The desirability and feasibility of economic studies of drugs post-launch.
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Cost-Benefit Analysis↗
Biomedical subjects
Anne Mason
Publications and source records attributed to Anne Mason.
Costs and prices for inpatient care in England: mirror twins or distant cousins?
The National Health Service (NHS) in England is introducing a national cost-per-case tariff system for the reimbursement of hospital services. Unlike most other countries with similar payment mechanisms, hospitals in England will have few alternative sources of income once the tariff system is fully implemented. This new financial regime generates powerful incentives for change, but exposes purchasers and providers to considerable financial risks. This paper examines the structure of the tariff. We describe how costs are determined, analyse the extent to which prices reflect costs, and review the results of an early evaluation of the system.
England↗
Publishing outcome data: is it an effective approach?
RATIONALE, AIMS AND OBJECTIVES: The publication of health outcome data--rather than merely the measurement and collection--is being given increasing consideration. Publication reflects society's increasing emphasis on a general 'right to know', as well as being a means of informing consumer choice. In theory, publication may help to promote public trust, support patient choice, and stimulate action to improve the quality of care whilst controlling costs. METHODS: Drawing on a literature review, this paper overviews the strategies employed in the UK and US to publish outcome data. The focus is on outcomes, and certain related process measures, that measure the performance of hospitals or surgeons. RESULTS AND CONCLUSIONS: Presenting the limited evidence that exists, we review the potential beneficial and harmful effects of publishing hospital outcome data. We also consider the risks of making incorrect inferences based on these data and the potential for dysfunctional consequences. Recognizing that the public largely mistrusts currently published health outcome data, we offer some recommendations for the future direction of strategies for publication.
Humans↗
Does the English NHS have a 'Health Benefit Basket'?
A 'health benefit basket' is a range of publicly entitled health-related goods and services. Primary legislation ensures the provision of broad categories of health care, but this provision is subject to political discretion. Case law has established that health care organisations may not operate a 'blanket ban' for particular services. This means that the English health basket currently has very few specific services explicitly included or excluded. Regulation may, however, be important in determining citizens' rights. With reference to 'services of curative care', this paper explores whether the NHS is moving towards a more explicit definition of a health basket.
Health Policy↗
Dementia services in rural areas: nursing implications.
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Aged↗
Influencing prescribing in English primary care: the views of primary care organisations.
OBJECTIVE: The rapid rise of prescribing expenditure is a concern in many industrialised countries and methods to manage medicines are widely employed. The purpose of this study was to identify the approaches to improve primary care prescribing by primary care organisations (PCOs) in the National Health Service (NHS) in England. METHODS: A questionnaire (Management of Medicines, MANMED) was mailed to prescribing advisers and prescribing leads in 332 PCOs. RESULTS: A response rate of 66% (220/332) was achieved. Most PCOs report the improvement of the quality of prescribing as their top priority, followed by budget adherence at both practice and PCO levels. Prescribing advisers typically offer several forms of support: practice visits, prescribing reviews, indicators of prescribing, prescribing newsletters, hands-on support, seminars and local formularies. PCOs are pursuing a wide range of prescribing initiatives, covering, on average, seven different therapeutic areas. National targets are the main driver for prescribing initiatives but other key influences include inappropriate prescribing and clinical governance. Although cost considerations are important, improving the quality of prescribing is perceived as the overriding principle on which PCO prescribing strategy is based. Multifaceted prescribing support is widespread and national targets are the largest single factor influencing choice of therapeutic area for prescribing initiatives. CONCLUSIONS: Diversity in approaches presents the opportunity to improve the evidence base for medicines management. Not only could such research inform PCOs in their central aim of improving the quality of prescribing within the NHS, but it may also offer insights of relevance to other countries if the influence of process and context upon the effectiveness of medicines management is systematically explored.
Budgets↗
The GP contract: reasons to be cheerful?
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Attitude of Health Personnel↗
Support services for carers of people with mental health problems: building an evidence base to inform policy decisions.
In Great Britain, over 1.5 million people look after someone with a mental disability. The UK government has shown an increasing awareness of the value of carers' contribution to society and of carers' need for support, information and care. As part of a recent scoping study, the current evidence for support services for mental health carers was reviewed and key stakeholders were consulted. This paper elucidates issues arising from the study and explores ways towards a more evidence-based future.
Adult↗
Optometrist prescribing of therapeutic agents: findings of the AESOP survey.
Throughout the USA and in some parts of Australia and Canada, licensed optometrists may prescribe therapeutic agents for certain eye conditions. However, this role is not currently available to European optometrists. The extension of prescribing rights to new professional groups was the subject of a UK government-commissioned review, which cited optometrists as potential candidates. A recent literature review found limited evidence to assess the appropriateness of eye care delivered by different health care providers. To inform the UK decision, we therefore conducted a national postal survey to explore how optometric practice might change with the introduction of therapeutic prescribing. The Anonymous Enquiry of the Scope for Optometrist Prescribing (AESOP), was sent to a random 10% sample of registered optometrists. Over 80% of respondents indicated that optometrists should be able to train as therapeutic prescribers. Most respondents were willing to undergo training, periodic re-accreditation and continuing education, as well to participate in simple professional audit of their prescribing. Respondents anticipated that referrals to general practitioners (GPs) would be reduced by nearly 40% and to ophthalmologists via a GP by nearly 20%. Optometrist participation could increase patient access to therapeutic ocular care by between 29% and 50%. Authorising UK optometrists to prescribe therapeutically for eye diseases would appear to make good use of their existing skills and improve patient access to eye care, while relieving pressures upon other healthcare providers. Tentative economic analysis suggests that the introduction of independent optometrist prescribing may be cost neutral. However, adequate comparative research on the performance of optometrists as prescribers is needed and the issue of reimbursement will require careful consideration.
Attitude of Health Personnel↗