 30–36 potential priority questions. Topic experts from the global research community then refined and ranked the proposed questions through an online platform. A final webinar on each theme sought feedback on findings.ResultsPolicy-makers continue to demand HPSR for many well-established issues such as health financing, human resources for health, and service delivery. In terms of service delivery, policy-makers wanted to know how best to strengthen primary health care and community-based systems. In the themes of social protection and multisectoral collaboration, prioritized questions had a strong emphasis on issues of practical implementation. For participatory and accountable institutions, the two priority questions focused on political factors affecting the adoption of accountability measures, as well as health worker reactions to such measures.ConclusionsTo achieve the SDGs, there is a continuing need for research in some already well established areas of HPSR as well as key areas highlighted by decision-makers. Identifying appropriate conceptual frameworks as well as typologies of examples may be a prerequisite for answering some of the substantive policymaker questions. In addition, implementation research engaging non-traditional stakeholders outside of the health sector will be critical.

Vaccination campaign strategies in recently arrived migrants: experience of an Italian reception centre.

Control of vaccine preventable diseases, while constituting a priority of European health policies, is challenged by migrations from countries with suboptimal levels of immunization coverage. We report here two different types of vaccination campaign strategy in one of the bigger Italian asylum seekers' centres. The vaccination service staff of the local national health institute came monthly during the first three years of observation, while in the last year, the vaccinations were offered directly upon arrival of migrants in the asylum seekers' centre. we performed a descriptive cross-sectional study that analysed data collected from the database of the internal healthcare facility and ARVA Target tool, regarding vaccinations performed from 2013 to 2017 in the asylum seekers' centre. In the four years of observation period the asylum seekers centre hosted 3941 migrants. Among them, 85% were vaccinated during their stay, for a total of 4252 vaccinations administered, covering 95% of minors and 85% of adults. During the study period, there was an important increase from an average of 10.5% of migrants vaccinated in the first three years to 66% in the last year, when vaccines were delivered directly upon arrival in the centre. To improve the rate of immunization in migrants, the first requirement is a strong collaboration with the local vaccine services and the second,vaccinations must be carried out when migrants arrive at the asylum seekers' centre, avoiding any delay.

Creating performance intelligence for primary health care strengthening in Europe

BackgroundPrimary health care and its strengthening through performance measurement is essential for sustainably working towards universal health coverage. Existing performance frameworks and indicators to measure primary health care capture system functions like governance, financing and resourcing but to a lesser extent the function of services delivery and its heterogeneous nature. Moreover, most frameworks have weak links with routine information systems and national health priorities, especially in the context of high- and middle-income countries. This paper presents the development of a tool that responds to this context with the aim to create primary health care performance intelligence for the 53 countries of the WHO European Region.MethodsThe work builds-off of an existing systematic review on primary care and draws on priorities of current European health policies and available (inter)national information systems. Its development included: (i) reviewing and classifying features of primary care; (ii) constructing a set of tracer conditions; and (iii) mapping existing indicators in the framework resulting from (i). The analysis was validated through a series of reviews: in-person meetings with country-nominated focal points and primary care experts; at-distance expert reviews; and, preliminary testing with country informants.ResultsThe resulting framework applies a performance continuum in the classical approach of structures-processes-outcomes spanning 6 domains – primary care structures, model of primary care, care contact, primary care outputs, health system outcomes, and health outcomes – that are further classified by 26 subdomains and 63 features of primary care. A care continuum was developed using a set of 12 tracer conditions. A total of 139 indicators were mapped to the classification, each with an identified data source to safeguard measurability. Individual indicator passports and a glossary of terms were developed to support the standardization of the findings.ConclusionThe resulting framework and suite of indicators, coined the Primary Health Care Impact, Performance and Capacity Tool (PHC-IMPACT), has the potential to be applied in Europe, closing the gap on existing data collection, analysis and use of performance intelligence for decision-making towards primary health care strengthening.

PNS146 WHAT APPROACH SHOULD BE TAKEN IN ORDER TO EFFECTIVELY MANAGE BEHAVIORAL HEALTH RISK FACTORS? A CONSENSUS PANEL ANALYSIS FOR GREECE

To assess which modifiable health risk factors should be the priorities of health policy and which management approaches would be most feasible and effective in the Greek environment. A digital delphi panel was conducted, consisting of experts in healthcare and health policy, seeking convergence with the use of a close-end questionnaire. The risk factors prioritized in the study were: road safety, physical activity, dietary risks, smoking, alcohol consumption, unsafe sexual behavior, obesity and substance use. Additionally, various health policy measures were assessed on terms of effectiveness and importance for each risk factor. Overall, 23 health professionals participated in the panel. Regarding prioritization, smoking ranked first (9.45/10), followed by obesity (8.35/10) and dietary risks (8.00/10), while unsafe sexual behavior ranked last (5.16/10). Current health policy for the selected risk factors was assessed ineffective, since road safety policy ranked first with 2.48/5, while health policy on obesity ranked last at 1.37/5. Sin taxes on products related to the selected risk factors were assessed quite effective by the panel, as higher taxation on sugary beverages gathered the highest score of 3.95/5, while VAT increase in red meat gathered the lowest score of 2.86/5. Regarding individual measures for each risk factor, prohibition of use in public spaces ranked as the most important measure for the management of smoking (9.22/10), expansion of sport facilities for the promotion of physical activity (8.65/10), while health promotion ranked as the most important approach for the management of alcohol consumption (9.18/10), dietary risks (9.09/10), obesity (8.70/10), substance use (8.64/10) and road safety (8.86/10). Based on the results, effective health policy for the management of the main behavioral risk factors is yet to be achieved. Health promotion and sin taxes are considered the most efficient approach to be utilized in health policies for the management of behavioral risk factors.

What does it take to provide clinical interventions with temporal consistency? A qualitative study of London hyperacute stroke units

ObjectivesSeven-day working in hospitals is a current priority of international health research and policy. Previous research has shown variability in delivering evidence-based clinical interventions across different times of day and...

EP1.16-09 Delays in Care of Lung Cancer: A Moroccan Public Health Problem

For several years, lung cancer, which is responsible for one in five cancer deaths, has been considered the leading cause of cancer death. In Morocco, in 2018, 6488 new cases of lung cancer were reported for both sexes and all ages with 22,9% of all new cases of male cancer (Globocan) It”s a real public health problem The delay between the different therapeutic sequences has a real impact on survival, which makes it”s optimization a real public health issue. The aim of this work was to describe the care pathway for patients treated for lung cancer at the Mohamed VI Center, as well as the different treatment delays in our context. To do this, we conducted a monocentric, retrospective study in patients treated for lung cancer between January 2012 and November 2017 at the Mohamed VI Cancer treatment Center. To study this period and obtain significant results, we referred to the statistical rules and retained one month pey year, one year out of two, for a total of six months spread between January 2012 and November 2017 Using the oncology department’s database, we identified all patients with histologically confirmed lung cancer and a usable archived record that was summarized in a farm with pre-established responses coded as numerical variables. The key point of this study was the study of the time between the appearance of the first clinical signs and the initiation of the different therapeutic sequences discussed in a multidisciplinary meeting. During the study period, 125 cases of lung cancer were collected. The average age was 57,6 years The average consult time also called patient time was 3.92 months. As for the delays related to the health system there are: An average diagnostic time of 63,5 days A therapeutic delay of 67,9 days on average An average overall delay of 216,3 days The time to diagnosis was therefore close to that recommended by the littérature, while the consultation, treatment and overall time to diagnosis were longer which significantly affects the survival curve. In several countries, delays in care and access to care services, considered as indicators of system performance, have become a priority in public health policies. The establishment of more specialized oncology and radiation oncology centers should help to reduce them A subsequent reassessment of these delays, after correction, will male it possible to assess the evolution of the quality of the managementof this cancet at the Mohamed VI center.

Global, regional and national estimates of Toxoplasma gondii seroprevalence in pregnant women: a protocol for a systematic review and modelling analysis

IntroductionTo set priorities for public health policy, funding for public health interventions, and healthcare planning which will ultimately contribute in bending the burden of toxoplasmosis towards maternal and neonatal health,...

Ethical and Legal Aspects of Medical Screening for Early Diagnosis of Diseases. Prevention and Prophylaxis.

The main priorities of the implemented health policies in the Republic of Bulgaria are directly aimed at preserving and improving the health of the population, providing equal access of patients to modern and efficient healthcare, promptness and quality, in compliance with the normative requirements of the offered health service. In this sense, the focus of these health policies is to prioritize prevention and prophylaxis of early diagnosis of diseases. It is much more reasonable to prevent the disease or to manage it at an early stage than to slow down the treatment until the pathological processes develop into severe or irreversible complications. The aim of this systematic review is to investigate the effectiveness of existing legal acts governing the implementation of a common health policy in the field of health promotion and prevention. Another aim is to localize regulatory gaps and make relevant optimization suggestions. The analysis of this systematic review is based on a thorough review of the existing regulatory framework (statutory and regulative legislation, case law, European practice) that concerns public health. Articles focused directly on the issues of medical screening and public health in a national and global perspective have been studied. Two major legal acts, two regulations and strategies of the World Health Organization are considered. Suggestions for optimization of the control activity of the administrative bodies in the sector are presented. From the analysis done, proposals for optimization of the existing legal framework in the sector of health-care were made. The proposals were made based on the results of the analysis of world trends regarding the methodology for state funding of medical screening for early diagnosis of diseases.

Characteristics and Health Care Utilization of Different Segments of a Multiethnic Asian Population in Singapore

Descriptive population-level health data are critical components of the evidence base for population health policy. Human populations often display marked heterogeneity in their health status among subgroups of the population. The recent widespread adoption of electronic health records provides opportunities to use routine real-world health care data to examine population health. To report population sociodemographic characteristics, health conditions, health care utilization, and health care costs for different population segments of a multiethnic Asian population divided according to a modified British Columbia Population Segmentation Framework. This population-based cross-sectional study used 2016 data from the Singapore Eastern Regional Health System, the largest Regional Health System in Singapore. Data were obtained from deidentified national-level electronic health records at the Ministry of Health Singapore. Participants included all residents in the Singapore Eastern Regional Health System catchment area in 2016. The descriptive analysis was conducted in August 2018. Socioeconomic profiles, disease prevalence, health care utilization, and cost patterns of population segments. The total size of the study population in 2016 was 1 181 024 residents (576 663 [48.83%] male; median [interquartile range] age, 40 [22-57] years). The population was divided into 8 segments: healthy with no outpatient utilization (493 483 residents), healthy with outpatient utilization (259 909 residents), healthy with inpatient admissions (49 588 residents), low complex (215 134 residents), medium complex (79 350 residents), high complex (44 445 residents), cancer (34 217 residents), and end of life (4898 residents). Overall, the 3 most prevalent conditions were chronic kidney disease (31.89%), hypertension (18.52%), and lipid disorders (18.33%). Distributions of chronic conditions differed across the segments. Different segments had varying health care utilization patterns: the high-complex segment had the highest number of primary care clinic visits (mean [SD], 4.25 [5.46] visits), the cancer segment had the highest number of specialist outpatient clinic visits (mean [SD], 5.55 [8.49] visits), and the end-of-life segment had the highest numbers of accident and emergency department visits (mean [SD], 1.80 [1.88] visits) and inpatient admissions (mean [SD], 1.99 [1.89] admissions) during 2016. For health care costs, specialist outpatient clinic and inpatient care together made up more than 85% of the total cost of nearly 2 billion Singapore dollars. The end-of-life segment contributed approximately 50% of the health care cost per capita of 60 000 Singapore dollars. Different population segments displayed heterogeneity in sociodemographic characteristics, health conditions, health care utilization, and health care cost patterns. This critical health information can be used as baseline data to inform regional and national health priorities for health services research and policy.