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.

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

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.

Modernising Education: New Public Management Reform in the Norwegian Education System

ERIC Educational Resources Information Center

Møller, Jorunn; Skedsmo, Guri

2013-01-01

Since the end of the 1980s, the Norwegian education system has gone through major reform, influenced largely by new managerialist ideas. Strategies to renew the public sector were promoted as the new public management (NPM). This paper investigates the way ideas connected to NPM reforms have been introduced and interpreted in the Norwegian…

[Public sector and social and health policy reforms. An inventory on the eve of the new millennium].

PubMed

Gerschman, S

1999-01-01

This study reflects on reforms in health systems and social policies within the framework of the so-called public sector reforms. The point of departure is a review of various explanations for the crisis in the Welfare State, present in the literature from the 1990s. Social policies, at the heart of the crisis, are heavily challenged. What we intend to demonstrate is that this argument plays a specific role, that of introducing neoliberal changes into economic policy, in which the economic tools used generate abstention by the state from the social sphere, deregulation of national economies in favor of the free market, and the fundamentally oversized role of the international financial market. Within this context we analyze the social security and health system reforms. The final part of the article deals with current difficulties in social policies, focusing the debate on a mapping of possible alternatives for developing social and health policies.

Sector Distinctions and the Privatization of Public Education Policymaking

ERIC Educational Resources Information Center

Lubienski, Christopher

2016-01-01

Current trends indicate declining distinctions between "public" and "private" sectors in education. Reformers see sector barriers as unnecessary impediments to innovation, distracting attention and effort from "what works". This analysis questions whether trends in education policy are simply a natural evolution away…

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.

Public Sector Transformation, Racial Inequality and Downward Occupational Mobility

ERIC Educational Resources Information Center

Wilson, George; Roscigno, Vincent J.; Huffman, Matt L.

2013-01-01

New "governance" reforms entailing shifts toward privatization have permeated the public sector over the last decade, possibly affecting workplace-based attainments. We examine the consequences of this reform for African American men, who during the civil rights era reached relative parity with whites. We analyze race-based inequities on one…

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

PubMed

Nordyke, Robert J; Peabody, John W

2002-03-01

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

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

PubMed

Axelrod, D A; Millman, D; Abecassis, M M

2010-10-01

The Patient Protection and Affordable Care Act passed in 2010 will result in dramatic expansion of publically funded health insurance coverage for low-income individuals. It is estimated that of the 32 million newly insured, 16 million will obtain coverage through expansion of the Medicaid Program, and the remaining 16 million will purchase coverage through their employer or newly legislated insurance exchanges. While the Act contains numerous provisions to improve access to private insurance as discussed in Part I of this analysis, public sector coverage will significantly be affected. The cost of health care reform will be borne disproportionately by Medicare, which faces nearly $500 billion in cuts to be identified by a new independent board. Transplant centers should be concerned about the impact of the reform on the financial aspects of transplantation. In addition, this legislation also utilizes the Medicare Program to drive reform of the health care delivery system, by encouraging the development of integrated Accountable Care Organizations, experimentation with new 'models' of healthcare delivery, and expanded support for Comparative Effectiveness Research. Transplant providers, including transplant centers and physicians/surgeons need to lead this movement, drawing on our experience providing comprehensive multidisciplinary care under global budgets with publically reported outcomes.

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.

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

[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.

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.

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.

Healthcare reforms in Cyprus 2013-2017: Does the crisis mark the end of the healthcare sector as we know it?

PubMed

Petrou, Panagiotis; Vandoros, Sotiris

2018-02-01

As part of a bailout agreement with the International Monetary Fund, the European Commission and the European Central Bank (known as the Troika), Cyprus had to achieve a fiscal surplus through budget constraints and efficiency enhancement. As a result, a number of policy changes were implemented, including a reform of the healthcare sector, and major healthcare reforms are planned for the upcoming years, mainly via the introduction of a National Health System. This paper presents the healthcare sector, provides an overview of recent reforms, assesses the recently implemented policies and proposes further interventions. Recent reforms targeting the demand and supply side included the introduction of clinical guidelines, user charges, introduction of coding for Diagnosis Related Groups (DRGs) and the revision of public healthcare coverage criteria. The latter led to a reduction in the number of people with public healthcare coverage in a time of financial crises, when this is needed the most, while co-payments must be reassessed to avoid creating barriers to access. However, DRGs and clinical guidelines can help improve performance and efficiency. The changes so far are yet to mark the end of the healthcare sector as we know it. A universal public healthcare system must remain a priority and must be introduced swiftly to address important existing coverage gaps. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

[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.

The project organization as a policy tool in implementing welfare reforms in the public sector.

PubMed

Jensen, Christian; Johansson, Staffan; Löfström, Mikael

2013-01-01

Organizational design is considered in policy literature as a forceful policy tool to put policy to action. However, previous research has not analyzed the project organization as a specific form of organizational design and, hence, has not given much attention to such organizations as a strategic choice when selecting policy tools. The purpose of the article is to investigate the project as a policy tool; how do such temporary organizations function as a specific form of organization when public policy is implemented? The article is based on a framework of policy implementation and is illustrated with two welfare reforms in the Swedish public sector, which were organized and implemented as project organizations. The case studies and the analysis show that it is crucial that a project organization fits into the overall governance structure when used as a policy tool. If not, the project will remain encapsulated and will not have sufficient impact on the permanent organizational structure. The concept of encapsulation indicates a need to protect the project from a potential hostile environment. The implication of this is that organizational design as a policy tool is a matter that deserves more attention in the strategic discussion on implementing public policies and on the suitability of using certain policy tools. Copyright © 2012 John Wiley & Sons, Ltd.

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.

Weighing public and private options for reforming long-term care financing: findings from a national survey of specialists.

PubMed

Miller, Edward Alan; Mor, Vincent; Clark, Melissa

2010-08-01

Deficiencies in current long-term care (LTC) financing models are substantial and must be addressed if the nation is going to meet the needs of the growing population of frail and disabled elders. Because debate over reforming LTC financing has traditionally focused on the relative roles of the public and private sectors, this article examines what characteristics predispose LTC specialists to weigh one approach--public or private--more than the other. Data are derived from a Web-based survey of 1,147 individuals with known or demonstrable experience with LTC, including consumer advocates, provider representatives, policy experts, and public officials. Results suggest that support for spurring private sector mechanisms, bolstering the government's role, and reforming Medicare and Medicaid vary with key characteristics of the respondents, including experiential, attitudinal, and background variables. Findings also suggest consensus that reform of LTC financing should improve on the current public-private partnership in this area.

Implications for Higher Education of the Public Sector Reform Agenda.

ERIC Educational Resources Information Center

Coaldrake, Peter

1995-01-01

It is argued that issues of accountability, competition, the technology, and internationalization of education suggest it is in the best interest of Australian higher education to adopt strategic management techniques being promoted for the public sector. This includes new emphases on staffing policies and practices, resource allocation and…

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.

Mediating Education Policy: Making up the "Anti-Politics" of Third-Sector Participation in Public Education

ERIC Educational Resources Information Center

Williamson, Ben

2014-01-01

This article examines the participation of "third-sector" organisations in public education in England. These organisations act as a cross-sectoral policy network made up of new kinds of policy experts: mediators and brokers with entrepreneurial careers in ideas. They have sought to make education reform thinkable, intelligible and…

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.

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.

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

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.

Designing effective power sector reform: A road map for the republic of Georgia

NASA Astrophysics Data System (ADS)

Kurdgelashvili, Lado

Around the world, network utilities (i.e., electricity, natural gas, railway, telecommunications, and water supply industries) are undergoing major structural transformation. A new wave of market liberalization, together with rapid technological changes, has challenged the previously dominant monopoly organization of these industries. A global trend toward deregulation and restructuring is evident in countries at different levels of social and economic development. The challenges of transition from a monopolistic to an open market competitive structure are numerous. Understanding these problems and finding solutions are essential to successful restructuring. In developing countries and economies in transition (i.e., the Eastern Europe and the former Soviet Union), government-owned utilities are often considered to be highly inefficient. The dominant power sector restructuring strategies seek to promote economic efficiency through a gradual introduction of competition into the power sector. Five components of power sector reform are commonly proposed by the World Bank and others for these countries: commercialization, privatization, establishment of an independent regulatory agency, unbundling and gradual introduction of competition in generation and retail markets. The Republic of Georgia, like many economies in transition (e.g., Hungary, Ukraine, and Kazakhstan) has followed this reform model. However, outcomes of the reform have not been as promised. The acute economic problems facing Georgia after it regained independence have compounded problems in the power sector. A review of Georgia's utility reforms reveals that the country has undertaken electricity industry restructuring without giving substantial consideration to the problems that these reforms might have created within the industry or society. The main task of this dissertation is to find the restructuring model, which can best serve economic, social and environmental goals under circumstances similar

The health sector reforms and the efficiency of public hospitals in Turkey: provincial markets.

PubMed

Sulku, Seher Nur

2012-10-01

Turkey initiated the 'Health Transformation Programme' (HTP) in 2003 to align its health care system with the European Union and OECD countries. This study investigates the impact of these reforms on the efficiency of public hospitals. Our study would contribute to the existing literature with a comprehensive analysis of the health system in a developing country. We employ the data envelopment approach and the Malmquist index to comparatively examine before and after the reform years. Our analyses compare the performances of public hospitals served in provincial markets. Inputs of number of beds, number of primary care physician, and number of specialists, and how they are used to produce outputs of inpatient discharges, outpatient visits and surgical operations are investigated. Indeed, as the performance indicators dead rate, hospital bed occupation rate and average length of stay are considered. The HTP was generally successful in boosting productivity due to advancements in technology and technical efficiency but in the socio-economically disadvantaged provinces productivity gains have not been achieved. The average technical efficiency gains took place because of the significantly improved scale efficiencies, as the average pure technical efficiency slightly improved. Lastly, the hospital performance indicators have not improved in the short run. It appears that the expected benefits from the health reforms in Turkey have been partially achieved in the short run.

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

PubMed

Bixby, Luis Rosero

2004-02-01

To assess the impact of health sector reform in Costa Rica on that country's child and adult mortality rates and on the people's access to primary health care. Health sector reform was initiated in Costa Rica in 1995 in some districts, but in others reforms were adopted later. This made it possible to perform a time series analysis, using a quasi-experimental study design, in which observations were made annually from 1985 through 2001 for each of the 420 districts that existed in Costa Rica in 1984. The time series were divided into three periods that allowed all districts to be grouped into three categories (pioneer, intermediate, and late) according to the year when they first implemented health sector reform: 1995-1996; 1997-2000; and 2001 or after, respectively. For each of these periods, mortality rates were broken down by cause (communicable, socially-determined, or chronic disease), sex, and age group. The status of the reform process in a particular district was described by two indicators: (1) the presence or absence of health sector reform during a given period and, wherever such reforms had been adopted, (2) the number of years that had transpired since their adoption. Eight variables were used to control for confounders. Vital statistics and demographic data were obtained from the National Institute for Statistics and Census' [Centro Nacional de Estadística y Censos] electronic database. Poisson multiple regression analysis with fixed effects was used to estimate the impact of reform on child and adult mortality from different causes. Assessment of the population's access to primary care before and after the reform was based on the percentage of people who lived within a 4 km radius of a health facility that offered patient visiting hours two or more days a week. This information came from a previous study that used census data from 2000 and geographic information systems to map health care facilities throughout the country. Multiple regression showed

Reform of Budgeting for Acquisition: Lessons from Private Sector Capital Budgeting for the Department of Defense

DTIC Science & Technology

2006-04-30

Åèìáëáíáçå= oÉëÉ~êÅÜ=póãéçëáìã= REFORM OF BUDGETING FOR ACQUISITION: LESSONS FROM PRIVATE SECTOR CAPITAL BUDGETING FOR THE DEPARTMENT OF DEFENSE...TITLE AND SUBTITLE Reform of Budgeting for Acquisition: Lessons from Private Sector Capital Budgeting for the Department of Defense 5a. CONTRACT...Reform of Budgeting for Acquisition: Lessons from Private Sector Capital Budgeting for the Department of Defense Presenter: Jerry McCaffery, PhD, serves

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

End of an era? Managerial losses of African American and Latinos in the public sector.

PubMed

Wilson, George; Roscigno, Vincent

2015-11-01

In this article, we examine whether "new governance" reforms in public sector work over the last two decades have generated managerial wage losses for African Americans and Latinos. Findings from Integrated Public Use Micro-Series data across three time points indicate that the new "business logic" encompassing, most notably, increased employer discretion has progressively disadvantaged African American and Latino men and women relative to their White and gender counterparts. Indeed, for both African Americans and Latinos in the managerial ranks, relative parity in wages that were witnessed in the public sector progressively eroded between 2000 and 2010. Qualifications to these findings indicate that levels of inequality become pronounced for African Americans, and more so among men than women. We discuss the historical niche status of public sector work for racial and ethnic minorities in the U.S. and the importance of conducting further analyses of the public sector because of its fluid nature as a locus of racial stratification. Copyright © 2015 Elsevier Inc. All rights reserved.

Public sector employment, relative deprivation and happiness in adult urban Chinese employees.

PubMed

Hu, Anning

2013-09-01

The decline in perceived happiness within economic prosperity in Chinese society calls for further examination. In this research, we investigate the effect of employment in public sector work units on perceived happiness through the mediation of economic and social status relative deprivations. In the reform era of China, work unit is still an important mechanism maintaining social inequality, and those working in government/Communist Party agencies and public institutions have advantages of getting access to high wage, comprehensive welfare and the manipulation of administrative public power. Such economic and social status advantages are expected to reduce their relative deprivation and further promote their perceived happiness. Using a nationwide survey data conducted in 2006, we find working in public sector can significantly reduce the odds of experiencing economic relative deprivation, which is further contributive to the improvement of subjective wellbeing.

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.

Public Pension Plan Reform: The Legal Framework

ERIC Educational Resources Information Center

Monahan, Amy B.

2010-01-01

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

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

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

PubMed

Vian, Taryn; Bicknell, William J

2014-09-01

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

Accelerated reforms in healthcare financing: the need to scale up private sector participation in Nigeria.

PubMed

Ejughemre, Ufuoma John

2014-01-01

The health sector, a foremost service sector in Nigeria, faces a number of challenges; primarily, the persistent under-funding of the health sector by the Nigerian government as evidence reveals low allocations to the health sector and poor health system performance which are reflected in key health indices of the country.Notwithstanding, there is evidence that the private sector could be a key player in delivering health services and impacting health outcomes, including those related to healthcare financing. This underscores the need to optimize the role of private sector in complementing the government's commitment to financing healthcare delivery and strengthening the health system in Nigeria. There are also concerns about uneven quality and affordability of private-driven health systems, which necessitates reforms aimed at regulation. Accordingly, the argument is that the benefits of leveraging the private sector in complementing the national government in healthcare financing outweigh the challenges, particularly in light of lean public resources and finite donor supports. This article, therefore, highlights the potential for the Nigerian government to scale up healthcare financing by leveraging private resources, innovations and expertise, while working to achieve the universal health coverage.

How Do Private Sector Schools Serve the Public Good by Fostering Inclusive Service Delivery Models?

ERIC Educational Resources Information Center

Scanlan, Martin; Tichy, Karen

2014-01-01

Conversations about promoting educational reforms that redress educational inequities often ignore private schools as irrelevant. Yet pursuits of inclusivity in private sector schools serve the public interest. This article focuses on how the system of Catholic schools in the Archdiocese of St. Louis has been purposefully striving for 2 decades to…

Democratizing Process Innovation? On Citizen Involvement in Public Sector BPM

NASA Astrophysics Data System (ADS)

Niehaves, Björn; Malsch, Robert

‘Open Innovation’ has been heavily discussed for product innovations; however, an information systems (IS) perspective on ‘process innovation’ has not yet been taken. Analyzing the example of the public sector in Germany, the paper seeks to investigate the factors that hinder and support ‘open process innovation’, a concept we define as the involvement of citizens in business process management (BPM) activities. With the help of a quantitative study (n=358), six factors are examined for their impact on citizen involvement in local government BPM initiatives. The results show that citizen involvement in reform processes is not primarily motivated by the aim of cost reduction, but rather related to legitimacy reasons and the intent to increase employee motivation. Based on these findings, implications for (design) theory and practice are discussed: Instead of detailed collaborative business processes modeling, the key of citizen involvement in public sector BPM lies in communication and mutual understanding.

The Common Core State Standards: School Reform at Three Suburban Middle Schools

ERIC Educational Resources Information Center

Morante-Brock, Sandra

2014-01-01

A growing body of research supports the idea that large scale school reform efforts often fail to create sustained change within the public school sector. Proponents of school reform argue that implementing school reform, effectively and with fidelity, can work to ensure the success of reform initiatives in public education. When implementing deep…

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.

Analysis of Security Sector Reform in Post-Conflict Sierra Leone: A Comparison of Current versus Historical Capabilities

DTIC Science & Technology

2010-03-01

6 A. M. Fitz -Gerald, Security Sector Reform in Sierra Leone. Shrivenham, GFN-SSR. 8–10. Osman Gbla...34Security Sector Reform: Bringing the Private in.", 1– 23; Peter Albrecht and Paul Jackson, eds. Security System Transformation in Sierra Leone, 1997–2007...veterans.38 33 John R. Cartwright, Political leadership in Sierra Leone (Toronto: University of

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

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.

Reforming Mexico’s Energy Sector to Enhance Stability

DTIC Science & Technology

2011-10-27

requirement to reform Mexico’s energy sector. Subsequent analysis demonstrates government ownership of Petroleos Mexico (Pemex) is the fundamental...ownership of Petroleos Mexico (Pemex) is the fundamental destabilizing flaw in regulatory policy, by tracing various problems back to this root cause... Petroleos Mexico (Pemex) is the second largest company in Latin America and the seventh largest producer of oil in the world.1 The government of

Applying OD to the Public Sector

ERIC Educational Resources Information Center

Warrick, D. D.

1976-01-01

Discusses special considerations affecting organizational development (OD) programs in public-sector organizations, presents guidelines for using OD procedures in the public sector, and offers conclusions about the applicability of OD in the public sector. (Author/JG)

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

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.

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

PubMed

Martin, Graham P

2011-01-01

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

Electricity sector liberalization in the European Union: The political economy of regulatory reform

NASA Astrophysics Data System (ADS)

Infante Durana, Maria Dolores

This dissertation looks into the reasons that pushed European countries to liberalize their electricity industries. The analysis of the political process leading to that decision in the areas pioneers of regulatory reform in this sector (United Kingdom, Sweden and the European Commission) shows that the liberalization of the European power sectors does not conform to the traditional theoretical explanations for regulatory reform that put interests and industry-specific considerations at the forefront of the explanation. The central argument of this dissertation is that, contrary to what most of the literature assumes and the theories predict, the primary impetus for the reforms in European electricity sectors did not come from industrial or economic worries, but rather from a neo-liberal turn to the ideas shared by European intellectual and political elites. The reform followed a political spill-over process by which the liberalization policy was emulated and introduced as a direct result of the international and sectoral diffusion of the new "efficiency regime" and the belief in the economic superiority of free markets over any form of government intervention. As an idea-driven policy, liberalization was not always coherent with the stated goals and, with means and ends that were not always consistent with each other, the reforms were often hampered and their results ambiguous. Liberalization transformed energy policy priorities in member states by adding the promotion and development of market-based mechanisms to the previous two of ensuring that security of supply, was adequate and of achieving ambitious environmental targets. By adding economic efficiency (and its political corollary, low prices) to its policy goals, governments effectively rendered the realization of the other two goals all the more difficult. As a result, liberalization did not entail the expected government disengagement from the affairs of the industry. On the contrary, it became

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

[Harassment in the public sector].

PubMed

Puech, Paloma; Pitcho, Benjamin

2013-01-01

The French Labour Code, which provides full protection against moral and sexual harassment, is not applicable to public sector workers. The public hospital is however not exempt from such behaviour, which could go unpunished. Public sector workers are therefore protected by the French General Civil Service Regulations and the penal code.

The Civil Aviation Sector in Lebanon. Part 1; Institutional Reforms

NASA Technical Reports Server (NTRS)

Baaj, M. Hadi

2002-01-01

Civil aviation is one of the key contributors to a successful economic system. This has been recognized within Lebanon, which is undertaking developing a new civil aviation strategy encompassing a program of organizational reform, coordinated internationally, to meet the challenges of the new century. Such strategy is vital, as it will provide a coherent vision for the sector, compliment the extensive investments deployed by Lebanon in its aviation infrastructure, and guide future planning and investments. The proposed Civil Aviation Strategy for Lebanon has two major components: (1) institutional reform aiming at creating effective overall legal and regulatory frameworks in-line with current international best practice; and (2) implementation of liberalization measures and open skies policy. This paper aims to: (1) present Lebanon's current institutional arrangements; (2) review the institutional arrangements in key select countries (in order to define current trends in best institutional practice); (3) discuss the proposed institutional reform (which are at the basis of Lebanon's Draft Civil Aviation Reform Law) while showing that they conform with the identified best institutional trends; and (4) outline an implementation plan. The Draft Law has been approved by the Council of Ministers and now awaits Parliamentary endorsement.

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.

Roles for international military medical services in stability operations (security sector reform).

PubMed

Bricknell, M C M; Thompson, D

2007-06-01

This is the second in a series of three papers that examine the role of international military medical services in stability operations in unstable countries. The paper discusses security sector reform in general terms and highlights the interdependency of the armed forces, police, judiciary and penal systems in creating a 'secure environment'. The paper then looks at components of a local military medical system for a counter-insurgency campaign operating on interior lines and the contribution and challenges faced by the international military medical community in supporting the development of this system. Finally the paper highlights the importance of planning the medical support of the international military personnel who will be supporting wider aspects of security sector reform. The paper is based on background research and my personal experience as Medical Director in the Headquarters of the NATO International Stability Assistance Force in Afghanistan in 2006.

Policy reform as creative destruction: political and administrative challenges in preserving the public-private mix.

PubMed

Brown, L D

1992-01-01

As political pressure for affordable universal coverage intensifies, various proposals have been crafted to improve the system without sacrificing the role of the private sector. Some analysts view the preservation of a mixed public-private system as an exercise in incrementalism, avoiding disquieting departures from familiar arrangements. A review of the political and administrative challenges of several main options--market innovation, tax credits, play or pay, and Medicaid expansion--suggests that the path to true reform is a slippery slope. Over time, changes in particular sectors, such as insurance, employers, government, and providers, will very likely implicate the others too. Although redefining the public-private mix may be more incremental than (say) adoption of a Canadian model, it will also entail considerable "creative destruction" of existing patterns and cannot fail to disturb the institutional status quo substantially.

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.

Have VET Reforms Resulted in Improvements in Quality? Illustrations from the Alcohol and Other Drugs Sector

ERIC Educational Resources Information Center

Roche, Ann; Kostadinov, Victoria; White, Michael

2014-01-01

Australian vocational education and training (VET) has undergone major reforms since the 1990s, including the introduction of competency based training (CBT) and the "streamlining" of qualifications. This paper examines the impact of these reforms, using the alcohol and other drugs sector as a case illustration. A survey of alcohol and…

The construction and legitimation of workplace bullying in the public sector: insight into power dynamics and organisational failures in health and social care.

PubMed

Hutchinson, Marie; Jackson, Debra

2015-03-01

Health-care and public sector institutions are high-risk settings for workplace bullying. Despite growing acknowledgement of the scale and consequence of this pervasive problem, there has been little critical examination of the institutional power dynamics that enable bullying. In the aftermath of large-scale failures in care standards in public sector healthcare institutions, which were characterised by managerial bullying, attention to the nexus between bullying, power and institutional failures is warranted. In this study, employing Foucault's framework of power, we illuminate bullying as a feature of structures of power and knowledge in public sector institutions. Our analysis draws upon the experiences of a large sample (n = 3345) of workers in Australian public sector agencies - the type with which most nurses in the public setting will be familiar. In foregrounding these power dynamics, we provide further insight into how cultures that are antithetical to institutional missions can arise and seek to broaden the debate on the dynamics of care failures within public sector institutions. Understanding the practices of power in public sector institutions, particularly in the context of ongoing reform, has important implications for nursing. © 2014 John Wiley & Sons Ltd.

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

PubMed

Petrou, P

2015-11-01

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

Why Americans Love to Reform the Public Schools

ERIC Educational Resources Information Center

Reese, William J.

2004-01-01

Americans from all walks of life espouse the cause of school reform. The past generation has witnessed the rise of education governors and education presidents. The CEO's of major corporations, big-city mayors, private sector entrepreneurs, inner city parents, the heads of teachers' unions, and every politician under the sun have often found the…

Cyclical absenteeism among private sector, public sector and self-employed workers.

PubMed

Pfeifer, Christian

2013-03-01

This research note analyzes differences in the number of absent working days and doctor visits and in their cyclicality between private sector, public sector and self-employed workers. For this purpose, I used large-scale German survey data for the years 1995 to 2007 to estimate random effects negative binomial (count data) models. The main findings are as follows. (i) Public sector workers have on average more absent working days than private sector and self-employed workers. Self-employed workers have fewer absent working days and doctor visits than dependent employed workers. (ii) The regional unemployment rate is on average negatively correlated with the number of absent working days among private and public sector workers as well as among self-employed men. The correlations between regional unemployment rate and doctor visits are only significantly negative among private sector workers. Copyright © 2012 John Wiley & Sons, Ltd.

Publicity as an Instrument of Reform.

ERIC Educational Resources Information Center

Caudill, Susan

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

Competition and Market Reform in the Australian VET Sector. Review of Research.

ERIC Educational Resources Information Center

Anderson, Damon

This report examines current knowledge about the nature, development, and consequences of competition and market reform in the Australian vocational education and training (VET) sector. In the process, the policy context and key aspects of the theory and practice of a competitive training market are analyzed. These other topics related to the…

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

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

Research Frontiers in Public Sector Performance Measurement

NASA Astrophysics Data System (ADS)

Zhonghua, Cai; Ye, Wang

In "New Public Management" era, performance measurement has been widely used in managerial practices of public sectors. From the content and features of performance measurement, this paper aims to explore inspirations on Chinese public sector performance measurement, which based on a review of prior literatures including influencial factors, methods and indicators of public sector performance evaluation. In the end, arguments are presented in this paper pointed out the direction of future researches in this field.

The Prospects for Security Sector Reform in Tunisia: A Year After the Revolution

DTIC Science & Technology

2012-09-01

included.86 This single, easily accessible, and searchable resource for all laws and amendments pertaining to the secu- rity sector greatly enhances ...Reform of the Peni - tentiary System,” Geneva Centre for the Democratic Control of Armed Forces, DCAF-Tunisie, October 5, 2011, available from dcaf

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

PubMed

Maheshwari, Sunil; Bhat, Ramesh; Saha, Somen

2008-02-01

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

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

PubMed

Daemmrich, Arthur

2013-01-01

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

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

NASA Astrophysics Data System (ADS)

Kaproń, Danuta; Stephan, Werner

1991-09-01

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

The politics of public sector change.

PubMed

Harvey, Peter

2003-05-01

As the changes underpinning the Coordinated Care Trials in South Australia have become more apparent, similarities have emerged between the rationalisation of public schooling in the mid 1980s and the transformation of public health in the 1990s. This article aims to discuss the evolution of health services in South Australia and help us answer the question of how best to manage our public and private health infrastructure in a changing economic and social context. Both strategies in education and health share common elements of cost cutting, attempts at improving efficiencies, a flirting with the private sector and the attendant risk of reduced quality of services to the public. This situation in both sectors is indicative of a shift in public policy and a growth in the belief that private management of public sector infrastructure can help resolve the funding crises around our education and health systems.

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

Recent Changes in Public-Sector Governance.

ERIC Educational Resources Information Center

Khademian, Anne Meredith

This report looks at recent changes in governance across the public sector to provide context and examples for the National Commission on Governing America's Schools' efforts. The report is presented in six sections. Following a brief introduction in section 1, section 2 provides an overview of the forces that have changed public-sector governance…

Educational Management Organizations as High Reliability Organizations: A Study of Victory's Philadelphia High School Reform Work

ERIC Educational Resources Information Center

Thomas, David E.

2013-01-01

This executive position paper proposes recommendations for designing reform models between public and private sectors dedicated to improving school reform work in low performing urban high schools. It reviews scholarly research about for-profit educational management organizations, high reliability organizations, American high school reform, and…

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

ERIC Educational Resources Information Center

Monahan, Amy B.

2009-01-01

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

The Progressive Era: The Limits of Reform. Public Issues Series.

ERIC Educational Resources Information Center

Giese, James R.

This booklet is part of a series designed to help students take and defend a position on public issues. In this unit, the progressive era, a major reform period in U.S. history that stretched from about 1900 to 1915 is discussed. The book suggests that large scale reform is difficult to achieve because reformers often assume that their interests,…

Behavioral economics perspectives on public sector pension plans.

PubMed

Beshears, John; Choi, James J; Laibson, David; Madrian, Brigitte C

2011-04-01

We describe the pension plan features of the states and the largest cities and counties in the U.S. Unlike in the private sector, defined benefit (DB) pensions are still the norm in the public sector. However, a few jurisdictions have shifted toward defined contribution (DC) plans as their primary savings plan, and fiscal pressures are likely to generate more movement in this direction. Holding fixed a public employee's work and salary history, we show that DB retirement income replacement ratios vary greatly across jurisdictions. This creates large variation in workers' need to save for retirement in other accounts. There is also substantial heterogeneity across jurisdictions in the savings generated in primary DC plans because of differences in the level of mandatory employer and employee contributions. One notable difference between public and private sector DC plans is that public sector primary DC plans are characterized by required employee or employer contributions (or both), whereas private sector plans largely feature voluntary employee contributions that are supplemented by an employer match. We conclude by applying lessons from savings behavior in private sector savings plans to the design of public sector plans.

Behavioral economics perspectives on public sector pension plans

PubMed Central

BESHEARS, JOHN; CHOI, JAMES J.; LAIBSON, DAVID; MADRIAN, BRIGITTE C.

2011-01-01

We describe the pension plan features of the states and the largest cities and counties in the U.S. Unlike in the private sector, defined benefit (DB) pensions are still the norm in the public sector. However, a few jurisdictions have shifted toward defined contribution (DC) plans as their primary savings plan, and fiscal pressures are likely to generate more movement in this direction. Holding fixed a public employee’s work and salary history, we show that DB retirement income replacement ratios vary greatly across jurisdictions. This creates large variation in workers’ need to save for retirement in other accounts. There is also substantial heterogeneity across jurisdictions in the savings generated in primary DC plans because of differences in the level of mandatory employer and employee contributions. One notable difference between public and private sector DC plans is that public sector primary DC plans are characterized by required employee or employer contributions (or both), whereas private sector plans largely feature voluntary employee contributions that are supplemented by an employer match. We conclude by applying lessons from savings behavior in private sector savings plans to the design of public sector plans. PMID:21789032

Willingness to pay for private primary care services in Hong Kong: are elderly ready to move from the public sector?

PubMed

Liu, Su; Yam, Carrie H K; Huang, Olivia H Y; Griffiths, Sian M

2013-10-01

How to provide better primary care and achieve the right level of public-private balance in doing so is at the centre of many healthcare reforms around the world. In a healthcare system like Hong Kong, where inpatient services are largely funded through general taxation and ambulatory services out of pocket, the family doctor model of primary care is underdeveloped. Since 2008, the Government has taken forward various initiatives to promote primary care and encourage more use of private services. However, little is known in Hong Kong or elsewhere about consumers' willingness to pay (WTP) for private services when care is available in the public sector. This study assessed willingness of the Hong Kong elderly to pay for specific primary care and preventive services in the private sector, through a cross-sectional in-person questionnaire survey and focus group discussions among respondents. The survey revealed that the WTP for private services in general was low among the elderly; particularly, reported WTP for chronic conditions and preventive care both fell below the current market prices. Sub-group analysis showed higher WTP among healthier and more affluent elderly. Among other things, concerns over affordability and uncertainty (of price and quality) in the private sector were associated with this low level of WTP. These results suggest that most elderly, who are heavy users of public health services but with limited income, may not use more private services without seeing significant reduction in price. Financial incentives for consumers alone may not be enough to promote primary care or public-private partnership. Public education on the value of prevention and primary care, as well as supply-side interventions should both be considered. Hong Kong's policy-making process of the initiative studied here may also provide lessons for other countries with ongoing healthcare reforms.

The Gateway Paper--health service delivery outside of the public sector in Pakistan.

PubMed

Nishtar, Sania

2006-12-01

As opposed to preventive healthcare where State mandated healthcare agencies play a pre-dominant role, a number of actors within the healthcare system other than the State play a role in providing personalized curative healthcare within the country. The sector constitutes a set of diverse group of doctors, nurses, pharmacists, traditional healers, drug venders as well as laboratory technicians, shopkeepers and unqualified practitioners. The services they produce include hospitals, nursing homes, maternity clinics, clinics run by a range of healthcare providers, diagnostic facilities and the sale of drugs from pharmacies and unqualified sellers. However, in some cases the distinction between public and private sector is not very clear as many public sector practitioners practice privately, legally and illegally. The sector is fragmented and characterized by a mixed ownership patterns, many types of providers and different systems of medicines. As a viewpoint on the configuration of a proposed health reform within Pakistan, the Gateway Paper flags key issues in relation to this sector. This encompasses lack of a formal regulatory mechanism for private sector providers and their delivery mechanisms, absence of a formal mechanism for building capacity and ensuring quality and absence accreditation arrangements for private hospitals and nursing homes. With this as a context recommendations focus on the nature of regulatory mechanisms and the institutional arrangements necessary support them with particular reference to quality and continuing medical. In regard to traditional medicines directions focus on exploring ways to harnessing the potential within the system in order to leverage its outreach and integrate it with the formal healthcare system. The Paper also stresses on the need to fully exploit the potential within behavioral change interventions in order improve health systems performance in Pakistan and to broaden its scope from lifestyle and prevention

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.

Motivating the Private vs. Public Sector Managers.

ERIC Educational Resources Information Center

Khojasteh, Mak

1993-01-01

A questionnaire on intrinsic/extrinsic rewards received 362 responses from 380 managers. Pay and security were greater motivators for private than for public sector managers. Recognition had higher motivating potential in the public sector. Both groups were motivated by achievement and advancement. (SK)

Reform, Inequalities of Process and the Transformative Potential of Communities of Practice in the Pre-School Sector of England

ERIC Educational Resources Information Center

Simpson, Donald

2011-01-01

The integration of care and education across pre-school sectors of several European countries is currently a key policy priority. In England this necessitates reform aimed at re-modelling a traditionally hierarchical and divided workforce. Drawing on research with early years professionals, this article explores the micro-politics of reform with a…

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.

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

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.

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.

Educational Reforms and Marketization in Norway--A Challenge to the Tradition of the Social Democratic, Inclusive School?

ERIC Educational Resources Information Center

Helgøy, Ingrid; Homme, Anne

2016-01-01

A social democratic, egalitarian public sector and a corporatist political economy have been strong, distinctive and enduring characteristics of Norwegian education. However, this article demonstrates that the education sector has experienced a period of rapid and extensive implementation of New Public Management (NPM) reforms and post-NPM reforms…

Labor in the Public and Nonprofit Sectors.

ERIC Educational Resources Information Center

Hamermesh, Daniel S., Ed.

Originally presented at a Conference on Labor in Nonprofit Industry and Government held at Princeton University, the studies are the first to provide an economic discussion of the public sector labor market. Melvin Reder examines the effect of the absence of the profit motive on employment and wage determination in the public sector. Orley…

Helping public sector health systems innovate: the strategic approach to strengthening reproductive health policies and programs.

PubMed

Fajans, Peter; Simmons, Ruth; Ghiron, Laura

2006-03-01

Public sector health systems that provide services to poor and marginalized populations in developing countries face great challenges. Change associated with health sector reform and structural adjustment often leaves these already-strained institutions with fewer resources and insufficient capacity to relieve health burdens. The Strategic Approach to Strengthening Reproductive Health Policies and Programs is a methodological innovation developed by the World Health Organization and its partners to help countries identify and prioritize their reproductive health service needs, test appropriate interventions, and scale up successful innovations to a subnational or national level. The participatory, interdisciplinary, and country-owned process can set in motion much-needed change. We describe key features of this approach, provide illustrations from country experiences, and use insights from the diffusion of innovation literature to explain the approach's dissemination and sustainability.

Policy and Workforce Reform in England

ERIC Educational Resources Information Center

Gunter, Helen M.

2008-01-01

Current workforce reform, known as Remodelling the School Workforce, is part of an enduring policy process where there have been tensions between public and private sector structures and cultures. I show that the New Right and New Labour governments who have built and configured site based performance management over the past quarter of a century…

Reforms: a quest for efficiency or an opportunity for vested interests'? A case study of pharmaceutical policy reforms in Tanzania.

PubMed

Mori, Amani Thomas; Kaale, Eliangiringa Amos; Risha, Peter

2013-07-13

Regulation of the pharmaceutical sector is a challenging task for most governments in the developing countries. In Tanzania, this task falls under the Food and Drugs Authority and the Pharmacy Council. In 2010, the Pharmacy Council spearheaded policy reforms in the pharmaceutical sector aimed at taking over the control of the regulation of the business of pharmacy from the Tanzania Food and Drugs Authority. This study provides a critical analysis of these reforms. The study employed a qualitative case-study design. Data was collected through in-depth interviews, focus group discussions and document reviews. Data was analyzed thematically using a policy triangle framework. The analysis was done manually. The reforms adopted an incremental model of public policy-making and the process was characterized by lobbying for political support, negotiations and bargaining between the interest groups. These negotiations were largely centred on vested interests and not on the impact of the reforms on the efficiency of pharmaceutical regulations in the country. Stakeholders from the micro and meso levels were minimally involved in the policy reforms. Recent pharmaceutical regulation reforms in Tanzania were overshadowed by vested interests, displacing a critical analysis of optimal policy options that have the potential to increase efficiency in the regulation of the business of pharmacy. Politics influenced decision-making at different levels of the reform process.

Feeling Good About the Iron Rice Bowl: Economic Sector and Happiness in Post-Reform Urban China*

PubMed Central

Wang, Jia; Xie, Yu

2015-01-01

Situated in China’s market transition, this study examines the relationship between economic sector and a worker’s happiness in post-reform urban China. Using datasets from the Chinese General Social Surveys 2003, 2006 and 2008, we find that workers in the state sector enjoy a subjective premium in well-being – reporting significantly higher levels of happiness than their counterparts in the private sector. We also find that during a period when a large wave of workers moved from the state sector to the private sector, those remaining in the state sector reported being significantly happier than did former state sector workers who had moved, whether the move was voluntary or involuntary. We attribute the higher level of reported happiness in the state sector than in the private sector to the disparity by sector in the provision of social welfare benefits. Those who made voluntary state-to-private moves experienced a trade-off in enjoying higher payoffs while losing job security, whereas involuntary mobiles experienced downward mobility and suffered a long-term psychological penalty. PMID:26188448

Feeling good about the iron rice bowl: Economic sector and happiness in post-reform urban China.

PubMed

Wang, Jia; Xie, Yu

2015-09-01

Situated in China's market transition, this study examines the relationship between economic sector and a worker's happiness in post-reform urban China. Using datasets from the Chinese General Social Surveys 2003, 2006 and 2008, we find that workers in the state sector enjoy a subjective premium in well-being - reporting significantly higher levels of happiness than their counterparts in the private sector. We also find that during a period when a large wave of workers moved from the state sector to the private sector, those remaining in the state sector reported being significantly happier than did former state sector workers who had moved, whether the move was voluntary or involuntary. We attribute the higher level of reported happiness in the state sector than in the private sector to the disparity by sector in the provision of social welfare benefits. Those who made voluntary state-to-private moves experienced a trade-off in enjoying higher payoffs while losing job security, whereas involuntary mobiles experienced downward mobility and suffered a long-term psychological penalty. Copyright © 2015 Elsevier Inc. All rights reserved.

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

ERIC Educational Resources Information Center

Brookhart, Susan M.

2013-01-01

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

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.

Public Sector Employee Assistance Programs.

ERIC Educational Resources Information Center

Kemp, Donna R.; Verlinde, Beverly

This document discusses employee assistance programs (EAPs), programs which have been developed to help employees deal with personal problems that seriously affect job performance. It reviews literature which specifically addresses EAPs in the public sector, noting that there are no exact figures on how many public entities have EAPs. Previous…

Private sector health reform in South Africa.

PubMed

Van Den Heever, A M

1998-06-01

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

[The use of management contracts and professional incentives in the public health sector].

PubMed

Ditterich, Rafael Gomes; Moysés, Simone Tetu; Moysés, Samuel Jorge

2012-04-01

Results-based management is a cornerstone of reform in public administration, including the health field, and has become the basis for other innovations such as the institutionalization of management contracts and the use of professional incentives. This review article aims to introduce and discuss the use of such management contracts in the public health sector. Management by results has developed means and tools that highlight the importance of shared responsibility and mutual commitment between workers and management-level directors. Thus, preset goals are negotiated among all the stakeholders and are evaluated periodically in order to grant professional incentives. It is necessary to improve the mechanisms for control and observation, to more precisely determine the healthcare and management indicators and their patterns, to train stakeholders in designing the plan, and to improve the use of professional incentives in order to effectively increase accountability vis-à-vis the desired results.

Abortion law in Nepal: the road to reform.

PubMed

Thapa, Shyam

2004-11-01

In 2002 Nepal's parliament passed a liberal abortion law, after nearly three decades of reform efforts. This paper reviews the history of the movement for reform and the combination of factors that contributed to its success. These include sustained advocacy for reform; the dissemination of knowledge, information and evidence; adoption of the reform agenda by the public sector and its leadership in involving other stakeholders; the existence of work for safe motherhood as the context in which the initiative could gain support; an active women's rights movement and support from international and multilateral organisations; sustained involvement of local NGOs, civil society and professional organisations; the involvement of journalists and the media; the absence of significant opposition; courageous government officials and an enabling democratic political system. The overriding rationale for reforming the abortion law in Nepal has been to ensure safe motherhood and women's rights. The first government abortion services officially began in March 2004 at the Maternity Hospital in Kathmandu; services will be expanded gradually to other public and private hospitals and private clinics in the coming years.

[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.

[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.

Publications | Geothermal Technologies | NREL

Science.gov Websites

Publications Publications NREL publishes a variety of publications related to geothermal energy geothermal energy research. Featured Publications Mexico's Geothermal Market Assessment Report NREL Technical investment in the country's geothermal energy sector. Since 2013, Mexico has enacted comprehensive reforms to

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

PubMed

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

2010-06-01

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

On to the Past: Wrong-Headed School Reform.

ERIC Educational Resources Information Center

Moffett, James

1994-01-01

Business should participate in school reform but has too narrow a perspective to guide it. Nationalizing education through comparative testing is a move to cut spending for social services, to increase accountability and efficiency without increasing financial responsibility or equity. Imposing private-sector rules on public education undermines…

Educating the future public health workforce: do schools of public health teach students about the private sector?

PubMed

Rutkow, Lainie; Traub, Arielle; Howard, Rachel; Frattaroli, Shannon

2013-01-01

Recent surveys indicate that approximately 40% of graduates from schools of public health are employed within the private sector or have an employer charged with regulating the private sector. These data suggest that schools of public health should provide curricular opportunities for their students--the future public health workforce--to learn about the relationship between the private sector and the public's health. To identify opportunities for graduate students in schools of public health to select course work that educates them about the relationship between the private sector and public health. We systematically identified and analyzed data gathered from publicly available course titles and descriptions on the Web sites of accredited schools of public health. Data were collected in the United States. The sample consisted of accredited schools of public health. Descriptions of the number and types of courses that schools of public health offer about the private sector and identification of how course descriptions frame the private sector relative to public health. We identified 104 unique courses with content about the private sector's relationship to public health. More than 75% of accredited schools of public health offered at least 1 such course. Nearly 25% of identified courses focused exclusively on the health insurance industry. Qualitative analysis of the data revealed 5 frames used to describe the private sector, including its role as a stakeholder in the policy process. Schools of public health face a curricular gap, with relatively few course offerings that teach students about the relationship between the private sector and the public's health. By developing new courses or revising existing ones, schools of public health can expose the future public health workforce to the varied ways public health professionals interact with the private sector, and potentially influence students' career paths.

Examination of the Work Organization Assessment Questionnaire in public sector workers.

PubMed

Wynne-Jones, Gwenllian; Varnava, Alice; Buck, Rhiannon; Karanika-Murray, Maria; Griffiths, Amanda; Phillips, Ceri; Cox, Tom; Kahn, Sayeed; Main, Chris J

2009-05-01

To investigate the utility of the Work and Organization Assessment Questionnaire (WOAQ) for public sector data. A cross-sectional survey was performed in public sector organizations measuring demographics, work characteristics, work perceptions (WOAQ), sickness absence, and work performance. Confirmatory factor analysis of the WOAQ showed that factor structure derived for the manufacturing sector, for which the questionnaire was developed, could be replicated moderately well with public sector data. The study then considered whether a better more specific fit for public sector data was possible. Principal components analysis of the public sector data identified a two-factor structure linked to four of the five scales of the WOAQ assessing Management and Work Design, and Work Culture. These two factors may offer a context-sensitive scoring method for the WOAQ in public sector populations. These two factors were found to have good internal consistency, and correlated with the full WOAQ scales and the measures of performance and absence. The WOAQ is a useful and potentially transferable tool. The modified scoring may be used to assess work and organizational factors in the public sector.

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

Halting a Runaway Train: Reforming Teacher Pensions for the 21st Century

ERIC Educational Resources Information Center

Lafferty, Michael B.

2011-01-01

When it comes to public-sector pensions, writes lead author Michael B. Lafferty in this report, "A major public-policy (and public-finance) problem has been defined and measured, debated and deliberated, but not yet solved. Except where it has been." As recounted in "Halting a Runaway Train: Reforming Teacher Pensions for the 21st…

Valuing public sector risk exposure in transportation public-private partnerships.

DOT National Transportation Integrated Search

2010-10-01

This report presents a methodological framework to evaluate public sector financial risk exposure when : delivering transportation infrastructure through public-private partnership (PPP) agreements in the United : States (U.S.). The framework is base...

Public Sector Employment Inequality in the United States and the Great Recession.

PubMed

Laird, Jennifer

2017-02-01

Historically in the United States, the public sector has served as an equalizing institution through the expansion of job opportunities for minority workers. This study examines whether the public sector continues to serve as an equalizing institution in the aftermath of the Great Recession. Using data from the Current Population Survey, I investigate changes in public sector employment between 2003 and 2013. My results point to a post-recession double disadvantage for black public sector workers: they are concentrated in a shrinking sector of the economy, and they are more likely than white and Hispanic public sector workers to experience job loss. These two trends are a historical break for the public sector labor market. I find that race and ethnicity gaps in public sector employment cannot be explained by differences in education, occupation, or any of the other measurable factors that are typically associated with employment. Among unemployed workers who most recently worked for the public sector, black women are the least likely to transition into private sector employment.

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.

Public Opinion and the Acceptance and Feasility of Educational Reforms. EENEE Analytical Report No. 28

ERIC Educational Resources Information Center

Busemeyer, Marius; Lergetporer, Philipp; Woessmann, Ludger

2016-01-01

In education policy, as in many other policy fields, well-designed policy reforms may fail to get enacted because policymakers may suddenly become confronted with a public backlash against their reform agenda. Thus, understanding the dynamics of public opinion is important in order to be able to assess the chances of successful reform. There is a…

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.

Education Sector Reform: The Ugandan Experience

ERIC Educational Resources Information Center

Penny, Alan; Ward, Michael; Read, Tony; Bines, Hazel

2008-01-01

In 1998 the Government of Uganda (GoU) began implementing an ambitious reform programme called the Education Strategic Investment Plan (ESIP) in order to effect Universal Primary Education (UPE). This paper offers a perspective on how the GoU has met the challenge of financing education reform, addressed the need to improve the quality of basic…

Higher Education for Public Value: Taking the Debate beyond New Public Management

ERIC Educational Resources Information Center

Broucker, Bruno; De Wit, Kurt; Verhoeven, Jef C.

2018-01-01

Many higher education (HE) system reforms in the past decades have been built on the paradigm of New Public Management (NPM). However, these reforms have not allowed HE to fully take its value for society into account. In recent years a growing call can be heard to orient the HE sector towards more collaboration, a focus on a larger set of…

Institutions and Organizational Change: Reforming New York City's Public School System

ERIC Educational Resources Information Center

Traver, Amy

2006-01-01

This paper reviews New York City Mayor Michael Bloomberg's education reform agenda, "Children first", in the light of organizational theory. I argue that this reform agenda reflects both coercive and mimetic isomorphism, as Bloomberg uses mayoral control to apply business concepts and practices to New York City's public school system.…

A Guide to Discipline in the Public Sector.

ERIC Educational Resources Information Center

Seidman, Joel

This monograph was prepared as an initial effort in development of a body of material for training public sector managers. It sets forth the basic principles of grievance arbitration covering discipline in the public sector. Major sections are devoted to the topics of just or proper cause for discipline, due process, the nature of discipline, and…

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.

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.

Public purchasing and private priorities for healthcare in New Zealand.

PubMed

Howden-Chapman, P; Ashton, T

2000-11-01

The 1993 Health and Disability Services Act heralded a range of structural reforms in the New Zealand health care system. Despite these reforms considerable resources being spent on convincing consumers of their merits, have failed to gain widespread public approval. This paper examines two key issues that have arisen during the reform process. These are the difficulties associated with trying to set priorities in ways which are effective and politically acceptable, and the relationship between the public and private sectors. Unacknowledged conflicts of interest have helped to undermine the priority setting process. The discussion suggests that it may be increasingly difficult for any government in future to determine the allocation of resources without taking private sector interests and rising public concern into account. It remains to be seen which of these factors is more powerful.

[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.

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

ERIC Educational Resources Information Center

Mintrop, Rick

2015-01-01

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

Environmental performance policy indicators for the public sector: the case of the defence sector.

PubMed

Ramos, Tomás B; Alves, Inês; Subtil, Rui; Joanaz de Melo, João

2007-03-01

The development of environmental performance policy indicators for public services, and in particular for the defence sector, is an emerging issue. Despite a number of recent initiatives there has been little work done in this area, since the other sectors usually focused on are agriculture, transport, industry, tourism and energy. This type of tool can be an important component for environmental performance evaluation at policy level, when integrated in the general performance assessment system of public missions and activities. The main objective of this research was to develop environmental performance policy indicators for the public sector, specifically applied to the defence sector. Previous research included an assessment of the environmental profile, through the evaluation of how environmental management practices have been adopted in this sector and an assessment of environmental aspects and impacts. This paper builds upon that previous research, developing an indicator framework--SEPI--supported by the selection and construction of environmental performance indicators. Another aim is to discuss how the current environmental indicator framework can be integrated into overall performance management. The Portuguese defence sector is presented and the usefulness of this methodology demonstrated. Feasibility and relevancy criteria are applied to evaluate the set of indicators proposed, allowing indicators to be scored and indicators for the policy level to be obtained.

Determinants of village doctors' job satisfaction under China's health sector reform: a cross-sectional mixed methods study.

PubMed

Li, Tongtong; Lei, Trudy; Sun, Fiona; Xie, Zheng

2017-04-18

To strengthen rural health workforce, the Chinese government has launched a series of policies to promote the job satisfaction of village doctors since the health sector reform. The purpose of this mixed-method study is to describe village doctors' job satisfaction under the context of health sector reform and investigate the associated factors. Data was obtained from a survey of village doctors across three Chinese provinces in 2014. Using a multistage sampling process, quantitative data was collected from village doctors through the self-administered questionnaire and analyzed by multilevel logistic regression models. Qualitative data was collected through face-to-face semi-structured interviews on both village doctors and health managers. Theoretical coding was then conducted to analyze qualitative data. Among the 1221 respondents, 48.6% felt satisfied with their job. Older village doctors with less of a workload and under high-level integrated management were more likely to feel satisfied with their job. Village doctors who earned the top level of monthly income felt more satisfied, while on the county level, those who lived in counties with the highest GDP felt less satisfied. However, enrollment in a pension plan showed no significant difference in regards to village doctors' job satisfaction. Among 34 participants of qualitative interviews, most believed that age, income, and integrated management had a positive influence on the job satisfaction, while pension plan and basic public health care policies exhibited negative effects. Also, the increasing in availability of healthcare and health resources along with local economic development had negative effects on village doctors' job satisfaction. Village doctors' job satisfaction was quite low in regards to several determinants including age, income, workload, enrollment in a pension plan, integrated management, and county economic and medical availability development.

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.

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

Elements of a Knowledge Management Guide for Public Sector Organizations

ERIC Educational Resources Information Center

Harris, Mark Cameron

2013-01-01

This study explored the factors that are critical to the success of public (government) sector knowledge management initiatives and the lessons from private sector knowledge management and organizational learning that apply in the public sector. The goal was to create a concise guide, based on research-validated success factors, to aid government…

New Public Management in Educational Reform in Norway

ERIC Educational Resources Information Center

Solhaug, Trond

2011-01-01

The article focuses on the similarities and differences in using new public management (NPM) administrative arrangements in educational policy as they have been presented in the educational reform process carried out this millennium by two governments in Norway: the Centre-Conservative government and the current Red-Green coalition government.…

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.

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.

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

ERIC Educational Resources Information Center

Mukhtar, Mohammed Ibn

2015-01-01

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

A fair day's wage? Perceptions of public sector pay.

PubMed

Furnham, Adrian; Stieger, Stefan; Haubner, Tanja; Voracek, Martin; Swami, Viren

2009-12-01

There is a scarcity of evidence pertaining to the general public's perception of public sector pay. Hence, in the present study, 161 women and 149 men were asked to estimate the wages 35 public sector professions should receive annually in the fictitious nation of Maldoria, based on a comparison value of an annual income of T10,000 for general practitioners. Analysis showed that only pilots were given a higher annual income than general practitioners; miners and local government workers were also provided with relatively high annual incomes. By contrast, newscasters were provided with the lowest annual income. Participants' sex did not affect these evaluations, and other demographic variables and public sector-related information of the participants were poor predictors of their evaluations. The implications of this research on public attitudes toward wage determination are discussed, and avenues for further research highlighted.

Public sector energy management: A strategy for catalyzing energy efficiency in Malaysia

NASA Astrophysics Data System (ADS)

Roy, Anish Kumar

To date the public sector role in facilitating the transition to a sustainable energy future has been envisaged mainly from a regulatory perspective. In such a role, the public sector provides the push factors---enforcing regulations and providing incentives---to correct market imperfections that impede energy transitions. An alternative and complementary role of the public sector that is now gaining increasing attention is that of catalyzing energy transitions through public sector energy management initiatives. This dissertation offers a conceptual framework to rationalize such a role for the public sector by combining recent theories of sustainable energy transition and public management. In particular, the framework identifies innovative public management strategies (such as performance contracting and procurement) for effectively implementing sustainable energy projects in government facilities. The dissertation evaluates a model of sustainable public sector energy management for promoting energy efficiency in Malaysia. The public sector in Malaysia can be a major player in leading and catalyzing energy efficiency efforts as it is not only the largest and one of the most influential energy consumers, but it also plays a central role in setting national development strategy. The dissertation makes several recommendations on how a public sector energy management strategy can be implemented in Malaysia. The US Federal Energy Management Program (FEMP) is used as a practical model. The analysis, however, shows that in applying the FEMP model to the Malaysian context, there are a number of limitations that will have to be taken into consideration to enable a public sector energy management strategy to be effectively implemented. Overall the analysis of this dissertation contributes to a rethinking of the public sector role in sustainable energy development that can strengthen the sector's credibility both in terms of governance and institutional performance. In

Why Americans Love to Reform the Public Schools

ERIC Educational Resources Information Center

Reese, William J.

2007-01-01

In this article, the author answers the question: "Why do Americans love to reform the public schools?" His answer has three parts. First, there is an old and persistent cultural strain in American history, derived from many sources, that seeks human perfection and sees education and schooling as essential to that perfectibility. That…

Public Housing Reform and Neighborhood Schools: How Local Contexts "Must" Matter

ERIC Educational Resources Information Center

Smrekar, Claire

2009-01-01

In 1992, Congress enacted the HOPE VI program to overhaul the nation's public housing policy. The reform legislation was prompted by a report commissioned by Congress that deemed two-thirds of all public housing "severely distressed." Since the landmark public housing policy was enacted in 1992, the Department of Housing and Urban Development…

Is the public healthcare sector a more strenuous working environment than the private sector for a physician?

PubMed

Heponiemi, Tarja; Kouvonen, Anne; Sinervo, Timo; Elovainio, Marko

2013-02-01

The present study examined the differences between physicians working in public and private health care in strenuous working environments (presence of occupational hazards, physical violence, and presenteeism) and health behaviours (alcohol consumption, body mass index, and physical activity). In addition, we examined whether gender or age moderated these potential differences. Cross-sectional survey data were compiled on 1422 female and 948 male randomly selected physicians aged 25-65 years from The Finnish Health Care Professionals Study. Logistic regression and linear regression analyses were used with adjustment for gender, age, specialisation status, working time, managerial position, and on-call duty. Occupational hazards, physical violence, and presenteeism were more commonly reported by physicians working in the public sector than by their counterparts in the private sector. Among physicians aged 50 years or younger, those who worked in the public sector consumed more alcohol than those who worked in the private sector, whereas in those aged 50 or more the reverse was true. In addition, working in the private sector was most strongly associated with lower levels of physical violence in those who were older than 50 years, and with lower levels of presenteeism among those aged 40-50 years. The present study found evidence for the public sector being a more strenuous work environment for physicians than the private sector. Our results suggest that public healthcare organisations should pay more attention to the working conditions of their employees.

Implementing Security Sector Reform

DTIC Science & Technology

2008-12-04

ownership and genuine reform. His experience in Diyala Province indicated that the most effective means of pursuing transition and transformation among...that I have no solution to the security situation in Afghanistan, or to the questions of violence, crime, insurrection, or militias vs . army vs ...than to merge those interests into a greater whole. Franchising of problems or solutions is often the result. In Afghanistan, problems and

Standards Driven Reform: Inspection as a Strategy for School Improvement.

ERIC Educational Resources Information Center

Fitz, John; Lee, John

This paper examines the work of the education inspectorates in England and Wales. It specifically addresses the inspectorates' articulation in the Labour Party's general policy shift toward standards-driven reform. The text states that the school inspectorates have been cast as uniquely powerful regulatory agencies within the public sector and are…

Factors associated with the recruitment and retention of dentists in the public sector.

PubMed

Hopcraft, Matthew Scott; Milford, Elizabeth; Yapp, Kehn; Lim, Yujin; Tan, Vanessa; Goh, Leo; Low, Cheng Cheng; Phan, Tung

2010-01-01

There is an increasing demand for public dental services in Australia, with many community dental clinics unable to meet this demand because of an inadequate number of dentists in the workforce. The aim of this study was to identify factors contributing to the recruitment and retention of dentists in the public sector. A postal questionnaire survey of 180 dentists (response rate 75.6 percent) working in the Victorian public sector was undertaken to investigate the characteristics of public sector dentists, job satisfaction, remuneration, perceptions of public dentistry, future career intentions, and issues that relate to recruitment and retention of staff. Victorian public dentists' main reason for entering the public sector was to work in a community-based setting in a supportive and mentored environment. The main factors related to dentists leaving the public sector were poor remuneration, lack of clinical experience, and frustration with administrative policies. Victoria's oral health workforce shortages in the public sector are mainly attributed to retention issues. The potential for mentoring and a desire for helping those in need were factors attracting dentists to work in the public sector. There was a disproportionate number of female dentists in the public sector compared with the general population, and female dentists had a lower mean salary than male dentists regardless of experience. A range of factors were associated with retention, and gradual frustration because of poor remuneration and lack of professional autonomy were significant reasons for the decision to leave the public sector.

Applying Goldwater-Nichols Reforms to Foster Interagency Cooperation Between Public Safety Agencies in New York City

DTIC Science & Technology

2007-03-01

release; distribution is unlimited APPLYING GOLDWATER-NICHOLS REFORMS TO FOSTER INTERAGENCY COOPERATION BETWEEN PUBLIC SAFTEY AGENCIES IN NEW YORK...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release; distribution is unlimited APPLYING GOLDWATER... Applying Goldwater-Nichols Reforms to Foster Interagency Cooperation Between Public Safety Agencies in New York City 6. AUTHOR(S) Joseph P

[Impact of the new system of resource allocation on French public healthcare establishments].

PubMed

Accary-Bézard, Catherine

2012-06-01

The reform of the tarification according to activity is now in place with a "T2A" rate said to be 100%, ie the hospitals are paid based on the national tariffs for a stay in hospital. The reform will continue with a list of stays for which, each year, a single tariff between the public sector and the private sector is applied. This single tariff results from the "inter-sector tariff convergence" policy which is applied.

[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.

Public-Sector Information Security: A Call to Action for Public-Sector CIOs

DTIC Science & Technology

2002-10-01

scenarios. However, in a larger sense, it is a story for all public-sector CIOs, a story both prophetic and sobering. Deep in this story, however, there...information technology (IT), our way of life, and the values that lay deep in the core of our American culture. These values include rights to...defines roles and accountabilities. The Scope of the Problem Today there are 109.5 million Internet hosts on the World Wide Web . Five years ago there

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.

"More Justice": The Role of Organized Labor in Educational Reform

ERIC Educational Resources Information Center

Rogers, John S.; Terriquez, Veronica

2009-01-01

This article explores the potential role of low-wage service sector unions in engaging in equity-minded school reform. The members of many such unions are parents of children attending poorly resourced public schools. In seeking to address the interests of their members, labor unions can draw upon resources, organizing strategies, and political…

Influence of organisational culture on the implementation of health sector reforms in low- and middle-income countries: a qualitative interpretive review.

PubMed

Mbau, Rahab; Gilson, Lucy

2018-01-01

Health systems, particularly in low- and middle-income countries, are commonly plagued by poor access, poor performance, inefficient use and inequitable distribution of resources. To improve health system efficiency, equity and effectiveness, the World Development Report of 1993 proposed a first wave of health sector reforms, which has been followed by further waves. Various authors, however, suggest that the early reforms did not lead to the anticipated improvements. They offer, as one plausible explanation for this gap, the limited consideration given to the influence over implementation of the software aspects of the health system, such as organisational culture - which has not previously been fully investigated. To identify, interpret and synthesise existing literature for evidence on organisational culture and how it influences implementation of health sector reforms in low- and middle-income countries. We conducted a systematic search of eight databases: PubMed; Africa-Wide Information, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Econlit, PsycINFO, SocINDEX with full text, Emerald and Scopus. Eight papers were identified. We analysed and synthesised these papers using thematic synthesis. This review indicates the potential influence of dimensions of organisational culture such as power distance, uncertainty avoidance, and in-group and institutional collectivism over the implementation of health sector reforms. This influence is mediated through organisational practices such as communication and feedback, management styles, commitment and participation in decision-making. This interpretive review highlights the dearth of empirical literature around organisational culture and therefore its findings can only be tentative. There is a need for health policymakers and health system researchers to conduct further analysis of organisational culture and change within the health system.

Costs and utilization of public sector family planning services in Pakistan.

PubMed

Abbas, Khadija; Khan, Adnan Ahmad; Khan, Ayesha

2013-04-01

The public sector provides a third of family planning (FP) services in Pakistan. However, these services are viewed as being underutilized and expensive. We explored the utilization patterns and costs of FP services in the public sector. We used overall budgets and time allocation by health and population departments to estimate the total costs of FP by these departments, costs per woman served, and costs per couple-year of protection (CYP). The public sector is the predominant provider of FP to the poorest and is the main provider of female sterilization services. The overall costs of FP in the public sector are USD 55 per woman served, annually (USD 17 per CYP). Within the public sector, the population welfare departments provide services at USD 72 per woman served, annually (USD 17 per CYP) and the health departments at USD 39 per woman per year (USD 29 per CYP). While the public sector has a critical niche in serving the poor and providing female sterilization, its services are considerably more expensive compared to international and even some Pakistani non-government organization (NGO) costs. This reflects inefficiencies in services provided, client mistrust in the quality of services provided, and inadequate referrals, and will require specific actions for improving referrals and the quality of services.

On Public Aid to Christian Schools in the United States: A Reformed Christian Perspective

ERIC Educational Resources Information Center

Kang, Young Taek

2006-01-01

This paper seeks to provide a conceptual framework for understanding the topic of public aid to Christian schools in a Reformed Christian perspective. To do so, I need to clarify a Reformed Christian approach in regard to this topic and then review the studies of the issue in legal and educational aspects in the light of the Reformed perspective.…

Challenges and responsibilities for public sector scientists.

PubMed

Van Montagu, Marc

2010-11-30

Current agriculture faces the challenge of doubling food production to meet the food needs of a population expected to reach 9 billion by mid-century whilst maintaining soil and water quality and conserving biodiversity. These challenges are more overwhelming for the rural poor, who are the custodians of environmental resources and at the same time particularly vulnerable to environmental degradation. Solutions have to come from concerted actions by different segments of society in which public sector science plays a fundamental role. Public sector scientists are at the root of all the present generation of GM crop traits under cultivation and more will come with the new knowledge that is being generated by systems biology. To speed up innovation, molecular biologists must interact with scientists from the different fields as well as with stakeholders outside the academic world in order to create an environment capable of capturing value from public sector knowledge. I highlight here the measures that have to be taken urgently to guarantee that science and technology can tackle the problems of subsistence farmers. Copyright © 2010 Elsevier B.V. All rights reserved.

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

ERIC Educational Resources Information Center

Walker, Richard M.; Boyne, George A.

2006-01-01

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

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

PubMed

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

2016-01-01

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

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

PubMed

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

2017-10-01

Low- and middle-income countries (LMICs) have been searching for effective strategies to reform their inefficient and wasteful public hospitals. Recently, China developed a model of systemic reforms called the Sanming model to address the inefficiency and waste at public hospitals. In this article, we explain and evaluate how the Sanming model reformed its 22 public hospitals in 2013 by simultaneously restructuring the hospital governance structure, altering the payment system to hospitals, and realigning physicians' incentives. By employing the difference-in-difference (DID) method and using the hospital-level data from 187 public hospitals in Fujian province, we find that the Sanming model has reduced medical costs significantly without measurably sacrificing clinical quality and productive efficiency. The systemic reform, on average, has reduced the medical care cost per outpatient visit and per inpatient admission by 6.1% (P-value = 0.0445) and 15.4% (P-value < 0.001), respectively. It is largely accomplished through a decrease in drug expenditures per outpatient visit and per inpatient admission of about 29% (P-value < 0.001) and 53% (P-value < 0.001). These results show that the Sanming model has achieved at least a short-term success in improving the performance of the public hospitals. These findings suggest that such a systemic transformation of public hospitals, where the governance structure, payment system and physician compensation methods are aligned, are crucial to improving their performance; it holds critical lessons for China and other LMICs. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Public Service Motivation as a Predictor of Attraction to the Public Sector

ERIC Educational Resources Information Center

Carpenter, Jacqueline; Doverspike, Dennis; Miguel, Rosanna F.

2012-01-01

According to public service motivation theory, individuals with a strong public service orientation are attracted to government jobs. This proposition was investigated in three studies by measuring public sector motivation at a pre-entry level as an individual difference variable affecting perceptions of fit and organizational attraction. Results…

28 CFR 302.1 - Public and private sector comment procedures.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Public and private sector comment procedures. 302.1 Section 302.1 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE COMMENTS ON UNICOR BUSINESS OPERATIONS § 302.1 Public and private sector comment procedures. (a...

28 CFR 302.1 - Public and private sector comment procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Public and private sector comment procedures. 302.1 Section 302.1 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE COMMENTS ON UNICOR BUSINESS OPERATIONS § 302.1 Public and private sector comment procedures. (a...

28 CFR 302.1 - Public and private sector comment procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Public and private sector comment procedures. 302.1 Section 302.1 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE COMMENTS ON UNICOR BUSINESS OPERATIONS § 302.1 Public and private sector comment procedures. (a...

28 CFR 302.1 - Public and private sector comment procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Public and private sector comment procedures. 302.1 Section 302.1 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE COMMENTS ON UNICOR BUSINESS OPERATIONS § 302.1 Public and private sector comment procedures. (a...

28 CFR 302.1 - Public and private sector comment procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Public and private sector comment procedures. 302.1 Section 302.1 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE COMMENTS ON UNICOR BUSINESS OPERATIONS § 302.1 Public and private sector comment procedures. (a...

Competence Development in the Public Sector: Development, or Dismantling of Professionalism?

ERIC Educational Resources Information Center

Hjort, Katrin

2008-01-01

For more than a decade, competence development has been a key concept of modern management in both the private and the public sector, but to some extent its meaning and practice have been different in the two sectors. In the public sector in particular, competence development has been closely related to a number of other buzzwords characterizing…

How Does Retiree Health Insurance Influence Public Sector Employee Saving?

PubMed Central

Clark, Robert L.

2017-01-01

Economic theory predicts that employer-provided retiree health insurance (RHI) benefits have a crowd-out effect on household wealth accumulation, not dissimilar to the effects reported elsewhere for employer pensions, Social Security, and Medicare. Nevertheless, we are unaware of any similar research on the impacts of retiree health insurance per se. Accordingly, the present paper utilizes a unique data file on respondents to the Health and Retirement Study, to explore how employer-provided retiree health insurance may influence net household wealth among public sector employees, where retiree healthcare benefits are still quite prevalent. Key findings include the following: -Most full-time public sector employees anticipate having employer-provided health insurance coverage in retirement, unlike most private sector workers;-Public sector employees covered by RHI had substantially less wealth than similar private sector employees without RHI. In our data, Federal workers had about $82,000 (18%) less net wealth than private sector employees lacking RHI; state/local workers with RHI accumulated about $69,000 (or 15%) less net wealth than their uninsured private sector counterparts.-After controlling on socioeconomic status and differences in pension coverage, net household wealth for Federal employees was $116,000 less than workers without RHI and the result is statistically significant; the state/local difference was not. PMID:25479891

Reforming primary healthcare: from public policy to organizational change.

PubMed

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

2015-01-01

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

Navigating Public-Private Partnerships: Introducing the Continuum of Control

ERIC Educational Resources Information Center

DiMartino, Catherine

2014-01-01

In many urban districts, the public education landscape is being transformed as private-sector providers such as educational management organizations, charter management organizations, and partner support organizations partner with or run district schools. While some private-sector providers' visions for school reform have remained static…

Institutional stakeholder perceptions of barriers to addiction treatment under Mexico's drug policy reform.

PubMed

Werb, Dan; Strathdee, Steffanie A; Meza, Emilo; Rangel Gomez, Maria Gudelia; Palinkas, Lawrence; Medina-Mora, Maria Elena; Beletsky, Leo

2017-05-01

Mexico has experienced disproportionate drug-related harms given its role as a production and transit zone for illegal drugs destined primarily for the USA. In response, in 2009, the Mexican federal government passed legislation mandating pre-arrest diversion of drug-dependent individuals towards addiction treatment. However, this federal law was not specific about how the scale-up of the addiction treatment sector was to be operationalised. We therefore conducted in-depth qualitative interviews with key 'interactors' in fields affected by the federal legislation, including participants from the law enforcement, public health, addiction treatment, and governmental administration sectors. Among 19 participants from the municipal, state and federal levels were interviewed and multiple barriers to policy reform were identified. First, there is a lack of institutional expertise to implement the reform. Second, the operationalisation of the reform was not accompanied by a coordinated action plan. Third, the law is an unfunded mandate. Institutional barriers are likely hampering the implementation of Mexico's policy reform. Addressing the concerns expressed by interactors through the scale-up of services, the provision of increased training and education programmes for stakeholders and a coordinated action plan to operationalise the policy reform are likely needed to improve the policy reform process.

Influence of organisational culture on the implementation of health sector reforms in low- and middle-income countries: a qualitative interpretive review

PubMed Central

Mbau, Rahab; Gilson, Lucy

2018-01-01

ABSTRACT Background: Health systems, particularly in low- and middle-income countries, are commonly plagued by poor access, poor performance, inefficient use and inequitable distribution of resources. To improve health system efficiency, equity and effectiveness, the World Development Report of 1993 proposed a first wave of health sector reforms, which has been followed by further waves. Various authors, however, suggest that the early reforms did not lead to the anticipated improvements. They offer, as one plausible explanation for this gap, the limited consideration given to the influence over implementation of the software aspects of the health system, such as organisational culture – which has not previously been fully investigated. Objective: To identify, interpret and synthesise existing literature for evidence on organisational culture and how it influences implementation of health sector reforms in low- and middle-income countries. Methods: We conducted a systematic search of eight databases: PubMed; Africa-Wide Information, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Econlit, PsycINFO, SocINDEX with full text, Emerald and Scopus. Eight papers were identified. We analysed and synthesised these papers using thematic synthesis. Results: This review indicates the potential influence of dimensions of organisational culture such as power distance, uncertainty avoidance, and in-group and institutional collectivism over the implementation of health sector reforms. This influence is mediated through organisational practices such as communication and feedback, management styles, commitment and participation in decision-making. Conclusion: This interpretive review highlights the dearth of empirical literature around organisational culture and therefore its findings can only be tentative. There is a need for health policymakers and health system researchers to conduct further analysis of organisational culture and change within the health

The willingness of private-sector doctors to manage public-sector HIV/AIDS patients in the eThekwini metropolitan region of KwaZulu-Natal

PubMed Central

Jinabhai, Champaklal C.; Taylor, Myra

2010-01-01

ABSTRACT Background South Africa is severely affected by the AIDS pandemic and this has resulted in an already under-resourced public sector being placed under further stress, while there remains a vibrant private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness of private-sector doctors in the eThekwini Metropolitan (Metro) region of KwaZulu-Natal, South Africa to manage public-sector HIV and AIDS patients. Objectives To gauge the willingness of private-sector doctor to manage public-sector HIV and AIDS patients and to describe factors that may influence their responses. Method A descriptive cross-sectional study was undertaken among private-sector doctors, both general practitioners (GPs) and specialists, working in the eThekwini Metro, using an anonymous, structured questionnaire to investigate their willingness to manage public-sector HIV and AIDS patients and the factors associated with their responses. Chi-square and independent t-tests were used to evaluate associations. Odds ratios were determined using a binary logistic regression model. A p value < 0.05 was considered statistically significant. Results Most of the doctors were male GPs aged 30–50 years who had been in practice for more than 10 years. Of these, 133 (77.8%) were willing to manage public-sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling, was the distance from public-sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public-sector HIV and AIDS patients

Wage Gaps Between the Public and Private Sectors in Spain.

ERIC Educational Resources Information Center

Lassibille, Gerard

1998-01-01

Estimates separate earnings equations by employment sector and gender in Spain and identifies returns to human capital, based on 1990-91 household survey data. Public wages are higher, and civil servants more highly educated. However, the public sector pays lower returns to education and experience. Earnings advantage is largest for least skilled…

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.

The moral economy of austerity: analysing UK welfare reform.

PubMed

Morris, Lydia

2016-03-01

This paper notes the contemporary emergence of 'morality' in both sociological argument and political rhetoric, and analyses its significance in relation to ongoing UK welfare reforms. It revisits the idea of 'moral economy' and identifies two strands in its contemporary application; that all economies depend on an internal moral schema, and that some external moral evaluation is desirable. UK welfare reform is analysed as an example of the former, with reference to three distinct orientations advanced in the work of Freeden (1996), Laclau (2014), and Lockwood (1996). In this light, the paper then considers challenges to the reform agenda, drawn from third sector and other public sources. It outlines the forms of argument present in these challenges, based respectively on rationality, legality, and morality, which together provide a basis for evaluation of the welfare reforms and for an alternative 'moral economy'. © London School of Economics and Political Science 2016.

Public sector administration of ecological economics systems using mediated modeling.

PubMed

van den Belt, Marjan; Kenyan, Jennifer R; Krueger, Elizabeth; Maynard, Alison; Roy, Matthew Galen; Raphael, Ian

2010-01-01

In today's climate of government outsourcing and multiple stakeholder involvement in public sector management and service delivery, it is more important than ever to rethink and redesign the structure of how policy decisions are made, implemented, monitored, and adapted to new realities. The traditional command-and-control approach is now less effective because an increasing amount of responsibility to deliver public goods and services falls on networks of nongovernment agencies. Even though public administrators are seeking new decision-making models in an increasingly more complex environment, the public sector currently only sparsely utilizes Mediated Modeling (MM). There is growing evidence, however, that by employing MM and similar tools, public interest networks can be better equipped to deal with their long-term viability while maintaining the short-term needs of their clients. However, it may require a shift in organizational culture within and between organizations to achieve the desired results. This paper explores the successes and barriers to implementing MM and similar tools in the public sector and offers insights into utilizing them through a review of case studies and interdisciplinary literature. We aim to raise a broader interest in MM and similar tools among public sector administrators at various administrative levels. We focus primarily, but not exclusively, on those cases operating at the interface of ecology and socio-economic systems.

Technology Transfer: A Think Tank Approach to Managing Innovation in the Public Sector

DTIC Science & Technology

1985-01-01

TECHNOLOGY TRANSFER: A THINK TANK APPROACH TO MANAGING INNOVATION IN THE PUBLIC SECTOR CISIRIBUTIOtl STATEMENT A Approved for Public Release...NAVAL FACILITIES ENGINEERING COMMAND TECHNOLOGY TRANSFER: A THINK TANK APPROACH TO MANAGING INNOVATION IN THE PUBLIC SECTOR Edited by J. W. Creighton...Publication of this book, Technology Transfer: A Think Tank Approach to Managing Innovation in the Public Sector, was in part supported by funds from the U.S

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.

The role of nurse practitioners in health sector reform in Iran (2011).

PubMed

Vatankhah, Soudabe; Khalesi, Nader; Ebadifardazar, Farbod; Ferdousi, Masoud; Naji, Homayon; Farahabadi, Seyed Mohammad Ehsaan

2013-09-01

Most countries use educated nurses called "nurse practitioners" (NPs) besides the family physicians for diagnosis, treatment, and specifically health education of the family. The main goal of this study was to redefine the role of NPs for better use of their capabilities in the so-called "family physician reform" in Iran. This is a qualitative and comparative study carried out in three stages (triangulation method) in 2011. In the first stage, we conducted a literature review to design a conceptual framework. The second stage was a comparative study on four countries. In this study, we focused on the role of NPs, which in turn helped to redefine this role in the health sector reform of Iran. In the third stage, two expert panels were involved and the suggested roles were confirmed. In the United States, NPs are licensed by the state in which they practice and have a national board certification. In Canada, nurses involved in clinics should participate in specific training course of diagnosis and management of health care after registration. In Austria, nurses in Nursing homes and maternity do some of the medical procedures under the supervision of the physicians. In the United Kingdom, NPs increasingly substitute for GPs in the care of minor illness and routine management of chronic diseases. There is still debate in nursing and medical circles about what the focus of the NP roles should be. In Iran, whereas a noticeable reform toward "family physician" is ongoing, redefining the nurses' role is essential. They can perform more active roles in associating with GPs in the clinics of family physicians, both in urban and rural areas, even with higher degrees of autonomy.

How does retiree health insurance influence public sector employee saving?

PubMed

Clark, Robert L; Mitchell, Olivia S

2014-12-01

Economic theory predicts that employer-provided retiree health insurance (RHI) benefits have a crowd-out effect on household wealth accumulation, not dissimilar to the effects reported elsewhere for employer pensions, Social Security, and Medicare. Nevertheless, we are unaware of any similar research on the impacts of retiree health insurance per se. Accordingly, the present paper utilizes a unique data file on respondents to the Health and Retirement Study, to explore how employer-provided retiree health insurance may influence net household wealth among public sector employees, where retiree healthcare benefits are still quite prevalent. Key findings include the following: Most full-time public sector employees anticipate having employer-provided health insurance coverage in retirement, unlike most private sector workers.Public sector employees covered by RHI had substantially less wealth than similar private sector employees without RHI. In our data, Federal workers had about $82,000 (18%) less net wealth than private sector employees lacking RHI; state/local workers with RHI accumulated about $69,000 (or 15%) less net wealth than their uninsured private sector counterparts.After controlling on socioeconomic status and differences in pension coverage, net household wealth for Federal employees was $116,000 less than workers without RHI and the result is statistically significant; the state/local difference was not. Copyright © 2014 Elsevier B.V. All rights reserved.

[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.

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

ERIC Educational Resources Information Center

Gobby, Brad

2016-01-01

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

Responding to Regulatory Jolts in the English Higher Education Sector

ERIC Educational Resources Information Center

Abreu Pederzini, Gerardo

2016-01-01

Throughout the world universities are having to face constantly changing environments. A particular type of important change is public policy reforms or regulatory jolts. The English higher education sector is an example of the latter, where constant regulatory jolts have been seen in past decades. Leaders at universities have needed to interpret…

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.

New labour and reform of the English NHS: user views and attitudes.

PubMed

Wallace, Andrew; Taylor-Gooby, Peter

2010-06-01

The British National Health Service has undergone significant restructuring in recent years. In England this has taken a distinctive direction where the New Labour Government has embraced and intensified the influence of market principles towards its vision of a 'modernized' NHS. This has entailed the introduction of competition and incentives for providers of NHS care and the expansion of choice for patients. To explore how users of the NHS perceive and respond to the market reforms being implemented within the NHS. In addition, to examine the normative values held by NHS users in relation to welfare provision in the UK. Qualitative interviews using a quota sample of 48 recent NHS users in South East England recruited from three local health economies. Some NHS users are exhibiting an ambivalent or anxious response to aspects of market reform such as patient choice, the use of targets and markets and the increasing presence of the private sector within the state healthcare sector. This has resulted in a sense that current reforms, are distracting or preventing NHS staff from delivering quality of care and fail to embody the relationships of care that are felt to sustain the NHS as a progressive public institution. The best way of delivering such values for patients is perceived to involve empowering frontline staffs who are deemed to embody the same values as service users, thus problematizing the current assumptions of reform frameworks that market-style incentives will necessarily gain public consent and support.

INSTITUTIONAL STAKEHOLDER PERCEPTIONS OF BARRIERS TO ADDICTION TREATMENT UNDER MEXICO’S DRUG POLICY REFORM

PubMed Central

Werb, Dan; Strathdee, Steffanie A.; Meza, Emilo; Gomez, Maria Gudelia Rangel; Palinkas, Lawrence; Medina-Mora, Maria Elena; Beletsky, Leo

2017-01-01

Background Mexico has experienced disproportionate drug-related harms given its role as a production and transit zone for illegal drugs destined primarily for the United States. In response, in 2009, the Mexican federal government passed legislation mandating pre-arrest diversion of drug-dependent individuals towards addiction treatment. However, this federal law was not specific about how the scale-up of the addiction treatment sector was to be operationalized. We therefore conducted in-depth qualitative interviews with key ‘interactors’ in fields affected by the federal legislation, including participants from the law enforcement, public health, addiction treatment, and governmental administration sectors. Among 19 participants from the municipal, state, and federal level, multiple barriers to policy reform were identified. First, there is a lack of institutional expertise to implement the reform. Second, the operationalization of the reform was not accompanied by a coordinated action plan. Third, the law is an unfunded mandate. Institutional barriers are likely hampering the implementation of Mexico’s policy reform. Addressing the concerns expressed by interactors through the scale up of services, the provision of increased training and education programs for stakeholders, and a coordinated action plan to operationalize the policy reform, are likely needed to improve the policy reform process. PMID:28278755

Tracking Environmental Sustainability Performance of Public Universities in Kenya

ERIC Educational Resources Information Center

Mungai, David N.

2017-01-01

Environmental Sustainability Performance Contract (PC) targets were introduced in the 2012/13 financial year as part of the broader public sector reforms and a strategy for performance improvement in the public service that includes Kenyan public universities. However, no evaluation has been conducted to assess performance improvement and impact.…

The Public Health Innovation Model: Merging Private Sector Processes with Public Health Strengths.

PubMed

Lister, Cameron; Payne, Hannah; Hanson, Carl L; Barnes, Michael D; Davis, Siena F; Manwaring, Todd

2017-01-01

Public health enjoyed a number of successes over the twentieth century. However, public health agencies have arguably been ill equipped to sustain these successes and address the complex threats we face today, including morbidity and mortality associated with persistent chronic diseases and emerging infectious diseases, in the context of flat funding and new and changing health care legislation. Transformational leaders, who are not afraid of taking risks to develop innovative approaches to combat present-day threats, are needed within public health agencies. We propose the Public Health Innovation Model (PHIM) as a tool for public health leaders who wish to integrate innovation into public health practice. This model merges traditional public health program planning models with innovation principles adapted from the private sector, including design thinking, seeking funding from private sector entities, and more strongly emphasizing program outcomes. We also discuss principles that leaders should consider adopting when transitioning to the PHIM, including cross-collaboration, community buy-in, human-centered assessment, autonomy and creativity, rapid experimentation and prototyping, and accountability to outcomes.

The Public Health Innovation Model: Merging Private Sector Processes with Public Health Strengths

PubMed Central

Lister, Cameron; Payne, Hannah; Hanson, Carl L.; Barnes, Michael D.; Davis, Siena F.; Manwaring, Todd

2017-01-01

Public health enjoyed a number of successes over the twentieth century. However, public health agencies have arguably been ill equipped to sustain these successes and address the complex threats we face today, including morbidity and mortality associated with persistent chronic diseases and emerging infectious diseases, in the context of flat funding and new and changing health care legislation. Transformational leaders, who are not afraid of taking risks to develop innovative approaches to combat present-day threats, are needed within public health agencies. We propose the Public Health Innovation Model (PHIM) as a tool for public health leaders who wish to integrate innovation into public health practice. This model merges traditional public health program planning models with innovation principles adapted from the private sector, including design thinking, seeking funding from private sector entities, and more strongly emphasizing program outcomes. We also discuss principles that leaders should consider adopting when transitioning to the PHIM, including cross-collaboration, community buy-in, human-centered assessment, autonomy and creativity, rapid experimentation and prototyping, and accountability to outcomes. PMID:28824899

[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

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.

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

Age of diagnosis of congenital hearing loss: Private v. public healthcare sector.

PubMed

Butler, I R T; Ceronio, D; Swart, T; Joubert, G

2015-11-01

The age of diagnosis of congenital hearing loss is one of the most important determinants of communication outcome. A previous study by the lead author had evaluated the performance of the public health services in Bloemfontein, South Africa (SA), in this regard. This study aimed to examine whether the private health services in the same city were any better. To determine whether the age of diagnosis of congenital hearing loss (CHL) in children seen in the private healthcare sector in Bloemfontein, Free State Province, SA, was lower than that in the public healthcare system in the same city. A comparative study design was utilised and a retrospective database review conducted. Data obtained from this study in the private healthcare sector were compared with data from a previous study in the public healthcare sector using the same study design. Forty-eight children aged <6 years with disabling hearing impairment (DHI) were identified in the private healthcare sector during the study period; 33/47 (70.2%) did not undergo hearing screening at birth. The median age of diagnosis of DHI in the private healthcare sector was 2.24 years, and this was statistically significantly lower than the median age of diagnosis of 3.71 years in the public healthcare sector (p<0.0001; 95% confidence interval (CI) 0.99-2.0). The median age of diagnosis of congenital hearing loss (CHL) in the private healthcare sector was 3.01 years in children who were not screened at birth, and 1.25 years in those who were screened at birth. This difference was statistically significant (p<0.01; 95% CI 0.72-2.47). We also compared the median age of diagnosis of CHL in children from the private healthcare sector who were not screened at birth (median 3.01 years) with that in children in the public healthcare sector (median 3.71 years). This difference was statistically significant (p<0.01; 95% CI 0.41-1.56). Children in the Free State are diagnosed with CHL at a younger age in the private healthcare

Health care of female outpatients in south-central India: comparing public and private sector provision.

PubMed

Bhatia, Jagdish; Cleland, John

2004-11-01

The object of this study was to compare components of quality of care provided to female outpatients by practitioners working in the private and public sectors in Karnataka State, India. Consultations conducted by 18 private practitioners and 25 public-sector practitioners were observed for 5 days using a structured protocol. Private practitioners were selected from members of the Indian Medical Association in a predominantly rural sub-district of Kolar District. Government doctors were selected from a random sample of hospitals and health centres in three sub-districts of Mysore District. A total of 451 private-sector and 650 public-sector consultations were observed; in each sector about half involved a female practitioner. The mean length of consultation was 2.81 minutes in the public sector and 6.68 minutes in the private sector. Compared with public-sector practitioners, private practitioners were significantly more likely to undertake a physical examination and to explain their diagnosis and prognosis to the patient. Privacy was much better in the private sector. One-third of public-sector patients received an injection compared with two-thirds of private patients. The mean cost of drugs dispensed or prescribed were Rupees 37 and 74 in public and private sectors, respectively. Both in terms of thoroughness of diagnosis and doctor-patient communication, the quality of care appears to be much higher in the private than in the public sector. However, over-prescription of drugs by private practitioners may be occurring.

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.

Changing Times: A Changing Public Sector May Require Changes to Public Management Education Programmes

ERIC Educational Resources Information Center

Oldfield, Chrissie

2017-01-01

It is becoming apparent that the environment in which Executive Masters in Public Administration programmes operate has changed dramatically in the wake of economic crisis and subsequent cuts in public spending. Changes in the funding of public sector organisations has been compounded by a broader "crisis" in the wider public sector…

Transparency in Nigeria's public pharmaceutical sector: perceptions from policy makers

PubMed Central

Garuba, Habibat A; Kohler, Jillian C; Huisman, Anna M

2009-01-01

Background Pharmaceuticals are an integral component of health care systems worldwide, thus, regulatory weaknesses in governance of the pharmaceutical system negatively impact health outcomes especially in developing countries [1]. Nigeria is one of a number of countries whose pharmaceutical system has been impacted by corruption and has struggled to curtail the production and trafficking of substandard drugs. In 2001, the National Agency for Food and Drug Administration and Control (NAFDAC) underwent an organizational restructuring resulting in reforms to reduce counterfeit drugs and better regulate pharmaceuticals [2]. Despite these changes, there is still room for improvement. This study assessed the perceived level of transparency and potential vulnerability to corruption that exists in four essential areas of Nigeria's pharmaceutical sector: registration, procurement, inspection (divided into inspection of ports and of establishments), and distribution. Methods Standardized questionnaires were adapted from the World Health Organization assessment tool and used in semi-structured interviews with key stakeholders in the public and private pharmaceutical system. The responses to the questions were tallied and converted to scores on a numerical scale where lower scores suggested greater vulnerability to corruption and higher scores suggested lower vulnerability. Results The overall score for Nigeria's pharmaceutical system was 7.4 out of 10, indicating a system that is marginally vulnerable to corruption. The weakest links were the areas of drug registration and inspection of ports. Analysis of the qualitative results revealed that the perceived level of corruption did not always match the qualitative evidence. Conclusion Despite the many reported reforms instituted by NAFDAC, the study findings suggest that facets of the pharmaceutical system in Nigeria remain fairly vulnerable to corruption. The most glaring deficiency seems to be the absence of conflict of

Transparency in Nigeria's public pharmaceutical sector: perceptions from policy makers.

PubMed

Garuba, Habibat A; Kohler, Jillian C; Huisman, Anna M

2009-10-29

Pharmaceuticals are an integral component of health care systems worldwide, thus, regulatory weaknesses in governance of the pharmaceutical system negatively impact health outcomes especially in developing countries 1. Nigeria is one of a number of countries whose pharmaceutical system has been impacted by corruption and has struggled to curtail the production and trafficking of substandard drugs. In 2001, the National Agency for Food and Drug Administration and Control (NAFDAC) underwent an organizational restructuring resulting in reforms to reduce counterfeit drugs and better regulate pharmaceuticals 2. Despite these changes, there is still room for improvement. This study assessed the perceived level of transparency and potential vulnerability to corruption that exists in four essential areas of Nigeria's pharmaceutical sector: registration, procurement, inspection (divided into inspection of ports and of establishments), and distribution. Standardized questionnaires were adapted from the World Health Organization assessment tool and used in semi-structured interviews with key stakeholders in the public and private pharmaceutical system. The responses to the questions were tallied and converted to scores on a numerical scale where lower scores suggested greater vulnerability to corruption and higher scores suggested lower vulnerability. The overall score for Nigeria's pharmaceutical system was 7.4 out of 10, indicating a system that is marginally vulnerable to corruption. The weakest links were the areas of drug registration and inspection of ports. Analysis of the qualitative results revealed that the perceived level of corruption did not always match the qualitative evidence. Despite the many reported reforms instituted by NAFDAC, the study findings suggest that facets of the pharmaceutical system in Nigeria remain fairly vulnerable to corruption. The most glaring deficiency seems to be the absence of conflict of interest guidelines which, if present and

International patients within the NHS: a case of public sector entrepreneurialism.

PubMed

Lunt, Neil; Exworthy, Mark; Hanefeld, Johanna; Smith, Richard D

2015-01-01

Many public health systems in high- and middle-income countries are under increasing financial pressures as a result of ageing populations, a rise in chronic and non-communicable diseases and shrinking public resources. At the same time the rise in patient mobility and concomitant market in medical tourism provides opportunities for additional income. This is especially the case where public sector hospitals have a reputation as global centres of excellence. Yet, this requires public sector entrepreneurship which, given the unique features of the public sector, means a change to professional culture. This paper examines how and under what conditions public sector entrepreneurship develops, drawing on the example of international patients in the UK NHS. It reports on a subset of data from a wider study of UK medical tourism, and explores inward flows and NHS responses through the lens of public entrepreneurship. Interviews in the English NHS were conducted with managers of Foundation Trusts with interest in international patient work. Data is from seven Foundation Trusts, based on indepth, semi-structured interviews with a range of NHS managers, and three other key stakeholders (n = 16). Interviews were analysed using a framework on entrepreneurship developed from academic literature. Empirical findings showed that Trust managers were actively pursuing a strategy of expanding international patient activity. Respondents emphasised that this was in the context of the current financial climate for the NHS. International patients were seen as a possible route to ameliorating pressure on stretched NHS resources. The analysis of interviews revealed that public entrepreneurial behaviour requires an organisational managerial or political context in order to develop, such as currently in the UK. Public sector workers engaged in this process develop entrepreneurship - melding political, commercial and stakeholder insights - as a coping mechanism to health system constraints

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

PubMed

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

2003-06-01

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

Public sector health financing in Pakistan: a retrospective study.

PubMed

Mohammad, Khalif Bile; Hafeez, Assad; Nishter, Sania

2007-06-01

To assess the existing situation relating to investments made by development partners in the health sector in Pakistan. This was a retrospective study completed over a period of 6 months in which financial data for the year July 2004 to June 2005 was collected. A uniform matrix was circulated to all the stakeholders in public sector and international donors who had a stake in health. Details of expenses in health over the last 5 years and plans for the next 10 years were requested. Initial draft was shared with all concerned for concurrence before finalization. Simple analysis was carried out on the collected data. About 80% of the financial resources in the public sector are provided by the Government of Pakistan with non-development and recurring expenses predominating in these allocations. The study shows that Pakistan's per capita spending on health by the public sector is Rs 375.00 (US$ 6.4) out of which Rs 80 (US$ 1.3) is being contributed by the partners. Majority of the partners contributions are used for development projects. The study concludes that an additional amount of about 250 billion rupees per year (keeping in mind the recommendations of Commission for Macroeconomics and Health) are required by the health sector. This can only be achieved by allocating at least 50% more for health every year for next 10 years in order to catch up on the lagging targets set by Millennium Development Goals for Pakistan.

The creation of the health consumer: challenges on health sector regulation after managed care era

PubMed Central

2011-01-01

Background We utilized our previous studies analyzing the reforms affecting the health sector developed in the 1990s by financial groups to frame the strategies implemented by the pharmaceutical industry to regain market positions and to understand the challenges that regulatory agencies are confronting. Methods We followed an analytical approach for analyzing the process generated by the disputes between the financial groups and the pharmaceutical corporations and the challenges created to governmental regulation. We analyzed primary and secondary sources using situational and discourse analyses. We introduced the concepts of biomedicalization and biopedagogy, which allowed us to analyze how medicalization was radicalized. Results In the 1990s, structural adjustment policies facilitated health reforms that allowed the entrance of multinational financial capital into publicly-financed and employer-based insurance. This model operated in contraposition to the interests of the medical industrial complex, which since the middle of the 1990s had developed silent reforms to regain authority in defining the health-ill-care model. These silent reforms radicalized the medicalization. Some reforms took place through deregulatory processes, such as allowing direct-to-consumer advertisements of prescription drugs in the United States. In other countries different strategies were facilitated by the lack of regulation of other media such as the internet. The pharmaceutical industry also has had a role in changing disease definitions, rebranding others, creating new ones, and pressuring for approval of treatments to be paid by public, employer, and private plans. In recent years in Brazil there has been a substantial increase in the number of judicial claims demanding that public administrations pay for new treatments. Conclusions We found that the dispute for the hegemony of the health sector between financial and pharmaceutical companies has deeply transformed the sector

The creation of the health consumer: challenges on health sector regulation after managed care era.

PubMed

Iriart, Celia; Franco, Tulio; Merhy, Emerson E

2011-02-24

We utilized our previous studies analyzing the reforms affecting the health sector developed in the 1990s by financial groups to frame the strategies implemented by the pharmaceutical industry to regain market positions and to understand the challenges that regulatory agencies are confronting. We followed an analytical approach for analyzing the process generated by the disputes between the financial groups and the pharmaceutical corporations and the challenges created to governmental regulation. We analyzed primary and secondary sources using situational and discourse analyses. We introduced the concepts of biomedicalization and biopedagogy, which allowed us to analyze how medicalization was radicalized. In the 1990s, structural adjustment policies facilitated health reforms that allowed the entrance of multinational financial capital into publicly-financed and employer-based insurance. This model operated in contraposition to the interests of the medical industrial complex, which since the middle of the 1990s had developed silent reforms to regain authority in defining the health-ill-care model. These silent reforms radicalized the medicalization. Some reforms took place through deregulatory processes, such as allowing direct-to-consumer advertisements of prescription drugs in the United States. In other countries different strategies were facilitated by the lack of regulation of other media such as the internet. The pharmaceutical industry also has had a role in changing disease definitions, rebranding others, creating new ones, and pressuring for approval of treatments to be paid by public, employer, and private plans. In recent years in Brazil there has been a substantial increase in the number of judicial claims demanding that public administrations pay for new treatments. We found that the dispute for the hegemony of the health sector between financial and pharmaceutical companies has deeply transformed the sector. Patients converted into consumers are

Health reform requires policy capacity

PubMed Central

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

2015-01-01

Among the many reasons that may limit the adoption of promising reform ideas, policy capacity is the least recognized. The concept itself is not widely understood. Although policy capacity is concerned with the gathering of information and the formulation of options for public action in the initial phases of policy consultation and development, it also touches on all stages of the policy process, from the strategic identification of a problem to the actual development of the policy, its formal adoption, its implementation, and even further, its evaluation and continuation or modification. Expertise in the form of policy advice is already widely available in and to public administrations, to well-established professional organizations like medical societies and, of course, to large private-sector organizations with commercial or financial interests in the health sector. We need more health actors to join the fray and move from their traditional position of advocacy to a fuller commitment to the development of policy capacity, with all that it entails in terms of leadership and social responsibility. PMID:25905476

Differences in public and private sector adoption of telemedicine: Indian case study for sectoral adoption.

PubMed

Sood, Sanjay P; Negash, Solomon; Mbarika, Victor W A; Kifle, Mengistu; Prakash, Nupur

2007-01-01

Telemedicine is the use of communication networks to exchange medical information for providing healthcare services and medical education from one site to another. The application of telemedicine is more promising in economically developing countries with agrarian societies. The American Telemedicine Association (ATA) identifies three healthcare services: clinical medical services, health and medical education, and consumer health information. However, it is not clear how these services can be adopted by different sectors: public and private. This paper looks at four Indian case studies, two each in public and private sectors to understand two research questions: Are there differences in telemedicine adoption between public and private hospitals. If there are differences: What are the differences in telemedicine adoption between public and private sectors? Authors have used the extant literature in telemedicine and healthcare to frame theoretical background, describe the research setting, present the case studies, and provide discussion and conclusions about their findings. Authors believe that as India continues to develop its telemedicine infrastructures, especially with continued government support through subsidies to private telemedicine initiatives, its upward trend in healthcare will continue. This is expected to put India on the path to increase its life expectancy rates, especially for it rural community which constitute over 70% of its populace.

Utilization of skilled birth attendants in public and private sectors in Vietnam.

PubMed

Do, Mai

2009-05-01

The private sector in health care in Vietnam has been increasingly competing with the government in primary health care services. However, little is known about the use of skilled birth attendance or about choice of public and private sectors among those who opt for skilled attendants. Using data from the Vietnam 2002 Demographic and Health Survey, this study examines factors related to women's decision-making of whether to have a skilled birth attendant at a recent childbirth, and if they did, whether it was a public or private sector provider. The study indicates that the use of the private sector for delivery services was significant. Women's household wealth, education, antenatal care and community's wealth were positively related to skilled birth attendance, while ethnicity and order of childbirth were negatively related. Order of childbirth was positively associated with skilled birth attendance in the private sector. Among service environment factors, increased access to public sector health centres was associated with an increased likelihood of skilled birth attendance in general, but a lowered chance of that in the private sector. Further studies are needed to assess the current situation in the private sector, the demand for delivery services in the private sector, and its readiness to provide quality services.

The public sector nursing workforce in Kenya: a county-level analysis

PubMed Central

2014-01-01

Background Kenya’s human resources for health shortage is well documented, yet in line with the new constitution, responsibility for health service delivery will be devolved to 47 new county administrations. This work describes the public sector nursing workforce likely to be inherited by the counties, and examines the relationships between nursing workforce density and key indicators. Methods National nursing deployment data linked to nursing supply data were used and analyzed using statistical and geographical analysis software. Data on nurses deployed in national referral hospitals and on nurses deployed in non-public sector facilities were excluded from main analyses. The densities and characteristics of the public sector nurses across the counties were obtained and examined against an index of county remoteness, and the nursing densities were correlated with five key indicators. Results Of the 16,371 nurses in the public non-tertiary sector, 76% are women and 53% are registered nurses, with 35% of the nurses aged 40 to 49 years. The nursing densities across counties range from 1.2 to 0.08 per 1,000 population. There are statistically significant associations of the nursing densities with a measure of health spending per capita (P value = 0.0028) and immunization rates (P value = 0.0018). A higher county remoteness index is associated with explaining lower female to male ratio of public sector nurses across counties (P value <0.0001). Conclusions An overall shortage of nurses (range of 1.2 to 0.08 per 1,000) in the public sector countrywide is complicated by mal-distribution and varying workforce characteristics (for example, age profile) across counties. All stakeholders should support improvements in human resources information systems and help address personnel shortages and mal-distribution if equitable, quality health-care delivery in the counties is to be achieved. PMID:24467776

The public sector nursing workforce in Kenya: a county-level analysis.

PubMed

Wakaba, Mabel; Mbindyo, Patrick; Ochieng, Jacob; Kiriinya, Rose; Todd, Jim; Waudo, Agnes; Noor, Abdisalan; Rakuom, Chris; Rogers, Martha; English, Mike

2014-01-27

Kenya's human resources for health shortage is well documented, yet in line with the new constitution, responsibility for health service delivery will be devolved to 47 new county administrations. This work describes the public sector nursing workforce likely to be inherited by the counties, and examines the relationships between nursing workforce density and key indicators. National nursing deployment data linked to nursing supply data were used and analyzed using statistical and geographical analysis software. Data on nurses deployed in national referral hospitals and on nurses deployed in non-public sector facilities were excluded from main analyses. The densities and characteristics of the public sector nurses across the counties were obtained and examined against an index of county remoteness, and the nursing densities were correlated with five key indicators. Of the 16,371 nurses in the public non-tertiary sector, 76% are women and 53% are registered nurses, with 35% of the nurses aged 40 to 49 years. The nursing densities across counties range from 1.2 to 0.08 per 1,000 population. There are statistically significant associations of the nursing densities with a measure of health spending per capita (P value = 0.0028) and immunization rates (P value = 0.0018). A higher county remoteness index is associated with explaining lower female to male ratio of public sector nurses across counties (P value <0.0001). An overall shortage of nurses (range of 1.2 to 0.08 per 1,000) in the public sector countrywide is complicated by mal-distribution and varying workforce characteristics (for example, age profile) across counties. All stakeholders should support improvements in human resources information systems and help address personnel shortages and mal-distribution if equitable, quality health-care delivery in the counties is to be achieved.

An Investigation of Conflict Management in Public and Private Sector Universities

ERIC Educational Resources Information Center

Din, Siraj ud; Khan, Bakhtiar; Rehman, Rashid; Bibi, Zainab

2011-01-01

The purpose of this paper is to gain an insight into the conflict management in public and private sector universities in Khyber Pakhtunkhwa, Pakistan. To achieve the earlier mentioned purpose, survey method was used with the help of questionnaire. In this research, impact of university type (public and private sector) was examined on the conflict…

[Collaboration between public health nurses and the private sector].

PubMed

Marutani, Miki; Okada, Yumiko; Hasegawa, Takashi

2016-01-01

We clarified collaborations between public health nurses (PHNs) and the private sector, such as nonprofit organizations. Semi-structured interviews were conducted with 11 private sector organizations and 13 PHNs who collaborate with them between December 2012 to October 2013. Interview guides were: overall suicide preventive measurements, details of collaboration between private sector organizations and PHNs, and suicide prevention outcomes/issues. Data from private sector organizations and PHNs were separately analyzed and categories created using qualitative and inductive design. Private sector organizations' and PHNs' categories were compared and separated into core categories by similarities. Six categories were created: 1. establishing a base of mutual understanding; 2. raising public awareness of each aim/characteristic; 3. competently helping high suicidal risk persons detected during each activity; 4. guarding lives and rehabilitating livelihoods after intervention; 5. restoring suicide attempters/bereaved met in each activity; and 6. continuing/expanding activities with reciprocal cohesion/evaluation. PHNs are required to have the following suicide prevention tasks when collaborating with private sector organizations: understanding the private sector civilization, sharing PHN experiences, improving social determinants of health, meeting basic needs, supporting foundation/difficulties each other (Dear editor. Thank you for kind comments. I was going to explain that PHNs and NPOs support each other their foundation of activity and difficulties in their activities. The foundations include knowledge, information, budgets, manpower etc. The difficulties mean like suffering faced with suicide during activities.), and enhancing local governments' flexibilities/ promptness.

Acute appendicitis in the public and private sectors in Cape Town, South Africa.

PubMed

Yang, Estin; Cook, Colin; Kahn, Delawir

2015-07-01

South Africa has a low incidence of acute appendicitis, but poor outcomes. However, South African studies on appendicitis focus solely on public hospitals, neglecting those who utilize private facilities. This study aims to compare appendicitis characteristics and outcomes in public and private hospitals in South Africa. A prospective cohort study was conducted among two public and three private hospitals in the Cape Town metropole, from September 2013 to March 2014. Hospital records, operative notes, and histology results were reviewed for patients undergoing appendectomy for acute appendicitis. Patients were interviewed during their hospitalization and followed up at monthly intervals until normal function was attained. A total of 134 patients were enrolled, with 73 in the public and 61 in the private sector. Education and employment were higher among private sector patients. Public sector patients had a higher rupture rate (30.6 vs 13.2 %, p = 0.023). Times to presentation were not statistically different between the two cohorts. Public sector patients had longer hospital stays (5.3 vs 2.9 days, p = 0.036) and longer return to work times (23.0 vs 12.1 days, p < 0.0001). Although complication rates were similar, complications in public hospitals were more severe. Public sector patients in South Africa with appendicitis have higher rupture rates, worse complications, longer hospital stays, and longer recoveries than private sector patients. Patients with perforation had longer delays in presentation than patients without perforation.

Social Mobility and Public Sector Employment.

ERIC Educational Resources Information Center

Rumberger, Russell W.

Although the government's role as provider of social services and guardian of individual rights has had little effect on the economic position of women and minorities, as an employer it has greatly improved their welfare in terms of job opportunities and earnings. U.S. census data from 1960 to 1980 show that the public sector currently employs…

Polling analysis: public support for health reform was broader than reported and depended on how proposals were framed.

PubMed

Grande, David; Gollust, Sarah E; Asch, David A

2011-07-01

The excessive focus of news organizations on "horse race" public opinion polls during the debate about health reform in 2010 left the impression that the public was fickle, as well as sharply divided on whether the government's role in health care should expand. We examined polling data and found that public support for health reform depended very much on how individual policies were described. For example, support for the public insurance option, which was not included in the final version of the Affordable Care Act, ranged from 46.5 percent to 64.6 percent depending on how pollsters worded their questions. Our findings indicate that public support for health reform was broader and more consistent than portrayed at the time. Going forward, policy makers should strive to communicate how health care policy choices are consistent with existing public preferences or should make changes to policy that reflect those preferences.

Jordan Reforms Public Education to Compete in a Global Economy

ERIC Educational Resources Information Center

Erickson, Paul W.

2009-01-01

The King of Jordan's vision for education is resulting in innovative projects for the country. King Abdullah II wants Jordan to develop its human resources through public education to equip the workforce with skills for the future. From King Abdullah II's vision, the Education Reform for a Knowledge Economy (ERfKE) project implemented by the…

Job Values in Today's Workforce: A Comparison of Public and Private Sector Employees.

ERIC Educational Resources Information Center

Karl, Katherine A.; Sutton, Cynthia L.

1998-01-01

A comparison of 47 public- and 170 private-sector workers revealed private-sector workers value good wages most and public-sector workers value interesting work. Results suggest that employers must keep in touch with employee values to design jobs, reward systems, and human-resource policies that will result in maximum job satisfaction. (JOW)

Public and private sector contributions to the discovery and development of "impact" drugs.

PubMed

Reichert, Janice M; Milne, Christopher-Paul

2002-01-01

Recently, well-publicized reports by Public Citizen and the Joint Economic Committee (JEC) of the US Congress questioned the role of the drug industry in the discovery and development of therapeutically important drugs. To gain a better understanding of the relative roles of the public and private sectors in pharmaceutic innovation, the Tufts Center for the Study of Drug Development evaluated the underlying National Institutes of Health (NIH) and academic research cited in the Public Citizen and JEC reports and performed its own assessment of the relationship between the private and public sectors in drug discovery and development of 21 "impact" drugs. We found that, ultimately, any attempt to measure the relative contribution of the public and private sectors to the research and development (R&D) of therapeutically important drugs by output alone, such as counting publications or even product approvals, is flawed. Several key factors (eg, degree of uncertainty, expected market value, potential social benefit) affect investment decisions and determine whether public or private sector funds, or both, are most appropriate. Because of the competitiveness and complexity of today's R&D environment, both sectors are increasingly challenged to show returns on their investment and the traditional boundaries separating the roles of the private and public research spheres have become increasingly blurred. What remains clear, however, is that the process still starts with good science and ends with good medicine.

An Exploratory Analysis of Public and Private Correctional Education Programs

ERIC Educational Resources Information Center

Sadeghi, Leila

2009-01-01

As prison populations soar at unprecedented rates, the need for high quality education behind bars has never been greater. Prison education programs are the vehicle for reform and may be the solution to curtailing an ever-growing prison population. Yet, as the public sector increasingly contracts with the private sector for prison management,…

Building state capacity in Russia: A case study of energy sector reform, 1992--1998

NASA Astrophysics Data System (ADS)

Kim, Younkyoo

This study seeks an explanation for the neglect of state building in Russia. The major hypothesis is that dependence on external rent leads to the weakness of the state. Three intervening variables---transaction costs, bargaining power of the state, and discount rates---are posited to explain variance on the dependent variable, the weakness of the state. Based on the exploration of three dimensions of energy sector reform, the dissertation argues that in the short run resource rents may be the only reliable and adequate source of finance for the Russian government. The division of resource rents among the many claimants (state vs. business, state vs. society, Moscow vs. regions, and Russia vs. foreign companies), it submits, will pose a stringent test of the viability of democratic governance in Russia. The dissertation concludes that some evidence indicates that Russia has in fact met the characteristics of the rentier state. The greater reliance on a large resource sector for revenue has led to high transaction costs of tax collection, weak bargaining power of the state, and high discount rates of government officials in Russia.

Reform of abortion law in Uruguay: context, process and lessons learned.

PubMed

Wood, Susan; Abracinskas, Lilián; Correa, Sonia; Pecheny, Mario

2016-11-01

In October 2012, a new law was approved in Uruguay that allows abortion on demand during the first 12 weeks of pregnancy, 14 weeks in the case of rape, and without a time limit when the woman's health is at risk or in the case of foetal anomalies. This paper analyses this legal reform. It is based on 27 individual and group interviews with key informants, and on review of primary documents and the literature. The factors explaining the reform include: secular values in society, favourable public opinion, a persistent feminist movement, effective coalition building, particular party politics, and a vocal public health sector. The content of the new law reflects the tensions between a feminist perspective of women's rights and public health arguments that stop short of fully recognizing women's autonomy. The Uruguayan reform shows that, even in Latin America, abortion can be addressed politically without electoral cost to the parties that promote it. On the other hand, the prevailing public health rationale and conditionalities built into the law during the negotiation process resulted in a law that cannot be interpreted as a full recognition of women's rights, but rather as a modified protectionist approach that circumscribes women's autonomy. Copyright © 2016 Elsevier Inc. All rights reserved.

Challenges in Preparing Veterinarians for Global Animal Health: Understanding the Public Sector.

PubMed

Hollier, Paul J; Quinn, Kaylee A; Brown, Corrie C

Understanding of global systems is essential for veterinarians seeking to work in realms outside of their national domain. In the global system, emphasis remains on the public sector, and the current curricular emphasis in developed countries is on private clinical practice for the domestic employment market. There is a resulting lack of competency at graduation for effective engagement internationally. The World Organisation for Animal Health (OIE) has created standards for public sector operations in animal health, which must be functional to allow for sustainable development. This public sector, known as the Veterinary Services, or VS, serves to control public good diseases, and once effectively built and fully operational, allows for the evolution of a functional private sector, focused on private good diseases. Until the VS is fully functional, support of private good services is non-sustainable and any efforts delivered are not long lasting. As new graduates opt for careers working in the international development sector, it is essential that they understand the OIE guidelines to help support continuing improvement. Developing global veterinarians by inserting content into the veterinary curriculum on how public systems can operate effectively could markedly increase the potential of our professional contributions globally, and particularly in the areas most in need.

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.

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

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.

Crowd-sourcing delivery system innovation: A public-private solution.

PubMed

Agrawal, Shantanu; Chen, Christopher; Tanio, Craig P

2015-03-01

We propose the establishment of a public-private approach which creates and maintains a "delivery systems innovations knowledge management system" to define, describe, and assess novel delivery approaches. The public sector could provide the foundational technology, resources and convening power for this innovations database. The private sector would contribute practical innovations that could guide annual strategic planning and implementation. A crowd-sourced effort would jump start delivery system reform. We believe that providing a comprehensive knowledge resource will not stifle competition or private sector opportunities but rather augment and speed the application of effective innovation. Copyright © 2014 Elsevier Inc. All rights reserved.

Assessment of public vs private MSW management: a case study.

PubMed

Massoud, M A; El-Fadel, M; Abdel Malak, A

2003-09-01

Public-private partnerships in urban environmental services have witnessed increased interest in recent years primarily to reform the weak performance of the public sector, reduce cost, improve efficiency, and ensure environmental protection. In this context, successful public-private partnerships require a thorough analysis of opportunities, a deliberate attention to process details, and a continuous examination of services to determine whether they are more effectively performed by the private sector. A comparative assessment of municipal solid waste collection services in the two largest cities in Lebanon where until recently municipal solid waste collection is private in one and public in the other is conducted. While quality of municipal solid waste collection improved, due to private sector participation, the corresponding cost did not, due to monopoly and an inadequate organizational plan defining a proper division of responsibilities between the private and the public sector.

A proposed framework of big data readiness in public sectors

NASA Astrophysics Data System (ADS)

Ali, Raja Haslinda Raja Mohd; Mohamad, Rosli; Sudin, Suhizaz

2016-08-01

Growing interest over big data mainly linked to its great potential to unveil unforeseen pattern or profiles that support organisation's key business decisions. Following private sector moves to embrace big data, the government sector has now getting into the bandwagon. Big data has been considered as one of the potential tools to enhance service delivery of the public sector within its financial resources constraints. Malaysian government, particularly, has considered big data as one of the main national agenda. Regardless of government commitment to promote big data amongst government agencies, degrees of readiness of the government agencies as well as their employees are crucial in ensuring successful deployment of big data. This paper, therefore, proposes a conceptual framework to investigate perceived readiness of big data potentials amongst Malaysian government agencies. Perceived readiness of 28 ministries and their respective employees will be assessed using both qualitative (interview) and quantitative (survey) approaches. The outcome of the study is expected to offer meaningful insight on factors affecting change readiness among public agencies on big data potentials and the expected outcome from greater/lower change readiness among the public sectors.

People Management Practices in the Public Health Sector: Developments from Victoria, Australia

ERIC Educational Resources Information Center

Stanton, Pauline; Bartram, Timothy; Harbridge, Raymond

2004-01-01

This study investigates the impact on human resource management (HRM) practices in the public health sector in Victoria, Australia of two different government policy environments. First, it explores the Liberal Coalition Government's decentralisation of public health sector management, from 1992-1999 and second, the Labor Government's…

Why do health workers in rural Tanzania prefer public sector employment?

PubMed Central

2012-01-01

Background Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. This article discusses health workers' preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts. Methods The study has a qualitative study design to elicit in-depth information on health workers' preferences for workplace. The data comprise ten focus group discussions (FGDs) and 29 in-depth interviews (IDIs) with auxiliary staff, nursing staff, clinicians and administrators in the public health sector and in a large church-run hospital in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. Results The study found a clear preference for public sector employment. This was associated with health worker rights and access to various benefits offered to health workers in government service, particularly the favourable pension schemes providing economic security in old age. Health workers acknowledged that church-run hospitals generally were better equipped and provided better quality patient care, but these concerns tended to be outweighed by the financial assets of public sector employment. In addition to the sector specific differences, family concerns emerged as important in decisions on workplace. Conclusions The preference for public sector employment among health workers shown in this study seems to be associated primarily with the favourable pension scheme. The overall shortage of health workers and the distribution between health facilities is a challenge in a

Why do health workers in rural Tanzania prefer public sector employment?

PubMed

Songstad, Nils Gunnar; Moland, Karen Marie; Massay, Deodatus Amadeus; Blystad, Astrid

2012-04-05

Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. This article discusses health workers' preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts. The study has a qualitative study design to elicit in-depth information on health workers' preferences for workplace. The data comprise ten focus group discussions (FGDs) and 29 in-depth interviews (IDIs) with auxiliary staff, nursing staff, clinicians and administrators in the public health sector and in a large church-run hospital in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. The study found a clear preference for public sector employment. This was associated with health worker rights and access to various benefits offered to health workers in government service, particularly the favourable pension schemes providing economic security in old age. Health workers acknowledged that church-run hospitals generally were better equipped and provided better quality patient care, but these concerns tended to be outweighed by the financial assets of public sector employment. In addition to the sector specific differences, family concerns emerged as important in decisions on workplace. The preference for public sector employment among health workers shown in this study seems to be associated primarily with the favourable pension scheme. The overall shortage of health workers and the distribution between health facilities is a challenge in a resource constrained health system

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

PubMed

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

2018-05-01

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

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

How to improve collaboration between the public health sector and other policy sectors to reduce health inequalities? - A study in sixteen municipalities in the Netherlands.

PubMed

Storm, Ilse; den Hertog, Frank; van Oers, Hans; Schuit, Albertine J

2016-06-22

The causes of health inequalities are complex. For the reduction of health inequalities, intersectoral collaboration between the public health sector and both social policy sectors (e.g. youth affairs, education) and physical policy sectors (e.g. housing, spatial planning) is essential, but in local practice difficult to realize. The aim of this study was to examine the collaboration between the sectors in question more closely and to identify opportunities for improvement. A qualitative descriptive analysis of five aspects of collaboration within sixteen Dutch municipalities was performed to examine the collaboration between the public health sector and other policy sectors: 1) involvement of the sectors in the public health policy network, 2) harmonisation of objectives, 3) use of policies by the relevant sectors, 4) formalised collaboration, and 5) previous experience. Empirical data on these collaboration aspects were collected based on document analysis, questionnaires and interviews. The study found that the policy workers of social sectors were more involved in the public health network and more frequently supported the objectives in the field of health inequality reduction. Both social policy sectors and physical policy sectors used policies and activities to reduce health inequalities. More is done to influence the determinants of health inequality through policies aimed at lifestyle and social setting than through policies aimed at socioeconomic factors and the physical environment. Where the physical policy sectors are involved in the public health network, the collaboration follows a very similar pattern as with the social policy sectors. All sectors recognise the importance of good relationships, positive experiences, a common interest in working together and coordinated mechanisms. This study shows that there is scope for improving collaboration in the field of health inequality reduction between the public health sector and both social policy sectors

Sectorial Relations & Chicago School Reform: A Preliminary View from the Foundation Sector. A Working Paper.

ERIC Educational Resources Information Center

McKersie, William S.

Are sectorial relations among nonprofit organizations, business, and government truly dependent, or are they instead a complex mix of dependent and independent actions? This working paper is based on a dissertation in progress, which is a comparative analysis of how private foundations influence the reform of urban public education. It compares…

The Accounting System and Resource Allocation Reform in a Public University

ERIC Educational Resources Information Center

Spathis, Charalambos; Ananiadis, John

2004-01-01

This paper studies the accounting system reform practised in Greek universities since January 2000, and more particularly at the Aristotle University of Thessaloniki (AUTH). It specifically examines the allocation of resources to faculties by university management based on certain criteria. The AUTH is the largest public university in Greece and…

Allocation Anatomy: How District Policies That Deploy Resources Can Support (or Undermine) District Reform Strategies

ERIC Educational Resources Information Center

Roza, Marguerite

2008-01-01

The goal of this paper is to explore the effects of micro-budgeting decisions and show how they might support or hamper district reform strategies. The study draws on public and private sector resource allocation literature to identify key elements of resource allocation decisions. These elements are used to highlight different allocation…

Charter School Competition, Organization, and Achievement in Traditional Public Schools

ERIC Educational Resources Information Center

Davis, Tomeka M.

2013-01-01

Market models of education reform predict that the growth of charter schools will infuse competition into the public school sector, forcing traditional public schools to improve the practices they engage in to educate students. Some scholars have criticized these models, arguing that competition from charter schools is unlikely to produce…

Cross-Sectoral Leaders of Partnerships in Reforming Senior L/earning in Queensland: Implications for the Professional Learning of Education and Training Leaders

ERIC Educational Resources Information Center

Singh, Michael; Chen, Xiafang; Harreveld, Bobby

2009-01-01

This working paper "investigates" the role of Vocational Education and Training in Schools (VETiS) in providing leaders with a driver for reforming Senior L/earning (Years 10, 11 and 12). Using a "case study methodology", this paper explores the collaboration and cooperation across different borders and sectors among leaders in…

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

Access to Power: Governance and Development in the Pakistani Electrical Power Sector

NASA Astrophysics Data System (ADS)

Naqvi, Ijlal

This dissertation explores governance in Pakistan through a study of the state-run electrical power sector. At both the micro and macro level, the Pakistani power sector provides a lens into the heart of the Pakistani state and its governance institutions. This ethnographic and historical study offers an in-depth look at state operations in a developing country, situates the current Pakistani power crisis in a larger context of continuity through periods of dictatorship and democracy, and suggests how efforts to make state service delivery more responsive to citizens might be reconceived. A historical review of the Pakistani power sector establishes first and foremost that the current crisis is the product of longer-term processes for which the policy solutions currently being proposed (with the support of international donors and multilateral lenders) are inadequate. Depoliticized attempts at power sector reform have little to offer in light of the pervasively informal and negotiated nature of the fragmented Pakistani state. The institutions of power sector governance are mutually constituted by the formal rules and the informal---personal relationships, language, violence, money, and power. These rules of the game are as relevant to relations within and between public sector organizations as they are to the engagement of citizens with their state. The same rules apply at the margins of the state---informal squatter settlements---as at the core, though the resources brought to bear and the resultant outcomes are different. The internal incoherence of this state underscores the limitations of formal rules in determining outcomes, and the poor prospects for reform efforts that focus exclusively on the formal aspects of governance. To proactively engage with the question of political will leads away from top-down policy perspectives and counter to the depoliticizing tendencies that currently shape policy reforms. Instead, an energized and informed local participation

How can psychiatrists offer psychotherapeutic leadership in the public sector?

PubMed

Cammell, Paul; Amos, Jackie; Baigent, Michael

2016-06-01

This article reviews the forms that psychotherapeutic leadership can take for psychiatrists attempting to optimise outcomes for individuals receiving treatment in the public mental health sector. It explores a range of roles and functions that psychiatrists can take on as psychotherapy leaders, and how these can be applied in clinical, administrative and research contexts. Psychiatrists need to play an increasing role in clinical, administrative and academic settings to advance service provision, resource allocation, training and research directed at psychotherapies in the public health sector. © The Royal Australian and New Zealand College of Psychiatrists 2016.

Cross-sector partnerships and public health: challenges and opportunities for addressing obesity and noncommunicable diseases through engagement with the private sector.

PubMed

Johnston, Lee M; Finegood, Diane T

2015-03-18

Over the past few decades, cross-sector partnerships with the private sector have become an increasingly accepted practice in public health, particularly in efforts to address infectious diseases in low- and middle-income countries. Now these partnerships are becoming a popular tool in efforts to reduce and prevent obesity and the epidemic of noncommunicable diseases. Partnering with businesses presents a means to acquire resources, as well as opportunities to influence the private sector toward more healthful practices. Yet even though collaboration is a core principle of public health practice, public-private or nonprofit-private partnerships present risks and challenges that warrant specific consideration. In this article, we review the role of public health partnerships with the private sector, with a focus on efforts to address obesity and noncommunicable diseases in high-income settings. We identify key challenges-including goal alignment and conflict of interest-and consider how changes to partnership practice might address these.

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.

The role of public-sector research in the discovery of drugs and vaccines.

PubMed

Stevens, Ashley J; Jensen, Jonathan J; Wyller, Katrine; Kilgore, Patrick C; Chatterjee, Sabarni; Rohrbaugh, Mark L

2011-02-10

Historically, public-sector researchers have performed the upstream, basic research that elucidated the underlying mechanisms of disease and identified promising points of intervention, whereas corporate researchers have performed the downstream, applied research resulting in the discovery of drugs for the treatment of diseases and have carried out development activities to bring them to market. However, the boundaries between the roles of the public and private sectors have shifted substantially since the dawn of the biotechnology era, and the public sector now has a much more direct role in the applied-research phase of drug discovery. We identified new drugs and vaccines approved by the Food and Drug Administration (FDA) that were discovered by public-sector research institutions (PSRIs) and classified them according to their therapeutic category and potential therapeutic effect. We found that during the past 40 years, 153 new FDA-approved drugs, vaccines, or new indications for existing drugs were discovered through research carried out in PSRIs. These drugs included 93 small-molecule drugs, 36 biologic agents, 15 vaccines, 8 in vivo diagnostic materials, and 1 over-the-counter drug. More than half of these drugs have been used in the treatment or prevention of cancer or infectious diseases. PSRI-discovered drugs are expected to have a disproportionately large therapeutic effect. Public-sector research has had a more immediate effect on improving public health than was previously realized.

Profiles of Regional Efficiency in Pakistan: Comparison of Public and Private Sector Manufacturing Firms

DTIC Science & Technology

1994-01-01

Public and Private Sector Manufacturing Firms 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e...REGIONAL EFFICIENCY IN PAKISTAN: COMPARISON OF PUBLIC AND PRIVATE SECTOR MANUFACTURING FIRMS by Robert E. Looney In an examination of the relative...efficiency in public and private sector enter- prises should be explored in more detail. In this vein the purpose of the analysis below is to examine the

Does Educational Expansion Encourage Female Workforce Participation? A Study of the 1968 Reform in Taiwan

ERIC Educational Resources Information Center

Tsai, Wehn-Jyuan; Liu, Jin-Tan; Chou, Shin-Yi; Thornton, Robert

2009-01-01

Between 1968 and 1973 the Taiwanese government undertook the most extensive expansion on record of the public junior high school system in Taiwan. This study analyzes the effects of the 1968 education reform and subsequent high school expansion on gender disparities in employment generally, as well in different sectors and classes of employment.…

Can ICT Reform Public Agencies?

NASA Astrophysics Data System (ADS)

Jansen, Arild; Løvdal, Einar

This study examines the reorganisation of the administration of admission to higher education in Norway, which has also included the development of a nationwide, ICT-based case handling system. This reform process was initiated out of the need to provide politicians with information for control and regulatory purposes, and the reform resulted in a centralised management information system. This system, however, has evolved into a coordinated but also partly locally delegated decision-making instrument which processes most of the applications for admission to higher education in Norway.

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

PubMed

Prinja, Shankar; Kanavos, Panos; Kumar, Rajesh

2012-09-01

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

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

PubMed Central

Prinja, Shankar; Kanavos, Panos; Kumar, Rajesh

2012-01-01

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

The economics of hospital reform from hierarchical to market-based incentives.

PubMed

Preker, Alexander S; Harding, April

2005-01-01

Heavy investment over the past 30 years has made the hospital sector the largest expenditure category of the health system in most developed and developing countries. In most countries hospitals remain a critical link to health care, providing both advanced and basic care for the population. Often, they are the provider 'of last resort' for the poor and critically ill. This article provides insights into recent hospital reforms undertaken throughout the world, with an emphasis on organisational changes such as increased management autonomy, corporatisation, and privatisation. It provides some insights about these popular reform modalities from a review of the literature, reform experiences in other sectors and empirical evidence from hospital sector itself. The material presented tries to answer three questions: (a) what problems did this type of reform try to address; (b) what are the core elements of their design, implementation and evaluation; and, (c) is there any evidence that this type of reform is successful in addressing problems for which they were intended? While this paper focuses on issues related to the design of the reforms, the paper also reports the findings from a larger study that examined the implementation and evaluation of such reforms so that they will be available to countries that are considering venturing down this reform path.

What can we learn from international comparisons of health systems and health system reform?

PubMed Central

McPake, B.; Mills, A.

2000-01-01

Most commonly, lessons derived from comparisons of international health sector reform can only be generalized in a limited way to similar countries. However, there is little guidance as to what constitutes "similarity" in this respect. We propose that a framework for assessing similarity could be derived from the performance of individual policies in different contexts, and from the cause and effect processes related to the policies. We demonstrate this process by considering research evidence in the "public-private mix", and propose variables for an initial framework that we believe determine private involvement in the public health sector. The most influential model of public leadership places the private role in a contracting framework. Research in countries that have adopted this model suggests an additional list of variables to add to the framework. The variables can be grouped under the headings "demand factors", "supply factors", and "strength of the public sector". These illustrate the nature of a framework that could emerge, and which would help countries aiming to learn from international experience. PMID:10916918

'It makes me want to run away to Saudi Arabia': management and implementation challenges for public financing reforms from a maternity ward perspective.

PubMed

Penn-Kekana, Loveday; Blaauw, Duane; Schneider, Helen

2004-10-01

Poor practice by health care workers has been identified as contributing to high levels of maternal mortality in South Africa. The country is undergoing substantial structural and financial reforms, yet the impact of these on health care workers performance and practice has not been studied. This study, which consisted of an ethnography of two labour wards (one rural and one urban), aimed to look at the factors that shaped everyday practice of midwives working in district hospitals in South Africa during the implementation of a public sector reform to improve financial management. The study found that the Public Financing Management Act, that aimed to improve the efficiency and accountability of public finance management, had the unintended consequence of causing the quality of maternal health services to deteriorate in the hospital wards studied. The article supports the need for increased dialogue between those working in the sexual and reproductive health and health systems policy arenas, and the importance of giving a voice to front-line health workers who implement systems changes. However, it cautions that there are no simple answers to how health systems should be organized in order to better provide sexual and reproductive health services, and suggests instead that more attention in the debate needs to be paid to the challenges of policy implementation and the socio-political context and process issues which affect the success or failure of the implementation. Copyright 2004 Oxford University Press

Technical quality of delivery care in private- and public-sector health facilities in Enugu and Lagos States, Nigeria.

PubMed

Hirose, Atsumi; Yisa, Ibrahim O; Aminu, Amina; Afolabi, Nathanael; Olasunmbo, Makinde; Oluka, George; Muhammad, Khalilu; Hussein, Julia

2018-06-01

Private-sector providers are increasingly being recognized as important contributors to the delivery of healthcare. Countries with high disease burdens and limited public-sector resources are considering using the private sector to achieve universal health coverage. However, evidence for the technical quality of private-sector care is lacking. This study assesses the technical quality of maternal healthcare during delivery in public- and private-sector facilities in resource-limited settings, from a systems and programmatic perspective. A summary index (the skilled attendance index, SAI), was used. Two-staged cluster sampling with stratification was used to select representative samples of case records in public- and private-sector facilities in Enugu and Lagos States, Nigeria. Information to assess criteria was extracted, and the SAI calculated. Linear regression models examined the relationship between SAI and the private and public sectors, controlling for confounders. The median SAI was 54.8% in Enugu and 85.7% in Lagos. The private for-profit sector's SAI was lower than and the private not-for-profit sector's SAI was higher than the public sector in Enugu [coefficient = -3.6 (P = 0.018) and 12.6 (P < 0.001), respectively]. In Lagos, the private for-profit sector's SAI was higher and the private not-for-profit sector's SAI was lower than the public sector [3.71 (P = 0.005) and -3.92 (P < 0.001)]. Results indicate that the technical quality of private for-profit providers' care was poorer than public providers where the public provision of care was weak, while private for-profit facilities provided better technical quality care than public facilities where the public sector was strong and there was a relatively strong regulatory body. Our findings raise important considerations relating to the quality of maternity care, the public-private mix and needs for regulation in global efforts to achieve universal healthcare.

No Child Left Behind: The Ongoing Movement for Public Education Reform

ERIC Educational Resources Information Center

Paige, Rod

2006-01-01

In this essay, former secretary of education Rod Paige depicts the No Child Left Behind Act (NCLB) as the culmination of more than half a century of urgent but largely unheeded calls for reform of the nation's public education system. He explains the rationale for the design of NCLB and responds to several criticisms of the legislation, including…

Healthcare reform: implications for knowledge translation in primary care

PubMed Central

2013-01-01

Background The primary care sector represents the linchpin of many health systems. However, the translation of evidence-based practices into patient care can be difficult, particularly during healthcare reform. This can have significant implications for patients, their communities, and the public purse. This is aptly demonstrated in the area of sexual health. The aim of this paper is to determine what works to facilitate evidence-based sexual healthcare within the primary care sector. Methods 431 clinicians (214 general practitioners and 217 practice nurses) in New South Wales, Australia, were surveyed about their awareness, their use, the perceived impact, and the factors that hindered the use of six resources to promote sexual healthcare. Descriptive statistics were calculated from the responses to the closed survey items, while responses to open-ended item were thematically analyzed. Results All six resources were reported to improve the delivery of evidence-based sexual healthcare. Two resources – both double-sided A4-placards – had the greatest reach and use. Barriers that hindered resource-use included limited time, limited perceived need, and limited access to, or familiarity with the resources. Furthermore, the reorganization of the primary care sector and the removal of particular medical benefits scheme items may have hampered clinician capacity to translate evidence-based practices into patient care. Conclusions Findings reveal: (1) the translation of evidence-based practices into patient care is viable despite reform; (2) the potential value of a multi-modal approach; (3) the dissemination of relatively inexpensive resources might influence clinical practices; and (4) reforms to governance and/or funding arrangements may widen the void between evidence-based practices and patient care. PMID:24274773

Sources of satisfaction and dissatisfaction among specialists within the public and private health sectors.

PubMed

Ashton, Toni; Brown, Paul; Sopina, Elizaveta; Cameron, Linda; Tenbensel, Timothy; Windsor, John

2013-09-27

As in many countries, medical and surgical specialists in New Zealand have the opportunity of working in the public sector, the private sector or both. This study aimed to explore the level and sources of satisfaction and dissatisfaction of specialists in New Zealand with working in the two sectors. Such information can assist workforce planning, management and policy and may inform the wider debate about the relationship between the two sectors. A postal survey was conducted of 1983 registered specialists throughout New Zealand. Respondents were asked to assess 14 sources of satisfaction and 9 sources of dissatisfaction according to a 5-point Likert scale. Means and standard deviations were calculated for the total sample, and for procedural and non-procedural specialties. Differences between the means of each source of satisfaction and dissatisfaction were also calculated. Completed surveys were received from 943 specialists (47% response rate). Overall mean levels of satisfaction were higher in the private sector than the public sector while levels of dissatisfaction were lower. While the public system is valued for its opportunities for further education and professional development, key sources of dissatisfaction are workload pressures, mentally demanding work and managerial interference. In the private sector specialists value the opportunity to work independently and apply their own ideas in the workplace. Sources of job satisfaction and dissatisfaction amongst specialists are different for the public and private sectors. Allowing specialists more freedom to work independently and to apply their own ideas in the workplace may enhance recruitment and retention of specialists in the public health system.

The use of private-sector contracts for primary health care: theory, evidence and lessons for low-income and middle-income countries.

PubMed Central

Palmer, N.

2000-01-01

Contracts for the delivery of public services are promoted as a means of harnessing the resources of the private sector and making publicly funded services more accountable, transparent and efficient. This is also argued for health reforms in many low- and middle-income countries, where reform packages often promote the use of contracts despite the comparatively weaker capacity of markets and governments to manage them. This review highlights theories and evidence relating to contracts for primary health care services and examines their implications for contractual relationships in low- and middle-income countries. PMID:10916919

A systematic tale of two differing reviews: evaluating the evidence on public and private sector quality of primary care in low and middle income countries.

PubMed

Coarasa, Jorge; Das, Jishnu; Gummerson, Elizabeth; Bitton, Asaf

2017-04-12

Systematic reviews are powerful tools for summarizing vast amounts of data in controversial areas; but their utility is limited by methodological choices and assumptions. Two systematic reviews of literature on the quality of private sector primary care in low and middle income countries (LMIC), published in the same journal within a year, reached conflicting conclusions. The difference in findings reflects different review methodologies, but more importantly, a weak underlying body of literature. A detailed examination of the literature cited in both reviews shows that only one of the underlying studies met the gold standard for methodological robustness. Given the current policy momentum on universal health coverage and primary health care reform across the globe, there is an urgent need for high quality empirical evidence on the quality of private versus public sector primary health care in LMIC.

Right place of human resource management in the reform of health sector.

PubMed

Hassani, Seyed Abas; Mobaraki, Hossein; Bayat, Maboubeh; Mafimoradi, Shiva

2013-01-01

In this paper the real role and place of human resource (HR) in health system reform will be discussed and determined within the whole system through the comprehensive Human Resource Management (HRM) model. Delphi survey and a questionnaire were used to 1) collect HR manager ideas and comments and 2) identify the main challenges of HRM. Then the results were discussed in an expert panel after being analyzed by content analysis method. Also, a deep focus study of recorded documents related to Health Human Resource Management was done. Then based on all achieved results, a rich picture was drawn to illustrate the right place of HRM in health sector. Finally, the authors revitalize the missed function of HRM within the health sector by drawing a holistic conceptual model. The most percentage of frequency about HR belongs to "Lack of reliable HR information system" (91%) and the least percentage of frequency belongs to "Low responsibility of HR" (28%). The most percentage of frequency about HR manager belongs to "Inattention to HR managers as key managers and consider them in background" (80%) and the least percentage of frequency belongs to "Lack of coordination between universities' policies" (30%). According to the conceptual framework, human resources employed in health system are viewed from two comprehensive approaches: instrumental approach and institutional. Unlike the common belief that looks HRM through the supportive approach, it is discussed that HRM not only has an instrumental role, but also do have a driver role.

Performance Contracting as a Performance Management Tool in the Public Sector in Kenya: Lessons of learning

ERIC Educational Resources Information Center

Hope, Kempe Ronald, Sr.

2013-01-01

The purpose of this article is to provide an assessment and analysis of public sector performance contracting as a performance management tool in Kenya. It aims to demonstrate that performance contracting remains a viable and important tool for improving public sector performance as a key element of the on-going public sector transformation…

Participatory environmental governance in China: public hearings on urban water tariff setting.

PubMed

Zhong, Li-Jin; Mol, Arthur P J

2008-09-01

In the late 1990s China started to expand its market economic reform to the public sector, such as water services. This reform led to major changes in urban water management, including water tariff management. The reforms in water tariff management relate not only to tariffs, but also to the decision-making on tariffs. Water tariff decision-making seems to move away from China's conventional mode of highly centralized and bureaucratic policy- and decision-making. The legalization, institutionalization and performance of public hearings in water tariff management forms a crucial innovation in this respect. This article analyzes the emergence, development and current functioning of public hearings in water tariff setting, and assesses to what extent public hearings are part of a turning point in China's tradition of centralized bureaucratic decision-making, towards more transparent, decentralized and participative governance.

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

ERIC Educational Resources Information Center

Oberman, Ida

2007-01-01

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

Reform in American Public Higher Education.

ERIC Educational Resources Information Center

Robles, Harriett J.

This paper provides an overview of higher education reform movements in the United States. While some of the 18th and 19th century reforms in the country are described, the emphasis is on the 20th century. Early in this period, the debate over general education and the need for a required core curriculum was central. McCarthyism influenced higher…

Vocational Education and Training in Tanzania and Zimbabwe in the Context of Economic Reform. Education Research Paper.

ERIC Educational Resources Information Center

Bennell, Paul; Bendera, Shane; Kanyenze, Godfrey; Kimambo, Emrode; Kiwia, Sixtus; Mbiriyakura, Tichafa; Mukyanuzi, Faustin; Munetsi, N.; Muzulu, Jo; Parsalaw, Willy; Temu, John

Developments in vocational education and training (VET) in Tanzania and Zimbabwe since the 1980s were examined in the context of economic reform. Formal VET provision in each country's public and private sectors was reviewed, and case studies of one firm in each country's manufacturing and tourism industries were conducted. The research identified…

Veteran status, disability rating, and public sector employment.

PubMed

Winters, John V

2018-06-01

This paper used microdata from the 2013-2015 American Community Survey to examine differences in federal government, state and local government, private sector, and self-employment among employed veterans and nonveterans. The U.S. federal and state governments have hiring preferences to benefit veterans, especially disabled veterans. Other factors may also push veterans toward public sector employment. I found that veteran status substantially increased the likelihood of federal employment, with the largest magnitudes for severely disabled veterans. Differences in state and local government employment were modest and exhibited heterogeneity by disability severity. Copyright © 2018 John Wiley & Sons, Ltd.

The End of Public Schools? The Corporate Reform Agenda to Privatize Education

ERIC Educational Resources Information Center

Hursh, David

2017-01-01

In this speech, Hursh shows how public education in the United States is undergoing profound changes. Education policy has been hijacked by the unelected and unaccountable corporate reformers who aspire to overhaul the education system through a corporate model of privatization and market competition. They aim to privatize education through…

Improving the public health sector in South Africa: eliciting public preferences using a discrete choice experiment.

PubMed

Honda, Ayako; Ryan, Mandy; van Niekerk, Robert; McIntyre, Diane

2015-06-01

The introduction of national health insurance (NHI), aimed at achieving universal coverage, is the most important issue currently on the South African health policy agenda. Improvement in public sector health-care provision is crucial for the successful implementation of NHI as, regardless of whether health-care services become more affordable and available, if the quality of the services provided is not acceptable, people will not use the services. Although there has been criticism of the quality of public sector health services, limited research is available to identify what communities regard as the greatest problems with the services. A discrete choice experiment (DCE) was undertaken to elicit public preferences on key dimensions of quality of care when selecting public health facilities in South Africa. Qualitative methods were applied to establish attributes and levels for the DCE. To elicit preferences, interviews with community members were held in two South African provinces: 491 in Western Cape and 499 in Eastern Cape. The availability of necessary medicine at health facilities has the greatest impact on the probability of attending public health facilities. Other clinical quality attributes (i.e. provision of expert advice and provision of a thorough examination) are more valued than non-clinical quality of care attributes (i.e. staff attitude, treatment by doctors or nurses, and waiting time). Treatment by a doctor was less valued than all other attributes. Communities are prepared to tolerate public sector health service characteristics such as a long waiting time, poor staff attitudes and lack of direct access to doctors if they receive the medicine they need, a thorough examination and a clear explanation of the diagnosis and prescribed treatment from health professionals. These findings prioritize issues that the South African government must address in order to meet their commitment to improve public sector health-care service provision. Published

Restructuring and performance in India's electricity sector

NASA Astrophysics Data System (ADS)

Panda, Arun Kumar

Restructuring and privatization, used as major tools in electricity sector reform, are often viewed as part of the same process and the terms used interchangeably. Although related, they represent quite different dimensions of change and reform. Privatization is the result of change in the management/ownership. Restructuring, on the other hand, refers to changes in structure such as the unbundling of vertically integrated utilities, and the introduction of competition. Most studies attempt to assess the impact of privatization of the electric utilities on their tariff structure, performance and efficiency. They have not tried to estimate the effect of restructuring on the performance of the unbundled utilities. Using panel data on the state electricity boards and the thermal power plants, and employing variance-component fixed effects and random effects models, this study examines the effects of restructuring and ownership on the performance of India's electricity sector. We also study the effects of absolute majority of political parties on performance. The study also uses a cross-country-comparison-framework to compare the electricity sector reforms of India with those of Chile, Hungary and Norway. Results show that restructuring has significantly positive effects on such performance indicators as plant availability, plant load factor, forced outage, average tariff collection, and sales revenue as a ratio of cost. With regard to labor efficiency indicators, we find mixed results. Restructuring also appears to entail reduction in the extent of cross-subsidization. However, the cost of supply seems to be unaffected by restructuring. Absolute majority of the party in government shows adverse effects on costs, sales revenue as a ratio of cost, and labor efficiency. The effects of ownership are somewhat mixed, with state ownership (as opposed to federal or private) indicating adverse effects on plant performance. Interestingly, after controlling for location

Financing Albanian Higher Education: Growth between the Public and Private Sectors

ERIC Educational Resources Information Center

Pere, Engjell; Minxhozi, Luljeta

2011-01-01

In many countries, reforms in higher education have follow-on effects on social and economic development. This article relates mainly to economic and financial issues regarding the development of higher education. Starting from the notable increase in demand for higher education and the budgetary constraints on public education financing, we argue…

Does the Wage Gap between Private and Public Sectors Encourage Political Corruption?

PubMed Central

Podobnik, Boris; Vukovic, Vuk; Stanley, H. Eugene

2015-01-01

We present a dynamic network model of corrupt and noncorrupt employees representing two states in the public and private sector. Corrupt employees are more connected to one another and are less willing to change their attitudes regarding corruption than noncorrupt employees. This behavior enables them to prevail and become the majority in the workforce through a first-order phase transition even though they initially represented a minority. In the model, democracy—understood as the principle of majority rule—does not create corruption, but it serves as a mechanism that preserves corruption in the long run. The motivation for our network model is a paradox that exists on the labor market. Although economic theory indicates that higher risk investments should lead to larger rewards, in many developed and developing countries workers in lower-risk public sector jobs are paid more than workers in higher-risk private sector jobs. To determine the long-run sustainability of this economic paradox, we study data from 28 EU countries and find that the public sector wage premium increases with the level of corruption. PMID:26495847

Does the Wage Gap between Private and Public Sectors Encourage Political Corruption?

PubMed

Podobnik, Boris; Vukovic, Vuk; Stanley, H Eugene

2015-01-01

We present a dynamic network model of corrupt and noncorrupt employees representing two states in the public and private sector. Corrupt employees are more connected to one another and are less willing to change their attitudes regarding corruption than noncorrupt employees. This behavior enables them to prevail and become the majority in the workforce through a first-order phase transition even though they initially represented a minority. In the model, democracy-understood as the principle of majority rule-does not create corruption, but it serves as a mechanism that preserves corruption in the long run. The motivation for our network model is a paradox that exists on the labor market. Although economic theory indicates that higher risk investments should lead to larger rewards, in many developed and developing countries workers in lower-risk public sector jobs are paid more than workers in higher-risk private sector jobs. To determine the long-run sustainability of this economic paradox, we study data from 28 EU countries and find that the public sector wage premium increases with the level of corruption.

Investigating the effectiveness of response strategies for vulnerabilities to corruption in the chinese public construction sector.

PubMed

Shan, Ming; Chan, Albert P C; Le, Yun; Hu, Yi

2015-06-01

Response strategy is a key for preventing widespread corruption vulnerabilities in the public construction sector. Although several studies have been devoted to this area, the effectiveness of response strategies has seldom been evaluated in China. This study aims to fill this gap by investigating the effectiveness of response strategies for corruption vulnerabilities through a survey in the Chinese public construction sector. Survey data obtained from selected experts involved in the Chinese public construction sector were analyzed by factor analysis and partial least squares-structural equation modeling. Analysis results showed that four response strategies of leadership, rules and regulations, training, and sanctions, only achieved an acceptable level in preventing corruption vulnerabilities in the Chinese public construction sector. This study contributes to knowledge by improving the understanding of the effectiveness of response strategies for corruption vulnerabilities in the public construction sector of developing countries.

A Call to the Village: Retooling Public Schools

ERIC Educational Resources Information Center

Duhart, Wana L.

2007-01-01

This book is a roadmap for developing collaborative strategies that integrate the knowledge, ideas, expertise, resources, networks, and systems of the nonprofit, private, public, and religious sectors in the transformation of elementary and secondary schools. While most books on school reform focus on micro issues such as curricula,…

Injuries among solid waste collectors in the private versus public sectors.

PubMed

Bunn, Terry L; Slavova, Svetla; Tang, Minao

2011-10-01

Solid waste collection is among the occupations with the highest risk for injuries and illnesses. Solid waste collector injuries were characterized in terms of injury risk and employment industry sector (public versus private) using Kentucky workers' compensation first reports of injury and claims data. When compared to 35-44-year-old workers, solid waste collectors who were under 35 years of age were less likely to have a workers' compensation first report of injury or claim that resulted in awarded benefits. The probability that a workers' compensation first report of injury or claim would result in an awarded benefit was higher if the worker was employed as a solid waste collector in the private sector compared to the public sector, or was injured due to a motor vehicle-related injury or a push-or-pull type of injury. A better understanding of the differences in the contributing factors for an injury that results in a first report of injury or claim with awarded benefits (e.g., job activities, new and refresher worker safety training, type of equipment used, differences in collection vehicle automation, and differential reporting of injuries on the job) between the public and private sectors is necessary to target injury prevention strategies in this high-risk occupation.

University Governance Reforms: Potential Problems of More Autonomy?

ERIC Educational Resources Information Center

Christensen, Tom

2011-01-01

University governance reforms are very much a reflection of the broader New Public Management reforms that are focusing on increasing efficiency in public organizations. The article deals with how university reform ideas of a generic nature, emphasizing that universities should be treated and reformed like any other public organizations, are…

A comparison between antenatal care quality in public and private sector in rural Hebei, China.

PubMed

Chen, Li; Dai, Yaohua; Zhang, Yanfeng; Wu, Qiong; Rudan, Diana; Saftić, Vanja; van Velthoven, Michelle H M M T; Su, Jianqiang; Tan, Zangwen; Scherpbier, Robert W

2013-04-01

To evaluate the quality of antenatal care (ANC) in Hebei Province and compare it between the public and private sector and within the public sector. We conducted a Maternal, Newborn and Child Health Household Survey in 2010 using a two-stage sampling procedure and included 1079 mothers. The quality of ANC was assessed on the basis of the number of ANC visits, the time of the first ANC visit, 16 different ANC procedures, owning a maternal health care booklet, and the type of service provider. Almost all women (98%) received ANC services at least once, 80% at least four times, and 54% at least five times. About half of the women (46%) visited ANC facility within their first trimester. Neither public nor private sector provided all 16 standardized services, but significantly more women in public sector received ANC procedures. Most women received ANC in county or higher-level hospitals (75%) and very few in township hospitals (8%). Significantly fewer women were weighed and tested for HIV/AIDS in township than in county or higher-level hospitals. The quality of ANC in Hebei was poorer than required by China's national and World Health Organization norms. Although the public sector performed better than the private sector, the utilization and quality of care of ANC services in this sector varied and women generally visited county or higher-level health facilities.

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

ERIC Educational Resources Information Center

Keddie, Amanda

2017-01-01

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

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.

Implications of private sector Hib vaccine coverage for the introduction of public sector Hib-containing pentavalent vaccine in India: evidence from retrospective time series data

PubMed Central

Sharma, Abhishek; Kaplan, Warren A; Chokshi, Maulik; Hasan Farooqui, Habib; Zodpey, Sanjay P

2015-01-01

Objective Haemophilus influenzae type b (Hib) vaccine has been available in India's private sector market since 1997. It was not until 14 December 2011 that the Government of India initiated the phased public sector introduction of a Hib (and DPT, diphtheria, pertussis, tetanus)-containing pentavalent vaccine. Our objective was to investigate the state-specific coverage and behaviour of Hib vaccine in India when it was available only in the private sector market but not in the public sector. This baseline information can act as a guide to determine how much coverage the public sector rollout of pentavalent vaccine (scheduled April 2015) will need to bear in order to achieve complete coverage. Setting 16 of 29 states in India, 2009–2012. Design Retrospective descriptive secondary data analysis. Data (1) Annual sales of Hib vaccines, by volume, from private sector hospitals and retail pharmacies collected by IMS Health and (2) national household surveys. Outcome measures State-specific Hib vaccine coverage (%) and its associations with state-specific socioeconomic status. Results The overall private sector Hib vaccine coverage among the 2009–2012 birth cohort was low (4%) and varied widely among the studied Indian states (minimum 0.3%; maximum 4.6%). We found that private sector Hib vaccine coverage depends on urban areas with good access to the private sector, parent's purchasing capacity and private paediatricians’ prescribing practices. Per capita gross domestic product is a key explanatory variable. The annual Hib vaccine uptake and the 2009–2012 coverage levels were several times higher in the capital/metropolitan cities than the rest of the state, suggesting inequity in access to Hib vaccine delivered by the private sector. Conclusions If India has to achieve high and equitable Hib vaccine coverage levels, nationwide public sector introduction of the pentavalent vaccine is needed. However, the role of private sector in universal Hib vaccine coverage is

Institutional delivery in India, 2004-14: unravelling the equity-enhancing contributions of the public sector.

PubMed

Joe, William; Perkins, Jessica M; Kumar, Saroj; Rajpal, Sunil; Subramanian, S V

2018-06-01

To achieve faster and equitable improvements in maternal and child health outcomes, the government of India launched the National Rural Health Mission in 2005. This paper describes the equity-enhancing role of the public sector in increasing use of institutional delivery care services in India between 2004 and 2014. Information on 24 661 births from nationally representative survey data for 2004 and 2014 is analysed. Concentration index is computed to describe socioeconomic-rank-related relative inequalities in institutional delivery and decomposition is used to assess the contributions of public and private sectors in overall socioeconomic inequality. Multilevel logistic regression is applied to examine the changes in socioeconomic gradient between 2004 and 2014. The analysis finds that utilization of institutional delivery care in India increased from 43% in 2004 to 83% in 2014. The bulk of the increase was in public sector use (21% in 2004 to 53% in 2014) with a modest increase in private sector use (22% in 2004 to 30% in 2014). The shift from a pro-rich to pro-poor distribution of public sector use is confirmed. Decomposition analysis indicates that 51% of these reductions in socioeconomic inequality are associated with improved pro-poor distribution of public sector births. Multilevel logistic regressions confirm the disappearance of a wealth-based gradient in public sector births between 2004 and 2014. We conclude that public health investments in India have significantly contributed towards an equitable increase in the coverage of institutional delivery care. Sustained policy efforts are necessary, however, with an emphasis on education, sociocultural and geographical factors to ensure universal coverage of institutional delivery care services in India.

Spatially Enabling the Health Sector

PubMed Central

Weeramanthri, Tarun Stephen; Woodgate, Peter

2016-01-01

Spatial information describes the physical location of either people or objects, and the measured relationships between them. In this article, we offer the view that greater utilization of spatial information and its related technology, as part of a broader redesign of the architecture of health information at local and national levels, could assist and speed up the process of health reform, which is taking place across the globe in richer and poorer countries alike. In making this point, we describe the impetus for health sector reform, recent developments in spatial information and analytics, and current Australasian spatial health research. We highlight examples of uptake of spatial information by the health sector, as well as missed opportunities. Our recommendations to spatially enable the health sector are applicable to high- and low-resource settings. PMID:27867933

Spatially Enabling the Health Sector.

PubMed

Weeramanthri, Tarun Stephen; Woodgate, Peter

2016-01-01

Spatial information describes the physical location of either people or objects, and the measured relationships between them. In this article, we offer the view that greater utilization of spatial information and its related technology, as part of a broader redesign of the architecture of health information at local and national levels, could assist and speed up the process of health reform, which is taking place across the globe in richer and poorer countries alike. In making this point, we describe the impetus for health sector reform, recent developments in spatial information and analytics, and current Australasian spatial health research. We highlight examples of uptake of spatial information by the health sector, as well as missed opportunities. Our recommendations to spatially enable the health sector are applicable to high- and low-resource settings.

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

PubMed

Selway, Joel Sawat

2011-01-01

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

'Going private': a qualitative comparison of medical specialists' job satisfaction in the public and private sectors of South Africa.

PubMed

Ashmore, John

2013-01-03

There is a highly inequitable distribution of health workers between public and private sectors in South Africa, partly due to within-country migration trends. This article elaborates what South African medical specialists find satisfying about working in the public and private sectors, at present, and how to better incentivize retention in the public sector. Seventy-four qualitative interviews were conducted - among specialists and key informants - based in one public and one private urban hospital in South Africa. Interviews were coded to determine common job satisfaction factors, both financial and non-financial in nature. This served as background to a broader study on the impacts of specialist 'dual practice', that is, moonlighting. All qualitative specialist respondents were engaged in dual practice, generally working in both public and private sectors. Respondents were thus able to compare what was satisfying about these sectors, having experience of both. Results demonstrate that although there are strong financial incentives for specialists to migrate from the public to the private sector, public work can be attractive in some ways. For example, the public hospital sector generally provides more of a team environment, more academic opportunities, and greater opportunities to feel 'needed' and 'relevant'. However, public specialists suffer under poor resource availability, lack of trust for the Department of Health, and poor perceived career opportunities. These non-financial issues of public sector dissatisfaction appeared just as important, if not more important, than wage disparities. The results are useful for understanding both what brings specialists to migrate to the private sector, and what keeps some working in the public sector. Policy recommendations center around boosting public sector resources and building trust of the public sector through including health workers more in decision-making, inter alia. These interventions may be more cost

Public sector scale-up of zinc and ORS improves coverage in selected districts in Bihar, India.

PubMed

Walker, Christa L Fischer; Taneja, Sunita; Lamberti, Laura M; Black, Robert E; Mazumder, Sarmila

2015-12-01

In Bihar, India, a new initiative to enhance diarrhea treatment with zinc and ORS in the public sector was rolled out in selected districts. We conducted an external evaluation to measure changes in diarrhea careseeking and treatment in intervention districts. We conducted baseline and endline household surveys among caregivers of children 2-59 months of age. We calculated summary statistics for household characteristics, knowledge, careseeking and treatments given to children with a diarrhea episode in the last 14 days and built logistic regression models to compare baseline and endline values. Caregivers named a public health center as an appropriate source of care for childhood diarrhea more often at endline (71.3%) compared to baseline (38.4%) but did not report increased careseeking to public sector providers for the current diarrhea episode. In logistic regression analyses, the odds of receiving zinc, with or without oral rehydration salts (ORS), increased at endline by more than 2.7 as compared to baseline. Children who were taken to the public sector for care were more likely to receive zinc (odds ratio, OR = 3.93) and zinc in addition to ORS (OR = 6.10) compared to children who were not taken to the public sector. Coverage of zinc and ORS can improve with public sector programs targeted at training and increasing product availability, but demand creation may be needed to increase public sector careseeking in areas where the private sector has historically provided much of the care.

AN ANALYSIS OF THE INEQUALITIES BETWEEN THE PUBLIC AND PRIVATE SECTOR IN SOUTH AFRICA.

PubMed

Dell, A; Kahn, D; Klopper, J

2017-09-01

The full extent of the global burden of surgical disease is largely unknown, however, the scope of the problem is thought to be large. Despite the substantial burden of surgical disease, surgical services are inaccessible to many of those who need them most. There are disparities between public and private sectors in South Africa, which compounds inequitable access to surgical care. This study involved a descriptive analysis of surgical resources and included the total number of hospitals, of hospital beds, the number of surgical beds, the number of general surgeons (specialist and non-specialist), and the number of functional operating theatres in South Africa. A comparison was performed between the public and private sectors. Hospitals were contacted during the period from the 1st October 2014 until the 31st of December 2014. Surgical resources were concentrated in metropolitan areas of urban provinces. There were striking differences between the public and private sectors, where private resources were comparable to those available in high income countries (HICs). Improving access to surgical services in lower middle income countries (LMICs) requires addressing gaps between the public and private sector regarding infrastructure, personnel, as well as equipment. South Africa is unique in that although it is classified as an upper middle income country (UMIC), is comprises of two sectors; a public sector which has resources similar to other LMICs, and a private sector which has resources similar to HICs. These data identified disparities between geographic regions which may be contributing to ongoing inequity in South Africa, and by doing so allows for evidence-based planning towards improving surgical infrastructure and workforce.

The quality of family planning services and client satisfaction in the public and private sectors in Kenya.

PubMed

Agha, Sohail; Do, Mai

2009-04-01

To compare the quality of family planning services delivered at public and private facilities in Kenya. Data from the 2004 Kenya Service Provision Assessment were analysed. The Kenya Service Provision Assessment is a representative sample of health facilities in the public and private sectors, and comprises data obtained from a facility inventory, service provider interviews, observations of client-provider interactions and exit interviews. Quality-of-care indicators are compared between the public and private sectors along three dimensions: structure, process and outcome. Private facilities were superior to public sector facilities in terms of physical infrastructure and the availability of services. Public sector facilities were more likely to have management systems in place. There was no difference between public and private providers in the technical quality of care provided. Private providers were better at managing interpersonal aspects of care. The higher level of client satisfaction at private facilities could not be explained by differences between public and private facilities in structural and process aspects of care. Formal private sector facilities providing family planning services exhibit greater readiness to provide services and greater attention to client needs than public sector facilities in Kenya. Consistent with this, client satisfaction is much higher at private facilities. Technical quality of care provided is similar in public and private facilities.

A comparison between antenatal care quality in public and private sector in rural Hebei, China

PubMed Central

Chen, Li; Dai, Yaohua; Zhang, Yanfeng; Wu, Qiong; Rudan, Diana; Saftić, Vanja; van Velthoven, Michelle H.M.M.T.; Su, Jianqiang; Tan, Zangwen; Scherpbier, Robert W.

2013-01-01

Aim To evaluate the quality of antenatal care (ANC) in Hebei Province and compare it between the public and private sector and within the public sector. Methods We conducted a Maternal, Newborn and Child Health Household Survey in 2010 using a two-stage sampling procedure and included 1079 mothers. The quality of ANC was assessed on the basis of the number of ANC visits, the time of the first ANC visit, 16 different ANC procedures, owning a maternal health care booklet, and the type of service provider. Results Almost all women (98%) received ANC services at least once, 80% at least four times, and 54% at least five times. About half of the women (46%) visited ANC facility within their first trimester. Neither public nor private sector provided all 16 standardized services, but significantly more women in public sector received ANC procedures. Most women received ANC in county or higher-level hospitals (75%) and very few in township hospitals (8%). Significantly fewer women were weighed and tested for HIV/AIDS in township than in county or higher-level hospitals. Conclusion The quality of ANC in Hebei was poorer than required by China’s national and World Health Organization norms. Although the public sector performed better than the private sector, the utilization and quality of care of ANC services in this sector varied and women generally visited county or higher-level health facilities. PMID:23630142

A study on moral hazard in dentistry: costs of care in the private and the public sector.

PubMed

Tuominen, Risto; Eriksson, Anna-Leena

2011-10-01

The aim of this study was to evaluate the costs of subsidized care for an adult population provided by private and public sector dentists. A sample of 210 patients was drawn systematically from the waiting list for nonemergency dental treatment in the city of Turku. Questionnaire data covering sociodemographic background, dental care utilization and marginal time cost estimates were combined with data from patient registers on treatment given. Information was available on 104 patients (52 from each of the public and the private sectors). The overall time taken to provide treatment was 181 days in the public sector and 80 days in the private sector (P<0.002). On average, public sector patients had significantly (P < 0.01) more dental visits (5.33) than private sector patients (3.47), which caused higher visiting fees. In addition, patients in the public sector also had higher other out-of-pocket costs than in the private sector. Those who needed emergency dental treatment during the waiting time for comprehensive care had significantly more costly treatment and higher total costs than the other patients. Overall time required for dental visits significantly increased total costs. The total cost of dental care in the public sector was slightly higher (P<0.05) than in the private sector. There is no direct evidence of moral hazard on the provider side from this study. The observed cost differences between the two sectors may indicate that private practitioners could manage their publicly funded patients more quickly than their private paying patients. On the other hand, private dentists providing more treatment per visit could be explained by private dentists providing more than is needed by increasing the content per visit. © 2011 John Wiley & Sons A/S.

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

PubMed

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

2010-12-01

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

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.

Public Disorder, Private Boons? Inter-Sectoral Dynamics Illustrated by the Kenyan Case. PROPHE Working Paper Series. WP No. 9

ERIC Educational Resources Information Center

Otieno, Wycliffe; Levy, Daniel

2007-01-01

Within and beyond Africa, it is the public sector much more than the private sector that is the scene of strikes and other forms of disorder, conflict and difficulty. Yet the private sector can be much affected by the public problems. Effects may be simultaneously positive for the private sector and deleterious for the public sector. Although a…

Private and Public Sector Enterprise Resource Planning System Post-Implementation Practices: A Comparative Mixed Method Investigation

ERIC Educational Resources Information Center

Bachman, Charles A.

2010-01-01

While private sector organizations have implemented enterprise resource planning (ERP) systems since the mid 1990s, ERP implementations within the public sector lagged by several years. This research conducted a mixed method, comparative assessment of post "go-live" ERP implementations between public and private sector organization. Based on a…

Teaching Chinese Students: Understanding Their Public Sector Paradigm

ERIC Educational Resources Information Center

Conrad, Cynthia; Coleman, Charles

2011-01-01

Teaching Chinese students in an American university can be both challenging and rewarding. Cultural and language differences can lead to some superficial confusion and interpretational problems. However, the vast differences in the ways Chinese students view the role of the public sector, as compared to the US, can mean that the instructors and…

Barriers of mistrust: public and private health sectors' perceptions of each other in Madhya Pradesh, India.

PubMed

De Costa, Ayesha; Johansson, Eva; Diwan, Vinod K

2008-06-01

India has one of the most highly privatized health care systems in the world. The dominant private health sector functions alongside a traditional tiered public health sector. There has been an overall lack of collaboration between the two sectors despite international policy recommendations and local initiatives. It has been postulated that "conflicting perceptions" might contribute to the uncooperative attitude between the two sectors. But there has been little empirical exploration of the existing perceptions that the private and public health sectors have of each other. We explored these perceptions among key stakeholders (who influence the direction of health policy) in the public and private health sectors in the province of Madhya Pradesh, India. The barriers of mistrust, which hinder true dialogue, are complex, and have social, moral, and economic bases. They can be best addressed by necessary structural change before any significant long-term partnership between the two sectors is possible.

Analyzing Differences Between Public and Private Sector Information Resource Management: Chief Information Officer Challenges and Critical Technologies

DTIC Science & Technology

2002-01-01

Private sector organizations have a valuable knowledge base from their CIO office implementation efforts and subsequent operations. This private sector knowledge could offer public sector CIOs invaluable insight into successful information resource management practices. However, public and private managers must take great care in deciphering which IRM prescriptions are relevant to their organizational situation. The goal of this research is to discover if public and private sector CIOs are faced with the same challenges and view

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.

AN ANALYSIS OF THE INEQUALITIES BETWEEN THE PUBLIC AND PRIVATE SECTOR IN SOUTH AFRICA.

PubMed

Dell, A J; Kahn, D; Klopper, J

2017-06-01

The full extent of the global burden of surgical disease is largely unknown; however, the scope of the problem is thought to be large. Despite the substantial burden of surgical disease, surgical services are inaccessible to many of those who need them most. There are disparities between public and private sectors in South Africa, which compounds inequitable access to surgical care. This study involved a descriptive analysis of surgical resources and included the total number of hospitals, hospital beds, surgical beds, general surgeons (specialist and nonspecialist), and the number of functional operating theatres in South Africa. A comparison was performed between the public sector resources per uninsured population and private sector resources per insured population. Hospitals were contacted during the period 01 October 2014 to 31 December 2014. Surgical resources were concentrated in metropolitan areas of urban provinces. There were striking differences between sectors when a comparison was made between patients with and without health insurance. Private resources were comparable to those available in high income countries (HICs) and were accessible to only 16% of South Africans. Improving access to surgical services in lower middle income countries (LMICs) requires addressing gaps between the public and private sector regarding infrastructure, personnel, as well as equipment. South Africa is unique in that although it is classified as an upper middle income country (UMIC), it comprises of two sectors; a public sector which has resources similar to other LMICs, and a private sector which has resources similar to HICs. These data identified disparities between geographic regions which may be contributing to ongoing inequity in South Africa, and by doing so allows for evidence-based planning towards improving surgical infrastructure and workforce.

Facilitating Expansive Learning in a Public Sector Organization

ERIC Educational Resources Information Center

Gustavsson, Maria

2009-01-01

The aim of this article is to discuss how learning opportunities can be organized to promote expansive learning in work practice. The discussion draws on results from a case study examining local development work and conditions that facilitate processes of expansive learning in a work team within a public sector organization in a Swedish…

Psychosocial Work Hazards, Self-Rated Health and Burnout: A Comparison Study of Public and Private Sector Employees.

PubMed

Liu, Hsi-Chen; Cheng, Yawen

2018-04-01

To compare psychosocial work conditions and health status between public and private sector employees and to examine if psychosocial work conditions explained the health differences. Two thousand four hundred fourty one public and 15,589 private sector employees participated in a cross-sectional survey. Psychosocial work hazards, self-rated health (SRH), and burnout status were assessed by questionnaire. As compared with private sector employees, public sector employees reported better psychosocial work conditions and better SRH, but higher risk of workplace violence (WPV) and higher levels of client-related burnout. Regression analyses indicated that higher psychosocial job demands, lower workplace justice, and WPV experience were associated with poor SRH and higher burnout. The public-private difference in client-related burnout remained even with adjustment of psychosocial work factors. Greater risks of WPV and client-related burnout observed in public sector employees warrant further investigation.

Local File Disclosure Vulnerability: A Case Study of Public-Sector Web Applications

NASA Astrophysics Data System (ADS)

Ahmed, M. Imran; Maruf Hassan, Md; Bhuyian, Touhid

2018-01-01

Almost all public-sector organisations in Bangladesh now offer online services through web applications, along with the existing channels, in their endeavour to realise the dream of a ‘Digital Bangladesh’. Nations across the world have joined the online environment thanks to training and awareness initiatives by their government. File sharing and downloading activities using web applications have now become very common, not only ensuring the easy distribution of different types of files and documents but also enormously reducing the time and effort of users. Although the online services that are being used frequently have made users’ life easier, it has increased the risk of exploitation of local file disclosure (LFD) vulnerability in the web applications of different public-sector organisations due to unsecure design and careless coding. This paper analyses the root cause of LFD vulnerability, its exploitation techniques, and its impact on 129 public-sector websites in Bangladesh by examining the use of manual black box testing approach.

Implications of private sector Hib vaccine coverage for the introduction of public sector Hib-containing pentavalent vaccine in India: evidence from retrospective time series data.

PubMed

Sharma, Abhishek; Kaplan, Warren A; Chokshi, Maulik; Hasan Farooqui, Habib; Zodpey, Sanjay P

2015-02-23

Haemophilus influenzae type b (Hib) vaccine has been available in India's private sector market since 1997. It was not until 14 December 2011 that the Government of India initiated the phased public sector introduction of a Hib (and DPT, diphtheria, pertussis, tetanus)-containing pentavalent vaccine. Our objective was to investigate the state-specific coverage and behaviour of Hib vaccine in India when it was available only in the private sector market but not in the public sector. This baseline information can act as a guide to determine how much coverage the public sector rollout of pentavalent vaccine (scheduled April 2015) will need to bear in order to achieve complete coverage. 16 of 29 states in India, 2009-2012. Retrospective descriptive secondary data analysis. (1) Annual sales of Hib vaccines, by volume, from private sector hospitals and retail pharmacies collected by IMS Health and (2) national household surveys. State-specific Hib vaccine coverage (%) and its associations with state-specific socioeconomic status. The overall private sector Hib vaccine coverage among the 2009-2012 birth cohort was low (4%) and varied widely among the studied Indian states (minimum 0.3%; maximum 4.6%). We found that private sector Hib vaccine coverage depends on urban areas with good access to the private sector, parent's purchasing capacity and private paediatricians' prescribing practices. Per capita gross domestic product is a key explanatory variable. The annual Hib vaccine uptake and the 2009-2012 coverage levels were several times higher in the capital/metropolitan cities than the rest of the state, suggesting inequity in access to Hib vaccine delivered by the private sector. If India has to achieve high and equitable Hib vaccine coverage levels, nationwide public sector introduction of the pentavalent vaccine is needed. However, the role of private sector in universal Hib vaccine coverage is undefined as yet but it should not be neglected as a useful complement to

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.

Information Technology and Value Creation in the Public Sector Organizations

ERIC Educational Resources Information Center

Pang, Min-Seok

2011-01-01

In this dissertation, I study the performance impact of information technology (IT) investments in the public sector. IT has been one of the key assets in public administration since the early MIS era. Even though the information systems (IS) discipline has witnessed a considerable amount of research efforts on the subject of IT business value for…

Five Things Education Supporters Should Know about Pension Reform. A Special Education Sector Guide for Legislators

ERIC Educational Resources Information Center

Tucker, Bill

2012-01-01

As a state legislator, you're well aware of the fiscal pressures that have caused many states to change their pension systems. But you should also be aware of the impact that pension reform has on public education. This brief guide shows you how and why pension programs affect your state's efforts to attract and retain the best teachers. It…

The Effect of Message Frames on Public Attitudes Toward Criminal Justice Reform for Nonviolent Offenses

PubMed Central

Gottlieb, Aaron

2017-01-01

In recent years, the rhetoric surrounding criminal justice policy has increasingly emphasized reform, rather than being “tough on crime.” Although this change in rhetoric is aimed at building public support for reform, little is known about its efficacy. To test the efficacy of reform rhetoric, I conducted an Internet experiment using Amazon Mechanical Turk. Respondents were randomly assigned to one of six message conditions or to a control condition (no message) and then asked their views about eliminating the use of incarceration for select nonviolent offenses. Results from ordinal logistic regression models suggest that message frames that appeal to a respondent’s self-interest or emphasize the unfairness of the punishment (not who is punished) tend to be most effective. PMID:28943646

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

PubMed

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

2018-06-01

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

Job Satisfaction and Burnout among Greek Early Educators: A Comparison between Public and Private Sector Employees

ERIC Educational Resources Information Center

Tsigilis, Nikolaos; Zachopoulou, Evridiki; Grammatikopoulos, Vasilios

2006-01-01

The purpose of the present study was to examine perceived levels of burnout and job satisfaction of Greek early educators, across public and private sector. One hundred and seventy eight childhood educators participated in the study. 108 were working in the public sector, 67 in private sector, whereas three did not respond. Participants were…

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.

Corporate governance of public health services: lessons from New Zealand for the state sector.

PubMed

Perkins, R; Barnett, P; Powell, M

2000-01-01

New Zealand public hospitals and related services were grouped into 23 Crown Health Enterprises and registered as companies in 1993. Integral to this change was the introduction of corporate governance. New directors, largely from the business sector, were appointed to govern these organisations as efficient and effective businesses. This article presents the results of a survey of directors of New Zealand publicly-owned health provider organisations. Although directors thought they performed well in business systems development, they acknowledged their shortcomings in meeting government expectations in respect to financial performance and social responsibility. Changes in public health sector provider performance indicators have resulted in a mixed report card for the sector six years after corporate governance was instituted.

Public High School Principals' Perceptions of Academic Reform. Center for Education Statistics Bulletin.

ERIC Educational Resources Information Center

Center for Education Statistics (ED/OERI), Washington, DC.

A survey of public high school principals asked which policies, programs, and practices designed to improve learning were currently in operation at their schools, and whether these policies were instituted or substantially strengthened in the past 5 years. These policies reflect the school-level recommendations for education reform made in "A…

Public health workforce employment in US public and private sectors.

PubMed

Kennedy, Virginia C

2009-01-01

The purpose of this study was to describe the number and distribution of 26 administrative, professional, and technical public health occupations across the array of US governmental and nongovernmental industries. This study used data from the Occupational Employment Statistics program of the US Bureau of Labor Statistics. For each occupation of interest, the investigator determined the number of persons employed in 2006 in five industries and industry groups: government, nonprofit agencies, education, healthcare, and all other industries. Industry-specific employment profiles varied from one occupation to another. However, about three-fourths of all those engaged in these occupations worked in the private healthcare industry. Relatively few worked in nonprofit or educational settings, and less than 10 percent were employed in government agencies. The industry-specific distribution of public health personnel, particularly the proportion employed in the public sector, merits close monitoring. This study also highlights the need for a better understanding of the work performed by public health occupations in nongovernmental work settings. Finally, the Occupational Employment Statistics program has the potential to serve as an ongoing, national data collection system for public health workforce information. If this potential was realized, future workforce enumerations would not require primary data collection but rather could be accomplished using secondary data.

‘Going private’: a qualitative comparison of medical specialists’ job satisfaction in the public and private sectors of South Africa

PubMed Central

2013-01-01

Background There is a highly inequitable distribution of health workers between public and private sectors in South Africa, partly due to within-country migration trends. This article elaborates what South African medical specialists find satisfying about working in the public and private sectors, at present, and how to better incentivize retention in the public sector. Methods Seventy-four qualitative interviews were conducted - among specialists and key informants - based in one public and one private urban hospital in South Africa. Interviews were coded to determine common job satisfaction factors, both financial and non-financial in nature. This served as background to a broader study on the impacts of specialist ‘dual practice’, that is, moonlighting. All qualitative specialist respondents were engaged in dual practice, generally working in both public and private sectors. Respondents were thus able to compare what was satisfying about these sectors, having experience of both. Results Results demonstrate that although there are strong financial incentives for specialists to migrate from the public to the private sector, public work can be attractive in some ways. For example, the public hospital sector generally provides more of a team environment, more academic opportunities, and greater opportunities to feel ‘needed’ and ‘relevant’. However, public specialists suffer under poor resource availability, lack of trust for the Department of Health, and poor perceived career opportunities. These non-financial issues of public sector dissatisfaction appeared just as important, if not more important, than wage disparities. Conclusions The results are useful for understanding both what brings specialists to migrate to the private sector, and what keeps some working in the public sector. Policy recommendations center around boosting public sector resources and building trust of the public sector through including health workers more in decision

The impact of healthcare reform on the efficiency of public county hospitals in China.

PubMed

Jiang, Shuai; Min, Rui; Fang, Peng-Qian

2017-12-20

The new round of Healthcare Reform in China has implemented over 3 years since 2009, and promoted greatly the development of public county hospitals. The purpose of this study is to evaluate county hospitals efficiency before and after the healthcare reform, and further assess the reform effectiveness through the comparative analysis of the efficiency. Data envelopment analysis (DEA) was employed to calculate the efficiency of 1105 sample hospitals which were selected from 31 provinces of China, also, Tobit regression was used to regress against those main external environmental factors. Our results show that the scales and amounts of service of hospitals had increased sharply, however, the efficiency was relatively low and decreased slightly from 2008 to 2012. Thirteen (1.18%) in 2008 and six (0.54%) hospitals in 2012 were defined as technically efficient, and the average scores were 0.2916 and 0.2503. The technical efficiency average score of the post-reform was significantly less than that of the pre-reform (p < 0.001), and the score of eastern region was highest and the western was lowest among three regions of China. It suggests the reform had not well improved county hospital efficiency although hospitals have reached a fair developing scale, and the corresponding policies and measures should be put into effect for improving efficiency, especially in the level and structure of health investment, operation and supervision mechanism of county hospitals.

Who are more responsive? Mixed-methods comparison of public and private sector physicians in rural Bangladesh.

PubMed

Joarder, Taufique; George, Asha; Sarker, Malabika; Ahmed, Saifuddin; Peters, David H

2017-11-01

Responsiveness of physicians (ROPs) reflects the social actions by physicians to meet the legitimate expectations of health care users. Responsiveness is important since it improves understanding and care seeking by users, as well as fostering trust in health systems rather than replicating discrimination and entrenching inequality. Given widespread public and private sector health care provision in Bangladesh, we undertook a mixed-methods study comparing responsiveness of public and private physicians in rural Bangladesh. The study included in-depth interviews with physicians (n = 12, seven public, five private) and patients (n = 7, three male, four female); focus group discussions with users (four sessions, two male and two female); and observations in consultation rooms of public and private sector physicians (1 week in each setting). This was followed by structured observation of patient consultations with 195 public and 198 private physicians using the ROPs Scale, consisting of five domains (Friendliness; Respecting; Informing and guiding; Gaining trust; and Financial sensitivity). Qualitative data were analysed by framework analysis and quantitative data were analyzed using two-sample t-test, multiple linear regression, multivariate analysis of variance, and descriptive discriminant analyses. The mean responsiveness score of public sector physicians was statistically different from private sector physicians: -0.29 vs 0.29, i.e. a difference of - 0.58 (P-value < 0.01; 95% CI - 0.77, -0.39) on a normalized scale. Despite relatively higher level of responsiveness of private sector, according to qualitative findings, neither of the sectors performed optimally. Private physicians scored higher in Friendliness, Respecting and Informing and guiding; while public sector physicians scored higher in other domains. 'Respecting' domain was found as the most important. Unlike findings from other studies in Bangladesh, instead of seeing one sector as better than

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

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.

Adaptation to climate change in the Ontario public health sector

PubMed Central

2012-01-01

Background Climate change is among the major challenges for health this century, and adaptation to manage adverse health outcomes will be unavoidable. The risks in Ontario – Canada’s most populous province – include increasing temperatures, more frequent and intense extreme weather events, and alterations to precipitation regimes. Socio-economic-demographic patterns could magnify the implications climate change has for Ontario, including the presence of rapidly growing vulnerable populations, exacerbation of warming trends by heat-islands in large urban areas, and connectedness to global transportation networks. This study examines climate change adaptation in the public health sector in Ontario using information from interviews with government officials. Methods Fifty-three semi-structured interviews were conducted, four with provincial and federal health officials and 49 with actors in public health and health relevant sectors at the municipal level. We identify adaptation efforts, barriers and opportunities for current and future intervention. Results Results indicate recognition that climate change will affect the health of Ontarians. Health officials are concerned about how a changing climate could exacerbate existing health issues or create new health burdens, specifically extreme heat (71%), severe weather (68%) and poor air-quality (57%). Adaptation is currently taking the form of mainstreaming climate change into existing public health programs. While adaptive progress has relied on local leadership, federal support, political will, and inter-agency efforts, a lack of resources constrains the sustainability of long-term adaptation programs and the acquisition of data necessary to support effective policies. Conclusions This study provides a snapshot of climate change adaptation and needs in the public health sector in Ontario. Public health departments will need to capitalize on opportunities to integrate climate change into policies and programs

A Comparative Analysis of Financial Reporting Models for Private and Public Sector Organizations.

DTIC Science & Technology

1995-12-01

The objective of this thesis was to describe and compare different existing and evolving financial reporting models used in both the public and...private sector. To accomplish the objective, this thesis identified the existing financial reporting models for private sector business organizations...private sector nonprofit organizations, and state and local governments, as well as the evolving financial reporting model for the federal government

Managerial competencies of hospital managers in South Africa: a survey of managers in the public and private sectors.

PubMed

Pillay, Rubin

2008-02-08

South Africa has large public and private sectors and there is a common perception that public sector hospitals are inefficient and ineffective while the privately owned and managed hospitals provide superior care and are more sustainable. The underlying assumption is that there is a potential gap in management capacity between the two sectors. This study aims to ascertain the skills and competency levels of hospital managers in South Africa and to determine whether there are any significant differences in competency levels between managers in the different sectors. A survey using a self administered questionnaire was conducted among hospital managers in South Africa. Respondents were asked to rate their proficiency with seven key functions that they perform. These included delivery of health care, planning, organizing, leading, controlling, legal and ethical, and self-management. Ratings were based on a five point Likert scale ranging from very low skill level to very high skill level. The results show that managers in the private sector perceived themselves to be significantly more competent than their public sector colleagues in most of the management facets. Public sector managers were also more likely than their private sector colleagues to report that they required further development and training. The findings confirm our supposition that there is a lack of management capacity within the public sector in South Africa and that there is a significant gap between private and public sectors. It provides evidence that there is a great need for further development of managers, especially those in the public sector. The onus is therefore on administrators and those responsible for management education and training to identify managers in need of development and to make available training that is contextually relevant in terms of design and delivery.

Managerial competencies of hospital managers in South Africa: a survey of managers in the public and private sectors

PubMed Central

Pillay, Rubin

2008-01-01

Background South Africa has large public and private sectors and there is a common perception that public sector hospitals are inefficient and ineffective while the privately owned and managed hospitals provide superior care and are more sustainable. The underlying assumption is that there is a potential gap in management capacity between the two sectors. This study aims to ascertain the skills and competency levels of hospital managers in South Africa and to determine whether there are any significant differences in competency levels between managers in the different sectors. Methods A survey using a self administered questionnaire was conducted among hospital managers in South Africa. Respondents were asked to rate their proficiency with seven key functions that they perform. These included delivery of health care, planning, organizing, leading, controlling, legal and ethical, and self-management. Ratings were based on a five point Likert scale ranging from very low skill level to very high skill level. Results The results show that managers in the private sector perceived themselves to be significantly more competent than their public sector colleagues in most of the management facets. Public sector managers were also more likely than their private sector colleagues to report that they required further development and training. Conclusion The findings confirm our supposition that there is a lack of management capacity within the public sector in South Africa and that there is a significant gap between private and public sectors. It provides evidence that there is a great need for further development of managers, especially those in the public sector. The onus is therefore on administrators and those responsible for management education and training to identify managers in need of development and to make available training that is contextually relevant in terms of design and delivery. PMID:18257936

Public-private sector interactions and the demand for supplementary health insurance in the United Kingdom.

PubMed

Bíró, Anikó; Hellowell, Mark

2016-07-01

We examine the demand for private health insurance (PHI) in the United Kingdom and relate this to changes in the supply of public and private healthcare. Using a novel collection of administrative, private sector and survey data, we re-assess the relationships between the quality and availability of public and private sector inpatient care, and the demand for PHI. We find that PHI coverage in the United Kingdom is positively related to the median of the region- and year-specific public sector waiting times. We find that PHI prevalence ceteris paribus increases with being self-employed and employed, while it decreases with having financial difficulties. In addition, we highlight the complexities of inter-sectoral relations and their impact on PHI demand. Within a region, we find that an increase in private healthcare supply is associated with a decrease in public sector waiting times, implying lower PHI demand. This may be explained by the usage of private facilities by NHS commissioners. These results have important implications for policymakers interested in the role of private healthcare supply in enhancing the availability of and equitable access to acute inpatient care. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Public/Private Sector Interactions: The Implications for Networking. A Discussion Report Prepared by the Network Advisory Committee.

ERIC Educational Resources Information Center

Network Planning Paper, 1983

1983-01-01

At a 2-day meeting in October 1982, the Library of Congress Network Advisory Committee (NAC) members discussed the complex issues involved in public and private sector interactions and their relationship to networking activities. The report, "Public Sector/Private Sector Interaction in Providing Information Services," prepared by the…

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

PubMed

Guimarães, Cristian Fabiano; da Silva, Rosane Azevedo Neves

2015-03-01

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

Managing the Public Sector Research and Development Portfolio Selection Process: A Case Study of Quantitative Selection and Optimization

DTIC Science & Technology

2016-09-01

PUBLIC SECTOR RESEARCH & DEVELOPMENT PORTFOLIO SELECTION PROCESS: A CASE STUDY OF QUANTITATIVE SELECTION AND OPTIMIZATION by Jason A. Schwartz...PUBLIC SECTOR RESEARCH & DEVELOPMENT PORTFOLIO SELECTION PROCESS: A CASE STUDY OF QUANTITATIVE SELECTION AND OPTIMIZATION 5. FUNDING NUMBERS 6...describing how public sector organizations can implement a research and development (R&D) portfolio optimization strategy to maximize the cost

How Will Teachers Fare in Rhode Island's New Hybrid Pension Plan? Public Pension Project Brief 4

ERIC Educational Resources Information Center

Johnson, Richard W.; Butrica, Barbara A.; Haaga, Owen; Southgate, Benjamin G.

2014-01-01

Hybrid retirement plans that combine defined benefit pensions with 401(k) type, defined contribution accounts can play important roles in the reform of public-sector pensions. Summarizing results from our longer report ["How Will Rhode Island's New Hybrid Pension Plan Affect Teachers? A Report of the Public Pension Project" (2014)], this…

Wisconsin's BadgerCare Plus reform: impact on low-income families' enrollment and retention in public coverage.

PubMed

Leininger, Lindsey Jeanne; Friedsam, Donna; Dague, Laura; Mok, Shannon; Hynes, Emma; Bergum, Alison; Aksamitauskas, Milda; Oliver, Thomas; DeLeire, Thomas

2011-02-01

To examine the impact of a Wisconsin health care reform enacted in early 2008 on public insurance enrollment and retention. Administrative data covering the period January 2007 to November 2009. We calculate unadjusted enrollment trends and exit rates stratified by age, income group, and enrollment mode. Kaplan-Meier curves and Cox proportional hazards models are estimated to assess the impact of the reform on program exits. Overall enrollment increased by approximately one-third and exit rates decreased by approximately one-fifth. The majority of new enrollment came from the previously income eligible. Wisconsin's enactment of eligibility expansions coupled with administrative simplification and targeted marketing and outreach efforts were successful in enrolling and retaining low-income children and families in public coverage. © Health Research and Educational Trust.

Buprenorphine Maintenance for Opioid Dependence in Public Sector Healthcare: Benefits and Barriers

PubMed Central

Duncan, Laura G.; Mendoza, Sonia; Hansen, Helena

2015-01-01

Background Since its U.S. FDA approval in 2002, buprenorphine has been available for maintenance treatment of opiate dependence in primary care physicians’ offices. Though buprenorphine was intended to facilitate access to treatment, disparities in utilization have emerged; while buprenorphine treatment is widely used in private care setting, public healthcare integration of buprenorphine lags behind. Results Through a review of the literature, we found that U.S. disparities are partly due to a shortage of certified prescribers, concern of patient diversion, as well as economic and institutional barriers. Disparity of buprenorphine treatment dissemination is concerning since buprenorphine treatment has specific characteristics that are especially suited for low-income patient population in public sector healthcare such as flexible dosing schedules, ease of concurrently treating co-morbidities such as HIV and hepatitis C, positive patient attitudes towards treatment, and the potential of reducing addiction treatment stigma. Conclusion As the gap between buprenorphine treatment in public sector settings and private sector settings persists in the U.S., current research suggests ways to facilitate its dissemination. PMID:27088135

Buprenorphine Maintenance for Opioid Dependence in Public Sector Healthcare: Benefits and Barriers.

PubMed

Duncan, Laura G; Mendoza, Sonia; Hansen, Helena

Since its U.S. FDA approval in 2002, buprenorphine has been available for maintenance treatment of opiate dependence in primary care physicians' offices. Though buprenorphine was intended to facilitate access to treatment, disparities in utilization have emerged; while buprenorphine treatment is widely used in private care setting, public healthcare integration of buprenorphine lags behind. Through a review of the literature, we found that U.S. disparities are partly due to a shortage of certified prescribers, concern of patient diversion, as well as economic and institutional barriers. Disparity of buprenorphine treatment dissemination is concerning since buprenorphine treatment has specific characteristics that are especially suited for low-income patient population in public sector healthcare such as flexible dosing schedules, ease of concurrently treating co-morbidities such as HIV and hepatitis C, positive patient attitudes towards treatment, and the potential of reducing addiction treatment stigma. As the gap between buprenorphine treatment in public sector settings and private sector settings persists in the U.S., current research suggests ways to facilitate its dissemination.

Third Sector Involvement in Public Education: The Israeli Case

ERIC Educational Resources Information Center

Berkovich, Izhak; Foldes, Vincent Jonathan

2012-01-01

Purpose: The purpose of this article is to address the involvement of third sector organizations in state public education in Israel, with emphasis on the decision-making processes affecting the geographic distribution of service provision. Design/methodology/approach: A collective case study approach was used to investigate non-governmental…

Comparing employee health benefits in the public and private sectors, 1997.

PubMed

Long, S H; Marquis, M S

1999-01-01

Data from the 1997 Robert Wood Johnson Foundation Employer Health Insurance Survey provide new information comparing public- and private-sector employee health benefits. The federal government is ahead of other employers in adopting managed competition principles using financial incentives and consumer information to promote choosing efficient plans. Federal employees experience a $200 annual compensation gap relative to those in the private sector, but it is partly explained by advantage in purchasing power. In contrast, state and local governments make higher payments toward health insurance than private-sector employers do. Their premiums are equivalent, but they pay a greater share of the total cost.

Homophobia and Heterosexism in Public School Reform: Constructions of Gender and Sexuality in California's Single Gender Academies

ERIC Educational Resources Information Center

Woody, Elisabeth L.

2003-01-01

This article examines heterosexist assumptions and the role of homophobia in students' experiences in California's public "Single Gender Academies," in an effort to include issues of sexuality in current discourses on adolescent gender identity and public school reform. Interviews with students, conducted as part of the most…

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

PubMed

Hartmann, Christopher

2016-12-01

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

Medicaid Waivers and Public Sector Mental Health Service Penetration Rates for Youth.

PubMed

Graaf, Genevieve; Snowden, Lonnie

2018-01-22

To assist families of youth with serious emotional disturbance in financing youth's comprehensive care, some states have sought and received Medicaid waivers. Medicaid waivers waive or relax the Medicaid means test for eligibility to provide insurance coverage to nonpoor families for expensive, otherwise out-of-reach treatment for youth with Serious Emotional Disturbance (SED). Waivers promote treatment access for the most troubled youth, and the present study investigated whether any of several Medicaid waiver options-and those that completely omit the means test in particular-are associated with higher state-wide public sector treatment penetration rates. The investigators obtained data from the U.S. Census, SAMHSA's Uniform Reporting System, and the Centers for Medicare and Medicaid Services. Analysis employed random intercept and random slope linear regression models, controlling for a variety of state demographic and fiscal variables, to determine whether a relationship between Medicaid waiver policies and state-level public sector penetration rates could be observed. Findings indicate that, whether relaxing or completely waiving Medicaid's qualifying income limits, waivers increase public sector penetration rates, particularly for youth under age 17. However, completely waiving Medicaid income limits did not uniquely contribute to penetration rate increases. States offering Medicaid waivers that either relax or completely waive Medicaid's means test to qualify for health coverage present higher public sector treatment rates for youth with behavioral health care needs. There is no evidence that restricting the program to waiving the means test for accessing Medicaid would increase treatment access. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Primer in Public Sector Labor Relations. A Practitioner's Guide.

ERIC Educational Resources Information Center

Indiana Univ., Bloomington. Midwest Center for Public Sector Labor Relations.

This guide is intended as a brief primer for the employer or employee new to public sector labor relations. A simple step-by-step approach to labor relations includes techniques for analysis of state enabling legislation, union self-perpetuation, scope of bargaining, preparing for and winning bargaining, settling disputes, solving contract…

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

PubMed

Kapronczay, Károly

2010-01-01

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

Healthcare identities at the crossroads of service modernisation: the transfer of NHS clinicians to the independent sector?

PubMed

Waring, Justin; Bishop, Simon

2011-07-01

Health policies increasingly support private businesses to take an active role in the organisation and delivery of public healthcare services. For the English NHS, this is exemplified by the introduction of Independent Sector Treatment Centres. A number of these facilities involve the wholesale secondment of NHS clinicians to the private sector which, we suggest, raises important questions about the identities of healthcare professionals accustomed to working in the public sector. Our paper investigates this transition highlighting three prominent discontinuities in clinical work: the ethos of private sector ownership, new lines of authority and fragmented relationships. Drawing on Giddens, we examine how clinicians experience and interpret these changes and how they keep their biographical 'narrative going'. The 'pioneers' interpreted the independent sector as an opportunity to re-invigorate their practice through new roles, relationships and higher quality care; the 'guardians' as an opportunity to replicate and protect the customs and standards of the NHS in the private sector; whilst the 'marooned' longed to return to the NHS. Our study illustrates how the sectoral context can shape healthcare identities, and how contemporary reforms aimed at promoting partnerships across public and private sectors can have profound implications for clinicians. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

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

PubMed

Slipicevic, Osman; Malicbegovic, Adisa

2012-01-01

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

Public and Private Sector in the Health Care System of the Federation Bosnia and Herzegovina: Policy and Strategy

PubMed Central

Slipicevic, Osman; Malicbegovic, Adisa

2012-01-01

In Bosnia and Herzegovina citizens receive health care from both public and private providers. The current situation calls for a clear government policy and strategy to ensure better position and services from both parts. This article examines how health care services are delivered, particularly with respect to relationship between public and private providers. The paper notes that the public sector is plagued by a number of weaknesses in terms of inefficiency of services provision, poorly motivated staff, prevalent dual practice of public employees, poor working conditions and geographical imbalances. Private sector is not developing in ways that address the weaknesses of the public sector. Poorly regulated, it operates as an isolated entity, strongly profit-driven. The increasing burdens on public health care system calls for government to abandon its passive role and take action to direct growth and use potential of private sector. The paper proposes a number of mechanisms that can be used to influence private as well as public sector, since actions directed toward one part of the system will inevitable influence the other. PMID:23678309

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.

The economics of hospital reform: from hierarchical to market-based incentives.

PubMed

Preker, Alexander; Harding, April

2003-01-01

Heavy investment over the past 30 years has made the hospital sector the largest expenditure category of the health system in most developed and developing countries. Despite shifts in attention and emphasis toward primary care as a first point of contact for patients, in most countries, hospitals remain a critical link to health care, providing both advanced and basic care for the population. Often, they are the provider "of last resort" for the poor and critically ill. Although, it is clear that hospitals play a critical role in ensuring delivery of health services there is much less agreement about how to improve the efficiency and quality of care provided. This article reviews recent hospital reforms undertaken throughout the world, with an emphasis on organizational changes such as increased management autonomy (often referred to as autonomization) and corporatization. It provides some insights about these popular reform modalities from a review of the literature, reform experiences in other sectors and empirical evidence from hospital sector itself. The material presented tries to answer three questions: (a) what problems did this type of reform try to address; (b) what are the core elements of their design, implementation and evaluation; and, (c) is there any evidence that this type of reform is successful in addressing problems for which they were intended? While this paper focuses on issues related to the design of the reforms, the paper also reports the findings from a larger study that examined the implementation and evaluation of such reforms so that they will be available to countries that are considering venturing down this reform path.

Public Sector Training: A "Blind" Spot in the 1999 South African National Levy-Grant Policy

ERIC Educational Resources Information Center

Paterson, Andrew

2005-01-01

In 2000, South Africa implemented a levy-grant policy (Skills Development Levies Act, 1999) to give an incentive for workplace training across private and public sector workplaces alike, but the impact of the levy-grant scheme in the public sector was restricted by financial and management processes unique to that environment. This article shows…

Downsizing in the public sector: Metro-Toronto's hospitals.

PubMed

Flint, Douglas H

2003-01-01

This study has two objectives. First, to predict the outcomes of a public sector downsizing; second to measure effects of downsizing at organizational and inter-organizational levels. Primary data to assess the organizational level effects was collected through interviews with senior executives at two of Metro-Toronto's hospitals. Secondary data, to assess the inter-organizational effects, was collected from government documents and media reports. Due to the exploratory nature of the study's objectives a case study method was employed. Most institutional downsizing practices aligned with successful outcomes. Procedures involved at the inter-organizational level aligned with unsuccessful outcomes and negated organizational initiatives. This resulted in an overall alignment with unsuccessful procedures. The implication, based on private sector downsizings, is that the post-downsized hospital system was more costly and less effective.

Public vs. Private: Time for an Honest Discussion That Could Benefit All Schools.

ERIC Educational Resources Information Center

DeBlois, Robert

1997-01-01

Notes there are many worthwhile educational programs serving a cross-section of students featuring elements of both public and private sectors. Reform initiatives recognize that schools need to form real partnerships with local businesses, community-based organizations, universities, and other organizations. Maintains that although Education…

[Health care plans: interfaces between the public and private system in the dental sector].

PubMed

Pietrobon, Louise; da Silva, Cíntia Magali; Batista, Luciana Rodrigues Vieira; Caetano, João Carlos

2008-01-01

The present work presents a brief history of health plans in Brazil examining the interface between the public and the private sector. The evolution and regulation of the supplementary care system is analyzed, the different care modalities are defined and the main differences between health plans and dental care insurance are pointed out. The coverage provided by the supplementary care system and its relationship with the public health system is shown on the basis of current data. On the other hand, the study focuses on the care services, health plans and the labor market in the sector correlating, also on the basis of current data, the challenges and new opportunities of the supplementary care market, mainly in the dental sector. Although the dental sector is living an extraordinary moment within the private health care system and given that ANS data are pointing to a growth of this sector of 210% over last the 7 years, the service coverage of the supplementary care sector mainly directed to medical and inpatient care does not meet the real demand for integrated health care.

Wisconsin's BadgerCare Plus Reform: Impact on Low-Income Families' Enrollment and Retention in Public Coverage

PubMed Central

Leininger, Lindsey Jeanne; Friedsam, Donna; Dague, Laura; Mok, Shannon; Hynes, Emma; Bergum, Alison; Aksamitauskas, Milda; Oliver, Thomas; DeLeire, Thomas

2011-01-01

Objectives To examine the impact of a Wisconsin health care reform enacted in early 2008 on public insurance enrollment and retention. Data Sources Administrative data covering the period January 2007 to November 2009. Study Design We calculate unadjusted enrollment trends and exit rates stratified by age, income group, and enrollment mode. Kaplan–Meier curves and Cox proportional hazards models are estimated to assess the impact of the reform on program exits. Principal Findings Overall enrollment increased by approximately one-third and exit rates decreased by approximately one-fifth. The majority of new enrollment came from the previously income eligible. Conclusions Wisconsin's enactment of eligibility expansions coupled with administrative simplification and targeted marketing and outreach efforts were successful in enrolling and retaining low-income children and families in public coverage. PMID:21143476

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

Indonesian heath care and the economic crisis: is managed care the needed reform?

PubMed

Hotchkiss, D R; Jacobalis, S

1999-03-01

The ramifications of the current economic crisis are being felt throughout Asia, but problems are particularly acute in Indonesia; in the midst of high inflation and unemployment the government is considering expanding managed care reform. In this paper, we discuss the impact of the recent economic crisis on the health sector in Indonesia, and analyze the potential for implementing effective reform following the managed care model. The health sector is discussed, highlighting pre-existing problems in the health care supply environment. The determinants of the economic crisis are summarized, and the broad impacts of the crisis to date on the health sector are assessed. Next the prospects for success of current managed-care reform proposals are examined in some detail: viability of expanded managed care reform measures are assessed in light of the continuing crisis and its likely impacts on the consumers and suppliers of health care. Analysis of the potential impact of the continuing crisis focuses on key participants in health care reform: households, the government, and private health care providers. In conclusion the potential viability of managed care appears poor, given the current economic, political, and institutional conditions and likely future impacts, and suggest some alternative reform measures.

Institutional and Regulatory Economics of Electricity Market Reforms: the Evidence from India, Pakistan, Bangladesh, Nepal, and Sri Lanka

NASA Astrophysics Data System (ADS)

Singh, Bipulendu

Five South Asian countries-- India, Pakistan, Bangladesh, Nepal and Sri Lanka -- embarked on electricity market reforms in the 1990's. The dissertation uses the framework of New Institutional Economics to assess the effects on electricity sector performance of both observables elements of reform (i.e. privatization, unbundling, establishment of independent regulatory agencies etc.) as well as the unobservable elements (informal beliefs, habit, norms and culture of the actors involved in reforms). The first part of the dissertation -- econometric analysis of the relationship between observable electricity market reform measures and performance indicators -- finds that for the most part electricity market reforms in South Asia are having a positive impact on the performance of the sector. This is particularly the case for reforms that have increased private sector participation in generation and distribution and have vertically unbundled utilities into generation, transmission and distribution entities. Many of the reforms are positively correlated with higher tariffs, indicating a cost to the consumers from the reforms. The relationship between independent regulation and performance indicators , however, is not established. The second part of the dissertation - analytical narrative of the reform experiences of Gujarat and Nepal -- examines the informal elements (such as beliefs, norms, culture) that motivate behavior and explains how and why reform outcomes differed in these two places. The dissertation finds that the strength of formal institutions rules and the nature of social norms and customs have a significant influence on the outcome of reforms. Aided by the strength of its formal institutional framework and more evolved social norms and customs that encouraged people to follow formal rules, reforms in the Indian state of Gujarat were a success. The weakness of the formal institutional framework and the predominance of relation-based norms and customs in

Effectiveness of health sector reforms in reducing disparities in utilization of skilled birth attendants in Tanzania.

PubMed

Kengia, James Tumaini; Igarashi, Isao; Kawabuchi, Koichi

2013-08-01

Improving maternal health is a Millennium Development Goal adopted at the 2000 Millennium Summit of the United Nations. As part of the improving maternal health in Tanzania, it has been recommended that skilled birth attendants be present at all births to help reduce the high maternal mortality ratio. However, utilization of these attendants varies across socio-economic groups. The government of Tanzania has repeatedly attempted to carry out health sector reforms (HSRs) to alleviate disparities in health service utilization. In particular, around 1999, HSRs were incorporated into two approaches, including Decentralization by Devolution and Sector Wide Approach. This study aims to clarify the unresolved questions with little published evidence on the effect of HSRs on reducing disparities in utilization of skilled birth attendants across socio-economic groups over time. We used four cross-sectional datasets from the Tanzania Demographic and Health Survey: 1992, 1996, 1999, and 2004/05. Subjects included 14,752 women of reproductive age (15-49 years) and data on the most recent birth in the 5 years before each survey. Logistic regression analysis was performed with the dependent variable of whether respondents utilized skilled birth attendants or not, and with the main independent variables of time and socio-economic group. Results showed that the disparity in utilization of skilled birth attendants was significantly decreased from 1999 to 2004/05. These findings suggest that the two strategies, Decentralization by Devolution and Sector Wide Approach, in the process of HSRs are effective in reducing the disparities in utilization of skilled birth attendants among socio-economic groups.

Optimal Incentives for Public Sector Workers: The Case of Teacher-Designed Incentive Pay in Texas. Working Paper 2009-05

ERIC Educational Resources Information Center

Taylor, Lori L.; Springer, Matthew G.

2009-01-01

Pay for performance is a popular public education reform, and millions of dollars are currently being targeted for pay for performance programs. These reforms are popular because economic and management theories suggest that well-designed incentive pay programs could improve teacher effectiveness. There is little evidence about the characteristics…

Petro-state constraints on health policy: guidelines for workable reform in Venezuela.

PubMed

Trujillo, Antonio J

2004-01-01

This article reviews the performance of the Venezuelan health care sector and suggests guidelines for workable health policy under difficult conditions. Two special circumstances constrain policy options. First, Venezuelans share a traditional value, solidarity, which includes a strong desire for equity. Reforms must comply with this norm to succeed. Second, foreign sales of state-controlled oil constitute the bulk of the government budget and the gross domestic product (GDP). Petroleum market fluctuations expose the country to extreme economic cycles. In response, policy making and stakeholders adopt a rentier attitude, focusing on preserving or enlarging entitlements to government oil monies. The side effects of this largesse include poor productivity, a weak private sector, a widespread sense of entitlement without accountability, and a crippled state which controls most of the available resources yet is unable to effectively tax, regulate, steer the economy, or pursue long-term policies. The health care sector shares these problems. As a result, Venezuela's health systems are fragmented, poorly coordinated, excessively centralized, inequitable, and ineffective. Policies to improve public health and public and private medical care must take into account these constraints.

Law of partial reform of the Organic Law of the Central Administration, 11 December 1986.

PubMed

1988-01-01

This document contains the provisions of Venezuela's 1986 Law of Partial Reform of the Organic Law of the Central Administration which sets out the activities of the newly created Ministry of the Family. The duties of the Ministry include protecting the family as a basic cell of society, protecting marriage, facilitating the acquisition of decent housing, formulating and directing state family policy, creating a General Plan for Social Development and Protection for the family, coordinating public sector programs directed towards the family, promoting the decentralization of family programs, formulating and promoting plans and programs to assist the family, advising in the creation of family-related public documents, overseeing the enforcement of legal provisions, conducting research and collecting data on family problems, promoting and executing training programs for family service personnel, and encouraging the formation of private sector programs to benefit the family.

Private dentists assess treatment required as more extensive, demanding and costly, than public sector dentists.

PubMed

Tuominen, Risto; Eriksson, Anna-Leena; Vahlberg, Tero

2012-08-01

The aim was to evaluate whether contracted private practitioners assess required treatment more extensive, demanding and economically more rewarding than mainly salaried public sector dentists and to estimate the cost consequences of using these alternative providers. All dental services included in comprehensive treatments funded by the city of Turku and provided to adult patients during the year 2009 were recorded. Patients were distributed randomly without any determination of treatment needs before appointing them to different dentists. Treatment courses for 7432 patients in public clinics included 63 906 procedures and for 2932 patients assigned to treatment by contracted private practitioners included 21 194 procedures. Public sector dentists were mainly salaried with production incentives, and private practitioners worked purely on a fee-for-service basis. The cost estimates were based on the distributions of competence classifications recorded by the providers, which also formed the basis for reimbursement. For each studied treatment category with more than one competence classification, private contractors were less likely than their public sector counterparts to give an assessment of simple or less demanding: 8% versus 29% of examinations, 46% versus 69% of periodontal treatments, 63% versus 85% of extractions, 31% versus 46% of fillings, 18% versus 35% of root canals. The excess cost to society varied from 7.0% for root canal treatments to 21.3% for extractions, causing on average 14.4% higher cost level from use of private practitioners compared with public sector dentists. Private practitioners systematically classified the treatment procedures they provided as more demanding, and therefore more economically rewarding, than their public sector counterparts. The findings indicate that the costs of publicly funded dental care may be increased by the use of private dental contractors. © 2012 John Wiley & Sons A/S.

Applying a private sector capitation model to the management of type 2 diabetes in the South African public sector: a cost-effectiveness analysis.

PubMed

Volmink, Heinrich C; Bertram, Melanie Y; Jina, Ruxana; Wade, Alisha N; Hofman, Karen J

2014-09-30

Diabetes mellitus contributes substantially to the non-communicable disease burden in South Africa. The proposed National Health Insurance system provides an opportunity to consider the development of a cost-effective capitation model of care for patients with type 2 diabetes. The objective of the study was to determine the potential cost-effectiveness of adapting a private sector diabetes management programme (DMP) to the South African public sector. Cost-effectiveness analysis was undertaken with a public sector model of the DMP as the intervention and a usual practice model as the comparator. Probabilistic modelling was utilized for incremental cost-effectiveness ratio analysis with life years gained selected as the outcome. Secondary data were used to design the model while cost information was obtained from various sources, taking into account public sector billing. Modelling found an incremental cost-effectiveness ratio (ICER) of ZAR 8 356 (USD 1018) per life year gained (LYG) for the DMP against the usual practice model. This fell substantially below the Willingness-to-Pay threshold with bootstrapping analysis. Furthermore, a national implementation of the intervention could potentially result in an estimated cumulative gain of 96 997 years of life (95% CI 71 073 years - 113 994 years). Probabilistic modelling found the capitation intervention to be cost-effective, with an ICER of ZAR 8 356 (USD 1018) per LYG. Piloting the service within the public sector is recommended as an initial step, as this would provide data for more accurate economic evaluation, and would also allow for qualitative analysis of the programme.

WARF's stem cell patents and tensions between public and private sector approaches to research.

PubMed

Golden, John M

2010-01-01

While society debates whether and how to use public funds to support work on human embryonic stem cells (hESCs), many scientific groups and businesses debate a different question - the extent to which patents that cover such stem cells should be permitted to limit or to tax their research. The Wisconsin Alumni Research Foundation (WARF), a non-profit foundation that manages intellectual property generated by researchers at the University of Wisconsin at Madison, owns three patents that have been at the heart of the latter controversy The story of WARF's patents and the controversy they have fostered highlights not only continuing tensions between proprietary and nonproprietary approaches to developing science and technology, but also an at least partly reassuring capacity of public and private sectors to deal with those tensions in a way that can render them substantially manageable, and frequently more manageable as a technology matures. More particularly, the cumulative story of WARF's patents features three leitmotifs that suggest how an attentive and engaged public sector might commonly succeed in working with public and private sector actors to achieve workable balances between proprietary rights and more general social interests: (1) right holders' decisions to pursue less than full rights assertion or enforcement; (2) the ability of government and other public sector actors to help bring about such decisions through co-option or pressure; and (3) the frequent availability or development of technological alternatives that limit research bottlenecks.

The incidence of public sector hospitalisations due to dog bites in Australia 2001-2013.

PubMed

Rajshekar, Mithun; Blizzard, Leigh; Julian, Roberta; Williams, Anne-Marie; Tennant, Marc; Forrest, Alex; Walsh, Laurence J; Wilson, Gary

2017-08-01

To estimate the incidence of dog bite-related injuries requiring public sector hospitalisation in Australia during the period 2001-13. Summary data on public sector hospitalisations due to dog bite-related injuries with an ICD 10-AM W54.0 coding were sourced from the Australian Institute of Health and Welfare for the study period 2001-2013. In Australia, on average, 2,061 persons were hospitalised each year for treatment for dog bite injuries at an annual rate of 12.39 (95%CI 12.25-12.53) per 100,000 during 2001-13. The highest annual rates of 25.95 (95%CI 25.16-26.72) and 18.42 (95%CI 17.75-19.07) per 100,000 were for age groups 0-4 and 5-9 years respectively. Rates of recorded events increased over the study period and reached 16.15 (95%CI 15.78-16.52) per 100,000 during 2011-13. Dog bites are a largely unrecognised and growing public health problem in Australia. Implications for public health: There is an increasing public sector burden of hospitalisations for injuries from dog bites in Australia. © 2017 Menzies Institute for Medical Research.

Digital Broadband Content: Public Sector Information. OECD Digital Economy Papers, No. 112

ERIC Educational Resources Information Center

OECD Publishing (NJ1), 2006

2006-01-01

Public bodies hold a range of information and content ranging from demographic, economic and meteorological data to art works, historical documents and books. Given the availability of information and communication technologies (ICTs) public sector information can play an important role in producing innovative value-added services and goods.…

Applications of aerospace technology in the public sector

NASA Technical Reports Server (NTRS)

Anuskiewicz, T.; Johnston, J.; Zimmerman, R. R.

1971-01-01

Current activities of the program to accelerate specific applications of space related technology in major public sector problem areas are summarized for the period 1 June 1971 through 30 November 1971. An overview of NASA technology, technology applications, and supporting activities are presented. Specific technology applications in biomedicine are reported including cancer detection, treatment and research; cardiovascular diseases, diagnosis, and treatment; medical instrumentation; kidney function disorders, treatment, and research; and rehabilitation medicine.

Factors Affecting Teachers' Motivation: An HRM Challenge for Public Sector Higher Educational Institutions of Pakistan (HEIs)

ERIC Educational Resources Information Center

Rasheed, Muhammad Imran; Humayon, Asad Afzal; Awan, Usama; Ahmed, Affan ud Din

2016-01-01

Purpose: The purpose of this paper is to explore/investigate various issues of teachers ' motivation in public sector Higher Educational Institutions of Pakistan. Design/methodology/approach: This is an exploratory research where surveys have been conducted in the well known public sector Universities of Pakistan; primary data have been collected…

Ebola Preparedness in the Netherlands: The Need for Coordination Between the Public Health and the Curative Sector.

PubMed

Swaan, Corien M; Öry, Alexander V; Schol, Lianne G C; Jacobi, André; Richardus, Jan Hendrik; Timen, Aura

During the Ebola outbreak in West Africa in 2014-2015, close cooperation between the curative sector and the public health sector in the Netherlands was necessary for timely identification, referral, and investigation of patients with suspected Ebola virus disease (EVD). In this study, we evaluated experiences in preparedness among stakeholders of both curative and public health sectors to formulate recommendations for optimizing preparedness protocols. Timeliness of referred patients with suspected EVD was used as indicator for preparedness. In focus group sessions and semistructured interviews, experiences of curative and public health stakeholders about the regional and national process of preparedness and response were listed. Timeliness recordings of all referred patients with suspected EVD (13) were collected from first date of illness until arrival in the referral academic hospital. Ebola preparedness was considered extensive compared with the risk of an actual patient, however necessary. Regional coordination varied between regions. More standardization of regional preparation and operational guidelines was requested, as well as nationally standardized contingency criteria, and the National Centre for Infectious Disease Control was expected to coordinate the development of these guidelines. For the timeliness of referred patients with suspected EVD, the median delay between first date of illness until triage was 2.0 days (range: 0-10 days), and between triage and arrival in the referral hospital, it was 5.0 hours (range: 2-7.5 hours). In none of these patients Ebola infection was confirmed. Coordination between the public health sector and the curative sector needs improvement to reduce delay in patient management in emerging infectious diseases. Standardization of preparedness and response practices, through guidelines for institutional preparedness and blueprints for regional and national coordination, is necessary, as preparedness for emerging infectious

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.

A comparison of private and public sector intensive care unit infrastructure in South Africa.

PubMed

Mahomed, S; Sturm, A W; Moodley, P

2017-11-27

Intensive care units (ICUs) are designed to care for patients who are often at increased risk of acquiring healthcare-associated infections. The structure of ICUs should be optimally designed to facilitate the care of these critically ill patients, and minimise their risk of infection. National regulations (R158) were developed to govern the building and registration of private hospitals, and until recently equivalent regulations were not available for public hospitals. To assess and compare the compliance of ICUs in the private and public sectors with the R158 regulations. A cross-sectional study design was used to assess the infrastructure of 25 private sector and 6 public sector ICUs in eThekwini Health District, KwaZulu-Natal Province, South Africa. We used the R158 checklist, which was developed by the KwaZulu-Natal Department of Health Private Licensing Unit and Infection Prevention and Control Unit. The aspects covered in the R158 checklist were categorised into the design, general safety and patient services of the ICUs. Most of the ICUs in both sectors met the general safety requirements. There were varying levels of compliance with the design criteria. Only 7 (28.0%) and 1 (16.7%) of the private and public ICUs, respectively, had sufficient space around the beds. Twenty-two private ICUs (88.0%) and 4 public ICUs (66.7%) had isolation rooms, but only some of these isolation rooms (15 private and 2 public) had appropriate mechanical ventilation. None of the ICUs had clinical hand-wash basins in the nurse stations and dirty utility rooms. The majority of the ICUs had the required number of oxygen and electric outlets at the bedside. None of the public ICUs met the light intensity requirement over the bed area. Adequate spacing in ICUs is an issue in many cases. Interventions need to be put in place to ensure that ICUs meet the relevant design standards. There is an urgent need to revise the R158 regulations to reflect current best practices, particularly

The role of retiree health insurance in the early retirement of public sector employees.

PubMed

Shoven, John B; Slavov, Sita Nataraj

2014-12-01

Most government employees have access to retiree health coverage, which provides them with group health coverage even if they retire before Medicare eligibility. We study the impact of retiree health coverage on the labor supply of public sector workers between the ages of 55 and 64. We find that retiree health coverage raises the probability of stopping full time work by 4.3 percentage points (around 38 percent) over two years among public sector workers aged 55-59, and by 6.7 percentage points (around 26 percent) over two years among public sector workers aged 60-64. In the younger age group, retiree health insurance mostly seems to facilitate transitions to part-time work rather than full retirement. However, in the older age group, it increases the probability of stopping work entirely by 4.3 percentage points (around 22 percent). Copyright © 2014 Elsevier B.V. All rights reserved.

Effects on the medical revenue of comprehensive pricing reform in Chinese urban public hospitals after removing drug markups: case of Nanjing.

PubMed

Tang, Wenxi; Xie, Jing; Lu, Yijuan; Liu, Qizhi; Malone, Daniel; Ma, Aixia

2018-04-01

The State Council of China requires that all urban public hospitals must eliminate drug markups by September 2017, and that hospital drugs must be sold at the purchase price. Nanjing-one of the first provincial capital cities to implement the reform-is studied to evaluate the effects of the comprehensive reform on drug prices in public hospitals, and to explore differential compensation plans. Sixteen hospitals were selected, and financial data were collected over the 48-month period before the reform and for 12 months after the reform. An analysis was carried out using a simple linear interrupted time series model. The average difference ratio of drug surplus fell 13.39% after the reform, and the drug markups were basically eliminated. Revenue from medical services showed a net growth of 28.25%. The overall compensation received from government financial budget and medical service revenue growth was 103.69% for the loss from policy-permitted 15% markup sales, and 116.48% for the net loss. However, there were large differences in compensation levels at different hospitals, ranging from -21.92% to 413.74% by medical services revenue growth, causing the combined rate of both financial and service compensation to vary from 28.87-413.74%, There was a significant positive correlation between the services compensation rate and the proportion of medical service revenue (p < .001), and the compensation rate increased by 8% for every 1% increase in the proportion of services revenue. Nanjing's pricing and compensation reform has basically achieved the policy targets of eliminating the drug markups, promoting the growth of medical services revenue, and adjusting the structure of medical revenue. However, the growth rate of service revenue of hospitals varied significantly from one another. Nanjing's reform represents successful pricing and compensation reform in Chinese urban public hospitals. It is recommended that a differentiated and dynamic compensation plan should

Design and implementation of an affordable, public sector electronic medical record in rural Nepal.

PubMed

Raut, Anant; Yarbrough, Chase; Singh, Vivek; Gauchan, Bikash; Citrin, David; Verma, Varun; Hawley, Jessica; Schwarz, Dan; Harsha Bangura, Alex; Shrestha, Biplav; Schwarz, Ryan; Adhikari, Mukesh; Maru, Duncan

2017-06-23

Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility.DevelopmentThe electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives. For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal.DiscussionOver the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty.

Design and implementation of an affordable, public sector electronic medical record in rural Nepal

PubMed Central

Raut, Anant; Yarbrough, Chase; Singh, Vivek; Gauchan, Bikash; Citrin, David; Verma, Varun; Hawley, Jessica; Schwarz, Dan; Harsha, Alex; Shrestha, Biplav; Schwarz, Ryan; Adhikari, Mukesh; Maru, Duncan

2018-01-01

Introduction Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility. Development The electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives. Application For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal. Discussion Over the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty. PMID:28749321

Public Schools in Marketized Environments: Shifting Incentives and Unintended Consequences of Competition-Based Educational Reforms

ERIC Educational Resources Information Center

Lubienski, Christopher

2005-01-01

By opening the system to competition, popular school choice reforms seek to remake public education into a more consumer-oriented endeavor. While the underlying theory holds that competitive pressures will induce change and improvement in educational processes, research indicates that organizations often respond instead by developing promotional…

Denver's Public Schools: Reforms, Challenges, and the Future

ERIC Educational Resources Information Center

Bray, Judy; Medler, Alex

2009-01-01

Denver is currently in the national education spotlight, largely because of its willingness to try a unique combination of major education reforms not seen in other large urban school districts. While many observers hold these reforms in high regard, a steep road lies ahead. Current student results are unacceptable by all measures. The time is…

Devolution, Market Dynamics and the Independent Public School Initiative in Western Australia: 'Winning Back' What Has Been Lost?

ERIC Educational Resources Information Center

Fitzgerald, Scott; Stacey, Meghan; McGrath-Champ, Susan; Parding, Karolina; Rainnie, Al

2018-01-01

The devolution of public sector schooling systems has been a feature of education reform since the 1980s. In Western Australia, the Independent Public School (IPS) initiative has recently been installed, announced by the state government in 2009. Now over 80% of the state's public school students attend IP schools. Drawing on interview data from a…

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.

Job satisfaction and motivation of health workers in public and private sectors: cross-sectional analysis from two Indian states.

PubMed

Peters, David H; Chakraborty, Subrata; Mahapatra, Prasanta; Steinhardt, Laura

2010-11-25

Ensuring health worker job satisfaction and motivation are important if health workers are to be retained and effectively deliver health services in many developing countries, whether they work in the public or private sector. The objectives of the paper are to identify important aspects of health worker satisfaction and motivation in two Indian states working in public and private sectors. Cross-sectional surveys of 1916 public and private sector health workers in Andhra Pradesh and Uttar Pradesh, India, were conducted using a standardized instrument to identify health workers' satisfaction with key work factors related to motivation. Ratings were compared with how important health workers consider these factors. There was high variability in the ratings for areas of satisfaction and motivation across the different practice settings, but there were also commonalities. Four groups of factors were identified, with those relating to job content and work environment viewed as the most important characteristics of the ideal job, and rated higher than a good income. In both states, public sector health workers rated "good employment benefits" as significantly more important than private sector workers, as well as a "superior who recognizes work". There were large differences in whether these factors were considered present on the job, particularly between public and private sector health workers in Uttar Pradesh, where the public sector fared consistently lower (P < 0.01). Discordance between what motivational factors health workers considered important and their perceptions of actual presence of these factors were also highest in Uttar Pradesh in the public sector, where all 17 items had greater discordance for public sector workers than for workers in the private sector (P < 0.001). There are common areas of health worker motivation that should be considered by managers and policy makers, particularly the importance of non-financial motivators such as working

Job satisfaction and motivation of health workers in public and private sectors: cross-sectional analysis from two Indian states

PubMed Central

2010-01-01

Background Ensuring health worker job satisfaction and motivation are important if health workers are to be retained and effectively deliver health services in many developing countries, whether they work in the public or private sector. The objectives of the paper are to identify important aspects of health worker satisfaction and motivation in two Indian states working in public and private sectors. Methods Cross-sectional surveys of 1916 public and private sector health workers in Andhra Pradesh and Uttar Pradesh, India, were conducted using a standardized instrument to identify health workers' satisfaction with key work factors related to motivation. Ratings were compared with how important health workers consider these factors. Results There was high variability in the ratings for areas of satisfaction and motivation across the different practice settings, but there were also commonalities. Four groups of factors were identified, with those relating to job content and work environment viewed as the most important characteristics of the ideal job, and rated higher than a good income. In both states, public sector health workers rated "good employment benefits" as significantly more important than private sector workers, as well as a "superior who recognizes work". There were large differences in whether these factors were considered present on the job, particularly between public and private sector health workers in Uttar Pradesh, where the public sector fared consistently lower (P < 0.01). Discordance between what motivational factors health workers considered important and their perceptions of actual presence of these factors were also highest in Uttar Pradesh in the public sector, where all 17 items had greater discordance for public sector workers than for workers in the private sector (P < 0.001). Conclusion There are common areas of health worker motivation that should be considered by managers and policy makers, particularly the importance of non

When Adopting a School Is Not Enough: Business Leadership in Reforming Public Education. Cresap Insight.