How do countries plan, purchase and use imaging technologies to prevent over-purchase and overuse?

Abstract Background The adoption of new and expensive technologies is one of the main causes of the growing expenditure on health. Regulators are concerned that health care providers purchase (and use) imaging technologies in quantities that exceed the need, increasing expenditure with little value. We review how countries regulate the purchase and use of imaging technologies. Methods Qualitative. We collected data using a questionnaire completed by researchers from 17 high-income countries purposefully selected based on variation of policies. We built and compared case studies. Results Eleven of the 17 countries analyzed have clear criteria for planning and purchasing imaging technologies. Countries plan different areas, such as supply of specialist care, hospitals by level and type of services, quantity or type of equipment, as well as expenditure on health services and resource allocation. Most countries combine three mechanisms that manage the purchase or use of imaging technologies: (1) seven countries regulate by requiring certificates of need, licenses, or purchase approvals; others regulate by directly limiting the amounts, types and quality of technologies. (2) All countries use financial tools such as activity-based payment, limited and conditional budgets, and caps on income or volume of services. (3) Nine countries centralize purchase by a government agency. The literature provides inconclusive evidence regarding the impact of these mechanisms on expenditure on health and access to imaging services. Conclusions Planning the imaging technologies market with clear criteria is essential to avoid abuse. Most countries combine the three mechanisms (regulation, financial tools, centralized purchase). Financial tools are more common and effective. Countries with single payers implement more regulation than countries with multiple, competing, payers. In the later, regulated competition seems to replace regulation. There is a trend of adopting centralized procurement. Key messages • Planning the imaging technology market is a precondition to avoid abuse. • Regulation, financial tools, and centralized purchase can be combined to manage the use of imaging technologies.


Background:
In many European countries, including the Netherlands, the healthcare system is based upon solidarity. It is important that public support for solidarity-based systems is sufficient, to ensure that people remain willing to contribute to them. Although support is generally high, as indicated by high levels of willingness to pay for the healthcare costs of others, there are differences between groups. Previous research has focused on individual and institutional characteristics when explaining these differences. However, people's social context may also play a role. Little research has been conducted into this. To fill this gap, we examined the role of perceived social support and social norms in order to explain differences in the willingness to pay for other people's healthcare costs. Methods: A questionnaire was sent to a representative sample of 1,500 members of the Dutch Healthcare Consumer Panel in November 2021 (56% response rate, N = 837). The relationship between the social context of people and their willingness to pay was studied via logistic regression analysis.

Results:
Higher levels of perceived social support are associated with higher levels of willingness to pay for other people's healthcare costs (p = 0.038). We also found that willingness to pay is higher when someone's social context is more supportive of the solidarity-based healthcare system (p = 0.001). Contrary to our expectations, the effect of social norms does not differ between people who perceive low and high levels of socials support.

Conclusions:
The degree to which people feel connected to others and the degree to which someone's social context supports the solidarity-based healthcare system affect the willingness to contribute to the healthcare system. Our results suggest that the social context of people has to be taken into account in both policy and research that addresses healthcare solidarity, next to individual and institutional characteristics. Key messages: Social support and social norms play a role in the willingness to pay for healthcare costs of others. People's social context must be taken into account in policy and research on healthcare solidarity.

Background:
The adoption of new and expensive technologies is one of the main causes of the growing expenditure on health. Regulators are concerned that health care providers purchase (and use) imaging technologies in quantities that exceed the need, increasing expenditure with little value. We review how countries regulate the purchase and use of imaging technologies.

Methods:
Qualitative. We collected data using a questionnaire completed by researchers from 17 high-income countries purposefully selected based on variation of policies. We built and compared case studies.

Results:
Eleven of the 17 countries analyzed have clear criteria for planning and purchasing imaging technologies. Countries plan different areas, such as supply of specialist care, hospitals by level and type of services, quantity or type of equipment, as well as expenditure on health services and resource allocation. Most countries combine three mechanisms that manage the purchase or use of imaging technologies: (1) seven countries regulate by requiring certificates of need, licenses, or purchase approvals; others regulate by directly limiting the amounts, types and quality of technologies.
(2) All countries use financial tools such as activity-based payment, limited and conditional budgets, and caps on income or volume of services.
(3) Nine countries centralize purchase by a government agency. The literature provides inconclusive evidence regarding the impact of these mechanisms on expenditure on health and access to imaging services.

Conclusions:
Planning the imaging technologies market with clear criteria is essential to avoid abuse. Most countries combine the three mechanisms (regulation, financial tools, centralized purchase). Financial tools are more common and effective. Countries with single payers implement more regulation than countries with multiple, competing, payers. In the later, regulated competition seems to replace regulation. There is a trend of adopting centralized procurement.

Background:
Disparity in cancer survival across countries has been linked to variation in cancer policy delivery but there is lack of empirical evidence for this association. We traced the evolution of cancer policies in 20 jurisdictions in Australia, Canada, Denmark, Ireland, Norway, New Zealand and the UK since 1995 and present the findings of an exploratory analysis linking cancer policy consistency to cancer survival.

Methods:
We systematically searched and analysed national/regional cancer plans and strategies, mapping timelines of cancer policy evolution. For 10 jurisdictions, evidence was synthesised into five categories: oversight function; cancer plan; implementation plan; budget for plan implementation; and evaluation. We assigned scores evaluating whether a category was present or absent, and weighted scores for consistency. Summed scores were correlated with trends in survival from seven cancers between 1995-2014. Results: All ten jurisdictions had implemented a high-level structure overseeing, steering or delivering cancer control policies (1995 -2014); all had also published at least one major cancer plan. There was great variation in oversight mechanisms, ranging from institutionalising cancer control (New South Wales, Ontario) to cancer steering groups or taskforces (Denmark, Northern Ireland, Wales). Frequency and consistency of cancer plans also varied, from a succession of plans that build on each other (Denmark, New South Wales, Ontario) to the publication of isolated plans (New Zealand, Northern Ireland). We found a positive, albeit weak, correlation of cancer policy consistency and improvements in survival over time for six of the seven cancers.

Conclusions:
Jurisdictions that have implemented consistent cancer control policies over time tended to be more successful in improving survival for a wide range of cancers. Our findings can help guide policymakers seeking approaches and frameworks to improve cancer services and, ultimately, cancer outcomes. Key messages: Sustained and consistent strategic cancer planning and investment are crucial for ensuring better patient outcomes, and this requires strong and sustained commitment at all levels.
The findings can help guide policymakers seeking approaches and frameworks to improve cancer services and, ultimately, cancer outcomes.
Abstract citation ID: ckac129.167 Hospital admissions in Austria during the COVID-19 Pandemic -a rapid analysis for 2020 and 2021 Herwig Ostermann H Ostermann 1,2 , K Eglau 1 1 Austrian National Public Health Institute, Gesundheit Ö sterreich GmbH, Vienna, Austria 2 Department of Public Health and HTA, University for Health Sciences, Medical Informatics and Technology, Hall/Tyrol, Austria Contact: herwig.ostermann@goeg.at

Background:
The COVID-19 pandemic posed a substantial shock to health service provision, in particular regarding hospital services. The reasons and also rationales for reduced health service provision were manifold ranging from limited supply due to resource restrictions, limited demand in order to avoid infections or due to reduced incidence of various diseases, and postponement of elective services. Nevertheless, the provision of services for acute care at an adequate level is paramount to avoid patient harm.

Methods:
Hospital admissions were analysed via administrative DRG data reported by Austrian hospitals. We compared health service provision on a monthly basis between 01/2018 and 12/ 2021. Services were classified according to ICD-10 and encompassed admissions due to acute heart failure, stroke, accidents, knee and hip surgery and breast cancer surgery.

Results:
Our findings show that hospital admissions for acute heart failure decreased by up to 25% between 03/2020 and 05/2020. In contrast, no significant difference to the initial prepandemic levels could be observed in the later stages of the pandemic. Stroke admissions remained at the initial levels throughout the whole period of analysis, while a substantial decrease (up to 50%) in admissions because of accidents was observed whenever severe NPIs were in place. Knee and hip surgery levels dropped in line with increasing ICU occupancy rates caused by COVID-19 patients. Decreases in breast cancer surgery could only be observed (up to 20%) during the four months of the pandemic (03-06/2020).

Conclusions:
Our analysis provides an aggregated insight into service provision management in Austrian hospitals throughout the pandemic. While acute care was continuously provided for most areas of diseases and elective surgeries were widely postponed in line with pressure on ICU capacities, the decline in breast cancer surgery demands attention and further clarification of whether this decline was supply-or demanddriven. Key messages: During the pandemic inpatient acute care services were continuously provided for most diseases in Austrian hospitals while elective surgeries were postponed in line with pressure on ICU capacities. The pandemic posed a substantial challenge to service provision management in hospitals and unwarranted levels of service provision so far indicate areas of action for future (pandemic) preparedness.