Full Text Available BACKGROUND: Starting from 90‘th, the Government of Georgia (GoG made several attempts to transform Georgian health care system into one with improved efficiency, accessibility, and quality services. Mandatory social health insurance which was introduced in the 1990s was abolished and private health insurance has been promoted as its replacement. The main principle of health care reform since 2006 was the transition towards complete marketization of the health care sector: private provision, private purchasing, liberal regulation, and minimum supervision.This paper aims to analyze an impact of ongoing reforms on public health and population health status.MATERIALS AND METHODS: A systematic review of the available literature was conducted through national and international organization reports; key informant interviews were conducted with major stakeholders. RESULTS: The country has attained critical achievements in relation to improved maternal and child health, national responses to HIV, TB and Malaria. Life expectancy has increased from 70.3 years in 1995 to 75.1 years in 2010. Under-5 mortality indicator has improved from 45.3 to 16.4 per 1000 live birth in 2005-2010 meaning a 64% decrease. However, Georgia is still facing a number of critical challenges securing better health for the population. Cardiovascular diseases are by far the largest cause of mortality, respiratory diseases are the leading cause of morbidity and have doubled during last decade. Georgia has one of the highest rates of male smoking in the world (over 50%.CONCLUSION: Governmental efforts in health promotion and disease prevention can have significant impact on health status by preventing chronic diseases and detecting health problems at a treatable stage. Government should consider increasing funding for public health and prevention programmes with the focus on prevention of the main risk factors affecting the population’s health: tobacco and drug use and unsafe
Shaner, Roderick; Thompson, Kenneth S; Braslow, Joel; Ragins, Mark; Parks, Joseph John; Vaccaro, Jerome V
This article reviews the fiscal, programmatic, clinical, and cultural forces of health care reform that are transforming the work of public psychiatrists. Areas of rapid change and issues of concern are discussed. A proposed health care reform agenda for public psychiatric leadership emphasizes (1) access to quality mental health care, (2) promotion of recovery practices in primary care, (3) promotion of public psychiatry values within general psychiatry, (4) engagement in national policy formulation and implementation, and (5) further development of psychiatric leadership focused on public and community mental health.
Sanjay P Zodpey
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.
Kirk, Megan; Tomm-Bonde, Laura; Schreiber, Rita
More than 25 years have passed since the release of the Ottawa Charter for Health Promotion. This document represented a substantial contribution to public health in its emphasis on the economic, legal, political and cultural factors that influence health. With public health renewal underway across Canada, and despite overwhelming support in the public health community for the Ottawa Charter, how much its principles will be included in the renewal process remains unclear. In this paper, we present the historical understanding of health promotion in Canada, namely highlighting the contributions from the Lalonde Report, Alma Ata Declaration, the Ottawa Charter for Health Promotion and the more recent population health movement. We discuss public health renewal, using the province of British Columbia in Canada as an example. We identify the potential threats to health promotion in public health renewal as it unfolds.
Meier, Benjamin Mason; Hodge, James G; Gebbie, Kristine M
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.
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.
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.
Erus, Burcay; Aktakke, Nazli
The Turkish healthcare system has been subject to major reforms since 2003. During the reform process, access to public healthcare providers was eased and private providers were included in the insurance package for public insurees. This study analyzes data on out-of-pocket (OOP) healthcare expenditures to look into the impact of reforms on the size of OOP health expenditures for premium-based public insurees. The study uses Household Budget Surveys that provide a range of individual- and household-level data as well as healthcare expenditures for the years 2003, before the reforms, and 2006, after the reforms. Results show that with the reforms ratio of households with non-zero OOP expenditure has increased. Share and level of OOP expenditures have decreased. The impact varies across income levels. A semi-parametric analysis shows that wealthier individuals benefited more in terms of the decrease in OOP health expenditures.
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.
Liu, Xingzhu; Mills, Anne
Financing reforms of China's public health services are characterised by a reduction in government budgetary support and the introduction of charges. These reforms have changed the financing structure of public health institutions. Before the financing reforms, in 1980, government budgetary support covered the full costs of public health institutions, while after the reforms by the middle of the 1990s, the government's contribution to the institutions' revenue had fallen to 30-50%, barely covering the salaries of health workers, and the share of revenue generated from charges had increased to 50-70%. These market-oriented financing reforms improved the productivity of public health institutions, but several unintended consequences became evident. The economic incentives that were built into the financing system led to over-provision of unnecessary services, and under-provision of socially desirable services. User fees reduced the take-up of preventive services with positive externalities. The lack of government funds resulted in under-provision of services with public goods' characteristics. The Chinese experience has generated important lessons for other nations. Firstly, a decline in the role of government in financing public health services is likely to result in decreased overall efficiency of the health sector. Secondly, levying charges for public health services can reduce demand for these services and increase the risk of disease transmission. Thirdly, market-oriented financing reforms of public health services should not be considered as a policy option. Once this step is made, the unintended consequences may outweigh the intended ones. Chinese experience strongly suggests that the government should take a very active role in financing public health services.
Brodie, Mollyann; Altman, Drew; Deane, Claudia; Buscho, Sasha; Hamel, Elizabeth
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.
Selway, Joel Sawat
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.
Denis, Jean L; Lamothe, Lise; Langley, Ann; Stéphane, Guérard
The article examines various healthcare systems reform projects in Canada and some Canadian provinces and reveals some tendencies in governance renewal. The analisis is based on the hypothesis that reform is an exercise aiming at the renewal of governance conception and practices. In renewing governance, reform leaders hope to use adequate and effective levers to attain announced reform objectives. The article shows that the conceptions and operational modalities of governance have changed over time and that they reveal tensions inherent to the transformation and legitimation process of public healthcare systems. The first section discusses the relationships between reform and change. The second section defines the conception of gouvernance used for the analisis. Based on a content analisis of the various reform reports, the third section reveals the evolution of the conception of governance in healthcare systems in Canada. In order to expose the new tendencies, ideologies and operational principles at the heart of the reform projects are analysed. Five ideologies are identified: the democratic ideology, the "population health" ideology, the business ideology, the managerial ideology and the ideology of equity and humanism. This leads to a discussion on the dominant influence of the managerial ideology in the current reform projects.
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.
Filc, Dani; Davidovitch, Nadav
To analyse the process of health care privatization using the case of Israeli health care reforms during the last three decades. We used mixed methods including quantitative analysis of trends in health expenditures in Israel and qualitative critical analysis of documents describing the main health reforms. Israel epitomizes how boundaries between the private and public sector become blurred when health care services are subject to privatization, both of finance and supply. Additionally, the continuous growth of public-private relationships in health care results in systems that lack both equity and efficiency. More than three decades of experience show that such private-public partnerships increase both inequality and inefficiency. While most discussion surrounding the private-public mix in health care focuses on financing infrastructure, in Israel, the public-private mix has become a central way of financing and delivering services, making its damaging influence more pervasive. © The Author(s) 2016.
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
Glied, Sherry A; Miller, Erin A
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.
Franco, Lynne Miller; Bennett, Sara; Kanfer, Ruth
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
Rasul Fani khiavi
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
Collins, Sara R; Kriss, Jennifer L
A Commonwealth Fund survey of adults age 19 and older,conducted from June 2007 to October 2007, finds that large majorities of the public, regardless of political affiliation or income level, say that the candidates' views on health care reform will be very important or somewhat important in their voting decision. Moreover, they believe employers--long the cornerstone of the health insurance system--should retain responsibility for providing health insurance, or at least contribute financially to covering the country's working families. A majority of adults would also favor a requirement that everyone have health insurance, with the government helping those who are unable to afford it; support for such a requirement, however, is not strong and varies by political affiliation, geographic region, and income. There is overwhelming agreement that financing for health insurance coverage for all Americans should be a responsibility shared by employers, government, and individuals.
In order to ensure fair and affordable health services for all Chinese citizens and to set up a healthcare system that covers both urban and rural residents, the Chinese Government put forward a strategic task of deepening the healthcare system reform. The major objective of this reform is to provide medical service as a public service. In an interview with Beijing-based Guangming Daily, Li Weiping, a fellow researcher at the Institute of Medicine and Economy under the Ministry of Health, says that public hospitals are key to making this reform work and medical workers will need to drive this process forward.
Inoue, Mariko; Yano, Eiji
Japan, known for its good healthcare access via universal health insurance, leads the world in terms of life expectancy, and possesses a public health system that has improved health standards markedly in the 20th century. However, we currently face major challenges to maintain and promote people's health. Although these complicated problems pose numerous threats to public welfare, education of public health for health professionals still retains 20th-century standards. This also means that graduate education of public health in Japan is traditionally based on obtaining licensure as a medical professional, conducting research and writing papers, and on-the-job training. Since graduate school education is expected to produce competent public health leaders, Japan requires a reform toward a new education design that caters to the current societal needs. The current global trend in the education of health professionals leans toward outcome-based education to meet core competencies. Here, "competency" refers to a set of features or particular behavioral patterns possessed by highly qualified persons. In 2006, the World Health Organization (WHO) established a general health professional competency standard that includes both management and leadership competencies. Moreover, the Lancet Commission concluded that there was a need for transformative education based on a "health system approach." In brief, this means that our education should correspond to the needs of the health system to allow for the resolution of problems by educated professionals with satisfactory levels of competencies. In addition, as "change agents," these competent professionals are expected to promote societal change toward the realization of better public health. In Japan, the Central Education Council has produced several reports on professional graduate school reform since 2000. These reports indicate that graduate school curricula require reform to allow the health professionals to work
Andersen, Mette Rye; Storm, Hans H
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
Wilson, Robert Lee; Blandamer, Will
Introduction: The Wigan Borough’s system wide approach is based on the fastest and greatest improvement in the health of the population of the Borough. The way services are delivered to citizens are being reformed to include improved access, standardisation to best practice, technology deployment, integrated approaches to care, shifts to community and primary care orientated service delivery.Description: Wigan Borough has developed integrated care based on populations’ assets and is actively ...
Hossain Md Zakir
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
Oborn, Eivor; Barrett, Michael; Exworthy, Mark
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.
Gunnar Helgi Kristinsson
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.
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.
Marušič, Dorjan; Prevolnik Rupel, Valentina
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.
de la Jara, J J; Bossert, T
This paper applies an interdisciplinary approach to analyze the process of health reform in four significant periods in Chilean history: (1) the consolidation of state responsibility for public health in the 1920s, (2) the creation of the state-run National Health Service in the 1950s, (3) the decentralization of primary care and privatization of health insurance in the 1980s, and (4) the strengthening of the mixed public-private market in the 1990s. Building on the authors' separate disciplines, the paper examines the epidemiological, political and economic contexts of these reforms to test simple hypotheses about how these factors shape reform adoption and implementation. The analysis underlines: (1) the importance of epidemiological data as an impetus to public policy; (2) the inhibiting role of economic recession in adoption and implementation of reforms: and (3) the importance of the congruence of reforms with underlying political ideology in civil society. The paper also tests several hypotheses about the reform processes themselves, exploring the role of antecedents, interest groups, and consensus-building in the policy process. It found that incremental processes building on antecedent trends characterize most reform efforts. However, interest group politics and consensus building were found to be complex processes that are not easily captured by the simple hypotheses that were tested. The interdisciplinary approach is found to be a promising form of analysis and suggests further theoretical and empirical issues to be explored.
Gerasimenko, N F; Grigor'ev, Iu I
The significance of a law-making process is substantially increasing under the conditions of intensified expansion of the scope of standard legal regulation in the field of human health care in the Russian Federation. The authors state that any law-making process should begin with the definition of the subject-matter of a future law, its role and value in medical law creation and also indicate that the choice of the subject-matter of a future law is of priority and the most important stage of its preparation from the points of both contents-rich and standard legal views. Moreover, the paper presents main groups of issues that can determine the subjects of sociomedical laws and states the basic rules how reflect systemic relations in legislation. The paper shows it important to create a code of laws in the field of health protection for legal assurance of health public reforms.
Sage, William M; Harding, Molly Colvard; Thomas, Eric J
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
Sorin Dan ȘANDOR
Full Text Available The present paper tries to assess the public administration reforms based on the opinions of public servants – the ones in charge with the actual implementation of the reforms. In November 2007 a mail survey was done in Romanian PA institutions. The opinions showed the necessity of the administrative reforms is accepted mainly as a request of the European Union. The way in which reforms were done is seen as a strenuous process, characterized by low coherence, with many changes of focus and done mainly through enacting new legislation over and over, which led to over-regulation. De-centralization (financial and managerial has still a long way to go, legislative improvement also (especially streamlining rules and procedures, citizens/community is not seen as a real partnership. More optimistic answers are regarding the functioning of local institutions (especially along the organizational culture dimension, which are seen as functioning very well in the context of reforms (a cautionary note should be made – loyalty or subjectivity may have lead to such answers.
Ross, Johnathon S
The 2008 presidential campaign season featured health care reform proposals. I discuss 3 approaches to health care reform and the tools for bringing about reform, such as insurance market reforms, tax credits, subsidies, individual and employer mandates, and public program expansions. I also discuss the politics of past and current health care reform efforts. Market-based reforms and mandates have been less successful than public program expansions at expanding coverage and controlling costs. New divisions among special interest groups increase the likelihood that reform efforts will succeed. Federal support for state efforts may be necessary to achieve national health care reform. History suggests that state-level success precedes national reform. History also suggests that an organized social movement for reform is necessary to overcome opposition from special interest groups.
Super, David A
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.
Smith, Ralph F
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.
He, Alex Jingwei; Qian, Jiwei
In recent years China has witnessed a surge in medical disputes, including many widely reported violent riots, attacks, and protests in hospitals. This is the result of a confluence of inappropriate incentives in the health system, the consequent distorted behaviors of physicians, mounting social distrust of the medical profession, and institutional failures of the legal framework. The detrimental effects of the damaged doctor-patient relationship have begun to emerge, calling for rigorous study and serious policy intervention. Using a sequential exploratory design, this article seeks to explain medical disputes in Chinese public hospitals with primary data collected from Shenzhen City. The analysis finds that medical disputes of various forms are disturbingly widespread and reveals that inappropriate internal incentives in hospitals and the heavy workload of physicians undermine the quality of clinical encounters, which easily triggers disputes. Empirically, a heavy workload is associated with a larger number of disputes. A greater number of disputes are associated with higher-level hospitals, which can afford larger financial settlements. The resolution of disputes via the legal channel appears to be unpopular. This article argues that restoring a healthy doctor-patient relationship is no less important than other institutional aspects of health care reform.
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
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
@@ The contributors to this special issue, "Reform of the Public Health Care System in China: Challenges and Responses," come from varying organizations - from academic institutions to policy research institutes-with varying research backgrounds - from health policy research to social policy research and sociology, and to agricultural economics.
Sorin Dan ŞANDOR
Full Text Available The advent of new ICTs brought a lot of new assumptions about radical changes in our society. In the context of the arrival of a new society, public administration was supposed to witness (and to address or implement changes at different levels, such as:• citizenship (citizens becoming participants in governance or even a shift to e-democracy;• the nature of public service jobs (in terms of skills, work processes and job design;• organizational changes (from a hierarchical to a more horizontal structure, to network or even virtual organizations; and• the entire government (from classic bureaucracy to New Public Management and to network and digital governance. Technological change cannot be judged outside the social, economic and political frameworks. The massive change in our society cannot be explained only by technological (especially ICT factors. Excluding other factors may help us predict easier (but not more accurately future evolutions but as a scientific effort it is a bad practice. Much of the assumptions about technological change came from hasty generalizations. The changing nature of some collective actions, jobs in certain areas of the economy or organizations were considered as optimal (and necessary paths for the entire society (from individual to national levels. Public administration reforms are far from being a consequence of new technologies. Moreover public administration reforms do not embed ICTs and do not have a happy marriage with e-government.
Guerrero, Erick G; Harris, Lesley; Padwa, Howard; Vega, William A; Palinkas, Lawrence
Little is known about how the Affordable Care Act (ACA) will be implemented in publicly funded addiction health services (AHS) organizations. Guided by a conceptual model of implementation of new practices in health care systems, this study relied on qualitative data collected in 2013 from 30 AHS clinical supervisors in Los Angeles County, California. Interviews were transcribed, coded, and analyzed using a constructivist grounded theory approach with ATLAS.ti software. Supervisors expected several potential effects of ACA implementation, including increased use of AHS services, shifts in the duration and intensity of AHS services, and workforce professionalization. However, supervisors were not prepared for actions to align their programs' strategic change plans with policy expectations. Findings point to the need for health care policy interventions to help treatment providers effectively respond to ACA principles of improving standards of care and reducing disparities.
Over the last ten years or so, many countries have undertaken public sector reforms. As a result of these changes, accounting has come to play a more important role. However, many of the studies have only discussed the reforms at a conceptual level and have failed to study how the reforms have been implemented and operated in practice. Based on the work of Lipsky (1980) and Gorz (1989), it can be argued that those affected by the reforms have a strong incentive to subvert the reforms. This prediction is explored via a case study of general practitioner (GP) response to the New Zealand health reforms. The creation of Independent Practice Associations (IPAs) allowed the State to impose contractual-accountability and to cap their budget exposure for subsidies. From the GP's perspective, the IPAs absorbed the changes initiated by the State, and managed the contracting, accounting and budgetary administration responsibilities that were created. This allowed individual GPs to continue practising as before and provided some collective protection against the threat of state intrusion into GP autonomy. The creation of IPAs also provided a new way to manage the professional/financial tension, the contradiction between the professional motivation noted by Gorz (1989) and the need to earn a living.
Recently enacted health reform legislation will have mostly positive effects on large employers, as millions more Americans gain access to affordable insurance and, potentially, primary care. But the law will impose new administrative burdens and financing costs on employers, while raising concerns about provisions that could allow their lower-wage employees to obtain coverage through insurance exchanges. Given the need to restrain the rate of growth of health spending, the private sector, especially large employers, must collaborate with the public sector to drive delivery system reform. And every public program and exchange should appoint a chief value officer who reports quarterly on spending, cost drivers, and potential ways to contain costs.
Fronstin, Paul; Ross, Murray N
HEALTH INSURANCE EXCHANGE: This Issue Brief examines issues related to managed competition and the use of a health insurance exchange for the purpose of addressing cost, quality, and access to health care services. It discusses issues that must be addressed when designing an exchange in order to reform the health insurance market and also examines state efforts at health reform that use an exchange. RISK VS. PRICE COMPETITION: The basic component of managed competition is the creation an organized marketplace that brings together health insurers and consumers (either as individuals or through their employers). The sponsor of the exchange would set "rules of engagement" for participating insurers and offer consumers a menu of choices among different plans. Ultimately, the goal of a health insurance exchange is to shift the market from competition based on risk to competition based on price and quality. ADVERSE SELECTION AND AFFORDABILITY: Among the issues that need to be addressed if an exchange that uses managed competition has a realistic chance of reducing costs, improving quality, and expanding coverage: Everyone needs to be in the risk pool, with individuals required to purchase insurance or face significant financial consequences; effective risk adjustment is essential to eliminate risk selection as an insurance business model--forcing competition on costs and quality; the insurance benefit must be specific and clear--without standards governing cost sharing, covered services, and network coverage there is no way to assess whether a requirement to purchase or issue coverage has been met; and subsidies would be necessary for low-income individuals to purchase insurance. THE PUBLIC PLAN OPTION: The public plan option is shaping up to be one of the most contentious issues in the health reform debate. Proponents also believe of a public plan is necessary to drive private insurers toward true competition. Opponents view it as a step toward government-run health
Vuyani S. Vellem
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.
Ramesh, M; Wu, Xun
Declining access to health care and rapidly rising health expenditures are a matter of grave public concern in China. After decades of efforts to reduce its involvement, the Chinese government is currently in the process of reforming the sector through increase in public expenditures and expansion of health insurance. The objective of this paper is to assess the potential of the reform direction in light of international experiences with similar reforms. It argues--on the basis of examination of reform experiences in Korea, Singapore and Thailand--that financing reforms without parallel measures to improve the provision system, especially how providers are paid, are unlikely to address the problems and may actually aggravate them. If the financing reforms are to succeed, it is vital for China to reform the incentives that guide the providers' behaviour.
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
During recent years there has been a growth of worldwide interest in health system reform. Countries at all levels of economic development are engaged in a creative search for better ways of organizing and financing health care, while promoting the goals of equity, effectiveness, and efficiency. Together with economic, political, and ideological reasons, this search has been fueled by the need to find answers to the complexities posed by the epidemiologic transition, whereby many nations are facing the simultaneous burdens of old, unresolved problems and new, emerging challenges. In order to better understand reform attempts, it is necessary to develop a clear conception of the object of reform: the health system. This paper presents the health system as a set of relationships among five major groups of actors: the health care providers, the population, the state as a collective mediator, the organizations that generate resources, and the other sectors that produce services with health effects. The relationships among providers, population, and the state form the basis for a typology of health care modalities. The type and number of modalities present in a country make it possible to characterize its health system. In the last part, the paper proposes that health system reform operates at four policy levels: systemic, which deals with the institutional arrangements for regulation, financing, and delivery of services; programmatic, which specifies the priorities of the system, by defining a universal package of health care interventions; organizational, which is concerned with the actual production of services by focusing on issues of quality assurance and technical efficiency; and instrumental, which generates the institutional intelligence for improving system performance through information, research, technological innovation, and human resource development. The dimensions of reform offer a repertoire of policy options, which need to be enriched by cross
Löfgren, Karl; Pedersen, John Storm
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...
Zhao, Dahai; Zhang, Zhiruo
Reforms in public hospitals are among the most important improvements in China's health care system over the last two decades. However, the reforms that should be implemented in public hospitals are unclear. Thus, a feasible direction of reforms in Chinese public hospitals is suggested and reliable policy suggestions are provided for the government to reform public hospitals. The data used in this study were mainly derived from a qualitative study. Focus group discussions and in-depth interviews were conducted in Shanghai, Guangdong, and Gansu between May and December 2014. Government funding accounted for approximately eight percent of the total annual revenue of public hospitals in China, and the insufficient government subsidy considerably affects the operation mechanism of public hospitals. However, solely increasing this subsidy cannot address the inappropriate incentives of public hospitals in China. The most crucial step in setting the direction of reforms in public hospitals in China is transforming inappropriate incentives by implementing a new evaluation index system for directors and physicians in public hospitals.
Berg, van den A.E.
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 ad
Berg, van den A.E.
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
Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A
Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.
Australia's high rates of overweight and obesity, and the associated increased population risk of non-communicable diseases, pose a challenge to policymakers across sectors beyond the health portfolio. In the last decade, strategies to promote healthy lifestyles and address non-communicable diseases have increasingly interested urban planners in Australia and internationally. However, Australian planning laws continue to operate largely without regard to public health goals, thus limiting the ability of communities to shape healthy built environments. In recent years, local governments have increasingly taken on responsibility for improving public health through community-based initiatives; however, their efforts are hindered by their limited capacity to influence planning priorities under current State-legislated planning schemes. This article considers the emerging body of research exploring the impact of urban planning on health and non-communicable diseases in Australia. It is contended that planning law in Australia is out of step with the evidence of planning's potential impact on health, and reforms are required to ensure consistency with public health priorities.
Jansen, Arild; Løvdal, Einar
This study examines the reorganisation of the administration of admission to higher education in Norway, which has also included the development of a nationwide, ICT-based case handling system. This reform process was initiated out of the need to provide politicians with information for control and regulatory purposes, and the reform resulted in a centralised management information system. This system, however, has evolved into a coordinated but also partly locally delegated decision-making instrument which processes most of the applications for admission to higher education in Norway.
Shemetova, M V; Blokhin, A B; Polzik, E V
Reformation of therapeutic and prophylactic institutions attached to various institutions and ministries is and important problem of public health at the modern stage of its development. A model developed and tried in Magnitogorsk can serve as a perspective trend of such reforms. A medical institution with mixed form of property has been created. The institution was set up by administration of the territory and a plant (Magnitogorsk metallurgical plant). Creation of a new health center as a non-commercial institution promoted its integration in the municipal public health system; the institution possesses all the potentialities of a budget organization and retains close contact with the plant. Such a solution of the problem improved the financial status of the health center and promoted its adaptation to marketing conditions. Attraction of additional finances from industry to municipal public health allowed the administration of the health center start and carry out internal restructuring aimed at priority development of outpatient care, restructuring of the bed fund, technological updating, and, in general, more rational utilization of the available resources.
This Issue Brief examines the major issues of the health reform debate. The issues that must be resolved before reform can be enacted include: allocation of health care resources, universal coverage versus universal access, composition of risk pools, employer and individual mandates, and distribution of health care services' costs. This report also contains short descriptions and analyses of the following proposals: McDermott-Wellstone, Clinton administration, Cooper-Breaux, Chafee-Thomas, Michel-Lott, Nickles-Stearns, and Gramm. Proposals without an individual mandate will not achieve universal coverage. An individual mandate raises significant enforcement issues. An employer mandate will not achieve universal coverage by itself. Depending on the number of hours an employee must work to be included in a mandate, an employer mandate could potentially extend health insurance coverage to as many as 85 percent of the currently uninsured. Each individual has a risk of needing health care services. Restructuring the health insurance market is accomplished by changing the way individuals and their risks are pooled. The composition of these risk pools will determine the costs of health insurance and the distribution of these costs. The theory behind medical saving accounts is that the market for health insurance currently leads to health care cost inflation because many events covered under most health insurance plans are not truly insurable. There are two issues involved in medical savings accounts--the impact on low-income individuals and individuals' ability to evaluate the quality of care they receive. The present market does not provide individuals with adequate information for assessing the quality or effectiveness of medical care. Among the critical issues in health reform is how to reduce the rate of health care cost inflation. The effect of proposals that impose explicit budget caps or price controls on health care cost inflation can be more easily estimated than
Full Text Available The existence of an efficient and democratic administration is one of the main criteria of defining the modernity of a country. At this moment, Romania has not such an administration. That is why a major priority of Romania is to achieve, in a few years, a real reform through which the public administration in our country to achieve the European standards and to be defined by transparency, predictability, responsability, adaptability and effectiveness. As a fact, this is a profound reform. It is obvious that, in order to be successful, this reform cannot be performed exclusively through the effort and political will of more Governments. A joint and structural effort at the level of the entire society is necessary.
Full Text Available The existence of an efficient and democratic administration is one of the main criteria of defining the modernity of a country. At this moment, Romania has not such an administration. That is why a major priority of Romania is to achieve, in a few years, a real reform through which the public administration in our country to achieve the European standards and to be defined by transparency, predictability, responsability, adaptability and effectiveness. As a fact, this is a profound reform. It is obvious that, in order to be successful, this reform cannot be performed exclusively through the effort and political will of more Governments. A joint and structural effort at the level of the entire society is necessary.
Littleton, Fiona Kisby
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.
Bara, AC; van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.
Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of
Bara, AC; van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.
Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of th
Laurell, Asa Cristina
Last year Lancet published a series of articles on Mexico's 2004 health system reform. This article reviews the reform and its presentation in the Lancet series. The author sees the 2004 reform as a continuation of those initiated in 1995 at the largest public social security institute and in 1996 at the Ministry of Health, following the same conceptual design: "managed competition". The cornerstone of the 2004 reform-the voluntary Popular Health Insurance (PHI)--will not resolve the problems of the public health care system. The author assesses the robustness and validity of the evidence on which the 2004 reform is based, noting some inconsistencies and methodological errors in the data analysis and in the construction of the "effective coverage" index. Finally, some predictions about the future of PHI are outlined, given its intrinsic weaknesses. The next two or three years are critical for the viability of PHI: both families and states will face increasing difficulties in paying the insurance premium; health infrastructure and staff are insufficient to guarantee the health package services; and the private service contracting will further strain state health ministries' ability to strengthen service supply. Moreover, redistribution of federal health expenditure favoring PHI at the cost of the Social Security Institute will further endanger public health care delivery.
Sage, William M; Hyman, David A
Physician leadership is required to improve the efficiency and reliability of the US health care system, but many physicians remain lukewarm about the changes needed to attain these goals. Malpractice liability-a sore spot for decades-may exacerbate physician resistance. The politics of malpractice have become so lawyer-centric that recognizing the availability of broader gains from trade in tort reform is an important insight for health policy makers. To obtain relief from malpractice liability, physicians may be willing to accept other policy changes that more directly improve access to care and reduce costs. For example, the American Medical Association might broker an agreement between health reform proponents and physicians to enact federal legislation that limits malpractice liability and simultaneously restructures fee-for-service payment, heightens transparency regarding the quality and cost of health care services, and expands practice privileges for other health professionals. There are also reasons to believe that tort reform can make ongoing health care delivery reforms work better, in addition to buttressing health reform efforts that might otherwise fail politically.
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.
Though public health situation in Nepal is under-developed, the public health education and workforce has not been prioritised. Nepal should institutionalise public health education by means of accrediting public health courses, registration of public health graduates in a data bank and increasing job opportunities for public health graduates in various institutions at government sector.
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.
Méndez, Claudio A
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.
Gomes-Temporão, José; Faria, Mariana
Health systems in South America still support segmentation, privatization and fragmentation. Health reforms of the structural adjustment programs in the 1980s and 1990s in South America followed different purposes and strategies ranging from privatization, commodification and state intervention for the implementation of a national public health service with universal access as a right of the citizens. Since the 2000s, many countries have expanded social policies, reduced poverty and social inequalities, and improved access to healthcare. This article proposes to discuss the health systems in South America from historical and political backgrounds, and the progress from the reforms in the last three decades. It also presents the three paradigmatic models of reform and their evolution, as well as the contrasts between universal coverage and universal systems. Finally, it presents current strengths and weaknesses of the twelve South American health systems as well as current opportunities and challenges in health for UNASUR.
Biscaia, André Rosa; Heleno, Liliana Correia Valente
The 2005 Portuguese primary health care (CSP) reform was one of the most successful reforms of the country's public services. The most relevant event was the establishment of Family Health Units (USF): voluntary and self-organized multidisciplinary teams that provide customized medical and nursing care to a group of people. Then, the remaining realms of CSP were reorganized with the establishment of Health Center Clusters (ACeS). Clinical governance was implemented aiming at achieving health gains by improving quality and participation and accountability of all. This paper aims to characterize the 2005 reform of Portuguese CSP with an analysis of its systemic and local realms. This is a case study of a CSP reform of a health system with documentary analysis and description of one of its facilities. This reform was Portuguese, modern and innovative. Portuguese by not breaking completely with the past, modern because it has adhered to technology and networking, and innovative because it broke with the traditional hierarchized model. It fulfilled the goal of a reform: it achieved improvements with greater satisfaction of all and health gains.
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...
Knoblauch, Heidi Katherine
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.
Knoblauch, Heidi Katherine
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
Freund, KM; Isabelle, AP; Hanchate, A; Kalish, RL; Kapoor, A; Bak, S; Mishuris, RG; Shroff, S; Battaglia, TA
We investigated the impact of the 2006 Massachusetts health care reform on insurance coverage and stability among minority and underserved women. We examined 36 months of insurance claims among 1,946 women who had abnormal cancer screening at six Community Health Centers pre-(2004–2005) and post-(2007–2008) insurance reform. We examined frequency of switches in insurance coverage as measures of longitudinal insurance instability. On the date of their abnormal cancer screening test, 36% of subjects were publicly insured and 31% were uninsured. Post-reform, the percent ever uninsured declined from 39% to 29% (p.001) and those consistently uninsured declined from 23% to 16%. To assess if insurance instability changed between the pre- and post-reform periods, we conducted Poisson regression models, adjusted for patient demographics and length of time in care. These revealed no significant differences from the pre- to post-reform period in annual rates of insurance switches, incident rate ratio 0.98 (95%-CI 0.88–1.09). Our analysis is limited by changes in the populations in the pre and post reform period and inability to capture care outside of the health system network. Insurance reform increased stability as measured by decreasing uninsured rates without increasing insurance switches. PMID:24583490
Freund, Karen M; Isabelle, Alexis P; Hanchate, Amresh D; Kalish, Richard L; Kapoor, Alok; Bak, Sharon; Mishuris, Rebecca G; Shroff, Swati M; Battaglia, Tracy A
We investigated the impact of the 2006 Massachusetts health care reform on insurance coverage and stability among minority and underserved women. We examined 36 months of insurance claims among 1,946 women who had abnormal cancer screening at six community health centers pre-(2004-2005) and post-(2007-2008) insurance reform. We examined frequency of switches in insurance coverage as measures of longitudinal insurance instability. On the date of their abnormal cancer screening test, 36% of subjects were publicly insured and 31% were uninsured. Post-reform, the percent ever uninsured declined from 39% to 29% (p .001) and those consistently uninsured declined from 23% to 16%. To assess if insurance instability changed between the pre- and post-reform periods, we conducted Poisson regression models, adjusted for patient demographics and length of time in care. These revealed no significant differences from the pre- to post-reform period in annual rates of insurance switches, incident rate ratio 0.98 (95%- CI 0.88-1.09). Our analysis is limited by changes in the populations in the pre- and post-reform period and inability to capture care outside of the health system network. Insurance reform increased stability as measured by decreasing uninsured rates without increasing insurance switches.
刘翔宇; 舒茂国; 刘宗辉
Objective:Under the ‘on deepening the medical and health care system reform views’ issued, ifrst time, it articulated clearly the basic medical and health care system as a public product to national peoples as the basic principles, establish aim of equal basic public health services, public hospitals as the center of the reform, promoting the transformation of government public service function and integration, and public medical and health care must adhere to the public-welfare nature. But plastic surgery is unconventional medicals. How to combine the health reform and the current training system to cultivate excellent plastic surgeon is a problem worthy of exploring.%《关于深化医药卫生体制改革的意见》的新医改文件，首次明确提出把基本医疗卫生制度作为公共产品向全民提供的基本改革原则，确立基本公共卫生服务均等化目标，并以公立医院改革为重心，促进政府服务性职能的进一步转变和整合，改革必须坚持公共医疗卫生的公益性质。但是整形外科非传统意义的医学，如何更好地结合医改政策及目前的培训体制来培养优秀的整形医师是目前值得探讨的问题。
Schaeffer, Leonard D
Rising health care costs have been an issue for decades, yet federal-level health care reform hasn't happened. Support for reform, however, has changed. Purchasers fear that health care cost growth is becoming unaffordable. Research on costs and quality is questioning value. International comparisons rank the United States low on important health system performance measures. Yet it is not these factors but the unsustainable costs of Medicare and Medicaid that will narrow the window for health care stakeholders to shape policy. Unless the health care system is effectively reformed, sometime after the 2008 election, budget hawks and national security experts will eventually combine forces to cut health spending, ultimately determining health policy for the nation.
Nigam, A; Ocasio, W.
We explore attention to Clinton's health care reform proposal, ongoing debates, and its political demise to develop theory that explains how events create opportunities for cognitive realignment and transformation in institutional logics. Our case analysis illustrates how a bottom-up process of environmental sensemaking led to the emergence and adoption of a logic of managed care, which provided new organizing principles in the hospitals' organizational field. In addition to theorization, hig...
The upcoming public health law must serve as the basis for public health reform. The text of the law should allow public health structures to be modernized and adapted to the country's new needs. A broader concept of public health and a redefinition of its functions and basic services are required. Some of the main suggestions for the upcoming law are the establishment of a Spanish Agency for Public Health and a Public Health Council, the design of a Spanish Strategy of Public Health, and reform of professional training.
May 14, 2009 ... tions, the sale of public enterprises to multinational companies, the migration of the best African ... jor role is to help the governments of donor and loan-recipient countries achieve ... So, the two parties are working at cross-purposes, ... appropriate name for public sector reform is 'body politic reform'. The.
Bartlett, Catherine; Wurtz, Rebecca
Twitter can serve as a powerful communication modality to both "push" and "pull" public health data; each user is a potential public health sensor and actor. However, in 2012, only 8% of local health departments had Twitter accounts. We outline how Twitter works, describe how to access public tweets for public health surveillance purposes, review the literature on Twitter's current and potential role supporting public health's essential services, summarize Twitter's limitations, and make recommendations for health department use.
Frenk, Julio; González-Pier, Eduardo; Gómez-Dantés, Octavio; Lezana, Miguel Angel; Knaul, Felicia Marie
Despite having achieved an average life expectancy of 75 years, much the same as that of more developed countries, Mexico entered the 21st century with a health system mared by its failure to offer financial protection in health to more than half of its citizens; this was both a result and a cause of the social inequalities that have marked the development process in Mexico. Several structural limitations have hampered performance and limited the progress of the health system. Conscious that the lack of financial protection was the major bottleneck, Mexico has embarked on a structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH), which has introduced new financial rules and incentives. The main innovation of the reform has been the Seguro Popular (Popular Health Insurance), the insurance-based component of the SSPH, aimed at funding health care for all those families, most of them poor, who had been previously excluded from social health insurance. The reform has allowed for a substantial increase in public investment in health while realigning incentives towards better technical and interpersonal quality. This paper describes the main features and initial results of the Mexican reform effort, and derives lessons for other countries considering health-system transformations under similarly challenging circumstances.
Frenk, Julio; González-Pier, Eduardo; Gómez-Dantés, Octavio; Lezana, Miguel A; Knaul, Felicia Marie
Despite having achieved an average life expectancy of 75 years, much the same as that of more developed countries, Mexico entered the 21st century with a health system marred by its failure to offer financial protection in health to more than half of its citizens; this was both a result and a cause of the social inequalities that have marked the development process in Mexico. Several structural limitations have hampered performance and limited the progress of the health system. Conscious that the lack of financial protection was the major bottleneck, Mexico has embarked on a structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH), which has introduced new financial rules and incentives. The main innovation of the reform has been the Seguro Popular (Popular Health Insurance), the insurance-based component of the SSPH, aimed at funding health care for all those families, most of them poor, who had been previously excluded from social health insurance. The reform has allowed for a substantial increase in public investment in health while realigning incentives towards better technical and interpersonal quality. This paper describes the main features and initial results of the Mexican reform effort, and derives lessons for other countries considering health-system transformations under similarly challenging circumstances.
New public management reforms in Nigerian democratic governance: issues and challenges. ... Journal of Research in National Development ... of the philosophy of administration broadly called “New Public Management” (NPM) in an effort to ...
Rosenberg, Sebastian; Hickie, Ian B; Mendoza, John
The Council of Australian Governments revitalised national mental health reform in 2006. Unfortunately, evidence-based models of collaborative care have not yet been supported. Previous attempts at national reform have lacked a strategic vision. We continue to rely on arrangements that are fragmented between different levels of government, poorly resourced community services, and an embattled public hospital sector. Our persisting unwillingness to record or publicly report key measures of health, social or economic outcomes undermines community confidence in the mental health system. Six priority areas for urgent national action are proposed and linked to key measures of improved health system performance. In Australia, we recognise special groups (such as war veterans) and organise and fund services to meet their specific health needs. Such systems could be readily adapted to meet the needs of people with psychosis.
Petrochuk, M A; Javalgi, R G
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.
Full Text Available This article proposes a critical but non-systematic review of recent health care system reforms in developing countries. The literature reports mixed results as to whether reforms improve the financial protection of the poor or not. We discuss the reasons for these differences by comparing three representative countries: Mexico, Vietnam, and China. First, the design of the health care system reform, as well as the summary of its evaluation, is briefly described for each country. Then, the discussion is developed along two lines: policy design and evaluation methodology. The review suggests that i background differences, such as social development, poverty level, and population health should be considered when taking other countries as a model; ii although demand-side reforms can be improved, more attention should be paid to supply-side reforms; and iii the findings of empirical evaluation might be biased due to the evaluation design, the choice of outcome, data quality, and evaluation methodology, which should be borne in mind when designing health care system reforms.
公立医院是履行医院社会责任的主体,强调医院公益性的回归是公立医院改革的重点.文章在进一步明确公立医院公益性的基础上,结合公立医院改革的措施,从政府、医院和社会的角度,对公立医院社会责任的实现机制进行探讨,使医院能更好地履行社会责任,保证医院的公益性.%Public hospitals are the main body of hospitals to fulfill social responsibilities.The medical health system reform also emphasizes the return of nonprofit nature of public hospitals.On the basis of clarifying the definition of public benefit, this paper discusses the realization mechanism of public hospital social responsibility to make public hospitals better fulfill the social responsibility and ensure the public benefit, from the degree of government, hospitals and society, combining the measures of public hospital reform.
Full Text Available The Republic of Kazakhstan is one of the largest and fastest growing post-Soviet economies in Central Asia. Despite recent improvements in health care in response to Kazakhstan 2030 and other state-mandated policy reforms, Kazakhstan still lags behind other members of the Commonwealth of Independent States of the European Region on key indicators of health and economic development. Although cardiovascular diseases are the leading cause of mortality among adults, HIV/AIDS, tuberculosis, and blood-borne infectious diseases are of increasing public health concern. Recent data suggest that while Kazakhstan has improved on some measures of population health status, many environmental and public health challenges remain. These include the need to improve public health infrastructure, address the social determinants of health, and implement better health impact assessments to inform health policies and public health practice. In addition, more than three decades after the Declaration of Alma-Ata, which was adopted at the International Conference on Primary Health Care convened in Kazakhstan in 1978, facilitating population-wide lifestyle and behavioral change to reduce risk factors for chronic and communicable diseases, as well as injuries, remains a high priority for emerging health care reforms and the new public health. This paper reviews the current public health challenges in Kazakhstan and describes five priorities for building public health capacity that are now being developed and undertaken at the Kazakhstan School of Public Health to strengthen population health in the country and the Central Asian Region.
Asa Cristina Laurell
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
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?
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.
How to control the increasing health expenditures is a common problem in the developed countries. The main causes of this increase are ageing of the society and medical innovation. The UK government has introduced a market oriented health reform in order to balance the increasing expenditures and the quality of care. For example, they have introduced the GP Fundholding, Private Financial Initiative (PFI) for construction of public hospital, and personal budget system (a patient owns a budget for buying health services in the deregulated market). However, there is little evidence indicating the effectiveness of these programs. On the other hand, it is important to strengthen the labor policy in order to maintain the social security system. For example, programs for increasing the employment rate and those for increasing productivity work sharing are such policies. From this viewpoint, the EU countries have introduced a series of active employment policies, i.e., job training for unemployed persons and work sharing. Furthermore, as other authors report in other articles of this volume, the government of the UK has introduced the Fit for Work (FFW) program that intends to medically support workers.
KAPUCU, Naim; Kösecik, Muhammet
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...
Chile is in the throes of health reforms aimed at ensuring that every person with specified chronic diseases receives timely and high quality care. CITs are crucial to the achievement of this vision because they make it possible to manage information and knowledge in a more efficient way. Until a few years ago, the incorporation of CITs was limited to individual initiatives, but since 2004 there has been a master plan to coordinate this task in the public sector. Some projects are now operative but there is still a long road to travel before getting to our destination. One of the most underdeveloped areas is the clinical applications of health CITs, especially the incorporation of biomedical knowledge to clinical practice. The two biggest challenges facing the Digital Agenda for the health care system are (i) to develop a critical mass of clinicians and health related professionals with expertise in Health Informatics; and (ii) to foster technical integration of the private and public sectors of the health care market.
Ugalde, Antonio; Homedes, Nuria
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.
Meyer, Pamela A; Brusuelas, Kristin M; Baden, Daniel J; Duncan, Heather L
Federal public health advisors provide guidance and assistance to health departments to improve public health program work. The Centers for Disease Control and Prevention (CDC) prepares them with specialized training in administering public health programs. This article describes the evolving training and is based on internal CDC documents and interviews. The first federal public health advisors worked in health departments to assist with controlling syphilis after World War II. Over time, more CDC prevention programs hired them. To meet emerging needs, 3 major changes occurred: the Public Health Prevention Service, a fellowship program, in 1999; the Public Health Associate Program in 2007; and integration of those programs. Key components of the updated training are competency-based training, field experience, supervision, recruitment and retention, and stakeholder support. The enduring strength of the training has been the experience in a public health agency developing practical skills for program implementation and management.
Nelson, Leonard J; Morrisey, Michael A; Becker, David J
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.
Notes: Public Consultation toward Ethiopia's Family Law Reform and the Revised Code's Response. ... Mizan Law Review ... inter alia, include the pros and cons of having a uniform family law, the various forms and impediments to marriage, ...
Allan Silveira dos Santos
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.
Valdivieso D, Vicente; Montero L, Joaquín
Five years ago Chile implemented a Health Care Reform to reduce the great inequalities in health care provision that affects the low- income, high-risk segment of its population. A universal care plan ("AUGE") was designed to make medical coverage available to all Chilean citizens suffering from one of a specified, growing list of diseases (66 at present time). The diseases are prioritized by the Ministry of Health and its inclusion in the plan is revised periodically by an Advisory Committee according to four cardinal criteria: burden of disease, effectiveness of treatment, specific capacity of the health system and financial costs. The plan is funded by the state and enforced by law through a set of four specific guarantees: access, opportunity, quality and financial protection. This paper reviews the origin and development of the reform, the benefits and drawbacks of the application of the specific guarantees and the perception of the public regarding its strengths and weaknesses.
Nieto Morales, F.; Wittek, R.P.M.; Heyse, L.
Proponents of new public management (NPM) expect public organizations to become more flexible and adaptive after administrative reforms, effectively showing convergence with patterns of organizational change in the private sector. This "convergence argument" is tested with a sample of 61 public and
D.S.D. Curry; G. Hammerschmid (Gerhard); S.R. Jilke (Sebastian); S.G.J. Van de Walle (Steven)
markdownabstract__Abstract__ Like most other areas of the world, the public sector in Europe has undergone significant reform in the past two decades, shaped in part by a broader New Public Management (NPM) paradigm, but one that also introduces a unique European flavour to this form of public mana
Nieto Morales, F.; Wittek, R.P.M.; Heyse, L.
Proponents of new public management (NPM) expect public organizations to become more flexible and adaptive after administrative reforms, effectively showing convergence with patterns of organizational change in the private sector. This "convergence argument" is tested with a sample of 61 public and
... Series Undergraduate Network Membership Contact Discover What is Public Health? Public health protects and improves the health of individuals, families, communities, and populations, locally and globally. Public health is personal. Public health professionals focus on preventing ...
In light of public sector reforms in Canada and elsewhere, this paper focuses on the shift of emphasis from social to private responsibilities and raises new questions about the forces of private enterprise and market-based partnerships. Under neoliberal governmental agendas, privatizing responsibility links to three main developments: the reconsideration of the relations of public and private; the mobilization of responsible citizenship; and the formation of a cultural mentality of rule that works alongside these developments. The research for this article is based on extensive analysis of policy documents and public sector reform initiatives, as well as interviews with Canadian federal public service employees.
Majette, Gwendolyn Roberts
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.
John E McDonough
Full Text Available In 2010, the United States adopted its first-ever comprehensive set of health system reforms in the Affordable Care Act (ACA. Implementation of the law, though politically contentious and controversial, has now reached a stage where reversal of most elements of the law is no longer feasible. The controversial portions of the law that expand affordable health insurance coverage to most U.S. citizens and legal residents do not offer any important lessons for the global community. The portions of the law seeking to improve the quality, effectiveness, and efficiency of medical care as delivered in the U.S., hold lessons for the global community as all nations struggle to gain greater value from the societal resources they invest in medical care for their peoples. Health reform is an ongoing process of planning, legislating, implementing, and evaluating system changes. The U.S. set of delivery system reforms has much for reformers around the globe to assess and consider.
Huong, Dang Boi; Phuong, Nguyen Khanh; Bales, Sarah; Jiaying, Chen; Lucas, Henry; Segall, Malcolm
China and Vietnam have adopted market reforms in the health sector in the context of market economic reforms. Vietnam has developed a large private health sector, while in China commercialization has occurred mainly in the formal public sector, where user fees are now the main source of facility finance. As a result, the integrity of China's planned health service has been disrupted, especially in poor rural areas. In Vietnam the government has been an important financer of public health facilities and the pre-reform health service is largely intact, although user fees finance an increasing share of facility expenditure. Over-servicing of patients to generate revenue occurs in both countries, but more seriously in China. In both countries government health expenditure has declined as a share of total health expenditure and total government expenditure, while out-of-pocket health spending has become the main form of health finance. This has particularly affected the rural poor, deterring them from accessing health care. Assistance for the poor to meet public-sector user fees is more beneficial and widespread in Vietnam than China. China is now criticizing the degree of commercialization of its health system and considers its health reforms "basically unsuccessful." Market reforms that stimulate growth in the economy are not appropriate to reform of social sectors such as health.
The failure of health reform in the USA reflects the individualism and lack of community responsibility of the American political culture, the power of interest groups, and the extraordinary process President Clinton followed in developing his highly elaborate plan. Despite considerable initial public support and a strong start, the reform effort was damaged by the cumbersome process, the complexity of the plan itself, and the unfamiliarity of key components such as alliances for pooled buying of health insurance. In addition, the alienation of important interest groups and the loss of presidential initiative in framing the public discussion as a result of international, domestic and personal issues contributed to the failure in developing public consensus. This paper considers an alternative strategy that would have built on the extension of the Medicare program as a way of exploring the possibilities and barriers to achieving health care reform. Such an approach would build on already familiar and popular pre-existing components. The massive losses in the most recent election and large budget cuts planned by the Republican majority makes it unlikely that gaps in insurance or comprehensiveness of coverage will be corrected in the foreseeable future.
Honekamp, Ivonne; Possenriede, Daniel
This article focuses on the redistributive effects of different measures to finance public health insurance. We analyse the implications of different financing options for public health insurance on the redistribution of income from good to bad health risks and from high-income to low-income individuals. The financing options considered are either income-related (namely income taxes, payroll taxes, and indirect taxes), health-related (co-insurance, deductibles, and no-claim), or neither (flat fee). We show that governments who treat access to health care as a basic right for everyone should consider redistributive effects when reforming health care financing.
Baltagi, Badi H; Yen, Yin-Fang
This study investigates the effect of the Temporary Aid to Needy Families (TANF) program on children's health outcomes using data from the Survey of Income and Program Participation over the period 1994 to 2005. The TANF policies have been credited with increased employment for single mothers and a dramatic drop in welfare caseload. Our results show that these policies also had a significant effect on various measures of children's medical utilization among low-income families. These health measures include a rating of the child's health status reported by the parents, the number of times that parents consulted a doctor, and the number of nights that the child stayed in a hospital. We compare the overall changes of health status and medical utilization for children with working and nonworking mothers. We find that the child's health status as reported by the parents is affected by the maternal employment status. Copyright © 2014 John Wiley & Sons, Ltd.
Real reforms attempt to change how health care is financed and how it is rationed. Three main explanations have been offered to explain why such reforms are so difficult: institutional gridlock, path dependency, and societal preferences. The latter posits that choices made regarding the health care system in a given country reflect the broader societal set of values in that country and that as a result public resistance to real reform may more accurately reflect citizens' personal convictions, self-interest, or even active social choices. "Conscientious objectors" may do more to derail reform than previously recognized.
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.
Background: Literature on the impact of health sector reform (HSR) on motivation of healthcare ... Data were analysed using a qualitative content analysis approach. ... Health Organization (WHO) proposed 'Better Health ..... tic testing. As a consequence the nursing personnel had to conduct basic laboratory tests in the ...
Kolstad, Jonathan T; Kowalski, Amanda E
We model the labor market impact of the key provisions of the national and Massachusetts "mandate-based" health reforms: individual mandates, employer mandates, and subsidies. We characterize the compensating differential for employer-sponsored health insurance (ESHI) and the welfare impact of reform in terms of "sufficient statistics." We compare welfare under mandate-based reform to welfare in a counterfactual world where individuals do not value ESHI. Relying on the Massachusetts reform, we find that jobs with ESHI pay $2812 less annually, somewhat less than the cost of ESHI to employers. Accordingly, the deadweight loss of mandate-based health reform was approximately 8 percent of its potential size.
Performance management in public hospitals are difficulties in pulic hospital reform. How to change the existing performance management related to the success of health reform, related to the ability to fundamentally solve the medical treatment is difficult and expensive problem. What this paper studied is to analyze the current performance management and evaluation of public hospitals in the drawbacks and problems, explore new mescal reform program in line with the spirit of a more scientific approach to performance management in public hospitals and models.%公立医院绩效管理模式是当前公立医院改革的难点.如何改变现有的绩效管理模式关系到医改能否成功,关系到能否从根本上解决看病难、看病贵问题.本文通过文献搜集,对国内公立医院绩效管理模式的现状、存在的问题、产生的原因进行了研究,提出了新医改背景下未来我国公立医院绩效管理模式的发展趋势及绩效管理模式.目的是为当前医疗体制改革探索合适的法人化绩效管理模式提供理论依据.
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Ierland, J. van & Schreuder, D.A.
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. -
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.
Full Text Available This paper explores the challenges faced by developing countries and countries in transition in their attempt at reforming the inherited bureaucratic public service. The paper explores how the public sector in Croatia has managed to come this far after the turbulent years of political and technocratic dislocation. Croatia is determined to reform its public sector to become eligible for joining the European Union (EU in near future. This has posed a major challenge for top senior officials and consultants alike. Adopting ‘action research’ as both a methodology and a strategy, a programme of intervention for change was designed and implemented in the Ministry of Finance. The overall results suggest that for the successful implementation of public sector reforms in the 21st century, attention should focus on strategic issues including systems thinking, HRMD, behavioural and attitudinal change, skills and competencies development and, above all, honest and responsible transformational leadership.
that is due primarily to lifestyle choices.79 If public willingness to subsidize poor lifestyle choices declines, then it will be time to tie personal...making healthy lifestyle choices and penalizes those making poor choices. America currently levies heavy sales taxes on tobacco, perhaps taxes on...fattening foods or similar disincentives would modify America’s lifestyle choices. If not, they would at least ensure that those making poor choices are
Zhang, Ju-Yang; Long, Ru-Yin; Yan, Hai; Yang, Qing; Yang, Bo
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.
The growth in undocumented immigration in the United States has garnered increasing interest in the arenas of immigration and health care policy reform. Undocumented immigrants are restricted from accessing public health and social service as a result of their immigration status. The Patient Protection and Affordability Care Act restricts undocumented immigrants from participating in state exchange insurance market places, further limiting them from accessing equitable health care services. This commentary calls for comprehensive policy reform that expands access to health care for undocumented immigrants based on an analysis of immigrant health policies and their impact on health care expenditures, public health, and the role of health care providers. The intersectional nature of immigration and health care policy emphasizes the need for nurse policymakers to advocate for comprehensive policy reform aimed at improving the health and well-being of immigrants and the nation as a whole. © The Author(s) 2014 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.
Nilson do Rosário Costa
Full Text Available O trabalho analisa as relações entre a reforma psiquiátrica brasileira, a adoção dos Centros de Atenção Psicossocial (CAPS e o desenvolvimento do Sistema Único de Saúde (SUS por meio do pacto federativo. A aderência dos governos municipais foi uma variável condicionante da disseminação da reforma, especialmente em função da dimensão continental e da fragmentação federativa do país. O trabalho demonstra uma trajetória de consistente estabilidade institucional da reforma psiquiátrica no Brasil ao longo de duas décadas. A institucionalidade do processo decisório no espaço público brasileiro ofereceu à agenda da reforma condições de implantação nos Municípios dos novos formatos organizacionais por meio da imitação, dos incentivos financeiros e pela bem sucedida defesa das vantagens sobre o modelo hospitalar e asilar dominante nas décadas passadas. As intervenções indutivas, reforçadas e acolhidas pela Lei 10.216/2001, transformaram a agenda da reforma psiquiátrica, limitada a cidades pioneiras, em uma política pública nacional.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
Frenk, Julio; Gómez-Dantés, Octavio
This paper illustrates, using as an example the recent reform of the Mexican health system, the potential of knowledge in the design and implementation of public policies. In the first part the relationship between knowledge and health is described. In part two, the efforts in Mexico to generate evidence that would eventually nourish the design and implementation of health policies are discussed. In the following sections the content and the guiding concept of the reform, the democratization of health, are analyzed. The paper concludes with the discussion of the main global lessons of this reform experience.
Nyman, John A; Li, Chia-Hsuan W
Many in Minnesota and the United States are promoting price and quality transparency as a means for reforming health care. The assumption is that with such information, consumers and providers would be motivated to change their behavior and this would lead to lower costs and higher-quality care.This article attempts to determine the extent to which publicizing information about the cost and quality of medical care does, in fact, improve quality and lower costs, and thus should be included in any reform strategy. The authors reviewed a number of studies and concluded that there is a general lack of empirical evidence on the effect of price transparency on health care costs and that the evidence on the effectiveness of quality transparency is mixed.
Boulton, Matthew L; Beck, Angela J; Coronado, Fátima; Merrill, Jacqueline A; Friedman, Charles P; Stamas, George D; Tyus, Nadra; Sellers, Katie; Moore, Jean; Tilson, Hugh H; Leep, Carolyn J
Thoroughly characterizing and continuously monitoring the public health workforce is necessary for ensuring capacity to deliver public health services. A prerequisite for this is to develop a standardized methodology for classifying public health workers, permitting valid comparisons across agencies and over time, which does not exist for the public health workforce. An expert working group, all of whom are authors on this paper, was convened during 2012-2014 to develop a public health workforce taxonomy. The purpose of the taxonomy is to facilitate the systematic characterization of all public health workers while delineating a set of minimum data elements to be used in workforce surveys. The taxonomy will improve the comparability across surveys, assist with estimating duplicate counting of workers, provide a framework for describing the size and composition of the workforce, and address other challenges to workforce enumeration. The taxonomy consists of 12 axes, with each axis describing a key characteristic of public health workers. Within each axis are multiple categories, and sometimes subcategories, that further define that worker characteristic. The workforce taxonomy axes are occupation, workplace setting, employer, education, licensure, certification, job tasks, program area, public health specialization area, funding source, condition of employment, and demographics. The taxonomy is not intended to serve as a replacement for occupational classifications but rather is a tool for systematically categorizing worker characteristics. The taxonomy will continue to evolve as organizations implement it and recommend ways to improve this tool for more accurate workforce data collection.
Caillol, Michel; Le Coz, Pierre; Aubry, Régis; Bréchat, Pierre-Henri
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.
Svendsen, Mette N.
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...... me mindful and watchful of the porous passages between animal and human bodies and environments that do not confine themselves to ‘national health programs’ directed towards a specific (human) population. These unrecognized species encounters and relationships, which exceed the conventional framework...... 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...
Chatelain-Ponroy, Stéphanie; Musselin, Christine; Mignot-Gérard, Stéphanie; Sponem, Samuel
NPM reforms that have been led recently in the public sector in many countries strongly emphasize the notion of performance. If the effects of these reforms on the core micro-processes of organizations retained a great deal of attention, few studies examined how these changes transformed the identities of civil servants. By contrast a growing body of "Public Service Motivation" research demonstrates that individuals may have predispositions to work in public institutions or organizations. In ...
Full Text Available The author of the article researched the teoretical and methodological approaches to the formation and development of the health insurance market conditions, also investigated the condition and features of the functioning of the health system in Ukraine and abroad, reasonable prospects of introducing mandatory and dissemination of voluntary health insurance, as well as ways of improving financial provide health insurance system in Ukraine.
Davis, Karen; Schoen, Cathy; Collins, Sara R
The presidential election has focused public attention on the need for health system reform--to ensure health insurance for all, to make health care more accessible and responsive to patients, and to slow the growth in health care cost. This issue brief sets forth a framework for expanding health coverage that offers Americans a choice of a product modeled on Medicare to those under age 65, made available through a national insurance connector. Coupled with reforms to Medicare provider payment, expansion of preventive health care, and improved information, such a strategy has the potential to achieve near-universal coverage and improve quality and access, while generating health system savings of $1.6 trillion over 10 years.
Full Text Available The European public procurement system has a major role in ensuring the efficient spending of the public money and in promoting economic competitiveness. The legislative bases of the system are represented by harmonized European regulations, which aim to facilitate the application of the principles and freedoms enshrined in the EU Treaties. This paper presents the main aspects of the reform of the European public procurement system, aiming to make the procedures for awarding public contracts more transparent and open to all European companies and to streamline public spending for the procurement of goods, services and works.
Menicucci, Telma Maria Gonçalves
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.
Breidahl, Karen Nielsen; Gjelstrup, Gunnar; Hansen, Hanne Foss
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. The impact of such reforms is considerable. Furthermore they change the context in which evaluations of other...... 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...... compare the evaluation process (focus and purpose), the evaluators and the organization of the evaluation as well as the utilization of the evaluation results. The analysis uncovers several significant findings including how the initial organization of the evaluation show strong impact on the utilization...
This article presents a structured survey of the German health care and health insurance system, and analyzes major developments of current German health policy. The German statutory health insurance system has been known as a system that provides all citizens with ready access to comprehensive high quality medical care at a cost the country considered socially acceptable. However, an increasing concern for rapidly rising health care expenditure led to a number of cost-containment measures since 1977. The aim was to bring the growth of health care expenditure in line with the growth of wages and salaries of the sickness fund members. The recent health care reforms of 1989 and 1993 yielded only short-term reductions of health care expenditure, with increases in the subsequent years. 'Stability of the contribution rate' is the uppermost political objective of current health care reform initiatives. Options under discussion include reductions in the benefit package and increases of patients' co-payments. The article concludes with the possible consequences of the 1997 health care reform of which the major part became effective 1 July 1997.
Pan, Jay; Qin, Xuezheng; Hsieh, Chee-Ruey
The new round of health care reforms in China achieved significant initial results. New and emerging problems coinciding with the deepening of the reforms, however, require further institutional changes to strengthen the competition mechanism and promote public hospital efficiency. This paper provides a conceptual framework and preliminary assessment of public hospital competition in China. Specifically, we distinguish between two closely related concepts - competition and privatization, and identify several critical conditions under which hospital competition can be used as a policy instrument to improve health care delivery in China. We also investigate the current performance and identify several unintended consequences of public hospital competition - mainly, medical arms race, drug over-prescription and the erosion of a trusting relationship between patients and physicians. Finally, we discuss the policy options for enhancing the internal competition in China's hospital market, and conclude that public investment on information provision is key to reaping the positive outcomes of pro-competition policies.
van den Heever, Alexander Marius
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 Â© 2016 Elsevier Ireland Ltd. All rights reserved.
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
The article focuses on the similarities and differences in using new public management (NPM) administrative arrangements in educational policy as they have been presented in the educational reform process carried out this millennium by two governments in Norway: the Centre-Conservative government and the current Red-Green coalition government.…
Crosby, Danielle A.; Hatfield, Bridget E.
The Personal Responsibility and Work Reconciliation Act of 1996 reformed public assistance programs and reduced the safety net of supports for low-income families. Children living in low-income immigrant families face particular challenges in the current policy environment. In this article, the authors consider what these changes have meant for…
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 met...
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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......-making, performance governance, and innovation and strategic HRM. NPG: networks and collaboration, public-private partnerships and new ways of engaging active citizens. The paper sees these ideas as competing for dominance in the public organization literature as they are new drivers for reforms. Together they form...
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. [...
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.
Călin Emilian HINȚEA
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
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
Full Text Available During the last decades, several countries worldwide have introduced financial management reforms, as an important part of the New Public Management (NPM initiative at one or more levels of government sector, by either replacing or transforming their traditional budgetary cash accounting systems towards a business-like accrual accounting concept. Following the example of this upcoming managerial trend, the Greek government introduced in 2003 the accrual basis accounting into public hospitals, as the hospital sector is one of the areas where NPM reforms have been introduced in search of higher efficiency, effectiveness and economy in service production.The purpose of this paper is twofold. The first goal is to provide an overview of the government sector reform initiatives in Greece and to present empirical evidence regarding the adoption level of the accrual basis accounting standards in the Greek public Health sector. The second goal of the research is to investigate the impact of a range of potentially contingent factors on hospitals compliance with the accrual financial and cost accounting reform.The present analysis is based on the results of an empirical survey that took place during 2009. For the purposes of this survey, a structured questionnaire was prepared and sent to the Chief Financial Officers (CFOs of 132 Greek public hospitals. In particular, alinear regression model analysis was used to examine the cross-sectional differences on a number of explanatory and implementation factors of the accounting reform adoption level.The empirical evidence reveals that the level of accrual and especially cost accounting adoption in Greek public hospitals is realized only to a limited extent. In particular, results show that the level of reform adoption is positively related to IT quality, reform related training, education level of accounting staff, and professional consultants’ support. However, no significant relationship was found between
S.G.J. Van de Walle (Steven)
markdownabstract__Abstract__ The balance between trust and distrust is shifting – yet again. The move towards public sector reforms inspired by the New Public Management (NPM) from the 1980s on introduced a series of innovations based on mutual distrust between public sector actors. More
S.G.J. Van de Walle (Steven)
markdownabstract__Abstract__ The balance between trust and distrust is shifting – yet again. The move towards public sector reforms inspired by the New Public Management (NPM) from the 1980s on introduced a series of innovations based on mutual distrust between public sector actors. More recently,
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.
McClellan, Mark B; Thoumi, Andrea I
Cancer care is transforming, moving toward increasingly personalized treatment with the potential to save and improve many more lives. Many oncologists and policymakers view current fee-for-service payments as an obstacle to providing more efficient, high-quality cancer care. However, payment reforms create new uncertainties for oncologists and may be challenging to implement. In this article, we illustrate how accountable care payment reforms that directly align payments with quality and cost measures are being implemented and the opportunities and challenges they present. These payment models provide more flexibility to oncologists and other providers to give patients the personalized care they need, along with more accountability for demonstrating quality improvements and overall cost or cost growth reductions. Such payment reforms increase the importance of person-level quality and cost measures as well as data analysis to improve measured performance. We describe key features of quality and cost measures needed to support accountable care payment reforms in oncology. Finally, we propose policy recommendations to move incrementally but fundamentally to payment systems that support higher-value care in oncology.
Hunter, David J
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.
Arzamet M. Kamkiya
Full Text Available In the present article author investigates problems of public service reforming at the present stage. In the research author notes that the centuries-old history of the state construction proved that any civilized state can't effectively function without highly professional device of public service, and effective public service serves as a key factor of durability of the government, her authority. In the conclusion author notes that during new state construction in Russia it is necessary to adopt federal laws which would regulate not only separate aspects, but also all process of legal support of professional activity on realization of powers of government bodies.
Helen de Pinho
Helen de Pinho focuses on the tension between market-driven health sector reform processes post-1990 and those reforms necessary to ensure sexual and reproductive health as mediated through health systems that are rights based and equitable. She argues that sexual and reproductive health services depend on progressive realization of the right to sexual and reproductive health through fundamental and systemic changes to the health system, with a focus on shifting power dynamics to ensure peopl...
谭雯; 阳秋林; 王志辉
新的医疗卫生体制改革的核心是坚持公立医院的公益性，如何判断公立医院的社会责任履行与否及其好坏，是政府和相关主管部门面临的新课题。文章根据公立医院的特点，从经济责任、社会责任和环境责任三个方面构建其社会责任会计三级评价指标，并采用层次分析法确定各项评价指标权重，该指标体系能够对公立医院社会责任的履行进行定量分析，推动公立医院社会责任的承担，缓解日益增长的医患矛盾。%Core goal of the new health care reform is to uphold the welfare of public hospitals, so a new task for government and related departments is how to evaluate social responsibilities of public hospitals. In this paper, public hospitals’ social responsibility ac-counting evaluation index system is built from economic responsibility, social responsibility and environmental responsibility according to social responsibility characteristics. Analytic Hierarchy Process ( AHP) is used to determine the evaluation index weight and to ana-lyze quantitatively the fulfillment of social responsibility of public hospitals, which could promote public hospitals to undertake social responsibility and reduce the growing contradiction between doctors and patients.
Piotti, B; Macome, E
It has been predicted that major introduction of information communication technology (ICT) for health care organisations (HCO) over the next 10 years will be used to achieve the universal coverage and improve the quality of health care delivered to people. Which is the best strategy on ICT transfer, adoption and adaptation for the local Mozambican HCO? This paper argues that a sociotechnical approach of ICT development can help policy makers and health managers to address the technology transfer in a better and more appropriate way to their social context and to the public health reforms in progress. The urgency of health care demands (e.g. AIDS epidemic) and the institutional changes implemented by the Government and the local Ministry of Health (MOH), open a dynamic process of re-organisation inside the health institutions in the next years. This process needs to be monitored and initiatives planned, which places pressure on the evolution of health information system (HIS). The increase in the use of ICT can be an ally for health managers. The emergence of the open source software (OSS) and the recent ICT market trends towards networking may also enable local HCO to better face and solve the long process of health care standardisation, which usually prepares and accompanies any introduction of ICT. On the other side, the "big bang" introduction of electronic packages, devices and software applications may be an obstacle framing and anchoring local HCO to external settings, "modern" and universal models. Thus, a uniform step-by-step implementation of hospital-based health information system is desirable.
The cost-effectiveness of a health intervention is an estimate of the relation between what it costs to be provided, and the improvement in health which results from such intervention. Health may improve because the incidence of illness or injury is reduced, because death is avoided or delayed, or because the duration or severity of disability is limited. The calculation of this health benefit combines objective factors, such as the age at incidence and whether or not the outcome is death, with subjective factors such as the severity of disability, the judgement as to the value of life lived at different ages, and the rate at which the future is discounted. The construction and interpretation of the estimate are explained. Also, the paper examines whether the concept of cost-effectiveness is consistent with ethical norms such as equity, and concludes that they are not in conflict. Finally, it addresses the question of how to incorporate cost-effectiveness into a health sector reform, and possible ways to implement it.
Reforming health care systems which are predominantly publicly provided and financed has usually been motivated as a way of increasing efficiency even if it seldom is explicit whether it is in the official sense related to individual utility or in the unofficial sense related to health outcomes. ...
Bonde, Lars Ole; Juel, Knud; Ekholm, Ola
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......: 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...
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...
Koornneef, Erik; Robben, Paul; Blair, Iain
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
Cromley, Ellen K
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
Bettcher, D; Lee, K
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.
Vargas, Ingrid; Vazquez, Maria Luisa; Jane, Elisabet
The aim of any health care system is to help improve the people's health, and to do so as efficiently as possible. In order to improve the efficiency and equity of health services provision, many countries around the world have implemented reforms, including several Latin American nations. However similar the objectives may appear, the various ways societies implement such reforms reflect different values and concepts. This article analyzes the egalitarian and neoliberal values underlying different concepts of equity in health care. The authors develop criteria to interpret selected health services funding and provision strategies in Latin American health system reforms. These criteria are then applied to health care financing and delivery policies under the reforms currently being implemented in Colombia and Costa Rica.
研究公立医院改革背景下，“权力归队”后，公立医院院长在承担岗位职责时应遵守的行为规范和准则。相关文献资料和《中国公立医院院长岗位职责、行为规范和领导力标准》研究结果。公立医院院长行为规范涵盖政治法律行为规范、职业道德行为规范和业务行为规范等三大类，包括坚持科学发展观、坚持依法办院、以全心全意为人民健康服务为宗旨、具有改革开放意识、奉公守法、文明修养、团结协作、民主集中、坚持战略管理理念、合理充分授权、科学决策、有效控制和顺畅协调等13条行为准则。%The study explore the code that the presidentofthepublic hospitalsshouldcomply with under the background of the new round public hospital reform. Literature review and the findings of the research named the responsibilities,code and leadership standards of public hospital presidentin China”.The code of public hospital presidentcovers the 3 types such aspolitical and legalcode,professional ethicalcode andimplementation code, which includesthe following 13 code:adhering tothescientific development concept, managing hospital by law,serving the health ofallthe people,having consciousnessof reform and opening, carrying out official duties and laws,civilization accomplishment,unity and cooperation,democratic centralism,being awareness of strategic management,reasonably sufficien tauthorization,scientific decision-making, effective control and smooth coordination of conduct, etc.
Carter, Stacy M; Kerridge, Ian; Sainsbury, Peter; Letts, Julie K
Public health ethics has emerged and grown as an independent discipline over the last decade. It involves using ethical theory and empirical analyses to determine and justify the right thing to do in public health. In this paper, we distinguish public health ethics from clinical ethics, research ethics, public health law and politics. We then discuss issues in public health ethics including: how to weigh up the benefits, harms and costs of intervening; how to ensure that public health interventions produce fair outcomes; the potential for public health to undermine or promote the rights of citizens; and the significance of being transparent and inclusive in public health interventions. We conclude that the explicit and systematic consideration of ethical issues will, and should, become central to every public health worker's daily practice.
Himmelstein, J; Rest, K
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 ...
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.
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
黄锟; 陶芳标; 郝加虎; 张腊香; 李佳; 胡传来
English for Special Purpose (ESP) is a competency-based training mode ,emphasizing on the language application ability matched for vocational capacity .In this article ,we have adopted ESP in the English teaching reform in Master of Public Health (MPH) .Based on the constructivism ,we start from the requirement analysis and establish multimodal approaches ,introducing task-based ap-proach and constructivism-based lexicological strategies ,conducting register analysis and discourse a-nalysis ,focusing on emotional factors and enhancing cooperative learning as well .By this way ,we aim to strengthen spoken and w ritten abilities in M PH ,and promote English applicability and practice in professional work of public health .%专门用途英语（ESP）是以“能力本位”为核心的教学形式，注重与职业能力相匹配的英语使用能力的培养。本文将ESP教学理念引入公共卫生硕士专业英语的教学改革，从学生需求出发，基于建构理论，开展任务型教学，引入多种建构主义词汇学习策略，结合语域分析和语篇分析，同时关注学习中的情感因素，构建多模态英语教学模式，加强合作学习，以提升公共卫生硕士听、说、读、写等技能，增强语言在公共卫生专业工作中的应用性和实践性。
宁黎霞; 路玲; 王素珍
Objective: To analyze the patients' cost change in Jiangxi Provinces' public hosptials under the background of new health system reform. Methods: Selecting outpatient and inpatient cost data from 2008 to 2011 from national health statistics information network,and do Excel analysis. Results: The effects of controlling cost are overall good. Conclusion: Basic drug system should be con tinued to be implemented, the medical seperation be explored, the reform of the Medicare payment methods be promoted, health service information be announced, and the appraisal system be improved.%目的:分析新医改背景下江西省公立医院病人费用变化情况.方法:从国家卫生统计信息网络直报系统选取2008年到2011年江西省各级公立医院门诊和住院病人费用的数据,并将其录入Excel进行统计分析.结果:江西省公立医院病人费用总体控制情况较好.2011年与2008年按可比价格比较,江西省公立医院次均门诊费用、药费、检查费分别上涨-9.7％、7.9％、39.8％,全国对应为20.1％、18.7％和22.1％;江西省公立医院人均住院费用、药费、检查费涨幅分别为15.9％、8.7％和72.7％,全国对应为19.2％、-1.1％和6.8％.其中,检查费用涨幅普遍高于全国平均水平,但绝对数远低于全国.结论:继续贯彻落实基本药物制度,探索医药分开,推进医保付费方式改革,公开医疗卫生服务信息,完善绩效考核制度.
Gilbert, Frédéric; Denis, Jean-Louis; Lamothe, Lise; Beaulieu, Marie-Dominique; D'amour, Danielle; Goudreau, Johanne
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
Milovich, L.; Ossewaarde, M.R.R.
As the post-war Bosnia and Herzegovina has turned its interest towards a European Union membership, it has entered an accession process requiring it, among other things, to reform its public administration system. The European Union's involvement within the reform has been placed under critique, as
Milovich, L.; Ossewaarde, Marinus R.R.
As the post-war Bosnia and Herzegovina has turned its interest towards a European Union membership, it has entered an accession process requiring it, among other things, to reform its public administration system. The European Union's involvement within the reform has been placed under critique, as
Ibrahim, Jennifer K; Burris, Scott; Hays, Scott
The importance of law in the organization and operation of public health systems has long been a matter of interest to public health lawyers and practitioners, but empirical research on law as a factor in health system performance has been limited in quantity and sophistication. The emergence of Public Health Law Research and Public Health Systems and Services Research within a coordinated effort to strengthen public health research and practice has dramatically changed matters. This article introduces Public Health Law Research as an integral part of Public Health Systems and Services Research, discusses the challenges of integrating the 2 fields, and highlights 2 examples of current research that demonstrate the benefits of an integrated approach to improve the use of law in public health practice.
Himmelstein, J; Rest, K
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?
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...
Whelen, A Christian; Kitagawa, Kent; Maddock, Jay; Hayes, Donald; St John, Tonya Lowery; Rajan, Ranjani
Chronically understaffed public health laboratories depend on a decreasing number of employees who must assume broader responsibilities in order to sustain essential functions for the many clients the laboratories support. Prospective scientists considering a career in public health are often not aware of the requirements associated with working in a laboratory regulated by the Clinical Laboratory Improvement Amendments (CLIA). The purpose of this pilot internship was two-fold; introduce students to operations in a regulated laboratory early enough in their academics so that they could make good career decisions, and evaluate internship methodology as one possible solution to workforce shortages. Four interns were recruited from three different local universities, and were paired with an experienced State Laboratories Division (SLD) staff mentor. Students performed tasks that demonstrated the importance of CLIA regulations for 10–15 hours per week over a 14 week period. Students also attended several directed group sessions on regulatory lab practice and quality systems. Both interns and mentors were surveyed periodically during the semester. Surveys of mentors and interns indicated overall positive experiences. One-on-one pairing of experienced public health professionals and students seems to be a mutually beneficial arrangement. Interns reported that they would participate if the internship was lower paid, unpaid, or for credit only. The internship appeared to be an effective tool to expose students to employment in CLIA-regulated laboratories, and potentially help address public health laboratory staffing shortfalls. Longer term follow up with multiple classes of interns may provide a more informed assessment. PMID:23386992
Tuma, Pepin Andrew
If upheld as constitutional, the Patient Protection and Affordable Care Act that passed in 2010 promises to change health care delivery systems in the United States, partly by shifting focus from disease treatment to disease prevention. Registered dietitians (RDs) have already taken an active role in health care areas that stand to be directly affected by provisions in the health care reform bill. However, nutrition's vital role in preventing diseases and conditions potentially could translate to additional opportunities for RDs as a result of this reform. Specific dietetics-related areas targeted by health care reform include medical nutrition therapy for chronic conditions and employee wellness incentive programs. However, dietetics practitioners are not necessarily established in the language of the bill as the essential providers of specific services or as reimbursable practitioners. Thus, although it is possible health care reform could affect demand-and, in turn, supply-of RDs, the actual effect of this legislation is difficult to predict.
Carlton, Erik L.; Holsinger, James W.; Martha C Riddell; Heather eBush
Public health leadership is an important topic in the era of U. S. health reform, population health innovation, and health system transformation. This study utilized the full-range leadership model in order to examine public health leadership. We sought to understand local public health leadership from the perspective of local health department leaders and those who work with and for them. Public health leadership was explored through interviews and focus groups with directors (n=4) and s...
Hayes, Donald K; Calhoun, Candice R; Joseph, Lin; Farnsworth, JoAnn Y; Arakaki, Kimberly B
The Hawai‘i Maternal and Infant Health Collaborative, founded in 2013, is a public-private partnership committed to improving birth outcomes and reducing infant mortality. The Collaborative was developed in partnership with the Executive Office on Early Learning Action Strategy with help from the Department of Health and National Governor's Association. The Action Strategy provides Hawai‘i with a roadmap for an integrated and comprehensive early childhood system, spanning preconception to third grade. The Collaborative helps advance goals within the Action Strategy by focusing on ensuring that children have the best start in life by being healthy and welcomed. The Collaborative has completed a strategic plan and accompanying Logic Model, The First 1,000 Days, aimed at achieving the outcomes of 8% reduction in preterm births and 4% reduction in infant mortality. To date over 120 people across Hawai‘i have been involved in the Collaborative. These members include physicians and clinicians, public health planners and providers, insurance providers and health care administrators. The work is divided into three primary areas and coordinated by a cross sector leadership team. Work is specific, outcome driven, informed by data and primarily accomplished in small work groups. PMID:27738566
Phillips, Simone; Pholsena, Soulivanh; Gao, Jun; Oliveira Cruz, Valeria
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.
Torheim, Liv Elin; Birgisdottir, Bryndis Eva; Robertson, Aileen
Public Health Nutrition Education Liv Elin Torheim* 1, Bryndis Eva Birgisdottir2, 3, Inga Thorsdottir2, 3, Aileen Robertson4, Runa Midtvåge4, Chalida Mae Svastisalee4, Hanne Gillett4, Agneta Yngve5, Arja Erkkilä6 1Department of Nursing and Health Promotion, Oslo and Akershus University College......) and healthy aging. Unhealthy dietary patterns, high blood pressure and obesity are major risk factors for NCDs such as cancers, type 2 diabetes and cardiovascular diseases. There exists enormous potential to promote health and prevent diseases through targeting unhealthy life style, and it is crucial......, educational, social, economic, structural, political and/or legislative. The knowledge, skills, competencies and cultural heritage of the broader community should form a basis for all analyses and actions. The competencies required to be an effective PHN practitioner has been described by several scholars...
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
Data synthesis: In terms of context and design of the cost recovery reform, there ... of appropriate policies and information to monitor and/or influence the process. ... of health services; equitable service utilisation; social sustainability through ...
Wynia, Matthew K
Each year, infection with Human Papillomavirus (HPV) leads to millions of abnormal Pap smears and thousands of cases of cervical cancer in the US. Throughout the developing world, where Pap smears are less common, HPV is a leading cause of cancer death among women. So when the international pharmaceutical giant Merck developed a vaccine that could prevent infection with several key strains of HPV, the public health community was anxious to celebrate a major advance. But then marketing and lobbying got in the way. Merck chose to pursue an aggressive lobbying campaign, trying to make its new vaccine mandatory for young girls. The campaign stoked public mistrust about how vaccines come to be mandated, and now it's not just Merck's public image that has taken a hit. The public health community has also been affected. What is the lesson to be learned from this story? Public health communication relies on public trust.
Enthoven, A C; Kronick, R
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.
Croatia's most recent reform of the healthcare system was implemented in 2008. The aim of the reform was to enhance financial stability of the system by introducing additional sources of financing, as well as increase the efficiency of the system by reducing sick pay transfers to households, rationalising spending on pharmaceuticals, restructuring hospitals etc. This paper attempts to assess the success of the 2008 healthcare system reform in reaching financial stability and sustainability, and to evaluate the effects of the reform on equity in funding the system. It takes into account the fact that the reform coincided with a severe economic crisis and decline in the overall living standard of Croatian citizens. The paper shows that the reform ended up being expansionary and thus impaired the necessary fiscal adjustment. Finally, it is argued that in circumstances of declining disposable incomes, increased co-payments aimed at the financial stabilisation of the health system made health services less affordable and could have had detrimental effects on equity in the utilisation of health care. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Mónica Uribe Gómez
Full Text Available This paper examines the reform process within the Mexican health system undertaken since the eighties that led to an increasing privatization of health services. It argues that such process have been led by a small group of techno-bureaucratic actors that have changed institutional rules according to their interests without considering the interests of local governments, public services providers and public health services users.
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…
Korenman, Sanders D; Remler, Dahlia K
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 Â© 2016 Elsevier B.V. All rights reserved.
Purpose The purpose of this paper is to identify social and organizational antecedents of stress. This paper also investigates whether attitudes toward organizational changes and reforms might explain stress perception (SP) and mediate the relationships between social and organizational job characteristics and SP. Design/methodology/approach A quantitative approach is used to identify the relationships between the research variables. The investigated population is composed of middle managers working in Swiss public hospitals ( n=720), which are currently being confronted by major reforms. Findings The findings show that perceived social support (work relationships with and support from colleagues), as well as several job characteristics (autonomy in performing tasks, flexibility in the organization of working time, degree of conflict) are significantly related to SP. Moreover, positive attitudes toward change are negatively related to stress, and mediate the relationships between perceived social support as well as job characteristics and SP. Practical implications This paper sheds light on several job characteristics which could contribute to mitigating SP among middle managers. The findings could therefore guide HRM specialists in their efforts to create a favorable work environment so as to facilitate middle managers' activities. Originality/value The innovation of this paper is grounded in the specific population the author investigate, as the empirical inquiry concerns middle managers working in public hospitals. Moreover, this research highlights the central role of job characteristics and attitudes toward change in explaining SP.
Марія Андріївна Знаменська
Full Text Available Actuality. The role of communications in effective reform of public health in the country is discovered in scientific literature last time. But there are no works that fully present the system of communications in public health; this fact defined actuality of the given research.Methods. The next scientific methods are used in this work: structural and logical analysis, conceptual modeling. The systematic approach became a base of research. Results. There was elaborated conceptual model of the system of communications in public health its node idea is a consistent solution of the priority problem of supply the population of the country in whole and the separate task groups of communicative impact with complex objective information in the system of public health. At constructing of the model there were separated the next groups of problems: structural construction of the system of communication; supply of the system with resources; methods and means of communication; monitoring and assessment of efficiency of communication.Conclusions. The use of this model allows at optimal costs to eliminate the organizational and administrative defects and increase an awareness of the people in organization of public health, in maintenance and improvement of personal health.
Freire, R M
An undestanding of the activities and functions of a speech therapist within the specific context of the Basic Health Units (Unidades Básicas de Saúde) is sought. Difficulties relating to the introduction of a new service on the basis of one of the health professions that has not hitherto belonged to the group of categories which are traditionally incorporated in these same Basic Units. When the statistical data on the demand for speech therapy services by the population who attend health centres were considered, it was discovered that 32% were of schooling age and had been referred by schools, allegedly due to "learning problems". Closer contact with these children, through speech therapy, has brought a different aspect to light i.e. that one cannot consider as disturbance/deviation/problem/pathology written signs which constitute indications of the shock between the process of literacy and that of learning how to read and write. To understand the problem from the point of view of public health, a programme of teacher counselling is proposed, with the purpose of helping the school to clarify its role as co-constructor of the child's literacy process and of returning to the teacher the responsibility for the success and/or failure of teaching how to read and write. A similar programme is proposed for creches where coincidently, a greater proportion (44%) of the younger children (2 to 5 years of age) are seen to have difficulties in oral language development.(ABSTRACT TRUNCATED AT 250 WORDS)
Full Text Available The Chilean health care system has been intensively reformed in the past 20 years. Reforms under the Pinochet government (1973-1990 aimed mainly at the decentralization of the system and the development of a private sector. Decentralization involved both a deconcentration process and the devolution of primary health care to municipalities. The democratic governments after 1990 chose to preserve the core organization but introduced reforms intended to correct the system's failures and to increase both efficiency and equity. The present article briefly explains the current organization of the Chilean health care system. It also reviews the different reforms introduced in the past 20 years, from the Pinochet regime to the democratic governments. Finally, a brief discussion describes the strengths and weaknesses of the system, as well as the challenges it currently faces.
Rogers, W A
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.
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.
Luna, Cristina; Emanuele, Carlos Andrés; Torre, Daniel De La
Analyze strategies implemented by Ecuador's Ministry of Public Health (MPH) to position the country in the global health agenda during the period 2011-2015 as a result of health sector reform. Documentary review and interviews with stakeholders in national and international agencies with respect to positioning in the global health sphere during the study period. It was observed that the reform process produced a new framework to manage international health relations. The MPH implemented strategies and mechanisms to place national health priorities and interests on the global health agenda at bilateral, regional, and global levels. As a result, the country took a leadership role in certain processes and attained recognition at various international forums. The MPH reform process contributed to recognition and establishment of Ecuador's public policy priorities in the global health agenda through strategies such as giving importance to putting national priorities on the global health agenda, guiding the global health approach exercised by the highest health authority, developing technical capabilities and skills in the International Relations Office, and raising awareness in technical bodies.
... health insurance coverage options in that State. In implementing these requirements, we seek to develop a... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary 45 CFR Part 159 RIN 0991-AB63 Health Care Reform Insurance Web...
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
Mihir K. R.
Full Text Available Tuberculosis is a major public health problem world o ver and it is India’s worst scourge. In the words of Charles Dickens “it is the disease medicine never cured, wealth warded off, or poverty could boast exemption from.... Which sometimes moves in giant strides & sometimes at tardy sluggish pace, but slow or quick... is never sur e and certain”. India bears 28.4% of the entire world’s burden of Tuberculosis. Every year 2 2 lakh persons contract Tuberculosis, but only half of them seek medical care. One Indian die s of Tuberculosis every 3 minutes! Tuberculosis is not only a medical malady but an ec onomic disaster too it perpetuates poverty and poverty begets Tuberculosis. In view of the enor mity of the problem let us leaf through the pages of history
Springston, Jeffrey K; Weaver Lariscy, Ruth Ann
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.
Malter, A D; Emerson, L L; Krieger, J. W.
Attitudes of Washington State physicians about health care reform and about specific elements of managed competition and single-payer proposals were evaluated. Opinions about President Clinton's reform plan were also assessed. Washington physicians (n = 1,000) were surveyed from October to November 1993, and responses were collected through January 1994; responses were anonymous. The response rate was 80%. Practice characteristics of respondents did not differ from other physicians in the sta...
Dorfman, Lori; Krasnow, Ingrid Daffner
Media advocacy blends communications, science, politics, and advocacy to advance public health goals. In this article, we explain how media advocacy supports the social justice grounding of public health while addressing public health's "wicked problems" in the context of American politics. We outline media advocacy's theoretical foundations in agenda setting and framing and describe its practical application, from the layers of strategy to storytelling, which can illuminate public health solutions for journalists, policy makers, and the general public. Finally, we describe the challenges in evaluating media advocacy campaigns.
Vázquez, M L; Siqueira, E; Kruze, I; Da Silva, A; Leite, I C
Currently, many countries throughout the world are reforming their health services. Even though these reforms differ according to the country's characteristics, they share many policies, one of which is the promotion of social participation in health-related matters. This policy, however, is not new in the field of health service organization. Throughout the last century, individual or collective collaboration between the population and health services has been promoted by several philosophies and concepts with different aims: from the search for collaboration with the general public to broaden public health system coverage to the promotion of the creation of mechanisms that would allow society to exercise control over these services' performance. Nevertheless, for the public to be involved with these services, several factors concerning both the services themselves and the population, need to converge. Although the theoretical frameworks that have encouraged social participation throughout the history of the development of health systems differ considerably, their practical implementation shares many common elements in all periods, from participation as a means of obtaining certain objectives to being an end in itself, as a democratic process. This can also be applied to the current promotion of social participation policies in the context of health care reforms, which are analyzed using Colombia and Brazil as examples.
In the November 1991 elections, popular support for national health reform (NHR) enabled Harry Wofford to become a U.S. Senator from Pennsylvania. Since then a bevy of congressional proposals to reform America's health care system have emerged, with even national health insurance, or a single payer system, becoming a prominent contender for the first time in 20 years. National health reform is now a regular feature on the evening news. However, this is not the first time that NHR has attracted national attention. As pointed out in the first article in this series (Physician Executive, March-April 1992, page 23), there have been numerous efforts to enact NHR in the U.S. Each has failed because of strident opposition by interest groups, lack of active presidential interest in the specific legislation, and the absence of strong popular interest.
Møller, Jorunn; Skedsmo, Guri
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…
Wu, Fenghong; Chi, Yan
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.
Waitzkin, Howard; Hellander, Ida
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.
Frenk, Julio; Gómez-Dantés, Octavio
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.
McBeath, W H
The approach of a millennial passage invites public health to a review of past performance and a preview of future prospects toward assuring a healthy public. Since the 1974 Canadian Lalonde report, the best national plans for health progress have emphasized disease prevention and health promotion. WHO's multinational Health for All by the Year 2000 promotes basic health services essential to leading a socially and economically productive life. Healthy People 2000, the latest US guide, establishes three goals: increase healthy life span, reduce health disparities, and achieve universal access to preventive services. Its objectives can be used to excite public understanding, equip program development, evaluate progress, and encourage public accountability for health initiatives. Needed is federal leadership in defining requisite action and securing necessary resources. Elsewhere a "new public health" emphasizes community life-style and multisectoral "healthy public policy." In the United States, a national health program is needed to achieve equity in access to personal health care. Even more essential is equitable sharing in basic health determinants in society--nutritious food, basic education, safe water, decent housing, secure employment, adequate income, and peace. Vital to such a future is able and active leadership now from governments and public health professionals.
In the immediate postwar era the primary object of health reform among the advanced industrial democracies was to expand, if not universalize, access to a broad spectrum of health services through sustained, high levels of government-mandated spending. The fiscal crises of the 1970s and 1980s ushered in a new generation of policies devoted to balancing the imperatives of guaranteeing access to basic health and social services and to improving the accountability, efficiency, and effectiveness of health care industries. In Canada, the regionalization of health care administration emerged as the most prominent strategy for grappling with the contradictions and paradoxes of contemporary health reform. This essay traces the historical evolution of federal-provincial deliberations that elevated regionalization to the forefront of health policy-making in the new era of fiscal restraint, and further, assesses recent efforts to institutionalize regional health authorities.
Breidahl, Karen Nielsen; Gjelstrup, Gunnar; Hansen, Morten Balle
This article explores differences and similarities between two evaluations of large-scale administrative reforms which were carried out in the 2000s: The evaluation of the Norwegian NAV reform (EVANAV) and the evaluation of the Danish Local Government Reform (LGR). We provide a comparative analys...
I. Mosca (Ilaria)
textabstractThe 2006 health care reform in the Netherlands attracted widespread international interest in the impact of regulated competition on key factors such as prices, quality, and volume of care. This article reviews evidence on the performance of the health care system six years after the ref
I. P. Krynychna
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
Hansen, Morten Balle; Breidahl, Karen Nielsen; Hjørdis Halvorsen, Anne;
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...... of the central, regional and local government and a social policy reform. Meta-evaluations assess the usefulness of one or more evaluations and should not be confused with meta-analyses. The purpose of this meta-evaluation was to identify general principles for organizing the evaluations of large-scale public...... 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....
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.
Nilsson, Lars J.; Arvidson, Anders; Eberhard, Anton (eds.)
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
Higgins, C W; Phillips, B U
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.
Drawing on interviews with English primary care doctors (GPs), this paper examines GP responses to reforms intended to introduce a market in primary health care. GPs' reactions are conceptualised in terms of a GP habitus, which takes for granted the superiority of 'public' providers (i.e. GP partnerships) in the provision of care. GPs are actively involved in the defence of the public sphere, which is neither a neo-liberal minimalist market state, nor a wholly altruistic state, responding to consumers' wants. The public sphere they defend is one in which boundaries are drawn about entitlements and GPs are actively engaged in defining and policing these boundaries. The GP habitus can be seen as shaping responses in ways which serve GP interests. In the context of struggles involving various social actors (e.g. private providers, third-party payers, patients) with different stakes in the field of general medical practice; this public service orientation may enable GPs to reap cultural capital. At the same time, the habitus constrains action in a way which limits resistance to reforms threatening GPs' interests, with GPs responding by coping, rather than downing tools or engaging in active confrontation.
Panthongviriyakul, Charnchai; Kessomboon, Pattapong; Sutra, Sumitr
Health problems and service utilization patterns among Thai populations have changed significantly over the past three decades. It is imperative to scrutinize the changes so that the health service and human resource development systems can appropriately respond to the changing health needs. To synthesize critical issues for future planning of health service reforms, medical education reforms and health research for Thai society. The authors analyzed data on health service utilization, types of illnesses and hospital deaths among Thais in the fiscal year 2010. Information on the illnesses of in-/out-patients and hospital deaths was extracted from the three main health insurance schemes providing coverage to 96% of the population. The authors then synthesized the key issues for reforming medical education and health services. In summary, Thai patients have better access to health services. The total number of out-patient visits was 326,230,155 times or 5.23 visits per population. The total number of in-patient admissions was 6,880,815 times or 0.11 admissions per population. The most frequent users were between 40-59 years of age. The most common conditions seen at OPD and IPD and the causes of in-hospital mortality varied between age-groups. The key health issues identified were: psychosocial conditions, health behaviour problems, perinatal complications, congenital malformations, teenage pregnancy, injury, infectious diseases, cardiovascular diseases and neoplasms. Medical education reforms need to be designed in terms of both undergraduate and post-graduate education and/or specialty clinical needs. Health service reforms should be designed in terms of patient care systems, roles of multidisciplinary teams and community involvement. The government and other responsible organizations need to actively respond by designing the health service systems and human resource development systems that are relevant, appropriate and integrated. Different levels of care need to
Meier, Benjamin Mason; Kayser, Georgia Lyn; Kestenbaum, Jocelyn Getgen; Amjad, Urooj Quezon; Dalcanale, Fernanda; Bartram, Jamie
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.
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
Hirschhorn, Joel S
Legally, governments use their police powers to protect public health, safety, and welfare through zoning. This paper presents a case for revisiting zoning on the basis of increasing evidence that certain types of community design promote public health, as opposed to the dominant pattern of sprawl development, which does not. Zoning, and the land use planning linked to it, that prohibits or disfavors health-promoting community designs contradicts the inherent public policy goal on which it is based. If there is a paradigm shift underway, from traditional sprawl to health-promoting community designs, then health professionals and others should understand why zoning must be reassessed.
Arcos González, Pedro; Castro Delgado, Rafael; Cuartas Alvarez, Tatiana; Pérez-Berrocal Alonso, Jorge
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.
Jose Arturo Ruiz-Larios
Full Text Available This study presents an assessment of the participation and training of nurses in public health areas in the Americas. Information was gathered through a literature review and interviews with key informants from Mexico, Colombia, and Paraguay. Results demonstrate that there is significant variation in definitions of public health nursing across the region and current systematized data about the workforce profile of public health nursing personnel is not available for many countries in the Americas. There are significant regional differences in the levels and types of training of nurses working in public health areas and an increasing number of nurses are pursuing training in public health at the master’s and doctoral levels. Many nurses carry out some or all of the essential functions of public health, but are not considered to be public health nurses. Generally, auxiliary and technical nurses have a broader presence in public health areas than professional nurses. In the future, regional health systems reforms should support increased recruitment and training of public health nurses, as well as stronger roles in public health research and health care at the individual, community, and population levels.
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.
This essay argues that no theory or single conception of justice can provide a fundamental grounding for health care reform in the United States. To provide such a grounding, (1) there would need to be widespread support among citizens for a particular conception of justice, (2) citizens would have to apprehend this common conception of justice as providing the strongest available rationale for health care reform, and (3) this rationale would have to overwhelm countervailing values. I argue that neither of the first two conditions is met.
Full Text Available The health matters associated with migration are crucial public health challenges faced by both governments and societies. According to United Nations estimates, 120 million of the approximately 175 million migrants worldwide are migrant workers with their families (1. Legal and illegal workers have a different status and, therefore, varying levels of access to social and health services. The collective health needs and implications of this sizeable population are considerable, and different health determinants and levels of vulnerability could impact on their health (2. The main public health goal is to avoid disparities in health status and access to health services between migrants and the host population (3. The second, closely associated principle, is to ensure migrants’ health rights, as stated during the 4th Conference on Migrant and Ethnic Minority Health in Europe which took place from 21st to 23rd June 2012 in Milan, where Migrants and ethnic minorities were confirmed as a benefit to the society (4.
Mukhtar, Mohammed Ibn
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…
Walker, Richard M.; Boyne, George A.
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.…
Kass-Hout, Taha A; Alhinnawi, Hend
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.
Broeder, Den Lea; Devilee, Jeroen; Oers, Van Hans; Schuit, A.J.; Wagemakers, Annemarie
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
Petersen, Poul E; Baehni, Pierre C
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 local, national and international resources to assure that people can be healthy. Social determinants of health, environmental hazards and unhealthy lifestyles are prioritized in modern public health-care. Disease prevention and health promotion are cornerstones in actions for public health. This volume of Periodontology 2000 is entitled ‘Periodontal health and global public health’; the 12 articles of this volume discuss different aspects of this statement. It covers a range of subjects from public health issues to patient care. This monograph intends to stimulate community action research in the field of periodontology in order to help the development of appropriate public health intervention and relevant surveillance programs. It also expects to stimulate health authorities and professional organizations to initiate and support actions to promote periodontal health in their respective countries.
African Journal of Reproductive Health ... A new model of reproductive health care delivery is unfolding, driven by ... A three-pronged approach based on reproductive health, problem-based learning and evidence-based medicine, has much ...
Italy's recent economic growth and strategic position in the Mediterranean Sea have made it a prime destination for immigrants and asylum seekers in Europe. Despite its well-developed health care system, statistics on foreign citizens' health are worrisome. In 1998 public health services were extended to illegal immigrants, giving them the right to necessary urgent and non-urgent medical assistance, even for a prolonged period. This paper examines a two-year joint intervention project between Centre for the Study and Research of Public Health (Mental Health), Local Health Agency ROMA E (LHA RME) and the non-governmental organization Médecins Sans Frontières (MSF) in Rome.
Mitenbergs, Uldis; Brigis, Girts; Quentin, Wilm
In the 1990s, Latvia aimed at introducing Social Health Insurance (SHI) but later changed to a National Health Service (NHS) type system. The NHS is financed from general taxation, provides coverage to the entire population, and pays for a basic service package purchased from independent public and private providers. In November 2013, the Cabinet of Ministers passed a draft Healthcare Financing Law, aiming at increasing public expenditures on health by introducing Compulsory Health Insurance (CHI) and linking entitlement to health services to the payment of income tax. Opponents of the reform argue that linking entitlement to health services to the payment of income tax does not have the potential to increase public expenditures on health but that it can contribute to compromising universal coverage and access to health services of certain population groups. In view of strong opposition, it is unlikely that the law will be adopted before parliamentary elections in October 2014. Nevertheless, the discussion around the law is interesting because of three main reasons: (1) it can illustrate why the concept of SHI remains attractive - not only for Latvia but also for other countries, (2) it shows that a change from NHS to SHI does not imply major institutional reforms, and (3) it demonstrates the potential problems of introducing SHI, i.e. of linking entitlement to health services to the payment of contributions.
Gakidou, Emmanuela; Lozano, Rafael; González-Pier, Eduardo; Abbott-Klafter, Jesse; Barofsky, Jeremy T; Bryson-Cahn, Chloe; Feehan, Dennis M; Lee, Diana K; Hernández-Llamas, Hector; Murray, Christopher J L
Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over 7 years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, we used a wide range of datasets to assess the effect of this reform on different dimensions of the health system. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affiliates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.
Gakidou, Emmanuela; Lozano, Rafael; González-Pier, Eduardo; Abbott-Klafter, Jesse; Barofsky, Jeremy T; Bryson-Cahn, Chloe; Feehan, Dennis M; Lee, Diana K; Hernández-Llamas, Héctor; Murray, Christopher J L
Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over seven years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, a wide range of datasets to assess the effect of this reform on different dimensions of the health system was used. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affilates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.
Bonias, Dimitra; Leggat, Sandra G; Bartram, Timothy
Recent health system enquiries and commissions, including the National Health and Hospital Reform Commission, have promoted clinical engagement as necessary for improving the Australian healthcare system. In fact, the Rudd Government identified clinician engagement as important for the success of the planned health system reform. Yet there is uncertainty about how clinical engagement is understood in health policy and management. This paper aims to clarify how clinical engagement is defined, measured and how it might be achieved in policy and management in Australia. We review the literature and consider clinical engagement in relation to employee engagement, a defined construct within the management literature. We consider the structure and employment relationships of the public health sector in assessing the relevance of this literature. Based on the evidence, we argue that clinical engagement is similar to employee engagement, but that engagement of clinicians who are employees requires a different construct to engagement of clinicians who are independent practitioners. The development of this second construct is illustrated using the case of Visiting Medical Officers in Victoria. Antecedent organisational and system conditions to clinical engagement appear to be lacking in the Australian public health system, suggesting meaningful engagement will be difficult to achieve in the short-term. This has the potential to threaten proposed reforms of the Australian healthcare system.
Deborah Chollet; Jeffrey Ballou; Alison Wellington; Thomas Bell; Allison Barrett; Gregory Peterson; Stephanie Peterson
Mathematica evaluated five health care reform proposals for the state of Washington in 2008. The proposals featured, respectively: reduced regulation in the current market; Massachusetts-style insurance reforms with a health insurance connector; a health partnership program similar to the current state employee health plan; a state-operated single payer plan; and a program that would guarantee catastrophic coverage for all residents. This report provides estimates of the changes in coverage a...
Dr. Katrin Kohl, a medical officer at the CDC, discusses the World Health Organizationâs 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.
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 se
Nordgren, R. D.
School reform in the past several decades has taken a "modernist" bent in that it has focused on quantitatively based accountability systems modeled after business (Ravitch, 2013; Tienken & Orlich, 2013). The author uses a model devised by a Finnish scholar to demonstrate that 1) these reforms are indeed modernist, and 2) the private…
Wang, Zhaoxin; Shi, Jianwei; Wu, Zhigui; Xie, Huiling; Yu, Yifan; Li, Ping; Liu, Rui; Jing, Limei
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.
Breidahl, Karen N.; Gjelstrup, Gunnar; Hansen, Hanne Foss; Hansen, Morten Balle
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…
Ramírez Hita, Susana
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.
Full Text Available Abstract The Patient Protection and Affordable Care Act (PPACA aims to provide affordable health insurance and expanded health care coverage for some 32 million Americans. The PPACA makes provisions for using technology, evidence-based treatments, and integrated, patient-centered care to modernize the delivery of health care services. These changes are designed to ensure effectiveness, efficiency, and cost-savings within the health care system. To gauge the addiction treatment field’s readiness for health reform, the authors developed a Health Reform Readiness Index (HRRI survey for addiction treatment agencies. Addiction treatment administrators and providers from around the United States completed the survey located on the http://www.niatx.net website. Respondents self-assessed their agencies based on 13 conditions pertinent to health reform readiness, and received a confidential score and instant feedback. On a scale of “Needs to Begin,” “Early Stages,” “On the Way,” and “Advanced,” the mean scores for respondents (n = 276 ranked in the Early Stages of health reform preparation for 11 of 13 conditions. Of greater concern was that organizations with budgets of $5 million to have information technology (patient records, patient health technology, and administrative information technology, evidence-based treatments, quality management systems, a continuum of care, or a board of directors informed about PPACA. The findings of the HRRI indicate that the addiction field, and in particular smaller organizations, have much to do to prepare for a future environment that has greater expectations for information technology use, a credentialed workforce, accountability for patient care, and an integrated continuum of care.
Molfenter, Todd; Capoccia, Victor A; Boyle, Michael G; Sherbeck, Carol K
The Patient Protection and Affordable Care Act (PPACA) aims to provide affordable health insurance and expanded health care coverage for some 32 million Americans. The PPACA makes provisions for using technology, evidence-based treatments, and integrated, patient-centered care to modernize the delivery of health care services. These changes are designed to ensure effectiveness, efficiency, and cost-savings within the health care system.To gauge the addiction treatment field's readiness for health reform, the authors developed a Health Reform Readiness Index (HRRI) survey for addiction treatment agencies. Addiction treatment administrators and providers from around the United States completed the survey located on the http://www.niatx.net website. Respondents self-assessed their agencies based on 13 conditions pertinent to health reform readiness, and received a confidential score and instant feedback.On a scale of "Needs to Begin," "Early Stages," "On the Way," and "Advanced," the mean scores for respondents (n = 276) ranked in the Early Stages of health reform preparation for 11 of 13 conditions. Of greater concern was that organizations with budgets of $5 million to have information technology (patient records, patient health technology, and administrative information technology), evidence-based treatments, quality management systems, a continuum of care, or a board of directors informed about PPACA.The findings of the HRRI indicate that the addiction field, and in particular smaller organizations, have much to do to prepare for a future environment that has greater expectations for information technology use, a credentialed workforce, accountability for patient care, and an integrated continuum of care.
and disease prevention, health economics and leadership, health sociology, ethics, etc.—unified under the comprehensive public health umbrella. This approach will contribute to the prevention of silo thinking and isolated, particularistic action. Conversely, just thinking in and engaging specialists...
Wong, V C; Chiu, S W
Analyses the features, strategies and characteristics of health-care reforms in the People's Republic of China. Since the 14th Central Committee of the Chinese Communist Party held in 1992, an emphasis has been placed on reform strategies such as cost recovery, profit making, diversification of services, and development of alternative financing strategies in respect of health-care services provided in the public sector. Argues that the reform strategies employed have created new problems before solving the old ones. Inflation of medical cost has been elevated very rapidly. The de-linkage of state finance bureau and health service providers has also contributed to the transfer of tension from the state to the enterprises. There is no sign that quasi-public health-care insurance is able to resolve these problems. Finally, cooperative medicine in the rural areas has been largely dismantled, though this direction is going against the will of the state. Argues that a new balance of responsibility has to be developed as a top social priority between the state, enterprises and service users in China in order to meet the health-care needs of the people.
Martín Martín, J; de Manuel Keenoy, E; Carmona López, G; Martínez Olmos, J
The article desired organizational and managerial changes in Primary Health Care, so as to develop a sound and feasible social marketing strategy. Key elements that should be changed are: 1. Rigid and centralized administrative structures and procedures. 2. Incentives system centralized and dissociated from the managerial structure. 3. Primary Health Care management units immersed in political conflict. 4. Absence of alternative in the margin. Users cannot choose. 5. Lack of an internal marketing strategy. Several ways of internal markets simulation are assessed as potential means for internal change. The need for an administration reform leading to a less inflexible system in the Spanish national and regional health services in reviewed too. Three changes are considered essential: a) Payment systems in Primary Health Care. b) Modifications in the personnel contracts. c) Reform of the budgeting processes. Specific strategies in each of these issues are suggested, making emphasizing the need of their interrelationship and coherence.
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.
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.
Laurell, Asa Ebba Cristina
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. PMID:26959328
Asa Ebba Cristina Laurell
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.
Parales-Quenza, Carlos J
This article uses the concept of anomie for understanding public mental-health issues and constructing strategies aimed at promoting health and preventing disease. Studying anomie involves many definitions and approaches; this article conceptualises anomie as dérréglement or derangement and as a total social fact as its effects and consequences are pervasive across all areas of human experience. The article suggests the pertinence of the concept to public health based on several authors' observations depicting Latin-America as being a set of anomic societies and Colombia as the extreme case. Current definitions of mental health in positive terms (not just as being the absence of mental illness) validate the need for considering anomie as an indicator of public mental health. The article proposes that if anomie expresses itself through rules as basic social structure components, then such rules should also be considered as the point of intervention in promoting mental health.
Mello, Guilherme Arantes; Bonfim, José Ruben de Alcântara
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.
Sakyi, E Kojo
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.
Maheshwari, Sunil; Bhat, Ramesh; Saha, Somen
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.
Market economy requires education to adapt to the needs of its development, public English teaching should reform the talent training model, the market economy as the guide, follow the market development direction, take the road of combining with the professional.
The article examines changes which have taken place in the health system in Vietnam as a result of the economic reform process dating back to the late 1980s. With the liberalization of the economy have come not only growth for many, and increased choice, but also increased income and regional disparities and the problem of access to social services for those households which are less successful in the market economy. While state official policy emphasizes equity and free access to services for the poor, health costs for patients have risen substantially in the form of official and unofficial payments to staff and payments for drugs. The public sector faces an unprecedented challenge in the form of dramatic decreases in the utilization of public facilities; a shift towards self-prescription and, to a lesser extent, private practice by public employees; and, increasing reliance on foreign donors for support to preventive programmes. The article makes some recommendations on priorities for health policy in Vietnam to face these challenges.
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......,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...... 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...
Leininger, Lindsey Jeanne; Friedsam, Donna; Dague, Laura; Mok, Shannon; Hynes, Emma; Bergum, Alison; Aksamitauskas, Milda; Oliver, Thomas; DeLeire, Thomas
To examine the impact of a Wisconsin health care reform enacted in early 2008 on public insurance enrollment and retention. Administrative data covering the period January 2007 to November 2009. We calculate unadjusted enrollment trends and exit rates stratified by age, income group, and enrollment mode. Kaplan-Meier curves and Cox proportional hazards models are estimated to assess the impact of the reform on program exits. Overall enrollment increased by approximately one-third and exit rates decreased by approximately one-fifth. The majority of new enrollment came from the previously income eligible. Wisconsin's enactment of eligibility expansions coupled with administrative simplification and targeted marketing and outreach efforts were successful in enrolling and retaining low-income children and families in public coverage. © Health Research and Educational Trust.
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.
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.
Alexander M. Trbovich
Full Text Available Public health genomics unifies the scientific disciplines of genetics and public health. Public health genomics aims to facilitate the transfer of newly acquired knowledge in genetic and molecular biology into classical medicine, to evaluate the currently available genetic tests, and to educate both the medical community and the general population about advancements in molecular and cell biology of medical interest. Due to various factors, the application of new genetic discoveries in classical medicine and the evaluation of the current genetic clinical tests occur at relatively slow paste. The challenge of public health genomics is to create the most effective modus for coexistence of new molecular and cell biology discoveries and classical medical techniques in applied medicine. The ultimate goal is to accomplish a truly individualized medical therapy.
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Dear public health professionals, Honestly, isn’t it time to ask whether or not we are doing “the right things”in public health? Are our present public health strategies evidence-based? The public health agenda demands a vision that reaches beyond research to the application of public health and the determination of it’s impact. In this scenario what is the role of genomics? In the past twenty years, advances in genome research have revolutionised what is known about the role of inheritance in health and disease.
Nowadays,we know that our DNA determines not only the cause of single-gene disorders, but also determines our predisposition to common diseases.Whereas medicine is currently undergoing extraordinary developments from its morphological and phenotype orientation to a molecular and genotype orientation, promoting the importance of prognosis and prediction, public health practice has to date concerned itself with environmental determinants of health and disease and has paid scant attention to genetic variations within the population.
The advances brought about by genomics is changing these perceptions.[2,3] Many predict, that this knowledge will enable health promotion messages and disease prevention programmes to be specifically directed at susceptible individuals or at subgroups of the population, based on their genetic profile.[4,5]
The new technologies will allow researchers to examine genetic mutations at the functional genomic unit level, and to better understand the significance of environmental factors such as noxious agents, nutrition and personal behaviour in relation to the causation of diseases such as cardiovascular diseases, psychiatric disorders and infectious diseases.
Lan, Jesse Yu-Chen
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.
Jong, J.D. de; Groenewegen, P.P.; Rijken, M.
On 1 January 2006, a number of far-reaching changes in the Dutch health insurance system came into effect. There is now one type of health care insurance for all. The standard package is compulsory for everyone who lives in The Netherlands or pays wage tax in The Netherlands. In the new system of ma
Reece, Richard L
America's attempts for healthcare reform are gridlocked. Healthcare special interests are reluctant to abandon profitable activities, and American culture-distrust of centralized federal power, belief in self-improvement, desire for choice, and belief in equal access to medical technologies-is slow to change. Physician entrepreneurship and innovation, coupled with consumer-driven healthcare and public-private partnerships, may break the present gridlock.
Tong, Michelle; Sentell, Tetine
Chinese Americans constitute the largest percentage of Asian Americans. In Hawai‘i, Chinese Americans make up approximately 4.7% of the total state population. Accurately assessing health disparities across specific Asian American subgroups is critically important to health research and policy, as there is often substantial variability in risk and outcomes. However, even for Chinese Americans, the largest of the Asian American subgroups, such analyses can present challenges in population-based surveys. This article considers these challenges generally and then specifically in terms of the issue of health literacy and heart disease in Chinese Americans using existing population-based survey data sets in the United States, California, and Hawai‘i.
Hence, at the turn of the 21st century, Africa remains the poorest region in the world. ... participation and, consequently, the sustainability of democratic governance. ..... with the implement action of the reforms have no capacity to do so.
Tippett, Troy M
Organized neurosurgery through its Washington Committee developed a number of principles against which all health care reform legislation was measured, and none of the bills were acceptable. The American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) worked through multiple venues to modify or reject the legislation. In the author's view, the American Medical Association (AMA) supported the bills because its board of trustees was too focused on eliminating the sustainable growth rate, or SGR. Physicians failed to shape the health care debate. The leadership of many medical organizations was not prepared for the debate. Many had no experience in this arena and thus were too willing to let lobbyists dictate their position. In the future there are 3 things organized neurosurgery must do: be prepared, never give in, and stick with their principles. Organized neurosurgery must be prepared by developing leaders that have experience in the full spectrum of organized medicine. Neurosurgeons must not count on others, and because the specialty is small all must be involved. Neurosurgeons must never give in. Organized neurosurgery started 2009 with little support for its positions but by the end of the debate had convinced many other organizations, representing almost 500,000 physicians, to take their position. From an organizational point of view, neurosurgeons should now do 3 things: 1) reform or reject the AMA; 2) develop a real surgical coalition; and 3) change the current political environment. Neurosurgeons must also follow their principles. In the author's opinion the most important principles are: health care as a responsibility, medical liability reform, and the right to privately contract. In the United Kingdom and Germany, where health care is considered a right rather than a responsibility, bureaucratic entities determine whether you have the right to health care just as the Independent Payment Advisory Board, established under
Roberts, Marc J; Reich, Michael R
Public-health regularly encounters serious ethical dilemmas, such as rationing scarce resources, influencing individuals to change their behaviour, and limiting freedom to diminish disease transmission. Yet unlike medical ethics, there is no agreed-upon framework for analysing these difficulties. We offer such a framework. It distinguishes three philosophical views, often invoked in public-health discourse: positions based on outcomes (utilitarianism), positions focused on rights and opportunities (liberalism), and views that emphasise character and virtue (communitarianism). We explore critical variations within each approach, and identify practical problems that arise in addressing the ethical dimensions of health policy. We conclude by examining challenges posed by the feminist argument of ethics-of-care and by postmodern views about the nature of ethics. Health professionals need enhanced skills in applied philosophy to improve the coherence, transparency, and quality of public deliberations over ethical issues inherent in health policy.
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.
Kaproń, Danuta; Stephan, Werner
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.
... Infectious Diseases has a new Spanish language website! https://t.co… RT @CDCgov: Know when you need ... Together we can fight antibiotic resistance. Be #AntibioticSmart. https://t.… RT @AMJPublicHealth: Whiteness of the #opioidepidemic is ...
May, Coral S; Russell, Craig S
During the last decade, debate about the nation's ailing healthcare system has moved to the forefront. In 2010, the Patient Protection and Affordable Care Act (PPACA) was signed into law. This groundbreaking piece of legislation impacts every aspect of the health industry, affecting everyone from doctors and health-care facilities to insurers and benefits consultants to business owners and patients. The ultimate goal of PPACA is to decrease the number of uninsured Americans and reduce the overall costs of healthcare.
Full Text Available This article argues that recent comparatives literatures on the welfare state have yet to adequately consider the public sector and how governments have reshaped their public services. Drawing on macro-level data from the OECD, qualitative studies, and trade union research, it is claimed that governments have substantially remade their administrative and financial procedures in order to cut expenditures and lower labour costs. It is also contended that because of financial globalization and rising debt, states have made a series of reforms to public sector industrial relations. These have worsened wages, working conditions, and jobs throughout the public sector. It is concluded that such developments are central to reforming the nature of state functioning across North America and Western Europe. This is the first study to report on government reforms to fiscal policies, public sector services, and public sector labour forces in 13 OECD countries between 1980-2005.
Johnston, David W; Lordan, Grace; Shields, Michael A; Suziedelyte, Agne
We investigate if there is a causal link between education and health knowledge using data from the 1984/85 and 1991/92 waves of the UK Health and Lifestyle Survey (HALS). Uniquely, the survey asks respondents what they think are the main causes of ten common health conditions, and we compare these answers to those given by medical professionals to form an index of health knowledge. For causal identification we use increases in the UK minimum school leaving age in 1947 (from 14 to 15) and 1972 (from 15 to 16) to provide exogenous variation in education. These reforms predominantly induced adolescents who would have left school to stay for one additionally mandated year. OLS estimates suggest that education significantly increases health knowledge, with a one-year increase in schooling increasing the health knowledge index by 15% of a standard deviation. In contrast, estimates from instrumental-variable models show that increased schooling due to the education reforms did not significantly affect health knowledge. This main result is robust to numerous specification tests and alternative formulations of the health knowledge index. Further research is required to determine whether there is also no causal link between higher levels of education - such as post-school qualifications - and health knowledge.
Full Text Available 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 leadership programs offered in various parts of the world, and suggests several principles to be taken into account for the development of public health leadership education in the future. A variety of educational programs in public health leadership are classified into several types in terms of their formats: degree programs offered by schools of public health or other programs of public health, those offered in partnership with public health agencies, and so on. All of these programs have important implications for the overall effectiveness of public health leadership education. For public health leadership education to be effective, the partnership between academia and public health agencies is vitally important. Programs should provide opportunities to learn on the basis of practical public health experience, a commitment to life-long learning, flexibility in design, and recognition of the diverse needs of individuals and communities. The application of distance learning methods is one of the options to make this possible.Keywords: public health leadership, public health professionals, school of public health
Marín, J M
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.
Domenici, P V
Rising health spending creates an increasing burden on families, businesses, and government. Federal health spending--chiefly on Medicare and Medicaid--is a major contributor to a budget deficit that threatens to exceed $400 billion. In order to control that deficit, the President and the Congress must cap mandatory spending, excluding Social Security. In turn, policymakers should adopt health reforms to fit spending within the cap including enrolling more consumers in managed care plans, resolving medical liability disputes in arbitration instead of courts, and increasing assessment of research into cost-effective new technology.
桑吉·古普塔; 本尼迪克特·克莱门茨; 戴维·科迪; 王宇(译)
At present, poor medical service availability, high health care costs and inefficient of public health spending are exsiting in many countries, and health care reform still faces big challenges. To improve people's health and to make a control of the costs are dilemma of health-care reform, and thus improving the efficiency of public health expenditure is the optimal choice to improve social health. The forms of government intervention and the level of public health expenditure are different due to different countries and period. Emerging economies should expand basic health care coverage on the premise of fiscal sustainable development while developed economies should pay attention to improve the public health spending efficiency and limit the spending growth.%当前，许多国家仍存在医疗服务可得性差、医疗成本高昂、公共卫生支出效率低下等问题，医保改革面临重大挑战。医保改革目标存在两难—既要改善人们的健康状况，又要控制支出成本，因而提高公共卫生支出效率是改善社会健康状况的最优选择。各国政府的干预形式和公共卫生支出水平因国别、时间等的不同而变化。财政状况较好的新兴经济体需在保证财政可持续的前提下扩大基本医保覆盖面；发达经济体则应注重提升公共卫生支出的效率并限制支出增长速度。
The UK's Minister for Health has again raised the debate about the role of health educators, and in particular that of the Health Education Council, in what is termed public policy work. 1 possible definition of public policy work as regards health education is that aspect that seeks to establish certain health promoting principles as part of the conscious factors always to be considered by individuals, by opinion leaders, by manufacturers, by employers and trade unions, by service providers, by local authorities, and by central government in their plans and decisions. The Health Education Council (HEC) has no power to make or impose public policy; the Department of Health and Social Security (DHSS) has that task. The world of health education providers includes the Health Education Officers working for the Health Authorities and with the Education Authorities, an increasing number of important academic workers in the field, the HEC, the Scottish Health Education Group (SHEG), the DHSS, and some of the members of various professions who provide health education to the public as part of their daily work. Most of the HEC's work consists of providing these people with health educational tools. If the HEC begins to do more in the public policy field, it will not be at the cost of providing health educational tools. At the HEC a staff of 4 liaison workers is responsible for keeping field workers informed about future and imminent HEC work programs. They also assess needs and ideas by holding periodic meetings with Health Education Officers and others in various parts of the country. HEC's efforts have contributed substantially to increasing attention to preventive health measures on the part of the DHSS, parliamentary committees, the Royal Colleges, other professional bodies, and the media. In regard to the future, several paths deserve exploration as part of the HEC's education of decision-makers and opinion-formers. These include: local authorities, relevant
Petersen, Poul E; Baehni, Pierre C
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...
Guerrero, Erick G; Andrews, Christina; Harris, Lesley; Padwa, Howard; Kong, Yinfei; M S W, Karissa Fenwick
In this mixed-method study, we examined coordination of mental health and public health services in addiction health services (AHS) in low-income racial and ethnic minority communities in 2011 and 2013. Data from surveys and semistructured interviews were used to evaluate the extent to which environmental and organizational characteristics influenced the likelihood of high coordination with mental health and public health providers among outpatient AHS programs. Coordination was defined and measured as the frequency of interorganizational contact among AHS programs and mental health and public health providers. The analytic sample consisted of 112 programs at time 1 (T1) and 122 programs at time 2 (T2), with 61 programs included in both periods of data collection. Forty-three percent of AHS programs reported high frequency of coordination with mental health providers at T1 compared to 66% at T2. Thirty-one percent of programs reported high frequency of coordination with public health services at T1 compared with 54% at T2. Programs with culturally responsive resources and community linkages were more likely to report high coordination with both services. Qualitative analysis highlighted the role of leadership in leveraging funding and developing creative solutions to deliver coordinated care. Overall, our findings suggest that AHS program funding, leadership, and cultural competence may be important drivers of program capacity to improve coordination with health service providers to serve minorities in an era of health care reform.
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.
Den Broeder, Lea; Devilee, Jeroen; Van Oers, Hans; Schuit, A Jantine; Wagemakers, Annemarie
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.
Malo-Serrano, Miguel; Ministerio de Salud Pública del Ecuador. Quito, Ecuador.; Malo-Corral, Nicolás; Ministerio de Inclusión Económica y Social. Quito, Ecuador.
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 Integ...
Full Text Available Background The main purpose of any government from a healthcare reform is to improve the service quality and raised public satisfaction. Objectives As the important role of managerial human resources in any organizational changes, this paper tried to examine the point of view of this group about the recent reform in governmental hospitals of Qazvin. Patients and Methods This cross-sectional study was conducted in January 2015. The statistical population consisted of 50 executive managers of Qazvin teaching hospitals. The data gathering instrument was a research-made questionnaire with approved reliability and validity (α = 0.84. Data analyse was performed in SPSS version 20 using descriptive and analytic statistics (analysis of variance (ANOVA, Pearson correlation test and one sample t-test. Results A total of 43.2% of managers believed that this reform was a good restrictor for malpractices in healthcare and 31.8% believed that it will not be so useful to improve the society health status. The average score of resource preparation, insurance companies coordination, changing the routine workflows, and finally achieving the goals, had a meaningful difference (P ˂ 0.05 and the average score of these fields were upper than average. Conclusions The findings showed that based on the managers’ point of view, the reform plan was able to achieve its primary goals; however, it could not meet their exceptions in improving the society health status. Therefore, it is necessary to design some interventions for changing this perception.
Williams, Robert L; Romney, Crystal; Kano, Miria; Wright, Randy; Skipper, Betty; Getrich, Christina; Susman, Andrew L; Zyzanski, Stephen J
Health care reform aims to increase evidence-based, cost-conscious, and patient-centered care. Family medicine is seen as central to these aims in part due to evidence of lower cost and comparable quality care compared with other specialties. We sought evidence that senior medical students planning family medicine residency differ from peers entering other fields in decision-making patterns relevant to these health care reform aims. We conducted a national, anonymous, internet-based survey of senior medical students. Students chose one of two equivalent management options for a set of patient vignettes based on preventive care, medication selection, or initial chronic disease management scenarios, representing in turn evidence-based care, cost-conscious care, and patient-centered care. We examined differences in student recommendations, comparing those planning to enter family medicine with all others using bivariate and weighted, multilevel, multivariable analyses. Among 4,656 surveys received from seniors at 84 participating medical schools, students entering family medicine were significantly more likely to recommend patient management options that were more cost conscious and more patient centered. We did not find a significant difference between the student groups in recommendations for evidence-based care vignettes. This study provides preliminary evidence suggesting that students planning to enter family medicine may already have clinical decision-making patterns that support health care reform goals to a greater extent than their peers. If confirmed by additional studies, this could have implications for medical school admission and training processes.
Sostrom, Kristen; Collmann, Jeff R.
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.
Johnson, Claire; Rubinstein, Sidney M; Côté, Pierre
through the lifespan, and effective participation in community health issues. The questions that are addressed include: Is spinal manipulative therapy for neck and low-back pain a public health problem? What is the role of chiropractic care in prevention or reduction of musculoskeletal injuries...... in children? What ways can doctors of chiropractic stay updated on evidence-based information about vaccines and immunization throughout the lifespan? Can smoking cessation be a prevention strategy for back pain? Does chiropractic have relevance within the VA Health Care System for chronic pain and comorbid...... of prevention and public health? What role do citizen-doctors of chiropractic have in organizing community action on health-related matters? How can our future chiropractic graduates become socially responsible agents of change?...
Choy, Lehua B; Smith, Heidi Hansen; Espiritu, Justine; Higa, Earl; Lee, Thomas; Maddock, Jay
Abstract In 2011, a small pilot bike share program was established in the town core of Kailua, Hawai‘i, with funding from the Hawai‘i State Department of Health. The Kailua system consisted of two stations with 12 bicycles, and the goal was to secure additional funding to expand the station network in the future. Community feedback consistently indicated support for the bike share program. However, system metrics showed low levels of usage, averaging 41.5 rides per month (2011–2014). From observational data, users were primarily tourists. With minimal local staff, the bike share program had limited resources for promotion and education, which may have hindered potential use by local residents. Management of station operations and bike maintenance were additional, ongoing barriers to success. Despite the challenges, the pilot bike share program was valuable in several ways. It introduced the bike share concept to Hawai‘i, thereby helping to build awareness and connect an initial network of stakeholders. Furthermore, the pilot bike share program informed the development of a larger bike share program for urban Honolulu. As limited information exists in the literature about the experiences of smaller bike share programs and their unique considerations, this article shares lessons learned for other communities interested in starting similar bike share programs. PMID:26535166
Niculescu Oana Marilena
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
Based on in-depth survey of township hospitals in Lushan County of Henan Province, this paper studies the development situations of rural medical care and health undertaking in the course of new medical reform. Results show that both rural medical institution and public health undertaking have considerable development in this course. Working capital situation gradually turns better. However, there are still problems and challenge of shortage of high quality medical care personnel, lack of employment mechanism, poor medical environment, and imperfect bidding and purchasing system of medicines. To further develop rural medical situation, it should improve medical environment, speed up informationization construction, and give prominence to functional orientation.
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.
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.
Iulian Bogdan Dobra; Attila Szora Tamas
Health care reform and health system financing required to meet population needsand current financial constraints proved to be a major challenge worldwide. In these conditions therole of Public Internal Audit Committee in the public system is extremely important. It is known thatthe requirement to provide proposals to the Board, to the overall management and grant supportrequired for their implementation has led to these structures.
Puertas, B; Schlesser, M
Health reform is an important movement in countries throughout the region of the Americas, which could profoundly influence how basic health services are provided and who receives them. Goals of health sector reform include to improve quality, correct inefficiencies, and reduce inequities in current systems. The latter may be especially important in countries with indigenous populations, which are thought to suffer from excess mortality and morbidity related to poverty. The purpose of this paper is to report the results of a community health assessment conducted in 26 indigenous communities in the Province of Cotopaxi in rural Ecuador. It is hoped that this information will inform the health reform movement by adding to the current understanding of the health and socioeconomic situation of indigenous populations in the region while emphasizing a participatory approach toward understanding the social forces impacting upon health. This approach may serve as a model for empowering people through collective action. Recommended health reform strategies include: 1) Develop a comprehensive plan for health improvement in conjunction with stakeholders in the general population, including representatives of minority groups; 2) Conduct research on the appropriate mix between traditional medicine, primary health care strategies, and high technology medical services in relation to the needs of the general population; 3) Train local health personnel and traditional healers in primary health care techniques; 4) Improve access to secondary and tertiary health services for indigenous populations in times of emergency; and 5) Advocate for intersectoral collaboration among government institutions as well as non-governmental organizations and the private sector.
Glass, Thomas A; Goodman, Steven N; Hernán, Miguel A; Samet, Jonathan M
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.
Scott J. N McNabb
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.
D E de Villiers
Full Text Available The Belhar Confession of the then Dutch Reformed Mission Church officially approved in 1986 confesses that the unity of the church should be made visible. Very little has since then come of this visible unity in the family of Dutch Reformed churches. Since 1996, however, new impetus has been given to the effort to bring about institutional unity. It has especially been in their ministries of public witness and service that these churches succeeded to a large extent to give visible and institutional expression to their unity. This would hopefully enable the churches of the Dutch Reformed family to play a more effective public role in the present South African society. They, however, face two serious restrictions in this regard: the limited scope for churches to play a public role within the new liberal democratic dispensation in South Africa and the limited motivation to play a transforming public role in the churches of the Dutch Reformed family. In the article a few pre-conditions for playing an effective public role the churches of the Dutch Reformed family have to meet are discussed. The most important one is that these churches should achieve full institutional unity as soon as possible. The conclusion of the article is therefore that the interdependence of institutional unity and public witness is a reality they will have to deal with effectively if they want to move forward.
This study describes how members of a health team, from the national health system to the local population, implement reform directives and activities in Lusaka, Zambia. In order to determine the influence of the different actors in the health system on the policy outcomes, the study applied the three-dimensional definition of power by Luke and the concept of veto point of Pressman and Wildavsky. This research showed that the different actors expressed agreement on the nature of the National Strategic Health Plan by the Ministry of Health, which became operational in 1995, but the consensus was nevertheless accompanied with opposing attitudes especially on its strong democratization tone. The information provided by the actors also differs in terms of the rationale and implementation mode of policies. Furthermore, in the Lusaka health system, the Minister, district managers, and in-charges were seen as influential on the implementation processes of the reform, sitting in a critical veto point and exercising three types of powers which were expressed through overt, covert, and latent conflicts.
Diem, Günter; Dorner, Thomas Ernst
The future challenges for the Austrian health care system require an increasing number of public health experts of different professions in all fields of public health. In this article the offer of public health education in Austrian universities and universities for applied sciences was searched based on the predominantly online available information on web platforms of the schools. Currently (2013), there are three postgraduate public health university courses and two public health doctoral programs in Austria. Additionally, 34 degree programmes could be identified, in which parts of public health are covered. But also in medical curricula at Austrian medical schools, public health contents have found their place. In Austria, there is already a multifaceted offer for public health education. However, to build an appropriate public health work force, capable to manage the public health challenges in all its dimensions in terms of health in all policies, this offer should still be intensified.
Voon, Lok Lew Yan
This talk will document my and associated colleagues' impact on physics pedagogy at the two universities I have been employed at from my initiation at the New Faculty Workshop as an assistant professor in 1998 to being currently a full professor and chair. The present reforms involving our introductory physics courses are connected to our science education program.
Atun, Rifat Ali; Menabde, Nata; Saluvere, Katrin; Jesse, Maris; Habicht, Jarno
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
Fleury, Marie-Josée; Grenier, Guy; Vallée, Catherine; Aubé, Denise; Farand, Lambert; Bamvita, Jean-Marie; Cyr, Geneviève
This study evaluates implementation of the Quebec Mental Health (MH) Reform (2005-2015) which aimed to improve accessibility, quality and continuity of care by developing primary care and optimizing integrated service networks. Implementation of MH primary care teams, clinical strategies for consolidating primary care, integration strategies to improve collaboration between primary care and specialized services, and facilitators and barriers related to these measures were examined. Eleven Quebec MH service networks provided the study setting. Networks were identified in consultation with 20 key MH decision makers and selected based on variation in services offered, integration strategies, best practices, and geographic criteria. Data collection included: primary documents, structured questionnaires completed by 25 managers from MH primary care teams and 16 respondent-psychiatrists working in shared-care, and semi-structured interviews with 102 network stakeholders involved in the reform. The study employed a mixed method approach, triangulating the three data sources across networks. While implementation was not fully achieved in most networks, the Quebec reform succeeded in improving primary care services with the creation of adult primary care teams, and one-stop services which increased access to care, mainly for clients with common MH disorders. In terms of clinical strategies implemented, the functions provided by respondent-psychiatrists had a greater impact on the MH primary care teams than on general practitioners (GPs) in medical clinics; whereas the implementation of best practices were indirect outcomes of another reform developed simultaneously by the Quebec substance use disorders program. The main integration strategies used for increasing continuity of care and collaboration between primary care and specialized services were those involving fewer formal procedures such as referrals between teams and organizations. The lack of operational mechanisms
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.
The paper analyzes the situation of the psychiatric reform 25 years of the General Health Law. The author wonders what has been done and what has been left undone, on the degree of implementation of the Community model that adopts the law and its future sustainability. It highlights, among the strengths, the loss of hegemony of the psychiatric hospital and the great development of alternative resources, and seeks to explain the reason for the inadequacies of care, policy and training, as well as threats: the changes in the management of social and health services, increased privatization of services, the theoretical impoverishment and changing demands of the population.
This paper concerns the potential outcome of a structural reform of Public Administration aimed at increasing efficiency in human and technological resources use. We analyze the Italian case after the reform introduced in 2009 and provide a tentative estimate of the potential increase in labor productivity stemming from the adoption of a comprehensive performance management cycle (productivity related pay, etc.) together with a widespread use of ICT. To this aim we devised both a logical sche...
Paiva, Carlos Henrique Assunção; Teixeira, Luiz Antonio
Within the context of the return to democracy, the new constitution enacted in 1988 transformed health into an individual right and initiated the process of creating a public, universal and decentralized health system, profoundly altering the organization of public health in Brazil. This article discusses the main institutional, political and social aspects of this health reform, along with the changes, the continuities and the major initiatives, based on the literature published by the most widely read authors in this field of study. Without purporting to offer an exhaustive analysis, we discuss how the historiography written by authors who were also actors in the process assess its main features, along with the genesis of the process and the legacy of health reform in Brazil.
... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Public Input on Reform of the Housing Finance System AGENCIES: Office of the Undersecretary for Domestic Finance, Department of the Treasury; Office of the Assistant... Development (HUD) seek public input on establishing a more stable and sound housing finance system....
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…
Makhloufi, Khaled; Ventelou, Bruno; Abu-Zaineh, Mohammad
A growing number of developing countries are currently promoting health system reforms with the aim of attaining ' universal health coverage' (UHC). In Tunisia, several reforms have been undertaken over the last two decades to attain UHC with the goals of ensuring financial protection in health and enhancing access to healthcare. The first of these goals has recently been addressed in a companion paper by Abu-Zaineh et al. (Int J Health Care Financ Econ 13(1):73-93, 2013). The present paper seeks to assess whether these reforms have in fact enhanced access to healthcare. The average treatment effects of two insurance schemes, formal-mandatory (MHI) and state-subsidized (MAS) insurance, on the utilization of outpatient and inpatient healthcare are estimated using propensity score matching. Results support the hypothesis that both schemes (MHI and MAS) increase the utilization of healthcare. However, significant variations in the average effect of these schemes are observed across services and areas. For all the matching methods used and compared with those the excluded from cover, the increase in outpatient and inpatient services for the MHI enrollees was at least 19 and 26 %, respectively, in urban areas, while for MAS beneficiaries this increase was even more pronounced (28 and 75 % in the urban areas compared with 27 and 46 % in the rural areas for outpatient and inpatient services, respectively). One important conclusion that emerges is that the current health insurance schemes, despite improving accessibility to healthcare services, are nevertheless incapable of achieving effective coverage of the whole population for all services. Attaining the latter goal requires a strategy that targets the "trees" not the "forest".
Gómez-Arias, Rubén Darío; Nieto, Emmanuel
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.
Full Text Available This paper deals with the Italian public administration reform, carried out on the basis of the “new public management” principles. This innovation is geared towards the introduction into the public sector of private management instruments, with a view to improving ef fi ciency, effectiveness and fi nancial stability. In particular, the paper will focus on relations between political authorities and public managers. As it regards this, the measures introduced by the reform are mainly designed to ensure that managers have greater autonomy in dealing with political bodies. However, there has been growing criticism over the last few decades of the results of the system introduced by this reform. In fact, it has been observed how the new regulation provides juridical instruments which might in fl uence the manager’s activities and his or her managerial autonomy. This paper aims to explore whether such instruments can really affect managers, by preventing them from exercising their functions autonomously; it also aims to verify whether the regulation system introduced by the reform has really brought about a clear distinction between managerial and political functions or whether, on the contrary, it has only brought about a formal separation, which does not ful fi ll the goals of the Italian public administration reform.
Leone, Claudia; Dussault, Gilles; Lapão, Luís Velez
The health sector's increasing complexity poses major challenges for administrators. There is considerable consensus on workforce quality as a key determinant of success for any health reform. This study aimed to explore the changes introduced by an action-training intervention in the organizational culture of the 73 executive directors of Health Center Groups (ACES) in Portugal during the primary health care reform. The study covers two periods, before and after the one-year ACES training, during which the data were collected and analyzed. The Competing Values Framework allowed observing that after the ACES action-training intervention, the perceptions of the executive directors regarding their organizational culture were more aligned with the practices and values defended by the primary health care reform. The study highlights the need to continue monitoring results over different time periods to elaborate further conclusions.
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.
David Carlton Taylor-Robinson
Full Text Available BACKGROUND: 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. METHODOLOGY/PRINCIPAL FINDINGS: 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. CONCLUSIONS: 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.
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
Australia has been a global leader in balancing public health law, human rights and HIV. The first National HIV/AIDS Strategy launched in 1989 set the agenda for law reform. The Intergovernmental Committee on AIDS subsequently established a legal working party with one of its key tasks to formulate public health legislation that would protect public health and human rights. The NSW Public Health Act 1991 has provided the framework for managing HIV in NSW over the subsequent decades. Recent changes to criminal law in NSW and opportunities to redefine public health law may affect how HIV transmission risks are managed in the future.
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.
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
Groenewegen, P.P.; Jong, J.D. de; Delnoij, D.M.J.
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
Leventhal, Alex; Karsenty, Eric; Sadetzki, Siegal
The increased use of mobile cellular phone by the public is associated with a wave of contradictory reports about the possible health effects, due to the exposure of the users to electromagnetic non-ionizing radiation. This article reviews the state of the art of the present knowledge concerning the biological and medical effects of exposure to cellular phones, with an emphasis on its possible carcinogenic effect. Health conditions, which have been ascribed to the use of mobile phones mainly include some types of cancer and changes of brain activity. However, the balance of evidence from available studies has not yet supported these claims. Following the recommendation of special international expert committees, the IARC (International Association for Research on Cancer) is conducting a multi-center study to determine the possible effect of cellular phone use on brain and salivary gland tumors. Israel is one of the participants of this study. The only established health effect associated with the use of such technology is an increased risk for road accidents, unrelated to the amount of radiation emitted by phone. The challenge posed by this new technology to health authorities all over the world has lead to the definition of a new principle, the so-called "prudent avoidance", used as guidelines for the definition of an adequate public health policy. The public policy in Israel has used the prudent avoidance principles, while awaiting the results of the multi-national epidemiological studies.
Eakin, Hallie; Eriksen, Siri; Eikeland, Per-Ove; Øyen, Cecilie
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.
Tuohy, Carolyn Hughes
This article examines the cases of three health care states -- two of which (Britain and the Netherlands) have undergone major policy reform and one of which (Canada) has experienced only marginal adjustments. The British and Dutch reforms have variously altered the balance of power, the mix of instruments of control, and the organizing principles. As a result, mature systems representing the ideal-typical health care state categories of national health systems and social insurance (Britain and the Netherlands, respectively) were transformed into distinctive national hybrids. These processes have involved a politics of redesign that differs from the politics of earlier phases of establishment and retrenchment. In particular, the redesign phase is marked by the activity of institutional entrepreneurs who exploit specific opportunities afforded by public programs to combine public and private resources in innovative organizational arrangements. Canada stands as a counterpoint: no window of opportunity for major change occurred, and the bilateral monopoly created by its prototypical single-payer model provided few footholds for entrepreneurial activity. The increased significance of institutional entrepreneurs gives greater urgency to one of the central projects of health policy: the design of accountability frameworks to allow for an assessment of performance against objectives.
Goodman, Richard A; Moulton, A; Matthews, G; Shaw, F; Kocher, P; Mensah, G; Zaza, S; Besser, R
Public health law is an emerging field in U.S. public health practice. The 20th century proved the indispensability of law to public health, as demonstrated by the contribution of law to each of the century's 10 great public health achievements. Former CDC Director Dr. William Foege has suggested that law, along with epidemiology, is an essential tool in public health practice. Public health laws are any laws that have important consequences for the health of defined populations. They derive from federal and state constitutions; statutes, and other legislative enactments; agency rules and regulations; judicial rulings and case law; and policies of public bodies. Government agencies that apply public health laws include agencies officially designated as "public health agencies," as well as health-care, environmental protection, education, and law enforcement agencies, among others.
Sparrow, Robert; Budiyati, Sri; Yumna, Athia; Warda, Nila; Suryahadi, Asep; Bedi, Arjun S
Indonesia has seen an emergence of local health care financing schemes over the last decade, implemented and operated by district governments. Often motivated by the local political context and characterized by a large degree of heterogeneity in scope and design, the common objective of the district schemes is to address the coverage gaps for the informal sector left by national social health insurance programs. This paper investigates the effect of these local health care financing schemes on access to health care and financial protection. Using data from a unique survey among District Health Offices, combined with data from the annual National Socioeconomic Surveys, the study is based on a fixed effects analysis for a panel of 262 districts over the period 2004-10, exploiting variation in local health financing reforms across districts in terms of type of reform and timing of implementation. Although the schemes had a modest impact on average, they do seem to have provided some contribution to closing the coverage gap, by increasing outpatient utilization for households in the middle quintiles that tend to fall just outside the target population of the national subsidized programs. However, there seems to be little effect on hospitalization or financial protection, indicating the limitations of local health care financing policies. In addition, we see effect heterogeneity across districts due to differences in design features. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Full Text Available BACKGROUND: The Australian Private Health Insurance Incentive (PHII policy reforms implemented in 1997-2000 increased PHI membership in Australia by 50%. Given the higher rate of obstetric interventions in privately insured patients, the reforms may have led to an increase in surgical deliveries and deliveries with longer hospital stays. We aimed to investigate the effect of the PHII policy introduction on birth characteristics in Western Australia (WA. METHODS AND FINDINGS: All 230,276 birth admissions from January 1995 to March 2004 were identified from administrative birth and hospital data-systems held by the WA Department of Health. Average quarterly birth rates after the PHII introduction were estimated and compared with expected rates had the reforms not occurred. Rate and percentage differences (including 95% confidence intervals were estimated separately for public and private patients, by mode of delivery, and by length of stay in hospital following birth. The PHII policy introduction was associated with a 20% (-21.4 to -19.3 decrease in public birth rates, a 51% (45.1 to 56.4 increase in private birth rates, a 5% (-5.3 to -5.1 and 8% (-8.9 to -7.9 decrease in unassisted and assisted vaginal deliveries respectively, a 5% (-5.3 to -5.1 increase in caesarean sections with labour and 10% (8.0 to 11.7 increase in caesarean sections without labour. Similarly, birth rates where the infant stayed 0-3 days in hospital following birth decreased by 20% (-21.5 to -18.5, but rates of births with >3 days in hospital increased by 15% (12.2 to 17.1. CONCLUSIONS: Following the PHII policy implementation in Australia, births in privately insured patients, caesarean deliveries and births with longer infant hospital stays increased. The reforms may not have been beneficial for quality obstetric care in Australia or the burden of Australian hospitals.
Full Text Available This paper aims to analyze, starting fromthe case of Romania, the degree to which publicadministration reform contributes to the reductionof corruption. In this paper, which has its ownmethodology, the level of corruption is estimatedand a series of factors that can contributeto its reduction in a certain time interval aredetermined.The analysis of the public administrationreform process was realized by using arepresentative survey conducted in May 2007at the public administration level. A two-phasesampling technique was used to build the sample,which included 971 civil servants from central andlocal public administration.The reforming process of the centraland local public administration in Romania isanalyzed with regard to the civil service reform,the decentralization process and fight againstcorruption in the public administration. Eightstatistical variables were defined in order toanalyze these aspects. Most of the variablesused in this study reveal significant differences atthe level of the four types of public administrationinstitutions. Nevertheless, the analysis shows thatthe intensification of the reform process at civilservice level leads to the reduction of the levelof corruption.
Basu, Sanjay; Rehkopf, David H; Siddiqi, Arjumand; Glymour, M Maria; Kawachi, Ichiro
We studied the health of low-income US women affected by the largest social policy change in recent US history: the 1996 welfare reforms. Using the Behavioral Risk Factor Surveillance System (1993-2012), we performed 2 types of analysis. First, we used difference-in-difference-in-differences analyses to estimate associations between welfare reforms and health outcomes among the most affected women (single mothers aged 18-64 years in 1997; n = 219,469) compared with less affected women (married mothers, single nonmothers, and married nonmothers of the same age range in 1997; n = 2,422,265). We also used a synthetic control approach in which we constructed a more ideal control group for single mothers by weighting outcomes among the less affected groups to match pre-reform outcomes among single mothers. In both specifications, the group most affected by welfare reforms (single mothers) experienced worse health outcomes than comparison groups less affected by the reforms. For example, the reforms were associated with at least a 4.0-percentage-point increase in binge drinking (95% confidence interval: 0.9, 7.0) and a 2.4-percentage-point decrease in the probability of being able to afford medical care (95% confidence interval: 0.1, 4.8) after controlling for age, educational level, and health care insurance status. Although the reforms were applauded for reducing welfare dependency, they may have adversely affected health.
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)
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
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)
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
Guterman, Stuart; Davis, Karen; Stremikis, Kristof; Drake, Heather
The health reform legislation signed into law by President Barack Obama contains numerous payment reform provisions designed to fundamentally transform the nation's health care system. Perhaps the most noteworthy of these is the establishment of a Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services. This paper presents recommendations that would maximize the new center's effectiveness in promoting reforms that can improve the quality and value of care in Medicare, Medicaid, and the Children's Health Insurance Program, while helping achieve health reform's goals of more efficient, coordinated, and effective care.
Professionalization in public health reflects wider institutional and political forces. Depending on the historical context in different countries, public health has developed as a medical specialty or as an independent field, entirely within the state or in mixed public-private institutions, closely or weakly tied to social movements, and in varying relations to fields such as engineering, nursing, environmental science, and the military. In early 20th-century America, the rise of the medical profession and the biomedical model of disease had a formative influence on public health, leading to a different institutional pattern from Britain. Public health in the United States emerged (1) largely outside the medical profession, but under the sway of the biomedical model; (2) without medicine's command of an exclusive jurisdiction and high status; and (3) with a limited role in healthcare organization and planning. Professionalism in public health continues to be subjected to contradictory pressures and uncertainties. Healthcare reform, bioterrorism, and environmental crises could expand its mandate and access to resources, but conflicts with other institutions are likely to result in limits on the capacity of public health professionals to assert an exclusive jurisdiction.
This report focuses principally on three key dimensions of better public expenditure management in Pakistan. First, it is paramount to continue financial discipline and reduce the overall size of the public sector deficit, including the sizable losses of public enterprises. The modest progress made in reducing the government's fiscal deficit during the past few years has been undermined by...
Hughes, Gordon B
The Patient Protection and Affordable Care Act of 2010 mandates a national comparative outcomes research project agenda. Comparative effectiveness research includes both clinical trials and observational studies and is facilitated by electronic health records. A national network of electronic health records will create a vast electronic data "warehouse" with exponential growth of observational data. High-quality associations will identify research topics for pragmatic clinical trials, and systematic reviews of clinical trials will provide optimal evidence-based medicine. Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Thus, health care reform will provide a robust environment for comparative effectiveness research, systematic reviews, and evidence-based medicine, and implementation of evidence-based medicine should lead to improved quality of care.
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
Arcaro, P; Mannocci, A; Saulle, R; Miccoli, S; Marzuillo, C; La Torre, G
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
Curtis, Valerie A.; Garbrah-Aidoo, Nana; Scott, Beth
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
Xu, L.; Wang, Yan; Collins, C. D.; Tang, Shenglan
Abstract Background In 1997 there was a major reform of the government run urban health insurance system in China. The principal aims of the reform were to widen coverage of health insurance for the urban employed and contain medical costs. Following this reform there has been a transition from the dual system of the Government Insurance Scheme (GIS) and Labour Insurance Scheme (LIS) to the new Urban Employee Basic Health Insurance Scheme (BHIS). Methods This paper uses data from the National...
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
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...
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
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
Gallagher, J.E.; Alajbeg, I.; Buchler, S.; Carrassi, A.; Hovius, M.; Jacobs, A.; Jenner, M.; Kinnunen, T.; Ulbricht, S.; Zoitopoulos, L.
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
Almeida, C; Travassos, C; Porto, S; Labra, M E
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.
Full Text Available Objective. To investigate and share the major challenges and experiences of building a regional health information exchange system in China in the context of health reform. Methods. This study used interviews, focus groups, a field study, and a literature review to collect insights and analyze data. The study examined Xinjin’s approach to developing and implementing a health information exchange project, using exchange usage data for analysis. Results. Within three years and after spending approximately $2.4 million (15 million RMB, Xinjin County was able to build a complete, unified, and shared information system and many electronic health record components to integrate and manage health resources for 198 health institutions in its jurisdiction, thus becoming a model of regional health information exchange for facilitating health reform. Discussion. Costs, benefits, experiences, and lessons were discussed, and the unique characteristics of the Xinjin case and a comparison with US cases were analyzed. Conclusion. The Xinjin regional health information exchange system is different from most of the others due to its government-led, government-financed approach. Centralized and coordinated efforts played an important role in its operation. Regional health information exchange systems have been proven critical for meeting the global challenges of health reform.
Williams, Arthur Robin
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.
Cohen, Jeffrey R; Gerrish, William; Galvin, J Robert
The recent federal Health Care Reform Act signed into law by President Obama is expected to lead to greater patient volumes at non-profit hospitals in Connecticut (and throughout the country). The financial implications for these hospitals depend on how the costs per patient are expected to change in response to the anticipated higher patient volumes. Using a regression analysis of costs with annual data on 30 Connecticut hospitals over the period 2006 to 2008, we find that there are considerable differences between outpatient and inpatient unit cost structures at these hospitals. Based on the results of our analysis, and assuming health care reform leads to an overall increase in the number of outpatients, we would expect Connecticut hospitals to experience lower costs per outpatient treated (economies of scale). On the other hand, an influx of additional inpatients would be expected to raise unit costs (diseconomies of scale). After controlling for other cost determinants, we find that the marginal cost of an inpatient is about $8,000 while the marginal cost of an outpatient is about $44. This disparity may provide an explanation for our finding that the effect of additional patient volumes overall (combining inpatient and outpatient) is an increase in hospitals' unit costs.
Yilong Wang; Yongjun Wang
China has made significant progress in modernizing its healthcare system in the past 20 years. However, there are some issues that are difficult to solve on the current healthcare status, including the lack of medical care satisfaction in rural areas and urban areas, excessive consumption of medical resources, conflict and tension between the healthcare provider and patients, and the problems caused by the change of model of healthcare. Therefore, the State Council in-troduced the Opinions of the CPC Central Committee and the State Council on Deepening the Health Care System Reform in 2009 in order to provide basic, safe, effective, convenient and affordable healthcare for all residents. Despite the goals and policies set by the gov-ernment, how to implement them remains to be chal-lenging. Like evidence-based medicine, comparative effective research ( CER ) which started in the US in 2000 ’s can provide diagnosis and treatment information for patients, doctors, and health policy makers to make decisions on the effective ways of caring for both indi-vidual and population. It also may apply to the condi-tions of healthcare reform in China. And there are op-portunities and challenges of conducting CER in our country. We suggest that the government should estab-lish the national-level CER research institute, CER Leadership Committee and relevant standards, fund the CER projects, and begin CER in certain disciplines.
Full Text Available Policy capacity focuses on the managerial and organizational abilities to inform policy decisions with sound research and analysis, and facilitate policy implementation with operational efficiency. It stems from a view of the policy process that is rational and positivistic, in which optimal policy choices can be identified, selected, and implemented with objectivity. By itself, however, policy capacity neglects the political aspects of policy-making that can dominate the process, even in health policies. These technical capabilities are certainly needed to advance reforms in health policies, but they are not sufficient. Instead, they must be complemented with public engagement and policy advocacy to ensure support from the public that policies are meant to serve.
Elisha, David; Grinshpoon, Alexander
Since the publication in 1990 of the Netanyahu Commission Report on Health Reform in Israel the issue of Mental Health Reform (MHR) has been discussed extensively. As steps toward the implementation of the MHR progressed, concerns were increasingly voiced that it would adversely affect the accessibility, availability and quality of mental health services. The main source of threat is attributed to the mechanisms of Managed Behavioral Health Care (MBHC) expected to be applied by the Health Funds. The authors review recent evaluation studies of MBHC in the US with a special reference to issues pertaining to ambulatory treatment of those suffering from mental illness and to outpatient psychotherapy. The findings reviewed suggest that the key to the success of MBHC systems is a strategy endeavoring to bring together the professional and the economic management mechanisms of the service system in a mutually supporting effort to bring about a paradigmatic change in the organization, payment methods and evaluation of the services. The authors also refer to recent studies of outpatient psychotherapy that provide information about trends and utilization patterns and provide support for its overall effectiveness. The authors discuss the implications of the findings reviewed to the implementation of the MHR in Israel.
Evgeny A. Kapoguzov
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
Beetsma, R.M.W.J.; Lekniute, Z.; Ponds, E.H.M.
Most public-sector pension plans in the United States provide quite generous defined benefits. Long-term projections show that full payment of these promises threatens the finances of many state and local employers, which implies that taxes will have to be increased or pensions and/or other public e
Abolhallaje, Masoud; Jafari, Mehdi; Seyedin, Hesam; Salehi, Masoud
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.
Harris, Mitchel B
Massachusetts was the first state to implement its own version of the Affordable Care Act (ACA), when it passed the Massachusetts Health Care Reform (MHR) in 2006. Similar to the ACA, its explicit purpose was universal access to health care to all residents of Massachusetts. We believe that the influence of MHR on orthopaedic trauma in Massachusetts will have implications on trauma systems across the country, given the similarities between ACA and MHR. Therefore, in this article, we discuss our experiences as Orthopaedic trauma surgeons with regard to MHR. In this regard, we reviewed the effects of the implementation of MHR on the orthopaedic trauma services at 3 of the 4 level one trauma centers in Boston, MA. Our results demonstrate a dramatic reduction in the proportion of uncompensated care at these centers in addition to the number of uninsured patients with orthopaedic trauma injuries.
Vallath, Nandini; Tandon, Tripti; Pastrana, Tania; Lohman, Diederik; Husain, S Asra; Cleary, James; Ramanath, Ganpati; Rajagopal, M R
The lack of adequate access to opioids in India as analgesics and for agonist therapies, forces millions to live with severe unalleviated pain, or languish with suffering associated with drug dependence. Although India is a major opium exporter, the excessively prohibitive 1985 narcotics law formulated to control harmful use of drugs, impeded the availability and access to opioids for medical and scientific purposes. Amendment of this law in 2014 established a new national regulatory framework for improved access to essential opioid analgesics. This article reflects on key elements and processes that led to this landmark achievement. Unlike quick timelines associated with effecting policy reforms for law enforcement, realizing the 2014 drug policy change primarily to mitigate human suffering, was a 22-year-long process. The most exacting challenges included recognizing the multilayered complexities of the prior policy framework and understanding their adverse impact on field practices to chart an appropriate and viable path for reform. The evolution of an informal civil society movement involving health care professionals, lawyers, media, policy analysts, government officials, and the public was pivotal in addressing these challenges and garnering momentum for reform. The success of the effort for improving access to opioid medications was underpinned by a three-pronged strategy of 1) persuading the executive arm of the government to take interim enabling measures; 2) leveraging judicial intervention through public interest litigation; and 3) crafting a viable policy document for legislative approval and implementation. We hope our findings are useful for realizing drug policy reforms, given the current transformed global policy mandates emphasizing humanitarian, healthcare, and quality-of-life considerations. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Grover, Atul; Niecko-Najjum, Lidia M
Workforce planning in an era of health care reform is a challenge as both delivery systems and patient demographics change. Current workforce projections are based on a future health care system that is either an identified "ideal" or a modified version of the existing system. The desire to plan for such an "ideal system," however, may threaten access to necessary services if it does not come to fruition or is based on theoretical rather than empirical data.Historically, workforce planning that concentrated only on an "ideal system" has been centered on incorrect assumptions. Two examples of such failures presented in the 1980s when the Graduate Medical Education National Advisory Committee recommended a decrease in the physician workforce on the basis of predetermined "necessary and appropriate" services and in the 1990s, when planners expected managed care and health maintenance organizations to completely overhaul the existing health care system. Neither accounted for human behavior, demographic changes, and actual demand for health care services, leaving the nation ill-prepared to care for an aging population with chronic disease.In this article, the authors argue that workforce planning should begin with the current system and make adjustments based on empirical data that accurately reflect current trends. Actual health care use patterns will become evident as systemic changes are realized-or not-over time. No single approach will solve the looming physician shortage, but the danger of planning only for an ideal system is being unprepared for the actual needs of the population.
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 fields of anthropology and the most important for public health.
王克春; 王小合; 马征
The county's health service needs a medical service set-up to take the medical service responsibility. The medical service set-up mainly consists of public hospitals. The county government governs public hospitals through the set-up to take form of the management and to be the duty of investment. In the condition of the set-up management and the medical insurance controlling-costs, the county public hospitals can build voluntarily the inside management system according to the outside management. There are two key problems in country public hospital reform, which are basic country health care organization as linkup body of two service systems and regulating the two benefit of patients and doctors in economy. The multi-reform of public hospital management system in country will go forward if the two problems to be solved.%从健康保障出发,县域的医疗服务需要由县域医疗服务体系承担,其中,县城医疗服务体系主要由公立医院组成.县政府通过县域医疗服务体系管理公立医院,由此确定相应的投入责任和管理体制.在医疗服务体系的管理下,外加医疗保险及新农合对医院医疗费用的管理,县级医院依据外部环境和条件,构造内部管理体制.当前县级医院管理体制改革中存在两个关键问题:一个是农村基层医疗卫生机构(乡镇卫生院和村卫生室)在医疗服务和预防保健服务上的连体问题:另一个是在经济上调整医患双方利益问题,解决这两个问题将有利于推进县公立医院综合改革.
Gross, R; Rosen, B; Shirom, A
Israel, like many other European countries, has recently reformed its health care system. The regulated market created by the National Health Insurance (NHI) law embodies many of the principles of managed competition. The purpose of this paper is to present initial findings from an evaluation of the first 3 years of the reform (1995-1997) regarding the implementation of the reform and the extent to which it has achieved its main goals. The evaluation was conducted using multiple quantitative and qualitative research tools: interviews with key informants; analysis of documents and sick fund financial statements; analysis of trends in sick fund membership; and population surveys conducted in 1995 and 1997 to assess the impact of the reform on outcome measures related to level of services to the public. Data from the evaluation show that the NHI law achieved a considerable number of its goals: to provide insurance coverage for the entire population, to ensure freedom of movement among sick funds, and to standardize the way resources are allocated to sick funds. The incentives that are embodied in the law have encouraged the sick funds to improve the level of services provided to the average insuree, and to develop services in the periphery and for some of the weaker populations. From the financial perspective, concerns that NHI would lead to a rise in the national health expenditure were not realized as of 1997. In the wake of NHI, there has been a decline in the age adjusted per capita expenditure in three sick funds, with no reports by insurees, at least through 1997, on a decline in satisfaction or level of service. However, the Israeli experience shows that regulating competition does not necessarily lead to economic stability and equality. Regulating the competition also did not solve some of the major policy issues in the Israeli health system including level of resources allocated to health, organizational structure of the hospital system, manpower planning and
Spathis, Charalambos; Ananiadis, John
This paper studies the accounting system reform practised in Greek universities since January 2000, and more particularly at the Aristotle University of Thessaloniki (AUTH). It specifically examines the allocation of resources to faculties by university management based on certain criteria. The AUTH is the largest public university in Greece and…
In this speech, Hursh shows how public education in the United States is undergoing profound changes. Education policy has been hijacked by the unelected and unaccountable corporate reformers who aspire to overhaul the education system through a corporate model of privatization and market competition. They aim to privatize education through…
What role does a person's support for local educational control play in determining her attitude towards equity-minded school finance reform? This article reports estimations of binary and ordered probit models of two state public opinion polls and discusses newspaper coverage from the same two states to determine if and how local control has such…
S.I. Bergh (Sylvia)
textabstractThis paper examines the recent, current and potential future role of the European Union in Morocco, especially with regard to public sector governance reforms under the ‘Hakama’ programme, and ‘advanced regionalization’. Based on several interviews with key EU officials in Rabat and Brus
This article focuses on the capacity of parties to cultivate public opinion to accept welfare state reform. 'Preference shaping', it is argued, depends on the intensity of party 'messages', which will be at their strongest where there are sharply defined partisan cleavages in opinion. The aversion o
Dhingra, Satvinder S; Zack, Matthew M; Strine, Tara W; Druss, Benjamin G; Simoes, Eduardo
We examined the impact of Massachusetts health reform and its public health component (enacted in 2006) on change in health insurance coverage by perceived health. We used 2003-2009 Behavioral Risk Factor Surveillance System data. We used a difference-in-differences framework to examine the experience in Massachusetts to predict the outcomes of national health care reform. The proportion of adults aged 18 to 64 years with health insurance coverage increased more in Massachusetts than in other New England states (4.5%; 95% confidence interval [CI] = 3.5%, 5.6%). For those with higher perceived health care need (more recent mentally and physically unhealthy days and activity limitation days [ALDs]), the postreform proportion significantly exceeded prereform (P health care need represented a disproportionate increase in health insurance coverage in Massachusetts compared with other New England states--from 4.3% (95% CI = 3.3%, 5.4%) for fewer than 14 ALDs to 9.0% (95% CI = 4.5%, 13.5%) for 14 or more ALDs. On the basis of the Massachusetts experience, full implementation of the Affordable Care Act may increase health insurance coverage especially among populations with higher perceived health care need.
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.
Lígia Mori Madeira
Full Text Available The aim of this article is to investigate the institutionalisation of the state Public Defender's Offices before and after the reform that granted independence and new functions to the Public Defender's Offices in Brazil. We attempt to understand these processes based on theories of judicial empowerment (ideational and governance perspectives, analyse them in the Brazilian states by means of an analysis of two indicators in three different time periods (before, during and after the reform and verify to what extent the formal (de jure advances were involved in the exercise of autonomy in the states. The analysis reveals that in spite of the formal achievement of independence, the majority of state Public Defender's Offices are not actually independent and there is a great gap between what the laws stipulate and what actually happens in the public provision of access to justice in Brazil.
Silverman, Ross D
Although interest in the field of public health law has dramatically increased over the past two decades, there remain significant challenges in communicating and sharing public health law-related knowledge. Access to quality information, which may assist in a public health department's efforts to protect the public's health, welfare, and safety, varies widely from jurisdiction to jurisdiction, and interjurisdictional communication remains at best a patchwork quilt with many holes. What follows is an analysis of several approaches the Public Health Law Association or other public health law-related organizations might undertake to serve as a conduit for the identification, gathering, and dissemination of extant public health law information, as well as the development of new public health law-related content, with a particular focus on the use of electronic means for such efforts.
... this? Submit Button Past Emails CDC Features Insufficient Sleep Is a Public Health Problem Language: English Español ( ... insufficient sleep is an important public health concern. Sleep-Related Unhealthy Behaviors The Behavioral Risk Factor Surveillance ...
.... 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...
Abd Rahman Ahmad; Alan Farley
The purpose of this paper is to explore the shift in funding reforms currently facing at Malaysian public universities focusing on issues and challenges experienced by the Focused Universities in particular. Previous research has shown that shifts in funding mechanisms to public universities are more likely to result in behavioural changes at such institutions. Under the National Higher Education Strategic Plan beyond 2020, the Federal Government has launched a strategic plan of government ob...
State capacity is optimized when public institutions are staffed by individuals with public-service motivation. However, when motivated agents value the collective reputation of their place of employment, steady-state equilibria with both high and low aggregate motivation (reputation) in the mission-oriented sector exist. Reforming a low-motivation institution requires a non-monotonic wage path: since the effect of higher wages on motivation is negative for a highreputation institution, but p...
Full Text Available The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date, and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms’ impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems.
Robert D. Friedberg
Full Text Available This short opinion paper discusses cognitive behavioral therapy (CBT with youth in the era of health care reform. The commentary addresses the ways CBT is consistent with health care reform imperatives. Further, CBT's focus on accountability, credentialing, early intervention, and interdisciplinary collaboration is emphasized.
Cawley, John; Schroeder, Mathis; Simon, Kosali I
To measure the change in U.S. women and children's health insurance coverage as a result of welfare reform (i.e. the creation of Temporary Assistance for Needy Families or TANF) in 1996. 1992-1999 longitudinal data from the Survey of Income and Program Participation (SIPP) merged with data on the timing of state implementation of welfare reform after 1996. Two key advantages of the SIPP data are that they permit matching type of insurance coverage to the welfare policy environment in each state in each month, and permit controlling for individual-level fixed effects. We measure how much insurance coverage changed after welfare reform using a difference in differences method that eliminates the influence of time-invariant unobserved individual heterogeneity and of statewide trends in insurance coverage. Models also control for individual, state, and year fixed effects, individual-level characteristics such as education, age, and number of children, plus state-level variables such as real per capita income, real minimum wage, and Medicaid eligibility. We limit our analysis to the SIPP data specific to the month just completed prior to the interview; as a result, we have up to twelve observations for each individual in the SIPP. This paper uses pooled data from the 1992-1996 panels of the SIPP covering the period 1992-1999. Publicly available state identifiers permit the merger of state policies and macroeconomic variables with the SIPP. TANF implementation is associated with an 8.1 percent increase in the probability that a welfare-eligible woman was uninsured. Welfare reform had less of an impact on the health insurance coverage of children. For example, TANF implementation was associated with a 3.0 percent increase in the probability that a welfare-eligible child lacked health insurance. An unintended consequence of welfare reform was to adversely impact the health insurance coverage of economically vulnerable women and children, and that this impact was several
Leggat, Sandra G; Bartram, Timothy; Stanton, Pauline
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.
Schaffer, Marjorie A.; Anderson, Linda J. W.; Rising, Shannon
School nurses (SNs) use public health nursing knowledge and skills to provide nursing services to school populations. The Public Health Intervention Wheel is a practice framework that can be used to explain and guide public health nursing interventions. SNs who were also members of the National Association of School Nurses completed an electronic…
Morse, Stephen S
Zoonotic infections are important sources of human disease; most known emerging infections are zoonotic (e.g., HIV, Ebola virus, severe acute respiratory syndrome, Nipah virus, and enteropathogenic Escherichia coli) and originated as natural infections of other species that acquired opportunities to come in contact with humans. There are also serious infectious diseases classically considered zoonotic, such as influenza, rabies, bubonic plague, brucellosis, and leptospirosis. More recently, it has been recognized that wildlife constitutes a particularly important source of novel zoonoses. With all this microbial movement, surveillance is considered the first line of public health defense. The zoonotic origin of many human and livestock infections argues strongly for the synergistic value of a One Health approach, which provides the capability to identify pathogens crossing into new species and could provide earlier warning of potential epidemics. This article discusses public health surveillance and major recent surveillance initiatives and reviews progress toward implementing a One Health surveillance framework. Networks discussed include global intergovernmental organizations and recent combined efforts of these organizations; Web-based nongovernmental systems (e.g., ProMED, the Program for Monitoring Emerging Diseases); and networks of bilateral or multilateral government programs (e.g., the CDC's Global Disease Detection [GDD] platform; the U.S. Department of Defense's Global Emerging Infections Surveillance and Response System [GEIS]; regional and subregional networks; and the U.S. Agency for International Development's Emerging Pandemic Threats [EPT] program and its surveillance component, PREDICT). Syndromic surveillance also has potential to complement existing systems. New technologies are enabling revolutionary capabilities for global surveillance, but in addition to serious technical needs, both sustainability and data-sharing mechanisms remain
Pudlowski, Edward M
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.
Social medicine, public health and governance for health have a long tradition in the Czech Republic but some problems persist. Possible solutions are reliable information, research, education and training. Action plans for Health 2020 implementation are appreciated as well as a valuable help of the WHO Country Office, Czech Republic.Key words: social medicine, public health, health, health governance, governance for health, Health 2020, World Health Organization.
Paskal Joseph Ferro, born on June 5th, 1753 in Bonn, Germany, in the course of his military service as a surgeon graduated medicine in 1777 in Strasbourg and Vienna. Here initially he worked as a private physician in a hospital. In 1785 he became an assistant to the leading municipal physician, in 1793 he was appointed director of the district hospitals and in 1793 medical official in charge of Lower Austria. In 1795 Ferro was the first on the now created position of "Protomedicus" (director of the health administration) of an Austrian country. His most important acts were the creation of the first medical cold water bath in Austria, the foundation of institutions for the salvation of casualties, the introduction of rooms to lay out the dead in the communities, the organization of dispersed health regulations and their publications for common knowledge and especially the introduction of the smallpox vaccination in 1799 first time outside the UK. After the battle of Wagram (north to Vienna) in the Napoleonic war (July 6th, 1809) he had to care for the wounded and 56,000 dead soldiers on the battle field. In this action he contracted typhoid fever and consequently died on August 21st, 1809.
The reform of public hospitals is one of five key tasks in the new medical reform program, which is related to solving the problem of “poor access and high cost”, is the important and difficult issue of healthcare reform, and concerns the overall process of healthcare reform. Meanwhile, the public hospital also plays the pathfinder role in the public institution reform, which has an important demonstration effect in exploring the path to the social management innovation. In 2010, the former Ministry of Health and other ministries issued a pilot program of public hospital reform and determined 16 pilot cities for public hospital reform (Beijing later added as the 17th pilot city). It has great realistic and theoretical significance for us to evaluate the progress and effectiveness of the pilot reform, deeply explore the reform model and approach, encounter the difficulties and the gains and losses, sum up the experience and provide the measures and suggestions to the next step of deepening reform.%公立医院改革是新医改方案确定的五项重点任务之一，关系到“看病难、看病贵”问题的解决；是医改的重点和难点问题，关系到医改的整体推进进程；同时，公立医院还承担着事业单位改革探路者的角色，对探索创新社会管理的实现路径具有重要示范作用。2010年，原卫生部等部委出台了公立医院改革试点方案，确定了16家公立医院改革试点城市（后增加北京市共为17家）。跟踪评价公立医院改革试点的进展和成效，深入探讨改革模式和路径，研究遇到的困难和得失，总结经验并为下一阶段深化改革提供对策和建议具有重大的现实意义和理论意义。
Kierkegaard, Patrick; Kaushal, Rainu; Vest, Joshua R.
Health information exchange (HIE) can support several aspects of public health practice by increasing the availability, timeliness, and comprehensiveness individual-level patient information. The potential benefits to disease monitoring, disaster response, and other public health activities served...... qualitative interviews and template analyses, we identified public health efforts and activities that were improved by participation in HIE. We derived the codes for the template analysis through a literature review. HIE supported public health activities consistent with expectations in the literature...
... 42 Public Health 1 2010-10-01 2010-10-01 false Public health advisory. 90.9 Section 90.9 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH... PROCEDURES § 90.9 Public health advisory. ATSDR may issue a public health advisory based on......
Myers, Kathleen M; Lieberman, Daniel
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.
Wong, Edwin S; Maciejewski, Matthew L; Hebert, Paul L; Batten, Adam; Nelson, Karin M; Fihn, Stephan D; Liu, Chuan-Fen
Massachusetts Health Reform (MHR), implemented in 2006, introduced new health insurance options that may have prompted some veterans already enrolled in the Veterans Affairs Healthcare System (VA) to reduce their reliance on VA health services. This study examined whether MHR was associated with changes in VA primary care (PC) use. Using VA administrative data, we identified 147,836 veterans residing in Massachusetts and neighboring New England (NE) states from October 2004 to September 2008. We applied difference-in-difference methods to compare pre-post changes in PC use among Massachusetts and other NE veterans. Among veterans not enrolled in Medicare, VA PC use was not significantly different following MHR for Massachusetts veterans relative to other NE veterans. Among VA-Medicare dual enrollees, MHR was associated with an increase of 24.5 PC visits per 1,000 veterans per quarter (p = .048). Despite new non-VA health options through MHR, VA enrollees continued to rely on VA PC. © The Author(s) 2016.
Healthcare represents a key area in the public agenda. In the case of Chile, this central part of citizen demands has emerged with an increasing criticism of the health system, its actors and institutions, while a major democratic and legitimacy crisis in Chilean society unfolds. The starting point of this analysis is the link between the critical and widespread societal dissatisfaction with the legitimacy crisis in the health sector. There is an interdependence and parallelism between these two different aspects of the crisis. The analysis is built around the dimensions of trust and legitimacy as a potential driver of the conflict, taking as an analytical framework the socio-political matrix. Conceptual elements around the ideas of trust and legitimacy in public policies are reviewed. This article focuses on recent situations surrounding the dynamics of the Chilean health system such as the rise of the Instituciones de Salud Previsional (ISAPRE) and the market-driven health system, the failed health care reform of the last decade, conflicts of interest in the formulation of public policies, loss of legitimacy of healthcare authorities, and the role of the health professionals in this process. Finally, a discussion arises seeking to regain public trust as a central issue for the future development and sustainability of health policies.
Pitonyak, Jennifer S.; Fogelberg, Donald; Leland, Natalie E.
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
Mroz, Tracy M; Pitonyak, Jennifer S; Fogelberg, Donald; Leland, Natalie E
Health reform promotes the delivery of patient-centered care. Occupational therapy's rich history of client-centered theory and practice provides an opportunity for the profession to participate in the evolving discussion about how best to provide care that is truly patient centered. However, the growing emphasis on patient-centered care also poses challenges to occupational therapy's perspectives on client-centered care. We compare the conceptualizations of client-centered and patient-centered care and describe the current state of measurement of client-centered and patient-centered care. We then discuss implications for occupational therapy's research agenda, practice, and education within the context of patient-centered care, and propose next steps for the profession. Copyright © 2015 by the American Occupational Therapy Association, Inc.
Vezure Oana Sabina
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.
Full Text Available Abstract This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that must be addressed in order to strengthen the public health workforce. The public health workforce is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organizational base. Although the public health workforce is central to the performance of health systems, very little is known about its composition, training or performance. The key policy question is: Should governments invest more in building and supporting the public health workforce and infrastructure to ensure the more effective functioning of health systems? Other questions concern: the nature of the public health workforce, including its size, composition, skills, training needs, current functions and performance; the appropriate roles of the workforce; and how the workforce can be strengthened to support new approaches to priority health problems. The available evidence to shed light on these policy issues is limited. The World Health Organization is supporting the development of evidence to inform discussion on the best approaches to strengthening public health capacity in developing countries. WHO's priorities are to build an evidence base on the size and structure of the public health workforce, beginning with ongoing data collection activities, and to map the current public health training programmes in developing countries and in Central and Eastern Europe. Other steps will include developing a consensus on the desired functions and activities of the public health workforce and developing a framework and methods for assisting countries to assess and enhance the performance of public health training institutions and of the public health workforce.
doctors, nurses, lawyers, and architects can enjoy the benefits of the 2005/36/EC Directive amended by 2013/55/EU Directive on the recognition of professional qualifications, public health professionals are left out from these influential (elite professions. Firstly, we use the profession traits theory as a framework in arguing whether public health can be a legitimate profession in itself; secondly, we explain who public health professionals are and what usually is required for shaping the public health profession; and thirdly, we attempt to sketch the road to the authorisation or licensing of public health professionals. Finally, we propose some recommendations.
Sallis, James F.; McKenzie, Thomas L.
Analyzes contributions physical education makes to child and adult health. Topics discussed are current levels of U.S. children's physical activity; status of elementary physical education programs; health-related physical activity interventions; public health analysis of elementary physical education; and public health role and goal for physical…
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.
This mixed methods study examined the relationship between the motivations for attending college of undergraduate students with a focus on students with a public health major, and their desire to pursue graduate training in public health and subsequently, public health careers. The study highlighted the current public health workforce shortage and…
Reviews of public health emergency responses have identified a need for crisis leadership skills in health leaders, but these skills are not routinely taught in public health curricula. To develop criteria for crisis leadership in public health, published sources were reviewed to identify attributes of successful crisis leadership in aviation, public safety, military operations, and mining. These sources were abstracted to identify crisis leadership attributes associated with those disciplines and compare those attributes with crisis leadership challenges in public health. Based on this review, the following attributes are proposed for crisis leadership in public health: competence in public health science; decisiveness with flexibility; ability to maintain situational awareness and provide situational assessment; ability to coordinate diverse participants across very different disciplines; communication skills; and the ability to inspire trust. Of these attributes, only competence in public health science is currently a goal of public health education. Strategies to teach the other proposed attributes of crisis leadership will better prepare public health leaders to meet the challenges of public health crises.
U.S. Department of Health & Human Services — A set of seven (7) public use files containing information on health insurance issuers participating in the Health Insurance Marketplace and certified qualified...
"This text has a large emphasis on mixed methods, examples relating to health research, new exercises pertaining to health research, and an introduction on qualitative and mixed methods in public health...
This paper outlines some general lessons developing nations can draw from the health system reform experiences of developed nations. Using the experiences of developed countries, developing countries should be better able to anticipate socio-economic changes and choose an optimal path for their health systems development to accompany those changes. Most developed countries have adopted rather common objectives and principles in their health systems because of market failure in health care; developing countries may start adopting those principles because they do not have market conditions in the first place. It is suggested that developing countries strengthen what is probably the most fundamental initial systemic asset they have: public finance. They should do so by attracting democratically, possibly through earmarked taxes, resources otherwise channelled through the private sector, competing with public finance for limited real resources. This effort can be promoted by giving consumers, mainly of high income groups and in urban areas, more say (through institutions performing the OMCC function) in the nature of care these groups have access to under auspices of public finance. Where feasible, private insurance as a major source of finance should be seen as a transitional phenomenon, giving way to the emergence of OMCC institutions which require similar financial and managerial market infrastructure. Private and competitive provision of care may be unrealistic in many developing areas because of both scarcity of real resources, mainly manpower, and health needs. The challenge of government is, as resources grow, to divest itself from the provision of care and stay involved in activities and facilities that are of 'public nature'--under specific circumstances--that foster private competitive provision. In general, the government should play an enabling role also by investing in health promotions and management skills for health systems.
Leipert, B D
It is a well-known fact that nursing and feminism have enjoyed an uneasy alliance. In recent years, however, nursing has begun to recognize the importance of feminism. Nevertheless, the literature still rarely addresses the relevance of feminism for public health nursing. In this article, I articulate the relevance of feminism for public health nursing knowledge and practice. First, I define and describe feminism and public health nursing and then I discuss the importance of feminism for public health nursing practice. The importance of feminism for the metaparadigm concepts of public health nursing is then reviewed. Finally, I examine several existing challenges relating to feminism and public health nursing research, education, and practice. The thesis of this article is that feminism is vitally important for the development of public health nursing and for public health care.
Hill, Peter S; Dodd, Rebecca; Dashdorj, Khurelmaa
Since its transition to democracy, Mongolia has undergone a series of reforms, both at national level and in the health sector. This paper examines the pace and scope of these reforms, the ways in which they have impacted on sexual and reproductive health services and their implications for the health workforce. Formerly pro-natalist, Mongolia has made significant advances in contraceptive use, women's education and reductions in maternal mortality. However, rising adolescent pregnancy and sexually transmitted infections, and persisting high levels of abortion, remain challenges. The implementation of the National Reproductive Health Programme has targeted skills development, outreach and the provision of resources. Innovative adolescent-friendly health services have engaged urban youth, and the development of family group practices has created incentives to provide primary medical care for marginalised communities, including sexual and reproductive health services. The Health Sector Strategic Masterplan offers a platform for coordinated development in health, but is threatened by a lack of consensus in both government and donor communities, competing health priorities and the politicisation of emerging debates on fertility and abortion. With previous gains in sexual and reproductive health vulnerable to political change, these tensions risk the exacerbation of existing disparities and the development by default of a two-tiered health care system.
Full Text Available Purpose: the article aims to analyse the reform of the European Union public procurement law on social aspects in different stages of the reformed public procurement procedures. Comprehensive reform of the European Union public procurement law was approved by the European Parliament in January 2014, adopted by the Council in February 2014, and legislative acts published on 28 March 2014. The current directives 2004/18/EC on procurement in public works, supply and service contracts, as well as 2004/17/EC on procurement in the water, energy, transport and postal services sectors were updated. Additionally, the new directive 2014/23/EU on the award of the concession contracts providing an orientation previously given only by the case law of the Court of Justice of the European Union was adopted. Among other things the reform is highly focused on greater scope of social issues to be addressed in the public procurement procedures. The authors’ aim to analyse the way social issues are being tackled under the new directives. Design/methodology/approach – logical systematic method will be used in order to ascertain the content of the laws within the scope of the social aspects, whereas comparative method will be applied to ascertain national and European Union legal acts. On the basis of analytical method conclusions will be drawn. Findings – the authors will focus on legal analysis and considerations on social aspects in different stages of the reformed public procurement procedures ie in the stage when deciding on the subject-matter of the contract and the technical specifications, in the qualitative selection, in applying the award criteria and in the stage of performance of the contract. Research limitations/implications – the new directives also set new mandatory grounds related to the infringements of social and labour laws for excluding suppliers from the competitions for contracts, though the Paper will not analyse in-depth the legal
Markiewicz, Milissa; Bevc, Christine A; Hegle, Jennifer; Horney, Jennifer A; Davies, Megan; MacDonald, Pia D M
In 2003, 11 public health epidemiologists were placed in North Carolina's largest hospitals to enhance communication between public health agencies and healthcare systems for improved emergency preparedness. We describe the specific services public health epidemiologists provide to local health departments, the North Carolina Division of Public Health, and the hospitals in which they are based, and assess the value of these services to stakeholders. We surveyed and/or interviewed public health epidemiologists, communicable disease nurses based at local health departments, North Carolina Division of Public Health staff, and public health epidemiologists' hospital supervisors to 1) elicit the services provided by public health epidemiologists in daily practice and during emergencies and 2) examine the value of these services. Interviews were transcribed and imported into ATLAS.ti for coding and analysis. Descriptive analyses were performed on quantitative survey data. Public health epidemiologists conduct syndromic surveillance of community-acquired infections and potential bioterrorism events, assist local health departments and the North Carolina Division of Public Health with public health investigations, educate clinicians on diseases of public health importance, and enhance communication between hospitals and public health agencies. Stakeholders place on a high value on the unique services provided by public health epidemiologists. Public health epidemiologists effectively link public health agencies and hospitals to enhance syndromic surveillance, communicable disease management, and public health emergency preparedness and response. This comprehensive description of the program and its value to stakeholders, both in routine daily practice and in responding to a major public health emergency, can inform other states that may wish to establish a similar program as part of their larger public health emergency preparedness and response system.
Full Text Available Abstract Background In 2003, 11 public health epidemiologists were placed in North Carolina's largest hospitals to enhance communication between public health agencies and healthcare systems for improved emergency preparedness. We describe the specific services public health epidemiologists provide to local health departments, the North Carolina Division of Public Health, and the hospitals in which they are based, and assess the value of these services to stakeholders. Methods We surveyed and/or interviewed public health epidemiologists, communicable disease nurses based at local health departments, North Carolina Division of Public Health staff, and public health epidemiologists' hospital supervisors to 1 elicit the services provided by public health epidemiologists in daily practice and during emergencies and 2 examine the value of these services. Interviews were transcribed and imported into ATLAS.ti for coding and analysis. Descriptive analyses were performed on quantitative survey data. Results Public health epidemiologists conduct syndromic surveillance of community-acquired infections and potential bioterrorism events, assist local health departments and the North Carolina Division of Public Health with public health investigations, educate clinicians on diseases of public health importance, and enhance communication between hospitals and public health agencies. Stakeholders place on a high value on the unique services provided by public health epidemiologists. Conclusions Public health epidemiologists effectively link public health agencies and hospitals to enhance syndromic surveillance, communicable disease management, and public health emergency preparedness and response. This comprehensive description of the program and its value to stakeholders, both in routine daily practice and in responding to a major public health emergency, can inform other states that may wish to establish a similar program as part of their larger public
Mahmood, Qamar; Muntaner, Carles
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
... RESEARCH MISCONDUCT Definitions § 93.220 Public Health Service or PHS. Public Health Service or PHS means... 42 Public Health 1 2010-10-01 2010-10-01 false Public Health Service or PHS. 93.220 Section 93.220 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS...
CDCâs Office of Public Health Preparedness and Response funds Preparedness and Emergency Response Research Centers (PERRCs) to examine components of the public health system. This podcast is an overview of mental and behavioral health tools developed by the Johns Hopkins PERRC. Created: 8/29/2011 by Emergency Risk Communication Branch (ERCB)/Joint Information Center (JIC); Office of Public Health Preparedness and Response (OPHPR). Date Released: 8/30/2011.
Winder, A.E.; Stanitis, M.A.
Twenty-three public health schools and 492 university schools of nursing were surveyed to gather specific information on educational programs related to nuclear war. Twenty public health schools and 240 nursing schools responded. Nuclear war-related content was most likely to appear in disaster nursing and in environmental health courses. Three schools of public health report that they currently offer elective courses on nuclear war. Innovative curricula included political action projects for nuclear war prevention.
Full Text Available Abstract Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies – decentralization and privatization – have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside.
Jacobson, Peter D; Wasserman, Jeffrey; Wu, Helen W; Lauer, Johanna R
We assessed the feasibility and desirability of public health entrepreneurship (PHE) in governmental public health. Using a qualitative case study approach with semistructured interview protocols, we conducted interviews between April 2010 and January 2011 at 32 local health departments (LHDs) in 18 states. Respondents included chief health officers and senior LHD staff, representatives from national public health organizations, health authorities, and public health institutes. Respondents identified PHE through 3 overlapping practices: strategic planning, operational efficiency, and revenue generation. Clinical services offer the strongest revenue-generating potential, and traditional public health services offer only limited entrepreneurial opportunities. Barriers include civil service rules, a risk-averse culture, and concerns that PHE would compromise core public health values. Ongoing PHE activity has the potential to reduce LHDs' reliance on unstable general public revenues. Yet under the best of circumstances, it is difficult to generate revenue from public health services. Although governmental public health contains pockets of entrepreneurial activity, its culture does not sustain significant entrepreneurial activity. The question remains as to whether LHDs' current public revenue sources are sustainable and, if not, whether PHE is a feasible or desirable alternative.
Full Text Available The adoption of web-based technologies in order to deliver government services has become a global trend in public administration. e-Government also means that governments have to act as a private entity and compete for best delivered services towards citizens due to the societal challenges and shifting relations. But such transformation has significant implications, such as answering in a collaborative, intelligent manner to the needs and demands of the citizens, to the different categories of users including the elderly, women, men, youngsters, or disadvantaged groups. The construction and management of the virtual space becomes an essential element of modern public administration. The assumption is that Governments become more efficient in an electronic “version”. In order to evaluate their e-Government projects governments’ need to point towards the value added that technology is bringing in terms of impact. To conduct such an evaluation one needs to include also the effort put forth in such projects - in terms of financial, human resources, and policy. All three dimensions are equally important and complementary.
David A. Sleet
Full Text Available Injuries are one of the most under-recognized public health problems facing the world today. With more than 5 million deaths every year, violence and injuries account for 9% of global mortality, as many deaths as from HIV, Malaria and Tuberculosis combined. Eight of the 15 leading causes of death for people ages 15 to 29 years are injury-related: road traffic injuries, suicides, homicides, drowning, burns, war injuries, poisonings and falls. For every death due to war, there are three deaths due to homicide and five deaths due to suicide. However, most violence happens to people behind closed doors and results not in death, but often in years of physical and emotional suffering . Injuries can be classified by intent: unintentional or intentional. Traffic injuries, fire-related injuries, falls, drowning, and poisonings are most often classified as unintentional injuries; injuries due to assault, selfinflicted violence such as suicide, and war are classified as intentional injuries, or violence. Worldwide, governments and public and private partners are increasingly aware of the strains that unintentional injuries and violence place on societies. In response they are strengthening data collection systems, improving services for victims and survivors, and increasing prevention efforts .
Full Text Available The current global economic crisis seriously threatens the health of the public. Challenges include increases in malnutrition; homelessness and inadequate housing; unemployment; substance abuse, depression, and other mental health problems; mortality; child health problems; violence; environmental and occupational health problems; and social injustice and violation of human rights; as well as decreased availability, accessibility, and affordability of quality medical and dental care. Health professionals can respond by promoting surveillance and documentation of human needs, reassessing public health priorities, educating the public and policymakers about health problems worsened by the economic crisis, advocating for sound policies and programs to address these problems, and directly providing necessary programs and services.
Annas, George J; Mariner, Wendy K
Public health's reliance on law to define and carry out public activities makes it impossible to define a set of ethical principles unique to public health. Public health ethics must be encompassed within--and consistent with--a broader set of principles that define the power and limits of governmental institutions. These include human rights, health law, and even medical ethics. The human right to health requires governments not only to respect individual human rights and personal freedoms, but also, importantly, to protect people from harm from external sources and third parties, and to fulfill the health needs of the population. Even if human rights are the natural language for public health, not all public health professionals are comfortable with the language of human rights. Some argue that individual human rights--such as autonomy and privacy--unfairly limit the permissible means to achieve the goal of health protection. We argue that public health should welcome and promote the human rights framework. In almost every instance, this will make public health more effective in the long run, because the goals of public health and human rights are the same: to promote human flourishing. Copyright © 2016 by Duke University Press.
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.
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Bazzoli, Gloria J; Clement, Jan P
Hospitals treat many uninsured patients and shoulder substantial amounts of uncompensated care. Health reform as implemented in Massachusetts, then, would be expected to bode well for hospitals as many people obtain coverage from private and public programs. We examined changes in Massachusetts hospital payer mix, unreimbursed costs of care for the uninsured and those in means-tested public programs, and overall financial condition for the period 2004 to 2010. Despite increases in coverage, unreimbursed costs for the uninsured and those in means-tested government programs did not decrease appreciably for Massachusetts hospitals over the study period. Major safety-net hospitals, which play a substantial role in serving the uninsured and Medicaid, had some initial easing of this burden but their financial situation weakened through 2010. The U.S. economic recession and Massachusetts budget pressures, which in part resulted from reform implementation, likely offset advantages hospitals experienced from reductions in the uninsured. Our analysis suggests that state actions in Massachusetts to change payment programs that the two major safety net hospitals relied on to support indigent care contributed to their financial difficulties.
The first stage of three-year health care reform came to ihe end with fruitful achievements, the paper summarize the healthcare reform framework and the main progress. This paper also provides suggestions on next stage reform, including: (1) Health cost containment, since rapidly increasing healthcare costs dilute ihe effect of health insurance; (2) Strengthen the basic healthcare system in community and rural area; (3) Improving the national essential drug system, reforming the drug distribution system; (4) Speeding up the puhlic hospital reform; (5) Setting up the public financing mechanism to insure the suitability of ihe reform.%通过描述新医改的主要内容,总结新医改的主要工作进展和目前所取得的成就与经验,进而提出了在不断深化医药卫生体制改革进程中尚须解决的问题.其中包括:(1)卫生总费用上涨过快,偏离医改初衷；(2)“保基本、强基层”需要进一步落实；(3)基本药物制度的根基尚不稳固,药品流通环节虚高费用还没有降下来；(4)公立医院改革尚未完全破题；(5)保障医改持续进行的长效机制尚未建立.
Ivanov, Luba L; Oden, Tami L
Public health nursing has a code of ethics that guides practice. This includes the American Nurses Association Code of Ethics for Nurses, Principles of the Ethical Practice of Public Health, and the Scope and Standards of Public Health Nursing. Human rights and Rights-based care in public health nursing practice are relatively new. They reflect human rights principles as outlined in the Universal Declaration of Human Rights and applied to public health practice. As our health care system is restructured and there are new advances in technology and genetics, a focus on providing care that is ethical and respects human rights is needed. Public health nurses can be in the forefront of providing care that reflects an ethical base and a rights-based approach to practice with populations.
鲁菁; 方红娟; 王小万
Based on the health reform framework of WHO European Commission “increasing wealth and the promotion of a healthy health system - Tallinn charter”, Health financing has been the key point in the European health care reforms. The paper introduced the policies and measures of health care financing reforms in European countries in recent years. European countries have increased public financial investment, established a diversified funding patterns and risk-sharing mechanisms, maintained the stability of health care system, improved the overall fundˊs risk-resistance ability,taken health services purchasing patterns and changed payment methods to enhance government health financing. These policies and methods have provided experiences for us to learn from in our deepening health reform process.%基于WHO欧洲委员会"增加财富与增进健康的卫生系统--塔林宪章"的卫生改革框架,卫生服务的筹资模式已经成为欧洲卫生改革的重点.本文从卫生筹资的角度系统地介绍了欧洲国家近年来所实施的改革政策与措施.通过增加公共财政投入、建立多元化的筹资模式、维护医疗保险制度的稳定性、提高统筹基金的抗风险能力以及改变支付方式来加强政府卫生筹资,为我国深化卫生改革提供了可借鉴经验.
Chen, Anthony S; Weir, Margaret
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.
Swenson, Peter; Greer, Scott
Existing accounts of the Clinton health reform efforts of the early 1990s neglect to examine how the change in big business reform interests during the short period between the late 1980s and 1994 might have altered the trajectory of compulsory health insurance legislation in Congress. This article explores evidence that big employers lost their early interest in reform because they believed their private remedies for bringing down health cost inflation were finally beginning to work. This had a discouraging effect on reform efforts. Historical analysis shows how hard times during the Great Depression also aligned big business interests with those of reformers seeking compulsory social insurance. Unlike the present case, however, the economic climate did not quickly improve, and the social insurance reform of the New Deal succeeded. The article speculates, therefore, that had employer health expenditures not flattened out, continuing and even growing big business support might have neutralized small business and other opposition that contributed heavily to the failure of reform. Thus in light of the Clinton administration's demonstrated willingness to compromise with business on details of its plan, some kind of major reform might have succeeded.
Gordon, Sarah E; O'Brien, Anthony
New Zealand's Mental Health (Compulsory Assessment and Treatment) Act (the Act) is now over 20 years old. As has occurred historically our conceptualisation of humane treatment of people with mental illness has altered significantly over the period in which the Act has been in force. The emergence of the philosophy of recovery, and its subsequent policy endorsement, has seen a significant shift in mental health service delivery towards a greater emphasis on autonomy. Human rights developments such as New Zealand's ratification of the 2006 United Nations Convention on the Rights of Persons with Disabilities have resulted in compulsory treatment, where it is justified in whole or part by a person's mental illness, now being considered antithetical to best practice, and discriminatory. However the number of people subject to the Act is increasing, especially in community settings, and it is questionable how effective the mechanisms for challenging compulsion are in practice. Moreover, monitoring of the situation at the systemic level lacks critical analysis. Complacency, including no indication that review and reform of this now antiquated legislation is nigh, continues a pattern of old where the situation of people with experience of mental illness is largely ignored and neglected.
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.
Stein, Richard; Davis, Devra Lee
Evaluating the potential health impacts of chemical, physical, and biological environmental factors represents a challenging task with profound medical, public health, and historical implications. The history of public health is replete with instances, ranging from tobacco to lead and asbestos, where the ability to obtain evidence on potential…
Smith, Jason A; Vargo, Jason; Hoverter, Sara Pollock
Climate change poses real and immediate impacts to the public health of populations around the globe. Adverse impacts are expected to continue throughout the century. Emphasizing co-benefits of climate action for health, combining adaptation and mitigation efforts, and increasing interagency coordination can effectively address both public health and climate change challenges.
Hofmarcher, Maria M
The Austrian health system is much more complex and fragmented than in other OECD countries. In 2013 legislation was adopted to enhance efficiency through better balancing care provision across providers by promoting new primary care models and better coordination of care. Reform objectives should be achieved by cooperative and unified decision making across key stakeholders and by adherence to a budget cap that prescribes fiscal containment on the order of 3.4 billion Euros until 2016. This is priced into the envisaged savings of the current consolidation program. Efforts have been made to bridge the accountability divide by establishing agreements and administrative layers to govern the health system by objectives. Yet, more could have been achieved. For example, cross-stakeholder pooling of funds for better contracting governance and effective purchasing across care settings could have been introduced. This would have required addressing over capacity and fragmentation within social security. At the same time, legal provisions for cooperative governance between Sickness Funds and the governments on the regional level should have been stipulated. The Austrian 2013 reform is interesting to other countries as it aims to ensure better-balanced care at a sustainable path by employing a public management approach to governance relations across key payers of care.
administration. Regarding the health status, five years after independence, compared with other European countries, post-war transitional Kosovo is still characterized by higher mortality rates including traditional public health problems pertinent to infant mortality and maternal deaths. In parallel, however, Kosovo is undergoing a rapid process of epidemiological transition characterized by an aging trend which is inevitably coupled with high cardiovascular and cancer mortality and morbidity along with an excess mortality in external causes of death and injuries among the adult population. Adoption of the new Health Law in December 2012 by the Kosovo Assembly aims the transition from centralized health care system established under emergency conditions of the post-war period towards a contemporary modern health care system with a clear purchaser-provider split based on a high transparency and accountability of the health care providers and their contractors. The health care reform, leading eventually to significant changes within the health sector in Kosovo, consists of two main pillars: (i structural and functional reorganization of the health care system through establishment of Kosovo Health Service (an autonomous and non-for-profit public enterprise at central level of the health care sector, and; (ii establishment for the first time of the public health insurance system with a Health Insurance Fund as its main body. Nevertheless, five years after declaration of independence, Kosovo, the newest state in Europe consisting of the youngest population, is currently facing a particularly difficult socioeconomic and political transition and is additionally struggling and mainstreaming all energies and efforts in order to get full international recognition.
Winett, L B
Once viewed primarily as a criminal justice problem, violence and its prevention are now often claimed by public health professionals as being within their purview. The author reviewed 282 articles published in public health and medical journals from 1985 through 1995 that discussed violence as a public health problem. She found that while authors tended to identify social and structural causes for violence, they suggested interventions that targeted individuals' attitudes or behaviors and improved public health practice. Her study illuminates the tension between public health professionals' vision of the social precursors of violence and their attempts to apply a traditional set of remedies. In targeting individuals to rid the nation of violence, the public health community is deemphasizing societal causes.
Burgmair, Wolfgang; Weber, Matthias M
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.
Pendzialek, Jonas B; Danner, Marion; Simic, Dusan; Stock, Stephanie
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.
Mendoza, Roger Lee
The essential health benefits mandate constitutes one of the most controversial health care reforms introduced under the U.S. Affordable Care Act of 2010. It bears important theoretical and practical implications for health care risk and insurance management. These essential health benefits are examined in this study from a rent-seeking perspective, particularly in terms of three interrelated questions: Is there an economic rationale for standardized, minimum health care coverage? How is the scope of essential health services and treatments determined? What are the attendant and incidental costs and benefits of such determination/s? Rents offer ample incentives to business interests to expend considerable resources for health care marketing, particularly when policy processes are open to contestation. Welfare losses inevitably arise from these incentives. We rely on five case studies to illustrate why and how rents are created, assigned, extracted, and dissipated in equilibrium. We also demonstrate why rents depend on persuasive marketing and the bargained decisions of regulators and rentiers, as conditioned by the Tullock paradox. Insights on the intertwining issues of consumer choice, health care marketing, and insurance reform are offered by way of conclusion.
Braendle, Thomas; Colombier, Carsten
A better understanding of the determinants of public health care expenditures is key to designing effective health policies. We integrate demand and supply-side determinants and factors from political economy into an empirical analysis of the highly decentralized Swiss health care system and control for major health care finance reforms. We compile a novel data set of the cantonal health care expenditure in Switzerland, which currently amounts to about one fifth of total health care expenditure. We analyze the period 1970-2012 and use dynamic panel estimation methods. We find that per capita income, the unemployment rate and the share of foreigners are positively related to public health care expenditure growth. With regard to political economy aspects, public health care expenditures increase with the share of women elected to parliament. However, institutional restrictions for politicians, such as fiscal rules, do not appear to limit public health care expenditure growth. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
It is implied by governing organizations that Australia is presently experiencing its first national curriculum reform, when as the title suggests it is the second. However, until now Australian states and territories have been responsible for the education curriculum delivered within schools. The present national curriculum reform promises one…
It is implied by governing organizations that Australia is presently experiencing its first national curriculum reform, when as the title suggests it is the second. However, until now Australian states and territories have been responsible for the education curriculum delivered within schools. The present national curriculum reform promises one…
Inhorn, Stanley L.; Astles, J. Rex; Gradus, Stephen; Malmberg, Veronica; Snippes, Paula M.; Wilcke, Burton W.; White, Vanessa A.
This article describes the development since 2000 of the State Public Health Laboratory System in the United States. These state systems collectively are related to several other recent public health laboratory (PHL) initiatives. The first is the Core Functions and Capabilities of State Public Health Laboratories, a white paper that defined the basic responsibilities of the state PHL. Another is the Centers for Disease Control and Prevention National Laboratory System (NLS) initiative, the go...
Mónica Marcela Jiménez
Full Text Available Introduction: During the last years Colombian health policy has experienced deep changes whose effects on public health are controversial. Objectives: Case study carried out in two municipalities in order to describe the changes in malaria control program and its relationship with Colombian health reforms. Methodology: The municipalities of Zaragoza and Tarazá were selected because they present high rates of malaria incidence in the department (state of Antioquia, Colombia. The study combined qualitative and quantitative techniques to obtain and to process the information. The official files of the program were analyzed for the period 1982-2004. Key informants, selected by their experience with malaria and its control programs, were interviewed. Results: In connection with the policy for malaria control, three moments were identified: the vertical program under Ministry of Health (1975-1982 responsability; the departmental program (19831990; and the organization of the program according to the regulated competition model (1991-2004. During the second moment improvement in the control activities accompanied by a reduction of the mortality were observed. Since 1991, a deterioration in the control of malaria, associated to the decentralization and the subjection of the sanitary politics to the principles of the market, was noted; this deterioration is characterized by the progressive lost of force of the responsibility of the State on malaria control, the loss of the installed capacity and the Know-How, the fragmentation of control actions, the collapse of information systems and the deterioration of mortality and morbidity indicators. Conclusions: Both observed cases suggest a detriment in the efficiency, effectiveness and quality of malaria control actions, associated with health reforms implemented in Colombia since 90s, which could also be present in other municipalities of the country.
Gabriel Astoni Sena
Full Text Available DOI: http://dx.doi.org/10.5007/2175-8077.2012v14n33p68This article aims to identify the profile of the brazilian Judiciary Reform, by examining the process of state reform. In this sense, the focus of the study was to identify the process of replacing the bureaucratic model for the management, implemented in the Brazilian public administration since 1995, trying to transplant it to the judicial management. In this sense, the paper noted that the National Council of Justice has exercised in this process and the logic of the plan goals of the institution, seeking to describe the bias of this reform. The results showed that sought to implement the goals established for more effective management in the strategic core of the state, with emphasis on promptness. Thus, the managerial logic exercised great influence in the new management model adopted with a view that the guidelines of the reform focused on the strategic objectives of this power and not the fiscal logic, predominantly economistic. It should be noted that not intend to exhaust the subject, however, is necessary to create a framework for debate, to discuss the consequences of adopting this model in the management of the judiciary and its consequences for Brazilian society.
Po-wah, J T
This paper aims to provide a rendition of the care ethic in Confucian philosophy and to argue that social policy developments in Hong Kong society, including health care policy, have been significantly shaped and justified in terms of the ideal of care in the Confucian moral tradition. On the basis of this analysis, the paper raises a number of questions about a recent proposal for health care reform for Hong Kong put forth by the Harvard School of Public Health which argues for adopting the principle of equity as the overriding value for the moral foundation of Hong Kong's health care system. The paper examines how the over-emphasis on equity in the Harvard Report proposals can lead to the erosion of care and ultimately the eclipse of the vision of care in Hong Kong's health care system. It argues that the pursuit of equity, which is itself a valuable principle, should not displace the importance of the value of care or undermine the ideal of care and that health care decisions must be firmly embedded in local cultures and moral traditions.
Dragoi Mihaela Cristina
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
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.
Alexandrova-Yankulovska, S; Bozhinov, P; Bojinova, S
Medical progress has enabled achievements that were not even thinkable earlier but at the same time society and public health have had to face new challenges. What are we ready to accept in the area of human reproduction? This paper aims at ethical analysis of Bulgarian laws on reproduction. The abortion debate nowadays has got new dimiension focusing not that much on its moral acceptability but rather on the acceptable indications for its performance. Is it ethical to perform abortion in case of undesired gender of the embryo or genetic malformations? Lots of moral issues mark the area of assisted reproduction which is due to the separation of the reproductive functions (ova, sperm and embryo donation, surrogacy), fragmentation of motherhood and fatherhood, differentiation of biological and social parenthood. Defining limits of acceptable interference or non-interference in human reproduction will never be easy, but dynamics of moral judgment shouldn't bother us. The rigidity of moral norms is what should be alarming because it threatens procreative autonomy.
Ambegaokar, Maia; Lush, Louisiana
Advocates of health system reform are calling for, among other things, decentralized, autonomous managerial and financial control, use of contracting and incentives, and a greater reliance on market mechanisms in the delivery of health services. The family planning and sexual health (FP&SH) sector already has experience of these. In this paper, we set forth three typical means of service provision within the FP&SH sector since the mid-1900s: independent not-for-profit providers, vertical government programmes and social marketing programmes. In each case, we present the context within which the service delivery mechanism evolved, the management techniques that characterize it and the lessons learned in FP&SH that are applicable to the wider debate about improving health sector management. We conclude that the FP&SH sector can provide both positive and negative lessons in the areas of autonomous management, use of incentives to providers and acceptors, balancing of centralization against decentralization, and employing private sector marketing and distribution techniques for delivering health services. This experience has not been adequately acknowledged in the debates about how to improve the quality and quantity of health services for the poor in developing countries. Health sector reform advocates and FP&SH advocates should collaborate within countries and regions to apply these management lessons.
Stanhope, Victoria; Choy-Brown, Mimi; Barrenger, Stacey; Manuel, Jennifer; Mercado, Micaela; McKay, Mary; Marcus, Steven C
Under the Affordable Care Act, States have obtained Medicaid waivers to overhaul their behavioral health service systems to improve quality and reduce costs. Critical to implementation of broad service delivery reforms has been the preparation of organizations responsible for service delivery. This study focused on one large-scale initiative to overhaul its service system with the goal of improving service quality and reducing costs. The study examined the participation of behavioral health organizations in technical assistance efforts and the extent to which organizational factors related to their participation. This study matched two datasets to examine the organizational characteristics and training participation for 196 behavioral health organizations. Organizational characteristics were drawn from the Substance Abuse and Mental Health Services Administration National Mental Health Services Survey (N-MHSS). Training variables were drawn from the Clinical Technical Assistance Center's master training database. Chi-square analyses and multivariate logistic regression models were used to examine the proportion of organizations that participated in training, the organizational characteristics (size, population served, service quality, infrastructure) that predicted participation in training, and for those who participated, the type (clinical or business) and intensity of training (webinar, learning collaborative, in-person) they received. Overall 142 (72. 4%) of the sample participated in training. Organizations who pursued training were more likely to be large in size (p = .02), serve children in addition to adults (p organizational readiness for health care reform initiatives among behavioral health organizations.
Collier, M T; Lambropoulos, A S; Williams-Glasser, G; Baron, S T; Birkmeyer, J
The Institute of Medicine's The Future of Public Health calls for a strengthening of linkages between public health and mental health, with a view to integrating the functions at the service delivery level. This paper details the history of the mental health/public health interface in Baltimore, Maryland. In 1977, mental health and addiction services were merged into the Department of Health. More recently, in 1988 adult mental health services were split off into a quasi-public corporation. Children's mental health, however, was retained as a distinct service within the Department of Health in order to enhance coordination with other health services for children. Replication of such coordinated-care models is certainly feasible.
Evans, W Douglas; Blitstein, Jonathan; Hersey, James C; Renaud, Jeanette; Yaroch, Amy L
Brands build relationships between consumers and products, services, or lifestyles by providing beneficial exchanges and adding value to their objects. Brands can be measured through associations that consumers hold for products and services. Public health brands are the associations that individuals hold for health behaviors, or lifestyles that embody multiple health behaviors. We systematically reviewed the literature on public health brands; developed a methodology for describing branded health messages and campaigns; and examined specific branding strategies across a range of topic areas, campaigns, and global settings. We searched the literature for published studies on public health branding available through all relevant, major online publication databases. Public health branding was operationalized as any manuscripts in the health, social science, and business literature on branding or brands in health promotion marketing. We developed formalized decision rules and applied them in identifying articles for review. We initially identified 154 articles and reviewed a final set of 37, 10 from Africa, Australia, and Europe. Branded health campaigns spanned most of the major domains of public health and numerous communication strategies and evaluation methodologies. Most studies provided clear information on planning, development, and evaluation of the branding effort, while some provided minimal information. Branded health messages typically are theory based, and there is a body of evidence on their behavior change effectiveness, especially in nutrition, tobacco control, and HIV/AIDS. More rigorous research is needed, however, on how branded health messages impact specific populations and behaviors.
Ogilvie, David; Craig, Peter; Griffin, Simon; Macintyre, Sally; Wareham, Nicholas J
The paradigm of translational medicine that underpins frameworks such as the Cooksey report on the funding of health research does not adequately reflect the complex reality of the public health environment...
and cardiovascular diseases. There exists enormous potential to promote health and prevent diseases through targeting unhealthy life style, and it is crucial to develop a qualified public health nutrition workforce to reduce the NCD burden. Professionals with broad capacity within the field of public health...... nutrition are necessary to identify and respond to the current health challenges. However, public health nutrition has not been recognized as a profession in all countries. Public health nutrition (PHN) is an evolving profession within nutrition science that focuses on solving nutritional problems affecting...... population groups rather than those of individuals. Central elements of the profession are to assess the impact of various aspects of the food systems on the nutritional status, health and health inequalities of population groups, and to develop, recommend and implement evidence-based measures to improve...
Full Text Available BACKGROUND: Many former Soviet Union (fSU countries face a high burden of disease and a much lower life expectancy compared to western countries. Many of the underlying causes are amenable to public health interventions, but the prevailing Soviet approach to prevention has largely failed to address the new and more complex public health issues these countries face. This study looks at public health challenges in Ukraine, in particular at those related to public health education. METHODS: The research is based on a small-scale, qualitative analysis of information collected through i review of literature related to public health and public health education in the former Soviet Union and Ukraine, as well as curricula and training material for epidemiology students in Ukrainian medical schools, ii observations during workshops for epidemiology students and teachers from Ukrainian medical schools and iii semi-structured interviews with epidemiology students and teachers from Ukrainian medical schools. The collected data was interpreted using the method of thematic discourse analysis, which allowed identifying major areas challenging public health education in the country. RESULTS: The main challenges identified were seen in the outdated conceptual understanding of public health, particularly in epidemiology. These challenges underlie further problems including limited hours and narrow content of epidemiology training, lack of training in research skills, inadequate training material and conservative attitudes among teachers and students towards prevailing ideas and development. DISCUSSION AND CONCLUSION: There is urgent need for a wider definition of public health, moving towards the “New Public Health” approach and subsequently a series of changes to education curricula and materials. Curricula reform should provide additional hours for covering non-communicable diseases, non-medical topics such as health policy and health promotion and ensure
Carolyn K. Shue
Full Text Available Since passage of the Affordable Care Act (ACA was signed into law by President Barrack Obama, little is known about state-level perceptions of residents on the ACA. Perceptions about the act could potentially affect implementation of the law to the fullest extent. This 3-year survey study explored attitudes about the ACA, the types of information sources that individuals rely on when creating those attitudes, and the predictors of these attitudes among state of Indiana residents. The respondents were split between favorable and unfavorable views of the ACA, yet the majority of respondents strongly supported individual components of the act. National TV news, websites, family members, and individuals’ own reading of the ACA legislation were identified as the most influential information sources. After controlling for potential confounders, the respondent’s political affiliation, age, sex, and obtaining ACA information from watching national television news were the most important predictors of attitudes about the ACA and its components. These results mirror national-level findings. Implications for implementing health care reform at the state-level are discussed.
Policy is an important feature of public and private organizations. Within the field of health as a policy arena, public health has emerged in which policy is vital to decision making and the deployment of resources. Public health practitioners and students need to be able to analyze public health policy, yet many feel daunted by the subject's complexity. This article discusses three approaches that simplify policy analysis: Bacchi's "What's the problem?" approach examines the way that policy represents problems. Colebatch's governmentality approach provides a way of analyzing the implementation of policy. Bridgman and Davis's policy cycle allows for an appraisal of public policy development. Each approach provides an analytical framework from which to rigorously study policy. Practitioners and students of public health gain much in engaging with the politicized nature of policy, and a simple approach to policy analysis can greatly assist one's understanding and involvement in policy work.
This paper explores the consequences of the oft ignored fact that public health insurance must actually be supplied by the state. Depending how the state is modeled, different health insurance outcomes are expected. The benevolent model of the state does not account for many actual features of public health insurance systems. One alternative is to use a standard public choice model, where state action is determined by interaction between self-interested actors. Another alternative--related to a strand in public choice theory--is to model the state as Leviathan. Interestingly, some proponents of public health insurance use an implicit Leviathan model, but not consistently. The Leviathan model of the state explains many features of public health insurance: its uncontrolled growth, its tendency toward monopoly, its capacity to buy trust and loyalty from the common people, its surveillance ability, its controlling nature, and even the persistence of its inefficiencies and waiting lines.
Rabarison, Kristina M; Bish, Connie L; Massoudi, Mehran S; Giles, Wayne H
Contemporary public health professionals must address the health needs of a diverse population with constrained budgets and shrinking funds. Economic evaluation contributes to evidence-based decision making by helping the public health community identify, measure, and compare activities with the necessary impact, scalability, and sustainability to optimize population health. Asking "how do investments in public health strategies influence or offset the need for downstream spending on medical care and/or social services?" is important when making decisions about resource allocation and scaling of interventions.
Kristina M. Rabarison
Full Text Available Contemporary public health professionals must address the health needs of a diverse population with constrained budgets and shrinking funds. Economic evaluation contributes to evidence-based decision making by helping the public health community identify, measure, and compare activities with the necessary impact, scalability, and sustainability to optimize population health. Asking how do investments in public health strategies influence or offset the need for downstream spending on medical care and /or social services? is important when making decisions about resource allocation and scaling of interventions.
Frumkin, Howard; Hess, Jeremy; Luber, George; Malilay, Josephine; McGeehin, Michael
There is scientific consensus that the global climate is changing, with rising surface temperatures, melting ice and snow, rising sea levels, and increasing climate variability. These changes are expected to have substantial impacts on human health. There are known, effective public health responses for many of these impacts, but the scope, timeline, and complexity of climate change are unprecedented. We propose a public health approach to climate change, based on the essential public health services, that extends to both clinical and population health services and emphasizes the coordination of government agencies (federal, state, and local), academia, the private sector, and nongovernmental organizations.
郑振佺; 汪雪莲; 瞿书铭
成功的支付制度改革可以赋予公立医院加强内控的原动力，倒逼公立医院进行改革。支付制度对公立医院实行契约化管理，当公立医院在约定的服务价格下，无法实现既定目标、获得应有回报时，可能会用抗拒、阻碍的方法来应对，反过来影响支付制度改革。支付制度改革成功后，公立医院则应以提高社会效率为指导，加强宏观和微观统筹管理，进行回归公益性的改革。%Successful payment system reform can give the motive force of the public hospitals to strengthen internal control, and push them to reform. The way of insurance payment makes a contract management of public hospital. However, when the public hospitals cannot achieve their goals and get their payment based on the contract service price, it will cause resisting or obstructing in health care, which in turn affect payment reform. After the successful reform of insurance payment, the public hospital should aim to improve their social efficiency, strengthen the macroscopic and microscopic overall management, and regress to their role of public welfare.
Kalita, Anuska; Zaidi, Sarover; Prasad, Vandana; Raman, V R
The Public Health Resource Network is an innovative distance-learning course in training, motivating, empowering and building a network of health personnel from government and civil society groups. Its aim is to build human resource capacity for strengthening decentralized health planning, especially at the district level, to improve accountability of health systems, elicit community participation for health, ensure equitable and accessible health facilities and to bring about convergence in programmes and services. The question confronting health systems in India is how best to reform, revitalize and resource primary health systems to deliver different levels of service aligned to local realities, ensuring universal coverage, equitable access, efficiency and effectiveness, through an empowered cadre of health personnel. To achieve these outcomes it is essential that health planning be decentralized. Districts vary widely according to the specific needs of their population, and even more so in terms of existing interventions and available resources. Strategies, therefore, have to be district-specific, not only because health needs vary, but also because people's perceptions and capacities to intervene and implement programmes vary. In centrally designed plans there is little scope for such adaptation and contextualization, and hence decentralized planning becomes crucial. To undertake these initiatives, there is a strong need for trained, motivated, empowered and networked health personnel. It is precisely at this level that a lack of technical knowledge and skills and the absence of a supportive network or adequate educational opportunities impede personnel from making improvements. The absence of in-service training and of training curricula that reflect field realities also adds to this, discouraging health workers from pursuing effective strategies. The Public Health Resource Network is thus an attempt to reach out to motivated though often isolated health
Full Text Available Abstract The Public Health Resource Network is an innovative distance-learning course in training, motivating, empowering and building a network of health personnel from government and civil society groups. Its aim is to build human resource capacity for strengthening decentralized health planning, especially at the district level, to improve accountability of health systems, elicit community participation for health, ensure equitable and accessible health facilities and to bring about convergence in programmes and services. The question confronting health systems in India is how best to reform, revitalize and resource primary health systems to deliver different levels of service aligned to local realities, ensuring universal coverage, equitable access, efficiency and effectiveness, through an empowered cadre of health personnel. To achieve these outcomes it is essential that health planning be decentralized. Districts vary widely according to the specific needs of their population, and even more so in terms of existing interventions and available resources. Strategies, therefore, have to be district-specific, not only because health needs vary, but also because people's perceptions and capacities to intervene and implement programmes vary. In centrally designed plans there is little scope for such adaptation and contextualization, and hence decentralized planning becomes crucial. To undertake these initiatives, there is a strong need for trained, motivated, empowered and networked health personnel. It is precisely at this level that a lack of technical knowledge and skills and the absence of a supportive network or adequate educational opportunities impede personnel from making improvements. The absence of in-service training and of training curricula that reflect field realities also adds to this, discouraging health workers from pursuing effective strategies. The Public Health Resource Network is thus an attempt to reach out to motivated
Erwin, Paul Campbell; Brownson, Ross C
The requisite capacities and capabilities of the public health practitioner of the future are being driven by multiple forces of change, including public health agency accreditation, climate change, health in all policies, social media and informatics, demographic transitions, globalized travel, and the repercussions of the Affordable Care Act. We describe five critical capacities and capabilities that public health practitioners can build on to successfully prepare for and respond to these forces of change: systems thinking and systems methods, communication capacities, an entrepreneurial orientation, transformational ethics, and policy analysis and response. Equipping the public health practitioner with the requisite capabilities and capacities will require new content and methods for those in public health academia, as well as a recommitment to lifelong learning on the part of the practitioner, within an increasingly uncertain and polarized political environment.
Kierkegaard, Patrick; Kaushal, Rainu; Vest, Joshua R
Increased information availability, timeliness, and comprehensiveness through health information exchange (HIE) can support public health practice. The potential benefits to disease monitoring, disaster response, and other public health activities served as an important justification for the US' investments in HIE. After several years of HIE implementation and funding, we sought to determine if any of the anticipated benefits of exchange participation were accruing to state and local public health practitioners participating in five different exchanges. Using qualitative interviews and template analyses, we identified public health efforts and activities that were improved by participation in HIE. HIE supported public health activities consistent with expectations in the literature. However, no single department realized all the potential benefits of HIE identified. These findings suggest ways to improve HIE usage in public health.
Long, Sharon K; Stockley, Karen; Nordahl, Kate Willrich
While the impacts of the Affordable Care Act will vary across the states given their different circumstances, Massachusetts' 2006 reform initiative, the template for national reform, provides a preview of the potential gains in insurance coverage, access to and use of care, and health care affordability for the rest of the nation. Under reform, uninsurance in Massachusetts dropped by more than 50%, due, in part, to an increase in employer-sponsored coverage. Gains in health care access and affordability were widespread, including a 28% decline in unmet need for doctor care and a 38% decline in high out-of-pocket costs.
Audibert, Martine; Xiao Xian HUANG; Mathonnat, Jacky; Pelissier, Aurore; Anning MA
In the rural health-care organization of China, township hospitals ensure the delivery of basic medical services. Particularly damaged by the economic reforms implemented from 1975 to the end of the 1990s, township hospitals efficiency is questioned, mainly with the implementation since 2003 of the reform of health insurance in rural areas. From a database of 24 randomly selected township hospitals observed over the period 2000-2008 in Weifang prefecture (Shandong), the study examines the eff...
Fairchild, Amy L; Rosner, David; Colgrove, James; Bayer, Ronald; Fried, Linda P
We trace the shifting definitions of the American public health profession's mission as a social reform and science-based endeavor. Its authority coalesced in the late nineteenth and early twentieth centuries as public health identified itself with housing, sanitation, and labor reform efforts. The field ceded that authority to medicine and other professions as it jettisoned its social mission in favor of a science-based identity. Understanding the potential for achieving progressive social change as it moves forward will require careful consideration of the industrial, structural, and intellectual forces that oppose radical reform and the identification of constituencies with which professionals can align to bring science to bear on the most pressing challenges of the day.
Sharma, Anjali; Zodpey, Sanjay P
A competent and motivated health workforce is indispensable to achieve the best health outcomes possible through given available resources and circumstances. However, apart from the shortages and unequal distribution, the workforce has fallen short of responding to the public health challenges of 21 st century also because of primarily the traditional training of health professionals. Although, health professionals have made enormous contributions to health and development over the past century, the 20 th century educational strategies are unfit to tackle 21 st century challenges. One of the key recommendations of the Lancet Commission on Education of Health Professionals is to improve health through reforms of professional education by establishing networks and partnerships which takes advantage of information and communication linkages. The primary goal of this manuscript is to highlight the potential of networks and partnerships in advancing the agenda of educational reforms to revitalize public health education in India. It outlines the current status and expanding scope of public health education in India, existing networks of public health professionals and public health education institutions in the country, and opportunities, advantages and challenges for such networks. Although, we have networks of individuals and institutions in the country, there potential to bring about change has still not being utilized fully and effectively. Immediate collaborative efforts could be directed towards designing and adaptation of competency driven curriculum frameworks suitable of addressing public health challenges of 21 st century, shifting the current focus of curriculum to multidisciplinary public health outlook, developing accreditation mechanisms for both the programs and institutions, engaging in creating job opportunities and designing career pathways for public health professionals in public and private sector. These efforts could certainly be facilitated
Savel, Thomas G; Foldy, Seth
Public health surveillance has benefitted from, and has often pioneered, informatics analyses and solutions. However, the field of informatics also serves other facets of public health including emergency response, environmental health, nursing, and administration. Public health informatics has been defined as the systematic application of information and computer science and technology to public health practice, research, and learning. It is an interdisciplinary profession that applies mathematics, engineering, information science, and related social sciences (e.g., decision analysis) to important public health problems and processes. Public health informatics is a subdomain of the larger field known as biomedical or health informatics. Health informatics is not synonymous with the term health information technology (IT). Although the concept of health IT encompasses the use of technology in the field of health care, one can think of health informatics as defining the science, the how and why, behind health IT. For example, health IT professionals should be able to resolve infrastructure problems with a network connection, whereas trained public health informaticians should be able to support public health decisions by facilitating the availability of timely, relevant, and high-quality information. In other words, they should always be able to provide advice on methods for achieving a public health goal faster, better, or at a lower cost by leveraging computer science, information science, or technology.
Rechel, B; Ahmedov, M; Akkazieva, B; Katsaga, A; Khodjamurodov, G; McKee, M
Since becoming independent at the break-up of the Soviet Union in 1991, the countries of Central Asia have made profound changes to their health systems, affecting organization and governance, financing and delivery of care. The changes took place in a context of adversity, with major political transition, economic recession, and, in the case of Tajikistan, civil war, and with varying degrees of success. In this paper we review these experiences in this rarely studied part of the world to identify what has worked. This includes effective governance, the co-ordination of donor activities, linkage of health care restructuring to new economic instruments, and the importance of pilot projects as precursors to national implementation, as well as gathering support among both health workers and the public.
Deng, F; Lv, J H; Wang, H L; Gao, J M; Zhou, Z L
The Chinese Government claims that China's health policy is primarily focused on prevention. However, this does not appear to be the case. Researchers with an interest in China's health policy may be aware that the Chinese Government launched a health reform in 2009 to improve the health status of the entire population by 2020.(1) This health reform has been in place for 7 years, and only 4 years now remain to achieve the overall objectives by 2020. This study analyzed the main inputs and outputs of China's health reform in order to identify the main problems and highlight the major challenges. It is hoped that this study will provide some reference for health reform in China and other developing countries. This study focused on health, with human resources and healthcare costs as the main input indicators, and 2-week prevalence of illness and prevalence of non-communicable diseases as the main output indicators. By longitudinal comparison of real data from 2009 to 2014, the effects of China's health reform were analyzed to identify the main challenges, enabling suggestions to be made for future reference. This was a retrospective analysis of empirical data. Data were collected between 2009 and 2014 as follows: (1) data on the distribution of healthcare professionals were collected from the Statistical Bulletin of China's Health Development, issued by the National Health and Family Planning Commission every year between 2009 and 2014; (2) data on government health expenditure were obtained from the Annual National Public Fiscal Expenditure Data, released by the Financial Ministry of the People's Republic of China from 2009 to 2014; (3) data on the prevalence of chronic diseases, 2-week prevalence of illness, residents' medical service demands, and utilization of health services were obtained from the Fourth and Fifth National Health Care Surveys in 2008 and 2013; and (4) data on total healthcare expenditure, medical expenditure and out-of-pocket payments were
Heuer, Chelsea A.
Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity. Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health. PMID:20075322
Medeiros, Regianne Leila Rolim; Atkinson, Sarah
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
Medeiros, Regianne Leila Rolim; Atkinson, Sarah
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.
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
DiPietro Mager, Natalie A; Ochs, Leslie; Ranelli, Paul L; Kahaleh, Abby A; Lahoz, Monina R; Patel, Radha V; Garza, Oscar W; Isaacs, Diana; Clark, Suzanne
To collect data on public health collaborations with schools of pharmacy, we sent a short electronic survey to accredited and preaccredited pharmacy programs in 2015. We categorized public health collaborations as working or partnering with local and/or state public health departments, local and/or state public health organizations, academic schools or programs of public health, and other public health collaborations. Of 134 schools, 65 responded (49% response rate). Forty-six (71%) responding institutions indicated collaborations with local and/or state public health departments, 34 (52%) with schools or programs of public health, and 24 (37%) with local and/or state public health organizations. Common themes of collaborations included educational programs, community outreach, research, and teaching in areas such as tobacco control, emergency preparedness, chronic disease, drug abuse, immunizations, and medication therapy management. Interdisciplinary public health collaborations with schools of pharmacy provide additional resources for ensuring the health of communities and expose student pharmacists to opportunities to use their training and abilities to affect public health. Examples of these partnerships may stimulate additional ideas for possible collaborations between public health organizations and schools of pharmacy.
Pascoe, Susan; Pascoe, Robert
This document reports on an in-depth study of the implementation of systemic reform in the state of Victoria. Called Schools of the Future, the reform was significant in its scale and complexity. Within 4 years in Victoria achieved the lowest per-pupil expenditure of any state of Australia. Data on academic achievements have been fragmentary and…
Akintola, S O
The preservation of the public's health is one of the most important goals of government. The enactment and enforcement of law is the primary means by which government can encourage as well as compel conditions for healthier and safer lifestyles. The Law creates and assigns functions for public health authorities. In this regard, law is a fundamental element of effective public health policy and practice. It has played a crucial role in many of public health's greatest achievements. In spite of its contribution to effective Public Health practice, the potential for the application of law to chronic disease prevention and control is yet to be fully recognized. The development and implementation of legal frameworks could broaden the range of effective public health strategies and provide valuable tools for the public health workforce. In order to expand the range of effective public health interventions, the government should use the law as a tool to achieve the goal of preventing chronic diseases and ameliorate the growing epidemic of obesity, heart disease, stroke, cancer and other chronic diseases and their risk factors.
This podcast discusses bullying as a public health problem, and provides information and resources for public health practitioners. Created: 1/19/2012 by National Center for Injury Prevention and Control (NCIPC). Date Released: 1/19/2012.
McKenzie, Thomas L.; Kahan, David
Physical inactivity is a serious public health problem that is associated with numerous preventable diseases. Public health concerns, particularly those related to the increased prevalence of overweight, obesity, and diabetes, call for schools to become proactive in the promotion of healthy, physically active lifestyles. This article begins by…
The topic suggests a conflict between ethics and economy in medical care. It is often argued that today's welfare state in affluent societies with their social insurance systems makes it easier for the doctor to translate ethical demands into reality without being hampered by economic restrictions. Both doctors and patients took advantage of this system of medical care by mingling social guarantees for health with the doctor's income. Hence, medical expenses expanded rapidly, additionally promoted by technical progress in medicine. This entailed a proportionate increase in medical expenses in relation to personal income, especially wage income. Budgets of state authorities were streamlined or deficits became larger. This state of affairs was promoted further by mechanisms of distribution of national income in accordance with the slogan "less state, more market". While national income continued to grow, although at a slower rate, the number of jobless persons grew continually and thus also the social expenses, this was not due, as is usually assumed and pretended, to an economic crisis. Society and economy are facing a crisis of distribution of national income under conditions of technical progress as a job killer, making economic production more productive and efficient. Not taking into account the new challenge of social market economy--the German innovation in market economy creating the economic miracle after World War II--reforms of the system of medical care took place and are still continuing along market principles, particularly the latest German reform law leading to individual contracts between patients and their doctors in respect of cost charging. However, marketing principles promote economy in medicine, but they do not promote medical ethics. Further German guidelines for medical care should take stock of past experiences. There will be more competition in the "growing market of medical care" (private and public) and this will need--as economic
Vissandjee, B; Hemlin, I; Gravel, S; Roy, S; Dupéré, S
Increasing immigration to Quebec has brought to the surface the need for adapting its public health systems and services, particularly in the area of primary care. The challenge is to take the heterogeneous nature of the population into account and to integrate diverse values, experience and know-how into the development of programmes and delivery of services, whilst simultaneously respecting the values of the various care providers and the norms of the institutions in the host country. This article addresses the question of adaptation strategies for health services, and namely the development of prevention and heath promotion programmes in public health within the framework of primary health care services within the intercultural context of Montreal. The issue of adaptation falls within the perspective and mandate of the Quebec government's policy on health and well-being (La politique de santé et du bien-être, 1992). Furthermore, it is a response to frequent demands from various health professionals and groups concerned with the adaptation of public services with respect to intercultural relationships confronted with the emerging realities associated with immigration. The article provides a reflection on specific ways of adapting prevention and health promotion initiatives targeting cultural communities and those who are undergoing immigration procedures or transitions. It also examines the development of ethno-cultural or other indicators which make it possible to capture migration experiences and their health impact. Since the Quebec health and social services system is currently in the process of major reform, it is hoped that it will seize this opportunity in order to make health and social service centres accountable for the adaptation of their programmes and services to the diversity of the populations they serve.
Full Text Available Background: Ethics is a discipline, which primarily deals with what is moral and immoral behavior. Public Health Ethics is translation of ethical theories and concepts into practice to address complex multidimensional public health problems. The primary purpose of this paper was to conduct a narrative literature review-addressing role of ethics in developing curriculum in programs and schools of public health, ethics-related instruction in schools and programs of public health and the role of ethics in developing a competent public health workforce. Methods: An open search of various health databases including Google scholar and Ebscohost yielded 15 articles related to use of ethics in public health practice or public health training and the salient features were reported. Results: Results indicated a variable amount of ethics' related training in schools and programs of public health along with public health practitioner training across the nation. Bioethics, medical ethics and public health ethics were found to be subspecialties' needing separate ethical frameworks to guide decision making.Conclusions: Ethics based curricular and non-curricular training for emerging public health professionals from schools and programs of public health in the United States is extremely essential. In the current age of public health challenges faced in the United States and globally, to have an ethically untrained public health force is arguably, immoral and unethical and jeopardizes population health. There is an urgent need to develop innovative ethic based curriculums in academia as well as finding effective means to translate these curricular competencies into public health practice.
Hill, H W
Public health is the science and art of conscious physical adjustment between man and his surroundings in the universe. The modern conception of man as a product of and a part of nature brings the subject of man's individual physical adjustments with his immediate surroundings into its proper place as the fundamental study-the basis of every form of education. Hence, public health is not only eligible for a position as an independent faculty in any university but is as definitely entitled to such a place as any of those now recognized. It is futile to consider the ordinary 45 hour course in public health, furnished as an incident in the ordinary 4000 to 5000 hour medical course, as more than a smattering, offered to medical students alone, of the 900 to 4500 hour courses in public health offered to professional public health students.
Friel, Sharon; Hattersley, Libby; Townsend, Ruth
Twenty-first-century trade policy is complex and affects society and population health in direct and indirect ways. Without doubt, trade policy influences the distribution of power, money, and resources between and within countries, which in turn affects the natural environment; people's daily living conditions; and the local availability, quality, affordability, and desirability of products (e.g., food, tobacco, alcohol, and health care); it also affects individuals' enjoyment of the highest attainable standard of health. In this article, we provide an overview of the modern global trade environment, illustrate the pathways between trade and health, and explore the emerging twenty-first-century trade policy landscape and its implications for health and health equity. We conclude with a call for more interdisciplinary research that embraces complexity theory and systems science as well as the political economy of health and that includes monitoring and evaluation of the impact of trade agreements on health.
Khoon, Chan Chee
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.
Pereira, Chrystian; McNamara, Anusha; Sorge, Lindsay; Arya, Vibhuti
To describe the creation of a health avatar, with the goals of providing patients with complete health information from various sources, establishing an interactive and customizable platform, empowering users to determine how the health information best fits or speaks to their personal needs, and providing perspective by comparing the health status of the individual with that of the individual's community. The Internet is rapidly becoming integrated into Americans' daily lives. According to the 2007 Health Information National Trends Study, 69% of U.S. adults had access to the Internet and 23% reported using a social networking site. The impact of social media has further grown, and an estimated 50% of adults in America have a profile on social media. The potential for using cyber communities to improve health messaging is great. Several health care organizations have implemented the use of social media in a variety of ways to varying degrees of success. We propose a platform that automatically gathers information and reflects the health status of an individual back to the user. An avatar, which is a representation of a user, could be created and assigned characteristics that allow users to appreciate their health status. The health avatar platform also would allow users to compare their personal status with that of their community. The overall goal is to engage and then motivate users to improve their overall health status. Medicine must acknowledge the evolving relationships that the next generation of patients will have with technology. The health avatar is a platform that incorporates a connection with the health system through electronic medical records and connects individuals to the greater community.
Tarin, Ehsanullah; Green, Andrew; Omar, Maye; Shaw, Jane
The health sector in the Punjab (Pakistan) faces many problems, and, the government introduced reforms during 1993-2000. This paper explores the policy process for the reforms. A case study method was used and, to assist this, a conceptual framework was developed. Analysis of four initiatives indicated that there were deviations from the government guidelines and that the policy processes used were weak. The progress of different reforms was affected by a variety of factors: the immaturity of the political process and civil society, which together with innate conservatism and resistance to change on the part of the bureaucracy resulted in weak strategic sectoral leadership and a lack of clear purpose underpinning the reforms. It also resulted in weaknesses in preparation of the detail of reforms leading to poor implementation. The study suggests a need for broadening the stakeholders' base, building the capacity of policy-makers in policy analysis and strengthening the institutional basis of policymaking bodies.
Myers, Julie; Frieden, Thomas R; Bherwani, Kamal M; Henning, Kelly J
Public health agencies increasingly use electronic means to acquire, use, maintain, and store personal health information. Electronic data formats can improve performance of core public health functions, but potentially threaten privacy because they can be easily duplicated and transmitted to unauthorized people. Although such security breaches do occur, electronic data can be better secured than paper records, because authentication, authorization, auditing, and accountability can be facilitated. Public health professionals should collaborate with law and information technology colleagues to assess possible threats, implement updated policies, train staff, and develop preventive engineering measures to protect information. Tightened physical and electronic controls can prevent misuse of data, minimize the risk of security breaches, and help maintain the reputation and integrity of public health agencies.
In this podcast, Erin Edgerton, CDC, and Eric Holman, President of SmartReply, discuss why mobile technologies are an important communications tool for disseminating health messages. Created: 9/5/2008 by National Center for Health Marketing (NCHM), Division of eHealth Marketing (DeHM). Date Released: 1/12/2009.
Ivanov, L Louise; Paganpegara, Galina
The collapse of the Soviet Union in 1990 brought many changes to Russia, including changes in nursing education. However, the changes did not include content in public health nursing. Most health care in Russia is provided at the tertiary level in hospitals. Health promotion and health education are new concepts in Russia and are not well understood. When health education does occur, it is at the individual level, taught by physicians, and in response to new diagnoses. Health promotion at the primary level and with aggregates is not often practiced. Russia currently is in a demographic crisis where health indicators continue to decline. Russian nurses trained in public health principles, such as health promotion, health education, and providing primary and secondary prevention services at the population and aggregate level, can positively affect the current demographic crisis.
Mustafa, Mybera; Berisha, Merita; Lenjani, Basri
Before its collapse, Kosovo's healthcare system was an integrated part of the Former Yugoslav Republics System (known as relatively well advanced for its time). Standstill had begun in the last decade of the twentieth century as the result of political disintegration of the former state. The enthusiasm of the healthcare professionals and the people of Kosovo that at the end of the conflict healthcare services will consolidate did not prove just right. Although we can claim that reorganization of Kosovo healthcare was a serious push (especially in the first years after the conflict), the intensity of development begun to fall at the latter stages. Although the basic legislation for the operation of the Healthcare System today in Kosovo does exist, the largest cause for the reform stagnation is where the law is not implemented properly and measures are not set as to a meaningful system of accountability. Twelve years have passed by since the 1999 war-conflict and, although, Kosovo has made progress in many other spheres, it has not yet reached to consolidate a health system comparable to those of other European countries. Intending to get out of difficult situation, several healthcare strategic plans have been developed in the past decade in Kosovo, but attempts in this direction have not been particularly fruitful. This script describes the actual Healthcare complexity of a situation in Kosovo 12 years after the end of the 1999 war-conflict. Interconnection and historical background is also looked upon and is described in the flow of events. Finally, the description of transfer competencies from international administrators to the local authorities as well as the flow of strategic planning that took place since 1999 has also been analyzed.
Holahan, J; Zedlewski, S
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.
Croner, Charles M
Internet access and use of georeferenced public health information for GIS application will be an important and exciting development for the nation's Department of Health and Human Services and other health agencies in this new millennium. Technological progress toward public health geospatial data integration, analysis, and visualization of space-time events using the Web portends eventual robust use of GIS by public health and other sectors of the economy. Increasing Web resources from distributed spatial data portals and global geospatial libraries, and a growing suite of Web integration tools, will provide new opportunities to advance disease surveillance, control, and prevention, and insure public access and community empowerment in public health decision making. Emerging supercomputing, data mining, compression, and transmission technologies will play increasingly critical roles in national emergency, catastrophic planning and response, and risk management. Web-enabled public health GIS will be guided by Federal Geographic Data Committee spatial metadata, OpenGIS Web interoperability, and GML/XML geospatial Web content standards. Public health will become a responsive and integral part of the National Spatial Data Infrastructure.