Ewout van Ginneken

Mental health in Vietnam: Burden of disease and availability of services

PURPOSE Despite the accomplishments, the economic and social reform program of Vietnam has had negative effects, such as limited access to health care services for those disadvantaged in the new market economy. Among this group are persons with mental disorders. This paper aims to understand the burden of mental disorders and availability of mental health services (MHS) in Vietnam. METHODS We reviewed both national as well as the international literature about the burden of mental disorders and MHS in Vietnam. This included academic literature (Medline, Pubmed), national (government) reports, World Health Organization (WHO) reports, and grey literature. RESULTS The burden of mental disorders in Vietnam is similar to that of other Asian countries and occurs across all population groups. MHS have been made one of the national health priorities and more efforts are being made to promote equity of access by integrating MHS into other health care programs and by increasing MHS capacity. However, it is not yet sufficient to meet the care demand of persons with mental disorders. Challenges remain in various areas of MHS, including: lack of mental health legislation, human resources, hospital beds, shortage and diversification of MHS. CONCLUSION Although MHS in Vietnam have considerably improved over the last decade, mainly in terms of accessibility, the care demand and the illness burden remain high. Therefore, more emphasis should be put on increasing MHS capacity and on human resource development. In that process, more representative epidemiological data and intervention research is needed.

Accountable care organizations in the USA: Types, developments and challenges

A historically fragmented U.S. health care system, where care has been delivered by multiple providers with little or no coordination, has led to increasing issues with access, cost, and quality. The Affordable Care Act included provisions to use Medicare, the U.S. near universal public coverage program for older adults, to broadly implement Accountable Care Organization (ACO) models with a triple aim of improving the experience of care, the health of populations, and reducing per capita costs. Private payers in the U.S. are also embracing ACO models. Various European countries are experimenting with similar reforms, particularly those in which coordinated (or integrated) care from a network of providers is reimbursed with bundled payments and/or shared savings. The challenges for these reforms remain formidable and include: (1) overcoming incentives for ACOs to engage in rationing and denial of care and taking on too much financial risk, (2) collecting meaningful data that capture quality and enable rewarding quality improvement and not just volume reduction, (3) creating incentives for ACOs that do not accept much risk to engage in prevention and health promotion, and (4) creating effective governance and IT structures that are patient-centered and integrate care.

Governing healthcare through performance measurement in Massachusetts and the Netherlands

Massachusetts and the Netherlands have implemented comprehensive health reforms, which have heightened the importance of performance measurement. The performance measures addressing access to health care and patient experience are similar in the two jurisdictions, but measures of processes and outcomes of care differ considerably. In both jurisdictions, the use of health outcomes to compare the quality of health care organizations is limited, and specific information about costs is lacking. New legislation in both jurisdictions led to the establishment of public agencies to monitor the quality of care, similar mandates to make the performance of health care providers transparent, and to establish a shared responsibility of providers, consumers and insurers to improve the quality of health care. In Massachusetts a statewide mandatory quality measure set was established to monitor the quality of care. The Netherlands is stimulating development of performance measures by providers based on a mandatory framework for developing such measures. Both jurisdictions are expanding the use of patient-reported outcomes to support patient care, quality improvement, and performance comparisons with the aim of explicitly linking performance to new payment incentives.

Public reporting on quality, waiting times and patient experience in 11 high-income countries.

This article maps current approaches to public reporting on waiting times, patient experience and aggregate measures of quality and safety in 11 high-income countries (Australia, Canada, England, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States). Using a questionnaire-based survey of key national informants, we found that the data most commonly made available to the public are on waiting times for hospital treatment, being reported for major hospitals in seven countries. Information on patient experience at hospital level is also made available in many countries, but it is not generally available in respect of primary care services. Only one of the 11 countries (England) publishes composite measures of overall quality and safety of care that allow the ranking of providers of hospital care. Similarly, the publication of information on outcomes of individual physicians remains rare. We conclude that public reporting of aggregate measures of quality and safety, as well as of outcomes of individual physicians, remain relatively uncommon. This is likely to be due to both unresolved methodological and ethical problems and concerns that public reporting may lead to unintended consequences.

Challenges facing the United States of America in implementing universal coverage

Abstract In 2010, immediately before the United States of America (USA) implemented key features of the Affordable Care Act (ACA), 18% of its residents younger than 65 years lacked health insurance. In the USA, gaps in health coverage and unhealthy lifestyles contribute to outcomes that often compare unfavourably with those observed in other high-income countries. By March 2014, the ACA had substantially changed health coverage in the USA but most of its main features – health insurance exchanges, Medicaid expansion, development of accountable care organizations and further oversight of insurance companies – remain works in progress. The ACA did not introduce the stringent spending controls found in many European health systems. It also explicitly prohibits the creation of institutes – for the assessment of the cost–effectiveness of pharmaceuticals, health services and technologies – comparable to the National Institute for Health and Care Excellence in the United Kingdom of Great Britain and Northern Ireland, the Haute Autorité de Santé in France or the Pharmaceutical Benefits Advisory Committee in Australia. The ACA was – and remains – weakened by a lack of cross-party political consensus. The ACA’s performance and its resulting acceptability to the general public will be critical to the Act’s future.

Major challenges ahead for Hungarian healthcare

The health sector in Hungary is facing its most serious crisis since the fall of the communist regime. Péter Gaál and colleagues discuss the challenges and how to respond to them

Restricting access to the NHS for undocumented migrants is bad policy at high cost

Charging migrants for access to health services will not reduce strain on the NHS, say Lilana Keith and Ewout van Ginneken

Coverage for undocumented migrants becomes more urgent.

The outcome of the presidential election has put immigration reform back on the national agenda. Once the coverage expansions of the Patient Protection and Affordable Care Act take effect in the st...

Implementing Insurance Exchanges — Lessons from Europe

As U.S. states prepare to create and implement health insurance exchanges under the Affordable Care Act, experiences in the Netherlands and Switzerland, where exchanges are part of health care reforms that have been ongoing for some time, provide cautionary lessons.

The Baltic states: building on 20 years of health reforms

The Baltic States are recovering from a crisis as deep as Greece’s. Van Ginneken and colleagues suggest that the crisis has provided an opportunity to improve efficiency and equity, although concerns about financial sustainability and the impact on public health remain