Academic literature on the topic 'Health Care System Long-Term Care Population Ageing'
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Journal articles on the topic "Health Care System Long-Term Care Population Ageing"
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Jakovljevic, Mihajlo. "Population ageing alongside health care spending growth." Srpski arhiv za celokupno lekarstvo 145, no. 9-10 (2017): 534–39. http://dx.doi.org/10.2298/sarh160906113j.
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The Silver Tsunami or population ageing has become a globally widespread phenomenon. The purpose of this review is to observe its dynamics and consequences from a local Balkan perspective. The main drivers of this unique demographic evolution are extended longevity, improved early childhood survival, absorption of women into the labor markets, and consequences of sexual revolution leading to falling female fertility. This process lasting well over a century is taking its toll on contemporary societies. Major side effects are shrinking young labor force and growing pool of elderly and retired citizens in many countries. This equation tends to worsen further in the future threatening long-term financial sustainability of public social and health insurance funds. Notable health expenditure growth, accelerating worldwide since the 1960s, is to a large degree attributable to ageing itself. Growing share of senior citizens increases demand for medical services and costs of health care provision. Home-based care provided by the family caregivers presents another important reality putting a huge burden on modern communities. Serbs are no exception in this landscape. Historical demographic evolution of this nation gives a clear evidence of advanced and accelerated ageing, which is well documented in post-World War II era. This synthesis of rich published evidence shows clear upward parallel trend between the pace of population aging and the growth of health expenditure. National authorities shall be forced to consider reform of the current health care financing pattern inherited from the demographic growth era. This might be the only way to smooth out the impact of population ageing on the financial sustainability of the health system and long-term medical care in Serbia.
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HernandezNavarro Espigares, Jose Luis, Elisa Hernández Torres, and Teresa García Muñoz. "Population Ageing, Dependency and Healthcare Services Utilisation." Studies of Applied Economics 26, no. 2 (2021): 1–30. http://dx.doi.org/10.25115/eea.v26i2.5555.
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The increase in the percentage of the elderly (the population 65 years or older) in developed countries is a cause for concern about the levels of health care services expenditures and the widening of long-term care services in these countries. The current debate includes the issue of establishing a system of protection for dependence as a new modality of social protection. The objective of this paper is to analyse the evolution of the degree of dependence in the Spanish population over 65 years during the period between 1997 and 2003, and to estimate the impact of dependence on health status and health care utilisation for the same period. An increasing trend of dependence prevalence as well as of the consumption of health care services has been found. A statistical association between the degree of dependence and the variables of health status, drug consumption and in-patient services has been observed. But this association is not significant in the case of medical consultations. The low degree of association between dependence and out-patient health care services strengthens the hypothesis that the elderly population presents specific necessities, oriented to assistance of dependence needs rather than ambulatory health care services.
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Thinley, Sangay. "Health and Care of an Ageing Population: Alignment of Health and Social Systems to Address the Need." Journal of Health Management 23, no. 1 (2021): 109–18. http://dx.doi.org/10.1177/0972063421994992.
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Population ageing is both an achievement and challenge, an achievement as longevity is the result of successful prevention and control of diseases, decreasing fertility rates and overall socio-economic development. It is at the same time a challenge as the increasing number of older people and the resultant demographic shift are accompanied by the need to adjust and scale up the social and health care systems. The challenges are of particular relevance to the developing world where the demographic shift is occurring much faster. Comprehensive efforts based on country contexts are required in the following areas: (a) older persons and development, (b) health and well-being and (c) enabling and supportive environments to address population ageing needs. This article, however, focuses only on three most crucial issues, that is, livelihood, health care systems and care of the older dependent people. Measures to sustain the livelihood of older people, to align the health systems to provide care and to develop long-term care systems are highlighted. Person-centred care, integration and functional capacity are advocated. Further, ageing in place or living in one’s own home, community or a place with the closest fit with the person’s needs and preferences is considered very important for healthy ageing. In terms of enhancing livelihood, major policy changes and reforms to improve the social security systems and expanding coverage as well as increasing the amounts to minimum subsistence levels are highlighted. Another area which needs to be strengthened is the tradition of existing family support systems. The health systems alignment required are reflected for each health system building block, and focuses mainly on (a) developing and ensuring access to services that provide older-person-centred care; (b) shifting the clinical focus from disease to intrinsic capacity; and (c) developing or reorienting the health workforce to provide care as per alignment. Long-term care systems would best meet the needs of dependent older people if families, communities, civil society organisations and private sector are equally involved while governments play leadership roles in setting up and monitoring quality.
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Rodríguez-Sánchez, Beatriz, Marta Pascual Sáez, and David Cantarero-Prieto. "Dependent, Poorer, and More Care-Demanding? An Analysis of the Relationship between Being Dependent, Household Income, and Formal and Informal Care Use in Spain." International Journal of Environmental Research and Public Health 18, no. 8 (2021): 4339. http://dx.doi.org/10.3390/ijerph18084339.
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Population ageing is one of the current challenges that most societies are facing, with great implications for health systems and social services, including long-term care. This increasing long-term care use is particularly rising for dependent older people, motivating the implementation of regional dependency laws to ensure their care needs’ coverage. Using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) from the year 2004 until 2017, the aim of this study is to assess the impact that the Spanish System for Personal Autonomy and Dependency might have on (i) household income, according to different needs for care levels, by running Generalized Linear Models (GLMs); and (ii) formal and informal care use depending on the income-related determinant through the performance of logit random-effects regression models. We show that the different degrees of needs for personal care are associated with a lower household income, being associated with an income reduction from €3300 to nearly €3800, depending on the covariates included, per year for the more severely in-need-for-care older adults. Moreover, our findings point towards a higher use of formal and informal care services by the moderate and severe dependents groups, regardless of the household income group and time period. Bearing in mind the demographic ageing, our results highlight the need for the identification of potentially vulnerable populations and the efficient planification of long-term care systems and social support services.
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Li, Yuchang, Linlin Hu, and Yuanli Liu. "Long-term care insurance facilitating integrated care: the "whole-person, full-responsibility" system in Qingdao City of China." International Journal of Integrated Care 23, S1 (2023): 346. http://dx.doi.org/10.5334/ijic.icic23464.
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Introduction: The ageing of China has brought the burden of long-term care, and some local areas started the piloting of long-term care insurance (LTCI). In response to its rapid ageing situation, Qingdao was the first city in China to establish LTCI, and it became a national pilot city in 2016. Qingdao has explored an integrated LTCI system, featuring "whole-person, full-responsibility", which promotes the integration of health and long-term care service delivery.
 Short description of practice change implemented: LTCI in Qingdao is financed through a variety of channels, including the reallocation of medical insurance funds, government financial subsidies and premiums. The scope of LTCI coverage is centred on people’s needs and facilitate the provision of integrated services, including medical care, nursing care, living care, functional maintenance and spiritual comfort services. It meets the complex care needs of people with long-term disabilities, reduces the use of hospital beds, and promotes the development of the care service market.
 Targeted population and stakeholders: The targeted population is the LTCI participants in Qingdao, especially the severely disabled and dementia population. Stakeholders include medical insurance agencies, medical institutions, long-term and elderly care facilities, families, etc.
 Timeline: Qingdao has been exploring the construction of LTCI since 2012, and in 2018 it introduced the concept of ""whole-person, full-responsibility"" as a new insurance model.
 Highlights: Qingdao has innovatively established a ""whole-person, full-responsibility"" integrated insurance model facilitating the combination of medical, ageing, nursing, rehabilitation and prevention services. The core is a person-centred, integrated approach to care needs, with the same designated care provider taking full responsibility for providing the integrated services.
 The care includes ""special care"", "" institutional care"", ""home care"" and ""ambulatory care"", covering longer-term hospitalization, institutional care and home care.
 People with dementia were also reimbursed for dementia care. In addition, the Dementia Prevention Fund has been established to promote the prevention of dementia.
 Sustainability and transfer-ability: The establishment of LTCI in Qingdao has effectively reduced the use of hospital beds, reduced the burden of medical insurance funds and promoted the development of the service market. It has been scaled up to the whole province of Shandong and became a national model for LCTI with potential of large scale duplication. But the scheme still faces funding pressure as its expansion of benefits.
 Conclusion: LTCI in Qingdao is based on the concept of ""whole-person, full-responsibility"", taking into account the care needs of people in a holistic manner, which addresses the care integration for long-term disabled and dementia population. It also promoted the development and capacity building of providers and reduced the burden of medical system, resulting in a win-win situation for all parties. It provided a model for China to explore the LTCI system and integrated care for the elderly.
 Discussion: To promote the sustainable development of Qingdao's LTCI system as well as the national LTCI system, issues should be considered in the next step including the sustainable fund raising through diversified channels, the supervision of service quality, training of professionals and workforce, and priority given to disability prevention.
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Horgan, Salinda, Jeanette Prorok, Katie Ellis, et al. "Optimizing Older Adult Mental Health in Support of Healthy Ageing: A Pluralistic Framework to Inform Transformative Change across Community and Healthcare Domains." International Journal of Environmental Research and Public Health 21, no. 6 (2024): 664. http://dx.doi.org/10.3390/ijerph21060664.
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This paper describes a pluralistic framework to inform transformative change across community and healthcare domains to optimize the mental health of older adults in support of healthy ageing. An extensive review and analysis of the literature informed the creation of a framework that contextualizes the priority areas of the WHO Decade of Health Ageing (ageism, age-friendly environments, long-term care, and integrated care) with respect to older adult mental health. The framework additionally identifies barriers, facilitators, and strategies for action at macro (social/system), meso (services/supports), and micro (older adults) levels of influence. This conceptual (analytical) framework is intended as a tool to inform planning and decision-making across policy, practice, education and training, research, and knowledge mobilization arenas. The framework described in this paper can be used by countries around the globe to build evidence, set priorities, and scale up promising practices (both nationally and sub-nationally) to optimize the mental health and healthy ageing trajectories of older adults as a population.
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Lobanov-Rostovsky, Sophia, Qianyu He, Yuntao Chen, et al. "GROWING OLD IN CHINA: SYSTEMATIC REVIEW OF LONG-TERM CARE INSURANCE PILOT STUDIES." Innovation in Aging 7, Supplement_1 (2023): 196–97. http://dx.doi.org/10.1093/geroni/igad104.0647.
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Abstract Between 1970 and 2020, there was a three-fold increase in China’s ≥65 population, compared to less than a doubling in UK. This rapid-ageing demographic has led to a rise in age-related disabilities. At the same time, internal migration and declining fertility have shaken traditional models of care. An important policy response is to pilot differing long-term care insurance (LTCI) systems, with the aim of establishing equitable care for all. Strengths and limitations of the first set of pilot studies have been identified. In 2020, a second set of 34 pilot studies was introduced. Following PRISMA guidelines, we undertook a systematic review of literature published since introduction of the second pilot phase, to answer the question: ‘what are the key challenges to China achieving an equitable nationwide long-term care system for older people?’. Records were eligible for inclusion if published between June 2020 and June 2022 in Mandarin or English. 42 studies (n=16 Mandarin) were included. Four themes emerged: poor quality of service provision, widespread preference for family care, inequitable distribution of cost burden, and varying LTCI eligibility. Key recommendations included increasing salaries to attract and retain staff, mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart care capacity can support preferences to age at home. Our systematic review highlighted significant challenges in provision of equitable care which suits preferences of its users. China’s LTCI pilots will provide useful lessons for other middle-income countries with rapidly ageing populations.
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Weaver, Haylee J., Grant A. Blashki, Anthony G. Capon, and Anthony J. McMichael. "Climate change and Australia's healthcare system - risks, research and responses." Australian Health Review 34, no. 4 (2010): 441. http://dx.doi.org/10.1071/ah09829.
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Climate change will affect human health, mostly adversely, resulting in a greater burden on the health care system, in addition to any other coexistent increases in demand (e.g. from Australia’s increasingly ageing population). Understanding the extent to which health is likely to be affected by climate change will enable policy makers and practitioners to prepare for changing demands on the health care system. This will require prioritisation of key research questions and building research capacity in the field. There is an urgent need to better understand the implications of climate change for the distribution and prevalence of diseases, disaster preparedness and multidisciplinary service planning. Research is needed to understand the relationship of climate change to health promotion, policy evaluation and strategic financing of health services. Training of health care professionals about climate change and its effects will also be important in meeting long-term workforce demands.
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Matei, Elena, Despina Saghin, Liliana Dumitrache, and Mariana Nae. "Multidimensional Approach on Sustainability of Ageing in Romanian Residential Care Centres for Elders." Sustainability 10, no. 9 (2018): 3336. http://dx.doi.org/10.3390/su10093336.
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Residential care centres for elders (RCCEs) in Romania have rapidly developed over the last two decades. In the absence of coherent policies regarding elderly people, RCCEs are mainly the result of businesses arising from an acceleration of the ageing process in Romania. This study uses a multidimensional approach to investigate issues related to the sustainability of ageing in RCCEs in Romania. Specifically, it aims to analyse whether the grouping of RCCEs is following the distribution of elderly Romanian population likely to require such amenities, and whether the characteristics and services of these facilities were appropriate for their users in line with World Health Organization’s Agenda of Ageing. The research relies on a combination of quantitative methods by Geographical Information System (GIS) spatial analysis, and qualitative methods by interviews. The results show that remote rural areas have clusters with high shares of aged population, while the distribution of the RCCEs prevails in large cities, being partly adapted to socio-spatial requirements, and the general trends of the demographic ageing process. These findings are in contrast with the dominant perception of RCCE beneficiaries, who want to be closer to their domiciles, as they are more oriented towards family values, emotionally affected by separation from their relatives, consider themselves socially and spatially segregated groups in care centres, although aware of the need for long-term institutional care. The study reveals the necessity for optimising health policies for elders, by improving the socio-spatial management of such services and building age-friendly environments in long-term care in consent with WHO calls.
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Ng, Tommy K. C., Ben Y. F. Fong, and Catherine K. Y. Kwong. "Transition of Hospital Acute-Centric to Long Term Care in An Ageing Population in Hong Kong - Is it an issue of service gap?" Asia Pacific Journal of Health Management 14, no. 1 (2019): 11. http://dx.doi.org/10.24083/apjhm.v14i1.207.
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Health expenditure at around 5.7% GDP is low for a developed society like Hong Kong, which is unique in having a dual track of public and private services in its health care system. Such phenomenon has been steady over the last three decades, apparently not affected at all by a major change in the Government in 1997. The public and private sections have equal share of the total health dollars consistently over the years, despite the increase of Government’s annual spending from 11% to 17% since 1990, implying a similar trend in the private sector, which is funded predominantly by out of the pocket expenses with some insurance contribution. However, Hong Kong has the longest life expectancy in the world. This has resulted in the increase in the demand for health and long-term care, casting doubt on whether the traditional model of financing and delivery of care will be sustainable. The Government has pledged that that no one is denied adequate medical treatment due to lack of means, a stance in existence for decades and being reflected by the steady state of public and private share of health expenditure. Apart from two major re-structuring of the governance system, there has been little change in the service provision organisations. The system is often criticized for being heavily hospital based and acute-centric, particularly in the public services. Primary care is taken up predominantly by the private sector, mostly in clinical services, not focusing on prevention. It is apparent that there is a significant service gap, that needs to be examined and addressed systematically before a practical solution can be formulated. A more holistic, humanistic and better integrated system of care, with innovative care patterns, shall be the way forward.
Dissertations / Theses on the topic "Health Care System Long-Term Care Population Ageing"
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Polisaitis, Ariane Eloiza Guilherme. "Cuidados pós-agudos: como estão inseridas nas políticas de saúde brasileira as Instituições de Longa Permanência para Idosos (ILPIs) e as Clínicas de Retaguarda?" reponame:Repositório Institucional do FGV, 2018. http://hdl.handle.net/10438/24065.
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Submitted by ARIANE ELOIZA GUILHERME POLISAITIS (arianeguilher@yahoo.com.br) on 2018-06-11T22:27:09Z
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Previous issue date: 2018-06-11<br>O rápido crescimento da população idosa portadora de doenças crônicas e degenerativas e a pressão por redução de custos nos hospitais por parte das fontes pagadoras têm demandado a necessidade de serviços de longo prazo por serem menos onerosos. Com o envelhecimento populacional as necessidades de saúde tendem a se tornar mais crônicas e complexas. É necessário alinhar os sistemas de saúde às necessidades das populações que, cada vez mais, exigirão mudanças no enfoque dos cuidados clínicos e assistenciais. O objetivo deste trabalho aplicado é identificar como são classificadas no Brasil as Instituições de Longa Permanência para Idosos e as Clínicas de Retaguarda. Realizado estudo exploratório e descritivo no site do Departamento de Informática do SUS (DATASUS), para consultar a Classificação Nacional de Atividades Econômicas (CNAE), e no site do Instituto Brasileiro de Geografia e Estatística (IBGE), para consulta do Cadastro Nacional de Estabelecimento de Saúde (CNES). Também foi analisada uma base de dados coletada no ano 2017, contendo registros de internação de pacientes de dois prestadores de serviços da região metropolitana de São Paulo, sendo uma Instituição de Longa Permanência para Idosos e uma Clínica de Retaguarda. A pesquisa identificou a falta de padrão na classificação do CNAE e no cadastramento CNES, dificultando o levantamento dos dados do total de estabelecimentos, e total de leitos de retaguarda e ILPIs. No que tange as políticas de saúde, considera-se frente ao atual cenário brasileiro, uma omissão do Estado, que até o presente momento não atualizou os cuidados continuados prestados em instituições de longa permanência para idosos no Brasil. Os idosos admitidos na ILPI para o serviço de curta permanência ficaram internados em média 49 dias. Do total de admissões na ILPI, 65% dos idosos receberam alta para seu domicilio. Os pacientes atendidos na Clínica de Retaguarda permaneceram em média 53 dias, e 76% dos pacientes receberam alta para seu domicílio. O Brasil tem um grande potencial para evoluir em um sistema de saúde que integre o Pre-Acute Care, o Acute Care e o Post-Acute Care, sendo assim possível a configuração de uma rede de cuidados.<br>The fast growth of the elderly population with chronic and degenerative diseases and underwrites influencing hospitals to reduce their costs have demanded the use of long-term services considering they are less expensive. Health requirements tend to become more chronic and complex due to population aging. Health systems need to be aligned with population demands, which will increasingly require changes in clinical care and assist approaches. This work aims to identify how Long-Term Care Facilities (LTCFs) for the elderly and Nursing Homes are classified in Brazil. An exploratory and descriptive study has been carried out on the SUS Department of Informatics website in order to browse the National Classification of Economic Activities (CNAE), and also on the Brazilian Institute of Geography and Statistics website in order to browse the National Registry of Establishment of Health (CNES). A database collected in 2017 has also been reviewed. It contains patient hospitalization records from two different service providers in the metropolitan region of São Paulo, the first one is a Long-Term Care Facility and the second one is a Nursing Home. This research has identified the lack of standardization in the classification of CNAE and in the CNES registration process, making it difficult to collect data about the amount of establishments, and amount of beds in Nursing Homes and LTCFs. With regard to health policies in the current Brazilian scenario it is considered a government’s omission, since long-term care provided in Brazilian LTCFs has not been updated up to the present moment. The elderly people admitted to the LTCF for the short-term care service were hospitalized for an average of 49 days. 65% of the total admissions to the LTCF were discharged to return to their home. Patients treated at the Nursing Home remained on an average of 53 days, and 76% of the patients were discharged to return to their home. Brazil has a great potential to build up a health system to integrate Pre-Acute Care, Acute Care and Post-Acute Care, thus enabling the configuration of a care network.
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MacLeod, Suzanne. "From the "rising tide" to solidarity: disrupting dominant crisis discourses in dementia social policy in neoliberal times." Thesis, 2014. http://hdl.handle.net/1828/5213.
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As a social worker practising in long-term residential care for people living with dementia, I am alarmed by discourses in the media and health policy that construct persons living with dementia and their health care needs as a threatening “rising tide” or crisis. I am particularly concerned about the material effects such dominant discourses, and the values they uphold, might have on the collective provision of care and support for our elderly citizens in the present neoliberal economic and political context of health care. To better understand how dominant discourses about dementia work at this time when Canada’s population is aging and the number of persons living with dementia is anticipated to increase, I have rooted my thesis in poststructural methodology. My research method is a discourse analysis, which draws on Foucault’s archaeological and genealogical concepts, to examine two contemporary health policy documents related to dementia care – one national and one provincial. I also incorporate some poetic representation – or found poetry – to write up my findings. While deconstructing and disrupting taken for granted dominant crisis discourses on dementia in health policy, my research also makes space for alternative constructions to support discursive and health policy possibilities in solidarity with persons living with dementia so that they may thrive.<br>Graduate<br>0452<br>0680<br>0351<br>macsuz@shaw.ca
Books on the topic "Health Care System Long-Term Care Population Ageing"
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Tomczyk, Łukasz. Perspectives and Theories of Social Innovation for Ageing Population. Frontiers Media, 2020.
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Singapore's Ageing Population: Managing healthcare and end-of-life decisions. Routledge, 2011.
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Michel, Jean-Pierre, B. Lynn Beattie, Finbarr C. Martin, and Jeremy Walston, eds. Oxford Textbook of Geriatric Medicine. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198701590.001.0001.
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The 3<sup>rd</sup> Edition of The Oxford Textbook of Geriatric Medicine brings together specialists from across the globe to provide every physician and health care provider involved in the care of older people with a comprehensive resource on the medical, social, and psychological issues they are likely to encounter in their practice and research. Beyond these issues, this comprehensive text provides insights into global population ageing, ageing-relevant policy developments, healthy ageing, lifecourse, multimorbidity, personalised and person-centred care.New material has been added throughout with a strong focus on integrating the impact of age-related physiological and cellular changes with the development of age-related diseases and conditions. Sections on sarcopenia, nutritional health, frailty and related geriatric syndromes have been expanded. Geriatric care principles from public health, primary and specialized care have also been updated and expanded. New models of care in general medicine and surgery and related sub-specialties, outpatient and emergency care, rehabilitation, oncology, palliative medicine and long-term care relevant to older adults are discussed in detail. In summary, the 3<sup>rd</sup> Edition of The Oxford Textbook of Geriatric Medicine 3e articulates important new global demographic trends and clinical practice patterns, the scientific basis of age-related diseases and conditions, and the ethical, legal, and socioeconomic concerns for healthcare policy and systems relevant to older adults around the globe.
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Vernon, Martin J. Advance care planning for an ageing population. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198802136.003.0005.
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Population ageing is driven by declining fertility and improved life expectancy. As people survive to later life with multiple long-term conditions, advance care planning ACP) is of increasing importance to those wishing to retain control over their end-of-life care. Understanding disability trajectories for people can assist with advance care planning, mindful that older people living with frailty have increased risk of acute and unexpected health decline. Routine frailty identification by severity in older people can prompt care planning in anticipation of health decline and imminent lost capacity to make important decisions. Recognizing potential professional and organizational barriers to advance carer planning for older people could also improve its uptake. Guided serious illness conversations could assist this process over time for older people and those important to them. In care homes and among people with dementia ACP is also likely to be beneficial.
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Adhikari, Neill KJ. Critical Illness and Long-Term Outcomes Worldwide. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0002.
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Interest in the global burden of critical illness and its sequelae are growing, but comprehensive data to describe the burden of acute and post-acute illness and the resources available to provide care are lacking. Challenges to obtaining population-based global estimates of critical illness include the syndrome-based definitions of critical illness, incorrect equating of ‘critical illness’ with ‘admission to an intensive care unit’, lack of reliable case ascertainment in administrative data, and short prodrome and high mortality of critical illness, limiting the number of prevalent cases. Estimates of the burden of post-critical illness morbidity are even less reliable, owing to the limited number of observational studies, inaccurate coding in administrative data, and the unclear attributable risk of these morbidities to critical illness. Modelling techniques will be required to estimate the burden of critical illness and disparities in access to critical care using existing data sources. Demands for critical care and post-discharge care for survivors are likely to increase because of urbanization, an ageing demographic, and ongoing wars, disasters, and pandemics, while the ability to assume the cost of increased critical care may be limited due to economic factors. Major public health questions remain unanswered regarding the worldwide burden of critical illness and its sequelae, variation in resources available for treatment, and strategies that are broadly effective and feasible to prevent and treat critical illness and its consequences.
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Takala, Jukka. Resource management and budgeting in critical care. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0021.
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Resource management is a core task for intensive care unit (ICU) leadership. Budgeting covers optimizing resource use, planning for future needs, and continuous monitoring of actual resource use. Short-term budgeting is operational planning, whereas mid- and long-term budgeting should focus on strategy. Resource management is an integral and continuous part of the ICU management process. Hence, the regional and local availability of health care services rarely depends on rational or objective factors alone. For budgeting purposes, the needs for intensive care for the population of the main referral area of the hospital, the actual structure of the local health care system and probable changes during the strategic planning period should be considered. The resources needed for emergency admissions is relatively constant as long as the referral population the indications for intensive care and the treatments offered do not change. The ICU is part of a multidisciplinary, horizontal care process. The amount and level of care provided in all the participating units must be considered.
Book chapters on the topic "Health Care System Long-Term Care Population Ageing"
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Fleßa, Steffen. "Social Long-Term Care Insurance in Germany." In Sustainable Aging. Springer Berlin Heidelberg, 2024. http://dx.doi.org/10.1007/978-3-662-69139-7_4.
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AbstractIn 1995, Germany launched a compulsory long-term care insurance to pool the growing financial risk of long-term care of the ageing population. Most of the population is covered by the social long-term care insurance following the same principles as the social health insurances stemming from the Bismarck model of 1883. Both employers and employees contribute to the fund. Potential beneficiaries are grouped into care grades and receive a wide portfolio of financial compensations for their care expenditure. The amount depends on the care grade. The German social long-term care insurance system is constantly reformed to reconcile the conflict between fair coverage of the population and continuously growing expenditure. The underlying problem of an ageing population with increasing demand for care cannot be solved by an insurance but has to be addressed by prevention and health promotion.
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Cavrini, Giulia, Elisa Cisotto, and Alex Weissensteiner. "Population ageing and sustainability in South Tyrol: measuring the economic implications of an ageing society." In Proceedings e report. Firenze University Press and Genova University Press, 2023. http://dx.doi.org/10.36253/979-12-215-0106-3.25.
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Meeting the challenge of population ageing requires a better understanding of frailty and disability, and appropriate strategies to ensure the resilience of the health and social care system, without destabilising public finances or over-burdening the economy. An increasing life expectancy will primarily affect the health care and the long-term care spending. Countries will face an ongoing challenge to provide care for a heterogeneous population of older adults. Within this context, the current paper is designed to (a) measure the current needs for social care in South Tyrol, (b) identify the local trajectories of health status, disaggregated by age, sex and severity of illness, (c) forecast the health care needs and the healthcare system’s financial sustainability. Demographic forecast data (up to 2050) on population age and sex structure is provided by ISTAT . Health care data for administrative and billing purposes is from the Autonomous Province of Bozen-Bolzano, which are used to study health care delivery, benefits, harms, and costs. Preliminary results show a decrease in the prevalence of individuals receiving home care allowance from 2009 to 2019 for all levels of severity and both for men and women. Overall, greater prevalence occurs at lower levels of health condition severity (levels 1 and 2 over a four points-scale of severity) and after age 75. Historical payments combined with the demographic forecast allow for an estimate of yearly average costs individual recipients (by age, sex, and health condition) as well as for the whole local social system.
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Vo, Man Thi Hue, and Ben Yuk Fai Fong. "Long-Term Care Initiatives in Southeast Asian Countries with Emerging Ageing Population and the Sustainability of Health and Social Care Systems." In The Handbook of Public Health in the Asia-Pacific. Springer Nature Singapore, 2025. https://doi.org/10.1007/978-981-97-1788-0_31-1.
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Santini, Sara. "Intergenerational Informal Caregiving in an Ageing European Society." In Vechtaer Beiträge zur Gerontologie. Springer Fachmedien Wiesbaden, 2025. https://doi.org/10.1007/978-3-658-48005-9_5.
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Abstract The ageing population and the consequent growing prevalence of chronic diseases and multimorbidity are increasing long-term care (LTC) demand worldwide. In Europe and beyond, regardless of the welfare policies, the bulk of care for older people is carried out by informal caregivers (ICGs), who are usually adults and older adults. Nevertheless, many studies have recently shed light on young people playing the role of caregivers (known as Adolescent Young Carers, or AYCs) of frail older family members, often grandparents (GrPs). Intergenerational informal caregiving can have negative outcomes (e.g. high levels of stress and poor physical health and mental well-being), especially in countries with underdeveloped LTC systems. The COVID-19 outbreak represented a real “stress-test” for the European LTC systems, bringing to light their limits and weaknesses. The virus containment measures exacerbated the health and living conditions of ICGs and older adults in need of care by restricting access to many social and health services. The overall aim of this article is to deepen our understanding of the characteristics of intergenerational caregiving both in ordinary circumstances and during the pandemic. To this purpose, four cross-European studies on informal intergenerational caregiving are presented, highlighting the difficulties faced by adolescents and adults in Europe, especially in Germany and Italy, and their support needs when they care for one or more older family members with LTC needs. Building on the caregiving stress appraisal model of Yates (Yates et al., .The Journal of Gerontology-Series B Psychological Sciences and Social Sciences 54:12–22, 1999), we propose a new conceptual framework for the interpretation of the intergenerational caregiving and for the provision of effective policies to support today’s informal caregivers.
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Werner, Gijsbert D. A., Arthur van Riel, Mérove I. L. Gijsberts, and Marianne de Visser. "Introduction." In Research for Policy. Springer Nature Switzerland, 2024. http://dx.doi.org/10.1007/978-3-031-58564-7_1.
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AbstractFinancial, staffing and societal sustainability of healthcare systems is coming under increasing pressure in the Netherlands and beyond. Causes include the ageing population and the widening of treatment options as a result of technological innovation. In this report we analyse how these trends are affecting the sustainability of healthcare. The broad picture is that the need for care is growing faster than both the economy and—even more urgently in the short term—the labour force. This situation is expected to persist for decades, giving cause for concern about the sustainability of healthcare. This presents a challenge not just for the health care sector, but for society as a whole. This report concludes that good healthcare for all requires better choices, precisely because these limits of its financial, staffing and societal sustainability are coming into view. Specifically, this means that the key task now before us is to better delineate the sector’s future growth, in so doing steering it as carefully as possible towards those healthcare and preventive interventions which achieve the greatest health benefits and safeguard public values most effectively. This will be no easy task. It requires clear and sometimes uncompromising decisions, which can be difficult to make from a normative point of view. And these in turn require a long-term vision of the role and function of healthcare in our society that has broad public support. In this report we explain how we have arrived at these conclusions. We also discuss perspectives drawn from various scientific disciplines on making choices within and about healthcare, and explain why the processes involved could be better. Finally, we suggest concrete ways to make better choices.
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Luk, Sabrina Ching Yuen. "Population ageing and financing health and long-term care in Asia." In Ageing, Long-term Care Insurance and Healthcare Finance in Asia. Routledge, 2020. http://dx.doi.org/10.4324/9781315115689-1.
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Lu, Bei, and Guanggang Feng. "Qingdao Long-Term Care Social Insurance Pilot." In Sustainable Aging. Springer Berlin Heidelberg, 2024. http://dx.doi.org/10.1007/978-3-662-69139-7_6.
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AbstractChina is grapping with a rapid increase in demand for public long-term care due to an ageing population. Some regions have initiated social insurance programs as pilot projects, with Qingdao being one of the earliest adopters. Existing literature has predominantly focused on policy introduction and demand analysis, providing limited insights into the operational aspects of such practices in China. This chapter sheds light on the evolution and progress of Qingdao’s long-term care social insurance since its inception. Additionally, it provides estimation of the premiums of this long-term care insurance and compares patients’ total health costs before and after the implementation of the long-term care program.
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Wu, Xiaolan. "Thoughts on China’s Long-Term Care Development Policy." In Sustainable Aging. Springer Berlin Heidelberg, 2024. http://dx.doi.org/10.1007/978-3-662-69139-7_2.
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AbstractIn the context of an ageing population, a prevalence of chronic diseases, health issues causing further impediments, and the shrinking of family structures, the development of long-term care has become an important social issue. This report takes a systematic look at policy evolution and the development of long-term care in China, to clarify the attributes and fundamental role long-term care plays in the development of elderly care services, as well as the importance of implementing a comprehensive plan with relevant and coherent infrastructure, consolidating the legal environment, policy and associated recommendations, so as to promote the healthy and rapid development of long-term care.
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Murphy, Mike, and Pekka Martikainen. "Demand for Long-term Residential Care and Acute Health Care by Older People in the Context of the Ageing Population of Finland." In Ageing, Care Need and Quality of Life. VS Verlag für Sozialwissenschaften, 2010. http://dx.doi.org/10.1007/978-3-531-92335-2_8.
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Ding, Chun, and Dan Liu. "Exploring the Establishment of Statutory Social Long-Term Care Insurance in China." In Sustainable Aging. Springer Berlin Heidelberg, 2024. http://dx.doi.org/10.1007/978-3-662-69139-7_5.
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AbstractThe non-stop ageing of the population in China has brought with it a surging demand for elderly nursing care. Along with current shrinking family structures and declining birth rates, the problem of providing long-term care to the disabled elderly has been catapulted into a social problem that needs to be solved urgently. In line with the “Guiding Opinions on Carrying out the Pilot Long-term Care Insurance System” issued by the Ministry of Human Resources and Social Security in 2016, a pilot programme introducing a long-term care insurance scheme was launched nationwide to explore and solve the problem of nursing needs in an ageing society. This paper reviews the implementation of the scheme across 15 pilot cities, and summarises the experience gained in the process of implementing specific care insurance, pointing out shortcomings, and putting forward opinions and expectations for the future development of China’s social long-term care insurance.
Conference papers on the topic "Health Care System Long-Term Care Population Ageing"
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Buciuceanu-Vrabie, Mariana. "Fragility of the support system in the context of the ageing society." In Economic growth in the face of global challenges. Consolidation of national economies and reduction of social inequalities: International Scientific-Practical Conference, XVIIIth edition. National Institute for Economic Research, 2024. https://doi.org/10.36004/nier.cdr.18.2024.03.
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Accelerated population ageing is one of the most pressing demographic and social challenges for the Republic of Moldova. People aged 60 and over comprise a quarter of the population, and their share is steadily increasing, directly impacting the demand for permanent care. The study analyzes this demand's current and future dimensions, focusing on disparities by residence and gender and the pressure on an underdeveloped social support system. The research highlights significant vulnerabilities by linking empirical data from 2024 with demographic projections for 2030 and 2040, including rural areas with limited access to social services. The results indicate a significant increase in the number of people aged 75+ who will require constant support, highlighting the need to expand social infrastructure, attract qualified staff and develop effective public policies. Without strategic interventions and the allocation of adequate resources, the social support system risks becoming incapable of responding to the growing needs, seriously affecting the well-being of the elderly population and long-term social stability. The study provides clear recommendations for adapting social and public health policies in the context of demographic change.
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Kuzmina, Lidiya K. "HEALTH CARE DEVELOPMENT AS A RESPONSE TO MODERN CHALLENGES." In Problems of transformation and regulation of regional socio-economic systems. Institute of Problems of Regional Economics of the Russian Academy of Sciences, 2024. https://doi.org/10.52897/978-5-7310-6504-7-2024-53-32-41.
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The concept of long-term development of the Russian Federation considers healthcare as one of the most important factors in economic development. including the for-mation of a new quality of human capital. The reproduction and effective use of human capital depends on the health of the population. The prospects for its development are largely deter-mined by the level of activity of the healthcare system. Healthcare must develop as a health industry, including an increase in healthy life expec-tancy, an active working life through a reduction in morbidity, technological development of the industry, improved organization and commitment to a healthy lifestyle. The state of healthcare that meets the requirements of a modern innovative economy and digital economy is becoming not only a strategically important goal of socio-economic develop-ment, but also a necessary condition for social stability, economic security, and sustainable de-velopment in the face of the emergence of new risks and challenges.
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Carlsson, Christer. "Self-Efficacy Improves UTAUT to Describe Adoption of HealthEnhancing Physical Activity Programs." In Digital Restructuring and Human (Re)action. University of Maribor Press, 2022. http://dx.doi.org/10.18690/um.fov.4.2022.37.
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There is consensus in health studies that regular physical activities of sufficient intensity and duration contribute to better health both in the short and long term. In an ongoing research program, we focus on getting young elderly, the 60-75 years age group, to adopt and include physical activities as part of their everyday routines. Regular health-enhancing physical activities can serve as preventive health care, which will improve and sustain quality of life and build up savings in health-care macro costs for an ageing population. We have learned that digital service tools can be instrumental for the adoption and use of activity programs, and that the Unified Theory of Acceptance and Use of Technology (UTAUT) is instrumental for the acceptance and use of digital tools and services. We will argue that the UTAUT is not sufficient as such but can be enhanced to describe the adoption and use of health-enhancing physical activity programs.
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Iordachi, Victoria, and Stela Ciobu. "Sustainable financing for the health sector: building a resilient healthcare system." In Economic growth in the face of global challenges. Consolidation of national economies and reduction of social inequalities: International Scientific-Practical Conference, XVIIIth edition. National Institute for Economic Research, 2024. https://doi.org/10.36004/nier.cecg.iii.2024.18.10.
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Sustainable financing of the health sector is an essential pillar for ensuring a resilient and affordable medical system in the long term. This article explores the multiple facets of sustainable financing, from securing adequate resources and using them effectively, to diversifying funding sources and promoting public health. The importance of equitable access to quality health care and innovative strategies to meet future financial challenges such as an aging population and expensive new medical technologies are discussed. Through an integrated and long-term approach, sustainable financing can transform health systems, contributing to improved population health and economic stability. The Republic of Moldova, a country with different dimensions and resources compared to European states, faces multiple challenges in ensuring access to quality medical services for its citizens. In this context, it is essential that the Republic of Moldova adopts sustainable financing policies that respond to its specific needs and support the development of a resilient medical system. The article analyzes concrete measures and international best practices that can be adapted and implemented in the Republic of Moldova to optimize available resources and ensure efficient and quality medical services. Through a well-founded and future-oriented strategy, the Republic of Moldova can build a health system capable of facing current and future challenges, thus ensuring the well-being and health of its population.
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Petroia, Andrei. "The Impact Of The Pandemic Crisis On The Financing Mechanism Of The Health Care System In The Republic Of Moldova." In 27th International Scientific Conference “Competitiveness and Innovation in the Knowledge Economy”. Academy of Economic Studies of Moldova, 2024. http://dx.doi.org/10.53486/cike2023.54.
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Health care is one of the basic services guaranteed by the state companies. The level of spending on health, like those on education, can be considered an indicator of the level of development of a nation. Most countries with advanced economies allocate important resources to finance the health sector, as a premise for the healthiest possible generations and long-term sustainable development. The COVID-19 pandemic is affecting everyone. Globally, millions of people have been infected with this virus, and hundreds of thousands have lost their lives. The topic addressed is considered to be actual considering that in the Republic of Moldova the pandemic is putting increasing pressure on the health care and social protection systems, causing major interruptions of economic processes and limitations of social life, deepening inequalities and proving how vulnerable we are. The era of COVID-19 has transformed the healthcare system into an extremely important sector. In addition to increasing spending on the necessary health care and implementing all actions in a non-pandemic situation, additional resources are needed to prevent, spread and treat the coronavirus. The Republic of Moldova has recognized the fundamental role of health protection, representing an essential condition that contributes to increasing the quality of life of the population, as well as to the development of health capital. The national security and economic development of the country largely depends on the functioning of an effective health care financing system in order to preserve the health of the population as the main productive force of society. The main purpose of the paper is to analyze the impact of the pandemic crisis on the financing mechanism of the health care system in the Republic of Moldova. The given research analyzes the total expenses for health protection and their structure in the Republic of Moldova. We also analyze the financing mechanism, during the pandemic crisis, of the health care system in the Republic of Moldova.
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Đuric, Petar, and Dragana Atanasijević. "Evaluation of burden on the capacity of the mental health care system in Serbia due to the leading causes of hospitalization, 2021-2023." In Proceedings of the International Congress Public Health - Achievements and Challenges. Institute of Public Health of Serbia "Dr Milan Jovanović Batut", 2024. http://dx.doi.org/10.5937/batutphco24164d.
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Background: Many mental disorders require hospital care (HC) and long-term care (LTC), while in their stable presentation, they can be treated in outpatient care (OC) settings. In light of the Serbian system's transition towards community-based mental health care, this study aimed to determine the extent of the system's burden by schizophrenia, depression and psychoses, which require hospitalization and how LTC and to what extent OC services relieve them. Methods and Objectives: We used data on the number of patients, hospital days (HD) and the episodes of hospital treatment, aggregated based on the diagnostic groups (DGs): F23-29: Psychoses, F20-21: Schizophrenia and F32-33: Depression, according to the International Classification of Diseases, Tenth Revision, for 2021-2023 in Serbian hospitals. Results: In the 2021-2023 period, among patients with psychoses, an increasing number of LTC days spent and its share in the total HD for the specified DG [(2021, 2022, 2023: 21.1; 22.0; 23.2), %] was observed. Patients with schizophrenia spent the highest number of HDs in the LTC setting, with a growing share of the total time spent in LTC [(2021, 2022, 2023: 17.3; 18.7; 18,5), %]. Compared to psychoses and schizophrenia, patients with depression spent a higher proportion of days in OC settings, with an increase in the observed period [(2021, 2022, 2023: 16.1; 18.3; 18.6), %]. At the same time, patients with depression had a higher number of treatment episodes in the OC per person than other DGs, with an annual increase (p<0.05). Conclusions: To be able to more efficiently monitor and more clearly interpret the performance of the mental health care system in Serbia, more detailed analyses of individual data are necessary, as well as the implementation of new indicators that would monitor the relationship between interventions and health outcomes at the individual and population level.
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Zegarac Leskovar, Vesna, and Vanja Skalicky Klemenčič. "Inclusive design: comparing models of living environments for older people." In 14th International Conference on Applied Human Factors and Ergonomics (AHFE 2023). AHFE International, 2023. http://dx.doi.org/10.54941/ahfe1003339.
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Many older adults who are no longer able to live independently due to a combination of impairments need to live in living environments that are adapted to their health conditions. Generally, these are various types of housing, such as nursing or retirement homes, skilled nursing facilities, assisted living facilities, residential care homes, palliative or rehabilitation centres, etc., which can be referred to as long-term care living environments. Although the recent trend in Europe has been to allow older adults to remain living at home as long as possible, the demand for institutionalised forms of long-term care living environments is quite high, and many older adults spend a significant portion of their lives in these settings. In general, the quality of the living environment has a significant impact on the physical and mental health of residents. Therefore, it is important to explore living environments for older adults that not only allow basic existential needs to be met, but also provide humane living conditions. Concepts of long-term care living environments vary from country to country and depend largely on the characteristics of each social and health care system. Among the various concepts of living environments for older adults, nursing homes house a relatively large proportion of the world's population aged 65 and older. The development of nursing home typologies has evolved from traditional to alternative forms which could be illustrated by five-generations model of nursing homes in Europe, whereby alternative types, fourth- and fifth-generation models provide residents with a higher quality of life due to specific architectural features and functional adaptations. The aim of this paper is to introduce some concepts of long-term care living environments in the U.S. and Europe and to analyse models of third-, fourth- and fifth-generation nursing homes, especially the architectural design features that can strongly influence the quality of life of older adults.
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Porada, N. E., and A. S. Bobrova. "ANALYSIS OF THE DYNAMICS AND CAUSES OF MORTALITY OF THE POPULATION OF THE REPUBLIC OF BELARUS IN 2010-2019." In SAKHAROV READINGS 2022: ENVIRONMENTAL PROBLEMS OF THE XXI CENTURY. International Sakharov Environmental Institute of Belarusian State University, 2022. http://dx.doi.org/10.46646/sakh-2022-2-38-41.
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Mortality is a socio-biological process, the quantitative side of which characterizes the level of health of the population [2]. The mortality of the population is an indicator reflecting the epidemiological patterns of morbidity. The value of this indicator depends both on the frequency of the spread of pathology among the population, and many other factors - the system of organizing data collection, the availability of medical care, the availability of specialists, etc. The mortality rate is an important criterion for the health of the population [4]. The paper analyzes the long-term dynamics and causes of mortality of the population of the Republic of Belarus in the period 20102019. The main trends in the mortality of the population by causes, by age groups, in the context of urban and rural population are determined
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Bjegović-Mikanović, Vesna. "Transforming health systems: Challenges in times of change." In Proceedings of the International Congress Public Health - Achievements and Challenges. Institute of Public Health of Serbia "Dr Milan Jovanović Batut", 2024. http://dx.doi.org/10.5937/batutphco24004b.
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Background: Health system transformation refers to comprehensive changes aimed at improving the efficiency, quality, equity, and sustainability of healthcare delivery. This transformation can be driven by various factors and often encompasses technological advancements, policy and regulatory changes, economic aspects, innovation in service delivery, and global health challenges. Objectives and Methods: This narrative review aims to comprehend different health system transformation models, drivers of change, and associated outcomes. Its scope focuses on European countries and their diverse population profiles, health status, and environmental, economic, and political contexts. The review covers the building blocks of health systems (governance, service delivery, workforce, information systems, medical products, vaccines, technologies, and financing). It particularly looks at initiatives integrating bottom-up and top-down approaches to system changes. Results: Inspired by the recent policy brief of the European Observatory on Health Systems and Policies titled "Transforming Health Service Delivery: What Can Policy-Makers Do to Drive Change?", this review provides a summary of the evidence, identifying common themes, trends, gaps, and divergences in the literature. The intended changes in the health system models of various European countries often aim to address current challenges, improve efficiency, enhance patient outcomes, and ensure sustainability. The theoretical and practical approaches to health system transformations often fail to emphasize practical steps for achieving higher quality and efficiency of health service delivery, which would be more responsive to demands. Nevertheless, the main themes in the transformation of health systems underline the consumer-centric approach with acknowledgement of human rights and vulnerable groups, universal health coverage, and application of innovative and affordable technologies with "more resources in the right places". Actual literature underlines coordination across primary, secondary, and tertiary care to provide comprehensive services that address the full spectrum of patient needs while also respecting a community-based approach by leveraging health workers and local resources to deliver care, particularly in underserved areas. Conclusions: In an era of rapid technological advancements and shifting demographics, transforming health systems has become critical. Integrating digital health solutions, promoting preventive care, and addressing social determinants of health are essential for long-term success in times of change.
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Pui-yuk King, Alex, and Kin Wai Michael Siu. "Universal Design in Public Housing: Enhancing the Quality of Life of Older People with Mild Cognitive Impairment Living Alone." In 10th International Conference on Human Interaction and Emerging Technologies (IHIET 2023). AHFE International, 2023. http://dx.doi.org/10.54941/ahfe1004016.
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The population of Hong Kong is ageing and is expected to gradually increase, and thus an increase in single older people with mild cognitive impairment is expected. This may progress to dementia overtime. By 2064, a third of Hong Kong's total population is expected to be aged 65 or above, which will put extreme pressure on long-term health services and increase social care costs. Studies of mild cognitive impairment (MCI) and dementia have mainly been conducted in the west, and evidence-based research addressing the genuine needs of patients with MCI in their daily activities is limited. The home is the central focus of many people's lives, and the elderly will spend most of time in it.The specific objectives of the study are first, to briefly review and explore the common strengths and limitations of public housing in Hong Kong and selected cities; second, to identify the deficiencies of current public housing in terms of universal design and broaden the scope of this approach; third, to develop a model of the relationships among coping strategies for enhancing quality of life, unmet needs and the feeling and concerns of people with MCI living alone.The present ethnographic study is aimed at revealing some of the contemporary concerns about human culture and social interaction. A triangulation study approach is taken, beginning with participatory design workshop followed by participant observations with five residents living alone with MCI, and an in-depth interview with a centre manager who assisted in this study and is a carer for those with dementia.This study suggests that universal design principles are not sufficiently applied in the development of public housing for single elderly people living with MCI. To address this deficit in interior, home furniture and product designs, the concept of a visible reminder has been suggested, which includes multisensory and psychological considerations. Design practitioners should fully utilise this conceptual model when developing universal design furniture for the general public, without stigmatising those with disabilities such as MCI. The coping strategies for improving the quality of life these older people are identified as continued home care and family support, an awareness of universal design principles, social networks and engagement and revisiting public health policies. Governments should take the lead in helping to improve the quality of life of people with MCI through healthcare, social engagement, caring and universal design.
Reports on the topic "Health Care System Long-Term Care Population Ageing"
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Hollick, Rosemary J., Michelle Stevenson, Michael Parker, et al. Mapping for Better Care: Supporting service planning for people with rheumatic and musculoskeletal conditions. RHEUMAPS study / University of Aberdeen, 2025. https://doi.org/10.57064/2164/25119.
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Rheumatic and musculoskeletal disorders (RMDs) affect approximately one-third of the UK population, yet access to timely and equitable care remains inconsistent. National audits have highlighted significant variations in service provision and health outcomes, shaped by individual socio-demographic characteristics and place-based factors. Rural populations, comprising around 20% of the UK, face unique challenges due to geographic remoteness, centralised specialist services, and an ageing demographic. Workforce constraints and service accessibility further exacerbate these disparities, limiting the ability of local health systems to meet the needs of their populations effectively. The RHEUMAPS study was designed to address key evidence gaps by exploring patient priorities for care, measuring the geographical prevalence of RMDs, and assessing health outcomes across Scotland and Wales using national healthcare data. Specifically, the study examined differences in outcomes between rural and urban populations and the extent to which these disparities could be attributed to socio-economic factors. Additionally, it assessed how historical rural healthcare policies in Scotland and Wales have shaped service delivery and identified opportunities for future policy direction. Findings from the study revealed that people living with RMDs share common care priorities, including pain and fatigue management, maintaining physical activity, sustaining social connections, and participating in work and daily activities. Access to multidisciplinary, integrated, and locally available care was highly valued, yet many participants expressed dissatisfaction with existing services due to long travel distances, fragmented care pathways, and a lack of accessible information. Structural barriers, such as limited local healthcare provision and travel challenges, disproportionately affected rural communities, further widening health inequalities. To support data-driven and place-sensitive healthcare planning, the study developed interactive geospatial maps, integrating information on RMD prevalence, socio-demographic factors, and service accessibility. These tools provide timely, actionable insights to inform local, regional, and national decision-making, helping policymakers and healthcare providers design services that better align with patient needs. Additionally, the study highlighted the need for a more integrated approach to rural healthcare policy, moving beyond historically siloed strategies that have addressed health, transport, housing, and workforce issues in isolation. This report offers critical evidence and resources to support a transition toward sustainable, equitable, and person-centred healthcare for people living with RMDs. By leveraging real-world data and patient insights, the findings underscore the importance of developing adaptable, learning healthcare systems that respond to the evolving needs of diverse populations across urban and rural settings.
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Wiener, Joshua M., Mary E. Knowles, and Erin E. White. Financing Long-Term Services and Supports: Continuity and Change. RTI Press, 2017. http://dx.doi.org/10.3768/rtipress.2017.op.0042.1709.
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This article provides an overview of financing for long-term services and supports (LTSS) in the United States, paying special attention to how it has changed and not changed over the last 30 years. Although LTSS expenditures have increased greatly (like the rest of health care), the broad outline of the financing system has remained remarkably constant. Medicaid—a means-tested program—continues to dominate LTSS financing, while private long-term care insurance plays a minor role. High out-of-pocket costs and spend-down to Medicaid because of those high costs continue to be hallmarks of the system. Although many major LTSS financing reform proposals were introduced over this period, none was enacted—except the Community Living Assistance Services and Supports Act, which was repealed before implementation because of concerns about adverse selection. The one major change during this time period has been the very large increase in Medicare spending for post-acute services, such as short-term skilled nursing facility and home health care. With the aging of the population, demand for LTSS is likely to increase, placing strain on the existing system.
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Cedergren, Elin, Diana Huynh, Michael Kull, John Moodie, Hjördís Rut Sigurjónsdóttir, and Mari Wøien Meijer. Public service delivery in the Nordic Region: An exercise in collaborative governance. Nordregio, 2021. http://dx.doi.org/10.6027/r2021:4.1403-2503.
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Nordic welfare states are world renowned for providing high quality public services. Nordic municipal and regional authorities, in particular, play a central role in the delivery of key public services in areas, such as, health, education, and social care. However, in recent years, public authorities have faced several challenges which have reduced capacity and resources, including long periods of austerity following the 2008 financial crash, rapid demographic changes caused by an ageing population, and the COVID-19 health crisis. In response to these challenges many public authorities have looked to inter-regional, inter-municipal and cross-border collaborations to improve the quality and effectiveness of public service delivery (OECD 2017; ESPON 2019). Indeed, collaborative public service delivery is becoming increasingly prominent in the Nordic Region due to a highly decentralized systems of governance (Nordregio 20015; Eythorsson 2018).
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Mobley, Erin M., Diana J. Moke, Joel Milam, et al. Disparities and Barriers to Pediatric Cancer Survivorship Care. Agency for Healthcare Research and Quality (AHRQ), 2021. http://dx.doi.org/10.23970/ahrqepctb39.
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Objectives. Survival rates for pediatric cancer have dramatically increased since the 1970s, and the population of childhood cancer survivors (CCS) exceeds 500,000 in the United States. Cancer during childhood and related treatments lead to long-term health problems, many of which are poorly understood. These problems can be amplified by suboptimal survivorship care. This report provides an overview of the existing evidence and forthcoming research relevant to disparities and barriers for pediatric cancer survivorship care, outlines pending questions, and offers guidance for future research. Data sources. This Technical Brief reviews published peer-reviewed literature, grey literature, and Key Informant interviews to answer five Guiding Questions regarding disparities in the care of pediatric survivors, barriers to cancer survivorship care, proposed strategies, evaluated interventions, and future directions. Review methods. We searched research databases, research registries, and published reviews for ongoing and published studies in CCS to October 2020. We used the authors’ definition of CCS; where not specified, CCS included those diagnosed with any cancer prior to age 21. The grey literature search included relevant professional and nonprofit organizational websites and guideline clearinghouses. Key Informants provided content expertise regarding published and ongoing research, and recommended approaches to fill identified gaps. Results. In total, 110 studies met inclusion criteria. We identified 26 studies that assessed disparities in survivorship care for CCS. Key Informants discussed subgroups of CCS by race or ethnicity, sex, socioeconomic status, and insurance coverage that may experience disparities in survivorship care, and these were supported in the published literature. Key Informants indicated that major barriers to care are providers (e.g., insufficient knowledge), the health system (e.g., availability of services), and payers (e.g., network adequacy); we identified 47 studies that assessed a large range of barriers to survivorship care. Sixteen organizations have outlined strategies to address pediatric survivorship care. Our searches identified only 27 published studies that evaluated interventions to alleviate disparities and reduce barriers to care. These predominantly assessed approaches that targeted patients. We found only eight ongoing studies that evaluated strategies to address disparities and barriers. Conclusions. While research has addressed disparities and barriers to survivorship care for childhood cancer survivors, evidence-based interventions to address these disparities and barriers to care are sparse. Additional research is also needed to examine less frequently studied disparities and barriers and to evaluate ameliorative strategies in order to improve the survivorship care for CCS.