WorldWideScience

Sample records for european healthcare reforms

  1. 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.

  2. 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.  

  3. Global implications of China's healthcare reform.

    Science.gov (United States)

    Yan, Fei; Tang, Shenglan; Zhang, Jian

    2016-01-01

    The ongoing healthcare reform in China has a powerful spillover effect beyond the health sector and the borders of China. A successful completion of the Chinese reform will offer a new model for social justice development, shift the global economy toward sustainability and create a new hub for science and technology in medical and health science. However, reforming the healthcare system in the most populated country is a daunting task. China will not live up to its promise, and all the potentials may end with hype not hope if coherent national strategies are not constructed and state-of-the-art navigation is not achieved with staggering domestic and global challenges. The cost of failure will be immensely high, socioeconomic costs for Chinese and an opportunity cost for the world as a whole. A full appreciation of the global implications of China's healthcare reform is crucial in keeping China receptive toward good practices evidence-approved elsewhere and open minded to fulfill its international obligations. More critically, the appreciation yields constructive engagements from global community toward a joint development and global prosperity. The current report provides a multiple disciplinary assessment on the global implications of the healthcare reform in China. Copyright © 2014 John Wiley & Sons, Ltd.

  4. 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.

  5. Board Governance: Transformational Approaches Under Healthcare Reform.

    Science.gov (United States)

    Zastocki, Deborah K

    2015-01-01

    Previous successes of healthcare organizations and effective governance practices in the pre-reform environment are not predictive of future success. Healthcare has been through numerous phases of growth and development using tried-and-true strategies. The challenge is that our toolbox does not contain what is needed to build the future healthcare delivery systems required in the post-reform world. Healthcare has had a parochial focus at the local level, with some broadening of horizons at the state and national levels. But healthcare delivery is now a global issue that requires a totally different perspective, and many countries are confronting similar issues. US healthcare reform initiatives have far-reaching implications. Compounding the reform dynamics are the simultaneously occurring, gamechanging accelerants such as enabling information technologies and mobile health, new providers of healthcare, increased consumer demands, and limited healthcare dollars, to name a few. Operating in this turbulent environment requires transformational board, executive, and physician leadership because traditional ways of planning for incremental change and attempting to time those adjustments can prove disastrous. Creating the legacy healthcare system for tomorrow requires governing boards and executive leadership to act today as they would in the desired future system. Boards need to create a culture that fosters.innovation with a tolerance for risk and some failure. To provide effective governance, boards must essentially develop new skills, expertise, and ways of thinking. The rapid rate of change requires board members to possess certain capabilities, including the ability to deal with ambiguity and uncertainty while demonstrating flexibility and adaptability, all with a driving commitment to metrics and results. This requires development plans for both individual members and the overall board. In short, the board needs to function differently, particularly regarding the

  6. 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

  7. Healthcare beyond reform: doing it right for half the cost

    National Research Council Canada - National Science Library

    Flower, Joe

    2012-01-01

    .... In Healthcare Beyond Reform: Doing It Right for Half the Cost, Joe Flower, a well respected healthcare futurist and industry thought leader, lays out his compelling practical vision of how healthcare can work better, and how we can get...

  8. Healthcare beyond reform: doing it right for half the cost

    National Research Council Canada - National Science Library

    Flower, Joe

    2012-01-01

    .... In Healthcare Beyond Reform: Doing It Right for Half the Cost, Joe Flower, a well respected healthcare futurist and industry thought leader, lays out his compelling practical vision of how healthcare can work better, and how we...

  9. 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.

  10. 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...

  11. Efficiency vs Effectiveness: a Benchmarking Study on European Healthcare Systems

    Directory of Open Access Journals (Sweden)

    Corrado lo Storto

    2017-10-01

    Full Text Available ABSTRACT. This paper illustrates a benchmarking study concerning the healthcare systems in 32 European countries as of 2011 and 2014. Particularly, this study proposes a two-dimensional approach (efficiency/effectiveness models to evaluate the performance of national healthcare systems. Data Envelopment Analysis has been adopted to compute two performance indices, measuring efficiency and effectiveness of these healthcare systems. The results of the study emphasize that the national healthcare systems achieve different efficiency and effectiveness levels. Their performance indices are uncorrelated and behave differently over time, suggesting that there might be no real trade-off between them. The healthcare systems’ efficiencies remain generally stable, while the effectiveness values significantly improved from 2011 to 2014. However, comparing the efficiency and effectiveness scores, the authors identified a group of countries with the lowest performing healthcare systems that includes Ukraine, Bulgaria, Switzerland, Lithuania, and Romania. These countries need to implement healthcare reforms aimed at reducing resource intensity and increasing the quality of medical services. The results also showed the benefits of the proposed approach, which can help policy makers to identify shortcomings in national healthcare systems and justify the need for their reform.

  12. Healthcare reform: the role of coordinated critical care.

    Science.gov (United States)

    Cerra, F B

    1993-03-01

    To evaluate and editorialize the evolving role of the discipline of critical care as a healthcare delivery system in the process of healthcare reform. The sources included material from the Federal Office of Management and Budget, Health Care Financing Review, President Bush's Office, Association of American Medical Colleges, and publications of the Society of Critical Care Medicine. Data were selected that the author felt was relevant to the healthcare reform process and its implications for the discipline of critical care. The data were extracted by the author to illustrate the forces behind healthcare reform, the implications for the practice of critical care, and role of critical care as a coordinated (managed) care system in the process of healthcare reform. Healthcare reform has been initiated because of a number of considerations that arise in evaluating the current healthcare delivery system: access, financing, cost, dissatisfactions with the mechanisms of delivery, and political issues. The reform process will occur with or without the involvement of critical care practitioners. Reforms may greatly alter the delivery of critical care services, education, training, and research in critical care. Critical care has evolved into a healthcare delivery system that provides services to patients who need and request them and provides these services in a coordinated (managed) care model. Critical care practitioners must become involved in the healthcare reform process, and critical care services that are effective must be preserved, as must the education, training, and research programs. Critical care as a healthcare delivery system utilizing a coordinated (managed) care model has the potential to provide services to all patients who need them and to deliver them in a manner that is cost effective and recognized as providing added value.

  13. 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...

  14. Environmental sustainability in European public healthcare.

    Science.gov (United States)

    Chiarini, Andrea; Vagnoni, Emidia

    2016-01-01

    Purpose - The purpose of this paper is to enlarge the debate concerning the influence of leadership on environmental sustainability implementation in European public healthcare organisations. Design/methodology/approach - This paper is a viewpoint. It is based on preliminary analysis of European standards dedicated to environmental sustainability and their spread across Europe in public healthcare organisations. Viewpoints concerning leadership are then discussed and asserted. Findings - This paper found a limited implementation of standards such as Green Public Procurement criteria, Eco-Management and Audit Scheme and ISO 14001 in public healthcare. Some clues indicate that the lack of implementation is related to leadership and management commitment. Originality/value - For the first time, this paper investigates relationships between leadership and environmental sustainability in European public healthcare opening further avenues of research on the subject.

  15. The Rise of a European Healthcare Union

    DEFF Research Database (Denmark)

    Vollaard, Hans; Martinsen, Dorte Sindbjerg

    2017-01-01

    Healthcare has only slowly appeared on the European Union’s (EU) policy agenda. EU involvement in policies concerning the organization, financing and the provision of diagnosis, care and cures to ill people developed along three fragmented tracks: (a) EU public health policies concerning the well......-being of all people; (b) the application of the free movement principle to national healthcare systems in particular by the EU’s Court of Justice (CJEU); and (c) the austerity packages and the stricter EU surveillance of national budgets since the debt crises. The key questions of this special issue...... are whether this fragmented EU involvement has now developed into a distinct European healthcare union, and if so what its driving forces have been. Thus, it explores how European integration in healthcare has moved forward despite widespread reluctance. It also examines the underexplored political dynamics...

  16. Two decades of reforms. Appraisal of the financial reforms in the Russian public healthcare sector.

    Science.gov (United States)

    Gordeev, Vladimir S; Pavlova, Milena; Groot, Wim

    2011-10-01

    This paper reviews the empirical evidence on the outcomes of the financial reforms in the Russian public healthcare sector. A systematic literature review identified 37 relevant publications that presented empirical evidence on changes in quality, equity, efficiency and sustainability in public healthcare provision due to the Russian public healthcare financial reforms. Evidence suggests that there are substantial inter-regional inequalities across income groups both in terms of financing and access to public healthcare services. There are large efficiency differences between regions, along with inter-regional variations in payment and reimbursement mechanisms. Informal and quasi-formal payments deteriorate access to public healthcare services and undermine the overall financing sustainability. The public healthcare sector is still underfinanced, although the implementation of health insurance gave some premises for future increases of efficiency. Overall, the available empirical data are not sufficient for an evidence-based evaluation of the reforms. More studies on the quality, equity, efficiency and sustainability impact of the reforms are needed. Future reforms should focus on the implementation of cost-efficiency and cost-control mechanisms; provide incentives for better allocation and distribution of resources; tackle problems in equity in access and financing; implement a system of quality controls; and stimulate healthy competition between insurance companies. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  17. Pension reform in the European periphery: the role of EU reform advocacy

    NARCIS (Netherlands)

    Stepan, M.; Anderson, K.A.

    2014-01-01

    SUMMARY: This paper analyzes the impact of international reform advocacy on national pension reforms. We analyze European Union (EU) reform advocacy in two EU member states: Greece and Hungary. Although the EU has articulated a fairly coherent template for sustainable pensions, its use of soft

  18. Healthcare reforms in Cyprus 2013-2017: Does the crisis mark the end of the healthcare sector as we know it?

    Science.gov (United States)

    Petrou, Panagiotis; Vandoros, Sotiris

    2018-02-01

    As part of a bailout agreement with the International Monetary Fund, the European Commission and the European Central Bank (known as the Troika), Cyprus had to achieve a fiscal surplus through budget constraints and efficiency enhancement. As a result, a number of policy changes were implemented, including a reform of the healthcare sector, and major healthcare reforms are planned for the upcoming years, mainly via the introduction of a National Health System. This paper presents the healthcare sector, provides an overview of recent reforms, assesses the recently implemented policies and proposes further interventions. Recent reforms targeting the demand and supply side included the introduction of clinical guidelines, user charges, introduction of coding for Diagnosis Related Groups (DRGs) and the revision of public healthcare coverage criteria. The latter led to a reduction in the number of people with public healthcare coverage in a time of financial crises, when this is needed the most, while co-payments must be reassessed to avoid creating barriers to access. However, DRGs and clinical guidelines can help improve performance and efficiency. The changes so far are yet to mark the end of the healthcare sector as we know it. A universal public healthcare system must remain a priority and must be introduced swiftly to address important existing coverage gaps. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

    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.

  20. 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.

  1. 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.

  2. Health sector reforms for 21 st century healthcare

    Directory of Open Access Journals (Sweden)

    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.

  3. 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.

  4. [Does the healthcare for rare diseases benefit from the legislative reforms?

    Science.gov (United States)

    Heyder, Ralf

    2017-05-01

    The founding of the National Action League for People with Rare Diseases (NAMSE) in 2010 represents the creation of a significant political platform. In addition, recent years had seen Germany and the EU adopt specific legislative measures aimed at improving healthcare for people with rare diseases. In this article we will give an overview of the legislative reforms adopted between 2013 and 2016 and evaluate how the specific healthcare situation of people with rare diseases has been improved. This article analyzes the health care legislative reforms adopted during the 18th term (since 2013) of the German lower house, the Bundestag, as well as their self-governing implementation. The analysis also extends to similar political initiatives of the European Commission. The impact of the recent hospital reforms on the health care received by patients or on the work of health care providers in the field of rare diseases cannot be assessed conclusively at this point (January 2017). One positive feature is that the health care coverage mandate of the university hospital outpatient departments now also comprises rare diseases. Recent legislative measures have created possibilities to improve the economic position of centers for rare diseases and university hospital outpatient departments. What these improvements will look like specifically depends on the implementation within the hospital plans of the federal states as well as on the outcome of the remuneration negotiations between university hospitals and health insurance funds.

  5. 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

  6. 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...

  7. 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

  8. New institutional analysis of European electric power reforms

    International Nuclear Information System (INIS)

    Perez, Yannick

    2002-01-01

    This research thesis reports a comparative analysis of reforms of the electric power sector implemented in European countries. In the first part, the authors proposes a presentation of the theoretical framework adopted for this analysis which is notably based on the New Institutional Economy approach. He also proposes an approach to the electric power industry based on the Transaction Cost Theory, and presents an overview of the various European reforms in the field of electricity, and of still unresolved problems which emerged after the creation of different power markets. The next part addresses an assessment of the attractive and desirable characters of reforms which have been implemented in the United Kingdom, in Germany and in Spain, with an attempt to identify winners and losers, and to classify these reforms. In the third part, the author defines a framework for the analysis of the feasibility of reforms which combine institutional and industrial dimensions, notably by reference to Noll and Williamson works. In the last part, the author sheds a new light on the concept of credibility. He introduces the conventional arbitrage of the Transaction Cost Theory between commitment stability and flexibility to generate uncertainty. He notably shows that the main problem in centralised institutional environments, is to guarantee the stability of commitments in front of opportunism, whereas in decentralised institutional environments, the main problem is to produce flexibility to manage uncertainty [fr

  9. China’s Healthcare Reform And Resources Redistribution: Lessons For Emerging Nations

    OpenAIRE

    Jia CUI; Shaomin HUANG; Gerald RAMEY

    2009-01-01

    Following China’s recent economic growth and healthcare reform, medical services quickly merged into the market economy. The burden of healthcare expense on the Chinese people has become a serious political issue. This research project reviews the changes in health expenditures made during the last two decades. This paper explores the cause of this rapid change in the healthcare sector and analyzes the corresponding statistics during the entire economic reform period. In addition, the paper a...

  10. Beyond patient care: the impact of healthcare reform on job satisfaction in the Ethiopian public healthcare sector.

    Science.gov (United States)

    Manyazewal, Tsegahun; Matlakala, Mokgadi C

    2017-02-03

    While healthcare reform has been a central attention for local governments, its impact on job satisfaction is poorly understood. This study aimed to determine the impact of healthcare reform on job satisfaction in the public healthcare sector in Ethiopia. The study was designed as a facility-based cross-sectional survey of healthcare professionals and carried out in all public hospitals in central Ethiopia which have been implementing healthcare reform (n = 5). All healthcare professionals in the hospitals who were involved in the reform from the inception (n = 476) were purposively sourced to complete a self-administered questionnaire adapted from a framework proposed for measuring job satisfaction of health professionals in sub-Saharan Africa. Kaiser-Meyer-Olkin and Bartlett's tests were conducted to measure sampling adequacy and sphericity for factor analysis. Likert's transformation formula was used to numerically analyse the satisfaction level of the respondents and to determine the cut-off value of satisfaction levels. Non-parametric and multiple logistic regression analysis were conducted to determine predictors of job satisfaction. A total of 410 healthcare professionals completed the survey, representing an 88% response rate. The median and mean job satisfaction scores were 50 and 49, respectively, on a scale 1-100, which was equivalent to 'Job dissatisfied' on the Likert scale. Only 25% of respondents perceived job satisfaction due to implementation of the reform. Moral satisfaction (adjusted odds ratio (aOR), 177.65; 95% confidence interval (CI), 59.54-530.08), management style (aOR, 4.02; 95% CI, 1.49-10.83), workload (aOR, 2.42; 95% CI, 0.93-6.34), and task (aOR, 5.49; 95% CI, 2.31-13.07) were the most significant predictors. Job satisfaction results were significantly different among the study hospitals (χ 2  = 30.56, p < .001). The healthcare reform significantly and negatively influences public healthcare professionals' job

  11. 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)

  12. 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.

  13. 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.

  14. Planes, straws and oysters: the use of metaphors in healthcare reform.

    Science.gov (United States)

    Millar, Ross; Dickinson, Helen

    2016-01-01

    The purpose of the paper is to examine the metaphors used by senior managers and clinicians in the delivery of healthcare reform. A study of healthcare reform in England carried out a series of semi structured interviews with senior managers and clinicians leading primary and secondary care organisations. Qualitative data analysis examines instances where metaphorical language is used to communicate how particular policy reforms are experienced and the implications these reforms have for organisational contexts. The findings show how metaphorical language is used to explain the interactions between policy reform and organisational contexts. Metaphors are used to illustrate both the challenges and opportunities associated with the reform proposals for organisational change. The authors provide the first systematic study of patterns and meanings of metaphors within English healthcare contexts and beyond. The authors argue that these metaphors provide important examples of "generative" dialogue in their illustration of the opportunities associated with reform. Conversely, these metaphors also provide examples of "degenerative" dialogue in their illustration of a demarcation between the reform policy proposals and existing organisational contexts.

  15. Job satisfaction of village doctors during the new healthcare reforms in China.

    Science.gov (United States)

    Zhang, Xiaoyan; Fang, Pengqian

    2016-04-01

    Objective China launched new healthcare reforms in 2009 and several policies targeted village clinics, which affected village doctors' income, training and duties. The aim of the present study was to assess village doctors' job satisfaction during the reforms and to explore factors affecting job satisfaction. Methods Using a stratified multistage cluster sampling process, 935 village doctors in Jiangxi Province were surveyed with a self-administered questionnaire that collected demographic information and contained a job satisfaction scale and questions regarding their work situation and individual perceptions of the new healthcare reforms. Descriptive analysis, Pearson's Chi-squared test and binary logistic regression were used to identify village doctors' job satisfaction and the factors associated with their job satisfaction. Results Only 12.72% of village doctors were either satisfied or very satisfied with their jobs and the top three items leading to dissatisfaction were pay and the amount of work that had to be done, opportunities for job promotion and work conditions. Marriage, income, intention to leave, satisfaction with learning and training, social status, relationship with patients and satisfaction with the new healthcare reforms were significantly associated with job satisfaction (Pjob satisfaction. For future healthcare reforms, policy makers should pay more attention to appropriate remuneration and approaches that incentivise village doctors to achieve the goals of the health reforms. What is known about the topic? Village doctors act as gatekeepers at the bottom tier of the rural health system. However, the policies of the new healthcare reform initiatives in China were centred on improving the quality of care delivered to the rural population and reducing fast-growing medical costs. There have been limited studies on village doctors' reactions to these reforms. What does this paper add? The findings of the present study indicate that in the

  16. 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.

  17. 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

  18. THE CONCEPT OF REFORMING THE HEALTHCARE INDUSTRY USING A PROJECT-BASED APPROACH

    Directory of Open Access Journals (Sweden)

    Владлен Володимирович ЛЕПСЬКИЙ

    2016-03-01

    Full Text Available The strategic goal of the state policy in the field of health Ukraine is to improve human health through providing the population with affordable and quality health care, and the development of a healthy lifestyle and expansion of preventive measures. The main problem with the current health system is called the low level of public health services. So, it is necessary to use modern innovation management technology to reform the healthcare industry. The author is invited to consider the applicability of strategic management to the management of the healthcare industry reforms through the application of innovative medical technologies and management, focusing on the development of innovations in the industry, as improving the existing health care system, and developing projects to reform and the creation of new approaches based on project management tools. The necessity of the organization of the healthcare industry focused on the development of innovations in the field of health and improvement of existing processes has been proved. A new look at the planning and implementation of Ukraine healthcare industry reforms through the integration strategic and project management has been proposed. It is shown how can be related vision, mission, goals and relevant reform programs. Further studies will be subject to the classification of projects that constitute the program, development structure programs and portfolios of projects, implementation of which will achieve the strategic goals of reforming the industry

  19. 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

  20. Healthcare reform's moral, spiritual issues. The problems are not just political.

    Science.gov (United States)

    Bouchard, C E

    1996-01-01

    Although President Clinton's proposals were defeated in 1994, healthcare reform is an issue that will not go away. But it is an especially complex issue because it is moral and spiritual as well as political. Catholic social teaching could help free us Americans from our confusion on the topic. For example, the Catholic ideas of justice, subsidiarity, and the common good could help us address the crux of the healthcare reform debate, which questions the fairness of forcing more fortunate people to provide healthcare for those who are sick and poor. Catholic social teaching tells us that our healthcare decisions must be made not only on the basis of what is good for me but what is good for us as a community. By the same token, we might find that several specifically spiritual ideas are helpful. Christianity says, for example, that sickness can be a gift because it is a window on immortality for us; that we should not prize life above all other values; and that friendship--including the civic friendship involved in healthcare--is a way we can enter full friendship with God. These moral and spiritual ideas lead us to certain political conclusions: Healthcare reform should be politically realistic, relatively simple. and inclusive. Because healthcare is a good like no other, it can be a powerful occasion for realizing God's own compassion, healing, and justice.

  1. 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…

  2. 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...

  3. 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 ...

  4. 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...

  5. Shifting subjects of health-care: placing "medical tourism" in the context of Malaysian domestic health-care reform.

    Science.gov (United States)

    Ormond, Meghann

    2011-01-01

    "Medical tourism" has frequently been held to unsettle naturalised relationships between the state and its citizenry. Yet in casting "medical tourism" as either an outside "innovation" or "invasion," scholars have often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic health-care systems of the "developing" countries recognised as international medical travel destinations. While there is little doubt that "medical tourism" impacts destinations' health-care systems, it remains essential to contextualise them. This paper offers a reading of the emergence of "medical tourism" from within the context of ongoing health-care privatisation reform in one of today's most prominent destinations: Malaysia. It argues that "medical tourism" to Malaysia has been mobilised politically both to advance domestic health-care reform and to cast off the country's "underdeveloped" image not only among foreign patient-consumers but also among its own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective health-care consumers.

  6. 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...

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. 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.

  13. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. 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)

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

    Directory of Open Access Journals (Sweden)

    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.

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. [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.

  4. 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

  5. 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

  6. 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.

  7. QUALIFICATIONS FRAMEWORKS LEADING TO REFORMS IN EAST EUROPEAN EDUCATION

    Directory of Open Access Journals (Sweden)

    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.

  8. 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

  9. 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…

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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

  12. 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)

  13. 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

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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 ...

  19. 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...

  20. 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

  1. 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.

  2. 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.

  3. 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

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. 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

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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.

  19. [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

  20. 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

  1. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  3. 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.

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

    Science.gov (United States)

    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.

  5. 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.

  6. 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....

  7. 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.

  8. 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.

  9. 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.

  10. 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...

  11. 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.

  12. Aligning emergency care with the triple aim: Opportunities and future directions after healthcare reform.

    Science.gov (United States)

    Agrawal, Shantanu; Conway, Patrick H

    2014-09-01

    The Triple Aim of better health, better care, and lower costs has become a fundamental framework for understanding the need for broad health care reform and describing health care value. While the framework is not specific to any clinical setting, this article focuses on the alignment between the framework and Emergency Department (ED) care. The paper explores where emergency care is naturally aligned with each Aim, as well as current barriers which must be addressed to meet the full vision of the Triple Aim. We propose a vision of EDs serving as a nexus for care coordination optimally consistent with the Triple Aim and the requirements for such a role. These requirements include: (1) substantial integration in coordinated care models; (2) development of reliable and actionable data on ED quality, population health, and cost outcomes; (3) specific initiatives to control and optimize ED utilization; and (4) payment models which preserve surge and disaster response capacity. Published by Elsevier Inc.

  13. Healthcare

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This report, provides detailed analyses and projections of occupations in healthcare fields, and wages earned. In addition, the important skills and work values associated with workers in those fields of healthcare are discussed. Finally, the authors analyze the implications of research findings for the racial, ethnic, and class diversity of the…

  14. 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

  15. 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

  16. 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.

  17. 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

  18. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. 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,

  1. 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.

  2. 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.

  3. 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

  4. 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.

  5. 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.

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

    Science.gov (United States)

    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/

  7. The European Gaucher Alliance: a survey of member patient organisations' activities, healthcare environments and concerns.

    Science.gov (United States)

    Žnidar, Irena; Collin-Histed, Tanya; Niemeyer, Pascal; Parkkinen, Johanna; Lauridsen, Anne-Grethe; Zariņa, Sandra; Cohen, Yossi; Manuel, Jeremy

    2014-09-02

    The European Gaucher Alliance (EGA) was established in 1994 and constituted in 2008 as an umbrella group supporting patient organisations for Gaucher disease. Every two years, the EGA conducts a questionnaire survey of member associations to help develop its priorities and annual work programme. Results of the latest survey are presented. Between June 2012 and April 2013, the 36 members and associate members of the EGA were asked to complete a questionnaire detailing membership numbers, disease specific treatments used by patients, means of access to treatment, availability of treatment centres and home infusions, sources of support for patients with Gaucher disease, patient organisations' activities, collaborations, funding sources and any issues of concern. Questionnaires completed in 2012 were revised in January 2013 and responses analysed between July and September 2013. Thirty three members returned data on one or more questions. Findings identified inequalities in access to treatment both within and between members' countries. Three of 27 countries, for which data were available, relied totally on humanitarian aid for treatment and 6% of untreated patients in 20 countries were untreated because of funding issues, a situation many feared would worsen with deteriorating economic climates. Access to treatment and reimbursement represented 45% of members' concerns, while 35% related to access to specialist treatment centres, home infusions and doctors with expertise in Gaucher disease. Member associations' main activities centred on patient support (59% of responses) and raising awareness of Gaucher disease and patients' needs amongst the medical community, government and healthcare decision makers and the general public (34% of responses). Twenty one (78% of respondents) indicated they were the only source of help for Gaucher disease patients in their country. For many, activities were constrained by funds; two members had no external funding source. Activities

  8. European conditionality, ethnic control or electoral disarray? The 2011 controversial territorial reform attempt in Romania

    Directory of Open Access Journals (Sweden)

    Dragoş DRAGOMAN

    2014-02-01

    Full Text Available Though much criticized, especially for its inability of spending European subsidies, the current regional administration in Romania remained unchanged until the communist times. The sudden rush in totally reshaping the regional administration in 2011 triggered an intense debate on the matter. Though brief, it shed light on political constraints operating when it comes to reshape regional design. Whereas official arguments pointed at a severe European conditionality, electoral calculations seem to be at stake. Yet the decisive opposition to the project by the Hungarian party in government unravels a more profound conditionality, namely ethnic balance, related to the political geography of Transylvania.

  9. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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

  12. 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...

  13. 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.

  14. Russian natural gas exports-Will Russian gas price reforms improve the European security of supply?

    International Nuclear Information System (INIS)

    Sagen, Eirik Lund; Tsygankova, Marina

    2008-01-01

    In this paper we use both theoretical and numerical tools to study potential effects on Russian gas exports from different Russian domestic gas prices and production capacities in 2015. We also investigate whether a fully competitive European gas market may provide incentives for Gazprom, the dominant Russian gas company, to change its export behaviour. Our main findings suggest that both increased domestic gas prices and sufficient production capacities are vital to maintain Gazprom's market share in Europe over the next decade. In fact, Russia may struggle to carry out its current long-term export commitments if domestic prices are sufficiently low. At the same time, if Russian prices approach European net-back levels, Gazprom may reduce exports in favour of a relatively more profitable domestic market

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

    OpenAIRE

    Jan Morávek

    2008-01-01

    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 ...

  16. 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.

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

    Science.gov (United States)

    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.

  18. 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

  19. 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,...

  20. 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.

  1. 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.

  2. 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.

  3. Are undocumented migrants’ entitlements and barriers to healthcare a public health challenge for the European Union?

    OpenAIRE

    De Vito, Elisabetta; de Waure, Chiara; Specchia, Maria Lucia; Parente, Paolo; Azzolini, Elena; Frisicale, Emanuela Maria; Favale, Marcella; Teleman, Adele Anna; Ricciardi, Walter

    2016-01-01

    Undocumented migrants (UMs) are at higher risk for health problems because of their irregular status and the consequences of economic and social marginalization. Moreover, the emergent reality of undocumented migration in Europe calls for action in the field of management of UM’s health demands as their access to health services has become a sensitive political and social issue. In this light, this paper aims to address UMs’ entitlement and barriers to healthcare and related policies citing e...

  4. Position statement on the role of healthcare professionals, patient organizations and industry in European Reference Networks

    NARCIS (Netherlands)

    Hollak, C.E.; Biegstraaten, M.; Baumgartner, M.R.; Belmatoug, N.; Bembi, B.; Bosch, A. van den; Brouwers, M.; Dekker, H.; Dobbelaere, D.; Engelen, M.; Groenendijk, M.C.; Lachmann, R.; Langendonk, J.G.; Langeveld, M.; Linthorst, G.; Morava, E.; Poll-The, B.T.; Rahman, S.; Rubio-Gozalbo, M.E.; Spiekerkoetter, U.; Treacy, E.; Wanders, R.; Zschocke, J.; Hagendijk, R.

    2016-01-01

    A call from the EU for the set-up of European Reference Networks (ERNs) is expected to be launched in the first quarter of 2016. ERNs are intended to improve the care for patients with low prevalent or rare diseases throughout the EU by, among other things, facilitating the pooling and exchange of

  5. Position statement on the role of healthcare professionals, patient organizations and industry in European Reference Networks

    NARCIS (Netherlands)

    C.E.M. Hollak (Carla); M. Biegstraaten (Marieke); M.R. Baumgartner (Matthias R.); N. Belmatoug (Nadia); B. Bembi (Bruno); A.M. Bosch (Annet); M.C.G.J. Brouwers (M. C G J); H. Dekker (Hanka); D. Dobbelaere (Dries); M. Engelen (Marc); M.C. Groenendijk (Marike C.); R.H. Lachmann (Robin); J.G. Langendonk (Janneke); M. Langeveld (Mirjam); G. Linthorst (Gabor); E. Morava (Eva); B.T. Poll-The; S. Rahman (Shamima); M.E. Rubio-Gozalbo (Estela); U. Spiekerkoeter (Ute); E. Treacy (Eileen); R.J.A. Wanders (Ronald); J. Zschocke (Johannes); R. Hagendijk (Rob)

    2016-01-01

    textabstractA call from the EU for the set-up of European Reference Networks (ERNs) is expected to be launched in the first quarter of 2016. ERNs are intended to improve the care for patients with low prevalent or rare diseases throughout the EU by, among other things, facilitating the pooling and

  6. 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.

  7. 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...

  8. 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.

  9. 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

  10.  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...

  11. 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.

  12. 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

  13. Investing in amnesia, or fantasy and forgetfulness in the World Bank's approach to healthcare reform in sub-Saharan Africa.

    Science.gov (United States)

    Epprecht, M

    1997-01-01

    "Investing in Health," the World Bank's 1993 World Development Report, and a follow-up report, "Better Health in Africa," advocate investments in Third World health sectors as a means of increasing individual productivity and strengthening economic growth. Both reports maintain that structural adjustment policies have enhanced the physical health of low-income populations by improving the fiscal health of business elites. This essay critiques the World Bank's approach through a historical analysis of health care problems in sub-Saharan Africa with an emphasis on the devastating effects of colonialism, patriarchy, and imperialism. Although these documents contain many useful recommendations for Western donors (e.g., recognition of the destructive potential of alcohol and tobacco, the need for state regulation over key parts of the health sector, and the effects of gender on health status), they reflect an "investment in amnesia" regarding historical evidence on health care reform in Africa and an erroneous assumption that Western biomedicine is politically neutral. Foreign aid has tended to serve the needs of multinational corporations rather than African populations. Recommended, in place of structural adjustment policies, are measures such as a massive rebuilding of Africa's urban infrastructure, the enforcement of minimum wage laws, the preservation of ecosystems that supply traditional medicines, attention to the ecologic and health consequences of economic growth, and a feminist-led reproductive rights movement.

  14. 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.

  15. 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

  16. Talking about quality: exploring how 'quality' is conceptualized in European hospitals and healthcare systems.

    Science.gov (United States)

    Wiig, Siri; Aase, Karina; von Plessen, Christian; Burnett, Susan; Nunes, Francisco; Weggelaar, Anne Marie; Anderson-Gare, Boel; Calltorp, Johan; Fulop, Naomi

    2014-10-11

    Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient

  17. Reimbursement of licensed cell and gene therapies across the major European healthcare markets

    Science.gov (United States)

    Jørgensen, Jesper; Kefalas, Panos

    2015-01-01

    Objective The aim of this research is to identify the pricing, reimbursement, and market access (P&R&MA) considerations most relevant to advanced therapy medicinal products (ATMPs) in the Big5EU, and to inform their manufacturers about the key drivers for securing adoption at a commercially viable reimbursed price. Methodology The research was structured following three main steps: 1) Identifying the market access pathways relevant to ATMPs through secondary research; 2) Validating the secondary research findings and addressing any data gaps in primary research, by qualitative interviews with national, regional, and local-level payers and their clinical and economic advisors; 3) Collating of primary and secondary findings to compare results across countries. Results The incremental clinical benefit forms the basis for all P&R&MA processes. Budget impact is a key consideration, regardless of geography. Cost-effectiveness analyses are increasingly applied; however, only the United Kingdom has a defined threshold that links the cost per quality-adjusted life year (QALY) specifically and methodologically to the reimbursed price. Funding mechanisms to enable adoption of new and more expensive therapies exist in all countries, albeit to varying extents. Willingness to pay is typically higher in smaller patient populations, especially in populations with high disease burden. Outcomes modelling and risk-sharing agreements (RSAs) provide strategies to address the data gap and uncertainties often associated with trials in niche populations. Conclusions The high cost of ATMPs, coupled with the uncertainty at launch around their long-term claims, present challenges for their adoption at a commercially viable reimbursed price. Targeting populations of high disease burden and unmet needs may be advantageous, as the potential for improvement in clinical benefit is greater, as well as the potential for capitalising on healthcare cost offsets. Also, targeting small populations can

  18. Compliance with European Guidelines for Diagnostic Mammography in a Decentralized Health-Care Setting

    International Nuclear Information System (INIS)

    Jensen, A.; Mikkelsen, G.J.; Vestergaard, M.; Lynge, E.; Vejborg, I.

    2005-01-01

    Purpose: To evaluate the compliance of Danish mammography clinics with requirements concerning organization, activity volume, and assessment procedures from two European guidelines for quality assurance in diagnostic mammography (EUSOMA and EUREF). Material and Methods: We used individual records on all diagnostic mammographies performed in Denmark in 2000, and questionnaires given to Danish mammography clinics in 2000, 2002, and 2004. Results: The study showed a marked centralization of the diagnostic activity from 2000 to 2004 to a smaller number of public breast assessment centers with full multidisciplinary breast assessment. However, a relatively large number of these centers did not comply with the activity volume requirement of 2000 mammograms per clinic per year. The number of private diagnostic mammography clinics performing basic diagnostic mammography has remained fairly stable in the period 2000 to 2004. Compared with public breast assessment centers, the private diagnostic mammography clinics had a lower compliance with activity volume requirements. Conclusion: A marked proportion of Danish public breast assessment centers operate with less than optimal activity volume, suggesting that further centralization would be appropriate. The situation in private diagnostic mammography clinics may cause concern, as our study showed that the majority of these clinics did not meet the activity volume requirements

  19. 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

    Directory of Open Access Journals (Sweden)

    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

  20. 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

  1. Current and future trends in public sector reform: The views of trade unions and consultants in ten European countries.

    NARCIS (Netherlands)

    D.S.D. Curry; W. Blijleven (Wieke); S.G.J. Van de Walle (Steven)

    2014-01-01

    markdownabstract__Abstract__ While public sector reform has been a constant process, sometimes evolutionary and sometimes revolutionary, the financial crisis that started in 2008, along with the streamlining and efficiency aims of New Public Management paradigms that began to emerge in the 1980s,

  2. 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.

  3. 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

  4. 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.

  5. 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.)

  6. The Public Administration Accounting in the Light Public Finance Managements Reform and Changes of the New Accounting Directive of the European Parliament and the European Council

    Directory of Open Access Journals (Sweden)

    Košovská Iveta

    2014-12-01

    Full Text Available The role of public administration accounting is to secure a database of relevant information essential for the management of public finances and need for presenting of operations results of our country within the European Union (EU. The accounting of public administration entities should provide a true and fair view on the assets and liabilities, as well as the financial situation and the use of public appropriations. After the entry of the Slovak Republic (SR to the European Union (EU the International Public Sector Accounting Standards began to be applied in our legislation. They provide a uniform basis for the data consolidation as well as more efficient information for the economic decisions of individual users

  7. Competitiveness effects of environmental tax reforms (COMETR). Final report to the European Commission, DG Research and DG TAXUD

    Energy Technology Data Exchange (ETDEWEB)

    Skou Andersen, M.; Speck, S. (Univ. of Aarhus, National Environmental Research Institute, Dept. of Policy Analysis (Denmark)); Barker, T.; Junankar, S.; Pollitt, H. (Cambridge Econometrics (United Kingdom)); Fitz Gerald, J.; Scott, S. (Economic and Social Research Institute (Ireland)); Jilkova, J. (Univ. of Economics Prague, Institute for Economic and Environmental Policy (Czech Republic)); Salmons, R.; Ekins, P. (Policy Studies Institute (United Kingdom)); Christie, E.; Michael Landesmann, M. (Vienna Institute for International Economic Studies (Austria))

    2007-12-15

    COMETR provides an ex-post assessment of experiences and competitiveness impacts of using carbon-energy taxes as an instrument of an Environmental Tax Reform (ETR), which shifts the tax burden and helps reduce the carbon emissions that cause global warming. COMETR: reviews the experience in ETR in seven EU Member States (Denmark, Germany, Netherlands, Finland, Slovenia, Sweden and UK); analyses world market conditions for a set of energy-intensive sectors, as a framework for considering competitiveness effects; analyses the effects of ETR on sector-specific energy usage and carbon emissions in Member States with carbon-energy taxes introduced on industry; presents a macroeconomic analysis of the competitiveness effects of ETR for individual Member States as well as for the EU as a whole; provides ex-post figures for environmental decoupling and assesses carbon leakage; reviews mitigation and compensation mechanisms for energy-intensive industries. (au)

  8. The development of a consensus definition for healthcare improvement science (HIS) in seven European countries: A consensus methods approach.

    Science.gov (United States)

    Skela-Savič, Brigita; Macrae, Rhoda; Lillo-Crespo, Manuel; Rooney, Kevin D

    2017-06-01

    There is a limited body of research in the field of healthcare improvement science (HIS). Quality improvement and 'change making' should become an intrinsic part of everyone's job, every day in all parts of the healthcare system. The lack of theoretical grounding may partly explain the minimal transfer of health research into health policy. This article seeks to present the development of the definition for healthcare improvement science. A consensus method approach was adopted with a two-stage Delphi process, expert panel and consensus group techniques. A total of 18 participants were involved in the expert panel and consensus group, and 153 answers were analysed as a part of the Delphi survey. Participants were researchers, educators and healthcare professionals from Scotland, Slovenia, Spain, Italy, England, Poland, and Romania. A high level of consensus was achieved for the broad definition in the 2nd Delphi iteration (86%). The final definition was agreed on by the consensus group: 'Healthcare improvement science is the generation of knowledge to cultivate change and deliver person-centred care that is safe, effective, efficient, equitable and timely. It improves patient outcomes, health system performance and population health.' The process of developing a consensus definition revealed different understandings of healthcare improvement science between the participants. Having a shared consensus definition of healthcare improvement science is an important step forward, bringing about a common understanding in order to advance the professional education and practice of healthcare improvement science.

  9. Xavier Zubiri and María Zambrano: from the European Crisis to a reform of enlightenment

    Directory of Open Access Journals (Sweden)

    Pamela Soto García

    2015-09-01

    period of «Escuela de Madrid», crosses and articulates in this paper research, through the criticism that both philosophers do about Cartesian self, allowing thus to address the originality of Spanish thought from an anthropological perspective. The solipsism, which is verified by Ortega y Gasset, is an evidence of the European crisis that outstands in modernity and the point of view of this analysis.

  10. The electricity prices in the European Union. The role of renewable energies and regulatory electric market reforms

    International Nuclear Information System (INIS)

    Moreno, Blanca; López, Ana J.; García-Álvarez, María Teresa

    2012-01-01

    The European Union electricity market has been gradually liberalized since 1990s. Theoretically, competitive markets should lead to efficiency gains in the economy thus reducing electricity prices. However, there is a controversial debate about the real effects of the electricity liberalization on electricity prices. Moreover, the increased generation of electricity from renewable energies RES-E (Electricity from Renewable Energy Sources) is also integrated in wholesale market reducing wholesale prices, but the final effect over household prices is not clear. In order to contribute to this debate, this paper provides an empirical investigation into the electricity prices determinants. In fact we develop econometric panel models to explore the relationship between the household electricity prices and variables related to the renewable energy sources and the competition in generation electricity market. More specifically we use a panel data set provided by Eurostat and covering 27 European Union countries during the period 1998–2009. Our results suggest that electricity prices increase with the deployment of RES-E and with the expansion of greenhouse gas emissions produced by energy industries- as a European Union CO 2 emission trading scheme exists. Results also reveal that country's characteristics can affect household electricity prices. -- Highlights: ► Electricity liberalized markets should lead to reduce electricity prices. ► The use of renewable energies (RES) reduce wholesale electricity prices. ► However, household electricity prices are increasing in European Union. ► Panel data models are developed to investigate the effect of RES and electricity competition on household electricity prices. ► We find that the deployment of RES increases prices paid by consumers in a liberalized market.

  11. Clinical evaluation of cardiovascular devices: principles, problems, and proposals for European regulatory reform. Report of a policy conference of the European Society of Cardiology.

    Science.gov (United States)

    Fraser, Alan G; Daubert, Jean-Claude; Van de Werf, Frans; Estes, N A Mark; Smith, Sidney C; Krucoff, Mitchell W; Vardas, Panos E; Komajda, Michel

    2011-07-01

    The European Commission announced in 2008 that a fundamental revision of the medical device directives is being considered in order to clarify and strengthen the current legal framework. The system for testing and approving devices in Europe was established >20 years ago as a 'New Approach' to a previously little-regulated industry. It is recognized by many that the regulatory system has not kept pace with technological advances and changing patterns of medical practice. New legislation will be drafted during 2011, but medical experts have been little involved in this important process. This context makes it an opportune time for a professional association to advise from both clinical and academic perspectives about changes which should be made to improve the safety and efficacy of devices used in clinical practice and to develop more appropriate systems for their clinical evaluation and post-marketing surveillance. This report summarizes how medical devices are regulated and it reviews some serious clinical problems that have occurred with cardiovascular devices. Finally, it presents the main recommendations from a Policy Conference on the Clinical Evaluation of Cardiovascular Devices that was held at the European Heart House in January 2011.

  12. 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.

    Science.gov (United States)

    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.

  13. 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.

  14. 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…

  15. Tailor-made finance versus tailor-made service : Can the state improve consumer choice in healthcare by reforming the financial structure?

    NARCIS (Netherlands)

    K.J. Grit (Kor); A.A. de Bont (Antoinette)

    2010-01-01

    textabstractABSTRACT Background: Policy instruments based on the working of markets have been introduced to empower consumers of healthcare, however it is not easy to become a critical consumer in healthcare. Objectives: The aim of this study is to analyze the possibilities of the state to

  16. Flexible Labour, Flexible Production and Innovation-by-Agreement: International Comparisons Contesting the Lindbeck-Snower Insider-Outsider Thesis and 'Structural Reforms' in the European Union

    Directory of Open Access Journals (Sweden)

    Teresa Carla Oliveira

    2017-09-01

    Full Text Available This paper critiques the case for flexibilisation of labour markets. It evidences that influential claims for this in terms of an insider-outsider thesis by former Nobel economics committee member Assar Lindbeck and the British economist Dennis Snower were purely theoretical without offering any evidence, or recognising contrary evidence. It cites a recent admission by the IMF that there is no basis for claiming that protection of employee rights inhibits economic efficiency and cites also a questioning of structural reforms and an obsession with competitiveness by Benoît Cœuré, an Executive Director of the ECB. It illustrates that the achievement of some of the most competitive companies in the world, in Japan, has been based on reinforcing insider rights through commitment to lifetime employment for core employees and how this has enabled high levels of efficiency and process innovation through continuous improvement. It relates this to theories of psychological and social contracts, and evidences the influence of this flexible production rather than flexible labour market model on the recommendation of innovation-by-agreement in the 2000 Lisbon Agenda of the European Council including the right to work-life balance which has not been integral to flexible production in Japan. It then summarises some implications.

  17. Energy market reform in Europe. European energy and climate policies: achievements and challenges to 2020 and beyond

    International Nuclear Information System (INIS)

    2015-01-01

    Since the 1992 Earth Summit in Rio and the negotiation of the United Nations Framework Convention on Climate Change (UNFCCC), the European Union has consistently been at the forefront of global action to combat climate change, leading the world to a low-carbon economy. The EU has set itself greenhouse gas emission targets designed to produce an almost carbon-free economy by 2050 in order to make a major contribution to limiting the global temperature increase by the end of the century to 2 deg. C, compared to the pre-industrial average. As an interim step on the way to 2050, EU leaders in March 2007 set a number of ambitious climate and energy targets known as the '20-20-20 targets by 2020' or the 3 x 20 policy. In this, the EU committed to: - A 20% reduction in EU greenhouse gas emissions from 1990 levels; - Raising the share of EU energy consumption produced from renewable resources to 20%; and - A 20% improvement in the EU's energy efficiency. This 3 x 20 package is a part of a wider European energy strategy that aims at enhancing: - Sustainability; - Competitiveness and affordability; and - Security of supply. The EU energy and climate package has attracted criticism in the last few years, as each day brought more evidence that the policy measures had numerous unexpected, or unintended impacts on the energy markets and industry: an excess of intermittent sources of electricity causing disruption for grid operators, surplus electricity resulting in a price collapse of the wholesale electricity market, electricity price increase at retail level, exit of gas from the fuels for power generation and the advent of coal as an electricity price-setter... At the same time, it has also become evident that EU policy has failed to solve the existing EU energy imbalances in general. Ironically, after years of huge investments aimed at achieving the ambitious policy targets, a number of the objectives still seem to be a long way away. Indeed some may not even

  18. 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

  19. 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

  20. 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.

  1. Integrated palliative care is about professional networking rather than standardisation of care: A qualitative study with healthcare professionals in 19 integrated palliative care initiatives in five European countries.

    Science.gov (United States)

    den Herder-van der Eerden, Marlieke; van Wijngaarden, Jeroen; Payne, Sheila; Preston, Nancy; Linge-Dahl, Lisa; Radbruch, Lukas; Van Beek, Karen; Menten, Johan; Busa, Csilla; Csikos, Agnes; Vissers, Kris; van Gurp, Jelle; Hasselaar, Jeroen

    2018-06-01

    Integrated palliative care aims at improving coordination of palliative care services around patients' anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of integrated care (content of care, patient flow, information logistics and availability of (human) resources and material) are lacking. To examine how integrated palliative care takes shape in practice across abovementioned key domains within several integrated palliative care initiatives in Europe. Qualitative group interview design. A total of 19 group interviews were conducted (2 in Belgium, 4 in the Netherlands, 4 in the United Kingdom, 4 in Germany and 5 in Hungary) with 142 healthcare professionals from several integrated palliative care initiatives in five European countries. The majority were nurses ( n = 66; 46%) and physicians ( n = 50; 35%). The dominant strategy for fostering integrated palliative care is building core teams of palliative care specialists and extended professional networks based on personal relationships, shared norms, values and mutual trust, rather than developing standardised information exchange and referral pathways. Providing integrated palliative care with healthcare professionals in the wider professional community appears difficult, as a shared proactive multidisciplinary palliative care approach is lacking, and healthcare professionals often do not know palliative care professionals or services. Achieving better palliative care integration into regular healthcare and convincing the wider professional community is a difficult task that will take time and effort. Enhancing standardisation of palliative care into education, referral pathways and guidelines and standardised information exchange may be necessary. External authority (policy makers, insurance companies and professional bodies) may be needed to support integrated palliative care practices across settings.

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

    Science.gov (United States)

    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.

  3. The Economy of Healthcare: Disparity of Insured/Uninsured Profiles among European Immigrants in the United States

    Directory of Open Access Journals (Sweden)

    Rohitha Goonatilake

    2016-01-01

    Full Text Available Immigration over the last seven years has been the highest for any seven-year period in the history of the United States (US, totaling 10.3 million immigrants. Of which, it is estimated that more than 50% are accounted as immigrants without legal status, according to the Center for Immigration Studies in Washington (Camarota, 2002. Data gathered in early 2000 provides a glimpse of the situation to bring in the disparity of insured and uninsured among European immigrants in the United States as the 9/11 attacks, the Obama care (the Patient Protection and Affordable Care Act (PPACA, or Affordable Care Act (ACA for short, and the (DREAM Act of 2010 the Development, Relief and Education for Alien Minors Act have significantly changed the patterns and profiles of this phenomenon as someone would shed light on the situation. This paper compares and contrasts the extent of health insurance coverage for the citizens, naturalized citizens, and non-citizens as identified in terms of the world regions of birth, of course, for the European descendants. Finally, the analysis is concluded by examining the extent of health insurance coverage among all foreign born population based on race, educational attainment, and family income in 2005.

  4. 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...

  5. Tailor-made finance versus tailor-made care. Can the state strengthen consumer choice in healthcare by reforming the financial structure of long-term care?

    Science.gov (United States)

    Grit, K; de Bont, A

    2010-02-01

    Policy instruments based on the working of markets have been introduced to empower consumers of healthcare. However, it is still not easy to become a critical consumer of healthcare. The aim of this study is to analyse the possibilities of the state to strengthen the position of patients with the aid of a new financial regime, such as personal health budgets. Data were collected through in-depth interviews with executives, managers, professionals and client representatives of six long-term care institutions. With the introduction of individual budgets the responsibility for budgetary control has shifted from the organisational level to the individual level in the caregiver-client relationship. Having more luxurious care on offer necessitates a stronger demarcation of regular care because organisations cannot simultaneously offer extra care as part of the standard care package. New financial instruments have an impact on the culture of receiving and giving care. Distributive justice takes on new meaning with the introduction of financial market mechanisms in healthcare; the distributing principle of 'need' is transformed into the principle of 'economic demand'. Financial instruments not only act as a countervailing power against providers insufficiently client-oriented, but are also used by providers to reinforce their own positions vis-à-vis demanding clients. Tailor-made finance is not the same as tailor-made care.

  6. Core Standards of the EUBIROD Project. Defining a European Diabetes Data Dictionary for Clinical Audit and Healthcare Delivery.

    Science.gov (United States)

    Cunningham, S G; Carinci, F; Brillante, M; Leese, G P; McAlpine, R R; Azzopardi, J; Beck, P; Bratina, N; Bocquet, V; Doggen, K; Jarosz-Chobot, P K; Jecht, M; Lindblad, U; Moulton, T; Metelko, Ž; Nagy, A; Olympios, G; Pruna, S; Skeie, S; Storms, F; Di Iorio, C T; Massi Benedetti, M

    2016-01-01

    A set of core diabetes indicators were identified in a clinical review of current evidence for the EUBIROD project. In order to allow accurate comparisons of diabetes indicators, a standardised currency for data storage and aggregation was required. We aimed to define a robust European data dictionary with appropriate clinical definitions that can be used to analyse diabetes outcomes and provide the foundation for data collection from existing electronic health records for diabetes. Existing clinical datasets used by 15 partner institutions across Europe were collated and common data items analysed for consistency in terms of recording, data definition and units of measurement. Where necessary, data mappings and algorithms were specified in order to allow partners to meet the standard definitions. A series of descriptive elements were created to document metadata for each data item, including recording, consistency, completeness and quality. While datasets varied in terms of consistency, it was possible to create a common standard that could be used by all. The minimum dataset defined 53 data items that were classified according to their feasibility and validity. Mappings and standardised definitions were used to create an electronic directory for diabetes care, providing the foundation for the EUBIROD data analysis repository, also used to implement the diabetes registry and model of care for Cyprus. The development of data dictionaries and standards can be used to improve the quality and comparability of health information. A data dictionary has been developed to be compatible with other existing data sources for diabetes, within and beyond Europe.

  7. Assessing the impact of DRGs on patient care and professional practice in Switzerland (IDoC) - a potential model for monitoring and evaluating healthcare reform.

    Science.gov (United States)

    Wild, Verina; Carina, Fourie; Frouzakis, Regula; Clarinval, Caroline; Fässler, Margrit; Elger, Bernice; Gächter, Thomas; Leu, Agnes; Spirig, Rebecca; Kleinknecht, Michael; Radovanovic, Dragana; Mouton Dorey, Corine; Burnand, Bernard; Vader, John-Paul; Januel, Jean-Marie; Biller-Andorno, Nikola; The IDoC Group

    2015-01-01

    The starting point of the interdisciplinary project "Assessing the impact of diagnosis related groups (DRGs) on patient care and professional practice" (IDoC) was the lack of a systematic ethical assessment for the introduction of cost containment measures in healthcare. Our aim was to contribute to the methodological and empirical basis of such an assessment. Five sub-groups conducted separate but related research within the fields of biomedical ethics, law, nursing sciences and health services, applying a number of complementary methodological approaches. The individual research projects were framed within an overall ethical matrix. Workshops and bilateral meetings were held to identify and elaborate joint research themes. Four common, ethically relevant themes emerged in the results of the studies across sub-groups: (1.) the quality and safety of patient care, (2.) the state of professional practice of physicians and nurses, (3.) changes in incentives structure, (4.) vulnerable groups and access to healthcare services. Furthermore, much-needed data for future comparative research has been collected and some early insights into the potential impact of DRGs are outlined. Based on the joint results we developed preliminary recommendations related to conceptual analysis, methodological refinement, monitoring and implementation.

  8. Agreement among healthcare professionals in ten European countries in diagnosing case-vignettes of surgical-site infections.

    Directory of Open Access Journals (Sweden)

    Gabriel Birgand

    Full Text Available OBJECTIVE: Although surgical-site infection (SSI rates are advocated as a major evaluation criterion, the reproducibility of SSI diagnosis is unknown. We assessed agreement in diagnosing SSI among specialists involved in SSI surveillance in Europe. METHODS: Twelve case-vignettes based on suspected SSI were submitted to 100 infection-control physicians (ICPs and 86 surgeons in 10 European countries. Each participant scored eight randomly-assigned case-vignettes on a secure online relational database. The intra-class correlation coefficient (ICC was used to assess agreement for SSI diagnosis on a 7-point Likert scale and the kappa coefficient to assess agreement for SSI depth on a three-point scale. RESULTS: Intra-specialty agreement for SSI diagnosis ranged across countries and specialties from 0.00 (95%CI, 0.00-0.35 to 0.65 (0.45-0.82. Inter-specialty agreement varied from 0.04 (0.00-0.62 in to 0.55 (0.37-0.74 in Germany. For all countries pooled, intra-specialty agreement was poor for surgeons (0.24, 0.14-0.42 and good for ICPs (0.41, 0.28-0.61. Reading SSI definitions improved agreement among ICPs (0.57 but not surgeons (0.09. Intra-specialty agreement for SSI depth ranged across countries and specialties from 0.05 (0.00-0.10 to 0.50 (0.45-0.55 and was not improved by reading SSI definition. CONCLUSION: Among ICPs and surgeons evaluating case-vignettes of suspected SSI, considerable disagreement occurred regarding the diagnosis, with variations across specialties and countries.

  9. 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.

  10. 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

  11. 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

    Science.gov (United States)

    Bracun Sova, Rajka; Kemperl, Metoda

    2012-01-01

    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…

  12. 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...

  13. 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...

  14. 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

  15. 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.

  16. Impact of mineral and bone disorder on healthcare resource use and associated costs in the European Fresenius medical care dialysis population: a retrospective cohort study.

    Science.gov (United States)

    Chiroli, Silvia; Mattin, Caroline; Belozeroff, Vasily; Perrault, Louise; Mitchell, Dominic; Gioni, Ioanna

    2012-10-29

    Secondary hyperparathyroidism (SHPT) is associated with mortality in patients with chronic kidney disease (CKD), but the economic consequences of SHPT have not been adequately studied in the European population. We assessed the relationship between SHPT parameters (intact parathyroid hormone [iPTH], calcium, and phosphate) and hospitalisations, medication use, and associated costs among CKD patients in Europe. The analysis of this retrospective cohort study used records of randomly selected patients who underwent haemodialysis between January 1, 2005 and December 31, 2006 at participating European Fresenius Medical Care facilities in 10 countries. Patients had ≥ 1 iPTH value recorded, and ≥ 1 month of follow-up after a 3-month baseline period during which SHPT parameters were assessed. Time at risk was post-baseline until death, successful renal transplantation, loss to follow-up, or the end of follow-up. Outcomes included cost per patient-month, rates of hospitalisations (cardiovascular disease [CVD], fractures, and parathyroidectomy [PTX]), and use of SHPT-, diabetes-, and CVD-related medications. National costs were applied to hospitalisations and medication use. Generalised linear models compared costs across strata of iPTH, total calcium, and phosphate, adjusting for baseline covariates. There were 6369 patients included in the analysis. Mean ± SD person-time at risk was 13.1 ± 6.4 months. Patients with iPTH > 600 pg/mL had a higher hospitalisation rate than those with lower iPTH. Hospitalisation rates varied little across calcium and phosphate levels. SHPT-related medication use varied with iPTH, calcium, and phosphate. After adjusting for demographic and clinical variables, patients with baseline iPTH > 600 pg/mL had 41% (95% CI: 25%, 59%) higher monthly total healthcare costs compared with those with iPTH in the K/DOQI target range (150-300 pg/mL). Patients with baseline phosphate and total calcium levels above target ranges (1.13-1.78 mmol/L and 2

  17. Exposure to benzodiazepines (anxiolytics, hypnotics and related drugs) in seven European electronic healthcare databases: a cross-national descriptive study from the PROTECT-EU Project.

    Science.gov (United States)

    Huerta, Consuelo; Abbing-Karahagopian, Victoria; Requena, Gema; Oliva, Belén; Alvarez, Yolanda; Gardarsdottir, Helga; Miret, Montserrat; Schneider, Cornelia; Gil, Miguel; Souverein, Patrick C; De Bruin, Marie L; Slattery, Jim; De Groot, Mark C H; Hesse, Ulrik; Rottenkolber, Marietta; Schmiedl, Sven; Montero, Dolores; Bate, Andrew; Ruigomez, Ana; García-Rodríguez, Luis Alberto; Johansson, Saga; de Vries, Frank; Schlienger, Raymond G; Reynolds, Robert F; Klungel, Olaf H; de Abajo, Francisco José

    2016-03-01

    Studies on drug utilization usually do not allow direct cross-national comparisons because of differences in the respective applied methods. This study aimed to compare time trends in BZDs prescribing by applying a common protocol and analyses plan in seven European electronic healthcare databases. Crude and standardized prevalence rates of drug prescribing from 2001-2009 were calculated in databases from Spain, United Kingdon (UK), The Netherlands, Germany and Denmark. Prevalence was stratified by age, sex, BZD type [(using ATC codes), i.e. BZD-anxiolytics BZD-hypnotics, BZD-related drugs and clomethiazole], indication and number of prescription. Crude prevalence rates of BZDs prescribing ranged from 570 to 1700 per 10,000 person-years over the study period. Standardization by age and sex did not substantially change the differences. Standardized prevalence rates increased in the Spanish (+13%) and UK databases (+2% and +8%) over the study period, while they decreased in the Dutch databases (-4% and -22%), the German (-12%) and Danish (-26%) database. Prevalence of anxiolytics outweighed that of hypnotics in the Spanish, Dutch and Bavarian databases, but the reverse was shown in the UK and Danish databases. Prevalence rates consistently increased with age and were two-fold higher in women than in men in all databases. A median of 18% of users received 10 or more prescriptions in 2008. Although similar methods were applied, the prevalence of BZD prescribing varied considerably across different populations. Clinical factors related to BZDs and characteristics of the databases may explain these differences. Copyright © 2015 John Wiley & Sons, Ltd.

  18. Administrative Reform

    DEFF Research Database (Denmark)

    Plum, Maja

    Through the example of a Danish reform of educational plans in early childhood education, the paper critically addresses administrative educational reforms promoting accountability, visibility and documentation. Drawing on Foucaultian perspectives, the relation between knowledge and governing...... of administrative technology, tracing how the humanistic values of education embed and are embedded within ‘the professional nursery teacher' as an object and subject of administrative practice. Rather than undermining the humanistic potential of education, it is argued that the technology of accounting...

  19. 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...

  20. 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.

  1. 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.

  2. The European Union in the grip of accumulated governance crises: the euro, the reform efforts, and the public-support dynamics

    NARCIS (Netherlands)

    Mamadouh, V.D.; van der Wusten, H.H.

    2013-01-01

    This paper considers how the 2008 banking crisis and the subsequent financial and economic crises - more specifically, the sovereign debt crisis of several European Union (EU) member states and the crisis of the euro, the common currency of the euro zone - affect the political geography of the EU.

  3. 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.

  4. 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

  5. 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...

  6. 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.

  7. 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.

  8. Financial re-regulation at a crossroads: How the European experience strengthens the case for a radical reform built on Minsky’s approach

    Directory of Open Access Journals (Sweden)

    Elisabetta Montanaro

    2012-12-01

    Full Text Available The current financial and sovereign crisis is pushing European politicians and EU bureaucrats to devise new institutional and policy solutions. However, the new EU institutional framework and stricter regulatory requirements do not introduce significant changes in the laissez-faire nature of the regulatory approach. Our opinion is that the entire re-regulation process does not go to the roots of how financial fragility endogenously accumulates, and how finally it produces a crisis each time starting from the weakest part of the financial system. Analysing the European banking sectors from this perspective, we show how domestic specificities add to the limits due to risk-based regulation and supervision. We then build on Minsky’s regulatory proposals to present the skeleton of a simple alternative to the existing regulatory approach.

  9. Reforming the U.S. Healthcare System

    OpenAIRE

    Bart Gordon

    2009-01-01

    I have heard from countless Tennesseans who have said they simply can't keep up with the rising costs of health insurance. In Tennessee alone, insurance costs have risen 129% for small businesses since 2000, forcing many to cut benefits or stop offering coverage for employees.

  10. 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...

  11. Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from the European Centre for Disease Prevention and Control

    Directory of Open Access Journals (Sweden)

    A. P. Magiorakos

    2017-11-01

    Full Text Available Abstract Background Infections with carbapenem-resistant Enterobacteriaceae (CRE are increasingly being reported from patients in healthcare settings. They are associated with high patient morbidity, attributable mortality and hospital costs. Patients who are “at-risk” may be carriers of these multidrug-resistant Enterobacteriaceae (MDR-E. The purpose of this guidance is to raise awareness and identify the “at-risk” patient when admitted to a healthcare setting and to outline effective infection prevention and control measures to halt the entry and spread of CRE. Methods The guidance was created by a group of experts who were functioning independently of their organisations, during two meetings hosted by the European Centre for Disease Prevention and Control. A list of epidemiological risk factors placing patients “at-risk” for carriage with CRE was created by the experts. The conclusions of a systematic review on the prevention of spread of CRE, with the addition of expert opinion, were used to construct lists of core and supplemental infection prevention and control measures to be implemented for “at-risk” patients upon admission to healthcare settings. Results Individuals with the following profile are “at-risk” for carriage of CRE: a a history of an overnight stay in a healthcare setting in the last 12 months, b dialysis-dependent or cancer chemotherapy in the last 12 months, c known previous carriage of CRE in the last 12 months and d epidemiological linkage to a known carrier of a CRE. Core infection prevention and control measures that should be considered for all patients in healthcare settings were compiled. Preliminary supplemental measures to be implemented for “at-risk” patients on admission are: pre-emptive isolation, active screening for CRE, and contact precautions. Patients who are confirmed positive for CRE will need additional supplemental measures. Conclusions Strengthening the microbiological

  12. Better and more efficient care through ICT-enabled integration of social care and healthcare services: experiences from two European projects

    Science.gov (United States)

    Müller, Sonja; Meyer, Ingo; Kubitschke, Lutz; Delaney, Sarah

    2012-01-01

    at corporate level. Triangulation is used to cross-reference data from different sources in order to maximize the reliability and robustness of conclusions drawn from the evaluation. Based on an overall framework taking into account themes such as integration, user outcomes, staff impact, organisational impact, technology, implementation and overall satisfaction, the specifics of each site are taken into account in operationally applying the overall framework in each case. The designs to be employed at each site have been developed to be as robust as possible, taking into account the constraints of the realities of the interventions. The evaluation is accompanied by a business case modelling approach that builds largely on a cost-benefit analysis covering the service development and implementation activities as well as the pilots and modelling the further deployment of services in each of the pilot sites. The presentation builds upon experiences gained within the framework of two European projects, CommonWell and INDEPENDENT. They are both co-funded under the EU’s Competitiveness and Innovation Framework Programme (CIP) focus on better joining-up of formal social/healthcare services and strengthening participation of the so-called ‘third sector’.

  13. 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.

  14. Reform and Backlash to Reform

    DEFF Research Database (Denmark)

    Hougaard Jensen, Svend E.; Hagen Jørgensen, Ole

    Using a stochastic general equilibrium model with overlapping generations, this paper studies (i) the effects on both extensive and intensive labor supply responses to changes in fertility rates, and (ii) the potential of a retirement reform to mitigate the effects of fertility changes on labor s...

  15. 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

  16. Hacia un nuevo sistema europeo de protección de datos : las claves de la reforma = Towards a new data protection european legal system : the keys of the reform

    Directory of Open Access Journals (Sweden)

    Artemi Rallo Lombarte

    2012-09-01

    reglas procesales y jurisdiccionales. Por último, la nueva normativa busca reforzar una estrategia preventiva eficaz que contemple la protección de la privacidad desde el diseño y por defecto, mediante evaluaciones de impacto, con la existencia de delegados de protección de datos y, ante las transferencias internacionales, reconociendo jurídicamente el valor de las normas corporativas vinculantes. The European Commission has presented legislative initiatives aimed at reforming the European legal system for data protection: a draft General Data Protection Regulation and a draft Directive in the area of Police and Criminal Justice. These proposals represent a comprehensive European data protection legal system review because they support on the basis of a different standard-setting instrument versus the previous Directive 95/46 and addresses new issues which were not being satisfactorily resolved by current rules (for example, the impact of new technologies and the Internet. These initiatives are called to revolutionize the global European data protection framework and make a special impact in the Spanish legal system because of the direct and immediate application of European Regulation and providing new rights to citizens. This new European data protection regulation is marked by a clear trend towards European centralization as evidenced with the strengthening of the powers of the European Commission through the use of the delegated and implementing acts, with the laying down of a common system of penalties which strengthens the repressive policy, with the recognizing of new powers to current institutions and organizations as the European Data Protection Board and the Data Protection European Supervisor and with the forecast of new European procedures for cooperation and consistency to ensure mutual assistance, joint investigations and, ultimately, effective European harmonisation. In addition, this new European framework seeks to address the technological

  17. 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.

  18. The political economy of austerity and healthcare: cross-national analysis of expenditure changes in 27 European nations 1995-2011.

    Science.gov (United States)

    Reeves, Aaron; McKee, Martin; Basu, Sanjay; Stuckler, David

    2014-03-01

    Why have patterns of healthcare spending varied during the Great Recession? Using cross-national, harmonised data for 27 EU countries from 1995 to 2011, we evaluated political, economic, and health system determinants of recent changes to healthcare expenditure. Data from EuroStat, the IMF, and World Bank (2013 editions) were evaluated using multivariate random- and fixed-effects models, correcting for pre-existing time-trends. Reductions in government health expenditure were not significantly associated with magnitude of economic recessions (annual change in GDP, p=0.31, or cumulative decline, p=0.40 or debt crises (measured by public debt as a percentage of GDP, p=0.38 or per capita, p=0.83)). Nor did ideology of governing parties have an effect. In contrast, each $100 reduction in tax revenue was associated with a $2.72 drop in health spending (95% CI: $1.03-4.41). IMF borrowers were significantly more likely to reduce healthcare budgets than non-IMF borrowers (OR=3.88, 95% CI: 1.95 -7.74), even after correcting for potential confounding by indication. Exposure to lending from international financial institutions, tax revenue falls, and decisions to implement cuts correlate more closely than underlying economic conditions or orientation of political parties with healthcare expenditure change in EU member states. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  19. 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.

  20. 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.

  1. 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.

  2. Arbitration Reform

    Directory of Open Access Journals (Sweden)

    Svetlana Stepurina

    2017-01-01

    Full Text Available УДК 347.73:341.63Subject. This informational article highlights recent changes to the Russian legislation on arbitration.Purpose. To highlight the most important aspects of arbitration law reform, and examines the effects they will have on the development of arbitration in RussiaMethodology. The author uses a formal-legal method.Results, scope of application. The author distinguishes the difference between constantly acting arbitration courts and arbitration courts ad hoc. The special status of a number of arbitration institutions (the ICAC and MAC at the Russian Chamber of Commerce and Industry, is contrary to the constitutional principle of equality under the law. A major achievement of the new legislation on arbitration courts is expanding the range arbitrarily disputes.Conclusions. The new legislation more clearly prescribed the interaction of arbitration and state courts, including requiring the latter to promote the arbitrators, acting under the regulations of the permanent arbitration institutions in obtaining evidence.In addition, the reform of the arbitration law have left aside the problem of improving the quality of judicial control over arbitration decisions.The arbitration law will still be able to improve the arbitration, to enhance its credibility and attractiveness for the participants of civil turnover.

  3. Lean healthcare.

    Science.gov (United States)

    Weinstock, Donna

    2008-01-01

    As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

  4. 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...

  5. 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?

    OpenAIRE

    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 exempt...

  6. 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...

  7. 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.

  8. 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.

    Science.gov (United States)

    Geelhoed-Duijvestijn, Petronella H; Pedersen-Bjergaard, Ulrik; Weitgasser, Raimund; Lahtela, Jorma; Jensen, Marie Markert; Östenson, Claes-Göran

    2013-12-01

    Hypoglycemia is a frequent side effect induced by insulin treatment of type 1 (T1DM) and type 2 diabetes (T2DM). Limited data exist on the associated healthcare resource use and patient impact of hypoglycemia, particularly at a country-specific level. This study investigated the effects of self-reported non-severe hypoglycemic events (NSHE) on use of healthcare resources and patient wellbeing. 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, NSHE occurrence in the last 7 days, hypoglycemia-related resource use, and patient impact. NSHE were defined as events with hypoglycemia symptoms, with or without blood glucose measurement, or low blood glucose measurement without symptoms, which the patient could manage without third-party assistance. Three thousand, nine hundred and fifty-nine respondents completed at least one wave of the survey, with 57% completing all four questionnaires; 3827 respondents were used for data analyses. Overall, 2.3% and 8.9% of NSHE in patients with T1DM and T2DM, respectively, resulted in healthcare professional contact. Across countries, there was a mean increase in blood glucose test use of 3.0 tests in the week following a NSHE. Among respondents who were employed (48%), loss of work-time after the last hypoglycemic event was reported for 9.7% of NSHE. Overall, 10.2% (daytime) and 8.0% (nocturnal) NSHE led to work-time loss, with a mean loss of 84.3 (daytime) and 169.6 (nocturnal) minutes among patients reporting work-time loss. Additionally, patients reported feeling tired, irritable, and having negative feelings following hypoglycemia. Direct comparisons between studies must be interpreted with caution because of different definitions of hypoglycemia severity, duration of the studies, and methods of data collection. NSHE were associated with use of extra healthcare resources and work-time loss in all

  9. Healthcare Robotics

    OpenAIRE

    Riek, Laurel D.

    2017-01-01

    Robots have the potential to be a game changer in healthcare: improving health and well-being, filling care gaps, supporting care givers, and aiding health care workers. However, before robots are able to be widely deployed, it is crucial that both the research and industrial communities work together to establish a strong evidence-base for healthcare robotics, and surmount likely adoption barriers. This article presents a broad contextualization of robots in healthcare by identifying key sta...

  10. 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

  11. 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...

  12. 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...

  13. 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…

  14. 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?

  15. 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.

  16. 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.

  17. 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...

  18. 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.

  19. Relations between professional medical associations and healthcare industry, concerning scientific communication and continuing medical education: a policy statement from the European Society of Cardiology.

    Science.gov (United States)

    2012-01-01

    Physicians have an ethical duty to keep up-to-date with current knowledge. Professional medical associations such as the European Society of Cardiology (ESC) support these obligations. In Europe, the costs of continuing medical education (CME) are insufficiently supported from governments and employers; however, medical associations have been criticized for accepting alternative financial support from industry. Medical education and training in research include learning how to assess the quality and reliability of any information. There is some risk of bias in any form of scientific communication including intellectual, professional, and financial and it is essential that in particular, the latter must be acknowledged by full disclosure. It is essential that there is strong collaboration between basic and clinical researchers from academic institutions on the one hand, with engineers and scientists from the research divisions of device and pharmaceutical companies on the other. This is vital so that new diagnostic methods and treatments are developed. Promotion of advances by industry may accelerate their implementation into clinical practice. Universities now frequently exhort their academic staff to protect their intellectual property or commercialize their research. Thus, it is not commercial activity or links per se that have become the target for criticism but the perceived influence of commercial enterprises on clinical decision-making or on messages conveyed by professional medical organizations. This document offers the perspective of the ESC on the current debate, and it recommends how to minimize bias in scientific communications and CME and how to ensure proper ethical standards and transparency in relations between the medical profession and industry. Copyright © 2012. Published by Elsevier España.

  20. Relations between professional medical associations and the health-care industry, concerning scientific communication and continuing medical education: a policy statement from the European Society of Cardiology.

    Science.gov (United States)

    2012-06-01

    Physicians have an ethical duty to keep up-to-date with current knowledge. Professional medical associations such as the European Society of Cardiology (ESC) support these obligations. In Europe, the costs of continuing medical education (CME) are insufficiently supported from governments and employers; however, medical associations have been criticized for accepting alternative financial support from industry. Medical education and training in research include learning how to assess the quality and reliability of any information. There is some risk of bias in any form of scientific communication including intellectual, professional, and financial and it is essential that in particular, the latter must be acknowledged by full disclosure. It is essential that there is strong collaboration between basic and clinical researchers from academic institutions on the one hand, with engineers and scientists from the research divisions of device and pharmaceutical companies on the other. This is vital so that new diagnostic methods and treatments are developed. Promotion of advances by industry may accelerate their implementation into clinical practice. Universities now frequently exhort their academic staff to protect their intellectual property or commercialize their research. Thus, it is not commercial activity or links per se that have become the target for criticism but the perceived influence of commercial enterprises on clinical decision-making or on messages conveyed by professional medical organizations. This document offers the perspective of the ESC on the current debate, and it recommends how to minimize bias in scientific communications and CME and how to ensure proper ethical standards and transparency in relations between the medical profession and industry.

  1. Constitutional reform as process

    OpenAIRE

    Schultze, Rainer-Olaf (Prof.)

    2000-01-01

    Constitutional reform as process. - In: The politics of constitutional reform in North America / Rainer-Olaf Schultze ... (eds.). - Opladen : Leske + Budrich, 2000. - S. 11-31. - (Politikwissenschaftliche paperbacks ; 30)

  2. 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.

  3. 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 ...

  4. 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.

  5. 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.

  6. 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

  7. 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...

  8. 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)....

  9. Healthcare Lean.

    Science.gov (United States)

    Long, John C

    2003-01-01

    Lean Thinking is an integrated approach to designing, doing and improving the work of people that have come together to produce and deliver goods, services and information. Healthcare Lean is based on the Toyota production system and applies concepts and techniques of Lean Thinking to hospitals and physician practices.

  10. 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.

  11. 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.

  12. Lesotho - Land Administration Reform

    Data.gov (United States)

    Millennium Challenge Corporation — Michigan State University was assigned to design the impact evaluation (IE) of the Land Administration Reform Project (LARP) funded under the Millennium Challenge...

  13. Philippines - Revenue Administration Reform

    Data.gov (United States)

    Millennium Challenge Corporation — The Millennium Challenge Account-Philippines' (MCA-P) implementation of the Revenue Administration Reform Project (RARP) is expected to improve tax administration,...

  14. 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

  15. 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)

  16. 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.

  17. Reforma da Atenção Primária em Portugal em duplo movimento: unidades assistenciais autónomas de saúde familiar e gestão em agrupamentos de Centros de Saúde Primary Healthcare Reform in Portugal on two fronts: autonomous family healthcare units and management of groupings of Health Centers

    Directory of Open Access Journals (Sweden)

    Luis Pisco

    2011-06-01

    Full Text Available Analisa-se o processo de reforma da atenção primária à saúde (APS em Portugal de 2005 a abril de 2010, período em que a Missão para os Cuidados de Saúde Primários teve a responsabilidade de conduzir essa profunda reconfiguração da APS Portuguesa. Os principais objectivos da reforma foram: melhorar a acessibilidade, eficiência, qualidade e continuidade dos cuidados e aumentar a satisfação dos profissionais e cidadãos. Suas principais características são a adesão voluntária, trabalho em equipa, existência obrigatória de sistema de informação, pagamento por desempenho, contratualização e avaliação. A reconfiguração dos centros de saúde obedeceu a um duplo movimento: por um lado, formação de pequenas unidades funcionais autónomas, as Unidades de Saúde Familiar (USF, prestando serviços com proximidade e qualidade; por outro lado, a agregação de recursos e estruturas de gestão, os agrupamentos de Centros de Saúde (ACES visando a eficiência e economia de escala. As USF conseguiram simultaneamente mais eficiência, acessibilidade, melhor clima laboral, maior satisfação dos cidadãos, numa palavra, mais qualidade. Salienta-se a importância de um forte apoio político, da criação de uma estrutura responsável pelo desenho e implementação da reforma e de uma boa comunicação social.In 2005, Portugal began a reform of Primary Health Care. This reform process through to April 2010 is described and analyzed. During this period the Mission for Primary Health Care was responsible for conducting a profound reconfiguration. The main objectives for this reform were to improve accessibility, efficiency, quality and continuity of care and increase the satisfaction of professionals and citizens. The main features are voluntary adhesion, teamwork, mandatory information system, performance-sensitive payment, contracting and evaluation. The reconfiguration of health centers was two pronged. First, there was the formation

  18. Reforming Organizational Structures

    NARCIS (Netherlands)

    S.G.J. 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

  19. 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.

  20. 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.

  1. 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...

  2. 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...

  3. 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.

  4. 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

  5. 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

  6. Catalytic reforming methods

    Science.gov (United States)

    Tadd, Andrew R; Schwank, Johannes

    2013-05-14

    A catalytic reforming method is disclosed herein. The method includes sequentially supplying a plurality of feedstocks of variable compositions to a reformer. The method further includes adding a respective predetermined co-reactant to each of the plurality of feedstocks to obtain a substantially constant output from the reformer for the plurality of feedstocks. The respective predetermined co-reactant is based on a C/H/O atomic composition for a respective one of the plurality of feedstocks and a predetermined C/H/O atomic composition for the substantially constant output.

  7. 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.

  8. 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.

  9. 医改背景下医院伦理文化建设与提升医院社会认知的路径探索%On the Construction of Hospital Ethical Culture and Exploration for the Promoting Hospital Social Cognition under the Background of Healthcare Reform

    Institute of Scientific and Technical Information of China (English)

    叶秋玲

    2012-01-01

    在当前医疗卫生改革的大背景下,加强医院伦理文化建设,已成为医院综合实力提升的不可回避且举足轻重的课题.医院须从坚持伦理文化理念创新,打造医院伦理文化品牌;加强伦理管理,完善医院伦理文化体系运行机制;强化医务人员伦理素养建设层面入手,营造伦理道德舆论环境,加强医务人员伦理文化建设,探索提升医院社会认知的路径.%The main problems exists in the current hospital ethical culture construction and hospital social cognition are: the current occupational ethics of medical works are not satisfactory; the hospital managers are insufficiency in innovation; the operating mechanism still needs perfected. Under the background of the healthcare reform , enhancing the hospital ethical culture construction becomes an unavoidable and important issue for improving the comprehensive strength of a hospital. Some suggestions are proposed: hospital should persist in ethical culture theory innovation, create an ethics culture brand; improve the ethical management, establish an operation mechanism for the hospital ethical culture system; strengthen the construction of ethical quality of medical workers, explore some paths for promoting hospital social cognition.

  10. 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.

  11. 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...

  12. 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

  13. 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.

  14. 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…

  15. Social Security Reform

    National Research Council Canada - National Science Library

    Nuschler, Dawn

    2005-01-01

    .... In recent years, reform ideas have ranged from relatively minor changes to the current pay-as-you-go social insurance system to a redesigned program based on personal savings and investments modeled after IRAs and 401(k...

  16. Railway Reform in China.

    OpenAIRE

    Wu, J. H.; Nash, C.

    1998-01-01

    The purpose of this working paper is to consider the current situation of Chinese Railways, the progress of reforms to date, and possible future developments. The first section describes the current problems of Chinese Railways, as a vast organisation subject to strong central control, facing enormous and rapidly growing demands which it is unable to satisfy. The progress of reform in Chinese Railways to date, and in particular the Economic Contract Responsibility System instituted in the lat...

  17. 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

  18. 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.

  19. 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.

  20. 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

  1. 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

  2. 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)

  3. Electronic healthcare information security

    CERN Document Server

    Dube, Kudakwashe; Shoniregun, Charles A

    2010-01-01

    The ever-increasing healthcare expenditure and pressing demand for improved quality and efficiency of patient care services are driving innovation in healthcare information management. The domain of healthcare has become a challenging testing ground for information security due to the complex nature of healthcare information and individual privacy. ""Electronic Healthcare Information Security"" explores the challenges of e-healthcare information and security policy technologies. It evaluates the effectiveness of security and privacy implementation systems for anonymization methods and techniqu

  4. Licensed Healthcare Facilities

    Data.gov (United States)

    California Natural Resource Agency — The Licensed Healthcare Facilities point layer represents the locations of all healthcare facilities licensed by the State of California, Department of Health...

  5. 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

  6. Healthcare beyond reform: doing it right for half the cost

    National Research Council Canada - National Science Library

    Flower, Joe

    2012-01-01

    ... of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in...

  7. Disability Insurance and Healthcare Reform: Evidence from Massachusetts

    OpenAIRE

    Nicole Maestas; Kathleen J. Mullen; Alexander Strand

    2013-01-01

    As health insurance becomes available outside of the employment relationship as a result of the Affordable Care Act (ACA), the cost of applying for Social Security Disability Insurance (SSDI)—potentially going without health insurance coverage during a waiting period totaling 29 months from disability onset—will decline for many people with employer-sponsored health insurance. At the same time, the value of SSDI and Supplemental Security Income (SSI) participation will decline for individuals...

  8. 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....

  9. Health care reforms.

    Science.gov (United States)

    Marušič, Dorjan; Prevolnik Rupel, Valentina

    2016-09-01

    In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

  10. Health care reforms

    Directory of Open Access Journals (Sweden)

    Marušič Dorjan

    2016-09-01

    Full Text Available In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

  11. The Danish Police Reform

    DEFF Research Database (Denmark)

    Degnegaard, Rex; Mark, Sofie

    2013-01-01

    Many cases highlight the need for responsible management in regards to transparency of organisations and involvement of stakeholders in decisions that will impact citizens, patients, customers and/or clients. Often these cases take an outside-in approach as they illustrate why it is essential...... for organisations to work with transparency and involvement with the aim of upholding and further developing a social responsibility to their environment. This case on the other hand takes an inside-out perspective on social responsibility by illustrating how social responsibility is necessary for public......, the reform process was problematic and the following years were challenging and filled with changes and turbulence. Media, politicians and the police itself directed heavy criticism towards the effects of the reform and reviews of the reform as well as of the work of the police were carried out resulting...

  12. 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

  13. 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.

  14. 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.

  15. Determinants of European air traffic development

    Directory of Open Access Journals (Sweden)

    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.

  16. Plasma devices for hydrocarbon reformation

    KAUST Repository

    Cha, Min

    2017-01-01

    Plasma devices for hydrocarbon reformation are provided. Methods of using the devices for hydrocarbon reformation are also provided. The devices can include a liquid container to receive a hydrocarbon source, and a plasma torch configured

  17. Reforming Technical and Technological Education.

    Science.gov (United States)

    Wilson, David N.

    1993-01-01

    Review of technical and technological educational reform in Brazil, Canada, Germany, Great Britain, Indonesia, Malaysia, Singapore, and Sweden shows that reform takes time to complete effectively, long-term approaches are needed, and reform is linked to industrial development, regional cooperation, and decentralized decision making. (SK)

  18. 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

  19. Prisons and Sentencing Reform.

    Science.gov (United States)

    Galvin, Jim

    1983-01-01

    Reviews current themes in sentencing and prison policy. The eight articles of this special issue discuss selective incapacitation, prison bed allocation models, computer-scored classification systems, race and gender relations, commutation, parole, and a historical review of sentencing reform. (JAC)

  20. Comments on regulatory reform

    International Nuclear Information System (INIS)

    Hendrie, J.M.

    1982-01-01

    Nuclear regulatory reform is divided into two parts. The first part contains all those matters for which new legislation is required. The second part concerns all those matters that are within the power of the Commission under existing statutes. Recommendations are presented

  1. Comments on regulatory reform

    Energy Technology Data Exchange (ETDEWEB)

    Hendrie, J.M.

    1982-01-01

    Nuclear regulatory reform is divided into two parts. The first part contains all those matters for which new legislation is required. The second part concerns all those matters that are within the power of the Commission under existing statutes. Recommendations are presented.

  2. Steam reforming of ethanol

    DEFF Research Database (Denmark)

    Trane-Restrup, Rasmus; Dahl, Søren; Jensen, Anker Degn

    2013-01-01

    Steam reforming (SR) of oxygenated species like bio-oil or ethanol can be used to produce hydrogen or synthesis gas from renewable resources. However, deactivation due to carbon deposition is a major challenge for these processes. In this study, different strategies to minimize carbon deposition...

  3. Teenagers and Welfare Reform.

    Science.gov (United States)

    Offner, Paul

    This report examines the extent to which welfare reform is changing adolescent behaviors that lead to welfare dependency. It begins by discussing the provisions in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 that require teenagers to stay in school and live with a parent, concluding that relatively little can be…

  4. Competition and PUHCA reform

    International Nuclear Information System (INIS)

    Williams, P.L.

    1991-01-01

    This article examines the national energy policy legislation being developed with respect to Public Utilities Holding Company Act issues. The topics of the article include the proposals to encourage competition among electric power producers, those involved in the process, qualifying facilities, independent power producers, competition and efficiency, and the outlook for reform

  5. 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.

  6. The 'reformation' of counselling

    Directory of Open Access Journals (Sweden)

    G.A. Lotter

    2001-08-01

    Full Text Available Although the Reformation took place some four hundred years ago, one area in which reformation is really needed today is the counselling of people. Since Wilhelm Wundt started the “study of the mind” in 1879, William James and Sigmund Freud followed and secular psychology gradually has developed to take the “front seat”; hence moving Biblical counselling, which has been practised since the times of the New Testament, to the “back burner”. This development had been going on for the greater part of the 20th century, up to the publication of Competent to Counsel by Jay E. Adams in 1970. In the model for counselling suggested by Adams, the principles of the Reformation of the sixteenth century, Soli Deo Gloria, Soli Scriptura, Soli Fidei, Sola Gratia, etc. were again implemented in assisting and counselling people with personal and interpersonal problems. The epistomological and anthropological approach of secular psychology differs radically from that of Biblical principles, thus necessitating a new “reformation” of counselling. Within this new form counselling, inter alia, implies the following: the Word of God has its rightful place, sin has to be taken seriously and the work of the Holy Spirit should be recognised. In this article it is proposed that the “reformation” of counselling was started by scholars with a Biblical Reformational approach and that this method of counselling followed the parameters of the Reformation of the sixteenth century. This “reformation” developed into a new direction in counselling and still continues today with fascinating new frontiers opening up for Biblical counselling.

  7. European Union

    International Nuclear Information System (INIS)

    Schaller, K.

    1995-01-01

    Different instruments used by European Commission of the European Union for financial support radioactive waste management activities in the Russian Federation are outlined. Three particular programmes in the area are described

  8. 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.

  9. Plasma devices for hydrocarbon reformation

    KAUST Repository

    Cha, Min Suk

    2017-02-16

    Plasma devices for hydrocarbon reformation are provided. Methods of using the devices for hydrocarbon reformation are also provided. The devices can include a liquid container to receive a hydrocarbon source, and a plasma torch configured to be submerged in the liquid. The plasma plume from the plasma torch can cause reformation of the hydrocarbon. The device can use a variety of plasma torches that can be arranged in a variety of positions in the liquid container. The devices can be used for the reformation of gaseous hydrocarbons and/or liquid hydrocarbons. The reformation can produce methane, lower hydrocarbons, higher hydrocarbons, hydrogen gas, water, carbon dioxide, carbon monoxide, or a combination thereof.

  10. 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

  11. 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.

  12. 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.

  13. 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

  14. 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.

  15. Health-care reform or labor market reform? A quantitative analysis of the affordable care act

    OpenAIRE

    Nakajima, Makoto; Tuzemen, Didem

    2015-01-01

    The Patient Protection and Affordable Care Act (ACA) requires all individuals to have health insurance, and introduces penalties to large firms that do not offer affordable coverage to their employees. While the possible effects of the ACA on the insurance decision of individuals have been studied, what is less studied is how the ACA can affect labor demand. In particular, since the ACA does not require small firms to offer health insurance, and does not require firms to offer health insuranc...

  16. 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

  17. 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

  18. 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

  19. 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

  20. Reforming process. Reformierungsverfahren

    Energy Technology Data Exchange (ETDEWEB)

    McCoy, C.S.

    1982-05-19

    A naphta fraction is subjected to a catalytic reforming process in several series-connected reactors. The first reactor is equipped with a moving catalyst bed containing not more the 30% of volume of the total catalyst amount. The other reactors are designed as packed-bed systems. The content of coke deposited on the catalyst of the first reactor owing to the reforming process is maintained at below 1% of weight. This is effected by periodic removal of a proportion of the contaminated catalyst from the bottom part of the bed, by its regeneration and re-feeding to the top part of the bed. This results in prolonged service life of the catalyst and simultaneous improvement of the anti-knock value of the product.

  1. Implementing Security Sector Reform

    Science.gov (United States)

    2008-12-04

    ownership and genuine reform. His experience in Diyala Province indicated that the most effective means of pursuing transition and transformation among...that I have no solution to the security situation in Afghanistan, or to the questions of violence, crime, insurrection, or militias vs . army vs ...than to merge those interests into a greater whole. Franchising of problems or solutions is often the result. In Afghanistan, problems and

  2. 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

  3. 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.

  4. Cooperação interprofissional e a Reforma Sanitária no Brasil: implicações para o modelo de atenção à saúde Interprofessional collaboration and the Brazilian Sanitary Reform: implications for delivery of healthcare

    Directory of Open Access Journals (Sweden)

    Caroline Guinoza Matuda

    2013-03-01

    which has required more intensive process of professional interaction. The aim of this article was to review the knowledge related to interprofessional collaboration as a research issue highlighting its importance for understanding of the relations among workers in the production of care within Brazilian health system. Historical characteristics that marked the health sector reforms in the world and particularly in the Brazil were summed up. Based on review studies, knowledge about interprofessional collaboration were summarized focusing definitions, theoretical models and the observed results. An approach directed to comprehension of process and relations implicated to the problem is indicated in order to surmount the barriers connected to the need for a more effective, efficient and equitable health care model. For this it is necessary to admit the professional as a social agent bearer of an interested practice considering that thinking frameworks as organizations and overall structure denote social construct. The understanding of the forces that guide the interprofessional conflict and collaboration may subsidize the formulation of strategies for improving healthcare in Brazilian health system.

  5. 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.

  6. Atomic energy in healthcare

    International Nuclear Information System (INIS)

    Gupta, Sudeep; Rangarajan, Venkatesh; Thakur, Meenakshi; Parmar, Vani; Jalali, Rakesh; Ashgar, Ali; Pramesh, C.S.; Shrivastava, Shyam; Badwe, Rajendra

    2013-01-01

    One of the socially important non-power programmes of the DAE is in the beneficial use of radiation and related techniques for healthcare. The diagnosis and therapy aspects of radiation based healthcare are discussed in this article. (author)

  7. Communicating with Healthcare Professionals

    Science.gov (United States)

    ... at follow-up appointments by talking with your healthcare team about your concerns, asking questions and getting ... from the time you spend with all your healthcare providers, not just your doctor. Use the skills ...

  8. European communion

    DEFF Research Database (Denmark)

    Manners, Ian James

    2013-01-01

    Political theory of European union, through an engagement between political concepts and theoretical understandings, provides a means of identifying the EU as a political object. It is argued that understanding the projects, processes and products of European union, based on ‘sharing’ or ‘communion......’, provides a better means of perceiving the EU as a political object rather than terms such as ‘integration’ or ‘co-operation’. The concept of ‘European communion’ is defined as the ‘subjective sharing of relationships’, understood as the extent to which individuals or groups believe themselves to be sharing...... relations (or not), and the consequences of these beliefs for European political projects, processes and products. By exploring European communion through an engagement with contemporary political theory, using very brief illustrations from the Treaty of Lisbon, the article also suggests that European...

  9. Healthcare. Executive Summary

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This executive summary highlights several findings about healthcare. These are: (1) Healthcare is 18 percent of the U.S. economy, twice as high as in other countries; (2) There are two labor markets in healthcare: high-skill, high-wage professional and technical jobs and low-skill, low-wage support jobs; (3) Demand for postsecondary education in…

  10. Economic Reforms and Constitutional Transition

    OpenAIRE

    Jeffrey D. Sachs; Wing Thye Woo; Xiaokai Yang

    2000-01-01

    This paper investigates the relationship between economic reforms and constitutional transition, which has been neglected by many transition economists. It is argued that assessment of reform performance might be very misleading if it is not recognized that economic reforms are just a small part of large scale of constitutional transition. Rivalry and competition between states and between political forces within each country are the driving forces for constitutional transition. We use Russia...

  11. Security Sector Reform in Albania

    OpenAIRE

    Abazi, Enika; Bumci, Aldo; Hide, Enri; Rakipi, Albert

    2009-01-01

    International audience; This paper analyses security sector reform (SSR) in Albania. In all its enterprises in reforming the security sector,Albania is assisted by different initiatives and projects that provide expertise and financial support. To assesswhether reforms improved the overall security environment (national and human) of the country, it is necessaryto measure the effectiveness of the various initiatives and projects. This is gauged by how well the initiatives andprojects achieved...

  12. 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

  13. 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....

  14. Education Reform in Hong Kong

    Directory of Open Access Journals (Sweden)

    Chris Dowson

    2000-05-01

    Full Text Available Since the early 1990s, the pace of educational reform in Hong Kong has accelerated and broadened to incorporate almost all areas of schooling. The reforms introduced during this period can be subsumed under what has generally been labelled the quality movement. In this paper, we review and comment on a number of policy reform initiatives in the four areas of "Quality Education," English Language Benchmarking, Initial Teacher Training and the Integration of Pupils with Special Needs into Ordinary Classrooms. Following a brief description of each policy initiative, the reforms are discussed in terms of their consistency, coherence and cultural fit.

  15. Steam reformer with catalytic combustor

    Science.gov (United States)

    Voecks, Gerald E. (Inventor)

    1990-01-01

    A steam reformer is disclosed having an annular steam reforming catalyst bed formed by concentric cylinders and having a catalytic combustor located at the center of the innermost cylinder. Fuel is fed into the interior of the catalytic combustor and air is directed at the top of the combustor, creating a catalytic reaction which provides sufficient heat so as to maintain the catalytic reaction in the steam reforming catalyst bed. Alternatively, air is fed into the interior of the catalytic combustor and a fuel mixture is directed at the top. The catalytic combustor provides enhanced radiant and convective heat transfer to the reformer catalyst bed.

  16. 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.

  17. Reform Drivers and Reform Obstacles in Natural Resource Management

    DEFF Research Database (Denmark)

    Gezelius, Stig S.; Raakjær, Jesper; Hegland, Troels Jacob

    2010-01-01

    ABSTRACT: The ability to transform historical learning into institutional reform is a key to success in the management of common pool natural resources. Based on a model of institutional inertia and a comparative analysis of Northeast Atlantic fisheries management from 1945 to the present....... Institutional inertia entails that large-scale management reform tends to be crisis driven....

  18. Turkish electricity reform

    Energy Technology Data Exchange (ETDEWEB)

    Bagdadioglu, Necmiddin [Department of Public Finance, Hacettepe University, 06800 Ankara (Turkey); Odyakmaz, Necmi [E.ON Holding, Armada Business Centre, 06520 Ankara (Turkey)

    2009-03-15

    Turkish electricity reform has progressed slowly due to internal resistance against privatisation, and gained momentum after Electricity Market Law of 2001, prepared in line with EU Energy Acquis and established required institutional and legal framework. Although the eligibility threshold has reached 39% market opening rate, the dominant position of public both as owner and decision-maker is still the major problem in the sector. Currently Turkey is self-sufficient in electricity, but likely to face shortages in 10 years if the growing demand is not met by either speeding the liberalisation process, or joining the South East Europe Electricity Market. (author)

  19. Novel Reforming Catalysts

    Energy Technology Data Exchange (ETDEWEB)

    Pfefferle, Lisa D; Haller, Gary L

    2012-10-16

    Aqueous phase reforming is useful for processing oxygenated hydrocarbons to hydrogen and other more useful products. Current processing is hampered by the fact that oxide based catalysts are not stable under high temperature hydrothermal conditions. Silica in the form of structured MCM-41 is thermally a more stable support for Co and Ni than conventional high surface area amorphous silica but hydrothermal stability is not demonstrated. Carbon nanotube supports, in contrast, are highly stable under hydrothermal reaction conditions. In this project we show that carbon nanotubes are stable high activity/selectivity supports for the conversion of ethylene glycol to hydrogen.

  20. 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...

  1. European Institutions?

    NARCIS (Netherlands)

    Meacham, Darian

    2016-01-01

    The aim of this article is to sketch a phenomenological theory of political institutions and to apply it to some objections and questions raised by Pierre Manent about the project of the European Union and more specifically the question of “European Construction”, i.e. what is the aim of the

  2. European Whiteness?

    DEFF Research Database (Denmark)

    Blaagaard, Bolette

    2008-01-01

    Born out of the United States’ (U.S.) history of slavery and segregation and intertwined with gender studies and feminism, the field of critical whiteness studies does not fit easily into a European setting and the particular historical context that entails. In order for a field of European...

  3. 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...

  4. Reforming Social Policy: Changing Perspectives on Sustainable ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Reforming Social Policy presents an overview of social policy reforms currently ... It shows how some experimental approaches to reform have worked in different ... and students in development studies and social sciences; policymakers and ...

  5. 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.

  6. 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.

  7. 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.

  8. Small School Reform

    Directory of Open Access Journals (Sweden)

    Carroll E. Bronson

    2013-05-01

    Full Text Available This qualitative ethnographic case study explored the evolution of a public urban high school in its 3rd year of small school reform. The study focused on how the high school proceeded from its initial concept, moving to a small school program, and emerging as a new small high school. Data collection included interviews, observations, and document review to develop a case study of one small high school sharing a multiplex building. The first key finding, “Too Many Pieces, Not Enough Glue,” revealed that the school had too many new programs starting at once and they lacked a clear understanding of their concept and vision for their new small school, training on the Montessori philosophies, teaching and learning in small schools, and how to operate within a teacher-cooperative model. The second key finding, “A Continuous Struggle,” revealed that the shared building space presented problems for teachers and students. District policies remain unchanged, resulting in staff and students resorting to activist approaches to get things done. These findings offer small school reform leaders suggestions for developing and sustaining a small school culture and cohesion despite the pressures to revert back to top-down, comprehensive high school norms.

  9. Ecological tax reform

    International Nuclear Information System (INIS)

    1996-01-01

    An environmental tax reform is seen by many as a possible solution to some crucial problems of modern society - pollution, excessive resource consumption and unemployment. Changes in the system of taxation are here seen as a long term process, one that must cheapen the costs of labour and make the costs of resource use more expensive - a process which can also create major changes in our society as to conceptions of quality, work, consumption etc. The conference presented proposals for an ecological tax and duty system that would contribute to: Changing technology so that it becomes more resource and energy effective. Changing the economic mechanisms so that resource consumption and pollution become more expensive while human resources become cheaper. Changing personal life styles and values so that material consumption becomes less decisive for our choices and priorities. An environmental tax reform is neither without problems nor painless. An economy and an industrial sector based on increasing consumption of energy and raw materials will, in the long run, lead to drawbacks that far outweigh those that are connected with an economic re-orientation whose driving force is another conception of nature. (EG)

  10. Ecological tax reform

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-12-31

    An environmental tax reform is seen by many as a possible solution to some crucial problems of modern society - pollution, excessive resource consumption and unemployment. Changes in the system of taxation are here seen as a long term process, one that must cheapen the costs of labour and make the costs of resource use more expensive - a process which can also create major changes in our society as to conceptions of quality, work, consumption etc. The conference presented proposals for an ecological tax and duty system that would contribute to: Changing technology so that it becomes more resource and energy effective. Changing the economic mechanisms so that resource consumption and pollution become more expensive while human resources become cheaper. Changing personal life styles and values so that material consumption becomes less decisive for our choices and priorities. An environmental tax reform is neither without problems nor painless. An economy and an industrial sector based on increasing consumption of energy and raw materials will, in the long run, lead to drawbacks that far outweigh those that are connected with an economic re-orientation whose driving force is another conception of nature. (EG)

  11. Pension Reform in China.

    Science.gov (United States)

    Liu, Tao; Sun, Li

    2016-01-01

    This article analyzes China's pension arrangement and notes that China has recently established a universal non-contributory pension plan covering urban non-employed workers and all rural residents, combined with the pension plan covering urban employees already in place. Further, in the latest reform, China has discontinued the special pension plan for civil servants and integrated this privileged welfare class into the urban old-age pension insurance program. With these steps, China has achieved a degree of universalism and integration of its pension arrangement unprecedented in the non-Western world. Despite this radical pension transformation strategy, we argue that the current Chinese pension arrangement represents a case of "incomplete" universalism. First, its benefit level is low. Moreover, the benefit level varies from region to region. Finally, universalism in rural China has been undermined due to the existence of the "policy bundle." Additionally, we argue that the 2015 pension reform has created a situation in which the stratification of Chinese pension arrangements has been "flattened," even though it remains stratified to some extent.

  12. Ecological tax reform

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-12-31

    An environmental tax reform is seen by many as a possible solution to some crucial problems of modern society - pollution, excessive resource consumption and unemployment. Changes in the system of taxation are here seen as a long term process, one that must cheapen the costs of labour and make the costs of resource use more expensive - a process which can also create major changes in our society as to conceptions of quality, work, consumption etc. The conference presented proposals for an ecological tax and duty system that would contribute to: Changing technology so that it becomes more resource and energy effective. Changing the economic mechanisms so that resource consumption and pollution become more expensive while human resources become cheaper. Changing personal life styles and values so that material consumption becomes less decisive for our choices and priorities. An environmental tax reform is neither without problems nor painless. An economy and an industrial sector based on increasing consumption of energy and raw materials will, in the long run, lead to drawbacks that far outweigh those that are connected with an economic re-orientation whose driving force is another conception of nature. (EG)

  13. 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...

  14. Common morality and moral reform.

    Science.gov (United States)

    Wallace, K A

    2009-01-01

    The idea of moral reform requires that morality be more than a description of what people do value, for there has to be some measure against which to assess progress. Otherwise, any change is not reform, but simply difference. Therefore, I discuss moral reform in relation to two prescriptive approaches to common morality, which I distinguish as the foundational and the pragmatic. A foundational approach to common morality (e.g., Bernard Gert's) suggests that there is no reform of morality, but of beliefs, values, customs, and practices so as to conform with an unchanging, foundational morality. If, however, there were revision in its foundation (e.g., in rationality), then reform in morality itself would be possible. On a pragmatic view, on the other hand, common morality is relative to human flourishing, and its justification consists in its effectiveness in promoting flourishing. Morality is dependent on what in fact does promote human flourishing and therefore, could be reformed. However, a pragmatic approach, which appears more open to the possibility of moral reform, would need a more robust account of norms by which reform is measured.

  15. 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)

  16. The Danish Regulatory Reform of Telecommunications

    DEFF Research Database (Denmark)

    Skouby, Knud Erik

    1998-01-01

    An overview of the liberalisation process and regulatory reform of telecommunications in Denmark......An overview of the liberalisation process and regulatory reform of telecommunications in Denmark...

  17. Implementing Comprehensive Reform: Implications for Practice

    Science.gov (United States)

    Stout, Karen A.

    2016-01-01

    This chapter describes the challenges and practical barriers community colleges face when implementing comprehensive reform, exploring how reforms are leading to some improvements but not often scaled improvements.

  18. 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

  19. Selective Europeanization

    DEFF Research Database (Denmark)

    Hoch Jovanovic, Tamara; Lynggaard, Kennet

    2014-01-01

    and rules. The article examines the reasons for both resistance and selectiveness to Europeanization of the Danish minority policy through a “path dependency” perspective accentuating decision makers’ reluctance to deviate from existing institutional commitments, even in subsequently significantly altered...... political contexts at the European level. We further show how the “translation” of international norms to a domestic context has worked to reinforce the original institutional setup, dating back to the mid-1950s. The translation of European-level minority policy developed in the 1990s and 2000s works most...

  20. Public Administration reforms and results

    Directory of Open Access Journals (Sweden)

    Gunnar Helgi Kristinsson

    2014-12-01

    Full Text Available Research on administrative reforms during the past thirty years indicates that reform efforts of countries differ. The Anglo Saxon states were at the forefront of the New Public Management movement while countries on mainland Europe were more hesitant and moved further towards the Neo-Weberian state. Academics have tried to explain different reform efforts within countries by looking at political, historical and cultural issues, values and economic factors to name just a few. Three hypotheses are put forward to explain reform efforts in different states. This research involves analysing the implementation of two different reform trends, New Public Management and the Neo-Weberian tradition. The analysis indicates that countries vary in their commitment to reform rather than in the emphasis on either New Public Management or the Neo-Weberian State. Decentralization, clear objectives and consultation with communities and experts are closely related to national reform efforts. However, Iceland does distinguish itself from Europe and the Nordic countries. The analysis reveals that although decentralization is high in the Icelandic system, autonomy of agencies does not have a strong relation to a varied use of administrative instruments. The second part of the article focuses on the results and achievements of reform programmes. The achievement of reform programmes are examined in relation to theories of bounded rationality, street level bureaucracy (bottom up and consensus decision making. Three hypotheses are presented and tested to explain what causes reforms programmes to be successful in some countries and not in others. The analysis reveals that countries are more likely to succeed if bounded rationality is applied with careful preparation and when stakeholders are consulted.

  1. 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.

  2. Green fiscal reform and employment. A survey

    International Nuclear Information System (INIS)

    Majocchi, A.

    1996-01-01

    In the European debate an increase in employment is generally regarded as an important extra-dividend - in addition to improved environmental quality - from environmental taxes. The scope of this paper is to evaluate, going through the existing empirical literature, if - and to what degree - this result could be achieved through a green fiscal reform. A further goal of this paper is to assess which taxes are more efficient in terms of employment-creation when they are utilized for recycling back to the economy the revenue flowing from environmental taxes. This kind of exercise is largely different from the theoretical analysis of the double dividend issue. A large quantity of literature has grown during the recent years according to this approach, but this version of the double dividend theory will be disregarded in this paper. 8 tabs., 38 refs

  3. 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.

  4. European Security

    DEFF Research Database (Denmark)

    Møller, Bjørn

    Theoretical chapters on "Security", "Organisations" and "Regions," Historical Chapters on "Europe and Its Distinguishing Features" and on "The United Nations," "NATO," "The CSCE/OSCE and the Council of Europe" and "The European Union"......Theoretical chapters on "Security", "Organisations" and "Regions," Historical Chapters on "Europe and Its Distinguishing Features" and on "The United Nations," "NATO," "The CSCE/OSCE and the Council of Europe" and "The European Union"...

  5. CONSIDERATIONS REGARDING THE REFORM OF THE EUROPEAN FINANCIAL SUPERVISION SYSTEM

    Directory of Open Access Journals (Sweden)

    Persida Cechin Crista

    2012-01-01

    Full Text Available Financial stability has a crucial role in the financial system and in the economy as a whole, as shown by the current worldwide economic crisis. Therefore, in order to protect the financial system and to ensure financial stability, the identification of the main risk and vulnerability sources is of utmost importance. All involved parties, as well as financial institutions and supervision authorities need to be informed about the risks.Banks, insurance companies and other financial institutions represent the first line of defence against financial crises. These institutions are responsible for maintaining their viability and solvency, as well as for checking the debtors’ credit worthiness and for managing the undertaken risks.

  6. Reforming European universities: Scope for an evidence-based process

    NARCIS (Netherlands)

    Veugelers, R.; van der Ploeg, F.; Dewatripont, M.; Thys-Clément, F.; Wilkin, L.

    2008-01-01

    Universities are key players in the successful transition to a knowledge-based economy and society. However, this crucial sector of society needs restructuring if Europe is not to lose out in the global competition in education, research and innovation. To allow a more evidence based process of

  7. Drug Pricing Reforms

    DEFF Research Database (Denmark)

    Kaiser, Ulrich; Mendez, Susan J.; Rønde, Thomas

    2015-01-01

    Reference price systems for prescription drugs have found widespread use as cost containment tools. Under such regulatory regimes, patients co-pay a fraction of the difference between pharmacy retail price of the drug and a reference price. Reference prices are either externally (based on drug...... prices in other countries) or internally (based on domestic drug prices) determined. In a recent study, we analysed the effects of a change from external to internal reference pricing in Denmark in 2005, finding that the reform led to substantial reductions in prices, producer revenues, and expenditures...... for patients and the health insurance system. We also estimated an increase in consumer welfare but the size effect depends on whether or not perceived quality differences between branded and other drugs are taken into account....

  8. 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...

  9. European Community.

    Science.gov (United States)

    1987-05-01

    The European Community was established in 1951 to reconcile France and Germany after World War II and to make possible the eventual federation of Europe. By 1986, there were 12 member countries: France, Italy, Belgium, the Federal Republic of Germany, Luxembourg, the Netherlands, Denmark, Ireland, the United Kingdom, Greece, Spain, and Portugal. Principal areas of concern are internal and external trade, agriculture, monetary coordination, fisheries, common industrial and commercial policies, assistance, science and research, and common social and regional policies. The European Community has a budget of US$34.035 billion/year, funded by customs duties and 1.4% of each member's value-added tax. The treaties establishing the European Community call for members to form a common market, a common customs tariff, and common agricultural, transport, economic, and nuclear policies. Major European Community institutions include the Commission, Council of Ministers, European Parliament, Court of Justice, and Economic and Social Committee. The Community is the world's largest trading unit, accounting for 15% of world trade. The 2 main goals of the Community's industrial policy are to create an open internal market and to promote technological innovation in order to improve international competitiveness. The European Community aims to contribute to the economic and social development of Third World countries as well.

  10. Why healthcare providers merge.

    Science.gov (United States)

    Postma, Jeroen; Roos, Anne-Fleur

    2016-04-01

    In many OECD countries, healthcare sectors have become increasingly concentrated as a result of mergers. However, detailed empirical insight into why healthcare providers merge is lacking. Also, we know little about the influence of national healthcare policies on mergers. We fill this gap in the literature by conducting a survey study on mergers among 848 Dutch healthcare executives, of which 35% responded (resulting in a study sample of 239 executives). A total of 65% of the respondents was involved in at least one merger between 2005 and 2012. During this period, Dutch healthcare providers faced a number of policy changes, including increasing competition, more pressure from purchasers, growing financial risks, de-institutionalisation of long-term care and decentralisation of healthcare services to municipalities. Our empirical study shows that healthcare providers predominantly merge to improve the provision of healthcare services and to strengthen their market position. Also efficiency and financial reasons are important drivers of merger activity in healthcare. We find that motives for merger are related to changes in health policies, in particular to the increasing pressure from competitors, insurers and municipalities.

  11. [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.

  12. 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...

  13. 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.

  14. Gender inequality indices for the European partnership countries comparison

    Directory of Open Access Journals (Sweden)

    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.

  15. On being African and Reformed? Towards an African Reformed ...

    African Journals Online (AJOL)

    2014-06-17

    Jun 17, 2014 ... It is furthermore our contention that the notion of culture and African worldviews was always perceived negatively ..... dean of the South East Asia Graduate School of Theology. He later .... Another Reformed church for Indian.

  16. on the accra document, reformed theology and reformed ecclesiology

    African Journals Online (AJOL)

    2009-12-14

    Dec 14, 2009 ... Many churches and ecumenical bodies have already responded, in diverse ways ..... and contains a number of practical commitments and appeals. (par. ..... rhetorical power and emotion that it seemingly has for Reformed.

  17. 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.

  18. 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.

  19. Stormy Weather in Healthcare

    DEFF Research Database (Denmark)

    Clemensen, Jane; Jakobsen, Pernille Ravn; Myhre Jensen, Charlotte

    2017-01-01

    and healthcare professionals, by a dominant paradigm. We suggest a shift in focus from valuing the neo-liberal approach, to focus on care by linking an Ecology of Care (EoC) approach to the healthcare context, as EoC can be used as a complementary philosophy to help change the paradigm and thereby secure...

  20. Healthcare. State Report

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This report projects education requirements linked to forecasted job growth in healthcare by state and the District of Columbia from 2010 through 2020. It complements a larger national report which projects educational demand for healthcare for the same time period. The national report shows that with or without Obamacare, the United States will…

  1. European visit

    CERN Multimedia

    2006-01-01

    The European Commissioner for Science and Research, Janez Potočnik, (on the right) visited the CMS assembly hall accompanied by Jim Virdee, Deputy Spokesman of CMS (on the left), and Robert Aymar, Director-General of CERN. The European Commissioner for Science and Research, Janez Potočnik, visited CERN on Tuesday 31 January. He was welcomed by the Director-General, Robert Aymar, who described the missions and current activities of CERN to him, in particular the realisation of the LHC with its three components: accelerator, detectors, storage and processing of data. The European Commissioner then visited the CMS assembly hall, then the hall for testing the LHC magnets and the ATLAS cavern. During this first visit since his appointment at the end of 2004, Janez Potočnik appeared very interested by the operation of CERN, an example of successful scientific co-operation on a European scale. The many projects (30 on average) that CERN and the European Commission carry out jointly for the benefit of res...

  2. 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.

  3. 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

  4. Migrants' access to healthcare

    DEFF Research Database (Denmark)

    Norredam, Marie

    2011-01-01

    There are strong pragmatic and moral reasons for receiving societies to address access to healthcare for migrants. Receiving societies have a pragmatic interest in sustaining migrants' health to facilitate integration; they also have a moral obligation to ensure migrants' access to healthcare...... according to international human rights principles. The intention of this thesis is to increase the understanding of migrants' access to healthcare by exploring two study aims: 1) Are there differences in migrants' access to healthcare compared to that of non-migrants? (substudy I and II); and 2) Why...... are there possible differences in migrants' access to healthcare compared to that of non-migrants? (substudy III and IV). The thesis builds on different methodological approaches using both register-based retrospective cohort design, cross-sectional design and survey methods. Two different measures of access were...

  5. Contract Reform Self Assessment Report

    National Research Council Canada - National Science Library

    1997-01-01

    The primary objective of this self assessment is to report on the Department of Energy's progress in implementing the Contract Reform initiative launched in February 1994 and to discuss remaining challenges...

  6. Applications of solar reforming technology

    Energy Technology Data Exchange (ETDEWEB)

    Spiewak, I. [Weizmann Inst. of Science, Rehovoth (Israel); Tyner, C.E. [Sandia National Labs., Albuquerque, NM (United States); Langnickel, U. [Deutsche Forschungsanstalt fuer Luft- und Raumfahrt e.V. (DLR), Koeln (Germany)

    1993-11-01

    Research in recent years has demonstrated the efficient use of solar thermal energy for driving endothermic chemical reforming reactions in which hydrocarbons are reacted to form synthesis gas (syngas). Closed-loop reforming/methanation systems can be used for storage and transport of process heat and for short-term storage for peaking power generation. Open-loop systems can be used for direct fuel production; for production of syngas feedstock for further processing to specialty chemicals and plastics and bulk ammonia, hydrogen, and liquid fuels; and directly for industrial processes such as iron ore reduction. In addition, reforming of organic chemical wastes and hazardous materials can be accomplished using the high-efficiency destruction capabilities of steam reforming. To help identify the most promising areas for future development of this technology, we discuss in this paper the economics and market potential of these applications.

  7. European hadrons

    International Nuclear Information System (INIS)

    Anon.

    1986-01-01

    The European Hadron Facility (EHF) is a project for particle and nuclear physics in the 1990s which would consist of a fast cycling high intensity proton synchrotron of about 30 GeV primary energy and providing a varied spectrum of intense high quality secondary beams (polarized protons, pions, muons, kaons, antiprotons, neutrinos). The physics case of this project has been studied over the last two years by a European group of particle and nuclear physicists (EHF Study Group), whilst the conceptual design for the accelerator complex was worked out (and is still being worked on) by an international group of machine experts (EHF Design Study Group). Both aspects have been discussed in recent years in a series of working parties, topical seminars, and workshops held in Freiburg, Trieste, Heidelberg, Karlsruhe, Les Rasses and Villigen. This long series of meetings culminated in the International Conference on a European Hadron Facility held in Mainz from 10-14 March

  8. Financial reform lessons and strategies

    OpenAIRE

    Caprio Jr, Gerard; Atiyas, Izak; Hanson, James

    1993-01-01

    The argument in favor of gradual - but sustained - financial reform is based on two factors. First, the development of borrower net worth will determine the health of the real and, ultimately, the financial sector. Thus, speeding up reforms when borrower net worth is subject to positive shocks - or slowing them when it is subject to negative shocks - appears sensible and appears to have worked better in practice. Second, the initial conditions of the banking sector - not just its net worth bu...

  9. Misrecognition and science education reform

    Science.gov (United States)

    Brandt, Carol B.

    2012-09-01

    In this forum, I expand upon Teo and Osborne's discussion of teacher agency and curriculum reform. I take up and build upon their analysis to further examine one teacher's frustration in enacting an inquiry-based curriculum and his resulting accommodation of an AP curriculum. In this way I introduce the concept of misrecognition (Bourdieu and Passeron 1977) to open up new ways of thinking about science inquiry and school reform.

  10. Reforming health care in Hungary.

    Science.gov (United States)

    Császi, L; Kullberg, P

    1985-01-01

    Over the past two decades Hungary has initiated a series of social and economic reforms which have emphasized decentralization of control and the reintroduction of market mechanisms into the socialized economy. These reforms both reflect and reinforce a changing social structure, in particular the growing influence of upper class special interest groups. Market reforms are an expression of concurrent ideological shifts in Hungarian society. We examined the political significance of three recent proposals to reform health services against the backdrop of broader social and economic changes taking place. The first proposes a bureaucratic reorganization, the second, patient co-payments, and the third, a voucher system. The problems each proposal identifies, as well as the constituency each represents, reveal a trend toward consolidation of class structure in Hungary. Only one of these proposals has any potential to democratize the control and management of the heath care system. Moreover, despite a governmental push toward decentralization, two of these proposals would actually increase centralized bureaucratic control. Two of the reforms incorporate market logic into their arguments, an indication that the philosophical premises of capitalism are re-emerging as an important component of the Hungarian world-view. In Hungary, as well as in other countries, social analysis of proposed health care reforms can effectively illuminate the social and political dynamics of the larger society.

  11. 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.

  12. 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.

  13. 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.

  14. Strategies for healthcare information systems

    NARCIS (Netherlands)

    Stegwee, R.A.; Spil, Antonius A.M.

    2001-01-01

    Information technologies of the past two decades have created significant fundamental changes in the delivery of healthcare services by healthcare provider organizations. Many healthcare organizations have been in search of ways and strategies to keep up with continuously emerging information

  15. Recommended Vaccines for Healthcare Workers

    Science.gov (United States)

    ... Vaccination Resources for Healthcare Professionals Recommended Vaccines for Healthcare Workers Recommend on Facebook Tweet Share Compartir On ... for More Information Resources for Those Vaccinating HCWs Healthcare workers (HCWs) are at risk for exposure to ...

  16. 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...

  17. 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...

  18. 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)

  19. European Cinema

    NARCIS (Netherlands)

    Elsaesser, Thomas

    2005-01-01

    In the face of renewed competition from Hollywood since the early 1980s and the challenges posed to Europe's national cinemas by the fall of the Wall in 1989, independent filmmaking in Europe has begun to re-invent itself. European Cinema: Face to Face with Hollywood re-assesses the different

  20. Turnover among healthcare professionals.

    Science.gov (United States)

    Wood, Ben D

    2009-01-01

    Turnover among healthcare professionals is a costly consequence. The existing body of knowledge on healthcare professional turnover is correlated with job satisfaction levels. A landmark study differentiated 2 areas of job satisfaction categories: satisfiers and dissatisfiers (intrinsic and extrinsic motivators). The aim of this article is to examine existing research on precursors of turnover, such as burnout behaviors experienced by healthcare professionals, job satisfaction levels, employee organizational commitment, health complications which precede turnover, some current strategies to reduce turnover, and some effects CEO turnover has on employee turnover intentions.

  1. 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...

  2. 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.

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

    Science.gov (United States)

    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…

  4. 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...

  5. 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…

  6. 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…

  7. 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…

  8. 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…

  9. 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

  10. 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

  11. 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.

  12. Reforming Preschools and Schools.

    Science.gov (United States)

    Duncan, Greg J; Magnuson, Katherine; Murnane, Richard J

    2016-04-01

    Compared with their higher-income counterparts, children growing up in low-income families in the United States typically complete less schooling, report worse health, and work and earn less in adulthood. Moreover, changes in the American economy over the last 40 years have raised the level of skills and qualifications that children need to obtain a good middle-class job, as well as making it much more difficult for children from low-income families to attend schools that support their learning of these skills. We first review strategies used in the past to improve K-12 schooling-including investing more money, introducing more accountability, and putting in place new governance structures (eg, charter schools)-and show why these strategies have been relatively ineffective. Drawing on the research literature and case studies, we then describe education reform strategies for prekindergarten programs and for elementary, middle, and high schools that may help meet these challenges. All of the initiatives described in our case studies provide ample opportunities for teachers and school leaders to improve their skills through coaching and other professional development activities; incorporate sensible systems of accountability, including requiring teachers to open their classrooms to the scrutiny of colleagues and school leaders and to work with their colleagues to improve their teaching practices; and incorporate high academic standards, such as those described in the Common Core State Standards. By focusing directly on improving teaching and promoting learning, these successful initiatives have boosted the achievement of low-income children. They show that it is indeed possible to make a real difference in the life chances of low-income children. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  13. 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.

  14. Healthcare Associated Infections - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Healthcare-Associated Infections (HAI) measures - national data. These measures are developed by Centers for Disease Control and Prevention (CDC) and collected...

  15. Healthcare Associated Infections - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Healthcare-Associated Infection (HAI) measures - provider data. These measures are developed by Centers for Disease Control and Prevention (CDC) and collected...

  16. Healthcare Associated Infections - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Healthcare-Associated Infections (HAI) measures - state data. These measures are developed by Centers for Disease Control and Prevention (CDC) and collected...

  17. 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...

  18. 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

  19. 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...

  20. Healthcare leadership's diversity paradox.

    Science.gov (United States)

    Silver, Reginald

    2017-02-06

    Purpose The purpose of this research study was to obtain healthcare executives' perspectives on diversity in executive healthcare leadership. The study focused on identifying perspectives about diversity and its potential impact on the access of healthcare services by people of color. The study also identified perspectives about factors that influence the attainment of executive healthcare roles by people of color. Design/methodology/approach A convenience sample of healthcare executives was obtained. The executives identified themselves as belonging to one of two subgroups, White healthcare executives or executives of color. Participants were interviewed telephonically in a semi-structured format. The interviews were transcribed and entered into a qualitative software application. The data were codified and important themes were identified. Findings The majority of the study participants perceive that diversity of the executive healthcare leadership team is important. There were differences in perspective among the subgroups as it relates to solutions to improve access to healthcare by people of color. There were also differences in perspective among the subgroups, as it relates to explaining the underrepresentation of people of color in executive healthcare leadership roles. Research limitations/implications This research effort benefited from the subject matter expertise of 24 healthcare executives from two states. Expansion of the number of survey participants and broadening the geographical spread of where participants were located may have yielded more convergence and/or more divergence in perspectives about key topics. Practical implications The findings from this research study serve to add to the existing body of literature on diversity in executive healthcare leadership. The findings expand on the importance of key elements in contemporary literature such as diversity, cultural competency and perspectives about the need for representation of people of

  1. 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...

  2. 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...

  3. 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.

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  6. 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

  7. A atenção em Saúde Mental em municípios de pequeno e médio portes: ressonâncias da reforma psiquiátrica Mental Healthcare in small and medium-sized cities: resonance of the psychiatric reform

    Directory of Open Access Journals (Sweden)

    Cristina Amélia Luzio

    2009-02-01

    Full Text Available A partir da análise da Política Nacional de Saúde Mental formulada nos últimos anos e das experiências desenvolvidas após 1987 no país, procura-se compreender como o Sistema Único de Saúde tem contribuído ao avanço da reforma psiquiátrica nos municípios; verificar como a assistência oferecida nesses municípios está viabilizando os princípios da reforma psiquiátrica e a melhora das condições de vida dos usuários, bem como pesquisar o papel dos trabalhadores e gestores na construção de novas práticas de cuidado em Saúde Mental. A análise das práticas discursivas aponta que os vários segmentos sociais envolvidos na Saúde Mental conhecem os princípios e propostas da reforma psiquiátrica. No entanto, as gestões municipais não assumem integralmente as propostas do Ministério da Saúde para a área, sob a alegação de falta de recursos financeiros para a contrapartida exigida. Os usuários e familiares têm aos poucos assumido as novas propostas de intervenção, mas os mecanismos de participação e organização popular ainda são incipientes. Por fim, deve-se destacar que, para uma efetiva consolidação das propostas atuais da reforma psiquiátrica, é necessário um maior compromisso dos gestores com a atenção em Saúde Mental, maior investimento nas equipes multiprofissionais, o estímulo à organização e à participação dos usuários e familiares e a integralidade dos dispositivos de saúde, de assistência social e de cultura existentes nas cidades.From the analysis of the national Mental Health policy, formulated in the past years, and from the experiences developed after 1987, it is sought to: understand how Brazilian Health System has contributed to the development of the psychiatric reform in towns; verify how the assistance offered in those towns is making the psychiatric reform principles feasible as well as improving the users´ living conditions; and research the role of the workers and managers

  8. 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,

  9. Arktisk Reform i Ukraines Skygge

    DEFF Research Database (Denmark)

    Rahbek-Clemmensen, Jon

    2015-01-01

    USA overtager formandskabet for Arktisk Råd ved udenrigsministermødet d. 24.-25. april 2015. Der er behov for nødvendige reformer af Rådets struktur, men Ukraine-konflikten gør det vanskeligt at nå de ambitiøse mål.......USA overtager formandskabet for Arktisk Råd ved udenrigsministermødet d. 24.-25. april 2015. Der er behov for nødvendige reformer af Rådets struktur, men Ukraine-konflikten gør det vanskeligt at nå de ambitiøse mål....

  10. The Economic Effects of Comprehensive Tax Reform

    National Research Council Canada - National Science Library

    1997-01-01

    .... This Congressional Budget Office (CBO) study analyzes the major economic effects of several tax reform plans and finds that much uncertainty surrounds the likelihood and magnitude of the economic gains from tax reform...

  11. TAX-REFORM - DREAMING ABOUT TOUGH REALITIES

    NARCIS (Netherlands)

    DEKAM, F

    1992-01-01

    This paper discusses four papers concerned with tax reform. It is concluded that tax reform has had a rather limited impact on behaviour so far but that governments should press ahead with gradual improvement and not expect dramatic results.

  12. INSTITUTIONAL THEORY OF ECONOMIC REFORMS: BASIC IMPERATIVES

    Directory of Open Access Journals (Sweden)

    Oleg Sergeevich SUKHAREV

    2015-07-01

    Full Text Available The ability of institutional economic theory to explain various kinds of economic reforms (changes on the basis of theoretical ideas about the dysfunction of institutions and systems are investigated. A number of classifications of reforms and dysfunctions is introduced and kinds of institutional efficiency of economic systems are defined. Qualitative regularities of various reforms of the twentieth century in different countries are generalized. A number of criteria of effective institutional reforms, capable to lower the depth and the scale of dysfunctions of the functioning economic subsystems is formed. System approach to the analysis of economic systems reforming with underlining the importance of reform “management” factor which defines productivity of economic development is elaborated. Life cycle of institution and economic system in the process of its reforming is presented and correction of J. Hellmann’s model, describing the reforming logic of economy is made.

  13. 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…

  14. On being African and Reformed? Towards an African Reformed ...

    African Journals Online (AJOL)

    Here, the notions of being African and Reformed are interrogated. The research notes that these notions are rarely used in the same vein. It is admitted that notions tend to pick up different meanings as they evolve, so these notions are especially seen in that light. The theological hegemony, which in the South African ...

  15. 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.

  16. 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.

  17. Political Parties, Clientelism, and Bureaucratic Reform

    OpenAIRE

    Cruz, Cesi; Keefer, Philip

    2015-01-01

    The challenge of public administration reform is well-known: politicians often have little interest in the efficient implementation of government policy. Using new data from 439 World Bank public sector reform loans in 109 countries, we demonstrate that such reforms are significantly less likely to succeed in the presence of non-programmatic political parties. Earlier research uses evidence from a small group of countries to conclude that clientelistic politicians resist reforms that restrict...

  18. 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.

  19. How 'healthy' are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations.

    Science.gov (United States)

    Bronkhorst, Babette

    2017-08-01

    Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.

  20. The Cuban National Healthcare System: Characterization of primary healthcare services.

    Directory of Open Access Journals (Sweden)

    Keli Regina DAL PRÁ

    2015-10-01

    Full Text Available This article presents a report on the experience of healthcare professionals in Florianópolis, who took the course La Atención Primaria de Salud y la Medicina Familiar en Cuba [Primary Healthcare and Family Medicine in Cuba], in 2014. The purpose of the study is to characterize the healthcare units and services provided by the Cuban National Healthcare System (SNS and to reflect on this experience/immersion, particularly on Cuba’s Primary Healthcare Service. The results found that in comparison with Brazil’s Single Healthcare System (SUS Cuba’s SNS Family Healthcare (SF service is the central organizing element of the Primary Healthcare Service. The number of SF teams per inhabitant is different than in Brazil; the programs given priority in the APS are similar to those in Brazil and the intersectorial nature and scope of the services prove to be effective in the resolution of healthcare problems.

  1. 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

  2. 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

  3. 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.

  4. Community Organizing as an Education Reform Strategy

    Science.gov (United States)

    Renee, Michelle; McAlister, Sara

    2011-01-01

    Community organizing for school reform offers an urgently needed alternative to traditional approaches to school change. Many current reforms fail to thrive due to lack of trust, understanding, or cultural relevance to the community being targeted. The high turnover of reformers (superintendents, principals, or outside organizations) in high-need…

  5. Considerations for Education Reform in British Columbia

    Science.gov (United States)

    Santos, Ana

    2012-01-01

    Countries around the world refer to twenty-first century education as essential to maintaining personal and national economic advantage and draw on this discourse to advocate for and embark on educational reform. This paper examines issues around education reform, particularly in British Columbia. It argues that reformers should give careful…

  6. 49 CFR 260.13 - Credit reform.

    Science.gov (United States)

    2010-10-01

    ... appropriations, direct payment of a Credit Risk Premium by the Applicant or a non-Federal infrastructure partner... 49 Transportation 4 2010-10-01 2010-10-01 false Credit reform. 260.13 Section 260.13... REHABILITATION AND IMPROVEMENT FINANCING PROGRAM Overview § 260.13 Credit reform. The Federal Credit Reform Act...

  7. Improving Healthcare Logistics Processes

    DEFF Research Database (Denmark)

    Feibert, Diana Cordes

    logistics processes in hospitals and aims to provide theoretically and empirically based evidence for improving these processes to both expand the knowledge base of healthcare logistics and provide a decision tool for hospital logistics managers to improve their processes. Case studies were conducted...... processes. Furthermore, a method for benchmarking healthcare logistics processes was developed. Finally, a theoretically and empirically founded framework was developed to support managers in making an informed decision on how to improve healthcare logistics processes. This study contributes to the limited...... literature concerned with the improvement of logistics processes in hospitals. Furthermore, the developed framework provides guidance for logistics managers in hospitals on how to improve their processes given the circumstances in which they operate....

  8. Competing Logics and Healthcare

    Science.gov (United States)

    Saks, Mike

    2018-01-01

    This paper offers a short commentary on the editorial by Mannion and Exworthy. The paper highlights the positive insights offered by their analysis into the tensions between the competing institutional logics of standardization and customization in healthcare, in part manifested in the conflict between managers and professionals, and endorses the plea of the authors for further research in this field. However, the editorial is criticized for its lack of a strong societal reference point, the comparative absence of focus on hybridization, and its failure to highlight structural factors impinging on the opposing logics in a broader neo-institutional framework. With reference to the Procrustean metaphor, it is argued that greater stress should be placed on the healthcare user in future health policy. Finally, the case of complementary and alternative medicine is set out which – while not explicitly mentioned in the editorial – most effectively concretizes the tensions at the heart of this analysis of healthcare. PMID:29626406

  9. Conization and healthcare use

    DEFF Research Database (Denmark)

    Frederiksen, Maria E.; Vázquez-Prada Baillet, Miguel; Jensen, Pernille T.

    2017-01-01

    The aim of this study was to assess whether negative psychological consequences of conization reported in questionnaire studies translated into increased use of the healthcare services that could relieve such symptoms. This was a population-based register study comparing women undergoing conization......, healthcare use increased significantly from the 'before' to the 'after' period. For contacts with GPs and hospitals, the increase was significantly larger for the conization group than for the control group, but this could be attributed to the standard postconization follow-up process. In the 'before' period......, women who later had a conization used fewer drugs than women of the control-group, but their drug use increased similarly over time. The conization event did not result in an increased use of the healthcare services that could relieve potential negative side effects. However, women who underwent...

  10. Queueing for healthcare.

    Science.gov (United States)

    Palvannan, R Kannapiran; Teow, Kiok Liang

    2012-04-01

    Patient queues are prevalent in healthcare and wait time is one measure of access to care. We illustrate Queueing Theory-an analytical tool that has provided many insights to service providers when designing new service systems and managing existing ones. This established theory helps us to quantify the appropriate service capacity to meet the patient demand, balancing system utilization and the patient's wait time. It considers four key factors that affect the patient's wait time: average patient demand, average service rate and the variation in both. We illustrate four basic insights that will be useful for managers and doctors who manage healthcare delivery systems, at hospital or department level. Two examples from local hospitals are shown where we have used queueing models to estimate the service capacity and analyze the impact of capacity configurations, while considering the inherent variation in healthcare.

  11. 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

  12. Access to healthcare for undocumented migrants in 11 European countries

    OpenAIRE

    Chauvin , Pierre; Parizot , Isabelle; Simonnot , Nathalie

    2009-01-01

    Through our national programmes we meet people in Europe who have fled extreme poverty, violent armies and police forces, conflict areas and disasters. A tiny minority of the children, women and men whom we try to support when we work in their countries end up coming here. After migration journeys which are very often long, dangerous and exhausting, many find themselves without permission to stay in the country, forced into the shadows of our towns and cities. At home, as abroad, Médecins du ...

  13. Characteristics of healthcare wastes

    International Nuclear Information System (INIS)

    Diaz, L.F.; Eggerth, L.L.; Enkhtsetseg, Sh.; Savage, G.M.

    2008-01-01

    A comprehensive understanding of the quantities and characteristics of the material that needs to be managed is one of the most basic steps in the development of a plan for solid waste management. In this case, the material under consideration is the solid waste generated in healthcare facilities, also known as healthcare waste. Unfortunately, limited reliable information is available in the open literature on the quantities and characteristics of the various types of wastes that are generated in healthcare facilities. Thus, sound management of these wastes, particularly in developing countries, often is problematic. This article provides information on the quantities and properties of healthcare wastes in various types of facilities located in developing countries, as well as in some industrialized countries. Most of the information has been obtained from the open literature, although some information has been collected by the authors and from reports available to the authors. Only data collected within approximately the last 15 years and using prescribed methodologies are presented. The range of hospital waste generation (both infectious and mixed solid waste fractions) varies from 0.016 to 3.23 kg/bed-day. The relatively wide variation is due to the fact that some of the facilities surveyed in Ulaanbaatar include out-patient services and district health clinics; these facilities essentially provide very basic services and thus the quantities of waste generated are relatively small. On the other hand, the reported amount of infectious (clinical, yellow bag) waste varied from 0.01 to 0.65 kg/bed-day. The characteristics of the components of healthcare wastes, such as the bulk density and the calorific value, have substantial variability. This literature review and the associated attempt at a comparative analysis point to the need for worldwide consensus on the terms and characteristics that describe wastes from healthcare facilities. Such a consensus would greatly

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

    Science.gov (United States)

    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.

  15. European Utility Requirements: European nuclear energy

    International Nuclear Information System (INIS)

    Komsi, M.; Patrakka, E.

    1997-01-01

    The work procedure and the content of the European Utility Requirements (EUR) concerning the future LWRs is described in the article. European Utility Requirements, produced by utilities in a number of European countries, is a document specifying the details relating to engineered safety, operating performance, reliability and economics of the reactors to be built by manufacturers for the European market

  16. Cultural Narcissism and Education Reform

    Science.gov (United States)

    Pajak, Edward F.

    2011-01-01

    Background/Context: Scholars have described American culture in recent decades as narcissistic, manifested by displays of self-absorption tantamount to a pathological syndrome that has reached epidemic proportions. An education reform movement that is highly critical of public schools, teachers, and students has simultaneously emerged, espousing a…

  17. The Brazilian electrical system reform

    International Nuclear Information System (INIS)

    Mendonca, A.F.; Dahl, C.

    1999-01-01

    Although the Brazilian electrical system has been a public monopoly, the threat of electricity shortages from a lack of investment triggered a comprehensive reform. In 1993 the government began a series of laws, decrees and regulations reforming the tariff policy, allowing privatization of utilities, foreign investments and independent power producers, and creating an independent transmission grid and a new electricity regulatory agency (ANEEL). The new regulatory framework is not completely defined but the proposed model intends to transform bulk electricity supply into a competitive market similar to that adopted in England. Our objective is to evaluate whether the proposed reform will succeed in attracting the required private capital, will allow an unregulated wholesale electricity market and will require a strict regulatory framework. The reform has been quite successful in privatizing the distribution companies but is allowing monopolistic rents, and has failed until now to attract private investments to expand generation capacity. The risk of blackouts has increased, and the proposed wholesale electricity market may not be appropriate because of barriers to constructing new hydroelectric units, now 90% of the system. Therefore, a new regulatory framework and a strong regulatory agency with a well-defined tariff policy should have preceded the privatization. (author)

  18. Agrarian Reform and Rural Development.

    Science.gov (United States)

    Biswas, Margaret R.

    1979-01-01

    This paper presents the plight of the world's poor, which was discussed at The World Conference on Agrarian Reform and Rural Development in July, 1979. Urban bias is attributed to the failure of rural development. More participation of rural people is needed. Progress is being made. Examples of literary programs in Iraq and the Sudan are included.…

  19. Free-Market School Reform.

    Science.gov (United States)

    Harrington-Lueker, Donna

    1997-01-01

    In Uxbridge, Massachusetts, a small working-class mill town, free-market reform rhetoric has become reality. The tiny district has adopted controversial changes, such as giving vouchers to parents of Title I students, reimbursing home-schooling parents, lengthening the school day and year, adopting flexible scheduling, allowing credit for Internet…

  20. Law Reform and Child Protection

    Directory of Open Access Journals (Sweden)

    Ronan Cormacain

    2014-10-01

    Full Text Available In this Editorial Ronan Cormacain (Editor-in-Chief, ISLRev, Institute of Advanced Legal Studies welcomes you to the third issue of the IALS Student Law Review. He explains the background to this special edition focusing on Law Reform and Child Protection and introduces the articles featured in this issue of the journal.

  1. Education Reform: A Managerial Agenda.

    Science.gov (United States)

    Bacharach, Samuel B.; Conley, Sharon C.

    1986-01-01

    Education reform has wrongly focused on teacher motivation and rewards, when the organizational system itself is at fault. Research shows that effective school management hinges on increased individual discretion and decision-making opportunities for teachers and less controlling behavior by administrators. Ten characteristics of effective…

  2. EIA: Educational Reform or Repression?

    Science.gov (United States)

    Monteith, Dianne S.

    A recent study (Cook, 1989) involving 58 randomly selected South Carolina elementary schools indicated that none of these schools could be characterized as having an "open climate." This paper suggests that this situation may have its origins in the educational reform movement of the 1980s, first ignited by the publication of "A…

  3. Steam hydrocarbon cracking and reforming

    NARCIS (Netherlands)

    Golombok, M.

    2004-01-01

    Many industrial chemical processes are taught as distinct contrasting reactions when in fact the unifying comparisons are greater than the contrasts. We examine steam hydrocarbon reforming and steam hydrocarbon cracking as an example of two processes that operate under different chemical reactivity

  4. Reforming the Russian electricity market

    International Nuclear Information System (INIS)

    Valladares, Mayra Rodriguez

    1999-08-01

    Contains Executive Summary and Chapters on: Overview; Russian energy markets; Evolution of the power sector; The electricity market; Regulation and proposed reforms; Politics in the power sector; Economics of the power sector; Regional differences; Foreign involvement; Valuation and company management; Conclusions. (Author)

  5. Forest policy reform in Brazil

    Science.gov (United States)

    S. Bauch; E. Sills; L.C. Rodriguez Estraviz; K. McGinley; F. Cubbage

    2009-01-01

    Rapid deforestation in the Brazilian Amazon, caused by economic, social, and policy factors, has focused global and national attention on protecting this valuable forest resource. In response, Brazil reformed its federal forest laws in 2006, creating new regulatory, development, and incentive policy instruments and institutions. Federal forestry responsibilities are...

  6. DGNB certified Healthcare Centres

    DEFF Research Database (Denmark)

    Brunsgaard, Camilla; Larsen, Tine Steen

    2015-01-01

    for sustainability and wants a certification. This research investigates the decision‐making and design process (DMaDP) behind four DGNB certified Healthcare Centres (HCC) in Northern Jutland in Denmark. In general, knowledge about the DMaDP is important. However it is important to know what part DGNB plays...... a dialog about DGNB and energy concept is important even before anyone start sketching. Experiences with the different approaches will be further outlined in the paper.Future research has the intention to collect further knowledge about DGNB and DMaDP in practise. This project was limited to Healthcare...

  7. Costing Practices in Healthcare

    DEFF Research Database (Denmark)

    Chapman, Christopher; Kern, Anja; Laguecir, Aziza

    2014-01-01

    .e., Diagnosis Related Group (DRG) systems, and costing practices. DRG-based payment systems strongly influence costing practices in multiple ways. In particular, setting DRG tariffs requires highly standardized costing practices linked with specific skill sets from management accountants and brings other...... jurisdictions (e.g., clinical coding) to bear on costing practice. These factors contribute to the fragmentation of the jurisdiction of management accounting.......The rising cost of healthcare is a globally pressing concern. This makes detailed attention to the way in which costing is carried out of central importance. This article offers a framework for considering the interdependencies between a dominant element of the contemporary healthcare context, i...

  8. The health of healthcare, Part II: patient healthcare has cancer.

    Science.gov (United States)

    Waldman, Deane

    2013-01-01

    In this article, we make the etiologic diagnosis for a sick patient named Healthcare: the cancer of greed. When we explore the two forms of this cancer--corporate and bureaucratic--we find the latter is the greater danger to We the Patients. The "treatments" applied to patient Healthcare by the Congressional "doctors" have consistently made the patient worse, not better. At the core of healthcare's woes is the government's diversion of money from healthcare services to healthcare bureaucracy. As this is the root cause, it is what we must address in order to cure, not sedate or palliate, patient Healthcare.

  9. 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.

  10. 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

  11. 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

  12. 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.

  13. Reforming technology for syngas production

    International Nuclear Information System (INIS)

    Epstein, M.

    1997-01-01

    Methane forming reactions using either steam or CO 2 have been known to industry for a long time. These endothermic reactions require the investment of a relatively large amount of energy. German researchers, in the 1970's, conceived and developed the idea to use this reaction and the reverse methanation reaction in a closed loop for the transportation and distribution of nuclear heat. The idea was also adopted for use with solar energy as a heat source. Utilizing solar energy as the heat source, the Weismann Institute of Science has fabricated, installed and operated a complete loop capable of the conversion and transportation of over 400 kW of heat. This system can be operated with a wide range of CO 2 /H 2 O/CH 4 feed mixtures. Steam reforming is the common reforming reaction in the ''open loop'' mode for the purpose of synthesis gas production. This is accomplished with a large excess of steam on a nickel catalyst. However, it has only recently been recognized that there is also a substantial market for CO 2 reforming. The CO 2 /CH 4 mixture in various proportions exists in many places and has, so far, not been used efficiently. The sources for this mixture are biogas produced in anaerobic digestion processes and gas resources such as the NATUNA gas field in Indonesia, and many others. Therefore, the system of CO 2 /CH 4 deserves more attention. Commercial catalysts used for steam reforming based on nickel are not suitable for this system. Therefore, other catalysts based on Rhodium and Ruthenium have been developed and some performance data is presented in this paper. Also presented is a conceptual schematic layout of a CO 2 reforming plant and matching methanator. A computer code for a detailed design of the entire loop in a commercial size system has been prepared where optimized operational conditions as well as equipment parameters can be determined. (author). 3 figs, 3 tabs

  14. Water Institutional Reforms in Scotland: Contested Objectives and Hidden Disputes

    Directory of Open Access Journals (Sweden)

    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.

  15. 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....

  16. Social marketing in healthcare

    Directory of Open Access Journals (Sweden)

    Radha Aras

    2011-08-01

    Full Text Available BackgroundSocial marketing is an important tool in the delivery ofhealthcare services. For any healthcare programme orproject to be successful, community/consumer participationis required. The four principles of social marketing can guidepolicymakers and healthcare providers to successfully planand implement health programmes.AimTo review the existing literature in order to project thebenefits of social marketing in healthcare.MethodA search of periodical literature by the author involvingsocial marketing and marketing concepts in health wascarried out. Items were identified initially through healthorientedindexing services such as Medline, Health STARand Cinahl, using the identifiers “social marketing“ and“marketing in health”. An extensive search was also carriedout on educational database ERIC.ResultsA literature review of various studies on social marketingindicated that the selection of the right product (accordingto the community need at the right place, with the rightstrategy for promotion and at the right price yields goodresults. However, along with technical sustainability(product, price, promotion and place, financialsustainability, institutional sustainability and marketsustainability are conducive factors for the success of socialmarketing.ConclusionThe purpose of this literature review was to ascertain thelikely effectiveness of social marketing principles andapproaches and behaviour change communication towardshealth promotion.It is important for all healthcare workers to understand andrespond to the public’s desires and needs and routinely useconsumer research to determine how best to help thepublic to solve problems and realise aspirations. Socialmarketing can optimise public health by facilitatingrelationship-building with consumers and making their liveshealthier.

  17. Organizational excellence in healthcare

    NARCIS (Netherlands)

    Does, R.J.M.M.; van den Heuvel, J.; Foley, K.J.; Hermel, P.

    2008-01-01

    Healthcare, as any other service operation, requires systematic innovation efforts to remain competitive, cost efficient and up to date. In this paper, we outline a methodology and present how principles of two improvement programs, i.e., Lean Thinking and Six Sigma, can be combined to provide an

  18. Coproduction of healthcare service.

    Science.gov (United States)

    Batalden, Maren; Batalden, Paul; Margolis, Peter; Seid, Michael; Armstrong, Gail; Opipari-Arrigan, Lisa; Hartung, Hans

    2016-07-01

    Efforts to ensure effective participation of patients in healthcare are called by many names-patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services. 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/

  19. Healthcare liquid waste management.

    Science.gov (United States)

    Sharma, D R; Pradhan, B; Pathak, R P; Shrestha, S C

    2010-04-01

    The management of healthcare liquid waste is an overlooked problem in Nepal with stern repercussions in terms of damaging the environment and affecting the health of people. This study was carried out to explore the healthcare liquid waste management practices in Kathmandu based central hospitals of Nepal. A descriptive prospective study was conducted in 10 central hospitals of Kathmandu during the period of May to December 2008. Primary data were collected through interview, observation and microbiology laboratory works and secondary data were collected by records review. For microbiological laboratory works,waste water specimens cultured for the enumeration of total viable counts using standard protocols. Evidence of waste management guidelines and committees for the management of healthcare liquid wastes could not be found in any of the studied hospitals. Similarly, total viable counts heavily exceeded the standard heterotrophic plate count (p=0.000) with no significant difference in such counts in hospitals with and without treatment plants (p=0.232). Healthcare liquid waste management practice was not found to be satisfactory. Installation of effluent treatment plants and the development of standards for environmental indicators with effective monitoring, evaluation and strict control via relevant legal frameworks were realized.

  20. Building National Healthcare Infrastructure

    DEFF Research Database (Denmark)

    Jensen, Tina Blegind; Thorseng, Anne

    2017-01-01

    This case chapter is about the evolution of the Danish national e-health portal, sundhed.dk, which provides patient-oriented digital services. We present how the organization behind sundhed.dk succeeded in establishing a national healthcare infrastructure by (1) collating and assembling existing...

  1. Infrastructures for healthcare

    DEFF Research Database (Denmark)

    Langhoff, Tue Odd; Amstrup, Mikkel Hvid; Mørck, Peter

    2018-01-01

    The Danish General Practitioners Database has over more than a decade developed into a large-scale successful information infrastructure supporting medical research in Denmark. Danish general practitioners produce the data, by coding all patient consultations according to a certain set of classif...... synergy into account, if not to risk breaking down the fragile nature of otherwise successful information infrastructures supporting research on healthcare....

  2. 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.

  3. 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.

  4. Healthcare waste management: current practices in selected healthcare facilities, Botswana.

    Science.gov (United States)

    Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

    2008-01-01

    Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

  5. Reforming the reform: the Greek National Health System in transition.

    Science.gov (United States)

    Tountas, Yannis; Karnaki, Panagiota; Pavi, Elpida

    2002-10-01

    The National Health System (ESY) in Greece, which was established in 1983, is in a state of continuous crisis. This situation is caused mainly by the system's problematic administration, low productivity and inadequate Primary Health Care. These have led the re-elected PASOK government to introduce by the end of 2000 a radical reform of the health system. The 200 reform measures announced by the new Minister of Health and Welfare include changes aiming at: the decentralization of the ESY, the creation of a unified financing system for the social insurance funds, a new management structure in public hospitals, the organization of a Primary Health System in urban areas, and the strengthening of Public Health and Health Promotion. These changes are presented and discussed in this paper.

  6. 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.

  7. Social marketing in healthcare.

    Science.gov (United States)

    Aras, Radha

    2011-01-01

    Social marketing is an important tool in the delivery of healthcare services. For any healthcare programme or project to be successful, community/consumer participation is required. The four principles of social marketing can guide policymakers and healthcare providers to successfully plan and implement health programmes. To review the existing literature in order to project the benefits of social marketing in healthcare. A search of periodical literature by the author involving social marketing and marketing concepts in health was carried out. Items were identified initially through health-oriented indexing services such as Medline, Health STAR and Cinahl, using the identifiers "social marketing" and "marketing in health". An extensive search was also carried out on educational database ERIC. A literature review of various studies on social marketing indicated that the selection of the right product (according to the community need) at the right place, with the right strategy for promotion and at the right price yields good results. However, along with technical sustainability (product, price, promotion and place), financial sustainability, institutional sustainability and market sustainability are conducive factors for the success of social marketing. The purpose of this literature review was to ascertain the likely effectiveness of social marketing principles and approaches and behaviour change communication towards health promotion. It is important for all healthcare workers to understand and respond to the public's desires and needs and routinely use consumer research to determine how best to help the public to solve problems and realise aspirations. Social marketing can optimise public health by facilitating relationship-building with consumers and making their lives healthier.

  8. 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

  9. 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.

  10. Factors Influencing Healthcare Service Quality

    Directory of Open Access Journals (Sweden)

    Ali Mohammad Mosadeghrad

    2014-07-01

    Full Text Available Background The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality.

  11. Architecture of personal healthcare information system in ubiquitous healthcare

    NARCIS (Netherlands)

    Bhardwaj, S.; Sain, M.; Lee, H.-J.; Chung, W.Y.; Slezak, D.; et al., xx

    2009-01-01

    Due to recent development in Ubiquitous Healthcare now it’s time to build such application which can work independently and with less interference of Physician. In this paper we are try to build the whole architecture of personal Healthcare information system for ubiquitous healthcare which also

  12. 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.

  13. centred healthcare in South Africa

    African Journals Online (AJOL)

    2016-07-15

    Puchalski) was one of the editors of the Oxford textbook on spirituality in ..... and in some cases provide up to 70% of all healthcare services. A hallmark of ..... including the business world, education, healthcare, the arts, ecology ...

  14. 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.

  15. 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.

  16. 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.

  17. 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)

  18. Curriculum reform and the market

    DEFF Research Database (Denmark)

    Petersen, Karen Bjerg

    2011-01-01

    A neo-liberal discourse in the 2000s has been prevalent not only in international and Danish educational policy contexts, but also within a specific area, namely the education of adult immigrants in Denmark. With the adoption of a new law in 2003 high-stakes testing, standards, new market economy...... in Denmark. Based on studies of curriculum reform and research about headmasters’ and teachers’ attitudes the article addresses paradoxes rising in the wake of the neo-liberal education policy. Despite the intention of high-stakes testing to increase adult migrants’ language and employment related....... Teachers furthermore find the new working conditions stressing. It is discussed whether a neo-liberal discourse in adult teaching is ‘dumping down’ the intentions of curriculum and education reform....

  19. Curriculum reform and the market

    DEFF Research Database (Denmark)

    Petersen, Karen Bjerg

    2012-01-01

    A neo-liberal discourse in the 2000s has been prevalent not only in international and Danish educational policy contexts, but also within a specific area, namely the education of adult immigrants in Denmark. With the adoption of a new law in 2003 high-stakes testing, standards, new market economy...... in Denmark. Based on studies of curriculum reform and research about headmasters’ and teachers’ attitudes the article addresses paradoxes rising in the wake of the neo-liberal education policy. Despite the intention of high-stakes testing to increase adult migrants’ language and employment related....... Teachers furthermore find the new working conditions stressing. It is discussed whether a neo-liberal discourse in adult teaching is ‘dumping down’ the intentions of curriculum and education reform....

  20. Lean six sigma in healthcare.

    Science.gov (United States)

    de Koning, Henk; Verver, John P S; van den Heuvel, Jaap; Bisgaard, Soren; Does, Ronald J M M

    2006-01-01

    Healthcare, as with any other service operation, requires systematic innovation efforts to remain competitive, cost efficient, and up-to-date. This article outlines a methodology and presents examples to illustrate how principles of Lean Thinking and Six Sigma can be combined to provide an effective framework for producing systematic innovation efforts in healthcare. Controlling healthcare cost increases, improving quality, and providing better healthcare are some of the benefits of this approach.