WorldWideScience

Sample records for health system reforms

  1. Reforms of health care system in Romania

    NARCIS (Netherlands)

    Bara, AC; van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.

    Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of

  2. Health System Reform in the United States

    Directory of Open Access Journals (Sweden)

    John E McDonough

    2014-01-01

    Full Text Available In 2010, the United States adopted its first-ever comprehensive set of health system reforms in the Affordable Care Act (ACA. Implementation of the law, though politically contentious and controversial, has now reached a stage where reversal of most elements of the law is no longer feasible. The controversial portions of the law that expand affordable health insurance coverage to most U.S. citizens and legal residents do not offer any important lessons for the global community. The portions of the law seeking to improve the quality, effectiveness, and efficiency of medical care as delivered in the U.S., hold lessons for the global community as all nations struggle to gain greater value from the societal resources they invest in medical care for their peoples. Health reform is an ongoing process of planning, legislating, implementing, and evaluating system changes. The U.S. set of delivery system reforms has much for reformers around the globe to assess and consider.

  3. Reforming the health care system: implications for health care marketers.

    Science.gov (United States)

    Petrochuk, M A; Javalgi, R G

    1996-01-01

    Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

  4. Local innovations and reforms can help strengthen health system in ...

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

    Evidence from the IDRC-supported project Neglected issues relating to African health systems: An incentive for reform has identified local innovations and reforms as factors that are important in strengthening overall health systems in Niger. The multi-year project (2012–2017), supported by IDRC's Maternal and Child ...

  5. An American approach to health system reform.

    Science.gov (United States)

    Holahan, J; Moon, M; Welch, W P; Zuckerman, S

    1991-05-15

    In terms of the major objectives one would have for health system reform, this plan makes the following choices: 1. It would cover everyone, through Medicare (the elderly), employer-based coverage (some workers and dependents) or a state-level public program that would replace Medicaid (the poor, unemployed, and other workers and dependents). 2. There would be a standard minimum package of required benefits for employer-based and public programs, with legislative requirements on maximum cost-sharing. Choice of provider might be restricted in some states. 3. Administration of the private programs would be the responsibility, as now, of the employers and/or insurance companies. Administration of the public program would be the responsibility of the states, with the objective of maximizing responsiveness to local needs and conditions. 4. It would control costs through giving the states a substantial financial stake in ensuring that the public program costs did not grow faster than nominal GNP. State control would also allow the testing of different mechanisms for cost control, with the ultimate objective of identifying the most effective cost-containment strategies. 5. The cost would be borne by employers, employees, and taxpayers. Employers would be protected from exorbitant costs by being allowed the option of paying into a public plan rather than providing health insurance themselves. The poor and unemployed would be protected by having their coverage under the public program subsidized on a sliding scale. 6. The political feasibility test would be met by retaining a major role for insurance companies and by retaining the role of employer-based coverage--thus reducing the tax increase needed to ensure universal coverage. By allowing flexibility in design of cost-containment strategy, some of the controversy over this issue would also be deflected. Our proposal is also not without problems. First, our approach would still have adverse effects on the profitability of

  6. The Chilean health system: 20 years of reforms.

    Science.gov (United States)

    Manuel, Annick

    2002-01-01

    The Chilean health care system has been intensively reformed in the past 20 years. Reforms under the Pinochet government (1973-1990) aimed mainly at the decentralization of the system and the development of a private sector. Decentralization involved both a deconcentration process and the devolution of primary health care to municipalities. The democratic governments after 1990 chose to preserve the core organization but introduced reforms intended to correct the system's failures and to increase both efficiency and equity. The present article briefly explains the current organization of the Chilean health care system. It also reviews the different reforms introduced in the past 20 years, from the Pinochet regime to the democratic governments. Finally, a brief discussion describes the strengths and weaknesses of the system, as well as the challenges it currently faces.

  7. The necessity for a health systems reform in Nigeria

    African Journals Online (AJOL)

    The necessity for a health systems reform in Nigeria. COMMENTARY. M. C. Asuzu. Department of Community Medicine. College of Medicine, University College Hospital, Ibadan. Definition. A health system is an organizational framework for the distribution or servicing of the health care needs of a given community. It is a ...

  8. 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.

  9. 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.

  10. Learning from health system reforms: lessons from Burkina Faso.

    Science.gov (United States)

    Haddad, Slim; Nougtara, Adrien; Fournier, Pierre

    2006-12-01

    Burkina Faso has implemented a macroeconomic adjustment programme (MAP) along with an ambitious reform of the health care system. Our aim was (1) to verify whether MAPs led to a reduction in health resources, and (2) to analyze the consequences of health policies implemented. Cross-sectional and retrospective study, spanning the years 1983-2003. The macro aspect is based upon documents from national and international sources, a database of secondary socioeconomic data, and interviews of key informants working in upper management. Household and health facility surveys were conducted in three regions covering 53 communities. Within the reforms, the health sector benefited from an important flow of resources. There were significant increases in public expenditures, health care staff, the number of primary care facilities and the availability of generic drugs. However, health facilities in the public sector remain underused and major inequities subsist. Access to health care is constrained by the population's ability to pay. Health expenditures impoverish households, creating new poor and impoverishing the already poor. The success of reforms depends largely on the extent to which they remove financial barriers to access to services. The experience of Burkina Faso also reveals the need for fundamental changes that will motivate staff, improve productivity, and ensure good quality services. Integrating health development policies with strategic plans for poverty reduction can provide new opportunities for African countries to redesign their health systems within this type of perspective.

  11. [A health system's neoliberal reform: evidence from the Mexican case].

    Science.gov (United States)

    López-Arellano, Oliva; Jarillo-Soto, Edgar C

    2017-07-27

    This study addressed the shaping of Mexico's health system in recent years, with an analysis of the social determination conditioning the system's current formulation, the consequences for the population's living and working conditions, and the technical and legal reform measures that shaped the system's transformation. The article then analyzes the survival of social security institutions and the introduction of an individual insurance model and its current implications and consequences. From the perspective of the right to health, the article compares the measures, resources, and interventions in both health care models and highlights the relevance of the social security system for Popular Insurance. The article concludes that the measures implemented to reform the Mexican health system have failed to achieve the intended results; on the contrary, they have led to a reduction in interventions, rising costs, and a decrease in the installed capacity and professional personnel for the system's operation, thus falling far short of solving the problem, rather aggravating the inequities without solving the system's structural contradictions. Health systems face new challenges, inevitably requiring that the analyses be situated in a broader framework rather than merely focusing on the functional, administrative, and financial operation of the systems in the respective countries.

  12. Mount Sinai Hospital's approach to Ontario's Health System Funding Reform.

    Science.gov (United States)

    Chalk, Tyler; Lau, Davina; Morgan, Matthew; Dietrich, Sandra; Beduz, Mary Agnes; Bell, Chaim M

    2014-01-01

    In April 2012, the Ontario government introduced Health System Funding Reform (HSFR), a transformational shift in how hospitals are funded. Mount Sinai Hospital recognized that moving from global funding to a "patient-based" model would have substantial operational and clinical implications. Adjusting to the new funding environment was set as a top corporate priority, serving as the strategic basis for re-examining and redesigning operations to further improve both quality and efficiency. Two years into HSFR, this article outlines Mount Sinai Hospital's approach and highlights key lessons learned. Copyright © 2014 Longwoods Publishing.

  13. Reforming "developing" health systems: Tanzania, Mexico, and the United States.

    Science.gov (United States)

    Chernichovsky, Dov; Martinez, Gabriel; Aguilera, Nelly

    2009-01-01

    Tanzania, Mexico, and the United States are at vastly different points on the economic development scale. Yet, their health systems can be classified as "developing": they do not live up to their potential, considering the resources available to them. The three, representing many others, share a common structural deficiency: a segregated health care system that cannot achieve its basic goals, the optimal health of its people, and their possible satisfaction with the system. Segregation follows and signifies first and foremost the lack of financial integration in the system that prevents it from serving its goals through the objectives of equity, cost containment and sustainability, efficient production of care and health, and choice. The chapter contrasts the nature of the developing health care system with the common goals', objectives, and principles of the Emerging Paradigm (EP) in developed, integrated--yet decentralized--systems. In this context, the developing health care system is defined by its structural deficiencies, and reform proposals are outlined. In spite of the vast differences amongst the three countries, their health care systems share strikingly similar features. At least 50% of their total funding sources are private. The systems comprise exclusive vertically integrated, yet segregated, "silos" that handle all systemic functions. These reflect and promote wide variations in health insurance coverage and levels of benefits--substantial portions of their populations are without adequate coverage altogether; a considerable lack of income protection from medical spending; an inability to formalize and follow a coherent health policy; a lack of financial discipline that threatens sustainability and overall efficiency; inefficient production of care and health; and an dissatisfied population. These features are often promoted by the state, using tax money, and donors. The situation can be rectified by (a) "centralizing"--at any level of development

  14. Health systems research in the time of health system reform in India: a review.

    Science.gov (United States)

    Rao, Krishna D; Arora, Radhika; Ghaffar, Abdul

    2014-08-09

    Research on health systems is an important contributor to improving health system performance. Importantly, research on program and policy implementation can also create a culture of public accountability. In the last decade, significant health system reforms have been implemented in India. These include strengthening the public sector health system through the National Rural Health Mission (NRHM), and expansion of government-sponsored insurance schemes for the poor. This paper provides a situation analysis of health systems research during the reform period. We reviewed 9,477 publications between 2005 and 2013 in two online databases, PubMed and IndMED. Articles were classified according to the WHO classification of health systems building blocks. Our findings indicate the number of publications on health systems progressively increased every year from 92 in 2006 to 314 in 2012. The majority of papers were on service delivery (40%), with fewer on information (16%), medical technology and vaccines (15%), human resources (11%), governance (5%), and financing (8%). Around 70% of articles were lead by an author based in India, the majority by authors located in only four states. Several states, particularly in eastern and northeastern India, did not have a single paper published by a lead author located in a local institution. Moreover, many of these states were not the subject of a single published paper. Further, a few select institutions produced the bulk of research. Of the foreign author lead papers, 77% came from five countries (USA, UK, Canada, Australia, and Switzerland). The growth of published research during the reform period in India is a positive development. However, bulk of this research is produced in a few states and by a few select institutions Further strengthening health systems research requires attention to neglected health systems domains like human resources, financing, and governance. Importantly, research capacity needs to be strengthened in

  15. Toward a 21st-century health care system: Recommendations for health care reform

    NARCIS (Netherlands)

    K. Arrow (Kenneth); A. Auerbach (Alan); J. Bertko (John); L.P. Casalino (Lawrence Peter); F.J. Crosson (Francis); A. Enthoven (Alain); E. Falcone; R.C. Feldman; V.R. Fuchs (Victor); A.M. Garber (Alan); M.R. Gold (Marthe Rachel); D.A. Goldman; G.K. Hadfield (Gillian); M.A. Hall (Mark Ann); R.I. Horwitz (Ralph); M. Hooven; P.D. Jacobson (Peter); T.S. Jost (Timothy Stoltzfus); L.J. Kotlikoff; J. Levin (Jonathan); S. Levine (Sharon); R. Levy; K. Linscott; H.S. Luft; R. Mashal; D. McFadden (Daniel); D. Mechanic (David); D. Meltzer (David); J.P. Newhouse (Joseph); R.G. Noll (Roger); J.B. Pietzsch (Jan Benjamin); P. Pizzo (Philip); R.D. Reischauer (Robert); S. Rosenbaum (Sara); W. Sage (William); L.D. Schaeffer (Leonard Daniel); E. Sheen; B.N. Silber (Bernie Michael); J. Skinner (Jonathan Robert); S.M. Shortell (Stephen); S.O. Thier (Samuel); S. Tunis (Sean); L. Wulsin Jr.; P. Yock (Paul); G.B. Nun; S. Bryan (Stirling); O. Luxenburg (Osnat); W.P.M.M. van de Ven (Wynand); J. Cooper (Jim)

    2009-01-01

    textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a

  16. [Evaluation of health system decentralization and reform of the Social Security system in Colombia].

    Science.gov (United States)

    Jaramillo, I

    2002-01-01

    The aim of this study is to present the results of the reforms in the health sector that have taken place in Colombia since 1990. These reforms replaced the previous national health system and the so-called Bismarkian social security system. The new system has three basic characteristics: a) the public subsidies are decentralized in the municipalities and territorial departments; b) the public hospitals have been converted into state social enterprises, which has led them towards a management model, and c) the health and social security system monopoly has been abolished and a system of health subsidies has been created for the poorest citizens. This article systematically collects secondary information extracted from the most important studies evaluating the health sector reforms in Colombia. The present author participated in some of these studies. The reforms have increased financial resources, which, has led to an increase in public system staff and their salaries. The availability of hospitals' budgetary resources has increased and the social security system has become wider, including 20% of the poorest population who have benefited from subsidies on demand. Ease of access and equity in the health system have significantly improved. However, indicators of public health have fallen and health professionals are critical of a system based on mediation, which increases transaction costs.

  17. [Intercultural aspects of the health system reform in Bolivia].

    Science.gov (United States)

    Ramírez Hita, Susana

    2014-01-01

    This article is a reflection on how interculturality, understood as the way to improve the health of the Bolivian population and coupled with the concept of living well, is not contributing to improving the quality of life and health of the most vulnerable populations in the country. The discourse is coupled with the intention of saving lives in its broadest sense; however, for this it is necessary to make decisions about environmental health and extractivist policies that are not taken into account in the health issues affecting indigenous communities, a population targeted by the intercultural aspects of the health reform.

  18. Health-system reform and universal health coverage in Latin America.

    Science.gov (United States)

    Atun, Rifat; de Andrade, Luiz Odorico Monteiro; Almeida, Gisele; Cotlear, Daniel; Dmytraczenko, T; Frenz, Patricia; Garcia, Patrícia; Gómez-Dantés, Octavio; Knaul, Felicia M; Muntaner, Carles; de Paula, Juliana Braga; Rígoli, Felix; Serrate, Pastor Castell-Florit; Wagstaff, Adam

    2015-03-28

    Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens--with defined and enlarged benefits packages--and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and improving access of the most disadvantaged populations. Hence, the distinguishing features of health-system strengthening for universal health coverage and lessons from the Latin American experience are relevant for countries advancing universal health coverage. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. 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

  20. Reforms and Challenges of Post-conflict Kosovo Health System.

    Science.gov (United States)

    Mustafa, Mybera; Berisha, Merita; Lenjani, Basri

    2014-04-01

    Before its collapse, Kosovo's healthcare system was an integrated part of the Former Yugoslav Republics System (known as relatively well advanced for its time). Standstill had begun in the last decade of the twentieth century as the result of political disintegration of the former state. The enthusiasm of the healthcare professionals and the people of Kosovo that at the end of the conflict healthcare services will consolidate did not prove just right. Although we can claim that reorganization of Kosovo healthcare was a serious push (especially in the first years after the conflict), the intensity of development begun to fall at the latter stages. Although the basic legislation for the operation of the Healthcare System today in Kosovo does exist, the largest cause for the reform stagnation is where the law is not implemented properly and measures are not set as to a meaningful system of accountability. Twelve years have passed by since the 1999 war-conflict and, although, Kosovo has made progress in many other spheres, it has not yet reached to consolidate a health system comparable to those of other European countries. Intending to get out of difficult situation, several healthcare strategic plans have been developed in the past decade in Kosovo, but attempts in this direction have not been particularly fruitful. This script describes the actual Healthcare complexity of a situation in Kosovo 12 years after the end of the 1999 war-conflict. Interconnection and historical background is also looked upon and is described in the flow of events. Finally, the description of transfer competencies from international administrators to the local authorities as well as the flow of strategic planning that took place since 1999 has also been analyzed.

  1. Obesity and health system reform: private vs. public responsibility.

    Science.gov (United States)

    Yang, Y Tony; Nichols, Len M

    2011-01-01

    Obesity is a particularly vexing public health challenge, since it not only underlies much disease and health spending but also largely stems from repeated personal behavioral choices. The newly enacted comprehensive health reform law contains a number of provisions to address obesity. For example, insurance companies are required to provide coverage for preventive-health services, which include obesity screening and nutritional counseling. In addition, employers will soon be able to offer premium discounts to workers who participate in wellness programs that emphasize behavioral choices. These policies presume that government intervention to reduce obesity is necessary and justified. Some people, however, argue that individuals have a compelling interest to pursue their own health and happiness as they see fit, and therefore any government intervention in these areas is an unwarranted intrusion into privacy and one's freedom to eat, drink, and exercise as much or as little as one wants. This paper clarifies the overlapping individual, employer, and social interest in each person's health generally to avoid obesity and its myriad costs in particular. The paper also explores recent evidence on the impact of government interventions on obesity through case studies on food labeling and employer-based anti-obesity interventions. Our analysis suggests a positive role for government intervention to reduce and prevent obesity. At the same time, we discuss criteria that can be used to draw lines between government, employer, and individual responsibility for health, and to derive principles that should guide and limit government interventions on obesity as health reform's various elements (e.g., exchanges, insurance market reforms) are implemented in the coming years. © 2011 American Society of Law, Medicine & Ethics, Inc.

  2. 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

  3. Health care reforms.

    Science.gov (United States)

    Marušič, Dorjan; Prevolnik Rupel, Valentina

    2016-09-01

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

  4. Health care reforms

    Directory of Open Access Journals (Sweden)

    Marušič Dorjan

    2016-09-01

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

  5. The Malaysian health care system: Ecology, plans, and reforms

    Directory of Open Access Journals (Sweden)

    Andrea Sebastian

    2016-08-01

    Full Text Available Malaysia is on its way to achieving developed nation status in the next 4 years. Currently, Malaysia is on track for three Millennium Development Goals (MDG1, MDG4, and MDG7. The maternal mortality rate, infant mortality rate, and mortality rate of children younger than 5 years improved from 25.6% (2012 to 6.6% (2013, and 7.7% (2012 per 100,000 live births, respectively whereas immunization coverage for infants increased to an average of 90%. As of 2013 the ratio of physicians to patients improved to 1:633 while the ratio of health facilities to the population was 1:10,272. The current government administration has proposed a reform in the form of the 10th Malaysian Plan coining the term “One Care for One Malaysia” as the newly improved and reorganized health care plan, where efficiency, effectiveness, and equity are the main focus. This review illustrates Malaysia’s transition from pre-independence to the current state, and its health and socioeconomic achievement as a country. It aims to contribute knowledge through identifying the plans and reforms by the Malaysian government while highlighting the challenges faced as a nation.

  6. The Economics of Public Health: Missing Pieces to the Puzzle of Health System Reform.

    Science.gov (United States)

    Mays, Glen P; Atherly, Adam J; Zaslavsky, Alan M

    2017-12-01

    The United States continues to experiment with health care delivery and financing innovations, but relatively little attention is given to the public health system and its capacity for improving health status in the U.S. population at large. The public health system operates as a multisector enterprise in which government agencies work in conjunction with private and voluntary organizations to identify health risks in the population and to mobilize community-wide actions that prevent and contain these risks. The Affordable Care Act and related health reform initiatives are generating new interest in the question of how best to expand and integrate public health approaches into the larger U.S. health system. The research articles featured in this issue of Health Services Research cluster around two broad topics: how public health agencies can deliver services efficiently and how public health agencies can interact productively with other elements of the health system. The results suggest promising avenues for aligning medical care and public health practices. © Health Research and Educational Trust.

  7. Health system reform in rural China: voices of healthworkers and service-users.

    Science.gov (United States)

    Zhou, Xu Dong; Li, Lu; Hesketh, Therese

    2014-09-01

    Like many other countries China is undergoing major health system reforms, with the aim of providing universal health coverage, and addressing problems of low efficiency and inequity. The first phase of the reforms has focused on strengthening primary care and improving health insurance coverage and benefits. The aim of the study was to explore the impacts of these reforms on healthworkers and service-users at township level, which has been the major target of the first phase of the reforms. From January to March 2013 we interviewed eight health officials, 80 township healthworkers and 80 service-users in eight counties in Zhejiang and Yunnan provinces, representing rich and poor provinces respectively. Thematic analysis identified key themes around the impacts of the health reforms. We found that some elements of the reforms may actually be undermining primary care. While the new health insurance system was popular among service-users, it was criticised for contributing to fast-growing medical costs, and for an imbalance of benefits between outpatient and inpatient services. Salary reform has guaranteed healthworkers' income, but greatly reduced their incentives. The essential drug list removed perverse incentives to overprescribe, but led to falls in income for healthworkers, and loss of autonomy for doctors. Serious problems with drug procurement also emerged. The unintended consequences have included a brain drain of experienced healthworkers from township hospitals, and patients have flowed to county hospitals at greater cost. In conclusion, in the short term resources must be found to ensure rural healthworkers feel appropriately remunerated and have more clinical autonomy, measures for containment of the medical costs must be taken, and drug procurement must show increased transparency and accountability. More importantly the study shows that all countries undergoing health reforms should elicit the views of stakeholders, including service-users, to avoid

  8. Human resources for health challenges of public health system reform in Georgia

    Directory of Open Access Journals (Sweden)

    Mataradze George

    2008-05-01

    Full Text Available Abstract Background Human resources (HR are one of the most important components determining performance of public health system. The aim of this study was to assess adequacy of HR of local public health agencies to meet the needs emerging from health care reforms in Georgia. Methods We used the Human Resources for Health Action Framework, which includes six components: HR management, policy, finance, education, partnerships and leadership. The study employed: (a quantitative methods: from September to November 2004, 30 randomly selected district Centers of Public Health (CPH were surveyed through face-to-face interviews with the CPH director and one public health worker randomly selected from all professional staff; and (b qualitative methods: in November 2004, Focus Group Discussions (FGD were held among 3 groups: a 12 district public health professionals, b 11 directors of district public health centers, and c 10 policy makers at central level. Results There was an unequal distribution of public health workers across selected institutions, with lack of professionals in remote rural district centers and overstaffing in urban centers. Survey respondents disagreed or were uncertain that public health workers possess adequate skills and knowledge necessary for delivery of public health programs. FGDs shed additional light on the survey findings that there is no clear vision and plans on HR development. Limited budget, poor planning, and ignorance from the local government were mentioned as main reasons for inadequate staffing. FGD participants were concerned with lack of good training institutions and training programs, lack of adequate legislation for HR issues, and lack of necessary resources for HR development from the government. Conclusion After ten years of public health system reforms in Georgia, the public health workforce still has major problems such as irrational distribution and inadequate knowledge and skills. There is an urgent need

  9. Human resources for health challenges of public health system reform in Georgia.

    Science.gov (United States)

    Djibuti, Mamuka; Gotsadze, George; Mataradze, George; Menabde, George

    2008-05-27

    Human resources (HR) are one of the most important components determining performance of public health system. The aim of this study was to assess adequacy of HR of local public health agencies to meet the needs emerging from health care reforms in Georgia. We used the Human Resources for Health Action Framework, which includes six components: HR management, policy, finance, education, partnerships and leadership. The study employed: (a) quantitative methods: from September to November 2004, 30 randomly selected district Centers of Public Health (CPH) were surveyed through face-to-face interviews with the CPH director and one public health worker randomly selected from all professional staff; and (b) qualitative methods: in November 2004, Focus Group Discussions (FGD) were held among 3 groups: a) 12 district public health professionals, b) 11 directors of district public health centers, and c) 10 policy makers at central level. There was an unequal distribution of public health workers across selected institutions, with lack of professionals in remote rural district centers and overstaffing in urban centers. Survey respondents disagreed or were uncertain that public health workers possess adequate skills and knowledge necessary for delivery of public health programs. FGDs shed additional light on the survey findings that there is no clear vision and plans on HR development. Limited budget, poor planning, and ignorance from the local government were mentioned as main reasons for inadequate staffing. FGD participants were concerned with lack of good training institutions and training programs, lack of adequate legislation for HR issues, and lack of necessary resources for HR development from the government. After ten years of public health system reforms in Georgia, the public health workforce still has major problems such as irrational distribution and inadequate knowledge and skills. There is an urgent need for re-training and training programs and development of

  10. 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.

  11. (Re)form with Substance? Restructuring and governance in the Australian health system 2004/05

    OpenAIRE

    Rix, Mark; Owen, Alan; Eagar, Kathy

    2005-01-01

    The Australian health system has been the subject of multiple reviews and reorganisations over the last twenty years or more. The year 2004–2005 was no different. This paper reviews the reforms, (re)structures and governance arrangements in place at both the national and state/territory levels in the last year. At the national level some progress has been made in 2004/05 through the Australian Health Ministers' Council and there is now a national health reform agenda, albeit not a comprehensi...

  12. The link between UHC reforms and health system governance: lessons from Asia.

    Science.gov (United States)

    Hort, Krishna; Jayasuriya, Rohan; Dayal, Prarthna

    2017-05-15

    Purpose The purpose of this paper is to examine how and to what extent the design and implementation of universal health coverage (UHC) reforms have been influenced by the governance arrangements of health systems in low- and middle-income countries (LMIC); and how governments in these countries have or have not responded to the challenges of governance for UHC. Design/methodology/approach Comparative case study analysis of three Asian countries with substantial experience of UHC reforms (Thailand, Vietnam and China) was undertaken using data from published studies and grey literature. Studies included were those which described the modifications and adaptations that occurred during design and implementation of the UHC programme, the actors and institutions involved and how these changes related to the governance of the health system. Findings Each country adapted the design of their UHC programmes to accommodate their specific institutional arrangements, and then made further modifications in response to issues arising during implementation. The authors found that these modifications were often related to the impacts on governance of the institutional changes inherent in UHC reforms. Governments varied in their response to these governance impacts, with Thailand prepared to adopt new governance modes (which the authors termed as an "adaptive" response), while China and Vietnam have tended to persist with traditional hierarchical governance modes ("reactive" responses). Originality/value This study addresses a gap in current knowledge on UHC reform, and finds evidence of a complex interaction between substantive health sector reform and governance reform in the LMIC context in Asia, confirming recent similar observations on health reforms in high-income countries.

  13. (Re)form with substance? Restructuring and governance in the Australian health system 2004/05.

    Science.gov (United States)

    Rix, Mark; Owen, Alan; Eagar, Kathy

    2005-08-24

    The Australian health system has been the subject of multiple reviews and reorganisations over the last twenty years or more. The year 2004-2005 was no different. This paper reviews the reforms, (re)structures and governance arrangements in place at both the national and state/territory levels in the last year. At the national level some progress has been made in 2004/05 through the Australian Health Ministers' Council and there is now a national health reform agenda, albeit not a comprehensive one, endorsed by the Council of Australian Governments (COAG) in June 2005. Quality and safety was an increasing focus in 2004-2005 at both the national and jurisdictional levels, as was the need for workforce reform. Although renewed policy attention was given to the need to better integrate and coordinate health care, there is little evidence of any real progress this last year. More progress was made on a national approach to workforce reform. At the jurisdictional level, the usual rounds of reviews and restructuring occurred in several jurisdictions and, in 2005, they are organisationally very different from each other. The structure and effectiveness of jurisdictional health authorities are now more important. All health authorities are being expected to drive an ambitious set of national and local reforms. At the same time, most have now blurred the boundary between policy and service delivery and are devoting significant resources to centrally 'crisis managing' their service systems. These same reasons led to decentralisation in previous restructuring cycles. While there were many changes in 2004-2005, and a new national report to COAG on health reform is expected at the end of 2005, based on current evidence there is little room for optimism about the prospects for real progress.

  14. The Australian health care system: reform, repair or replace?

    Science.gov (United States)

    Duckett, Stephen J

    2008-05-01

    A Festshrift gives us the opportunity to look both backwards and forwards. Ken Donald's career stretches back to his intern days in 1963 and has encompassed clinical and population health, academe, clinical settings and the bureaucracy, and playing sport at state and national levels. There has been considerable change in the health care system over the period of Ken's involvement in the sector with more change to come -- where have those changes left us? This paper discusses these changes in relation to performance criteria.

  15. Reforming America's health system through innovation and entrepreneurship.

    Science.gov (United States)

    Reece, Richard L

    2005-01-01

    America's attempts for healthcare reform are gridlocked. Healthcare special interests are reluctant to abandon profitable activities, and American culture-distrust of centralized federal power, belief in self-improvement, desire for choice, and belief in equal access to medical technologies-is slow to change. Physician entrepreneurship and innovation, coupled with consumer-driven healthcare and public-private partnerships, may break the present gridlock.

  16. 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

  17. Academic health centers and health care reform.

    Science.gov (United States)

    Miles, S H; Lurie, N; Fisher, E S; Haugen, D

    1993-09-01

    There is increasing support for the proposition that academic health centers have a duty to accept broad responsibility for the health of their communities. The Health of the Public program has proposed that centers become directly involved in the social-political process as advocates for reform of the health care system. Such engagement raises important issues about the roles and responsibilities of centers and their faculties. To address these issues, the authors draw upon the available literature and their experiences in recent health care reform efforts in Minnesota and Vermont in which academic health center faculty participated. The authors discuss (1) the problematic balance between academic objectivity and social advocacy that faculty must attempt when they engage in the health care reform process; (2) the management of the sometimes divergent interests of academic health centers, some of their faculty, and society (including giving faculty permission to engage in reform efforts and developing a tacit understanding that distinguishes faculty positions on reform issues from the center's position on such issues); and (3) the challenge for centers to develop infrastructure support for health reform activities. The authors maintain that academic health centers' participation in the process of health care reform helps them fulfill the trust of the public that they are obligated to and ultimately depend on.

  18. Development prospects of health and reform of the fiscal system in bosnia and herzegovina.

    Science.gov (United States)

    Salihbasic, Sehzada

    2011-01-01

    The functions of the health system, according to the key objectives and relationships within the sub-systems that are available to the policy makers and managers in the Health Care system in Bosnia and Herzegovina - B&H, have been elaborated in detail, with the analytical overview of relevant indicators, thus confirming the limitations of the health promotion in B&H. The ability to overcome the expressed problems is in the startup of process for structural adjustment of the health sector, reform of the health care system and its financing. The reform in health system implies fundamental changes that need to take place, in B&H, as a state in health policy and institutions in the health care system, in order to improve the functioning of health systems with the aim of ensuring better health of the population. Reform implies the existence of documents with clearly formulated health policy objectives, for which the state stands, and for which a consensus was reached on the national level with all key actors in the political structure: public promotion of the basic principles for carrying out the reform, its implementation within a reasonable time frame, the corresponding effects for providers and customer satisfaction, as well as improving health services' efficacy (i.e. micro and macro) and the quality of healthcare. In this article, we elaborated the criteria for the classification of health systems, whereby the scientifically-based and empirical analysis is conducted on the health system in B&H and elaborated the key levers of the system. Leveraged organizational arrangements relating to the economic and political environment, organization and management functions, in connection with the services of finance, funds, customers and service providers, from which it follows the framework of state legislation related to health policy and health institutions at the state level are responsible for finance, planning, the organization, payment, regulation and conduct. If we

  19. [Knowledge and evaluation of health-system reforms as reflected in social determinants].

    Science.gov (United States)

    Schnitzer, S; Kuhlmey, A; Balke, K; Litschel, A; Walter, A; Schenk, L

    2011-03-01

    Significant reforms have been instituted in Germany's health system in recent years. Although a number of studies have examined the population's knowledge of and attitudes towards the new regulations, little information is available on status-specific differences. This article examines the extent to which knowledge and evaluation of health policy measures is influenced by social determinants. The analysis draws on a survey conducted by the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, 2009) based on a sample representative of the German population. In this context, 2 032 respondents aged between 18 and 79 years were interviewed on health-care policy issues. Results of bivariate analysis and logistic regression show that knowledge of the reform measures is significantly associated with educational level, age, and nationality. For example, respondents with the lowest level of formal education have an approximately four times higher risk as those with a higher level of formal education of not knowing about the health fund, and non-Germans have around twice the risk as Germans of not knowing about the reform measures. The main difference to emerge in respondents' EVALUATION of the reform measures is between East and West Germans. West Germans are significantly more likely than East Germans to evaluate the reform measures in negative terms. These status-specific differences in respondent knowledge can be attributed at least to some extent to the information asymmetry between patients and physicians/health-care providers. There is an urgent need for policy makers and care providers to render the reform measures transparent, accessible and comprehensible - especially to disadvantaged groups - to facilitate their effective implementation and positive evaluation. © Georg Thieme Verlag KG Stuttgart · New York.

  20. [Democracy without equity: analysis of health reform and nineteen years of National Health System in Brazil].

    Science.gov (United States)

    Coelho, Ivan Batista

    2010-01-01

    This paper aims to evaluate the nineteen years of the National Health System in Brazil, under the prism of equity. It takes into account the current political context in Brazil in the 80s, that the democratization of the country and the health sector could, per se, lead to a more equitable situation regarding the access to health services. Democracy and equity concepts are here discussed; analyzing which situations may facilitate or make it difficult its association in a theoretical plan, applying them to the Brazilian context in a more general form and, to emphasizing practical implications to the National Health System and to groups of activism related to health reforms. It also seeks to show the limits and possibilities of these groups with regards to the reduction of inequality, in relation to the access to health services, which still remain. To conclude, the author points out the need for other movements to be established which seek the reduction of such and other inequalities, such as access to education, housing, etc, drawing special attention to the role played by the State, which is questioned regarding its incapacity of promoting equity, once it presents itself as being powerful when approaching other matters.

  1. Encouraging participation in health system reform: is clinical engagement a useful concept for policy and management?

    Science.gov (United States)

    Bonias, Dimitra; Leggat, Sandra G; Bartram, Timothy

    2012-11-01

    Recent health system enquiries and commissions, including the National Health and Hospital Reform Commission, have promoted clinical engagement as necessary for improving the Australian healthcare system. In fact, the Rudd Government identified clinician engagement as important for the success of the planned health system reform. Yet there is uncertainty about how clinical engagement is understood in health policy and management. This paper aims to clarify how clinical engagement is defined, measured and how it might be achieved in policy and management in Australia. We review the literature and consider clinical engagement in relation to employee engagement, a defined construct within the management literature. We consider the structure and employment relationships of the public health sector in assessing the relevance of this literature. Based on the evidence, we argue that clinical engagement is similar to employee engagement, but that engagement of clinicians who are employees requires a different construct to engagement of clinicians who are independent practitioners. The development of this second construct is illustrated using the case of Visiting Medical Officers in Victoria. Antecedent organisational and system conditions to clinical engagement appear to be lacking in the Australian public health system, suggesting meaningful engagement will be difficult to achieve in the short-term. This has the potential to threaten proposed reforms of the Australian healthcare system.

  2. Qualitative analysis of governance trends after health system reforms in Latin America: lessons from Mexico.

    Science.gov (United States)

    Arredondo, A; Orozco, E; Recaman, A L

    2018-03-01

    Health policies in Latin America are centered on the democratization of health. Since 2003, during the last generation of reforms, health systems in this region have promoted governance strategies for better agreements between governments, institutions, and civil society. In this context, we develop an evaluative research to identify trends and evidence of governance after health care reforms in six regions of Mexico. Evaluative research was developed with a retrospective design based on qualitative analysis. Primary data were obtained from 189 semi-structured interviews with purposively selected health care professionals and key informants. Secondary data were extracted from a selection of 95 official documents on results of the reform project at the national level, national health policies, and lines of action for good governance. Data processing and analysis were performed using ATLAS.ti and PolicyMaker. A list of main strengths and weaknesses is presented as evidence of health system governance. Accountability at the federal level remains prescriptive; in the regions, a system of accountability and transparency in the allocation of resources and in terms of health democratization strategies is still absent. Social protection and decentralization schemes are strategies that have allowed for improvements with a proactive role of users and civil society. Regarding challenges, there are still low levels of governance and difficulties in the effective conduct of programs and reform strategies together with a lack of precision in the rules and roles of the different actors of the health system. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  3. [The reformation of the public health system in Russia in the conditions of globalization].

    Science.gov (United States)

    Mikhaĭlova, Iu V; Matinian, N S

    2009-01-01

    Actually, the public health system in Russia has a task to develop an effective model of national health care congruent to new global local conditions. The issues of alteration of the role of state and market in the medical services provision sector, the decentralization processes, the increase of possibilities to make use of health services, the overall revision of the role of public health system are to be considered to make possible the assessment of needs in medical services and the proper functioning of corresponding public health services. These requirements are conditioned by the changes in the globalized world and the course of reforms within the country.

  4. Lebanon: mental health system reform and the Syrian crisis

    Science.gov (United States)

    Karam, Elie; Richa, Sami; Naja, Wadih; Fayyad, John; Ammar, Walid

    2016-01-01

    The Lebanese Ministry of Public Health has launched a National Mental Health Programme, which in turn has established the Mental Health and Substance Use Strategy for Lebanon 2015–2020. In parallel, research involving refugees has been conducted since the onset of the Syrian crisis. The findings point to an increase in mental health disorders in the Syrian refugee population, which now numbers more than 1 million. PMID:29093915

  5. Health Care Reform: A Values Debate.

    Science.gov (United States)

    Popko, Kathleen

    1992-01-01

    Addresses the crisis in health care, considering costs, lack of access, and system ineffectiveness. Reviews "Setting Relationships Right," the Catholic Health Association's proposal for health care reform. Advocates educators' awareness of children's health needs and health care reform issues and support for the Every Fifth Child Act of…

  6. 'Doi moi' and health: the effect of economic reforms on the health system in Vietnam.

    Science.gov (United States)

    Witter, S

    1996-01-01

    The article examines changes which have taken place in the health system in Vietnam as a result of the economic reform process dating back to the late 1980s. With the liberalization of the economy have come not only growth for many, and increased choice, but also increased income and regional disparities and the problem of access to social services for those households which are less successful in the market economy. While state official policy emphasizes equity and free access to services for the poor, health costs for patients have risen substantially in the form of official and unofficial payments to staff and payments for drugs. The public sector faces an unprecedented challenge in the form of dramatic decreases in the utilization of public facilities; a shift towards self-prescription and, to a lesser extent, private practice by public employees; and, increasing reliance on foreign donors for support to preventive programmes. The article makes some recommendations on priorities for health policy in Vietnam to face these challenges.

  7. Local innovations and reforms can help strengthen health system in ...

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

    2017-03-30

    Mar 30, 2017 ... ... she is examining the interactions and relations between health workers providing post-abortion care and women who have sought abortions with the drug Misoprostol. Given the high rate of self-induced abortions in the country, her findings will be an important contribution to improving policy and practice.

  8. Health insurance system and provider payment reform in the Republic of Macedonia

    Directory of Open Access Journals (Sweden)

    Doncho M. Donev

    2009-03-01

    Full Text Available This article gives an insight to the current health insurance system in the Republic of Macedonia. Special emphasis is given to the specificities and practice of both obligatory and voluntary health insurance, to the scope of the insured persons and their benefits and obligations, the way of calculating and payment of the contributions and the other sources of revenues for health insurance, user participation in health care expenses, payment to the health care providers and some other aspects of realization of health insurance in practice. According to the Health Insurance Law, which was adopted in March 2000, a person can become an insured to the Health Insurance Fund on various modalities. More than 90% of the citizens are eligible to the obligatory health insurance, which provides a broad scope of basic health care benefits. Till end of 2008 payroll contributions were equal to 9.2%, and from January 1st, 2009 are equal to 7.5% of gross earned wages and almost 60% of health sector revenues are derived from them. Within the autonomy and scope of activities of the Health Insurance Fund the structures of the revenues and expenditures are presented. Health financing and reform of the payment to health care providers are of high importance within the ongoing health care reform in Macedonia. It is expected that the newly introduced methods of payments at the primary health care level (capitation and at the hospital sector (global budgeting, DRGs will lead to increased equity, efficiency and quality of health care in hospitals and overall system

  9. [Theory and practice of the health systems reforms: the cases of Brazil and Mexico].

    Science.gov (United States)

    Abrantes Pego, Raquel; Almeida, Celia

    2002-01-01

    This study focuses on the role of public health experts in the contemporary health sector reform process. The authors discuss the issue based on the case of Brazil and Mexico, where a group of public health specialists have oriented their participation to influence the conflict concerning health policy reform in the respective countries. One approach has been to develop a new cognitive framework for technical health sector reform projects viewed as policy proposals with technical content. The purpose is to demonstrate how these specialists have managed to influence the national debate over health sector reform when the technical and scientific discussion leaves the academic sphere and reaches the social and political realm. The authors contend that this occurs because such technical and scientific knowledge has been postulated (independently of its intrinsic value) as a political and ideological alternative platform for sustaining a health sector reform proposal which, once transformed into a policy project, has served to aggregate certain political and social forces.

  10. The impact of health system reform plan on the hospital\\'s performance indicators of Lorestan University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Reza Dadgar

    2017-10-01

    Conclusion: The health system  reform plan has been positive changes in indicators of hospital performance. Therefore, while considering the current trend of continuous improvement, the continuity of the project was advised based on the results of this study.

  11. 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

  12. National health care reform and a single-payer system: messiah or pariah?

    Science.gov (United States)

    Norato, J F

    1997-01-01

    U.S. health care spending consumed about 14% of the GDP in 1992 and current trends threaten to boost this figure to 18% by the year 2000 (CBO, 1992). Our health care delivery system needs an overhaul but there is evidently little consensus on what format a new system should follow. Persuasive befuddling, and frequently contradictory, suggestions have ranged from the federal government's active involvement in a single-payer national health care plan to enactment of a nationwide mandate compelling (taxing?) employers to provide a minimum health benefit package to all workers. There were two common objectives shared by the major, recently contending health care reform proposals: first, to provide universal access to health care with assurances that coverage is maintained when economic circumstances change or when someone experiences poor health; second, to stunt the growth rate of health care spending nationally. Single-payer alternatives, previously introduced by Congressman McDermott and others, would have required a heavy federal subsidy, regulation, and blocking directing each state to establish and administer a health care system covering its entire population. Currently, the single-payer system has become a fading contender in a dissolving list of health care reform options that previously included a new, widely publicized option embracing managed care and so-called "managed competition." Most recently, however, the single-payer proposals have apparently gone nowhere, seriously sustaining sound political defeat. Divergent views of proponents and detractors of a single-payer plan, its funding and operation, are presented. It has become extremely difficult to get Congress to advance any particular proposal because of dire, unsubstantiated socioeconomic impact hypothesizing and the unrestrained politicizing of the health policy formulation process. On February 10th, 1994, the prestigious American College of Surgeons literally stunned the national health care

  13. How to do better health reform: a snapshot of change and improvement initiatives in the health systems of 30 countries.

    Science.gov (United States)

    Braithwaite, Jeffrey; Matsuyama, Yukihiro; Mannion, Russell; Johnson, Julie; Bates, David W; Hughes, Cliff

    2016-12-01

    Health systems are continually being reformed. Why, and how? To answer these questions, we draw on a book we recently contributed, Healthcare Reform, Quality and Safety: Perspectives, Participants, Partnerships and Prospects in 30 Countries. We analyse the impact that these health-reform initiatives have had on the quality and safety of care in an international context-that is, in low-, middle- and high-income countries-Argentina, Australia, Brazil, Chile, China, Denmark, England, Ghana, Germany, the Gulf states, Hong Kong, India, Indonesia, Israel, Italy, Japan, Mexico, Myanmar, New Zealand, Norway, Oman, Papua New Guinea (PNG), South Africa, the USA, Scotland and Sweden. Popular reforms in less well-off countries include boosting equity, providing infrastructure, and reducing mortality and morbidity in maternal and child health. In countries with higher GDP per capita, the focus is on new IT systems or trialling innovative funding models. Wealthy or less wealthy, countries are embracing ways to enhance quality of care and keep patients safe, via mechanisms such as accreditation, clinical guidelines and hand hygiene campaigns. Two timely reminders are that, first, a population's health is not determined solely by the acute system, but is a product of inter-sectoral effort-that is, measures to alleviate poverty and provide good housing, education, nutrition, running water and sanitation across the population. Second, all reformers and advocates of better-quality of care should include well-designed evaluation in their initiatives. Too often, improvement is assumed, not measured. That is perhaps the key message. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care.

  14. Prospects for Health Care Reform.

    Science.gov (United States)

    Kastner, Theodore

    1992-01-01

    This editorial reviews areas of health care reform including managed health care, diagnosis-related groups, and the Resource-Based Relative Value Scale for physician services. Relevance of such reforms to people with developmental disabilities is considered. Much needed insurance reform is not thought to be likely, however. (DB)

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

    Directory of Open Access Journals (Sweden)

    Tania Herrera Martínez

    2014-05-01

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

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

    Science.gov (United States)

    Herrera, Tania

    2014-05-28

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

  17. Service Providers’ Experiences and Perspectives on Recovery-Oriented Mental Health System Reform

    Science.gov (United States)

    Piat, Myra; Lal, Shalini

    2016-01-01

    Objective With the use of a qualitative approach, this study focuses on service providers’ experiences and perspectives on recovery-oriented reform. Methods Nine focus groups were conducted with a sample of 68 service providers recruited from three Canadian sites. Results Three major themes were identified: 1) positive attitudes towards recovery-oriented reform; 2) skepticism towards recovery-oriented reform; and 3) challenges associated with implementing recovery-oriented practice. These challenges pertained to conceptual uncertainty and consistency around the meanings of recovery; application of recovery-oriented practice with certain populations and in certain contexts; bureaucratization of recovery-oriented tools; limited leadership support; and, societal stigma and social exclusion of persons with mental illnesses. Conclusions and Implications for Practice The findings point towards challenges that might arise as system planners move ahead in their efforts toward implementing recovery within the mental health system. In this regard, we offer several recommendations for the planning of organizational and educational practices that support the implementation of recovery-oriented practice. PMID:22491368

  18. Health system reform in peri-urban communities: an exploratory study of policy strategies towards healthcare worker reform in Epworth, Zimbabwe

    Directory of Open Access Journals (Sweden)

    Bernard Hope Taderera

    2016-12-01

    Full Text Available Background: Human resources for health (HRH remains a critical challenge, according to the Kampala Declaration and Agenda for Global Action of 2008 and the 2030 Sustainable Development Agenda. Available literature on health system reforms does not provide a detailed narrative on strategies that have been used to reform HRH challenges in peri-urban communities. This study explores such strategies implemented in Epworth, Zimbabwe, during 2009–2014, and the implications these strategies might have on other peri-urban areas. Design: Qualitative and quantitative methods were used in an exploratory and cross-sectional design. Purposive sampling was used to select key informants, a sample of healthcare workers that participated in in-depth interviews and community members who took part in focus group discussions. Secondary data were collected through a documentary search. Qualitative data were analysed through thematic analysis. Quantitative secondary data were examined using descriptive statistics and then compared with qualitative data to reinforce analysis. Results: The HRH reform policy strategies that were identified included ministerial intervention; policy review; and revival of the human resource for health planning, financial planning, multi-sector collaboration, and community engagement. These had some positive effects; however, desired outcomes were undermined by financial, material, human resource, and social constraints. Conclusions: Despite constraints, the strategies helped revive the health delivery system in Epworth. In turn, this had a favourable outlook on post-2008 efforts by the Global Health Alliance towards healthcare worker reform and the 2030 Sustainable Development Agenda in peri-urban communities.

  19. Women's health and behavioral health issues in health care reform.

    Science.gov (United States)

    Chin, Jean Lau; Yee, Barbara W K; Banks, Martha E

    2014-01-01

    As health care reform promises to change the landscape of health care delivery, its potential impact on women's health looms large. Whereas health and mental health systems have historically been fragmented, the Affordable Care Act (ACA) mandates integrated health care as the strategy for reform. Current systems fragment women's health not only in their primary care, mental health, obstetrical, and gynecological needs, but also in their roles as the primary caregivers for parents, spouses, and children. Changes in reimbursement, and in restructuring financing and care coordination systems through accountable care organizations and medical homes, will potentially improve women's health care.

  20. 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.

  1. 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

  2. HIPAA and the military health system: organizing technological and organizational reform in large enterprises

    Science.gov (United States)

    Collmann, Jeff R.

    2001-08-01

    The global scale, multiple units, diverse operating scenarios and complex authority structure of the Department of Defense Military Health System (MHS) create social boundaries that tend to reduce communication and collaboration about data security. Under auspices of the Defense Health Information Assurance Program (DHIAP), the Telemedicine and Advanced Technology Research Center (TATRC) is contributing to the MHS's efforts to prepare for and comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 through organizational and technological innovations that bridge such boundaries. Building interdisciplinary (clinical, administrative and information technology) medical information security readiness teams (MISRT) at each military treatment facility (MTF) constitutes the heart of this process. DHIAP is equipping and training MISRTs to use new tools including 'OCTAVE', a self-directed risk assessment instrument and 'RIMR', a web-enabled Risk Information Management Resource. DHIAP sponsors an interdisciplinary, triservice workgroup for review and revision of relevant DoD and service policies and participates in formal DoD health information assurance activities. These activities help promote a community of proponents across the MHS supportive of improved health information assurance. The MHS HIPAA-compliance effort teaches important general lessons about organizational reform in large civilian or military enterprises.

  3. Reframing the debate over health care reform: the role of system performance and affordability.

    Science.gov (United States)

    Thorpe, Kenneth E

    2007-01-01

    The failure to pass comprehensive national health care reform requires a new approach for framing and structuring the debate. Since 85 percent of Americans have health insurance, framing the debate around the affordability of coverage is important. More important is understanding the factors responsible for driving growth in spending, and crafting effective interventions. Our work shows that much of the rise in spending is linked to the rise in the prevalence of treated disease--much of which is preventable. Reform strategies that address this issue are not inherently partisan and may prove to be a fruitful starting point for launching the debate.

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

    NARCIS (Netherlands)

    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

  5. The new architects of health care reform.

    Science.gov (United States)

    Schaeffer, Leonard D

    2007-01-01

    Rising health care costs have been an issue for decades, yet federal-level health care reform hasn't happened. Support for reform, however, has changed. Purchasers fear that health care cost growth is becoming unaffordable. Research on costs and quality is questioning value. International comparisons rank the United States low on important health system performance measures. Yet it is not these factors but the unsustainable costs of Medicare and Medicaid that will narrow the window for health care stakeholders to shape policy. Unless the health care system is effectively reformed, sometime after the 2008 election, budget hawks and national security experts will eventually combine forces to cut health spending, ultimately determining health policy for the nation.

  6. The impact of health system reform plan on the hospital\\'s performance indicators of Lorestan University of Medical Sciences

    OpenAIRE

    Reza Dadgar; Mohamad Jahani; GHahreman Mahmoudi

    2017-01-01

    Background : Health systems in order to confirmity with changing conditions and responding to community needs, community needs to change and continuous improvement of their structure,  function, and subsequent evaluationindicators. Therefore the purpose of this study was to evaluate effect of health system reform plan on performance indicators. Materials and Methods : This study was a cross-sectional descriptive study using data from the years 1392 to 1394, the years before and after ...

  7. Health system reform in the Czech Republic. Policy lessons from the initial experience of the general health insurance company.

    Science.gov (United States)

    Massaro, T A; Nemec, J; Kalman, I

    1994-06-15

    The Czech Republic is among the most aggressive of the former Warsaw Pact countries in encouraging competition and free-market reform. This aggressiveness was extended into the health care sector when, in 1992, a mandatory employment-based health insurance system was introduced. The move from a controlled socialist structure to an insurance-based, fee-for-service model occurred in a short time. Health care spending increased 50% in 2 years and now approaches that of many industrialized nations. Claims for reimbursements are increasing at a rate of 5% to 7% per quarter. Market incentives have changed behaviors within the medical community. Newly privatized physicians generate greater volume and consume more resources than those continuing as state employees. Policy issues requiring further evaluation include supply, distribution, and relative valuation of physician services; clinical resource allocation; and cost containment.

  8. Academic Health Centers and Health Care Reform.

    Science.gov (United States)

    Miles, Stephen H.; And Others

    1993-01-01

    A discussion of the role of academic health centers in health care reform efforts looks at the following issues: balancing academic objectivity and social advocacy; managing sometimes divergent interests of centers, faculty, and society; and the challenge to develop infrastructure support for reform. Academic health centers' participation in…

  9. Health Care Reform: Recommendations and Analysis.

    Science.gov (United States)

    Lewit, Eugene M.; And Others

    1993-01-01

    Health care reform needs to assure coverage to all children regardless of income level or illnesses; address benefits, financing, administration, and delivery systems; provide substantial subsidies to low-income families; be equitable for all people; provide better monitoring of child health; protect and strengthen health providers who assist…

  10. [PUBLIC ADMINISTRATION OF PERSONNEL POLICY IN REFORMING OF UKRAINIAN HEALTH CARE SYSTEM USING THE EXAMPLE OF DERMATOVENEREOLOGICAL SERVICE].

    Science.gov (United States)

    Korolenko, V V; Dykun, O P; Isayenko, R M; Remennyk, O I; Avramenko, T P; Stepanenko, V I; Petrova, K I; Volosovets, O P; Lazoryshynets, V V

    2014-01-01

    The health care system, its modernization and optimization are among the most important functions of the modern Ukrainian state. The main goal of the reforms in the field of healthcare is to improve the health of the population, equal and fair access for all to health services of adequate quality. Important place in the health sector reform belongs to optimizing the structure and function of dermatovenereological service. The aim of this work is to address the issue of human resources management of dermatovenereological services during health sector reform in Ukraine, taking into account the real possibility of disengagement dermatovenereological providing care between providers of primary medical care level (general practitioners) and providers of secondary (specialized) and tertiary (high-specialized) medical care (dermatovenerologists and pediatrician dermatovenerologists), and coordinating interaction between these levels. During research has been found, that the major problems of human resources of dermatovenereological service are insufficient staffing and provision of health-care providers;,growth in the number of health workers of retirement age; sectoral and regional disparity of staffing; the problem of improving the skills of medical personnel; regulatory support personnel policy areas and create incentives for staff motivation; problems of rational use of human resources for health care; problems of personnel training for dermatovenereological service. Currently reforming health sector should primarily serve the needs of the population in a fairly effective medical care at all levels, to ensure that there must be sufficient qualitatively trained and motivated health workers. To achieve this goal directed overall work of the Ministry of Health of Uktaine, the National Academy of Medical Sciences of Ukraine, medical universities, regional health authorities, professional medical associations. Therefore Ukrainian dermatovenereological care, in particular

  11. Health Care Reform and the Academic Health Center.

    Science.gov (United States)

    Kimmey, James R.

    1994-01-01

    A discussion of the implications of health care reform for academic health centers (a complex of institutions which educate health professionals) looks at problems in the current system, the role of academic health centers in the current system, financial pressures, revenue sources other than patient care, impact on health research, and human…

  12. Health Reforms and Public Health in Georgia

    Directory of Open Access Journals (Sweden)

    Raminashvili, D.

    2012-07-01

    Full Text Available BACKGROUND: Starting from 90‘th, the Government of Georgia (GoG made several attempts to transform Georgian health care system into one with improved efficiency, accessibility, and quality services. Mandatory social health insurance which was introduced in the 1990s was abolished and private health insurance has been promoted as its replacement. The main principle of health care reform since 2006 was the transition towards complete marketization of the health care sector: private provision, private purchasing, liberal regulation, and minimum supervision.This paper aims to analyze an impact of ongoing reforms on public health and population health status.MATERIALS AND METHODS: A systematic review of the available literature was conducted through national and international organization reports; key informant interviews were conducted with major stakeholders. RESULTS: The country has attained critical achievements in relation to improved maternal and child health, national responses to HIV, TB and Malaria. Life expectancy has increased from 70.3 years in 1995 to 75.1 years in 2010. Under-5 mortality indicator has improved from 45.3 to 16.4 per 1000 live birth in 2005-2010 meaning a 64% decrease. However, Georgia is still facing a number of critical challenges securing better health for the population. Cardiovascular diseases are by far the largest cause of mortality, respiratory diseases are the leading cause of morbidity and have doubled during last decade. Georgia has one of the highest rates of male smoking in the world (over 50%.CONCLUSION: Governmental efforts in health promotion and disease prevention can have significant impact on health status by preventing chronic diseases and detecting health problems at a treatable stage. Government should consider increasing funding for public health and prevention programmes with the focus on prevention of the main risk factors affecting the population’s health: tobacco and drug use and unsafe

  13. The impact of primary care reform on health system performance in Canada: a systematic review.

    Science.gov (United States)

    Carter, Renee; Riverin, Bruno; Levesque, Jean-Frédéric; Gariepy, Geneviève; Quesnel-Vallée, Amélie

    2016-07-30

    We aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity. We searched the Embase, PubMed and Web of Science databases for records from 2000 to September 2015. We based our risk of bias assessment on the Grading of Recommendations Assessment, Development and Evaluation guidelines. Full-text studies were synthesized and organized according to the three outcome categories: health service utilization, processes of care, and physician costs and productivity. We found moderate quality evidence that team-based models of care led to reductions in emergency department use, but the evidence was mixed for hospital admissions. We also found low quality evidence that team-based models, blended capitation models and pay-for-performance incentives led to small and sometimes non-significant improvements in processes of care. Studies examining new payment models on physician costs and productivity were of high methodological quality and provided a coherent body of evidence assessing enhanced fee-for-service and blended capitation payment models. A small number of studies suggested that team-based models contributed to reductions in emergency department use in Quebec and Alberta. Regarding processes of diabetes care, studies found higher rates of testing for blood glucose levels, retinopathy and cholesterol in Alberta's team-based primary care model and in practices eligible for pay-for-performance incentives in Ontario. However pay-for-performance in Ontario was found to have null to moderate effects on other prevention and screening activities. Although blended capitation payment in Ontario contributed to decreases in the number of services delivered and patients seen per day, the number of enrolled patients and number of days worked in a year was similar to that of enhanced fee

  14. The impact of rural health system reform on hospitalization rates in the Islamic Republic of Iran: an interrupted time series.

    Science.gov (United States)

    Rashidian, Arash; Joudaki, Hossein; Khodayari-Moez, Elham; Omranikhoo, Habib; Geraili, Bijan; Arab, Mohamad

    2013-12-01

    To assess the effects on hospital utilization rates of a major health system reform - a family physician programme and a social protection scheme - undertaken in rural areas of the Islamic Republic of Iran in 2005. A "tracer" province that was not a patient referral hub was selected for the collection of monthly hospitalization data over a period of about 10 years, beginning two years before the rural health system reform (the "intervention") began. An interrupted time series analysis was conducted and segmented regression analysis was used to assess the immediate and gradual effects of the intervention on hospitalization rates in an intervention group composed of rural residents and a comparison group composed of urban residents primarily. Before the intervention, the hospitalization rate in the rural population was significantly lower than in the comparison group. Although there was no significant increase or decline in hospitalization rates in the intervention or comparison group before the intervention, after the intervention a significant increase in the hospitalization rate - of 4.6 hospitalizations per 100 000 insured persons per month on average - was noted in the intervention group (P < 0.001). The monthly increase in the hospitalization rate continued for over a year and stabilized thereafter. No increase in the hospitalization rate was observed in the comparison group. The primary health-care programme instituted as part of the health system reform process has increased access to hospital care in a population that formerly underutilized hospital services. It has not reduced hospitalizations or hospitalization-related expenditure.

  15. Who needs what from a national health research system:lessons from reforms to the English Department of Health's R&D system

    Directory of Open Access Journals (Sweden)

    Soper Bryony

    2010-05-01

    Full Text Available Abstract Health research systems consist of diverse groups who have some role in health research, but the boundaries around such a system are not clear-cut. To explore what various stakeholders need we reviewed the literature including that on the history of English health R&D reforms, and we also applied some relevant conceptual frameworks. We first describe the needs and capabilities of the main groups of stakeholders in health research systems, and explain key features of policymaking systems within which these stakeholders operate in the UK. The five groups are policymakers (and health care managers, health professionals, patients and the general public, industry, and researchers. As individuals and as organisations they have a range of needs from the health research system, but should also develop specific capabilities in order to contribute effectively to the system and benefit from it. Second, we discuss key phases of reform in the development of the English health research system over four decades - especially that of the English Department of Health's R&D system - and identify how far legitimate demands of key stakeholder interests were addressed. Third, in drawing lessons we highlight points emerging from contemporary reports, but also attempt to identify issues through application of relevant conceptual frameworks. The main lessons are: the importance of comprehensively addressing the diverse needs of various interacting institutions and stakeholders; the desirability of developing facilitating mechanisms at interfaces between the health research system and its various stakeholders; and the importance of additional money in being able to expand the scope of the health research system whilst maintaining support for basic science. We conclude that the latest health R&D strategy in England builds on recent progress and tackles acknowledged weaknesses. The strategy goes a considerable way to identifying and more effectively meeting the

  16. Welfare Reform & the Health of Single Mothers

    OpenAIRE

    Narain, Kimberly Danae Cauley

    2016-01-01

    Objective: This dissertation explores the relationship between welfare reform and the health of single mothers with less than a high school diploma or GED (LESMS) by addressing six research questions: (1) what impact did welfare reform have on the health insurance coverage of LESMS, (2) what impact did welfare reform have on the annual medical provider contact of LESMS, (3) what impact did welfare reform have on the health outcomes of LESMS, (4) what impact did welfare reform have on the fede...

  17. The Chilean Health System: 20 Years of Reforms El sistema de salud chileno: 20 años de reformas

    Directory of Open Access Journals (Sweden)

    Annick Manuel

    2002-01-01

    Full Text Available The Chilean health care system has been intensively reformed in the past 20 years. Reforms under the Pinochet government (1973-1990 aimed mainly at the decentralization of the system and the development of a private sector. Decentralization involved both a deconcentration process and the devolution of primary health care to municipalities. The democratic governments after 1990 chose to preserve the core organization but introduced reforms intended to correct the system's failures and to increase both efficiency and equity. The present article briefly explains the current organization of the Chilean health care system. It also reviews the different reforms introduced in the past 20 years, from the Pinochet regime to the democratic governments. Finally, a brief discussion describes the strengths and weaknesses of the system, as well as the challenges it currently faces.El sistema de salud chileno ha sido intensamente reformado en los últimos 20 años. Las reformas bajo el gobierno de Pinochet (1973-1990 apuntaron principalmente a la descentralización del sistema y al desarrollo del sector privado. La descentralización involucró un proceso de desconcentración y la devolución de las unidades de atención primaria a las municipalidades. Los gobiernos democráticos posteriores a 1990 escogieron preservar el núcleo organizacional, pero las reformas introducidas buscaron corregir las fallas del sistema y aumentar la eficacia y la equidad. El presente artículo explica brevemente la organización actual del sistema de salud chileno y revisa las diferentes reformas introducidas en los últimos 20 años desde el régimen de Pinochet hasta los gobiernos democráticos. Finalmente, presenta una discusión breve para describir las fortalezas y debilidades del sistema, así como los desafíos que enfrenta actualmente.

  18. Environmental Health: Health Care Reform's Missing Pieces.

    Science.gov (United States)

    Fadope, Cece Modupe; And Others

    1994-01-01

    A series of articles that examine environmental health and discuss health care reform; connections between chlorine, chlorinated pesticides, and dioxins and reproductive disorders and cancers; the rise in asthma; connections between poverty and environmental health problems; and organizations for health care professionals who want to address…

  19. Financial Management Reforms in the Health Sector: A Comparative Study Between Cash-based and Accrual-based Accounting Systems.

    Science.gov (United States)

    Abolhallaje, Masoud; Jafari, Mehdi; Seyedin, Hesam; Salehi, Masoud

    2014-10-01

    Financial management and accounting reform in the public sectors was started in 2000. Moving from cash-based to accrual-based is considered as the key component of these reforms and adjustments in the public sector. Performing this reform in the health system is a part of a bigger reform under the new public management. The current study aimed to analyze the movement from cash-based to accrual-based accounting in the health sector in Iran. This comparative study was conducted in 2013 to compare financial management and movement from cash-based to accrual-based accounting in health sector in the countries such as the United States, Britain, Canada, Australia, New Zealand, and Iran. Library resources and reputable databases such as Medline, Elsevier, Index Copernicus, DOAJ, EBSCO-CINAHL and SID, and Iranmedex were searched. Fish cards were used to collect the data. Data were compared and analyzed using comparative tables. Developed countries have implemented accrual-based accounting and utilized the valid, reliable and practical information in accrual-based reporting in different areas such as price and tariffs setting, operational budgeting, public accounting, performance evaluation and comparison and evidence based decision making. In Iran, however, only a few public organizations such as the municipalities and the universities of medical sciences use accrual-based accounting, but despite what is required by law, the other public organizations do not use accrual-based accounting. There are advantages in applying accrual-based accounting in the public sector which certainly depends on how this system is implemented in the sector.

  20. Ideology drives health care reforms in Chile.

    Science.gov (United States)

    Reichard, S

    1996-01-01

    The health care system of Chile evolved from rather unique historical circumstances to become one of the most progressive in Latin America, offering universal access to all citizens. Since the advent of the Pinochet regime in 1973, Chile has implemented Thatcherite/Reaganite reforms resulting in the privatization of much of the health care system. In the process, state support for health care has been sharply curtailed with deleterious effects on health services. As Chile emerges from the shadow of the Pinochet dictatorship, it faces numerous challenges as it struggles to rebuild its health care system. Other developing nations considering free-market reforms may wish to consider the high costs of the Chilean experiment.

  1. Evolution of US Health Care Reform.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

    2017-03-01

    Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.

  2. Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation.

    Science.gov (United States)

    Witter, Sophie; Toonen, Jurrien; Meessen, Bruno; Kagubare, Jean; Fritsche, György; Vaughan, Kelsey

    2013-09-29

    Performance-based financing is increasingly being applied in a variety of contexts, with the expectation that it can improve the performance of health systems. However, while there is a growing literature on implementation issues and effects on outputs, there has been relatively little focus on interactions between PBF and health systems and how these should be studied. This paper aims to contribute to filling that gap by developing a framework for assessing the interactions between PBF and health systems, focusing on low and middle income countries. In doing so, it elaborates a general framework for monitoring and evaluating health system reforms in general. This paper is based on an exploratory literature review and on the work of a group of academics and PBF practitioners. The group developed ideas for the monitoring and evaluation framework through exchange of emails and working documents. Ideas were further refined through discussion at the Health Systems Research symposium in Beijing in October 2012, through comments from members of the online PBF Community of Practice and Beijing participants, and through discussion with PBF experts in Bergen in June 2013. The paper starts with a discussion of definitions, to clarify the core concept of PBF and how the different terms are used. It then develops a framework for monitoring its interactions with the health system, structured around five domains of context, the development process, design, implementation and effects. Some of the key questions for monitoring and evaluation are highlighted, and a systematic approach to monitoring effects proposed, structured according to the health system pillars, but also according to inputs, processes and outputs. The paper lays out a broad framework within which indicators can be prioritised for monitoring and evaluation of PBF or other health system reforms. It highlights the dynamic linkages between the domains and the different pillars. All of these are also framed within

  3. The Soft Underbelly of System Change: The Role of Leadership and Organizational Climate in Turnover during Statewide Behavioral Health Reform.

    Science.gov (United States)

    Aarons, Gregory A; Sommerfeld, David H; Willging, Cathleen E

    2011-01-01

    This study examined leadership, organizational climate, staff turnover intentions, and voluntary turnover during a large-scale statewide behavioral health system reform. The initial data collection occurred nine months after initiation of the reform with a follow-up round of data collected 18 months later. A self-administered structured assessment was completed by 190 participants (administrators, support staff, providers) employed by 14 agencies. Key variables included leadership, organizational climate, turnover intentions, turnover, and reform-related financial stress ("low" versus "high") experienced by the agencies. Analyses revealed that positive leadership was related to a stronger empowering climate in both high and low stress agencies. However, the association between more positive leadership and lower demoralizing climate was evident only in high stress agencies. For both types of agencies empowering climate was negatively associated with turnover intentions, and demoralizing climate was associated with stronger turnover intentions. Turnover intentions were positively associated with voluntary turnover. Results suggest that strong leadership is particularly important in times of system and organizational change and may reduce poor climate associated with turnover intentions and turnover. Leadership and organizational context should be addressed to retain staff during these periods of systemic change.

  4. The Soft Underbelly of System Change: The Role of Leadership and Organizational Climate in Turnover during Statewide Behavioral Health Reform

    Science.gov (United States)

    Aarons, Gregory A.; Sommerfeld, David H.; Willging, Cathleen E.

    2011-01-01

    This study examined leadership, organizational climate, staff turnover intentions, and voluntary turnover during a large-scale statewide behavioral health system reform. The initial data collection occurred nine months after initiation of the reform with a follow-up round of data collected 18 months later. A self-administered structured assessment was completed by 190 participants (administrators, support staff, providers) employed by 14 agencies. Key variables included leadership, organizational climate, turnover intentions, turnover, and reform-related financial stress (“low” versus “high”) experienced by the agencies. Analyses revealed that positive leadership was related to a stronger empowering climate in both high and low stress agencies. However, the association between more positive leadership and lower demoralizing climate was evident only in high stress agencies. For both types of agencies empowering climate was negatively associated with turnover intentions, and demoralizing climate was associated with stronger turnover intentions. Turnover intentions were positively associated with voluntary turnover. Results suggest that strong leadership is particularly important in times of system and organizational change and may reduce poor climate associated with turnover intentions and turnover. Leadership and organizational context should be addressed to retain staff during these periods of systemic change. PMID:22229021

  5. REORGANISATION OF HOSPITAL SYSTEM – A KEY FACTOR IN REFORMATION OF THE REPUBLIC OF MOLDOVA’S HEALTH SYSTEM

    Directory of Open Access Journals (Sweden)

    Victor MOCANU

    2016-01-01

    Full Text Available Topicality. Starting with the middle of the ‘90s of the previous century, the Republic of Moldova started to implement a series of important reforms, aimed at improving the access and quality of the services for increasing the efficiency and the performances of the health system. The aim of the research is the analysis of the Regionalization Plan of the Hospital Services and the assessment of medical workers opinion from district and republican hospitals regarding the envisaged transformations, in order to elaborate conclusions and recommendations that will be considered at the stage of reform’s implementation. The object of the research is the physicians of different profile (therapeutic, surgical, diagnostic, which work in republican and district hospitals. Methods: questioners, statistic data analyze, comparative method. Results. The logic of the regionalization suggests a reality, and namely, the need to transfer the physicians from the republican institutions to regional hospitals will be little. As a result, it will be applied only for the provision of the highly specialized services, for the solution of the associated cases or for the use of certain sophisticated methods of diagnosis and treatment (cardiac catheterization with subsequent plasty, etc. Therefore, it can be appreciated positively the fact that only 1/5 of physicians that work in the republican hospitals accept to commute or the transfer. It is more regrettable another reality, which shows that almost ½ of the specialists from the republican medical institutions generally do not want the regionalization and boycott the reform, just when they should promote the change. It results that mainly these physicians plead for the continuous maintenance of poor quality of hospital medical assistance, for the access limitation of the rural population at quality health service and, as consequence, and the financial burden to be left on patients shoulders – a fact mentioned in all

  6. Health sector reforms: implications for reproductive health in Nigeria ...

    African Journals Online (AJOL)

    Health sector reforms emerged as a major focus in the 1990s covering a wide range of structural and institutional changes. The components of ... The approach of “basket funding” should be continued to ensure quality monitoring and evaluation of the health system in general and assuring the quality of health related data.

  7. The proportion of unmet costs considering inpatients billing of selected hospitals, after 2014 Health System reform implementation in Isfahan Province.

    Science.gov (United States)

    Naghdi, Parnaz; Mohammadi, Mahan; Jahangard, Mohammad Ali; Yousefe, Alireza; Rafiee, Noora

    2017-01-01

    Since 2013, in Iran's health care, the contribution of direct payments for health-care services was estimated more than 50 % of all expenditures. In May 2014, Iran's health-care reform was established to improve health services quality and reduce patients' out-of-pocket payments reform coverage mentioned in Sections 1.2.2 and 1.2.1, Article 6 of the Health Minister Reform Guideline) in the inpatient billings within the first 5 months from the reform implementation. This study was conducted as a cross-sectional research in the second half of 2014 on the selected hospitals in Isfahan Province. Data were collected by investigating 97,000 inpatients' billing records issued by 28 hospitals affiliated to Isfahan University of Medical Sciences using census method. Findings of the study showed that the average of unmet costs paid by the inpatients constituted 21.8% of the total billing costs in 28 hospitals, and the average unmet costs paid by each patient was 1,903,832 Rials. Considering the definition of unmet cost in the context of health-care reform guideline and hospitals' problems in providing some costly services, drugs, and medical equipment (that were not covered by insurance organizations and the reform scheme) within the obligations of the reform, it is necessary to review these obligations and further interact with insurance companies about expanding the coverage to some costly services required by the patients.

  8. Health Reform Cycles in Tanzania: 1924–1994 | Semali | Tanzania ...

    African Journals Online (AJOL)

    Predominant information in each wave showed that the health system was underfinanced, there was poor performance of PHC strategies, non-integration of DMO and poor health workers income. Health reforms should focus on health system finance, integrated district health system, health workers welfare and community ...

  9. Implementing Lean Health Reforms in Saskatchewan

    Directory of Open Access Journals (Sweden)

    Greg Marchildon

    2013-07-01

    Full Text Available Saskatchewan has gone further than any other Canadian province in implementing health system process improvements using Lean, a production line discipline that originated with the automobile industry. The goal of the Lean reform is to reduce waste and improve quality and overall health system performance by long-term changes in behaviour. Lean enjoys a privileged position on the provincial government’s agenda because of the policy’s championing by the Deputy Minister of Health and the policy’s fit with the government’s patient-centred care agenda. The implementation of reform depends on a major investment of time in the training and Lean-certification of key leaders and managers in the provincial health system. The Saskatchewan Union of Nurses, the union representing the single largest group of health workers in the province, has agreed to co-operate with the provincial government in implementing Lean-type reforms. Thus far, the government has had limited independent evaluation of Lean while internal evaluations claim some successes.

  10. Health Care Reform: Out Greatest Opportunity...Ever!

    Science.gov (United States)

    Keigher, Sharon M.

    1993-01-01

    Discusses inevitability of health care reform in United States, considers the reform process itself, and explains the plan of the President's Task Force on National Health Care Reform. Also considers the prospects for Congressional response to reform proposals. (NB)

  11. Setting a research agenda for interprofessional education and collaborative practice in the context of United States health system reform.

    Science.gov (United States)

    Lutfiyya, May Nawal; Brandt, Barbara; Delaney, Connie; Pechacek, Judith; Cerra, Frank

    2016-01-01

    Interprofessional education (IPE) and collaborative practice (CP) have been prolific areas of inquiry exploring research questions mostly concerned with local program and project assessment. The actual sphere of influence of this research has been limited. Often discussed separately, this article places IPE and CP in the same conceptual space. The interface of these form a nexus where new knowledge creation may be facilitated. Rigorous research on IPE in relation to CP that is relevant to and framed by health system reform in the U.S. is the ultimate research goal of the National Center for Interprofessional Practice and Education at the University of Minnesota. This paper describes the direction and scope for a focused and purposive IPECP research agenda linked to improvement in health outcomes, contextualized by health care reform in the U.S. that has provided a revitalizing energy for this area of inquiry. A research agenda articulates a focus, meaningful and robust questions, and a theory of change within which intervention outcomes are examined. Further, a research agenda identifies the practices the area of inquiry is interested in informing, and the types of study designs and analytic approaches amenable to carrying out the proposed work.

  12. Setting a research agenda for interprofessional education and collaborative practice in the context of United States health system reform

    Science.gov (United States)

    Lutfiyya, May Nawal; Brandt, Barbara; Delaney, Connie; Pechacek, Judith; Cerra, Frank

    2016-01-01

    ABSTRACT Interprofessional education (IPE) and collaborative practice (CP) have been prolific areas of inquiry exploring research questions mostly concerned with local program and project assessment. The actual sphere of influence of this research has been limited. Often discussed separately, this article places IPE and CP in the same conceptual space. The interface of these form a nexus where new knowledge creation may be facilitated. Rigorous research on IPE in relation to CP that is relevant to and framed by health system reform in the U.S. is the ultimate research goal of the National Center for Interprofessional Practice and Education at the University of Minnesota. This paper describes the direction and scope for a focused and purposive IPECP research agenda linked to improvement in health outcomes, contextualized by health care reform in the U.S. that has provided a revitalizing energy for this area of inquiry. A research agenda articulates a focus, meaningful and robust questions, and a theory of change within which intervention outcomes are examined. Further, a research agenda identifies the practices the area of inquiry is interested in informing, and the types of study designs and analytic approaches amenable to carrying out the proposed work. PMID:26230379

  13. Health workforce policy and Turkey's health care reform.

    Science.gov (United States)

    Agartan, Tuba I

    2015-12-01

    The health care industry is labor intensive and depends on well-trained and appropriately deployed health professionals to deliver services. This article examines the health workforce challenges in the context of Turkey's recent health reform initiative, Health Transformation Program (HTP). Reformers identified shortages, imbalances in the skills-mix, and inequities in the geographical distribution of health professionals as among the major problems. A comprehensive set of policies was implemented within the HTP framework to address these problems. The article argues that these policies addressed some of the health workforce challenges, while on the other hand exacerbating others and hence may have resulted in increasing the burden on the workforce. So far HTP's governance reforms and health human resource policy have not encouraged meaningful participation of other key stakeholders in the governance of the health care system. Without effective participation of health professionals, the next stages of HTP implementation that focus on managerial reforms such as restructuring public hospitals, improving the primary care system and implementing new initiatives on quality improvement could be very difficult. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Market reforms in Swedish health care

    DEFF Research Database (Denmark)

    Diderichsen, Finn

    1993-01-01

    This report presents the main characteristics of reforms in the Swedish health services, as exemplified by the "Stockholm Model" introduced in 1992 in Stockholm county. The author discusses the motives behind these reforms, the already-evident increases in costs that are occurring, and the effect...... of these reforms on public support for the welfare state.......This report presents the main characteristics of reforms in the Swedish health services, as exemplified by the "Stockholm Model" introduced in 1992 in Stockholm county. The author discusses the motives behind these reforms, the already-evident increases in costs that are occurring, and the effect...

  15. Methodological approach and tools for systems thinking in health systems research: technical assistants' support of health administration reform in the Democratic Republic of Congo as an application.

    Science.gov (United States)

    Ribesse, Nathalie; Bossyns, Paul; Marchal, Bruno; Karemere, Hermes; Burman, Christopher J; Macq, Jean

    2017-03-01

    In the field of development cooperation, interest in systems thinking and complex systems theories as a methodological approach is increasingly recognised. And so it is in health systems research, which informs health development aid interventions. However, practical applications remain scarce to date. The objective of this article is to contribute to the body of knowledge by presenting the tools inspired by systems thinking and complexity theories and methodological lessons learned from their application. These tools were used in a case study. Detailed results of this study are in process for publication in additional articles. Applying a complexity 'lens', the subject of the case study is the role of long-term international technical assistance in supporting health administration reform at the provincial level in the Democratic Republic of Congo. The Methods section presents the guiding principles of systems thinking and complex systems, their relevance and implication for the subject under study, and the existing tools associated with those theories which inspired us in the design of the data collection and analysis process. The tools and their application processes are presented in the results section, and followed in the discussion section by the critical analysis of their innovative potential and emergent challenges. The overall methodology provides a coherent whole, each tool bringing a different and complementary perspective on the system.

  16. Reforming Victoria's primary health and community service sector: rural implications.

    Science.gov (United States)

    Alford, K

    2000-01-01

    In 1999 the Victorian primary care and community support system began a process of substantial reform, involving purchasing reforms and a contested selection process between providers in large catchment areas across the State. The Liberal Government's electoral defeat in September 1999 led to a review of these reforms. This paper questions the reforms from a rural perspective. They were based on a generic template that did not consider rural-urban differences in health needs or other differences including socio-economic status, and may have reinforced if not aggravated rural-urban differences in the quality of and access to primary health care in Victoria.

  17. Health sector reform in Pakistan: future directions.

    Science.gov (United States)

    Islam, A

    2002-04-01

    The health care system in Pakistan is beset with numerous problems--structural fragmentation, gender insensitivity, resource scarcity, inefficiency and lack of functional specificity and accessibility. Faced with a precarious economic situation characterized by heavy external debt and faltering productivity, Pakistan's room to maneuver with health sector reform is quite limited. Although the recently announced Devolution Plan provides a window of opportunity, it must go beyond and introduce far-reaching changes in the health and social sectors. Regionalization of health care services in an integrated manner with functional specificity for each level of care is an essential step. Integration of current vertical programs within the framework of a need-based comprehensive primary health care system is another necessary step. Most importantly, fostering a public-private partnership to share the cost of basic primary health care and public health services must be an integral part of any reform. Pakistan must also make the health care system more gender sensitive through appropriate training programs for the service providers along with wide community participation in decision-making processes. Relevant WHO/World Bank/UNDP developed tools could be extremely useful in this respect. The article is based on a critical analysis of secondary data from the public domain as well as from various research projects undertaken by the Aga Khan University. It also draws from the experiences of health sector reform carried out in other countries, particularly those in the Asia-Pacific region. The purpose is to inform and hopefully influence, public policy as the country moves towards devolution.

  18. [The questions of improving the information-analytical component in the reform of the health care system in Ukraine].

    Science.gov (United States)

    Беликова, Инна В; Руденко, Леся А

    2016-01-01

    A priority task of the development strategy of the Ukrainian health care system is the saving and improving of public health. With the development of new economic relations, health care restructuring, the introduction of new financing mechanisms to policy-makers have an important task of the organization of operational management on the basis of timely quality information. According to many authors, the ability to improve the quality of the received information is possible due to the intercalation of information technologies. The main aim of our study is to determine the main directions of modernization of information-analytical component during the health care reform. The medical institutions reporting forms (f.20, f.12, f.17, f.47) were analyzed to achieve the goal, were conducted a survey of primary care physicians. The survey was attended by 265 family doctors, 80 of whom are family doctors of family medicine clinic of the regional center, 185 - medical centers of primary health care district centers. The analysis of the sociological research indicates that the work of the family doctor is accompanied by filling a large number of records, so according to the survey, an average of doctors per day filled about 15.74 +2.2 registration forms, on average per month 333,7+ 30 a month. The necessity of reform of the information-analytical component of the health care system have noted by 94% 1.4. Do not have a automated workstation 34.5% + 5.3 physicians of the regional center and 68% + 3.4 countryside. Possession of the computer at user level observed by 92% + 1.6, which is a good basis for the introduction of information in healthcare system. The data of the sociological survey confirm the necession of structural-functional procuring of the system of information-analytical supporting of the healthcare system of Ukraine. Annual health statistics reports are still relevant, but they need to improve and adapt to the new conditions of functioning of healthcare system and

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

    Science.gov (United States)

    Intaranongpai, Siranee; Hughes, David; Leethongdee, Songkramchai

    2012-01-01

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

  20. Mental health reforms in Eastern Europe.

    Science.gov (United States)

    Tomov, T

    2001-01-01

    To describe the background in general culture, public and professional discourse against which mental health care reform initiatives in Eastern Europe need to be seen. An account of some key aspects of sociopolitical and cultural transition in Eastern European countries is given, and core results of a research project on attitudes and needs assessment in psychiatry in six Eastern European countries are reported. In post-totalitarian cultures mental health reforms impinge on imagination in ways which are not easy to predict. Some of the reasons for this are traced to the psychiatric practices under the system of total control, e.g. dispensary care, political abuse, reification of classificatory terms. Data on a study of attitudes suggest that institutions had replaced community life in those parts of Europe. It is predicted that with time trust in the capacity of community to contain mental illness will be regained.

  1. The Grand Coalition and Pension and Health Care Reform

    NARCIS (Netherlands)

    Haverland, M.; Stiller, S.J.

    2010-01-01

    This article focuses on German pension and health care reform politics under the Grand Coalition. All rich democracies face functional pressures to reform these sectors but are confronted with political and sometimes also institutionalobstacles. This holds in particular for the German party system,

  2. Change management in an environment of ongoing primary health care system reform: A case study of Australian primary health care services.

    Science.gov (United States)

    Javanparast, Sara; Maddern, Janny; Baum, Fran; Freeman, Toby; Lawless, Angela; Labonté, Ronald; Sanders, David

    2017-03-22

    Globally, health reforms continue to be high on the health policy agenda to respond to the increasing health care costs and managing the emerging complex health conditions. Many countries have emphasised PHC to prevent high cost of hospital care and improve population health and equity. The existing tension in PHC philosophies and complexity of PHC setting make the implementation and management of these changes more difficult. This paper presents an Australian case study of PHC restructuring and how these changes have been managed from the viewpoint of practitioners and middle managers. As part of a 5-year project, we interviewed PHC practitioners and managers of services in 7 Australian PHC services. Our findings revealed a policy shift away from the principles of comprehensive PHC including health promotion and action on social determinants of health to one-to-one disease management during the course of study. Analysis of the process of change shows that overall, rapid, and top-down radical reforms of policies and directions were the main characteristic of changes with minimal communication with practitioners and service managers. The study showed that services with community-controlled model of governance had more autonomy to use an emergent model of change and to maintain their comprehensive PHC services. Change is an inevitable feature of PHC systems continually trying to respond to health care demand and cost pressures. The implementation of change in complex settings such as PHC requires appropriate change management strategies to ensure that the proposed reforms are understood, accepted, and implemented successfully. Copyright © 2017 John Wiley & Sons, Ltd.

  3. Exploring status and determinants of prenatal and postnatal visits in western China: in the background of the new health system reform

    Directory of Open Access Journals (Sweden)

    Xiaojing Fan

    2017-07-01

    Full Text Available Abstract Background Prenatal and postnatal visits are two effective interventions for protection and promotion of maternal health by reducing maternal mortality and improving the quality of birth. There is limited nationally representative data regarding the changes of prenatal and postnatal visits since the latest health system reform initiated in 2009 in Shaanxi, China. The aim of this study was to explore the current status and determinants of prenatal and postnatal visits in the background of new health system reform. Methods Data were drawn from two waves of National Health Service Surveys in Shaanxi Province which were conducted prior and post the health system reform in 2008 and 2013, respectively. A concentration index was employed to measure the degree of income-related inequality of maternal health services utilization. Multilevel mix-effects logistic regressions were applied to study the factors associated with prenatal and postnatal visits. Results The study sample consists of 2398 women aged 15-49 years old. The data of the 5th National Health Services Survey in 2013 showed in the criterion of the World Health Organization (WHO, the percentage of women receiving ≥4 prenatal visits was 84.79% for urban women and 82.20% for rural women, with women receiving ≥3 postnatal visits were 26.48 and 25.29% for urban and rural women respectively. In the criterion of China’s ≥ 5 prenatal visits the percentages were 72.25% for urban women and 70.33% for rural women; 61.69% of urban women and 71.50% of rural women received ≥1 postnatal visits. As for urban women, the concentration index of postnatal visit utilization was −0.075 (95% CI:-0.148, −0.020 after the health system reform. The determinants related to prenatal and postnatal visits were the change of reform, women’s education, parity and the delivery institution. Conclusions This study showed the utilization of prenatal and postnatal visits met the requirement of the WHO

  4. Exploring status and determinants of prenatal and postnatal visits in western China: in the background of the new health system reform.

    Science.gov (United States)

    Fan, Xiaojing; Zhou, Zhongliang; Dang, Shaonong; Xu, Yongjian; Gao, Jianmin; Zhou, Zhiying; Su, Min; Wang, Dan; Chen, Gang

    2017-07-20

    Prenatal and postnatal visits are two effective interventions for protection and promotion of maternal health by reducing maternal mortality and improving the quality of birth. There is limited nationally representative data regarding the changes of prenatal and postnatal visits since the latest health system reform initiated in 2009 in Shaanxi, China. The aim of this study was to explore the current status and determinants of prenatal and postnatal visits in the background of new health system reform. Data were drawn from two waves of National Health Service Surveys in Shaanxi Province which were conducted prior and post the health system reform in 2008 and 2013, respectively. A concentration index was employed to measure the degree of income-related inequality of maternal health services utilization. Multilevel mix-effects logistic regressions were applied to study the factors associated with prenatal and postnatal visits. The study sample consists of 2398 women aged 15-49 years old. The data of the 5th National Health Services Survey in 2013 showed in the criterion of the World Health Organization (WHO), the percentage of women receiving ≥4 prenatal visits was 84.79% for urban women and 82.20% for rural women, with women receiving ≥3 postnatal visits were 26.48 and 25.29% for urban and rural women respectively. In the criterion of China's ≥ 5 prenatal visits the percentages were 72.25% for urban women and 70.33% for rural women; 61.69% of urban women and 71.50% of rural women received ≥1 postnatal visits. As for urban women, the concentration index of postnatal visit utilization was -0.075 (95% CI:-0.148, -0.020) after the health system reform. The determinants related to prenatal and postnatal visits were the change of reform, women's education, parity and the delivery institution. This study showed the utilization of prenatal and postnatal visits met the requirement of the WHO, higher than other areas in China and other developing countries after

  5. Neoliberal reforms in health systems and the construction of long-lasting inequalities in health care: A case study from Chile.

    Science.gov (United States)

    Rotarou, Elena S; Sakellariou, Dikaios

    2017-05-01

    The aim of this article is to discuss how neoliberal policies implemented in the Chilean health system during the Pinochet regime have a lingering effect on equal access to health care today. The two-tier health system - public and private - that was introduced in the early 1980s as a means to improve efficiency and lower health-related costs, has led instead to inequality of access and dehumanisation of health care. Health has changed from being a right to being a marketable need, thus creating a structural disadvantage for several parts of the population - particularly the poor, the elderly, and women - who cannot afford the better-quality services and timely attention of private health providers, and thus, are not adequately protected against health risks. Despite the recent health reforms that aim at improving equity in health care access and financing, we argue that the Chilean health system is still biased against the poorer segments of the population, while it favours the more affluent groups that can afford private health care. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Improvements in health status after Massachusetts health care reform.

    Science.gov (United States)

    Van Der Wees, Philip J; Zaslavsky, Alan M; Ayanian, John Z

    2013-12-01

    Massachusetts enacted health care reform in 2006 to expand insurance coverage and improve access to health care. The objective of our study was to compare trends in health status and the use of ambulatory health services before and after the implementation of health reform in Massachusetts relative to that in other New England states. We used a quasi-experimental design with data from the Behavioral Risk Factor Surveillance System from 2001 to 2011 to compare trends associated with health reform in Massachusetts relative to that in other New England states. We compared self-reported health and the use of preventive services using multivariate logistic regression with difference-in-differences analysis to account for temporal trends. We estimated predicted probabilities and changes in these probabilities to gauge the differential effects between Massachusetts and other New England states. Finally, we conducted subgroup analysis to assess the differential changes by income and race/ethnicity. The sample included 345,211 adults aged eighteen to sixty-four. In comparing the periods before and after health care reform relative to those in other New England states, we found that Massachusetts residents reported greater improvements in general health (1.7%), physical health (1.3%), and mental health (1.5%). Massachusetts residents also reported significant relative increases in rates of Pap screening (2.3%), colonoscopy (5.5%), and cholesterol testing (1.4%). Adults in Massachusetts households that earned up to 300% of the federal poverty level gained more in health status than did those above that level, with differential changes ranging from 0.2% to 1.3%. Relative gains in health status were comparable among white, black, and Hispanic residents in Massachusetts. Health care reform in Massachusetts was associated with improved health status and the greater use of some preventive services relative to those in other New England states, particularly among low

  7. Let's Get Real About Health Care Reform.

    Science.gov (United States)

    Karpf, Michael

    2017-09-01

    In light of the ongoing debate about health care policy in the United States, including efforts to repeal and replace the Affordable Care Act, it will be critically important for the academic community to engage in the dialogue. Developing a viable approach to health care reform requires an understanding of the interaction and interdependence between choice, cost, and coverage in a competitive and functional market-based system. Some institutions have implemented models that indicate the feasibility of providing high-quality, efficient patient care while working within fixed budgets. The academic community must stay engaged in these conversations because of its moral commitment to equitable access to health care for all. Academic medical centers will also have to define and protect their roles in an evolving health care delivery system in the United States.

  8. Health reform requires policy capacity.

    Science.gov (United States)

    Forest, Pierre-Gerlier; Denis, Jean-Louis; Brown, Lawrence D; Helms, David

    2015-04-17

    Among the many reasons that may limit the adoption of promising reform ideas, policy capacity is the least recognized. The concept itself is not widely understood. Although policy capacity is concerned with the gathering of information and the formulation of options for public action in the initial phases of policy consultation and development, it also touches on all stages of the policy process, from the strategic identification of a problem to the actual development of the policy, its formal adoption, its implementation, and even further, its evaluation and continuation or modification. Expertise in the form of policy advice is already widely available in and to public administrations, to well-established professional organizations like medical societies and, of course, to large private-sector organizations with commercial or financial interests in the health sector. We need more health actors to join the fray and move from their traditional position of advocacy to a fuller commitment to the development of policy capacity, with all that it entails in terms of leadership and social responsibility. © 2015 by Kerman University of Medical Sciences.

  9. Improvements in health status after massachusetts health care reform

    NARCIS (Netherlands)

    Wees, P.J. van der; Zaslavsky, A.M.; Ayanian, J.Z.

    2013-01-01

    CONTEXT: Massachusetts enacted health care reform in 2006 to expand insurance coverage and improve access to health care. The objective of our study was to compare trends in health status and the use of ambulatory health services before and after the implementation of health reform in Massachusetts

  10. Massachusetts health care reform: is it working?

    Science.gov (United States)

    McAdoo, Joshua; Irving, Julian; Deslich, Stacie; Coustasse, Alberto

    2013-01-01

    Before 2006, Massachusetts had more than 500 000 residents who lacked health insurance. Governor Mitt Romney enacted landmark legislation requiring all residents to obtain health insurance. Also, the legislation established a health insurance exchange for the purpose of broadening the choices of insurance plans made available to individuals in the state. The purpose of this research was to assess the Massachusetts health care reform in terms of access, cost, and sustainability. The methodology used was a literature review from 2006 to 2013; a total of 43 references were used. Health reform resulted in additional overall state spending of $2.42 billion on Medicaid for Massachusetts. Since the 2006 reform, 401 000 additional residents have obtained insurance. The number of Massachusetts residents who had access to health care increased substantially after the health care reform was enacted, to 98.1% of residents. The Massachusetts health care reform has not saved money for the state; its funding has been covered by Federal spending. However, reform has been sustained over time because of the high percentage of state residents who have supported the state mandate to obtain health care coverage.

  11. La equidad y la imparcialidad en la reforma del sistema mexicano de salud Equity and fairness in the Mexican health system reform

    Directory of Open Access Journals (Sweden)

    Octavio Gómez-Dantés

    2004-10-01

    Full Text Available OBJETIVO: Evaluar el impacto de la reforma de finales de la década de 1990 en la equidad e imparcialidad del sistema mexicano de salud. MATERIAL Y MÉTODOS: Para evaluar el impacto de esta reforma se utilizó un sistema de parámetros diseñado por Daniels y colaboradores que se adaptó a la realidad mexicana y al que se adicionaron indicadores específicos. Se hizo, finalmente, una revisión documental de la reforma para calificar su desempeño en cada uno de estos parámetros. RESULTADOS: Excepto por las intervenciones en vivienda y nutricias, la reforma mostró poca preocupación por los determinantes de las condiciones de salud. En relación con la atención a la salud, las principales iniciativas de reforma tuvieron que ver con la ampliación de la cobertura de servicios esenciales y con la descentralización de los servicios de salud. Las actividades relacionadas con la justicia del financiamiento, la fragmentación del sistema, el énfasis en la atención curativa especializada, la rendición de cuentas y la transparencia fueron escasas. CONCLUSIONES: La reforma del sistema mexicano de salud de la segunda mitad de la década de 1990 tuvo cierto impacto sobre el acceso de los pobres a la atención a la salud y la eficiencia administrativa, pero un efecto mínimo sobre la justicia del financiamiento y el gobierno democrático.OBJECTIVE: To assess the equity and fairness of the Mexican health system reform that occurred in the late 1990's. MATERIAL AND METHODS: The Mexican reform process was evaluated using the benchmark-system designed by Daniels et al. This benchmark system was adapted to the Mexican setting by adding specific indicators. A documentary review of the Mexican reform process was conducted to score its performance for each benchmark. RESULTS: Except for housing and nutrition components, the reform included few actions related to health determinants. For health care, the main reform initiatives were those related to extending

  12. Prisons and Health Reforms in England and Wales

    Science.gov (United States)

    Hayton, Paul; Boyington, John

    2006-01-01

    Prison health in England and Wales has seen rapid reform and modernization. Previously it was characterized by over-medicalization, difficulties in staff recruitment, and a lack of professional development for staff. The Department of Health assumed responsibility from Her Majesty’s Prison Service for health policymaking in 2000, and full budgetary and health care administration control were transferred by April 2006. As a result of this reorganization, funding has improved and services now relate more to assessed health need. There is early but limited evidence that some standards of care and patient outcomes have improved. The reforms address a human rights issue: that prisoners have a right to expect their health needs to be met by services that are broadly equivalent to services available to the community at large. We consider learning points for other countries which may be contemplating prison health reform, particularly those with a universal health care system. PMID:17008562

  13. The First Step in Health Reform for Those With Serious Mental Illness: Integrating the Dis-Integrated Mental Health System.

    Science.gov (United States)

    Geller, Jeffrey L

    2015-12-01

    Increasing attention is being directed toward meeting the psychiatric and medical needs of persons with persistent or recurrent mental illness through the integration of behavioral and medical healthcare. There are many models being considered or tested to achieve this objective. These models, however, generally ignore the challenge of integrating systems that are themselves dis-integrated. Also ignored is the fact that many persons with persistent or recurrent mental illness operate in the context of an array of entitlements; receive "services" from the criminal justice, as well as the health and behavioral health systems; and all these systems are both siloed and fail to meet the needs of this population. This article examines the current state of the cornucopia of services available to individuals with persistent or recurrent mental illness inclusive of federal statutes and policies to impact these services. Recommendations are made to move the dis-integrated system of mental health services toward an internally integrated system that would have the capacity to become integrated with a medical system of care and treatment to achieve a behavioral-medical integrated health delivery system.

  14. Primary Health Care Reform in Portugal: Portuguese, modern and innovative.

    Science.gov (United States)

    Biscaia, André Rosa; Heleno, Liliana Correia Valente

    2017-03-01

    The 2005 Portuguese primary health care (CSP) reform was one of the most successful reforms of the country's public services. The most relevant event was the establishment of Family Health Units (USF): voluntary and self-organized multidisciplinary teams that provide customized medical and nursing care to a group of people. Then, the remaining realms of CSP were reorganized with the establishment of Health Center Clusters (ACeS). Clinical governance was implemented aiming at achieving health gains by improving quality and participation and accountability of all. This paper aims to characterize the 2005 reform of Portuguese CSP with an analysis of its systemic and local realms. This is a case study of a CSP reform of a health system with documentary analysis and description of one of its facilities. This reform was Portuguese, modern and innovative. Portuguese by not breaking completely with the past, modern because it has adhered to technology and networking, and innovative because it broke with the traditional hierarchized model. It fulfilled the goal of a reform: it achieved improvements with greater satisfaction of all and health gains.

  15. Physician payments under health care reform.

    Science.gov (United States)

    Dunn, Abe; Shapiro, Adam Hale

    2015-01-01

    This study examines the impact of major health insurance reform on payments made in the health care sector. We study the prices of services paid to physicians in the privately insured market during the Massachusetts health care reform. The reform increased the number of insured individuals as well as introduced an online marketplace where insurers compete. We estimate that, over the reform period, physician payments increased at least 11 percentage points relative to control areas. Payment increases began around the time legislation passed the House and Senate-the period in which their was a high probability of the bill eventually becoming law. This result is consistent with fixed-duration payment contracts being negotiated in anticipation of future demand and competition. Published by Elsevier B.V.

  16. Oncology payment reform to achieve real health care reform.

    Science.gov (United States)

    McClellan, Mark B; Thoumi, Andrea I

    2015-05-01

    Cancer care is transforming, moving toward increasingly personalized treatment with the potential to save and improve many more lives. Many oncologists and policymakers view current fee-for-service payments as an obstacle to providing more efficient, high-quality cancer care. However, payment reforms create new uncertainties for oncologists and may be challenging to implement. In this article, we illustrate how accountable care payment reforms that directly align payments with quality and cost measures are being implemented and the opportunities and challenges they present. These payment models provide more flexibility to oncologists and other providers to give patients the personalized care they need, along with more accountability for demonstrating quality improvements and overall cost or cost growth reductions. Such payment reforms increase the importance of person-level quality and cost measures as well as data analysis to improve measured performance. We describe key features of quality and cost measures needed to support accountable care payment reforms in oncology. Finally, we propose policy recommendations to move incrementally but fundamentally to payment systems that support higher-value care in oncology. Copyright © 2015 by American Society of Clinical Oncology.

  17. National Health Care Reform, Medicaid, and Children in Foster Care.

    Science.gov (United States)

    Halfon, Neal; And Others

    1994-01-01

    Outlines access to health care for children in out-of-home care under current law, reviews how health care access for these children would be affected by President Clinton's health care reform initiative, and proposes additional measures that could be considered to improve access and service coordination for children in the child welfare system.…

  18. Improving the quality of Health Care in the Romanian public health system--a priority in the reform process.

    Science.gov (United States)

    Purcărea, V L; Coculescu, B I; Coculescu, E C

    2015-01-01

    To meet the shortfalls caused by the economic crisis, the Romanian medical system needed an objective analysis of the quality of medical care as a whole, of the entire package of health services as well as accountable joint efforts to identify system problems and, especially, firm action without compromising resolution, regardless of any limitations or emotional picture. In addition, last but not least, the judicious use of available resources.

  19. Equidad y reformas de los sistemas de salud en Latinoamérica Equity and health systems reform in Latin America

    Directory of Open Access Journals (Sweden)

    Ingrid Vargas

    2002-08-01

    Full Text Available El fin último de cualquier sistema de salud es contribuir a la mejora de la salud de la población y hacerlo de la manera más eficiente posible. Buscando mejorar las condiciones de eficiencia y equidad en que se prestan los servicios de salud, numerosos países en todo el mundo, incluyendo los latinoamericanos, han implementado reformas. A pesar de la aparente coincidencia en los objetivos de las reformas, la forma en que se implementan responden a conceptos y valores diferentes. En este artículo analizamos los valores, igualitarios y neoliberales, subyacentes en los distintos conceptos de equidad. A partir de ellos desarrollamos criterios que nos permitan interpretar algunas de las estrategias, financiamiento y prestación de los servicios de salud aplicados por las reformas de los sistemas de salud en Latinoamérica. Estos criterios son aplicados a las políticas de financiamiento y prestaciones de las reformas aplicadas en los sistemas de salud de Colombia y Costa Rica.The aim of any health care system is to help improve the people's health, and to do so as efficiently as possible. In order to improve the efficiency and equity of health services provision, many countries around the world have implemented reforms, including several Latin American nations. However similar the objectives may appear, the various ways societies implement such reforms reflect different values and concepts. This article analyzes the egalitarian and neoliberal values underlying different concepts of equity in health care. The authors develop criteria to interpret selected health services funding and provision strategies in Latin American health system reforms. These criteria are then applied to health care financing and delivery policies under the reforms currently being implemented in Colombia and Costa Rica.

  20. Health Care Reform and Social Movements in the United States

    Science.gov (United States)

    Hoffman, Beatrix

    2003-01-01

    Because of the importance of grassroots social movements, or “change from below,” in the history of US reform, the relationship between social movements and demands for universal health care is a critical one. National health reform campaigns in the 20th century were initiated and run by elites more concerned with defending against attacks from interest groups than with popular mobilization, and grassroots reformers in the labor, civil rights, feminist, and AIDS activist movements have concentrated more on immediate and incremental changes than on transforming the health care system itself. However, grassroots health care demands have also contained the seeds of a wider critique of the American health care system, leading some movements to adopt calls for universal coverage. PMID:12511390

  1. The imperative for systems thinking to promote access to medicines, efficient delivery, and cost-effectiveness when implementing health financing reforms: a qualitative study.

    Science.gov (United States)

    Achoki, Tom; Lesego, Abaleng

    2017-03-21

    also comes with many challenges. Decision-makers keen to achieve universal health coverage, must view health financing reform through the holistic lens of the health system and its interactions with the population, in order to anticipate its potential benefits and risks. Failure to embrace this comprehensive approach, would potentially lead to counterproductive results.

  2. Health Care Service Reform in Colombia

    OpenAIRE

    Loaiza Quintero, Osmar Leandro

    2005-01-01

    This paper aims to provide a general overview of the health care sector reform in Colombia, which introduced the market principles of competition into the sector functioning. Therefor, this article analyzes its antecedents, characteristics and consequences. Relying on the interpretation of the empirical evidence existing about this reform, the present analysis seeks to identify the key features on which it is based. The paper ends with some observations and criticism about the results and the...

  3. Nursing leadership and health sector reform.

    Science.gov (United States)

    Borthwick, C; Galbally, R

    2001-06-01

    The political, technological and economic changes that have occurred over the past decade are increasingly difficult to manage within the traditional framework of health-care, and the organisation of health-care is seen to need radical reform to sweep away many of the internal barriers that now divide one form of health-care, and one profession, from another. Nursing must equip itself with skills in advocacy and political action to influence the direction the system will take. Nursing currently suffers from a weakness in self-concept that goes hand in hand with a weakness in political status, and nursing leadership must build the foundations for both advocacy for others and self-advocacy for the nursing movement. The profession faces tensions between different conceptions of its role and status, its relationship to medicine, and its relationship to health. Health indices are tightly linked to status, and to trust, hope, and control of one's own life. Can nurses help empower others when they are not particularly good at empowering themselves? What will the role of the nurse be in creating the information flows that will guide people toward health? Nursing's long history of adaptation to an unsettled and negotiated status may mean that it is better fitted to make this adaptation than other more confident disciplines.

  4. Mental health care delivery system reform in Belgium: the challenge of achieving deinstitutionalisation whilst addressing fragmentation of care at the same time.

    Science.gov (United States)

    Nicaise, Pablo; Dubois, Vincent; Lorant, Vincent

    2014-04-01

    Most mental health care delivery systems in welfare states currently face two major issues: deinstitutionalisation and fragmentation of care. Belgium is in the process of reforming its mental health care delivery system with the aim of simultaneously strengthening community care and improving integration of care. The new policy model attempts to strike a balance between hospitals and community services, and is based on networks of services. We carried out a content analysis of the policy blueprint for the reform and performed an ex-ante evaluation of its plan of operation, based on the current knowledge of mental health service networks. When we examined the policy's multiple aims, intermediate goals, suggested tools, and their articulation, we found that it was unclear how the new policy could achieve its goals. Indeed, deinstitutionalisation and integration of care require different network structures, and different modes of governance. Furthermore, most of the mechanisms contained within the new policy were not sufficiently detailed. Consequently, three major threats to the effectiveness of the reform were identified. These were: issues concerning the relationship between network structure and purpose, the continued influence of hospitals despite the goal of deinstitutionalisation, and the heterogeneity in the actual implementation of the new policy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Health care reform: preparing the psychology workforce.

    Science.gov (United States)

    Rozensky, Ronald H

    2012-03-01

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

  6. Primary health care in China: is China's health reform reform for the whole nation?

    Science.gov (United States)

    Cheng, Jing-Min; Yuan, Yong-Xu; Lu, Wei; Yang, Le

    2017-07-01

    Good primary health care can enhance national health status at relatively low cost. The barefoot doctor model in China was once considered to have been a successful health care policy. It was a model which was followed by other low-developed or developing countries. In recent decades, the Chinese government promulgated a number of new policies and health reforms to improve its health care system. This paper aimed to highlight the great significance of primary health care and appeal to the policymakers to change the priority to primary health care in order to be able to guarantee universal health care for the whole nation at least at primary care level. This study discussed Chinese primary health care by reviewing its history and development. Chinese government's efforts do not seem to be leading to a completely successful outcome for all the people of China as a result of the substantial imbalance of investments between tertiary level hospitals and grass-root level health care institutions. The government appears to have neglected the importance of primary health care in the implementation of health systems and resources.

  7. Global development challenges and health care reform.

    Science.gov (United States)

    Preker, A S

    2001-01-01

    Changes in the role of the state and private sector are seen as central to success of many health care reforms. The article argues for a more focused "stewardship" function of governments in securing equity, efficiency, and quality objectives through more effective policy making (steering), regulating, contracting, and ensuring that adequate financing arrangements are available for the whole population. At the same time, the author argues a strong case for greater private participation in providing health services (rowing). The article reviews related reform trends in health care financing, generation of inputs and service providers. It concludes that reforms often fail, not because of a flawed technical design, but because of other factors. These include a lack of political commitment to change, resistance from vested stakeholders who fear loosing some of their existing benefits, and a failure by policymakers to translate successful aspects of the reforms into something visible that ordinary people and the public can see with their own eyes when next they use the reformed services.

  8. Connecting statewide health information technology strategy to payment reform.

    Science.gov (United States)

    Toussaint, John S; Queram, Christopher; Musser, Josephine W

    2011-03-01

    To develop an effective way to link statewide healthcare information technology strategy to payment reform. Investigation of what Wisconsin did to develop and publicly share provider performance data and then use those data to drive payment reform. We examine 2 statewide organizations (Wisconsin Collaborative for Healthcare Quality and Wisconsin Health Information Organization) and 1 integrated health system (ThedaCare) to evaluate how they pool data and use those data to measure provider performance. When aggregated data regarding health outcomes are shared, a clearer picture emerges of provider performance baselines and improvements with which payment models can be developed. Aggregating commercial and Medicare claims data will help states to better measure provider performance and to compare providers on quality and cost. The ability to compare performance using broad databases is necessary if the current payment system in the United States is to be reformed.

  9. Managing risk selection incentives in health sector reforms.

    Science.gov (United States)

    Puig-Junoy, J

    1999-01-01

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

  10. [Efficiency of medical and economic activities of a sanatorium-and-spa facility in the active phase of the public health system reform under macroeconomic instability].

    Science.gov (United States)

    Poliakov, B A; Kizeev, M V

    2010-01-01

    Results of a comprehensive study have demonstrated that the reform of the public health system currently underway in this country provides conditions for the extension of medical care based at sanatorium-and-spa facilities with simultaneous rise in relevant expenses. Bearing in mind the unstable macroeconomic situation, this requires thorough monitoring medical and economic activities of health resorts for the purpose of enhancing cost efficiency. The goal of optimization can be achieved by increasing competitive capacity based on strict control of expenditures and income redistribution for financing the most promising projects.

  11. The Big Ideas behind Whole System Reform

    Science.gov (United States)

    Fullan, Michael

    2010-01-01

    Whole system reform means that every vital part of the system--school, community, district, and government--contributes individually and in concert to forward movement and success, using practice, not research, as the driver of reform. With this in mind, several "big ideas", based on successful implementation, informed Ontario's reform…

  12. Health care reform in the USA: Recommendations from USA and non-USA radiologists.

    Science.gov (United States)

    Burke, Lauren Mb; Martin, Diego R; Bader, Till; Semelka, Richard C

    2012-02-28

    To compare the opinions and recommendations of imaging specialists from United States (USA) and non-USA developed nations for USA health care reform. A survey was emailed out to 18 imaging specialists from 17 non-USA developed nation countries and 14 radiologists within the USA regarding health care reform. The questionnaire contained the following questions: what are the strengths of your health care system, what problems are present in your nation's health care system, and what recommendations do you have for health care reform in the USA. USA and non-USA radiologists received the same questionnaire. Strengths of the USA health care system include high quality care, autonomy, and access to timely care. Twelve of 14 (86%) USA radiologists identified medicolegal action as a major problem in their health care system and felt that medicolegal reform was a critical aspect of health care reform. None of the non-USA radiologists identified medicolegal aspects as a problem in their own country nor identified it as a subject for USA health care reform. Eleven of 14 (79%) USA radiologists and 16/18 (89%) non-USA radiologists identified universal health care coverage as an important recommendation for reform. Without full universal coverage, meaningful health care reform will likely require medicolegal reform as an early and important aspect of improved and efficient health care.

  13. [The main directions of public health reforms in the Republic of Uzbekistan].

    Science.gov (United States)

    Ibragimov, A Iu; Asadov, D A; Menlikulov, P R

    2012-01-01

    The article covers the directive documents regulating the development of public health. The main directions of reforms of public health system of the Republic of Uzbekistan are covered too. The statistical data reflecting the structural changes in public health is presented. The purpose and tasks of reformation of the key public health issues in the Republic of Uzbekistan are explained.

  14. Delivering Health Care and Mental Health Care Services to Children in Family Foster Care after Welfare and Health Care Reform.

    Science.gov (United States)

    Simms, Mark D.; Freundlich, Madelyn; Battistelli, Ellen S.; Kaufman, Neal D.

    1999-01-01

    Describes the essential features of a health care system that can meet the special needs of children in out-of-home care. Discusses some of the major recent changes brought about by welfare and health care reform. Notes that it remains to be seen whether the quality of services will improve as a result of these reforms. (Author)

  15. Communication problems in Swedish Mental Health reform.

    Science.gov (United States)

    Aberg, Jonas

    2005-01-01

    In a study on the implementation of the Swedish Mental Health reform in the county of Gavleborg in Sweden, attention was called, at an early stage, to the need for relevant theories on the nature of the obstacles that slowed down the reform process. Data had initially been gathered from interviews with persons from all levels of the implementation work. A Grounded Theory (GT) study was carried out using these data in order to generate a theory on the nature of the obstacles. Two separate analyses were made, one based on data from experts and decision makers and the other based on data from consumers and staff. Each of these analyses generated a theory with great explanatory and predictive value. In a further analysis, it became possible to merge the theories into an expanded theory with a greater general validity within the entire field of the Swedish Mental Health reform process. The expanded theory states that the psychiatric reform in Sweden is slowed down by obstacles preventing the transfer of information: 1) between staff in the mental health services and staff in the social services; 2) between social services' care givers and consumers. One reason for not removing these obstacles is that they serve an important purpose for those involved, in terms of preserving group identity, which gives them the opportunity to exert influence on their situation and provides room for manoeuvring.

  16. Community health changes under welfare reform.

    Science.gov (United States)

    Burger, Susan

    2004-01-01

    This comparative case study examined changes in community health under New Jersey welfare reform policy implementation (1994-2001). The boundaries of these case descriptions were directed by Milii's ecological framework for policy studies. The separate cases consist of descriptions of changes in social climate and health indicators within Camden, Essex, and Hudson counties in New Jersey. Data analysis revealed a greater public health challenge in these counties than the state as a whole. A large increase in the numbers of low income and uninsured in the population may begin in 2004, 2 years following the 5-year lifetime limit of the receipt of welfare benefits. A growing uninsured population would place additional burdens on the abilities of safety net providers to meet health care needs of vulnerable populations. If left unchanged, these wider effects of the New Jersey welfare reform policy would have negative implications for improving quality of care.

  17. Reforming the American Military Officer Personnel System

    Science.gov (United States)

    2015-12-02

    AGING PUBLIC SAFETY SCIENCE AND TECHNOLOGY TERRORISM AND HOMELAND SECURITY Testimony Reforming the American Military Officer Personnel System Bernard......For a long time, I have argued and written about the need to reform the career military structure by increasing the maximum years of service an

  18. Improving Rural Health: How system-level innovation and policy reform can enhance health outcomes across the United States.

    Science.gov (United States)

    Gondi, Suhas; Patel, Kavita

    2016-01-01

    The United States is hailed as providing the most advanced health care the world has to offer. With cutting-edge medical devices, groundbreaking procedures, and innovative technologies, our hospitals and medical centers define what the global community sees as modern biomedicine. Engineers and clinicians continue to push and reshape this standard with new inventions enabled by a rapidly developing knowledge base. However, the fruit of this advancement has not benefited Americans equally. Millions still face significant obstacles to access health care, and our rural communities in particular have been left behind (see also "The Challenge of Rural Health Care").

  19. Solid oxide fuel cell steam reforming power system

    Science.gov (United States)

    Chick, Lawrence A.; Sprenkle, Vincent L.; Powell, Michael R.; Meinhardt, Kerry D.; Whyatt, Greg A.

    2013-03-12

    The present invention is a Solid Oxide Fuel Cell Reforming Power System that utilizes adiabatic reforming of reformate within this system. By utilizing adiabatic reforming of reformate within the system the system operates at a significantly higher efficiency than other Solid Oxide Reforming Power Systems that exist in the prior art. This is because energy is not lost while materials are cooled and reheated, instead the device operates at a higher temperature. This allows efficiencies higher than 65%.

  20. Health sector reforms and human resources for health in Uganda and Bangladesh: mechanisms of effect

    Directory of Open Access Journals (Sweden)

    Kielmann Tara

    2007-02-01

    Full Text Available Abstract Background Despite the expanding literature on how reforms may affect health workers and which reactions they may provoke, little research has been conducted on the mechanisms of effect through which health sector reforms either promote or discourage health worker performance. This paper seeks to trace these mechanisms and examines the contextual framework of reform objectives in Uganda and Bangladesh, and health workers' responses to the changes in their working environments by taking a 'realistic evaluation' approach. Methods The study findings were generated by triangulating both qualitative and quantitative methods of data collection and analysis among policy technocrats, health managers and groups of health providers. Quantitative surveys were conducted with over 700 individual health workers in both Bangladesh and Uganda and supplemented with qualitative data obtained from focus group discussions and key interviews with professional cadres, health managers and key institutions involved in the design, implementation and evaluation of the reforms of interest. Results The reforms in both countries affected the workforce through various mechanisms. In Bangladesh, the effects of the unification efforts resulted in a power struggle and general mistrust between the two former workforce tracts, family planning and health. However positive effects of the reforms were felt regarding the changes in payment schemes. Ugandan findings show how the workforce responded to a strong and rapidly implemented system of decentralisation where the power of new local authorities was influenced by resource constraints and nepotism in recruitment. On the other hand, closer ties to local authorities provided the opportunity to gain insight into the operational constraints originating from higher levels that health staff were dealing with. Conclusion Findings from the study suggest that a reform planners should use the proposed dynamic responses model to

  1. Productivity and quality of Dutch hospitals during system reform

    OpenAIRE

    van Ineveld, Martin; van Oostrum, Jeroen; Vermeulen, Roel; Steenhoek, Adri; van de Klundert, Joris

    2015-01-01

    markdownabstractThis study addresses the productivity of Dutch hospitals since the start of the health systems reform in 2005. We consider DEA based measures, which include efficiency and quality for the complete set of Dutch hospitals and present cross-sectional and longitudinal analysis. In particular, we consider how hospital efficiency has developed. As the reform created an environment of regulated competition, we pay special attention to relative efficiency. Our results suggest that the...

  2. Welfare Reform and Children's Health.

    Science.gov (United States)

    Baltagi, Badi H; Yen, Yin-Fang

    2016-03-01

    This study investigates the effect of the Temporary Aid to Needy Families (TANF) program on children's health outcomes using data from the Survey of Income and Program Participation over the period 1994 to 2005. The TANF policies have been credited with increased employment for single mothers and a dramatic drop in welfare caseload. Our results show that these policies also had a significant effect on various measures of children's medical utilization among low-income families. These health measures include a rating of the child's health status reported by the parents, the number of times that parents consulted a doctor, and the number of nights that the child stayed in a hospital. We compare the overall changes of health status and medical utilization for children with working and nonworking mothers. We find that the child's health status as reported by the parents is affected by the maternal employment status. Copyright © 2014 John Wiley & Sons, Ltd.

  3. Employer-sponsored health insurance and the promise of health insurance reform.

    Science.gov (United States)

    Buchmueller, Thomas C; Monheit, Alan C

    2009-01-01

    The central role that employers play in financing health care is a distinctive feature of the U.S. health care system, and the provision of health insurance through the workplace has important implications well beyond its role as a source of health care financing. In this paper, we consider the "goodness of fit" of employer-sponsored health insurance (ESI) in the current economic and health insurance environments and in light of prospects for a vigorous national debate over the shape of health care reform. The main issue that we explore is whether ESI can have a viable role in health system reform efforts or whether such coverage will need to be significantly modified or even abandoned as reform seeks to address important issues in the efficient provision and equitable distribution of health insurance coverage.

  4. Mental Health under National Health Care Reform: The Empirical Foundations.

    Science.gov (United States)

    Hudson, Christopher G.; DeVito, Jo Anne

    1994-01-01

    Reviews research pertinent to mental health services under health care reform proposals. Examines redistributional impact of inclusion of outpatient mental health benefits, optimal benefit packages, and findings that mental health services lower medical utilization costs. Argues that extending minimalist model of time-limited benefits to national…

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

    Science.gov (United States)

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

    2013-02-01

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

  6. Dilemma of healthcare reform and invention of new discipline of health fiscalogy.

    Science.gov (United States)

    Liu, Jitong; Miao, Jianchun; Zhang, Dongqi

    2016-01-01

    China's Reform and Open up Policy in 1980s has brought rapid economic development to Chinese society. With the deepening of economic reform, the withdrawal of the state in China has had visible and worrisome consequences for health and for the functioning of health services. The new round of healthcare reform after 2009 has made significant achievements on improving fundamental health and bringing back the nature of welfare of health. However, the financing mechanism of health system has not been established, and the underlying reason behind the healthcare reform dilemma and the theoretical solution need to be found. This study used the methods of literature review, theoretical research and comparative research to summarize and analyze the reasons and solutions of current dilemma in healthcare reform, and created the new discipline of health fiscalogy through theoretical analysis and vertical and horizontal comparison of healthcare system, especially health financing. Dilemma in healthcare system emerged from the circumstances of rapid process of industrialization, urbanization and population aging, including the profit-driven phenomena, tendency of excessive marketization in public hospitals, strained doctor-patient relationship, high disease burden on individuals and families, and so on. It can be concluded that the theoretical basis of healthcare system and the nature of health resources are crucial in solving the dilemma of healthcare reform. The theoretical basis of healthcare reform should be health fiscalogy focusing on government as the main body of health care responsibility rather than health economics focusing on anti-monopoly. There are two key differences between health economics and health fiscalogy: responsible person/department of disease and health welfare, and nature of resource. The new discipline of health fiscalogy has universal and important implications on both China's healthcare reform and the healthcare reform in the world. China

  7. Unpacking “Health Reform” and “Policy Capacity”; Comment on “Health Reform Requires Policy Capacity”

    Directory of Open Access Journals (Sweden)

    David Legge

    2015-10-01

    Full Text Available Health reform is the outcome of dispersed policy initiatives in different sectors, at different levels and across time. Policy work which can drive coherent health reform needs to operate across the governance structures as well as the institutions that comprise healthcare systems. Building policy capacity to support health reform calls for clarity regarding the nature of such policy work and the elements of policy capacity involved; and for evidence regarding effective strategies for capacity building.

  8. Ukraine: health system review.

    Science.gov (United States)

    Lekhan, Valery; Rudiy, Volodymyr; Shevchenko, Maryna; Nitzan Kaluski, Dorit; Richardson, Erica

    2015-03-01

    This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population's health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3 % in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conflict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system. World Health Organization 2015 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

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

    African Journals Online (AJOL)

    Background: Literature on the impact of health sector reform (HSR) on motivation of healthcare workers (HWs) and performance in health service provision in developing countries is still limited. Objective: To describe the impact of HSR on HW motivation and performance in providing quality health care in Tanzania.

  10. Health Care Reform: Opportunities for Improving Adolescent Health.

    Science.gov (United States)

    Irwin, Charles E., Jr., Ed.; And Others

    Health care reform represents a major step toward achieving the goal of improved preventive and primary care services for all Americans, including children and adolescents. Adolescence is a unique developmental age district from both childhood and adulthood with special vulnerabilities, health concerns, and barriers to accessing health care. It is…

  11. Reforma integral para mejorar el desempeño del sistema de salud en México Comprehensive reform to improve health system performance in Mexico

    Directory of Open Access Journals (Sweden)

    Julio Frenk

    2007-01-01

    . Several structural limitations have hampered performance and limited the progress of the health system. Conscious that the lack of financial protection was the major bottleneck, Mexico has embarked on a structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH, which has introduced new financial rules and incentives. The main innovation of the reform has been the Seguro Popular (Popular Health Insurance, the insurance-based component of the SSPH, aimed at funding health care for all those families, most of them poor, who had been previously excluded from social health insurance. The reform has allowed for a substantial increase in public investment in health while realigning incentives towards better technical and interpersonal quality. This paper describes the main features and initial results of the Mexican reform effort, and derives lessons for other countries considering health-system transformations under similarly challenging circumstances.

  12. The readiness of addiction treatment agencies for health care reform.

    Science.gov (United States)

    Molfenter, Todd; Capoccia, Victor A; Boyle, Michael G; Sherbeck, Carol K

    2012-05-02

    The Patient Protection and Affordable Care Act (PPACA) aims to provide affordable health insurance and expanded health care coverage for some 32 million Americans. The PPACA makes provisions for using technology, evidence-based treatments, and integrated, patient-centered care to modernize the delivery of health care services. These changes are designed to ensure effectiveness, efficiency, and cost-savings within the health care system.To gauge the addiction treatment field's readiness for health reform, the authors developed a Health Reform Readiness Index (HRRI) survey for addiction treatment agencies. Addiction treatment administrators and providers from around the United States completed the survey located on the http://www.niatx.net website. Respondents self-assessed their agencies based on 13 conditions pertinent to health reform readiness, and received a confidential score and instant feedback.On a scale of "Needs to Begin," "Early Stages," "On the Way," and "Advanced," the mean scores for respondents (n = 276) ranked in the Early Stages of health reform preparation for 11 of 13 conditions. Of greater concern was that organizations with budgets of  $5 million to have information technology (patient records, patient health technology, and administrative information technology), evidence-based treatments, quality management systems, a continuum of care, or a board of directors informed about PPACA.The findings of the HRRI indicate that the addiction field, and in particular smaller organizations, have much to do to prepare for a future environment that has greater expectations for information technology use, a credentialed workforce, accountability for patient care, and an integrated continuum of care.

  13. What Health Care Reform Means for Immigrants: Comparing the Affordable Care Act and Massachusetts Health Reforms.

    Science.gov (United States)

    Joseph, Tiffany D

    2016-02-01

    The 2010 Patient Protection and Affordable Care Act (ACA) was passed to provide more affordable health coverage to Americans beginning in 2014. Modeled after the 2006 Massachusetts health care reform, the ACA includes an individual mandate, Medicaid expansion, and health exchanges through which middle-income individuals can purchase coverage from private insurance companies. However, while the ACA provisions exclude all undocumented and some documented immigrants, Massachusetts uses state and hospital funds to extend coverage to these groups. This article examines the ACA reform using the Massachusetts reform as a comparative case study to outline how citizenship status influences individuals' coverage options under both policies. The article then briefly discusses other states that provide coverage to ACA-ineligible immigrants and the implications of uneven ACA implementation for immigrants and citizens nationwide. Copyright © 2016 by Duke University Press.

  14. Does dental health of 6-year-olds reflect the reform of the Israeli dental care system?

    Science.gov (United States)

    Natapov, Lena; Sasson, Avi; Zusman, Shlomo P

    2016-01-01

    The National health insurance law enacted in 1995 did not include dental care in its basket of services. Dental care for children was first included in 2010, initially up till 8 years of age. The eligibility age rose to 12 years in 2013. The dental survey of 6 year-olds in 2007 found that the average of decayed, missing and filled teeth index (dmft) was 3.31 and 35 % of children were caries free. The current cross sectional survey of dental health for 6 year-olds was conducted as a comparison to the pre-reform status. Twenty-three local authorities were randomly selected nationwide. Two Grade 1 classes were randomly chosen in each. The city of Jerusalem was also included in the survey because of its size. The children were examined according to the WHO Oral Health Survey Methods 4th ed protocol. The dental caries index for deciduous teeth (dmft: decayed, missing, filled teeth) was calculated. One thousand two hundred ten children were examined. 61.7 % of the children suffered from dental decay and only 38.3 % were caries free. The mean dmft was 2.56; d = 1.41 (teeth with untreated caries), f = 1.15 (teeth damaged by decay and restored), virtually none were missing due to caries. Dental caries prevalence was rather consistent, an average of over 2 teeth affected per child. Although there is no major change in comparison to former surveys, there is more treated than untreated disease. In the present survey the f component is higher than in the past, especially in the Jewish sector where it is the main component. It is still lower in the Arab sector. Although the level of dental disease remained rather constant, an increase in the treatment component was observed. In order to reduce caries prevalence, preventive measures such as school dental services and drinking water fluoridation should be extended and continued. Primary preventive dental services should be established for children from birth, with an emphasis on primary health care and educational

  15. Change theory for accounting system reform in health sector: a case study of kerman university of medical sciences in iran

    National Research Council Canada - National Science Library

    Mehrolhassani, Mohammad Hossein; Emami, Mozhgan

    2013-01-01

    ... fluctuations and to predict the changing patterns of individuals and technology. The current study aimed to explore whether the change in the public accounting system of the Iranian health sector has followed Kurt Lewin's change theory...

  16. Health Care Reform: Impact on Total Joint Replacement.

    Science.gov (United States)

    Chambers, Monique C; El-Othmani, Mouhanad M; Saleh, Khaled J

    2016-10-01

    The US health care system has been fragmented for more than 40 years; this model created a need for modification. Sociopoliticomedical system-related factors led to the Affordable Care Act (ACA) and a restructuring of health care provision/delivery. The ACA increases access to high-quality "affordable care" under cost-effective measures. This article provides a comprehensive review of health reform and the motivating factors that drive policy to empower arthroplasty providers to effectively advocate for the field of orthopedics as a whole, and the patients served. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. "Barking up the right tree": challenges for health care reform.

    Science.gov (United States)

    Sturmberg, Joachim P; O'Halloran, Diana E; Jackson, Claire; Mitchell, Christopher D; Martin, Carmel M

    2009-07-20

    Current approaches to health care reform are largely based on the metaphor of imminent flood waves threatening to inundate the health care system. This metaphor reflects the system's preoccupation with disease and disease management in a hospital-centric environment. We suggest that the debate needs to be reframed around health, or more precisely the patient's health experience. Most patients are healthy most of the time, and even those with identifiable morbidities generally regard themselves as being in good health. The majority of people receive most of their care in the community from primary care professionals. An integrated, effective and efficient primary health care system supports continuity of care through a primary care provider and fosters clinical leadership that is supported by other primary health care professionals and medical specialists. Each primary care setting will have its own model that best provides flexible and responsive services to meet its patients' needs and expectations.

  18. Health policy reform in the People's Republic of China.

    Science.gov (United States)

    Yang, P L; Lin, V; Lawson, J

    1991-01-01

    With very limited resources, China has developed perhaps the world's largest network of health care services. The health status of its peoples has risen dramatically during the past 40 years. The reasons for these achievements are complex and include an ideology of equity for all citizens, the near universal availability of adequate food, education, housing, jobs, and transport, and the universal availability of accessible and affordable treatment and preventive health services. Despite these achievements China is facing new problems. These include the aging of the population, continued growth of the population leading to ever increasing demands on all sectors of the economy including health services, urban-rural inequalities, low productivity in the health services, lack of legal safeguards for health protection, a continued burden of infectious and endemic diseases, weak infrastructure for prevention and primary health care, and an increasing burden of chronic diseases associated with tobacco smoking and atherosclerotic circulatory diseases and trauma due to traffic accidents and occupational hazards. Decentralized management, financial incentives for health workers, privatization of medical practitioners, health legislation, and changes to health insurance arrangements have been introduced as a means of addressing the issues. The outcomes have been uneven, with little or no improvements in some problems and good progress in others. Changes in the health system appear to be reflecting not only health reform measures but also general economic reforms.

  19. Sistemas de salud en condiciones de mercado: las reformas del último cuarto de siglo* / Health systems under market conditions: the reforms carried out during the last quarter century

    Directory of Open Access Journals (Sweden)

    Álvaro Franco-Girald

    2014-01-01

    Full Text Available Objetivo: el ensayo explora los cambios a partir de la introducción de los mecanismos del mercado en las reformas del último cuarto de siglo. Metodología: se toma como eje analítico las condiciones de mercado, determinante de las configuraciones y de los resultados que presentan actualmente los sistemas de salud en la mayoría de los países. Se complementa con el análisis de la presencia o no de mecanismos de regulación que permitan reducir el impacto negativo de las imperfecciones del mercado sobre la salud. Discusión: el artículo parte de caracterizar varios tipos de mercados de servicios de salud y considera, de otro lado, la función estatal, y su articulación en la mezcla público- privado, luego de analizar algunas tipologías de los sistemas de salud relacionadas con los modelos de mercado. Conclusión: los mecanismos del mercado introducidos en las reformas de salud en el último cuarto de siglo en la mayoría de países de América Latina (al han transformado los servicios de salud en favor del mercado financiero transnacional, y han generado inequidad, ineficiencia, corrupción, desequilibrio financiero del sistema de salud, y malogrado las condiciones de salud de la población Objective: the essay explores the changes based on market mechanisms introduced in the reforms of the last quarter century. Methodology: market conditions are taken as an analytical axis determining the configurations and results of health systems seen today in the majority of countries. The analysis is complemented by the presence or absence of regulatory mechanisms which reduce the negative impact of market imperfections on health. Discussion: this paper aims to characterize various health care market types while taking into account the function of the State, and its articulation within the public-private sector after analyzing some of the types of health system that are related to the market models. Conclusion: the market mechanisms introduced in

  20. The new institutionalist approaches to health care reform: lessons from reform experiences in Central Europe.

    Science.gov (United States)

    Sitek, Michał

    2010-08-01

    This article discusses the applicability of the new institutionalism to the politics of health care reform in postcommunist Central Europe. The transition to a market economy and democracy after the fall of communism has apparently strengthened the institutional approaches. The differences in performance of transition economies have been critical to the growing understanding of the importance of institutions that foster democracy, provide security of property rights, help enforce contracts, and stimulate entrepreneurship. From a theoretical perspective, however, applying the new institutionalist approaches has been problematic. The transitional health care reform exposes very well some inherent weaknesses of existing analytic frameworks for explaining the nature and mechanisms of institutional change. The postcommunist era in Central Europe has been marked by spectacular and unprecedented radical changes, in which the capitalist system was rebuilt in a short span of time and the institutions of democracy became consolidated. Broad changes to welfare state programs were instituted as well. However, the actual results of the reform processes represent a mix of change and continuity, which is a challenge for the theories of institutional change.

  1. Productivity and quality of Dutch hospitals during system reform

    NARCIS (Netherlands)

    B.M. van Ineveld (Martin); J.M. van Oostrum (Jeroen); R. Vermeulen (Roel); A. Steenhoek (Adri); J.J. van de Klundert (Joris)

    2016-01-01

    markdownabstractThis study addresses the productivity of Dutch hospitals since the start of the health systems reform in 2005. We consider DEA based measures, which include efficiency and quality for the complete set of Dutch hospitals and present cross-sectional and longitudinal analysis. In

  2. School Readiness Goal Begins with Health Care Reform.

    Science.gov (United States)

    Penning, Nick

    1992-01-01

    Currently 59 bills are awaiting Congressional action. Meanwhile, a national coalition of economists and medical specialists (the National Leadership Coalition for Health Care Reform) are circulating a sensible consensus health reform plan proposing national practice guidelines; universal health care access; and efficient cost control, delivery,…

  3. Sociology of health care reform: building on research and analysis to improve health care.

    Science.gov (United States)

    Mechanic, David; McAlpine, Donna D

    2010-01-01

    Health reform efforts in the United States have focused on resolving some of the fundamental irrationalities of the system whereby costs and services utilization are often not linked to improved patient outcomes. Sociologists have contributed to these efforts by documenting the extent of problems and by confronting central questions around issues of accountability, reimbursement, and rationing that must be addressed in order to achieve meaningful reform that controls costs, expands access, and improves quality. Major reform rarely occurs without "paying off" powerful interests, a particularly difficult challenge in the context of a large and growing deficit. Central to achieving increased coverage and access, high quality, and cost control is change in reimbursement arrangements, increased accountability for both costs and outcomes, and criteria for rationing based on the evidence and accepted as legitimate by all stakeholders. Consensus about health reform requires trust. The traditional trust patients have in physicians provides an important base on which to build.

  4. Research for optimization in organ donation in a macro-area after federal reform of the Italian health system.

    Science.gov (United States)

    Pretagostini, R; Fiaschetti, P; Peritore, D; Stabile, D; Gabbrielli, F; Oliveti, A; Vaia, F

    2012-09-01

    Law number 91, dated April 1, 1999, established an organizational model for the activities of donation, retrieval, and transplantation of organs consisting of 4 levels: national, interregional, regional, and local. After 12 years this organizational project, called the "National Transplant Network," has reached an excellent level of effectiveness and efficiency. Since 2001 regional administrative districts have been entrusted increasingly with responsibilities concerning health. In 2008 health federalism was approved and in 2010 the federal health fiscal system entered in force. In a country with a federal organization, where regional districts are completely autonomous, is there a reason to still have a national transplant center and 3 interregional transplantation centers? We have developed a hypothesis on the function of Interregional Transplant Centers (CIR). The risk of federalism is the fragmentation of the National Healthcare System. To adequately meet the needs of citizens, smaller regions should sign agreements with larger regions regarding transplantation programs that require a large pool of donors whereas they could retain management of patients during the presurgery and postsurgery phases. The CIR should be committed to increase organ donation, to establish shared protocols and procedures, to disseminate knowledge, and to ensure equal access to health care. In conclusion, the adoption of health and fiscal federalism provides an opportunity to build healthcare systems to optimize resources. The network model should be kept but it is necessary to overcome localism and create positive federalism. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. South Africa's universal health coverage reforms in the post-apartheid period.

    Science.gov (United States)

    van den Heever, Alexander Marius

    2016-12-01

    In 2011, the South African government published a Green Paper outlining proposals for a single-payer National Health Insurance arrangement as a means to achieve universal health coverage (UHC), followed by a White Paper in 2015. This follows over two decades of health reform proposals and reforms aimed at deepening UHC. The most recent reform departure aims to address pooling and purchasing weaknesses in the health system by internalising both functions within a single scheme. This contrasts with the post-apartheid period from 1994 to 2008 where pooling weaknesses were to be addressed using pooling schemes, in the form of government subsidies and risk-equalisation arrangements, external to the public and private purchasers. This article reviews both reform paths and attempts to reconcile what may appear to be very different approaches. The scale of the more recent set of proposals requires a very long reform path because in the mid-term (the next 25 years) no single scheme will be able to raise sufficient revenue to provide a universal package for the entire population. In the interim, reforms that maintain and improve existing forms of coverage are required. The earlier reform framework (1994-2008) largely addressed this concern while leaving open the final form of the system. Both reform approaches are therefore compatible: the earlier reforms addressed medium- to long-term coverage concerns, while the more recent define the long-term institutional goal. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. The reform of the essential medicines system in China: a comprehensive approach to universal coverage

    Directory of Open Access Journals (Sweden)

    Sarah L. Barber

    2013-06-01

    Full Text Available To achieve universal health care coverage, the Government of China invested in large–scale health care reform. One of the major reform components focuses on improving access to essential medicines to reduce high out–of–pocket medicines spending. The reform policies were comprehensive, and included systematic selection of essential medicines to improve availability, centralized procurement and tendering at provincial levels, pricing policies, provision of essential medicines at cost in primary level facilities, and stronger quality and safety standards. While challenges remain, China's system sets an example of a comprehensive approach that other countries could emulate in reforming their health care systems and achieving universal coverage.

  7. [Good governance in the Burundi health sector financial reform].

    Science.gov (United States)

    Peerenboom, Peter Bob; Basenya, Olivier; Bossuyt, Michel; Ndayishimiye, Juvénal; Ntakarutimana, Léonard; van de Weerd, Jennie

    2014-01-01

    Burundi introduced free healthcare for children under five and pregnant women in 2006. In 2010, this was linked to the Performance-Based Financing (PBF) approach. This article is designed to identify factors in these health financing reforms that have contributed to good governance in the health sector. Six criteria of good governance were used as an analytical framework. Results were derived from official reports and the international literature. The main contributions of these reforms to good governance in Burundi were the separation of functions, transparency in management and a meticulous description of administrative procedures. Scrupulous monitoring resulted in several corrective measures. Several unresolved questions remain, concerning the integration of vertical programmes and the sustainability of the system given the considerable costs, since funding is not yet fully ensured by the State and its partners.

  8. Future directions for Public Health Education reforms in India

    Directory of Open Access Journals (Sweden)

    Sanjay P Zodpey

    2014-09-01

    Full Text Available Health systems globally are experiencing a shortage of competent public health professionals. Public health education across developing countries is stretched by capacity generation and maintaining an adequate ‘standard’ and ‘quality’ of their graduate product. We analyzed the Indian public health education scenario using the institutional and instructional reforms framework advanced by the Lancet Commission report on Education of Health Professionals. The emergence of a new century necessitates a re-visit on the institutional and instructional challenges surrounding public health education. Currently, there is neither an accreditation council nor a formal structure or system of collaboration between academic stakeholders. Health systems have little say in health professional training with limited dialogue between health systems and public health education institutions. Despite a recognized shortfall of public health professionals, there are limited job opportunities for public health graduates within the health system and absence of a structured career pathway for them. Public health institutions need to evolve strategies to prevent faculty attrition. A structured development program in teaching-learning methods and pedagogy is the need of the hour.

  9. Main Reform on Higher Education Systems in Korea

    Directory of Open Access Journals (Sweden)

    Jeong-Kyu Lee

    2000-11-01

    Full Text Available This article examines the main reform in current Korean higher education by briefly reviewing a historical perspective on higher education reform, then discussing the main issues of recent education reform since 1994 by focusing on legal and administrative system changes, reforms or innovations of university management, and reforms of organizational culture. Finally, the main challenges and visions of Korean higher education systems toward the 21 st century are presented.

  10. Can history improve big bang health reform? Commentary.

    Science.gov (United States)

    Marchildon, Gregory P

    2018-01-26

    At present, the professional skills of the historian are rarely relied upon when health policies are being formulated. There are numerous reasons for this, one of which is the natural desire of decision-makers to break with the past when enacting big bang policy change. This article identifies the strengths professional historians bring to bear on policy development using the establishment and subsequent reform of universal health coverage as an example. Historians provide pertinent and historically informed context; isolate the forces that have historically allowed for major reform; and separate the truly novel reforms from those attempted or implemented in the past. In addition, the historian's use of primary sources allows potentially new and highly salient facts to guide the framing of the policy problem and its solution. This paper argues that historians are critical for constructing a viable narrative of the establishment and evolution of universal health coverage policies. The lack of this narrative makes it difficult to achieve an accurate assessment of systemic gaps in coverage and access, and the design or redesign of universal health coverage that can successfully close these gaps.

  11. Policy experimentation and innovation as a response to complexity in China's management of health reforms.

    Science.gov (United States)

    Husain, Lewis

    2017-08-03

    There are increasing criticisms of dominant models for scaling up health systems in developing countries and a recognition that approaches are needed that better take into account the complexity of health interventions. Since Reform and Opening in the late 1970s, Chinese government has managed complex, rapid and intersecting reforms across many policy areas. As with reforms in other policy areas, reform of the health system has been through a process of trial and error. There is increasing understanding of the importance of policy experimentation and innovation in many of China's reforms; this article argues that these processes have been important in rebuilding China's health system. While China's current system still has many problems, progress is being made in developing a functioning system able to ensure broad population access. The article analyses Chinese thinking on policy experimentation and innovation and their use in management of complex reforms. It argues that China's management of reform allows space for policy tailoring and innovation by sub-national governments under a broad agreement over the ends of reform, and that shared understandings of policy innovation, alongside informational infrastructures for the systemic propagation and codification of useful practices, provide a framework for managing change in complex environments and under conditions of uncertainty in which 'what works' is not knowable in advance. The article situates China's use of experimentation and innovation in management of health system reform in relation to recent literature which applies complex systems thinking to global health, and concludes that there are lessons to be learnt from China's approaches to managing complexity in development of health systems for the benefit of the poor.

  12. Equity in Reform: Case Studies of Five Middle Schools Involved in Systemic Reform

    Science.gov (United States)

    Kahle, Jane Butler; Kelly, Mary Kay

    Science and mathematics education reform documents of the last decade have called for improved teaching and learning for all children. To overcome inequalities, a systemic approach to reform has been adopted. The case studies synthesized in this analysis arc part of a larger effort to reform science and mathematics education systemically and assess the progress of systemic reform. The purpose of this study was to assess the progress toward achieving equitable systemic reform in five middle schools. A multiple-case study design was used, and qualitative data were collected. Kahle's Equity Metric was used to analyze the schools' progress toward achieving equitable systemic reform of mathematics and science. Two results occurred: Various equity issues were identified in the five case studies, and the metric proved efficacious in identifying barriers to or facilitators of equitable reform in the schools. Overall, the study illustrates how schools might assess their commitments to providing high-quality science and mathematics education to all students.

  13. Effectiveness of the Health Complex Model in Iranian primary health care reform: the study protocol.

    Science.gov (United States)

    Tabrizi, Jafar Sadegh; Farahbakhsh, Mostafa; Sadeghi-Bazargani, Homayoun; Hassanzadeh, Roya; Zakeri, Akram; Abedi, Leili

    2016-01-01

    Iranian traditional primary health care (PHC) system, although proven to be successful in some areas in rural populations, suffers major pitfalls in providing PHC services in urban areas especially the slum urban areas. The new government of Iran announced a health reform movement including the health reform in PHC system of Iran. The Health Complex Model (HCM) was chosen as the preferred health reform model for this purpose. This paper aims to report a detailed research protocol for the assessment of the effectiveness of the HCM in Iran. An adaptive controlled design is being used in this research. The study is planned to measure multiple endpoints at the baseline and 2 years after the intervention. The assessments will be done both in a population covered by the HCM, as intervention area, and in control populations covered by the traditional health care system as the control area. Assessing the effectiveness of the HCM, as the Iranian PHC reform initiative, could help health system policy makers for future decisions on its continuation or modification.

  14. US Spending On Complementary And Alternative Medicine During 2002–08 Plateaued, Suggesting Role In Reformed Health System

    Science.gov (United States)

    Davis, Matthew A.; Martin, Brook I.; Coulter, Ian D.; Weeks, William B.

    2013-01-01

    Complementary and alternative medicine services in the United States are an approximately $9 billion market each year, equal to 3 percent of national ambulatory health care expenditures. Unlike conventional allopathic health care, complementary and alternative medicine is primarily paid for out of pocket, although some services are covered by most health insurance. Examining trends in demand for complementary and alternative medicine services in the United States reported in the Medical Expenditure Panel Survey during 2002–08, we found that use of and spending on these services, previously on the rise, have largely plateaued. The higher proportion of out-of-pocket responsibility for payment for services may explain the lack of growth. Our findings suggest that any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best. Should some forms of complementary and alternative medicine—for example, chiropractic care for back pain—be proven more efficient than allopathic and specialty medicine, the inclusion of complementary and alternative medicine providers in new delivery systems such as accountable care organizations could help slow growth in national health care spending. PMID:23297270

  15. US spending on complementary and alternative medicine during 2002-08 plateaued, suggesting role in reformed health system.

    Science.gov (United States)

    Davis, Matthew A; Martin, Brook I; Coulter, Ian D; Weeks, William B

    2013-01-01

    Complementary and alternative medicine services in the United States are an approximately $9 billion market each year, equal to 3 percent of national ambulatory health care expenditures. Unlike conventional allopathic health care, complementary and alternative medicine is primarily paid for out of pocket, although some services are covered by most health insurance. Examining trends in demand for complementary and alternative medicine services in the United States reported in the Medical Expenditure Panel Survey during 2002-08, we found that use of and spending on these services, previously on the rise, have largely plateaued. The higher proportion of out-of-pocket responsibility for payment for services may explain the lack of growth. Our findings suggest that any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best. Should some forms of complementary and alternative medicine-for example, chiropractic care for back pain-be proven more efficient than allopathic and specialty medicine, the inclusion of complementary and alternative medicine providers in new delivery systems such as accountable care organizations could help slow growth in national health care spending.

  16. Change Theory for Accounting System Reform in Health Sector: A Case Study of Kerman University of Medical Sciences in Iran

    OpenAIRE

    Mohammad Hossein Mehrolhasani; Mozhgan Emami

    2013-01-01

    BackgroundChange theories provide an opportunity for organizational managers to plan, monitor and evaluate changes using a framework which enable them, among others, to show a fast response to environmental fluctuations and to predict the changing patterns of individuals and technology. The current study aimed to explore whether the change in the public accounting system of the Iranian health sector has followed Kurt Lewin’s change theory or not. MethodsThis study which adopted a mixed method...

  17. Arbona system reengineered in the Garcia-Ariz Model: a national health reform plan from an orthopedics program perspective.

    Science.gov (United States)

    García Ariz, Manuel; García-Peña, Enrique; Hernández-Polo, Víctor; Pino-Delgado, Franz; Pérez-Carrillo, Omar

    2010-01-01

    During the 1950's the healthcare system of Puerto Rico was maintained exclusively by the local government. The Arbona system, as it came to be known, although it provided health care professionals on the island with multiple educational experiences, presented substantial costs for the government. In the early 1990's a program of privatization known as "La Reforma" was implemented with the ultimate goal of providing a universal coverage system for the poor and the needy. At present this program has brought other issues regarding the quality of medical services and loss of academic centers. This is a preliminary report that analyzes various aspects of both systems through the search and analysis of background resources and literature, interviews, and physician/patient satisfaction surveys (on working conditions and quality of services). The main purpose of this report is to create a model that proves to be efficient and coherent with the island's idiosyncrasies.

  18. Study-design selection criteria in systematic reviews of effectiveness of health systems interventions and reforms: A meta-review.

    Science.gov (United States)

    Rockers, Peter C; Feigl, Andrea B; Røttingen, John-Arne; Fretheim, Atle; de Ferranti, David; Lavis, John N; Melberg, Hans Olav; Bärnighausen, Till

    2012-03-01

    At present, there exists no widely agreed upon set of study-design selection criteria for systematic reviews of health systems research, except for those proposed by the Cochrane Collaboration's Effective Practice and Organisation of Care (EPOC) review group (which comprises randomized controlled trials, controlled clinical trials, controlled before-after studies, and interrupted time series). We conducted a meta-review of the study-design selection criteria used in systematic reviews available in the McMaster University's Health Systems Evidence or the EPOC database. Of 414 systematic reviews, 13% did not indicate any study-design selection criteria. Of the 359 studies that described such criteria, 50% limited their synthesis to controlled trials and 68% to some or all of the designs defined by the EPOC criteria. Seven out of eight reviews identified at least one controlled trial that was relevant for the review topic. Seven percent of the reviews included either no or only one relevant primary study. Our meta-review reveals reviewers' preferences for restricting synthesis to controlled experiments or study designs that comply with the EPOC criteria. We discuss the advantages and disadvantages of the current practices regarding study-design selection in systematic reviews of health systems research as well as alternative approaches. Copyright © 2012. Published by Elsevier Ireland Ltd.

  19. Agents of Change for Health Care Reform

    Science.gov (United States)

    Buchanan, Larry M.

    2007-01-01

    It is widely recognized throughout the health care industry that the United States leads the world in health care spending per capita. However, the chilling dose of reality for American health care consumers is that for all of their spending, the World Health Organization ranks the country's health care system 37th in overall performance--right…

  20. The Impact of Mental Health Reform on Mental Illness Stigmas in Israel.

    Science.gov (United States)

    Ben Natan, Merav; Drori, Tal; Hochman, Ohad

    2017-12-01

    This study examined public perception of stigmas relating to mental illness six months after a reform, which integrated mental health care into primary care in Israel. The results reveal that the public feels uncomfortable seeking referral to mental health services through the public health system, with Arab Israelis and men expressing lower levels of comfort than did Jewish Israelis. The current reform has not solved the issue of public stigma regarding mental health care. The study suggests that the current reforms must be accompanied over time with appropriate public education regarding mental illness. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. The Potential Impact of Health Care Reform on Higher Education.

    Science.gov (United States)

    Reace, Diana

    1994-01-01

    A survey of 522 colleges and universities investigated the impact of health care reform proposals. Results provide an overview of typical current medical plan design, including coverage for part- and full-time employees, and give insight into attitudes toward the idea of regional health alliances, a potentially useful reform approach. (MSE)

  2. Time is ripe for health-care reform

    OpenAIRE

    2008-01-01

    The global financial crisis has created an environment that is more favourable to government intervention, social protection and health reform in the United States of America (USA) than in recent years. Paul Krugman, this year’s Nobel economics laureate, talks to the Bulletin about the challenges of pushing through health reform and the shape this could take after the 4 November presidential election.

  3. Human resources: the Cinderella of health sector reform in Latin America

    Directory of Open Access Journals (Sweden)

    Ugalde Antonio

    2005-01-01

    Full Text Available Abstract Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies – decentralization and privatization – have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside.

  4. Reformations in Zimbabwe's juvenile justice system | Ruparanganda ...

    African Journals Online (AJOL)

    Social work practice continues to play a pivotal role that centers on preventing recidivism and providing remedial and preventive services. Despite these reforms, gaps remain in the current system. For example, children continue to spend prolonged periods of time in adult prisons while they await repatriation to institutions ...

  5. SYSTEMIC CHEMICAL EDUCATION REFORM [SCER] IN THE ...

    African Journals Online (AJOL)

    IICBA01

    Systemic chemical education reform [SCER] has gained a great importance internationally due to the competitive job market and global market economy which create global challenges and stresses on our .... Program outcome includes statements of personal transferable skills, or key skills in chemistry. The following are ...

  6. Hospitals, finance, and health system reform in Britain and the United States, c. 1910-1950: historical revisionism and cross-national comparison.

    Science.gov (United States)

    Gorsky, Martin

    2012-06-01

    Comparative histories of health system development have been variously influenced by the theoretical approaches of historical institutionalism, political pluralism, and labor mobilization. Britain and the United States have figured significantly in this literature because of their very different trajectories. This article explores the implications of recent research on hospital history in the two countries for existing historiographies, particularly the coming of the National Health Service in Britain. It argues that the two hospital systems initially developed in broadly similar ways, despite the very different outcomes in the 1940s. Thus, applying the conceptual tools used to explain the U.S. trajectory can deepen appreciation of events in Britain. Attention focuses particularly on working-class hospital contributory schemes and their implications for finance, governance, and participation; these are then compared with Blue Cross and U.S. hospital prepayment. While acknowledging the importance of path dependence in shaping attitudes of British bureaucrats toward these schemes, analysis emphasizes their failure in pressure group politics, in contrast to the United States. In both countries labor was also crucial, in the United States sustaining employment-based prepayment and in Britain broadly supporting system reform.

  7. Implications of health reform for the medical technology industry.

    Science.gov (United States)

    Nexon, David; Ubl, Stephen J

    2010-07-01

    Health care reform will greatly affect the medical technology industry in both positive and negative ways. Expanded coverage is a modest benefit that will increase demand for products. But the medical device excise tax authorized by the Patient Protection and Affordable Care Act could have negative effects on research, profits, and investments. Moreover, limits on Medicare payments could reduce revenues. The largest long-term impact on medical technology will come from measures to improve quality and efficiency. These could improve the health care system and increase opportunities for medical technology, but inappropriate implementation could slow medical progress and limit patients' access to needed care.

  8. The potential for nurse practitioners in health care reform.

    Science.gov (United States)

    Archibald, Mandy M; Fraser, Kimberly

    2013-01-01

    In Canada, health care reform is underway to address escalating costs, access and quality of care issues, and existing personnel shortages in various health disciplines. One response of the nursing profession to these stimuli has been the development of the advanced practice nurse, namely, the nurse practitioner (NP). NPs are in an excellent position to address current shortcomings through increasing points of access to the health care system, providing an emphasis on education and disease prevention, and delivering high-quality, cost-effective care in a multitude of practice settings. With an emphasis on the social determinants of health, NPs are in a prime position to provide care to underserved and vulnerable populations across Canada. Despite the potential for NPs to be instrumental in health care reform, there is a lack of support and regulation necessary for their optimal use. Barriers to mobilizing NPs in Canada exist and impede the integration of NPs into the Canadian health care system, which has both quality of care and social justice implications. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. [Colombia: what has happened with its health reform?].

    Science.gov (United States)

    Gómez-Arias, Rubén Darío; Nieto, Emmanuel

    2014-01-01

    The health reform adopted in Colombia in 1993 was promoted by different agencies as the model to follow in matters of health policy. Following the guidelines of the Washington Consensus and the World Bank, the Government of Colombia, with the support of national political and economic elites, reorganized the management of health services based on market principles, dismantled the state system, increased finances of the sector, assigned the management of the system to the private sector, segmented the provision of services, and promoted interaction of actors in a competitive scheme of low regulation. After 20 years of implementation, the Colombian model shows serious flaws and is an object of controversy. The Government has weakened as the governing entity for health; private groups that manage the resources were established as strong centers of economic and political power; and violations of the right to health increased. Additionally, corruption and service cost overruns have put a strain on the sustainability of the system, and the state network is in danger of closing. Despite its loss of prestige at the internal level, various actors within and outside the country tend to keep the model based on contextual reforms.

  10. Global lessons of the mexican health reform: empowerment through the use of evidence

    OpenAIRE

    Frenk, Julio; Dean, Harvard School of Public Health, Harvard University. Boston, USA. Médico. Magíster en Salud Pública. Magíster en Sociología. Doctor (PhD) en Organización del Cuidado Médico y Sociología.; Gómez-Dantés, Octavio; Instituto Nacional de Salud Pública. Cuernavaca, México. Médico. Magíster en Salud Pública.

    2010-01-01

    This paper illustrates, using as an example the recent reform of the Mexican health system, the potential of knowledge in the design and implementation of public policies. In the first part the relationship between knowledge and health is described. In part two, the efforts in Mexico to generate evidence that would eventually nourish the design and implementation of health policies are discussed. In the following sections the content and the guiding concept of the reform, the democratization ...

  11. Health Insurance Reform and Economic Growth : Simulation Analysis in Japan

    OpenAIRE

    Ihori, Toshihiro; Kato, Ryuta Ray; Kawade, Masumi; Bessho, Shun-ichiro

    2011-01-01

    This paper evaluates the drastic reforms of Japanese public health insurance initiated in 2006. We employ a computable general equilibrium framework to numerically examine the reforms for an aging Japan in the dynamic context of overlapping generations.Our simulation produced the following results: First, an increase in the co-payment rate, a prominent feature of the 2006 reform, would promote economic growth and welfare by encouraging private saving. Second, the ex-post moral hazard behavior...

  12. Health sector reforms in Central and Eastern Europe

    Directory of Open Access Journals (Sweden)

    2004-04-01

    Full Text Available The political and economic transition of the 1990s in the countries of central and eastern Europe has been accompanied by wide ranging health care reform. The initial Soviet model has given way to a variety of forms of health insurance. Yet, as this paper argues, reform has too often been preoccupied with ideological imperatives, such as provider autonomy and the creation of funds separate from government, and has given much less thought to the contribution that health care can make to population health. The paper begins by examining the changing nature of health care. It recalls how the Soviet model was able to provide basic care to dispersed populations at low cost but notes how this is no longer sufficient in the face of an increasingly complex health care environment. This complexity reflects several factors, such as the growth in chronic disease, the emergence of new forms of infectious disease, and the introduction of new treatments requiring integrated delivery systems. It reviews evidence on how the former communist countries failed to keep up with developments in the west from the 1970s onwards, at a time when the complexity of health care was becoming apparent. It continues by setting out a framework for the organisation of health care based on the goal of health gain. This involves a series of activities that can be summarised as active purchasing, and which include assessment of health needs, designing effective packages of care, and monitoring outcomes. It concludes by arguing that a new relationship is needed between the state and the organisations involved in funding and delivering health care, to design a system that will tackle the considerable health needs of the people who live in this region.

  13. Lessons from Early Medicaid Expansions Under Health Reform..

    Data.gov (United States)

    U.S. Department of Health & Human Services — Lessons from Early Medicaid Expansions Under Health Reform, Interviews with Medicaid Officials In a new study entitled Lessons from Early Medicaid Expansions Under...

  14. Healthy incentives: Canadian health reform in an international context

    National Research Council Canada - National Science Library

    Walker, Michael; McArthur, William; Ramsay, Cynthia

    1996-01-01

    .... Since health expenditures are one of the largest and fastest growing segments of provincial budgets, much of the fiscal reform taking place across the country has centred around cuts to health funding...

  15. Welfare reform and health insurance of immigrants.

    Science.gov (United States)

    Kaushal, Neeraj; Kaestner, Robert

    2005-06-01

    To investigate the effect of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) on the health insurance coverage of foreign- and U.S.-born families headed by low-educated women. Secondary data from the March series of the Current Population Surveys for 1994-2001. Multivariate regression methods and a pre- and post-test with comparison group research design (difference-in-differences) are used to estimate the effect of welfare reform on the health insurance coverage of low-educated, foreign- and U.S.-born unmarried women and their children. Heterogeneous responses by states to create substitute Temporary Aid to Needy Families or Medicaid programs for newly arrived immigrants are used to investigate whether the estimated effect of PRWORA on newly arrived immigrants is related to the actual provisions of the law, or the result of fears engendered by the law. PRWORA increased the proportion of uninsured among low-educated, foreign-born, unmarried women by 9.9-10.7 percentage points. In contrast, the effect of PRWORA on the health insurance coverage of similar U.S.-born women is negligible. PRWORA also increased the proportion of uninsured among foreign-born children living with low-educated, single mothers by 13.5 percentage points. Again, the policy had little effect on the health insurance coverage of the children of U.S.-born, low-educated single mothers. There is some evidence that the fear and uncertainty engendered by the law had an effect on immigrant health insurance coverage. This research demonstrates that PRWORA adversely affected the health insurance of low-educated, unmarried, immigrant women and their children. In the case of unmarried women, it may be partly because the jobs that they obtained in response to PRWORA were less likely to provide health insurance. The research also suggests that PRWORA may have engendered fear among immigrants and dampened their enrollment in safety net programs.

  16. Health Education: What Can It Look Like after Health Care Reform? 1993 SOPHE Presidential Address.

    Science.gov (United States)

    Jorgensen, Cynthia M.

    1994-01-01

    In plans for health care reform, the role of health education in reducing risk behaviors associated with leading causes of death must be recognized. Reform offers new opportunities for prevention programs in schools, worksites, and communities. (SK)

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

    Directory of Open Access Journals (Sweden)

    Carol Molinari

    2014-02-01

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

  18. [The context of health care reforms].

    Science.gov (United States)

    Vergara, C

    2000-01-01

    In Latin America, health sector reforms have gone hand in hand with social and economic trends during the latter half of the twentieth century and have reflected the particular concept of "development" that has been in vogue at different times. Economic stagnation and increased social spending, both hallmarks of the 1960s, led to the decline of the "import substitution" development model, which had prevailed since the beginning of the century, and slowly gave way in the 1980s to the "globalization" model. From the earlier model, a transition took place toward a restructuring of production and a series of economic adjustment policies that led, ironically, to an increase in poverty in Latin America. Implementation of the new model has occurred in two phases. The first, known as the "social reform" or "first generation" phase, sprang from the notion that poverty is the sum of a number of material shortages that can be corrected through an equitable redistribution of a fixed volume of goods belonging to society. This conceptual framework, which was completely devoid of all historical linkages and separated from economic policy, led to social policies whose entire purpose was to mitigate poverty through subsidies targeting the poorest persons in the society. In the second phase of the globalization model, which arose in the 1990s and became known as the "second generation" or "postadjustment" phase, new economic rules came into play that were based primarily on international competition, efficiency in production, and openness and fairness in the capital markets. And if during the initial stage the conceptual strategy behind all social policy was to fight poverty, in the second stage the strategy became one of achieving equity, which was no longer interpreted as the even distribution of a fixed volume of capital goods, but as the sustained provision of greater and better opportunities for all. Having grown accustomed to the protectionism inherent in the earlier

  19. Energizing a Large Urban System: Reform through a Standards Driven Model.

    Science.gov (United States)

    Robbins, Stephen B.

    This paper describes the District of Columbia Public School System (DCPS); articulates challenges it faced prior to standards based reform; presents strategies for reforming large urban systems' health and physical education (HPE) programs; and notes strategies for incorporating a standards-based performance-driven model. DCPS reading and math…

  20. SISTEMAS SANITARIOS Y REFORMA AUGE EN CHILE SISTEMAS SANITÁRIOS E REFORMA AUGE NO CHILE HEALTH CARE SYSTEMS AND "AUGE" REFORM IN CHILE

    Directory of Open Access Journals (Sweden)

    Alejandra Zúñiga Fajuri

    2007-11-01

    Full Text Available A partir de la clasificación de los sistemas sanitarios en términos de su financiamiento, número de actores y consecuencias en equidad, este ensayo pretende analizar algunas de las transformaciones producidas en Chile con la reforma del sistema de salud llamada "Plan AUGE" (Acceso Universal de Garantías Explícitas. Se examinan las tareas pendientes para la conversión de un sistema que, manteniendo su carácter mixto, sea capaz de superar sus actuales consecuencias fuertemente regresivasA partir da classificação de dois sistemas sanitários em termos de seu financiamento, número de atores e conseqüências em termos de equidade, este ensaio pretende analisar algumas das transformações produzidas no Chile com a reforma do sistema de saúde chamado "Plano AUGE" (Acesso Universal de Garantias Explícitas. São examinados as tarefas pendentes para a conversão de um sistema que, mantendo seu caráter misto, seja capaz de superar suas conseqüências fortemente regressivasThrough the classification of health care systems in terms of their financing, number of stakeholders and consequences for health care equity, this essay pretends to analyze some of the changes that have taken place in Chile due to the health care reform system "AUGE" (Universal Access to Explicit Guarantees. Pending tasks are examined for conversion to the system that, while maintaining its mixed character, may be able to overcome its present strongly regressive consequences

  1. Change Theory for Accounting System Reform in Health Sector: A Case Study of Kerman University of Medical Sciences in Iran

    Science.gov (United States)

    Mehrolhassani, Mohammad Hossein; Emami, Mozhgan

    2013-01-01

    Background: Change theories provide an opportunity for organizational managers to plan, monitor and evaluate changes using a framework which enable them, among others, to show a fast response to environmental fluctuations and to predict the changing patterns of individuals and technology. The current study aimed to explore whether the change in the public accounting system of the Iranian health sector has followed Kurt Lewin’s change theory or not. Methods: This study which adopted a mixed methodology approach, qualitative and quantitative methods, was conducted in 2012. In the first phase of the study, 41 participants using purposive sampling and in the second phase, 32 affiliated units of Kerman University of Medical Sciences (KUMS) were selected as the study sample. Also, in phase one, we used face-to-face in-depth interviews (6 participants) and the quote method (35 participants) for data collection. We used a thematic framework analysis for analyzing data. In phase two, a questionnaire with a ten-point Likert scale was designed and then, data were analyzed using descriptive indicators, principal component and factorial analyses. Results: The results of phase one yielded a model consisting of four categories of superstructure, apparent infrastructure, hidden infrastructure and common factors. By linking all factors, totally, 12 components based on the quantitative results showed that the state of all components were not satisfactory at KUMS (5.06±2.16). Leadership and management; and technology components played the lowest and the greatest roles in implementing the accrual accounting system respectively. Conclusion: The results showed that the unfreezing stage did not occur well and the components were immature, mainly because the emphasis was placed on superstructure components rather than the components of hidden infrastructure. The study suggests that a road map should be developed in the financial system based on Kurt Lewin’s change theory and the

  2. Change Theory for Accounting System Reform in Health Sector: A Case Study of Kerman University of Medical Sciences in Iran

    Directory of Open Access Journals (Sweden)

    Mohammad Hossein Mehrolhasani

    2013-11-01

    Full Text Available BackgroundChange theories provide an opportunity for organizational managers to plan, monitor and evaluate changes using a framework which enable them, among others, to show a fast response to environmental fluctuations and to predict the changing patterns of individuals and technology. The current study aimed to explore whether the change in the public accounting system of the Iranian health sector has followed Kurt Lewin’s change theory or not. MethodsThis study which adopted a mixed methodology approach, qualitative and quantitative methods, was conducted in 2012. In the first phase of the study, 41 participants using purposive sampling and in the second phase, 32 affiliated units of Kerman University of Medical Sciences (KUMS were selected as the study sample. Also, in phase one, we used face-to-face in-depth interviews (6 participants and the quote method (35 participants for data collection. We used a thematic framework analysis for analyzing data. In phase two, a questionnaire with a ten-point Likert scale was designed and then, data were analyzed using descriptive indicators, principal component and factorial analyses. ResultsThe results of phase one yielded a model consisting of four categories of superstructure, apparent infrastructure, hidden infrastructure and common factors. By linking all factors, totally, 12 components based on the quantitative results showed that the state of all components were not satisfactory at KUMS (5.06±2.16. Leadership and management; and technology components played the lowest and the greatest roles in implementing the accrual accounting system respectively. ConclusionThe results showed that the unfreezing stage did not occur well and the components were immature, mainly because the emphasis was placed on superstructure components rather than the components of hidden infrastructure. The study suggests that a road map should be developed in the financial system based on Kurt Lewin’s change theory and

  3. Change theory for accounting system reform in health sector: a case study of kerman university of medical sciences in iran.

    Science.gov (United States)

    Mehrolhassani, Mohammad Hossein; Emami, Mozhgan

    2013-11-01

    Change theories provide an opportunity for organizational managers to plan, monitor and evaluate changes using a framework which enable them, among others, to show a fast response to environmental fluctuations and to predict the changing patterns of individuals and technology. The current study aimed to explore whether the change in the public accounting system of the Iranian health sector has followed Kurt Lewin's change theory or not. This study which adopted a mixed methodology approach, qualitative and quantitative methods, was conducted in 2012. In the first phase of the study, 41 participants using purposive sampling and in the second phase, 32 affiliated units of Kerman University of Medical Sciences (KUMS) were selected as the study sample. Also, in phase one, we used face-to-face in-depth interviews (6 participants) and the quote method (35 participants) for data collection. We used a thematic framework analysis for analyzing data. In phase two, a questionnaire with a ten-point Likert scale was designed and then, data were analyzed using descriptive indicators, principal component and factorial analyses. The results of phase one yielded a model consisting of four categories of superstructure, apparent infrastructure, hidden infrastructure and common factors. By linking all factors, totally, 12 components based on the quantitative results showed that the state of all components were not satisfactory at KUMS (5.06±2.16). Leadership and management; and technology components played the lowest and the greatest roles in implementing the accrual accounting system respectively. The results showed that the unfreezing stage did not occur well and the components were immature, mainly because the emphasis was placed on superstructure components rather than the components of hidden infrastructure. The study suggests that a road map should be developed in the financial system based on Kurt Lewin's change theory and the model presented in this paper underpins the change

  4. Equity, governance and financing after health care reform: lessons from Mexico.

    Science.gov (United States)

    Arredondo, Armando; Orozco, Emanuel

    2008-01-01

    To determine, from the perspective of providers, community leaders and users of health services, equity, governance and health financing outcomes of the Mexican health system reform.Cross-sectional study oriented towards the qualitative analysis of financing, governance and equity indicators for the uninsured population. Taking into account feasibility, as well as political and technical criteria, six Mexican states were selected as study populations and a qualitative research was conducted during 2004-2006. Two hundred and forty in-depth interviews were applied, in all selected states, to 60 decision-makers, including medical and administrative personnel; 60 service providers at health centres; 60 representatives of civil organizations, including municipal representatives and, finally, 60 members of health committees and users of services at second and first levels of care units. The analysis of interviews was performed using ATLAS-Ti software. An outcome mapping of health reform was developed. For political actors, Mexican health system reform has not modified dependence on the central level; ignorance about reform strategies and lack of participation in the search for financial resources to finance health systems were evidenced. Also, in all states under study, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Health strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. There are relevant positive and negative effects of the reform on equity, governance and financing in health. Special emphasis is placed on the analysis of lessons learned in Mexico and the usefulness of the main strengths and weaknesses, as relevant evidences for other middle-income countries which

  5. Why public health services? Experiences from profit-driven health care reforms in Sweden.

    Science.gov (United States)

    Dahlgren, Göran

    2014-01-01

    Market-oriented health care reforms have been implemented in the tax-financed Swedish health care system from 1990 to 2013. The first phase of these reforms was the introduction of new public management systems, where public health centers and public hospitals were to act as private firms in an internal health care market. A second phase saw an increase of tax-financed private for-profit providers. A third phase can now be envisaged with increased private financing of essential health services. The main evidence-based effects of these markets and profit-driven reforms can be summarized as follows: efficiency is typically reduced but rarely increased; profit and tax evasion are a drain on resources for health care; geographical and social inequities are widened while the number of tax-financed providers increases; patients with major multi-health problems are often given lower priority than patients with minor health problems; opportunities to control the quality of care are reduced; tax-financed private for-profit providers facilitate increased private financing; and market forces and commercial interests undermine the power of democratic institutions. Policy options to promote further development of a nonprofit health care system are highlighted.

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

    Directory of Open Access Journals (Sweden)

    Mauricio Toyama

    2017-09-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

  8. Conceptual framework of public health surveillance and action and its application in health sector reform

    Directory of Open Access Journals (Sweden)

    Alemu Wondi

    2002-01-01

    Full Text Available Abstract Background Because both public health surveillance and action are crucial, the authors initiated meetings at regional and national levels to assess and reform surveillance and action systems. These meetings emphasized improved epidemic preparedness, epidemic response, and highlighted standardized assessment and reform. Methods To standardize assessments, the authors designed a conceptual framework for surveillance and action that categorized the framework into eight core and four support activities, measured with indicators. Results In application, country-level reformers measure both the presence and performance of the six core activities comprising public health surveillance (detection, registration, reporting, confirmation, analyses, and feedback and acute (epidemic-type and planned (management-type responses composing the two core activities of public health action. Four support activities – communications, supervision, training, and resource provision – enable these eight core processes. National, multiple systems can then be concurrently assessed at each level for effectiveness, technical efficiency, and cost. Conclusions This approach permits a cost analysis, highlights areas amenable to integration, and provides focused intervention. The final public health model becomes a district-focused, action-oriented integration of core and support activities with enhanced effectiveness, technical efficiency, and cost savings. This reform approach leads to sustained capacity development by an empowerment strategy defined as facilitated, process-oriented action steps transforming staff and the system.

  9. Health policy thoughtleaders' views of the health workforce in an era of health reform.

    Science.gov (United States)

    Donelan, Karen; Buerhaus, Peter I; DesRoches, Catherine; Burke, Sheila P

    2010-01-01

    Although registered nurses rank similarly with physicians in the public's esteem, physicians are more visible than nurses in media coverage, public policy, and political spheres. Thus, nursing workforce issues are overshadowed by those of other health priorities, including Medicare and health reform. The purpose of this research was to understand the visibility and salience of the health workforce in general, gain an understanding about the effectiveness of messages concerning the nursing workforce in particular, and to understand why nursing workforce issues do not appear to have gained more traction in national health care policymaking. The National Survey of Thoughtleaders about the Health Workforce was administered via mail, telephone and online to health workforce and policy thoughtleaders from August 2009-October 2009. Of 301 thoughtleaders contacted, 123 completed questionnaires for a response rate of 41%. Thoughtleaders agree that nurses are critical to the quality and safety of our healthcare system, that there are current nursing shortages, and that nursing shortages will be intensified by health reform. Thoughtleaders reported that while they do hear about nursing issues frequently, they do not view most sources of information as proposing effective policy solutions. This study highlights a critical gap in effective policy advocacy and leadership to advance nurse workforce issues higher on the national health agenda. Copyright 2010 Mosby, Inc. All rights reserved.

  10. Colombia and Cuba, contrasting models in Latin America's health sector reform.

    Science.gov (United States)

    De Vos, Pol; De Ceukelaire, Wim; Van der Stuyft, Patrick

    2006-10-01

    Latin American national health systems were drastically overhauled by the health sector reforms the 1990s. Governments were urged by donors and by the international financial institutions to make major institutional changes, including the separation of purchaser and provider functions and privatization. This article first analyses a striking paradox of the far-reaching reform measures: contrary to what is imposed on public health services, after privatization purchaser and provider functions are reunited. Then we compare two contrasting examples: Colombia, which is internationally promoted as a successful--and radical--example of 'market-oriented' health care reform, and Cuba, which followed a highly 'conservative' path to adapt its public system to the new conditions since the 1990s, going against the model of the international institutions. The Colombian reform has not been able to materialize its promises of universality, improved equity, efficiency and better quality, while Cuban health care remains free, accessible for everybody and of good quality. Finally, we argue that the basic premises of the ongoing health sector reforms in Latin America are not based on the people's needs, but are strongly influenced by the needs of foreign--especially North American--corporations. However, an alternative model of health sector reform, such as the Cuban one, can probably not be pursued without fundamental changes in the economic and political foundations of Latin American societies.

  11. Implementing insurance market reforms under the federal health reform law.

    Science.gov (United States)

    Nichols, Len M

    2010-06-01

    Lost in the rhetoric about the supposed government takeover of health care is an appreciation of the inherently federalist approach of the Patient Protection and Affordable Care Act. This federalist tradition, particularly with regard to health insurance, has a history that dates back at least to the 1940s. The new legislation broadens federal power and oversight considerably, but it also vests considerable new powers and responsibilities in the states. The precedents and examples it follows will guide federal and state policy makers, stakeholders, and ordinary citizens as they breathe life into the new law. The challenges ahead are formidable, and the greatest ones are likely to be political.

  12. Institutions, interest groups, and ideology: an agenda for the sociology of health care reform.

    Science.gov (United States)

    Quadagno, Jill

    2010-06-01

    A central sociological premise is that health care systems are organizations that are embedded within larger institutions, which have been shaped by historical precedents and operate within a specific cultural context. Although bound by policy legacies, embedded constituencies, and path dependent processes, health care systems are not rigid, static, and impervious to change. The success of health care reform in 2010 has shown that existing regimes do have the capacity to respond to new needs in ways that transcend their institutional and ideological limits. For the United States the question is how health care reform will reconfigure the existing network of public and private benefits and the power relationships between the numerous constituencies surrounding them. This article considers how institutions, interest groups, and ideology have affected the organization of the health care system in the United States as well as in other nations. It then discusses issues for future research in the aftermath of the 2009-10 health care reform debate.

  13. Foundation's consumer advocacy health reform initiative strengthened groups' effectiveness

    National Research Council Canada - National Science Library

    Strong, Debra; Lipson, Debra; Honeycutt, Todd; Kim, Jung

    2011-01-01

    Private foundations may hesitate to fund consumer advocacy for enacting and implementing health reform because the effects are hard to measure, and because they are concerned that funds will be used...

  14. Health Reform in Ceará: the process of decentralisation in the 1990s

    Science.gov (United States)

    Medeiros, Regianne Leila Rolim; Atkinson, Sarah

    2015-01-01

    The objective of this article is to offer an overview of the health reform in Ceará focusing on the decentralisation process in the 1990s. The driving factor behind the Brazilian health reform movement was the necessity to reorganise the national health system and overcome inequalities. For the reformists, decentralisation, and together with it the idea of popular participation, is seen as essential to guarantee the fulfilment of the people’s needs and to incorporate their voice in the decision-making processes of the health system. In the state of Ceará, after the 1986 elections, health reform movement members took control over the management of the state Health Secretariat. This is the main cause of the acceleration of the decentralisation process with the transference of responsibility over the management of health care delivery to municipalities. PMID:25729333

  15. [Governance and health: the rise of the managerialism in public sector reform].

    Science.gov (United States)

    Denis, Jean L; Lamothe, Lise; Langley, Ann; Stéphane, Guérard

    2010-01-01

    The article examines various healthcare systems reform projects in Canada and some Canadian provinces and reveals some tendencies in governance renewal. The analisis is based on the hypothesis that reform is an exercise aiming at the renewal of governance conception and practices. In renewing governance, reform leaders hope to use adequate and effective levers to attain announced reform objectives. The article shows that the conceptions and operational modalities of governance have changed over time and that they reveal tensions inherent to the transformation and legitimation process of public healthcare systems. The first section discusses the relationships between reform and change. The second section defines the conception of gouvernance used for the analisis. Based on a content analisis of the various reform reports, the third section reveals the evolution of the conception of governance in healthcare systems in Canada. In order to expose the new tendencies, ideologies and operational principles at the heart of the reform projects are analysed. Five ideologies are identified: the democratic ideology, the "population health" ideology, the business ideology, the managerial ideology and the ideology of equity and humanism. This leads to a discussion on the dominant influence of the managerial ideology in the current reform projects.

  16. Health sector reforms for 21 st century healthcare

    Directory of Open Access Journals (Sweden)

    Darshan Shankar

    2015-01-01

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

  17. [The absence of stewardship in the Chilean health authority after the 2004 health reform].

    Science.gov (United States)

    Herrera, Tania; Sánchez, Sergio

    2014-11-26

    Stewardship is the most important political function of a health system. It is a government responsibility carried out by the health authority. Among other dimensions, it is also a meta-function that includes conduction and regulation. The Health Authority and Management Act, which came about from the health reform of 2004, separated the functions of service provision and stewardship with the aim of strengthening the role of the health authority. However, the current structure of the health system contains overlapping functions between the different entities that leads to lack of coordination and inconsistencies, and a greater weight on individual health actions at the expense of collective ones. Consequently, a properly funded national health strategy to improve the health of the population is missing. Additionally, the components of citizen participation and governance are weak. It is necessary, therefore, to revisit the Chilean health structure in order to develop one that truly enables the exercise of the health authority’s stewardship role.

  18. Health Behaviors, Mental Health, and Health Care Utilization Among Single Mothers After Welfare Reforms in the 1990s.

    Science.gov (United States)

    Basu, Sanjay; Rehkopf, David H; Siddiqi, Arjumand; Glymour, M Maria; Kawachi, Ichiro

    2016-03-15

    We studied the health of low-income US women affected by the largest social policy change in recent US history: the 1996 welfare reforms. Using the Behavioral Risk Factor Surveillance System (1993-2012), we performed 2 types of analysis. First, we used difference-in-difference-in-differences analyses to estimate associations between welfare reforms and health outcomes among the most affected women (single mothers aged 18-64 years in 1997; n = 219,469) compared with less affected women (married mothers, single nonmothers, and married nonmothers of the same age range in 1997; n = 2,422,265). We also used a synthetic control approach in which we constructed a more ideal control group for single mothers by weighting outcomes among the less affected groups to match pre-reform outcomes among single mothers. In both specifications, the group most affected by welfare reforms (single mothers) experienced worse health outcomes than comparison groups less affected by the reforms. For example, the reforms were associated with at least a 4.0-percentage-point increase in binge drinking (95% confidence interval: 0.9, 7.0) and a 2.4-percentage-point decrease in the probability of being able to afford medical care (95% confidence interval: 0.1, 4.8) after controlling for age, educational level, and health care insurance status. Although the reforms were applauded for reducing welfare dependency, they may have adversely affected health. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Organizational and structural changes in PHC centres during health care reform in Lithuania.

    NARCIS (Netherlands)

    Liseckiene, I.; Boerma, W.; Milasauskiene, Z.; Valius, L.; Miseviciene, I.; Groenewegen, P.

    2007-01-01

    Background: The increasing health care inequalities and morbidity, inefficient payment system challenged to a new health care reform with its priority primary health care after Lithuania’s independence in 1990. Former district doctors have been re-trained to become GPs and former policlinics have

  20. Comparison of health care financing in Egypt and Cuba: lessons for health reform in Egypt.

    Science.gov (United States)

    Gericke, C A

    2005-01-01

    Egypt and Cuba are both lower-middle income countries with a history of socialist rule, which have embarked on economic liberalization since the 1990s. Cuba has achieved exemplary health status whereas health status in Egypt is lower than could be expected for its level of income. In this article, health care financing mechanisms in both countries are analysed on their effectiveness, efficiency, and equity, with the objective of identifying the determinants of success in the Cuban health system from which valuable lessons for current health reforms in Egypt may be derived.

  1. Online Simulation of Health Care Reform: Helping Health Educators Learn and Participate

    Science.gov (United States)

    Jecklin, Robert

    2010-01-01

    Young and healthy undergraduates in health education were not predisposed to learn the complex sprawl of topics in a required course on U.S. Health Care. An online simulation of health care reform was used to encourage student learning about health care and participating in health care reform. Students applied their understanding of high costs,…

  2. Evaluación de la descentralización de la salud y la reforma de la Seguridad Social en Colombia Evaluation of health system decentralization and reform of the Social Security system in Colombia

    Directory of Open Access Journals (Sweden)

    I. Jaramillo

    2002-02-01

    Full Text Available El objetivo de este trabajo es presentar los resultados de las reformas al sector salud en Colombia acaecidas desde 1990. Con ellas se sustituyó el antiguo Sistema Nacional de Salud y el denominado modelo «bismarckiano» de la Seguridad Social. El nuevo sistema tiene tres características básicas: a el sistema público y de subsidios fiscales se encuentra descentralizado en las entidades territoriales departamentales y municipales; b los hospitales públicos se han convertido en empresas sociales del Estado y se les ha conducido hacia un manejo gerencial, y c se ha desmonopolizado el sistema de seguridad social en salud y se ha creado un régimen subsidiado de salud para los más pobres. Este artículo es una recopilación sistemática de información secundaria, extraída de los estudios más importantes que se han realizado para evaluar las reformas del sector salud en Colombia. En algunos de ellos ha participado el autor. La reforma ha conseguido multiplicar los recursos financieros, lo cual ha permitido incrementar los recursos humanos públicos y su remuneración, así como la disponibilidad de recursos presupuestarios por parte de los hospitales y la ampliación de la cobertura de la seguridad social, incluyendo al 20% de la población más pobre, beneficiaria de subsidios a demanda. El acceso y la equidad en los servicios personales de salud ha mejorado significativamente; sin embargo, se registra una caída de los indicadores de salud pública y los profesionales asumen una posición critica frente al nuevo sistema basado en la intermediación, que favorece el incremento de los costes de transacción.The aim of this study is to present the results of the reforms in the health sector that have taken place in Colombia since 1990. These reforms replaced the previous national health system and the so-called Bismarkian social security system. The new system has three basic characteristics: a the public subsidies are decentralized in the

  3. Historical and comparative reflections on the U.S. national health insurance reforms.

    Science.gov (United States)

    Light, Donald W

    2011-01-01

    The 2010 US reforms addressed forms of public and private insurance designed to reinforce a delivery system that developed to maximize the autonomy of physicians and hospitals. That autonomy emphasizes fees and specialization, which led to for-profit incorporation and overtreatment. Powerful corporate lobbies have defeated previous reforms and diluted the impact of the Obama reform. It barely passed and does little to manage costs or rationalize medicine. US health care does not fit established models of welfare states and contains five different models of health care delivery. Most interesting are forms of democratically run community health centres. Selected features of the reforms are highlighted. Copyright © 2010. Published by Elsevier Ltd.

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

    NARCIS (Netherlands)

    Kroneman, M.; Zee, J. van der

    2011-01-01

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

  5. Successful Integration of Pediatrics Into State Health Care Reform Efforts.

    Science.gov (United States)

    Shaw, Judith S; Varni, Susan E; Tolmie, Elizabeth Cheng; Mohlman, Mary Kate; Harder, Valerie S

    2017-09-12

    Health care reform in Vermont promotes patient-centered medical homes (PCMH) and multi-disciplinary community health teams to support population health. This qualitative study describes the expansion of Vermont's health care reform efforts, initially focused on adult primary care, to pediatrics through interviews with project managers and facilitators, CHT members, pediatric practitioners and care coordinators, and community-based providers. Analyses used grounded theory, identifying themes confirmed by repeat occurrence across respondents. Respondents believed that PCMH recognition and financial and community supports would improve care for pediatric patients and families. Respondents shared three main challenges with health care reform efforts: achieving PCMH recognition, adapting community health teams for pediatric patients and families, and defining roles for care coordinators. For health care reform efforts to support pediatric patients and be family-centered, states may need additional resources to understand how pediatric and adult primary care differ and how best to support pediatrics during health care reform efforts. Copyright © 2017. Published by Elsevier Inc.

  6. Still missing: undocumented immigrants in health care reform.

    Science.gov (United States)

    Galarneau, Charlene

    2011-05-01

    The health care reform signed by President Obama in March 2010 mirrors the Clinton reform proposal of 1993 in that both excluded undocumented immigrants from federal insurance coverage. In both cases substantive discussion of their possible inclusion was stifled by political timidity. This paper begins with a brief descriptive overview of undocumented immigrants in the U.S. and their health care and insurance coverage. It highlights the most common moral, economic, and public health arguments made for and against the inclusion of undocumented immigrants in the 2010 health care reform. The paper then asserts that undocumented immigrants are part of the U.S. health care community and urges health care workers to become more active participants in this policy arena.

  7. Health sector reform processes in Nigeria: A review of factors that ...

    African Journals Online (AJOL)

    Introduction: In most countries health care reform is aimed at improving the efficiency, equity and effectiveness of the health sector. Documentation of health sector reform experiences has focused primarily on efficiency and design of reforms, largely neglecting equity and the frequent experience that reforms are not fully ...

  8. Health Care Reform: How Will It Impact You?

    Science.gov (United States)

    Lukaszewski, Thomas

    1993-01-01

    Discusses the impact of health care reform on child-care centers and child-care employees. Topics covered include requirements to provide health insurance for all employees; subsidies for businesses with fewer than 50 employees; subsidies for low income employees; family coverage; health are costs for 2 working parents; and costs to day-care…

  9. Health care reform, 2014: no matter what the question, mission is the answer.

    Science.gov (United States)

    Khatri, Parinda

    2014-06-01

    In this column, the president of the Collaborative Family Healthcare Association (CFHA) addresses the lack of understanding and agreement to the question What is health care reform? It is a daunting task to understand, let alone redesign, the most expensive (but not most effective or most efficient) health care system in the world. In this critical window of opportunity, influencing positive movement through leadership, communication, and teamwork is a strategic priority of the CFHA and its journal, Family Systems & Health. The emphases on comprehensive, coordinated, and cost-effective care, although novel concepts for many, have been core features of CFHA's philosophy for almost two decades (see CFHA's mission statement). As we mark the halfway point in this pivotal year in health care reform, we continue to struggle. CFHA can help illuminate the path of what health care reform can be and what it can do for each citizen in our communities.

  10. Mental health reform, economic globalization and the practice of citizenship.

    Science.gov (United States)

    Morrow, Marina

    2004-01-01

    Drawing on research conducted in British Columbia, Ontario, and Quebec it is argued that tension exists between mental health reforms born out of concern for the well-being and care of people and those that are being driven by cost-containment and efficiency. Contributing to this tension are competing discourses about mental health and mental illness. It is argued that progressive change requires the meaningful engagement of mental health care recipients in policy decision-making processes and ongoing analysis about the interconnections between economic globalization, social welfare state restructuring and mental health reform.

  11. Graduate medical education in the era of health care reform.

    Science.gov (United States)

    Ward, Robert C; Mainiero, Martha B

    2013-09-01

    Medicare is the primary source of funding for graduate medical education (GME) in the United States. The growing deficit, a sluggish economy, and rising health care costs have focused attention on cutting spending, and GME reimbursement from Medicare is being considered among the entitlement programs for spending reduction. At the same time, health care reform will place new demands on residency training. The authors review the history of GME financing, the potential impact of GME spending cuts and health care reform on radiology training, and the new skills residents will need to practice in the era of health reform. As health care financing evolves, so must resident education. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  12. Health Reform in Mexico City, 2000-2006

    Directory of Open Access Journals (Sweden)

    Asa Cristina Laurell

    2008-07-01

    Full Text Available With the goal of fully guaranteeing the constitutional right to health protection, Mexico City’s leftist administration (2000-2006 undertook a reform to provide health services to people without insurance. The reform had four components: free medicine and health services; the introduction of a new service model (MAS; the strengthening, expansion, and improvement of services, and legislation to ensure that the city government become guarantor of this constitutional right. The reform resulted in 95% of eligible families being enrolled in free care; expansion of health care infrastructure with the construction of five new health care centers and a 1/3 increase in the number of public hospital beds in impoverished and disadvantaged areas; increased access to and use of health services particularly by the poor and for expensive interventions; and the legal guarantee of the continuity of this policy. The implementation of this new policy was made possible through an 80% budget increase, improvements in efficiency, and a successful fight against corruption. The health impact of the reform was seen in decline of mortality rates in all age groups between 1997 and 2005 (22% for child mortality, 11% for economically active age groups, and 7.9% for retired age groups and by a 16% decline in AIDS related mortality between 2000 and 2005. This reform contrasts with the health care reform promoted by the right wing Federal government in the rest of the country; the latter was based on voluntary health insurance, cost-sharing by families, access to a limited package of services, and gradual enrollment of the population

  13. Health policy in the concertación era (1990-2010): Reforms the chilean way.

    Science.gov (United States)

    Martinez-Gutierrez, María Soledad; Cuadrado, Cristóbal

    2017-06-01

    The Chilean health system has experienced important transformations in the last decades with a neoliberal turn to privatization of the health insurance and healthcare market since the Pinochet reforms of the 1980s. During 20 years of center-left political coalition governments several reforms were attempted to regulate and reform such markets. This paper analyzes regulatory policies for the private health insurance and health care delivery market, adopted during the 1990-2010 period. A framework of variation in market types developed by Gingrich is adopted as analytical perspective. The set of policies advanced in this period could be expected to shift the responsibility of access to care from individuals to the collective and give control to the State or the consumers vis a vis producers. Nevertheless, the effect of the implemented reforms has been mixed. Regulations on private health insurers were ineffective in terms of shifting power to the consumer or the state. In contrast, the healthcare delivery market showed a trend of increasing payers' and consumers' control and the set of implemented reforms partially steered the market toward collective responsibility of access by creating a submarket of guaranteed services (AUGE) with lower copayments and fully funded services. Emerging unintended consequences of the adopted policies and potential explanations are discussed. In sum, attempts to use regulation to improve the collective dimension of the Chilean health system has enabled some progress, but several challenges had persisted. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Use of a policy debate to teach residents about health care reform.

    Science.gov (United States)

    Nguyen, Vu Q C; Hirsch, Mark A

    2011-09-01

    Resident education involves didactics and pedagogic strategies using a variety of tools and technologies in order to improve critical thinking skills. Debating is used in educational settings to improve critical thinking skills, but there have been no reports of its use in residency education. The present paper describes the use of debate to teach resident physicians about health care reform. We aimed to describe the method of using a debate in graduate medical education. Second-year through fourth-year physical medicine and rehabilitation residents participated in a moderated policy debate in which they deliberated whether the United States has one of the "best health care system(s) in the world." Following the debate, the participants completed an unvalidated open-ended questionnaire about health care reform. Although residents expressed initial concerns about participating in a public debate on health care reform, all faculty and residents expressed that the debate was robust, animated, and enjoyed by all. Components of holding a successful debate on health care reform were noted to be: (1) getting "buy-in" from the resident physicians; (2) preparing the debate; and (3) follow-up. The debate facilitated the study of a large, complex topic like health care reform. It created an active learning process. It encouraged learners to keenly attend to an opposing perspective while enthusiastically defending their position. We conclude that the use of debates as a teaching tool in resident education is valuable and should be explored further.

  15. Kyrgyzstan: Health system review.

    Science.gov (United States)

    Ibraimova, Ainura; Akkazieva, Baktygul; Ibraimov, Aibek; Manzhieva, Elina; Rechel, Bernd

    2011-01-01

    Kyrgyzstan has undertaken wide-ranging reforms of its health system in a challenging socioeconomic and political context. The country has developed two major health reform programmes after becoming independent: Manas (1996 to 2006) and Manas Taalimi (2006 to 2010). These reforms introduced comprehensive structural changes to the health care delivery system with the aim of strengthening primary health care, developing family medicine and restructuring the hospital sector.Major service delivery improvements have included the introduction of new clinical practice guidelines, improvements in the provision and use of pharmaceuticals, quality improvements in the priority programmes for mother and child health, cardiovascular diseases, tuberculosis and HIV/AIDS, strengthening of public health and improvements in medical education. A Community Action for Health programme was introduced through new village health committees, enhancing health promotion and allowing individuals and communities to take more responsibility for their own health. Health financing reform consisted of the introduction of a purchaser provider split and the establishment of a single payer for health services under the state-guaranteed benefit package (SGBP). Responsibility for purchasing health services has been consolidated under the Mandatory Health Insurance Fund (MHIF), which pools general revenue and health insurance funding. Funds have been pooled at national level since 2006, replacing the previous pooling at oblast level. The transition from oblast-based pooling of funds to pooling at the national level allowed the MHIF to distribute funds more equitably for the SGBP and the Additional Drug Package. Although utilization of both primary care and hospital services declined during the 1990s and early 2000s, it is increasing again. There is increasing equality of access across regions, improved financial protection and a decline in informal payments, but more efforts will be required in these

  16. Curriculum reform for reproductive health | Olatunbosun | African ...

    African Journals Online (AJOL)

    Les impératives supplémentaires dans l'assurance des services pour la santé de la femme, rendent obligatoire les reformes dans l'éducation médicale au niveau ... des principes de la santé reproductive et la nouvelle philosophie du rapport médecin-malade dans la surveillance clinique et dans la formation des étudiants.

  17. Benefits for Infants and Toddlers in Health Care Reform

    Science.gov (United States)

    Cole, Patricia

    2010-01-01

    Routine health care can spell the difference between a strong beginning and a fragile start. After much public and Congressional debate, President Obama signed into law landmark health care reform legislation. Although many provisions will not go into effect this year, several important changes could benefit children within a few months. The…

  18. Health Care Reform: Designing the Standard Benefits Package.

    Science.gov (United States)

    McArdle, Frank B.

    1994-01-01

    Considerations in designing a standard health care benefits package as a part of national health care reform are discussed. Specific features examined include deductibles, employer contributions, regional variations, cost management techniques such as managed care and higher copayments, annual out-of-pocket maximums, and lifetime benefit maximums.…

  19. Public Opinion and Health Care Reform for Children.

    Science.gov (United States)

    Bales, Susan Nall

    1993-01-01

    Recent polling data suggest that there is a growing consensus to pay special attention to children's needs in the health care reform debate. The public generally desires children to have greater access to health care services, even if this would mean higher taxes, but is unsure that government is the best vehicle to provide such services. (MDM)

  20. A comprehensive approach to women’s health: lessons from the Mexican health reform

    Directory of Open Access Journals (Sweden)

    Frenk Julio

    2012-12-01

    Full Text Available Abstract Background This paper discusses the way in which women’s health concerns were addressed in Mexico as part of a health system reform. Discussion The first part sets the context by examining the growing complexity that characterizes the global health field, where women’s needs occupy center stage. Part two briefly describes a critical conceptual evolution, i.e. from maternal to reproductive to women’s health. In the third and last section, the novel “women and health” (W&H approach and its translation into policies and programs in the context of a structural health reform in Mexico is discussed. W&H simultaneously focuses on women’s health needs and women’s critical roles as both formal and informal providers of health care, and the links between these two dimensions. Summary The most important message of this paper is that broad changes in health systems offer the opportunity to address women’s health needs through innovative approaches focused on promoting gender equality and empowering women as drivers of change.

  1. Health Care Reform Tracking Project: Tracking State Health Care Reforms as They Affect Children and Adolescents with Emotional Disorders and Their Families.

    Science.gov (United States)

    Pires, Sheila A.; Stroul, Beth A.

    The Health Care Reform Tracking Project is a 5-year national project to track and analyze state health care reform initiatives as they affect children and adolescents with emotional/behavioral disorders and their families. The study's first phase was a baseline survey of all 50 states to describe current state reforms as of 1995. Among findings of…

  2. Health in China. From Mao to market reform.

    Science.gov (United States)

    Hesketh, T; Wei, X Z

    1997-05-24

    After the Liberation by Mao Ze Dong's Communist army in 1949, China experienced massive social and economic change. The dramatic reductions in mortality and morbidity of the next two decades were brought about through improvements in socioeconomic conditions, an emphasis on prevention, and almost universal access to basic health care. The economic mismanagement of the Great Leap Forward brought about a temporary reversal in these positive trends. During the Cultural Revolution there was a sustained attack on the privileged position of the medical profession. Most city doctors were sent to work in the countryside, where they trained over a million barefoot doctors. Deng Xiao Ping's radical economic reforms of the late 1970s replaced the socialist system with a market economy. Although average incomes have increased, the gap between rich and poor has widened.

  3. Education System Reform in China after 1978: Some Practical Implications

    Science.gov (United States)

    Sun, Miantao

    2010-01-01

    Purpose: This paper aims to provide an overview of education system reform in China since 1978, and its practical implications. Design/methodology/approach: Data were collected from literature review and interview. An overview of education system reform and its practical implications was found through data analysis. Findings: There has been two…

  4. The health care reform in Mexico: before and after the 1985 earthquakes.

    Science.gov (United States)

    Soberón, G; Frenk, J; Sepúlveda, J

    1986-06-01

    The earthquakes that hit Mexico City in September 1985 caused considerable damage both to the population and to important medical facilities. The disaster took place while the country was undertaking a profound reform of its health care system. This reform had introduced a new principle for allocating and distributing the benefits of health care, namely, the principle of citizenship. Operationally, the reform includes an effort to decentralize the decision-making authority, to modernize the administration, to achieve greater coordination within the health sector and among sectors, and to extend coverage to the entire population through an ambitious primary care program. This paper examines the health context in which the reform was taking place when the September earthquakes hit. After presenting the damages caused by the quakes, the paper analyzes the characteristics of the immediate response by the health system. Since many facilities within the system were severely damaged, a series of options for reconstruction are posited. The main lesson to be learned from the Mexican case is that cuts in health care programs are not the inevitable response to economic or natural crises. On the contrary, it is precisely when the majority of the population is undergoing difficulties that a universal and equitable health system becomes most necessary.

  5. [Proposals for health reform and equity in Uruguay: a redefinition of the Welfare State?].

    Science.gov (United States)

    Mitjavila, Myriam; Fernandez, José; Moreira, Constanza

    2002-01-01

    This article reviews and analyzes health sector reform proposals in Uruguay and the possible effects of such reforms in terms of equity, the health sector's institutional structure, and the power relationship between the various actors in the process. The authors contend that a highly structured yet simultaneously fragmented system has conspired against any attempt to introduce major reforms into the system. Thus the only possibility for reform resides neither in the consolidation of the so-called Institutions for Collective Medical Care (IAMCs) nor in the move towards a residual model. Rather, Uruguay is witnessing the system's passive restructuring (i.e., reform by default). In this context and given the system's built-in inequities, the current trend is towards an even more regressive distribution of goods and services. The authors use qualitative and quantitative techniques to show that inequities in expenditure, access, and quality have resulted from long-term developments and adaptive movements of an IAMC system in fiscal stress and the public system's declining quality. Thus, in the absence of changes in state policy that redefine the actors' power or in the absence of system collapse, the country should expect this same regressive trend to deepen.

  6. Designing HIGH-COST medicine: hospital surveys, health planning, and the paradox of progressive reform.

    Science.gov (United States)

    Perkins, Barbara Bridgman

    2010-02-01

    Inspired by social medicine, some progressive US health reforms have paradoxically reinforced a business model of high-cost medical delivery that does not match social needs. In analyzing the financial status of their areas' hospitals, for example, city-wide hospital surveys of the 1910s through 1930s sought to direct capital investments and, in so doing, control competition and markets. The 2 national health planning programs that ran from the mid-1960s to the mid-1980s continued similar strategies of economic organization and management, as did the so-called market reforms that followed. Consequently, these reforms promoted large, extremely specialized, capital-intensive institutions and systems at the expense of less complex (and less costly) primary and chronic care. The current capital crisis may expose the lack of sustainability of such a model and open up new ideas and new ways to build health care designed to meet people's health needs.

  7. Implementing a Nation-Wide Mental Health Care Reform: An Analysis of Stakeholders' Priorities.

    Science.gov (United States)

    Lorant, Vincent; Grard, Adeline; Nicaise, Pablo

    2016-04-01

    Belgium has recently reformed its mental health care delivery system with the goals to strengthen the community-based supply of care, care integration, and the social rehabilitation of users and to reduce the resort to hospitals. We assessed whether these different reform goals were endorsed by stakeholders. One-hundred and twenty-two stakeholders ranked, online, eighteen goals of the reform according to their priorities. Stakeholders supported the goals of social rehabilitation of users and community care but were reluctant to reduce the resort to hospitals. Stakeholders were averse to changes in treatment processes, particularly in relation to the reduction of the resort to hospitals and mechanisms for more care integration. Goals heterogeneity and discrepancies between stakeholders' perspectives and policy priorities are likely to produce an uneven implementation of the reform process and, hence, reduce its capacity to achieve the social rehabilitation of users.

  8. Characterization and Modeling of a Methanol Reforming Fuel Cell System

    DEFF Research Database (Denmark)

    Sahlin, Simon Lennart

    topologies is the Reformed Methanol Fuel Cell (RMFC) system that operates on a mix of methanol and water. The fuel is reformed with a steam reforming to a hydrogen rich gas, however with additional formation of Carbon Monoxide and Carbon Dioxide. High Temperature Polymer Electrolyte Membrane Fuel Cell (HT...... to heat up the steam reforming process. However, utilizing the excess hydrogen in the system complicates the RMFC system as the amount of hydrogen can vary depending on the fuel methanol supply, fuel cell load and the reformer gas composition. This PhD study has therefore been involved in investigating......Many fuel cells systems today are operated with compressed hydrogen which has great benefits because of the purity of the hydrogen and the relatively simple storage of the fuel. However, compressed hydrogen is stored in the range of 800 bar, which can be expensive to compress.One of the interesting...

  9. Opportunities in Reform: Bioethics and Mental Health Ethics.

    Science.gov (United States)

    Williams, Arthur Robin

    2016-05-01

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

  10. A comparison of how behavioral health organizations utilize training to prepare for health care reform.

    Science.gov (United States)

    Stanhope, Victoria; Choy-Brown, Mimi; Barrenger, Stacey; Manuel, Jennifer; Mercado, Micaela; McKay, Mary; Marcus, Steven C

    2017-02-14

    Under the Affordable Care Act, States have obtained Medicaid waivers to overhaul their behavioral health service systems to improve quality and reduce costs. Critical to implementation of broad service delivery reforms has been the preparation of organizations responsible for service delivery. This study focused on one large-scale initiative to overhaul its service system with the goal of improving service quality and reducing costs. The study examined the participation of behavioral health organizations in technical assistance efforts and the extent to which organizational factors related to their participation. This study matched two datasets to examine the organizational characteristics and training participation for 196 behavioral health organizations. Organizational characteristics were drawn from the Substance Abuse and Mental Health Services Administration National Mental Health Services Survey (N-MHSS). Training variables were drawn from the Clinical Technical Assistance Center's master training database. Chi-square analyses and multivariate logistic regression models were used to examine the proportion of organizations that participated in training, the organizational characteristics (size, population served, service quality, infrastructure) that predicted participation in training, and for those who participated, the type (clinical or business) and intensity of training (webinar, learning collaborative, in-person) they received. Overall 142 (72. 4%) of the sample participated in training. Organizations who pursued training were more likely to be large in size (p = .02), serve children in addition to adults (p organizational readiness for health care reform initiatives among behavioral health organizations.

  11. The Reform of the Inservice Teacher Education System in Poland.

    Science.gov (United States)

    Zawadoska, Janina

    1995-01-01

    Poland is in the midst of sweeping educational reform, including reform of inservice teacher education. The system is abandoning totalitarianism for democracy. Most Polish teachers are specialized in only one subject, and there are surpluses of teachers in some subjects, so inservice education is focusing on helping teachers change specialties.…

  12. The effects of health care reforms on health inequalities: a review and analysis of the European evidence base.

    Science.gov (United States)

    Gelormino, Elena; Bambra, Clare; Spadea, Teresa; Bellini, Silvia; Costa, Giuseppe

    2011-01-01

    Health care is widely considered to be an important determinant of health. The health care systems of Western Europe have recently experienced significant reforms, under pressure from economic globalization. Similarly, in Eastern Europe, health care reforms have been undertaken in response to the demands of the new market economy. Both of these changes may influence equality in health outcomes. This article aims to identify the mechanisms through which health care may affect inequalities. The authors conducted a literature review of the effects on health inequalities of European health care reforms. Particular reference was paid to interventions in the fields of financing and pooling, allocation, purchasing, and provision of services. The majority of studies were from Western Europe, and the outcomes most often examined were access to services or income distribution. Overall, the quality of research was poor, confirming the need to develop an appropriate impact assessment methodology. Few studies were related to pooling, allocation, or purchasing. For financing and purchasing, the studies showed that publicly funded universal health care reduces the impact of ill health on income distribution, while insurance systems can increase inequalities in access to care. Out-of-pocket payments increase inequalities in access to care and contribute to impoverishment. Decentralizing health services can lead to geographic inequalities in health care access. Nationalized, publicly funded health care systems are most effective at reducing inequalities in access and reducing the effects on health of income distribution.

  13. Parental education and child health: evidence from a schooling reform

    NARCIS (Netherlands)

    Lindeboom, M.; Llena Nozal, A.; van der Klaauw, B.

    2009-01-01

    This paper investigates the impact of parental education on child health outcomes. To identify the causal effect we explore exogenous variation in parental education induced by a schooling reform in 1947, which raised the minimum school leaving age in the UK. Findings based on data from the National

  14. Monitoring and evaluation of health sector reforms in the WHO ...

    African Journals Online (AJOL)

    Concerning results of the expected results of implementing cost recovery reforms such as improved quality of health services; equitable service utilisation; social sustainability through active community participation; and gains in efficiency were not always realised. Conclusions: Given that the aspects of the analysis ...

  15. Health Care Reform and Medical Education: Forces toward Generalism.

    Science.gov (United States)

    O'Neil, Edward H.; Seifer, Sarena D.

    1995-01-01

    Health care reforms will dramatically change the culture of medical schools in areas of patient care, research, and education programs. Academic medical centers must construct mutually beneficial partnerships that will position them to take advantage of the opportunities rather than leave them without the diversity of resources needed to make…

  16. Policy conflicts : Market-oriented reform in health care

    NARCIS (Netherlands)

    Dolfsma, W.A.; Mcmaster, R.

    From an institutionalist perspective, we identify five sources of policy conflict. Each may explain why policies intended to obtain particular goals for an institutionalized practice may have unintended consequences. We illustrate by analyzing attempts at introducing market-oriented reform in health

  17. Health Care Reform and Its Implications for the Administrative Sciences.

    Science.gov (United States)

    Kolassa, E. M.

    1994-01-01

    It is argued that the discipline of pharmacoeconomics has much to offer the pharmacy field during a period of health care reform but that these specialists must let their colleagues in related fields know how they can assist in facilitating change. (MSE)

  18. Revisiting the Issues: Children and National Health Care Reform.

    Science.gov (United States)

    Rosenbaum, Sara

    1994-01-01

    Summarizes principal features of 6 bills on health care reform introduced in the 103rd Congress as they relate to children. Proposals are compared on 11 major issues, highlighting the degree to which each bill would achieve universal coverage, access to care, equity of treatment, and quality of comprehensive care. (SLD)

  19. Pharmacy Education in an Era of Health Care Reform.

    Science.gov (United States)

    Benet, Leslie Z.

    1994-01-01

    The president of the American Association of Colleges of Pharmacy outlines the association's position on national policy concerning health care reform, then looks at some related controversial issues, including changes in the dispensing of prescriptions, pharmacist-managed medication review, adequacy of pharmacy training, and the role of research.…

  20. Health care reform and the hospital supply chain.

    Science.gov (United States)

    Colletti, J J

    1994-02-01

    With health care reform, hospitals will be differentiated in the marketplace by how well they manage the costs of services. Because products will be market priced, hospital materiel managers will have to minimize all other related acquisition costs. The key opportunities will be in changing processes to eliminate non-value added administrative, supply chain, and process activities and their attendant costs.

  1. COMMENTARY: GLOBALIZATION, HEALTH SECTOR REFORM, AND THE HUMAN RIGHT TO HEALTH: IMPLICATIONS FOR FUTURE HEALTH POLICY.

    Science.gov (United States)

    Schuftan, Claudio

    2015-01-01

    The author here distills his long-time personal experience with the deleterious effects of globalization on health and on the health sector reforms embarked on in many of the more than 50 countries where he has worked in the last 25 years. He highlights the role that the "human right to health" framework can and should play in countering globalization's negative effects on health and in shaping future health policy. This is a testimonial article.

  2. Reforming the Welfare System in the People's Republic of China

    National Research Council Canada - National Science Library

    Mai Lu; Mingliang Feng

    2008-01-01

    This paper reviews the recent progress in welfare system reforms in the People's Republic of China and looks at the experiences of Japan and Republic of Korea in establishing their modern welfare systems...

  3. Denmark: Health system review

    DEFF Research Database (Denmark)

    Juul, Annegrete; Krasnik, Allan; Rudkjøbing, Andreas

    The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery...... of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health...... system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability)....

  4. Health Care Reform: Ethical Foundations, Policy, and Law

    Science.gov (United States)

    Sade, Robert M

    2015-01-01

    Health care system reform has enormous implications for the future of American society and economic life. Since the early days of the republic, 2 world views have vied for determination of this country’s political system: the view of the individual as sovereign vs government as sovereign. As they developed the foundations of our nation’s governance, the founders were heavily influenced by the Enlightenment philosophy of the late 17th and 18th centuries—the US Constitution sharply limited the power of central government to specific narrowly defined functions, and the economic system was largely laissez faire, that is, economic exchange was mostly free of government regulation and securing individual liberty was a high priority. This situation has slowly reversed—the federal government originally was narrowly limited, but now it dominates states and individuals. The economic system has followed, lagging by several decades, so although it still retains some features of laissez faire capitalism, federal and state regulation have produced a decidedly mixed economy. PMID:22626914

  5. Stepwise expansion of evidence-based care is needed for mental health reform.

    Science.gov (United States)

    McGorry, Patrick D; Hamilton, Matthew P

    2016-05-16

    Mortality from mental illnesses is increasing and, because they frequently occur early in the life cycle, they are the largest source of disability and reduced economic productivity of all non-communicable diseases. Successful mental health reform can reduce the mortality, morbidity, growing welfare costs and losses in economic productivity caused by mental illness. The government has largely adopted the recommendations of the National Mental Health Commission focusing on early intervention and stepwise care and will implement a reform plan that involves devolving commissioning of federally funded mental health services to primary health networks, along with a greater emphasis on e-mental health. Stepwise expanded investment in and structural support (data collection, evaluation, model fidelity, workforce training) for evidence-based care that rectifies high levels of undertreatment are essential for these reforms to succeed. However, the reforms are currently constrained by a cost-containment policy framework that envisages no additional funding. The early intervention reform aim requires financing for the next stage of development of Australia's youth mental health system, rather than redirecting funds from existing evidence-based programs. People with complex, enduring mental disorders need more comprehensive care. In the context of the National Disability Insurance Scheme, there is a risk that these already seriously underserved patients may paradoxically receive a reduction in coverage. E-health has a key role to play at all stages of illness but must be integrated in a complementary way, rather than as a barrier to access. Research and evaluation are the keys to cost-effective, sustainable reform.

  6. Banking system reform, earnings quality and credit allocation

    Directory of Open Access Journals (Sweden)

    Xiuli Zhu

    2012-09-01

    Full Text Available This paper investigates credit allocation before and after the 2003 banking system reform in China. We find that relationships between earnings quality and new short-term loans, long-term loans and total loans in listed companies changed significantly after the banking system reform, especially in state-owned listed companies. Further investigation shows that due to the influence of rent-seeking, banks have eased the earnings requirements of non-state-owned listed companies. These findings enhance our understanding of the economic consequences of the banking system reform and of credit discrimination under the new regime.

  7. A miniature fuel reformer system for portable power sources

    Science.gov (United States)

    Dolanc, Gregor; Belavič, Darko; Hrovat, Marko; Hočevar, Stanko; Pohar, Andrej; Petrovčič, Janko; Musizza, Bojan

    2014-12-01

    A miniature methanol reformer system has been designed and built to technology readiness level exceeding a laboratory prototype. It is intended to feed fuel cells with electric power up to 100 W and contains a complete setup of the technological elements: catalytic reforming and PROX reactors, a combustor, evaporators, actuation and sensing elements, and a control unit. The system is engineered not only for performance and quality of the reformate, but also for its lightweight and compact design, seamless integration of elements, low internal electric consumption, and safety. In the paper, the design of the system is presented by focussing on its miniaturisation, integration, and process control.

  8. Eqüidade e reforma em sistemas de serviços de saúde: o caso do SUS Equity and reform in health services system: the case of Unified Health System of Brazil

    Directory of Open Access Journals (Sweden)

    Jairnilson Silva Paim

    2006-08-01

    Full Text Available O ensaio procurou responder a seguinte pergunta: o SUS é uma política pública de promoção da eqüidade? Nesse sentido, apresenta alguns delineamentos prévios sobre certas noções presentes na pergunta, especialmente sobre as concepções de eqüidade e do SUS. Realiza uma breve revisão sobre reformas setoriais em contraponto com a Reforma Sanitária Brasileira e um sumário do perfil de desigualdades em saúde no país. Conclui examinando alguns esforços para a redução dessas desigualdades levantando a hipótese de que o SUS pode promover eqüidade no sentido de justiça sem comprometer o seu caráter universal e igualitário.This paper aimed to answer the following question: Is SUS a public policy of equity promotion? In this direction, it presents previous thoughts on some terms, especially on the concepts of equity and on SUS. A brief review is carried out on sector's reforms in order to discuss the Brazilian Sanitary Reform. Also, a summary of health inequalities profile in the country is given. It concludes by examining some efforts for the reduction of these inequalities by formulating the hypothesis that SUS can promote equity in the direction of justice without compromising its universal and egalitarian character.

  9. International monetary system – between crisis and reform

    Directory of Open Access Journals (Sweden)

    Ramona ORĂŞTEAN

    2013-08-01

    Full Text Available The 2008 global crisis that hit in the heart of the system highlighted main deficiencies and vulnerabilities of the current international monetary system and revived the old concerns about its functioning. The reform of the international monetary system is under discussion again after a long period, during the ’90 crises, especially in Southeast Asia, Russia and Brazil. To explain the relation between crisis and reform, this paper identifies some variables and hypotheses. It also analyses the matters that have sparked interest in reforming the international monetary system, in the context of the causes of the crisis and its vulnerabilities, admitting that the current system is not a perfect one. The paper concludes that it is time for a deep reform of the international monetary system.

  10. Parental education and child health: evidence from a schooling reform.

    Science.gov (United States)

    Lindeboom, Maarten; Llena-Nozal, Ana; van der Klaauw, Bas

    2009-01-01

    This paper investigates the impact of parental education on child health outcomes. To identify the causal effect we explore exogenous variation in parental education induced by a schooling reform in 1947, which raised the minimum school leaving age in the UK. Findings based on data from the National Child Development Study suggest that increasing the school leaving age by 1 year had little effect on the health of their offspring. Schooling did however improve economic opportunities by reducing financial difficulties among households.

  11. Electoral reform and public policy outcomes in Thailand: the politics of the 30-Baht health scheme.

    Science.gov (United States)

    Selway, Joel Sawat

    2011-01-01

    How do changes in electoral rules affect the nature of public policy outcomes? The current evidence supporting institutional theories that answer this question stems almost entirely from quantitative cross-country studies, the data of which contain very little within-unit variation. Indeed, while there are many country-level accounts of how changes in electoral rules affect such phenomena as the number of parties or voter turnout, there are few studies of how electoral reform affects public policy outcomes. This article contributes to this latter endeavor by providing a detailed analysis of electoral reform and the public policy process in Thailand through an examination of the 1997 electoral reforms. Specifically, the author examines four aspects of policy-making: policy formulation, policy platforms, policy content, and policy outcomes. The article finds that candidates in the pre-1997 era campaigned on broad, generic platforms; parties had no independent means of technical policy expertise; the government targeted health resources to narrow geographic areas; and health was underprovided in Thai society. Conversely, candidates in the post-1997 era relied more on a strong, detailed national health policy; parties created mechanisms to formulate health policy independently; the government allocated health resources broadly to the entire nation through the introduction of a universal health care system, and health outcomes improved. The author attributes these changes in the policy process to the 1997 electoral reform, which increased both constituency breadth (the proportion of the population to which politicians were accountable) and majoritarianism.

  12. The Impact of Health Care and Immigration Reform on Latino Support for President Obama and Congress

    Science.gov (United States)

    Sanchez, Gabriel R.; Medeiros, Jillian; Sanchez-Youngman, Shannon

    2012-01-01

    At the start of their term, the Obama administration pledged to reform two failing policy systems in the United States: immigration and health care. The Latino populations' attitudes toward these two critical policy areas are particularly relevant due to the large foreign born population in the Latino community and the large number of Latinos who…

  13. Health Education Careers in a Post-Health Reform Era.

    Science.gov (United States)

    Auld, M Elaine

    2017-09-01

    Since enactment of the Patient Protection and Affordable Care Act in 2010, health education specialists (HES) have made important contributions in implementing the law's provisions at the individual, family, and population levels. Using their health education competencies and subcompetencies, HES are improving public understanding of health insurance literacy and enrollment options, conducting community health needs assessments required of nonprofit hospitals, modifying policies or systems to improve access to health screenings and preventive health services, strengthening clinical and community linkages, and working with employee benefit plans. In addition to educating stakeholders about their complementary training and roles with respect to clinical providers, HES must keep abreast of rapid changes catalyzed by the Affordable Care Act in terms of health standards, payment models, government regulations, statistics, and business practices. For continued career growth, HES must continually acquire new knowledge and skills, access and analyze data, and develop interprofessional partnerships that meet the evolving needs of employers as the nation pursues health for all.

  14. Labor Informality and the Incentive Effects of Social Security: Evidence from a Health Reform in Uruguay

    OpenAIRE

    Marcelo Bérgolo; Guillermo Cruces

    2011-01-01

    This paper studies the incentive effects of social security benefits on labor market informality following a policy reform in Uruguay. The reform extended health benefits to dependent children of private sector salaried workers, and thus altered the incentive structure of holding formal jobs within the household. The identification strategy of the reform¿s effects relies on a comparison between workers with children (affected by the reform) and those without children (unaffected by the reform...

  15. Exploring health care reform in a changing Europe: lessons from Greece.

    Science.gov (United States)

    Kousoulis, Antonis A; Angelopoulou, Konstantina-Eleni; Lionis, Christos

    2013-09-01

    The economic crisis is the major theme in the Eurozone and its impact on public health and outcomes is largely discussed. Under this pressure, concerns of further inequalities exist that may have an impact on the burden of several diseases in certain European countries. In this context, Greece is currently an issue of top interest in any international economic discussion. Although the background of the recession has been largely discussed as a political crisis, its health effects on the population, as well as the key role of primary care and general practice/family medicine in health care reform remain to be explored. Serving both the worldwide trend of orienting health care systems towards strengthened primary care and the inner need for minimizing the demand and lessening the burden from the dysfunctional and costly hospital-care system, the economic crisis sets the perfect timing for prioritizing primary health care. In this article a unique window of opportunity for health care reform in Greece is examined, attempting to establish the axes of an example of how health care system can be reshaped amidst the economic crisis. Equity, quality, value framework, medical professionalism, information technology and decentralization emerge as topics of central interest. There is no doubt that Europe is transitioning under challenging social, economic and public health perspectives. However, taking Greece as an example, the current economic situation sets a good timing for health care reform and the key messages of this paper could be used by other countries facing similar problems.

  16. Study of a methanol reforming polymer electrolyte fuel cell system

    Science.gov (United States)

    Bhatia, Krishan Kumar

    As an alternative to on-board gaseous storage of hydrogen for fuel cell vehicles, a simple liquid hydrocarbon, such as methanol, could be stored and reformed into hydrogen as needed. However, carbon monoxide (CO), a by-product of both the on-board and off-board hydrocarbon reforming processes, is a poison to fuel cell catalysts. In addition, the size of either an on-board hydrogen storage system or hydrocarbon reforming system puts severe packaging constraints on vehicle architecture. This thesis is a comprehensive study of the effects of methanol reformate on the performance of a polymer electrolyte membrane (PEM) fuel cell. While investigating the problem of vehicle architecture constraints, it was found that humidification and pressurization of this fuel cell system can be optimized, and thus make room available on-board for either a methanol reforming/CO treatment system or hydrogen storage system. In addition, it was found that methanol reformate, which contains dilute hydrogen and trace quantities of CO, is extremely detrimental to the performance of a PEM fuel cell. Furthermore, it was discovered, both experimentally and theoretically, that the transient process of poisoning is not only a function of CO concentration, but is also highly dependent on the level of hydrogen dilution. After studying the poisoning process, an actual methanol reforming fuel cell system was integrated and tested for overall efficiency. It was found that anode air injection was capable of greatly reducing the poisoning effect. This integrated methanol reforming system was compared to a direct methanol fuel cell system at various power levels. For automotive power applications, cost constraints proved the indirect system superior to the direct methanol system. However, with a well-to-wheel efficiency of 22%, the indirect methanol system was inferior to direct hydrogen fuel cell vehicles.

  17. Oral Health Care Reform in Finland – aiming to reduce inequity in care provision

    Directory of Open Access Journals (Sweden)

    Widström Eeva

    2008-01-01

    increased by 21% during the study period. Private patients who had previously not been entitled to reimbursements seemed to gain most from the reform. Conclusion The results of this study indicate that implementation of a substantial reform, that changes the traditionally defined tasks of the public and private sectors in an established oral health care provision system, proceeds slowly, is expensive and probably requires more stringent steering than was the case in Finland 2001 – 2004. However, the equity and fairness of the oral health care provision system improved and access to services and cost-sharing improved slightly.

  18. Health care reform 2009-2010: a neurosurgeon's perspective.

    Science.gov (United States)

    Tippett, Troy M

    2010-12-01

    Organized neurosurgery through its Washington Committee developed a number of principles against which all health care reform legislation was measured, and none of the bills were acceptable. The American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) worked through multiple venues to modify or reject the legislation. In the author's view, the American Medical Association (AMA) supported the bills because its board of trustees was too focused on eliminating the sustainable growth rate, or SGR. Physicians failed to shape the health care debate. The leadership of many medical organizations was not prepared for the debate. Many had no experience in this arena and thus were too willing to let lobbyists dictate their position. In the future there are 3 things organized neurosurgery must do: be prepared, never give in, and stick with their principles. Organized neurosurgery must be prepared by developing leaders that have experience in the full spectrum of organized medicine. Neurosurgeons must not count on others, and because the specialty is small all must be involved. Neurosurgeons must never give in. Organized neurosurgery started 2009 with little support for its positions but by the end of the debate had convinced many other organizations, representing almost 500,000 physicians, to take their position. From an organizational point of view, neurosurgeons should now do 3 things: 1) reform or reject the AMA; 2) develop a real surgical coalition; and 3) change the current political environment. Neurosurgeons must also follow their principles. In the author's opinion the most important principles are: health care as a responsibility, medical liability reform, and the right to privately contract. In the United Kingdom and Germany, where health care is considered a right rather than a responsibility, bureaucratic entities determine whether you have the right to health care just as the Independent Payment Advisory Board, established under

  19. Health Care Reform: America's Dilemma. Report on the National Meeting (Boston, Massachusetts, November 28-29, 1990).

    Science.gov (United States)

    Labor/Higher Education Council, Washington, DC.

    Health care reform's direct effect on higher education and labor is the subject of this conference report. Individual, panel, and interactive work group presentations addressing the values and options on health care issues are included. Following an introduction, three papers discuss the U.S. health care system: (1) "National Health Care…

  20. Specialization in psychology and health care reform.

    Science.gov (United States)

    Kaslow, Nadine J; Graves, Chanda C; Smith, Chaundrissa Oyeshiku

    2012-03-01

    This article begins by contextualizing specialization and board certification of psychologists, with attention paid to relevant definitions and expectations of other health care professionals. A brief history of specialization and board certification in professional psychology is offered. The benefits of board certification through the American Board of Professional Psychology are highlighted. Consideration is then given to the primary reasons for psychologists working in academic health sciences centers to specialize in the current health care climate and to obtain board certification as a mark of such specialization.

  1. National Health Care Reform and Solvency Risk

    OpenAIRE

    Deborah Chollet

    2012-01-01

    Health insurance companies hold uncommitted assets, called surplus, for a number of reasons. In some cases, surplus is used to finance planned but unobligated capital expenditures such as information technology.

  2. Investing in health information infrastructure: can it help achieve health reform?

    Science.gov (United States)

    Clancy, Carolyn M; Anderson, Kristine Martin; White, P Jon

    2009-01-01

    Health care reform has reemerged as a policy imperative. Congressional discussions regarding sizable federal investments in health information technology (IT) infrastructure have revitalized the vision of health IT as a critical component of accelerating improvements in the quality and value of health care for all Americans. Policymakers will be challenged to link investments in the health information infrastructure to the objectives of health care reform. The purpose of this paper is to articulate some near- and long-term steps that increase the likelihood of achieving high-value health care with the aid of health IT.

  3. The absence of stewardship in the Chilean health authority after the 2004 health reform

    Directory of Open Access Journals (Sweden)

    Tania Herrera

    2014-11-01

    Full Text Available Stewardship is the most important political function of a health system. It is a government responsibility carried out by the health authority. Among other dimensions, it is also a meta-function that includes conduction and regulation. The Health Authority and Management Act, which came about from the health reform of 2004, separated the functions of service provision and stewardship with the aim of strengthening the role of the health authority. However, the current structure of the health system contains overlapping functions between the different entities that leads to lack of coordination and inconsistencies, and a greater weight on individual health actions at the expense of collective ones. Consequently, a properly funded national health strategy to improve the health of the population is missing. Additionally, the components of citizen participation and governance are weak. It is necessary, therefore, to revisit the Chilean health structure in order to develop one that truly enables the exercise of the health authority’s stewardship role

  4. Achieving and Sustaining Universal Health Coverage: Fiscal Reform of the National Health Insurance in Taiwan.

    Science.gov (United States)

    Lan, Jesse Yu-Chen

    2017-12-01

    The paper discusses the expansion of the universal health coverage (UHC) in Taiwan through the establishment of National Health Insurance (NHI), and the fiscal crisis it caused. Two key questions are addressed: How did the NHI gradually achieve universal coverage, and yet cause Taiwanese health spending to escalate to fiscal crisis? What measures have been taken to reform the NHI finance and achieve moderate success to date? The main argument of this paper is that the Taiwanese Government did try to implement various reforms to save costs and had moderate success, but the path-dependent process of reform does not allow increasing contribution rates significantly and thereby makes sustainability challenging.

  5. Medical malpractice reform and employer-sponsored health insurance premiums.

    Science.gov (United States)

    Morrisey, Michael A; Kilgore, Meredith L; Nelson, Leonard Jack

    2008-12-01

    Tort reform may affect health insurance premiums both by reducing medical malpractice premiums and by reducing the extent of defensive medicine. The objective of this study is to estimate the effects of noneconomic damage caps on the premiums for employer-sponsored health insurance. Employer premium data and plan/establishment characteristics were obtained from the 1999 through 2004 Kaiser/HRET Employer Health Insurance Surveys. Damage caps were obtained and dated based on state annotated codes, statutes, and judicial decisions. Fixed effects regression models were run to estimate the effects of the size of inflation-adjusted damage caps on the weighted average single premiums. State tort reform laws were identified using Westlaw, LEXIS, and statutory compilations. Legislative repeal and amendment of statutes and court decisions resulting in the overturning or repealing state statutes were also identified using LEXIS. Using a variety of empirical specifications, there was no statistically significant evidence that noneconomic damage caps exerted any meaningful influence on the cost of employer-sponsored health insurance. The findings suggest that tort reforms have not translated into insurance savings.

  6. Welfare reform and older immigrants' health insurance coverage.

    Science.gov (United States)

    Nam, Yunju

    2008-11-01

    I examined changes in older immigrants' health insurance coverage after welfare reform in the United States to determine whether the reform measures achieved their goal of saving money by reducing Medicaid participation without increasing the number of uninsured people. Data were obtained from older adults who participated in the Current Population Survey's Annual Social and Economic Supplement from 1994 to 1996 and 2001 to 2005. I used logistic regression to estimate changes in the sample's Medicaid and health insurance coverage after welfare reform, paying special attention to noncitizens and recent immigrants. Older immigrants' health insurance status was associated with their citizenship status and length of stay in the United States. Medicaid participation significantly decreased among noncitizens and recent immigrants but increased among naturalized citizens. Private health insurance and employer-sponsored insurance coverage significantly increased among recent immigrants but decreased among established immigrants and naturalized citizens. The probability of being uninsured did not significantly change among any group of immigrants. Given increases in postreform Medicaid participation among some immigrant groups, my findings suggest that the long-term cost-saving effectiveness of the current restrictive Medicaid eligibility policy is doubtful.

  7. Rethinking the private-public mix in health care: analysis of health reforms in Israel during the last three decades.

    Science.gov (United States)

    Filc, Dani; Davidovitch, Nadav

    2016-10-01

    To analyse the process of health care privatization using the case of Israeli health care reforms during the last three decades. We used mixed methods including quantitative analysis of trends in health expenditures in Israel and qualitative critical analysis of documents describing the main health reforms. Israel epitomizes how boundaries between the private and public sector become blurred when health care services are subject to privatization, both of finance and supply. Additionally, the continuous growth of public-private relationships in health care results in systems that lack both equity and efficiency. More than three decades of experience show that such private-public partnerships increase both inequality and inefficiency. While most discussion surrounding the private-public mix in health care focuses on financing infrastructure, in Israel, the public-private mix has become a central way of financing and delivering services, making its damaging influence more pervasive. © The Author(s) 2016.

  8. Education and health knowledge: evidence from UK compulsory schooling reform.

    Science.gov (United States)

    Johnston, David W; Lordan, Grace; Shields, Michael A; Suziedelyte, Agne

    2015-02-01

    We investigate if there is a causal link between education and health knowledge using data from the 1984/85 and 1991/92 waves of the UK Health and Lifestyle Survey (HALS). Uniquely, the survey asks respondents what they think are the main causes of ten common health conditions, and we compare these answers to those given by medical professionals to form an index of health knowledge. For causal identification we use increases in the UK minimum school leaving age in 1947 (from 14 to 15) and 1972 (from 15 to 16) to provide exogenous variation in education. These reforms predominantly induced adolescents who would have left school to stay for one additionally mandated year. OLS estimates suggest that education significantly increases health knowledge, with a one-year increase in schooling increasing the health knowledge index by 15% of a standard deviation. In contrast, estimates from instrumental-variable models show that increased schooling due to the education reforms did not significantly affect health knowledge. This main result is robust to numerous specification tests and alternative formulations of the health knowledge index. Further research is required to determine whether there is also no causal link between higher levels of education - such as post-school qualifications - and health knowledge. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. The National Health Service reforms as an electoral issue in the United Kingdom.

    Science.gov (United States)

    Barraclough, S

    1993-01-01

    The implementation of National Health Service (NHS) reforms left the Conservative Government with a major electoral problem. As Britain approached the 1992 general election, opinion polls revealed a popular perception that the Conservatives were planning to privatise the NHS. This perception was both fuelled and acted upon by the Labour Opposition which, at its 1991 annual conference, signalled its intention to make the health service a major item on the electoral agenda. In this article several issues associated with popular perceptions of the health reforms are explored including increased levels of copayment, the language of commerce, entrepreneurial activities within the NHS, and 'opting out'. The ways in which the Labour Party sought to place health on the electoral agenda are examined, together with the response of the government. Labour sought to portray the reforms as creeping privatisation while the Conservatives dismissed this as a crude propaganda ploy and have stressed their commitment to a more effective NHS. It is argued that the British experience exemplifies the perennial problems for any government seeking to introduce substantive changes to a national health system in a partisan political environment: the need to explain changes and legitimize them, and the danger that reforms will be politicized by an opposition eager for issues with immediate popular impact.

  10. The Impact of Health Care Reform on Workers' Compensation Medical Care: Evidence from Massachusetts

    OpenAIRE

    Heaton, Paul

    2012-01-01

    This article shares the results of research that uses the experience of Massachusetts's heath care reform to empirically estimate how health reform impacts the volume and cost of workers' compensation hospital care.

  11. Price and quality transparency: how effective for health care reform?

    Science.gov (United States)

    Nyman, John A; Li, Chia-Hsuan W

    2009-07-01

    Many in Minnesota and the United States are promoting price and quality transparency as a means for reforming health care. The assumption is that with such information, consumers and providers would be motivated to change their behavior and this would lead to lower costs and higher-quality care.This article attempts to determine the extent to which publicizing information about the cost and quality of medical care does, in fact, improve quality and lower costs, and thus should be included in any reform strategy. The authors reviewed a number of studies and concluded that there is a general lack of empirical evidence on the effect of price transparency on health care costs and that the evidence on the effectiveness of quality transparency is mixed.

  12. Addiction treatment centers' progress in preparing for health care reform.

    Science.gov (United States)

    Molfenter, Todd D

    2014-02-01

    The Patient Protection and Affordable Care Act (PPACA) is expected to significantly alter addiction treatment service delivery. Researchers designed the Health Reform Readiness Index (HRRI) for addiction treatment organizations to assess their readiness for the PPACA. Four-hundred twenty-seven organizations completed the HRRI throughout a 3-year period, using a four-point scale to rank their readiness on 13 conditions. HRRI results completed during two different time periods (between 10/1/2010-6/30/2011 and 9/1/2011-9/30/2012) were analyzed and compared. Most respondents self-assessed as being in the early stages of preparation for 9 of the 13 conditions. Survey results showed that organizations with annual budgets $5 million (n=132). The HRRI results suggest that the addiction field, and in particular smaller organizations, is not preparing adequately for health care reform; organizations that are making preparations are making only modest gains. © 2013.

  13. Sweden health system review.

    Science.gov (United States)

    Anell, Anders; Glenngård, Anna H; Merkur, Sherry

    2012-01-01

    Life expectancy in Sweden is high and the country performs well in comparisons related to disease-oriented indicators of health service outcomes and quality of care. The Swedish health system is committed to ensuring the health of all citizens and abides by the principles of human dignity, need and solidarity, and cost-effectiveness. The state is responsible for overall health policy, while the funding and provision of services lies largely with the county councils and regions. The municipalities are responsible for the care of older and disabled people. The majority of primary care centres and almost all hospitals are owned by the county councils. Health care expenditure is mainly tax funded (80%) and is equivalent to 9.9% of gross domestic product (GDP) (2009). Only about 4% of the population has voluntary health insurance (VHI). User charges fund about 17% of health expenditure and are levied on visits to professionals, hospitalization and medicines. The number of acute care hospital beds is below the European Union (EU) average and Sweden allocates more human resources to the health sector than most OECD countries. In the past, the Achilles heel of Swedish health care included long waiting times for diagnosis and treatment and, more recently, divergence in quality of care between regions and socioeconomic groups. Addressing long waiting times remains a key policy objective along with improving access to providers. Recent principal health reforms over the past decade relate to: concentrating hospital services; regionalizing health care services, including mergers; improving coordinated care; increasing choice, competition and privatization in primary care; privatization and competition in the pharmacy sector; changing co-payments; and increasing attention to public comparison of quality and efficiency indicators, the value of investments in health care and responsiveness to patients needs. Reforms are often introduced on the local level, thus the pattern of

  14. Equity aspects of the Primary Health Care Choice Reform in Sweden - a scoping review.

    Science.gov (United States)

    Burström, Bo; Burström, Kristina; Nilsson, Gunnar; Tomson, Göran; Whitehead, Margaret; Winblad, Ulrika

    2017-01-28

    Good health and equal health care are the cornerstones of the Swedish Health and Medical Service Act. Recent studies show that the average level of health, measured as longevity, improves in Sweden, however, social inequalities in health remain a major issue. An important issue is how health care services can contribute to reducing inequalities in health, and the impact of a recent Primary Health Care (PHC) Choice Reform in this respect. This paper presents the findings of a review of the existing evidence on impacts of these reforms. We reviewed the published accounts (reports and scientific articles) which reported on the impact of the Swedish PHC Choice Reform of 2010 and changes in reimbursement systems, using Donabedian's framework for assessing quality of care in terms of structure, process and outcomes. Since 2010, over 270 new private PHC practices operating for profit have been established throughout the country. One study found that the new establishments had primarily located in the largest cities and urban areas, in socioeconomically more advantaged populations. Another study, adjusting for socioeconomic composition found minor differences. The number of visits to PHC doctors has increased, more so among those with lesser needs of health care. The reform has had a negative impact on the provision of services for persons with complex needs. Opinions of doctors and staff in PHC are mixed, many state that persons with lesser needs are prioritized. Patient satisfaction is largely unchanged. The impact of PHC on population health may be reduced. The PHC Choice Reform increased the average number of visits, but particularly among those in more affluent groups and with lower health care needs, and has made integrated care for those with complex needs more difficult. Resource allocation to PHC has become more dependent on provider location, patient choice and demand, and less on need of care. On the available evidence, the PHC Choice Reform may have damaged

  15. The challenges of primary health care nurse leaders in the wake of New Health Care Reform in Norway.

    Science.gov (United States)

    Tingvoll, Wivi-Ann; Sæterstrand, Torill; McClusky, Leon Mendel

    2016-01-01

    The local municipality, whose management style is largely inspired by the New Public Management (NPM) model, has administrative responsibilities for primary health care in Norway. Those responsible for health care at the local level often find themselves torn between their professional responsibilities and the municipality's market-oriented funding system. The introduction of the new health care reform process known as the Coordination Reform in January 2012 prioritises primary health care while simultaneously promoting a more collaborative and multidisciplinary approach to health care. Nurse leaders experience constant cross-pressure in their roles as members of the municipal executive team, the execution of their professional and administrative duties, and the overall political aims of the new reform. The aim of this article is to illuminate some of the major challenges facing nurse leaders in charge of nursing homes and to draw attention to their professional concerns about the quality of nursing care with the introduction of the new reform and its implementation under NPM-inspired municipal executive leadership. This study employs a qualitative design. In-depth interviews were conducted with 10 nurse leaders in 10 municipalities, with a phenomenological-hermeneutic approach used for data analysis and interpretation. Findings highlighted the increasingly complex challenges facing nurse leaders operating in the context of the municipality's hierarchical NPM management structure, while they are required to exercise collaborative professional interactions as per the guidelines of the new Coordination Reform. The interview findings were interpreted out of three sub-themes 1) importance of support for the nurse leader, 2) concerns about overall service quality, and 3) increased tasks unrelated to nursing leadership. The priorities of municipal senior management and the focus of the municipality's care service need clarification in the light of this reform. The voices

  16. United States Health Care Reform: Progress to Date and Next Steps.

    Science.gov (United States)

    Obama, Barack

    2016-08-02

    The Affordable Care Act is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. The law implemented comprehensive reforms designed to improve the accessibility, affordability, and quality of health care. To review the factors influencing the decision to pursue health reform, summarize evidence on the effects of the law to date, recommend actions that could improve the health care system, and identify general lessons for public policy from the Affordable Care Act. Analysis of publicly available data, data obtained from government agencies, and published research findings. The period examined extends from 1963 to early 2016. The Affordable Care Act has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law's reforms. Research has documented accompanying improvements in access to care (for example, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (for example, an estimated reduction in debts sent to collection of $600-$1000 per person gaining Medicaid coverage), and health (for example, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points). The law has also begun the process of transforming health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. Despite this progress, major opportunities to improve the health care system remain. Policy

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

    African Journals Online (AJOL)

    system being controlled by district and central level authorities, leaving little room for lower level stake- holders to participate. Conclusion: For ... as staff directly involved in health-care service delivery and their allied personnel within ..... diagnoses; and prevention of infections at HFs, espe- cially at dispensary levels. HWs in ...

  18. Outcomes of a Freedom of Choice Reform in Community Mental Health Day Center Services.

    Science.gov (United States)

    Eklund, Mona; Markström, Urban

    2015-11-01

    A freedom-of-choice reform within mental health day center services was evaluated. The reform aimed to (1) facilitate users' change between units and (2) increase the availability of service providers. Seventy-eight users responded to questionnaires about the reform, empowerment, social network, engagement and satisfaction and were followed-up after 15 months. Fifty-four percent knew about the reform. A majority stated the reform meant nothing to them; ~25 % had a negative and ~20 % a positive opinion. Satisfaction with the services had decreased after 15 months. Empowerment decreased for a more intensively followed subgroup. No positive consequences of the reform could thus be discerned.

  19. National Public Opinion on School Health Education: Implications for the Health Care Reform Initiatives.

    Science.gov (United States)

    Torabi, Mohammad R.; Crowe, James W.

    1995-01-01

    This study investigated national public opinion on school health education and the implications for health-care reform initiatives. Telephone surveys of 1,005 adults nationwide indicated that the public at large believes in the importance of health education to reduce health problems among children, considering it the responsibility of parents and…

  20. 3 CFR 13507 - Executive Order 13507 of April 8, 2009. Establishment of the White House Office of Health Reform

    Science.gov (United States)

    2010-01-01

    ... and must be improved, in order to improve the health of our citizens and our economic security. Sec. 2... improve the performance of the health care system; (h) work with the Congress and executive departments... President's agenda on health reform; and (j) help ensure that policymakers across the executive branch work...

  1. A reforma sanitária brasileira e o Sistema Único de Saúde: dialogando com hipóteses concorrentes The Brazilian Health Sector Reform and the Unified Health System: talking to competing hypotheses

    Directory of Open Access Journals (Sweden)

    Jairnilson Silva Paim

    2008-01-01

    Reform. Therefore, the aim of the present research is to analyze the emergence and the development of a Health Sector Reform inside a capitalist social formation, its foundations and characteristics, discussing the praxis challenges. The point of depart are four types of praxis and social changes: partial reform, general reform, revolutionary political movement and global social revolution. The thesis that is supported is that the Brazilian Health Sector Reform, as a social and historic phenomenon, is a social Reform. The hypothesis of the study is that the Brazilian Health Sector Reform, even though proposed as a global reform in its praxis and theorized to reach a revolution in people's way of life, has became a partial reform - sectorial and institutional. It was carried out a case study research based on documental analysis over two conjunctures. The descriptive component of the study was the cycle: idea-proposal-project-movement-process, and the explanatory one was the analysis of Brazilian society's development based on Gramsci's theoretical referential, particularly the categories of passive revolution and transformism. The results points in the direction of a partial reform. The importance of the Jacobin compound in a Democratic Health Sector Reform is discussed. In this case, the democratic radicalization would help change the correlation of forces, unbalancing the binomial conservation-change in the benefit of the latter and conferring a more progressive characteristic for the passive revolution.

  2. The Interface of School, Community, and Health Care Reform: Organizational Directions toward Effective Services for Children and Youth.

    Science.gov (United States)

    Knoff, Howard M.

    1996-01-01

    Three areas of reform have been under national scrutiny: school reform, community services reform, and health-care reform. Few have discussed how these three areas interface and can be organized toward more effective services for children and youth. Describes organizational and planning methodology that coordinates these three reform areas into a…

  3. Determination of optimal reformer temperature in a reformed methanol fuel cell system using ANFIS models and numerical optimization methods

    DEFF Research Database (Denmark)

    Justesen, Kristian Kjær; Andreasen, Søren Juhl

    2015-01-01

    In this work a method for choosing the optimal reformer temperature for a reformed methanol fuel cell system is presented based on a case study of a H3 350 module produced by Serenergy A/S. The method is based on ANFIS models of the dependence of the reformer output gas composition on the reformer...... temperature and fuel flow, and the dependence of the fuel cell voltage on the fuel cell temperature, current and anode supply gas CO content. These models are combined to give a matrix of system efficiencies at different fuel cell currents and reformer temperatures. This matrix is then used to find...... the reformer temperature which gives the highest efficiency for each fuel cell current. The average of this optimal efficiency curve is 32.11% and the average efficiency achieved using the standard constant temperature is 30.64% an increase of 1.47 percentage points. The gain in efficiency is 4 percentage...

  4. Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

    Science.gov (United States)

    Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan

    2012-01-01

    Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools – accountability measures and payment designs – to improve access to and quality of care for patients with behavioral health needs. PMID:23188486

  5. The implications of managed care and welfare reform for the integration of health and welfare services.

    Science.gov (United States)

    Austin, Michael J; Prince, Jonathan

    2003-01-01

    In this era of managed care and welfare reform, the two systems of public health and public welfare are increasingly focused on a shared population and the services designed to promote self-sufficiency and good health among low-income individuals, families and communities. The two service systems are often constrained by categorical funding mechanisms that contribute to service fragmentation, discontinuity and redundancy. This paper focuses on the changing nature of health and welfare, the impact of categorical funding mechanisms, the barriers to service integration, the potentials for partnership, and concludes with implications for enhancing service integration and the quality of services. Copyright 2003 The Haworth Press, Inc.

  6. Risk avoidance and missed opportunities in mental health reform: the case of Israel.

    Science.gov (United States)

    Aviram, Uri; Guy, Dalia; Sykes, Israel

    2007-01-01

    political, economic and social context, on the other. Findings show that conflict of interests and risk avoidance of the major stakeholders were major obstacles to reaching agreement on a formula for implementation. The major risks were related to the inability to predict future demand for ambulatory services, uncertainty regarding future costs, and disagreements regarding the reliability and validity of data. Contextual factors that undermined the chances for successful implementation of the reform included lack of a strong political commitment and a coalition supporting the reform, a financial crisis in the health system resulting from early stages of implementation of the National Health Insurance Law, and social turmoil created by the Rabin government's attempts to implement the Oslo agreements. This turmoil ultimately culminated in the assassination of the Prime Minister Yitzchak Rabin, creating a climate far from conducive to generating public interest in mental health reform and facilitating the planned change. As a result the mental health system remained virtually unchanged.

  7. Integrating reproductive health services in a reforming health sector: the case of Tanzania.

    Science.gov (United States)

    Oliff, Monique; Mayaud, Philippe; Brugha, Ruairí; Semakafu, Ave Maria

    2003-05-01

    Universal access to comprehensive reproductive health services, integrated into a well-functioning health system, remains an unfulfilled objective in many countries. In 2000-2001, in Tanzania, in-depth interviews were conducted with central level stakeholders and focus group discussions held with health management staff in three regional and nine district health offices, to assess progress in the integration of reproductive health services. Respondents at all levels reported stalled integration and lack of synchronisation in the planning and management of key services. This was attributed to fear of loss of power and resources among national level managers, uncertainty as to continuation of donor support and lack of linkages with the Health Sector Reform Secretariat. Among reproductive health programmes, sexually transmitted infection (STI) control alone retained its vertical planning, management and implementation structures. District-level respondents expressed frustration in their efforts to coordinate STI service delivery with other, more integrated programmes. They reported contradictory directives and poor communication channels with higher levels of the Ministry of Health; lack of technical skills at district level to undertake supervision of integrated services; low morale due to low salaries; and lack of district autonomy in decision-making. Integration requires a coherent policy environment. The uncoordinated and conflicting agendas of donors, on whom Tanzania is too heavily reliant, is a major obstacle.

  8. Use rates under President Clinton's health reform plan.

    Science.gov (United States)

    Weil, T P

    1993-01-01

    During the 1992 presidential debates there was considerable rhetoric on health reform. Based on the broad principles now available concerning President Clinton's plan, this article compares differences in hospital and physician use rates of the now uninsured, who would be covered by his proposal, to those who have been traditionally enrolled in health insurance plans. Numerous studies illustrate that these new insurees have historically needed more and received less health care than the insured. Hospitals and physicians will be under pressure to provide a greater volume of benefits. It is predicted that these future estimated use rates will be more akin to the Canadian single-payor rather than the German multipayor national health insurance plan.

  9. DOD Health Care: Cost Impact of Health Care Reform and the Extension of Dependent Coverage

    Science.gov (United States)

    2011-09-26

    care reform legislation—the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA...Estimated Costs for Compliance Patient Protection and Affordable Care Act (PPACA) and Health Care and Education Reconciliation Act of 2010 (HCERA...including inpatient hospitals, home health agencies, nursing homes, hospice providers, psychiatric hospitals, long-term care hospitals, inpatient

  10. Is the time finally ripe? Health insurance reforms in the 1990s.

    Science.gov (United States)

    Skocpol, T

    1993-01-01

    Reformers feel certain that the time is now ripe for progressive legislation to ensure universal citizen access to health insurance and to contain rising costs in the health care industry. But history shows us that reformers were equally confident in earlier periods of modern U.S. history, only to find themselves defeated by conservatives willing to deploy ideological, emotionally charged arguments against government-sponsored reforms. Today's advocates of inside-the-beltway bargains for hammering out compromise reforms may be vulnerable to similar conservative counterattacks. Reformers need to engage the U.S. citizenry as a whole in democratic discussion about the ideals of government-sponsored health care reforms. Advocates of single-payer plans can do this more readily than supporters of complex public-private schemes such as play or pay or managed competition, but all those who want inclusive and effective reforms during the 1990s must face the challenge of democratic dialogue.

  11. The political challenges that may undermine health reform.

    Science.gov (United States)

    Skocpol, Theda

    2010-07-01

    As with all major social legislation, years of decisions and disputes over implementation lie ahead for the Patient Protection and Affordable Care Act. Opponents at the state and national levels may seek the law's judicial overturn or repeal. However, a far more serious effort to undermine the law will come about through challenges to various administrative arrangements, taxes, and subsidies to fund expansions of coverage. The redistributive aspects of health reform will be especially at risk, as business interests and groups of more-privileged citizens press for lower taxes, looser regulations, and reduced subsidies for low-income people.

  12. Systemic Chemical Education Reform [SCER] in the global era ...

    African Journals Online (AJOL)

    Systemic chemical education reform [SCER] has gained a great importance internationally due to the competitive job market and global market economy which create global challenges and stresses on our current educational system. SCER is a dynamic process that requires constant communication, evaluation and has ...

  13. Sub-national health care financing reforms in Indonesia.

    Science.gov (United States)

    Sparrow, Robert; Budiyati, Sri; Yumna, Athia; Warda, Nila; Suryahadi, Asep; Bedi, Arjun S

    2017-02-01

    Indonesia has seen an emergence of local health care financing schemes over the last decade, implemented and operated by district governments. Often motivated by the local political context and characterized by a large degree of heterogeneity in scope and design, the common objective of the district schemes is to address the coverage gaps for the informal sector left by national social health insurance programs. This paper investigates the effect of these local health care financing schemes on access to health care and financial protection. Using data from a unique survey among District Health Offices, combined with data from the annual National Socioeconomic Surveys, the study is based on a fixed effects analysis for a panel of 262 districts over the period 2004-10, exploiting variation in local health financing reforms across districts in terms of type of reform and timing of implementation. Although the schemes had a modest impact on average, they do seem to have provided some contribution to closing the coverage gap, by increasing outpatient utilization for households in the middle quintiles that tend to fall just outside the target population of the national subsidized programs. However, there seems to be little effect on hospitalization or financial protection, indicating the limitations of local health care financing policies. In addition, we see effect heterogeneity across districts due to differences in design features. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. What attracts students to interprofessional education and other health care reform initiatives?

    Science.gov (United States)

    Hoffman, Steven J; Rosenfield, Daniel; Nasmith, Louise

    2009-01-01

    An international consensus has emerged that interprofessional education (IPE) and other health care reforms are necessary to address the increasing complexity of patients' health needs. Despite overwhelming barriers to its system-wide implementation, health professional students worldwide have organized themselves to promote IPE and have achieved considerable attention. This study seeks to offer insights into what attracts students to IPE and other health care reform initiatives and how advocates of change can stimulate this interest. Using a qualitative research methodology, 69 students representing 25 disciplines from 22 institutions across North America were interviewed and surveyed on why and how they became interested in IPE. Students were attracted to the possibility of enhancing patient care (n=17), advancing their careers (n=17) and learning more about the issue (n=15). The participating students first became involved in IPE after they joined a student organization (n=21), attended an IPE conference (n=10) or received personal encouragement to do so from a dean (n=2), instructor (n=3), school administrator (n=7) or peer (n=11). These findings point to several strategies that advocates can use to capitalize on the potential of student advocacy to gain support for IPE and new health care innovations. This study is the first of its kind to delineate how clinicians, educators, researchers and policymakers can attract students to health care reform initiatives. This work can inform the strategic efforts of advocates to make the idea of IPE and health care reform more attractive to students (as both learners and leaders) and enlist their help in achieving it in the future.

  15. The quest for equity in Latin America: a comparative analysis of the health care reforms in Brazil and Colombia

    Directory of Open Access Journals (Sweden)

    Esteves Roberto JF

    2012-02-01

    Full Text Available Abstract Introduction Brazil and Colombia have pursued extensive reforms of their health care systems in the last couple of decades. The purported goals of such reforms were to improve access, increase efficiency and reduce health inequities. Notwithstanding their common goals, each country sought a very different pathway to achieve them. While Brazil attempted to reestablish a greater level of State control through a public national health system, Colombia embraced market competition under an employer-based social insurance scheme. This work thus aims to shed some light onto why they pursued divergent strategies and what that has meant in terms of health outcomes. Methods A critical review of the literature concerning equity frameworks, as well as the health care reforms in Brazil and Colombia was conducted. Then, the shortfall inequality values of crude mortality rate, infant mortality rate, under-five mortality rate, and life expectancy for the period 1960-2005 were calculated for both countries. Subsequently, bivariate and multivariate linear regression analyses were performed and controlled for possibly confounding factors. Results When controlling for the underlying historical time trend, both countries appear to have experienced a deceleration of the pace of improvements in the years following the reforms, for all the variables analyzed. In the case of Colombia, some of the previous gains in under-five mortality rate and crude mortality rate were, in fact, reversed. Conclusions Neither reform seems to have had a decisive positive impact on the health outcomes analyzed for the defined time period of this research. This, in turn, may be a consequence of both internal characteristics of the respective reforms and external factors beyond the direct control of health reformers. Among the internal characteristics: underfunding, unbridled decentralization and inequitable access to care seem to have been the main constraints. Conversely

  16. The quest for equity in Latin America: a comparative analysis of the health care reforms in Brazil and Colombia

    Science.gov (United States)

    2012-01-01

    Introduction Brazil and Colombia have pursued extensive reforms of their health care systems in the last couple of decades. The purported goals of such reforms were to improve access, increase efficiency and reduce health inequities. Notwithstanding their common goals, each country sought a very different pathway to achieve them. While Brazil attempted to reestablish a greater level of State control through a public national health system, Colombia embraced market competition under an employer-based social insurance scheme. This work thus aims to shed some light onto why they pursued divergent strategies and what that has meant in terms of health outcomes. Methods A critical review of the literature concerning equity frameworks, as well as the health care reforms in Brazil and Colombia was conducted. Then, the shortfall inequality values of crude mortality rate, infant mortality rate, under-five mortality rate, and life expectancy for the period 1960-2005 were calculated for both countries. Subsequently, bivariate and multivariate linear regression analyses were performed and controlled for possibly confounding factors. Results When controlling for the underlying historical time trend, both countries appear to have experienced a deceleration of the pace of improvements in the years following the reforms, for all the variables analyzed. In the case of Colombia, some of the previous gains in under-five mortality rate and crude mortality rate were, in fact, reversed. Conclusions Neither reform seems to have had a decisive positive impact on the health outcomes analyzed for the defined time period of this research. This, in turn, may be a consequence of both internal characteristics of the respective reforms and external factors beyond the direct control of health reformers. Among the internal characteristics: underfunding, unbridled decentralization and inequitable access to care seem to have been the main constraints. Conversely, international economic adversities

  17. Systemic Reform in a Federated System:Los Angeles at the Turn of the Millennium

    Directory of Open Access Journals (Sweden)

    David Menefee-Libey

    2004-10-01

    Full Text Available I synthesize some of the lessons we have learned about systemic school reform in order and derive two explicit hypotheses about when such reforms are likely to be more and less successful. The first hypothesis focuses on program implementation: to achieve success, any systemic reform must overcome challenges at each stage of the policy-making process, from agenda-setting to policy choice to implementation. The second hypothesis focuses on the federated nature of education policymaking in the United States: any successful systemic reform must offer a program that aligns local efforts with state and sometimes federal policy. I derive and test more specific hypotheses related to recent systemic reform efforts in the Los Angeles region—especially the Los Angeles Annenberg Metropolitan Project, or LAAMP—which ran from 1995 through 2001. The case confirms the hypotheses and enables a clearer understanding of systemic school reform.

  18. Switzerland: Health System Review.

    Science.gov (United States)

    De Pietro, Carlo; Camenzind, Paul; Sturny, Isabelle; Crivelli, Luca; Edwards-Garavoglia, Suzanne; Spranger, Anne; Wittenbecher, Friedrich; Quentin, Wilm

    2015-01-01

    This analysis of the Swiss health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Swiss health system is highly complex, combining aspects of managed competition and corporatism (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes. The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good. Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low and middle-income households contribute a greater share of their income to

  19. Urban health insurance reform and coverage in China using data from National Health Services Surveys in 1998 and 2003

    Directory of Open Access Journals (Sweden)

    Collins Charles D

    2007-03-01

    Full Text Available Abstract Background In 1997 there was a major reform of the government run urban health insurance system in China. The principal aims of the reform were to widen coverage of health insurance for the urban employed and contain medical costs. Following this reform there has been a transition from the dual system of the Government Insurance Scheme (GIS and Labour Insurance Scheme (LIS to the new Urban Employee Basic Health Insurance Scheme (BHIS. Methods This paper uses data from the National Health Services Surveys of 1998 and 2003 to examine the impact of the reform on population coverage. Particular attention is paid to coverage in terms of gender, age, employment status, and income levels. Following a description of the data between the two years, the paper will discuss the relationship between the insurance reform and the growing inequities in population coverage. Results An examination of the data reveals a number of key points: a The overall coverage of the newly established scheme has decreased from 1998 to 2003. b The proportion of the urban population without any type of health insurance arrangement remained almost the same between 1998 and 2003 in spite of the aim of the 1997 reform to increase the population coverage. c Higher levels of participation in mainstream insurance schemes (i.e. GIS-LIS and BHIS were identified among older age groups, males and high income groups. In some cases, the inequities in the system are increasing. d There has been an increase in coverage of the urban population by non-mainstream health insurance schemes, including non-commercial and commercial ones. The paper discusses three important issues in relation to urban insurance coverage: institutional diversity in the forms of insurance, labour force policy and the non-mainstream forms of commercial and non-commercial forms of insurance. Conclusion The paper concludes that the huge economic development and expansion has not resulted in a reduced disparity in

  20. Portugal: Health System Review.

    Science.gov (United States)

    de Almeida Simoes, Jorge; Augusto, Goncalo Figueiredo; Fronteira, Ines; Hernandez-Quevedo, Cristina

    2017-03-01

    This analysis of the Portuguese health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Overall health indicators such as life expectancy at birth and at age 65 years have shown a notable improvement over the last decades. However, these improvements have not been followed at the same pace by other important dimensions of health: child poverty and its consequences, mental health and quality of life after 65. Health inequalities remain a general problem in the country. All residents in Portugal have access to health care provided by the National Health Service (NHS), financed mainly through taxation. Out-of-pocket payments have been increasing over time, not only co-payments, but particularly direct payments for private outpatient consultations, examinations and pharmaceuticals. The level of cost-sharing is highest for pharmaceutical products. Between one-fifth and one-quarter of the population has a second (or more) layer of health insurance coverage through health subsystems (for specific sectors or occupations) and voluntary health insurance (VHI). VHI coverage varies between schemes, with basic schemes covering a basic package of services, whereas more expensive schemes cover a broader set of services, including higher ceilings of health care expenses. Health care delivery is by both public and private providers. Public provision is predominant in primary care and hospital care, with a gate-keeping system in place for access to hospital care. Pharmaceutical products, diagnostic technologies and private practice by physicians constitute the bulk of private health care provision. In May 2011, the economic crisis led Portugal to sign a Memorandum of Understanding with the International Monetary Fund, the European Commission and the European Central Bank, in exchange for a loan of 78 billion euros. The agreed Economic and Financial Adjustment Programme included

  1. Changes in chronic disease management among community health centers (CHCs) in China: Has health reform improved CHC ability?

    Science.gov (United States)

    Wang, Zhaoxin; Shi, Jianwei; Wu, Zhigui; Xie, Huiling; Yu, Yifan; Li, Ping; Liu, Rui; Jing, Limei

    2017-07-01

    Since the 1980s, China has been criticized for its mode of chronic disease management (CDM) that passively provides treatment in secondary and tertiary hospitals but lacks active prevention in community health centers (CHCs). Since there are few systematic evaluations of the CHCs' methods for CDM, this study aimed to analyze their abilities. On the macroperspective, we searched the literature in China's largest and most authoritative databases and the official websites of health departments. Literature was used to analyze the government's efforts in improving CHCs' abilities to perform CDM. At the microlevel, we examined the CHCs' longitudinal data after the New Health Reform in 2009, including financial investment, facilities, professional capacities, and the conducted CDM activities. A policy analysis showed that there was an increasing tendency towards government efforts in developing CDM, and the peak appeared in 2009. By evaluating the reform at CHCs, we found that there was an obvious increase in fiscal and public health subsidies, large-scale equipment, general practitioners, and public health physicians. The benefited vulnerable population in this area also rose significantly. However, rural centers were inferior in their CDM abilities compared with urban ones, and the referral system is still not effective in China. This study showed that CHCs are increasingly valued in managing chronic diseases, especially after the New Health Reform in 2009. However, we still need to improve collaborative management for chronic diseases in the community and strengthen the abilities of CHCs, especially in rural areas. Copyright © 2017 John Wiley & Sons, Ltd.

  2. Lithuania: health system review.

    Science.gov (United States)

    Murauskiene, Liubove; Janoniene, Raimonda; Veniute, Marija; van Ginneken, Ewout; Karanikolos, Marina

    2013-01-01

    This analysis of the Lithuanian health system reviews the developments in organization and governance, health financing, health-care provision, health reforms and health system performance since 2000.The Lithuanian health system is a mixed system, predominantly funded from the National Health Insurance Fund through a compulsory health insurance scheme, supplemented by substantial state contributions on behalf of the economically inactive population amounting to about half of its budget. Public financing of the health sector has gradually increased since 2004 to 5.2 per cent of GDP in 2010.Although the Lithuanian health system was tested by the recent economic crisis, Lithuanias counter-cyclical state health insurance contribution policies (ensuring coverage for the economically inactive population) helped the health system to weather the crisis, and Lithuania successfully used the crisis as a lever to reduce the prices of medicines.Yet the future impact of cuts in public health spending is a cause for concern. In addition, out-of-pocket payments remain high (in particular for pharmaceuticals) and could threaten health access for vulnerable groups.A number of challenges remain. The primary care system needs strengthening so that more patients are treated instead of being referred to a specialist, which will also require a change in attitude by patients. Transparency and accountability need to be increased in resource allocation, including financing of capital investment and in the payer provider relationship. Finally, population health,albeit improving, remains a concern, and major progress can be achieved by reducing the burden of amenable and preventable mortality. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  3. Massachusetts' health care reform increased access to care for Hispanics, but disparities remain.

    Science.gov (United States)

    Maxwell, James; Cortés, Dharma E; Schneider, Karen L; Graves, Anna; Rosman, Brian

    2011-08-01

    Hispanics are more likely than any other racial or ethnic group in the United States to lack health insurance. This paper draws on quantitative and qualitative research to evaluate the extent to which health reforms in Massachusetts, a model for the Affordable Care Act of 2010, have reduced disparities in insurance coverage and access to health care. We found that rates of coverage and the likelihood of having a usual provider increased dramatically for Massachusetts Hispanics after the state's reforms, but disparities remained. The increase in insurance coverage among Hispanics was more than double that experienced by non-Hispanic whites. Even so, in 2009, 78.9 percent of Hispanics had coverage, versus 96 percent of non-Hispanic whites. Language and other cultural factors remained significant barriers: Only 66.6 percent of Hispanics with limited proficiency in English were insured. One-third of Spanish-speaking Hispanics still did not have a personal provider in 2009, and 26.8 percent reported not seeing a doctor because of cost, up from 18.9 percent in 2005. We suggest ways to reduce such disparities through national health care reform, including simplified enrollment and reenrollment processes and assistance in finding a provider and navigating an unfamiliar care system.

  4. The World Bank, pharmaceutical policies, and health reforms in Latin America.

    Science.gov (United States)

    Homedes, Núria; Ugalde, Antonio; Forns, Joan Rovira

    2005-01-01

    Health care systems spend a relatively high percentage of their resources on the purchase of medicines, and the poor spend a disproportionate amount of their income on pharmaceuticals. There is ample evidence in the literature that drugs are very poorly used. World Bank-led health reforms aim at improving equity, efficiency, quality, and users' satisfaction, and it will be difficult to achieve these goals without making medicines accessible and affordable. The purpose of this article is to examine the adequacy of World Bank pharmaceutical policies, as recommended in various Bank documents, for Latin America and to examine the implementation of the policy recommendations. The authors found that the World Bank identified and recommended a set of pharmaceutical policies that matched the needs of the region. But, as revealed through fieldwork and a review of the literature, the recommended pharmaceutical interventions were left out of the health reforms, and most of the loans that included pharmaceutical interventions allocated funds only to the purchase of drugs. The authors formulate four hypotheses that may explain the lack of congruence between the recommended policies and the strategies financed by World Bank health reform loans to the Latin American region.

  5. Whole-system change: case study of factors facilitating early implementation of a primary health care reform in a South African province.

    Science.gov (United States)

    Schneider, Helen; English, Rene; Tabana, Hanani; Padayachee, Thesandree; Orgill, Marsha

    2014-11-29

    Whole-system interventions are those that entail system wide changes in goals, service delivery arrangements and relationships between actors, requiring approaches to implementation that go beyond projects or programmes. Drawing on concepts from complexity theory, this paper describes the catalysts to implementation of a whole-system intervention in the North West Province of South Africa. This province was an early adopter of a national primary health care (PHC) strategy that included the establishment of PHC outreach teams based on generalist community health workers. We interviewed a cross section of provincial actors, from senior to frontline, observed processes and reviewed secondary data, to construct a descriptive-explanatory case study of early implementation of the PHC outreach team strategy and the factors facilitating this in the province. Implementation of the PHC outreach team strategy was characterised by the following features: 1) A favourable provincial context of a well established district and sub-district health system and long standing values in support of PHC; 2) The forging of a collective vision for the new strategy that built on prior history and values and that led to distributed leadership and ownership of the new policy; 3) An implementation strategy that ensured alignment of systems (information, human resources) and appropriate sequencing of activities (planning, training, piloting, household campaigns); 4) The privileging of 'community dialogues' and local manager participation in the early phases; 5) The establishment of special implementation structures: a PHC Task Team (chaired by a senior provincial manager) to enable feedback and ensure accountability, and an NGO partnership that provided flexible support for implementation. These features resonate with the deliberative, multi-level and context sensitive approaches described as the "simple rules" of successful PHC system change in other settings. Although implementation was not

  6. IMPLEMENTATION OF MODERN FOREIGN APPROACHES TO UKRAINIAN PENSION SYSTEM REFORMING

    Directory of Open Access Journals (Sweden)

    Anna Khemii

    2017-11-01

    Full Text Available A study of the experience of Western European countries in implementing structural reforms of the pension insurance system and the implementation of such experience in Ukraine. The main task of the pension system of any country in the world is to ensure the corresponding stable level of incomes of pensioners and at the same time maintain their financial stability. The increase in the proportion of pensioners increases the burden on pension systems, and mainly measures taken by countries are aimed at reducing pension costs and parametric reforms. Methodology. This article investigates the prerequisites and consequences of reforming the pension systems of the Member States of the Organization for International Cooperation and Development. Considered measures to ensure the financial stability of pension systems of the countries concerned, increased the social and stimulating role of pension insurance in the society. The methodological basis of the article is methods of scientific cognition, which enable to expose basic conformities to the law of development of the pension systems, priority ways to ensure their financial sustainability. Such methods are in particular used: analysis and synthesis – during research of financial indicators of pension systems; systematization – for revealing methods for reforming pension systems, their detailed analysis and the definition of their features; scientific abstraction – with the purpose of forming theoretical generalizations and conclusions. Results. The article investigates the trends of reforming pension insurance systems in some countries. It is established that today the main characteristics of pension reforms in foreign countries are increasing the retirement age, improving the solidary component of the pension system, reducing the role of state pension insurance. Some countries raise their contribution rates; the conditions for early retirement are becoming tougher. Almost nobody decided to

  7. Healthcare financing reform in Latvia: switching from social health insurance to NHS and back?

    Science.gov (United States)

    Mitenbergs, Uldis; Brigis, Girts; Quentin, Wilm

    2014-11-01

    In the 1990s, Latvia aimed at introducing Social Health Insurance (SHI) but later changed to a National Health Service (NHS) type system. The NHS is financed from general taxation, provides coverage to the entire population, and pays for a basic service package purchased from independent public and private providers. In November 2013, the Cabinet of Ministers passed a draft Healthcare Financing Law, aiming at increasing public expenditures on health by introducing Compulsory Health Insurance (CHI) and linking entitlement to health services to the payment of income tax. Opponents of the reform argue that linking entitlement to health services to the payment of income tax does not have the potential to increase public expenditures on health but that it can contribute to compromising universal coverage and access to health services of certain population groups. In view of strong opposition, it is unlikely that the law will be adopted before parliamentary elections in October 2014. Nevertheless, the discussion around the law is interesting because of three main reasons: (1) it can illustrate why the concept of SHI remains attractive - not only for Latvia but also for other countries, (2) it shows that a change from NHS to SHI does not imply major institutional reforms, and (3) it demonstrates the potential problems of introducing SHI, i.e. of linking entitlement to health services to the payment of contributions. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  8. Optimizing the Heat Exchanger Network of a Steam Reforming System

    DEFF Research Database (Denmark)

    Nielsen, Mads Pagh; Korsgaard, Anders Risum; Kær, Søren Knudsen

    2004-01-01

    gas steam reformer along with gas purification reactors to generate clean hydrogen suited for a PEM stack. The temperatures in the various reactors in the fuel processing system vary from around 1000°C to the stack temperature at 80°C. Furthermore, external heating must be supplied to the endothermic...... steam reforming reaction and steam must be generated. The dependence of the temperature profiles on conversion in shift reactors for gas purification is also significant. The optimum heat integration in the system is thus imperative in order to minimize the need for hot and cold utilities. A rigorous 1D......Proton Exchange Membrane (PEM) based combined heat and power production systems are highly integrated energy systems. They may include a hydrogen production system and fuel cell stacks along with post combustion units optionally coupled with gas turbines. The considered system is based on a natural...

  9. The role of strategic health planning processes in the development of health care reform policies: a comparative study of Eritrea, Mozambique and Zimbabwe.

    Science.gov (United States)

    Green, Andrew; Collins, Charles; Stefanini, Angelo; Ferrinho, Paulo; Chapman, Glyn; Hagos, Besrat; Adams, Yussuf; Omar, Mayeh

    2007-01-01

    This paper reports on comparative analysis of health planning and its relationship with health care reform in three countries, Eritrea, Mozambique and Zimbabwe. The research examined strategic planning in each country focusing in particular on its role in developing health sector reforms. The paper analyses the processes for strategic planning, the values that underpin the planning systems, and issues related to resources for planning processes. The resultant content of strategic plans is assessed and not seen to have driven the development of reforms; whilst each country had adopted strategic planning systems, in all three countries a more complex interplay of forces, including influences outside both the health sector and the country, had been critical forces behind the sectoral changes experienced over the previous decade. The key roles of different actors in developing the plans and reforms are also assessed. The paper concludes that a number of different conceptions of strategic planning exist and will depend on the particular context within which the health system is placed. Whilst similarities were discovered between strategic planning systems in the three countries, there are also key differences in terms of formality, timeframes, structures and degrees of inclusiveness. No clear leadership role for strategic planning in terms of health sector reforms was discovered. Planning appears in the three countries to be more operational than strategic. Copyright (c) 2006 John Wiley & Sons, Ltd.

  10. Reforming the American Military Officer Personnel System: Addendum: Thoughts on Contractors

    Science.gov (United States)

    2016-05-24

    Testimony Reforming the American Military Officer Personnel System Addendum: Thoughts on Contractors Bernard D. Rostker CT-446/1 Document...1 Reforming the American Military Officer Personnel System Addendum: Thoughts on Contractors Testimony of Bernard D. Rostker 1 The RAND

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

    Directory of Open Access Journals (Sweden)

    Mayumi Nomura

    2008-10-01

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

  12. Change of government: one more big bang health care reform in England's National Health Service.

    Science.gov (United States)

    Hunter, David J

    2011-01-01

    Once again the National Health Service (NHS) in England is undergoing major reform, following the election of a new coalition government keen to reduce the role of the state and cut back on big government. The NHS has been undergoing continuous reform since the 1980s. Yet, despite the significant transaction costs incurred, there is no evidence that the claimed benefits have been achieved. Many of the same problems endure. The reforms follow the direction of change laid down by the last Conservative government in the early 1990s, which the recent Labour government did not overturn despite a commitment to do so. Indeed, under Labour, the NHS was subjected to further market-style changes that have paved the way for the latest round of reform. The article considers the appeal of big bang reform, questions its purpose and value, and critically appraises the nature and extent of the proposed changes in this latest round of reform. It warns that the NHS in its current form may not survive the changes, as they open the way to privatization and a weakening of its public service ethos.

  13. Turkey. Health system review.

    Science.gov (United States)

    Tatar, Mehtap; Mollahaliloğlu, Salih; Sahin, Bayram; Aydin, Sabahattin; Maresso, Anna; Hernández-Quevedo, Cristina

    2011-01-01

    Turkey has accomplished remarkable improvements in terms of health status in the last three decades, particularly after the implementation of the Health Transformation Program (HTP (Saglikta Donus, um Programi)). Average life expectancy reached 71.8 for men and 76.8 for women in 2010. The infant mortality rate (IMR) decreased to 10.1 per 1000 live births in 2010, down from 117.5 in 1980. Despite these achievements, there are still discrepancies in terms of infant mortality between rural and urban areas and different parts of the country, although these have been diminishing over the years. The higher infant mortality rates in rural areas can be attributed to low socioeconomic conditions, low female education levels and the prevalence of infectious diseases. The main causes of death are diseases of the circulatory system followed by malignant neoplasms. Turkeys health care system has been undergoing a far-reaching reform process (HTP) since 2003 and radical changes have occurred both in the provision and the financing of health care services. Health services are now financed through a social security scheme covering the majority of the population, the General Health Insurance Scheme (GHIS (Genel Saglik Sigortasi)), and services are provided both by public and private sector facilities. The Social Security Institution (SSI (Sosyal Guvenlik Kurumu)), financed through payments by employers and employees and government contributions in cases of budget deficit, has become a monopsonic (single buyer) power on the purchasing side of health care services. On the provision side, the Ministry of Health (Saglik Bakenligi) is the main actor and provides primary, secondary and tertiary care through its facilities across the country. Universities are also major providers of tertiary care. The private sector has increased its range over recent years, particularly after arrangements paved the way for private sector provision of services to the SSI. The most important reforms since

  14. Steam Methane Reformation Testing for Air-Independent Solid Oxide Fuel Cell Systems

    Science.gov (United States)

    Mwara, Kamwana N.

    2015-01-01

    Recently, NASA has been looking into utilizing landers that can be propelled by LOX-CH (sub 4), to be used for long duration missions. Using landers that utilize such propellants, also provides the opportunity to use solid oxide fuel cells as a power option, especially since they are able to process methane into a reactant through fuel reformation. One type of reformation, called steam methane reformation, is a process to reform methane into a hydrogen-rich product by reacting methane and steam (fuel cell exhaust) over a catalyst. A steam methane reformation system could potentially use the fuel cell's own exhaust to create a reactant stream that is hydrogen-rich, and requires less internal reforming of the incoming methane. Also, steam reformation may hold some advantages over other types of reforming, such as partial oxidation (PROX) reformation. Steam reformation does not require oxygen, while up to 25 percent can be lost in PROX reformation due to unusable CO (sub 2) reformation. NASA's Johnson Space Center has conducted various phases of steam methane reformation testing, as a viable solution for in-space reformation. This has included using two different types of catalysts, developing a custom reformer, and optimizing the test system to find the optimal performance parameters and operating conditions.

  15. Policy and ideology: the politics of post-reform health policy in the United Kingdom.

    Science.gov (United States)

    Fierlbeck, K

    1996-01-01

    While it is commonly accepted that the broader political and economic climate directly influences the nature of any major changes in the provision of health care (witness the 1991 National Health Service reforms in the United Kingdom), there is less consideration of the effect of paradigm changes in health care and health care management themselves on wider political and ideological strategies. This article examines the recent health policy initiatives presented by Britain's Labour Party. The author argues that while the Conservatives' market-oriented reforms reflected the perceived political and economic realities of the 1980s, the rapidly increasing credibility of strategies of prevention within the health care sector (including an emphasis on the social determinants of ill-health, the need to plan a shift from acute to community care, and the desire for greater lay participation in policy-making) allows Labour to highlight the limitations of a strongly market-oriented system in the health care sector more so than in any other policy area.

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

    Science.gov (United States)

    Tang, Wenxi; Wei, Lai; Zhang, Liang

    2017-06-19

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

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

    Directory of Open Access Journals (Sweden)

    Wenxi Tang

    2017-06-01

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

  18. Control of a methanol reformer system using an Adaptive Neuro‐Fuzzy Inference System approach

    DEFF Research Database (Denmark)

    Justesen, Kristian Kjær; Andersen, John; Ehmsen, Mikkel Præstholm

    This work presents a stoichiometry control strategy for a reformed methanol fuel cell system, which uses a reformer to produce hydrogen for an HTPEM fuel cell. One such system is the Serenus H3-350 battery charger developed by the Danish company Serenegy® which this work is based on. The poster...

  19. The Impact of Health Care Reform on Hospital and Preventive Care: Evidence from Massachusetts☆

    Science.gov (United States)

    Kolstad, Jonathan T.; Kowalski, Amanda E.

    2012-01-01

    In April 2006, Massachusetts passed legislation aimed at achieving near-universal health insurance coverage. The key features of this legislation were a model for national health reform, passed in March 2010. The reform gives us a novel opportunity to examine the impact of expansion to near-universal coverage state-wide. Among hospital discharges in Massachusetts, we find that the reform decreased uninsurance by 36% relative to its initial level and to other states. Reform affected utilization by decreasing length of stay, the number of inpatient admissions originating from the emergency room, and preventable admissions. At the same time, hospital cost growth did not increase. PMID:23180894

  20. Defining the road ahead: thinking strategically in the new era of health care reform.

    Science.gov (United States)

    Pudlowski, Edward M

    2011-01-01

    Understanding the implications of the new health care reform legislation, including those provisions that do not take effect for several years, will be critical in developing a successful strategic plan under the new environment of health care reform and avoiding unintended consequences of decisions made without the benefit of long-term thinking. Although this article is not a comprehensive assessment of the challenges and opportunities that exist under health care reform, nor a layout of all of the issues, it looks at some of the key areas in order to demonstrate why employers need to identify critical pathways and the associated risks and benefits of each decision. Key health care reform areas include insurance market reforms, grandfather rules, provisions that have the potential to influence the underlying cost of health care, the individual mandate, the employer mandate (including the free-choice voucher program) and the excise tax on high-cost plans.

  1. Critical interactionism: an upstream-downstream approach to health care reform.

    Science.gov (United States)

    Martins, Diane Cocozza; Burbank, Patricia M

    2011-01-01

    Currently, per capita health care expenditures in the United States are more than 20% higher than any other country in the world and more than twice the average expenditure for European countries, yet the United States ranks 37th in life expectancy. Clearly, the health care system is not succeeding in improving the health of the US population with its focus on illness care for individuals. A new theoretical approach, critical interactionism, combines symbolic interactionism and critical social theory to provide a guide for addressing health care problems from both an upstream and downstream approach. Concepts of meaning from symbolic interactionism and emancipation from critical perspective move across system levels to inform and reform health care for individuals, organizations, and societies. This provides a powerful approach for health care reform, moving back and forth between the micro and macro levels. Areas of application to nursing practice with several examples (patients with obesity; patients who are lesbian, gay, bisexual, and transgender; workplace bullying and errors), nursing education, and research are also discussed.

  2. Client Centeredness and Health Reform: Key Issues for Occupational Therapy

    Science.gov (United States)

    Pitonyak, Jennifer S.; Fogelberg, Donald; Leland, Natalie E.

    2015-01-01

    Health reform promotes the delivery of patient-centered care. Occupational therapy’s rich history of client-centered theory and practice provides an opportunity for the profession to participate in the evolving discussion about how best to provide care that is truly patient centered. However, the growing emphasis on patient-centered care also poses challenges to occupational therapy’s perspectives on client-centered care. We compare the conceptualizations of client-centered and patient-centered care and describe the current state of measurement of client-centered and patient-centered care. We then discuss implications for occupational therapy’s research agenda, practice, and education within the context of patient-centered care, and propose next steps for the profession. PMID:26356651

  3. Client Centeredness and Health Reform: Key Issues for Occupational Therapy.

    Science.gov (United States)

    Mroz, Tracy M; Pitonyak, Jennifer S; Fogelberg, Donald; Leland, Natalie E

    2015-01-01

    Health reform promotes the delivery of patient-centered care. Occupational therapy's rich history of client-centered theory and practice provides an opportunity for the profession to participate in the evolving discussion about how best to provide care that is truly patient centered. However, the growing emphasis on patient-centered care also poses challenges to occupational therapy's perspectives on client-centered care. We compare the conceptualizations of client-centered and patient-centered care and describe the current state of measurement of client-centered and patient-centered care. We then discuss implications for occupational therapy's research agenda, practice, and education within the context of patient-centered care, and propose next steps for the profession. Copyright © 2015 by the American Occupational Therapy Association, Inc.

  4. Has Massachusetts health care reform worked for the working poor? Results from an analysis of opportunity.

    Science.gov (United States)

    Tinsley, Liane J; Hall, Susan A; McKinlay, John B

    2014-04-01

    Health care reform was introduced in Massachusetts (MA) in 2006 and serves as a model for what was subsequently introduced nationally as the Patient Protection and Affordable Care Act. The Boston Area Community Health survey collected data before (2002-2005) and after (2006-2010) introduction of the MA health insurance mandate, providing a unique opportunity to assess its effects in a large, epidemiologic cohort. We report on the apparent effects of the mandate on the same participants over time, focusing specifically on the vulnerable working poor (WP). We evaluated differences in subpopulations of interest at pre- and post-reform periods to explore whether MA health care reform resulted in an overall gain in insurance coverage. MA health care reform was associated with net gains in health insurance coverage overall and among the subgroups studied. Our findings suggest that despite being targeted by health care reform legislation, the WP in MA continue to report lower rates of insurance coverage compared with both the nonworking poor and the not poor. MA health care reform legislation, including the expansion of Medicaid, resulted in substantial overall gains in coverage. Disparities in insurance coverage persist among some subgroups following health care reform implementation in MA. These results have important implications for health services researchers and policy makers, particularly in light of the ongoing implementation of the Patient Protection and Affordable Care Act. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Can biosimilars help achieve the goals of US health care reform?

    Science.gov (United States)

    Boccia, Ralph; Jacobs, Ira; Popovian, Robert; de Lima Lopes, Gilberto

    2017-01-01

    The US Patient Protection and Affordable Care Act (ACA) aims to expand health care coverage, contain costs, and improve health care quality. Accessibility and affordability of innovative biopharmaceuticals are important to the success of the ACA. As it is substantially more difficult to manufacture them compared with small-molecule drugs, many of which have generic alternatives, biologics may increase drug costs. However, biologics offer demonstrated improvements in patient care that can reduce expensive interventions, thus lowering net health care costs. Biosimilars, which are highly similar to their reference biologics, cost less than the originators, potentially increasing access through reduced prescription drug costs while providing equivalent therapeutic results. This review evaluates 1) the progress made toward enacting health care reform since the passage of the ACA and 2) the role of biosimilars, including the potential impact of expanded biosimilar use on access, health care costs, patient management, and outcomes. Barriers to biosimilar adoption in the USA are noted, including low awareness and financial disincentives relating to reimbursement. The evaluated evidence suggests that the ACA has partly achieved some of its aims; however, the opportunity remains to transform health care to fully achieve reform. Although the future is uncertain, increased use of biosimilars in the US health care system could help achieve expanded access, control costs, and improve the quality of care.

  6. Support for National Health Insurance Seven Years Into Massachusetts Healthcare Reform: Views of Populations Targeted by the Reform.

    Science.gov (United States)

    Saluja, Sonali; Zallman, Leah; Nardin, Rachel; Bor, David; Woolhandler, Steffie; Himmelstein, David U; McCormick, Danny

    2016-01-01

    Before the Affordable Care Act (ACA), many surveys showed majority support for national health insurance (NHI), also known as single payer; however, little is currently known about views of the ACA's targeted population. Massachusetts residents have had seven years of experience with state health care reform that became the model for the ACA. We surveyed 1,151 adults visiting safety-net emergency departments in Massachusetts in late 2013 on their preference for NHI or the Massachusetts reform and on their experiences with insurance. Most of the patients surveyed were low-income and non-white. The majority of patients (72.0%) preferred NHI to the Massachusetts reform. Support for NHI among those with public insurance, commercial insurance, and no insurance was 68.9%, 70.3%, and 86.3%, respectively (p insurance plan (83.3% vs. 68.9%, p = .014), who delayed medical care (81.2% vs. 69.6%, p health reform, a reappraisal of the ACA's ability to meet the needs of underserved patients is warranted. © The Author(s) 2015.

  7. Health financing reform in Kenya- assessing the social health ...

    African Journals Online (AJOL)

    For economic, social, political and organisational reasons a transition period will be necessary, which is likely to last more than a decade. However, important objectives such as access to health care and avoiding impoverishment due to direct health care payments should be recognised from the start so that steady progress ...

  8. Uzbekistan: health system review.

    Science.gov (United States)

    Ahmedov, Mohir; Azimov, Ravshan; Mutalova, Zulkhumor; Huseynov, Shahin; Tsoyi, Elena; Rechel, Bernd

    2014-01-01

    Uzbekistan is a central Asian country that became independent in 1991 with the break-up of the Soviet Union. Since then, it has embarked on several major health reforms covering health care provision, governance and financing, with the aim of improving efficiency while ensuring equitable access. Primary care in rural areas has been changed to a two-tiered system, while specialized polyclinics in urban areas are being transformed into general polyclinics covering all groups of the urban population. Secondary care is financed on the basis of past expenditure and inputs (and increasingly self-financing through user fees), while financing of primary care is increasingly based on capitation. There are also efforts to improve allocative efficiency, with a slowly increasing share of resources devoted to the reformed primary health care system. Health care provision has largely remained in public ownership but nearly half of total health care expenditure comes from private sources, mostly in the form of out-of-pocket expenditure. There is a basic benefits package, which includes primary care, emergency care and care for certain disease and population categories. Yet secondary care and outpatient pharmaceuticals are not included in the benefits package for most of the population, and the reliance on private health expenditure results in inequities and catastrophic expenditure for households. While the share of public expenditure is slowly increasing, financial protection thus remains an area of concern. Quality of care is another area that is receiving increasing attention. World Health Organization 2014 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  9. School-Based Health Centers in an Era of Health Care Reform: Building on History

    Science.gov (United States)

    Keeton, Victoria; Soleimanpour, Samira; Brindis, Claire D.

    2013-01-01

    School-based health centers (SBHCs) provide a variety of health care services to youth in a convenient and accessible environment. Over the past 40 years, the growth of SBHCs evolved from various public health needs to the development of a specific collaborative model of care that is sensitive to the unique needs of children and youth, as well as to vulnerable populations facing significant barriers to access. The SBHC model of health care comprises of on-school site health care delivery by an interdisciplinary team of health professionals, which can include primary care and mental health clinicians. Research has demonstrated the SBHCs’ impacts on delivering preventive care, such as immunizations; managing chronic illnesses, such as asthma, obesity, and mental health conditions; providing reproductive health services for adolescents; and even improving youths’ academic performance. Although evaluation of the SBHC model of care has been complicated, results have thus far demonstrated increased access to care, improved health and education outcomes, and high levels of satisfaction. Despite their proven success, SBHCs have consistently faced challenges in securing adequate funding for operations and developing effective financial systems for billing and reimbursement. Implementation of health care reform (The Patient Protection and Affordable Care Act [P.L. 111-148]) will profoundly affect the health care access and outcomes of children and youth, particularly vulnerable populations. The inclusion of funding for SBHCs in this legislation is momentous, as there continues to be increased demand and limited funding for affordable services. To better understand how this model of care has and could further help promote the health of our nation’s youth, a review is presented of the history and growth of SBHCs and the literature demonstrating their impacts. It may not be feasible for SBHCs to be established in every school campus in the country. However, the lessons

  10. Dissatisfaction with current integration reforms of health insurance schemes in China: are they a success and what matters?

    Science.gov (United States)

    Shan, Linghan; Zhao, Miaomiao; Ning, Ning; Hao, Yanhua; Li, Ye; Liang, Libo; Kang, Zheng; Sun, Hong; Ding, Ding; Liu, Baohua; Liang, Chao; Yu, Miao; Wu, Qunhong; Hao, Mo; Fan, Hua

    2018-01-06

    Integration reforms have been piloted as key policies to address the fragmented health insurance system in China. They are also regarded as a better choice for realizing a Universal Basic Medical Insurance System (UBMIS). This study has attempted to explore the determinants that may affect respondents' dissatisfaction with the reforms. The aim is to provide evidence for more effective policy adjustment during the next round of nationwide integration reforms in China. A cross-sectional questionnaire survey was conducted in Ningbo, Chongqing and Heilongjiang from 2014 to 2015. A stratified cluster sampling method was adopted. A total of 1644 respondents, working in units related to health insurance, were selected. A multivariate logistic regression model was employed to identify any association between dissatisfaction and the features of the ongoing integration reforms of health insurance schemes. Overall, about 47.6% of the respondents reported dissatisfaction with the ongoing integration reforms. This high level of dissatisfaction was found to be associated with ineffective outcomes of the integration reforms in achieving management system improvement [odds ratio (OR) = 1.846], inequity reduction (OR = 1.464) and actual coverage expansion (OR = 1.350), as perceived by the respondents. Those who were satisfied with the previously separated health insurance schemes (OR = 0.643), and those who preferred other policy options for achieving a UBMIS (OR = 1.471) were more likely to report dissatisfaction with the current reforms. Higher expectations of the risk-pooling level (with ORs ranging from 1.361 to 1.661) also significantly contributed to dissatisfaction. Health insurance managers in China have conflicting opinions about the performance of piloted integration reforms. Many believe that these reforms have failed significantly to improve the management systems, narrow inequity and expand actual benefit coverage. Various strategies should be

  11. Gendering the Burden of Care: Health Reform and the Paradox of Community Participation in Western Belize.

    Science.gov (United States)

    Uzwiak, Beth A; Curran, Siobhan

    2016-03-01

    Belizean health policy supports a primary health care (PHC) strategy of universal access, community participation, and multisectoral collaboration. The principals of PHC were a key part of Belize's emergent national identity and built on existing community-based health strategies. Ethnographic research in western Belize, however, reveals that ongoing health reform is removing providers from participatory arenas. In this article, we foreground a particular moment in Belizean health history--the rise and demise of multisectoral collaboration--to question what can constitute meaningful community participation in the midst of health reform. Many allied health providers continue to believe in the potential of PHC to alleviate the structural causations of poor health and to invest in PHC despite a lack of state support. This means that providers, the majority women, are palliating the consequences of neoliberal reform; it also means that they provide spaces of contestation to the consumer "logic" of this reform. © 2015 by the American Anthropological Association.

  12. REFORMATIONS IN ZIMBABWE'S JUVENILE JUSTICE SYSTEM

    African Journals Online (AJOL)

    Mugumbate

    1996-05-23

    May 23, 1996 ... Juvenile crime is a common problem throughout the world. Delinquency and criminal behaviour is common among young children as they negotiate the transition from childhood to .... background information on the child-family situation, health, education, special problems and strengths to help determine ...

  13. Croatia: health system review.

    Science.gov (United States)

    Džakula, Aleksandar; Sagan, Anna; Pavić, Nika; Lonćčarek, Karmen; Sekelj-Kauzlarić, Katarina

    2014-01-01

    Croatia is a small central European country on the Balkan peninsula, with a population of approximately 4.3 million and a gross domestic product (GDP) of 62% of the European Union (EU) average (expressed in purchasing power parity; PPP) in 2012. On 1 July 2013, Croatia became the 28th Member State of the EU. Life expectancy at birth has been increasing steadily in Croatia (with a small decline in the years following the 1991 to 1995 War of Independence) but is still lower than the EU average. Prevalence of overweight and obesity in the population has increased during recent years and trends in physical inactivity are alarming. The Croatian Health Insurance Fund (CHIF), established in 1993, is the sole insurer in the mandatory health insurance (MHI) system that provides universal health coverage to the whole population. The ownership of secondary health care facilities is distributed between the State and the counties. The financial position of public hospitals is weak and recent reforms were aimed at improving this. The introduction of concessions in 2009 (public private partnerships whereby county governments organize tenders for the provision of specific primary health care services) allowed the counties to play a more active role in the organization, coordination and management of primary health care; most primary care practices have been privatized. The proportion of GDP spent on health by the Croatian government remains relatively low compared to western Europe, as does the per capita health expenditure. Although the share of public expenditure as a proportion of total health expenditure (THE) has been decreasing, at around 82% it is still relatively high, even by European standards. The main source of the CHIFs revenue is compulsory health insurance contributions, accounting for 76% of the total revenues of the CHIF, although only about a third of the population (active workers) is liable to pay full health care contributions. Although the breadth and scope

  14. Experience of the Veterans Health Administration in Massachusetts after state health care reform.

    Science.gov (United States)

    Chan, Stephanie H; Burgess, James F; Clark, Jack A; Mayo-Smith, Michael F

    2014-11-01

    Starting in 2006, Massachusetts enacted a series of health insurance reforms that successfully led to 96.6% of its population being covered by 2011. As the rest of the nation undertakes similar reforms, it is unknown how the Veterans Health Administration (VHA), one of many important Federal health care programs, will be affected. Our state-level study approach assessed the effects of health reform on utilization of VHA services in Massachusetts from 2005 to 2011. Models were adjusted for state-level demographic and economic characteristics, including health insurance rates, unemployment rates, median household income, poverty rates, and percent of population 65 years and older. No statistically significant associative change was observed in Massachusetts relative to other states over this time period. The findings raise important questions about the continuing role of VHA in American health care as health insurance coverage is one of many factors that influence decisions on where to seek health care. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  15. Analysing 'big picture' policy reform mechanisms: the Australian health service safety and quality accreditation scheme.

    Science.gov (United States)

    Greenfield, David; Hinchcliff, Reece; Banks, Margaret; Mumford, Virginia; Hogden, Anne; Debono, Deborah; Pawsey, Marjorie; Westbrook, Johanna; Braithwaite, Jeffrey

    2015-12-01

    Agencies promoting national health-care accreditation reform to improve the quality of care and safety of patients are largely working without specific blueprints that can increase the likelihood of success. This study investigated the development and implementation of the Australian Health Service Safety and Quality Accreditation Scheme and National Safety and Quality Health Service Standards (the Scheme), their expected benefits, and challenges and facilitators to implementation. A multimethod study was conducted using document analysis, observation and interviews. Data sources were eight government reports, 25 h of observation and 34 interviews with 197 diverse stakeholders. Development of the Scheme was achieved through extensive consultation conducted over a prolonged period, that is, from 2000 onwards. Participants, prior to implementation, believed the Scheme would produce benefits at multiple levels of the health system. The Scheme offered a national framework to promote patient-centred care, allowing organizations to engage and coordinate professionals' quality improvement activities. Significant challenges are apparent, including developing and maintaining stakeholder understanding of the Scheme's requirements. Risks must also be addressed. The standardized application of, and reliable assessment against, the standards must be achieved to maintain credibility with the Scheme. Government employment of effective stakeholder engagement strategies, such as structured consultation processes, was viewed as necessary for successful, sustainable implementation. The Australian experience demonstrates that national accreditation reform can engender widespread stakeholder support, but implementation challenges must be overcome. In particular, the fundamental role of continued stakeholder engagement increases the likelihood that such reforms are taken up and spread across health systems. © 2014 John Wiley & Sons Ltd.

  16. Teoría y práctica de las reformas en los sistemas de salud: los casos de Brasil y México Theory and practice in health systems reform in Brazil and Mexico

    Directory of Open Access Journals (Sweden)

    Raquel Abrantes Pêgo

    2002-08-01

    Full Text Available Este trabajo se propone reflexionar sobre el lugar que la comunidad de los especialistas en salud pública está ocupando en las reformas contemporáneas de los sistemas de salud. Discutimos la cuestión a partir de los casos de Brasil y de México porque, en ambos países, un grupo de especialistas en salud pública proyectó su participación más allá del ámbito técnico-científico y logró influir en el conflicto en torno a la reorientación de las políticas de salud de sus países. Una de sus acciones consistió en elaborar un marco cognoscitivo en el cual se alimentan proyectos técnico-asistenciales de reforma entendidos como propuestas políticas con contenido técnico. Nuestro propósito es demonstrar que estos profesionales logran influir en el debate nacional en el momento en que la discusión técnico-científica rebasa el ámbito de los especialistas para instalarse en el palco del debate socio-político. En nuestra opinión, esto sucede porque el conocimiento técnico-científico producido por esos grupos fue postulado, independendiente de su valor intrínseco, como plataforma ideológica alternativa, capaz de dar sustento a un proyecto técnico-asistencial de referencia que, convertido en proyecto político, sirvió para aglutinar a determinados sectores sociales.This study focuses on the role of public health experts in the contemporary health sector reform process. The authors discuss the issue based on the case of Brazil and Mexico, where a group of public health specialists have oriented their participation to influence the conflict concerning health policy reform in the respective countries. One approach has been to develop a new cognitive framework for technical health sector reform projects viewed as policy proposals with technical content. The purpose is to demonstrate how these specialists have managed to influence the national debate over health sector reform when the technical and scientific discussion leaves the

  17. Universal health coverage reforms: implications for the distribution of the health workforce in low-and middle-income countriess.

    Science.gov (United States)

    McPake, Barbara; Edoka, Ijeoma

    2014-01-01

    To achieve universal health coverage (UHC), a range of health-financing reforms, including removal of user fees and the expansion of social health insurance, have been implemented in many countries. While the focus of much research and discussion on UHC has been on the impact of health-financing reforms on population coverage, health-service utilization and out-of-pocket payments, the implications of such reforms for the distribution and performance of the health workforce have often been overlooked. Shortages and geographical imbalances in the distribution of skilled health workers persist in many low- and middle-income countries, posing a threat to achieving UHC. This paper suggests that there are risks associated with health-financing reforms, for the geographical distribution and performance of the health workforce. These risks require greater attention if poor and rural populations are to benefit from expanded financial protection.

  18. REFORMING THE ETHIOPIAN ELECTORAL SYSTEM: LOOKING ...

    African Journals Online (AJOL)

    conciliation, reduce the number of ignored votes, enable geographic representation, ensure fair results ... 4Andrew Reynolds et al., Electoral System Design (the New International Idea Handbook,. International .... et al, supra note 4. 21To illustrate this by way of example, let's take the case of New Zealand; New Zealand had.

  19. Reform and the politics of hybridization in mature health care states.

    Science.gov (United States)

    Tuohy, Carolyn Hughes

    2012-08-01

    This article examines the cases of three health care states -- two of which (Britain and the Netherlands) have undergone major policy reform and one of which (Canada) has experienced only marginal adjustments. The British and Dutch reforms have variously altered the balance of power, the mix of instruments of control, and the organizing principles. As a result, mature systems representing the ideal-typical health care state categories of national health systems and social insurance (Britain and the Netherlands, respectively) were transformed into distinctive national hybrids. These processes have involved a politics of redesign that differs from the politics of earlier phases of establishment and retrenchment. In particular, the redesign phase is marked by the activity of institutional entrepreneurs who exploit specific opportunities afforded by public programs to combine public and private resources in innovative organizational arrangements. Canada stands as a counterpoint: no window of opportunity for major change occurred, and the bilateral monopoly created by its prototypical single-payer model provided few footholds for entrepreneurial activity. The increased significance of institutional entrepreneurs gives greater urgency to one of the central projects of health policy: the design of accountability frameworks to allow for an assessment of performance against objectives.

  20. Australian Curriculum Reform II: Health and Physical Education

    Science.gov (United States)

    Lynch, Timothy

    2014-01-01

    It is implied by governing organizations that Australia is presently experiencing its first national curriculum reform, when as the title suggests it is the second. However, until now Australian states and territories have been responsible for the education curriculum delivered within schools. The present national curriculum reform promises one…

  1. Crisis in U.S. Health Care: Corporate Power Still Blocks Reform.

    Science.gov (United States)

    Geyman, John

    2017-01-01

    The corporate, largely privatized market-based U.S. health care system is deteriorating in terms of increasing costs, decreasing access, unacceptable quality of care, inequities, and disparities. Reform efforts to establish universal insurance coverage have failed on six occasions over the last century, largely through opposition of corporate stakeholders in the medical-industrial complex. This article provides historical perspective to previous reform attempts, updates the current battle between Republicans and Democrats over repeal of the 2010 Affordable Care Act (ACA), and compares three financing alternatives-continuation of the ACA; its replacement by a Republican plan (the House's American Health Care Act or its Senate counterpart, the Better Care Reconciliation Act); and single-payer national health insurance (NHI or Medicare for All). Markers are described that reveal the extent of the current crisis in U.S. health care. Evidence is presented that the private insurance industry, increasingly dependent on bailout by the government, is in a "death spiral." NHI is gaining increasing public support as the only financing alternative to provide universal coverage. Nine lessons that are still unlearned in the United States concerning health care are discussed, together with future prospects to establish universal coverage in this embattled and changing political environment.

  2. Impact of the 2006 Massachusetts health care insurance reform on neurosurgical procedures and patient insurance status.

    Science.gov (United States)

    Villelli, Nicolas W; Das, Rohit; Yan, Hong; Huff, Wei; Zou, Jian; Barbaro, Nicholas M

    2017-01-01

    OBJECTIVE The Massachusetts health care insurance reform law passed in 2006 has many similarities to the federal Affordable Care Act (ACA). To address concerns that the ACA might negatively impact case volume and reimbursement for physicians, the authors analyzed trends in the number of neurosurgical procedures by type and patient insurance status in Massachusetts before and after the implementation of the state's health care insurance reform. The results can provide insight into the future of neurosurgery in the American health care system. METHODS The authors analyzed data from the Massachusetts State Inpatient Database on patients who underwent neurosurgical procedures in Massachusetts from 2001 through 2012. These data included patients' insurance status (insured or uninsured) and the numbers of procedures performed classified by neurosurgical procedural codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Each neurosurgical procedure was grouped into 1 of 4 categories based on ICD-9-CM codes: 1) tumor, 2) other cranial/vascular, 3) shunts, and 4) spine. Comparisons were performed of the numbers of procedures performed and uninsured patients, before and after the implementation of the reform law. Data from the state of New York were used as a control. All data were controlled for population differences. RESULTS After 2008, there were declines in the numbers of uninsured patients who underwent neurosurgical procedures in Massachusetts in all 4 categories. The number of procedures performed for tumor and spine were unchanged, whereas other cranial/vascular procedures increased. Shunt procedures decreased after implementation of the reform law but exhibited a similar trend to the control group. In New York, the number of spine surgeries increased, as did the percentage of procedures performed on uninsured patients. Other cranial/vascular procedures decreased. CONCLUSIONS After the Massachusetts health care

  3. The Gateway Paper--public sector service delivery infrastructure and health reforms in Pakistan.

    Science.gov (United States)

    Nishtar, Sania

    2006-12-01

    Pakistan has an extensive public sector service delivery infrastructure consisting of a three tiered healthcare delivery system which includes Basic Health Units and Rural Health Centers forming the core of the primary health model, secondary care including first and second referral facilities providing acute, ambulatory and inpatient care through Tehsil Headquarter and District Headquarter hospitals and Tertiary Care comprising teaching hospitals. Notwithstanding, most people receive healthcare through private out-of-pocket payments made directly to the providers at the point of care. Recently, many attempts have been made to mainstream alternative arrangements of service delivery at various levels in order to bridge gaps in the present system of service delivery, albeit with limited success. As one of the core areas of reform-related interventions, the Gateway Paper makes a strong case for introducing change at two levels in order to obviate these issues. Firstly, at the level of hospitals the hospital sustainability reform process calls for major structural and financing adjustments, the development of appropriate policy frameworks, decentralizing hospital management to autonomous hospital boards and providing legal, managerial and fiscal autonomy to hospitals with appropriate community representation. At the primary healthcare level, a system for restructuring BHUs and RHCs has been supported--one that makes a case for appropriate checks and balances in order to ensure sustained improvements by redefining the roles of management, quality assurance, regulation and community oversight the latter through linkages with the devolution initiative. The Gateway Paper dovetails these alternative service delivery arrangements with parallel financing models.

  4. Massachusetts health reform and access for children with special health care needs.

    Science.gov (United States)

    Smith, Anna Jo; Chien, Alyna T

    2014-08-01

    Children with special health care needs (CSHCN) face unique challenges in accessing affordable health care. Massachusetts implemented major health reform in 2006; little is known about the impact of this state's health reform on uninsurance, access to care, and financial protection for privately and publicly insured CSHCN. We used a difference-in-differences (DD) approach to compare uninsurance, access to primary and specialty care, and financial protection in Massachusetts versus other states and Washington, DC before and after Massachusetts health reform. Parent-reported data were used from the 2005-2006 and 2009-2010 National Survey of Children with Special Health Care Needs and adjusted for age, gender, race/ethnicity, non-English language at home, and functional difficulties. Postreform, living in Massachusetts was not associated with significant decreases in uninsurance or increases in access to primary care for CSHCN. For privately insured CSHCN, Massachusetts was associated with increased access to specialists (DD = 6.0%; P ≤ .001) postreform. For publicly insured CSHCN, however, there was a significant decrease in access to prescription medications (DD = -7.2%; P = .003) postreform. Living in Massachusetts postreform was not associated with significant changes in financial protection compared with privately or publicly insured CSHCN in other states. Massachusetts health reform likely improved access to specialists for privately insured CSHCN but did not decrease instances of uninsurance, increase access to primary care, or improve financial protection for CSHCN in general. Comparable provisions within the Affordable Care Act may produce similarly modest outcomes for CSHCN. Copyright © 2014 by the American Academy of Pediatrics.

  5. ABOUT THE IMPENDING DEMOGRAPHIC PIT AND A MORATORIUM ON THE REFORM OF THE NATIONAL HEALTH CARE

    Directory of Open Access Journals (Sweden)

    V. A. Alekseev

    2013-01-01

    Full Text Available Abstract. Despite the upbeat statements by politicians about positive changes in the lives of citizens, according to the WHO report on the health situation in Europe, a true picture of their wealth in the Eastern part of the region, which includes Russia, is far from blissful. The country is currently covered by an epidemic of reforms in all spheres of society. Particularly malignant character epidemic in health care reform is, clearly manifesting itself in a tendency of avoiding the constitutional right to an affordable, skilled and free medical care to the commercial side of medicine. The necessity of ads temporary moratorium on ineffective reforms in health care.

  6. Analysis & commentary. The foundation that health reform lays for improved payment, care coordination, and prevention.

    Science.gov (United States)

    Thorpe, Kenneth E; Ogden, Lydia L

    2010-06-01

    The Patient Protection and Affordable Care Act represents a major opportunity to achieve several key goals at once: improving disease prevention; reforming care delivery; and bending the cost curve of health spending while also realizing greater value for the dollars spent. Reform-based initiatives could produce major gains in a relatively short time. The U.S. Department of Health and Human Services should develop an action plan detailing how the programs that the health reform law sets into motion throughout various agencies can work synergistically. It should also detail how best practices in finance and payment, in the organization and delivery of care, and in prevention can be expanded nationally.

  7. The role of civil society in health care reforms: an arena for hegemonic struggles.

    Science.gov (United States)

    Filc, Dani

    2014-12-01

    The present paper argues that current mainstream understandings of civil society as ontologically different from the state and essentially positive (either normative or functionally) are problematic in order to understand the development of health care reforms. The paper proposes to ground an explanation of the role of civil society in health care reforms in a Gramscian understanding of civil society as analytically different from the state, and as an arena for hegemonic struggles. The study of health care reform in Israel serves as a case study for this claim. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Health sector reforms in Nigeria: The need to integrate traditional ...

    African Journals Online (AJOL)

    Inspite of the wide spread use, traditional medicines have not yet been integrated into the national health care systems of many developing countries, including Nigeria. This paper focuses on the need to integrate folk medicine into the mainstream health care system of Nigeria, which is hitherto dominated by allopathic ...

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

    Science.gov (United States)

    Ormond, Meghann

    2011-01-01

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

  10. Whole-system change: case study of factors facilitating early implementation of a primary health care reform in a South African province

    National Research Council Canada - National Science Library

    Schneider, Helen; English, Rene; Tabana, Hanani; Padayachee, Thesandree; Orgill, Marsha

    2014-01-01

    Whole-system interventions are those that entail system wide changes in goals, service delivery arrangements and relationships between actors, requiring approaches to implementation that go beyond projects or programmes...

  11. Undocumented Immigrants and Access to Health Care: Making a Case for Policy Reform.

    Science.gov (United States)

    Edward, Jean

    2014-02-01

    The growth in undocumented immigration in the United States has garnered increasing interest in the arenas of immigration and health care policy reform. Undocumented immigrants are restricted from accessing public health and social service as a result of their immigration status. The Patient Protection and Affordability Care Act restricts undocumented immigrants from participating in state exchange insurance market places, further limiting them from accessing equitable health care services. This commentary calls for comprehensive policy reform that expands access to health care for undocumented immigrants based on an analysis of immigrant health policies and their impact on health care expenditures, public health, and the role of health care providers. The intersectional nature of immigration and health care policy emphasizes the need for nurse policymakers to advocate for comprehensive policy reform aimed at improving the health and well-being of immigrants and the nation as a whole. © The Author(s) 2014 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.

  12. A critical commentary on management science in relation to reforms after institutional National Health Service failures.

    Science.gov (United States)

    Regan, Paul; Ball, Elaine

    2017-03-01

    A discussion paper on the United Kingdom (UK) National Health Service (NHS) market reforms. NHS market reforms reliance on management science methods introduced a fundamental shift in measuring care for commissioning. A number of key reports are discussed in relation to NHS market reforms and management science. NHS market reforms were influenced through a close alliance between policy makers, the department of health, free market think tanks and management consultancies. The timing of reforms coincided with reports on NHS failings and the evolution of measurement methods to focus on finance. The balance in favour of measurement practises is of concern. Management science methods are criticised in the Francis Report yet promoted as the solution to some of the key findings; why may be explained by the close alliance. A return to principles of management involving consensus, trust and involvement to promote quality care and use management science methods to this end. © 2016 John Wiley & Sons Ltd.

  13. ACTIVE AGEING AND REFORMING PENSION SYSTEM. MAIN CHALLENGES

    Directory of Open Access Journals (Sweden)

    VALENTINA VASILE

    2012-05-01

    Full Text Available Active ageing and economic crisis create a great pressure on pension systems, from the financial sustainability and performance of the old architectures of the 3 tired system point of view. Reforms of public pension systems during the last years highlight that demographic ageing is a major influence factor on financial sustainability of the national insurance and social assistance systems, with long-term effects. Associated with “classic” demographic ageing (low birth-rate, increase of the average life expectancy for some new member states, such Romania, labour mobility on medium- and long-term and the change of its largest part into emigration, heightens labour force ageing and diminishes participation to insurance systems (due to the low portability of pensions. To these are added also the specific effects generated by the crisis that have put pressure on decreasing social expenditures, in reverse trend against the demand generated by demographic ageing. Romania, and also several EU member countries are involved in large-scale actions of reforming pension systems both as answer to the increase in the numbers of elderly population, and implicitly of associated social expenditures, but also for stimulating the extension of active life. The increase in the standard retirement age and its correlation to life expectancy constitute priorities of changing the methodology in pension computation. The reformed policies in the field of pensions pursue as well restricting accessibility and diminishing early-age retirement schemes in parallel with stimulating the employability of individuals aged 50 and over. In this paper we present the main policy action in order to stimulate and develop a new model of old age insurance and a new pattern of incomes after retirement, and also to investigate the support measures among EU member state for active ageing and increase incomes for elder persons.

  14. [Reform of mental health legislation: a practical tool].

    Science.gov (United States)

    Laguerre, A; Schürhoff, F

    2012-04-01

    It was widely agreed that the June 27, 1990 law needed to be changed. The new mental health legislation provides new procedures, which challenge our work habits and balance the rights of individual patient with the need to ensure public safety. In view of the very short time between the publication of the law in the Bulletin Officiel (July 6, 2011) and its application (August 1, 2011), the changes in legislation have led to concrete modifications of our practices. The scope of this article is to provide a practical tool, which will help to better understand the new measures in the law and to provide an accessible guide of use in relation to mental health care decisions. For the purpose of involuntary admissions, we provide two flow-charts outlining the changes in the legislation in its various aspects. We propose to summarize the points, which are not modified by this legislation, and we further develop the several new aspects of the law. Notably, procedures involving compulsory detention including the care and observation period of 72 hours, medical certificates, care in an emergency situation, the panel of caregivers, systematic review of each decision to detain by the Juge de la Détention et des Libertés (JLD), the particular case of patients under a criminal procedure or subjects who were hospitalized in units for dangerous patients, planned discharges, and disagreements between psychiatrists and the civil servant responsible. The aim of this article is not to criticize the law. It simply sets out the new measures for the compulsory admission of patients in hospital and defines the new procedures for continued detention or discharge. Due to its recent implementation, we don't have any feedback concerning long-term implications of this reform of mental health legislation, and it is premature to fully appreciate its advantages or disadvantages. Copyright © 2012 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  15. System model development for a methanol reformed 5 kW high temperature PEM fuel cell system

    DEFF Research Database (Denmark)

    Sahlin, Simon Lennart; Andreasen, Søren Juhl; Kær, Søren Knudsen

    2015-01-01

    This work investigates the system performance when reforming methanol in an oil heated reformer system for a 5 kW fuel cell system. A dynamic model of the system is created and evaluated. The system is divided into 4 separate components. These components are the fuel cell, reformer, burner...... and evaporator, which are connected by two separate oil circuits, one with a burner and reformer and one with a fuel cell and evaporator. Experiments were made on the reformer and measured oil and bed temperatures are presented in multiple working points. The system is examined at loads from 0 to 5000 W electric...

  16. Business Pattern of Distributed Energy in Electric Power System Reformation

    Science.gov (United States)

    Liang, YUE; Zhuochu, LIU; Jun, LI; Siwei, LI

    2017-05-01

    Under the trend of the electric power system revolution, the operation mode of micro power grid that including distributed power will be more diversified. User’s demand response and different strategies on electricity all have great influence on the operation of distributed power grid. This paper will not only research sensitive factors of micro power grid operation, but also analyze and calculate the cost and benefit of micro power grid operation upon different types. Then it will build a tech-economic calculation model, which applies to different types of micro power grid under the reformation of electric power system.

  17. [Primary Healthcare Reform in Portugal on two fronts: autonomous family healthcare units and management of groupings of Health Centers].

    Science.gov (United States)

    Pisco, Luis

    2011-06-01

    In 2005, Portugal began a reform of Primary Health Care. This reform process through to April 2010 is described and analyzed. During this period the Mission for Primary Health Care was responsible for conducting a profound reconfiguration. The main objectives for this reform were to improve accessibility, efficiency, quality and continuity of care and increase the satisfaction of professionals and citizens. The main features are voluntary adhesion, teamwork, mandatory information system, performance-sensitive payment, contracting and evaluation. The reconfiguration of health centers was two pronged. First, there was the formation of small autonomous functional units, known as Family Health Units (USF) providing services with proximity and quality. The second measure involved the aggregation of resources and management structures, groups of health centers (ACES), seeking to achieve efficiency and economies of scale. The FHU proved to offer simultaneously more efficiency, accessibility, better working environment, greater citizen satisfaction, namely better quality. The importance of strong political support, the creation of a structure responsible for the design and implementation of reform and good liaison with the media are stressed.

  18. Health Reform and the Obama Administration: Reflections in Mid-2010

    Science.gov (United States)

    Marmor, Theodore R.

    2010-01-01

    The reforms that finally emerged from the Obama administration's initiative were the result of a year of nasty, demagogic and misleading claims in the US public forum, coupled with the complexities of crafting legislation that stood a chance of passing both the House of Representatives and the Senate. The resulting “hybrid” approach to healthcare reform produced a conservative strategy that ignores the experience of other wealthy democracies. More significantly, its long period of implementation, given a possible change of administration in 2012, increases uncertainty regarding whether and how reforms will be rolled out by 2014 and after. PMID:21804835

  19. REFORMING OF LAND MANAGEMENT SYSTEM UNDER AUTHORITY OF DECENTRALIZATION

    Directory of Open Access Journals (Sweden)

    Dorosh O.S.

    2016-05-01

    Full Text Available The article is devoted to the problems related to the reform of land management from the beginning of the land reform ill the presentine. This need has arisen due to making another attempt to reorganize the structure of the land structures. With the launch of the land reform established the State Committee of Ukraine for Land Resources in 1992. To speed up land reform and land privatization in 2001 formed the administrative bodies of the State Committee for Land Resources of Ukraine. In order to improve the system of state land management in 2011 created the State Agency of Land Resources of Ukraine, which was reorganized in 2014 into the State Service of Ukraine of geodesy, cartography and cadastre. Over the years, in order to "optimize" the system of central executive body, content of this body has not been changed and constantly was changing its name and subordination, namely: the State Committee for Land Resources - Ministry of Ecology and Natural Resources of Ukraine, the State Agency of Land Resources of Ukraine - Ministry of Agrarian policy and Food of Ukraine, State Service of Ukraine of geodesy, cartography and cadastre - Ministry of regional development, construction and housing. On the basis of analysis concerning the powers of the central executive authorities, local authorities found that the newly farmed Service State Land Cadastre das not contribute to the effectiveness of the administration, especially at the national level, as these features ave not provided by "Regulations on State Land Cadastre " and other regulations. In addition, the local level detected removal of local government in matters of land relations. In conclusion, proposed system based redistribution of powers on the level of central executive bodies and local authorities to reform the system of land management with regard to decentralized processes in Ukraine. It is advisable to restore central authority for land reform and regulation of land relations to the

  20. Price elasticities in the German Statutory Health Insurance market before and after the health care reform of 2009.

    Science.gov (United States)

    Pendzialek, Jonas B; Danner, Marion; Simic, Dusan; Stock, Stephanie

    2015-05-01

    This paper investigates the change in price elasticity of health insurance choice in Germany after a reform of health insurance contributions. Using a comprehensive data set of all sickness funds between 2004 and 2013, price elasticities are calculated both before and after the reform for the entire market. The general price elasticity is found to be increased more than 4-fold from -0.81 prior to the reform to -3.53 after the reform. By introducing a new kind of health insurance contribution the reform seemingly increased the price elasticity of insured individuals to a more appropriate level under the given market parameters. However, further unintended consequences of the new contribution scheme were massive losses of market share for the more expensive sickness funds and therefore an undivided focus on pricing as the primary competitive element to the detriment of quality. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. [Health reform and the creation of the Sistema Único de Saúde: notes on contexts and authors].

    Science.gov (United States)

    Paiva, Carlos Henrique Assunção; Teixeira, Luiz Antonio

    2014-01-01

    Within the context of the return to democracy, the new constitution enacted in 1988 transformed health into an individual right and initiated the process of creating a public, universal and decentralized health system, profoundly altering the organization of public health in Brazil. This article discusses the main institutional, political and social aspects of this health reform, along with the changes, the continuities and the major initiatives, based on the literature published by the most widely read authors in this field of study. Without purporting to offer an exhaustive analysis, we discuss how the historiography written by authors who were also actors in the process assess its main features, along with the genesis of the process and the legacy of health reform in Brazil.

  2. Health policy as a fuzzy concept: methodological problems encountered when evaluating health policy reforms in an international perspective.

    NARCIS (Netherlands)

    Kroneman, M.W.; Zee, J. van der

    1997-01-01

    Investigating health policy reforms at a national level is a troublesome task, since it is difficult to establish exactly when a certain policy change took place and it is also difficult to determine the content of the reform. In this paper three main causes are distinguished that contribute to the

  3. Reforming the road freight transportation system using systems thinking: An investigation of Coronial inquests in Australia.

    Science.gov (United States)

    Newnam, Sharon; Goode, Natassia; Salmon, Paul; Stevenson, Mark

    2017-04-01

    Road freight transport is considered to be one of the most dangerous industries in Australia, accounting for over 30% of all work fatalities. Whilst system reform (i.e., change to policy and practice) is needed, it is not clear what this reform should be, or what approaches should be used to drive it. This article argues that road freight transportation reform should be underpinned by a systems thinking approach. Efforts to understand crash causation should be focused beyond the driver and identify contributing factors at other levels with the road freight system. Accordingly, we present the findings from a study that examined whether Australian Coronial investigations into road freight crashes reflect support appropriate system reform. Content analysis was used to identify the contributing factors and interrelations implicated in the road freight crashes described in publicly available Australian Coroner's inquest reports from the last 10 years (2004-2014; n=21). The results found evidence to suggest that the Coronial inquests provide some understanding of the complex system of factors influencing road freight transportation crashes in Australia. However, there was a lack of evidence to suggest an understanding of system-based reform based on the identification of reductionist-focused recommendations. It is concluded that researchers and practitioners (ie., government and industry) need to work together to develop prevention efforts focused on system reforms. Systems thinking based data collection and analysis frameworks are urgently required to help develop this understanding in road freight transportation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Health Care Reform Bureaucracy In The District Merauke In Perspective Agency Theory

    National Research Council Canada - National Science Library

    Samel W. Ririhena; H. Suratman; Alwi; Gita Susanti

    2015-01-01

    .... The purpose of writing is to analyze the theory of agency in order to verify the health care bureaucracy reformas Merauke district which includes reform of the bureaucracy adverse selection and moral hazard...

  5. Reformed Methanol Fuel Cell Systems - and their use in Electric Hybrid Systems

    DEFF Research Database (Denmark)

    Justesen, Kristian Kjær

    . Alternative system topologies that use a liquid fuel is therefore of great interest. One such topology is the Reformed Methanol Fuel Cell (RMFC) system where a mixture of liquid methanol and water is reformed via the steam reformation process to hydrogen and carbon monoxide. Most of the hydrogen is then used......PEM fuel cells are widely regarded as a promising technology which has the potential to replace more polluting and less efficient internal combustion engines in many applications. They do, however, have the drawback that their hydrogen fuel is cumbersome and energy consuming to store and transport...... in a fuel cell and the rest is passed to a catalytic burner which supplies the process heat for the reformer. This makes RMFCs complex systems where the different parts of the system affect each other and it makes demands on the way they are integrated with the loads they supply. This PhD study has...

  6. Condliff v North Staffordshire Primary Care Trust: can human rights redress inequities in United Kingdom and Australian cost-containment-driven health care reforms?

    Science.gov (United States)

    Townsend, Ruth; Faunce, Thomas

    2011-12-01

    A recent case from the English Court of Appeal (R (on the application of Condliff) v North Staffordshire Primary Care Trust [2011] EWCA Civ 910, concerning denial by a regional health care rationing committee of laparoscopic gastric bypass surgery for morbid obesity) demonstrates the problems of attempting to rely post hoc on human rights protections to ameliorate inequities in health care reforms that emphasise institutional budgets rather than universal access. This column analyses the complexities of such an approach in relation to recent policy debates and legislative reform of the health systems in the United Kingdom and Australia. Enforceable human rights, such as those available in the United Kingdom to the patient Tom Condliff, appear insufficient to adequately redress issues of inequity promoted by such "reforms". Equity may fare even worse under Australian cost-containment health care reforms, given the absence of relevant enforceable human rights in that jurisdiction.

  7. Policy Capacity Meets Politics: Comment on "Health Reform Requires Policy Capacity".

    Science.gov (United States)

    Fafard, Patrick

    2015-07-22

    It is difficult to disagree with the general argument that successful health reform requires a significant degree of policy capacity or that all players in the policy game need to move beyond self-interested advocacy. However, an overly broad definition of policy capacity is a problem. More important perhaps, health reform inevitably requires not just policy capacity but political leadership and compromise. © 2015 by Kerman University of Medical Sciences.

  8. Policy Capacity Meets Politics; Comment on “Health Reform Requires Policy Capacity”

    Directory of Open Access Journals (Sweden)

    Patrick Fafard

    2015-10-01

    Full Text Available It is difficult to disagree with the general argument that successful health reform requires a significant degree of policy capacity or that all players in the policy game need to move beyond self-interested advocacy. However, an overly broad definition of policy capacity is a problem. More important perhaps, health reform inevitably requires not just policy capacity but political leadership and compromise.

  9. Can biosimilars help achieve the goals of US health care reform?

    Directory of Open Access Journals (Sweden)

    Boccia R

    2017-06-01

    Full Text Available Ralph Boccia,1 Ira Jacobs,2 Robert Popovian,3 Gilberto de Lima Lopes Jr4 1Center for Cancers and Blood Disorders, Bethesda, MD, 2Global Medical Affairs, Pfizer Inc., New York, NY, 3US Government Relations, Pfizer Inc., Washington, DC, 4Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA Abstract: The US Patient Protection and Affordable Care Act (ACA aims to expand health care coverage, contain costs, and improve health care quality. Accessibility and affordability of innovative biopharmaceuticals are important to the success of the ACA. As it is substantially more difficult to manufacture them compared with small-molecule drugs, many of which have generic alternatives, biologics may increase drug costs. However, biologics offer demonstrated improvements in patient care that can reduce expensive interventions, thus lowering net health care costs. Biosimilars, which are highly similar to their reference biologics, cost less than the originators, potentially increasing access through reduced prescription drug costs while providing equivalent therapeutic results. This review evaluates 1 the progress made toward enacting health care reform since the passage of the ACA and 2 the role of biosimilars, including the potential impact of expanded biosimilar use on access, health care costs, patient management, and outcomes. Barriers to biosimilar adoption in the USA are noted, including low awareness and financial disincentives relating to reimbursement. The evaluated evidence suggests that the ACA has partly achieved some of its aims; however, the opportunity remains to transform health care to fully achieve reform. Although the future is uncertain, increased use of biosimilars in the US health care system could help achieve expanded access, control costs, and improve the quality of care. Keywords: Affordable Care Act, biologics, health policy, patient care, access

  10. Rents From the Essential Health Benefits Mandate of Health Insurance Reform.

    Science.gov (United States)

    Mendoza, Roger Lee

    2015-01-01

    The essential health benefits mandate constitutes one of the most controversial health care reforms introduced under the U.S. Affordable Care Act of 2010. It bears important theoretical and practical implications for health care risk and insurance management. These essential health benefits are examined in this study from a rent-seeking perspective, particularly in terms of three interrelated questions: Is there an economic rationale for standardized, minimum health care coverage? How is the scope of essential health services and treatments determined? What are the attendant and incidental costs and benefits of such determination/s? Rents offer ample incentives to business interests to expend considerable resources for health care marketing, particularly when policy processes are open to contestation. Welfare losses inevitably arise from these incentives. We rely on five case studies to illustrate why and how rents are created, assigned, extracted, and dissipated in equilibrium. We also demonstrate why rents depend on persuasive marketing and the bargained decisions of regulators and rentiers, as conditioned by the Tullock paradox. Insights on the intertwining issues of consumer choice, health care marketing, and insurance reform are offered by way of conclusion.

  11. Health Sector Reform in sub-Saharan Africa: a synthesis of country ...

    African Journals Online (AJOL)

    Health sector reform is a 'sustained process of fundamental changes in national health policy, institutional arrangements, etc. guided by government and designed to improve the functioning and performance of the health sector and, ultimately, the health status of the population'. All the forty six countries in the African ...

  12. Effect of primary health care reforms in Turkey on health service utilization and user satisfaction.

    Science.gov (United States)

    Hone, Thomas; Gurol-Urganci, Ipek; Millett, Christopher; Başara, Berrak; Akdağ, Recep; Atun, Rifat

    2017-02-01

    Strengthening primary health care (PHC) is considered a priority for efficient and responsive health systems, but empirical evidence from low- and middle-income countries is limited. The stepwise introduction of family medicine across all 81 provinces of Turkey (a middle-income country) between 2005 and 2010, aimed at PHC strengthening, presents a natural experiment for assessing the effect of family medicine on health service utilization and user satisfaction.The effect of health system reforms, that introduced family medicine, on utilization was assessed using longitudinal, province-level data for 12 years and multivariate regression models adjusting for supply-side variables, demographics, socio-economic development and underlying yearly trends. User satisfaction with primary and secondary care services was explored using data from annual Life Satisfaction Surveys. Trends in preferred first point of contact (primary vs secondary, public vs. private), reason for choice and health services issues, were described and stratified by patient characteristics, provider type, and rural/urban settings.Between 2002 and 2013, the average number of PHC consultations increased from 1.75 to 2.83 per person per year. In multivariate models, family medicine introduction was associated with an increase of 0.37 PHC consultations per person (P care consultations. Following family medicine introduction, the growth of PHC and secondary care consultations per person was 0.08 and 0.30, respectively, a year. PHC increased as preferred provider by 9.5% over 7 years with the reasons of proximity and service satisfaction, which increased by 14.9% and 11.8%, respectively. Reporting of poor facility hygiene, difficulty getting an appointment, poor physician behaviour and high costs of health care all declined (P < 0.001) in PHC settings, but remained higher among urban, low-income and working-age populations. © The Author 2016. Published by Oxford University Press in association with

  13. Urban employee health insurance reform and the impact on out-of-pocket payment in China.

    Science.gov (United States)

    Liu, Gordon G; Zhao, Zhongyun

    2006-01-01

    Since the middle of the 1990s, China has undertaken a significant reform in urban employee health insurance programs. Using data from the pilot experiment conducted in Zhenjiang, this study examines changes in the pre- and post-reform distributions of out-of-pocket (OOP) expenditures across four representative groups by chronic disease, income, education, and job status. Major findings suggested increased OOP expenditures for all groups after the reform. However, the redistributions in OOP appear to be in favor of the disadvantaged groups, suggesting a more equitable change led by the reform. This study concludes that the post-reform insurance model did not compromise equity in cost-sharing while containing cost inflation and increasing insurance coverage for the urban population.

  14. Role of Geography and Nurse Practitioner Scope-of-Practice in Efforts to Expand Primary Care System Capacity: Health Reform and the Primary Care Workforce.

    Science.gov (United States)

    Graves, John A; Mishra, Pranita; Dittus, Robert S; Parikh, Ravi; Perloff, Jennifer; Buerhaus, Peter I

    2016-01-01

    Little is known about the geographic distribution of the overall primary care workforce that includes both physician and nonphysician clinicians--particularly in areas with restrictive nurse practitioner scope-of-practice laws and where there are relatively large numbers of uninsured. We investigated whether geographic accessibility to primary care clinicians (PCCs) differed across urban and rural areas and across states with more or less restrictive scope-of-practice laws. An observational study. 2013 Area Health Resource File (AHRF) and US Census Bureau county travel data. The measures included percentage of the population in low-accessibility, medium-accessibility, and high-accessibility areas; number of geographically accessible primary care physicians (PCMDs), nurse practitioners (PCNPs), and physician assistants (PCPAs) per 100,000 population; and number of uninsured per PCC. We found divergent patterns in the geographic accessibility of PCCs. PCMDs constituted the largest share of the workforce across all settings, but were relatively more concentrated within urban areas. Accessibility to nonphysicians was highest in rural areas: there were more accessible PCNPs per 100,000 population in rural areas of restricted scope-of-practice states (21.4) than in urban areas of full practice states (13.9). Despite having more accessible nonphysician clinicians, rural areas had the largest number of uninsured per PCC in 2012. While less restrictive scope-of-practice states had up to 40% more PCNPs in some areas, we found little evidence of differences in the share of the overall population in low-accessibility areas across scope-of-practice categorizations. Removing restrictive scope-of-practice laws may expand the overall capacity of the primary care workforce, but only modestly in the short run. Additional efforts are needed that recognize the locational tendencies of physicians and nonphysicains.

  15. Market reforms in health care and sustainability of the welfare state: lessons from Sweden.

    Science.gov (United States)

    Diderichsen, F

    1995-01-01

    Reforming health care systems which are predominantly publicly provided and financed has usually been motivated as a way of increasing efficiency even if it seldom is explicit whether it is in the official sense related to individual utility or in the unofficial sense related to health outcomes. In the case of Sweden the welfare state has been made politically sustainable through a construction where cash benefits and service provision are tailored to satisfy not only the basic needs but even the more discriminating needs of the middle classes. Their loyalty with the taxes is politically crucial and therefore their evaluation of the services in the welfarist sense equally important. That loyalty was however threatened in a situation where cost-containment policies were applied while equity principles were still a strong priority. Health care utilization was increasing among the very old and chronically ill while it was decreasing for other groups. The reforms introduced in some counties during the 1990s have been focussing on a purchaser-provider split and fee-for-service payment of providers. They have increased productivity sharply, increased utilization even among the groups that previously were 'pressed out' and reduced waiting lists. Increased efficiency however, threatens equity in some specific aspects. Fee-for-service payment means increased production and so far even increased costs. If they are to be met with increased private financing, rather than with present tax financing, it will bring the risk of inequities. Payment of hospitals through DRG systems means payment to providers for medical interventions with no incentives to deal with social consequences of illness. Inequities in health care can be related to the way health care deals with inequalities in health due to inequalities in living conditions or inequalities in living conditions due to ill health. In the short perspective the reforms may threaten equity in the second aspect, in the longer

  16. Lost in the rush to national reform: recommendations to improve impact on behavioral health providers in rural areas.

    Science.gov (United States)

    Semansky, Rafael; Willging, Cathleen; Ley, David J; Rylko-Bauer, Barbara

    2012-05-01

    As the United States embarks on the most ambitious national health reform since the 1960s, this article highlights the challenges faced by behavioral health agencies, providers, and clients in rural areas and presents recommendations to improve access to and quality of services. Lessons learned from five years of research on a major systems-change initiative in New Mexico illuminate potential problem areas for rural agencies under national health reform, including insufficient financial resources, shortages of trained staff, particularly clinicians with advanced credentials, and delays in adopting the latest information technology. We recommend that rural states: (1) undertake careful planning for smooth transitions; (2) provide financial resources and technical assistance to expand rural safety-net services and capacity; (3) modify the health home model for the rural context; and (4) engage in ongoing evaluation, which can help ensure the early identification and rectification of unanticipated implementation issues.

  17. [Gender equity in health sector reform policies in Latin America and the Caribbean].

    Science.gov (United States)

    Gómez, Elsa Gómez

    2002-01-01

    Gender equity is increasingly being acknowledged as an essential aspect of sustainable development and more specifically, of health development. The Pan American Health Organization's Program for Women, Health, and Development has been piloting for a year now a project known as Equidad de género en las políticas de reforma del sector de salud, whose objective is to promote gender equity in the health sector reform efforts in the Region. The first stage of the project is being conducted in Chile and Peru, along with some activities throughout the Region. The core of the project is the production and use of information as a tool for introducing changes geared toward achieving greater gender equity in health, particularly in connection with malefemale disparities that are unnecessary, avoidable, and unfair in health status, access to health care, and participation in decision-making within the health system. We expect that in three years the project will have brought about changes in the production of information and knowledge, advocacy, and information dissemination, as well as in the development, appropriation, and identification of intersectoral mechanisms that will make it possible for key figures in government and civil society to work together in setting and surveying policy on gender equity in health.

  18. Model development of integrated CPOx reformer and SOFC stack system

    Directory of Open Access Journals (Sweden)

    Pianko-Oprych Paulina

    2016-12-01

    Full Text Available The main purpose of this study was to develop a mathematical model, in a steady state and dynamic mode, of a Catalytic Partial Oxidation (CPOx reformer – Solid Oxide Fuel Cell (SOFC stack integrated system in order to assess the system performance. Mass balance equations were written for each component in the system together with energy equation and implemented into the MATLAB Simulink simulation tool. Temperature, gas concentrations, pressure and current density were computed in the steady-state mode and validated against experimental data. The calculated I–V curve matched well the experimental one. In the dynamic modelling, several different conditions including step changes in fuel flow rates, stack voltage as well as temperature values were applied to estimate the system response against the load variations. Results provide valuable insight into the operating conditions that have to be achieved to ensure efficient CPOx performance for fuel processing for the SOFC stack applications.

  19. Women and health reform: how national health care can enhance coverage, affordability, and access for women (examples from massachusetts).

    Science.gov (United States)

    Fitzgerald, Therese; Cohen, Laura; Hyams, Tracey; Sullivan, Katherine M; Johnson, Paula A

    2014-01-01

    Massachusetts women have the highest rates of health insurance coverage in the nation and women's access to care has improved across all demographic groups. However, important challenges persist. As national health reform implementation moves forward under the Affordable Care Act (ACA), states will likely encounter many of the same women's health challenges experienced in Massachusetts over the past 7 years. A review of the literature and data analyses comparing health care services access, utilization, and cost, and health outcomes from Massachusetts pre- and post-2006 health care reform identified two key challenges in women's continuity of coverage and affordability. These areas are crucial for state and national policymakers to consider in improving women's health as they work to implement health care reform at the state and federal levels. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  20. Health services reform in Bangladesh: hearing the views of health workers and their professional bodies

    Directory of Open Access Journals (Sweden)

    Cockcroft Anne

    2011-12-01

    Full Text Available Abstract Background In Bangladesh, widespread dissatisfaction with government health services did not improve during the Health and Population Sector Programme (HPSP reforms from 1998-2003. A 2003 national household survey documented public and health service users' views and experience. Attitudes and behaviour of health workers are central to quality of health services. To investigate whether the views of health workers influenced the reforms, we surveyed local health workers and held evidence-based discussions with local service managers and professional bodies. Methods Some 1866 government health workers in facilities serving the household survey clusters completed a questionnaire about their views, experience, and problems as workers. Field teams discussed the findings from the household and health workers' surveys with local health service managers in five upazilas (administrative sub-districts and with the Bangladesh Medical Association (BMA and Bangladesh Nurses Association (BNA. Results Nearly one half of the health workers (45% reported difficulties fulfilling their duties, especially doctors, women, and younger workers. They cited inadequate supplies and infrastructure, bad behaviour of patients, and administrative problems. Many, especially doctors (74%, considered they were badly treated as employees. Nearly all said lack of medicines in government facilities was due to inadequate supply, not improved during the HPSP. Two thirds of doctors and nurses complained of bad behaviour of patients. A quarter of respondents thought quality of service had improved as a result of the HPSP. Local service managers and the BMA and BNA accepted patients had negative views and experiences, blaming inadequate resources, high patient loads, and patients' unrealistic expectations. They said doctors and nurses were demotivated by poor working conditions, unfair treatment, and lack of career progression; private and unqualified practitioners sought to

  1. Including health insurance in poverty measurement: The impact of Massachusetts health reform on poverty.

    Science.gov (United States)

    Korenman, Sanders D; Remler, Dahlia K

    2016-12-01

    We develop and implement what we believe is the first conceptually valid health-inclusive poverty measure (HIPM) - a measure that includes health care or insurance in the poverty needs threshold and health insurance benefits in family resources - and we discuss its limitations. Building on the Census Bureau's Supplemental Poverty Measure, we construct a pilot HIPM for the under-65 population under ACA-like health reform in Massachusetts. This pilot demonstrates the practicality, face validity and value of a HIPM. Results suggest that public health insurance benefits and premium subsidies accounted for a substantial, one-third reduction in the health inclusive poverty rate. Copyright © 2016 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

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

    2015-05-05

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

  3. Strategies for Increasing the Role of Family Medicine in Mexican Health Care Reform.

    Science.gov (United States)

    Ramírez Aranda, José Manuel; van Weel, Chris; Goodyear-Smith, Felicity

    2017-01-01

    There is little or no role for primary care and family medicine in current health reforms in Mexico. However, robust evidence shows that primary care helps prevent morbidity and mortality and increases health equity. Mexico has participated in several international meetings sponsored by the World Organization of National Colleges, Academies and Academic Associations and the North American Primary Care Research Group that are aimed at increased understanding of national health systems and the need to strengthen primary care for improved health outcomes. From 1 of these meetings the Cancún Manifesto emerged, with a strategic plan to increase the stature and impact of the Mexican College of Family Physicians (COLMEXAC) in strengthening primary care in Mexico. We aim to describe this strategic plan and discuss its early implementation, and for this account to serve as a possible formula for other countries. The 5 specific strategies discussed are 1) the need for consensus on the leading role of the Mexican family physician in the national health system; 2) health ecology research; 3) to improve the perception of patients about the benefits of primary care and family medicine; 4) to organize meetings of health providers, users, and other stakeholders; and 5) to promote the professionalization of COLMEXAC as a legal entity. © Copyright 2017 by the American Board of Family Medicine.

  4. Health Systems Governance for health equity: critical reflections.

    Science.gov (United States)

    Labonté, Ronald

    2010-01-01

    This article addresses several issues pertinent to health systems governance for health equity. It argues the importance of health systems using measures of positive health (well-being), discriminating in favour of historically less advantaged groups and weighing the costs of health care against investments in the social determinants of health. It cautions that the concept of governance could weaken the role of government, with disequalizing effects, while emphasizing the importance of two elements of good governance (transparency and participation) in health systems decision-making. It distinguishes between participation as volunteer labour and participation as exercising political rights, and questions the assumption that decentralization in health systems is necessarily empowering. It then identifies five health system roles to address issues of equity (educator/watchdog, resource broker, community developer, partnership developer and advocate/catalyst) and the implications of these roles for practice. Drawing on preliminary findings of a global research project on comprehensive primary health care, it discusses political aspects of progressive health system reform and the implications of equity-focused health system governance on health workers' roles, noting the importance of health workers claiming their identity as citizens. The article concludes with a commentary on the inherently political nature of health reforms based on equity; the necessary confrontation with power relations politics involves; and the health systems governance challenge of managing competing health discourses of efficiency and results-based financing, on the one hand, and equity and citizen empowerment, on the other.

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

    Science.gov (United States)

    Hankivsky, Olena; Vorobyova, Anna; Salnykova, Anastasiya; Rouhani, Setareh

    2016-08-17

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

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

    Directory of Open Access Journals (Sweden)

    Olena Hankivsky

    2017-03-01

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

  7. Policy entrepreneurship and policy networks in healthcare systems - the case of Israel's pediatric dentistry reform.

    Science.gov (United States)

    Cohen, Nissim; Horev, Tuvia

    2017-01-01

    Can the entry of a policy entrepreneur challenge the equilibrium of a policy network and promote changes that might clash with the goals of powerful civil-servants and/or interest groups and, if so, why and how? Our goal is to examine two sides of the same coin: how does an in-depth analysis of Israel's dental care reform enrich our understanding of policy networks and policy entrepreneurship? Second, how does the literature on policy networks and policy entrepreneurship help us understand this reform? Based on a theoretical framework that appears in the literature of policy entrepreneurship and policy networks, we analyze the motivations, goals and strategies of the main actors involved in the process of reforming pediatric dental care in Israel. We demonstrate how a policy entrepreneur navigated within a policy network and managed to promote a reform that, until his appearance, no one else in that network had succeeded in enacting. Our goals are advanced through a case study of a reform in pediatric dentistry implemented in Israel in 2010. It rests on textual analyses of the literature, reports, committee minutes, parliamentary proceedings, print and online media, and updates in relevant legislation and case law between 2009 and 2015. In addition, the case study draws on the insights of one of the authors (TH), who played a role in the reform process. Historical circumstances and the Israeli public's longstanding lack of interest in changing the existing model as well as interest groups that preferred the dominance of the private sector in the dental healthcare system kept that area out of the services supplied, universally, under the National Health Insurance Law. This situation changed significantly following the publication in 2007 of a policy analysis that contributed to shifts in the motivations and balance of power within the policy network, which in turn prepared the ground for a policy change. In this environment a determined policy entrepreneur, who

  8. Policy entrepreneurship and policy networks in healthcare systems - the case of Israel's pediatric dentistry reform.

    Science.gov (United States)

    Cohen, Nissim; Horev, Tuvia

    2017-04-21

    Can the entry of a policy entrepreneur challenge the equilibrium of a policy network and promote changes that might clash with the goals of powerful civil-servants and/or interest groups and, if so, why and how? Our goal is to examine two sides of the same coin: how does an in-depth analysis of Israel's dental care reform enrich our understanding of policy networks and policy entrepreneurship? Second, how does the literature on policy networks and policy entrepreneurship help us understand this reform? Based on a theoretical framework that appears in the literature of policy entrepreneurship and policy networks, we analyze the motivations, goals and strategies of the main actors involved in the process of reforming pediatric dental care in Israel. We demonstrate how a policy entrepreneur navigated within a policy network and managed to promote a reform that, until his appearance, no one else in that network had succeeded in enacting. Our goals are advanced through a case study of a reform in pediatric dentistry implemented in Israel in 2010. It rests on textual analyses of the literature, reports, committee minutes, parliamentary proceedings, print and online media, and updates in relevant legislation and case law between 2009 and 2015. In addition, the case study draws on the insights of one of the authors (TH), who played a role in the reform process. Historical circumstances and the Israeli public's longstanding lack of interest in changing the existing model as well as interest groups that preferred the dominance of the private sector in the dental healthcare system kept that area out of the services supplied, universally, under the National Health Insurance Law. This situation changed significantly following the publication in 2007 of a policy analysis that contributed to shifts in the motivations and balance of power within the policy network, which in turn prepared the ground for a policy change. In this environment a determined policy entrepreneur, who

  9. [Health care reform in the Obama administration: difficulties of reaching a similar agreement in Argentina].

    Science.gov (United States)

    Belmartino, Susana

    2014-04-01

    This article presents a comparative analysis of the processes leading to health care reform in Argentina and in the USA. The core of the analysis centers on the ideological references utilized by advocates of the reform and the decision-making processes that support or undercut such proposals. The analysis begins with a historical summary of the issue in each country. The political process that led to the sanction of the Obama reform is then described. The text defends a hypothesis aiming to show that deficiencies in the institutional capacities of Argentina's decision-making bodies are a severe obstacle to attaining substantial changes in this area within the country.

  10. La reforma del sistema de salud de los Estados Unidos de América Health Reform in the USA

    Directory of Open Access Journals (Sweden)

    Cecilia Ganduglia

    2010-08-01

    Full Text Available A principios de 2010 se aprobó en EE.UUUU. la reforma del sistema de salud. La ley que legisla dicha reforma incluye cambios que apuntan a expandir la cobertura médica del pueblo, contener los costos y mejorar la calidad de atención. El debate previo a la aprobación de la reforma fue arduo, y no se consiguió finalmente un consenso entre los diferentes partidos políticos. Si bien la gran ampliación del sistema de cobertura médica no reduce a cero el actual grado de inaccesibilidad al sistema de salud, lo logrado puede ser considerado un muy importante primer paso. Aun así, la reforma promete continuar siendo tan polémica como las negociaciones previas que la concibieron.The United States of America passed early this year the bill enforcing their health reform. This reform aims at achieving universal insurance, cost containment and improving quality of care. The debate around this reform has been long and unable to arrive to an agreement between the parts. Even if the expansion in the medical coverage system does not reduce to zero the current degree of inaccessibility to the health system, these achievements could be considered a very important first step. Nonetheless, chances are that this reform will continue being as polemic as the negotiations previous to its conception.

  11. The Affordable Care Act: a case study for understanding and applying complexity concepts to health care reform.

    Science.gov (United States)

    Larkin, D Justin; Swanson, R Chad; Fuller, Spencer; Cortese, Denis A

    2016-02-01

    The current health system in the United States is the result of a history of patchwork policy decisions and cultural assumptions that have led to persistent contradictions in practice, gaps in coverage, unsustainable costs, and inconsistent outcomes. In working toward a more efficient health system, understanding and applying complexity science concepts will allow for policy that better promotes desired outcomes and minimizes the effects of unintended consequences. This paper will consider three applied complexity science concepts in the context of the Patient Protection and Affordable Care Act (PPACA): developing a shared vision around reimbursement for value, creating an environment for emergence through simple rules, and embracing transformational leadership at all levels. Transforming the US health system, or any other health system, will be neither easy nor quick. Applying complexity concepts to health reform efforts, however, will facilitate long-term change in all levels, leading to health systems that are more effective, efficient, and equitable. © 2014 John Wiley & Sons, Ltd.

  12. A call for action. The Pepper Commission's blueprint for health care reform.

    Science.gov (United States)

    Rockefeller, J D

    1991-05-15

    After a year of deliberation and investigation, the Pepper Commission recommended action to ensure that all Americans would have health insurance protection in an efficient, effective health care system. Because it believes that action is urgent, the commission would build universal coverage by securing, improving, and extending the combination of job-based and public coverage we now have. Reform would entail the following elements: a combination of incentives and requirements that would guarantee all workers (with their nonworking dependents) insurance coverage through their jobs; replacement of Medicaid with a new federal program that would cover all those not covered through the workplace and workers whose employers find public coverage more affordable; guaranteed affordable coverage for employers--through reform of private insurance, tax credits for small employers, and the opportunity to purchase public coverage; a minimum benefit standard for private and public plans that would cover preventive and primary services as well as catastrophic care and would include cost sharing, subject to ability to pay; and a combination of public and private sector initiatives to promote quality and contain costs.

  13. 75 FR 62684 - Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction...

    Science.gov (United States)

    2010-10-13

    ... HUMAN SERVICES Office of the Secretary 45 CFR Part 162 RIN 0938-AM50 Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction Standards Adopted Under the Health Insurance...: This document announces maintenance changes to some of the Health Insurance Portability and...

  14. Modelling and Optimization of Reforming Systems for use in PEM Fuel Cell

    DEFF Research Database (Denmark)

    Berry, Melissa; Korsgaard, Anders Risum; Nielsen, Mads Pagh

    2004-01-01

    reactors needed for CO removal to make the synthesis gas suitable for use in a PEM fuel cell. The systems are optimized to minimize the total volume, and must supply adequate hydrogen to a fuel cell with a 100kW load. The resultant system efficiencies are calculated. The CPOX system is the smallest......Three different reforming methods for the conversion of natural gas to hydrogen are studied and compared: Steam Reforming (SR), Auto-thermal Reforming (ATR), and Catalytic Partial Oxidation (CPOX). Thermodynamic and kinetic models are developed for the reforming reactors as well as the subsequent...

  15. Market reforms in health care and sustainability of the welfare state

    DEFF Research Database (Denmark)

    Diderichsen, Finn

    1995-01-01

    'pressed out' and reduced waiting lists. Increased efficiency however, threatens equity in some specific aspects. Fee-for-service payment means increased production and so far even increased costs. If they are to be met with increased private financing, rather than with present tax financing, it will bring......Reforming health care systems which are predominantly publicly provided and financed has usually been motivated as a way of increasing efficiency even if it seldom is explicit whether it is in the official sense related to individual utility or in the unofficial sense related to health outcomes....... In the case of Sweden the welfare state has been made politically sustainable through a construction where cash benefits and service provision are tailored to satisfy not only the basic needs but even the more discriminating needs of the middle classes. Their loyalty with the taxes is politically crucial...

  16. The group employed model as a foundation for health care delivery reform.

    Science.gov (United States)

    Minott, Jenny; Helms, David; Luft, Harold; Guterman, Stuart; Weil, Henry

    2010-04-01

    With a focus on delivering low-cost, high-quality care, several organizations using the group employed model (GEM)-with physician groups whose primary and specialty care physicians are salaried or under contract-have been recognized for creating a culture of patient-centeredness and accountability, even in a toxic fee-for-service environment. The elements that leaders of such organizations identify as key to their success are physician leadership that promotes trust in the organization, integration that promotes teamwork and coordination, governance and strategy that drive results, transparency and health information technology that drive continual quality improvement, and a culture of accountability that focuses providers on patient needs and responsibility for effective care and efficient use of resources. These organizations provide important lessons for health care delivery system reform.

  17. Access to Oral Health Care: A National Crisis and Call for Reform.

    Science.gov (United States)

    Bersell, Catherine H

    2017-02-01

    Purpose: According to the report Healthy People 2020, oral health is integral to overall health and access to dental services is essential to promoting and maintaining good oral health. Yet, those who need dental care the most are often the least likely to receive it. The dental hygiene profession is poised to play a pivotal role in the resolution of oral health disparities. The purpose of this manuscript is to examine the critical issue of access to oral health care in the United States from various perspectives and consider potential implications for dental professionals and the oral health care system. This report focuses on major underserved and vulnerable populations and highlights several barriers that significantly affect the ability to access and navigate the oral health care system. These include low socioeconomic status; the shortage and maldistribution of dentists; a lack of professional training regarding current evidence-based oral health guidelines; deficient continuity of care due to inadequate interdisciplinary collaboration; low oral health literacy; and patient perceptions and misconceptions about preventive dental care. This report also contains an update on provider participation in Medicaid; the state of children's oral health; and emerging workforce models, state initiatives, and legislative reforms. Recommendations increasing access to care require local, state, and federal stakeholders to combine forces that take advantage of the existing dental hygiene workforce, utilize innovative delivery models, improve license reciprocity, reduce prohibitive supervision, and expand the dental hygiene scope of practice. The major focus of future research will be on the implementation of mid-level oral health care providers. Dental hygienists are an integral part of the access to care solution and have a great opportunity to lead the call to action and fulfill the American Dental Hygienists' Association's mandate that oral health care is the right of all

  18. Health Care Reform Bureaucracy In The District Merauke In Perspective Agency Theory

    Directory of Open Access Journals (Sweden)

    Samel W. Ririhena

    2015-04-01

    Full Text Available Abstract Reforms are demands to improve services especially health services to the community in Merauke. The purpose of writing is to analyze the theory of agency in order to verify the health care bureaucracy reformas Merauke district which includes reform of the bureaucracy adverse selection and moral hazard. This study used a qualitative approach and data collection is done by using interviews and intervieuw based on interactive model of Milles and Huberman. The results showed that the reform of health care bureaucracy in Merauke not running optimally and the problem of adverse selection and moral hazard is still happening in the agency relationship between the Department of Health and the Health Center.

  19. Characterization and Modeling of a Methanol Reforming Fuel Cell System:Karakterisering og Modellering af en Methanol Reformering Fuel Cell System

    OpenAIRE

    Sahlin, Simon Lennart

    2016-01-01

    Many fuel cells systems today are operated with compressed hydrogen which has great benefits because of the purity of the hydrogen and the relatively simple storage of the fuel. However, compressed hydrogen is stored in the range of 800 bar, which can be expensive to compress.One of the interesting topologies is the Reformed Methanol Fuel Cell (RMFC) system that operates on a mix of methanol and water. The fuel is reformed with a steam reforming to a hydrogen rich gas, however with additional...

  20. Rational Observational Systems of Educational Accountability and Reform

    Directory of Open Access Journals (Sweden)

    Audrey Amrein-Beardsley

    2015-08-01

    Full Text Available There is something incalculable about teacher expertise and whether it can be observed, detected, quantified, and as per current educational policies, used as an accountability tool to hold America's public school teachers accountable for that which they do (or do not do well. In this commentary, authors (all of whom are former public school teachers argue that rubric-based teacher observational systems, developed to assess the extent to which teachers adapt and follow sets of rubric-based rules, might actually constrain teacher expertise. Moreover, authors frame their comments using the Dreyfus Model (1980, 1986 to illustrate how observational systems and the rational conceptions on which they are based might be stifling educational progress and reform.

  1. Americans' political participation in the 1993-94 national health care reform debate.

    Science.gov (United States)

    Brodie, M

    1996-01-01

    The health politics and policy communities are still struggling with the question of "what went wrong" in the 1993-94 health care reform effort. Here I identify which Americans were politically active and inactive during the health care reform debate to explore the role political participation may have had in determining the outcome of the debate. Using data from a national and California random-sample telephone surveys, and controlling for other demographic attributes, I found that those who engaged in political activity specifically related to health care reform were disproportionately more likely to be self-identified conservatives, less likely to favor an employer mandate plan, more likely to be fifty to sixty-four years old, more likely to be men, and more likely to have greater interest in and knowledge of the health care issue. Even in California, where a single-payer proposal was on the November ballot, self-identified liberals were no more likely to engage in political activity on health care reform than were moderates or conservatives. I consider implications for the reform outcome given that liberals, the elderly, and those favoring the employer mandate proposal were all disproportionately "silent" during this debate, and finally I discuss the potential for mobilization during future debates.

  2. Implications of land rights reform for Indigenous health.

    Science.gov (United States)

    Watson, Nicole L

    2007-05-21

    In August 2006, the Aboriginal Land Rights (Northern Territory) Amendment Bill 2006 (Cwlth) was passed into law, introducing, among other things, a system of 99-year leases over Indigenous townships. The leasing scheme will diminish the control that traditional owners previously exercised over their lands. This is at odds with research indicating that control over land is a positive influence on Indigenous health.

  3. Twitter and the health reforms in the English National Health Service.

    Science.gov (United States)

    King, Dominic; Ramirez-Cano, Daniel; Greaves, Felix; Vlaev, Ivo; Beales, Steve; Darzi, Ara

    2013-05-01

    Social media (for example Facebook and YouTube) uses online and mobile technologies to allow individuals to participate in, comment on and create user-generated content. Twitter is a widely used social media platform that lets users post short publicly available text-based messages called tweets that other users can respond to. Alongside traditional media outlets, Twitter has been a focus for discussions about the controversial and radical reforms to the National Health Service (NHS) in England that were recently passed into law by the current coalition Government. Looking at over 120,000 tweets made about the health reforms, we have investigated whether any insights can be obtained about the role of Twitter in informing, debating and influencing opinion in a specific area of health policy. In particular we have looked at how the sentiment of tweets changed with the passage of the Health and Social Care Bill through Parliament, and how this compared to conventional opinion polls taken over the same time period. We examine which users appeared to have the most influence in the 'Twittersphere' and suggest how a widely used metric of academic impact - the H-index - could be applied to measure context-dependent influence on Twitter. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  4. Hospital Utilization and Universal Health Insurance Coverage: Evidence from the Massachusetts Health Care Reform Act.

    Science.gov (United States)

    Cseh, Attila; Koford, Brandon C; Phelps, Ryan T

    2015-12-01

    The Affordable Care Act is currently in the roll-out phase. To gauge the likely implications of the national policy we analyze how the Massachusetts Health Care Reform Act impacted various hospitalization outcomes in each of the 25 major diagnostic categories (MDC). We utilize a difference-in-difference approach to identify the impact of the Massachusetts reform on insurance coverage and patient outcomes. This identification is achieved using six years of data from the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project. We report MDC-specific estimates of the impact of the reform on insurance coverage and type as well as length of stay, number of diagnoses, and number of procedures. The requirement of universal insurance coverage increased the probability of being covered by insurance. This increase was in part a result of an increase in the probability of being covered by Medicaid. The percentage of admissions covered by private insurance fell. The number of diagnoses rose as a result of the law in the vast majority of diagnostic categories. Our results related to length of stay suggest that looking at aggregate results hides a wealth of information. The most disparate outcomes were pregnancy related. The length of stay for new-born babies and neonates rose dramatically. In aggregate, this increase serves to mute decreases across other diagnoses. Also, the number of procedures fell within the MDCs for pregnancy and child birth and that for new-born babies and neonates. The Massachusetts Health Care Reform appears to have been effective at increasing insurance take-up rates. These increases may have come at the cost of lower private insurance coverage. The number of diagnoses per admission was increased by the policy across nearly all MDCs. Understanding the changes in length of stay as a result of the Massachusetts reform, and perhaps the Affordable Care Act, requires MDC-specific analysis. It appears that the most important distinction

  5. The Anthropology of Science Education Reform: An Alabama Model for Building an Integrated Stakeholder Systems Approach

    Science.gov (United States)

    Denson, R. L.; Cox, G. N.

    2004-12-01

    Anthropologists are concerned with every aspect of the culture they are investigating. One of the five main branches of anthropology, socio-cultural anthropology, concerns itself with studying the relationship between behavior and culture. This paper explores the concept that changing the behavior of our culture - its beliefs and values - towards science is at the heart of science education reform. There are five institutions that socio-cultural anthropologists use to study the social organization of cultures: the educational system is only one of them. Its function - across all cultures - is to serve as a mechanism for implementing change in cultural beliefs and values. As leaders of science education reform, the Alabama model contends that we must stop the struggle with our purpose and get on with the business of leading culture change through an integrated stakeholder systems approach. This model stresses the need for the interaction of agencies other than education - including government, industry, the media and our health communities to operate in an integrated and systemic fashion to address the issues of living among a technically literate society. Twenty-five years of science education reform needs being voiced and programs being developed has not produced the desired results from within the educational system. This is too limited a focus to affect any real cultural change. It is when we acknowledge that students spend only an average of 12 percent of their life time in schools, that we can begin to ask ourselves what are our students learning the other 88 percent of their time - from their peers, their parents and the media - and what should we be doing to address this cultural crisis in these other arenas in addition to the educational system? The Alabama Math, Science and Technology Education Coalition (AMSTEC) is a non-profit 501c(3) organization operating in the state of Alabama to provide leadership in improving mathematics, science, and technology

  6. Health insurance reform and HMO penetration in the small group market.

    Science.gov (United States)

    Buchmueller, Thomas C; Liu, Su

    This study uses data from several national employer surveys conducted between the late 1980s and the mid-1990s to investigate the effect of state-level underwriting reforms on HMO penetration in the small group health insurance market. We identify reform effects by exploiting cross-state variation in the timing and content of reform legislation and by using mid-sized and large employers, which were not affected by the legislation, as within-state control groups. While it is difficult to disentangle the effect of state reforms from other factors affecting HMO penetration in the small group markets, the results suggest a positive relationship between insurance market regulations and HMO penetration.

  7. [Exploration of the oral health education experimental teaching for oral health education reform].

    Science.gov (United States)

    Jiang, Yingying; Hu, Wenting; Zhang, Juanjuan; Sun, Yan; Gao, Yuguang

    2014-04-01

    This study aimed to improve students' ability in practical and theoretical courses of oral health education and to promote students' learning interest and initiative. Fourth-year students of the oral medical profession from 2006 to 2008 at Weifang Medical University were chosen as research objects for oral health education to explore the experimental teaching reform. The students were divided into test and control groups, with the test group using the "speak out" way of teaching and the control group using the traditional teaching method. Results of after-class evaluation of the test group, as well as final examination and practice examination of the two groups, were analyzed and compared. After-class evaluation results of the test group showed that the "speak out" teaching method was recognized by the students and improved students' ability to understand oral health education. The final examination and practice examination results showed that the score of the test group was higher than that of the control group (P education, in accordance with the trend of teaching reform.

  8. "Sticker Shock" in Individual Insurance under Health Reform

    OpenAIRE

    Mark Pauly; Scott Harrington; Adam Leive

    2014-01-01

    This paper provides estimates of the changes in premiums, average or expected out of pocket payments, and the sum of premiums and out of pocket payments (total expected price) for a sample of consumers who bought individual insurance in 2010 to 2012, comparing total expected prices before the Affordable Care Act with estimates of total expected prices if they were to purchase silver or bronze coverage after reform, before the effects of any premium subsidies. We provide comparisons for purcha...

  9. Commentary: teaching health centers and the path to graduate medical education reform.

    Science.gov (United States)

    Rich, Eugene C

    2012-12-01

    The primary-care-oriented Teaching Health Center Graduate Medical Education (THCGME) program funded by the Patient Protection and Affordable Care Act of 2010 offers opportunities to explore alternative solutions to such graduate medical education (GME) policy issues as institutional indirect educational costs, variations in trainee-related productivity gains, and the program costs of GME innovations. THCGME reporting requirements may also provide data on the impact of various educational innovations on career choice and clinical care as well as other information that could be useful in devising a more transparent and equitable system of support for GME.THCGME program advocates should, however, be cautious in applying any lessons learned to broader GME policy reform. Unlike the THCGME funding, Medicare GME payments are part of the Medicare entitlement, tied to provision of clinical services and financed outside the annual congressional appropriations process. Pressure on domestic discretionary spending makes substantially expanded appropriations for the THCGME program an unlikely path for widespread reform. Absent secure "all-payer financing" of GME, residency program sponsors lack sufficient Medicare funds to cover all GME costs and must favor investments in specialties that meet local concerns, not long-term national workforce priorities. Nonetheless, the THCGME program provides an exciting opportunity to improve and to study primary care GME. Furthermore, the organizational infrastructures established, program leaders developed, data collected, and lessons learned from the program can inform more fundamental change in U.S. GME payment policy.

  10. The Public Pension System of Romania between Crisis and Reforms. The Case of Special Pensions System

    Directory of Open Access Journals (Sweden)

    Ingrid-Mihaela DRAGOTĂ

    2010-09-01

    Full Text Available The public pension systems have real difficulties, at the international level. The public authorities take different measures to reform the system, the multi-pillar system being considered as a “miraculous” solution. The incidence of the political factor is significant for the particular reforms and the social inequities will remain, no matter the specific efforts, as long as the interests of the financial institutions and the political factor stay strongly interconnected. Special pensions raise political and academic debates, mainly for the sums received by their beneficiaries. In this study we analyse the actual stage for the specific reforms and the degree of social inequity for the special pension case.

  11. Strategies for Increasing the Role of Family Medicine in Mexican Health Care Reform

    NARCIS (Netherlands)

    Aranda, J.M. Ramirez; Weel, C. van; Goodyear-Smith, F.

    2017-01-01

    There is little or no role for primary care and family medicine in current health reforms in Mexico. However, robust evidence shows that primary care helps prevent morbidity and mortality and increases health equity. Mexico has participated in several international meetings sponsored by the World

  12. Health Inequity and "Restoring Fairness" Through the Canadian Refugee Health Policy Reforms: A Literature Review.

    Science.gov (United States)

    Antonipillai, Valentina; Baumann, Andrea; Hunter, Andrea; Wahoush, Olive; O'Shea, Timothy

    2016-09-02

    Refugees and refugee claimants experience increased health needs upon arrival in Canada. The Federal Government funded the Interim Federal Health Program (IFHP) since 1957, ensuring comprehensive healthcare insurance for all refugees and refugee claimants seeking protection in Canada. Over the past 4 years, the Canadian government implemented restrictions to essential healthcare services through retrenchments to the IFHP. This paper will review the IFHP, in conjunction with other immigration policies, to explore the issues associated with providing inequitable access to healthcare for refugee populations. It will examine changes made to the IFHP in 2012 and in response to the federal court decision in 2014. Findings of the review indicate that the retrenchments to the 2012 IFHP instigated health outcome disparities, social exclusion and increased costs for vulnerable refugee populations. The 2014 reforms reinstated some services; however the policy continued to produce inequitable healthcare access for some refugees and refugee claimants.

  13. Romanian Health Care Reform in the Context of Economic Crisis

    Directory of Open Access Journals (Sweden)

    Victoria Gheonea

    2010-12-01

    Full Text Available The effects of financial crisis are strongly felt in Romania, which already face with asignificant slowdown in economic growth or even economic recession. The current and internationalsituation remains still difficult, and requires high budget constraints. Under these conditions, thehealth system in Romania has become one of the most inefficient in Europe, mainly characterized bylack of transparency in the allocation of funds and inefficiency in resource use. The lack of clear andcoherent criteria to evaluate the performance of health institutions results in a difficultimplementation of efficient managerial systems to reward the efficient manager.

  14. Need to reform education in graduate schools of public health in Japan: Toward outcome-based education to cultivate competencies.

    Science.gov (United States)

    Inoue, Mariko; Yano, Eiji

    2016-01-01

    Japan, known for its good healthcare access via universal health insurance, leads the world in terms of life expectancy, and possesses a public health system that has improved health standards markedly in the 20th century. However, we currently face major challenges to maintain and promote people's health. Although these complicated problems pose numerous threats to public welfare, education of public health for health professionals still retains 20th-century standards. This also means that graduate education of public health in Japan is traditionally based on obtaining licensure as a medical professional, conducting research and writing papers, and on-the-job training. Since graduate school education is expected to produce competent public health leaders, Japan requires a reform toward a new education design that caters to the current societal needs. The current global trend in the education of health professionals leans toward outcome-based education to meet core competencies. Here, "competency" refers to a set of features or particular behavioral patterns possessed by highly qualified persons. In 2006, the World Health Organization (WHO) established a general health professional competency standard that includes both management and leadership competencies. Moreover, the Lancet Commission concluded that there was a need for transformative education based on a "health system approach." In brief, this means that our education should correspond to the needs of the health system to allow for the resolution of problems by educated professionals with satisfactory levels of competencies. In addition, as "change agents," these competent professionals are expected to promote societal change toward the realization of better public health. In Japan, the Central Education Council has produced several reports on professional graduate school reform since 2000. These reports indicate that graduate school curricula require reform to allow the health professionals to work

  15. Temperature Control of Autothermal Reformer System with Coefficient Diagram Method

    Science.gov (United States)

    Srisiriwat, N.; Wutthithanyawat, C.

    2017-10-01

    The objective of this paper is to design the autothermal reformer (ATR) temperature control by using a coefficient diagram method (CDM). The adiabatic temperature is a main controlled variable of the ATR which is a combination of endothermic and exothermic reactions. The simulation results of control parameters were calculated to maintain the ATR reaction temperature by manipulating air feed flow rate. In this work, two strategies of ATR temperature controller system with and without the feed temperature control of a preheater unit are compared to investigate the appropriate controller system when the change of surrounding temperature is considered as a key disturbance. The results showed that by using the CDM, the stability and robustness for controlling the ATR temperature system were considered to offer the proper control parameters and the designed temperature control of ATR system gave a good performance to maintain the controlled variables and reject the disturbance. Moreover, the ATR control system design with the feed temperature controller can compensate the surrounding temperature better than that without the feed temperature control.

  16. The Effect of Massachusetts' Health Reform on Employer-Sponsored Insurance Premiums.

    Science.gov (United States)

    Cogan, John F; Hubbard, R Glenn; Kessler, Daniel

    2010-01-01

    In this paper, we use publicly available data from the Medical Expenditure Panel Survey - Insurance Component (MEPS-IC) to investigate the effect of Massachusetts' health reform plan on employer-sponsored insurance premiums. We tabulate premium growth for private-sector employers in Massachusetts and the United States as a whole for 2004 - 2008. We estimate the effect of the plan as the difference in premium growth between Massachusetts and the United States between 2006 and 2008-that is, before versus after the plan-over and above the difference in premium growth for 2004 to 2006. We find that health reform in Massachusetts increased single-coverage employer-sponsored insurance premiums by about 6 percent, or $262. Although our research design has important limitations, it does suggest that policy makers should be concerned about the consequences of health reform for the cost of private insurance.

  17. The Affordable Care Act: How Nixon's Health Reform Proposal Became Democrats' Albatross.

    Science.gov (United States)

    Woolhandler, Steffie; Himmelstein, David U

    2017-10-01

    President Obama's signature health care reform, the Affordable Care Act (ACA), was passed in 2010 and fully implemented in 2014. Two years later, Republicans' attacks on the ACA as a failed reform helped fuel their recent electoral victory. The legislation significantly expanded insurance coverage. But it was built on, and fortified, private health insurance firms, and it accelerated the corporate takeover of hospitals and physicians' practices. This obeisance to corporate interests precluded making coverage universal or care affordable. As a result, the reform failed to address the grave health care problems faced by most working- and middle-class Americans and left many of them feeling betrayed by Democrats who oversold the ACA's benefits.

  18. The 2010 U.S. health care reform: approaching and avoiding how other countries finance health care.

    Science.gov (United States)

    White, Joseph

    2013-07-01

    This article describes and analyzes the U.S. health care legislation of 2010 by asking how far it was designed to move the U.S. system in the direction of practices in all other rich democracies. The enacted U.S. reform could be described, extremely roughly, as Japanese pooling with Swiss and American problems at American prices. Its policies are distinctive, yet nevertheless somewhat similar to examples in other rich democracies, on two important dimensions: how risks are pooled and the amount of funds redistributed to subsidize care for people with lower incomes. Policies about compelling people to contribute to a finance system would be further from international norms, as would the degree to which coverage is set by clear and common substantive standards--that is, standardization of benefits. The reform would do least, however, to move the United States toward international practices for controlling spending. This in turn is a major reason why the results would include less standard benefits and incomplete coverage. In short, the United States would remain an outlier on coverage less because of a failure to make an effort to redistribute--a lack of solidarity--than due to a failure to control costs.

  19. Drivers of health reform in the United States: 2012 and beyond.

    Science.gov (United States)

    Lexa, Frank J

    2012-10-01

    American medicine has seen radical changes in the past decade. In particular, radiology has been affected, notably first with the passage of the Deficit Reduction Act in 2005 and then with the Patient Protection and Affordable Care Act in 2010. Health care reforms are not only driven by political agendas. This process is also a response to underlying social, economic, and technological realities. It is unlikely that reform efforts will just evaporate because of a single change in government or with a decision by the US Supreme Court. Regardless of who sits in the Oval Office and which party controls Congress, there are forces that will need to be addressed through policy changes in the coming years. The underlying drivers of health care reform are legion, but health care inflation, fiscal mismanagement by government, poor planning for demographic changes that affect entitlement programs, questions about the quality of health outcomes, and a desire for universal health care were all central factors in the reforms put forth since 2009. Radiologists should be preparing now for continued change in both the public and private sectors in health care for the foreseeable future. These changes are likely to have profound impacts on our profession. Radiologists and their groups should plan to pay greater attention to these events and should seek to have a much greater level of involvement in the political and social processes that lead to policy changes in health care. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  20. [Health-care reforms and insurees' preferences: a cluster analysis with data from the representative KBV survey 2010].

    Science.gov (United States)

    Schnitzer, S; Grittner, U; Balke, K; Kuhlmey, A

    2013-12-01

    This study examines insurees' knowledge of and attitudes towards a number of recent reforms of the German healthcare system (electronic health insurance card, reimbursement tariff, etc.). It further examines whether it is possible to identify groups of respondents with similar patterns of preferences and knowledge. The analysis draws on a representative survey conducted by the German National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV, 2010), in which 6 065 respondents aged between 18 and 79 years were interviewed. 4 groups of respondents can be distinguished: the "quality oriented," the "uninformed," the "internet savvy," and the "informed." The most striking finding is that members of the "uninformed" group, who knew the least about recent reforms, tended to be employed middle-aged men with a high level of formal education. To foster the successful implementation of reforms in the health-care system and their communication to specific target groups, it is recommended to take into account not only specific social determinants, but the full personal circumstances and situation of insurees. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Petro-state constraints on health policy: guidelines for workable reform in Venezuela.

    Science.gov (United States)

    Trujillo, Antonio J

    2004-01-01

    This article reviews the performance of the Venezuelan health care sector and suggests guidelines for workable health policy under difficult conditions. Two special circumstances constrain policy options. First, Venezuelans share a traditional value, solidarity, which includes a strong desire for equity. Reforms must comply with this norm to succeed. Second, foreign sales of state-controlled oil constitute the bulk of the government budget and the gross domestic product (GDP). Petroleum market fluctuations expose the country to extreme economic cycles. In response, policy making and stakeholders adopt a rentier attitude, focusing on preserving or enlarging entitlements to government oil monies. The side effects of this largesse include poor productivity, a weak private sector, a widespread sense of entitlement without accountability, and a crippled state which controls most of the available resources yet is unable to effectively tax, regulate, steer the economy, or pursue long-term policies. The health care sector shares these problems. As a result, Venezuela's health systems are fragmented, poorly coordinated, excessively centralized, inequitable, and ineffective. Policies to improve public health and public and private medical care must take into account these constraints.

  2. Changes in mortality after Massachusetts health care reform: a quasi-experimental study.

    Science.gov (United States)

    Sommers, Benjamin D; Long, Sharon K; Baicker, Katherine

    2014-05-06

    The Massachusetts 2006 health care reform has been called a model for the Affordable Care Act. The law attained near-universal insurance coverage and increased access to care. Its effect on population health is less clear. To determine whether the Massachusetts reform was associated with changes in all-cause mortality and mortality from causes amenable to health care. Comparison of mortality rates before and after reform in Massachusetts versus a control group with similar demographics and economic conditions. Changes in mortality rates for adults in Massachusetts counties from 2001 to 2005 (prereform) and 2007 to 2010 (postreform) were compared with changes in a propensity score-defined control group of counties in other states. Adults aged 20 to 64 years in Massachusetts and control group counties. Annual county-level all-cause mortality in age-, sex-, and race-specific cells (n = 146,825) from the Centers for Disease Control and Prevention's Compressed Mortality File. Secondary outcomes were deaths from causes amenable to health care, insurance coverage, access to care, and self-reported health. Reform in Massachusetts was associated with a significant decrease in all-cause mortality compared with the control group (-2.9%; P = 0.003, or an absolute decrease of 8.2 deaths per 100,000 adults). Deaths from causes amenable to health care also significantly decreased (-4.5%; P care, and self-reported health. The number needed to treat was approximately 830 adults gaining health insurance to prevent 1 death per year. Nonrandomized design subject to unmeasured confounders. Massachusetts results may not generalize to other states. Health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care. None.

  3. Columbia River Hatchery Reform System-Wide Report.

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Dan [Hatchery Scientific Review Group

    2009-04-16

    The US Congress funded the Puget Sound and Coastal Washington Hatchery Reform Project via annual appropriations to the US Fish and Wildlife Service (USFWS) beginning in fiscal year 2000. Congress established the project because it recognized that while hatcheries have a necessary role to play in meeting harvest and conservation goals for Pacific Northwest salmonids, the hatchery system was in need of comprehensive reform. Most hatcheries were producing fish for harvest primarily to mitigate for past habitat loss (rather than for conservation of at-risk populations) and were not taking into account the effects of their programs on naturally spawning populations. With numerous species listed as threatened or endangered under the Endangered Species Act (ESA), conservation of salmon in the Puget Sound area was a high priority. Genetic resources in the region were at risk and many hatchery programs as currently operated were contributing to those risks. Central to the project was the creation of a nine-member independent scientific review panel called the Hatchery Scientific Review Group (HSRG). The HSRG was charged by Congress with reviewing all state, tribal and federal hatchery programs in Puget Sound and Coastal Washington as part of a comprehensive hatchery reform effort to: conserve indigenous salmonid genetic resources; assist with the recovery of naturally spawning salmonid populations; provide sustainable fisheries; and improve the quality and cost-effectiveness of hatchery programs. The HSRG worked closely with the state, tribal and federal managers of the hatchery system, with facilitation provided by the non-profit organization Long Live the Kings and the law firm Gordon, Thomas, Honeywell, to successfully complete reviews of over 200 hatchery programs at more than 100 hatcheries across western Washington. That phase of the project culminated in 2004 with the publication of reports containing the HSRG's principles for hatchery reform and recommendations

  4. Nursing and health care reform: implications for curriculum development.

    Science.gov (United States)

    Bowen, M; Lyons, K J; Young, B E

    2000-01-01

    The health care system is undergoing profound changes. Cost containment efforts and restructuring have resulted in cutbacks in registered nurse (RN) positions. These changes are often related to the increased market penetration by managed care companies. To determine how RN graduates perceive these changes and their impact on the delivery of patient care, Healthcare Environment Surveys were mailed to graduates of the classes of 1986 and 1991. Using the Survey's 5-point Likert Scale, we measured the graduates' satisfaction with their salary, quality of supervision they received, opportunities for advancement, recognition for their job, working conditions, the overall job and the changes in their careers over the previous five year period. Our study suggests that the changes in the health care system are having an impact on how health care is being delivered and the way nurses view their jobs. Respondents reported that insurance companies are exerting increased control over patient care and perceive that the quality of patient care is declining. Increased workloads and an increase in the amount of paperwork were reported. Participants perceived that there were fewer jobs available and that job security was decreasing. The percentage of nurses who see job satisfaction as remaining the same or increasing are a majority. However, the relatively high percent of nurses who see job satisfaction as declining should provide a note of warning. The major implications of this study are that the professional nursing curriculum must be modified to include content on communication, organization, legislative/policy skills, and leadership. The nation's health care system is undergoing profound changes. There are numerous forces at work that are effecting the delivery of care and, consequently, the work of health professionals. These forces include significant efforts at cost containment, restructuring and downsizing of hospitals, and the movement of health care delivery out of acute

  5. Changes in the care of patients with cervical spine fractures following health reform in Massachusetts.

    Science.gov (United States)

    Schoenfeld, Andrew J; Wahlquist, Trevor C; Bono, Christopher M; Lehrich, Jessica L; Power, Robyn K; Harris, Mitchel B

    2015-08-01

    There is a substantial concern among spine surgeons that healthcare reform efforts will alter the processes through which spinal care is delivered and decrease overall quality. We used the Statewide Inpatient Dataset for Massachusetts to evaluate changes in hospital processes and quality of care for patients with cervical fractures following the implementation of health reform. This was a pre-post retrospective analysis of patients (n=9,387) treated for cervical fractures in Massachusetts between 2003-2006 and 2008-2010. Changes in hospital processes (surgical intervention, length of stay (LOS) and environment of care) and quality of care (mortality, complications, reoperation and failure to rescue (FTR)) were the outcomes of interest. FTR is a quality measure that evaluates a hospital's capacity to avoid mortality following the occurrence of a sentinel complication. Patients treated between 2003 and 2006 were considered the pre-reform group. The post-reform cohort consisted of those treated from 2008 to 2010. Baseline differences between cohorts were evaluated using chi-square or Mann-Whitney U tests. Unadjusted comparisons between the dependent variables and the onset of healthcare reform were performed, followed by regression techniques that adjusted for differences in case-mix and whether a surgical intervention was performed. Multivariable logistic regression was used for categorical variables and negative binomial regression was employed for continuous variables. The rates of surgical intervention remained unchanged pre- and post-reform (p=0.25). Hospital length of stay (RC: -0.18, 95% CI: -0.22, -0.14) and the FTR rate following surveillance insensitive complications (OR: 0.49, 95% CI: 0.25, 0.94) were significantly reduced following health reform. Post-reform, academic centers experienced a 22% reduction in mortality (95% CI: 0.61, 0.99) a 40% decrease in FTR (95% CI: 0.40, 0.89), a 30% decrease in surveillance insensitive complications (95% CI: 0.51, 0

  6. Governance structure reform and antibiotics prescription in community health centres in Shenzhen, China.

    Science.gov (United States)

    Liang, Xiaoyun; Xia, Tingsong; Zhang, Xiulan; Jin, Chenggang

    2014-06-01

    It is unclear whether changing the governance structure of community health centres (CHCs) could affect antibiotic prescribing behaviour. To explore how changes in governance structure affect antibiotic prescription for children younger than 5 years of age with acute upper respiratory tract infections (AURI) in CHCs in Shenzhen, China. This study used an interrupted time series design with a comparison series. On 1 June 2009, the Health Bureau of Shenzhen's Baoan District transferred CHCs from a hospital-affiliated model to a self-managed independent model regarding finance, personnel and employee compensation. We collected 23481 electronic medical records of children younger than 5 years of age who were treated for AURI on an outpatient basis 1 year before and 1 year after governance structure reform. We used segmented regression analysis to evaluate the effect of reform on antibiotic prescription. After the reform, the proportion of patients receiving an antibiotic injection per month and the proportion of patients receiving two or more antibiotics conditional on receiving an antibiotic per month decreased 9.17% and 7.34%, respectively (P governance structure reform can have positive effects on behaviour for antibiotic prescribing. Moreover, this short-term effect might have important implications for further community health reforms in China. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Modernising Education: New Public Management Reform in the Norwegian Education System

    Science.gov (United States)

    Møller, Jorunn; Skedsmo, Guri

    2013-01-01

    Since the end of the 1980s, the Norwegian education system has gone through major reform, influenced largely by new managerialist ideas. Strategies to renew the public sector were promoted as the new public management (NPM). This paper investigates the way ideas connected to NPM reforms have been introduced and interpreted in the Norwegian…

  8. Changing emphases in public health and medical education in health care reform.

    Science.gov (United States)

    Patrick, Walter K; Cadman, Edwin C

    2002-01-01

    Globalisation of economies, diseases and disasters with poverty, emerging infectious diseases, ageing and chronic conditions, violence and terrorism has begun to change the face of public health and medical education. Escalating costs of care and increasing poverty have brought urgency to professional training to improve efficiency, cut costs and maintain gains in life expectancy and morbidity reduction. Technology, genetics research and designer drugs have dramatically changed medical practice. Creatively, educational institutions have adopted the use of: (1) New educational and communication technologies: internet and health informatics; (2) Problem based learning approaches; Integrated Practice and Theory Curricula; Research and Problem Solving methodologies and (3) Partnership and networking of institutions to synergise new trends (e.g. core competencies). Less desirably, changes are inadequate in key areas, e.g., Health Economics, Poverty and Health Development, Disaster Management & Bioterrorism and Ethics. Institutions have begun to adjust and develop new programs of study to meet challenges of emerging diseases, design methodologies to better understand complex social and economic determinants of disease, assess the effects of violence and address cost containment strategies in health. Besides redesigning instruction, professional schools need to conduct research to assess the impact of health reform. Such studies will serve as sentinels for the public's health, and provide key indicators for improvements in training, service provision and policy.

  9. [Positioning Ecuador in the global health agenda as a result of sector reform].

    Science.gov (United States)

    Luna, Cristina; Emanuele, Carlos Andrés; Torre, Daniel De La

    2017-06-08

    Analyze strategies implemented by Ecuador's Ministry of Public Health (MPH) to position the country in the global health agenda during the period 2011-2015 as a result of health sector reform. Documentary review and interviews with stakeholders in national and international agencies with respect to positioning in the global health sphere during the study period. It was observed that the reform process produced a new framework to manage international health relations. The MPH implemented strategies and mechanisms to place national health priorities and interests on the global health agenda at bilateral, regional, and global levels. As a result, the country took a leadership role in certain processes and attained recognition at various international forums. The MPH reform process contributed to recognition and establishment of Ecuador's public policy priorities in the global health agenda through strategies such as giving importance to putting national priorities on the global health agenda, guiding the global health approach exercised by the highest health authority, developing technical capabilities and skills in the International Relations Office, and raising awareness in technical bodies.

  10. Modeling of Pem Fuel Cell Systems Including Controls and Reforming Effects for Hybrid Automotive Applications

    National Research Council Canada - National Science Library

    Boettner, Daisie

    2001-01-01

    .... This study develops models for a stand-alone Proton Exchange Membrane (PEM) fuel cell stack, a direct-hydrogen fuel cell system including auxiliaries, and a methanol reforming fuel cell system for integration into a vehicle performance simulator...

  11. Protecting patients with cardiovascular diseases from catastrophic health expenditure and impoverishment by health finance reform.

    Science.gov (United States)

    Sun, Jing; Liabsuetrakul, Tippawan; Fan, Yancun; McNeil, Edward

    2015-12-01

    To compare the incidences of catastrophic health expenditure (CHE) and impoverishment, the risk protection offered by two health financial reforms and to explore factors associated with CHE and impoverishment among patients with cardiovascular diseases (CVDs) in rural Inner Mongolia, China. Cross-sectional study conducted in 2014 in rural Inner Mongolia, China. Patients with CVDs aged over 18 years residing in the sample areas for at least one year were eligible. The definitions of CHE and impoverishment recommended by WHO were adopted. The protection of CHE and impoverishment was compared between the New Cooperative Medical Scheme (NCMS) alone and NCMS plus National Essential Medicines Scheme (NEMS) using the percentage change of incidences for CHE and impoverishment. Logistic regression was used to explore factors associated with CHE and impoverishment. The incidences of CHE and impoverishment under NCMS plus NEMS were 11.26% and 3.30%, respectively, which were lower than those under NCMS alone. The rates of protection were higher among households with patients with CVDs covered by NCMS plus NEMS (25.68% and 34.65%, respectively). NCMS plus NEMS could protect the poor households more from CHE but not impoverishment. NCMS plus NEMS protected more than one-fourth of households from CHE and more than one-third from impoverishment. NCMS plus NEMS was more effective at protecting households with patients with CVDs from CHE and impoverishment than NCMS alone. An integration of NCMS with NEMS should be expanded. However, further strategies to minimise catastrophic health expenditure after this health finance reform are still needed. © 2015 John Wiley & Sons Ltd.

  12. Seven Ethical Issues Affecting Neurosurgeons in the Context of Health Care Reform.

    Science.gov (United States)

    Dagi, T Forcht

    2017-04-01

    Ethical discussions around health care reform typically focus on problems of social justice and health care equity. This review, in contrast, focuses on ethical issues of particular importance to neurosurgeons, especially with respect to potential changes in the physician-patient relationship that may occur in the context of health care reform.The Patient Protection and Affordable Care Act (ACA) of 2010 (H.R. 3590) was not the first attempt at health care reform in the United States but it is the one currently in force. Its ambitions include universal access to health care, a focus on population health, payment reform, and cost control. Each of these aims is complicated by a number of ethical challenges, of which 7 stand out because of their potential influence on patient care: the accountability of physicians and surgeons to individual patients; the effects of financial incentives on clinical judgment; the definition and management of conflicting interests; the duty to preserve patient autonomy in the face of protocolized care; problems in information exchange and communication; issues related to electronic health records and data security; and the appropriate use of "Big Data."Systematic social and economic reforms inevitably raise ethical concerns. While the ACA may have driven these 7 to particular prominence, they are actually generic. Nevertheless, they are immediately relevant to the practice of neurosurgery and likely to reflect the realities the profession will be obliged to confront in the pursuit of more efficient and more effective health care. Copyright © 2017 by the Congress of Neurological Surgeons.

  13. [Strengthening of the steering role of health++ authorities in health care reforms].

    Science.gov (United States)

    Marín, J M

    2000-01-01

    Strengthening the ability of health authorities to provide leadership and guidance, now and in the future, is an important issue within the context of health sector reform. It means, among other things, redefining the role of health in light of leading social and economic trends seen in the world at the beginning of the 21st century, increasing participation in health by nongovernmental entities, moving toward participatory democracy in many countries, and modifying concepts of what is considered "public" and "private." Within this scenario, it is necessary to redirect the role of the health sector toward coordinating the mobilization of national resources, on a multisectoral scale, in order to improve equity and social well-being and to channel the limited available resources to the most disadvantaged groups in society. The liberalization of the production and distribution of health-related goods and services, including insurance, challenges the exercise of authority in the area of health. Furthermore, the formation of regional economic blocks and the enormous weight wielded by multinational companies in the areas of pharmaceuticals and other medical supplies and technologies are forcing the health sector to seek ways of harmonizing health legislation and international negotiations. According to many experts, all of these demands surpass the ability of Latin American ministries of health to effectively respond, given most countries' current organizational, legal, and political conditions and technical infrastructure. The countries of the Americas must make it a priority to strengthen their health officials' ability to provide leadership and guidance in order to meet present and future challenges.

  14. Mandates for Collaboration: Health Care and Child Welfare Policy and Practice Reforms Create the Platform for Improved Health for Children in Foster Care.

    Science.gov (United States)

    Zlotnik, Sarah; Wilson, Leigh; Scribano, Philip; Wood, Joanne N; Noonan, Kathleen

    2015-10-01

    Improving the health of children in foster care requires close collaboration between pediatrics and the child welfare system. Propelled by recent health care and child welfare policy reforms, there is a strong foundation for more accountable, collaborative models of care. Over the last 2 decades health care reforms have driven greater accountability in outcomes, access to care, and integrated services for children in foster care. Concurrently, changes in child welfare legislation have expanded the responsibility of child welfare agencies in ensuring child health. Bolstered by federal legislation, numerous jurisdictions are developing innovative cross-system workforce and payment strategies to improve health care delivery and health care outcomes for children in foster care, including: (1) hiring child welfare medical directors, (2) embedding nurses in child welfare agencies, (3) establishing specialized health care clinics, and (4) developing tailored child welfare managed care organizations. As pediatricians engage in cross-system efforts, they should keep in mind the following common elements to enhance their impact: embed staff with health expertise within child welfare settings, identify long-term sustainable funding mechanisms, and implement models for effective information sharing. Now is an opportune time for pediatricians to help strengthen health care provision for children involved with child welfare. Copyright © 2015. Published by Elsevier Inc.

  15. Increased use of the emergency department after health care reform in Massachusetts.

    Science.gov (United States)

    Smulowitz, Peter B; O'Malley, James; Yang, Xiaowen; Landon, Bruce E

    2014-08-01

    With implementation of the Patient Protection and Affordable Care Act, 30 million individuals are predicted to gain access to health insurance. The experience in Massachusetts, which implemented a similar reform beginning in 2006, should provide important lessons about the effect of health care reform on emergency department (ED) utilization. Our objective is to understand the extent to which Massachusetts health care reform was associated with changes in ED utilization. We compared changes in ED utilization at the population level for individuals from areas of the state that were affected minimally by health care reform with those from areas that were affected the most, as well as for those younger than 65 years and aged 65 years or older. We used a difference-in-differences identification strategy to compare rates of ED visits in the prereform period, during the reform, and in the postreform period. Because we did not have population-level data on insurance status, we estimated area-level insurance rates by using the percentage of actual visits made during each period by individuals with insurance. We studied 13.3 million ED visits during 2004 to 2009. Increasing insurance coverage in Massachusetts was associated with increasing use of the ED; these results were consistent across all specifications, including the younger than 65 years versus aged 65 years or older comparison. Depending on the model used, the implementation of health care reform was estimated to result in an increase in ED visits per year of between 0.2% and 1.2% within reform and 0.2% and 2.2% postreform compared with the prereform period. The implementation of health care reform in Massachusetts was associated with a small but consistent increase in the use of the ED across the state. Whether this was due to the elimination of financial barriers to seeking care in the ED, a persistent shortage in access to primary care for those with insurance, or some other cause is not entirely clear and will

  16. Systems Thinking and the Leadership Conundrum in Health Care

    Science.gov (United States)

    Marchildon, Gregory P.; Fletcher, Amber J.

    2016-01-01

    The ability to think in terms of a system is critical to achieving common direction, alignment, and commitment in highly distributed health systems. In Canada, provincial and territorial ministries of health provide leadership on the direction of health reform while leadership to align system levels is determined by a far more distributed group of…

  17. Evidence on equity, governance and financing after health care reform in Mexico: lessons for Latin American countries

    Directory of Open Access Journals (Sweden)

    Armando Arredondo

    2015-06-01

    Full Text Available This article includes evidence on equity, governance and health financing outcomes of the Mexican health system. An evaluative research with a cross-sectional design was oriented towards the qualitative and quantitative analysis of financing, governance and equity indicators. Taking into account feasibility, as well as political and technical criteria, seven Mexican states were selected as study populations and an evaluative research was conducted during 2002-2010. The data collection techniques were based on in-depth interviews with key personnel (providers, users and community leaders, consensus technique and document analysis. The qualitative analysis was done with ATLAS TI and POLICY MAKER softwares. The Mexican health system reform has modified dependence at the central level; there is a new equity equation for resources allocation, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. Inequality on resources allocation in some regions and catastrophic expenditure for users is unequal in all states, producing more negative effects on states with high social marginalization. Special emphasis is placed on the analysis of the main strengths and weaknesses, as relevant evidences for other Latin American countries which are designing, implementing and evaluating reform strategies in order to achieve equity, good governance and a greater financial protection in health.

  18. Reform of Rural Land System from the Perspective of New Urbanization

    OpenAIRE

    ZHANG, Jue; YU, Zhongxiang

    2015-01-01

    In view of artificially high urbanization rate of China and possible causes, survey and data analysis methods were used to discuss reform of household registration system, and path for promoting rural land system reform. Results show that it is required to eliminate bottlenecks of land system in the advance of new urbanization process. In line with land system bottlenecks of new urbanization, it is recommended to take following measures. (i) Promoting land right confirmation centered land sys...

  19. Does Health Reform Change Femoral Neck Fracture Care? A Natural Experiment in the State of Massachusetts.

    Science.gov (United States)

    Schoenfeld, Andrew J; Weaver, Michael J; Power, Robyn K; Harris, Mitchel B

    2015-11-01

    To determine whether hospital processes and hospital quality associated with the care of femoral neck fractures were significantly altered by the implementation of healthcare reform in Massachusetts. Pre-post retrospective study. Massachusetts Statewide Inpatient Dataset (SID). Patients treated for femoral neck fracture (n = 23,485) in the periods prehealth (2003-06) and posthealth reform (2008-10). Differences in hospital processes for fracture care and quality measures were assessed for the periods before and after health reform. Differences in hospital processes for fracture care (type of surgical intervention, length of stay, and discharge disposition) and quality metrics [mortality, complications, re-operation, and failure to rescue (FTR)] in the periods before and after health reform were assessed using regression techniques to adjust for differences in case mix and the type of surgical intervention. There were no significant differences in the type of surgical intervention performed prereform and postreform (P = 0.27). After adjustment for case mix and surgical intervention, length of stay was significantly reduced {regression coefficient -0.07 [95% confidence interval (CI), -0.09 to -0.06]} as were the odds of FTR [odds ratio 0.73 (95% CI, 0.59-0.92)]. Discharges to skilled nursing facilities significantly increased in the postreform period [relative risk ratio 1.15 (95% CI, 1.03-1.30)]. Findings associated with FTR were driven by changes in the detection of surveillance sensitive complications. Health reform in Massachusetts led to no clinically meaningful differences in hospital processes for femoral neck fracture care. Although some differences in quality measures were noted, these cannot necessarily be attributed to health care reform.

  20. The Affordable Care Act, health care reform, prescription drug formularies and utilization management tools.

    Science.gov (United States)

    Ung, Brian L; Mullins, C Daniel

    2015-01-01

    The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. American Heart Association's Call to Action for Payment and Delivery System Reform.

    Science.gov (United States)

    Bufalino, Vincent J; Berkowitz, Scott A; Gardner, Timothy J; Piña, Ileana L; Konig, Madeleine

    2017-08-15

    The healthcare system is undergoing a transition from paying for volume to paying for value. Clinicians, as well as public and private payers, are beginning to implement alternative delivery and payment models, such as the patient-centered medical home, accountable care organizations, and bundled payment arrangements. Implementation of these new models will necessitate delivery system transformation and will actively involve all fields of medical care, in particular medicine and surgery. This call to action, on behalf of the American Heart Association's Expert Panel on Payment and Delivery System Reform, serves to offer support and direction for further involvement by the American Heart Association. In doing so, it (1) provides baseline review and definition of the present models and some of the early results of these delivery models, including outcomes; (2) initiates a conversation within the American Heart Association on the impact of payment and delivery system reform, as well as how the American Heart Association should engage in the interest of patients; (3) issues a call to action to our organization and to cardiovascular and stroke health professionals across the country to become educated about these models so to as to understand their impact on patient care; and (4) asks the government and other funding agencies, including the American Heart Association, to begin supporting and prioritizing meaningful research endeavors to further evaluate these models. © 2017 American Heart Association, Inc.

  2. Efficiency performance of China's health care delivery system.

    Science.gov (United States)

    Zhang, Luyu; Cheng, Gang; Song, Suhang; Yuan, Beibei; Zhu, Weiming; He, Li; Ma, Xiaochen; Meng, Qingyue

    2017-07-01

    Improving efficiency performance of the health care delivery system has been on the agenda for the health system reform that China initiated in 2009. This study examines the changes in efficiency performance and determinants of efficiency after the reform to provide evidence to assess the progress of the reform from the perspective of efficiency. Descriptive analysis, Data Envelopment Analysis, the Malmquist Index, and multilevel regressions are used with data from multiple sources, including the World Bank, the China Health Statistical Yearbook, and routine reports. The results indicate that over the last decade, health outcomes compared with health investment were relatively higher in China than in most other countries worldwide, and the trend was stable. The overall efficiency and total factor productivity increased after the reform, indicating that the reform was likely to have had a positive impact on the efficiency performance of the health care delivery system. However, the health care delivery structure showed low system efficiency, mainly attributed to the weakened primary health care system. Strengthening the primary health care system is central to enhancing the future performance of China's health care delivery system. Copyright © 2017 John Wiley & Sons, Ltd.

  3. Capitation and integrated health care systems.

    Science.gov (United States)

    Rice, J A; Isakova, L; Zelckovich, R; Frid, E

    1996-01-01

    Integrated health care systems: a concept being discussed throughout Russia and the world. A concept with three different applications and a confusing interaction with the concept of "capitation payments." The health reform debate in Russia and the NIS can only advance if greater clarity is found for these concepts, and if medical leaders are prepared for the substantial changes in provider behavior that are required with integrated health care systems fueled by capitation payments. This article explores the twin concepts of capitation and integrated health care systems, and then the leadership challenges for Russian health sector managers as they prepare for these challenges of the twenty-first century.

  4. Rates of insurance for injured patients before and after health care reform in Massachusetts: a possible case of double jeopardy.

    Science.gov (United States)

    Santry, Heena P; Collins, Courtney E; Wiseman, Jason T; Psoinos, Charles M; Flahive, Julie M; Kiefe, Catarina I

    2014-06-01

    We determined how preinjury insurance status and injury-related outcomes among able-bodied, community-dwelling adults treated at a Level I Trauma Center in central Massachusetts changed after health care reform. We compared insurance status at time of injury among non-Medicare-eligible adult Massachusetts residents before (2004-2005) and after (2009-2010) health care reform, adjusted for demographic and injury covariates, and modeled associations between insurance status and trauma outcomes. Among 2148 patients before health care reform and 2477 patients after health care reform, insurance rates increased from 77% to 84% (P health care reform but remained lower than in the general population. Certain Americans may be in "double jeopardy" of both higher injury incidence and worse outcomes because socioeconomic factors placing them at risk for injury also present barriers to compliance with an individual insurance mandate.

  5. United Kingdom (Northern Ireland): Health system review.

    Science.gov (United States)

    O'Neill, Ciaran; McGregor, Pat; Merkur, Sherry

    2012-01-01

    The political context within which Northern Irelands integrated health and social care system operates has changed since the establishment of a devolved administration (the Northern Ireland Assembly, set up in 1998 but suspended between 2002 and 2007). A locally elected Health Minister now leads the publicly financed system and has considerable power to set policy and, in principle, to determine the operation of other health and social care bodies. The system underwent major reform following the passing of the Health and Social Care (Reform) Act (Northern Ireland) in 2009. The reform maintained the quasi purchaser provider split already in place but reduced the number and increased the size of many of the bodies involved in purchasing (known locally as commissioning) and delivering services. Government policy has generally placed greater emphasis on consultation and cooperation among health and social care bodies (including the department, commissioners and care providers) than on competition. The small size of the population (1.8 million) and Northern Irelands geographical isolation from the rest of the United Kingdom provide a rationale for eschewing a more competitive model. Without competition, effective control over the system requires information and transparency to ensure provider challenge, and a body outside the system to hold it to account. The restoration of the locally elected Assembly in 2007 has created such a body, but it remains to be seen how effectively it will exercise accountability. World Health Organization 2012 (acting as the host organization for, and secretariat of, the European Observatory on health systems and Policies).

  6. Methanol steam reforming in a fuel cell drive system

    Science.gov (United States)

    Wiese, W.; Emonts, B.; Peters, R.

    Within the framework of the Joule III project a compact methanol reformer (CMR) with a specific weight of 2 kg/kW (lower heating value of H 2) was developed. This CMR contains a methanol and water vaporizer, a steam reformer, a heat carrier circuit and a catalytic burner unit. A laboratory fixed-bed reactor consisting of four tubes which could be filled with different amounts of catalyst was used to investigate the catalyst performance and the ageing behaviour. A hydrogen yield of 10 m N3/(h l Cat) can be achieved at 280°C. In this case, the methanol conversion rate is 95% and the dry product gas contains 0.9% CO. A linear decrease of the catalyst activity was observed which can be described by a loss of active catalyst mass of 5.5 mg/h. The catalyst was operated for more than 1000 h without having exhibited activity losses that made a catalyst change necessary. Besides, the stationary behaviour of the reforming reactor, the dynamic behaviour was studied. The time needed for start-up procedures has to be improved for reformers of a next generation. Moreover, the hydrogen production during reformer load changes will be discussed. Simulations of the power train in driving cycles show the different states of a reformer during dynamic operation.

  7. Gas composition modeling in a reformed Methanol Fuel Cell system using adaptive Neuro-Fuzzy Inference Systems

    DEFF Research Database (Denmark)

    Justesen, Kristian Kjær; Andreasen, Søren Juhl; Shaker, Hamid Reza

    2013-01-01

    This work presents a method for modeling the gas composition in a Reformed Methanol Fuel Cell system. The method is based on Adaptive Neuro-Fuzzy-Inference-Systems which are trained on experimental data. The developed models are of the H2, CO2, CO and CH3OH mass flows of the reformed gas. The ANFIS...

  8. The challenges of change management in Aboriginal community-controlled health organisations. Are there learnings for Cape York health reform?

    Science.gov (United States)

    Coombe, Leanne L

    2008-11-01

    The health status of Aboriginal and Torres Strait Islander peoples continues to be significantly poorer than Australia's general population. Clearly there is a need for change, hence the renewed interest in transitioning to a community control model for health services as a health intervention. Yet this requires a significant change management process, which is a process developed using Western business philosophies, and may not be applicable for community-controlled services that need to operate within the Aboriginal cultural domain. This paper examines the literature on organisational change management processes, and features of Aboriginal community-controlled health organisations and Aboriginal management styles. It identifies challenges and synergies that can be used to inform more effective transition processes to a community-control model for health services. The findings also highlight the need for a fundamental systems change approach to achieve such major reform agendas through the creation of a "collective responsibility" to achieve the vision for change, utilising participatory change management processes both internally and externally.

  9. What Does Health Care Reform Mean to Children with Special Needs and Their Families?

    Science.gov (United States)

    Minoux, Ankeny

    2010-01-01

    After the passage of the Patient Protection and Affordable Care Act, thousands of families across the U.S. breathed a sigh of relief at the White House's reassurance: "Reform will eliminate health insurance discrimination against people with disabilities." However, the actual language of the law and the proposed implementation timeline of the…

  10. Reforms to Limit Increases in Health Care Expenditures, With Special Attention to the Netherlands

    NARCIS (Netherlands)

    Gradus, R.H.J.M.

    2012-01-01

    In Europe, an ageing population and technological innovation are the most significant drivers behind public health care expenditure increases. Several reforms are needed in order to limit these increases. International research has shown that market mechanisms and better public management have the

  11. Health Reform in Minnesota: An Analysis of Complementary Initiatives Implementing Electronic Health Record Technology and Care Coordination.

    Science.gov (United States)

    Soderberg, Karen; Rajamani, Sripriya; Wholey, Douglas; LaVenture, Martin

    2016-01-01

    Minnesota enacted legislation in 2007 that requires all health care providers in the state to implement an interoperable electronic health record (EHR) system by 2015. 100% of hospitals and 98% of clinics had adopted EHR systems by end of 2015. Minnesota's 2008 health reform included a health care home (HCH) program, Minnesota's patient centered medical home. By end of 2014, 43% of HCH eligible clinics were certified with 335 certified HCHs and 430 eligible but not certified clinics. To study the association between adoption and use of EHRs in primary care clinics and HCH certification, including use of clinical decision support tools, patient registries, electronic exchange of patient information, and availability of patient portals. Study utilized data from the 2015 Minnesota Health Information Technology Clinic Survey conducted annually by the Minnesota Department of Health. The response rate was 80% with 1,181 of 1,473 Minnesota clinics, including 662 HCH eligible primary care clinics. The comparative analysis focused on certified HCHs (311) and eligible but not certified clinics (351). HCH clinics utilized the various tools of EHR technology at a higher rate than non-HCH clinics. This greater utilization was noted across a range of functionalities: clinical decision support, patient disease registries, EHR to support quality improvement, electronic exchange of summary care records and availability of patient portals. HCH certification was significant for clinical decision support tools, registries and quality improvement. HCH requirements of care management, care coordination and quality improvement can be better supported with EHR technology, which underscores the higher rate of utilization of EHR tools by HCH clinics. Optimizing electronic exchange of health information remains a challenge for all clinics, including HCH certified clinics. This research presents the synergy between complementary initiatives supporting EHR adoption and HCH certification

  12. Child Mortality under Chinese Reforms

    OpenAIRE

    Christopher GRIGORIOU; Patrick GUILLAUMONT

    2004-01-01

    This paper looks for the impact of the Chinese economic reforms on its health performance. From an appropriate health outcomes indicator, it appears that while still being one of the most performing countries, China’s relative advance decreased during the reforms. Consistent with the fact that the health system had to rely more and more on private expenditures, we find an increasing impact of income on infant survival. We also show that relative prices matter for infant survival: for a given ...

  13. Methanol Reformer System Modeling and Control using an Adaptive Neuro-Fuzzy Inference System approach

    DEFF Research Database (Denmark)

    Justesen, Kristian Kjær; Ehmsen, Mikkel Præstholm; Andersen, John

    2012-01-01

    This work presents the experimental study and modelling of a methanol reformer system for a high temperature polymer electrolyte membrane (HTPEM) fuel cell stack. The analyzed system is a fully integrated HTPEM fuel cell system with a DC/DC control output able to be used as e.g. a mobile battery...... charger. The advantages of using a HTPEM methanol reformer is that the high quality waste heat can be used as a system heat input to heat and evaporate the input methanol/water mixture which afterwards is catalytically converted into a hydrogen rich gas usable in the high CO tolerant HTPEM fuel cells....... Creating a fuel cell system able to use a well known and easily distributable liquid fuel such as methanol is a good choice in some applications such as range extenders for electric vehicles as an alternative to compressed hydrogen. This work presents a control strategy called Current Correction...

  14. Sri Lanka : Achieving Pro-Poor Universal Health Coverage without Health Financing Reforms

    OpenAIRE

    Smith, Owen

    2018-01-01

    Sri Lanka’s health system has a long track record of strong performance. This case study describes the main features and achievements of Sri Lanka’s high-performing health system, to distill lessons for the rest of the world. UNICO case studies focus on a particular health coverage program. In Sri Lanka, the selected health coverage program is the government’s national health service (NHS)...

  15. Impact of Massachusetts Health Reform on Enrollment Length and Health Care Utilization in the Unsubsidized Individual Market.

    Science.gov (United States)

    Garabedian, Laura F; Ross-Degnan, Dennis; Soumerai, Stephen B; Choudhry, Niteesh K; Brown, Jeffrey S

    2017-06-01

    To evaluate the impact of the 2006 Massachusetts health reform, the model for the Affordable Care Act, on short-term enrollment and utilization in the unsubsidized individual health insurance market. Seven years of administrative and claims data from Harvard Pilgrim Health Care. We employed pre-post survival analysis and an interrupted time series design to examine changes in enrollment length, utilization patterns, and use of elective procedures (discretionary inpatient surgeries and infertility treatment) among nonelderly adult enrollees before (n = 6,912) and after (n = 29,207) the MA reform. The probability of short-term enrollment dropped immediately after the reform. Rates of inpatient encounters (HR = 0.83, 95 percent CI: 0.74, 0.93), emergency department encounters (HR = 0.85, 95 percent CI: 0.80, 0.91), and discretionary inpatient surgeries (HR = 0.66 95 percent CI: 0.45, 0.97) were lower in the postreform period, whereas the rate of ambulatory visits was somewhat higher (HR = 1.04, 95 percent CI: 1.00, 1.07). The rate of infertility treatment was higher after the reform (HR = 1.61, 95 percent CI: 1.33, 1.97), driven by women in individual (vs. family) plans. The reform was not associated with increased utilization among short-term enrollees. MA health reform was associated with a decrease in short-term enrollment and changes in utilization patterns indicative of reduced adverse selection in the unsubsidized individual market. Adverse selection may be a problem for specific, high-cost treatments. © Health Research and Educational Trust.

  16. Abortion law reform in Nepal: women's right to life and health.

    Science.gov (United States)

    Shakya, Ganga; Kishore, Sabitri; Bird, Cherry; Barak, Jennifer

    2004-11-01

    In Nepal, the effects of the low social status of women and lack of access to health care and family planning have resulted in a maternal mortality ratio that is among the highest in South Asia. By the mid-1990s, the contribution of unsafe abortions to maternal deaths and morbidity was acknowledged by key individuals in the Ministry of Health and Department of Health Services. Advocacy for abortion law reform over several decades culminated in the passage of a new law on abortion in 2002. The parliamentary process took almost four years from the tabling of the bill. Almost two years elapsed between the passage of the bill and approval of the Procedural Order for implementing it This paper describes the development of policy and programme strategies for implementing the new law, led by the government in collaboration with NGOs, donors and other stakeholders. During that time, documents required for implementation were prepared, training of service providers was begun and a model service delivery and training site was established in Kathmandu Maternity Hospital. Simple systems to enable rapid expansion of services and a women-friendly approach were devised, promoting universal availability of affordable services provided by physicians and eventually nurses, the latter particularly in remote and rural areas, where 88% of the population live.

  17. Implementing the Affordable Care Act: state action to reform the individual health insurance market.

    Science.gov (United States)

    Giovannelli, Justin; Lucia, Kevin W; Corlette, Sabrina

    2014-07-01

    The Affordable Care Act contains numerous consumer protections designed to remedy shortcomings in the availability, affordability, adequacy, and transparency of individual market insurance. However, because states remain the primary regulators of health insurance and have considerable flexibility over implementation of the law, consumers are likely to experience some of the new protections differently, depending on where they live. This brief explores how federal reforms are shaping standards for individual insurance and exam­ines specific areas in which states have flexibility when implementing the new protections. We find that consumers nationwide will enjoy improved protections in each area targeted by the reforms. Further, some states already have embraced the opportunity to customize their markets by implementing consumer protec­tions that exceed minimum federal requirements. States likely will continue to adjust their market rules as policymakers gain a greater understanding of how reform is working for consumers.

  18. Biopsychosocial law, health care reform, and the control of medical inflation in Colorado.

    Science.gov (United States)

    Bruns, Daniel; Mueller, Kathryn; Warren, Pamela A

    2012-05-01

    A noteworthy attempt at health care reform was the 1992 Colorado workers' compensation reform bill, which led to the creation of what has been called "biopsychosocial laws." These laws mandated the use of treatment guidelines for patients with injury or chronic pain, which advocated a biopsychosocial model of rehabilitation, and aspired to use a "best practice" approach to controlling costs. The purpose of this study was to examine the financial impact of this health care reform process, and to test the hypothesis that this approach can be an effective strategy to contain costs while providing good care. This study utilized a dataset collected prospectively from 1992 to 2007 in 45 U.S. states for regulatory purposes. These data summarized the medical treatment and disability costs of 520,314 injured workers in Colorado, and an estimated 28.6 million injured workers nationally. As no other state passed a comparable bill, the Colorado worker compensation reform bill created a natural experiment, where a treatment group was created by legally enforceable medical treatment guidelines. In the 15 years following the implementation of the reform, the inflation of medical costs in Colorado workers' compensation was only one third that of the national average, saving an estimated $859 million on patients injured in 2007 alone. Although there were confounding variables, and causality could not be determined, these data are consistent with the hypothesis that Colorado's 1992 legislative efforts to reform workers compensation law using the biopsychosocial model worked as intended to provide good care while controlling costs. PsycINFO Database Record (c) 2012 APA, all rights reserved.

  19. HEALTH SYSTEMS

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

    According to United Nations' esti- mates, in 2010, some 800 women died every day from complications of pregnancy or childbirth, 99% of them in developing countries. Some 7.6 mil- lion children died before the age of five. While these numbers are high, they do reflect considerable gains for maternal and child health since ...

  20. Medical Malpractice Reform and Employer‐Sponsored Health Insurance Premiums

    National Research Council Canada - National Science Library

    Morrisey, Michael A; Kilgore, Meredith L; Nelson, Leonard (Jack)

    2008-01-01

    ...‐sponsored health insurance. Data Sources/Study Setting. Employer premium data and plan/establishment characteristics were obtained from the 1999 through 2004 Kaiser/HRET Employer Health Insurance Surveys...

  1. Lower Costs, Better Care- Reforming Our Health Care Delivery

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly...

  2. A solar assisted polygeneration system integrating methane reforming and chemical looping combustion with zero carbon emission

    National Research Council Canada - National Science Library

    WANG, Jiangjiang; FU, Chao

    2017-01-01

    .... This paper combines chemical-looping combustion (CLC) and methane reforming with CO2 to accomplish CO2 capture and utilization and proposes a novel polygeneration system to produce syngas, electricity, chilled water for cooling, and hot water...

  3. Health Care Access among Latinos: Implications for Social and Health Care Reforms

    Science.gov (United States)

    Perez-Escamilla, Rafael

    2010-01-01

    According to the Institute of Medicine, health care access is defined as "the degree to which people are able to obtain appropriate care from the health care system in a timely manner." Two key components of health care access are medical insurance and having access to a usual source of health care. Recent national data show that 34% of Latino…

  4. [Bavarian mental health reform 1851. An instrument of administrative modernization].

    Science.gov (United States)

    Burgmair, Wolfgang; Weber, Matthias M

    2008-01-01

    By 1850 the reformation of institutional psychiatric care in Bavaria was given the highest priority by monarchy and administration. Cooperating with experts, especially the psychiatrist Karl August von Solbrig, they provided for new asylums to be established throughout Bavaria in a surprisingly short period of time. It was, however, only at personal intervention of King Max II. that the administrative and financial difficulties which had existed since the beginning of the 19th century could be overcome. The planning of asylums done by each administrative district of Bavaria vividly reflects rivalry as well as cooperation between all governmental and professional agencies involved. Modernization of psychiatry was publicly justified by referring to scientism, the need for a more progressive restructuring of administration, and the paternalistic care of the monarchy, whereas, from an administrative point of view, aspects of psychiatric treatment, like what kind of asylum would be best, were rather insignificant. The structures established by means of the alliance between state administration and psychiatric care under the rule of King Max II. had a lasting effect on the further development of Bavaria.

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

    Directory of Open Access Journals (Sweden)

    Niculescu Oana Marilena

    2011-07-01

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

  6. Sexual and reproductive health and rights in changing health systems.

    Science.gov (United States)

    Sen, Gita; Govender, Veloshnee

    2015-01-01

    Sexual and reproductive health and rights (SRHR) are centrally important to health. However, there have been significant shortcomings in implementing SRHR to date. In the context of health systems reform and universal health coverage/care (UHC), this paper explores the following questions. What do these changes in health systems thinking mean for SRHR and gender equity in health in the context of renewed calls for increased investments in the health of women and girls? Can SRHR be integrated usefully into the call for UHC, and if so how? Can health systems reforms address the continuing sexual and reproductive ill health and violations of sexual and reproductive rights (SRR)? Conversely, can the attention to individual human rights that is intrinsic to the SRHR agenda and its continuing concerns about equality, quality and accountability provide impetus for strengthening the health system? The paper argues that achieving equity on the UHC path will require a combination of system improvements and services that benefit all, together with special attention to those whose needs are great and who are likely to fall behind in the politics of choice and voice (i.e., progressive universalism paying particular attention to gender inequalities).

  7. Judicial Reform of the 1864 as a Stage of Russian Judicial System Democratic Development

    Directory of Open Access Journals (Sweden)

    Lyubov F. Miloserdova

    2014-03-01

    Full Text Available In the present article, author considers the place of judicial reform of 1864 in the public and social reforms of Alexander II. This paper attempts to show the place of justice in the legal system of Russian Empire in the post-reform period. Author emphasizes democratic and progressive nature of judicial reform of 1864, noting lack of preconditions for the formation of democratic judicial system under the autocracy. Author analyzes relationship and development of the judicial system and the dynamics of social relations. Author also revealed the way of judicial system in the formation of civil society prerequisites. This paper attempts to show and prove that judicial reform is actually a first step towards the formation of the Russian system of powers separation. Author concludes that undertaken by the Government of Russian Empire in the mid-nineteenth century attempt of the Russian Empire judicial system democratization had neither political nor social assumptions. In conclusion, author concludes that in the present conditions of judicial system democratization in modern Russian Federation a number of principles and institutions of judicial reform of 1864 was applied.

  8. Reforming Technologies to Improve the Performance of Combustion Systems

    Directory of Open Access Journals (Sweden)

    Hashim Hassan

    2014-09-01

    Full Text Available A large number of theoretical and experimental studies have shown that the performance of kerosene combustion increases significantly if combustion is being assisted by the addition of hydrogen to the fuel/air mixture during the combustion process. It reduces the amount of CO, CO2 and NOx emissions, while increasing the flame stability limits. It also helps in bruning fuel/air mixtures at much leaner equivalence ratios. The same principle could be applied to gain benefits in gas turbine combustors. Hydrogen for this purpose could be produced by the reforming of hydrocarbon fuels using a reformer module. This paper presents key hydrogen reforming technologies which, by implementation in gas turbine combustors, hold potential for improving both their performance and service life.

  9. Design and Operation of the Synthesis Gas Generator System for Reformed Propane and Glycerin Combustion

    Science.gov (United States)

    Pickett, Derek Kyle

    Due to an increased interest in sustainable energy, biodiesel has become much more widely used in the last several years. Glycerin, one major waste component in biodiesel production, can be converted into a hydrogen rich synthesis gas to be used in an engine generator to recover energy from the biodiesel production process. This thesis contains information detailing the production, testing, and analysis of a unique synthesis generator rig at the University of Kansas. Chapter 2 gives a complete background of all major components, as well as how they are operated. In addition to component descriptions, methods for operating the system on pure propane, reformed propane, reformed glycerin along with the methodology of data acquisition is described. This chapter will serve as a complete operating manual for future students to continue research on the project. Chapter 3 details the literature review that was completed to better understand fuel reforming of propane and glycerin. This chapter also describes the numerical model produced to estimate the species produced during reformation activities. The model was applied to propane reformation in a proof of concept and calibration test before moving to glycerin reformation and its subsequent combustion. Chapter 4 first describes the efforts to apply the numerical model to glycerin using the calibration tools from propane reformation. It then discusses catalytic material preparation and glycerin reformation tests. Gas chromatography analysis of the reformer effluent was completed to compare to theoretical values from