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Background: For better supporting the science-governance interface, the potential of health assessments appears underrated. Aims: To identify what various types of health assessment have in common; how they differ; which assessment(s) to apply for which purpose; and what needs and options there are for future joint development. Methods: This review is based on five types of health assessment: monitoring/surveillance/reporting, assessment of health impact, of health technology, of health systems performance, health-related economic assessment. The approach is exploratory and includes: applying an agreed set of comparative criteria; circulating and supplementing synoptic tables; and interpreting the results. Results: Two of the assessments deal with the question 'Where do we stand?', two others with variants of 'What if' questions. Economic Assessment can take place in combination with any of the others. The assessments involve both overall 'procedures' and a variety of 'methods' which inescapably reflect some subjective assumptions and decisions, e.g. on issue framing. Resources and assistance exist for all these assessments. The paper indicates which type of assessment is appropriate for what purpose. Conclusions: Although scientific soundness of health assessments is not trivial to secure, existing types of health assessment can be interpreted as a useful 'toolkit' for supporting governance. If current traces of 'silo' thinking can be overcome, the attainability of a more unified culture of health assessments increases and such assessments might more widely be recognized as a prime, 'tried and tested' way to voice Public Health knowledge and to support rational governance and policy-making.
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Atención a la Salud/organización & administración , Política de Salud , Estado de Salud , Humanos , Formulación de PolíticasRESUMEN
Capacity assessment has become a popular measure in the health sector to assess the ability of various stakeholders to pursue agreed activities. The European Commission (EC) is increasingly dealing with a variety of health issues to coordinate and complement national health policies. This study analyses the functional capacity of the Directorate-General for Health and Consumers (DG SANCO) between 1999 and 2004. It applies the UNDP Capacity Assessment Framework and uses a literature review, a document review of EU policy documents and expert interviews to assess the capacity of DG SANCO to fulfill its mandate for public health and health systems. Our results suggest that DG SANCO has established capacities to engage with stakeholders; to assess various health issues, to define issue-specific health policies and to collect information for evaluative purposes. In contrast, capacities tend to be less established for defining a clear strategy for the overall sector, for setting priorities and for budgeting, managing and implementing policies. We conclude that improvements to the effectiveness of DG SANTE's (the successor of DG SANCO) policies can be made within the existing mandate. A priority setting exercise may be conducted to limit the number of pursued actions to those with the greatest European added value within DG SANTE's responsibilities.
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Unión Europea/organización & administración , Política de Salud , Unión Europea/historia , Gestión de la Información en Salud , Historia del Siglo XX , Historia del Siglo XXI , Evaluación de Programas y Proyectos de Salud , Salud Pública/historia , Salud Pública/legislación & jurisprudencia , Administración en Salud PúblicaRESUMEN
Making up a third of the EU budget, Structural and Investment Funds can provide important opportunities for investing in policies that tackle inequalities in health. This article looks back and forward at the 2007-2013 and 2014-2020 financial periods in an attempt to inform the development of health equity as a strand of policy intervention under regional development. It combines evidence from health projects funded through Structural Funds and a document analyses that locates interventions for health equity under the new regulations. The map of opportunities has changed considerably since the last programming period, creating more visibility for vulnerable groups, social determinants of health and health systems sustainability. As the current programming period is progressing, this paper contributes to maximizing this potential but also identifying challenges and implementation gaps for prospective health system engagement in pursuing health equity as part of Structural Funds projects. The austerity measures and their impact on public spending, building political support for investments as well as the difficulties around pursuing health gains as an objective of other policy areas are some of the challenges to overcome. European Structural and Investment Funds could be a window of opportunity that triggers engagement for health equity if sectors adopt a transformative approach and overcome barriers, cooperate for common goals and make better use of the availability of these resources.
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Administración Financiera , Programas de Gobierno , Política de Salud , Disparidades en Atención de Salud , Presupuestos , Atención a la Salud , Economía , Humanos , Estudios Prospectivos , Política Pública , Poblaciones VulnerablesRESUMEN
BACKGROUND: Despite the acknowledged value of an EU health information system (EU-HISys) and the many achievements in this field, the landscape is still heavily fragmented and incomplete. Through a systematic analysis of the opinions and valuations of public health stakeholders, this study aims to conceptualize key features of an EU-HISys. METHODS: Public health professionals and policymakers were invited to participate in a concept mapping procedure. First, participants (N = 34) formulated statements that reflected their vision of an EU-HISys. Second, participants (N = 28) rated the relative importance of each statement and grouped conceptually similar ones. Principal Component and cluster analyses were used to condense these results to EU-HISys key features in a concept map. The number of key features and the labelling of the concept map were determined by expert consensus. RESULTS: The concept map contains 10 key features that summarize 93 statements. The map consists of a horizontal axis that represents the relevance of an 'organizational strategy', which deals with the 'efforts' to design and develop an EU-HISys and the 'achievements' gained by a functioning EU-HISys. The vertical axis represents the 'professional orientation' of the EU-HISys, ranging from the 'scientific' through to the 'policy' perspective. The top ranking statement expressed the need to establish a system that is permanent and sustainable. The top ranking key feature focuses on data and information quality. CONCLUSIONS: This study provides insights into key features of an EU-HISys. The results can be used to guide future planning and to support the development of a health information system for Europe.
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Sistemas de Información en Salud/organización & administración , Formulación de Políticas , Desarrollo de Programa/métodos , Administración en Salud Pública , Unión Europea , HumanosRESUMEN
This report addresses the current trends in Member States of the European Union (EU) and European Free Trade Association (EFTA) in how to promote better integration of health information systems. To understand what better integration means from a pragmatic perspective, experts from 13 EU Member States were interviewed and the results combined with the findings from a literature search.
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Recolección de Datos/estadística & datos numéricos , Telemedicina/métodos , Sistemas de Información en Salud/organización & administración , Indicador de ColaboraciónRESUMEN
This report addresses the current trends in Member States of the European Union (EU) and European Free Trade Association in how to promote better integration of health information systems. To understand what better integration means from a pragmatic perspective, experts from 13 EU Member States were interviewed and the results combined with the findings from a literature search. This synthesis report identifies the following policy options for further consideration, namely the needs: to continue the work on some basics (such as data availability and quality, inventories of data and registries, standardization, legislation, physical infrastructure and workforce capacities) and on more “concept-driven” indicator sets; to define what better integration means and to demonstrate concrete benefits of integration; to build leadership for capacity-building in further integration of health information systems; and to pursue further international exchange about activities under way in this area.
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Colaboración Intersectorial , Recolección de Datos , Telemedicina , Práctica Clínica Basada en la Evidencia , Sistemas de Información en Salud , Europa (Continente)RESUMEN
В настоящем отчете рассматриваются наблюдаемые в государствах-членах Европейского союза и Европейской ассоциации свободной торговли тенденции в отношении способов интеграции систем информации здравоохранения. В нем приведены результаты опроса, проведенного среди экспертов из 13 стран ЕС, а также анализа литературы, которые позволяют получить лучшее представление о том, что понимается под интеграцией с прагматической позиции. В сводном отчете для дальнейшего изучения приводятся следующие варианты политики, связанные с необходимостью: продолжить работу над “основными элементами” (наличие качественных данных, перечни и реестры данных, стандартизация, законодательство, физическая инфраструктура и кадровый потенциал) и более “концептуальными” наборами показателей; определить, что следует понимать под “улучшением интеграции”, и продемонстрировать конкретные преимущества интеграции; выстраивать структуру лидерства в области наращивания потенциала для дальнейшей интеграции систем информации здравоохранения; способствовать дальнейшему обмену информацией о работе в данной области.
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Colaboración Intersectorial , Recolección de Datos , Telemedicina , Práctica Clínica Basada en la Evidencia , Sistemas de Información en Salud , Europa (Continente)RESUMEN
The concept of capacity building for public health has gained much attention during the last decade. National as well as international organizations increasingly focus their efforts on capacity building to improve performance in the health sector. During the past two decades, a variety of conceptual frameworks have been developed which describe relevant dimensions for public health capacity. Notably, these frameworks differ in design and conceptualization. This paper therefore reviews the existing conceptual frameworks and integrates them into one framework, which contains the most relevant dimensions for public health capacity at the country- or regional level. A comprehensive literature search was performed to identify frameworks addressing public health capacity building at the national or regional level. We content-analysed these frameworks to identify the core dimensions of public health capacity. The dimensions were subsequently synthesized into a set of thematic areas to construct a conceptual framework which describes the most relevant dimensions for capacities at the national- or regional level. The systematic review resulted in the identification of seven core domains for public health capacity: resources, organizational structures, workforce, partnerships, leadership and governance, knowledge development and country specific context. Accordingly, these dimensions were used to construct a framework, which describes these core domains more in detail. Our research shows that although there is no generally agreedupon model of public health capacity, a number of key domains for public health and health promotion capacity are consistently recurring in existing frameworks, regardless of their geographical location or thematic area. As only little work on the core concepts of public health capacities has yet taken place, this study adds value to the discourse by identifying these consistencies across existing frameworks and by synthesising them into a new framework. The framework proposed in this paper can act as a theoretical guide for academic researchers and institutions to set up their own public health capacity assessment. Significance for public healthAs the concept of public health capacities is increasingly debated across countries and national/ international organizations, there is no consensus on the main dimensions of public health capacity. This paper therefore provides a rigorous review of currently existing frameworks, which describe public health capacities at the national or regional level. The main objective is to highlight commonalities among these frameworks, and propose a country-level framework which integrates all reoccurring dimensions. Such a comparison can yield vital information on those dimensions for public health capacities, which are common across all frameworks, and hence could be considered indispensable, irrespective of their context or geographic origin. As such, this review and the subsequent presentation of a conceptual framework is targeted at academic researchers and policy makers, who are interested in setting up a capacity mapping process and who are looking for concepts and frameworks on which they can base their work.
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Hospitals have become a focal point for health care reform strategies in many European countries during the current financial crisis. It has been called for both, short-term reforms to reduce costs and long-term changes to improve the performance in the long run. On the basis of a literature and document analysis this study analyses how EU member states align short-term and long-term pressures for hospital reforms in times of the financial crisis and assesses the EU's influence on the national reform agenda. The results reveal that there has been an emphasis on cost containment measures rather than embarking on structural redesign of the hospital sector and its position within the broader health care system. The EU influences hospital reform efforts through its enhanced economic framework governance which determines key aspects of the financial context for hospitals in some countries. In addition, the EU health policy agenda which increasingly addresses health system questions stimulates the process of structural hospital reforms by knowledge generation, policy advice and financial incentives. We conclude that successful reforms in such a period would arguably need to address both the organisational and financing sides to hospital care. Moreover, critical to structural reform is a widely held acknowledgement of shortfalls in the current system and belief that new models of hospital care can deliver solutions to overcome these deficits. Advancing the structural redesign of the hospital sector while pressured to contain cost in the short-term is not an easy task and only slowly emerging in Europe.
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Economía Hospitalaria , Reforma de la Atención de Salud/economía , Política de Salud/economía , Control de Costos , Atención a la Salud/organización & administración , Unión Europea , Administración Hospitalaria , Humanos , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/organización & administraciónRESUMEN
Since the start of the economic crisis, the European Union's (EU's) predominant discourse has been austerity and fiscal consolidation. The detrimental effects on Europe's health systems and the health status of its citizens are well described. However, little is known about the emerging EU-level initiatives to support national health systems handle the challenges of efficient care provision and system reorganisation aimed to meet their future needs. This review analyses the manner, conditions and prospects of such EU support. First, health system objectives are increasingly entering the EU health policy agenda. Second, professional and patient mobility provisions may support member states (MS) in copying with crisis related health challenges but can potentially acerbate them at the same time. Third, in recent initiatives health system goals are more closely tied to the EU's economic growth narrative. And fourth, health system issues are taken up in existing EU-level structures for debate and exchange between MS. In addition, the design of some policies may have the potential to intensify socioeconomic and health inequalities rather than ameliorate them.
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Atención a la Salud/economía , Unión Europea/economía , Reforma de la Atención de Salud/economía , Política de Salud/economía , Programas Nacionales de Salud/economía , Atención a la Salud/organización & administración , Recesión Económica , Europa (Continente) , Apoyo Financiero , Humanos , Cooperación Internacional , Turismo Médico/economía , Turismo Médico/tendencias , Programas Nacionales de Salud/organización & administraciónAsunto(s)
Atención a la Salud/economía , Recesión Económica , Políticas , Europa (Continente) , HumanosRESUMEN
OBJECTIVES: The aim of this study was to develop an health technology assessment (HTA) decision tool to support the decision-making process on health technologies for hospital decision makers in cross-border regions. METHODS: Several methods were used to collect information necessary to develop the cross-border mini-HTA decision tool. The literature was inventoried on HTA in border regions and local settings and the use of HTA by local decision makers. Semi-structured interviews with hospital decision makers in cross-border regions were also performed. Based on group discussion of the resulting information, it was decided to use the Danish mini-HTA guideline as a starting point for development of the decision tool. After finishing the first version of the decision tool it was tested in two pilot studies. RESULTS: Some questions in the Danish mini-HTA guideline were not relevant. Other questions needed rephrasing and questions about cross-border situations were added. The pilots showed several missing topics, including legal questions and reimbursement issues. The final decision tool consists of three sections: a general section, a section for hospitals not cooperating cross-border and a section for hospitals that are cooperating with hospitals across a national or regional border. CONCLUSIONS: Based on our literature search, this may be the first cross-border mini-HTA decision tool. The decision tool will be of help for healthcare professionals and decision makers in border settings who would like to use HTA evidence to support their decision-making process.
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Tecnología Biomédica , Sistemas de Apoyo a Decisiones Clínicas , Hospitales , Internacionalidad , Dinamarca , Humanos , Proyectos Piloto , Investigación CualitativaRESUMEN
BACKGROUND: In 2007 the European Commission issued the White Paper: "Together for Health". Considered the EU Health Strategy for the years 2008-2013, it offers the cornerstones for setting priorities in EU health actions. OBJECTIVES: The public health framework offered in this strategy is explicitly built on shared values--including the overarching values of universality, access to good quality care, equity and solidarity that reacted to certain health care challenges within the EU. This article analyses the Health Strategy via its ethical scope and considers implications for future health policy making. METHODS: The Health Strategy and related documents are scrutinised to explore how the mentioned values are defined and enfolded. Additionally, scientific databases are searched for critical discussions of the value base of the Health Strategy. The results are discussed and reasoned from a public health ethical perspective. RESULTS: The Health Strategy is barely documented and discussed in the scientific literature. Furthermore, no attention was given to the value base of the Health Strategy. Our analysis shows that the mentioned values are particularly focussed on health care in general rather than on public health in particular. Besides this, the given values of the Health Strategy are redundant. CONCLUSIONS: An additional consideration of consequentialist public health ethics values would normatively strengthen a population-based health approach of EU health policy making.
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Unión Europea , Política de Salud , Prioridades en Salud , Salud Pública/normas , Accesibilidad a los Servicios de Salud , Humanos , Formulación de Políticas , Calidad de la Atención de SaludRESUMEN
Arginine (R)-based ER localization signals are sorting motifs that confer transient ER localization to unassembled subunits of multimeric membrane proteins. The COPI vesicle coat binds R-based signals but the molecular details remain unknown. Here, we use reporter membrane proteins based on the proteolipid Pmp2 fused to GFP and allele swapping of COPI subunits to map the recognition site for R-based signals. We show that two highly conserved stretches--in the beta- and delta-COPI subunits--are required to maintain Pmp2GFP reporters exposing R-based signals in the ER. Combining a deletion of 21 residues in delta-COP together with the mutation of three residues in beta-COP gave rise to a COPI coat that had lost its ability to recognize R-based signals, whilst the recognition of C-terminal di-lysine signals remained unimpaired. A homology model of the COPI trunk domain illustrates the recognition of R-based signals by COPI.
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Proteína Coatómero/química , Proteína Coatómero/metabolismo , Subunidades de Proteína/química , Subunidades de Proteína/metabolismo , Saccharomyces cerevisiae/metabolismo , Complejo 1 de Proteína Adaptadora/metabolismo , Secuencia de Aminoácidos , Arginina , Sitios de Unión , Secuencia Conservada , Retículo Endoplásmico/metabolismo , Genes Fúngicos , Datos de Secuencia Molecular , Proteínas Mutantes/metabolismo , Mutación/genética , Señales de Clasificación de Proteína , Transporte de Proteínas , Saccharomyces cerevisiae/citología , Saccharomyces cerevisiae/genética , Homología Estructural de ProteínaRESUMEN
Arginine (Arg)-based endoplasmic reticulum (ER) localization signals are sorting motifs involved in the quality control of multimeric membrane proteins. They are distinct from other ER localization signals like the C-terminal di-lysine [-K(X)KXX] signal. The Pmp2p isoproteolipid, a type I yeast membrane protein, reports faithfully on the activity of sorting signals when fused to a tail containing either an Arg-based motif or a -KKXX signal. This reporter reveals that the Arg-based ER localization signals from mammalian Kir6.2 and GB1 proteins are functional in yeast. Thus, the machinery involved in recognition of Arg-based signals is evolutionarily conserved. Multimeric presentation of the Arg-based signal from Kir6.2 on Pmp2p results in forward transport, which requires 14-3-3 proteins encoded in yeast by BMH1 and BMH2 in two isoforms. Comparison of a strain without any 14-3-3 proteins (Deltabmh2) and the individual Deltabmh1 or Deltabmh2 shows that the role of 14-3-3 in the trafficking of this multimeric Pmp2p reporter is isoform-specific. Efficient forward transport requires the presence of Bmh1p. The specific role of Bmh1p is not due to differences in abundance or affinity between the isoforms. Our results imply that 14-3-3 proteins mediate forward transport by a mechanism distinct from simple masking of the Arg-based signal.
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Proteínas 14-3-3/metabolismo , Proteínas de la Membrana/metabolismo , Proteínas del Tejido Nervioso/metabolismo , Proteolípidos/metabolismo , Proteínas de Saccharomyces cerevisiae/metabolismo , Saccharomyces cerevisiae/metabolismo , Proteínas Adaptadoras Transductoras de Señales , Secuencia de Aminoácidos , Arginina/genética , Arginina/metabolismo , Retículo Endoplásmico/metabolismo , Eliminación de Gen , Dosificación de Gen , Genes Reporteros/genética , Proteínas de la Membrana/química , Proteínas de la Membrana/genética , Datos de Secuencia Molecular , Proteínas del Tejido Nervioso/química , Proteínas del Tejido Nervioso/genética , Fenotipo , Canales de Potasio de Rectificación Interna/metabolismo , Unión Proteica , Isoformas de Proteínas/metabolismo , Subunidades de Proteína/genética , Subunidades de Proteína/metabolismo , Transporte de Proteínas , Proteolípidos/química , Proteolípidos/genética , Receptores de GABA/genética , Receptores de GABA/metabolismo , Saccharomyces cerevisiae/química , Proteínas de Saccharomyces cerevisiae/química , Proteínas de Saccharomyces cerevisiae/genética , Transducción de SeñalRESUMEN
Arginine-based endoplasmic reticulum (ER)-localization signals are sorting motifs that are involved in the biosynthetic transport of multimeric membrane proteins. After their discovery in the invariant chain of the major histocompatibility complex class II, several hallmarks of these signals have emerged. They occur in polytopic membrane proteins that are subunits of membrane protein complexes; the presence of the signal maintains improperly assembled subunits in the ER by retention or retrieval until it is masked as a result of heteromultimeric assembly. A distinct consensus sequence and their position independence with respect to the distal termini of the protein distinguish them from other ER-sorting motifs. Recognition by the coatomer (COPI) vesicle coat explains ER retrieval. Often, di-leucine endocytic signals occur close to arginine-based signals. Recruitment of 14-3-3 family or PDZ-domain proteins can counteract ER-localization activity, as can phosphorylation. This, and the occurrence of arginine-based signals in alternatively spliced regions, implicates them in the regulated surface expression of multimeric membrane proteins in addition to their function in quality control.
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Arginina/química , Membrana Celular/metabolismo , Retículo Endoplásmico/metabolismo , Proteínas 14-3-3/química , Secuencias de Aminoácidos , Animales , Endocitosis , Humanos , Iones , Sustancias Macromoleculares , Proteínas de la Membrana/química , Modelos Biológicos , Potasio/química , Estructura Terciaria de Proteína , Transporte de ProteínasRESUMEN
BACKGROUND: Arginine-based endoplasmic reticulum (ER) localization signals are involved in the heteromultimeric assembly of membrane protein complexes like ATP-sensitive potassium channels (K(ATP)) or GABA(B) G protein-coupled receptors. They constitute a trafficking checkpoint that prevents ER exit of unassembled subunits or partially assembled complexes. For K(ATP) channels, the mechanism that leads to masking of the ER localization signals in the fully assembled octameric complex is unknown. RESULTS: By employing a tetrameric affinity construct of the C terminus of the K(ATP) channel alpha subunit, Kir6.2, we found that 14-3-3 isoforms epsilon and zeta specifically recognize the arginine-based ER localization signal present in this cytosolic tail. The interaction was reconstituted by using purified 14-3-3 proteins. Competition with a nonphosphorylated 14-3-3 high-affinity binding peptide implies that the canonical substrate binding groove of 14-3-3 is involved. Comparison of monomeric CD4, dimeric CD8, and artificially tetramerized CD4 fusions correlates the copy number of the tail containing the arginine-based signal with 14-3-3 binding, resulting in the surface expression of the membrane protein. Binding experiments revealed that the COPI vesicle coat can specifically recognize the arginine-based ER localization signal and competes with 14-3-3 for the binding site. CONCLUSIONS: The COPI vesicle coat and proteins of the 14-3-3 family recognize arginine-based ER localization signals on multimeric membrane proteins. The equilibrium between these two competing reactions depends on the valency and spatial arrangement of the signal-containing tails. We propose a mechanism in which 14-3-3 bound to the correctly assembled multimer mediates release of the complex from the ER.