Showing papers in "Health policy and technology in 2020"

Telemedicine, COVID-19, and disparities: Policy implications.

Abstract: While the rapid expansion of telemedicine in response to the COVID-19 pandemic highlights the impressive ability of health systems to adapt quickly to new complexities, it also raises important concerns about how to implement these novel modalities equitably. As the healthcare system becomes increasingly virtual, it risks widening disparities among marginalized populations who have worse health outcomes at baseline and limited access to the resources necessary for the effective use of telemedicine. In this article, we review recent policy changes and outline important recommendations that governments and health care systems can adopt to improve access to telemedicine and to tailor the use of these technologies to best meet the needs of underserved patients. We suggest that by making health equity integral to the implementation of telemedicine now, it will help to ensure that all can benefit from its use going forward and that this will be increasingly integral to care delivery.

Responses to COVID-19 in five Latin American countries.

Abstract: Background COVID-19 reached Latin-American countries slightly later than European countries, around February/March, allowing some emergency preparedness response in countries characterized by low health system capacities and socioeconomic disparities. Objective This paper focuses on the first months of the pandemic in five Latin American countries: Brazil, Chile, Colombia, Ecuador and Peru. It analyses how the pre-pandemic context, and the government's responses to contain and mitigate the spread together with economic measures have affected the COVID-19 health outcomes. Methods Extensive qualitative document analysis was conducted focused on publicly-available epidemiological data and federal and state/regional policy documents since the beginning of the pandemic. Results The countries were quick to implement stringent COVID-19 measures and incrementally scaled up their health systems capacity, although tracing and tracking have been poor. All five countries have experienced a large number of cases and deaths due to COVID-19. The analysis on the excess deaths also shows that the impact in deaths is far higher than the official numbers reported to date for some countries. Conclusion Despite the introduction of stringent measures of containment and mitigation, and the scale up of health system capacities, pre-pandemic conditions that characterize these countries (high informal employment, and social inequalities) have undermined the effectiveness of the countries’ responses to the pandemic. The economic support measures put in place were found to be too timid for some countries and introduced too late in most of them. Additionally, the lack of a comprehensive strategy for testing and tracking has also contributed to the failure to contain the spread of the virus.

Defending against the Novel Coronavirus (COVID-19) Outbreak: How Can the Internet of Things (IoT) help to save the World?

Abstract: •IoT within infectious disease epidemiology is an emerging field of research, however the ubiquitous availability of smart technologies, as well as increased risks of infectious disease spread through the globalization and interconnectedness of the world necessitates its use for predicting, preventing and controlling emerging infectious diseases.•Considering the present situation in China, IoT based smart disease surveillance systems have the potential to be a major breakthrough in efforts to control the current pandemic. With much of the infrastructure itself in place already (i.e. smartphones, wearable technologies, internet access) the role this technology can have in limiting the spread of the pandemic involves only the collection and analysis of data already gathered.•More research must be carried out for the development of automated and effective alert systems to provide early and timely detection of outbreaks of such diseases in order to reduce morbidity mortality and prevent global spread.

COVID-19 pandemic in the United States.

Abstract: Objectives The paper highlights US health policy and technology responses to the COVID-19 pandemic from January 1, 2020 – August 9, 2020. Methods A review of primary data sources in the US was conducted. The data were summarized to describe national and state-level trends in the spread of COVID-19 and in policy and technology solutions. Results COVID-19 cases and deaths initially peaked in late March and April, but after a brief reduction in June cases and deaths began rising again during July and continued to climb into early August. The US policy response is best characterized by its federalist, decentralized nature. The national government has led in terms of economic and fiscal response, increasing funding for scientific research into testing, treatment, and vaccines, and in creating more favorable regulations for the use of telemedicine. State governments have been responsible for many of the containment, testing, and treatment responses, often with little federal government support. Policies that favor economic re-opening are often followed by increases in state-level case numbers, which are then followed by stricter containment measures, such as mask wearing or pausing re-opening plans. Conclusions While all US states have begun to “re-open” economic activities, this trend appears to be largely driven by social tensions and economic motivations rather than an ability to effectively test and surveil populations.

The COVID-19 pandemic in Ireland: An overview of the health service and economic policy response.

Abstract: Objectives To outline the situation in Ireland with regard to the COVID-19 pandemic. Methods Analyse the evolution of the COVID-19 pandemic in Ireland. Review the key public health and health system responses. Results Over 1700 people have died with COVID-19 by July 19th while almost 3000 people had been admitted to hospital with COVID-19. A high proportion of the deaths occurred in nursing homes and other residential centres who did not receive sufficient attention during the early phase of the pandemic. Conclusions Ireland's response to the COVID-19 crisis has been comprehensive and timely. Transparency, a commitment to a relatively open data policy, the use of traditional and social media to inform the population, and the frequency of updates from the Department of Health and the Health Services Executive are all commendable and have led to a high level of compliance among the general public with the various non-medical measures introduced by the government.

Swedish Policy Analysis for COVID-19

Abstract: Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged health care systems and put societies to the test in the world beyond expectations. Objective Our aim is to describe and analyze the Swedish approach in combating the pandemic. Methods We present and discuss data collated from various sources - published scientific studies, pre-print material, agency reports, media communication, public surveys, etc. - with specific focus on the approach itself, Covid-19 trends, healthcare system response, policy and measures overview, and implications. Results The main intervention to manage the curve has been the general recommendations to adhere to good hand hygiene, beware of physical distance to others, to refrain from large gatherings and restrain from non-essential travel. Persons with suspected Covid-19 infection were recommended to stay at home and avoid social contacts. Additionally, visits to the elderly care homes and meetings with more than 50 people were forbidden. As a result, the healthcare system in the country has so far, never been overwhelmed. However, the relatively high mortality among the elderly, together with the vulnerability of some migrants, points out the drawbacks. Conclusions Many countries have both marvelled and criticized the Swedish strategy that is formed in a close partnership between the government and the society based on a mutual trust giving the responsibility to individuals. It already highlights how much can be achieved with voluntary measures (recommendations) - something that was noticed and proposed as a future model by the World Health Organization.

An analysis of the policy responses to the COVID-19 pandemic in France, Belgium, and Canada

Abstract: Objectives This paper presents an overview and comparative analysis of the epidemiological situation and the policy responses in France, Belgium, and Canada during the early stages of the 2020 Covid-19 pandemic (Feb.-Aug. 2020). These three countries are compared because they represent a spectrum of different governance structures while also being OECD nations that are similar in many other respects. Methods A rapid review of primary data from the three countries was conducted. Data was collected from official government documents whenever possible, supplemented by information from international databases and local media reports. The data was then analysed to identify common patterns as well as significant divergences across the three countries, especially in the areas of health policy and technology use. Results France, Belgium and Canada faced differing epidemiological situations during the Covid-19 pandemic, and the wide variety of policy actions taken appears to be linked to existing governance and healthcare structures. The varying degrees of federalism and regional autonomy across the three countries highlight the different constraints faced by national policy-makers within different governance models. Conclusions The actions taken by all three countries appear to have been largely dictated by existing health system capacity, with increasing federalism associated with more fragmented strategies and less coordination across jurisdictions. However, the implications of certain policies related to economic resilience and health system capacity cannot yet be fully evaluated and may even prove to have net negative impacts into the future.

Europe's Covid-19 outliers: German, Austrian and Swiss policy responses during the early stages of the 2020 pandemic

Abstract: Objectives This paper presents an overview of the policy responses in Germany, Austria and Switzerland (the DACH region) during the early stages of the 2020 Covid-19 pandemic (Feb.-June 2020), which provides the context for a comparative policy analysis. This analysis provides insight into the possible implications of the policy actions taken in the region. Methods An in-depth review and analysis of available data from the DACH countries was conducted. Data was collected from official government sources whenever possible, and supplemented by information from international databases and local reports. The data was then analyzed to identify common patterns as well as significant divergences across the DACH region, especially in the area of health policy and technology use. Results The DACH countries faced similar epidemiological situations during the Covid-19 pandemic, and were largely successful at preventing many of the negative impacts seen across the rest of Europe. Although many differences in health systems and governance structures existed, the policy responses in all three countries managed to address some of the most important factors in containing an infectious disease outbreak of this magnitude. Conclusions The actions taken by all three DACH countries appear to have been largely successful in reducing the health impact of Covid-19, allowing a return to normal economic activities much earlier than in neighboring countries. However, the implications of certain policies related to economic resilience and health system capacity cannot yet be fully evaluated and may even prove to have negative impacts into the future.

Implementing healthcare services on a large scale: Challenges and remedies based on blockchain technology

Abstract: The accessibility of electronic healthcare data is necessary for effective treatment, policy decisions, and healthcare information exchange. Due to the intangibility of digital data, healthcare information is also prone to privacy-breach and security attacks. Further, the importance of immutability and privacy of healthcare data becomes colossal when a nationwide healthcare and wellness scheme is planned to be implemented. Providing quality healthcare services to such an enormous population size is challenging and requires proper technological infrastructure. The cooperation from the society is equally important to lay such a copious architecture on which the healthcare services should seamlessly run. Objective To assess the social and technical challenges that lie ahead in implementing large-scale comprehensive healthcare services and suggest a technology-intervening solution to serve the society at large. Method This study considers India's National Health Policy (2017) initiatives. The social and technical hurdles in implementation of the schemes are discussed, and AarogyaChain, a Blockchain technology-based solution is proposed to eliminate the health policy implementation hiccups. Result We find that the scalability is a primary concern in implementing healthcare services on blockchain at such a large scale. We experimented by creating a blockchain and found that the system throughput is a function of the number of special nodes called ordering nodes, and a trade-off is required to balance between time-to-commit and system's fault tolerance. Conclusion Blockchain provides a secure and transparent system of integrated healthcare services that keeps patients at the center and provides for corruption intolerant and efficient implementation of nationwide health-insurance programs.

The COVID-19 pandemic in Italy: policy and technology impact on health and non-health outcomes.

Abstract: Italy was the first Western country to experience a major coronavirus outbreak and consequently faced large-scale health and socio-economic challenges. The Italian government enforced a wide set of homogeneous interventions nationally, despite the differing incidences of the virus throughout the country. Objective: The paper aims to analyse the policies implemented by the government and their impact on health and non-health outcomes considering both scaling-up and scaling-down interventions. Methods: To categorise the policy interventions, we rely on the comparative and conceptual framework developed by Moy et al. (2020). We investigate the impact of policies on the daily reported number of deaths, case fatality rate, confirmation rate, intensive care unit saturation, and financial and job market indicators across the three major geographical areas of Italy (North, Centre, and South). Qualitative and quantitative data are gathered from mixed sources: Italian national and regional institutions, National Health Research and international organisations. Our analysis contributes to the literature on the COVID-19 pandemic by comparing policy interventions and their outcomes. Results: Our findings suggest that the strictness and timing of containment and prevention measures played a prominent role in tackling the pandemic, both from a health and economic perspective. Technological interventions played a marginal role due to the inadequacy of protocols and the delay of their implementation. Conclusions: Future government interventions should be informed by evidence-based decision making to balance, the benefits arising from the timing and stringency of the interventions against the adverse social and economic cost, both in the short and long term.

COVID-19 pandemic in China: Context, experience and lessons.

Abstract: The first cluster of COVID-19 cases was reported in Wuhan, China on December 29th, 2019. Since then, China has experienced a pandemic of COVID-19. Objective: This study aims to present the context in which the pandemic has evolved, the government's response and the pandemic's impact on public health and national economy. Methods: A review was conducted to collect relevant data from press releases and government reports. Results: COVID-19 poses a major public health threat on China with a cumulative number of cases over 89,000 (data cut-off date: August 9th, 2020). Between January and February 2020, China implemented a series of escalating policies (including a stringent nation-wide lockdown) to combat the pandemic. Therefore, it has been to a large extent limited to the Wuhan region. Social media such as WeChat and SinaWeibo played a crucial role in disseminating government information and public campaigns during the pandemic. Technologies were adopted to enable contact tracing and population travel patterns. The Chinese central government mobilized healthcare resources including healthcare personnel and medical materials to Wuhan in a highly effective way. Both central and regional governments launched financial policies to stimulate the economy, including special loans, tax extension, reduction or waiver. Nevertheless, the economy in China was significantly impacted especially during the lockdown period. Conclusions: China has responded to the COVID-19 epidemic in a highly centralized and effective way. Balancing the needs to prevent a future pandemic and to boost economic recovery remains a challenge.

COVID-19 pandemic in Finland - preliminary analysis on health system response and economic consequences.

Abstract: Objectives The objective of this study was to describe and analyze the impact of the coronavirus disease COVID-19 on health policy, social- and health system, and economic and financing system to prevent, treat, contain and monitor the virus in Finland. Methods This study provides early outcomes of health policy measures, social- and health system capacity as well as economic challenges in COVID-19 pandemic in Finland. This paper is based available documents and reports of different ministries and social, health and economic authorities collected online. This was complemented by other relevant pandemic data from Finland. Results The impact of COVID-19 pandemic on the Finnish society has been unpredictable although it has not been as extensive and massive than in many other countries. As the situation evolved the Government took strict measures to stop the spread of the virus (e.g. Emergency Powers Act). Available information shows that the economic consequences will be drastic also in Finland, albeit perhaps less dramatic than in large industrial economies. Conclusions Finland has transferred gradually to a “hybrid strategy”, referring to a move from extensive restrictive measures to enhanced management of the epidemic. However, health system must be prepared for prospective setback. It is possible, that COVID-19 pandemic has accelerated the development of digital health services and telemedicine in Finnish healthcare system.

COVID-19 pandemic in the United Kingdom.

Abstract: Objectives To describe epidemiological data on cases of COVID-19 and the spread of Severe Acute Respiratory Syndrome Coronavirus 2 in the United Kingdom (UK), and the subsequent policy and technological response to the pandemic, including impact on healthcare, business and the economy. Methods Epidemiological, business and economic data were extracted from official government sources covering the period 31st January to 13th August 2020; healthcare system data up to end of June 2019. Results UK-wide COVID-19 cases and deaths were 313,798 and 46,706 respectively (472 cases and 70 deaths per 100,000 population) by 12th August. There were regional variations in England, with London and North West (756 and 666 cases per 100,000 population respectively) disproportionately affected compared with other regions. As of 11th August, 13,618,470 tests had been conducted in the UK. Increased risk of mortality was associated with age (≥60 years), gender (male) and BAME groups. Since onset of the pandemic, emergency department attendance, primary care utilisation and cancer referrals and inpatient/outpatient referrals have declined; emergency ambulance and NHS111 calls increased. Business sectors most impacted are the arts, entertainment and recreation, followed by accommodation and food services. Government interventions aimed at curtailing the business and economic impact have been implemented, but applications for state benefits have increased. Conclusions The impact of COVID-19 on the UK population, health system and economy has been profound. More data are needed to implement the optimal policy and technological responses to preventing further spikes in COVID-19 cases, and to inform strategic planning to manage future pandemics.

Easing of lockdown measures in Nigeria: Implications for the healthcare system.

Abstract: The year 2020 was ushered in with a historical novel virus (COVID-19) pandemic in a manner that the world has never witnessed before. The human-to-human transmission rates of the virus are not only alarming and worrisome but also, the respiratory dysfunction and unwavering deaths it caused have risen global concerns. We employ the daily situation data on reported cases of COVID-19 to explicate the implications of the lockdown lifting in Nigeria using both qualitative and descriptive statistics. The study is particularly motivated by the urgency of need to inform policymakers and the government on the pending danger of an unplanned phased lifting of lockdown, which contravenes medical standards at the local and international fora. Of the three episodes of COVID-19 identified in Nigeria, the easing up phases witness the highest cases of the virus with the addition of over 32,000 in just 73 days. Besides, there are clear indications that the pre-planning processes that led to easing the lockdown did not adhere to the global practices and guidelines as stipulated by WHO. Every day of the easing phase of the lockdown has witnessed an increasing number of cases indicating the possibility is that the COVID 19 cases may escalate in future dates. By implication, the healthcare system is at the risk of being overwhelmed and thus unable to rescue the situation which could further aggravate the number of untimely death afflicting the citizens.

The COVID-19 pandemic in Greece, Iceland, New Zealand, and Singapore: Health Policies and Lessons Learned.

Abstract: Objective(s) This paper aims at providing an overview of the COVID-19 situation, health policies, and economic impact in Greece, Iceland, New Zealand, and Singapore. The four countries were chosen due to their ability to contain the spread and mitigate the effects of COVID-19 on their societies. Method(s) We use document analysis based on the available national reports, media announcements, official coronavirus websites and governmental decrees in each of the four countries starting from the 1st of January o the 9th of August announcements. We apply a policy gradient to compare and examine the policies implemented in the four countries. Finding(s) The four countries have different demographic, epidemiological, socioeconomic profiles but managed to control the pandemic at an early stage in terms of total number of positive cases. The four countries managed to absorb the health system shock and decrease the case fatality ratio of COVID-19. Early interventions were crucial to avoid expected life lost in case of no early lockdown. The pandemic triggered several economic stimulus and relief measures in the four countries; the impact or the economic rebound is yet to be fully observed. Conclusion(s) We conclude that early, proactive and strict interventions along with leveraging previous experience on communicable diseases and the evolution of testing strategies are key lessons that can be synthesized from the interventions of the four countries and that could be useful for a potential second wave or similar pandemics.

Technical efficiency of healthcare systems in African countries: An application based on data envelopment analysis

Abstract: Aim This study aimed to measure the healthcare system efficiency of 36 African countries and to compare efficiency levels between countries. Method Data envelopment analysis (DEA) was used to evaluate efficiency. The input variables employed within the scope of DEA consisted of the proportion of total health expenditures in the gross domestic product (HE); the number of physicians (PHY), nurses (NUR) and hospital beds (BN) per 1000 people; the unemployment rate (UN); and the Gini coefficient (Gini). The study's output variables were life expectancy at birth and 1/(infant mortality rate). After DEA, the variables affecting the performance of national healthcare systems were identified using a Tobit regression model. Results According to DEA results, 21 (58.33%) of 36 African healthcare systems were found to be efficient. Among the efficient countries, Senegal was the country most referenced for inefficient countries. According to the Tobit regression analysis results, the number of nurses per 1000 people and Gini coefficient variables statistically significantly affected the inefficiency of national healthcare systems. Conclusion This study's results suggest that in order to achieve the same health outcomes, national healthcare systems need to use public and private health resources more effectively and efficiently. By assessing the efficiency of countries’ healthcare systems and health services through international comparison, effectiveness and efficiency can be ensured within these systems.

The First Months of the COVID-19 Pandemic in Spain

Abstract: Background The COVID-19 outbreak has led to an unprecedented crisis in Spain. After Italy, the spread of the virus was quick, and Spain became the second epicenter in Europe by number of cases and deceased. To tackle the outbreak and contain the spread, the Spanish authorities undertook exceptional measures based on a generalized lockdown by which the majority of the economic activity ceased for several weeks. Objectives The goal of this paper is to examine the spread of COVID-19 in Spain from February to May 2020, as well as the public policies and technologies used to contain the evolution of the pandemic. In particular it aims to assess the effectivity of the policies applied within the different autonomous communities. Cases are presented until August as well as the main changes in containment and mitigation measures. Methods Data was collected from various official sources, including government reports, press releases and datasets provided by national and international level institutions. Results We show that the main measure to contain the spread of the pandemic was a stringent confinement policy enforced through fines. It resulted in a substantial reduction in the mobility and the economic activity. At a regional level, the negative consequences of the crisis affected differently across regions.

The COVID-19 pandemic in Norway: The dominance of social implications in framing the policy response.

Abstract: Objectives To describe the impact and policy response to the COVID-19 Pandemic on Norway and the implications this has for future policy development and Norwegian society. Methods Documentary analysis of publicly available statistics, government documents and media sources. Results Three different agendas motivated Norwegian policy: stemming the spread of the virus domestically, mitigating the impact on the economy and addressing the social costs of the policy response. Conclusions The oil and gas industry and the Sovereign Wealth Fund have permitted Norway to manage the costs of the pandemic. But may also lead to a shift in government priorities in health, social and economic policy.

International Experiences of the Active Period of COVID-19 - Mental Health Care.

Abstract: Aim To summarise commonalities and variations in the mental health response to COVID-19 across different sites and countries, with a view to better understanding key steps not only in crisis management, but for future systemic reform of mental health care. Method We conducted a Rapid Synthesis and Translation Process of lessons learned from an international panel of experts, collecting on the ground experiences of the pandemic as it evolved in real time. Digital conferencing and individual interviews were used to rapidly acquire knowledge on the COVID-19 outbreak across 16 locations in Australia, Denmark, Italy, Spain, Taiwan, the UK, and the USA. Results COVID-19 has had massive impacts on mental health care internationally. Most systems were under-resourced and under-prepared, struggling to manage both existing and new clients. There were significant differences between sites, depending on the explosivity the pandemic and the readiness of the mental health system. Integrated, community mental health systems exhibited greater adaptability in contrast to services which depended on face-to-face and hospital-based care. COVID-19 has demonstrated the need for a new approach to rapid response to crisis in mental health. New decision support system tools are necessary to ensure local decision-makers can effectively respond to the enormous practical challenges posed in these circumstances. Conclusions The process we have undertaken has generated clear lessons for mental health policymakers worldwide, beyond pandemic planning and response to guide next steps in systemic mental health reform. Key here is achieving some balance between national leadership and local context adaptation of evidence.

The Dutch COVID-19 approach: Regional differences in a small country.

Abstract: Objectives This paper describes the first months of the COVID-19 pandemic in the Netherlands, including policies to reduce the health-related and economic consequences. The Netherlands started with containment and shifted to mitigation within three weeks when implementing a ‘mild’ lockdown. The initial focus was to obtain herd immunity while preventing Intensive Care Units from getting overwhelmed. Methods An in-depth analysis of available national and international COVID-19 data sources was conducted. Due to regional variation in COVID-19 hospitalization rates, this paper focuses on three distinct regions; the initial epicenter; the most northern provinces which – contrary to national policy – decided not to switch to mitigation; and the Bible Belt, as congregations of religious groups were initially excluded from the ban on group formation. Results On August 11th, 6,159 COVID-19 deaths were reported with at the peak an excess mortality Z-score of 21.7. As a result of the pandemic, the economy took a severe hit and is predicted to shrink 6.5% compared to projection. The hospitalization rates in the northern regions were over 70% lower compared to the rest of the country (18 versus 66 per 100,000 inhabitants). Differences between the Bible Belt and the rest of the country were hardly detectable. Conclusion The Dutch have shown a way to effectively slow down transmission while allowing more personal and economic freedom than most other countries. Furthermore, the regional differences suggest that containment prevented a surge of infections in the northern provinces. The results should be interpreted with caution, due to the descriptive nature of this study.

Possibility of introducing telemedicine services in Asian and African countries

Abstract: Objectives In some developing countries, despite advancements in Information Technology (IT), medical resources are scarce; hence, introduction of telemedicine services can solve this problem. In this study, we examined the possibility of introducing telemedicine-based services in developing countries utilizing the available data. Methods In Asia, the study was conducted in nine developing countries, excluding those where data were unavailable. In Africa, thirteen countries whose per capita Gross Domestic Product (GDP) was less than USD 1000, and where data were unavailable, were also excluded. We chose the number of doctors, nurses, and midwives as indicators of the healthcare environment. We used the number of internet contracts and mobile phone contracts as indicators of IT penetration, and set per capita GDP and its growth rate as economic indicators. We combined the two continents’ data and performed a principal component analysis (PCA) and cluster analysis. Results We used cluster analysis to classify the target countries into the following five clusters: Cluster A: Algeria, Egypt, Morocco, Indonesia, Ghana, Tunisia, Madagascar, Nigeria, and Thailand; Cluster B: Bangladesh, Ethiopia, Kenya, Uganda, India, and Pakistan; Cluster C: Sudan, Malaysia, Vietnam, Tanzania, Philippines, and China; Cluster D: South Africa, and Cluster E: Japan and Singapore. As a result of conducting PCA, Cluster A emerged as the region with the highest progressiveness and development possibility. Conclusions Introduction of telemedicine services has been visualized by using cluster analysis and PCA. However, it is necessary to incorporate future medical needs as indicators to make a more appropriate assessment of its potential.

Assessing factors critical to smart technology applications to mobile health care - the fgm-fahp approach.

Abstract: Smart technologies present numerous opportunities for enhancing mobile health care. However, some concerns regarding the viability of smart technology applications must be addressed. This study investigated these concerns by reviewing the current practices of smart technology applications to mobile health care. As a result, five factors critical to the applicability of a smart technology to mobile health care are identified, and the fuzzy geometric mean-fuzzy analytic hierarchy process (FGM-FAHP) approach is proposed to assess the relative importance levels of the identified factors. The experimental results showed that the three most critical factors identified include: (a) the relaxation of the related medical laws; (b) unobtrusiveness; and (c) the precise need and situation of a user. Accordingly, approximately 44%, 26%, and 15% of the budget should be allocated to the realization of the three critical factors, respectively. In addition, the challenges involved and opportunities for enhancing the effectiveness of existing applications are discussed.

Rapid response to crisis: Health system lessons from the active period of COVID-19.

Abstract: Background: This paper outlines the need for a health systems approach and rapid response strategy for gathering information necessary for policy decisions during pandemics and similar crises. It suggests a new framework for assessing the phases of the pandemic. Method: The paper draws its information and conclusions from a rapid synthesis and translation process (RSTP) of a series of webinars and online discussions from the Pandemic-Mental Health International Network (Pan-MHIN) - policy experts from across 16 locations in Australia, Denmark, Italy, Spain, Taiwan, the UK and the USA. While the initial focus of this research was on mental health, COVID-19 has raised much broader issues and questions for health planners. Results: We identified gaps affecting the capacity to respond effectively and quickly, including in relation to system indicators, the inadequacy of the prior classification of the phases of the pandemic, the absences of a healthcare ecosystem approach, and the quick shift to digital technologies. The strengths and weaknesses of COVID-19 responses across different systems, services, sites and countries been identified and compared, including both low and high impacted areas. Conclusions: There is an urgent need for managerial epidemiology based on healthcare ecosystem research encompassing multidisciplinary teams, visualization tools and decision analytics for rapid response. Policy and healthcare context played a key role in the response to COVID-19. Its severity, the containment measures and the societal response varied greatly across sites and countries. Understanding this variation is vital to assess the impact of COVID-19 in specific areas such as ageing or mental health.

Court Innovations and Access to Justice in Times of Crisis

Abstract: Background : COVID-19 has disrupted not only the health sector but also justice systems. Courts around the world have had to respond quickly to the challenges presented by the pandemic and the associated social distancing restrictions. This has created significant challenges for the justice system and such challenges are likely to be further compounded in the post-pandemic era as there is a ‘tsunami’ of COVID-19-related disputes predicted. Methods : This study will examine how global court responses have transitioned from being primarily traditional, face-to-face proceedings to online court processes (as supported by internet technology). By adopting a comparative approach, we will analyse how some countries have adopted to this shift to online mode while also maintaining a focus on access to justice. Results : We argue that online modes of dispute resolution, often referred to as Online Dispute Resolution (ODR), can promote resolution while facilitating social distancing in this new COVID-era. The rapid shift from traditional court processes to an online mode has further assisted the public, lawyers and experts to access the justice system in some jurisdictions, even during the crisis. In light of the scale of recent changes, there have been concerns about the capacity of courts to adopt newer technologies as well as issues relating to the impact of a new online model of justice, particularly in terms of the barriers for more vulnerable members of society. Further, the use of disruptive technologies in some courts have posed questions around whether outcomes generated by these innovations reflect the meaning of ‘justice’ in its traditional sense. Conclusions : This article argues that courts should embrace newer technologies that support court services while being mindful of possible tech-related issues that can impact on justice objectives. We argue that by placing further emphasis on alternative dispute resolution methods and ODR into the future, this might offset the likely tsunami of COVID-related litigation which would enable courts, hospitals, medical professionals and patients to settle disputes in a just, equitable and more efficient manner.

The Antecedents and Results of Seniors' Use of Activity Tracking Wearable Devices

Abstract: Objective Wearable devices have potential benefits for seniors healthcare. However, the rate of adoption of these devices is very low for seniors compared to other age groups. This study aims at examining the factors that influence seniors’ use of wearable devices and the effect of these devices on seniors’ behavior. Methods This study uses qualitative methods to address the research questions. We conducted 26 interviews of seniors who have never used wearable devices before. We interviewed seniors before and after using activity tracking wearable devices. Furthermore, we collected wearable device quantitative data to support interview results. Results Seniors adoption of wearable devices involve several factors that can be categorized as technology related factors such as the complexity and customizability of wearable devices and individual related factors such as social influence, self-efficacy. Furthermore, the effects of using wearable devices vary among seniors depending on their activity patterns and exercise schedule. Conclusion seniors’ use of wearable devices is a complex process that involves the interactions of social, psychological, and technological factors. By understanding these factors, we can develop strategies to enhance seniors’ use of wearable devices and improve their overall health and quality of life.

Cost-effectiveness of a mobile-phone text messaging intervention on type 2 diabetes—A randomized-controlled trial

Abstract: Aims To evaluate the cost-effectiveness of a mobile phone text messaging program for people with type 2 diabetes mellitus. Methods We performed a generalized cost-effectiveness analysis in a randomized controlled trial in Bangladesh. Patients with type 2 diabetes were randomized (1:1) to a text messaging intervention plus standard-care or standard-care alone. Intervention participants received a text message daily for 6 months encouraging healthy lifestyles. Costs to users and the health systems were measured. The EQ-5D-3L was used to measure improvements in health-related quality-adjusted life years (QALYs). Intervention costs were expressed as average cost-effectiveness ratios (cost-per 1% unit-reduction in glycated haemoglobin HbA1c and cost per QALY gained), based on the World Health Organization cost effectiveness and strategic planning (WHO-CHOICE) method. Results In 236 patients [mean age 48 (SD9.6) years] the adjusted difference in accumulated QALYs between the intervention and the control group over the 6-month period was 0.010 (95%CI: 0.000; 0.021). Additional costs per-patient averaged 24 international dollars (Intl.$), resulting in incremental cost-effectiveness ratios of 38 Intl.$ per % glycated haemoglobin (HbA1c) reduction and 2406 Intl.$ per QALY gained. The total intervention costs for the mobile phone text messaging program was 2842 Int.$. Conclusion Text messaging might be a valuable addition to standard treatment for diabetes care in low-resource settings and predicted to lead an overall saving in health systems costs. Studies with longer follow-up and larger samples are needed to draw reliable conclusions.

COVID-19: the need for an Australian Economic Pandemic Response Plan.

Abstract: Objectives Pandemics pressure national governments to respond swiftly. Mitigation efforts created an imbalance between population health, capacity of the healthcare system and economic prosperity. Each pandemic arising from a new virus is unknown territory for policy makers, and there is considerable uncertainty of the appropriateness of responses and outcomes. Methods A qualitative approach was used to review mixed sources of data including Australian reports, official government publications, and COVID-19 data to discern robust future responses. Publicly available epidemiological and economic data were utilised to provide insight into the impact of the pandemic on Australia's healthcare system and economy. Results Policies implemented by the Australian Government to mitigate the spread of COVID-19 impacted the healthcare sector and economy. This paper incorporates lessons learned to inform optimal economic preparedness. The rationale for an economic response plan concomitant with the health pandemic plan is explored to guide Australian Government policy makers in ensuring holistic and robust solutions for future pandemics. Conclusions In future, an Australian Economic Pandemic Response Plan will aid in health and economic system preparedness, whilst a strong Australian economy and strategic planning will ensure resilience to future pandemics.

Policies and Innovations to Battle COVID-19 – A Case Study of South Korea

Abstract: Objectives To describe how health care crisis resulting from the COVID-19 pandemic in South Korea has led to innovation and changes to government policy. This paper presents the significant cluster events, relevant developments of innovation, and economical impact in Korea that could inform policy makers on how to respond to health crises in the future. Methods Health care, economy, epidemiological data are collected from various sources including the Korea Centers for Disease Control and Prevention (KCDC) or other government sources. Results The KCDC jointly with medical professionals developed a series of innovations such as 1) Full contact tracing and rapid testing with a 12 h turnaround and 10 min movement tracking systems, 2) transparent disclosure of all contract tracing data to the public through a central database, 3) Drive-Through and Walk-Through testing methods, and 4) a 4 tier patient severity index and community treatment isolation centers. Korea moved from the 4th in the world for total confirmed cases in March down to 76th in August. Conclusions Expedited enforcement of amended legislation acts to protect the healthcare workforce resulted in only 10 healthcare professionals contracting the virus while caring for Covid-19 patients. This has resulted in minimal human capital loss and the government was able to re-direct existing medical workforce to areas in need. The quarantine strategies implemented resulted in little need to lock down the whole economy but also limited the cost spent to gain a year of life to 193,848 Won (US$163).