These are used to help the Editor identify suitable reviewers. We recommend the use of a tool such as Reference Manager for reference management and formatting. Titles not listed should be written in full. References with titles in languages other than English must be translated. Number references consecutively in the order in which they are first mentioned in the text at which reference to a particular document is made, its number is inserted.
To cite a specific part of a source articles pages and book chapters in the reference list , indicate the page number s as well References should be cited from primary sources. Example: Dealey C. Where the reference relates to a chapter in an edited book, details of author and Editors should be given as well as publisher, place of publication, and first and last page numbers. Example: Pence G. Virtue theory. The edition where appropriate of all books should be identified, e.
Do not give more than two or maximum three references in the text for verifying the same content. References stated as being 'in press' are not acceptable: all references cited must have been published. Data and data citation. Scandinavian Journal of Caring Sciences encourages authors to share the data and other artefacts supporting the results in the paper by archiving it in an appropriate public repository. Authors should include a data accessibility statement, including a link to the repository they have used, in order that this statement can be published alongside their paper.
Publication on preprint servers This journal will consider for review articles previously available as preprints on non-commercial servers such as ArXiv, bioRxiv, psyArXiv, SocArXiv, engrXiv, etc. Authors may also post the submitted version of their manuscript to non-commercial servers at any time. Authors are requested to update any pre-publication versions with a link to the final published article.
Editorial Review and Acceptance The acceptance criteria for all papers are the quality and originality of the research and its significance to our readership. Except where otherwise stated, manuscripts are double-blind peer reviewed.
Read Nursing in Europe: A Resource for Better Health (WHO Regional Publications European Series)
Papers will only be sent to review if the Editors-in-Chief determine that the paper meets the appropriate quality and relevance requirements. Wiley's policy on confidentiality of the review process is available here. Data storage and documentation Scandinavian Journal of Caring Sciences encourages data sharing wherever possible, unless this is prevented by ethical, privacy or confidentiality matters. Authors publishing in the journal are therefore encouraged to make their data, scripts and other artefacts used to generate the analyses presented in the paper available via a publicly available data repository, however this is not mandatory.
If the study includes original data, at least one author must confirm that he or she had full access to all the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. MEDLINE evaluates a journal's ethical policy by checking that journals ask submitting authors to provide three things: a declaration of conflict of interest CoI , confirmation that informed consent was sought from test subjects, and that animal rights were taken into consideration.
The reviewer will then check three things during the review:.
WHO/Europe | Nursing in Europe. A resource for better health
Policy Exists: is there evidence in the author guidelines that the journal requires that the appropriate ethical requirements are followed. Policy is Adequate: is the policy appropriate for the journal, e. Policy Consistently Followed: is there evidence in all the published articles that authors have declared their conflicts of interest, and that appropriate procedures were followed when the research was conducted. This will be checked in the final published articles.
There should be robust journal workflows in place to ensure all three criteria are met.
Examples of failures would be: a journal that requires authors to declare that institutional review board IRB approval was sought for their research, but this is not communicated to the readers of the final article; journals that do require declarations of informed consent, but don't say so in the author guidelines; or journals that only publish statements when conflicts-of-interest were declared, and assume that all readers know omission means that there aren't any conflicts.
Human Studies and Subjects For manuscripts reporting medical studies involving human participants, we require a statement identifying the ethics committee that approved the study, and that the study conforms to recognized standards, for example: Declaration of Helsinki ; US Federal Policy for the Protection of Human Subjects ; or European Medicines Agency Guidelines for Good Clinical Practice. Images and information from individual participants will only be published where the authors have obtained the individual's free prior informed consent.
Authors do not need to provide a copy of the consent form to the publisher, however in signing the author license to publish authors are required to confirm that consent has been obtained. Wiley has a standard patient consent form available for use. Animal Studies A statement indicating that the protocol and procedures employed were ethically reviewed and approved, and the name of the body giving approval, must be included in the Methods section of the manuscript. We encourage authors to adhere to animal research reporting standards, for example the ARRIVE reporting guidelines for reporting study design and statistical analysis; experimental procedures; experimental animals and housing and husbandry.
Clinical Trial Registration We require that clinical trials are prospectively registered in a publicly accessible database and clinical trial registration numbers should be included in all papers that report their results. Please include the name of the trial register and your clinical trial registration number at the end of your abstract. If your trial is not registered, or was registered retrospectively, please explain the reasons for this. Research Reporting Guidelines Accurate and complete reporting enables readers to fully appraise research, replicate it, and use it.
We expect authors to adhere to the following research reporting standards. Species Names Upon its first use in the title, abstract and text, the common name of a species should be followed by the scientific name genus, species and authority in parentheses.
For well-known species, however, scientific names may be omitted from article titles. If no common name exists in English, the scientific name should be used only. Genetic Nomenclature Sequence variants should be described in the text and tables using both DNA and protein designations whenever appropriate. Proteins sequence data should be submitted to either of the following repositories. Conflict of Interest The journal requires that all authors disclose any potential sources of conflict of interest.
Any interest or relationship, financial or otherwise that might be perceived as influencing an author's objectivity is considered a potential source of conflict of interest. These must be disclosed when directly relevant or directly related to the work that the authors describe in their manuscript.
Potential sources of conflict of interest include, but are not limited to, patent or stock ownership, membership of a company board of directors, membership of an advisory board or committee for a company, and consultancy for or receipt of speaker's fees from a company. The existence of a conflict of interest does not preclude publication. If the authors have no conflict of interest to declare, they must also state this at submission. It is the responsibility of the corresponding author to review this policy with all authors and collectively to disclose with the submission ALL pertinent commercial and other relationships.
The Conflict of Interest Statement should be included within the main text file of your submission. Funding Authors should list all funding sources in the Acknowledgments section. Authors are responsible for the accuracy of their funder designation. Authorship The list of authors should accurately illustrate who contributed to the work and how.
All those listed as authors should qualify for authorship according to the following criteria: 1. Have made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; 2. Been involved in drafting the manuscript or revising it critically for important intellectual content; 3. Given final approval of the version to be published. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content; and 4.
Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Contributions from anyone who does not meet the criteria for authorship should be listed, with permission from the contributor, in an Acknowledgments section for example, to recognize contributions from people who provided technical help, collation of data, writing assistance, acquisition of funding, or a department chairperson who provided general support.
Prior to submitting the article all authors should agree on the order in which their names will be listed in the manuscript. Additional authorship options Joint first or senior authorship: In the case of joint first authorship a footnote should be added to the author listing, e. This takes around 2 minutes to complete.
Find more information. If your paper is accepted, the author identified as the formal corresponding author will receive an email prompting them to log in to Author Services, where via the Wiley Author Licensing Service WALS they will be required to complete a copyright license agreement on behalf of all authors of the paper. General information regarding licensing and copyright is available here.
Note that certain funders mandate that a particular type of CC license has to be used; to check this please click here. Self-Archiving definitions and policies.
Please click here for more detailed information about self-archiving definitions and policies. Open Access fees: If you choose to publish using OnlineOpen you will be charged a fee. A list of Article Publication Charges for Wiley journals is available here. You will be asked to sign a publication license at this point. After publication of the final version article the article of record , the DOI remains valid and can continue to be used to cite and access the article.
Accepted Articles will be indexed by PubMed; submitting authors should therefore carefully check the names and affiliations of all authors provided in the cover page of the manuscript so it is correct for indexing. Subsequently the final copyedited and proofed articles will appear in an issue on Wiley Online Library; the link to the article in PubMed will automatically be updated.
Regarding the process of selection of indicators, it started with an extensive review of the literature concerning the whole set of determinants of population health. This was followed by an enchained 2-round Delphi process 51 Consortium experts and 30 stakeholders participated in this exercise and two meetings and one decision conference of the Project Steering Group [ 4 , 5 ]. The second function is proxied by medical doctors per , inhabitants. Being a supply side variable, it reflects the capacity of health care systems to deliver adequate care to their populations, but, as noted above, although human resources are the most relevant inputs, we should bear in mind what they can provide and how this also depends on physical inputs and consumables.
Finally, proxies used for the financing function include not only total health expenditure but also public expenditure and out-of-pocket payments.
The breakdown of total health expenditure gives an indication of access to health care as direct payments are a regressive mode of financing and can thus act as relevant barriers to access. Additional indicators have also been used to describe clusters. Our statistical analysis of the data collected followed a 3-step procedure.
In the first step, using factor analysis with a varimax with Kaiser normalization for rotation method, we searched for three factors which could express the common variance of the original indicators used as proxies for health systems functions appearing in the WHO framework. In this step, the KMO measure of sampling adequacy was estimated and the Bartlett test of sphericity was performed. The factor analysis was based on the correlation matrix, and the factor scores, to be used in the following cluster analysis, were obtained using the Bartlett method.
The second step was a cluster analysis of the factors found in the previous step for each country in order to identify groups of objects that are similar to each other but different from objects from other groups. The clustering performed here was based on a hierarchical method, which may be visualized in a dendrogram. The third part of this work was descriptive. It aimed to characterize the clusters found in the previous step.
The characteristics used to present the clusters were grouped in socioeconomic characteristics and health outcome indicators. As we can observe, most bivariate correlations are not statistically significant, except for those relating to the funding function of health systems.
These two tests guaranteed that the sample of data was adequate for factor analysis. Factor analysis assumes an extraction method by the principal component analysis of three factors and a varimax rotation method with Kaiser normalization. The first factor, named funding, aggregates the indicators related to health systems financing THEG, THE, OOP ; the second factor includes medical doctors MD and it includes resources; and finally, the third factor is represented by hospital discharges HD and includes provision. Using the three factors previously found, we clustered the countries by using a hierarchical procedure.
This procedure considers the Ward clustering method based on the Euclidean distance. In the absence of an objective method to optimally select the number of clusters, we determined that 5 clusters represented the reasonable and preferable number to reflect well observed reality, to allow for easy labelling, and to enable international comparisons.
The five clusters of countries are displayed in Fig. The clusters labels do not indicate any correlation between geographical positioning and health system characteristics; their only purpose is to simplify identification. The difference between Eastern countries clusters lies in the provision function. Otherwise, with respect to funding and resources, both clusters have high values.
Finally, we described the clusters of EU health systems created above according to certain socioeconomic characteristics and health outcome indicators. The figures presented are unweighted averages for each cluster with respect to the selected indicators, with the purpose being to perform a description and a comparison across the clusters. For its part, growth in EU economies during this same period of time was seen to be very slow. The individual labor markets of all EU countries display features which vary significantly. Despite an identical level of development across the 28 EU countries, certain health outcomes are not so similar.
There is an observable difference in infant mortality rates across clusters. This fact can also be confirmed by the outstanding values of DALY. A common shortcoming across these countries points to the low level of financing and thus a lack of financial protection; in addition, the general economic context of these nations is not very favorable, as shown by low GDP per capita, although growth rates seem to indicate some dynamism.
Higher hospital discharges can reflect higher levels of hospital activities in , for instance, hospital discharge rates in general were highest in Austria and Germany [ 16 ]. However, hospital activities are affected not only by the capacity of hospitals to treat patients but also by the ability of the primary care sector to prevent avoidable hospital admissions and by the availability of post-acute care settings to provide rehabilitative and long-term care services.
As for human resources, there is some degree of input substitution between medical doctors and other health personnel, namely nurses, meaning that some countries might compensate for a lower number of medical doctors with a higher number of other health personnel. Indeed, in , countries such as Finland, Denmark, Luxembourg and Ireland were among the countries with highest ratios of nurses to doctors [ 16 ].
Two Eastern countries clusters were created based on the main difference found with respect to the provision function. The economic context is characterized by high levels of unemployment and negative growth. Also, despite the good health outcomes, authorities should not lose sight of potential long term effects from the economic crisis that affected Southern countries. The main objective of this work was, nonetheless, to propose a classification of the EU health systems with no intention to advance conclusions regarding health systems performance.
This was done by simply interpreting figures for the indicators collected in the light of the clusters generated. But the framework used in this work and the groups generated may well prove to be quite useful to guide future health policy assessments and policy recommendations within each health system cluster.
Our classification shows some similarities with the clusters proposed by Wendt [ 17 ], who also used indicators related with health expenditure total, public and out-of-pocket payments. In our case, Austria and Germany appear in a separate cluster whereas in his work they come together with the countries that essentially comprise our Central and Northern countries cluster. Two other differences concern the positions occupied by Finland and Italy. Also, Netherlands and Greece were left out from the clusters in Wendt [ 9 ], but in our work, they were placed as expected: in Central and Northern countries and Southern countries, respectively.
Comparisons with other studies are even less straightforward, not only due to the number of countries analyzed but also due to the nature of the indicators considered. Some limitations are reflected in our results, as often occurs with the application of a method. Firstly, the results from factor analysis may be subjective, always depending on the variables included and on the prior choice of the number of factors. For this reason, it does not yield a unique solution [ 18 ]. Secondly, cluster analysis algorithms rely on the following initial assumptions with implicit implications [ 19 ] on the good performance of the algorithm: i spherical clusters, meaning that clusters are not very different in size, density and globular shape, ii the prior probability of the k clusters is the same, that is, each cluster has a roughly equal number of observations, and iii error variances are cluster invariant and equal across variables.
It may be argued as to whether these features are indeed observable in the data because the results are different-sized clusters. The final limitation to be mentioned concerns the set of indicators selected to create the clusters of EU health systems. The indicators are mainly associated with the supply side, which implies that the classification proposed here is grouping countries according to their health system supply structures. This may have implications both for policy or managerial analytical perspectives as any performance comparison across countries based on our classification must exercise caution as costs and quality are distorting and influencing features in these types of comparisons.
However, in spite of these potential drawbacks, we defend that an acceptable alternative for an EU-country typology has been achieved. The main contribution of this work is the proposal of a simple, updated and easy classification for 28 EU health systems into four homogeneous groups. The purpose of this paper was to contribute to the discussion on the classification of the 28 European health systems. Our proposal was based on three functions of the health systems, namely, provision, resource generation and financing. The methods used for this analysis have been the factor and the cluster analyses for 28 EU countries and referring to or the latest available year for the statistical indicator in question.
The variables used were hospital discharges, medical doctors, total health expenditure, public health expenditure, and out-of-pocket expenditures, collected within the scope of the EURO-HEALTHY research project. An overview of the clusters reveals that there is a diversity of socioeconomic characteristics across clusters. This work has provided a review on some of the health system typologies that may be found in the literature. Despite the limitations of the statistical analysis, it is our conviction that the proposal offered in this work contributes positively to the discussion of this topic in the literature and is grounds for potential comparison across the EU health systems.
Moreover, the clustering of all EU health systems allows for performance and policy assessments and for policy recommendations within each cluster. Healthcare systems: improving performance. World Health Report. Geneve: WHO; Geneva: WHO; European Parliament. Directorate general for research; Euro-healthy website. Euro-healthy Consortium. Promoting population health and equity in Europe: from evidence to policy: University of Coimbra Press; Financing health care in the European Union, challenges and policy responsews.
In: Observatory Studies Series European Observatory on Health Systems and Policies. Reibling N. Healthcare systems in Europe: towards an incorporation of patient access. J Eur Soc Policy. Classifying OECD healthcare systems: a deductive approach. TranState Working Papers. Wendt C. Mapping European healthcare systems: a comparative analysis of financing, service provision and access to healthcare. Health care systems: efficiency and institutions. Economics department working papers no. Paris: OECD; Eurostat Database Accessed 10 Sept Kaiser HF, Rice J.
Little jiffy, mark IV. Educ Psychol Meas. Hatcher L. Indrayan A, Holt MP. Concise Encyclopaedia of biostatistics for medical professionals, vol. Health at a glance OECD indicators. Healthcare system types: a conceptual framework for comparison. Soc Pol Admin. Creasy M. Some criticisms of factor analysis with suggestions for alternative methods. Br J Psychiatry. Magidson J, Vermunt JK. Chapter Latent class models. In: Kaplan D, editor. The SAGE handbook of quantitative methodology for the social sciences. Field M.
Soc Sci Med. Financing and delivering healthcare: a comparative analysis of OECD countries. Donaldson C, Gerard K.