WorldWideScience

Sample records for public health reforms

  1. Community health events for enrolling uninsured into public health insurance programs: implications for health reform.

    Science.gov (United States)

    Cheng, Scott; Tsai, Kai-ya; Nascimento, Lori M; Cousineau, Michael R

    2014-01-01

    To determine whether enrollment events may serve as a venue to identify eligible individuals, enroll them into health insurance programs, and educate them about the changes the Patient Protection and Affordable Care Act will bring about. More than 2900 surveys were administered to attendees of 7 public health insurance enrollment events in California. Surveys were used to identify whether participants had any change in understanding of health reform after participating in the event. More than half of attendees at nearly all events had no knowledge about health reform before attending the event. On average, more than 80% of attendees knew more about health reform following the event and more than 80% believed that the law would benefit their families. Enrollment events can serve as an effective method to educate the public on health reform. Further research is recommended to explore in greater detail the impact community enrollment events can have on expanding public understanding of health reform.

  2. 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.

  3. Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform.

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    Guyon, Ak'ingabe; Perreault, Robert

    2016-10-20

    Public health is currently being weakened in several Canadian jurisdictions. Unprecedented and arbitrary cuts to the public health budget in Quebec in 2015 were a striking example of this. In order to support public health leaders and citizens in their capacity to advocate for evidence-informed public health reforms, we propose a knowledge synthesis of elements of public health systems that are significantly associated with improved performance. Research consistently and significantly associates four elements of public health systems with improved productivity: 1) increased financial resources, 2) increased staffing per capita, 3) population size between 50,000 and 500,000, and 4) specific evidence-based organizational and administrative features. Furthermore, increased financial resources and increased staffing per capita are significantly associated with improved population health outcomes. We contend that any effort at optimization of public health systems should at least be guided by these four evidence-informed factors. Canada already has existing capacity in carrying out public health systems and services research. Further advancement of our academic and professional expertise on public health systems will allow Canadian public health jurisdictions to be inspired by the best public health models and become stronger advocates for public health's resources, interventions and outcomes when they need to be celebrated or defended.

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

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    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.

  5. Transitions in state public health law: comparative analysis of state public health law reform following the Turning Point Model State Public Health Act.

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    Meier, Benjamin Mason; Hodge, James G; Gebbie, Kristine M

    2009-03-01

    Given the public health importance of law modernization, we undertook a comparative analysis of policy efforts in 4 states (Alaska, South Carolina, Wisconsin, and Nebraska) that have considered public health law reform based on the Turning Point Model State Public Health Act. Through national legislative tracking and state case studies, we investigated how the Turning Point Act's model legal language has been considered for incorporation into state law and analyzed key facilitating and inhibiting factors for public health law reform. Our findings provide the practice community with a research base to facilitate further law reform and inform future scholarship on the role of law as a determinant of the public's health.

  6. Postneoliberal Public Health Care Reforms: Neoliberalism, Social Medicine, and Persistent Health Inequalities in Latin America.

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    Hartmann, Christopher

    2016-12-01

    Several Latin American countries are implementing a suite of so-called "postneoliberal" social and political economic policies to counter neoliberal models that emerged in the 1980s. This article considers the influence of postneoliberalism on public health discourses, policies, institutions, and practices in Bolivia, Ecuador, and Venezuela. Social medicine and neoliberal public health models are antecedents of postneoliberal public health care models. Postneoliberal public health governance models neither fully incorporate social medicine nor completely reject neoliberal models. Postneoliberal reforms may provide an alternative means of reducing health inequalities and improving population health.

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

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    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.

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

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    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.

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

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    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.

  10. [Psychiatric reform, federalism, and the decentralization of the public health in Brazil].

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    Costa, Nilson do Rosário; Siqueira, Sandra Venâncio; Uhr, Deborah; Silva, Paulo Fagundes da; Molinaro, Alex Alexandre

    2011-12-01

    This study examines the relationships between Brazilian psychiatric reform, the adoption of the Centers for Psychosocial Care (CAPS) and the development of the Unified Health System (SUS). The adherence of municipal governments was a variable determinant for the spread of reform, especially due to the continental scale and fragmentation of the Brazilian federation. The article demonstrates the institutional stability of psychiatric reform in Brazil over two decades. The institutional nature of the decision-making process in the public arena has permitted the implementation of new organizational formats through imitation and financial incentives. The psychiatric reform was successful in defending the advantages of CAPS in relation to the asylum and hospital model dominant in past decades. The inductive policies, strengthened and upheld by Law 10.216/2001, transformed the agenda of psychiatric reform, limited to pioneering cities in a national public policy.

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

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    Manyazewal, Tsegahun; Matlakala, Mokgadi C

    2018-06-01

    Understanding the way health care reforms have succeeded or failed thus far would help policy makers cater continued reform efforts in the future and provides insight into possible levels of improvement in the health care system. This work aims to assess and describe the implications of health care reform on the performance of public hospitals in central Ethiopia. A facility-based, cross-sectional study was carried out in five public hospitals with different operational characteristics that have been implementing health care reform in central Ethiopia. The reform documents were reviewed to assess the nature and targets of the reform for interpretive analysis. Adopting dimensions of health system performance as the theoretical framework, a self-administered questionnaire was developed. Consenting health care professionals who have been involved in the reform from inception to implementation filled the questionnaire. Cronbach's alpha was measured to ensure internal consistency of the instrument. Descriptive statistics, weighted median score, χ 2 , and Mann-Whitney U and Kruskal-Wallis tests were used for data analysis. s Despite implementation of the reform, the health care system in public hospitals was still fragmented as confirmed by 50% of respondents. Limited effects were reported in favour of quality (48%), access (50%), efficiency (51%), sustainability (53%), and equity (61%) of care, while poor effects were reported in patient-provider (41%) and provider-management (32%) interactions. Though there was substantial gain in infrastructure and workspace, stewardship of health care resources was less benefited. The predominant hindrances of the reform were the working environment (adjusted Odds Ratio (aOR) = 2.27, 95% confidence interval (CI): 1.15-4.47), financial resources (aOR = 3.54, 95%CI = 1.97-6.33), management (aOR = 2.27, 95% CI = 1.15-4.47), and information technology system (aOR = 3.15, 95% CI = 1.57-6.32). s The Ethiopian

  12. Liking the pieces, not the package: contradictions in public opinion during health reform.

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    Brodie, Mollyann; Altman, Drew; Deane, Claudia; Buscho, Sasha; Hamel, Elizabeth

    2010-06-01

    Public opinion played a prominent role during the recent health care reform debate. Critics of reform pointed to poll results as evidence that a majority of Americans opposed sweeping changes. Supporters cited polls showing that people favored many specific aspects of the legislation. A closer examination of past and present polling shows that opinion tracked with historic patterns and was relatively stable, even if the contentious public debate suggested a volatile public mood in 2009 and 2010. Going forward, the public will begin reacting to reform implementation, primarily by judging it in terms of their perceptions of and experiences with what the new law does and does not do for people. These opinions could in turn influence implementation or future legislation.

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

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    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.

  14. The 2009 Health Confidence Survey: public opinion on health reform varies; strong support for insurance market reform and public plan option, mixed response to tax cap.

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    Fronstin, Paul; Helman, Ruth

    2009-07-01

    PUBLIC SUPPORT FOR HEALTH REFORM: Findings from the 2009 Health Confidence Survey--the 12th annual HCS--indicate that Americans have already formed strong opinions regarding various aspects of health reform, even before details have been released regarding various key factors. These issues include health insurance market reform, the availability of a public plan option, mandates on employers and individuals, subsidized coverage for the low-income population, changes to the tax treatment of job-based health benefits, and regulatory oversight of health care. These opinions may change as details surface, especially as they concern financing options. In the absence of such details, the 2009 HCS finds generally strong support for the concepts of health reform options that are currently on the table. U.S. HEALTH SYSTEM GETS POOR MARKS, BUT SO DOES A MAJOR OVERHAUL: A majority rate the nation's health care system as fair (30 percent) or poor (29 percent). Only a small minority rate it excellent (6 percent) or very good (10 percent). While 14 percent of Americans think the health care system needs a major overhaul, 51 percent agree with the statement "there are some good things about our health care system, but major changes are needed." NATIONAL HEALTH PLAN ELEMENTS RATED HIGHLY: Between 68 percent and 88 percent of Americans either strongly or somewhat support health reform ideas such as national health plans, a public plan option, guaranteed issue, expansion of Medicare and Medicaid, and employer and individual mandates. MIXED REACTION TO HEALTH BENEFITS TAX CAP: Reaction to capping the current tax exclusion of employment-based health benefits is mixed. Nearly one-half of Americans (47 percent) would switch to a lower-cost plan if the tax exclusion were capped, 38 percent would stay on their current plan and pay the additional taxes, and 9 percent don't know. CONTINUED FAITH IN EMPLOYMENT-BASED BENEFITS, BUT DOUBTS ON AFFORDABILITY: Individuals with employment

  15. Public sector reform and demand for human resources for health (HRH

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    Lethbridge Jane

    2004-11-01

    Full Text Available Abstract This article considers some of the effects of health sector reform on human resources for health (HRH in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector. Fiscal reform results in pressure to measure the staff outputs of the health sector. Financial decentralisation often leads to hospitals becoming "corporatised" institutions, operating with business principles but remaining in the public sector. The introduction of market mechanisms often involves the formation of an internal market within the health sector and market testing of different functions with the private sector. This has immediate implications for the employment of health workers in the public sector, because the public sector may reduce its workforce if services are purchased from other sectors or may introduce more short-term and temporary employment contracts. Decentralisation of budgets and administrative functions can affect the health sector, often in negative ways, by reducing resources available and confusing lines of accountability for health workers. Governance and regulation of health care, when delivered by both public and private providers, require new systems of regulation. The increase in private sector provision has led health workers to move to the private sector. For those remaining in the public sector, there are often worsening working conditions, a lack of employment security and dismantling of collective bargaining agreements. Human resource development is gradually being recognised as crucial to future reforms and the formulation of health policy. New information systems at local and regional level will be needed to collect data on human resources. New employment arrangements, strengthening organisational culture, training and continuing education will also be needed.

  16. Is the Colombian health system reform improving the performance of public hospitals in Bogotá?

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    McPake, Barbara; Yepes, Francisco Jose; Lake, Sally; Sanchez, Luz Helena

    2003-06-01

    Many countries are experimenting with public hospital reform - both increasing the managerial autonomy with which hospitals conduct their affairs, and separating 'purchaser' and 'provider' sides of the health system, thus increasing the degree of market pressure brought to bear on hospitals. Evidence suggesting that such reform will improve hospital performance is weak. From a theoretical perspective, it is not clear why public hospitals should be expected to behave like firms and seek to maximize profits as this model requires. Empirically, there is very slight evidence that such reforms may improve efficiency, and reason to be concerned about their equity implications. In Colombia, an ambitious reform programme includes among its measures the attempt to universalize a segmented health system, the creation of a purchaser-provider split and the transformation of public hospitals into 'autonomous state entities'. By design, the Colombian reform programme avoids the forces that produce equity losses in other developing countries. This paper reports the results of a study that has tried to track hospital performance in other dimensions in the post-reform period in Bogotá. Trends in hospital inputs, production and productivity, quality and patient satisfaction are presented, and qualitative data based on interviews with hospital workers are analyzed. The evidence we have been able to collect is capable of providing only a partial response to the study question. There is some evidence of increased activity and productivity and sustained quality despite declining staffing levels. Qualitative data suggest that hospital workers have noticed considerable changes, which include greater responsiveness to patients but also a heavier administrative burden. It is difficult to attribute specific causality to all of the changes measured and this reflects the inherent difficulty of judging the effects of large-scale reform programmes as well as weaknesses and gaps in the data

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

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    Zhang X

    2016-03-01

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

  18. Economics and Health Reform: Academic Research and Public Policy.

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    Glied, Sherry A; Miller, Erin A

    2015-08-01

    Two prior studies, conducted in 1966 and in 1979, examined the role of economic research in health policy development. Both concluded that health economics had not been an important contributor to policy. Passage of the Affordable Care Act offers an opportunity to reassess this question. We find that the evolution of health economics research has given it an increasingly important role in policy. Research in the field has followed three related paths over the past century-institutionalist research that described problems; theoretical research, which proposed relationships that might extend beyond existing institutions; and empirical assessments of structural parameters identified in the theoretical research. These three strands operating in concert allowed economic research to be used to predict the fiscal and coverage consequences of alternative policy paths. This ability made economic research a powerful policy force. Key conclusions of health economics research are clearly evident in the Affordable Care Act. © The Author(s) 2015.

  19. Health sector reform and public sector health worker motivation: a conceptual framework.

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    Franco, Lynne Miller; Bennett, Sara; Kanfer, Ruth

    2002-04-01

    Motivation in the work context can be defined as an individual's degree of willingness to exert and maintain an effort towards organizational goals. Health sector performance is critically dependent on worker motivation, with service quality, efficiency, and equity, all directly mediated by workers' willingness to apply themselves to their tasks. Resource availability and worker competence are essential but not sufficient to ensure desired worker performance. While financial incentives may be important determinants of worker motivation, they alone cannot and have not resolved all worker motivation problems. Worker motivation is a complex process and crosses many disciplinary boundaries, including economics, psychology, organizational development, human resource management, and sociology. This paper discusses the many layers of influences upon health worker motivation: the internal individual-level determinants, determinants that operate at organizational (work context) level, and determinants stemming from interactions with the broader societal culture. Worker motivation will be affected by health sector reforms which potentially affect organizational culture, reporting structures, human resource management, channels of accountability, types of interactions with clients and communities, etc. The conceptual model described in this paper clarifies ways in which worker motivation is influenced and how health sector reform can positively affect worker motivation. Among others, health sector policy makers can better facilitate goal congruence (between workers and the organizations they work for) and improved worker motivation by considering the following in their design and implementation of health sector reforms: addressing multiple channels for worker motivation, recognizing the importance of communication and leadership for reforms, identifying organizational and cultural values that might facilitate or impede implementation of reforms, and understanding that reforms

  20. Identifying Factors Influencing the Establishment of a Health System Reform Plan in Iran's Public Hospitals

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    Rasul Fani khiavi

    2016-09-01

    Full Text Available In today's world, health views have found a wider perspective in which non-medical expectations are particularly catered to. The health system reform plan seeks to improve society's health, decrease treatment costs, and increase patient satisfaction. This study investigated factors affecting the successful establishment of a health system reform plan. A mixed qualitative – quantitative approach was applied to conduct to explore influential factors associated with the establishment of a health system reform plan in Iran's public hospitals. The health systems and approaches to improving them in other countries have been studied. A Likert-based five-point questionnaire was the measurement instrument, and its content validity based on content validity ratio (CVR was 0.87. The construct validity, calculated using the factorial analysis and Kaiser Mayer Olkin (KMO techniques, was 0.964, which is a high level and suggests a correlation between the scale items. To complete the questionnaire, 185 experts, specialists, and executives of Iran’s health reform plan were selected using the Purposive Stratified Non Random Sampling and snowball methods. The data was then analyzed using exploratory factorial analysis and SPSS and LISREL software applications. The results of this research imply the existence of a pattern with a significant and direct relationship between the identified independent variables and the dependent variable of the establishment of a health system reform plan. The most important indices of establishing a health system reform plan, in the order of priority, were political support; suitable proportion and coverage of services presented in the society; management of resources; existence of necessary infrastructures; commitment of senior managers; constant planning, monitoring, and evaluation; and presentation of feedback to the plan's executives, intrasector/extrasector cooperation, and the plan’s guiding committee. Considering the

  1. [Reform of public health in Central Europe during the 18th century].

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    Kapronczay, Károly

    2010-01-01

    Author outlines the history of making and of development of public health during the period of enlightenment in Central Europe, with special regards on the Habsurg Empire, on Poland and on Russia. This development--including the foundation or reforms of medical education--was highly influenced by the ideas of the enlightened absolutism and by other international trends of the age as well. The detailed analysis of the factors shaping the history of public health in the three rather different countries shows an interesing parallelism regarding main issues. While re-organization of public health in all these countries was initiated and directed by the government and shaped according to western models, it was strongly influenced by local possibilities, culture and history.

  2. The health of hospitals and lessons from history: public health and sanitary reform in the Dublin hospitals, 1858-1898.

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    Fealy, Gerard M; McNamara, Martin S; Geraghty, Ruth

    2010-12-01

    The aim was to examine, critically, 19th century hospital sanitary reform with reference to theories about infection and contagion. In the nineteenth century, measures to control epidemic diseases focused on providing clean water, removing waste and isolating infected cases. These measures were informed by the ideas of sanitary reformers like Chadwick and Nightingale, and hospitals were an important element of sanitary reform. Informed by the paradigmatic tradition of social history, the study design was a historical analysis of public health policy. Using the methods of historical research, documentary primary sources, including official reports and selected hospital archives and related secondary sources, were consulted. Emerging theories about infection were informing official bodies like the Board of Superintendence of Dublin Hospitals in their efforts to improve hospital sanitation. The Board secured important reforms in hospital sanitation, including the provision of technically efficient sanitary infrastructure. Public health measures to control epidemic infections are only as effective as the state of knowledge of infection and contagion and the infrastructure to support sanitary measures. Today, public mistrust about the safety of hospitals is reminiscent of that of 150 years ago, although the reasons are different and relate to a fear of contracting antimicrobial-resistant infections. A powerful historical lesson from this study is that resistance to new ideas can delay progress and improved sanitary standards can allay public mistrust. In reforming hospital sanitation, policies and regulations were established--including an inspection body to monitor and enforce standards--the benefits of which provide lessons that resonate today. Such practices, especially effective independent inspection, could be adapted for present-day contexts and re-instigated where they do not exist. History has much to offer contemporary policy development and practice reform and

  3. Public behavioral health care reform in North Carolina: will we get it right this time around?

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    Swartz, Marvin; Morrissey, Joseph

    2012-01-01

    North Carolina seeks to provide affordable and high-quality care for people with mental health, developmental disabilities and substance abuse conditions by reforming its behavioral health care system. This article presents an overview of current efforts to achieve that goal and discusses the challenges that must be overcome if reform is to be effective.

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

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    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.

  5. Health system reform.

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    Ortolon, Ken

    2009-06-01

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

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

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    Andersen, Mette Rye; Storm, Hans H

    2015-06-01

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

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

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    Chernichovsky, Dov

    2013-04-01

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

  8. Navajo nation public health nurses inspire thoughts on health care reform.

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    Douglas, Kathy S

    2012-01-01

    The wisdom and experience of pubic health nurses serving on a Navajo Reservation, who work far from the typical hospital setting, may well hold some of the keys to how we can successfully plan for and navigate the future of our shifting health care system. As more of the nursing workforce moves outside the walls of the hospital, competencies in autonomy, clinical judgment, decision making, and communication will increase in importance. long with safety and quality implications, this may also influence changes in nursing education, job requirements, hiring, and measuring performance. In addition, there may be implications around how new nurses are oriented and how they get the experience needed to function in more independent roles. Within their routine days, the conditions they work in, the situations they face, and the many ways public health nurses find to meet the needs of the people they serve, is a wealth of knowledge that may well translate into solutions for some of the challenges our nation's health care system is facing.

  9. Health insurance reform: labor versus health perspectives.

    Science.gov (United States)

    Ammar, Walid; Awar, May

    2012-01-01

    The Ministry of Labor (MOL) has submitted to the Council of Ministers a social security reform plan. The Ministry of Public Health (MOPH) considers that health financing should be dealt with as part of a more comprehensive health reform plan that falls under its prerogatives. While a virulent political discussion is taking place, major stakeholders' inputs are very limited and civil society is totally put away from the whole policy making process. The role of the media is restricted to reproducing political disputes, without meaningful substantive debate. This paper discusses health insurance reform from labor market as well as public health perspectives, and aims at launching a serious public debate on this crucial issue that touches the life of every citizen.

  10. Public Administration reforms and results

    Directory of Open Access Journals (Sweden)

    Gunnar Helgi Kristinsson

    2014-12-01

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

  11. What did the public think of health services reform in Bangladesh? Three national community-based surveys 1999–2003

    Directory of Open Access Journals (Sweden)

    Hossain Md Zakir

    2007-02-01

    Full Text Available Abstract Background Supported by development partners, the Government of Bangladesh carried out a comprehensive reform of health services in Bangladesh between 1998 and 2003, intended to make services more responsive to public needs: the Health and Population Sector Programme (HPSP. They commissioned a series of surveys of the public, as part of evaluation of the HPSP. This article uses the survey findings to examine the changes in public opinions, use and experience of health services in the period of the HPSP. Methods We carried out three household surveys (1999, 2000 and 2003 of a stratified random sample of 217 rural sites and 30 urban sites. Each site comprised 100–120 contiguous households. Each survey included interviews with 25,000 household respondents and managers of health facilities serving the sites, and gender-stratified focus groups in each site. We measured: household ratings of government health services; reported use of services in the preceding month; unmet need for health care; user reports of waiting times, payments, explanations of condition, availability of prescribed medicines, and satisfaction with service providers. Results Public rating of government health services as "good" fell from 37% to 10% and the proportion using government treatment services fell from 13% to 10%. Unmet need increased from 3% to 9% of households. The proportion of visits to government facilities fell from 17% to 13%, while the proportion to unqualified practitioners rose from 52% to 60%. Satisfaction with service providers' behaviour dropped from 66% to 56%. Users were more satisfied when waiting time was shorter, prescribed medicines were available, and they received explanations of their condition. Conclusion Services have retracted despite increased investment and the public now prefer unqualified practitioners over government services. Public opinion of government health services has deteriorated and the reforms have not specifically

  12. Promoting good health in the age of reform: the medical publications of Henry H. Porter of Philadelphia, 1829-32.

    Science.gov (United States)

    Horrocks, T A

    1995-01-01

    In the early 1830s, the Philadelphia publisher Henry H. Porter rapidly published five journals, six books, and an almanac, works having a particular emphasis on health and personal hygiene. Porter's health publications linked the traditional message about the importance of personal hygiene to health to the messages conveyed by the flourishing American reform movements at the time, and his Journal of Health was among the first American medically oriented periodicals published for the layperson. Yet Porter did not survive in the intensely competitive and financially unstable book trade. This study examines Porter's health publications, attempting to explain why he chose to publish what he did, the message(s) his works contained, the audience(s) he tried to reach, and the failure of his business.

  13. 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.

  14. 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.

  15. Policy entrepreneurship in the development of public sector strategy: the case of London health reform.

    Science.gov (United States)

    Oborn, Eivor; Barrett, Michael; Exworthy, Mark

    2011-01-01

    The development of health policy is recognized as complex; however, there has been little development of the role of agency in this process. Kingdon developed the concept of policy entrepreneur (PE) within his ‘windows’ model. He argued inter-related ‘policy streams' must coincide for important issues to become addressed. The conjoining of these streams may be aided by a policy entrepreneur. We contribute by clarifying the role of the policy entrepreneur and highlighting the translational processes of key actors in creating and aligning policy windows. We analyse the work in London of Professor Sir Ara Darzi as a policy entrepreneur. An important aspect of Darzi's approach was to align a number of important institutional networks to conjoin related problems. Our findings highlight how a policy entrepreneur not only opens policy windows but also yokes together a network to make policy agendas happen. Our contribution reveals the role of clinical leadership in health reform.

  16. Welfare Reform and Health

    Science.gov (United States)

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

    2005-01-01

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

  17. Resolving Malpractice Claims after Tort Reform: Experience in a Self-Insured Texas Public Academic Health System.

    Science.gov (United States)

    Sage, William M; Harding, Molly Colvard; Thomas, Eric J

    2016-12-01

    To describe the litigation experience in a state with strict tort reform of a large public university health system that has committed to transparency with patients and families in resolving medical errors. Secondary data collected from The University of Texas System, which self-insures approximately 6,000 physicians at six health campuses across the state. We obtained internal case management data for all medical malpractice claims closed during 1 year before and 6 recent years following the enactment of state tort reform legislation. We retrospectively reviewed information about malpractice claimants, malpractice claims, and the process and outcome of dispute resolution. We accessed an internal case management database, supplemented by both electronic and paper records compiled by the university's Office of General Counsel. Closed claims dropped from 244 in 2001-2002 to an annual mean of 96 in 2009-2015, closures following lawsuits from 136 in 2001-2002 to an annual mean of 28 in 2009-2015, and paid claims from 60 in 2001 to an annual mean of 20 in 2009-2015. Patterns of resolution suggest efforts by the university to provide some compensation to injured patients in cases that were no longer economically viable for plaintiffs' lawyers to litigate. The percentage of payments relating to cases in which lawsuits had been filed decreased from 82 percent in 2001-2002 to 47 percent in 2009-2012 and again to 29 percent in 2012-2015, although most paid claimants were represented by attorneys. Unrepresented patients received payment in 13 cases closed in 2009-2012 (22 percent of payments; mean amount $60,566) and in 24 cases closed in 2012-2015 (41 percent of payments; mean amount $109,410). Even after tort reform, however, claims that resulted in payment remained slow to resolve, which was worsened for claimants subject to Medicare secondary payer rules. Strict confidentiality became a more common condition of settlement, although restrictions were subsequently relaxed

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

    Science.gov (United States)

    Tountas, Yannis; Karnaki, Panagiota; Pavi, Elpida

    2002-10-01

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

  19. The modernization of American public law: health care reform and popular constitutionalism.

    Science.gov (United States)

    Super, David A

    2014-04-01

    The Patient Protection and Affordable Care Act (ACA) transformed U.S. public law in crucial ways extending far beyond health care. As important as were the doctrinal shifts wrought by National Federation of Independent Business v. Sebelius, the ACA's structural changes to public law likely will prove far more important should they become entrenched. The struggle over the ACA has triggered the kind of "constitutional moment" that has largely replaced Article V's formal amendment procedure since the Prohibition fiasco. The Court participates in this process, but the definitive and enduring character of these constitutional moments' outcomes springs from broad popular engagement. Despite the Court's ruling and the outcome of the 2012 elections, the battle over whether to implement or shelve the ACA will continue unabated, both federally and in the states, until We the People render a clear decision. Whether the ACA survives or fails will determine the basic principles that guide the development of federalism, social insurance, tax policy, and privatization for decades to come. In each of these areas, the New Deal bequeathed us a delicate accommodation between traditionalist social values and modernizing norms of economic efficiency and interest group liberalism. This balance has come under increasing stress, with individual laws rejecting tradition far more emphatically than the New Deal did. But absent broad popular engagement, no definitive new principles could be established. The ACA's entrenchment would elevate technocratic norms across public law, the first change of our fundamental law since the civil rights revolution. The ACA's failure would rejuvenate individualistic, moralistic, pre-New Deal norms and allow opponents to attempt a counterrevolution against technocracy.

  20. Narratives of Public Health in Dickens's Journalism: The Trouble with Sanitary Reform.

    Science.gov (United States)

    Smith, Ralph F

    2015-01-01

    Although Dickens is still known as having been a highly visible supporter of England's well-known nineteenth-century sanitary movement, he became, in fact, deeply troubled by many of this movement's fundamental tenets, as evidenced by journal narratives on fever that he edited and wrote in the mid-nineteenth century. Rather than water and sewer engineering works and a sanitary regime policed by government agencies as envisaged by Edwin Chadwick and other sanitary reformers, Dickens's view by 1855 was that only a massive erasure of the existing social and political systems and their replacement by an utterly new infrastructure would suffice.

  1. Public Pension Plan Reform: The Legal Framework

    Science.gov (United States)

    Monahan, Amy B.

    2010-01-01

    There is significant interest in reforming retirement plans for public school employees, particularly in light of current market conditions. This article presents an overview of the various types of state regulation of public pension plans that affect possibilities for reform. Nearly all of the various approaches to public pension plan protection…

  2. [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

  3. Public Consultation toward Ethiopia's Family Law Reform ...

    African Journals Online (AJOL)

    Mandefrot Belay

    A comprehensive and open public consultation was conducted during the revision ... in Ethiopia which are expected to guide any legal reform process so that the ... law, the way in which public consultation forums were organized, and the ...

  4. The Reformed tradition as public theology

    Directory of Open Access Journals (Sweden)

    Vuyani S. Vellem

    2013-05-01

    Full Text Available This article is a South African perspective of a Black African reflection on the publicity of Reformed faith. Whilst the notion of public theology is fairly new, the article argues, it is important to define the ‘public’ of the type of public theology to which Reformed faith and tradition could be linked. As a confessional tradition, Reformed faith is intrinsically public, the article demonstrates. The publicity of this tradition is however ambivalent and tainted. I attempt to show this by discussing two important tenets of the Reformed Tradition: sola scriptura and sola fide, within the festering wounds of Black African colonialism, apartheid and the hegemony of the neoliberal paradigm in the 21st century.

  5. Health Reform Requires Policy Capacity

    Directory of Open Access Journals (Sweden)

    Pierre-Gerlier Forest

    2015-05-01

    Full Text Available 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

  6. Reforming health care in Hungary.

    Science.gov (United States)

    Császi, L; Kullberg, P

    1985-01-01

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

  7. Public Sector Reforms: New Public Management without Marketization?

    DEFF Research Database (Denmark)

    Löfgren, Karl; Pedersen, John Storm

    2012-01-01

    Is it possible to imagine New Public Management without marketization? In Denmark the present liberal-conservative Government has, throughout its 10 years in power, designed and implemented more than 15 major management reforms in the public sector. Although most of the reforms are rhetorically...... firmly rooted in neo-liberal ideologies they have, in practice, promoted tools and mechanisms of the “traditional,” or Old, Public Management. Based on an empirical study of the reforms, we suggest that the notion of “pragmatic” New Public Management is introduced to enhance the current understanding...... of New Public Management in the Western industrialized societies....

  8. [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.

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

    Science.gov (United States)

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

    2011-10-01

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

  10. Publicity as an Instrument of Reform.

    Science.gov (United States)

    Caudill, Susan

    Albert Einstein and the Emergency Committee of Atomic Scientists (ECAS) conducted a reform-based public communication campaign for the international control of atomic energy after the Second World War. The Committee raised funds and sought publicity for its proposed solution to the problem of war and the management of peace. Its solution was the…

  11. Optimising implementation of reforms to better prevent and respond to child sexual abuse in institutions: Insights from public health, regulatory theory, and Australia's Royal Commission.

    Science.gov (United States)

    Mathews, Ben

    2017-12-01

    The Australian Royal Commission Into Institutional Responses to Child Sexual Abuse has identified multiple systemic failures to protect children in government and non-government organizations providing educational, religious, welfare, sporting, cultural, arts and recreational activities. Its recommendations for reform will aim to ensure organizations adopt more effective and ethical measures to prevent, identify and respond to child sexual abuse. However, apart from the question of what measures institutions should adopt, an under-explored question is how to implement and regulate those measures. Major challenges confronting reform include the diversity of organizations providing services to children; organizational resistance; and the need for effective oversight. Failure to adopt theoretically sound strategies to overcome implementation barriers will jeopardize reform and compromise reduction of institutional child sexual abuse. This article first explains the nature of the Royal Commission, and focuses on key findings from case studies and data analysis. It then analyzes public health theory and regulatory theory to present a novel analysis of theoretically justified approaches to the implementation of measures to prevent, identify and respond to CSA, while isolating challenges to implementation. The article reviews literature on challenges to reform and compliance, and on prevention of institutional CSA and situational crime prevention, to identify measures which have attracted emerging consensus as recommended practice. Finally, it applies its novel integration of regulatory theory and public health theory to the context of CSA in institutional contexts, to develop a theoretical basis for a model of implementation and regulation, and to indicate the nature and functions of a regulatory body for this context. Copyright © 2017 The Author. Published by Elsevier Ltd.. All rights reserved.

  12. Electroconvulsive therapy in Brazil after the "psychiatric reform": a public health problem--example from a university service.

    Science.gov (United States)

    Ribeiro, Rafael Bernardon; Melzer-Ribeiro, Débora Luciana; Rigonatti, Sérgio Paulo; Cordeiro, Quirino

    2012-09-01

    The Brazilian public health system does not provide electroconvulsive therapy (ECT), which is limited to a few academic services. National mental health policies are against ECT. Our objectives were to analyze critically the public policies toward ECT and present the current situation using statistics from the Institute of Psychiatry of the University of São Paulo (IPq-HCFMUSP) and summary data from the other 13 ECT services identified in the country. Data regarding ECT treatment at the IPq-HCFMUSP were collected from January 2009 to June 2010 (demographical, number of sessions, and diagnoses). All the data were analyzed using SPSS 19, Epic Info 2000, and Excel. During this period, 331 patients were treated at IPq-HCFMUSP: 221 (67%) were from São Paulo city, 50 (15.2%) from São Paulo's metropolitan area, 39 (11.8%) from São Paulo's countryside, and 20 (6.1%) from other states; 7352 ECT treatments were delivered-63.0% (4629) devoted entirely via the public health system (although not funded by the federal government); the main diagnoses were a mood disorder in 86.4% and schizophrenia in 7.3% of the cases. There is an important lack of public assistance for ECT, affecting mainly the poor and severely ill patients. The university services are overcrowded and cannot handle all the referrals. The authors press for changes in the mental health policies.

  13. Trust and Control in Public Sector Reform

    DEFF Research Database (Denmark)

    Vallentin, Steen; Thygesen, Niels Thyge

    2017-01-01

    to a substitution view when it comes to accounting for public sector reform as structure and process. Also, we propose a widening of the theoretical lens in the form of an emergent view of how trust and control, instead of being beforehand determinable and more or less stable identities, emerge in multiple......This paper provides an analysis of trust-based management reform in the Danish public sector from the point of view of the trust–control nexus. Based on a qualitative case study of home care in the municipality of Copenhagen we argue that a complementary view of trust and control is superior...... and singular ways from multiple events in the organisation. Noticing a dearth of research that explicitly addresses trust issues with regard to public sector management and organisation, the paper is a response to the call for more studies of trust as an institutionally embedded phenomenon....

  14. [Alteration of profile of treatment of the public psychiatric hospitals of Belo Horizonte, Brazil, in the context of mental health care reform].

    Science.gov (United States)

    Coelho, Vívian Andrade Araújo; Volpe, Fernando Madalena; Diniz, Sabrina Stephanie Lana; Silva, Eliane Mussel da; Cunha, Cristiane de Freitas

    2014-08-01

    This article seeks to describe the profile of treatment and internment in public psychiatric hospitals in Belo Horizonte, Brazil, from 2002 to 2011. The changes in the characteristics of treatment and the profiles of the patients treated are analyzed in the context of health care reform. It is a study of temporal series with trend analysis by means of linear regression. There was a reduction in the total of patients treated in the period under scrutiny. Inversely, there was an increase in internments with a reduction in length of stay, though no change in readmission rates. Patients from Belo Horizonte prevailed, however a relative increase in demand from the surrounding area was observed. There was a reversal in the prevalence of morbidity switching from psychotic disorders to disorders resulting from the use of alcohol and/or other drugs. The alteration observed in the profile of treatment in public psychiatric hospitals in Belo Horizonte was concomitant with the progressive implementation of community mental health services, which have probably met the demand that was formerly directed to these hospitals. Currently the psychiatric hospital is not the first, much less the only venue for treatment in the mental health network in Minas Gerais.

  15. How to Develop Sustainable Public Administration Reforms

    Directory of Open Access Journals (Sweden)

    Liviu RADU

    2015-02-01

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

  16. The English and Swedish health care reforms.

    Science.gov (United States)

    Glennerster, H; Matsaganis, M

    1994-01-01

    England and Sweden have two of the most advanced systems of universal access to health care in the world. Both have begun major reforms based on similar principles. Universal access and finance from taxation are retained, but a measure of competition between providers of health care is introduced. The reforms therefore show a movement toward the kind of approach advocated by some in the United States. This article traces the origins and early results of the two countries' reform efforts.

  17. Health services reform in Bangladesh: hearing the views of health workers and their professional bodies

    OpenAIRE

    Cockcroft, Anne; Milne, Deborah; Oelofsen, Marietjie; Karim, Enamul; Andersson, Neil

    2011-01-01

    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 evide...

  18. Health care reform and federalism.

    Science.gov (United States)

    Greer, Scott L; Jacobson, Peter D

    2010-04-01

    Health policy debates are replete with discussions of federalism, most often when advocates of reform put their hopes in states. But health policy literature is remarkably silent on the question of allocation of authority, rarely asking which levels of government ought to lead. We draw on the larger literatures about federalism, found mostly in political science and law, to develop a set of criteria for allocating health policy authority between states and the federal government. They are social justice, procedural democracy, compatibility with value pluralism, institutional capability, and economic sustainability. Of them, only procedural democracy and compatibility with value pluralism point to state leadership. In examining these criteria, we conclude that American policy debates often get federalism backward, putting the burden of health care coverage policy on states that cannot enact or sustain it, while increasing the federal role in issues where the arguments for state leadership are compelling. We suggest that the federal government should lead present and future financing of health care coverage, since it would require major changes in American intergovernmental relations to make innovative state health care financing sustainable outside a strong federal framework.

  19. How teen girls think about fertility and the reproductive lifespan. Possible implications for curriculum reform and public health policy.

    Science.gov (United States)

    Littleton, Fiona Kisby

    2014-09-01

    Despite an 'epidemic' of delayed childbirth in England and Wales beyond a woman's optimally fertile years, research shows that young adults are unaware of or misunderstand the risks regarding starting or extending families that such behaviour entails. Currently, sex education syllabi in British schools neglect these issues, rendering school leavers ignorant of them.These curricula cannot be improved until more is known about adolescents' knowledge of relevant topics. In the light of this, this article describes exploratory research on how teenage girls in one English school think about the reproductive lifespan. Going beyond recent 'scientific' investigations which have mostly only tested the extent of ignorance of young adults, this qualitative enquiry used theories of the life course and emerging adulthood to analyse data gathered in interviews. It sought to understand not only what girls know, but how they apply their knowledge in relation to their assumptions about aging, motherhood, pregnancy, parenting and employment. One finding is highlighted here: that whilst "correct" knowledge about the reproductive lifespan does appear to be held by teenage girls, the ability to apply that knowledge and connect the socio-cultural with the biological domain, may not always be in place. This is relevant for curriculum developers aiming to prepare future citizens to take full control of their reproductive health, and policy makers responsible for ensuring an appropriate public health message about these concerns is available after formal schooling ends.

  20. Public health

    NARCIS (Netherlands)

    Berg, van den A.E.

    2007-01-01

    Agnes van den Berg wrote an essay about human health and nature, establishing that subject as an important policy argument in developing (urban) nature in the Netherlands. She studied the public balance of fear and fascination for nature, summarising benefits on human health. In this chapter, she

  1. 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.

  2. Health sector reform in Argentina: a cautionary tale.

    Science.gov (United States)

    Lloyd-Sherlock, Peter

    2005-04-01

    In November 2002 the World Bank published a report on the Argentine health sector. The report accurately portrays the complexity and severity of the problems facing the health care system. It stresses that these problems are not purely a product of the country's economic collapse, noting that the system has suffered from long-standing structural problems and inefficiencies. Curiously, the report makes no mention of the leading role played by the World Bank in health reform efforts during the 1990s. This paper demonstrates that these reforms did much to worsen pre-existing weaknesses of the sector. The paper criticises the content of the reform agenda and the manner in which it was produced, arguing that these were reforms in which considerations of public health were less significant than conformity to the wider model of neo-liberal social and economic development prevailing at the time. It also highlights problems of implementing the reform agenda, which reduced the coherency of the reforms. The paper goes on to examine the impact of the crisis, noting links with the preceding reforms. It identifies a number of insights and lessons of potential value to other countries which are pursuing similar policies.

  3. 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...

  4. New Reforms to the Health System

    OpenAIRE

    Tran Dai, Candice; Duchâtel, Mathieu

    2012-01-01

    Based on:– Li Ling, “Successful reform of the health system hangs on two key elements,” Zhongguo jingyingbao (China Management News), 18 April 2009.– Li Hongmei, Li Xiaohong, Wang Junping, “Ten experts comment on the new reform of the health system: Providing better and cheaper access to medical care,” Renmin ribao (People’s Daily), 15 April 2009.– Yao Qi, “The new reform of the health system must first and foremost compensate for the shortcomings in the local hospitals,” Yangcheng wanbao (Ya...

  5. Equity in health and health care reforms.

    Science.gov (United States)

    Glick, S M

    1999-01-01

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

  6. Final report of the National Health and Hospitals Reform Commission: will we get the health care governance reform we need?

    Science.gov (United States)

    Stoelwinder, Johannes U

    2009-10-05

    The National Health and Hospitals Reform Commission (NHHRC) has recommended that Australia develop a "single health system", governed by the federal government. Steps to achieving this include: a "Healthy Australia Accord" to agree on the reform framework; the progressive takeover of funding of public hospitals by the federal government; and the possible implementation of a consumer-choice health funding model, called "Medicare Select". These proposals face significant implementation issues, and the final solution needs to deal with both financial and political sustainability. If the federal and state governments cannot agree on a reform plan, the Prime Minister may need to go to the electorate for a mandate, which may be shaped by other economic issues such as tax reform and intergenerational challenges.

  7. [Human resources for health in Chile: the reform's pending challenge].

    Science.gov (United States)

    Méndez, Claudio A

    2009-09-01

    Omission of human resources from health policy development has been identified as a barrier in the health sector reform's adoption phase. Since 2002, Chile's health care system has been undergoing a transformation based on the principles of health as a human right, equity, solidarity, efficiency, and social participation. While the reform has set forth the redefinition of the medical professions, continuing education, scheduled accreditation, and the introduction of career development incentives, it has not considered management options tailored to the new setting, a human resources strategy that has the consensus of key players and sector policy, or a process for understanding the needs of health care staff and professionals. However, there is still time to undo the shortcomings, in large part because the reform's implementation phase only recently has begun. Overcoming this challenge is in the hands of the experts charged with designing public health strategies and policies.

  8. Reproductive Health Policies in Peru: Social Reforms and Citizenship Rights

    Directory of Open Access Journals (Sweden)

    Stéphanie Rousseau

    2007-05-01

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

  9. Formation of a new social paradigm in the public administration of health care in Ukraine in the conditions of the reform

    Directory of Open Access Journals (Sweden)

    Evgheni KULGHINSKI

    2016-12-01

    Full Text Available The article considers the review of approaches for the creation of a new social paradigm in the health care system management based on the principles of humanism. The paradigms are based on responsible partnership and person-oriented approach. Major principles of the paradigm’s creation are given in details, as well as their expected impact on implementing reforms in the health care management of Ukraine.

  10. Neo-institutional Perspectives on Public Management Reform

    NARCIS (Netherlands)

    Gestel, N.M. van; Teelken, J.C.

    2006-01-01

    In this paper, theoretical explanations of competing drivers of change from neo-institutional theory are applied to public sector patterns of reform. The aim is to investigate basic ideas, assumptions, and practices of public management reform over the past two decades and analyze these elements of

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

    African Journals Online (AJOL)

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

  12. 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.

  13. Health care reform in Belgium.

    Science.gov (United States)

    Schokkaert, Erik; Van de Voorde, Carine

    2005-09-01

    Curbing the growth of public sector health expenditures has been the proclaimed government objective in Belgium since the 1980s. However, the respect for freedom of choice for patients and for therapeutic freedom for providers has blocked the introduction of microeconomic incentives and quality control. Therefore--with some exceptions, particularly in the hospital sector--policy has consisted mainly of tariff and supply restrictions and increases in co-payments. These measures have not been successful in curbing the growth of expenditures. Moreover, there remains a large variation in medical practices. While the structure of health financing is relatively progressive from an international perspective, socioeconomic and regional inequalities in health persist. The most important challenge is the restructuring of the basic decision-making processes; i.e. a simplification of the bureaucratic procedures and a re-examination of the role of regional authorities and sickness funds. Copyright (c) 2002 John Wiley & Sons, Ltd.

  14. “A Campaign Won as a Public Issue Will Stay Won”: Using Cartoons and Comics to Fight National Health Care Reform, 1940s and Beyond

    Science.gov (United States)

    Knoblauch, Heidi Katherine

    2014-01-01

    On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. As it went through Congress, the legislation faced forceful resistance. Individuals and organizations opposing the ACA circulated propaganda that varied from photographs of fresh graves or coffins with the caption “Result of ObamaCare” to portrayals of President Obama as the Joker from the Batman movies, captioned with the single word “socialism.” The arguments embedded in these images have striking parallels to cartoons circulated by physicians to their patients in earlier fights against national health care. Examining cartoons used in the formative health care reform debates of the 1940s provides a means for tracing the lineage of emotional arguments employed against health care reform. PMID:24328659

  15. "A campaign won as a public issue will stay won": using cartoons and comics to fight national health care reform, 1940s and beyond.

    Science.gov (United States)

    Knoblauch, Heidi Katherine

    2014-02-01

    On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. As it went through Congress, the legislation faced forceful resistance. Individuals and organizations opposing the ACA circulated propaganda that varied from photographs of fresh graves or coffins with the caption "Result of ObamaCare" to portrayals of President Obama as the Joker from the Batman movies, captioned with the single word "socialism." The arguments embedded in these images have striking parallels to cartoons circulated by physicians to their patients in earlier fights against national health care. Examining cartoons used in the formative health care reform debates of the 1940s provides a means for tracing the lineage of emotional arguments employed against health care reform.

  16. The prospects for national health insurance reform.

    Science.gov (United States)

    Belcher, J R; Palley, H A

    1991-01-01

    This article explores the unequal access to health care in the context of efforts by the American Medical Association (AMA) and its allies to maintain a market-maximizing health care system. The coalition between the AMA and its traditional allies is breaking down, in part, because of converging developments creating an atmosphere which may be more conducive to national health care reform and the development of a reformed health care delivery system that will be accessible, adequate, and equitable in meeting the health care and related social service needs of the American people.

  17. Economic reforms and health insurance in China.

    Science.gov (United States)

    Du, Juan

    2009-08-01

    During the 1990s, Chinese state-owned enterprises (SOEs) and collective enterprises continually decreased coverage of public health insurance to their employees. This paper investigates this changing pattern of health insurance coverage in China using panel data from the China Nutrition and Health Survey (1991-2000). It is the first attempt in this literature that tries to identify precisely the effects of specific policies and reforms on health insurance coverage in the transitional period of China. The fixed effects linear model clustering at the province level is used for estimation, and results are compared to alternative models, including pooled OLS, random effects GLS model and fixed effects logit model. Strong empirical evidence is found that unemployment as a side effect of the Open Door Policy, and the deregulation of SOE and collective enterprises were the main causes for the decreasing trend. For example, urban areas that were highly affected by the Open Door Policy were associated with 17 percentage points decrease in the insurance coverage. Moreover, I found evidence that the gaps between SOE and non-SOE employees, collective and non-collective employees, urban and rural employees have considerably decreased during the ten years.

  18. TRANSFERABILITY OF ADMINISTRATIVE REFORMS: NEW PUBLIC MANAGEMENT AS AN EXAMPLE

    OpenAIRE

    Kapucu, Naim; Kösecik, Muhammet

    2002-01-01

    This article begins with the examination of models of analyzing the process of policy transfer, lesson drawing and policy streams with regard to initiating and directing factors and dynamics of the process. The paper continues with the assessment of administrative reform transferring by evaluating the necessity, major themes and transferability of administrative reform. Strategies for successful administrative reform transferring are emphasized. Special reference is given to New Public Manage...

  19. Public Health Data in Action: An Analysis of Using Louisiana Vital Statistics for Quality Improvement and Payment Reform.

    Science.gov (United States)

    Danilack, Valery A; Gee, Rebekah E; Berthelot, Danielle P; Gurvich, Rebecca; Muri, Janet H

    2017-05-01

    Introduction In 2012, the Louisiana (LA) Department of Health and Hospitals revised the LA birth certificate to include medical reasons for births before 39 completed weeks' gestation. We compared the completeness and validity of these data with hospital discharge records. Methods For births occurring 4/1/2012-9/30/2012 at Woman's Hospital of Baton Rouge, we linked maternal delivery and newborn birth data collected through the National Perinatal Information Center with LA birth certificates. Among early term births (37-38 completed weeks' gestation), we quantified the reasons for early delivery listed on the birth certificate and compared them with ICD-9-CM codes from Woman's discharge data. Results Among 4353 birth certificates indicating delivery at Woman's Hospital, we matched 99.8% to corresponding Woman's administrative data. Among 1293 early term singleton births, the most common reasons for early delivery listed on the birth certificate were spontaneous active labor (57.5%), gestational hypertensive disorders (15.3%), gestational diabetes (8.7%), and premature rupture of membranes (8.1%). Only 2.7% of births indicated "other reason" as the only reason for early delivery. Most reasons for early delivery had >80% correspondence with ICD-9-CM codes. Lower correspondence (35 and 72%, respectively) was observed for premature rupture of membranes and abnormal heart rate or fetal distress. Discussion There was near-perfect ability to match LA birth certificates with Woman's Hospital records, and the agreement between reasons for early delivery on the birth certificate and ICD-9-CM codes was high. A benchmark of 2.7% can be used as an attainable frequency of "other reason" for early delivery reported by hospitals. Louisiana implemented an effective mechanism to identify and explain early deliveries using vital records.

  20. 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.

  1. 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

  2. Reform, change, and continuity in Finnish health care.

    Science.gov (United States)

    Häkkinen, Unto; Lehto, Juhani

    2005-01-01

    This article describes some essential aspects of the Finnish political and governmental system and the evolution of the basic institutional elements of the health care system. We examine the developments that gave rise to a series of health care reforms and reform proposals in the late 1980s and early 1990s and relate them to changes in health care expenditure, structure, and performance. Finally, we discuss the relationship between policy changes, reforms, and health system changes and the strength of neo-institutional theory in explaining both continuity and change. Much of the change in Finnish health care can be explained by institutional path dependency. The tradition of strong but small local authorities and the lack of legitimate democratic regional authorities as well as the coexistence of a dominant Beveridge-style health system with a marginal Bismarckian element explain the specific path of Finnish health care reform. Public responsibility for health care has been decentralized to smaller local authorities (known as municipalities) more than in any other country. Even an exceptionally deep economic recession in the early 1990s did not lead to systems change; rather, the economic imperative was met by the traditional centralized policy pattern. Some of the developments of the 1990s are, however, difficult to explain by institutional theory. Thus, there is a need for testing alternative theories as well.

  3. Leprosy: International Public Health Policies and Public Health Eras

    Directory of Open Access Journals (Sweden)

    Niyi Awofeso

    2011-09-01

    Full Text Available Public health policies continue to play important roles in national and international health reforms. However, the influence and legacies of the public health eras during which such policies are formulated remain largely underappreciated. The limited appreciation of this relationship may hinder consistent adoption of public health policies by nation-states, and encumber disinvestment from ineffective or anachronistic policies. This article reviews seven public health eras and highlights how each era has influenced international policy formulation for leprosy control—“the fertile soil for policy learning”. The author reiterates the role of health leadership and health activism in facilitating consistency in international health policy formulation and implementation for leprosy control.

  4. The French prescription for health care reform.

    Science.gov (United States)

    Segouin, C; Thayer, C

    1999-01-01

    In 1996, the French government introduced a wide-ranging health care reform which aimed to resolve the problems of rising health expenditure and a levelling off in health sector income. Changes in the regulation of the health care system sought to strengthen quality while improving professional practice. At the same time the changes were intended to encourage greater synergy both between professionals and between the different parts of the system, thus promoting greater cost-effectiveness. The tools designed to achieve these results included: the creation of new regional hospital agencies, the introduction of cash-limited budgets at national and regional level, the launching of a contracting procedure between health authorities and hospitals and the setting up of a new health care accreditation agency. With some signs of improvement in the overall health insurance budgetary situation, the Jospin government seems to be supporting the broad lines of the reform introduced by its predecessor.

  5. Tax Reform in Brazil: a Public Choice Theory approach

    Directory of Open Access Journals (Sweden)

    Allan Silveira dos Santos

    2013-12-01

    Full Text Available This article aims to analyze tax reform necessity and the barriers to the implementation of tax reform at the light of public choice theory. The research identifies the arguments that provides the explanation for the tax reform does not occur in Brazil. The question that the article searches to answer is: what are the justifications for the Brazil not have done tax reform? The literature review addresses the failures of government, public choice theory and the theory of optimal taxation. The evidence and studies show that there are reasons to think about a tax system more consistent with the Brazilian reality, indicating the existence of "government failures" that may be the probable cause of impairment of the tax reform.

  6. Medical liability and health care reform.

    Science.gov (United States)

    Nelson, Leonard J; Morrisey, Michael A; Becker, David J

    2011-01-01

    We examine the impact of the Affordable Care Act (ACA) on medical liability and the controversy over whether federal medical reform including a damages cap could make a useful contribution to health care reform. By providing guaranteed access to health care insurance at community rates, the ACA could reduce the problem of under-compensation resulting from damages caps. However, it may also exacerbate the problem of under-claiming in the malpractice system, thereby reducing incentives to invest in loss prevention activities. Shifting losses from liability insurers to health insurers could further undermine the already weak deterrent effect of the medical liability system. Republicans in Congress and physician groups both pushed for the adoption of a federal damages cap as part of health care reform. Physician support for damages caps could be explained by concerns about the insurance cycle and the consequent instability of the market. Our own study presented here suggests that there is greater insurance market stability in states with caps on non-economic damages. Republicans in Congress argued that the enactment of damages caps would reduce aggregate health care costs. The Congressional Budget Office included savings from reduced health care utilization in its estimates of cost savings that would result from the enactment of a federal damages cap. But notwithstanding recent opinions offered by the CBO, it is not clear that caps will significantly reduce health care costs or that any savings will be passed on to consumers. The ACA included funding for state level demonstration projects for promising reforms such as offer and disclosure and health courts, but at this time the benefits of these reforms are also uncertain. There is a need for further studies on these issues.

  7. Organizational and Managerial Challenges of Reforming Slovenian Public Agencies

    Directory of Open Access Journals (Sweden)

    Kovač Polonca

    2014-11-01

    Full Text Available Introduction: Agencies are among the key contemporary public organizations, prospering within reforms carried out worldwide to increase professionalism and rationalism in public administration (PA. Hence, countries have been establishing agencies and delegating them public tasks in order to achieve expertise-based instead of politically-driven and thus more efficient public policies. In such context, the present article addresses the most important strategic documents related to public administration reform (PAR in Slovenia, analyzing their goals in terms of agencification and the main implementation results and gaps.

  8. Interest groups and health reform: lessons from California.

    Science.gov (United States)

    Oliver, T R; Dowell, E B

    We review the 1992 policy choices in California for expanding health insurance coverage, focusing on the rejection of an employer mandate by legislators and voters. We analyze how interest-group politics, gubernatorial politics, and national politics shaped those choices. Although public opinion and the shift of organized medicine showed considerable support for extending health insurance coverage, the opposition of liberal and conservative groups and a foundering economy prevented a significant change in public policy. The president's health reform plan appears to address many of the unresolved concerns in California, but overcoming resistance to any kind of mandate will require skilled leadership and negotiation.

  9. The Legacy of the U. S. Public Health Services Study of Untreated Syphilis in African American Men at Tuskegee on the Affordable Care Act and Health Care Reform Fifteen Years After President Clinton's Apology.

    Science.gov (United States)

    Mays, Vickie M

    2012-11-01

    This special issue addresses the legacy of the United States Public Health Service Syphilis Study on health reform, particularly the Affordable Care Act (ACA). The 12 manuscripts cover the history and current practices of ethical abuses affecting American Indians, Latinos, Asian Americans and African Americans in the United States and in one case, internationally. Commentaries and essays include the voice of a daughter of one of the study participants in which we learn of the stigma and maltreatment some of the families experienced and how the study has impacted generations within the families. Consideration is given in one essay to utilizing narrative storytelling with the families to help promote healing. This article provides the reader a roadmap to the themes that emerged from the collection of articles. These themes include population versus individual consent issues, need for better government oversight in research and health care, the need for overhauling our bioethics training to develop a population level, culturally driven approach to research bioethics. The articles challenge and inform us that some of our assumptions about how the consent process best works to protect racial/ethnic minorities may be merely assumptions and not proven facts. Articles challenge the belief that low participation rates seen in biomedical studies have resulted from the legacy of the USPHS Syphilis Study rather than a confluence of factors rooted in racism, bias and negative treatment. Articles in this special issue challenge the "cultural paranoia" of mistrust and provide insights into how the distrust may serve to lengthen rather than shorten the lives of racial/ethnic minorities who have been used as guinea pigs on more than one occasion. We hope that the guidance offered on the importance of developing a new framework to bioethics can be integrated into the foundation of health care reform.

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

    Science.gov (United States)

    Crawford, Mark

    2006-01-01

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

  11. Bending the curve through health reform implementation.

    Science.gov (United States)

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

    2010-11-01

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

  12. Narrativity and the mediation of health reform agendas.

    Science.gov (United States)

    Hodgetts, Darrin; Chamberlain, Kerry

    2003-09-01

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

  13. Health Care Reform: a Socialist Vision

    Directory of Open Access Journals (Sweden)

    Martha Livingston

    2010-04-01

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

  14. Liking Health Reform But Turned Off By Toxic Politics.

    Science.gov (United States)

    Jacobs, Lawrence R; Mettler, Suzanne

    2016-05-01

    Six years after the Affordable Care Act (ACA) became law, the number of nonelderly Americans with health insurance has expanded by twenty million, and the uninsurance rate has declined nearly 9 percentage points. Nevertheless, public opinion about the law remains deeply divided. We investigated how individuals may be experiencing and responding to health reform implementation by analyzing three waves of a panel study we conducted in 2010, 2012, and 2014. While public opinion about the ACA remains split (45.6 percent unfavorable and 36.2 percent favorable), there have been several detectable shifts. The share of respondents believing that reform had little or no impact on access to health insurance or medical care diminished by 18 percentage points from 2010 to 2014, while those considering reform to have some or a great impact increased by 19 percentage points. Among individuals who held unfavorable views toward the law in 2010, the percentage who supported repeal-while still high, at 72 percent-shrank by 9 percentage points from 2010 to 2014. We found that party affiliation and distrust in government were influential factors in explaining the continuing divide over the law. The ACA has delivered discernible benefits, and some Americans are increasingly recognizing that it is improving access to health insurance and medical care. Project HOPE—The People-to-People Health Foundation, Inc.

  15. 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.

  16. Market reforms and public incentives: finding a balance in the Republic of Macedonia.

    Science.gov (United States)

    Nordyke, Robert J; Peabody, John W

    2002-03-01

    The Republic of Macedonia is undertaking sweeping reforms of its health sector. Funded by a World Bank credit, the reforms seek to improve the efficiency and quality of primary health care (PHC) by significantly strengthening the role of the market in health care provision. On the supply-side, one of the key reform proposals is to implement a capitation payment system for PHC physicians. By placing individual physicians on productivity-based contracts, these reforms will effectively marketize all PHC provision. In addition, the Ministry of Health is considering the sale or concessions of public PHC clinics to private groups, indicating the government's commitment to marketization of health care provision. Macedonia is in a unique position to develop a new role for the private sector in PHC provision. The private provision of outpatient care was legalized soon after independence in 1991; private physicians now account for nearly 10% of all physicians and 22% of PHC physicians. If the reforms are fully realized, all PHC physicians-over 40% of all physicians-will be financially responsible for their clinical practices. This study draws on Macedonia's experience with limited development of private outpatient care starting in 1991 and the reform proposals for PHC, finding a network of policies and procedures throughout the health sector that negatively impact private and public sector provision. An assessment of the effects that this greater policy environment has on private sector provision identifies opportunities to strategically enhance the reforms. With respect to established market economies, the study finds justification for a greater role for government intervention in private health markets in transition economies. In addition to micro-level payment incentives and administrative controls, marketization in Central and Eastern Europe requires an examination of insurance contracting procedures, quality assurance practices, public clinic ownership, referral

  17. Surveying Public Attitudes of Security Sector Reforms in the Arab ...

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

    The notion that the security sector's primary responsibility is to protect and preserve autocratic Arab regimes is widely discredited today. ... of public opinion in security sector reform by providing evidence-based information on public perceptions, and in so doing, encouraging civilian oversight and transparency in the sector.

  18. Reforming the Public Agricultural Extension System in China ...

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

    Reforming the Public Agricultural Extension System in China : Supporting Rural Innovation. The public agricultural extension system has played a critical role in Chinese agricultural development over the past few decades. There is growing evidence that since the mid-1990s the system has failed to provide new and ...

  19. British Columbia's health reform: "new directions" and accountability.

    Science.gov (United States)

    Davidson, A R

    1999-01-01

    The health policy New Directions committed the British Columbia government to a population health perspective and extensive community involvement in the health services reform process. The policy envisaged elected citizen boards with authority to raise revenues and exercise a significant degree of local autonomy. Academic and public attention has been paid to the decision in November 1996 to collapse New Directions' two-tier governance structure into a single level. Less attention has been paid to the profound changes that occurred prior to the government's reversal on the question of governance. This paper focuses on those changes. During the critical three years between the 1993 launch of the reform and its formal revision in 1996, the government's positions on elections, taxation power, local autonomy and scope of action for regional boards all changed. Those changes marked a retreat from political accountability to the community and an advance towards managerial accountability to the government.

  20. Public Health

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

    ian health ministry, and the Canadian. International ... Tanzanian and Canadian researchers began work on ... information on the major causes of death ... The effects have been dramatic. Accord- ... destroy mosquito breeding grounds, such.

  1. [Health reform in Ecuador: never again the right to health as a privilege].

    Science.gov (United States)

    Malo-Serrano, Miguel; Malo-Corral, Nicolás

    2014-01-01

    The process of the health reform being experienced by Ecuador has had significant achievements because it occurs within the framework of a new Constitution of the Republic, which allowed the incorporation of historical social demands that arose from the criticism of neoliberalism in the restructure and modernization of the state. The backbone of the reform consists of three components: organization of a National Health System that overcomes the previous fragmentation and constitutes the Integral Public Health Network; development of policies to strengthen primary health care, articulating actions on the determinants of health, and finally, increasing funding to consolidate these changes. We conclude that challenges to the reform are related to the sustainability of the processes, financial sustainability of the system, greater activation of participatory mechanisms that enable citizen assessment of services and citizen empowerment regarding their right to health.

  2. Four proposals for market-based health care system reform.

    Science.gov (United States)

    Sumner, W

    1994-08-01

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

  3. National Health-Care Reform

    Science.gov (United States)

    2009-03-24

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

  4. The politics of health sector reform in developing countries: three cases of pharmaceutical policy.

    Science.gov (United States)

    Reich, M R

    1995-01-01

    This paper examines the political dynamics of health sector reform in poor countries, through a comparative study of pharmaceutical policy reform in Sri Lanka, Bangladesh, and the Philippines. The paper first reviews five reasons why policy reform is political. It then presents three political economic models of the policy reform process: the political will, political factions, and political survival models. Next, the paper describes the three cases of national pharmaceutical policy reform, and identifies common conditions that made these reforms politically feasible. The paper's analysis suggests that health sector reform is feasible at certain definable, and perhaps predictable, political moments, especially in the early periods of new regimes. The most important and manipulable political factors are: political timing, which provides opportunities for policy entrepreneurs to introduce their ideas into public debate, and political management of group competition, which allows leaders to control the political effects of distributional consequences and protect the regime's stability. A strong and narrow political coalition improves the capacity of political leaders to resist the pressures of concentrated economic costs (both inside and outside national boundaries). The paper argues that for reform to succeed, policy-makers need effective methods to analyze relevant political conditions and shape key political factors in favor of policy reform. The method of Political Mapping is briefly introduced as a technique that can help policy-makers in analyzing and managing the political dimensions of policy reform and in improving the political feasibility of reform.

  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. THE NECESSITY AND JUSTIFICATION OF REFORMS OF PUBLIC CORPORATIONS

    Directory of Open Access Journals (Sweden)

    Jokić Zoran

    2016-04-01

    Full Text Available In the present business environment, negative opinion on the work of the public sector prevails. According to the public opinion, one gets the impression that it is necessary to privatize the public corporations as soon as possible and this way get rid of this kind of ballast. Having in mind the negative effects of previous transitional period, it is necessary to approach this issue cautiously, so the process of the reforms would give optimal social benefits.

  7. Mental health service delivery following health system reform in Colombia.

    Science.gov (United States)

    Romero-González, Mauricio; González, Gerardo; Rosenheck, Robert A

    2003-12-01

    In 1993, Colombia underwent an ambitious and comprehensive process of health system reform based on managed competition and structured pluralism, but did not include coverage for mental health services. In this study, we sought to evaluate the impact of the reform on access to mental health services and whether there were changes in the pattern of mental health service delivery during the period after the reform. Changes in national economic indicators and in measures of mental health and non-mental health service delivery for the years 1987 and 1997 were compared. Data were obtained from the National Administrative Department of Statistics of Colombia (DANE), the Department of National Planning and Ministry of the Treasury of Colombia, and from national official reports of mental health and non-mental health service delivery from the Ministry of Health of Colombia for the same years. While population-adjusted access to mental health outpatient services declined by -2.7% (-11.2% among women and +5.8% among men), access to general medical outpatient services increased dramatically by 46%. In-patient admissions showed smaller differences, with a 7% increase in mental health admissions, as compared to 22.5% increase in general medical admissions. The health reform in Colombia imposed competition across all health institutions with the intention of encouraging efficiency and financial autonomy. However, the challenge of institutional survival appears to have fallen heavily on mental health care institutions that were also expected to participate in managed competition, but that were at a serious disadvantage because their services were excluded from the compulsory standardized package of health benefits. While the Colombian health care reform intended to close the gap between those who had and those who did not have access to health services, it appears to have failed to address access to specialized mental health services, although it does seem to have promoted a

  8. Policy and Practice Model of Public-Private Partnership in Public Hospitals during the New Medical Reform Period.

    Science.gov (United States)

    Zhang, Ju-Yang; Long, Ru-Yin; Yan, Hai; Yang, Qing; Yang, Bo

    2016-01-01

    Purpose: Since the beginning of the new health care reform in 2009, the state has illustrated the top design and health care improvement strategy of "encouraging social capital to participate in the reform of public hospitals", in accordance with the program's general objective. All areas have been explored on this matter and the results obtained are very interesting, not to mention the acquisition of significant experience. At present, the existing business models in China are mainly the following: Rebuild-Operate-Transfer (ROT), franchise business model, Build-Own-Operate-Transfer (BOOT) model, mixed ownership model and business insurance model. This paper introduces a variety of alternative models, and provides a simple analysis of the advantages and disadvantages. Moreover, for the reform of public hospitals, the government shares should go into franchise mode or mixed ownership, and all property rights should be transferred to the government to ensure the conservation and proliferation of state-owned assets.

  9. Public Health Departments

    Data.gov (United States)

    Department of Homeland Security — State and Local Public Health Departments in the United States Governmental public health departments are responsible for creating and maintaining conditions that...

  10. [Health system reforms, economic constraints and ethical and legal values].

    Science.gov (United States)

    Caillol, Michel; Le Coz, Pierre; Aubry, Régis; Bréchat, Pierre-Henri

    2010-01-01

    Health system and hospital reforms have led to important and on-going legislative, structural and organizational changes. Is there any logic at work within the health system and hospitals that could call into question the principle of solidarity, the secular values of ethics that govern the texts of law and ethics? In order to respond, we compared our experiences to a review of the professional and scientific literature from 1992 to 2010. Over the course of the past eighteen years, health system organization was subjected to variations and significant tensions. These variations are witnesses to a paradigm shift: although a step towards the regionalization of the health system integrating the choice of public health priorities, consultation and participatory democracy has been implemented, nevertheless the system was then re-oriented towards the trend of returning to centralization on the basis of uniting economics, technical modernization and contracting. This change of doctrine may undermine the social mission of hospitals and the principle of solidarity. Progress, the aging population and financial constraints would force policy-makers to steer the health system towards more centralized control. Hospitals, health professionals and users may feel torn within a system that tends to simplify and minimize what is becoming increasingly complex and global. Benchmarks on values, ethics and law for the hospitals, healthcare professionals and users are questioned. These are important elements to consider when the law on the reform of hospitals, patients, health care and territories and regional health agencies is implemented.

  11. Indonesia - Country Procurement Assessment Report : Reforming the Public Procurement System

    OpenAIRE

    World Bank

    2001-01-01

    The main objectives of the Country Procurement Assessment Review (CPAR) are to diagnose the public procurement system in Indonesia, assess actual compliance with the country's procurement laws and regulations on the ground, and identify reforms to improve the existing system in line with internationally accepted principles. Section 1 gives an overview. Section 2 describes Indonesia's exist...

  12. China Public Budget Reform Program (CPBR) - Phase II | IDRC ...

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

    The Government of China has adopted a national reform program aimed at making budgeting more transparent and accountable through public involvement and enhanced oversight. Building on work carried out under Phase I (102965), the China Development Research Foundation (CDRF) will analyze China's current ...

  13. Evaluation of Large-scale Public Sector Reforms

    DEFF Research Database (Denmark)

    Breidahl, Karen Nielsen; Gjelstrup, Gunnar; Hansen, Hanne Foss

    2017-01-01

    and more delimited policy areas take place. In our analysis we apply four governance perspectives (rational-instrumental, rational-interest based, institutional-cultural and a chaos perspective) in a comparative analysis of the evaluations of two large-scale public sector reforms in Denmark and Norway. We...

  14. Renovating the Commons: Swedish health care reforms in perspective.

    Science.gov (United States)

    Saltman, Richard B; Bergman, Sven-Eric

    2005-01-01

    Recent reform experience in Sweden supports the premise that key dimensions of a country's health care system reflect the core social norms and values held by its citizenry. The fundamental structure of the Swedish health system has remained notably consistent over the past half century, that is, tax-based financing and publicly operated hospitals. Yet on other, nearly as important, parameters, there has been substantial change, for example, the persistent pursuit for thirty years of a stronger primary care framework and the effort to allow patient choice of doctor, health center, and hospital within the publicly operated system. This particular combination of continuity and change has occurred as traditional Swedish values of jamlikhet (equality) and trygghet (security) have been challenged in an environment shaped by an aging population, changing medical technology, and Sweden's integration into the European Single Market. This article explores the ongoing process of health system development in Sweden in the context of the country's broader social and cultural characteristics.

  15. 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.

  16. Proposals for the Reform of Constitutional Regulations on Public Finances

    OpenAIRE

    Tibor András Hetei

    2011-01-01

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

  17. Strategic Planning and Public management Reform: The Case of Romania

    Directory of Open Access Journals (Sweden)

    Călin Emilian HINȚEA

    2015-12-01

    Full Text Available Strategic planning is an excellent tool that local governments can (and should use in order to deal effi ciently with change, which means that planning is an important aspect of public sector reform, arguably one of the defi ning elements of the public policy landscape for the past three decades (Pollitt and Bouckaert, 2011. Our main objective with this research is twofold: to analyze why and how local public administration uses strategic planning as a managerial tool for managing change (reform, and to identify whether the planning efforts display a specifi c reform pattern. We employed a quantitative methodology – online survey – to collect data on the strategic planning process at the local level in Romania, with a specifi c framework for the strategic profi le (Hinţea, 2015 and another three dimension model – NPM, NWS, NPG1 – for the reform component (Pollitt and Bouckaert, 2011. Our analysis indicates that over 70% of strategic planning efforts are done because it is a mandatory condition for accessing EU funds. Major issues concern implementation, monitoring and evaluation with only around a third of organizations having a formal body responsible for this. Although the process has mixed characteristics, NWS type elements are more common/preferred, while NPM seem least common/preferred by local authorities

  18. Reforming health care in Canada: current issues

    Directory of Open Access Journals (Sweden)

    Baris Enis

    1998-01-01

    Full Text Available This paper examines the current health care reform issues in Canada. The provincial health insurance plans of the 1960s and 1970s had the untoward effects of limiting the federal government's clout for cost control and of promoting a system centered on inpatient and medical care. Recently, several provincial commissions reported that the current governance structures and management processes are outmoded in light of new knowledge, new fiscal realities and the evolution of power among stake-holders. They recommend decentralized governance and restructuring for better management and more citizen participation. Although Canada's health care system remains committed to safeguarding its guiding principles, the balance of power may be shifting from providers to citizens and "technocrats". Also, all provinces are likely to increase their pressure on physicians by means of salary caps, by exploring payment methods such as capitation, limiting access to costly technology, and by demanding practice changes based on evidence of cost-effectiveness.

  19. An "All-American" health reform proposal.

    Science.gov (United States)

    Reinhardt, U E

    1993-01-01

    Reforming the U.S. health care system is frequently thought of in absolutist terms: managed competition versus rate regulation; federal versus state administration; and business mandates versus individual insurance purchases. While these choices must be resolved over the long run, the transition to a new health care system will take several years and require more flexible solutions. The "All-American" Deal offers just that. It requires individual households to be insured and allows businesses to voluntarily offer health insurance; relies on the federal income tax system to collect income-based premiums and transfer funds to states through risk-adjusted payments; and lets states manage the disbursement of funds for uninsured residents.

  20. Massachusetts health reform: employer coverage from employees' perspective.

    Science.gov (United States)

    Long, Sharon K; Stockley, Karen

    2009-01-01

    The national health reform debate continues to draw on Massachusetts' 2006 reform initiative, with a focus on sustaining employer-sponsored insurance. This study provides an update on employers' responses under health reform in fall 2008, using data from surveys of working-age adults. Results show that concerns about employers' dropping coverage or scaling back benefits under health reform have not been realized. Access to employer coverage has increased, as has the scope and quality of their coverage as assessed by workers. However, premiums and out-of-pocket costs have become more of an issue for employees in small firms.

  1. The third sector, user involvement and public service reform: a case study in the co-governance of health service provision.

    Science.gov (United States)

    Martin, Graham P

    2011-01-01

    The ‘modernization’ of British public services seeks to broaden public sector governance networks, bringing the views of third sector organizations, the public and service users (among others) to the design, management and delivery of welfare. Building on previous analyses of the contradictions generated by these roles, this paper draws on longitudinal qualitative research to enunciate the challenges faced by one third-sector organization in facilitating service user influence in a UK National Health Service (NHS) pilot programme, alongside other roles in tension with this advocacy function. The analysis highlights limits in the extent to which lateral governance networks pluralize stakeholder involvement. The ‘framing’ of governance may mean that traditional concerns outweigh the views of new stakeholders such as the third sector and service users. Rather than prioritizing wider stakeholders' views in the design and delivery of public services, placing third sector organizations at the centre of governance networks may do more to co-opt these organizations in reproducing predominant priorities.

  2. [The history of the public health reform in Brazil and of the Sistema Único de Saúde: changes, continuities, and the current agenda].

    Science.gov (United States)

    Menicucci, Telma Maria Gonçalves

    2014-01-01

    The paper offers a historical retrospective of Brazil's Sistema Único de Saúde (SUS), including its background and its legacy on its current design. It begins describing some of the system's structural problems, especially the co-existence of a public system alongside a private one. It identifies problems that have hampered a firmer solidification of SUS, while it also highlights the immense import of establishing a unified, universal system in a country the size of Brazil. The discussion includes the effects of the system, which has represented a major change in the field of social rights, introducing new actors, and internalizing the notion of health as a right. Lastly, recent developments that have put SUS on the public agenda are discussed.

  3. 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

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

    Science.gov (United States)

    Arrieta, Alejandro

    2011-02-01

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

  5. 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.

  6. 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.

  7. Health reforms as examples of multilevel interventions in cancer care.

    Science.gov (United States)

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

    2012-05-01

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

  8. 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.

  9. 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.

  10. Health sector reforms for 21(st) century healthcare.

    Science.gov (United States)

    Shankar, Darshan

    2015-01-01

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

  11. 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...

  12. PPACA and public health: creating a framework to focus on prevention and wellness and improve the public's health.

    Science.gov (United States)

    Majette, Gwendolyn Roberts

    2011-01-01

    PPACA epitomizes comprehensive health care reform legislation. Public health, disease prevention, and wellness were integral considerations in its development. This article reveals the author's personal experiences while working on the framework for health care reform in the United States Senate and reviews activity in the United States House of Representatives. This insider's perspective delineates PPACA's positive effect on public health by examining the infrastructure Congress designed to focus on prevention, wellness, and public health, with a particular focus on the National Prevention, Health Promotion and Public Health Council; the National Prevention, Health Promotion, Public Health, and Integrative Health Care Strategy; and the Prevention and Public Health Fund. The Council, strategy, and fund are especially important because they reflect compliance with some of the Institute of Medicine's recommendations to improve public health in the United States, as well as international health and human rights norms that protect the right to health. © 2011 American Society of Law, Medicine & Ethics, Inc.

  13. [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

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

    Science.gov (United States)

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

    2012-01-01

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

  15. Health care reform and people with disabilities.

    Science.gov (United States)

    Batavia, A I

    1993-01-01

    As a group, people with disabilities or chronic conditions experience higher-than-average health care costs and have difficulty gaining access to affordable private health insurance coverage. While the Americans with Disabilities Act will enhance access by prohibiting differential treatment without sound actuarial justification, it will not guarantee equal access for people in impairment groups with high utilization rates. Health care reform is needed to subsidize the coverage of such individuals. Such subsidization can be achieved under either a casualty insurance model, in which premiums based on expected costs are subsidized directly, or a social insurance model, in which low-cost enrollees cross-subsidize high-cost enrollees. Cost containment provisions that focus on the provider, such as global budgeting and managed competition, will adversely affect disabled people if providers do not have adequate incentives to meet these people's needs. Provisions focusing on the consumer, such as cost sharing, case management, and benefit reductions, will adversely affect disabled people if they unduly limit needed services or impose a disproportionate financial burden on disabled people.

  16. Reforming primary healthcare: from public policy to organizational change.

    Science.gov (United States)

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

    2015-01-01

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

  17. Working on reform. How workers' compensation medical care is affected by health care reform.

    Science.gov (United States)

    Himmelstein, J; Rest, K

    1996-01-01

    The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies?

  18. 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.

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

    Science.gov (United States)

    Adams, Owen

    2015-09-04

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

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

    Science.gov (United States)

    Koornneef, Erik; Robben, Paul; Blair, Iain

    2017-09-20

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

  1. Market-oriented health care reforms: trends and future options.

    Science.gov (United States)

    van de Ven, W P

    1996-09-01

    In many (predominantly) publicly financed health care systems market-oriented health care reforms are being implemented or have been proposed. The purpose of these reforms is to make resource allocation in health care more efficient, more innovative and more responsive to consumers preferences while maintaining equity. At the same time, the advances in technology result in a divergence of consumers' preferences with respect to health care and urge society to (re)think about the meaning of the solidarity principle in health care. In this paper we indicate some international trends in health care reforms and explore some potential future options. From an international perspective we can observe a trend towards universal mandatory health insurance, contracts between third-party purchasers and the providers of care, competition among providers of care and a strengthening of primary care. These trends can be expected to continue. A more controversial issue is whether there should also be competition among the third-party purchasers and whether in the long run there will occur a convergence towards some "ideal" model. Although regulated competition in health care can be expected to yield more value for money, it might yield both more efficiency and higher total costs. It has been argued that equity can be maintained in a competitive health care system if we interpret equity as "equal access to cost-effective care within a reasonable period of time". Because the effectiveness of care has to be considered in relation to the medical indication and the condition of the patient, the responsibility for cost-effective care rests primarily with the providers of care. Guidelines and protocols should be developed by the profession and sustained by financial incentives embedded in contracts. It has been argued that the third-party purchasers could start to concentrate on the contracts with the primary care physicians. Contracts with other providers could then be a natural

  2. Investigating the interface between health system reform and HIV ...

    African Journals Online (AJOL)

    During the period in which the HIV/AIDS epidemic has taken hold in sub-Saharan Africa, health system reforms have and continue to be introduced throughout the region. In spite of the multidisciplinary research undertaken, it can be questioned whether the relationships between processes of reform and some of the critical ...

  3. Pigs in Public Health

    DEFF Research Database (Denmark)

    Svendsen, Mette N.

    2017-01-01

    of public health, made me re-evaluate both what ‘public’ and what ‘health’ means in public health. In this commentary I provide a short personal account of that intellectual journey. I argue that entanglements between species make it urgent that public health scholars investigate the moral, socio......Animals are rare topics in public health science texts and speech despite the fact that animal bodies and lives are woven into the health of human populations, and vice versa. Years of ethnographic and documentary research – following pigs and their humans in and out of biomedical research – made......-economic, material, and bacterial passages between humans and animals that constitute the various publics of public health and profoundly shape the health of human and animal populations in a globalized world....

  4. Transportation and public health.

    Science.gov (United States)

    Litman, Todd

    2013-01-01

    This article investigates various ways that transportation policy and planning decisions affect public health and better ways to incorporate public health objectives into transport planning. Conventional planning tends to consider some public health impacts, such as crash risk and pollution emissions measured per vehicle-kilometer, but generally ignores health problems resulting from less active transport (reduced walking and cycling activity) and the additional crashes and pollution caused by increased vehicle mileage. As a result, transport agencies tend to undervalue strategies that increase transport system diversity and reduce vehicle travel. This article identifies various win-win strategies that can help improve public health and other planning objectives.

  5. Physicians' Plan for a healthy Minnesota. The MMA proposal for health care reform. The report of the Minnesota Medical Association Health Care Reform Task Force.

    Science.gov (United States)

    2005-03-01

    The health care system in the United States, according to some, is on the verge of imploding. The rapidly rising cost of services is causing more and more Minnesotans to forego needed care. At the same time, the increasing costs are placing additional pressure on families, businesses, and state and local government budgets. The Minnesota Medical Association's (MMA) Health Care Reform Task Force has proposed a bold new approach that seeks to ensure affordable health care for all Minnesotans. The proposal is a roadmap to provide all Minnesotans with affordable insurance for essential health care services. In creating this plan, the task force strove to achieve three common reform goals: expand access to care, improve quality, and control costs. To achieve those ends, it has proposed a model built on four key features: (1) A strong public health system, (2) A reformed insurance market that delivers universal coverage, (3) A reformed health care delivery market that creates incentives for increasing value, (4) Systems that fully support the delivery of high-quality care. The task force believes that these elements will provide the foundation for a system that serves everyone and allows Minnesotans to purchase better health care at a relatively lower price. Why health care reform again? The average annual cost of health care for an average Minnesota household is about 11,000 dollars--an amount that's projected to double by 2010, if current trends continue. Real wages are not growing fast enough to absorb such cost increases. If unabated, these trends portend a reduction in access to and quality of care, and a heavier economic burden on individuals, employers, and the government. Furthermore, Minnesota and the United States are not getting the best value for their health care dollars. The United States spends 50 percent more per capita than any other country on health care but lags far behind other countries in the health measures of its population.

  6. Challenges to Public Health

    Indian Academy of Sciences (India)

    First page Back Continue Last page Graphics. Challenges to Public Health. Tracing of the infection. Isolation of patients to stop spread. Laboratory diagnosis. Hospitalization &Treatment. Stock pile & supply of drugs. Planning & mitigation. Information to public. Support to SEARO countries.

  7. Lighting and public health.

    NARCIS (Netherlands)

    Ierland, J. van & Schreuder, D.A.

    1969-01-01

    The following topics; are discussed with respect to public health: - the effect of visible and ultraviolet radiation upon man. - vision with respect to lighting. interior lighting. - artificial lighting of work environments. - day light and windows. - recommendations for lighting. public lighting. -

  8. The Public Understanding of Assessment in Educational Reform in the United States

    Science.gov (United States)

    Brookhart, Susan M.

    2013-01-01

    The United States education system depends on legislation and funding at the federal, state and local levels. Public understanding of assessment therefore is important to educational reform in the USA. Educational reformers often invoke assessment information as a reason for reform, typically by citing unacceptable achievement on some measure or…

  9. Putting "The System" into a School Autonomy Reform: The Case of the Independent Public Schools Program

    Science.gov (United States)

    Gobby, Brad

    2016-01-01

    The Australian Federal and state governments have been introducing neoliberal reforms to the governance of their education systems for a number of decades. One of the most recent programs of reform is the Western Australian Independent Public Schools (IPS) initiative. Similar to decentralizing reforms around the world, the IPS program seeks…

  10. Reducing Health Services for Refugees Through Reforms to the Interim Federal Health Program

    Directory of Open Access Journals (Sweden)

    Andrew C. Stevenson

    2018-04-01

    Full Text Available Since 1957 the Interim Federal Health Program (IFHP has provided temporary health care coverage to refugees and refugee claimants, but in 2012 the Conservative government reformed the IFHP, reducing, or eliminating access to health services for these groups. The government framed the changes around fairness and safety, stating that it would save tax payers $100 million over five years, reduce incentive for migrants with unfounded refugee claims from coming to Canada, protect public health and safety, and defend the integrity of the immigration system. With a Conservative majority, the reform was easily implemented despite a lack of evidence supporting these claims. In 2014, the Federal Court rejected the government's notion of fairness and safety, ruling that the cuts were cruel and unusual treatment of an already vulnerable population. The government appealed this ruling but, in 2016, the Liberals took power and restored funding to the IFHP to pre-2012 levels. Ad hoc evaluations predicted inequitable and adverse impacts on refugees, negative impacts on health, and increased costs to refugees, provincial governments, and health providers. Overall the threats and weaknesses of this reform clearly outweighed the few and unconvincing opportunities and strengths of the program, leading to its demise.

  11. Environmental Public Health Tracking

    Centers for Disease Control (CDC) Podcasts

    In this podcast series, CDC scientists address frequently asked questions about the National Environmental Public Health Tracking Network, including using and applying data, running queries, and much more.

  12. The anti-politics of health reform: household power relations and child health in rural Senegal.

    Science.gov (United States)

    Foley, Ellen E

    2009-04-01

    This article employs ethnographic evidence from rural Senegal to explore two dimensions of health sector reform. First, it makes the case that health reforms intersect with and exacerbate existing social, political, and economic inequalities. Current equity analysis draws attention to the ways that liberal and utilitarian frameworks for health reform fail to achieve distributive justice. The author's data suggest that horizontal power relations within households and small communities are equally important for understanding health disparities and the effects of health reform. Second, the article explores how liberal discourses of health reform, particularly calls for 'state-citizen partnerships' and 'responsiblization', promote depoliticised understandings of health. Discourses associated with health reform paradoxically highlight individual responsibility for health while masking the ways that individual health practice is constrained by structural inequalities.

  13. 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.

  14. Eight attention points when evaluating large-scale public sector reforms

    DEFF Research Database (Denmark)

    Hansen, Morten Balle; Breidahl, Karen Nielsen; Furubo, Jan-Eric

    2017-01-01

    This chapter analyses the challenges related to evaluations of large-scale public sector reforms. It is based on a meta-evaluation of the evaluation of the reform of the Norwegian Labour Market and Welfare Administration (the NAV-reform) in Norway, which entailed both a significant reorganization...... sector reforms. Based on the analysis, eight crucial points of attention when evaluating large-scale public sector reforms are elaborated. We discuss their reasons and argue that other countries will face the same challenges and thus can learn from the experiences of Norway....

  15. Child public health

    National Research Council Canada - National Science Library

    Blair, Mitch

    2010-01-01

    "Despite children making up around a quarter of the population, the first edition of this book was the first to focus on a public health approach to the health and sickness of children and young people...

  16. A public health perspective

    African Journals Online (AJOL)

    user

    EDITORIAL. Enabling local health departments to save more lives: A public ... promoting health through the organized efforts of society” (1) ... and synergistic with achieving the sustainable development goals because its furtherance brings a ...

  17. Public Management Reform without Managers: The Case of German Public Schools

    Science.gov (United States)

    Mintrop, Rick

    2015-01-01

    Purpose: The purpose of this paper is to discuss the role of principals in light of public management reforms taking place in the German educational system and in reference to the empirical patterns uncovered by the papers contained in the Special Issue. Policy makers have created new expectations and new technologies that seem to suggest to…

  18. Universal health insurance through incentives reform.

    Science.gov (United States)

    Enthoven, A C; Kronick, R

    1991-05-15

    Roughly 35 million Americans have no health care coverage. Health care expenditures are out of control. The problems of access and cost are inextricably related. Important correctable causes include cost-unconscious demand, a system not organized for quality and economy, market failure, and public funds not distributed equitably or effectively to motivate widespread coverage. We propose Public Sponsor agencies to offer subsidized coverage to those otherwise uninsured, mandated employer-provided health insurance, premium contributions from all employers and employees, a limit on tax-free employer contributions to employee health insurance, and "managed competition". Our proposed new government revenues equal proposed new outlays. We believe our proposal will work because efficient managed care does exist and can provide satisfactory care for a cost far below that of the traditional fee-for-service third-party payment system. Presented with an opportunity to make an economically responsible choice, people choose value for money; the dynamic created by these individual choices will give providers strong incentives to render high-quality, economical care. We believe that providers will respond to these incentives.

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

    Directory of Open Access Journals (Sweden)

    Widström Eeva

    2008-01-01

    Full Text Available Abstract Background In Finland, dental services are provided by a public (PDS and a private sector. In the past, children, young adults and special needs groups were entitled to care and treatment from the public dental services (PDS. A major reform in 2001 – 2002 opened the PDS and extended subsidies for private dental services to all adults. It aimed to increase equity by improving adults' access to oral health care and reducing cost barriers. The aim of this study was to assess the impacts of the reform on the utilization of publicly funded and private dental services, numbers and distribution of personnel and costs in 2000 and in 2004, before and after the oral health care reform. An evaluation was made of how the health political goals of the reform: integrating oral health care into general health care, improving adults' access to care and lowering cost barriers had been fulfilled during the study period. Methods National registers were used as data sources for the study. Use of dental services, personnel resources and costs in 2000 (before the reform and in 2004 (after the reform were compared. Results In 2000, when access to publicly subsidised dental services was restricted to those born in 1956 or later, every third adult used the PDS or subsidised private services. By 2004, when subsidies had been extended to the whole adult population, this increased to almost every second adult. The PDS reported having seen 118 076 more adult patients in 2004 than in 2000. The private sector had the same number of patients but 542 656 of them had not previously been entitled to partial reimbursement of fees. The use of both public and subsidised private services increased most in big cities and urban municipalities where access to the PDS had been poor and the number of private practitioners was high. The PDS employed more dentists (6.5% and the number of private practitioners fell by 6.9%. The total dental care expenditure (PDS plus private

  20. [Economic problems in military public health].

    Science.gov (United States)

    Petrov, G M; Moretskiĭ, A A

    2000-03-01

    There are discussed the problems of military treatment and prophylactic institution (TPI) functioning under conditions of market reform of Russian public health. Main marketing concepts in military health are determined and some recommendations on work improvement in TPI of the Armed Forces in the system of obligatory medical insurance are presented, granting population paid medical services. It is necessary to form a new type of director--military and medical manager.

  1. 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

  2. Public health and Plowshare

    Energy Technology Data Exchange (ETDEWEB)

    Terrill, Jr, J G [Consumer Protection and Environmental Health Service, U.S. PubIic Health Service, Washington, DC (United States)

    1969-07-01

    The protection of public health and safety is a principal area of concern in any application of nuclear energy. A health and safety analysis must be conducted and reviewed by appropriate agencies and the final results made available to interested agencies and groups, both public and private, prior to the application. This is especially important for the Plowshare Program - the peaceful uses of nuclear explosives - where the public is to be the ultimate beneficiary. Because public health must be a primary concern in the Plowshare Program, it is essential that the potential risk be weighed against the expected benefits to the public. Public health agencies must play an increasingly important role in the planning and operational stages of the peaceful applications of nuclear explosives and in the final stage of consumer use of Plowshare-generated products. There are many long term and long distance ramifications of the Plowshare Program, such a the potential radiological contamination of consumer products that may reach the consumer at long times after the event or at great distances from the site of the event. Criteria for evaluating public exposure to radiation from these products need to be developed based on sound scientific research. Standards for radioactivity in consumer products must be developed in relation to potential exposure of the public. Above all, a clear benefit to the public with a minimum of risk must be shown. The major purpose of this Symposium on the Public Health Aspects of Peaceful Uses of Nuclear-Explosives is to focus attention on the health and safety aspects, present the results of safety analyses accomplished to date and other information necessary to an understanding of the public health aspects, and to identify areas where additional research is required. A general overview of the total symposium content is presented with emphasis on the relationship of the topics to public health. (author)

  3. Public health and Plowshare

    International Nuclear Information System (INIS)

    Terrill, J.G. Jr.

    1969-01-01

    The protection of public health and safety is a principal area of concern in any application of nuclear energy. A health and safety analysis must be conducted and reviewed by appropriate agencies and the final results made available to interested agencies and groups, both public and private, prior to the application. This is especially important for the Plowshare Program - the peaceful uses of nuclear explosives - where the public is to be the ultimate beneficiary. Because public health must be a primary concern in the Plowshare Program, it is essential that the potential risk be weighed against the expected benefits to the public. Public health agencies must play an increasingly important role in the planning and operational stages of the peaceful applications of nuclear explosives and in the final stage of consumer use of Plowshare-generated products. There are many long term and long distance ramifications of the Plowshare Program, such a the potential radiological contamination of consumer products that may reach the consumer at long times after the event or at great distances from the site of the event. Criteria for evaluating public exposure to radiation from these products need to be developed based on sound scientific research. Standards for radioactivity in consumer products must be developed in relation to potential exposure of the public. Above all, a clear benefit to the public with a minimum of risk must be shown. The major purpose of this Symposium on the Public Health Aspects of Peaceful Uses of Nuclear-Explosives is to focus attention on the health and safety aspects, present the results of safety analyses accomplished to date and other information necessary to an understanding of the public health aspects, and to identify areas where additional research is required. A general overview of the total symposium content is presented with emphasis on the relationship of the topics to public health. (author)

  4. Private sector health reform in South Africa.

    Science.gov (United States)

    Van Den Heever, A M

    1998-06-01

    This paper discusses some of the trends, debates and policy proposals in relation to the financing of the private health sector in South Africa. The public and private sectors in South Africa are of equivalent size in terms of overall expenditure, but cover substantially different population sizes. Within this context the government has reached the unavoidable conclusion that the private sector has to play some role in ensuring that equity, access and efficiency objectives are achieved for the health system as a whole. However, the private sector is some way off from taking on this responsibility. Substantial increases in per capita costs over the past 15 years, coupled with a degree of deregulation by the former government, have resulted in increasing instability and volatility. The development of a very competitive medical scheme (health insurance) market reinforced by intermediaries with commercial interests has accelerated trends toward excluding high health risks from cover. The approach taken by the government has been to define a new environment which leaves the market open for extensive competition, but removes from schemes the ability to compete by discriminating against high health risks. The only alternatives left to the private market, policy makers hope, will be to go out of business, or to survive through productivity improvements.

  5. 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.

  6. An analysis of policy levers used to implement mental health reform in Australia 1992-2012.

    Science.gov (United States)

    Grace, Francesca C; Meurk, Carla S; Head, Brian W; Hall, Wayne D; Carstensen, Georgia; Harris, Meredith G; Whiteford, Harvey A

    2015-10-24

    Over the past two decades, mental health reform in Australia has received unprecedented government attention. This study explored how five policy levers (organisation, regulation, community education, finance and payment) were used by the Australian Federal Government to implement mental health reforms. Australian Government publications, including the four mental health plans (published in 1992, 1998, 2003 and 2008) were analysed according to policy levers used to drive reform across five priority areas: [1] human rights and community attitudes; [2] responding to community need; [3] service structures; [4] service quality and effectiveness; and [5] resources and service access. Policy levers were applied in varying ways; with two or three levers often concurrently used to implement a single initiative or strategy. For example, changes to service structures were achieved using various combinations of all five levers. Attempts to improve service quality and effectiveness were instead made through a single lever-regulation. The use of some levers changed over time, including a move away from prescriptive, legislative use of regulation, towards a greater focus on monitoring service standards and consumer outcomes. Patterns in the application of policy levers across the National Mental Health Strategy, as identified in this analysis, represent a novel way of conceptualising the history of mental health reform in Australia. An improved understanding of the strategic targeting and appropriate utilisation of policy levers may assist in the delivery and evaluation of evidence-based mental health reform in the future.

  7. Issues in public health

    National Research Council Canada - National Science Library

    Sim, Fiona; McKee, Martin

    2011-01-01

    ..., there is increasing understanding of the inevitable limits of individual health care and of the need to complement such services with effective public health strategies. Major improvements in people's health will come from controlling communicable diseases, eradicating environmental hazards, improving people's diets and enhancing the availability ...

  8. 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.

  9. Public Sector Reform: Which way are we headed? An overview of recent literature and research

    NARCIS (Netherlands)

    Vries, M.S. de; Nemec, J.; Spalkova, D.; Furova, L.

    2012-01-01

    This paper investigates recent literature and research on public sector reform and aims to answer the question to what degree public administration systems and reforms are still influenced by recommendations flowing from the NPM tradition. This paper distinguishes two dimensions of NPM: the internal

  10. 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…

  11. Legal Limitations on Public Pension Plan Reform. Conference Paper 2009-08

    Science.gov (United States)

    Monahan, Amy B.

    2009-01-01

    There is significant interest in reforming retirement plans for public school employees, particularly in light of current market conditions. This paper presents an overview of the various types of state regulation of public pension plans that affect possibilities for reform. Several states have legal protections that effectively prevent a state…

  12. 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

  13. [Using the concept of universal health coverage to promote the health system reform in China].

    Science.gov (United States)

    Hu, S L

    2016-11-06

    The paper is systematically explained the definition, contents of universal health coverage (UHC). Universal health coverage calls for all people to have access to quality health services they need without facing undue financial burden. The relationship between five main attributes, i.e., quality, efficiency, equity, accountability and resilience, and their 15 action plans has been explained. The nature of UHC is belonged to the State and government. The core function is commitment with equality. The whole-of-system method is used to promoting the health system reform. In China, the universal health coverage has been reached to the preliminary achievements, which include universal coverage of social medical insurance, basic medical services, basic public health services, and the provision of essential medicines. China has completed millennium development goals (MDG) and is being stepped to the sustainable development goals (SDG).

  14. 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.

  15. Regulatory system reform of occupational health and safety in China.

    Science.gov (United States)

    Wu, Fenghong; Chi, Yan

    2015-01-01

    With the explosive economic growth and social development, China's regulatory system of occupational health and safety now faces more and more challenges. This article reviews the history of regulatory system of occupational health and safety in China, as well as the current reform of this regulatory system in the country. Comprehensive, a range of laws, regulations and standards that promulgated by Chinese government, duties and responsibilities of the regulatory departments are described. Problems of current regulatory system, the ongoing adjustments and changes for modifying and improving regulatory system are discussed. The aim of reform and the incentives to drive forward more health and safety conditions in workplaces are also outlined.

  16. Wofford-Thornburgh: a turning point for health reform.

    Science.gov (United States)

    Tokarski, C

    1992-01-01

    The November 5 special election in Pennsylvania pitting appointed Senator Harris Wofford against former U.S. Attorney General Richard Thornburgh was a turning point in the national debate over health reform. Under the glare of media spotlights, Wofford mounted a come-from-behind victory over the heavily favored Thornburgh by trumpeting "national health insurance." Since Wofford's victory, President Bush has rethought his previous indifference to health reform and promised to announce a comprehensive plan in January, more than a year ahead of schedule.

  17. Public health and peace.

    Science.gov (United States)

    Laaser, Ulrich; Donev, Donco; Bjegović, Vesna; Sarolli, Ylli

    2002-04-01

    The modern concept of public health, the New Public Health, carries a great potential for healthy and therefore less aggressive societies. Its core disciplines are health promotion, environmental health, and health care management based on advanced epidemiological methodologies. The main principles of living together in healthy societies can be summarized as four ethical concepts of the New Public Health essential to violence reduction equity, participation, subsidiarity, and sustainability. The following issues are discussed as violence determinants: the process of urbanization; type of neighborhood and accommodation, and consequent stigmatization; level of education; employment status; socialization of the family; women's status; alcohol and drug consumption; availability of the firearms; religious, ethnic, and racial prejudices; and poverty. Development of the health systems has to contribute to peace, since aggression, violence, and warfare are among the greatest risks for health and the economic welfare. This contribution can be described as follows: 1) full and indiscriminate access to all necessary services, 2) monitoring of their quality, 3) providing special support to vulnerable groups, and 4) constant scientific and public accountability of the evaluation of the epidemiological outcome. Violence can also destroy solidarity and social cohesion of groups, such as family, team, neighborhood, or any other social organization. Durkheim coined the term anomie for a state in which social disruption of the community results in health risks for individuals. Health professionals can make a threefold contribution to peace by 1) analyzing the causal interrelationships of violence phenomena, 2) curbing the determinants of violence according to the professional standards, and 3) training professionals for this increasingly important task. Because tolerance is an essential part of an amended definition of health, monitoring of the early signs of public intolerance is

  18. Stakeholder learning for health sector reform in Lao PDR.

    Science.gov (United States)

    Phillips, Simone; Pholsena, Soulivanh; Gao, Jun; Oliveira Cruz, Valeria

    2016-09-01

    Development organizations and academic institutions have expressed the need for increased research to guide the development and implementation of policies to strengthen health systems in low- and middle-income countries. The extent to which evidence-based policies alone can produce changes in health systems remains a point of debate; other factors, such as a country's political climate and the level of actor engagement, have been identified as influential variables in effective policy development and implementation. In response to this debate, this article contends that the success of health sector reform depends largely on policy learning-the degree to which research recommendations saturate a given political environment in order to successfully inform the ideas, opinions and perceived interests of relevant actors. Using a stakeholder analysis approach to analyze the case of health sector reform in Lao PDR, we examine the ways that actors' understanding and interests affect the success of reform-and how attitudes towards reform can be shaped by exposure to policy research and international health policy priorities. The stakeholder analysis was conducted by the WHO during the early stages of health sector reform in Lao PDR, with the purpose of providing the Ministry of Health with concrete recommendations for increasing actor involvement and strengthening stakeholder support. We found that dissemination of research findings to a broad array of actors and the inclusion of diverse stakeholder groups in policy design and implementation increases the probability of a sustainable and successful health sector reform. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Children's Health Publications

    Science.gov (United States)

    Each title has a brief description and link for downloading the full text. Includes the publications catalog, the Child Health Champion resource guide, student curriculum materials, reports, fact sheets, and booklets/brochures of advice and tools.

  20. Global public health today: connecting the dots

    Directory of Open Access Journals (Sweden)

    Marta Lomazzi

    2016-02-01

    Full Text Available Background: Global public health today faces new challenges and is impacted by a range of actors from within and outside state boundaries. The diversity of the actors involved has created challenges and a complex environment that requires a new context-tailored global approach. The World Federation of Public Health Associations has embarked on a collaborative consultation with the World Health Organization to encourage a debate on how to adapt public health to its future role in global health. Design: A qualitative study was undertaken. High-level stakeholders from leading universities, multilateral organizations, and other institutions worldwide participated in the study. Inductive content analyses were performed. Results: Stakeholders underscored that global public health today should tackle the political, commercial, economic, social, and environmental determinants of health and social inequalities. A multisectoral and holistic approach should be guaranteed, engaging public health in broad dialogues and a concerted decision-making process. The connection between neoliberal ideology and public health reforms should be taken into account. The WHO must show leadership and play a supervising and technical role. More and better data are required across many programmatic areas of public health. Resources should be allocated in a sustainable and accountable way. Public health professionals need new skills that should be provided by a collaborative global education system. A common framework context-tailored to influence governments has been evaluated as useful. Conclusions: The study highlighted some of the main public health challenges currently under debate in the global arena, providing interesting ideas. A more inclusive integrated vision of global health in its complexity, shared and advocated for by all stakeholders involved in decision-making processes, is crucial. This vision represents the first step in innovating public health at the

  1. Global public health today: connecting the dots

    Science.gov (United States)

    Lomazzi, Marta; Jenkins, Christopher; Borisch, Bettina

    2016-01-01

    Background Global public health today faces new challenges and is impacted by a range of actors from within and outside state boundaries. The diversity of the actors involved has created challenges and a complex environment that requires a new context-tailored global approach. The World Federation of Public Health Associations has embarked on a collaborative consultation with the World Health Organization to encourage a debate on how to adapt public health to its future role in global health. Design A qualitative study was undertaken. High-level stakeholders from leading universities, multilateral organizations, and other institutions worldwide participated in the study. Inductive content analyses were performed. Results Stakeholders underscored that global public health today should tackle the political, commercial, economic, social, and environmental determinants of health and social inequalities. A multisectoral and holistic approach should be guaranteed, engaging public health in broad dialogues and a concerted decision-making process. The connection between neoliberal ideology and public health reforms should be taken into account. The WHO must show leadership and play a supervising and technical role. More and better data are required across many programmatic areas of public health. Resources should be allocated in a sustainable and accountable way. Public health professionals need new skills that should be provided by a collaborative global education system. A common framework context-tailored to influence governments has been evaluated as useful. Conclusions The study highlighted some of the main public health challenges currently under debate in the global arena, providing interesting ideas. A more inclusive integrated vision of global health in its complexity, shared and advocated for by all stakeholders involved in decision-making processes, is crucial. This vision represents the first step in innovating public health at the global level and should lead

  2. Public Benefits and Power Sector Reform. Report from an International Workshop

    Energy Technology Data Exchange (ETDEWEB)

    Nilsson, Lars J.; Arvidson, Anders; Eberhard, Anton (eds.)

    2003-10-01

    The Workshop on Public Benefits and Power Sector Reform was motivated by the need to address broader development goals and advance the provision of public benefits in power sector reforms. The primary objectives were: To provide a forum for a discussion among specialists, of how the provision of public benefits can be expanded as power sectors in developing countries are reformed, and review the experience (Day 1). To identify the needs for training and capacity building and institutional arrangements, as well as make recommendations for their design and implementation, for policy makers, regulators, and other professionals in developing countries (Day 2). Public benefits is a socially constructed concept that includes activities that are not adequately conceived by competitive markets. Public benefit policies and programmes include those that expand electricity access to rural areas and the urban poor, improve security of supply, promote energy efficiency and renewable energy, etc. Reforms have indeed been a threat to public benefits as traditionally delivered through electric utilities. However, in many cases public benefit programmes have also been rescued. In fewer cases, public benefit programmes have been conceived in the reform process. From experience so far it is clear that power sector reforms must be made more compatible with broader sustainable development goals. Recognising the need for broader policy integration and putting public benefits higher on the reform agenda points to the importance of reaching beyond energy ministries and power sector experts at an early stage in the reform process. Other actors, such as NGOs and academia, may also be instrumental in monitoring and assessing the impacts of reform. Public benefits can be an integral part of a reform package, or a complement to reform. It does appear that reform creates space and opportunity to achieve public benefits, but someone has to utilise that opportunity. The need to make trade

  3. Public Benefits and Power Sector Reform. Report from an International Workshop

    International Nuclear Information System (INIS)

    Nilsson, Lars J.; Arvidson, Anders; Eberhard, Anton

    2003-10-01

    The Workshop on Public Benefits and Power Sector Reform was motivated by the need to address broader development goals and advance the provision of public benefits in power sector reforms. The primary objectives were: To provide a forum for a discussion among specialists, of how the provision of public benefits can be expanded as power sectors in developing countries are reformed, and review the experience (Day 1). To identify the needs for training and capacity building and institutional arrangements, as well as make recommendations for their design and implementation, for policy makers, regulators, and other professionals in developing countries (Day 2). Public benefits is a socially constructed concept that includes activities that are not adequately conceived by competitive markets. Public benefit policies and programmes include those that expand electricity access to rural areas and the urban poor, improve security of supply, promote energy efficiency and renewable energy, etc. Reforms have indeed been a threat to public benefits as traditionally delivered through electric utilities. However, in many cases public benefit programmes have also been rescued. In fewer cases, public benefit programmes have been conceived in the reform process. From experience so far it is clear that power sector reforms must be made more compatible with broader sustainable development goals. Recognising the need for broader policy integration and putting public benefits higher on the reform agenda points to the importance of reaching beyond energy ministries and power sector experts at an early stage in the reform process. Other actors, such as NGOs and academia, may also be instrumental in monitoring and assessing the impacts of reform. Public benefits can be an integral part of a reform package, or a complement to reform. It does appear that reform creates space and opportunity to achieve public benefits, but someone has to utilise that opportunity. The need to make trade

  4. Toward an Anthropology of Insurance and Health Reform: An Introduction to the Special Issue.

    Science.gov (United States)

    Dao, Amy; Mulligan, Jessica

    2016-03-01

    This article introduces a special issue of Medical Anthropology Quarterly on health insurance and health reform. We begin by reviewing anthropological contributions to the study of financial models for health care and then discuss the unique contributions offered by the articles of this collection. The contributors demonstrate how insurance accentuates--but does not resolve tensions between granting universal access to care and rationing limited resources, between social solidarity and individual responsibility, and between private markets and public goods. Insurance does not have a single meaning, logic, or effect but needs to be viewed in practice, in context, and from multiple vantage points. As the field of insurance studies in the social sciences grows and as health reforms across the globe continue to use insurance to restructure the organization of health care, it is incumbent on medical anthropologists to undertake a renewed and concerted study of health insurance and health systems. © 2016 by the American Anthropological Association.

  5. 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.

  6. The global context for public health nutrition taxation.

    Science.gov (United States)

    Thow, Anne Marie; Heywood, Peter; Leeder, Stephen; Burns, Lee

    2011-01-01

    To assess critically the scope for public health nutrition taxation within the framework of the global tax reform agenda. Review of the tax policy literature for global policy priorities relevant to public health nutrition taxation; critical analysis of proposals for public health nutrition taxation judged against the global agenda for tax reform. The global tax reform agenda shapes decisions of tax policy makers in all countries. By understanding this agenda, public health nutritionists can make feasible taxation proposals and thus improve the development, uptake and implementation of recommendations for nutrition-related taxation. The priorities of the global tax reform agenda relevant to public health nutrition taxation are streamlining of taxes, adoption of value-added tax (VAT), minimisation of excise taxes (except to correct for externalities) and removal of import taxes in line with trade liberalisation policies. Proposals consistent with the global tax reform agenda have included excise taxes, extension of VAT to currently exempted (unhealthy) foods and tariff reductions for healthy foods. Proposals for public health nutrition taxation should (i) use existing types and rates of taxes where possible, (ii) use excise taxes that specifically address externalities, (iii) avoid differential VAT on foods and (iv) use import taxes in ways that comply with trade liberalisation priorities.

  7. GIS and Public Health

    Directory of Open Access Journals (Sweden)

    Stefania Bertazzon

    2014-06-01

    Full Text Available This Special Issue on GIS and public health is the result of a highly selective process, which saw the participation of some 20 expert peer-reviewers and led to the acceptance of one half of the high-quality submissions received over the past year. Many threads link these papers to each other and, indeed, to our original call for papers, but the element that most clearly emerges from these works is the inextricable connection between public health and the environment. Indeed, GIS analysis of public health simply cannot disregard the geospatial dimension of environmental resources and risks. What consistently emerges from these analyses is that current geospatial research can only scratch the surface of the complex interactions of spatial resources, risks, and public health. In today’s world, or at least in the developed world, researchers and practitioners can count on virtually endless data, on inexpensive computational power, and on seamless connectivity. In this research environment, these papers point to the need for improved analytical tools, covering concepts, representation, modeling and reliability. These works are important contributions that help us to identify what advances in geospatial analysis can better address the complex interactions of public health with our physical and cultural environment, and bridge research and practice, so that geospatial analyses can inform public health policy making. [...

  8. Ethical and Human Rights Foundations of Health Policy: Lessons from Comprehensive Reform in Mexico.

    Science.gov (United States)

    Frenk, Julio; Gómez-Dantés, Octavio

    2015-12-10

    This paper discusses the use of an explicit ethical and human rights framework to guide a reform intended to provide universal and comprehensive social protection in health for all Mexicans, independently of their socio-economic status or labor market condition. This reform was designed, implemented, and evaluated by making use of what Michael Reich has identified as the three pillars of public policy: technical, political, and ethical. The use of evidence and political strategies in the design and negotiation of the Mexican health reform is briefly discussed in the first part of this paper. The second part examines the ethical component of the reform, including the guiding concept and values, as well as the specific entitlements that gave operational meaning to the right to health care that was enshrined in Mexico's 1983 Constitution. The impact of this rights-based health reform, measured through an external evaluation, is discussed in the final section. The main message of this paper is that a clear ethical framework, combined with technical excellence and political skill, can deliver major policy results. Copyright © 2015 Frenk and Gómez-Dantés. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

  9. The History and Future of Neoliberal Health Reform: Obamacare and Its Predecessors.

    Science.gov (United States)

    Waitzkin, Howard; Hellander, Ida

    2016-10-01

    The Colombian reform of 1994, through a strange historical sequence, became a model for health reform in Latin America, Europe, and the United States. Officially, the reform aimed to improve access for the uninsured and underinsured, in collaboration with the private, for-profit insurance industry. After several historical attempts at health reform adhering to the neoliberal pattern, favored by international financial institutions and multinational insurance corporations, the Affordable Care Act (ACA) similarly enhanced access by corporations to public-sector trust funds. An ideology favoring for-profit corporations in the marketplace justified these reforms through unproven claims about the efficiency of the private sector and enhanced quality of care under principles of competition and business management. The ACA maintains this historical continuity by dealing with health care as a commodity bought and sold in a marketplace, rather than a fundamental human right to be guaranteed according to principles of social solidarity. As the ACA heads toward probable failure, a space finally will open for a U.S. national health program that does not follow same historical patterns of the neoliberal model. © The Author(s) 2016.

  10. 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

  11. Health services reform in Bangladesh: hearing the views of health workers and their professional bodies.

    Science.gov (United States)

    Cockcroft, Anne; Milne, Deborah; Oelofsen, Marietjie; Karim, Enamul; Andersson, Neil

    2011-12-21

    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. 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). 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 please patients instead of giving medically

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

    Science.gov (United States)

    Saltman, Richard B

    2018-01-24

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

  13. Experiences and Lessons from Urban Health Insurance Reform in China.

    Science.gov (United States)

    Xin, Haichang

    2016-08-01

    Health care systems often face competing goals and priorities, which make reforms challenging. This study analyzed factors influencing the success of a health care system based on urban health insurance reform evolution in China, and offers recommendations for improvement. Findings based on health insurance reform strategies and mechanisms that did or did not work can effectively inform improvement of health insurance system design and practice, and overall health care system performance, including equity, efficiency, effectiveness, cost, finance, access, and coverage, both in China and other countries. This study is the first to use historical comparison to examine the success and failure of China's health care system over time before and after the economic reform in the 1980s. This study is also among the first to analyze the determinants of Chinese health system effectiveness by relating its performance to both technical reasons within the health system and underlying nontechnical characteristics outside the health system, including socioeconomics, politics, culture, values, and beliefs. In conclusion, a health insurance system is successful when it fits its social environment, economic framework, and cultural context, which translates to congruent health care policies, strategies, organization, and delivery. No health system can survive without its deeply rooted socioeconomic environment and cultural context. That is why one society should be cautious not to radically switch from a successful model to an entirely different one over time. There is no perfect health system model suitable for every population-only appropriate ones for specific nations and specific populations at the right place and right time. (Population Health Management 2016;19:291-297).

  14. 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.

  15. Financing reform and structural change in the health services industry.

    Science.gov (United States)

    Higgins, C W; Phillips, B U

    1986-08-01

    This paper reviews the major trends in financing reform, emphasizing their impact on those characteristics of the market for health services that economists have viewed as monopolistic, and discusses the implications of structural change for the allied health professions. Hopefully, by understanding the fundamental forces of change and responding to uncertainty with flexibility and imagination, the allied health professions can capitalize on the opportunities afforded by structural change. Overall, these trends should result in the long-term outlook for use of allied health services to increase at an average annual rate of 9% to 10%. Allied health professionals may also witness an increase in independent practice opportunities. Finally, redistribution of jobs will likely occur in favor of outpatient facilities, home health agencies, and nontraditional settings. This in turn will have an impact on allied health education, which will need to adapt to these types of reforms.

  16. Perceived affordability of health insurance and medical financial burdens five years in to Massachusetts health reform.

    Science.gov (United States)

    Zallman, Leah; Nardin, Rachel; Sayah, Assaad; McCormick, Danny

    2015-10-29

    Under the Massachusetts health reform, low income residents (those with incomes below 150 % of the Federal Poverty Level [FPL]) were eligible for Medicaid and health insurance exchange-based plans with minimal cost-sharing and no premiums. Those with slightly higher incomes (150 %-300 % FPL) were eligible for exchange-based plans that required cost-sharing and premium payments. We conducted face to face surveys in four languages with a convenience sample of 976 patients seeking care at three hospital emergency departments five years after Massachusetts reform. We compared perceived affordability of insurance, financial burden, and satisfaction among low cost sharing plan recipients (recipients of Medicaid and insurance exchange-based plans with minimal cost-sharing and no premiums), high cost sharing plan recipients (recipients of exchange-based plans that required cost-sharing and premium payments) and the commercially insured. We found that despite having higher incomes, higher cost-sharing plan recipients were less satisfied with their insurance plans and perceived more difficulty affording their insurance than those with low cost-sharing plans. Higher cost-sharing plan recipients also reported more difficulty affording medical and non-medical health care as well as insurance premiums than those with commercial insurance. In contrast, patients with low cost-sharing public plans reported higher plan satisfaction and less financial concern than the commercially insured. Policy makers with responsibility for the benefit design of public insurance available under health care reforms in the U.S. should calibrate cost-sharing to income level so as to minimize difficulty affording care and financial burdens.

  17. The rise and fall of democratic universalism: health care reform in Italy, 1978-1994.

    Science.gov (United States)

    Ferrera, M

    1995-01-01

    In 1978, a sweeping reform created the first national health service of continental Europe: Italy's Servizio Sanitario Nazionale. This new scheme was based on the principle of "full democratic universalism": The state would provide free and equal benefits to every citizen and the organization of public health would subject to popular control, essentially through political parties. However, the severe problems encountered in implementing the reform design and rapidly increasing health expenditures soon eroded any consensus on this principle. Thus the 1980s and early 1990s witnessed a gradual shift to "conditional and well managed universalism." These latter principles stress the need to differentiate access to care according to some criterion to regulate demand and the need for efficient use of scarce resources through adequate valorization of managerial skills and the use of "market-type" incentives. An elaborated system of user copayments was introduced gradually, and in 1992 a "reform of the reform" profoundly changed the organizational framework of the Servizio Sanitario Nazionale. The new government elected in the spring of 1994 announced ambitious plans to partially dismantle public universal insurance. Although these plans may prove difficult, the potential to form an anti-universalistic coalition seems strong in the contemporary Italian health care arena.

  18. Translating the human right to water and sanitation into public policy reform.

    Science.gov (United States)

    Meier, Benjamin Mason; Kayser, Georgia Lyn; Kestenbaum, Jocelyn Getgen; Amjad, Urooj Quezon; Dalcanale, Fernanda; Bartram, Jamie

    2014-12-01

    The development of a human right to water and sanitation under international law has created an imperative to implement human rights in water and sanitation policy. Through forty-three interviews with informants in international institutions, national governments, and non-governmental organizations, this research examines interpretations of this new human right in global governance, national policy, and local practice. Exploring obstacles to the implementation of rights-based water and sanitation policy, the authors analyze the limitations of translating international human rights into local water and sanitation practice, concluding that system operators, utilities, and management boards remain largely unaffected by the changing public policy landscape for human rights realization. To understand the relevance of human rights standards to water and sanitation practitioners, this article frames a research agenda to ensure that human rights aspirations lead to public policy reforms and public health outcomes.

  19. The Public Manager, the Structure of Public Institution, and Implementation: The 2002-2012 Finnish Senior Bureaucratic Manager Reform

    Science.gov (United States)

    Mukhtar, Mohammed Ibn

    2015-01-01

    Public management and administration today is about crafting, structuring and instituting. Structuration is a very integral part of all organisations. Unlike the gradualist approach, structural reform transforms the dominant system touching on main elements. Structural reform had largely come and gone without necessarily touching on some public…

  20. Public Management Reform and Organizational Performance: An Empirical Assessment of the U.K. Labour Government's Public Service Improvement Strategy

    Science.gov (United States)

    Walker, Richard M.; Boyne, George A.

    2006-01-01

    We present the first empirical assessment of the U.K. Labour government's program of public management reform. This reform program is based on rational planning, devolution and delegation, flexibility and incentives, and enhanced choice. Measures of these variables are tested against external and internal indicators of organizational performance.…

  1. Patient Protection and Affordable Care Act of 2010: reforming the health care reform for the new decade.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Caraway, David L; Parr, Allan T; Fellows, Bert; Hirsch, Joshua A

    2011-01-01

    accounted for, we will be facing a significant increase in deficits rather than a reduction. When posed as a global question, polls suggest that public opinion continues to be against the health insurance reform. The newly elected Republican congress is poised to pass a bill aimed at repealing health care reform. However, advocates of the repeal of health care reform have been criticized for not providing a meaningful alternative approach. Those criticisms make clear that it is not sufficient to provide vague arguments against the ACA without addressing core issues embedded in health care reform. It is the opinion of the authors that while some parts of the ACA may be reformed, it is unlikely to be repealed. Indeed, the ACA already is growing roots. Consequently, it will be extremely difficult to repeal. In this manuscript, we look at reducing the regulatory burden on the public and providers and elimination of IPAB and PCORI. The major solution lies in controlling the drug and durable medical supply costs with appropriate negotiating capacity for Medicare, and consequently for other insurers.

  2. Public mental health.

    Science.gov (United States)

    Lindert, Jutta; Bilsen, Johan; Jakubauskiene, Marija

    2017-10-01

    Public mental health (PMH) is a major challenge for public health research and practice. This article is organized in six parts. First, we will highlight the significance of PMH; second, we will define mental health and mental disorders; third, we identify and describe determinants of mental health and mental disorders on which we worked in the past 10 years since the establishment of the PMH section such as social determinants and violence. Fourth, we will describe the development of the EUPHA PMH section and provide details on vulnerable groups in the field of PMH, on violence as a main determinant and on suicide as an outcome which affects all countries in the European region. Fifth, we describe policy and practice implications of the development of PMH and highlight the European dimension of PMH. We will conclude this article by providing an outlook on potential further development of PMH as regards research and policy and practice. Finally, we hope that the EUPHA PMH section will contribute to public health in the next 25 years and we can contribute to improvement of PMH in Europe. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  3. 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

  4. PROPOSAL REGARDING THE REFORMATION OF THE ROMANIAN PUBLIC PENSION SYSTEM

    Directory of Open Access Journals (Sweden)

    Nicolae ECOBICI

    2016-06-01

    Full Text Available The social insurance system from Romania, reformed continuously since the 90`s, is undergoing a period of serious crisis, with huge and growing deficits, while being far from the principle of social reasonability. Similar situations are found also internationally. The paper aims to answer the following question: how could we implement the principle "equality between present and future generations"? Taking into account the data provided by the National Institute of Statistics from Romania, Eurostat, the World Bank and EU regarding: developments in the birth rate, the number of contributors, life expectancy, the forecasts made in Romania, but also internationally, on sustainability and reasonability of public pension systems, are pessimistic. This paper proposes a solution as simple as it is effective. Why could it not exist in Romania a decent unique minimum pension linked to a decent minimum wage through the mandatory pension contribution rates? Why the welfare of pensioners in 2065 must depend on the existing number of employees in 2065, particularly given the pessimistic demographic forecasts that indicate a population decrease of 20% since 2060? The current PAYG pension system it will not be sustainable in future. Therefore it has to be changed.

  5. Impact of ACA Health Reforms for People With Mental Health Conditions.

    Science.gov (United States)

    Thomas, Kathleen C; Shartzer, Adele; Kurth, Noelle K; Hall, Jean P

    2018-02-01

    This brief report explores the impact of health reform for people with mental illness. The Health Reform Monitoring Survey was used to examine health insurance, access to care, and employment for 1,550 people with mental health conditions pre- and postimplementation of the Affordable Care Act (ACA) and by state Medicaid expansion status. Multivariate logistic regressions with predictive margins were used. Post-ACA reforms, people with mental health conditions were less likely to be uninsured (5% versus 13%; t=-6.89, df=50, peffects were experienced in both Medicaid expansion and nonexpansion states. Findings underscore the importance of ACA improvements in the quality of health insurance coverage.

  6. Evaluation of Large-Scale Public-Sector Reforms: A Comparative Analysis

    Science.gov (United States)

    Breidahl, Karen N.; Gjelstrup, Gunnar; Hansen, Hanne Foss; Hansen, Morten Balle

    2017-01-01

    Research on the evaluation of large-scale public-sector reforms is rare. This article sets out to fill that gap in the evaluation literature and argues that it is of vital importance since the impact of such reforms is considerable and they change the context in which evaluations of other and more delimited policy areas take place. In our…

  7. National health insurance reform in South Africa: estimating the implications for demand for private health insurance.

    Science.gov (United States)

    Okorafor, Okore Apia

    2012-05-01

    A recent health reform proposal in South Africa proposes universal access to a comprehensive package of healthcare services in the public sector, through the implementation of a national health insurance (NHI) scheme. Implementation of the scheme is likely to involve the introduction of a payroll tax. It is implied that the introduction of the payroll tax will significantly reduce the size of the private health insurance market. The objective of this study was to estimate the impact of an NHI payroll tax on the demand for private health insurance in South Africa, and to explore the broader implications for health policy. The study applies probit regression analysis on household survey data to estimate the change in demand for private health insurance as a result of income shocks arising from the proposed NHI. The introduction of payroll taxes for the proposed NHI was estimated to result in a reduction to private health insurance membership of 0.73%. This suggests inelasticity in the demand for private health insurance. In the literature on the subject, this inelasticity is usually due to quality differences between alternatives. In the South African context, there may be other factors at play. An NHI tax may have a very small impact on the demand for private health insurance. Although additional financial resources will be raised through a payroll tax under the proposed NHI reform, systemic problems within the South African health system can adversely affect the ability of the NHI to translate additional finances into better quality healthcare. If these systemic challenges are not adequately addressed, the introduction of a payroll tax could introduce inefficiencies within the South African health system.

  8. Prospect Theory and Public Service Outcomes: When do Citizen Prefer Risky Reforms to Reforms with Certain Outcomes?

    DEFF Research Database (Denmark)

    Bækgaard, Martin

    Prospect theory (Kahneman and Tversky 1979; Tversky and Kahneman 1992) has been widely acknowledged in the social sciences as a potential frame for understanding how people deal with uncertainty. Yet, little is known about whether key expectations from prospect theory also hold in a complex public...... service setting with outcomes in multiple dimensions. In this paper I draw on prospect theory to examine under what conditions citizens prefer uncertain – but potentially advantageous – reforms to reforms with more certain outcomes. Using a population based survey experiment with participation of 1......,395 Danish citizens I find support for some of the expectations derived from prospect theory while the evidence is in outright opposition to the expectations in other instances. Most notably, I find that that citizens are more willing to take risks if reforms are associated with gains than...

  9. 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

  10. Governing Health Care through Free Choice: Neoliberal Reforms in Denmark and the United States.

    Science.gov (United States)

    Larsen, Lars Thorup; Stone, Deborah

    2015-10-01

    We compare free choice reforms in Denmark and the United States to understand what ideas and political forces could generate such similar policy reforms in radically different political contexts. We analyze the two cases using our own interpretation of neoliberalism as having "two faces." The first face seeks to expand private markets and shrink the public sector; the second face seeks to strengthen the public sector's capacity to govern through incentives and competition. First, we show why these two most-different cases offer a useful comparison to understand similar policy tools. Second, we develop our theoretical framework of the two faces of neoliberalism. Third, we examine Denmark's introduction of a free choice of hospitals in 2002, a policy that for the first time allowed some patients to receive care either in a public hospital outside their local area or in a private hospital. Fourth, we examine the introduction of free choice among private managed care plans into the US Medicare program in 1997. We show how policy makers in both countries used neoliberal reform as a mechanism to make their public health care sectors governable. Fifth, on the basis of our analysis, we draw five lessons about neoliberal policy reforms. Copyright © 2015 by Duke University Press.

  11. Good governance and budget reform in Lesotho Public Hospitals: performance, root causes and reality.

    Science.gov (United States)

    Vian, Taryn; Bicknell, William J

    2014-09-01

    Lesotho has been implementing financial management reforms, including performance-based budgeting (PBB) since 2005 in an effort to increase accountability, transparency and effectiveness in governance, yet little is known about how these efforts are affecting the health sector. Supported by several development partners and $24 million in external resources, the PBB reform is intended to strengthen government capacity to manage aid funds directly and to target assistance to pressing social priorities. This study designed and tested a methodology for measuring implementation progress for PBB reform in the hospital sector in Lesotho. We found that despite some efforts on the national level to promote and support reform implementation, staff at the hospital level were largely unaware of the purpose of the reform and had made almost no progress in transforming institutions and systems to fully realize reform goals. Problems can be traced to a complex reform design, inadequate personnel and capacity to implement, professional boundaries between financial and clinical personnel and weak leadership. The Lesotho reform experience suggests that less complex designs for budget reform, better adapted to the context and realities of health sectors in developing countries, may be needed to improve governance. It also highlights the importance of measuring reform implementation at the sectoral level. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

  12. 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.

  13. Are we there yet? A journey of health reform in Australia.

    Science.gov (United States)

    Bennett, Christine C

    2013-08-19

    • Five years on from the establishment of the National Health and Hospitals Reform Commission, it is timely to review the context for reform and some of the actions taken to date, and to highlight remaining areas of concern and priority. • The Commission's final report was released in July 2009 and presented 123 recommendations organised under four reform themes: Taking responsibility: individual and collective action to build good health and wellbeing - by people, families, communities, health professionals, employers, health funders and governments Connecting care: comprehensive care for people over their lifetime Facing inequities: recognise and tackle the causes and impacts of health inequities Driving quality performance: leadership and systems to achieve best use of people, resources and evolving knowledge. • Overall, the Australian Government's response to the Commission's report has been very positive, but challenges remain in some key areas: Financial sustainability and the vertical fiscal imbalance between the federal and state governments Getting the best value from the health dollar by reducing inefficiency and waste and using value-based purchasing across the public and private health sectors National leadership across the system as a whole Getting the right care in the right place at the right time Health is about more than health care - increasing focus on prevention and recognising and tackling the broader social determinants of health.

  14. Towards a public health profession

    DEFF Research Database (Denmark)

    Foldspang, Anders

    2015-01-01

    in the theoretical as well as the practical potential of the public health professional. Thus, he and she must be able to perform, what WHO Europe has developed as Essential Public Health Operations (EPHOs).3 This, in turn, implies that the public health professional possesses the set of intellectual (knowledge...... endorsed by WHO Europe’s member states as the basis for the public health education in Europe.5 The sections of the lists include: Public health methods; Population health and: Its social and economic determinants, and: Its material environmental determinants; Man-made interventions and systems, namely...... Health policy, health economics, organizational theory, health legislation, and public health leadership and management; Health promotion—health education, health protection, disease prevention; public health ethics. This should form the central part of the basis for all public health professionals...

  15. Music and Public Health

    DEFF Research Database (Denmark)

    Bonde, Lars Ole; Juel, Knud; Ekholm, Ola

    2016-01-01

    Background: ‘Music and public health’ is a new field of study. Few scientific studies with small samples have documented health implications of musical participation. Research questions in this epidemiological study were: 1) Is there an association between self-rated health and active use of musi......: 57%. Multiple logistic regression analyses were performed to investigate associations between musical background/activities and health-related indicators. Discussion: The study documents that a majority of informants use music to regulate physical and psychological states......Background: ‘Music and public health’ is a new field of study. Few scientific studies with small samples have documented health implications of musical participation. Research questions in this epidemiological study were: 1) Is there an association between self-rated health and active use of music...... in daily life? 2) What associations can be observed between musical background, uses and understanding of music as a health factor, and self-reported health? Method: Data came from the Danish Health and Morbidity Survey 2013, based on a simple random sample of 25.000 adult Danes (16+ years). Response rate...

  16. Viewpoint: Prevention is missing: is China's health reform reform for health?

    Science.gov (United States)

    Yang, Le; Zhang, Xiaoli; Tan, Tengfei; Cheng, Jingmin

    2015-02-01

    Ancient China emphasized disease prevention. As a Chinese saying goes, 'it is more important to prevent the disease than to cure it'. Traditional Chinese medicine posits that diseases can be understood, thus, prevented. In today's China, the state of people's health seems worse than in the past. Thus the Chinese government undertook the creation of a new health system. Alas, we believe the results are not very satisfactory. The government seems to have overlooked rational allocation between resources for treatment and prevention. Public investment has been gradually limited to the domain of treatment. We respond to this trend, highlighting the importance of prevention and call for government and policymakers to adjust health policy and work out a solution suitable for improving the health of China's people.

  17. 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.

  18. 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.

  19. Getting value from health spending: going beyond payment reform.

    Science.gov (United States)

    Ho, Sam; Sandy, Lewis G

    2014-05-01

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

  20. The hazards of correcting myths about health care reform.

    Science.gov (United States)

    Nyhan, Brendan; Reifler, Jason; Ubel, Peter A

    2013-02-01

    Misperceptions are a major problem in debates about health care reform and other controversial health issues. We conducted an experiment to determine if more aggressive media fact-checking could correct the false belief that the Affordable Care Act would create "death panels." Participants from an opt-in Internet panel were randomly assigned to either a control group in which they read an article on Sarah Palin's claims about "death panels" or an intervention group in which the article also contained corrective information refuting Palin. The correction reduced belief in death panels and strong opposition to the reform bill among those who view Palin unfavorably and those who view her favorably but have low political knowledge. However, it backfired among politically knowledgeable Palin supporters, who were more likely to believe in death panels and to strongly oppose reform if they received the correction. These results underscore the difficulty of reducing misperceptions about health care reform among individuals with the motivation and sophistication to reject corrective information.

  1. Gis and public health

    CERN Document Server

    Cromley, Ellen K

    2011-01-01

    Authoritative and comprehensive, this is the leading text and professional resource on using geographic information systems (GIS) to analyze and address public health problems. Basic GIS concepts and tools are explained, including ways to access and manage spatial databases. The book presents state-of-the-art methods for mapping and analyzing data on population, health events, risk factors, and health services, and for incorporating geographical knowledge into planning and policy. Numerous maps, diagrams, and real-world applications are featured. The companion Web page provides lab exercises w

  2. [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.

  3. Globalisation and public health.

    Science.gov (United States)

    Bettcher, D; Lee, K

    2002-01-01

    At the dawn of the 21st century, globalisation is a word that has become a part of everyday communication in all corners of the world. It is a concept that for some holds the promise of a new and brighter future, while for others it represents a threat that needs to be confronted and counteracted. In the area of public health, a wide range of claims have been made about the various impacts, both positive and negative, that can be attributed to globalisation. In the ever expanding literature on globalisation and health, it has become apparent that considerable confusion is emerging in both the ways that terminology is applied and concepts are defined. The determinants of health are increasingly multisectoral, and in tackling these challenges it is necessary to take a multidisciplinary approach that includes policy analyses in such areas as trade, environment, defence/security, foreign policy, and international law. In assembling the terms for this glossary, we have attempted to demonstrate the richness of the globalisation and public health debate, and in so doing have selected some of the core terms that require definition. We hope that this glossary will help to clarify this interesting and challenging area, and will also serve as a useful entry point to this new debate in public health.

  4. Mental health policy and development in Egypt - integrating mental health into health sector reforms 2001-9

    Directory of Open Access Journals (Sweden)

    Siekkonen Inkeri

    2010-06-01

    Full Text Available Abstract Background Following a situation appraisal in 2001, a six year mental health reform programme (Egymen 2002-7 was initiated by an Egyptian-Finnish bilateral aid project at the request of a former Egyptian minister of health, and the work was incorporated directly into the Ministry of Health and Population from 2007 onwards. This paper describes the aims, methodology and implementation of the mental health reforms and mental health policy in Egypt 2002-2009. Methods A multi-faceted and comprehensive programme which combined situation appraisal to inform planning; establishment of a health sector system for coordination, supervision and training of each level (national, governorate, district and primary care; development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at each level; integration of mental health into health management systems; and dedicated efforts to improve forensic services, rehabilitation services, and child psychiatry services. Results The project has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, mental health masterplan (policy guidelines to accompany the general health policy, updated Egyptian mental health legislation, Code of Practice, adaptation of the WHO primary care guidelines, primary care training, construction of a quality system of roles and responsibilities, availability of medicines at primary care level, public education about mental health, and a research programme to inform future developments. Intersectoral liaison with education, social welfare, police and prisons at national level is underway, but has not yet been established for governorate and district levels, nor mental health training for police, prison staff and teachers. Conclusions The bilateral collaboration programme

  5. Changing public attitudes towards corporal punishment: the effects of statutory reform in Sweden.

    Science.gov (United States)

    Roberts, J V

    2000-08-01

    One justification for a statutory ban on physical punishment is that passage of such legislation changes public attitudes towards the use of this form of parental discipline. The experience in Sweden is often cited as an example of legislation which changed public opinion. The aim of this brief article is to review the public opinion findings in Sweden in order to evaluate in greater detail the impact of changing the law. A search was conducted to generate all published and publicly-available quantitative surveys of the public in Sweden and elsewhere. The results of time-series analysis of the data are clear. The 1979 legal reform in Sweden did not reduce the level of public support for parental use of corporal punishment as a means of disciplining children. Support for physical punishment began declining years before the reform was passed and the decline was in no way accelerated by the law reform. Changes in public opinion may have generated the legal reform, but the reverse is not true. Data from other jurisdictions also support the view that there is no relationship between the status of the law and the nature of public views with regard to corporal punishment. This result is consistent with analyses of the effects of legal reforms in other areas. The Swedish ban on corporal punishment did not affect public attitudes. Changing public views requires other initiatives.

  6. Health Sector Reform in the Kurdistan Region - Iraq: Financing Reform, Primary Care, and Patient Safety.

    Science.gov (United States)

    Anthony, C Ross; Moore, Melinda; Hilborne, Lee H; Mulcahy, Andrew W

    2014-12-30

    In 2010, the Kurdistan Regional Government asked the RAND Corporation to help guide reform of the health care system in the Kurdistan Region of Iraq. The overarching goal of reform was to help establish a health system that would provide high-quality services efficiently to everyone to prevent, treat, and manage physical and mental illnesses and injuries. This article summarizes the second phase of RAND's work, when researchers analyzed three distinct but intertwined health policy issue areas: development of financing policy, implementation of early primary care recommendations, and evaluation of quality and patient safety. For health financing, the researchers reviewed the relevant literature, explored the issue in discussions with key stakeholders, developed and assessed various policy options, and developed plans or approaches to overcome barriers and achieve stated policy objectives. In the area of primary care, they developed and helped to implement a new management information system. In the area of quality and patient safety, they reviewed relevant literature, discussed issues and options with health leaders, and recommended an approach toward incremental implementation.

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

    Science.gov (United States)

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

    2013-06-13

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

  8. The ambiguity of contents and results in the Norwegian internal control of safety, health and environment reform

    Energy Technology Data Exchange (ETDEWEB)

    Hovden, Jan

    1998-05-01

    The results of introducing a mandatory public reform in Norway with regard to the requirements on enterprises' management of safety, health and environment (SHE) systems are reviewed and discussed. The reform, named internal control (IC), implies a delegation of the direct control of SHE conditions to the enterprises, and introduces system auditing as the main tool for the regulatory bodies. A mixture of successes and failures in implementing the reform, including some perspectives for further adaptation and development of the IC concept are discussed.

  9. 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

  10. Regulatory system reform of occupational health and safety in China

    Science.gov (United States)

    WU, Fenghong; CHI, Yan

    2015-01-01

    With the explosive economic growth and social development, China’s regulatory system of occupational health and safety now faces more and more challenges. This article reviews the history of regulatory system of occupational health and safety in China, as well as the current reform of this regulatory system in the country. Comprehensive, a range of laws, regulations and standards that promulgated by Chinese government, duties and responsibilities of the regulatory departments are described. Problems of current regulatory system, the ongoing adjustments and changes for modifying and improving regulatory system are discussed. The aim of reform and the incentives to drive forward more health and safety conditions in workplaces are also outlined. PMID:25843565

  11. A retrospective content analysis of studies on factors constraining the implementation of health sector reform in Ghana.

    Science.gov (United States)

    Sakyi, E Kojo

    2008-01-01

    Ghana has undertaken many public service management reforms in the past two decades. But the implementation of the reforms has been constrained by many factors. This paper undertakes a retrospective study of research works on the challenges to the implementation of reforms in the public health sector. It points out that most of the studies identified: (1) centralised, weak and fragmented management system; (2) poor implementation strategy; (3) lack of motivation; (4) weak institutional framework; (5) lack of financial and human resources and (6) staff attitude and behaviour as the major causes of ineffective reform implementation. The analysis further revealed that quite a number of crucial factors obstructing reform implementation which are particularly internal to the health system have either not been thoroughly studied or overlooked. The analysis identified lack of leadership; weak communication and consultation; lack of stakeholder participation, corruption and unethical professional behaviour as some of the missing variables in the literature. The study, therefore, indicated that there are gaps in the literature that needed to be filled through rigorous reform evaluation based on empirical research particularly at district, sub-district and community levels. It further suggested that future research should be concerned with the effects of both systems and structures and behavioural factors on reform implementation.

  12. Efficiency and competition in the Dutch non-life insurance industry: Effects of the 2006 health care reform

    NARCIS (Netherlands)

    Bikker, Jaap; Popescu, Adelina

    This paper investigates the cost efficiency and competitive behaviour of the non-life – or property and casualty – insurance market in the Netherlands over the period 1995-2012. We focus on the 2006 health care reform, where public health care insurance has been included in the non-life insurance

  13. Educational reform and the public: Two case studies of Poland and Saskatchewan (Canada)

    Science.gov (United States)

    Kaproń, Danuta; Stephan, Werner

    1991-09-01

    The involvement of the public in educational reform processes in modern democratic societies primarily serves the purpose of politically legitimizing the reform agenda. This study examines the rationales implicitly or explicitly submitted to the public to explain why educational reforms in the two countries should be endorsed. Although differences in the political culture caution against a hasty comparison of the two case studies, a number of politico-economic similarities allow for a valid juxtaposition. In Poland the context of socio-political and economic renewal prompted the reformers to emphasize the human-capital model which heightened public awareness and participation in the debate surrounding the reform. Public involvement in Saskatchewan was negatively affected for mainly two reasons. First, the government evidently manipulated public input by various means and thereby appears to have predetermined the outcome. Second, the rationale for the reform, based on a free-market model, tightened the linkage between the needs of the labour market and the mandate of the schools. As a result, public interest and participation was greatly diminished.

  14. Reform of health insurance in Croatia.

    Science.gov (United States)

    Turek, S

    1999-06-01

    After democratic changes in 1990 and the declaration of independence in 1991, Croatia inherited an archaic system of economy, similar to all the other post-communist countries, which had especially negative effects on the health system. Health services were divided into 113 independent offices with their own local rules; they could not truly support the health care system, which gradually stagnated, both organizationally and technologically. Such an administrative system devoured 17.5% of the total funds, and primary care used only 10.3% of this. Despite the costly hospital medicine the entire system was financed with US$300 per citizen. The system was functioning only because of professionalism and enthusiasm of well-educated medical personnel. Such health policy had a negative effect on all levels of the system, with long-term consequences. The new health insurance system instituted a standard of 1,700 insureds per family medicine team, reducing hospital capacities to 3.8 beds per 1,000 citizens for acute illnesses. Computerization of the system makes possible the transparency of accounting income and expenses. In a relatively short period, in spite of the war, and in a complex, socially and ethically delicate area, Croatian Health Insurance Institute has successfully carried out the rationalization and control of spending, without lowering the level of health care or negatively influencing the vital statistics data.

  15. Innovations in health service delivery: the corporatization of public hospitals

    National Research Council Canada - National Science Library

    Harding, April; Preker, Alexander S

    2003-01-01

    ... hospitals play a critical role in ensuring delivery of health services, less is known about how to improve the efficiency and quality of care provided. Much can be learned in this respect from the experiences of hospital reforms initiated during the 1990s. Innovations in Health Service Delivery: The Corporatization of Public Hospitals is an a...

  16. Bioethics and Public Health

    Directory of Open Access Journals (Sweden)

    Víctor Penchaszadeh

    2018-06-01

    Full Text Available This article looks at the evolution of bioethics a discipline from its initial focus, concerned with issues of personal autonomy and the conflicts around the use of complex technology in medicine, to where it is now; focused on major population issues in public health, with a focus on equality, justice and the right to health. As part of this it considers the 18 guiding principles and issues in bioethics contained in the Universal Declaration of Bioethics and Human Rights of UNESCO.

  17. Facebook and Public Health

    DEFF Research Database (Denmark)

    Straton, Nadiya; Vatrapu, Ravi; Mukkamala, Raghava Rao

    2017-01-01

    This paper reports on a survey about the perceptions and practices of social media managers and experts in the area of public health. We have collected Facebook data from 153 public health care organizations and conducted a survey on them. 12% of organizations responded to the questionnaire....... The survey results were combined with the findings from our previous work of applying clustering and supervised learning algorithms on big social data from the official Facebook walls of these organizations. In earlier research, we showed that the most successful strategy that leads to higher post engagement...... is visual content. In this paper, we investigated if organisations pursue this strategy or some other strategy that was successful and has not been uncovered by the machine learning algorithms. Performance of each organisation on Facebook is based on the number of posts (volume share) and the number...

  18. 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.

  19. Geomatics and public health.

    Science.gov (United States)

    Jaishankar, R; Jhonson, C P

    2006-01-01

    Geomatics technology has tremendous potential to address public health issues particularly under the present circumstances of global climate change and climate or technology induced human migration, which result in an increase in the geographical extent and re-emergence of vector-borne diseases. The authors present an overview of the science of geomatics, describe the potential impacts of climate change on vector-borne diseases and review the applications of remote sensing for disease vector surveillance.

  20. Doping and Public Health

    DEFF Research Database (Denmark)

    Christiansen, Ask Vest

    rad av världens främsta idrottsvetare och dopningsexperter hade mött upp för att presentera papers till en intresserad och engagerad publik. Temat för konferensen var "Doping and Public Health", och den aspekten behandlades också; dock tolkade flera presentatörer temat på sina egna vis, och hela...

  1. 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

  2. A Conversation About Health Care Reform

    Science.gov (United States)

    Fuchs, Victor R.

    1994-01-01

    Professor Victor R. Fuchs is the Henry J. Kaiser Jr Professor at Stanford (California) University, where he applies economic analysis to social problems of national concern, with special emphasis on health and medical care. He holds joint appointments in the Economics Department and the School of Medicine's Department of Health Research and Policy. Professor Fuchs is a Distinguished Fellow of the American Economic Association and a member of the American Philosophical Society, the American Academy of Arts and Sciences, and the Institute of Medicine of the National Academy of Sciences. He was the first economist to receive the Distinguished Investigator Award of the Association for Health Services Research and has also received the Baxter Foundation Health Services Research Prize. Professor Fuchs is president-elect of the American Economic Association. His latest book, The Future of Health Policy, was published by Harvard University Press in 1993. The following edited conversation between Professor Fuchs and Linda Hawes Clever, MD, Editor of the journal, took place on April 8, 1994. PMID:7941523

  3. 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.

  4. Health maintenance organizations: critical issues raised by restructuring delivery for health systems reform.

    Science.gov (United States)

    Gold, M

    1993-10-01

    In sum, the potential that managed care will grow under health systems reform creates an opportunity for the HMO industry but also serves as a challenge and a threat. Faced with greater scrutiny and growing demands, HMOs increasingly are being forced to demonstrate their potential and live up to their expectation. At the same time, the changing nature of the health care system creates a challenge for HMOs. Cost pressures create needs to review the entire delivery system, including the ambulatory component, with a focus on enhancing cost-effectiveness. Greater visibility also creates demands; growing market penetration argues for the creation of a new paradigm to define an appropriate structure for public accountability and management. Finally, the transformation of an HMO industry into a managed care industry is not without its risks as HMO performance becomes evaluated not only against itself but as part of the performance of the broader managed care industry in which HMOs have become embedded.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. Insured without moral hazard in the health care reform of China.

    Science.gov (United States)

    Wong, Chack-Kie; Cheung, Chau-Kiu; Tang, Kwong-Leung

    2012-01-01

    Public insurance possibly increases the use of health care because of the insured person's interest in maximizing benefits without incurring out-of-pocket costs. A newly reformed public insurance scheme in China that builds on personal responsibility is thus likely to provide insurance without causing moral hazard. This possibility is the focus of this study, which surveyed 303 employees in a large city in China. The results show that the coverage and use of the public insurance scheme did not show a significant positive effect on the average employee's frequency of physician consultation. In contrast, the employee who endorsed public responsibility for health care visited physicians more frequently in response to some insurance factors. On balance, public insurance did not tempt the average employee to consult physicians frequently, presumably due to personal responsibility requirements in the insurance scheme.

  10. Commitment among state health officials & its implications for health sector reform: lessons from Gujarat.

    Science.gov (United States)

    Maheshwari, Sunil; Bhat, Ramesh; Saha, Somen

    2008-02-01

    Commitment, competencies and skills of people working in the health sector can significantly impact the performance and its reform process. In this study we attempted to analyse the commitment of state health officials and its implications for human resource practices in Gujarat. A self-administered questionnaire was used to measure commitment and its relationship with human resource (HR) variables. Employee's organizational commitment (OC) and professional commitment (PC) were measured using OC and PC scale. Fifty five medical officers from Gujarat participated in the study. Professional commitment of doctors (3.21 to 4.01) was found to be higher than their commitment to the organization (3.01 to 3.61). Doctors did not perceive greater fairness in the system on promotion (on the scale of 5, score: 2.55) and were of the view that the system still followed seniority based promotion (score: 3.42). Medical officers were upset about low autonomy in the department with regard to reward and recognition, accounting procedure, prioritization and synchronization of health programme and other administrative activities. Our study provided some support for positive effects of progressive HR practices on OC, specifically on affective and normative OC. Following initiatives were identified to foster a development climate among the health officials: providing opportunities for training, professional competency development, developing healthy relationship between superiors and subordinates, providing useful performance feedback, and recognising and rewarding performance. For reform process in the health sector to succeed, there is a need to promote high involvement of medical officers. There is a need to invest in developing leadership quality, supervision skills and developing autonomy in its public health institutions.

  11. 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.

  12. Training public health superheroes: five talents for public health leadership.

    Science.gov (United States)

    Day, Matthew; Shickle, Darren; Smith, Kevin; Zakariasen, Ken; Moskol, Jacob; Oliver, Thomas

    2014-12-01

    Public health leaders have been criticized for their policy stances, relationships with governments and failure to train the next generation. New approaches to the identification and training of public health leaders may be required. To inform these, lessons can be drawn from public health 'superheroes'; public health leaders perceived to be the most admired and effective by their peers. Members and Fellows of the UK Faculty of Public Health were contacted via e-newsletter and magazine and asked to nominate their 'Public Health Superhero'. Twenty-six responses were received, nominating 40 different people. Twelve semi-structured interviews were conducted. Thematic analysis, based on 'grounded theory', was conducted. Five leadership 'talents' for public health were identified: mentoring-nurturing, shaping-organizing, networking-connecting, knowing-interpreting and advocating-impacting. Talent-based approaches have been effective for leadership development in other sectors. These talents are the first specific to the practice of public health and align with some aspects of existing frameworks. An increased focus on identifying and developing talents during public health training, as opposed to 'competency'-based approaches, may be effective in strengthening public health leadership. Further research to understand the combination and intensity of talents across a larger sample of public health leaders is required. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. A global public health imperative

    African Journals Online (AJOL)

    MESKE

    Actions towards closing the health equity gap: A global public health imperative. Tewabech ... global health development. With only two ... of himself and of his family; including food, clothing .... impact on health equity and in the end issued the.

  14. Reviewing and reforming policy in health enterprise information security

    Science.gov (United States)

    Sostrom, Kristen; Collmann, Jeff R.

    2001-08-01

    Health information management policies usually address the use of paper records with little or no mention of electronic health records. Information Technology (IT) policies often ignore the health care business needs and operational use of the information stored in its systems. Representatives from the Telemedicine & Advanced Technology Research Center, TRICARE and Offices of the Surgeon General of each Military Service, collectively referred to as the Policies, Procedures and Practices Work Group (P3WG), examined military policies and regulations relating to computer-based information systems and medical records management. Using a system of templates and matrices created for the purpose, P3WG identified gaps and discrepancies in DoD and service compliance with the proposed Health Insurance Portability and Accountability Act (HIPAA) Security Standard. P3WG represents an unprecedented attempt to coordinate policy review and revision across all military health services and the Office of Health Affairs. This method of policy reform can identify where changes need to be made to integrate health management policy and IT policy in to an organizational policy that will enable compliance with HIPAA standards. The process models how large enterprises may coordinate policy revision and reform across broad organizational and work domains.

  15. Have Recent Financial Reforms Improved Financial Accountability in the Australian Commonwealth Public Sector?

    Directory of Open Access Journals (Sweden)

    Graham Bowrey

    2007-09-01

    Full Text Available Since the early 1990s the Australian Commonwealth public sector has undergone significant financialreforms, due primarily to the current federal Liberal government’s drive to improve the financialaccountability of the Commonwealth Government. These reforms include the adoption of accrualaccounting and budgeting and the development and implementation of an outcomes and outputs framework.These reforms culminated in the first full federal budget to be developed on an accrual basis in 1999 – 2000.This paper will examine the implementation of these reforms and the associated processes to determinewhether or not the Commonwealth government is more financially transparent and better able to dischargeits financial accountability. It is argued the complexity of the processes associated with, and the reportingrequirements of these reforms may have actually decreased the level of accountability to the key party towhom accountability is due — the Australian public.

  16. Nanotechnology and public health

    Directory of Open Access Journals (Sweden)

    Ferdi Tanır

    2015-08-01

    Full Text Available Nanotechnology is a new revolution in technology; being used in different parts of life such as self-cleaning paints, dirt repellent fabrics, the destruction of cancer cells without harming the person, biosensors that can detect even a single bacterium, odorless socks due to the destruction of bacteria, germ-free refrigerators, disinfection etc. In this article, we consider in the perspective of public health the possible risks of this new technology, which is starting to appear in all areas of our daily lives. 

  17. Advances in dental public health.

    Science.gov (United States)

    Holt, R D

    2001-07-01

    Dental public health has been defined as 'the science and art of preventing oral diseases, promoting oral health and improving the quality of life through the organised efforts of society'. Dental practitioners most often have the oral health of individual patients as their primary focus but the aim of public health is to benefit populations. Early developments in dental public health were concerned largely with demonstrating levels of disease and with treatment services. With greater appreciation of the nature of oral health and disease, and of their determinants has come recognition of the need for wider public health action if the effects of prevention and oral health promotion are to be maximized.

  18. Globalization of public health law and ethics.

    Science.gov (United States)

    Sohn, Myongsei

    2012-09-01

    The Constitution of the World Health Organization (1946) states that the "enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social position." The international legal framework for this right was laid by the Universal Declaration of Human Rights (1948) and reaffirmed in the International Covenant on Economic, Social, and Cultural Rights (1966) and the Declaration of Alma-Ata (1978). In recent years, the framework has been developed on 10 key elements: national and international human rights, laws, norms, and standards; resource constraints and progressive realization; obligations of immediate effect; freedoms and entitlements; available, accessible, acceptable, and good quality; respect, protect, and fulfill; non-discrimination, equality, and vulnerability; active and informed participation; international assistance and cooperation; and monitoring and accountability. Whereas public health law plays an essential role in the protection and promotion of the right to health, the emergence of SARS (2003) highlighted the urgent need to reform national public health laws and international obligations relating to public health in order to meet the new realities of a globalized world, leading to the WHO Framework Convention on Tobacco Control (2003) and the revision of the WHO International Health Regulations (2005). The Asian Institute for Bioethics and Health Law, in conjunction with the Republic of Korea's Ministry of Health and Welfare and the WHO International Digest of Health Legislation, conducted a comparative legal analysis of national public health laws in various countries through a project entitled Domestic Profiles of Public/Population Health Legislation (2006), which underscored the importance of recognizing the political and social contexts of distinct legal cultures, including Western, Asian, Islamic, and African.

  19. Health Sector Reform in sub-Saharan Africa: a synthesis of country ...

    African Journals Online (AJOL)

    Health reforms in the region have been influenced largely by the poor performance of the health systems, particularly with regard to the quality of health services. Most countries have taken due cognizance of the deficiencies on their health systems in the design of their health reform programmes and they have made some ...

  20. 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

  1. Public Sector Financial Management Reform: A Case Study of Local Government Agencies in Indonesia

    OpenAIRE

    Monir Mir; Wahyu Sutiyono

    2013-01-01

    Indonesia has taken initiatives to reform its public sector financial management. One of the reform agendas was to introduce ‘cash to accrual’ accounting for improved financial reporting. It is expected that improved financial reporting will enhance financial accountabilities of the governmental agencies and will assist both internal and external decision makers whose decisions will be based on the financial reports. However, it has been observed that there is a significant increa...

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

    International Nuclear Information System (INIS)

    Finon, Dominique; Roques, Fabien

    2013-01-01

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

  3. Mobile health clinics in the era of reform.

    Science.gov (United States)

    Hill, Caterina F; Powers, Brian W; Jain, Sachin H; Bennet, Jennifer; Vavasis, Anthony; Oriol, Nancy E

    2014-03-01

    Despite the role of mobile clinics in delivering care to the full spectrum of at-risk populations, the collective impact of mobile clinics has never been assessed. This study characterizes the scope of the mobile clinic sector and its impact on access, costs, and quality. It explores the role of mobile clinics in the era of delivery reform and expanded insurance coverage. A synthesis of observational data collected through Mobile Health Map and published literature related to mobile clinics. Analysis of data from the Mobile Health Map Project, an online platform that aggregates data on mobile health clinics in the United States, supplemented by a comprehensive literature review. Mobile clinics represent an integral component of the healthcare system that serves vulnerable populations and promotes high-quality care at low cost. There are an estimated 1500 mobile clinics receiving 5 million visits nationwide per year. Mobile clinics improve access for vulnerable populations, bolster prevention and chronic disease management, and reduce costs. Expanded coverage and delivery reform increase opportunities for mobile clinics to partner with hospitals, health systems, and insurers to improve care and lower costs. Mobile clinics have a critical role to play in providing high-quality, low-cost care to vulnerable populations. The postreform environment, with increasing accountability for population health management and expanded access among historically underserved populations, should strengthen the ability for mobile clinics to partner with hospitals, health systems, and payers to improve care and lower costs.

  4. 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

  5. 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.

  6. Profile of Public Health Leadership.

    Science.gov (United States)

    Little, Ruth Gaskins; Greer, Annette; Clay, Maria; McFadden, Cheryl

    2016-01-01

    Public health leaders play pivotal roles in ensuring the population health for our nation. Since 2000, the number of schools of public health has almost doubled. The scholarly credentials for leaders of public health in academic and practice are important, as they make decisions that shape the future public health workforce and important public health policies. This research brief describes the educational degrees of deans of schools of public health and state health directors, as well as their demographic profiles, providing important information for future public health leadership planning. Data were extracted from a database containing information obtained from multiple Web sites including academic institution Web sites and state government Web sites. Variables describe 2 sets of public health leaders: academic deans of schools of public health and state health directors. Deans of schools of public health were 73% males and 27% females; the PhD degree was held by 40% deans, and the MD degree by 33% deans. Seventy percent of deans obtained their terminal degree more than 35 years ago. State health directors were 60% males and 40% females. Sixty percent of state health directors had an MD degree, 4% a PhD degree, and 26% no terminal degree at all. Sixty-four percent of state health directors received their terminal degree more than 25 years ago. In addition to terminal degrees, 56% of deans and 40% of state health directors held MPH degrees. The findings call into question competencies needed by future public health professionals and leadership and the need to clarify further the level of public health training and degree type that should be required for leadership qualifications in public health.

  7. Public Health Nursing: Public Health Centers

    Science.gov (United States)

    Misuse and Addiction Prevention Finance & Management Services Health Care Services Juvenile Justice , Alaska 99752 Phone: 442-7144 Fax: 442-7292 e-mail: Josephine Oke, Program Manager [back to top] North Phone: 852-0270 Fax: 852-2855 email: Andrey Boskhomdzhiev [back to top] Municipality of Anchorage P.O

  8. Critical perspectives in public health

    National Research Council Canada - National Science Library

    Green, Judith; Labonte, Ronald N

    2008-01-01

    ... the contemporary roles of 'critical voices' in public health research and practice from a range of disciplines and contexts. The book covers many of the pressing concerns for public health practitioners and researchers, including: * * * * * the implications of new genetic technologies for public health; the impact of globalisation on local practice...

  9. 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.

  10. Management of health system reform: a view of changes within New Zealand.

    Science.gov (United States)

    Ritchie, D

    1998-08-01

    This paper reports on the context and process of health system reform in New Zealand. The study is based on interviews conducted with 31 managers from three Crown Health Enterprises (publicly funded hospital-based health care organizations). A number of countries with publicly funded health services (e.g., UK, Australia and New Zealand) have sought to shift from the traditional 'passive' health management style (using transactional management skills to balance historically-based expenditure budgets) to 'active' transformational leadership styles that reflect a stronger 'private sector' orientation (requiring active management of resources--including a return on 'capital' investment, identification of costs and returns on 'product lines', 'marketing' a 'product mix', reducing non-core activities and overhead costs, and a closer relationship with 'shareholders', suppliers and customers/clients). Evidence of activities and processes associated with transformational leadership are identified. Success of the New Zealand health reforms will be determined by the approach the new managers adopt to improve their organization's performance. Transformational leadership has been frequently linked to the successful implementation of significant organizational change in other settings (Kurz et al., 1988; Dunphy and Stace, 1990) but it is too early to assess whether this is applicable in a health care context.

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

    Science.gov (United States)

    Daemmrich, Arthur

    2013-01-01

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

  12. Public Management Reform in Napoleonic states: france, greece, Italy, Portugal, Spain

    OpenAIRE

    E. Ongaro

    2008-01-01

    The special issue fills a gap in literature by providing systematic and comparative analysis of public management reform in five under-investigated countries in the Napoleonic administrative tradition: France, Greece, Italy, Portugal, Spain. It thus provides an important contribution to the widening of the comparative research agenda in public management

  13. Learning From Rudolf Steiner: The Relevance of Waldorf Education for Urban Public School Reform

    Science.gov (United States)

    Oberman, Ida

    2007-01-01

    The author of this paper investigates the relevance of Waldorf education for public urban school reform. Based on analysis of survey data from over 500 graduates of private U.S. Waldorf schools, review of documents from the Gates Foundation, and staff-interview and student-achievement data from four public Waldorf-methods schools, she develops…

  14. [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.

  15. [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.

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

    Science.gov (United States)

    Manyazewal, Tsegahun; Matlakala, Mokgadi C

    2017-02-03

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

  17. Introducing a complex health innovation--primary health care reforms in Estonia (multimethods evaluation).

    Science.gov (United States)

    Atun, Rifat Ali; Menabde, Nata; Saluvere, Katrin; Jesse, Maris; Habicht, Jarno

    2006-11-01

    All post-Soviet countries are trying to reform their primary health care (PHC) systems. The success to date has been uneven. We evaluated PHC reforms in Estonia, using multimethods evaluation: comprising retrospective analysis of routine health service data from Estonian Health Insurance Fund and health-related surveys; documentary analysis of policy reports, laws and regulations; key informant interviews. We analysed changes in organisational structure, regulations, financing and service provision in Estonian PHC system as well as key informant perceptions on factors influencing introduction of reforms. Estonia has successfully implemented and scaled-up multifaceted PHC reforms, including new organisational structures, user choice of family physicians (FPs), new payment methods, specialist training for family medicine, service contracts for FPs, broadened scope of services and evidence-based guidelines. These changes have been institutionalised. PHC effectiveness has been enhanced, as evidenced by improved management of key chronic conditions by FPs in PHC setting and reduced hospital admissions for these conditions. Introduction of PHC reforms - a complex innovation - was enhanced by strong leadership, good co-ordination between policy and operational level, practical approach to implementation emphasizing simplicity of interventions to be easily understood by potential adopters, an encircling strategy to roll-out which avoided direct confrontations with narrow specialists and opposing stakeholders in capital Tallinn, careful change-management strategy to avoid health reforms being politicized too early in the process, and early investment in training to establish a critical mass of health professionals to enable rapid operationalisation of policies. Most importantly, a multifaceted and coordinated approach to reform - with changes in laws; organisational restructuring; modifications to financing and provider payment systems; creation of incentives to enhance

  18. The Dutch health insurance law: the accumulation of 30 years of reform thought.

    NARCIS (Netherlands)

    Groenewegen, P.P.; Jong, J.D. de; Delnoij, D.M.J.

    2006-01-01

    Background: The new health insurance law builds on a history of 30 years of reform plans and small steps, eventually leading to the recent reform. Methods: We use policy documents and papers from government, advisory bodies, and independent analysts to describe backgrounds of the reform and actual

  19. Analysis of the National Modernizers Network for the Support of the Public Administration Reform Process from Romania

    Directory of Open Access Journals (Sweden)

    Alina PROFIROIU

    2010-10-01

    Full Text Available The reform process of the state and implicitly of the public administration was a priority for the past governments of Romania. During 2004- 2009, within the reform process, the main actors involved in the coordination, implementation and monitoring of reform measures were: the Prime Minister, the Superior Council for Public Administration Reform, Public Policy Coordination and Structural Adjustment, the Ministry of Public Finance, the General Secretariat of Government, Ministry of Administration and Interior (renamed for a short time Ministry of Interior and Administrative Reform, the Central Unit for Public Administration Reform, National Institute of Administration, the National Agency of Civil Servants, and the National Modernizers Network. For evaluation of aspects related to the reform process it was designed a selective research within the members of the National Modernizers Network, for assessing their perception of the public administration reform undertaken by the institutions presented above. Evaluating their opinion can be an important point in the revitalization of the area of the administration reform process. Also, the research conducted aimed at assessing the degree of modernizers’ involvement in activities related to important aspects of the reform process: strategic planning, formulating and evaluating public policies, financial management, human resources management, decentralization, introduction of new information and communication technologies and administrative simplification.

  20. [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.

  1. Feminism and public health ethics.

    Science.gov (United States)

    Rogers, W A

    2006-06-01

    This paper sketches an account of public health ethics drawing upon established scholarship in feminist ethics. Health inequities are one of the central problems in public health ethics; a feminist approach leads us to examine not only the connections between gender, disadvantage, and health, but also the distribution of power in the processes of public health, from policy making through to programme delivery. The complexity of public health demands investigation using multiple perspectives and an attention to detail that is capable of identifying the health issues that are important to women, and investigating ways to address these issues. Finally, a feminist account of public health ethics embraces rather than avoids the inescapable political dimensions of public health.

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

    Directory of Open Access Journals (Sweden)

    Owen Adams

    2016-01-01

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

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

    Science.gov (United States)

    Wren, Maev-Ann; Connolly, Sheelah

    2017-12-26

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

  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

    2013-01-01

    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.

  5. Publication ethics in public health emergencies.

    Science.gov (United States)

    Shaw, David; Elger, Bernice S

    2017-09-01

    In this article, we describe and analyse three issues in publication ethics that are raised when conducting research in emergencies and disasters. These include reluctance to share data and samples because of concerns about publications, loss of individual authorship in high high-profile multi-entity publications, and the deaths of authors during dangerous research projects. An emergency research pledge may be useful in avoiding some of these issues. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Public relations effectiveness in public health institutions.

    Science.gov (United States)

    Springston, Jeffrey K; Weaver Lariscy, Ruth Ann

    2005-01-01

    This article explores public relations effectiveness in public health institutions. First, the two major elements that comprise public relations effectiveness are discussed: reputation management and stakeholder relations. The factors that define effective reputation management are examined, as are the roles of issues and crisis management in building and maintaining reputation. The article also examines the major facets of stakeholder relations, including an inventory of stakeholder linkages and key audiences, such as the media. Finally, methods of evaluating public relations effectiveness at both the program level and the institutional level are explored.

  7. Neuroeconomics and Public Health

    DEFF Research Database (Denmark)

    Larsen, Torben

    2010-01-01

      Objective: To identify and describe the parameters of the Frontal Power of Concentration (C). Method: Systematic review of EEG- and fMRI-studies from a neuroeconomic point of view. Results: C is a quadripartite executive integrator depending on: 1) Limbic system (L) generates emotions and cogni...... + εI → 1   Discussion:  How to reinforce volitional flexibility (c)? Firstly, cognitive predictions are improved by open-mindedness. Secondly, emotional control is best maintaining an appropriate level of physical fitness. Thirdly, our imagination is directly facilitated by in...... predicts that well-organized stress-management integrating LowTech-interventions as exercise (L↓ and c↑), in-depth-relaxation (c↓) and diet (integrating L, R and c) tailored to the individual would improve public health (national life expectancy) significantly...

  8. [Notes for understanding the problem of "public" health in the health sector].

    Science.gov (United States)

    Guimarães, Cristian Fabiano; da Silva, Rosane Azevedo Neves

    2015-03-01

    This paper presents a theoretical review of how the public health concept has been perceived in health practices, based on the problematic field introduced in Italian and Brazilian health reforms, in order to understand the construction of public health and the meanings that this term acquires in the health arena. The main goal is to understand how public health appears in the context of health movements in Italy and Brazil, as well as its movement of variation. In this sense, an attempt is made to identify elements that contribute to the composition of a genealogy of public health. From the investigation of public health practices, the tensions produced by this concept are analyzed, giving visibility to those practices that demonstrate the public health experience as a force in the world of health.

  9. 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

  10. National findings regarding health IT use and participation in health care delivery reform programs among office-based physicians.

    Science.gov (United States)

    Heisey-Grove, Dawn; Patel, Vaishali

    2017-01-01

    Our objective was to characterize physicians' participation in delivery and payment reform programs over time and describe how participants in these programs were using health information technology (IT) to coordinate care, engage patients, manage patient populations, and improve quality. A nationally representative cohort of physicians was surveyed in 2012 (unweighted N = 2567) and 2013 (unweighted N = 2399). Regression analyses used those survey responses to identify associations between health IT use and participation in and attrition from patient-centered medical homes (PCMHs), accountable care organizations (ACOs), and pay-for-performance programs (P4Ps). In 2013, 45% of physicians participated in PCMHs, ACOs, or P4Ps. While participation in each program increased (P payment reform programs increased between 2012 and 2013. Participating physicians were more likely to use health IT. There was significant attrition from and switching between PCMHs, ACOs, and P4Ps. This work provides the basis for understanding physician participation in and attrition from delivery and payment reform programs, as well as how health IT was used to support those programs. Understanding health IT use by program participants may help to identify factors enabling a smooth transition to alternative payment models. Published by Oxford University Press on behalf of the American Medical Informatics Association 2016. This work is written by US Government employees and is in the public domain in the United States.

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

    OpenAIRE

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

    2013-01-01

    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 H...

  12. YANG Bong-keun as a Health Reformer and a Pioneer of Social Medicine

    Directory of Open Access Journals (Sweden)

    SHIN Young-Jeon

    2005-06-01

    Full Text Available YANG Bong-keun (1897-1982 had lived as a medical doctor and a social and public health reformer during the turbulent period of the opening of the port to the western society occupation by and liberation from Japan and the partition of the Korean Peninsular He actively participated in the March First Movement Shinganhoe and other activities for Korea’s liberation from Japan He also founded Bogunwoondongsa an organization for public health movement for Korean people and published Bogeunwoondong a magazine for introducing and educating new ideas and knowledge of health for Korean people After the defeat of Japan in the World War II he worked for the protection and repatriation of Korean residents in the Manjoo area as a head of policy division of the Northeastern office of the Korean Provisional Government He also participated in the foundation of Yanbian Hospital and medical school for Korean-Chinese in China His holistic approach of health and public health movement accentuation of preventive medicine and a body under his/her own will public health movement as a part of everyday life movement and minjoong oriented humanism were closely linked with the idea of social medicine that originated from the European society in the 19th century Those are also valuable ideas to be considered and implemented in this time Moreover his effort of health for Korean people on the way of modernization and liberation of Korea provides an example of being a respectable health reformer and pioneer of social medicine

  13. 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.

  14. Iran's Health Reform Plan: Measuring Changes in Equity Indices.

    Science.gov (United States)

    Assari Arani, Abbas; Atashbar, Tohid; Antoun, Joseph; Bossert, Thomas

    2018-03-01

    Two years after the implementation of the Health Sector Evolution Plan (HSEP), this study evaluated the effects of the plan on health equity indices. The main indices assessed by the study were the Out-of-Pocket (OOP) health expenditures, the Fairness in Financial Contribution (FFC) to the health system index, the index of households' Catastrophic Health Expenditure (CHE) and the headcount ratio of Impoverishing Health Expenditure (IHE). The per capita share of costs for total health services has been decreased. The lowered costs have been more felt in rural areas, generally due to sharp decrease in inpatient costs. Per capita pay for outpatient services is almost constant or has slightly increased. The reform plan has managed to improve households' Catastrophic Health Expenditure (CHE) index from an average of 2.9% before the implementation of the plan to 2.3% after the plan. The Fairness in Financial Contribution (FFC) to the health system index has worsened from 0.79 to 0.76, and the headcount ratio of Impoverishing Health Expenditure (IHE) index deteriorated after the implementation of plan from 0.34 to 0.50. Considerable improvement, in decreasing the burden of catastrophic hospital costs in low income strata which is about 26% relative to the time before the implementation of the plan can be regarded as the main achievement of the plan, whereas the worsening in the headcount ratio of IHE and FFC are the equity bottlenecks of the plan.

  15. Public Sector Reform and Governance for Adaptation: Implications of New Public Management for Adaptive Capacity in Mexico and Norway

    Science.gov (United States)

    Eakin, Hallie; Eriksen, Siri; Eikeland, Per-Ove; Øyen, Cecilie

    2011-03-01

    Although many governments are assuming the responsibility of initiating adaptation policy in relation to climate change, the compatibility of "governance-for-adaptation" with the current paradigms of public administration has generally been overlooked. Over the last several decades, countries around the globe have embraced variants of the philosophy of administration broadly called "New Public Management" (NPM) in an effort to improve administrative efficiencies and the provision of public services. Using evidence from a case study of reforms in the building sector in Norway, and a case study of water and flood risk management in central Mexico, we analyze the implications of the adoption of the tenets of NPM for adaptive capacity. Our cases illustrate that some of the key attributes associated with governance for adaptation—namely, technical and financial capacities; institutional memory, learning and knowledge; and participation and accountability—have been eroded by NPM reforms. Despite improvements in specific operational tasks of the public sector in each case, we show that the success of NPM reforms presumes the existence of core elements of governance that have often been found lacking, including solid institutional frameworks and accountability. Our analysis illustrates the importance of considering both longer-term adaptive capacities and short-term efficiency goals in public sector administration reform.

  16. 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.

  17. Developing an ‘integrated health system’: the reform of health and social services in Quebec

    Science.gov (United States)

    Levine, David

    2008-01-01

    The Quebec health care system, founded in 1970 as a public, single payer, state run system had by 2004 reached a turning point. Rising costs, working in silos, difficulty accessing physicians, increased waiting time for diagnostic imaging and surgical intervention led policy makers and politicians to propose a new model for the organisation and delivery of care. Based on populational responsibility and the clear distinction between a community primary care and specialised services a new model was proposed to develop integrated health networks. The 7.2 million population of Quebec was divided into 95 territories. 95 Health and social service centres were created by merging a community hospital, rehab centre, long-term care centres, home care and primary care services into a single institution with a new CEO and board of directors. These new networks received the mandate to manage the health and well being of their population, to manage the utilisation of services by their population and to manage all primary care services on their territory. The implementation of a chronic care model, the development of primary care multidisciplinary teams, empowering the population and performance management, are the key elements of Montreal's vision in implementing the Reform. After three years of operation the results are promising.

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

    Directory of Open Access Journals (Sweden)

    GEORGETA MODIGA

    2012-05-01

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

  19. Gender equity and health sector reform in Colombia: mixed state-market model yields mixed results.

    Science.gov (United States)

    Ewig, Christina; Bello, Amparo Hernández

    2009-03-01

    In 1993, Colombia carried out a sweeping health reform that sought to dramatically increase health insurance coverage and reduce state involvement in health provision by creating a unitary state-supervised health system in which private entities are the main insurers and health service providers. Using a quantitative comparison of household survey data and an analysis of the content of the reforms, we evaluate the effects of Colombia's health reforms on gender equity. We find that several aspects of these reforms hold promise for greater gender equity, such as the resulting increase in women's health insurance coverage. However, the reforms have not achieved gender equity due to the persistence of fees which discriminate against women and the introduction of a two-tier health system in which women heads of household and the poor are concentrated in a lower quality health system.

  20. How primary care reforms influenced health indicators in Manisa district in Turkey: Lessons for general practitioners.

    Science.gov (United States)

    Cevik, Celalettin; Sozmen, Kaan; Kilic, Bulent

    2018-12-01

    Turkish health reforms began in 2003 and brought some significant changes in primary care services. Few studies in Turkey compare the shift from health centres (HC) to family physicians (FP) approach, which was initiated by reforms. This study compares health status indicators during the HC period before reforms (2003-2007) and the FP period after reforms (2008-2012) in Turkey. This study encompasses time series data consisting of the results of a 10-year assessment (2003-2012) in Manisa district. All the data were obtained electronically and by month. The intersection points of the regression curves of these two periods and the beta coefficients were compared using segmented linear regression analysis. The mean number of follow-up per person/year during the HC period in infants (10.5), pregnant women (6.6) and women (1.8) was significantly higher than the mean number of follow-up during the FP period in infants (6.7), pregnant women (5.6) and women (0.9). Rates of BCG and measles vaccinations were significantly higher during the FP period; however, rates of HBV and DPT were same. The mean number of outpatient services per person/year during the FP period (3.3) was significantly higher than HC period (2.8). Within non-communicable diseases, no difference was detected for hypertension prevalence. Within communicable diseases, there was no difference for rabies suspected bites but acute haemorrhagic gastroenteritis significantly decreased. The infant mortality rate and under five-year child mortality rate significantly increased during the FP period. Primary care services should be reorganized and integrated with public health services.

  1. [Changes necessary for continuing health reform: I. The "external" change].

    Science.gov (United States)

    Martín Martín, J; de Manuel Keenoy, E; Carmona López, G; Martínez Olmos, J

    1990-01-01

    The article analyzes the need to obtain support from all actors if the reform of the health system is to be finalized. The relevant groups are the government, professional groups, workers, the population, civil servants, managers and firms with interests in the health field. It is necessary to develop a social marketing strategy that reinforces and broadens the current supports to change. Basic elements would be: Develop new service to satisfy users' needs; orient the services to defined "market" segments; position new services or "re-position" the existing ones in order to communicate their advantages; develop a plan of marketing based on promotion, prize and place focused on the role of health professionals as the main service sellers.

  2. Consumer subjectivity and U.S. health care reform.

    Science.gov (United States)

    West, Emily

    2014-01-01

    Health care consumerism is an important frame in U.S. health care policy, especially in recent media and policy discourse about federal health care reform. This article reports on qualitative fieldwork with health care users to find out how people interpret and make sense of the identity of "health care consumer." It proposes that while the term consumer is normally understood as a descriptive label for users who purchase health care and insurance services, it should actually be understood as a metaphor, carrying with it a host of associations that shape U.S. health care policy debates in particular ways. Based on interviews with 36 people, patient was the dominant term people used to describe themselves, but consumer was the second most popular. Informants interpreted the health care consumer as being informed, proactive, and having choices, but there were also "semiotic traps," or difficult-to-resolve tensions for this identity. The discourse of consumerism functions in part as code for individual responsibility, and therefore as a classed moral discourse, with implications for U.S. health care policy.

  3. An evaluation of systemic reforms of public hospitals: the Sanming model in China.

    Science.gov (United States)

    Fu, Hongqiao; Li, Ling; Li, Mingqiang; Yang, Chunyu; Hsiao, William

    2017-10-01

    Low- and middle-income countries (LMICs) have been searching for effective strategies to reform their inefficient and wasteful public hospitals. Recently, China developed a model of systemic reforms called the Sanming model to address the inefficiency and waste at public hospitals. In this article, we explain and evaluate how the Sanming model reformed its 22 public hospitals in 2013 by simultaneously restructuring the hospital governance structure, altering the payment system to hospitals, and realigning physicians' incentives. By employing the difference-in-difference (DID) method and using the hospital-level data from 187 public hospitals in Fujian province, we find that the Sanming model has reduced medical costs significantly without measurably sacrificing clinical quality and productive efficiency. The systemic reform, on average, has reduced the medical care cost per outpatient visit and per inpatient admission by 6.1% (P-value = 0.0445) and 15.4% (P-value transformation of public hospitals, where the governance structure, payment system and physician compensation methods are aligned, are crucial to improving their performance; it holds critical lessons for China and other LMICs. © The Author 2017. 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.

  4. Personal and political histories in the designing of health reform policy in Bolivia.

    Science.gov (United States)

    Bernstein, Alissa

    2017-03-01

    While health policies are a major focus in disciplines such as public health and public policy, there is a dearth of work on the histories, social contexts, and personalities behind the development of these policies. This article takes an anthropological approach to the study of a health policy's origins, based on ethnographic research conducted in Bolivia between 2010 and 2012. Bolivia began a process of health care reform in 2006, following the election of Evo Morales Ayma, the country's first indigenous president, and leader of the Movement Toward Socialism (Movimiento al Socialism). Brought into power through the momentum of indigenous social movements, the MAS government platform addressed racism, colonialism, and human rights in a number of major reforms, with a focus on cultural identity and indigeneity. One of the MAS's projects was the design of a new national health policy in 2008 called The Family Community Intercultural Health Policy (Salud Familiar Comunitaria Intercultural). This policy aimed to address major health inequities through primary care in a country that is over 60% indigenous. Methods used were interviews with Bolivian policymakers and other stakeholders, participant observation at health policy conferences and in rural community health programs that served as models for aspects of the policy, and document analysis to identify core premises and ideological areas. I argue that health policies are historical both in their relationship to national contexts and events on a timeline, but also because of the ways they intertwine with participants' personal histories, theoretical frameworks, and reflections on national historical events. By studying the Bolivian policymaking process, and particularly those who helped design the policy, it is possible to understand how and why particular progressive ideas were able to translate into policy. More broadly, this work also suggests how a uniquely anthropological approach to the study of health policy

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

    Directory of Open Access Journals (Sweden)

    Diana-Camelia IANCU

    2012-08-01

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

  6. Ideas in Public Management Reform for the 2010s

    DEFF Research Database (Denmark)

    Greve, Carsten

    2015-01-01

    management to what has been the dominant paradigm in recent years, the New Public Management (NPM). “Self-styled” means that they explicitly present themselves as alternatives to NPM and address the shortcomings in NPM to promote alternative conceptualizations. They include Digital-Era Governance, Public......The purpose of this paper is to discuss the three key ideas for an agenda for the public sector that are emerging as dominant ideas in the 2010’s in the literature on public organizations. The paper examines a select number of self-styled conceptual alternatives from the literature on public...... Value Management (PVM), Collaborative Governance, also known to some as the New Public Governance (NPG). The paper takes each of these as broad categories, and proposes that each shelters sub-categories of ideas. DEG: transparency, social media and shared service centers. PVM: strategy...

  7. [Relevant public health enteropathogens].

    Science.gov (United States)

    Riveros, Maribel; Ochoa, Theresa J

    2015-01-01

    Diarrhea remains the third leading cause of death in children under five years, despite recent advances in the management and prevention of this disease. It is caused by multiple pathogens, however, the prevalence of each varies by age group, geographical area and the scenario where cases (community vs hospital) are recorded. The most relevant pathogens in public health are those associated with the highest burden of disease, severity, complications and mortality. In our country, norovirus, Campylobacter and diarrheagenic E. coli are the most prevalent pathogens at the community level in children. In this paper we review the local epidemiology and potential areas of development in five selected pathogens: rotavirus, norovirus, Shiga toxin-producing E. coli (STEC), Shigella and Salmonella. Of these, rotavirus is the most important in the pediatric population and the main agent responsible for child mortality from diarrhea. The introduction of rotavirus vaccination in Peru will have a significant impact on disease burden and mortality from diarrhea. However, surveillance studies are needed to determine the impact of vaccination and changes in the epidemiology of diarrhea in Peru following the introduction of new vaccines, as well as antibiotic resistance surveillance of clinical relevant bacteria.

  8. Discrete Institutional Alternatives of Public Administration Reforms in Countries with Developed and Developing Institutional Environment

    Directory of Open Access Journals (Sweden)

    Evgeny A. Kapoguzov

    2016-09-01

    Full Text Available The paper presents an approach to evaluation the impact of the level of development of institutional environment on the success of the reforms of public administration. The indicators that characterize the degree of development of the institutional environment, in particular, the level of protection of property rights, the development of political competition, civil society, corruption, and trust in society are shown. Depending on the elements of the political-administrative system, socio-economic features, that determine the trajectories of reforms, showing alternative purposes and characterized some indicators, that characterizing the results of reforms for the OECD-counties. Showing institutional problems is implementing reforms in the transition countries, depending on the elements of the political and administrative systems, and socio-cultural factors that determine the path of reform, showing alternative purposes and characterized by individual indicators characterizing the results of the OECD reform. From the point of view of the classification results, the emphasis is made on quantitative results of the operational type, in particular, the dynamics of the general government expenditure and the level of employment of civil servants in relation to employment in the economy as a whole. Showing institutional problems in the implementation of reforms in the transition countries, in particular the gap of development of the bureaucratic ethos, the weakness of the market environment and the insufficient level of external pressure on the quality of public services. The significance for the success of reform and systemic cultural change within the state apparatus, which affects the quality of citizens' satisfaction with public services is observed. It is noted that the preliminary formalization of the public sector, the formation of Weberian bureaucracy type is essential for successful implementation of the New Public Management. The factors that

  9. Neglected environmental health impacts of China's supply-side structural reform.

    Science.gov (United States)

    Zhang, Wei; Zhang, Lei; Li, Ying; Tian, Yuling; Li, Xiaoran; Zhang, Xue; Mol, Arthur P J; Sonnenfeld, David A; Liu, Jianguo; Ping, Zeyu; Chen, Long

    2018-03-15

    "Supply-side structural reform" (SSSR) has been the most important ongoing economic reform in China since 2015, but its important environmental health effects have not been properly assessed. The present study addresses that gap by focusing on reduction of overcapacity in the coal, steel, and iron sectors, combined with reduction of emissions of sulfur dioxide (SO 2 ), nitrogen oxide (NO x ), and fine particulate matter (PM 2.5 ), and projecting resultant effects on air quality and public health across cities and regions in China. Modeling results indicate that effects on air quality and public health are visible and distributed unevenly across the country. This assessment provides quantitative evidence supporting projections of the transregional distribution of such effects. Such uneven transregional distribution complicates management of air quality and health risks in China. The results challenge approaches that rely solely on cities to improve air quality. The article concludes with suggestions on how to integrate SSSR measures with cities' air quality improvement attainment planning and management performance evaluation. Copyright © 2018 Elsevier Ltd. All rights reserved.

  10. Interactions: Trade Policy and Healthcare Reform After Chaoulli v. Quebec: Is it time for Canada to acknowledge the fragile boundary between health and trade policies and strengthen the separation between private and public health insurance?

    OpenAIRE

    Crawford, Mark

    2006-01-01

    The insulation of Canada’s healthcare system from trade treaty obligations is crucial to the legitimacy of Canada’s trade policy. Legal analysis has suggested, however, that competitive and for-profit delivery of the kind contemplated by the Kirby Report and some provinces may make healthcare more vulnerable to challenges under NAFTA and GATS. The Government of Canada has tried to counter this interpretation by stressing the importance of public financing as the principal criterion for exempt...

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

    Science.gov (United States)

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

    2006-02-01

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

  12. Conventional and ecological public health.

    Science.gov (United States)

    Rayner, G

    2009-09-01

    This paper suggests that current models of public health are no longer sufficient as a means for understanding the health challenges of the anthropogenic age, and argues for an alternative based upon an ecological model. The roots of this perspective originated within the Victorian era, although it found only limited expression at that time. Ecological thinking in public health has only been revived relatively recently. Derived from an analysis of obesity, this paper proposes the development of an approach to ecological public health based on four dimensions of existence: the material, the physiological, the social and the cultural-cognitive. The implications for public policy are considered.

  13. Climate Change and Public Health.

    Science.gov (United States)

    Ciesielski, Timothy

    2017-05-01

    It is clear that the public health community is concerned about the human health impacts of climate change, but are we inadvertently underestimating the scope of the problem and obfuscating potentially useful interventions by using a narrow intellectual frame in our discussions with policy makers? If we take a more holistic approach, we see that the public health impacts of climate change are only one subset of the enormous public health impacts of fossil fuel burning. This broader perspective can provide a more accurate and comprehensive assessment that is more useful for decision making in public policy settings.

  14. Modernizarea serviciilor publice – prioritate a procesului de reformă a administrației publice locale

    Directory of Open Access Journals (Sweden)

    Ion POPOVICI

    2018-06-01

    Full Text Available Realizarea cu succes a reformei administrației publice locale depinde și este conexă cu alte reforme, care trebuie implementate în Republica Moldova, precum Reforma de modernizare a serviciilor publice sau Strategia națională de descentralizare. Prestarea unor servicii publice administrative eficace, moderne şi eficiente, care să apropie administrația de cetăţean, reprezintă una dintre priorităţile procesului de reformă a administraţiei publice, administraţie care să răspundă cerinţelor societăţii democratice.

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

    African Journals Online (AJOL)

    International Journal of Medicine and Health Development ... district health system, community-based health insurance ,immunization and disease- ... of the key factors which have determined whether reforms preferentially benefit the poorest ...

  16. 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

  17. The need for tort reform as part of health care reform.

    Science.gov (United States)

    Thornton, Tiffany; Saha, Subrata

    2008-01-01

    There is no doubt about the need for tort reform. The current state of the legal system imposes great costs on the U.S. health care system and society in general-an astounding $865 billion each year. Physicians are forced to practice defensive medicine to protect themselves from litigation. Caps on non-economic damages have helped reduce malpractice insurance rates and encouraged young physicians to pursue specialties such as obstetrics. Collective insurance pools and national insurance programs for physicians and hospitals are some options that other countries employ to reduce malpractice rates. Regulation of expert testimony by medical societies would curb false or biased testimony. Other recommendations to improve the tort system include establishing expert health courts similar to those that currently exist for tax and patent law, using mediation, creating patient compensation funds, making acknowledgment of errors inadmissible in court, providing certificates of merit or pretrial screening panels to confirm the validity of lawsuits, and developing treatment contracts. Clearly some action must be taken to amend our current wasteful tort system.

  18. Health sector reform in Brazil: a case study of inequity.

    Science.gov (United States)

    Almeida, C; Travassos, C; Porto, S; Labra, M E

    2000-01-01

    Health sector reform in Brazil built the Unified Health System according to a dense body of administrative instruments for organizing decentralized service networks and institutionalizing a complex decision-making arena. This article focuses on the equity in health care services. Equity is defined as a principle governing distributive functions designed to reduce or offset socially unjust inequalities, and it is applied to evaluate the distribution of financial resources and the use of health services. Even though in the Constitution the term "equity" refers to equal opportunity of access for equal needs, the implemented policies have not guaranteed these rights. Underfunding, fiscal stress, and lack of priorities for the sector have contributed to a progressive deterioration of health care services, with continuing regressive tax collection and unequal distribution of financial resources among regions. The data suggest that despite regulatory measures to increase efficiency and reduce inequalities, delivery of health care services remains extremely unequal across the country. People in lower income groups experience more difficulties in getting access to health services. Utilization rates vary greatly by type of service among income groups, positions in the labor market, and levels of education.

  19. BUILDING AN EU MEMBER STATE THROUGH DEMOCRACY PROMOTION: THE CASE OF CROATIA'S PUBLIC ADMINISTRATION REFORM

    Directory of Open Access Journals (Sweden)

    Sonja Grimm

    2013-01-01

    Full Text Available This contribution studies the process of building an EU member state through democracy promotion in the case of Croatia with a special focus on two reform initiatives in the field of Public Administration Reform (PAR. Croatia’s experience is representative of intense efforts of the international community to overcome the consequences of violent state dissolution and civil war. The EU in particular has assisted post-conflict democratization with diplomatic initiatives, the provision of aid, and political conditionality. The Croatian political elite showed great willingness to implement democratic reforms, while at the same time remaining critical of what they viewed as ‘too much’ external interference in domestic state affairs. Based on 30 interviews with Croatian officials, Croatian civil society actors, members of the EU delegation and other representatives of the International donor community, we empirically assess progress and setbacks in Croatia’s public administration reform and explain why some reform initiatives have been successfully implemented while others are still pending.

  20. Discover: What Is Public Health?

    Science.gov (United States)

    ... a variety of comprehensive classroom and curriculum resources. Framing The Future Faculty Resources Educational Models and Reports ... research, and regulate health systems to achieve these goals. Its reach is global. The public health field ...

  1. School Autonomy Reform and Public Education in Australia: Implications for Social Justice

    Science.gov (United States)

    Keddie, Amanda

    2017-01-01

    The renewed commitment to school autonomy reform in Australia is based on the view that it will drive up academic standards. There remains, however, little conclusive evidence to support this view. Simply instating the structural changes to bring about greater autonomy for schools within public education systems across the world has not led…

  2. Insights in Public Health

    Science.gov (United States)

    Taira, Deborah; Sentell, Tetine; Albright, Cheryl; Lansidell, Doug; Nakagawa, Kazuma; Seto, Todd; Stevens, Joel Mark

    2017-01-01

    Hypertension is one of the leading causes of death and disability worldwide. Blood pressure reduction and control are associated with reduced risk of stroke and cardiovascular disease. To achieve optimal reduction and control, reliable and valid methods for blood pressure measurement are needed. Office based measurements can result in ‘white coat’ hypertension, which is when a patient's blood pressure in a clinical setting is higher than in other settings, or ‘masked’ hypertension, which occurs when a patient's blood pressure is normal in a clinical setting, but elevated outside the clinical setting. In 2015, the US Preventative Services Task Force recommended Ambulatory Blood Pressure Monitoring (ABPM) as the “best method” for measuring blood pressure, endorsing its use both for confirming the diagnosis of hypertension and for excluding ‘white coat’ hypertension. ABPM is a safe, painless and non-invasive test wherein patients wear a small digital blood pressure machine attached to a belt around their body and connected to a cuff around their upper arm that enables multiple automated blood pressure measurements at designated intervals (typically every 15 to 30 minutes) throughout the day and night for a specified period (eg, 24 hours). Patients can go about their typical daily activities wearing the device as much as possible, except when they are bathing, showering, or engaging in heavy exercise. Given the importance of blood pressure monitoring and control to population public health, this article provides details on the relevance and challenges of blood pressure measurement broadly then describes ABPM generally and specifically in the Hawai‘i context. PMID:29164016

  3. Health sector reform in South Asia: new challenges and constraints.

    Science.gov (United States)

    Islam, Anwar; Tahir, M Zaffar

    2002-05-01

    In early 1990s, Jamison, Mosley and others concluded that a profound demographic and consequent epidemiological transition is taking place in developing countries. According to this classical model, by the year 2015, infectious diseases will account for only about 20% of deaths in developing countries as chronic diseases become more pronounced. These impending demographic and epidemiological transitions were to dominate the health sector reform agenda in developing countries. Following an analysis of fertility, mortality and other demographic and epidemiological data from South Asian and other developing countries, the paper argues that the classical model is in need of re-evaluation. A number of new 'challenges' have complicated the classical interplay of demographic and epidemiological factors. These new challenges include continuing population growth in some countries, rapid unplanned urbanization, the HIV/AIDS pandemic in Sub-Saharan Africa (and its impending threat in South Asia), and globalization and increasing marginalisation of developing countries. While the traditional lack of investment in human development makes the developing countries more vulnerable to the vicissitudes of globalization, increasing economic weakness of their governments forces them to retreat further from the social sector. Pockets of poverty and deprivation, therefore, persist giving rise to three simultaneous burdens for South Asia and much of the rest of the developing world: continuing communicable diseases, increasing burden of chronic diseases, and increasing demand for both primary and tertiary levels of health care services. While these complex factors, on the one hand, underscore the need for health sector reform, on the other, they make the task much more difficult and challenging. The paper emphasizes the need to revisit the classical model of demographic and epidemiological transition. It is argued that the health sector in developing countries must be aware of and

  4. Las reformas neoliberales del sector de la salud: déficit gerencial y alienación del recurso humano en América Latina Neoliberal health sector reforms in Latin America: unprepared managers and unhappy workers

    Directory of Open Access Journals (Sweden)

    Antonio Ugalde

    2005-03-01

    Full Text Available This work analyzes the neoliberal health sector reforms that have taken place in Latin America, the preparation of health care workers for the reforms, the reforms' impacts on the workers, and the consequences that the reforms have had on efficiency and quality in the health sector. The piece also looks at the process of formulating and implementing the reforms. The piece utilizes secondary sources and in-depth interviews with health sector managers in Bolivia, Colombia, Costa Rica, the Dominican Republic, Ecuador, El Salvador, and Mexico. Neoliberal reforms have not solved the human resources problems that health sector evaluations and academic studies had identified as the leading causes of health system inefficiency and low-quality services that existed before the reforms. The reforms worsened the situation by putting new pressures on health personnel, in terms of both the lack of necessary training to face the challenges that came with the reforms and efforts to take away from workers the rights and benefits that they had gained during years of struggles by unions, and to replace them with temporary contracts, reduced job security, and lower benefits. The secrecy with which the reforms were developed and applied made workers even more unified. In response, unions opposed the reforms, and in some countries they were able to delay the reforms. The neoliberal reforms have not improved the efficiency or quality of health systems in Latin America despite the resources that have been invested. Nor have the neoliberal reforms supported specific changes that have been applied in the public sector and that have demonstrated their ability to solve important health problems. These specific changes have produced better results than the neoliberal reforms, and at a lower cost.

  5. Liberalism and Public Health Ethics.

    Science.gov (United States)

    Rajczi, Alex

    2016-02-01

    Many public health dilemmas involve a tension between the promotion of health and the rights of individuals. This article suggests that we should resolve the tension using our familiar liberal principles of government. The article considers the common objections that (i) liberalism is incompatible with standard public health interventions such as anti-smoking measures or intervention in food markets; (2) there are special reasons for hard paternalism in public health; and (3) liberalism is incompatible with proper protection of the community good. The article argues that we should examine these critiques in a larger methodological framework by first acknowledging that the right theory of public health ethics is the one we arrive at in reflective equilibrium. Once we examine the arguments for and against liberalism in that light, we can see the weaknesses in the objections and the strength of the case for liberalism in public health. © 2015 John Wiley & Sons Ltd.

  6. Public Sector Reforms In Africa: A Philosophical Re-Thinking

    African Journals Online (AJOL)

    seriane.camara

    2009-05-14

    May 14, 2009 ... and impact on their people provided these policies are part of the new public ... consequent perpetual slavery. So, the two ..... officials are shareholders. ..... those prevailing in non-modern sectors of African society by which.

  7. Public Sector Reforms In Africa: A Philosophical Re-Thinking

    African Journals Online (AJOL)

    seriane.camara

    2009-05-14

    May 14, 2009 ... sector management in the name of PSR. ... the importance attached to this agenda, the World Bank created a fully fledged. Public Sector Group in 1997. ..... There is also a need to exploit indigenous knowledge in carrying out.

  8. Introduction Public Sector Reforms and the Quest for Democratic ...

    African Journals Online (AJOL)

    seriane.camara

    substantive (or emancipatory) democracy in the long run”. Democratic .... the paradigm focused exclusively on short-term macro-economic stabilization, with little ..... Paper presented at the Guy Mhone Memorial Conference on Public Sector.

  9. Mental health in schools and public health

    OpenAIRE

    Adelman, Howard S; Taylor, Linda

    2006-01-01

    Health policy and practice call for health and mental health parity and for a greater focus on universal interventions to promote, prevent, and intervene as early after problem onset as is feasible. Those in the public health field are uniquely positioned to help promote the mental health of young people and to reshape how the nation thinks about and addresses mental health. And schools are essential partners for doing the work.

  10. Competing health policies: insurance against universal public systems

    Directory of Open Access Journals (Sweden)

    Asa Ebba Cristina Laurell

    2016-01-01

    Full Text Available Objectives: This article analyzes the content and outcome of ongoing health reforms in Latin America: Universal Health Coverage with Health Insurance, and the Universal and Public Health Systems. It aims to compare and contrast the conceptual framework and practice of each and verify their concrete results regarding the guarantee of the right to health and access to required services. It identifies a direct relationship between the development model and the type of reform. The neoclassical-neoliberal model has succeeded in converting health into a field of privatized profits, but has failed to guarantee the right to health and access to services, which has discredited the governments. The reform of the progressive governments has succeeded in expanding access to services and ensuring the right to health, but faces difficulties and tensions related to the permanence of a powerful, private, industrial-insurance medical complex and persistence of the ideologies about medicalized 'good medicine'. Based on these findings, some strategies to strengthen unique and supportive public health systems are proposed.

  11. [Terrorism, public health and health services].

    Science.gov (United States)

    Arcos González, Pedro; Castro Delgado, Rafael; Cuartas Alvarez, Tatiana; Pérez-Berrocal Alonso, Jorge

    2009-01-01

    Today the terrorism is a problem of global distribution and increasing interest for the international public health. The terrorism related violence affects the public health and the health care services in an important way and in different scopes, among them, increase mortality, morbidity and disability, generates a context of fear and anxiety that makes the psychopathological diseases very frequent, seriously alters the operation of the health care services and produces important social, political and economic damages. These effects are, in addition, especially intense when the phenomenon takes place on a chronic way in a community. The objective of this paper is to examine the relation between terrorism and public health, focusing on its effects on public health and the health care services, as well as to examine the possible frames to face the terrorism as a public health concern, with special reference to the situation in Spain. To face this problem, both the public health systems and the health care services, would have to especially adapt their approaches and operational methods in six high-priority areas related to: (1) the coordination between the different health and non health emergency response agencies; (2) the reinforcement of the epidemiological surveillance systems; (3) the improvement of the capacities of the public health laboratories and response emergency care systems to specific types of terrorism as the chemical or biological terrorism; (3) the mental health services; (4) the planning and coordination of the emergency response of the health services; (5) the relations with the population and mass media and, finally; (6) a greater transparency in the diffusion of the information and a greater degree of analysis of the carried out health actions in the scope of the emergency response.

  12. 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.

  13. Implementing accountable management reforms in public sector : the difficult travel from intentions to effects

    OpenAIRE

    Pettersen, Inger Johanne

    2000-01-01

    Over the last decade a number of management accounting practices and techniques have appeared to improve the quality and reliability of management accounting information in public sector. The aim of this paper is to gain more insight into the link between management accounting reforms and organizational learning and change in the hospital sector. Especially, the focus is put on the processes of defining, interpreting and sense-making of accounting information in this complex public sector man...

  14. Social media in public health.

    Science.gov (United States)

    Kass-Hout, Taha A; Alhinnawi, Hend

    2013-01-01

    While social media interactions are currently not fully understood, as individual health behaviors and outcomes are shared online, social media offers an increasingly clear picture of the dynamics of these processes. Social media is becoming an increasingly common platform among clinicians and public health officials to share information with the public, track or predict diseases. Social media can be used for engaging the public and communicating key public health interventions, while providing an important tool for public health surveillance. Social media has advantages over traditional public health surveillance, as well as limitations, such as poor specificity, that warrant additional study. Social media can provide timely, relevant and transparent information of public health importance; such as tracking or predicting the spread or severity of influenza, west nile virus or meningitis as they propagate in the community, and, in identifying disease outbreaks or clusters of chronic illnesses. Further work is needed on social media as a valid data source for detecting or predicting diseases or conditions. Also, whether or not it is an effective tool for communicating key public health messages and engaging both, the general public and policy-makers.

  15. Health Sector Reform, Emotional Exhaustion, and Nursing Burnout: A Retrospective Panel Study in Iran.

    Science.gov (United States)

    Sadati, Ahmad Kalateh; Rahnavard, Farnaz; Heydari, Seyed Taghi; Hemmati, Soroor; Ebrahimzadeh, Najmeh; Lankarani, Kamran Bagheri

    2017-10-01

    Nursing burnout is affected by various factors, including work overload. Since the inauguration of the Health Sector Evolution Plan (HSEP) in Iran in 2014, government hospitals have been required to provide health services to the public at all levels. This decision, however, has increased the volume of patients admitted to government hospitals. Because nurses are on the front line of health services, they are faced with a greater load of care provision. This study aimed to evaluate nursing burnout before and after HSEP in Iran, with an emphasis on the differences between government and private hospitals. This retrospective panel study used Maslach's burnout inventory to evaluate nursing burnout in 371 nurses working in government and private hospitals in Shiraz, Iran, before and 7 months after the health sector reform. Chi-square test and paired t test were used to compare burnout scores. The results showed that nursing burnout had changed significantly after HSEP was launched (p = .030). A more detailed assessment found that burnout and emotional exhaustion had both increased significantly in the government-hospital group (ps = .014 and .001, respectively). However, no significant change in burnout was found in the private-hospital group over the same period. The findings of this study indicate an increase in nursing burnout in government hospitals. An important issue in every health sector reform is nursing resource management, with a focus on burnout. Accordingly, policymakers should consider the work overload situation of nurses and work to prevent increased burnout, especially emotional exhaustion.

  16. Citizen Science for public health

    NARCIS (Netherlands)

    Broeder, Den Lea; Devilee, Jeroen; Oers, Van Hans; Schuit, A.J.; Wagemakers, Annemarie

    2016-01-01

    Community engagement in public health policy is easier said than done. One reason is that public health policy is produced in a complex process resulting in policies that may appear not to link up to citizen perspectives. We therefore address the central question as to whether citizen engagement in

  17. Citizen Science for public health

    NARCIS (Netherlands)

    Den Broeder, Lea; Devilee, Jeroen; Van Oers, J.A.M.; Schuit, A.J.; Wagemakers, Annemarie

    2017-01-01

    Community engagement in public health policy is easier said than done. One reason is that public health policy is produced in a complex process resulting in policies that may appear not to link up to citizen perspectives. We therefore address the central question as to whether citizen engagement in

  18. GIS and public health

    National Research Council Canada - National Science Library

    Cromley, Ellen K; McLafferty, Sara

    2012-01-01

    ...s. The book presents state-of-the-art methods for mapping and analyzing data on population, health events, risk factors, and health services, and for incorporating geographical knowledge into planning and policy...

  19. American Public Health Association

    Science.gov (United States)

    ... like Saba are about three to four times… https://www.nytimes.com/2017/11/13/health/colombia- ... often be overlooked as a cause of death": https://insideclimatenews.… Environmental health matters: https://www.theatlantic.com/ ...

  20. 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

  1. Primary care and health reform in New Zealand.

    Science.gov (United States)

    Grant, C C; Forrest, C B; Starfield, B

    1997-02-14

    (1) To describe New Zealand's primary care system (2) to compare New Zealand to other Anglo-American members of the OECD with respect to the adequacy of primary care, and (3) to assess the cost-efficiency and effectiveness of New Zealand's system by comparing health spending and health indicators relevant to primary care. A cross-national comparison of primary care, health spending and health indicators in New Zealand, Australia, Canada, the United Kingdom and the United States of America. Main outcome measures were health spending measured in purchasing power parties. Health indicators: mean life expectancy in years, years of potential life lost and infant mortality rates. New Zealand's primary care system ranked below the UK, above the USA and similar to Canada and Australia. Favourable characteristics of New Zealand's primary care system were the use of generalists as the predominant type of practitioner and the low proportion of active physicians who were specialists. Compared to the other countries, New Zealand scored poorly for financial that are necessary for the practise of good primary care. New Zealand and the UK had the lowest spending per capita on health care. New Zealand and the USA scored lowest for all three of the health care indicators. The quality of primary care in New Zealand is limited by barriers to access to care and the intermediate level of practise characteristics essential to primary care. Compared to other AngloAmerican OECD nations, New Zealand has relatively low levels of national health expenditure. In order to improve the quality of primary care, future reform should aim to facilitate access to care, increase the gatekeeping role of primary care physicians, and promote the practise characteristics essential to primary care.

  2. Chiropractic care and public health

    DEFF Research Database (Denmark)

    Johnson, Claire; Rubinstein, Sidney M; Côté, Pierre

    2012-01-01

    The purpose of this collaborative summary is to document current chiropractic involvement in the public health movement, reflect on social ecological levels of influence as a profession, and summarize the relationship of chiropractic to the current public health topics of: safety, health issues...... disorders? How can chiropractic use cognitive behavioral therapy to address chronic low back pain as a public health problem? What opportunities exist for doctors of chiropractic to more effectively serve the aging population? What is the role of ethics and the contribution of the chiropractic profession...

  3. 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

    .... Establishment of the White House Office of Health Reform 13507 Order 13507 Presidential Documents Executive Orders Executive Order 13507 of April 8, 2009 EO 13507 Establishment of the White House Office of Health.... Establishment. (a) There is established a White House Office of Health Reform (Health Reform Office) within the...

  4. Palestinian Security Sector Reform : the View of the Public | IDRC ...

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

    PSR will consult with various stakeholders - the Ministry of the Interior, the security services, the judiciary, members of Parliament, human rights organizations and international donors - in extensive surveys of the public's perception of the security sector in all its dimensions, including capacity, mission, performance, service ...

  5. New public management reforms in Nigerian democratic governance

    African Journals Online (AJOL)

    This paper brings concepts and ideas from around the world about the need for and ways of achieving more responsive and accountable new public management within the framework of democratic governance. The paper adopts a content analysis method through the use of secondary data. The findings of the paper ...

  6. 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

  7. 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

  8. A public health physician named Walter Leser.

    Science.gov (United States)

    Mello, Guilherme Arantes; Bonfim, José Ruben de Alcântara

    2015-09-01

    A brief review of the career of the public health physician Walter Sidney Pereira Leser, who died in 2004 aged 94. Self-taught, from his 1933 doctoral thesis he became a country reference in the field of statistics and epidemiology, with dozens of studies and supervisions. In the clinical field he is one of the founders of Fleury Laboratory, and participates in the creation of CREMESP. As an academic, Leser was a professor at the Escola de Sociologia e Política de São Paulo, Escola Paulista de Medicina e Faculdade de Farmácia e Odontologia da USP. Also, Leser introduced objective tests in the college entrance examination, and led the creation of CESCEM and Carlos Chagas Foundation. In the Escola Paulista de Medicina he created the first Preventive Medicine Department of the country. As a public official, he was secretary of the State Department of Health of São Paulo between 1967 and 1971 and between 1975 and 1979, responsible for extensive reforms and innovations. Among the most remembered, the creation of sanitary medical career. Throughout this legacy, he lent his name to the "Medal of Honor and Merit Public Health Management" of the State of São Paulo.

  9. [Health services research for the public health service (PHS) and the public health system].

    Science.gov (United States)

    Hollederer, A; Wildner, M

    2015-03-01

    There is a great need for health services research in the public health system and in the German public health service. However, the public health service is underrepresented in health services research in Germany. This has several structural, historical and disciplinary-related reasons. The public health service is characterised by a broad range of activities, high qualification requirements and changing framework conditions. The concept of health services research is similar to that of the public health service and public health system, because it includes the principles of multidisciplinarity, multiprofessionalism and daily routine orientation. This article focuses on a specified system theory based model of health services research for the public health system and public health service. The model is based on established models of the health services research and health system research, which are further developed according to specific requirements of the public health service. It provides a theoretical foundation for health services research on the macro-, meso- and microlevels in public health service and the public health system. Prospects for public health service are seen in the development from "old public health" to "new public health" as well as in the integration of health services research and health system research. There is a significant potential for development in a better linkage between university research and public health service as is the case for the "Pettenkofer School of Public Health Munich". © Georg Thieme Verlag KG Stuttgart · New York.

  10. Why feminism in public health?

    Science.gov (United States)

    Hammarström, A

    1999-12-01

    The issues raised in this editorial and exemplified within a number of the studies reported in this issue indicate new directions for public health, directions which take feminist scholarship, both outside and within the medical framework, into account. The changing potential of feminist public health, as derived from the articles in this issue, can be summarised within the following issues: new research areas, positioning women as actors, development of theoretical frameworks, reflexive theory of science, interplay between sex and gender, gender-sensitive methods, diversities among women/men, pro-feminist research on men's health and using the results for change. Thus, feminist public health represents a shift towards the new public health, with holistic and multidisciplinary activities, based on theoretical pluralism, multiple perspectives and collective actions with the aim of improving the health of gender-subordinated groups.

  11. 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.

  12. 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

    2014-01-01

    Background: 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. Objectives: The current study aimed to analyze the movement from cash-based to accrual-based accounting in the health sector in Iran. Patients and Methods: 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. Results: 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. Conclusions: There are advantages in applying accrual-based accounting in the public sector which certainly depends on how this system is implemented in the sector. PMID:25763194

  13. 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.

  14. 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

  15. Primary health care reform, dilemmatic space and risk of burnout among health workers.

    Science.gov (United States)

    Freeman, Toby; Baum, Fran; Labonté, Ronald; Javanparast, Sara; Lawless, Angela

    2018-05-01

    Health system changes may increase primary health care workers' dilemmatic space, created when reforms contravene professional values. Dilemmatic space may be a risk factor for burnout. This study partnered with six Australian primary health care services (in South Australia: four state government-managed services including one Aboriginal health team and one non-government organisation and in Northern Territory: one Aboriginal community-controlled service) during a period of change and examined workers' dilemmatic space and incidence of burnout. Dilemmatic space and burnout were assessed in a survey of 130 staff across the six services (58% response rate). Additionally, 63 interviews were conducted with practitioners, managers, regional executives and health department staff. Dilemmatic space occurred across all services and was associated with higher rates of self-reported burnout. Three conditions associated with dilemmatic space were (1) conditions inherent in comprehensive primary health care, (2) stemming from service provision for Aboriginal and Torres Strait Islander peoples and (3) changes wrought by reorientation to selective primary health care in South Australia. Responses to dilemmatic space included ignoring directives or doing work 'under the radar', undertaking alternative work congruent with primary health care values outside of hours, or leaving the organisation. The findings show that comprehensive primary health care was contested and political. Future health reform processes would benefit from considering alignment of changes with staff values to reduce negative effects of the reform and safeguard worker wellbeing.

  16. Bioethics in Public Health Practice

    Directory of Open Access Journals (Sweden)

    Matilde Peguero

    2018-06-01

    Full Text Available The bioethics study method concerns the duties and values that must be fulfilled for respect for life. The aim of this article is to provide a reflection on bioethics in public health actions. It is a review article that includes authors with different positions. Bioethics, despite its apparent individual focus, is vital to fulfil essential functions in public health, and to guarantee the right to health and respect for human dignity.

  17. 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.

  18. THE NECESSITY OF IMPLEMENTING REFORMS IN THE FIELD OF LOCAL PUBLIC FINANCE

    Directory of Open Access Journals (Sweden)

    Vezure Oana Sabina

    2013-06-01

    Full Text Available The difficulties faced by local authorities as a result of the austerity conditions in which they work, the elements inherited from the previous regime, the need for additional resources to optimize public finance to meet the needs, optimally, if possible, citizens, require the design and continue the reform of public finances at the local level that correspond to these requirements. Optimization of the reform process in local public finances depend to a great extent on the use of financial levers of fiscal efficiency, fulfilment of the functions of public finance, the way resources are provided and how their administration for economic and social development. The uneven development of economic weakness of the assembly reflect and are unacceptable because, in their turn, become a source of economic and political instability. Responsibility for ensuring sufficient local revenue must not belong to a large measure, the central authorities, the context in which local authorities should prioritize finding solutions to supplement the local budget and obtain funds from the central budget. At the same time, cannot be intended directions of reform in the field of public administration without taking into account the financial implications reflected in the budgets for each level of Government, pyramid-shaped, from central to local level.

  19. Reform towards National Health Insurance in Malaysia: the equity implications.

    Science.gov (United States)

    Yu, Chai Ping; Whynes, David K; Sach, Tracey H

    2011-05-01

    This paper assesses the potential equity impact of Malaysia's projected reform of its current tax financed system towards National Health Insurance (NHI). The Kakwani's progressivity index was used to assess the equity consequences of the new NHI system (with flat rate NHI scheme) compared to the current tax financed system. It was also used to model a proposed system (with a progressive NHI scheme) that can generate the same amount of funding more equitably. The new NHI system would be less equitable than the current tax financed system, as evident from the reduction of Kakwani's index to 0.168 from 0.217. The new flat rate NHI scheme, if implemented, would reduce the progressivity of the health finance system because it is a less progressive finance source than that of general government revenue. We proposed a system with a progressive NHI scheme that generates the same amount of funding whilst preserving the equity at the Kakwani's progressivity index of 0.213. A NHI system with a progressive NHI scheme is proposed to be implemented to raise health funding whilst preserving the equity in health care financing. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

    Myers, Kathleen M; Lieberman, Daniel

    2013-06-01

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

  1. Public Health Events and International Health Regulations

    Centers for Disease Control (CDC) Podcasts

    2012-06-21

    Dr. Katrin Kohl, a medical officer at the CDC, discusses the World Health Organization’s International Health Regulations for assessing and reporting on public health events across the world.  Created: 6/21/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 6/21/2012.

  2. Division of Public Health

    Science.gov (United States)

    Frontier Learn what marijuana means for Alaska and you It's your health - Teen Health Autism: Learn the Outbreak of Life-threatening Coagulopathy Associated with Synthetic Cannabinoids Use Friday, May 25, 2018 Impacts of Climate Change in Alaska PDF Monday, January 8, 2018 Breastfeeding mothers reporting marijuana

  3. Opportunities for Public Relations Research in Public Health.

    Science.gov (United States)

    Wise, Kurt

    2001-01-01

    Considers how communication researchers have developed a solid body of knowledge in the health field but know little about the activities of public relations practitioners in public health bodies. Suggests that public relations scholarship and practice have much to offer the field of public health in helping public health bodies meet their…

  4. 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

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

    Science.gov (United States)

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

    2011-01-01

    service organisations reported high levels of strategic HRM, the human resource and other managers reported a distinct lack of HPWS from their perspectives. The authors discuss why health care organisations may have difficulty in achieving HPWS. Leaders in health care organisations should focus on ensuring human resource management systems, structures and processes that support HPWS. Policy makers need to consider HPWS as a necessary component of health system reform. There is a strong need to reorient organisational human resource management policies and procedures in public health care organisations towards high performing work systems.

  6. Child public health

    National Research Council Canada - National Science Library

    Blair, Mitch

    2010-01-01

    .... It combined clinical and academic perspectives to explore the current state of health of our children, the historical roots of the speciality and the relationship between early infant and child...

  7. Public health leadership education in North America

    OpenAIRE

    Uno, Hideo; Zakariasen,Kenneth

    2010-01-01

    Hideo Uno, Kenneth ZakariasenDepartment of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, AB, CanadaAbstract: Public health leadership is one of the priority disciplines public health professionals need to learn well if they are to deal with demanding public health issues effectively and efficiently. This article looks at the trends in public health leadership education by reviewing the literature and using the Internet to explore the public health leadershi...

  8. The Gateway Paper--financing health in Pakistan and its linkage with health reforms.

    Science.gov (United States)

    Nishtar, Sania

    2006-12-01

    Pakistan currently principally uses three modes of financing health--taxation, out of pocket payments and donor contributions of which the latter is the least significant in terms of size. Less than 3.6% of the employees are covered under the social security scheme and there is a limited social protection mechanism, which collectively serves the health needs of 3.4% of the population. The main issues in health financing include low spending, lack of attention to alternate sources of financing and issues with fund mobilization and utilization. With respect to the first, health reforms proposed as part of the Gateway Paper make a strong case for promoting the reallocation of tax-based revenues and developing sustainable alternatives to low levels of public spending on health. With respect to alternative sources of health financing, the Gateway Paper lays stress on exploring policy options for private health insurance, broadening the base of Employees Social Security, creating a Federal Employees Social Security Programme, developing social health insurance within the framework of a broad-based social protection strategy, which scopes beyond the formally employed sector, establishing a widely inclusive safety net for the poor; mainstreaming philanthropic grants as a major source of health financing; developing a conducive tax configuration; generating greater corporate support for social sector causes within the framework of the concept of Corporate Social Responsibility and developing cost-sharing programmes, albeit with safeguards. The Gateway Paper regards efficient fund utilization a priority and lays stress on striking a balance between minimizing costs, controlling costs and using resources more efficiently and equitably--in other words, getting the best value for the money, on the one hand, and increasing the pool of available resources, on the other. Specific interventions such as the promotion of transparent financial administration, budgeting and cost

  9. The Impact of State Medical Malpractice Reform on Individual-Level Health Care Expenditures.

    Science.gov (United States)

    Yu, Hao; Greenberg, Michael; Haviland, Amelia

    2017-12-01

    Past studies of the impact of state-level medical malpractice reforms on health spending produced mixed findings. Particularly salient is the evidence gap concerning the effect of different types of malpractice reform. This study aims to fill the gap. It extends the literature by examining the general population, not a subgroup or a specific health condition, and controlling for individual-level sociodemographic and health status. We merged the Database of State Tort Law Reforms with the Medical Expenditure Panel Survey between 1996 and 2012. We took a difference-in-differences approach to specify a two-part model for analyzing individual-level health spending. We applied the recycled prediction method and the bootstrapping technique to examining the difference in health spending growth between states with and without a reform. All expenditures were converted to 2010 U.S. dollars. Only two of the 10 major state-level malpractice reforms had significant impacts on the growth of individual-level health expenditures. The average annual expenditures in states with caps on attorney contingency fees increased less than that in states without the reform (p negligence rule, the average annual expenditures increased more in both states with a pure comparative fault reform (p < .05) and states with a comparative fault reform that barred recovery if the plaintiff's fault was equal to or greater than the defendant's (p < .05). A few state-level malpractice reforms had significantly affected the growth of individual-level health spending, and the direction and magnitude of the effects differed by type of reform. © Health Research and Educational Trust.

  10. Public Health Perspectives on Aquaculture.

    Science.gov (United States)

    Gormaz, Juan G; Fry, Jillian P; Erazo, Marcia; Love, David C

    2014-01-01

    Nearly half of all seafood consumed globally comes from aquaculture, a method of food production that has expanded rapidly in recent years. Increasing seafood consumption has been proposed as part of a strategy to combat the current non-communicable disease (NCD) pandemic, but public health, environmental, social, and production challenges related to certain types of aquaculture production must be addressed. Resolving these complicated human health and ecologic trade-offs requires systems thinking and collaboration across many fields; the One Health concept is an integrative approach that brings veterinary and human health experts together to combat zoonotic disease. We propose applying and expanding the One Health approach to facilitate collaboration among stakeholders focused on increasing consumption of seafood and expanding aquaculture production, using methods that minimize risks to public health, animal health, and ecology. This expanded application of One Health may also have relevance to other complex systems with similar trade-offs.

  11. Public Policy and Health Informatics.

    Science.gov (United States)

    Bell, Katherine

    2018-04-05

    To provide an overview of the history of electronic health policy and identify significant laws that influence health informatics. US Department of Health and Human Services. The development of health information technology has influenced the process for delivering health care. Public policy and regulations are an important part of health informatics and establish the structure of electronic health systems. Regulatory bodies of the government initiate policies to ease the execution of electronic health record implementation. These same bureaucratic entities regulate the system to protect the rights of the patients and providers. Nurses should have an overall understanding of the system behind health informatics and be able to advocate for change. Nurses can utilize this information to optimize the use of health informatics and campaign for safe, effective, and efficient health information technology. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. Personalism for public health ethics

    Directory of Open Access Journals (Sweden)

    Carlo Petrini

    2010-06-01

    Full Text Available In public health ethics, as in bioethics, utilitarian approaches usually prevail, followed by Kantian and communitarian foundations. If one considers the nature and core functions of public health, which are focused on a population perspective, utilitarianism seems still more applicable to public health ethics. Nevertheless, faulting additional protections towards the human person, utilitarianism doesn't offer appropriate solutions when conflicts among values do arise. Further criteria must be applied to protect the fundamental principles of respect for human life. Personalism offers similar advantages to utilitarianism but warrants more protection to the human person. We suggest a possible adaptation of personalism in the specific field of public health by means of four principles: absolute respect for life or principle of inviolability; subsidiarity and the "minimum" mandatory principle; solidarity; justice and non discrimination.

  13. Personalism for public health ethics.

    Science.gov (United States)

    Petrini, Carlo; Gainotti, Sabina; Requena, Pablo

    2010-01-01

    In public health ethics, as in bioethics, utilitarian approaches usually prevail, followed by Kantian and communitarian foundations. If one considers the nature and core functions of public health, which are focused on a population perspective, utilitarianism seems still more applicable to public health ethics. Nevertheless, faulting additional protections towards the human person, utilitarianism doesn't offer appropriate solutions when conflicts among values do arise. Further criteria must be applied to protect the fundamental principles of respect for human life. Personalism offers similar advantages to utilitarianism but warrants more protection to the human person. We suggest a possible adaptation of personalism in the specific field of public health by means of four principles: absolute respect for life or principle of inviolability; subsidiarity and the "minimum" mandatory principle; solidarity; justice and non discrimination.

  14. Public Health Nutrition Education

    DEFF Research Database (Denmark)

    Torheim, Liv Elin; Birgisdottir, Bryndis Eva; Robertson, Aileen

    2016-01-01

    , Oslo, Norway, 2Unit for Nutrition Research, Landspitali University Hospital , 3Department of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland, 4Global Nutrition and Health, Metropolitan University College, Copenhagen, Denmark, 5School of Hospitality, culinary arts and meal science...

  15. Influencing public health without authority.

    Science.gov (United States)

    Suresh, K

    2012-01-01

    This paper analyzes the present processes, products and needs of post-graduate public health education for the health programming, implementation and oversight responsibilities at field level and suggests some solutions for the institutes to adopt or adapt for improving the quality of their scholars. Large number of institutions has cropped up in India in the recent years to meet the growing demand of public health specialists/practitioners in various national health projects, international development partners, national and international NGOs. Throwing open MPH courses to multi-disciplinary graduate's is a new phenomenon in India and may be a two edged sword. On one hand it is advantageous to produce multi-faceted Public health postgraduates to meet the multi tasking required, on the other hand getting all of them to a common basic understanding, demystifying technical teaching and churning out products that are acceptable to the traditional health system. These Institutions can and must influence public health in the country through producing professionals of MPH/ MD degree with right attitude and skill-mix. Engaging learners in experimentation, experience sharing projects, stepping into health professionals' roles and similar activities lead to development of relatively clear and permanent neural traces in the brain. The MPH institutes may not have all efficient faculties, for which they should try to achieve this by inviting veterans in public health and professionals from corporate health industry for interface with students on a regular basis. The corporate and public health stalwarts have the capacities to transmit the winning skills and knowledge and also inspire them to adopt or adapt in order to achieve the desired goals.

  16. Achieving excellence in community health centers: implications for health reform.

    Science.gov (United States)

    Gurewich, Deborah; Capitman, John; Sirkin, Jenna; Traje, Diana

    2012-02-01

    Existing studies tell us little about care quality variation within the community health center (CHC) delivery system. They also tell us little about the organizational conditions associated with CHCs that deliver especially high quality care. The purpose of this study was to examine the operational practices associated with a sample of high performing CHCs. Qualitative case studies of eight CHCs identified as delivering high-quality care relative to other CHCs were used to examine operational practices, including systems to facilitate care access, manage patient care, and monitor performance. Four common themes emerged that may contribute to high performance. At the same time, important differences across health centers were observed, reflecting differences in local environments and CHC capacity. In the development of effective, community-based models of care, adapting care standards to meet the needs of local conditions may be important.

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

    Science.gov (United States)

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

    2003-11-15

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

  18. [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.

  19. Some Considerations Regarding the Reform in the Field of Civil Status Activity and Public Record

    Directory of Open Access Journals (Sweden)

    Gabriela Lupsan

    2009-10-01

    Full Text Available The objectives imposed by the European Union on Romania regarding upgrading local public administration on the basis of information technologies, including the one in the marital status activity, which includes, in addition to setting the legal framework and setting up technological infrastructure and the identification of the organizational tools necessary to achieve operational objectives. In our work we present, based on the normative acts, a short history of the reform in the domain of marital status activity and population records.

  20. Hawaii's public mental health system.

    Science.gov (United States)

    VanderVoort, Debra J

    2005-03-01

    The following article addresses the nature of and problems with the public mental health system in Hawaii. It includes a brief history of Hawaii's public mental health system, a description and analysis of this system, economic factors affecting mental health, as well as a needs assessment of the elderly, individuals with severe mental illness, children and adolescents, and ethnically diverse individuals. In addition to having the potential to increase suicide rates and unnecessarily prolong personal suffering, problems in the public mental health system such as inadequate services contribute to an increase in social problems including, but not limited to, an increase in crime rates (e.g., domestic violence, child abuse), divorce rates, school failure, and behavioral problems in children. The population in need of mental health services in Hawaii is under served, with this inadequacy of services due to economic limitations and a variety of other factors.

  1. Bradley vs. Gore: how media covered proposals for health insurance reform in the context of the 2000 presidential campaign.

    Science.gov (United States)

    Mebane, Felicia

    2003-01-01

    This study examines how often national media reported key aspects of Senator Bill Bradley's and Vice President Al Gore's proposals for health insurance reform during the 2000 Democratic primary campaign. The results show that news media reported on Bradley's plan and major features of his plan significantly more often than Gore's. Additionally, few reports contained explicit comparisons that explained which plan would have covered more people or cost more. Public health and media professionals need to work together to improve the quality of information the public depends on to develop views about and support for the uninsured.

  2. Building institutions for an effective health system: lessons from China's experience with rural health reform.

    Science.gov (United States)

    Bloom, Gerald

    2011-04-01

    This paper is concerned with the management of health system changes aimed at substantially increasing the access to safe and effective health services. It argues that an effective health sector relies on trust-based relationships between users, providers and funders of health services, and that one of the major challenges governments face is to construct institutional arrangements within which these relationships can be embedded. It presents the case of China, which is implementing an ambitious health reform, drawing on a series of visits to rural counties by the author over a 10-year period. It illustrates how the development of reform strategies has been a response both to the challenges arising from the transition to a market economy and the result of actions by different actors, which have led to the gradual creation of increasingly complex institutions. The overall direction of change has been strongly influenced by the efforts made by the political leadership to manage a transition to a modern economy which provides at least some basic benefits to all. The paper concludes that the key lessons for other countries from China's experience with health system reform are less about the detailed design of specific interventions than about its approach to the management of institution-building in a context of complexity and rapid change. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Mahmood, Qamar; Muntaner, Carles

    2013-03-01

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

  4. Keeping the "public" in schools of public health.

    Science.gov (United States)

    Freudenberg, Nicholas; Klitzman, Susan; Diamond, Catherine; El-Mohandes, Ayman

    2015-03-01

    In this article, we compared the characteristics of public and private accredited public health training programs. We analyzed the distinct opportunities and challenges that publicly funded schools of public health face in preparing the nation's public health workforce. Using our experience in creating a new, collaborative public school of public health in the nation's largest urban public university system, we described efforts to use our public status and mission to develop new approaches to educating a workforce that meets the health needs of our region and contributes to the goal of reducing health inequalities. Finally, we considered policies that could protect and strengthen the distinct contributions that public schools of public health make to improving population health and reducing health inequalities.

  5. [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.

  6. How health care reform can lower the costs of insurance administration.

    Science.gov (United States)

    Collins, Sara R; Nuzum, Rachel; Rustgi, Sheila D; Mika, Stephanie; Schoen, Cathy; Davis, Karen

    2009-07-01

    The United States leads all industrialized countries in the share of national health care expenditures devoted to insurance administration. The U.S. share is over 30 percent greater than Germany's and more than three times that of Japan. This issue brief examines the sources of administrative costs and describes how a private-public approach to health care reform--with the central feature of a national insurance exchange (largely replacing the present individual and small-group markets)--could substantially lower such costs. In three variations on that approach, estimated administrative costs would fall from 12.7 percent of claims to an average of 9.4 percent. Savings--as much as $265 billion over 2010-2020--would be realized through less marketing and underwriting, reduced costs of claims administration, less time spent negotiating provider payment rates, and fewer or standardized commissions to insurance brokers.

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

    Science.gov (United States)

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

    1999-05-15

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

  8. 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.

  9. Digital government and public health.

    Science.gov (United States)

    Fountain, Jane E

    2004-10-01

    Digital government is typically defined as the production and delivery of information and services inside government and between government and the public using a range of information and communication technologies. Two types of government relationships with other entities are government-to-citizen and government-to-government relationships. Both offer opportunities and challenges. Assessment of a public health agency's readiness for digital government includes examination of technical, managerial, and political capabilities. Public health agencies are especially challenged by a lack of funding for technical infrastructure and expertise, by privacy and security issues, and by lack of Internet access for low-income and marginalized populations. Public health agencies understand the difficulties of working across agencies and levels of government, but the development of new, integrated e-programs will require more than technical change - it will require a profound change in paradigm.

  10. Implementation of the Decentralization Reform in Ukraine: Current Issues of Public Administration Modernization

    Directory of Open Access Journals (Sweden)

    Yaroshenko Igor V.

    2016-05-01

    Full Text Available The need of all parts of the modern Ukrainian society for structural transformations determines the direction of development of the country and its territories. One of such priority vectors is the decentralization reform, efficiency of which is inextricably linked with the changes that occur in all vital for the development of society and every individual public areas: public administration, judicial system, law enforcement bodies, deregulation and development of business, banking and financial sectors, innovation and trade policies, education, medicine and other sectors of the economy and social sphere. The initiated in Ukraine transformations, including the decentralization of public power, require further legislative changes and desire of all public institutions to ensure their effective implementation through public initiative and public support. Monitoring the course of the decentralization reform in Ukraine has demonstrated little actual results of its implementation. Today an adequate legislation framework concerning the powers, resources and responsibilities has not been established yet. It is advisable to carry out a profound theoretical and practical study of the world and Ukrainian experience, develop and introduce an own science-based system of power decentralization with consideration for historical, ideological, cultural, social, economic, geographical and other features of the country, while taking into account the best practices, which can be effectively used.

  11. 75 FR 24470 - Health Care Reform Insurance Web Portal Requirements

    Science.gov (United States)

    2010-05-05

    ... benefit and pricing information. Benefit and pricing information includes data such as premiums, cost... percentage of total premium revenue expended on nonclinical costs (as reported under section 2718(a) of the Public Health Service Act), eligibility, availability, premium rates, and cost sharing with respect to...

  12. New Zealand health reforms: effect on ophthalmic practice.

    Science.gov (United States)

    Raynel, S; Reynolds, H

    1999-01-01

    Are specialized ophthalmic units with inpatient facilities going to disappear in the New Zealand public health system? We have entered the era of cost containment, business methodologies, bench marking, day case surgery, and technologic advances. The dilemma for nursing is maintenance of a skill base with dwindling clinical practice areas.

  13. Las reformas sanitarias y los modelos de gestión Health sector reform and management models

    Directory of Open Access Journals (Sweden)

    Ginés González García

    2001-06-01

    Full Text Available This article tries to indicate the direction of progress in management being taken in health sector reforms in Latin America. The piece first discusses the tension between local forces and international neoliberal trends being manifested in the reform in various countries. The article next looks at the distinction between the tools and the management models that are being applied, presenting a taxonomy of three management levels: macromanagement (national health systems, midlevel management (hospitals, insurers, and other such institutions, and micromanagement (clinics. The piece concludes by reflecting on the future of management in the health sector in Latin America, where health systems are overadministered and undermanaged. Their future depends on multiple factors, most of which are outside the health care field itself. Better management of policies, institutions, and patients would be a tremendous tool in directing the future. Management is here to stay, with greater emphasis on either supply--hospitals and physicians--or demand--citizens or clients. For both the public and private sectors, health management is central to health sector reforms in Latin America.

  14. The long shadow of the past: risk pooling and the political development of health care reform in the States.

    Science.gov (United States)

    Chen, Anthony S; Weir, Margaret

    2009-10-01

    Why do the states seem to be pursuing different types of policy innovation in their health reform? Why so some seem to follow a "solidarity principle," while others seem guided by a commitment to "actuarial fairness"? Our analysis highlights the reciprocal influence of stakeholder mobilization and public policy over time. We find that early policy choices about how to achieve cost containment led the states down different paths of reform. In the 1970s and 1980s, states that featured oligopolistic or near-monopolistic markets for private insurance (usually dominated by Blue Cross) and strong urban-academic hospitals tended to adopt regulatory strategies for cost containment that led to broader forms of pooling and financing the costs of health risks--which subsequently positioned them to pursue major, solidaristic reform on favorable terms. On the other hand, states with competitive markets for private insurance and weak, decentralized hospitals tended to adopt market-based strategies for cost containment that led to the hypersegmentation of risk and the uneven financing of costs--thereby encouraging the proliferation of incremental policies that reinforce the principle of actuarial fairness. We illustrate our analysis with a brief comparison of Massachusetts and California, and we conclude with some thoughts on what our findings imply for the federal role in catalyzing health reform.

  15. Targeted marketing and public health.

    Science.gov (United States)

    Grier, Sonya A; Kumanyika, Shiriki

    2010-01-01

    Targeted marketing techniques, which identify consumers who share common needs or characteristics and position products or services to appeal to and reach these consumers, are now the core of all marketing and facilitate its effectiveness. However, targeted marketing, particularly of products with proven or potential adverse effects (e.g., tobacco, alcohol, entertainment violence, or unhealthful foods) to consumer segments defined as vulnerable raises complex concerns for public health. It is critical that practitioners, academics, and policy makers in marketing, public health, and other fields recognize and understand targeted marketing as a specific contextual influence on the health of children and adolescents and, for different reasons, ethnic minority populations and other populations who may benefit from public health protections. For beneficial products, such understanding can foster more socially productive targeting. For potentially harmful products, understanding the nature and scope of targeted marketing influences will support identification and implementation of corrective policies.

  16. Greek Exit from the Crisis—A Pressing and Much-Needed Public Service Reform

    Directory of Open Access Journals (Sweden)

    Demetrios Argyriades

    2013-04-01

    Full Text Available Greece is in a deep crisis; the worst in all of Europe and the worst experienced in 45 years. Greece is no stranger to crises, but most have been exogenous: the Second World War and the Cold War, for instance. Sadly, unlike these crises, the present one is home-made. The wounds that it has caused are largely self-inflicted. It is especially difficult to fathom the logic of strikes by public service unions—repeated, relentless and militant. They paralyzed the country, drove investors and tourists away and added to the burdens that the economy and the people have had to bear. These strikes, and some public servants’ attitudes in the face of the crisis itself, brought into sharp relief the serious capacity deficit in the Greek administrative system, which has been at the root of the problem the country is currently facing. This statement begs the question: how can that be? What, after 30 years of public service reform, presumed to modernize and help the country approximate the standards embedded in the Common European Administrative Space? The paper will suggest that the reforms of the 1980s were only superficially reforms to improve the effectiveness and quality of the Service. Like parallel changes in higher education, the principal objective was harnessing officialdom, and as many voters as possible, to the chariot of PASOK—the political party established by Andreas Papandreou—which effectively governed the country for most of the period in question. The lesson from this experience may be none other, in fact, than clear convincing proof that partisan concerns and institution-building seldom make a good combination. For Greece, in light of the crisis, effective integration in the EU remains a daunting challenge. It calls for bold reforms, but these must be undertaken with institution-building, the country’s general interest, and long term needs in mind.

  17. Effect of health system reforms in Turkey on user satisfaction.

    Science.gov (United States)

    Stokes, Jonathan; Gurol-Urganci, Ipek; Hone, Thomas; Atun, Rifat

    2015-12-01

    In 2003, the Turkish government introduced major health system changes, the Health Transformation Programme (HTP), to achieve universal health coverage (UHC). The HTP leveraged changes in all parts of the health system, organization, financing, resource management and service delivery, with a new family medicine model introducing primary care at the heart of the system. This article examines the effect of these health system changes on user satisfaction, a key goal of a responsive health system. Utilizing the results of a nationally representative yearly survey introduced at the baseline of the health system transformation, multivariate logistic regression analysis is used to examine the yearly effect on satisfaction with health services. During the 9-year period analyzed (2004-2012), there was a nearly 20% rise in reported health service use, coinciding with increased access, measured by insurance coverage. Controlling for factors known to contribute to user satisfaction in the literature, there is a significant (P < 0.001) increase in user satisfaction with health services in almost every year (bar 2006) from the baseline measure, with the odds of being satisfied with health services in 2012, 2.56 (95% confidence interval (CI) of 2.01-3.24) times that in 2004, having peaked at 3.58 (95% CI 2.82-4.55) times the baseline odds in 2011. Additionally, those who used public primary care services were slightly, but significantly (P < 0.05) more satisfied than those who used any other services, and increasingly patients are choosing primary care services rather than secondary care services as the provider of first contact. A number of quality indicators can probably help account for the increased satisfaction with public primary care services, and the increase in seeking first-contact with these providers. The implementation of primary care focused UHC as part of the HTP has improved user satisfaction in Turkey.

  18. Effect of health system reforms in Turkey on user satisfaction

    Directory of Open Access Journals (Sweden)

    Jonathan Stokes

    2015-12-01

    Full Text Available In 2003, the Turkish government introduced major health system changes, the Health Transformation Programme (HTP, to achieve universal health coverage (UHC. The HTP leveraged changes in all parts of the health system, organization, financing, resource management and service delivery, with a new family medicine model introducing primary care at the heart of the system. This article examines the effect of these health system changes on user satisfaction, a key goal of a responsive health system. Utilizing the results of a nationally representative yearly survey introduced at the baseline of the health system transformation, multivariate logistic regression analysis is used to examine the yearly effect on satisfaction with health services. During the 9–year period analyzed (2004–2012, there was a nearly 20% rise in reported health service use, coinciding with increased access, measured by insurance coverage. Controlling for factors known to contribute to user satisfaction in the literature, there is a significant (P < 0.001 increase in user satisfaction with health services in almost every year (bar 2006 from the baseline measure, with the odds of being satisfied with health services in 2012, 2.56 (95% Confidence Interval (CI of 2.01–3.24 times that in 2004, having peaked at 3.58 (CI, 2.82–4.55 times the baseline odds in 2011. Additionally, those who used public primary care services were slightly, but significantly (P < 0.05 more satisfied than those who used any other services, and increasingly patients are choosing primary care services rather than secondary care services as the provider of first contact. A number of quality indicators can probably help account for the increased satisfaction with public primary care services, and the increase in seeking first–contact with these providers. The implementation of primary care focused UHC as part of the HTP has improved user satisfaction in Turkey.

  19. [Public health as a subject for the Assembly].

    Science.gov (United States)

    Garces, S; Torres, R

    1997-12-01

    Six Ecuadorian political figures and physicians were interviewed on their opinions concerning the problems of the health sector and possible solutions. Ecuadorians anticipate that installation of the National Assembly will lead to diagnosis and reform of societal ills. Health has not been a high priority of political leaders. Only 10% of the population has access to the social security system. Infant mortality rates are very high in the rural sierra, and nearly 70% of indigenous sierra children suffer from chronic malnutrition. The need for broad reform of the health sector has been recognized. The interview subjects agreed that reforms are needed, especially in regard to the Ecuadorian Institute of Social Security, which all agreed had become weakened by excessive political patronage and presence of unqualified political appointees. They agreed that the nation's health is deteriorating each day, but they did not always agree on how to solve the crisis. Among the themes debated were the need for improved coordination of services, increased investment in health services, redefinition of the role of public and private services, participation of the population in the construction of health policy, the need for professional administration, whether the poor should be charged for services, and whether monopolies should be permitted in the field of health care.

  20. The right to public health.

    Science.gov (United States)

    Wilson, James

    2016-06-01

    Much work in public health ethics is shaped by an 'autonomy first' view, which takes it to be axiomatic that it is difficult to justify state interference in the lives of competent adults unless the behaviours interfered with are compromised in terms of their autonomy, or would wrongfully infringe on the autonomy of others. However, such an approach is difficult to square with much of traditional public heath practice. Recent years have seen running battles between those who assume that an 'autonomy first' approach is basically sound (and so much the worse for public health practice) and those who assume that public health practice is basically sound (and so much the worse for the 'autonomy first' approach). This paper aims to reconcile in a normatively satisfying way what is best about the 'autonomy first' approach with what is best about a standard public health approach. It develops a positive case for state action to promote and protect health as a duty that is owed to each individual. According to this view, the state violates individuals' rights if it fails to take cost-effective and proportionate measures to remove health threats from the environment. It is thus a mistake to approach public health in the way that 'autonomy first' accounts do, as primarily a matter of individual entitlements versus the common good. Too little state intervention in the cause of improving population health can violate individuals' rights, just as too much can. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. 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 < 0.001), and slower annual growth in PHC and secondary 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

  2. Citizen Science for public health.

    Science.gov (United States)

    Den Broeder, Lea; Devilee, Jeroen; Van Oers, Hans; Schuit, A Jantine; Wagemakers, Annemarie

    2016-12-23

    Community engagement in public health policy is easier said than done. One reason is that public health policy is produced in a complex process resulting in policies that may appear not to link up to citizen perspectives. We therefore address the central question as to whether citizen engagement in knowledge production could enable inclusive health policy making. Building on non-health work fields, we describe different types of citizen engagement in scientific research, or 'Citizen Science'. We describe the challenges that Citizen Science poses for public health, and how these could be addressed. Despite these challenges, we expect that Citizen Science or similar approaches such as participatory action research and 'popular epidemiology' may yield better knowledge, empowered communities, and improved community health. We provide a draft framework to enable evaluation of Citizen Science in practice, consisting of a descriptive typology of different kinds of Citizen Science and a causal framework that shows how Citizen Science in public health might benefit both the knowledge produced as well as the 'Citizen Scientists' as active participants. © The Author 2016. Published by Oxford University Press.

  3. "Diagnosing" Saudi health reforms: is NHIS the right "prescription"?

    Science.gov (United States)

    Al-Sharqi, Omar Zayan; Abdullah, Muhammad Tanweer

    2013-01-01

    This paper outlines the health context of the Kingdom of Saudi Arabia (KSA). It reviews health systems development in the KSA from 1925 through to contemporary New Health Insurance System (NHIS). It also examines the consistency of NHIS in view of the emerging challenges. This paper identifies the determinants and scope of contextual consistency. First, it indicates the need to evolve an indigenous, integrated, and comprehensive insurance system. Second, it highlights the access and equity gaps in service delivery across the rural and remote regions and suggests how to bring these under insurance coverage. Third, it suggests how inputs from both the public and private sectors should be harmonized - the "quality" of services in the private healthcare industry to be regulated by the state and international standards, its scope to be determined primarily by open-market dynamics and the public sector welfare-model to ensure "access" of all to essential health services. Fourth, it states the need to implement an evidence-based public health policy and bridge inherent gaps in policy design and personal-level lifestyles. Fifth, it points out the need to produce a viable infrastructure for health insurance. Because social research and critical reviews in the KSA health scenario are rare, this paper offers insights into the mainstream challenges of NHIS implementation and identifies the inherent weaknesses that need attention. It guides health policy makers, economists, planners, healthcare service managers, and even the insurance businesses, and points to key directions for similar research in future. Copyright © 2012 John Wiley & Sons, Ltd.

  4. Health complaints and regulatory reform: Implications for vulnerable populations?

    Science.gov (United States)

    Carney, Terry; Beaupert, Fleur; Chiarella, Mary; Bennett, Belinda; Walton, Merrilyn; Kelly, Patrick J; Satchell, Claudette S

    2016-03-01

    Complaints and disciplinary processes play a significant role in health professional regulation. Many countries are transitioning from models of self-regulation to greater external oversight through systems including meta-regulation, responsive (risk-based) regulation, and "networked governance". Such systems harness, in differing ways, public, private, professional and non-governmental bodies to exert influence over the conduct of health professionals and services. Interesting literature is emerging regarding complainants' motivations and experiences, the impact of complaints processes on health professionals, and identification of features such as complainant and health professional profiles, types of complaints and outcomes. This article concentrates on studies identifying vulnerable groups and their participation in health care regulatory systems.

  5. 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.

  6. Periodontal health and global public health

    DEFF Research Database (Denmark)

    Petersen, Poul E; Baehni, Pierre C

    2012-01-01

    Chronic diseases are a growing burden to people, to health-care systems and to societies across the world. The rapid increase in the burden of chronic diseases is particularly prevalent in the developing countries. Periodontal disease is one of the two most important oral diseases contributing...... to the global burden of chronic disease. In addition to social determinants, periodontal health status is related to several proximal factors. Modifiable risk factors, such as tobacco use, excessive alcohol consumption, poor diet and nutrition, obesity, psychological stress and insufficient personal....../oral hygiene, are important and these principal risk factors for periodontal disease are shared by other chronic diseases. The present monograph is devoted to the existing evidence on the practice of public health related to periodontal health. Public health is defined as the process of mobilizing and engaging...

  7. 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

  8. 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.

  9. Barriers to partnership working in public health: a qualitative study.

    Directory of Open Access Journals (Sweden)

    David Carlton Taylor-Robinson

    Full Text Available Public health provision in England is undergoing dramatic changes. Currently established partnerships are thus likely to be significantly disrupted by the radical reforms outlined in the Public Health White Paper. We therefore explored the process of partnership working in public health, in order to better understand the potential opportunities and threats associated with the proposed changes.70 participants took part in an in-depth qualitative study involving 40 semi-structured interviews and three focus group discussions. Participants were senior and middle grade public health decision makers working in Primary Care Trusts, Local Authorities, Department of Health, academia, General Practice and Hospital Trusts and the third sector in England. Despite mature arrangements for partnership working in many areas, and much support for joint working in principle, many important barriers exist. These include cultural issues such as a lack of shared values and language, the inherent complexity of intersectoral collaboration for public health, and macro issues including political and resource constraints. There is particular uncertainty and anxiety about the future of joint working relating to the availability and distribution of scarce and diminishing financial resources. There is also the concern that existing effective collaborative networks may be completely disrupted as the proposed changes unfold. The extent to which the proposed reforms might mitigate or potentiate these issues remains unclear. However the threats currently remain more salient than opportunities.The current re-organisation of public health offers real opportunity to address some of the barriers to partnership working identified in this study. However, significant threats exist. These include the breakup of established networks, and the risk of cost cutting on effective public health interventions.

  10. Prioritizing Sleep Health: Public Health Policy Recommendations.

    Science.gov (United States)

    Barnes, Christopher M; Drake, Christopher L

    2015-11-01

    The schedules that Americans live by are not consistent with healthy sleep patterns. In addition, poor access to educational and treatment aids for sleep leaves people engaging in behavior that is harmful to sleep and forgoing treatment for sleep disorders. This has created a sleep crisis that is a public health issue with broad implications for cognitive outcomes, mental health, physical health, work performance, and safety. New public policies should be formulated to address these issues. We draw from the scientific literature to recommend the following: establishing national standards for middle and high school start times that are later in the day, stronger regulation of work hours and schedules, eliminating daylight saving time, educating the public regarding the impact of electronic media on sleep, and improving access to ambulatory in-home diagnostic testing for sleep disorders. © The Author(s) 2015.

  11. Reforming health service delivery at district level in Ghana: the perspective of a district medical officer.

    Science.gov (United States)

    Agyepong, I A

    1999-03-01

    Many countries in sub-Saharan Africa face the problem of organizing health service delivery in a manner that provides adequate quality and coverage of health care to their populations against a background of economic recession and limited resources. In response to these challenges, different governments, including that of Ghana, have been considering or are in the process of implementing varying degrees of reform in the health sector. This paper examines aspects of health services delivery, and trends in utilization and coverage, using routine data over time in the Dangme West district of the Greater Accra region of Ghana, from the perspective of a district health manager. Specific interventions through which health services delivery and utilization at district level could be improved are suggested. Suggestions include raising awareness among care providers and health managers that increased resource availability is only a success in so far as it leads to improvements in coverage, utilization and quality; and developing indicators of performance which assess and reward use of resources at the local level to improve coverage, utilization and quality. Also needed are more flexibility in Central Government regulations for resource allocation and use; integration of service delivery at district level with more decentralized planning to make services better responsive to local needs; changes in basic and inservice training strategies; and exploration of how the public and private sectors can effectively collaborate to achieve maximum coverage and quality of care within available resources.

  12. 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.

  13. Implementing health financing reform: lessons from countries in transition

    National Research Council Canada - National Science Library

    Kutzin, Joseph; Cashin, Cheryl; Jakab, Melitta

    2010-01-01

    Since 1990, the social and economic policies of the transition countries of central and eastern Europe, the Caucasus and central Asia have diverged, including the way they have reformed the financing...

  14. Crowdsourcing applications for public health.

    Science.gov (United States)

    Brabham, Daren C; Ribisl, Kurt M; Kirchner, Thomas R; Bernhardt, Jay M

    2014-02-01

    Crowdsourcing is an online, distributed, problem-solving, and production model that uses the collective intelligence of networked communities for specific purposes. Although its use has benefited many sectors of society, it has yet to be fully realized as a method for improving public health. This paper defines the core components of crowdsourcing and proposes a framework for understanding the potential utility of crowdsourcing in the domain of public health. Four discrete crowdsourcing approaches are described (knowledge discovery and management; distributed human intelligence tasking; broadcast search; and peer-vetted creative production types) and a number of potential applications for crowdsourcing for public health science and practice are enumerated. © 2013 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.

  15. Public health financial management competencies.

    Science.gov (United States)

    Honoré, Peggy A; Costich, Julia F

    2009-01-01

    The absence of appropriate financial management competencies has impeded progress in advancing the field of public health finance. It also inhibits the ability to professionalize this sector of the workforce. Financial managers should play a critical role by providing information relevant to decision making. The lack of fundamental financial management knowledge and skills is a barrier to fulfilling this role. A national expert committee was convened to examine this issue. The committee reviewed standards related to financial and business management practices within public health and closely related areas. Alignments were made with national standards such as those established for government chief financial officers. On the basis of this analysis, a comprehensive set of public health financial management competencies was identified and examined further by a review panel. At a minimum, the competencies can be used to define job descriptions, assess job performance, identify critical gaps in financial analysis, create career paths, and design educational programs.

  16. Causal inference in public health.

    Science.gov (United States)

    Glass, Thomas A; Goodman, Steven N; Hernán, Miguel A; Samet, Jonathan M

    2013-01-01

    Causal inference has a central role in public health; the determination that an association is causal indicates the possibility for intervention. We review and comment on the long-used guidelines for interpreting evidence as supporting a causal association and contrast them with the potential outcomes framework that encourages thinking in terms of causes that are interventions. We argue that in public health this framework is more suitable, providing an estimate of an action's consequences rather than the less precise notion of a risk factor's causal effect. A variety of modern statistical methods adopt this approach. When an intervention cannot be specified, causal relations can still exist, but how to intervene to change the outcome will be unclear. In application, the often-complex structure of causal processes needs to be acknowledged and appropriate data collected to study them. These newer approaches need to be brought to bear on the increasingly complex public health challenges of our globalized world.

  17. Informatics enables public health surveillance

    Directory of Open Access Journals (Sweden)

    Scott J. N McNabb

    2017-01-01

    Full Text Available Over the past decade, the world has radically changed. New advances in information and communication technologies (ICT connect the world in ways never imagined. Public health informatics (PHI leveraged for public health surveillance (PHS, can enable, enhance, and empower essential PHS functions (i.e., detection, reporting, confirmation, analyses, feedback, response. However, the tail doesn't wag the dog; as such, ICT cannot (should not drive public health surveillance strengthening. Rather, ICT can serve PHS to more effectively empower core functions. In this review, we explore promising ICT trends for prevention, detection, and response, laboratory reporting, push notification, analytics, predictive surveillance, and using new data sources, while recognizing that it is the people, politics, and policies that most challenge progress for implementation of solutions.

  18. Digital Government and Public Health

    OpenAIRE

    Fountain, Jane E.

    2004-01-01

    Digital government is typically defined as the production and delivery of information and services inside government and between government and the public using a range of information and communication technologies. Two types of government relationships with other entities are government-to-citizen and government-to-government relationships. Both offer opportunities and challenges. Assessment of a public health agencys readiness for digital government includes examination of technical, manage...

  19. Basing care reforms on evidence: the Kenya health sector costing model.

    Science.gov (United States)

    Flessa, Steffen; Moeller, Michael; Ensor, Tim; Hornetz, Klaus

    2011-05-27

    The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health care costs proportionally. Instead

  20. Basing care reforms on evidence: The Kenya health sector costing model

    Science.gov (United States)

    2011-01-01

    Background The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Methods Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. Results The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. Conclusions The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health

  1. 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.

  2. 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.

  3. Public Health and Solitary Confinement in the United States.

    Science.gov (United States)

    Cloud, David H; Drucker, Ernest; Browne, Angela; Parsons, Jim

    2015-01-01

    The history of solitary confinement in the United States stretches from the silent prisons of 200 years ago to today's supermax prisons, mechanized panopticons that isolate tens of thousands, sometimes for decades. We examined the living conditions and characteristics of the populations in solitary confinement. As part of the growing movement for reform, public health agencies have an ethical obligation to help address the excessive use of solitary confinement in jails and prisons in accordance with established public health functions (e.g., violence prevention, health equity, surveillance, and minimizing of occupational and psychological hazards for correctional staff). Public health professionals should lead efforts to replace reliance on this overly punitive correctional policy with models based on rehabilitation and restorative justice.

  4. Public Health and Solitary Confinement in the United States

    Science.gov (United States)

    Drucker, Ernest; Browne, Angela; Parsons, Jim

    2015-01-01

    The history of solitary confinement in the United States stretches from the silent prisons of 200 years ago to today’s supermax prisons, mechanized panopticons that isolate tens of thousands, sometimes for decades. We examined the living conditions and characteristics of the populations in solitary confinement. As part of the growing movement for reform, public health agencies have an ethical obligation to help address the excessive use of solitary confinement in jails and prisons in accordance with established public health functions (e.g., violence prevention, health equity, surveillance, and minimizing of occupational and psychological hazards for correctional staff). Public health professionals should lead efforts to replace reliance on this overly punitive correctional policy with models based on rehabilitation and restorative justice. PMID:25393185

  5. Public health preparedness and response to a radiological terrorist attack

    International Nuclear Information System (INIS)

    Yamaguchi, Ichiro

    2016-01-01

    Given the potential for intentional malevolent acts, the security of radioactive sources should be ensured. In the event of a terrorist attack using a radioactive source, we should care not only about health concerns of victims, especially including first responders who suffer from radiation injury, but also public health activities with affected people during the long recovery phase. Regarding the radiological public health viewpoint, preventive efforts are also important. In fact, regulatory reform is progressing in Japan according to the code of conduct issued by IAEA. One of the difficulties of countermeasures for the security of radioactive sources in Japan is to establish a disposal facility for disused sealed radioactive sources, since radioactive waste has been additionally a point of contention in society since the nuclear disaster. This paper presents an overview of countermeasures for terrorist attacks using a radioactive source, from the viewpoint of public health in Japan including the results of survey targeted hospitals equipped with blood irradiation machines. (author)

  6. Identifying health facilities outside the enterprise: challenges and strategies for supporting health reform and meaningful use.

    Science.gov (United States)

    Dixon, Brian E; Colvard, Cyril; Tierney, William M

    2014-06-24

    Objective: To support collation of data for disability determination, we sought to accurately identify facilities where care was delivered across multiple, independent hospitals and clinics. Methods: Data from various institutions' electronic health records were merged and delivered as continuity of care documents to the United States Social Security Administration (SSA). Results: Electronic records for nearly 8000 disability claimants were exchanged with SSA. Due to the lack of standard nomenclature for identifying the facilities in which patients received the care documented in the electronic records, SSA could not match the information received with information provided by disability claimants. Facility identifiers were generated arbitrarily by health care systems and therefore could not be mapped to the existing international standards. Discussion: We propose strategies for improving facility identification in electronic health records to support improved tracking of a patient's care between providers to better serve clinical care delivery, disability determination, health reform and meaningful use. Conclusion: Accurately identifying the facilities where health care is delivered to patients is important to a number of major health reform and improvement efforts underway in many nations. A standardized nomenclature for identifying health care facilities is needed to improve tracking of care and linking of electronic health records.

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

    Science.gov (United States)

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

    2002-10-01

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

  8. A simple simulation model as a tool to assess alternative health care provider payment reform options in Vietnam.

    Science.gov (United States)

    Cashin, Cheryl; Phuong, Nguyen Khanh; Shain, Ryan; Oanh, Tran Thi Mai; Thuy, Nguyen Thi

    2015-01-01

    Vietnam is currently considering a revision of its 2008 Health Insurance Law, including the regulation of provider payment methods. This study uses a simple spreadsheet-based, micro-simulation model to analyse the potential impacts of different provider payment reform scenarios on resource allocation across health care providers in three provinces in Vietnam, as well as on the total expenditure of the provincial branches of the public health insurance agency (Provincial Social Security [PSS]). The results show that currently more than 50% of PSS spending is concentrated at the provincial level with less than half at the district level. There is also a high degree of financial risk on district hospitals with the current fund-holding arrangement. Results of the simulation model show that several alternative scenarios for provider payment reform could improve the current payment system by reducing the high financial risk currently borne by district hospitals without dramatically shifting the current level and distribution of PSS expenditure. The results of the simulation analysis provided an empirical basis for health policy-makers in Vietnam to assess different provider payment reform options and make decisions about new models to support health system objectives.

  9. 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

  10. The effects of hospital reforms on the management of public hospitals in Tanzania: Challenges and lessons learnt.

    Science.gov (United States)

    Shwekerela, Byera

    2014-01-01

    Although hospital reforms are being advocated internationally as part of a solution to hospital management problems in developing countries, studies have shown that they do give rise to some challenges. A study was undertaken that used in-depth interviews, focus group discussion and document review to examine hospital reforms. The article examines the effects of reforms on the management of Level II public hospitals in Tanzania and documents the related challenges and lessons Learnt. It is shown that hospital reforms have mixed effects in resource-strained hospitals, and that hospital reform actions may have replaced the bureaucratic inefficiencies associated with hospitals being managed from the central level (MoHSW) with the equally bureaucratic inefficiencies that characterize the management of these hospitals from a supposedly local level, the office of the Regional Administrative Secretary (RAS). Managing hospitals from this level seems to cause many hospital management problems to be left unattended.

  11. 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

  12. Nuclear power and public health

    International Nuclear Information System (INIS)

    1974-01-01

    The nuclear power industry has always emphasized the health and safety aspects of the various stages of power production. Nevertheless, the question of public acceptance is becoming increasingly important in the expansion of nuclear power programmes. Objections may arise partly from the tendency to accept familiar hazards but to react violently to unfamiliar ones such as radiation, which is not obvious to the senses and may result in delayed adverse effects, sometimes manifested only in the descendants of the individuals subjected to the radiation. The public health authorities therefore have an important role in educating the public to overcome these fears. However, they also have the duty to reassure the public and convince it that proper care has been taken to protect man and his environment. This duty can be fulfilled by means of independent evaluation and control to ensure that safe nuclear facilities are built, care is taken with their siting, they are operated safely, and the effects of possible accidents are minimized. The selection and development of a nuclear power facility should be carried out with a sound understanding of the factors involved. WHO has collaborated with the International Atomic Energy Agency (IAEA) in the preparation of a booklet summarizing the available information on the subject. It deals with the role of atomic energy in meeting future power needs, radiation protection standards, the safe handling of radioactive materials, disturbances of the environment arising from plant construction and ancillary operations, and the public health implications

  13. Nuclear power and public health

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1974-07-01

    The nuclear power industry has always emphasized the health and safety aspects of the various stages of power production. Nevertheless, the question of public acceptance is becoming increasingly important in the expansion of nuclear power programmes. Objections may arise partly from the tendency to accept familiar hazards but to react violently to unfamiliar ones such as radiation, which is not obvious to the senses and may result in delayed adverse effects, sometimes manifested only in the descendants of the individuals subjected to the radiation. The public health authorities therefore have an important role in educating the public to overcome these fears. However, they also have the duty to reassure the public and convince it that proper care has been taken to protect man and his environment. This duty can be fulfilled by means of independent evaluation and control to ensure that safe nuclear facilities are built, care is taken with their siting, they are operated safely, and the effects of possible accidents are minimized. The selection and development of a nuclear power facility should be carried out with a sound understanding of the factors involved. WHO has collaborated with the International Atomic Energy Agency (IAEA) in the preparation of a booklet summarizing the available information on the subject. It deals with the role of atomic energy in meeting future power needs, radiation protection standards, the safe handling of radioactive materials, disturbances of the environment arising from plant construction and ancillary operations, and the public health implications.

  14. Public Sector Financial Management Reform: A Case Study of Local Government Agencies in Indonesia

    Directory of Open Access Journals (Sweden)

    Monir Mir

    2013-12-01

    Full Text Available Indonesia has taken initiatives to reform its public sector financial management. One of the reform agendas was to introduce ‘cash to accrual’ accounting for improved financial reporting. It is expected that improved financial reporting will enhance financial accountabilities of the governmental agencies and will assist both internal and external decision makers whose decisions will be based on the financial reports. However, it has been observed that there is a significant increase in the number of qualified audit reports when these financial reports were audited. This also means that these financial reports are lacking in providing true and fair views on the financial activities of the governmental agencies, thereby not assisting in discharging their accountabilities. This study seeks to answer the question as to why the numbers of qualified audit reports have increased despite the existence of various governmental accounting reform agendas. Based on the in-depth case studies of three Indonesian local governments, it is found that the demand, the supply and the quality assurance of the accounting information outputs in these local governments are not in parity, and this lacking in parties actually has impacted in producing unqualified and usable accounting reports.

  15. 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

  16. Policy, politics and public health.

    Science.gov (United States)

    Greer, Scott L; Bekker, Marleen; de Leeuw, Evelyne; Wismar, Matthias; Helderman, Jan-Kees; Ribeiro, Sofia; Stuckler, David

    2017-10-01

    If public health is the field that diagnoses and strives to cure social ills, then understanding political causes and cures for health problems should be an intrinsic part of the field. In this article, we argue that there is no support for the simple and common, implicit model of politics in which scientific evidence plus political will produces healthy policies. Efforts to improve the translation of evidence into policy such as knowledge transfer work only under certain circumstances. These circumstances are frequently political, and to be understood through systematic inquiry into basic features of the political economy such as institutions, partisanship and the organization of labour markets. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  17. State , Citizenship and Participatory Democracy Between Managerial Reform and Legitimation of Social Power in Public Management

    Directory of Open Access Journals (Sweden)

    Marana Sotero De Sousa

    2016-06-01

    Full Text Available The present article tries to point out the importance of participatory democracy for continuous affirmation of Law Democratic State, shrouded at modifications about citizenship in his evolution between State models following as suffered reforms under Brazilian Public Administration. Through qualitative methodology, especially with historical and hermeneutic procedures and bibliographical sources, the objective is develop the discussion about Popular Participation As legitimation instrument in the decisions that are limited in the administrator space. At the end, show the popular participation and citizens are fundamentals for current democratic model of state.

  18. 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

  19. 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

  20. Benefits of a single payment system: case study of Abu Dhabi health system reforms.

    Science.gov (United States)

    Vetter, Philipp; Boecker, Klaus

    2012-12-01

    In 2005 leaders in the wealthy Emirate of Abu Dhabi inherited an health system from their predecessors that was well-intentioned in its historic design, but that did not live up to aspirations in any dimension. First, the Emirate defined a vision to deliver "world-class" quality care in response to citizen's needs. It has since introduced tiered mandatory health insurance for all inhabitants linked to a single standard payment system, which generates accurate data as an invaluable by-product. A newly created independent health system regulator monitors these data and licenses, audits, and inspects all health service professionals, facilities, and insurers accordingly. We analyse these health system reforms using the "Getting Health Reform Right" framework. Our analysis suggests that an integrated set of reforms addressing all reform levers is critical to achieving the outcomes observed. The reform programme has improved access, by giving all residents health cards. The approximate doubling of demand has been matched by flexible supply, with the private sector adding 5 new hospitals and 93 clinics to the health system infrastructure since 2006. The focus on reliable raw-data flows through the single standard payment system functions as a motor for improvement services, innovation, and investment, for instance by allowing payers to 'pay for quality', which may well be applicable in other contexts. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Yaroshenko Igor V.

    2017-11-01

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

  2. New public management in Iran's health complex: a management framework for primary health care system.

    Science.gov (United States)

    Tabrizi, Jafar Sadegh; HaghGoshayie, Elaheh; Doshmangir, Leila; Yousefi, Mahmood

    2018-05-01

    New public management (NPM) was developed as a management reform to improve the efficiency and effectiveness in public organizations, especially in health sector. Using the features of private sector management, the managers of health organizations may try to implement the elements of NPM with the hope to improve the performance of their systems.AimsOur aim in the present study was to identify the elements and infrastructures suitable for implementing NPM in the Iranian health complex. In this qualitative study with conventional content analysis approach, we tried to explore the NPM elements and infrastructures in Iranian public health sector. A series of semi-structured interviews (n=48) were conducted in 2016 with a managers in public and private health complex. Three focus group discussions with nine faculty members were also conducted. A data collection form was used to collect the demographic characteristics and perspectives of the participants.FindingsFrom the perspective of managers, managerialism, decentralization, using market mechanism, performance management, customer orientation and performance budgeting were the main elements of NPM in the Iranian context. The most important infrastructures for implementing this reform were as follows: education and training, information technology, the proper use of human resources, decision support systems, top management commitment, organizational culture, flexibility of rules, rehabilitating of the aging infrastructures, and expanding the coverage of services. The NPM was generally identified to be an effective replacement for the traditional administration method. These reforms may be helpful in strengthening the public health complex and the management capacity, as well. NPM also seems to be useful in interacting the public health sector with the private sector in terms of personnel and resources, performance, reward structure, and methods of doing business.

  3. Privatizing the welfarist state: health care reforms in Malaysia.

    Science.gov (United States)

    Khoon, Chan Chee

    2003-01-01

    In Malaysia, the shifting balance between market and state has many nuances. Never a significant welfare state in the usual mold, the Malaysian state nonetheless has been a dominant social and economic presence dictated by its affirmative action-type policies, which eventually metamorphosed into state-led indigenous capitalism. Privatisation is also intimately linked with emergence of an indigenous bourgeoisie with favored access to the vast accumulation of state assets and prerogatives. Internationally, it is conditioned by the fluid relationships of converging alliances and contested compromise with international capital, including transnational health services industries. As part of its vision of a maturing, diversified economy, the Malaysian government is fostering a private-sector advanced health care industry to cater to local demand and also aimed at regional and international patrons. The assumption is that, as disposable incomes increase, a market for such services is emerging and citizens can increasingly shoulder their own health care costs. The government would remain the provider for the indigent. But the key assumption remains: the growth trajectory will see the emergence of markets for an increasingly affluent middle class. Importantly, the health care and social services market would be dramatically expanded as the downsizing of public-sector health care proceeds amid a general retreat of government from its provider and financing roles.

  4. "Blueprint version 2.0": updating public health surveillance for the 21st century.

    Science.gov (United States)

    Smith, Perry F; Hadler, James L; Stanbury, Martha; Rolfs, Robert T; Hopkins, Richard S

    2013-01-01

    Rapid changes to the United States public health system challenge the current strategic approach to surveillance. During 2011, the Council of State and Territorial Epidemiologists convened national experts to reassess public health surveillance in the United States and update surveillance strategies that were published in a 1996 report and endorsed by the Council of State and Territorial Epidemiologists. Although surveillance goals, historical influences, and most methods have not changed, surveillance is being transformed by 3 influences: public health information and preparedness as national security issues; new information technologies; and health care reform. Each offers opportunities for surveillance, but each also presents challenges that public health epidemiologists can best meet by rigorously applying surveillance evaluation concepts, engaging in national standardization activities driven by electronic technologies and health care reform, and ensuring an adequately trained epidemiology workforce.

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

    NARCIS (Netherlands)

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

    2017-01-01

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

  6. 75 FR 62684 - Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction...

    Science.gov (United States)

    2010-10-13

    ... 0938-AM50 Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction Standards Adopted Under the Health Insurance Portability and Accountability Act of 1996 AGENCY: Office of... of the Health Insurance Portability and Accountability Act of 1996 standards made by the Designated...

  7. International financial institutions and human rights: implications for public health.

    Science.gov (United States)

    Stubbs, Thomas; Kentikelenis, Alexander

    2017-01-01

    Serving as lender of last resort to countries experiencing unsustainable levels of public debt, international financial institutions have attracted intense controversy over the past decades, exemplified most recently by the popular discontent expressed in Eurozone countries following several rounds of austerity measures. In exchange for access to financial assistance, borrowing countries must settle on a list of often painful policy reforms that are aimed at balancing the budget. This practice has afforded international financial institutions substantial policy influence on governments throughout the world and in a wide array of policy areas of direct bearing on human rights. This article reviews the consequences of policy reforms mandated by international financial institutions on the enjoyment of human rights, focusing on the International Monetary Fund and World Bank. It finds that these reforms undermine the enjoyment of health rights, labour rights, and civil and political rights, all of which have deleterious implications for public health. The evidence suggests that for human rights commitments to be met, a fundamental reorientation of international financial institutions' activities will be necessary.

  8. CRIMEAN WAR AND ESTABLISHING OF PUBLIC HEALTH SYSTEM IN GREAT BRITAIN

    OpenAIRE

    SKLYAROVA ELENA

    2017-01-01

    Crimean War of 1853 1856 is a factor of important socio-political and socio-medical reforms. Study of these cases is characterized as interdisciplinary. At the edge of Crimean War Great Britain press highlighted aspiration of the empire to capture russian territories of Black sea region, also reforms and work of E.Chadwick, founder of public health system, were criticized, he was wanted to be away from members of parliament and London oligarchs due to his extreme reforms and British corruptio...

  9. Health, welfare reform, and narratives of uncertainty among Cambodian refugees.

    Science.gov (United States)

    Becker, G; Beyene, Y; Ken, P

    2000-06-01

    Massive disruptions to a way of life, such as those brought on by widespread violence, terror, and genocide, disorder the body as well as the social order. When they flee their homelands, refugees bring their experiences of violence and terror with them. Drawing on an ethnographic study of 40 Cambodian refugees between the ages of 50 and 79 who suffered from one or more chronic illnesses, we explore how refugees who live with chronic illnesses and are dependent on government support were affected by the threat of welfare reform. When welfare reform threatened to cut Cambodian refugees' income, it posed a new crisis for those who were chronically in limbo and placed further constraints on their lives. Through their narratives, Cambodian refugees enacted their bodily distress and resisted the threat of welfare reform. The story of threatened welfare reform in the U.S. and its possible consequences for refugees is a story of quixotic U.S. politics, policies and antidotes for refugeeism gone awry.

  10. 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.

  11. Equity in health personnel financing after Universal Coverage: evidence from Thai Ministry of Public Health?s hospitals from 2008?2012

    OpenAIRE

    Ruangratanatrai, Wilailuk; Lertmaharit, Somrat; Hanvoravongchai, Piya

    2015-01-01

    Background Shortage and maldistribution of the health workforce is a major problem in the Thai health system. The expansion of healthcare access to achieve universal health coverage placed additional demand on the health system especially on the health workers in the public sector who are the major providers of health services. At the same time, the reform in hospital payment methods resulted in a lower share of funding from the government budgetary system and higher share of revenue from hea...

  12. [Social marketing and public health].

    Science.gov (United States)

    Arcaro, P; Mannocci, A; Saulle, R; Miccoli, S; Marzuillo, C; La Torre, G

    2013-01-01

    Social marketing uses the principles and techniques of commercial marketing by applying them to the complex social context in order to promote changes (cognitive; of action; behavioral; of values) among the target population in the public interest. The advent of Internet has radically modified the communication process, and this transformation also involved medical-scientific communication. Medical journals, health organizations, scientific societies and patient groups are increasing the use of the web and of many social networks (Twitter, Facebook, Google, YouTube) as channels to release scientific information to doctors and patients quickly. In recent years, even Healthcare in Italy reported a considerable application of the methods and techniques of social marketing, above all for health prevention and promotion. Recently the association for health promotion "Social marketing and health communication" has been established to promote an active dialogue between professionals of social marketing and public health communication, as well as among professionals in the field of communication of the companies involved in the "health sector". In the field of prevention and health promotion it is necessary to underline the theme of the growing distrust in vaccination practices. Despite the irrefutable evidence of the efficacy and safety of vaccines, the social-cultural transformation together with the overcoming of compulsory vaccination and the use of noninstitutional information sources, have generated confusion among citizens that tend to perceive compulsory vaccinations as needed and safe, whereas recommended vaccinations as less important. Moreover, citizens scarcely perceive the risk of disease related to the effectiveness of vaccines. Implementing communication strategies, argumentative and persuasive, borrowed from social marketing, also for the promotion of vaccines is a priority of the health system. A typical example of the application of social marketing, as

  13. Surgery, public health, and Pakistan.

    Science.gov (United States)

    Zafar, Syed Nabeel; McQueen, K A Kelly

    2011-12-01

    Surgical healthcare is rapidly gaining recognition as a major public health issue. Surgical disparities are large, with poorest populations receiving the least amount of emergency and essential surgical care. In light of recent evidence, developing countries, such as Pakistan, must acknowledge surgical disease as a major public health issue and prioritize research and intervention accordingly. We review information from various sources and describe the current situation of surgical health care in Pakistan and highlight areas of neglect. Pakistan suffers an annual deficit of 17 million surgeries. Surgical disease kills more people than infectious diseases inclusive of tuberculosis, HIV/AIDS, diarrheal disease, and childhood infections. The incidence of trauma and maternal mortality ratio are staggeringly high. There is a severe dearth of surgical and anesthesia-related epidemiological data. Important information that would help to drive policy and planning is not available. Corruption and neglect have led to a dilapidated health care infrastructure. Surgical care is largely inaccessible to the poor, especially those living in rural areas. The country faces a dearth of healthcare professionals, especially paramedics, anesthetists, and surgeons. Unsafe surgery and anesthesia poses a significant risk to patients. There is no national policy on surgical illness and the preventive aspects of surgery are nonexistent. Consistent with other underdeveloped countries, surgical care in Pakistan is dismal. Neglecting surgery and safe anesthesia has led to countless deaths and disability. Physicians, researchers, policy makers, and the government health care system must engage and commit to provide access to emergency, essential, and safe surgical care.

  14. Ethics in Public Health Research

    Science.gov (United States)

    Curtis, Valerie A.; Garbrah-Aidoo, Nana; Scott, Beth

    2007-01-01

    Skill in marketing is a scarce resource in public health, especially in developing countries. The Global Public–Private Partnership for Handwashing with Soap set out to tap the consumer marketing skills of industry for national handwashing programs. Lessons learned from commercial marketers included how to (1) understand consumer motivation, (2) employ 1 single unifying idea, (3) plan for effective reach, and (4) ensure effectiveness before national launch. After the first marketing program, 71% of Ghanaian mothers knew the television ad and the reported rates of handwashing with soap increased. Conditions for the expansion of such partnerships include a wider appreciation of what consumer marketing is, what it can do for public health, and the potential benefits to industry. Although there are practical and philosophical difficulties, there are many opportunities for such partnerships. PMID:17329646

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  16. Public Higher Education Reform Five Years after the Kellogg Commission on the Future of State and Land-Grant Universities

    Science.gov (United States)

    Byrne, John V.

    2006-01-01

    The Kellogg Commission on the Future of State and Land grant Universities existed between January 1996 and March 2000 in order to create an awareness among public universities of the need for higher education reform. The Commission, consisting of the presidents and chancellors of 25 major public universities, produced six reports and held numerous…

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

    Science.gov (United States)

    Pritchard, A M; Page, D

    2008-05-01

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

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

    Science.gov (United States)

    Anell, A

    1996-07-01

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

  19. The early NHS and the crisis of public health nursing.

    Science.gov (United States)

    Webster, C

    2000-01-01

    Establishment of the NHS in 1948 is rightly seen as a major turning point in health care in the United Kingdom. Notwithstanding conditions of severe austerity, the NHS succeeded remarkably well in its basic remit to make all essential medical care available to the entire population, free at point of delivery. The benefits of the new system extended across the entire front of its services. However, it is important to recognise that the reforms of 1948 were uniformly advantageous. It has for instance long been recognised that the NHS failed to bring about the expected transformation in standards of general medical practice. In this short paper the author argues that public health represented a further major sphere of underdevelopment. The fact that, with minor exceptions, public health is the least studied aspect of the early NHS is itself suggestive of its status as the Cinderella of the modern health services. The author also underlines the adverse implications of this inferior position for domiciliary midwifery, district nursing and health visiting. These constituted small but strategically important sectors of nursing, all of which fell under public health administration in the new health service. The author concentrates on the first phase of the NHS, the period between 1948 and 1974, now often regarded as its golden age. For the purposes of this discussion, most of the evidence relates to the formative phase of the new service, when many major policy questions relating to public health were first confronted. It is suggested that the early neglect of public health and its constituent nursing functions has left a legacy of problems that have still not entirely been resolved. For the purposes of this paper the term will be used to embrace the totality of health functions administered by departments of local government in the period from 1948 to 1974. Most of these services fell within the public health departments of local government, headed by the Medical Office

  20. [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 teaching methods can improve students' ability for oral health education, in accordance with the trend of teaching reform.

  1. 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.

  2. 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

  3. Strengthening public health research for improved health

    Directory of Open Access Journals (Sweden)

    Enrique Gea-Izquierdo

    2012-08-01

    Full Text Available Research in public health is a range that includes from fundamental research to research in clinical practice, including novel advances, evaluation of results and their spreading. Actually, public health research is considered multidisciplinary incorporating numerous factors in its development. Establishing as a mainstay the scientific method, deepens in basic research, clinical epidemiological research and health services. The premise of quality and relevance is reflected in international scientific research, and in the daily work and good biomedical practices that should be included in the research as a common task. Therefore, the research must take a proactive stance of inquiry, integrating a concern planned and ongoing development of knowledge. This requires improve international coordination, seeking a balance between basic and applied research as well as science and technology. Thus research cannot be considered without innovation, weighing up the people and society needs. Acting on knowledge of scientific production processes requires greater procedures thoroughness and the effective expression of the results. It is noted as essential to establish explicit principles in review and evaluation of the adjustments of actions, always within the standards of scientific conduct and fairness of the research process. In the biomedical scientific lines it have to be consider general assessments that occur related to the impact and quality of health research, mostly leading efforts to areas that require further attention. However, other subject areas that may be deficient or with lower incidence in the population should not be overlook. Health research as a source of new applications and development provides knowledge, improving well-being. However, it is understandable without considering the needs and social demands. Therefore, in public health research and to improve the health of the population, we must refine and optimize the prevention and

  4. Economic Segmentation and Health Inequalities in Urban Post-Reform China.

    Science.gov (United States)

    Kwon, Soyoung

    2016-01-01

    During economic reform, Chinese economic labor markets became segmented by state sector associated with a planned redistributive economy and private sector associated with the market economy. By considering an economic sector as a concrete institutional setting in post-reform China, this paper compares the extent to which socioeconomic status, measured by education and income, is associated with self-rated health between state sector and private sector. The sample is limited to urban Chinese employees between the ages of 18 and 55 who were active in the labor force. By analyzing pooled data from the 1991-2006 Chinese Health and Nutrition Survey , I find that there is a stronger association between income and self-rated health in the private sector than in the state sector. This study suggests that sectoral differences between market and redistributive economies are an important key to understanding health inequalities in post-reform urban China.

  5. Economic Segmentation and Health Inequalities in Urban Post-Reform China

    Directory of Open Access Journals (Sweden)

    Soyoung Kwon

    2016-08-01

    Full Text Available During economic reform, Chinese economic labor markets became segmented by state sector associated with a planned redistributive economy and private sector associated with the market economy. By considering an economic sector as a concrete institutional setting in post-reform China, this paper compares the extent to which socioeconomic status, measured by education and income, is associated with self-rated health between state sector and private sector. The sample is limited to urban Chinese employees between the ages of 18 and 55 who were active in the labor force. By analyzing pooled data from the 1991–2006 Chinese Health and Nutrition Survey, I find that there is a stronger association between income and self-rated health in the private sector than in the state sector. This study suggests that sectoral differences between market and redistributive economies are an important key to understanding health inequalities in post-reform urban China.

  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. Lessons for health care reform from the less developed world: the case of the Philippines.

    Science.gov (United States)

    Obermann, Konrad; Jowett, Matthew R; Taleon, Juanito D; Mercado, Melinda C

    2008-11-01

    International technical and financial cooperation for health-sector reform is usually a one-way street: concepts, tools and experiences are transferred from more to less developed countries. Seldom, if ever, are experiences from less developed countries used to inform discussions on reforms in the developed world. There is, however, a case to be made for considering experiences in less developed countries. We report from the Philippines, a country with high population growth, slow economic development, a still immature democracy and alleged large-scale corruption, which has embarked on a long-term path of health care and health financing reforms. Based on qualitative health-related action research between 2002 and 2005, we have identified three crucial factors for achieving progress on reforms in a challenging political environment: (1) strive for local solutions, (2) make use of available technology and (3) work on the margins towards pragmatic solutions whilst having your ethical goals in mind. Some reflection on these factors might stimulate and inform the debate on how health care reforms could be pursued in developed countries.

  8. 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.

  9. Barriers to contraceptive access after health care reform: experiences of young adults in Massachusetts.

    Science.gov (United States)

    Bessett, Danielle; Prager, Joanna; Havard, Julia; Murphy, Danielle J; Agénor, Madina; Foster, Angel M

    2015-01-01

    To explore how Massachusetts' 2006 health insurance reforms affected access to sexual and reproductive health (SRH) services for young adults. We conducted 11 focus group discussions across Massachusetts with 89 women and men aged 18 to 26 in 2009. Most young adults' primary interaction with the health system was for contraceptive and other SRH services, although they knew little about these services. Overall, health insurance literacy was low. Parents were primary decision makers in health insurance choices or assisted their adult children in choosing a plan. Ten percent of our sample was uninsured at the time of the discussion; a lack of knowledge about provisions in Chapter 58 rather than calculated risk analysis characterized periods of uninsurance. The dynamics of being transitionally uninsured, moving between health plans, and moving from a location defined by insurance companies as the coverage area limited consistent access to contraception. Notably, staying on parents' insurance through extended dependency, a provision unique to the post-reform context, had implications for confidentiality and access. Young adults' access to and utilization of contraceptive services in the post-reform period were challenged by unanticipated barriers related to information and privacy. The experience in Massachusetts offers instructive lessons for the implementation of national health care reform. Young adult-targeted efforts should address the challenges of health service utilization unique to this population. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  10. Public health aspects of tobacco control revisited

    NARCIS (Netherlands)

    Gallagher, Jennifer E.; Alajbeg, Ivan; Buechler, Silvia; Carrassi, Antonio; Hovius, Marjolijn; Jacobs, Annelies; Jenner, Maryan; Kinnunen, Taru; Ulbricht, Sabina; Zoitopoulos, Liana

    The tobacco epidemic presents a major public health challenge, globally, and within Europe. The aim of the Public Health Work Stream at the 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals was to review the public health aspects of tobacco control and make

  11. Public health interventions: evaluating the economic evaluations

    Directory of Open Access Journals (Sweden)

    Martin Forster

    2013-10-01

    Full Text Available Recent years have witnessed much progress in the incorporation of economic considerations into the evaluation of public health interventions. In England, the Centre for Public Health Excellence within the National Institute for Health and Care Excellence works to develop guidance for preventing illness and assessing which public health interventions are most effective and provide best value for money...

  12. 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.

  13. 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.

  14. The private-public literacy divide amid educational reform in Qatar: What does PISA tell us?

    Science.gov (United States)

    Cheema, Jehanzeb R.

    2015-04-01

    The education system in Qatar comprises of both private schools, which receive money through student fees, and public schools, which are fully government-funded. In the mid-2000s, Qatar started its transition towards an independent school model with the aim of eventually converting all public schools into government-supported independent schools. The idea was to give public schools more autonomy in terms of hiring decisions, adoption of curriculum and textbooks, and budget spending, enabling them to emulate some of the private schools' strategies for turning out successful students. This study examines evidence from the 2006-2012 administrations of the Program for International Student Assessment (PISA) in Qatar in order to evaluate whether or not recent educational reform efforts in this country have succeeded in bridging the literacy divide between private and public schools. The results, presented in a number of detailed tables and discussed in the last part of the article, indicate that there is a significant difference in key literacy skills between the two types of schools. Private schools were found to outperform their public counterparts in areas such as mathematics, reading and science, both before and after controlling for important student-level differences, and this gap has evidently persisted from 2006 to 2012.

  15. The Empowering of Public Sector Officers in the Mauritian Public Sector in the Context of Reforms: How Far Has Management Education Helped?

    Science.gov (United States)

    Bhiwajee, Soolakshna Lukea; Garavan, Thomas N.

    2016-01-01

    Purpose: The purpose of this study is to provide insights about the usefulness of management education for the public sector in the Republic of Mauritius, which embarked on reforms initiatives around two decades ago. In this context, public officers were encouraged to follow specialised management courses. However, as at date, there is…

  16. A recente reforma dos serviços de saúde na província do Québec, Canadá: as fronteiras da preservação de um sistema público Recent health services reform in Quebec Province, Canada: on the frontier of preserving a public system

    Directory of Open Access Journals (Sweden)

    Eleonor Minho Conill

    2000-12-01

    Full Text Available O trabalho analisa mudanças recentes no sistema de saúde canadense por meio do estudo de caso do Quebec. Última província a adotar princípios federais de universalização, integralidade e gestão pública, sua reforma realizada em 1971 ultrapassou esses objetivos com características inovadoras. Na década de 80 e início dos anos 90, ocorrem avaliações nessa província e no conjunto canadense, iniciando-se um período de transformações. As principais medidas em curso são descritas: descentralização e gestão regional, virada ambulatorial, redução seletiva da oferta, novos mecanismos de alocação de recursos e de controle social. Observa-se uma tendência para um ambiente de competição pública, mas o modo de regulação adotado não corresponde aos principais modelos discutidos para países centrais. Em um cenário de restrições orçamentárias, medidas tecnocraticamente definidas permitiram acomodar interesses, preservando princípios norteadores do sistema. Essa constatação é uma contribuição importante da análise comparada para reformas de países periféricos. Relações dessas medidas com a tendência de controle de custos e políticas de ajustes são apontadas, discutindo-se implicações nos serviços.This paper analyzes recent changes in the Canadian health system through a case study of Quebec. As the last Province to adopt federal principles of universal coverage, comprehensiveness, and public management, its reform, conducted in 1971, met these objectives by means of key innovations. In the 1980s and early 90s, a process of health services evaluation in this Province and in Canada as a whole launched a period of extensive changes. The relevant measures are described herein: decentralization and regional management, "clinical shift", selective reduction in the supply of services, and new mechanisms for resource allocation and social control. There is a tendency towards an environment of public competition

  17. Greening Australia's public health system: the role of public hospitals in responding to climate change.

    Science.gov (United States)

    Primozic, Lauren

    2010-05-01

    Climate change is one of the most important social, economic, ecological and ethical issues of the 21st century. The effects of climate change on human health are now widely accepted as a genuine threat and the Australian Government has initiated policy and legislative responses. In addition, in the 2009-2010 budget the Australian Government has committed A$64 billion to public health and hospital reform. But will this Commonwealth funding support--and should it support--the government's high-profile climate change policy? Does Commonwealth funding translate to an obligation to support Commonwealth policies? This article explores the role of public hospitals as champions and role models of the Australian Government's climate change policy and how this might be done without detracting from the primary purpose of public hospital funding: improving patient care.

  18. [Parmentier hygiene and public health].

    Science.gov (United States)

    Lafont, O

    2014-05-01

    The legend about Parmentier is quite reductive when it limits his activity to the promotion of potato. This military pharmacist intended mainly to make science serve human being, whatever could be his various activities. Actor of the foundation of food chemistry, reorganizer of military pharmacy, he has always been highly concerned with hygiene and public health. He then studied the quality of water, particularly in the case of river Seine, or the purity of air, especially in hospitals. The affair of Dunkerque exhumations or that of cesspools, or the utilisation of human excrements in agriculture were parts of the occurrences for which he had the opportunity to find a scientific approach allowing to solve the difficult questions that were asked to him, for the best benefit of public health. The exhaustive study he published in "Bulletin de pharmacie" for the conservation of meat shows that he did not ignore anything about freezing of food in order to preserve it. It is necessary not to forget the important role he played, as soon as he were informed of Jenner's discovery, for the diffusion of vaccination in France. It is simply astounding to observe how modern were the questions he solved and how intense was his spirit of dedication to the public good, when exerting his functions in "Comité de Salubrité de la Seine" or "Conseil de Santé des Armées", as well as outside these prestigious institutions. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Health Reform for Communities: Financing Substance Abuse Services. Recommendations from a Join Together Policy Panel.

    Science.gov (United States)

    Join Together, Boston, MA.

    Substance abuse treatment has been demonstrated to be effective in reducing not only substance use, but also the economic, health, and social costs associated with substance abuse. This document examines how health care reform can preserve and enhance community substance abuse services. The cost effectiveness of funding substance abuse prevention…

  20. Surfing the net for public health resources.

    Science.gov (United States)

    Angell, C; Hemingway, A; Hartwell, H

    2011-08-01

    To identify public health open educational resources (OER) available online, map the identified OER to The Public Health Skills and Career Framework (PHSCF), and triangulate these findings with public health practitioners. Systematic online search for public health OER. An online search was undertaken using a pre-defined set of search terms and inclusion/exclusion criteria. Public health OER were then mapped against the UK PHSCF. The findings of the search were discussed with public health specialists to determine whether or not they used these resources. A number of public health OER were identified, located on 42 websites from around the world. Mapping against the UK PHSCF demonstrated a lack of coverage in some areas of public health education. It was noted that many of the OER websites identified were not those generally used in practice, and those sites preferred by public health specialists were not identified by the online search. Public health OER are available from a number of providers, frequently universities and government organizations. However, these reflect a relatively small pool of original OER providers. Tagging of websites does not always identify their public health content. In addition, users of public health OER may not use search engines to identify resources but locate them using other means. Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  1. Japan's Public Health Paradigm: Governmentality and the Containment of Harmful Behavior.

    Science.gov (United States)

    Borovoy, Amy

    2017-01-01

    In this essay, I revisit the politics of social control in the context of contemporary public health discussions, touching on the management of obesity and chronic illness. Foucault's cautionary observations regarding the infiltration of normative social values into the terrain of healing offer a productive framework for considering the politics of public health in the industrialized world. I explore Japan's public health paradigm and its key features of bureaucratic reform and health interventions through screening, socialization, education, and aggressive lifestyle training, and I consider the close proximity between health and socio-cultural values in the management of chronic conditions in Japan.

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

    OpenAIRE

    Nakajima, Makoto; Tuzemen, Didem

    2015-01-01

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

  3. Public health and demographic statistics

    International Nuclear Information System (INIS)

    Patrick, C.H.; Loebl, A.S.; Miller, F.L.; Ritchey, P.N. Jr.

    1976-01-01

    The purpose of this program is to assess the methodology and available data sources appropriate for use in analytical studies and environmental impact statements concerning the health effects of nuclear power plants. The techniques developed should be applicable as well to evaluation of the known risks of high levels of radiation exposure and of conflicting evidence on low-level effects, such as those associated with the normal operations of nuclear power plants. To accomplish this purpose, a two-pronged approach has been developed. The first involves a determination of the public health and demographic data sources of local, state, and federal origin that are available for use in analyses of health effects and environmental impact statements. The second part involves assessment of the methods used by epidemiologists, biostatisticians, and other scientists as found in the literature on health effects. This two-pronged approach provides a means of assessing the strength and shortcomings of studies of the impact of nuclear facilities on the health of the general population in a given locality

  4. The Partnership of Public Health and Anthropology.

    Science.gov (United States)

    Jelenc, Marjetka

    2016-06-01

    Public health focuses on health of the population and it is concerned with threats to health based on population health analysis. Anthropology covers most aspects that concern human beings. Both sciences converge on community and this fact represents a foundation for the partnership between public health and anthropology. Biological/medical anthropology is one of the highly developed fi elds of anthropology and the most important for public health.

  5. Impact of the Local Public Hospital Reform on the Efficiency of Medium-Sized Hospitals in Japan: An Improved Slacks-Based Measure Data Envelopment Analysis Approach.

    Science.gov (United States)

    Zhang, Xing; Tone, Kaoru; Lu, Yingzhe

    2018-04-01

    To assess the change in efficiency and total factor productivity (TFP) of the local public hospitals in Japan after the local public hospital reform launched in late 2007, which was aimed at improving the financial capability and operational efficiency of hospitals. Secondary data were collected from the Ministry of Internal Affairs and Communications on 213 eligible medium-sized hospitals, each operating 100-400 beds from FY2006 to FY2011. The improved slacks-based measure nonoriented data envelopment analysis models (Quasi-Max SBM nonoriented DEA models) were used to estimate dynamic efficiency score and Malmquist Index. The dynamic efficiency measure indicated an efficiency gain in the first several years of the reform and then was followed by a decrease. Malmquist Index analysis showed a significant decline in the TFP between 2006 and 2011. The financial improvement of medium-sized hospitals was not associated with enhancement of efficiency. Hospital efficiency was not significantly different among ownership structure and law-application system groups, but it was significantly affected by hospital location. The results indicate a need for region-tailored health care policies and for a more comprehensive reform to overcome the systemic constraints that might contribute to the decline of the TFP. © Health Research and Educational Trust.

  6. New evidence on financing equity in China's health care reform - A case study on Gansu province, China

    Science.gov (United States)

    2012-01-01

    Background In the transition from a planned economy to a market-oriented economy, China’s state funding for health care declined and traditional coverage plans collapsed, leaving China’s poor exposed to potentially ruinous health care costs. In reforming health care for the 21st century, equity in health care financing has become a major policy goal. To assess progress towards this goal, this paper examines the equity characteristics of health care financing in a province of northwestern China, comparing the equity performance between urban and rural areas at two different points in time. Methods Analysis of whether health care financing contributions were progressive according to income were made using the Kakwani index for each of the four health care financing channels of general taxes, public and private health insurance, and out-of-pocket payments. Two rounds of surveys were conducted, the first in 2003 (13,619 individuals in 3946 households) and the second in 2008 (12,973 individuals in 3958 households). Household socio-economic, health care payment, and utilization information were recorded in household interviews. Results Low-income households have undertaken a larger share of the health care financing burden in recent years, reflected by negative Kakwani indices, which indicate a regressive system. We found that the indices for general taxation were −0.0024 (urban) and −0.0281 (rural) in 2002, and −0.0177 (urban) and −0.0097 (rural) in 2007. Public health insurance presented different financing distributions in urban and rural areas (urban: 0.0742 in 2002, 0.0661 in 2007; rural: –0.0615 in 2002,–0.1436 in 2007.). Out-of-pocket payments were progressive but not equitable. Public health insurance coverage has expanded but financing equity has decreased. Conclusions Health care financing policies in China need ongoing reform. Given the inequity of general consumption taxes, elimination of these would improve financing equity considerably

  7. New evidence on financing equity in China's health care reform - A case study on Gansu province, China

    Directory of Open Access Journals (Sweden)

    Chen Mingsheng

    2012-12-01

    Full Text Available Abstract Background In the transition from a planned economy to a market-oriented economy, China’s state funding for health care declined and traditional coverage plans collapsed, leaving China’s poor exposed to potentially ruinous health care costs. In reforming health care for the 21st century, equity in health care financing has become a major policy goal. To assess progress towards this goal, this paper examines the equity characteristics of health care financing in a province of northwestern China, comparing the equity performance between urban and rural areas at two different points in time. Methods Analysis of whether health care financing contributions were progressive according to income were made using the Kakwani index for each of the four health care financing channels of general taxes, public and private health insurance, and out-of-pocket payments. Two rounds of surveys were conducted, the first in 2003 (13,619 individuals in 3946 households and the second in 2008 (12,973 individuals in 3958 households. Household socio-economic, health care payment, and utilization information were recorded in household interviews. Results Low-income households have undertaken a larger share of the health care financing burden in recent years, reflected by negative Kakwani indices, which indicate a regressive system. We found that the indices for general taxation were −0.0024 (urban and −0.0281 (rural in 2002, and −0.0177 (urban and −0.0097 (rural in 2007. Public health insurance presented different financing distributions in urban and rural areas (urban: 0.0742 in 2002, 0.0661 in 2007; rural: –0.0615 in 2002,���0.1436 in 2007.. Out-of-pocket payments were progressive but not equitable. Public health insurance coverage has expanded but financing equity has decreased. Conclusions Health care financing policies in China need ongoing reform. Given the inequity of general consumption taxes, elimination of these would improve

  8. New evidence on financing equity in China's health care reform--a case study on Gansu province, China.

    Science.gov (United States)

    Chen, Mingsheng; Chen, Wen; Zhao, Yuxin

    2012-12-18

    In the transition from a planned economy to a market-oriented economy, China's state funding for health care declined and traditional coverage plans collapsed, leaving China's poor exposed to potentially ruinous health care costs. In reforming health care for the 21st century, equity in health care financing has become a major policy goal. To assess progress towards this goal, this paper examines the equity characteristics of health care financing in a province of northwestern China, comparing the equity performance between urban and rural areas at two different points in time. Analysis of whether health care financing contributions were progressive according to income were made using the Kakwani index for each of the four health care financing channels of general taxes, public and private health insurance, and out-of-pocket payments. Two rounds of surveys were conducted, the first in 2003 (13,619 individuals in 3946 households) and the second in 2008 (12,973 individuals in 3958 households). Household socio-economic, health care payment, and utilization information were recorded in household interviews. Low-income households have undertaken a larger share of the health care financing burden in recent years, reflected by negative Kakwani indices, which indicate a regressive system. We found that the indices for general taxation were -0.0024 (urban) and -0.0281 (rural) in 2002, and -0.0177 (urban) and -0.0097 (rural) in 2007. Public health insurance presented different financing distributions in urban and rural areas (urban: 0.0742 in 2002, 0.0661 in 2007; rural: -0.0615 in 2002,-0.1436 in 2007.). Out-of-pocket payments were progressive but not equitable. Public health insurance coverage has expanded but financing equity has decreased. Health care financing policies in China need ongoing reform. Given the inequity of general consumption taxes, elimination of these would improve financing equity considerably. Optimizing benefit packages in public health insurance is

  9. East African Journal of Public Health: Submissions

    African Journals Online (AJOL)

    Author Guidelines; » Copyright Notice; » Privacy Statement ... and noncommunicable diseases, health leadership and management issues. ... current scientific and policy debates, including methodological issues in public health research.

  10. The public health system in England

    National Research Council Canada - National Science Library

    Hunter, David J; Marks, Linda; Smith, Katherine E

    2010-01-01

    .... The Public Health System in England offers a wide-ranging, provocative and accessible assessment of challenges confronting a public health system, exploring how its parameters have shifted over time...

  11. Challenges and actual problems in reforming the public administration in the Republic of Macedonia

    Directory of Open Access Journals (Sweden)

    Argëtim Saliu

    2016-03-01

    Full Text Available Taking into consideration the fact that the public administration has a very important role in offering services and being a public service to the citizens and business community, as well as the need of improvement and harmonization of the norms and standards with the European Union, as one of the most important demands toward the integration process of Macedonia in the EU, makes this paper necessary to be taken into consideration for at least as a humble research in the area of public administration. Primary goal of this paper is that through comparative and quantitative methods to represent the challenges of reforming the public and state administration in Macedonia. De-politicization, more professional administration services and lowering the number of clerks in administration is one of the main criteria that our country needs to fulfil towards full integration in NATO and EU. The more time passes, the least progress is seen in this process, as we see stagnation in the aspect of quality of services, as well as in the aspect of total number of administrative clerks.

  12. Public Service Delivery in Hybrid Organisations : public management reform and horizontalisation as main challenges for public leaders

    NARCIS (Netherlands)

    Kuitert, L.; Volker, L.

    2016-01-01

    The public sector has been subject to some major movements the last 15 years. In public service delivery a trend called socialisation, leading to the displacement between public and private, is most crucial. A withdrawing government and privatization led to increased collaboration between public and

  13. 77 FR 76064 - Notice of Proposed Information Collection for Public Comment; Public Housing Reform Act: Changes...

    Science.gov (United States)

    2012-12-26

    ... through the Freedom of Information Act. Written documentation of policies relating to public housing and... . Persons with hearing or speech impairments may access this number through TTY by calling the toll-free... is not a toll-free number). Persons with hearing or speech impairments may access this number via TTY...

  14. Presidents and health reform: from Franklin D. Roosevelt to Barack Obama.

    Science.gov (United States)

    Morone, James A

    2010-06-01

    The health care reforms that President Barack Obama signed into law in March 2010 were seventy-five years in the making. Since Franklin D. Roosevelt, U.S. presidents have struggled to enact national health care reform; most failed. This article explores the highly charged political landscape in which Obama maneuvered and the skills he brought to bear. It contrasts his accomplishments with the experiences of his Oval Office predecessors. Going forward, implementation poses formidable challenges for Democrats, Republicans, and the political process itself.

  15. The case for transforming governmental public health.

    Science.gov (United States)

    Salinsky, Eileen; Gursky, Elin A

    2006-01-01

    Changing threats to the public's health necessitate a profound transformation of the public health enterprise. Despite recent attention to the biodefense role of public health, policymakers have not developed a clear, realistic vision for the structure and functionality of the governmental public health system. Lack of leadership and organizational disconnects across levels of government have prevented strategic alignment of resources and undermined momentum for meaningful change. A transformed public health system is needed to address the demands of emergency preparedness and health protection. Such transformation should include focused, risk-based resource allocation; regional planning; technological upgrades; workforce restructuring; improved integration of private-sector assets; and better performance monitoring.

  16. [Medicine on mission: The international health reform of Seventh-Day Adventists and their health care facilities in Sweden].

    Science.gov (United States)

    Eklöf, Motzi

    2008-01-01

    The international non-conformist denomination, Seventh-day Adventists, have since their foundation in 1863, had a distinctive health care model for their members. The life-style has included vegetarian diet, abstinence from alcohol, tobacco and other drugs and the observance of a day of rest once a week. The health policy has striven to care for God's creation in the hope of resurrection at the Day of Judgment and to reform the conventional medical practice. The Adventists have pursued an extensive international health care system--from the start based on dietary and physical treatment methods, such as hydrotherapy, massage and physiotherapy--in line with the Christian mission. Health care establishments have been inaugurated around the world as a vehicle for enabling the Christian health care message to reach the upper classes. With Adventist and Doctor, John Harvey Kellogg's Battle Creek Sanatorium in Michigan as both inspirational source and educational institution, the health care mission--including a vegetarian health food industry, following in the footsteps of cornflakes--spread to the Nordic countries by the turn of the century, 1900. Skodsborgs Badesanatorium near Copenhagen became the model institution for several health care establishments in Sweden during the 1900's, such as Hultafors Sanatorium. The American-Nordic link has manifested itself through co-publication of papers, exchange of health care personnel and reporting to the central Adventist church. The American non-conformist domain as well as a private sphere of activity, aiming mainly from the outset at society's upper classes, has encountered certain difficulties in maintaining this distinction in Sweden's officially increasing secularised society, and in relation to a state health insurance and a publicly financed health care system. With the passing of time, the socioeconomic composition of patients at Hultafors became more heterogeneous, and conventional medical procedures were increasingly

  17. Constitutional framework of the process of decentralization and public administration reform in Serbia and Croatia

    Directory of Open Access Journals (Sweden)

    Čiplić Svetozar M.

    2016-01-01

    Full Text Available The work is devoted to the comparative analyze of the processes of the decentralization reorganization and reform of the public administration at the level of the horizontal governance organization in Serbia and Croatia. At the first part of the work the authors analyze the decentralization and devolution as well as their demarcation in the sense of their related but not similar meanings. The second part is devoted to the historical experiences and genesis foundations of the common state where Serbia and Croatia were joined. The particular historical developments of Serbia and Croatia influenced the present attitude of their political elites toward decentralization. The third, final part/conclusion, is d