Objectives: To identify the financing and policy challenges for Medicare and universal health care in Australia, as well as opportunities for whole‐of‐system strengthening.Study design: Review of publications on Medicare, the Pharmaceutical Benefits Scheme, and the universal health care system in Australia published 1 January 2000 – 14 August 2021 that reported quantitative or qualitative research or data analyses, and of opinion articles, debates, commentaries, editorials, perspectives, and news reports on the Australian health care system published 1 January 2015 – 14 August 2021. Program‐, intervention‐ or provider‐specific articles, and publications regarding groups not fully covered by Medicare (eg, asylum seekers, prisoners) were excluded.Data sources: MEDLINE Complete, the Health Policy Reference Centre, and Global Health databases (all via EBSCO); the Analysis & Policy Observatory, the Australian Indigenous HealthInfoNet, the Australian Public Affairs Information Service, Google, Google Scholar, and the Organisation for Economic Co‐operation and Development (OECD) websites.Results: The problems covered by the 76 articles included in our review could be grouped under seven major themes: fragmentation of health care and lack of integrated health financing, access of Aboriginal and Torres Strait Islander people to health services and essential medications, reform proposals for the Pharmaceutical Benefits Scheme, the burden of out‐of‐pocket costs, inequity, public subsidies for private health insurance, and other challenges for the Australian universal health care system.Conclusions: A number of challenges threaten the sustainability and equity of the universal health care system in Australia. As the piecemeal reforms of the past twenty years have been inadequate for meeting these challenges, more effective, coordinated approaches are needed to improve and secure the universality of public health care in Australia.

Objective: The study sought to review the different assessment items that have been used within existing health app evaluation frameworks aimed at individual, clinician, or organizational users, and to analyze the scoring and evaluation methods used in these frameworks. Materials and Methods: We searched multiple bibliographic databases and conducted backward searches of reference lists, using search terms that were synonyms of “health apps,” “evaluation,” and “frameworks.” The review covered publications from 2011 to April 2020. Studies on health app evaluation frameworks and studies that elaborated on the scaling and scoring mechanisms applied in such frameworks were included. Results: Ten common domains were identified across general health app evaluation frameworks. A list of 430 assessment criteria was compiled across 97 identified studies. The most frequently used scaling mechanism was a 5-point Likert scale. Most studies have adopted summary statistics to generate the total scoring of each app, and the most popular approach taken was the calculation of mean or average scores. Other frameworks did not use any scaling or scoring mechanism and adopted criteria-based, pictorial, or descriptive approaches, or “threshold” filter. Discussion: There is wide variance in the approaches to evaluating health apps within published frameworks, and this variance leads to ongoing uncertainty in how to evaluate health apps. Conclusions: A new evaluation framework is needed that can integrate the full range of evaluative criteria within one structure, and provide summative guidance on health app rating, to support individual app users, clinicians, and health organizations in choosing or recommending the best health app.

As understanding grows of the scale of health care’s environmental impacts, so too does interest in measuring and reporting on sustainability as a facet of health care system performance. This arti...

Objective: To explore the support needs and experiences of patients who had received publicly or privately funded bariatric surgery and the importance of this support in mediating outcomes of surgery.Methods: Seven semi‐structured focus groups were conducted. A broad interview schedule guided the discussions which were audio‐recorded and transcribed verbatim. Data were analysed thematically.Results: Twenty‐six women and 15 men with a mean age of 54 years (range 24–72) participated in the study. Participants described support needs from health professionals, significant others (family and friends), peers (bariatric surgery recipients) and the general community. Peer, dietetic and psychological support were identified as important factors influencing the outcomes (e.g. weight reduction or health improvement) or experience of bariatric surgery but were identified as infrequently received or inadequately provided. Psychological support was proposed as one of the most significant but commonly overlooked components of care. Support needs appeared higher in the first year post‐surgery, when subsequent related or unrelated surgeries were required and following significant life change such as worsening health. For some participants, deficits in support appeared to negatively influence the experience or outcomes of surgery.Conclusion: Providers of bariatric surgery should discuss support needs and accessibility regularly with patients especially in the first year post‐surgery and following significant change in a patient's life (e.g. declined health or childbirth). Nutrition, psychological and peer support (e.g. through support groups) may be especially important for some patients.

This article examines the pattern of change in hospital provision in established market economies, the countries of eastern Europe and the former Soviet Union, and lower income countries. Despite the great differences between these areas, hospitals in all systems have to deal with rising expectations and, more often than not, a need to contain the costs of health care. Outside the developing countries the generic response to this has been to reduce hospital stays and to improve the efficiency of the system, a strategy which seems to be at least partly successful. The experience of the health systems in the United States and the United Kingdom shows that cost pressures and changes in healthcare delivery mean that this strategy will lead to hospital mergers and closures in the longer term. #### Summary points Increasing rates of admission are not just a British phenomenon Some countries have experienced reductions in admissions Almost all developed countries have made substantial reductions in beds, and in many places there is still further scope for this Eastern Europe and the former Soviet Union still have an overdeveloped hospital sector Hospitals are more of a growth industry in developing countries, but care is needed if the right investment is to be made Medical practice, hospital management, and technology have undergone great changes over the past 20 years. This has led to substantial shifts in demand for secondary care facilities and notable changes in the types of facilities required. Hospital costs are the largest component of health expenditure in most countries in the Organisation for Economic Cooperation and Development (OECD), and they have therefore been a key focus in the drive for increased efficiency in the health sector.1 While this financial pressure has played a part in developments in the provision of secondary care, the influence of technology and …