Miribel, Benoît, rapp. ; Pajares y Sanchez, Catherine, rapp., Conseil économique social et environnemental (CESE), avril 2022, 90p.Le CESE formule 17 préconisations pour poser les bases d’une Europe de la Santé efficace, à même de répondre à ces nouveaux défis et aux attentes des citoyens pour développer une démocratie sanitaire européenne et coordonner davantage, intensifier la prévention et relever les défis.
Veille sur la santé dans toutes les politiques et politiques de santé
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Front Public Health. 2022 Jul 8;10:902724. doi: 10.3389/fpubh.2022.902724. eCollection 2022.
In hindsight, the early response of liberal governments to the SARS-CoV-2 pandemic was chaotic and generally inefficient. Though one might be tempted to attribute these failures to the incompetence of certain political decision-makers, we propose another explanation. Global threats require a coordinated international response, which is only possible if the threat is perceived in the same way by all, and if government priorities are similar. The effectiveness of the response also relies on massive adhesion of citizens to the measures imposed, which in turn requires trust in government. Our hypothesis is that certain fundamental features of liberalism complicate such global and collective responses: neutrality of the state and primacy of the individual over collective society. Liberalism considers that institutions and public policy must not be designed to favor any specific conception of the common good. That which is best for all is usually determined by a "competition of opinions," which frequently leads to scientific expertise being considered as only one opinion among many. Liberalism also imposes strict respect for individual freedoms and private interests and tends to reject any form of collectivism or dictate imposed by the common good. In order to solve these structural problems and improve society's management of global threats, we make several proposals, such as the introduction of a minimal and consensual definition of the common good and the promotion of a health policy guided by One Health-like concepts. Overall, our analysis suggests that because political ideologies provide their own definitions of the common good and the place of scientific knowledge in the governance process and can thus affect the response to global threats, they should be urgently taken into consideration by public health experts.
Whole-of-Government Wellbeing Approaches: A Comparative Analysis of Four Central Government Initiatives
In Canada and elsewhere, the health and economic consequences of the COVID-19 pandemic have led governments to reflect on promising avenues to support an economic recovery focused on population health and wellbeing, sustainable development, and equity, including for future generations. In this regard, wellbeing approaches are innovative initiatives for incorporating wellbeing (or quality of life) indicators into policymaking and budget allocation processes. Among other things, they aim to guide and improve the intersectoral action needed to address population health and health inequalities. These approaches are starting to take hold in Canada, as illustrated by the federal government’s adoption of the Quality of Life Strategy for Canada.
Comparative analysis of four wellbeing approaches
In order to inform decision making related to wellbeing approaches, the NCCHPP has produced a comparative analysis of four wellbeing approaches put forward by the governments of Scotland, Finland, New Zealand, and Wales. This study allowed us to identify similarities and differences between these four approaches in the following areas:
- The wellbeing frameworks used;
- The main objectives pursued;
- The implementation, evaluation and accountability mechanisms;
- The roles of various actors, including those in public health;
- The difficulties encountered during implementation and the pathways to overcoming them.
Auteur : Adam Baïz, Avec la collaboration de Mathilde Guyot, Marianne Lewandowski et Achille SutyPremier volet – Qui utilise les évaluations académiquesdes politiques publiques ?Deuxième volet – Quelles évaluations sont mobilisées avant et aprèsle vote d’une loi ?L’évaluation des politiques publiques suscite un intérêt croissant auprès des institutions publiques, des sphères décisionnelles, des chercheurs et plus généralement dans la société civile . Vecteur de connaissances scientifiques et de transparence démocratique, l’évaluation des politiques publiques apparaît en effet comme un outil incontournable pour rationaliser l’action publique et pour accroître la légitimité des décisions politiques. Dans tous les domaines, qu’il s’agisse de santé, d’éducation ou de travail, il s’agit désormais de concevoir des politiques publiques éclairées par les preuves (evidence-based policies). En 2018 et en 2019, France Stratégie a publié une analyse bibliométrique et une analyse monographique de la production des évaluations de politiques publiques en France et dans certains pays avancés en la matière. Il en ressort une augmentation générale de la production de travaux évaluatifs. Cette tendance tient à des impulsions politiques plus vigoureuses, à une institutionnalisation de l’évaluation et à un renforcement des compé-tences et des standards évaluatifs au sein des institutions publiques, privées et de recherche. Il apparaît aussi, en particulier, que la France rattrape son retard en la matière, relativement aux pays précurseurs anglo-saxons (États-Unis, Canada, Royaume-Uni)...
Entretien avec Laurence Warin, lauréate du programme jeune recherche du LIEPP
Lauréate 2021-2022 du programme de soutien à la jeune recherche en évaluation des politiques publiques du LIEPP, Laurence Warin est docteure en droit d'Université Paris Cité , où elle a soutenu le 30 mars 2022 une thèse sur l'approche « Santé dans toutes les politiques ».En quoi consiste l'approche « santé dans toutes les politiques » ?La « santé dans toutes les politiques » est une approche transversale des politiques publiques qui promeut la prise en compte des enjeux sanitaires dans la prise de décision publique de l’ensemble des secteurs. Selon François Bourdillon, ancien directeur de Santé publique France, le Nutriscore est l’un des meilleurs exemples de l’intégration de la santé dans une autre politique en France. En effet, en accord avec la réglementation européenne, et suite à l'adoption de la loi de modernisation de notre système de santé en 2016, le législateur français a mis en œuvre un dispositif complémentaire d’information nutritionnelle facultatif mais dont la forme est unifiée par la loi.
Alors que le Canada doit composer avec la pandémie de COVID-19, l’un des plus grands défis de santé publique de notre époque, le besoin de renforcer les systèmes de santé publique n’a jamais été aussi grand. Des systèmes de santé publique forts sont essentiels pour assurer la viabilité du système de santé, pour améliorer la santé des populations et l’équité en santé, et pour se préparer et répondre aux crises actuelles et futures. De grandes variations existent entre les provinces et les territoires en ce qui a trait aux manières dont la santé publique est organisée, gouvernée et financée, et aussi en ce qui concerne les réformes et les restructurations dont les systèmes de santé publique ont fait l’objet au cours des dernières années. Ce rapport s’appuie sur des rapports antérieurs et...
EORTC QLQ-C30 general population normative data for Italy by sex, age and health condition: an analysis of 1,036 individuals
BMC Public Health. 2022 May 24;22(1):1040. doi: 10.1186/s12889-022-13211-y.
BACKGROUND: General population normative values for the widely used health-related quality of life (HRQoL) measure, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ-C30), are available for a range of countries. These are mostly countries in northern Europe. However, there is still a lack of such normative values for southern Europe. Therefore, this study aims to provide sex-, age- and health condition-specific normative values for the general Italian population for the EORTC QLQ-C30.
MATERIAL AND METHODS: This study is based on Italian EORTC QLQ-C30 general population data previously collected in an international EORTC project comprising over 15,000 respondents across 15 countries. Recruitment and assessment were carried out via online panels. Quota sampling was used for sex and age groups (18-39, 40-49, 50-59, 60-69 and ≥ 70 years), separately for each country. We applied weights to match the age and sex distribution in our sample with UN statistics for Italy. Along with descriptive statistics, linear regression models were estimated to describe the associations of sex, age and health condition with the EORTC QLQ-C30 scores.
RESULTS: A total of 1,036 respondents from Italy were included in our analyses. The weighted mean age was 49.3 years, and 536 (51.7%) participants were female. Having at least one health condition was reported by 60.7% of the participants. Men reported better scores than women on all EORTC QLQ-C30 scales but diarrhoea. While the impact of age differed across scales, older age was overall associated with better HRQoL as shown by the summary score. For all scales, differences were in favour of participants who did not report any health condition, compared to those who reported at least one.
CONCLUSION: The Italian normative values for the EORTC QLQ-C30 scales support the interpretation of HRQoL profiles in Italian cancer populations. The strong impact of health conditions on EORTC QLQ-C30 scores highlights the importance of adjusting for the impact of comorbidities in cancer patients when interpreting HRQoL data.
Ashira Vantrees, JD of Aimed Alliance discuss what the Cancer Drug Parity Act is and how it impacts various issues in oncology.
Could you briefly describe what the Cancer Drug Parity Act is?
Absolutely. So, the Cancer Drug Parity Act has been introduced in the Senate by Senator Tina Smith, and it’s been introduced in the House of Representatives by Representative Brian Higgins, and it’s federal legislation that if passed, would require health plans to have the same cost sharing requirements, that’s your co-pay, or your co-insurance, for oral chemotherapy treatments, IV chemotherapy treatments.
So, are there other issues in oncology that the Cancer Drug Parity Act addresses?
So, the Cancer Drug Parity Act primarily addresses the issue of co-pay parity. So, the issue of copay parity is that some health plans required different cost sharing and typically a higher cost sharing for oral treatment compared to IV treatments, and co-pay parity requires that health plan provide the same cost sharing requirements for the oral and IV treatment. And really the issue of copay parity really came up when health plans started charging patients with cancer a higher copay for oral chemotherapy treatments compared to their IV chemotherapy treatment, and so obviously, this is really upsetting for patients with cancer who had come to this decision with their healthcare provider that this oral chemotherapy treatment was the best option for them. And then what was happening is they would go to collect their medication, and then be hit with this unexpectedly higher copay, than what they were used to. So, in response to this practice by insurers and health plans, states are passing Oral Parity Laws which prohibited health plans from charging a higher cost sharing, so a co-pay or a co-insurance for oral chemotherapy compared to IV chemotherapy and the Cancer Drug Parity Act is the federal version of that state legislation.
And the reason federal legislation is needed is because while state laws are great, state laws don’t regulate all types of insurance. So, for example, state laws don’t regulate insurance that individuals get from their employer, federal legislation can do that, and so that’s why we need the Cancer Drug Parity Act to pass to ensure that patients with cancer when they’re choosing which treatment is the best for them, that’s not a decision they’re forced to make based on their cost sharing requirements.
Joe Kvedar, MD from the American Telemedicine Association discusses how telehealth regulations have changed since the start of the COVID-19 pandemic.
Can you briefly describe how telehealth regulations changed during the beginning of the pandemic?
Yes, so as part of the original CARES Act, there were several things that happened. Some had to do with technology, some had to do with reimbursement, some had to do with privacy. And the whole idea was telehealth had to happen overnight, as you know, we sort of went into locked down them immediately in the middle of the month of March of 2020, and the government had the forthrightness to do some of these things. So, I’ll just tick them off at a high level, number one was Medicare and really all private payers began to pay for video visits with your doctor at the same rate they pay for an office visit. So that was a big one. The second one was that the doctor could use and the patient could use any technology, whether it be FaceTime, Google Meets, etcetera, Skype, to do those visits at the time, knowing full well that not all of those were HIPAA-compliant or exceptional privacy, but in order to get that going. That by the way, has since changed, perhaps we’ll come back to that later. And the third big one had to do with licensure and states, and so at the time, you could, as a doctor, I could practice across state lines. Again, that’s been whittled back subsequently as well, but the big one that stood the test of time has been about reimbursement, and that one has really led to about a 24-fold increase in the amount of telehealth that’s going on since if you compare April of 2022 with April of 2019, it’s about a 24-fold increase, extraordinary. And it’s been quite consistent over the last year or so, that we continue to see that, so it’s what we call two-channel healthcare delivery, and it’s been a wonderful thing to see happen.
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