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

Science.gov (United States)

Goic, Alejandro

2015-06-01

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

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

Science.gov (United States)

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

2012-06-01

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

Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area

Directory of Open Access Journals (Sweden)

Niakas Dimitris

2006-11-01

Full Text Available Abstract Background Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors. Methods Data was obtained from a representative sample (N = 1426 residing in the broader Athens area (response rate 70.6%. Perceived health-related quality of life (HRQOL, as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a last-month visits to public sector physicians, b last-month visits to private sector physicians, c last-year visits to hospital emergency departments and d last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models. Results Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector. Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care. Conclusion This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.

Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area.

Science.gov (United States)

Pappa, Evelina; Niakas, Dimitris

2006-11-02

Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors. Data was obtained from a representative sample (N = 1426) residing in the broader Athens area (response rate 70.6%). Perceived health-related quality of life (HRQOL), as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a) last-month visits to public sector physicians, b) last-month visits to private sector physicians, c) last-year visits to hospital emergency departments and d) last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models. Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector). Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care. This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.

Public trust in health care : Exploring the mechanisms

NARCIS (Netherlands)

van der Schee, E.

2016-01-01

The aim of this thesis is to investigate how public trust in health care is formed, by studying the mechanisms behind it, addressing the following research question: ‘Which mechanisms explain differences in public trust in health care?’. Public trust in health care is important. Low levels of trust

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

Science.gov (United States)

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

2017-12-01

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

Assessing the Capacity of the US Health Care System to Use Additional Mechanical Ventilators During a Large-Scale Public Health Emergency.

Science.gov (United States)

Ajao, Adebola; Nystrom, Scott V; Koonin, Lisa M; Patel, Anita; Howell, David R; Baccam, Prasith; Lant, Tim; Malatino, Eileen; Chamberlin, Margaret; Meltzer, Martin I

2015-12-01

A large-scale public health emergency, such as a severe influenza pandemic, can generate large numbers of critically ill patients in a short time. We modeled the number of mechanical ventilators that could be used in addition to the number of hospital-based ventilators currently in use. We identified key components of the health care system needed to deliver ventilation therapy, quantified the maximum number of additional ventilators that each key component could support at various capacity levels (ie, conventional, contingency, and crisis), and determined the constraining key component at each capacity level. Our study results showed that US hospitals could absorb between 26,200 and 56,300 additional ventilators at the peak of a national influenza pandemic outbreak with robust pre-pandemic planning. The current US health care system may have limited capacity to use additional mechanical ventilators during a large-scale public health emergency. Emergency planners need to understand their health care systems' capability to absorb additional resources and expand care. This methodology could be adapted by emergency planners to determine stockpiling goals for critical resources or to identify alternatives to manage overwhelming critical care need.

Domestic violence against women, public policies and community health workers in Brazilian Primary Health Care.

Science.gov (United States)

Signorelli, Marcos Claudio; Taft, Angela; Pereira, Pedro Paulo Gomes

2018-01-01

Domestic violence creates multiple harms for women's health and is a 'wicked problem' for health professionals and public health systems. Brazil recently approved public policies to manage and care for women victims of domestic violence. Facing these policies, this study aimed to explore how domestic violence against women is usually managed in Brazilian primary health care, by investigating a basic health unit and its family health strategy. We adopted qualitative ethnographic research methods with thematic analysis of emergent categories, interrogating data with gender theory and emergent Brazilian collective health theory. Field research was conducted in a local basic health unit and the territory for which it is responsible, in Southern Brazil. The study revealed: 1) a yawning gap between public health policies for domestic violence against women at the federal level and its practical application at local/decentralized levels, which can leave both professionals and women unsafe; 2) the key role of local community health workers, paraprofessional health promotion agents, who aim to promote dialogue between women experiencing violence, health care professionals and the health care system.

[Affordability and availability of drugs for treatment of chronic diseases in the public health care system].

Science.gov (United States)

Helfer, Ana Paula; Camargo, Aline Lins; Tavares, Noemia Urruth Leão; Kanavos, Panos; Bertoldi, Andréa Dâmaso

2012-03-01

To assess the affordability by workers of drugs used for treatment of chronic diseases, as well as the availability of the reference, similar, or generic forms of these drugs in the public health care system. We employed the methodology recommended by the World Health Organization (WHO) and Health Action International (HAI) for the standardized collection of information on selling prices in the private sector and availability in the public health care system of drugs in six cities in the state of Rio Grande do Sul, Brazil. Data were collected from November 2008 to January 2009. Affordability was estimated as the number of salary days required for a worker receiving the national minimum wage to buy, in a private pharmacy, the amount of medication required for one month of treatment. Availability was assessed by the presence of these drugs in public health care system facilities. Twenty-two public facilities and 30 private pharmacies were studied. Of 21 drugs used for the treatment of seven chronic disorders, only nine were available free of charge in the six cities. Mean availability ranged from 83.3% (São Leopoldo) to 97.6% (Caxias do Sul). Affordability ranged from 0.4 to 10.5 salary days for reference drugs, 0.2 to 8.4 salary days for similar drugs, and 0.3 to 3.8 salary days for generic drugs. The overall availability of the drugs surveyed was higher than the 80% recommended by WHO. However, some treatments were not available, or had limited availability in the public system. Concerning affordability, the number of salary days required to buy these drugs may affect the continuation of drug treatments for chronic diseases.

Strengthening primary health care through primary care and public health collaboration: the influence of intrapersonal and interpersonal factors.

Science.gov (United States)

Valaitis, Ruta K; O'Mara, Linda; Wong, Sabrina T; MacDonald, Marjorie; Murray, Nancy; Martin-Misener, Ruth; Meagher-Stewart, Donna

2018-04-12

AimThe aim of this paper is to examine Canadian key informants' perceptions of intrapersonal (within an individual) and interpersonal (among individuals) factors that influence successful primary care and public health collaboration. Primary health care systems can be strengthened by building stronger collaborations between primary care and public health. Although there is literature that explores interpersonal factors that can influence successful inter-organizational collaborations, a few of them have specifically explored primary care and public health collaboration. Furthermore, no papers were found that considered factors at the intrapersonal level. This paper aims to explore these gaps in a Canadian context. This interpretative descriptive study involved key informants (service providers, managers, directors, and policy makers) who participated in one h telephone interviews to explore their perceptions of influences on successful primary care and public health collaboration. Transcripts were analyzed using NVivo 9.FindingsA total of 74 participants [from the provinces of British Columbia (n=20); Ontario (n=19); Nova Scotia (n=21), and representatives from other provinces or national organizations (n=14)] participated. Five interpersonal factors were found that influenced public health and primary care collaborations including: (1) trusting and inclusive relationships; (2) shared values, beliefs and attitudes; (3) role clarity; (4) effective communication; and (5) decision processes. There were two influencing factors found at the intrapersonal level: (1) personal qualities, skills and knowledge; and (2) personal values, beliefs, and attitudes. A few differences were found across the three core provinces involved. There were several complex interactions identified among all inter and intra personal influencing factors: One key factor - effective communication - interacted with all of them. Results support and extend our understanding of what influences

Public Trust in Health Information Sharing: Implications for Biobanking and Electronic Health Record Systems

Directory of Open Access Journals (Sweden)

Jodyn Platt

2015-02-01

Full Text Available Biobanks are made all the more valuable when the biological samples they hold can be linked to health information collected in research, electronic health records, or public health practice. Public trust in such systems that share health information for research and health care practice is understudied. Our research examines characteristics of the general public that predict trust in a health system that includes researchers, health care providers, insurance companies and public health departments. We created a 119-item survey of predictors and attributes of system trust and fielded it using Amazon’s MTurk system (n = 447. We found that seeing one’s primary care provider, having a favorable view of data sharing and believing that data sharing will improve the quality of health care, as well as psychosocial factors (altruism and generalized trust were positively and significantly associated with system trust. As expected, privacy concern, but counterintuitively, knowledge about health information sharing were negatively associated with system trust. We conclude that, in order to assure the public’s trust, policy makers charged with setting best practices for governance of biobanks and access to electronic health records should leverage critical access points to engage a diverse public in joint decision making.

Public and private sector in the health care system of the Federation bosnia and herzegovina: policy and strategy.

Science.gov (United States)

Slipicevic, Osman; Malicbegovic, Adisa

2012-01-01

In Bosnia and Herzegovina citizens receive health care from both public and private providers. The current situation calls for a clear government policy and strategy to ensure better position and services from both parts. This article examines how health care services are delivered, particularly with respect to relationship between public and private providers. The paper notes that the public sector is plagued by a number of weaknesses in terms of inefficiency of services provision, poorly motivated staff, prevalent dual practice of public employees, poor working conditions and geographical imbalances. Private sector is not developing in ways that address the weaknesses of the public sector. Poorly regulated, it operates as an isolated entity, strongly profit-driven. The increasing burdens on public health care system calls for government to abandon its passive role and take action to direct growth and use potential of private sector. The paper proposes a number of mechanisms that can be used to influence private as well as public sector, since actions directed toward one part of the system will inevitable influence the other.

Organizational factors influencing successful primary care and public health collaboration.

Science.gov (United States)

Valaitis, Ruta; Meagher-Stewart, Donna; Martin-Misener, Ruth; Wong, Sabrina T; MacDonald, Marjorie; O'Mara, Linda

2018-06-07

Public health and primary care are distinct sectors within western health care systems. Within each sector, work is carried out in the context of organizations, for example, public health units and primary care clinics. Building on a scoping literature review, our study aimed to identify the influencing factors within these organizations that affect the ability of these health care sectors to collaborate with one another in the Canadian context. Relationships between these factors were also explored. We conducted an interpretive descriptive qualitative study involving in-depth interviews with 74 key informants from three provinces, one each in western, central and eastern Canada, and others representing national organizations, government, or associations. The sample included policy makers, managers, and direct service providers in public health and primary care. Seven major organizational influencing factors on collaboration were identified: 1) Clear Mandates, Vision, and Goals; 2) Strategic Coordination and Communication Mechanisms between Partners; 3) Formal Organizational Leaders as Collaborative Champions; 4) Collaborative Organizational Culture; 5) Optimal Use of Resources; 6) Optimal Use of Human Resources; and 7) Collaborative Approaches to Programs and Services Delivery. While each influencing factor was distinct, the many interactions among these influences are indicative of the complex nature of public health and primary care collaboration. These results can be useful for those working to set up new or maintain existing collaborations with public health and primary care which may or may not include other organizations.

Public health system - current status and world experience

Directory of Open Access Journals (Sweden)

Andreyeva І.А.

2016-09-01

Full Text Available In the review, the evolution of Public Health and global development tendencies of Public Health system have been discussed. Stages of formation of the updated concept, principles of Public Health organization and the role of various organizations have been shown in the connection with development of the global concept of "Health for All". A well-functioning public health system is primarily the result of multisectoral cooperation. The aim of modern Public Health is to provide conditions of access to appropriate and cost-effective health care for all population groups, including health promotion and disease prevention.

The problems and prospects of public health care development in ...

African Journals Online (AJOL)

The abysmal failure of public health care system in Nigeria has attracted comments and criticisms from local and national levels. The provision of adequate health care services to the citizens, particularly those residing at the rural areas has left much to be desired. In spite of media propaganda and the current health sector ...

Social inequalities in the organization of pregnancy care in a universally funded public health care system.

Science.gov (United States)

Sutherland, Georgina; Yelland, Jane; Brown, Stephanie

2012-02-01

To examine the social organization of pregnancy care and the extent to which socioeconomic factors affect women's experience of care. We consider these data in the global discussion on taking action to reduce health inequalities. This study draws on cross-sectional data from a large population-based survey of Australian women 6 months after giving birth. Only those women reporting to attend publically-funded models of antenatal care (i.e., public clinic, midwife clinic, shared care, primary medical care, primary midwife care) were included in analyses. Results showed a social patterning in the organization and experience of care with clear links between model of care attended in pregnancy and a number of individual-level indicators of social disadvantage. Our findings show model of care is a salient feature in how women view their care. How women from socially disadvantaged backgrounds navigate available care options are important considerations. Pregnancy care is recognized as an opportunity to intervene to give children 'the best start in life.' Our data show the current system of universally accessible pregnancy care in Australia is failing to support the most vulnerable women and families. This information can inform actions to reduce social disparities during this critical period.

Understanding multinational companies in public health systems, using a competitive advantage framework.

Science.gov (United States)

Lethbridge, Jane

2011-07-01

This paper discusses the findings of a study which developed five case studies of five multinational health care companies involved in public health care systems. Strategies were analysed in terms of attitude to marketing, pricing and regulation. The company strategies have been subjected to an analysis using Porter's Five Forces, a business strategy framework, which is unusual in health policy studies. This paper shows how analysing company strategy using a business tool can contribute to understanding the strategies of global capital in national health systems. It shows how social science methodologies can draw from business methods to explain company strategies. The five companies considered in this paper demonstrate that their strategies have many dimensions, which fit into Porter's Five Forces of comparative advantage. More importantly the Five Forces can be used to identify factors that influence company entry into public health care systems. The process of examining the strategic objectives of five health care companies shows that a business tool can help to explain the actions and motives of health care companies towards public health care systems, and so contribute to a better understanding of the strategies of global capital in national health systems. Health service commissioners need to understand this dynamic process, which will evolve as the nature of public health care systems change.

Guidelines for Psychological Practice in Health Care Delivery Systems

Science.gov (United States)

American Psychologist, 2013

2013-01-01

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

The Child Health Care System in Italy.

Science.gov (United States)

Corsello, Giovanni; Ferrara, Pietro; Chiamenti, Gianpietro; Nigri, Luigi; Campanozzi, Angelo; Pettoello-Mantovani, Massimo

2016-10-01

Pediatric care in Italy has been based during the last 40 years on the increased awareness of the importance of meeting the psychosocial and developmental needs of children and of the role of families in promoting the health and well-being of their children. The pediatric health care system in Italy is part of the national health system. It is made up of 3 main levels of intervention: first access/primary care, secondary care/hospital care, and tertiary care based on specialty hospital care. This overview will also include a brief report on neonatal care, pediatric preventive health care, health service accreditation programs, and postgraduate training in pediatrics. The quality of the Italian child health care system is now considered to be in serious danger because of the restriction of investments in public health caused both by the 2008 global and national economic crisis and by a reduction of the pediatric workforce as a result of progressively insufficient replacement of specialists in pediatrics. Copyright © 2016 Elsevier Inc. All rights reserved.

The Delivery of Health Promotion and Environmental Health Services; Public Health or Primary Care Settings?

Directory of Open Access Journals (Sweden)

Lene Bjørn Jensen

2018-05-01

Full Text Available The WHO Regional Office for Europe developed a set of public health functions resulting in the ten Essential Public Health Operations (EPHO. Public health or primary care settings seem to be favorable to embrace all actions included into EPHOs. The presented paper aims to guide readers on how to assign individual health promotion and environmental health services to public health or primary care settings. Survey tools were developed based on EPHO 2, 3 and 4; there were six key informant surveys out of 18 contacted completed via e-mails by informants working in Denmark on health promotion and five face-to-face interviews were conducted in Australia (Melbourne and Victoria state with experts from environmental health, public health and a physician. Based on interviews, we developed a set of indicators to support the assignment process. Population or individual focus, a system approach or one-to-one approach, dealing with hazards or dealing with effects, being proactive or reactive were identified as main element of the decision tool. Assignment of public health services to one of two settings proved to be possible in some cases, whereas in many there is no clear distinction between the two settings. National context might be the one which guides delivery of public health services.

The Delivery of Health Promotion and Environmental Health Services; Public Health or Primary Care Settings?

Science.gov (United States)

Bjørn Jensen, Lene; Lukic, Irena; Gulis, Gabriel

2018-05-07

The WHO Regional Office for Europe developed a set of public health functions resulting in the ten Essential Public Health Operations (EPHO). Public health or primary care settings seem to be favorable to embrace all actions included into EPHOs. The presented paper aims to guide readers on how to assign individual health promotion and environmental health services to public health or primary care settings. Survey tools were developed based on EPHO 2, 3 and 4; there were six key informant surveys out of 18 contacted completed via e-mails by informants working in Denmark on health promotion and five face-to-face interviews were conducted in Australia (Melbourne and Victoria state) with experts from environmental health, public health and a physician. Based on interviews, we developed a set of indicators to support the assignment process. Population or individual focus, a system approach or one-to-one approach, dealing with hazards or dealing with effects, being proactive or reactive were identified as main element of the decision tool. Assignment of public health services to one of two settings proved to be possible in some cases, whereas in many there is no clear distinction between the two settings. National context might be the one which guides delivery of public health services.

Understanding multinational companies in public health systems, using a competitive advantage framework

Directory of Open Access Journals (Sweden)

Lethbridge Jane

2011-07-01

Full Text Available Abstract Background This paper discusses the findings of a study which developed five case studies of five multinational health care companies involved in public health care systems. Strategies were analysed in terms of attitude to marketing, pricing and regulation. The company strategies have been subjected to an analysis using Porter's Five Forces, a business strategy framework, which is unusual in health policy studies. Methods This paper shows how analysing company strategy using a business tool can contribute to understanding the strategies of global capital in national health systems. It shows how social science methodologies can draw from business methods to explain company strategies. Results The five companies considered in this paper demonstrate that their strategies have many dimensions, which fit into Porter's Five Forces of comparative advantage. More importantly the Five Forces can be used to identify factors that influence company entry into public health care systems. Conclusions The process of examining the strategic objectives of five health care companies shows that a business tool can help to explain the actions and motives of health care companies towards public health care systems, and so contribute to a better understanding of the strategies of global capital in national health systems. Health service commissioners need to understand this dynamic process, which will evolve as the nature of public health care systems change.

Understanding multinational companies in public health systems, using a competitive advantage framework

Science.gov (United States)

2011-01-01

Background This paper discusses the findings of a study which developed five case studies of five multinational health care companies involved in public health care systems. Strategies were analysed in terms of attitude to marketing, pricing and regulation. The company strategies have been subjected to an analysis using Porter's Five Forces, a business strategy framework, which is unusual in health policy studies. Methods This paper shows how analysing company strategy using a business tool can contribute to understanding the strategies of global capital in national health systems. It shows how social science methodologies can draw from business methods to explain company strategies. Results The five companies considered in this paper demonstrate that their strategies have many dimensions, which fit into Porter's Five Forces of comparative advantage. More importantly the Five Forces can be used to identify factors that influence company entry into public health care systems. Conclusions The process of examining the strategic objectives of five health care companies shows that a business tool can help to explain the actions and motives of health care companies towards public health care systems, and so contribute to a better understanding of the strategies of global capital in national health systems. Health service commissioners need to understand this dynamic process, which will evolve as the nature of public health care systems change. PMID:21722372

Public Health Insurance and Health Care Utilization for Children in Immigrant Families.

Science.gov (United States)

Percheski, Christine; Bzostek, Sharon

2017-12-01

Objectives To estimate the impacts of public health insurance coverage on health care utilization and unmet health care needs for children in immigrant families. Methods We use survey data from National Health Interview Survey (NHIS) (2001-2005) linked to data from Medical Expenditures Panel Survey (MEPS) (2003-2007) for children with siblings in families headed by at least one immigrant parent. We use logit models with family fixed effects. Results Compared to their siblings with public insurance, uninsured children in immigrant families have higher odds of having no usual source of care, having no health care visits in a 2 year period, having high Emergency Department reliance, and having unmet health care needs. We find no statistically significant difference in the odds of having annual well-child visits. Conclusions for practice Previous research may have underestimated the impact of public health insurance for children in immigrant families. Children in immigrant families would likely benefit considerably from expansions of public health insurance eligibility to cover all children, including children without citizenship. Immigrant families that include both insured and uninsured children may benefit from additional referral and outreach efforts from health care providers to ensure that uninsured children have the same access to health care as their publicly-insured siblings.

Integration of health care organizations: using the power strategies of horizontal and vertical integration in public and private health systems.

Science.gov (United States)

Thaldorf, Carey; Liberman, Aaron

2007-01-01

Integration in health care attempts to provide all elements in a seamless continuum of care. Pressures influencing development of system-wide integration primarily come from unsustainable cost increases in the United States over the later part of the 20th century and the early 21st century. Promoters of health care integration assume that it will lead to increased effectiveness and quality of care while concurrently increasing cost-effectiveness and possibly facilitating cost savings. The primary focus of this literature review is on the Power Strategies of Horizontal and Vertical Integration. The material presented suggests that vertical integration is most effective in markets where the partners involved are larger and dominant in the regions they serve. The research has also found that integrating health care networks had little or no significant effect on improving overall organizational efficiencies or profits. Capital investment in information technologies still is cost prohibitive and outweighs its benefits to integration efficiencies in the private sector; however, there are some indications of improvements in publicly provided health care. Further research is needed to understand the reasons the public sector has had greater success in improving effectiveness and efficiency through integration than the private sector.

Primary health care quality and hospitalizations for ambulatory care sensitive conditions in the public health system in Porto Alegre, Brazil.

Science.gov (United States)

Gonçalves, Marcelo Rodrigues; Hauser, Lisiane; Prestes, Isaías Valente; Schmidt, Maria Inês; Duncan, Bruce Bartholow; Harzheim, Erno

2016-06-01

To investigate the relation of hospitalization for ambulatory care sensitive conditions (ACSC) with the quality of public primary care health services in Porto Alegre, Brazil. Cohort study constructed by probabilistic record linkage performed from August 2006 to December 2011 in a population ≥18 years of age that attended public primary care health services. The Primary Care Assessment Tool (PCATool-Brazil) was used for evaluation of primary care services. Of 1200 subjects followed, 84 were hospitalized for primary care sensitive conditions. The main causes of ACSC hospital admissions were cardiovascular (40.5%) and respiratory (16.2%) diseases. The PCATool average score was 5.3, a level considerably below that considered to represent quality care. After adjustment through Cox proportional hazard modelling for covariates, >60 years of age [hazard ratio (HR): 1.13; P = 0.001), lesser education (HR: 0.66; P = 0.02), ethnicity other than white (HR: 1.77; P = 0.01) and physical inactivity (HR: 1.65; P = 0.04) predicted hospitalization, but higher quality of primary health care did not. Better quality of health care services, in a setting of overwhelmingly low quality services not adapted to the care of chronic conditions, did not influence the rate of avoidable hospitalizations, while social and demographic characteristics, especially non-white ethnicity and lesser schooling, indicate that social inequities play a predominant role in health outcomes. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Public and private health-care financing with alternate public rationing rules.

Science.gov (United States)

Cuff, Katherine; Hurley, Jeremiah; Mestelman, Stuart; Muller, Andrew; Nuscheler, Robert

2012-02-01

We develop a model to analyze parallel public and private health-care financing under two alternative public sector rationing rules: needs-based rationing and random rationing. Individuals vary in income and severity of illness. There is a limited supply of health-care resources used to treat individuals, causing some individuals to go untreated. Insurers (both public and private) must bid to obtain the necessary health-care resources to treat their beneficiaries. Given individuals' willingnesses-to-pay for private insurance are increasing in income, the introduction of private insurance diverts treatment from relatively poor to relatively rich individuals. Further, the impact of introducing parallel private insurance depends on the rationing mechanism in the public sector. We show that the private health insurance market is smaller when the public sector rations according to need than when allocation is random. Copyright © 2010 John Wiley & Sons, Ltd.

Health care inequities in north India: role of public sector in universalizing health care.

Science.gov (United States)

Prinja, Shankar; Kanavos, Panos; Kumar, Rajesh

2012-09-01

Income inequality is associated with poor health. Inequities exist in service utilization and financing for health care. Health care costs push high number of households into poverty in India. We undertook this study to ascertain inequities in health status, service utilization and out-of-pocket (OOP) health expenditures in two States in north India namely, Haryana and Punjab, and Union Territory of Chandigarh. Data from National Sample Survey 60 th Round on Morbidity and Health Care were analyzed by mean consumption expenditure quintiles. Indicators were devised to document inequities in the dimensions of horizontal and vertical inequity; and redistribution of public subsidy. Concentration index (CI), and equity ratio in conjunction with concentration curve were computed to measure inequity. Reporting of morbidity and hospitalization rate had a pro-rich distribution in all three States indicating poor utilization of health services by low income households. Nearly 57 and 60 per cent households from poorest income quintile in Haryana and Punjab, respectively faced catastrophic OOP hospitalization expenditure at 10 per cent threshold. Lower prevalence of catastrophic expenditure was recorded in higher income groups. Public sector also incurred high costs for hospitalization in selected three States. Medicines constituted 19 to 47 per cent of hospitalization expenditure and 59 to 86 per cent OPD expenditure borne OOP by households in public sector. Public sector hospitalizations had a pro-poor distribution in Haryana, Punjab and Chandigarh. Our analysis indicates that public sector health service utilization needs to be improved. OOP health care expenditures at public sector institutions should to be curtailed to improve utilization of poorer segments of population. Greater availability of medicines in public sector and regulation of their prices provide a unique opportunity to reduce public sector OOP expenditure.

Health information systems to improve health care: A telemedicine case study

Directory of Open Access Journals (Sweden)

Liezel Cilliers

2013-03-01

Full Text Available Background: E-health has been identified as an integral part of the future of South African public healthcare. Telemedicine was first introduced in South Africa in 1997 and since then the cost of running the Telemedicine projects has increased substantially. Despite these efforts to introduce the system, only 34% of the Telemedicine sites in South Africa are functional at present. Objectives: Literature has suggested that one of the barriers to the successful implementation of health information systems is the user acceptance by health care workers of systems such as Telemedicine. This study investigated the user acceptance of Telemedicine in the public health care system in the Eastern Cape Province, making use of the Unified Theory of the Use and Acceptance of Technology. Method: The study employed a quantitative survey approach. A questionnaire was developed making use of existing literature and was distributed to various clinics around the province where Telemedicine has been implemented. Statistics were produced making use of Statistical Package for the Social Sciences (SPSS. Results: In general, the health care workers did understand the value and benefit of health information systems to improve the effectiveness and efficiency of the health care system. The barriers to the effective implementation of a health information system include the lack of knowledge and the lack of awareness regarding the Telemedicine system. This in turn means that the user is apprehensive when making use of the system thus contributing to less frequent usage. Conclusion: Health care workers do acknowledge that information systems can help to increase the effectiveness of the health care system. In general, the acceptance of Telemedicine in the Eastern Cape Department of Health is positive, but in order to integrate it into standard work practices, more must be done with regards to the promotion and education of telemedicine.

Public trust in the Spanish health‐care system

Science.gov (United States)

Jovell, Albert; Blendon, Robert J.; Navarro, Maria Dolors; Fleischfresser, Channtal; Benson, John M.; DesRoches, Catherine M.; Weldon, Kathleen J.

2007-01-01

Abstract Background  Fifteen years ago, public opinion surveys in Spain showed substantial dissatisfaction with the health‐care system. Since that time, health‐care in Spain has undergone significant changes, including a decentralization of the system, an increase in spending and a change in the way the system is financed. Objective  This study examines how Spanish citizens rate the performance of their health system today, both as compared with other sectors of society and as compared with earlier time periods. Methods  Data are drawn from nationally representative telephone surveys of the non‐institutionalized adult Spanish population (age 18 years and over). The study was carried out in two phases: October–November 2005 (n = 3010) and January 2006 (n = 2101). Results  The majority of the Spanish population thinks the health system needs to be changed. The problems cited relate mostly to long wait times to get health‐care. Nevertheless, over the last 15 years, the proportion of people who have very negative views about the health system has decreased by half. The majority believes that not enough money is spent on health‐care, but few people would support an increase in taxes to provide additional funding. The survey finds the National Health System’s institutions and health professionals to be more highly trusted than other institutions and professional groups in the country. Conclusions  Government policy‐makers in Spain face a dilemma: the public wants more health spending to decrease wait times, but there is substantial resistance to increasing taxes as a means to finance improvements in the system’s capacity. PMID:17986071

'The public is too subjective': public involvement at different levels of health-care decision making.

Science.gov (United States)

Litva, Andrea; Coast, Joanna; Donovan, Jenny; Eyles, John; Shepherd, Michael; Tacchi, Jo; Abelson, Julia; Morgan, Kieran

2002-06-01

There are a number of impulses towards public participation in health care decision making including instrumentalist, communitarian, educative and expressive impulses and the desire for increased accountability. There has, however, been little research looking systematically at the public's preferences for being involved in particular types of rationing decisions, nor indeed, has there been a critical examination of the degree of involvement desired by the public. The research reported here uses findings from focus groups and in-depth interviews to explore these questions. Eight focus groups were conducted with a total of 57 informants, four amongst randomly selected members of the public and four with informants from health and non-health related organisations. Nineteen interviews were conducted to allow the elaboration of focus group comments, to probe views more deeply and to pursue emerging themes. The findings show variations in the willingness of members of the public to be involved in health care decisions and consistency across the different forms of the public as represented by the focus groups with randomly selected citizens and pre-existing organisations. There was a strong desire in all the groups for the public to be involved both at the system and programme levels, with much less willingness to be involved at the individual level. At the system and programme levels informants generally favoured consultation, without responsibility for decisions, but with the guarantee that their contribution would be heard and that decisions taken following consultation would be explained. At the patient level informants felt that the public should participate only by setting criteria for deciding between potential beneficiaries of treatment. The public has much to contribute, particularly at the system and programme levels, to supplement the inputs of health care professionals.

Role of pharmacogenetics in public health and clinical health care: a SWOT analysis.

Science.gov (United States)

Kapoor, Ritika; Tan-Koi, Wei Chuen; Teo, Yik-Ying

2016-12-01

Pharmacogenomics has been lauded as an important innovation in clinical medicine as a result of advances in genomic science. As one of the cornerstones in precision medicine, the vision to determine the right medication in the right dosage for the right treatment with the use of genetic information has not exactly materialised, and few genetic tests have been implemented as the standard of care in health systems worldwide. Here we review the findings from a SWOT analysis to examine the strengths, weaknesses, opportunities and threats around the role of pharmacogenetics in public health and clinical health care, at the micro, meso and macro levels corresponding to the perspectives of the individuals (scientists, patients and physicians), the health-care institutions and the health systems, respectively.

The public health leadership certificate: a public health and primary care interprofessional training opportunity.

Science.gov (United States)

Matson, Christine C; Lake, Jeffrey L; Bradshaw, R Dana; Matson, David O

2014-03-01

This article describes a public health leadership certificate curriculum developed by the Commonwealth Public Health Training Center for employees in public health and medical trainees in primary care to share didactic and experiential learning. As part of the program, trainees are involved in improving the health of their communities and thus gain a blended perspective on the effectiveness of interprofessional teams in improving population health. The certificate curriculum includes eight one-credit-hour didactic courses offered through an MPH program and a two-credit-hour, community-based participatory research project conducted by teams of trainees under the mentorship of health district directors. Fiscal sustainability is achieved by sharing didactic courses with MPH degree students, thereby enabling trainees to take advantage of a reduced, continuing education tuition rate. Public health employee and primary care trainees jointly learn knowledge and skills required for community health improvement in interprofessional teams and gain an integrated perspective through opportunities to question assumptions and broaden disciplinary approaches. At the same time, the required community projects have benefited public health in Virginia.

Public health capacity in the provision of health care services.

Science.gov (United States)

Valdmanis, Vivian; DeNicola, Arianna; Bernet, Patrick

2015-12-01

In this paper, we assess the capacity of Florida's public health departments. We achieve this by using bootstrapped data envelopment analysis (DEA) applied to Johansen's definition of capacity utilization. Our purpose in this paper is to measure if there is, theoretically, enough excess capacity available to handle a possible surge in the demand for primary care services especially after the implementation of the Affordable Care Act that includes provisions for expanded public health services. We measure subunit service availability using a comprehensive data source available for all 67 county health departments in the provision of diagnostic care and primary health care. In this research we aim to address two related research questions. First, we structure our analysis so as to fix budgets. This is based on the assumption that State spending on social and health services could be limited, but patient needs are not. Our second research question is that, given the dearth of primary care providers in Florida if budgets are allowed to vary is there enough medical labor to provide care to clients. Using a non-parametric approach, we also apply bootstrapping to the concept of plant capacity which adds to the productivity research. To preview our findings, we report that there exists excess plant capacity for patient treatment and care, but question whether resources may be better suited for more traditional types of public health services.

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

Directory of Open Access Journals (Sweden)

Menizibeya Osain Welcome

2011-01-01

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

Can "giving preference to my patients" be explained as a role related duty in public health care systems?

Science.gov (United States)

Holm, Søren

2011-03-01

Most of us have two strong intuitions (or sets of intuitions) in relation to fairness in health care systems that are funded by public money, whether through taxation or compulsory insurance. The first intuition is that such a system has to treat patients (and other users) fairly, equitably, impartially, justly and without discrimination. The second intuition is that doctors, nurses and other health care professionals are allowed to, and may even in some cases be obligated to give preference to the interests of their particular patients or clients over the interests of other patients or clients of the system. These two intuitions are in potential conflict. One of the most obvious ways in which to ensure impartiality in a health care system is to require impartiality of all actors in the system, i.e. to give health care professionals a duty to treat everyone impartially and to deny them the 'right' to give their patients preferential treatment. And one of the possible side-effects of allowing individual health care professionals to give preference to 'their clients' is to create inequality in health care. This paper explores the conflict and proposes that it can be right to give preference to 'your' patients in certain circumstances.

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

Science.gov (United States)

Manyazewal, Tsegahun; Matlakala, Mokgadi C

2018-06-01

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

Individual responsibility for what? : A conceptual framework for exploring the suitability of private financing in a publicly funded health-care system

OpenAIRE

Tinghög, Gustav; Carlsson, Per; Lyttkens, Carl H.

2010-01-01

Policymakers in publicly funded health-care systems are frequently required to make intricate decisions on which health-care services to include or exclude from the basic health-care package. Although it seems likely that the concept of individual responsibility is an essential feature of such decisions, it is rarely explicitly articulated or evaluated in health policy. This paper presents a tentative conceptual framwork for exploring when health-care services contain characteristics that fac...

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

Science.gov (United States)

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

2006-10-01

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

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

Science.gov (United States)

Aldulaimi, Sommer; Mora, Francisco E

2017-01-01

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

Role of information systems in public health services.

Science.gov (United States)

Hartshorne, J E; Carstens, I L

1990-07-01

The purpose of this review is to establish a conceptual framework on the role of information systems in public health care. Information is indispensable for effective management and development of health services and therefore considered as an important operational asset or resource. A Health Information System is mainly required to support management and operations at four levels: namely transactional and functional; operational control; management planning and control; and strategic planning. To provide the necessary information needs of users at these levels of management in the health care system, a structured information system coupled with appropriate information technology is required. Adequate and relevant information is needed regarding population characteristics, resources available and expended, output and outcome of health care activities. Additionally information needs to be reliable, accurate, timely, easily accessible and presented in a compact and meaningful form. With a well-planned health information system health authorities would be in a position to provide a quality, cost-effective and efficient health service for as many people as need it, optimal utilisation of resources and to maintain and improve the community's health status.

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

Science.gov (United States)

O'Brien, Paula

2013-09-01

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

The contribution of traditional healers' clinics to public health care system in Addis Ababa, Ethiopia: a cross-sectional study.

Science.gov (United States)

Birhan, Wubet; Giday, Mirutse; Teklehaymanot, Tilahun

2011-12-02

Ethiopian people have been using traditional medicine since time immemorial with 80% of its population dependent on traditional medicines. However, the documentation of traditional healers' clinics contribution to modern public health system in cosmopolitan cities is scanty. Studies conducted so far are limited and focused on the perceptions and practices of modern and traditional health practitioners about traditional medicine. Thus, a cross sectional study was conducted from February to May 2010 to assess the contribution of traditional healers' clinics to public health care system in Addis Ababa. Ten traditional healers who were willing to participate in the study and 306 patients who were visiting these traditional healers' clinics were interviewed using two types of semi-structured questionnaires. Data were summarized using percentages, tables and bar chart. The diseases mostly treated by traditional healers were wound, inflammation, herpes zoster, hemorrhoids, fracture, paralysis, back-pain, liver diseases, cancer and eczema. This study showed that traditional healers' clinics considerably contribute to public health care in Addis Ababa. Fifty two percent of patients reported that traditional healers' clinics were their first choice when they faced health problems. The reasons for visiting these clinics were 175 (57.2%) efficacy, 109 (35.6%) dissatisfaction with modern medicine, 10 (3.3%) dissatisfaction with modern medicine and efficacy, 6 (2.0%) cost and 6 (2.0%) dissatisfaction and cost. Females (55.2%), young age (20-40 years, 65.0%), never married (56.9%), orthodox (73.9%), Amhara (52.3%), educational status above grade 12 (34.6%) and government employees (29.4%) were frequent visitors. Healers reported that there was no form of cooperation with modern health professionals. The reasons were lack of motivation to collaborate and communicate with modern health service workers. Family based apprenticeship was the sources of knowledge for majority of the

Difficulties in accessing and availing of public health care systems among rural population in Chittoor District, Andhra Pradesh

OpenAIRE

Geetha Lakshmi Sreerama; Sai Varun Matavalum; Paraiveedu Arumugam Chandresekharan; Veronica Thunga

2015-01-01

Context: Despite policies to make health care accessible to all, it is not universally accessible. Frequent evaluation of barriers to accessibility of health care services paves path for improvement. Hence, present study is undertaken to evaluate the factors and public health policies influencing health care access to rural people in Chittoor District, Andhra Pradesh, which can be interpolated for other regions. Aims: To assess knowledge, perceptions, availing of public health care services, ...

Quality comparisons between privately and publicly managed health care centres in a suburban area of Stockholm, Sweden.

Science.gov (United States)

Hansagi, H; Calltorp, J; Andréasson, S

1993-03-01

As in many other countries, the health care system in Sweden is currently undergoing rapid changes. Within a framework of public financing, the delivery of health care is to an increasing extent being transferred to various entrepreneurs; private, public or cooperatives. A privately run, but publicly financed, health care centre was evaluated with regard to quality and costs. Quality was defined in terms of the central guidelines for Swedish primary health care: first level responsibility, accessibility, a holistic view of the patient, and continuity of care and safety. The services offered by the private health care centre were evaluated by different methods--questionnaires, health care utilization data and economic analyses--and found to be of similar quality but produced at a lower cost than by three publicly managed health care centres.

[Terrorism, public health and health services].

Science.gov (United States)

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

2009-01-01

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

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

Science.gov (United States)

Hollederer, A; Wildner, M

2015-03-01

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

Comparing Dental and Pharmacy Students’ Perceptions on Public Health and Preventive Health Care Course

Science.gov (United States)

Mandiracioglu, Aliye; Dogan, Fethi

2012-01-01

Objectives: A Public health course has an important role in the undergraduate education of pharmacy and dentistry in terms of emphasizing preventive care. The purpose of this study is to evaluate the views of pharmacy and dentistry students on a public health course and preventive health care. Methods: 173 students enrolled at Ege University, Faculties of Pharmacy and Dentistry completed a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis and replied to 18 Likert type question to determine their perceptions on a public health course and preventive health care. The comments of the students were reviewed and categorized into key themes. Results: SWOT analysis and the results of quantitative Likert type questions supported each other. According to the quantitative results, there was no significant difference between the scores of students from both schools in terms of their statements about the public health course and preventive care. Both groups of students mentioned the contribution of the public health course to their professions in the future. They also appreciated the importance of preventive care in the health services. PMID:22347604

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

Science.gov (United States)

Munro, Neil; Duckett, Jane

2016-06-01

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

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

Science.gov (United States)

Devoe, Jennifer E; Gold, Rachel

2013-01-01

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

Public trust in Dutch health care.

Science.gov (United States)

Straten, G F M; Friele, R D; Groenewegen, P P

2002-07-01

This article describes the development of a valid and reliable instrument to measure different dimensions of public trust in health care in the Netherlands. This instrument is needed because the concept was not well developed, or operationalized in earlier research. The new instrument will be used in a research project to monitor trust and to predict behaviour of people such as consulting "alternative practitioners". The idea for the research was suggested by economic research into public trust. In the study, a phased design was used to overcome the operationalization problem. In the first phase, a qualitative study was conducted; and, in the second, a quantitative study. In the first phase, more than 100 people were interviewed to gain insight into the issues they associated with trust. Eight categories of issues that were derived from the interviews were assumed to be possible dimensions of trust. On the basis of these eight categories and the interviews, a questionnaire was developed that was used in the second phase. In this phase, the questionnaire was sent to 1500 members of a consumer panel; the response was 70 percent. The analysis reveals that six of the eight possible dimensions appear in factor analysis. These dimensions are trust in: the patient-focus of health care providers; macro policies level will have no consequences for patients; expertise of health care providers; quality of care; information supply and communication by care providers and the quality of cooperation. The reliability of most scales is higher than 0.8. The validity of the dimensions is assessed by determining the correlation between the scales on the one hand, and people's experience and a general mark they would assign on the other. We conclude that public trust is a multi-dimensional concept, including not only issues that relate to the patient-doctor relationship, but also issues that relate to health care institutions. The instrument appears to be reliable and valid.

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

Science.gov (United States)

Li, Ling; Fu, Hongqiao

2017-07-01

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

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

Science.gov (United States)

Janssen, Richard

2002-02-01

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

Who does the public think should perform health care tasks?

Science.gov (United States)

Koteski, D R; McKinney, S

1988-10-01

The dietitian was identified as the most appropriate provider of such key nutrition services as nutrition assessment, determination of caloric requirements, provision of diet counseling, and prescription of diets. Several tasks fundamental to nutrition services were not viewed as highly suitable tasks for the dietitian, e.g., plan for care at home, monitor client progress, and check laboratory values. Activities that constitute key nutrition services need to be accentuated to clarify the numerous skills and extensive knowledge that dietitians possess. In the health care system of today, the dietetic profession must be associated with a wider range of health-related tasks than the traditional triad of diet, food, and hospital. Public relations and marketing strategies should focus on activities that provide the public with a clearer understanding of how the dietetic profession contributes to patient/client care.

The contribution of traditional healers' clinics to public health care system in Addis Ababa, Ethiopia: a cross-sectional study

Directory of Open Access Journals (Sweden)

Birhan Wubet

2011-12-01

Full Text Available Abstract Background Ethiopian people have been using traditional medicine since time immemorial with 80% of its population dependent on traditional medicines. However, the documentation of traditional healers' clinics contribution to modern public health system in cosmopolitan cities is scanty. Studies conducted so far are limited and focused on the perceptions and practices of modern and traditional health practitioners about traditional medicine. Thus, a cross sectional study was conducted from February to May 2010 to assess the contribution of traditional healers' clinics to public health care system in Addis Ababa. Materials and methods Ten traditional healers who were willing to participate in the study and 306 patients who were visiting these traditional healers' clinics were interviewed using two types of semi-structured questionnaires. Data were summarized using percentages, tables and bar chart. Results The diseases mostly treated by traditional healers were wound, inflammation, herpes zoster, hemorrhoids, fracture, paralysis, back-pain, liver diseases, cancer and eczema. This study showed that traditional healers' clinics considerably contribute to public health care in Addis Ababa. Fifty two percent of patients reported that traditional healers' clinics were their first choice when they faced health problems. The reasons for visiting these clinics were 175 (57.2% efficacy, 109 (35.6% dissatisfaction with modern medicine, 10 (3.3% dissatisfaction with modern medicine and efficacy, 6 (2.0% cost and 6 (2.0% dissatisfaction and cost. Females (55.2%, young age (20-40 years, 65.0%, never married (56.9%, orthodox (73.9%, Amhara (52.3%, educational status above grade 12 (34.6% and government employees (29.4% were frequent visitors. Healers reported that there was no form of cooperation with modern health professionals. The reasons were lack of motivation to collaborate and communicate with modern health service workers. Family based

Factors influencing women's utilization of public health care services ...

African Journals Online (AJOL)

the determinants influencing women's use of public health facilities at the time they give birth. Results: Of .... due to distance between their places of abode and health care facilities ..... care: what works for safe motherhood: Bull World Health.

Why Even the Logic of Re-Defined Choice May Still Contradict the Logic of Care in Public Health Systems?

Directory of Open Access Journals (Sweden)

Marianna Fotaki

2013-01-01

Full Text Available I would like to thank Dr. Benjamin Ewert (1 for his commentary on my short paper ‘Is patient choice the future of health care systems?’ (2 for three reasons. First, because I take heart from his support for my key thesis about the need to replace simplistic economic constructs underlying policy assumptions to explain how patients make health-related decisions in real life. Second, because it gives me the opportunity to, on the one hand, clarify my arguments on how health users’ embeddedness in social relations and patients’ multiple identities and personal circumstances influence these decisions; and to elaborate on the role of trust in this processes in more detail on the other hand. Third, because Dr. Ewert’s contribution helped me re-think issues concerning the importance of patient choice in the context of new challenges that public health systems face such as the threat to free and universal provision of health care services. Although I fully agree with the rejection of the obsolete conception of choice that tends to dominate current policy debates, I do believe that his conviction concerning the inescapability of choice requires some further qualifications. This stems from the recognition of users expressed desire to trade off choice against other more important attributes of health care which have to do with their values and norms originating in the ethics of care, and which makes provision of health services possible. Let me now explicate in brief these three points of agreement before presenting my ultimate disclaimer in the conclusion of this response to Dr. Ewert’s comment. On the first point concerning the inadequacy of economic models as a guide for public health policy, without repeating the arguments expressed eloquently in the commentary, I would like to reiterate that these are at odds with reality because a simple notion of preference which underlies the idea of consumerist choice fails to account for the host of

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

Science.gov (United States)

Douglas, Kathy S

2012-01-01

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

Western impressions of the Hong Kong health care system.

Science.gov (United States)

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

1996-01-01

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

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

Science.gov (United States)

Shishkin, S

1999-06-01

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

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

Science.gov (United States)

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

2015-04-01

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

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

Science.gov (United States)

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

2007-01-01

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

Using data warehousing and OLAP in public health care.

Science.gov (United States)

Hristovski, D; Rogac, M; Markota, M

2000-01-01

The paper describes the possibilities of using data warehousing and OLAP technologies in public health care in general and then our own experience with these technologies gained during the implementation of a data warehouse of outpatient data at the national level. Such a data warehouse serves as a basis for advanced decision support systems based on statistical, OLAP or data mining methods. We used OLAP to enable interactive exploration and analysis of the data. We found out that data warehousing and OLAP are suitable for the domain of public health and that they enable new analytical possibilities in addition to the traditional statistical approaches.

Right care, right place, right time: improving the timeliness of health care in New South Wales through a public-private hospital partnership.

Science.gov (United States)

Saunders, Carla; Carter, David J

2017-10-01

Objective The overall aim of the study was to investigate and assess the feasibility of improving the timeliness of public hospital care through a New South Wales (NSW)-wide public-private hospital partnership. Methods The study reviewed the academic and professional grey literature, and undertook exploratory analyses of secondary data acquired from two national health data repositories informing in-patient access and utilisation across NSW public and private hospitals. Results In 2014-15, the NSW public hospital system was unable to deliver care within the medically recommended time frame for over 27400 people who were awaiting elective surgery. Available information indicates that the annual commissioning of 15% of public in-patient rehabilitation bed days to the private hospital system would potentially free up enough capacity in the NSW public hospital system to enable elective surgery for all public patients within recommended time frames. Conclusions The findings of the study justify a strategic whole-of-health system approach to reducing public patient wait times in NSW and highlight the need for research efforts aimed at securing a better understanding of available hospital capacity across the public and private hospital systems, and identifying and testing workable models that improve the timeliness of public hospital care. What is known about the topic? There are very few studies available to inform public-private hospital service partnerships and the opportunities available to improve timely health care access through such partnerships. What does this paper add? This paper has the potential to open and prompt timely discussion and debate, and generate further fundamental investigation, on public-private hospital service partnerships in Australia where opportunity is available to address elective surgery wait times in a reliable and effective manner. What are the implications for practitioners? The NSW Ministry of Health and its Local Health Districts

Health Care Spending: Changes in the Perceptions of the Australian Public.

Directory of Open Access Journals (Sweden)

Jane Robertson

Full Text Available Increasing demand for services and rising health care costs create pressures within the Australian health care system and result in higher health insurance premiums and out-of-pocket costs for consumers.To measure changes in consumer views on the quality of the Australian health care system, contributors to rising costs and attitudes towards managing these costs.Two computer-assisted telephone interviews were conducted in 2006 (533 respondents and 2015 (1318 respondents and results compared.More respondents in 2015 rated the Australian health care system 'very adequate' than in 2006 (22.3% vs 8.3%; Odds Ratio OR 3.2, 99% CI 2.1, 5.1 with fewer 'concerned' or 'fairly concerned' about the health care costs (69.0% vs 85.7%; OR 0.37, 99% CI 0.25, 0.53. The 2015 respondents were more likely to identify new treatments for cancer (77% vs 65.7%; OR 1.75, 99% CI 1.30, 2.35 and community expectations for access to the latest technologies (73.8% vs 67%; OR 1.39, 99% CI 1.04, 1.86 as contributors to rising health care costs. While more 2015 respondents agreed that patients should pay a greater part of the health care costs, this remained a minority view (37.9% vs 31.7%; OR 1.32, 99% CI 0.99, 1.76. They were less likely to agree that doctors should offer medical treatments regardless of the cost and chance of benefit (63.6% vs 82.9%; OR 0.36, 99% CI 0.25, 0.50.Satisfaction with the Australian health care system has increased over time. Consumers recognise the cost pressures and have lower expectations that all services should be provided regardless of their costs and potential benefit. Public consultation on the allocation of health care resources and involvement in health care decision-making remains important. There should be community consultation about the principles and values that should guide resource allocation decisions.

Health Care Spending: Changes in the Perceptions of the Australian Public.

Science.gov (United States)

Robertson, Jane; Newby, David A; Walkom, Emily J

2016-01-01

Increasing demand for services and rising health care costs create pressures within the Australian health care system and result in higher health insurance premiums and out-of-pocket costs for consumers. To measure changes in consumer views on the quality of the Australian health care system, contributors to rising costs and attitudes towards managing these costs. Two computer-assisted telephone interviews were conducted in 2006 (533 respondents) and 2015 (1318 respondents) and results compared. More respondents in 2015 rated the Australian health care system 'very adequate' than in 2006 (22.3% vs 8.3%; Odds Ratio OR 3.2, 99% CI 2.1, 5.1) with fewer 'concerned' or 'fairly concerned' about the health care costs (69.0% vs 85.7%; OR 0.37, 99% CI 0.25, 0.53). The 2015 respondents were more likely to identify new treatments for cancer (77% vs 65.7%; OR 1.75, 99% CI 1.30, 2.35) and community expectations for access to the latest technologies (73.8% vs 67%; OR 1.39, 99% CI 1.04, 1.86) as contributors to rising health care costs. While more 2015 respondents agreed that patients should pay a greater part of the health care costs, this remained a minority view (37.9% vs 31.7%; OR 1.32, 99% CI 0.99, 1.76). They were less likely to agree that doctors should offer medical treatments regardless of the cost and chance of benefit (63.6% vs 82.9%; OR 0.36, 99% CI 0.25, 0.50). Satisfaction with the Australian health care system has increased over time. Consumers recognise the cost pressures and have lower expectations that all services should be provided regardless of their costs and potential benefit. Public consultation on the allocation of health care resources and involvement in health care decision-making remains important. There should be community consultation about the principles and values that should guide resource allocation decisions.

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

Directory of Open Access Journals (Sweden)

I. P. Krynychna

2015-03-01

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

Prevalence of burnout among public health nurses in charge of mental health services and emergency care systems in Japan.

Science.gov (United States)

Imai, Hirohisa; Nakao, Hiroyuki; Nakagi, Yoshihiko; Niwata, Satoko; Sugioka, Yoshihiko; Itoh, Toshihiro; Yoshida, Takahiko

2006-11-01

The Community Health Act came into effect in 1997 in Japan. This act altered the work system for public health nurses (PHNs) in public health centers (PHCs) nationwide from region-specific to service-specific work. Such major changes to working environment in the new system seem to be exposing PHNs to various types of stress. The present study examined whether prevalence of burnout is higher among PHNs in charge of mental health services (psychiatric PHNs) than among PHNs in charge of other services (non-psychiatric PHNs), and whether attributes of emergency mental health care systems in communities are associated with increased prevalence of burnout. A questionnaire including the Pines burnout scale for measuring burnout was mailed to 525 psychiatric PHNs and 525 non-psychiatric PHNs. The 785 respondents included in the final analysis comprised 396 psychiatric PHNs and 389 non-psychiatric PHNs. Prevalence of burnout was significantly higher for psychiatric PHNs (59.2%) than for non-psychiatric PHNs (51.5%). When prevalence of burnout in each group was analyzed in relation to question responses regarding emergency service and patient referral systems, prevalence of burnout for psychiatric PHNs displayed significant correlations to frequency of cases requiring overtime emergency services, difficulties referring patients, and a feeling of "restriction". Prevalence of burnout is high among psychiatric PHNs, and inadequate emergency mental health service systems contribute to burnout among these nurses. Countermeasures for preventing such burnout should be taken as soon as possible.

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

Science.gov (United States)

Petersen, Poul Erik

2014-01-01

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

Overcoming Barriers to Rural Children's Mental Health: An Interconnected Systems Public Health Model

Science.gov (United States)

Huber, Brenda J.; Austen, Julie M.; Tobin, Renée M.; Meyers, Adena B.; Shelvin, Kristal H.; Wells, Michael

2016-01-01

A large, Midwestern county implemented a four-tiered public health model of children's mental health with an interconnected systems approach involving education, health care, juvenile justice and community mental health sectors. The community sought to promote protective factors in the lives of all youth, while improving the capacity,…

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

Science.gov (United States)

Guyon, Ak'ingabe; Perreault, Robert

2016-10-20

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

[Public health and mental health: methodological tools to evaluate the Brazilian Network of Referral Centers for Psycho-Social Care (CAPS) in the Brazilian Unified Health System].

Science.gov (United States)

Onocko-Campos, Rosana Teresa; Furtado, Juarez Pereira

2006-05-01

This article presents a preliminary discussion of potential methodological tools for qualitative research on the Network of Referral Centers for Psycho-Social Care (CAPS) in the Brazilian Unified Health System (SUS). The relevance of mental health within the field of public health is examined. The study focuses on the high prevalence of mental disorders and the disproportionate lack of studies on the interface between mental health and public health. The establishment of an interdisciplinary field between public health and mental health is proposed to meet common needs by achieving similar perspectives in knowledge and practice. A particular group of tools is proposed, emphasizing the importance of reclaiming and guaranteeing the roles of various social actors to shape the assessment process, the need for collecting and standardizing academic studies on the topic, and the importance of promoting a new research field focusing on public health policies to support policymakers, managers, and health teams in reshaping their practices.

Health and social care regulation in Wales: an integrated system of political, corporate and professional governance for improving public health.

Science.gov (United States)

Jewell, Tony; Wilkinson, Jane

2008-11-01

Wales is developing a unique integrated system of governance to improve public health, which is diverging from some recent developments in the rest of the UK but shares many common features. There is a focus on strengthening collaborative working and co-ordination between bodies inspecting, regulating and auditing health and social care. Systems are being developed that are proportionate to the level of risk, eliminate unnecessary burdens of external review and support the improvement of services for patients, service users and carers. This is consistent with the Assembly Government's aim to improve the way that public services are delivered in Wales, including strengthening input from the public in the planning, delivery and reporting of regulation and inspection work. The test in the future will be how far we can demonstrate quantitatively and qualitatively the added value from our uniquely Welsh approach, built as it is on devolution and the aspirations for small-country governance.

MEDICARE PAYMENTS AND SYSTEM-LEVEL HEALTH-CARE USE

Science.gov (United States)

ROBBINS, JACOB A.

2015-01-01

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

Rural-Urban Differences in Access to Preventive Health Care Among Publicly Insured Minnesotans.

Science.gov (United States)

Loftus, John; Allen, Elizabeth M; Call, Kathleen Thiede; Everson-Rose, Susan A

2018-02-01

Reduced access to care and barriers have been shown in rural populations and in publicly insured populations. Barriers limiting health care access in publicly insured populations living in rural areas are not understood. This study investigates rural-urban differences in system-, provider-, and individual-level barriers and access to preventive care among adults and children enrolled in a public insurance program in Minnesota. This was a secondary analysis of a 2008 statewide, cross-sectional survey of publicly insured adults and children (n = 4,388) investigating barriers associated with low utilization of preventive care. Sampling was stratified with oversampling of racial/ethnic minorities. Rural enrollees were more likely to report no past year preventive care compared to urban enrollees. However, this difference was no longer statistically significant after controlling for demographic and socioeconomic factors (OR: 1.37, 95% CI: 1.00-1.88). Provider- and system-level barriers associated with low use of preventive care among rural enrollees included discrimination based on public insurance status (OR: 2.26, 95% CI: 1.34-2.38), cost of care concerns (OR: 1.72, 95% CI: 1.03-2.89) and uncertainty about care being covered by insurance (OR: 1.70, 95% CI: 1.01-2.85). These and additional provider-level barriers were also identified among urban enrollees. Discrimination, cost of care, and uncertainty about insurance coverage inhibit access in both the rural and urban samples. These barriers are worthy targets of interventions for publicly insured populations regardless of residence. Future studies should investigate additional factors associated with access disparities based on rural-urban residence. © 2017 National Rural Health Association.

Health system strategies supporting transition to adult care.

Science.gov (United States)

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

2015-06-01

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

Child Poverty and the Health Care System.

Science.gov (United States)

Racine, Andrew D

2016-04-01

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

Intersectoral cooperation in the sphere of public health care: ways of optimization

Directory of Open Access Journals (Sweden)

Natan G. Korshever

2017-08-01

Material and Methods — There were analyzed the normative legal field of public health care, the results of anonymous survey of 838 physicians – health care organizers including 34 experts, and of 6,106 persons not engaged in medical professions. Results — There were established the list and significance of 37 health determinants; the effect produced on them by 23 state and public sectors engaged in health care; characteristics of these sectors’ interaction. There were substantiated 38 informative vectors for evaluating the effectiveness of intersectoral cooperation in the sphere of public health care – 22 simple (each representing a single informative criterion and 16 complex (consisting of several, from 3 to 12 informative criteria. There was developed an automatic multi-vector method for assessing success in intersectoral cooperation in the sphere of public health care in a territorial formation (formations, and there was designed an appropriate technology of optimization, including the primary multi-vector analysis, purposeful correction and dynamic evaluation. Conclusion — Public health care optimization is a process which should be carried out with regard to hierarchic interaction of the engaged sectors and peculiarities of their influence on health determinants, multi-vector evaluation of intersectoral cooperation efficacy aimed to substantiate and choose such administrative decisions which prove to be the best from the viewpoint of resulting effective achievements. The obtained materials may be realized in everyday practice of public health care.

Utilization of dental health services by Danish adolescents attending private or public dental health care systems

DEFF Research Database (Denmark)

Christensen, Lisa Bøge; Petersen, Poul Erik; Bastholm, Annelise

2002-01-01

The objectives of the study were: 1) to describe the choice of dental care system among 16-year-olds, 2) to describe the utilization of dental services among 16-17-year-olds enrolled in either public or private dental care systems, and to compare the dental services provided by the alternative...

[The scientometric analysis of dissertation studies in the field of specialty public health and health care concerning children population].

Science.gov (United States)

Albitskiy, V S; Ustinova, N V; Antonova, Ye V

2014-01-01

The article considers trends and priority directions of research studies of the field of public health and health care of children population. The interpretative content analysis was applied to study dissertations in the field of public health and health care in 1991-2012. The sampling included 4194 units of information. The first stage of study established that problems of children population are considered in 14.8% dissertations defended on the mentioned specialty. The next stage the categories of content-analysis were examined. They were divided on the following axes: axis I "Main problem of study", axis II "Localization of study", axis III "Examined age groups", axis IV "Distribution of studies on gender of examined contingent", axis V "Examined contingent", axis VI "Additional medical specialty". It is established that in dissertations on public health and health care of children population on axis I prevails organizational subject matter (27.2%). The health condition of various contingents of children population (16.8%), preventive aspects of pediatrics (12.2%), examination of particular conditions/diseases/classes of diseases (10.8%) are fixed as priority directions. In the most dissertations the regional character of studies is presented (98.2%). The prevailing age group in studies is the adolescent group (19.9%). The inter-disciplinary relationships of dissertations on problems of public health and health care of children population are revealed with such specialties as "Pediatrics" (16.2%), "Obstetrics and gynecology" (3.8%) and "Hygiene" (3.4%). With consideration for recognition of health promotion and optimization of health care of children population as priority directions of public health policy amount of research studies in this field is to be admitted as inadequate. With purpose of optimization of scientific knowledge and development of system of medical social care to children population it is needed to promote research studies of problems of

Differences in essential newborn care at birth between private and public health facilities in eastern Uganda.

Science.gov (United States)

Waiswa, Peter; Akuze, Joseph; Peterson, Stefan; Kerber, Kate; Tetui, Moses; Forsberg, Birger C; Hanson, Claudia

2015-01-01

In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted. The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007). Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (pprivate facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities. In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was slightly lower in private compared to public facilities, calling for quality improvement in both

Differences in essential newborn care at birth between private and public health facilities in eastern Uganda

Directory of Open Access Journals (Sweden)

Peter Waiswa

2015-03-01

Full Text Available Background: In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. Objective: To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. Design: Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted. Results: The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007. Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (p<0.001. Women delivering in private facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities. Conclusions: In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was

Human rights in patient care and public health-a common ground.

Science.gov (United States)

Peled-Raz, Maya

2017-01-01

Medical law and public health law have both served extensively as instruments of health protection and promotion-yet both are limited in their effect and scope and do not sufficiently cover nor supply a remedy to systematic, rather than anecdotal, mistreatments in the health care system. A possible solution to this deficiency may be found in the human rights in patient care legal approach. The concept of human rights in patient care is a reframing of international human rights law, as well as constitutional thought and tools, into a coherent approach aimed at the protection and furthering of both personal and communal health. It applies human rights discourse and human rights law onto the patient care setting while moving away from the narrow consumeristic view of health care delivery. By applying human rights in patient care approach, both national and international courts may and should serve as policy influencing instruments, protecting the rights of the most vulnerable and prejudiced against groups, which are want of a remedy through traditional patients' rights legal schemes.

Public trust in Dutch health care.

NARCIS (Netherlands)

Straten, G.F.M.; Friele, R.D.; Groenewegen, P.P.

2002-01-01

This article describes the development of a valid and reliable instrument to measure different dimensions of public trust in health care in the Netherlands. This instrument is needed because the concept was not well developed, or operationalized in earlier research. The new instrument will be used

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

Science.gov (United States)

Janecka, Ivo

2017-02-15

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

Public support for social financing of health care in Switzerland.

Science.gov (United States)

Perneger, Thomas V; Hudelson, Patricia M

2005-01-01

The purpose of this study was to identify factors associated with the public's preference for financing health care according to people's ability to pay. The authors compared voters' support in 26 Swiss cantons for a legislative proposal to replace regionally rated health insurance premiums (current system) with premiums proportional to income and wealth, and co-financed through the value added tax. The vote took place in May 2003, and the initiative was rejected, with only 27 percent of support nationwide. However, support varied more than threefold, from 13 to 44 percent, among cantons. In multivariate analysis, support was most strongly correlated with the approval rate of the 1994 law on health insurance, which strengthened solidarity between the sick and the healthy. More modest associations were seen between support for the initiative and the health insurance premium of 2003, and proportions of elderly and urban residents in the population. Hence support for more social financing of health care was best explained by past preference for a social health insurance system in the local community.

Evaluation of the awareness and effectiveness of IT security programs in a large publicly funded health care system.

Science.gov (United States)

Hepp, Shelanne L; Tarraf, Rima C; Birney, Arden; Arain, Mubashir Aslam

2017-01-01

Electronic health records are becoming increasingly common in the health care industry. Although information technology (IT) poses many benefits to improving health care and ease of access to information, there are also security and privacy risks. Educating health care providers is necessary to ensure proper use of health information systems and IT and reduce undesirable outcomes. This study evaluated employees' awareness and perceptions of the effectiveness of two IT educational training modules within a large publicly funded health care system in Canada. Semi-structured interviews and focus groups included a variety of professional roles within the organisation. Participants also completed a brief demographic data sheet. With the consent of participants, all interviews and focus groups were audio recorded. Thematic analysis and descriptive statistics were used to evaluate the effectiveness of the IT security training modules. Five main themes emerged: (i) awareness of the IT training modules, (ii) the content of modules, (iii) staff perceptions about differences between IT security and privacy issues, (iv) common breaches of IT security and privacy, and (v) challenges and barriers to completing the training program. Overall, nonclinical staff were more likely to be aware of the training modules than were clinical staff. We found e-learning was a feasible way to educate a large number of employees. However, health care providers required a module on IT security and privacy that was relatable and applicable to their specific roles. Strategies to improve staff education and mitigate against IT security and privacy risks are discussed. Future research should focus on integrating health IT competencies into the educational programs for health care professionals.

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

Science.gov (United States)

Parthasarathi, R; Sinha, S P

2016-01-01

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

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

Directory of Open Access Journals (Sweden)

R Parthasarathi

2016-01-01

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

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

Directory of Open Access Journals (Sweden)

Li Zhijian

2012-06-01

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

A framework for current public mental health care practice in South Africa.

Science.gov (United States)

Janse Van Rensburg, A B

2007-11-01

One of the main aims of the new Mental Health Care Act, Act No. 17 of 2002 (MHCA) is to promote the human rights of people with mental disabilities in South Africa. However, the upholding of these rights seems to be subject to the availability of resources. Chapter 2 of the MHCA clarifies the responsibility of the State to provide infrastructure and systems. Chapters 5, 6 and 7 of the Act define and regulate the different categories of mental health care users, clarify the procedures around these categories and spell out mental health practitioners' roles and responsibilities in this regard. Also according to the National Health Act No. 61 of 2003, the State remains the key role player in mental health care provision, being responsible for adequate mental health infrastructure and resource allocation. Due to "limited resources" practitioners however often work in environments where staff ratios may be fractional of what should be expected and in units of which the physical structure and security is totally inadequate. The interface between professional responsibility of clinical workers versus the inadequacy of clinical interventions resulting from infrastructure and staffing constraints needs to be defined. This paper considered recent legislation currently relevant to mental health care practice in order to delineate the legal, ethical and labour framework in which public sector mental health practitioners operate as state employees. These included the Mental Health Care Act, No.17 of 2002; the National Health Act, No. 61 of 2003 and the proposed Traditional Health Practitioners Act, No. 35 of 2004. Formal legal review of and advice on this legislation as it pertains to public sector mental health practitioners as state employees, is necessary and should form the basis of the principles and standards for care endorsed by organized mental health care practitioner groups such as the South African Society of Psychiatrists (SASOP).

Understanding the organization of public health delivery systems: an empirical typology.

Science.gov (United States)

Mays, Glen P; Scutchfield, F Douglas; Bhandari, Michelyn W; Smith, Sharla A

2010-03-01

Policy discussions about improving the U.S. health care system increasingly recognize the need to strengthen its capacities for delivering public health services. A better understanding of how public health delivery systems are organized across the United States is critical to improvement. To facilitate the development of such evidence, this article presents an empirical method of classifying and comparing public health delivery systems based on key elements of their organizational structure. This analysis uses data collected through a national longitudinal survey of local public health agencies serving communities with at least 100,000 residents. The survey measured the availability of twenty core public health activities in local communities and the types of organizations contributing to each activity. Cluster analysis differentiated local delivery systems based on the scope of activities delivered, the range of organizations contributing, and the distribution of effort within the system. Public health delivery systems varied widely in organizational structure, but the observed patterns of variation suggested that systems adhere to one of seven distinct configurations. Systems frequently migrated from one configuration to another over time, with an overall trend toward offering a broader scope of services and engaging a wider range of organizations. Public health delivery systems exhibit important structural differences that may influence their operations and outcomes. The typology developed through this analysis can facilitate comparative studies to identify which delivery system configurations perform best in which contexts.

Public health and primary care: struggling to "win friends and influence people".

Science.gov (United States)

Mayes, Rick; McKenna, Sean

2011-01-01

Why are the goals of public health and primary care less politically popular and financially supported than those of curative medicine? A major part of the answer to this question lies in the fact that humans often worry wrongly by assessing risk poorly. This reality is a significant obstacle to the adequate promotion of and investment in public health, primary care, and prevention. Also, public health's tendency to infringe on personal privacy-as well as to call for difficult behavioral change-often sparks intense controversy and interest group opposition that discourage broader political support. Finally, in contrast to curative medicine, both the cost-benefit structure of public health (costs now, benefits later) and the way in which the profession operates make it largely invisible to and, thus, underappreciated by the general public. When curative medicine works well, most everybody notices. When public health and primary care work well, virtually nobody notices.

Transitioning from learning healthcare systems to learning health care communities.

Science.gov (United States)

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

2018-02-26

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

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

Science.gov (United States)

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

2011-01-29

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

Leveraging human capital to reduce maternal mortality in India: enhanced public health system or public-private partnership?

Science.gov (United States)

Krupp, Karl; Madhivanan, Purnima

2009-02-27

Developing countries are currently struggling to achieve the Millennium Development Goal Five of reducing maternal mortality by three quarters between 1990 and 2015. Many health systems are facing acute shortages of health workers needed to provide improved prenatal care, skilled birth attendance and emergency obstetric services - interventions crucial to reducing maternal death. The World Health Organization estimates a current deficit of almost 2.4 million doctors, nurses and midwives. Complicating matters further, health workforces are typically concentrated in large cities, while maternal mortality is generally higher in rural areas. Additionally, health care systems are faced with shortages of specialists such as anaesthesiologists, surgeons and obstetricians; a maldistribution of health care infrastructure; and imbalances between the public and private health care sectors. Increasingly, policy-makers have been turning to human resource strategies to cope with staff shortages. These include enhancement of existing work roles; substitution of one type of worker for another; delegation of functions up or down the traditional role ladder; innovation in designing new jobs;transfer or relocation of particular roles or services from one health care sector to another. Innovations have been funded through state investment, public-private partnerships and collaborations with nongovernmental organizations and quasi-governmental organizations such as the World Bank. This paper focuses on how two large health systems in India--Gujarat and Tamil Nadu--have successfully applied human resources strategies in uniquely different contexts to the challenges of achieving Millennium Development Goal Five.

Leveraging human capital to reduce maternal mortality in India: enhanced public health system or public-private partnership?

Directory of Open Access Journals (Sweden)

Madhivanan Purnima

2009-02-01

Full Text Available Abstract Developing countries are currently struggling to achieve the Millennium Development Goal Five of reducing maternal mortality by three quarters between 1990 and 2015. Many health systems are facing acute shortages of health workers needed to provide improved prenatal care, skilled birth attendance and emergency obstetric services – interventions crucial to reducing maternal death. The World Health Organization estimates a current deficit of almost 2.4 million doctors, nurses and midwives. Complicating matters further, health workforces are typically concentrated in large cities, while maternal mortality is generally higher in rural areas. Additionally, health care systems are faced with shortages of specialists such as anaesthesiologists, surgeons and obstetricians; a maldistribution of health care infrastructure; and imbalances between the public and private health care sectors. Increasingly, policy-makers have been turning to human resource strategies to cope with staff shortages. These include enhancement of existing work roles; substitution of one type of worker for another; delegation of functions up or down the traditional role ladder; innovation in designing new jobs;transfer or relocation of particular roles or services from one health care sector to another. Innovations have been funded through state investment, public-private partnerships and collaborations with nongovernmental organizations and quasi-governmental organizations such as the World Bank. This paper focuses on how two large health systems in India – Gujarat and Tamil Nadu – have successfully applied human resources strategies in uniquely different contexts to the challenges of achieving Millennium Development Goal Five.

Telemedicine spirometry training and quality assurance program in primary care centers of a public health system.

Science.gov (United States)

Marina Malanda, Nuria; López de Santa María, Elena; Gutiérrez, Asunción; Bayón, Juan Carlos; Garcia, Larraitz; Gáldiz, Juan B

2014-04-01

Forced spirometry is essential for diagnosing respiratory diseases and is widely used across levels of care. However, several studies have shown that spirometry quality in primary care is not ideal, with risks of misdiagnosis. Our objective was to assess the feasibility and performance of a telemedicine-based training and quality assurance program for forced spirometry in primary care. The two phases included (1) a 9-month pilot study involving 15 centers, in which spirometry tests were assessed by the Basque Office for Health Technology Assessment, and (2) the introduction of the program to all centers in the Public Basque Health Service. Technicians first received 4 h of training, and, subsequently, they sent all tests to the reference laboratory using the program. Quality assessment was performed in accordance with clinical guidelines (A and B, good; C-F, poor). In the first phase, 1,894 spirometry tests were assessed, showing an improvement in quality: acceptable quality tests increased from 57% at the beginning to 78% after 6 months and 83% after 9 months (passessed after the inclusion of 36 additional centers, maintaining the positive trend (61%, 87%, and 84% at the same time points; pquality of spirometry tests improved in all centers. (2) The program provides a tool for transferring data that allows monitoring of its quality and training of technicians who perform the tests. (3) This approach is useful for improving spirometry quality in the routine practice of a public health system.

Addressing Health Care Disparities and Increasing Workforce Diversity: The Next Step for the Dental, Medical, and Public Health Professions

Science.gov (United States)

Mitchell, Dennis A.; Lassiter, Shana L.

2006-01-01

The racial/ethnic composition of our nation is projected to change drastically in the coming decades. It is therefore important that the health professions improve their efforts to provide culturally competent care to all patients. We reviewed literature concerning health care disparities and workforce diversity issues—particularly within the oral health field—and provide a synthesis of recommendations to address these issues. This review is highly relevant to both the medical and public health professions, because they are facing similar disparity and workforce issues. In addition, the recent establishment of relationships between oral health and certain systemic health conditions will elevate oral health promotion and disease prevention as important points of intervention in the quest to improve our nation’s public health. PMID:17077406

The State Public Health Laboratory System.

Science.gov (United States)

Inhorn, Stanley L; Astles, J Rex; Gradus, Stephen; Malmberg, Veronica; Snippes, Paula M; Wilcke, Burton W; White, Vanessa A

2010-01-01

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 goal of which is to promote public-private collaboration to assure quality laboratory services and public health surveillance. To enhance the realization of the NLS, the Association of Public Health Laboratories (APHL) launched in 2004 a State Public Health Laboratory System Improvement Program. In the same year, APHL developed a Comprehensive Laboratory Services Survey, a tool to measure improvement through the decade to assure that essential PHL services are provided.

The Impact of Public Health Awareness Campaigns on the Awareness and Quality of Palliative Care.

Science.gov (United States)

Seymour, Jane

2018-01-01

The right to health includes a right of access to good quality palliative care, but inequalities persist. Raising awareness is a key plank of the public health approach to palliative care, but involves consideration of subjects most of us prefer not to address. This review addresses the question: "do public health awareness campaigns effectively improve the awareness and quality of palliative care"? The evidence shows that public awareness campaigns can improve awareness of palliative care and probably improve quality of care, but there is a lack of evidence about the latter. Rapid review and synthesis. A comprehensive public awareness campaign about palliative care (including advance care planning and end-of-life decision making) should be based on clear and shared terminology, use well piloted materials, and the full range of mass media to suit different ages, cultures, and religious/spiritual perspectives. Arts and humanities have a role to play in allowing individuals and communities to express experiences of illness, death, and grief and encourage conversation and thoughtful reflection. There is evidence about key factors for success: targeting, networking, and use of specific, measurable, achievable, realistic time-bound objectives; continuous evaluation; and complementarity to national and international policy. Campaigns should be located within the framework of public health promotion and the synergy between short national mass media campaigns and longer term local community action initiatives carefully considered. National and local projects to raise awareness should identify and address any barriers at the level of individuals, communities, and systems of care, for example, literacy skills and unequal access to resources.

Public Trust in Health Information Sharing: A Measure of System Trust.

Science.gov (United States)

Platt, Jodyn E; Jacobson, Peter D; Kardia, Sharon L R

2018-04-01

To measure public trust in a health information sharing in a broadly defined health system (system trust), inclusive of health care, public health, and research; to identify individual characteristics that predict system trust; and to consider these findings in the context of national health initiatives (e.g., learning health systems and precision medicine) that will expand the scope of data sharing. Survey data (n = 1,011) were collected in February 2014. We constructed a composite index of four dimensions of system trust-competency, fidelity, integrity, and trustworthiness. The index was used in linear regression evaluating demographic and psychosocial predictors of system trust. Data were collected by GfK Custom using a nationally representative sample and analyzed in Stata 13.0. Our findings suggest the public's trust may not meet the needs of health systems as they enter an era of expanded data sharing. We found that a majority of the U.S. public does not trust the organizations that have health information and share it (i.e., the health system) in one or more dimensions. Together, demographic and psychosocial factors accounted for ~18 percent of the observed variability in system trust. Future research should consider additional predictors of system trust such as knowledge, attitudes, and beliefs to inform policies and practices for health data sharing. © Health Research and Educational Trust.

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

Science.gov (United States)

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

2018-05-01

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

Towards equivalent health care of prisoners: European soft law and public health policy in Geneva.

Science.gov (United States)

Elger, Bernice S

2008-07-01

Prisoners have a right to health care and to be protected against inhumane and degrading treatment. Health care personnel and public policy makers play a central role in the protection of these rights and in the pursuit of public health goals. This article examines the legal framework for prison medicine in the canton of Geneva, Switzerland and provides examples of this framework that has shaped prisoners' medical care, including preventive measures. Geneva constitutes an intriguing example of how the Council of Europe standards concerning prison medicine have acquired a legal role in a Swiss canton. Learning how these factors have influenced implementation of prison medicine standards in Geneva may be helpful to public health managers elsewhere and encourage the use of similar strategies.

Value Chains of Public and Private Health-care Services in a Small EU Island State: A SWOT Analysis.

Science.gov (United States)

Buttigieg, Sandra C; Schuetz, Marcus; Bezzina, Frank

2016-01-01

The global financial and macroeconomic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically, in health care, governments started to explore ways of establishing collaborations between the public and private health-care sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health-care systems in Malta, a small European Union island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains, and this was followed by an analysis of strengths, weaknesses, opportunities, and threats (SWOT). The latter revealed several strengths and opportunities, which can better equip health-policy makers in the quest to maximize provision of health-care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that, unless addressed, may threaten the state's health-care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health-care services in Malta.

Public perceptions of health care professionals' participation in pharmaceutical marketing.

Science.gov (United States)

Crigger, Nancy J; Courter, Laura; Hayes, Kristen; Shepherd, K

2009-09-01

Trust in the nurse-patient relationship is maintained not by how professionals perceive their actions but rather by how the public perceives them. However, little is known about the public's view of nurses and other health care professionals who participate in pharmaceutical marketing. Our study describes public perceptions of health care providers' role in pharmaceutical marketing and compares their responses with those of a random sample of licensed family nurse practitioners. The family nurse practitioners perceived their participation in marketing activities as significantly more ethically appropriate than did the public responders. Further research is warranted before conclusions can be drawn, but these early findings suggest that nurse practitioners should consider a conservative approach to participating in pharmaceutical marketing.

[A Maternal Health Care System Based on Mobile Health Care].

Science.gov (United States)

Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

2016-02-01

Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.

Managed care: employers' influence on the health care system.

Science.gov (United States)

Corder, K T; Phoon, J; Barter, M

1996-01-01

Health care reform is a complex issue involving many key sectors including providers, consumers, insurers, employers, and the government. System changes must involve all sectors for reform to be effective. Each sector has a responsibility to understand not only its own role in the health care system, but the roles of others as well. The role of business employers is often not apparent to health care providers, especially nurses. Understanding the influence employers have on the health care system is vital if providers want to be proactive change agents ensuring quality care.

Public health nursing, ethics and human rights.

Science.gov (United States)

Ivanov, Luba L; Oden, Tami L

2013-05-01

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. © 2013 Wiley Periodicals, Inc.

Health care delivery systems.

NARCIS (Netherlands)

Stevens, F.; Zee, J. van der

2007-01-01

A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective,

CURRENT ECONOMIC AND MEDICAL REFORMS IN THE ROMANIAN HEALTH CARE SYSTEM

Directory of Open Access Journals (Sweden)

Dragoi Mihaela Cristina

2011-12-01

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

Public Health Investment in Team Care: Increasing Access to Clinical Preventive Services in Los Angeles County

Directory of Open Access Journals (Sweden)

Tony Kuo

2018-02-01

Full Text Available As part of federal and local efforts to increase access to high quality, clinical preventive services (CPS in underserved populations, the Los Angeles County Department of Public Health (DPH partnered with six local health system and community organization partners to promote the use of team care for CPS delivery. Although these partners were at different stages of organizational capacity, post-program review suggests that each organization advanced team care in their clinical or community environments, potentially affecting >250,000 client visits per year. Despite existing infrastructure and DPH’s funding support of CPS integration, partner efforts faced several challenges. They included lack of sustainable funding for prevention services; limited access to community resources that support disease prevention; and difficulties in changing health-care provider behavior. Although team care can serve as a catalyst or vehicle for delivering CPS, downstream sustainability of this model of practice requires further state and national policy changes that prioritize prevention. Public health is well positioned to facilitate these policy discussions and to assist health system and community organizations in strengthening CPS integration.

Social media in public health care

DEFF Research Database (Denmark)

Andersen, Kim Normann; Medaglia, Rony; Henriksen, Helle Zinner

2012-01-01

This paper investigates the impacts of social media use in Danish public health care with respect to capabilities, interactions, orientations, and value distribution. Taking an exploratory approach, the paper draws on an array of quantitative and qualitative data, and puts forward four propositions......: social media transform the access to health-related information for patients and general practitioners, the uptake of social media can be a cost driver rather than a cost saver, social media provide empowerment to patients, and the uptake of social media is hindered by legal and privacy concerns...

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

Science.gov (United States)

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

2016-01-01

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

Health care issues in Croatian elections 2005-2010: series of public opinion surveys.

Science.gov (United States)

Radin, Dagmar; Dzakula, Aleksandar; Benkovic, Vanesa

2011-10-15

To compare the results of a series of public opinion surveys on experiences with the health care sector in Croatia conducted in the time of elections and to analyze whether political party affiliation had any influence on issues of priority ranking. The surveys were conducted during 2005, 2007, and 2009. They were administered through a Computer Assisted Telephone Interviewing method to representative samples of Croatian population and were statistically weighted according to sex, age, level of education, and political party affiliation. The random sampling of the person within the household was done using the table of random numbers. Health and health care system was the most important issue (58%) during the 2007 parliamentary election and the second most important issue during the 2005 and 2009 elections (46% and 28%). In the 2007 election, health care was viewed as most important by women, respondents with lower education levels, and respondents with lower income. In 2005, the most important health care issues were corruption and lack of funding (45% and 43%, respectively), in 2007 poor organization and lack of funding (43% and 42%, respectively), and in 2009 lack of funding and corruption (51% and 45%, respectively). Health and health care system were consistently among the top two issues in all elections from 2005 to 2009. The top three most important health care sector issues were corruption, poor organization, and lack of funding. This indicates that political parties should include solutions to these issues in their health care policymaking.

Does corruption undermine trust in health care? Results from public opinion polls in Croatia.

Science.gov (United States)

Radin, Dagmar

2013-12-01

Health and health care provision are one of the most important topics in public policy, and often a highly debated topic in the political arena. The importance of considering trust in the health care sector is highlighted by studies showing that trust is associated, among others, with poor self-related health, and poorer health outcomes. Similarly, corruption has shown to create economic costs and inefficiencies in the health care sector. This is particularly important for a newly democratized country such as Croatia, where a policy responsive government indicates a high level of quality of democracy (Roberts, 2009) and where a legacy of corruption in the health care sector has been carried over from the previous regime. In this study, I assess the relationship between health care corruption and trust in public health care and hypothesize that experience with health care corruption as well as perception of corruption has a negative effect on trust in public care facilities. Data were collected in two surveys, administered in 2007 and 2009 in Croatia. Experience with corruption and salience with corruption has a negative effect on trust in public health care in the 2007 survey, but not in the 2009 survey. While the results are mixed, they point to the importance of further studying this relationship. Copyright © 2013 Elsevier Ltd. All rights reserved.

Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

Science.gov (United States)

Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

2017-01-01

Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

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

Science.gov (United States)

Petrochuk, M A; Javalgi, R G

1996-01-01

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

Determinants of and opportunities for continuing education among health care professionals in public health care institutions in Jimma township, Southwest Ethiopia

Directory of Open Access Journals (Sweden)

Fentahun N

2012-09-01

Full Text Available Netsanet Fentahun,1 Ashagre Molla21Department of Health Education and Behavioral Sciences, 2Department of Nursing, Jimma University, Jimma, EthiopiaBackground: An effectively prepared and continually updated workforce of health professionals is essential to maintenance and improvement in patient care. The major goal of continuing education is to improve and promote quality care. Continuing education is also important to an organization's strategic plan because of its positive influence on the quality of care provided. The purpose of this study was to identify the determinants of and opportunities for continuing education among health care professionals at public health facilities in Jimma township.Methods: A cross-sectional study of 319 health care professionals working in the public health facilities of Jimma township was conducted from January 10, 2012 to February 28, 2012. A self-administered questionnaire was used to collect the data. First, descriptive analysis was done to describe the characteristics of the study participants. Finally logistic regression was then used to determine the independent predictors of continuing education.Results: Only 70 (25% of the study participants were participating in continuing education. As working experience increased, participation in continuing education did not steadily increase. The working hours per week were higher for diploma holders than for those with any other qualification. One hundred and fifty-three (71.8% participants mentioned lack of support from their current employer as the reason for not participating in continuing education. Health care professionals with a lack of support from management were 2.4 times more likely not to participate in advanced education. Health care professionals with lack of funding were 0.3 times less likely to participate in advanced education. Health care professionals with lack of resources other than financial were 2.2 times more likely not to participate in

Impact of the Great East Japan Earthquake and tsunami on health, medical care and public health systems in Iwate Prefecture, Japan, 2011.

Science.gov (United States)

Nohara, Masaru

2011-10-01

The Great East Japan Earthquake was one of the largest earthquakes ever recorded in global history. The damage was spread over a wide area, with the worst-hit areas being Iwate, Miyagi and Fukushima prefectures. In this paper we report on the damage and the impact of the damage to describe the health consequences among disaster victims in Iwate Prefecture. In Iwate Prefecture the tsunami claimed 4659 lives, with 1633 people missing. In addition to electricity, water and gas being cut off following the disaster, communication functions were paralysed and there was a lack of gasoline. Medical and public health teams from Iwate Prefecture and around the country, including many different specialists, engaged in a variety of public health activities mainly at evacuation centres, including medical and mental health care and activities to prevent infectious diseases. Given the many fatalities, there were relatively few patients who required medical treatment for major injuries. However, there were significant medical needs in the subacute and chronic phases of care in evacuation centres, with great demand for medical treatment and public health assistance, measures to counteract infection and mental health care. By referring to past experiences of national and international large-scale disasters, it was possible to respond effectively to the health-related challenges. However, there are still challenges concerning how to share information and coordinate overall activities among multiple public health response teams. Further examination will be required to ensure better preparedness in response to future disasters.

RETRACTED M-HEALTH SERVICES: CAN IT BE A POTENTIAL MECHANISM IN IMPROVING PUBLIC HEALTH SYSTEM OF INDIA?

Directory of Open Access Journals (Sweden)

Sanjeev Davey

2013-09-01

Full Text Available Background: The role of mobile in health system is now important for us, to make use of this very fastly growing technology in improving the public health of Indian people. Objectives: To critically review the role of m-health in public health system of India. Methods: A systematic review of related studies and literature of last 10 years published in pubmed etc till 31st March 2013 on role of m-Health in public health was done. Results and discussion: A wide variety of m-health applications are available in mobile phone market, needing proper regulation from health care authorities and with a hope of better future results. Recommendations: We must use these applications weighing their benefits and utility in public health as well as capitalizing the better prospect of m-health worldwide in the field of public health. This can give a greater access to larger segments of a rural and underserved population in developing countries like India with a hope of improving the capacity of health system to provide quality healthcare to Indian people.

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

Science.gov (United States)

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

2015-01-01

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

Value-Based Health Care Delivery, Preventive Medicine and the Medicalization of Public Health.

Science.gov (United States)

Vilhelmsson, Andreas

2017-03-01

The real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a 'value-based health care delivery'. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges. In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of a better healthcare for all, with real benefits for the individual patient provided a tailored and optimized treatment plan suitable for his or her genetic makeup. And maybe, therefore, the assumptions underpinning personalized medicine have largely escaped questioning. The use of personalized medicine and the use of digital technologies is reshaping our health care system and how we think of health interventions and our individual responsibility. However, encouraging individuals to engage in preventive health activities possibly avoids one form of medicalization (clinical), but on the other hand, it takes up another form (preventive medicine and 'self-care') that moves medical and health concerns into every corner of everyday life. This ought to be of little value to the individual patient and public health. We ought to instead demand proof of these value ideas and the lacking research. Before this is in place critical appraisal and cynicism are requisite skills for the future. Otherwise, we are just listening to visionaries when we put our future health into their hands and let personalized solutions reach into people's everyday life regardless of patient safety and integrity.

Value Chains of Public and Private Health-care Services in a Small EU Island State: A SWOT Analysis

Science.gov (United States)

Buttigieg, Sandra C.; Schuetz, Marcus; Bezzina, Frank

2016-01-01

The global financial and macroeconomic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically, in health care, governments started to explore ways of establishing collaborations between the public and private health-care sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health-care systems in Malta, a small European Union island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains, and this was followed by an analysis of strengths, weaknesses, opportunities, and threats (SWOT). The latter revealed several strengths and opportunities, which can better equip health-policy makers in the quest to maximize provision of health-care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that, unless addressed, may threaten the state’s health-care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health-care services in Malta. PMID:27683658

Hawaii's public mental health system.

Science.gov (United States)

VanderVoort, Debra J

2005-03-01

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

On Robust Methodologies for Managing Public Health Care Systems

Directory of Open Access Journals (Sweden)

Shastri L. Nimmagadda

2014-01-01

Full Text Available Authors focus on ontology-based multidimensional data warehousing and mining methodologies, addressing various issues on organizing, reporting and documenting diabetic cases and their associated ailments, including causalities. Map and other diagnostic data views, depicting similarity and comparison of attributes, extracted from warehouses, are used for understanding the ailments, based on gender, age, geography, food-habits and other hereditary event attributes. In addition to rigor on data mining and visualization, an added focus is on values of interpretation of data views, from processed full-bodied diagnosis, subsequent prescription and appropriate medications. The proposed methodology, is a robust back-end application, for web-based patient-doctor consultations and e-Health care management systems through which, billions of dollars spent on medical services, can be saved, in addition to improving quality of life and average life span of a person. Government health departments and agencies, private and government medical practitioners including social welfare organizations are typical users of these systems.

Does public insurance provide better financial protection against rising health care costs for families of children with special health care needs?

Science.gov (United States)

Yu, Hao; Dick, Andrew W; Szilagyi, Peter G

2008-10-01

Health care costs grew rapidly since 2001, generating substantial economic pressures on families, especially those with children with special health care needs (CSHCN). To examine how the growth of health care costs affected financial burden for families of CSHCN between 2001 and 2004 and to determine the extent to which health insurance coverage protected families of CSHCN against financial burden. In 2001-2004, 5196 families of CSHCN were surveyed by the national Medical Expenditure Panel Survey (MEPS). The main outcome was financial burden, defined as the proportion of family income spent on out-of-pocket (OOP) health care expenditures for all family members, including OOP costs and premiums. Family insurance coverage was classified as: (1) all members publicly insured, (2) all members privately insured, (3) all members uninsured, (4) partial coverage, and (5) a mix of public and private with no uninsured periods. An upward trend in financial burden for families of CSHCN occurred and was associated with growth of economy-wide health care costs. A multivariate analysis indicated that, given the economy-wide increase in medical costs between 2001 and 2004, a family with CSHCN was at increased risk in 2004 for having financial burden exceeding 10% of family income [odds ratio (OR) = 1.39; P financial burden exceeding 20% of family income. Over 15% of families with public insurance had financial burden exceeding 10% of family income compared with 20% of families with private insurance (P financial burden of >10% or 20% of family income than privately-insured families. Rising health care costs increased financial burden on families of CSHCN in 2001-2004. Public insurance coverage provided better financial protection than private insurance against the rapidly rising health care costs for families of CSHCN.

Dementia care in public health in Brazil and the world: A systematic review

Directory of Open Access Journals (Sweden)

Bianca Bolzan Cieto

Full Text Available ABSTRACT OBJECTIVE: This study aimed to identify in the recent scientific literature, information on health care provided to people with dementia, dementia costs and its resource implications for public health. METHODS: This was a systematic review of the literature in which the articles were consulted from the databases PubMed/MEDLINE, LILACS and SciELO. The review sample consisted of 45 articles. RESULTS: Examination of the studies identified the current scenario of dementia in relation to public health and public policy in Brazil and the world. The analyzed studies revealed key information on aspects of dementia in the world. There was consensus on the high prevalence of the syndrome and on the significant cost of health care and public policy for assisting the elderly with dementia. CONCLUSION: The importance of planning and implementing new public policies was recognized, since these are essential for the organization and management of health services and directly influence the country's ability to provide health care for people with dementia.

World Health Organization Public Health Model: A Roadmap for Palliative Care Development.

Science.gov (United States)

Callaway, Mary V; Connor, Stephen R; Foley, Kathleen M

2018-02-01

The Open Society Foundation's International Palliative Care Initiative (IPCI) began to support palliative care development in Central and Eastern Europe and the Former Soviet Union in 1999. Twenty-five country representatives were invited to discuss the need for palliative care in their countries and to identify key areas that should be addressed to improve the care of adults and children with life-limiting illnesses. As a public health concern, progress in palliative care requires integration into health policy, education and training of health care professionals, availability of essential pain relieving medications, and health care services. IPCI created the Palliative Care Roadmap to serve as a model for government and/or nongovernment organizations to use to frame the necessary elements and steps for palliative care integration. The roadmap includes the creation of multiple Ministry of Health-approved working groups to address: palliative care inclusion in national health policy, legislation, and finance; availability of essential palliative care medications, especially oral opioids; education and training of health care professionals; and the implementation of palliative care services at home or in inpatient settings for adults and children. Each working group is tasked with developing a pathway with multiple signposts as indicators of progress made. The roadmap may be entered at different signposts depending upon the state of palliative care development in the country. The progress of the working groups often takes place simultaneously but at variable rates. Based on our experience, the IPCI Roadmap is one possible framework for palliative care development in resource constrained countries but requires both health care professional engagement and political will for progress to be made. Copyright © 2017. Published by Elsevier Inc.

Mobile health in China: a review of research and programs in medical care, health education, and public health.

Science.gov (United States)

Corpman, David W

2013-01-01

There are nearly 1 billion mobile phone subscribers in China. Health care providers, telecommunications companies, technology firms, and Chinese governmental organizations use existing mobile technology and social networks to improve patient-provider communication, promote health education and awareness, add efficiency to administrative practices, and enhance public health campaigns. This review of mobile health in China summarizes existing clinical research and public health text messaging campaigns while highlighting potential future areas of research and program implementation. Databases and search engines served as the primary means of gathering relevant resources. Included material largely consists of scientific articles and official reports that met predefined inclusion criteria. This review includes 10 reports of controlled studies that assessed the use of mobile technology in health care settings and 17 official reports of public health awareness campaigns that used text messaging. All source material was published between 2006 and 2011. The controlled studies suggested that mobile technology interventions significantly improved an array of health care outcomes. However, additional efforts are needed to refine mobile health research and better understand the applicability of mobile technology in China's health care settings. A vast potential exists for the expansion of mobile health in China, especially as costs decrease and increasingly sophisticated technology becomes more widespread.

What is Clinical Safety in Electronic Health Care Record Systems?

Science.gov (United States)

Davies, George

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

Czechoslovakia's changing health care system.

Science.gov (United States)

Raffel, M W; Raffel, N K

1992-01-01

Before World War II, Czechoslovakia was among the most developed European countries with an excellent health care system. After the Communist coup d'etat in 1948, the country was forced to adapt its existing health care system to the Soviet model. It was planned and managed by the government, financed by general tax money, operated in a highly centralized, bureaucratic fashion, and provided service at no direct charge at the time of service. In recent years, the health care system had been deteriorating as the health of the people had also been declining. Life expectancy, infant mortality rates, and diseases of the circulatory system are higher than in Western European countries. In 1989, political changes occurred in Czechoslovakia that made health care reform possible. Now health services are being decentralized, and the ownership of hospitals is expected to be transferred to communities, municipalities, churches, charitable groups, or private entities. Almost all health leaders, including hospital directors and hospital department heads, have been replaced. Physicians will be paid according to the type and amount of work performed. Perhaps the most important reform is the establishment of an independent General Health Care Insurance Office financed directly by compulsory contributions from workers, employers, and government that will be able to negotiate with hospitals and physicians to determine payment for services.

Health care issues in Croatian elections 2005-2009: series of public opinion surveys

Science.gov (United States)

Radin, Dagmar; Džakula, Aleksandar; Benković, Vanesa

2011-01-01

Aim To compare the results of a series of public opinion surveys on experiences with the health care sector in Croatia conducted in the time of elections and to analyze whether political party affiliation had any influence on issues of priority ranking. Methods The surveys were conducted during 2005, 2007, and 2009. They were administered through a Computer Assisted Telephone Interviewing method to representative samples of Croatian population and were statistically weighted according to sex, age, level of education, and political party affiliation. The random sampling of the person within the household was done using the table of random numbers. Results Health and health care system was the most important issue (58%) during the 2007 parliamentary election and the second most important issue during the 2005 and 2009 elections (46% and 28%). In the 2007 election, health care was viewed as most important by women, respondents with lower education levels, and respondents with lower income. In 2005, the most important health care issues were corruption and lack of funding (45% and 43%, respectively), in 2007 poor organization and lack of funding (43% and 42%, respectively), and in 2009 lack of funding and corruption (51% and 45%, respectively). Conclusion Health and health care system were consistently among the top two issues in all elections from 2005 to 2009. The top three most important health care sector issues were corruption, poor organization, and lack of funding. This indicates that political parties should include solutions to these issues in their health care policymaking. PMID:21990075

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

Science.gov (United States)

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

2012-01-01

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

eHealth provides a novel opportunity to exploit the advantages of the Nordic countries in psychiatric genetic research, building on the public health care system, biobanks, and registries.

Science.gov (United States)

Andreassen, Ole A

2017-07-07

Nordic countries have played an important role in the recent progress in psychiatric genetics, both with large well-characterized samples and expertise. The Nordic countries have research advantages due to the organization of their societies, including system of personal identifiers, national health registries with information about diseases, treatment and prescriptions, and a public health system with geographical catchment areas. For psychiatric genetic research, the large biobanks and population surveys are a unique added value. Further, the population is motivated to participate in research, and there is a trust in the institutions of the society. These factors have been important for Nordic contributions to biomedical research, and particularly psychiatric genetics. In the era of eHealth, the situation seems even more advantageous for Nordic countries. The system with public health care makes it easy to implement national measures, and most of the Nordic health care sector is already based on electronic information. The potential advantages regarding informed consent, large scale recruitment and follow-up, and longitudinal cohort studies are tremendous. New precision medicine approaches can be tested within the health care system, with an integrated approach, using large hospitals or regions of the country as a test beds. However, data protection and legal framework have to be clarified. In order to succeed, it is important to keep the people's trust, and maintain the high ethical standards and systems for secure data management. Then the full potential of the Nordic countries can be leveraged in the new era of precision medicine including psychiatric genetics. © 2017 Wiley Periodicals, Inc.

Impact of the Great East Japan Earthquake and tsunami on health, medical care and public health systems in Iwate Prefecture, Japan, 2011

Directory of Open Access Journals (Sweden)

Masaru Nohara

2011-12-01

Full Text Available Problem: The Great East Japan Earthquake was one of the largest earthquakes ever recorded in global history. The damage was spread over a wide area, with the worst-hit areas being Iwate, Miyagi and Fukushima prefectures. In this paper we report on the damage and the impact of the damage to describe the health consequences among disaster victims in Iwate Prefecture.Context: In Iwate Prefecture the tsunami claimed 4659 lives, with 1633 people missing. In addition to electricity, water and gas being cut off following the disaster, communication functions were paralysed and there was a lack of gasoline.Action: Medical and public health teams from Iwate Prefecture and around the country, including many different specialists, engaged in a variety of public health activities mainly at evacuation centres, including medical and mental health care and activities to prevent infectious diseases.Outcome: Given the many fatalities, there were relatively few patients who required medical treatment for major injuries. However, there were significant medical needs in the subacute and chronic phases of care in evacuation centres, with great demand for medical treatment and public health assistance, measures to counteract infection and mental health care.Discussion: By referring to past experiences of national and international large-scale disasters, it was possible to respond effectively to the health-related challenges. However, there are still challenges concerning how to share information and coordinate overall activities among multiple public health response teams. Further examination will be required to ensure better preparedness in response to future disasters.

[Does public health insurance improve health care? The case of prenatal care for adolescents in Mexico].

Science.gov (United States)

Saavedra-Avendaño, Biani; Darney, Blair G; Reyes-Morales, Hortensia; Serván-Mori, Edson

2016-01-01

To test the association between public health insurance and adequate prenatal care among female adolescents in Mexico. Cross-sectional study, using the National Health and Nutrition Survey 2000, 2006, and 2012.We included 3 978 (N=4 522 296) adolescent (12-19) women who reported a live birth.We used logistic regression models to test the association of insurance and adequate (timeliness, frequency and content) prenatal care. The multivariable predicted probability of timely and frequent prenatal care improved over time, from 0.60 (IC95%:0.56;0.64) in 2000 to 0.71 (IC95%:0.66;0.76) in 2012. In 2012, the probability of adequate prenatal care was 0.54 (IC95%:0.49;0.58); women with Social Security had higher probability than women with Seguro Popular and without health insurance. Having Social Security is associated with receipt of adequate prenatal care among adolescents in Mexico.

eHealth Search Patterns: A Comparison of Private and Public Health Care Markets Using Online Panel Data.

Science.gov (United States)

Schneider, Janina Anne; Holland, Christopher Patrick

2017-04-13

Patient and consumer access to eHealth information is of crucial importance because of its role in patient-centered medicine and to improve knowledge about general aspects of health and medical topics. The objectives were to analyze and compare eHealth search patterns in a private (United States) and a public (United Kingdom) health care market. A new taxonomy of eHealth websites is proposed to organize the largest eHealth websites. An online measurement framework is developed that provides a precise and detailed measurement system. Online panel data are used to accurately track and analyze detailed search behavior across 100 of the largest eHealth websites in the US and UK health care markets. The health, medical, and lifestyle categories account for approximately 90% of online activity, and e-pharmacies, social media, and professional categories account for the remaining 10% of online activity. Overall search penetration of eHealth websites is significantly higher in the private (United States) than the public market (United Kingdom). Almost twice the number of eHealth users in the private market have adopted online search in the health and lifestyle categories and also spend more time per website than those in the public market. The use of medical websites for specific conditions is almost identical in both markets. The allocation of search effort across categories is similar in both the markets. For all categories, the vast majority of eHealth users only access one website within each category. Those that conduct a search of two or more websites display very narrow search patterns. All users spend relatively little time on eHealth, that is, 3-7 minutes per website. The proposed online measurement framework exploits online panel data to provide a powerful and objective method of analyzing and exploring eHealth behavior. The private health care system does appear to have an influence on eHealth search behavior in terms of search penetration and time spent per

A conceptual framework for evaluation of public health and primary care system performance in iran.

Science.gov (United States)

Jahanmehr, Nader; Rashidian, Arash; Khosravi, Ardeshir; Farzadfar, Farshad; Shariati, Mohammad; Majdzadeh, Reza; Akbari Sari, Ali; Mesdaghinia, Alireza

2015-01-26

The main objective of this study was to design a conceptual framework, according to the policies and priorities of the ministry of health to evaluate provincial public health and primary care performance and to assess their share in the overall health impacts of the community. We used several tools and techniques, including system thinking, literature review to identify relevant attributes of health system performance framework and interview with the key stakeholders. The PubMed, Scopus, web of science, Google Scholar and two specialized databases of Persian language literature (IranMedex and SID) were searched using main terms and keywords. Following decision-making and collective agreement among the different stakeholders, 51 core indicators were chosen from among 602 obtained indicators in a four stage process, for monitoring and evaluation of Health Deputies. We proposed a conceptual framework by identifying the performance area for Health Deputies between other determinants of health, as well as introducing a chain of results, for performance, consisting of Input, Process, Output and Outcome indicators. We also proposed 5 dimensions for measuring the performance of Health Deputies, consisting of efficiency, effectiveness, equity, access and improvement of health status. The proposed Conceptual Framework illustrates clearly the Health Deputies success in achieving best results and consequences of health in the country. Having the relative commitment of the ministry of health and Health Deputies at the University of Medical Sciences is essential for full implementation of this framework and providing the annual performance report.

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

Science.gov (United States)

Hartmann, Christopher

2016-12-01

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

The public health system in England

National Research Council Canada - National Science Library

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

2010-01-01

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

Public reporting in health care: how do consumers use quality-of-care information? A systematic review.

NARCIS (Netherlands)

Faber, M.J.; Bosch, M.C.; Wollersheim, H.C.H.; Leatherman, S.; Grol, R.P.T.M.

2009-01-01

BACKGROUND: One of the underlying goals of public reporting is to encourage the consumer to select health care providers or health plans that offer comparatively better quality-of-care. OBJECTIVE: To review the weight consumers give to quality-of-care information in the process of choice, to

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

Science.gov (United States)

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

2017-08-01

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

The Cuban health care system and factors currently undermining it.

Science.gov (United States)

Nayeri, K

1995-08-01

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

Preconception healthcare delivery at a population level: construction of public health models of preconception care.

Science.gov (United States)

Shannon, Geordan D; Alberg, Corinna; Nacul, Luis; Pashayan, Nora

2014-08-01

A key challenge of preconception healthcare is identifying how it can best be delivered at a population level. To review current strategies of preconception healthcare, explore methods of preconception healthcare delivery, and develop public health models which reflect different preconception healthcare pathways. Preconception care strategies, programmes and evaluations were identified through a review of Medline and Embase databases. Search terms included: preconception, pre-pregnancy, intervention, primary care, healthcare, model, delivery, program, prevention, trial, effectiveness, congenital disorders OR abnormalities, evaluation, assessment, impact. Inclusion criteria for review articles were: (1) English, (2) human subjects, (3) women of childbearing age, (4) 1980–current data, (5) all countries, (6) both high risk and universal approaches, (7) guidelines or recommendations, (8) opinion articles, (9) experimental studies. Exclusion criteria were: (1) non-human subjects, (2) non-English, (3) outside of the specified timeframe, (4) articles on male healthcare. The results of the literature review were synthesised into public health models of care: (1) primary care; (2) hospital-based and inter-conception care; (3) specific preconception care clinics; and, (4) community outreach. Fifteen evaluations of preconception care were identified. Community programmes demonstrated a significant impact on substance use, folic acid supplementation, diabetes optimization, and hyperphenylalaninemia. An ideal preconception visits entail risk screening, education, and intervention if indicated. Subsequently, four public health models were developed synthesizing preconception care delivery at a population level. Heterogeneity of risk factors, health systems and strategies of care reflect the lack of consensus about the best way to deliver preconception care. The proposed models aim to reflect differing aspects of preconception healthcare delivery.

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

Science.gov (United States)

Lauerer, M; Emmert, M; Schöffski, O

2013-08-01

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

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

Science.gov (United States)

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

2011-12-01

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

Los (descaminos de la formación profesional del psicólogo en Brasil para la actuación en la salud publica Misdirections in the professional training used to prepare psychologists in Brazil to work in the public health-care system

Directory of Open Access Journals (Sweden)

Magda Dimenstein

2003-05-01

Full Text Available In Brazil, the practice of psychologists in public health-care institutions is hampered by the professional training that they have received. That training is inadequate in meeting the requirements of primary health care, in satisfying the needs of the patients who use the public health-care system, and in overcoming the social inequalities that exist in Brazil. This piece is intended to identify the factors that make it harder to provide adequate psychological care in public health-care institutions, especially in the local Basic Health Units of Brazil's public health-care system, the Unified Health System. These hindrances to providing good care mainly originate in training that points psychologists in the direction of very restricted models of health care. These narrow models prevent the psychologists from responding appropriately to the needs of their patient clientele and of the public institutions. These limited models also make it hard for psychologists to adapt to the dynamic conditions that they will face in the Unified Health System.

Value chains of public and private health care services in a small EU Island State: A SWOT analysis

Directory of Open Access Journals (Sweden)

Sandra C. Buttigieg

2016-09-01

Full Text Available The global financial and macro-economic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically in health care, governments started to explore ways of establishing collaborations between the public and private healthcare sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care, as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health care systems in Malta, a small EU island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains and this was followed by an analysis of strengths, weaknesses, opportunities and threats (SWOT. The latter revealed several strengths and opportunities, which can better equip health policy makers in the quest to maximize provision of health care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that unless addressed, may threaten the state’s health care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health care services in Malta.

The French Health Care System: What Can We Learn?

Directory of Open Access Journals (Sweden)

El Taguri A

2008-01-01

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

Public dental health care program for persons with disability

DEFF Research Database (Denmark)

Christensen, Lisa Bøge; Hede, Børge; Petersen, Poul Erik

2005-01-01

The objectives of the study were (1) to describe the organization and content of the Danish public oral health care program for persons with disability, and (2) to analyse possible variations in relation to the goals and requirements set by the health authorities. Data were collected by means......) payment of service, (4) providers of oral health care, (5) special training of staff, 6) dental services delivered, (7) ethical issues, and (8) patient rights. Less than one-third of persons estimated by the health authorities were enrolled in the program. On average, 0.4% of the municipal population...... of knowledge of oral health and oral health care for persons with disability were barriers to equal access to the program. Preventive dental services were the most frequent services delivered, although relatively few oral hygienists were involved in the program. Special training was most frequent in large...

France: Health System Review.

Science.gov (United States)

Chevreul, Karine; Berg Brigham, Karen; Durand-Zaleski, Isabelle; Hernandez-Quevedo, Cristina

2015-01-01

This analysis of the French health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The French population has a good level of health, with the second highest life expectancy in the world for women. It has a high level of choice of providers, and a high level of satisfaction with the health system. However, unhealthy habits such as smoking and harmful alcohol consumption remain significant causes of avoidable mortality. Combined with the significant burden of chronic diseases, this has underscored the need for prevention and integration of services, although these have not historically been strengths of the French system. Although the French health care system is a social insurance system, it has historically had a stronger role for the state than other Bismarckian social insurance systems. Public financing of health care expenditure is among the highest in Europe and out-of-pocket spending among the lowest. Public insurance is compulsory and covers the resident population; it is financed by employee and employer contributions as well as increasingly through taxation. Complementary insurance plays a significant role in ensuring equity in access. Provision is mixed; providers of outpatient care are largely private, and hospital beds are predominantly public or private non-profit-making. Despite health outcomes being among the best in the European Union, social and geographical health inequities remain. Inequality in the distribution of health care professionals is a considerable barrier to equity. The rising cost of health care and the increasing demand for long-term care are also of concern. Reforms are ongoing to address these issues, while striving for equity in financial access; a long-term care reform including public coverage of long-term care is still pending. World Health Organization 2015 (acting as the host organization for, and secretariat of, the

Public Health System Research in Public Health Emergency Preparedness in the United States (2009-2015): Actionable Knowledge Base.

Science.gov (United States)

Savoia, Elena; Lin, Leesa; Bernard, Dottie; Klein, Noah; James, Lyndon P; Guicciardi, Stefano

2017-09-01

communication barriers experienced by public health and health care personnel. Forty-eight studies provided evidence on how to create and sustain preparedness systems. Results included how to build social capital across organizations and citizens and how to develop sustainable and useful planning efforts that maintain flexibility and rely on available medical data. Twenty-six studies provided evidence on the usefulness of measurement efforts, such as community and organizational needs assessments, and new methods to learn from the response to critical incidents. In the United States, the field of public health emergency preparedness system research has been supported by the US Centers for Disease Control and Prevention since the release of the 2008 Institute of Medicine letter report. The first definition of public health emergency preparedness appeared in 2007, and before 2008 there was a lack of research and empirical evidence across all 4 research areas identified by the Institute of Medicine. This field can be considered relatively new compared with other research areas in public health; for example, tobacco control research can rely on more than 70 years of knowledge production. However, this review demonstrates that, during the past 7 years, public health emergency preparedness system research has evolved from generic inquiry to the analysis of specific interventions with more empirical studies. Public Health Implications: The results of this review provide an evidence base for public health practitioners responsible for enhancing key components of preparedness and response such as communication, training, and planning efforts.

Outlining a preventive oral health care system for China.

Science.gov (United States)

Saekel, Rüdiger

2015-01-01

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

Budget-makers and health care systems.

Science.gov (United States)

White, Joseph

2013-10-01

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

[Images of Ageing in Health Care Magazines of the Public Health System].

Science.gov (United States)

Hartmann-Tews, Ilse; Hoppe, Theresa

2018-03-01

Collective images of ageing influence attitudes towards ageing and health- related activities. The aim of this study was to explore images of ageing and old age in magazines published by public health institutions, namely health insurance companies and pharmacies. A standardized content analysis was conducted covering age-related articles (n=146) and accompanying photographs (n=218) of public health institutions. The stock of material comprises age-related articles of all magazines published 2012-2013 of 2 public health insurance companies (Allgemeine Ortskrankenkasse: "Bleib gesund", Barmer Ersatzkasse: "Gesundheit konkret"), 2 private health insurance companies (Gothaer Versicherung: "Gothaer magazin", Deutsche Krankenversicherung: "DKV impulse") and 2 consumer magazines of pharmacies ("Apothekenumschau","Senioren Ratgeber"). Illness turns out to be the most often focused main theme and key issue of age-related articles. With reference to the central dimensions of somatic culture - health, body-centered performance and appearance - most of the articles focus on deficits of old age, in particular illness and decrease of performance, and thus communicate a negative image of ageing. The visual presentation of elderly people is much more positive. There are various differences in the communication of images of ageing between the 2 types of magazines, with the consumer magazines of the pharmacy covering a broader spectrum of topics, referring more often to a healthy lifestyle and prevention and communicating a more multifaceted image of old age and ageing in comparison to the membership magazines of health insurance companies. Institutions of public health have many duties and responsibilities. One of these is to strengthen health competencies and locus of control of the population - in our case - elderly people. As images of ageing influence attitudes towards ageing and health-related activities, it seems to be sensible and of good economic sense to communicate a

The need to include obstetric nurses in prenatal care visits in the public health system

Directory of Open Access Journals (Sweden)

Selma Aparecida Lagrosa Garcia

2010-06-01

Full Text Available Objective: To investigate, with a qualitative approach, the role of Obstetric Nurses at the primary level of care given to women’s health as a vital component of the multidisciplinary team, which today is fundamental for providing care, prevention as well as health education and promotion, especially in programs whose activities are geared towards primary care of pregnant, parturient, and puerpera women. Methods: Brazilian laws and the determinations of Nursing Councils in reference to the activities of the obstetric nurse were researched, including the nurse’s responsibilities and limits. The bibliographic search was conducted in health-related journals, lay publications, and the Internet. Results: The conflicts between professional physicians and nurses were discussed. Conclusions: It was concluded that the activities of the nurse, conducting low-risk prenatal clinical visits in the basic healthcare network, has legal and ethical support and provides true benefit to the clients.

Public health nurse perceptions of Omaha System data visualization.

Science.gov (United States)

Lee, Seonah; Kim, Era; Monsen, Karen A

2015-10-01

Electronic health records (EHRs) provide many benefits related to the storage, deployment, and retrieval of large amounts of patient data. However, EHRs have not fully met the need to reuse data for decision making on follow-up care plans. Visualization offers new ways to present health data, especially in EHRs. Well-designed data visualization allows clinicians to communicate information efficiently and effectively, contributing to improved interpretation of clinical data and better patient care monitoring and decision making. Public health nurse (PHN) perceptions of Omaha System data visualization prototypes for use in EHRs have not been evaluated. To visualize PHN-generated Omaha System data and assess PHN perceptions regarding the visual validity, helpfulness, usefulness, and importance of the visualizations, including interactive functionality. Time-oriented visualization for problems and outcomes and Matrix visualization for problems and interventions were developed using PHN-generated Omaha System data to help PHNs consume data and plan care at the point of care. Eleven PHNs evaluated prototype visualizations. Overall PHNs response to visualizations was positive, and feedback for improvement was provided. This study demonstrated the potential for using visualization techniques within EHRs to summarize Omaha System patient data for clinicians. Further research is needed to improve and refine these visualizations and assess the potential to incorporate visualizations within clinical EHRs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

Science.gov (United States)

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

2018-04-18

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

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

Science.gov (United States)

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

2018-02-13

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

Four proposals for market-based health care system reform.

Science.gov (United States)

Sumner, W

1994-08-01

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

An integrated approach to preventing cardiovascular disease: community-based approaches, health system initiatives, and public health policy

Directory of Open Access Journals (Sweden)

Tina Karwalajtys

2010-09-01

Full Text Available Tina Karwalajtys1, Janusz Kaczorowski2,31Department of Family Medicine, McMaster University, Hamilton, ON, Canada; 2Primary Care & Community Research, Child & Family Research Institute, Vancouver, BC, Canada; 3Department of Family Practice, University of British Columbia, Vancouver, BC, CanadaAbstract: Cardiovascular disease (CVD is largely the product of interactions among modifiable risk factors that are common in developed nations and increasingly of concern in developing countries. Hypertension is an important precursor to the development of CVD, and although detection and treatment rates have improved in recent years in some jurisdictions, effective strategies and policies supporting a shift in distribution of risk factors at the population level remain paramount. Challenges in managing cardiovascular health more effectively include factors at the patient, provider, and system level. Strategies to reduce hypertension and CVD should be population based, incorporate multilevel, multicomponent, and socioenvironmental approaches, and integrate community resources with public health and clinical care. There is an urgent need to improve monitoring and management of risk factors through community-wide, primary care-linked initiatives, increase the evidence base for community-based prevention strategies, further develop and evaluate promising program components, and develop new approaches to support healthy lifestyle behaviors in diverse age, socioeconomic, and ethnocultural groups. Policy and system changes are critical to reduce risk in populations, including legislation and public education to reduce dietary sodium and trans-fatty acids, food pricing policies, and changes to health care delivery systems to explicitly support prevention and management of CVD.Keywords: risk factors, blood pressure determination, community health services, community health planning, public health practice

A Conceptual Framework for Evaluation of Public Health and Primary Care System Performance in Iran

Science.gov (United States)

Jahanmehr, Nader; Rashidian, Arash; Khosravi, Ardeshir; Farzadfar, Farshad; Shariati, Mohammad; Majdzadeh, Reza; Sari, Ali Akbari; Mesdaghinia, Alireza

2015-01-01

Introduction: The main objective of this study was to design a conceptual framework, according to the policies and priorities of the ministry of health to evaluate provincial public health and primary care performance and to assess their share in the overall health impacts of the community. Methods: We used several tools and techniques, including system thinking, literature review to identify relevant attributes of health system performance framework and interview with the key stakeholders. The PubMed, Scopus, web of science, Google Scholar and two specialized databases of Persian language literature (IranMedex and SID) were searched using main terms and keywords. Following decision-making and collective agreement among the different stakeholders, 51 core indicators were chosen from among 602 obtained indicators in a four stage process, for monitoring and evaluation of Health Deputies. Results: We proposed a conceptual framework by identifying the performance area for Health Deputies between other determinants of health, as well as introducing a chain of results, for performance, consisting of Input, Process, Output and Outcome indicators. We also proposed 5 dimensions for measuring the performance of Health Deputies, consisting of efficiency, effectiveness, equity, access and improvement of health status. Conclusion: The proposed Conceptual Framework illustrates clearly the Health Deputies success in achieving best results and consequences of health in the country. Having the relative commitment of the ministry of health and Health Deputies at the University of Medical Sciences is essential for full implementation of this framework and providing the annual performance report. PMID:25946937

Retention in a public health care system with free access to treatment

DEFF Research Database (Denmark)

Helleberg, Marie; Engsig, Frederik N; Kronborg, Gitte

2012-01-01

were retained in care 95.0% of person-years under observation, increasing to 98.1% after initiation of antiretroviral treatment (HAART). The overall IR/100 person-years for first episode of LTFU was 2.6 (95% CI: 2.5-2.8) and was significantly lower after initiation of HAART (1.2 (95% CI: 1......, especially after initiation of HAART. Absence from HIV care is associated with increased mortality. We conclude that high rates of retention can be achieved in a health care system with free access to treatment and is associated with a favorable outcome....

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

Science.gov (United States)

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

2011-01-01

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

Job satisfaction of primary health-care providers (public sector in urban setting

Directory of Open Access Journals (Sweden)

Pawan Kumar

2013-01-01

Full Text Available Introduction: Job satisfaction is determined by a discrepancy between what one wants in a job and what one has in a job. The core components of information necessary for what satisfies and motivates the health work force in our country are missing at policy level. Therefore present study will help us to know the factors for job satisfaction among primary health care providers in public sector. Materials and Methods: Present study is descriptive in nature conducted in public sector dispensaries/primary urban health centers in Delhi among health care providers. Pretested structured questionnaire was administered to 227 health care providers. Data was analyzed using SPSS and relevant statistical test were applied. Results: Analysis of study reveals that ANMs are more satisfied than MOs, Pharmacist and Lab assistants/Lab technicians; and the difference is significant (P < 0.01. Age and education level of health care providers don′t show any significant difference in job satisfaction. All the health care providers are dissatisfied from the training policies and practices, salaries and opportunities for career growth in the organization. Majority of variables studied for job satisfaction have low scores. Five factor were identified concerned with job satisfaction in factor analysis. Conclusion: Job satisfaction is poor for all the four groups of health care providers in dispensaries/primary urban health centers and it is not possible to assign a single factor as a sole determinant of dissatisfaction in the job. Therefore it is recommended that appropriate changes are required at the policy as well as at the dispensary/PUHC level to keep the health work force motivated under public sector in Delhi.

Constitutional rights to health, public health and medical care: the status of health protections in 191 countries.

Science.gov (United States)

Heymann, Jody; Cassola, Adèle; Raub, Amy; Mishra, Lipi

2013-07-01

United Nations (UN) member states have universally recognised the right to health in international agreements, but protection of this right at the national level remains incomplete. This article examines the level and scope of constitutional protection of specific rights to public health and medical care, as well as the broad right to health. We analysed health rights in the constitutions of 191 UN countries in 2007 and 2011. We examined how rights protections varied across the year of constitutional adoption; national income group and region; and for vulnerable groups within each country. A minority of the countries guaranteed the rights to public health (14%), medical care (38%) and overall health (36%) in their constitutions in 2011. Free medical care was constitutionally protected in 9% of the countries. Thirteen per cent of the constitutions guaranteed children's right to health or medical care, 6% did so for persons with disabilities and 5% for each of the elderly and the socio-economically disadvantaged. Valuable next steps include regular monitoring of the national protection of health rights recognised in international agreements, analyses of the impact of health rights on health outcomes and longitudinal multi-level studies to assess whether specific formulations of the rights have greater impact.

Value-Based Health Care Delivery, Preventive Medicine and the Medicalization of Public Health

Science.gov (United States)

2017-01-01

The real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a ‘value-based health care delivery’. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges. In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of a better healthcare for all, with real benefits for the individual patient provided a tailored and optimized treatment plan suitable for his or her genetic makeup. And maybe, therefore, the assumptions underpinning personalized medicine have largely escaped questioning. The use of personalized medicine and the use of digital technologies is reshaping our health care system and how we think of health interventions and our individual responsibility. However, encouraging individuals to engage in preventive health activities possibly avoids one form of medicalization (clinical), but on the other hand, it takes up another form (preventive medicine and ‘self-care’) that moves medical and health concerns into every corner of everyday life. This ought to be of little value to the individual patient and public health. We ought to instead demand proof of these value ideas and the lacking research. Before this is in place critical appraisal and cynicism are requisite skills for the future. Otherwise, we are just listening to visionaries when we put our future health into their hands and let personalized solutions reach into people's everyday life regardless of patient safety and integrity. PMID:28409064

Variation In Health Outcomes: The Role Of Spending On Social Services, Public Health, And Health Care, 2000-09.

Science.gov (United States)

Bradley, Elizabeth H; Canavan, Maureen; Rogan, Erika; Talbert-Slagle, Kristina; Ndumele, Chima; Taylor, Lauren; Curry, Leslie A

2016-05-01

Although spending rates on health care and social services vary substantially across the states, little is known about the possible association between variation in state-level health outcomes and the allocation of state spending between health care and social services. To estimate that association, we used state-level repeated measures multivariable modeling for the period 2000-09, with region and time fixed effects adjusted for total spending and state demographic and economic characteristics and with one- and two-year lags. We found that states with a higher ratio of social to health spending (calculated as the sum of social service spending and public health spending divided by the sum of Medicare spending and Medicaid spending) had significantly better subsequent health outcomes for the following seven measures: adult obesity; asthma; mentally unhealthy days; days with activity limitations; and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes. Our study suggests that broadening the debate beyond what should be spent on health care to include what should be invested in health-not only in health care but also in social services and public health-is warranted. Project HOPE—The People-to-People Health Foundation, Inc.

Mental health leadership and patient access to care: a public-private initiative in South Africa.

Science.gov (United States)

Szabo, Christopher Paul; Fine, Jennifer; Mayers, Pat; Naidoo, Shan; Zabow, Tuviah

2017-01-01

Mental health leadership is a critical component of patient access to care. More specifically, the ability of mental health professionals to articulate the needs of patients, formulate strategies and engage meaningfully at the appropriate level in pursuit of resources. This is not a skill set routinely taught to mental health professionals. A public-private mental health leadership initiative, emanating from a patient access to care programme, was developed with the aim of building leadership capacity within the South African public mental health sector. The express aim was to equip health care professionals with the requisite skills to more effectively advocate for their patients. The initiative involved participants from various sites within South Africa. Inclusion was based on the proposal of an ongoing "project", i.e. a clinician-initiated service development with a multidisciplinary focus. The projects were varied in nature but all involved identification of and a plan for addressing an aspect of the participants' daily professional work which negatively impacted on patient care due to unmet needs. Six such projects were included and involved 15 participants, comprising personnel from psychiatry, psychology, occupational therapy and nursing. Each project group was formally mentored as part of the initiative, with mentors being senior professionals with expertise in psychiatry, public health and nursing. The programme design thus provided a unique practical dimension in which skills and learnings were applied to the projects with numerous and diverse outcomes. Benefits were noted by participants but extended beyond the individuals to the health institutions in which they worked and the patients that they served. Participants acquired both the skills and the confidence which enabled them to sustain the changes that they themselves had initiated in their institutions. The initiative gave impetus to the inclusion of public mental health as part of the curriculum

Public health care providers and market competition: the case of Finnish occupational health services.

Science.gov (United States)

Kankaanpää, Eila; Linnosmaa, Ismo; Valtonen, Hannu

2011-02-01

As reforms in publicly funded health systems rely heavily on competition, it is important to know if and how public providers react to competition. In many European countries, it is empirically difficult to study public providers in different markets, but in Finnish occupational health services, both public and private for-profit and non-profit providers co-exist. We studied possible differences in public providers' performance (price, intensity of services, service mix-curative medical services/prevention, productivity and revenues) according to the competitiveness of the market. The Finnish Institute of Occupational Health (FIOH) collected data on clients, services and personnel for 1992, 1995, 1997, 2000 and 2004 from occupational health services (OHS) providers. Employers defray the costs of OHS and apply for reimbursement from the Social Insurance Institution (SII). The SII data was merged with FIOH's questionnaire. The unbalanced panel consisted of about 230 public providers, totalling 1,164 observations. Local markets were constructed from several municipalities based on commuting practices and regional collaboration. Competitiveness of the market was measured by the number of providers and by the Herfindahl index. The effect of competition was studied by ordinary least square regression analysis and panel models. The more competitive the environment was for a public provider the higher were intensity, productivity and the share of medical care. Fixed panel models showed that these differences were not due to differences and changes in the competitiveness of the market. Instead, in more competitive markets public providers had higher unit prices and higher revenues.

Congenital Anomalies: Public Health Interventions to Ensure its Prevention and Expansion of Care to the Patients

Directory of Open Access Journals (Sweden)

Saurabh RamBihariLal Shrivastava

2015-03-01

Full Text Available Congenital anomalies can be defined as structural or functional anomalies, including metabolic / biochemical disorders, which are present at the time of birth. Congenital anomalies has been recognized as a major public health concern, owing to its universal distribution, associated long-term disability; social stigma; emotional / psychological stress for the family members; increased medical expenditure; and burden on the health care delivery system and societies. To prevent the occurrence of congenital anomalies, due attention should be given to establishment of appropriate surveillance systems to record cases from both community and hospital settings; strengthening of public health system; promoting research to explore the etiological factors and diagnosis/prevention strategies; fostering international cooperation; and discouraging the practice of consanguineous marriage / conception at an advanced age / further reproduction after birth of a malformed child. To conclude, there is an indispensable need to formulate a comprehensive policy, that should be well-supported by an efficient surveillance system, dedicated health care professionals and involvement of all stakeholders. [Cukurova Med J 2015; 40(1.000: 135-137

Peer pressure and public reporting within healthcare setting: improving accountability and health care quality in hospitals.

Science.gov (United States)

Specchia, Maria Lucia; Veneziano, Maria Assunta; Cadeddu, Chiara; Ferriero, Anna Maria; Capizzi, Silvio; Ricciardi, Walter

2012-01-01

In the last few years, the need of public reporting of health outcomes has acquired a great importance. The public release of performance results could be a tool for improving health care quality and many attempts have been made in order to introduce public reporting programs within the health care context at different levels. It would be necessary to promote the introduction of a standardized set of outcome and performance measures in order to improve quality of health care services and to make health care providers aware of the importance of transparency and accountability.

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

Science.gov (United States)

Globerman, Steven; Hodges, Hart; Vining, Aidan

2002-01-01

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

An assessment of equity in the distribution of non-financial health care inputs across public primary health care facilities in Tanzania.

Science.gov (United States)

Kuwawenaruwa, August; Borghi, Josephine; Remme, Michelle; Mtei, Gemini

2017-07-11

proportional (non dominance), whereas the distribution of oxytocics, anti-retroviral therapy (ART) and anti-hypertensive drugs was pro-rich, with the 45 degree line dominating the concentration curve for ART. This study has shown there are inequities in the distribution of health care inputs across public primary care facilities. This highlights the need to ensure a better coordinated and equitable distribution of inputs through regular monitoring of the availability of health care inputs and strengthening of reporting systems.

The Danish health care system from a British perspective.

Science.gov (United States)

Hurst, Jeremy

2002-02-01

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

Cognitive systems engineering in health care

CERN Document Server

Bisantz, Ann M; Fairbanks, Rollin J

2014-01-01

Cognitive Engineering for Better Health Care Systems, Ann M. Bisantz, Rollin J. Fairbanks, and Catherine M. BurnsThe Role of Cognitive Engineering in Improving Clinical Decision Support, Anne Miller and Laura MilitelloTeam Cognitive Work Analysis as an Approach for Understanding Teamwork in Health Care, Catherine M. BurnsCognitive Engineering Design of an Emergency Department Information System, Theresa K. Guarrera, Nicolette M. McGeorge, Lindsey N. Clark, David T. LaVergne, Zachary A. Hettinger, Rollin J. Fairbanks, and Ann M. BisantzDisplays for Health Care Teams: A Conceptual Framework and Design Methodology, Avi ParushInformation Modeling for Cognitive Work in a Health Care System, Priyadarshini R. PennathurSupport for ICU Clinician Cognitive Work through CSE, Christopher Nemeth, Shilo Anders, Jeffrey Brown, Anna Grome, Beth Crandall, and Jeremy PamplinMatching Cognitive Aids and the "Real Work" of Health Care in Support of Surgical Microsystem Teamwork, Sarah Henrickson Parker and Shawna J. PerryEngageme...

Improved Diagnosis and Care for Rare Diseases through Implementation of Precision Public Health Framework.

Science.gov (United States)

Baynam, Gareth; Bowman, Faye; Lister, Karla; Walker, Caroline E; Pachter, Nicholas; Goldblatt, Jack; Boycott, Kym M; Gahl, William A; Kosaki, Kenjiro; Adachi, Takeya; Ishii, Ken; Mahede, Trinity; McKenzie, Fiona; Townshend, Sharron; Slee, Jennie; Kiraly-Borri, Cathy; Vasudevan, Anand; Hawkins, Anne; Broley, Stephanie; Schofield, Lyn; Verhoef, Hedwig; Groza, Tudor; Zankl, Andreas; Robinson, Peter N; Haendel, Melissa; Brudno, Michael; Mattick, John S; Dinger, Marcel E; Roscioli, Tony; Cowley, Mark J; Olry, Annie; Hanauer, Marc; Alkuraya, Fowzan S; Taruscio, Domenica; Posada de la Paz, Manuel; Lochmüller, Hanns; Bushby, Kate; Thompson, Rachel; Hedley, Victoria; Lasko, Paul; Mina, Kym; Beilby, John; Tifft, Cynthia; Davis, Mark; Laing, Nigel G; Julkowska, Daria; Le Cam, Yann; Terry, Sharon F; Kaufmann, Petra; Eerola, Iiro; Norstedt, Irene; Rath, Ana; Suematsu, Makoto; Groft, Stephen C; Austin, Christopher P; Draghia-Akli, Ruxandra; Weeramanthri, Tarun S; Molster, Caron; Dawkins, Hugh J S

2017-01-01

Public health relies on technologies to produce and analyse data, as well as effectively develop and implement policies and practices. An example is the public health practice of epidemiology, which relies on computational technology to monitor the health status of populations, identify disadvantaged or at risk population groups and thereby inform health policy and priority setting. Critical to achieving health improvements for the underserved population of people living with rare diseases is early diagnosis and best care. In the rare diseases field, the vast majority of diseases are caused by destructive but previously difficult to identify protein-coding gene mutations. The reduction in cost of genetic testing and advances in the clinical use of genome sequencing, data science and imaging are converging to provide more precise understandings of the 'person-time-place' triad. That is: who is affected (people); when the disease is occurring (time); and where the disease is occurring (place). Consequently we are witnessing a paradigm shift in public health policy and practice towards 'precision public health'.Patient and stakeholder engagement has informed the need for a national public health policy framework for rare diseases. The engagement approach in different countries has produced highly comparable outcomes and objectives. Knowledge and experience sharing across the international rare diseases networks and partnerships has informed the development of the Western Australian Rare Diseases Strategic Framework 2015-2018 (RD Framework) and Australian government health briefings on the need for a National plan.The RD Framework is guiding the translation of genomic and other technologies into the Western Australian health system, leading to greater precision in diagnostic pathways and care, and is an example of how a precision public health framework can improve health outcomes for the rare diseases population.Five vignettes are used to illustrate how policy

Health Care in Brazil: Implications for Public Health and Epidemiology.

Science.gov (United States)

Younger, David S

2016-11-01

A network of family-based community-oriented primary health programs, or Programa Agentes Communita˙rios de Saúde, and family health programs, or Programa Saúde da Família, introduced almost 2 decades ago were the Brazilian government's health care models to restructure primary care under the Unified Health System, or Sistema Único de Saúde. The latter offers comprehensive coverage to all, although it is used by those of lower income, and despite achievement in the last quarter century, access to health services and gradients of health status continue to persist along income, educational background, racial, and religious lines. Copyright © 2016 Elsevier Inc. All rights reserved.

Examining fiscal federalism, regionalization and community-based initiatives in Canada's health care delivery system.

Science.gov (United States)

Forest, Pierre-Gerlier; Palley, Howard A

2008-01-01

This study focuses on the ability of Canadian provinces to shape in different ways the development of various provincial health delivery systems within the constraints of the mandates of the federal Canada Health Act of 1984 and the fiscal revenues that the provinces receive if they comply with these mandates. In so doing, it will examine the operation of Canadian federalism with respect to various provincial health systems. This study applies a comparative analysis framework developed by Heisler and Peters to facilitate an understanding of the dimensionality of provincial health delivery systems as applied to the case of provincial regionalization and community-based initiatives. The three sets of relationships touched upon are: first, the levels of government and the nature of their involvement in public policy concerning the provincial health care delivery systems; and secondly, understanding of the factors influencing provincial governments' political dispositions to act in various directions. A third dimension that is taken are the factors influencing the "timing" of particular decisions. A fourth area noted by Heisler and Peters and other comparative analysts is the nature and characteristics of public and private sector activities in health care and other social policy areas. While the evolving nature of public and private sector health care delivery activities within Canada's provincial and territorial systems is a significant policy matter in the Canadian context, due to the space limitations of this article, they are not discussed herein.

The health system cost of post-abortion care in Rwanda

Science.gov (United States)

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

2015-01-01

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

Validating the accuracy of GIS-based accessibility analysis in determining public primary health care demand in metropolitan areas: conference presentation

CSIR Research Space (South Africa)

Mokgalaka, H

2014-07-01

Full Text Available selected for the analysis are mainly those that offered public primary health care services and acted as first point of contact with the health service delivery system. Attached to the facility data are attribute data indicating the capacity...-Based Accessibility Analysis in Determining Public Primary Health Care Demand in Metropolitan Areas Hunadi Mokgalaka July 2014 Contents • Service access planning • GIS-based accessibility analysis • Key challenges to application • Methodology...

What systemic factors contribute to collaboration between primary care and public health sectors? An interpretive descriptive study.

Science.gov (United States)

Wong, Sabrina T; MacDonald, Marjorie; Martin-Misener, Ruth; Meagher-Stewart, Donna; O'Mara, Linda; Valaitis, Ruta K

2017-12-01

Purposefully building stronger collaborations between primary care (PC) and public health (PH) is one approach to strengthening primary health care. The purpose of this paper is to report: 1) what systemic factors influence collaborations between PC and PH; and 2) how systemic factors interact and could influence collaboration. This interpretive descriptive study used purposive and snowball sampling to recruit and conduct interviews with PC and PH key informants in British Columbia (n = 20), Ontario (n = 19), and Nova Scotia (n = 21), Canada. Other participants (n = 14) were knowledgeable about collaborations and were located in various Canadian provinces or working at a national level. Data were organized into codes and thematic analysis was completed using NVivo. The frequency of "sources" (individual transcripts), "references" (quotes), and matrix queries were used to identify potential relationships between factors. We conducted a total of 70 in-depth interviews with 74 participants working in either PC (n = 33) or PH (n = 32), both PC and PH (n = 7), or neither sector (n = 2). Participant roles included direct service providers (n = 17), senior program managers (n = 14), executive officers (n = 11), and middle managers (n = 10). Seven systemic factors for collaboration were identified: 1) health service structures that promote collaboration; 2) funding models and financial incentives supporting collaboration; 3) governmental and regulatory policies and mandates for collaboration; 4) power relations; 5) harmonized information and communication infrastructure; 6) targeted professional education; and 7) formal systems leaders as collaborative champions. Most themes were discussed with equal frequency between PC and PH. An assessment of the system level context (i.e., provincial and regional organization and funding of PC and PH, history of government in successful implementation of health care reform, etc) along

Integrating Social impacts on Health and Health-Care Systems in Systemic Seismic Vulnerability Analysis

Science.gov (United States)

Kunz-Plapp, T.; Khazai, B.; Daniell, J. E.

2012-04-01

This paper presents a new method for modeling health impacts caused by earthquake damage which allows for integrating key social impacts on individual health and health-care systems and for implementing these impacts in quantitative systemic seismic vulnerability analysis. In current earthquake casualty estimation models, demand on health-care systems is estimated by quantifying the number of fatalities and severity of injuries based on empirical data correlating building damage with casualties. The expected number of injured people (sorted by priorities of emergency treatment) is combined together with post-earthquake reduction of functionality of health-care facilities such as hospitals to estimate the impact on healthcare systems. The aim here is to extend these models by developing a combined engineering and social science approach. Although social vulnerability is recognized as a key component for the consequences of disasters, social vulnerability as such, is seldom linked to common formal and quantitative seismic loss estimates of injured people which provide direct impact on emergency health care services. Yet, there is a consensus that factors which affect vulnerability and post-earthquake health of at-risk populations include demographic characteristics such as age, education, occupation and employment and that these factors can aggravate health impacts further. Similarly, there are different social influences on the performance of health care systems after an earthquake both on an individual as well as on an institutional level. To link social impacts of health and health-care services to a systemic seismic vulnerability analysis, a conceptual model of social impacts of earthquakes on health and the health care systems has been developed. We identified and tested appropriate social indicators for individual health impacts and for health care impacts based on literature research, using available European statistical data. The results will be used to

Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

Directory of Open Access Journals (Sweden)

Kantonen Jarmo

2012-01-01

Full Text Available Abstract Background Many Finnish emergency departments (ED serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland. Methods The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital. A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care, B (to be examined within 10 min, C (to be examined within 1 h, D (to be examined within 2 h and E (no need for immediate treatment for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. Results After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month as compared to the three previous years in the EDs

A decade review of publications in Families, Systems, & Health: 2005-2015.

Science.gov (United States)

Mendenhall, Tai J; Li, Yiting; Schulz, Catherine L

2016-09-01

The purpose of this investigation was to review recent publication content and trends in Families, Systems, & Health ( FSH ). How do the journal’s articles reflect current and emerging challenges in health care? We hope that our findings can guide special issues and content foci. All work published in FSH between 2005 and 2015 was included (n = 452); each piece was coded for article type, general foci, and specific foci. The most common type of article published over the 10-year time frame was research reports (43%; n = 195), followed by other types (e.g., tribute pieces, poems), commentaries, conceptual/theory papers, literature reviews, and case studies. The most common general focus included family health and/or functioning (28%; n = 128). The most common specific foci centered on children (15%; n = 55). Common themes found in FSH ’s most frequently cited publications included family relationships in care, chronic physical illnesses, and mental health. Marked trends in journal content included increases in articles targeting family health and/or functioning and primary care and decreased attention to theory. FSH’s emphasis on research reports to inform current and evolving interventions that target contemporary health challenges suggests that the journal is keeping stride with the most pressing issues in health care today. Future special issues can continue to serve and meet these needs. FSH’s robust inclusion of other article types sustains the journal’s mission to advance multiple ways of understanding health-care phenomena. PsycINFO Database Record (c) 2016 APA, all rights reserved

Attitudes and Perceptions of the Brazilian Public Health System by Transgender Individuals

Directory of Open Access Journals (Sweden)

Kátia Bones Rocha

2009-05-01

Full Text Available This study aims to describe how transgender people perceive services offered by the Brazilian Public Health System (SUS. This qualitative study, using the phenomenological technique, is based on eight semi-structured interviews conducted with individuals whose gender identity and/or gender expression differs from the sex they were assigned at birth. Each interview was evaluated by two interviewers and a content analysis performed by all members of the research group. The analysis identified the following categories as having high relevance to the participants’ experiences: homophobia, receptiveness, and humanization, access to health care, and suggestions to improve the SUS. Information shared by participants emphasized their belief that health care professionals are not adequately prepared to assist transgendered individuals and that health care providers should use a more sensitive approach towards them. A recurrent theme was the need to use appropriate and socially acceptable terminology when providing health care services in order to facilitate transgendered individuals' inclusive treatment. Despite the effort of Brazilian authorities, there is a need for significant improvement in health care practices in order to comply with SUS quality standards. This study highlights the importance of qualitative investigations to improve planning and to help define public health policies with the goal of including the most vulnerable and marginalized groups of the population. URN: urn:nbn:de:0114-fqs0902281

Distribution of physical therapists working on public and private establishments in different levels of complexity of health care in Brazil.

Science.gov (United States)

Costa, Larissa R; Costa, José L R; Oishi, Jorge; Driusso, Patricia

2012-01-01

The Brazilian Health System is organized on a regional and hierarchical form with three levels of complexity of health care. The Primary Care represents the first element of a continuing health care process, complemented by specialized actions. However, the centrality of the specialized care is still a problem in Brazil, especially in the private sector. Studies on the distribution of professionals in the health system allowing the formulation of appropriate policies are needed. To investigate the distribution of physical therapists in the levels of complexity of health care and between public and private establishments, according to data from the National Register of Health Service Providers (NRHSP). A descriptive cross-sectional study was performed considering NRHSP-national bank data collected in March 2010 and demographic census 2010 data. Data were analyzed through descriptive statistics techniques. We identified 53,181 registries of physical therapists, 60% linked to the private sector. Only 13% of all entries were linked to primary care. The predominance in specialized care occurred in the public sector (65%) and private sector (100%). The specialized establishments of private sector linked to the southeast region (16,043) were the main sites of physical therapists. Only the public sector in the south had a majority in the Primary Care. When considering the sizes of the cities, there is focus on specialist care in bigger cities. This study identified the concentration of physical therapists in the specialized care, mostly in metropolis and big cities and in the private sector, with restricted to participation in the primary care.

Adherence and health care costs

Directory of Open Access Journals (Sweden)

Iuga AO

2014-02-01

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

Harnessing the privatisation of China's fragmented health-care delivery.

Science.gov (United States)

Yip, Winnie; Hsiao, William

2014-08-30

Although China's 2009 health-care reform has made impressive progress in expansion of insurance coverage, much work remains to improve its wasteful health-care delivery. Particularly, the Chinese health-care system faces substantial challenges in its transformation from a profit-driven public hospital-centred system to an integrated primary care-based delivery system that is cost effective and of better quality to respond to the changing population needs. An additional challenge is the government's latest strategy to promote private investment for hospitals. In this Review, we discuss how China's health-care system would perform if hospital privatisation combined with hospital-centred fragmented delivery were to prevail--population health outcomes would suffer; health-care expenditures would escalate, with patients bearing increasing costs; and a two-tiered system would emerge in which access and quality of care are decided by ability to pay. We then propose an alternative pathway that includes the reform of public hospitals to pursue the public interest and be more accountable, with public hospitals as the benchmarks against which private hospitals would have to compete, with performance-based purchasing, and with population-based capitation payment to catalyse coordinated care. Any decision to further expand the for-profit private hospital market should not be made without objective assessment of its effect on China's health-policy goals. Copyright © 2014 Elsevier Ltd. All rights reserved.

The spectrum of ethical issues in a Learning Health Care System: a systematic qualitative review.

Science.gov (United States)

McLennan, Stuart; Kahrass, Hannes; Wieschowski, Susanne; Strech, Daniel; Langhof, Holger

2018-04-01

To determine systematically the spectrum of ethical issues that is raised for stakeholders in a 'Learning Health Care System' (LHCS). The systematic review was conducted in PubMed and Google Books between the years 2007 and 2015. The literature search retrieved 1258 publications. Each publication was independently screened by two reviewers for eligibility for inclusion. Ethical issues were defined as arising when a relevant normative principle is not adequately considered or two principles come into conflict. A total of 65 publications were included in the final analysis and were analysed using an adapted version of qualitative content analysis. A coding frame was developed inductively from the data, only the highest-level categories were generated deductively for a life-cycle perspective. A total of 67 distinct ethical issues could be categorized under different phases of the LHCS life-cycle. An overarching theme that was repeatedly raised was the conflict between the current regulatory system and learning health care. The implementation of a LHCS can help realize the ethical imperative to continuously improve the quality of health care. However, the implementation of a LHCS can also raise a number of important ethical issues itself. This review highlights the importance for health care leaders and policy makers to balance the need to protect and respect individual participants involved in learning health care activities with the social value of improving health care.

[Corruption and health care system].

Science.gov (United States)

Marasović Šušnjara, Ivana

2014-06-01

Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.

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

NARCIS (Netherlands)

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

2009-01-01

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

[The development of the public health system between an increasing market orientation (commercialisation) and social responsibility].

Science.gov (United States)

Trabert, G

2008-02-01

The development of the public health system between an increasing market orientation (commercialisation) and social responsibility is critically reflected by examining the medical care of those who are deprived. Poverty in Germany is dramatically increasing. There are confirmed findings on the correlation of being poor and being ill. Poverty leads to an increased number of cases of illness and a higher mortality rate. And vice versa, chronic illnesses very often cause impoverishment. This correlation has largely been ignored not only by the public but also by experts, especially when public health-care issues are on the political agenda. With reference to the current discussion about public health-care and the widespread disregard of the living conditions of the poor, the categories of "reasonable behaviour" (Kant) and "communicative behaviour" (Habermas) are reflected on in a philosophical excursion. Further interest groups affecting the political sphere, such as the pharmaceutical industry, the medical profession, patients and scientists are also examined with regard to public health-care. What are the premises of a health-care discussion that is controlled by economic considerations, particularly when keeping in mind the humanistic and Christian ethics of our society? And what does this mean for our responsibility for those who are handicapped and are in need of our help? Do decision makers and participants of the health-care discussion satisfy these ethical challenges? And what are the effects of the so-called "social peace" on social cooperation and economic power of a country? The increasing market orientation (commercialisation) of the public health sector can only be accepted on the basis of practiced humanity and social responsibility. In the light of a human public health-care, deprived people are in need of our solidarity.

[Quality management (TQM) in public health-care (PHC): principles for cost-performance calculations and cost reductions with better quality].

Science.gov (United States)

Bergholz, W

2008-11-01

In many high-tech industries, quality management (QM) has enabled improvements of quality by a factor of 100 or more, in combination with significant cost reductions. Compared to this, the application of QM methods in health care is in its initial stages. It is anticipated that stringent process management, embedded in an effective QM system will lead to significant improvements in health care in general and in the German public health service in particular. Process management is an ideal platform for controlling in the health care sector, and it will significantly improve the leverage of controlling to bring down costs. Best practice sharing in industry has led to quantum leap improvements. Process management will enable best practice sharing also in the public health service, in spite of the highly diverse portfolio of services that the public health service offers in different German regions. Finally, it is emphasised that "technical" QM, e.g., on the basis of the ISO 9001 standard is not sufficient to reach excellence. It is necessary to integrate soft factors, such as patient or employee satisfaction, and leadership quality into the system. The EFQM model for excellence can serve as proven tool to reach this goal.

Efficiency performance of China's health care delivery system.

Science.gov (United States)

Zhang, Luyu; Cheng, Gang; Song, Suhang; Yuan, Beibei; Zhu, Weiming; He, Li; Ma, Xiaochen; Meng, Qingyue

2017-07-01

Improving efficiency performance of the health care delivery system has been on the agenda for the health system reform that China initiated in 2009. This study examines the changes in efficiency performance and determinants of efficiency after the reform to provide evidence to assess the progress of the reform from the perspective of efficiency. Descriptive analysis, Data Envelopment Analysis, the Malmquist Index, and multilevel regressions are used with data from multiple sources, including the World Bank, the China Health Statistical Yearbook, and routine reports. The results indicate that over the last decade, health outcomes compared with health investment were relatively higher in China than in most other countries worldwide, and the trend was stable. The overall efficiency and total factor productivity increased after the reform, indicating that the reform was likely to have had a positive impact on the efficiency performance of the health care delivery system. However, the health care delivery structure showed low system efficiency, mainly attributed to the weakened primary health care system. Strengthening the primary health care system is central to enhancing the future performance of China's health care delivery system. Copyright © 2017 John Wiley & Sons, Ltd.

Using Behavior Over Time Graphs to Spur Systems Thinking Among Public Health Practitioners.

Science.gov (United States)

Calancie, Larissa; Anderson, Seri; Branscomb, Jane; Apostolico, Alexsandra A; Lich, Kristen Hassmiller

2018-02-01

Public health practitioners can use Behavior Over Time (BOT) graphs to spur discussion and systems thinking around complex challenges. Multiple large systems, such as health care, the economy, and education, affect chronic disease rates in the United States. System thinking tools can build public health practitioners' capacity to understand these systems and collaborate within and across sectors to improve population health. BOT graphs show a variable, or variables (y axis) over time (x axis). Although analyzing trends is not new to public health, drawing BOT graphs, annotating the events and systemic forces that are likely to influence the depicted trends, and then discussing the graphs in a diverse group provides an opportunity for public health practitioners to hear each other's perspectives and creates a more holistic understanding of the key factors that contribute to a trend. We describe how BOT graphs are used in public health, how they can be used to generate group discussion, and how this process can advance systems-level thinking. Then we describe how BOT graphs were used with groups of maternal and child health (MCH) practitioners and partners (N = 101) during a training session to advance their thinking about MCH challenges. Eighty-six percent of the 84 participants who completed an evaluation agreed or strongly agreed that they would use this BOT graph process to engage stakeholders in their home states and jurisdictions. The BOT graph process we describe can be applied to a variety of public health issues and used by practitioners, stakeholders, and researchers.

Development of a Community-Based Palliative Care Model for Advance Cancer Patients in Public Health Centers in Busan, Korea.

Science.gov (United States)

Kim, Sook-Nam; Choi, Soon-Ock; Shin, Seong Hoon; Ryu, Ji-Sun; Baik, Jeong-Won

2017-07-01

A feasible palliative care model for advance cancer patients is needed in Korea with its rapidly aging population and corresponding increase in cancer prevalence. This study describes the process involved in the development of a community-based palliative care (CBPC) model implemented originally in a Busan pilot project. The model development included steps I and II of the pilot project, identification of the service types, a survey exploring the community demand for palliative care, construction of an operational infrastructure, and the establishment of a service delivery system. Public health centers (including Busan regional cancer centers, palliative care centers, and social welfare centers) served as the regional hubs in the development of a palliative care model. The palliative care project included the provision of palliative care, establishment of a support system for the operations, improvement of personnel capacity, development of an educational and promotional program, and the establishment of an assessment system to improve quality. The operational infrastructure included a service management team, provision teams, and a support team. The Busan Metropolitan City CBPC model was based on the principles of palliative care as well as the characteristics of public health centers that implemented the community health projects. The potential use of the Busan CBPC model in Korea should be explored further through service evaluations.

Variations in levels of care between nursing home patients in a public health care system.

Science.gov (United States)

Døhl, Øystein; Garåsen, Helge; Kalseth, Jorid; Magnussen, Jon

2014-03-05

Within the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given. The study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000. There are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent. In a financial reimbursement model for nursing homes with no adjustment for case-mix, the amount of care patients receive does not solely depend on the patients' own needs, but also on the needs of all the other residents.

The Ariadne's thread in co-payment, primary health care usage and financial crisis: findings from Cyprus public health care sector.

Science.gov (United States)

Petrou, P

2015-11-01

Cyprus entered a prolonged financial recession in 2011 and by early 2013 it applied for an international bail-out agreement. This presupposed massive reforms in public governance. Health sector was considerably reformed and one of the measures was the introduction of co-payment for outpatient visits to public health care sector. The scope of this study is to assess the impact of financial crisis and co-payment to public outpatient visits in Nicosia urban and greater Nicosia region. An Interrupted time-series analysis. All outpatient visits to public health care family doctor/general practitioners in Nicosia urban and greater Nicosia region from January 2011 until May of 2014 were registered and analysed. Financial crisis did not alter outpatient visits. Introduction of co-payment led to a statistically significant decrease from the second month after its introduction (p = 0.048) (R(2) = 0.329, Q = 23.75, p = 0.137). This decrease was consistent until the end of the observational period and it did not level off. Financial crisis did not affect outpatient visits while co-payment can be considered as a potent cost containment measure during financial recession, by normalising utilisation of healthcare resources. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Creating an integrated public sector? Labour's plans for the modernisation of the English health care system

Directory of Open Access Journals (Sweden)

Nick Goodwin

2002-03-01

Full Text Available The current Labour Government has embarked on radical public sector reform in England. A so-called ‘Modernisation Agenda’ has been developed that is encapsulated in the NHS Plan—a document that details a long-term vision for health care. This plan involves a five-fold strategy: investment through greater public funding; quality assurance; improving access; service integration and inter-professional working; and providing a public health focus. The principles of Labour's vision have been broadly supported. However, achieving its aims appears reliant on two key factors. First, appropriate resources are required to create capacity, particularly management capacity, to enable new functions to develop. Second, promoting access and service integration requires the development of significant co-ordination, collaboration and networking between agencies and individuals. This is particularly important for health and social care professionals. Their historically separate professions suggest that a significant period of change management is required to allow new roles and partnerships to evolve. In an attempt to secure delivery of its goals, however, the Government has placed the emphasis on further organisational restructuring. In doing so, the Government may have missed the key challenges faced in delivering its NHS Plan. As this paper argues, cultural and behavioural change is probably a far more appropriate and important requirement for success than a centrally directed approach that emphasises the rearrangement of structural furniture.

Health care financing and the sustainability of health systems.

Science.gov (United States)

Liaropoulos, Lycourgos; Goranitis, Ilias

2015-09-15

The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to "traditional" issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy. These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability.

Chiropractic care and public health

DEFF Research Database (Denmark)

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

2012-01-01

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

Collaboration across private and public sector primary health care services: benefits, costs and policy implications.

Science.gov (United States)

McDonald, Julie; Powell Davies, Gawaine; Jayasuriya, Rohan; Fort Harris, Mark

2011-07-01

Ongoing care for chronic conditions is best provided by interprofessional teams. There are challenges in achieving this where teams cross organisational boundaries. This article explores the influence of organisational factors on collaboration between private and public sector primary and community health services involved in diabetes care. It involved a case study using qualitative methods. Forty-five participants from 20 organisations were purposively recruited. Data were collected through semi-structured interviews and from content analysis of documents. Thematic analysis was used employing a two-level coding system and cross case comparisons. The patterns of collaborative patient care were influenced by a combination of factors relating to the benefits and costs of collaboration and the influence of support mechanisms. Benefits lay in achieving common or complementary health or organisational goals. Costs were incurred in bridging differences in organisational size, structure, complexity and culture. Collaboration was easier between private sector organisations than between private and public sectors. Financial incentives were not sufficient to overcome organisational barriers. To achieve more coordinated primary and community health care structural changes are also needed to better align funding mechanisms, priorities and accountabilities of the different organisations.

Greece: Health system review.

Science.gov (United States)

Economou, Charalambos

2010-01-01

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The health status of the Greek population has strongly improved over the last few decades and seems to compare relatively favourably with other OECD and European Union (EU) countries. The health system is a mixture of public integrated, public contract and public reimbursement models, comprising elements from both the public and private sectors and incorporating principles of different organizational patterns. Access to services is based on citizenship as well as on occupational status.The system is financed by the state budget, social insurance contributions and private payments.The largest share of health expenditure constitutes private expenditure, mainly in the form of out of pocket payments which is also the element contributing most to the overall increase in health expenditure. The delivery of health care services is based on both public and private providers. The presence of private providers is more obvious in primary care,especially in diagnostic technologies, private physicians' practices and pharmaceuticals. Despite success in improving the health of the population, the Greek health care system faces serious structural problems concerning the organization, financing and delivery of services. It suffers from the absence of cost-containment measures and defined criteria for funding, resulting in sickness funds experiencing economic constraints and budget deficits. The high percentage of private expenditure goes against the principle of fair

[The French health care funding system for research and innovation in oncology].

Science.gov (United States)

Wiernik, Harvey; Katz, Gregory; Coulonjou, Hélène; Salagnac, André; Kletz, Frédéric; Thariat, Juliette

2018-06-01

This article provides an overview of the French health system with respect to allocation of public resources to hospitals, to encourage research and innovation, particularly in the field of oncology. It is explained in a historical, economic and scientific perspective. Important structural and conceptual reforms (T2A, HPST law, etc.) have been carried out. These have significantly impacted the way public funding is allocated. Funding of innovation and research has been modified into a more incentive logic, aimed at strengthening competitiveness between all health care actors. The funding allocation system has evolved towards a more ubiquitous redistribution, including non-academic and private institutions. The baseline endowment includes indicators relating to scientific publications (60% of the endowment), teaching (25%) and clinical trials (15%). Research funding is then redistributed by regional health agencies, and used in health care institutions at the discretion of the directorates. Other funding sources such as calls for grants, funding for mobile research centers and teams, tumor banks and temporary user licenses are also part of the funding by the French Ministry of health. Changes in the health research funding system have an incentive purpose. They have significantly modified the global healthcare landscape. Feedback on these changes will be necessary to assess the success of the reinforcement of the dynamics of research and innovation. Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Gambling and the Health of the Public: Adopting a Public Health Perspective.

Science.gov (United States)

Korn, David A.; Shaffer, Howard J.

1999-01-01

During the last decade there has been an unprecedented expansion of legalized gambling throughout North America. Three primary forces appear to be motivating this growth: (1) the desire of governments to identify new sources of revenue without invoking new or higher taxes; (2) tourism entrepreneurs developing new destinations for entertainment and leisure; and (3) the rise of new technologies and forms of gambling (e.g., video lottery terminals, powerball mega-lotteries, and computer offshore gambling). Associated with this phenomenon, there has been an increase in the prevalence of problem and pathological gambling among the general adult population, as well as a sustained high level of gambling-related problems among youth. To date there has been little dialogue within the public health sector in particular, or among health care practitioners in general, about the potential health impact of gambling or gambling-related problems. This article encourages the adoption of a public health perspective towards gambling. More specifically, this discussion has four primary objectives:1. Create awareness among health professionals about gambling, its rapid expansion and its relationship with the health care system;2. Place gambling within a public health framework by examining it from several perspectives, including population health, human ecology and addictive behaviors;3. Outline the major public health issues about how gambling can affect individuals, families and communities;4. Propose an agenda for strengthening policy, prevention and treatment practices through greater public health involvement, using the framework of The Ottawa Charter for Health Promotion as a guide.By understanding gambling and its potential impacts on the public's health, policy makers and health practitioners can minimize gambling's negative impacts and appreciate its potential benefits.

An integrated approach to preventing cardiovascular disease: community-based approaches, health system initiatives, and public health policy.

Science.gov (United States)

Karwalajtys, Tina; Kaczorowski, Janusz

2010-01-01

Cardiovascular disease (CVD) is largely the product of interactions among modifiable risk factors that are common in developed nations and increasingly of concern in developing countries. Hypertension is an important precursor to the development of CVD, and although detection and treatment rates have improved in recent years in some jurisdictions, effective strategies and policies supporting a shift in distribution of risk factors at the population level remain paramount. Challenges in managing cardiovascular health more effectively include factors at the patient, provider, and system level. Strategies to reduce hypertension and CVD should be population based, incorporate multilevel, multicomponent, and socioenvironmental approaches, and integrate community resources with public health and clinical care. There is an urgent need to improve monitoring and management of risk factors through community-wide, primary care-linked initiatives, increase the evidence base for community-based prevention strategies, further develop and evaluate promising program components, and develop new approaches to support healthy lifestyle behaviors in diverse age, socioeconomic, and ethnocultural groups. Policy and system changes are critical to reduce risk in populations, including legislation and public education to reduce dietary sodium and trans-fatty acids, food pricing policies, and changes to health care delivery systems to explicitly support prevention and management of CVD.

Corruption in health-care systems and its effect on cancer care in Africa.

Science.gov (United States)

Mostert, Saskia; Njuguna, Festus; Olbara, Gilbert; Sindano, Solomon; Sitaresmi, Mei Neni; Supriyadi, Eddy; Kaspers, Gertjan

2015-08-01

At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

Science.gov (United States)

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

2013-02-01

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

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

Science.gov (United States)

Flood, Colleen; Gross, Aeyal

2014-12-11

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

Health Care Public Sector Share and the U.S. Life Expectancy Lag: A Country-level Longitudinal Study.

Science.gov (United States)

Reynolds, Megan M

2018-04-01

Growing research on the political economy of health has begun to emphasize sociopolitical influences on cross-national differences in population health above and beyond economic growth. While this research investigates the impact of overall public health spending as a share of GDP ("health care effort"), it has for the most part overlooked the distribution of health care spending across the public and private spheres ("public sector share"). I evaluate the relative contributions of health care effort, public sector share, and GDP to the large and growing disadvantage in U.S. life expectancy at birth relative to peer nations. I do so using fixed effects models with data from 16 wealthy democratic nations between 1960 and 2010. Results indicate that public sector share has a beneficial effect on longevity net of the effect of health care effort and that this effect is nonlinear, decreasing in magnitude as levels rise. Moreover, public sector share is a more powerful predictor of life expectancy at birth than GDP per capita. This study contributes to discussions around the political economy of health, the growth consensus, and the American lag in life expectancy. Policy implications vis-à-vis the U.S. Affordable Care Act are discussed.

Chiropractic practice in the Danish public health care sector

DEFF Research Database (Denmark)

Myburgh, Corrie

2009-01-01

This commentary offers preliminary considerations around a phenomenological investigation of chiropractic services in a Danish public sector setting. In this narrative description, the main venue for chiropractic public (secondary) sector practice in the Danish context is briefly described...... and defined. Furthermore, a contextually relevant definition of an integral health care service is presented; and the professional importance for chiropractic in providing such services is also discussed. Finally, salient questions requiring empirical investigation in this context are posed; and selected...

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

Science.gov (United States)

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

2013-01-01

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

Direct costs of dengue hospitalization in Brazil: public and private health care systems and use of WHO guidelines.

Science.gov (United States)

Vieira Machado, Alessandra A; Estevan, Anderson Oliveira; Sales, Antonio; Brabes, Kelly Cristina da Silva; Croda, Júlio; Negrão, Fábio Juliano

2014-09-01

Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care.

Genetics, health care, and public policy: an introduction to public health genetics

National Research Council Canada - National Science Library

Stewart, Alison

2007-01-01

... initiative About this book Further reading and resources Principles of public health The emergence of public health genetics The human genome project and 'genomic medicine' Community genetics Current developments in public health genetics Genomics and global health 2 Genetic science and technology Basic molecular genetics Genes and the geno...

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

Science.gov (United States)

Odeyemi, Isaac Ao; Nixon, John

2013-01-01

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

The Public Health Community Platform, Electronic Case Reporting, and the Digital Bridge.

Science.gov (United States)

Cooney, Mary Ann; Iademarco, Michael F; Huang, Monica; MacKenzie, William R; Davidson, Arthur J

At the intersection of new technology advancements, ever-changing health policy, and fiscal constraints, public health agencies seek to leverage modern technical innovations and benefit from a more comprehensive and cooperative approach to transforming public health, health care, and other data into action. State health agencies recognized a way to advance population health was to integrate public health with clinical health data through electronic infectious disease case reporting. The Public Health Community Platform (PHCP) concept of bidirectional data flow and knowledge management became the foundation to build a cloud-based system connecting electronic health records to public health data for a select initial set of notifiable conditions. With challenges faced and lessons learned, significant progress was made and the PHCP grew into the Digital Bridge, a national governance model for systems change, bringing together software vendors, public health, and health care. As the model and technology advance together, opportunities to advance future connectivity solutions for both health care and public health will emerge.

Public health dental hygiene: an option for improved quality of care and quality of life.

Science.gov (United States)

Olmsted, Jodi L; Rublee, Nancy; Zurkawski, Emily; Kleber, Laura

2013-10-01

The purpose of this research was to document quality of life (QoL) and quality of care (QoC) measures for families receiving care from dental hygienists within public health departments, and to consider if oral health for families with economic disparities and cultural differences was improved. A descriptive research study using a retrospective record review was conducted considering QoC. A review of state epid "Do preventive oral health programs based in local health departments provide quality care services, thus impacting QoL for underserved populations?" A dental hygienist working in public health made significant contributions to improving access to care and QoL in a rural, socioeconomically disadvantaged community. A total of 2,364 children received education, 1,745 received oral screenings and 1,511 received dental sealants. Of these, 804 children with caries were referred, with 463 receiving restorations and follow-up care. QoL metrics basis assessed Health Outcomes & Health Determinants. Initial QoL data was ranked in the bottom half of the state, while 70% of original determinant data was also ranked in the bottom half of reported metrics. Dental hygienists in public health settings can positively affect patients offering preventive care outreach services. Education and sealant placement were considered effective as measured by access, delivery and, when required, referral for restorative care. Improvement in QoL for individuals was noted through improved health outcomes and determinant metrics.

A change of direction in the Dutch health care system?

Science.gov (United States)

Lapré, R M

1988-08-01

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

Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

Directory of Open Access Journals (Sweden)

Magnavita Nicola

2012-05-01

Full Text Available Abstract Background Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention. Methods All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form for reporting violent incidents, the DCS (demand/control/support model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health. Results One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress. Conclusion Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.

Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

Science.gov (United States)

2012-01-01

Background Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention. Methods All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form) for reporting violent incidents, the DCS (demand/control/support) model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health. Results One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress. Conclusion Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors. PMID:22551645

Rationalising health care in india : Challenges & strategies

Directory of Open Access Journals (Sweden)

K I Mathai

2014-01-01

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

Nigerian health care: A quick appraisal

Directory of Open Access Journals (Sweden)

Yau Zakari Lawal

2017-01-01

Full Text Available Qualitative health care is a fundamental right of all citizens of a given country. How this health care is delivered depends significantly on the economy, dedication, and quality of the health-care providers and the political will of the government of the country. Health care may be public run or organized by private health-care providers. We can also have an intercalated program where there is public–private partnership. Whichever way this basic fundamental human right is delivered, sustainability, affordability, and accessibility are vital to its success. The Nigerian health-care delivery can be broadly classified into two; the hitherto existing traditional medicine and the modern orthodox medicine which came to our shores with the arrival of the European colonialists. The traditional system is still patronized by most Nigerians and is known by different linguistic terminologies such as the “Wanzami” or Barber in Hausa and the “Babalawo” in Yoruba language. Traditional birth attendants also exist in all communities in Nigeria complemented by herbalist and spiritualists of different shades and callings. It is our aim to give a brief account of our observations on the Nigerian health-care system with a view to correcting the challenges by the government and the public in general.

[About development of public health of the Russian Federation].

Science.gov (United States)

Shchepin, O P

2013-01-01

The article presents public health system characterized by public responsibility for health of citizen under various forms of property. The issues of management, planning, financing and organization of health care are discussed.

Public health preparedness in Alberta: a systems-level study.

Science.gov (United States)

Moore, Douglas; Shiell, Alan; Noseworthy, Tom; Russell, Margaret; Predy, Gerald

2006-12-28

Recent international and national events have brought critical attention to the Canadian public health system and how prepared the system is to respond to various types of contemporary public health threats. This article describes the study design and methods being used to conduct a systems-level analysis of public health preparedness in the province of Alberta, Canada. The project is being funded under the Health Research Fund, Alberta Heritage Foundation for Medical Research. We use an embedded, multiple-case study design, integrating qualitative and quantitative methods to measure empirically the degree of inter-organizational coordination existing among public health agencies in Alberta, Canada. We situate our measures of inter-organizational network ties within a systems-level framework to assess the relative influence of inter-organizational ties, individual organizational attributes, and institutional environmental features on public health preparedness. The relative contribution of each component is examined for two potential public health threats: pandemic influenza and West Nile virus. The organizational dimensions of public health preparedness depend on a complex mix of individual organizational characteristics, inter-agency relationships, and institutional environmental factors. Our study is designed to discriminate among these different system components and assess the independent influence of each on the other, as well as the overall level of public health preparedness in Alberta. While all agree that competent organizations and functioning networks are important components of public health preparedness, this study is one of the first to use formal network analysis to study the role of inter-agency networks in the development of prepared public health systems.

Contributions of Public Health to nursing practice

Directory of Open Access Journals (Sweden)

Káren Mendes Jorge de Souza

Full Text Available ABSTRACT Objective: Analyze the perceptions of undergraduate nursing students about the contributions of public health to nursing practice in the Unified Health System. Method: Qualitative Descriptive Study. Data collection was carried out through semi-directed interviews with 15 students. The language material was analyzed according to content and thematic analysis. Results: Thematic categories were established, namely: "Perceptions about Public Health" and "Contribution of Public Health to nursing practice in the Unified Health System". Final considerations: Perceptions about Public Health are diversified, but converge to the recognition of this field as the basis for training nurses qualified to work in the SUS with technical competence, autonomy and focusing on the integrality in health care.