Sample records for health service reforms

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

    PubMed

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

    2003-12-01

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

  2. Health services reforms in revolutionary Nicaragua.

    PubMed Central

    Garfield, R M; Taboada, E

    1984-01-01

    Before the Nicaraguan revolution of 1979, access to health services was largely limited to the affluent sectors of the urban population and the minority of workers with social security coverage. Repeated attempts at reform by organized medicine were ineffective. Since the revolution, a tremendous expansion in health services has occurred. The national health system receives approximately one-third of its funds from the social security system. Steadily increasing equity in access is a result of the promotion of primary care, health campaigns involving up to 10 per cent of the general population as volunteers, the use of paramedical aides, and foreign assistance. Private practice nevertheless remains strong. In the coming years, several complex issues must be examined, including: a balance in the number of nurses and doctors trained, the role of private practice, and the relationship of the Ministry of Health to the social security system. Further progress in health reforms may be delayed by the defensive war which Nicaragua is fighting on its northern and southern borders. Despite emergent health problems in the war zones, most of the innovative aspects of the health system remain intact as of this writing. PMID:6476169

  3. Financing reforms of public health services in China: lessons for other nations.

    PubMed

    Liu, Xingzhu; Mills, Anne

    2002-06-01

    Financing reforms of China's public health services are characterised by a reduction in government budgetary support and the introduction of charges. These reforms have changed the financing structure of public health institutions. Before the financing reforms, in 1980, government budgetary support covered the full costs of public health institutions, while after the reforms by the middle of the 1990s, the government's contribution to the institutions' revenue had fallen to 30-50%, barely covering the salaries of health workers, and the share of revenue generated from charges had increased to 50-70%. These market-oriented financing reforms improved the productivity of public health institutions, but several unintended consequences became evident. The economic incentives that were built into the financing system led to over-provision of unnecessary services, and under-provision of socially desirable services. User fees reduced the take-up of preventive services with positive externalities. The lack of government funds resulted in under-provision of services with public goods' characteristics. The Chinese experience has generated important lessons for other nations. Firstly, a decline in the role of government in financing public health services is likely to result in decreased overall efficiency of the health sector. Secondly, levying charges for public health services can reduce demand for these services and increase the risk of disease transmission. Thirdly, market-oriented financing reforms of public health services should not be considered as a policy option. Once this step is made, the unintended consequences may outweigh the intended ones. Chinese experience strongly suggests that the government should take a very active role in financing public health services.

  4. Progressive segmented health insurance: Colombian health reform and access to health services.

    PubMed

    Ruiz, Fernando; Amaya, Liliana; Venegas, Stella

    2007-01-01

    Equal access for poor populations to health services is a comprehensive objective for any health reform. The Colombian health reform addressed this issue through a segmented progressive social health insurance approach. The strategy was to assure universal coverage expanding the population covered through payroll linked insurance, and implementing a subsidized insurance program for the poorest populations, those not affiliated through formal employment. A prospective study was performed to follow-up health service utilization and out-of-pocket expenses using a cohort design. It was representative of four Colombian cities (Cendex Health Services Use and Expenditure Study, 2001). A four part econometric model was applied. The model related medical service utilization and medication with different socioeconomic, geographic, and risk associated variables. Results showed that subsidized health insurance improves health service utilization and reduces the financial burden for the poorest, as compared to those non-insured. Other social health insurance schemes preserved high utilization with variable out-of-pocket expenditures. Family and age conditions have significant effect on medical service utilization. Geographic variables play a significant role in hospital inpatient service utilization. Both, geographic and income variables also have significant impact on out-of-pocket expenses. Projected utilization rates and a simulation favor a dual policy for two-stage income segmented insurance to progress towards the universal insurance goal. Copyright (c) 2006 John Wiley & Sons, Ltd.

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

    PubMed

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

    2014-09-01

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

  6. Big bang health care reform--does it work?: the case of Britain's 1991 National Health Service reforms.

    PubMed

    Klein, R

    1995-01-01

    The costs and benefits are examined of one of the very few examples of a government driving through health care reform in the face of near unanimous opposition: Britain's 1991 reforms of the National Health Service (NHS), which sought to inject the dynamics of a market into the framework of a universal, tax-financed service. The political costs to the government have been high. The public continues to see the NHS through the eyes of disgruntled doctors and nurses. The benefits, measured in efficiency gains or service improvements, are as yet difficult to establish. However, the NHS has changed in key respects. The balance has shifted from hospital specialists to general practitioners and from providers to purchasers, with increasing emphasis on professional accountability and consumerism. But the NHS continues to evolve as it strives to resolve the tensions implicit in the reforms, and the only certainty is that no future government can return to the pre-1991 situation.

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

    PubMed Central

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

    2017-01-01

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

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

    PubMed

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

    2017-01-22

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

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

    PubMed

    Higgins, C W; Phillips, B U

    1986-08-01

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

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

    PubMed

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

    2011-12-21

    In Bangladesh, widespread dissatisfaction with government health services did not improve during the Health and Population Sector Programme (HPSP) reforms from 1998-2003. A 2003 national household survey documented public and health service users' views and experience. Attitudes and behaviour of health workers are central to quality of health services. To investigate whether the views of health workers influenced the reforms, we surveyed local health workers and held evidence-based discussions with local service managers and professional bodies. Some 1866 government health workers in facilities serving the household survey clusters completed a questionnaire about their views, experience, and problems as workers. Field teams discussed the findings from the household and health workers' surveys with local health service managers in five upazilas (administrative sub-districts) and with the Bangladesh Medical Association (BMA) and Bangladesh Nurses Association (BNA). Nearly one half of the health workers (45%) reported difficulties fulfilling their duties, especially doctors, women, and younger workers. They cited inadequate supplies and infrastructure, bad behaviour of patients, and administrative problems. Many, especially doctors (74%), considered they were badly treated as employees. Nearly all said lack of medicines in government facilities was due to inadequate supply, not improved during the HPSP. Two thirds of doctors and nurses complained of bad behaviour of patients. A quarter of respondents thought quality of service had improved as a result of the HPSP.Local service managers and the BMA and BNA accepted patients had negative views and experiences, blaming inadequate resources, high patient loads, and patients' unrealistic expectations. They said doctors and nurses were demotivated by poor working conditions, unfair treatment, and lack of career progression; private and unqualified practitioners sought to please patients instead of giving medically

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

    PubMed

    Eklund, Mona; Markström, Urban

    2015-11-01

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

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

    PubMed

    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 (P<0.01). 25.39% of the respondents thought that their financial burden had increased and 38.49% thought that drugs had become more expensive. 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

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

    PubMed

    Pritchard, A M; Page, D

    2008-05-01

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

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

    PubMed Central

    2011-01-01

    Background In Bangladesh, widespread dissatisfaction with government health services did not improve during the Health and Population Sector Programme (HPSP) reforms from 1998-2003. A 2003 national household survey documented public and health service users' views and experience. Attitudes and behaviour of health workers are central to quality of health services. To investigate whether the views of health workers influenced the reforms, we surveyed local health workers and held evidence-based discussions with local service managers and professional bodies. Methods Some 1866 government health workers in facilities serving the household survey clusters completed a questionnaire about their views, experience, and problems as workers. Field teams discussed the findings from the household and health workers' surveys with local health service managers in five upazilas (administrative sub-districts) and with the Bangladesh Medical Association (BMA) and Bangladesh Nurses Association (BNA). Results Nearly one half of the health workers (45%) reported difficulties fulfilling their duties, especially doctors, women, and younger workers. They cited inadequate supplies and infrastructure, bad behaviour of patients, and administrative problems. Many, especially doctors (74%), considered they were badly treated as employees. Nearly all said lack of medicines in government facilities was due to inadequate supply, not improved during the HPSP. Two thirds of doctors and nurses complained of bad behaviour of patients. A quarter of respondents thought quality of service had improved as a result of the HPSP. Local service managers and the BMA and BNA accepted patients had negative views and experiences, blaming inadequate resources, high patient loads, and patients' unrealistic expectations. They said doctors and nurses were demotivated by poor working conditions, unfair treatment, and lack of career progression; private and unqualified practitioners sought to please patients instead

  15. Commentary: recent reforms in the British National Health Service--lessons for the United States.

    PubMed Central

    Holland, W W; Graham, C

    1994-01-01

    President Clinton recently announced his reform plan for health care in the United States. The United Kingdom, along with other countries, has already enacted reforms in an effort to overcome the basic problem of having insufficient funds to provide a health service to meet modern demands. This paper briefly describes the recent health reforms in the United Kingdom and highlights some lessons for the United States, which include the need to choose procedures that should be universally provided. Health reforms that involve some fundamental restructuring need to be evaluated everywhere and agreed to by the staff in advance. PMID:8296937

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

    PubMed

    Dahlgren, Göran

    2014-01-01

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

  17. Prospects for Health Care Reform.

    ERIC Educational Resources Information Center

    Kastner, Theodore

    1992-01-01

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

  18. Let's make a deal: trading malpractice reform for health reform.

    PubMed

    Sage, William M; Hyman, David A

    2014-01-01

    Physician leadership is required to improve the efficiency and reliability of the US health care system, but many physicians remain lukewarm about the changes needed to attain these goals. Malpractice liability-a sore spot for decades-may exacerbate physician resistance. The politics of malpractice have become so lawyer-centric that recognizing the availability of broader gains from trade in tort reform is an important insight for health policy makers. To obtain relief from malpractice liability, physicians may be willing to accept other policy changes that more directly improve access to care and reduce costs. For example, the American Medical Association might broker an agreement between health reform proponents and physicians to enact federal legislation that limits malpractice liability and simultaneously restructures fee-for-service payment, heightens transparency regarding the quality and cost of health care services, and expands practice privileges for other health professionals. There are also reasons to believe that tort reform can make ongoing health care delivery reforms work better, in addition to buttressing health reform efforts that might otherwise fail politically.

  19. Health care reform: clarifying the concepts.

    PubMed

    Miller, A M

    1993-01-01

    Despite agreement about problems with the health care system, there is disagreement about the remedy. Like most health care reform debates, this article focuses on financing methods rather than service delivery. Reform strategies are intentionally oversimplified into four categories: employer-based or "play or pay"; single-payer and modifications, such as expanding Medicaid or Medicare; market competition; and managed competition, which appears to be favored by the Clinton administration. Cost-control mechanisms and insurance reforms are applicable to all four financing methods. Reform is inevitable. The challenge for nurses is to understand reform issues and then influence policymakers to initiate reforms that make essential medical and preventive services universally available.

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

    PubMed

    Hunter, David J

    2011-01-01

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

  1. Modernizing UK health services: 'short-sharp-shock' reform, the NHS subsistence economy, and the spectre of health care famine.

    PubMed

    Charlton, Bruce G; Andras, Peter

    2005-04-01

    Modernization is the trend for societies to grow functionally more complex, efficient and productive. Modernization usually occurs by increased specialization of function (e.g. division of labour, such as the proliferation of specialists in medicine), combined with increased organization in order to co-ordinate the numerous specialized functions (e.g. the increased size of hospitals and specialist teams, including the management of these large groups). There have been many attempts to modernize the National Health Service (NHS) over recent decades, but it seems that none have significantly enhanced either the efficiency or output of the health care system. The reason may be that reforms have been applied as a 'drip-drip' of central regulation, with the consequence that health care has become increasingly dominated by the political system. In contrast, a 'short-sharp-shock' of radical and rapid modernization seems to be a more successful strategy for reforming social systems - in-between waves of structural change the system is left to re-orientate towards its client group. An example was the Flexner-initiated reform of US medical education which resulted in the closure of nearly half the medical colleges, an immediate enhancement in quality and efficiency of the system and future growth based on best institutional practices. However, short-sharp-shock reforms would probably initiate an NHS 'health care famine' with acute shortages and a health care crisis, because the NHS constitutes a 'subsistence economy' without any significant surplus of health services. The UK health care system must grow to generate a surplus before it can adequately be modernized. Efficient and rapid growth in health services could most easily be generated by stimulating provision outside the NHS, using mainly staff trained abroad and needs-subsidized 'item-of-service'-type payment schemes. Once there is a surplus of critically vital health services (e.g. acute and emergency provision), then

  2. Mental Health Commissions: making the critical difference to the development and reform of mental health services.

    PubMed

    Rosen, Alan; Goldbloom, David; McGeorge, Peter

    2010-11-01

    Several Mental Health Commissions (MHCs) have emerged in developed countries over recent years, often in connection with mental health reform strategies. It is timely to consider the types of MHC which exist in different countries, their characteristics which may contribute to making them more effective, and any possible limitations and concerns raised about them. The emerging literature on MHCs indicates, particularly with the wider types of MHCs, that they may contribute to the substantial enhancement of mental health resources and sustainability of services; mental health reform is much more likely to be implemented properly with an independent monitor such as a MHC which has official influence at the highest levels of government; and they can encourage, champion and monitor the transformation of services into more evidence-based, community-centred, recovery-oriented, consumer, family and human rights-focused mental health services. The advent of MHCs may enhance the resourcing, quality and consistency of distribution of effective clinical practices and crucial support services, and foster more relevant practice-based research. MHC variants can work in different countries and the model can be adapted to state jurisdictions, single state nations and federated systems of government, without duplicating bureaucracies. Achievements and possible limitations are considered.

  3. Twitter and the health reforms in the English National Health Service.

    PubMed

    King, Dominic; Ramirez-Cano, Daniel; Greaves, Felix; Vlaev, Ivo; Beales, Steve; Darzi, Ara

    2013-05-01

    Social media (for example Facebook and YouTube) uses online and mobile technologies to allow individuals to participate in, comment on and create user-generated content. Twitter is a widely used social media platform that lets users post short publicly available text-based messages called tweets that other users can respond to. Alongside traditional media outlets, Twitter has been a focus for discussions about the controversial and radical reforms to the National Health Service (NHS) in England that were recently passed into law by the current coalition Government. Looking at over 120,000 tweets made about the health reforms, we have investigated whether any insights can be obtained about the role of Twitter in informing, debating and influencing opinion in a specific area of health policy. In particular we have looked at how the sentiment of tweets changed with the passage of the Health and Social Care Bill through Parliament, and how this compared to conventional opinion polls taken over the same time period. We examine which users appeared to have the most influence in the 'Twittersphere' and suggest how a widely used metric of academic impact - the H-index - could be applied to measure context-dependent influence on Twitter. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  4. Strengthening health systems by health sector reforms.

    PubMed

    Senkubuge, Flavia; Modisenyane, Moeketsi; Bishaw, Tewabech

    2014-01-01

    The rising burden of disease and weak health systems are being compounded by the persistent economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses. A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. Further, we explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health. Health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging 'street level' policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms. The process of reform needs a fundamental rather than merely an incremental and evolutionary change. Without radical structural and systemic changes, existing governance structures and management systems will continue to fail to address the existing health problems.

  5. Strengthening health systems by health sector reforms

    PubMed Central

    Senkubuge, Flavia; Modisenyane, Moeketsi; Bishaw, Tewabech

    2014-01-01

    Background The rising burden of disease and weak health systems are being compounded by the persistent economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses. Methods A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. Further, we explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health. Findings Health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging ‘street level’ policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms. Conclusions The process of reform needs a fundamental rather than merely an incremental and evolutionary change. Without radical structural and systemic changes, existing governance structures and management systems will continue to fail to address the existing health problems. PMID:24560261

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

    PubMed Central

    Piat, Myra; Lal, Shalini

    2016-01-01

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

  7. Anatomy of health care reform proposals.

    PubMed Central

    Soffel, D; Luft, H S

    1993-01-01

    The current proliferation of proposals for health care reform makes it difficult to sort out the differences among plans and the likely outcome of different approaches to reform. The current health care system has two basic features. The first, enrollment and eligibility functions, includes how people get into the system and gain coverage for health care services. We describe 4 models, ranging from an individual, voluntary approach to a universal, tax-based model. The second, the provision of health care, includes how physician services are organized, how they are paid for, what mechanisms are in place for quality assurance, and the degree of organization and oversight of the health care system. We describe 7 models of the organization component, including the current fee-for-service system with no national health budget, managed care, salaried providers under a budget, and managed competition with and without a national health budget. These 2 components provide the building blocks for health care plans, presented as a matrix. We also evaluate several reform proposals by how they combine these 2 elements. PMID:8273344

  8. Mental health care reforms in Asia: the urgency of now: building a recovery-oriented, community mental health service in china.

    PubMed

    Tse, Samson; Ran, Mao-Sheng; Huang, Yueqin; Zhu, Shimin

    2013-07-01

    For the first time in history, China has a mental health legal framework. People in China can now expect a better life and more accessible, better-quality health care services for their loved ones. Development of a community mental health service (CMHS) is at a crossroads. In this new column on mental health reforms in Asia, the authors review the current state of the CMHS in China and propose four strategic directions for future development: building on the strengths of the "686 Project," the 2004 initiative that launched China's mental health reform; improving professional skills of the mental health workforce, especially for a recovery approach; empowering families and caregivers to support individuals with severe mental illness; and using information and communications technology to promote self-help and reduce the stigma associated with psychiatric disorders.

  9. Free to Choose? Reform, Choice, and Consideration Sets in the English National Health Service.

    PubMed

    Gaynor, Martin; Propper, Carol; Seiler, Stephan

    2016-11-01

    Choice in public services is controversial. We exploit a reform in the English National Health Service to assess the effect of removing constraints on patient choice. We estimate a demand model that explicitly captures the removal of the choice constraints imposed on patients. We find that, post-removal, patients became more responsive to clinical quality. This led to a modest reduction in mortality and a substantial increase in patient welfare. The elasticity of demand faced by hospitals increased substantially post- reform and we find evidence that hospitals responded to the enhanced incentives by improving quality. This suggests greater choice can raise quality.

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

    PubMed

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

    2018-01-01

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

  11. Prisons and Health Reforms in England and Wales

    PubMed Central

    Hayton, Paul; Boyington, John

    2006-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2006-11-01

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

  14. Mental health system reform: a multi country comparison.

    PubMed

    Shera, Wes; Aviram, Uri; Healy, Bill; Ramon, Shula

    2002-01-01

    In recent years many countries have embarked on various types of health and mental health reform. These reforms have in large part been driven by governments' concerns for cost containment which has, in turn, been driven by an increasing process of global marketization and the need to control national deficits. A critical issue in these reforms is the increased emphasis on the use of "market mechanisms" in the delivery of health and mental health services. This paper uses a policy analysis framework to compare recent developments in the mental health sector in Canada, the United States, Britain and Australia. The common framework to be used for this will focus on: the defining characteristics of the society; legislative mandate; sectorial location (within or separate from health sector); funding streams; organising values of the system; locus of service delivery; service technologies; the role of social work; interprofessional dynamics; the role of consumers; and evaluation of outcomes at multiple levels. This analysis provides an opportunity to explore similarities and differences in mental system reform and in particular identify the challenges for social work in the field of mental health in the 21st century.

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

    PubMed

    Alford, K

    2000-01-01

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

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

    ERIC Educational Resources Information Center

    Join Together, Boston, MA.

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

  17. Coverage of genetic technologies under national health reform.

    PubMed Central

    Mehlman, M. J.; Botkin, J. R.; Scarrow, A.; Woodhall, A.; Kass, J.; Siebenschuh, E.

    1994-01-01

    This article examines the extent to which the technologies expected to emerge from genetic research are likely to be covered under Government-mandated health insurance programs such as those being proposed by advocates of national health reform. Genetic technologies are divided into three broad categories; genetic information services, including screening, testing, and counseling; experimental technologies; and gene therapy. This article concludes that coverage of these technologies under national health reform is uncertain. The basic benefits packages provided for in the major health reform plans are likely to provide partial coverage of experimental technologies; relatively broad coverage of information services; and varying coverage of gene therapies, on the basis of an evaluation of their costs, benefits, and the degree to which they raise objections on political and religious grounds. Genetic services that are not included in the basic benefits package will be available only to those who can purchase supplemental insurance or to those who can purchase the services with personal funds. The resulting multitiered system of access to genetic services raises serious questions of fairness. PMID:7977343

  18. State welfare reform policies and maternal and child health services: a national study.

    PubMed

    Romero, D; Chavkin, W; Wise, P H; Hess, C A; VanLandeghem, K

    2001-09-01

    Welfare reform (Personal Responsibility and Work Opportunity Reconciliation Act of 1996) resulted in dramatic policy changes, including health-related requirements and the administrative separation of cash assistance from Medicaid. We were interested in determining if changes in welfare and health policies had had an impact on state MCH services and programs. We conducted a survey in fall 1999 of state MCH Title V directors. Trained interviewers administered the telephone survey over a 3-month period. MCH directors from all 50 states, Washington, DC, and Puerto Rico participated (n = 52; response rate = 100%). Among the most noteworthy findings is that similar proportions of respondents reported that welfare policy changes had either helped (46%) or hindered (42%) the agency's work, with most of the positive impact attributed to increased funding. MCH data linkages with welfare and other social programs were low. Despite welfare reform's emphasis on work, limited services and exemptions were available for mothers with CSHCN. Almost no efforts have been undertaken to specifically address the needs of substance abusers in the context of new welfare policies. Few MCH agencies have developed programs to address the special needs of women receiving TANF who either have health problems themselves or have children with health problems. Recommendations including increased MCH and family planning funding and improved coordination between TANF and MCH to facilitate linkages and services are put forth in light of reauthorization of PRWORA.

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

    PubMed

    Regan, Paul; Ball, Elaine

    2017-03-01

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

  20. Health sector reform and reproductive health in Latin America and the Caribbean: strengthening the links.

    PubMed Central

    Langer, A.; Nigenda, G.; Catino, J.

    2000-01-01

    Many countries in Latin America and the Caribbean (LAC) are currently reforming their national health sectors and also implementing a comprehensive approach to reproductive health care. Three regional workshops to explore how health sector reform could improve reproductive health services have revealed the inherently complex, competing, and political nature of health sector reform and reproductive health. The objectives of reproductive health care can run parallel to those of health sector reform in that both are concerned with promoting equitable access to high quality care by means of integrated approaches to primary health care, and by the involvement of the public in setting health sector priorities. However, there is a serious risk that health reforms will be driven mainly by financial and/or political considerations and not by the need to improve the quality of health services as a basic human right. With only limited changes to the health systems in many Latin American and Caribbean countries and a handful of examples of positive progress resulting from reforms, the gap between rhetoric and practice remains wide. PMID:10859860

  1. Health Financing And Insurance Reform In Morocco

    PubMed Central

    Ruger, Jennifer Prah; Kress, Daniel

    2010-01-01

    The government of Morocco approved two reforms in 2005 to expand health insurance coverage. The first is a payroll-based mandatory health insurance plan for public-and formal private–sector employees to extend coverage from the current 16 percent of the population to 30 percent. The second creates a publicly financed fund to cover services for the poor. Both reforms aim to improve access to high-quality care and reduce disparities in access and financing between income groups and between rural and urban dwellers. In this paper we analyze these reforms: the pre-reform debate, benefits covered, financing, administration, and oversight. We also examine prospects and future challenges for implementing the reforms. PMID:17630444

  2. In defiance of the evidence: conservatives threaten to "reform" away England's National Health Service.

    PubMed

    Lister, John

    2012-01-01

    David Cameron's Conservative-led coalition government is pressing ahead with a highly controversial bill to "reform" the National Health Service (NHS), abolishing existing management structures, opening up provider services to private competition from "any qualified provider", and establishing a competitive market system in place of planning. The proposals fragment the structures and run counter to the founding principles of the NHS, which in 1948 transcended the limitations of markets, delivering health care on the basis of maximum risk sharing and universal access to services, free at the point of use. Evidence shows markets are a costly and inadequate mechanism to deliver universal and comprehensive health care, and private providers will only bid for services where profits are guaranteed. Opposition to the proposals is strong among health professionals and informed opinion, and the bill has divided the coalition parties--but time is running out for those who reject the bill to mount a sustained and concerted resistance.

  3. Reforming the mission of public dental services.

    PubMed

    Wright, F A C; List, P F

    2012-10-01

    Australia has a complex history of providing public dental services to its communities. From the early days of Colonial settlement, the provision of dental care to the Australian public has largely been driven and influenced by organized groups and associations of dentists. The Constitution of Australia, under Section 51 xxiii A, allows for the Commonwealth to provide for medical and dental services. Unlike the United Kingdom, however, dental services have not been embedded into a universal national health service agenda. In 1974, that the Australian Government through the Australian School Dental Program provided the first funding and national direction for public dental services - and that, limited to children. The Commonwealth Dental Health Program 1993-1997 was the second national endeavor to provide public dental services, this time to financially disadvantaged adults. Since that time, public dental service responsibility has been shuttled between States/Territories and the Commonwealth. A new paradigm for public dental services in Australia requires strong Commonwealth leadership, as well as the commitment of State and Territories and the organized dental profession. The National Health and Hospitals Reform Commission provided the most recent scenario for a radical change in mission. This paper canvases the competing roles of strategic, functional, and structural issues in relationship to social network and policy issues, which must be recognized if Australians truly seek to reform public dental services. © 2012 John Wiley & Sons A/S.

  4. The prospects for national health insurance reform.

    PubMed

    Belcher, J R; Palley, H A

    1991-01-01

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

  5. Lessons learned from health sector reform: a four-country comparison.

    PubMed

    Talukder, Md Noorunnabi; Rob, Ubaidur; Mahabub-Ul-Anwar, Md

    Various reforms have been undertaken to improve the functioning of health systems in developing countries, but there is limited comparative analysis of reform initiatives. This article discusses health sector reform experiences of four developing countries and identifies the lessons learned. The article is based on the review of background papers on Bangladesh, Pakistan, Indonesia, and Tanzania prepared as part of a multi-country study on health sector reform. Findings suggest that decentralization works effectively while implementing primary and secondary health programs. Decentralization of power and authority to local authorities requires strengthening and supporting these units. Along with the public sector, the private sector plays an effective role in institutional and human resources development as well as in improving service delivery. Community participation facilitates recruitment and development of field workers, facility improvement, and service delivery. For providing financial protection to the poor, there is a need to review user fees and develop affordable health insurance with an exemption mechanism. There is no uniform health sector reform approach; therefore, the experiences of other countries will help countries undertake appropriate reforms. Here, it is important to examine the context and determine the reform measures that constitute the best means in terms of equity, efficiency, and sustainability.

  6. [The main directions of reforming the service of medical statistics in Ukraine].

    PubMed

    Golubchykov, Mykhailo V; Orlova, Nataliia M; Bielikova, Inna V

    2018-01-01

    Introduction: Implementation of new methods of information support of managerial decision-making should ensure of the effective health system reform and create conditions for improving the quality of operational management, reasonable planning of medical care and increasing the efficiency of the use of system resources. Reforming of Medical Statistics Service of Ukraine should be considered only in the context of the reform of the entire health system. The aim: This work is an analysis of the current situation and justification of the main directions of reforming of Medical Statistics Service of Ukraine. Material and methods: In the work is used a range of methods: content analysis, bibliosemantic, systematic approach. The information base of the research became: WHO strategic and program documents, data of the Medical Statistics Center of the Ministry of Health of Ukraine. Review: The Medical Statistics Service of Ukraine has a completed and effective structure, headed by the State Institution "Medical Statistics Center of the Ministry of Health of Ukraine." This institution reports on behalf of the Ministry of Health of Ukraine to the State Statistical Service of Ukraine, the WHO European Office and other international organizations. An analysis of the current situation showed that to achieve this goal it is necessary: to improve the system of statistical indicators for an adequate assessment of the performance of health institutions, including in the economic aspect; creation of a developed medical and statistical base of administrative territories; change of existing technologies for the formation of information resources; strengthening the material-technical base of the structural units of Medical Statistics Service; improvement of the system of training and retraining of personnel for the service of medical statistics; development of international cooperation in the field of methodology and practice of medical statistics, implementation of internationally

  7. [The main directions of reforming the service of medical statistics in Ukraine].

    PubMed

    Golubchykov, Mykhailo V; Orlova, Nataliia M; Bielikova, Inna V

    Introduction: Implementation of new methods of information support of managerial decision-making should ensure of the effective health system reform and create conditions for improving the quality of operational management, reasonable planning of medical care and increasing the efficiency of the use of system resources. Reforming of Medical Statistics Service of Ukraine should be considered only in the context of the reform of the entire health system. The aim: This work is an analysis of the current situation and justification of the main directions of reforming of Medical Statistics Service of Ukraine. Material and methods: In the work is used a range of methods: content analysis, bibliosemantic, systematic approach. The information base of the research became: WHO strategic and program documents, data of the Medical Statistics Center of the Ministry of Health of Ukraine. Review: The Medical Statistics Service of Ukraine has a completed and effective structure, headed by the State Institution "Medical Statistics Center of the Ministry of Health of Ukraine." This institution reports on behalf of the Ministry of Health of Ukraine to the State Statistical Service of Ukraine, the WHO European Office and other international organizations. An analysis of the current situation showed that to achieve this goal it is necessary: to improve the system of statistical indicators for an adequate assessment of the performance of health institutions, including in the economic aspect; creation of a developed medical and statistical base of administrative territories; change of existing technologies for the formation of information resources; strengthening the material-technical base of the structural units of Medical Statistics Service; improvement of the system of training and retraining of personnel for the service of medical statistics; development of international cooperation in the field of methodology and practice of medical statistics, implementation of internationally

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

    PubMed

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

    2018-05-01

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

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

    PubMed

    Himmelstein, J; Rest, K

    1996-01-01

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

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

    PubMed

    Arredondo, Armando; Orozco, Emanuel

    2008-01-01

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

  11. Implementation of Integrated Service Networks under the Quebec Mental Health Reform: Facilitators and Barriers associated with Different Territorial Profiles.

    PubMed

    Fleury, Marie-Josée; Grenier, Guy; Vallée, Catherine; Aubé, Denise; Farand, Lambert

    2017-03-10

    This study evaluates implementation of the Quebec Mental Health Reform (2005-2015), which promoted the development of integrated service networks, in 11 local service networks organized into four territorial groups according to socio-demographic characteristics and mental health services offered. Data were collected from documents concerning networks; structured questionnaires completed by 90 managers and by 16 respondent-psychiatrists; and semi-structured interviews with 102 network stakeholders. Factors associated with implementation and integration were organized according to: 1) reform characteristics; 2) implementation context; 3) organizational characteristics; and 4) integration strategies. While local networks were in a process of development and expansion, none were fully integrated at the time of the study. Facilitators and barriers to implementation and integration were primarily associated with organizational characteristics. Integration was best achieved in larger networks including a general hospital with a psychiatric department, followed by networks with a psychiatric hospital. Formalized integration strategies such as service agreements, liaison officers, and joint training reduced some barriers to implementation in networks experiencing less favourable conditions. Strategies for the implementation of healthcare reform and integrated service networks should include sustained support and training in best-practices, adequate performance indicators and resources, formalized integration strategies to improve network coordination and suitable initiatives to promote staff retention.

  12. What's happened to Georgia's mental health reform?

    PubMed

    Elliott, R L

    1995-02-01

    In April 1993, Governor Miller signed House Bill (HB) 100, intended to reform Georgia's mental health system. This legislation called for, among other things, the creation of Regional and Community Service Boards designed to empower consumers and families served by the mental health system. This report reviews the rationale behind HB 100 and progress made toward implementing the legislation. Several problems are discussed which may severely impede actual reform, including the system fragmentation created by the new Regional Board system. A proposal is made to further improve Georgia's mental health system by creating a separate Department of Mental Health governed by a Board having significant consumer and family membership, reducing the number of Regional Boards, and developing a system of performance measures to monitor the progress of reform and to improve accountability.

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

    PubMed

    Ho, Sam; Sandy, Lewis G

    2014-05-01

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

  14. [Impact of health care reform on human resources and employment management].

    PubMed

    Brito Quintana, P E

    2000-01-01

    According to those in charge of health sector reform, human resources are the key component of health sector reform processes and offer health services their greatest competitive advantage. With the help of the Observatory for Human Resources within Health Sector Reform promoted by the Pan American Health Organization and other groups, countries of the Region of the Americas have now begun to gather, in a methodical fashion, tangible evidence of the decisive importance of human resources within health sector reform initiatives and particularly of the impact of these initiatives on health personnel. This mutual influence is the main theme of this article, which explores the most disturbing aspects of health sector reform from a human resources perspective, including job instability and conflicting interests of employers and employees.

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

    PubMed Central

    Himmelstein, J; Rest, K

    1996-01-01

    The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies? Images p13-a p14-a p15-a p16-a p18-a p19-a p20-a p22-a p24-a PMID:8610187

  16. Exploring Massachusetts Health Care Reform Impact on Fee-for-Service-Funded Substance Use Disorder Treatment Providers.

    PubMed

    Fields, Dail; Pruett, Jana; Roman, Paul M

    2015-01-01

    The Affordable Care Act (ACA) is forecast to increase the demand for and utilization of substance use disorder (SUD) treatment. Massachusetts implemented health reforms similar to the ACA in 2006-2007 that included expanding coverage for SUD treatment. This study explored the impact of Massachusetts health reforms from 2007 to 2010 on SUD treatment providers in Massachusetts, who relied on fee-for-service billings for more than 50% of their revenue. The changes across treatment facilities located in Massachusetts were compared to changes in other similar fee-for-service-funded SUD treatment providers in Northeast states bordering Massachusetts and in all other states across the US. From 2007-2010, the percentage changes for Massachusetts based providers were significantly different from the changes among providers located in the rest of the US for admissions, outpatient census, average weeks of outpatient treatment, residential/in-patient census, detoxification census, length of average inpatient and outpatient stays, and provision of medication-assisted treatment. Contrary to previous studies of publicly funded treatment providers, the results of this exploratory study of providers dependent on fee-for-service revenues were consistent with some predictions for the overall effects of the ACA.

  17. Managing risk selection incentives in health sector reforms.

    PubMed

    Puig-Junoy, J

    1999-01-01

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

  18. Three periods of health system reforms in the Republic of Macedonia (1991-2011).

    PubMed

    Lazarevik, V; Donev, D; Gudeva Nikovska, D; Kasapinov, B

    2012-01-01

    To investigate, describe and classify main health policies and reform activities within the healthcare system undertaken over the past twenty years in R. Macedonia. Desk research was conducted on scientific literature and relevant documentation (in English and Macedonian) about healthcare reforms. Relevant documents available at the Ministry of Health, Health Insurance Fund, World Bank and World Health Organization were reviewed. Official data on demographic and health status indicators were collected from the Institute of Public Health and the State Statistical Office. A working hypothesis, that the health system reforms were not continuous, was generated following the shifts in decision-making power over allocation of resources and political influences. Our study identified three periods of health system reforms in Macedonia: post-socialistic, pro-market and manifesto-driven. Throughout these periods poor maintenance, low efficiency and high operational costs increased out-of-pocket expenditures for health services and drugs and reflected on the deterioration of public hospital infrastructure. In parallel, liberal healthcare market regulation initiated commercialization of the healthcare services. Disappointed in the quality of healthcare services provided in the public health sector, many citizens opt to ask for services in private health care facilities, where social health insurance largely does not cover the costs. The pace of the reforms is not continuous and the influence of politics is highly visible over the whole period of transition in the Republic of Macedonia. The main problems of the healthcare system in the Republic of Macedonia are politicization of the health sector, high centralization and government control, and poor efficiency of public health institutions. Evaluation framework should be developed to further assess the impact of the health reforms.

  19. Why some market reforms lack legitimacy in health care.

    PubMed

    Laugesen, Miriam

    2005-12-01

    Market-oriented health policy reforms in the 1980s and 1990s generally included five kinds of proposals: increased cost sharing for patients through user fees, the separation of purchaser-provider functions, management reforms of hospitals, provider competition, and vouchers for purchasing health insurance. These policies are partly derived from agency theory and a model of managed competition in health insurance. The essay reviews the course of reform in five countries that had a national health service model in place in the late 1980s: Italy, New Zealand, Spain, Sweden, and the United Kingdom. Special consideration is given to New Zealand, where the market model was extensively adopted but short lived. In New Zealand, surveys and polls are compared to archival records of reformers' deliberations. Voters saw health care differently from elites, and voters particularly felt that health care was ill suited to commercialization. There are similarities across all five countries in what has been adopted and rejected. Some market reforms are more legitimate than others. Reforms based on resolving principal-agent problems, including purchaser-provider splits and managerial reforms, have been more successful, although cost sharing has not. Competition-based reforms in financing and to a lesser extent in provision have not gained legitimacy. Most voters in these countries see health care as different from other parts of the economy and view managerial reforms differently from policies that try to make health care more like other sectors.

  20. The Gateway Paper--context and configuration of the proposed health reforms in Pakistan.

    PubMed

    Nishtar, Sania

    2006-12-01

    As an opening of a dialogue on health reforms in Pakistan, the Gateway Paper presents a viewpoint on its proposed directions making a strong case for systems reforms, which need to scope beyond the healthcare system. Positioning the reform process to strengthen Pakistan's health policy cycle, the paper articulates a roadmap for a paradigm shift to achieve health outcomes in Pakistan with major structural reorganization within the health system. The proposed reform points in the four areas namely, reforms within the health sector, overarching measures, reconfiguration of health within an inter-sectoral scope and generating evidence for reforms. Reforms within the health sector focus on developing new models of service delivery and health financing which can enable the state to leverage the private sector outreach to deliver health-related public goods on the one hand and maximize the outreach of the State's health care delivery mechanisms through mainstreaming the role of the private sector on the other, albeit with safeguards. In addition, these call for strengthening the stewardship role to regulate these arrangements. The second area of reform focuses on overarching measures; these include developing frameworks for public-private partnerships which will enable the bringing together of organizations with the mandate to offer public goods and those that could facilitate this goal through the provision of resources, technical expertise or outreach; mainstreaming health into the country's social protection strategy in order to address issues of access and affordability for the poor and introducing civil service and public service reform focused on good governance, accountability, breakdown of institutional corruption which are critical to improving health outcomes. The third area of reform involves broadening health to its inter-sectoral scope, redefinition of objectives and targets within the health sector and garnering support from across the sectors to forester

  1. Multi-Source, Multi-Level Articulation in the Era of Health Reform: Articulating the Health Sciences to Health Services Administration Baccalaureate Programs.

    ERIC Educational Resources Information Center

    Prager, Carolyn; And Others

    The education and reeducation of health care professionals remain essential, if somewhat neglected, elements in reforming the nation's health care system. The Pew Health Professions Commission (PHPC) has made the reform of health care contingent upon the reform of education, urging educational institutions to design core curricula with…

  2. Where dentistry stands in light of health care reform.

    PubMed

    Collignon, B H

    1994-01-01

    The hot topic from Capitol Hill in Washington to Capitol Hill in Jefferson City is health care reform. President Clinton started the ball rolling during the campaign in 1992 by including health care reform in his platform. He continued the effort after his election by appointing his wife, Hillary, to chair a task force to present an outline for federal legislation. Since the package was presented to Congress, there has been much discussion, lobbying, and rumoring about the implications of health care reform and what it could mean to all of us as dentists. On the home front, Governor Carnahan has introduced legislation in Missouri to reform the health care system. This effort is known as the Missouri Health Assurance Plan (H.B. 1622). Missouri Dental Association members are vitally concerned about the impact of health care reform on their practice, their taxes, their relationship with their patients and employees, and on their ability to seek out health care services since each member is also a consumer of health care. This article represents answers to some of the questions being asked by MDA members in order that they might be more aware of the activities by the MDA, the ADA, and other levels of organized dentistry relating to health care reform.

  3. Back to the market: yet more reform of the National Health Service.

    PubMed

    Lewis, Richard; Gillam, Stephen

    2003-01-01

    Yet more reform of the National Health Service in England has been announced by the Department of Health. In opposition, the Labour Party criticized the creation of an "internal market" for health care by the Conservative government, but five years into the Blair administration, market incentives are to be reinvigorated and the private sector is to be embraced in ways not seen hitherto. New guidance signals the introduction of competitive contracting using cost-per-case currencies, more choice for patients in where they will receive hospital treatment, and the freeing of NHS care providers from the direct political control of ministers. It is intended that the monopolistic features of the NHS in England should give way to greater pluralism, in particular through contracts with privately owned health care organizations. However, there is little evidence to suggest that these policies will be effective, and a number of practical problems may obstruct implementation.

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

    PubMed

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

    2015-03-28

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

  5. Rural health care in Vietnam and China: conflict between market reforms and social need.

    PubMed

    Huong, Dang Boi; Phuong, Nguyen Khanh; Bales, Sarah; Jiaying, Chen; Lucas, Henry; Segall, Malcolm

    2007-01-01

    China and Vietnam have adopted market reforms in the health sector in the context of market economic reforms. Vietnam has developed a large private health sector, while in China commercialization has occurred mainly in the formal public sector, where user fees are now the main source of facility finance. As a result, the integrity of China's planned health service has been disrupted, especially in poor rural areas. In Vietnam the government has been an important financer of public health facilities and the pre-reform health service is largely intact, although user fees finance an increasing share of facility expenditure. Over-servicing of patients to generate revenue occurs in both countries, but more seriously in China. In both countries government health expenditure has declined as a share of total health expenditure and total government expenditure, while out-of-pocket health spending has become the main form of health finance. This has particularly affected the rural poor, deterring them from accessing health care. Assistance for the poor to meet public-sector user fees is more beneficial and widespread in Vietnam than China. China is now criticizing the degree of commercialization of its health system and considers its health reforms "basically unsuccessful." Market reforms that stimulate growth in the economy are not appropriate to reform of social sectors such as health.

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

    PubMed Central

    Cockcroft, Anne; Andersson, Neil; Milne, Deborah; Hossain, Md Zakir; Karim, Enamul

    2007-01-01

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

  7. The Impact of State Behavioral Health Reform on Native American Individuals, Families, and Communities

    PubMed Central

    Willging, Cathleen E.; Goodkind, Jessica; Lamphere, Louise; Saul, Gwendolyn; Fluder, Shannon; Seanez, Paula

    2012-01-01

    In 2005, the State of New Mexico undertook a sweeping transformation of all publicly funded behavioral health services. The reform was intended to enhance the cultural responsiveness and appropriateness of these services. To examine achievement of this objective, we conducted a qualitative study of the involvement of Native Americans in reform efforts and the subsequent impacts of reform on services for Native Americans. We found that the reform was relatively unsuccessful at creating mechanisms for genuine community input or improving behavioral health care for this population. These shortcomings were related to limited understandings of administrators concerning how tribal governments and health care systems operate, and the structural limitations of a managed care system that does not allow flexibility for culturally appropriate utilization review, screening, or treatment. However, interaction between the State and tribes increased, and we conclude that aspects of the reform could be strengthened to achieve more meaningful involvement and service improvements. PMID:22427455

  8. The impact of state behavioral health reform on Native American individuals, families, and communities.

    PubMed

    Willging, Cathleen E; Goodkind, Jessica; Lamphere, Louise; Saul, Gwendolyn; Fluder, Shannon; Seanez, Paula

    2012-07-01

    In 2005, the State of New Mexico undertook a sweeping transformation of all publicly funded behavioral health services. The reform was intended to enhance the cultural responsiveness and appropriateness of these services. To examine achievement of this objective, we conducted a qualitative study of the involvement of Native Americans in reform efforts and the subsequent impacts of reform on services for Native Americans. We found that the reform was relatively unsuccessful at creating mechanisms for genuine community input or improving behavioral health care for this population. These shortcomings were related to limited understandings of administrators concerning how tribal governments and health care systems operate, and the structural limitations of a managed care system that does not allow flexibility for culturally appropriate utilization review, screening, or treatment. However, interaction between the State and tribes increased, and we conclude that aspects of the reform could be strengthened to achieve more meaningful involvement and service improvements.

  9. Early appraisal of China's huge and complex health-care reforms.

    PubMed

    Yip, Winnie Chi-Man; Hsiao, William C; Chen, Wen; Hu, Shanlian; Ma, Jin; Maynard, Alan

    2012-03-03

    China's 3 year, CN¥850 billion (US$125 billion) reform plan, launched in 2009, marked the first phase towards achieving comprehensive universal health coverage by 2020. The government's undertaking of systemic reform and its affirmation of its role in financing health care together with priorities for prevention, primary care, and redistribution of finance and human resources to poor regions are positive developments. Accomplishing nearly universal insurance coverage in such a short time is commendable. However, transformation of money and insurance coverage into cost-effective services is difficult when delivery of health care is hindered by waste, inefficiencies, poor quality of services, and scarcity and maldistribution of the qualified workforce. China must reform its incentive structures for providers, improve governance of public hospitals, and institute a stronger regulatory system, but these changes have been slowed by opposition from stakeholders and lack of implementation capacity. The pace of reform should be moderated to allow service providers to develop absorptive capacity. Independent, outcome-based monitoring and evaluation by a third-party are essential for mid-course correction of the plans and to make officials and providers accountable. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

    PubMed

    Sang, Shuping; Wang, Zhenkun; Yu, Chuanhua

    2014-02-21

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

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

    PubMed

    Biscaia, André Rosa; Heleno, Liliana Correia Valente

    2017-03-01

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

  12. Immigration and health care reform: shared struggles.

    PubMed

    Gardner, Deborah B

    2007-01-01

    The connection between health care and immigration share overlaping key areas in policy reform. General concern, anger, and fear about immigration has been spreading nationwide. While illegal immigrants' use of expensive emergency department services does add to the cost for uncompensated care, this expenditure is not a primary cost driver but more a symptom of little or no access to preventative or primary health care. As a result of federal inaction, more state politicians are redefining how America copes with illegal residents including how or whether they have access to health care. The overlap of immigration and health care reform offers an opportunity for us to enter the next round of debate from a more informed vantage point.

  13. Prevention in Poland: health care system reform.

    PubMed Central

    Sheahan, M D

    1995-01-01

    Despite the political and economic reforms that have swept Eastern Europe in the past 5 years, there has been little change in Poland's health care system. The Ministry of Health and Social Welfare has targeted preventive care as a priority, yet the enactment of legislation to meet this goal has been slow. The process of reform has been hindered by political stagnation, economic crisis, and a lack of delineation of responsibility for implementing the reforms. Despite the delays in reform, recent developments indicate that a realistic, sustainable restructuring of the health care system is possible, with a focus on preventive services. Recent proposals for change have centered on applying national goals to limited geographic areas, with both local and international support. Regional pilot projects to restructure health care delivery at a community level, local health education and disease prevention initiatives, and a national training program for primary care and family physicians and nurses are being planned. Through regionalization, an increase in responsibility for both the physician and the patient, and redefinition of primary health care and the role of family physicians, isolated local movements and pilot projects have shown promise in achieving these goals, even under the current budgetary constraints. PMID:7610217

  14. Prevention in Poland: health care system reform.

    PubMed

    Sheahan, M D

    1995-01-01

    Despite the political and economic reforms that have swept Eastern Europe in the past 5 years, there has been little change in Poland's health care system. The Ministry of Health and Social Welfare has targeted preventive care as a priority, yet the enactment of legislation to meet this goal has been slow. The process of reform has been hindered by political stagnation, economic crisis, and a lack of delineation of responsibility for implementing the reforms. Despite the delays in reform, recent developments indicate that a realistic, sustainable restructuring of the health care system is possible, with a focus on preventive services. Recent proposals for change have centered on applying national goals to limited geographic areas, with both local and international support. Regional pilot projects to restructure health care delivery at a community level, local health education and disease prevention initiatives, and a national training program for primary care and family physicians and nurses are being planned. Through regionalization, an increase in responsibility for both the physician and the patient, and redefinition of primary health care and the role of family physicians, isolated local movements and pilot projects have shown promise in achieving these goals, even under the current budgetary constraints.

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

    PubMed

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

    2018-02-01

    This brief report explores the impact of health reform for people with mental illness. The Health Reform Monitoring Survey was used to examine health insurance, access to care, and employment for 1,550 people with mental health conditions pre- and postimplementation of the Affordable Care Act (ACA) and by state Medicaid expansion status. Multivariate logistic regressions with predictive margins were used. Post-ACA reforms, people with mental health conditions were less likely to be uninsured (5% versus 13%; t=-6.89, df=50, p<.001) and to report unmet need due to cost of mental health care (17% versus 21%; t=-3.16, df=50, p=.002) and any health services (46% versus 51%; t=-3.71, df=50, p<.001), and they were more likely to report a usual source of care (82% versus 76%; t=3.11, df=50, p=.002). These effects were experienced in both Medicaid expansion and nonexpansion states. Findings underscore the importance of ACA improvements in the quality of health insurance coverage.

  16. Family planning and sexual health organizations: management lessons for health system reform.

    PubMed

    Ambegaokar, Maia; Lush, Louisiana

    2004-10-01

    Advocates of health system reform are calling for, among other things, decentralized, autonomous managerial and financial control, use of contracting and incentives, and a greater reliance on market mechanisms in the delivery of health services. The family planning and sexual health (FP&SH) sector already has experience of these. In this paper, we set forth three typical means of service provision within the FP&SH sector since the mid-1900s: independent not-for-profit providers, vertical government programmes and social marketing programmes. In each case, we present the context within which the service delivery mechanism evolved, the management techniques that characterize it and the lessons learned in FP&SH that are applicable to the wider debate about improving health sector management. We conclude that the FP&SH sector can provide both positive and negative lessons in the areas of autonomous management, use of incentives to providers and acceptors, balancing of centralization against decentralization, and employing private sector marketing and distribution techniques for delivering health services. This experience has not been adequately acknowledged in the debates about how to improve the quality and quantity of health services for the poor in developing countries. Health sector reform advocates and FP&SH advocates should collaborate within countries and regions to apply these management lessons. Copyright 2004 Oxford University Press

  17. Primary care and reform of health systems: a framework for the analysis of Latin American experiences.

    PubMed

    Frenk, J; González-Block, M A

    1992-03-01

    The article first proposes a framework within which to assess the potential of health sector reforms in Latin America for primary health care (PHC). Two dimensions are recognized: the scope of the reforms, content, and the means of participation that are put into play. This framework is then complemented through a critique of the often-sought but little-analyzed PHC reform strategies of decentralization and health sector integration. The analytical framework is next directed to the financing of health services, a chief aspect of any reform aiming toward PHC. Two facets of health service finance are first distinguished: its formal aspect as a means for economic subsistence and growth, and its substantive aspect as a means to promote the rational use of services and thus improvement of health. Once finance is understood in this microeconomic perspective, the focus shifts to the analysis of health care reforms at the macro, health policy level. The article concludes by positing that PHC is in essence a new health care paradigm, oriented by the values of universality, redistribution, integration, plurality, quality, and efficiency.

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

    PubMed

    Malo-Serrano, Miguel; Malo-Corral, Nicolás

    2014-01-01

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

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

    PubMed

    Gómez-Arias, Rubén Darío; Nieto, Emmanuel

    2014-01-01

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

  20. Health insurance coverage and use of family planning services among current and former foster youth: implications of the health care reform law.

    PubMed

    Dworsky, Amy; Ahrens, Kym; Courtney, Mark

    2013-04-01

    This research uses data from a longitudinal study to examine how two provisions in the Patient Protection and Affordable Care Act could affect health insurance coverage among young women who have aged out of foster care. It also explores how allowing young people to remain in foster care until age twenty-one affects their health insurance coverage, use of family planning services, and information about birth control. We find that young women are more likely to have health insurance if they remain in foster care until their twenty-first birthday and that having health insurance is associated with an increase in the likelihood of receiving family planning services. Our results also suggest that many young women who would otherwise lack health insurance after aging out of foster care will be eligible for Medicaid under the health care reform law. Because having health insurance is associated with use of family planning services, this increase in Medicaid eligibility may result in fewer unintended pregnancies among this high-risk population.

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

    PubMed

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

    2015-10-24

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

  2. Managing between the agendas: implementing health care reform policy in an acute care hospital.

    PubMed

    Sorensen, Roslyn; Paull, Glenn; Magann, Linda; Davis, JanMaree

    2013-01-01

    This paper aims to assess administrative and clinical manager stances on health system reform. Understanding these stances will help to identify cultural differences and competing agendas between these two key health service stakeholders and contribute to developing strategies to improve organisational performance. A qualitative methodology was used comprising in-depth open-ended interviews conducted in 2007 with 26 administrative and clinical managers who managed clinical units. This paper provides empirical insights into the ways that administrative and clinical mangers conceive of their managerial roles in relation to health care reform and performance improvement in health services. The findings suggest that developing a hybrid clinical manager culture as a means to bridge the gap between administrative and clinical manager stances on reform objectives, while possible, is not yet being realised. The research has relevance for health services that are experiencing organisational transformation. However, its location in one health service limits the generalisability of findings to other sites. Further research is needed to assess the opportunities for a hybrid culture to emerge as well as its effect. While attention is predominantly directed to clinician groups as a key stakeholder in implementing health reform policies, this paper has implications for how administrative managers also structure their roles and responsibilities to create an organisational climate conducive to change. This will include strategies to support clinical managers to make the transition from a predominantly clinical, to a clinical managerial, orientation. This paper addresses a significant problem in health service governance, namely the divide between the value stances of dual hierarchies. This problem is only now gaining prominence as a significant barrier to health reform.

  3. Dental attendance among adult Finns after a major oral health care reform.

    PubMed

    Raittio, Eero; Kiiskinen, Urpo; Helminen, Sari; Aromaa, Arpo; Suominen, Anna Liisa

    2014-12-01

    Between 2001 and 2002, all age limits restricting the availability of subsidized private dental care and Public Dental Services (PDS) were abolished in Finland. In addition, the reform aimed to address income- and residence-related disparities in access to subsidized oral health care services. The aim of this study was to analyse how dental attendance and factors associated with it changed after the reform. We carried out three consecutive surveys on the use of oral health care services and perceived oral health. The surveys were conducted in 2001 (n = 2837), in 2004 (n = 2420) and in 2007 (n = 2296), and the study population comprised Finnish adults born in 1970 or earlier. Logistic regression analyses were used to examine factors associated with the use of the services. The percentage of respondents who attended dental care regularly or had used oral health care services over the past 12 months rose between 2001 and 2007. In particular, there was an increase in the proportion of subjects who used PDS. The average number of visits to a private dentist decreased between 2001 and 2007. In the regression analyses, the use of services was associated with older age, perceived lack of need for care, perceived toothache during the past 12 months, perceived good oral health, lower number of missing teeth and regular dental visiting habits. The use of private dental care services was associated with perceived good oral health and perceived lack of need for care, higher household income and older age in all three study years while the use of PDS was associated with younger age, perceived good oral health and perceived lack of need for care only in 2001. The use of oral health care services rose and age did not seem to be a barrier to the use of oral health care services after the reform, as was the aim of the reform. No change in the association of household income with the use of oral health care services was seen after the OHCR. © 2014 John Wiley & Sons A

  4. Do health care reforms in Turkey have a significant effect in equal access to maternal and child health services in Turkey: An evidence from 20 years.

    PubMed

    Santas, Fatih; Celik, Yusuf; Eryurt, Mehmet Ali

    2018-01-01

    This study aimed to investigate whether there was an improvement in the equitable access to maternal and child health care services by examining the effects of socioeconomic and individual factors in Turkey from 1993 to 2013 and determine the effectiveness of health care reforms implemented mainly under the Health Transformation Program since 2003 on equitable access t;o maternal and child health care services in terms of years. The study used nationally representative 5 Turkey Demographic and Health Surveys (1993, 1998, 2003, 2008, and 2013). Prenatal care utilization rate increased from 67.0% in 1993 to 96.2% in 2013 while the rate of women giving birth at health care facilities increased from 63.8% to 98.1% in 2013. Prenatal care utilization and giving birth at health care facilities were higher among women who were under health insurance coverage, first time mothers, those staying in the western region and urban areas, and those with the highest level of wealth. The findings suggest that the issue of equity in the utilization of maternal and child health care services exists in Turkey, and the latest health care reforms under HTP are not effective in diminishing the effect of wealth. Copyright © 2017 John Wiley & Sons, Ltd.

  5. Are joint health plans effective for coordination of health services? An analysis based on theory and Danish pre-reform results

    PubMed Central

    Strandberg-Larsen, Martin; Bernt Nielsen, Mikkel; Krasnik, Allan

    2007-01-01

    Background Since 1994 formal health plans have been used for coordination of health care services between the regional and local level in Denmark. From 2007 a substantial reform has changed the administrative boundaries of the system and a new tool for coordination has been introduced. Purpose To assess the use of the pre-reform health plans as a tool for strengthening coordination, quality and preventive efforts between the regional and local level of health care. Methods A survey addressed to: all counties (n=15), all municipalities (n=271) and a randomised selected sample of general practitioners (n=700). Results The stakeholders at the administrative level agree that health plans have not been effective as a tool for coordination. The development of health plans are dominated by the regional level. At the functional level 27 percent of the general practitioners are not familiar with health plans. Among those familiar with health plans 61 percent report that health plans influence their work to only a lesser degree or not at all. Conclusion Joint health planning is needed to achieve coordination of care. Efforts must be made to overcome barriers hampering efficient whole system planning. Active policies emphasising the necessity of health planning, despite involved cost, are warranted to insure delivery of care that benefits the health of the population. PMID:17925882

  6. Effect of primary health care reforms in Turkey on health service utilization and user satisfaction.

    PubMed

    Hone, Thomas; Gurol-Urganci, Ipek; Millett, Christopher; Başara, Berrak; Akdağ, Recep; Atun, Rifat

    2017-02-01

    Strengthening primary health care (PHC) is considered a priority for efficient and responsive health systems, but empirical evidence from low- and middle-income countries is limited. The stepwise introduction of family medicine across all 81 provinces of Turkey (a middle-income country) between 2005 and 2010, aimed at PHC strengthening, presents a natural experiment for assessing the effect of family medicine on health service utilization and user satisfaction.The effect of health system reforms, that introduced family medicine, on utilization was assessed using longitudinal, province-level data for 12 years and multivariate regression models adjusting for supply-side variables, demographics, socio-economic development and underlying yearly trends. User satisfaction with primary and secondary care services was explored using data from annual Life Satisfaction Surveys. Trends in preferred first point of contact (primary vs secondary, public vs. private), reason for choice and health services issues, were described and stratified by patient characteristics, provider type, and rural/urban settings.Between 2002 and 2013, the average number of PHC consultations increased from 1.75 to 2.83 per person per year. In multivariate models, family medicine introduction was associated with an increase of 0.37 PHC consultations per person (P < 0.001), and slower annual growth in PHC and secondary care consultations. Following family medicine introduction, the growth of PHC and secondary care consultations per person was 0.08 and 0.30, respectively, a year. PHC increased as preferred provider by 9.5% over 7 years with the reasons of proximity and service satisfaction, which increased by 14.9% and 11.8%, respectively. Reporting of poor facility hygiene, difficulty getting an appointment, poor physician behaviour and high costs of health care all declined (P < 0.001) in PHC settings, but remained higher among urban, low-income and working-age populations. © The Author 2016

  7. [Psychiatric care act of Ukraine and issues concerning reformation of the mental health protection service].

    PubMed

    Moskalenko, V F; Gorban', E N; Tabachnikov, S I; Syropiatov, O G; Shtengelov, V V

    2000-01-01

    An analysis was performed of the conception and content of a new Psychiatric Care Act by making a comparison with data from published literature and the present-day status of the mental health protection service. The main features of the crisis of psychiatry in Ukraine are characterized together with possible ways of resolving it. Main trends in reformation of the psychiatric service are identified that are to be secured by relevant acts of departmental and interdepartmental character based on law. Priority is emphasized to defence of the patients' rights and liberties together with a need for a guarantee of a highly skilled medical care to be provided for mental patients.

  8. The effects of the Norwegian Coordination Reform on the use of rehabilitation services: panel data analyses of service use, 2010 to 2013.

    PubMed

    Monkerud, Lars C; Tjerbo, Trond

    2016-08-05

    In 2012 the Norwegian Coordination Reform was implemented. The main motivation was to encourage municipalities to expand local, primary health care services. From 2012 to 2014, under the Municipal Co-Financing regime, municipalities were obliged to cover 20 % of the costs of health services provided at the specialist (hospital) level. Importantly, use of rehabilitation services in private institutions was not part of the cost-sharing mechanism of Municipal Co-Financing. Rehabilitation services may be seen as quite similar in nature whether they be provided by municipalities, hospitals or private institutions. Thus, with rehabilitation patients readily "transferrable" between levels, the question is whether the reform brought with it a sought after shift towards more municipal rehabilitation and less specialist rehabilitation. Data from the Norwegian Patient Register and from Statistics Norway/KOSTRA were utilized to gauge annual expenditures and inputs in specialist, municipal and private institution rehabilitation services respectively. Fixed effects and first difference regression analyses for the period 2010-2013 were carried out to account for certain time-invariant traits of municipalities and/or hospital regions, and results were adjusted for contemporaneous trends in local needs. Expenditures in specialist rehabilitation services declined sharply (typically by 8-10 %) from 2011 (pre-reform) to 2012 (post-reform), while expenditures in private rehabilitation services rose markedly in the same period (typically by 42-44 %). The results do not suggest any general expansion of municipal rehabilitation services. The results of the analyses suggest that municipalities shift away from the use of specialist rehabilitation services and towards the use of rehabilitation services in private institutions since the latter becomes relatively cheaper (free-of charge) than both municipal and specialist services in post-reform periods (as specialist services come at a cost

  9. Health sector reforms in Argentina and the performance of the health financing system.

    PubMed

    Cavagnero, Eleonora

    2008-10-01

    In Argentina, health sector reforms put particular emphasis on decentralization and self-management of the tax-funded health sector, and the restructuring of the social health insurance during the 1990s. Unlike other countries in the region, there was no comprehensive plan to reform and unify the sector. In order to assess the effects of the reforms on the performance of the health financing system, this study looks at impacts on the three inter-related functions of revenue collection, pooling, and purchasing/provision of health services. Data from various sources are used to illustrate the findings. It was found that the introduction of cost recovery by self-managed hospitals increased their budgets only marginally and competition among social health insurance funds did not reduce fragmentation as expected. Although reforming the Solidarity Redistribution Fund and implementing a single basic package for the insured was an important step towards equity and transparency, the extent of risk pooling is still very limited. This study also provides recommendations regarding strengthening reimbursement mechanisms for public hospitals, and regulating the private sector as approaches to improving the fairness of the health financing system and protecting people from financial hardship as a result of illness.

  10. Health reform and shifts in funding for sexually transmitted infection services.

    PubMed

    Drainoni, Mari-Lynn; Sullivan, Meg; Sequeira, Shwetha; Bacic, Janine; Hsu, Katherine

    2014-07-01

    In the Affordable Care Act era, no-cost-to-patient publicly funded sexually transmitted infection (STI) clinics have been challenged as the standard STI care delivery model. This study examined the impact of removing public funding and instituting a flat fee within an STI clinic under state-mandated insurance coverage. Cross-sectional database analysis examined changes in visit volumes, demographics, and payer mix for 4 locations in Massachusetts' largest safety net hospital (STI clinic, primary care [PC], emergency department [ED], obstetrics/gynecology [OB/GYN] for 3 periods: early health reform implementation, reform fully implemented but public STI clinic funding retained, termination of public funding and institution of a US$75 fee in STI clinic for those not using insurance). Sexually transmitted infection visits decreased 20% in STI clinic (P < 0.001), increased 107% in PC (P < 0.001), slightly decreased in ED, and did not change in OB/GYN. The only large demographic shift observed was in the sex of PC patients--women comprised 51% of PC patients seen for STI care in the first time period, but rose sharply to 70% in the third time period (P < 0.0001). After termination of public funding, 50% of STI clinic patients paid flat fee, 35% used public insurance, and 15% used private insurance. Mandatory insurance, public funding loss, and institution of a flat STI clinic fee were associated with overall decreases in STI visit volume, with significant STI clinic visit decreases and PC STI visit increases. This may indicate partial shifting of STI services into PC. Half of STI clinic patients chose to pay the flat fee even after reform was fully implemented.

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

    PubMed

    Haddad, Slim; Nougtara, Adrien; Fournier, Pierre

    2006-12-01

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

  12. Health reform and out-of-pocket payments: lessons from China.

    PubMed

    Zhang, Lufa; Liu, Nan

    2014-03-01

    China's ongoing new health reform aims to reduce individual out-of-pocket (OOP) payments for healthcare services. The aim of this article is to analyse the impact of this reform and to draw policy implications. Data are retrieved from the relevant government publications. Polynomial regression models are used to predict future health expenditures. An extensive sensitivity analysis is conducted to investigate the ratios of OOP payments to the total health expenditures (THEs) and to the disposable personal income (DPI) for 2009-11 under different scenarios of cost projections and personal income distributions. Both quantitative and qualitative analyses are carried out to draw conclusions. The ratios of OOP payments to THE and DPI vary significantly across scenarios tested. Only if all committed government investments and social health expenditure are realized can China's new health reform reduce both ratios and achieve its target goals. In particular, the ratio of OOP payments to DPI can also be significantly reduced by improving income distribution. Due to the complicated interplay among different cost components in health expenditures, these two ratios may not change in the same direction, indicating that both need to be examined when evaluating the reform. The new health reform in China aims to alleviate the high OOP payments for healthcare services, but it has not yet been able to reduce both OOP-to-THE and OOP-to-DPI ratios simultaneously. Major reasons include (1) inability of local governments to fulfil their responsible investments due to health finance decentralization and uneven economic development in China and (2) a serious cost inflation in health expenditures coupled with a low level of income distribution. It is suggested that the central government should bear more financial responsibility and assist local governments to fully invest, and should improve individual incomes, in particular for the poor.

  13. Patients' rights to care under Clinton's Health Security Act: the structure of reform.

    PubMed Central

    Mariner, W K

    1994-01-01

    Like most reform proposals, President Clinton's proposed Health Security Act offers universal access to care but does not significantly alter the nature of patients' legal rights to services. The act would create a system of delegated federal regulation in which the states would act like federal administrative agencies to carry out reform. To achieve uniform, universal coverage, the act would establish a form of mandatory health insurance, with federal law controlling the minimum services to which everyone would be entitled. Because there is no constitutionally protected right to health care and no independent constitutional standard for judging what insurance benefits are appropriate, the federal government would retain considerable freedom to decide what services would and would not be covered. If specific benefits are necessary for patients, they will have to be stated in the legislation that produces reform. PMID:8059899

  14. Reforming health care financing in Bulgaria: the population perspective.

    PubMed

    Balabanova, Dina; McKee, Martin

    2004-02-01

    Health financing reform in Bulgaria has been characterised by lack of political consensus on reform direction, economic shocks, and, since 1998, steps towards social insurance. As in other eastern European countries, the reform has been driven by an imperative to embrace new ideas modelled on systems elsewhere, but with little attention to whether these reflect popular values. This study explores underlying values, such as views on the role of the state and solidarity, attitudes to, and understanding of compulsory and voluntary insurance, and co-payments. The study identifies general principles (equity, transparency) considered important by the population and practical aspects of implementation of reform. Data were obtained from a representative survey (n=1547) and from 58 in-depth interviews and 6 focus groups with users and health professionals, conducted in 1997 before the actual reform of the health financing system in Bulgaria. A majority supports significant state involvement in health care financing, ranging from providing safety net for the poor, through co-subsidising or regulating the social insurance system, to providing state-financed universal free care (half of all respondents). Collectivist values in Bulgaria remain strong, with support for free access to services regardless of income, age, or health status and progressive funding. There is strong support (especially among the well off) for a social insurance system based on the principle of solidarity and accountability rather than the former tax-based model. The preferred health insurance fund was autonomous, state regulated, financing only health care, and offering optional membership. Voluntary insurance and, less so, co-payments were acceptable if limited to selected services and better off groups. In conclusion, a health financing system under public control that fits well with values and population preferences is likely to improve compliance and be more sustainable. Universal health insurance

  15. Health care reforms.

    PubMed

    Marušič, Dorjan; Prevolnik Rupel, Valentina

    2016-09-01

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

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

    PubMed

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

    2017-12-01

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

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

    PubMed

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

    2002-04-01

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

  18. Health reform: setting the agenda for long term care.

    PubMed

    Hatch, O G; Wofford, H; Willging, P R; Pomeroy, E

    1993-06-01

    The White House Task Force on National Health Care Reform, headed by First Lady Hillary Rodham Clinton, is expected to release its prescription for health care reform this month. From the outset, Clinton's mandate was clear: to provide universal coverage while reining in costs for delivering quality health care. Before President Clinton was even sworn into office, he had outlined the major principles that would shape the health reform debate. Global budgeting would establish limits on all health care expenditures, thereby containing health costs. Under a system of managed competition, employers would form health alliances for consumers to negotiate for cost-effective health care at the community level. So far, a basic approach to health care reform has emerged. A key element is universal coverage--with an emphasis on acute, preventive, and mental health care. Other likely pieces are employer-employee contributions to health care plans, laws that guarantee continued coverage if an individual changes jobs or becomes ill, and health insurance alliances that would help assure individual access to low-cost health care. What still is not clear is the extent to which long term care will be included in the basic benefits package. A confidential report circulated by the task force last month includes four options for long term care: incremental Medicaid reform; a new federal/state program to replace Medicaid; a social insurance program for home and community-based services; or full social insurance for long term care. Some work group members have identified an additional option: prefunded long term care insurance.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Health Insurance Coverage and Use of Family Planning Services among Current and Former Foster Youth: Implications of the Health Care Reform Law

    PubMed Central

    Dworsky, Amy; Ahrens, Kym; Courtney, Mark

    2013-01-01

    This research uses data from a longitudinal study to examine how two provisions in the Patient Protection and Affordable Care Act could affect health insurance coverage among young women who have aged out of foster care. It also explores how allowing young people to remain in foster care until age twenty-one affects their health insurance coverage, use of family planning services, and information about birth control. We find that young women are more likely to have health insurance if they remain in foster care until their twenty-first birthday and that having health insurance is associated with an increase in the likelihood of receiving family planning services. Our results also suggest that many young women who would otherwise lack health insurance after aging out of foster care will be eligible for Medicaid under the health care reform law. Because having health insurance is associated with use of family planning services, this increase in Medicaid eligibility may result in fewer unintended pregnancies among this high-risk population. PMID:23262773

  20. Health care reform 2010: a fresh view on tort reform.

    PubMed

    Stimson, C J; Dmochowski, Roger; Penson, David F

    2010-11-01

    We reviewed the state of medical malpractice tort reform in the context of a new political climate and the current debate over comprehensive health care reform. Specifically we asked whether medical malpractice tort reform is necessary, and evaluated the strengths and weaknesses of contemporary reform proposals. The medical, legal and public policy literature related to medical malpractice tort reform was reviewed and synthesized. We include a primer for understanding the current structure of medical malpractice law, identify the goals of the current system and analyze whether these goals are presently being met. Finally, we describe and evaluate the strengths and weaknesses of the current reform proposals including caps on damages, safe harbors and health care courts. Medical malpractice tort law is designed to improve health care quality and appropriately compensate patients for medical malpractice injuries, but is failing on both fronts. Of the 3 proposed remedies, caps on damages do little to advance the quality and compensatory goals, while safe harbors and health care courts represent important advancements in tort reform. Tort reform should be included in the current health policy debate because the current medical malpractice system is not adequately achieving the basic goals of tort law. While safe harbors and health care courts both represent reasonable remedies, health care courts may be preferred because they do not rely on jury determination in the absence of strong medical evidence. Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  1. Health system reform.

    PubMed

    Ortolon, Ken

    2009-06-01

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

  2. Unpacking "Health Reform" and "Policy Capacity": Comment on "Health Reform Requires Policy Capacity".

    PubMed

    Legge, David; Gleeson, Deborah H

    2015-07-20

    Health reform is the outcome of dispersed policy initiatives in different sectors, at different levels and across time. Policy work which can drive coherent health reform needs to operate across the governance structures as well as the institutions that comprise healthcare systems. Building policy capacity to support health reform calls for clarity regarding the nature of such policy work and the elements of policy capacity involved; and for evidence regarding effective strategies for capacity building. © 2015 by Kerman University of Medical Sciences.

  3. Implementing Health Financing Reforms in Africa: Perspectives of Health System Stewards.

    PubMed

    Achoki, Tom; Lesego, Abaleng

    A majority of health systems in the sub-Saharan Africa region are faced with multiple competing priorities amid pressing resource constraints. Health financing reforms, characterized by expansion of health insurance coverage, have been proposed as promising in the quest to improve health sustainably. However, in many countries where these measures are being attempted, their broader implications have not been fully appreciated. This study was based on perspectives of 37 health system stewards from Botswana who were interviewed in order to understand opportunities and challenges that would result in the quest to expand health insurance coverage in the country. Thematic synthesis of their perspectives, focusing on the key aspects of the health systems, was done in order to draw informative lessons that could be applicable to a broader set of low- and middle-income countries. Health systems attempting to expand health insurance coverage would be faced with various opportunities and challenges that have implications on performance. By increasing the pool of resources available to spend on health, health insurance would afford health systems the opportunity to increase population access to and use of health services. However, if unchecked, this could also translate to uncontrolled demand for expensive medicines and other health technologies, leading to cost escalation and inefficiencies within the system. Therefore, the success of any health financing reform is dependent on embracing sound policies, regulations, and accountability measures. Health financing reforms have broader implications to health system performance that should be fully appreciated and anticipated before implementation. Therefore, health system leaders who are keen to improve health must view any health financing reforms through the broader framework of the health system framework in order to make progress. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  4. Reviewing and reforming policy in health enterprise information security

    NASA Astrophysics Data System (ADS)

    Sostrom, Kristen; Collmann, Jeff R.

    2001-08-01

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

  5. Draft Clinton health reform proposal is circulated as alternatives surface.

    PubMed

    1993-09-20

    A brief summary is provided of the Clinton draft health reform proposal (a 240-page draft outline) that predated the presidential address before Congress on September 22, 1993, and the complete health reform plan. Hillary Rodham Clinton will present a statement before the Senate Finance Committee and the Labor and Human Resources Committee on September 28, as the chairperson of the President's Task Force on Health Care Reform. Top policy aide Ira Magaziner believes that a coalition of moderate Republicans, liberal Democrats, and moderate Democrats will be to pass the bill. Observers see the battle as one of the most difficult for the Clinton administration. The outlined plan would require employers to pay about 80% of health insurance coverage for their employees, including part-time workers and their dependents. Families would pay the remaining 20%. All individuals would be covered, and special subsidies would be available for those under a specified income threshold. Regional health alliances would mediate between consumer and health plans. Premiums would be paid to the alliances, which would have a discrete geographic territory. Alliances would negotiate with health insurance companies for the best care at the lowest prices. Preexisting medical conditions would not prevent coverage. A standard benefit package would be provided and there would be comparability across plans. For instance, covered care would include hospital care, physician and health professional services, clinical preventive services, mental health and substance abuse, family planning services, pregnancy-related services, and drugs. Prevention coverage would include prenatal and well-baby care and routine physical examinations, and reproductive health service procedures such as mammogram and pelvic examinations. Family planning and pregnancy-related services were not defined, and although contraceptive pills would be covered as prescriptions, it is unclear whether diaphragms or IUDs would be

  6. The reorientation of market-oriented reforms in Swedish health-care.

    PubMed

    Harrison, M I; Calltorp, J

    2000-01-01

    Sweden was an important pioneer of market-oriented reform in publicly funded health-care systems. Yet by the mid-1990s the county councils, which fund and manage most health-care, had substantially scaled back reforms based on provider competition while continuing to constrain health budgets. As policy makers faced new issues, they turned increasingly to longer-term and more cooperative contracts to define relations between hospitals and the county councils. Growing regionalization of government and hospital mergers further reconfigured acute care and limited opportunities for competition between hospitals. We seek to explain this reorientation of market-oriented reforms between 1989 and 1996 in terms of shifts in the positions taken by powerful policy actors, and in particular by county council politicians. During this period, elections moved liberal and conservative politicians, who were the most enthusiastic supporters of market-oriented reform, in and out of control of most county governments. Meanwhile many Social Democratic politicians gradually turned from initial support of competitive reform toward opposition. Politicians and county administrators from all parties were particularly concerned about controlling health expenditures during a period of recession. In addition, the public, politicians in the counties and municipalities, and health professionals resisted steps that threatened health sector employment and would have allowed market mechanisms, rather than governments, to determine the prices and distribution of health services. During the years under study Sweden's market-oriented reforms followed a course of development similar to that taken by other management and policy fashions (Abrahamson E. Management fashion, Academy of Management Review 1996;21: 254-85). At first the reforms enjoyed uncritical support by a broad spectrum of stakeholders. Gradually participants in the reform process recognized inherent tensions among the goals of the reform

  7. Health Sector Reform and Social Determinants of Health: building up theoretical and methodological interconnections to approach complex global challenges.

    PubMed

    Junior, Garibaldi Dantas Gurgel

    2014-01-01

    Health Sector Reform and Social Determinants of Health are central issues for the current international policy debate, considering the turbulent scenario and the threat of economic recession in a global scale. Although these themes have been discussed for a long time, three major issues still calls the attention of the scientific community and health policymakers. The first one is the matter of how to approach scientifically the intricate connections between them in order to understand the consequences of policies for healthcare services, once this debate will become much more tensioned in the coming years. The second one is the lack of explanatory frameworks to investigate the policies of reform strategies, simultaneously observed in a variety of countries within distinct health services, which aim to achieve multiple and contradictory goals vis-à-vis the so-called social determinants of health. The third one is the challenge that governments face in developing and sustaining equitable health services, bearing in mind the intense political dispute behind the health sector reform processes. This article discusses an all-embracing theoretical and methodological scheme to address these questions. The aim is to connect macro- and middle-range theories to examine Social Determinants and Health Sector Reform interdependent issues, with view to developing new knowledge and attaining scientific understanding upon the role of universal and equitable healthcare systems, in order to avoid deepening economic crises.

  8. Commissioning for health improvement following the 2012 health and social care reforms in England: what has changed?

    PubMed

    Gadsby, E W; Peckham, S; Coleman, A; Bramwell, D; Perkins, N; Jenkins, L M

    2017-02-17

    The wide-ranging program of reforms brought about by the Health and Social Care Act (2012) in England fundamentally changed the operation of the public health system, moving responsibility for the commissioning and delivery of services from the National Health Service to locally elected councils and a new national public health agency. This paper explores the ways in which the reforms have altered public health commissioning. We conducted multi-methods research over 33 months, incorporating national surveys of Directors of Public Health and local council elected members at two time-points, and in-depth case studies in five purposively selected geographical areas. Public health commissioning responsibilities have changed and become more fragmented, being split amongst a range of different organisations, most of which were newly created in 2013. There is much change in the way public health commissioning is done, in who is doing it, and in what is commissioned, since the reforms. There is wider consultation on decisions in the local council setting than in the NHS, and elected members now have a strong influence on public health prioritisation. There is more (and different) scrutiny being applied to public health contracts, and most councils have embarked on wide-ranging changes to the health improvement services they commission. Public health money is being used in different ways as councils are adapting to increasing financial constraint. Our findings suggest that, while some of the intended opportunities to improve population health and create a more joined-up system with clearer leadership have been achieved, fragmentation, dispersed decision-making and uncertainties regarding funding remain significant challenges. There have been profound changes in commissioning processes, with consequences for what health improvement services are ultimately commissioned. Time (and further research) will tell if any of these changes lead to improved population health outcomes

  9. Health Care Reform: Implications of the President's Plan for Nursing Education.

    ERIC Educational Resources Information Center

    Bednash, Geraldine

    This paper discusses factors emerging from the health care reform movement that will shape health care service delivery in general and nursing practice and education in particular. First, cost concerns will increase moves toward managed competition which will, in turn, create changes in service use patterns. These patterns seem overall to tend…

  10. Health system reform and safe abortion: a case study of Mongolia.

    PubMed

    Beck, Christina; Berry, Nicole S; Choijil, Semjidmaa

    2013-01-01

    Unsafe abortion serves as a marker of global inequity as it is concentrated in the developing world where the poorest and most vulnerable women live. While liberalisation of abortion law is essential to the reduction of unsafe abortion, a number of challenges exist beyond this important step. This paper investigates how popular health system reforms consonant with neoliberal agendas can challenge access to safe abortion. We use Mongolia, a country that has liberalised abortion law, yet, limited access to safe abortion, as a case study. Mongolia embraced market reforms in 1990 and subsequently reformed its health system. We document how common reforms in the areas of finance and regulation can compromise the safety of abortions as they foster challenges that include inconsistencies in service delivery that further foment health inequities, adoption of reproductive health programmes that are incompatible with the local sociocultural context, unregulated growth of the private sector and poor enforcement of standards and technical guidelines for safe abortion. We then discuss how this case study suggests the conversations that reproductive health policy-makers must have with those engineering health sector reform to ensure access to safe abortion in a liberalised environment.

  11. Evaluating the Labour Government's English NHS health system reforms: the 2008 Darzi reforms.

    PubMed

    Mays, Nicholas

    2013-10-01

    Starting in 2002, the UK Labour Government of 1997-2010 introduced a series of changes to the National Health Service (NHS) in England designed to increase patients' choices of the place of elective hospital care and encourage competition among public and private providers of elective hospital services for NHS-funded patients. In 2006, the Department of Health initiated the Health Reform Evaluation Programme (HREP) to assess the impact of the changes. In June 2008, the White Paper, High quality care for all, was published. It represented the government's desire to focus the next phase of health care system reform in England as much on the quality of care as on improving its responsiveness and efficiency. The 2008 White Paper led to the commissioning of a further wave of evaluative research under the auspices of HREP, as follows: an evaluation of the implementation and outcomes of care planning for people with long-term conditions; an evaluation of the personal health budget pilots; an evaluation of the implementation and outcomes of the Commissioning for Quality and Innovation (CQUIN) framework; and an evaluation of cultural and behavioural change in the NHS focused on ensuring high quality care for all. This Supplement includes papers from each project. The evaluations present a mixed picture of the impact and success of the 2008 reforms. All the studies identify some limitations of the policies in the White Paper. The introduction of personal health budgets appears to have been the least problematic and, depending on assumptions, likely to be cost-effective for the sorts of patients involved in the pilot. For the rest of the changes, impacts ranged from little or none (CQUIN and care planning for people with chronic conditions) to patchy and highly variable (instilling a culture of quality in acute hospitals) in the three years following the publication of the White Paper. On the other hand, each of the studies identifies important insights relevant to modifying

  12. The aftermath of health sector reform in the Republic of Georgia: effects on people's health.

    PubMed

    Collins, Téa

    2003-04-01

    After the collapse of the Former Soviet Union a health reform process was undertaken in Georgia beginning in 1994. This process was intended to encompass all aspects of the health-care sector and to transform the Soviet-style health system into one that was directed towards quality of care, improved access, efficiency, and a strengthened focus on Primary Health Care (PHC). Health sector reform fundamentally changed the ways health care is financed in Georgia. There has been a transition to program-based financing, and payroll-tax-based social insurance schemes have been introduced. Despite these measures, the performance of the health system is still disappointing. All health programs are severely under-funded, and when the majority of the population is unemployed or self-employed, collection of taxes seems impossible. Overall, Georgian consumers are uninformed about the basic principles of health reforms and their entitlements and therefore do not support them. The analysis introduced in this paper of the current situation in Georgia establishes that the rush to insurance-based medicine was more a rush from the previous system than a well-thought-out policy direction. After 70 years of a Soviet rule, the country had no institutional capacity to provide insurance-based health care. To achieve universal coverage, or at least ensure that the majority of the population has access to basic health services, government intervention is essential. In addition, educating the public on reforms would allow the reform initiators to fundamentally change the nature of the reform process from a "top-down" centralized process to one that is demand-driven and collaborative.

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

    PubMed

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

    2016-01-01

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

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

    PubMed

    Ewig, Christina; Bello, Amparo Hernández

    2009-03-01

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

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

    PubMed

    Vetter, Philipp; Boecker, Klaus

    2012-12-01

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

  16. Changes in utilization of health services among poor and rural residents in Uganda: are reforms benefitting the poor?

    PubMed

    Pariyo, George W; Ekirapa-Kiracho, Elizabeth; Okui, Olico; Rahman, Mohammed Hafizur; Peterson, Stefan; Bishai, David M; Lucas, Henry; Peters, David H

    2009-11-12

    Uganda implemented health sector reforms to make services more accessible to the population. An assessment of the likely impact of these reforms is important for informing policy. This paper describes the changes in utilization of health services that occurred among the poor and those in rural areas between 2002/3 and 2005/6 and associated factors. Secondary data analysis was done using the socio-economic component of the Uganda National Household Surveys 2002/03 and 2005/06. The poor were identified from wealth quintiles constructed using an asset based index derived from Principal Components Analysis (PCA). The probability of choice of health care provider was assessed using multinomial logistic regression and multi-level statistical models. The odds of not seeking care in 2005/6 were 1.79 times higher than in 2002/3 (OR = 1.79; 95% CI 1.65 - 1.94). The rural population experienced a 43% reduction in the risk of not seeking care because of poor geographical access (OR = 0.57; 95% CI 0.48 - 0.67). The risk of not seeking care due to high costs did not change significantly. Private for profit providers (PFP) were the major providers of services in 2002/3 and 2005/6. Using PFP as base category, respondents were more likely to have used private not for profit (PNFP) in 2005/6 than in 2002/3 (OR = 2.15; 95% CI 1.58 - 2.92), and also more likely to use public facilities in 2005/6 than 2002/3 (OR = 1.31; 95% CI 1.15 - 1.48). The most poor, females, rural residents, and those from elderly headed households were more likely to use public facilities relative to PFP. Although overall utilization of public and PNFP services by rural and poor populations had increased, PFP remained the major source of care. The odds of not seeking care due to distance decreased in rural areas but cost continued to be an important barrier to seeking health services for residents from poor, rural, and elderly headed households. Policy makers should consider targeting subsidies to the poor and

  17. Health reform: a bipartisan view.

    PubMed

    Cooper, Jim; Castle, Michael

    2009-01-01

    This optimistic assessment of the prospects for health reform from senior Democratic and Republican congressmen spells out several reasons why reform can be achieved early in the first year of the Obama administration. Political and policy factors suggest that President-elect Barack Obama is in a much better position than his predecessors to achieve comprehensive health reform, including universal coverage. The Obama administration will have to overcome numerous obstacles and resistance to enact reform. Still, after decades of frustration and disappointment, policymakers should set aside their differences and enable the United States to join the ranks of developed nations by making sure every American has health insurance.

  18. Finance Committee actions ready health reform debate for House, Senate floors.

    PubMed

    1994-07-07

    The activity of the US Senate Finance Committee was reported for the health care reform bill, which was sent out of committee to the floor of the Senate on July 2, 1994. The bill out of committee did not include provision for universal insurance coverage, and included amendments that might remove abortion, family planning, and reproductive health services from the standard package of required employee benefits. Other health reform measures where reported out of the Senate Labor and Human Resources Committee, the House Ways and Means Committee, and the Education and Labor Committee, which all contained a provision for universal insurance coverage through employer mandates, a standard benefits package, and comprehensive family planning services and reproductive health care. The Labor and Human Resources bill included counseling and education for family planning. Both House bills exempted family planning services from cost sharing requirements. Abortion coverage in these three bills was covered under "services for pregnant women." The Senate Finance Committee bill adopted "market reforms" which would reduce the cost of coverage for employers. A standard benefits package would be determined by all employers, regardless of whether employers contributed to coverage. The critical point of the Senate Finance bill is that it provides the opportunity to deny services for abortion on religious or moral grounds and to deny services for contraception, AIDS treatment, or substance abuse, by making acceptance optional by states and by insurers and by employers. The House Rules Committee will begin the first week in August to reconcile differences in the House bills. The Senate will reconcile differences in some fashion, without a prescribed procedure.

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

    PubMed

    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.

  20. New Zealand's post-2008 health system reforms: toward re-centralization of organizational arrangements.

    PubMed

    Gauld, Robin

    2012-07-01

    The election of a centre-right government in 2008 has spawned a series of ongoing reforms to the structures for governing New Zealand's health system. These mainly involve creation of a series of new national agencies designed to stimulate national coordination and centralization of some planning and service delivery functions along with performance improvements in specific areas, namely quality, information technology, service efficiency, reduction of administrative costs, and comparative-effectiveness research. This brief article provides an overview of the post-2008 reforms. It notes that, while there appears to be agreement within the health system that the reforms are moving in the right direction, the new institutional arrangements are perhaps overly complicated. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  1. Health Care Services for Children and Adolescents.

    ERIC Educational Resources Information Center

    Perrin, James; And Others

    1992-01-01

    Identifies health risks and other factors that determine the need for health care services among children and adolescents. Recommendations are made to develop reforms through a coordinated care program rather than through competing systems of services. Models for community-based health care monitoring and coordination exist in other industrialized…

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

    ERIC Educational Resources Information Center

    Halfon, Neal; And Others

    1994-01-01

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

  3. Health insurance reform: labor versus health perspectives.

    PubMed

    Ammar, Walid; Awar, May

    2012-01-01

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

  4. Narrativity and the mediation of health reform agendas.

    PubMed

    Hodgetts, Darrin; Chamberlain, Kerry

    2003-09-01

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

  5. Financial and clinical risk in health care reform: a view from below.

    PubMed

    Smith, Pam; Mackintosh, Maureen; Ross, Fiona; Clayton, Julie; Price, Linnie; Christian, Sara; Byng, Richard; Allan, Helen

    2012-04-01

    This paper examines how the interaction between financial and clinical risk at two critical phases of health care reform in England has been experienced by frontline staff caring for vulnerable patients with long term conditions. The paper draws on contracting theory and two interdisciplinary and in-depth qualitative research studies undertaken in 1995 and 2007. Methods common to both studies included documentary analysis and interviews with managers and front line professionals. The 1995 study employed action-based research and included observation of community care; the 2007 study used realistic evaluation and included engagement with service user groups. In both reform processes, financial risk was increasingly devolved to frontline practitioners and smaller organizational units such as GP commissioning groups, with payment by unit of activity, aimed at changing professionals' behaviour. This financing increased perceived clinical risk and fragmented the delivery of health and social care services requiring staff efforts to improve collaboration and integration, and created some perverse incentives and staff demoralisation. Health services reform should only shift financial risk to frontline professionals to the extent that it can be efficiently borne. Where team work is required, contracts should reward collaborative multi-professional activity.

  6. Addressing the epidemiologic transition in the former Soviet Union: strategies for health system and public health reform in Russia.

    PubMed Central

    Tulchinsky, T H; Varavikova, E A

    1996-01-01

    OBJECTIVES. This paper reviews Russia's health crisis, financing, and organization and public health reform needs. METHODS. The structure, policy, supply of services, and health status indicators of Russia's health system are examined. RESULTS. Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic. CONCLUSIONS. The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to noninfectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended. PMID:8604754

  7. What have health care reforms achieved in Turkey? An appraisal of the "Health Transformation Programme".

    PubMed

    Ökem, Zeynep Güldem; Çakar, Mehmet

    2015-09-01

    Poor health status indicators, low quality care, inequity in the access to health services and inefficiency due to fragmented health financing and provision have long been problems in Turkey's health system. To address these problems a radical reform process known as the Health Transformation Programme (HTP) was initiated in 2003. The health sector reforms in Turkey are considered to have been among the most successful of middle-income countries undergoing reform. Numerous articles have been published that review these reforms in terms of, variously, financial sustainability, efficiency, equity and quality. Evidence suggests that Turkey has indeed made significant progress, yet these achievements are uneven among its regions, and their long-term financial sustainability is unresolved due to structural problems in employment. As yet, there is no comprehensive evidence-based analysis of how far the stated reform objectives have been achieved. This article reviews the empirical evidence regarding the outcomes of the HTP during 10 years of its implementation. Strengthening the strategic purchasing function of the Social Security Institution (SSI) should be a priority. Overall performance can be improved by linking resource allocation to provider performance. More emphasis on prevention rather than treatment, with an effective referral chain, can also bring better outcomes, greater efficiency gains and contribute to sustainability. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. School-Based Mental Health Services: Service System Reform in South Carolina.

    ERIC Educational Resources Information Center

    Motes, Patricia Stone; Pumariega, Andres; Simpson, Mary Ann; Sanderson, Jennifer

    This paper reports on the University of South Carolina School-Based Mental Health Project, a program which provides mental health services within a public school setting in an effort to maximize the preventive and educational effects of mental health services within schools. The project is also developing a model to serve as a foundation for a…

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

    PubMed

    Arrieta, Alejandro

    2011-02-01

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

  10. [Health reform in the USA].

    PubMed

    Ganduglia, Cecilia

    2010-01-01

    The United States of America passed early this year the bill enforcing their health reform. this reform aims at achieving universal insurance, cost containment and improving quality of care. The debate around this reform has been long and unable to arrive to an agreement between the parts. Even if the expansion in the medical coverage system does not reduce to zero the current degree of inaccessibility to the health system, these achievements could be considered a very important first step. Nonetheless, chances are that this reform will continue being as polemic as the negotiations previous to its conception.

  11. Health Card: a new reform plan.

    PubMed

    Seidman, L S

    1995-01-01

    Health Card is a new reform plan. Every household, regardless of employment of health status, would receive a government-issued health credit card to use at the doctor's office or hospital like MasterCard. Later, it would be billed a percentage of the provider's charge--a percentage scaled to its last income tax return; its annual burden would never exceed a designated percentage of its income. Health Card would simply and directly achieve universal coverage and equitable patient cost-sharing. Like MasterCard, government would pay bills, not regulate providers. Each household would choose its medical provider (fee-for-service or HMO), bearing a percentage of the charge. Provider competition for cost-sharing consumers would help contain health care costs.

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

    PubMed

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

    2017-02-14

    Under the Affordable Care Act, States have obtained Medicaid waivers to overhaul their behavioral health service systems to improve quality and reduce costs. Critical to implementation of broad service delivery reforms has been the preparation of organizations responsible for service delivery. This study focused on one large-scale initiative to overhaul its service system with the goal of improving service quality and reducing costs. The study examined the participation of behavioral health organizations in technical assistance efforts and the extent to which organizational factors related to their participation. This study matched two datasets to examine the organizational characteristics and training participation for 196 behavioral health organizations. Organizational characteristics were drawn from the Substance Abuse and Mental Health Services Administration National Mental Health Services Survey (N-MHSS). Training variables were drawn from the Clinical Technical Assistance Center's master training database. Chi-square analyses and multivariate logistic regression models were used to examine the proportion of organizations that participated in training, the organizational characteristics (size, population served, service quality, infrastructure) that predicted participation in training, and for those who participated, the type (clinical or business) and intensity of training (webinar, learning collaborative, in-person) they received. Overall 142 (72. 4%) of the sample participated in training. Organizations who pursued training were more likely to be large in size (p = .02), serve children in addition to adults (p < .01), provide child evidence-based practices (p = .01), and use computerized scheduling (p = .01). Of those trained, 95% participated in webinars, 64% participated in learning collaboratives and 35% participated in in-person trainings. More organizations participated in business trainings than clinical (63.8 vs. 59

  13. Rents From the Essential Health Benefits Mandate of Health Insurance Reform.

    PubMed

    Mendoza, Roger Lee

    2015-01-01

    The essential health benefits mandate constitutes one of the most controversial health care reforms introduced under the U.S. Affordable Care Act of 2010. It bears important theoretical and practical implications for health care risk and insurance management. These essential health benefits are examined in this study from a rent-seeking perspective, particularly in terms of three interrelated questions: Is there an economic rationale for standardized, minimum health care coverage? How is the scope of essential health services and treatments determined? What are the attendant and incidental costs and benefits of such determination/s? Rents offer ample incentives to business interests to expend considerable resources for health care marketing, particularly when policy processes are open to contestation. Welfare losses inevitably arise from these incentives. We rely on five case studies to illustrate why and how rents are created, assigned, extracted, and dissipated in equilibrium. We also demonstrate why rents depend on persuasive marketing and the bargained decisions of regulators and rentiers, as conditioned by the Tullock paradox. Insights on the intertwining issues of consumer choice, health care marketing, and insurance reform are offered by way of conclusion.

  14. Health Reform Redux: Learning From Experience and Politics

    PubMed Central

    2009-01-01

    The 2008 presidential campaign season featured health care reform proposals. I discuss 3 approaches to health care reform and the tools for bringing about reform, such as insurance market reforms, tax credits, subsidies, individual and employer mandates, and public program expansions. I also discuss the politics of past and current health care reform efforts. Market-based reforms and mandates have been less successful than public program expansions at expanding coverage and controlling costs. New divisions among special interest groups increase the likelihood that reform efforts will succeed. Federal support for state efforts may be necessary to achieve national health care reform. History suggests that state-level success precedes national reform. History also suggests that an organized social movement for reform is necessary to overcome opposition from special interest groups. PMID:19299668

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

    PubMed

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

    1990-01-01

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

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

    PubMed

    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.

  17. 45 CFR 147.130 - Coverage of preventive health services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Coverage of preventive health services. 147.130 Section 147.130 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS...

  18. 45 CFR 147.130 - Coverage of preventive health services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Coverage of preventive health services. 147.130 Section 147.130 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS...

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

    PubMed

    Martinez-Gutierrez, María Soledad; Cuadrado, Cristóbal

    2017-06-01

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

  20. DESperately Seeking Service: A narrative review informing a disability employment services reform framework for Australians with mental illness.

    PubMed

    Mellifont, Damian

    2017-01-01

    Notwithstanding efforts by vocational services to assist Australians with mental illness into employment many of these consumers remain unemployed. To inform policymakers and practitioners of a disability employment services reform framework that endeavours to help more consumers who are experiencing mental illness to attain and retain employment. Thematic analysis was directed to summarize results obtained from a narrative literature review of disability employment service reforms utilising Scopus, Medline and Pubmed databases and including articles published between 2000 and 2016. Research results reveal a preparative framework covering three levels of disability employment services reform for consumers with mental illness. This research makes important theoretical contributions across three areas. First this study reveals individualised, integrated and outcome-oriented services as dimensions of disability employment services reform that warrant greater government investment, practitioner focus and consumer involvement. Second recognising that none of these service reforms are immune from challenges which may hinder their effectiveness, future research is needed to identify evidence-based mitigation measures. Finally with individualised services positioned at the nucleus of the reform framework, integrated services and outcome-oriented reforms should be operationalised in ways that remain sensitive to the principle of strength-based support.

  1. Community participation in health service reform: the development of an innovative remote Aboriginal primary health-care service.

    PubMed

    Reeve, Carole; Humphreys, John; Wakerman, John; Carroll, Vicki; Carter, Maureen; O'Brien, Tim; Erlank, Carol; Mansour, Rafik; Smith, Bec

    2015-01-01

    The aim of this study was to describe the reorientation of a remote primary health-care service, in the Kimberley region of Australia, its impact on access to services and the factors instrumental in bringing about change. A unique community-initiated health service partnership was developed between a community-controlled Aboriginal health organisation, a government hospital and a population health unit, in order to overcome the challenges of delivering primary health care to a dispersed, highly disadvantaged Aboriginal population in a very remote area. The shared goals and clear delineation of responsibilities achieved through the partnership reoriented an essentially acute hospital-based service to a prevention-focussed comprehensive primary health-care service, with a focus on systematic screening for chronic disease, interdisciplinary follow up, health promotion, community advocacy and primary prevention. This formal partnership enabled the primary health-care service to meet the major challenges of providing a sustainable, prevention-focussed service in a very remote and socially disadvantaged area.

  2. The dynamics of health care reform--learning from a complex adaptive systems theoretical perspective.

    PubMed

    Sturmberg, Joachim P; Martin, Carmel M

    2010-10-01

    Health services demonstrate key features of complex adaptive systems (CAS), they are dynamic and unfold in unpredictable ways, and unfolding events are often unique. To better understand the complex adaptive nature of health systems around a core attractor we propose the metaphor of the health care vortex. We also suggest that in an ideal health care system the core attractor would be personal health attainment. Health care reforms around the world offer an opportunity to analyse health system change from a complex adaptive perspective. At large health care reforms have been pursued disregarding the complex adaptive nature of the health system. The paper details some recent reforms and outlines how to understand their strategies and outcomes, and what could be learnt for future efforts, utilising CAS principles. Current health systems show the inherent properties of a CAS driven by a core attractor of disease and cost containment. We content that more meaningful health systems reform requires the delicate task of shifting the core attractor from disease and cost containment towards health attainment.

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

    PubMed

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

    2014-12-30

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

  4. Public Health Law Reform

    PubMed Central

    Gostin, Lawrence O.

    2001-01-01

    Public health law reform is necessary because existing statutes are outdated, contain multiple layers of regulation, and are inconsistent. A model law would define the mission and functions of public health agencies, provide a full range of flexible powers, specify clear criteria and procedures for activities, and provide protections for privacy and against discrimination. The law reform process provides an opportunity for public health agencies to draw attention to their resource needs and achievements and to form ties with constituency groups and enduring relations with the legislative branch of government. Ultimately, the law should become a catalyst, rather than an impediment, to reinvigorating the public health system. PMID:11527757

  5. Public health law reform.

    PubMed

    Gostin, L O

    2001-09-01

    Public health law reform is necessary because existing statutes are outdated, contain multiple layers of regulation, and are inconsistent. A model law would define the mission and functions of public health agen cies, provide a full range of flexible powers, specify clear criteria and procedures for activities, and provide protections for privacy and against discrimination. The law reform process provides an opportunity for public health agencies to draw attention to their resource needs and achievements and to form ties with constituency groups and enduring relations with the legislative branch of government. Ultimately, the law should become a catalyst, rather than an impediment, to reinvigorating the public health system.

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

    PubMed Central

    Rix, Mark; Owen, Alan; Eagar, Kathy

    2005-01-01

    The Australian health system has been the subject of multiple reviews and reorganisations over the last twenty years or more. The year 2004–2005 was no different. This paper reviews the reforms, (re)structures and governance arrangements in place at both the national and state/territory levels in the last year. At the national level some progress has been made in 2004/05 through the Australian Health Ministers' Council and there is now a national health reform agenda, albeit not a comprehensive one, endorsed by the Council of Australian Governments (COAG) in June 2005. Quality and safety was an increasing focus in 2004–2005 at both the national and jurisdictional levels, as was the need for workforce reform. Although renewed policy attention was given to the need to better integrate and coordinate health care, there is little evidence of any real progress this last year. More progress was made on a national approach to workforce reform. At the jurisdictional level, the usual rounds of reviews and restructuring occurred in several jurisdictions and, in 2005, they are organisationally very different from each other. The structure and effectiveness of jurisdictional health authorities are now more important. All health authorities are being expected to drive an ambitious set of national and local reforms. At the same time, most have now blurred the boundary between policy and service delivery and are devoting significant resources to centrally 'crisis managing' their service systems. These same reasons led to decentralisation in previous restructuring cycles. While there were many changes in 2004–2005, and a new national report to COAG on health reform is expected at the end of 2005, based on current evidence there is little room for optimism about the prospects for real progress. PMID:16120207

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

    PubMed

    Davidson, A R

    1999-01-01

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

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

    PubMed

    Saltman, Richard B

    2018-01-24

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

  9. Dementia in Ontario: Prevalence and Health Services Utilization

    ERIC Educational Resources Information Center

    Tranmer, J. E.; Croxford, R.; Coyte, P. C.

    2003-01-01

    To understand the impact of ongoing reform of mental health and dementia care in Ontario, an examination of prevalence and health services utilization rates is needed. However, there exists a gap in current prevalence and health services research specific to dementia care in Ontario. The objective of this study was to address these concerns using…

  10. Mandate-Based Health Reform and the Labor Market: Evidence from the Massachusetts Reform*

    PubMed Central

    Kolstad, Jonathan T.; Kowalski, Amanda E.

    2016-01-01

    We model the labor market impact of the key provisions of the national and Massachusetts “mandate-based” health reforms: individual mandates, employer mandates, and subsidies. We characterize the compensating differential for employer-sponsored health insurance (ESHI) and the welfare impact of reform in terms of “sufficient statistics.” We compare welfare under mandate-based reform to welfare in a counterfactual world where individuals do not value ESHI. Relying on the Massachusetts reform, we find that jobs with ESHI pay $2,812 less annually, somewhat less than the cost of ESHI to employers. Accordingly, the deadweight loss of mandate-based health reform was approximately 8 percent of its potential size. PMID:27037897

  11. Standardizing the home?: Women reformers and domestic service in New Deal New York.

    PubMed

    May, Vanessa

    2011-01-01

    In response to the poor working conditions suffered by domestics struggling to survive the Depression, middle-class women's organizations initiated various legislative reforms aimed at tackling the problems they believed plagued the occupation. Throughout these years, organized women debated three key pieces of reform related to domestic service: efforts to suppress street-corner markets, health requirements for prospective domestics, and state-level wage and hour reform. These reforms were united by the rhetoric of privacy, which clubwomen used both to oppose wage and hour reform and to support requirements that domestics have physicals before applying for work. This article examines the fine distinction that middle-class women's organizations drew between public and private in the appropriate application of government power and the resulting conflict between progressive women's gender ideology and their most deeply-held reform ideals. In doing so, it reveals organized women's struggle to reconcile their humane ideals with the reality in their kitchens.

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

    PubMed

    Filc, Dani; Davidovitch, Nadav

    2016-10-01

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

  13. Health care reform and care at the behavioral health--primary care interface.

    PubMed

    Druss, Benjamin G; Mauer, Barbara J

    2010-11-01

    The historic passage of the Patient Protection and Affordable Care Act in March 2010 offers the potential to address long-standing deficits in quality and integration of services at the interface between behavioral health and primary care. Many of the efforts to reform the care delivery system will come in the form of demonstration projects, which, if successful, will become models for the broader health system. This article reviews two of the programs that might have a particular impact on care on the two sides of that interface: Medicaid and Medicare patient-centered medical home demonstration projects and expansion of a Substance Abuse and Mental Health Services Administration program that colocates primary care services in community mental health settings. The authors provide an overview of key supporting factors, including new financing mechanisms, quality assessment metrics, information technology infrastructure, and technical support, that will be important for ensuring that initiatives achieve their potential for improving care.

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

    PubMed

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

    2000-01-01

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

  15. Patient empowerment as a component of health system reforms: rights, benefits and vested interests.

    PubMed

    Colombo, Cinzia; Moja, Lorenzo; Gonzalez-Lorenzo, Marien; Liberati, Alessandro; Mosconi, Paola

    2012-04-01

    Different strategies have been developed across countries to foster citizens' and patients' involvement, from health policies to patients' active participation in decisions regarding their health. The spectrum varies from systems where patients lead the reform of health care services, to others where a paternalistic approach still limits patients' autonomy in decision-making. This paper describes: (1) different interventions for involving patients; (2) experiences to promote consumer evidence-based advocacy; and (3) barriers to consumer involvement in health system reforms, including vested interests in patients' associations. Citizens' involvement in health systems can vary substantially, but is gaining increasing weight.

  16. Health care reform and changes: the Malaysian experience.

    PubMed

    Merican, Mohd Ismail; bin Yon, Rohaizat

    2002-01-01

    Health care reform is an intentional, sustained and systematic process of structural change to one or more health subsystems to improve efficiency, effectiveness, patient choices and equity. Health care all over the world is continuously reforming with time. Health care reform has become an increasingly important agenda for policy change in both developed and developing countries including Malaysia. This paper provides an overview of the Malaysian health care system, its achievements, and issues and challenges leading to ongoing reform towards a more efficient and equitable health care system that possess a better quality of life for the population.

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

    PubMed Central

    2012-01-01

    The Patient Protection and Affordable Care Act (PPACA) aims to provide affordable health insurance and expanded health care coverage for some 32 million Americans. The PPACA makes provisions for using technology, evidence-based treatments, and integrated, patient-centered care to modernize the delivery of health care services. These changes are designed to ensure effectiveness, efficiency, and cost-savings within the health care system. To gauge the addiction treatment field’s readiness for health reform, the authors developed a Health Reform Readiness Index (HRRI) survey for addiction treatment agencies. Addiction treatment administrators and providers from around the United States completed the survey located on the http://www.niatx.net website. Respondents self-assessed their agencies based on 13 conditions pertinent to health reform readiness, and received a confidential score and instant feedback. On a scale of “Needs to Begin,” “Early Stages,” “On the Way,” and “Advanced,” the mean scores for respondents (n = 276) ranked in the Early Stages of health reform preparation for 11 of 13 conditions. Of greater concern was that organizations with budgets of < $5 million (n = 193) were less likely than those with budgets > $5 million to have information technology (patient records, patient health technology, and administrative information technology), evidence-based treatments, quality management systems, a continuum of care, or a board of directors informed about PPACA. The findings of the HRRI indicate that the addiction field, and in particular smaller organizations, have much to do to prepare for a future environment that has greater expectations for information technology use, a credentialed workforce, accountability for patient care, and an integrated continuum of care. PMID:22551101

  18. Fee-for-service will remain a feature of major payment reforms, requiring more changes in Medicare physician payment.

    PubMed

    Ginsburg, Paul B

    2012-09-01

    Many health policy analysts envision provider payment reforms currently under development as replacements for the traditional fee-for-service payment system. Reforms include per episode bundled payment and elements of capitation, such as global payments or accountable care organizations. But even if these approaches succeed and are widely adopted, the core method of payment to many physicians for the services they provide is likely to remain fee-for-service. It is therefore critical to address the current shortcomings in the Medicare physician fee schedule, because it will affect physician incentives and will continue to play an important role in determining the payment amounts under payment reform. This article reviews how the current payment system developed and is applied, and it highlights areas that require careful review and modification to ensure the success of broader payment reform.

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

    PubMed

    Mitenbergs, Uldis; Brigis, Girts; Quentin, Wilm

    2014-11-01

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

  20. Health Care System Reforms in Developing Countries

    PubMed Central

    Han, Wei

    2012-01-01

    This article proposes a critical but non-systematic review of recent health care system reforms in developing countries. The literature reports mixed results as to whether reforms improve the financial protection of the poor or not. We discuss the reasons for these differences by comparing three representative countries: Mexico, Vietnam, and China. First, the design of the health care system reform, as well as the summary of its evaluation, is briefly described for each country. Then, the discussion is developed along two lines: policy design and evaluation methodology. The review suggests that i) background differences, such as social development, poverty level, and population health should be considered when taking other countries as a model; ii) although demand-side reforms can be improved, more attention should be paid to supply-side reforms; and iii) the findings of empirical evaluation might be biased due to the evaluation design, the choice of outcome, data quality, and evaluation methodology, which should be borne in mind when designing health care system reforms. PMID:25170464

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

    PubMed

    Hu, S L

    2016-11-06

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

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

    PubMed

    Tountas, Yannis; Karnaki, Panagiota; Pavi, Elpida

    2002-10-01

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

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

    PubMed

    Salihbasic, Sehzada

    2011-01-01

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

  4. Evolution of US Health Care Reform.

    PubMed

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

    2017-03-01

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

  5. Human resource solutions--the Gateway Paper proposed health reforms in Pakistan.

    PubMed

    Nishtar, Sania

    2006-12-01

    The existence of appropriate institutional and human resource capacity underpins the viability and sustainability of a health reform process within a country. Building human resource capacity within the health sector involves building the capacity of health service providers, health managers and administers as well as the stewards of health. Although capacity building is linked to a generic process closely linked to the broader economic, social and developmental context, it has specific health system connotations which should be the focus of a concerted effort. These include quantitative issues, in-effective deployment and brain-drain, qualitative considerations which stem from gaps in the quality of undergraduate as well as discrepancies in the content and format of training and absence of this in service of training health professionals and gaps in regulation. As one of the fundamental corner stones of health reform the Gateway Paper calls attention to the need to avert these issues with the development of a well-defined policy in human resource development as an entry point. This should be based on an analysis of the human resource need and should clearly define career structures for all categories of healthcare providers, and articulate the mechanisms of their effective deployment. Creating a conducive an rewarding environment, institutionalizing personnel management reform which go beyond personnel actions and set standards of performance, and develop appropriate incentives around this, would be critical. It would also be important to pay due attention to the content and format of training at an undergraduate level, at a postgraduate level and with reference to ongoing education and the allied roles of continuing medical education programs and accreditation of health systems educational institutions. The Gateway Paper also lays stress on effective regulation to curb the practice of quackery.

  6. Choice of contracts in the British National Health Service: an empirical study.

    PubMed

    Chalkley, Martin; McVicar, Duncan

    2008-09-01

    Following major reforms of the British National Health Service (NHS) in 1990, the roles of purchasing and providing health services were separated, with the relationship between purchasers and providers governed by contracts. Using a mixed multinomial logit analysis, we show how this policy shift led to a selection of contracts that is consistent with the predictions of a simple model, based on contract theory, in which the characteristics of the health services being purchased and of the contracting parties influence the choice of contract form. The paper thus provides evidence in support of the practical relevance of theory in understanding health care market reform.

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

    PubMed

    Lethbridge, Jane

    2004-11-23

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

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

    PubMed

    Cevik, Celalettin; Sozmen, Kaan; Kilic, Bulent

    2018-12-01

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

  9. Creating an innovative youth mental health service in the United Kingdom: The Norfolk Youth Service.

    PubMed

    Wilson, Jon; Clarke, Tim; Lower, Rebecca; Ugochukwu, Uju; Maxwell, Sarah; Hodgekins, Jo; Wheeler, Karen; Goff, Andy; Mack, Robert; Horne, Rebecca; Fowler, David

    2017-08-04

    Young people attempting to access mental health services in the United Kingdom often find traditional models of care outdated, rigid, inaccessible and unappealing. Policy recommendations, research and service user opinion suggest that reform is needed to reflect the changing needs of young people. There is significant motivation in the United Kingdom to transform mental health services for young people, and this paper aims to describe the rationale, development and implementation of a novel youth mental health service in the United Kingdom, the Norfolk Youth Service. The Norfolk Youth Service model is described as a service model case study. The service rationale, national and local drivers, principles, aims, model, research priorities and future directions are reported. The Norfolk Youth Service is an innovative example of mental health transformation in the United Kingdom, comprising a pragmatic, assertive and "youth-friendly" service for young people aged 14 to 25 that transcends traditional service boundaries. The service was developed in collaboration with young people and partnership agencies and is based on an engaging and inclusive ethos. The service is a social-recovery oriented, evidence-based and aims to satisfy recent policy guidance. The redesign and transformation of youth mental health services in the United Kingdom is long overdue. The Norfolk Youth Service represents an example of reform that aims to meet the developmental and transitional needs of young people at the same time as remaining youth-oriented. © 2017 John Wiley & Sons Australia, Ltd.

  10. Inequities in mental health care after health care system reform in Chile.

    PubMed

    Araya, Ricardo; Rojas, Graciela; Fritsch, Rosemarie; Frank, Richard; Lewis, Glyn

    2006-01-01

    We compared differences in mental health needs and provision of mental health services among residents of Santiago, Chile, with private and public health insurance coverage. We conducted a cross-sectional survey of a random sample of adults. Presence of mental disorders and use of health care services were assessed via structured interviews. Individuals were classified as having public, private, or no health insurance coverage. Among individuals with mental disorders, only 20% (95% confidence interval [CI]=16%, 24%) had consulted a professional about these problems. A clear mismatch was found between need and provision of services. Participants with public insurance coverage exhibited the highest prevalence of mental disorders but the lowest rates of consultation; participants with private coverage exhibited exactly the opposite pattern. After adjustment for age, income, and severity of symptoms, private insurance coverage (odds ratio [OR]=2.72; 95% CI=1.6, 4.6) and higher disability level (OR=1.27, 95% CI=1.1, 1.5) were the only factors associated with increased frequency of mental health consultation. The health reforms that have encouraged the growth of the private health sector in Chile also have increased risk segmentation within the health system, accentuating inequalities in health care provision.

  11. Inequities in Mental Health Care After Health Care System Reform in Chile

    PubMed Central

    Araya, Ricardo; Rojas, Graciela; Fritsch, Rosemarie; Frank, Richard; Lewis, Glyn

    2006-01-01

    Objectives. We compared differences in mental health needs and provision of mental health services among residents of Santiago, Chile, with private and public health insurance coverage. Methods. We conducted a cross-sectional survey of a random sample of adults. Presence of mental disorders and use of health care services were assessed via structured interviews. Individuals were classified as having public, private, or no health insurance coverage. Results. Among individuals with mental disorders, only 20% (95% confidence interval [CI]=16%, 24%) had consulted a professional about these problems. A clear mismatch was found between need and provision of services. Participants with public insurance coverage exhibited the highest prevalence of mental disorders but the lowest rates of consultation; participants with private coverage exhibited exactly the opposite pattern. After adjustment for age, income, and severity of symptoms, private insurance coverage (odds ratio [OR]=2.72; 95% CI=1.6, 4.6) and higher disability level (OR=1.27, 95% CI=1.1, 1.5) were the only factors associated with increased frequency of mental health consultation. Conclusions. The health reforms that have encouraged the growth of the private health sector in Chile also have increased risk segmentation within the health system, accentuating inequalities in health care provision. PMID:16317207

  12. [Universal coverage of health services in Mexico].

    PubMed

    2013-01-01

    The reforms made in recent years to the Mexican Health System have reduced inequities in the health care of the population, but have been insufficient to solve all the problems of the MHS. In order to make the right to health protection established in the Constitution a reality for every citizen, Mexico must warrant effective universal access to health services. This paper outlines a long-term reform for the consolidation of a health system that is akin to international standards and which may establish the structural conditions to reduce coverage inequity. This reform is based on a "structured pluralism" intended to avoid both a monopoly exercised within the public sector and fragmentation in the private sector, and to prevent falling into the extremes of authoritarian procedures or an absence of regulation. This involves the replacement of the present vertical integration and segregation of social groups by a horizontal organization with separation of duties. This also entails legal and fiscal reforms, the reinforcement of the MHS, the reorganization of health institutions, and the formulation of regulatory, technical and financial instruments to operationalize the proposed scheme with the objective of rendering the human right to health fully effective for the Mexican people.

  13. The financial crisis and health care systems in Europe: universal care under threat? Trends in health sector reforms in Germany, the United Kingdom, and Spain.

    PubMed

    Giovanella, Lígia; Stegmüller, Klaus

    2014-11-01

    The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date), and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms' impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems.

  14. Management of reforming of housing-and-communal services

    NASA Astrophysics Data System (ADS)

    Skripnik, Oksana

    2017-10-01

    The international experience of reforming of housing and communal services is considered. The main scientific and methodical approaches of system transformation of the housing sphere are analyzed in the article. The main models of reforming are pointed out, interaction of participants of structural change process from the point of view of their commercial and social importance is characterized, advantages and shortcomings are revealed, model elements of the reform transformations from the point of view of the formation of investment appeal, competitiveness, energy efficiency and social importance of the carried-out actions are allocated.

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

    ERIC Educational Resources Information Center

    Fadope, Cece Modupe; And Others

    1994-01-01

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

  16. Combining service marketing and strategic alliances in health care.

    PubMed

    Lazarus, I R

    1993-11-01

    With or without federal health care reform to impact the delivery of health care services in the U.S., hospitals must commit to service marketing and strategic alliances as a fundamental business strategy. Service marketing not only differentiates the provider, but with the proper programs in place, it may actually facilitate the formation of strategic alliances. The combination of these strategies will be particularly effective in preparing for any health care policy change.

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

    PubMed

    Yang, Y Tony; Nichols, Len M

    2011-01-01

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

  18. Health-financing reforms in southeast Asia: challenges in achieving universal coverage.

    PubMed

    Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn; Ir, Por; Aljunid, Syed Mohamed; Mukti, Ali Ghufron; Akkhavong, Kongsap; Banzon, Eduardo; Huong, Dang Boi; Thabrany, Hasbullah; Mills, Anne

    2011-03-05

    In this sixth paper of the Series, we review health-financing reforms in seven countries in southeast Asia that have sought to reduce dependence on out-of-pocket payments, increase pooled health finance, and expand service use as steps towards universal coverage. Laos and Cambodia, both resource-poor countries, have mostly relied on donor-supported health equity funds to reach the poor, and reliable funding and appropriate identification of the eligible poor are two major challenges for nationwide expansion. For Thailand, the Philippines, Indonesia, and Vietnam, social health insurance financed by payroll tax is commonly used for formal sector employees (excluding Malaysia), with varying outcomes in terms of financial protection. Alternative payment methods have different implications for provider behaviour and financial protection. Two alternative approaches for financial protection of the non-poor outside the formal sector have emerged-contributory arrangements and tax-financed schemes-with different abilities to achieve high population coverage rapidly. Fiscal space and mobilisation of payroll contributions are both important in accelerating financial protection. Expanding coverage of good-quality services and ensuring adequate human resources are also important to achieve universal coverage. As health-financing reform is complex, institutional capacity to generate evidence and inform policy is essential and should be strengthened. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Health reform through tax reform: a primer.

    PubMed

    Furman, Jason

    2008-01-01

    Tax incentives for employer-sponsored insurance and other medical spending cost about $200 billion annually and have pervasive effects on coverage and costs. This paper surveys a range of proposals to reform health care, either by adding new tax incentives or by limiting or replacing the existing tax incentives. Replacing the current tax preference for insurance with an income-related, refundable tax credit has the potential to expand coverage and reduce inefficient spending at no net federal cost. But such an approach by itself would entail substantial risks, so complementary reforms to the insurance market are essential to ensure success.

  20. Medical liability and health care reform.

    PubMed

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

    2011-01-01

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

  1. The Impacts of State Health Reform Initiatives on Adults in New York and Massachusetts

    PubMed Central

    Long, Sharon K; Stockley, Karen

    2011-01-01

    Objective To analyze the effects of health reform efforts in two large states—New York and Massachusetts. Data Sources/Study Setting National Health Interview Survey (NHIS) data from 1999 to 2008. Study Design We take advantage of the “natural experiments” that occurred in New York and Massachusetts to compare health insurance coverage and health care access and use for adults before and after the implementation of the health policy changes. To control for underlying trends not related to the reform initiatives, we subtract changes in the outcomes over the same time period for comparison groups of adults who were not affected by the policy changes using a differences-in-differences framework. The analyses are conducted using multiple comparison groups and different time periods as a check on the robustness of the findings. Data Collection/Extraction Methods Nonelderly adults ages 19–64 in the NHIS. Principal Findings We find evidence of the success of the initiatives in New York and Massachusetts at expanding insurance coverage, with the greatest gains reported by the initiative that was broadest in scope—the Massachusetts push toward universal coverage. There is no evidence of improvements in access to care in New York, reflecting the small gains in coverage under that state's reform effort and the narrow focus of the initiative. In contrast, there were significant gains in access to care in Massachusetts, where the impact on insurance coverage was greater and a more comprehensive set of reforms were implemented to improve access to a full array of health care services. The estimated gains in coverage and access to care reported here for Massachusetts were achieved in the early period under health reform, before the state's reform initiative was fully implemented. Conclusions Comprehensive reform initiatives are more successful at addressing gaps in coverage and access to care than are narrower efforts, highlighting the potential gains under national

  2. Perspectives: parity--prelude to a fifth cycle of reform.

    PubMed

    Goldman, Howard H

    2002-09-01

    Based on 2000 Carl Taube Lecture at the NIMH Mental Health Economics Meeting. This perspective article examines the relationship between a policy of parity in financing mental health services and the future of reform in service delivery. Applying theories of static and dynamic efficiency to an understanding of parity and the evolution of mental health services, drawing upon Burton Weisbrod s concept of the health care quadrilemma . Each of four cycles of reform in mental health services have contended with issues of static and dynamic efficiency. Each cycle was associated with static efficiency in the management and financing of services, and each was associated with a set of new treatment technologies intended to improve dynamic efficiency. Each reform proved ultimately unsuccessful primarily because of the failure of the treatment technologies to prevent future patient chronicity or to achieve sustained recovery. Recent advances in treatment technology and management of care can permit an unprecedented level of efficiency consistent with a policy of improved access to mainstream health and social welfare resources, including insurance coverage. This policy of so-called financing parity can improve current mental health service delivery, but it may also portend a future fifth cycle of reform. If new technologies continue to advance as full technologies - simple to deliver and producing true recovery - and mainstream resources are made available, then the specialty mental health services may contract dramatically in favor of effective care and treatment of mental illness in primary care and other mainstream settings. Predicting the future of health care is speculative, but it may be easier using the Weisbrod formulation to understand the process of mental health reform. Over-reliance on administrative techniques for building static efficiency and false optimism about dynamic efficiency from new technology have stymied previous reforms. All the same, a fifth cycle

  3. The potential impact of the World Trade Organization's general agreement on trade in services on health system reform and regulation in the United States.

    PubMed

    Skala, Nicholas

    2009-01-01

    The collapse of the World Trade Organization's (WTO) Doha Round of talks without achieving new health services liberalization presents an important opportunity to evaluate the wisdom of granting further concessions to international investors in the health sector. The continuing deterioration of the U.S. health system and the primacy of reform as an issue in the 2008 presidential campaign make clear the need for a full range of policy options for addressing the national health crisis. Yet few commentators or policymakers realize that existing WTO health care commitments may already significantly constrain domestic policy options. This article illustrates these constraints through an evaluation of the potential effects of current WTO law and jurisprudence on the implementation of a single-payer national health insurance system in the United States, proposed incremental national and state health system reforms, the privatization of Medicare, and other prominent health system issues. The author concludes with some recommendations to the U.S. Trade Representative to suspend existing liberalization commitments in the health sector and to interpret current and future international trade treaties in a manner consistent with civilized notions of health care as a universal human right.

  4. Shopping for health: purchasing health services through contracts.

    PubMed

    Howden-Chapman, P; Ashton, T

    1994-01-01

    The 1993 New Zealand health service reforms were based on the purported efficiencies of the purchaser/provider split. Purchasers are required to contract for services that will maintain, improve and restore the health of the populations they serve. The purchasing role, which requires the development of contracting skills as well as the setting of strategic directions and priorities, is new and as yet poorly developed. This paper describes the role of purchasing agents in setting priorities, the different approaches that are being taken to contracting for services and some of the problems that have arisen in the first year of contracting. It explores the trade-off that is evident between the potential for improving efficiency through contestable contracting and the need to minimise transaction costs associated with the contracting process. The purchasers' accountability to the public and the Minister is analysed in the broader political context of the purchasers' role in shaping a public health service and improving the health of the population.

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

    PubMed

    Lloyd-Sherlock, Peter

    2005-04-01

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

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

    PubMed

    Long, Sharon K; Stockley, Karen

    2009-01-01

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

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

    PubMed

    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.

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

    PubMed

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

    2014-01-01

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

  9. Health sector reform in central and eastern Europe: the professional dimension.

    PubMed

    Healy, J; Mckee, M

    1997-12-01

    The success or failure of health sector reform in the countries of Central and Eastern Europe depends, to a large extent, on their health care staff. Commentators have focused on the structures to be put in place, such as mechanisms of financing or changes in ownership of facilities, but less attention has been paid to the role and status of the different groups working in health care services. This paper draws on a study of trends in staffing and working conditions throughout the region. It identifies several key issues including the traditionally lower status and pay of health sector workers compared to the West, the credibility crisis of trade unions, and the under-developed roles of professional associations. In order to implement health sector reforms and to address the deteriorating health status of the population, the health sector workforce has to be restructured and training programmes reoriented towards primary care. Finally, the paper identifies emerging issues such as the erosion of 'workplace welfare' and its adverse effects upon a predominantly female health care workforce.

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

    PubMed Central

    2011-01-01

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

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

    PubMed

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

    2011-05-27

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

  12. Necessity and feasibility of improving mental health services in China: A systematic qualitative review.

    PubMed

    Zhao, Xudong; Liu, Liang; Hu, Chengping; Chen, Fazhan; Sun, Xirong

    2017-07-01

    It has been nearly 40 years since the reform and opening up of Mainland China. The mental health services system has developed rapidly as a part of the profound socioeconomic changes that ensued. However, its development has not been as substantial as other areas of medical care. For the current qualitative systematic review, we searched databases, including China Biology Medicine disc, Weipu, China National Knowledge Infrastructure, Wanfang digital periodical full text data, China's important newspaper full text database, China Statistical Yearbook database, etc. The content of primary research, literature, and policy papers about the evolution and development of Chinese mental health services was systemically reviewed and analysed by using thematic analysis. Two main themes relative to the necessity and feasibility of reforming the current mental health services system emerged. We discuss 5 corresponding subthemes under the umbrella of the necessity of improving the current treatment, rehabilitation, prevention, and service systems and 7 requirements for the feasibility of reforming the current system. We conclude that as the development of the Chinese economy and the spirit of humanistic care continue, the improvement and reformation of the mental health services system are both necessary and feasible. Copyright © 2017 John Wiley & Sons, Ltd.

  13. The English and Swedish health care reforms.

    PubMed

    Glennerster, H; Matsaganis, M

    1994-01-01

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

  14. Steering without navigation equipment: the lamentable state of Australian health policy reform

    PubMed Central

    2009-01-01

    Background Commentary on health policy reform in Australia often commences with an unstated logical error: Australians' health is good, therefore the Australian Health System is good. This possibly explains the disconnect between the options discussed, the areas needing reform and the generally self-congratulatory tone of the discussion: a good system needs (relatively) minor improvement. Results This paper comments on some issues of particular concern to Australian health policy makers and some areas needing urgent reform. The two sets of issues do not overlap. It is suggested that there are two fundamental reasons for this. The first is the failure to develop governance structures which promote the identification and resolution of problems according to their importance. The second and related failure is the failure to equip the health services industry with satisfactory navigation equipment - independent research capacity, independent reporting and evaluation - on a scale commensurate with the needs of the country's largest industry. These two failures together deprive the health system - as a system - of the chief driver of progress in every successful industry in the 20th Century. Conclusion Concluding comment is made on the National Health and Hospitals Reform Commission (NHHRC). This continued the tradition of largely evidence free argument and decision making. It failed to identify and properly analyse major system failures, the reasons for them and the form of governance which would maximise the likelihood of future error leaning. The NHHRC itself failed to error learn from past policy failures, a key lesson from which is that a major - and possibly the major - obstacle to reform, is government itself. The Commission virtually ignored the issue of governance. The endorsement of a monopolised system, driven by benevolent managers will miss the major lesson of history which is illustrated by Australia's own failures. PMID:19948044

  15. The interface between health sector reform and human resources in health

    PubMed Central

    Rigoli, Felix; Dussault, Gilles

    2003-01-01

    The relationship between health sector reform and the human resources issues raised in that process has been highlighted in several studies. These studies have focused on how the new processes have modified the ways in which health workers interact with their workplace, but few of them have paid enough attention to the ways in which the workers have influenced the reforms. The impact of health sector reform has modified critical aspects of the health workforce, including labor conditions, degree of decentralization of management, required skills and the entire system of wages and incentives. Human resources in health, crucial as they are in implementing changes in the delivery system, have had their voice heard in many subtle and open ways – reacting to transformations, supporting, blocking and distorting the proposed ways of action. This work intends to review the evidence on how the individual or collective actions of human resources are shaping the reforms, by spotlighting the reform process, the workforce reactions and the factors determining successful human resources participation. It attempts to provide a more powerful way of predicting the effects and interactions in which different "technical designs" operate when they interact with the human resources they affect. The article describes the dialectic nature of the relationship between the objectives and strategies of the reforms and the objectives and strategies of those who must implement them. PMID:14613523

  16. Mental health services development in Latin America and the Caribbean: achievements, barriers and facilitating factors.

    PubMed

    Caldas de Almeida, J M

    2013-03-01

    Mental health services reforms in Latin America and the Caribbean in the last 20 years have led to a significant improvement of mental health services. They also contributed to the development of new evidence that may help the implementation of future reforms. These advances, however, were clearly insufficient to respond to the huge challenges countries of Latin American and the Caribbean face to improve mental health services. Insufficient funding, one of the most important barriers to mental health services development found in most countries, was related to the absence of a strong consensus among all stakeholders and the weakness of user and family associations. Other barriers were the lack of technical capacity of the coordination unit responsible for development of services in the ministries of health, resistance from professionals towards changing to new models of care and lack of human resources. Transition to democracy in some countries and natural disasters proved to be windows of opportunity for mental health services reform. Facilitating factors included alliance with the human rights defence movement, development of research capacity in Latin American and the Caribbean countries, and international cooperation.

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

    PubMed

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

    2003-11-15

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

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

    PubMed

    Stoelwinder, Johannes U

    2009-10-05

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

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

    PubMed

    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.

  20. Leadership collaboration during health reform: an action learning approach with an interagency group of executives in Tasmania.

    PubMed

    Harpur, Siobhan

    2012-05-01

    To use an action learning approach to encourage a group of executive leaders, responsible for the implementation of a state health reform agenda, to consider the leadership required to drive improvement in healthcare services. Based on an assertion that knowledge is co-produced and that deliberative and structured conversation can be a mechanism to drive change, an action learning approach was used to facilitate an interagency group of executive leaders, responsible for the implementation of a state health reform agenda, who were encouraged to consider the leadership required to drive improvement in healthcare services. It was difficult to assert how the group contributed specifically to the implementation of the health reform agenda but individuals gained insights and there was informal resolution of institutional tensions and differences. The method may provide new knowledge to the reform process over time. Getting the participants together was challenging, which may reflect the reality of time-poor executives, or a low commitment to giving time to structured and deliberative informal dialogue. Further work is required to test this thesis and the action learning approach with other parts of healthcare workforce.

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

    PubMed

    Koornneef, Erik; Robben, Paul; Blair, Iain

    2017-09-20

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

  2. Changes in Equity in Out-of-pocket Payments during the Period of Health Care Reforms: Evidence from Hungary

    PubMed Central

    2012-01-01

    Background At the beginning of 2007, health care reforms were implemented in Hungary in order to decrease public expenditure on health care. Reforms involved the increase of co-payments for pharmaceuticals and the introduction of co-payments for health care services. Objective The objective of this paper is to examine the progressivity of household expenditure on health care during the reform period, separately for expenditures on pharmaceuticals and medical devices, as well as for formal and informal patient payments for health care services. Methods We use data on household expenditure from the Household Budget Survey carried out by the Central Statistical Office of Hungary. We present household expenditure as a percentage of household income across different income quintiles and calculate Kakwani indexes as a measure of progressivity for a four years period (2005–2008): before, during and after the implementation of the health care reforms. Results We find that out-of-pocket payments on health care are highly regressive in Hungary with a Kakwani index of −0.22. In particular, households from the lowest income quintile spend an about three times larger share of their income on out-of-pocket payments (6–7 %) compared to households in the highest income quintile (2 %). Expenditures on pharmaceuticals and medical devices are the most regressive types of expenditure (Kakwani index −0.23/-0.24), and at the same time they represent a major part of the total household expenditure on health care (78–85 %). Informal payments are also regressive while expenditures on formal payments for services are the most proportional to income. We find that expenditures on formal payments became regressive after the introduction of user fees (Kakwani index −0.1). At the same time, we observe that expenditures on informal payments became less regressive during the reform period (Kakwani index increases from −0.20/-0.18 to −0.12.) Conclusions More attention should

  3. "Liberalizing" the English National Health Service: background and risks to healthcare entitlement.

    PubMed

    Filippon, Jonathan; Giovanella, Ligia; Konder, Mariana; Pollock, Allyson M

    2016-08-29

    The recent reform of the English National Health Service (NHS) through the Health and Social Care Act of 2012 introduced important changes in the organization, management, and provision of public health services in England. This study aims to analyze the NHS reforms in the historical context of predominance of neoliberal theories since 1980 and to discuss the "liberalization" of the NHS. The study identifies and analyzes three phases: (i) gradual ideological and theoretical substitution (1979-1990) - transition from professional and health logic to management and commercial logic; (ii) bureaucracy and incipient market (1991-2004) - structuring of the bureaucracy focused on administration of the internal market and expansion of pro-market measures; and (iii) opening to the market, fragmentation, and discontinuity of services (2005-2012) - weakening of the territorial health model and consolidation of health as an open market for public and private providers. This gradual but constant liberalization has closed services and restricted access, jeopardizing the system's comprehensiveness, equity, and universal healthcare entitlement in the NHS.

  4. Access, cost, and financing: achieving an ethical health reform.

    PubMed

    Daniels, Norman; Saloner, Brendan; Gelpi, Adriane H

    2009-01-01

    Three key ethical issues should inform the broader debate about health reform: (1) Why pursue universal coverage? (2) Why is cost containment an ethical issue? (3) What is fairness in financing? After examining these issues, we conclude that the core ethical values underlying each of these goals-including expanding opportunity, sharing burdens equally, and respect for persons-limit the means that can be pursued in health reform. Although national health reform will not accomplish all of the objectives of social justice, true comprehensive reform-even under conditions of political compromise-represents an important step forward.

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

    ERIC Educational Resources Information Center

    Jecklin, Robert

    2010-01-01

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

  6. Payment Reform

    PubMed Central

    Schneider, Eric C.; Hussey, Peter S.; Schnyer, Christopher

    2011-01-01

    Abstract Insurers and purchasers of health care in the United States are on the verge of potentially revolutionary changes in the approaches they use to pay for health care. Recently, purchasers and insurers have been experimenting with payment approaches that include incentives to improve quality and reduce the use of unnecessary and costly services. The Patient Protection and Affordable Care Act of 2010 is likely to accelerate payment reform based on performance measurement. This article provides details of the results of a technical report that catalogues nearly 100 implemented and proposed payment reform programs, classifies each of these programs into one of 11 payment reform models, and identifies the performance measurement needs associated with each model. A synthesis of the results suggests near-term priorities for performance measure development and identifies pertinent challenges related to the use of performance measures as a basis for payment reform. The report is also intended to create a shared framework for analysis of future performance measurement opportunities. This report is intended for the many stakeholders tasked with outlining a national quality strategy in the wake of health care reform legislation. PMID:28083159

  7. Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization.

    PubMed

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

    2013-01-01

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

  8. Primary care reform and service use by people with serious mental illness in Ontario.

    PubMed

    Steele, Leah S; Durbin, Anna; Lin, Elizabeth; Charles Victor, J; Klein-Geltink, Julie; Glazier, Richard H; Zagorski, Brandon; Kopp, Alexander

    2014-01-01

    To examine service use by adults with serious mental illness (SMI) rostered in new primary care models: enhanced fee-for-service (FFS), blended-capitation (CAP) and team-based capitation (TBC) models with and without mental health workers (MHW) in Ontario. This cross-sectional study used administrative health service databases to compare use of mental health and general health services among persons with SMI enrolled in new models (n = 125,233). Relative to persons rostered in enhanced FFS, those in CAP and TBC had fewer mental health primary care visits (adjusted rate ratios and 95% confidence limits: CAP: 0.77 [0.74, 0.81]; TBC with MHW: 0.72 [0.68, 0.76]; TBC with no MHW: 0.81 [0.72, 0.93]). Compared to patients in enhanced FFS, those in TBC models also had more mental health hospital admissions (TBC with MHW: 1.12 [1.05, 1.20]; TBC with no MHW: 1.22 [1.05, 1.41]). Patterns of use of general services were similar. Further attention to financial incentives in capitation that influence care of persons with SMI is necessary to determine if they are aligned with aims of primary care reform. Copyright © 2014 Longwoods Publishing.

  9. Effects of Medicare Payment Reform: Evidence from the Home Health Interim and Prospective Payment Systems

    PubMed Central

    Huckfeldt, Peter J; Sood, Neeraj; Escarce, José J; Grabowski, David C; Newhouse, Joseph P

    2014-01-01

    Medicare continues to implement payment reforms that shift reimbursement from fee-for-service towards episode-based payment, affecting average and marginal payment. We contrast the effects of two reforms for home health agencies. The Home Health Interim Payment System in 1997 lowered both types of payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The Home Health Prospective Payment System in 2000 raised average but lowered marginal payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality. PMID:24395018

  10. [Assessing the impact of health sector reform in Costa Rica through a quasi-experimental study].

    PubMed

    Bixby, Luis Rosero

    2004-02-01

    that the reform was associated with an overall 8% reduction in deaths among children and with a 2% reduction in deaths among adults, both statistically significant. Also noted were a 14% reduction in deaths from communicable diseases or from conditions brought on by the presence of infectious processes, a 0% reduction in deaths from socially-determined causes, and a 2% reduction in deaths from chronic diseases. An estimated 120 child lives and 350 adult lives were saved by the reform in 2001 alone. Also, the percentage of people without equitable access to primary health services dropped by 15% between 1994 and 2000 in areas where health sector reform was implemented in 1995-1996, whereas areas that had not yet initiated health sector reform in 2000 experienced only a 3% reduction. Health sector reform significantly reduced mortality in Costa Rica and put an end to a decade of stagnation, as shown by certain health indicators, such as life expectancy. Equity in access to primary care improved considerably, perhaps because the first reforms were implemented in less developed areas of the country.

  11. South African mental health care service user views on priorities for supporting recovery: implications for policy and service development.

    PubMed

    Kleintjes, Sharon; Lund, Crick; Swartz, Leslie

    2012-01-01

    The paper documents the views of South African mental health care service users on policy directions and service developments that are required to support their recovery. Semi-structured interviews were conducted with forty service users and service user advocates. A framework analysis approach was used to analyse the qualitative data. Service user priorities included addressing stigma, discrimination and disempowerment, and the links between mental health and poverty. They suggested that these challenges be addressed through public awareness campaigns, legislative and policy reform for rights protection, development of a national lobby to advocate for changes, and user empowerment. Users suggested that empowerment can be facilitated through opportunities for improved social relatedness and equitable access to social and economic resources. This study suggests three strategies to bridge the gap between mental health care service users rights and needs on one hand, and unsupportive attitudes, policies and practices on the other. These are: giving priority to service user involvement in policy and service reform, creating empathic alliances to promote user priorities, and building enabling partnerships to effect these priorities.

  12. The effect of health payment reforms on cost containment in Taiwan hospitals: the agency theory perspective.

    PubMed

    Chang, Li

    2011-01-01

    This study aims to determine whether the Taiwanese government's implementation of new health care payment reforms (the National Health Insurance with fee-for-service (NHI-FFS) and global budget (NHI-GB)) has resulted in better cost containment. Also, the question arises under the agency theory whether the monitoring system is effective in reducing the risk of information asymmetry. This study uses panel data analysis with fixed effects model to investigate changes in cost containment at Taipei municipal hospitals before and after adopting reforms from 1989 to 2004. The results show that the monitoring system does not reduce information asymmetry to improve cost containment under the NHI-FFS. In addition, after adopting the NHI-GB system, health care costs are controlled based on an improved monitoring system in the policymaker's point of view. This may suggest that the NHI's fee-for-services system actually causes health care resource waste. The GB may solve the problems of controlling health care costs only on the macro side.

  13. Examining the health care payment reforms in Abu Dhabi.

    PubMed

    Hamidi, Samer; Akinci, Fevzi

    2015-01-01

    The purpose of this paper is to provide an overview of the current health care payment reforms in Abu Dhabi and discuss the potential impact of these reforms on health care consumers and providers as we all as long-term sustainability of the mandatory health care insurance system. A focused literature review was conducted to systematically identify and summarize relevant literature published on the recent payments reforms in Abu Dhabi along with a secondary review and analysis of existing related government documents, technical reports, and press releases by the Health Authority-Abu Dhabi (HAAD) and other relevant research groups. The implementation of the mandatory health insurance system allowed all UAE nationals and foreign workings in Abu Dhabi to have access to medical care insurance and access to care. Prospective payment reforms represent critical sustainability interventions for health care funding in Abu Dhabi. The full impact of payment reforms on affordability, system efficiency, and patient outcomes is yet to be documented. Given the Government of Abu Dhabi has identified the sustainability of healthcare funding as a key governmental policy, more research is needed to systematically examine the impact of the current payment reforms on multiple stakeholders. Copyright © 2014 John Wiley & Sons, Ltd.

  14. A Tentative Study on the Evaluation of Community Health Service Quality*

    NASA Astrophysics Data System (ADS)

    Ma, Zhi-qiang; Zhu, Yong-yue

    Community health service is the key point of health reform in China. Based on pertinent studies, this paper constructed an indicator system for the community health service quality evaluation from such five perspectives as visible image, reliability, responsiveness, assurance and sympathy, according to service quality evaluation scale designed by Parasuraman, Zeithaml and Berry. A multilevel fuzzy synthetical evaluation model was constructed to evaluate community health service by fuzzy mathematics theory. The applicability and maneuverability of the evaluation indicator system and evaluation model were verified by empirical analysis.

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

    PubMed

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

    2017-07-20

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

  16. Disparities in home health service providers among Medicare beneficiaries with stroke.

    PubMed

    Iyer, Medha; Bhavsar, Grishma P; Bennett, Kevin J; Probst, Janice C

    2016-01-01

    This study examined the intensity of home health services, as defined by the number of visits and service delivery by rehabilitation specialists, among Medicare beneficiaries with stroke. A cross-sectional secondary data analysis was conducted using 2009 home health claims data obtained from the Centers for Medicare and Medicaid Services' Research Data Assistance Center. There were no significant rural-urban differences in the number of home health visits. Rural beneficiaries were significantly less likely than urban beneficiaries to receive services from rehabilitation specialists. Current home health payment reform recommendations may have unintended consequences for rural home health beneficiaries who need therapy services.

  17. Costs and coverage. Pressures toward health care reform.

    PubMed Central

    Lee, P R; Soffel, D; Luft, H S

    1992-01-01

    Signs of discontent with the health care system are growing. Calls for health care reform are largely motivated by the continued increase in health care costs and the large number of people without adequate health insurance. For the past 20 years, health care spending has risen at rates higher than the gross national product. As many as 35 million people are without health insurance. As proposals for health care reform are developed, it is useful to understand the roots of the cost problem. Causes of spiraling health care costs include "market failure" in the health care market, expansion in technology, excessive administrative costs, unnecessary care and defensive medicine, increased patient complexity, excess capacity within the health care system, and low productivity. Attempts to control costs, by the federal government for the Medicare program and then by the private sector, have to date been mostly unsuccessful. New proposals for health care reform are proliferating, and important changes in the health care system are likely. PMID:1441510

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

    PubMed Central

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

    2012-01-01

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

  19. Assessing the quality of reproductive health services in Egypt via exit interviews.

    PubMed

    Zaky, Hassan H M; Khattab, Hind A S; Galal, Dina

    2007-05-01

    This study assesses the quality of reproductive health services using client satisfaction exit interviews among three groups of primary health care units run by the Ministry of Health and Population of Egypt. Each group applied a different model of intervention. The Ministry will use the results in assessing its reproductive health component in the health sector reform program, and benefits from the strengths of other models of intervention. The sample was selected in two stages. First, a stratified random sampling procedure was used to select the health units. Then the sample of female clients in each health unit was selected using the systematic random approach, whereby one in every two women visiting the unit was approached. All women in the sample coming for reproductive health services were included in the analysis. The results showed that reproductive health beneficiaries at the units implementing the new health sector reform program were more satisfied with the quality of services. Still there were various areas where clients showed significant dissatisfaction, such as waiting time, interior furnishings, cleanliness of the units and consultation time. The study showed that the staff of these units did not provide a conductive social environment as other interventions did. A significant proportion of women expressed their intention to go to private physicians owing to their flexible working hours and variety specializations. Beneficiaries were generally more satisfied with the quality of health services after attending the reformed units than the other types of units, but the generalization did not fully apply. Areas of weakness are identified.

  20. Reforming Central Government Health Scheme into a 'Universal Health Coverage' model.

    PubMed

    Sarwal, Rakesh

    2015-01-01

    Universal Health Coverage (UHC) is now recognized as a goal of all health systems, irrespective of income levels. In the absence of a one-size solution, each country has to develop strategies suited to its circumstances. How does the Central Government Health Scheme (CGHS) stand up to the goals and global experience of UHC, and what can be done to make it a model? I relied on publicly available documents to identify key features of UHC, and relate it to the architecture of and practices in CGHS. Combining WHO's framework of health systems functions with log frame approach, I constructed a 'UHC status tool' of key elements and expected norms of UHC. CGHS has been performing strongly on financing function and for the range of services covered. It has performed rather poorly on all other elements of UHC. I build the argument for continued public provision of health, as opposed to insurance, on grounds of cost, public good nature of outpatient care and public health services. I suggest and strategize a sequence of reforms in CGHS anchored in health system strengthening, governance and financing, comprehensive primary care and client participation. It is both possible and desirable to transform CGHS into a UHC model within the same fiscal space. Merger of finance pools of centrally administered health schemes is suggested as a step towards UHC in India. Copyright 2015, NMJI.

  1. The role of independent agents in the success of health insurance market reforms.

    PubMed

    Hall, M A

    2000-01-01

    The impact of reforms on the health insurance markets cannot be understood without more information about the role played by insurance agents and a closer analysis of their contribution. An in-depth, qualitative study of insurance-market reforms in seven illustrative states forms the basis for this report on how agents help to shape the efficiency and fairness of insurance markets. Different types of agents relate to insurers in their own ways and are compensated differently. This study shows agents to be almost uniformly enthusiastic about guaranteed-issue requirements and other components of market reforms. Although insurers devise strategies for manipulating agents in order to avoid undesirable business, these opportunities are limited and do not appear to be seriously undermining the effectiveness of market reforms. Despite the layer of cost that agents add to the system, they play an important role in making market reforms work, and they fill essential information and service functions for which many purchasers have no ready substitute.

  2. The Role of Independent Agents in the Success of Health Insurance Market Reforms

    PubMed Central

    Hall, Mark A.

    2000-01-01

    The impact of reforms on the health insurance markets cannot be understood without more information about the role played by insurance agents and a closer analysis of their contribution. An in-depth, qualitative study of insurance-market reforms in seven illustrative states forms the basis for this report on how agents help to shape the efficiency and fairness of insurance markets. Different types of agents relate to insurers in their own ways and are compensated differently. This study shows agents to be almost uniformly enthusiastic about guaranteed-issue requirements and other components of market reforms. Although insurers devise strategies for manipulating agents in order to avoid undesirable business, these opportunities are limited and do not appear to be seriously undermining the effectiveness of market reforms. Despite the layer of cost that agents add to the system, they play an important role in making market reforms work, and they fill essential information and service functions for which many purchasers have no ready substitute. PMID:10834080

  3. Public service or commodity goods? Electricity reforms, access, and the politics of development in Tanzania

    NASA Astrophysics Data System (ADS)

    Ghanadan, Rebecca Hansing

    Since the 1990s, power sector reforms have become paramount in energy policy, catalyzing a debate in Africa about market-based service provision and the effects of reforms on access. My research seeks to move beyond the conceptual divide by grounding attention not in abstract 'market forces' but rather in how development institutions shape energy services and actually practice policy on the ground. Using the case of Tanzania, a country known for having instituted some of the most extensive reforms and a 'success story' in Africa, I find that reforms are creating large burdens and barriers for access and use of services, including: increasing costs, enforcement pressures, and measures to impose 'market' discipline. However, I also find that many of the most significant outcomes are not found in direct 'market' changes, but rather how reforms are selective, partial, and shaped by the wider needs and claims of the institutions driving reforms, so that questions of how reforms are implemented, how they are measured, and who tells the story become as important as the policies themselves. Using a multiple-arenas framework, including (i) a household and community level study of urban energy conditions, (ii) a study of service and management conditions at the national electric utility, (iii) an examination of the international policy process, and (iv) a study of the history of electricity services across colonial, post-independence, and reform periods, I show that African energy reforms are a technical and political project connecting energy to international investments, donor aid programs, and elite interests within national governments. Energy reforms also involve fundamental service changes that are reorganizing how the costs and benefits of energy systems are distributed, allocated, and managed. The effects of reform extend beyond formal services to have wide-reaching repercussions within natural resources, and uneven social dynamics on the ground. These features point

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

    PubMed

    Ferrera, M

    1995-01-01

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

  5. Health reform in Mexico: the promotion of inequality.

    PubMed

    Laurell, A C

    2001-01-01

    The Mexican health reform can be understood only in the context of neoliberal structural adjustment, and it reveals some of the basic characteristics of similar reforms in the Latin American region. The strategy to transform the predominantly public health care system into a market-driven system has been a complex process with a hidden agenda to avoid political resistance. The compulsory social security system is the key sector in opening health care to private insurance companies, health maintenance organizations, and hospital enterprises mainly from abroad. Despite the government's commitment to universal coverage, equity, efficiency, and quality, the empirical data analyzed in this article do not confirm compliance with these objectives. Although an alternative health policy that gradually grants the constitutional right to health would be feasible, the new democratically elected government will continue the previous regressive health reform.

  6. Primary Health Care Reform in the cities of Lisbon and Rio de Janeiro: context, strategies, results, learning and challenges.

    PubMed

    Soranz, Daniel; Pisco, Luís Augusto Coelho

    2017-03-01

    On the 30th anniversary of Alma-Ata, the World Health Organization published in 2008 the "Primary Health Care Now More Than Ever" Report, calling on all governments to reflect on the need to reflect on four sets of reforms. These included: (i) universal coverage reforms; (ii) service delivery reforms; (iii) public policies reforms that would ensure healthier communities; and (iv) leadership reforms. In this context, in the period 2005-2016, the cities of Rio de Janeiro and Lisbon developed a profound primary healthcare reform, and did so by sharing many of the solutions based on the best internationally recognized organizational practices. Several factors were fundamental throughout Lisbon and Rio de Janeiro's path of reforms, namely: (i) teamwork with professional motivation; (ii) internal and external communication; (iii) strengthening of training activities; (iv) investment in facilities and equipment; (v) commitment to the information system and computerization; (vi) pay-for-performance; (vii) health care contractualisation between funders and providers; (viii) technical leadership; (ix) political leadership; and finally (x) quality and accreditation of facilities by public agency.

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

    PubMed

    Mitjavila, Myriam; Fernandez, José; Moreira, Constanza

    2002-01-01

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

  8. Overview of devolution of health services in the Philippines.

    PubMed

    Grundy, J; Healy, V; Gorgolon, L; Sandig, E

    2003-01-01

    In 1991 the Philippines Government introduced a major devolution of national government services, which included the first wave of health sector reform, through the introduction of the Local Government Code of 1991. The Code devolved basic services for agriculture extension, forest management, health services, barangay (township) roads and social welfare to Local Government Units. In 1992, the Philippines Government devolved the management and delivery of health services from the National Department of Health to locally elected provincial, city and municipal governments. The aim of this review is to (i) Provide a background to the introduction of devolution to the health system in the Philippines and to (ii) describe the impact of devolution on the structure and functioning of the health system in defined locations. International literature was reviewed on the subjects of decentralization. Rapid appraisals of health management systems were conducted in both provinces. Additional data were accessed from the rural health information system and previous consultant reports. Subsequent to the introduction of devolution, quality and coverage of health services declined in some locations, particularly in rural and remote areas. It was found that in 1992-1997, system effects included a breakdown in management systems between levels of government, declining utilization particularly in the hospital sector, poor staff morale, a decline in maintenance of infrastructure and under financing of operational costs of services. The aim of decentralization is to widen decision-making space of middle level managers, enhance resource allocations from central to peripheral areas and to improve the efficiency and effectiveness of health services management. The findings of the historical review of devolution in the Philippines reveals some consistencies with the international literature, which describe some negative effects of decentralization, and provide a rationale for the Philippines

  9. Health equity in an unequal country: the use of medical services in Chile

    PubMed Central

    2012-01-01

    Introduction A recent health reform was implemented in Chile (the AUGE reform) with the objective of reducing the socioeconomic gaps to access healthcare. This reform did not seek to eliminate the private insurance system, which coexists with the public one, but to ensure minimum conditions of access to the entire population, at a reasonable cost and with a quality guarantee, to cover an important group of health conditions. This paper’s main objective is to enquire what has happened with the use of several healthcare services after the reform was fully implemented. Methods Concentration and Horizontal Inequity indices were estimated for the use of general practitioners, specialists, emergency room visits, laboratory and x-ray exams and hospitalization days. The change in such indices (pre and post-reform) was decomposed, following Zhong (2010). A “mean effect” (how these indices would change if the differential use in healthcare services were evenly distributed) and a “distribution effect” (how these indices would change with no change in average use) were obtained. Results Changes in concentration indices were mainly due to mean effects for all cases, except for specialists (where “distribution effect” prevailed) and hospitalization days (where none of these effects prevailed over others). This implies that by providing more services across socioeconomic groups, less inequality in the use of services was achieved. On the other hand, changes in horizontal inequity indices were due to distribution effects in the case of GP, ER visits and hospitalization days; and due to mean effect in the case of x-rays. In the first three cases indices reduced their pro-poorness implying that after the reform relatively higher socioeconomic groups used these services more (in relation to their needs). In the case of x-rays, increased use was responsible for improving its horizontal inequity index. Conclusions The increase in the average use of healthcare services

  10. Health equity in an unequal country: the use of medical services in Chile.

    PubMed

    Paraje, Guillermo; Vásquez, Felipe

    2012-12-18

    A recent health reform was implemented in Chile (the AUGE reform) with the objective of reducing the socioeconomic gaps to access healthcare. This reform did not seek to eliminate the private insurance system, which coexists with the public one, but to ensure minimum conditions of access to the entire population, at a reasonable cost and with a quality guarantee, to cover an important group of health conditions. This paper's main objective is to enquire what has happened with the use of several healthcare services after the reform was fully implemented. Concentration and Horizontal Inequity indices were estimated for the use of general practitioners, specialists, emergency room visits, laboratory and x-ray exams and hospitalization days. The change in such indices (pre and post-reform) was decomposed, following Zhong (2010). A "mean effect" (how these indices would change if the differential use in healthcare services were evenly distributed) and a "distribution effect" (how these indices would change with no change in average use) were obtained. Changes in concentration indices were mainly due to mean effects for all cases, except for specialists (where "distribution effect" prevailed) and hospitalization days (where none of these effects prevailed over others). This implies that by providing more services across socioeconomic groups, less inequality in the use of services was achieved. On the other hand, changes in horizontal inequity indices were due to distribution effects in the case of GP, ER visits and hospitalization days; and due to mean effect in the case of x-rays. In the first three cases indices reduced their pro-poorness implying that after the reform relatively higher socioeconomic groups used these services more (in relation to their needs). In the case of x-rays, increased use was responsible for improving its horizontal inequity index. The increase in the average use of healthcare services after the AUGE reform has not always led to improved

  11. Health system reform and the role of field sites based upon demographic and health surveillance.

    PubMed Central

    Tollman, S. M.; Zwi, A. B.

    2000-01-01

    Field sites for demographic and health surveillance have made well-recognized contributions to the evaluation of new or untested interventions, largely through efficacy trials involving new technologies or the delivery of selected services, e.g. vaccines, oral rehydration therapy and alternative contraceptive methods. Their role in health system reform, whether national or international, has, however, proved considerably more limited. The present article explores the characteristics and defining features of such field sites in low-income and middle-income countries and argues that many currently active sites have a largely untapped potential for contributing substantially to national and subnational health development. Since the populations covered by these sites often correspond with the boundaries of districts or subdistricts, the strategic use of information generated by demographic surveillance can inform the decentralization efforts of national and provincial health authorities. Among the areas of particular importance are the following: making population-based information available and providing an information resource; evaluating programmes and interventions; and developing applications to policy and practice. The question is posed as to whether their potential contribution to health system reform justifies arguing for adaptations to these field sites and expanded investment in them. PMID:10686747

  12. Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.

    PubMed

    Huckfeldt, Peter J; Sood, Neeraj; Escarce, José J; Grabowski, David C; Newhouse, Joseph P

    2014-03-01

    Medicare continues to implement payment reforms that shift reimbursement from fee-for-service toward episode-based payment, affecting average and marginal payment. We contrast the effects of two reforms for home health agencies. The home health interim payment system in 1997 lowered both types of payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The home health prospective payment system in 2000 raised average but lowered marginal payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. The Public Mind: Views of Pennsylvania Citizens. Smoking, Education, Tax Reform, Crime Control, Welfare Reform, Health Care Reform. Report No. 6.

    ERIC Educational Resources Information Center

    Mansfield Univ., PA. Rural Services Inst.

    The sixth annual survey conducted by the Rural Services Institute examined the opinions of Pennsylvania residents on crime control, welfare reform, smoking, and education reform proposals. Sixty percent of respondents believed that the most urgent issue facing Pennsylvania was violent crime and strongly supported measures to reduce the…

  14. Enhanced Performance of Community Health Service Centers during Medical Reforms in Pudong New District of Shanghai, China: A Longitudinal Survey.

    PubMed

    Sun, Xiaoming; Li, Yanting; Liu, Shanshan; Lou, Jiquan; Ding, Ye; Liang, Hong; Gu, Jianjun; Jing, Yuan; Fu, Hua; Zhang, Yimin

    2015-01-01

    The performance of community health service centers (CHSCs) has not been well monitored and analysed since China's latest community health reforms in 2009. The aim of the current investigation was to evaluate the performing trends of the CHSCs and to analyze the main factors that could affect the performance in Pudong new district of Shanghai, China. A regional performance assessment indicator system was applied to the evaluation of Pudong CHSCs' performance from 2011 to 2013. All of the data were sorted out by a panel, and analyzed using descriptive statistics and a generalized estimating equation model. We found that the overall performance increased annually, with a growing number of CHSCs achieving high scores. Significant differences were observed in institutional management, public health services, basic medical services and comprehensive satisfaction during the period of three years. However, we found no differences in the service scores of Chinese traditional medicine (CTM). The investigation also demonstrated that the key factors affecting performance were the location, information system level, family GP program and medical association program rather than the size of the center. However, the medical association participation appeared to have a significant negative effect on performance. It can be concluded from the three-year investigation that the overall performance was improved, but that it could have been further enhanced, especially in institutional management and basic medical service; therefore, it is imperative that CHSCs undertake approaches such as optimizing the resource allocation and utilization, reinforcing the establishment of the information system level, extending the family GP program to more local communities, and promoting the medical association initiative.

  15. Neoliberal reforms in Swedish primary health care: for whom and for what purpose?

    PubMed

    Dahlgren, Göran

    2008-01-01

    The conservative government that came to power in Sweden in 2006 has initiated major market-oriented reforms in the health sector. Its first health care policy bill changed the health legislation to make it possible to sell/transfer public hospitals to commercial providers while maintaining public funding. Far-reaching market-oriented primary health care reforms are also initiated, for example in Stockholm County. They are typically presented as "free choice models" in which "the money follows the patient." The actual and likely effects of these reforms in terms of access and quality of care are discussed in this article. One main finding is that existing social inequities in geographic access to care not only are reinforced but also become very difficult to change by democratic political decisions. Furthermore, dynamic market forces will gradually reduce the quality of care in low-income areas while both access and quality of care will be even better in high-income areas. Public funds are thus transferred from people living in low-income areas to people living in high-income areas, even though the need for good health services is much greater in the low-income areas. Certain policy options for reversing the inverse law of care are also presented.

  16. State 'laboratories' test health care reform solutions.

    PubMed

    Elliott, B A

    1993-02-01

    Widely recognized by the states as a pressing policy issue, health care reform appears to have moved up on the national policy agenda as well. President Clinton has promised to address the issue during his first 100 days in office. Previously, however, the federal government has been deadlocked on health care reform, leaving the states to become the laboratories for developing and testing proposed solutions to our health care crisis. By passing MinnesotaCare in last year's legislative session, Minnesota joined the growing number of states attempting to provide access to affordable, quality health care to their citizens.

  17. The Implementation of the Full Service School Reform Model and Its Impact on Middle School Climate and Student Achievement: An Investigative Study

    ERIC Educational Resources Information Center

    Johnson, Joseph Hamilton

    2012-01-01

    The Full Service Schools (FSS) reform model is an inter-agency collaboration between the District of Columbia Public Schools (DCPS), Choices, Inc., Insights Education Group and the DC Department of Mental Health. This comprehensive school reform model is based in the Response to Intervention paradigm and is designed to mitigate student academic…

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

    PubMed

    West, Emily

    2014-01-01

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

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

    PubMed

    Häkkinen, Unto; Lehto, Juhani

    2005-01-01

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

  20. National health care reform and the 103rd Congress: the activities and influence of public health advocates.

    PubMed Central

    Schauffler, H; Wilkerson, J

    1997-01-01

    OBJECTIVES: This study examined the activities and influence of public health interest groups and coalitions on the national health care reform debates in the 103rd Congress. METHODS: Congressional staff and representatives of public health interest groups, coalitions, and government health agencies were interviewed. Content analysis of eight leading national health care reform bills was performed. RESULTS: The public health community coalesced around public health in health care reform; nearly all the major interest groups and government health agencies joined two or more public health or prevention coalitions, and half joined three or more. The most effective influence on health care reform legislation was early, sustained personal contact with Congress members and their staffs, accompanied by succinct written materials summarizing key points. Media campaigns and grassroots mobilization were less effective. Seven of the eight leading health care reform bills included one or more of the priorities supported by public health advocates. CONCLUSIONS: The public health community played an important role in increasing awareness and support for public health programs in the health care reform bills of the 103rd Congress. PMID:9240098

  1. Impacts of the Interim Federal Health Program reforms: A stakeholder analysis of barriers to health care access and provision for refugees.

    PubMed

    Antonipillai, Valentina; Baumann, Andrea; Hunter, Andrea; Wahoush, Olive; O'Shea, Timothy

    2017-11-09

    Changes to the Interim Federal Health Program (IFHP) in 2012 reduced health care access for refugees and refugee claimants, generating concerns among key stakeholders. In 2014, a new IFHP temporarily reinstated access to some health services; however, little is known about these changes, and more information is needed to map the IFHP's impact. This study explores barriers occurring during the time period of the IFHP reforms to health care access and provision for refugees. A stakeholder analysis, using 23 semi-structured interviews, was conducted to obtain insight into stakeholder perceptions of the 2014 reforms, as well as stakeholders' position and their influence to assess the acceptability of the IFHP changes. The majority of stakeholders expressed concerns about the 2014 IFHP changes as a result of the continuing barriers posed by the 2012 retrenchments and the emergence of new barriers to health care access and provision for refugees. Key barriers identified included lack of communication and awareness, lack of continuity and comprehensive care, negative political discourse and increased costs. A few stakeholders supported the reforms as they represented some, but limited, access to health care. Overall, the reforms to the IFHP in 2014 generated barriers to health care access and provision that contributed to confusion among stakeholders, the transfer of refugee health responsibility to provincial authorities and the likelihood of increased health outcome disparities, as refugees and refugee claimants chose to delay seeking health care. The study recommends that policy-makers engage with refugee health stakeholders to formulate a policy that improves health care provision and access for refugee populations.

  2. Health Reforms as Examples of Multilevel Interventions in Cancer Care

    PubMed Central

    Fennell, Mary L.; Devers, Kelly J.

    2012-01-01

    To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation’s health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform. PMID:22623600

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

    PubMed

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

    2012-05-01

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

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

    PubMed

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

    2016-09-01

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

  5. The impact of health insurance reform on insurance instability.

    PubMed

    Freund, Karen M; Isabelle, Alexis P; Hanchate, Amresh D; Kalish, Richard L; Kapoor, Alok; Bak, Sharon; Mishuris, Rebecca G; Shroff, Swati M; Battaglia, Tracy A

    2014-02-01

    We investigated the impact of the 2006 Massachusetts health care reform on insurance coverage and stability among minority and underserved women. We examined 36 months of insurance claims among 1,946 women who had abnormal cancer screening at six community health centers pre-(2004-2005) and post-(2007-2008) insurance reform. We examined frequency of switches in insurance coverage as measures of longitudinal insurance instability. On the date of their abnormal cancer screening test, 36% of subjects were publicly insured and 31% were uninsured. Post-reform, the percent ever uninsured declined from 39% to 29% (p .001) and those consistently uninsured declined from 23% to 16%. To assess if insurance instability changed between the pre- and post-reform periods, we conducted Poisson regression models, adjusted for patient demographics and length of time in care. These revealed no significant differences from the pre- to post-reform period in annual rates of insurance switches, incident rate ratio 0.98 (95%- CI 0.88-1.09). Our analysis is limited by changes in the populations in the pre- and post-reform period and inability to capture care outside of the health system network. Insurance reform increased stability as measured by decreasing uninsured rates without increasing insurance switches.

  6. Commentary: health care payment reform and academic medicine: threat or opportunity?

    PubMed

    Shomaker, T Samuel

    2010-05-01

    Discussion of the flaws of the current fee-for-service health care reimbursement model has become commonplace. Health care costs cannot be reduced without moving away from a system that rewards providers for providing more services regardless of need, effectiveness, or quality. What alternatives are likely under health care reform, and how will they impact the challenged finances of academic medical centers? Bundled payment methodologies, in which all providers rendering services to a patient during an episode of care split a global fee, are gaining popularity. Also under discussion are concepts like the advanced medical home, which would establish primary care practices as a regular source of care for patients, and the accountable care organization, under which providers supply all the health care services needed by a patient population for a defined time period in exchange for a share of the savings resulting from enhanced coordination of care and better patient outcomes or a per-member-per-month payment. The move away from fee-for-service reimbursement will create financial challenges for academic medicine because of the threat to clinical revenue. Yet academic health centers, because they are in many cases integrated health care organizations, may be aptly positioned to benefit from models that emphasize coordinated care. The author also has included a series of recommendations for how academic medicine can prepare for the implementation of new payment models to help ease the transition away from fee-for-service reimbursement.

  7. Seeing difference: market health reform in Europe.

    PubMed

    Jacobs, A

    1998-02-01

    The comparative literature on health care reform has identified a convergence upon market models as nations respond to similar economic, technological, social, and demographic pressures. In this article I first challenge the conventional view by comparing "market" reforms of the late 1980s and early 1990s in the United Kingdom, the Netherlands, and Sweden. Though these nations did indeed converge upon the instrument of the market incentive, there was considerable divergence in the content and aims of their reform strategies. These nations designed their respective markets to make different tradeoffs among competing values. While all three exploited the principle of provider competition, they appointed different actors to judge the contest: the cost-conscious public authority in the United Kingdom, the quality-conscious patient in Sweden, and the optimizing consumer in the Netherlands. I argue that these countries were thus using common market tools to promote different health policy goals. Distinguishing these reforms further is the fact that--particularly in the Netherlands--there was a gap between market plans and the reality of implemented change. I then ask why nations responded so differently to such similar objective pressures. My contention is that this divergence reflects, in part, the different ideological orientations of the ruling party or coalition in each nation. Yet divergence is also the result of differences in both the design of political institutions and the structure of the pre-reform health system in each country.

  8. Economic growth and health progress in Italy: 30 years of National Health Service.

    PubMed

    Vannelli, Alberto; Buongiorno, Massimo; Zanardo, Michele; Basilico, Valerio; Capriata, Giulio; Rossi, Fabrizio; Pruiti, Vincenzo; Battaglia, Luigi

    2012-01-01

    On December 23 of 1978, during first Italian recession since the end of World War II, Parliament voted for Law 833 that gives birth to the Italian National Public Health Services (SSN) as the new and alternative model of health care system. It was the beginning of the match of Italian health care with the world class level of the public health care. Each crisis requires solidarity and actions. Maintaining levels of health and other social expenditures is critical to protect life and livelihood and to boost productivity. The purpose of the present study is to establish an alternative point of view to demonstrate that Gross Domestic Product, is a function of health care expenditure. The chronology of the events was created by using the laws published on "Gazzetta Ufficiale" (GU). In order to analyze the corporate effectiveness and efficiency, we have divided the SSN into its three main components, namely resources (input), services (output) and performances (outcome). Health services have certainly been pioneers and are still today standard-bearers of a challenge which has borne its fruits. According to the "Organization for Economic Co-operation and Development", SSN ranks second in the world classification of the return on the health care services in 2000. The World Health Organization has published in 2005 the same result: SSN ranks second in the world for ability and quality of the health care in relationship to the resources invested The continuous reforms of health care system introduced stability to the Italian system more than others countries. Success of SSN function rooted in the ability of system to adapt assuring mechanism of positive feed-back correction. In the future SSN, will required new set of reforms, such as redefinition of structures and mechanisms of governance, strategic plans, clinical administrations.

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

    PubMed Central

    Molfenter, Todd D.

    2013-01-01

    The Patient Protection and Affordable Care Act (PPACA) is expected to significantly alter addiction treatment service delivery. Researchers designed the Health Reform Readiness Index (HRRI) for addiction treatment organizations to assess their readiness for the PPACA. Four-hundred twenty-seven organizations completed the HRRI throughout a three-year period, using a four-point scale to rank their readiness on 13 conditions. HRRI results completed during two different time periods (between 10/1/2010–6/30/2011 and 9/1/2011–9/30/2012) were analyzed and compared. Most respondents self-assessed as being in the early stages of preparation for 9 of the 13 conditions. Survey results showed that organizations with annual budgets <$5 million (n = 295) were less likely to be prepared for the PPACA than organizations with annual budgets >$5 million (n = 132). The HRRI results suggest that the addiction field, and in particular smaller organizations, is not preparing adequately for health care reform; organizations that are making preparations are making only modest gains. PMID:24074851

  10. Income-related inequality and inequity in the use of dental services in Finland after a major subsidization reform.

    PubMed

    Raittio, Eero; Kiiskinen, Urpo; Helminen, Sari; Aromaa, Arpo; Suominen, Anna Liisa

    2015-06-01

    In Finland, a major oral healthcare reform (OHCR), implemented during 2001-2002, opened the public dental services (PDS) and extended subsidies for private dental services to entire adult population. Before the reform, adults born earlier than 1956 were not entitled to use PDS nor did they receive any reimbursements for their private dental costs. We aimed to examine changes in the income-related inequality and inequity in the use of dental services among the adult Finns after the reform. Representative data from Finnish adults born in 1970 or earlier were gathered from three identical postal surveys concerning the use of dental services and subjective perceptions of oral health. Those surveys were conducted before the OHCR in 2001 (n = 1907) and after the OHCR in 2004 (n = 1629) and 2007 (n = 1509). We used concentration index and its decomposition to analyse income-related inequality and inequity in the use of dental services and factors associated with them. Results showed that pro-rich inequality and inequity in the overall use of dental services narrowed from 2001 to 2004. However, between 2004 and 2007, pro-rich inequality and inequity widened, so it returned to a rather similar level in 2007 as it had been in 2001. Most of the pro-rich inequality and inequity were related to regular dental visiting habit and income level. While there was pro-poor inequality and inequity in the use of PDS, there was pro-rich inequality and inequity in the use of private dental services throughout the study years. It seems that income-related inequality and inequity in the use of dental services narrowed only temporarily after the reform. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Expected Impact of Health Care Reform on the Organization and Service Delivery of Publicly Funded Addiction Health Services.

    PubMed

    Guerrero, Erick G; Harris, Lesley; Padwa, Howard; Vega, William A; Palinkas, Lawrence

    2017-07-01

    Little is known about how the Affordable Care Act (ACA) will be implemented in publicly funded addiction health services (AHS) organizations. Guided by a conceptual model of implementation of new practices in health care systems, this study relied on qualitative data collected in 2013 from 30 AHS clinical supervisors in Los Angeles County, California. Interviews were transcribed, coded, and analyzed using a constructivist grounded theory approach with ATLAS.ti software. Supervisors expected several potential effects of ACA implementation, including increased use of AHS services, shifts in the duration and intensity of AHS services, and workforce professionalization. However, supervisors were not prepared for actions to align their programs' strategic change plans with policy expectations. Findings point to the need for health care policy interventions to help treatment providers effectively respond to ACA principles of improving standards of care and reducing disparities.

  12. Expected Impact of Health Care Reform on the Organization and Service Delivery of Publicly Funded Addiction Health Services

    PubMed Central

    Harris, Lesley; Padwa, Howard; Vega, William A.; Palinkas, Lawrence

    2015-01-01

    Little is known about how the Affordable Care Act (ACA) will be implemented in publicly funded addiction health services (AHS) organizations. Guided by a conceptual model of implementation of new practices in health care systems, this study relied on qualitative data collected in 2013 from 30 AHS clinical supervisors in Los Angeles County, California. Interviews were transcribed, coded, and analyzed using a constructivist grounded theory approach with ATLAS.ti software. Supervisors expected several potential effects of ACA implementation, including increased use of AHS services, shifts in the duration and intensity of AHS services, and workforce professionalization. However, supervisors were not prepared for actions to align their programs’ strategic change plans with policy expectations. Findings point to the need for health care policy interventions to help treatment providers effectively respond to ACA principles of improving standards of care and reducing disparities. PMID:26008902

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

    PubMed

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

    2012-06-01

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

  14. Towards a comparative analysis of health systems reforms in the Asia-Pacific Region.

    PubMed

    Phua, Kai Hong; Chew, Amelia Huibin

    2002-01-01

    The paper will review a representative selection of health systems reforms throughout the Asia-Pacific region to summarise the regional experience, identify the key lessons learnt from innovative health reforms and propose policy recommendations for sustainable health systems development. Broad descriptive trends of health systems reforms will be compared across the Asia-Pacific region within the context of rapid demographic, health and socio-economic development. More specifically, the study will address the following questions: 1. What are the main features of innovative health systems reforms? 2. How have these reforms affected the health systems? 3. Are there lessons and other implications from these reforms? A common conceptual framework to compare health systems reforms is adopted, using a standardised format to report data of national health systems. A classification of health systems is constructed by categorising them according to the level of development of their respective economies: 1) Developed 2 )High Performing 3) Newly Industrialising 4) Transitional, and 5) Developing. A typology of common issues, challenges and responses are generalised for these health systems at different stages of socio-economic development of individual countries. Evaluative criteria are proposed to compare the long-term effects of these reforms on national health systems in terms of efficiency, equity, quality and sustainability.

  15. Situational analysis of the health insurance market and related educational needs in the era of health care reform in Thailand.

    PubMed

    Sriratanaban, J; Supapong, S; Kamolratanakul, P; Tatiyakawee, K; Srithamrongsawat, S

    2000-12-01

    The purposes of this study were to explore the situation of health insurance in Thailand, to compare public and private perspectives and to identify related educational needs. Between March and April of 1998, the study employed in-depth interviews of 12 public and private major stakeholders of the health insurance systems, including policy makers, providers and insurers. Additional inputs were gathered in a brainstorming session with 41 participants from organizations with important roles in regulating, monitoring, paying, or providing health care services, as well as research and education. The findings indicated the health insurance market was expanding. But there was no national policy on health insurance. Insurance-related law was outdated. Public and private schemes overlapped, and were generally characterized by inadequate risk diversification, overutilization of services, lack of effective cost containment, inconsistent service quality, and poor understanding of health insurance principles. There were needs for more education and training in various aspects of health services management and health-insurance related functions. Consequently, continuing education and training related to health insurance services for policy makers, system administrators, managers, providers and insurers are strongly recommended during the health-care reform process.

  16. [Desperately seeking decentralisation: Mexican health policies in two periods of reform: the 1920s-30s and the 1980s].

    PubMed

    Birn, Anne-Emannuelle

    2005-01-01

    This article compares public health policy reforms in Mexico during the 1920s and 1930s with subsequent reforms initiated in the 1980s. The attempts at decentralization in the 1920s-30s were supported by the Rockefeller Foundation, which was interested in the formation of local cooperative health units. In the 1980s, the aim of the Mexican government and international financial agencies, such as the Inter-American Development Bank, was to reduce public spending (as part of "structural adjustment" policies). One of the hypotheses of this article is that, in the end, the public health reforms were unable to overcome the limitations imposed by Mexico's political centralization and longstanding inequities in public spending. At the same time, one of the unforeseen achievements of these reforms was an increase in local capabilities to demand a better distribution of social services.

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

    PubMed

    Tokarski, C

    1992-01-01

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

  18. Providing Primary Health Care to Children: Integrating Primary Care Services with Health Insurance Principles.

    ERIC Educational Resources Information Center

    Rosenbaum, Sara

    1993-01-01

    Examines how health care reform might be structured to provide support for a package of primary care services for children of all socioeconomic strata. An insurance-like financing system, such as the special Medicaid payment system adopted by New York State for public and nonprofit primary health care programs, may be useful as a model for a…

  19. Mental health reform in Georgia, 1992 to 1996.

    PubMed

    Elliott, R L

    1996-11-01

    In 1992 Georgia embarked on an ambitious reform of its public mental health system. Regional mental health authorities were created with consumers and family members as decision makers. Reform legislation required that hospital and community funds be combined to provide for flexible shifting of funds to communities as use of state hospitals decreased. However, after four years and at a cost of almost $15 million, few tangible results can be demonstrated. In fact, hospital admissions have increased since 1991. Further, a proposal for a Medicaid section 1115 waiver that would permit managed care organizations to assume responsibility for key decisions threatens to undermine the decision-making authority of regional mental health authorities. This paper summarizes the background leading to Georgia's reform, reviews its accomplishments, and suggests lessons to be gained from Georgia's experiences.

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

    PubMed Central

    Homedes, Núria; Ugalde, Antonio

    2005-01-01

    Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies – decentralization and privatization – have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside. PMID:15659241

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

    PubMed

    Herrera, Tania; Sánchez, Sergio

    2014-11-26

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

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

    PubMed

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

    2014-08-09

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

  3. Health sector reform in the Occupied Palestinian Territories (OPT): targeting the forest or the trees?

    PubMed Central

    GIACAMAN, RITA; ABDUL-RAHIM, HANAN F; WICK, LAURA

    2006-01-01

    Since the signing of the Oslo Peace Accords and the establishment of the Palestinian Authority in 1994, reform activities have targeted various spheres, including the health sector. Several international aid and UN organizations have been involved, as well as local and international non-governmental organizations, with considerable financial and technical investments. Although important achievements have been made, it is not evident that the quality of care has improved or that the most pressing health needs have been addressed, even before the second Palestinian Uprising that began in September 2000. The crisis of the Israeli re-invasion of Palestinian-controlled towns and villages since April 2002 and the attendant collapse of state structures and services have raised the problems to critical levels. This paper attempts to analyze some of the obstacles that have faced reform efforts. In our assessment, those include: ongoing conflict, frail Palestinian quasi-state structures and institutions, multiple and at times inappropriate donor policies and practices in the health sector, and a policy vacuum characterized by the absence of internal Palestinian debate on the type and direction of reform the country needs to take. In the face of all these considerations, it is important that reform efforts be flexible and consider realistically the political and economic contexts of the health system, rather than focus on mere narrow technical, managerial and financial solutions imported from the outside. PMID:12582108

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

    PubMed

    Sakyi, E Kojo

    2008-01-01

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

  5. Key findings from HSC's 2010 site visits: health care markets weather economic downturn, brace for health reform.

    PubMed

    Felland, Laurie E; Grossman, Joy M; Tu, Ha T

    2011-05-01

    Lingering fallout--loss of jobs and employer coverage--from the great recession slowed demand for health care services but did little to slow aggressive competition by dominant hospital systems for well-insured patients, according to key findings from the Center for Studying Health System Change's (HSC) 2010 site visits to 12 nationally representative metropolitan communities. Hospitals with significant market clout continued to command high payment rate increases from private insurers, and tighter hospital-physician alignment heightened concerns about growing provider market power. High and rising premiums led to increasing employer adoption of consumer-driven health plans and continued increases in patient cost sharing, but the broader movement to educate and engage consumers in care decisions did not keep pace. State and local budget deficits led to some funding cuts for safety net providers, but an influx of federal stimulus funds increased support to community health centers and shored up Medicaid programs, allowing many people who lost private insurance because of job losses to remain covered. Hospitals, physicians and insurers generally viewed health reform coverage expansions favorably, but all worried about protecting revenues as reform requirements phase in.

  6. Commentary: Medicaid reform issues affecting the Indian health care system.

    PubMed Central

    Wellever, A; Hill, G; Casey, M

    1998-01-01

    Substantial numbers of Indian people rely on Medicaid for their primary health insurance coverage. When state Medicaid programs enroll Indians in managed care programs, several unintended consequences may ensue. This paper identifies some of the perverse consequences of Medicaid reform for Indians and the Indian health care system and suggests strategies for overcoming them. It discusses the desire of Indian people to receive culturally appropriate services, the need to maintain or improve Indian health care system funding, and the duty of state governments to respect tribal sovereignty. Because of their relatively small numbers, Indians may be treated differently under Medicaid managed care systems without significantly endangering anticipated program savings. Failure of Medicaid programs to recognize the uniqueness of Indian people, however, may severely weaken the Indian health care system. PMID:9491006

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

    PubMed

    Ritchie, D

    1998-08-01

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

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

    PubMed

    Theurl, E

    1999-01-01

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

  9. Issue ads and the health reform debate.

    PubMed

    Bergan, Daniel; Risner, Genevieve

    2012-06-01

    The public debate over health care reform in 2009 was carried out partly through issue advertisements aired online and on television. Did these advertisements alter the course of the debate over health care reform? While millions of dollars are spent each year on issue ads, little is known about their effects. Results from a naturalistic online experiment on the effects of issue ads suggest that they can influence the perceived importance of an issue and perceptions of politicians associated with the featured policy while influencing policy support only among those low in political awareness.

  10. The National Health Services of Brazil and Northern Europe: Universality, Equity, and Integrality-Time Has Come for the Latter.

    PubMed

    Gurgel, Garibaldi D; de Sousa, Islândia M Carvalho; de Araujo Oliveira, Sydia Rosana; de Assis da Silva Santos, Francisco; Diderichsen, Finn

    2017-10-01

    In 1990 the national health services in the United Kingdom and Sweden started to split up in internal markets with purchasers and providers. It was also the year when Brazil started to implement a national health service (SUS) inspired by the British national health service that aimed at principles of universality, equity, and integrality. While the reform in Brazil aimed at improving equity and effectiveness, reforms in Europe aimed at improving efficiency in order to contain costs. The European reforms increased supply and utilization but never provided the large increase in efficiency that was hoped for, and inequities have increased. The health sector reform in Brazil, on the other hand, contributed to great improvements in population health but never succeeded in changing the fact that more than half of health care spending was private. Demographic and epidemiological changes, with more elderly people having chronic disorders and very unequal comorbidities, bring the issue of integrality in the forefront in all 3 countries, and neither the public purchaser provider markets nor the 2-tier system in Brazil delivers on that front. It will demand political leadership and strategic planning with population responsibility to deal with such challenges.

  11. Health and social security reforms in Latin America: the convergence of the World Health Organization, the World Bank, and transnational corporations.

    PubMed

    Armada, F; Muntaner, C; Navarro, V

    2001-01-01

    International financial institutions have played an increasing role in the formation of social policy in Latin American countries over the last two decades, particularly in health and pension programs. World Bank loans and their attached policy conditions have promoted several social security reforms within a neoliberal framework that privileges the role of the market in the provision of health and pensions. Moreover, by endorsing the privatization of health services in Latin America, the World Health Organization has converged with these policies. The privatization of social security has benefited international corporations that become partners with local business elites. Thus the World Health Organization, international financial institutions, and transnational corporations have converged in the neoliberal reforms of social security in Latin America. Overall, the process represents a mechanism of resource transfer from labor to capital and sheds light on one of the ways in which neoliberalism may affect the health of Latin American populations.

  12. Health care reform and people with disabilities.

    PubMed

    Batavia, A I

    1993-01-01

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

  13. Welfare Reform and Health

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  14. Preparing for a public sector mental health reform in New Mexico: the experience of agencies serving adults with serious mental illness.

    PubMed

    Semansky, Rafael M; Hodgkin, Dominic; Willging, Cathleen E

    2012-06-01

    In 2005, New Mexico began a comprehensive reform of state-funded mental health care. This paper reports on differences in characteristics, infrastructure, financial status, and services across mental health agencies. We administered a telephone survey to senior leadership to assess agency status prior to and during the first year of reform. Non-profit/public agencies were more likely than others to report reductions or no changes in administrative staff. CMHCs were more likely to report a decline in their financial situation. Findings demonstrated that CMHCs, non-profit/public agencies and rural agencies were more likely to offer critical services to adults with serious mental illness.

  15. Where does the insurance industry stand on health reform today?

    PubMed

    Bodaken, Bruce G

    2008-01-01

    With another national health care debate on the horizon, many assume that health plans will present a major source of opposition to universal coverage and other reforms. But a closer look reveals signs of change. Some plans continue their reflexive opposition to increasing government's role in health care; other plans have stepped forward to advocate meaningful reform. Experience in Massachusetts, California, Minnesota, and elsewhere suggests a clear lesson for policymakers. Sensible proposals and a genuine commitment to cooperation can not only neutralize opposition from a potentially powerful opponent, but can actually bring health plans on board to support coverage mandates, guaranteed issue, and other reforms.

  16. Ecologically Oriented School-Based Mental Health Services: Implications for Service System Reform.

    ERIC Educational Resources Information Center

    Motes, Patricia Stone; Melton, Gary; Simmons, Wendy E. Waithe; Pumariega, Andres

    1999-01-01

    Describes an integrated school-based mental health services model established in pilot schools in under-served areas of South Carolina. States the approach bridges preventive efforts across settings, and links interventions with youths and their families to changes in environments and systems. Reports that findings are supportive of a broad…

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

    PubMed

    van den Heever, Alexander Marius

    2016-12-01

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

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

    PubMed

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

    2018-03-01

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

  19. What was the programme theory of New Labour's Health System Reforms?

    PubMed

    Millar, Ross; Powell, Martin; Dixon, Anna

    2012-01-01

    To examine whether the Health System Reforms delivered the promise of being a coherent and mutually supporting reform programme; to identify the underlying programme theory of the reform programme; to reflect on whether lessons have been learned. Documentary analysis mapping the implicit and explicit programme theories about how the reforms intended to achieve its goals and outcomes. Semi-structured interviews with policy-makers to further understand the programme theory. The Health System Reforms assumed a 'one size fits all' approach to policy implementation with little recognition that some contexts can be more receptive than others. There was evidence of some policy evolution and rebalancing between the reform streams as policy-makers became aware of some perverse incentives and unforeseen consequences. Later elements aimed to restore balance to the system. The Health System Reforms do not appear to comprise a coherent and mutually supportive set of levers and incentives. They appear unbalanced with the centre of gravity favouring suppliers over commissioners. However, recent reform changes have sought to redress this imbalance to some extent, suggesting that lessons have been learned and policies have been adapted over time.

  20. The French prescription for health care reform.

    PubMed

    Segouin, C; Thayer, C

    1999-01-01

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

  1. Health care reform: motivation for discrimination?

    PubMed

    Navin, J C; Pettit, M A

    1995-01-01

    One of the major issues in the health care reform debate is the requirement that employers pay a portion of their employees' health insurance premiums. This paper examines the method for calculating the employer share of the health care premiums, as specified in the President's health care reform proposal. The calculation of the firm's cost of providing employee health care benefits is a function of marital status as well as the incidence of two-income earner households. This paper demonstrates that this method provides for lower than average premiums for married employees with no dependents in communities in which there is at least one married couple where both individuals participate in the labor market. This raises the non-wage labor costs of employing single individuals relative to individuals which are identical in every respect except their marital status. This paper explores the economic implications for hiring, as well as profits, for firms located in a perfectly-competitive industry. The results of the theoretical model presented here are clear. Under this proposed version of health care reform, ceteris paribus, firms have a clear preference for two-earner households. This paper also demonstrates that the incentive to discriminate is related to the size of the firm and to the size of the average wage of full-time employees for firms which employ fewer than fifty individuals. While this paper examines the specifics of President Clinton's original proposal, the conclusions reached here would apply to any form of employer-mandated coverage in which the premiums are a function of family status and the incidence of two-earner households.

  2. Rural vs urban hospital performance in a 'competitive' public health service.

    PubMed

    Garcia-Lacalle, Javier; Martin, Emilio

    2010-09-01

    In some western countries, market-driven reforms to improve efficiency and quality have harmed the performance of some hospitals, occasionally leading to their closure, mostly in rural areas. This paper seeks to explore whether these reforms affect urban and rural hospitals differently in a European health service. Rural and urban hospital performance is compared taking into account their efficiency and perceived quality. The study is focused on the Andalusian Health Service (SAS) in Spain, which has implemented a freedom of hospital choice policy and a reimbursement system based on hospital performance. Data Envelopment Analysis, the Mann-Whitney U test and Multidimensional Scaling techniques are conducted for two years, 2003 and 2006. The results show that rural and urban hospitals perform similarly in the efficiency dimension, whereas rural hospitals perform significantly better than urban hospitals in the patient satisfaction dimension. When the two dimensions are considered jointly, some rural hospitals are found to be the best performers. As such, market-driven reforms do not necessary result in a difference in the performance of rural and urban hospitals. Copyright 2010 Elsevier Ltd. All rights reserved.

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

    PubMed Central

    Hoffman, Beatrix

    2003-01-01

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

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

    PubMed

    Anell, A

    1996-07-01

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

  5. Accomplishing reform: successful case studies drawn from the health systems of 60 countries.

    PubMed

    Braithwaite, Jeffrey; Mannion, Russell; Matsuyama, Yukihiro; Shekelle, Paul; Whittaker, Stuart; Al-Adawi, Samir; Ludlow, Kristiana; James, Wendy; Ting, Hsuen P; Herkes, Jessica; Ellis, Louise A; Churruca, Kate; Nicklin, Wendy; Hughes, Clifford

    2017-10-01

    Healthcare reform typically involves orchestrating a policy change, mediated through some form of operational, systems, financial, process or practice intervention. The aim is to improve the ways in which care is delivered to patients. In our book 'Health Systems Improvement Across the Globe: Success Stories from 60 Countries', we gathered case-study accomplishments from 60 countries. A unique feature of the collection is the diversity of included countries, from the wealthiest and most politically stable such as Japan, Qatar and Canada, to some of the poorest, most densely populated or politically challenged, including Afghanistan, Guinea and Nigeria. Despite constraints faced by health reformers everywhere, every country was able to share a story of accomplishment-defining how their case example was managed, what services were affected and ultimately how patients, staff, or the system overall, benefited. The reform themes ranged from those relating to policy, care coverage and governance; to quality, standards, accreditation and regulation; to the organization of care; to safety, workforce and resources; to technology and IT; through to practical ways in which stakeholders forged collaborations and partnerships to achieve mutual aims. Common factors linked to success included the 'acorn-to-oak tree' principle (a small scale initiative can lead to system-wide reforms); the 'data-to-information-to-intelligence' principle (the role of IT and data are becoming more critical for delivering efficient and appropriate care, but must be converted into useful intelligence); the 'many-hands' principle (concerted action between stakeholders is key); and the 'patient-as-the-pre-eminent-player' principle (placing patients at the centre of reform designs is critical for success). © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care.

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

    PubMed

    Adams, Owen

    2015-09-04

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

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

    PubMed

    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

  8. The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States

    PubMed Central

    Rodwin, Victor G.

    2003-01-01

    The French health system combines universal coverage with a public–private mix of hospital and ambulatory care and a higher volume of service provision than in the United States. Although the system is far from perfect, its indicators of health status and consumer satisfaction are high; its expenditures, as a share of gross domestic product, are far lower than in the United States; and patients have an extraordinary degree of choice among providers. Lessons for the United States include the importance of government’s role in providing a statutory framework for universal health insurance; recognition that piecemeal reform can broaden a partial program (like Medicare) to cover, eventually, the entire population; and understanding that universal coverage can be achieved without excluding private insurers from the supplementary insurance market. PMID:12511380

  9. Challenging the neoliberal trend: the Venezuelan health care reform alternative.

    PubMed

    Muntaner, Carles; Salazar, René M Guerra; Rueda, Sergio; Armada, Francisco

    2006-01-01

    Throughout the 1990s, all Latin American countries but Cuba implemented to varying degrees health care sector reforms underpinned by a neoliberal paradigm that redefined health care as less of a social right and more of a market commodity. These health care sector reforms were couched in the broader structural adjustment of Latin American welfare states prescribed consistently by international financial institutions since the mid-1980s. However, since 2003, Venezuela has been developing an alternative to this neoliberal trend through its health care reform program called Misión Barrio Adentro (Inside the Neighbourhood). In this article, we introduce Misión Barrio Adentro in its historical, political, and economic contexts. We begin by analyzing Latin American neoliberal health sector reforms in their political economic context, with a focus on Venezuela. The analysis reveals that the major beneficiaries of both broader structural adjustment of Latin American welfare states and neoliberal health reforms have been transnational capital interests and domestic Latin American elites. We then provide a detailed description of Misión Barrio Adentro as a challenge to neoliberalism in health care in its political economic context, noting the role played in its development by popular resistance to neoliberalism and the unique international cooperation model upon which it is based. Finally, we suggest that the Venezuelan experience may offer valuable lessons not only to other low- to middle-income countries, but also to countries such as Canada.

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

    PubMed

    Yu, Hao; Greenberg, Michael; Haviland, Amelia

    2017-12-01

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

  11. Enhancing School-Based Mental Health Services with a Preventive and Promotive Approach to Universal Screening for Complete Mental Health

    ERIC Educational Resources Information Center

    Dowdy, Erin; Furlong, Michael; Raines, Tara C.; Bovery, Bibliana; Kauffman, Beth; Kamphaus, Randy W.; Dever, Bridget V.; Price, Martin; Murdock, Jan

    2015-01-01

    Universal screening for complete mental health is proposed as a key step in service delivery reform to move school-based psychological services from the back of the service delivery system to the front, which will increase emphasis on prevention, early intervention, and promotion. A sample of 2,240 high school students participated in a schoolwide…

  12. The Genesis, Implementation and Impact of the Better Access Mental Health Initiative Introducing Medicare-Funded Psychology Services

    ERIC Educational Resources Information Center

    Littlefield, Lyn; Giese, Jill

    2008-01-01

    The Australian Government's Better Access to Mental Health Care initiative introduced mental health reforms that included the availability of Medicare-funded psychology services. The mental health initiative has resulted in a huge uptake of these services, demonstrating the strong community demand for psychological treatment. The initiative has…

  13. Home Care and Health Reform: Changes in Home Care Utilization in One Canadian Province, 1990-2000

    ERIC Educational Resources Information Center

    Penning, Margaret J.; Brackley, Moyra E.; Allan, Diane E.

    2006-01-01

    Purpose: This study examines population-based trends in home care service utilization, alone and in conjunction with hospitalizations, during a period of health reform in Canada. It focuses on the extent to which observed trends suggest enhanced community-based care relative to three competing hypotheses: cost-cutting, medicalization, and…

  14. A systemic approach to understanding mental health and services.

    PubMed

    Cohen, Mark

    2017-10-01

    In the UK mental health and associated NHS services face considerable challenges. This paper aims to form an understanding both of the complexity of context in which services operate and the means by which services have sought to meet these challenges. Systemic principles as have been applied to public service organisations with reference to interpersonal relations, the wider social culture and its manifestation in service provision. The analysis suggests that the wider culture has shaped service demand and the approaches adopted by services resulting in a number of unintended consequences, reinforcing loops, increased workload demands and the limited value of services. The systemic modelling of this situation provides a necessary overview prior to future policy development. The paper concludes that mental health and attendant services requires a systemic understanding and a whole system approach to reform. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  15. Rising to the challenge of health care reform with entrepreneurial and intrapreneurial nursing initiatives.

    PubMed

    Wilson, Anne; Whitaker, Nancy; Whitford, Deirdre

    2012-05-31

    Health reform worldwide is required due to the largely aging population, increase in chronic diseases, and rising costs. To meet these needs, nurses are being encouraged to practice to the full extent of their skills and take significant leadership roles in health policy, planning, and provision. This can involve entrepreneurial or intrapreneurial roles. Although nurses form the largest group of health professionals, they are frequently restricted in their scope of practice. Nurses can help to improve health services in a cost effective way, but to do so, they must be seen as equal partners in health service provision. This article provides a global perspective on evolving nursing roles for innovation in health care. A historical overview of entrepreneurship and intrapreneurship is offered. Included also is discussion of a social entrepreneurship approach for nursing, settings for nurse entre/intrapreneurship, and implications for research and practice.

  16. Values and health care: the Confucian dimension in health care reform.

    PubMed

    Lim, Meng-Kin

    2012-12-01

    Are values and social priorities universal, or do they vary across geography, culture, and time? This question is very relevant to Asia's emerging economies that are increasingly looking at Western models for answers to their own outmoded health care systems that are in dire need of reform. But is it safe for them to do so without sufficient regard to their own social, political, and philosophical moorings? This article argues that historical and cultural legacies influence prevailing social values with regard to health care financing and resource allocation, and that the Confucian dimension provides a helpful entry point for a deeper understanding of ongoing health care reforms in East Asia--as exemplified by the unique case of Singapore.

  17. A comparative analysis of the changes in nursing practice related to health sector reform in five countries of the Americas.

    PubMed

    Guevara, Edilma B; Mendias, Elnora P

    2002-11-01

    To identify changes in nursing practice and the nursing-practice environment that have occurred with implementation of health sector reform in five countries in the Americas. An exploratory study of selected settings in Argentina, Brazil, Colombia, Mexico, and the United States of America was conducted between 1997 and 1999 to collect narrative data from 125 professional nurses about their perceptions of nursing practice and changes in work environments. Descriptions of characteristics and trends in nursing practice in the study sites were also obtained. Reorganization of health services has occurred in all five of the countries, responding to health sector reform initiatives and affecting nursing practice in each country. Respondents from all five countries mentioned an emphasis on private enterprise, changes in payment systems for patients and providers, redistributions in the nursing workforce, changes in the personnel mix and nursing-practice functions, work shifting from the hospital to the community, and greater emphasis on cost control and prevention in practice settings. The study provides initial information about current nursing issues that have arisen as a result of health care reform initiatives. Regardless of differences in service models or phases of health sector reform implementation, in all the countries the participating nurses identified many common themes, trends, and changes in nursing practice. The driving forces for change and their intensity have been different in the five countries. Nurses maintain their core values despite increased work stress and greater patient care needs in all the countries as well as economic crises in the Latin American countries.

  18. Payment reform in the patient-centered medical home: Enabling and sustaining integrated behavioral health care.

    PubMed

    Miller, Benjamin F; Ross, Kaile M; Davis, Melinda M; Melek, Stephen P; Kathol, Roger; Gordon, Patrick

    2017-01-01

    The patient-centered medical home (PCMH) is a promising framework for the redesign of primary care and more recently specialty care. As defined by the Agency for Healthcare Research and Quality, the PCMH framework has 5 attributes: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety. Evidence increasingly demonstrates that for the PCMH to best achieve the Triple Aim (improved outcomes, decreased cost, and enhanced patient experience), treatment for behavioral health (including mental health, substance use, and life stressors) must be integrated as a central tenet. However, challenges to implementing the PCMH framework are compounded for real-world practitioners because payment reform rarely happens concurrently. Nowhere is this more evident than in attempts to integrate behavioral health clinicians into primary care. As behavioral health clinicians find opportunities to work in integrated settings, a comprehensive understanding of payment models is integral to the dialogue. This article describes alternatives to the traditional fee for service (FFS) model, including modified FFS, pay for performance, bundled payments, and global payments (i.e., capitation). We suggest that global payment structures provide the best fit to enable and sustain integrated behavioral health clinicians in ways that align with the Triple Aim. Finally, we present recommendations that offer specific, actionable steps to achieve payment reform, complement PCMH, and support integration efforts through policy. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  19. The Return of Two-Class Medicine—III Effects of Medi-Cal Reform

    PubMed Central

    Waitzkin, Howard

    1985-01-01

    California's drastic Medi-Cal reforms have created great difficulties in health care for the poor. Patients' clinical problems seldom are apparent in descriptions of changes in public insurance programs. Rapidly escalating costs of Medi-Cal led to irresistible pressures for reform, especially from the business community. The new Medi-Cal regulations provide for prospective contracts with hospitals for inpatient services, the transfer of “Medically Indigent Adults” to the responsibility of county governments and various other straightforward funding cutbacks. Confusion, disruption of services and adverse health outcomes have accompanied the Medi-Cal reforms. PMID:3892917

  20. [Development of child mental health services in Lithuania: achievements and obstacles].

    PubMed

    Pūras, Dainius

    2002-01-01

    In 1990, political, economic and social changes in Lithuania introduced the possibility to develop for the first time in nations's history an effective and modern system of child mental health services. During the period between 1990 and 1995 a new model of services was developed in the Department of Social pediatrics and child psychiatry of Vilnius University. The model included development of child and adolescent psychiatric services, as well as early intervention services for infants and preschool children with developmental disabilities. The emphasis, following recommendations of WHO and existing international standards, was made on deinstitutionalization and development of family-oriented and community-based services, which have been ignored by previous system. In the first half of 90's of 20th century, new training programs for professionals were introduced, more than 50 methods of assessment, treatment and rehabilitation, new for Lithuanian clinical practice, were implemented, and a new model of services, including primary, secondary and tertiary level of prevention, was introduced in demonstration sites. However, during next phase of development, in 1997-2001, serious obstacles for replicating new approaches across the country, have been identified, which threatened successful implementation of the new model of services into everyday clinical practice. Analysis of obstacles, which are blocking development of new approaches in the field of child mental health, is presented in the article. The main obstacles, identified during analysis of socioeconomic context, planning and utilization of resources, running of the system of services and evaluation of outcomes, are as follows: lack of intersectorial cooperation between health, education and social welfare systems; strong tradition of discrimination of psychosocial interventions in funding schemes of health services; societal attitudes, which tend to discriminate and stigmatize marginal groups, including

  1. [Managed care in Latin America: transnationalization of the health sector in the context of reform].

    PubMed

    Iriart, C; Merhy, E E; Waitzkin, H

    2000-01-01

    This article presents the results of the comparative research project "Managed Care in Latin America: Its Role in Health Reform". The project was conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States. The study's objective was to analyze the process by which managed care is exported, especially from the United States, and how managed care is adopted in Latin American countries. Our research methods included qualitative and quantitative techniques. Adoption of managed care reflects transnationalization of the health sector. Our findings demonstrate the entrance of large multinational financial capital into the private insurance and health services sectors and their intention of participating in the administration of government institutions and medical/social security funds. We conclude that this basic change involving the slow adoption of managed care is facilitated by ideological changes with discourses accepting the inexorable nature of public sector reform.

  2. The politics of health reform: why do bad things happen to good plans?

    PubMed

    Oberlander, Jonathan

    2003-01-01

    This paper examines political feasibility and its implications for health reform. I discuss the political obstacles to health reform in the United States, disentangling perennial barriers from contemporary constraints. I then explore major reform options and their political prospects. I argue that while incremental reform now appears to be the most feasible option, the political climate may change in a way that permits a bolder vision. Moreover, incremental reform may not be sustainable in the long run, for the same reason that makes it politically popular now: It does not change the status quo in the health system.

  3. Beyond Incrementalism? SCHIP and the politics of health reform.

    PubMed

    Oberlander, Jonathan B; Lyons, Barbara

    2009-01-01

    When Congress enacted the State Children's Health Insurance Program (SCHIP) in 1997, it was heralded as a model of bipartisan, incremental health policy. However, despite the program's achievements in the ensuing decade, SCHIP's reauthorization triggered political conflict, and efforts to expand the program stalemated in 2007. The 2008 elections broke that stalemate, and in 2009 the new Congress passed, and President Barack Obama signed, legislation reauthorizing SCHIP. Now that attention is turning to comprehensive health reform, what lessons can reformers learn from SCHIP's political adventures?

  4. Surveying perceptions of the progress of national mental health reform.

    PubMed

    Hickie, Ian; Groom, Grace

    2004-06-01

    To provide comment on the latest Australian government commitment to a 5 year plan under the National Mental Health Strategy. In the absence of a credible system of accountability for the implementation of mental health reform, the Mental Health Council of Australia, in association with the Brain and Mind Research Institute, has taken up the task of auditing. A national, government-supported system needs to be developed in order to monitor progress of genuine mental health reform in Australia.

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

    PubMed

    Méndez, Claudio A

    2009-09-01

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

  6. Existing and Emerging Payment and Delivery Reforms in Cardiology

    PubMed Central

    Farmer, Steven A.; Darling, Margaret L.; George, Meaghan; Casale, Paul N.; Hagan, Eileen; McClellan, Mark B.

    2017-01-01

    IMPORTANCE Recent health care reforms aim to increase patient access, reduce costs, and improve health care quality as payers turn to payment reform for greater value. Cardiologists need to understand emerging payment models to succeed in the evolving payment landscape. We review existing payment and delivery reforms that affect cardiologists, present 4 emerging examples, and consider their implications for clinical practice. OBSERVATIONS Public and commercial payers have recently implemented payment reforms and new models are evolving. Most cardiology models are modified fee-for-service or address procedural or episodic care, but population models are also emerging. Although there is widespread agreement that payment reform is needed, existing programs have significant limitations and the adoption ofnew programs has been slow. New payment reforms address some of these problems, but many details remain undefined. CONCLUSIONS AND RELEVANCE Early payment reforms were voluntary and cardiologists’ participation is variable. However, conventional fee-for-service will become less viable, and enrollment in new payment models will be unavoidable. Early participation in new payment models will allow clinicians to develop expertise in new care pathways during a period of relatively lower risk. PMID:27851858

  7. Enabling Health Reform through Regional Health Information Exchange: A Model Study from China

    PubMed Central

    Wen, Dong; Meng, Qun

    2017-01-01

    Objective. To investigate and share the major challenges and experiences of building a regional health information exchange system in China in the context of health reform. Methods. This study used interviews, focus groups, a field study, and a literature review to collect insights and analyze data. The study examined Xinjin's approach to developing and implementing a health information exchange project, using exchange usage data for analysis. Results. Within three years and after spending approximately $2.4 million (15 million RMB), Xinjin County was able to build a complete, unified, and shared information system and many electronic health record components to integrate and manage health resources for 198 health institutions in its jurisdiction, thus becoming a model of regional health information exchange for facilitating health reform. Discussion. Costs, benefits, experiences, and lessons were discussed, and the unique characteristics of the Xinjin case and a comparison with US cases were analyzed. Conclusion. The Xinjin regional health information exchange system is different from most of the others due to its government-led, government-financed approach. Centralized and coordinated efforts played an important role in its operation. Regional health information exchange systems have been proven critical for meeting the global challenges of health reform. PMID:29065565

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

    PubMed

    Xin, Haichang

    2016-08-01

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

  9. An Implication of Health Sector Reform for Disadvantaged Women's Struggle for Birth Control: A Case of Kurdish Rural-Urban Migrant Women in Van, Turkey.

    PubMed

    Him, Miki Suzuki; Hoşgör, Ayşe Gündüz

    2015-09-01

    In this article, we examine how socioeconomically disadvantaged women are affected by health sector reform and family planning policy changes in Turkey through a case study of Kurdish women's struggles for birth control. In Turkey, a family planning program became relatively marginalized in primary health care services as a result of health sector reform as well as a shift of population policy toward a moderately pronatal approach. We argue that an emerging health care system would leave disadvantaged women unable to benefit from contraceptives and would perpetuate reproductive health inequalities between women in the country.

  10. Policy challenges and reforms in small EU member state health systems: a narrative literature review.

    PubMed

    Azzopardi-Muscat, Natasha; Funk, Tjede; Buttigieg, Sandra C; Grech, Kenneth E; Brand, Helmut

    2016-12-01

    The EU directive on patients' rights and cross-border care is of particular interest to small states as it reinforces the concept of health system cooperation. An analysis of the challenges faced by small states, as well as a deep evaluation of their health system reform characteristics is timely and justified. This paper identifies areas in which EU level cooperation may bring added value to these countries' health systems. Literature search is based primarily on PUBMED and is limited to English-language papers published between January 2000 and September 2014. Results of 76 original research papers appearing in peer-reviewed journals are summarised in a literature map and narrative review. Primary care, health workforce and medicines emerge as the salient themes in the review. Lack of capacity and small market size are found to be the frequently encountered challenges in governance and delivery of services. These constraints appear to also impinge on the ability of small states to effectively implement health system reforms. The EU appears to play a marginal role in supporting small state health systems, albeit the stimulus for reform associated with EU accession. Small states face common health system challenges which could potentially be addressed through enhanced health system cooperation at EU level. The lessons learned from research on small states may be of relevance to health systems organized at regional level in larger European states. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  11. Health Services Research for Drug and Alcohol Treatment and Prevention.

    PubMed

    McCarty, Dennis; Roman, Paul M; Sorensen, James; Weisner, Constance

    2009-01-01

    Health services research is a multidisciplinary field that examines ways to organize, manage, finance, and deliver high-quality care. This specialty within substance abuse research developed from policy analyses and needs assessments that shaped federal policy and promoted system development in the 1970s. After the authorization of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA), patient information systems supported studies of treatment processes and outcomes. Health services research grew substantially in the 1990s when NIAAA and NIDA moved into the National Institutes of Health and legislation allocated 15% of their research portfolio to services research. The next decade will emphasize research on quality of care, adoption and use of evidence-based practices (including medication), financing reforms and integration of substance abuse treatment with primary care and mental health services.

  12. Effecting Successful Community Re-Entry: Systems of Care Community Based Mental Health Services

    ERIC Educational Resources Information Center

    Estes, Rebecca I.; Fette, Claudette; Scaffa, Marjorie E.

    2005-01-01

    The need for system reform for child and adolescent mental health services, long recognized as a vital issue, continues to challenge mental health professionals. While past legislation has not adequately addressed the issues, the 2003 President's New Freedom Commission may begin to reorient mental health systems toward recovery. Supported by this…

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

    PubMed

    Marchildon, Gregory P

    2018-07-01

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

  14. [Patient-Proposed Health Services].

    PubMed

    Fujiwara, Yasuhiro

    2016-06-01

    The Patient-Proposed Health Services(PPHS)was launched in April 2016. PPHS was proposed by the Council for Regulatory Reform, which was established in January 2013 under the Second Abe Administration. After discussion within the council, PPHS was published in the Japan Revitalization Strategy(2014 revised edition), which was endorsed by the Cabinet on June 24, 2014. PPHS was proposed therein as a new mechanism within the mixed billing system to apply for a combination of treatment not covered by the public health insurance with treatment covered by the insurance. Subsequently, PPHS was submitted for diet deliberations in April and May 2015 and inserted into article 63 of the health insurance act in accordance with "a law for making partial amendments to the National Health Insurance Act, etc., in order to create a sustainable medical insurance system", which was promulgated on May 29, 2015. In this paper I will review the background of the birth of PPHS and discuss its overview.

  15. Accomplishing reform: successful case studies drawn from the health systems of 60 countries

    PubMed Central

    Braithwaite, Jeffrey; Mannion, Russell; Matsuyama, Yukihiro; Shekelle, Paul; Whittaker, Stuart; Al-Adawi, Samir; Ludlow, Kristiana; James, Wendy; Ting, Hsuen P; Herkes, Jessica; Ellis, Louise A; Churruca, Kate; Nicklin, Wendy; Hughes, Clifford

    2017-01-01

    Abstract Healthcare reform typically involves orchestrating a policy change, mediated through some form of operational, systems, financial, process or practice intervention. The aim is to improve the ways in which care is delivered to patients. In our book ‘Health Systems Improvement Across the Globe: Success Stories from 60 Countries’, we gathered case-study accomplishments from 60 countries. A unique feature of the collection is the diversity of included countries, from the wealthiest and most politically stable such as Japan, Qatar and Canada, to some of the poorest, most densely populated or politically challenged, including Afghanistan, Guinea and Nigeria. Despite constraints faced by health reformers everywhere, every country was able to share a story of accomplishment—defining how their case example was managed, what services were affected and ultimately how patients, staff, or the system overall, benefited. The reform themes ranged from those relating to policy, care coverage and governance; to quality, standards, accreditation and regulation; to the organization of care; to safety, workforce and resources; to technology and IT; through to practical ways in which stakeholders forged collaborations and partnerships to achieve mutual aims. Common factors linked to success included the ‘acorn-to-oak tree’ principle (a small scale initiative can lead to system-wide reforms); the ‘data-to-information-to-intelligence’ principle (the role of IT and data are becoming more critical for delivering efficient and appropriate care, but must be converted into useful intelligence); the ‘many-hands’ principle (concerted action between stakeholders is key); and the ‘patient-as-the-pre-eminent-player’ principle (placing patients at the centre of reform designs is critical for success). PMID:29036604

  16. Responsible choices for achieving reform of the American health system.

    PubMed

    Ellwood, P; Enthoven, A

    1996-01-01

    "Responsible Choices" identifies the actions the private sector and government should take to improve the American health system and accelerate and expand the health care revolution that is already underway. Policy proposals are made for: Medicare; Medicaid; reforming the tax treatment of health insurance; insurance reforms and expanding group purchasing opportunities; and improving the availability of comparative information on health benefit offerings, quality accountability, and cost and coverage information. The recommendations refocus the Jackson Hole Group's original managed competition proposals contained in "The 21st Century American Health System" (1991).

  17. Cultures for mental health care of young people: an Australian blueprint for reform.

    PubMed

    McGorry, Patrick D; Goldstone, Sherilyn D; Parker, Alexandra G; Rickwood, Debra J; Hickie, Ian B

    2014-12-01

    Mental ill health is now the most important health issue facing young people worldwide. It is the leading cause of disability in people aged 10-24 years, contributing 45% of the overall burden of disease in this age group. Despite their manifest need, young people have the lowest rates of access to mental health care, largely as a result of poor awareness and help-seeking, structural and cultural flaws within the existing care systems, and the failure of society to recognise the importance of this issue and invest in youth mental health. We outline the case for a specific youth mental health stream and describe the innovative service reforms in youth mental health in Australia, using them as an example of the processes that can guide the development and implementation of such a service stream. Early intervention with focus on the developmental period of greatest need and capacity to benefit, emerging adulthood, has the potential to greatly improve the mental health, wellbeing, productivity, and fulfilment of young people, and our wider society. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Health sector reforms for 21st century healthcare

    PubMed Central

    Shankar, Darshan

    2015-01-01

    The form of the public health system in India is a three tiered pyramid-like structure consisting primary, secondary, and tertiary healthcare services. The content of India's health system is mono-cultural and based on western bio-medicine. Authors discuss need for health sector reforms in the wake of the fact that despite huge investment, the public health system is not delivering. Today, 70% of the population pays out of pocket for even primary healthcare. Innovation is the need of the hour. The Indian government has recognized eight systems of healthcare viz., Allopathy, Ayurveda, Siddha, Swa-rigpa, Unani, Naturopathy, Homeopathy, and Yoga. Allopathy receives 97% of the national health budget, and 3% is divided amongst the remaining seven systems. At present, skewed funding and poor integration denies the public of advantage of synergy and innovations arising out of the richness of India's Medical Heritage. Health seeking behavior studies reveal that 40–70% of the population exercise pluralistic choices and seek health services for different needs, from different systems. For emergency and surgery, Allopathy is the first choice but for chronic and common ailments and for prevention and wellness help from the other seven systems is sought. Integrative healthcare appears to be the future framework for healthcare in the 21st century. A long-term strategy involving radical changes in medical education, research, clinical practice, public health and the legal and regulatory framework is needed, to innovate India's public health system and make it both integrative and participatory. India can be a world leader in the new emerging field of “integrative healthcare” because we have over the last century or so assimilated and achieved a reasonable degree of competence in bio-medical and life sciences and we possess an incredibly rich and varied medical heritage of our own. PMID:25878456

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

    PubMed

    Shankar, Darshan

    2015-01-01

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

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

    PubMed

    Lan, Jesse Yu-Chen

    2017-12-01

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

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

    PubMed

    Nicaise, Pablo; Dubois, Vincent; Lorant, Vincent

    2014-04-01

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

  2. Turkish health system reform from the people’s perspective: a cross sectional study

    PubMed Central

    2014-01-01

    Background Since 2003, Turkey has implemented major health care reforms to develop easily accessible, high-quality, efficient, and effective healthcare services for the population. The purpose of this study was to bring out opinions of the Turkish people on health system reform process, focusing on several aspects of health system and assessing whether the public prefer the current health system or that provided a decade ago. Methods A cross sectional survey study was carried out in Turkey to collect data on people’s opinions on the healthcare reforms. Data was collected via self administered household’s structured questionnaire. A five-point Likert-type scale was used to score the closed comparative statements. Each statement had response categories ranging from (1) “strongly agree” to (5) “strongly disagree.” A total of 482 heads of households (response rate: 71.7%) with the mean age of (46.60 years) were selected using a multi stage sampling technique from seven geographical regions in Turkey from October 2011 to January 2012. Multiple logistic regressions were performed to identify significant contributing factors in this study. Results Employing descriptive statistics it is observed that among the respondents, more than two third of the population believes that the changes have had positive effects on the health system. A vast majority of respondents (82.0%) believed that there was an increase in accessibility, 73.7% thought more availability of health resources, 72.6% alleged improved quality of care, and 72.6% believed better attitude of politician/mass media due to the changes in the last 10 years. Indeed, the majority of respondents (77.6%) prefer the current health care system than the past. In multivariate analysis, there was a statistically significant relationship between characteristics and opinions of the respondents. The elderly, married females, perceived themselves healthy and those who believe that people are happier now than 10 years

  3. Health care reform in the new South Africa.

    PubMed

    Benatar, S R

    1997-03-20

    The social transition which must follow the political transition in South Africa will pose major challenges for many decades. While it clear that inequities must be reduced, it is less clear how to effectively and sustainably achieve that end, especially given current rapid population growth and minimal additional resources in an economy which is growing less rapidly than hoped for by the new government. Health care reform is one of the country's many challenges. This paper provides insight into the shift from the conventional biomedical model of health care to the primary health care approach within a fixed public health budget. Obstacles to change, threats to academic activities, the 1980s and 1990s, political and social transition, health care reform since 1994, academic medicine and medical education, choices facing society, movement from political apartheid to economic apartheid, and public awareness are described.

  4. Health care reform and professionalism.

    PubMed

    Wennberg, J E

    1994-01-01

    With its emphasis on consumer choice of health plans, the current health care debate neglects a more fundamental crisis: changes in the traditional physician-patient relationship. This paper discusses how this relationship is being redefined and what it means for professionals in the future, particularly in the context of managed competition. The paper asserts that the final health reform plan must address flaws in the scientific and ethical basis of clinical practice. It calls for a flexible workforce policy that promotes shared decision making, lifetime learning, professional commitment to improved quality of care, a national evaluation program, and organizations to coordinate these efforts.

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

    PubMed

    Okorafor, Okore Apia

    2012-05-01

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

  6. Welfare reform and health insurance: consequences for parents.

    PubMed

    Holl, Jane L; Slack, Kristen Shook; Stevens, Amy Bush

    2005-02-01

    We assessed the relation between the work promotion, welfare reduction, and marriage goals of welfare reform and the stability of health insurance of parents in transition from welfare to work. We analyzed a panel survey (1999-2002) of a stratified random sample of Illinois families receiving welfare in 1998 (n=1363). Medicaid remains the foremost source of health insurance despite a significant decline in the proportion of parents with Medicaid. Regardless of work/welfare status in year 1, transitioning to work only or no work/no welfare increased the likelihood of having unstable health insurance in years 2 and 3 compared with those who remained on welfare only. Parents who meet the welfare reform goals of work promotion and reduction of welfare dependence experience significant loss and instability of health insurance.

  7. Provider perceptions of reproductive health service quality in jordanian public community health centers.

    PubMed

    Al-Qutob, Raeda; Nasir, Laeth S

    2008-05-01

    Enhancing the quality of reproductive health care delivery in developing countries is a key prerequisite to increased utilization and sustainability of these services in the target population. Our objective was to assess the perception of quality of reproductive health (RH) care services provided by Jordanian Ministry of Health community-based centers from the perspective of service providers in these settings. A purposeful nationwide sample of 50 primary health care providers took part in five focus group discussions with the purpose of exploring their perceptions of the quality of care provided by their centers and perceived barriers to the provision of quality RH care. Health care providers felt that the quality of RH care provided by their centers was suboptimal. Focus group participants reported numerous barriers to the provision of high quality-care in the clinical setting. These included issues related to patient overload, patient and physician characteristics, as well as problems inherent to supervisory and administrative functions. Exploring and aligning goals and expectations of RH care providers and administrators may result in improvements in the quality of RH care service delivery and morale in public health settings in Jordan, which is a requirement for public sector reform.

  8. Improving health care delivery to aging adults with disabilities: social work with dual eligibles in a climate of health care reform.

    PubMed

    Bachman, Sara S; Gonyea, Judith G

    2012-01-01

    Adults aging with disabilities comprise a diverse group. In this article, we identify the prevalence and characteristics of this target population, focusing on adults who are dually eligible for Medicare and Medicaid. We articulate challenges in the delivery of health, social, and support services to adults aging with disabilities, particularly how existing health care policy and financing contributes to fragmentation of care. Finally, we identify opportunities for social workers to advocate for and promote system improvements in the delivery of care for aging adults with disabilities in the current climate of health care reform.

  9. Universal coverage and its impact on reproductive health services in Thailand.

    PubMed

    Tangcharoensathien, Viroj; Tantivess, Sripen; Teerawattananon, Yot; Auamkul, Nanta; Jongudoumsuk, Pongpisut

    2002-11-01

    Thailand has recently introduced universal health care coverage for 45 million of its people, financed by general tax revenue. A capitation contract model was adopted to purchase ambulatory and hospital care, and preventive care and promotion, including reproductive health services, from public and private service providers. This paper describes the health financing system prior to universal coverage, and the extent to which Thailand has achieved reproductive health objectives prior to this reform. It then analyses the potential impact of universal coverage on reproductive health services. Whether there are positive or negative effects on reproductive health services will depend on the interaction between three key aspects: awareness of entitlement on the part of intended beneficiaries of services, the response of health care providers to capitation, and the capacity of purchasers to monitor and enforce contracts. In rural areas, the district public health system is the sole service provider and the contractual relationship requires trust and positive engagement with purchasers. We recommend an evidence-based approach to fine-tune the reproductive health services benefits package under universal coverage, as well as improved institutional capacity for purchasers and the active participation of civil society and other partners to empower beneficiaries.

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

    PubMed

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

    2011-01-01

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

  11. Health situation analysis of Thai population 2010: implications for health education and health service reform.

    PubMed

    Sutra, Sumitr; Chirawatkul, Aroon; Leelapanmetha, Pichet; Sirisuwan, Somnuk; Thavompitak, Yupa; Thepsuthammarat, Kaewjai

    2012-07-01

    Between 1990 and 2010, many national and international factors converged to both beneficially and antagonistically affect people's health and the Thai healthcare system. Moreover Thailand is moving to aged society and a low birth rates. To analyze Thailand's health issues for baseline information for changing medical education, services and researches. Information on illness of in-patients, out-patients and casualties came from hospitals nationwide and from hospitals withdrawals from the three health insurance schemes in fiscal 2010. The data included 96% of the population. Research literature was also extensively reviewed. The data were analyzed by age groups and burdensome diseases. Out-patients were treated 326,230,155 times and in-patients 6,880,815 times at Community Hospitals (44%), Provincial Hospitals (22%), Central or University Hospitals (26%) and Private Hospitals (8%). Infants and elderly were the patients most commonly treated in hospital. Among pediatric patients, perinatal disease, intestinal infection, respiratory tract infection, injury and poisoning and teenage pregnancy predominated; while among adults, it was accident, non-communicable and chronic disease. Thailand is faced with the dual burden of infection and non-communicable diseases. Risky behavior and changing social structure are underlined this epidemiological transition. Medical schools and health service systems need to be recalibrated to response proactively to these challenges.

  12. Mental health services commissioning and provision: Lessons from the UK?

    PubMed

    Ikkos, G; Sugarman, Ph; Bouras, N

    2015-01-01

    The commissioning and provision of healthcare, including mental health services, must be consistent with ethical principles - which can be summarised as being "fair", irrespective of the method chosen to deliver care. They must also provide value to both patients and society in general. Value may be defined as the ratio of patient health outcomes to the cost of service across the whole care pathway. Particularly in difficult times, it is essential to keep an open mind as to how this might be best achieved. National and regional policies will necessarily vary as they reflect diverse local histories, cultures, needs and preferences. As systems of commissioning and delivering mental health care vary from country to country, there is the opportunity to learn from others. In the future international comparisons may help identify policies and systems that can work across nations and regions. However a persistent problem is the lack of clear evidence over cost and quality delivered by different local or national models. The best informed economists, when asked about the international evidence do not provide clear answers, stating that it depends how you measure cost and quality, the national governance model and the level of resources. The UK has a centrally managed system funded by general taxation, known as the National Health Service (NHS). Since 2010, the UK's new Coalition* government has responded by further reforming the system of purchasing and providing NHS services - aiming to strengthen choice and competition between providers on the basis of quality and outcomes as well as price. Although the present coalition government's intention is to maintain a tax-funded system, free at the point of delivery, introducing market-style purchasing and provider-side reforms to encompass all of these bring new risks, whilst not pursuing reforms of a system in crisis is also seen to carry risks. Competition might bring efficiency, but may weaken cooperation between providers

  13. [The health care structure law as a political public health reform in ambulatory and day surgery].

    PubMed

    Sorgatz, H

    1994-01-01

    The statutory opening of hospitals for ambulatory surgery can't without more ado be derived from the health-care reform which came into force on the 1st of January 1993. From the genesis of this reform it can be understood that the field of ambulatory surgery has been integrated just shortly before its legislation into the outlines of the health-care reform. As a consequence the hospitals are obliged to follow the principle "ambulatory before stationary" even in the stationary field. In this way the strict separation between the two fields (ambulatory and stationary) will be overcome to a great extent. Taking into consideration the further changes brought by the health-care reform in the stationary field new ranges of action for hospitals, with their chances but also their risks, have to be expected.

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

    PubMed

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

    2008-12-01

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

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

    PubMed

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

    2017-10-01

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

  16. Experiences with Health Insurance and Health Care in the Context of Welfare Reform.

    PubMed

    Narain, Kimberly Danae; Katz, Marian Lisa

    2016-11-20

    Studies have shown that in the wake of welfare reform there has been a drop in the health insurance coverage and health care utilization of low-income mothers. Using data from 20 telephone interviews, this study explored the health insurance and health care experiences of current and former welfare participants living in Los Angeles County. This study found that half of these women had been uninsured at some point. Many of these lapses in health insurance coverage were linked to employment transitions and lack of knowledge regarding eligibility for different safety net programs. This study also found that satisfaction with access to health care was high among the insured respondents; however, barriers to care remained for many individuals, including appointment scheduling issues, limited scope of health insurance coverage, narrow provider networks, lack of care continuity, and perceived low quality of care. Better linkages between social programs assisting with health insurance coverage and improved knowledge among program clients may reduce health insurance cycling in this group. New rules for Medicaid managed care, currently being considered by the Centers for Medicare and Medicaid Services, have the potential to improve access to health care and the quality of care for these individuals. © 2016 National Association of Social Workers.

  17. [Commodification of health care services for development: the case of Colombia].

    PubMed

    Echeverri, Oscar

    2008-09-01

    This is a succinct analysis of the circular relationship between health and development and the changes occurring over recent decades regarding health care services production and delivery that have resulted in a new paradigm. From the late 1970s through the 1980s, three major, worldwide shifts occurred that changed health care services in Colombia and in other Latin American countries: the privatization of government entities, the commodification of health care services, and the failure of the Soviet model. Health care system reform in Colombia, considered by some experts to be a model, is an example of health care commodification that, 15 years later, has not achieved the coverage, nor the equity, nor the efficiency, nor the quality, that it should have. More so than the market, the problem has been with the market entities that seek disproportionate profits. A solution for this situation is to appeal to nonprofit organizations for the purchase and sale of health care services.

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

    PubMed

    Kwon, Soyoung

    2016-01-01

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

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

    PubMed Central

    Kwon, Soyoung

    2016-01-01

    During economic reform, Chinese economic labor markets became segmented by state sector associated with a planned redistributive economy and private sector associated with the market economy. By considering an economic sector as a concrete institutional setting in post-reform China, this paper compares the extent to which socioeconomic status, measured by education and income, is associated with self-rated health between state sector and private sector. The sample is limited to urban Chinese employees between the ages of 18 and 55 who were active in the labor force. By analyzing pooled data from the 1991–2006 Chinese Health and Nutrition Survey, I find that there is a stronger association between income and self-rated health in the private sector than in the state sector. This study suggests that sectoral differences between market and redistributive economies are an important key to understanding health inequalities in post-reform urban China. PMID:29546178

  20. Relief, restoration and reform: economic upturn yields modest and uneven health returns.

    PubMed

    Hurley, Robert; Katz, Aaron; Felland, Laurie

    2008-01-01

    The sensitivity of state budgets to economic cycles contributes to fluctuations in health coverage, eligibility, benefits and provider payment levels in public programs, as well as support for safety net hospitals and community health centers (CHCs). The aftershocks of the 2001 recession on state budgets were felt well into 2004. More recently, the economic recovery allowed many states to restore cuts and, in some cases, expand health services for low-income people, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Along with bolstering support of safety net providers and raising Medicaid payments for private physicians, some states advanced even more ambitious health reform proposals. Yet across communities, safety net systems face mounting challenges of caring for more uninsured patients, and these pressures will likely increase given the current economic downturn.

  1. Welfare Reform and Health Insurance: Consequences for Parents

    PubMed Central

    Holl, Jane L.; Slack, Kristen Shook; Stevens, Amy Bush

    2005-01-01

    Objectives. We assessed the relation between the work promotion, welfare reduction, and marriage goals of welfare reform and the stability of health insurance of parents in transition from welfare to work. Methods. We analyzed a panel survey (1999–2002) of a stratified random sample of Illinois families receiving welfare in 1998 (n=1363). Results. Medicaid remains the foremost source of health insurance despite a significant decline in the proportion of parents with Medicaid. Regardless of work/welfare status in year 1, transitioning to work only or no work/no welfare increased the likelihood of having unstable health insurance in years 2 and 3 compared with those who remained on welfare only. Conclusions. Parents who meet the welfare reform goals of work promotion and reduction of welfare dependence experience significant loss and instability of health insurance. PMID:15671465

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

    PubMed

    Wren, Maev-Ann; Connolly, Sheelah

    2017-12-26

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

  3. Americans' political participation in the 1993-94 national health care reform debate.

    PubMed

    Brodie, M

    1996-01-01

    The health politics and policy communities are still struggling with the question of "what went wrong" in the 1993-94 health care reform effort. Here I identify which Americans were politically active and inactive during the health care reform debate to explore the role political participation may have had in determining the outcome of the debate. Using data from a national and California random-sample telephone surveys, and controlling for other demographic attributes, I found that those who engaged in political activity specifically related to health care reform were disproportionately more likely to be self-identified conservatives, less likely to favor an employer mandate plan, more likely to be fifty to sixty-four years old, more likely to be men, and more likely to have greater interest in and knowledge of the health care issue. Even in California, where a single-payer proposal was on the November ballot, self-identified liberals were no more likely to engage in political activity on health care reform than were moderates or conservatives. I consider implications for the reform outcome given that liberals, the elderly, and those favoring the employer mandate proposal were all disproportionately "silent" during this debate, and finally I discuss the potential for mobilization during future debates.

  4. Universal coverage and cost control: the United Kingdom National Health Service.

    PubMed

    Maynard, A; Bloor, K

    1998-01-01

    The UK NHS has a number of important strengths. Its costs are relatively low compared to the health care systems of other developed countries due in part to cash limited central budgeting. It is extremely popular with the electorate and surveys show overall satisfaction with the NHS despite some dissatisfaction with waiting lists and a public perception of underfunding. The NHS model of general medical care provided by independent contractors has been acclaimed as "a British success" (General Medical Services Council, 1983). The role of the UK GP combines providing primary care and acting as a gatekeeper to secondary care. This increases equitable access to care for the population and assists in cost containment. As a model, it is currently being emulated in other countries including Sweden and US Health Maintenance Organizations but, as in these countries, the UK primary care model has been evaluated poorly. There are of course continuing weaknesses in the UK health care system. There is insufficient knowledge upon which to base health care services and increase efficiency. In the future, if a knowledge-based health care service is to be created, a considerable amount of research and evaluation is required to identify "what works" in health care (i.e., what is effective) and also the cost effective ways of altering provider behaviour to maximise the amount of health gain which can be achieved using a limited budget. The NHS reforms created a lot of enthusiasm and energy but its effects are difficult to disentangle from the simultaneous increases in funding. There is little evidence from the UK or elsewhere that competition in health care produces efficiency or improvements in resource allocation. Evaluation is required to identify which of the reforms are increasing efficiency. Competition needs to be used with caution and recognised as a mean and not an end in itself. It is remarkable how both clinical practice and health policy reform, in the UK and elsewhere

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

    PubMed

    Hort, Krishna; Jayasuriya, Rohan; Dayal, Prarthna

    2017-05-15

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

  6. A healthier future for all Australians: an overview of the final report of the National Health and Hospitals Reform Commission.

    PubMed

    Bennett, Christine C

    2009-10-05

    After extensive community and health industry consultation, the final report of the National Health and Hospitals Reform Commission, A healthier future for all Australians, was presented to the Australian Government on 30 June 2009. The reform agenda aims to tackle major access and equity issues that affect health outcomes for people now; redesign our health system so that it is better positioned to respond to emerging challenges; and create an agile, responsive and self-improving health system for long-term sustainability. The 123 recommendations are grouped in four themes: Taking responsibility: supporting greater individual and collective action to build good health and wellbeing. Connecting care: delivering comprehensive care for people over their lifetime, by strengthening primary health care, reshaping hospitals, improving subacute care, and opening up greater consumer choice and competition in aged care services. Facing inequities: taking action to tackle the causes and impact of health inequities, focusing on Aboriginal and Torres Strait Islander people, people in rural and remote areas, and access to mental health and dental services. Driving quality performance: having leadership and systems to achieve the best use of people, resources and knowledge, including "one health system" with national leadership and local delivery, revised funding arrangements, and changes to health workforce education, training and practice.

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

    PubMed Central

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

    2013-01-01

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

  8. Network resilience in the face of health system reform.

    PubMed

    Sheaff, Rod; Benson, Lawrence; Farbus, Lou; Schofield, Jill; Mannion, Russell; Reeves, David

    2010-03-01

    Many health systems now use networks as governance structures. Network 'macroculture' is the complex of artefacts, espoused values and unarticulated assumptions through which network members coordinate network activities. Knowledge of how network macroculture during 2006-2008 develops is therefore of value for understanding how health networks operate, how health system reforms affect them, and how networks function (and can be used) as governance structures. To examine how quasi-market reforms impact upon health networks' macrocultures we systematically compared longitudinal case studies of these impacts across two care networks, a programme network and a user-experience network in the English NHS. We conducted interviews with key informants, focus groups, non-participant observations of meetings and analyses of key documents. We found that in these networks, artefacts adapted to health system reform faster than espoused values did, and the latter adapted faster than basic underlying assumptions. These findings contribute to knowledge by providing empirical support for theories which hold that changes in networks' core practical activity are what stimulate changes in other aspects of network macroculture. The most powerful way of using network macroculture to manage the formation and operation of health networks therefore appears to be by focusing managerial activity on the ways in which networks produce their core artefacts. 2009 Elsevier Ltd. All rights reserved.

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

    PubMed

    Coelho, Ivan Batista

    2010-01-01

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

  10. Opportunities and Challenges for Payment Reform: Observations from Massachusetts.

    PubMed

    Mechanic, Robert E

    2016-08-01

    Policy makers and private health plans are expanding their efforts to implement new payment models that will encourage providers to improve quality and deliver health care more efficiently. Over the past five years, payment reforms have progressed faster in Massachusetts than in any other state. The reasons include a major effort by Blue Cross Blue Shield of Massachusetts to implement global payment, the presence of large integrated systems willing to take on financial risk, and a supportive state policy environment. By 2014, thirty-seven percent of Massachusetts's residents enrolled in health plans were covered under risk-based payment models tied to global budgets. But the expansion of payment reform in Massachusetts slowed between 2012 and 2015 because some commercial enrollment shifted from risk-based health maintenance organization products to fee-for-service preferred provider organization (PPO) plans, and the state Medicaid program fell short of its payment reform goals. Provider groups will not fully commit to population-based clinical models if they believe it will result in large reductions in fee-for-service revenue. The use of alternative payment models will accelerate in 2016 when Blue Cross begins implementing PPO payment reforms, but it is unknown how quickly other payers will follow. Massachusetts's experience illustrates the complexity of payment reform in pluralistic health care markets and the need for complementary efforts by public and private stakeholders. Copyright © 2016 by Duke University Press.

  11. Failure of health care reform in the USA.

    PubMed

    Mechanic, D

    1996-01-01

    The failure of health reform in the USA reflects the individualism and lack of community responsibility of the American political culture, the power of interest groups, and the extraordinary process President Clinton followed in developing his highly elaborate plan. Despite considerable initial public support and a strong start, the reform effort was damaged by the cumbersome process, the complexity of the plan itself, and the unfamiliarity of key components such as alliances for pooled buying of health insurance. In addition, the alienation of important interest groups and the loss of presidential initiative in framing the public discussion as a result of international, domestic and personal issues contributed to the failure in developing public consensus. This paper considers an alternative strategy that would have built on the extension of the Medicare program as a way of exploring the possibilities and barriers to achieving health care reform. Such an approach would build on already familiar and popular pre-existing components. The massive losses in the most recent election and large budget cuts planned by the Republican majority makes it unlikely that gaps in insurance or comprehensiveness of coverage will be corrected in the foreseeable future.

  12. Health care delivery system reform: accountable care organizations.

    PubMed

    Dove, James T; Weaver, W Douglas; Lewin, Jack

    2009-09-08

    Health care reform is moving forward at a frantic pace. There have been 3 documents released from the Senate Finance Committee and proposed legislation from the Senate HELP Committee and the House of Representatives Tri-Committee on Health Reform. The push for legislative action has not been sidetracked by the economic conditions. Integrated health care delivery is the current favored approach to aligning resource use and cost. Accountable care organizations (ACOs), a concept included in health care reform legislation before both the House and Senate, propose to translate the efficiencies and lessons learned from large integrated systems and apply them to nonintegrated practices. The ACO design could be real or virtual integration of local delivery providers. This new structure is complicated, and clinicians, patients, and payers should have input regarding the design and function of it. Because most of health care is delivered in the ambulatory setting, it remains to be determined whether the ACOs are best developed in parallel among physician practices and hospitals or as partnerships between hospitals and physicians. Many are concerned that hospital-led ACOs will force physician employment by hospitals with possible unintended negative consequences for physicians, hospitals, and patients. Patients, physicians, other providers, and payers are in a better position to guide the redesign of the health care delivery system than government agencies, policy organizations, or elected officials, no matter how well intended. We strongly believe-and ACC has proclaimed-that change in health care delivery must be accomplished with patients and physicians at the table.

  13. Themes and Reform of Primary Health Care (RCAPS) in the city of Rio de Janeiro, Brazil.

    PubMed

    Soranz, Daniel; Pinto, Luiz Felipe; Penna, Gerson Oliveira

    2016-05-01

    During the period of 1990-2000, Rio de Janeiro was characterized by a limited supply of public and universal primary care services. In 2008, family health team coverage corresponded to 3.5% of the population, the lowest among capital cities. At the end of 2013, coverage reached more than 40% of Rio residents with teams comprised of doctors, nurses, practical nurses, community health agents, and health surveillance agents, in addition to oral health teams. This article describes and analyzes the main components of the Reform in Primary Health Care (RCAPS) implemented since 2009, focusing on three lines of action: administrative reform, organizational model, and model of care. A new organizational chart of the Municipal Health Secretary and a legal framework for a new results-based model were created. As for the model of care, the standardization of procedures and health activities for all units and the monthly assessment of clinical indicators of results of implanted electronic medical records were created. Experience has shown the feasibility of RCAPS, pointing to new challenges that will allow consolidation of the expansion of access, training of human resources, health communication, and a shift to a managerial results-driven model.

  14. Size Matters — Determinants of Modern, Community-Oriented Mental Health Services

    PubMed Central

    Ala-Nikkola, Taina; Pirkola, Sami; Kontio, Raija; Joffe, Grigori; Pankakoski, Maiju; Malin, Maili; Sadeniemi, Minna; Kaila, Minna; Wahlbeck, Kristian

    2014-01-01

    Governances, structures and contents of mental health services are being reformed across countries. There is a need for data to support those changes. The aim of this study was to explore the quality, i.e., diversity and community orientation, and quantity, i.e., personnel resources, of mental health and substance abuse services (MHS) and evaluate correlation between population needs and quality and quantity of MHS. The European Service Mapping Schedule—Revised (ESMS-R) was used to classify mental health and substance abuse services in southern Finland. Municipal-level aggregate data, local data on unemployment rate, length of education, age of retirement, proportion of single households, alcohol sales and a composite mental health index were used as indicators of population mental health needs. Population size correlated strongly with service diversity, explaining 84% of the variance. Personnel resources did not associate with diversity or community orientation. The indicators of mental health services need did not have the expected association with quality and quantity of services. In terms of service organization, the results may support larger population bases, at least 150,000 adult inhabitants, when aiming for higher diversity. PMID:25153471

  15. Which moral hazard? Health care reform under the Affordable Care Act of 2010.

    PubMed

    Mendoza, Roger Lee

    2016-06-20

    Purpose - Moral hazard is a concept that is central to risk and insurance management. It refers to change in economic behavior when individuals are protected or insured against certain risks and losses whose costs are borne by another party. It asserts that the presence of an insurance contract increases the probability of a claim and the size of a claim. Through the US Affordable Care Act (ACA) of 2010, this study seeks to examine the validity and relevance of moral hazard in health care reform and determine how welfare losses or inefficiencies could be mitigated. Design/methodology/approach - This study is divided into three sections. The first contrasts conventional moral hazard from an emerging or alternative theory. The second analyzes moral hazard in terms of the evolution, organization, management, and marketing of health insurance in the USA. The third explains why and how salient reform measures under the ACA might induce health care consumption and production in ways that could either promote or restrict personal health and safety as well as social welfare maximization. Findings - Insurance generally induces health care (over) consumption. However, not every additional consumption, with or without adverse selection, can be considered wasteful or risky, even if it might cost insurers more in the short run. Moral hazard can generate welfare and equity gains. These gains might vary depending on which ACA provisions, insured population, covered illnesses, treatments, and services, as well as health outcomes are taken into account, and because of the relative ambiguities surrounding definitions of "health." Actuarial risk models can nonetheless benefit from incorporating welfare and equity gains into their basic assumptions and estimations. Originality/value - This is the first study which examines the ACA in the context of the new or alternative theory of moral hazard. It suggests that containing inefficient moral hazard, and encouraging its desirable

  16. Efficiency and Counter-Revolution: Connecting University and Civil Service Reform in the 1850s

    ERIC Educational Resources Information Center

    Ellis, Heather

    2013-01-01

    Historians have often recognised important links between the processes of university and civil service reform in mid-nineteenth-century England. Yet such connections are usually seen as forming part of a wider project of modernising reform with any conservative or counter-revolutionary aims largely discounted. However, as this article suggests,…

  17. Ethics in American Health 2: An Ethical Framework for Health System Reform

    PubMed Central

    2008-01-01

    I argue that an ethical vision resting on explicitly articulated values and norms is critical to ensuring comprehensive health reform. Reform requires a consensus on the public good transcending self-interest and narrow agendas and underpinning collective action for universal coverage. In what I call shared health governance, individuals, providers, and institutions all have essential roles in achieving health goals and work together to create a positive environment for health. This ethical paradigm provides (1) reasoned consensus through a joint scientific and deliberative approach to judge the value of a health care intervention; (2) a method for achieving consensus that differs from aggregate tools such as a strict majority vote; (3) combined technical and ethical rationality for collective choice; (4) a joint clinical and economic approach combining efficiency with equity, but with economic solutions following and complementing clinical progress; and (5) protection for disabled individuals from discrimination. PMID:18703448

  18. Ethics in American health 2: an ethical framework for health system reform.

    PubMed

    Ruger, Jennifer Prah

    2008-10-01

    I argue that an ethical vision resting on explicitly articulated values and norms is critical to ensuring comprehensive health reform. Reform requires a consensus on the public good transcending self-interest and narrow agendas and underpinning collective action for universal coverage. In what I call shared health governance, individuals, providers, and institutions all have essential roles in achieving health goals and work together to create a positive environment for health. This ethical paradigm provides (1) reasoned consensus through a joint scientific and deliberative approach to judge the value of a health care intervention; (2) a method for achieving consensus that differs from aggregate tools such as a strict majority vote; (3) combined technical and ethical rationality for collective choice; (4) a joint clinical and economic approach combining efficiency with equity, but with economic solutions following and complementing clinical progress; and (5) protection for disabled individuals from discrimination.

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

    ERIC Educational Resources Information Center

    Lukaszewski, Thomas

    1993-01-01

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

  20. Reforming Mental Health Services for Seriously Emotionally Disturbed Youth: Rhetoric, Practice, and Research.

    ERIC Educational Resources Information Center

    Saxe, Leonard; And Others

    Children with serious emotional disorders receive inadequate and inappropriate services, rather than the comprehensive and coordinated system of care needed. To develop the knowledge needed to provide adequate and appropriate services, an alliance is needed among advocates, practitioners, and researchers. The Mental Health Services Program for…

  1. Primary Care Reform: Can Quebec's Family Medicine Group Model Benefit from the Experience of Ontario's Family Health Teams?

    PubMed Central

    Breton, Mylaine; Lévesque, Jean-Frédéric; Pineault, Raynald; Hogg, William

    2011-01-01

    Canadian politicians, decision-makers, clinicians and researchers have come to agree that reforming primary care services is a key strategy for improving healthcare system performance. However, it is only more recently that real transformative initiatives have been undertaken in different Canadian provinces. One model that offers promise for improving primary care service delivery is the family medicine group (FMG) model developed in Quebec. A FMG is a group of physicians working closely with nurses in the provision of services to enrolled patients on a non-geographic basis. The objectives of this paper are to analyze the FMG's potential as a lever for improving healthcare system performance and to discuss how it could be improved. First, we briefly review the history of primary care in Quebec. Then we present the FMG model in relation to the four key healthcare system functions identified by the World Health Organization: (a) funding, (b) generating human and technological resources, (c) providing services to individuals and communities and (d) governance. Next, we discuss possible ways of advancing primary care reform, looking particularly at the family health team (FHT) model implemented in the province of Ontario. We conclude with recommendations to inspire other initiatives aimed at transforming primary care. PMID:23115575

  2. Rating maternal and neonatal health services in developing countries.

    PubMed Central

    Bulatao, Rodolfo A.; Ross, John A.

    2002-01-01

    OBJECTIVE: To assess maternal and neonatal health services in 49 developing countries. METHODS: The services were rated on a scale of 0 to 100 by 10 - 25 experts in each country. The ratings covered emergency and routine services, including family planning, at health centres and district hospitals, access to these services for both rural and urban women, the likelihood that women would receive particular forms of antenatal and delivery care, and supporting elements of programmes such as policy, resources, monitoring, health promotion and training. FINDINGS: The average rating was only 56, but countries varied widely, especially in access to services in rural areas. Comparatively good ratings were reported for immunization services, aspects of antenatal care and counselling on breast feeding. Ratings were particularly weak for emergency obstetric care in rural areas, safe abortion and HIV counselling. CONCLUSION: Maternal health programme effort in developing countries is seriously deficient, particularly in rural areas. Rural women are disadvantaged in many respects, but especially regarding the treatment of emergency obstetric conditions. Both rural and urban women receive inadequate HIV counselling and testing and have quite limited access to safe abortion. Improving services requires moving beyond policy reform to strengthening implementation of services and to better staff training and health promotion. Increased financing is only part of the solution. PMID:12378290

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

    PubMed

    Pudlowski, Edward M

    2011-01-01

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

  4. Changing times: the role of academe in health reform.

    PubMed

    Hewlett, Peggy O'Neill; Bleich, Michael; Cox, Mary Foster; Hoover, Kim Welch

    2009-01-01

    What is the role of nursing educators in the politics surrounding health reform? This critical question is posed, and exemplars of how nurse faculty can and should become more involved in the political arena are shared. The authors issue a call to action for every nurse educator in the country to become actively engaged in health reform discussions to bring this all-important perspective to the table. Recognizing and overcoming traditional roles and barriers for nurse faculty on university campuses are essential parts of the political activism that must be assumed. Opening the doors for increased patient access will result in higher utilization of health care providers, and if the nursing shortage is not abated, then bottlenecking of qualified students in programs with critical faculty shortages will create immense pressure in an overloaded care delivery system. The full impact of legislated health reform changes on academe may not be fully realized until after the fact-and as often experienced in the past, this may come too late for policy makers to adequately address questions that should have been raised by the faculty corps beforehand. The time to get involved is now.

  5. Medical Malpractice Reform and Employer-Sponsored Health Insurance Premiums

    PubMed Central

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

    2008-01-01

    Objective Tort reform may affect health insurance premiums both by reducing medical malpractice premiums and by reducing the extent of defensive medicine. The objective of this study is to estimate the effects of noneconomic damage caps on the premiums for employer-sponsored health insurance. Data Sources/Study Setting Employer premium data and plan/establishment characteristics were obtained from the 1999 through 2004 Kaiser/HRET Employer Health Insurance Surveys. Damage caps were obtained and dated based on state annotated codes, statutes, and judicial decisions. Study Design Fixed effects regression models were run to estimate the effects of the size of inflation-adjusted damage caps on the weighted average single premiums. Data Collection/Extraction Methods State tort reform laws were identified using Westlaw, LEXIS, and statutory compilations. Legislative repeal and amendment of statutes and court decisions resulting in the overturning or repealing state statutes were also identified using LEXIS. Principal Findings Using a variety of empirical specifications, there was no statistically significant evidence that noneconomic damage caps exerted any meaningful influence on the cost of employer-sponsored health insurance. Conclusions The findings suggest that tort reforms have not translated into insurance savings. PMID:18522666

  6. Service user involvement in undergraduate mental health nursing in New Zealand.

    PubMed

    Schneebeli, Carole; O'Brien, Anthony; Lampshire, Debra; Hamer, Helen P

    2010-02-01

    This paper describes a service user role in the mental health component of an undergraduate nursing programme in New Zealand. The paper provides a background to mental health nursing education in New Zealand and discusses the implications of recent reforms in the mental health sector. The undergraduate nursing programme at the University of Auckland has a strong commitment to service user involvement. The programme aims to educate nurses to be responsive and skillful in meeting the mental health needs of service users in all areas of the health sector and to present mental health nursing as an attractive option for nurses upon graduation. We outline the mental health component of the programme, with an emphasis on the development of the service user role. In the second half of the paper, we present a summary of responses to a student satisfaction questionnaire. The responses indicate that the service user role is an important element of the programme and is well received by a substantial proportion of students. We consider the implications for nursing education and for recruitment into mental health nursing. Finally, we discuss some issues related to service user involvement in the development of new models of mental health service delivery.

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

    PubMed

    Waitzkin, Howard; Hellander, Ida

    2016-10-01

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

  8. Healthcare reform: the role of coordinated critical care.

    PubMed

    Cerra, F B

    1993-03-01

    To evaluate and editorialize the evolving role of the discipline of critical care as a healthcare delivery system in the process of healthcare reform. The sources included material from the Federal Office of Management and Budget, Health Care Financing Review, President Bush's Office, Association of American Medical Colleges, and publications of the Society of Critical Care Medicine. Data were selected that the author felt was relevant to the healthcare reform process and its implications for the discipline of critical care. The data were extracted by the author to illustrate the forces behind healthcare reform, the implications for the practice of critical care, and role of critical care as a coordinated (managed) care system in the process of healthcare reform. Healthcare reform has been initiated because of a number of considerations that arise in evaluating the current healthcare delivery system: access, financing, cost, dissatisfactions with the mechanisms of delivery, and political issues. The reform process will occur with or without the involvement of critical care practitioners. Reforms may greatly alter the delivery of critical care services, education, training, and research in critical care. Critical care has evolved into a healthcare delivery system that provides services to patients who need and request them and provides these services in a coordinated (managed) care model. Critical care practitioners must become involved in the healthcare reform process, and critical care services that are effective must be preserved, as must the education, training, and research programs. Critical care as a healthcare delivery system utilizing a coordinated (managed) care model has the potential to provide services to all patients who need them and to deliver them in a manner that is cost effective and recognized as providing added value.

  9. Seven Ethical Issues Affecting Neurosurgeons in the Context of Health Care Reform.

    PubMed

    Dagi, T Forcht

    2017-04-01

    Ethical discussions around health care reform typically focus on problems of social justice and health care equity. This review, in contrast, focuses on ethical issues of particular importance to neurosurgeons, especially with respect to potential changes in the physician-patient relationship that may occur in the context of health care reform.The Patient Protection and Affordable Care Act (ACA) of 2010 (H.R. 3590) was not the first attempt at health care reform in the United States but it is the one currently in force. Its ambitions include universal access to health care, a focus on population health, payment reform, and cost control. Each of these aims is complicated by a number of ethical challenges, of which 7 stand out because of their potential influence on patient care: the accountability of physicians and surgeons to individual patients; the effects of financial incentives on clinical judgment; the definition and management of conflicting interests; the duty to preserve patient autonomy in the face of protocolized care; problems in information exchange and communication; issues related to electronic health records and data security; and the appropriate use of "Big Data."Systematic social and economic reforms inevitably raise ethical concerns. While the ACA may have driven these 7 to particular prominence, they are actually generic. Nevertheless, they are immediately relevant to the practice of neurosurgery and likely to reflect the realities the profession will be obliged to confront in the pursuit of more efficient and more effective health care. Copyright © 2017 by the Congress of Neurological Surgeons.

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

    PubMed

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

    2015-05-01

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

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

    PubMed

    Sitek, Michał

    2010-08-01

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

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

    PubMed

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

    2011-10-01

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

  13. The Clintons stump for health care reform plan as details slowly emerge.

    PubMed

    1993-10-05

    In September 1993, in the US, Hillary Rodham Clinton, testified before 5 key congressional committees on President Clinton's plan to reform health care. Most of the money needed to finance the plan would come from elimination of waste in the current system. The administration has not yet formally sent the proposal to Congress. Family planning services are part of the proposed mandated benefit package, but the draft document does not provide details on family planning coverage while it discusses other mandated services in detail. Further, the draft document mentions neither family planning supplies (e.g., pills, IUDs, or diaphragms) nor whether family planning services will be considered preventive care, thereby exempting them from copayments or deductibles. It specifies prenatal care, periodic examinations, and screening test for children and adults (e.g., well-baby care and immunizations) as preventive services. The plan covers pregnancy-related care, but, other than exclusion of in vitro fertilization, this is not defined. The plan has a conscientious exemption option, but it is not clear as to whether the administration plans to continue the standing policy granting conscientious exemption to individuals and medical facilities or to expand it to include entire health plans. The administration emphasizes that, even though the plan covers abortion. The Health Insurance Association of America opposes the plan while the American Medical Association (AMA) neither supports nor opposes it. The AMA does object, however, to the plans provisions on malpractice and limits on annual premium increases. Families USA strongly favors the plan. The Congressional Caucus on Women's Issues asks the President to include all reproductive health services. The National Black Women's Health Project appreciates the Administration's commitment and the plan's coverage of preventive care and reproductive health, but stresses that it must improve access to poor women, most of whom are black.

  14. Price elasticity of expenditure across health care services.

    PubMed

    Duarte, Fabian

    2012-12-01

    Policymakers in countries around the world are faced with rising health care costs and are debating ways to reform health care to reduce expenditures. Estimates of price elasticity of expenditure are a key component for predicting expenditures under alternative policies. Using unique individual-level data compiled from administrative records from the Chilean private health insurance market, I estimate the price elasticity of expenditures across a variety of health care services. I find elasticities that range between zero for the most acute service (appendectomy) and -2.08 for the most elective (psychologist visit). Moreover, the results show that at least one third of the elasticity is explained by the number of visits; the rest is explained by the intensity of each visit. Finally, I find that high-income individuals are five times more price sensitive than low-income individuals and that older individuals are less price-sensitive than young individuals. Copyright © 2012 Elsevier B.V. All rights reserved.

  15. Impact of Alabama's immigration law on access to health care among Latina immigrants and children: implications for national reform.

    PubMed

    White, Kari; Yeager, Valerie A; Menachemi, Nir; Scarinci, Isabel C

    2014-03-01

    We conducted in-depth interviews in May to July 2012 to evaluate the effect of Alabama's 2011 omnibus immigration law on Latina immigrants and their US- and foreign-born children's access to and use of health services. The predominant effect of the law on access was a reduction in service availability. Affordability and acceptability of care were adversely affected because of economic insecurity and women's increased sense of discrimination. Nonpregnant women and foreign-born children experienced the greatest barriers, but pregnant women and mothers of US-born children also had concerns about accessing care. The implications of restricting access to health services and the potential impact this has on public health should be considered in local and national immigration reform discussions.

  16. Health sector reform and trends in the United Kingdom hospital workforce.

    PubMed

    Buchan, J; Hancock, C; Rafferty, A M

    1997-10-01

    The authors examine changing trends in the profile and patterns of employment of the workforce in hospitals in the National Health Service (NHS) in the United Kingdom. The effect of the implementation of the NHS reforms is considered, with particular reference to the changing composition of the nursing workforce. The authors note that there are problems with establishing trend data because of altered information requirements as a result of the NHS reforms. Analysis and review of data from secondary sources and research publications. Although hospital activity rates have grown, patient length of hospital stays decreased, and patient activity levels increased, there has not been a linked growth in the size of the nursing workforce. The main changes in the profile of the nursing workforce highlighted are a marked reduction in the numbers of nursing students and alterations in the skill mix between first- and second-level qualified nurses. The authors also note a large increase in the number of managerial and administrative staff employed and growth in medical staff numbers. Changes in working patterns and increases in contracting for support services and in the use of temporary staff also are discussed. There have been pronounced changes in the profile of the hospital workforce but little evaluation of the impact of these changes on outcomes of care.

  17. Provision of ambulatory health services in Poland: a case study from Krakow.

    PubMed

    Chawla, Mukesh; Berman, Peter; Windak, Adam; Kulis, Marzena

    2004-01-01

    This study provides a comprehensive picture of the organization and delivery of ambulatory health care services in Poland. A main finding of the study is that, following the introduction of health insurance in 1999, the newly introduced Sickness Funds have become the main players in the medical services market, introducing new bidding procedures and contracts for provision of medical services. Contracts, and negotiations which precede them, have introduced elements of market competition, which has affected the number and types of services provided by health care centers operating under a contract. The health financing reforms have led to an even playing field for public and non-public providers, marked by a proliferation of structurally smaller health units. The introduction of a market environment has changed the way in which providers are compensated, with a discernible shift away from salary-based systems to capitation and fee-for-service compensation. The analysis of the provider market for outpatient care underscores the importance of understanding the organization and supply of health services, particularly insofar as it relates to the design of appropriate financial and other incentives for providers of health services and of policy interventions necessary for achieving systemic changes.

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

    PubMed

    Nguyen, Vu Q C; Hirsch, Mark A

    2011-09-01

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

  19. Impact of Massachusetts Health Reform on Enrollment Length and Health Care Utilization in the Unsubsidized Individual Market.

    PubMed

    Garabedian, Laura F; Ross-Degnan, Dennis; Soumerai, Stephen B; Choudhry, Niteesh K; Brown, Jeffrey S

    2017-06-01

    To evaluate the impact of the 2006 Massachusetts health reform, the model for the Affordable Care Act, on short-term enrollment and utilization in the unsubsidized individual health insurance market. Seven years of administrative and claims data from Harvard Pilgrim Health Care. We employed pre-post survival analysis and an interrupted time series design to examine changes in enrollment length, utilization patterns, and use of elective procedures (discretionary inpatient surgeries and infertility treatment) among nonelderly adult enrollees before (n = 6,912) and after (n = 29,207) the MA reform. The probability of short-term enrollment dropped immediately after the reform. Rates of inpatient encounters (HR = 0.83, 95 percent CI: 0.74, 0.93), emergency department encounters (HR = 0.85, 95 percent CI: 0.80, 0.91), and discretionary inpatient surgeries (HR = 0.66 95 percent CI: 0.45, 0.97) were lower in the postreform period, whereas the rate of ambulatory visits was somewhat higher (HR = 1.04, 95 percent CI: 1.00, 1.07). The rate of infertility treatment was higher after the reform (HR = 1.61, 95 percent CI: 1.33, 1.97), driven by women in individual (vs. family) plans. The reform was not associated with increased utilization among short-term enrollees. MA health reform was associated with a decrease in short-term enrollment and changes in utilization patterns indicative of reduced adverse selection in the unsubsidized individual market. Adverse selection may be a problem for specific, high-cost treatments. © Health Research and Educational Trust.

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

    PubMed

    McNabb, Scott J N; Chungong, Stella; Ryan, Mike; Wuhib, Tadesse; Nsubuga, Peter; Alemu, Wondi; Carande-Kulis, Vilma; Rodier, Guenael

    2002-01-01

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

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

    PubMed Central

    Soberón, G; Frenk, J; Sepúlveda, J

    1986-01-01

    The earthquakes that hit Mexico City in September 1985 caused considerable damage both to the population and to important medical facilities. The disaster took place while the country was undertaking a profound reform of its health care system. This reform had introduced a new principle for allocating and distributing the benefits of health care, namely, the principle of citizenship. Operationally, the reform includes an effort to decentralize the decision-making authority, to modernize the administration, to achieve greater coordination within the health sector and among sectors, and to extend coverage to the entire population through an ambitious primary care program. This paper examines the health context in which the reform was taking place when the September earthquakes hit. After presenting the damages caused by the quakes, the paper analyzes the characteristics of the immediate response by the health system. Since many facilities within the system were severely damaged, a series of options for reconstruction are posited. The main lesson to be learned from the Mexican case is that cuts in health care programs are not the inevitable response to economic or natural crises. On the contrary, it is precisely when the majority of the population is undergoing difficulties that a universal and equitable health system becomes most necessary. PMID:3706595

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

    PubMed

    Soberón, G; Frenk, J; Sepúlveda, J

    1986-06-01

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

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

    PubMed

    Husain, Lewis

    2017-08-03

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

  4. Adopting and adapting managed competition: health care reform in Southern Europe.

    PubMed

    Cabiedes, L; Guillén, A

    2001-04-01

    A new paradigm appeared in Europe in the early 1990 s regarding the reform of health care systems. This paradigm has come to be known as the managed competition paradigm, among other terms. First introduced in Great Britain, it entails the separation of the financing/purchasing and providing functions, so that competition among providers is enhanced, while maintaining universal access and public financing, at least in principle. This article explores to what extent such paradigm has been emulated within the Greek, Italian, Portuguese and Spanish health care systems. Reform in the direction of managed competition may be ascertained in all four countries. However, each country has emphasized different aspects of the paradigm, and the degree and rhythm of implementation of reform has varied. The article considers the circumstances under which the new paradigm was born, and its main characteristics; analyzes actual reforms in Southern European countries; and provides a tentative explanation of the diffusion mechanisms. It concludes that the crucial factor explaining the different paths of policy adoption and adaptation is the character of the initial health care system.

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

    PubMed

    Jacobs, Lawrence R; Mettler, Suzanne

    2016-05-01

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

  6. Health care reform: a short summary.

    PubMed

    Harolds, Jay

    2010-09-01

    The Health Care Reform legislation has many provisions of importance to the nuclear medicine community. This article is not a complete summary of the thousands of pages in the legislation, but emphasizes some relevant aspects of the bills. When the plan is fully implemented, about 32 million more Americans will have health insurance. Pre-existing medical conditions will no longer result in insurance denials. There are many initiatives to slow the growth of spending on health care in various ways, such as by setting up the new Medicare Advisory Board. There are also new fees, taxes, penalties, subsidies, and tax deduction changes.

  7. Not-for-profits' role in a reformed system.

    PubMed

    Clinton, H R

    1994-06-01

    As head of the White House task force that helped to craft President Bill Clinton's healthcare reform proposal (the Health Security Act), First Lady Hillary Rodham Clinton demonstrated her determination that reform result in a system that has caring and service at its center. In an address a year ago at the Catholic Health Association assembly, she stressed the administration's goal of providing the security of healthcare coverage to everyone in the United States. Saying the current complex, disjointed system "fragments the care people receive," the First Lady applauded programs that reach out to underserved populations and strengthen the country's healthcare infrastructure. In this interview with Health Progress, Mrs. Clinton discusses tough issues in achieving the system she envisions and the role of Catholic healthcare organizations in a reformed system. Here are her remarks.

  8. The Changing Political Undercurrents in Health Services Delivery in Sub-Saharan Africa.

    PubMed

    Ichoku, H E; Ifelunini, A I

    2017-07-01

    This article reviews the changing political undercurrent in health service delivery in Sub-Saharan Africa, chronicling the ideological shift in orientation toward neoliberalism in the health sector, an ideology crafted and introduced into Sub-Saharan Africa by the International Monetary Fund and the World Bank. The article examines the implication of this neoliberal reform on the efficiency in health care provision and on the quality and accessibility of health services by the poor and vulnerable. Drawing inference from countries like Nigeria, the authors argue that the ascendency of neoliberalism in the health systems of Sub-Saharan Africa has engendered unethical practices and introduced elements of moral hazard in the health sector, reducing the incentive for governments to develop effective service delivery over the long term. The authors therefore advocate for a rejection of neoliberal ideology in favor of a universal coverage principle if an inclusive health system is to be developed.

  9. [Health impact assessment of occupational health policy reform at a multinational chemical company in Japan].

    PubMed

    Fujino, Yoshihisa; Nagata, Tomohisa; Kuroki, Naomi; Dohi, Seitaro; Uehara, Masamichi; Oyama, Ichiro; Kajiki, Shigeyuki; Mori, Koji

    2009-09-01

    A health impact assessment (HIA) was conducted to identify potential health impacts arising from policy reform of occupational health and safety at S-chemical company, a multinational global company that employs about 13,000 workers. A multidisciplinary team of health professionals including occupational physicians, an epidemiologist, and public health researchers oversaw the HIA. A project manager from S-company was also involved in the whole HIA process. A literature review, profiling using annual health examination data and interviews with stakeholders and key informants were undertaken in order to identify possible impacts. A range of positive and negative health impacts were identified and develop recommendations for implementation of the new occupational health policy were proposed. The HIA added value to the planning process for the occupational health policy reform.

  10. Catastrophic health expenditure in households with chronic disease patients: A pre-post comparison of the New Health Care Reform in Shaanxi Province, China

    PubMed Central

    Xu, Yongjian; Ma, Jie; Wu, Na; Fan, Xiaojing; Zhang, Tao; Zhou, Zhongliang; Ren, Jianping; Chen, Gang

    2018-01-01

    Introduction In 2009, China officially launched the New Health Care Reform (NHCR). One important purpose of the reform was to reduce financial burden of health care through health insurance expansion and health care provider regulations. This study aimed to provide evidence on the effect of the NHCR reform on catastrophic health expenditure (CHE) by comparing the occurrence and inequality of CHE among households with chronic diseases patients before and after the reform. Methods This study used the subset of data from the 2008 and 2013 National Health Services Survey conducted in Shaanxi Province. Our sample included households with chronic diseases patients and excluded observations with key variables missing. The final sample size was 1942 households in 2008 and 7704 households in 2013. We defined CHE occurrence following the definition of the World Health Organization (WHO). The income-related inequality in CHE was measured by the concentration index. A multi-level logistic regression model was used in the study to explore the influence of the NHCR on CHE occurrence, controlling for important covariates. Results From 2008 to 2013, the occurrence rate of CHE in rural areas declined from 29.15% to 23.62%. However, the CHE rate in urban areas increased from 19.18% to 24.95%. The interaction term between year and rural/urban location was statistically significant, confirming that the influence of the NHCR on the CHE occurrence rates were heterogeneous between rural and urban areas. As for the CHE inequality, the concentration index in rural areas decreased from -0.4572 to -0.5499 with a p-value less than 0.05. This implied that the CHE occurrence inequality was increased after the implementation of the NHCR. Conclusion Our study suggested that the implementation of the NHCR might not have been effective in reducing the CHE occurrence for households with chronic disease patients. Although the occurrence of CHE of rural households had decreased, the occurrence of CHE

  11. Shifting from Categories to Services: Comprehensive School-Based Mental Health for Children with Emotional Disturbance and Social Maladjustment

    ERIC Educational Resources Information Center

    Heathfield, Lora Tuesday; Clark, Elaine

    2004-01-01

    To meet the present and future educational and mental health needs of our nation's youth, current models of mental health service delivery need to be reformed. Any more time spent arguing the differences between categories such as Emotional Disturbance (ED) and Social Maladjustment (SM) will only delay much needed services and deplete our already…

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

    PubMed Central

    2012-01-01

    Background This paper discusses the way in which women’s health concerns were addressed in Mexico as part of a health system reform. Discussion The first part sets the context by examining the growing complexity that characterizes the global health field, where women’s needs occupy center stage. Part two briefly describes a critical conceptual evolution, i.e. from maternal to reproductive to women’s health. In the third and last section, the novel “women and health” (W&H) approach and its translation into policies and programs in the context of a structural health reform in Mexico is discussed. W&H simultaneously focuses on women’s health needs and women’s critical roles as both formal and informal providers of health care, and the links between these two dimensions. Summary The most important message of this paper is that broad changes in health systems offer the opportunity to address women’s health needs through innovative approaches focused on promoting gender equality and empowering women as drivers of change. PMID:23228037

  13. [Strengthening of the steering role of health++ authorities in health care reforms].

    PubMed

    Marín, J M

    2000-01-01

    Strengthening the ability of health authorities to provide leadership and guidance, now and in the future, is an important issue within the context of health sector reform. It means, among other things, redefining the role of health in light of leading social and economic trends seen in the world at the beginning of the 21st century, increasing participation in health by nongovernmental entities, moving toward participatory democracy in many countries, and modifying concepts of what is considered "public" and "private." Within this scenario, it is necessary to redirect the role of the health sector toward coordinating the mobilization of national resources, on a multisectoral scale, in order to improve equity and social well-being and to channel the limited available resources to the most disadvantaged groups in society. The liberalization of the production and distribution of health-related goods and services, including insurance, challenges the exercise of authority in the area of health. Furthermore, the formation of regional economic blocks and the enormous weight wielded by multinational companies in the areas of pharmaceuticals and other medical supplies and technologies are forcing the health sector to seek ways of harmonizing health legislation and international negotiations. According to many experts, all of these demands surpass the ability of Latin American ministries of health to effectively respond, given most countries' current organizational, legal, and political conditions and technical infrastructure. The countries of the Americas must make it a priority to strengthen their health officials' ability to provide leadership and guidance in order to meet present and future challenges.

  14. Policy Capacity Meets Politics: Comment on "Health Reform Requires Policy Capacity".

    PubMed

    Fafard, Patrick

    2015-07-22

    It is difficult to disagree with the general argument that successful health reform requires a significant degree of policy capacity or that all players in the policy game need to move beyond self-interested advocacy. However, an overly broad definition of policy capacity is a problem. More important perhaps, health reform inevitably requires not just policy capacity but political leadership and compromise. © 2015 by Kerman University of Medical Sciences.

  15. National Health Insurance or Incremental Reform: Aim High, or at Our Feet?

    PubMed Central

    Himmelstein, David U.; Woolhandler, Steffie

    2003-01-01

    Single-payer national health insurance could cover the uninsured and upgrade coverage for most Americans without increasing costs; savings on insurance overhead and other bureaucracy would fully offset the costs of improved care. In contrast, proposed incremental reforms are projected to cover a fraction of the uninsured, at great cost. Moreover, even these projections are suspect; reforms of the past quarter century have not stemmed the erosion of coverage. Despite incrementalists’ claims of pragmatism, they have proven unable to shepherd meaningful reform through the political system. While national health insurance is often dismissed as ultra left by the policy community, it is dead center in public opinion. Polls have consistently shown that at least 40%, and perhaps 60%, of Americans favor such reform. PMID:12511395

  16. National Health Insurance or Incremental Reform: Aim High, or at Our Feet?

    PubMed Central

    Himmelstein, David U.; Woolhandler, Steffie

    2008-01-01

    Single-payer national health insurance could cover the uninsured and upgrade coverage for most Americans without increasing costs; savings on insurance overhead and other bureaucracy would fully offset the costs of improved care. In contrast, proposed incremental reforms are projected to cover a fraction of the uninsured, at great cost. Moreover, even these projections are suspect; reforms of the past quarter century have not stemmed the erosion of coverage. Despite incrementalists’ claims of pragmatism, they have proven unable to shepherd meaningful reform through the political system. While national health insurance is often dismissed as ultra left by the policy community, it is dead center in public opinion. Polls have consistently shown that at least 40%, and perhaps 60%, of Americans favor such reform. PMID:18687624

  17. Mandates for Collaboration: Health Care and Child Welfare Policy and Practice Reforms Create the Platform for Improved Health for Children in Foster Care.

    PubMed

    Zlotnik, Sarah; Wilson, Leigh; Scribano, Philip; Wood, Joanne N; Noonan, Kathleen

    2015-10-01

    Improving the health of children in foster care requires close collaboration between pediatrics and the child welfare system. Propelled by recent health care and child welfare policy reforms, there is a strong foundation for more accountable, collaborative models of care. Over the last 2 decades health care reforms have driven greater accountability in outcomes, access to care, and integrated services for children in foster care. Concurrently, changes in child welfare legislation have expanded the responsibility of child welfare agencies in ensuring child health. Bolstered by federal legislation, numerous jurisdictions are developing innovative cross-system workforce and payment strategies to improve health care delivery and health care outcomes for children in foster care, including: (1) hiring child welfare medical directors, (2) embedding nurses in child welfare agencies, (3) establishing specialized health care clinics, and (4) developing tailored child welfare managed care organizations. As pediatricians engage in cross-system efforts, they should keep in mind the following common elements to enhance their impact: embed staff with health expertise within child welfare settings, identify long-term sustainable funding mechanisms, and implement models for effective information sharing. Now is an opportune time for pediatricians to help strengthen health care provision for children involved with child welfare. Copyright © 2015. Published by Elsevier Inc.

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

    PubMed

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

    2009-03-01

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

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

    PubMed

    Wu, Fenghong; Chi, Yan

    2015-01-01

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

  20. [Social health insurance in China: principal reforms and inequalities].

    PubMed

    Ferreira, Fabianna Bacil Lourenço

    2017-01-01

    This article analyzes the social health insurance system in China, its reforms and the principal social inequalities uncovered. Based in the work of a number of authors of reference, it is possible to observe that rural and urban reforms follow the same pattern: large systems that were gradually reduced and then again expanded relatively quickly. Improvements notwithstanding, some of China's historical problems persist, especially the rural-urban gap and regional disparities. The lack of integration of workers that migrate from the country to the city is reproduced in the current Chinese public health system, constituting one of the primary challenges to be faced at present.

  1. Experiences with primary healthcare in Fuzhou, urban China, in the context of health sector reform: a mixed methods study.

    PubMed

    McCollum, Rosalind; Chen, Lieping; ChenXiang, Tang; Liu, Xiaoyun; Starfield, Barbara; Jinhuan, Zheng; Tolhurst, Rachel

    2014-01-01

    China has recently placed increased emphasis on the provision of primary healthcare services through health sector reform, in response to inequitably distributed health services. With increasing funding for community level facilities, now is an opportune time to assess the quality of primary care delivery and identify areas in need of further improvement. A mixed methodology approach was adopted for this study. Quantitative data were collected using the Primary Care Assessment Tool-Chinese version (C-PCAT), a questionnaire previously adapted for use in China to assess the quality of care at each health facility, based on clients' experiences. In addition, qualitative data were gathered through eight semi-structured interviews exploring perceptions of primary care with health directors and a policy maker to place this issue in the context of health sector reform. The study found that patients attending community health and sub-community health centres are more likely to report better experiences with primary care attributes than patients attending hospital facilities. Generally low scores for community orientation, family centredness and coordination in all types of health facility indicate an urgent need for improvement in these areas. Healthcare directors and policy makers perceived the need for greater coordination between levels of health providers, better financial reimbursement, more formal government contracts and recognition/higher status for staff at the community level and more appropriate undergraduate and postgraduate training. Copyright © 2013 John Wiley & Sons, Ltd.

  2. Use of a Policy Debate to Teach Residents About Health Care Reform

    PubMed Central

    Nguyen, Vu Q. C; Hirsch, Mark A

    2011-01-01

    Background Resident education involves didactics and pedagogic strategies using a variety of tools and technologies in order to improve critical thinking skills. Debating is used in educational settings to improve critical thinking skills, but there have been no reports of its use in residency education. The present paper describes the use of debate to teach resident physicians about health care reform. Objective We aimed to describe the method of using a debate in graduate medical education. Methods Second-year through fourth-year physical medicine and rehabilitation residents participated in a moderated policy debate in which they deliberated whether the United States has one of the “best health care system(s) in the world.” Following the debate, the participants completed an unvalidated open-ended questionnaire about health care reform. Results Although residents expressed initial concerns about participating in a public debate on health care reform, all faculty and residents expressed that the debate was robust, animated, and enjoyed by all. Components of holding a successful debate on health care reform were noted to be: (1) getting “buy-in” from the resident physicians; (2) preparing the debate; and (3) follow-up. Conclusion The debate facilitated the study of a large, complex topic like health care reform. It created an active learning process. It encouraged learners to keenly attend to an opposing perspective while enthusiastically defending their position. We conclude that the use of debates as a teaching tool in resident education is valuable and should be explored further. PMID:22942966

  3. The Effect of Massachusetts' Health Reform on Employer-Sponsored Insurance Premiums.

    PubMed

    Cogan, John F; Hubbard, R Glenn; Kessler, Daniel

    2010-01-01

    In this paper, we use publicly available data from the Medical Expenditure Panel Survey - Insurance Component (MEPS-IC) to investigate the effect of Massachusetts' health reform plan on employer-sponsored insurance premiums. We tabulate premium growth for private-sector employers in Massachusetts and the United States as a whole for 2004 - 2008. We estimate the effect of the plan as the difference in premium growth between Massachusetts and the United States between 2006 and 2008-that is, before versus after the plan-over and above the difference in premium growth for 2004 to 2006. We find that health reform in Massachusetts increased single-coverage employer-sponsored insurance premiums by about 6 percent, or $262. Although our research design has important limitations, it does suggest that policy makers should be concerned about the consequences of health reform for the cost of private insurance.

  4. On a hiding to nothing? Assessing the corporate governance of hospital and health services in New Zealand 1993-1998.

    PubMed

    Barnett, P; Perkins, R; Powell, M

    2001-01-01

    In New Zealand the governance of public sector hospital and health services has changed significantly over the past decade. For most of the century hospitals had been funded by central government grants but run by locally elected boards. In 1989 a reforming Labour government restructured health services along managerialist lines, including changing governance structures so that some area health board members were government appointments, with the balance elected by the community. More market oriented reform under a new National government abolished this arrangement and introduced (1993) a corporate approach to the management of hospitals and related services. The hospitals were established as limited liability companies under the Companies Act. This was an explicitly corporate model and, although there was some modification of arrangements following the election of a more politically moderate centre-right coalition government in 1996, the corporate model was largely retained. Although significant changes occurred again after the election of a Labour government in 1999, the corporate governance experience in New Zealand health services is one from which lessons can, nevertheless, be learnt. This paper examines aspects of the performance and process of corporate governance arrangements for public sector health services in New Zealand, 1993-1998.

  5. The Importance of Community Consultations for Generating Evidence for Health Reform in Ukraine

    PubMed Central

    Hankivsky, Olena; Vorobyova, Anna; Salnykova, Anastasiya; Rouhani, Setareh

    2017-01-01

    Background: The paper presents the results of community consultations about the health needs and healthcare experiences of the population of Ukraine. The objective of community consultations is to engage a community in which a research project is studying, and to gauge feedback, criticism and suggestions. It is designed to seek advice or information from participants directly affected by the study subject of interest. The purpose of this study was to collect first-hand perceptions about daily life, health concerns and experiences with the healthcare system. This study provides policy-makers with additional evidence to ensure that health reforms would include a focus not only on health system changes but also social determinants of health (SDH). Methods: The data collection consisted of the 21 community consultations conducted in 2012 in eleven regions of Ukraine in a mix of urban and rural settings. The qualitative data was coded in MAXQDA 11 software and thematic analysis was used as a method of summarizing and interpreting the results. Results: The key findings of this study point out the importance of the SDH in the lives of Ukrainians and how the residents of Ukraine perceive that health inequities and premature mortality are shaped by the circumstances of their daily lives, such as: political and economic instability, environmental pollution, low wages, poor diet, insufficient physical activity, and unsatisfactory state of public services. Study participants repeatedly discussed these conditions as the reasons for the perceived health crisis in Ukraine. The dilapidated state of the healthcare system was discussed as well; high out-of-pocket (OOP) payments and lack of trust in doctors appeared as significant barriers in accessing healthcare services. Additionally, the consultations highlighted the economic and health gaps between residents of rural and urban areas, naming rural populations among the most vulnerable social groups in Ukraine. Conclusion: The

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

    PubMed Central

    Medeiros, Regianne Leila Rolim; Atkinson, Sarah

    2015-01-01

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

  7. Vertical equity of healthcare in Taiwan: health services were distributed according to need.

    PubMed

    Wang, Shiow-Ing; Yaung, Chih-Liang

    2013-01-31

    To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. People with greater health need received more healthcare services, indicating a pro-need character of healthcare distribution, conforming to the meaning of vertical equity. For outpatient service, subjects with the highest health need had higher proportion of ever use in a year than those who had the least health need and consumed more outpatient visits and expenditures per person per year. Similar patterns were observed for emergency services and hospitalization. The concentration indices of utilization for outpatient, emergency services, and hospitalization suggest that the distribution of utilization was related to health need, whereas the preventive service was less related to need. The universal coverage plus healthcare networking system makes it possible for healthcare to be utilized according to need. Taiwan's experience can serve as a reference for health reform.

  8. A CLAS act? Community-based organizations, health service decentralization and primary care development in Peru. Local Committees for Health Administration.

    PubMed

    Iwami, Michiyo; Petchey, Roland

    2002-12-01

    In 1994 Peru embarked on a programme of health service reform, which combined primary care development and community participation through Local Committees for Health Administration (CLAS). They are responsible for carrying out local health needs assessments and identifying unmet health needs through regular household surveys. These enable them to determine local health provision and tailor services to local requirements. CLAS build on grassroots self-help circles that developed during the economic and political crises of the 1980s, and in which women have been prominent. However, they function under a 3 year contract with the Ministry of Health and within a framework of centrally determined guidelines and regulations. These reforms were implemented in the context of neo-liberal economic policies, which stressed financial deregulation and fiscal and monetary restraint, and were aimed at reducing foreign indebtedness and inflation. We evaluate the achievements of the CLAS and analyse the relationship between health and economic policy in Peru, with the aid of two contrasting models of the role of the state - 'agency' and 'stewardship'. We argue that Peru's experience holds valuable lessons for other countries seeking to foster community involvement. These include the need for community capacity building and partnership between community organizations and state (and other civil) agencies.

  9. US health care policy and reform: implications for cardiac electrophysiology.

    PubMed

    Turakhia, Mintu P; Ullal, Aditya J

    2013-03-01

    In response to unsustainably rising costs, variable quality and access to health care, and the projected insolvency of vital safety net insurance programs, the federal government has proposed important health policy and regulatory changes in the USA. The US Supreme Court's decision to uphold most of the major provisions of the Affordable Care Act will lead to some of the most sweeping government reforms on entitlements since the creation of Medicare. Furthermore, implementation of new organizational, reimbursement, and health care delivery models will strongly affect the practice of cardiac electrophysiology. In this brief review, we will provide background and context to the problem of rising health care costs and describe salient reforms and their projected impacts on the field and practice of cardiac electrophysiology.

  10. Impact of Alabama’s Immigration Law on Access to Health Care Among Latina Immigrants and Children: Implications for National Reform

    PubMed Central

    Yeager, Valerie A.; Menachemi, Nir; Scarinci, Isabel C.

    2014-01-01

    We conducted in-depth interviews in May to July 2012 to evaluate the effect of Alabama’s 2011 omnibus immigration law on Latina immigrants and their US- and foreign-born children’s access to and use of health services. The predominant effect of the law on access was a reduction in service availability. Affordability and acceptability of care were adversely affected because of economic insecurity and women’s increased sense of discrimination. Nonpregnant women and foreign-born children experienced the greatest barriers, but pregnant women and mothers of US-born children also had concerns about accessing care. The implications of restricting access to health services and the potential impact this has on public health should be considered in local and national immigration reform discussions. PMID:24432880

  11. Quality and Importance of Health Policy, Reform, and Public Health Topics: A Study in Physician Assistant Education.

    PubMed

    Angerer-Fuenzalida, Frances M

    2018-06-01

    As key players in a changing US health care system, physician assistants (PAs) must be prepared to act with a clear understanding of health policy as reform changes are enacted. The purpose of this study was to assess the perceptions of graduating PA students about the importance of health policy, reform, and public health and their perception of their preparedness in these areas. The research question was: Do PA students identify these topic areas as important, and, for each topic area, do they feel adequately prepared with sufficient knowledge for clinical practice? Participants in the study included 352 PA students from 14 PA programs randomly selected from 4 geographic regions of the continental United States. A 20-item instrument, the Health Policy Perception Tool, was developed and validated for data collection. Physician assistant students rated content items high on the importance scale and displayed a wide range of ratings on their perceived preparedness in each content area. Health policy/reform items demonstrated the highest disparity, with students indicating that they were least prepared in content areas relating to the Affordable Care Act, such as patient-centered medical home and accountable care organizations. They also rated health system structure/function items as moderately important, but indicated that they were ill prepared on this topic. Public health topics were rated highly on both scales. Physician assistant programs appear to be addressing public health issues well; however, PA education leaders must address the low levels of preparedness in the other areas of health care, specifically those related to health structure/function and health reform.

  12. Global trade, public health, and health services: stakeholders' constructions of the key issues.

    PubMed

    Waitzkin, Howard; Jasso-Aguilar, Rebeca; Landwehr, Angela; Mountain, Carolyn

    2005-09-01

    Focusing mainly on the United States and Latin America, we aimed to identify the constructions of social reality held by the major stakeholders participating in policy debates about global trade, public health, and health services. In a multi-method, qualitative design, we used three sources of data: research and archival literature, 1980-2004; interviews with key informants who represented major organizations participating in these debates, 2002-2004; and organizational reports, 1980-2004. We targeted several types of organizations: government agencies, international financial institutions (IFIs) and trade organizations, international health organizations, multinational corporations, and advocacy groups. Many governments in Latin America define health as a right and health services as a public good. Thus, the government bears responsibility for that right. In contrast, the US government's philosophy of free trade and promoting a market economy assumes that by expanding the private sector, improved economic conditions will improve overall health with a minimum government provision of health care. US government agencies also view promotion of global health as a means to serve US interests. IFIs have emphasized reforms that include reduction and privatization of public sector services. International health organizations have tended to adopt the policy perspectives of IFIs and trade organizations. Advocacy groups have emphasized the deleterious effects of international trade agreements on public health and health services. Organizational stakeholders hold widely divergent constructions of reality regarding trade, public health, and health services. Social constructions concerning trade and health reflect broad ideologies concerning the impacts of market processes. Such constructions manifest features of "creed," regarding the role of the market in advancing human purposes and meeting human needs. Differences in constructions of trade and health constrain policies to

  13. Transitions in State Public Health Law: Comparative Analysis of State Public Health Law Reform Following the Turning Point Model State Public Health Act

    PubMed Central

    Meier, Benjamin Mason; Gebbie, Kristine M.

    2009-01-01

    Given the public health importance of law modernization, we undertook a comparative analysis of policy efforts in 4 states (Alaska, South Carolina, Wisconsin, and Nebraska) that have considered public health law reform based on the Turning Point Model State Public Health Act. Through national legislative tracking and state case studies, we investigated how the Turning Point Act's model legal language has been considered for incorporation into state law and analyzed key facilitating and inhibiting factors for public health law reform. Our findings provide the practice community with a research base to facilitate further law reform and inform future scholarship on the role of law as a determinant of the public's health. PMID:19150900

  14. Junior doctors' working hours: perspectives on the reforms.

    PubMed

    Wilkinson, Carol

    2008-06-01

    The European Working Time Directive for junior doctors came into force in Britain in August 2004. The reforms themselves have been a long time in development and implementation since the inception and debates regarding the New Deal, to the current formations under health and safety legislation. This study, undertaken within a hospital trust setting in England, provides an insight into the perspectives of doctors, nurses and human resources managers in relation to the European Working Time Directive. Critical consideration is given to the impact of the reforms upon the National Health Service and more specifically to daily working relationships at the point of implementation. The results demonstrate some ambivalence towards the reforms because of the major shift in culture for the professions per se, but also for the future of health-care delivery where there are considerable tensions.

  15. Efficiency and equity implications of the health care reforms.

    PubMed

    Carr-Hill, R A

    1994-11-01

    The purpose of the paper is to reflect on the recent health care reforms in both developed and developing countries, in the light of the evidence that has accumulated over the last few years about the efficiency and equity of different fiscal and organisational arrangements. The scene is set by a brief review of the definitions of efficiency and equity and of the confusions that often arise; and of the problems of making assessments in practice with real data. The evidence about effectiveness, efficiency and equity at the macro level are reviewed: among OECD countries, there is little evidence that variations in the levels and composition of health service expenditure actually affect levels of health; equity in financing and delivery appears to mirror equity in other sectors in the same countries; about the only solid--although rather limp--conclusion which is transferable is that costs can be contained best via global budgeting. The range of reforms in the North is sketched: despite calls to give people 'freedom' to opt out, public finances continues to be preferred among OECD countries; and the evidence that health care markets can actually function is 'weak'. Whilst geographical redistribution of finance has proved to be possible, inequalities in health remain in most countries. But the overwhelming impression is that the quality of the data base for many of these studies is appalling, and the analytice techniques used are simplistic. The move to introduce user charges in the South is discussed. It seems unlikely that they will raise a significant fraction of overall revenue; exemptions intended for the poor do not always work; and other trends are likely to exacerbate the patchy coverage of health care systems in the South. The final section reflects on the pressures for increased accountability. The emphasis on consumerism in the North has led to an increasing number of poorly designed 'patient satisfaction' surveys; in the South, there has been an increasing

  16. US Health Care Reform and Transplantation. Part I: overview and impact on access and reimbursement in the private sector.

    PubMed

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

    2010-10-01

    The Health Care Reform (HCR) legislation passed by Congress in 2010 will have significant impact on transplant centers, patients and health care professionals. The Act seeks to expand coverage, limit the growth in health care costs and reform the delivery and insurance systems. In Part I of this two part series, we provide an overview and perspective of changes in private health insurance resulting from HCR. Under the plan, all Americans will be required to purchase coverage through their employer or via an improved individual/small group market. This legislation limits abusive practices such as limitations on preexisting conditions, lifetime and annual coverage limitations and dropping of beneficiaries if they become sick. The legislation will also limit high-cost plans and regulate premium increases. Private sector reforms are likely to benefit our patients by increasing the number of patients with access to transplant services, since the use of 'preexisting' conditions will be eliminated. However without a concomitant increase in the organ supply, longer waiting times and greater use of marginal organs are likely to increase the cost of transplant. Furthermore, transplant providers will receive reduced reimbursement as a result of market consolidation and the growing power of large transplant networks.

  17. Politicians in apron: case study of rebel health services in Nepal.

    PubMed

    Devkota, Bhimsen; van Teijlingen, Edwin R

    2009-10-01

    This article presents the findings of a systematic review on the health consequences of Nepal's armed conflict waged by the Maoists and the development and trajectory of their health workers. Nepal's decade-long violent conflict resulted in more than 13,000 deaths, the destruction of more than 1000 health posts and poor health services delivery. At present, most of the former rebel health workers live in remote/rural areas and some are running health centers. The review found that the Maoists had trained more than 2000 health workers, who can be categorized into 4 levels. However, there is little evidence on their competencies and career motivation. The Maoists demand restructuring of the Nepalese health sector and the integration of their health workforce into the national health system. However, there has been no national discussion in Nepal of what kind of health reform and integration model is appropriate for a sustainable peace and improved service delivery.

  18. Comprehensive health care reform in Vermont: a conversation with Governor Jim Douglas. Interview by James Maxwell.

    PubMed

    Douglas, Jim

    2007-01-01

    In this conversation, Vermont's Republican governor, Jim Douglas, discusses his role in and views on the state's comprehensive health reforms adopted in 2006. The reforms are designed to provide universal access to coverage, improve the quality and performance of the health care system, and promote health and wellness across the lifespan. He describes the specific features of the reforms, the plan for their financing, and the difficult compromises that had to be reached with the Democratically controlled legislature. He talks about his need, as governor, to balance the goals of health reform against other state priorities such as education and economic development.

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

    PubMed

    Bennett, Christine C

    2013-08-19

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

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

    PubMed Central

    WU, Fenghong; CHI, Yan

    2015-01-01

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

  1. Foul weather friends: big business and health care reform in the 1990s in historical perspective.

    PubMed

    Swenson, Peter; Greer, Scott

    2002-08-01

    Existing accounts of the Clinton health reform efforts of the early 1990s neglect to examine how the change in big business reform interests during the short period between the late 1980s and 1994 might have altered the trajectory of compulsory health insurance legislation in Congress. This article explores evidence that big employers lost their early interest in reform because they believed their private remedies for bringing down health cost inflation were finally beginning to work. This had a discouraging effect on reform efforts. Historical analysis shows how hard times during the Great Depression also aligned big business interests with those of reformers seeking compulsory social insurance. Unlike the present case, however, the economic climate did not quickly improve, and the social insurance reform of the New Deal succeeded. The article speculates, therefore, that had employer health expenditures not flattened out, continuing and even growing big business support might have neutralized small business and other opposition that contributed heavily to the failure of reform. Thus in light of the Clinton administration's demonstrated willingness to compromise with business on details of its plan, some kind of major reform might have succeeded.

  2. The group employed model as a foundation for health care delivery reform.

    PubMed

    Minott, Jenny; Helms, David; Luft, Harold; Guterman, Stuart; Weil, Henry

    2010-04-01

    With a focus on delivering low-cost, high-quality care, several organizations using the group employed model (GEM)-with physician groups whose primary and specialty care physicians are salaried or under contract-have been recognized for creating a culture of patient-centeredness and accountability, even in a toxic fee-for-service environment. The elements that leaders of such organizations identify as key to their success are physician leadership that promotes trust in the organization, integration that promotes teamwork and coordination, governance and strategy that drive results, transparency and health information technology that drive continual quality improvement, and a culture of accountability that focuses providers on patient needs and responsibility for effective care and efficient use of resources. These organizations provide important lessons for health care delivery system reform.

  3. Product policy - the main component of the marketing mix in the Romanian health services.

    PubMed

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

    2016-01-01

    The objectives of the reforms in the EU healthcare systems are based on the implementation of the marketing concept in the health systems, which are, among other things: • efficient management of the financial resources and control costs of the rendered health services; • increased satisfaction of the clients of health care services; • broad accessibility to health services; • effective implementation of modern technologies; • rational stimulation of medical services consumption; • achievement of a fair and neutral competition between the public/ private providers and health insurance companies; • introduction of performance criteria in order to increase the incomes of the medical staff and hierarchy in hospitals; • implementation of modern management methods in health services management; • decentralization of the public healthcare system. Product policy in the medical system of healthcare - the most important component of the marketing mix - is the attitude that addresses a medical organization to the volume, structure, and diversity of services subject to their own activities in relation to the requirements of the services market and the competitive actions of other medical institutions.

  4. Product policy - the main component of the marketing mix in the Romanian health services

    PubMed Central

    Coculescu, BI; Purcarea, VL; Coculescu, EC

    2016-01-01

    The objectives of the reforms in the EU healthcare systems are based on the implementation of the marketing concept in the health systems, which are, among other things: • efficient management of the financial resources and control costs of the rendered health services; • increased satisfaction of the clients of health care services; • broad accessibility to health services; • effective implementation of modern technologies; • rational stimulation of medical services consumption; • achievement of a fair and neutral competition between the public/ private providers and health insurance companies; • introduction of performance criteria in order to increase the incomes of the medical staff and hierarchy in hospitals; • implementation of modern management methods in health services management; • decentralization of the public healthcare system. Product policy in the medical system of healthcare - the most important component of the marketing mix - is the attitude that addresses a medical organization to the volume, structure, and diversity of services subject to their own activities in relation to the requirements of the services market and the competitive actions of other medical institutions. PMID:27974913

  5. Children and Their Families in Big Cities: Strategies for Service Reform.

    ERIC Educational Resources Information Center

    Kahn, Alfred J., Ed.; Kamerman, Sheila B., Ed.

    Papers in this collection result from an 18-month exploration of ways to reform services for children and families in big cities, a so-called "rolling seminar" searching for ways to provide supportive and nourishing communities for city children. Contributions to this collection include: (1) "Themes and Viewpoints" (Editors);…

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

    PubMed Central

    Obama, Barack

    2016-01-01

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

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

    PubMed

    Obama, Barack

    2016-08-02

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

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

    PubMed

    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.

  9. Social accounting matrix and the effects of economic reform on health price index and household expenditures: Evidence from Iran.

    PubMed

    Keshavarz, Khosro; Najafi, Behzad; Andayesh, Yaghob; Rezapour, Aziz; Abolhallaj, Masoud; Sarabi Asiabar, Ali; Hashemi Meshkini, Amir; Sanati, Ehsan; Mirian, Iman; Nikfar, Shekoofeh; Lotfi, Farhad

    2017-01-01

    Background: Socioeconomic indicators are the main factors that affect health outcome. Health price index (HPI) and households living costs (HLC) are affected by economic reform. This study aimed at examining the effect of subsidy targeting plan (STP) on HPI and HLC. Methods: The social accounting matrix was used to study the direct and indirect effects of STP. We chose 11 health related goods and services including insurance, compulsory social security services, hospital services, medical and dental services, other human health services, veterinary services, social services, environmental health services, laundry& cleaning and dyeing services, cosmetic and physical health services, and pharmaceutical products in the social accounting matrix to examine the health price index. Data were analyzed by the I-O&SAM software. Results: Due to the subsidy release on energy, water, and bread prices, we found that (i) health related goods and services groups' price index rose between 33.43% and 77.3%, (ii) the living cost index of urban households increased between 48.75% and 58.21%, and (iii) the living cost index of rural households grew between 53.51% and 68.23%. The results demonstrated that the elimination of subsidy would have negative effects on health subdivision and households' costs such that subsidy elimination increased the health prices index and the household living costs, especially among low-income families. The STP had considerable effects on health subdivision price index. Conclusion: The elimination or reduction of energy carriers and basic commodities subsidies have changed health price and households living cost index. Therefore, the policymakers should consider controlling the price of health sectors, price fluctuations and shocks.

  10. America's "undiscovered" laboratory for health services research.

    PubMed

    Gimbel, Ronald W; Pangaro, Louis; Barbour, Galen

    2010-08-01

    Debate over reforming the nation's healthcare system has stimulated a need for health services research (HSR) models that are nationally applicable. Toward this end, the authors identify the Military Health System (MHS) as America's "undiscovered" laboratory for HSR. Although many may confuse the MHS with the Department of Veterans Affairs (VA), the 2 systems vary dramatically with respect to their beneficiary populations, access to care, and other important attributes. In this article, the authors describe key characteristics of the MHS including its large beneficiary base, its direct care operating environment, its dedicated medical school and graduate education programs, and its fully operational integrated health information system. Although a few health systems (eg, Kaiser Permanente, Partners Healthcare, and Department of Veterans Affairs) possess some characteristics, no other has all of these components in place. This article sets the stage for contemporary HSR studies with broad applicability to current issues in American healthcare that could be performed within the MHS. Inclusion of the MHS environment in HSR studies of health services delivery modalities, adoption of health information technology, access to care, relationship of medical education to effective safe care delivery, health disparities, child health, and behavioral health would provide strong underpinnings for proposed changes in American healthcare delivery. Finally, the article highlights current regulatory barriers to research within the MHS whereas suggesting steps to minimize their impact in conducting HSR.

  11. Health insurance reform and HMO penetration in the small group market.

    PubMed

    Buchmueller, Thomas C; Liu, Su

    This study uses data from several national employer surveys conducted between the late 1980s and the mid-1990s to investigate the effect of state-level underwriting reforms on HMO penetration in the small group health insurance market. We identify reform effects by exploiting cross-state variation in the timing and content of reform legislation and by using mid-sized and large employers, which were not affected by the legislation, as within-state control groups. While it is difficult to disentangle the effect of state reforms from other factors affecting HMO penetration in the small group markets, the results suggest a positive relationship between insurance market regulations and HMO penetration.

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

    PubMed

    Morone, James A

    2010-06-01

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

  13. The politics of paying for health reform: zombies, payroll taxes, and the holy grail.

    PubMed

    Oberlander, Jonathan

    2008-01-01

    This paper analyzes the politics of paying for health care reform. It surveys the political strengths and weaknesses of major options to fund universal coverage and explores obstacles to changing how the United States finances health care. Finding a politically viable means to finance universal coverage remains a central barrier to enacting health reform.

  14. Assessing the Changing Landscape of Sexual Health Clinical Service After the Implementation of the Affordable Care Act.

    PubMed

    Mettenbrink, Christie; Al-Tayyib, Alia; Eggert, Jeffrey; Thrun, Mark

    2015-12-01

    Federal health reform has the potential to impact many public health services, especially sexual health clinics. To assess the impact of such reform within the Denver Sexual Health Clinic (DSHC), we conducted a survey of patients to better understand our client population and their care-seeking behavior. Survey data were collected from patients attending the DSHC at 3 different points in time to ascertain insurance status, reasons for not having insurance, reasons for choosing care at the DSHC, and health care use over the past 12 months. A total of 1603 surveys were completed. Forty-two percent of participants were enrolled in health insurance at the time of visit. The percentage of patients with Medicaid increased more than 200% across the survey cycles. Cost was the main reason cited for not having insurance. Participants identified confidentiality and convenience among the top reasons for seeking care at the DSHC regardless of sex or insurance. Although there was no difference in health care use for sexual health services, individuals with health insurance were more likely to have used nonsexual health services in the past 12 months than those without insurance. Patients continue to visit the DSHC despite having health insurance. Sexual health clinics must work to understand what drives people to seek care so that they can better prepare for the future.

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

    PubMed

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

    2008-11-01

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

  16. Aligning Transition Services with Secondary Educational Reform: A Position Statement of the Division on Career Development and Transition

    PubMed Central

    Morningstar, Mary E.; Bassett, Diane S.; Cashman, Joanne; Kochhar-Bryant, Carol; Wehmeyer, Michael L.

    2014-01-01

    Society has witnessed significant improvements in the lives of students receiving transition services over the past 30 years. The field of transition has developed an array of evidence-based interventions and promising practices, however, secondary school reform efforts have often overlooked these approaches for youth without disabilities. If we are to see improvements in postsecondary outcomes for all youth, reform efforts must begin with active participation of both general and special educators and critical home, school, and community stakeholders. In the Division on Career Development for Exceptional Individuals’ position paper, we discuss the evolution of transition in light of reform efforts in secondary education. We review and identify secondary educational initiatives that embrace transition principles. Finally, recommendations are provided for advancing alignment of transition services with secondary education reforms. PMID:25221733

  17. General practice and the New Zealand health reforms – lessons for Australia?

    PubMed Central

    McAvoy, Brian R; Coster, Gregor D

    2005-01-01

    New Zealand's health sector has undergone three significant restructures within 10 years. The most recent has involved a Primary Health Care Strategy, launched in 2001. Primary Health Organisations (PHOs), administered by 21 District Health Boards, are the local structures for implementing the Primary Health Care Strategy. Ninety-three percent of the New Zealand population is now enrolled within 79 PHOs, which pose a challenge to the well-established Independent Practitioner Associations (IPAs). Although there was initial widespread support for the philosophy underlying the Primary Health Care Strategy, there are concerns amongst general practitioners (GPs) and their professional organisations relating to its implementation. These centre around 6 main issues: 1. Loss of autonomy 2. Inadequate management funding and support 3. Inconsistency and variations in contracting processes 4. Lack of publicity and advice around enrolment issues 5. Workforce and workload issues 6. Financial risks On the other hand, many GPs are feeling positive regarding the opportunities for PHOs, particularly for being involved in the provision of a wider range of community health services. Australia has much to learn from New Zealand's latest health sector and primary health care reforms. The key lessons concern: • the need for a national primary health care strategy • active engagement of general practitioners and their professional organisations • recognition of implementation costs • the need for infrastructural support, including information technology and quality systems • robust management and governance arrangements • issues related to critical mass and population/distance trade offs in service delivery models PMID:16262908

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

    PubMed

    Filc, Dani

    2014-12-01

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

  19. Vertical equity of healthcare in Taiwan: health services were distributed according to need

    PubMed Central

    2013-01-01

    Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health need received more healthcare services, indicating a pro-need character of healthcare distribution, conforming to the meaning of vertical equity. For outpatient service, subjects with the highest health need had higher proportion of ever use in a year than those who had the least health need and consumed more outpatient visits and expenditures per person per year. Similar patterns were observed for emergency services and hospitalization. The concentration indices of utilization for outpatient, emergency services, and hospitalization suggest that the distribution of utilization was related to health need, whereas the preventive service was less related to need. Conclusions The universal coverage plus healthcare networking system makes it possible for healthcare to be utilized according to need. Taiwan’s experience can serve as a reference for health reform. PMID:23363855

  20. Harry and Louise and health care reform: romancing public opinion.

    PubMed

    Goldsteen, R L; Goldsteen, K; Swan, J H; Clemeña, W

    2001-12-01

    The question whether the "Harry and Louise" campaign ads, sponsored by the Health Insurance Association of America (HIAA) during the 1993-1994 health care reform debate, influenced public opinion has particular relevance today since interest groups are increasingly choosing commercial-style mass media campaigns to sway public opinion about health policy issues. Our study revisits the issue of the Harry and Louise campaign's influence on public opinion, comparing the ad campaign's messages to changes in opinion about health care reform over a twenty-six-month period in Oklahoma. Looking at the overall trends just prior to the introduction of the Harry and Louise campaign, public opinion was going in the "wrong" direction, from the HIAA perspective. Moreover, public opinion continued in the wrong direction until the mid-point of the campaign. However, in either the turning point of the campaign in terms of message content and tone or in the lag period following it, public opinion reversed on each health reform issue and returned to pre-campaign levels. It appears from these findings that the campaign captured public opinion when support for issues that were unfavorable to HIAA members was increasing and turned public opinion back to pre-campaign levels. The campaign may result in many more such marriages of political interest groups and commercial advertisers for the purpose of demobilizing public support for health policy initiatives that are unfavorable to special interests.

  1. A discourse analysis on how service providers in non-medical primary health and social care services understand their roles in mental health care.

    PubMed

    Mitchell, Penelope Fay

    2009-04-01

    Enhancing collaboration between specialist mental health services, primary health care and social care services has been a key priority in mental health policy reform in many countries for about 20 years and remains so. Yet progress in terms of widespread implementation of demonstrably effective models of collaborative care has been slow. The views that different providers hold regarding the parameters of their roles, and the values that guide their approach to service delivery, are likely to exert profound effects on engagement with collaborative initiatives. Little research has explored these issues. In this study, discourse analysis from a structurational perspective was used to explore the views of providers in a diverse purposive sample of non-medical primary health and social care services in the state of Victoria, Australia regarding their mental health care roles. Four interconnected discourses were revealed as supporting role positions constructed in opposition to the putative role positions of specialist mental health services: an informal as opposed to a formal approach; a normalising as opposed to a pathologising approach; holistic social and emotional health and wellbeing, and an individualised or client-focused model of care as opposed to an illness-focused model. These oppositional role constructions may contribute to reluctance among providers in these sectors to engage with some agendas being promoted by specialist mental health services, through either reduced self-efficacy or active resistance to innovations that conflict with strongly held values. Greater awareness of, and critical reflection upon, contrasting role constructions, and the implications of these for practice may facilitate the design of more appropriate collaborative models and stronger commitment to their implementation.

  2. Reform of health care in Germany

    PubMed Central

    Hurst, Jeremy W.

    1991-01-01

    For the past 45 years Germany has had two health care systems: one in the former Federal Republic of Germany and one in the former German Democratic Republic. The system in the Federal Republic was undergoing some important reforms when German reunification took place in October 1990. Now the system in eastern Germany is undergoing a major transformation to bring it more into line with that in western Germany. PMID:10110879

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

    PubMed Central

    Kolstad, Jonathan T.; Kowalski, Amanda E.

    2012-01-01

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

  4. Health-care reform's great expectations and physician reality.

    PubMed

    Van Mol, Andre

    2010-09-01

    The Patient Protection and Affordable Care Act will not prove to be the reform for which physicians were long hoping. Private insurance rates will climb sharply, forcing people onto government programs; physician reimbursement will plummet; the physician shortage will worsen; rationing in the form of waiting lists is certain; health care as a whole will worsen; and once fully engaged, nationalization of health care will be irreversible.

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

    PubMed

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

    2011-01-01

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

  6. Addressing governance challenges in the provision of animal health services: A review of the literature and empirical application transaction cost theory.

    PubMed

    Ilukor, John; Birner, Regina; Nielsen, Thea

    2015-11-01

    Providing adequate animal health services to smallholder farmers in developing countries has remained a challenge, in spite of various reform efforts during the past decades. The focuses of the past reforms were on market failures to decide what the public sector, the private sector, and the "third sector" (the community-based sector) should do with regard to providing animal health services. However, such frameworks have paid limited attention to the governance challenges inherent in the provision of animal health services. This paper presents a framework for analyzing institutional arrangements for providing animal health services that focus not only on market failures, but also on governance challenges, such as elite capture, and absenteeism of staff. As an analytical basis, Williamson's discriminating alignment hypothesis is applied to assess the cost-effectiveness of different institutional arrangements for animal health services in view of both market failures and governance challenges. This framework is used to generate testable hypotheses on the appropriateness of different institutional arrangements for providing animal health services, depending on context-specific circumstances. Data from Uganda and Kenya on clinical veterinary services is used to provide an empirical test of these hypotheses and to demonstrate application of Williamson's transaction cost theory to veterinary service delivery. The paper concludes that strong public sector involvement, especially in building and strengthening a synergistic relation-based referral arrangement between paraprofessionals and veterinarians is imperative in improving animal health service delivery in developing countries. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Toward health reform for seniors in Bermuda: historical constraints on political possibilities.

    PubMed

    Miller, Edward Alan; Nadash, Pamela

    2011-01-01

    In 2009, as the United States moved toward health care reform, the government of Bermuda implemented its FutureCare program to make health care for seniors more affordable. This article investigates how preferences for reform and its eventual design were shaped by the country's social history and commitment to free market values. Data derive from 36 in-depth interviews with key stakeholders deemed knowledgeable about health care financing and delivery in Bermuda, including government officials, provider representatives, insurance executives, and consumer advocates. Data also derive from a variety of documentary sources. Results indicate that although a clear need for health care and the ability to finance it for seniors exists in Bermuda, the scope of reform was circumscribed by preferences for prior policy decisions, creating a favorable tax and business environment for international corporations and a minimalist social welfare state for addressing racial and economic inequality. This suggests that widespread agreement on the challenges in meeting the health and long-term care needs of the elderly does not necessarily lead to equally commensurable solutions to addressing it.

  8. The political economy of healthy system reform in Israel.

    PubMed

    Chernichovsky, D; Chinitz, D

    1995-01-01

    On June 15, 1994, the Israeli Parliament voted to enact the National Health Insurance bill (NHI). The bill marks the end of a process that lasted for virtually as long as Israel's almost 50 year history. Israel's attempts at health reform began long before the current spate of reforms in many Western countries. Faced with many of the same problems of access, equity and cost control common to many of its counterparts, Israel initiated a reform process based on the recommendations of a prominent State Commission of Inquiry into the Israeli Health System (the Netanyahu Commission) which reported to the Government in 1990. The Commission's proposals were based on a diagnosis indicating that the major problems of the system stem from the lack of clarity regarding the rights of citizens to health care, the lack of a clear allocation of responsibility and accountability among government, insurance or sick funds, and providers in the system, and undue centralization of system operations. This diagnosis led to three major planks for reform: (1) enactment of national health insurance legislation granting a basic package of care to each citizen and hence bringing most of the system's finance under public auspices; (2) divesting the Government from the organization, management and provision of care; hence integrating the management of preventive and psychiatric services provided by the government with the primary and other services provided by sick funds, and granting financial and operational independence to at least government hospitals; and (3) restructuring the Ministry of Health. As is often the case in public policy, more consensus surrounds the diagnosis than the solutions. As a result, nearly four years of implementation efforts have only recently resulted in a major breakthrough. In this paper we make an effort to outline the inherent weaknesses of the Israeli health care system that have led to the crisis in the mid 1980s, summarize the recommendations of the State

  9. Mental health policy in Eastern Europe: a comparative analysis of seven mental health systems

    PubMed Central

    2014-01-01

    Background The objective of this international comparative study is to describe and compare the mental health policies in seven countries of Eastern Europe that share their common communist history: Bulgaria, the Czech Republic, Hungary, Moldova, Poland, Romania, and Slovakia. Methods The health policy questionnaire was developed and the country-specific information was gathered by local experts. The questionnaire includes both qualitative and quantitative information on various aspects of mental health policy: (1) basic country information (demography, health, and economic indicators), (2) health care financing, (3) mental health services (capacities and utilisation, ownership), (4) health service purchasing (purchasing organisations, contracting, reimbursement of services), and (5) mental health policy (policy documents, legislation, civic society). Results The social and economic transition in the 1990s initiated the process of new mental health policy formulation, adoption of mental health legislation stressing human rights of patients, and a strong call for a pragmatic balance of community and hospital services. In contrast to the development in the Western Europe, the civic society was suppressed and NGOs and similar organizations were practically non-existent or under governmental control. Mental health services are financed from the public health insurance as any other health services. There is no separate budget for mental health. We can observe that the know-how about modern mental health care and about direction of needed reforms is available in documents, policies and programmes. However, this does not mean real implementation. Conclusions The burden of totalitarian history still influences many areas of social and economic life, which also has to be taken into account in mental health policy. We may observe that after twenty years of health reforms and reforms of health reforms, the transition of the mental health systems still continues. In spite of

  10. Cancer Prevention Health Services Research: An Emerging Field

    PubMed Central

    Zhao, Hui; Tektiridis, Jennifer H.; Zhang, Ning

    2013-01-01

    In October 2009, The University of Texas MD Anderson Cancer Center hosted a symposium, “Future Directions in Cancer Prevention and Control: Workforce Implications for Training, Practice, and Policy.” This article summarizes discussions and an Internet and literature review by the symposium's Health Services Infrastructure Working Group. We agree on the need for the recognition of Cancer Prevention Health Services Research (CP-HSR) as a unified research field. With advances in cancer screening and increased emphasis on preventive services under healthcare reform, there is a growing need for investigators with both cancer prevention and HSR expertise to consider the comparative effectiveness of cancer screening methods, the cost-effectiveness of early detection technologies, and the accessibility of preventive care for individuals at risk of cancer. Defining CP-HSR as a field will provide investigators with credibility and will serve to draw more researchers to the field. Increasing funding to train individuals in CP-HSR will be important to help meet the anticipated demand for investigators with this specialized multidisciplinary expertise. PMID:22311693

  11. Benefits for Infants and Toddlers in Health Care Reform

    ERIC Educational Resources Information Center

    Cole, Patricia

    2010-01-01

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

  12. [Fundamental strategies to address the problem of public health service delivery insufficiency of disease prevention and control system of China].

    PubMed

    Shao, Jing-jing; Yu, Jing-jin; Yu, Ming-zhu; Duan, Yong; Gong, Xiangguang; Chen, Zheng; Wang, Hua; Shi, Peiwu; Liang, Zhankai; Yang, Feng; Wang, Dunzhi; Yue, Jianning; Luo, Shi; Luo, Li; Wang, Weicheng; Wang, Ying; Sun, Mei; Su, Zhongxin; Ma, Ning; Xie, Hongbin; Hao, Mo

    2005-03-01

    To develop and demonstrate the strategies to solve the problem of public health service delivery insufficiency of disease prevention and control system of China. 205 literatures in 8 national academic journals concerning health service management have been reviewed. The method of boundary analysis has been employed to conclude the various reform strategies. Based on the causes and mechanism of public health service delivery insufficiency of disease prevention and control system, the logic analysis has been employed to develop fundamental strategies, which has been demonstrated by 154 CDC using intention questionnaires. There are fundamental strategies to which the agreeing rate for sampling CDC was over 95%: to make sure government should afford the financing function of disease prevention and control and secure the feasible investment for centers of disease prevention and control. Meanwhile, the working efficiency of CDC should be improved through strengthening management and reforming government investing manner.

  13. Health services and policy research in hepatology.

    PubMed

    Talwalkar, Jayant A

    2014-05-01

    This article examines recent health services and policy research studies in hepatology and liver transplantation. Critical issues include access to medical care, timeliness of referral and consultation, resource utilization in clinical practice, comparative effectiveness research, and the evaluation of care delivery models. Despite policymaking efforts, there continues to be unwarranted variation in access to subspecialty care and liver transplantation services based on race and geographic location. Variations in primary care and specialist awareness of practice guidelines for liver disease contribute to disparities in appropriateness and timeliness of treatments. Defining the cost-effectiveness of increased resource utilization for novel antiviral therapies and liver transplantation continues to stimulate controversy. Few comparative effectiveness studies in hepatology exist to date, yet a growing number of analyses using national datasets will help inform policy in this arena. Identifying care delivery models that demonstrate high value for populations with chronic liver disease is critical in the context of recent healthcare reform efforts. Health services and policy research is a growing field of investigation in hepatology and liver transplantation. Further emphasis on research training and workforce development in this area will be critical for understanding and improving patient-centered outcomes for this population.

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

    PubMed

    Jaramillo, I

    2002-01-01

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

  15. The Importance of Community Consultations for Generating Evidence for Health Reform in Ukraine.

    PubMed

    Hankivsky, Olena; Vorobyova, Anna; Salnykova, Anastasiya; Rouhani, Setareh

    2016-08-17

    The paper presents the results of community consultations about the health needs and healthcare experiences of the population of Ukraine. The objective of community consultations is to engage a community in which a research project is studying, and to gauge feedback, criticism and suggestions. It is designed to seek advice or information from participants directly affected by the study subject of interest. The purpose of this study was to collect first-hand perceptions about daily life, health concerns and experiences with the healthcare system. This study provides policy-makers with additional evidence to ensure that health reforms would include a focus not only on health system changes but also social determinants of health (SDH). The data collection consisted of the 21 community consultations conducted in 2012 in eleven regions of Ukraine in a mix of urban and rural settings. The qualitative data was coded in MAXQDA 11 software and thematic analysis was used as a method of summarizing and interpreting the results. The key findings of this study point out the importance of the SDH in the lives of Ukrainians and how the residents of Ukraine perceive that health inequities and premature mortality are shaped by the circumstances of their daily lives, such as: political and economic instability, environmental pollution, low wages, poor diet, insufficient physical activity, and unsatisfactory state of public services. Study participants repeatedly discussed these conditions as the reasons for the perceived health crisis in Ukraine. The dilapidated state of the healthcare system was discussed as well; high out-of-pocket (OOP) payments and lack of trust in doctors appeared as significant barriers in accessing healthcare services. Additionally, the consultations highlighted the economic and health gaps between residents of rural and urban areas, naming rural populations among the most vulnerable social groups in Ukraine. The study concludes that any meaningful reforms of

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

    PubMed

    Schuftan, Claudio

    2015-01-01

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

  17. Health reform: getting the essentials right.

    PubMed

    Fuchs, Victor R

    2009-01-01

    As the ninety-year history and failure of health care reform illustrates, it is easy for policymakers to disagree about the details of any new plan. In this Perspective, the author suggests trying a new approach this time: enacting a plan that encompasses four essential principles and then making midcourse adjustments later to get the details right. He defines the essentials as the Four Cs: coverage, cost control, coordinated care, and choice.

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

    PubMed

    Fronstin, Paul; Helman, Ruth

    2009-07-01

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

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

    PubMed

    Intaranongpai, Siranee; Hughes, David; Leethongdee, Songkramchai

    2012-01-01

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

  20. 76 FR 16481 - Lifeline and Link Up Reform and Modernization; Federal-State Joint Board on Universal Service...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-23

    ... permitted to receive universal service support reimbursement for offering certain services to qualifying low... when many service offerings are not rate regulated. 10. We also propose reforms to put Lifeline/Link Up... eligible households be permitted to use Lifeline discounts on bundled voice and broadband service offerings...

  1. Medicalizing the Opioid Epidemic in the U.S. in the Era of Health Care Reform.

    PubMed

    Smith, David E

    2017-01-01

    The medicalization of the current opioid epidemic in the era of health care reform and parity, and its possible dismantling, poses many challenges. Between 2002 and 2013, drug overdose rates quadrupled. Parallel to an increase in prescription opioid overdose, heroin overdose deaths are increasing as patients shift to cheaper and more accessible heroin from the prescription opioids which physicians are prescribing less often due to increasing regulatory restrictions, as well as enhanced education and awareness. In many areas, the leading cause of death for young adults is drug overdose. Unlike previous heroin use in the U.S., the nexus of spread is coming primarily out of the medical system, as the line between legal and illicit narcotics has become blurred. The economic and social benefits of bringing the previously excluded addicted population into the mainstream health care system will be substantial and will bring changes in three major areas: mental health and substance abuse services in health plans; parity protection in all insurance plans; substance abuse and mental health services. Long-term implementation of these changes in a medically oriented system will require the development of many new systems and procedures.

  2. Reductions in abortion-related mortality following policy reform: evidence from Romania, South Africa and Bangladesh

    PubMed Central

    2011-01-01

    Unsafe abortion is a significant contributor to worldwide maternal mortality; however, abortion law and policy liberalization could lead to drops in unsafe abortion and related deaths. This review provides an analysis of changes in abortion mortality in three countries where significant policy reform and related service delivery occurred. Drawing on peer-reviewed literature, population data and grey literature on programs and policies, this paper demonstrates the policy and program changes that led to declines in abortion-related mortality in Romania, South Africa and Bangladesh. In all three countries, abortion policy liberalization was followed by implementation of safe abortion services and other reproductive health interventions. South Africa and Bangladesh trained mid-level providers to offer safe abortion and menstrual regulation services, respectively, Romania improved contraceptive policies and services, and Bangladesh made advances in emergency obstetric care and family planning. The findings point to the importance of multi-faceted and complementary reproductive health reforms in successful implementation of abortion policy reform. PMID:22192901

  3. Implementing health care reform in Israel: organizational response to perceived incentives.

    PubMed

    Gross, Revital

    2003-08-01

    Devising new incentives was a main element of health care reform in Israel, which created a regulated market that embodies many principles of managed competition. This study examined sick fund directors' perceptions of the new incentives and their strategic responses to these incentives, enabling the testing of how managed competition works in practice. The methodology used was a multiple case study of Israel's four sick funds. Data were gathered through in-depth interviews with 160 senior officials, analysis of national health insurance legislation, and analysis of published and unpublished archival documents, newspaper articles, public statements of senior managers, and other published data on the sick funds' behavior. The study revealed discrepancies between planned and perceived incentives and highlighted the effect of the latter on strategy formulation. Analysis of sick fund strategies showed that their responses to managed competition incentives deviated from theoretical expectations, compromising some of the objectives of the reform. The study also shows that contextual features account for the specific model of managed competition that was implemented and for the specific strategies employed by the sick funds. The study concludes by highlighting the need to build a process that will enable policy makers to consider local contextual factors when planning and implementing reform, involving health care providers in designing incentives, continuously monitoring processes and outcomes in the reformed system, and allowing for flexibility in policy making.

  4. Health care reform and influenza immunization.

    PubMed

    Tucker, Sharon; Poland, Gregory A

    2013-05-01

    Health care reform calls for the nursing profession, with a focus on disease prevention and health restoration, to innovate and create new models of care that are client-centric, evidence-based, and cost-effective. To do so, nurses must develop a fundamentally different paradigm and epistemology. New care models are required that focus on issues such as evidence-based prevention. Among the prevention foci for hospitals are hospital-acquired infections, including influenza, which kills 36,000 Americans annually. One crucial step in eliminating hospital-acquired influenza is to require influenza vaccination of all health care workers. This article challenges nursing leadership to seize opportunities to lead health care initiatives and encourage courageous innovative actions that depart from old paradigms; these actions must be based on scientific evidence, reduce costs, and promote patient safety and quality care and outcomes. Copyright 2013, SLACK Incorporated.

  5. The British National Health Service 1948–2008: A Review of the Historiography

    PubMed Central

    Gorsky, Martin

    2008-01-01

    Summary This article surveys historical writing on the British National Health Service since its inception in 1948. Its main focus is on policy-making and organisation and its principal concerns are primary care and the hospital sector, although public health, and psychiatric and geriatric care are briefly discussed. The over-arching narrative is one of transition from paternalism and technocratic planning to market disciplines and a discourse of choice, and of the ceding of professional autonomy by clinicians to managers and to the state. These issues are discussed in a chronological survey of policy-making from Bevan's ‘creation’ to the Blair era. Later sections consider evaluations of the service, starting with Webster's thesis that the NHS has been subject to prolonged under-funding, particularly under Conservative stewardship, then moving to assessments of the Thatcher, Major and Blair reforms. Much of the historical literature on the NHS is contentious and opinions are sharply divided on the reform era since the 1970s and the trajectories this has set for the future.

  6. Health care reform and change in public-private mix of financing: a Korean case.

    PubMed

    Jeong, Hyoung-Sun

    2005-10-01

    The objective of this paper is to examine the changes in the Korean health care system invoked by the reform (in the latter part of 2000) in regard to the separation of drug prescription and dispensation, especially from the point of view of the public-private financing mix. It seeks particularly to estimate and analyse the relative financing mix in terms of both modes of production and types of medical provider. The data used to estimate health care expenditure financed by out-of-pocket expenditure by were sourced from the National Health and Nutritional Survey (conducted by interviewing representatives of households) and the General Household Survey (a household diary survey). National Health Insurance data, etc. were used to estimate health expenditure financed by public sources. This study concentrates on the short-run empirical links between the reform and the public-private mix in finance. The reform increased remarkably the public share in total health expenditure. This public share increase has been prominent particularly in the case of expenditure on drugs since the reform has absorbed much of the previously uncovered drugs into the National Health Insurance coverage. However, a higher public share in medical goods than in out-patient care would raise an issue in terms of prioritization of benefit packages. The five-fold increase in the public share of expenditure at pharmacies reflects not only the fact that drugs previously not covered by NHI are covered now but also the fact that prescribed drugs are currently purchased mainly at pharmacies, as opposed to in doctors' clinics, as a result of the reform.

  7. Exploring the Impact of Reform Mathematics on Entry-Level Pre-Service Primary Teachers Attitudes towards Mathematics

    ERIC Educational Resources Information Center

    Leavy, Aisling; Hourigan, Mairead; Carroll, Claire

    2017-01-01

    This study reports entry-level mathematics attitudes of pre-service primary teachers entering an initial teacher education (ITE) program one decade apart. Attitudes of 360 pre-service primary teachers were compared to 419 pre-service teachers entering the same college of education almost one decade later. The latter experienced reform school…

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

    PubMed

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

    1999-05-15

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

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

    PubMed

    Martins, Diane Cocozza; Burbank, Patricia M

    2011-01-01

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

  10. Welfare dynamics, support services, mothers' earnings, and child cognitive development: implications for contemporary welfare reform.

    PubMed

    Yoshikawa, H

    1999-01-01

    This prospective longitudinal study, using data from the National Longitudinal Survey of Youth (NLSY; N = 614), addresses the gap in the research literature regarding the effects of welfare reform on children. Key questions addressed include whether welfare dynamics and support services relevant to welfare reform, both measured across the first 5 years of life, are associated with mothers' earnings in the 6th year and three child cognitive outcomes in the 7th and 8th years: Peabody Individual Achievement Test (PIAT) math and reading scores, and the Peabody Picture Vocabulary Test (PPVT). Welfare dynamics are represented by total time on welfare, degree of cycling on and off welfare, and degree to which welfare and work are combined. Support services measured include three forms of child care (relative, babysitter, and center-based), as well as three forms of human capital supports (child support, job training, and education). Controlling for a range of background factors and for different patterns of welfare use across the first 5 years, small positive associations with mother's earnings were found for child support, education, and job training. Small positive associations also were found between child support and both math and reading scores. Finally positive associations of medium effect size were found between center care and both mothers' earnings and child PPVT scores. Although effect sizes are generally small, the results suggest the potential value of welfare reform approaches that emphasize long-term human capital development. Interactions between welfare dynamics and support services suggest subgroup differences. Specifically, positive effects of support services on earnings are strongest among mothers with higher levels of human capital (higher levels of work while on welfare, lower total time on welfare). Babysitter care appears to have negative effects on both reading and math scores of children whose mothers report low levels of work while on welfare

  11. State Perspectives on Health Care Reform: Oregon, Hawaii, Tennessee, and Rhode Island

    PubMed Central

    Thome, Jean I.; Bianchi, Barbara; Bonnyman, Gordon; Greene, Clark; Leddy, Tricia

    1995-01-01

    The general consensus among States which have had their section 1115 demonstration projects approved is that there is no one best way to implement State health care reform. The Health Care Financing Administration (HCFA), however, wished to discern how States were accomplishing the task of implementing the demonstrations, and solicited responses from State representatives whose section 1115 demonstration waivers had been approved. The resulting article gives an overview of this implementation process from four State perspectives. Written by representatives from Oregon, Hawaii, Tennessee, and Rhode Island, the ideas presented here are indicative of the complex undertaking of State health care reform. PMID:10142573

  12. Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program.

    PubMed

    Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish

    2012-09-01

    In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

  13. [The latest reform of the Colombian healthcare-related social security system].

    PubMed

    Franco-Giraldo, Álvaro

    2012-10-01

    This essay was aimed at exploring and analysing the challenges and opportunities arising from reforming Colombian law 1438/2011 dealing with the healthcare-related social security system. Some outstanding issues from the reform introduced by Law 100/1993 were reviewed and then compared to the 2011 regulations; they were also contrasted (in market model conditions) with some public health strategies which were inoperative during the reform stage. This second reform phase was discussed in relation to the scope of the right to health, access and overall equity. Progress regarding important issues such as benefit package equalisation, primary healthcare attention, integrated healthcare service networks was recognised; however, its failure to change core aspects of the system was discussed, i.e. financial sustainability and the economic rationale imposed on the aforementioned strategies which curtailed its responsiveness to keep the model introduced by law 100/1993 intact. The crucial points necessary for major structural reform of the Colombian healthcare system based on the right to health and equity were then outlined.

  14. Impact of healthcare reforms on out-of-pocket health expenditures in Turkey for public insurees.

    PubMed

    Erus, Burcay; Aktakke, Nazli

    2012-06-01

    The Turkish healthcare system has been subject to major reforms since 2003. During the reform process, access to public healthcare providers was eased and private providers were included in the insurance package for public insurees. This study analyzes data on out-of-pocket (OOP) healthcare expenditures to look into the impact of reforms on the size of OOP health expenditures for premium-based public insurees. The study uses Household Budget Surveys that provide a range of individual- and household-level data as well as healthcare expenditures for the years 2003, before the reforms, and 2006, after the reforms. Results show that with the reforms ratio of households with non-zero OOP expenditure has increased. Share and level of OOP expenditures have decreased. The impact varies across income levels. A semi-parametric analysis shows that wealthier individuals benefited more in terms of the decrease in OOP health expenditures.

  15. Mobile health clinics in the era of reform.

    PubMed

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

    2014-03-01

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

  16. Health Services Research in Rehabilitation and Disability-The Time is Now.

    PubMed

    Graham, James E; Middleton, Addie; Roberts, Pamela; Mallinson, Trudy; Prvu-Bettger, Janet

    2018-01-01

    Policy drives practice, and health services research (HSR) is at the intersection of policy, practice, and patient outcomes. HSR specific to rehabilitation and disability is particularly needed. As rehabilitation researchers and providers, we are uniquely positioned to provide the evidence that guides reforms targeting rehabilitative care. We have the expertise to define the value of rehabilitation in a policy-relevant context. HSR is a powerful tool for providing this evidence. We need to continue building capacity for conducting rigorous, timely rehabilitation-related HSR. Fostering stakeholder engagement in these research efforts will ensure we maintain a patient-centered focus as we address the "Triple Aim" of better care, better health, and better value. In this Special Communication we discuss the role of rehabilitation researchers in HSR. We also provide information on current resources available in our field for conducting HSR and identify gaps for capacity building and future research. Health care reforms are a reality, and through HSR we can give rehabilitation a strong voice during these transformative times. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  17. The informatics of health care reform.

    PubMed Central

    Masys, D R

    1996-01-01

    Health care in the United States has entered a period of economic upheaval. Episodic, fee-for-service care financed by indemnity insurance is being replaced by managed care financed by fixed-price, capitated health plans. The resulting focus on reducing costs, especially in areas where there is competition fueled by oversupply of health services providers and facilities, poses new threats to the livelihood of medical libraries and medical librarians but also offers new opportunities. Internet services, consumer health education, and health services research will grow in importance, and organizational mergers will provide librarians with opportunities to assume new roles within their organizations. PMID:8938325

  18. Achieving health care cost containment through provider payment reform that engages patients and providers.

    PubMed

    Ginsburg, Paul B

    2013-05-01

    The best opportunity to pursue cost containment in the next five to ten years is through reforming provider payment to gradually diminish the role of fee-for-service reimbursement. Public and private payers have launched many promising payment reform pilots aimed at blending fee-for-service with payment approaches based on broader units of care, such as an episode or patients' total needs over a period of time, a crucial first step. But meaningful cost containment from payment reform will not be achieved until Medicare and Medicaid establish stronger incentives for providers to contract in this way, with discouragement of nonparticipation increasing over time. In addition, the models need to evolve to engage beneficiaries, perhaps through incentives for patients to enroll in an accountable care organization and to seek care within that organization's network of providers.

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

    PubMed

    Quadagno, Jill

    2010-06-01

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

  20. Type of Insurance and Use of Preventive Health Services Among Older Adults in Mexico.

    PubMed

    Rivera-Hernandez, Maricruz; Galarraga, Omar

    2015-09-01

    The main purpose of this article was to assess the differences between Seguro Popular (SP) and employer-based health insurance in the use of preventive services, including screening tests for diabetes, cholesterol, hypertension, cervical cancer, and prostate cancer among older adults at more than a decade of health care reform in Mexico. Logistic regression models were used with data from the Mexican Health and Nutrition Survey, 2012. After adjusting for other factors influencing preventive service utilization, SP enrollees were more likely to use screening tests for diabetes, cholesterol, hypertension, and cervical cancer than the uninsured; however, those in employment-based and private insurances had higher odds of using preventive care for most of these services, except Pap smears. Despite all the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in health care access and utilization still exist in Mexico. © The Author(s) 2015.

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

    PubMed

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

    2017-02-01

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

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

    PubMed

    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.

  3. Midwives' perceptions of their role within the context of maternity service reform: An Appreciative Inquiry.

    PubMed

    Sidebotham, Mary; Fenwick, Jennifer; Rath, Susan; Gamble, Jenny

    2015-06-01

    In 2010 Australian Government reform of maternity services enabled midwives to access Medicare. This significant change provides midwives with new opportunities to engage in patterns of working that provide continuity of care to childbearing women. There remains limited evidence, however, on midwives perceptions of how the reforms impact them both personally and professionally. This research examined midwives' perceptions of their role and how, in light of the reform agenda, they might conceptualise a change in working patterns and environment to provide greater levels of continuity of care. A qualitative descriptive approach was employed using the four-stage Appreciative Inquiry model. Twenty-three midwives from three maternity units within south-east Queensland participated in one of six focus groups. Thematic iterative analysis was employed to identify empirical codes and examine relationships within and across the data. Midwives endorsed the reforms and considered the concept of continuity of midwifery care as fundamental to achieving a woman centred maternity system. Most participants, however, found it difficult to conceptualise how they might contribute to any level of system change. In addition the majority passively accepted the status quo of their employing organisation and believed they were powerless to effect change. In order to promote the growth of evidence based continuity of care models midwives need to work to their full scope of practice. Strong midwifery leadership is required to enable midwives to re-conceptualise roles and work patterns and identify how they can engage with and contribute to reform of maternity services. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  4. Systematic review of youth mental health service integration research.

    PubMed

    Kinchin, Irina; Tsey, Komla; Heyeres, Marion; Cadet-James, Yvonne

    2016-01-01

    Quality mental health care is based on the integration of care across organisations and disciplines. The aims of this study were, first, to assess the extent, characteristics and reported outcomes of publications concerned with youth mental health service integration in Australia and internationally; and second, to investigate the study design quality of evaluative interventions and determine whether the studies report on the cost-effectiveness of the integration in order to inform the reform of youth mental health services by Queensland Health. A systematic search of the peer-reviewed literature and a narrative synthesis were undertaken of English language publications from 21 electronic databases. Inclusion criteria were: published 1998-2014 (inclusive); peer-reviewed research; focused on mental health services integration; reported data for youth aged 12-25 years. The methodological quality of evaluative interventions was assessed using the Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project (EPHPP). Twenty-five studies met the inclusion criteria: one (4%) was classified as a measurement research, 13 (52%) as descriptive, and 11 (44%) as interventions including five (45%) evaluative interventions. Four out of the five evaluative interventions reported positive effects of youth mental health service integration. Particular problems included ambiguity of definitions, absence of economic or cost analyses and insufficient consumer involvement. The methodological quality of the interventions was variable with, on average, a moderate level of selection bias and study design. Despite a slight increase in the number of studies in the last couple of years, there are important gaps in the evidence base for youth mental health service integration processes. The relatively small number of evaluative studies and lack of economic evaluations point to the need for additional research in this important area.

  5. Commentary: preparing for health care reform: ten recommendations for academic health centers.

    PubMed

    Shomaker, T Samuel

    2011-05-01

    Health care reform, the subject of intense national debate and discussion during the presidential campaign and the first year of the Obama presidency, is now reality. The Patient Protection and Affordable Care Act of 2010 (PPACA) became law in March 2010. Despite efforts by the new Republican majority in the House of Representatives of the 112th Congress to repeal the bill, some aspects of PPACA have already taken effect, and the majority of the remainder are scheduled to be implemented by 2014. PPACA will change the U.S. health care system in fundamental ways. Perhaps more than other entities in the U.S. health care system, academic health centers (AHCs) will bear the impact of the struggle to care for 32 million new, primarily low-income insurance beneficiaries. A large influx of new patients trying to access the health care system through AHCs will coincide with major changes in the financing of health care, the training of health professions students, and the conduct of biomedical research. Although many of the sweeping changes coming through PPACA will not happen until later in this decade, AHCs must begin planning for the future now if they are to prosper, or even survive, in the brave new world of health care reform. The author of this commentary first briefly analyzes some of the most important effects PPACA will have on AHCs and then makes recommendations for how AHCs can prepare to take advantage of the opportunities and mitigate the challenges inherent in implementing PPACA. Copyright © by the Association of American medical Colleges.

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

    PubMed

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

    2015-02-01

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

  7. Inexpensive health care reform: the mathematics of medicine.

    PubMed

    Forsyth, Roger A

    2010-02-01

    There is data to support the hypothesis that US healthcare reform will require systemic changes in their delivery system rather than a segment-by-segment approach to improving individual components such as administrative or pharmaceutical costs or illness-by-illness programs such as comparative effectiveness or disease management. Mathematically, personnel costs provide the largest potential for savings. These costs are reflected in utilization rates. However, when governments or insurers try to control utilization, shortages or dissatisfaction ensue. Therefore, reform should be structured to encourage individually initiated reductions in utilization. This can be facilitated by changing from employer-paid comprehensive group policies of variable coverage to a three-part, standardized, individually purchased, group policy with a targeted deductible and co-pays that provide disincentives to over-utilization and incentives (refunds on unused contributions) to reduce utilization. There will be a public health policy (maternal, infant, and immunizations) that will be very inexpensive and not subject to any disincentives, a catastrophic policy with a deductible and enhanced but diminishing co-pays, and a Health Savings Account that pre-positions funds to cover the deductible and co-pays. These changes will lead to a reduction in administrative costs. The excess capacity created will provide care for the currently uninsured. Savings will be refunded to individuals thereby generating taxes that can pay for needed subsidies. Reform can be inexpensive if it puts the mathematics before the politics.

  8. Quality assurance guides health reform in Jordan.

    PubMed

    Abubaker, W; Abdulrahman, M

    1996-01-01

    In November 1995, a World Bank mission went to Jordan to conduct a study of the health sector. The study recommended three strategies to reform the health sector: decentralization of Ministry of Health (MOH) management; improvement of clinical practices, quality of care, and consumer satisfaction; and adoption of treatment protocols and standards. The MOH chose quality assurance (QA) methods and quality management (QM) techniques to accomplish these reforms. The Monitoring and QA Directorate oversees QA applications within MOH. It also institutes and develops the capacity of local QA units in the 12 governorates. The QA units implement and monitor day-to-day QA activities. The QM approach encompasses quality principles: establish objectives; use a systematic approach; teach lessons learned and applicable research; use QA training to teach quality care, quality improvement, and patient satisfaction; educate health personnel about QM approaches; use assessment tools and interviews; measure the needs and expectations of local health providers and patients; ensure feedback on QA improvement projects; ensure valid and reliable data; monitor quality improvement efforts; standardize systemic data collection and outcomes; and establish and disseminate QA standards and performance improvement efforts. The Jordan QA Project has helped with the successful institutionalization of a QA system at both the central and local levels. The bylaws of the QA councils and committees require team participation in the decision-making process. Over the last two years, the M&QA Project has adopted 21 standards for nursing, maternal and child health care centers, pharmacies, and medications. The Balqa pilot project has developed 44 such protocols. Quality improvement (COUGH) studies have examined hyper-allergy, analysis of patient flow rate, redistribution of nurses, vaccine waste, and anemic pregnant women. There are a considerable number of on-going clinical and non-clinical COUGH studies

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

    PubMed

    Nyman, John A; Li, Chia-Hsuan W

    2009-07-01

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

  10. Health services research and data linkages: issues, methods, and directions for the future.

    PubMed

    Bradley, Cathy J; Penberthy, Lynne; Devers, Kelly J; Holden, Debra J

    2010-10-01

    Research on pressing health services and policy issues requires access to complete, accurate, and timely patient and organizational data. This paper describes how administrative and health records (including electronic medical records) can be linked for comparative effectiveness and health services research. We categorize the major agents (i.e., who owns and controls data and who carries out the data linkage) into three areas: (1) individual investigators; (2) government sponsored linked data bases; and (3) public-private partnerships that facilitate linkage of data owned by private organizations. We describe challenges that may be encountered in the linkage process, and the benefits of combining secondary databases with primary qualitative and quantitative sources. We use cancer care research to illustrate our points. To fill the gaps in the existing data infrastructure, additional steps are required to foster collaboration among institutions, researchers, and public and private components of the health care sector. Without such effort, independent researchers, governmental agencies, and nonprofit organizations are likely to continue building upon a fragmented and costly system with limited access. Discussion. Without the development and support for emerging information technologies across multiple health care settings, the potential for data collected for clinical and transactional purposes to benefit the research community and, ultimately, the patient population may go unrealized. The current environment is characterized by budget and technical challenges, but investments in data infrastructure are arguably cost-effective given the need to reform our health care system and to monitor the impact of health reform initiatives. © Health Research and Educational Trust.

  11. 45 CFR 261.80 - How do existing welfare reform waivers affect a State's penalty liability under this part?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES ENSURING THAT RECIPIENTS WORK How Do Welfare Reform Waivers Affect State Penalties? § 261.80 How do existing welfare reform waivers affect a State's penalty... 45 Public Welfare 2 2010-10-01 2010-10-01 false How do existing welfare reform waivers affect a...

  12. Private and public cross-subsidization: financing Beijing's health-insurance reform.

    PubMed

    Wu, Ming; Xin, Ying; Wang, Huihui; Yu, Wei

    2005-04-01

    In 1998, the Chinese government proposed a universal health-insurance program for urban employees. However, this reform has been advancing slowly, primarily due to an unpractical financing policy. We surveyed over 2000 families and evaluated the financial impacts of Beijing's reform on public and private enterprises. We found that most state-owned enterprises provided effective health insurance, whereas most private firms did not; overall, 33% of employees had little or no coverage. On average, employees of private firms were healthier and earned more compared to public firms. Because the premium was proportional to income, private firms would pay more for insurance than the predicted health-care expense of their employees. International firms subsidize the most, contributing more than 60% of their insurance premiums to the employees of the public sector. Such an aggressive cross-subsidization policy is difficult to be accepted by private firms.

  13. Primary care-led commissioning and public involvement in the English National Health Service. Lessons from the past.

    PubMed

    Petsoulas, Christina; Peckham, Stephen; Smiddy, Jane; Wilson, Patricia

    2015-05-01

    Patient and Public involvement (PPI) in health care occupies a central place in Western democracies. In England, this theme has been continuously prominent since the introduction of market reforms in the early 1990s. The health care reforms implemented by the current Coalition Government are making primary care practitioners the main commissioners of health care services in the National Health Service, and a duty is placed on them to involve the public in commissioning decisions and strategies. Since implementation of PPI initiatives in primary care commissioning is not new, we asked how likely it is that the new reforms will make a difference. We scanned the main literature related to primary care-led commissioning and found little evidence of effective PPI thus far. We suggest that unless the scope and intended objectives of PPI are clarified and appropriate resources are devoted to it, PPI will continue to remain empty rhetoric and box ticking. To examine the effect of previous PPI initiatives on health care commissioning and draw lessons for future development. We scanned the literature reporting on previous PPI initiatives in primary care-led commissioning since the introduction of the internal market in 1991. In particular, we looked for specific contexts, methods and outcomes of such initiatives. 1. PPI in commissioning has been constantly encouraged by policy makers in England. 2. Research shows limited evidence of effective methods and outcomes so far. 3. Constant reconfiguration of health care structures has had a negative impact on PPI. 4. The new structures look hardly better poised to bring about effective public and patient involvement.

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

    PubMed

    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.

  15. Integrating Continuing Professional Development With Health System Reform: Building Pillars of Support.

    PubMed

    Davis, David A; Rayburn, William F

    2016-01-01

    Clinical failures sparked a widespread desire for health system reform at the beginning of the 21st century, but related efforts have resulted in changes that are either slow or nonexistent. In response, academic medicine has moved in two directions: (1) system-wide reform using electronic health records, practice networks, and widespread data applications (a macro pathway); and (2) professional development of individual clinicians through continuous performance improvement (a micro pathway). Both pathways exist to improve patient care and population health, yet each suffers from limitations in widespread implementation. The authors call for a better union between these two parallel pathways through four pillars of support: (1) an acknowledgment that both pathways are essential to each other and to the final outcome they intend to achieve, (2) a strong faculty commitment to educate about quality improvement and patient safety at all education levels, (3) a reengineering of tools for professional development to serve as effective change agents, and (4) the development of standards to sustain this alignment of pathways. With these pillars of support integrating continuing professional development with health system reform, the authors envision a better functioning system, with improved metrics and value to enhance patient care and population health.

  16. Does the leading pharmaceutical reform in China really solve the issue of overly expensive healthcare services? Evidence from an empirical study

    PubMed Central

    He, Yunzhen; Dou, Guanshen; Huang, Qiaoyun; Zhang, Xinyu; Ye, Yingfeng; Qian, Mengcen

    2018-01-01

    Background Healthcare system reform of Sanming city has become a leading healthcare reform model in China. It has developed a rigorous pharmaceutical reform consisted of the Zero Mark-up Drug Policy and the Centralized Procurement of Medicine Policy to bring down drug expenses and total health expenditures. However, despite the credit and much attention have been given to Sanming’s pharmaceutical reform, its impact still remains unclear. Therefore, the purpose of this study was to explore the impact of the pharmaceutical reform of Sanming on both drug and total health expenditures. Methods Interrupted time series analysis with three segments divided by two intervention points was employed to evaluate the impact of the pharmaceutical reform. Segment 1 was the pre-reform period which captured the baseline information. Segment 2 occurred after the first intervention point when the Zero Mark-up Drug Policy was implemented, whereas Segment 3 was after the implementation of the Centralized Procurement of Medicine Policy. Primary outcomes are outpatient drug expenditure, outpatient total health expenditure, inpatient drug expenditure, and inpatient total health expenditure. Data spanning from May 2012 to May 2014 are included. Results Both drug and total health expenditures exhibited rising trends before any policy was carried out. The launch of Zero Mark-up Drug Policy led to significant instant reductions in levels of outpatient drug expenditure (coefficient = -6,602.99, p<0.01), outpatient total health expenditure (coefficient = -9,958.58, p<0.05), inpatient drug expenditure (coefficient = -7,520.90, p<0.01), and inpatient total health expenditure (coefficient = -16,737, p<0.01). Moreover, the previous upward trends were changed into downward trends for inpatient drug expenditure (coefficient = -2,747.02, p = 0.00) and total health expenditure (coefficient = -3,069.29, p = 0.12). However, after the implementation of Centralized Procurement of Medicine Policy, we

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

    PubMed

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

    2010-01-01

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

  18. Protect the sick: health insurance reform in one easy lesson.

    PubMed

    Stone, Deborah

    2008-01-01

    In thinking about how to expand insurance coverage, the issue that matters is whether insurance enables sick and high-risk people to get medical care. Over the course of three decades, market-oriented insurance reforms have shifted more costs of illness onto people who need and use medical care. By making the users of care pay for it (or even some of it), cost-sharing discourages sick people from getting care, even if they have insurance, and for people with low-incomes and tight budgets, cost-sharing can effectively deny them access to care. Thus, covering or not covering sick people is the core issue of health insurance reform, both as a determinant of support and opposition to proposals, and as the proper yardstick for evaluating reform ideas.

  19. Leveraging health information technology to achieve the "triple aim" of healthcare reform.

    PubMed

    Sheikh, Aziz; Sood, Harpreet S; Bates, David W

    2015-07-01

    To investigate experiences with leveraging health information technology (HIT) to improve patient care and population health, and reduce healthcare expenditures. In-depth qualitative interviews with federal government employees, health policy, HIT and medico-legal experts, health providers, physicians, purchasers, payers, patient advocates, and vendors from across the United States. The authors undertook 47 interviews. There was a widely shared belief that Health Information Technology for Economic and Clinical Health (HITECH) had catalyzed the creation of a digital infrastructure, which was being used in innovative ways to improve quality of care and curtail costs. There were however major concerns about the poor usability of electronic health records (EHRs), their limited ability to support multi-disciplinary care, and major difficulties with health information exchange, which undermined efforts to deliver integrated patient-centered care. Proposed strategies for enhancing the benefits of HIT included federal stimulation of competition by mandating vendors to open-up their application program interfaces, incenting development of low-cost consumer informatics tools, and promoting Congressional review of the The Health Insurance Portability and Accountability Act (HIPPA) to optimize the balance between data privacy and reuse. Many underscored the need to "kick the legs from underneath the fee-for-service model" and replace it with a data-driven reimbursement system that rewards high quality care. The HITECH Act has stimulated unprecedented, multi-stakeholder interest in HIT. Early experiences indicate that the resulting digital infrastructure is being used to improve quality of care and curtail costs. Reform efforts are however severely limited by problems with usability, limited interoperability and the persistence of the fee-for-service paradigm-addressing these issues therefore needs to be the federal government's main policy target. © The Author 2015

  20. Type of insurance and use of preventive health services among older adults in Mexico

    PubMed Central

    Rivera-Hernandez, Maricruz; Galarraga, Omar

    2016-01-01

    Objectives The main purpose of this paper was to assess the differences between Seguro Popular (SP) and employer-based health insurance in the use of preventive services, including screening tests for diabetes, cholesterol, hypertension, cervical cancer and prostate cancer among older adults at more than a decade of health care reform in Mexico. Methods Logistic regression models were used with data from the Mexican Health and Nutrition Survey 2012. Results After adjusting for other factors influencing preventive service utilization, SP enrollees were more likely to use screening tests for diabetes, cholesterol, hypertension and cervical cancer than the uninsured; however, those in employment-based and private insurances had higher odds of using preventive care for most of these services, except Pap smears. Discussion Despite all the evidence that suggests that Seguro Popular has increased access to health insurance for the poor, inequalities in healthcare access still exist in Mexico. PMID:25804897