Administrative Reform in Romania and the European Union

OpenAIRE

Călin HINŢEA; Sorin Dan ŞANDOR; Veronica JUNJAN

2002-01-01

The issue of public administration reform is an old one for the professional literature. It has always been at the basis of a significant theoretical debate that started with the idea of compatibility between the concepts of “public administration” and “reform”. Central and Eastern European countries have been faced with the acute need of reform after the crash of communist regimes and painful disclosure of the inefficiency of previous bureaucratic models.

Networks and social capital: a relational approach to primary healthcare reform

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Scott Catherine

2007-09-01

Full Text Available Abstract Collaboration among health care providers and across systems is proposed as a strategy to improve health care delivery the world over. Over the past two decades, health care providers have been encouraged to work in partnership and build interdisciplinary teams. More recently, the notion of networks has entered this discourse but the lack of consensus and understanding about what is meant by adopting a network approach in health services limits its use. Also crucial to this discussion is the work of distinguishing the nature and extent of the impact of social relationships – generally referred to as social capital. In this paper, we review the rationale for collaboration in health care systems; provide an overview and synthesis of key concepts; dispel some common misconceptions of networks; and apply the theory to an example of primary healthcare network reform in Alberta (Canada. Our central thesis is that a relational approach to systems change, one based on a synthesis of network theory and social capital can provide the fodation for a multi-focal approach to primary healthcare reform. Action strategies are recommended to move from an awareness of 'networks' to fully translating knowledge from existing theory to guide planning and practice innovations. Decision-makers are encouraged to consider a multi-focal approach that effectively incorporates a network and social capital approach in planning and evaluating primary healthcare reform.

The making of a European healthcare union

DEFF Research Database (Denmark)

Vollaard, Hans; van de Bovenkamp, Hester M.; Martinsen, Dorte Sindbjerg

2016-01-01

that federalism offers the most fruitful way to do so because of its sensitivity to the EU’s institutional settings and to the territorial dimension of politics. The division of competences and national diversity of healthcare systems have been major obstacles for the formation of a healthcare union. However......, the EU obtained a role in healthcare through the impact of non-healthcare legislation, voluntary co-operation, court rulings, governments’ joint-decision traps, and fiscal stress of member states. The emerging European healthcare union is a system of cooperative federalism without much cost-sharing...

How social policies can improve financial accessibility of healthcare: a multi-level analysis of unmet medical need in European countries.

Science.gov (United States)

Israel, Sabine

2016-03-05

The article explores in how far financial accessibility of healthcare (FAH) is restricted for low-income groups and identifies social protection policies that can supplement health policies in guaranteeing universal access to healthcare. The article is aimed to advance the literature on comparative European social epidemiology by focussing on income-related barriers of healthcare take-up. The research is carried out on the basis of multi-level cross-sectional analyses using 2012 EU-SILC data for 30 European countries. The social policy data stems from EU-SILC beneficiary information. It is argued that unmet medical needs are a reality for many individuals within Europe - not only due to direct user fees but also due to indirect costs such as waiting time, travel costs, time not spent working. Moreover, low FAH affects not only the lowest income quintile but also the lower middle income class. The study observes that social allowance increases the purchasing power of both household types, thereby helping them to overcome financial barriers to healthcare uptake. Alongside healthcare system reform aimed at improving the pro-poor availability of healthcare facilities and financing, policies directed at improving FAH should aim at providing a minimum income base to the low-income quintile. Moreover, categorical policies should address households exposed to debt which form the key vulnerable group within the low-income classes.

European Union dairy policy reform: impact and challenges

NARCIS (Netherlands)

Jongeneel, R.A.

2011-01-01

Recent Common Agricultural Policy (CAP) reforms have affected dairy policy, including the milk quota system, and increased the market orientation of the sector. A modelling exercise, using the European Dairy Industry Model (EDIM), simulates an initial sharp decline in the EU milk price in response

European security framework for healthcare.

Science.gov (United States)

Ruotsalainen, Pekka; Pohjonen, Hanna

2003-01-01

eHealth and telemedicine services are promising business areas in Europe. It is clear that eHealth products and services will be sold and ordered from a distance and over national borderlines in the future. However, there are many barriers to overcome. For both national and pan-European eHealth and telemedicine applications a common security framework is needed. These frameworks set security requirements needed for cross-border eHealth services. The next step is to build a security infrastructure which is independent of technical platforms. Most of the European eHealth platforms are regional or territorial. Some countries are looking for a Public Key Infrastructure, but no large scale solutions do exist in healthcare. There is no clear candidate solution for European-wide interoperable eHealth platform. Gross-platform integration seems to be the most practical integration method at a European level in the short run. The use of Internet as a European integration platform is a promising solution in the long run.

Dental healthcare reforms in Germany and Japan: A comparison of statutory health insurance policy

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Mayumi Nomura

2008-10-01

Full Text Available This article aims to compare statutory health insurance policy during the dental healthcare reforms in Germany and Japan. Germany and Japan have categorized their statutory health insurance systems. People in both countries have been provided with a wide coverage of dental treatment and prosthetics. To compare the trends of the indicators of oral healthcare systems over time, it has been suggested that the strategic allocation of dental expenditure is more important than the amount of expense. German dental healthcare policy has shifted under political and socio-economic pressures towards a cost-effective model. In contrast, Japanese healthcare reforms have focused on keeping the basic statutory health insurance scheme, whereby individuals share more of the cost of statutory health insurance. As a result, Germany has succeeded in dramatically decreasing the prevalence of dental caries among children. On comparing the dental conditions of both countries, the rate of decline in replacement of missing teeth among adults and the elderly in Germany and Japan has been interpreted as indicating the price-conscious demands of prosthetics. The difference in the decline of DMFT in 12-year-olds in Germany and Japan could be described as being due to the dental health insurance policy being shifted from treatment-oriented to preventive-oriented in Germany. These findings suggest that social health insurance provides people with equal opportunity for dental services, and healthcare reforms have improved people's oral health. A mixed coverage of social health insurance coverage for dental care should be reconsidered in Japan.

Enlargement of the European Union and agricultural policy reform

DEFF Research Database (Denmark)

Jensen, Maria Skovager; Lind, Kim Martin Hjorth; Zobbe, Henrik

2009-01-01

A connection exists between enlargement of the European Union and reforms of the Common Agricultural Policy (CAP). Based upon rational choice theory, we examine whether the member states’ CAP positions are related to structures in their agricultural sectors. The overall hypothesis...

The reform of the European energy tax directive: Exploring potential economic impacts in the EU27

International Nuclear Information System (INIS)

Rocchi, Paola; Serrano, Mònica; Roca, Jordi

2014-01-01

The aim of this study is to analyze the effect that the Energy Tax Directive reform proposed in 2011 would have, if implemented, on the level of prices in the different sectors of the 27 countries of the European Union. We apply a multiregional and multisectoral model of trade flows that takes into account all the intersectoral and intercountry interdependences in the production processes. Using the World Input–Output Database we perform two different simulations. The first one considers the tax changes proposed by the reform; the second one shows the impact the reform would have entailed if it were applied also to sectors belonging to the European Trade System. The main finding of the first simulation shows that the new energy tax regime would have had a low economic cost in terms of impact on prices (less than 1% in all the countries). So, the concerns about competitiveness do not find empirical support in our results, suggesting the need for further analyses to find out the reasons that caused the failure of a reform that was an important step to introduce a taxation explicitly linked to CO 2 emissions. The second simulation, however, leads to strongly different results, pointing out the relevance of maintaining significant economic incentives to reduce carbon emissions for the European Trade System sectors, by improving the emission market performance or by applying carbon taxation also to these sectors. - Highlights: • We analyze the reform of the European energy tax proposed in 2011, rejected in 2012. • We simulate what potential economic effect this reform would have if implemented. • We find that this reform would have weak effects on prices in all 27 EU countries. • We study the effect of the reform if applied to European emission market sectors. • In this second scenario, the economic impacts would have been much stronger

Telemental health: responding to mandates for reform in primary healthcare.

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Myers, Kathleen M; Lieberman, Daniel

2013-06-01

Telemental health (TMH) has established a niche as a feasible, acceptable, and effective service model to improve the mental healthcare and outcomes for individuals who cannot access traditional mental health services. The Accountability Care Act has mandated reforms in the structure, functioning, and financing of primary care that provide an opportunity for TMH to move into the mainstream healthcare system. By partnering with the Integrated Behavioral Healthcare Model, TMH offers a spectrum of tools to unite primary care physicians and mental health specialist in a mind-body view of patients' healthcare needs and to activate patients in their own care. TMH tools include video-teleconferencing to telecommute mental health specialists to the primary care setting to collaborate with a team in caring for patients' mental healthcare needs and to provide direct services to patients who are not progressing optimally with this collaborative model. Asynchronous tools include online therapies that offer an efficient first step to treatment for selected disorders such as depression and anxiety. Patients activate themselves in their care through portals that provide access to their healthcare information and Web sites that offer on-demand information and communication with a healthcare team. These synchronous and asynchronous TMH tools may move the site of mental healthcare from the clinic to the home. The evolving role of social media in facilitating communication among patients or with their healthcare team deserves further consideration as a tool to activate patients and provide more personalized care.

Oral healthcare systems in the extended European union.

Science.gov (United States)

Widström, Eeva; Eaton, Kenneth A

2004-01-01

This article reports a survey of the systems for the provision of oral healthcare in the 28 member and accession states of the EU/EEA in 2003. Descriptions of the systems were collected from the principal dental advisers to governments in the individual states. In many states these were the Chief Dental Officers (CDOs). In states without a CDO, descriptions were gathered from CDO equivalents or senior academics. A template (model description) was used to guide all respondents. Additional statistical information on oral healthcare costs and workforce was collected from the Council of European Chief Dental Officers, WHO and World Bank websites. The study showed that in broad terms there were six patterns (Beveridgian, Bismarkian, The Eastern European (in transition), Nordic, Southern European and Hybrid) for the administration and financing of oral healthcare in the expanding EU. The extent and nature of government involvement in planning and coordinating oral healthcare services and the numbers and pay of the oral healthcare workforce varied between the different models. The biggest recent changes in European oral healthcare were found to have occurred in Eastern Europe, where there has been wide scale privatization of the previously public dental services. However, most of the EU accession (Eastern European) states seemed to be slowly developing insurance systems to cover oral health treatment costs. In the existing EU/EEA, the public dental services such as those in the Nordic countries still have strong political support and some expansion has occurred. In Southern Europe public dental services seemed to have gained some acceptance for the treatment of children and special needs groups. In UK, which has a unique public dental service system, there are plans to make big changes in the delivery, commissioning and remuneration of dental services in the near future. Some EU member states which operate the Bismarkian system with health insurances offering wide

The European influence on workers' compensation reform in the United States

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LaDou Joseph

2011-12-01

Full Text Available Abstract Workers' compensation law in the United States is derived from European models of social insurance introduced in Germany and in England. These two concepts of workers' compensation are found today in the federal and state workers' compensation programs in the United States. All reform proposals in the United States are influenced by the European experience with workers' compensation. In 2006, a reform proposal termed the Public Health Model was made that would abolish the workers' compensation system, and in its place adopt a national disability insurance system for all injuries and illnesses. In the public health model, health and safety professionals would work primarily in public health agencies. The public health model eliminates the physician from any role other than that of privately consulting with the patient and offering advice solely to the patient. The Public Health Model is strongly influenced by the European success with physician consultation with industry and labor.

The role of institutional entrepreneurs in reforming healthcare.

Science.gov (United States)

Lockett, Andy; Currie, Graeme; Waring, Justin; Finn, Rachael; Martin, Graham

2012-02-01

We draw on institutional entrepreneurship theory to analyse the dynamics of institutional change in a healthcare context. The focus of our interest is in the relationship between an institutional entrepreneur's 'subject position', defined in terms of their structural and normative legitimacy within the existing institutional landscape, and the nature of the change enacted. We develop this approach through an examination of the implementation of new pathways for cancer genetic services within the English National Health Service. Employing comparative case analysis we show that those who have limited structural legitimacy under prevailing conditions are most willing to engender change, but also least able; whereas those who have strong structural legitimacy are most able, but often least willing. However, those who are able rhetorically to combine a balance of structural and normative legitimacy are most able to produce change. In doing so, we demonstrate the importance of the concept of institutional entrepreneurship to understand healthcare reform. Copyright © 2011 Elsevier Ltd. All rights reserved.

Health sector reforms for 21 st century healthcare

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Darshan Shankar

2015-01-01

Full Text Available The form of the public health system in India is a three tiered pyramid-like structure consisting primary, secondary, and tertiary healthcare services. The content of India′s health system is mono-cultural and based on western bio-medicine. Authors discuss need for health sector reforms in the wake of the fact that despite huge investment, the public health system is not delivering. Today, 70% of the population pays out of pocket for even primary healthcare. Innovation is the need of the hour. The Indian government has recognized eight systems of healthcare viz., Allopathy, Ayurveda, Siddha, Swa-rigpa, Unani, Naturopathy, Homeopathy, and Yoga. Allopathy receives 97% of the national health budget, and 3% is divided amongst the remaining seven systems. At present, skewed funding and poor integration denies the public of advantage of synergy and innovations arising out of the richness of India′s Medical Heritage. Health seeking behavior studies reveal that 40-70% of the population exercise pluralistic choices and seek health services for different needs, from different systems. For emergency and surgery, Allopathy is the first choice but for chronic and common ailments and for prevention and wellness help from the other seven systems is sought. Integrative healthcare appears to be the future framework for healthcare in the 21 st century. A long-term strategy involving radical changes in medical education, research, clinical practice, public health and the legal and regulatory framework is needed, to innovate India′s public health system and make it both integrative and participatory. India can be a world leader in the new emerging field of "integrative healthcare" because we have over the last century or so assimilated and achieved a reasonable degree of competence in bio-medical and life sciences and we possess an incredibly rich and varied medical heritage of our own.

Health sector reforms for 21(st) century healthcare.

Science.gov (United States)

Shankar, Darshan

2015-01-01

The form of the public health system in India is a three tiered pyramid-like structure consisting primary, secondary, and tertiary healthcare services. The content of India's health system is mono-cultural and based on western bio-medicine. Authors discuss need for health sector reforms in the wake of the fact that despite huge investment, the public health system is not delivering. Today, 70% of the population pays out of pocket for even primary healthcare. Innovation is the need of the hour. The Indian government has recognized eight systems of healthcare viz., Allopathy, Ayurveda, Siddha, Swa-rigpa, Unani, Naturopathy, Homeopathy, and Yoga. Allopathy receives 97% of the national health budget, and 3% is divided amongst the remaining seven systems. At present, skewed funding and poor integration denies the public of advantage of synergy and innovations arising out of the richness of India's Medical Heritage. Health seeking behavior studies reveal that 40-70% of the population exercise pluralistic choices and seek health services for different needs, from different systems. For emergency and surgery, Allopathy is the first choice but for chronic and common ailments and for prevention and wellness help from the other seven systems is sought. Integrative healthcare appears to be the future framework for healthcare in the 21(st) century. A long-term strategy involving radical changes in medical education, research, clinical practice, public health and the legal and regulatory framework is needed, to innovate India's public health system and make it both integrative and participatory. India can be a world leader in the new emerging field of "integrative healthcare" because we have over the last century or so assimilated and achieved a reasonable degree of competence in bio-medical and life sciences and we possess an incredibly rich and varied medical heritage of our own.

A European late starter: lessons from the history of reform in Irish health care.

Science.gov (United States)

Wren, Maev-Ann; Connolly, Sheelah

2017-12-26

The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care. The majority of the population pays out-of-pocket fees to access primary health care. Due to long waits for public hospital care, many purchase private health insurance, which facilitates faster access to public and private hospital services. The system has been the subject of much criticism and repeated reform attempts. Proposals in 2011 to develop a universal health care system, funded by Universal Health Insurance, were abandoned in 2015 largely due to cost concerns. Despite this experience, there remains strong political support for developing a universal health care system. By applying an historical institutionalist approach, the paper develops an understanding of why Ireland has been a European outlier. The aim of the paper is to identify and discuss issues that may arise in introducing a universal healthcare system to Ireland informed by an understanding of previous unsuccessful reform proposals. Challenges in system design faced by a late-starter country like Ireland, including overcoming stakeholder resistance, achieving clarity in the definition of universality and avoiding barriers to access, may be shared by countries whose universal systems have been compromised in the period of austerity.

Factors of the medical career choice within the context of ukrainian healthcare reforms.

Science.gov (United States)

Lymar, Lesia; Omelchuk, Sergii

2018-01-01

Introduction: The article is dedicated to the motives of medical career choice studied by Ukrainian and foreign scientists, and by the authors themselves. The authors define the main motives, grouped into the pragmatic, social, scientific and professional ones, paying particular attention to the proposed reforms of the Healthcare of Ukraine "Health 2020". The aim: The study has been aimed at detection of the medical career choice factor groups and their possible correction during the medical training, defining possible influence of the Ukrainian Healthcare reformation onto alterations of the medical career choice. Materials and methods: This article is based on bibliosemantic, dialectical, comparative, analytic, synthetic and comprehensive research methods. Review and conclusion: The authors have analyzed medical career motives according to the A. Maslow hierarchy of needs, comparing the present motives with the motives to be changed after reforming the Ukrainian healthcare. The authors conclude that according to the Maslow's hierarchy of needs, the medical career choice corresponding to the first, second and third needs level would be directly related to the pragmatic, social and scientific motives, further disappointment in career, low professional performance and professional "burnout". The career choice corresponding to the last levels of the needs hierarchy is related to the professional motives and self-actualization, but, due to the applicants' age and financial status of medical specialists in Ukraine, is not likely to occur. Positive changes in medical specialists' salary rise, social protection offered by the State and state support of the profession will provide for correction of motives onto the higher level, in this way, benefiting the patients.

Impact of Québec’s healthcare reforms on the organization of primary healthcare (PHC): a 2003-2010 follow-up

Science.gov (United States)

2014-01-01

Background Healthcare reforms initiated in the early 2000s in Québec involved the implementation of new modes of primary healthcare (PHC) delivery and the creation of Health and Social Services Centers (HSSCs) to support it. The objective of this article is to assess and explain the degree of PHC organizational change achieved following these reforms. Methods We conducted two surveys of PHC organizations, in 2005 and 2010, in two regions of the province of Québec, Canada. From the responses to these surveys, we derived a measure of organizational change based on an index of conformity to an ideal type (ICIT). One set of explanatory variables was contextual, related to coercive, normative and mimetic influences; the other consisted of organizational variables that measured receptivity towards new PHC models. Multilevel analyses were performed to examine the relationships between ICIT change in the post-reform period and the explanatory variables. Results Positive results were attained, as expressed by increase in the ICIT score in the post-reform period, mainly due to implementation of new types of PHC organizations (Family Medicine Groups and Network Clinics). Organizational receptivity was the main explanatory variable mediating the effect of coercive and mimetic influences. Normative influence was not a significant factor in explaining changes. Conclusion Changes were modest at the system level but important with regard to new forms of PHC organizations. The top-down decreed reform was a determining factor in initiating change whereas local coercive and normative influences did not play a major role. The exemplar role played by certain PHC organizations through mimetic influence was more important. Receptivity of individual organizations was both a necessary condition and a mediating factor in influencing change. This supports the view that a combination of top-down and bottom-up strategy is best suited for achieving substantial changes in PHC local

Healthcare reforms: implications for the education and training of acute and critical care nurses

OpenAIRE

Glen, S

2004-01-01

This paper offers a wide ranging analysis of the drivers that resulted in scrutiny of medical, nursing, and healthcare professional roles. It suggests that what is needed is a coherent vision of the future shape of the health workforce. This requires moving beyond the presumption that reforming working practices primarily involves "delegating doctors" responsibilities to nurses. The paper argues that it is self evident that the implications of changes in healthcare roles and the ability of ex...

The healthcare experiences of Arab Israeli women in a reformed healthcare system.

Science.gov (United States)

Elnekave, Eldad; Gross, Revital

2004-07-01

Arab Israeli women are subject to unique social stresses deriving from their status as part of an ethno-political minority and from their position as women in a patriarchal community. Collectively, their health profiles rate poorly in comparison to Jewish Israeli women or to women in the vast majority of developed countries. To examine the experiences of Arab Israeli women in the contemporary Israeli healthcare system, following implementation of the National Health Insurance Law (NHIL). The study combined quantitative and qualitative research methodologies. A telephone survey utilizing a structured questionnaire was conducted during August-September 1998 among a random national sample of 849 women, with a response rate of 83%. Between the months of January and July of 2000, qualitative data was attained via participant-observation, long and short semi-structured interviews, and focus groups in one large Muslim Arab Israeli village. Arab Israeli women in the national survey reported poorer self-assessed health, lower rates of care by a woman primary care physician, lower satisfaction ratings for primary care physicians and more frequently foregoing medical care than did native or immigrant Jewish Israeli women. Three major factors contributing to Arab Israeli women's healthcare experiences were elucidated by the qualitative study: (1) the threat of physical and social exposure (2) difficulties in communicating with male physicians and (3) the stifling effect of family politics and surveillance on healthcare. We discuss our findings in relation to structural changes associated with the recent reform of the Israeli health care system. We conclude by suggesting policy measures for better adapting primary care services to the needs of Arab Israeli women, and note the relevance to other systems that aim to provide service to cultural and ethno-political minorities, in which healthcare delivery is shaped by unique local circumstances.

Reliable in their failure: an analysis of healthcare reform policies in public systems.

Science.gov (United States)

Contandriopoulos, Damien; Brousselle, Astrid

2010-05-01

In this paper, we analyze recommendations of past governmental commissions and their implementation in Quebec as a case to discuss the obstacles that litter the road to healthcare system reform. Our analysis shows that the obstacles to tackling the healthcare system's main problems may have less to do with programmatic (what to do) than with political and governance (how to do it) questions. We then draw on neo-institutional theory to discuss the causes and effects of this situation. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

The political economy of healthcare reform in China: negotiating public and private.

Science.gov (United States)

Daemmrich, Arthur

2013-01-01

China's healthcare system is experiencing significant growth from expanded government-backed insurance, greater public-sector spending on hospitals, and the introduction of private insurance and for-profit clinics. An incremental reform process has sought to develop market incentives for medical innovation and liberalize physician compensation and hospital finance while continuing to keep basic care affordable to a large population that pays for many components of care out-of-pocket. Additional changes presently under consideration by policymakers are likely to further restructure insurance and the delivery of care and will alter competitive dynamics in major healthcare industries, notably pharmaceuticals, medical devices, and diagnostic testing. This article describes the institutional history of China's healthcare system and identifies dilemmas emerging as the country negotiates divisions between public and private in healthcare. Building on this analysis, the article considers opportunities for public-private partnerships and greater systems integration to reconcile otherwise incommensurable approaches to rewarding innovation and improving access. The article concludes with observations on the public function of health insurance and its significance to further development of China's healthcare system.

A network approach for researching political feasibility of healthcare reform: the case of universal healthcare system in Taiwan.

Science.gov (United States)

Wang, Guang-Xu

2012-12-01

This study evaluates the political feasibility of healthcare reform taking place in Taiwan in the past decade. Since Taiwan adopted National Health Insurance (NHI) in 1995, it has provided coverage for virtually all of the island's citizens. However, the imbalance between expenditure and revenue has resulted in a cycle of unsustainable spending which has necessitated financial reforms and political confrontations. By applying social network analysis, this paper examines multiple types of ties between policy elites and power distribution that have evolved in crucial policy events of the NHI's financial reforms between 1998 and 2010. Data sources include official documents and 62 social network interviews that were held with government officials and related unofficial policy participants. Blockmodeling and multidimensional scaling (MDS) are used to determine the major participants and network structures in the NHI domain, as well as the influential policy actors, based on information transmission, resource exchange, reputation attribution and action-set coalition networks in Taiwan's current political situation. The results show that although both public actors and all medical associations are the leading actors in the NHI reform, without good communication with societal actors, the promotion of reform proposals ends in failure. As a tool of political feasibility evaluation, social network analysis can map the political conflict between policy stakeholders systematically when policy makers pursue the result of policy adoption. Copyright © 2012 Elsevier Ltd. All rights reserved.

Reforming the court management system of Romania in the European Union integration process

Directory of Open Access Journals (Sweden)

Nicolae Elvis Cioabă

2014-11-01

Full Text Available The Superior Council of Magistracy represent a cornerstone of the Romanian court management system. This responsibility is partly shared with the Ministry of Justice. The reform of the court management system in Romania has been and still is disputable, the main actors being on one hand the magistrates and on the other the Ministry of Justice. While observing this „dispute“ we may discover a third actor, namely the European Union, who has entered scene in the context of Romania’s European integration. This research is looking to plausibly explain which was the part played by the EU and how did it influence the above mentioned reform, with special emphasis on the Superior Council of Magistracy.

Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province.

Directory of Open Access Journals (Sweden)

Hao Zhang

Full Text Available High drug costs due to supplier-induced demand (SID obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices.A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization.Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID; this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase.The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research

Reforming primary healthcare: from public policy to organizational change.

Science.gov (United States)

Gilbert, Frédéric; Denis, Jean-Louis; Lamothe, Lise; Beaulieu, Marie-Dominique; D'amour, Danielle; Goudreau, Johanne

2015-01-01

Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of "intermediate change" and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. This research is one of few studies to examine a primary care reform from emergence to implementation

The healthcare system and provision of oral healthcare in European Union member states. Part 4: Greece.

Science.gov (United States)

Damaskinos, P; Koletsi-Kounari, H; Economou, C; Eaton, K A; Widström, E

2016-03-11

This paper presents a description of the healthcare system and how oral healthcare is organised and provided in Greece, a country in a deep economic and social crisis. The national health system is underfunded, with severe gaps in staffing levels and the country has a large private healthcare sector. Oral healthcare has been largely provided in the private sector. Most people are struggling to survive and have no money to spend on general and oral healthcare. Unemployment is rising and access to healthcare services is more difficult than ever. Additionally, there has been an overproduction of dentists and no development of team dentistry. This has led to under or unemployment of dentists in Greece and their migration to other European Union member states, such as the United Kingdom, where over 600 Greek dentists are currently working.

Interview with a quality leader: Dr. Suzanne Delbanco, on healthcare payment reform. Interviewed by Kevin Warren.

Science.gov (United States)

Delbanco, Suzanne

2011-01-01

Suzanne F. Delbanco is the executive director of Catalyst for Payment Reform (CPR), a nonprofit organization working for coordinated action among the largest purchasers of healthcare and health plans to reform the way we pay for healthcare in the United States to improve quality and cost. In addition to her duties at CPR, Suzanne is on the Advisory Committee to the Director and the National Biosurveillance Advisory Subcommittee of the Centers for Disease Control and Prevention. She also serves on the boards of HCI3, the Anvita Health Advisory Council, the executive committee of the California Maternal Quality Care Collaborative, and participates in the Healthcare Executives Leadership Network. Before CPR, Suzanne was President, Health Care Division at Arrowsight Inc., a company using video to help hospitals measure the performance of healthcare workers and provide them with feedback while they are working to improve adherence to safety and quality protocols. From 2000 to 2007, Suzanne was the founding CEO of The Leapfrog Group. The Leapfrog Group uses the collective leverage of its large corporate and public members to initiate breakthrough improvements in the safety, quality, and affordability of healthcare for Americans. Before joining Leapfrog, Suzanne was a senior manager at the Pacific Business Group on Health where she worked on the Quality Team. Suzanne holds a PhD in Public Policy from the Goldman School of Public Policy and a MPH from the School of Public Health at the University of California, Berkeley. © 2011 National Association for Healthcare Quality.

The 2015 hospital treatment choice reform in Norway: Continuity or change?

Science.gov (United States)

Ringard, Ånen; Saunes, Ingrid Sperre; Sagan, Anna

2016-04-01

In several European countries, including Norway, polices to increase patient choice of hospital provider have remained high on the political agenda. The main reason behind the interest in hospital choice reforms in Norway has been the belief that increasing choice can remedy the persistent problem of long waiting times for elective hospital care. Prior to the 2013 General Election, the Conservative Party campaigned in favour of a new choice reform: "the treatment choice reform". This article describes the background and process leading up to introduction of the reform in the autumn of 2015. It also provides a description of the content and discusses possible implications of the reform for patients, providers and government bodies. In sum, the reform contains elements of both continuity and change. The main novelty of the reform lies in the increased role of private for-profit healthcare providers. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Hospital Acquisitions Before Healthcare Reform.

Science.gov (United States)

McCue, Michael J; Thompson, Jon M; Kim, Tae Hyun

2015-01-01

The hospital industry has experienced increased consolidation in the past 20 years. Since 2010, in particular, there has been a large rise in the number of hospital acquisitions, and observers have suggested this is due in part to the expected impact of federal healthcare reform legislation. This article reports on a study undertaken to identify the market, management, and financial factors affecting acute care, community hospitals acquired between 2010 and 2012. We identified 77 such hospitals and compared them to other acute care facilities. To assess how different factors were associated with acquisitions, the study used multiple logistic regressions whereby market factors were included first, followed by management and financial factors. Study findings show that acquired hospitals were located in markets with lower rates of preferred provider organization (PPO) penetration compared with nonacquired hospitals. Occupancy rate was found to be inversely related to acquisition rate; however, case-mix index was significantly and positively related to a hospital's being acquired. Financial factors negatively associated with a hospital's being acquired included age of plant and cash flow margin. In contrast to the findings from earlier studies of hospital acquisitions, our results showed that acquired hospitals possessed newer assets. However, similar to the findings of other studies, the cash flow margin of acquired hospitals was lower than that of nonacquired facilities.

Something is amiss in Denmark: A comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente

DEFF Research Database (Denmark)

Schiøtz, Michaela Louise; Price, Mary; Frølich, Anne

2011-01-01

As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison...

Comparison of Chinese inpatients with different types of medical insurance before and after the 2009 healthcare reform.

Science.gov (United States)

Wang, Shan; Liu, Lihua; Li, Lin; Liu, Jianchao

2014-09-29

Since 1994, China has established three major basic medical insurance (MI) schemes that aim to provide greater financial protection to members. The 2009 Chinese medical reform emphasized the enhancement of basic medical insurance. This study aims to investigate changes in hospital services costs for inpatients with different types of MI before and after the new Chinese medical reform. A total of 532,120 inpatient medical records, completed by 11 different hospitals nationwide in 2008 and 2011, were collected from the Ministry of Health retrospectively. Median and mean values were calculated to describe costs and average length of stay, respectively. A chi-square test was used to compare the distribution of patient visits. Wilcoxon rank-sum tests were conducted to compare costs. The number of patients hospitalized increased. The average cost per stay in the three basic MI schemes increased, while out-of-pocket (OOP) spending decreased (P trends. The purchase of Western medication accounted for the largest proportion of costs in all MI schemes in both years; however, these ratios decreased from 2008 to 2011, while those for other social insurance and OOP patients almost doubled. The average length of stay remained unchanged, and the average lengths of stay in the MI schemes differed before and after the healthcare reform. Healthcare reform with multipartite policies may make interactional impacts on hospitalization services for patients enrolled in MI schemes.

 Railway Reforms

DEFF Research Database (Denmark)

Asmild, Mette; Holvad, Torben; Hougaard, Jens Leth

This paper considers railway operations in 23 European countries during 1995-2001, where a series of reform initiatives were launched by the European Commission, and analyses whether these reform initiatives improved the operating efficiency of the railways. Efficiency is measured using Multi......-directional Efficiency Analysis, which enables investigation of how railway reforms affect the inefficiencies of specific cost drivers. The main findings are that the reform initiatives generally improve operating efficiency but potentially differently for different cost drivers. Specifically, the paper provides clear...

Information report submitted by the Commission for European Affairs on the reform of the emission allowances market. Nr 4569

International Nuclear Information System (INIS)

Leroy, Arnaud

2017-01-01

This parliamentary report first proposes a presentation of the European carbon emission allowances market or emission trading scheme (ETS) by recalling the context of its creation, and by describing its operation (a trading platform to reduce CO_2 emission in Europe), and commenting critics which are generally made about this market. Then, the authors present and comment proposals of reform with notably the creation of a reserve fund of stability, and a structural reform of the market. The authors then explain why and how the ETS reform must go beyond that if the European Union wants to meet commitments defined in the Paris agreement

Redesigning and reforming European regional policy : The reasons, the logic and the outcomes

NARCIS (Netherlands)

McCann, P.; Ortega-Argilés, R.

This article discusses the reforms to European Union (EU) regional development policy, or more precisely EU Cohesion Policy, which have been taking place over recent years. Following a discussion of the evolution of the policy, the changes in the rationale, the logic, the architecture, and the

European electricity markets reforms: the 'visible hand' of public coordination

International Nuclear Information System (INIS)

Finon, Dominique; Roques, Fabien

2013-01-01

The paper investigates how proposed reforms on policies to maintain generation adequacy and encourage clean technology investments in a number of European countries modify the role of the market. In these reforms the government, regulator and system operator take on explicit planning and coordination responsibilities with the introduction of capacity mechanisms and long-term support for clean technologies. We highlight the interactions of these mechanisms with the electricity market and how they reallocate risks between generators, government and consumers. The different mechanisms offer varying degrees of autonomy to generators with regards to investment decisions. In a prospective way, the paper also explores how designs of these different mechanisms might converge towards a unified technology neutral mechanism in the long-run. This could involve auctioning of long-term contracts for all types of existing and new capacities, whether it is low carbon or fossil fueled. (authors)

Rehabilitation robotics in robotics for healthcare ; a roadmap study for the European Commission

NARCIS (Netherlands)

Gelderblom, G.J.; Wilt, M.de; Cremers, G.; Rensma, A.R.

2009-01-01

To gain understanding in the current status of Robotics in healthcare the European Commission issued a roadmap study into this domain. This paper reports on the main characteristics and results of this study. The study covered the wide domain of Healthcare and in this paper the domains relevant for

Florence Nightingale and healthcare reform.

Science.gov (United States)

Kudzma, Elizabeth Connelly

2006-01-01

The purpose of this article was to examine the work of Florence Nightingale in light of her collaboration with William Farr, the eminent medical statistician. Nightingale's epidemiological investigations supported by Farr illustrated that attention to environmental cleanliness was an important factor in preventing spread of disease. Nightingale channeled her investigations to support hospital reforms and the need for an educated nurse who could provide better management of the hospital environment. Statistical support and solicited criticism allowed Nightingale to argue more forcefully for her reforms.

Human resource for health reform in peri-urban areas: a cross-sectional study of the impact of policy interventions on healthcare workers in Epworth, Zimbabwe.

Science.gov (United States)

Taderera, Bernard Hope; Hendricks, Stephen James Heinrich; Pillay, Yogan

2017-12-16

The need to understand how healthcare worker reform policy interventions impact health personnel in peri-urban areas is important as it also contributes towards setting of priorities in pursuing the universal health coverage goal of health sector reform. This study explored the impact of post 2008 human resource for health reform policy interventions on healthcare workers in Epworth, a peri-urban community in Harare, Zimbabwe, and the implications towards health sector reform policy in peri-urban areas. The study design was exploratory and cross-sectional and involved the use of qualitative and quantitative methods in data collection, presentation, and analysis. A qualitative study in which data were collected through a documentary search, five key informant interviews, seven in-depth interviews, and five focus group discussions was carried out first. This was followed by a quantitative study in which data were collected through a documentary search and 87 semi-structured sample interviews with healthcare workers. Qualitative data were analyzed thematically whilst descriptive statistics were used to examine quantitative data. All data were integrated during analysis to ensure comprehensive, reliable, and valid analysis of the dataset. Three main factors were identified to help interpret findings. The first main factor consisted policy result areas that impacted most successfully on healthcare workers. These included the deployment of community health workers with the highest correlation of 0.83. Policy result areas in the second main factor included financial incentives with a correlation of 0.79, training and development (0.77), deployment (0.77), and non-financial incentives (0.75). The third factor consisted policy result areas that had the lowest satisfaction amongst healthcare workers in Epworth. These included safety (0.72), equipment and tools of trade (0.72), health welfare (0.65), and salaries (0.55). The deployment of community health volunteers impacted

Prevalence of experienced abuse in healthcare and associated obstetric characteristics in six European countries

DEFF Research Database (Denmark)

Lukasse, Mirjam; Schroll, Anne-Mette; Karro, Helle

2015-01-01

OBJECTIVES: To assess the prevalence and current suffering of experienced abuse in healthcare, to present the socio-demographic background for women with a history of abuse in healthcare and to assess the association between abuse in healthcare and selected obstetric characteristics. DESIGN: Cross......-sectional study. SETTING: Routine antenatal care in six European countries. POPULATION: In total 6923 pregnant women. METHODS: Cross-tabulation and Pearson's chi-square was used to study prevalence and characteristics for women reporting abuse in healthcare. Associations with selected obstetric factors were...

Project IVOR - Implementing victim-oriented reform of the criminal justice system in the European Union

NARCIS (Netherlands)

Biffi, Emanuela; Mulder, Eva; Pemberton, Antony; Santos, Manuela; Valério, Mafalda; Vanfraechem, Inge; van der Vorm, Benny

2016-01-01

Project IVOR – Implementing victim-oriented reform of the criminal justice system in the European Union (2014-2016) offers an overview of current research into and with victims’ rights and services, identifying lacunas in the knowledge base and offering a model which can serve to connect experience

Did Socioeconomic Inequality in Self-Reported Health in Chile Fall after the Equity-Based Healthcare Reform of 2005? A Concentration Index Decomposition Analysis.

Science.gov (United States)

Cabieses, Baltica; Cookson, Richard; Espinoza, Manuel; Santorelli, Gillian; Delgado, Iris

2015-01-01

Chile, a South American country recently defined as a high-income nation, carried out a major healthcare system reform from 2005 onwards that aimed at reducing socioeconomic inequality in health. This study aimed to estimate income-related inequality in self-reported health status (SRHS) in 2000 and 2013, before and after the reform, for the entire adult Chilean population. Using data on equivalized household income and adult SRHS from the 2000 and 2013 CASEN surveys (independent samples of 101 046 and 172 330 adult participants, respectively) we estimated Erreygers concentration indices (CIs) for above average SRHS for both years. We also decomposed the contribution of both "legitimate" standardizing variables (age and sex) and "illegitimate" variables (income, education, occupation, ethnicity, urban/rural, marital status, number of people living in the household, and healthcare entitlement). There was a significant concentration of above average SRHS favoring richer people in Chile in both years, which was less pronounced in 2013 than 2000 (Erreygers corrected CI 0.165 [Standard Error, SE 0.007] in 2000 and 0.047 [SE 0.008] in 2013). To help interpret the magnitude of this decline, adults in the richest fifth of households were 33% more likely than those in the poorest fifth to report above-average health in 2000, falling to 11% in 2013. In 2013, the contribution of illegitimate factors to income-related inequality in SRHS remained higher than the contribution of legitimate factors. Income-related inequality in SRHS in Chile has fallen after the equity-based healthcare reform. Further research is needed to ascertain how far this fall in health inequality can be attributed to the 2005 healthcare reform as opposed to economic growth and other determinants of health that changed during the period.

Did Socioeconomic Inequality in Self-Reported Health in Chile Fall after the Equity-Based Healthcare Reform of 2005? A Concentration Index Decomposition Analysis.

Directory of Open Access Journals (Sweden)

Baltica Cabieses

Full Text Available Chile, a South American country recently defined as a high-income nation, carried out a major healthcare system reform from 2005 onwards that aimed at reducing socioeconomic inequality in health. This study aimed to estimate income-related inequality in self-reported health status (SRHS in 2000 and 2013, before and after the reform, for the entire adult Chilean population.Using data on equivalized household income and adult SRHS from the 2000 and 2013 CASEN surveys (independent samples of 101 046 and 172 330 adult participants, respectively we estimated Erreygers concentration indices (CIs for above average SRHS for both years. We also decomposed the contribution of both "legitimate" standardizing variables (age and sex and "illegitimate" variables (income, education, occupation, ethnicity, urban/rural, marital status, number of people living in the household, and healthcare entitlement.There was a significant concentration of above average SRHS favoring richer people in Chile in both years, which was less pronounced in 2013 than 2000 (Erreygers corrected CI 0.165 [Standard Error, SE 0.007] in 2000 and 0.047 [SE 0.008] in 2013. To help interpret the magnitude of this decline, adults in the richest fifth of households were 33% more likely than those in the poorest fifth to report above-average health in 2000, falling to 11% in 2013. In 2013, the contribution of illegitimate factors to income-related inequality in SRHS remained higher than the contribution of legitimate factors.Income-related inequality in SRHS in Chile has fallen after the equity-based healthcare reform. Further research is needed to ascertain how far this fall in health inequality can be attributed to the 2005 healthcare reform as opposed to economic growth and other determinants of health that changed during the period.

Accelerated reforms in healthcare financing: the need to scale up private sector participation in Nigeria.

Science.gov (United States)

Ejughemre, Ufuoma John

2014-01-01

The health sector, a foremost service sector in Nigeria, faces a number of challenges; primarily, the persistent under-funding of the health sector by the Nigerian government as evidence reveals low allocations to the health sector and poor health system performance which are reflected in key health indices of the country.Notwithstanding, there is evidence that the private sector could be a key player in delivering health services and impacting health outcomes, including those related to healthcare financing. This underscores the need to optimize the role of private sector in complementing the government's commitment to financing healthcare delivery and strengthening the health system in Nigeria. There are also concerns about uneven quality and affordability of private-driven health systems, which necessitates reforms aimed at regulation. Accordingly, the argument is that the benefits of leveraging the private sector in complementing the national government in healthcare financing outweigh the challenges, particularly in light of lean public resources and finite donor supports. This article, therefore, highlights the potential for the Nigerian government to scale up healthcare financing by leveraging private resources, innovations and expertise, while working to achieve the universal health coverage.

Work motivation among healthcare professionals.

Science.gov (United States)

Kjellström, Sofia; Avby, Gunilla; Areskoug-Josefsson, Kristina; Andersson Gäre, Boel; Andersson Bäck, Monica

2017-06-19

Purpose The purpose of this paper is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives. Design/methodology/approach Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. In total, 43 interviews were completed with different medical professions and qualitative deductive content analysis was conducted. Findings Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers' positive management was due to a unique combination of factors, such as clear direction of goals, a culture of non-hierarchical collaboration, and systematic quality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. Practical implications Leaders need to consistently translate and integrate reforms with the professionals' drives and values. This is done by encouraging participation through teamwork, time for structured reflection, and quality improvement work. Social implications The design of the reforms and leadership are essential preconditions for work motivation. Originality/value The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.

The European Network of Coloproctology: a strategy towards the European research and healthcare system.

Science.gov (United States)

Rubbini, Michele

2016-12-01

Many documents from the International Institutions point out that Health represents an engine of economic and social development. Based on these documents and concepts, the European Parliament decided to create a system of European Reference Networks as a synthesis of clinical and research activities, particularly in the field of rare diseases. This initiative, properly implemented, could be first step towards a new European health system. This article instead, wanting to deepen this perspective, postulates that the ERNs may also be related to widespread diseases, such as those of coloproctological interest, with the aim of setting up a European Network of Coloproctology (ENCP). Here are analyzed: (a) the documents related to ERNs and others related to research and training, the characteristics of the coloproctological diseases, and proposal of the ENCP; (b) a survey that involves 14 out of 25 of the National and Regional Representative of the European Society of Coloproctology. Hundred percent of the people interviewed agree to the ENCP project. The percentage of the approved proposed fields of activity of the ENCP are: Healthcare 71%, Research 100%, Training 86%, Support to legislation 78%, Professional Mobility 64%, Patient Database 71%, and Expenditure control 64%. From the analysis of the documents and the result of the survey, ERNs are appropriate not only in relation to rare diseases but also in those fields with higher diffusion and the creation of a European Network of Coloproctology is then postulated.

Current healthcare in Bulgaria: time for predictive diagnostics and preventive medicine.

Science.gov (United States)

Dimitrov, Dimiter V

2010-12-01

Since 1990 Bulgaria gradually moved from monopolistic to market regulated economy and healthcare. In 2007 the country became member of the European Union and started to adopt EU legislations. However, significant gaps between the average European and Bulgarian level of social, health and economic efficiency remain to be narrowed. The major challenge is the demographic situation, where recent trends give alarming signals. Plans for reformation include transition towards out-patient palliative healthcare centers for the aging population as well as reduction of the costs with new electronic system of health insurance. The favorable location of the country at the Black Sea coast gives opportunities for medical tourism, which can provide quality health service for foreign customers. Finally, national platforms on prevention of major non-communicable diseases, such as obesity, cancer and diabetes, must be established as coordinated actions for the health and wellness of next generations.

Redefining the Core Competencies of Future Healthcare Executives under Healthcare Reform

Science.gov (United States)

Love, Dianne B.; Ayadi, M. Femi

2015-01-01

As the healthcare industry has evolved over the years, so too has the administration of healthcare organizations. The signing into law of the Patient Protection and Affordable Care Act (ACA) has brought additional changes to the healthcare industry that will require changes to the healthcare administration curriculum. The movement toward a…

Health reforms as examples of multilevel interventions in cancer care.

Science.gov (United States)

Flood, Ann B; Fennell, Mary L; Devers, Kelly J

2012-05-01

To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation's health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.

Individual and Institutional Corruption in European and US Healthcare: Overview and Link of Various Corruption Typologies.

Science.gov (United States)

Sommersguter-Reichmann, Margit; Wild, Claudia; Stepan, Adolf; Reichmann, Gerhard; Fried, Andrea

2018-06-01

In recent years, the fight against healthcare corruption has intensified. Estimates from the European Healthcare Fraud and Corruption Network calculate an approximate €56 billion annual loss to Europe as a result of corruption. To promote understanding of the complexity and interconnection of corrupt activities, we aim to present healthcare-related corruption typologies of the European Union and European Healthcare Fraud and Corruption Network. We subsequently link them to the typology of individual and institutional corruption introduced by Dennis Thompson in the context of investigating misconduct of US Congressional members. According to Thompson, individual corruption is the personal gain of individuals performing duties within an institution in exchange for nurturing private interests, while institutional corruption pertains to the failure of the institution in directing the individual's behaviour towards the achievement of the institution's primary purpose because the institutional design promotes the pursuit of individual goals. Effective anti-corruption activities not only require the enactment of anti-corruption laws but also the monitoring and, where appropriate, revision of institutional frameworks to prevent the undermining of the primary purposes of health systems or institutions. To gain further understanding of the similarities and differences of the three typologies, prime examples of corrupt activities in the health sector in the European Union and USA (along with their potential remedies) are provided. Linking corruption cases to Thompson's typology revealed that many corrupt activities may show elements of both individual and institutional corruption because they are intertwined, partly overlap and may occur jointly. Hence, sanctioning individual actors only does not target the problem.

Ukrainian Economic Reforms: Current Status and Perspectives in the Face of Competition on European Union Markets

Directory of Open Access Journals (Sweden)

Greta Marianna

2016-06-01

Full Text Available The conflict in Ukraine since the beginning of 2014 has been the important in the history of Ukraine as an independent state. Despite the danger of economic collapse, the loss of Crimea, and war in its most industrialized region, Ukraine is still trying to conduct reforms and implement Western standards. Through persistent work Ukraine has been moving forward, despite all the difficulties. The society is staying together with the government to save the economy and defend the integrity of the whole country. This article outlines key processes in the Ukrainian reforms during 2014 and describes the cooperation of Ukraine with the European Union and international organizations in the field of financial support and reforms. The main goal of the article is to present the situation in various spheres of the country’s development, but it is also an attempt to present a wider perspective on both the achievements and shortcomings in the process of reforms. The authors focus on those aspects having a significant impact on the Ukrainian economy after February 2014.

Health Care Reform: a Socialist Vision

Directory of Open Access Journals (Sweden)

Martha Livingston

2010-04-01

Full Text Available At first glance, it doesn't seem as though socialism and health-care reform have a whole lot to do with each other. After all, the most visible "left" position in the current discussion of health-care reform merely advocates for the government to assume the function of national insurer, leaving the delivery of health care - from its often-questionable content to its hierarchical relationships - firmly in place. As such, a single payer, Medicare-for-All insurance program is a modest, even tepid reform. Those of us on the left who have been active in the single payer movement have always seen it as a steppingstone toward health-care justice: until the question of access to care is solved, how do we even begin to address not only health care but also health inequities? How, for example, can working-class Americans, Americans of color, and women demand appropriate, respectful, humane, first-rate care when our ability to access any health-care services at all is so tightly constrained?

International Institutions and Domestic Reform: Equal Pay and British Membership in the European Economic Community.

Science.gov (United States)

Frader, Laura Levine

2018-03-01

Despite having been overlooked in the standard histories of the UK and the European Community, gender politics and gender policies played a significant role in Britain's applications for membership in the EEC in the 1960s. Joining the European Community required that Britain comply with Article 119 on equal pay for equal work. A combination of domestic feminist and labour movement activism, the commitment of unions and parties, and the internationalization of formal commitments to women's rights constituted internal and external pressures for the passage of an Equal Pay Act in 1970. The article argues that the formal legislative commitment to gender pay equality, changing public attitudes towards women's employment, and European membership impacted further domestic social policy reform and slowly began to shift government attitudes towards gender equality.

Understanding frailty: a qualitative study of European healthcare policy-makers' approaches to frailty screening and management.

Science.gov (United States)

Gwyther, Holly; Shaw, Rachel; Jaime Dauden, Eva-Amparo; D'Avanzo, Barbara; Kurpas, Donata; Bujnowska-Fedak, Maria; Kujawa, Tomasz; Marcucci, Maura; Cano, Antonio; Holland, Carol

2018-01-13

To elicit European healthcare policy-makers' views, understanding and attitudes about the implementation of frailty screening and management strategies and responses to stakeholders' views. Thematic analysis of semistructured qualitative interviews. European healthcare policy departments. Seven European healthcare policy-makers representing the European Union (n=2), UK (n=2), Italy (n=1), Spain (n=1) and Poland (n=1). Participants were sourced through professional networks and the European Commission Authentication Service website and were required to be in an active healthcare policy or decision-making role. Seven themes were identified. Our findings reveal a 'knowledge gap', around frailty and awareness of the malleability of frailty, which has resulted in restricted ownership of frailty by specialists. Policy-makers emphasised the need to recognise frailty as a clinical syndrome but stressed that it should be managed via an integrated and interdisciplinary response to chronicity and ageing. That is, through social co-production. This would require a culture shift in care with redeployment of existing resources to deliver frailty management and intervention services. Policy-makers proposed barriers to a culture shift, indicating a need to be innovative with solutions to empower older adults to optimise their health and well-being, while still fully engaging in the social environment. The cultural acceptance of an integrated care system theme described the complexities of institutional change management, as well as cultural issues relating to working democratically, while in signposting adult care , the need for a personal navigator to help older adults to access appropriate services was proposed. Policy-makers also believed that screening for frailty could be an effective tool for frailty management. There is potential for frailty to be managed in a more integrated and person-centred manner, overcoming the challenges associated with niche ownership within the

The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms.

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Intaranongpai, Siranee; Hughes, David; Leethongdee, Songkramchai

2012-01-01

This paper examines the implementation of Thailand's universal coverage healthcare reforms in a rural province, using data from field studies undertaken in 2003-2005 and 2008-2011. We focus on the strand of policy that aimed to develop primary care by allocating funds to contracting units for primary care (CUPs) responsible for managing local service networks. The two studies document a striking change in the balance of power in the local healthcare system over the 8-year period. Initially, the newly formed CUPs gained influence as 'power followed the money', and the provincial health offices (PHOs), which had commanded the service units, were left with a weaker co-ordination role. However, the situation changed as a new insurance purchaser, the National Health Security Office, took financial control and established regional outposts. National Health Security Office outposts worked with PHOs to develop rationalised management tools-strategic plans, targets, KPIs and benchmarking-that installed the PHOs as performance managers of local healthcare systems. New lines of accountability and changed budgetary systems reduced the power of the CUPs to control resource allocation and patterns of services within CUP networks. Whereas some CUPs fought to retain limited autonomy, the PHO has been able to regain much of its former control. We suggest that implementation theory needs to take a long view to capture the complexity of a major reform initiative and argue for an analysis that recognises the key role of policy networks and advocacy coalitions that span national and local levels and realign over time. Copyright © 2012 John Wiley & Sons, Ltd.

Healthcare reforms: implications for the education and training of acute and critical care nurses.

Science.gov (United States)

Glen, S

2004-12-01

This paper offers a wide ranging analysis of the drivers that resulted in scrutiny of medical, nursing, and healthcare professional roles. It suggests that what is needed is a coherent vision of the future shape of the health workforce. This requires moving beyond the presumption that reforming working practices primarily involves "delegating doctors" responsibilities to nurses. The paper argues that it is self evident that the implications of changes in healthcare roles and the ability of existing professionals to function effectively in the future will require education, training, and human resource investment supportive of the changes. It suggests a clear definition of competence and a national standard to practice is essential for nurses working in acute and acute critical settings. There should therefore be a correlation between levels of practice, levels of education, and remuneration. Furthermore, education programmes for senior nurses should sit coherently alongside the education programmes required by Modernising Medical Careers. Finally, the realisation of the government's service and modernisation agenda will require a culture change within higher education institutions, postgraduate deaneries, professional organisations, workforce development confederations, and NHS trusts.

The regulatory reform in the European Union environmental policy: A first appraisal

International Nuclear Information System (INIS)

Leveque, Francois

1996-01-01

This paper is aimed to outline the expected outcome of the regulatory reform which is occurring in the European Union environmental policy: it intends to point out the new institutional procedures for rulemaking introduced by the Maastricht Treaty and the fifth Programme of Action, which would result in the use of market-based instruments and voluntary approaches oppositely to traditional command and control mechanisms. The paper consists of three sections: while the first one is plainly introductory, the following two sections represent a survey on eight recent pieces of European Union legislation, chiefly directives, showing the systematic decrease in the environmental objectives due to the presence of industrial interest groups, and the new problems affecting public intervention caused by the development of the above mentioned voluntary approaches. Moreover, the former provides an analytical model of a firm's involvement in the policy process, the latter an analytical apparatus on the very nature and failures of self-and co-regulation

The monopolistic integrated model and health care reform: the Swedish experience.

Science.gov (United States)

Anell, A

1996-07-01

This article reviews recent reforms geared to creating internal markets in the Swedish health-care sector. The main purpose is to describe driving forces behind reforms, and to analyse the limitations of reforms oriented towards internal markets within a monopolistic integrated health-care model. The principal part of the article is devoted to a discussion of incentives within Swedish county councils, and of how these incentives have influenced reforms in the direction of more choices for consumers and a separation between purchasers and providers. It is argued that the current incentives, in combination with criticism against county council activities in the early 1990's, account for the present inconsistencies as regards reforms. Furthermore, the article maintains that a weak form of separation between purchasers and providers will lead to distorted incentives, restricting innovative behaviour and structural change. In conclusion, the process of reforming the Swedish monopolistic integrated health-care model in the direction of some form of internal market is said to rest on shaky ground.

Potential consequences of discard reform for seabird communities

NARCIS (Netherlands)

Bicknell, A.W.J.; Oro, D.; Camphuysen, K.; Votier, S.C.

2013-01-01

Upcoming reform of the European Union (EU) Common Fisheries Policy will be the biggest change in European fisheries management for a generation. A central plank of this reform is a proposed ban on discards, to aid the creation of economically and environmentally sustainable fisheries. This, together

Drug pricing reform in China: analysis of piloted approaches and potential impact of the reform

Science.gov (United States)

Chen, Yixi; Hu, Shanlian; Dong, Peng; Kornfeld, Åsa; Jaros, Patrycja; Yan, Jing; Ma, Fangfang; Toumi, Mondher

2016-01-01

Objectives In 2009, the Chinese government launched a national healthcare reform programme aiming to control healthcare expenditure and increase the quality of care. As part of this programme, a new drug pricing reform was initiated on 1 June 2015. The objective of this study was to describe the changing landscape of drug pricing policy in China and analyse the potential impact of the reform. Methods The authors conducted thorough research on the drug pricing reform using three Chinese databases (CNKI, Wanfang, and Weipu), Chinese health authority websites, relevant press releases, and pharmaceutical blogs and discussion forums. This research was complemented with qualitative research based on targeted interviews with key Chinese opinion leaders representing the authorities’ and prescribers’ perspectives. Results With the current reform, the government has attempted to replace its direct control over the prices of reimbursable drugs with indirect, incentive-driven influence. Although the exact implementation of the reform remains unclear at the moment, the changes introduced so far and the pilot project designs indicate that China is considering adaptation of some form of internal and external reference pricing policies, commonly used in the Organisation for Economic Co-operation and Development countries. Several challenges related to the potential new mechanism were identified: 1) the risk of hospital underfunding, if hospital funding reform is not prioritised; 2) the risk of promoting the use of cheap, low-quality drugs, if a reliable quality control system is not in place and discrepancy between the available drugs is present; 3) the risk of increasing disparity in access to care between poor and rich regions, in case of country-wide price convergence; and 4) the risk of industry underinvestment, resulting in reduced competition, issues with quality and sustainability of supply, and potentially negative social impact. Conclusions Foreign pricing policies

The healthcare system and the provision of oral healthcare in European Union member states. Part 8: Italy.

Science.gov (United States)

Bindi, M; Paganelli, C; Eaton, K A; Widström, E

2017-05-26

In Italy healthcare is provided for all Italian citizens and residents and it is delivered mainly by public providers, with some private or private-public entities. Italy's public healthcare system - the Servizio Sanitario Nazionale (SSN) - is organised by the Ministry of Health and administered on a devolved regional basis. It is financed by general taxation that provides universal coverage, largely free of charge at the point of service. The central government establishes the basic national health benefits package, which must be uniformly provided throughout the country, through services guaranteed under the NHS provision called LEA - (Livelli Essenziali di Assistenza [Essential Level of Assistance]) and allocates national funds to the regions. The regions, through their regional health departments, are responsible for organising, administering and delivering primary, secondary and tertiary healthcare services as well as preventive and health promotion services. Regions are allowed a large degree of autonomy in how they perform this role and regarding decisions about the local structure of the system. Complementary and supplementary private health insurance is also available. However, as in most other Mediterranean European countries, in Italy oral healthcare is mainly provided under private arrangements. The public healthcare system provides only 5-8% of oral healthcare services and this percentage varies from region to region. Oral healthcare is included in the Legislation on Essential levels of care (LEAs) for specific populations such as children, vulnerable people (medically compromised and those on low income) and individuals who need oral healthcare in some urgent/emergency cases. For other people, oral healthcare is generally not covered. Apart from the national benefits package, regions may also carry out their own initiatives autonomously, but must finance these themselves. The number of dentists working in Italy has grown rapidly in the last few years

National Health-Care Reform

Science.gov (United States)

2009-03-24

and pre/ post partum care during delivery. America should select measures that reflect the health-care goals of the nation. As an example, the Healthy...accidents (8) More than 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression ...reflect the cumulative efforts of different types of individual care. For example, infant mortality is a reflection of pre-natal care, post - natal care

Health care in China: improvement, challenges, and reform.

Science.gov (United States)

Wang, Chen; Rao, Keqin; Wu, Sinan; Liu, Qian

2013-02-01

Over the past 2 decades, significant progress has been made in improving the health-care system and people's health conditions in China. Following rapid economic growth and social development, China's health-care system is facing new challenges, such as increased health-care demands and expenditure, inefficient use of health-care resources, unsatisfying implementation of disease management guidelines, and inadequate health-care insurance. Facing these challenges, the Chinese government carried out a national health-care reform in 2009. A series of policies were developed and implemented to improve the health-care insurance system, the medical care system, the public health service system, the pharmaceutical supply system, and the health-care institution management system in China. Although these measures have shown promising results, further efforts are needed to achieve the ultimate goal of providing affordable and high-quality care for both urban and rural residents in China. This article not only covers the improvement, challenges, and reform of health care in general in China, but also highlights the status of respiratory medicine-related issues.

What triggers reforms in OECD countries? Improved reform measurement and evidence from the healthcare sector

NARCIS (Netherlands)

Wiese, Rasmus

The main contribution of this paper is the development of a novel and versatile methodology to identify economic reforms. The methodology is a combination of the Bai & Perron structural break filter, and validation of the structural breaks identified using de jure evidence of reforms. The procedure

Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis

Science.gov (United States)

Bayati, Mohsen

2018-01-01

Objectives One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Methods Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. Results In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p<0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p<0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. Conclusions The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing. PMID:29631352

The European Model Company Act

DEFF Research Database (Denmark)

Cleff, Evelyne Beatrix

2011-01-01

European Company Law regulation is currently undergoing a reform. These reforms raise a number of regulatory questions, such as what should be the aims of companies' legislation, and how these aims should best be met by regulation. Many of the reforms and discussions (both on EU and national level...... an increasing influence on the framing of company legislation, such as the choice between mandatory or default rules. This article introduces the project 'European Company Law and the choice of Regulatory Method' which is carried out in collaboration with the 'European Model Company Act Group'. The project aims...

Problem Drug Use, Marijuana, and European Projects: How Epidemiology Helped Czech Policy Reformers

Directory of Open Access Journals (Sweden)

Jan Morávek

2008-12-01

Full Text Available I examine the transfer of the Problem Drug Use (PDU concept into Czech scientific discourse through European institutions’ projects, and view PDU’s utilization by Czech researchers in relation to marijuana decriminalization efforts.PDU is defined as intravenous and/or long-term and regular use of opiates, cocaine, or amphetamines. Out of a vast array of illicit drug use patterns, this concept isolates a relatively small population with the riskiest use patterns to become the focus of public policies. A series of European Union and Council of Europe projects in 1990’s helped bring PDU into European research mainstream. The new common standard, promoted by the European Monitoring Centre for Drugs and Drug Addiction, was utilized by Czech authors in a 2001 policy analysis entitled “Impact Analysis Project of the New Drug Legislation in the Czech Republic” (PAD. PDU played a crucial role in PAD’s drug problem modeling, focusing on a “hard core” of opiate and methamphetamine users, while diverting attention from a large group of cannabis users.By using the new European methodological standard, PAD’s authors constructed marijuana as a non-problem. This helped drug policy reformers in the Czech Government legitimize their focus on “harder” drugs, and subsequently propose more lenient sanctions for the possession and cultivation of marijuana. I argue that continued ignorance of marijuana problems might jeopardize the tolerant expert-driven drug policy in the Czech Republic. Measurement of problem cannabis use should be introduced.

Prevalence of experienced abuse in healthcare and associated obstetric characteristics in six European countries.

Science.gov (United States)

Lukasse, Mirjam; Schroll, Anne-Mette; Karro, Helle; Schei, Berit; Steingrimsdottir, Thora; Van Parys, An-Sofie; Ryding, Elsa Lena; Tabor, Ann

2015-05-01

To assess the prevalence and current suffering of experienced abuse in healthcare, to present the socio-demographic background for women with a history of abuse in healthcare and to assess the association between abuse in healthcare and selected obstetric characteristics. Cross-sectional study. Routine antenatal care in six European countries. In total 6923 pregnant women. Cross-tabulation and Pearson's chi-square was used to study prevalence and characteristics for women reporting abuse in healthcare. Associations with selected obstetric factors were estimated using multiple logistic regression analysis. Abuse in healthcare, fear of childbirth and preference for birth by cesarean section. One in five pregnant women attending routine antenatal care reported some lifetime abuse in healthcare. Prevalence varied significantly between the countries. Characteristics for women reporting abuse in healthcare included a significantly higher prevalence of other forms of abuse, economic hardship and negative life events as well as a lack of social support, symptoms of post-traumatic stress and depression. Among nulliparous women, abuse in healthcare was associated with fear of childbirth, adjusted odds ratio 2.25 (95% CI 1.23-4.12) for severe abuse in healthcare. For multiparous women only severe current suffering from abuse in healthcare was significantly associated with fear of childbirth, adjusted odds ratio 4.04 (95% CI 2.08-7.83). Current severe suffering from abuse in healthcare was significantly associated with the wish for cesarean section, and counselling for fear of childbirth for both nulli- and multiparous women. Abuse in healthcare among women attending routine antenatal care is common and for women with severe current suffering from abuse in healthcare, this is associated with fear of childbirth and a wish for cesarean section. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

REFORMING THE EUROPEAN FINANCIAL AND BANKING ARCHITECTURE IN THE CRISIS CONTEXT. THE BANKING UNION CONCEPT

Directory of Open Access Journals (Sweden)

Magdalena, RADULESCU

2014-11-01

Full Text Available Deep financial crisis which started in 2007 proved to be extremely contagious affecting the financial and banking EU system. Achieving an integrated banking market is the main component of the European policy in the financial-banking services area. The latest developments underlined that the difficulties faced by the banks can negatively impact on the entire financial stability of the member states. That's why, the European Central Bank will be entitled to supervise any bank of the euro area, especially the ones that benefit of public support. Reforming the financial and banking system must be shaped in the frame of insuring some durable national finances, of an urgent recapitalizing of the banks that need that and of elaborating some common fiscal and financial and banking regulations effective in the eurozone.

Workforce flexibility - in defence of professional healthcare work.

Science.gov (United States)

Wise, Sarah; Duffield, Christine; Fry, Margaret; Roche, Michael

2017-06-19

Purpose The desirability of having a more flexible workforce is emphasised across many health systems yet this goal is as ambiguous as it is ubiquitous. In the absence of empirical studies in healthcare that have defined flexibility as an outcome, the purpose of this paper is to draw on classic management and sociological theory to reduce this ambiguity. Design/methodology/approach The paper uses the Weberian tool of "ideal types". Key workforce reforms are held against Atkinson's model of functional flexibility which aims to increase responsiveness and adaptability through multiskilling, autonomy and teams; and Taylorism which seeks stability and reduced costs through specialisation, fragmentation and management control. Findings Appeals to an amorphous goal of increasing workforce flexibility make an assumption that any reform will increase flexibility. However, this paper finds that the work of healthcare professionals already displays most of the essential features of functional flexibility but many widespread reforms are shifting healthcare work in a Taylorist direction. This contradiction is symptomatic of a failure to confront inevitable trade-offs in reform: between the benefits of specialisation and the costs of fragmentation; and between management control and professional autonomy. Originality/value The paper questions the conventional conception of "the problem" of workforce reform as primarily one of professional control over tasks. Holding reforms against the ideal types of Taylorism and functional flexibility is a simple, effective way the costs and benefits of workforce reform can be revealed.

Narrativity and the mediation of health reform agendas.

Science.gov (United States)

Hodgetts, Darrin; Chamberlain, Kerry

2003-09-01

Over the last two decades the repositioning of state-funded health systems and the increased use of private services have been the focus of extensive public debate. This paper explores the ways in which media coverage of healthcare reform is made sense of by lower socio-economic status (SES) audiences. We presented television documentaries to participants and analysed their accounts from focus group discussions following the viewing. We explore these discussions as shared social spaces within which participants work through the dilemmas posed by the reforms. In exploring reception as a storytelling process, we link audience and lay beliefs research and investigate how aspects of television coverage are appropriated by viewers to make sense of the causes and implications of healthcare reform.

Healthcare 2025 : buildings for the future

NARCIS (Netherlands)

2008-01-01

Healthcare in Europe is changing. Many countries are introducing reforms, and creating more competition and an open healthcare market. Product pricing is becoming normal; in some cases, such as the Netherlands, capital costs are becoming a component of charges. Experiments with public/private

Aspects of financial history in Romania. Reform and reformers. The financial tax reform accomplished BY Nicolae Titulescu

Directory of Open Access Journals (Sweden)

Ciobanu, R.

2012-01-01

Full Text Available This paper presents a brief history of the financial reform designed by Nicolae Titulescu at the beginning of the 1920’s. His tax reform law was formulated after thorough research of other European tax systems. He tried to implement it while he was Minister of Finance. Even though the law was adopted, it was never enacted. It met a certain amount of controversy in the Assembly of Deputies. The analysis made also tries to explain the cedular tax system.

Tax reform Ukraine: implementation mechanisms and consequences

Directory of Open Access Journals (Sweden)

J.Lebedzevіch

2015-06-01

Full Text Available In the article the main shortcomings of the existing domestic tax systems, which were the main reasons for the need for its reform in the context of integration into the European Community. Determined the first stage of reforming tax systems Ukraine, which is associated with the adoption of the Law of Ukraine «On Amendments to the Tax Code of Ukraine and laws of Ukraine». The main provisions of this legal act, revealing the essence of the mechanism for implementing tax reform. Analyzed the mechanism of implementation of tax reform by analyzing the major innovations of the Tax Code of Ukraine and their comparison with the tax «standards» that operated the implementation of tax reform 2015. Thesis there is determined a number of tax loopholes and nedoopratsyuvan conducted tax reform and their implications for payers of taxes and duties, and the need for further research and improvement. The experience of European countries towards the introduction of electronic filing and processing of tax returns.

Experiences with primary healthcare in Fuzhou, urban China, in the context of health sector reform: a mixed methods study.

Science.gov (United States)

McCollum, Rosalind; Chen, Lieping; ChenXiang, Tang; Liu, Xiaoyun; Starfield, Barbara; Jinhuan, Zheng; Tolhurst, Rachel

2014-01-01

China has recently placed increased emphasis on the provision of primary healthcare services through health sector reform, in response to inequitably distributed health services. With increasing funding for community level facilities, now is an opportune time to assess the quality of primary care delivery and identify areas in need of further improvement. A mixed methodology approach was adopted for this study. Quantitative data were collected using the Primary Care Assessment Tool-Chinese version (C-PCAT), a questionnaire previously adapted for use in China to assess the quality of care at each health facility, based on clients' experiences. In addition, qualitative data were gathered through eight semi-structured interviews exploring perceptions of primary care with health directors and a policy maker to place this issue in the context of health sector reform. The study found that patients attending community health and sub-community health centres are more likely to report better experiences with primary care attributes than patients attending hospital facilities. Generally low scores for community orientation, family centredness and coordination in all types of health facility indicate an urgent need for improvement in these areas. Healthcare directors and policy makers perceived the need for greater coordination between levels of health providers, better financial reimbursement, more formal government contracts and recognition/higher status for staff at the community level and more appropriate undergraduate and postgraduate training. Copyright © 2013 John Wiley & Sons, Ltd.

Equity in health and health care reforms.

Science.gov (United States)

Glick, S M

1999-01-01

In planning healthcare reforms increasing attention has been focused on the issue of equity. Inequities in the provision of healthcare exist even in relatively egalitarian societies. Poverty is still one of the major contributors to ill health and there are many powerful influences in society that continue to thwart the goal of a maximally equitable system for the provision of healthcare. The principles of equity in a healthcare system have been well articulated in recent years. It is incumbent on healthcare professionals who understand the issues to join the efforts towards a more humane and equitable healthcare system in their societies.

The Dynamics of Reforming the Public Administration System in Ukraine: Monitoring and Analysis of Implementation of the Reform of Decentralization of Power

Directory of Open Access Journals (Sweden)

Yaroshenko Igor V.

2017-11-01

Full Text Available The European integration choice of Ukraine, enshrined in the Association Agreement between Ukraine and the European Union, has defined the strategic direction of the country’s development for the near future. One of the main directions of the country modernization is the reform of administrative-territorial, political, public administration systems and establishment of the democratic institution of public power – the local self-government. Formation of foundations and principles of reforming the local self-government and territorial organization of power in Ukraine in accordance with the basic provisions of the European Charter of local self-government is an integral part of the national legislation in this sphere. Carrying out monitoring and analysis of the implementation of the reform of decentralization in Ukraine, as well as assessment of the level of its implementation and efficiency of functioning, identification of problematic issues and risks of implementation of the decentralization reform are very important for timely provision of recommendations for the appropriate solutions.

Newspaper advertising by health maintenance organizations during the reform of healthcare services in Israel.

Science.gov (United States)

Reuveni, H; Shvarts, S; Meyer, J; Elhayany, A; Greenberg, D

2001-06-01

On 1 January 1995 a new mandatory National Health Insurance Law was enacted in Israel. The new law fostered competition among the four major Israeli healthcare providers (HMOs or sick funds) already operating in the market due to the possibility that an unlimited number of patients and the relative budget share would shift among the HMOs. This led them to launch advertising campaigns to attract new members. To examine newspaper advertising activities during the early stages of healthcare market reform in Israel. Advertising efforts were reviewed during a study period of 24 months (July 1994 to June 1996). Advertisements were analyzed in terms of marketing strategy, costs and quality of information. During the study period 412 newspaper advertisements were collected. The total advertising costs by all HMOs was approximately US$4 million in 1996 prices. Differences were found in marketing strategy, relative advertising costs, contents and priorities among the HMOs. The content of HMOs' newspaper advertising was consistent with their marketing strategy. The messages met the criteria of persuasive advertising in that they cultivated interest in the HMOs but did not provide meaningful information about them. Future developments in this area should include consensus guidelines for advertising activities of HMOs in Israel, instruction concerning the content of messages, and standardization of criteria to report on HMO performance.

Integrated specialty service readiness in health reform: connections in haemophilia comprehensive care.

Science.gov (United States)

Pritchard, A M; Page, D

2008-05-01

The World Health Organization (WHO) has identified primary healthcare reform as a global priority whereby innovative practice changes are directed at improving health. This transformation to health reform in haemophilia service requires clarification of comprehensive care to reflect the WHO definition of health and key elements of primary healthcare reform. While comprehensive care supports effective healthcare delivery, comprehensive care must also be regarded beyond immediate patient management to reflect the broader system purpose in the care continuum with institutions, community agencies and government. Furthermore, health reform may be facilitated through integrated service delivery (ISD). ISD in specialty haemophilia care has the potential to reduce repetition of assessments, enhance care plan communication between providers and families, provide 24-h access to care, improve information availability regarding care quality and outcomes, consolidate access for multiple healthcare encounters and facilitate family self-efficacy and autonomy [1]. Three core aspects of ISD have been distinguished: clinical integration, information management and technology and vertical integration in local communities [2]. Selected examples taken from Canadian haemophilia comprehensive care illustrate how practice innovations are bridged with a broader system level approach and may support initiatives in other contexts. These innovations are thought to indicate readiness regarding ISD. Reflecting on the existing capacity of haemophilia comprehensive care teams will assist providers to connect and direct their existing strengths towards ISD and health reform.

SOCIAL POLICIES AND STRUCTURAL REFORMS IN EUROPE

Directory of Open Access Journals (Sweden)

Ferran Brunet Cid

2006-12-01

Full Text Available This paper considers the social and structural policies in contemporary Europe. The presentation is organized in four sections. First, we discuss the emerging Europe, the new unity based on democracy and the market economy, the special European Union formula, and comparisons with America. Second, we analyze the dynamics of the European economy, the convergence process, the gaps between United States in productivity and standard of living, competitiveness issues, and the emergence of a new European economy and new European policy mix.Third, we consider European social conditions, the stationary and aging population, Europe’s low employment rate and permanently high unemployment. European economic growth could draw on two major sources: the labor reserves and reforms in factor, product and service markets. In a monetary union, advanced industrial relations should promote labor mobility and salary flexibility. The social security systems permit the redistribution and cohesion which defines the European model.Fourth, for the new Europe, the structural reform strategy is the way forward for the challenge of European economic policy and social policy: more and better jobs thanks to sustainable growth in a dynamic and competitive knowledge-based economy, favoring greater social cohesion.

GP-income development in relation to recent health care reforms: an international comparison.

NARCIS (Netherlands)

Kroneman, M.; Zee, J. van der

2011-01-01

Background: Health care reforms have been introduced in several European countries in the past decade. In most countries, these reforms had (intended and unintended) consequences for the remuneration and incomes of GPs. The reforms can be grouped into two types: incremental reforms and reforms that

[A proposal for reforming psychologists' training in France and in the European Union].

Science.gov (United States)

Bouchard, J-P

2009-02-01

In France, as in the European Union, the number of psychologists continues to increase and constitutes by far the most important source of professionals in this field. The requests for services of psychologists in many various domains have also increased in an unprecedented way over a number of years. In spite of this development, which should continue to increase considerably, the initial training of psychologists remains uneven and disparate and often remote from, even unsuitable to, the legitimate expectations of users. It is therefore important to reform this training by extending, updating, homogenising and adapting it to current knowledge and needs, and by marking it by a single and specific degree: that of a doctorate. This new eight-year doctoral curriculum would be at the same time more complete and simpler than the European Diploma in Psychology model (EuroPsy), for instance. This latter is a very complicated and insufficient subject and would not completely resolve the great problems of psychologists' training and the competences they need to gain in order to access professional practise, research and teaching. This extension of the psychologists' training would make it possible to integrate new data concerning traditional fields of psychology and data concerning new fields of application of psychology and should obviously include the essential training for psychotherapies referred to the great theoretical and practical models, since their interest is clinically acknowledged (psychoanalysis and psychoanalytical therapies, cognitive and behavioural therapies, systemic therapies, therapies for individuals, couples, families, groups...). This polyreferred training would make it possible to go from a culture still too often axed on orientation and deficiencies of the therapist, to a culture of indication, opening and competence, focused on the patient's interest. Teaching of psychophysiology and neurosciences should be updated and harmonised by taking into

Changes in government spending on healthcare and population mortality in the European union, 1995-2010: a cross-sectional ecological study.

Science.gov (United States)

Budhdeo, Sanjay; Watkins, Johnathan; Atun, Rifat; Williams, Callum; Zeltner, Thomas; Maruthappu, Mahiben

2015-12-01

Economic measures such as unemployment and gross domestic product are correlated with changes in health outcomes. We aimed to examine the effects of changes in government healthcare spending, an increasingly important measure given constrained government budgets in several European Union countries. Multivariate regression analysis was used to assess the effect of changes in healthcare spending as a proportion of total government expenditure, government healthcare spending as a proportion of gross domestic product and government healthcare spending measured in purchasing power parity per capita, on five mortality indicators. Additional variables were controlled for to ensure robustness of data. One to five year lag analyses were conducted. European Union countries 1995-2010. Neonatal mortality, postneonatal mortality, one to five years of age mortality, under five years of age mortality, adult male mortality, adult female mortality. A 1% decrease in government healthcare spending was associated with significant increase in all mortality metrics: neonatal mortality (coefficient -0.1217, p = 0.0001), postneonatal mortality (coefficient -0.0499, p = 0.0018), one to five years of age mortality (coefficient -0.0185, p = 0.0002), under five years of age mortality (coefficient -0.1897, p = 0.0003), adult male mortality (coefficient -2.5398, p = 0.0000) and adult female mortality (coefficient -1.4492, p = 0.0000). One per cent decrease in healthcare spending, measured as a proportion of gross domestic product and in purchasing power parity, was both associated with significant increases (p < 0.05) in all metrics. Five years after the 1% decrease in healthcare spending, significant increases (p < 0.05) continued to be observed in all mortality metrics. Decreased government healthcare spending is associated with increased population mortality in the short and long term. Policy interventions implemented in response to the financial crisis may be associated with worsening

Healthcare mergers and acquisitions: strategies for consolidation.

Science.gov (United States)

Zuckerman, Alan M

2011-01-01

The passage of federal healthcare reform legislation, in combination with other factors, makes it likely that the next few years will be a major period of consolidation for healthcare organizations. This article examines the seven key forces reshaping healthcare delivery--from insurance industry consolidation to cost inflation to the increasing gap between financially strong and struggling providers--and provides advice for organizations on both sides of an acquisition.

It's all about the money? A qualitative study of healthcare worker motivation in urban China.

Science.gov (United States)

Millar, Ross; Chen, Yaru; Wang, Meng; Fang, Liang; Liu, Jun; Xuan, Zhidong; Li, Guohong

2017-07-07

China's healthcare reform programme continues to receive much attention. Central to these discussions has been how the various financial incentives underpinning reform efforts are negatively impacting on the healthcare workforce. Research continues to document these trends, however, qualitative analysis of how these incentives impact on the motivation of healthcare workers remains underdeveloped. Furthermore, the application of motivational theories to make sense of healthcare worker experiences has yet to be undertaken. The purpose of our paper is to present a comparative case study account of healthcare worker motivation across urban China. It draws on semi structured interviews (n = 89) with a range of staff and organisations across three provinces. In doing so, the paper analyses how healthcare worker motivation is influenced by a variety of financial incentives; how motivation is influenced by the opportunities for career development; and how motivation is influenced by the day to day pressures of meeting patient expectations. The experience of healthcare workers in China highlights how a reliance on financial incentives has challenged their ability to maintain the values and ethos of public service. Our findings suggest greater attention needs to be paid to the motivating factors of improved income and career development. Further work is also needed to nurture and develop the motivation of healthcare workers through the building of trust between fellow workers, patients, and the public. Through the analysis of healthcare worker motivation, our paper presents a number of ways China can improve its current healthcare reform efforts. It draws on the experience of other countries in calling for policy makers to support alternative approaches to healthcare reform that build on multiple channels of motivation to support healthcare workers.

The European Common Agricultural Policy on fruits and vegetables: exploring potential health gain from reform.

Science.gov (United States)

Veerman, J Lennert; Barendregt, Jan J; Mackenbach, Johan P

2006-02-01

Consumption of fruits and vegetables is associated with a reduced risk of cardiovascular disease and cancer. The European Union Common Agricultural Policy keeps prices high by limiting the availability of fruits and vegetables. This policy is at odds with public health interests. We assess the potential health gain for the Dutch population of discontinuing EU withdrawal support for fruits and vegetables. The maximum effect of the reform was estimated by assuming that a quantity equivalent to the amount of produce withdrawn in recent years would be brought onto the market. For the calculation of the effect of consumption change on health we constructed a multi-state life table model in which consumption of fruits and vegetables is linked to ischaemic heart disease, stroke, and cancer of the oesophagus, stomach, colorectum, lung and breast. Uncertainty is quantified using Monte Carlo simulation. The reform would maximally increase the average consumption of fruits and vegetables by 1.80% (95% uncertainty interval 1.12-2.73), with an ensuing increase in life expectancy of 3.8 (2.2-5.9) days for men and 2.6 (1.5-4.2) days for women. The reform is also likely to decrease socio-economic inequalities in health. Ending EU withdrawal support for fruits and vegetables could result in a modest health gain for the Dutch population, though uncertainty in the estimates is high. A more comprehensive examination of the health effects of the EU agricultural policy could help to ensure health is duly considered in decision-making.

Reforming Pensions in Europe: Economic Fundamentals and Political Factors

OpenAIRE

Ondřej Schneider

2009-01-01

This paper analyzes pension reforms in Europe and their determinants. As pension reforms are intrinsically difficult to define and pinpoint, we introduce an alternative measure of pension reforms by comparing long-term forecasts of pension expenditures for seventeen European countries. The larger the decrease in expected spending on public pensions in 2050 between two base years, the more successful a pension reform the country achieved (after controlling for other factors, such as demography...

Evaluating the medical malpractice system and options for reform.

Science.gov (United States)

Kessler, Daniel P

2011-01-01

The U.S. medical malpractice liability system has two principal objectives: to compensate patients who are injured through the negligence of healthcare providers and to deter providers from practicing negligently. In practice, however, the system is slow and costly to administer. It both fails to compensate patients who have suffered from bad medical care and compensates those who haven't. According to opinion surveys of physicians, the system creates incentives to undertake cost-ineffective treatments based on fear of legal liability--to practice "defensive medicine." The failures of the liability system and the high cost of health care in the United States have led to an important debate over tort policy. How well does malpractice law achieve its intended goals? How large of a problem is defensive medicine and can reforms to malpractice law reduce its impact on healthcare spending? The flaws of the existing system have led a number of states to change their laws in a way that would reduce malpractice liability--to adopt "tort reforms." Evidence from several studies suggests that wisely chosen reforms have the potential to reduce healthcare spending significantly with no adverse impact on patient health outcomes.

Reforming voluntary drug insurance in Russian healthcare: does social solidarity matter?

Science.gov (United States)

Gerry, Christopher J; Kaneva, Maria; Zasimova, Liudmila

2017-11-01

With low take-up of both private health insurance and the existing public drug reimbursement scheme, it is thought that less than 5% of the Russian population have access to free outpatient drug treatment. This represents a major policy challenge for a country grappling with reforms of its healthcare system and experiencing low or no economic growth and significant associated reductions in spending on social services. In this paper, we draw on data from a 2011 Levada-Center survey to examine the attitudes and social solidarity of the Russian population towards drug policies in general and towards the introduction of a proposed voluntary drug insurance system in particular. In addition to being among the first to explore these important questions in the post-Communist setting, we make three important contributions to the emerging policy debates. First, we find that, if introduced immediately and without careful planning and preparation, Russia's voluntary drug insurance scheme is likely to collapse financially due to the over-representation of high-risk unhealthy individuals opting in to the scheme. Second, the negative attitude of higher income groups towards the redistribution of wealth to the poor may further impede government efforts to introduce voluntary drug insurance. Finally, we argue that Russia currently lacks the breadth and depth of social solidarity necessary for implementing this form of health financing. Copyright © 2017 Elsevier B.V. All rights reserved.

Migrants' access to healthcare services within the European Union: a content analysis of policy documents in Ireland, Portugal and Spain.

Science.gov (United States)

Ledoux, Céline; Pilot, Eva; Diaz, Esperanza; Krafft, Thomas

2018-06-15

The current migration flow into Europe is leading to a growing ethnically diverse population in many European countries. Now more than ever, those populations have different healthcare needs, languages, traditions, and previous level of care. This higher level of diversity is likely to increase health inequalities that might challenge healthcare systems if not addressed. In this context, this study aims at reviewing the policy framework for migrants' access to healthcare in Spain, Portugal and Ireland, countries with a long history of immigration, to identify lessons to be learned for policies on migrants' health. A content analysis of official policy documents was undertaken and the conceptual framework developed by Mladowsky was adapted to classify the actions indicated in the policies. The content analysis revealed that the policy aim for all three analysed countries is the improvement of the health status of the immigrant population based on equity and equality principles. The main strategies are the adaptation of services through actions targeting patients and providers, such as the implementation of cultural mediators and trainings for health professionals. The three countries propose a great range of policies aiming at improving access to healthcare services for immigrants that can inspire other European countries currently welcoming refugees. Developing inclusive policies, however does not necessarily mean they will be implemented or felt on the ground. Inclusive policies are indeed under threat due to the economic and social crises and due to the respective nationalistic attitudes towards integration. The European Union is challenged to take a more proactive leadership and ensure that countries effectively implement inclusive actions to improve migrant's access to health services.

Concordance between European and US case definitions of healthcare-associated infections

Science.gov (United States)

2012-01-01

Background Surveillance of healthcare-associated infections (HAI) is a valuable measure to decrease infection rates. Across Europe, inter-country comparisons of HAI rates seem limited because some countries use US definitions from the US Centers for Disease Control and Prevention (CDC/NHSN) while other countries use European definitions from the Hospitals in Europe Link for Infection Control through Surveillance (HELICS/IPSE) project. In this study, we analyzed the concordance between US and European definitions of HAI. Methods An international working group of experts from seven European countries was set up to identify differences between US and European definitions and then conduct surveillance using both sets of definitions during a three-month period (March 1st -May 31st, 2010). Concordance between case definitions was estimated with Cohen’s kappa statistic (κ). Results Differences in HAI definitions were found for bloodstream infection (BSI), pneumonia (PN), urinary tract infection (UTI) and the two key terms “intensive care unit (ICU)-acquired infection” and “mechanical ventilation”. Concordance was analyzed for these definitions and key terms with the exception of UTI. Surveillance was performed in 47 ICUs and 6,506 patients were assessed. One hundred and eighty PN and 123 BSI cases were identified. When all PN cases were considered, concordance for PN was κ = 0.99 [CI 95%: 0.98-1.00]. When PN cases were divided into subgroups, concordance was κ = 0.90 (CI 95%: 0.86-0.94) for clinically defined PN and κ = 0.72 (CI 95%: 0.63-0.82) for microbiologically defined PN. Concordance for BSI was κ = 0.73 [CI 95%: 0.66-0.80]. However, BSI cases secondary to another infection site (42% of all BSI cases) are excluded when using US definitions and concordance for BSI was κ = 1.00 when only primary BSI cases, i.e. Europe-defined BSI with ”catheter” or “unknown” origin and US-defined laboratory-confirmed BSI (LCBI), were

Concordance between European and US case definitions of healthcare-associated infections

Directory of Open Access Journals (Sweden)

Hansen Sonja

2012-08-01

Full Text Available Abstract Background Surveillance of healthcare-associated infections (HAI is a valuable measure to decrease infection rates. Across Europe, inter-country comparisons of HAI rates seem limited because some countries use US definitions from the US Centers for Disease Control and Prevention (CDC/NHSN while other countries use European definitions from the Hospitals in Europe Link for Infection Control through Surveillance (HELICS/IPSE project. In this study, we analyzed the concordance between US and European definitions of HAI. Methods An international working group of experts from seven European countries was set up to identify differences between US and European definitions and then conduct surveillance using both sets of definitions during a three-month period (March 1st -May 31st, 2010. Concordance between case definitions was estimated with Cohen’s kappa statistic (κ. Results Differences in HAI definitions were found for bloodstream infection (BSI, pneumonia (PN, urinary tract infection (UTI and the two key terms “intensive care unit (ICU-acquired infection” and “mechanical ventilation”. Concordance was analyzed for these definitions and key terms with the exception of UTI. Surveillance was performed in 47 ICUs and 6,506 patients were assessed. One hundred and eighty PN and 123 BSI cases were identified. When all PN cases were considered, concordance for PN was κ = 0.99 [CI 95%: 0.98-1.00]. When PN cases were divided into subgroups, concordance was κ = 0.90 (CI 95%: 0.86-0.94 for clinically defined PN and κ = 0.72 (CI 95%: 0.63-0.82 for microbiologically defined PN. Concordance for BSI was κ = 0.73 [CI 95%: 0.66-0.80]. However, BSI cases secondary to another infection site (42% of all BSI cases are excluded when using US definitions and concordance for BSI was κ = 1.00 when only primary BSI cases, i.e. Europe-defined BSI with ”catheter” or “unknown” origin and US-defined laboratory-confirmed BSI

Redefining Health: Implication for Value-Based Healthcare Reform.

Science.gov (United States)

Putera, Ikhwanuliman

2017-03-02

Health definition consists of three domains namely, physical, mental, and social health that should be prioritized in delivering healthcare. The emergence of chronic diseases in aging populations has been a barrier to the realization of a healthier society. The value-based healthcare concept seems in line with the true health objective: increasing value. Value is created from health outcomes which matter to patients relative to the cost of achieving those outcomes. The health outcomes should include all domains of health in a full cycle of care. To implement value-based healthcare, transformations need to be done by both health providers and patients: establishing true health outcomes, strengthening primary care, building integrated health systems, implementing appropriate health payment schemes that promote value and reduce moral hazards, enabling health information technology, and creating a policy that fits well with a community.

Redefining Health: Implication for Value-Based Healthcare Reform

OpenAIRE

Putera, Ikhwanuliman

2017-01-01

Health definition consists of three domains namely, physical, mental, and social health that should be prioritized in delivering healthcare. The emergence of chronic diseases in aging populations has been a barrier to the realization of a healthier society. The value-based healthcare concept seems in line with the true health objective: increasing value. Value is created from health outcomes which matter to patients relative to the cost of achieving those outcomes. The health outcomes should ...

Engineering the system of healthcare delivery

National Research Council Canada - National Science Library

Rouse, William B; Cortese, Denis A

2010-01-01

"As the United States continues to debate reform of its healthcare system, this book argues that providing health insurance for all without improving the delivery system will not improve the current...

Interconnections between economic subsystems and the IT innovation in avoiding unpredictable effects of finance reforms in East-European Countries

Directory of Open Access Journals (Sweden)

Teodora ALECU

2009-07-01

Full Text Available The tax measures are rapidly changing in East-European countries. The permanence is a concept rarely put in practice. The changes of fiscal policy are usually important, affecting the whole finance system and the investors need to adapt to these various changes. Under such circumstances, the management of information of any kind regarding the activity of investors becomes very important, the information gathered represent a statistic proof of the effects of the economic and finance reforms.

Welfare Reform and Health

Science.gov (United States)

Bitler, Marianne P.; Gelback, Jonah B.; Hoynes, Hilary W.

2005-01-01

A study of the effect of state and federal welfare reforms over the period 1990-2000 on health insurance coverage and healthcare utilization by single women aged between 20-45 is presented. It is observed that Personal Responsibility and Work Opportunity Act of 1996 which replaced the Aid to Families with Dependent Children program of 1990s with…

F-Word or Blueprint for Institutional Reform? European Integration and the Continued Relevance of Federalism

Directory of Open Access Journals (Sweden)

Maximilian Conrad

2012-12-01

Full Text Available Federalist thought has historically been an important source of inspiration in European integration. Although the last few decades have witnessed a gradual decline of the concept’s relevance, the most recent developments in the wake of the Eurozone debt crisis have drawn renewed attention to shortcomings in the European Union’s institutional architecture as well as to the feasibility of federal solutions to such institutional shortcomings. This article explores the potential of federalist thought as a blueprint for institutional reform in the EU. Based on a brief introduction to the concept of federalism, the article contextualizes federalism in debates on the democratic deficit, the EU’s sources of legitimacy and the relationship between the union institutions and the member states. If shortcomings in institutional design are the source of the current (and future crises, then closer attention needs to be paid to the costs and benefits of federal reorganization in terms of democracy, legitimacy and sovereignty, particularly from the perspective of small states in the EU. Federal reorganization would not only improve the democratic character of EU decision making, but also strengthen the role of small states in the union. However, it also prompts a number of thorny questions, most importantly regarding the construction of a European demos and its relationship to deeply engrained ideas about the nation state as a more or less natural home of democracy.

Strengthening revenue cycle capabilities in an era of reform.

Science.gov (United States)

Glaser, John

2011-05-01

Strategies that healthcare finance professionals should incorporate to help their organizations respond effectively to payment reforms include: Assessing the organization's ability to capture and share relevant data. Educating themselves, the board of trustees, and the medical staff on pertinent rules as payment reforms are rolled out. Examining inefficiencies related to care processes. Establishing policies and procedures to address "commingled" data.

What direction for the European Council? Institutional reforms and counter-reforms in EU

Directory of Open Access Journals (Sweden)

Gheorghe Ciascai

2012-12-01

Full Text Available The aim of this paper is to analyse the political and institutional impact of the juridical consecration of the European Council that official institution of European Union by the Lisbon Treaty. Until 1 December 2009, the European Council was a political body with a strong informal role within the european decision making process, but with ambiguous institutional and legal powers. After entry in force of the Lisbon Treaty, European Council becomes an institution that try to exercise a collective leadership in EU.

Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need.

Directory of Open Access Journals (Sweden)

Jens Detollenaere

Full Text Available Access to healthcare is inequitably distributed across different socioeconomic groups. Several vulnerable groups experience barriers in accessing healthcare, compared to their more wealthier counterparts. In response to this, many countries use resources to strengthen their primary care (PC system, because in many European countries PC is the first entry-point to the healthcare system and plays a central role in the coordination of patients through the healthcare system. However it is unclear whether this strengthening of PC leads to less inequity in access to the whole healthcare system. This study investigates the association between strength indicators of PC and inequity in unmet need by merging data from the European Union Statistics on Income and Living Conditions database (2013 and the Primary Healthcare Activity Monitor for Europe (2010. The analyses reveal a significant association between the Gini coefficient for income inequality and inequity in unmet need. When the Gini coefficient of a country is one SD higher, the social inequity in unmet need in that particular country will be 4.960 higher. Furthermore, the accessibility and the workforce development of a country's PC system is inverse associated with the social inequity of unmet need. More specifically, when the access- and workforce development indicator of a country PC system are one standard deviation higher, the inequity in unmet healthcare needs are respectively 2.200 and 4.951 lower. Therefore, policymakers should focus on reducing income inequality to tackle inequity in access, and strengthen PC (by increasing accessibility and better-developing its workforce as this can influence inequity in unmet need.

Elite Decision Makers’ Strategic Use of European Integration and Globalisation Discourses

DEFF Research Database (Denmark)

Lynggaard, Kennet

2013-01-01

This article investigates decision makers’ strategic use of European integration and globalisation discourses to justify and coordinate national sector reforms. This is done using the example of banking sector reforms in two small European Union (EU) member states, Ireland and Denmark. Two key...... in line with European integration measures, even in the absence of national commitment to the latter. Discourses of globalisation have thus become ‘the last resort’ for Danish decision makers in justifying and coordinating reforms that are in line with EU regulations and recommendations....

Connectivity for Healthcare and Well-Being Management: Examples from Six European Projects

Directory of Open Access Journals (Sweden)

Ulises Cortes

2009-07-01

Full Text Available Technological advances and societal changes in recent years have contributed to a shift in traditional care models and in the relationship between patients and their doctors/carers, with (in general an increase in the patient-carer physical distance and corresponding changes in the modes of access to relevant care information by all groups. The objective of this paper is to showcase the research efforts of six projects (that the authors are currently, or have recently been, involved in, CAALYX, eCAALYX, COGKNOW, EasyLine+, I2HOME, and SHARE-it, all funded by the European Commission towards a future where citizens can take an active role into managing their own healthcare. Most importantly, sensitive groups of citizens, such as the elderly, chronically ill and those suffering from various physical and cognitive disabilities, will be able to maintain vital and feature-rich connections with their families, friends and healthcare providers, who can then respond to, and prevent, the development of adverse health conditions in those they care for in a timely manner, wherever the carers and the people cared for happen to be.

Connectivity for Healthcare and Well-Being Management: Examples from Six European Projects

Science.gov (United States)

Kamel Boulos, Maged N.; Lou, Ricardo Castellot; Anastasiou, Athanasios; Nugent, Chris D.; Alexandersson, Jan; Zimmermann, Gottfried; Cortes, Ulises; Casas, Roberto

2009-01-01

Technological advances and societal changes in recent years have contributed to a shift in traditional care models and in the relationship between patients and their doctors/carers, with (in general) an increase in the patient-carer physical distance and corresponding changes in the modes of access to relevant care information by all groups. The objective of this paper is to showcase the research efforts of six projects (that the authors are currently, or have recently been, involved in), CAALYX, eCAALYX, COGKNOW, EasyLine+, I2HOME, and SHARE-it, all funded by the European Commission towards a future where citizens can take an active role into managing their own healthcare. Most importantly, sensitive groups of citizens, such as the elderly, chronically ill and those suffering from various physical and cognitive disabilities, will be able to maintain vital and feature-rich connections with their families, friends and healthcare providers, who can then respond to, and prevent, the development of adverse health conditions in those they care for in a timely manner, wherever the carers and the people cared for happen to be. PMID:19742164

Patient charges for health services: the opinions of healthcare stakeholders in Bulgaria.

Science.gov (United States)

Atanasova, Elka; Pavlova, Milena; Moutafovа, Emanuela; Kostadinova, Todorka; Groot, Wim

2015-01-01

The reforms of the Bulgarian healthcare sector have been widely discussed, both nationally and internationally. In spite of the reforms, problems with the efficiency, equity and quality in healthcare provision continue to exist in Bulgaria. Among others, the reforms included the implementation of formal patient charges for the use of healthcare services. These were established in the country in 2000. Formal patient charges are applied to all levels of medical services with the exception of emergency care. The aim of this paper is to describe and analyze the attitudes of Bulgarian healthcare stakeholders toward patient charges. The analysis is based on data collected in focus group discussions and in-depth interviews carried out in Bulgaria in May-June 2009. The paper concludes by recommendations for policies related to patient payments. The social sensitivity of these payments requires broad discussion before policy decisions are implemented. There is also a need of a well-thought communication strategy on the issue of patient payments by the Ministry of Health. Copyright © 2013 John Wiley & Sons, Ltd.

A critical assessment of the European approach to financial reforms

Directory of Open Access Journals (Sweden)

Mario Tonveronachi

2011-01-01

Full Text Available The paper offers a critical assessment of the financial reforms adopted or proposed at the European level. The reshaping of the EU institutional architecture and the adoption of the new Basel 3 rules should reduce the national margins of discretion that have up to now characterised supervisory practices, often leading to light touch supervision, and restrain the growth of bankarisation, hence excessive systemic leveraging. However, the limitations of a purely prudential approach to regulation may not be overcome by setting up new institutions and make prudential requirements more stringent. In addition, given unavoidable national banking specificities, more severe rulebooks homogenously applied across the EU countries could further worsen the inconsistencies of a one-size-fits-all rule. The criticisms directed at the new regulatory framework assume particular relevance in the EU, whose peculiar construction requires that the financial sector should not be permitted to jeopardise its critical fiscal equilibrium. This opens the way to the adoption of structural measures, as the one presented by the Vickers Commission on ring-fencing. Looking at the financial system as a whole, we argue that even these measures do not offer effective protection for the economy and tax-payers, and that much more radical interventions are needed.

Health care reform: preparing the psychology workforce.

Science.gov (United States)

Rozensky, Ronald H

2012-03-01

This article is based on the opening presentation by the author to the Association of Psychologists in Academic Health Centers' 5th National Conference, "Preparing Psychologists for a Rapidly Changing Healthcare Environment" held in March, 2011. Reviewing the patient protection and affordable care act (ACA), that presentation was designed to set the stage for several days of symposia and discussions anticipating upcoming changes to the healthcare system. This article reviews the ACA; general trends that have impacted healthcare reform; the implications of the Act for psychology's workforce including the growing focus on interprofessional education, training, and practice, challenges to address in order to prepare for psychology's future; and recommendations for advocating for psychology's future as a healthcare profession.

Hospital reform and staff morale in South Africa: a case study of Dr ...

African Journals Online (AJOL)

2012-02-16

Feb 16, 2012 ... Settings and subjects: This study included all medical and nursing staff working at ... Keywords: hospital reform, staff morale, quality of care, healthcare resources ..... of healthcare workers' goals to cure patients.3 This differs.

Unemployment, public-sector health-care spending and breast cancer mortality in the European Union: 1990-2009.

Science.gov (United States)

Maruthappu, Mahiben; Watkins, Johnathan A; Waqar, Mueez; Williams, Callum; Ali, Raghib; Atun, Rifat; Faiz, Omar; Zeltner, Thomas

2015-04-01

The global economic crisis has been associated with increased unemployment, reduced health-care spending and adverse health outcomes. Insights into the impact of economic variations on cancer mortality, however, remain limited. We used multivariate regression analysis to assess how changes in unemployment and public-sector expenditure on health care (PSEH) varied with female breast cancer mortality in the 27 European Union member states from 1990 to 2009. We then determined how the association with unemployment was modified by PSEH. Country-specific differences in infrastructure and demographic structure were controlled for, and 1-, 3-, 5- and 10-year lag analyses were conducted. Several robustness checks were also implemented. Unemployment was associated with an increase in breast cancer mortality [P unemployment rises (P unemployment and breast cancer mortality remained in all robustness checks. Rises in unemployment are associated with significant short- and long-term increases in breast cancer mortality, while increases in PSEH are associated with reductions in breast cancer mortality. Initiatives that bolster employment and maintain total health-care expenditure may help minimize increases in breast cancer mortality during economic crises. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Energy policies in the European Union. Germany's ecological tax reform

International Nuclear Information System (INIS)

Welfens, P.J.J.; Jungmittag, A.; Meyer, B.; Jasinski, P.

2001-01-01

The chapters discuss the following aspects: 1. Energy policy as a strategic element of economic policy in dynamic open economies. 2. Phasing out nuclear energy and core elements of sustainable energy strategy. 3. Ecological tax reform: Theory, modified double dividend and international aspects. 4. The policy framework in Europe and Germany. 5. Optimal ecological tax reform: Options and recommendations for an EU-action plan. 6. Conclusions. (orig./CB)

What Is the “China Model” of Financial Reform?

Institute of Scientific and Technical Information of China (English)

应展宇

2008-01-01

Based on a comparative study of China’s three-decade financial system reform and the financial reform model of Russia and selected Eastern European countries, we found noticeable discrepancies between China and other transitional countries in respect to objective setting, path and sequence selection, power sources and advancement strategy. We conclude that a "China model" of nancial system reform does exist. The formation and evolution of the "China model" is closely related to China’s special political and economic environment. More importantly, it is significantly influenced by China’s overall economic reform model as well.

The electoral feedback effects of welfare reform in mature European welfare states

DEFF Research Database (Denmark)

Arndt, Christoph

2012-01-01

The electoral hazard of welfare state reforms in mature welfare states has been a widely acknowledged feedback effect in the literature. However, the literature does typically no distinct between party families when it comes to the electoral consequences of welfare state reforms and treats...... electorates as unity. This paper analysis the feedback effects of social policy retrenchment under Third Way social democracy since 1994. The paper argues that Third Way reforms resulted in lasting electoral setback for social democracy since these reforms went against the social policy preferences of social....... The restructuring of mature Western welfare states thus accounts for changing patterns of political behaviour as a consequence of policy feedback....

Reforming the European Scene

Directory of Open Access Journals (Sweden)

Joseph Ezra Bigio

2010-10-01

Full Text Available An unbridled globalization based on a simple premise about earnings and profit may be detrimental to the livelihood of many thousands of individuals. The greed and utter selfishness that result from the adherence to this sort of business practice are the two things that generate more unemployment, misery and degradation than most other characteristics of the human species. These considerations present the challenge for Western societies and call for the implementation of other principles, standards and procedures, such as cooperation, cohesion, development objectives and social responsibility. In the first part of the paper this approach is tested in the case of the EU-US foreign exchange relationships. The second part of the paper raises more general and fundamental issues. While adhering to the Schumpeter-type innovation environment, it aims to introduce the social dimension ahead of the immediate competitiveness and, therefore, argues for the fundamental reform of the catechism of the capitalist manager. The EU, due to its advanced integration, is relatively well-equipped to move towards the new economic system.  

Narrating health and scarcity: Guyanese healthcare workers, development reformers, and sacrifice as solution from socialist to neoliberal governance.

Science.gov (United States)

Walker, Alexis

2017-08-01

In oral history interviews, Guyanese healthcare workers emphasize continuity in public health governance throughout the late twentieth century, despite major shifts in broader systems of governance during this period. I argue that these healthcare workers' recollections reflect long-term scarcities and the discourses through which both socialist politicians and neoliberal reformers have narrated them. I highlight the striking similarities in discourses of responsibility and efficiency advanced by socialist politicians in 1970s Guyana and by World Bank representatives designing the country's market transition in the late 1980s, and the ways these discourses have played out in Guyana's health system. Across diverging ideologies, politicians and administrators have promoted severe cost-control as the means to a more prosperous future, presenting short-term pains as necessary to creating new, better, leaner ways of life. In the health sector this has been enacted through a focus on self-help, and on nutrition as a tool available without funds dedicated for pharmaceuticals, advanced medical technologies, or a fully staffed public health system. I argue that across these periods Guyanese citizens have been offered a very similar recipe of ongoing sacrifice. I base my analysis on oral histories with forty-six healthcare workers conducted between 2013 and 2015 in Guyana in Regions 3, 4, 5, 9, and 10, as well as written records from World Bank and Guyanese national archives; I analyze official discourses as well as recollections and experiences of public health governance by those working in Guyana's health system. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Analysis of Public Administration Reforms in Macedonia and the Evaluation of the Performance of Public Administration by the European Commission

OpenAIRE

Abdula Azizi

2011-01-01

The objective of this paper is to underline the deficiencies in the funcioning of Public Administration in the Republic of Macedonia. The issue of Public Administration reforms in Macedonia has been dealt with by other scholars, but the European Commission reports have not been analyzed years after receiving the status of candidate country for EU membership. The results will reflect the realistic assessments and objective perceptions of citizens about the functioning of Public Administration,...

Examining quality and efficiency of the U.S. healthcare system.

Science.gov (United States)

Kumar, Sameer; Ghildayal, Neha S; Shah, Ronak N

2011-01-01

The fundamental concern of this research study is to learn the quality and efficiency of U.S. healthcare services. It seeks to examine the impact of quality and efficiency on various stakeholders to achieve the best value for each dollar spent for healthcare. The study aims to offer insights on quality reformation efforts, contemporary healthcare policy and a forthcoming change shaped by the Federal healthcare fiscal policy and to recommend the improvement objective by comparing the U.S. healthcare system with those of other developed nations. The US healthcare system is examined utilizing various data on recent trends in: spending, budgetary implications, economic indicators, i.e., GDP, inflation, wage and population growth. Process maps, cause and effect diagrams and descriptive data statistics are utilized to understand the various drivers that influence the rising healthcare cost. A proposed cause and effect diagram is presented to offer potential solutions, for significant improvement in U.S. healthcare. At present, the US healthcare system is of vital interest to the nation's economy and government policy (spending). The U.S. healthcare system is characterized as the world's most expensive yet least effective compared with other nations. Growing healthcare costs have made millions of citizens vulnerable. Major drivers of the healthcare costs are institutionalized medical practices and reimbursement policies, technology-induced costs and consumer behavior. Reviewing many articles, congressional reports, internet websites and related material, a simplified process map of the US healthcare system is presented. The financial process map is also created to further understand the overall process that connects the stakeholders in the healthcare system. Factors impacting healthcare are presented by a cause and effect diagram to further simplify the complexities of healthcare. This tool can also be used as a guide to improve efficiency by removing the "waste" from the

Re(De-Forming public administration: an expert outlook on reform planning in Romania

Directory of Open Access Journals (Sweden)

Diana-Camelia IANCU

2012-08-01

Full Text Available It has been argued that the West with its well-established democracies was largely responsible for the filling of the institutional vacuum the East experienced after the fall of totalitarian regimes in the eve of the 90s. Scholars of international relations and public policies loudly debated on the existent causality between the European enlargement and the administrative reforms Central and Eastern European countries experienced in the last two decades. Be it in the form of soft or hard law, financial aid or penalties, Western norms were supposed to have been transferred to acceding countries in a rather alert tempo, and with a high(er rate of compliance success. This research builds on these arguments without yet embracing them completely and tackles the issue of Western values successful transfer to public administration reform planning in Romania. The main question it attempts to answer is to what extent substantial compliance to the European expectations for building a consolidated public administration was achieved. In doing so, it compares formal national discourses of successful public administration reform with personal experiences of Romanian public managers, four years after Romania’s accession to the European Union. Between 2005 and 2008, the Romanian Government acknowledged the need for developing a highly professional, apolitical category of civil servants later to be called “public managers”. These managers, young people that were offered Governmental grants to train themselves in Western universities, were supposed to guide national reforms from the inside of the system. Their informal role was to use their Western academic and training experiences and place them against the national background so as to plan and execute a “good” public administration reform. Was this achieved? What were the intervening factors? The interviews performed on public managers from central government organizations are placed against the

The telecom reform process in Europe and the upcoming challenges

DEFF Research Database (Denmark)

Henten, Anders

2013-01-01

of the whole information communications technology (ICT) area requiring new policy and regulatory answers. Originality/value – The paper provides a brief introduction to the European telecommunication reform process, its achievements, present challenges, and the policy responses of the European Union......Purpose – The purpose of this paper is to provide a brief introduction to the telecommunication reform process in Europe, its status, and upcoming policy issues. Furthermore, it also aims to provide an overview of the papers in this special issue. Design/methodology/approach – The paper provides...

The PERSIAN Cohort: Providing the Evidence Needed for Healthcare Reform.

Science.gov (United States)

Eghtesad, Sareh; Mohammadi, Zahra; Shayanrad, Amaneh; Faramarzi, Elnaz; Joukar, Farahnaz; Hamzeh, Behrooz; Farjam, Mojtaba; Zare Sakhvidi, Mohammad Javad; Miri-Monjar, Mohammadreza; Moosazadeh, Mahmood; Hakimi, Hamid; Rahimi Kazerooni, Salar; Cheraghian, Bahman; Ahmadi, Ali; Nejatizadeh, Azim; Mohebbi, Iraj; Pourfarzi, Farhad; Roozafzai, Farzin; Motamed-Gorji, Nazgol; Montazeri, Seyed Ali; Masoudi, Sahar; Amin-Esmaeili, Masoumeh; Danaie, Navid; Mirhafez, Seyed Reza; Hashemi, Hasan; Poustchi, Hossein; Malekzadeh, Reza

2017-11-01

In the past, communicable diseases caused the highest mortality in Iran. Improvements in socioeconomic status and living standards including access to safe drinking water, along with the inception of Health Houses in the 1980s, have changed disease patterns, decreasing the spread of and deaths from infectious and communicable diseases. The incidence and prevalence of non-communicable diseases (NCD), however, have now increased in Iran, accounting for nearly 80% of deaths and disabilities. Without interventions, NCD are predicted to impose a substantial human and economic burden in the next 2 decades. However, Iran's health system is not equipped with the necessary policies to combat this growth and must refocus and reform. Therefore, in the year 2013, the Ministry of Health and Medical Education funded a well-designed nationwide cohort study-Prospective Epidemiological Research Studies in IrAN (PERSIAN)-in order to assess the burden of NCD and investigate the risk factors associated with them in the different ethnicities and geographical areas of Iran. The PERSIAN Cohort, which aims to include 200000 participants, has 4 components: Adult (main), Birth, Youth and Elderly, which are being carried out in 22 different regions of Iran. Having an enormous dataset along with a biobank of blood, urine, hair and nail samples, the PERSIAN Cohort will serve as an important infrastructure for future implementation research and will provide the evidence needed for new healthcare policies in order to better control, manage and prevent NCD. Copyright © 2017 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

Welfare reform in European countries

DEFF Research Database (Denmark)

Immervoll, Herwig; Kleven, Henrik Jacobsen; Kreiner, Claus Thustrup

2007-01-01

This article compares the effects of increasing traditional welfare to introducing in-work benefits in the 15 (pre-enlargement) countries of the European Union. We use a labour supply model encompassing responses to taxes and transfers along both the intensive and extensive margins, and the EUROMOD...

The Danish National Reform Programme 2005 and the gender aspect of the Danish Employment Strategy

DEFF Research Database (Denmark)

Emerek, Ruth

This assessment of the gender aspect of the Danish Employment Strategy in the National Reform Programme 2005 form along with assessments from the other European-member states the basis for the synthesis report The National Reform programme 2005 and the gender aspect of the European Employment...... Strategy prepared for the Equality Unit in the European Commission by Jill Rubery et al. It is part of the work of the EU expert group on Gender, Social Inclusion and Employment (EGGSIE)....

Achieving compliance with healthcare waste management regulations : empirical evidence from small European healthcare units

OpenAIRE

Botelho, Anabela

2011-01-01

Healthcare units generate substantial amounts of hazardous or potentially hazardous wastes as by-products of their medical services. The inappropriate management of these wastes poses significant risks to people and the environment. In Portugal, as in other EU countries, the collection, storage, treatment and disposal of healthcare waste is regulated by law. Although legal provisions covering the safe management of healthcare waste date back to the 1990s, little is known about the compliance ...

Perceived Impact of Health Sector Reform on Motivation of Health ...

African Journals Online (AJOL)

Perceived Impact of Health Sector Reform on Motivation of Health Workers and Quality of Health Care in Tanzania: the Perspectives of Healthcare Workers and District Council Health Managers in Four Districts.

Point Climat no. 22 'Reform of the Common Agricultural Policy is laying the initial foundations for a European agricultural climate policy'

International Nuclear Information System (INIS)

Foucherot, Claudine; Bellassen, Valentin

2012-01-01

Among the publications of CDC Climat Research, 'Climate Briefs' presents, in a few pages, hot topics in climate change policy. This issue addresses the following points: The Common Agricultural Policy (CAP) has had a very small climate component since 1992. The recent inclusion of green payments and the climate risk management tools proposed for the CAP for the period beyond 2013 illustrate the European Commission's willingness to expand this climate component. Furthermore, there is little mention of the agricultural sector in the tools rolled out by the European climate policy, particularly those derived from the 2009 'Climate and Energy' Package. Therefore, even if this autumn's parliamentary debate results in the reform proposals being diluted, the post-2013 CAP could nevertheless become a principal tool for a common EU climate policy in the agricultural sector

Realizing the European Higher Education Area: Berlin Conference of European Higher Education Ministers

Science.gov (United States)

European Education, 2004

2004-01-01

The Bologna Declaration of June 1999 has put in motion a series of reforms needed to make European higher education more compatible and comparable, more competitive and attractive for European citizens and for citizens and scholars from other continents. In Prague, in May 2001, the ministers took note of the progress so far and added three new…

Railway Reform in Germany: Restructuring, Service Contracts, and Infrastructure Charges

OpenAIRE

Peter, Benedikt

2008-01-01

We analyse the reform process in the German railway sector. We take a look at the process and the outcome of the reform and compare it with the theoretical findings. The regionalisation of the regional rail passenger services is of a special importance to us. We scrutinise the contracts for the provision of these services and try to find interrelations between the different contract elements. A further emphasis is placed on the influence of the European Commission on the reform process. We an...

How Is European Governance Configuring the EHEA?

Science.gov (United States)

Magalhães, António; Veiga, Amélia; Sousa, Sofia; Ribeiro, Filipa

2012-01-01

This article focuses on the interaction between the European dimension driven by the creation of the European Higher Education Area (EHEA) and the development of national reforms to fulfil that objective. On the basis of data gathered in eight countries involved in EuroHESC project TRUE (Transforming European Universities), the curricular and the…

Financing healthcare in Gulf Cooperation Council countries: a focus on Saudi Arabia.

Science.gov (United States)

Alkhamis, Abdulwahab; Hassan, Amir; Cosgrove, Peter

2014-01-01

This paper presents an analysis of the main characteristics of the Gulf Cooperation Council's (GCC) health financing systems and draws similarities and differences between GCC countries and other high-income and low-income countries, in order to provide recommendations for healthcare policy makers. The paper also illustrates some financial implications of the recent implementation of the Compulsory Employment-based Health Insurance (CEBHI) system in Saudi Arabia. Employing a descriptive framework for the country-level analysis of healthcare financing arrangements, we compared expenditure data on healthcare from GCC and other developing and developed countries, mostly using secondary data from the World Health Organization health expenditure database. The analysis was supported by a review of related literature. There are three significant characteristics affecting healthcare financing in GCC countries: (i) large expatriate populations relative to the national population, which leads GCC countries to use different strategies to control expatriate healthcare expenditure; (ii) substantial government revenue, with correspondingly high government expenditure on healthcare services in GCC countries; and (iii) underdeveloped healthcare systems, with some GCC countries' healthcare indicators falling below those of upper-middle-income countries. Reforming the mode of health financing is vital to achieving equitable and efficient healthcare services. Such reform could assist GCC countries in improving their healthcare indicators and bring about a reduction in out-of-pocket payments for healthcare. © 2013 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.

Evidence-based health policy: three generations of reform in Mexico.

Science.gov (United States)

Frenk, Julio; Sepúlveda, Jaime; Gómez-Dantés, Octavio; Knaul, Felicia

2003-11-15

The Mexican health system has evolved through three generations of reform. The creation of the Ministry of Health and the main social security agency in 1943 marked the first generation of health reforms. In the late 1970s, a second generation of reforms was launched around the primary health-care model. Third-generation reforms favour systemic changes to reorganise the system through the horizontal integration of basic functions-stewardship, financing, and provision. The stability of leadership in the health sector is emphasised as a key element that allowed for reform during the past 60 years. Furthermore, there has been a transition in the second generation of reforms to a model that is increasingly based on evidence; this has been intensified and extended in the third generation of reforms. We also examine policy developments that will provide social protection in health for all. These developments could be of interest for countries seeking to provide their citizens with universal access to health care that incorporates equity, quality, and financial protection.

Environmental fiscal reforms

OpenAIRE

Ashish Chaturvedi; Manjeet S. Saluja; Abhijit Banerjee; Rachna Arora

2014-01-01

The paper presents concepts and instruments of environmental fiscal reforms (EFR) and their application in the Indian context. EFR can lead to environmental improvement more efficiently and cost effectively than traditional regulation. There is substantial experience of successful EFR implementation in the European Union. India has also adopted some EFR measures such as deregulation of petrol prices, coal cess, and subsidy for setting up common effluent treatment plants. The challenges of imp...

Understanding the failure of health-care exceptionalism in the Supreme Court's Obamacare decision.

Science.gov (United States)

Moncrieff, Abigail R

2012-09-01

On June 28, 2012, a mere century after the first presidential proposal for national health insurance, the Supreme Court issued a resounding victory for President Obama and for health-care reform generally, upholding the Patient Protection and Affordable Care Act against a serious constitutional challenge. Nevertheless, the Court also struck a potential blow to future health-care reform efforts in refusing to accept the solicitor general's argument that health care is a unique market with unique regulatory needs that justify special constitutional treatment. The failure of health-care exceptionalism in the Court's opinion might render future reform efforts more difficult than they would have been if the solicitor general's argument had carried the day. This commentary seeks to shed light on the Court's hesitation to recognize the uniqueness of health insurance and health care, noting that market-based exceptionalism in constitutional law has a long, dark history that the Court was understandably loath to repeat. Although the result of Chief Justice John Roberts' one-size-fits-all approach to constitutional analysis in this case is an odd holding that elides some genuine uniqueness of American health care, the alternative of health-care exceptionalism might have been much worse for our overall constitutional system.

THE CONSTITUTIONAL CONCEPTS OF THE REFORM TREATY (THE LISBON TREATY

Directory of Open Access Journals (Sweden)

Emilian Ciongaru

2017-12-01

Full Text Available The Lisbon Treaty also known as the Reform Treaty provides only an amendment of the treaties considered as fundamental, namely the Treaty on the European Union and the Treaty on the functioning of the European Union and is the result of the constitutional process triggered by the Laeken Declaration adopted by the European Council. The Lisbon Treaty is still built on the content of the European Constitution from which they eliminated the most controversial provisions, first of all the title of Constitution that might produce concern and panic among the European Union population through the symbolic power it contained, and for Romania this new treaty was the first it signed in quality of a Union member state. Even if does not bear the name of European Constitution, the Lisbon Treaty is a European Constitution for the following reasons: first it is a Constitution because it gathers together most of the fundamental elements of the Constitutional Treaty, even if it does not have the structure or the name thereof, and second the treaties after the Lisbon reform have become small constitutions from the operational viewpoint, they develop the functions of a constitution, limit power and organize the operation of the organization.

The pension reform: foreign experience for Ukraine

Directory of Open Access Journals (Sweden)

O. A. Vyshnevska

2016-09-01

Full Text Available Problem setting. Pension provision of citizens is among the priority tasks of social policy that is constantly on the agenda of public administration in developed countries. Under current conditions, the formation of the optimal pensions model that takes into account social and economic aspects of society is an important task for the state. Recent research and analysis of publications. There are certain theoretical and scientific achievements in the area under consideration. A significant contribution have been made by researchers and scientists in various fields, including V.Bessarab, I.Hnybidenko, M.Kravchenko, O.Krentovska, E. Libanova, B.Nadtochiy, A.Nechay, V.Skurativskyy, V.Tolub and others. However, some issues related to reforming of the pension system require further study with due regard for further modernization of state social policy. The paper objective is to review the European experience in reforming the pension system in the context of its possible application in the realities of current Ukraine. The main body of paper. Reforming of pension systems in Europe relied on the rapid aging of the population and increased pension burden on employees. Thus, in 2010, the EU population over 60 years made up about 24%, up to 2040, according to the experts, it could reach the figure of 35%, an increase by more than 10%. Thus, the population of working age (20-59 years will decrease from 54% to 47%, or by 7% during the same period. Currently, pension systems in most European countries are based on the three-level models that include unfunded pension scheme with the provision of basic pension and funded one (mandatory and voluntary scheme and are combined in different options. Analysis of pension systems in some European countries, including Great Britain, Germany, Denmark, the Netherlands, Finland, Sweden, shows that their reforms were carried out in the following directions: increasing the retirement age (for men -  to 65, women - 60 years

Progress and outcomes of health systems reform in the United Arab Emirates: a systematic review.

Science.gov (United States)

Koornneef, Erik; Robben, Paul; Blair, Iain

2017-09-20

The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent and success of these reforms has not recently been comprehensively reviewed. In this paper we review the progress and outcomes of health systems reform in the UAE. We searched relevant databases and other sources to identify published and unpublished studies and other data available between 01 January 2002 and 31 March 2016. Eligible studies were appraised and data were descriptively and narratively synthesized. Seventeen studies were included covering the following themes: the UAE health system, population health, the burden of disease, healthcare financing, healthcare workforce and the impact of reforms. Few, if any, studies prospectively set out to define and measure outcomes. A central part of the reforms has been the introduction of mandatory private health insurance, the development of the private sector and the separation of planning and regulatory responsibilities from provider functions. The review confirmed the commitment of the UAE to build a world class health system but amongst researchers and commentators opinion is divided on whether the reforms have been successful although patient satisfaction with services appears high and there are some positive indications including increasing coverage of hospital accreditation. The UAE has a rapidly growing population with a unique age and sex distribution, there have been notable successes in improving child and maternal mortality and extending life expectancy but there are high levels of chronic diseases. The relevance of the reforms for public health and their impact on the determinants of chronic diseases have been questioned. From the existing research literature it is not possible to conclude whether UAE health system reforms are

Demonstration of direct internal reforming for MCFC power plants

Energy Technology Data Exchange (ETDEWEB)

Aasberg-Petersen, K.; Christensen, P.S.; Winther, S.K. [HALDOR TOPSOE A/S, Lynby (Denmark)] [and others

1996-12-31

The conversion of methane into hydrogen for an MCFC by steam reforming is accomplished either externally or internally in the stack. In the case of external reforming the plant electrical efficiency is 5% abs. lower mainly because more parasitic power is required for air compression for stack cooling. Furthermore, heat produced in the stack must be transferred to the external reformer to drive the endothermic steam reforming reaction giving a more complex plant lay-out. A more suitable and cost effective approach is to use internal steam reforming of methane. Internal reforming may be accomplished either by Indirect Internal Reforming (DIR) and Direct Internal Reforming (DIR) in series or by DIR-only as illustrated. To avoid carbon formation in the anode compartment higher hydrocarbons in the feedstock are converted into hydrogen, methane and carbon oxides by reaction with steam in ail adiabatic prereformer upstream the fuel cell stack. This paper discusses key elements of the desire of both types of internal reforming and presents data from pilot plants with a combined total of more than 10,000 operating hours. The project is being carried out as part of the activities of the European MCFC Consortium ARGE.

Harnessing the privatisation of China's fragmented health-care delivery.

Science.gov (United States)

Yip, Winnie; Hsiao, William

2014-08-30

Although China's 2009 health-care reform has made impressive progress in expansion of insurance coverage, much work remains to improve its wasteful health-care delivery. Particularly, the Chinese health-care system faces substantial challenges in its transformation from a profit-driven public hospital-centred system to an integrated primary care-based delivery system that is cost effective and of better quality to respond to the changing population needs. An additional challenge is the government's latest strategy to promote private investment for hospitals. In this Review, we discuss how China's health-care system would perform if hospital privatisation combined with hospital-centred fragmented delivery were to prevail--population health outcomes would suffer; health-care expenditures would escalate, with patients bearing increasing costs; and a two-tiered system would emerge in which access and quality of care are decided by ability to pay. We then propose an alternative pathway that includes the reform of public hospitals to pursue the public interest and be more accountable, with public hospitals as the benchmarks against which private hospitals would have to compete, with performance-based purchasing, and with population-based capitation payment to catalyse coordinated care. Any decision to further expand the for-profit private hospital market should not be made without objective assessment of its effect on China's health-policy goals. Copyright © 2014 Elsevier Ltd. All rights reserved.

A position paper on how cost and quality reforms are changing healthcare in America: focus on nutrition.

Science.gov (United States)

Rosen, Barry S; Maddox, P J; Ray, Nancy

2013-11-01

Healthcare spending in the United States is the highest in the world, yet quality indicators such as life expectancy and infant mortality lag other countries. U.S. reforms are under way to lower costs and raise quality of care, notably the Patient Protection and Affordable Care Act (PPACA). Value-based purchasing (VBP) and programs for reducing the incidence of hospital-acquired conditions (HACs) and hospital readmissions represent initial changes. With these programs, overarching themes are to coordinate care during and beyond hospitalization and to ensure that physicians and hospitals are aligned in their treatment strategies. Hospital malnutrition represents a large, hidden, and costly component of medical care; hospital administrators and caregivers alike must harness the benefits of nutrition as a vital component of healthcare. Medical, nursing, and allied health training programs must find places in their curricula to increase awareness of nutrition and promote knowledge of best-practice nutrition interventions. Hospitals use dietitians and nutrition support teams as critical members of the patient care team, but more work needs to be done to disseminate and enforce best nutrition practices. Such training, nutrition interventions, and practice changes can help prevent and treat malnutrition and thus help avert HACs, reduce hospital readmissions, lower infection and complication rates, and shorten hospital stays. Nutrition care is an effective way to reduce costs and improve patient outcomes. This article calls hospital executives and bedside clinicians to action: recognize the value of nutrition care before, during, and after hospitalization, as well as develop training programs and policies that promote nutrition care.

Innovative treatment modalities for urinary incontinence: a European survey identifying experience and attitude of healthcare providers.

Science.gov (United States)

Kastelein, Arnoud W; Dicker, Maarten F A; Opmeer, Brent C; Angles, Sonia S; Raatikainen, Kaisa E; Alonso, Joan F; Tăut, Diana; Airaksinen, Olavi; Cardozo, Linda D; Roovers, Jan-Paul W R

2017-11-01

Urinary incontinence is a common condition in women, with a reported prevalence ranging from 25% to 51%. Of these women, an estimated 38% suffer from stress urinary incontinence (SUI). A European research consortium is investigating an innovative system based on information and communication technology for the conservative treatment of women with SUI. When introducing a new intervention, implementation barriers arise and need to be identified. Therefore, we investigated healthcare providers' experience with and attitude towards innovative care options. We performed an online survey to assess (1) the characteristics and practice of healthcare providers, (2) current protocols for SUI, (3) current use of biofeedback, and (4) knowledge about serious gaming. The survey was sent to members of professional societies in Europe (EUGA), UK (BSUG) and The Netherlands (DPFS). Of 341 questionnaires analyzed (response rate between 18% and 30%), 64% of the respondents had access to a protocol for the treatment of SUI, and 31% used biofeedback when treating patients with SUI. However, 92% considered that biofeedback has a clear or probable added value, and 97% of those who did not use biofeedback would change their practice if research evidence supported its use. Finally, 89% of respondents indicated that they had no experience of serious gaming, but 92% considered that it could be useful. Although inexperienced, European urogynecologists and physical therapists welcome innovative treatment options for the conservative treatment of SUI such as portable wireless biofeedback and serious gaming. Scientific evidence is considered a prerequisite to incorporate such innovations into clinical practice.

NRCMS capitation reform and effect evaluation in Pudong New Area of Shanghai.

Science.gov (United States)

Jing, Limei; Bai, Jie; Sun, Xiaoming; Zakus, David; Lou, Jiquan; Li, Ming; Zhang, Qunfang; Zhuang, Yuehong

2016-07-01

The Rural Cooperative Medical Scheme (RCMS) had played an important role in guaranteeing the acquisition of basic medical healthcare of China's rural populations, being an innovative model of the medical insurance system for so many years here in China. Following the boom and bust of RCMS, the central government rebuilt the New Rural Cooperative Medical Scheme (NRCMS) in 2003 across the whole country. Shanghai, one of the developed cities in China, has developed its RCMS and NRCMS as an advanced and exemplary representative of Chinese rural health insurance. But in the past 10 years, its NRCMS has encountered such challenges as a spiral of medical expenditures and a decrease of insurance participants. Previous investigations showed that the capitation and general practitioner (GP) system had great effect on medical cost containment. Thus, the capitation reform combined with GP system reform of NRCMS, based on a system design, was implemented in Pudong New Area of Shanghai as of 1 August 2012. The aim of the current investigation was to present how the reform was designed and implemented, evaluating its effect by analyzing the data acquired from 12 months before and after the reform. This was an empirical study; we made a conceptual design of the reform to be implemented in Pudong New Area. Most data were derived from the institution-based surveys and supplemented by a questionnaire survey, qualitative interviews and policy document analysis. We found that most respondents held an optimistic attitude towards the reform. We employed a structure-process-outcome evaluation index system to evaluate the effect of the reform, finding that the growth rate of the insured population's total medical costs and NRCMS funds slowed down significantly after the reform; that the total medical expenditure of the insured rural population decreased by 3.60%; and that the total expenditure of NRCMS decreased by 3.99%. The capitation was found to help the medical staff build active

Bending the curve through health reform implementation.

Science.gov (United States)

Antos, Joseph; Bertko, John; Chernew, Michael; Cutler, David; de Brantes, Francois; Goldman, Dana; Kocher, Bob; McClellan, Mark; McGlynn, Elizabeth; Pauly, Mark; Shortell, Stephen

2010-11-01

In September 2009, we released a set of concrete, feasible steps that could achieve the goal of significantly slowing spending growth while improving the quality of care. We stand by these recommendations, but they need to be updated in light of the new Patient Protection and Affordable Care Act (ACA). Reducing healthcare spending growth remains an urgent and unresolved issue, especially as the ACA expands insurance coverage to 32 million more Americans. Some of our reform recommendations were addressed completely or partially in ACA, and others were not. While more should be done legislatively, the current reform legislation includes important opportunities that will require decisive steps in regulation and execution to fulfill their potential for curbing spending growth. Executing these steps will not be automatic or easy. Yet doing so can achieve a healthcare system based on evidence, meaningful choice, balance between regulation and market forces, and collaboration that will benefit patients and the economy (see Appendix A for a description of these key themes). We focus on three concrete objectives to be reached within the next five years to achieve savings while improving quality across the health system: 1. Speed payment reforms away from traditional volume-based payment systems so that most health payments in this country align better with quality and efficiency. 2. Implement health insurance exchanges and other insurance reforms in ways that assure most Americans are rewarded with substantial savings when they choose plans that offer higher quality care at lower premiums. 3. Reform coverage so that most Americans can save money and obtain other meaningful benefits when they make decisions that improve their health and reduce costs. We believe these are feasible objectives with much progress possible even without further legislation (see Appendix B for a listing of recommendations). However, additional legislation is still needed to support consumers �

Priority for import capacity. The fear of the European Union for a free European energy market

International Nuclear Information System (INIS)

Roggen, M.

2002-01-01

Brussels (the seat of the European Union in Belgium) is worried about the performance of the liberalized European energy market. The natural gas and electricity networks are suffering from chronic congestion. Some areas are largely or even entirely cut off from the European energy infrastructure. Those problems must be addressed to realize the internal market. A package of reforms has been put forward by the European Commission the end of 2001 and 12 priority projects are identified and briefly discussed in this article [nl

EU agricultural reform fails on biodiversity

NARCIS (Netherlands)

Pe'er, G.; Dicks, L.V.; Visconti, A.; Arlettaz, R.; Baldi, A.; Kleijn, D.; Scott, A.V.

2014-01-01

In December 2013, the European Union (EU) enacted the reformed Common Agricultural Policy (CAP) for 2014–2020, allocating almost 40% of the EU's budget and influencing management of half of its terrestrial area. Many EU politicians are announcing the new CAP as “greener,” but the new environmental

Resisting market-inspired reform in healthcare: the role of professional subcultures in medicine.

Science.gov (United States)

Martinussen, Pål Erling; Magnussen, Jon

2011-07-01

The reorganisation efforts of the hospital sector in many Western countries in recent decades have challenged the role, identity and autonomy of medical professionals. This has led to increased focus on the role and impact of physicians who are also managers and on the unique discourse being formed through the integration of medical and managerial knowledge. Following the line of studies addressing the professional subcultures in medicine, we investigated whether assessments of health reform differ between medical doctors with managerial responsibilities and their colleagues at the clinical level as well as between those involved in direct patient care and those who are not. The analysis was performed within the context of the Norwegian hospital sector, where a major reform was implemented in 2002, and it was based on a survey of a representative sample of hospital physicians in 2006. The analysis focused on how the respondents viewed the overall effect of the reform and on the reform's effect on three central health policy goals: equity, quality and productivity. Combining data from the survey with organisational and financial data from the hospitals, we employed multilevel techniques to control for a number of individual and hospital-specific factors that could explain the physicians' views. As expected, respondents with managerial responsibilities were more positive in their evaluations of the reform, whereas respondents who spent time on direct patient-related work showed the opposite pattern. Of the hospital-specific factors of interest, the share of department managers with medical backgrounds and the economic situation positively affected the evaluations. Our findings support the view that, rather than managerialist values colonising the medical profession through a process of hybridisation, there is heterogeneity within the profession: some physician managers are adopting management values and tools, whereas others remain alienated from them. Copyright �

How to Develop Sustainable Public Administration Reforms

Directory of Open Access Journals (Sweden)

Liviu RADU

2015-02-01

Full Text Available Public administration reform and reform in general is a never ending story. The human so-cieties are evolving and so do their needs. Pub-lic administration has to keep the pace with the changes that are taking place in society. Specifc issues like ageing of the population and the mi-gration from small to larger communities, or from poor to wealthy regions are placing supplemen-tary burdens on modern administrative systems for decades. The economic crisis that started in 2008 made administrative matters even more complicated. Functional economies and consol-idated democracies proved to be vulnerable to what was considered by many as a market failure. The crisis and the responses of the governments around the world raised a number of questions related to the role that state and public authority in general should play in a modern democracy. The paper is briefy exploring the challenges that administrative systems from the new European Union member states and from the candidatestates were or are facing in their attempt to meet the requirements of the European Union mem-bership, and is proposing a challenging measure: the development of an acquis communautaire for the feld of public administration and consequent-ly the establishment of a correspondent structure inside the European Commission. The acquis communautaire will comprise of a minimum set of principles, widely accepted, that should rep-resent a ‘to do list’ for new member states that are having diffculties in promoting a sound and sustainable reform in public administration.

Healthcare financing in Croatia

Directory of Open Access Journals (Sweden)

Nevenka Kovač

2013-12-01

Full Text Available Healthcare financing system is of crucial importance for the functioning of any healthcare system, especially because there is no country in the world that is able to provide all its residents with access to all the benefits afforded by modern medicine. Lack of resources in general and rising healthcare expenditures are considered a difficult issue to solve in Croatia as well. Since Croatia gained its independence, its healthcare system has undergone a number of reforms, the primary objective of which was to optimize healthcare services to the actual monetary capacity of the Croatian economy. The objectives of the mentioned re - forms were partially achieved. The solutions that have been offered until now, i.e. consolidation measures undertaken in the last 10 years were necessary; however, they have not improved the operating conditions. There is still the issue of the deficit from the previous years, i.e. outstanding payments, the largest in the last decade. Analysis of the performance of healthcare institutions in 2011 shows that the decision makers will have to take up a major challenge of finding a solution to the difficulties the Croatian healthcare system has been struggling with for decades, causing a debt of 7 billion kuna. At the same time, they will need to uphold the basic principles of the Healthcare Act, i.e. to provide access to healthcare and ensure its continuity, comprehensiveness and solidarity, keeping in mind that the National Budget Act and Fiscal Responsibility Act have been adopted.

The NHS and market forces in healthcare: the need for organisational ethics.

Science.gov (United States)

Frith, Lucy

2013-01-01

The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further 'market-style' reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers.

Healthcare is primary

Directory of Open Access Journals (Sweden)

Raman Kumar

2015-01-01

Full Text Available India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2 nd National Conference on Family Medicine and Primary Care 2015 (FMPC brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care, the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

Levelling vs competition – political trend reversal in the German healthcare system?

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Sascha Wolf

2014-12-01

Full Text Available For almost 20 years, the German federal government has declared that competition is the key to ensuring the financial sustainability of the healthcare system. The aim of this paper is to investigate if German government indeed has followed a direct path to enhancing competition. For this purpose, a qualitative analysis of the most important healthcare reform acts has been conducted. In conclusion, especially since the introduction of the Health Fund in 2009, a clear trend towards more levelling and regulation can be observed. This trend is confirmed by the most recent healthcare reform act in June 2014. The abolishment of flat-rate premiums is the expression of the government’s fear that competitive pressure could endanger the solvency and viability of sickness funds (statutory health insurance funds. In contrast, on the market for selective contracts, an ambivalent picture emerges. On the one hand, several possibilities for establishing new forms of healthcare and strengthening competition have been introduced. On the other hand, sickness funds as well as service providers are often reluctant to enter into selective contracts.

Determinants of European air traffic development

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Tomislav MIHETEC

2008-01-01

Full Text Available The paper elaborates main determinants of the strategic development as well as the key factors, which influence European air traffic dynamics. The problem of European airspace fragmentation should be solved by the comprehensive dynamic harmonization programmes, which can contribute to effective increase of airspace capacity and increase of air transport efficiency. The main objective of development strategy refers to the implementation of reformation processes of the European air traffic management system through functional ATM regionalization and adoption of Single European Sky legislation.

QUALIFICATIONS FRAMEWORKS LEADING TO REFORMS IN EAST EUROPEAN EDUCATION

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Arjen Vos

2014-01-01

Full Text Available The paper examines the evolution of qualifications frameworks across Europe. Five years ago, it was not clear if the discussions on national qualification frameworks (NQF in Eastern Europe would lead to the new standards and qualifications development, or initiate the reforms in education and training. Now, there is evidence of more countries using the NQFs to promote a dialogue between the public and private sectors on the expected outcomes of educational process. In some countries, the private sector has even taken the lead in the NQF discussions, being increasingly involved in their implementation. This is a fundamentally new paradigm in education policies and a cornerstone of the demand driven education and training. Each country is following its own patterns while moving to the comparable results. However, this is just the initial stage of NQF implementation. The author regards learning by doing and the local expertise expansion as the key challenges of the coming years. Although the reforms take time, they increasingly tend to become a shared public and private responsibility.

Politics, class actors, and health sector reform in Brazil and Venezuela.

Science.gov (United States)

Mahmood, Qamar; Muntaner, Carles

2013-03-01

Universal access to healthcare has assumed renewed importance in global health discourse, along with a focus on strengthening health systems. These developments are taking place in the backdrop of concerted efforts to advocate moving away from vertical, disease-based approaches to tackling health problems. While this approach to addressing public health problems is a step in the right direction, there is still insufficient emphasis on understanding the socio-political context of health systems. Reforms to strengthen health systems and achieve universal access to healthcare should be cognizant of the importance of the socio-political context, especially state-society relations. That context determines the nature and trajectory of reforms promoting universality or any pro-equity change. Brazil and Venezuela in recent years have made progress in developing healthcare systems that aim to achieve universal access. These achievements are noteworthy given that, historically, both countries had a long tradition of healthcare systems which were highly privatized and geared towards access to healthcare for a small segment of the population while the majority was excluded. These achievements are also remarkable since they took place in an era of neoliberalism when many states, even those with universally-based healthcare systems, were moving in the opposite direction. We analyze the socio-political context in each of these countries and look specifically at how the changing state-society relations resulted in health being constitutionally recognized as a social right. We describe the challenges that each faced in developing and implementing healthcare systems embracing universality. Our contention is that achieving the principle of universality in healthcare systems is less of a technical matter and more a political project. It involves opposition from the socially conservative elements in the society. Navigation to achieve this goal requires a political strategy that

The competitiveness through taxes in the Central and Eastern European countries

Directory of Open Access Journals (Sweden)

Daniela Pîrvu

2009-05-01

Full Text Available In the last few years, many countries Central and Eastern European countrieshave reduced their corporate income tax rates with the purpose of attractingmultinational companies. Various studies indicate the fact that the level of the corporateincome tax represents an important advantage that drives the decisions to place foreigndirect investments. Many European Union member states have initiated corporateincome tax reforms, in order to generate the increase in the competitiveness of nationaleconomies. In the case of the Central and Eastern European countries, where thedecrease in the corporate income taxes was higher, these reforms brought profoundchanges in the economic environment.

Energy deprivation dynamics and regulatory reforms in Europe: Evidence from household panel data

International Nuclear Information System (INIS)

Poggi, Ambra; Florio, Massimo

2010-01-01

The typical ingredients of energy reforms in the European Union (EU) in the 1990s were full or partial privatization, vertical disintegration and liberalization. This paper analyses the effects of energy reforms on the probability of households experiencing deprivation, defined as difficulty in paying the bills. We use two sets of micro-data. First, the European Community Household Panel (ECHP), a large EU survey, offers evidence on people who report having been unable to pay scheduled utility bills. We consider seven European countries: Denmark, Belgium, France, Ireland, Italy, the Netherlands and Spain, and eight ECHP waves (1994-2001), with around 28,000 observations. Second, we also use micro-data from the European Statistics on Income and Living Conditions survey (EU-SILC) 2004-2005, with around 84,000 observations. The countries included are Belgium, France, Ireland, Italy, Spain, Austria, Finland, Luxembourg, Norway and Sweden. As indicators of regulatory reforms in the same countries and years we use ECTR (formerly REGREF), a database provided by the OECD. In both samples we find evidence that privatization increases the probability of households experiencing deprivation. Vertical disintegration has a similar effect and also increases the persistence in the status of household deprivation. Liberalization has no statistically significant effect. We discuss possible interpretations of these findings.

Energy deprivation dynamics and regulatory reforms in Europe: Evidence from household panel data

Energy Technology Data Exchange (ETDEWEB)

Poggi, Ambra [Department of Economics, University of Milan-Bicocca and LABORatorio Revelli, Collegio C. Alberto (Italy); Florio, Massimo, E-mail: massimo.florio@unimi.i [Department of Economics, Business and Statistics, University of Milan, Via Conservatorio 7, 20122 Milan (Italy)

2010-01-15

The typical ingredients of energy reforms in the European Union (EU) in the 1990s were full or partial privatization, vertical disintegration and liberalization. This paper analyses the effects of energy reforms on the probability of households experiencing deprivation, defined as difficulty in paying the bills. We use two sets of micro-data. First, the European Community Household Panel (ECHP), a large EU survey, offers evidence on people who report having been unable to pay scheduled utility bills. We consider seven European countries: Denmark, Belgium, France, Ireland, Italy, the Netherlands and Spain, and eight ECHP waves (1994-2001), with around 28,000 observations. Second, we also use micro-data from the European Statistics on Income and Living Conditions survey (EU-SILC) 2004-2005, with around 84,000 observations. The countries included are Belgium, France, Ireland, Italy, Spain, Austria, Finland, Luxembourg, Norway and Sweden. As indicators of regulatory reforms in the same countries and years we use ECTR (formerly REGREF), a database provided by the OECD. In both samples we find evidence that privatization increases the probability of households experiencing deprivation. Vertical disintegration has a similar effect and also increases the persistence in the status of household deprivation. Liberalization has no statistically significant effect. We discuss possible interpretations of these findings.

Energy deprivation dynamics and regulatory reforms in Europe. Evidence from household panel data

Energy Technology Data Exchange (ETDEWEB)

Poggi, Ambra [Department of Economics, University of Milan-Bicocca and LABORatorio Revelli, Collegio C. Alberto (Italy); Florio, Massimo [Department of Economics, Business and Statistics, University of Milan, Via Conservatorio 7, 20122 Milan (Italy)

2010-01-15

The typical ingredients of energy reforms in the European Union (EU) in the 1990s were full or partial privatization, vertical disintegration and liberalization. This paper analyses the effects of energy reforms on the probability of households experiencing deprivation, defined as difficulty in paying the bills. We use two sets of micro-data. First, the European Community Household Panel (ECHP), a large EU survey, offers evidence on people who report having been unable to pay scheduled utility bills. We consider seven European countries: Denmark, Belgium, France, Ireland, Italy, the Netherlands and Spain, and eight ECHP waves (1994-2001), with around 28,000 observations. Second, we also use micro-data from the European Statistics on Income and Living Conditions survey (EU-SILC) 2004-2005, with around 84,000 observations. The countries included are Belgium, France, Ireland, Italy, Spain, Austria, Finland, Luxembourg, Norway and Sweden. As indicators of regulatory reforms in the same countries and years we use ECTR (formerly REGREF), a database provided by the OECD. In both samples we find evidence that privatization increases the probability of households experiencing deprivation. Vertical disintegration has a similar effect and also increases the persistence in the status of household deprivation. Liberalization has no statistically significant effect. We discuss possible interpretations of these findings. (author)

The clinical nurse leader: prepared for an era of healthcare reform.

Science.gov (United States)

Jeffers, Brenda Recchia; Astroth, Kim S

2013-01-01

Passage of the 2010 Patient Protection and Affordable Care Act will require change in the healthcare systems. The clinical nurse leader must be prepared to lead and shape the changing environment to achieve maximum outcomes for patients and families. Movement toward integrated care delivery across the care continuum, the transition of the Centers for Medicare & Medicaid Services to a value-based funding model, and accountability for high-quality, cost-effective care are just some of the drivers of this new integrated healthcare system. Reimbursement models that reward those health systems that are able to meet benchmark performance standards will result in major shifts in how health systems operate. Expertise in care coordination across the healthcare continuum is essential for maximum reimbursement. Payment for value instead of volume delivered is a major reimbursement transition coming to the acute care setting, necessitating increased attention to mining data necessary to capture quality patient outcomes for maximum reimbursement. The clinical nurse leader is ideally suited to function within these integrated systems of the future, and possesses the skills needed to assist healthcare systems to meet this challenge. © 2013 Wiley Periodicals, Inc.

Sláintecare - A ten-year plan to achieve universal healthcare in Ireland.

Science.gov (United States)

Burke, Sara; Barry, Sarah; Siersbaek, Rikke; Johnston, Bridget; Ní Fhallúin, Maebh; Thomas, Steve

2018-05-22

In May 2017, an Irish cross-party parliamentary committee published the 'Houses of the Oireachtas Committee on the Future of Healthcare "Sláintecare" report'. The report, known as 'Sláintecare', is unique and historic as it is the first time there has been a cross-party political consensus on major health reform in Ireland. Sláintecare sets out a high level policy roadmap to deliver whole system reform and universal healthcare, phased over a ten year period and costed. Sláintecare details reform proposals which, if delivered, will establish; a universal, single-tier health service where patients are treated solely on the basis of health need; the reorientation of the health system 'towards integrated primary and community care, consistent with the highest quality of patient safety in as short a time-frame as possible'. Sláintecare has five interrelated components: population health; entitlements and access to healthcare; integrated care; funding; and implementation. In this article, the authors use documents in the public domain (parliamentary reports, public hearings, submissions to the Committee, media coverage, the final report of the Committee, speeches by Committee members) to describe the policy process and the main contents of the proposed Sláintecare reforms. It is too soon tell if the political consensus in the policy formation can hold for its implementation. Copyright © 2018 The Author(s). Published by Elsevier B.V. All rights reserved.

Policy Capacity for Health Reform: Necessary but Insufficient: Comment on "Health Reform Requires Policy Capacity".

Science.gov (United States)

Adams, Owen

2015-09-04

Forest and colleagues have persuasively made the case that policy capacity is a fundamental prerequisite to health reform. They offer a comprehensive life-cycle definition of policy capacity and stress that it involves much more than problem identification and option development. I would like to offer a Canadian perspective. If we define health reform as re-orienting the health system from acute care to prevention and chronic disease management the consensus is that Canada has been unsuccessful in achieving a major transformation of our 14 health systems (one for each province and territory plus the federal government). I argue that 3 additional things are essential to build health policy capacity in a healthcare federation such as Canada: (a) A means of "policy governance" that would promote an approach to cooperative federalism in the health arena; (b) The ability to overcome the "policy inertia" resulting from how Canadian Medicare was implemented and subsequently interpreted; and (c) The ability to entertain a long-range thinking and planning horizon. My assessment indicates that Canada falls short on each of these items, and the prospects for achieving them are not bright. However, hope springs eternal and it will be interesting to see if the July, 2015 report of the Advisory Panel on Healthcare Innovation manages to galvanize national attention and stimulate concerted action. © 2016 by Kerman University of Medical Sciences.

The European Union in International Financial Governance

Directory of Open Access Journals (Sweden)

Niamh Moloney

2017-01-01

Full Text Available This article considers the role of the European Union in international financial governance after the institutional reforms it undertook in connection with the global financial crisis. It suggests that the new administrative actors that support the governance of the European Union's single financial market, notably the European Supervisory Authorities, have the potential to reshape how the European Union engages with international financial governance. It finds that the European Union’s effectiveness in influencing international financial governance—and the effectiveness of international financial governance more generally—is likely to strengthen as a result.

Peruvian Mental Health Reform: A Framework for Scaling-up Mental Health Services

Science.gov (United States)

Toyama, Mauricio; Castillo, Humberto; Galea, Jerome T.; Brandt, Lena R.; Mendoza, María; Herrera, Vanessa; Mitrani, Martha; Cutipé, Yuri; Cavero, Victoria; Diez-Canseco, Francisco; Miranda, J. Jaime

2017-01-01

Background: Mental, neurological, and substance (MNS) use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major rearranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face. Methods: Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up. Results: Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru. Conclusion: Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru has achieved a

Peruvian Mental Health Reform: A Framework for Scaling-up Mental Health Services

Directory of Open Access Journals (Sweden)

Mauricio Toyama

2017-09-01

Full Text Available Background Mental, neurological, and substance (MNS use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major rearranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face. Methods Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up. Results Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru. Conclusion Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru

Reform trajectories in Southeastern Europe: Greece and Romania in comparative perspective

Directory of Open Access Journals (Sweden)

Gabriela Creţu

2014-06-01

Full Text Available The paper employs an institutional approach in order to analyze the role of administrative traditions in understanding the trajectories of reforms in two Southeast European countries which are members of the European Union, namely Greece and Romania. The research employs the case study method, in comparative perspective. It is a dynamic approach to politico-administrative systems that emphasizes an evolutionary context form the perspective of historical institutionalism. Both Greece and Romania have undergone dictatorial regimes followed by transition to democracy. These countries share peculiar societal and state features which are representative for Southeastern Europe, such as: centralism, strong national accents, clientelism. The results confirm that past legacies influence the reform outcomes in the analyzed countries.

The Effect of the Common Agricultural Policy Reform by 2013 on Direct Payments in Relation to Animal Welfare in the European Union - Review

Directory of Open Access Journals (Sweden)

Marek Angelovič

2011-10-01

Full Text Available The primary role of agriculture is to provide food and the European Union should be able to contribute to rising world food demand. The Common Agriculture Policy covers the wide variety of measures used to support and protect the European Union farmers. The most important measure within the Common Agriculture Policy is direct payments paid directly to farmers to protect their income. The Common Agriculture Policy is due to be reformed by 2013. The main object of the Common Agriculture Policy, which is a provision of safe, healthy choice of food at transparent and affordable prices, will remain unchanged, but further changes of the Common Agriculture Policy are necessary to respond to the new challenges such as animal welfare, global food security, natural resources such as water, air, biodiversity and soil, climate changes, increasing globalization and rising price volatility.

Philosophy, medicine and healthcare: insights from the Italian experience.

Science.gov (United States)

Adinolfi, Paola

2014-09-01

To contribute to our understanding of the relationship between philosophical ideas and medical and healthcare models. A diachronic analysis is put in place in order to evaluate, from an innovative perspective, the influence over the centuries on medical and healthcare models of two philosophical concepts, particularly relevant for health: how Man perceives his identity and how he relates to Nature. Five epochs are identified--the Archaic Age, Classical Antiquity, the Middle Ages, the Modern Age, the 'Postmodern' Era--which can be seen, à la Foucault, as 'fragments between philosophical fractures'. From a historical background perspective, up to the early 1900s progress in medical and healthcare models has moved on a par with the evolution of philosophical debate. Following the Second World War, the Health Service started a series of reforms, provoked by anti-positivistic philosophical transformations. The three main reforms carried out however failed and the medical establishment remained anchored to a mechanical, reductionist approach, perfectly in line with the bureaucratic stance of the administrators. In this context, future scenarios are delineated and an anthropo-ecological model is proposed to re-align philosophy, medicine and health care.

Leveraging health information technology to achieve the "triple aim" of healthcare reform.

Science.gov (United States)

Sheikh, Aziz; Sood, Harpreet S; Bates, David W

2015-07-01

To investigate experiences with leveraging health information technology (HIT) to improve patient care and population health, and reduce healthcare expenditures. In-depth qualitative interviews with federal government employees, health policy, HIT and medico-legal experts, health providers, physicians, purchasers, payers, patient advocates, and vendors from across the United States. The authors undertook 47 interviews. There was a widely shared belief that Health Information Technology for Economic and Clinical Health (HITECH) had catalyzed the creation of a digital infrastructure, which was being used in innovative ways to improve quality of care and curtail costs. There were however major concerns about the poor usability of electronic health records (EHRs), their limited ability to support multi-disciplinary care, and major difficulties with health information exchange, which undermined efforts to deliver integrated patient-centered care. Proposed strategies for enhancing the benefits of HIT included federal stimulation of competition by mandating vendors to open-up their application program interfaces, incenting development of low-cost consumer informatics tools, and promoting Congressional review of the The Health Insurance Portability and Accountability Act (HIPPA) to optimize the balance between data privacy and reuse. Many underscored the need to "kick the legs from underneath the fee-for-service model" and replace it with a data-driven reimbursement system that rewards high quality care. The HITECH Act has stimulated unprecedented, multi-stakeholder interest in HIT. Early experiences indicate that the resulting digital infrastructure is being used to improve quality of care and curtail costs. Reform efforts are however severely limited by problems with usability, limited interoperability and the persistence of the fee-for-service paradigm-addressing these issues therefore needs to be the federal government's main policy target. © The Author 2015

A Community Standard: Equivalency of Healthcare in Australian Immigration Detention.

Science.gov (United States)

Essex, Ryan

2017-08-01

The Australian government has long maintained that the standard of healthcare provided in its immigration detention centres is broadly comparable with health services available within the Australian community. Drawing on the literature from prison healthcare, this article examines (1) whether the principle of equivalency is being applied in Australian immigration detention and (2) whether this standard of care is achievable given Australia's current policies. This article argues that the principle of equivalency is not being applied and that this standard of health and healthcare will remain unachievable in Australian immigration detention without significant reform. Alternate approaches to addressing the well documented issues related to health and healthcare in Australian immigration detention are discussed.

Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability-Adjusted Life Years through a Population Prevalence-Based Modelling Study.

Directory of Open Access Journals (Sweden)

Alessandro Cassini

2016-10-01

Full Text Available Estimating the burden of healthcare-associated infections (HAIs compared to other communicable diseases is an ongoing challenge given the need for good quality data on the incidence of these infections and the involved comorbidities. Based on the methodology of the Burden of Communicable Diseases in Europe (BCoDE project and 2011-2012 data from the European Centre for Disease Prevention and Control (ECDC point prevalence survey (PPS of HAIs and antimicrobial use in European acute care hospitals, we estimated the burden of six common HAIs.The included HAIs were healthcare-associated pneumonia (HAP, healthcare-associated urinary tract infection (HA UTI, surgical site infection (SSI, healthcare-associated Clostridium difficile infection (HA CDI, healthcare-associated neonatal sepsis, and healthcare-associated primary bloodstream infection (HA primary BSI. The burden of these HAIs was measured in disability-adjusted life years (DALYs. Evidence relating to the disease progression pathway of each type of HAI was collected through systematic literature reviews, in order to estimate the risks attributable to HAIs. For each of the six HAIs, gender and age group prevalence from the ECDC PPS was converted into incidence rates by applying the Rhame and Sudderth formula. We adjusted for reduced life expectancy within the hospital population using three severity groups based on McCabe score data from the ECDC PPS. We estimated that 2,609,911 new cases of HAI occur every year in the European Union and European Economic Area (EU/EEA. The cumulative burden of the six HAIs was estimated at 501 DALYs per 100,000 general population each year in EU/EEA. HAP and HA primary BSI were associated with the highest burden and represented more than 60% of the total burden, with 169 and 145 DALYs per 100,000 total population, respectively. HA UTI, SSI, HA CDI, and HA primary BSI ranked as the third to sixth syndromes in terms of burden of disease. HAP and HA primary BSI were

Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability-Adjusted Life Years through a Population Prevalence-Based Modelling Study

Science.gov (United States)

Eckmanns, Tim; Abu Sin, Muna; Ducomble, Tanja; Harder, Thomas; Sixtensson, Madlen; Velasco, Edward; Weiß, Bettina; Kramarz, Piotr; Monnet, Dominique L.; Kretzschmar, Mirjam E.; Suetens, Carl

2016-01-01

Background Estimating the burden of healthcare-associated infections (HAIs) compared to other communicable diseases is an ongoing challenge given the need for good quality data on the incidence of these infections and the involved comorbidities. Based on the methodology of the Burden of Communicable Diseases in Europe (BCoDE) project and 2011–2012 data from the European Centre for Disease Prevention and Control (ECDC) point prevalence survey (PPS) of HAIs and antimicrobial use in European acute care hospitals, we estimated the burden of six common HAIs. Methods and Findings The included HAIs were healthcare-associated pneumonia (HAP), healthcare-associated urinary tract infection (HA UTI), surgical site infection (SSI), healthcare-associated Clostridium difficile infection (HA CDI), healthcare-associated neonatal sepsis, and healthcare-associated primary bloodstream infection (HA primary BSI). The burden of these HAIs was measured in disability-adjusted life years (DALYs). Evidence relating to the disease progression pathway of each type of HAI was collected through systematic literature reviews, in order to estimate the risks attributable to HAIs. For each of the six HAIs, gender and age group prevalence from the ECDC PPS was converted into incidence rates by applying the Rhame and Sudderth formula. We adjusted for reduced life expectancy within the hospital population using three severity groups based on McCabe score data from the ECDC PPS. We estimated that 2,609,911 new cases of HAI occur every year in the European Union and European Economic Area (EU/EEA). The cumulative burden of the six HAIs was estimated at 501 DALYs per 100,000 general population each year in EU/EEA. HAP and HA primary BSI were associated with the highest burden and represented more than 60% of the total burden, with 169 and 145 DALYs per 100,000 total population, respectively. HA UTI, SSI, HA CDI, and HA primary BSI ranked as the third to sixth syndromes in terms of burden of disease

A future for primary care for the Greek population

NARCIS (Netherlands)

Groenewegen, P.P.; Jurgutis, A.

2013-01-01

Background: Greece is hit hard by the state debt crisis. This calls for comprehensive reforms to restore sustainable and balanced growth. Healthcare is one of the public sectors needing reform. The European Union (EU) Task Force for Greece asked the authors to assess the situation of primary care

A future for primary care for the Greek population.

NARCIS (Netherlands)

Groenewegen, P.P.; Jurgutis, A.

2013-01-01

Background: Greece is hit hard by the state debt crisis. This calls for comprehensive reforms to restore sustainable and balanced growth. Healthcare is one of the public sectors needing reform. The European Union (EU) Task Force for Greece asked the authors to assess the situation of primary care

Healthcare reform from the inside: A neurosurgical clinical quality program

OpenAIRE

Afsar-Manesh, Nasim; Martin, Neil A.

2012-01-01

During the past decade, the U.S. health care system has faced increasing challenges in delivering high quality of care, ensuring patient safety, providing access to care, and maintaining manageable costs. While reform progresses at a national level, health care providers have a responsibility and obligation to advance quality and safety. In 2009, the authors implemented a department-wide Clinical Quality Program. This Program comprised of an inter-disciplinary group of providers and staff wor...

Policy Capacity for Health Reform: Necessary but Insufficient; Comment on “Health Reform Requires Policy Capacity”

Directory of Open Access Journals (Sweden)

Owen Adams

2016-01-01

Full Text Available Forest and colleagues have persuasively made the case that policy capacity is a fundamental prerequisite to health reform. They offer a comprehensive life-cycle definition of policy capacity and stress that it involves much more than problem identification and option development. I would like to offer a Canadian perspective. If we define health reform as re-orienting the health system from acute care to prevention and chronic disease management the consensus is that Canada has been unsuccessful in achieving a major transformation of our 14 health systems (one for each province and territory plus the federal government. I argue that 3 additional things are essential to build health policy capacity in a healthcare federation such as Canada: (a A means of “policy governance” that would promote an approach to cooperative federalism in the health arena; (b The ability to overcome the ”policy inertia” resulting from how Canadian Medicare was implemented and subsequently interpreted; and (c The ability to entertain a long-range thinking and planning horizon. My assessment indicates that Canada falls short on each of these items, and the prospects for achieving them are not bright. However, hope springs eternal and it will be interesting to see if the July, 2015 report of the Advisory Panel on Healthcare Innovation manages to galvanize national attention and stimulate concerted action.

On democratic concerns and legal traditions. The Dutch 1953 and 1956 constitutional reforms ‘towards’ Europe

NARCIS (Netherlands)

van Leeuwen, K.

2012-01-01

This study analyses the 1953 and 1956 Dutch constitutional reforms ‘towards’ Europe, revealing the complexity and mutuality between national constitutional reform and the development of European integration in the 1950s. It demonstrates that long-standing Dutch traditions of adherence to

Nudging Domestic Judicial Reforms from Strasbourg: How the European Court of Human Rights shapes domestic judicial design

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David Kosař

2017-03-01

Full Text Available This article discusses to what extent and how the European Court of Human Rights (ECtHR has initiated and engaged in domestic judicial reforms. It shows that the judgments of the Strasbourg Court, rather than having effects only with respect to the individual whose rights have been violated, have much deeper structural effects in the design and operation of domestic judicial systems. This article argues that this phenomenon goes rather unnoticed, but it has deep implications for both the developing and developed European democracies. To demonstrate this phenomenon, this article assesses the impact of the ECtHR on three judicial design issues. First, it illustrates how the ECtHR has challenged the role of the advocates general. Second, it explains how the ECtHR has gradually curbed the jurisdiction of military courts both over civilians and over military officers, which has brought these courts to the brink of their abolition. Finally, it outlines how the ECtHR in its judgments regarding the disciplining of judges empowers the judiciary at the expense of other political institutions within the State. Based on the analysis of these three judicial design issues, we conclude that the Strasbourg Court is affecting the internal architecture of domestic judiciaries as it gradually endorses the unification of court administration and changes the power structures within the judiciary.

Robotics for healthcare. Final report

OpenAIRE

Butter, Maurits; Rensma, Arjan; Boxsel, Joey van; Kalisingh, Sandy; Schoone, Marian; Leis, Miriam; Gelderblom, Gert J.; Cremers, Ger; Wilt, Monique de; Kortekaas, Willem; Thielmann, Axel; Cuhls, Kerstin; Sachinopoulou, Anna; Korhonen, Ilkka

2008-01-01

For the last two decades the European Commission (EC), and in particular the Directorate General Information Society and Media, has been strongly supporting the application of Information and Communication Technologies (ICT) in healthcare. ICT is an enabling technology which can provide various solutions in the healthcare sector, ranging from electronic patient records and health information networks to intelligent prosthetics and robotised surgery. The EC funded the present study with the ai...

Robotics for healthcare: final report

OpenAIRE

Butter, M.; Rensma, A.; Boxsel, J. van; Kalisingh, S.; Schoone, M.; Leis, M.; Gelderblom, G.J.; Cremers, G.; Wilt, M. de; Kortekaas, W.; Thielmaan, A.; Cuhls, K.; Sachinopoulou, A.; Korhonen, I.

2008-01-01

For the last two decades the European Commission (EC), and in particular the Directorate General Information Society and Media, has been strongly supporting the application of Information and Communication Technologies (ICT) in healthcare. ICT is an enabling technology which can provide various solutions in the healthcare sector, ranging from electronic patient records and health information networks to intelligent prosthetics and robotised surgery. The EC funded the present study with the ai...

Healthcare Firms and the ERP Systems

Directory of Open Access Journals (Sweden)

A. Garefalakis

2016-04-01

Full Text Available With the continuous and drastic changes due to the economic crisis, along with the increasing market demands, major reforms are initiated in the healthcare sector in order to improve the quality of healthcare and operational efficiency, while reducing costs and optimizing back-end operations. ERP systems have been the basic technological infrastructure to many sectors as well as healthcare. The main objective of this study is to discuss how the adoption of ERP systems in healthcare organizations improves their functionality, simplifies their business processes, assure the quality of care services and helps their management accounting and controlling. This study presents also the stages required for the implementation of ERP system in healthcare organizations. This study utilizes a literature review in order to reach the research conclusions. Specifically, through related case studies and research, it examines how ERP systems are used to evaluate the better functionality of the healthcare organizations, addressing in parallel important problems, and possible malfunctions. The implementation of ERP systems in healthcare organizations promises to evolve and align strictly to the organizations’ corporate objectives and high-levels of healthcare quality. In order to accomplish this goal, the right decisions should be made by the managers of the healthcare organization regarding the choice of the appropriate ERP system following its installation and its application. Limited research exists on the significance ERP systems implementation in healthcare organizations, while possible dysfunctions and challenges during its installation and implementation are recorded. Therefore, new evidence in the significance of ERP systems in healthcare organization is provided.

Time for TIGER to ROAR! Technology Informatics Guiding Education Reform.

Science.gov (United States)

O'Connor, Siobhan; Hubner, Ursula; Shaw, Toria; Blake, Rachelle; Ball, Marion

2017-11-01

Information Technology (IT) continues to evolve and develop with electronic devices and systems becoming integral to healthcare in every country. This has led to an urgent need for all professions working in healthcare to be knowledgeable and skilled in informatics. The Technology Informatics Guiding Education Reform (TIGER) Initiative was established in 2006 in the United States to develop key areas of informatics in nursing. One of these was to integrate informatics competencies into nursing curricula and life-long learning. In 2009, TIGER developed an informatics competency framework which outlines numerous IT competencies required for professional practice and this work helped increase the emphasis of informatics in nursing education standards in the United States. In 2012, TIGER expanded to the international community to help synthesise informatics competencies for nurses and pool educational resources in health IT. This transition led to a new interprofessional, interdisciplinary approach, as health informatics education needs to expand to other clinical fields and beyond. In tandem, a European Union (EU) - United States (US) Collaboration on eHealth began a strand of work which focuses on developing the IT skills of the health workforce to ensure technology can be adopted and applied in healthcare. One initiative within this is the EU*US eHealth Work Project, which started in 2016 and is mapping the current structure and gaps in health IT skills and training needs globally. It aims to increase educational opportunities by developing a model for open and scalable access to eHealth training programmes. With this renewed initiative to incorporate informatics into the education and training of nurses and other health professionals globally, it is time for educators, researchers, practitioners and policy makers to join in and ROAR with TIGER. Copyright © 2017 Elsevier Ltd. All rights reserved.

Healthcare beyond reform: doing it right for half the cost

National Research Council Canada - National Science Library

Flower, Joe

2012-01-01

... can get there by utilizing the resources we already have. The author provides a comprehensive, positive, and intriguing vision of the future of healthcare for professionals, employers and investors...

Do reviews of healthcare interventions teach us how to improve healthcare systems?

Science.gov (United States)

Pawson, Ray; Greenhalgh, Joanne; Brennan, Cathy; Glidewell, Elizabeth

2014-08-01

Planners, managers and policy makers in modern health services are not without ingenuity - they will always try, try and try again. They face deep-seated or 'wicked' problems, which have complex roots in the labyrinthine structures though which healthcare is delivered. Accordingly, the interventions devised to deal with such stubborn problems usually come in the plural. Many different reforms are devised to deal with a particular stumbling block, which may be implemented sequentially, simultaneously or whenever policy fashion or funding dictates. This paper examines this predicament from the perspective of evidence based policy. How might researchers go about reviewing the evidence when they are faced with multiple or indeed competing interventions addressing the same problem? In the face of this plight a rather unheralded form of research synthesis has emerged, namely the 'typological review'. We critically review the fortunes of this strategy. Separating the putative reforms into series of subtypes and producing a scorecard of their outcomes has the unintended effect of divorcing them all from an understanding of how organisations change. A more fruitful approach may lie in a 'theory-driven review' underpinned by an understanding of dynamics of social change in complex organisations. We test this thesis by examining the primary and secondary research on the many interventions designed to tackle a particularly wicked problem, namely the inexorable rise in demand for healthcare. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Healthcare and healthcare systems: inspiring progress and future prospects.

Science.gov (United States)

Durrani, Hammad

2016-01-01

Healthcare systems globally have experienced intensive changes, reforms, developments, and improvement over the past 30 years. Multiple actors (governmental and non-governmental) and countries have played their part in the reformation of the global healthcare system. New opportunities are presenting themselves while multiple challenges still remain especially in developing countries. Better way to proceed would be to learn from historical patterns while we plan for the future in a technology-driven society with dynamic demographic, epidemiological and economic uncertainties. A structured review of both peer-reviewed and gray literature on the topic was carried out. On the whole, people are healthier, doing better financially and live longer today than 30 years ago. The number of under-5 mortality worldwide has declined from 12.7 million in 1990 to 6.3 million in 2013. Infant and maternal mortality rates have also been reduced. However, both rates are still considered high in Africa and some Asian countries. The world's population nearly doubled in these 30 years, from 4.8 billion in 1985 to 7.2 billion in 2015. The majority of the increasing population was coming from the least developed countries, i.e., 3.66 to 5.33 billion. The world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million. Health care expenditures among countries also show sharp differences. In high income countries, per person health expenditure is over USD 3,000 on average, while in poor countries, it is as low as USD 12, WHO estimate of minimum spending per person per year needed to provide basic, life-saving services is USD 44. The challenges faced by the global health system over the past 30 years have been increased in population and urbanization, behavioral changes, rise in chronic diseases, traumatic injuries, infectious diseases, specific regional conflicts and healthcare delivery security. Over the next 30 years, most of the world population

Financing of health care in four Caribbean territories: a comparison with reforms in Europe.

Science.gov (United States)

Rutten, F; Lapré, R; Antonius, R; Dokoui, S; Haqq, E; Roberts, R; Mills, A

2002-10-01

This paper considers health care finance in four Caribbean territories and plans for reform in comparison with developments in European countries, to which these territories are historically linked. European health care reforms are aimed at making resource allocation in health care more efficient and more responsive to consumers' demands and preferences. These reforms in Europe have been continuing without appearing to have influenced the developments in the Caribbean very much, except in Martinique. In Trinidad and Tobago current reform entails delegation of responsibility for providing services to four regional health authorities and no purchaser/provider split at the regional or facility level as in the UK has been implemented. In the Bahamas, managed care arrangements are likely to emerge given the proximity of the United States. Recent universal coverage reform in Martinique was aimed at harmonisation of finance by bringing social security and social aid functions together under one management structure and may provide more opportunities for contracting and other initiatives towards greater efficiency. The first priority in Suriname is to restore proper functioning of the current system. Reforms in the four Caribbean territories have a largely administrative character and affect the organisation of the third party role in health care rather than fundamentally changing the relationship between this third party and the various other parties in health care.

Contact Allergy in Danish Healthcare Workers

DEFF Research Database (Denmark)

Schwensen, Jakob F; Menné, Torkil; Sommerlund, Mette

2016-01-01

Contact dermatitis in healthcare workers is a pan-European problem. We conducted a retrospective observational study of the patch-test results of 1402 healthcare workers and 1402 matched controls with contact dermatitis who were treated at 3 hospitals departments in Denmark between 2007 and 2014....... The primary objective was to determine whether healthcare work was associated with contact allergy to thiuram mix. Unadjusted univariate analyses revealed that healthcare work was significantly associated with occupational contact dermatitis and hand dermatitis. Contact allergy to thiuram mix was more common...... in healthcare workers was significantly associated with having occupational contact dermatitis, hand dermatitis and older age. In conclusion, we report here a potential problem of contact allergy to thiurams in healthcare workers with contact dermatitis. Legislative authorities may in the future focus...

International Experience in Reforming the System of Higher Education Governance in terms of Increasing the University Autonomy

Directory of Open Access Journals (Sweden)

Chmutova Iryna M.

2017-12-01

Full Text Available The aim of the article is to summarize the international experience of reforming the system of higher education governance and develop directions that will contribute to increasing the effectiveness of the Ukrainian model for governance of higher education and ensuring its autonomy. There identified common elements and trends in European higher education reforms: greater autonomy for higher education institutions with less direct administrative intervention; greater emphasis on private rather than public funding; emphasis on the quality and effectiveness of education. The tools for implementing reforms in the European higher education system are identified: the New Public Management (NPM model, governance through networks, and new forms of governance. The changes in the university autonomy of European countries for the period of 2010-2016 are summarized. The content of the reforms in terms of increasing the autonomy of HEIs in the countries of Asia is disclosed. Possible vectors for reforming the system of higher education governance in Ukraine are identified: introduction of a model for funding HEIs on the basis of combining a one-time full budgeting and financing by results; assigning universities ownership of their buildings and their sale in the market; strengthening the decentralization of government control of higher education; development of legislative bases for the self-sufficiency of HEIs; inclusion of external stakeholders in decision-making governing bodies of HEIs; maximum involvement of students in decision-making.

THE AUSTRIAN CONSTITUTIONAL CONVENTION: CONTINUING THE PATH TO REFORM THE FEDERAL STATE?

Directory of Open Access Journals (Sweden)

Anna Gamper

2006-04-01

Full Text Available This article discusses the different debates and attempts to reform the Austrianfederal system over the last fifteen years. The article is based on a historicalperspective that describes the most relevant developments of Austrianfederalism during the 20th century, highlighting the importance of thecentralisation process through the constant transfer of powers from the Länderto the Federal Government, as well as various debates in this regard.According to the author, since 1995, the year of Austrian adhesion to theEuropean Union, two opportunities have been missed to carry out a generalreform of the federal system which could contribute to compensating thecentralisation process.The first missed opportunity is directly related to the Austrian adhesion tothe European Union. The Länder agreed to the adhesion under the conditionthat the Federal Constitution would include their participation in Europeandecision-making processes. By focussing on this point, the Länder set aside the opportunity to take advantage of the debate and, as a consequence,press for structural reform of the federal system. The second missed opportunitywas related to the dispersion of proposals resulting from the work ofthe Austrian Constitutional Convention. The Convention, created in 2003,had the mission of discussing those aspects of the reform of the Constitutionthat regulated the federal structure of the country and, as a consequence,of making a first draft reform. The incapability of establishing and definingcommon ground for reform, together with the lack of flexibility and ofseeking political commitment, weakened the role of the Convention and,thus, any possibility to carry on with the reform.

Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis.

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Leone, Tiziana; Cetorelli, Valeria; Neal, Sarah; Matthews, Zoë

2016-01-28

Evidence on whether removing fees benefits the poorest is patchy and weak. The aim of this paper is to measure the impact of user fee reforms on the probability of giving birth in an institution or undergoing a caesarean section (CS) in Ghana, Burkina Faso, Zambia, Cameroon and Nigeria for the poorest strata of the population. Women's experience of user fees in 5 African countries. Using quasi-experimental regression analysis we tested the impact of user fee reforms on facilities' births and CS differentiated by wealth, education and residence in Burkina Faso and Ghana. Mapping of the literature followed by key informant interviews are used to verify details of reform implementation and to confirm and support our countries' choice. We analysed data from consecutive surveys in 5 countries: 2 case countries that experienced reforms (Ghana and Burkina Faso) by contrast with 3 that did not experience reforms (Zambia, Cameroon, Nigeria). User fee reforms are associated with a significant percentage of the increase in access to facility births (27 percentage points) and to a much lesser extent to CS (0.7 percentage points). Poor (but not the poorest), and non-educated women, and those in rural areas benefitted the most from the reforms. User fees reforms have had a higher impact in Burkina Faso compared with Ghana. Findings show a clear positive impact on access when user fees are removed, but limited evidence for improved availability of CS for those most in need. More women from rural areas and from lower socioeconomic backgrounds give birth in health facilities after fee reform. Speed and quality of implementation might be the key reason behind the differences between the 2 case countries. This calls for more research into the impact of reforms on quality of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Trends and correlates of the public's perception of healthcare systems in the European Union: a multilevel analysis of Eurobarometer survey data from 2009 to 2013.

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AlSaud, AlJohara M; Taddese, Henock B; Filippidis, Filippos T

2018-01-08

The aim of the study is to assess trends in public perceptions of health systems in 27 European Union (EU) member states following the financial crisis (2009-2013), in order to discuss observed changes in the context of the financial crisis. Repeated cross-sectional studies. 27 EU countries. EU citizens aged 15 years and older. The study mainly uses the Eurobarometer Social Climate Survey, conducted annually between 2009 and 2013, thereby analysing 116 706 observations. A multilevel logistic regression was carried out to analyse trends over time and the factors associated with citizens' perceptions of their healthcare systems. Europeans generally exhibit positive perceptions of their national healthcare systems, 64.0% (95% CI 63.6% to 64.4%). However, we observed a significant drop in positive perceptions in the years following the crisis, especially within countries most affected by the crisis. Concerning fiscal characteristics, wealthier countries and those dedicating higher proportion of their national income to health were more likely to maintain positive perceptions. At the individual level, perceptions of healthcare systems were significantly associated with respondents' self-perceptions of their social status, financial capacity and overall satisfaction in life. Our finding confirms previous observations that citizens' perceptions of their healthcare systems may reflect their overall prospects within the broader socioeconomic systems they live in; which have in turn been affected by the financial crisis and the policy measures instituted in response. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Does the Energy Sector Reform Call for Reform

International Nuclear Information System (INIS)

Granic, G.

2007-01-01

This paper discusses the course of the energy sector reforms in Europe so far, its objectives, achievements, issues, and dilemmas. In particular, long term and security aspects of energy supply of Europe are analyzed. In addition to the legislative changes regarding the open energy market regulation, and primarily the changes, concerning electricity and natural gas markets, the past period saw dynamic changes of institutional framework such as: increasing members of the European Union, increased number of countries aspiring to the EU (candidate countries and potential candidates), changes in other European countries out of which Russia is the most significant energy producer. The paper analyzes the issue of responsibility between state - regulator - system operator - trader - energy buyer. In Europe, it is more a complex question because the system of responsibility includes the institution of the European Union. Therefore, the relations between EU - state - regulator - system operator - trader - energy buyer are especially important. The paper looks in to the issue of energy company integrations, creation of energy mega-undertakings and their influence on further market development. The question of monopolies now appears in s new form. The conclusions suggest possible measures for institutional influence on energy market development, especially in the network energy systems, which may have a positive impact on system security and stability and markets development and their long term sustainability.(author)

Cancer registration, public health and the reform of the European data protection framework: Abandoning or improving European public health research?

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Andersen, Mette Rye; Storm, Hans H

2015-06-01

The importance of cancer- and other disease registries for planning, management and evaluation of healthcare systems has been shown repeatedly during the last 50 years. Complete and unbiased population-level analyses on routinely collected, individual data concerning health and personal characteristics can address significant concerns about risk factors for cancer and provide sound evidence about public health and the effectiveness of healthcare systems. The existence of quality controlled and comprehensive data in registries, allowed to be used for quality control, research and public health purposes are taken as granted by most health professionals and researchers. However, the current revision of the European Union (EU) data protection framework suggests a harmonisation of requirements for confidentiality and individual consent to data processing, likely at the expense of proper use of registry data in the health sector. Consequences of excessive confidentiality rules that may lead to missed data linkages have been simulated. The simulations provide one possible explanation for observed heterogeneity among some cancer incidence data. Further, public health, quality control and epidemiological research on large populations can no longer provide evidence for health interventions, if requirements for consent renders research impossible or where attempts to obtain consent from each data subject generates biased results. Health professionals should engage in the on-going debate on the Commission's proposal for a General Data Protection Regulation. The nature and use of registry data in public health research must be explained and known to policy-makers and the public. Use of cancer registry data and other epidemiological activity will terminate abruptly if an unnecessarily strict EU data protection regulation is adopted. Research based interventions, as well as the international recognised standing of cancer registries and register-based research institutions in

Environmental fiscal reforms

Directory of Open Access Journals (Sweden)

Ashish Chaturvedi

2014-09-01

Full Text Available The paper presents concepts and instruments of environmental fiscal reforms (EFR and their application in the Indian context. EFR can lead to environmental improvement more efficiently and cost effectively than traditional regulation. There is substantial experience of successful EFR implementation in the European Union. India has also adopted some EFR measures such as deregulation of petrol prices, coal cess, and subsidy for setting up common effluent treatment plants. The challenges of implementing EFR measures in India are also discussed, including inadequate analysis, policy framework and institutional capacity, as well as conflict with poverty reduction and building political support.

Stakeholders' views on the strengths and weaknesses of maternal care financing and its reform in Georgia.

Science.gov (United States)

Shengelia, Lela; Pavlova, Milena; Groot, Wim

2017-08-08

The improvement of maternal health has been one of the aims of the health financing reforms in Georgia. Public-private relationships are the most notable part of the reform. This study aimed to assess the strengths and weakness of the maternal care financing in Georgia in terms of adequacy and effects. A qualitative design was used to explore the opinions of key stakeholders about the adequacy of maternal care financing and financial protection of pregnant women in Georgia. Women who had used maternal care during the past 4 years along with health care providers, policy makers, and representatives of international partner organizations and national professional body were the respondents in this study. Six focus group discussions to collect data from women and 15 face-to-face in-depth interviews to collect data from the other stakeholders were conducted. Each focus group discussion consisted of 7-8 women. Two focus group discussions were carried out at each of the target settings (i.e. Tbilisi, Imereti and Adjara). Women were selected in each location through the hospital registry and snowballing method. The evidence shows that there is a consensus among maternal care stakeholder groups on the influence of the healthcare financing reforms on maternal health. Specifically, the privatization of the maternal care services has had positive effects because it significantly improved the environment and technical capacity of the maternity houses. Also, in contrast to other former-soviet republics, there are no informal payments anymore for maternal care in Georgia. However the privatization, which was done without strict regulation, negatively influenced the reform process and provided the possibility to private providers to manipulate the formal user fees in maternal care. Stakeholders also indicated that the UHC programs implemented at the last stage of the healthcare financing reform as well as other state maternal health programs protect women from catastrophic health

Managing risk selection incentives in health sector reforms.

Science.gov (United States)

Puig-Junoy, J

1999-01-01

The object of the paper is to review theoretical and empirical contributions to the optimal management of risk selection incentives ('cream skimming') in health sector reforms. The trade-off between efficiency and risk selection is fostered in health sector reforms by the introduction of competitive mechanisms such as price competition or prospective payment systems. The effects of two main forms of competition in health sector reforms are observed when health insurance is mandatory: competition in the market for health insurance, and in the market for health services. Market and government failures contribute to the assessment of the different forms of risk selection employed by insurers and providers, as the effects of selection incentives on efficiency and their proposed remedies to reduce the impact of these perverse incentives. Two European (Netherlands and Spain) and two Latin American (Chile and Colombia) case studies of health sector reforms are examined in order to observe selection incentives, their effects on efficiency and costs in the health system, and regulation policies implemented in each country to mitigate incentives to 'cream skim' good risks.

Values, participatory democracy, and healthcare resource allocation: an application to a campus community.

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Bentley, J P; Larson, L N; Brenton, M A

1995-03-01

As healthcare reform is debated, it is important that decision makers consider the values of all citizens, that is, what people find desirable or useful about healthcare services. Several states have used town meetings in an effort to determine their citizens' views on the values in the realm of healthcare. In this article, the authors describe a process in which individuals actively participate in an open discussion about issues surrounding allocation of healthcare resources in a university setting. Three different groups from the university community participated in separate, structured meetings to discuss their values concerning the allocation of scarce healthcare resources. Such meetings give participants opportunities to learn about their values and those of other persons in the community.

How to Reform the EU Budget? A Multidisciplinary Approach

NARCIS (Netherlands)

Figueira, F.

The European Commission is currently drafting a proposal for a review of the EU budget, which could lead to its most significant reform to date. This paper proposes a method for restructuring the EU budget, based on a multidisciplinary approach. The insights of public sector economics, fiscal

Three decades of policy layering and politically sustainable reform in the European Union's agricultural policy

DEFF Research Database (Denmark)

Daugbjerg, Carsten; Swinbank, Alan

2016-01-01

The study of policy reform has tended to focus on single-stage reforms taking place over a relatively short period. Recent research has drawn attention to gradual policy changes unfolding over extended periods. One strategy of gradual change is layering, in which new policy dimensions...

European Union's French Presidency: priority to the fight against climate change

International Nuclear Information System (INIS)

Laurent, Eloi; Le Cacheux, Jacques

2008-06-01

Very much like the Lisbon Agenda, the European strategy against climate change suffers from a discrepancy between high ambitions and weak collective instruments. As France takes the EU Presidency in July 2008, one of its priorities is precisely to make some significant progress in reducing the gap between ends and means. With the negotiation on the reform of the EU budget, a perfect opportunity of furthering the cooperation between European member states presents itself. A reformed EU budget could in fact become the first step towards an integrated environmental and energetic European policy, by reorienting spending towards climate change mitigation policies, and creating new resources

Targeting Environmental Quality to Improve Population Health and Lower Healthcare Costs

Science.gov (United States)

Key goals of health care reform are to stimulate innovative approaches to improve healthcare quality and clinical outcomes while holding down costs. To achieve these goals value-based payment places the needs of the patient first and encourages multi-stakeholder cooperation. Ye...

Changes in health expenditures in China in 2000s: has the health system reform improved affordability.

Science.gov (United States)

Long, Qian; Xu, Ling; Bekedam, Henk; Tang, Shenglan

2013-06-13

China's health system reform launched in early 2000s has achieved better coverage of health insurance and significantly increased the use of healthcare for vast majority of Chinese population. This study was to examine changes in the structure of total health expenditures in China in 2000-2011, and to investigate the financial burden of healthcare placed on its population, particularly between urban and rural areas and across different socio-economic development regions. Health expenditures data came from the China National Health Accounts study in 1990-2011, and other data used to calculate the financial burden of healthcare were from China Statistical Yearbook and China Population Statistical Yearbook. Total health expenditures were divided into government and social expenditure, and out-of-pocket payment. The financial burden of healthcare was estimated as out-of-pocket payment per capita as a percentage of annual household living consumption expenditure per capita. Between 2000 and 2011, total health expenditures in China increased from Chinese yuan 319 to 1888 (United States dollars 51 to 305), with average annual increase of 17.4%. Government and social health expenditure increased rapidly being 22.9% and 18.8% of average annual growth rate, respectively. The share of out-of-pocket payment in total health expenditure for the urban population declined from 53% in 2005 to 36% in 2011, but had only a slight decrease for the rural population from 53% to 50%. Out-of-pocket payment, as a percentage of annual household living consumption, has continued to rise, particularly in the rural population from the less developed region (6.1% in 2000 to 8.8% in 2011). The rapid increase of public funding to subsidize health insurance in China, as part of the reform strategy, did not mitigate the out-of-pocket payment for healthcare over the past decade. Financial burden of healthcare on the rural population increased. Affordability among the rural households with sick

Effects of patient-reported non-severe hypoglycemia on healthcare resource use, work-time loss, and wellbeing in insulin-treated patients with diabetes in seven European countries

DEFF Research Database (Denmark)

Geelhoed-Duijvestijn, Petronella H; Pedersen-Bjergaard, Ulrik; Weitgasser, Raimund

2013-01-01

the effects of self-reported non-severe hypoglycemic events (NSHE) on use of healthcare resources and patient wellbeing. Methods: Patients with T1DM or insulin-treated T2DM diabetes from seven European countries were invited to complete four weekly questionnaires. Data were collected on patient demographics...

Governance mechanisms for healthcare apps

DEFF Research Database (Denmark)

Manikas, Konstantinos; Hansen, Klaus Marius; Kyng, Morten

2014-01-01

The introduction of the `app store' concept has challenged the way software is distributed and marketed: developers have easier access to customers, while customers have easy access to innovative applications. Apps today are increasingly focusing on more "mission-critical" areas like healthcare...... with the Apple AppStore counting more than 40,000 apps under the category "health & fitness". This rapid development of healthcare apps increases the necessity of governance as, currently, healthcare apps are not thoroughly governed. The U.S. Food and Drug Administration and the European Commission only have...... policies for apps that are medical devices.In this paper, we approach the problem of how to govern healthcare and medical apps by addressing the risks the use of these apps pose, while at the same time inviting for development of new apps. To do so we (i) analyze four cases of healthcare app governance...

Getting value from health spending: going beyond payment reform.

Science.gov (United States)

Ho, Sam; Sandy, Lewis G

2014-05-01

It is widely held that fee-for-service (FFS) payment systems reward volume and intensity of services, contributing to overall cost inflation, while doing little to reward quality, efficiency, or care coordination. Recently, The National Commission on Physician Payment Reform (sponsored by SGIM) has recommended that payers "should largely eliminate stand-alone fee-for-service payment to medical practices because of its inherent inefficiencies and problematic financial incentives." As the current and former Chief Medical Officers of a large national insurer, we agree that payment reform is a critical component of health care modernization. But calls to transform payment simultaneously go too far, and don't go far enough. Based on our experience, we believe there are several critical ingredients that are either missing or under-emphasized in most payment reform proposals, including: health care is local so no one size fits all; upgrading performance measures; monitoring/overcoming unintended consequences; using a full toolbox to achieve transformation; and ensuring that the necessary components for successful delivery reform are in place. Thinking holistically and remembering that healthcare is a complex adaptive system are crucial to achieving better results for patients and the health system.

Compulsory Schooling Laws and Migration Across European Countries.

Science.gov (United States)

Aparicio Fenoll, Ainhoa; Kuehn, Zoë

2017-12-01

Educational attainment is a key factor for understanding why some individuals migrate and others do not. Compulsory schooling laws, which determine an individual's minimum level of education, can potentially affect migration. We test whether and how increasing the length of compulsory schooling influences migration of affected cohorts across European countries, a context where labor mobility is essentially free. We construct a novel database that includes information for 31 European countries on compulsory education reforms passed between 1950 and 1990. Combining this data with information on recent migration flows by cohorts, we find that an additional year of compulsory education reduces the number of individuals from affected cohorts who migrate in a given year by 9 %. Our results rely on the exogeneity of compulsory schooling laws. A variety of empirical tests indicate that European legislators did not pass compulsory education reforms as a reaction to changes in emigration rates or educational attainment.

Croatian Energy Sector Reform - Results Achieved

International Nuclear Information System (INIS)

Nota, R.

2001-01-01

During the past ten years, the energy sector has passed through significant changes including fundamental market, economic, legislative and institutional aspects of sector operation. As the main goal of the Republic of Croatia is the integration into the European Union, the energy sector reform ought to be conducted in keeping with the present market development processes of the EU in such a way as to fulfil all safety criteria. In view of the above mentioned, the Croatian Parliament brought a number of laws during its session in July 2001 (''Official Gazette'' 68/01): 1. Energy Law 2. Energy Activities Regulation Law 3. Electricity Market Law 4. Gas Market Law 5. Oil and Oil Derivatives Market Law, which present the commencement of the energy sector reform (www.mingo.hr).(author)

Physician leadership: a health-care system's investment in the future of quality care.

Science.gov (United States)

Orlando, Rocco; Haytaian, Marcia

2012-08-01

The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system.

Workplace Bullying among Healthcare Workers

Science.gov (United States)

Ariza-Montes, Antonio; Muniz, Noel M.; Montero-Simó, María José; Araque-Padilla, Rafael Angel

2013-01-01

This paper aims to assess consistent predictors through the use of a sample that includes different actors from the healthcare work force to identify certain key elements in a set of job-related organizational contexts. The utilized data were obtained from the 5th European Working Conditions Survey, conducted in 2010 by the European Foundation for the Improvement of Living and Working Conditions. In light of these objectives, we collected a subsample of 284 health professionals, some of them from the International Standard Classification of Occupations—subgroup 22—(ISCO-08). The results indicated that the chance of a healthcare worker referring to him/herself as bullied increases among those who work on a shift schedule, perform monotonous and rotating tasks, suffer from work stress, enjoy little satisfaction from their working conditions, and do not perceive opportunities for promotions in their organizations. The present work summarizes an array of outcomes and proposes within the usual course of events that workplace bullying could be reduced if job demands were limited and job resources were increased. The implications of these findings could assist human resource managers in facilitating, to some extent, good social relationships among healthcare workers. PMID:23887621

Workplace Bullying among Healthcare Workers

Directory of Open Access Journals (Sweden)

María José Montero-Simó

2013-07-01

Full Text Available This paper aims to assess consistent predictors through the use of a sample that includes different actors from the healthcare work force to identify certain key elements in a set of job-related organizational contexts. The utilized data were obtained from the 5th European Working Conditions Survey, conducted in 2010 by the European Foundation for the Improvement of Living and Working Conditions. In light of these objectives, we collected a subsample of 284 health professionals, some of them from the International Standard Classification of Occupations—subgroup 22—(ISCO-08. The results indicated that the chance of a healthcare worker referring to him/herself as bullied increases among those who work on a shift schedule, perform monotonous and rotating tasks, suffer from work stress, enjoy little satisfaction from their working conditions, and do not perceive opportunities for promotions in their organizations. The present work summarizes an array of outcomes and proposes within the usual course of events that workplace bullying could be reduced if job demands were limited and job resources were increased. The implications of these findings could assist human resource managers in facilitating, to some extent, good social relationships among healthcare workers.

Analysis of Private Sector Care Reform Authorities and Savings

Science.gov (United States)

2016-12-01

coordination, and promotion of health outcomes—in short, it was not a sustainable business model. FFS purchasing remains an element of an overall...primarily focused on the cost (or supply side) of delivering the healthcare services. The reforms examined in this paper (VBP of purchased care) affect ...J. Kerstein. “How do financial incentives affect physicians’ clinical decisions and the financial performance of health maintenance organizations

[Transnational solidarity? Cross-border heath-care in the European Union].

Science.gov (United States)

Schmucker, R

2010-03-01

The responsibilities of the European Union surrounding public health are concentrated on co-ordinating and complementary practices. A mandatory European harmonization of standards and policies is in effect in only a few areas such as pharmaceutical authorization and health protection at the workplace. The implementation of single market rights over the national health-care systems (negative integration) is growing at the European level. This has ambivalent repercussions. Whilst the rights of patients on the basis of the four fundamental freedoms in the context of cross-border health-care have got stronger, national governments see themselves confronted with a limitation of scope for their health-care policies. The basic principles of the integration project place European pressure on national governments. They are subject to sanctions if their policies are not directly in accordance with the single market concept. Georg Thieme Verlag KG Stuttgart. New York.

Article Commentary: Integral Healthcare: The Benefits and Challenges of Integrating Complementary and Alternative Medicine with a Conventional Healthcare Practice

Directory of Open Access Journals (Sweden)

Christina L. Ross PhD

2009-01-01

Full Text Available Today's medicine is in the midst of an undeniable crisis. Calls to reform healthcare are in the forefront of economic and political discussions worldwide. Economic pressures reduce the amount of time physicians can spend with patients contributing to burnout among medical staff and endangering the patient iatrogenically. Politicians are getting involved as the public is calling for more affordable healthcare. A new paradigm must be embraced in order to address all aspects of this dilemma. It is clear that science and technology have resulted in vastly improved understanding, diagnosis, and treatment of disease, but the emphasis on science and technology to the exclusion of other elements of healing has also served to limit the development of a model that humanizes healthcare. The healing of a patient must include more than the biology and chemistry of their physical body; by necessity, it must include the mental, emotional and spiritual aspects. Because of these challenges, the development of an integral healthcare system that is rooted in appropriate regulation and supported by rigorous scientific evidence is the direction that many models of integrative healthcare are moving towards in the 21st century.

Corporate Governance Convergence : Evidence from Takeover Regulation Reforms in Europe

NARCIS (Netherlands)

Goergen, M.; Martynova, M.; Renneboog, L.D.R.

2005-01-01

This paper contributes to the research on corporate governance by predicting the effects of European takeover regulation.In particular, we investigate whether the recent reforms of takeover regulation in Europe are leading to a harmonization of the national legislations.With the help of 150

The development of intelligent healthcare in China.

Science.gov (United States)

Zheng, Xiaochen; Rodríguez-Monroy, Carlos

2015-05-01

Intelligent healthcare (IH) is proposed with the fast application of Internet of Things technology in the healthcare area in recent years. It is considered as an expansion of e-health and telemedicine. As the largest developing country, China is investing large amounts of resources to push forward the development of IH. It is one of the centerpieces of the country's New Healthcare Reform, and great expectation is placed on it to help solve the conflict between limited healthcare resources and the large patient population. Essential policies, milestones, standards, and specifications from the Chinese government since the 1990s were reviewed to show the brief development history of IH in China. Some typical cases and products have been analyzed to present the current situation. The main problems and future development directions have been summarized. The IH industry in China has great potential and is growing very fast, but a lot of challenges also exist. In the future both government support and the active participation of nongovernmental capital are needed to push forward the whole industry.

PRIORITIES OF PENSION REFORM IN UKRAINE AT THE PRESENT STAGE

Directory of Open Access Journals (Sweden)

Volodymyr Rudyk

2017-03-01

Full Text Available The issues of reforming the national pension system in modern conditions are considered. Their main elements, level of  their using in the general pension model of the country are analyzed. The financial security of the pension sector, increasing in pension costs, tendencies of increase of  their share relative to GDP for the future were assessed. Comparison of this indicator on the European countries was made. Priorities for pension reform were identified, main directions of reorganization of the solidarity pension system, the necessity of introduction of obligatory accumulative pension insurance were justified, the ways of further development of private pension provision were determined. Special attention was paid to the need to improve the legislative framework, which will be the legal basis for the successful conduction of this stage of the pension reform. Key words: pension reform, pension system, pension system, pension provision, pension system, pension assets, pension programs, financial risks, pension management.

A Decade Lost: Primary Healthcare Performance Reporting across Canada under the Action Plan for Health System Renewal.

Science.gov (United States)

Johnston, Sharon; Hogel, Matthew

2016-05-01

In 2004, Canada's First Ministers committed to reforms that would shape the future of the Canadian healthcare landscape. These agreements included commitments to improved performance reporting within the primary healthcare system. The aim of this paper was to review the state of primary healthcare performance reporting after the public reporting mandate agreed to a decade ago in the Action Plan for Health System Renewal of 2003 expired. A grey literature search was performed to identify reports released by the governmental and independent reporting bodies across Canada. No province, or the federal government, met their performance reporting obligations from the 2004 accords. Although the indicators required to report on in the 2004 Accord no longer reflect the priorities of patients, policy makers and physicians, provinces are also failing to report on these priorities. Canada needs better primary healthcare performance reporting to enable accountability and improvement within and across provinces. Despite the national mandate to improve public health system reporting, an opportunity to learn from the diverse primary healthcare reforms, underway across Canada for the past decade, has already been lost. Copyright © 2016 Longwoods Publishing.

Generation Y in healthcare: leading millennials in an era of reform.

Science.gov (United States)

Piper, Llewellyn E

2012-01-01

The healthcare workforce has grown with the addition of a new group of physicians, nurses, allied health professionals, administrators, and support staff who belong to America's youngest generation now in the workforce-generation Y, or the millennials. This generation consists of more than 70 million people, the oldest of whom are now in their late 20s and early 30s. With traits and workplace expectations that differ from those observed in other generations, and with a size that threatens to overtake the total number of baby boomers, generation Yers are positioned to influence (if not drastically change) current leadership approaches. The common traits that define or are associated with generation Y workers are often regarded as barriers yet provide healthcare leaders with a clear guide to understanding these employees and drawing out their best qualities and performance. For the organization to fulfill its social contract to provide high-quality, cost-effective, and safe healthcare, it must satisfy the needs and manage the expectations of those who directly deliver these services. This is especially important in today's environment, which is marked by the still-fluid stipulations of the Affordable Care Act (ACA), changed consumer expectations, and public demands for transparency and accountability.

The British parliament: An effort towards the constitutional reform

Directory of Open Access Journals (Sweden)

Pejić Irena

2015-01-01

Full Text Available The British Parliament is the eldest representative assembly which inspired the development of most European parliamentary systems. This institution provides a framework for the Westminster model of democracy. The Parliament structure is based on bicameralism, including two chambers: the House of Commons and the House of Lords. The two-chamber structure is an integral part of the British parliamentary system. During the last century, many reforms took place regarding the modernization of Parliament. Thus, the number of members of the House of Lord has been reduced in order to ensure more efficiency in the working procedures. However, the House of Commons is still 'the dominant House' given its capacity to recruit a political majority which is eligible to control the Cabinet. During the 20th century, several waves of reforms engulfed the traditional English parliamentarism and its 'unwritten' constitution. Although the reforms have yielded some results, they have not yet produced a constitution in the formal sense. The partially reformed Parliament has not lost the traditional supremacy it was initially vested under the original postulates of the parliamentary sovereignty doctrine. The great constitutional reform in the UK, initiated in 1997, has encompassed not only Parliament but also a vast array of other areas ranging from the state power organization to human rights. In this process, the British Parliament should exercise a dual function: as a subject of reform ('reformer', as well as an object of reform ('the reformed'. Undoubtedly, the United Kingdom has been facing one of the largest waves of constitutional reforms in its long history, which will sooner or later lead to a constitutional codification in the state whose system is still predominantly based on the historical and 'unwritten' constitution.

Robotics for healthcare: final report

NARCIS (Netherlands)

Butter, M.; Rensma, A.; Boxsel, J. van; Kalisingh, S.; Schoone, M.; Leis, M.; Gelderblom, G.J.; Cremers, G.; Wilt, M. de; Kortekaas, W.; Thielmaan, A.; Cuhls, K.; Sachinopoulou, A.; Korhonen, I.

2008-01-01

For the last two decades the European Commission (EC), and in particular the Directorate General Information Society and Media, has been strongly supporting the application of Information and Communication Technologies (ICT) in healthcare. ICT is an enabling technology which can provide various

Competition through regulation - efforts aimed at reform in the European and German gas industries: Appropriate, feasible and consistent with the economic facts?

International Nuclear Information System (INIS)

Klaue, S.

1994-01-01

At the forefront of the ongoing debate in Europe on the political, economic and legal aspects of energy supplies are considerations for introducing a new regulatory framework, especially the general third-party access (TPA) regime for grid energies. Most advocates of such reform claim that it is needed for the sake of more competition in the energy sector. However, they do not set out from economic facts and seek a solution to the problems. Instead, the solution is laid down as the target, to which the economic facts are subordinated. Blind activism inspired by theoretical motives and without regard for the consequences must be avoided. Otherwise there is a danger of the new framework being unsuitable for really bringing about any movement, be it in the intended direction or towards the envisaged goal. The introduction of general TPA can only be successful if there are certain structures and market trends. Do such structures and market trends exist in the European and German gas industries? In answering this question, it is necessary to proceed from the economic conditions, on which both a general and an economical/legal assessment of reform efforts should actually be based. Reference is therefore made to Jonathan P. Stern, who gathered in facts and whose evaluations are taken into account here. (orig.)

Does the Accountable Care Act Aim to Promote Quality, Health, and Control Costs or Has It Missed the Mark? ;Comment on “Health System Reform in the United States”

Directory of Open Access Journals (Sweden)

Carol Molinari

2014-02-01

Full Text Available McDonough’s perspective on healthcare reform in the US provides a clear, coherent analysis of the mix of access and delivery reforms in the Affordable Care Act (ACA aka Obamacare. As noted by McDonough, this major reform bill is designed to expand access for health coverage that includes both prevention and treatment benefits among uninsured Americans. Additionally, this legislation includes several financial strategies (e.g. incentives and penalties to improve care coordination and quality in the hospital and outpatient settings while also reducing healthcare spending and costs. This commentary is intended to discuss this mix of access and delivery reform in terms of its potential to achieve the Triple Aim: population health, quality, and costs. Final remarks will include the role of the US federal government to reform the American private health industry together with that of an informed consumer.

Building an integrated methodology of learning that can optimally support improvements in healthcare.

Science.gov (United States)

Lynn, Joanne

2011-04-01

The methods for healthcare reform are strikingly underdeveloped, with much reliance on political power. A methodology that combined methods from sources such as clinical trials, experience-based wisdom, and improvement science could be among the aims of the upcoming work in the USA on comparative effectiveness and on the agenda of the Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services. Those working in quality improvement have an unusual opportunity to generate substantial input into these processes through professional organisations such as the Academy for Healthcare Improvement and dominant leadership organisations such as the Institute for Healthcare Improvement.

Determinants of patients choice of healthcare providers: a scoping review.

NARCIS (Netherlands)

Victoor, A.; Delnoij, D.M.J.; Friele, R.D.; Rademakers, J.J.D.J.M.

2012-01-01

Background: In several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice

Interpreting ethnic inequalities in healthcare consumption: a conceptual framework for research

NARCIS (Netherlands)

Essink-Bot, Marie-Louise; Lamkaddem, Majda; Jellema, Petra; Nielsen, Signe Smith; Stronks, Karien

2013-01-01

The increasing diversity of the Western-European population demands identification of potential ethnic healthcare inequities. We developed a framework that helps researchers in interpreting ethnic inequalities in healthcare consumption in equity terms. From this framework, we develop recommendations

Do political or economic factors drive healthcare financing privatisations? Empirical evidence from OECD countries

OpenAIRE

Wiese, Rasmus

2013-01-01

This paper adds new empirical evidence to the political economy literature of economic reform. One of the main contributions of this paper is the development of a novel methodology to identify privatisations. The methodology is a combination of the Bai & Perron structural break filter, and validation of the breaks identified by this filter using de jure evidence of reforms. 21 de facto healthcare financing privatisations are identified in a sample of 23 OECD countries. It is analysed which fa...

HTA Implementation Roadmap in Central and Eastern European Countries

DEFF Research Database (Denmark)

Kaló, Zoltán; Gheorghe, Adrian; Huic, Mirjana

2016-01-01

The opportunity cost of inappropriate health policy decisions is greater in Central and Eastern European (CEE) compared with Western European (WE) countries because of poorer population health and more limited healthcare resources. Application of health technology assessment (HTA) prior to health......The opportunity cost of inappropriate health policy decisions is greater in Central and Eastern European (CEE) compared with Western European (WE) countries because of poorer population health and more limited healthcare resources. Application of health technology assessment (HTA) prior......, use of local data, scope of mandatory HTA, decision criteria, and international collaboration in HTA. Although HTA implementation strategies from the region can be relevant examples for other CEE countries with similar cultural environment and economic status, HTA roadmaps are not still fully...

Interactions: trade policy and healthcare reform after Chaoulli v. Quebec: is it time for Canada to acknowledge the fragile boundary between health and trade policies and strengthen the separation between private and public health insurance?

Science.gov (United States)

Crawford, Mark

2006-01-01

The insulation of Canada's healthcare system from trade treaty obligations is crucial to the legitimacy of Canada's trade policy. Legal analysis has suggested, however, that competitive and for-profit delivery of the kind contemplated by the Kirby Report and some provinces may make healthcare more vulnerable to challenges under NAFTA and GATS. The Government of Canada has tried to counter this interpretation by stressing the importance of public financing as the principal criterion for exemption of healthcare from trade treaties, but now the potential for private financing of essential medical services indicated by the Supreme Court's decision in Chaoulli v. Quebec has made that line of argument look risky as well. It is apparent that Canada failed to anticipate the possible interactions of domestic, international and constitutional law when it made commitments in the area of private health insurance at the WTO in 1997. Accordingly, the time has come to acknowledge the fragility of the boundary between health and trade policies, to take the risks and costs associated with trade treaty obligations fully into account when undertaking healthcare reform and to strengthen the separation between private and public health insurance.

[Policies encouraging price competition in the generic drug market: Lessons from the European experience].

Science.gov (United States)

Puig-Junoy, Jaume

2010-01-01

To describe alternative policies aimed at encouraging price competition in generic drug markets in countries with strict price regulation, and to present some case studies drawn from the European experience. Systematic literature review of articles and technical reports published after 1999. The shortcomings in consumer price competition observed in some European generic markets, including Spain, may be reduced through three types of public reimbursement or financing reforms: policies aimed at improving the design of current maximum reimbursement level policies; policies aimed at monitoring competitive prices in order to reimburse real acquisition cost to pharmacies; and, more radical and market-oriented policies such as competitive tendering of public drug purchases. The experience of recent reforms adopted in Germany, Belgium, Holland, Norway, and Sweden offers a useful guide for highly price-regulated European countries, such as Spain, currently characterized by limited consumer price competition and the high discounts offered to pharmacy purchases. Direct price regulation and/or the generic reference pricing systems used to reduce generic drug prices in many European countries can be successfully reformed by adopting measures more closely aimed at encouraging consumer price competition in generic drug markets. Copyright 2009 SESPAS. Published by Elsevier Espana. All rights reserved.

The health of nations: A transatlantic trade and investment agenda for better healthcare

OpenAIRE

Erixon, Fredrik; Ferracane, Martina Francesca; Van der Marel, Erik

2015-01-01

Today, increases in the demand for healthcare are driving European governments to look for ways to control growth in healthcare expenditures and at the same time improve health outcomes. Consideration of ways to enhance trade in healthcare goods and services is important for governments as they struggle to find resources to finance this increasing demand for healthcare.

Specialist participation in healthcare delivery transformation: influence of patient self-referral.

Science.gov (United States)

Aliu, Oluseyi; Sun, Gordon; Burke, James; Chung, Kevin C; Davis, Matthew M

2014-01-01

Improving coordination of care and containing healthcare costs are prominent goals of healthcare reform. Specialist involvement in healthcare delivery transformation efforts like Accountable Care Organizations (ACOs) is necessary to achieve these goals. However, patients’ self-referrals to specialists may undermine care coordination and incur unnecessary costs if patients frequently receive care from specialists not engaged in such healthcare delivery transformation efforts. Additionally, frequent self-referrals may also diminish the incentive for specialist participation in reform endeavors like ACOs to get access to a referral base. To examine recent national trends in self-referred new visits to specialists. A descriptive cross-sectional study of new ambulatory visits to specialists from 2000 to 2009 using data from the National Ambulatory Medical Care Survey. We calculated nationally representative estimates of the proportion of new specialist visits through self-referrals among Medicare and private insurance beneficiaries. We also estimated the nationally representative absolute number of self-referred new specialist visits among both groups of beneficiaries. Among Medicare and private insurance beneficiaries, self-referred visits declined from 32.2% (95% confidence interval [CI], 24.0%-40.4%) to 19.6% (95% CI, 13.9%-23.3%) and from 32.4% (95% CI, 27.9%-36.8%) to 24.1% (95% CI,18.8%-29.4%), respectively. Hence, at least 1 in 5 and 1 in 4 new visits to specialists among Medicare and private insurance beneficiaries, respectively, are self-referred. The current considerable rate of self-referred new specialist visits among both Medicare and private insurance beneficiaries may have adverse implications for organizations attempting to transform healthcare delivery with improved care coordination.

Towards a stakeholders' consensus on patient payment policy: the views of health-care consumers, providers, insurers and policy makers in six Central and Eastern European countries.

Science.gov (United States)

Tambor, Marzena; Pavlova, Milena; Golinowska, Stanisława; Sowada, Christoph; Groot, Wim

2015-08-01

Although patient charges for health-care services may contribute to a more sustainable health-care financing, they often raise public opposition, which impedes their introduction. Thus, a consensus among the main stakeholders on the presence and role of patient charges should be worked out to assure their successful implementation. To analyse the acceptability of formal patient charges for health-care services in a basic package among different health-care system stakeholders in six Central and Eastern European countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). Qualitative data were collected in 2009 via focus group discussions and in-depth interviews with health-care consumers, providers, policy makers and insurers. The same participants were asked to fill in a self-administrative questionnaire. Qualitative and quantitative data are analysed separately to outline similarities and differences in the opinions between the stakeholder groups and across countries. There is a rather weak consensus on patient charges in the countries. Health policy makers and insurers strongly advocate patient charges. Health-care providers overall support charges but their financial profits from the system strongly affects their approval. Consumers are against paying for services, mostly due to poor quality and access to health-care services and inability to pay. To build consensus on patient charges, the payment policy should be responsive to consumers' needs with regard to quality and equity. Transparency and accountability in the health-care system should be improved to enhance public trust and acceptance of patient payments. © 2012 John Wiley & Sons Ltd.

Reproductive Health Policies in Peru: Social Reforms and Citizenship Rights

Directory of Open Access Journals (Sweden)

Stéphanie Rousseau

2007-05-01

Full Text Available The article analyzes the case of reproductive health policy-making in Peru in the context of recent social policy reforms. Health-sector reforms have only partially redressed Peruvian women’s unequal access to family planning, reproductive rights and maternal care. The main sources of inequalities are related to the segmented character of the health-care system, with the highest burden placed on the public sector. The majority of women from popular classes, who are not protected by an insurance plan, are dependent upon what and how public services are provided. Simultaneously, the continuing role of conservative sectors in public debates about reproductive health policy has a strong impact on public family planning services and other reproductive rights.

Healthcare system information at language schools for newly arrived immigrants

DEFF Research Database (Denmark)

Tynell, Lena Lyngholt; Wimmelmann, Camilla Lawaetz; Jervelund, Signe Smith

2017-01-01

a language school in Copenhagen in 2012 received either a course or written information on the Danish healthcare system and subsequently evaluated this quantitatively. Results: The evaluation revealed a positive appraisal of the course/information provided. Conclusion: In times of austerity, incorporating......Objective: In most European countries, immigrants do not systematically learn about the host countries’ healthcare system when arriving. This study investigated how newly arrived immigrants perceived the information they received about the Danish healthcare system. Method: Immigrants attending...... healthcare information into an already existing language programme may be pertinent for providing immigrants with knowledge on the healthcare system....

Healthcare in the UK: understanding continuity and change

National Research Council Canada - National Science Library

Greener, Ian

2009-01-01

... of the 1960s The 1970s The 1980s The 1990s The 2000s Conclusion 39 39 39 50 57 58 60 63 66 71 four the double-bed Introduction The relationship between the state and the medical profession The deelopment of the double-bed relationship Deelopments in the 1950s The 1960s and the first organisational reform of the NHS 75 75 77 81 81 84 Healthcar...

IMPLICATIONS OF THE ASSOCIATION AGREEMENT WITH THE EUROPEAN UNION ON THE FINANCIAL PUBLIC MANAGEMENT IN THE REPUBLIC OF MOLDOVA

Directory of Open Access Journals (Sweden)

Lilia ROTARU

2015-09-01

Full Text Available European integration is not just a goal of the foreign policy of the Republic of Moldova, but also a natural aspiration of an European nation to join the European family and the signing of the Association Agreement between Moldova and the European Union is an important step in achieving this goal. The Republic of Moldova has developed and continues to promote rigorous reforms in the area of public finance management. In this article we have analyzed the main reforms and achievements in the field of public finance management in the Republic of Moldova, their importance by reference to good European practices, but also the need to continue them in the context of signing the Association Agreement. The authors argue that until now, the public finance management reform had been focused mainly on the planning and execution phases of National Public Budget, nonetheless the main problems lay in poor budgetary reporting and control. Corruption and fraud are the main risk areas for all the promoted reforms. The conclusion of this paper is that the most urgent actions that should be undertaken consist in improving public procurement procedures, enhancing the internal control, financial inspection and external audit. Only in such a way trustful relation with EU could be created and this is particularly important as it could permit to absorb more European funds to invest in the economic and social development in our country.

European healthcare policies for controlling drug expenditure.

Science.gov (United States)

Ess, Silvia M; Schneeweiss, Sebastian; Szucs, Thomas D

2003-01-01

In the last 20 years, expenditures on pharmaceuticals - as well as total health expenditures - have grown faster than the gross national product in all European countries. The aim of this paper was to review policies that European governments apply to reduce or at least slow down public expenditure on pharmaceutical products. Such policies can target the industry, the wholesalers and retailers, prescribers, and patients. The objectives of pharmaceutical policies are multidimensional and must take into account issues relating to public health, public expenditure and industrial incentives. Both price levels and consumption patterns determine the level of total drug expenditure in a particular country, and both factors vary greatly across countries. Licensing and pricing policies intend to influence the supply side. Three types of pricing policies can be recognised: product price control, reference pricing and profit control. Profit control is mainly used in the UK. Reference pricing systems were first used in Germany and The Netherlands and are being considered in other countries. Product price control is still the most common method for establishing the price of drugs. For the aim of fiscal consolidation, price-freeze and price-cut measures have been frequently used in the 1980s and 1990s. They have affected all types of schemes. For drug wholesalers and retailers, most governments have defined profit margins. The differences in price levels as well as the introduction of a Single European Pharmaceutical Market has led to the phenomenon of parallel imports among member countries of the European Union. This may be facilitated by larger and more powerful wholesalers and the vertical integration between wholesalers and retailers. To control costs, the use of generic drugs is encouraged in most countries, but only few countries allow pharmacists to substitute generic drugs for proprietary brands. Various interventions are used to reduce the patients' demand for drugs by

Health reform and cesarean sections in the private sector: The experience of Peru.

Science.gov (United States)

Arrieta, Alejandro

2011-02-01

To test the hypothesis that the health reform enacted in Peru in 1997 increased the rate of cesarean sections in the private sector due to non-clinical factors. Different rounds of the Demographic and Health Survey are used to estimate determinants of c-section rates in private and public facilities before and after the healthcare reform. Estimations are based on a pooled linear regression controlling by obstetric and socioeconomic characteristics. C-section rates in the private sector grew from 28 to 53% after the health reform. Compared to the Ministry of Health (MOH), giving birth in a private hospital in the post-reform period adds 19% to the probability of c-section. The health reform implemented in the private sector increased physician incentives to over-utilize c-sections. The reform consolidated and raised the market power of private health insurers, but at the same time did not provide mechanisms to enlarge, regulate and disclose information of private providers. All these factors created the conditions for fee-for-service paid providers to perform more c-sections. Comparable trends in c-section rates have been observed in Latin American countries who implemented similar reforms in their private sector, suggesting a need to rethink the role of private health providers in developing countries. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Peer Pressure: Comments on the European Educational Reform

Science.gov (United States)

Liesner, Andrea

2012-01-01

This article reports on the growing influence of informal and not democratically legitimised authority within the educational field in Europe. The Programme for International Student Assessment (PISA), the Bologna Process and the European Qualifications Framework are discussed as instances of neoliberal strategies of modernisation that change the…

A cost-effectiveness analysis to evaluate a system change in mental healthcare in the Netherlands for patients with depression or anxiety.

NARCIS (Netherlands)

Mens, K.; Lokkerbol, J.; Janssen, R.T.J.M.; van Orden, M.; Kloos, M.; Tiemens, B.

2018-01-01

Over the last decade, the Dutch mental healthcare system has been subject to profound policy reforms, in order to achieve affordable, accessible, and high quality care. One of the adjustments was to substitute part of the specialized care for general mental healthcare. Using a quasi-experimental

The European legislative framework for audit committees

NARCIS (Netherlands)

van der Elst, C.F.

In 2014 the European Union reformed the regulatory framework of statutory audits in Directive 2014/56/EC and Regulation (EU) Nr. 537/2014. Part of the new legislation addresses the composition and responsibilities of the audit committee of public-interest entities. This contribution studies the

Measuring the efficiency of a healthcare waste management system in Serbia with data envelopment analysis.

Science.gov (United States)

Ratkovic, Branislava; Andrejic, Milan; Vidovic, Milorad

2012-06-01

In 2007, the Serbian Ministry of Health initiated specific activities towards establishing a workable model based on the existing administrative framework, which corresponds to the needs of healthcare waste management throughout Serbia. The objective of this research was to identify the reforms carried out and their outcomes by estimating the efficiencies of a sample of 35 healthcare facilities engaged in the process of collection and treatment of healthcare waste, using data envelopment analysis. Twenty-one (60%) of the 35 healthcare facilities analysed were found to be technically inefficient, with an average level of inefficiency of 13%. This fact indicates deficiencies in the process of collection and treatment of healthcare waste and the information obtained and presented in this paper could be used for further improvement and development of healthcare waste management in Serbia.

Citizenship of the European Union under the Treaty of Lisbon

Directory of Open Access Journals (Sweden)

Ioana Nely MILITARU

2011-06-01

Full Text Available The paper is structured in two parts. The first part covers history, "Union citizenship, according to previous Treaties Lisbon Treaty, and the second refers to the privileges which they have as citizens of the Union Treaty as a result of reforming the European Union, referring to documents on which this Treaty adhere it recognizes as having the same legal force, treaties, (Treaty on European Union and the Treaty on the Functioning of the European Union.

Survey of Attitudes towards Curriculum Reforms among Medical Teachersin Different Socio-economic and Cultural Environments

DEFF Research Database (Denmark)

Dahl, Mads Ronald

2007-01-01

Curriculum reforms in medical schools require cultural and conceptual changes from the faculty. We assessed attitudes towards curriculum reforms in different academic, economic, and social environments among 776 teachers from 2 Western European medical schools (Belgium and Denmark) and 7 medical...... schools in 3 countries in post-communist transition (Croatia, Slovenia, Bosnia and Herzegovina). The survey included a 5-point Likert-type scale on attitudes towards reforms in general and towards reforms of medical curriculum (10 items each). Teaching staff from medical schools in Bosnia and Herzegovina...... had more positive attitude towards reforms of medical curriculum (mean score 36.8 out of maximum 50 [95% CI 36.1 to 37.3]) than those from medical schools in Croatia or Slovenia (30.7 [29.8 to 31.6]) or Western Europe (27.7 [27.1 to 28.3]) (Pattitudes...

The impacts of implementation of National Essential Medicines Policies on primary healthcare institutions: a cross-sectional study in China.

Science.gov (United States)

Guo, Zhigang; Guan, Xiaodong; Shi, Luwen

2017-11-13

In 2009, China implemented the National Essential Medicines Policies (NEMPs) as part of a new round of medical system reforms. This study aims to evaluate the impacts of the NEMPs on primary healthcare institutions and discuss the roles of the policies in the new healthcare reforms of China. The study selected a total of six representative provinces of China, generating a sample of 261 primary healthcare institutions from August to December in 2010. A questionnaire survey developed by the study team was distributed to all of the primary healthcare institutions. Nine indicators from three dimensions as the outcome variables were used and calculated to evaluate the impacts of implementation of policies. All of the outcome variables were tested using independent-samples T test between the treatment group (with the NEMPs implemented) and the control group (without the NEMPs implemented). The ratio of drug sales and institution revenues at primary healthcare institutions was 42.99% in the treatment group, which was significantly lower than the control group (53.90%, p financial subsidies of the treatment group was shown to be higher (30.78% VS 20.82%, p institutions, the improvement of the mechanisms for government investment, and the healthcare pricing system. Meanwhile, the gaps between urban and rural areas need to be addressed. In conclusion, the NEMPs of China are instrumental to the aim of providing basic healthcare services to every citizen.

Role of Australian primary healthcare organisations (PHCOs) in primary healthcare (PHC) workforce planning: lessons from abroad.

Science.gov (United States)

Naccarella, Lucio; Buchan, James; Newton, Bill; Brooks, Peter

2011-08-01

To review international experience in order to inform Australian PHC workforce policy on the role of primary healthcare organisations (PHCOs/Medicare Locals) in PHC workforce planning. A NZ and UK study tour was conducted by the lead author, involving 29 key informant interviews with regard to PHCOs roles and the effect on PHC workforce planning. Interviews were audio-taped with consent, transcribed and analysed thematically. Emerging themes included: workforce planning is a complex, dynamic, iterative process and key criteria exist for doing workforce planning well; PHCOs lacked a PHC workforce policy framework to do workforce planning; PHCOs lacked authority, power and appropriate funding to do workforce planning; there is a need to align workforce planning with service planning; and a PHC Workforce Planning and Development Benchmarking Database is essential for local planning and evaluating workforce reforms. With the Australian government promoting the role of PHCOs in health system reform, reflections from abroad highlight the key action within PHC and PHCOs required to optimise PHC workforce planning.

The Lisbon Treaty and the role of the European Parliament in the European Atomic Energy Community

International Nuclear Information System (INIS)

Thomas, S.

2008-01-01

In June 2007, the European Council commissioned an intergovernmental conference to draft a 'treaty of reform' of the European Union. The wording of the treaty was signed by the heads of state and government of the member countries on December 13, 2007. The ongoing process of ratification in the 27 EU member countries is to be completed before the next elections to the European Parliament in June 2009. The treaty is now referred to as 'Lisbon Treaty'. The Lisbon Treaty (Treaty Amending the Treaty about the European Union and the Treaty Establishing the European Community) does not replace the European Treaties currently in force, but merely amends them. Also the 'Treaty Establishing the European Atomic Energy Community (EURATOM)' is amended in this way. On the basis of the contributions about 'The German Presidency Program of the Council Working Group on Nuclear Issues - an Interim Report' (W. Sandtner and S. Thomas) and 'Euratom Treaty and Intergovernmental Conference' (S. Thomas), current links to the Euratom Treaty with potential amendments are presented and commented upon. (orig.)

Study on assessing the environmental fiscal reform potential for the EU28

DEFF Research Database (Denmark)

Hogg, Dominic; Elliott, Timothy; Elliott, Laurence

2016-01-01

and consumption taxes”. The AGS set out three pillars that it foresaw as underpinning the EU’s economic and social policy for 2015:  A coordinated response to boosting investment;  A renewed commitment to structural reforms; and  The pursuit of fiscal responsibility. Environmental taxes (together......, and the expressed desire to promote more efficient use of both energy and other resources, point towards a role for environmental fiscal reform (EFR) as a means to set the European economy on a trajectory of growth with a strong shade of green....

Gatekeepers in the healthcare sector: Knowledge and Bourdieu's concept of field.

Science.gov (United States)

Collyer, Fran M; Willis, Karen F; Lewis, Sophie

2017-08-01

Choice is an imperative for patients in the Australian healthcare system. The complexity of this healthcare 'maze', however, means that successfully navigating and making choices depends not only on the decisions of patients, but also other key players in the healthcare sector. Utilising Bourdieu's concepts of capital, habitus and field, we analyse the role of gatekeepers (i.e., those who control access to resources, services and knowledge) in shaping patients' experiences of healthcare, and producing opportunities to enable or constrain their choices. Indepth interviews were conducted with 41 gatekeepers (GPs, specialists, nurses, hospital administrators and policymakers), exploring how they acquire and use knowledge within the healthcare system. Our findings reveal a hierarchy of knowledges and power within the healthcare field which determines the forms of knowledge that are legitimate and can operate as capital within this complex and dynamic arena. As a consequence, forms of knowledge which can operate as capital, are unequally distributed and strategically controlled, ensuring democratic 'reform' remains difficult and 'choices' limited to those beneficial to private medicine. Copyright © 2017 Elsevier Ltd. All rights reserved.

Performance Audit in Public Sector Entities - A New Challenge for Eastern European Countries

Directory of Open Access Journals (Sweden)

Adriana TIRON TUDOR

2007-02-01

Full Text Available Performance measurement provides an objective basis for evaluating how efficiently public resources are being used and how effectively public service outcomes are being achieved. It is a process used to support government selfanalysis and provide a basis for more informed and publicly defensible decision-making. In this context an important role is reserved to performance external audit performed by external audit institutions. The performance audit analyses the quality of financial administration from the point of view of the three elements of performance: economy, efficiency and effectiveness. We intend to realize a comparative study for some Eastern European countries regarding the performance audit, knowing the fact that since countries differ at the level of individual reforms, there is no single model of reform. Nonetheless, reform strategies have many points in common emphasizing the international character of public management reform. By cross-national comparisons we intend to analyze the impact of implementing the new performance audit in certain Eastern European Countries, and in Romania, focused on the external audit institutions.

Private Healthcare Institutions and Insurance Companies: from Cooperators to Market Competitors

Directory of Open Access Journals (Sweden)

Željko Jović

2015-05-01

Full Text Available The provision of adequate healthcare nowadays has a global character, so the implementation of efficient andwell-formulated health reforms has become of serious importance. Among many contemporary trends in this area, there is a tendency of privatization of health care institutions and growth in private insurance premiums. This raises the necessity of developing a cooperation between private healthcare institutions and insurance companies in order to provide services of an improved quality. This paper emphasizes the extremes of their cooperation, moving from fully integrated systems towards competition over the market. The findings indicate that, due to the insufficient development of Serbian healthcare sector, their cooperation is so far not at a highlevel, which brings many issues into question and that should be legally better defined.

Relations between decision indicators for implementing technology in healthcare logistics – a bed logistics case study

DEFF Research Database (Denmark)

Feibert, Diana Cordes; Jacobsen, Peter

2015-01-01

The cost of healthcare is rising and reforms have been introduced across Europe to address the cost issue in healthcare. There is potential to improve logistical processes within healthcare to save costs and at the same time provide services that support high quality patient care. Re......-designing processes and implementing technology can improve the efficiency of processes and reduce costs. A relations diagram has been developed that identifies the effects between the constructs Logistics, Technology, Procedure and Structure. Knowledge about how these constructs affect each other is important when...

[Austerity policies and changes in healthcare use patterns. SESPAS report 2014].

Science.gov (United States)

Urbanos Garrido, Rosa; Puig-Junoy, Jaume

2014-06-01

This article analyzes the main changes in healthcare use patterns in Spain related to the economic recession and to the measures taken to address it. The impact of the reform of drug copayment is examined; the number of prescriptions has decreased, although the effects of this reform on adherence, access to necessary and effective treatments, and health, are still unknown. This article also describes how waiting times and waiting lists for surgery have increased in recent years, as has the population's dissatisfaction with the national health system. Analysis of microdata from the Spanish national health surveys for 2006 and 2011/12 show that the economic recession is deterring the use of uncovered dental visits among the lowest social class. We recommend clearer definition of the role played by copayments within the national health system, and focussing on those who most need healthcare in order to prevent the more socioeconomically advantaged collectives from consuming a larger share of available services after the cuts. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

The Europeanization of Health Care Governance

DEFF Research Database (Denmark)

Martinsen, Dorte Sindbjerg; Vrangbæk, Karsten

2008-01-01

that the EU has a significant impact and that we may be witnessing the formation of a new institutional legacy that represents the initiation of a Europeanized healthcare model: a model emerging around a new set of stakeholders, principles and structures, which includes the market, principles of free movement...... increasingly conspicuous and has contributed to a gradual restructuring of healthcare boundaries as well as of some of its organizing principles. Furthermore, the process and impact have a de-structuring effect on the more traditional governance tools used in relation to healthcare. The paper concludes...

[The reform of primary health care: the economic, care and satisfaction results].

Science.gov (United States)

Durán, J; Jodar, G; Pociello, V; Parellada, N; Martín, A; Pradas, J

1999-05-15

To compare the overall effect on the general public before and after the primary care reform, its economic outcome and professional satisfaction, following the model of the European Foundation for Quality Management. A descriptive analysis of results at reformed primary care centres compared with results at non-reformed centres in the same city. The study was conducted at Sant Boi de Llobregat, a town of 77,591 inhabitants in Baix Llobregat county (Barcelona). 32.7% of the population was covered by two reformed centres. The rest was covered by one single non-reformed primary care centre. Clinical audits and data on pharmaceutical prescription quality were used to find attendance. For economic results, the formula of attribution of cost/inhabitant and cost/inhabitant seen, including the costs of labour, structure, referral, further tests and pharmacy, were used. The satisfaction of the outside customer (user) was measured by a population survey. Internal customer satisfaction was measured by a survey of the professionals. Results were compared with those for 1997. The study showed that the reformed primary care sector's results, measured in terms of professional satisfaction, user-outside customer, attendance, economic results and social impact, were better than the non-reformed sector's. Inside and outside customers' satisfaction was higher in the reformed network. The cost per inhabitant in the reformed network was 31,874 pesetas, against 25,177 in the non-reformed network. The cost per inhabitant seen was 34,482 and 44,603, respectively. The reform creates efficient resource management and greater satisfaction of the general public and professionals, when an indicator sensitive to the real use of services is used.

Progress and outcomes of health systems reform in the United Arab Emirates: A systematic review

NARCIS (Netherlands)

E.J. Koornneef (Erik J.); P.B.M. Robben (Paul); Blair, I. (Iain)

2017-01-01

textabstractBackground: The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent

Hydrogen from methanol for fuel cells in mobile systems: development of a compact reformer

Energy Technology Data Exchange (ETDEWEB)

Hoehlein, B [Forschungszentrum Juelich GmbH (Germany); Boe, M [H. Topsoee A/S, Lyngby (Denmark); Boegild-Hansen, J [H. Topsoee A/S, Lyngby (Denmark); Broeckerhoff, P [Forschungszentrum Juelich GmbH (Germany); Colsman, G [Forschungszentrum Juelich GmbH (Germany); Emonts, B [Forschungszentrum Juelich GmbH (Germany); Menzer, R [Forschungszentrum Juelich GmbH (Germany); Riedel, E

1996-07-01

On-board generation of hydrogen from methanol with a reformer in connection with the use of a proton-exchange membrane fuel cell (PEMFC) is an attractive option for a passenger car drive. Special considerations are required to obtain low weight and volume. Furthermore, the PEMFC of today cannot tolerate more than 10 ppm of carbon monoxide in the fuel. Therefore a gas conditioning step is needed after the methanol reformer. Our main research activities focus on the conceptual design of a drive system for a passenger car with methanol reformer and PEMFC: Engineering studies with regard to different aspects of this design including reformer, catalytic burner, gas conditioning, balances of the fuel cycles and basic design of a compact methanol reformer. The work described here was carried out within the framework of a JOULE II project of the European Union (1993-1995). Extensive experimental studies have been carried out at the Forschungszentrum Juelich GmbH (KFA) in Germany and at Haldor Topsoee A/S in Denmark. (orig.)

Analysing a Chinese Regional Integrated Healthcare Organisation Reform Failure using a Complex Adaptive System Approach

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Wenxi Tang

2017-06-01

Full Text Available Introduction: China’s organised health system has remained outdated for decades. Current health systems in many less market-oriented countries still adhere to traditional administrative-based directives and linear planning. Furthermore, they neglect the responsiveness and feedback of institutions and professionals, which often results in reform failure in integrated care. Complex adaptive system theory (CAS provides a new perspective and methodology for analysing the health system and policy implementation.  Methods: We observed the typical case of Qianjiang’s Integrated Health Organization Reform (IHO for 2 years to analyse integrated care reforms using CAS theory. Via questionnaires and interviews, we observed 32 medical institutions and 344 professionals. We compared their cooperative behaviours from both organisational and inter-professional levels between 2013 and 2015, and further investigated potential reasons for why medical institutions and professionals did not form an effective IHO. We discovered how interested parties in the policy implementation process influenced reform outcome, and by theoretical induction, proposed a new semi-organised system and corresponding policy analysis flowchart that potentially suits the actual realisation of CAS.  Results: The reform did not achieve its desired effect. The Qianjiang IHO was loosely integrated rather than closely integrated, and the cooperation levels between organisations and professionals were low. This disappointing result was due to low mutual trust among IHO members, with the main contributing factors being insufficient financial incentives and the lack of a common vision.  Discussion and Conclusions: The traditional 'organised health system' is old-fashioned. Rather than being completely organised or adaptive, the health system is currently more similar to a s'emi-organised system'. Medical institutions and professionals operate in a middle ground between complete adherence

Healthcare in Asia: a perspective from primary care at the gateway to a continent.

Science.gov (United States)

Jiwa, Moyez; Othman, Sajaratulnisah; Hanafi, Nik Sherina; Ng, Chirk Jenn; Khoo, Ee Ming; Chia, Yook Chin

2012-01-01

Malaysia has achieved reasonable health outcomes even though the country spends a modest amount of Gross Domestic Product on healthcare. However, the country is now experiencing a rising incidence of both infectious diseases and chronic lifestyle conditions that reflect growing wealth in a vibrant and successful economy. With an eye on an ageing population, reform of the health sector is a government priority. As in other many parts of the world, general practitioners are the first healthcare professional consulted by patients. The Malaysian health system is served by public and private care providers. The integration of the two sectors is a key target for reform. However, the future health of the nation will depend on leadership in the primary care sector. This leadership will need to be informed by research to integrate care providers, empower patients, bridge cultural gaps and ensure equitable access to scarce health resources.

Assistive Robotics in Robotics for healthcare, roadmap study for the EC

NARCIS (Netherlands)

Gelderblom, G.J.; Wilt, M. de; Cremers, G.; Rensma, A.

2009-01-01

To gain understanding in the current status of Robotics in healthcare the European Commission issued a roadmap study into this domain. This paper reports on the main characteristics and results of this study. The study covered the wide domain of Healthcare and in this paper the domains relevant for

The role of the European Structural and Investment Funds in Financing Health System in Lithuania: Experience from 2007 to 2013 funding period and implications for the future.

Science.gov (United States)

Murauskiene, Liubove; Karanikolos, Marina

2017-07-01

European Structural and Investment Funds (ESIF) are a major source of investments in the newer EU member states. In Lithuania's health sector, the amount for the 2007-2013 funding period reached more than €400 million. In this paper we aim to (i) identify the key areas in the health sector which were supported by ESIF, (ii) determine the extent to which ESIF assisted the implementation of the ongoing health system reform; and (iii) assess whether the use of funds has led to expected improvements in healthcare. We review the national strategic documents and legislation, and perform calculations to determine funding allocations by specific area, based on the available data. We analyse changes according to a set of selected indicators. We find that implementation of programmes funded by the ESIF lacks formal evaluation. Existing evidence suggests that some improvement has been achieved by 2013. However, there are persisting challenges, including failure to reach a broad agreement on selection of health and healthcare indicators, lack of transparency in allocations, and absence of coherent assessment measures of healthcare quality and accessibility. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

COMMON AGRICULTURAL POLICY FROM HEALTH CHECK DECISIONS TO THE POST-2013 REFORM

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Niculescu Oana Marilena

2011-07-01

Full Text Available The paper proposed for being presented belongs to the field research International Affairs and European Integration. The paper entitled Common Agricultural Policy from Health Check decisions to the post-2013 reform aims to analyze the Common Agricultural Policy (CAP from the Health Check adoption in November 2008 to a new reform post-2013. The objectives of the paper are the presentation of the Health Check with its advantages and disadvantages as well as the analysis of the opportunity of a new European policy and its reforming having in view that the analysis of Health Check condition was considered a compromise. The paper is related to the internal and international research consisting in several books, studies, documents that analyze the particularities of the most debated, controversial and reformed EU policy. A personal study is represented by the first report within the PhD paper called The reform of CAP and its implications for Romanias agriculture(coordinator prof. Gheorghe Hurduzeu PhD, Academy of Economic Studies Bucharest, Faculty of International Business, research studies in the period 2009-2012. The research methodology used consists in collecting and analysis data from national and international publications, their validation, followed by a dissemination of the results in order to express a personal opinion regarding CAP and its reform. The results of the research consist in proving the opportunity of a new reform due to the fact that Health Check belongs already to the past. The paper belongs to the field research mentioned, in the attempt to prove the opportunity of building a new EU agricultural policy. The challenges CAP is facing are: food safety, environmental and climate changes, territorial balance as well as new challenges-improving sustainable management of natural resources, maintaining competitiveness in the context of globalization growth, strengthening EU cohesion in rural areas, increasing the support of CAP for

The Agenda 2000 CAP reform, world prices and GATT-WTO export constraints

NARCIS (Netherlands)

Meijl, van H.; Tongeren, van F.W.

2002-01-01

This paper examines the compatibility of the Agenda 2000 reform of the Common Agricultural Policy (CAP) of the European Union (EU) with the EU's commitments to reduce export subsidies made under the GATT Uruguay Round Agreement on Agriculture. A multi-region applied general equilibrium model, which

The importance of measuring unmet healthcare needs.

Science.gov (United States)

Gauld, Robin; Raymont, Antony; Bagshaw, Philip F; Nicholls, M Gary; Frampton, Christopher M

2014-10-17

Major restructuring of the health sector has been undertaken in many countries, including New Zealand and England, yet objective assessment of the outcomes has rarely been recorded. In the absence of comprehensive objective data, the success or otherwise of health reforms has been inferred from narrowly-focussed data or anecdotal accounts. A recent example relates to a buoyant King's Fund report on the quest for integrated health and social care in Canterbury, New Zealand which prompted an equally supportive editorial article in the British Medical Journal (BMJ) suggesting it may contain lessons for England's National Health Service. At the same time, a report published in the New Zealand Medical Journal expressed concerns at the level of unmet healthcare needs in Canterbury. Neither report provided objective information about changes over time in the level of unmet healthcare needs in Canterbury. We propose that the performance of healthcare systems should be measured regularly, objectively and comprehensively through documentation of unmet healthcare needs as perceived by representative segments of the population at formal interview. Thereby the success or otherwise of organisational changes to a health system and its adequacy as demographics of the population evolve, even in the absence of major restructuring of the health sector, can be better documented.

Governance and Funding Reforms in Dutch Higher Education: Past, Present, and Future

Science.gov (United States)

Ritzen, Jozef M. M.; Marconi, Gabriele

2012-01-01

This article reviews the history of higher education governance and funding in The Netherlands, generalising when possible to other European countries. It finds that governance reforms and the funding of higher education appear to be driven by economic and demographic factors, including massification. Furthermore, the Bologna Process can be…

The Curricular Reform of Art Education in Primary School in Slovenia in Terms of Certain Components of the European Competence of Cultural Awareness and Expression

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Rajka Bračun Sova

2012-01-01

Full Text Available One of the important positions of the last curricular reform in Slovenia, which included systemic issues of education (White Paper on Education, 2011 and curricula for compulsory subjects in primary school, is the fact that Slovenia has been integrated into Europe, and thus education should also include the development of core European competences. One such competence is cultural awareness and expression, which until now has been an issue more in the context of cultural policies than school policies in Slovenia. The purpose of the present article is to critically analyse the curricular reform of art education (i.e., visual art education, through which, in terms of certain components of the competence of cultural awareness and expression, it is foreseen that the student will gain a knowledge of art, develop an ability to experience works of art and develop a creative attitude towards art and heritage. Because the starting point and goal of curricular change is the curriculum, our analysis is derived from curriculum theories, and not from the art theories and pedagogical theories that have predominantly framed previous attempts at curriculum analysis. Critical consideration of the curricular reform of art education in primary school in terms of certain components of the competence of cultural awareness and expression was undertaken by comparing curricula in the field of aesthetic education. We compared art education with music education and literature within the Slovenian language curriculum. Qualitative analysis showed that, despite the reform, the curriculum for arts education does not realise selected components of the competence of cultural awareness and expression, largely due to the curriculum’s conceptual structure. Art education is centred principally on art-making activities, with an obvious neglect of appreciation. The integration of arts subjects at school, as proposed by the White Paper, is therefore not possible, due to the existing

Food and Health Inequalities in European Union

DEFF Research Database (Denmark)

Robertson, Aileen

Food and Inequalities in European Union Dr. Aileen Robertson, Public Health Nutritionist at the Metropolitan University College, Copenhagen. Dr. Robertson focused on food and inequality in light of the increased prevalence of overweight and obesity in Europe. On average over 50% of Europeans...... public procurement; 3) more democratic sustainable food systems with fairer prices to producers; 4) realise that food and nutrition policies are at the heart of achieving all 17 Sustainable Development Goals and the COP21climate goals; 5) a ‘Health in All Policies’ approach applied to CAP reform...

BETWEEN EUROPEANIZATION, UNITARISM AND AUTONOMY. REMARKS ON THE CURRENT SITUATION OF FEDERALISM IN AUSTRIA

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Peter Bußjäger

2010-04-01

Full Text Available The following article describes current challenges of Austrian federalism. On ground of the Federal Constitution from 1920 Austria is a federation with nine autonomous Länder. Federalism is one of the basic principles of the constitution. Nevertheless the Länder are faced with centralizing drive due to Europeanization and unitarism. On the other hand the Länder have a strong regional identity. The Länder are emotionally deeply rooted in theAustrian population. The Länder also participate well in the decision making process on European level.Nevertheless the division of competencies both in legislation and administration between Federation and Länder is complicated and needs to be modernised. In the past various reform projects on federal level had failed while various reforms in the Land constitutions have led to more innovation on Land level. Despite these facts paradigms of reform debates on Austria´s federal system have changed: Until the early nineties of 20th century constitutionalreforms aimed to strengthen the role of the Länder. Since Austria´saccession to the EU reform projects the efficiency of the federal structures of Austria are doubted. Economical and financial crisis probably will increase the pressure for structural reforms.

Reading Augustine in the Reformation: the flexibility of intellectual authority in Europe, 1500-1620

NARCIS (Netherlands)

Visser, A.S.Q.

2011-01-01

This book explores the reception of Augustine of Hippo in the European Reformations. In this religious revolution Augustine was a highly contested authority, with different parties assimilating his thought in contrasting ways. This flexible reception raises fundamental questions about the

Healthcare reform. Is the NHS ready for US business guru's strategy?

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Cavendish, Will; Edwards, Nigel; Swindells, Matthew; Henke, Nicolaus; Robinson, Edna; Smith, Richard

2006-12-07

The central argument of the new book by renowned US academics Michael Porter and Elizabeth Olmsted Teisberg is that the US health system is broken because rather than improving quality and efficiency, it focuses on budgetary battles. HSJ gathered together six leading healthcare insiders to discuss whether his diagnosis is applicable to the NHS. Nick Edwards was there.

Competition in European electricity markets: a cross-country comparison

International Nuclear Information System (INIS)

Glachant, J.-M.; Finon, D.

2003-01-01

In 1988, the European Commission floated the idea of liberalising the power sector as the key to improving competition and creating jobs in Western Europe, and many reforms have taken place since then. This book examines and evaluates those changes drawing on 12 specific countries. An introductory chapter presents an overview of the typology of institutional structure, approaches to reform, industrial response and progress. The heart of the book looks at three separate areas, viz. the northerners, western-central, and southern and Latin Europe. A dozen chapters by 21 writers present an analysis of the issues faced in dealing with the reforms. The book discusses price convergence and why this cannot be forced. Both practical and academic perspectives are dealt with

Carbon taxation reform in the European Union. The options involved

International Nuclear Information System (INIS)

Laurent, Eloi; Le Cacheux, Jacques

2011-01-01

Even though the EU clearly leads the global fight against climate change and despite the additional reduction in emissions due to the global crisis and European recession, the ambitious objectives flagged in the '20-20-20 by 2020' strategy and 'climate-energy package' may be out of reach if a more resolute and consistent policy of carbon taxation is not rapidly put in place in the EU. In this paper, we detail and discuss the different options available for such European carbon taxation. Initially published in 'Revue de l'OFCE' No. 116

Agent-Oriented Privacy-Based Information Brokering Architecture for Healthcare Environments

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Abdulmutalib Masaud-Wahaishi

2009-01-01

Full Text Available Healthcare industry is facing a major reform at all levels—locally, regionally, nationally, and internationally. Healthcare services and systems become very complex and comprise of a vast number of components (software systems, doctors, patients, etc. that are characterized by shared, distributed and heterogeneous information sources with varieties of clinical and other settings. The challenge now faced with decision making, and management of care is to operate effectively in order to meet the information needs of healthcare personnel. Currently, researchers, developers, and systems engineers are working toward achieving better efficiency and quality of service in various sectors of healthcare, such as hospital management, patient care, and treatment. This paper presents a novel information brokering architecture that supports privacy-based information gathering in healthcare. Architecturally, the brokering is viewed as a layer of services where a brokering service is modeled as an agent with a specific architecture and interaction protocol that are appropriate to serve various requests. Within the context of brokering, we model privacy in terms of the entities ability to hide or reveal information related to its identities, requests, and/or capabilities. A prototype of the proposed architecture has been implemented to support information-gathering capabilities in healthcare environments using FIPA-complaint platform JADE.

Agent-oriented privacy-based information brokering architecture for healthcare environments.

Science.gov (United States)

Masaud-Wahaishi, Abdulmutalib; Ghenniwa, Hamada

2009-01-01

Healthcare industry is facing a major reform at all levels-locally, regionally, nationally, and internationally. Healthcare services and systems become very complex and comprise of a vast number of components (software systems, doctors, patients, etc.) that are characterized by shared, distributed and heterogeneous information sources with varieties of clinical and other settings. The challenge now faced with decision making, and management of care is to operate effectively in order to meet the information needs of healthcare personnel. Currently, researchers, developers, and systems engineers are working toward achieving better efficiency and quality of service in various sectors of healthcare, such as hospital management, patient care, and treatment. This paper presents a novel information brokering architecture that supports privacy-based information gathering in healthcare. Architecturally, the brokering is viewed as a layer of services where a brokering service is modeled as an agent with a specific architecture and interaction protocol that are appropriate to serve various requests. Within the context of brokering, we model privacy in terms of the entities ability to hide or reveal information related to its identities, requests, and/or capabilities. A prototype of the proposed architecture has been implemented to support information-gathering capabilities in healthcare environments using FIPA-complaint platform JADE.

Corruption in health-care systems and its effect on cancer care in Africa.

Science.gov (United States)

Mostert, Saskia; Njuguna, Festus; Olbara, Gilbert; Sindano, Solomon; Sitaresmi, Mei Neni; Supriyadi, Eddy; Kaspers, Gertjan

2015-08-01

At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

How China's new health reform influences village doctors' income structure: evidence from a qualitative study in six counties in China.

Science.gov (United States)

Zhang, Shengfa; Zhang, Weijun; Zhou, Huixuan; Xu, Huiwen; Qu, Zhiyong; Guo, Mengqi; Wang, Fugang; Zhong, You; Gu, Linni; Liang, Xiaoyun; Sa, Zhihong; Wang, Xiaohua; Tian, Donghua

2015-05-05

In 2009, health-care reform was launched to achieve universal health coverage in China. A good understanding of how China's health reforms are influencing village doctors' income structure will assist authorities to adjust related polices and ensure that village doctors employment conditions enable them to remain motivated and productive. This study aimed to investigate the village doctors' income structure and analyse how these health policies influenced it. Based on a review of the previous literature and qualitative study, village doctors' income structure was depicted and analysed. A qualitative study was conducted in six counties of six provinces in China from August 2013 to January 2014. Forty-nine village doctors participated in in-depth interviews designed to document their income structure and its influencing factors. The themes and subthemes of key factors influencing village doctors' income structure were analysed and determined by a thematic analysis approach and group discussion. Several policies launched during China's 2009 health-care reform had major impact on village doctors. The National Essential Medicines System cancelled drug mark-ups, removing their primary source of income. The government implemented a series of measures to compensate, including paying them to implement public health activities and provide services covered by social health insurance, but these have also changed the village doctors' role. Moreover, integrated management of village doctors' activities by township-level staff has reduced their independence, and different counties' economic status and health reform processes have also led to inconsistencies in village doctors' payment. These changes have dramatically reduced village doctors' income and employment satisfaction. The health-care reform policies have had lasting impacts on village doctors' income structure since the policies' implementation in 2009. The village doctors have to rely on the salaries and subsidies from

The Agenda 2000 CAP reform, world prices and URAA GATT-WTO export constraints

NARCIS (Netherlands)

Meijl, van H.; Tongeren, van F.W.

2002-01-01

This paper examines the compatibility of the Agenda 2000 reform of the Common Agricultural Policy (CAP) of the European Union (EU) with the EU's commitments to reduce export subsidies made under the GATT Uruguay Round Agreement on Agriculture. A multi-region applied general equilibrium model, which

Has the Reform of the Japanese Healthcare Provision System Improved the Value in Healthcare? A Cost-Consequence Analysis of Organized Care for Hip Fracture Patients.

Science.gov (United States)

Fukuda, Haruhisa; Shimizu, Sayuri; Ishizaki, Tatsuro

2015-01-01

To assess the value of organized care by comparing the clinical outcomes and healthcare expenditure between the conventional Japanese "integrated care across specialties within one hospital" mode of providing healthcare and the prospective approach of "organized care across separate facilities within a community". Retrospective cohort study. Two groups of hospitals were categorized according to healthcare delivery approach: the first group included 3 hospitals autonomously providing integrated care across specialties, and the second group included 4 acute care hospitals and 7 rehabilitative care hospitals providing organized care across separate facilities. Patients aged 65 years and above who had undergone hip fracture surgery. Regression models adjusting for patient characteristics and clinical variables were used to investigate the impact of organized care on the improvements to the mobility capability of patients before and after hospitalization and the differences in healthcare resource utilization. The sample for analysis included 837 hip fracture surgery cases. The proportion of patients with either unchanged or improved mobility capability was not statistically associated with the healthcare delivery approaches. Total adjusted mean healthcare expenditure for integrated care and organized care were US$28,360 (95% confidence interval: 27,787-28,972) and US$21,951 (21,511-22,420), respectively, indicating an average increase of US$6,409 in organized care. Our cost-consequence analysis underscores the need to further investigate the actual contribution of organized care to the provision of efficient and high-quality healthcare.

The European Ideal of a University: Portugal's Views from the 1950s and 1960s

Science.gov (United States)

Brandão, Tiago

2015-01-01

This study stems from research on the "Standing Conferences of Rectors and Vice-Chancellors of the European Universities" (1948-), an experimental initiative for co-operation among European universities, emphasising the reformative ideal that appeared in international circles in the years following the Second World War. These conceptions…

Health Reform and its Impact on Healthcare Workers: A Case Study of the National Clinical Hospital of Cordova, Argentina

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Carlos Álvarez

2007-10-01

Full Text Available Since the mid 1990’s, health in Argentina has no longer been considered a social function of the State but was transformed into a market commodity. Neoliberal decentralization favored the introduction of corporate methods and incentivized privatization. In practice, this led to self-management for hospitals, deregulation of social services and incorporation of private capital to the public health business. This exploratory study looks at the impact of these reforms in the public health services sector. It analyzes living and working conditions, changes produced in the organization of work and their effect on labor relations and on participation in union, political and social activities by workers at the National Clinical Hospital of Cordoba, Argentina. Data was primarily collected through an interview survey of a convenience sample of 68 workers from the non-teaching staff; this represents 10% of the total professional, administrative and maintenance staff of the hospital. The interviews demonstrate deterioration in income and living conditions. Hospital self-management for these workers led to increased competition, the fragmentation in the work spaces, tension and the distrust between co-workers, as well as increased intensity in the workload of some employees. The profile of these healthcare workers is structured and marked by silence, the resolution of the conflicts by means of individual action in the workplace, and minimal participation in social-political-union or community organizations.

The environmental tax reforms in Europe: mitigation, compensation, and CO2-stabilization

DEFF Research Database (Denmark)

Andersen, M. S.; Speck, S.

2009-01-01

It has been suggested that carbon-energy taxes would need to be increased to a level of 20-30 ?/tonne CO2 in 2020 in order to accomplish a stabilisation target for greenhouse gas concentrations. While increases of carbon-energy taxes inevitably raise questions about the negative impacts on economic...... growth and competitiveness, the European experience shows that governments as part of already agreed environmental tax reforms (ETR) have in fact implicit carbon-energy taxes with a nominal level that in many cases exceeds this level. Still, European governments have exempt especially the energy...

Will Gender Equality Ever Fit In? Contested Discursive Spaces of University Reform

Science.gov (United States)

Kreissl, Katharina; Striedinger, Angelika; Sauer, Birgit; Hofbauer, Johanna

2015-01-01

Similar to other European countries, the introduction of non-academic, especially managerial, criteria in higher education has shaped and altered Austrian universities since over a decade. This paper presents the results of a frame analysis of Austrian higher education debates from 1993 until 2010. It outlines how reforms in higher education were…

The European Trauma Course (ETC) and the team approach

DEFF Research Database (Denmark)

Lott, Carsten; Araujo, Rui; Cassar, Mary Rose

2009-01-01

The European Trauma Course (ETC) was officially launched during the international conference of the European Resuscitation Council (ERC) in 2008. The ETC was developed on behalf of ESTES (European Society of Trauma and Emergency Surgery), EuSEM (European Society of Emergency Medicine), the ESA...... (European Society of Anaesthesiology) and the ERC. The objective of the ETC is to provide an internationally recognised and certified life support course, and to teach healthcare professionals the key principles of the initial care of severely injured patients. Its core elements, that differentiates it from...

Audit Risk Assessment in the Light of Current European Regulations

OpenAIRE

Ciprian-Costel Munteanu

2015-01-01

Recent European reforms on audit regulations have been motivated by efforts to increase audit quality, functioning and performance. We believe the adoption of Directive 2014/56 and Regulation 537/2014 strengthened the role of independent audit and risk committees, which will positively contribute towards audit quality. This paper aims to critically assess the status quo of audit risk assessment in current European standards and regulations, by conducting a theoretical analysis of different as...

Increasing carbon and material productivity through environmental tax reform

International Nuclear Information System (INIS)

Ekins, Paul; Pollitt, Hector; Summerton, Philip; Chewpreecha, Unnada

2012-01-01

Environmental tax reform (ETR), a shift in taxation towards environmental taxes, has been implemented on a small scale in a number of European countries. This paper first gives a short review of the literature about ETR. An Appendix briefly describes the model used for a modelling exercise to explore, through scenarios with low and high international energy prices, the implications of a large-scale ETR in the European Union, sufficient to reach the EU's emission reduction targets for 2020. The paper then reports the results of the exercise. The ETR results in increased carbon and materials, but reduced labour, productivity, with the emission reductions distributed across all sectors as a reduction in the demand for all fossil fuels. There are also small GDP increases for most, but not all, EU countries for all the scenarios, and for the EU as a whole. Both the environmental and macroeconomic outcomes are better with low than with high energy prices, because the former both increases the scale of the ETR required to reach the targets, and reduces the outflow of foreign exchange to pay for energy imports. ETR emerges from the exercise as an attractive and cost-effective policy for environmental improvement. - Highlights: ► European experience with environmental tax reform (ETR) is reviewed. ► Scenarios which meet EU carbon emission targets are modelled. ► The ETR results in increased carbon and materials, but reduced labour, productivity. ► There are small GDP increases for most, but not all, EU countries. ► ETR emerges as an attractive and cost-effective environmental policy.

Opportunities in Reform: Bioethics and Mental Health Ethics.

Science.gov (United States)

Williams, Arthur Robin

2016-05-01

Last year marks the first year of implementation for both the Patient Protection and Affordable Care Act and the Mental Health Parity and Addiction Equity Act in the United States. As a result, healthcare reform is moving in the direction of integrating care for physical and mental illness, nudging clinicians to consider medical and psychiatric comorbidity as the expectation rather than the exception. Understanding the intersections of physical and mental illness with autonomy and self-determination in a system realigning its values so fundamentally therefore becomes a top priority for clinicians. Yet Bioethics has missed opportunities to help guide clinicians through one of medicine's most ethically rich and challenging fields. Bioethics' distancing from mental illness is perhaps best explained by two overarching themes: 1) An intrinsic opposition between approaches to personhood rooted in Bioethics' early efforts to protect the competent individual from abuses in the research setting; and 2) Structural forces, such as deinstitutionalization, the Patient Rights Movement, and managed care. These two themes help explain Bioethics' relationship to mental health ethics and may also guide opportunities for rapprochement. The potential role for Bioethics may have the greatest implications for international human rights if bioethicists can re-energize an understanding of autonomy as not only free from abusive intrusions but also with rights to treatment and other fundamental necessities for restoring freedom of choice and self-determination. Bioethics thus has a great opportunity amid healthcare reform to strengthen the important role of the virtuous and humanistic care provider. © 2015 John Wiley & Sons Ltd.

Strategic planning: how medical practices can succeed in a post-healthcare-reform world.

Science.gov (United States)

Howrigon, Ron

2013-01-01

This article addresses the recent trend of physicians being pressured to sell to hospitals in order to stay in practice. The author utilizes his experience in the healthcare industry to identify causes of this trend and ways in which physician groups can avoid finding themselves in these situations. The author uses real data from an existing medical practice to support his ideas and demonstrate how implementing change now will be beneficial for the success of this medical practice in the future. Objective practice evaluation and the execution of an efficient strategic plan are cited as the most important factors contributing to the financial solvency of medical practices in the current and future healthcare environment.

Intelligence Reform in Albania: Its Relation to Democratization and Integration into the EU and NATO

National Research Council Canada - National Science Library

Bala, Eduart

2008-01-01

...) that are now part of the European Union (EU) and NATO. For most of the CEECs, the need to satisfy the challenging conditions for membership in the EU and NATO has acted as an "anchor" of democratization and other reforms...

Internal Border Controls in the European Union

DEFF Research Database (Denmark)

Jørgensen, Carsten Willemoes; Sørensen, Karsten Engsig

2012-01-01

Recent events, involving inter alia France and Denmark, have stimulated renewed interest in the introduction of different forms of border controls at the internal borders within the European Union. These border control measures are aimed at checking either persons or goods or both. Against...... the background of these events, this article analyses the existing rules regulating controls of persons and goods, and explores how these rules may or may not stand in the way of introducing border controls at the European Union’s internal borders. These events have resulted in a call for reforms of the current...

Consumer choice among Mutual Healthcare Purchasers: a feasible option for China?

Science.gov (United States)

Xu, Weiwei; van de Ven, Wynand P M M

2013-11-01

In its 2009 blue print of healthcare reform, the Chinese government aimed to create a competitive health insurance market in order to increase efficiency in the health insurance sector. A major advantage of a competitive health insurance market is that insurers are stimulated to act as well-motivated prudent purchasers of healthcare on behalf of their enrolees, and that consumers can choose among these purchasers. To emphasize the insurers' role of purchasers of care we denote them, as well as other entities that can fulfil this role (e.g. fundholding community health centres), as 'Mutual Healthcare Purchasers' (MHPs). As feasible proposals for creating competition in China's health insurance sector have yet to be made, we suggest two potential approaches to create competition among MHPs: (1) separating finance and operation of social health insurance and allowing consumer choice among operators of social health insurance schemes; (2) allowing consumer choice among fund-holding community health centres. Although the benefits of competition are widely accepted in China, the problematic consequences of a free competitive health insurance market - especially in relation to affordability and accessibility - are generally neglected. To solve the problems of lack of affordability and inaccessibility that would occur in the case of unregulated competition among MHPs, at least the following regulations are proposed to the Chinese policy makers: a 'standard benefit package' for basic health insurance, a 'risk-equalization scheme', and 'open enrolment'. Potential obstacles for implementing a risk equalization scheme are examined based on theoretical arguments and international experiences. We conclude that allowing consumer choice among MHPs and implementing a risk equalization scheme in China is politically and technically complex. Therefore, the Chinese government should prepare carefully for a market-oriented reform in its healthcare sector and adopt a strategic approach

Tough love : the European Union's relations with the Western Balkans

NARCIS (Netherlands)

Blockmans, Steven

2007-01-01

As part of the international presence in the Western Balkans, the European Union has adopted sanctions, brokered political agreements, launched its first-ever police and military missions and directed economic, legal and administrative reforms to eradicate the root causes of instability. Yet,

Between Competition Imperative and Europeanisation: The Case of Higher Education Reform in Poland

Science.gov (United States)

Dakowska, Dorota

2015-01-01

While the Europeanisation of Higher Education (HE) systems has triggered much debate, the relationship between European factors and domestic economic processes, has been less thoroughly analysed. This article analyses HE reforms in the light of two parallel processes, which have shaped this sector: the introduction of market mechanisms and a…

Development of healthcare waste management in Serbia and challenges in the improvement of the quality of healthcare services

Directory of Open Access Journals (Sweden)

Jovanović Verica S.

2014-01-01

Full Text Available Proper Healthcare Waste Management (HCWM was introduced in the Republic of Serbia in 2007 with the support of the European Union. Since then, the amounts of waste treated, prior to landfill, have steadily increased and more and more healthcare institutions adopted HCWM systems. In parallel large numbers of healthcare workers were trained in proper HCWM. This study quantifies the progress made. The study analyzed the period 2009 to 2012 using three methods of data collection. On basis of data collected, it has been established that with a population of just over seven million, Serbia generates between 4,500 and 5,000 tones of infectious waste on an annual basis of which some 20% originates from the treatment of out-patients, 75% from the treatment of in-patients and 5% from micro-biological laboratory tests. While in 2009 only one third of this waste was treated prior to disposal, this fraction has increased to two thirds in 2011. The data also show that more than 90% of healthcare facilities have developed individual healthcare waste management plans up from less than 20% in 2009. In every healthcare facility there are at least 2 people trained in healthcare waste management, and in total there are approximately 3000 staff members who received formal HCWM training provided through the Institute for Public Health. Healthcare waste management is continuously improving in the Republic of Serbia and is well established in more than 85% of healthcare facilities. There are still issues to be improved especially regarding treatment on healthcare waste other than infectious waste.

Qualitative interviews with healthcare staff in four European countries to inform adaptation of an intervention to increase chlamydia testing.

Science.gov (United States)

McNulty, Cliodna; Ricketts, Ellie J; Fredlund, Hans; Uusküla, Anneli; Town, Katy; Rugman, Claire; Tisler-Sala, Anna; Mani, Alix; Dunais, Brigitte; Folkard, Kate; Allison, Rosalie; Touboul, Pia

2017-09-25

To determine the needs of primary healthcare general practice (GP) staff, stakeholders and trainers to inform the adaptation of a locally successful complex intervention (Chlamydia Intervention Randomised Trial (CIRT)) aimed at increasing chlamydia testing within primary healthcare within South West England to three EU countries (Estonia, France and Sweden) and throughout England. Qualitative interviews. European primary healthcare in England, France, Sweden and Estonia with a range of chlamydia screening provision in 2013. 45 GP staff, 13 trainers and 18 stakeholders. The iterative interview schedule explored participants' personal attitudes, subjective norms and perceived behavioural controls around provision of chlamydia testing, sexual health services and training in general practice. Researchers used a common thematic analysis. Findings were similar across all countries. Most participants agreed that chlamydia testing and sexual health services should be offered in general practice. There was no culture of GP staff routinely offering opportunistic chlamydia testing or sexual health advice, and due to other priorities, participants reported this would be challenging. All participants indicated that the CIRT workshop covering chlamydia testing and sexual health would be useful if practice based, included all practice staff and action planning, and was adequately resourced. Participants suggested minor adaptations to CIRT to suit their country's health services. A common complex intervention can be adapted for use across Europe, despite varied sexual health provision. The intervention (ChlamydiA Testing Training in Europe (CATTE)) should comprise: a staff workshop covering sexual health and chlamydia testing rates and procedures, action planning and patient materials and staff reminders via computer prompts, emails or newsletters, with testing feedback through practice champions. CATTE materials are available at: www.STItraining.eu. © Article author(s) (or their

Implementing health care reform: implications for performance of public hospitals in central Ethiopia.

Science.gov (United States)

Manyazewal, Tsegahun; Matlakala, Mokgadi C

2018-06-01

health care reform has laid the groundwork for health system improvement, but progress was slow and the health care delivery system was still fragile. Healthcare reform efforts in such settings are feasible, but with regular mapping of programmatic outcomes and bringing a common understanding of the reform among stakeholders.

Nuclear power and European Union enlargement challenge

International Nuclear Information System (INIS)

Chirica, Teodor; Bilegan, Constantin

2001-01-01

From 1991 through 1996 the European Union signed the Association Agreements with ten East European countries (EE10), namely: Czech Republic, Estonia, Hungary, Poland, Slovenia, Latvia, Lithuania, Slovakia, Bulgaria and Romania. In the period 1994-1996 European Union received membership applications from all ten countries. The paper analyzes the approach of complying the requirements and regulations for European Union accession in the field of the Romanian nuclear power based on the CANDU technology. In this process, the real challenge is represented by the preparation and implementation of new regulations aiming to improve the general business environment by introducing International Accounting Standards simplification of bankruptcy laws, reform of taxation procedures and secureness of financial instruments. A new stand-by agreement with the International Monetary Fund and World Bank was set out in late April 1999 for an one-year loan of 475 million dollars. (authors)

O processo de Bolonha no espaço europeu e a reforma universitária brasileira/The Bologna process in the european space and the brazilian higher education reform

Directory of Open Access Journals (Sweden)

Carmen Célia Barradas Correia Bastos

2007-01-01

Full Text Available Este artigo aborda questões que envolvem o movimento de reformas educacionais na educação superior, a partir do final do Século XX, como a Declaração de Bolonha assinada em 1999, por ministros da Educação europeus, e que promove, atualmente, a reforma chamada Processo de Bolonha. Outros documentos como a Declaração Mundial sobre Educação Superior, 1998, representam marco referencial das reformas a que se refere este texto. Em sua essência, os documentos europeus vinculam o movimento reformista da educação superior às necessidades contextualizadas pelo padrão de globalização da economia. São articulações que têm como base o incentivo à competitividade, mobilidade discente, adaptação ao mercado de trabalho. No Brasil, em que sentido é possível situar os reflexos desse movimento? Na busca desse entendimento, focalizamos o movimento empreendido pelo Ministério da Educação para discutir a reforma universitária para o país, em especial destacamos o Seminário Internacional Universidade XXI e a Declaração de Brasília. Resguardadas as especificidades de cada situação, vislumbramos refletir sobre possíveis intersecções dos movimentos reformistas na educação superior contemporânea. This article approaches questions that involve the movement of educational reforms in the higher education, from the end of Century XX, until the Declaration of Bologna signed in 1999, by European ministers of Education that promoted the reform called Bologna Process. Other documents as the World-wide Declaration on Higher Education, 1998, represent referential landmark of the reforms that this text is related to. In its essence, the European documents tie the reformist movement of the higher education to the necessities contextualized by the economy globalization standard. They are have as base the competitiveness encouragement, learning mobility, and adaptation to the work market. In Brazil, where is possible to point out the

Contextualising change through a common strategy: Lecturers' perceptions and key role in supporting academic reform

Science.gov (United States)

Kindelan, Paz; Martin, Ana

2014-05-01

European universities are currently going through a process of change in order to meet the common goals set for higher education by the European Commission. They are revising their educational models to adjust them to the guidelines of the "Bologna Process" and are devising an institutional strategy for its implementation. In practical terms, this means aligning former national degrees and diplomas to standard European Bachelor and Masters degrees and PhD doctorates, by creating acknowledged professional qualification benchmarks that also include adjusted course lengths and contents. This process, in the end, mostly affects academic staff members who have a fundamental role to play in carrying out the pedagogical reforms on the teaching front. Besides presenting a commentary on the institutional approach of one particular technical university in Spain, the purpose of this paper is to propose, from the authors' point of view as lecturers, a strategy which has the potential to create a favourable atmosphere for carrying out such a reform. The article's main objective is to highlight a series of action points which may serve to reinforce and advance the main institutional strategy by relying on the powerful influence of its academic staff members.

Job satisfaction of urban community health workers after the 2009 healthcare reform in China: a systematic review.

Science.gov (United States)

Zhang, Mingji; Yang, Rongrong; Wang, Wei; Gillespie, James; Clarke, Susan; Yan, Fei

2016-02-01

In 2009 China introduced a new round of healthcare reform to strengthen primary care networks through the development of Community Health Services (CHS). This study aimed to measure the degree of overall job satisfaction and also satisfaction dimensions and then find common causes of dissatisfaction among Community Health Workers (CHWs) in urban China by conducting a systematic review of relevant studies on CHWs' job satisfaction. Web of Science, PubMed, Google scholar, Wanfangdata and CNKI were searched. Publications about job satisfaction of CHWs were screened and assessed. Finally 18 Chinese articles and 4 English articles were included. Quantitative and qualitative data were extracted for nine themes concerning job satisfaction. Narrative synthesis was employed to analyze the data. CHWs were generally neither satisfied nor dissatisfied with their work after 2009. Financial rewards and opportunities for professional development were the most important determinants of job dissatisfaction. Workers were generally satisfied with interpersonal relationships in the workplace. The expanded public health services package and human-resources related regulations, e.g. the professional rank promotion system, government-controlled staffing policy (i.e. staff-quota system) and government-controlled budgetary planning (i.e. the Separation of Revenue and Expenditure), were policies that had an effect on job satisfaction. Financial rewards and professional development were the two main predictors of job satisfaction. To improve CHS in China, policy-makers (especially the central government) need to consider the impact of current policies on job satisfaction in order to reduce job dissatisfaction. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis.

Science.gov (United States)

Zandian, Hamed; Takian, Amirhossein; Rashidian, Arash; Bayati, Mohsen; Zahirian Moghadam, Telma; Rezaei, Satar; Olyaeemanesh, Alireza

2018-03-01

One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (pfinancing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

Health promotion interventions and policies addressing excessive alcohol use: a systematic review of national and global evidence as a guide to health-care reform in China.

Science.gov (United States)

Li, Qing; Babor, Thomas F; Zeigler, Donald; Xuan, Ziming; Morisky, Donald; Hovell, Melbourne F; Nelson, Toben F; Shen, Weixing; Li, Bing

2015-01-01

Steady increases in alcohol consumption and related problems are likely to accompany China's rapid epidemiological transition and profit-based marketing activities. We reviewed research on health promotion interventions and policies to address excessive drinking and to guide health-care reform. We searched Chinese- and English-language databases and included 21 studies in China published between 1980 and 2013 that covered each policy area from the World Health Organization (WHO) Global Strategy to Reduce the Harmful Use of Alcohol. We evaluated and compared preventive interventions to the global alcohol literature for cross-national applicability. In contrast with hundreds of studies in the global literature, 11 of 12 studies from mainland China were published in Chinese; six of 10 in English were on taxation from Taiwan or Hong Kong. Most studies demonstrated effectiveness in reducing excessive drinking, and some reported the reduction of health problems. Seven were randomized controlled trials. Studies targeted schools, drink-driving, work-places, the health sector and taxation. China is the world's largest alcohol market, yet there has been little growth in alcohol policy research related to health promotion interventions over the past decade. Guided by a public health approach, the WHO Global Strategy and health reform experience in Russia, Australia, Mexico and the United States, China could improve its public health response through better coordination and implementation of surveillance and evidence-based research, and through programmatic and legal responses such as public health law research, screening and early intervention within health systems and the implementation of effective alcohol control strategies. © 2014 Society for the Study of Addiction.

EU ECONOMIC GOVERNANCE REFORM: ARE WE AT A TURNING POINT?

Directory of Open Access Journals (Sweden)

Daniel Daianu

2011-03-01

Full Text Available The sovereign debt crisis is creating enormous anguish in the European Monetary Union (EMU. Not surprisingly, emergency measures continue to be used at a time when a sort of economic recovery seems to be underway. Against this background the European Council summit of last October considered a Task Force report with a telling name: "Strengthening economic governance in the EU". This document is to be examined in conjunction with the governance reform proposals issued by the European Commission at the end of September and related documents. For the depth of this financial crisis and the "Great Recession" have forced EU governments and EU institutions to take a hard look at the governance structure of the Union. But it would be wrong to say that this demarche is an attempt to explore a terra incognita. From the very beginning of the European Monetary Union (EMU there was some discomfort with its institutional underpinnings and there were misgivings regarding its optimality as a currency area. This explains why a train of thought underlines a political rationale, too, for the creation of the EMU. Likewise, criticism regarding the way regulation and supervision have been established in the Union is not of recent vintage. And insufficiencies of the Stability and Growth Pact (SGP, with almost all member states flouting its rules at various points in time, have been repeatedly pointed out. This said, however, the flaws of financial intermediation have been less tackled by policy-makers and central bankers for reasons which, partially, are to be found in a paradigm which has dominated economic thinking in recent decades. This paper focuses on roots of the huge strain in the EU (EMU and main policy issues ensuing from the current crisis. It also looks at the stake NMSs have in a reformed EU economic governance structure. The challenges for EU economic governance reform are to be seen from a broad perspective: the crisis of the financial intermediation

Telecom Reform

DEFF Research Database (Denmark)

Telecom Reform: Principles, Policies and Regulatory Practices, provides a comprehensive and definitive review and assessment of the unfolding telecom reform process, and its implications for information society development. It is an invaluable resource and authoritative reference on telecom reform...... and information infrastructure issues - for people in government, academia, industry and the consulting community. This book addresses the process of policy and regulatory reform in telecom that is now in its formative stage. It draws on detailed knowledge of industry development and regulatory experience......, as well as expertise in the new technologies, industries, economics, policy development, and law to present and critique the principles, policies and regulatory practices associated with telecom reform. Twenty six international experts address thirty two topics that are essential to successful telecom...

Economic reform in Europe: integrating and liberalizing the market for services

International Nuclear Information System (INIS)

Newbery, David M.

2001-01-01

The European Union faces challenges in reforming the Gas and Electricity Directives to implement the single market in electricity and gas. The paper argues that there is unfinished business in the areas of regulation, restructuring, encouraging proper risk management through contracting, and designing markets and regulation to ensure effective and sustainable competition in the services supplied over the networks. Regulators often lack critical information and appropriate power to act. Restructuring is problematic, requiring forceful competition authorities with a clear agenda to achieve desirable structural reforms. A key issue is striking the right balance between complete liberalisation and ensuring adequate capacity and investment. Finally, proactive competition policies will be necessary to resist the powerful forces for vertical and horizontal integration visible in the Union. (Author)

Steepest Ascent Tariff Reform

DEFF Research Database (Denmark)

Raimondos-Møller, Pascalis; Woodland, Alan

2014-01-01

. In undertaking this task, and by focusing on tariff reforms, we introduce the concept of a steepest ascent policy reform, which is a locally optimal reform in the sense that it achieves the highest marginal gain in utility of any feasible local reform. We argue that this reform presents itself as a natural......The policy reform literature is primarily concerned with the construction of reforms that yield welfare gains. By contrast, this paper’s contribution is to develop a theoretical concept for which the focus is upon the sizes of welfare gains accruing from policy reforms rather than upon their signs...... benchmark for the evaluation of the welfare effectiveness of other popular tariff reforms such as the proportional tariff reduction and the concertina rules, since it provides the maximal welfare gain of all possible local reforms. We derive properties of the steepest ascent tariff reform, construct...

IMPACT OF THE REFORM PROCESS OF THE PUBLIC ADMINISTRATION ECONOMIC AND SOCIAL DEVELOPMENT OF ROMANIA

Directory of Open Access Journals (Sweden)

GEORGETA MODIGA

2012-05-01

Full Text Available Romanian society is in a continuous process of change in which all the economic, social, political, civic saw a new dynamic in trying to adapt to specific conditions of the phenomenon of Europeanization (full member of the European Union. The changing of Romanian society requires the public administration reform to be analyzed and disseminated on the following levels: strategic - by which to redefine the role of the state clearly, legally - using larger framework laws, organizational - administrative and fiscal decentralization, cultural - following a change of values and modes of action of public officials, non governmental organizations, the citizen / customer of public service. The term administrative reform is trivial, repetitive and recurrent nets into change, public administration reform is invited to constantly readjust the organization and the action and to clearly state objectives, called sometimes the brakes released, blockages to overcome obstacles of the past which is manifested by the upward trend of the society. Public administration is criticized especially by the public and less by governments in office. Almost general belief is that the administration functions poorly, fulfil its mission in an unsatisfactory manner, but nevertheless has an impact too on community life, economy and society. This paper aims to identify the type of problems that other countries have had to solve and the need hierarchy and management combined in a single system. Understanding the types of problems encountered and they do other countries in this process will shorten the learning cycle for Romania. The objectives of this approach is that the critical analysis of the relationship between public administration reform and administrative capacity based on the literature, outlining the operational model to assess the reform process in our country, the study of democratization (the stage of democratization of public administration modernization strategy

European Union definitely introduces common taxes on energy

International Nuclear Information System (INIS)

Schoenweisner, R.

2003-01-01

In this paper taxes of the European Union on energy are reviewed. European Union Ministers of environment Council definitely ratified new common system of minimal energy taxes in last week. Council introduces par excellence minimal all-European size of an electricity, coal and natural gas consumption tax. New directive according to European Commission will improve operation of internal market and eliminate deformation of competitive environment among individual members as well as among mineral oils and the other energy sources. Slovak Republic taxes all motor fuel types by higher charge as is minimal level demanded by EU according to new directive after rising of consumable tax from mineral oils in August 2003. According to Minister of Finances Slovak Republic demanded European Union for a temporary 10-year period for utilizing electricity, coal, coke, and natural gas consumption tax. According to Ministry, Utilizing new taxes and rising of tax load is not in interest of started tax reform in Slovak Republic

Public-Privat e Partnership in the System of Regional Healthcare Financing

Directory of Open Access Journals (Sweden)

Margarita Yur’evna Molchanova

2016-05-01

Full Text Available Healthcare financing reform in the Russian Federation, besides its positive consequences, has led to the emergence of several major organizational and economic problems that hinder the expansion of financing sources for this sphere, which also involves public-private partnership (PPP. The paper highlights the regional specifics of such healthcare projects compared to similar projects of other spheres of the national economy. The author describes the problems of PPP projects implementation in healthcare; they include the insufficiency of substantiation of public-private partnership application in healthcare, and the absence of typical models for establishment of relations between PPP participants. The paper presents the healthcare priorities put forward by the author; these priorities are based on the theory of the life cycle of a service. The author presents her own model for organizing a regional concession, which is the most common form of public-private partnership in healthcare so far. The cluster brings together on a voluntary basis the legally independent organizations that are interested in improving the quality and increasing the accessibility of health services. These can include medical institutions of various forms of ownership located in the region, clinics, facilities, institutions that train healthcare workers, authorities, etc. The author shows that a favorable environment for the formation and implementation of PPP projects can be created under the cluster approach to the organization of healthcare. When establishing the medical cluster, the main task is to organize interaction between all its subjects in the interest of the overall development of healthcare in the region and the implementation of one’s own interests

Prospects for Reforming the Organizational and Legal Mechanism for Ensuring Human and Civil Rights and Freedoms

Directory of Open Access Journals (Sweden)

Myroslav Kovaliv

2017-10-01

Full Text Available The purpose of the article is analyzing the prospect of reforming the organizational and legal mechanism for ensuring the rights and freedoms of individuals and citizens of Ukraine from the systemic approach. Based on the methodology of system analysis, the prospects of reforming the organizational and legal mechanism for ensuring the rights and freedoms of men and citizens of Ukraine in the context of association with the European Union are considered. The key factors that influence the effectiveness of the submitted organizational and legal mechanism are analyzed. The measures aimed at the improvement of normative-legal regulation, which shall promote the maintenance of constitutional rights and freedoms in the conditions of reforming all spheres of society's life, are presented.

Study on Environmental Fiscal Reform Potential in 14 EU Member States: Main Report & Appendices

DEFF Research Database (Denmark)

Hogg, Dominic; Andersen, Mikael Skou; Elliott, Timothy

2015-01-01

Environment Agency between 2010 and 2013 on the potential for environmental fiscal reform in four EU Member States affected by the economic crisis. As with the last study for the European Commission, the intention of this study is to indicate where this potential may lie, and to demonstrate the order...

The Road to Change? A Case Study Examining Educational Reform in Sibiu County, Romania

Science.gov (United States)

Tucker, Stan; Trotman, Dave; Rusu, Horatiu; Mara, Daniel

2014-01-01

This article examines processes of educational reform and change in a post-Communist Eastern European country. Focusing on the experiences and challenges facing one geographical community in Sibiu County, Romania, an attempt is made to understand some of the macro and micro factors, influences and external policy drivers, shaping the organization…

Between Accommodating and Activating: Framing Policy Reforms in Response to Workforce Aging across Europe.

Science.gov (United States)

Kroon, Anne C; Vliegenthart, Rens; van Selm, Martine

2017-07-01

In the past decade, European governments have implemented activating policy reforms to maximize older workers' employment and employability, representing a paradigmatic change in approaches to work and retirement. This study isolates the factors that explain the relative success and failure of competitive frames that are either in favor of or against activating policies in European news coverage, by applying time-series analysis (ordinary least squares with panel-corrected standard errors) to monthly aggregated news coverage in the Netherlands, the United Kingdom, Denmark, and Spain over the timespan 2006-2013. The results show that pro-activating and counteractivating frames generally coincide in competitive framing environments. The pro-activating frame proliferated in times of high employment protection, whereas the counteractivating frame prevailed stronger in conservative compared with progressive newspapers, and gained momentum during the aftermath of the financial crisis and in times governments on the economic left were in power. The study advances knowledge of competitive issue framing by demonstrating how the economic, policy, and political context matters for the emergence and evolvement of competing frames. In addition, the findings contribute to the understanding of the factors that contribute to news representations that promote active aging in European news, which may foster support for policy reforms that sustain older workers' employability.

European Electricity Markets in Crisis: Diagnostic and Way Forward

International Nuclear Information System (INIS)

Roques, Fabien

2013-01-01

The European electricity industry is going through a profound crisis as several factors combine to create a challenging operating environment for thermal plants. The key issue is that the regulatory and market framework create a climate of deep policy and regulatory uncertainty which will hamper investments and will not deliver on the long term objectives of decarbonization and competitiveness of the European economy. This report analyses both the short and long term challenges for the European electricity markets, and highlights some directions for reform. The report has three main parts. The first part describes the current status quo and challenges associated with the long term decarbonization of the European economy: Section 1 sets the scene by describing the current challenges for the European electricity industry and the challenges associated with the long term decarbonization of the European economy; Section 2 quantifies the investment challenge for the electricity industry and shows how the current regulatory uncertainty undermines investments and will likely not deliver on the stated policy objectives; The second part of the report focusses on the 'extrinsic' issues which affect electricity markets: Section 3 reviews the wider context for electricity market liberalization, which calls for a rethink of the European energy policy framework, including the recent developments in global energy markets, as well as the impact of rising energy prices on economic competitiveness; Section 4 presents the distortive effects of support policies for low carbon technologies and the issues with the European carbon Trading Scheme; The third and last part of the report concentrates on the 'intrinsic issues' with electricity markets: Section 5 details the experience to date with European electricity markets liberalization, and highlights the achievements as well as the shortcomings of the liberalization and integration process; Section 6 dwells into the 'intrinsic issues

Socio-Statistical Research on the Internalization of European Administrative Space Principles in the Romanian Public Administration

OpenAIRE

Matei, Ani; Matei, Lucica; Iancu, Diana-Camelia

2011-01-01

The authors propose an analysis of the public administration reform in Romania by assessing whether the Romanian civil servants perform their duties according to the regulations of the European Administrative Space. The paper offers a socio-statistic perspective on the internalization of the European Administrative Space principles, namely, the rule of law, openness towards citizens, and public administration responsibility in a Romanian context, after the European Union accession. Designed w...

Antidepressant prescribing in five European countries

DEFF Research Database (Denmark)

Abbing-Karahagopian, V; Huerta, C; Souverein, P C

2014-01-01

, calculated in a uniform manner, in seven European electronic healthcare databases. METHODS: Annual prevalence per 10,000 person-years (PYs) was calculated for 2001-2009 in databases from Spain, Germany, Denmark, the United Kingdom (UK), and the Netherlands. Prevalence data were stratified according to age...

Forging a Frailty-Ready Healthcare System to Meet Population Ageing.

Science.gov (United States)

Lim, Wee Shiong; Wong, Sweet Fun; Leong, Ian; Choo, Philip; Pang, Weng Sun

2017-11-24

The beginning of the 21st century has seen health systems worldwide struggling to deliver quality healthcare amidst challenges posed by ageing populations. The increasing prevalence of frailty with older age and accompanying complexities in physical, cognitive, social and psychological dimensions renders the present modus operandi of fragmented, facility-centric, doctor-based, and illness-centered care delivery as clearly unsustainable. In line with the public health framework for action in the World Health Organization's World Health and Ageing Report, meeting these challenges will require a systemic reform of healthcare delivery that is integrated, patient-centric, team-based, and health-centered. These reforms can be achieved through building partnerships and relationships that engage, empower, and activate patients and their support systems. To meet the challenges of population ageing, Singapore has reorganised its public healthcare into regional healthcare systems (RHSs) aimed at improving population health and the experience of care, and reducing costs. This paper will describe initiatives within the RHS frameworks of the National Health Group (NHG) and the Alexandra Health System (AHS) to forge a frailty-ready healthcare system across the spectrum, which includes the well healthy ("living well"), the well unhealthy ("living with illness"), the unwell unhealthy ("living with frailty"), and the end-of-life (EoL) ("dying well"). For instance, the AHS has adopted a community-centered population health management strategy in older housing estates such as Yishun to build a geographically-based care ecosystem to support the self-management of chronic disease through projects such as "wellness kampungs" and "share-a-pot". A joint initiative by the Lien Foundation and Khoo Teck Puat Hospital aims to launch dementia-friendly communities across the island by building a network comprising community partners, businesses, and members of the public. At the National

Do different welfare states engender different policy preferences?: opinions on pension reforms in Eastern and Western Europe

NARCIS (Netherlands)

Velladics, K.; Henkens, C.J.I.M.; van Dalen, H.P.

2006-01-01

This article examines whether the different welfare states of the European Union member states engender different policy preferences and attitudes among the population. More specifically, it investigates variations in attitudes towards population ageing and pension reforms, and variations in

Non-catalytic recuperative reformer

Science.gov (United States)

Khinkis, Mark J.; Kozlov, Aleksandr P.; Kurek, Harry

2015-12-22

A non-catalytic recuperative reformer has a flue gas flow path for conducting hot flue gas from a thermal process and a reforming mixture flow path for conducting a reforming mixture. At least a portion of the reforming mixture flow path is embedded in the flue gas flow path to permit heat transfer from the hot flue gas to the reforming mixture. The reforming mixture flow path contains substantially no material commonly used as a catalyst for reforming hydrocarbon fuel (e.g., nickel oxide, platinum group elements or rhenium), but instead the reforming mixture is reformed into a higher calorific fuel via reactions due to the heat transfer and residence time. In a preferred embodiment, extended surfaces of metal material such as stainless steel or metal alloy that are high in nickel content are included within at least a portion of the reforming mixture flow path.

Policies of ‘modernisation’ in European education

DEFF Research Database (Denmark)

Rasmussen, Palle Damkjær; Larson, Anne; Rönnberg, Linda

2015-01-01

This special issue offers empirically and theoretically informed accounts from education policy research carried out in different national contexts in Europe. This special issue sheds light on how modernising approaches to educational governance and reform, grouped under the umbrella of new public...... management, are strongly present in European education policy, both at transnational levels and in individual countries, and points to important implications for these developments....

European Institutional Developments and Evolutions Post‑Lisbon Treaty

Directory of Open Access Journals (Sweden)

Cristian Sorin Dumitrescu

2014-11-01

Full Text Available The current article aims at analysing the main difficulties the European institutions were confronted to and identifying the axes of urgent reforms of the European construction, which are claimed to be applied, immediately, after the recent parliamentary elections from 25 of May together with the installation of the new decision teams in Brussels. While the first part of the article examine the action of the various European institutions within the new constitutional architecture, the second part will cover some axes needed which could be followed by the Union starting with the new term. In the context of the economic and financial crisis, the first European institutional cycle under the terms of the Lisbon Treaty –2009-2014, became an important challenge for the application of the provisions concerning the functioning of the European institutions. An objective assessment of the ways regarding the practical implementation of the Treaty must take into consideration the negative influence of the economic crisis upon the decisions assumed by the high national and European responsibles.

Healthcare payments under the budget deal: mostly good news for physicians

Directory of Open Access Journals (Sweden)

Robbins RA

2018-02-01

Full Text Available No abstract available. Article truncated after 150 words. In the early morning hours last Friday (2/9/18 Congress passed and President Trump signed a massive budget agreement (1. The spending package will cost about $320 billion over 10 years, according to the Congressional Budget Office. Payments for healthcare substantially increase under the deal. Most praised the agreement. "Congress made the right choice this morning for patients and communities by voting to halt damaging cuts to hospitals that care for low-income working families and others who face financial challenges," said Dr. Bruce Siegel, CEO of America's Essential Hospitals, which represents the nation's safety-net facilities. Marc Goldwein of the Center for a Responsible Federal Budget called the healthcare provisions the one "beacon of light" in what otherwise is an exorbitantly costly budget bill. Goldwein praised its mix of structural reforms with "reasonable policy” and liked that the bill pays for the increased healthcare spending. The bill extends Medicare physician fee cuts ….

A comparative study of contemporary user involvement within healthcare systems across England, Poland and Slovenia.

Science.gov (United States)

Lichon, Mateusz; Kavcic, Matic; Masterson, Daniel

2015-01-01

The purpose of this paper is to explore how healthcare-users' engagement is perceived, how it occurs and how these perceptions differ between three European countries: England, Poland and Slovenia, using the concepts of voice, choice and coproduction. This comparative, qualitative study is based on a review of legal documents, academic literature and semi-structured interviews conducted in October and November 2011. A research sample consisted of 21 interviewees representing various stakeholders including healthcare-users, doctors and managers. Primary and secondary data were analysed using theoretical thematic analysis. Emerging themes were identified from the interviews and related to the indicators describing healthcare-users' involvement in the voice, choice and coproduction model. Results of the comparative qualitative research suggest that the healthcare-users' influence is strongly grounded in England where the healthcare system and professionals are prepared to include healthcare-users in the decision-making process. In Slovenia, cultural development of healthcare-users' involvement seems to proceed the institutional development. In Poland, institutions are ready to involve healthcare-users in decision-making process although the cultural desirability of involving users among doctors and patients is lacking. The notion of user involvement is increasingly gaining importance and research attention, yet there is still little known about the way cultural, political, historical differences between various European countries influence it. This paper explores this little known area using the original approach of user involvement (Dent et al., 2011) with input from various stakeholders including patients, healthcare representatives and academics.

[Private health insurance in Brazil: approaches to public/private patterns in healthcare].

Science.gov (United States)

Sestelo, José Antonio de Freitas; Souza, Luis Eugenio Portela Fernandes de; Bahia, Lígia

2013-05-01

This article draws on a previous review of 270 articles on private health plans published from 2000 to 2010 and selects 17 that specifically address the issue of the relationship between the public and private healthcare sectors. Content analysis considered the studies' concepts and terms, related theoretical elements, and predominant lines of argument. A reading of the argumentative strategies detected the existence of a critical view of the modus operandi in the public/private relationship based on Social Medicine and the theoretical tenets of the Brazilian Health Reform Movement. The study also identified contributions based on neoliberal business approaches that focus strictly on economic issues to discuss private health insurance. Understanding the public/private link in healthcare obviously requires the development of a solid empirical base, analyzed with adequate theoretical assumptions due to the inherent degree of complexity in the public/private healthcare interface.

Can vouchers make a difference to the use of private primary care services by older people? Experience from the healthcare reform programme in Hong Kong.

Science.gov (United States)

Yam, Carrie H K; Liu, Su; Huang, Olivia H Y; Yeoh, E K; Griffiths, Sian M

2011-10-07

As part of its ongoing healthcare reform, the Hong Kong Government introduced a voucher scheme, intended for encouraging older patients to use primary healthcare services in the private sector, thereby, reducing burden on the overwhelmed public sector. The voucher program is also considered one of the strategies to further develop the public private partnership in healthcare, a policy direction of high political priority as indicated in the Chief Executive Policy Address in 2008-09. This study assessed whether the voucher scheme, as implemented so far, has reached its intended goals, and how it might be further improved in the context of public-private partnership. This was a cross-sectional study using structured questionnaires by face-to-face interviews with older people aged 70 or above in Hong Kong, the target group of the demand-side voucher program. 71.2% of 1,026 older people were aware of the new voucher scheme but only 35.0% had ever used it. The majority of the older people used the vouchers for acute curative services in the private sector (82.4%) and spent less on preventive services. Despite the provision of vouchers valued US$30 per year as an incentive to encourage the use of private primary care services, after 12-months of implementation, 66.2% of all respondents agreed with the statement that "the voucher scheme does not change their health seeking behaviours on seeing public or private healthcare professionals". The most common reasons for no change in their behaviours included "I am used to seeing doctors in the public system" and "The amount of the subsidy is too low". Those who usually used a mix of public and private doctors and those with better self-reported health condition compared to last year were more likely to perceive a change in their own health seeking behaviours. Our study showed that despite a reasonably high awareness of the voucher scheme, its usage was low. The voucher alone was not enough to realize the government's policy of

Mental health care institutions in nine European countries, 2002 to 2006

NARCIS (Netherlands)

Priebe, Stefan; Frottier, Patrick; Gaddini, Andrea; Kilian, Reinhold; Lauber, Christoph; Martinez-Leal, Rafael; Munk-Jorgensen, Povl; Walsh, Dermot; Wiersma, Durk; Wright, Donna

Objective: Although mental health reforms in the 20th century were characterized by deinstitutionalization, previous research suggested a new era of reinstitutionalization in six European countries between 1990 and 2002. This study aimed to establish whether there has been a trend in Europe toward

The political economy of management knowledge : management texts in English healthcare organizations

OpenAIRE

Ferlie, Ewan; Ledger, Jean; Dopson, Sue; Fischer, Michael D.; Fitzgerald, Louise; McGivern, Gerry; Bennett, Christopher P.

2016-01-01

Have generic management texts and associated knowledges now extensively diffused into public services organizations? If so, why? Our empirical study of English healthcare organizations detects an extensive presence of such texts. We argue that their ready diffusion relates to two macro-level forces: (i) the influence of the underlying political economy of public services reform and (ii) a strongly developed business school/management consulting knowledge nexus. This macro perspective theoreti...

Reforms of a real estate cadastre in Poland / Reformy katastru nieruchomości w Polsce

Science.gov (United States)

Pietrzak, Ludmiła; Hopfer, Andrzej; Cegielski, Stanisław

2012-11-01

On May 7, 2010 the act dated March 4, 2010 on the spatial information infrastructure was published which transposes the European Parliament and the European Council Directive No 2007/2/WE dated March 14, 2007 established the spatial information infrastructure (INSPIRE) in the European Community. This act introduced basic changes to the binding Act, i.e. the Law of Geodesy and Cartography and, as the consequence, the demand to develop various administrative decrees occurred. The authors of the paper present the analysis of the existing conditions of the cadastre, the task of governmental and public government administration, related to demands concerning the cadastral reforms, following the act on the spatial information infrastructure and they discuss possibilities to perform such reforms at the local and national scales. W dniu 7 maja 2010 r. weszła w życie ustawa a dnia 4 marca 2012 r. o infrastrukturze informacji przestrzennej dokonująca transpozycji dyrektywy Parlamentu Europejskiego i Rady nr 2007/3/WE ustanawiającej infrastrukturę informacji przestrzennej w Europie. Ustawa to wprowadziła zasadnicze zmiany do obowiązującej ustawy prawo geodezyjne i kartograficzne, i w konsekwencji powstała konieczność opracowania nowych rozporządzeń wykonawczych. W chwili obecnej większość rozporządzeń jest już opracowana, część jest jeszcze konsultowana z organizacjami zawodowymi geodetów. W artykule autorzy dokonują analizy stanu istniejącego, zadań administracji rządowej i samorządowej związanych z koniecznością modernizacji katastru oraz podają zakres koniecznych do przeprowadzenie reform w skali kraju oraz w skali lokalnej.

Negotiating reform at an arm's length from the state: Disease Management Programmes and the introduction of clinical standards in Germany.

Science.gov (United States)

Burau, Viola

2009-07-01

Studies of German health policy often highlight institutional constraints to reform. However, based on a case study of the introduction of clinical standards as part of the Disease Management Programmes for chronic illnesses, this article suggests that negotiating reform at an arm's length from the state can also lead to governance change, although the strengthening of hierarchy is not as prominent as that in some of the countries studied in this special issue. As such, the case of Germany offers interesting insights into the politics of governance change that occur in the shadow, but largely without the direct involvement of the state, which is typical of a corporatist health-care state. In this respect, the analysis identifies three leverages for change. First, the change in medical governance explicitly builds on earlier reforms and gives the reform alliance a competitive edge. Second, the organisations of the joint self-administration, as a more or less open ally of the state, play an influential role throughout the reform process. Importantly and third, this is complemented by the state steering at a distance.

The impact of regulatory compliance behavior on hazardous waste generation in European private healthcare facilities

OpenAIRE

Botelho, Anabela

2013-01-01

Along with the increased provision of healthcare by private outpatient healthcare facilities within the EU countries, there is also an increase on waste generation from these facilities. A significant fraction of this waste is amongst the most hazardous of all wastes arising in communities, posing significant risks to people and the environment if inappropriately managed. The growing awareness that mismanagement of healthcare waste has serious environmental and public health consequences is r...

European Integration between Equity, Efficiency and Welfare

Directory of Open Access Journals (Sweden)

Gabriela Marchis

2012-05-01

Full Text Available Throughout this article I tried to highlight the path for improving the Europeans standards ofliving. Poverty, inequality and efficiency are the key concepts of the welfare economic. Similar to many otherarticles about equity, efficiency and welfare, this article offers an account of the challenges facing theEuropean Union welfare in a context of global economy assessing the ability of different components of thewelfare governance to respond to these challenges. The welfare of European Union is analyzed under themultidimensional aspects of integration, such as: internal versus external integration and multilevelintegration. Aging, changes in the labor market, increased mobility are particular aspects that characterize EUand under the fundamental reform of Europe 2020 Strategy, welfare economic becomes a priority even if thepolitical integration comes first to the economic one. As Europe grows more diverse, the welfare economictranslates from desire to necessity.

Healthcare systems--an international review: an overview.

Science.gov (United States)

Lameire, N; Joffe, P; Wiedemann, M

1999-01-01

Based on the source of their funding, three main models of healthcare can be distinguished. The first is the Beveridge model, which is based on taxation and has many public providers. The second is the Bismarck 'mixed' model, funded by a premium-financed social insurance system and with a mixture of public and private providers. Finally, the 'Private Insurance model' is only in existence in the US. The present report explores the impact of these healthcare models on the access to, quality and cost of healthcare in selected European countries. Access is nearly 100% in countries with a public provider system, while in most of the 'mixed' countries, the difference from 100% is made up by supplementary private insurance. No differences are seen between public and mixed provider systems in terms of quality of care, despite the fact that the countries with the former model spend, in general, less of their Gross National Product on healthcare. The Private Insurance/private provider model of the US produces the highest costs, but is lowest in access and is close to lowest ranking in quality parameters.

Procedural aspects of healthcare quality control in Latvia and its effect on legal protection of patients

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Liepins A.

2018-01-01

Full Text Available According to the European Commission data, 8–12% of patients cared for in hospitals throughout the European Union have suffered accidents related to the healthcare provided for them. The Directive 2011/24/EU of the European Parliament and Council of 9th March 2011 on the application of patients’ rights in cross-border healthcare provides that the Member States shouldensurethat patients have easily accessible and transparent appeal procedures and mechanisms that provide possibilities for legal remedies in cases of inflicted harm during medical treatment according to regulations of the respective Member State. Healthcare quality control mechanisms are intended for two major purposes: to identify accidents that have occurred during medical treatment and to prevent similar accidents from reoccurring in the future. The aim of this article is to evaluate, firstly, the procedural aspects of healthcare quality control mechanisms in Latvia and, secondly, how healthcare quality control mechanisms have been affected with the implementation of the Directive 2011/24/EU in Latvian legal order, providing for a specific legal remedy – the newly created Medical risk fund. Conclusions are made on the procedural nature of the patients’ right to submit complaints and also the developments in Latvian court practice related to the healthcare quality control. The authors have also analysed regulations related to the Medical risk fund, its influence on the civil liability mechanisms of medical practitioners, as well as the patient’s right to obtainjust compensation for the harm inflicted to his health and the legal nature of opinions of the Health Inspectorate of Latvia.

Depression and diabetes: Treatment and health-care delivery

DEFF Research Database (Denmark)

Petrak, Frank; Baumeister, Harald; Skinner, Timothy C.

2015-01-01

© 2015 Elsevier Ltd. Despite research efforts in the past 20 years, scientific evidence about screening and treatment for depression in diabetes remains incomplete and is mostly focused on North American and European health-care systems. Validated instruments to detect depression in diabetes......, which are often implemented through collaborative care and stepped-care approaches. The evidence for improved glycaemic control in the treatment of depression by use of selective serotonin reuptake inhibitors or psychological approaches is conflicting; only some analyses show small to moderate...... improvements in glycaemic control. More research is needed to evaluate treatment of different depression subtypes in people with diabetes, the cost-effectiveness of treatments, the use of health-care resources, the need to account for cultural differences and different health-care systems, and new treatment...

Use of Generics—A Critical Cost Containment Measure for All Healthcare Professionals in Europe?

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F. Cankat Tulunay

2010-08-01

Full Text Available Pharmaceutical expenditures in ambulatory care rose rapidly in Europe in the 1990s and early 2000s. This was typically faster than other components of healthcare spending, leading to reforms to moderate future growth. A number of these centered on generic medicines with measures to lower reimbursed prices as well as enhance their prescribing and dispensing. The principal objective of this paper is to review additional measures that some European countries can adopt to further reduce reimbursed prices for generics. Secondly, potential approaches to address concerns with generics when they arise to maximize savings. Measures to enhance the prescribing of generics will also briefly be discussed. A narrative review of the extensive number of publications and associated references from the co-authors was conducted supplemented with known internal or web-based articles. In addition, health authority and health insurance databases, principally from 2001 to 2007, were analyzed to assess the impact of the various measures on price reductions for generic omeprazole and generic simvastatin vs. pre-patent loss prices, as well as overall efficiency in Proton Pump Inhibitor (PPI and statin prescribing. The various initiatives generally resulted in considerable lowering of the prices of generics as well as specifically for generic omeprazole and generic simvastatin vs. pre-patent loss prices. At one stage in the UK, generic simvastatin was just 2% of the originator price. These measures also led to increased efficiency for PPI and statin prescribing with reimbursed expenditure for the PPIs and statins either falling or increasing at appreciably lower rates than increases in utilization. A number of strategies have also been introduced to address patient and physician concerns with generics to maximize savings. In conclusion, whilst recent reforms have been successful, European countries must continue learning from each other to fund increased volumes and new

Greek mental health reform: views and perceptions of professionals and service users.

Science.gov (United States)

Loukidou, E; Mastroyiannakis, A; Power, T; Craig, T; Thornicroft, G; Bouras, N

2013-01-01

The Greek mental health system has been undergoing radical reforms for over the past twenty years. In congruence with trends and practices in other European countries, Greek mental health reforms were designed to develop a community-based mental health service system. The implementation of an extensive transformation became possible through the "Psychargos" program, a national strategic and operational plan, which was developed by the Ministry of Health and Social Solidarity. The Psychargos program was jointly funded by the European Union by 75% of the cost over a period of 5 years and the Greek State. After the period of 5 years, the entire cost of the new services became the responsibility of the Greek National Budget. Over the years the Psychargos program became almost synonymous with the deinstitutionalisation of long term psychiatric patients with the development of a wide range of community mental health services. The Psychargos program ended in December 2009. This article presents the views of service providers and service users as part an ex-post evaluation of the Psychargos program carried out in 2010. Data derived for this part of the evaluation are from the application of the qualitative method of focus groups. The outcomes of the study identified several positive and noteworthy achievements by the reforms of the Greek mental health system as well as weaknesses. There was considerable similarity of the views expressed by both focus groups. In addition the service users' focus group emphasized more issues related to improving their mental health wellbeing and living a satisfying, hopeful, and contributing life.

Teamed up for reform. As Obama looks to teamed up solve healthcare's problems, Daschle, Lambrew healthcare team makes sense, industry executives say.

Science.gov (United States)

DoBias, Matthew; Galloro, Vince

2008-12-15

The president-elect sent strong signals that he's serious about reform, with some key appointments last week. The move drew applause from industry executives, including one who said the system is now set on a crash course. "There's no guarantee that someone is going to be able to put Humpty Dumpty back together, but we're never going to know until someone starts sorting through the pieces," says William Atkinson, left, of WakeMed.

Reforming Organizational Structures

OpenAIRE

Van de Walle, Steven

2016-01-01

textabstractPublic sectors have undergone major transformations. Public sector reform touches upon the core building blocks of the public sector: organizational structures, people and finances. These are objects of reform. This chapter presents and discusses a set of major transformations with regard to organizational structures. It provides readers a fairly comprehensive overview of the key reforms that have taken place in Western public sectors. Structural reforms in the public sector show ...

Proposals for the Reform of Constitutional Regulations on Public Finances

OpenAIRE

Tibor András Hetei

2011-01-01

The main purpose of this paper is to make specific proposals in the areas of public finance and the budget process in the context of the reform of the Hungarian Constitution. In preparing the proposals the author has reviewed the prevailing constitutional regulations as well as the relevant practice of the Constitutional Court, and examined and compared the constitutional schemes of European countries. The paper finds that a number of aspects of the constitutional regulation of public finance...

In Pursuit of Excellence? Discursive Patterns in European Higher Education Research

Science.gov (United States)

Ramirez, Francisco O.; Tiplic, Dijana

2014-01-01

European higher education is awash with educational reform initiatives that purport to transform universities into better-managed higher quality organizations that more directly contribute to national development. This exploratory study examines patterns of research discourse in higher education in Europe. We argue that these patterns are changing…

Adult Students in the European Higher Educational Environment

Directory of Open Access Journals (Sweden)

N. G. Gordiyenko

2013-01-01

Full Text Available The paper considers the issue of accessibility of higher education for adults – the people of various ages and social status. The author analyzes the educational policy of the European Union and its different members, and demonstrates the priority of the given issue. The Bologna agreement involves the reforms aimed at guaranteeing the lifelong education at any level.The interest to the adults education in the European Union results from the rising education requirements in the labor market; tough demographic situation and aging of professionals; redistribution of young people’s educational preferences; prolonged educational programs; flexible and consistent adult education policies in the European Union. Various approaches to interpreting a definition of the adult student are analyzed; classification according to students’ motivation and social status is given. 

Veto player theory and reform making in Western Europe.

Science.gov (United States)

Angelova, Mariyana; Bäck, Hanna; Müller, Wolfgang C; Strobl, Daniel

2018-05-01

Veto player theory generates predictions about governments' capacity for policy change. Due to the difficulty of identifying significant laws needed to change the policy status quo, evidence about governments' ability to change policy has been mostly provided for a limited number of reforms and single-country studies. To evaluate the predictive power of veto player theory for policy making across time, policy areas and countries, a dataset was gathered that incorporates about 5,600 important government reform measures in the areas of social, labour, economic and taxation policy undertaken in 13 Western European countries from the mid-1980s until the mid-2000s. Veto player theory is applied in a combined model with other central theoretical expectations on policy change derived from political economy (crisis-driven policy change) and partisan theory (ideology-driven policy change). Robust support is found that governments introduce more reform measures when economic conditions are poor and when the government is positioned further away from the policy status quo. No empirical support is found for predictions of veto player theory in its pure form, where no differentiation between government types is made. However, the findings provide support for the veto player theory in the special case of minimal winning cabinets, where the support of all government parties is sufficient (in contrast to minority cabinets) and necessary (in contrast to oversized cabinets) for policy change. In particular, it is found that in minimal winning cabinets the ideological distance between the extreme government parties significantly decreases the government's ability to introduce reforms. These findings improve our understanding of reform making in parliamentary democracies and highlight important issues and open questions for future applications and tests of the veto player theory.

Challenges to healthcare reform in China: profit-oriented medical practices, patients' choice of care and guanxi culture in Zhejiang province.

Science.gov (United States)

Wu, Dan; Lam, Tai Pong; Lam, Kwok Fai; Zhou, Xu Dong; Sun, Kai Sing

2017-11-01

Doctors' profit-oriented practices in public institutions were widespread in China. Two major targets of the healthcare reform launched in 2009 were to curb the profit-making practices in public institutions and to encourage the citizens to use primary care. After 6 years, the status of profit-orientation of public institutions remains unknown. Compared with hospitals, there is no trend of increasing use of primary care. Our study aimed to explore the status of profit-orientation of public institutions and patients' utilization preference. The impacts of guanxi (personal relationship) on patients' utilization of healthcare and doctors' practices were also explored. From September 2014 to September 2015, we conducted focus group and individual interviews, followed by a survey with doctors (n = 1111) in Hangzhou, Zhejiang province. Thematic analysis, independent t-test and Fisher's exact test were conducted to analyse the data. This study found that 36.8% of survey respondents needed to consider making profits for their institutions, especially the hospital specialists. A total of 38.5% and 40.7% thought that their practices led to patients' worries of unnecessary drugs and tests, respectively. Doctors attributed their profit-oriented practices to institutions' agenda setting, poor salary and an organizational bonus system. Their awareness of breaching medical ethics created a guilt feeling and frustration. Nearly 65.0% reported patients' preference for hospital-based care even for minor conditions and 76.2% if the patient was a child. Ineffective gate-keeping mechanism, weak primary care and mistrust in community-based care were major reasons. More specialists than primary care practitioners (41.0 vs 21.5%, P < 0.001) said that patients would use guanxi to gain better services and 64.5% of doctors reported better dedication when patients were somehow connected. In conclusion, profit-orientated practice widely exists in public institutions. Patients

The development of the European public service: from modernisation to post-modernisation

Directory of Open Access Journals (Sweden)

O. V. Onufriienko

2016-08-01

2. Further convergence with the civil society seems to be the major perspective of the public service development in the European Union countries (it is also typical for relatively new East-European Member States but with established restrictions. It is not a contingency that not only the variety of social studies (first of all, political and social ones develop the idea of the very necessity to bring private and public sectors together, mainly, independently of each other, but it also involve the state-building practice and public service reformation in the developed European countries, particularly in the United Kingdom, Germany and France.

Balancing influence between actors in healthcare decision making

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Babad Yair M

2011-04-01

Full Text Available Abstract Background Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. Discussion A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc. motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. Summary A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include

Balancing influence between actors in healthcare decision making.

Science.gov (United States)

Kaplan, Robert M; Babad, Yair M

2011-04-19

Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc.) motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include improved transparency of all aspects of medical decision

[Analysis of outpatient healthcare utilization in the context of the universal healthcare coverage reform in Mexico].

Science.gov (United States)

Bautista-Arredondo, Sergio; Serván-Mori, Edson; Colchero, M Arantxa; Ramírez-Rodríguez, Baruch; Sosa-Rubí, Sandra G

2014-01-01

Understand and quantify the relationship between socio-economic and health insurance profiles and the use of outpatient medical services in the context of universal health care in Mexico. Using ENSANUT 2012 multinomial regression models were estimated to analyze the use of outpatient services and associated factors. Population with greater poverty levels, lower educational level and living in highly marginalized areas have lower odds to use outpatient health services. In contrast, health insurance and higher income increase the odds to use health services and influence the choice of provider. Barriers to access to health care related to poverty and social protection persist. However, there is space to lower the effect of these barriers by addressing constraints linked to the supply and the perceived quality of healthcare services.

Vertical equity of healthcare in Taiwan: health services were distributed according to need

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Wang Shiow-Ing

2013-01-01

Full Text Available Abstract Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health need received more healthcare services, indicating a pro-need character of healthcare distribution, conforming to the meaning of vertical equity. For outpatient service, subjects with the highest health need had higher proportion of ever use in a year than those who had the least health need and consumed more outpatient visits and expenditures per person per year. Similar patterns were observed for emergency services and hospitalization. The concentration indices of utilization for outpatient, emergency services, and hospitalization suggest that the distribution of utilization was related to health need, whereas the preventive service was less related to need. Conclusions The universal coverage plus healthcare networking system makes it possible for healthcare to be utilized according to need. Taiwan’s experience can serve as a reference for health reform.

The Importance of Community Consultations for Generating Evidence for Health Reform in Ukraine

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Olena Hankivsky

2017-03-01

Full Text Available Background The paper presents the results of community consultations about the health needs and healthcare experiences of the population of Ukraine. The objective of community consultations is to engage a community in which a research project is studying, and to gauge feedback, criticism and suggestions. It is designed to seek advice or information from participants directly affected by the study subject of interest. The purpose of this study was to collect first-hand perceptions about daily life, health concerns and experiences with the healthcare system. This study provides policy-makers with additional evidence to ensure that health reforms would include a focus not only on health system changes but also social determinants of health (SDH. Methods The data collection consisted of the 21 community consultations conducted in 2012 in eleven regions of Ukraine in a mix of urban and rural settings. The qualitative data was coded in MAXQDA 11 software and thematic analysis was used as a method of summarizing and interpreting the results. Results The key findings of this study point out the importance of the SDH in the lives of Ukrainians and how the residents of Ukraine perceive that health inequities and premature mortality are shaped by the circumstances of their daily lives, such as: political and economic instability, environmental pollution, low wages, poor diet, insufficient physical activity, and unsatisfactory state of public services. Study participants repeatedly discussed these conditions as the reasons for the perceived health crisis in Ukraine. The dilapidated state of the healthcare system was discussed as well; high out-of-pocket (OOP payments and lack of trust in doctors appeared as significant barriers in accessing healthcare services. Additionally, the consultations highlighted the economic and health gaps between residents of rural and urban areas, naming rural populations among the most vulnerable social groups in Ukraine

The impact of slow economic growth on health sector reform: a cross-national perspective.

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Saltman, Richard B

2018-01-24

This paper assesses recent health sector reform strategies across Europe adopted since the onset of the 2008 financial crisis. It begins with a brief overview of the continued economic pressure on public funding for health care services, particularly in tax-funded Northern European health care systems. While economic growth rates across Europe have risen a bit in the last year, they remain below the level necessary to provide the needed expansion of public health sector revenues. This continued public revenue shortage has become the central challenge that policymakers in these health systems confront, and increasingly constrains their potential range of policy options. The paper then examines the types of targeted reforms that various European governments have introduced in response to this increased fiscal stringency. Particularly in tax-funded health systems, these efforts have been focused on two types of changes on the production side of their health systems: consolidating and/or centralizing administrative authority over public hospitals, and revamping secondary and primary health services as well as social services to reduce the volume, cost and less-than-optimal outcomes of existing public elderly care programs. While revamping elderly care services also was pursued in the social health insurance (SHI) system in the Netherlands, both the Dutch and the German health systems also made important changes on the financing side of their health systems. Both types of targeted reforms are illustrated through short country case studies. Each of these country assessments flags up new mechanisms that have been introduced and which potentially could be reshaped and applied in other national health sector contexts. Reflecting the tax-funded structure of the Canadian health system, the preponderance of cases discussed focus on tax-funded countries (Norway, Denmark, Sweden, Finland, England, Ireland), with additional brief assessments of recent changes in the SHI

Laying Bare Educational Crosstalk: A Study of Discursive Repertoires in the Wake of Educational Reform

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McGrath, Cormac; Laksov, Klara Bolander

2014-01-01

In the wake of the Bologna process, many European universities are undergoing comprehensive educational reform. Our attention in this paper is focused on how a medical university came to terms with the challenges presented therein. We wished to explore how educators identify, understand and deal with opportunities for change at a medical…

The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use.

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Zarb, P; Coignard, B; Griskeviciene, J; Muller, A; Vankerckhoven, V; Weist, K; Goossens, Mm; Vaerenberg, S; Hopkins, S; Catry, B; Monnet, Dl; Goossens, H; Suetens, C

2012-11-15

A standardised methodology for a combined point prevalence survey (PPS) on healthcare-associated infections (HAIs) and antimicrobial use in European acute care hospitals developed by the European Centre for Disease Prevention and Control was piloted across Europe. Variables were collected at national, hospital and patient level in 66 hospitals from 23 countries. A patient-based and a unit-based protocol were available. Feasibility was assessed via national and hospital questionnaires. Of 19,888 surveyed patients, 7.1% had an HAI and 34.6% were receiving at least one antimicrobial agent. Prevalence results were highest in intensive care units, with 28.1% patients with HAI, and 61.4% patients with antimicrobial use. Pneumonia and other lower respiratory tract infections (2.0% of patients; 95% confidence interval (CI): 1.8–2.2%) represented the most common type (25.7%) of HAI. Surgical prophylaxis was the indication for 17.3% of used antimicrobials and exceeded one day in 60.7% of cases. Risk factors in the patient-based protocol were provided for 98% or more of the included patients and all were independently associated with both presence of HAI and receiving an antimicrobial agent. The patient-based protocol required more work than the unit-based protocol, but allowed collecting detailed data and analysis of risk factors for HAI and antimicrobial use.

Use of fused deposit modeling for additive manufacturing in hospital facilities: European certification directives.

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Otero, Joel J; Vijverman, An; Mommaerts, Maurice Y

2017-09-01

The goal of this study was to identify current European Union regulations governing hospital-based use of fused deposit modeling (FDM), as implemented via desktop three-dimensional (3D) printers. Literature and Internet sources were screened, searching for official documents, regulations/legislation, and views of specialized attorneys or consultants regarding European regulations for 3D printing or additive manufacturing (AM) in a healthcare facility. A detailed review of the latest amendment (2016) of the European Parliament and Council legislation for medical devices and its classification was performed, which has regularly updated published guidelines for medical devices, that are classified by type and duration of patient contact. As expected, regulations increase in accordance with the level (I-III) of classification. Custom-made medical devices are subject to different regulations than those controlling serially mass-produced items, as originally specified in 98/79/EC European Parliament and Council legislation (1993) and again recently amended (2016). Healthcare facilities undertaking in-house custom production are not obliged to fully follow the directives as stipulated, given an exception for this scenario (Article 4.4a, 98/79/EC). Patient treatment and diagnosis with the aid of customized 3D printing in a healthcare facility can be performed without fully meeting the European Parliament and Council legislation if the materials used are ISO 10993 certified and article 4.4a applies. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Antidepressant use in 27 European countries: associations with sociodemographic, cultural and economic factors.

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Lewer, Dan; O'Reilly, Claire; Mojtabai, Ramin; Evans-Lacko, Sara

2015-09-01

Prescribing of antidepressants varies widely between European countries despite no evidence of difference in the prevalence of affective disorders. To investigate associations between the use of antidepressants, country-level spending on healthcare and country-level attitudes towards mental health problems. We used Eurobarometer 2010, a large general population survey from 27 European countries, to measure antidepressant use and regularity of use. We then analysed the associations with country-level spending on healthcare and country-level attitudes towards mental health problems. Higher country spending on healthcare was strongly associated with regular use of antidepressants. Beliefs that mentally ill people are 'dangerous' were associated with higher use, and beliefs that they 'never recover' or 'have themselves to blame' were associated with lower and less regular use of antidepressants. Contextual factors, such as healthcare spending and public attitudes towards mental illness, may partly explain variations in antidepressant use and regular use of these medications. © The Royal College of Psychiatrists 2015.

Understanding healthcare innovation systems: the Stockholm region case.

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Larisch, Lisa-Marie; Amer-Wåhlin, Isis; Hidefjäll, Patrik

2016-11-21

Purpose There is an increasing interest in understanding how innovation processes can address current challenges in healthcare. The purpose of this paper is to analyze the wider socio-economic context and conditions for such innovation processes in the Stockholm region, using the functional dynamics approach to innovation systems (ISs). Design/methodology/approach The analysis is based on triangulation using data from 16 in-depth interviews, two workshops, and additional documents. Using the functional dynamics approach, critical structural and functional components of the healthcare IS were analyzed. Findings The analysis revealed several mechanisms blocking innovation processes such as fragmentation, lack of clear leadership, as well as insufficient involvement of patients and healthcare professionals. Furthermore, innovation is expected to occur linearly as a result of research. Restrictive rules for collaboration with industry, reimbursement, and procurement mechanisms limit entrepreneurial experimentation, commercialization, and spread of innovations. Research limitations/implications In this study, the authors analyzed how certain functions of the functional dynamics approach to ISs related to each other. The authors grouped knowledge creation, resource mobilization, and legitimacy as they jointly constitute conditions for needs articulation and entrepreneurial experimentation. The economic effects of entrepreneurial experimentation and needs articulation are mainly determined by the stage of market formation and existence of positive externalities. Social implications Stronger user involvement; a joint innovation strategy for healthcare, academia, and industry; and institutional reform are necessary to remove blocking mechanisms that today prevent innovation from occurring. Originality/value This study is the first to provide an analysis of the system of innovation in healthcare using a functional dynamics approach, which has evolved as a tool for public

TAXATION OF ENERGY PRODUCTS AND ELECTRICITY TO THE EUROPEAN UNION LEVEL

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PĂUNESCU ALBERTO NICOLAE

2012-06-01

Full Text Available U.E established to increase socio-economic stability and security of supply, the Energy Community has set a good example of regional cooperation in which the EU and the South-Eastern European countries can diversify their energy sources. It has created a functioning institutional framework and more legal certainty for investors. Next steps are to enhance market reforms and to boost investments in the energy sector. The final objective is that the regional market should be fully integrated in the European's internal energy market

Emerging organisational models of primary healthcare and unmet needs for care: insights from a population-based survey in Quebec province

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Levesque Jean-Frédéric

2012-07-01

Full Text Available Abstract Background Reform of primary healthcare (PHC organisations is underway in Canada. The capacity of various types of PHC organizations to respond to populations’ needs remains to be assessed. The main objective of this study was to evaluate the association of PHC affiliation with unmet needs for care. Methods Population-based survey of 9205 randomly selected adults in two regions of Quebec, Canada. Outcomes Self-reported unmet needs for care and identification of the usual source of PHC. Results Among eligible adults, 18 % reported unmet needs for care in the last six months. Reasons reported for unmet needs were: waiting times (59 % of cases; unavailability of usual doctor (42 %; impossibility to obtain an appointment (36 %; doctors not accepting new patients (31 %. Regression models showed that unmet needs were decreasing with age and was lower among males, the least educated, and unemployed or retired. Controlling for other factors, unmet needs were higher among the poor and those with worse health status. Having a family doctor was associated with fewer unmet needs. People reporting a usual source of care in the last two-years were more likely to report unmet need for care. There were no differences in unmet needs for care across types of PHC organisations when controlling for affiliation with a family physician. Conclusion Reform models of primary healthcare consistent with the medical home concept did not differ from other types of organisations in our study. Further research looking at primary healthcare reform models at other levels of implementation should be done.

Challenges facing the finance reform of the health system in Chile.

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Herrera, Tania

2014-05-28

Financing is one of the key functions of health systems, which includes the processes of revenue collection, fund pooling and acquisitions in order to ensure access to healthcare for the entire population. The article analyzes the financing model of the Chilean health system in terms of the first two processes, confirming low public spending on healthcare and high out-of-pocket expenditure, in addition to an appropriation of public resources by private insurers and providers. Insofar as pooling, there is lack of solidarity and risk sharing leading to segmentation of the population that is not consistent with the concept of social security, undermines equity and reduces system-wide efficiency. There is a pressing need to jumpstart reforms that address these issues. Treatments must be considered together with public health concerns and primary care in order to ensure the right to health of the entire population.

Improvements of reforming performance of a nuclear heated steam reforming process

International Nuclear Information System (INIS)

Hada, Kazuhiko

1996-10-01

Performance of an energy production process by utilizing high temperature nuclear process heat was not competitive to that by utilizing non-nuclear process heat, especially fossil-fired process heat due to its less favorable chemical reaction conditions. Less favorable conditions are because a temperature of the nuclear generated heat is around 950degC and the heat transferring fluid is the helium gas pressurized at around 4 MPa. Improvements of reforming performance of nuclear heated steam reforming process were proposed in the present report. The steam reforming process, one of hydrogen production processes, has the possibility to be industrialized as a nuclear heated process as early as expected, and technical solutions to resolve issues for coupling an HTGR with the steam reforming system are applicable to other nuclear-heated hydrogen production systems. The improvements are as follows: As for the steam reformer, (1) increase in heat input to process gas by applying a bayonet type of reformer tubes and so on, (2) increase in reforming temperature by enhancing heat transfer rate by the use of combined promoters of orifice baffles, cylindrical thermal radiation pipes and other proposal, and (3) increase in conversion rate of methane to hydrogen by optimizing chemical compositions of feed process gas. Regarding system arrangement, a steam generator and superheater are set in the helium loop as downstream coolers of the steam reformer, so as to effectively utilize the residual nuclear heat for generating feed steam. The improvements are estimated to achieve the hydrogen production rate of approximately 3800 STP-m 3 /h for the heat source of 10 MW and therefore will provide the potential competitiveness to a fossil-fired steam reforming process. Those improvements also provide the compactness of reformer tubes, giving the applicability of seamless tubes. (J.P.N.)

Analysis of outpatient healthcare utilization in the context of the universal healthcare coverage reform in Mexico.

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Sergio Bautista-Arredondo

2014-01-01

Full Text Available Objective. Understand and quantify the relationship between socio-economic and health insurance profiles and the use of outpatient medical services in the context of universal health care in Mexico. Materials and methods. Using ENSANUT 2012 multinomial regression models were estimated to analyze the use of outpatient services and associated factors. Results. Population with greater poverty levels, lower educational level and living in highly marginalized areas have lower odds to use outpatient health services. In contrast, health insurance and higher income increase the odds to use health services and influence the choice of provider. Conclusions. Barriers to access to health care related to poverty and social protection persist. However, there is space to lower the effect of these barriers by addressing constraints linked to the supply and the perceived quality of healthcare services.

[Social medicine and healthcare economics. The framework for future forms of healthcare].

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Rebscher, Herbert

2008-05-01

In the political debate, even in academia, the concepts of "profitability" or "efficiency" are thrown around very robustly and freely with no regard for the players themselves. Economically speaking there can be no efficiency without a definition of targets in terms of outcomes and their level of quality. If even the government's Council of Economic Experts itself finds in its assessment of hospital funding that the "reform's target parameters - improving the profitability of service provision - have developed positively", but adds that "whether this also applies to the quality of services provided or to the realisation of healthcare outcomes remains to be seen due to the lack of evidence" [21], this indicates a one-sided and problematic curtailment of the concept even by highly competent bodies. Economic control of new forms of healthcare by means of prices and fees for clearly defined services is a complex problem that has not been dealt with adequately. All pricing is based on classification models aimed at ensuring cost and benefit clusters that are as homogeneous as possible. Classification models in healthcare as a basis for price control targets need constant adjusting to ensure accuracy of mapping and appropriateness to performance. A prerequisite for the methodology behind price control models of this kind is presupposing a responsible, rule-bound and criteria-based handling of "variance" and "coincidence" by means of risk-adjusted quality and price systems. They will define the character of a wide range of steering tools and have an effect that goes beyond the narrow formal confines of the sector. That is why the regulatory framework will need first and foremost to define a qualitative framework for the political "security infrastructure" by means of deregulated economic processes in which price control becomes accountable and is justified in terms of content.

Healthcare for migrants, participatory health research and implementation science--better health policy and practice through inclusion. The RESTORE project.

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MacFarlane, Anne; O'Reilly-de Brún, Mary; de Brún, Tomas; Dowrick, Christopher; O'Donnell, Catherine; Mair, Frances; Spiegel, Wolfgang; van den Muijsenbergh, Maria; van Weel Baumgarten, Evelyn; Lionis, Christos; Clissmann, Ciaran

2014-06-01

This is a time of unprecedented mobility across the globe. Healthcare systems need to adapt to ensure that primary care is culturally and linguistically appropriate for migrants. Evidence-based guidelines and training interventions for cultural competence and the use of professional interpreters are available across European healthcare settings. However, in real-world practice migrants and their healthcare providers 'get by' with a range of informal and inadequate strategies. RESTORE is an EU FP7 funded project, which is designed to address this translational gap. The objective of RESTORE is to investigate and support the implementation of guidelines and training initiatives to support communication in cross-cultural consultations in selected European primary care settings. RESTORE is a qualitative, participatory health project running from 2011-2015. It uses a novel combination of normalization process theory and participatory learning and action research to follow and shape the implementation journeys of relevant guidelines and training initiatives. Research teams in Ireland, England, the Netherlands, Austria and Greece are conducting similar parallel qualitative case study fieldwork, with a complementary health policy analysis led by Scotland. In each setting, key stakeholders, including migrants, are involved in participatory data generation and analysis. RESTORE will provide knowledge about the levers and barriers to the implementation of guidelines and training initiatives in European healthcare settings and about successful, transferrable strategies to overcome identified barriers. RESTORE will elucidate the role of policy in shaping these implementation journeys; generate recommendations for European policy driving the development of culturally and linguistically appropriate healthcare systems.

Land reform in Russia in 1990-2000-ies, or how land reform was "reformed" during the departmental reorganization

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Barsukova Svetlana, Yu.

2015-06-01

Full Text Available The paper provides an overview of the land reform in Russia's recent history. Analysis of land reform, which started in 1990, shows what actions and what logic led the land sector in the state in which it was at the finish line of the quarter-century reform marathon. The reform process was not linear, it highlighted the steps differing objectives and strategies to achieve them. Land reform is presented as a struggle of different political forces, which were reflected in the redistribution of functions between agencies in lobbying for appointment to senior positions promoted various commands. The authors conclude about the gradual displacement of state regulation of land relations, the deliberate destruction of the land management as a basis for the development of land resources.

Radiant non-catalytic recuperative reformer

Energy Technology Data Exchange (ETDEWEB)

Khinkis, Mark J.; Kozlov, Aleksandr P.

2017-10-31

A radiant, non-catalytic recuperative reformer has a flue gas flow path for conducting hot exhaust gas from a thermal process and a reforming mixture flow path for conducting a reforming mixture. At least a portion of the reforming mixture flow path is positioned adjacent to the flue gas flow path to permit heat transfer from the hot exhaust gas to the reforming mixture. The reforming mixture flow path contains substantially no material commonly used as a catalyst for reforming hydrocarbon fuel (e.g., nickel oxide, platinum group elements or rhenium), but instead the reforming mixture is reformed into a higher calorific fuel via reactions due to the heat transfer and residence time. In a preferred embodiment, a portion of the reforming mixture flow path is positioned outside of flue gas flow path for a relatively large residence time.

Candidates stick to party guns. In lieu of new healthcare plans, Bush, Gore follow party reform proposals.

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Gardner, J; Hallam, K

2000-07-03

As the Democratic and GOP nominating conventions approach next month, presumptive nominees Al Gore and George W. Bush are offering no new healthcare plans, both preferring to ride the healthcare waves already set in motion by their respective party's leadership. And the really interesting thing is, the plans aren't that different. Call it creeping incrementalism.

Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil.

Science.gov (United States)

Vargas, Ingrid; Mogollón-Pérez, Amparo Susana; De Paepe, Pierre; Ferreira da Silva, Maria Rejane; Unger, Jean-Pierre; Vázquez, María-Luisa

2016-07-01

Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen

Migrants' utilization of somatic healthcare services in Europe - a systematic review

DEFF Research Database (Denmark)

Nørredam, Marie Louise; Nielsen, Signe Smith; Krasnik, Allan

2010-01-01

on the abstracts. Additional searches were conducted via the references of the selected articles. The final number of studies included was 21. Results: The results suggested a diverging picture regarding utilization of somatic healthcare services by migrants compared to non-migrants in Europe. Overall, migrants......Background: Utilization of services is an important aspect of migrants' access to healthcare. The aim was to review the European literature on utilization of somatic healthcare services related to screening, general practitioner, specialist, emergency room and hospital by adult first......-generation migrants. Our study question was: ‘Are there differences in migrants' utilization of somatic healthcare services compared to non-migrants?' Methods: Publications were identified by a systematic search of PUBMED and EMBASE. Appropriateness of the studies was judged independently by two researchers based...

APPLICATION OF EUROPEAN STANDARDS OF FINANCIAL STATEMENTS – INFORMATIONAL RESOURSE OF CONSUMER COOPERATION DEVELOPMENT IN UKRAINE

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Stepan KOSHKAROV

2016-07-01

Full Text Available More than 120 countries use the International Financial Reporting Standards (IFRS and the International Accounting Standards (IAS. The Association Agreement between Ukraine and the EU obliges Ukraine to consider European convergence of accounting and reporting. Since 2012 for some entities the use of IFRS has been compulsory, but for others – voluntary. This trend coincides with the imperative necessity of the consumer cooperation of Ukraine to reform its multilevel informational system as a key component of its effective management and successful implementation of controlling. It is proposed to start reforming with the introduction of IFRS and IAS. Consumer cooperation represents cooperative sector of Ukrainian economy and is included into different international and European cooperative associations. With its historic mission to meet the needs of its members, socio-economic and cultural development of rural areas, in terms of the crisis it faces the serious problem of the systemic reforming under existing conditions through the innovative development and use of experience of economically developed countries, especially the EU.

Healthcare System Information at Language Schools for Newly Arrived Immigrants: A Pertinent Setting in Times of Austerity

Science.gov (United States)

Tynell, Lena Lyngholt; Wimmelmann, Camilla Lawaetz; Jervelund, Signe Smith

2017-01-01

Objective: In most European countries, immigrants do not systematically learn about the host countries' healthcare system when arriving. This study investigated how newly arrived immigrants perceived the information they received about the Danish healthcare system. Methods: Immigrants attending a language school in Copenhagen in 2012 received…

Lisbon Treaty – the architect of a new European institutional structure

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Maria POPESCU

2013-06-01

Full Text Available The European Union is today managed by the Lisbon Treaty, which stated, in his time, and rightly so, that is a step towards European integration, both at the institutional and human level, a treaty that succeed, despite difficulties, to move forward the European project that combined his account about half a century. The changes introduced by the Lisbon Treaty have a significant impact on EU governance. Treaty of Lisbon makes substantial changes in the management of the EU, especially with regard to the European Council, the Council of Ministers and the EU's rotating presidency. The main task of the research in this paper is the approach of the provisions of the EU Reform Treaty (Lisbon Treaty in terms of constitutional law. Research conducted prior to permit formulation of a general belief, namely that common European history of all its successes and difficulties demonstrates the viability of the European idea and the correct direction of institutional developments in the EU and the Member States.

The Failure of Muslim Reformation: "Jadidism" in Eastern Europe, 1699-1922

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Ataullah Bogdan Kopanski

1994-12-01

Full Text Available The advent of Western influence has led to a number of responses in the Muslims, one of them being an attempt to "reform" Islam-Jadidism. This study examines the influence (lf such movements from the early eighteenth century to the first quarter of the twentieth century, in eastern European countries, particularly relating to Polish, Crimean, Turkish and Tatar Muslims. It is shown that all such attempts resulted in cultural decay, and loss of identity and power.

From heterogeneity to harmonization? Recent trends in European health policy

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Thomas Gerlinger

2007-01-01

Full Text Available In the European Union (EU, health policy and the institutional reform of health systems have been treated primarily as national affairs, and health care systems within the EU thus differ considerably. However, the health policy field is undergoing a dynamic process of Europeanization. This process is stimulated by the orientation towards a more competitive economy, recently inaugurated and known as the Lisbon Strategy, while the regulatory requirements of the European Economic and Monetary Union are stimulating the Europeanization of health policy. In addition, the so-called open method of coordination, representing a new mode of regulation within the European multi-level system, is applied increasingly to the health policy area. Diverse trends are thus emerging. While the Lisbon Strategy goes along with a strategic upgrading of health policy more generally, health policy is increasingly used to strengthen economic competitiveness. Pressure on Member States is expected to increase to contain costs and promote market-based health care provision.

Healthcare resources and expenditure in financial crisis: scenarios and managerial strategies.

Science.gov (United States)

Nuti, Sabina; Vainieri, Milena; Frey, Marco

2012-10-01

What are the implications of financial crisis on healthcare expenditure? This paper explores different approaches applied across European countries focusing on the role that managerial tools may have in coping with this challenge. The paper reports the results of recent studies on responses to financial crisis from European countries and which are the techniques they had applied to reallocate resources. Although resources scarcity, some governments did not reduce the healthcare expenditure because they believe in its focal role on the economic development and on maintaining social cohesion and protection of vulnerable people. Other countries decided a strong reduction of costs which often has affected services delivered. In both cases authors suggest to avoid across-the-board cuts in favor of approach involving priority setting. The public sector has assumed new responsibilities following the global crisis and the rising demand for social services. Some countries shifted the healthcare costs from the public purse to private households undermining the survival of the health system and the universal coverage. A way to avoid this risk is based on the ability to share discussion about where to cut and where to reallocate resources.

Cross-Cultural Adaptation and Validation of the Attitudes Toward Suicide Questionnaire Among Healthcare personnel in Malaysia.

Science.gov (United States)

Siau, Ching Sin; Wee, Lei-Hum; Ibrahim, Norhayati; Visvalingam, Uma; Wahab, Suzaily

2017-01-01

Understanding attitudes toward suicide, especially among healthcare personnel, is an important step in both suicide prevention and treatment. We document the adaptation process and establish the validity and reliability of the Attitudes Toward Suicide (ATTS) questionnaire among 262 healthcare personnel in 2 major public hospitals in the Klang Valley, Malaysia. The findings indicate that healthcare personnel in Malaysia have unique constructs on suicide attitude, compared with the original study on a Western European sample. The adapted Malay ATTS questionnaire demonstrates adequate reliability and validity for use among healthcare personnel in Malaysia.

Gender inequality indices for the European partnership countries comparison

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E I Kharchenko

2016-12-01

Full Text Available Overcoming gender inequality is a serious challenge for many countries all over the world. Different reforms aiming at reduction of gender inequality are often a necessary condition for joining international alliances and associations. The article presents an example of comparative analysis of gender statuses in European partnership countries: Armenia, Azerbaijan, Georgia, Moldova, Ukraine and Russian Federation (1 on the one hand, and Iceland - on the other hand due to the latter leading position in the Global Gender Gap ranking. This ranking as well as the results of the comparative analysis can be useful for lecturers in the courses on gender inequality, international comparative studies and others. The author provides a definition of the concept “gender inequality”, an overview of existing methodological approaches to the international gender inequality measurement and interpretation. Based on the Global Gender Gap Index (GGGI author describes men and women positions in the countries mentioned above in such socially important fields as politics, economy, education, and life expectancy; provides her own explanations of the current situation and perspectives for its development. The study shows that for all the countries under consideration the most problematic are (1 political sphere in the terms of women’s empowerment and (2 the sphere of healthcare from the point of quality and duration of men’s lives. The most unproblematic field from the comparative gender analysis point of view is educational sphere. According to the results of the comparative analysis, the most egalitarian country seems to be Moldova, while the least egalitarian - Azerbaijan. This article is based on the data of the International project ReSET «European visions and divisions: comparative studies in improving of teaching sociology” (supported by OSI HESP in 2010-2012.

Water Institutional Reforms in Scotland: Contested Objectives and Hidden Disputes

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Antonio A.R. Ioris

2008-10-01

Full Text Available One fundamental limitation of the contemporary debate over water institutional reforms has been the excessive concentration on scientific assessments and management techniques, with insufficient consideration of the underlying politics of decision-making and socio-economic asymmetries. This article examines the 'sociology of water regulation' to demonstrate how the implementation of the European Water Framework Directive (WFD in Scotland is profoundly influenced by broader political and economic circumstances. The ongoing reforms of regulatory institutions became entangled in the reorganisation of a devolved Scottish Administration in the late 1990s, which has directly influenced the channels of representation and the overall decision-making processes. It is claimed here that, despite a discursive construction around sustainability and public participation, the new institutional landscape has so far failed to improve long-term patterns of water use and conservation. The article also analyses how the exacerbation of the economic dimension of water management has permeated the entire experience, serving as a political filter for the assessment of impacts and formulation of solutions. The ultimate conclusion is that formal changes in the legislation created a positive space for institutional reforms, but the effective improvement of water policy and catchment management has been curtailed by political inertia and the hidden balance of power.

Steepest Ascent Tariff Reforms

DEFF Research Database (Denmark)

Raimondos-Møller, Pascalis; Woodland, Alan D.

2006-01-01

a theoretical concept where the focus is upon the size of welfare gains accruing from tariff reforms rather than simply with the direction of welfare effects that has been the concern of theliterature.JEL code: F15.Keywords: Steepest ascent tariff reforms; piecemeal tariff policy; welfare; market access; small......This paper introduces the concept of a steepest ascent tariff reform for a small open economy. By construction, it is locally optimal in that it yields the highest gain in utility of any feasible tariff reform vector of the same length. Accordingly, it provides a convenient benchmark...... for the evaluation of the welfare effectiveness of other well known tariff reform rules, as e.g. the proportional and the concertina rules. We develop the properties of this tariff reform, characterize the sources of the potential welfare gains from tariff reform, use it to establish conditions under which some...

With Bologna in Mind and the Sword in the Hand: The German Bachelor/Master Reform Reconsidered

Science.gov (United States)

Mause, Karsten

2013-01-01

Since the late 1990s, many European countries have adapted their traditional one-cycle curriculum structure in higher education to the two-cycle structure employed in the Anglo-American world. In the large social science literature dealing with this reform phenomenon, the Bologna Process -- starting with the 1999 Declaration of Bologna -- is…

The use of deliberative method in educational reform

Directory of Open Access Journals (Sweden)

Ivan Buljan

2016-12-01

Full Text Available The project named Higher Education Reform was established in 2004 as one of the implementation elements of the European higher education policy. The core activities of the project were executed throughout the formation of National Teams of Bologna Experts who had the task and duty to contribute to the general and real awareness-rising on the topic of the higher education reform among different stakeholders in participating countries of the Bologna Process. The Croatian National Team of Bologna Expert (Hrvatska stručna skupina za Bolonjski proces was established in 2011. Among the diversity of activities executed by the student representatives in the Team, the important place is reserved for the deliberative workshops held during 2013. The target groups of the deliberative workshops were students and other stakeholders in the higher education. This paper presents the process of including the stakeholders in educational reform through the deliberative workshops. During the workshops, the organizers found out how the stakeholders are rethinking on some of the aspects of the Bologna Process, how they perceive and value the work of student representative and volunteering activities, and what they think about the extra-curricular activities of the student and how they value such activities. The form of deliberative workshops encouraged participants to freely and in constructive way express their thoughts and expectances in order to exchange ideas and knowledge about the matter, and to make a decision on common suggestions to solve a particular problem in the context of higher education (introduction of a new practice, modifications and alternations of existing practices, etc. This type of the application of deliberation method is extremely useful, which is the reason for the suggestion of the method’s use in preparing, implementing and evaluating the educational reforms.

The crisis as catalyst for reframing health care policies in the European Union.

Science.gov (United States)

Helderman, Jan-Kees

2015-01-01

Seen from the perspective of health, the global financial crisis (GFC) may be conceived of as an exogenous factor that has undermined the fiscal sustainability of European welfare states and consequently, their (expanding) health systems as well. Being one of the core programs of European welfare states, health care has always belonged to the sovereignty of European Member States. However, in past two decades, European welfare states have in fact become semi-sovereign states and the European Union (EU) no longer is an exogenous actor in European health policy making. Today, the EU not only puts limits to unsustainable growth levels in health care spending, it also acts as an health policy agenda setter. Since the outbreak of the GFC, it does so in an increasingly coercive and persuasive way, claiming authority over health system reforms alongside the responsibilities of its Member States.

Health system reform.

Science.gov (United States)

Ortolon, Ken

2009-06-01

A vote on reforming the nation's health care system seems likely this summer as President Obama makes good on a campaign pledge. Although the Democratic leadership in Congress appears ready to push through reform legislation before the next election, TMA and AMA leaders say very little is known about what that "reform" likely will look like.

Medical Education and Curriculum Reform: Putting Reform Proposals in Context

Directory of Open Access Journals (Sweden)

Daniel Kam Yin Chan, MD, MB.BS, MHA

2004-01-01

Full Text Available The purpose of this paper is to elaborate criteria by which the principles of curriculum reform can be judged. To this end, the paper presents an overview of standard critiques of medical education and examines the ways medical curriculum reforms have responded to these critiques. The paper then sets out our assessment of these curriculum reforms along three parameters: pedagogy, educational context, and knowledge status. Following on from this evaluation of recent curriculum reforms, the paper puts forward four criteria with which to gauge the adequacy medical curriculum reform. These criteria enable us to question the extent to which new curricula incorporate methods and approaches for ensuring that its substance: overcomes the traditional opposition between clinical and resource dimensions of care; emphasizes that the clinical work needs to be systematized in so far as that it feasible; promotes multi-disciplinary team work, and balances clinical autonomy with accountability to non-clinical stakeholders.

Energy policy and European utilities' strategy: Lessons from the liberalisation and privatisation of the energy sector in Romania

International Nuclear Information System (INIS)

Haar, Laura N.; Marinescu, Nicolae

2011-01-01

In the context of energy sector reforms pursued by Romanian government since 1990s, we compare and contrast the market outcomes of European utilities' investment with the host government policy objectives. We begin with energy market reform in Romania and review governments' efforts to attract foreign direct investment (FDI) and to gradually withdraw from the distribution and supply segments of electricity market. Subsequently, we illustrate the scope European utilities have had, market policy and design notwithstanding, for consolidating market power through regional dominance. We examine the extent to which these utilities have sought to enhance their positions through horizontal and vertical integration, counter to the EU plans for a competitive market structure. We find that the investments of European incumbents have not been resoundingly successful: although market entrance may have been justified on long-term strategic grounds, in the immediate term, segments acquired through competitive auctions have yielded modest regulated returns. Finally, we discuss the extent to which policy makers have achieved their goals. Although the short-term benefits of a competitive market structure have reached some consumers, a renewed interest in promoting 'national champions' reflect frustration with market mechanisms as a means of ensuring long-term strategic investments in the sector. - Research highlights: → We analyze the European Utilities activities in Romania after market liberalization. → We find government efforts to reform energy sector attracted foreign direct investment. → We find utilities consolidated market power horizontally in Central European region. → The short-term benefits of competitive forces contrast the weak returns by utilities. → To encourage further investment, government should not promote national champions.

THE AFTERMATH OF THE ECONOMIC CRISIS: HEALTHCARE SYSTEMS’ INEQUALITIES IN EUROPE

Directory of Open Access Journals (Sweden)

Silvia PALASCA

2014-12-01

Full Text Available During an economic downturn the non-productive sectors (education, health, and social services are the most exposed to sudden policy changes, as a result of austerity measures. This article aims to assess the impact of the late 2000’s crisis on some European countries’ healthcare systems in order to highlight the link between the breakdown of the economic context and the negative outcomes on a social level. In this regard, a panel data analysis was employed, focusing on out-of-pocket health expenses as an estimation of a nation’s wellbeing and healthcare development level. The cross-time results indicated a clear collapse of all national healthcare systems in 2009 while the cross-section effects implied that the twenty three countries could be divided in three groups according to their healthcare policy, especially regarding health insurance. Thus, countries should pay more attention to the private insurances component of the healthcare systems as the others are defenseless against business cycle fluctuations.

Patient satisfaction and loyalty among military healthcare beneficiaries enrolled in a managed care program.

Science.gov (United States)

Jennings, B M; Loan, L A

1999-11-01

A study was performed to evaluate military beneficiaries' motivation for choosing to change from a civilian managed care system to the military managed care system. Concerns about healthcare cost, quality, and access underpin major reform in military healthcare. The military health system (MHS) is implementing managed care through an initiative known as TRICARE. Patient choice and satisfaction are highly relevant to all healthcare delivery systems; they are being explored aggressively in the MHS as TRICARE evolves. This descriptive study was conducted using a telephone survey consisting of 63 items derived from four pre-existing instruments as well as five facility-specific questions and demographics. The population of interest targeted military beneficiaries on a TRICARE waiting list who, at the time of enrollment, indicated a desire to receive care at the military facility. Consumers were inclined to return to the military system because of loyalty. Also, this study provided evidence that staff courtesy is important to those who seek healthcare. Good quality and accessibility were verified as essential elements in sustaining a consumer's positive view of and attraction to a particular healthcare system. Cost was proven to be a less substantial factor of consumer decision making. Surveys such as this give healthcare providers more information about aspects of care, such as patient loyalty and interpersonal dynamics, that attract people to their healthcare delivery systems. For healthcare systems to thrive, consumer influence and the power of patient dissatisfaction must be understood.

Crowding and delivery of healthcare in emergency departments: the European perspective.

LENUS (Irish Health Repository)

Jayaprakash, Namita

2009-11-01

Emergency department (ED) crowding is a multifactorial problem, resulting in increased ED waiting times, decreased patient satisfaction and deleterious domino effects on the entire hospital. Although difficult to define and once limited to anecdotal evidence, crowding is receiving more attention as attempts are made to quantify the problem objectively. It is a worldwide phenomenon with regional influences, as exemplified when analyzing the problem in Europe compared to that of the United States. In both regions, an aging population, limited hospital resources, staff shortages and delayed ancillary services are key contributors; however, because the structure of healthcare differs from country to country, varying influences affect the issue of crowding. The approach to healthcare delivery as a right of all people, as opposed to a free market commodity, depends on governmental organization and appropriation of funds. Thus, public funding directly influences potential crowding factors, such as number of hospital beds, community care facilities, and staffing. Ultimately ED crowding is a universal problem with distinctly regional root causes; thus, any approach to address the problem must be tailored to regional influences.

Enhanced Cooperation, EMU Reforms and Their Implications for Differentiation in the European Union

Directory of Open Access Journals (Sweden)

Kubin Tomasz

2017-10-01

Full Text Available Initially, before the entry into force of the Maastricht Treaty, differences in integration between members of the European Communities (EC; later the European Union were relatively few and usually temporary in nature. The Schengen Agreement, the Maastricht Treaty and the Treaty of Amsterdam, and the possibility of establishing enhanced cooperation meant that the problem was becoming more and more important in the functioning of the EU—both in theory and in practice.

FOREIGN EXPERIENCE OF PENSION SYSTEM REFORMING AND POSSIBILITY OF ADAPTATION IN UKRAINE

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Anastasiia Svyrydovska

2016-11-01

Full Text Available The purpose of the paper is to analyze foreign experience of reforming pension systems. Reforming pension systems around the world is due to the need to balance the cost of social support for people who are growing, with the financial capabilities of the country. Ukraine, like other European countries is facing the crisis of public pensions. One reason – the rapid aging of the population. The experience of some countries shows that the increase in the rates of deductions has a negative impact on employment, leads to a significant increase in public debt, and therefore is unacceptable. Some economists believe that a full transition to retirement savings scheme – a solution. However, this would create an additional burden on public financial systems and current generation of taxpayers. Therefore, it is necessary to determine the main directions of the crisis of pensions. With the economic downturn global scale of the efficiency of the pension system of Ukraine, its compliance with the standards of the welfare state is becoming more acute. That is why there is an urgent need for adaptation based on international experience to review previously proposed ways to reform the pension system of Ukraine. Methodology is actual works of scientists and researchers. Results are exploring the features of the international experience of reforming pension systems and proposition of directions of reform of the pension system of Ukraine on the basis of demographic, social, financial, political and cultural characteristics of its development. Value. Background research finding is due to government regulation mechanisms of social insurance in Ukraine. The most developed social protection system with the EU. Consideration of these specific programs of effective systems of social insurance is an important basis for the analysis of international experience. Decisive impact on the social security system in the EU provides current demographic trends (falling birth

Reform despite politics? The political economy of power sector reform in Fiji, 1996–2013

International Nuclear Information System (INIS)

Dornan, Matthew

2014-01-01

Attempts to reform the electricity sector in developing countries have achieved mixed results, despite the implementation of similar reforms in many developed countries, and concerted effort by donors to transfer reform models. In many cases, political obstacles have prevented full and effective implementation of donor-promoted reforms. This paper examines the political economy of power sector reform in Fiji from 1996 to 2013. Reform has been pursued with political motives in a context of clientelism. Policy inconsistency and reversal is explained by the political instability of ethnic-based politics in Fiji. Modest success has been achieved in recent years despite these challenges, with Fiji now considered a model of power sector reform for other Small Islands Developing States (SIDS) in the Pacific. The experience demonstrates that reform is possible within difficult political environments, but it is challenging, takes time and is not guaranteed. The way in which political motives have driven and shaped reform efforts also highlights the need for studies of power sector reform to direct greater attention toward political drivers behind reform. - Highlights: • This is the first study of power sector reform in Fiji or other Small Island Developing States (SIDS) of the Pacific. • The clientelist nature of politics in Fiji is found to have both driven and shaped reform efforts. • There has been modest success in recent years despite these obstacles, with Fiji now considered a model for other SIDS. • The experience demonstrates that reform is possible within difficult political environments, but it is challenging, takes time and is not guaranteed

EUROPEAN EXPERIENCE OF SOCIAL PARTNERSHIP IN THE LABOUR FIELD: PERSPECTIVES FOR THE REPUBLIC OF MOLDOVA

Directory of Open Access Journals (Sweden)

Irina Nicolaescu

2012-06-01

Full Text Available European integration is not a slogan, a political discourse or a foundation for the political platform of political parties. European integration includes concrete directives of action to be taken into account by all states. One of the most important of them might be considered the social partnership in the labour field. Under current circumstances, the need to study relations established within social partnership, factors contributing to social dialogue development and fulfillment of social partnership potential within existing political and socio-economic reforms increased. Analysis of European dimension of Moldovan social partnership evolution is essential for further democratization of labour field and European perspectives of the country.

Physician-Pharmacist collaboration in a pay for performance healthcare environment.

Science.gov (United States)

Farley, T M; Izakovic, M

2015-01-01

Healthcare is becoming more complex and costly in both European (Slovak) and American models. Healthcare in the United States (U.S.) is undergoing a particularly dramatic change. Physician and hospital reimbursement are becoming less procedure focused and increasingly outcome focused. Efforts at Mercy Hospital have shown promise in terms of collaborative team based care improving performance on glucose control outcome metrics, linked to reimbursement. Our performance on the Centers for Medicare and Medicaid Services (CMS) post-operative glucose control metric for cardiac surgery patients increased from a 63.6% pass rate to a 95.1% pass rate after implementing interventions involving physician-pharmacist team based care.Having a multidisciplinary team that is able to adapt quickly to changing expectations in the healthcare environment has aided our institution. As healthcare becomes increasingly saturated with technology, data and quality metrics, collaborative efforts resulting in increased quality and physician efficiency are desirable. Multidisciplinary collaboration (including physician-pharmacist collaboration) appears to be a viable route to improved performance in an outcome based healthcare system (Fig. 2, Ref. 12).

Using disease management and market reforms to address the adverse economic effects of drug budgets and price and reimbursement regulations in Germany.

Science.gov (United States)

Schwermann, Tim; Greiner, Wolfgang; v d Schulenburg, J M Graf

2003-01-01

Germany spends the highest share (10.4%) of its gross domestic product on health care among European Union countries. The majority of this financing comes from an earmarked tax on labor earnings. Drug spending, as a share (12.7%), is relatively low, as is per-capita drug spending. Over the past decade, a number of specific budgeting initiatives were introduced to control drug spending-with some success, at least until the 11% increase in the first 6 months of 2001. This article describes and analyzes these governmental initiatives as well as other market reforms. Germany has had a "drug budget silo mentality" throughout this period. But the focus of the mentality moved rapidly from the central budget to regional budgets and to drug budgets per physician based on historical data. These amounts do not correspond to either medical necessity or economic considerations. An analysis of the health-care system as a whole shows that the efforts to constrain spending with budget in one area can lead to higher total costs. This article also considers the impact of introducing other actual or proposed reforms such as a positive list to replace the negative list, generic substitution, retail price competition among pharmacies, and E-health commerce. There is also a new national institute constructing a database of information on health technology assessments. To overcome the strong segmentation of the health system in physician, drug, and hospital budgets, we recommend using this information from proper cost-effectiveness evaluations to develop clear guidelines for disease management programs, reinforced by appropriate financial incentives.

Civil society, third sector, and healthcare: the case of social cooperatives in Italy.

Science.gov (United States)

Borzaga, Carlo; Fazzi, Luca

2014-12-01

In many European countries, the third sector is considered an actor able to improve both the efficiency and the efficacy of public healthcare systems afflicted by the crisis of the welfare state. Attributed to third-sector organizations is the role of a hybrid actor tasked with the professional supply of services, not for profit but rather for mutualistic purposes, and to serve the public interest. However, empirical evidence on the capacity of the third sector to pursue objectives of social inclusion in a phase of withdrawal by the public sector is almost entirely lacking in the European countries. The article describes the results of research on the transformation of the Italian healthcare system and on the emergence of a new third sector in Italy. The results of the inquiry highlight the strategies, characteristics, and governance processes which enable third-sector organizations operating in the healthcare sector to pursue objectives of inclusion, and to serve the needs of disadvantaged groups by assuming the form of social enterprises. Copyright © 2014 Elsevier Ltd. All rights reserved.

Corporate Mobility in the European Union - a Flash in the Pan?

DEFF Research Database (Denmark)

Ringe, Georg

This paper discusses new data on regulatory competition in European company law and the impact of national law reforms, using the example of English company law forms being used by German start-ups. Since 1999, entrepreneurs in the EU have been allowed to select foreign legal forms to govern...... their affairs. The data show that English limited companies were very popular with German entrepreneurs in the first few years of the last decade but have experienced a sharp decline since early 2006. This decline casts doubt over the claim that the German company law reform from November 2008 ‘successfully...... fought off’ the use of foreign company forms. Moreover, by contrasting the German data with the corresponding developments in Austria, the paper further demonstrates that the latter jurisdiction is also seeing a similar decline, and without having reformed its company law. Instead of exclusively seeing...

Corporate Mobility in the European Union - a Flash in the Pan?

DEFF Research Database (Denmark)

Ringe, Georg

2013-01-01

This paper discusses new data on regulatory competition in European company law and the impact of national law reforms, using the example of English company law forms being used by German start-ups. Since 1999, entrepreneurs in the EU have been allowed to select foreign legal forms to govern...... their affairs. The data show that English limited companies were very popular with German entrepreneurs in the first few years of the last decade but have experienced a sharp decline since early 2006. This decline casts doubt over the claim that the German company law reform from November 2008 ‘successfully...... fought off’ the use of foreign company forms. Moreover, by contrasting the German data with the corresponding developments in Austria, the paper further demonstrates that the latter jurisdiction is also seeing a similar decline, and without having reformed its company law. Instead of exclusively seeing...

The reform of the Spanish public administration and the Wellfare State during the economic crisis (2012-2015

Directory of Open Access Journals (Sweden)

Carlos Vidal Prado

2017-05-01

Full Text Available This work analyzes some structural reforms of public administrations implemented from 2012 in Spain, as a result of the economic crisis, and public policies implemented to achieve them, and if truly met the intended objectives (improve the quality and efficiency of services, transparency in public administrations and creating an Open Government. The work part of a brief diagnosis of the causes and consequences of the economic crisis, to tackle after reforms in public administration and in the model of Welfare State, especially in what refers to public employment, education, healthcare and the attention to the dependence. Finally, a brief assessment of the adopted solutions and its real impact on the current situation of the economy and the Spanish Administration is performed.

Survey of surveillance systems and select prevention activities for hepatitis B and C, European Union/European Economic Area, 2009.

Science.gov (United States)

Duffell, E F; van de Laar, M J

2015-04-02

Hepatitis B and C viral infections are leading causes of hepatic cirrhosis and cancer. The incidence and prevalence of both hepatitis B and C varies across European countries. European wide surveillance data help to understand the dynamic epidemiology of hepatitis B and C, which is important for the implementation and effectiveness of prevention and control activities.Comparison of surveillance data between countries in Europe is hampered by the differences in national healthcare and reporting systems. This report presents the results of a survey in 2009 which was undertaken to collect baseline information on surveillance systems and core prevention programmes for hepatitis B and C in individual European Union/ European Economic Area countries. The results provide key information to aid the interpretation of surveillance data, and while indicating heterogeneity in national surveillance systems and programmes, they highlight the potential of these systems. This resource has supported the implementation of a standardised European enhanced surveillance programme.

Performance management of the public healthcare services in Ireland: a review.

Science.gov (United States)

Mesabbah, Mohammed; Arisha, Amr

2016-01-01

Performance Management (PM) processes have become a potent part of strategic and service quality decisions in healthcare organisations. In 2005, the management of public healthcare in Ireland was amalgamated into a single integrated management body, named the Health Service Executive (HSE). Since then, the HSE has come up with a range of strategies for healthcare developments and reforms, and has developed a PM system as part of its strategic planning. The purpose of this paper is to review the application of PM in the Irish Healthcare system, with a particular focus on Irish Hospitals and Emergency Services. An extensive review of relevant HSE's publications from 2005 to 2013 is conducted. Studies of the relevant literature related to the application of PM and of international best practices in healthcare performance systems are also presented. PM and performance measurement systems used by the HSE include many performance reports designed to monitor performance trends and strategic goals. Issues in the current PM system include inconsistency of measures and performance reporting, unclear strategy alignment, and deficiencies in reporting (e.g. feedback and corrective actions). Furthermore, PM processes have not been linked adequately into Irish public hospitals' management systems. The HSE delivers several services such as mental health, social inclusion, etc. This study focuses on the HSE's PM framework, with a particular interest in acute hospitals and emergency services. This is the first comprehensive review of Irish healthcare PM since the introduction of the HSE. A critical analysis of the HSE reports identifies the shortcomings in its current PM system.

Critical Study Regarding the Evolution of Incomes and Expenses of the Romanian Healthcare System in the Context of Budgetary Decentralization

Directory of Open Access Journals (Sweden)

Violeta ISAI

2016-04-01

Full Text Available The healthcare system in Romania is continuously under a reform process, in order to make more efficient the medical care and to allow a wide access for the population to the healthcare services. The incomes of the healthcare system mainly come from the contribution to the social healthcare insurance, but also from other taxes, the system also benefits from subsidies from the state budget. The public healthcare expenses have a relatively low percentage from the total public expenses, being mainly oriented towards hospitals, subsidized drugs and primary medical assistance. The integration of Romania into the EU brought for the healthcare system opportunities as well as threats: the increase of the competence and quality of the medical act, the favourable context of decentralization but also the increase of the costs for medical services, the mobility of the patients and the pronounced migration of the qualified medical staff to other countries of the EU. The paper wants to analyse the incomes and expenses from the healthcare, taking into account all these aspects.

Emerging Administrations under European Union Rules

Directory of Open Access Journals (Sweden)

Bogdan Berceanu

2012-05-01

Full Text Available The idea of emergence is generally used to indicate the appearance of patterns, structures, orproperties that cannot be adequately explained by referring only to the system’s pre-existing componentsand their interactions. The term “emergence” has an interdisciplinary approach specific to administrativesciences, too. In this article, the concept of “emergence” signifies lato sensu a kind of change and it will beused to refer to countries that have a high volatility and that are in transition and to define the changes thatsuffer the public administrations of the countries which are part of the European construction. EuropeanUnion through its policies and legislation has a great impact on economic and social conditions in MemberStates. The aim of the paper is to present a theoretical approach on the dimension of emergingadministrations understood as changes and reforms that suffer the institutions from the EU member statesunder the pressure of the European Union rules. The study is using the concept of emergence to researchand to analyze the nature of the changes in the public administration starting from the approach of thesystems theory.

Corporate coalitions and policy making in the European Union: how and why British American Tobacco promoted "Better Regulation".

Science.gov (United States)

Smith, Katherine Elizabeth; Fooks, Gary; Gilmore, Anna B; Collin, Jeff; Weishaar, Heide

2015-04-01

Over the past fifteen years, an interconnected set of regulatory reforms, known as Better Regulation, has been adopted across Europe, marking a significant shift in the way that European Union policies are developed. There has been little exploration of the origins of these reforms, which include mandatory ex ante impact assessment. Drawing on documentary and interview data, this article discusses how and why large corporations, notably British American Tobacco (BAT), worked to influence and promote these reforms. Our analysis highlights (1) how policy entrepreneurs with sufficient resources (such as large corporations) can shape the membership and direction of advocacy coalitions; (2) the extent to which "think tanks" may be prepared to lobby on behalf of commercial clients; and (3) why regulated industries (including tobacco) may favor the use of "evidence tools," such as impact assessments, in policy making. We argue that a key aspect of BAT's ability to shape regulatory reform involved the deliberate construction of a vaguely defined idea that could be strategically adapted to appeal to diverse constituencies. We discuss the theoretical implications of this finding for the Advocacy Coalition Framework, as well as the practical implications of the findings for efforts to promote transparency and public health in the European Union. Copyright © 2015 by Duke University Press.

HOW DOES CORRUPTION AFFECTS HEALTHCARE SECTOR IN BULGARIA

Directory of Open Access Journals (Sweden)

Jordan Deliversky

2016-03-01

Full Text Available Corruption in the healthcare sector is a reflection of the structural challenges in the health care system. The problem of corruption in healthcare is of a multidimensional nature. The Bulgarian health care system is based on a regulated regime. On one hand there is the functioning of a state-owned and state-controlled health fund financed through obligatory contributions by all income earners, and on the other, a union of health providers that negotiate a national framework health contract with the fund. Causes of corruption are classified as different factors such as structural factors and government policies factors. The health sector is susceptible to corruption for various reasons, mostly related to its organization. The health sector is a complex sector. In order to be effective, reforms to combat corruption must be informed by theory, guided by evidence and adapted to context. It is necessary to review and develop diagnostic and treatment algorithms as standards of good medical practice, which would help to assess the package of medical and non-medical activities.

Reforming Romanian energy policy

International Nuclear Information System (INIS)

Perkins, S.

1993-01-01

Success in reforming energy sector depends on the implementation of the programme of economic reform agreed in February 1993. The difficulty of the negotiations between the International Monetary Fund and the Romanian government reflects the wider difficulties faced by the economy as a whole. They can be blamed in part on the legacy of uneconomic and inflexible industrial development and in part on opposition from interest groups which stand to lose from reform. Nonetheless, in spite of hesitant approach, the government does appear committed to the economic reform necessary to establish a market-oriented economy. But as the danger of a financial crisis engendered by the inadequately supported short-term borrowing of foreign exchange becomes urgent, the question is whether economic reform can be now implemented fast enough to protect economic enterprises and saving from a debt crisis. The scope for further delay in implementing the 1993 economic reform programme is fast disappearing. Procrastination should not be allowed to threaten the success of the reforms achieved in the energy and other sectors of the economy. 8 refs., 2 figs

Energy policy and European utilities' strategy: Lessons from the liberalisation and privatisation of the energy sector in Romania

Energy Technology Data Exchange (ETDEWEB)

Haar, Laura N., E-mail: laura.n.haar@mbs.ac.u [University of Manchester, Manchester Business School, Booth Street West, Manchester M15 6PB (United Kingdom); Marinescu, Nicolae, E-mail: marinescu@unitbv.r [Transylvania University of Brasov, Faculty of Economic Sciences, 29 Eroilor Bd, Brasov 500 036 (Romania)

2011-05-15

In the context of energy sector reforms pursued by Romanian government since 1990s, we compare and contrast the market outcomes of European utilities' investment with the host government policy objectives. We begin with energy market reform in Romania and review governments' efforts to attract foreign direct investment (FDI) and to gradually withdraw from the distribution and supply segments of electricity market. Subsequently, we illustrate the scope European utilities have had, market policy and design notwithstanding, for consolidating market power through regional dominance. We examine the extent to which these utilities have sought to enhance their positions through horizontal and vertical integration, counter to the EU plans for a competitive market structure. We find that the investments of European incumbents have not been resoundingly successful: although market entrance may have been justified on long-term strategic grounds, in the immediate term, segments acquired through competitive auctions have yielded modest regulated returns. Finally, we discuss the extent to which policy makers have achieved their goals. Although the short-term benefits of a competitive market structure have reached some consumers, a renewed interest in promoting 'national champions' reflect frustration with market mechanisms as a means of ensuring long-term strategic investments in the sector. - Research highlights: {yields} We analyze the European Utilities activities in Romania after market liberalization. {yields} We find government efforts to reform energy sector attracted foreign direct investment. {yields} We find utilities consolidated market power horizontally in Central European region. {yields} The short-term benefits of competitive forces contrast the weak returns by utilities. {yields} To encourage further investment, government should not promote national champions.

Incentive Problems in Banking Supervision: The European Case

OpenAIRE

Schüler, Martin

2003-01-01

This paper discusses the incentive conflicts that arise in banking supervision in the EU in a principal-agent framework, where the regulator is the agent and the taxpayers is the principal. The regulatory agent in addition to maintaining financial stability (the objective of the principal) may pursue private interests. Incomplete information, insufficient accountability of the agent and lack of enforceability of compliance result in an incentive problem. A reform of the European supervisory s...

Education in infection control : A need for European certification

NARCIS (Netherlands)

Zingg, W.; Mutters, N. T.; Harbarth, S.; Friedrich, A. W.

2015-01-01

Healthcare-associated infections are common adverse events in acute-care medicine, causing significant morbidity and mortality. There has been a significant increase in the commitment to infection prevention and control (IPC) among European countries in recent years. However, there is still

Quality Procedures in the European Higher Education Area and Beyond--Visions for the Future: Third ENQA Survey. ENQA Occasional Papers 18

Science.gov (United States)

Grifoll, Josep; Hopbach, Achim; Kekalainen, Helka; Lugano, Nathalie; Rozsnyai, Christina; Shopov, Todor

2012-01-01

Higher education reforms over the last decade, resulting in the establishment of the European Higher Education Area, with new social demands and expectations, have greatly impacted quality assurance in higher education. As a follow-up activity to two previous surveys on external quality procedures, the European Association for Quality Assurance in…

The Importance of Community Consultations for Generating Evidence for Health Reform in Ukraine.

Science.gov (United States)

Hankivsky, Olena; Vorobyova, Anna; Salnykova, Anastasiya; Rouhani, Setareh

2016-08-17

The paper presents the results of community consultations about the health needs and healthcare experiences of the population of Ukraine. The objective of community consultations is to engage a community in which a research project is studying, and to gauge feedback, criticism and suggestions. It is designed to seek advice or information from participants directly affected by the study subject of interest. The purpose of this study was to collect first-hand perceptions about daily life, health concerns and experiences with the healthcare system. This study provides policy-makers with additional evidence to ensure that health reforms would include a focus not only on health system changes but also social determinants of health (SDH). The data collection consisted of the 21 community consultations conducted in 2012 in eleven regions of Ukraine in a mix of urban and rural settings. The qualitative data was coded in MAXQDA 11 software and thematic analysis was used as a method of summarizing and interpreting the results. The key findings of this study point out the importance of the SDH in the lives of Ukrainians and how the residents of Ukraine perceive that health inequities and premature mortality are shaped by the circumstances of their daily lives, such as: political and economic instability, environmental pollution, low wages, poor diet, insufficient physical activity, and unsatisfactory state of public services. Study participants repeatedly discussed these conditions as the reasons for the perceived health crisis in Ukraine. The dilapidated state of the healthcare system was discussed as well; high out-of-pocket (OOP) payments and lack of trust in doctors appeared as significant barriers in accessing healthcare services. Additionally, the consultations highlighted the economic and health gaps between residents of rural and urban areas, naming rural populations among the most vulnerable social groups in Ukraine. The study concludes that any meaningful reforms of

Does the energy sector call for reform?

Energy Technology Data Exchange (ETDEWEB)

Granic, Goran; Pesut, Damir; Jandrilovic, Nada; Jelavic, Branka; Zeljko, Mladen

2007-07-01

This paper discusses the course of the energy sector reforms in Europe so far, its objectives, achievements, issues, and dilemmas. In particular, long term and security aspects of energy supply of Europe are analyzed. In addition to the legislative changes regarding the open energy market regulation, and primarily the changes concerning electricity and natural gas markets, the past period saw dynamic changes of institutional framework, such as: increasing members of the european Union, increased number of countries aspiring to the EU (candidate countries or potential candidates), and changes in other European countries out of which Russia is the most significant energy producer. The paper analyzes the issue of responsibility between state - regulator - system operator - trader - energy buyer. In Europe, it is more a complex question because the system of responsibility includes the institution of the European Union. Therefore, the relations between EU - state - regulator - system operator - trader - energy buyer are especially important. The paper looks in to the issue of energy company integrations, creation of energy mega-undertakings and their influence on further market development. The question of monopolies now appears in a new form. The conclusions suggest possible measures for institutional influence on energy market development, especially in the network energy systems, which may have a positive impact on system security and stability and markets development and their long term sustainability. (auth)

Productivity changes in OECD healthcare systems: bias-corrected Malmquist productivity approach.

Science.gov (United States)

Kim, Younhee; Oh, Dong-Hyun; Kang, Minah

2016-10-01

This study evaluates productivity changes in the healthcare systems of 30 Organization for Economic Co-operation and Development (OECD) countries over the 2002-2012 periods. The bootstrapped Malmquist approach is used to estimate bias-corrected indices of healthcare performance in productivity, efficiency and technology by modifying the original distance functions. Two inputs (health expenditure and school life expectancy) and two outputs (life expectancy at birth and infant mortality rate) are used to calculate productivity growth. There are no perceptible trends in productivity changes over the 2002-2012 periods, but positive productivity improvement has been noticed for most OECD countries. The result also informs considerable variations in annual productivity scores across the countries. Average annual productivity growth is evenly yielded by efficiency and technical changes, but both changes run somewhat differently across the years. The results of this study assert that policy reforms in OECD countries have improved productivity growth in healthcare systems over the past decade. Countries that lag behind in productivity growth should benchmark peer countries' practices to increase performance by prioritizing an achievable trajectory based on socioeconomic conditions. For example, relatively inefficient countries in this study indicate higher income inequality, corresponding to inequality and health outcomes studies. Although income inequality and globalization are not direct measures to estimate healthcare productivity in this study, these issues could be latent factors to explain cross-country healthcare productivity for future research. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Healthcare waste management practice in the West Black Sea Region, Turkey: A comparative analysis with the developed and developing countries.

Science.gov (United States)

Ciplak, Nesli; Kaskun, Songul

2015-12-01

The need for proper healthcare waste management has been a crucial issue in many developing countries as it is in Turkey. The regulation regarding healthcare wastes in Turkey was updated in 2005 in accordance with the European Union (EU) waste directives, but it still falls behind meeting the requirements of current waste treatment technologies. Therefore, this study aims to reveal deficiencies, inconsistencies, and improper applications of healthcare waste management in the western part of the Turkish Black Sea Region. In this study, it was revealed that nearly 1 million people live in the region, resulting in 5 million hospital admissions annually. All the healthcare waste produced (1000 tons yr(-1)) is treated in an autoclave plant. However, treating some categories of healthcare wastes in autoclave units mismatches with the EU waste regulations, as alternative treatment technologies are not technically able to treat all types of healthcare wastes. A proper waste management system, therefore, requires an internal segregation scheme to divert these wastes from the main healthcare waste stream. The existing malpractice in the region could cause serious health problems if no measure is taken urgently. It is expected that healthcare waste management in the region and then all across Turkey will be improved with the significant deficiencies and inconsistencies pointed out in this research. In developed countries, specific rules and regulations have already been implemented along with the recommendations for handling of healthcare waste. However, in Turkey, these wastes are treated in autoclave units, which mismatches with the European Union waste regulations, as alternative treatment technologies are not technically capable to treat all types of healthcare wastes. The existing malpractice could cause serious health problems if no measure is taken urgently. The authors demonstrated the existing status of Turkish waste management and revealed deficiencies

Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC).

Science.gov (United States)

De Hert, M; Dekker, J M; Wood, D; Kahl, K G; Holt, R I G; Möller, H-J

2009-09-01

People with severe mental illnesses, such as schizophrenia, depression or bipolar disorder, have worse physical health and reduced life expectancy compared to the general population. The excess cardiovascular mortality associated with schizophrenia and bipolar disorder is attributed in part to an increased risk of the modifiable coronary heart disease risk factors; obesity, smoking, diabetes, hypertension and dyslipidaemia. Antipsychotic medication and possibly other psychotropic medication like antidepressants can induce weight gain or worsen other metabolic cardiovascular risk factors. Patients may have limited access to general healthcare with less opportunity for cardiovascular risk screening and prevention than would be expected in a non-psychiatric population. The European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC) published this statement with the aim of improving the care of patients suffering from severe mental illness. The intention is to initiate cooperation and shared care between the different healthcare professionals and to increase the awareness of psychiatrists and primary care physicians caring for patients with severe mental illness to screen and treat cardiovascular risk factors and diabetes.

The Future of the European Union: A Critical Trade Union View

Directory of Open Access Journals (Sweden)

John Medhurst

2009-12-01

Full Text Available This paper offers a radical critique of the current framework of economic policy within the European Union and its negative effect on social cohesion. It defends the aspirations of the “Social Europe” model but suggests this model is now withering on the vine, not least because employers and governments no longer support it and have withdrawn from genuine social partnership. The paper asserts that the undemocratic nature of European policy making institutions is a fundamental bloc to progressive reform of the EU, and criticises the economic philosophy inherent in the Lisbon Agenda and recent controversial European Court of Justice decisions that have expanded that agenda. Lastly, it sketches some alternatives to this direction of travel, drawn from successful models within and outside Europe.

Plasma-catalytic reforming of ethanol: influence of air activation rate and reforming temperature

International Nuclear Information System (INIS)

Nedybaliuk, O.A.; Chernyak, V.Ya.; Fedirchuk, I.I.; Demchina, V.P.; Bortyshevsky, V.A.; Korzh, R.V.

2016-01-01

This paper presents the study of the influence that air activation rate and reforming temperature have on the gaseous products composition and conversion efficiency during the plasma-catalytic reforming of ethanol. The analysis of product composition showed that the conversion efficiency of ethanol has a maximum in the studied range of reforming temperatures. Researched system provided high reforming efficiency and high hydrogen energy yield at the lower temperatures than traditional conversion technologies

Developing a framework for evaluating the impact of Healthcare Improvement Science Education across Europe: a qualitative study

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Manuel Lillo-Crespo

2017-11-01

Full Text Available Purpose Frontline healthcare professionals are well positioned to improve the systems in which they work. Educational curricula, however, have not always equipped healthcare professionals with the skills or knowledge to implement and evaluate improvements. It is important to have a robust and standardized framework in order to evaluate the impact of such education in terms of improvement, both within and across European countries. The results of such evaluations will enhance the further development and delivery of healthcare improvement science (HIS education. We aimed to describe the development and piloting of a framework for prospectively evaluating the impact of HIS education and learning. Methods The evaluation framework was designed collaboratively and piloted in 7 European countries following a qualitative methodology. The present study used mixed methods to gather data from students and educators. The framework took the Kirkpatrick model of evaluation as a theoretical reference. Results The framework was found to be feasible and acceptable for use across differing European higher education contexts according to the pilot study and the participants’ consensus. It can be used effectively to evaluate and develop HIS education across European higher education institutions. Conclusion We offer a new evaluation framework to capture the impact of HIS education. The implementation of this tool has the potential to facilitate the continuous development of HIS education.

Business Entity Selection: Why It Matters to Healthcare Practitioners. Part III--Nonprofits, Ethics, Practice Implications, and Conclusions.

Science.gov (United States)

Nithman, Robert W

2015-01-01

The Bureau of Labor statistics indicates only a 50% four-year survivability rate among businesses classified as "education and health services." Gaining knowledge of IRS business entities can result in cost savings, operational efficiency, reduced liability, and enhanced sustainability. Each entity has unique disadvantages, depending on size, diversity of ownership, desire to expand, and profitability. Business structures should be compatible with organizational mission or vision statements, services and products, and professional codes of ethics. Healthcare reform will require greater business acumen. We have an ethical duty to disseminate and acquire the knowledge to properly establish and manage healthcare practices to ensure sustainable services that protect and serve the community.

Business entity selection: why it matters to healthcare practitioners--part I--Conceptual framework, sole proprietorships, and partnerships.

Science.gov (United States)

Nithman, Robert W

2015-01-01

The Bureau of Labor statistics indicates only a 50% four-year survivability rate among businesses classified as "education and health services." Gaining knowledge of IRS business entities can result in cost savings, operational efficiency, reduced liability, and enhanced sustainability. Each entity has unique disadvan- tages, depending on size, diversity of ownership, desire to expand, and profitability. Business structures should be compatible with the organizational mission or vision statement, services and products, and professional codes of ethics. Healthcare reform will require greater business acumen. We have an ethical duty to disseminate and acquire the knowledge to properly establish and manage healthcare practices to ensure sustainable services that protect and serve the community.

Reforming European electricity industries: to each, his own ''single market''

International Nuclear Information System (INIS)

Glachant, J.M.

2000-01-01

National transpositions of the European directive on domestic electricity markets have maintained a degree of diversity; and this also characterizes the other conditions for accessing national electricity markets (physical, commercial, industrial and capital access). As a look at the prices of electricity shows, these national markets do not operate in a single way Europe-wide. Furthermore, electricity companies - key actors in this competition - differ widely from each other in size, electrical potential, investment portfolios and strategies for growth. (authors)

Value-Based Pricing and Reimbursement in Personalised Healthcare: Introduction to the Basic Health Economics.

Science.gov (United States)

Garrison, Louis P; Towse, Adrian

2017-09-04

'Value-based' outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: "What kinds of pricing and reimbursement models should be applied in personalized healthcare?" The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency. We argue that-to meet this social objective of optimal innovation in personalized healthcare-payers, as agents of their plan participants, should aim to send clear signals to their suppliers about what they value. We begin by revisiting the concept of value from an economic perspective, and argue that a broader concept of value is needed in the context of personalized healthcare. We discuss the market for personalized healthcare and the interplay between price and reimbursement. We close by emphasizing the potential barrier posed by inflexible or cost-based reimbursement systems, especially for biomarker-based predictive tests, and how these personalized technologies have global public goods characteristics that require global value-based differential pricing to achieve dynamic efficiency in terms of the optimal rate of innovation and adoption.

Dutch healthcare reform: did it result in performance improvement of health plans? A comparison of consumer experiences over time.

NARCIS (Netherlands)

Hendriks, M.; Spreeuwenberg, P.; Rademakers, J.; Delnoij, D.M.J.

2009-01-01

BACKGROUND: Many countries have introduced elements of managed competition in their healthcare system with the aim to accomplish more efficient and demand-driven health care. Simultaneously, generating and reporting of comparative healthcare information has become an important quality-improvement

The Current Reforms Of The Labour Markets And Of The Related Social Policies At European Union Level – Are They The Best Solutions To Solve The Problems Which Appeared During The Crisis?

Directory of Open Access Journals (Sweden)

Alina Georgeta AILINCĂ

2012-06-01

Full Text Available The global economic and financial crisis seems to have unfortunate residual effects materialised in the increase of the budget deficits and of the public debt within the European Union, situation observed mostly in the old member states. Among the major effects of the crisis we can notice more serious fiscal-budgetary problems, as well as social and labour market problems, with a strong impact on the restoration of the present and future macroeconomic balance. Actually, the measures meant to restore the public finances on their floating line, thus ensuring the fiscal-budgetary sustainability, were the starting line for the economic and social reforms, which many times had rather adverse effects than beneficial effects on the analysed economies. In this paper we will present the measures proposed by the governments of some EU (European Union countries for the labour market, health systems, education and social protection, highlighting the criticisable aspects, such as the lack of concrete results of the employment programs and of the social policies aiming to ameliorate and compensate the effects of population ageing.

Do Economic Reforms Alleviate Subjective Well-Being Losses of Economic Crises?

DEFF Research Database (Denmark)

Bjørnskov, Christian

2014-01-01

Major economic crises tend to be followed by crises in subjective well-being. Following the financial and debt crises, politicians and social scientists have engaged in heated discussions of ways to alleviate such losses. In particular, should governments intervene more or less? This paper explores...... whether liberalizing economic institutions, a type of reform favoured by some economists, is likely to alleviate such loses. Estimating the effects of crises across European states 1975–2011 suggest that countries with relatively easy market regulations suffered smaller well-being losses....

A Global Perspective of Vaccination of Healthcare Personnel against Measles: Systematic Review

Science.gov (United States)

Fiebelkorn, Amy Parker; Seward, Jane F.; Orenstein, Walter

2015-01-01

Measles transmission has been well documented in healthcare facilities. Healthcare personnel who are unvaccinated and who lack other evidence of measles immunity put themselves and their patients at risk for measles. We conducted a systematic literature review of measles vaccination policies and their implementation in healthcare personnel, measles seroprevalence among healthcare personnel, measles transmission and disease burden in healthcare settings, and impact/costs incurred by healthcare facilities for healthcare-associated measles transmission. Five database searches yielded 135 relevant articles; 47 additional articles were found through cross-referencing. The risk of acquiring measles is estimated to be 2 to 19 times higher for susceptible healthcare personnel than for the general population. Fifty-three articles published worldwide during 1989–2013 reported measles transmission from patients to healthcare personnel; many of the healthcare personnel were unvaccinated or had unknown vaccination status. Eighteen articles published worldwide during 1982–2013 described examples of transmission from healthcare personnel to patients or to other healthcare personnel. Half of European countries have no measles vaccine policies for healthcare personnel. There is no global policy recommendation for the vaccination of healthcare personnel against measles. Even in countries such as the United States or Finland that have national policies, the recommendations are not uniformly implemented in healthcare facilities. Measles serosusceptibility in healthcare personnel varied widely across studies (median 6.5%, range 0%-46%) but was consistently higher among younger healthcare personnel. Deficiencies in documentation of two doses of measles vaccination or other evidence of immunity among healthcare personnel presents challenges in responding to measles exposures in healthcare settings. Evaluating and containing exposures and outbreaks in healthcare settings can be

The Effects of the Saakashvili Era Reforms on Informal Practices in the Republic of Georgia

Directory of Open Access Journals (Sweden)

Huseyn Aliyev

2014-06-01

Full Text Available Since the 2003 Rose Revolution, the Georgian government implemented a number of major institutional reforms which have succeeded in modernising Georgia’s state institutions, reducing corruption and ‘formalising’ the public sector. While the effects of Saakashvili’s reforms on state and institution-building, corruption and the rule of law have been examined by a large and growing body of academic literature, there has been little discussion about the impact of institutional changes on the previously widespread culture of informality in Georgia. This article explores the effects of Georgian institution-building from such aspects of informality as the use of informal networks and connections in exchanges of favours, gift-giving and other types of informal activities. The findings of this study, based on the analysis of recent surveys and in-depth interviews, conclude that the reforms succeeded in undermining the overall importance of informal practices in dealings with state bureaucracy, education system, healthcare, law enforcement, judiciary and some other areas previously dominated by informality. However, the reliance on informality did not disappear, and informal networks are still employed as coping mechanisms and as social safety nets.

Community participation in health service reform: the development of an innovative remote Aboriginal primary health-care service.

Science.gov (United States)

Reeve, Carole; Humphreys, John; Wakerman, John; Carroll, Vicki; Carter, Maureen; O'Brien, Tim; Erlank, Carol; Mansour, Rafik; Smith, Bec

2015-01-01

The aim of this study was to describe the reorientation of a remote primary health-care service, in the Kimberley region of Australia, its impact on access to services and the factors instrumental in bringing about change. A unique community-initiated health service partnership was developed between a community-controlled Aboriginal health organisation, a government hospital and a population health unit, in order to overcome the challenges of delivering primary health care to a dispersed, highly disadvantaged Aboriginal population in a very remote area. The shared goals and clear delineation of responsibilities achieved through the partnership reoriented an essentially acute hospital-based service to a prevention-focussed comprehensive primary health-care service, with a focus on systematic screening for chronic disease, interdisciplinary follow up, health promotion, community advocacy and primary prevention. This formal partnership enabled the primary health-care service to meet the major challenges of providing a sustainable, prevention-focussed service in a very remote and socially disadvantaged area.

Assessing maternal healthcare inequities among migrants: a qualitative study

Directory of Open Access Journals (Sweden)

Ligia Moreira Almeida

2014-02-01

Full Text Available Considering pregnancy and motherhood as periods of increased vulnerability in migrant women, to characterize the healthcare provided to this collective, we sought to identify and understand patterns of satisfaction and demand of maternal and child healthcare, assessing women’s perceptions about its quality. The study followed a qualitative methodology (semi-structured interviews for collecting and analysing data (content analysis and was conducted in Porto, the second largest city of Portugal. Participants were 25 recent immigrant mothers from Eastern European countries, Brazil, Portuguese-speaking African countries and six native Portuguese recent mothers (for comparison, contacted through social associations and institutions. Data suggests that healthcare depends not only on accessibility but especially on social opportunities. Equitable public health action must provide individuals and groups the equal opportunity to meet their needs, which may not be achieved by providing the same standard if care to all.

Human rights and correctional health policy: a view from Europe.

Science.gov (United States)

Rogan, Mary

2017-03-13

Purpose Correctional healthcare should promote the protection of human rights. The purpose of this paper is to bring a discussion of human rights into debates on how such policy should be best organized. Design/methodology/approach The paper achieves its aim by providing an analysis of European prison law and policy in the area of prison health, through assessing decisions of the European Court of Human Rights, as well as policies created by the European Committee for the Prevention of Torture. Findings The paper describes the position of the European Court of Human Rights on the topics of access to healthcare, ill health and release from prison, mental illness in prison, and the duty to provide rehabilitative programming for those seeking to reduce their level of "risk." It also argues that human rights law can be a source of practical reform, and that legal frameworks have much to offer healthcare leaders seeking to uphold the dignity of those in their care. Originality/value This paper will provide a rare example of the engagement of human rights law with correctional health policy. It provides practical recommendations arising out of an analysis of European human rights law in the area of prisons.

Relevant factors to consider prior to an investor-owned acquisition of a nonprofit healthcare entity.

Science.gov (United States)

Ault, Kelvin; Childs, Brad; Wainright, Charles F; Young, Marilyn

2011-01-01

The purpose of this article is to explore the factors that affect the negotiations for an acquisition of a nonprofit system by an investor-owned entity. The recent economic downturn, accompanying credit crisis, and healthcare reform legislation will likely encourage and accelerate the pace of merger and acquisition (M&A) transactions between investor-owned entities and nonprofit hospitals. As many nonprofits are smaller, more financially vulnerable, and more limited in their access to capital than their investor-owned counterparts, nonprofits could be prime targets for investor-owned acquirers during the healthcare reform implementation period. In M&A transactions of this type, the investor-owned acquirer typically is motivated to pursue an acquisition when the deal promises an acceptable return on investment and decreased operating costs from economies of scale. Alternatively, the nonprofit target is typically seeking funding for upgrades to facilities and information technology systems as well as a continued commitment to charity care and managed-care contracting leverage. A successful acquisition of a nonprofit hospital by an investor-owned company requires a careful analysis of relevant tax, economic, and strategic factors prior to closing the deal. This article lists the most significant factors to consider in these deals and explains how these factors should influence the purchase price and postacquisition cash flow.

Reforms to the European Union Financial Supervisory and Regulatory Architecture and Their Implications for Asia

NARCIS (Netherlands)

Z. Darvas (Zsolt); D. Schoenmaker (Dirk); N. Véron (Nicolas)

2017-01-01

textabstractEuropean Union (EU) countries offer a unique experience of financial regulatory and supervisory integration, complementing various other European integration efforts following the Second World War. Financial regulatory and supervisory integration was a very slow process before 2008,

Regulating interface science healthcare products: myths and uncertainties.

Science.gov (United States)

Bravery, Christopher A

2010-12-06

Whenever new technology emerges it brings with it concerns and uncertainties about whether or how it will need to be regulated, particularly when it is applied to human healthcare. Drawing on the recent history in the European Union (EU) of the regulation of cell-based medicinal products, and in particular tissue-engineered products, this paper explores the myths that persist around their regulation and speculates on whether the existing regulatory landscape in the EU is flexible enough to incorporate nanotechnology and other new technologies into healthcare products. By untangling these myths a number of clear conclusions are revealed that, when considered in the context of risk-benefit, make it clear that what hinders the uptake of new technology is not regulatory process but basic science.

Reforming science: methodological and cultural reforms.

Science.gov (United States)

Casadevall, Arturo; Fang, Ferric C

2012-03-01

Contemporary science has brought about technological advances and an unprecedented understanding of the natural world. However, there are signs of dysfunction in the scientific community as well as threats from diverse antiscience and political forces. Incentives in the current system place scientists under tremendous stress, discourage cooperation, encourage poor scientific practices, and deter new talent from entering the field. It is time for a discussion of how the scientific enterprise can be reformed to become more effective and robust. Serious reform will require more consistent methodological rigor and a transformation of the current hypercompetitive scientific culture.

THE FOREIGN AND SECURITY POLICIES OF THE EUROPEAN UNION

Directory of Open Access Journals (Sweden)

Anand Menon

2003-09-01

Full Text Available In only a decade the European Union has moved from being a new kid on the block in terms of foreign and security policies to being a high profile and surprisingly effective international actor. Certainly, it has failed to match the ambitions of some of its most enthusiastic proponents. Certainly, too, European publics know next to nothing about what the Union does in the international realm. It is because of this that, despite their potential and their effectiveness to date, EU policies in this sphere were widely derided as failures following the moment when the attacks of 11 September 2001 shook the western world to its core. The Convention on the Future of Europe and subsequent intergovernmental conference look set to make significant institutional changes to the Union’s foreign and security policy systems. In undertaking these reforms, Convention members, and national governments are doubtless motivated by the laudable objective of enabling the Union to do more on the international stage. One can only hope that these motives notwithstanding, they do not simply propose reforms for their own sake and, in the process, undermine a system that, to the surprise of many, has continued to function respectably in an ever more complex and ever more dangerous world.

Economic and Social Models in Europe and the Importance of Reform

Directory of Open Access Journals (Sweden)

Martin Heipertz

2008-09-01

Full Text Available This paper contributes to the ongoing debate on European economic and social models. It provides a comparative assessment of fiscal and regulatory policies in 17 industrialised countries (the EU15, US and Japan and presents the records of these countries in attaining key economic and social objectives. Social and economic systems that feature efficient public sectors and flexible market structures tend to experience reasonably sustainable public finances, high economic growth, education standards and employment, and well-functioning markets. Anglo-Saxon countries broadly fit this mould, albeit, seemingly, at some cost of income equality. A more pronounced emphasis on welfare state policies and the corresponding relatively high levels of public spending bring benefit to income distribution in the Nordic countries while the resulting inefficiencies in their economies are counterbalanced by flexibility in labour and particularly product markets. Also, a number of reform-minded European countries have improved their fiscal and regulatory policies while significantly enhancing the functioning of markets, fiscal sustainability and economic performance. This was generally attained without jeopardising social objectives. On the other hand, those continental and Mediterranean countries that maintain market inefficiencies and at the same time sustain expensive and inefficient welfare states generally suffer from low growth and employment and less well-functioning markets and face serious risks to their economies’ fiscal sustainability. The findings of this note support calls for the comprehensive reform of fiscal policies, as well as of product and labour markets.

A critique of the regulation of data science in healthcare research in the European Union.

Science.gov (United States)

Rumbold, John M M; Pierscionek, Barbara K

2017-04-08

The EU offers a suitable milieu for the comparison and harmonisation of healthcare across different languages, cultures, and jurisdictions (albeit with a supranational legal framework), which could provide improvements in healthcare standards across the bloc. There are specific ethico-legal issues with the use of data in healthcare research that mandate a different approach from other forms of research. The use of healthcare data over a long period of time is similar to the use of tissue in biobanks. There is a low risk to subjects but it is impossible to gain specific informed consent given the future possibilities for research. Large amounts of data on a subject present a finite risk of re-identification. Consequently, there is a balancing act between this risk and retaining sufficient utility of the data. Anonymising methods need to take into account the circumstances of data sharing to enable an appropriate balance in all cases. There are ethical and policy advantages to exceeding the legal requirements and thereby securing the social licence for research. This process would require the examination and comparison of data protection laws across the trading bloc to produce an ethico-legal framework compatible with the requirements of all member states. Seven EU jurisdictions are given consideration in this critique.

Unemployment, public-sector healthcare expenditure and colorectal cancer mortality in the European Union: 1990-2009.

Science.gov (United States)

Maruthappu, Mahiben; Watson, Robert A; Watkins, Johnathan; Williams, Callum; Zeltner, Thomas; Faiz, Omar; Ali, Raghib; Atun, Rifat

2016-01-01

We examined the association between unemployment and government spending on healthcare with colorectal cancer mortality. Retrospective observational study using data from the World Bank and WHO. Multivariate regression analysis was used, controlling for country-specific differences in infrastructure and demographics. A 1 % increase in unemployment was associated with a significant increase in colorectal cancer mortality in both men and women [men: coefficient (R) = 0.0995, 95 % confidence interval (CI) 0.0132-0.1858, P = 0.024; women: R = 0.0742, 95 % CI 0.0160-0.1324, P = 0.013]. A 1 % increase in government spending on healthcare was associated with a statistically significant decrease in colorectal cancer mortality across both sexes (men: R = -0.4307, 95 % CI -0.6057 to -0.2557, P < 0.001; women: R = -0.2162, 95 % CI -0.3407 to -0.0917, P = 0.001). The largest changes in mortality occurred 3-4 years following changes in either economic variable. Unemployment rises are associated with a significant increase in colorectal cancer mortality, whilst government healthcare spending rises are associated with falling mortality. This is likely due, in part, to reduced access to healthcare services and has major implications for clinicians and policy makers alike.

European Union's public fishing access agreements in developing countries.

Science.gov (United States)

Le Manach, Frédéric; Chaboud, Christian; Copeland, Duncan; Cury, Philippe; Gascuel, Didier; Kleisner, Kristin M; Standing, André; Sumaila, U Rashid; Zeller, Dirk; Pauly, Daniel

2013-01-01

The imperative to increase seafood supply while dealing with its overfished local stocks has pushed the European Union (EU) and its Member States to fish in the Exclusive Economic Zones of other countries through various types of fishing agreements for decades. Although European public fishing agreements are commented on regularly and considered to be transparent, this is the first global and historical study on the fee regime that governs them. We find that the EU has subsidized these agreements at an average of 75% of their cost (financial contribution agreed upon in the agreements), while private European business interests paid the equivalent of 1.5% of the value of the fish that was eventually landed. This raises questions of fisheries benefit-sharing and resource-use equity that the EU has the potential to address during the nearly completed reform of its Common Fisheries Policy.