3rd International Conference on Health Care Systems Engineering

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Li, Jingshan; Matta, Andrea; Sahin, Evren; Vandaele, Nico; Visintin, Filippo

2017-01-01

This book presents statistical processes for health care delivery and covers new ideas, methods and technologies used to improve health care organizations. It gathers the proceedings of the Third International Conference on Health Care Systems Engineering (HCSE 2017), which took place in Florence, Italy from May 29 to 31, 2017. The Conference provided a timely opportunity to address operations research and operations management issues in health care delivery systems. Scientists and practitioners discussed new ideas, methods and technologies for improving the operations of health care systems, developed in close collaborations with clinicians. The topics cover a broad spectrum of concrete problems that pose challenges for researchers and practitioners alike: hospital drug logistics, operating theatre management, home care services, modeling, simulation, process mining and data mining in patient care and health care organizations.

Primary health care in Canada: systems in motion.

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Hutchison, Brian; Levesque, Jean-Frederic; Strumpf, Erin; Coyle, Natalie

2011-06-01

During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged. This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada. Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support. Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert. © 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

Systems Health Care: daily measurement and lifestyle change

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Nakajima, Hiroshi; Tsuchiya, Naoki; Shiga, Toshikazu; Hata, Yutaka

2012-06-01

Health is quite important to be realized in our daily life. However, its idea covers wide area and has individual dependency. Activities in health care have been widely developed by medical, drag, insurance, food, and other types of industries mainly centering diseases. In this article, systems approach named Systems Health Care is introduced and discussed to generate new and precious values based on measurements in daily life to change lifestyle habits for realizing each health. Firstly, issues related to health such as its definitions are introduced and discussed by centering health rather than disease. In response to the discussions on health, Home and Medical Care is continuously introduced to point out the important role causality between life style and vital signal such as exercise and blood pressure based on detailed sampling time. Systems approaches of Systems Health Care are discussed from various points of views. Real applications of devices and services are used to make the studies and discussions deeper on the subjects of the article.

Open Source, Open Standards, and Health Care Information Systems

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2011-01-01

Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment. To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy. PMID:21447469

Primary health care and public health: foundations of universal health systems.

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White, Franklin

2015-01-01

The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable. © 2015 S. Karger AG, Basel.

A Primary Care System to Improve Health Care Efficiency: Lessons from Ecuador.

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Aldulaimi, Sommer; Mora, Francisco E

2017-01-01

Ecuador is a country with few resources to spend on health care. Historically, Ecuador has struggled to find a model for health care that is efficient, effective, and available to all people in the country, even those in underserved and rural communities. In 2000, the Ecuador Ministry of Public Health implemented a new system of health care that used primary care as its platform. Since then, Ecuador has been able to increase its health care efficiency, increasing its ranking from 111 of 211 countries worldwide in 2000, to 20 of 211 countries in 2014. This article briefly reviews the new components of the system implemented in Ecuador and examines the tools used to accomplish this. The discussion also compares and contrasts the Ecuador and US systems, and identifies concepts and policies from Ecuador that could improve the US system. © Copyright 2017 by the American Board of Family Medicine.

Systemic racism and U.S. health care.

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Feagin, Joe; Bennefield, Zinobia

2014-02-01

This article draws upon a major social science theoretical approach-systemic racism theory-to assess decades of empirical research on racial dimensions of U.S. health care and public health institutions. From the 1600s, the oppression of Americans of color has been systemic and rationalized using a white racial framing-with its constituent racist stereotypes, ideologies, images, narratives, and emotions. We review historical literature on racially exploitative medical and public health practices that helped generate and sustain this racial framing and related structural discrimination targeting Americans of color. We examine contemporary research on racial differentials in medical practices, white clinicians' racial framing, and views of patients and physicians of color to demonstrate the continuing reality of systemic racism throughout health care and public health institutions. We conclude from research that institutionalized white socioeconomic resources, discrimination, and racialized framing from centuries of slavery, segregation, and contemporary white oppression severely limit and restrict access of many Americans of color to adequate socioeconomic resources-and to adequate health care and health outcomes. Dealing justly with continuing racial "disparities" in health and health care requires a conceptual paradigm that realistically assesses U.S. society's white-racist roots and contemporary racist realities. We conclude briefly with examples of successful public policies that have brought structural changes in racial and class differentials in health care and public health in the U.S. and other countries. Copyright © 2013 Elsevier Ltd. All rights reserved.

Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records.

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Monroe, C Douglas; Chin, Karen Y

2013-05-01

The specialty pharmaceuticals market is expanding more rapidly than the traditional pharmaceuticals market. Specialty pharmacy operations have evolved to deliver selected medications and associated clinical services. The growing role of specialty drugs requires new approaches to managing the use of these drugs. The focus, expectations, and emphasis in specialty drug management in an integrated health care delivery system such as Kaiser Permanente (KP) can vary as compared with more conventional health care systems. The KP Specialty Pharmacy (KP-SP) serves KP members across the United States. This descriptive account addresses the impetus for specialty drug management within KP, the use of tools such as an electronic health record (EHR) system and process management software, the KP-SP approach for specialty pharmacy services, and the emphasis on quality measurement of services provided. Kaiser Permanente's integrated system enables KP-SP pharmacists to coordinate the provision of specialty drugs while monitoring laboratory values, physician visits, and most other relevant elements of the patient's therapy. Process management software facilitates the counseling of patients, promotion of adherence, and interventions to resolve clinical, logistic, or pharmacy benefit issues. The integrated EHR affords KP-SP pharmacists advantages for care management that should become available to more health care systems with broadened adoption of EHRs. The KP-SP experience may help to establish models for clinical pharmacy services as health care systems and information systems become more integrated.

Corruption in the health care system: the circumstantial evidence.

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Ibrahim, Joseph; Majoor, Jennifer

2002-01-01

Health care systems are under intense scrutiny, and there is an increasing emphasis on patient safety and quality of care in general. Evidence continues to emerge demonstrating that health systems are performing at sub-optimal levels. The evidence includes the under-use, over-use and mis-use of health care services; new standards asking for respect, dignity, honesty and transparency; the corporatization of health; and the existing inequalities in power and health outcomes. Recommendations for improving health care often refer to increasing the level of collaboration and consultation. These strategies are unlikely to remedy the root causes of our ailing health systems if we accept the circumstantial evidence that suggests the system is rotten.

The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems

Directory of Open Access Journals (Sweden)

Menizibeya Osain Welcome

2011-01-01

Full Text Available Objectives : As an important element of national security, public health not only functions to provide adequate and timely medical care but also track, monitor, and control disease outbreak. The Nigerian health care had suffered several infectious disease outbreaks year after year. Hence, there is need to tackle the problem. This study aims to review the state of the Nigerian health care system and to provide possible recommendations to the worsening state of health care in the country. To give up-to-date recommendations for the Nigerian health care system, this study also aims at reviewing the dynamics of health care in the United States, Britain, and Europe with regards to methods of medical intelligence/surveillance. Materials and Methods : Databases were searched for relevant literatures using the following keywords: Nigerian health care, Nigerian health care system, and Nigerian primary health care system. Additional keywords used in the search were as follows: United States (OR Europe health care dynamics, Medical Intelligence, Medical Intelligence systems, Public health surveillance systems, Nigerian medical intelligence, Nigerian surveillance systems, and Nigerian health information system. Literatures were searched in scientific databases Pubmed and African Journals OnLine. Internet searches were based on Google and Search Nigeria. Results : Medical intelligence and surveillance represent a very useful component in the health care system and control diseases outbreak, bioattack, etc. There is increasing role of automated-based medical intelligence and surveillance systems, in addition to the traditional manual pattern of document retrieval in advanced medical setting such as those in western and European countries. Conclusion : The Nigerian health care system is poorly developed. No adequate and functional surveillance systems are developed. To achieve success in health care in this modern era, a system well grounded in routine

A decision technology system for health care electronic commerce.

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Forgionne, G A; Gangopadhyay, A; Klein, J A; Eckhardt, R

1999-08-01

Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice.

Child Poverty and the Health Care System.

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Racine, Andrew D

2016-04-01

The persistence of child poverty in the United States and the pervasive health consequences it engenders present unique challenges to the health care system. Human capital theory and empirical observation suggest that the increased disease burden experienced by poor children originates from social conditions that provide suboptimal educational, nutritional, environmental, and parental inputs to good health. Faced with the resultant excess rates of pediatric morbidity, the US health care system has developed a variety of compensatory strategies. In the first instance, Medicaid, the federal-state governmental finance system designed to assure health insurance coverage for poor children, has increased its eligibility thresholds and expanded its benefits to allow greater access to health services for this vulnerable population. A second arm of response involves a gradual reengineering of health care delivery at the practice level, including the dissemination of patient-centered medical homes, the use of team-based approaches to care, and the expansion of care management beyond the practice to reach deep into the community. Third is a series of recent experiments involving the federal government and state Medicaid programs that includes payment reforms of various kinds, enhanced reporting, concentration on high-risk populations, and intensive case management. Fourth, pediatric practices have begun to make use of specific tools that permit the identification and referral of children facing social stresses arising from poverty. Finally, constituencies within the health care system participate in enhanced advocacy efforts to raise awareness of poverty as a distinct threat to child health and to press for public policy responses such as minimum wage increases, expansion of tax credits, paid family leave, universal preschool education, and other priorities focused on child poverty. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights

The Military Health Care System May Have the Potential to Prevent Health Care Disparities.

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Pierre-Louis, Bosny J; Moore, Angelo D; Hamilton, Jill B

2015-09-01

The existence of health disparities in military populations has become an important topic of research. However, to our knowledge, this is the first study to examine health disparities, as related to access to care and health status, among active duty soldiers and their families. Specifically, the purpose of this analysis was to evaluate whether health disparities exist in access to care and health outcomes of patient satisfaction, physical health status, and mental health status according to race, gender, and sponsor rank in the population of active duty soldiers and their family members. In this cross-sectional study, active duty army soldiers and family members were recruited from either one particular army health clinic where they received their health care or from an adjacent shopping center frequented by eligible participants. Data were collected using validated measures to assess concepts of access to care and health status. Statistical analysis, including one-way analysis of variance (ANOVA) was performed to investigate differences in study outcome measures across four key demographic subgroups: race, gender, sponsor rank, and component (active soldier or family member). A total of 200 participants completed the study questionnaires. The sample consisted of 45.5 % soldiers and 54.5 % family members, with 88.5 % reporting a sponsor rank in the category of junior or senior enlisted rank. Mean scores for access to care did not differ significantly for the groups race/ethnicity (p = 0.53), gender (p = 0.14), and sponsor rank (p = 0.10). Furthermore, no significant differences were observed whether respondents were active soldiers or their family members (p = 0.36). Similarly, there were no statistically significant subgroup (race/ethnicity, gender, sponsor rank, or component) differences in mean patient satisfaction, physical health, and mental health scores. In a health equity system of care such as the military health care system, active duty

Declining amenable mortality: a reflection of health care systems?

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Gianino, Maria Michela; Lenzi, Jacopo; Fantini, Maria Pia; Ricciardi, Walter; Damiani, Gianfranco

2017-11-15

Some studies have analyzed the association of health care systems variables, such as health service resources or expenditures, with amenable mortality, but the association of types of health care systems with the decline of amenable mortality has yet to be studied. The present study examines whether specific health care system types are associated with different time trend declines in amenable mortality from 2000 to 2014 in 22 European OECD countries. A time trend analysis was performed. Using Nolte and McKee's list, age-standardized amenable mortality rates (SDRs) were calculated as the annual number of deaths over the population aged 0-74 years per 100,000 inhabitants. We classified health care systems according to a deductively generated classification by Böhm. This classification identifies three dimensions that are not entirely independent of each other but follow a clear order: the regulation dimension is first, followed by the financing dimension and finally service provision. We performed a hierarchical semi-log polynomial regression analysis on the annual SDRs to determine whether specific health care systems were associated with different SDR trajectories over time. The results showed a clear decline in SDRs in all 22 health care systems between 2000 and 2014 although at different annual changes (slopes). Regression analysis showed that there was a significant difference among the slopes according to provision dimension. Health care systems with a private provision exhibited a slowdown in the decline of amenable mortality over time. It therefore seems that ownership is the most relevant dimension in determining a different pattern of decline in mortality. All countries experienced decreases in amenable mortality between 2000 and 2014; this decline seems to be partially a reflection of health care systems, especially when affected by the provision dimension. If the private ownership is maintained or promoted by health systems, these findings might be

Guidelines for Psychological Practice in Health Care Delivery Systems

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American Psychologist, 2013

2013-01-01

Psychologists practice in an increasingly diverse range of health care delivery systems. The following guidelines are intended to assist psychologists, other health care providers, administrators in health care delivery systems, and the public to conceptualize the roles and responsibilities of psychologists in these diverse contexts. These…

Health system challenges to integration of mental health delivery in primary care in Kenya--perspectives of primary care health workers.

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Jenkins, Rachel; Othieno, Caleb; Okeyo, Stephen; Aruwa, Julyan; Kingora, James; Jenkins, Ben

2013-09-30

Health system weaknesses in Africa are broadly well known, constraining progress on reducing the burden of both communicable and non-communicable disease (Afr Health Monitor, Special issue, 2011, 14-24), and the key challenges in leadership, governance, health workforce, medical products, vaccines and technologies, information, finance and service delivery have been well described (Int Arch Med, 2008, 1:27). This paper uses focus group methodology to explore health worker perspectives on the challenges posed to integration of mental health into primary care by generic health system weakness. Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 20 health workers drawn from a randomised controlled trial to evaluate the impact of a mental health training programme for primary care, 10 from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training). These focus group discussions suggested that there are a number of generic health system weaknesses in Kenya which impact on the ability of health workers to care for clients with mental health problems and to implement new skills acquired during a mental health continuing professional development training programmes. These weaknesses include the medicine supply, health management information system, district level supervision to primary care clinics, the lack of attention to mental health in the national health sector targets, and especially its absence in district level targets, which results in the exclusion of mental health from such district level supervision as exists, and the lack of awareness in the district management team about mental health. The lack of mental health coverage included in HIV training courses experienced by the health workers was also striking, as was the intensive focus during district supervision on HIV to the detriment of other

Ambivalent implications of health care information systems: a study in the Brazilian public health care system

Directory of Open Access Journals (Sweden)

João Porto de Albuquerque

2011-01-01

Full Text Available This article evaluates social implications of the "SIGA" Health Care Information System (HIS in a public health care organization in the city of São Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.

[Costs of maternal-infant care in an institutionalized health care system].

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Villarreal Ríos, E; Salinas Martínez, A M; Guzmán Padilla, J E; Garza Elizondo, M E; Tovar Castillo, N H; García Cornejo, M L

1998-01-01

Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities.

Dealing with Health and Health Care System Challenges in China: assessing health determinants and health care reforms

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H. Zhang (Hao)

2017-01-01

markdownabstractThis dissertation investigates the challenges faced by China around 2010 in two domains – population health and the health care system. Specifically, chapters 2 and 3 are devoted to health challenges, explaining the female health disadvantage in later life and assessing the effect

Health Care Performance Indicators for Health Information Systems.

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Hyppönen, Hannele; Ronchi, Elettra; Adler-Milstein, Julia

2016-01-01

Health Information Systems (HISs) are expected to have a positive impact on quality and efficiency of health care. Rapid investment in and diffusion of HISs has increased the importance of monitoring the adoption and impacts of them in order to learn from the initiatives, and to provide decision makers evidence on the role of HISs in improving health care. However, reliable and comparable data across initiatives in various countries are rarely available. A four-phase approach is used to compare different HIS indicator methodologies in order to move ahead in defining HIS indicators for monitoring effects of HIS on health care performance. Assessed approaches are strong on different aspects, which provide some opportunities for learning across them but also some challenges. As yet, all of the approaches do not define goals for monitoring formally. Most focus on health care structural and process indicators (HIS availability and intensity of use). However, many approaches are generic in description of HIS functionalities and context as well as their impact mechanisms on health care for HIS benchmarking. The conclusion is that, though structural and process indicators of HIS interventions are prerequisites for monitoring HIS impacts on health care outputs and outcomes, more explicit definition is needed of HIS contexts, goals, functionalities and their impact mechanisms in order to move towards common process and outcome indicators. A bottom-up-approach (participation of users) could improve development and use of context-sensitive HIS indicators.

Co-Creating an Expansive Health Care Learning System.

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Cribb, Alan; Owens, John; Singh, Guddi

2017-11-01

How should practices of co-creation be integrated into health professions education? Although co-creation permits a variety of interpretations, we argue that realizing a transformative vision of co-creation-one that invites professionals to genuinely reconsider the purposes, relationships, norms, and priorities of health care systems through new forms of collaborative thought and practice-will require radically rethinking existing approaches to professional education. The meaningful enactment of co-creative roles and practices requires health professionals and students to negotiate competing traditions, pressures, and expectations. We therefore suggest that the development of what we call an "expansive health care learning system" is crucial for supporting learners in meeting the challenges of establishing genuinely co-creative health care systems. © 2017 American Medical Association. All Rights Reserved.

[The Chilean Health Care System: the task ahead].

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Goic, Alejandro

2015-06-01

The most important event in Chilean public health in the XXth Century was the creation of the National Health Service (NHS), in 1952. Systematic public policies for the promotion of health, disease prevention, medical care, and rehabilitation were implemented, while a number of more specific programs were introduced, such as those on infant malnutrition, complementary infant feeding, medical control of pregnant women and healthy infants, infant and adult vaccination, and essential sanitation services. In 1981, a parallel private health care system was introduced in the form of medical care financial institutions, which today cover 15% of the population, as contrasted with the public system, which covers about 80%. From 1952 to 2014, public health care policies made possible a remarkable improvement in Chile's health indexes: downward trends in infant mortality rate (from 117.8 to 7.2 x 1,000 live births), maternal mortality (from 276 to 18.5 x 100,000), undernourished children purchasing power parity increased from US$ 3,827 to US$ 20,894 and poverty decreased from 60% to 14.4% of the population. Related indexes such as illiteracy, average schooling, and years of primary school education, were significantly improved as well. Nevertheless, compared with OECD countries, Chile has a relatively low public investment in health (45.7% of total national investment), a deficit in the number of physicians (1.7 x 1,000 inhabitants) and nurses (4.8 x 1,000), in the number of hospital beds (2.1 x 1,000), and in the availability of generic drugs in the market (30%). Chile and the USA are the two OECD countries with the lowest public investment in health. A generalized dissatisfaction with the current Chilean health care model and the need of the vast majority of the population for timely access to acceptable quality medical care are powerful arguments which point to the need for a universal public health care system. The significant increase in public expenditure on health care

Enhancing Health-Care Services with Mixed Reality Systems

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Stantchev, Vladimir

This work presents a development approach for mixed reality systems in health care. Although health-care service costs account for 5-15% of GDP in developed countries the sector has been remarkably resistant to the introduction of technology-supported optimizations. Digitalization of data storing and processing in the form of electronic patient records (EPR) and hospital information systems (HIS) is a first necessary step. Contrary to typical business functions (e.g., accounting or CRM) a health-care service is characterized by a knowledge intensive decision process and usage of specialized devices ranging from stethoscopes to complex surgical systems. Mixed reality systems can help fill the gap between highly patient-specific health-care services that need a variety of technical resources on the one side and the streamlined process flow that typical process supporting information systems expect on the other side. To achieve this task, we present a development approach that includes an evaluation of existing tasks and processes within the health-care service and the information systems that currently support the service, as well as identification of decision paths and actions that can benefit from mixed reality systems. The result is a mixed reality system that allows a clinician to monitor the elements of the physical world and to blend them with virtual information provided by the systems. He or she can also plan and schedule treatments and operations in the digital world depending on status information from this mixed reality.

Western impressions of the Hong Kong health care system.

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Bennett, C L; Pei, G K; Ultmann, J E

1996-01-01

Hong Kong, Taiwan, Singapore, and Malaysia are initiating health care reform to meet the changing demands of populations with improved socioeconomic status and access to modern technologies and who are living longer than in previous generations. Hong Kong, in particular, is facing a unique set of circumstances as its people prepare for the transition in 1997 from a British colony to a Special Administrative Region of China. While spending only 4% of its gross domestic product on health care, it has a large and regulated public hospital system for most inpatient medical care and a separate, loosely regulated private health care system for most outpatient medical care. In 1993 the Secretary for Health and Welfare of Hong Kong initiated a year-long process to debate the pros and cons of 5 fundamental programs for health care reform. After a year of open consultation, options were chosen. We describe the Hong Kong health care system, the fundamental changes that have been adopted, and lessons for reformers in the United States.

[Interpretation in the Danish health-care system].

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Lund Hansen, Marianne Taulo; Nielsen, Signe Smith

2013-03-04

Communication between health professional and patient is central for treatment and patient safety in the health-care system. This systematic review examines the last ten years of specialist literature concerning interpretation in the Danish health-care system. Structural search in two databases, screening of references and recommended literature from two scientists led to identification of seven relevant articles. The review showed that professional interpreters were not used consistently when needed. Family members were also used as interpreters. These results were supported by international investigations.

Transformational change in health care systems: an organizational model.

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Lukas, Carol VanDeusen; Holmes, Sally K; Cohen, Alan B; Restuccia, Joseph; Cramer, Irene E; Shwartz, Michael; Charns, Martin P

2007-01-01

The Institute of Medicine's 2001 report Crossing the Quality Chasm argued for fundamental redesign of the U.S. health care system. Six years later, many health care organizations have embraced the report's goals, but few have succeeded in making the substantial transformations needed to achieve those aims. This article offers a model for moving organizations from short-term, isolated performance improvements to sustained, reliable, organization-wide, and evidence-based improvements in patient care. Longitudinal comparative case studies were conducted in 12 health care systems using a mixed-methods evaluation design based on semistructured interviews and document review. Participating health care systems included seven systems funded through the Robert Wood Johnson Foundation's Pursuing Perfection Program and five systems with long-standing commitments to improvement and high-quality care. Five interactive elements appear critical to successful transformation of patient care: (1) Impetus to transform; (2) Leadership commitment to quality; (3) Improvement initiatives that actively engage staff in meaningful problem solving; (4) Alignment to achieve consistency of organization goals with resource allocation and actions at all levels of the organization; and (5) Integration to bridge traditional intra-organizational boundaries among individual components. These elements drive change by affecting the components of the complex health care organization in which they operate: (1) Mission, vision, and strategies that set its direction and priorities; (2) Culture that reflects its informal values and norms; (3) Operational functions and processes that embody the work done in patient care; and (4) Infrastructure such as information technology and human resources that support the delivery of patient care. Transformation occurs over time with iterative changes being sustained and spread across the organization. The conceptual model holds promise for guiding health care

Quality systems in Dutch health care institutions.

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Casparie, A.F.; Sluijs, E.M.; Wagner, C.; Bakker, D.H. de

1997-01-01

The implementation of quality systems in Dutch health care was supervised by a national committee during 1990-1995. To monitor the progress of implementation a large survey was conducted in the beginning of 1995. The survey enclosed all subsectors in health care. A postal questionnaire-derived

Strategic management of health care information systems: nurse managers' perceptions.

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Lammintakanen, Johanna; Kivinen, Tuula; Saranto, Kaija; Kinnunen, Juha

2009-01-01

The aim of this study is to describe nurse managers' perceptions of the strategic management of information systems in health care. Lack of strategic thinking is a typical feature in health care and this may also concern information systems. The data for this study was collected by eight focus group interviews including altogether 48 nurse managers from primary and specialised health care. Five main categories described the strategic management of information systems in health care; IT as an emphasis of strategy; lack of strategic management of information systems; the importance of management; problems in privacy protection; and costs of IT. Although IT was emphasised in the strategies of many health care organisations, a typical feature was a lack of strategic management of information systems. This was seen both as an underutilisation of IT opportunities in health care organisations and as increased workload from nurse managers' perspective. Furthermore, the nurse managers reported that implementation of IT strengthened their managerial roles but also required stronger management. In conclusion, strategic management of information systems needs to be strengthened in health care and nurse managers should be more involved in this process.

HealthStyles: a new psychographic segmentation system for health care marketers.

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Endresen, K W; Wintz, J C

1988-01-01

HealthStyles is a new psychographic segmentation system specifically designed for the health care industry. This segmentation system goes beyond traditional geographic and demographic analysis and examines health-related consumer attitudes and behaviors. Four statistically distinct "styles" of consumer health care preferences have been identified. The profiles of the four groups have substantial marketing implications in terms of design and promotion of products and services. Each segment of consumers also has differing expectations of physician behavior.

Performance analysis of online health care system | Kohli ...

African Journals Online (AJOL)

This paper deals with selection of appropriate indexing techniques applied on MySQL database for a health care system and its related performance issues. The proposed Smart Card based Online Health Care System deals with frequent data storage, exchange and retrieval of data from the database servers. Speed and ...

2nd International Conference on Health Care Systems Engineering

CERN Document Server

Sahin, Evren; Li, Jingshan; Guinet, Alain; Vandaele, Nico

2016-01-01

In this volume, scientists and practitioners write about new methods and technologies for improving the operation of health care organizations. Statistical analyses play an important role in these methods with the implications of simulation and modeling applied to the future of health care. Papers are based on work presented at the Second International Conference on Health Care Systems Engineering (HCSE2015) in Lyon, France. The conference was a rare opportunity for scientists and practitioners to share work directly with each other. Each resulting paper received a double blind review. Paper topics include: hospital drug logistics, emergency care, simulation in patient care, and models for home care services. Discusses statistical analysis and operations management for health care delivery systems based on real case studies Papers in this volume received a double blind review Brings together the work of scientists, practitioners, and clinicians to unite research and practice in the future of these systems Top...

Applying principles of health system strengthening to eye care

Directory of Open Access Journals (Sweden)

Karl Blanchet

2012-01-01

Full Text Available Understanding Health systems have now become the priority focus of researchers and policy makers, who have progressively moved away from a project-centred perspectives. The new tendency is to facilitate a convergence between health system developers and disease-specific programme managers in terms of both thinking and action, and to reconcile both approaches: one focusing on integrated health systems and improving the health status of the population and the other aiming at improving access to health care. Eye care interventions particularly in developing countries have generally been vertically implemented (e.g. trachoma, cataract surgeries often with parallel organizational structures or specialised disease specific services. With the emergence of health system strengthening in health strategies and in the service delivery of interventions there is a need to clarify and examine inputs in terms governance, financing and management. This present paper aims to clarify key concepts in health system strengthening and describe the various components of the framework as applied in eye care interventions.

Health Care Information System (HCIS) Data File

Data.gov (United States)

U.S. Department of Health & Human Services — The data was derived from the Health Care Information System (HCIS), which contains Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency (Part A...

MEDICARE PAYMENTS AND SYSTEM-LEVEL HEALTH-CARE USE

Science.gov (United States)

ROBBINS, JACOB A.

2015-01-01

The rapid growth of Medicare managed care over the past decade has the potential to increase the efficiency of health-care delivery. Improvements in care management for some may improve efficiency system-wide, with implications for optimal payment policy in public insurance programs. These system-level effects may depend on local health-care market structure and vary based on patient characteristics. We use exogenous variation in the Medicare payment schedule to isolate the effects of market-level managed care enrollment on the quantity and quality of care delivered. We find that in areas with greater enrollment of Medicare beneficiaries in managed care, the non–managed care beneficiaries have fewer days in the hospital but more outpatient visits, consistent with a substitution of less expensive outpatient care for more expensive inpatient care, particularly at high levels of managed care. We find no evidence that care is of lower quality. Optimal payment policies for Medicare managed care enrollees that account for system-level spillovers may thus be higher than those that do not. PMID:27042687

Rapid assessment of infrastructure of primary health care facilities - a relevant instrument for health care systems management.

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Scholz, Stefan; Ngoli, Baltazar; Flessa, Steffen

2015-05-01

Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.

Health Care System Measures to Advance Preconception Wellness: Consensus Recommendations of the Clinical Workgroup of the National Preconception Health and Health Care Initiative.

Science.gov (United States)

Frayne, Daniel J; Verbiest, Sarah; Chelmow, David; Clarke, Heather; Dunlop, Anne; Hosmer, Jennifer; Menard, M Kathryn; Moos, Merry-K; Ramos, Diana; Stuebe, Alison; Zephyrin, Laurie

2016-05-01

Preconception wellness reflects a woman's overall health before conception as a strategy to affect health outcomes for the woman, the fetus, and the infant. Preconception wellness is challenging to measure because it attempts to capture health status before a pregnancy, which may be affected by many different service points within a health care system. The Clinical Workgroup of the National Preconception Health and Health Care Initiative proposes nine core measures that can be assessed at initiation of prenatal care to index a woman's preconception wellness. A two-stage web-based modified Delphi survey and a face-to-face meeting of key opinion leaders in women's reproductive health resulted in identifying seven criteria used to determine the core measures. The Workgroup reached unanimous agreement on an aggregate of nine preconception wellness measures to serve as a surrogate but feasible assessment of quality preconception care within the larger health community. These include indicators for: 1) pregnancy intention, 2) access to care, 3) preconception multivitamin with folic acid use, 4) tobacco avoidance, 5) absence of uncontrolled depression, 6) healthy weight, 7) absence of sexually transmitted infections, 8) optimal glycemic control in women with pregestational diabetes, and 9) teratogenic medication avoidance. The focus of the proposed measures is to quantify the effect of health care systems on advancing preconception wellness. The Workgroup recommends that health care systems adopt these nine preconception wellness measures as a metric to monitor performance of preconception care practice. Over time, monitoring these baseline measures will establish benchmarks and allow for comparison within and among regions, health care systems, and communities to drive improvements.

Health, Health Care, and Systems Science: Emerging Paradigm.

Science.gov (United States)

Janecka, Ivo

2017-02-15

Health is a continuum of an optimized state of a biologic system, an outcome of positive relationships with the self and others. A healthy system follows the principles of systems science derived from observations of nature, highlighting the character of relationships as the key determinant. Relationships evolve from our decisions, which are consequential to the function of our own biologic system on all levels, including the genome, where epigenetics impact our morphology. In healthy systems, decisions emanate from the reciprocal collaboration of hippocampal memory and the executive prefrontal cortex. We can decide to change relationships through choices. What is selected, however, only represents the cognitive interpretation of our limited sensory perception; it strongly reflects inherent biases toward either optimizing state, making a biologic system healthy, or not. Health or its absence is then the outcome; there is no inconsequential choice. Public health effort should not focus on punitive steps (e.g. taxation of unhealthy products or behaviors) in order to achieve a higher level of public's health. It should teach people the process of making healthy decisions; otherwise, people will just migrate/shift from one unhealthy product/behavior to another, and well-intended punitive steps will not make much difference. Physical activity, accompanied by nutrition and stress management, have the greatest impact on fashioning health and simultaneously are the most cost-effective measures. Moderate-to-vigorous exercise not only improves aerobic fitness but also positively influences cognition, including memory and senses. Collective, rational societal decisions can then be anticipated. Health care is a business system principally governed by self-maximizing decisions of its components; uneven and contradictory outcomes are the consequences within such a non-optimized system. Health is not health care. We are biologic systems subject to the laws of biology in spite of

The equity lens in the health care performance evaluation system.

Science.gov (United States)

Barsanti, Sara; Nuti, Sabina

2014-01-01

The main objective of this paper is to describe how indicators of the equity of access to health care according to socioeconomic conditions may be included in a performance evaluation system (PES) in the regional context level and in the planning and strategic control system of healthcare organisations. In particular, the paper investigates how the PES adopted, in the experience of the Tuscany region in Italy, indicators of vertical equity over time. Studies that testify inequality of access to health services often remain just a research output and are not used as targets and measurements in planning and control systems. After a brief introduction to the concept of horizontal and vertical equity in health care systems and equity measures in PES, the paper describes the 'equity process' by which selected health indicators declined by socioeconomic conditions were shared and used in the evaluation of health care institutions and in the CEOs' rewarding system, and subsequently analyses the initial results. Results on the maternal and child path and the chronicity care path not only show improvements in addressing health care inequalities, but also verify whether the health system responds appropriately to different population groups. Copyright © 2013 John Wiley & Sons, Ltd.

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

Science.gov (United States)

Orlando, Rocco; Haytaian, Marcia

2012-08-01

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

The Chinese Health Care System

DEFF Research Database (Denmark)

Hougaard, Jens Leth; Østerdal, Lars Peter; Yu, Yi

In the present paper we describe the structure of the Chinese health care system and sketch its future development. We analyse issues of provider incentives and the actual burden sharing between government, enterprises and people. We further aim to identify a number of current problems and link...

Impact Of Health Care Delivery System Innovations On Total Cost Of Care.

Science.gov (United States)

Smith, Kevin W; Bir, Anupa; Freeman, Nikki L B; Koethe, Benjamin C; Cohen, Julia; Day, Timothy J

2017-03-01

Using delivery system innovations to advance health care reform continues to be of widespread interest. However, it is difficult to generalize about the success of specific types of innovations, since they have been examined in only a few studies. To gain a broader perspective, we analyzed the results of forty-three ambulatory care programs funded by the first round of the Center for Medicare and Medicaid Innovation's Health Care Innovations Awards. The innovations' impacts on total cost of care were estimated by independent evaluators using multivariable difference-in-differences models. Through the first two years, most of the innovations did not show a significant effect on total cost of care. Using meta-regression, we assessed the effects on costs of five common components of these innovations. Innovations that used health information technology or community health workers achieved the greatest cost savings. Savings were also relatively large in programs that targeted clinically fragile patients-clinically complex populations at risk for disease progression. While the magnitude of these effects was often substantial, none achieved conventional levels of significance in our analyses. Meta-analyses of a larger number of delivery system innovations are needed to more clearly establish their potential for patient care cost savings. Project HOPE—The People-to-People Health Foundation, Inc.

Studying integrated health care systems with a structurationist approach

Science.gov (United States)

Demers, Louis; Arseneault, Stéphane; Couturier, Yves

2010-01-01

Introduction To implement an integrated health care system is not an easy task and to ensure its sustainability is yet more difficult. Aim Discuss how a structurationist approach can shed light on the stakes of these processes and guide the managers of such endeavours. Theory and method Structuration theory [1] has been used by numerous authors to cast new light on complex organizational phenomena. One of the central tenets of this theory is that social systems, such as integrated health care systems, are recurrent social practices across time-space and are characterized by structural properties which simultaneously constrain and enable the constitutive social actors who reproduce and transform the system through their practices. We will illustrate our theoretical standpoint with empirical material gathered during the study of an integrated health care system for the frail elderly in Quebec, Canada. This system has been implemented in 1997 and is still working well in 2010. Results and conclusion To implement an integrated health care system that is both effective and sustainable, its managers must shrewdly allow for the existing system and progressively introduce changes in the way managers and practitioners at work in the system view their role and act on a daily basis.

Health care systems in Sweden and China: Legal and formal organisational aspects.

Science.gov (United States)

Albin, Björn; Hjelm, Katarina; Chang Zhang, Wen

2010-06-22

Sharing knowledge and experience internationally can provide valuable information, and comparative research can make an important contribution to knowledge about health care and cost-effective use of resources. Descriptions of the organisation of health care in different countries can be found, but no studies have specifically compared the legal and formal organisational systems in Sweden and China. To describe and compare health care in Sweden and China with regard to legislation, organisation, and finance. Literature reviews were carried out in Sweden and China to identify literature published from 1985 to 2008 using the same keywords. References in recent studies were scrutinized, national legislation and regulations and government reports were searched, and textbooks were searched manually. The health care systems in Sweden and China show dissimilarities in legislation, organisation, and finance. In Sweden there is one national law concerning health care while in China the law includes the "Hygienic Common Law" and the "Fundamental Health Law" which is under development. There is a tendency towards market-orientated solutions in both countries. Sweden has a well-developed primary health care system while the primary health care system in China is still under development and relies predominantly on hospital-based care concentrated in cities. Despite dissimilarities in health care systems, Sweden and China have similar basic assumptions, i.e. to combine managerial-organisational efficiency with the humanitarian-egalitarian goals of health care, and both strive to provide better care for all.

Health system strategies supporting transition to adult care.

Science.gov (United States)

Hepburn, Charlotte Moore; Cohen, Eyal; Bhawra, Jasmin; Weiser, Natalie; Hayeems, Robin Z; Guttmann, Astrid

2015-06-01

The transition from paediatric to adult care is associated with poor clinical outcomes, increased costs and low patient and family satisfaction. However, little is known about health system strategies to streamline and safeguard care for youth transitioning to adult services. Moreover, the needs of children and youth are often excluded from broader health system reform discussions, leaving this population especially vulnerable to system 'disintegration'. (1) To explore the international policy profile of paediatric-to-adult care transitions, and (2) to document policy objectives, initiatives and outcomes for jurisdictions publicly committed to addressing transition issues. An international policy scoping review of all publicly available government documents detailing transition-related strategies was completed using a web-based search. Our analysis included a comparable cohort of nine wealthy Organisation for Economic Co-operation and Development (OECD) jurisdictions with Beveridge-style healthcare systems (deemed those most likely to benefit from system-level transition strategies). Few jurisdictions address transition of care issues in either health or broader social policy documents. While many jurisdictions refer to standardised practice guidelines, a few report the intention to use powerful policy levers (including physician remuneration and non-physician investments) to facilitate the uptake of best practice. Most jurisdictions do not address the policy infrastructure required to support successful transitions, and rigorous evaluations of transition strategies are rare. Despite the well-documented risks and costs associated with a poor transition from paediatric to adult care, little policy attention has been paid to this issue. We recommend that healthcare providers engage health system planners in the design and evaluation of system-level, policy-sensitive transition strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not

The international right to health: state obligations and private actors in the health care system.

Science.gov (United States)

O'Brien, Paula

2013-09-01

Most health systems have historically used a mix of public and private actors for financing and delivering care. But the last 30 years have seen many rich and middle-income countries moving to privatise parts of their health care systems. This phenomenon has generated concerns, especially about equitable access to health care. This article examines what the international right to the highest attainable standard of health in Art 12 of the International Covenant on Economic, Social and Cultural Rights says about the obligations of states which use private actors in health care. The article involves a close study of the primary documents of the key institutions responsible for interpreting and promoting Art 12. From this study, the article concludes that in mixed public-private health care systems, states not only retain primary responsibility for fulfilling the right to health but are subject to a range of additional specific responsibilities.

Evaluation of health care system reform in Hubei Province, China.

Science.gov (United States)

Sang, Shuping; Wang, Zhenkun; Yu, Chuanhua

2014-02-21

This study established a set of indicators for and evaluated the effects of health care system reform in Hubei Province (China) from 2009 to 2011 with the purpose of providing guidance to policy-makers regarding health care system reform. The resulting indicators are based on the "Result Chain" logic model and include the following four domains: Inputs and Processes, Outputs, Outcomes and Impact. Health care system reform was evaluated using the weighted TOPSIS and weighted Rank Sum Ratio methods. Ultimately, the study established a set of indicators including four grade-1 indicators, 16 grade-2 indicators and 76 grade-3 indicators. The effects of the reforms increased year by year from 2009 to 2011 in Hubei Province. The health status of urban and rural populations and the accessibility, equity and quality of health services in Hubei Province were improved after the reforms. This sub-national case can be considered an example of a useful approach to the evaluation of the effects of health care system reform, one that could potentially be applied in other provinces or nationally.

China's health care system reform: Progress and prospects.

Science.gov (United States)

Li, Ling; Fu, Hongqiao

2017-07-01

This paper discusses the progress and prospects of China's complex health care reform beginning in 2009. The Chinese government's undertaking of systemic reform has achieved laudable achievements, including the expansion of social health insurance, the reform of public hospitals, and the strengthening of primary care. An innovative policy tool in China, policy experimentation under hierarchy, played an important role in facilitating these achievements. However, China still faces gaps and challenges in creating a single payer system, restructuring the public hospitals, and establishing an integrated delivery system. Recently, China issued the 13th 5-year plan for medical reform, setting forth the goals, policy priorities, and strategies for health reform in the following 5 years. Moreover, the Chinese government announced the "Healthy China 2030" blueprint in October 2016, which has the goals of providing universal health security for all citizens by 2030. By examining these policy priorities against the existing gaps and challenges, we conclude that China's health care reform is heading in the right direction. To effectively implement these policies, we recommend that China should take advantage of policy experimentation to mobilize bottom-up initiatives and encourage innovations. Copyright © 2017 John Wiley & Sons, Ltd.

Genuine federalism in the Russian health care system: changing roles of government.

Science.gov (United States)

Chernichovsky, D; Potapchik, E

1999-02-01

The reforms that have affected the Russian health care system since the breakup of the Soviet Union, principally those in the general administration of the Russian Federation, have suffered from inconsistency and the absence of a strategy. The various reforms have caused a shift from a national health system characterized by highly centralized management and control, typical of the totalitarian uniform state, to a highly decentralized but fragmented multitude of state systems. Each of these systems is relatively centralized at the local level and run by local administrations with limited government infrastructure and experience. The role of government in the emerging system, and in particular the role of the federal government, remains ill defined. As a result, there is a grave risk that the Russian health care system may disintegrate as a national system. This undermines (a) the prevailing universal and fairly equitable access to care, (b) stabilization of the system following a long period of transition, and (c) the long-term reform that is required to bring the Russian health care system up to par with the health care systems in other developed countries. A rapid transition to a genuine federal health system with well-articulated roles for different levels of government, in tandem with implementation of the 1993 Compulsory Health Insurance System, is essential for the stabilization and reform of the Russian health care system.

New systems of care for substance use disorders: treatment, finance, and technology under health care reform.

Science.gov (United States)

Pating, David R; Miller, Michael M; Goplerud, Eric; Martin, Judith; Ziedonis, Douglas M

2012-06-01

This article outlined ways in which persons with addiction are currently underserved by our current health care system. However, with the coming broad scale reforms to our health care system, the access to and availability of high-quality care for substance use disorders will increase. Addiction treatments will continue to be offered through traditional substance abuse care systems, but these will be more integrated with primary care, and less separated as treatment facilities leverage opportunities to blend services, financing mechanisms, and health information systems under federally driven incentive programs. To further these reforms, vigilance will be needed by consumers, clinicians, and policy makers to assure that the unmet treatment needs of individuals with addiction are addressed. Embedded in this article are essential recommendations to facilitate the improvement of care for substance use disorders under health care reform. Ultimately, as addiction care acquires more of the “look and feel” of mainstream medicine, it is important to be mindful of preexisting trends in health care delivery overall that are reflected in recent health reform legislation. Within the world of addiction care, clinicians must move beyond their self-imposed “stigmatization” and sequestration of specialty addiction treatment. The problem for addiction care, as it becomes more “mainstream,” is to not comfortably feel that general slogans like “Treatment Works,” as promoted by Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment during its annual Recovery Month celebrations, will meet the expectations of stakeholders outside the specialty addiction treatment community. Rather, the problem is to show exactly how addiction treatment works, and to what extent it works-there have to be metrics showing changes in symptom level or functional outcome, changes in health care utilization, improvements in workplace attendance and

Evaluation of the organization and financing of the Danish health care system.

Science.gov (United States)

Janssen, Richard

2002-02-01

The organization and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weaknesses, opportunities and threats) by a panel of five members with a background in health economics. The evaluation was based on the reading of an extensive range of documents and literature on the Danish health care system, and a 1-week visit to health care authorities, providers and key persons. The present paper describes the main findings of one of the panel members. A quality assessment approach is combined with the principles of a SWOT analysis to assess the main features of the Danish health care system. In addition, a public health perspective has been used in judging the coherence of the subsystems of the health systems. It is concluded that the macro-efficiency of the health care system could be increased by improving the cooperation between the subsystems. The relatively high mortality rates suggest that greater input into health education programs could significantly improve the health status of the Danish population. Finally, it is suggested that the steering power of the public board be strengthened by transferring ownership of health care institutions to other hands (privatization).

Medical tourism and its impact on the US health care system.

Science.gov (United States)

Forgione, Dana A; Smith, Pamela C

2007-01-01

The health care industry within the United States continues to face unprecedented increases in costs, along with the task of providing care to an estimated 46 million uninsured or underinsured patients. These patients, along with both insurers and employers, are seeking to reduce the costs of treatment through international outsourcing of medical and surgical care. Knows as medical tourism, this trend is on the rise, and the US health care system has not fully internalized the effects this will have on its economic structure and policies. The demand for low-cost health care services is driving patients to seek treatment on a globally competitive basis, while balancing important quality of care issues. In this article, we outline some of the issues facing legislators, health care policy makers, providers, and health service researchers regarding the impact of medical tourism on the US health care system.

Assessing the role of GPs in Nordic health care systems.

Science.gov (United States)

Quaye, Randolph K

2016-05-03

Purpose This paper examines the changing role of general practitioners (GPs) in Nordic countries of Sweden, Norway and Denmark. It aims to explore the "gate keeping" role of GPs in the face of current changes in the health care delivery systems in these countries. Design/methodology/approach Data were collected from existing literature, interviews with GPs, hospital specialists and representatives of Danish regions and Norwegian Medical Association. Findings The paper contends that in all these changes, the position of the GPs in the medical division of labor has been strengthened, and patients now have increased and broadened access to choice. Research limitations/implications Health care cost and high cancer mortality rates have forced Nordic countries of Sweden, Norway and Denmark to rethink their health care systems. Several attempts have been made to reduce health care cost through market reform and by strenghtening the position of GPs. The evidence suggests that in Norway and Denmark, right incentives are in place to achieve this goal. Sweden is not far behind. The paper has limitations of a small sample size and an exclusive focus on GPs. Practical implications Anecdotal evidence suggests that physicians are becoming extremely unhappy. Understanding the changing status of primary care physicians will yield valuable information for assessing the effectiveness of Nordic health care delivery systems. Social implications This study has wider implications of how GPs see their role as potential gatekeepers in the Nordic health care systems. The role of GPs is changing as a result of recent health care reforms. Originality/value This paper contends that in Norway and Denmark, right incentives are in place to strengthen the position of GPs.

Involving the health care system in domestic violence: what women want.

Science.gov (United States)

Usta, Jinan; Antoun, Jumana; Ambuel, Bruce; Khawaja, Marwan

2012-01-01

PURPOSE Domestic violence is prevalent among women using primary health care services in Lebanon and has a negative effect on their health, yet physicians are not inquiring about it. In this study, we explored the attitudes of these women regarding involving the health care system in domestic violence management. METHODS We undertook a qualitative focus group study. Health care professionals in 6 primary health care centers routinely screened women for domestic violence using the HITS (Hurt, Insult, Threaten, Scream) instrument. At each center, 12 women who were screened (regardless of the result) were recruited to participate in a focus group discussion. RESULTS Most of the 72 women encouraged involvement of the health care system in the management of domestic violence and considered it to be a "socially accepted way to break the silence." Women expected health care professionals to have an "active conscience"; to be open minded, ready to listen, and unhurried; and to respect confidentiality. Additionally, they recommended mass media and community awareness campaigns focusing on family relationships to address domestic violence. CONCLUSIONS Addressing domestic violence through the health care system, if done properly, may be socially acceptable and nonoffensive even to women living in conservative societies such as Lebanon. The women in this study described characteristics of health professionals that would be conducive to screening and that could be extrapolated to the health care of immigrant Arab women.

Task-role-based Access Control Model in Smart Health-care System

OpenAIRE

Wang Peng; Jiang Lingyun

2015-01-01

As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for...

Population aging and its impacts: strategies of the health-care system in Taipei.

Science.gov (United States)

Lin, Ming-Hsien; Chou, Ming-Yueh; Liang, Chih-Kuang; Peng, Li-Ning; Chen, Liang-Kung

2010-11-01

Taiwan is one of the fastest aging countries in the world. As such, the government has developed various strategies to promote an age-friendly health-care system. Health services are supported by National Health Insurance (NHI), which insures over 97% of citizens and over 99% of health-care institutes. The current health-care system has difficulties in caring for older patients with multiple comorbidities, complex care needs, functional impairments, and post-acute care needs. Taipei, an international metropolis with a well-preserved tradition of filial piety in Chinese societies, has developed various strategies to overcome the aforementioned barriers to an age-friendly health-care system. These include an emphasis on general medical care and a holistic approach in all specialties, development of a geriatrics specialty training program, development of post-acute services, and strengthening of linkages between health and social care services. Despite achievements thus far, challenges still include creating a more extensive integration between medical specialties, promotion of an interdisciplinary care model across specialties and health-care settings, and integration of health and social care services. The experiences of Taipei in developing an age-friendly health-care service system may be a culturally appropriate model for other Chinese and Asian communities. Copyright © 2010 Elsevier B.V. All rights reserved.

Community of solution for the U.S. health care system: lessons from the U.S. educational system.

Science.gov (United States)

Devoe, Jennifer E; Gold, Rachel

2013-01-01

The Folsom Group asserts that radical changes are needed to fix the health care system in the United States. The U.S. education system is one potential model to emulate. Could a future health care system-level community of solution be modeled after the U.S. education system? Could community health care services be planned, organized, and delivered at the neighborhood level by district, similar to the structure for delivering public education? Could community health centers, governed by community boards, serve every neighborhood? This essay imagines how U.S. health care system reforms could be designed using our public school system as a roadmap. Our intention is to challenge readers to recognize the urgent need for radical reform in the U.S. health care system, to introduce one potential model for reform, and to encourage creative thinking about other system-level communities of solution that could lead to profound change and improvements in the U.S. health care system.

Assessing systems quality in a changing health care environment: the 2009-10 national survey of children with special health care needs.

Science.gov (United States)

Strickland, Bonnie B; Jones, Jessica R; Newacheck, Paul W; Bethell, Christina D; Blumberg, Stephen J; Kogan, Michael D

2015-02-01

To provide a national, population-based assessment of the quality of the health care system for children and youth with special health care needs using a framework of six health care system quality indicators. 49,242 interviews with parents of children with special health care needs from the 2009-10 National Survey of Children with Special Health Care Needs (NS-CSHCN) were examined to determine the extent to which CSHCN had access to six quality indicators of a well-functioning system of services. Criteria for determining access to each indicator were established and applied to the survey data to estimate the proportion of CSHCN meeting each quality indicator by socio-demographic status and functional limitations. 17.6% of CSHCN received care consistent with all six quality indicators. Results for each component of the system quality framework ranged from a high of 70.3% of parents reporting that they shared decision-making with healthcare providers to a low of 40% of parents reporting receipt of services needed for transition to adult health care. Attainment rates were lower for CSHCN of minority racial and ethnic groups, those residing in households where English was not the primary language, those in lower income households, and those most impacted by their health condition. Only a small proportion of CSHCN receive all identified attributes of a high-quality system of services. Moreover, significant disparities exist whereby those most impacted by their conditions and those in traditionally disadvantaged groups are served least well by the current system. A small proportion of CSHCN appear to remain essentially outside of the system, having met few if any of the elements studied.

Who pays for health care in the United States? Implications for health system reform.

Science.gov (United States)

Holahan, J; Zedlewski, S

1992-01-01

This paper examines the distribution of health care spending and financing in the United States. We analyze the distribution of employer and employee contributions to health insurance, private nongroup health insurance purchases, out-of-pocket expenses, Medicaid benefits, uncompensated care, tax benefits due to the exemption of employer-paid health benefits, and taxes paid to finance Medicare, Medicaid, and the health benefit tax exclusion. All spending and financing burdens are distributed across the U.S. population using the Urban Institute's TRIM2 microsimulation model. We then examine the distributional effects of the U.S. health care system across income levels, family types, and regions of the country. The results show that health care spending increases with income. Spending for persons in the highest income deciles is about 60% above that of persons in the lowest decile. Nonetheless, the distribution of health care financing is regressive. When direct spending, employer contributions, tax benefits, and tax spending are all considered, the persons in the lowest income deciles devote nearly 20% of cash income to finance health care, compared with about 8% for persons in the highest income decile. We discuss how alternative health system reform approaches are likely to change the distribution of health spending and financing burdens.

Task-role-based Access Control Model in Smart Health-care System

Directory of Open Access Journals (Sweden)

Wang Peng

2015-01-01

Full Text Available As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for the medical health-care environment, task-role-based access control model, which overcomes the disadvantages of traditional access control models. The task-role-based access control (T-RBAC model introduces a task concept, dividing tasks into four categories. It also supports supervision role hierarchy. T-RBAC is a proper access control model for Smart Health-care System, and it improves the management of access rights. This paper also proposes an implementation of T-RBAC, a binary two-key-lock pair access control scheme using prime factorization.

HEALTH CARE SYSTEM AS AN OBJECT OF STATISTICAL RESEARCH

Directory of Open Access Journals (Sweden)

Pavel A. Smelov

2015-01-01

Full Text Available The article describes the health care system of the Russian Federation as anobject of statistical analysis. The features of accounting of the health system in Russia. The article highlights the key aspects of the health system, which is characterized as fully as possible the object of study.

Canada's health care system: A relevant approach for South Africa ...

African Journals Online (AJOL)

Background. While countries such as the USA, South Africa and China debate health reforms to improve access to care while rationalising costs, Canada's health care system has emerged as a notable option. In the USA, meaningful discussion of the advantages and disadvantages of the Canadian system has been ...

Involving the Health Care System in Domestic Violence: What Women Want

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Usta, Jinan; Antoun, Jumana; Ambuel, Bruce; Khawaja, Marwan

2012-01-01

PURPOSE Domestic violence is prevalent among women using primary health care services in Lebanon and has a negative effect on their health, yet physicians are not inquiring about it. In this study, we explored the attitudes of these women regarding involving the health care system in domestic violence management. METHODS We undertook a qualitative focus group study. Health care professionals in 6 primary health care centers routinely screened women for domestic violence using the HITS (Hurt, Insult, Threaten, Scream) instrument. At each center, 12 women who were screened (regardless of the result) were recruited to participate in a focus group discussion. RESULTS Most of the 72 women encouraged involvement of the health care system in the management of domestic violence and considered it to be a “socially accepted way to break the silence.” Women expected health care professionals to have an “active conscience”; to be open minded, ready to listen, and unhurried; and to respect confidentiality. Additionally, they recommended mass media and community awareness campaigns focusing on family relationships to address domestic violence. CONCLUSIONS Addressing domestic violence through the health care system, if done properly, may be socially acceptable and nonoffensive even to women living in conservative societies such as Lebanon. The women in this study described characteristics of health professionals that would be conducive to screening and that could be extrapolated to the health care of immigrant Arab women. PMID:22585885

The Cuban health care system and factors currently undermining it.

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Nayeri, K

1995-08-01

This paper explores the dynamics of health and health care in Cuba during a period of severe crisis by placing it within its economic, social, and political context using a comparative historical approach. It outlines Cuban achievements in health care as a consequence of the socialist transformations since 1959, noting the full commitment by the Cuban state, the planned economy, mass participation, and a self-critical, working class perspective as crucial factors. The roles of two external factors, the U.S. economic embargo and the Council of Mutual Economic Cooperation (CMEA), are explored in shaping the Cuban society and economy, including its health care system. It is argued that the former has hindered health efforts in Cuba. The role of the latter is more complex. While the CMEA was an important source for economic growth, Cuban relations with the Soviet bloc had a damaging effect on the development of socialism in Cuba. The adoption of the Soviet model of economic development fostered bureaucracy and demoralization of Cuban workers. As such, it contributed to two internal factors that have undermined further social progress including in health care: low productivity of labor and the growth of bureaucracy. While the health care system is still consistently supported by public policy and its structure is sound, economic crisis undermines its material and moral foundations and threatens its achievements. The future of the current Cuban health care system is intertwined with the potentials for its socialist development.

Outlining a preventive oral health care system for China.

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Saekel, Rüdiger

2015-01-01

The most recent Chinese health care reform, scheduled to run until 2020, has been underway for a number of years. Oral health care has not been explicitly mentioned in the context of this reform. However, oral health is an integral part of general health and the under-servicing of the Chinese population in the area of dental care is particularly high. The article describes how this problem could be addressed. Based on present scientific knowledge,specifically on evidence-based strategies and long-term empirical experience from Western industrialised countries, as well as findings from Chinese pilot studies, the author outlines a preventive oral health care system tailored specifically to the conditions prevailing in China. He describes the background and rationale for a clearly structured, preventive system and summarises the scientific cornerstones on which this concept is founded. The single steps of this model, that are adapted specifically to China, are presented so as to facilitate a critical discussion on the pros and cons of the approach. The author concludes that, by implementing preventive oral care, China could gradually reduce the under-servicing of great parts of the population with dental care that largely avoids dental disease and preserves teeth at a price that is affordable to both public health and patients. This approach would minimise the danger of starting a cycle of re-restorations, owing to outdated treatment methods. The proposal would both fit in well with and add to the current blueprint for Chinese health care reform.

The Professional Development Plan of a Health Care Workforce as a Qualitative Indicator of the Health Care System's Well-Being

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Saiti, Anna; Mylona, Vasiliki

2015-01-01

The quality of a health care system is heavily dependent on a capable and skillful health care workforce so as to guarantee the delivery of quality health care services to its user groups. Hence, only through continuous training and development can the health care workforce follow rapid scientific progress while equitably balancing investment…

Personal health systems and value creation mechanisms in occupational health care.

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Auvinen, Ari-Matti

2007-01-01

Personal Health Systems are believed to have great business potential among citizens, but they might reach also an important market in occupational health care. However, in reaching the occupational health care market, it is important to understand the value creation and value configuration mechanisms of this particular market. This paper also claims that in such a business-to-business market service integrators are needed to compose for the various customers specific offerings combing a tailored variety of products and services to suit their specific needs.

Coordinating Systems of Care Using Health Information Technology: Development of the ADHD Care Assistant

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Power, Thomas J.; Michel, Jeremy; Mayne, Stephanie; Miller, Jeffrey; Blum, Nathan J.; Grundmeier, Robert W.; Guevara, James P.; Fiks, Alexander G.

2016-01-01

Perhaps the two principal venues for the delivery of mental health services are schools and primary care practices. Unfortunately, these systems of care are poorly connected, which may result in care that is fragmented and suboptimal. This article describes the development and implementation of an electronic health record portal, known as the ADHD…

Analyzing the Historical Development and Transition of the Korean Health Care System.

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Lee, Sang-Yi; Kim, Chul-Woung; Seo, Nam-Kyu; Lee, Seung Eun

2017-08-01

Many economically advanced countries have attempted to minimize public expenditures and pursue privatization based on the principles of neo-liberalism. However, Korea has moved contrary to this global trend. This study examines why and how the Korean health care system was formed, developed, and transformed into an integrated, single-insurer, National Health Insurance (NHI) system. We describe the transition in the Korean health care system using an analytical framework that incorporates such critical variables as government economic development strategies and the relationships among social forces, state autonomy, and state power. This study focuses on how the relationships among social forces can change as a nation's economic development or governing strategy changes in response to changes in international circumstances such as globalization. The corporatist Social Health Insurance (SHI) system (multiple insurers) introduced in 1977 was transformed into the single-insurer NHI in July 2000. These changes were influenced externally by globalization and internally by political democratization, keeping Korea's private-dominant health care provision system unchanged over several decades. Major changes such as integration reform occurred, when high levels of state autonomy were ensured. The state's power (its policy capability), based on health care infrastructures, acts to limit the direction of any change in the health care system because it is very difficult to build the infrastructure for a health care system in a short timeframe.

Activity monitoring systems in health care

NARCIS (Netherlands)

Kröse, B.; van Oosterhout, T.; van Kasteren, T.; Salah, A.A.; Gevers, T.

2011-01-01

This chapter focuses on activity monitoring in a home setting for health care purposes. First the most current sensing systems are described, which consist of wearable and ambient sensors. Then several approaches for the monitoring of simple actions are discussed, like falls or therapies. After

The Danish health care system from a British perspective.

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Hurst, Jeremy

2002-02-01

The organisation and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weakness, opportunities and threats) by a panel of five members with a background in health economics. The evaluation was based on reading an extensive amount of selected documents and literature on the Danish health care system, and a one-week visit to health care authorities, providers and key persons. The present paper includes the main findings by one of the panel members. The dominance of tax financing helps to achieve control over the level of health care expenditure, as well as securing equity in financing the services. The reliance on local government for financing and running health care has both advantages and disadvantages, and the split between county and municipal responsibility leads to problems of co-ordination. The remuneration of general practitioners by a mix of capitation payment and fee for services has the advantage of capping expenditure whilst leaving the GPs with an incentive to compete for patients by providing them with good services. The GP service is remarkably economical. The hospital sector displays much strength, but there seem to be problems with respect to: (i) perceived lack of resources and waiting lists; (ii) impersonal care, lack of continuity of care and failures in communication between patients and staff; (iii) management problems and sometimes demotivated staff. The relationship between patients and providers is facilitated by free access to GPs and absence of any charges for hospital treatment. The biggest threat is continuation of avoidable illness caused by poor health habits in the population. The biggest opportunity is to strengthen public health measures to tackle these poor health habits.

System dynamics modeling on health care: supply and demand of dementia care

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Rouwette, E.A.J.A.

2006-01-01

This presentation will address the use of system dynamics models to analyze complex problems in health care. System dynamics has been used on health related issues since at least the 1960s and in the Netherlands since the 1980s. In this approach a group of experts and stakeholders participates in

Guidelines for Management Information Systems in Canadian Health Care Facilities

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Thompson, Larry E.

1987-01-01

The MIS Guidelines are a comprehensive set of standards for health care facilities for the recording of staffing, financial, workload, patient care and other management information. The Guidelines enable health care facilities to develop management information systems which identify resources, costs and products to more effectively forecast and control costs and utilize resources to their maximum potential as well as provide improved comparability of operations. The MIS Guidelines were produced by the Management Information Systems (MIS) Project, a cooperative effort of the federal and provincial governments, provincial hospital/health associations, under the authority of the Canadian Federal/Provincial Advisory Committee on Institutional and Medical Services. The Guidelines are currently being implemented on a “test” basis in ten health care facilities across Canada and portions integrated in government reporting as finalized.

Canadian and the United States' health care systems performance and governance: elements of convergence.

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Globerman, Steven; Hodges, Hart; Vining, Aidan

2002-01-01

International comparisons of the organisation and performance of health care sectors are increasingly informing policy makers about potential policies relating to health care. Politicians, academics and critics in both the United States and Canada have compared and contrasted the health care systems in the two countries. Public debate tends to emphasise the differences between the US and Canadian health care systems. But, dramatic differences between the organisation and performances of health care systems of the two countries would be surprising given that most elements of divergence have only emerged in the last fifty years, and that health systems tend to be driven by the same basic economic problems. This paper provides an overview of the main economic efficiency issues that must be addressed by health care delivery systems, as well as statistical and related evidence on both input usage and output performance of the two health care systems. While Canada clearly spends less on health care, it is difficult to conclude that Canada has a more efficient health care system than the United States. In particular, the US population puts greater demands on its national health care system owing to a combination of behavioural patterns and socio-economic disparities that contribute to much higher rates of violent accidents, as well as specific diseases and other health problems. Also, the stylized representation of the US system as being 'market-driven' and the Canadian system as being 'centrally controlled' is, increasingly, inept. Both systems are evolving toward bureaucratic models that rely more on internal competition than market competition for governance. In this respect, economic forces are nudging both systems towards a convergence of structure and performance.

Capital investment strategies in health care systems.

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Reiter, K L; Smith, D G; Wheeler, J R; Rivenson, H L

2000-01-01

Capital investment decisions are among the most important decisions made by firms. They determine the firm's capacity for providing services and commit the firm's cash for an extended period of time. Interviews with chief financial officers of leading health care systems reveal capital investment strategies that generally follow the recommendations of modern finance theory. Still, there is substantial variation in capital budgeting techniques, methods of risk adjustment, and the importance of qualitative considerations in investment decision making. There is also variation in delegation of investment decision making to operating units and methods of performance evaluation. Health care systems face the same challenges as other organizations in developing and implementing capital investment strategies that use consistent methods for evaluation of projects that have inconsistent aims and outcomes.

Transitioning from learning healthcare systems to learning health care communities.

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Mullins, C Daniel; Wingate, La'Marcus T; Edwards, Hillary A; Tofade, Toyin; Wutoh, Anthony

2018-02-26

The learning healthcare system (LHS) model framework has three core, foundational components. These include an infrastructure for health-related data capture, care improvement targets and a supportive policy environment. Despite progress in advancing and implementing LHS approaches, low levels of participation from patients and the public have hampered the transformational potential of the LHS model. An enhanced vision of a community-engaged LHS redesign would focus on the provision of health care from the patient and community perspective to complement the healthcare system as the entity that provides the environment for care. Addressing the LHS framework implementation challenges and utilizing community levers are requisite components of a learning health care community model, version two of the LHS archetype.

Four proposals for market-based health care system reform.

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Sumner, W

1994-08-01

A perfectly free, competitive medical market would not meet many social goals, such as universal access to health care. Micromanagement of interactions between patients and providers does not guarantee quality care and frequently undermines that relationship, to the frustration of all involved. Furthermore, while some North American health care plans are less expensive than others, none have reduced the medical inflation rate to equal the general inflation rate. Markets have always fixed uneven inflation rates in other domains. The suggested reforms could make elective interactions between patients and providers work more like a free market than did any preceding system. The health and life insurance plan creates cost-sensitive consumers, informed by a corporation with significant research incentives and abilities. The FFEB proposal encourages context-sensitive pricing, established by negotiation processes that weigh labor and benefit. Publication of providers' expected outcomes further enriches the information available to consumers and may reduce defensive medicine incentives. A medical career ladder would ease entry and exit from medical professions. These and complementary reforms do not specifically cap spending yet could have a deflationary impact on elective health care prices, while providing incentives to maintain quality. They accomplish these ends by giving more responsibility, information, incentives, and choice to citizens. We could provide most health care in a marketlike environment. We can incorporate these reforms in any convenient order and allow them to compete with alternative schemes. Our next challenge is to design, implement, and evaluate marketlike health care systems.

Consumer-sponsored prepaid group practice: restructuring the health care system.

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Warden, G L

1984-01-01

The traditional separation of health care delivery and financing systems is breaking down as various new types of health care facilities are established and as payment continues to be a major concern. Group Health Cooperative of Puget Sound (GHC) was organized as a prepaid group practice system responsive to consumers. Costs, methods of payment and delivery of care are interrelated and are all influenced by consumer ownership. GHC has been refining its benefit programs since 1945. Strategies for controlling use and costs focus on improved provider management and on flexibility. This article explains how the structure of GHC benefits the consumer.

Assessing Systems Quality in a Changing Health Care Environment: The 2009–10 National Survey of Children with Special Health Care Needs

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Jones, Jessica R.; Newacheck, Paul W.; Bethell, Christina D.; Blumberg, Stephen J.; Kogan, Michael D.

2016-01-01

To provide a national, population-based assessment of the quality of the health care system for children and youth with special health care needs using a framework of six health care system quality indicators. 49,242 interviews with parents of children with special health care needs from the 2009–10 National Survey of Children with Special Health Care Needs (NS-CSHCN) were examined to determine the extent to which CSHCN had access to six quality indicators of a well-functioning system of services. Criteria for determining access to each indicator were established and applied to the survey data to estimate the proportion of CSHCN meeting each quality indicator by socio-demographic status and functional limitations. 17.6 % of CSHCN received care consistent with all six quality indicators. Results for each component of the system quality framework ranged from a high of 70.3 % of parents reporting that they shared decision-making with healthcare providers to a low of 40 % of parents reporting receipt of services needed for transition to adult health care. Attainment rates were lower for CSHCN of minority racial and ethnic groups, those residing in households where English was not the primary language, those in lower income households, and those most impacted by their health condition. Only a small proportion of CSHCN receive all identified attributes of a high-quality system of services. Moreover, significant disparities exist whereby those most impacted by their conditions and those in traditionally disadvantaged groups are served least well by the current system. A small proportion of CSHCN appear to remain essentially outside of the system, having met few if any of the elements studied. PMID:24912943

Using systems science for population health management in primary care.

Science.gov (United States)

Li, Yan; Kong, Nan; Lawley, Mark A; Pagán, José A

2014-10-01

Population health management is becoming increasingly important to organizations managing and providing primary care services given ongoing changes in health care delivery and payment systems. The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes. The New York Academy of Medicine Cardiovascular Health Simulation model (an agent-based model) and data from the Behavioral Risk Factor Surveillance System were used to evaluate a lifestyle program that could be implemented in primary care practice settings. The program targeted Medicare-age adults and focused on improving diet and exercise and reducing weight. The simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 years). Similar results were found for the subpopulations with high cholesterol, but the proposed intervention would not have a significant effect in the proportion of the population with hypertension over a time period of Systems science methodologies can be useful to compare the health outcomes of different interventions. These tools can become an important component of population health management because they can help managers and other decision makers evaluate alternative programs in primary care settings. © The Author(s) 2014.

Population preferences for health care in liberia: insights for rebuilding a health system.

Science.gov (United States)

Kruk, Margaret E; Rockers, Peter C; Tornorlah Varpilah, S; Macauley, Rose

2011-12-01

OBJECTIVE. To quantify the influence of health system attributes, particularly quality of care, on preferences for health clinics in Liberia, a country with a high burden of disease that is rebuilding its health system after 14 years of civil war. DATA SOURCES/STUDY SETTING. Informed by focus group discussions, a discrete choice experiment (DCE) was designed to assess preferences for structure and process of care at health clinics. The DCE was fielded in rural, northern Liberia as part of a 2008 population-based survey on health care utilization. DATA COLLECTION. The survey response rate was 98 percent with DCE data available for 1,431 respondents. Mixed logit models were used to estimate the influence of six attributes on choice of hypothetical clinics for a future illness. PRINCIPAL FINDINGS. Participants' choice of clinic was most influenced by provision of a thorough physical exam and consistent availability of medicines. Respectful treatment and government (versus NGO) management marginally increased utility, whereas waiting time was not significant. CONCLUSIONS. Liberians value technical quality of care over convenience, courtesy, and public management in selecting clinics for curative care. This suggests that investments in improved competence of providers and availability of medicines may increase population utilization of essential services as well as promote better clinical outcomes. © Health Research and Educational Trust.

Grounds of necessity to carry out reforms in health care system in Ukraine: historical aspect

Directory of Open Access Journals (Sweden)

I. P. Krynychna

2015-03-01

Full Text Available The article studies the historical experience of reforming the health care system in Ukraine, which allow clearing up the basic problems of public administration. Thus, the health care legislation is characterized as a fragmentary and complex thing with common overlaps and vaguely defined areas of accountability of financial and material resources and a significant deficit of funding. In turn, there is an urgent need for a fundamental change in strategy of the state policy concerning the restructuring of the health care system, which would involve fundamentally new mechanisms of public administration that must be adapted to the specific social problems and opportunities, particularly in conditions of limited resources. It is determined that reforming the health care systems of the former Soviet Union countries has similar nature with Ukraine, namely: the lack of government funding, poor quality of medical care, high level of medical services payment by citizens, the low level of wages of health care employees, and, as a consequence, the limited availability of the population to qualitative health services. On the basis of the results of the analysis of existing and not solved problems of the health care system it is proved the necessity to introduce new mechanisms of control in this field: the development of a system of compulsory medical insurance; the combination of budget and insurance sources of financing the health care system; the growing funding for the health care system; the development of initial care; adjustment of the state guarantees, according to the state financial opportunities; increasing the wages of health care employees; search for new organizational forms of health care institutions; increase the efficiency of health care resources; privatization and improvement of the structure of the medical care system . Keywords: public administration, health care reform, health insurance, initial care, medical care, medical services

Practice Parameter on Child and Adolescent Mental Health Care in Community Systems of Care

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Journal of the American Academy of Child and Adolescent Psychiatry, 2007

2007-01-01

This parameter presents overarching principles and practices for child and adolescent mental health care in community systems of care. Community systems of care are defined broadly as comprising the wide array of child-serving agencies, programs, and practitioners (both public and private), in addition to natural community supports such as…

CURRENT ECONOMIC AND MEDICAL REFORMS IN THE ROMANIAN HEALTH CARE SYSTEM

Directory of Open Access Journals (Sweden)

Dragoi Mihaela Cristina

2011-12-01

Full Text Available The issue of health has always been, both in social reality and in academia and research, a sensitive topic considering the relationship each individual has with his own health and the health care system as a public policy. At public opinion levels and not only, health care is the most important sector demanding the outmost attention, considering that individual health is the fundamental prerequisite for well-being, happiness and a satisfying life. The ever present research and practical question is on the optimal financing of the health care system. Any answer to this question is also a political decision, reflecting the social-economic value of health for a particular country. The size of the resource pool and the criteria and methods for resource allocation are the central economic problems for any health system. This paper takes into consideration the limited resources of the national health care system (the rationalization of health services, the common methods of health financing, the specificity of health services market (the health market being highly asymmetric, with health professionals knowing most if not all of the relevant information, such as diagnosis, treatment options and costs and consumers fully dependent on the information provided in each case and the performance of all hospitals in Romania, in order to assess the latest strategic decisions (introduction of co-payment and merging and reconversion of hospitals taken within the Romanian health care system and their social and economic implications. The main finding show that, even though the intention of reforming and transforming the Romanian health care system into a more efficient one is obvious, the lack of economic and demographic analysis may results into greater discrepancies nationwide. This paper is aimed to renew the necessity of joint collaboration between the economic and medical field, since the relationship between health and economic development runs both ways

Open architecture for health care systems: the European RICHE experience.

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Frandji, B

1997-01-01

Groupe RICHE is bringing to the market of health IT the Open Systems approach allowing a new generation of health information systems to arise with benefit for patients, health care professionals, hospital managers, agencies and citizens. Groupe RICHE is a forum for exchanging information, expertise around open systems in health care. It is open to any organisation interested by open systems in health care and wanting to participate and influence the work done by its user, marketing and technical committees. The Technical Committee is in charge of the maintenance of the architecture and impact the results of industrial experiences on new releases. Any Groupe RICHE member is entitled to participate to this process. This unique approach in Europe allows health care professionals to benefit from applications supporting their business processes, including providing a cooperative working environment, a shared electronic record, in an integrated system where the information is entered only once, customised according to the user needs and available to the administrative applications. This allows Hospital managers to satisfy their health care professionals, to smoothly migrate from their existing environment (protecting their investment), to choose products in a competitive environment, being able to mix and match system components and services from different suppliers, being free to change suppliers without having to replace their existing system (minimising risk), in line with national and regional strategies. For suppliers, this means being able to commercialise products well fitted to their field of competence in a large market, reducing investments and increasing returns. The RICHE approach also allows agencies to define a strategy, allowing to create a supporting infrastructure, organising the market leaving enough freedom to health care organisations and suppliers. Such an approach is based on the definition of an open standard architecture. The RICHE esprit project

United States and Canadian approaches to justice in health care: a comparative analysis of health care systems and values.

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Jecker, N S; Meslin, E M

1994-06-01

The purpose of this study is to compare and contrast the basic ethical values underpinning national health care policies in the United States and Canada. We use the framework of ethical theory to name and elaborate ethical values and to facilitate moral reflection about health care reform. Section one describes historical and contemporary social contract theories and clarifies the ethical values associated with them. Sections two and three show that health care debates and health care systems in both countries reflect the values of this tradition; however, each nation interprets the tradition differently. In the U.S., standards of justice for health care are conceived as a voluntary agreement reached by self-interested parties. Canadians, by contrast, interpret the same justice tradition as placing greater emphasis on concern for others and for the community. The final section draws out the implications of these differences for future U.S. and Canadian health care reforms.

The Nuka System of Care: improving health through ownership and relationships.

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Gottlieb, Katherine

2013-01-01

Southcentral Foundation's Nuka System of Care, based in Anchorage, Alaska, is a result of a customer-driven overhaul of what was previously a bureaucratic system centrally controlled by the Indian Health Service. Alaska Native people are in control as the "customer-owners" of this health care system. The vision and mission focus on physical, mental, emotional, and spiritual wellness and working together as a Native Community. Coupled with operational principles based on relationships, core concepts and key points, this framework has fostered an environment for creativity, innovation and continuous quality improvement. Alaska Native people have received national and international recognition for their work and have set high standards for performance excellence, community engagement, and overall impact on population health. In this article, the health care transformation led by Alaska Native people is described and the benefits and results of customer ownership and the relationship-based Nuka System of Care are discussed.

The French Health Care System: What Can We Learn?

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El Taguri A

2008-01-01

Full Text Available All public systems look for the best organizational structure to funnel part of their national income into healthcare services. Appropriate policies may differ widely across country settings. Most healthcare systems fall under one of two broad categories, either Bismark or Beveridge systems. There is no simple ideal model for the organization of health services, but most healthcare systems that follow the Beveridge healthcare model are poor performers. The Libyan Health system is a low responsive, inefficient and underperforming system that lacks goals and/or SMART. (Specific, Measurable, Achievable, Realistic, Time specific objectives. A look at different organization models in the world would reinforce efforts to reorganize and improve the performance of the Libyan National Healthcare services.The French Health Care System (FHCS ranked first according to the WHO and the European Health Consumer Powerhouse. The FHCS was described to have a technically efficient, generous healthcare system that provides the best overall health care. This makes the FHCS a practical model of organization having many of the essential aspects of a modern national health service. In this review, we describe the main features of the FHCS, current challenges and future trends with particular attention paid to aspects that could be of importance to the Libyan Healthcare System.

Budget-makers and health care systems.

Science.gov (United States)

White, Joseph

2013-10-01

Health programs are shaped by the decisions made in budget processes, so how budget-makers view health programs is an important part of making health policy. Budgeting in any country involves its own policy community, with key players including budgeting professionals and political authorities. This article reviews the typical pressures on and attitudes of these actors when they address health policy choices. The worldview of budget professionals includes attitudes that are congenial to particular policy perspectives, such as the desire to select packages of programs that maximize population health. The pressures on political authorities, however, are very different: most importantly, public demand for health care services is stronger than for virtually any other government activity. The norms and procedures of budgeting also tend to discourage adoption of some of the more enthusiastically promoted health policy reforms. Therefore talk about rationalizing systems is not matched by action; and action is better explained by the need to minimize blame. The budget-maker's perspective provides insight about key controversies in healthcare policy such as decentralization, competition, health service systems as opposed to health insurance systems, and dedicated vs. general revenue finance. It also explains the frequency of various "gaming" behaviors. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Health and health-care systems in southeast Asia: diversity and transitions.

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Chongsuvivatwong, Virasakdi; Phua, Kai Hong; Yap, Mui Teng; Pocock, Nicola S; Hashim, Jamal H; Chhem, Rethy; Wilopo, Siswanto Agus; Lopez, Alan D

2011-01-29

Southeast Asia is a region of enormous social, economic, and political diversity, both across and within countries, shaped by its history, geography, and position as a major crossroad of trade and the movement of goods and services. These factors have not only contributed to the disparate health status of the region's diverse populations, but also to the diverse nature of its health systems, which are at varying stages of evolution. Rapid but inequitable socioeconomic development, coupled with differing rates of demographic and epidemiological transitions, have accentuated health disparities and posed great public health challenges for national health systems, particularly the control of emerging infectious diseases and the rise of non-communicable diseases within ageing populations. While novel forms of health care are evolving in the region, such as corporatised public health-care systems (government owned, but operating according to corporate principles and with private-sector participation) and financing mechanisms to achieve universal coverage, there are key lessons for health reforms and decentralisation. New challenges have emerged with rising trade in health services, migration of the health workforce, and medical tourism. Juxtaposed between the emerging giant economies of China and India, countries of the region are attempting to forge a common regional identity, despite their diversity, to seek mutually acceptable and effective solutions to key regional health challenges. In this first paper in the Lancet Series on health in southeast Asia, we present an overview of key demographic and epidemiological changes in the region, explore challenges facing health systems, and draw attention to the potential for regional collaboration in health. Copyright © 2011 Elsevier Ltd. All rights reserved.

Local health systems in 21st century: who cares?-An exploratory study on health system governance in Amsterdam.

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Plochg, T; Delnoij, D M J; Hogervorst, W V G; van Dijk, P; Belleman, S; Klazinga, N S

2006-10-01

There is a growing awareness that there should be a public health perspective to health system governance. Its intrinsic population health orientation provides the ultimate ground for determining the health needs and governing collaborative care arrangements within which these needs can be met. Notwithstanding differences across countries, population health concerns are not central to European health reforms. Governments currently withdraw leaving governance roles to care providers and/or financiers. Thereby, incentives that trigger the uptake of a public health perspective are often ignored. In this study we addressed this issue in the city of Amsterdam. Using a qualitative study design, we explored whether there is a public health perspective to the governance practices of the municipality and the major sickness fund in Amsterdam. And if so, what the scope of this perspective is. And if not, why not. Findings indicate that the municipality has a public health perspective to local health system governance, but its scope is limited. The municipality facilitates rather than governs health care provision in Amsterdam. Furthermore, the sickness fund runs major financial risks when adapting a public health perspective. It covers an insured population that partly overlaps the Amsterdam population. Returns on investments in population health are therefore uncertain, as competitors would also profit from the sickness fund's investments. The local health system in Amsterdam is not consistently aligned to the health needs of the Amsterdam population. The Amsterdam case is not unique and general consequences for local health system governance are discussed.

The Child Health Care System of Croatia.

Science.gov (United States)

Mestrovic, Julije; Bralic, Irena; Simetin, Ivana Pavic; Mujkic, Aida; Radonić, Marija; Rodin, Urelija; Trošelj, Mario; Stevanović, Ranko; Benjak, Tomislav; Pristaš, Ivan; Mayer, Dijana; Tomić, Branimir

2016-10-01

The Republic of Croatia is a Parliamentary Republic with a population of 4.2 million people that sits on the Adriatic coast within Central Europe. Gross domestic product is approximately 60% of the European Union average, which in turn, limits health service spending. The health system is funded through universal health insurance administered by the Croatian Health Insurance Fund based on the principles of social solidarity and reciprocity. The children of Croatia are guaranteed access to universal primary, hospital, and specialist care provided by a network of health institutions. Pediatricians and school medicine specialists provide comprehensive preventive health care for both preschool and school-aged children. Despite the Croatian War of Independence in the late 20th century, indicators of child health and measures of health service delivery to children and families are steadily improving. However, similar to many European countries, Croatia is experiencing a rise in the "new morbidities" and is responding to these new challenges through a whole society approach to promote healthy lifestyles and insure good quality of life for children. Copyright © 2016 Elsevier Inc. All rights reserved.

Discourse analysis: A useful methodology for health-care system researches.

Science.gov (United States)

Yazdannik, Ahmadreza; Yousefy, Alireza; Mohammadi, Sepideh

2017-01-01

Discourse analysis (DA) is an interdisciplinary field of inquiry and becoming an increasingly popular research strategy for researchers in various disciplines which has been little employed by health-care researchers. The methodology involves a focus on the sociocultural and political context in which text and talk occur. DA adds a linguistic approach to an understanding of the relationship between language and ideology, exploring the way in which theories of reality and relations of power are encoded in such aspects as the syntax, style, and rhetorical devices used in texts. DA is a useful and productive qualitative methodology but has been underutilized within health-care system research. Without a clear understanding of discourse theory and DA it is difficult to comprehend important research findings and impossible to use DA as a research strategy. To redress this deficiency, in this article, represents an introduction to concepts of discourse and DA, DA history, Philosophical background, DA types and analysis strategy. Finally, we discuss how affect to the ideological dimension of such phenomena discourse in health-care system, health beliefs and intra-disciplinary relationship in health-care system.

Closing the Health Care Gap in Communities: A Safety Net System Approach.

Science.gov (United States)

Gabow, Patricia A

2016-10-01

The goal of U.S. health care should be good health for every American. This daunting goal will require closing the health care gap in communities with a particular focus on the most vulnerable populations and the safety net institutions that disproportionately serve these communities. This Commentary describes Denver Health's (DH's) two-pronged approach to achieving this goal: (1) creating an integrated system that focuses on the needs of vulnerable populations, and (2) creating an approach for financial viability, quality of care, and employee engagement. The implementation and outcomes of this approach at DH are described to provide a replicable model. An integrated delivery system serving vulnerable populations should go beyond the traditional components found in most integrated health systems and include components such as mental health services, school-based clinics, and correctional health care, which address the unique and important needs of, and points of access for, vulnerable populations. In addition, the demands that a safety net system experiences from an open-door policy on access and revenue require a disciplined approach to cost, quality of care, and employee engagement. For this, DH chose Lean, which focuses on reducing waste to respect the patients and employees within its health system, as well as all citizens. DH's Lean effort produced almost $195 million of financial benefit, impressive clinical outcomes, and high employee engagement. If this two-pronged approach were widely adopted, health systems across the United States would improve their chances of giving better care at costs they can afford for every person in society.

Strengthening of Oral Health Systems: Oral Health through Primary Health Care

Science.gov (United States)

Petersen, Poul Erik

2014-01-01

Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work with the newly established WHO Collaborating Centre, Kuwait University, to strengthen the development of appropriate models for primary oral health care. PMID:24525450

Population Preferences for Health Care in Liberia: Insights for Rebuilding a Health System

Science.gov (United States)

Kruk, Margaret E; Rockers, Peter C; Tornorlah Varpilah, S; Macauley, Rose

2011-01-01

Objective To quantify the influence of health system attributes, particularly quality of care, on preferences for health clinics in Liberia, a country with a high burden of disease that is rebuilding its health system after 14 years of civil war. Data Sources/Study Setting Informed by focus group discussions, a discrete choice experiment (DCE) was designed to assess preferences for structure and process of care at health clinics. The DCE was fielded in rural, northern Liberia as part of a 2008 population-based survey on health care utilization. Data Collection The survey response rate was 98 percent with DCE data available for 1,431 respondents. Mixed logit models were used to estimate the influence of six attributes on choice of hypothetical clinics for a future illness. Principal Findings Participants' choice of clinic was most influenced by provision of a thorough physical exam and consistent availability of medicines. Respectful treatment and government (versus NGO) management marginally increased utility, whereas waiting time was not significant. Conclusions Liberians value technical quality of care over convenience, courtesy, and public management in selecting clinics for curative care. This suggests that investments in improved competence of providers and availability of medicines may increase population utilization of essential services as well as promote better clinical outcomes. PMID:21517835

[Health care networks].

Science.gov (United States)

Mendes, Eugênio Vilaça

2010-08-01

The demographic and epidemiologic transition resulting from aging and the increase of life expectation means an increment related to chronic conditions. The healthcare systems contemporary crisis is characterized by the organization of the focus on fragmented systems turned to the acute conditions care, in spite of the chronic conditions prevalence, and by the hierarchical structure without communication flow among the different health care levels. Brazil health care situation profile is now presenting a triple burden of diseases, due to the concomitant presence of infectious diseases, external causes and chronic diseases. The solution is to restore the consistence between the triple burden of diseases on the health situation and the current system of healthcare practice, with the implantation of health care networks. The conclusion is that there are evidences in the international literature on health care networks that these networks may improve the clinical quality, the sanitation results and the user's satisfaction and the reduction of healthcare systems costs.

A SUSTAINABLE HEALTH CARE SYSTEM REQUIRES MANAGEMENT TRANSFORMATION

Directory of Open Access Journals (Sweden)

Kanellopoulos Dimitros

2011-12-01

Full Text Available In order to be the health care system sustainable , management transformations must be based on very precise diagnostic analysis that includes complete and current information. It is necessary to implement an information system that collects information in real time, that watches the parameters that significantly influence the sustainability of the system. Such an information system should point out a radiography(a scan of the system at some time under following aspects:: 1. An overview of system; 2 An overview of the economic situation; 3 A technical presentation ;4. A legal overview; 5. A social overview ; 6. A management overview .Based on these Xrays of the health system, it outlines a series of conclusions and recommendations together with a SWOT analysis that highlights the potential internal (strengths and weaknesses and external potential (opportunities and threats. Based on this analysis and recommendations, the management is going to redesign the system in order to be adapted to the changing environmental requirements. Management transformation is recommended to be by following steps. :1. The development of a new management system that would make a positive change in the health care system 2. Implementation of the new management system 3. Assessment of the changes

In place of fear: aligning health care planning with system objectives to achieve financial sustainability.

Science.gov (United States)

Birch, Stephen; Murphy, Gail Tomblin; MacKenzie, Adrian; Cumming, Jackie

2015-04-01

The financial sustainability of publicly funded health care systems is a challenge to policymakers in many countries as health care absorbs an ever increasing share of both national wealth and government spending. New technology, aging populations and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in need for care within populations. Attempts to promote financial sustainability of systems such as limiting the range of services is covered or the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper, an alternative view of financial sustainability is presented which identifies the failure of planning and management of health care to reflect needs for care in populations and to integrate planning and management functions for health care expenditure, health care services and the health care workforce. We present a Health Care Sustainability Framework based on disaggregating the health care expenditure into separate planning components. Unlike other approaches to planning health care expenditure, this framework explicitly incorporates population health needs as a determinant of health care requirements, and provides a diagnostic tool for understanding the sources of expenditure increase. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Sources of project financing in health care systems.

Science.gov (United States)

Smith, D G; Wheeler, J R; Rivenson, H L; Reiter, K L

2000-01-01

Through discussions with chief financial officers of leading health care systems, insights are offered on preferences for project financing and development efforts. Data from these same systems provide at least anecdotal evidence in support of pecking-order theory.

The Healthcare Administrator's Desk Reference: A Managed Care and Health Care Contracting Dictionary for the Military Health System

National Research Council Canada - National Science Library

Korody-Colwell, Carol

1998-01-01

.... Specifically, a thorough knowledge of the language, terminology, and acronyms is fundamental to understanding today s health care delivery processes both in the civilian sector and the military health system...

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes.

Science.gov (United States)

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10-20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

Oral Health Care Delivery Within the Accountable Care Organization.

Science.gov (United States)

Blue, Christine; Riggs, Sheila

2016-06-01

The accountable care organization (ACO) provides an opportunity to strategically design a comprehensive health system in which oral health works within primary care. A dental hygienist/therapist within the ACO represents value-based health care in action. Inspired by health care reform efforts in Minnesota, a vision of an accountable care organization that integrates oral health into primary health care was developed. Dental hygienists and dental therapists can help accelerate the integration of oral health into primary care, particularly in light of the compelling evidence confirming the cost-effectiveness of care delivered by an allied workforce. A dental insurance Chief Operating Officer and a dental hygiene educator used their unique perspectives and experience to describe the potential of an interdisciplinary team-based approach to individual and population health, including oral health, via an accountable care community. The principles of the patient-centered medical home and the vision for accountable care communities present a paradigm shift from a curative system of care to a prevention-based system that encompasses the behavioral, social, nutritional, economic, and environmental factors that impact health and well-being. Oral health measures embedded in the spectrum of general health care have the potential to ensure a truly comprehensive healthcare system. Published by Elsevier Inc.

Problems of transition from tax-based system of health care finance to mandatory health insurance model in Russia.

Science.gov (United States)

Shishkin, S

1999-06-01

This article examines three problems burdening the Russian system of health care finance in transition period: (a) unrealistic government promise to cover health care coverage too wide to be achieved with available resources; (b) inefficient management of health care delivery systems; and (c) lack in evidence of actual positive changes effected by the new players: mandatory health insurance carriers and funds. Radical reshaping of the health benefits promised by the government and introduction of patient co-payments are considered as a way to normalize public health sector finance and operations. Two alternative approaches to the reform of the existing eclectic system of health care management are available. Institutional preconditions for operational effectiveness of third-party purchasers of health services in public-financed health sector are defined.

Bureaucratic Itineraries in Colombia. A theoretical and methodological tool to assess managed-care health care systems.

Science.gov (United States)

Abadia, Cesar Ernesto; Oviedo, Diana G

2009-03-01

Steady increases in the number of Colombians insured by the health care system contrasts with the hundreds of thousands of legal actions interposed to warrant citizen's right to health. This study aims to analyze the relationships among patients' experiences of denials by the system, the country's legal mechanisms, and the functioning of insurance companies and service providing institutions. We conducted a mixed-methods case study in Bogotá and present a quantitative description of 458 cases, along with semi-structured interviews and an in-depth illness history. We found that Colombians' denials of care most commonly include appointments, laboratory tests or treatments. Either insurance companies or service providing institutions use the system's legal structure to justify the different kinds of denials. To warrant their right to health care, citizens are forced to interpose legal mechanisms, which are largely ruled in favor, but delays result in a progressive and cumulative pattern of harmful consequences, as follows: prolongation of suffering, medical complications of health status, permanent harmful consequences, permanent disability, and death. We diagram the path that Colombians need to follow to have their health care claims attended by the system in a matrix called Bureaucratic Itineraries. Bureaucratic Itineraries is a theoretical and methodological construct that links the personal experience of illness with the system's structure and could be an important tool for understanding, evaluating and comparing different systems' performances. In this case, it allowed us to conclude that managed care in Colombia has created complex bureaucracies that delay and limit care through cost-containment mechanisms, which has resulted in harmful consequences for people's lives.

Explaining public satisfaction with health-care systems: findings from a nationwide survey in China.

Science.gov (United States)

Munro, Neil; Duckett, Jane

2016-06-01

To identify factors associated with health-care system satisfaction in China. Recent research suggests that socio-demographic characteristics, self-reported health, income and insurance, ideological beliefs, health-care utilization, media use and perceptions of services may affect health-care system satisfaction, but the relative importance of these factors is poorly understood. New data from China offer the opportunity to test theories about the sources of health-care system satisfaction. Stratified nationwide survey sample analysed using multilevel logistic regression. 3680 Chinese adults residing in family dwellings between 1 November 2012 and 17 January 2013. Satisfaction with the way the health-care system in China is run. We find only weak associations between satisfaction and socio-demographic characteristics, self-reported health and income. We do, however, find that satisfaction is strongly associated with having insurance and belief in personal responsibility for meeting health-care costs. We also find it is negatively associated with utilization, social media use, perceptions of access as unequal and perceptions of service providers as unethical. To improve satisfaction, Chinese policymakers - and their counterparts in countries with similar health-care system characteristics - should improve insurance coverage and the quality of health services, and tackle unethical medical practices. © 2015 The Authors. Health Expectations published by John Wiley & Sons Ltd.

Current pulse: can a production system reduce medical errors in health care?

Science.gov (United States)

Printezis, Antonios; Gopalakrishnan, Mohan

2007-01-01

One of the reasons for rising health care costs is medical errors, a majority of which result from faulty systems and processes. Health care in the past has used process-based initiatives such as Total Quality Management, Continuous Quality Improvement, and Six Sigma to reduce errors. These initiatives to redesign health care, reduce errors, and improve overall efficiency and customer satisfaction have had moderate success. Current trend is to apply the successful Toyota Production System (TPS) to health care since its organizing principles have led to tremendous improvement in productivity and quality for Toyota and other businesses that have adapted them. This article presents insights on the effectiveness of TPS principles in health care and the challenges that lie ahead in successfully integrating this approach with other quality initiatives.

Exploring information systems outsourcing in U.S. hospital-based health care delivery systems.

Science.gov (United States)

Diana, Mark L

2009-12-01

The purpose of this study is to explore the factors associated with outsourcing of information systems (IS) in hospital-based health care delivery systems, and to determine if there is a difference in IS outsourcing activity based on the strategic value of the outsourced functions. IS sourcing behavior is conceptualized as a case of vertical integration. A synthesis of strategic management theory (SMT) and transaction cost economics (TCE) serves as the theoretical framework. The sample consists of 1,365 hospital-based health care delivery systems that own 3,452 hospitals operating in 2004. The findings indicate that neither TCE nor SMT predicted outsourcing better than the other did. The findings also suggest that health care delivery system managers may not be considering significant factors when making sourcing decisions, including the relative strategic value of the functions they are outsourcing. It is consistent with previous literature to suggest that the high cost of IS may be the main factor driving the outsourcing decision.

Mental health care system optimization from a health-economics perspective: where to sow and where to reap?

Science.gov (United States)

Lokkerbol, Joran; Weehuizen, Rifka; Mavranezouli, Ifigeneia; Mihalopoulos, Cathrine; Smit, Filip

2014-06-01

Health care expenditure (as % of GDP) has been rising in all OECD countries over the last decades. Now, in the context of the economic downturn, there is an even more pressing need to better guarantee the sustainability of health care systems. This requires that policy makers are informed about optimal allocation of budgets. We take the Dutch mental health system in the primary care setting as an example of new ways to approach optimal allocation. To demonstrate how health economic modelling can help in identifying opportunities to improve the Dutch mental health care system for patients presenting at their GP with symptoms of anxiety, stress, symptoms of depression, alcohol abuse/dependence, anxiety disorder or depressive disorder such that changes in the health care system have the biggest leverage in terms of improved cost-effectiveness. Investigating such scenarios may serve as a starting point for setting an agenda for innovative and sustainable health care policies. A health economic simulation model was used to synthesize clinical and economic evidence. The model was populated with data from GPs' national register on the diagnosis, treatment, referral and prescription of their patients in the year 2009. A series of `what-if' analyses was conducted to see what parameters (uptake, adherence, effectiveness and the costs of the interventions) are associated with the most substantial impact on the cost-effectiveness of the health care system overall. In terms of improving the overall cost-effectiveness of the primary mental health care system, substantial benefits could be derived from increasing uptake of psycho-education by GPs for patients presenting with stress and when low cost interventions are made available that help to increase the patients' compliance with pharmaceutical interventions, particularly in patients presenting with symptoms of anxiety. In terms of intervention costs, decreasing the costs of antidepressants is expected to yield the biggest

Children in Greenland: disease patterns and contacts to the health care system

Directory of Open Access Journals (Sweden)

Marius Kløvgaard

2016-12-01

Full Text Available Background: Previous studies of Greenlandic children’s disease pattern and contacts to the health care system are sparse and have focused on the primary health care sector. Objective: We aimed to identify the disease pattern and use of health care facilities of children aged 0–10 in two Greenlandic cohorts. Methods and design: In a retrospective, descriptive follow-up of the Ivaaq (The Greenland Child Cohort and the CLEAR (climate changes, environmental contaminants and reproductive health birth cohorts (total n=1,000, we reviewed medical records of children aged 6–10 in 2012 with residence in Nuuk or Ilulissat (n=332. Data on diseases and health care system contacts were extracted. Diagnoses were validated retrospectively. Primary health care contacts were reviewed for a random sample of 1:6. Results: In 311 children with valid social security number, the total number of health care system contacts was 12,471 equalling 4.6 contacts per child per year. The annual incidence rate of hospital admissions was 1:10 children (total n=266, 1,220 days, 4.6 days/admission, outpatient contacts 2:10 children and primary care 3.6 per child. Contacts were overall more frequent in boys compared with girls, 39.5 versus 34.6 during the study period, p=0.02. The highest annual contact rates for diseases were: hospitalisations/acute respiratory diseases 13.9:1,000; outpatient contacts/otitis media 5.1:1,000; primary care/conjunctivitis or nasopharyngitis 410:1,000 children. Outpatient screening for respiratory tuberculosis accounted 6.2:1,000, primary care non-disease (Z-diagnosis 2,081:1,000 annually. Complete adherence to the child vaccination programme was seen in 40%, while 5% did not receive any vaccinations. Conclusions: In this first study of its kind, the health care contact pattern in Greenlandic children showed a relatively high hospitalisation rate and duration per admission, and a low primary health care contact rate. The overall contact rate and

Supporting Active Patient and Health Care Collaboration: A Prototype for Future Health Care Information Systems.

Science.gov (United States)

Åhlfeldt, Rose-Mharie; Persson, Anne; Rexhepi, Hanife; Wåhlander, Kalle

2016-12-01

This article presents and illustrates the main features of a proposed process-oriented approach for patient information distribution in future health care information systems, by using a prototype of a process support system. The development of the prototype was based on the Visuera method, which includes five defined steps. The results indicate that a visualized prototype is a suitable tool for illustrating both the opportunities and constraints of future ideas and solutions in e-Health. The main challenges for developing and implementing a fully functional process support system concern both technical and organizational/management aspects. © The Author(s) 2015.

Impact of extreme weather events and climate change for health and social care systems.

Science.gov (United States)

Curtis, Sarah; Fair, Alistair; Wistow, Jonathan; Val, Dimitri V; Oven, Katie

2017-12-05

This review, commissioned by the Research Councils UK Living With Environmental Change (LWEC) programme, concerns research on the impacts on health and social care systems in the United Kingdom of extreme weather events, under conditions of climate change. Extreme weather events considered include heatwaves, coldwaves and flooding. Using a structured review method, we consider evidence regarding the currently observed and anticipated future impacts of extreme weather on health and social care systems and the potential of preparedness and adaptation measures that may enhance resilience. We highlight a number of general conclusions which are likely to be of international relevance, although the review focussed on the situation in the UK. Extreme weather events impact the operation of health services through the effects on built, social and institutional infrastructures which support health and health care, and also because of changes in service demand as extreme weather impacts on human health. Strategic planning for extreme weather and impacts on the care system should be sensitive to within country variations. Adaptation will require changes to built infrastructure systems (including transport and utilities as well as individual care facilities) and also to institutional and social infrastructure supporting the health care system. Care sector organisations, communities and individuals need to adapt their practices to improve resilience of health and health care to extreme weather. Preparedness and emergency response strategies call for action extending beyond the emergency response services, to include health and social care providers more generally.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

Directory of Open Access Journals (Sweden)

Janya McCalman

2018-03-01

Full Text Available Continuous quality improvement (CQI processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

Science.gov (United States)

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally. PMID:29623271

Social Workers' Role in the Canadian Mental Health Care System

Science.gov (United States)

Towns, Ashley M.; Schwartz, Karen

2012-01-01

Objective: Using Canadian survey data this research provides social workers in Canada with a better understanding of their role in the Canadian mental health care system. Methods: By analyzing data from the Canadian Community Health Survey, Cycle 1.2 Mental Health and Well-being, the role of social workers in the Canadian mental health system was…

Viewpoint: Re-instating a 'public health' system under universal health care in India.

Science.gov (United States)

George, Mathew

2015-02-01

I examine possibilities for strengthening essential public health functions in the context of India's drive to implement universal health care. In a country where population health outcomes are rooted in social, political, economic, cultural, and ecological conditions, it is important to have a state mediated public health system that can modify the causes of the major public health problems. This calls for strengthening the social epidemiological approach in public health by demarcating public health functions distinct from medical care. This will be a prerequisite for the growth of the public health profession in the country, because it can offer avenues for newly trained professionals within the country to work in 'core' public health.

[Perceptions of primary care physicians in Madrid on the austerity measures in the health care system].

Science.gov (United States)

Heras-Mosteiro, Julio; Otero-García, Laura; Sanz-Barbero, Belén; Aranaz-Andrés, Jesús María

2016-01-01

To address the current economic crisis, governments have promoted austerity measures that have affected the taxpayer-funded health system. We report the findings of a study exploring the perceptions of primary care physicians in Madrid (Spain) on measures implemented in the Spanish health system. We carried out a qualitative study in two primary health care centres located in two neighbourhoods with unemployment and migrant population rates above the average of those in Madrid. Interviews were conducted with 12 primary health care physicians. Interview data were analysed by using thematic analysis and by adopting some elements of the grounded theory approach. Two categories were identified: evaluation of austerity measures and evaluation of decision-making in this process. Respondents believed there was a need to promote measures to improve the taxpayer-funded health system, but expressed their disagreement with the measures implemented. They considered that the measures were not evidence-based and responded to the need to decrease public health care expenditure in the short term. Respondents believed that they had not been properly informed about the measures and that there was adequate professional participation in the prioritization, selection and implementation of measures. They considered physician participation to be essential in the decision-making process because physicians have a more patient-centred view and have first-hand knowledge of areas requiring improvement in the system. It is essential that public authorities actively involve health care professionals in decision-making processes to ensure the implementation of evidence-based measures with strong professional support, thus maintaining the quality of care. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

HIV-positive migrants’ encounters with the Swedish health care system

DEFF Research Database (Denmark)

Mehdiyar, Manijeh; Andersson, Rune; Hjelm, Katarina

2016-01-01

of access and adversity’ was identified as the core category of the study. Three additional categories were ‘appreciation of free access to treatment’, ‘the impact of the Swedish Disease Act on everyday life’, and ‘encountering discrimination in the general health care system’. The main finding indicated......Background: There is limited knowledge about human immunodeficiency virus (HIV)-positive migrants and their experiences in the Swedish health care system. It is necessary to increase our knowledge in this field to improve the quality of care and social support for this vulnerable group of patients....... Objective: The aim of this study was to describe the experiences of HIV-positive migrants and their encounters with the health care system in Sweden. Design: This is a Grounded Theory study based on qualitative interviews with 14 HIV-positive migrants living in Sweden, aged 29–55 years. Results: ‘A hybrid...

The Oral Health Care Delivery System in 2040: Executive Summary.

Science.gov (United States)

Bailit, Howard L

2017-09-01

This executive summary for Section 4 of the "Advancing Dental Education in the 21 st Century" project examines the projected oral health care delivery system in 2040 and the likely impact of system changes on dental education. Dental care is at an early stage of major changes with the decline in solo practice and increase in large group practices. These groups are not consolidated at the state level, but further consolidation is expected as they try to increase their negotiating leverage with dental insurers. At this time, there is limited integration of medical and dental care in terms of financing, regulation, education, and delivery. This pattern may change as health maintenance organizations and integrated medical systems begin to offer dental care to their members. By 2040, it is expected that many dentists will be employed in large group practices and working with allied dental staff with expanded duties and other health professionals, and more dental graduates will seek formal postdoctoral training to obtain better positions in group practices.

When health systems are barriers to health care: challenges faced by uninsured Mexican kidney patients.

Science.gov (United States)

Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J

2013-01-01

Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort.

The Active Duty Primigravada's Perception of Prenatal Care in the Military Health Care System

National Research Council Canada - National Science Library

Brady, Vicki

1998-01-01

.... In this study a qualitative descriptive design using the active duty primigravada as the population of interest was used to explore perceptions of and satisfaction with prenatal care in the military health care system...

The role and uptake of private health insurance in different health care systems: are there lessons for developing countries?

Directory of Open Access Journals (Sweden)

Odeyemi IA

2013-03-01

Full Text Available Isaac AO Odeyemi,1 John Nixon21Senior Director and Head of Health Economics and Outcomes Research, Astellas Pharma UK Ltd, Chertsey, UK; 2Teaching Associate in Health Economics, Department of Economics and Related Studies, University of York, York, UKBackground: Social and national health insurance schemes are being introduced in many developing countries in moving towards universal health care. However, gaps in coverage are common and can only be met by out-of-pocket payments, general taxation, or private health insurance (PHI. This study provides an overview of PHI in different health care systems and discusses factors that affect its uptake and equity.Methods: A representative sample of countries was identified (United States, United Kingdom, The Netherlands, France, Australia, and Latvia that illustrates the principal forms and roles of PHI. Literature describing each country's health care system was used to summarize how PHI is utilized and the factors that affect its uptake and equity.Results: In the United States, PHI is a primary source of funding in conjunction with tax-based programs to support vulnerable groups; in the UK and Latvia, PHI is used in a supplementary role to universal tax-based systems; in France and Latvia, complementary PHI is utilized to cover gaps in public funding; in The Netherlands, PHI is supplementary to statutory private and social health insurance; in Australia, the government incentivizes the uptake of complementary PHI through tax rebates and penalties. The uptake of PHI is influenced by age, income, education, health care system typology, and the incentives or disincentives applied by governments. The effect on equity can either be positive or negative depending on the type of PHI adopted and its role within the wider health care system.Conclusion: PHI has many manifestations depending on the type of health care system used and its role within that system. This study has illustrated its common applications

Mobile technologies and geographic information systems to improve health care systems: a literature review.

Science.gov (United States)

Nhavoto, José António; Grönlund, Ake

2014-05-08

A growing body of research has employed mobile technologies and geographic information systems (GIS) for enhancing health care and health information systems, but there is yet a lack of studies of how these two types of systems are integrated together into the information infrastructure of an organization so as to provide a basis for data analysis and decision support. Integration of data and technical systems across the organization is necessary for efficient large-scale implementation. The aim of this paper is to identify how mobile technologies and GIS applications have been used, independently as well as in combination, for improving health care. The electronic databases PubMed, BioMed Central, Wiley Online Library, Scopus, Science Direct, and Web of Science were searched to retrieve English language articles published in international academic journals after 2005. Only articles addressing the use of mobile or GIS technologies and that met a prespecified keyword strategy were selected for review. A total of 271 articles were selected, among which 220 concerned mobile technologies and 51 GIS. Most articles concern developed countries (198/271, 73.1%), and in particular the United States (81/271, 29.9%), United Kingdom (31/271, 11.4%), and Canada (14/271, 5.2%). Applications of mobile technologies can be categorized by six themes: treatment and disease management, data collection and disease surveillance, health support systems, health promotion and disease prevention, communication between patients and health care providers or among providers, and medical education. GIS applications can be categorized by four themes: disease surveillance, health support systems, health promotion and disease prevention, and communication to or between health care providers. Mobile applications typically focus on using text messaging (short message service, SMS) for communication between patients and health care providers, most prominently reminders and advice to patients. These

The health system cost of post-abortion care in Rwanda

Science.gov (United States)

Vlassoff, Michael; Musange, Sabine F; Kalisa, Ina R; Ngabo, Fidele; Sayinzoga, Felix; Singh, Susheela; Bankole, Akinrinola

2015-01-01

Based on research conducted in 2012, we estimate the cost to the Rwandan health-care system of providing post-abortion care (PAC) due to unsafe abortions, a subject of policy importance not studied before at the national level. Thirty-nine public and private health facilities representing three levels of health care were randomly selected for data collection from key care providers and administrators for all five regions. Using an ingredients approach to costing, data were gathered on drugs, supplies, material, personnel time and hospitalization. Additionally, direct non-medical costs such as overhead and capital costs were also measured. We found that the average annual PAC cost per client, across five types of abortion complications, was $93. The total cost of PAC nationally was estimated to be $1.7 million per year, 49% of which was expended on direct non-medical costs. Satisfying all demands for PAC would raise the national cost to $2.5 million per year. PAC comprises a significant share of total expenditure in reproductive health in Rwanda. Investing more resources in provision of contraceptive services to prevent unwanted or mistimed pregnancies would likely reduce health systems costs. PMID:24548846

Decision support system for health care resources allocation.

Science.gov (United States)

Sebaa, Abderrazak; Nouicer, Amina; Tari, AbdelKamel; Tarik, Ramtani; Abdellah, Ouhab

2017-06-01

A study about healthcare resources can improve decisions regarding the allotment and mobilization of medical resources and to better guide future investment in the health sector. The aim of this work was to design and implement a decision support system to improve medical resources allocation of Bejaia region. To achieve the retrospective cohort study, we integrated existing clinical databases from different Bejaia department health sector institutions (an Algerian department) to collect information about patients from January 2015 through December 2015. Data integration was performed in a data warehouse using the multi-dimensional model and OLAP cube. During implementation, we used Microsoft SQL server 2012 and Microsoft Excel 2010. A medical decision support platform was introduced, and was implemented during the planning stages allowing the management of different medical orientations, it provides better apportionment and allotment of medical resources, and ensures that the allocation of health care resources has optimal effects on improving health. In this study, we designed and implemented a decision support system which would improve health care in Bejaia department to especially assist in the selection of the optimum location of health center and hospital, the specialty of the health center, the medical equipment and the medical staff.

The role and uptake of private health insurance in different health care systems: are there lessons for developing countries?

Science.gov (United States)

Odeyemi, Isaac Ao; Nixon, John

2013-01-01

Social and national health insurance schemes are being introduced in many developing countries in moving towards universal health care. However, gaps in coverage are common and can only be met by out-of-pocket payments, general taxation, or private health insurance (PHI). This study provides an overview of PHI in different health care systems and discusses factors that affect its uptake and equity. A representative sample of countries was identified (United States, United Kingdom, The Netherlands, France, Australia, and Latvia) that illustrates the principal forms and roles of PHI. Literature describing each country's health care system was used to summarize how PHI is utilized and the factors that affect its uptake and equity. In the United States, PHI is a primary source of funding in conjunction with tax-based programs to support vulnerable groups; in the UK and Latvia, PHI is used in a supplementary role to universal tax-based systems; in France and Latvia, complementary PHI is utilized to cover gaps in public funding; in The Netherlands, PHI is supplementary to statutory private and social health insurance; in Australia, the government incentivizes the uptake of complementary PHI through tax rebates and penalties. The uptake of PHI is influenced by age, income, education, health care system typology, and the incentives or disincentives applied by governments. The effect on equity can either be positive or negative depending on the type of PHI adopted and its role within the wider health care system. PHI has many manifestations depending on the type of health care system used and its role within that system. This study has illustrated its common applications and the factors that affect its uptake and equity in different health care systems. The results are anticipated to be helpful in informing how developing countries may utilize PHI to meet the aim of achieving universal health care.

On residents’ satisfaction with community health services after health care system reform in Shanghai, China, 2011

Directory of Open Access Journals (Sweden)

Li Zhijian

2012-06-01

Full Text Available Abstract Background Health care system reform is a major issue in many countries and therefore how to evaluate the effects of changes is incredibly important. This study measured residents’ satisfaction with community health care service in Shanghai, China, and aimed to evaluate the effect of recent health care system reform. Methods Face-to-face interviews were performed with a stratified random sample of 2212 residents of the Shanghai residents using structured questionnaires. In addition, 972 valid responses were retrieved from internet contact. Controlling for sex, age, income and education, the study used logistic regression modeling to analyze factors associated with satisfaction and to explain the factors that affect the residents’ satisfaction. Results Comparing current attitudes with those held at the initial implementation of the reform in this investigation, four dimensions of health care were analyzed: 1 the health insurance system; 2 essential drugs; 3 basic clinical services; and 4 public health services. Satisfaction across all dimensions improved since the reform was initiated, but differences of satisfaction level were found among most dimensions and groups. Residents currently expressed greater satisfaction with clinical service (average score=3.79, with 5 being most satisfied and the public health/preventive services (average score=3.62; but less satisfied with the provision of essential drugs (average score=3.20 and health insurance schemes (average score=3.23. The disadvantaged groups (the elderly, the retired, those with only an elementary education, those with lower incomes had overall poorer satisfaction levels on these four aspects of health care (P Conclusion The respondents showed more satisfaction with the clinical services (average score=3.79 and public health services/interventions (average score=3.79; and less satisfaction with the health insurance system (average score=3.23 and the essential drug system

What is Clinical Safety in Electronic Health Care Record Systems?

Science.gov (United States)

Davies, George

There is mounting public awareness of an increasing number of adverse clinical incidents within the National Health Service (NHS), but at the same time, large health care projects like the National Programme for IT (NPFIT) are claiming that safer care is one of the benefits of the project and that health software systems in particular have the potential to reduce the likelihood of accidental or unintentional harm to patients. This paper outlines the approach to clinical safety management taken by CSC, a major supplier to NPFIT; discusses acceptable levels of risk and clinical safety as an end-to-end concept; and touches on the future for clinical safety in health systems software.

Care and pedagogical production: integration of Public Health System scenarios

Directory of Open Access Journals (Sweden)

Túlio Batista Franco

2007-01-01

Full Text Available Throughout Brazilian Public Health System's (Centralized Health System - SUS construction history there has been a reasonable investment in the education for the sector. However, it has been frequently noticed by health professionals and managers the fact that this investment in educational programs has not converted into change of healthcare practices. Assuming that education can be used as a tool for changes in health, the text suggests that the pedagogical practices should be directed towards the production of individuals implied with the care production. Hence it proposes to work on a field of subjectivity in addition to cognition. This work reveals the management of the Brazilian public health system and its flows of permanent education, focusing "micromanagement" to think about the context on which they structuralize the diverse scenarios of care production, treating them as Pedagogical Production Units where it would be possible to develop entailed educational methodologies to a general idea of permanent education in health.

Knowledge Management System in Health & Social Care: Review on 20 Practiced Knowledge Management

Directory of Open Access Journals (Sweden)

Muhammad Saiful Ridhwan

2014-02-01

Full Text Available The importance of managing medical information has become very critical in the healthcare delivery system. Medical information nowadays are optimized towards serving different areas such as; diagnosing of diseases, planning and administration, treatment and monitoring of patient outcomes, services and costs. This article provides a review into various Health and Social Care systems which encompasses the Knowledge Management value. For analysis, more than 30 systems that are related to Health and Social Care were gathered via Internet research, only 20 of these systems were finally selected based on recent system development and popularity of the system.Keywords: Health Care, Knowledge, Knowledge Management, Social Care, systemdoi:10.12695/ajtm.2013.6.2.4 How to cite this article:Ridhwan, M.S., and Oyefolahan, I.O. (2013. Knowledge Management System in Health & Social Care: Review on 20 Practiced Knowledge Management. The Asian Journal of Technology Management 6 (2: 92-101. Print ISSN: 1978-6956; Online ISSN: 2089-791X. doi:10.12695/ajtm.2013.6.2.4

System-wide lean implementation in health care: A multiple case study.

Science.gov (United States)

Centauri, Federica; Mazzocato, Pamela; Villa, Stefano; Marsilio, Marta

2018-05-01

Background Lean practices have been widely used by health care organizations to meet efficiency, performance and quality improvement needs. The lean health care literature shows that the effective implementation of lean requires a holistic system-wide approach. However, there is still limited evidence on what drives effective system-wide lean implementation in health care. The existing literature suggests that a deeper understanding of how lean interventions interact with the organizational context is necessary to identify the critical variables to successfully sustain system-wide lean strategies. Purpose and methodology: A multiple case study of three Italian hospitals is conducted with the aim to explore the organizational conditions that are relevant for an effective system-wide lean implementation. A conceptual framework, built on socio-technical system schemas, is used to guide data collection and analysis. The analysis points out the importance to support lean implementation with an integrated and coordinated strategy involving the social, technical, and external components of the overall hospital system.

On residents' satisfaction with community health services after health care system reform in Shanghai, China, 2011.

Science.gov (United States)

Li, Zhijian; Hou, Jiale; Lu, Lin; Tang, Shenglan; Ma, Jin

2012-01-01

Health care system reform is a major issue in many countries and therefore how to evaluate the effects of changes is incredibly important. This study measured residents' satisfaction with community health care service in Shanghai, China, and aimed to evaluate the effect of recent health care system reform. Face-to-face interviews were performed with a stratified random sample of 2212 residents of the Shanghai residents using structured questionnaires. In addition, 972 valid responses were retrieved from internet contact. Controlling for sex, age, income and education, the study used logistic regression modeling to analyze factors associated with satisfaction and to explain the factors that affect the residents' satisfaction. Comparing current attitudes with those held at the initial implementation of the reform in this investigation, four dimensions of health care were analyzed: 1) the health insurance system; 2) essential drugs; 3) basic clinical services; and 4) public health services. Satisfaction across all dimensions improved since the reform was initiated, but differences of satisfaction level were found among most dimensions and groups. Residents currently expressed greater satisfaction with clinical service (average score=3.79, with 5 being most satisfied) and the public health/preventive services (average score=3.62); but less satisfied with the provision of essential drugs (average score=3.20) and health insurance schemes (average score=3.23). The disadvantaged groups (the elderly, the retired, those with only an elementary education, those with lower incomes) had overall poorer satisfaction levels on these four aspects of health care (Phealth services/interventions (average score=3.79); and less satisfaction with the health insurance system (average score=3.23) and the essential drug system (average score=3.20). Disadvantaged groups showed lower satisfaction levels overall relative to non-disadvantaged groups.

Coordination of care in the Chinese health care systems: a gap analysis of service delivery from a provider perspective.

Science.gov (United States)

Wang, Xin; Birch, Stephen; Zhu, Weiming; Ma, Huifen; Embrett, Mark; Meng, Qingyue

2016-10-12

Increases in health care utilization and costs, resulting from the rising prevalence of chronic conditions related to the aging population, is exacerbated by a high level of fragmentation that characterizes health care systems in China. There have been several pilot studies in China, aimed at system-level care coordination and its impact on the full integration of health care system, but little is known about their practical effects. Huangzhong County is one of the pilot study sites that introduced organizational integration (a dimension of integrated care) among health care institutions as a means to improve system-level care coordination. The purposes of this study are to examine the effect of organizational integration on system-level care coordination and to identify factors influencing care coordination and hence full integration of county health care systems in rural China. We chose Huangzhong and Hualong counties in Qinghai province as study sites, with only Huangzhong having implemented organizational integration. A mixed methods approach was used based on (1) document analysis and expert consultation to develop Best Practice intervention packages; (2) doctor questionnaires, identifying care coordination from the perspective of service provision. We measured service provision with gap index, overlap index and over-provision index, by comparing observed performance with Best Practice; (3) semi-structured interviews with Chiefs of Medicine in each institution to identify barriers to system-level care coordination. Twenty-nine institutions (11 at county-level, 6 at township-level and 12 at village-level) were selected producing surveys with a total of 19 schizophrenia doctors, 23 diabetes doctors and 29 Chiefs of Medicine. There were more care discontinuities for both diabetes and schizophrenia in Huangzhong than in Hualong. Overall, all three index scores (measuring service gaps, overlaps and over-provision) showed similar tendencies for the two conditions

The importance of examining movements within the US health care system: sequential logit modeling

Directory of Open Access Journals (Sweden)

Lee Chioun

2010-09-01

Full Text Available Abstract Background Utilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements. Methods The sample included 6,772 adults aged 18 years and older who participated in the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. A sequential logit model was used to account for movement in all stages of utilization: use of any health services (i.e., first stage, having a perceived need for specialty care (i.e., second stage, and utilization of specialty care (i.e., third stage. In the sequential logit model, all stages are nested within the previous stage. Results Gender, race/ethnicity, education and poor health had significant explanatory effects with regard to use of any health services and having a perceived need for specialty care, however racial/ethnic, gender, and educational disparities were not present in utilization of specialty care. After controlling for use of any health services and having a perceived need for specialty care, inability to pay for specialty care via income (AOR = 1.334, CI = 1.10 to 1.62 or health insurance (unstable insurance: AOR = 0.26, CI = 0.14 to 0.48; no insurance: AOR = 0.12, CI = 0.07 to 0.20 were significant barriers to utilization of specialty care. Conclusions Use of a sequential logit model to examine utilization of specialty care resulted in a detailed representation of utilization behaviors and patient characteristics that impact these behaviors at all stages within the health care system. After controlling for sequential movements within the health care system, the biggest barrier to utilizing specialty care is the inability to pay, while racial, gender, and educational disparities

Assessing the contribution of the dental care delivery system to oral health care disparities.

Science.gov (United States)

Pourat, Nadereh; Andersen, Ronald M; Marcus, Marvin

2015-01-01

Existing studies of disparities in access to oral health care for underserved populations often focus on supply measures such as number of dentists. This approach overlooks the importance of other aspects of the dental care delivery system, such as personal and practice characteristics of dentists, that determine the capacity to provide care. This study aims to assess the role of such characteristics in access to care of underserved populations. We merged data from the 2003 California Health Interview Survey and a 2003 survey of California dentists in their Medical Study Service Areas (MSSAs). We examined the role of overall supply and other characteristics of dentists in income and racial/ethnic disparities in access, which was measured by annual dental visits and unmet need for dental care due to costs. We found that some characteristics of MSSAs, including higher proportions of dentists who were older, white, busy or overworked, and did not accept public insurance or discounted fees, inhibited access for low-income and minority populations. These findings highlight the importance of monitoring characteristics of dentists in addition to traditional measures of supply such as licensed-dentist-to-population ratios. The findings identify specific aspects of the delivery system such as dentists' participation in Medicaid, provision of discounted care, busyness, age, race/ethnicity, and gender that should be regularly monitored. These data will provide a better understanding of how the dental care delivery system is organized and how this knowledge can be used to develop more narrowly targeted policies to alleviate disparities. © 2014 American Association of Public Health Dentistry.

Service Line Management: A New Paradigm in Health Care System

Directory of Open Access Journals (Sweden)

Rafat Rezapour Nasrabad

2016-12-01

Full Text Available Health care organizations are required to implement modern management practices and approaches due to the importance of improving quality and increasing efficiency of health care services. Service line management of healthcare services is one of the new approaches that managers of health sectors are interested in. The “service line” approach will organize the management of inpatient and outpatient in clinical services focusing on patient diagnostic clusters. Services specific in each patient diagnostic cluster will be offered by a multidisciplinary team including nurses, physicians, and so no. Accordingly, the present study aims to evaluate the features, process and benefits of service line management approach in the provision of health services. In this descriptive study, internal and external scientific database have been reviewed and the necessary data have been extracted from the latest research projects and related scientific documents. The results showed that the new management approach is based on a paradigm shift from traditional health care system management to healthcare service line management with a focus on managers’ competencies. Four specific manager’s competencies in this new management model are: conceptual, collaborative, interpersonal, and leadership competencies. Theses competencies should be developed in health system managers so as to lead to organizational excellency and improvement of health service quality. The health sector managers should strengthen these four key competencies and act on them. Then they will become effective leaders and managers in the health system.

THE DEVELOPMENT OF GEOPORTAL ʻTHE HEALTH CARE SYSTEM OF STAVROPOL REGIONʼ

Directory of Open Access Journals (Sweden)

P. D. Agapitova

2015-01-01

Full Text Available The article discusses the problems and principles of the development of geoportal of the Health Care System of the region using geoinformation technologies which will enable monitoring network of health facilities and morbidity rates of the population. This article offers effective tools for improving the management of the health care system, as well as the prospects of the proposed Internet resource.

Operations management in health care.

Science.gov (United States)

Henderson, M D

1995-01-01

Health care operations encompass the totality of those health care functions that allow those who practice health care delivery to do so. As the health care industry undergoes dramatic reform, so will the jobs of those who manage health care delivery systems. Although health care operations managers play one of the most vital and substantial roles in the new delivery system, the criteria for their success (or failure) are being defined now. Yet, the new and vital role of the operations manager has been stunted in its development, which is primarily because of old and outdated antipathy between hospital administrators and physicians. This article defines the skills and characteristics of today's health care operations managers.

Creating Age-Friendly Health Systems - A vision for better care of older adults.

Science.gov (United States)

Mate, Kedar S; Berman, Amy; Laderman, Mara; Kabcenell, Andrea; Fulmer, Terry

2018-03-01

Safe and effective care of older adults is a crucial issue given the rapid growth of the aging demographic, many of whom have complex health and social needs. At the same time, the health care delivery environment is rapidly changing, offering a new set of opportunities to improve care of older adults. We describe the background, evidence-based changes, and testing, scale-up, and spread strategy that are part of the design of the Creating Age-Friendly Health Systems initiative. The goal is to reach 20% of U.S. hospitals and health systems by 2020, with plans to reach additional hospitals and health systems in subsequent years. Copyright © 2017 Elsevier Inc. All rights reserved.

Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study.

Science.gov (United States)

Muinga, Naomi; Magare, Steve; Monda, Jonathan; Kamau, Onesmus; Houston, Stuart; Fraser, Hamish; Powell, John; English, Mike; Paton, Chris

2018-04-18

The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a

Pluralist social constraints on the development of a health care system: the case of Israel.

Science.gov (United States)

Palley, H A; Yishai, Y; Ever-Hadani, P

1983-01-01

The effectiveness of Israel's health care system is hindered by pluralism, in terms both of its many separate health service institutions and of the particularism of those institutions. Although the health care system provides modern health care to a widely insured population, it does so inefficiently and at unnecessary expense. The lack of vertical and horizontal integration of the health care system has led to problems of fragmentation, duplication, and lack of coordination of services. Because of its limited resources, Israel must work to surmount this pluralism and achieve integrated planning if it is to succeed in providing the efficient and cost-effective care its population needs.

The ethical self-fashioning of physicians and health care systems in culturally appropriate health care.

Science.gov (United States)

Shaw, Susan J; Armin, Julie

2011-06-01

Diverse advocacy groups have pushed for the recognition of cultural differences in health care as a means to redress inequalities in the U.S., elaborating a form of biocitizenship that draws on evidence of racial and ethnic health disparities to make claims on both the state and health care providers. These efforts led to federal regulations developed by the U.S. Office of Minority Health requiring health care organizations to provide Culturally and Linguistically Appropriate Services. Based on ethnographic research at workshops and conferences, in-depth interviews with cultural competence trainers, and an analysis of postings to a moderated listserv with 2,000 members, we explore cultural competence trainings as a new type of social technology in which health care providers and institutions are urged to engage in ethical self-fashioning to eliminate prejudice and embody the values of cultural relativism. Health care providers are called on to re-orient their practice (such as habits of gaze, touch, and decision-making) and to act on their own subjectivities to develop an orientation toward Others that is "culturally competent." We explore the diverse methods that cultural competence trainings use to foster a health care provider's ability to be self-reflexive, including face-to-face workshops and classes and self-guided on-line modules. We argue that the hybrid formation of culturally appropriate health care is becoming detached from its social justice origins as it becomes rationalized by and more firmly embedded in the operations of the health care marketplace.

Requirements Engineering for a Pervasive Health Care System

DEFF Research Database (Denmark)

Jørgensen, Jens Bæk; Bossen, Claus

2003-01-01

We describe requirements engineering for a new pervasive health care system for hospitals in Denmark. The chosen requirements engineering approach composes iterative prototyping and explicit environment description in terms of workflow modelling. New work processes and their proposed computer...

Resilient health care

DEFF Research Database (Denmark)

Hollnagel, E.; Braithwaite, J.; Wears, R. L.

Health care is everywhere under tremendous pressure with regard to efficiency, safety, and economic viability - to say nothing of having to meet various political agendas - and has responded by eagerly adopting techniques that have been useful in other industries, such as quality management, lean...... production, and high reliability. This has on the whole been met with limited success because health care as a non-trivial and multifaceted system differs significantly from most traditional industries. In order to allow health care systems to perform as expected and required, it is necessary to have...... engineering's unique approach emphasises the usefulness of performance variability, and that successes and failures have the same aetiology. This book contains contributions from acknowledged international experts in health care, organisational studies and patient safety, as well as resilience engineering...

A study on the equality and benefit of China's national health care system.

Science.gov (United States)

Zhai, Shaoguo; Wang, Pei; Dong, Quanfang; Ren, Xing; Cai, Jiaoli; Coyte, Peter C

2017-08-29

This study is designed to evaluate whether the benefit which the residents received from the national health care system is equal in China. The perceived equality and benefit are used to measure the personal status of health care system, health status. This study examines variations in perceived equality and benefit of the national health care system between urban and rural residents from five cities of China and assessed their determinants. One thousand one hundred ninty eight residents were selected from a random survey among five nationally representative cities. The research characterizes perceptions into four population groupings based on a binary assessment of survey scores: high equality & high benefit; low equality & low benefit; high equality & low benefit; and low equality & high benefit. The distribution of the four groups above is 30.4%, 43.0%, 4.6% and 22.0%, respectively. Meanwhile, the type of health insurance, educational background, occupation, geographic regions, changes in health status and other factors have significant impacts on perceived equality and benefit derived from the health care system. The findings demonstrate wide variations in perceptions of equality and benefit between urban and rural residents and across population characteristics, leading to a perceived lack of fairness in benefits and accessibility. Opportunities exist for policy interventions that are targeted to eliminate perceived differences and promote greater equality in access to health care.

Equity, autonomy, and efficiency: what health care system should we have?

Science.gov (United States)

Menzel, Paul T

1992-02-01

The U.S. has a wide range of options in choosing a health care system. Rational choice of a system depends on analysis and prioritization of the basic moral goals of equitable access to all citizens, the just sharing of financial costs between well and ill, respect for the values and choices of subscribers and patients, and efficiency in the delivery of costworthy care. These moral goals themselves, however, tell us little about what health care system the United States should have. Equitable access does not demand a level and scope of care for the poor equal to that rationally chosen by the middle class, and there are ways within mixed systems, though not easy ways, to achieve a fair distribution of costs between well and ill. Despite pluralistic systems' apparent advantage in allowing subscribers to choose their own forms of rationing, problems in translating serious long-term subscriber choices into actual medical practice may be greater in pluralistic than in unitary systems. Final choice of a system hinges primarily on peculiar historical facts about U.S. political culture, not on moral principle.

Equality, autonomy, and efficiency: what health care system should we have?

Science.gov (United States)

Menzel, P T

1992-02-01

The U.S. has a wide range of options in choosing a health care system. Rational choice of a system depends on analysis and prioritization of the basis moral goals of equitable access to all citizens, the just sharing of financial costs between well and ill, respect for the values and choices of subscribers and patients, and efficiency in the delivery of costworthy care. These moral goals themselves, however, tell us little about what health care system the United States should have. Equitable access does not demand a level and scope of care for the poor equal to that rationally chosen by the middle class, and there are ways within mixed systems, though not easy ways, to achieve a fair distribution of costs between well and ill. Despite pluralistic systems' apparent advantage in allowing subscribers to choose their own forms of rationing, problems in translating serious long-term subscriber choices into actual medical practice may be greater in pluralistic than in unitary systems. Final choice of a system hinges primarily on peculiar historical facts about U.S. political culture, not on moral principle.

Home birth integration into the health care systems of eleven international jurisdictions.

Science.gov (United States)

Comeau, Amanda; Hutton, Eileen K; Simioni, Julia; Anvari, Ella; Bowen, Megan; Kruegar, Samantha; Darling, Elizabeth K

2018-02-13

The purpose of this study was to develop assessment criteria that could be used to examine the level of integration of home birth within larger health care systems in developed countries across 11 international jurisdictions. An expert panel developed criteria and a definition to assess home birth integration within health care systems. We selected jurisdictions based on the publications that were eligible for inclusion in our systematic review and meta-analysis on planned place of birth. We sent the authors of the included publications a questionnaire about home birth practitioners and practices in their respective health care system at the time of their studies. We searched published peer-reviewed, non-peer-reviewed, and gray literature, and the websites of professional bodies to document information about home birth integration in each jurisdiction based on our criteria. Where information was lacking, we contacted experts in the field from the relevant jurisdiction. Home birth is well integrated into the health care system in British Columbia (Canada), England, Iceland, the Netherlands, New Zealand, Ontario (Canada), and Washington State (USA). Home birth is less well integrated into the health care system in Australia, Japan, Norway, and Sweden. This paper is the first to propose criteria for the evaluation of home birth integration within larger maternity care systems. Application of these criteria across 11 international jurisdictions indicates differences in the recognition and training of home birth practitioners, in access to hospital facilities, and in the supplies and equipment available at home births, which give rise to variation in the level of integration across different settings. Standardized criteria for the evaluation of systems integration are essential for interpreting planned home birth outcomes that emerge from contextual differences. © 2018 Wiley Periodicals, Inc.

[Time based management in health care system: the chosen aspects].

Science.gov (United States)

Kobza, Joanna; Syrkiewicz-Świtała, Magdalena

2014-01-01

Time-based management (TBM) is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms). Over the past two decades a systematic review of Polish literature (since 1990) and peer reviewed articles published in international journals based on PubMed/Medline (2001-2011) have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary.

Time based management in health care system: The chosen aspects

Directory of Open Access Journals (Sweden)

Joanna Kobza

2014-08-01

Full Text Available Time-based management (TBM is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms. Over the past two decades a systematic review of Polish literature (since 1990 and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011 have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary

[The basis of modern technologies in management of health care system].

Science.gov (United States)

Nemytin, Iu V

2014-12-01

For the development of national heaIth care it is required to implement modern and effective methods and forms of governance. It is necessary to clearly identify transition to process management followed by an introduction of quality management care. It is necessary to create a complete version of the three-level health care system based on the integration into the system "Clinic - Hospital - Rehabilitation", which will ensure resource conservation in general throughout the industry. The most important task is purposeful comprehensive management training for health care--statesmen who have the potential ability to manage. The leader must possess all forms of management and apply them on a scientific basis. Standards and other tools of health management should constantly improve. Standards should be a teaching tool and help to improve the quality and effectiveness of treatment processes, the transition to the single-channel financing--the most advanced form of payment for the medical assistance. This type of financing requires managers to new management approaches, knowledge of business economics. One of the breakthrough objectives is the creation of a new type of health care organizations, which as lead locomotives for a rest.

High performance work systems: the gap between policy and practice in health care reform.

Science.gov (United States)

Leggat, Sandra G; Bartram, Timothy; Stanton, Pauline

2011-01-01

Studies of high-performing organisations have consistently reported a positive relationship between high performance work systems (HPWS) and performance outcomes. Although many of these studies have been conducted in manufacturing, similar findings of a positive correlation between aspects of HPWS and improved care delivery and patient outcomes have been reported in international health care studies. The purpose of this paper is to bring together the results from a series of studies conducted within Australian health care organisations. First, the authors seek to demonstrate the link found between high performance work systems and organisational performance, including the perceived quality of patient care. Second, the paper aims to show that the hospitals studied do not have the necessary aspects of HPWS in place and that there has been little consideration of HPWS in health system reform. The paper draws on a series of correlation studies using survey data from hospitals in Australia, supplemented by qualitative data collection and analysis. To demonstrate the link between HPWS and perceived quality of care delivery the authors conducted regression analysis with tests of mediation and moderation to analyse survey responses of 201 nurses in a large regional Australian health service and explored HRM and HPWS in detail in three casestudy organisations. To achieve the second aim, the authors surveyed human resource and other senior managers in all Victorian health sector organisations and reviewed policy documents related to health system reform planned for Australia. The findings suggest that there is a relationship between HPWS and the perceived quality of care that is mediated by human resource management (HRM) outcomes, such as psychological empowerment. It is also found that health care organisations in Australia generally do not have the necessary aspects of HPWS in place, creating a policy and practice gap. Although the chief executive officers of health

Multipurpose Health Care Telemedicine System

National Research Council Canada - National Science Library

Kyriacou, E

2001-01-01

.... Ambulances, Rural Health Centers (RHC) or other remote health location, Ships navigating in wide seas and Airplanes in flight are common examples of possible emergency sites, while critical care telemetry, and telemedicine home follow-ups...

How and why do countries differ in their governance and financing-related administrative expenditure in health care? An analysis of OECD countries by health care system typology.

Science.gov (United States)

Hagenaars, Luc L; Klazinga, Niek S; Mueller, Michael; Morgan, David J; Jeurissen, Patrick P T

2018-01-01

Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending differences between health care system typologies, and differences in the scale and scope of administrative functions across typologies. We used OECD data, which include health system governance and financing-related administrative activities by regulators, governance bodies, and insurers (macrolevel), but exclude administrative expenditure by health care providers (mesolevel and microlevel). We find that governance and financing-related administrative spending at the macrolevel has remained stable over the last decade at slightly over 3% of total health spending. Cross-country differences range from 1.3% of health spending in Iceland to 8.3% in the United States. Voluntary private health insurance bears much higher administrative costs than compulsory schemes in all countries. Among compulsory schemes, multiple payers exhibit significantly higher administrative spending than single payers. Among single-payer schemes, those where entitlements are based on residency have significantly lower administrative spending than those with single social health insurance, albeit with a small difference. These differences can partially be explained because multi-payer and voluntary private health insurance schemes require additional administrative functions and enjoy less economies of scale. Studies in hospitals and primary care indicate similar differences in administrative costs across health system typologies at the mesolevel and microlevel of health care delivery, which warrants more research on total administrative costs at all the levels of health systems. Copyright © 2017 John Wiley & Sons, Ltd.

Prospects for regulated competition in the health care system: what can China learn from Russia's experience?

Science.gov (United States)

Xu, Weiwei; Sheiman, Igor; van de Ven, Wynand P M M; Zhang, Wei

2011-05-01

As China explores new directions to reform its health care system, regulated competition among both insurers and providers of care might be one potential model. The Russian Federation in 1993 implemented legislation intended to stimulate such regulated competition in the health care sector. The subsequent progress and lessons learned over these 17 years can shed light on and inform the future evolution of the Chinese system. In this paper, we list the necessary pre-conditions for reaping the benefits of regulated competition in the health care sector. We indicate to what extent these conditions are being fulfilled in the post-reform Russian and current Chinese health care systems. We draw lessons from the Russian experience for the Chinese health care system, which shares a similar economic and political background with the pre-reform Russian health care system in terms of the starting point of the reform, and analyse the prospects for regulated competition in China.

Assessment of management capacity to improve the value of health-care systems: a survey

OpenAIRE

Rebecca L Weintraub, MD; Keri Wachter, BA; Jennifer Goldsmith, MS; Marie J Teichman, BA; Eda Algur; Julie D Rosenberg, MPH

2017-01-01

Background: Strong management is important for high-value health-care systems if returns on global health investments are to be delivered and the Sustainable Development Goals met by 2030. Managers are responsible for care delivery systems and strategies, making sure that health services benefit the population they intend to serve. Most managers in resource-limited settings work at the district level and below, with little training in non-clinical skills. They are often health care providers ...

Active Involvement of Students in the Learning Process of the American Health Care System.

Science.gov (United States)

Poirier, Sylvie

1997-01-01

Over 200 pharmacy students in a University of Georgia class on the American health care system engaged in debates on health care issues, discussed newspaper articles, conducted client home visits, analyzed county health statistics, and completed exercises on pharmacists' compensation and health care planning. Most participating students responded…

Exploring a model-driven architecture (MDA) approach to health care information systems development.

Science.gov (United States)

Raghupathi, Wullianallur; Umar, Amjad

2008-05-01

To explore the potential of the model-driven architecture (MDA) in health care information systems development. An MDA is conceptualized and developed for a health clinic system to track patient information. A prototype of the MDA is implemented using an advanced MDA tool. The UML provides the underlying modeling support in the form of the class diagram. The PIM to PSM transformation rules are applied to generate the prototype application from the model. The result of the research is a complete MDA methodology to developing health care information systems. Additional insights gained include development of transformation rules and documentation of the challenges in the application of MDA to health care. Design guidelines for future MDA applications are described. The model has the potential for generalizability. The overall approach supports limited interoperability and portability. The research demonstrates the applicability of the MDA approach to health care information systems development. When properly implemented, it has the potential to overcome the challenges of platform (vendor) dependency, lack of open standards, interoperability, portability, scalability, and the high cost of implementation.

Towards a Better Health Care Delivery System: The Tamil Nadu model.

Science.gov (United States)

Parthasarathi, R; Sinha, S P

2016-01-01

The Tamil Nadu model of public health is renowned for its success in providing quality health services at an affordable cost especially to the rural people. Tamil Nadu is the only state with a distinctive public health cadre in the district level and also the first state to enact a Public Health Act in 1939. Tamil Nadu has gained significant ground in the various aspects of health in the last few decades largely because of the significant reforms in its health sector which dates back to 1980s which saw rigorous expansion of rural health infrastructure in the state besides deployment of thousands of multipurpose health workers as village health nurses in rural areas. Effective implementation of Universal Immunization Programme, formation of Tamil Nadu Medical Services Corporation for regulating the drug procurement and promoting generic drugs, early incorporation of indigenous system of medicine into health care service, formulation of a health policy in 2003 by the state with special emphasis on low-income, disadvantaged communities alongside efficient implementation of The Tamil Nadu Health Systems Project (TNHSP) are the major factors which contributed for the success of the state. The importance of good political commitment and leadership in the health gains of the state warrants special mention. Moreover, the economic growth of the state, improved literacy rate, gender equality, and lowered fertility rate in the last few decades and contributions from the private sector have their share in the public health success of the state. In spite of some flaws and challenges, the Tamil Nadu Model remains the prototype health care delivery system in resource-limited settings which can be emulated by other states also toward a better health care delivery system.

Towards a better health care delivery system: The Tamil Nadu model

Directory of Open Access Journals (Sweden)

R Parthasarathi

2016-01-01

Full Text Available The Tamil Nadu model of public health is renowned for its success in providing quality health services at an affordable cost especially to the rural people. Tamil Nadu is the only state with a distinctive public health cadre in the district level and also the first state to enact a Public Health Act in 1939. Tamil Nadu has gained significant ground in the various aspects of health in the last few decades largely because of the significant reforms in its health sector which dates back to 1980s which saw rigorous expansion of rural health infrastructure in the state besides deployment of thousands of multipurpose health workers as village health nurses in rural areas. Effective implementation of Universal Immunization Programme, formation of Tamil Nadu Medical Services Corporation for regulating the drug procurement and promoting generic drugs, early incorporation of indigenous system of medicine into health care service, formulation of a health policy in 2003 by the state with special emphasis on low-income, disadvantaged communities alongside efficient implementation of The Tamil Nadu Health Systems Project (TNHSP are the major factors which contributed for the success of the state. The importance of good political commitment and leadership in the health gains of the state warrants special mention. Moreover, the economic growth of the state, improved literacy rate, gender equality, and lowered fertility rate in the last few decades and contributions from the private sector have their share in the public health success of the state. In spite of some flaws and challenges, the Tamil Nadu Model remains the prototype health care delivery system in resource-limited settings which can be emulated by other states also toward a better health care delivery system.

The Future of Health Care in the Kurdistan Region - Iraq: Toward an Effective, High-Quality System with an Emphasis on Primary Care.

Science.gov (United States)

Moore, Melinda; Anthony, C Ross; Lim, Yee-Wei; Jones, Spencer S; Overton, Adrian; Yoong, Joanne K

2014-01-01

At the request of the Kurdistan Regional Government (KRG), RAND researchers undertook a yearlong analysis of the health care system in the Kurdistan Region of Iraq, with a focus on primary care. RAND staff reviewed available literature on the Kurdistan Region and information relevant to primary care; interviewed a wide range of policy leaders, health practitioners, patients, and government officials to gather information and understand their priorities; collected and studied all available data related to health resources, services, and conditions; and projected future supply and demand for health services in the Kurdistan Region; and laid out the health financing challenges and questions. In this volume, the authors describe the strengths of the health care system in the Kurdistan Region as well as the challenges it faces. The authors suggest that a primary care-oriented health care system could help the KRG address many of these challenges. The authors discuss how such a system might be implemented and financed, and they make recommendations for better utilizing resources to improve the quality, access, effectiveness, and efficiency of primary care.

[Computerization and the importance of information in health system, as in health care resources registry].

Science.gov (United States)

Troselj, Mario; Fanton, Davor

2005-01-01

The possibilities of creating a health care resources registry and its operating in Croatia as well as the importance of information in health system are described. At the Croatian Institute of Public Health, monitoring of human resources is performed through the national Health Workers Registry. It also covers basic data on all health units, bed capacities of health facilities included. The initiated health care computerization has urged the idea of forming one more database on physical resources, i.e. on registered medical devices and equipment, more complete. Linking these databases on health resources would produce a single Health Care Resources Registry. The concept views Health Care Resources Registry as part of the overall health information system with centralized information on the health system. The planned development of segments of a single health information system is based on the implementation of the accepted international standards and common network services. Network services that are based on verified Internet technologies are used within a safe, reliable and closed health computer network, which makes up the health intranet (WAN--Wide Area Network). The resource registry is a software solution based on the relational database that monitors history, thus permitting the data collected over a longer period to be analyzed. Such a solution assumes the existence of a directory service, which would replace the current independent software for the Health Workers Registry. In the Health Care Resources Registry, the basic data set encompasses data objects and attributes from the directory service. The directory service is compatible with the LDAP protocol (Lightweight Directory Access Protocol), providing services uniformly to the current records on human and physical resources. Through the storage of attributes defined according to the HL7 (Health Level Seven) standard, directory service is accessible to all applications of the health information system

WHAT CAN TANZANIA'S HEALTH CARE SYSTEM LEARN FROM OECD COUNTRIES?

OpenAIRE

Kajuna, Dezidery Theobard

2014-01-01

Abstract Healthcare systems around the world have different shapes that are largely affected by socio-economic and political situations of a particular country. It is essential for the population to have better health services which requires the country to have better health policies, enough funding for health care sector, and a well structured delivery system. Tanzania like any other developing countries continue to face different challenges in healthcare sector greatly influenced by poor ec...

A Good Samaritan inspired foundation for a fair health care system.

Science.gov (United States)

Frangenberg, Elmar H

2011-02-01

Distributive justice on the income and on the service aspects is the most vexing modern day problem for the creation and maintenance of an all inclusive health care system. A pervasive problem of all current schemes is the lack of effective cost control, which continues to result in increasing burdens for all public and private stakeholders. This proposal posits that the responsibility and financial obligation to achieve an ideal outcome of equal and affordable access and benefits for all citizens is misplaced. The Good Samaritan demonstrated basic ethical principles, which are revisited, elaborated and integrated into a new approach to health care. The participants are limited to individual contributors and beneficiaries and organized as a citizen carried, closed, independent, and self-sufficient self-governing cooperative for their own and the benefit of a minority of disadvantaged health care consumers. The government assumes oversight, provides arbitration, enforces democratic decision making, a scheme of progressive taxation, a separate and transparent accounting system, and a balance between income and reinvestment in health care. The results are a fair distribution of cost, its effective control, and increased individual motivation to take on responsibility for personal health as a private good and a sharpened focus towards community health. At the sociopolitical level the government as well as employers are released from the inappropriate burden of catering to individual health.

Environmental Impacts of the U.S. Health Care System and Effects on Public Health.

Science.gov (United States)

Eckelman, Matthew J; Sherman, Jodi

2016-01-01

The U.S. health care sector is highly interconnected with industrial activities that emit much of the nation's pollution to air, water, and soils. We estimate emissions directly and indirectly attributable to the health care sector, and potential harmful effects on public health. Negative environmental and public health outcomes were estimated through economic input-output life cycle assessment (EIOLCA) modeling using National Health Expenditures (NHE) for the decade 2003-2013 and compared to national totals. In 2013, the health care sector was also responsible for significant fractions of national air pollution emissions and impacts, including acid rain (12%), greenhouse gas emissions (10%), smog formation (10%) criteria air pollutants (9%), stratospheric ozone depletion (1%), and carcinogenic and non-carcinogenic air toxics (1-2%). The largest contributors to impacts are discussed from both the supply side (EIOLCA economic sectors) and demand side (NHE categories), as are trends over the study period. Health damages from these pollutants are estimated at 470,000 DALYs lost from pollution-related disease, or 405,000 DALYs when adjusted for recent shifts in power generation sector emissions. These indirect health burdens are commensurate with the 44,000-98,000 people who die in hospitals each year in the U.S. as a result of preventable medical errors, but are currently not attributed to our health system. Concerted efforts to improve environmental performance of health care could reduce expenditures directly through waste reduction and energy savings, and indirectly through reducing pollution burden on public health, and ought to be included in efforts to improve health care quality and safety.

Environmental Impacts of the U.S. Health Care System and Effects on Public Health.

Directory of Open Access Journals (Sweden)

Matthew J Eckelman

Full Text Available The U.S. health care sector is highly interconnected with industrial activities that emit much of the nation's pollution to air, water, and soils. We estimate emissions directly and indirectly attributable to the health care sector, and potential harmful effects on public health. Negative environmental and public health outcomes were estimated through economic input-output life cycle assessment (EIOLCA modeling using National Health Expenditures (NHE for the decade 2003-2013 and compared to national totals. In 2013, the health care sector was also responsible for significant fractions of national air pollution emissions and impacts, including acid rain (12%, greenhouse gas emissions (10%, smog formation (10% criteria air pollutants (9%, stratospheric ozone depletion (1%, and carcinogenic and non-carcinogenic air toxics (1-2%. The largest contributors to impacts are discussed from both the supply side (EIOLCA economic sectors and demand side (NHE categories, as are trends over the study period. Health damages from these pollutants are estimated at 470,000 DALYs lost from pollution-related disease, or 405,000 DALYs when adjusted for recent shifts in power generation sector emissions. These indirect health burdens are commensurate with the 44,000-98,000 people who die in hospitals each year in the U.S. as a result of preventable medical errors, but are currently not attributed to our health system. Concerted efforts to improve environmental performance of health care could reduce expenditures directly through waste reduction and energy savings, and indirectly through reducing pollution burden on public health, and ought to be included in efforts to improve health care quality and safety.

To Study and Compare Perception of Health Care Professionals Regarding the Role of Pharmacist in Health Care System in Pakistan

Directory of Open Access Journals (Sweden)

Tashfeen Akhtar

2017-09-01

Full Text Available The healthcare team is mainly a triad of Physicians, Pharmacist & Nurses. Objective: The purpose of this paper is to help healthcare professionals understand more clearly the role of pharmacists within a health care team, especially inter-professional communication, pharmacists' responsibilities, and availability issues. A total of 200 samples were selected from 4 hospitals which include 100 samples of doctors and 100 of the nurses. Each sample is basically a questionnaire comprising of 23 questions. A total of two hundred questionnaires were distributed and one hundred and seventy-six questionnaires were returned resulting in the response rate of 88%. Pharmacists are being one of the major healthcare professional groups in the world after physicians and nurses are playing a very significant role in health care system. This understanding is a requirement for better communication and collaboration among the professions and for accomplishing the combined goal of better health care system.

A change of direction in the Dutch health care system?

Science.gov (United States)

Lapré, R M

1988-08-01

The Dutch health care system seems to be undergoing a clear change of direction. The publication of the Report of the Committee of the Structure and Financing of the Health Care System is a prominent document which marks the emergence of a new trend. After an analysis of the characteristics of the Dutch health care system in the periods 1960-1975 and 1975-1985, an account is given of the most important proposals of the committee. The proposals clearly alter the trend towards more governmental involvement. They envisage a more market-oriented approach and freedom of operation while at the same time paying attention to aspects such as solidarity and social justice. The Committee's suggestions include the introduction of a basic insurance scheme for every citizen with a coverage determined by law, and in addition a voluntary supplementary insurance scheme in which the insured can decide what coverage he requires and that the insurer is obliged to accept him. The fact that there is a certain amount of agreement, at least over the direction that the strategy for change should take, justifies the expectation that many of the committee's proposals will be implemented.

Midwives and obstetric nurses in the Brazilian Unified Health System and Primary Health Care: for a systemic and progressive incorporation

OpenAIRE

Armando Henrique Norman; Charles Dalcanale Tesser

2015-01-01

The objective of this paper is to present a proposal for a gradual and systemic incorporation of midwives and obstetric nurses into the Brazilian Unified Health System (SUS) and Primary Health Care (PHC). The proposal was born from contact with the British experience, based on midwives, which is briefly described. In Brazil, these professionals would progressively take over the prenatal, delivery and postpartum care for pregnant women of usual risk in a region, in partnership with the PHC tea...

TRICARE: transformation of the military health care system : demystifying military medicine and the mission impossible

OpenAIRE

Zeliff, Barbara Hundley.

2004-01-01

The Department of Defense's military health care system, entitled TRICARE, brings together the direct health care resources of the Department of Defense and supplements this capability through the use of managed care support services contracts and purchased care. This blended system is charged with providing a comprehensive health benefit to approximately 8.9 million beneficiaries, including active duty and retired uniformed services members, their families, and survivors, while also providin...

Internet infrastructures and health care systems: a qualitative comparative analysis on networks and markets in the British National Health Service and Kaiser Permanente.

Science.gov (United States)

Séror, Ann C

2002-12-01

The Internet and emergent telecommunications infrastructures are transforming the future of health care management. The costs of health care delivery systems, products, and services continue to rise everywhere, but performance of health care delivery is associated with institutional and ideological considerations as well as availability of financial and technological resources. to identify the effects of ideological differences on health care market infrastructures including the Internet and telecommunications technologies by a comparative case analysis of two large health care organizations: the British National Health Service and the California-based Kaiser Permanente health maintenance organization. A qualitative comparative analysis focusing on the British National Health Service and the Kaiser Permanente health maintenance organization to show how system infrastructures vary according to market dynamics dominated by health care institutions ("push") or by consumer demand ("pull"). System control mechanisms may be technologically embedded, institutional, or behavioral. The analysis suggests that telecommunications technologies and the Internet may contribute significantly to health care system performance in a context of ideological diversity. The study offers evidence to validate alternative models of health care governance: the national constitution model, and the enterprise business contract model. This evidence also suggests important questions for health care policy makers as well as researchers in telecommunications, organizational theory, and health care management.

Selecting, adapting, and sustaining programs in health care systems

Directory of Open Access Journals (Sweden)

Zullig LL

2015-04-01

Full Text Available Leah L Zullig,1,2 Hayden B Bosworth1–4 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Medicine, Duke University Medical Center, Durham, NC, USA; 3School of Nursing, 4Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA Abstract: Practitioners and researchers often design behavioral programs that are effective for a specific population or problem. Despite their success in a controlled setting, relatively few programs are scaled up and implemented in health care systems. Planning for scale-up is a critical, yet often overlooked, element in the process of program design. Equally as important is understanding how to select a program that has already been developed, and adapt and implement the program to meet specific organizational goals. This adaptation and implementation requires attention to organizational goals, available resources, and program cost. We assert that translational behavioral medicine necessitates expanding successful programs beyond a stand-alone research study. This paper describes key factors to consider when selecting, adapting, and sustaining programs for scale-up in large health care systems and applies the Knowledge to Action (KTA Framework to a case study, illustrating knowledge creation and an action cycle of implementation and evaluation activities. Keywords: program sustainability, diffusion of innovation, information dissemination, health services research, intervention studies 

A SWOT analysis of the organization and financing of the Danish health care system.

Science.gov (United States)

Christiansen, Terkel

2002-02-01

The organization and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of Strengths, Weaknesses, Opportunities and Threats) by a panel of five members with a background in health economics. The present paper describes the methods and materials used for the evaluation: selection of panel members, structure of the evaluation task according to the health care triangle model, selection of background material consisting of documents and literature on the Danish health care system, and a 1-week study visit.

[The quality of the German health-care system in an international comparison - a systematic review].

Science.gov (United States)

Lauerer, M; Emmert, M; Schöffski, O

2013-08-01

Studies assessing the quality of the German health-care system in an international comparison come to different results. Therefore, this review aims to investigate how the German health-care system is evaluated in comparison to other health-care systems by reviewing international publications. Results show starting points for ways to improve the German health-care system, to maintain and expand its strengths as well as to derive strategies for solving identified problems. A systematic review searching different databases [library catalogues, WorldCat (including MEDLINE and OAIster-search), German National Library, Google Scholar and others]. Search requests were addressed to English or German language publications for the time period 2000-2010 (an informal search was conducted in October 2011 for an update). Results of the identified studies were aggregated and main statements derived. In total, 13 publications assessing the German health-care system in an international comparison were identified. These comparisons are based on 377 measures. After aggregation, 244 substantially different indicators remained, which were dedicated to 14 categories. It became apparent that the German health-care system can be characterised by a high level of expenses, a well-developed health-care infrastructure as well as a high availability of personal and material resources. Outcome measures demonstrate heterogeneous results. It can be stated that, particularly in this field, there is potential for further improvement. The utilisation of health-care services is high, the access is mostly not regulated and out of pocket payments can pose a barrier for patients. Waiting times are not regarded as a major weakness. Although civic satisfaction seems to be acceptable, a large portion of the citizens calls for elementary modifications. Especially, more patient-centred health-care delivery should be addressed as well as management of information and the adoption of meaningful electronic

Health care information systems and formula-based reimbursement: an empirical study.

Science.gov (United States)

Palley, M A; Conger, S

1995-01-01

Current initiatives in health care administration use formula-based approaches to reimbursement. Examples of such approaches include capitation and diagnosis related groups (DRGs). These approaches seek to contain medical costs and to facilitate managerial control over scarce health care resources. This article considers various characteristics of formula-based reimbursement, their operationalization on hospital information systems, and how these relate to hospital compliance costs.

Health Care Efficiencies: Consolidation and Alternative Models vs. Health Care and Antitrust Regulation - Irreconcilable Differences?

Science.gov (United States)

King, Michael W

2017-11-01

Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation. Fundamentally, what is the best way to reduce U.S. health care spending, while improving the patient experience of care in terms of quality and satisfaction, and driving better patient health outcomes? Mergers, partnerships, and consolidation in the health care industry, new care delivery models like Accountable Care Organizations and integrated care systems, bundled payments, information technology, innovation through new drugs and new medical devices, or some combination of the foregoing? More importantly, recent ambitious reform efforts fall short of a cohesive approach, leaving fundamental internal inconsistencies across divergent arms of the federal government, raising the issue of whether the U.S. health care system can drive sufficient efficiencies within the current health care and antitrust regulatory environments. While debate rages on Capitol Hill over "repeal and replace," only limited attention has been directed toward reforming the current "fee-for-service" model pursuant to which providers are paid for volume of care rather than quality or outcomes. Indeed, both the Patient Protection and Affordable Care Act ("ACA") 3 and proposals for its replacement focus primarily on the reach and cost of providing coverage for

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

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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.

Using the Knowledge Base of Health Services Research to Redefine Health Care Systems.

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Brook, Robert H; Vaiana, Mary E

2015-10-01

This Perspective discusses 12 key facts derived from 50 years of health services research and argues that this knowledge base can stimulate innovative thinking about how to make health care systems safer, more efficient, more cost effective, and more patient centered, even as they respond to the needs of diverse communities.

Consumer Directed Health Care

OpenAIRE

John Goodman

2006-01-01

Consumer driven health care (CDHC) is a potential solution to two perplexing problems: (1) How to choose between health care and other uses of money, and (2) how to allocate resources in an industry where normal market forces have been systemically suppressed. In the consumer-driven model, consumers occupy the primary decision-making role regarding the health care that they receive. From an employee benefits perspective, consumer driven health care in the broadest sense may refer to limited e...

Measuring the mental health care system responsiveness: results of an outpatient survey in Tehran

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Setareh eForouzan

2016-01-01

Full Text Available AbstractAs explained by the World Health Organisation (WHO in 2000, the concept of health system responsiveness is one of the core goals of health systems. Since 2000, further efforts have been made to measure health system responsiveness and the factors affecting responsiveness, yet few studies have applied responsiveness concepts to the evaluation of mental health systems. The present study aims to measure responsiveness and its related domains in the mental health care system of Tehran. Utilising the same method used by the WHO for its responsiveness survey, responsiveness for outpatient mental health care was evaluated using a validated Farsi questionnaire. A sample of 500 public mental health service users in Tehran participated and subsequently completed the questionnaire. On average, 47% of participants reported experiencing poor responsiveness. Among responsiveness domains, confidentiality and dignity were the best performing factors while autonomy, access to care and quality of basic amenities were the worst performing. Respondents who reported their social status as low were more likely to experience poor responsiveness overall. Autonomy, quality of basic amenities and clear communication were responsiveness dimensions that performed poorly but were considered to be important by study participants. In summary, the study suggests that measuring responsiveness could provide guidance for further development of mental health care systems to become more patient orientated and provide patients with more respect.

A Laboratory Test Expert System for Clinical Diagnosis Support in Primary Health Care

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Rodrigo Fernandez-Millan

2015-08-01

Full Text Available Clinical Decision Support Systems have the potential to reduce lack of communication and errors in diagnostic steps in primary health care. Literature reports have showed great advances in clinical decision support systems in the recent years, which have proven its usefulness in improving the quality of care. However, most of these systems are focused on specific areas of diseases. In this way, we propose a rule-based expert system, which supports clinicians in primary health care, providing a list of possible diseases regarding patient’s laboratory tests results in order to assist previous diagnosis. Our system also allows storing and retrieving patient’s data and the history of patient’s analyses, establishing a basis for coordination between the various health care levels. A validation step and speed performance tests were made to check the quality of the system. We conclude that our system could improve clinician accuracy and speed, resulting in more efficiency and better quality of service. Finally, we propose some recommendations for further research.

Provider′s constraints and difficulties in primary health care system

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Pawan Kumar

2014-01-01

Full Text Available Background: The contractualization of human resource in recent years has resulted into various human resource management issues. Objective: To explore the administrative and management issues of contractual model of human resource under primary health care system in Delhi. Materials and Methods: Comparative study was conducted on randomly selected sample of 333, comprised of Medical Officers, ANMs, Pharmacist and Laboratory Assistants and Technicians, both regular and contractual cadre. The data was collected using the semi-structured interview schedule and thematic content analysis was done. Results: The five major themes emerged in the analysis; these are (i physical infrastructure, (ii organization′s working environment, (iii privileges of staff, (iv discontentment, (v human resource development. Comparative analysis of themes between regular and contractual staff revealed significant differences in factors which are embedded into the organization′s culture. Element of discontentment is high amongst contractual staff particularly for discrimination in job, undermining of authority, patient care relationship and privileges provided to regular staff. This reflects the area of dissatisfaction which varies between regular and contractual staff in the organization. Conclusion: If primary health care system fails to address genuine constraints of human resources of both regular and contractual cadre and perception of discrimination persists, it is bound to result into poor motivation for good performance in the system of health care. So, adopting good practices in human resource management keeping regular and contractual employees grievances at forefront are urgently needed to ensure the availability of adequately trained and motivated personnel′s in health facilities.

ORIGINAL ARTICLES Canada's health care system: A relevant ...

African Journals Online (AJOL)

Canada's universal health care system, named Medicare, was fully in place. While this universal .... through lotteries and 'sin taxes' on alcohol and cigarettes. Since 2004, the federal portion of ..... Himmelstein DU, Thorne D, Warren E, Woolhandler S. Medical bankruptcy in the United. States, 2007: results of a national study.

Health system challenges in organizing quality diabetes care for urban poor in South India.

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Bhojani, Upendra; Devedasan, Narayanan; Mishra, Arima; De Henauw, Stefaan; Kolsteren, Patrick; Criel, Bart

2014-01-01

Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients' medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes and other chronic conditions.

Health system challenges in organizing quality diabetes care for urban poor in South India.

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Upendra Bhojani

Full Text Available BACKGROUND: Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. METHODS: We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. RESULT: There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients' medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. CONCLUSIONS: Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes

An e-health trend plan for the Jordanian health care system: a review.

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Rawabdeh, Ali Ahamd Awad

2007-01-01

The purpose of this research is to examine the potential of e-health by focusing explicitly on the delivery of health care products and services. The examination of e-health activity is guided by one broad research question, "What is the potential for constructing e-health strategy as an innovative health technology?". A great amount of attention has been given to e-health activity in the present day. However important this form of e-health is, this type of service simply does not face the same constraints that must be addressed by those actually delivering health care services. The researchers employed a qualitative data collection technique to formulate more examples and cases to derive lessons for Jordan. Phone interviews in a random sample were conducted with corporate officers in Jordan in order to reveal the internal organizational structure and business trends, interface issues, marketing strategies, as well as comparing and contrasting the online health world to the traditional health care realm. Internet-related projects is a top priority for health care information technology executives in the present day, with a cautious approach toward "e-health", as many products have yet to mature, and that the "click and mortar" model may perhaps be the optimal strategy for e-health in Jordan. This paper reviews the e-health trends to demonstrate the tremendous potential for health-related commercial activity on the internet. However, the researcher examining the barriers facing e-health to the Jordanian health system also pointed out almost insurmountable challenges. Despite the apparent promise of e-health, its instability is measured by its failure so far to systematically penetrate the organization of health care. Beyond the pragmatic negotiation of e-health in the immediate context of clinical practice, there are wider issues about how the development/implementation of e-health is funded, about its organization and management at the policy level; and about its

Working toward financial sustainability of integrated behavioral health services in a public health care system.

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Monson, Samantha Pelican; Sheldon, J Christopher; Ivey, Laurie C; Kinman, Carissa R; Beacham, Abbie O

2012-06-01

The need, benefit, and desirability of behavioral health integration in primary care is generally accepted and has acquired widespread positive regard. However, in many health care settings the economics, business aspects, and financial sustainability of practice in integrated care settings remains an unsolved puzzle. Organizational administrators may be reluctant to expand behavioral health services without evidence that such programs offer clear financial benefits and financial sustainability. The tendency among mental health professionals is to consider positive clinical outcomes (e.g., reduced depression) as being globally valued indicators of program success. Although such outcomes may be highly valued by primary care providers and patients, administrative decision makers may require demonstration of more tangible financial outcomes. These differing views require program developers and evaluators to consider multiple outcome domains including clinical/psychological symptom reduction, potential cost benefit, and cost offset. The authors describe a process by which a pilot demonstration project is being implemented to demonstrate programmatic outcomes with a focus on the following: 1) clinician efficiency, 2) improved health outcomes, and 3) direct revenue generation associated with the inclusion of integrated primary care in a public health care system. The authors subsequently offer specific future directions and commentary regarding financial evaluation in each of these domains.

Structural and contextual dimensions of Iranian primary health care system at local level.

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Zanganeh Baygi, Mehdi; Seyedin, Hesam; Salehi, Masoud; Jafari Sirizi, Mehdi

2015-01-01

In recent years, family physician plan was established as the main strategy of health system in Iran, while organizational structure of the primary health care system has remained the same as thirty years ago. This study was performed to illustrate structural and contextual dimensions of organizational structure and relationship between them in Iranian primary health care system at local level. A cross-sectional quantitative study was conducted from January to June 2013, during which 121 questionnaires were distributed among senior and junior managers of city health centers at Medical Sciences universities in Iran. Validity of the questionnaire was confirmed by experts (CVI = 0.089 and CVR more than 0.85) and Cronbach α was utilized for reliability (α = 0.904). We used multistage sampling method in this study and analysis of the data was performed by SPSS software using different tests. Local level of primary health care system in Iran had mechanical structure, but in contextual dimensions the results showed different types. There was a significant relationship between structural and contextual dimensions (r = 0.642, P value structural dimensions. Because of the changes in goals and strategies of Iranian health system in recent years, it is urgently recommended to reform the current structure to increase efficiency and effectiveness of the system.

Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model

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Stewart Allison

2008-05-01

Full Text Available Abstract Background Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. Methods This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members. Results Participating health centres had distinct areas of strength and weakness in each component of systems: 1 organisational influence – strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2 community linkages – facilitated by working together with community organisations (e.g. local stores and running community-based programs (e.g. "health week", but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3 self management – promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4 decision support – facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5 delivery system

Rapid Business Transformations in Health Care: A Systems Approach

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Shulaiba, Refaat A.

2011-01-01

The top two priorities of health care business leaders are to constantly improve the quality of health care while striving to contain and reduce the high cost of health care. The Health Care industry, similar to all businesses, is motivated to deliver innovative solutions that accelerate business transformation and increase business capabilities. …

Health care system in Sudan: review and analysis of Strength ...

African Journals Online (AJOL)

Health care system in Sudan: review and analysis of Strength, Weakness, Opportunity, and Threats (SWOT Analysis). Ebrahim M.A. Ebrahim, Luam Ghebrehiwot, Tasneem Abdalgfar, Muhammad Hanafiah Juni ...

Status of governmental oral health care delivery system in Haryana, India

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Ashish Vashist

2016-01-01

Full Text Available Background: Health system should be organized to meet the needs of entire population of the nation. This means that the state has the direct responsibility for the health of its population and improving the quality of life through research, education, and provision of health services. The present study was conducted to evaluate the government oral health care delivery system in Haryana, India. Materials and Methods: The present cross-sectional study was conducted among 135 dental care units (DCUs of various primary health centers (PHCs, community health centers (CHCs, and general hospitals (GHs existing in the state by employing a cluster random sampling technique. Data regarding the provision of water and electricity supply, dental man power and their qualification, number and type of instruments in the dental operatory unit, etc., were collected on a structured format. Statistical analysis was done using number and percentages (SPSS package version 16. Results: Alternative source of electricity (generator existed in only a few of health centers. About 93.4% (155 of the staff were graduates (BDS and 6.6% (11 were postgraduates (MDS. Ultrasonic scaler was available at dental units of 83.1% (64 of PHCs, 73.1% (19 of CHCs, and 93.8% (30 of GHs. Patient drapes were provided in 48.1% (65 of the DCUs, doctor′s aprons were provided in 74.1% (100 of the places. Conclusion: There is a shortfall in infrastructure and significant problem with the adequacy of working facilities. A great deal of effort is required to harmonize the oral health care delivery system.

Discrimination and Delayed Health Care Among Transgender Women and Men: Implications for Improving Medical Education and Health Care Delivery.

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Jaffee, Kim D; Shires, Deirdre A; Stroumsa, Daphna

2016-11-01

The transgender community experiences health care discrimination and approximately 1 in 4 transgender people were denied equal treatment in health care settings. Discrimination is one of the many factors significantly associated with health care utilization and delayed care. We assessed factors associated with delayed medical care due to discrimination among transgender patients, and evaluated the relationship between perceived provider knowledge and delayed care using Anderson's behavioral model of health services utilization. Multivariable logistic regression analysis was used to test whether predisposing, enabling, and health system factors were associated with delaying needed care for transgender women and transgender men. A sample of 3486 transgender participants who took part in the National Transgender Discrimination Survey in 2008 and 2009. Predisposing, enabling, and health system environment factors, and delayed needed health care. Overall, 30.8% of transgender participants delayed or did not seek needed health care due to discrimination. Respondents who had to teach health care providers about transgender people were 4 times more likely to delay needed health care due to discrimination. Transgender patients who need to teach their providers about transgender people are significantly more likely to postpone or not seek needed care. Systemic changes in provider education and training, along with health care system adaptations to ensure appropriate, safe, and respectful care, are necessary to close the knowledge and treatment gaps and prevent delayed care with its ensuing long-term health implications.

Georeferenced and secure mobile health system for large scale data collection in primary care.

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Sa, Joao H G; Rebelo, Marina S; Brentani, Alexandra; Grisi, Sandra J F E; Iwaya, Leonardo H; Simplicio, Marcos A; Carvalho, Tereza C M B; Gutierrez, Marco A

2016-10-01

Mobile health consists in applying mobile devices and communication capabilities for expanding the coverage and improving the effectiveness of health care programs. The technology is particularly promising for developing countries, in which health authorities can take advantage of the flourishing mobile market to provide adequate health care to underprivileged communities, especially primary care. In Brazil, the Primary Care Information System (SIAB) receives primary health care data from all regions of the country, creating a rich database for health-related action planning. Family Health Teams (FHTs) collect this data in periodic visits to families enrolled in governmental programs, following an acquisition procedure that involves filling in paper forms. This procedure compromises the quality of the data provided to health care authorities and slows down the decision-making process. To develop a mobile system (GeoHealth) that should address and overcome the aforementioned problems and deploy the proposed solution in a wide underprivileged metropolitan area of a major city in Brazil. The proposed solution comprises three main components: (a) an Application Server, with a database containing family health conditions; and two clients, (b) a Web Browser running visualization tools for management tasks, and (c) a data-gathering device (smartphone) to register and to georeference the family health data. A data security framework was designed to ensure the security of data, which was stored locally and transmitted over public networks. The system was successfully deployed at six primary care units in the city of Sao Paulo, where a total of 28,324 families/96,061 inhabitants are regularly followed up by government health policies. The health conditions observed from the population covered were: diabetes in 3.40%, hypertension (age >40) in 23.87% and tuberculosis in 0.06%. This estimated prevalence has enabled FHTs to set clinical appointments proactively, with the aim of

Crew Health Care System (CHeCS) Design Research, Documentations, and Evaluations

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CLement, Bethany M.

2011-01-01

The Crew Health Care System (CHeCS) is a group within the Space Life Science Directorate (SLSD) that focuses on the overall health of astronauts by reinforcing the three divisions - the Environmental Maintenance System (EMS), the Countermeasures System (CMS), and the Health Maintenance System (HMS). This internship provided opportunity to gain knowledge, experience, and skills in CHeCS engineering and operations tasks. Various and differing tasks allowed for occasions to work independently, network to get things done, and show leadership abilities. Specific exercises included reviewing hardware certification, operations, and documentation within the ongoing Med Kit Redesign (MKR) project, and learning, writing, and working various common pieces of paperwork used in the engineering and design process. Another project focused on the distribution of various pieces of hardware to off-site research facilities with an interest in space flight health care. The main focus of this internship, though, was on a broad and encompassing understanding of the engineering process as time was spent looking at each individual step in a variety of settings and tasks.

Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria.

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Abimbola, Seye; Ukwaja, Kingsley N; Onyedum, Cajetan C; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra L C

2015-10-01

Health care costs incurred prior to the appropriate patient-provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers.

Wearable biosensor systems and resilience: a perfect storm in health care?

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Drury, Robert L

2014-01-01

We begin by placing our discussion in the context of the chronic crisis in medical care, noting key features, including economic, safety and conceptual challenges. Then we review the most promising elements of a broadened conceptual approach to health and wellbeing, which include an expanded role for psychological, social, cultural, spiritual and environmental variables. The contributions of positive and evolutionary psychology, complex adaptive systems theory, genomics and neuroscience are described and the rapidly developing synthetic field of resilience as a catalytic unifying development is traced in some detail, including analysis of the rapidly growing empirical literature on resilience and its constituents, particularly heart rate variability. Finally, a review of the use of miniaturized ambulatory data collection, analysis and self-management and health management systems points out an exemplar, the Extensive Care System (ECS), which takes advantage of the continuing advances in biosensor technology, computing power, networking dynamics and social media to facilitate not only personalized health and wellbeing, but higher quality evidence-based preventive, treatment and epidemiological outcomes. This development will challenge the acute care episode model typified by the ER or ICU stay and replace it with an ECS capable of facilitating not only healthy autonomic functioning, but both ipsative/individual and normative/population health.

Regional Decentralisation in the Greek Health Care System: Rhetoric and Reality

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Athanasiadis, Athanasios; Kostopoulou, Stella; Philalithis, Anastas

2015-01-01

Decentralisation is a complex, yet basic feature of health care systems in many countries entailing the transfer of authority or dispersal of power in public planning, management and decision making from higher to lower levels of government. This paper describes the attempts made in Greece from 1923 until today to decentralise its highly centralised health care system, drawing on a thorough documentary analysis of legislative acts and official reports regarding regional health policy. The analysis shows that, although decentralisation has been attempted on several occasions, in the end it was abandoned every time. The first ever implementation of a decentralised system of governance in 2001 was also curtailed, resulting in only minor decentralisation of authority and real powers. It is suggested that decentralisation has been impeded by many factors, especially obstruction by opposition from key interest groups, absence of policy continuity between governments, the inability to tackle the bureaucratic and highly centralised system and lack of political will. PMID:26153163

Health federalism: the role of health care professionals in Nepal.

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Dulal, R K

2009-01-01

Nepal has entered from its unitary system into a new "Federal Democratic Republic State". The current constitution presents basic health care services as a fundamental right. The Ministry for Health and Population has been providing resources to meet health demands, but managers are wrestling to meet these demands. Persistent disparities between rural and urban and across regions resulted inferior health outcomes, e.g., life expectancy in an urban district like Bhaktapur is 71 years, whereas in the rural district of Mugu it is 44 years. The poor health and poor access to health care in the past systems prompted people to seek a different model. Ultimately, all political parties except one have agreed on federalism. The exact number of federal states that are going to be created is unknown. In federalism, all federated states have to assume certain relationships between the locality, the region, and the nation that apply not only in politics but in health care too. Managing changes in health care organization during the transitional period and after restructuring the unitary Nepal into federal states should be carefully planned. In case, if new system also fails to deliver necessary health care services, the possibility of igniting of dissatisfaction, public unrest and even disintegration cannot be ignored. In order to outline a structure and give life to a health care system under federalism, health care professionals need to engage themselves seriously.

HEALING THE ROMANIAN HEALTH CARE SYSTEM THROUGH THE TOTAL QUALITY MANAGEMENT METHOD

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Cosmin Dobrin

2015-07-01

Nowadays, this method is used with success and covers a large area of industries, including the sanitary industry. European hospitals have used this method in order to rearrange, from the quality’s point of view, their departments and keep their customers and employees satisfied with the sanitary institution.Total Quality Management is a method that has the ability to convert the health care system, and to cover all “gaps” formed for several years. Starting with correcting as much as possible all the issues found in the health care system, will lead to the top and most important objective: focusing on patient and assuring him a significant level of satisfaction. The applicability of this method made is possible also for Romanian hospitals. Since our health care system is confronting daily with issues that affect the patients (some issues being even deadly, a change in the way the quality is perceived, is suitable for our hospitals and clinics.

Primary Health Care Software-A Computer Based Data Management System

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Tuli K

1990-01-01

Full Text Available Realising the duplication and time consumption in the usual manual system of data collection necessitated experimentation with computer based management system for primary health care in the primary health centers. The details of the population as available in the existing manual system were used for computerizing the data. Software was designed for data entry and analysis. It was written in Dbase III plus language. It was so designed that a person with no knowledge about computer could use it, A cost analysis was done and the computer system was found more cost effective than the usual manual system.

The effectiveness of the health system in Serbia in 2014 and 2015 and mental health care indicators

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Simonović Periša

2016-01-01

Full Text Available The World Health Organization emphasized the importance of mental health by including it in their definition of health as 'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.' Mental health has direct influence to the quality of life of citizens as well as to productivity of economy. Therefore, both government and enterprises are interested for further improvement in this field. The European Health Consumer Index (EHCI was founded as a project in 2006, and it has been working ever since on comparison and ranking of the health systems of the European countries. Its main aim is the setting of standards for well-functioning and organization of health care from the perspective of patients (consumers - users of the health system. Assessment of the health system is based on pre-determined forty eight indicators, divided into six groups. The aim of this study was to assess the state of Serbian mental health care in 2014 and 2015 from the perspective of European health consumer index and propose recommendations for its improvement and functioning in accordance with the norms of European standards. The Republic of Serbia, according to the European Health Consumer Index, was ranked 33rd. in 2014 among European countries, with 473 points, while in 2015 was ranked 30 with 554 points. Mental health care indicators shows improvement in 2015 comparing with 2014. year.

QUANTITATIVE СHARACTERISTICS OF COMPLEMENTARY INTEGRATED HEALTH CARE SYSTEM AND INTEGRATED MEDICATION MANAGEMENT INFORMATION SYSTEM

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L. Yu. Babintseva

2015-05-01

i mportant elements of state regulation of the pharmaceutical sector health. For the first time creation of two information systems: integrated medication management infor mation system and integrated health care system in an integrated medical infor mation area, operating based on th e principle of complementarity was justified. Global and technological coefficients of these systems’ functioning were introduced.

Ensuring the security and privacy of information in mobile health-care communication systems

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Ademola P. Abidoye

2011-09-01

Full Text Available The sensitivity of health-care information and its accessibility via the Internet and mobile technology systems is a cause for concern in these modern times. The privacy, integrity and confidentiality of a patient’s data are key factors to be considered in the transmission of medical information for use by authorised health-care personnel. Mobile communication has enabled medical consultancy, treatment, drug administration and the provision of laboratory results to take place outside the hospital. With the implementation of electronic patient records and the Internet and Intranets, medical information sharing amongst relevant health-care providers was made possible. But the vital issue in this method of information sharing is security: the patient’s privacy, as well as the confidentiality and integrity of the health-care information system, should not be compromised. We examine various ways of ensuring the security and privacy of a patient’s electronic medical information in order to ensure the integrity and confidentiality of the information.

Interorganizational health care systems implementations: an exploratory study of early electronic commerce initiatives.

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Payton, F C; Ginzberg, M J

2001-01-01

Changing business practices, customers needs, and market dynamics have driven many organizations to implement interorganizational systems (IOSs). IOSs have been successfully implemented in the banking, cotton, airline, and consumer-goods industries, and recently attention has turned to the health care industry. This article describes an exploratory study of health care IOS implementations based on the voluntary community health information network (CHIN) model.

Intensive Care Nurses’ Belief Systems Regarding the Health Economics: A Focused Ethnography

Science.gov (United States)

Heydari, Abbas; Vafaee-Najar, Ali; Bakhshi, Mahmoud

2016-01-01

Background: Health care beliefs can have an effect on the efficiency and effectiveness of nursing practices. Nevertheless, how belief systems impact on the economic performance of intensive care unit (ICU) nurses is not known. This study aimed to explore the ICU nurses’ beliefs and their effect on nurse’s: practices and behavior patterns regarding the health economics. Methods: In this study, a focused ethnography method was used. Twenty-four informants from ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations were used for data collection. Data analysis was performed using the methods described by Miles and Huberman (1994). Findings: Eight beliefs were found that gave meaning to ICU nurse’s practices regarding the health economics. 1. The registration of medications and supplies disrupt the nursing care; 2. Monitoring and auditing improve consumption; 3. There is a fear of possible shortage in the future; 4. Supply and replacement of equipment is difficult; 5. Higher prices lead to more accurate consumption; 6. The quality of care precedes the costs; 7. Clinical Guidelines are abundant but useful; and 8. Patient economy has priority over hospital economy. Maintaining the quality of patient care with least attention to hospital costs was the main focus of the beliefs formed up in the ICU regarding the health economics. Conclusions: ICU nurses’ belief systems have significantly shaped in relation to providing a high-quality care. Although high quality of care can lead to a rise in the effectiveness of nursing care, cost control perspective should also be considered in planning for improve the quality of care. Therefore, it is necessary to involve the ICU nurses in decision-making about unit cost management. They must become familiar with the principles of heath care economics and productivity by applying an effective cost management program. It may be optimal to implement the

Intensive Care Nurses' Belief Systems Regarding the Health Economics: A Focused Ethnography.

Science.gov (United States)

Heydari, Abbas; Vafaee-Najar, Ali; Bakhshi, Mahmoud

2016-09-01

Health care beliefs can have an effect on the efficiency and effectiveness of nursing practices. Nevertheless, how belief systems impact on the economic performance of intensive care unit (ICU) nurses is not known. This study aimed to explore the ICU nurses' beliefs and their effect on nurse's practices and behavior patterns regarding the health economics. In this study, a focused ethnography method was used. Twenty-four informants from ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations were used for data collection. Data analysis was performed using the methods described by Miles and Huberman (1994). Eight beliefs were found that gave meaning to ICU nurse's practices regarding the health economics. 1. The registration of medications and supplies disrupt the nursing care; 2.Monitoring and auditing improve consumption; 3.There is a fear of possible shortage in the future; 4.Supply and replacement of equipment is difficult; 5.Higher prices lead to more accurate consumption; 6.The quality of care precedes the costs; 7. Clinical Guidelines are abundant but useful; and 8.Patient economy has priority over hospital economy. Maintaining the quality of patient care with least attention to hospital costs was the main focus of the beliefs formed up in the ICU regarding the health economics. ICU nurses' belief systems have significantly shaped in relation to providing a high-quality care. Although high quality of care can lead to a rise in the effectiveness of nursing care, cost control perspective should also be considered in planning for improve the quality of care. Therefore, it is necessary to involve the ICU nurses in decision-making about unit cost management. They must become familiar with the principles of heath care economics and productivity by applying an effective cost management program. It may be optimal to implement the reforms in various aspects, such as the hospital

The Theoretical and Practical Aspects of Forming the Financial Support for the Health Care System

Directory of Open Access Journals (Sweden)

Goncharuk Svitlana M.

2017-04-01

Full Text Available The objectives of the article are: defining the theoretical and methodological foundations for financial support for health care institutions; disclosure of the concept and substance of the targeted budget programs in the health care system; a critical analysis of the current practice in the use of performance indicators for the targeted budget programs; improving the methods for managerial decision-making in the course of implementation of the targeted budget programs; determining ways to improve the effectiveness and efficiency of the targeted budget programs in the health care system. In order to develop the health care sector, there’s a necessity to define the order and mechanisms for the priority financing, as well as the personnel and material-technical provision of health care institutions. There is also a need for the State support and regulation of an adequate financing for health care programs to achieve equal access in different regions of Ukraine. It is important further to define the specifics of the health sector’s targeted programs that will facilitate management of them.

US Health Care Reform and Transplantation, Part II: impact on the public sector and novel health care delivery systems.

Science.gov (United States)

Axelrod, D A; Millman, D; Abecassis, M M

2010-10-01

The Patient Protection and Affordable Care Act passed in 2010 will result in dramatic expansion of publically funded health insurance coverage for low-income individuals. It is estimated that of the 32 million newly insured, 16 million will obtain coverage through expansion of the Medicaid Program, and the remaining 16 million will purchase coverage through their employer or newly legislated insurance exchanges. While the Act contains numerous provisions to improve access to private insurance as discussed in Part I of this analysis, public sector coverage will significantly be affected. The cost of health care reform will be borne disproportionately by Medicare, which faces nearly $500 billion in cuts to be identified by a new independent board. Transplant centers should be concerned about the impact of the reform on the financial aspects of transplantation. In addition, this legislation also utilizes the Medicare Program to drive reform of the health care delivery system, by encouraging the development of integrated Accountable Care Organizations, experimentation with new 'models' of healthcare delivery, and expanded support for Comparative Effectiveness Research. Transplant providers, including transplant centers and physicians/surgeons need to lead this movement, drawing on our experience providing comprehensive multidisciplinary care under global budgets with publically reported outcomes.

Filling the Gaps in a Fragmented Health Care System : Development of the Health and Welfare Information Portal (ZWIP)

NARCIS (Netherlands)

Robben, Sarah H. M.; Huisjes, Mirjam; van Achterberg, Theo; Zuidema, Sytse U.; Rikkert, Marcel G. M. Olde; Schers, Henk J.; Heinen, Maud M.; Melis, Rene J. F.

2012-01-01

Background: Current health care systems are not optimally designed to meet the needs of our aging populations. First, the fragmentation of care often results in discontinuity of care that can undermine the quality of care provided. Second, patient involvement in care decisions is not sufficiently

Filling the Gaps in a Fragmented Health Care System: Development of the Health and Welfare Information Portal (ZWIP)

NARCIS (Netherlands)

Robben, S.H.M.; Huisjes, M.; van Achterberg, T.; Zuidema, S.; Olde Rikkert, M.G.M.; Schers, H.J.; Heinen, M.M.; Melis, R.J.F.

2012-01-01

Background: Current health care systems are not optimally designed to meet the needs of our aging populations. First, the fragmentation of care often results in discontinuity of care that can undermine the quality of care provided. Second, patient involvement in care decisions is not sufficiently

UPMC's blueprint for BuILDing a high-value health care system.

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Keyser, Donna; Kogan, Jane; McGowan, Marion; Peele, Pamela; Holder, Diane; Shrank, William

2018-03-30

National-level demonstration projects and real-world studies continue to inform health care transformation efforts and catalyze implementation of value-based service delivery and payment models, though evidence generation and diffusion of learnings often occurs at a relatively slow pace. Rapid-cycle learning models, however, can help individual organizations to more quickly adapt health care innovations to meet the challenges and demands of a rapidly changing health care landscape. Integrated delivery and financing systems (IDFSs) offer a unique platform for rapid-cycle learning and innovation. Since both the provider and payer benefit from delivering care that enhances the patient experience, improves quality, and reduces cost, incentives are aligned to experiment with value-based models, enhance learning about what works and why, and contribute to solutions that can accelerate transformation. In this article, we describe how the UPMC Insurance Services Division, as part of a large IDFS, uses its Business, Innovation, Learning, and Dissemination (BuILD) model to prioritize, design, test, and refine health care innovations and accelerate learning. We provide examples of how the BuILD model offers an approach for quickly assessing the impact and value of health care transformation efforts. Lessons learned through the BuILD process will offer insights and guidance for a wide range of stakeholders whether an IDFS or independent payer-provider collaborators. Copyright © 2018 Elsevier Inc. All rights reserved.

[The Japanese Health Care System: An Analysis of the Funding and Reimbursement System].

Science.gov (United States)

Rump, Alexis; Schöffski, Oliver

2017-08-10

Objective The modern Japanese health care system was established during the Meiji period (1868-1912) using the example of Germany. In this paper, the funding and remuneration of health services and products in Japan are described. The focus lies on the mechanisms used to implement health policy goals and to control costs. Method Selective literature search. Results All permanent residents in Japan are enrolled in one of more than 3,000 compulsory health funds. Employees and public servants are covered through company or government-related health insurance schemes. Independent workers, the unemployed and the pensioners are usually assigned to health insurance plans managed by local city governments. The elderly over 75 years are insured through special health funds managed at the prefectural level. To correct the fiscal disparities among the health insurance programs, a risk adjustment is realized by compensatory financial transfers between the funds and substantial subsidies from the central and local governments. The statutory benefits package that is identical for all insurance plans is regulated in a single comprehensive schedule. All the covered health services and products are listed with the fees and compensations, and the conditions for the service providers to be remunerated are also stated. This fee and compensation schedule is regularly revised every 2 years under the leadership of the Ministry of Health, Labor and Welfare. The revisions are intended to contain health expenditures and to set incentives for the achievement of health policy goals. Conclusion The funding of the Japanese health care system and the risk adjustment mechanisms among health funds are well established and show a rather static character. The short- and mid-term development of the system is mainly controlled on the side of the expenditures through the unique and comprehensive fee and compensation schedule. The regular revisions of this schedule permit to react at relatively short

[Aspects of economic responsibility in health care].

Science.gov (United States)

Hauke, Eugen

2007-01-01

According to the final consensus of a panel of intense discussions, the health care system should/can not be excluded from the economic laws of efficiency. Appropriate adaptation of various methods and instruments of economics make these tools applicable for use in the health care system. Due to errors in the implementation of economic methods, though, the question arises who is economically responsible in the health care system. The answer is found at three different levels of the health care system. The physician plays a leading role, both personally and professionally, in being primarily responsible for the direct medical treatment of the patient. The physician's dependence, however, on the health care system reduces his independence, which markedly affects his decision-making and treatment. Management of and in health care institutions is largely independent of the profession learned. Managers and physicians acting as managers must be appropriately and duly educated in the necessary specific talents and knowledge. The organisation of a health care system should also be reserved for trained specialists where the physicians as well as other professionals are obliged to acquire the skills necessary.

Audit Trail Management System in Community Health Care Information Network.

Science.gov (United States)

Nakamura, Naoki; Nakayama, Masaharu; Nakaya, Jun; Tominaga, Teiji; Suganuma, Takuo; Shiratori, Norio

2015-01-01

After the Great East Japan Earthquake we constructed a community health care information network system. Focusing on the authentication server and portal server capable of SAML&ID-WSF, we proposed an audit trail management system to look over audit events in a comprehensive manner. Through implementation and experimentation, we verified the effectiveness of our proposed audit trail management system.

Improving Health Care Coverage, Equity, And Financial Protection Through A Hybrid System: Malaysia's Experience.

Science.gov (United States)

Rannan-Eliya, Ravindra P; Anuranga, Chamara; Manual, Adilius; Sararaks, Sondi; Jailani, Anis S; Hamid, Abdul J; Razif, Izzanie M; Tan, Ee H; Darzi, Ara

2016-05-01

Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia's health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia's results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia's hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia's hybrid health system presents continuing unresolved policy challenges, but the country's experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources. Project HOPE—The People-to-People Health Foundation, Inc.

The impact of prospective pricing on the information system in the health care industry.

Science.gov (United States)

Matta, K F

1988-02-01

The move from a retrospective payment system (value added) to a prospective payment system (diagnostic related) has not only influenced the health care business but also changed their information systems' requirements. The change in requirements can be attributed both to an increase in data processing tasks and also to an increase in the need for information to more effectively manage the organization. A survey was administered to capture the response of health care institutions, in the area of information systems, to the prospective payment system. The survey results indicate that the majority of health care institutions have responded by increasing their information resources, both in terms of hardware and software, and have moved to integrate the medical and financial data. In addition, the role of the information system has changed from a cost accounting system to one intended to provide a competitive edge in a highly competitive marketing environment.

Mental health care in general practice in the context of a system reform.

NARCIS (Netherlands)

Magnée, T.

2017-01-01

The aim of this thesis was to monitor mental health care in Dutch general practices in recent years. In 2014, a reform of the Dutch mental health care system was introduced. Since this reform, general practitioners (GPs) are expected to only refer patients with a (suspected) psychiatric disorder or

Investigating the health care delivery system in Japan and reviewing the local public hospital reform

Directory of Open Access Journals (Sweden)

Zhang X

2016-03-01

Full Text Available Xing Zhang, Tatsuo Oyama National Graduate Institute for Policy Studies, Tokyo, Japan Abstract: Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying a multivariate analysis and regression model techniques, we show the functional differences between urban populated prefectures and remote ones; the equality gap among all prefectures with respect to the distribution of the number of beds, staff, and doctors; and managerial differences between private and public hospitals. We also review and evaluate the local public hospital reform executed in 2007 from various financial aspects related to the expenditure and revenue structure by comparing public and private hospitals. We show that the 2007 reform contributed to improving the financial situation of local public hospitals. Strategic differences between public and private hospitals with respect to their management and strategy to improve their financial situation are also quantitatively analyzed in detail. Finally, the remaining problems and the future strategy to further improve the Japanese health care system are described. Keywords: health care system, health care resource, public hospital, multivariate regression model, financial performance

Holistic health care: Patients' experiences of health care provided by an Advanced Practice Nurse.

Science.gov (United States)

Eriksson, Irene; Lindblad, Monica; Möller, Ulrika; Gillsjö, Catharina

2018-02-01

Advanced Practice Nurse (APN) is a fairly new role in the Swedish health care system. To describe patients' experiences of health care provided by an APN in primary health care. An inductive, descriptive qualitative approach with qualitative open-ended interviews was chosen to obtain descriptions from 10 participants regarding their experiences of health care provided by an APN. The data were collected during the spring 2012, and a qualitative approach was used for analyze. The APNs had knowledge and skills to provide safe and secure individual and holistic health care with high quality, and a respectful and flexible approach. The APNs conveyed trust and safety and provided health care that satisfied the patients' needs of accessibility and appropriateness in level of care. The APNs way of providing health care and promoting health seems beneficial in many ways for the patients. The individual and holistic approach that characterizes the health care provided by the APNs is a key aspect in the prevailing change of health care practice. The transfer of care and the increasing number of older adults, often with a variety of complex health problems, call for development of the new role in this context. © 2017 The Authors. International Journal of Nursing Practice Published by John Wiley & Sons Australia, Ltd.

Beneficiaries of conflict: a qualitative study of people's trust in the private health care system in Mogadishu, Somalia.

Science.gov (United States)

Gele, Abdi A; Ahmed, Mohamed Yusuf; Kour, Prabhjot; Moallim, Sadiyo Ali; Salad, Abdulwahab Moallim; Kumar, Bernadette

2017-01-01

In 2005, the World Health Conference called for all nations to move toward universal health coverage, which is defined as "access to adequate health care for all at an affordable price". Despite this, an estimated 90% of Somalia's largely impoverished population use private health care. Therefore, considering that the private health care system is the dominant health care system in Mogadishu, Somalia, exploring the accessibility to, as well as people's trust in, the private sector is essential to help contribute an equitable and affordable health care system in the country. A qualitative study using unstructured interviews was conducted in Mogadishu from August to November of 2016. A purposive sampling approach was used to recruit 23 participants, including seven medical doctors who own private health centers, eight patients, five medical students and three senior officials who work for the Ministry of Health. Data were analyzed using a thematic analysis. Our findings show that the private health care system in Mogadishu is not only unregulated but also expensive, with the cost of health care often unaffordable for the majority of the country's citizens. There is evidence of prescription of inappropriate treatment, tendency to conduct unnecessary laboratory tests, excessive use of higher diagnostic technologies and overcharging - including the widespread practice of further appointments for follow-up - which inflates the costs. The study also found poor patient-provider relationship and widespread distrust of the private health care system. The study findings underline the need for the Somali government to develop regulatory mechanisms and guidelines with the potential to guide the private health care sector to provide equitable and affordable health care to people in Mogadishu. The doctor-patient relationship has been - and remains - a keystone of care; thus, there is an urgent need for guidelines for private health care providers to treat their patients with

A New Remote Health-Care System Based on Moving Robot Intended for the Elderly at Home

Directory of Open Access Journals (Sweden)

Bing Zhou

2018-01-01

Full Text Available Nowadays, due to the growing need for remote care and the constantly increasing popularity of mobile devices, a large amount of mobile applications for remote care support has been developed. Although mobile phones are very suitable for young people, there are still many problems related to remote health care of the elderly. Due to hearing loss or limited movements, it is difficult for the elderly to contact their families or doctors via real-time video call. In this paper, we introduce a new remote health-care system based on moving robots intended for the elderly at home. Since the proposed system is an online system, the elderly can contact their families and doctors quickly anytime and anywhere. Besides call, our system involves the accurate indoor object detection algorithms and automatic health data collection, which are not included in existing remote care systems. Therefore, the proposed system solves some challenging problems related to the elderly care. The experiment has shown that the proposed care system achieves excellent performance and provides good user experience.

Impact of laboratory accreditation on patient care and the health system.

Science.gov (United States)

Peter, Trevor F; Rotz, Philip D; Blair, Duncan H; Khine, Aye-Aye; Freeman, Richard R; Murtagh, Maurine M

2010-10-01

Accreditation is emerging as a preferred framework for building quality medical laboratory systems in resource-limited settings. Despite the low numbers of laboratories accredited to date, accreditation has the potential to improve the quality of health care for patients through the reduction of testing errors and attendant decreases in inappropriate treatment. Accredited laboratories can become more accountable and less dependent on external support. Efforts made to achieve accreditation may also lead to improvements in the management of laboratory networks by focusing attention on areas of greatest need and accelerating improvement in areas such as supply chain, training, and instrument maintenance. Laboratory accreditation may also have a positive influence on performance in other areas of health care systems by allowing laboratories to demonstrate high standards of service delivery. Accreditation may, thus, provide an effective mechanism for health system improvement yielding long-term benefits in the quality, cost-effectiveness, and sustainability of public health programs. Further studies are needed to strengthen the evidence on the benefits of accreditation and to justify the resources needed to implement accreditation programs aimed at improving the performance of laboratory systems.

Fair equality of opportunity critically reexamined: the family and the sustainability of health care systems.

Science.gov (United States)

Engelhardt, H Tristram

2012-12-01

A complex interaction of ideological, financial, social, and moral factors makes the financial sustainability of health care systems a challenge across the world. One difficulty is that some of the moral commitments of some health care systems collide with reality. In particular, commitments to equality in access to health care and to fair equality of opportunity undergird an unachievable promise, namely, to provide all with the best of basic health care. In addition, commitments to fair equality of opportunity are in tension with the existence of families, because families are aimed at advantaging their own members in preference to others. Because the social-democratic state is committed to fair equality of opportunity, it offers a web of publicly funded entitlements that make it easier for persons to exit the family and to have children outside of marriage. In the United States, in 2008, 41% of children were born outside of wedlock, whereas, in 1940, the percentage was only 3.8%, and in 1960, 5%, with the further consequence that the social and financial capital generated through families, which aids in supporting health care in families, is diminished. In order to explore the challenge of creating a sustainable health care system that also supports the traditional family, the claims made for fair equality of opportunity in health care are critically reconsidered. This is done by engaging the expository device of John Rawls's original position, but with a thin theory of the good that is substantively different from that of Rawls, one that supports a health care system built around significant copayments, financial counseling, and compulsory savings, with a special focus on enhancing the financial and social capital of the family. This radical recasting of Rawls, which draws inspiration from Singapore, is undertaken as a heuristic to aid in articulating an approach to health care allocation that can lead past the difficulties of social-democratic policy.

Rationalising health care in india : Challenges & strategies

Directory of Open Access Journals (Sweden)

K I Mathai

2014-01-01

Full Text Available An overview of health care delivery in India is essential, if we are to plan and to improve health care delivery and the indices of health in the coming decades. The health sector in India is a mix of private and government services. While some health care indices appear dismal, several others, including life expectancy are heartening. A balance between regulation and free enterprise is possibly the best option. In this paper we provide a glimpse of health and health related statistics & a n overview of the public health care delivery systems. In the end, we offer suggestion on rationalisation of health care delivery to provide maximum services for the majority of our population within the budget of an optimal health care system outlay

The impact of BPO on cost reduction in mid-sized health care systems.

Science.gov (United States)

Perry, Andy; Kocakülâh, Mehmet C

2010-01-01

At the convergence of two politico-economic "hot topics" of the day--outsourcing and the cost of health care-lie opportunities for mid-sized health systems to innovate, collaborate, and reduce overhead. Competition in the retail health care market can serve as both an impetus and an inhibitor to such measures, though. Here we are going to address the motivations, influences, opportunities, and limitations facing mid-sized, US non-profit health systems in business process outsourcing (BPO). Advocates cite numerous benefits to BPO, particularly in cost reduction and strategy optimization. BPO can elicit cost savings due to specialization among provider firms, returns to scale and technology, standardization and automation, and gains in resource arbitrage (off-shoring capabilities). BPO can also free an organization of non-critical tasks and focus resources on core competencies (treating patients). The surge in BPO utilization has rarely extended to the back-office functions of many mid-sized health systems. Health care providers, still a largely fragmented bunch with many rural, independent non-profit systems, have not experienced the consolidation and organizational scale growth to make BPO as attractive as other industries. Smaller firms, spurning merger and acquisition pressure from large, tertiary health systems, often wish to retain their autonomy and identity; hence, they face a competitive cost disadvantage compared to their larger competitors. This article examines the functional areas for these health systems in which BPO is not currently utilized and dissects the various methods available in which to practice BPO. We assess the ongoing adoption of BPO in these areas as well as the barriers to adoption, and identify the key processes that best represent opportunity for success. An emphasis is placed on a collaborative model with other health systems compared to a single system, unilateral BPO arrangement.

Collaborative HIV care in primary health care: nurses' views.

Science.gov (United States)

Ngunyulu, R N; Peu, M D; Mulaudzi, F M; Mataboge, M L S; Phiri, S S

2017-12-01

Collaborative HIV care between the nurses and traditional health practitioners is an important strategy to improve health care of people living with HIV. To explore and describe the views of nurses regarding collaborative HIV care in primary healthcare services in the City of Tshwane, South Africa. A qualitative, descriptive design was used to explore and describe the views of nurses who met the study's inclusion criteria. In-depth individual interviews were conducted to collect data from purposively selected nurses. Content analysis was used to analyse data. Two main categories were developed during the data analysis stage. The views of nurses and health system challenges regarding collaborative HIV care. The study findings revealed that there was inadequate collaborative HIV care between the nurses and the traditional health practitioners. It is evident that there is inadequate policy implementation, monitoring and evaluation regarding collaboration in HIV care. The study findings might influence policymakers to consider the importance of collaborative HIV care, and improve the quality of care by strengthening the referral system and follow-up of people living with HIV and AIDS, as a result the health outcomes as implied in the Sustainable Development Goals 2030 might be improved. Training and involvement of traditional health practitioners in the nursing and health policy should be considered to enhance and build a trustworthy working relationship between the nurses and the traditional health practitioners in HIV care. © 2017 International Council of Nurses.

Purchased Behavioral Health Care Received by Military Health System Beneficiaries in Civilian Medical Facilities, 2000-2014.

Science.gov (United States)

Wooten, Nikki R; Brittingham, Jordan A; Pitner, Ronald O; Tavakoli, Abbas S; Jeffery, Diana D; Haddock, K Sue

2018-02-06

Behavioral health conditions are a significant concern for the U.S. military and the Military Health System (MHS) because of decreased military readiness and increased health care utilization. Although MHS beneficiaries receive direct care in military treatment facilities, a disproportionate majority of behavioral health treatment is purchased care received in civilian facilities. Yet, limited evidence exists about purchased behavioral health care received by MHS beneficiaries. This longitudinal study (1) estimated the prevalence of purchased behavioral health care and (2) identified patient and visit characteristics predicting receipt of purchased behavioral health care in acute care facilities from 2000 to 2014. Medical claims with Major Diagnostic Code 19 (mental disorders/diseases) or 20 (alcohol/drug disorders) as primary diagnoses and TRICARE as the primary/secondary payer were analyzed for MHS beneficiaries (n = 17,943) receiving behavioral health care in civilian acute care facilities from January 1, 2000, to December 31, 2014. The primary dependent variable, receipt of purchased behavioral health care, was modeled for select mental health and substance use disorders from 2000 to 2014 using generalized estimating equations. Patient characteristics included time, age, sex, and race/ethnicity. Visit types included inpatient hospitalization and emergency department (ED). Time was measured in days and visits were assumed to be correlated over time. Behavioral health care was described by both frequency of patients and visit type. The University of South Carolina Institutional Review Board approved this study. From 2000 to 2014, purchased care visits increased significantly for post-traumatic stress disorder, adjustment, anxiety, mood, bipolar, tobacco use, opioid/combination opioid dependence, nondependent cocaine abuse, psychosocial problems, and suicidal ideation among MHS beneficiaries. The majority of care was received for mental health disorders (78

Discrimination against older women in health care.

Science.gov (United States)

Belgrave, L L

1993-01-01

Growing awareness of apparent gaps in health care received by women and men raises concern over possible discrimination. This literature review examines this issue for elderly women, whose health care is obtained in a system that also may be permeated with age discrimination. Physicians tend to spend more time with women and older patients, suggesting that discrimination may not be an issue in the physician-patient relationship or may work in favor of older women. However, this may simply reflect elderly women's poorer health. Gender and age disparities in medical treatments received provide a more compelling argument that the health care system is a source of discrimination against older women, who are less likely than others to receive available treatments for cardiac, renal, and other conditions. The history of medical treatment of menopause suggests that stereotypes of older women have been advantageous for segments of the health care system. Finally, in addition to discrimination that has its source within the health care system itself, societal-wide inequities, particularly economic, are extremely detrimental to older women's health care. As we respond to the health care crisis, we must be alert to the potential to rectify those structures and tendencies that can lead to discrimination against women and the aged. Health care reform presents a unique opportunity to ensure health care equity.

Dedicated real-time monitoring system for health care using ZigBee.

Science.gov (United States)

Alwan, Omar S; Prahald Rao, K

2017-08-01

Real-time monitoring systems (RTMSs) have drawn considerable attentions in the last decade. Several commercial versions of RTMS for patient monitoring are available which are used by health care professionals. Though they are working satisfactorily on various communication protocols, their range, power consumption, data rate and cost are really bothered. In this study, the authors present an efficient embedded system based wireless health care monitoring system using ZigBee. Their system has a capability to transmit the data between two embedded systems through two transceivers over a long range. In this, wireless transmission has been applied through two categories. The first part which contains Arduino with ZigBee will send the signals to the second device, which contains Raspberry with ZigBee. The second device will measure the patient data and send it to the first device through ZigBee transceiver. The designed system is demonstrated on volunteers to measure the body temperature which is clinically important to monitor and diagnose for fever in the patients.

76 FR 13209 - United States and State of Texas v. United Regional Health Care System; Proposed Final Judgment...

Science.gov (United States)

2011-03-10

... of Texas v. United Regional Health Care System, Civil Action No. 7:11-cv- 00030-O. On February 25..., ambulatory surgery center or radiology center in [a] 15 mile radius of United Regional Health Care System... 95% of billed charges for all inpatient and outpatient services at United Regional Health Care System...

Some aspects of the reform of the health care systems in Austria, Germany and Switzerland.

Science.gov (United States)

Theurl, E

1999-01-01

The health care systems in Austria, Germany and Switzerland owe their institutional structure to different historical developments. While Austria and Germany voted for the Bismarck-Model of social health insurance, Switzerland adopted a voluntary system of health insurance. In all three countries, until very recently, the different challenges which the health care sector faced were met by piecemeal approaches and by stop and go policies, which, in the long run were not very successful either in containing costs or in improving efficacy and efficiency. During the 1990 more fundamental reforms in the health care systems of all three countries took place. Germany and Switzerland chose the path of deregulation of the health insurance system, which consequently strengthened the competition between the insurance companies, and, to some extent between the suppliers of medical services. While this can be seen as an essential part of the reform process for these two countries. Austria favors a state-oriented and interventionist approach in order to meet the challenges.

TRICARE: Transformation of the Military Health Care System - Demystifying Military Medicine and the Mission Impossible

National Research Council Canada - National Science Library

Zeliff, Barbara

2004-01-01

The Department of Defense's military health care system, entitled TRICARE, brings together the direct health care resources of the Department of Defense and supplements this capability through the use...

A System for Planning and Achieving Comprehensive Health Care in Residential Institutions for the Mentally Retarded.

Science.gov (United States)

Decker, Harold A.

Based on a view of health care intertwining medicine intimately with other components of institutional care, the monograph presents a system of concepts and operating techniques for providing comprehensive health care to institutionalized retardates. Background of the system is explained in terms of its research basis (two studies by the author of…

Litigating the right to health: what can we learn from a comparative law and health care systems approach.

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Flood, Colleen; Gross, Aeyal

2014-12-11

This article presents research demonstrating that the right to health plays different roles in different types of health systems. In high-income countries with tax-funded health systems, we usually encounter a lack of an enforceable right to heath. In contrast, rights play a more significant role in social health insurance/managed competition systems (which are present in a mixture of high-income and middle-income countries). There is concern, for example in Colombia, that a high volume of rights litigation can challenge the very sustainability of a public health care system and distort resources away from those most in need. Finally, in middle-income countries with big gaps between a poor public health system and a rich private one, we are more likely to find an express constitutional right to health care (or one is inferred from, for example, the right to life). In some of these countries, constitutional rights were included as part of the transition to democracy and an attempt to address huge inequities within society. Here the scale of health inequities suggests that courts need to be bolder in their interpretation of health care rights. We conclude that in adjudicating health rights, courts should scrutinize decision-making through the lens of health equity and equality to better achieve the inherent values of health human rights. Copyright © 2014 Gross and Flood. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Improving eye care in the primary health care setting

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M de Wet

2000-09-01

Full Text Available One of the challenges facing primary health care in South Africa is the delivery of quality eye care to all South Africans. In this regard the role of the primary health care worker, as the first point of contact, is crucial. This paper reports on the problems primary health care workers experience in providing quality eye care in Region B of the Free State. Problems identified by those involved in the study include the cumbersome referral system, the unavailability of appropriate medicine at clinics, the insufficient knowledge of primary health care workers regarding eye conditions and the lack of communication between the various eye care service providers. Suggestions to address the problems identified included more in-service training of primary health care workers regarding eye conditions, liaison with NGO’s providing eye care, decentralisation of services and the establishment of an eye care committee in the region.

Arts and cultural activity: A vital part of the health and care system.

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Cann, Paul L

2017-06-01

This article discusses how the arts and cultural activities are a vital part of a health and care system and have potential to fulfil the theme of active ageing. The changing nature of care provision in response to demographic change, fiscal pressure and increasingly consumerist attitudes on the part of care users, is considered. Selected examples of how participation in arts and cultural activities increases not only well-being but also health outcomes are then outlined. The article highlights the potential of 'cultural commissioning' and within that 'arts on prescription' - public funding of arts-related activities for people with care needs - and advocates investment in arts and cultural activities to better meet the demands of health, social care and aged care. Concluding remarks are made, and a way forward is suggested. © 2017 AJA Inc.

Adherence and health care costs

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Iuga AO

2014-02-01

Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost

The authoritarian reign in American health care.

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Ballou, Kathryn A; Landreneau, Kandace J

2010-02-01

The aim of this article is to increase understanding of the mechanisms of the continuation of elite hegemonic control of a highly valued social system--American health care. White, male physicians and administrators achieved control of the health care industry and its workers, including nurses, at the start of the 20th century. Using critical theorists' work on authoritarianism and incorporating gender analysis, the authors describe the health care system from a critical social- psychological perspective. The authors discuss the meaning and presence of authoritarian hierarchy and gender effects in today's health system through a critical analysis of the profession of medicine, the profession of nursing, corporate and bureaucratic health care, and patients or consumers. It is concluded that the social-psychological behavior of the American health care system has profound implications that must be taken into account in any recommendations for change.

COMPARATIVE STUDY ON THE RIGHT TO HEALTH CARE SYSTEM PRISON LAW INTENDED TO ROMANIAN NATIONAL HEALTH LAW

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Florentina Laurenţia GĂIŞTEANU

2017-05-01

Full Text Available Health protection represents a protection measure for persons being a guaranteed right in Romania provided by the 34 Article of Romanian Constitution. The state is liable for taking measures of protecting physical and mental health, both for free persons and for those persons serving custodial measures. Starting from the Recommendation of the Committee of Ministers of the Member States relating to the European Prison Rules Rec (2006 2, which provides in paragraph 2 of subparagraph 40 – “The organization of health care in prisons”- that health policy from prison will be integrated in national health policy, being compatible with that. That comparative study aims at the implementation of European’s recommendations in different medical specialty areas. During this presentation are highlighted identical or different provisions stipulated in the relevant legislation of both two health systems, concluding that in certain areas of prison system, the state provides extra healthcare legislation. Comparative study between the right of medical assistance provided by Romanian Prison Legislation and the right of medical assistance provided by Romanian National Health Care System.

Reforms are needed to increase public funding and curb demand for private care in Israel's health system.

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Chernichovsky, Dov

2013-04-01

Historically, the Israeli health care system has been considered a high-performance system, providing universal, affordable, high-quality care to all residents. However, a decline in the ratio of physicians to population that reached a modern low in 2006, an approximate ten-percentage-point decline in the share of publicly financed health care between 1995 and 2009, and legislative mandates that favored private insurance have altered Israel's health care system for the worse. Many Israelis now purchase private health insurance to supplement the state-sponsored universal care coverage, and they end up spending more out of pocket even for services covered by the entitlement. Additionally, many publicly paid physicians moonlight at private facilities to earn more money. In this article I recommend that Israel increase public funding for health care and adopt reforms to address the rising demand for privately funded care and the problem of publicly paid physicians who moonlight at private facilities.

The Danish health care system: it ain't broke... so don't fix it.

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Mooney, Gavin

2002-02-01

The organisation and financing of the Danish health care system was evaluated within a framework of analysis of strengths, weaknesses, opportunities and threats (a SWOT analysis) by a panel of five members with a background in health economics. The evaluation was based on reading an extensive amount of selected documents and literature on the Danish health care system, and a 1 week-visit to health care authorities, providers and key persons. This paper includes the main findings by one of the panel members. The international competition 'wave' passed by Denmark, and the Danish might rightly say 'thank goodness'. Funding is very largely public and there is a single dominant authority, i.e. the county, which makes planning easier. Low levels of patient payments and the smaller size of the private sector reflect Danish 'solidarity' and promote equity. Planning is good. Exceptions to this are the over-concern with hospital waiting lists and the flirting with DRG based funding. Greater investment in planning approaches would make the system yet better. The GP blended remuneration system with capitation and fee for service is a major strength. The fact that the system has such potential for technical and allocative efficiency and also equity but is not fully exploited suggests the need for more investment in health services research. While there is scope for improving the health care system in Denmark, the rest of the world has as much to learn from the Danes as the Danes have from the rest of the world.

How and why do countries differ in their governance and financing-related administrative expenditure in health care? An analysis of OECD countries by health care system typology

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Hagenaars, L.L.; Klazinga, N.S.; Muller, M.; Morgan, D.J.; Jeurissen, P.P.T.

2018-01-01

INTRODUCTION: Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending

Fitting Community Based Newborn Care Package into the health systems of Nepal.

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Pradhan, Y V; Upreti, S R; Kc, N P; Thapa, K; Shrestha, P R; Shedain, P R; Dhakwa, J R; Aryal, D R; Aryal, S; Paudel, D C; Paudel, D; Khanal, S; Bhandari, A; Kc, A

2011-10-01

Community-based strategies for delivering effective newborn interventions are an essential step to avert newborn death, in settings where the health facilities are unable to effectively deliver the interventions and reach their population. Effective implementation of community-based interventions as a large scale program and within the existing health system depends on the appropriate design and planning, monitoring and support systems. This article provides an overview of implementation design of Community-Based Newborn Care Package (CB-NCP) program, its setup within the health system, and early results of the implementation from one of the pilot districts. The evaluation of CB-NCP in one of the pilot districts shows significant improvement in antenatal, intrapartum and post natal care. The implementation design of the CB-NCP has six different health system management functions: i) district planning and orientation, ii) training/human resource development, iii) monitoring and evaluation, iv) logistics and supply chain management, v) communication strategy, and vi) pay for performance. The CB-NCP program embraced the existing system of monitoring with some additional components for the pilot phase to test implementation feasibility, and aligns with existing safe motherhood and child health programs. Though CB-NCP interventions are proven independently in different local and global contexts, they are piloted in 10 districts as a "package" within the national health system settings of Nepal.

Curing a meagre health care system by lean methods--translating 'chains of care' in the Swedish health care sector.

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Trägårdh, Björn; Lindberg, Kajsa

2004-01-01

The purpose of this article is to discuss what happens when work embedded in a 'meagre' organizational context is changed by lean production-related methods. The article is based on studies of seven lean production-inspired projects in the Swedish health care sector, a sector already poor due to organizational slack. The projects were directed to develop 'health care chains', an organizational concept regarded as a way to rationalize health care organizations as well as to develop them, i.e. increase productivity, quality from a customer perspective and quality of working conditions. The article analyses the projects from an interpretative perspective and discusses how modem management models with ambitions to concurrently rationalize and develop organizations--e.g. lean production and health care chains--are used in a 'meagre' organizational field. As an outcome, a model is presented that explores what is beyond simple imitations and unique translations of ideas when a new concept is implemented in local organizations.

How and why do countries differ in their governance and financing-related administrative expenditure in health care? An analysis of OECD countries by health care system typology

NARCIS (Netherlands)

Hagenaars, Luc L.; Klazinga, Niek S.; Mueller, Michael; Morgan, David J.; Jeurissen, Patrick P. T.

2017-01-01

Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending differences between

What Are the Professional, Political, and Ethical Challenges of Co-Creating Health Care Systems?

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Singh, Guddi; Owens, John; Cribb, Alan

2017-11-01

Co-creation is seen by many as a means of meeting the multiple challenges facing contemporary health care systems by involving institutions, professionals, patients, and stakeholders in new roles, relationships, and collaborative practices. While co-creation has the potential to positively transform health care systems, it generates a number of political and ethical challenges that should not be overlooked. We suggest that those involved in envisioning and implementing co-creation initiatives pay close attention to significant questions of equity, power, and justice and to the fundamental challenge of securing a common vision of the aims of and agendas for health care systems. While such initiatives present significant opportunities for improvement, they need to be viewed in light of their accompanying professional, political, and ethical challenges. © 2017 American Medical Association. All Rights Reserved.

Unraveling care integration: Assessing its dimensions and antecedents in the Italian Health System.

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Calciolari, Stefano; Ilinca, Stefania

2016-01-01

In recent decades, consensus has grown on the need to organize health systems around the concept of care integration to better confront the challenges associated with demographic trends and financial sustainability. However, care integration remains an imprecise umbrella term in both the academic and policy arenas. In addition, little substantive knowledge exists on the success factors for integration initiatives. We propose a composite measure of care integration and a conceptual framework suggesting its relationships with three types of antecedents: contextual, cultural, and organizational factors. Our framework was tested using data from the Italian National Health System (NHS). We administered an ad-hoc questionnaire to all Italian local health units (LHUs), with a 60.4% response rate, and used structural equation modeling to assess the relationships between the relevant latent constructs. The results validated our measure of care integration and supported the hypothesized relationships. In particular, integration was found to be fostered by results-oriented institutional settings, a professional culture conducive to inclusiveness and shared goals, and organizational arrangements promoting clear expectations among providers. Thus, integration improves care and mediates the effects of specific operating means on care enhancement. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Development and testing of the Multidimensional Trust in Health Care Systems Scale.

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Egede, Leonard E; Ellis, Charles

2008-06-01

To describe the development and psychometric testing of the Multidimensional Trust in Health Care Systems Scale (MTHCSS). Scale development occurred in 2 phases. In phase 1, a pilot instrument with 70 items was generated from the review of the trust literature, focus groups, and expert opinion. The 70 items were pilot tested in a sample of 256 students. Exploratory factor analysis was used to derive an orthogonal set of correlated factors. In phase 2, the final scale was administered to 301 primary care patients to assess reliability and validity. Phase 2 participants also completed validated measures of patient-centered care, health locus of control, medication nonadherence, social support, and patient satisfaction. In phase 1, a 17-item scale (MTHCSS) was developed with 10 items measuring trust in health care providers, 4 items measuring trust in health care payers, and 3 items measuring trust in health care institutions. In phase 2, the 17-item MTHCSS had a mean score of 63.0 (SD 8.8); the provider subscale had a mean of 40.0 (SD 6.2); the payers subscale had a mean of 12.8 (SD 3.0); and the institutions subscale had a mean of 10.3 (SD 2.1). Cronbach's alpha for the MTHCSS was 0.89 and 0.92, 0.74, and 0.64 for the 3 subscales. The MTHCSS was significantly correlated with patient-centered care (r = .22 to .62), locus of control-chance (r = .42), medication nonadherence (r = -.22), social support (r = .25), and patient satisfaction (r = .67). The MTHCSS is a valid and reliable instrument for measuring the 3 objects of trust in health care and is correlated with patient-level health outcomes.

Individual and organizational impact of enterprises resources planning system in health care sector

International Nuclear Information System (INIS)

Ilyas, A.; Fiaz, M.; Tayyaba, A.

2016-01-01

Use of ERPS (Enterprise Resource Planning System) in health care sector has positive impacts. The purpose of this research is to find out the individual and organizational impact in health care sector. Hypotheses were postulated that the use of ERPS has positive individual and organizational impacts. A research questionnaire was used to test these hypotheses which have twelve dimensions for both impacts. This instrument was adopted from literature and self-administrated to 504 individuals with response rate of 60 percentage and only 56 percentage of questionnaires were used. The results of this study revealed that the use of ERPS has positive individual and organizational impacts. This study will help the health care organizations to find out impacts of ERPS in health care sector and also to better understand the individual and organizational impacts. (author)

The dynamic system of parental work of care for children with special health care needs: A conceptual model to guide quality improvement efforts

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Hexem Kari R

2011-10-01

Full Text Available Abstract Background The work of care for parents of children with complex special health care needs may be increasing, while excessive work demands may erode the quality of care. We sought to summarize knowledge and develop a general conceptual model of the work of care. Methods Systematic review of peer-reviewed journal articles that focused on parents of children with special health care needs and addressed factors related to the physical and emotional work of providing care for these children. From the large pool of eligible articles, we selected articles in a randomized sequence, using qualitative techniques to identify the conceptual components of the work of care and their relationship to the family system. Results The work of care for a child with special health care needs occurs within a dynamic system that comprises 5 core components: (1 performance of tasks such as monitoring symptoms or administering treatments, (2 the occurrence of various events and the pursuit of valued outcomes regarding the child's physical health, the parent's mental health, or other attributes of the child or family, (3 operating with available resources and within certain constraints (4 over the passage of time, (5 while mentally representing or depicting the ever-changing situation and detecting possible problems and opportunities. These components interact, some with simple cause-effect relationships and others with more complex interdependencies. Conclusions The work of care affecting the health of children with special health care needs and their families can best be understood, studied, and managed as a multilevel complex system.

Health care reforms.

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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.

Transforming health care delivery through consumer engagement, health data transparency, and patient-generated health information.