International Journal of Health Policy and Management
Volume:9 Issue: 12, Dec 2020

During this coronavirus disease 2019 (COVID-19) global pandemic, nations are taking bold measures to mitigate the spread of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in order to avoid the overwhelming its critical care facilities. While these “flattening the curve” initiatives are showing signs of impeding the potential surge in COVID-19 cases, it is not known whether these measures alleviate the burden placed on intensive care units. Much has been made of the desperate need for critical care beds and medical supplies, especially personal protective equipment (PPE). But while these initiatives may provide health systems time to bolster their critical care infrastructure, they do little to protect the most essential element – the critical care providers. This article examines bolder initiatives that may be needed to both protect crucial health systems and the essential yet vulnerable providers during this global pandemic.

Background The first outbreak of coronavirus disease 2019 (COVID-19) was successfully restrained in many countries around the world by means of a severe lockdown. Now, we are entering the second phase of the pandemics in which the spread of the virus needs to be contained within the limits that national health systems can cope with. This second phase of the epidemics is expected to last until a vaccination is available or herd immunity is reached. Long-term management strategies thus need to be developed.   Methods In this paper we present a new agent-based simulation model “COVID-19 ABM” with which we simulate 4 alternative scenarios for the second “new normality” phase that can help decision-makers to take adequate control and intervention measures.   Results The scenarios resulted in distinctly different outcomes. A continued lockdown could regionally eradicate the virus within a few months, whereas a relaxation back to 80% of former activity-levels was followed by a second outbreak. Contact-tracing as well as adaptive response strategies could keep COVID-19 within limits.   Conclusion The main insights are that low-level voluntary use of tracing apps shows no relevant effects on containing the virus, whereas medium or high-level tracing allows maintaining a considerably higher level of social activity. Adaptive control strategies help in finding the level of least restrictions. A regional approach to adaptive management can further help in fine-tuning the response to regional dynamics and thus minimise negative economic effects.

Many articles over the last two decades have enumerated barriers to and facilitators for evidence use in health systems. Bowen et al’s article “Response to Experience of Health Leadership in Partnering with University-Based Researchers: A Call to ‘Re-imagine Research’” furthers the debate by focusing on an under-explored research area (health system design and health service organization) with an under-studied stakeholder group (health system leaders), by undertaking a broad program of research on partnerships, and, based on participant responses, by calling for re-imagining of research itself. In response to the claim that the research community is not providing expertise to this pressing issue in the health system, I provide four high level reasons: partnerships mean different things to different people, our language does not reflect the reality we want, our health systems have yet to fully embrace evidence use, and complexity is easier to talk about than act within. Bowen et al’s study, and their broader program of research, is well-placed to explore these issues further, helping identify appropriate researcher-health system leader partnership models for various health system change projects. Given the positive shifts identified in this study, and the knowledge that participants demonstrate about what needs to change, the time is right for bold action, re-imagining not only research, but healthcare, such that the production and use of evidence for better health is embraced and supported.

This article compares the provision of long-term care (LTC) in Japan and Spain, two countries with similar demographic structures but which address the provision of LTCs in very different ways. Both countries provide universal LTC. However, Japan has developed a generous benefit package of formal services for dependents to alleviate the care burden on the family, but provides no cash benefits. In Spain, on the other hand, cash allowances are the norm rather than the exception in the practical implementation of LTC services. After discussing the necessary delineation of LTC in response to future sociodemographic challenges, we discuss LTC system characteristics and the recent cost containment reforms implemented in Japan and Spain. Finally, we consider the lessons that may be drawn from each country’s experience and the reforms that must be undertaken in order ensure the sustainability of LTC provision in other countries with incipient or more developed LTC systems. In addition, since Japan and Spain are both faced with challenging demographic projections, it is important for each country to learn from the other’s initiatives and reforms.

Canada’s federal government intends to take steps to implement national pharmacare so that all Canadians have prescription drug coverage they need at an affordable price. Relatively limited funds have so far been pledged to support national pharmacare, which raises the question: what kind of program is envisioned? Since the government has already introduced regulations intended to reduce new drug prices drastically, national pharmacare seems likely to be a basic system designed to assist low-income Canadians with accessing primary care medicines. What Canadians actually need is a system that provides access to the medicine considered appropriate by the patient and their healthcare provider for the patient’s specific condition. Equitable national pharmacare will not be achieved if patients are denied access to new high-cost specialized medicines that can improve or extend their lives, any more than if patients who cannot afford basic drugs are not helped.

The movement for a national pharmacare plan in Canada is growing, but at the same time the multinational pharmaceutical companies and their supporters are critical of such a move. The three major arguments that they make are that all that is needed is to “fill in the gaps,” ie, cover those who currently are uninsured or underinsured, that private drug plans are superior to public ones because they cover a larger number of drugs and that Canada cannot afford pharmacare. This commentary examines each of these arguments and makes the case that none of them is valid and that it is time to get on with implementing pharmacare.

The ambition of the Canadian Institutes for Health Research Health System Impact (HSI) Fellowship initiative to modernise the health system is impressive. Embedded researchers who work between academia and nonacademic settings offer an opportunity to reframe the problem of evidence uptake as a product of a gap between those who produce knowledge and those who use it. As such, there has been an increasing interest in the potential of people in embedded research roles to work with stakeholders in the co-production of knowledge to address service challenges. In this commentary, we draw on research and experiential evidence of an embedded researcher initiative, which has similar intentions to the HSI Fellowships programme: the National Institute for Health Research (NIHR) Knowledge Mobilisation Research Fellowship (KMRF) scheme. We outline the similarities and differences between the two schemes, and then consider the work, characteristics and skills, and organisational arrangements evident in operationalising these types of roles.