scholarly journals Proposal of a Learning Health System to Transform the National Health System of Spain

Processes ◽  
2019 ◽  
Vol 7 (9) ◽  
pp. 613 ◽  
Author(s):  
Rafael Carnicero ◽  
David Rojas ◽  
Ignacio Elicegui ◽  
Javier Carnicero
Keyword(s):  
Big Data ◽  
National Health Service ◽  
Health Service ◽  
Health System ◽  
Information And Communication Technologies ◽  
National Health ◽  
Perfect Match ◽  
National Health System ◽  
World Health ◽  
Learning Health System

This article identifies the main challenges of the National Health Service of Spain and proposes its transformation into a Learning Health System. For this purpose, the main indicators and reports published by the Spanish Ministries of Health and Finance, Organization for Economic Co-operation and Development (OECD) and World Health Organization (WHO) were reviewed. The Learning Health System proposal is based on some sections of an unpublished report, written by two of the authors under request of the Ministry of Health of Spain on Big Data for the National Health System. The main challenges identified are the rising old age dependency ratio; health expenditure pressures and the likely increase of out-of-pocket expenditure; drug expenditures, both retail and consumed in hospitals; waiting lists for surgery; potentially preventable hospital admissions; and the use of electronic health record (EHR) data to fulfil national health information and research objectives. To improve its efficacy, efficiency, and quality, the National Health Service of Spain should be transformed into a Learning Health System. Information and communication technologies (IT) enablers are a fundamental tool to address the complexity and vastness of health data as well as the urgency that clinical and management decisions require. Big Data solutions are a perfect match for that problem in health systems.

Looking forward to the next 70 years: from a National Ill-Health Service to a National Health System

2018 ◽  
Vol 14 (1) ◽  
pp. 11-14
Author(s):  
David J. Hunter
Keyword(s):  
National Health Service ◽  
Local Government ◽  
Health Service ◽  
Health System ◽  
21St Century ◽  
National Health ◽  
National Health System ◽  
Well Being ◽  
Tipping Point ◽  
Health And Well Being

AbstractAmidst the NHS’s (National Health Service) success lies its major weakness, although one that Klein overlooks in his reflections on the NHS as it approaches 70. The focus on, and investment in, curing ill-health has been at the expense of attending to the public’s overall health and well-being. This preoccupation poses a greater threat to the NHS’s future than privatisation. Despite the weakness having been diagnosed decades ago, redressing the imbalance has proved stubbornly hard to achieve. Rhetoric has not been translated into reality. Yet, we may be on the cusp of a tipping point where in order to ensure a sustainable NHS, and one that is capable of meeting the 21st century challenges facing it, there is a renewed and overdue interest in promoting health and well-being in communities. But for this to succeed, the NHS will need to embrace its bete noire, local government.

scholarly journals Inteligência Artificial e Medicina

2017 ◽  
Vol 41 (2) ◽  
pp. 185-193 ◽  
Author(s):  
Luiz Carlos Lobo
Keyword(s):  
Big Data ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Wearable Devices ◽  
Cancer Hospital ◽  
Self Learning

RESUMO Ao mesmo tempo em que se discutem problemas na relação médico-paciente e a deficiência do exame clínico na atenção médica, que torna o diagnóstico clínico mais dependente de exames complementares, enfatiza-se cada vez mais a importância do computador em medicina e na saúde pública. Isto se dá seja pela adoção de sistemas de apoio à decisão clínica, seja pelo uso integrado de novas tecnologias, incluindo as tecnologias vestíveis/corporais (wearable devices), seja pelo armazenamento de grandes volumes de dados de saúde de pacientes e da população. A capacidade de armazenamento e processamento de dados aumentou exponencialmente ao longo dos recentes anos, criando o conceito de big data. A Inteligência Artificial processa esses dados por meio de algoritmos, que tendem a se aperfeiçoar pelo seu próprio funcionamento (self learning) e a propor hipóteses diagnósticas cada vez mais precisas. Sistemas computadorizados de apoio à decisão clínica, processando dados de pacientes, têm indicado diagnósticos com elevado nível de acurácia. O supercomputador da IBM, denominado Watson, armazenou um volume extraordinário de informações em saúde, criando redes neurais de processamento de dados em vários campos, como a oncologia e a genética. Watson assimilou dezenas de livros-textos em medicina, toda a informação do PubMed e Medline, e milhares de prontuários de pacientes do Sloan Kettering Memorial Cancer Hospital. Sua rede de oncologia é hoje consultada por especialistas de um grande número de hospitais em todo o mundo. O supercomputador inglês Deep Mind, da Google, registrou informações de 1,6 milhão de pacientes atendidos no National Health Service (NHS), permitindo desenvolver novos sistemas de apoio à decisão clínica, analisando dados desses pacientes, permitindo gerar alertas sobre a sua evolução, evitando medicações contraindicadas ou conflitantes e informando tempestivamente os profissionais de saúde sobre seus pacientes. O Deep Mind, ao avaliar um conjunto de imagens dermatológicas na pesquisa de melanoma, mostrou um desempenho melhor do que o de especialistas (76% versus 70,5%), com uma especificidade de 62% versus 59% e uma sensibilidade de 82%. Mas se o computador fornece o know-what, caberá ao médico discutir o problema de saúde e suas possíveis soluções com o paciente, indicando o know-why do seu caso. Isto requer uma contínua preocupação com a qualidade da educação médica, enfatizando o conhecimento da fisiopatologia dos processos orgânicos e o desenvolvimento das habilidades de ouvir, examinar e orientar um paciente e, consequentemente, propor um diagnóstico e um tratamento de seu problema de saúde, acompanhando sua evolução.

scholarly journals Litigation costs of wrong-site surgery and other non-technical errors in orthopaedic operating theatres

2015 ◽  
Vol 97 (8) ◽  
pp. 592-597 ◽  
Author(s):  
WD Harrison ◽  
B Narayan ◽  
AW Newton ◽  
JV Banks ◽  
G Cheung
Keyword(s):  
Patient Safety ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Improve Patient Safety ◽  
World Health ◽  
Wrong Site Surgery ◽  
Technical Errors ◽  
Operating Theatres ◽  
Wrong Site

Introduction This study reviews the litigation costs of avoidable errors in orthopaedic operating theatres (OOTs) in England and Wales from 1995 to 2010 using the National Health Service Litigation Authority Database. Materials and methods Litigation specifically against non-technical errors (NTEs) in OOTs and issues regarding obtaining adequate consent was identified and analysed for the year of incident, compensation fee, cost of legal defence, and likelihood of compensation. Results There were 550 claims relating to consent and NTEs in OOTs. Negligence was related to consent (n=126), wrong-site surgery (104), injuries in the OOT (54), foreign body left in situ (54), diathermy and skin-preparation burns (54), operator error (40), incorrect equipment (25), medication errors (15) and tourniquet injuries (10). Mean cost per claim was £40,322. Cumulative cost for all cases was £20 million. Wrong-site surgery was error that elicited the most successful litigation (89% of cases). Litigation relating to implantation of an incorrect prosthesis (eg right-sided prosthesis in a left knee) cost £2.9 million. Prevalence of litigation against NTEs has declined since 2007. Conclusions Improved patient-safety strategies such as the World Health Organization Surgical Checklist may be responsible for the recent reduction in prevalence of litigation for NTEs. However, addition of a specific feature in orthopaedic surgery, an ‘implant time-out’ could translate into a cost benefit for National Health Service hospital trusts and improve patient safety.

scholarly journals Euthanasia in Spain. Analysis compared with other legal regulations of the European Union

2021 ◽  
Vol 87 (87(03)) ◽  
pp. 265-274
Author(s):  
María del Carmen González Leonor ◽  
Carlos del Castillo Rodríguez ◽  
Antonio González Bueno
Keyword(s):  
European Union ◽  
Health Service ◽  
Comparative Study ◽  
Health System ◽  
National Health ◽  
National Health System ◽  
The Other ◽  
Legal Regulations ◽  
The European Union ◽  
Spanish National Health System

The publication of Organic Law 3/2021 regulating euthanasia (BOE 03.25.2021), converted Spain in the fourth country in the European Union to decriminalize such practice. In this article we analyze this rule and the introduction of euthanasia in the Health Service of the Spanish National Health System, which guarantees access to the provision. On the other hand, we will carry out a comparative study of other legal systems in the European Union in which this practice is allowed or penalized.

Greece

2021 ◽  
pp. 353-374
Author(s):  
Ilias Kyriopoulos ◽  
Elias Mossialos
Keyword(s):  
Primary Care ◽  
National Health Service ◽  
Health Service ◽  
Health Services ◽  
Health System ◽  
Interest Groups ◽  
Healthcare System ◽  
National Health ◽  
Health Politics ◽  
Care Network

This chapter offers an in-depth look at health politics and the health system in Greece. It traces the development of the Greek healthcare system, characterized by an historical inability to implement significant reform, despite ambitious ideas. The chapter outlines the politics behind several reform attempts, among them the creation in the 1980s of the national health service, key elements of which were never implemented, and more recent efforts to establish a single purchaser of health services and a primary care network, both of which became law but were slow to take off. The chapter argues that the difficulty in undertaking reform can be explained by two elements that have historically influenced the policymaking process in Greece: electoral competition and the power of interest groups.

scholarly journals The creation of the National Health System in Italy (1961-1978)

Dynamis ◽  
2019 ◽  
Vol 39 (1) ◽  
Author(s):  
Giovanna Vicarelli
Keyword(s):  
Health Service ◽  
Health System ◽  
National Health ◽  
Catholic Church ◽  
National Health System ◽  
Well Being ◽  
Health Claims ◽  
Social Events ◽  
Institutional Model ◽  
The 1960S

The Italian health system has changed its welfare model three times over the course of its 160-year existence. From a form of "residual welfare" during the liberal period (1861-1921), it became "meritocratic welfare" during the fascist period (1922-1943) and in the years of the first republic (1945-1977). Finally, in 1978, the "universalistic institutional" model of health protection was approved. For a long time, therefore, the main responsibility for citizens’ well-being was attributed to families, to the Catholic Church and its welfare networks, to entrepreneurial paternalism, and to the different health insurance institutions associated with employment sectors. Only with Law 833, which established the National Health Service (NHS), did the State recognise full and direct responsibility for citizens’ health. This paper describes the complex path that led to the establishment of the Italian NHS, highlighting the diversity of the actors involved, the multiplicity of their social and health claims, the  configuration of the public health service designed in the 1960s, and the political and social conditions that led to the effective enactment of Law 833. On the whole, it was a long, non-linear path with various barriers, where the conditions of implementation were determined by the particularity of the Italian political, economic, and social events that characterised the 1970s.

scholarly journals Anticipating Policy, Orienting Services, Celebrating Provision: Reflecting on Scotland’s PrEP Journey

2021 ◽  
pp. 59-72
Author(s):  
Ingrid Young
Keyword(s):  
National Health Service ◽  
Hiv Prevention ◽  
Health Service ◽  
Health System ◽  
National Health ◽  
Specific Nature ◽  
Great Expectation ◽  
Risk Practices ◽  
The Uk ◽  
Roll Out

AbstractPrEP in Scotland came with great expectation and celebration. As the first country in the UK to offer PrEP through the National Health Service (NHS), Scotland was heralded as a leader in HIV prevention. This chapter asks: how has the anticipation of PrEP shaped provision and use within the health system; how does the emergent and ongoing orientation of PrEP towards specific risk practices affect awareness, access and use, but also wider narratives of prevention, inequalities and ‘progress’; and, what kinds of biosexual citizens does it demand and produce? The chapter explores how the implementation of PrEP and the specific nature of its roll-out contribute to an orientation towards certain (gendered) PrEP users and PrEP use. It considers how the anticipation of PrEP as a biotechnology for particular risk practices, bodies and communities shapes promissory HIV prevention futures and determines what success and ‘celebration’ could be.

Portugal

2021 ◽  
pp. 275-306
Author(s):  
Maria Asensio
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Health System ◽  
National Health ◽  
Market Mechanisms ◽  
Public And Private ◽  
Health Politics ◽  
Provision Of Services ◽  
Constitutional Right ◽  
Public Private Mix

This chapter provides an extended look at health politics and the health system in Portugal, characterized by overlapping tiers of coverage including a national health service. The chapter traces the historical development of the Portuguese healthcare system through a series of regime changes, particularly the transition from conservative dictatorship to democracy beginning in 1974. Since the 1979 foundation of the National Health Service, the main issues facing the health system have been the relationship between public and private provision of services and the system’s fiscal solvency. A 1989 constitutional revision, which redefined healthcare from being a constitutional right to universal free healthcare to one which “tended towards” no cost at the time of treatment and was based on individuals’ particular social and economic situation, shifted the system away from universalism, removed obstacles to privatization, and allowed the introduction of other forms of market mechanisms. As the chapter argues, though left and right political parties have differed in their approaches, actors in health politics seem to have largely agreed to move in the direction of a public–private mix of service providers.

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