No health without peace. Nothing more to say.

The right to health was laid out in the Universal Declaration of Human Rights, reaffirmed in the Alma Ata declaration, and remains embedded in contemporary WHO priorities. There is no credible path to achieving it that can run through perpetual conflict. Responding to the health consequences of war is necessary, but it cannot substitute for the conditions required to build, protect, and sustain health systems. Ambitions for equity, resilience, preparedness, and universal access cannot be realised amid chronic insecurity. 

Peace is not adjacent to health—it is foundational.

The Lancet editorial (2026) (pdf Volume 407, Issue 10523, 1)

Photo Jordi Soldevila. Geometries de la injustícia. Desesperació.
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The future hospital in Global Health Systems

Future hospitals must be able to adapt in many ways to the changing demands on their roles and functions within evolving healthcare delivery infrastructures. These include changing population structures and needs, new models of healthcare provision, technological advances, and innovations in design, all while enhancing their environmental sustainability.

This article sets out the issues that those determining healthcare policy and designing future hospitals must consider if they are to become and remain fit for purpose within the wider health and social care system. It also examines the need for, and challenges to, strategic healthcare planning, creating future hospitals that are sustainable, net‐zero carbon organisations, and ensuring resilience in the face of a range of potential shocks.

Future hospitals play a crucial role in healthcare worldwide, regardless of the country's income level. Hospitals cannot be viewed without broader health system changes, infrastructure, community and cultural factors, staffing and other considerations. Future hospitals will enhance population health in all settings and support the move towards more consumer‐centric healthcare. The authors urge clinical and policy planners to consider the factors discussed carefully to maximise the benefits.

Article (2025) open access

Sebire NJ, Adams A, Celi L, Charlesworth A, Gorgens M, Gorsky M, Landeg O, Nagasawa Y, Nimako KT, Onoka C, Roder-DeWan S, Watts N, McKee M. The Future Hospital in Global Health Systems: The Future Hospital Within the Healthcare System. Int J Health Plann Manage. 2025 May;40(3):741-751. doi: 10.1002/hpm.3891. Epub 2025 Jan 15. PMID: 39815953; PMCID: PMC12045726.

Photo Jordi Soldevila. Posidònies. Cicatriu 1

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When you see your neighbor's beard peeling, soak yours.

The NHS turns 77 this year 2025. Until recently, it has been widely regarded as the “crown jewel” of the British welfare state. Throughout its history, the NHS has achieved significant successes, including providing financial protection against the costs of ill health, incorporating formal assessments of new medical technologies, and delivering generally well-received care once accessed. Moreover, the NHS has been a driving force in medical research and innovation, pioneering advancements in treatments, healthcare delivery, and disease prevention. However, over a decade of austerity funding, compounded by the impact of the COVID-19 pandemic, has exposed its vulnerabilities. The NHS has shown limited resilience to external shocks and appears increasingly unsustainable in the face of growing demand.

Waiting lists are at an all-time high, population health outcomes in the UK are worsening, staff shortages and dissatisfaction remain persistent, and public confidence in the institution is wavering. In short, the NHS is in crisis.

The Labour government has increased NHS funding, but not to a level that several experts—including the LSE-Lancet Commission—deem sufficient to meet rising demands. The government has also announced a new 10-year plan. But will these measures be enough?

This event organized by the LSE last june explored the current state of the NHS, assessed whether the government's responses are adequate, and discussed whether more radical reforms are necessary. The discussion provided both critical reflection and potential solutions to address the crisis.

• Podcast to listen to.
• Video of the event to watch
• Slides and Speakers: to download here.

Photo Jordi Soldevila. Homenatge a Toni Catany Mandarina

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Is competitive pressure essential for sustaining quality in primary care services?

The authors Eduard Brüll, Davud Rostam-Afschar, and Oliver Schlenker study how the threat of entry affects service quantity and quality of general practitioners (GPs).

They leverage Germany’s needs-based primary care planning system, in which the likelihood of new GPs reduces by 20 percentage points when primary care coverage exceeds a cut-off. They compile novel data covering all German primary care regions and up to 30,000 GP-level observations from 2014 to 2019. Reduced threat of entry lowers patient satisfaction for incumbent GPs without nearby competitors but not in areas with competitors. They find no effects on working hours or quality measures at the regional level including hospitalizations and mortality.

While entry restrictions aim to ensure equitable access to care, they can unintentionally reduce service quality by weakening competition. Policymakers must navigate this trade-off carefully, ensuring that access does not come at the expense of quality. By preserving competitive incentives even in regulated markets, healthcare systems can achieve both equitable and high-quality care.

IZA Discussion Paper No. 17534

Access to working paper 2024 (pdf)

Photo Jordi Soldevila. Merry Christmas

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Back to basics: Michael Grossman

The Health Economics journal publishes the Michael Grossman editorial related to the 50th anniversary of the publication of the demand for health model in “On the Concept of Health Capital and the Demand for Health,” Journal of Political Economy 80(2): 223–255, and in The Demand for Health: A Theoretical and Empirical Investigation, NBER Occasional Paper 119 New York: Columbia University Press for the NBER.

The editorial focuses on the history of the model and its impacts on the field of health economics.

Editorial:  The demand for health turns 50: Reflections Michael Grossman

Michael Grossman and the Demand for Health Model

The Demand for Health introduced a new theoretical model for determining the health status of the population. His work uniquely synthesized economic and public health knowledge and has catalyzed a vastly influential body of health economics literature.

The demand for health is somewhat more complicated than the demand for a typical product. Here, the individual demands health and not health care. The demand for health care is, therefore, a derived demand.

The central idea behind Grossman’s model of demand for health is how age, education, health status, income etc. affect the production of health through the demand for health capital. Michael Grossman defined health both as a consumption good as well as a production good. He provided two reasons behind this; one health is consumed directly i.e. people are happier when they are healthier. Second, health is an investment i.e. good health permits people to do other things. Thus, the individual is both the consumer and the producer of health.

This model introduces the idea of investing in human capital (health and education) to improve outcomes in both the market (work) and non-market (household) sectors. The goal is to improve the earnings. Health is characterized as a capital good because it can be seen as lasting over time periods and depreciating at a non-constant rate.

Grossman bases his approach on Gary S. Becker's household production function model and his theory of investment in human capital. Consumers demand health, which can include illness-free days in a given year or life expectancy, and then produce it through the input of medical care services, diet, other market goods and services, and time.

Grossman also treats health and knowledge as equal parts of the durable stock of human capital. Consumers therefore have an incentive to invest in health to increase their earnings in the future. 

Grossman examines complementarities between health capital and other forms of human capital, the most important of which is knowledge capital earned through schooling and its effect on the efficiency of production.

He concludes that the rate of return on investing in health by increasing education may exceed the rate of return on investing in health through greater medical care. Higher income may not lead to better health outcomes, as wealth enables the consumption of goods and services with adverse health effects.

photo Jordi Soldevila. Homenatge a Toni Catany. Ampolles silencioses  

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The addiction to technology adoption in health

A major driver of cost growth in health care is the rapid increase in the utilisation of existing technology and not simply the adoption of new technology.

Health economists and health technology assessment analysts have become obsessed by technology adoption questions and have largely ignored ‘technology management’ questions.

Technology management would include the life-cycle assessment of technologies in use, to assess their real-world performance; and monitoring of technology indication creep. A rebalancing of focus might serve to encourage a more self-critical and learning culture amongst those involved in technology evaluation analysis.

Further, health economists and health technology assessment analysts could make a more significant contribution to system efficiency through rebalancing their efforts away from technology adoption questions towards technology management issues.

Article (pdf) 
Url: Health Economics:  

Authors: Cam Donaldson , Stirling Bryan , Craig Mitton

photo: Rose generated by Artificial Intelligence Sant Jordi 2022 (UPC)

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War is hell: Mental health consequences of war #stopthewar

War has a catastrophic effect on the health and well being of nations. Studies have shown that conflict situations cause more mortality and disability than any major disease. War destroys communities and families and disrupts the social and economic development of nations.

The effects of war include long-term physical and psychological harm to children and adults, as well as reduction in material and human capital. Among the consequences of war, the impact on the mental health of the civilian population is one of the most significant. Other consequences, besides deaths include endemic poverty, malnutrition, disability, economic/social decline and psychosocial illness, to mention only a few.

Women are more affected than men. Other vulnerable groups are children, the elderly and the disabled.

This paper briefly reviews the evidence from published literature about the impact of war on the mental health of the general population, the refugees, the soldiers and specific vulnerable groups. The review presents data concerning some major wars/conflicts and then briefly outlines the risk factors emerging from the literature.

Prevalence rates are associated with the degree of trauma, and the availability of physical and emotional support. The use of cultural and religious coping strategies is frequent in developing countries.

Mental health and war: brief review (article pdf) (2006)

photo: Emilio Morenatti

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The benefits of Women's Health research

Women's health has suffered from insufficient research addressing women. The research community has not widely embraced the value of this research, and the impact of limited knowledge about women's health relative to men's is far-reaching. Without information on the potential return on investment for women's health research, research funders, policymakers, and business leaders lack a basis for altering research investments to improve knowledge of women's health.

As part of an initiative of the Women's Health Access Matters (WHAM) nonprofit foundation, RAND Corporation researchers examined the impact of increasing funding for women's health research, with a focus on the following three disease areas: brain health, immune and autoimmune disease, and cardiovascular disease. Using microsimulation analyses, the research team studied the societal cost impact of increasing research funding in three diseases that present a large disease burden for women: Alzheimer's disease and Alzheimer's disease–related dementias (AD/ADRD), coronary artery disease (CAD), and rheumatoid arthritis (RA).

Key Findings

• Investing in women's health research yields benefits beyond investing in general research
• The return on investment is higher for most scenarios in which research funding impact is assumed to be higher for women than men. Assuming an equal impact of research on women and men generally results in lower returns.
• Research investment yields benefits for all people, but the specific emphasis on women’s health can result in downstream socioeconomic benefits that improve on general research.
• Large societal gains may be possible by increasing investment in women's health research
• Savings include increased life years, reduced years with disease, fewer years of functional dependence, and reductions in disruptions to work productivity.

Recommendations

• Increase research funding directed at women's health. The potential gains from women-focused research are substantial, given the limitations in knowledge about disease development and impacts for women relative to men.
• Pursue research on the biology of disease in women, including early identification, and identify barriers to diagnosis in women.
• Expand research agendas to address the complicated relationships between disease and work productivity in women. Impacts include lost productivity for those with the disease and for informal caregivers, the majority of whom are women.
• Raise awareness of the potential value of investment in women's health research. The ways in which women's health research is disadvantaged relative to general research are multifaceted, with major implications for disease burdens.

Article (pdf) 

Authors: Baird, Matthew D., Melanie A. Zaber, Annie Chen, Andrew W. Dick, Chloe E. Bird, Molly Waymouth, Grace Gahlon, Denise D. Quigley, Hamad Al-Ibrahim, and Lori Frank, Research Funding for Women's Health: Modeling Societal Impact. Santa Monica, CA: RAND Corporation, 2021. https://www.rand.org/pubs/research_reports/RRA708-4.html.

photo: Lluïsa Vidal

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Physician health management skills and patient outcomes

 

There are large, persistent differences in patient outcomes across physicians and health facilities. The root causes of these differences are not well understood. One reason could be to find if physicians’ health management styles can affect patient health outcomes and health costs.

As quality contracts become increasingly popular across various health care systems, it is important to highlight what facets of individual physicians’ health management styles have meaningful impact on health outcomes and to what extent they vary across physicians. The physician’s ability to correctly diagnose and treat common conditions is one of the central tenets of quality contracts. But the link between these skills and patient outcomes is at best tenuous. Critics have emphasized that unobserved patient-specific characteristics are important and under-researched contributors to the variability of patient health outcomes conditional on physician clinical skill.

Emilia Simeonova et al. published a working paper in 2020 in the NBER where using data on the population of statin users in Denmark between 2004 and 2008 and matching patients to their primary care physicians, they demostrated that

• The physician’s ability to facilitate adherence with prescription medications (as a proxie of physicians's health management skills) has significant positive effects on patient outcomes and health costs even after controlling for observable and unobservable patient characteristics.
• It is important to know that when we talk of physician skills is more than reflecting the clinical quality of the physician. Physician skills are related to their ability to make an adequate diagnosis and prescribe the correct treatment.
• Younger physicians have on average more adherent patients.There didn't find substantial difference in health management skills between male and female physicians after they controlled for physician age and the patient mix. 
• The interventions aiming at improving physicians’ health management skills as they relate to patient adherence with prescribed therapy will have positive impacts on patient health outcome

Access to NBER working paper (pdf)

photo: Homenatge a Ramon Llull (1976) Josep M. Subirachs ______________________________________________________________________

false optimism not to be at risk of COVID-19

 

 

 

 

 

Koula Asimakopoulou et al. from King’s College London investigated comparative optimism for infection and recovery from COVID-19, and the implications this may have on the second wave and the possible lockdown. The study found that during the first lockdown period, most respondents believed that compared to others, they were unlikely to be at risk of COVID-19.

Data were collected through an international survey (N = 6485) exploring people’s thoughts and psychosocial behaviours relating to COVID‐19. The paper reports UK data.

They found the belief that negative events surrounding risk and recovery from COVID‐19 are perceived as more likely to happen to others rather than to oneself. Researchers believe that comparative optimism may have brought out the anecdotally observed, lack of compliance with lockdown guidelines in the UK. People who believe COVID‐19 is less likely to happen to them than to others may infer that their actual risk is much smaller than that communicated in the media, and thus the strict adherence to lockdown restrictions is unnecessary in their case.

The results showed how participants overwhelmingly believed that as compared to people of their age and gender, they were somewhat or extremely unlikely to have accidentally infected people with COVID‐19 in the past and to infect others or get infected themselves in the next month. They were also comparatively optimistic, but to a lesser extent, about their likelihood of getting hospitalized due to COVID‐19, finding themselves in an ICU, being ventilated, and making a full recovery.

In contrast, participants showed comparative pessimism about COVID‐19 infections in the more distant future. As compared to the average person of their age and gender they felt likely to get infected by COVID‐19 in the next year and to develop COVID‐19‐related symptoms. The authors argued that this finding supports earlier research that shows that people who have experienced some ill health tend to unduly exaggerate their future risk of experiencing further ill health. One important difference between COVID‐19 and other risks is that controlling the pandemic was very much placed in the hands of individuals restricting their lives in the UK—as seen in the slogan urging people to ‘Stay at home’. It is reasonable that participants would reason that in the long term, staying at home would be less possible, plausible or practical. Feeling that compliance with social distancing rules cannot be maintained indefinitely may thus explain these perceptions, in line with research showing that high prevalence negative events may engender comparative pessimism.

The implication for a second lockdown is that where people's experience so far may be that they have not been ill with COVID, they are likely to be even more comparatively optimistic than they were in March. Thinking that COVID has not happened to you so far so it is unlikely to happen to you now, can be even more dangerous than it was earlier in the spring. Both comparative optimism and comparative pessimism may have important consequences for people’s psychological well‐being and their likelihood of engaging in risk behaviours or responding to further lockdown measures.

Acces article (pdf free) Comparative optimism about infection and recovery from COVID‐19; Implications for adherence with lockdown advice

photo: Càpsules de confinament. Museu Can Framis Fundació Vilacasas. 2020 

Obra 'Sense títol' d'Eulàlia Valldosera, (Vertical)

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Alert: health care professionals and stress impact during the COVID-19

Healthcare professionals (HCPs) on the front lines against COVID-19 may face increased workload, and stress. Understanding HCPs’ risk for burnout is critical to supporting HCPs and maintaining the quality of healthcare during the pandemic.

Large numbers of healthcare professionals (HCPs) on the frontlines against COVID-19 face high adversity, workloads, and stress, making them vulnerable to burnout.

• Burnout: Defined as emotional exhaustion, depersonalization, and low personal achievement, is known to detract from optimal working capacities, It has been found to be driven by high job stress, high time pressure and workload, and poor organizational support.

We present a preprint article: Factors Contributing to Healthcare Professional Burnout During the COVID-19 Pandemic: A Rapid Turnaround Global Survey (2020)

Method: To assess exposure, perceptions, workload, and possible burnout of HCPs during the COVID-19 pandemic the authors conducted a cross-sectional survey.

The main outcomes and measures were HCPs’ self-assessment of burnout and other experiences and attitudes associated with working during the COVID-19 pandemic.

Results: Burnout was associated with:

• Work impacting household activities
• Feeling pushed beyond training
• Exposure to COVID-19 patients
• Making life prioritizing decisions
• Lack of adequate personal protective equipment (PPE)
• Limited organizatins support

Implications: Athough the results have multiple limitations including a non-validated questionnaire, minimal demographic data collection, and sampling method using social media the institutions should put the emphasis in support these individuals as they face enormous stress that can negatively impact their emotional and physical well-being.

Some actions that proactively instituions should do:

• Develop a resilience training: resilience refers to an individual’s ability to handle stress and recover quickly from the effects of adversity
• Cut drastically the belief of  HCP feeling that their organization doesn’t value their well-being.
• HCPs should feel secure knowing that management care about them and the management are doing as much as possible to handle with the adverse situation
  
• Support for HCPs’ families,
  
• Provide PPE,
  
• Provide mental health resources

Acces to the preprint article (pdf available)

Final article

photo: Life

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Florence Nightingale bicentenary 2020

Florence Nightingale "the Lady of the Lamp" was born on May 12, 1820, in Florence. This 2020 the worldwide celebrates of Florence Nightingale’s bicentenary. In her honour The World Health Organisation have named 2020 the Year of the Nurse and Midwife.

Despite family pressures to marry and live as a conventional wealthy woman, she considered her dedication to nursing to be a response to the call of God to care for the sick. Her success in radically lowering the death rate of wounded soldiers in the Crimean War led to society’s acceptance of her proposals for better sanitation and nutrition, accurate medical knowledge, and professionally trained nurses.

While Nightingale is best known worldwide for revolutionising nursing and healthcare through her campaigning for health reform, her far-reaching recommendations were based on impressive statistical work and popularised through pioneering data visualisation and her evidence-based approach to healthcare.

Florence Nigthtingale was the first female fellow in 1858 from Royal Statistical Society. The Significance magazine from Royal Statistical Society and American Statistical Association has published a special issue: Significance magazine, 2020, Volume 17, Issue 2: Florence Nightingale

More information:
Celebrating Nightingale 2020 Bicentenary
Mujeres con ciencia: Florence Nightingale (in spanish)
Florence Nightingale foundation
Guys and St Thomas Hospital

picture: Helping the wounded. Shutterstock/Everett Historical
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stay at home

 

Image: Milo Manara 2020
https://www.milomanara.it/?lang=en 
Milo Manara is an Italian comic book writer and artist.
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stay at home

photo: Sabadell (AHS, 1936...)
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clinical practice guidelines and the voice of patients

Clinical practice guidelines (CPG) are the user manuals of modern medicine. If the human body can suffer it, chances are there's a guideline for treating it, from burns and breaks to cancers and strokes. At their best, they provide gold-standard guidance to doctors: how to diagnose and treat a condition, what symptoms to watch for, what tests to order. But that's not always the reality. Clinicians are experts, but the patients with the disease are also experts. They're the ones living with it on a daily basis.

Guideline development could be unsatisfactory and unreliable. Because it so often fails to engage any patients or caregivers. Usually guidelines are developed without any input from the people who would actually experience them. Also, there is no consensus on what exactly patients and their representatives should be asked to do during CPG development. For example, should they be active members of guideline groups, or should patient input and preferences be shared only with clinicians in guideline groups. Moreover, there is little clarity about how guidelines should reflect patient-based evidence, or information generated by patients about different aspects of care, patient preferences, and care experience.

Rand (2019) in an interdisciplinary team of researchers, patient representatives from the Parent Project Muscular Dystrophy (PPMD) and clinicians developed the RAND/PPMD Patient-Centeredness Method (RPM) - a version of a Delphi method- with a online approach to engaging patients and their representatives in Clinicial Practice Guildelines.

The authors said that Duchenne was a good test case, because the disease is so rare, so complex, and the balance between treatment and quality of life is so precarious. but this method should be formally validated and tested in the context of other clinical conditions and compared to other ways of engaging patients in CPG development.

Open access article

photo: Moda ald carrer 1971. Joana Biarnés (1935-2018)
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poverty and health

Michaela Benzeval et al. published in 2014 in The Joseph Rowntree Foundation the report How does money influence health?

The study explores the association between income and health throughout the life course and within families. Researchers reviewed theories from 272 wide-ranging papers, most of which examined the complex interactions between people’s income and their health throughout their lives.

The research identifies four main ways money affects people’s wellbeing:

1. Material: Money buys goods and services that improve health. The more money families have, the better the goods they can buy.
2. Psychosocial: Managing on a low income is stressful. Comparing oneself to others and feeling at the bottom of the social ladder can be distressing, which can lead to biochemical changes in the body, eventually causing ill health.
3. Behavioural: For various reasons, people on low incomes are more likely to adopt unhealthy behaviours – smoking and drinking, for example – while those on higher incomes are more able to afford healthier lifestyles.
4. Reverse causation (poor health leads to low income): Health may affect income by preventing people from taking paid employment. Childhood health may also affect educational outcomes, limiting job opportunities and potential earnings.

These pathways are all likely to be important and interact across people’s lives in a complex web of links between income and health. The broader context is also important. Living on a low income in a country with a well-developed welfare state is unlikely to have the same health-damaging effects as living in one with poorer provision for healthcare and education.

Given this complexity of interconnection between people’s income and health, a broad approach to improving the health of those with limited resources is important.
Acces full report

photo: Toni Catany

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The CEOs in the NHS

Katharina Janke, Carol Propper* and Raffaella Sadum published in may 2019 a working paper where they investigate whether top managers affect the performance of large public sector organizations. The study examined CEOs of English public hospitals, which are large, complex organizations with multi-million turnover. They studied the impact of individual CEOs on a wide set of measures of hospital performance, intermediate operational outcomes and inputs.

Findings: "There is little evidence that individual CEOs have an impact on a large set of measures of hospital performance".

There are some possible explanations for their findings.

• The first is public sector-specific. The public sector nature of the NHS wich distort the effort of ther NHS CEOs to pursuit of political targets rather than performance-enhacing policies. The NHS is central in political discourse in the UK. Its importance means that politicians are very concerned about NHS performance, particularly negative performance, and are also keen to be seen to be doing something, which is generally manifest in a desire to implement new policies. The lack of persistent CEO effects is consistent with a scenario in which top managers simply chase political goals, rather than policies that might actually improve hospital performance. In this context, the rational response of a NHS CEO is not necessarily to improve the long-term performance of the hospital but, instead, to minimizethe amount of bad news that ends up on the Secretary of State’s desk. 
• A second explanation is that hospitals are large complex organizations, in which highly trained (and hard to monitor) individuals run separate but interconnected production processes. Management at the very top of such organizations may find it difficult to engage in coordination and getting a large number of actors, who traditionally have not worked together, to work cooperatively. The organizational inertia of a large hospital is too strong for a single manager – even if this person is the CEO – to be able to impact performance within the short time period in which they are in office, and consistently across organizations. This situation, of course, is not specific to public sector hospitals. But it may have more of an effect in hospitals, public or private, where there are many dimensions of performance (clinical, access, financial) that can be pursued and can in the short run conflict. This inertia may also be exacerbated by the often much longer contract durations of clinical staff relative to CEOs.
• The short tenure of CEOS (around 3.5 years) in the NHS may dampen their ability to systematically impress their mark in the organization they lead. A leading NHS manager recently argued that it takes five years for a CEO to make a difference but the average time in post is much shorter than that.
• The management capabilities of middle managers inhospitals are systematically associated with better outcomes. The authors suggest that rather than seeking to rapidly change hospital performance through the appointment of a cadre of “superheads”, strategies for improvement should instead focus on nurturing and sustaining the skills of middle managers.

Paper: CEOs-NHS working paper (2019, pdf)

*Carol Propper will be next friday the 14th in the plenary session of the XXIX Jornadas de Economía de la Salud  presenting this study

photo: Anna de Jaume Plensa, Monestir de Montserrat 2019  Jordi Soldevila 
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The Spanish National Health Service: chinese porcelain

 

The principles and goals of the Spanish National Health System focus on universality, free access, equity and fairness of financing. The evolution of performance measures over the last decade shows the resilience of the health system to the recent economic crisis. In terms of mortality and self perceived health it does not seem to have affected heavily at least in the sort term, although some structural reforms may be required in the medium and long term, specially to avoid the increasing income inequality, poverty, and risk of social exclusions that worsen the health indicators.

Here we have some ligth about some policy iniciatives and reforms that experts said should be adressed in the Spanish National Health System

• Cuadernos Económicos de ICE  scientific journal edited by the Secretariat of State for Trade (Government of Spain) since 1977. The current issue published in january 2019. Eight articles written by well known researchers from health economics and public health reviewing these hot topics: 

1. The arrival of new technologies with innovative mechanisms and health financing decisions.
2. Areas of public-private collaboration in health systems. focusing on continuing medical education, health research and health care management.
3. The healthcare management, its quality and the consideration of the impact of this quality on health outcomes.
4. The hospital expenditure and hospitalization evolution in the Spanish National Health System (SNS), during the period 2004-2009 and 2010-2015, analyzing their trends and medical practice variability between health areas.
5. Coordination between the health care system and the long-term care system.
6. Public health go beyond the performance of health care services. Health problems are global and require actions at a global level.
7. Good governance is a prerequisite for changing the health policy and the design of the National Health System in the right direction. Good governance in terms of: prioritization, comprehensive health policy, leadership, national health agency, and cultural and intellectual environment.
8. Economic crisis and health: lessons learned and recommendations for the future,

  Acces Full issue (pdf)  CICE Issue (2018)

• The European Observatory on Health Systems and Policies released a new health system review (HiT) on Spain.

Acces (pdf) Spain HiT (2018)

photo: "Homeless", 2005. google search words: name of the 25th richest people in the world in 2004 by Forbes (Joan Fontcuberta)  
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breaking the hospital model

The hospitals have to move from the concept of “repair shop” function to a "hub" in their community: providing social services, improving education and becoming aware of their significant economic role in communities. Hospitals have the potential to affect the economic model and the social determinants of health by leveraging their hiring, purchasing, investing, and other operational assets more intentionally.

• HUB means an organization or institution that is a focal point in a community and helps blend together a range of stakeholders and services that improve the health and economic mobility of residents. It does not necessarily lead activities or function as the sole focal point—often it is a partner with other institutions. But through partnerships and its own services it enables organizations and people with particular skills, assets, and connections to work more effectively together to improve the neighborhood.

Some recomendations to promote a Hub:

Data
Improve the collection, use, and sharing of data among sectors to facilitate partnerships. Hospitals as data warehouses centers for the community, assuring interoperability and data governance including detailed demographic data, and other information to build a picture of the community.

Partnerships
Make greater use of intermediaries. Hospitals, are often seen by many community organizations as remote yet powerful institutions, and a lack of trust arising from little or no history of partnerships. Hospitals has to build trust inside their community. Intermediaries are organizations or individuals that provide specialized skills or “connecting” functions that facilitate partnerships,

Leadership
Widen the skill sets of hospital leaders and key staff. Train the leaders and the staff. The full potential of hospitals as hubs requires leaders in these institutions to have a broad vision and set of skills, to manage the delivery of less traditional services, and to work with partners and intermediaries.

Essay and error
Government has to increase the promotion of the pilot projects and programs in different communities and encourage the impact evaluation. Also, they should give more flexibility in the hospital's payment systems being less oriented to outputs and more to outcomes. Take steps to facilitate the braiding and blending of public and private resources from multiple sectors and sources.

Access to the article: Hospitals and Schools as a Hubs (2016)
Authors: Stuart Butler and Carmen Diaz

photo: Third and Colectivo Rua
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Performance culture in hospitals: if you are good in one dimension you'll probably will be good in the rest

Nils Gutacker and Andrew Street using a sample of 95955 patients treated in 252 hospitals during  april 2009 and march 2012 on hip replacement surgery in the English National Health Service, explored the performance of the hospitals. They use four performance indicators: 1) Post operative health status (post OHS); 2) Length of stay (LOS); 3) Waiting time >18 weeks; 4) 28-day emergency readmission.

Using a multidimensional model and a dominance criteria they show us that there are a significance correlation between them.

• Hospitals with shorter LOS also realise better post operative health status (the fast track or enhanced recovery).
• Hospitals that have a lower proportion of patients waiting more than 18 weeks to be admitted also have a shorter LOS
• Hospitals with better post OHS also tend to have a lower proportion of patients waiting for more 18 weeks
• The emergency readmission within 28 days has a negative impact on health status

They also classified the hospitals in three categories: dominant (perform well), dominated (perform poorly) and non-comparable in overall performance effects: All dominant hospitals are private Independent Sector Treatment Centres (ISTCs), and all dominated hospitals are public NHS.

• Volume outcome are not important in explaining overall performance differences between them. 
• Dominant providers operates in a more competitive markets (in a quality competition in-price regulated market). 
• Dominant providers have economies of scope. Good overall performance is associated with more concentrated delivery system. 
• ISTCs don't cherry pick healthier cases to treat or “dump” complex cases back into the NHS.

Providers to perform better in one dimension have an excellent performance on another. This means that some providers have a better performance culture than others and this are better for patients.

Access to the article (pdf): Multidimensional performance assessment of public sector organisations using dominance criteria (Health Economics 2017)

photo: Light: (*) Photosolde.
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