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Imagine a health professional in any European country who fell asleep in 1960 and awoke in a health facility in 2019. Much of what the observer saw would be quite different. There would be many more patients who were surviving into old age thanks to advances in therapy. Many of the treatments that they were receiving would be much more complex, involving radically new techniques such as laparoscopic or even robotic surgery, and they would be amazed by the advances in diagnostic capacity. Yet, in many health systems, some things would have changed very little. Among them would be the traditional roles of different types of health worker, with responsibility for certain task being reserved for those with particular qualifications based on custom and practice rather than on evidence. This opinion argues that this situation must change. There is now an impressive body of evidence that things can often be done differently. This does not mean that they should be. Change is only appropriate where it helps to achieve the goals of the health system and allows it to provide better care in ways that are more responsive to the needs of users. Tasks can be shifted from health workers to patients and their carers, to machines, and to other health workers. Where these shifts have been evaluated, they often, but not always, are associated with outcomes that are as good or even better than with the status quo. However, the results are often context dependent, and it cannot be assumed that what works in one situation will apply equally to another. What matters is the evidence, rather than traditional, but often obsolete rules. If a health system can ensure that tasks are being undertaken by those most appropriate to do them, it will enhance patient care. However, change is often difficult. Those involved must be convinced of the rationale for change and must be supported in implementing it. This should recognise that any change in roles will have implication for their status and thus existing hierarchies. It may also be necessary to challenge outdated legislative or regulatory barriers. Finally, it is essential the changes are evaluated, results are documented, and lessons are learned, both in relation to what works and in what circumstances. Task shifting, where it is based on robust evidence and implemented effectively, can make a major contribution to health outcomes and to the sustainability of health systems. It is not, however, a panacea for all of the challenges health systems face. ; Představte si zdravotnického odborníka v kterékoli evropské zemi, který usnul v roce 1960 a probudil se ve zdravotnickém zařízení v roce 2019. Hodně z toho, co by pozorovatel viděl, by bylo úplně jiné. Bylo by mnohem více pacientů, kteří přežili do stáří díky pokrokům v terapii. Mnoho z ošetření, které dostávali, by bylo mnohem složitější, zahrnovalo radikálně nové techniky, jako je laparoskopická nebo dokonce robotická chirurgie, a byl by ohromen pokrokem v diagnostickém rozsahu. Přesto by se v mnoha zdravotnických systémech některé věci změnily jen velmi málo. Mezi nimi by byly tradiční role různých typů zdravotnických pracovníků, přičemž odpovědnost za určitý úkol by byla vyhrazena těm, kteří mají zvláštní kvalifikaci založenou spíše na zvyklostech a praxi než na důkazech. Toto stanovisko tvrdí, že se tato situace musí změnit. Nyní existuje impozantní soubor důkazů, že věci lze často dělat jinak. To neznamená, že by měli být jinak dělány. Změna je vhodná pouze tam, kde pomáhá dosahovat cílů zdravotnického systému a umožňuje jí poskytovat lepší péči způsoby, které lépe reagují na potřeby uživatelů. Úkoly lze převádět ze zdravotnických pracovníků na pacienty a jejich pečovatele, na stroje a další zdravotnické pracovníky. Tam, kde byly tyto posuny vyhodnoceny, jsou často, ale ne vždy, spojeny s výsledky, které jsou stejně dobré nebo dokonce lepší než za současného stavu. Výsledky jsou však často závislé na kontextu a nelze předpokládat, že to, co funguje v jedné situaci, se bude vztahovat stejně na jiné. Důležitý je důkaz spíše než tradiční, ale často zastaralá pravidla. Pokud zdravotní systém může zajistit, že osoby, které jsou pro ně nejvhodnější, plní správně alokované úkoly, zlepší se péče o pacienty. Změna je však často obtížná. Zúčastněné strany musí být přesvědčeny o důvodech změny a musí být podporovány při jejich provádění. Musí uznat, že každá změna rolí bude mít dopad na jejich stav, a tedy na existující hierarchie. Může být také třeba změnit zastaralé legislativní nebo regulační překážky. Nakonec je nezbytné, aby byly změny vyhodnoceny, výsledky zdokumentovány a vedly k ponaučení, co funguje a za jakých okolností. Posun úkolů, činností a kompetencí, pokud je založen na spolehlivých důkazech a je účinně prováděn, může významně přispět k lepším výsledkům v oblasti zdraví a k udržitelnosti zdravotních systémů. Nejedná se však o všelék na všechny výzvy, kterým zdravotnické systémy čelí. ; Imagine a health professional in any European country who fell asleep in 1960 and awoke in a health facility in 2019. Much of what the observer saw would be quite different. There would be many more patients who were surviving into old age thanks to advances in therapy. Many of the treatments that they were receiving would be much more complex, involving radically new techniques such as laparoscopic or even robotic surgery, and they would be amazed by the advances in diagnostic capacity. Yet, in many health systems, some things would have changed very little. Among them would be the traditional roles of different types of health worker, with responsibility for certain task being reserved for those with particular qualifications based on custom and practice rather than on evidence. This opinion argues that this situation must change. There is now an impressive body of evidence that things can often be done differently. This does not mean that they should be. Change is only appropriate where it helps to achieve the goals of the health system and allows it to provide better care in ways that are more responsive to the needs of users. Tasks can be shifted from health workers to patients and their carers, to machines, and to other health workers. Where these shifts have been evaluated, they often, but not always, are associated with outcomes that are as good or even better than with the status quo. However, the results are often context dependent, and it cannot be assumed that what works in one situation will apply equally to another. What matters is the evidence, rather than traditional, but often obsolete rules. If a health system can ensure that tasks are being undertaken by those most appropriate to do them, it will enhance patient care. However, change is often difficult. Those involved must be convinced of the rationale for change and must be supported in implementing it. This should recognise that any change in roles will have implication for their status and thus existing hierarchies. It may also be necessary to challenge outdated legislative or regulatory barriers. Finally, it is essential the changes are evaluated, results are documented, and lessons are learned, both in relation to what works and in what circumstances. Task shifting, where it is based on robust evidence and implemented effectively, can make a major contribution to health outcomes and to the sustainability of health systems. It is not, however, a panacea for all of the challenges health systems face.

Background and Objectives Common health state valuation methodology, such as time tradeoff (TTO) and standard gamble (SG), is typically applied under several descriptively invalid assumptions, for example, related to linear quality-adjusted life years (QALYs) or expected utility (EU) theory. Hence, the current use of results from health state valuation exercises may lead to biased QALY weights, which may in turn affect decisions based on economic evaluations using such weights. Methods have been proposed to correct responses for the biases associated with different health state valuation techniques. In this article we outline the relevance of prospect theory (PT), which has become the dominant descriptive alternative to EU, for health state valuations and economic evaluations. Methods and Results We provide an overview of work in this field, which aims to remove biases from QALY weights. We label this "the corrective approach." By quantifying PT parameters, such as loss aversion, probability weighting, and nonlinear utility, it may be possible to correct TTO and SG responses for biases in an attempt to produce more valid estimates of preferences for health states. Through straightforward examples, this article illustrates the effects of this corrective approach and discusses several unresolved issues that currently limit the relevance of corrected weights for policy. Conclusions Suggestions for research addressing these issues are provided. Nonetheless, if validly corrected health state valuations become available, we argue in favor of using these in economic evaluations.

The COVID-19 pandemic highlights the need for effective infectious disease outbreak prevention. This could entail installing an integrated, international early warning system, aiming to contain and mitigate infectious diseases outbreaks. The amount of resources governments should spend on such preventive measures can be informed by the value citizens attach to such a system. This was already recognized in 2018, when a contingent valuation willingness to pay (WTP) experiment was fielded, eliciting the WTP for such a system in six European countries. We replicated that experiment in the spring of 2020 to test whether and how WTP had changed during an actual pandemic (COVID-19), taking into account differences in infection rates and stringency of measures by government between countries. Overall, we found significant increases in WTP between the two time points, with mean WTP for an early warning system increasing by about 50% (median 30%), from around €20 to €30 per month. However, there were marked differences between countries and subpopulations, and changes were only partially explained by COVID-19 burden. We discuss possible explanations for and implication of our findings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10198-021-01353-6.

Het stimuleren van gezond gedrag staat hoog op de politieke agenda. Overheidsmaatregelen op het gebied van gezonde voeding staan echter nog in de kinderschoenen. Onlangs pleitte de Raad voor Volksgezondheid en Samenleving dan ook voor meer overheidsmaatregelen om ongezond eetgedrag tegen te gaan. Het ontwerpen van zulke maatregelen op een zowel acceptabele als effectieve wijze is complex. We legden zevenhonderd Nederlanders vijf stellingen voor met betrekking tot overheidsingrijpen op het gebied van gezonde voeding. We vroegen hen welk effect ze voor zichzelf en voor anderen verwachten van de maatregelen die zijn gesuggereerd in het zogenaamde Nationaal Preventieakkoord en eveneens zijn aangehaald door de Raad voor Volksgezondheid en Samenleving.

Governments across Europe are required to make decisions about how best to allocate scarce health care resources. There are legitimate arguments for eliciting societal vales in relation to health care resource allocation given the roles of the general public as payers and potential patients. However, relatively little is known about the views of the general public on general principles which could guide these decisions. In this paper we present five societal viewpoints on principles for health care resources allocation and develop a new approach, Q2S, designed to investigate the extent to which these views are held across a range of European countries. An online survey was developed, based on a previously completed study Q methodology, and delivered between November 2009 and February 2010 across nine countries to 33,515 respondents. The largest proportion of our respondents (44%), were found to most associate themselves with an egalitarian perspective. Differences in views were more strongly associated with countries than with socio-demographic characteristics. These results provide information which could be useful for decision makers in understanding the pluralistic context in which they are making health care resource allocation decisions and how different groups in society may respond to such decisions.

To understand the public sentiment toward the measures used by policymakers for COVID-19 containment, a survey among representative samples of the population in seven European countries was carried out in the first two weeks of April 2020. The study addressed people's support for containment policies, worries about COVID-19 consequences, and trust in sources of information. Citizens were overall satisfied with their government's response to the pandemic; however, the extent of approval differed across countries and policy measures. A north-south divide in public opinion was noticeable across the European states. It was particularly pronounced for intrusive policy measures, such as mobile data use for movement tracking, economic concerns, and trust in the information from the national government. Considerable differences in people's attitudes were noticed within countries, especially across individual regions and age groups. The findings suggest that the epidemic acts as a stressor, causing health and economic anxieties even in households that were not directly affected by the virus. At the same time, the burden of stress was unequally distributed across regions and age groups. Based on the data collected, we draw lessons from the containment stage and identify several insights that can facilitate the design of lockdown exit strategies and future containment policies so that a high level of compliance can be expected.

BACKGROUND AND OBJECTIVE: The COVID-19 pandemic and the measures taken by governments to contain it have affected many aspects of the daily lives of citizens. This study aimed to describe changes in the productivity of paid work and time allocation to paid and unpaid work and leisure resulting from working at home during the pandemic. METHODS: A sample of 851 people from the Netherlands who had paid work (≥ 24 h/week) and worked at least 4 hours per week extra at home because of lockdown measures completed a questionnaire during the first COVID-19 lockdown (April 2020). Respondents reported time spent on paid and unpaid work and leisure before and during the lockdown. Productivity was measured in terms of quantity and quality of paid work. RESULTS: On average, respondents spent less time (14%) on paid work and productivity decreased 5.5%. Changes in productivity were associated with the age of children, net income and having a separate home office. Respondents spent more time on unpaid work (27%) and leisure (11%). Women spent more time on unpaid work in absolute but not in relative terms. People with a partner and with children spent more time on unpaid work and less time on leisure. CONCLUSIONS: Productivity of paid work decreased, and people reallocated time between paid and unpaid work and leisure during the first COVID-19 lockdown. Changes in time allocation and productivity differed across subgroups. If working at home becomes more common, future research should focus on the long-term impact on productivity and mental and physical health.

The impact of digitalization of health services has been profound and is expected to be even more profound in the future. It is important to evaluate whether digital health services contribute to health system goals in an optimal way. This should be done at the level of the service, not the 'digital transformation'. Decisions to adopt new digital health services, at different levels of the health care system, are ideally based on evidence regarding their performance in light of health system goals. In order to evaluate this, a broad perspective should be taken in evaluations of digital health services. Attainment of the broad health system goals, including quality, efficiency and equity, are objectives against which to judge new digital health services. These goals in a broad sense are unaltered by the process of digitalization. Governance should be designed and tailored in such a way to capture all relevant changes in an adequate way. When evaluating digital health services many specific aspects need to be considered. Like for other innovations and (new) technologies, such promises may or may not materialize and potential benefits may also be accompanied by unintended and/or negative (side) effects in the short or long term. Hence, the introduction, implementation, use and funding of digital health technologies should be carefully evaluated and monitored. Governments should play a more active role in the further optimization both of the process of decision making (both at the central and decentral level) and the related outcomes. They need to find a balance between centralized and decentralized activity. Moreover, the broader preparation of the health care system to be able to deal with digitalization, from education, through financial and regulatory preconditions, to implementation of monitoring systems to monitor its effects on health system performance remains important. ; other ; published

Objectives Medical devices are potentially good candidates for coverage with evidence development (CED) schemes, as clinical data at market entry are often sparse and (cost-)effectiveness depends on real-world use. The objective of this research was to explore the diffusion of CED schemes for devices in Europe, and the factors that favour or hamper their utilization. Methods We conducted structured interviews with 25 decision-makers from 22 European countries to explore the characteristics of existing CED programmes for devices, and how decision makers perceived 13 pre-identified challenges associated with initiating and operating CED schemes for devices. We also collected data on individual schemes that were either initiated or still ongoing in the last 5 years. Results We identified seven countries with CED programmes for devices and 78 ongoing schemes. The characteristics of CED programmes varied across countries, including eligibility criteria, roles and responsibilities of stakeholders, funding arrangements, and type of decisions being contemplated at the outset of each scheme. We observed a high variability in how decision makers perceived CED-related challenges possibly reflecting country-specific arrangements and different experiences with CED. One general finding across all countries was that relatively little attention was paid to the evaluation of schemes, both during and at their completion. Conclusions CED programmes for devices with different characteristics exist in Europe. Decision-makers' perceptions differ on the challenges associated with these schemes. More exchange of knowledge and experience will help decision makers anticipate the likely challenges in CED schemes for devices, and to learn from good practices existing elsewhere.

The impact of digitalization of health services has been profound and is expected to be even more profound in the future. It is important to evaluate whether digital health services contribute to health system goals in an optimal way. This should be done at the level of the service, not the 'digital transformation'. Decisions to adopt new digital health services, at different levels of the health care system, are ideally based on evidence regarding their performance in light of health system goals. In order to evaluate this, a broad perspective should be taken in evaluations of digital health services. Attainment of the broad health system goals, including quality, efficiency and equity, are objectives against which to judge new digital health services. These goals in a broad sense are unaltered by the process of digitalization. Governance should be designed and tailored in such a way to capture all relevant changes in an adequate way. When evaluating digital health services many specific aspects need to be considered. Like for other innovations and (new) technologies, such promises may or may not materialize and potential benefits may also be accompanied by unintended and/or negative (side) effects in the short or long term. Hence, the introduction, implementation, use and funding of digital health technologies should be carefully evaluated and monitored. Governments should play a more active role in the further optimization both of the process of decision making (both at the central and decentral level) and the related outcomes. They need to find a balance between centralized and decentralized activity. Moreover, the broader preparation of the health care system to be able to deal with digitalization, from education, through financial and regulatory preconditions, to implementation of monitoring systems to monitor its effects on health system performance remains important.