[Rebuilding the healthcare system: governance, organization and digitalization. SESPAS Report 2022]. / Reconstrucción del sistema sanitario: gobernanza, organización y digitalización. Informe SESPAS 2022.

Reflection on three major levers for rebuilding the healthcare system: governance, integration of health and social care and digitalization. Spain has worrying levels of quality of democracy and public confidence in its politicians, and major changes are required in public administration to achieve a better state. Healthcare suffers from a deficient institutional architecture that prevents adequate macrogovernance. There is also a lack of autonomy in the management of public health centers, which hinders competition by comparison, care integration and coordination within and between levels of care. The pandemic has highlighted the value of professionalism and has shown that agile healthcare management is possible, but the challenge is to maintain this flexibility outside state of alarm. Care integration is more necessary as the population ages (albeit healthily), and per capita financing is a powerful tool to achieve it. Digitization concerns practically all areas of healthcare and population health, and will bring with it far-reaching organizational changes, requiring new methods of evaluation that differ according to the degree of intrusiveness in individual health. Telemedicine, sponsored during the pandemic with a view to permanence, induces changes in labor relations, among others. It is necessary to measure the value of digital tools and technologies. Spain has a unique opportunity for its digital transformation, thanks to European funds.

Digitally enabled supply chain as a strategic asset for the COVID-19 response in Alberta.

This provincial case study, one of seven conducted as part of a national research program on healthcare supply chain management during COVID-19, focuses on Alberta. With a history of emergency preparedness, Alberta's unique context, one that includes having an already established, centralized, and digital healthcare supply chain strategy, sets this case apart from the others in terms of pandemic responses. A key challenge navigated by Alberta was the inadequacies of traditional sourcing and procurement approaches to meet surges in product demand, which was overcome by the implementation of unique procurement strategies. Opportunities for Alberta included the integration of supply chain teams into senior leadership structures, which enabled access to data to inform public health decision-making. This case demonstrated how Alberta's healthcare supply chain assets-its supply chain infrastructure, data, and leadership expertise, especially-contributed to resilient supply chain capacity across the province.

The risks and benefits of providing HIV services during the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic has caused widespread disruptions including to health services. In the early response to the pandemic many countries restricted population movements and some health services were suspended or limited. In late 2020 and early 2021 some countries re-imposed restrictions. Health authorities need to balance the potential harms of additional SARS-CoV-2 transmission due to contacts associated with health services against the benefits of those services, including fewer new HIV infections and deaths. This paper examines these trade-offs for select HIV services. METHODS: We used four HIV simulation models (Goals, HIV Synthesis, Optima HIV and EMOD) to estimate the benefits of continuing HIV services in terms of fewer new HIV infections and deaths. We used three COVID-19 transmission models (Covasim, Cooper/Smith and a simple contact model) to estimate the additional deaths due to SARS-CoV-2 transmission among health workers and clients. We examined four HIV services: voluntary medical male circumcision, HIV diagnostic testing, viral load testing and programs to prevent mother-to-child transmission. We compared COVID-19 deaths in 2020 and 2021 with HIV deaths occurring now and over the next 50 years discounted to present value. The models were applied to countries with a range of HIV and COVID-19 epidemics. RESULTS: Maintaining these HIV services could lead to additional COVID-19 deaths of 0.002 to 0.15 per 10,000 clients. HIV-related deaths averted are estimated to be much larger, 19-146 discounted deaths per 10,000 clients. DISCUSSION: While there is some additional short-term risk of SARS-CoV-2 transmission associated with providing HIV services, the risk of additional COVID-19 deaths is at least 100 times less than the HIV deaths averted by those services. Ministries of Health need to take into account many factors in deciding when and how to offer essential health services during the COVID-19 pandemic. This work shows that the benefits of continuing key HIV services are far larger than the risks of additional SARS-CoV-2 transmission.

[Liaison geriatrics with nursing homes in COVID time. A new coordination model arrived to stay]. / La Geriatría de Enlace con residencias en la época de la COVID-19. Un nuevo modelo de coordinación que ha llegado para quedarse.

Older people living in nursing homes fulfil the criteria to be considered as geriatric patients, but they often do not have met their health care needs. Current deficits appeared as a result of COVID-19 pandemic. The need to improve the coordination between hospitals and nursing homes emerged, and in Madrid it materialized with the implantation of Liaison Geriatrics teams or units at public hospitals. The Sociedad Española de Geriatría y Gerontología has defined the role of the geriatricians in the COVID-19 pandemic and they have given guidelines about prevention, early detection, isolation and sectorization, training, care homes classification, patient referral coordination, and the role of the different care settings, among others. These units and teams also must undertake other care activities that have a shortfall currently, like nursing homes-hospital coordination, geriatricians visits to the homes, telemedicine sessions, geriatric assessment in emergency rooms, and primary care and public health services coordination. This paper describes the concept of Liaison Geriatrics and its implementation at the Autonomous Community of Madrid hospitals as a result of COVID-19 pandemic. Activity data from a unit at a hospital with a huge number of nursing homes in its catchment area are reported. The objective is to understand the need of this activity in order to avoid the current fragmentation of care between hospitals and nursing homes. This activity should be consolidated in the future.

Belgium: Health System Review.

The Belgian health system covers almost the entire population for a large range of services. The main source of financing is social contributions, proportional to income. The provision of care is based on the principles of independent medical practice, free choice of physician and care facility, and predominantly fee-for-service payment. The Belgian population enjoys good health and long life expectancy. This is partly due to the population's good access to many high-quality health services. However, some challenges remain in terms of appropriateness of pharmaceutical care (overuse of antibiotics and psychotropic drugs), reduced accessibility for mental health and dental care due to higher user charges, socioeconomic inequalities in health status and the need for further strengthening of prevention policies. The system must also continue to evolve to cope with an ageing population, an increase of chronic diseases and the development of new technologies. This Belgian HiT profile (2020) presents the evolution of the health system since 2014, including detailed information on new policies. The most important reforms concern the transfer of additional health competences from the Federal State to the Federated entities and the plan to redesign the landscape of hospital care. Policy-makers have also pursued the goals of further improving access to high-quality services, while maintaining the financial sustainability and efficiency of the system, resulting in the implementation of several measures promoting multidisciplinary and integrated care, the concentration of medical expertise, patient care trajectories, patient empowerment, evidence-based medicine, outcome-based care and the so-called one health approach. Cooperation with neighbouring countries on pricing and reimbursement policies to improve access to (very high price) innovative medicines are also underway. Looking ahead, because additional challenges will be highlighted by the COVID-19 crisis, a focus on the resilience of the system is expected.

Leadership by Fire: Stephanie Stephens New Texas Medicaid, CHIP Director.

Stephanie Stephens received a not-so-welcome gift entering her new job running Medicaid operations for the nation's second-largest state: A global pandemic. In that sense, the universe wasn't easy on Ms. Stephens, the new director of Medicaid and CHIP for the Texas Health and Human Services Commission (HHSC).

COVID-19: All the wrong moves in all the wrong places.

In this Editorial, Barrett and Yaffe highlight shortcomings in our collective response to the COVID-19 pandemic and underscore the need for more basic research into this new disease.

Health systems preparedness during COVID-19 pandemic: China and India.

This commentary reviews the health systems preparedness during the COVID-19 epidemic in China and India. It provides insight into how nonmedical measures were employed to contain and control the epidemic in Wuhan which was the epicenter. The methods employed by the Chinese provided the roadmap for the countries as the epidemic became pandemic. It provides contrasts in health system preparedness between China and India.

COVID-19 and paediatric health services: A survey of paediatric physicians in Australia and New Zealand.

AIMS: COVID-19 is now a global pandemic. At the time of survey, fewer than 150 children in Australia and New Zealand had documented infection. The aim of this study was to assess attitudes, readiness and confidence in the early stages of the COVID-19 pandemic through an online survey of paediatric physicians and sub-specialists across Australia and New Zealand. METHODS: Multiple email list groups were used to contact paediatric physicians to undertake an online Likert scale survey between 17 and 24 March. Respondents' specialty, experience and work setting were recorded. Ordinal logistic regression was used to determine respondent factors. RESULTS: There were 542 respondents from across Australia and New Zealand: an estimated 11% of the paediatric physician workforce. A minority (36.6%) agreed that their national response had been well coordinated; the majority (92.7%) agreed that senior-level hospital administrators were taking the situation seriously. Most reported a good understanding of the natural history of COVID-19 in children, and knowledge of where to find local information. A large proportion of physicians (86.1%) were worried about becoming infected through their work; few (5.8%) reported that they would not come to work to avoid infection. Closure of school and childcares would reduce the ability to continue work at current capacity for 23.6% of respondents. CONCLUSION: Despite limited experience in pandemics, most paediatric physicians felt informed. Concern about exposure at work is common; most were willing to work regardless. The closure of schools and daycares may have an impact on staffing. Coordination and leadership will be critical.